Grief counseling

Grief counseling supports people in coping with the experiences they have suffered or are expected to experience. Grief counseling supports people in their process of grief through existence, silence, listening as well as various offers and methods. Grief counseling should not be confused with medical therapy for an illness, but can be provided by anyone who is willing to face this situation and to endure it with the person who grieves.

history

The grief counseling has its historical roots in the Church's pastoral care and has remained a focus in the parochial activities. In the modern age , living out grief was increasingly suppressed by taboos in the areas of illness and death . In particular, the impulses from Elisabeth Kübler-Ross led to a rethink and the emergence of the hospice movement . The movement around Johann-Christoph Student also endeavored to bring dying and mourning back into society. The accompaniment of relatives and friends of the dying and deceased has increasingly become a social consciousness and is also part of palliative medicine concepts.

Overall, this development has led to the emergence of diverse forms of grief counseling since the 1980s: accompanied mourning groups as well as unaccompanied self-help groups ; Mourning cafés were set up and mourning journeys developed. Independent agencies and individuals offered grief counseling; Undertakers also added this offer to their portfolio.

In the course of this development it became increasingly clear that responsible support for people who find themselves in such a crisis situation does not necessarily require professional training, but does require appropriate training. Courses on grief counseling were set up by both church and private organizations.

The fact that a number of offers are by no means free of charge has also led to the increasing discussion of quality standards and quality assurance in grief counseling. In 2007, the then federal working group for grief counseling formulated common professional standards for qualifications in grief counseling. These standards are increasingly being adopted by people and institutions who also offer further training in bereavement support, but do not belong to the Federal Association of Bereavement Support.

Models of grief counseling

The explicatory (explanatory) models focus on the interpretation of the loss experience. The descriptive (descriptive) models describe the grief reactions. These include symptomatologies, course, phase and task models.

EXPLICATORY MODEL E.
Loss as object loss: Interpersonal dynamics of grief work	Psychoanalysis: Sigmund Freud 1856-1939	Intervention focus: Realizing the loss and the feelings associated with it
Depressive Position Theorem	Melanie Klein 1882-1960
psychodynamic coping mechanisms	Yorick Spiegel 1935-2010
Loss as loss of attachment: Attachment theory	Behavioral Research: Edward John Mostyn Bowlby 1907-1990	Intervention focus: Accompany search behavior and attachment efforts as a learning process
Continuation of a modified bond	Collin Parkes 1928
Detachment and lasting relationship	Dennis Class
Loss of reinforcement: Died pats	Behaviorism: RW Ramsay	Intervention focus: Restructuring through reinforcement of adaptive behavior
Control through social reinforcement	J. Gauthier et al.
Loss as a loss of genetic chance of survival	Sociobiologism: Christine H. Littlefield J. Philippe Rushton
Loss of sense and meaning structures In situations of upheaval	Cognitive psychology Peter Rammis	Intervention focus: Continuity of care, reconstruction of meaningful life history
Loss as a trigger for multiple losses Coping Grief as stressful situations	Cognitive stress theory Richard S. Lazarus	Intervention focus: Help identify personal and social resources to cover deficits that have arisen
	Mardi J. Horowitz
	Margret u. Wolfgang Stroebe
DESCRIPTIVE MODELS
Symptomatologies Pathological grief	Erich Lindemann Collin Parkes Ralf Jernetzig u. Arnold Langenmayr Beverly Raphael et al. Warwick Middleton	Intervention focus: Conveying grief knowledge Client-centered advice
Phase and course models	Bowlby Elisabeth Kübler-Ross Yorick Spiegel Verena Kast	Intervention focus: phase-specific support
Task models Styles of grief	Yorick Spiegel William W. Worden Michael Schibilsky	Intervention focus: Task-related support

Situation of the mourners

The grief counseling is an attempt to meet the human need for comfort and support in a more targeted manner. In addition, mourners who have lost a loved one through a sudden or violent death often need intensive support, which the social environment cannot or insufficiently provide. Here, grief counseling acts as a crisis intervention , especially in the early stages , but also provides long-term support, which is often not possible in a family environment.

Differentiation between grief and trauma reaction

The distinction between grief and trauma is important for the accompaniment in grief. Even if grief counselors do not make a diagnosis, they must be able to recognize the signs of a trauma reaction. Mourning and trauma often go together. “Because trauma means that an event in which too much, too quickly and too suddenly happened for the person concerned” (cf. Chris Paul ). The trauma reaction is the developed strategy to live with it and make survival possible. If a person is overwhelmed with a trauma reaction, this person does not need grief counseling, but trauma therapy .

Complicated grief can mean a longer and more intense path through grief and can be caused by:

• unclear loss situations (disappeared, missing, missing persons)
• Taboo losses (suicide, abortion, ...)
• Death against time (children, grandchildren, ...)
• socially negated love relationships (triangular relationships, priest children, priest women, homosexual relationships, ...)
• previous particularly stressful relationship constellations
• several existential loss experiences
• dramatic circumstances of death (plane crash, rampage, mass panic, ...)
• Self-inflicted cause of death (drunk drivers, speeders, ...)
• Responsibility attributed to oneself to provide assistance in the event of incapacity to act (e.g. grandparents or parents of deceased (grand) children)
• Inadequate processing options (necessary survival management, limited cognitive skills)
• Cross-generational "long-term effects" with proxy grief (war, family secrets, ...)
• Missing networks (especially for people who are affected by social isolation)
• Unhelpful forms of communication, lack of emotional exchange and avoidance of dealing with the experience.

Grief reaction (also complicated)	Trauma response
Timeline is clear. In the course of the narrative, the narratives change over time and can	Timeline not clear Those affected cannot tell in chronological order, fall back into the situation and feel just as threatened as they did then.
Thoughts and memories can be influenced and stopped in an emergency. Breaks and distractions can be taken. The wave of mourning is perceived ("It goes up and down" an almost uniform explanation of grieving people.)	Thoughts cannot be controlled, flashbacks (horror film-like detailed scenarios in which the person concerned cannot recognize that this is a memory and not a reliving). “Triggered by stimuli, an involuntary 'journey through time' takes place, the past becomes the constant revived present: Everything is really dangerous here and now. It re-traumatizes people every time. ” 1
Feelings are different and constantly changing	Insomnia, sweating, blushing, accelerating the heart rate, physical restlessness, fear, disorientation, withdrawal behavior, depression,
Talking about the terrible experience at that time changes and through the multiple narration the content of what is said is integrated into the personal understanding of the world and self in an increasingly psychologically compatible dose.	Compulsion to speak (speaking quickly and abruptly), words are missing, memories are real and dangerous

Mourning process and bereavement support

Since Sigmund Freud's classic monograph on "Grief and Melancholy" from 1917, psychological science and practice have shared the basic assumption that mourners must be confronted with their feelings in order to process their loss. If they avoid this confrontation, they run the risk of maladjustment, which can result in neuroses and depression due to the unprocessed grief . So the mourners have to do “ mourning work ”. Grief work is the process of emotional and cognitive confrontation with the reality of loss: the widowed repeatedly deal with events before and during death and with their memories of the deceased. The function of the grief work should be to redefine the emotional ties to the deceased and to integrate them into his life as a component that has, however, passed away. The term or concept of "grief work" has not been scientifically studied. Although theorists have recently developed a more differentiated picture of the cognitive processes of grief processing, most therapy programs still assign grief work a central role and see pathological grief as the result of inadequately performed " grief work ".

Revealing your own feelings about the loss to friends, family, fellow sufferers or professional helpers is not a necessary prerequisite for grief work, as you can deal with your feelings on your own. However, there is a close relationship between the two processes: some people only manage to come to terms with their grief through conversation. By talking to others, the situation clears up for them and so they process their grief. It is a function of grief counseling and grief therapy to face up to the confrontation with the loss and to empathize with the bereaved in their grief work. The aim is not to free them from the grief, but to support them in accepting and integrating the loss they have experienced and the associated grief as part of their lives in order to be able to live strengthened and life-affirming after the grief process has been completed . Losses can only be accepted if they have been processed mentally and spiritually.

One of the most extensive studies on this topic is the Tübingen longitudinal study of widowhood . In this study, a group of widowed men and women were questioned several times over a period of two years after their loss and compared with married people who were comparable in terms of age , gender , number of children and socio-economic status . As a result of this study, it can be summarized that grief counseling or grief therapy only helps those who grieve who are unable to come to terms with their grief because they lack someone to talk to. As a result, in the practice of bereavement counseling, help is limited to those people who benefit most from it.

Child bereavement support

In child grief counseling, children and parents are accompanied in their grief process. In children's grief groups, the children are taught through conversation and creative activity that their grief is not an illness, but a natural reaction to the loss of a loved one. You will be encouraged to express your feelings and learn to accept them. Symbols and symbolic language play a special role in grief work with children. The Federal Association for Grief Counseling is currently developing its own standards for advanced training in child grief counseling.

See also

Hospice , hospice , Orphaned parents , dignity therapy

literature

• Peter Godzik (Ed.): Be close in difficult times. Handout for preparing volunteers in grief counseling. Management manual , Rosengarten b. Hamburg: Steinmann 2011, ISBN 978-3-927043-49-7 .
  • Participant's Guide Basic Course: Confronting Your Own Grief. A life and learning book , Rosengarten b. Hamburg: Steinmann 2011, ISBN 978-3-927043-45-9 .
  • Participant manual advanced course: Being close to those who mourn. A way of learning and life , Rosengarten b. Hamburg: Steinmann 2011, ISBN 978-3-927043-46-6 . In it at a glance: Researched phases in the processing of crises, dying, grief (p. 42); Modern alternatives: cycles, spiral paths and tides (p. 43)
• Ralf Jerneizig, Arnold Langenmayr , Ulrich Schubert: Guide to grief therapy and grief counseling. Göttingen 1991, ISBN 3-525-45737-5 .
• Ida Lamp, Sabine Smith: Grief and Counseling. in: Frank Nestmann, Frank Engel, Ursel Sickendiek (ed.): The handbook of advice. Volume 2: Approaches and Methods. 2nd edition 2007, ISBN 978-3-87159-049-8 .
• Arnold Langenmayr: Grief counseling. Advice - therapy - advanced training. Vandenhoeck & Ruprecht GmbH & Co. KG, Göttingen 1999, ISBN 3-525-45851-7 .
• Monika Müller (Hrsg.), Lukas Radbruch (Hrsg.), Sylvia Brathuhn (Hrsg.): Leidfaden - specialist magazine for crises, suffering, grief. Vandenhoeck & Ruprecht , Göttingen, from issue 0/2011, ISSN  2192-1202 .
• Monika Müller , David Pfister, Sigrun Müller: Does grief counseling work at all, and if so, in what way? In: Zeitschrift für Palliativmedizin , Volume 12, Issue 5, September 2011, pp. 210–215.
• Monika Müller, Sylvia Brathuhn , Matthias Schnegg , Handbook of Grief Encounters and Accompaniment. Theory and practice in hospice work and palliative care. Göttingen 2013, ISBN 978-3-525-45188-5 .
• Chris Paul, Monika Müller: Organizational framework for grief counseling. In: Eberhard Aulbert, Friedemann Nauck, Lukas Radbruch (eds.): Textbook of palliative medicine. Schattauer, Stuttgart (1997) 3rd, updated edition 2012, ISBN 978-3-7945-2666-6 , pp. 1189–1194.
• Petra Rechenberg-Winter, Esther Fischinger: Course book systemic grief counseling. Göttingen 2008, ISBN 978-3-525-49133-1 .
• Mechthild Schroeter-Rupieper : Practice book mourning groups. Patmos Verlag 2015, ISBN 978-3-8436-0674-5 .
• Ruthmarijke Smeding, Eberhard Aulbert: Grief and grief counseling. In: Eberhard Aulbert, Friedemann Nauck, Lukas Radbruch (eds.): Textbook of palliative medicine. Schattauer, Stuttgart (1997) 3rd, updated edition 2012, ISBN 978-3-7945-2666-6 , pp. 1173–1188.
• Johann Christoph Student (Ed.): Die, Tod und Mrauer - Handbook for companions. 2nd edition, Herder, Freiburg 2004 ISBN 978-3-451-28343-7 .
• Stephanie Witt-Loers : Young people grieving at school. Vandenhoeck & Ruprecht GmbH & Co. KG, Göttingen 2012, ISBN 978-3-525-77008-5 .

Web links

• Bundesverband Griefegleitung eV BVT
• Peter Godzik : Website grief counseling (online at pkgodzik.de)

Individual evidence

1. ↑ Grief counseling People accompanying grief workers need competencies Offer of the Bundesverband Griefegleitung eV (BVT). (PDF) In: https://bv-trauerbegleitung.de/ . Retrieved February 23, 2018 . 
2. ^ Christoph Morgenthaler: Pastoral care. Gütersloh, 2nd edition 2012
3. ↑ cf. z. B. TrauerInstitut Deutschland eV (Ed.), Quality in bereavement support. Documentation of the 2nd NRW Mourning Conference, Wuppertal 2003, ISBN 3-9808351-1-1
4. ↑ since 2010 Bundesverband Trauerbegleitung eV
5. ^ Press report on the founding of the Federal Association for Trauerbegleitung eV
6. ↑ http://www.bv-trauerbegleitung.de/http://www.bv-trauerbegleitung.de/Qualitaetsstandards  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.  
7. ^ Rechenberg-Winter Petra and Fischinger Esther: Course book systemic grief counseling . Vandenhoeck & Ruprecht, Göttingen 2010, p. 36 .
8. ↑ Petra Rechenberg-Winter, Esther Fischinger: Course book systemic grief counseling . 2nd Edition. Vandenhoeck & Ruprecht, Göttingen, ISBN 978-3-525-49133-1 .
9. ^ Sigmund Freud : Trauer und Melancholie, 1917, study edition, Vol. III. Year of publication 1915.
10. ↑ Saegner, Uwe: Papa, where are you? A children's book on death and grief for children. The Hospiz Verlag, Wuppertal 2005. ISBN 3-9810020-4-0 .