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  1. 1. Crisis Intervention
  2. 2. <ul><li>Grief is a multi-faceted response to loss. </li></ul><ul><ul><li>-multifaceted; there are many aspects when dealing with </li></ul></ul><ul><ul><li>grief. </li></ul></ul><ul><li>Grief is a profound emotional crisis. </li></ul><ul><ul><li>-it is profound because it is enormously complex and </li></ul></ul><ul><ul><li>related to a wide array of circumstances. </li></ul></ul><ul><ul><li>-it is a crisis because it brings one to the necessity of </li></ul></ul><ul><ul><li>decisions (Carse, pg.3) </li></ul></ul>
  3. 3. <ul><li>Grief is a state in which the bereaved person has lost someone or something of personal value. </li></ul><ul><li>Grief is a time when individuals experience major physical, emotional, and cognitive changes. </li></ul><ul><li>It must be dealt with, and because it is profoundly complicated, it must be dealt with in a fundamental manner (Carse, pg. 3). </li></ul>
  4. 4. <ul><li>According to John Bowlby’s attachment theory, the meaning of attachment furthers our ability to comprehend grief. </li></ul><ul><li>Continual attachments to others are formed. </li></ul><ul><li>Attachments develop from needs for security and safety, which are acquired through life, and directed towards a few specific individuals. </li></ul>
  5. 5. <ul><li>The goal of attachment behavior is to form and maintain affectionate bonds, throughout child and adulthood. </li></ul><ul><li>Bowlby proposed grief responses are biologically general responses to separation and loss. </li></ul><ul><li>Behavioral responses making up the grieving process are pro-survival mechanisms geared towards restoring the lost bonds (Worden, pg. 12) </li></ul>
  6. 6. <ul><li>According to Barbato & Irwin, it is described that the vast repertoire of grieving behaviors are categorized as the following: </li></ul><ul><li>- Emotional Response </li></ul><ul><li>- Physical Sensations </li></ul><ul><li>- Cognitive Responses </li></ul><ul><li>- Behaviors </li></ul><ul><li>(Barbato and Irwin, pg. 22) </li></ul>
  7. 7. <ul><li>Grief is fundamentally an emotional response to loss, the expressions can include the following: </li></ul><ul><li>-sadness, sorrow, fatigue, depression, relief, shock, anger, guilt, anxiety, sleep and appetite disturbances. </li></ul><ul><li>Intense feelings of loneliness and isolation, following the death of a loved one, can sometimes become so overwhelming that the bereaved may withdraw from social contact, which may mean isolating themselves from support (Barbato & Irwin, pg 23). </li></ul><ul><li>Anger is a frequently experienced emotion following the loss, the anger may be directed at the deceased for leaving . </li></ul><ul><li>If not addressed, complications will soon arise, and anger will be directed towards others through blame. </li></ul>
  8. 8. <ul><li>Grief not only elicits emotional disturbances, but also physical symptoms such as; </li></ul><ul><li>-tight feelings in the throat and chest </li></ul><ul><li>-over sensitivity to noise </li></ul><ul><li>-breathlessness </li></ul><ul><li>-muscular weakness </li></ul><ul><li>-lack of energy </li></ul><ul><li>Feeling this way is normal when one is going through the grieving process, they are usually transitory, and may sometimes become a concern (Barbato & Irwin, pg. 23). </li></ul>
  9. 9. <ul><li>Disbelief is often the initial cognitive reaction to the news of a death, especially if the death was sudden. </li></ul><ul><li>Transitory, but it can persist and become denial where the bereaved does not accept the death. </li></ul><ul><li>Other cognitive responses include feelings of confusion, difficulty organizing thoughts and preoccupation with the deceased. </li></ul><ul><li>The bereaved person may report a sense of presence of the deceased and may think that the deceased is still around (Worden, pg. 31). </li></ul>
  10. 10. <ul><li>The most commonly reported behaviors include: </li></ul><ul><li>-sleep disturbance </li></ul><ul><li>-altered appetite (over/under eating) </li></ul><ul><li>-absent mindedness </li></ul><ul><li>-social withdrawal </li></ul><ul><li>-dreams of the deceased </li></ul><ul><li>-avoidance behavior </li></ul><ul><li>-restlessness </li></ul><ul><li>-searching or calling out for the deceased </li></ul><ul><li>-crying, which is believed to relieve emotional stress </li></ul><ul><li>(Worden, pg. 37) </li></ul>
  11. 11. <ul><li>Mourning is a process, not a state of mind, and as in any process, work is done so that the process can proceed to successful finalization. </li></ul><ul><li>There are four tasks to mourning , which may take place in any order (Worden, pp.101-104). </li></ul><ul><ul><li>-Task 1: Accepting the reality of the loss </li></ul></ul><ul><ul><li>-Denying the fact of the loss. </li></ul></ul><ul><ul><li>- Denying the meaning of the loss. </li></ul></ul><ul><ul><li>-Denying that death is irreversible. </li></ul></ul>
  12. 12. <ul><li>Task 2: To work through the pain of grief. </li></ul><ul><li>Task 3: To adjust to an environment in which the deceased is missing . </li></ul><ul><li>Task 4: To emotionally relocate the deceased and move on with life (Worden, pp. 101-104) </li></ul>
  13. 13. <ul><li>Complicated bereavement is the intensification of grief to a level such the person feels overwhelmed, resorts to maladaptive behavior, or remains interminably in a state of grief without progression of the mourning process towards completion. </li></ul><ul><li>Normal and complicated mourning are on a continuum, with extremes of effect, intensity and time scale determining pathology, rather than the presence of any one particular symptom </li></ul><ul><li>(Worden, pg, 115). </li></ul><ul><li>Normal process of mourning can turn to complicated mourning for a number of reasons; </li></ul><ul><ul><li>-difficult circumstances surrounding death </li></ul></ul><ul><ul><li>-a person’s history of grieving experiences </li></ul></ul><ul><ul><li>-the personality of the bereaved person </li></ul></ul><ul><ul><li>-social factors </li></ul></ul>
  14. 14. <ul><li>Childhood Bereavement </li></ul><ul><li>Death of a child </li></ul><ul><li>Death of a spouse </li></ul><ul><li>Death of a parent </li></ul><ul><li>Death of a sibling </li></ul><ul><li>( </li></ul>
  15. 15. <ul><li>Grief therapy is a kind of psychotherapy used to treat severe or complicated traumatic grief reactions. </li></ul><ul><li>Social workers should inform the bereaved that the goal of grief therapy is to identify and solve the psychological and emotional problems which appeared as a consequence. </li></ul><ul><li>Example, identifying which of the grief tasks have not been resolved and working through them with the person. </li></ul><ul><li>If the social worker believes that a previous death may still be lingering with the current death, helping the bereaved to explore the past relationship may resolve the current problems (Worden, pg. 130) </li></ul>
  16. 16. <ul><li>When helping someone deal with the loss of a loved one the social worker should: </li></ul><ul><ul><li>-assess the impact of loss the deceased has on the bereaved </li></ul></ul><ul><ul><li>-be informed about the available formal and informal resources to help minimize grief and isolation from family, friends and supporters </li></ul></ul><ul><ul><li>-be aware of their own feelings about death, dying, and the grieving process, so that they may become more comfortable being physically and emotionally present with clients and their loved ones </li></ul></ul><ul><ul><li>-identify literature, cultural experiences, and other ongoing education about the ways in which your client(s) deal with death. Remember, the client may be your best teacher (Hutchinson, pg.450) </li></ul></ul>
  17. 17. <ul><li>Denial </li></ul><ul><li>-”I feel fine.” “This cannot be happening to me.” </li></ul><ul><li>Anger </li></ul><ul><li>-”Why me? It’s not fair!” </li></ul><ul><li>Bargaining </li></ul><ul><li>-”I’ll do anything, can you stretch it out just a few more years.” </li></ul><ul><li>Depression </li></ul><ul><li>-”I’m so sad, why bother with anything?” </li></ul><ul><li>Acceptance </li></ul><ul><li>-”I can’t fight it, I may as well prepare for it.” ( </li></ul>
  18. 18.
  19. 19. <ul><li>Barbato, A., & Irwin, H., (2004). Major therapeutic systems and the bereaved client. Australian Psychologist, 27, 22-27. </li></ul><ul><li>Carse, J., (1981). Grief as a cosmic crisis . Acute Grief. Columbia University Press: New York. </li></ul><ul><li>Hutchinson, E., (2008). Dimensions of Human Behavior: The Changing Life Course. (3 rd ed.) Thousand Oaks, CA: Sage Publications, Inc. </li></ul><ul><li>Walsh, J., (2006). Crisis Assessment and Intervention . Theories for direct social work practice. Brooks/Cole: Belmont, CA. </li></ul><ul><li>Worden, J.,(1991). Grief Counseling and grief therapy: A handbook for the mental health practitioner. (2 nd ed.). London: Springer. </li></ul>