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Case Review, Assessment and Goal
   Setting in Grief Counseling



      Andy M cNiel, M A, L PC
Development Theories
• Piaget’s Learning Theory
• Freud's Ideas about The Mind
• Erickson’s Stages of Development
BASI C C ONC EPTS OF PI AG ET’S
L EAR NI NG THEOR Y
• Schemas
• Adaptation
   – A ssi m i l ati o n
   – A c c o m m o d ati o n




                D ev el o p m en tal T h eo r i es
S c h em a
A cognitive framework, construct or
concept that helps organize and interpret
information. 
Adaptation

Assimilation – the integration of new ideas
with existing internal structures.

Accommodation – adjustment of internal
structures to new ideas.
BASI C C ONC EPTS OF L EAR NI NG
                                         THEOR Y
                      • Schemata (Mental Constructs)
                      • Adaptation
                           – A ssi m i l ati o n
                           – A c c o m m o d ati o n


W h at m en tal c o n str u c ts ar e b ei n g ad ap ted b y a b er eav ed c h i l d ?



                                          D ev el o p m en tal T h eo r i es
M ental C onstructs



Fam l y
   i         Fr i ends               Jus t i ce


Tr us t   God/ Spi r i t ual i t y       Deat h


      Meani ng           Joy/ Laught er
BASI C C ONC EPTS FR UED’S THEOR Y

• The Mind

      The Conscious Mind 

      The Preconscious Mind

      The Unconscious Mind.

          D ev el o p m en tal T h eo r i es
The Conscious Mind is what you are aware of at
any particular moment, your present perceptions,
memories, thoughts, fantasies, feelings, what have you.
The Preconscious Mind is anything that can easily be
made conscious, the memories you are not at the
moment thinking about but can readily bring to mind.
The Unconscious Mind. It includes all the things
that are not easily available to awareness, including many
things that have their origins there, such as our drives or
instincts, and things that are put there because we can't
bear to look at them, such as the memories and emotions
associated with trauma.
BASI C C ONC EPTS FR UED’S THEOR Y

                    • The Mind
                    • Thoughts and Perceptions
                      (Conscious and/or Unconscious)



W h at ar e th e t h o u g h ts an d p er c ep ti o n s asso c i ated w i th g r i ef ?




                                          D ev el o p m en tal T h eo r i es
Thoughts & Perceptions
       “To h a ve a n o r m a l f a m i l y I h a v e t o l i ve wi t h
       m y m o m a n d m y d a d .”
“M y f r i en d s d o n o t u n d er stan d m e b ec au se th ey h av e
b o th o f th ei r p ar en ts.”

    “It i s n o t f a i r t h a t m y m o m d i ed .”

 “I t d o es n o t m atter w h at I d o , b ec au se b ad th i n g s
 c an h ap p en to m e an y w ay .”

       “If Go d i s go o d , t h en wh y d i d m y d a d d i e?”

“I ’ m af r ai d m y m o m m i g h t d i e to o an d th en w h at w i l l
h ap p en to m e.”
           “Wh a t i s t h e p o i n t o f l i vi n g, i f we a r e a l l j u st
           go i n g t o d i e a n y wa y .”
BASI C C ONC EPTS ER I K SON’S STAG ES

• Crises (Developmental Tasks)
• Virtues
• Maladaptions/Malignancies




           D ev el o p m en tal T h eo r i es
Erikson’s 8 Stages of Development
                                                    Psychosocial                Maladaptations &
Stage (age)          Psychosocial crisis
                                                    virtues                     malignancies
I (0-1) --                                                                      sensory distortion --
                     trust vs.. mistrust            hope, faith
infant                                                                          withdrawal
II (2-3) --          autonomy vs.. shame                                        impulsivity --
                                                    will, determination
toddler              and doubt                                                  compulsion
III (3-6) --                                                                    ruthlessness --
                     initiative vs. guilt           purpose, courage
preschooler                                                                     inhibition
IV (7-12 or so) --                                                              narrow virtuosity --
                     industry vs. inferiority       competence
school-age child                                                                inertia
V (12-18 or so) --   ego-identity vs. role-                                     fanaticism --
                                                    fidelity, loyalty
adolescence          confusion                                                  repudiation
VI (the 20’s) --                                                                promiscuity --
                     intimacy vs. isolation         love
young adult                                                                     exclusivity
VII (late 20’s to
                     generativity vs. self-                                     overextension --
50’s) -- middle                                     care
                     absorption                                                 rejectivity
adult
VIII (50’s and
beyond) -- old       integrity vs. despair          wisdom                      presumption -- despair
adult
                       Chart adapted from Erikson's 1959 Identity and the Life Cycle (Psychological Issues vol 1, #1)
BASI C C ONC EPTS ER I C K SON’S STAG ES

                          • Crises (Developmental Tasks)
                          • Virtues
                          • Maladaptions


              W h at ar e th e d ev el o p m en tal task s o f g r i ef ?
W h at ar e th e p o ssi b l e v i r tu es an d /o r m al ad ap ti o n s (m al i g n an c i es)?



                                               D ev el o p m en tal T h eo r i es
Tasks of Grief
Worden’s 4 Tasks of Mourning
  – To accept the reality of the loss
  – To work through the pain of grief
  – To adjust to all of the changes
    the loss brings
  – To emotionally reinvest in life
     (With death: emotionally relocate the
     deceased in present life)



                                      Worden, J.W. Grief Counseling & Grief
                                      Therapy: A handbook for the mental health
                                      practitioner. (3rd ed). New York: Springer
                                      Publishing
Developmental Tasks

           C o n g r u en c y b etw een I d eal s
           an d R eal i ty (A c c ep tan c e).

                                               Rec o gn i z i n g a n d a c c ep t i n g
                                               t h e Ro l e o t h er s p l a y i n o u r l i f e.
B eg i n n i n g th e p r o c ess o f
c o m i n g to ter m s w i th th e
r eal i ty o f d eath .
                                                        Ad a p t i n g t o l i f e wi t h o u t
                                                        t h e p er so n wh o d i ed .

    L ear n i n g to l i v e w i th su f f er i n g /p ai n .

                              Fi n d i n g sec u r i t y a n d sa f et y
                              Wi t h o u t t h e p er so n wh o d i ed .
Developmental Tasks

          Ad a p t i n g y o u r sc h em a o f f a m i l y .


                                 I n v esti n g i n N ew R el ati o n sh i p s

Al l o wi n g m y sel f t o ex p er i en c e j o y .


                                          I d en ti f y i n g m y r o l e i n th e
                                          l i v es o f o th er s.


      In c o r p o r a t i n g m em o r i es o f t h o se wh o h a ve d i ed
      i n t o m y p r esen t r ea l i t y .
Assessment & Setting Goals
… M en t al C o n str u c ts

… T h o u g h t s an d P er c ep ti o n s

… D ev el o p m en tal T ask s

… B eh av i o r s

… S tr en g th s w i t h i n th e F am i l y

… P er so n al an d F am i l y S tr ateg i c P l an n i n g
Strategic Planning
… W h at ar e y o u d o i n g th at i s w o r k i n g w el l ?

… W h at ar e y o u d o i n g th at y o u sh o u l d p r o b ab l y sto p d o i n g ?

… W h at ar e y o u n o t d o i n g th at m i g h t b e g o o d to star t d o i n g ?

… W h at h av e y o u sto p p ed d o i n g th at y o u w an t to star t d o i n g
ag ai n ?

… W h at h av e y o u sto p p ed d o i n g th at y o u d o n o t ev er w an t to d o
ag ai n ?
Assessment & Setting Goals
A p er so n ’s g o al s b ec o m e th ei r task s…

B r en d a’s G o al s –

• C r eati n g r eg u l ar , r o u ti n e, r i tu al i sti c ti m e f o r f am i l y
  to g eth er n ess.
• S eek i n g p r o f essi o n al h el p f o r d ep r essi o n .
• O r g an i z i n g an d c l ean i n g h er h o m e.
• S h ar i n g h er g r i ef w i th o th er s w h o h av e h ad si m i l ar l o sses.
• B e a g r an d m o th er to al l h er g r an d c h i l d r en .
Assessment & Setting Goals

S h ay l a’s G o al s –

4. S p en d ti m e w i th h er au n t, u n c l e an d b ab y si ster .
5. T o d o m ak e g o o d g r ad es.
6. T o n ev er f o r g et h er m o th er an d tel l h er si ster ab o u t h er m o th er .
ROLE OF THE HELPER

              Fa c i l i t a t e i n t er a c t i o n wi t h o t h er s.

Li st en t o t h em t el l t h ei r st o r y .

       Ed u c a t e & En c o u r a ge t h em a n d
       t h ei r c a r egi v er .

Of f er a sa f e p l a c e f o r v en t i l a t i o n o f f eel i n gs
a n d eva l u a t i o n o f i d ea s.

       Ac t a s a MIRROR

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104 c McNiel presentation

  • 1. Case Review, Assessment and Goal Setting in Grief Counseling Andy M cNiel, M A, L PC
  • 2. Development Theories • Piaget’s Learning Theory • Freud's Ideas about The Mind • Erickson’s Stages of Development
  • 3. BASI C C ONC EPTS OF PI AG ET’S L EAR NI NG THEOR Y • Schemas • Adaptation – A ssi m i l ati o n – A c c o m m o d ati o n D ev el o p m en tal T h eo r i es
  • 4. S c h em a A cognitive framework, construct or concept that helps organize and interpret information. 
  • 5. Adaptation Assimilation – the integration of new ideas with existing internal structures. Accommodation – adjustment of internal structures to new ideas.
  • 6.
  • 7.
  • 8. BASI C C ONC EPTS OF L EAR NI NG THEOR Y • Schemata (Mental Constructs) • Adaptation – A ssi m i l ati o n – A c c o m m o d ati o n W h at m en tal c o n str u c ts ar e b ei n g ad ap ted b y a b er eav ed c h i l d ? D ev el o p m en tal T h eo r i es
  • 9. M ental C onstructs Fam l y i Fr i ends Jus t i ce Tr us t God/ Spi r i t ual i t y Deat h Meani ng Joy/ Laught er
  • 10. BASI C C ONC EPTS FR UED’S THEOR Y • The Mind The Conscious Mind  The Preconscious Mind The Unconscious Mind. D ev el o p m en tal T h eo r i es
  • 11. The Conscious Mind is what you are aware of at any particular moment, your present perceptions, memories, thoughts, fantasies, feelings, what have you.
  • 12. The Preconscious Mind is anything that can easily be made conscious, the memories you are not at the moment thinking about but can readily bring to mind.
  • 13. The Unconscious Mind. It includes all the things that are not easily available to awareness, including many things that have their origins there, such as our drives or instincts, and things that are put there because we can't bear to look at them, such as the memories and emotions associated with trauma.
  • 14. BASI C C ONC EPTS FR UED’S THEOR Y • The Mind • Thoughts and Perceptions (Conscious and/or Unconscious) W h at ar e th e t h o u g h ts an d p er c ep ti o n s asso c i ated w i th g r i ef ? D ev el o p m en tal T h eo r i es
  • 15. Thoughts & Perceptions “To h a ve a n o r m a l f a m i l y I h a v e t o l i ve wi t h m y m o m a n d m y d a d .” “M y f r i en d s d o n o t u n d er stan d m e b ec au se th ey h av e b o th o f th ei r p ar en ts.” “It i s n o t f a i r t h a t m y m o m d i ed .” “I t d o es n o t m atter w h at I d o , b ec au se b ad th i n g s c an h ap p en to m e an y w ay .” “If Go d i s go o d , t h en wh y d i d m y d a d d i e?” “I ’ m af r ai d m y m o m m i g h t d i e to o an d th en w h at w i l l h ap p en to m e.” “Wh a t i s t h e p o i n t o f l i vi n g, i f we a r e a l l j u st go i n g t o d i e a n y wa y .”
  • 16. BASI C C ONC EPTS ER I K SON’S STAG ES • Crises (Developmental Tasks) • Virtues • Maladaptions/Malignancies D ev el o p m en tal T h eo r i es
  • 17. Erikson’s 8 Stages of Development Psychosocial Maladaptations & Stage (age) Psychosocial crisis virtues malignancies I (0-1) -- sensory distortion -- trust vs.. mistrust hope, faith infant withdrawal II (2-3) -- autonomy vs.. shame impulsivity -- will, determination toddler and doubt compulsion III (3-6) -- ruthlessness -- initiative vs. guilt purpose, courage preschooler inhibition IV (7-12 or so) -- narrow virtuosity -- industry vs. inferiority competence school-age child inertia V (12-18 or so) -- ego-identity vs. role- fanaticism -- fidelity, loyalty adolescence confusion repudiation VI (the 20’s) -- promiscuity -- intimacy vs. isolation love young adult exclusivity VII (late 20’s to generativity vs. self- overextension -- 50’s) -- middle care absorption rejectivity adult VIII (50’s and beyond) -- old integrity vs. despair wisdom presumption -- despair adult Chart adapted from Erikson's 1959 Identity and the Life Cycle (Psychological Issues vol 1, #1)
  • 18. BASI C C ONC EPTS ER I C K SON’S STAG ES • Crises (Developmental Tasks) • Virtues • Maladaptions W h at ar e th e d ev el o p m en tal task s o f g r i ef ? W h at ar e th e p o ssi b l e v i r tu es an d /o r m al ad ap ti o n s (m al i g n an c i es)? D ev el o p m en tal T h eo r i es
  • 19. Tasks of Grief Worden’s 4 Tasks of Mourning – To accept the reality of the loss – To work through the pain of grief – To adjust to all of the changes the loss brings – To emotionally reinvest in life (With death: emotionally relocate the deceased in present life) Worden, J.W. Grief Counseling & Grief Therapy: A handbook for the mental health practitioner. (3rd ed). New York: Springer Publishing
  • 20. Developmental Tasks C o n g r u en c y b etw een I d eal s an d R eal i ty (A c c ep tan c e). Rec o gn i z i n g a n d a c c ep t i n g t h e Ro l e o t h er s p l a y i n o u r l i f e. B eg i n n i n g th e p r o c ess o f c o m i n g to ter m s w i th th e r eal i ty o f d eath . Ad a p t i n g t o l i f e wi t h o u t t h e p er so n wh o d i ed . L ear n i n g to l i v e w i th su f f er i n g /p ai n . Fi n d i n g sec u r i t y a n d sa f et y Wi t h o u t t h e p er so n wh o d i ed .
  • 21. Developmental Tasks Ad a p t i n g y o u r sc h em a o f f a m i l y . I n v esti n g i n N ew R el ati o n sh i p s Al l o wi n g m y sel f t o ex p er i en c e j o y . I d en ti f y i n g m y r o l e i n th e l i v es o f o th er s. In c o r p o r a t i n g m em o r i es o f t h o se wh o h a ve d i ed i n t o m y p r esen t r ea l i t y .
  • 22. Assessment & Setting Goals … M en t al C o n str u c ts … T h o u g h t s an d P er c ep ti o n s … D ev el o p m en tal T ask s … B eh av i o r s … S tr en g th s w i t h i n th e F am i l y … P er so n al an d F am i l y S tr ateg i c P l an n i n g
  • 23. Strategic Planning … W h at ar e y o u d o i n g th at i s w o r k i n g w el l ? … W h at ar e y o u d o i n g th at y o u sh o u l d p r o b ab l y sto p d o i n g ? … W h at ar e y o u n o t d o i n g th at m i g h t b e g o o d to star t d o i n g ? … W h at h av e y o u sto p p ed d o i n g th at y o u w an t to star t d o i n g ag ai n ? … W h at h av e y o u sto p p ed d o i n g th at y o u d o n o t ev er w an t to d o ag ai n ?
  • 24. Assessment & Setting Goals A p er so n ’s g o al s b ec o m e th ei r task s… B r en d a’s G o al s – • C r eati n g r eg u l ar , r o u ti n e, r i tu al i sti c ti m e f o r f am i l y to g eth er n ess. • S eek i n g p r o f essi o n al h el p f o r d ep r essi o n . • O r g an i z i n g an d c l ean i n g h er h o m e. • S h ar i n g h er g r i ef w i th o th er s w h o h av e h ad si m i l ar l o sses. • B e a g r an d m o th er to al l h er g r an d c h i l d r en .
  • 25. Assessment & Setting Goals S h ay l a’s G o al s – 4. S p en d ti m e w i th h er au n t, u n c l e an d b ab y si ster . 5. T o d o m ak e g o o d g r ad es. 6. T o n ev er f o r g et h er m o th er an d tel l h er si ster ab o u t h er m o th er .
  • 26. ROLE OF THE HELPER Fa c i l i t a t e i n t er a c t i o n wi t h o t h er s. Li st en t o t h em t el l t h ei r st o r y . Ed u c a t e & En c o u r a ge t h em a n d t h ei r c a r egi v er . Of f er a sa f e p l a c e f o r v en t i l a t i o n o f f eel i n gs a n d eva l u a t i o n o f i d ea s. Ac t a s a MIRROR