How adult children of incarcerated parents experience ambiguous loss.

Families can experience grief when they lose a loved one to incarceration. Although there has not been a death, the removal of a family member from day-to-day life and the uncertainty and stigma surrounding incarceration pose major challenges. We applied consensual qualitative research methods to understand the unique grief experience that adult children have when a parent is incarcerated. Our findings elaborate on the impacts of the loss, the complicating factors of stigma and disenfranchisement, as well as how individuals have made meaning and pursued healing from this experience over time. Impacts included changes to member roles within the new family structure and difficulty forming secure bonds with peers. Participants characterized stigma toward their parent as extending to themselves and complicating their ability to openly miss their parent or process complicated reactions to the incarceration. Despite systemic challenges, participants set their personal life goals and used a combination of problem-focused coping and distancing themselves from the incarceration to successfully manage the loss. Consistent with these findings, mental health professionals serving this population can validate incarceration as a loss, repair ambiguity in family roles, develop an accepting therapeutic relationship that reduces perceived stigma, and identify possibilities for activism.

The Stubborn Persistence of Grief Stage Theory.

Bereavement professionals who keep up with current research have wisely discarded the "five stages of grief" theory in favor of more contemporary, more functional models, including continuing bonds, tasks of grieving, meaning-reconstruction, the six Rs of mourning, and the dual-process model. But the stage theory has stubbornly persisted, despite a steady stream of criticism in academia and countless commentaries on the dangers of using it in bereavement counseling. Public support and pockets of professional endorsement for the stages continues to exist, undeterred by the knowledge that there is very little, if any, evidence to support its usefulness. Because there is a tendency for the general public to embrace ideas popularized in mainstream media, the stage theory clings tenaciously to public acceptance.

The Stubborn Persistence of Grief Stage Theory.

Bereavement professionals who keep up with current research have wisely discarded the "five stages of grief" theory in favor of more contemporary, more functional models, including continuing bonds , tasks of grieving. meaning-reconstruction , the six Rs of mourning ,and Stroebe & Schut's dual-process model. But the stage theory has stubbornly persisted, despite a steady stream of criticism in academia and countless commentaries on the dangers of using it in bereavement counseling . Public support and pockets of professional endorsement for the stages continues to exist, undeterred by the knowledge that there is very little, if any, evidence to support its usefulness. Because there is a tendency for the general public to embrace ideas popularized in mainstream media, the stage theory clings tenaciously to public acceptance.

The Function of Connection: Examining Social Supports in the Lives of Parentally Bereaved Youth.

Through reflexive thematic analysis, this study explored three forms of social support in the lives of parentally bereaved youth: support derived from one's spirituality, caregiver support via parent-child communication, and therapist support from grief counseling (N = 30 youth, Mage = 12.5 years, SD = 2.8 years). Results showed that these sources of support serve varied and vital functions in the lives of parentally bereaved youth. Namely, the benefits of grief counseling and spirituality were consistently identified by youth as critical in facilitating their coping with the loss of a parent; while parent-child communication regarding the deceased varied widely, highlighting the need for additional supports beyond their surviving caregiver. Findings also revealed differences among these supports across youth gender, race, ethnicity, and age. Adolescents were more likely to disengage from counseling services and reported less parental and spiritual support. Males and minoritized youth experienced more benefits from spiritual and therapist supports.

Status of grief counseling for medical workers from coronavirus disease 2019 designated hospitals in Wuhan. / 武汉市2019å† çŠ¶ç— æ¯’ç— å®šç‚¹åŒ»é™¢åŒ»æŠ¤äººå‘˜å“€ä¼¤è¾ å¯¼çŽ°çŠ¶.

OBJECTIVES: To investigate the attitudes and skills of grief counseling in the front-line medical workers from coronavirus disease 2019 (COVID-19) designated hospitals in Wuhan for the bereaved family members and to provide the basis for proper hospital management strategies. METHODS: The convenience sampling method was applied to select 422 medical workers who kept touch with the bereaved family members in five COVID-19 designated hospitals in Wuhan from January to February 2020. Questionnaire regarding grief counseling attitudes and questionnaire regarding grief counseling skills were used to evaluate the attitudes and skills of grief counseling in medical workers. The scores of grief counseling attitudes and skills in group of different characteristics were further compared. Pearson correlation was used to analyze the attitudes and skills of grief counseling in medical workers. RESULTS: The scores of grief counseling attitudes in medical workers were 15-46 (33.00±9.31). Length of service, professional title, whether or not receiving relevant training, frequency of contact with bereaved family members contributed to impacting the medical workers' attitudes of grief counseling (all P<0.05). The scores of grief counseling skills in medical workers were 9-30 (19.30±4.42). Length of service, professional title, religion, whether or not receiving relevant training, frequency of contact with bereaved family members contributed to impacting the medical workers' skills of grief counseling (all P<0.05). There was a significant positive correlation between the attitudes and skills of grief counseling in the medical workers (r=0.608, P<0.01). CONCLUSIONS: The attitudes and skills of grief counseling in the medical workers from COVID-19 designated hospitals in Wuhan still need to be improved. Grief counseling group and a long-term, comprehensive training system are recommended.

[Applying the Concept of Grief Counseling in Caring for an Elderly Dialysis Patient With Bereavement Due to the Death of Spouse: A Nursing Care Experience].

This article describes a 76-year-old dialysis patient who experienced widowhood. The nursing intervention occurred between April 2nd to June 28th, 2015. Using observation, interviews, medical records and health examinations, the authors assessed the patient's physical, psychological, social, intellectual, and spiritual status. The patient not only presented poor appetite, insomnia, hopelessness, and grief but had also attempted suicide. Thus, three health problems were identified, including dysfunctional grieving, hopelessness, and sleep pattern disturbance. Employing caring, active listening, and empathy, we helped the patient achieve the four tasks of Worden's Mourning: (1) to accept the reality of loss; (2) to work through the pain of grief; (3) to adjust to an environment in which the deceased is missing; and (4) to emotionally relocate the deceased and move on with life. With comprehensive and persistent nursing intervention, the patient got the support from her family members and eventually readapted to life without the deceased and continued to take hemodialysis and found new life motivation.

Self-compassion-based online group psychotherapy for bereavement-related grief: The COMPACT feasibility trial.

OBJECTIVE: This study aimed to examine the feasibility and effectiveness of online group psychotherapy focused on self-compassion for individuals experiencing bereavement-related grief. METHOD: This single-arm feasibility trial involved participants aged 18 years or older who had experienced bereavement at least 6 months prior the five-week intervention. Outcomes were measured at baseline, immediately post-intervention, and 4 and 12 weeks later. The primary endpoint was the percentage of participants who completed four out of five sessions; the pre-defined feasibility criterion was 70%. Secondary endpoints included measures of grief, depression, anxiety, self-compassion, and resilience. RESULTS: The program was conducted in three courses with 18, 26, and 16 participants, respectively. The primary endpoint was met for 83.1% of participants (54/65). Cohen's d effect sizes ([95% CI] 12 weeks vs. baseline) for grief, depression, anxiety, self-compassion, and resilience were - 0.25 [-0.52, 0.03], -0.64 [-0.94, -0.34], -0.48 [-0.77, -0.19], 0.50 [0.21, 0.79], and - 0.07 [-0.34, 0.21], respectively. CONCLUSIONS: Online group psychotherapy focused on self-compassion for individuals with bereavement-related grief is feasible and effective for addressing grief and psychological distress. Randomized controlled trials are warranted to confirm the intervention's efficacy. TRIAL REGISTRATION NUMBER: UMIN000048554, registered 2 August 2022.

Development of a Scale of Nurses' Competency in Anticipatory Grief Counseling for Caregivers of Patients with Terminal Cancer.

Anticipatory grief leads to a highly stressful and conflicting experience among caregivers of patients with terminal cancer. Nurses lack the competency to assess and manage the caregivers' psychological problems, which in turn affects the caregivers' quality of life. A scale assessing the anticipatory grief counseling competency among nurses is unavailable. In this study, an Anticipatory Grief Counseling Competency Scale (AGCCS) was developed for nurses. The Scale (AGCCS) was translated into Chinese and then revised. Psychometric testing of the scale was conducted on 252 nurses who participated in the care of patients with terminal cancer at a regional teaching hospital in Southern Taiwan. The data were analyzed using descriptive statistics, reliability, and Pearson's correlation, and principal component analysis and analysis of variance were performed. Item- and scale-content validity indexes were 0.99 and 0.93, respectively. The Cronbach α of internal consistency was 0.981. The final 53-item AGCCS had five factors, which accounted for 70.81% of the total variance. The Pearson correlation coefficients of these factors ranged between 0.406 and 0.880 (p < 0.001). The AGCCS can be used to evaluate the aforementioned competency for improving caregivers' quality of care. It can also facilitate in-service education planning and evaluation.

'Feeling disconnected' - risk factors for PGD and themes in grief counselling during the COVID-19 pandemic. A mixed-method study.

Background: Due to its high death toll and measures to curb the pandemic, COVID-19 has affected grieving experiences and may contribute to risk factors for Prolonged Grief Disorder (PGD). Persons at risk for PGD often seek support from grief counselling.Objective: To explore whether pandemic-associated risk factors have become more important topics in counselling in a mixed-method design.Method: German grief counsellors (n = 93) rated whether pre-defined risk factors had become more important in grief counselling and indicated additional important themes in an open format.Results: The counsellors indicated that all pre-defined risk factors had become more important, though differing significantly in their frequency. Most frequently endorsed risk factors were lack of social support, limited possibilities to accompany a dying loved one and absence of traditional grief rituals. Qualitative analysis identified three additional themes: the societal impact of the pandemic, its impact on bereavement support and health care, and a chance for personal growth.Conclusions: The pandemic has affected bereavement experiences and grief counselling. Counsellors should monitor grief processes and specific risk factors to provide the best possible care for bereaved people when needed.

Pandemic-associated risk factors for PGD have become more important topics in grief counselling during COVID-19.Risk factors include especially a lack of social support, limited possibility to accompany a dying significant other and absence of traditional grief rituals.Future research is needed to investigate whether monitoring and addressing these risk factors can improve bereavement care.

Cross-Sectional Survey to Assess Health-Care Workers' Grief Counseling for Bereaved Families of COVID-19 Victims in Wuhan, China.

OBJECTIVE: This research aimed to examine health-care workers' grief counseling for bereaved families of coronavirus disease 2019 (COVID-19) victims in China. Our research may provide a new opportunity to stimulate development of grief counseling in China. METHODS: A cross-sectional survey was conducted with 724 health-care workers selected by convenience sampling from 7 hospitals in Wuhan. Data collection tools included a sociodemographic questionnaire, the skills of grief counseling scale (SGCS), and the attitudes of grief counseling scale (AGCS). RESULTS: The average SGCS score was 18.96 ± 4.66, whose influencing factors consisted of sense of responsibility, frequency of contact with bereaved families, and relevant training (P < 0.05). The average AGCS score was 33.36 ± 8.70, whose influencing factors consisted of other grief counseling skills, communication skills, education background, and relevant training (P < 0.05). CONCLUSIONS: The skills and attitudes toward grief counseling among health-care workers combating COVID-19 were at a lower level in Wuhan, China, indicating the need to build a comprehensive grief counseling system, establish a standardized training course, and strengthen the popularization of grief counseling services to the public.

Grief Reactions and Grief Counseling among Bereaved Chinese Individuals during COVID-19 Pandemic: Study Protocol for a Randomized Controlled Trial Combined with a Longitudinal Study.

COVID-19 has caused nearly 4.3 million deaths all around the world. People who have experienced loss during this special period may find it difficult to adapt to life after loss, and may even suffer from prolonged grief disorder or other mental health problems. However, there is a huge gap of grief research in China, with almost no comprehensive grief intervention training system or very few professional grief consultants. Considering the large number of bereaved individuals who are suffering from grief and other mental health problems, it is significant to develop a suitable and effective intervention protocol immediately. This article illustrates a study protocol initiated by a Chinese university to investigate the mental health of bereaved individuals during the COVID-19 pandemic and train grief counselors to provide grief counseling to the bereaved, as well as to evaluate the effectiveness of the grief counseling. The method is as follows: (1) 300 psychological counselors will be recruited to attend the grief counseling training. Assessments will be conducted at three time points: baseline (T0), after the basic training (T1), and after the advanced training (T2); (2) 500 bereaved Chinese will be recruit to join the online survey and will be assessed at two time points with a six-month interval; and (3) a two-armed (grief counseling versus wait-list controls) RCT (random control trials) will be conducted with 160 bereaved individuals. Assessments will be conducted at three time points: before randomization (baseline, T0), at the post-counseling (T1), and three months after the post-counseling (T2). Primary outcomes will be assessed by the Prolonged Grief Questionnaire (PG-13), the 20-item PTSD Checklist for DSM-5 (PCL-5), the Depression Anxiety and Stress Scale (DASS-21), and the Posttraumatic Growth Inventory (PTGI). This research will help develop grief research and grief counseling in China, as well as provide professional mental health services for individuals who may suffer from grief-related disorders in the future.

Lessons Learned: Forty Years of Clinical Work With Suicide Loss Survivors.

The author has been a grief therapist in private practice for almost 40 years. The largest percentage of his clients have been suicide loss survivors, and in this article, the author reflects on the "lessons learned" about how grief therapy with survivors is both the same as, and very different from, work with clients bereaved after other types of losses. After briefly reviewing some of the empirical literature about differences between suicide bereavement and grief after other modes of death, the author argues that perhaps the most distinguishing and difficult aspect of a suicide loss is the "perceived intentionality" of the death, and the related "perceived responsibility" for the death. The author goes on to identify a number of tasks of psychological reintegration after a suicide loss that can serve as a template for treatment goals for clinicians and clients alike. These include the cultivation of a very specific type of secure and nurturing therapeutic alliance; extensive psychoeducation about suicide, trauma, and grief; the need to help the client repair the psychological continuing bond with the deceased; and providing gentle support for the survivor in rebuilding an assumptive world that has been shattered by the suicide of a loved one. Finally, the article concludes with a discussion of the clinical implications of these differences for work with suicide loss survivors.

The Impact of Hospice Patient Disease Type and Length of Stay on Caregiver Utilization of Grief Counseling: A 10-Year Retrospective Study.

This investigation explored the relationship between hospice patient disease type, length of stay (LOS) in hospice, and caregiver utilization of grief counseling in bereavement. A 10-year retrospective study was conducted utilizing data from caregivers associated with hospice patients who died between 2004 and 2014. A threshold of inclusion for disease type (≥1.00% of hospice admissions) resulted in a sample size of 3704 patients, comprising 19 different disease types and 348 associated caregivers who received counseling. Replicating a previous study, brain cancer, lung cancer, and renal failure were among the top 4 disease types associated with higher-than-average utilization of bereavement services among caregivers, regardless of the patient's LOS. This finding may be related to factors such as the duration of the disease, the deterioration of the patient, the absence of symptom control, and secondary losses. LOS as a predictor of whether counseling will be utilized by hospice caregivers was unsupported by this study, as the percentage of caregivers receiving counseling closely paralleled the patient's LOS across 4 cohorts (1-30 days, 31-60 days, 61-90 days, and 91+ days). However, among the caregivers who utilized counseling, the LOS was a statistically significant predictor of the number of counseling sessions utilized. For caregivers who utilized only 1 counseling session, the associated patient median LOS was 21.5 days. For caregivers who utilized 5 or more counseling sessions, the associated patient median LOS dropped to 12 days, suggesting an inverted relationship between hospice patient LOS and the duration of counseling in bereavement.

Helping the angels: a review of understanding and helping dying children.

According to the World Health Organization, 53,000 children die every year in United States because of a chronic medical condition. Physicians have to face various ethical and psychological challenges while managing these conditions. These challenges range from disclosure of diagnosis to effective grief counseling to the family. In this article we have discussed some of these challenges and strategies to effectively meet these challenges.