第九章 哀痛咨詢

Chapter9GriefCounseling哀痛咨詢Supportingthebereaved:theoryandpractice支持未亡人：理論與實踐Whydoweneedmodelsofgrieving?AnnDentoutlinesthetheoriesandexplainshowtheycanbeusefulforpractitionerssupportingthebereaved為什么我們需要哀痛模式？安娜概要地描述了這方面的理論，并解釋了它們?nèi)绾文苡兄谥С治赐鋈说墓ぷ髡?。IntroductionAlthoughSigmundFreudpioneeredthestudyofmourning,itisonlyinthelast30yearsorsothatbereavementresearchhasrealprominence.Researchershavenowgivenusseveralnewmodelsandinsightstoguideandhelpthebereaved.Butwhydoweneedmodels?Afterall,peoplehavebeenbereavedsincehumanlifebeganandhavegenerallyrecoveredwithoutthehelpofanymodelofgrieving.導(dǎo)言盡管弗洛伊德早已經(jīng)是悼念研究的先驅(qū)者，但是直到最近30年左右，喪親的研究才有了真正的進展。研究者現(xiàn)在已經(jīng)給了我們幾種新的模式和洞察，去引導(dǎo)和幫助未亡人。但是為什么我們需要模式呢？畢竟自從有人類生活以來，人類就有了喪親之痛，而且一般來說他們在沒有哀痛模式幫助的情況下就恢復(fù)過來了。IntroductionWenowrecognizethatgriefreactionscanhavephysical,emotional,cognitive,behavioral,sexualandspiritualcomponents,varyinginlengthanddisruptiveness.Adequateandappropriatesupportmayalleviatetheprobabilityoffutureill-healthandcomplications.Thisisnottosaythatallbereavedpeoplewillneedhelp,northatgriefshouldbepathologised.However,whenprofessionalsareinvolvedinsupportingthebereaved,theyneedaknowledgebasefromwhichtopracticeandscientificknowledgeprovidesaparticularlysolidbase.Personalexperienceandintuitionareimportantbuttheyhavetwomajorlimitationsasabasisofunderstanding:first,apractitioner’sexperiencemaybetoorestrictedtomakevalidgeneralisationsaboutnewsituations,andsecond,personalexperiencesmaybecolouredbysubjectivevaluesandprejudices.導(dǎo)言我們現(xiàn)在認(rèn)識到，哀痛反應(yīng)可以有身體的，情感和情緒的，認(rèn)知的，行為的，性生活的，以及精神的要素，其延續(xù)的時間長度和破壞性都各不相同。充分和適當(dāng)?shù)闹С挚梢越档臀磥斫】祿p害和并發(fā)癥的可能性。這并等于說，所有的未亡人都需要幫助，也并非說，哀痛應(yīng)該并視為病態(tài)。然而，當(dāng)專業(yè)人員涉入對未亡人的支持時，他們需要在一定知識的基礎(chǔ)上開展實踐，而科學(xué)的知識則能夠提供具體的堅實的基礎(chǔ)。個人的經(jīng)驗和直覺是重要的，但是作為理解的基礎(chǔ)它們具有2個重大的局限：第一，某個工作者的經(jīng)驗對于作出一個有效的普遍性的概括也許過于受限。第二，個人的經(jīng)驗也許會染上主觀的價值和偏見的色彩。IntroductionIhavechosenfivebereavementmodelsthatmayenhanceoursensitivitytowhathappenswhenweworkwiththebereaved.Sinceallthemodelsoutlinedareconcernedwithloss,theycanbeusedwithotherlife-changingeventsinvolvingloss,suchasdivorce,redundancy(layoff)andillness.導(dǎo)言我選出了5種哀痛模式，它們也許可以在我們?yōu)槲赐鋈朔?wù)時，提高我們對于所發(fā)生事件的敏感性。由于這里描述的所有模式都圍繞喪失這一主題，因此它們可以被用于所有關(guān)于喪失的生活劇變事件，諸如離婚，下崗（redundancy(layoff)）和疾病。1StagesandphasesJohnBowlby’stheoryonattachment(19611)wouldseemtounderpinthebasisforunderstandingbereavement.Bowlbyprovidesanexplanationforthecommonhumantendencytodevelopstrongaffectionalbonds.Heviewsattachmentasareciprocalrelationshipthatoccursasaresultoflong-terminteractions,startingininfancybetweenachildanditscaregivers.Hesuggeststhatgriefisaninstinctiveuniversalresponsetoseparation.Stagesandphases階段和相位鮑比的依戀理論似乎是理解哀痛的基礎(chǔ)。對于人類常見的發(fā)展出強烈情感紐帶的傾向，鮑比提供了一種解釋。他將依戀視為一種相互作用的關(guān)系，它們是一種長期互動的結(jié)果，始于嬰兒時期孩子與照護者之間的互動。他提示說，哀痛是對于分離的本能的普遍反應(yīng)。1StagesandphasesBothBowlby(19612)andParkes(19723)suggestthatgriefisapredictableorderlypatternofresponsestoadeath.Parkessuggeststhatgrievingisaprocess,asequenceofreactionstothedeathofasignificantlovedone.Theinitialshock,resultinginnumbness,canlastfordays,especiallywhenadeathissuddenleadingontointensegrief.Physicalsymptomssuchastightnessinthechest,shortnessofbreath,lossofappetiteandinsomniaarecommon.Lackofconcentrationandrestlessnessmayalsobeexperienced,aswellasfeelingsofisolationandloneliness.Stagesandphases階段和相位鮑比和帕克都認(rèn)為，哀痛是一種對于死亡的可預(yù)測的，有序的反應(yīng)模式。帕克認(rèn)為，哀痛是一個過程，是對一位所摯愛者的死亡所產(chǎn)生的反應(yīng)序列。最初的震驚，導(dǎo)致麻木，可以持續(xù)數(shù)日，特別是當(dāng)死亡非常突然，導(dǎo)致了強烈的哀痛時。身體的癥狀，諸如胸部發(fā)緊，氣短，食欲不振，失眠是常見的癥狀。注意力難以集中和躁動不安也可能被體驗到，還可能包括被隔離和孤獨感。1StagesandphasesInterspersedwiththesereactionsmaybefeelingsofanger,guiltandfear.Angermayfocusondifferentareas,dependingonaperson’scircumstances;guiltisfrequentlyassociatedwith‘ifonlyIhad...or‘ifonlyIhadn’t’.Theexpressionandacknowledgementofangerandguiltmaybringsomerelief,asmayreassurancethattheseare‘normal’reactions.Whensuchfeelingsaresuppressed,thebereavedpersonmayexhibitsignsofconstantirritationand/orphysicaltension.Fearcanmanifestitselfasinsecurity,adesiretoescapefromreality,andanxietyoverapparenttrivialities,leadingsometimestopanicattacksinwhichtheanxietyandfearareoverwhelminganddisruptnormalliving.Stagesandphases階段和相位與這些反應(yīng)間或同時出現(xiàn)的可以有憤怒，負(fù)罪和恐懼。憤怒也許注目于不同的領(lǐng)域，取決于該人所處的環(huán)境；負(fù)罪感頻繁地與“如果我當(dāng)時那樣…”或“如果我當(dāng)時沒有那樣…”聯(lián)系在一起。對于憤怒和負(fù)罪感的表達(dá)和承認(rèn)也許會帶來一些解脫，如同“這是正常反應(yīng)”的寬慰所帶來的效應(yīng)。當(dāng)這樣的情感被壓抑時，未亡人可能會展現(xiàn)出持續(xù)的煩躁和/或身體的緊張?？謶挚梢员憩F(xiàn)為不安全感，想從現(xiàn)實生活逃避的愿望，以及明顯微不足道小事的焦慮，有時候甚至導(dǎo)致驚恐發(fā)作，在這樣的發(fā)作中，焦慮和恐懼會占據(jù)壓倒性地位，以至于正常生活遭到破壞。2TasksforthebereavedWilliamJWordeninthe1980s4formulatedaslightlydifferentmodelofgrievingtothoseofBowlbyandParkes.Describinggriefasaprocessandnotastate,Wordensuggestedthatpeopleneedtoworkthroughtheirreactionsinordertomakeacompleteadjustment.InWorden’stasksofbereavement,griefisconsideredtoconsistoffouroverlappingtasks,requiringthebereavedpersontoworkthroughtheemotionalpainoftheirlosswhileatthesametimeadjustingtochangesintheircircumstances,roles,statusandidentity.Thetasksarecompletewhenthebereavedpersonhasintegratedthelossintotheirlifeandletgoofemotionalattachmentstothedeceased,allowingthemtoinvestinthepresentandthefuture.2Tasksforthebereaved未亡人的任務(wù)WilliamJWordeninthe1980s4formulatedaslightlydifferentmodelofgrievingtothoseofBowlbyandParkes.Describinggriefasaprocessandnotastate,Wordensuggestedthatpeopleneedtoworkthroughtheirreactionsinordertomakeacompleteadjustment.威廉.沃頓在80年代形成了一個與鮑比和帕克稍有些不同的哀痛模式。他將哀痛描述為一個過程，而非狀態(tài)，沃頓認(rèn)為，人們需要努力通過他們的反應(yīng)過程，以便獲得完全的適應(yīng)。TasksofGrief哀痛的任務(wù)TasksOneToAccepttheRealityoftheLoss接受喪失的現(xiàn)實TaskTwoToWorkthroughthePainofGrief

努力克服哀傷的痛苦TaskThreeToAdjusttoanEnvironmentinWhichTheDeceasedisMissing

適應(yīng)逝者已經(jīng)不復(fù)存在的環(huán)境。TaskFourToEmotionallyRelocatetheDeceasedandMoveOnwithLife將對于逝者的情感重新定位，繼續(xù)在生活中前進。3DualprocessmodelAmorerecentandsignificantadvanceinourunderstandingofgriefworkisthedualprocessmodeldevelopedbyStroebeandSchut(19955,19996).Theysuggestedthatavoidinggriefmaybebothhelpfulanddetrimental(harmful),dependingonthecircumstances.Whilepreviousmodelscentredonloss,thedualprocessmodelrecognisesthatbothexpressingandcontrollingfeelingsareimportant–anditintroducesanewconcept,thatofOscillation(predictablevariation)betweencopingbehaviours.3Dualprocessmodel雙重過程模式AmorerecentandsignificantadvanceinourunderstandingofgriefworkisthedualprocessmodeldevelopedbyStroebeandSchut(19955,19996).Theysuggestedthatavoidinggriefmaybebothhelpfulanddetrimental(harmful),dependingonthecircumstances.Whilepreviousmodelscentredonloss,thedualprocessmodelrecognisesthatbothexpressingandcontrollingfeelingsareimportant–anditintroducesanewconcept,thatofOscillation(predictablevariation)betweencopingbehaviours.對于理解哀痛工作更為晚近和明顯的進步是St和Sc所開發(fā)的雙重過程模式。他們認(rèn)為，回避哀痛可以是有利的，也可以是有害的，取決于不同的條件。前人的模式聚焦于喪失，雙重過程模式則意識到，表達(dá)和控制情感都是重要的，它引入了一個新的概念，即在兩種應(yīng)對行為之間的“擺動”（可預(yù)測的變化）。3DualprocessmodelGriefisviewedasadynamicprocessinwhichthereisanalternationbetweenfocusingonthelossofthepersonwhohasdied(lossorientation)andavoidingthatfocus(restorationorientation).Thelossorientationencompassesgriefwork,whiletherestorationorientationinvolvesdealingwithsecondarylossesasaresultofthedeath.Forinstance,anolderwidowmayhavetodealwithfinances,andhousemaintenance,whichpreviouslyherhusbanddealtwith.3Dualprocessmodel哀痛被視為一種動力學(xué)的過程，在其中存在兩種可能的選擇，或者應(yīng)對逝者的喪失（喪失取向）或者是回避這樣的聚焦點（恢復(fù)取向）。喪失取向包含了克服哀痛的努力。而恢復(fù)取向則注目于處理由于死者的逝去而造成的次生的喪失。例如，一位年長的寡婦也許必須應(yīng)對各種賬目，房子的維持，而這些都原來是由她丈夫來處理的。3DualprocessmodelBoththelossorientationandtherestorationorientationarenecessaryforfutureadjustment,butthedegreeandemphasisoneachapproachwilldependonthecircumstancesofthedeath,personality,genderandculturalbackgroundofeachperson.Themodelalsopositsthatbytakingtimeofffromthepainofgrief,whichcanbeoverwhelming,abereavedpersonmaybemoreabletocopewiththeirdailylifeandthesecondarychangestoit.3Dualprocessmodel喪失取向和恢復(fù)取向?qū)τ谖磥淼倪m應(yīng)而言都是必要的，但是每一種取向的程度和對它們的強調(diào)將取決于死亡的情況，以及每一個人的人格，性別和文化背景。這個模式也認(rèn)為，通過將花在哀痛上的時間（這樣的取向是可以將人壓垮的）引向別處，未亡人可以更有能力去應(yīng)對他們的日常生活和死亡所派生的改變。4ContinuingbondsAfurtherimportantdevelopmentingrieftheoryhasbeenprovidedbytheworkofKlassetal(19967),whochallengedconventionalthinkingthatthepurposeofgrievingwasthereconstitutionofanautonomousindividualwhocouldleavethedeceasedbehindandformnewattachments,inotherwords,’breakthebonds’withthedeceased.Klassandhiscolleaguessuggestthatthepurposeofgrievingisinsteadtomaintainacontinuingbondwiththedeceased,compatiblewithother,newandcontinuingrelationships.4Continuingbonds持續(xù)的紐帶哀痛理論的進一步的重要發(fā)展是通過Klass等人的工作形成的。他挑戰(zhàn)了傳統(tǒng)的思維，這種思維認(rèn)為哀痛的目的是要重構(gòu)一個獨立的個體，以便能夠脫離逝者，并形成新的依戀，換句話說，即“掙斷與逝者的紐帶?！盞lass和他的同事們認(rèn)為，哀痛的目的其實是為了維持一條與逝者之間的不間斷的紐帶，它與其他的，新的并且持續(xù)的關(guān)系是相容的。5FamiliesmakingsenseofdeathMostmodelsofgriefdealwiththegriefofindividuals.Frequently,however,deathaffectsawholefamily,inwhichfamilymembers,includingchildren,caninfluenceandbeinfluencedbyothers,andinwhichthedeathmaymeandifferentthingstoeach.Inmanycases,thefamilyisveryoftentheprimeproviderofsocialisation,socialcontrolandsupport.Certainfactorseitherinhibitorenhanceafamily’sgrief.Familiesinwhichtherearefragilerelationships,secretsanddivergentbeliefsmayhavemoredifficultyinadjusting;whereasfamilieswhohavefrequentcontact,ritualsandawillingnessforeachmembertosharetheirfeelings,mayfinditeasier.5Familiesmakingsenseofdeath影響哀痛的家庭因素大部分哀痛模式討論的都是哀痛的個體。然而，死亡往往影響整個家庭，包括孩子在內(nèi)的家庭成員可以影響別人或被別人影響，而且死亡對他們而言也許具有不同的意義。在許多情況下，家庭往往是社會化，社會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。存在有脆弱的關(guān)系，私人隱秘和不同信念的家庭在適應(yīng)時會有更多困難，而那些各個成員間都具有頻繁接觸，并具有分享情感的慣例和意愿的家庭，就比較容易克服哀痛。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?理解哀痛與悼念的區(qū)別哀痛是當(dāng)親愛者離世后我們所體驗到的內(nèi)心思想情感的糾結(jié)。悼念是哀痛的外在的表達(dá)。悼念對于心靈創(chuàng)傷的愈合是必不可少的。我往往將孩子稱為“被遺忘的悼念者，”為什么？因為盡管當(dāng)親愛者離世時，所有的孩子都會哀痛，我們并不總是鼓勵他們悼念。通過鼓勵哀痛的孩子悼念，你可以幫助這些你所愛的孩子。你可以成為孩子感到可以與之表達(dá)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.注意孩子表達(dá)哀痛往往更多地通過行為，而不是言語哀痛的孩子往往不說話，不談?wù)撍麄兊那楦小Ｋ麄兊那楦袝ㄟ^行為宣泄。例如，孩子也許表現(xiàn)出凄凄慘慘，無精打采，但是也許沒有相應(yīng)的言語來具體地表達(dá)其情感或其中的特殊的緣由。讓我們觀察一下孩子表達(dá)哀痛的行為。正感到困惑的孩子也許很容易難過。對死亡感到很氣憤的孩子也許會胡鬧，或挑釁其他孩子。孩子也會通過游玩來表達(dá)哀痛。注意觀察他們表達(dá)情感的種種方式，他們或以偽裝的方式，或通過與孩子的關(guān)系，肢體的運動，所創(chuàng)造的藝術(shù)品等方式，來表達(dá)他們的情感。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(紀(jì)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