At the AOCC All Ohio Counselors Conference held November 6th to 8th in Columbus, Annette Sauselen, PCC Ohio University, gave a presentation on assisting survivors in creating meaning out of traumatic loss. Traumatic loss is defined as persons who have lost someone close to them through unexpected, untimely or sudden death. Sauselen explained that persons experience loss through trauma very differently than through natural causes. Most of the literature on grief is focused on non-traumatic loss. Typical interventions in grief counseling are more applicable for death/separation in a traditional manner.
An individual experiencing such loss usually experiences discomfort and often avoidance. Surviving family members don’t ask and don’t tell- especially if the cause of death involved homicide or suicide which carry negative stereotypes. Sauselen said the survivor may often replay repulsive gory details of the departed’s last moments over and over in their mind in the case of traumatic death (experiencing PTSD symptoms).
A literature review shows survivors often experience denial, shock, guilt, blame, anxiety, symptoms of depression, PTSD, shame, social isolation, physical symptoms and related health issues. Their religious/spiritual beliefs are tested and they may engage in a more intense search for meaning. The public is increasingly seeking more help from counselors than clergy for this level of traumatic loss. Complicating the issue, legal and medical experts may be involved for extended periods of time.
She said that as the survivors return to activities of daily living they attempt to generate meaning out of the loss. However, cognitive tasks may become more complicated and survivors may lose focus. They may experience irritability, unpredictable crying spells, decreased energy, or reduced tolerance for a typical day/typical schedule.
Sauselen has used reflective writing in a form of constructivist and narrative therapy to assist survivors to gain increased perspective, generate new options and alternative ways of being, creating meaning, re-authoring stories as experts in their own life and experiences. She has the survivor/s relate the story of the death, their own story, and the story of the one who died. Research by Neimeyer et al 2010, Wagner et al 2005 show that this approach reduces PTSD symptoms. However, done too early in the grief process, the exercise may be harmful (Wagner et al 2005). The experts recommend this approach at approximately mid-stage grief of 3-24 months for the exercise.
Sauselen shared three exercise prompts. The first goes something like this: ‘What I want you to know about how my loved one died is’ . . . and ‘what I need from you as my witness is’ . . . Group participants take about 20-30 minutes to do the reflective writing before sharing out loud and processing the experience among supportive peers. (There is a confidentiality pledge among group members). The second prompt, ‘As I reflect on my relationship with the person I lost I have come to realize their impact on my life. Today I will reflect on my relationship with (departed)’. This is often helpful in family therapy, as each member realizes how others close to them processed the loss. (example: ‘Oh, I didn’t realize that Dad xyz . . . ‘)
Another variation might address the departed directly. ‘I’m grieving that I can’t share these experiences with you,’ (and name the experiences). This exercise is also important if the relationship wasn’t particularly close in naming what wasn’t, couldn’t be, or never happened. The final prompt is to move survivors beyond today’s state of mind and help them to get ‘un-stuck’. It goes something like this: ‘If you desire things to be different in your life, how would it be for you if you continue the rest of your life the way you are now?’ Sauselen prefers that the exercise be done in-person on-site rather than as homework, where they might censor what they say/feel rather than sharing it with the support structure in the here and now.
An ending prompt might include, ‘Being in counseling, I have been given an opportunity to find meaning in my loss and what I’ve found on my journey is” . . . . These exercises work best with individual pre-screened group of 7-8 people, though 6-8 is ideal over a 90-minute time frame. Matt, who was angry following the loss of siblings in a car accident, found that talking with his departed brothers while fishing or camping was therapeutic. (Rather than writing) There is something about gazing into a campfire, up at the starry expanse, or casting a fishing line into a clear lake and telling them his thoughts, which he felt ‘connected them’ on a much deeper level and made their presence feel very close and immediate. It was as if they could hear and give him a loving nudge, and there was that shooting star. He will never understand the why, but now he is in a better place to feel his sense of purpose in carrying their memory forward.
[photo credit: Dmcale/Dreamstime 8345708 Depressed teen girl with best friend]