第九章 哀痛咨询

Chapter9GriefCounseling哀痛咨询Supportingthebereaved:theoryandpractice支持未亡人：理论与实践Whydoweneedmodelsofgrieving?AnnDentoutlinesthetheoriesandexplainshowtheycanbeusefulforpractitionerssupportingthebereaved为什么我们需要哀痛模式？安娜概要地描述了这方面的理论，并解释了它们如何能有助于支持未亡人的工作者。IntroductionAlthoughSigmundFreudpioneeredthestudyofmourning,itisonlyinthelast30yearsorsothatbereavementresearchhasrealprominence.Researchershavenowgivenusseveralnewmodelsandinsightstoguideandhelpthebereaved.Butwhydoweneedmodels?Afterall,peoplehavebeenbereavedsincehumanlifebeganandhavegenerallyrecoveredwithoutthehelpofanymodelofgrieving.导言尽管弗洛伊德早已经是悼念研究的先驱者，但是直到最近30年左右，丧亲的研究才有了真正的进展。研究者现在已经给了我们几种新的模式和洞察，去引导和帮助未亡人。但是为什么我们需要模式呢？毕竟自从有人类生活以来，人类就有了丧亲之痛，而且一般来说他们在没有哀痛模式帮助的情况下就恢复过来了。IntroductionWenowrecognizethatgriefreactionscanhavephysical,emotional,cognitive,behavioral,sexualandspiritualcomponents,varyinginlengthanddisruptiveness.Adequateandappropriatesupportmayalleviatetheprobabilityoffutureill-healthandcomplications.Thisisnottosaythatallbereavedpeoplewillneedhelp,northatgriefshouldbepathologised.However,whenprofessionalsareinvolvedinsupportingthebereaved,theyneedaknowledgebasefromwhichtopracticeandscientificknowledgeprovidesaparticularlysolidbase.Personalexperienceandintuitionareimportantbuttheyhavetwomajorlimitationsasabasisofunderstanding:first,apractitioner’sexperiencemaybetoorestrictedtomakevalidgeneralisationsaboutnewsituations,andsecond,personalexperiencesmaybecolouredbysubjectivevaluesandprejudices.导言我们现在认识到，哀痛反应可以有身体的，情感和情绪的，认知的，行为的，性生活的，以及精神的要素，其延续的时间长度和破坏性都各不相同。充分和适当的支持可以降低未来健康损害和并发症的可能性。这并等于说，所有的未亡人都需要帮助，也并非说，哀痛应该并视为病态。然而，当专业人员涉入对未亡人的支持时，他们需要在一定知识的基础上开展实践，而科学的知识则能够提供具体的坚实的基础。个人的经验和直觉是重要的，但是作为理解的基础它们具有2个重大的局限：第一，某个工作者的经验对于作出一个有效的普遍性的概括也许过于受限。第二，个人的经验也许会染上主观的价值和偏见的色彩。IntroductionIhavechosenfivebereavementmodelsthatmayenhanceoursensitivitytowhathappenswhenweworkwiththebereaved.Sinceallthemodelsoutlinedareconcernedwithloss,theycanbeusedwithotherlife-changingeventsinvolvingloss,suchasdivorce,redundancy(layoff)andillness.导言我选出了5种哀痛模式，它们也许可以在我们为未亡人服务时，提高我们对于所发生事件的敏感性。由于这里描述的所有模式都围绕丧失这一主题，因此它们可以被用于所有关于丧失的生活剧变事件，诸如离婚，下岗（redundancy(layoff)）和疾病。1StagesandphasesJohnBowlby’stheoryonattachment(19611)wouldseemtounderpinthebasisforunderstandingbereavement.Bowlbyprovidesanexplanationforthecommonhumantendencytodevelopstrongaffectionalbonds.Heviewsattachmentasareciprocalrelationshipthatoccursasaresultoflong-terminteractions,startingininfancybetweenachildanditscaregivers.Hesuggeststhatgriefisaninstinctiveuniversalresponsetoseparation.Stagesandphases阶段和相位鲍比的依恋理论似乎是理解哀痛的基础。对于人类常见的发展出强烈情感纽带的倾向，鲍比提供了一种解释。他将依恋视为一种相互作用的关系，它们是一种长期互动的结果，始于婴儿时期孩子与照护者之间的互动。他提示说，哀痛是对于分离的本能的普遍反应。1StagesandphasesBothBowlby(19612)andParkes(19723)suggestthatgriefisapredictableorderlypatternofresponsestoadeath.Parkessuggeststhatgrievingisaprocess,asequenceofreactionstothedeathofasignificantlovedone.Theinitialshock,resultinginnumbness,canlastfordays,especiallywhenadeathissuddenleadingontointensegrief.Physicalsymptomssuchastightnessinthechest,shortnessofbreath,lossofappetiteandinsomniaarecommon.Lackofconcentrationandrestlessnessmayalsobeexperienced,aswellasfeelingsofisolationandloneliness.Stagesandphases阶段和相位鲍比和帕克都认为，哀痛是一种对于死亡的可预测的，有序的反应模式。帕克认为，哀痛是一个过程，是对一位所挚爱者的死亡所产生的反应序列。最初的震惊，导致麻木，可以持续数日，特别是当死亡非常突然，导致了强烈的哀痛时。身体的症状，诸如胸部发紧，气短，食欲不振，失眠是常见的症状。注意力难以集中和躁动不安也可能被体验到，还可能包括被隔离和孤独感。1StagesandphasesInterspersedwiththesereactionsmaybefeelingsofanger,guiltandfear.Angermayfocusondifferentareas,dependingonaperson’scircumstances;guiltisfrequentlyassociatedwith‘ifonlyIhad...or‘ifonlyIhadn’t’.Theexpressionandacknowledgementofangerandguiltmaybringsomerelief,asmayreassurancethattheseare‘normal’reactions.Whensuchfeelingsaresuppressed,thebereavedpersonmayexhibitsignsofconstantirritationand/orphysicaltension.Fearcanmanifestitselfasinsecurity,adesiretoescapefromreality,andanxietyoverapparenttrivialities,leadingsometimestopanicattacksinwhichtheanxietyandfearareoverwhelminganddisruptnormalliving.Stagesandphases阶段和相位与这些反应间或同时出现的可以有愤怒，负罪和恐惧。愤怒也许注目于不同的领域，取决于该人所处的环境；负罪感频繁地与“如果我当时那样…”或“如果我当时没有那样…”联系在一起。对于愤怒和负罪感的表达和承认也许会带来一些解脱，如同“这是正常反应”的宽慰所带来的效应。当这样的情感被压抑时，未亡人可能会展现出持续的烦躁和/或身体的紧张。恐惧可以表现为不安全感，想从现实生活逃避的愿望，以及明显微不足道小事的焦虑，有时候甚至导致惊恐发作，在这样的发作中，焦虑和恐惧会占据压倒性地位，以至于正常生活遭到破坏。2TasksforthebereavedWilliamJWordeninthe1980s4formulatedaslightlydifferentmodelofgrievingtothoseofBowlbyandParkes.Describinggriefasaprocessandnotastate,Wordensuggestedthatpeopleneedtoworkthroughtheirreactionsinordertomakeacompleteadjustment.InWorden’stasksofbereavement,griefisconsideredtoconsistoffouroverlappingtasks,requiringthebereavedpersontoworkthroughtheemotionalpainoftheirlosswhileatthesametimeadjustingtochangesintheircircumstances,roles,statusandidentity.Thetasksarecompletewhenthebereavedpersonhasintegratedthelossintotheirlifeandletgoofemotionalattachmentstothedeceased,allowingthemtoinvestinthepresentandthefuture.2Tasksforthebereaved未亡人的任务WilliamJWordeninthe1980s4formulatedaslightlydifferentmodelofgrievingtothoseofBowlbyandParkes.Describinggriefasaprocessandnotastate,Wordensuggestedthatpeopleneedtoworkthroughtheirreactionsinordertomakeacompleteadjustment.威廉.沃顿在80年代形成了一个与鲍比和帕克稍有些不同的哀痛模式。他将哀痛描述为一个过程，而非状态，沃顿认为，人们需要努力通过他们的反应过程，以便获得完全的适应。TasksofGrief哀痛的任务TasksOneToAccepttheRealityoftheLoss接受丧失的现实TaskTwoToWorkthroughthePainofGrief

努力克服哀伤的痛苦TaskThreeToAdjusttoanEnvironmentinWhichTheDeceasedisMissing

适应逝者已经不复存在的环境。TaskFourToEmotionallyRelocatetheDeceasedandMoveOnwithLife将对于逝者的情感重新定位，继续在生活中前进。3DualprocessmodelAmorerecentandsignificantadvanceinourunderstandingofgriefworkisthedualprocessmodeldevelopedbyStroebeandSchut(19955,19996).Theysuggestedthatavoidinggriefmaybebothhelpfulanddetrimental(harmful),dependingonthecircumstances.Whilepreviousmodelscentredonloss,thedualprocessmodelrecognisesthatbothexpressingandcontrollingfeelingsareimportant–anditintroducesanewconcept,thatofOscillation(predictablevariation)betweencopingbehaviours.3Dualprocessmodel双重过程模式AmorerecentandsignificantadvanceinourunderstandingofgriefworkisthedualprocessmodeldevelopedbyStroebeandSchut(19955,19996).Theysuggestedthatavoidinggriefmaybebothhelpfulanddetrimental(harmful),dependingonthecircumstances.Whilepreviousmodelscentredonloss,thedualprocessmodelrecognisesthatbothexpressingandcontrollingfeelingsareimportant–anditintroducesanewconcept,thatofOscillation(predictablevariation)betweencopingbehaviours.对于理解哀痛工作更为晚近和明显的进步是St和Sc所开发的双重过程模式。他们认为，回避哀痛可以是有利的，也可以是有害的，取决于不同的条件。前人的模式聚焦于丧失，双重过程模式则意识到，表达和控制情感都是重要的，它引入了一个新的概念，即在两种应对行为之间的“摆动”（可预测的变化）。3DualprocessmodelGriefisviewedasadynamicprocessinwhichthereisanalternationbetweenfocusingonthelossofthepersonwhohasdied(lossorientation)andavoidingthatfocus(restorationorientation).Thelossorientationencompassesgriefwork,whiletherestorationorientationinvolvesdealingwithsecondarylossesasaresultofthedeath.Forinstance,anolderwidowmayhavetodealwithfinances,andhousemaintenance,whichpreviouslyherhusbanddealtwith.3Dualprocessmodel哀痛被视为一种动力学的过程，在其中存在两种可能的选择，或者应对逝者的丧失（丧失取向）或者是回避这样的聚焦点（恢复取向）。丧失取向包含了克服哀痛的努力。而恢复取向则注目于处理由于死者的逝去而造成的次生的丧失。例如，一位年长的寡妇也许必须应对各种账目，房子的维持，而这些都原来是由她丈夫来处理的。3DualprocessmodelBoththelossorientationandtherestorationorientationarenecessaryforfutureadjustment,butthedegreeandemphasisoneachapproachwilldependonthecircumstancesofthedeath,personality,genderandculturalbackgroundofeachperson.Themodelalsopositsthatbytakingtimeofffromthepainofgrief,whichcanbeoverwhelming,abereavedpersonmaybemoreabletocopewiththeirdailylifeandthesecondarychangestoit.3Dualprocessmodel丧失取向和恢复取向对于未来的适应而言都是必要的，但是每一种取向的程度和对它们的强调将取决于死亡的情况，以及每一个人的人格，性别和文化背景。这个模式也认为，通过将花在哀痛上的时间（这样的取向是可以将人压垮的）引向别处，未亡人可以更有能力去应对他们的日常生活和死亡所派生的改变。4ContinuingbondsAfurtherimportantdevelopmentingrieftheoryhasbeenprovidedbytheworkofKlassetal(19967),whochallengedconventionalthinkingthatthepurposeofgrievingwasthereconstitutionofanautonomousindividualwhocouldleavethedeceasedbehindandformnewattachments,inotherwords,’breakthebonds’withthedeceased.Klassandhiscolleaguessuggestthatthepurposeofgrievingisinsteadtomaintainacontinuingbondwiththedeceased,compatiblewithother,newandcontinuingrelationships.4Continuingbonds持续的纽带哀痛理论的进一步的重要发展是通过Klass等人的工作形成的。他挑战了传统的思维，这种思维认为哀痛的目的是要重构一个独立的个体，以便能够脱离逝者，并形成新的依恋，换句话说，即“挣断与逝者的纽带。”Klass和他的同事们认为，哀痛的目的其实是为了维持一条与逝者之间的不间断的纽带，它与其他的，新的并且持续的关系是相容的。5FamiliesmakingsenseofdeathMostmodelsofgriefdealwiththegriefofindividuals.Frequently,however,deathaffectsawholefamily,inwhichfamilymembers,includingchildren,caninfluenceandbeinfluencedbyothers,andinwhichthedeathmaymeandifferentthingstoeach.Inmanycases,thefamilyisveryoftentheprimeproviderofsocialisation,socialcontrolandsupport.Certainfactorseitherinhibitorenhanceafamily’sgrief.Familiesinwhichtherearefragilerelationships,secretsanddivergentbeliefsmayhavemoredifficultyinadjusting;whereasfamilieswhohavefrequentcontact,ritualsandawillingnessforeachmembertosharetheirfeelings,mayfinditeasier.5Familiesmakingsenseofdeath影响哀痛的家庭因素大部分哀痛模式讨论的都是哀痛的个体。然而，死亡往往影响整个家庭，包括孩子在内的家庭成员可以影响别人或被别人影响，而且死亡对他们而言也许具有不同的意义。在许多情况下，家庭往往是社会化，社会控制和支持的主要提供者。某些因素或者抑制，或者提高家庭的哀痛。存在有脆弱的关系，私人隐秘和不同信念的家庭在适应时会有更多困难，而那些各个成员间都具有频繁接触，并具有分享情感的惯例和意愿的家庭，就比较容易克服哀痛。SummaryMostmodelsofgriefsuggestthatthebereavedneedtoengagewiththeirlossandworkthroughit,sothatlifecanbereorderedandmeaningfulagain.Mostpractitionerswillbefamiliarwiththestage/phasetheoriesinidentifyingcognitive,socialandemotionalfactors.SummaryWorden’stasksofbereavementgiveaframeworktoguidethebereavedintheirgriefwork,whilethedualprocessmodeldemonstratestheneedtodealwithsecondarystressesaswellastheprimaryloss,withtimeawayfromboth.Itisalsoimportanttorecognisethatthebereaveddonotneedtoforgetandleavethedeceasedbehind,butcanintegratethemintotheirfuturelivesbymeansofacontinuingbond.SummaryWhilemostresearchhasfocusedontheindividual,understandingthefamilydynamicisoftenofgreatimportanceforcounsellorsinidentifyingpossibletensionsbetweenmembersandassessinghowmembersmayinfluenceorbeinfluencedbyothers,aswellasunderstandingwhatthedeathmeanstoeachmember.SummaryEachbereavedpersonisuniqueandwilldealwithasignificantdeathintheirownway;thereforethereisnoonerightorwrongwaytogrieve.Thechallengethatfacespractitionerseachtimewemeetabereavedpersonistofindwhathelpsthembest.Nosinglemodelofgrievingisrecommendedabovetherest,asallhavevariouscomponentsthatmaybehelpful.Regardlessofwhichmodelisused,themostimportantpartofsupportingabereavedpersonliesin‘beingwith’them,listeningintentlytotheirstory,acknowledgingtheirfeelingsandguidingthemtoworktowardsanew,differentandmeaningfullifewithoutthedeceased.acknowledgementAnnDentisabereavementconsultantandtrainer,ChairoftheBereavementResearchForum,PatronofCompassionateFriends,andChairoftheBristolBereavementForum.Sheisparticularlyinterestedinfamilybereavementworkthatincludeschildrenandinsupportstructuresforfamiliesafterthesuddendeathofachild.WhatHasBecomeofGriefCounseling?AnEvaluationoftheEmpirical

FoundationsoftheNewPessimismApessimisticviewofgriefcounselinghasemergedoverthelast7years,exemplifiedbyR.A.Neimeyer’s(2000)oft-citedclaimthat“suchinterventionsaretypicallyineffective,andperhapsevendeleterious,atleastforpersonsexperiencinganormalbereavement”(p.541).Thisnegativecharacterizationhaslittleornoempiricalgrounding,however.Theclaimrestson2piecesofevidence.The1stisanunorthodoxanalysisofdeteriorationeffectsin10outcomestudiesinB.V.Fortner’s(1999)dissertation,usuallyattributedtoNeimeyer(2000).NeithertheanalysisnorFortner’sfindingshaveeverbeenpublishedorsubjectedtopeerreview,untilnow.Thisreviewshowsthatthereisnostatisticalorempiricalbasisforclaimsaboutdeteriorationeffectsingriefcounseling.The2ndpieceofevidenceinvolveswhattheauthorsbelievetobeill-informedsummariesofconventionalmeta-analyticfindings.Thismisrepresentationofempiricalfindingshasdamagedthereputationofgriefcounselinginthefieldandinthepopularmediaandofferslessonsforbothresearchersandresearchconsumersinterestedintherelationshipbetweenscienceandpracticeinpsychology.HowtohelpGrievingChildren1.UnderstandthedifferencebetweengriefandmourningGriefistheconstellationofinternalthoughtsandfeelingsweexperiencewhensomeonelovediesMourningistheoutwardexpressionofourgrief.Mourningisnecessaryforhealingtotakeplace.Ioftenrefertochildrenas“forgottenmourners.”Why?Becausethoughallchildrengrievewhensomeoneloveddies,we(associety,asfamiliesandoftenasindividuals)don’talwaysencouragethemtomourn.Youcanhelpthegrievingchildyoulovebyencouraginghertomourn.Youcanbethepersonshefeels“”tomourninthepresenceof.Thinkaboutyourownexperienceswithgrief.Didyoumourn?Ifso,whatwaysofmourningwerehelpfultoyou?理解哀痛与悼念的区别哀痛是当亲爱者离世后我们所体验到的内心思想情感的纠结。悼念是哀痛的外在的表达。悼念对于心灵创伤的愈合是必不可少的。我往往将孩子称为“被遗忘的悼念者，”为什么？因为尽管当亲爱者离世时，所有的孩子都会哀痛，我们并不总是鼓励他们悼念。通过鼓励哀痛的孩子悼念，你可以帮助这些你所爱的孩子。你可以成为孩子感到可以与之表达哀痛的人。2.Observethatkidsmournmorethroughbehaviorsthanwords.Oftengrievingchildrendon’ttalkandtalkbouttheirfeelings.Insteadtheyactthemout.Forexample,thechildmayactmopy(bemiserable)lethargicbutmaynothavethewordstopinpointhowhe’sfeelingorwhy,specifically,he’sfeelingthatway.Watchformourningbehavioursinkids.Achildwhoisfeelingconfusedmightgeteasilyupset.Achildwhoisangryaboutthedeathmightmisbehaveorpickfightswithotherkids.Childrenalsomournthroughtheirplay.Watchfortheirfeelingstocomeoutinthewaystheypretend,relatetootherkids,physicallymove,createartwork,etc.注意孩子表达哀痛往往更多地通过行为，而不是言语哀痛的孩子往往不说话，不谈论他们的情感。他们的情感会通过行为宣泄。例如，孩子也许表现出凄凄惨惨，无精打采，但是也许没有相应的言语来具体地表达其情感或其中的特殊的缘由。让我们观察一下孩子表达哀痛的行为。正感到困惑的孩子也许很容易难过。对死亡感到很气愤的孩子也许会胡闹，或挑衅其他孩子。孩子也会通过游玩来表达哀痛。注意观察他们表达情感的种种方式，他们或以伪装的方式，或通过与孩子的关系，肢体的运动，所创造的艺术品等方式，来表达他们的情感。3.understandthesixneedsofmourningNeed1.Acknowledgetherealityofthedeath.Thechildmustgentlyconfronttherealitythatsomeonesheloveisdeadandwillneverphysicallybepresenttoheragain.Childrentendtoaccepttherealityofadeathin“doses.”Thatis,theyletinjustalittleofthepainatatimethenreturntotheirplayorotherdistractions.This“dosing”ofgriefisnotonlynormalbutnecessary,foritmakestheearlydaysofgriefbearable.Helpthechildunderstandwhat“dead”physicallymeans.Explainthatthebodycannolongerthink,feel,hear,breathe,etc.andwillneverbe“alive”again.Whetherthedeathwassuddenoranticipated,thechildmaytakeyearstofullyintegratetherealityoftheloss.Asshegetsolderandmaturesdevelopmentally,thedeathwilltakeonnewlayersofmeaningandgreaterdepth.Today,talkaboutthephysicalrealityofthedeath,Makesurethechildunderstandshowandwhythepersondied.4.understandthesixneedsofmourningNeed2.Feelthepainoftheloss.Likeallmourners,childrenneedtoembracethepainoftheloss.Fortunately,mostchildrenhaven’tyetlearnedhowtorepressordenytheirfeelings.Iftheyaresad,theygenerallyallowthemselvestobesad.Youcanhelpbyencouragingthechildtotalkabouthispainfulthoughtsandfeelingsandbybeinganonjudgmentallistener.Youcanalsomodelyourowngrieffeelings.Ifyou’resad,expressyoursadnessinthechild’spresence.Childrenwillnaturally“dose”theirpain.Supportthischildasheallowshispainin,littlebylittle.Thenexttimethechildcries,resistthenaturalurgetoencouragehistostopcrying.Instead,holdhimgentlyandlethimcryaslongandashard(andasoften)ashewantsto.5.understandthesixneedsofmourningNeed3.Rememberthepersonwhodied.Whensomeoneloveddies,theyliveoninusthroughmemory.Grievingchildrenneedtoactivelyrememberthepersonwhodiedandhelpcommemoratethelifethatwaslived.Nevertrytotakeawayachild’smemoriesinamisguidedattempttosaveherfrompain.It’sgoodforthechildtocontinuetolookatphotosorvideotapesofthepersonwhodied.It’sgoodforhertosharestoriesoftheperson’slifeandtohearotherpeopletalkaboutthepersonwhodied,too.Rememberingthepastmakeshopingforthefuturepossible.Invitethechildtotellyouaboutamemoryofthepersonwhodied.Oraskthechildtoshowyouasnapshotofthepersonwhodiedthentellyouwhatwasgoingonwhenthepicturewastaken.6.understandthesixneedsofmourningNeed4.Developanewself-identity.Partofthechild’sself-identitywasformedbytherelationshiphehadwiththepersonwhodied.Maybehehadafatherandnowhedoesn’t.ormaybehewasabigbrotherandnowhisyoungersiblinghasdied.Howhasthechild’ssenseofwhoheischangedasaresultofthisdeath?Noonecan“fillin”forthepersonwhodied.Don’ttrytofindasubstitutefather/bestfriend/grandparent/etc,forthechild,atleastnotintheearlymonthsafterthedeath.Supportiverelationships-yes.Replacements-no!Sometimesgrievingchildrenareencouragedtotakeonrolesandtasksthatbelongedtothepersonwhodied,yetforcingchildrentotakeonadultresponsibilitieswillonlyhindertheirhealingandstealtheirchildhoodfromthem.Askthechildtodrawtwopictures:oneofhislifebeforethedeathandoneofhislifeafterthedeath.Thentalkwithhimaboutthedifferencesdepictedinthepictures.7.understandthesixneedsofmourningNeed5.Searchformeaning.Whensomeoneloveddies,wenaturallyquestionthemeaningandpurposeoflife.Childrentendtodothisverysimplythroughquestionssuchas,“whydopeopledie?”and“whathappenstopeopleaftertheydie?”and“cangrandmagobowlinginheaven?”Grievingkidswillonlyfeelfreetoaskthesequestionsofadultswhomtheytrust.Alsobeonthewatchforthechild’ssearchformeaninginherplay.Don’ttrytohaveanswerstoallthechild’squestionsaboutthemeaningoflife.It’sok-evendesirable-toadmitthatyoustrugglewiththesameissues.Shareyourbeliefsaboutlifeanddeathandspiritualitywiththechildwithoutpressuringthechildtobelievewhatyoubelive.8.understandthesixneedsofmourningNeed6.Receiveongoingsupportfromcaringadults.Griefisaprocess-notanevent,Children,likeadults,willgrievelongafterthehasdied.Thegrievingchildneedsyourcompassionatesupportandpresencenotonlyinthedaysandweeksfollowingthedeath,butinthemonthsandyearstocome.Astheygrowandmaturedevelopmentally,childrenwillnaturallygrievethedeathonnewandeverdeeperlevels.Ifyoucanhelpthegrievingchildmournastheneedarises(evenyearsafterthedeath),youwillbehelpinghergrowintoahealthy,lovingadult.Createaplantohelpthischildthroughoutthenextyear.Markregulardatestocontactandspendtimewithherinyourdailyplanner.Don’tforgetimportantdates,suchasthechild’sbirthdayandtheanniversaryofthedeath.Includethechildinplanningandcarryingoutthefuneral

Attendingthefuneralofsomeonelovedismorethanaprivilege,itisaright.Andanyonewholovedthepersonwhodiedshouldbeencouragedtoattend-evenchildren.Childrenoftendon’tknowwhattoexpectfromafuneral.Youcanhelpbyexplainingwhatwillhappenbefore,duringandaftertheceremony.Letthechild’squestionsandnaturalcuriosityguidethediscussion.Grievingkidsoftenfeelliketheirfeelings“matter”whentheycanshareafavoritememoryorreadaspecialpoemaspartofthefuneral.Shyerchildrencanparticipatebylightingacandleorplacingsomethingspecial(amemento,photoordrawing,forexample)inoronthecasket.Ifthefuneralhasalreadytakenplace,talktothechildabouthisexperiencewiththeceremony.Helpanswerlingeringquestionsanddiscussongoingwaysforhimtohonorthepersonwhodied.Helpthechildchooseakeepsake(纪念品)Followingadeath,survivorsareoftenfacedwiththetaskofsortingthroughanddisposingofthebelongingsofthepersonwhodied.Childrenshouldbeincludedinthisprocesswhenpossible.Askthegrievingchildifshewouldliketokeepanythingthatbelongedtothepersonwhodied.Ifthepersonwhodiedwasspeciallysignificantinheryounglife,youmaywanttoboxupotheritemsandsavethemforappropriatetimeslaterinthechild’slife.Sometimeskeepsakescanbestoredina“memorybox”createdespeciallyforthechild.TheTeenGriefGroupTheValueofaGroupinDealingWithGriefPeers:SomeAreHelpful;OthersAreNotSoHelpfulNormalizingtheExperienceofGriefInitiatingandOrganizingaGriefGroupInitiatingthePlanPublicizingtheGroupRegistrationandInterviewAnewapproachtocomplicatedgriefBetterassessmentsandtreatmentsleadtoabrighteroutlookforpeoplewithseveregriefComplicatedgriefAnewunderstandingofthebiopsychosocialimpactofthedeathofalovedonehasfocusedthegrief-counselingfieldonidentifyingandtreatingpeopleatriskformentalandphysicalcomplicationsasaresultoftheirloss.Ratherthanusingaone-size-fits-allapproachtobereavement,likeassumingallpeoplewillneedthesameamountoftreatment,psychologistsneedtoemploycarefulassessmentandtailoredtreatments,accordingtoareportproducedbymembersofAPA'sAdHocCommitteeonEnd-of-LifeIssuesandpublishedinProfessionalPsychology:ResearchandPractice(Vol.34,No.6)inDecember.ComplicatedgriefMostbereavedmenandwomencopeeffectively,saysadhoccommitteememberRobertNeimeyer,PhD,oftheUniversityofMemphis,butresearchhasshownthatthestressesassociatedwithprofoundloss,suchaslivingaloneandconfrontingdeath,canhaveaserious--evendeadly--impactonasizableminority.Theworkoftheadhoccommitteepromptedthereporttoidentifyrolesforpsychologistsinend-of-lifecare,Neimeyersays.ComplicatedgriefIndeed,thereportcitesresearchbypsychiatristSelbyJacobs,MD,PhD,ofYaleUniversity,thatshows40percentofpeoplewholoseaspouseexperiencegeneralizedanxietyorpanicsyndromesinthefirstyear.AndpsychiatristColinMurrayParkes,MD,formerlyoftheLondonHospitalMedicalCollege,hasfoundthatmortalityamongsurvivingspousesinthesixmonthsfollowingalossincreases40to70percentcomparedwiththegeneralpopulation.ComplicatedgriefOfparticularconcern,saysNeimeyer,isthefindingbyYaleUniversitypsychologistHollyPrigerson,PhD,thatroughly15percentofpeoplewho'velostalovedonemightbesusceptibleto"complicatedgrief,"aconditionmoreseverethantheaverageloss-relatedlifetransition,depressionandanxiety.Distinguishablefromdepressionandanxiety,itismarkedbybroadchangestoallpersonalrelationships,asenseofmeaninglessness,aprolongedyearningorsearchingforthedeceasedandasenseofruptureinpersonalbeliefs.ComplicatedgriefInlightofthatnewunderstanding,psychologicalresearchersandpractitionersareworkingtodevelopnewwaystoassessandtreatseveregriefthattakeintoaccountabroadersenseofhowgriefmanifestsitself;individualdifferencesinthegriefexperiencerequirecustom-tailoringoftreatmentplans,Neimeyersays.EvolutioninassessmentOnegroupofresearchers,forexample,isexaminingfactorsthatidentifypeopleatriskforcomplicatedgrief,Neimeyersays.Theresearchersareobjectivelyassessingriskfactorsbyreviewingthecircumstancessurroundingdeaths.Chronicandunremitting（constant）griefistypicallyassociatedwithsudden,unexpectedandtraumaticdeath,thelossofchildrenoryoungpeople,andtherelativeclosenessofthebereavedpersontothedeceased,thereportsays.Particularriskfactorsincludeexcessivedependencyintherelationshipwiththedecedentorahistoryofmentalillnessessuchasdepressioninthebereaved,Neimeyersays.EvolutioninassessmentInthepast,thementalhealthcommunitydefinedvaryingreactionstogrief,suchasdelayedonsetofgrief,asdisorders,Neimeyersays.Inparticular,peoplewhogrievedinwaysuncharacteristicfortheirculturalbackgroundwerelabeledasdisordered.Butnewresearchandagrowingunderstandingofgriefhaspromptedpsychologiststousedifferentdiagnosticfactorsforcomplicatedgrief,suchaschangedrelationshipswithfamilyandfriends,feelingsofmeaninglessnessan