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，并解釋了它們如何能有助于支持未亡人的工作者。IntroductionAlthoughSigmundFreudpioneeredthestudyofmourning,itisonlyinthelast30yearsorsothatbereavementresearchhasrealprominence.Researchershavenowgivenusseveralnewmodelsandinsightstoguideandhelpthebereaved.Butwhydoweneedmodels?Afterall,peoplehavebeenbereavedsincehumanlifebeganandhavegenerallyrecoveredwithoutthehelpofanymodelofgrieving.導言盡管弗洛伊德早已經是悼念研究的先驅者，但是直到最近30年左右，喪親的研究才有了真正的進展。研究者現在已經給了我們幾種新的模式和洞察，去引導和幫助未亡人。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過來了。IntroductionWenowrecognizethatgriefreactionscanhavephysical,emotional,cognitive,behavioral,sexualandspiritualcomponents,varyinginlengthanddisruptiveness.Adequateandappropriatesupportmayalleviatetheprobabilityoffutureill-healthandcomplications.Thisisnottosaythatallbereavedpeoplewillneedhelp,northatgriefshouldbepathologised.However,whenprofessionalsareinvolvedinsupportingthebereaved,theyneedaknowledgebasefromwhichtopracticeandscientificknowledgeprovidesaparticularlysolidbase.Personalexperienceandintuitionareimportantbuttheyhavetwomajorlimitationsasabasisofunderstanding:first,apractitioner’sexperiencemaybetoorestrictedtomakevalidgeneralisationsaboutnewsituations,andsecond,personalexperiencesmaybecolouredbysubjectivevaluesandprejudices.導言我們現在認識到，哀痛反應可以有身體的，情感和情緒的，認知的，行為的，性生活的，以及精神的要素，其延續的時間長度和破壞性都各不相同。充分和適當的支持可以降低未來健康損害和并發癥的可能性。這并等于說，所有的未亡人都需要幫助，也并非說，哀痛應該并視為病態。然而，當專業人員涉入對未亡人的支持時，他們需要在一定知識的基礎上開展實踐，而科學的知識則能夠提供具體的堅實的基礎。個人的經驗和直覺是重要的，但是作為理解的基礎它們具有2個重大的局限：第一，某個工作者的經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.導言我選出了5種哀痛模式，它們也許可以在我們為未亡人服務時，提高我們對于所發生事件的敏感性。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。對于人類常見的發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系，它們是一種長期互動的結果，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。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為，哀痛是一種對于死亡的可預測的，有序的反應模式。帕克認為，哀痛是一個過程，是對一位所摯愛者的死亡所產生的反應序列。最初的震驚，導致麻木，可以持續數日，特別是當死亡非常突然，導致了強烈的哀痛時。身體的癥狀，諸如胸部發緊，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間或同時出現的可以有憤怒，負罪和恐懼。憤怒也許注目于不同的領域，取決于該人所處的環境；負罪感頻繁地與“如果我當時那樣…”或“如果我當時沒有那樣…”聯系在一起。對于憤怒和負罪感的表達和承認也許會帶來一些解脫，如同“這是正常反應”的寬慰所帶來的效應。當這樣的情感被壓抑時，未亡人可能會展現出持續的煩躁和/或身體的緊張。恐懼可以表現為不安全感，想從現實生活逃避的愿望，以及明顯微不足道小事的焦慮，有時候甚至導致驚恐發作，在這樣的發作中，焦慮和恐懼會占據壓倒性地位，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，沃頓認為，人們需要努力通過他們的反應過程，以便獲得完全的適應。TasksofGrief哀痛的任務TasksOneToAccepttheRealityoftheLoss接受喪失的現實TaskTwoToWorkthroughthePainofGrief

努力克服哀傷的痛苦TaskThreeToAdjusttoanEnvironmentinWhichTheDeceasedisMissing

適應逝者已經不復存在的環境。TaskFourToEmotionallyRelocatetheDeceasedandMoveOnwithLife將對于逝者的情感重新定位，繼續在生活中前進。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所開發的雙重過程模式。他們認為，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，即在兩種應對行為之間的“擺動”（可預測的變化）。3DualprocessmodelGriefisviewedasadynamicprocessinwhichthereisanalternationbetweenfocusingonthelossofthepersonwhohasdied(lossorientation)andavoidingthatfocus(restorationorientation).Thelossorientationencompassesgriefwork,whiletherestorationorientationinvolvesdealingwithsecondarylossesasaresultofthedeath.Forinstance,anolderwidowmayhavetodealwithfinances,andhousemaintenance,whichpreviouslyherhusbanddealtwith.3Dualprocessmodel哀痛被視為一種動力學的過程，在其中存在兩種可能的選擇，或者應對逝者的喪失（喪失取向）或者是回避這樣的聚焦點（恢復取向）。喪失取向包含了克服哀痛的努力。而恢復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喪失取向和恢復取向對于未來的適應而言都是必要的，但是每一種取向的程度和對它們的強調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持續的紐帶哀痛理論的進一步的重要發展是通過Klass等人的工作形成的。他挑戰了傳統的思維，這種思維認為哀痛的目的是要重構一個獨立的個體，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。”Klass和他的同事們認為，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，新的并且持續的關系是相容的。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。存在有脆弱的關系，私人隱秘和不同信念的家庭在適應時會有更多困難，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別哀痛是當親愛者離世后我們所體驗到的內心思想情感的糾結。悼念是哀痛的外在的表達。悼念對于心靈創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，不談論他們的情感。他們的情感會通過行為宣泄。例如，孩子也許表現出凄凄慘慘，無精打采，但是也許沒有相應的言語來具體地表達其情感或其中的特殊的緣由。讓我們觀察一下孩子表達哀痛的行為。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哀痛。注意觀察他們表達情感的種種方式，他們或以偽裝的方式，或通過與孩子的關系，肢體的運動，所創造的藝術品等方式，來表達他們的情感。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