Black Grief and Trauma

Chapter 18: Black Grief and Trauma

• Black grief and trauma include the impact of police brutality and deaths like those of George Floyd and Breonna Taylor
• Stress arises from community violence and gunshot wounds
• Disparities in healthcare affect Black communities throughout the COVID-19 pandemic
• Disenfranchised and suffocated grief involves invalidating grief expressions in marginalized communities
• Systemic oppression increases grief experiences
• There are barriers that make accessing mental health services difficult

Keara’s Story

• Keara is a nurse practitioner, a mother of three, living in a high-violence area of Chicago, confronts systemic healthcare disparities
• Her personal losses include her father passing from Covid-19
• Her mother succumbed to cancer
• Her nephew, Eli, was fatally shot
• She faces difficulty processing her nephew’s death while increasing protective measures for her children
• Keara deals with struggles in workplace discrimination
• She receives significant support from her church community
• Challenges arise from reduced cultural capital after family deaths

Clinical Approaches to Supporting Black Individuals Experiencing Grief

• Culturally conscientious practices require one to examine biases in systemic discrimination
• Developing critical consciousness and self-awareness is important
• Address mistrust to build therapeutic alliances
• Honouring cultural strengths requires valuing informal networks, spirituality and collectivism
• Recognize the impact of Black grief fatigue
• Rituals and healing consist of funeral rituals and communal grieving
• It is important to navigate disruptions due to Covid restrictions

Narrative Retelling and Counternarratives

• Storytelling in healing is of vital importance
• Providing space for clients to share personal narratives is also important

Implications for Practice

• Systemic barriers exist in mental health access
• There are historical and ongoing challenges in accessing culturally responsive care
• Increased efforts are needed in outreach and support for Black clients
• Addressing disenfranchisement: avoid pathologizing grief expressions and understand the complexity of Black grief
• Providing tangible support includes Victim Assistance Program resources
• Advocate for policy changes to support Black families

Keara’s Challenges and Strengths

• Family dynamics relies on the essential role of fictive kin relationships impacts family structure after bereavement
• Workplace dynamics involve coping with microaggressions and systemic workplace bias
• Creating a safety plan and identifying allies is essential

Conclusion on Black Grief

• There is a significant burden of Black grief that causes chronic stress and fatigue from racialized trauma
• Culturally competent practices and advocacy are of vital importance

Other

• Further reading available on social justice concepts in Black bereavement

Chapter 21: Suicide Loss

• Case Study: Kerry and Paul are parents of Cami, aged 35, who died by overdose
• Cami has a history of depression, experienced violence in marriage, and became addicted to opioids
• Her parents took custody of her son, helped with mental health treatment
• Cami was found dead by her father, suicide confirmed by medical examiner after ingesting lethal doses of street opioids and medications

Grief Responses to Suicide

• Paul experienced nightmares and anger towards Cami
• Kerry believed in accidental overdose and denied the suicide
• Different grief responses led to conflicts between Kerry and Paul

Suicide Statistics

• There were 47,511 suicides in the US in 2019, and almost 7,000 in Great Britain
• Exposure: 135 people are exposed per suicide, affecting 5.5 million annually
• Suicide loss survivors experience profound disruptions and many report major or devastating impacts

Terminology

• Suicide Loss Survivors: Individuals grieving a loved one who died by suicide
• Disfavoured Terms: Avoid "victim of suicide death" as it is disempowering

Suicide Bereavement vs. Other Grief

• Grief assessment differs as the experiences vary, it is clinically complex
• Common trauma features include shock, guilt, shame, and social stigma
• Unique aspects include post-traumatic stress symptoms and intrusive re-experiencing

Clinical Features of Suicide Loss

• Individuals struggle to make sense of suicide involving abandonment, blame, and personal responsibility
• Unresolved relational issues contribute to poor mental health
• Uncertainty over intention to end life adds turmoil to grief which creates ambiguous loss

Risks in Those Bereaved by Suicide

• There are increased risks of new or worsening mental health issues, including depression and PTSD
• There is a heightened risk of suicide in partners and parents bereaved by suicide

Clinical Assessment

• Grief Assessment Tools: Prolonged Grief Disorder-13R (PG-13R), Grief and Meaning Reconstruction Inventory (GMRI)
• Assessment considerations include storytelling, loss history and the cultural context

Treatment Approaches

• Peer support connects grievers with others who have similar experiences
• Individual Counseling should focus on trauma, self-blame, and meaning-making
• Complicated Grief Treatment includes Prolonged Grief Therapy, Cognitive Behaviour Therapy, and Meaning Reconstruction Therapy

Treatment Outcomes for Kerry and Paul

• Paul experienced improvement in trauma symptoms and joined a support group
• Kerry underwent Prolonged Grief Disorder Therapy and redefined her grief narrative

Therapist Guidance During Suicide Loss

• Self-care is vital for therapists working with suicide loss survivors
• A new model for clinicians who lose a client to suicide is the SUPPORT-S Trial

Key Points Regarding Suicide

• 135 people are affected per suicide
• Complicated Grief affects 63% of bereaved individuals
• Care needs include psychoeducation, emotion regulation, and social stigma navigation

Key Terms and Concepts for Suicide

• Suicide Loss Survivors
• Disenfranchised Grief
• Prolonged Grief Disorder
• Postvention Services
• Ambiguous Loss

Chapter 22: Grief Therapy with Children and Adolescents

• Summary of Case Study: Daniela is a 12-year-old Hispanic female who attended an outpatient clinic
• Her sister, Cora, died suddenly 6 months prior
• Her family attended local grief support groups and were referred to the clinic by the group leader
• Cora was ill for a week leading up to her sudden death for which CPR was administered
• The family waited for autopsy, cause described as "complications from an unknown illness"
• Daniela displayed symptoms like social withdrawal, declining school performance and dropped out of soccer
• The assessment findings: clinically significant symptoms of separation, existential/identity, and circumstance-related distress, no full PTSD, but elevated re-experiencing and avoidance

Treatment for Children Experiencing Grief

• Multidimensional Grief Therapy (MGT) was used, involved parents in feedback session

MGT

• Purpose: Reduce maladaptive grieving, promote healthy development
• MGT Theoretical Basis: Multidimensional grief theory has three dimensions which includes
  • Separation Distress
  • Existential/Identity Distress
  • Circumstance-Related Distress

Grief Psychoeducation for Children

• Objective: Educate about grief, variability in reactions
• Method: Use a True/False game to facilitate communication in the family

Emotion Identification and Regulation

• Purpose to increase emotional vocabulary and teach regulation skills
• Techniques involve deep breathing, muscle relaxation, and guided imagery

Cognitive Coping and Restructuring

• Objective: Identify and replace unhelpful cognitions about death
• Activities: Best friend exercise and third-person perspective

Grief and Trauma Processing

• Trauma Narrative: Revisiting traumatic experience details
• Loss Narrative: Explore thoughts, feelings about the deceased, integrate future goals

Memorializing and Continuing Bonds

• Transition relationship to memory and spiritual presence
• Activities include rituals like prayers before bed

Meaning Making

• Objective: Understand circumstances, transform the experience
• Method involves Legacy-building by identifying positive traits of the deceased

Parental Grief Facilitation

• The objective is to enhance parenting skills and parent–child communication
• Activities include session preparation and addressing parental reactions

Treatment Outcomes for Children Experiencing Grief

• Daniela's Progress showed reduction in PTSD, maladaptive grief, and depressive symptoms
• Family Dynamics showed improved communication and understanding of grief experiences

Therapists Should

• Write a termination letter to new child in clinic, focusing on positive outcomes

Pediatric Grief Practice Elements

• Core Practice Elements: Psychoeducation, emotion regulation, cognitive restructuring, trauma processing, memorializing, meaning-making, parental facilitation
• Challenges: Separation, existential, and circumstance distress
• Caregiver Support: Provides a vital role in children's adaptive grief reactions

Chapter 23: Parental Grief

• Bereaved Parents: Parents who have lost a child experiences profound pain and grief
• Prolonged Grief Disorder (PGD): Grief accompanied by debilitating symptoms like for example anger, avoidance, and loss of meaning
• Meaning-Centred Grief Therapy (MCGT): Therapeutic approach to help grieving parents find meaning and coexist with their grief
• Cognitive Behavioural Therapy (CBT): Therapy method adapted for parental grief.
• Life-limiting Illness: Illness that leads to a child's death, influences parents' grief process
• Sudden Death such as homicide or suicide often increases PGD and PTSD symptoms in parents

Pediatric Grief and Identity Challenges

• Parents often feel their identity is challenged/meaningless after losing a child
• Isolation from family and friends intensifies grief
• Friends/family struggle with what to say sometimes unintentionally causing more pain

Clinical Pediatric Grief Concerns

• Grief is concerning when it impairs daily functioning which leads to suicidal ideation, or debilitating symptoms like anger/avoidance
• Formal grief interventions are recommended for those with impairing psychological symptoms

Pediatric Grief Intervention Overview

• Only a few empirically-tested interventions exist for parental grief
• Interventions include support groups, cognitive-behavioural/psychodynamic therapies/crisis interventions
• Many studies lack methodological rigor

Compassionate Pediatric Grief Therapy

• Meaning-Centred Grief Therapy (MCGT) focuses on finding meaning rather than reducing grief intensity
• This is based on logotherapy and the meaning reconstruction paradigm
• MCGT helps parents coexist with grief which focuses on attitude, sources/constructing meaning, and connections to the child
• Creative/experiential sources of meaning, self-compassion, and the ability to tolerate pain are emphasized
• Imaginal conversations/legacy work are incorporated

Nancy's Compassionate Pediatric Grief Therapy Case Study

• Nancy lost her daughter Whitney, she uses MCGT to find meaning
• Nancy reflects on Whitney's qualities, admires her resilience, and works to live a meaningful life inspired by Whitney
• MCGT helps Nancy reconnect with loved ones and engage in purposeful work, for example teaching/creating a legacy project

Alternative Therapies for Bereaved Parents

• CBT needs to avoid pathologizing grief
• Bereavement groups provide space for understanding/support

Considerations for Types of Child Loss

• Life-limiting Illness: Continuous care is crucial. Parents struggle with medical decisions/secondary losses
• Sudden Death: Greater PGD/PTSD symptoms, and difficulty making sense of loss. Parents may avoid discussing loss due to the existing stigma/guilt

Pediatric Grief Guidance

• Pediatric Loss is uniquely painful to the client as Child loss in uniquely painful and should not be pathologized
• Evidence-based interventions are limited
• Meaning-Centred Grief Therapy shows promise for supporting bereaved parents

Summary Pediatric Loss Case Study

• Nancy struggled to find meaning after her daughter Whitney.
• MCGT helped Nancy focus on Whitney's positive impact by integrating her into her life narrative
• Nancy engaged in meaningful activities, which found solace in memories, and reconnected with family as part of healing

Summary: Chapter 24

• Case Study: Olivia lost her son Dennis in unclear circumstances. Her partner Ralph and daughter Kathleen did not express their grief similarly
• Olivia’s past coping mechanism sharing but lacked support after mother’s passing
• Olivia was angry towards Ralph for wanting her to move on too quickly
• The therapist noted the risk of anger towards Ralph and suggested therapy

Sharing Grief with Partner

• Individual therapy is emphasized which is resulting in increasing interactive processes
• Family interventions improve compared to individual interventions
• Couples fight due to differing grief processes
• Interactive coping promotes unique insights and understanding of grief

Dual Process Model

• DPM includes relational aspects
• Adaptation involves loss and restoration-oriented coping
• DPM highlights the dynamic process
• Couple therapy adapts simultaneous loss and restoration-oriented coping

Polarized

• Couples polarize in styles; one focuses on loss while the other shifts to restoration
• Polarized can threaten; couples must understand and validate each other

Strategies

• Therapists encourage exploring loss and restoration when addressing polarization

Keywords

• Grief focuses interactive coping
• Dual processing: loss and restoration; adaptation
• Incongruent grieving may lead to polarization. Couples must develop understanding
• EFT is a therapy that has a couples approach that focuses creating new events
• Attunement is intrapersonal and horizontal
• Interactive: Understanding the dynamic between couples coping styles
• Polarization occurs one focuses on loss, therapy softens it

Steps

• Explore loss and restoration
• Validate relational efforts for interaction
• Encourage partners to communicate

Exams

• Partner therapy matters especially when connection is threatened
• Dual processing helps with incongruent grieving
• Exploration and validation soften polarization

Chapter 26 Overview

• Therapy complements therapeutic encounters/analysis which bridges theory and practice

Tools

• Integration: Stressful Experiences focuses meaning in grief
• GMRI tracks evolution

Initial

• Initial: Loss highlights therapeutic approaches
• IS: Identifies support
• CA: Tailors therapy
• UR: Guides regret

Pediatric Bereavement

• Direct questions are encouraged in relation to assessments (Hogan)
• Prolonged grief evaluates; (persistent complex) differentiates PG; (Pandemic severity responses)

Outcomes

• Bereavement provides resilient outcomes; post-traumatic memory measures’ gross

Therapy Implementation

• Facilitating therapy (Death Imagery) identifies violence
• Social meanings validate grief

Reflection

• Meaning centers grief and therapist help with epistemology

Summary

• IS, GMRI, DC tools
• There is no test case here but examples can be extracted from assessments
• For now follow these tools

Chapter 27 Introduction

• Feifel is the founder
• Fulton started the first course
• There was growth in death courses and professional orgs that started death education, and journals

Challenges

• Lack of attention, time, training and awareness
• There are also benefits in increased confidence/competence (Impacts of inadequate training)/ barriers include loads of limited training
• There are many modes of delivery online such as ADEC,HFA,ACGB, and CCG
• Challenges include resistance, commitment, resources sporadic offerings such as King’s University, Maryland, and Marian
• Graduate Education focuses increasing empathy and theory’s art film/music
• Supervision supports these efforts by asking open ended questions and encouraging mindfulness activities leading to...
• graduate training and pedagogical encouraged so there is increased integration of human and course work

Conclusions

• compassionate reflection integrates systems which encourage personal exploration.
• This focuses on empathy and kindness which helps with assumptions.
• This welcomes parts of one’s inner landscape by understanding non judgement
• The practice is reflexive it helps with fatigue
• Reflexivity helps to see the identity
• Compassionate reflection is a life style

1. Compassion is (compassion and honesty)
2. Meaning (personal meaning)
3. Internal help for inner self examination

Takeaways

• Insight and self care is key
• Effective care is routine/expressive
• Reflex helps and culture helps/ vulnerability is key and it heals each other