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Featured this Month:

Managing Traumatic Bereavement
Friday, July 01, 2016 by Cynthia Waderlow MSE, LCSW
In May some of our LOSS clinicians attended a conference devoted to the impact on survivors of sudden death or traumatic bereavement. We were moved by the seriousness of the subject because it has so much relevance for families who have experienced a suicide loss. We know the importance of grief work and making sense of the suicide, but this conference emphasized that the natural traumatic response to the sudden loss of a loved one changes everything about the survivor’s brain and body for a period of time, which can actually impede the grief process. Therese Rando, a major figure in grief research , and a grief therapist herself, asserted that after a sudden death like suicide, even if the relationship with the deceased was difficult and complicated, each child, adolescent and adult survivor is ” personally traumatized by the suddenness and lack of warning that preceded the death” (Rando, In Press 2016). Intrusive images, numbing and emotional and physiological dysregulation are some of the erratic symptoms that can present when the primitive brain of the most normal of persons triggers the freeze, flight or fight response. Traumatic assault also affects the survivor’s sense of reality. What they previously understood about themselves, their relationship with the deceased and the known world is impacted, sometimes nearly stripped away. Think about the tender, developmental work that children and adolescents have achieved related to identity, the security they have formed around attachments, and a sense of how the world works. Traumatic loss will shake up these reality constructions.

Dr. Rando emphasized the importance of understanding and attending to trauma both in grief therapy sessions, as well as the parent-child relationship within surviving families. In families traumatized by sudden loss, parents and caregivers may need to deepen attunement and empathic response toward their children, and this is where skills in insight and support through counseling can be helpful. Although Rando had a hopeful perspective on healing from trauma’s impact, she asserted that sudden or violent loss should not be minimized after an essential attachment relationship has been disrupted. Additionally, there are factors which can increase the level of trauma, such as exposure to the death, especially where children are concerned. We also need to consider added disturbing layers, such as police presence, screaming, even misperceptions that children can ascribe to CPR interventions. Dr. Rando described three levels of trauma, with the second and third levels including symptoms of Post-Traumatic-Stress- Syndrome. Rando described four sets of traumatic effects after a sudden loss, all contributing to dysregulation. The trauma:

• -instantly propels your brain into “survival mode,
• -overwhelms your usual coping abilities,
• -creates significant psychological distress and dysfunction,
• violates your assumptive world” (Rando 2016, In Press).

Although we may understand that trauma has implications for grief, we also learned the inverse: that grief interferes with the needed personal mastery of trauma symptoms, and that both grief and trauma can intensify and escalate symptoms that are common to both. So now we will bring our awareness to a dual process of healing for both trauma and grief. Dr. Rando stated that with level 1 traumas, grief and trauma can be addressed together. With more intense traumas, professional intervention is recommended, and trauma should be addressed prior to the grief.

Therapists will help children, teens and parents attend to the initial traumatic experience and the feelings in small doses until the trauma “is robbed of its potency” (Rando, 2016, In Press). In addition, there will be goals for:

• -mourning the loss of the deceased loved one;
• -discouraging maladaptive behaviors that may be used to cope with the trauma while developing new skills for healthy living in the world after trauma;
• -developing mastery over a sense of powerlessness / helplessness, personal worth and value;
• -developing a perspective on what happened, why, and what one was, and was not able to do to control (Rando, 2016, In Press).

These are the essential workings that promote a sense of groundedness and continued development for survivors of all ages.

So, given that untreated trauma has implications for a person’s, health and development, how should surviving parents address the impact of trauma on their children and teens? I have summarized Dr. Rando’s directives for structuring the tasks for responsible management of trauma’s impact.

• -Educate yourself about traumatic grief, its symptoms and requirements for healing.
• -Consider evaluations for you and your child by a grief or trauma specialist.
• -Ensure that structure and consistent routines are prioritized at home. Healing is supported with at least eight hours of sleep each night. Communicate with your child what happens next as you move through your day. This will create a sense of holding and security.
• -Support your child in bringing to consciousness and working through the traumatic experience, preferably with a therapist. Tell them that the details of their story of the loss are very important. Encourage and appreciate your child’s efforts to express, write or draw their story. Model for your child the release of feelings in small doses.
• -Learn flexibility regarding expectations for your child’s school performance and behaviors. Try to talk with your child about their difficulties and offer understanding.
• -Enable your child to learn new skills or to retrieve former skills to counter the sense of helplessness that accompanies trauma.
• -Create conditions for you and your child to connect to others who can provide a valuing reflection to you of your worth.

Rando’s careful guidelines offer a message of hope. When we take these steps patiently and attentively, requesting support as needed, trauma can be healed and integrated in children, teens and adults. As either parents or children, surviving the sudden loss of a loved one can lead to greater attunement and care for ourselves and others, sometimes with transformative outcomes. The LOSS Program for Children and Youth continues to provide trauma informed services. We provide individual, family and group services to children and families who are addressing the unique healing challenges of life after a loved one’s suicide.

The information in this article is a synopsis of statements provided solely by Therese R. Rando, PhD regarding her research on traumatic bereavement.



Archives:

Managing Traumatic Bereavement
Friday, July 01, 2016 by Cynthia Waderlow MSE, LCSW
In May some of our LOSS clinicians attended a conference devoted to the impact on survivors of sudden death or traumatic bereavement. We were moved by the seriousness of the subject because it has so much relevance for families who have experienced a suicide loss. We know the importance of grief work and making sense of the suicide, but this conference emphasized that the natural traumatic response to the sudden loss of a loved one changes everything about the survivor’s brain and body for a period of time, which can actually impede the grief process. Therese Rando, a major figure in grief research , and a grief therapist herself, asserted that after a sudden death like suicide, even if the relationship with the deceased was difficult and complicated, each child, adolescent and adult survivor is ” personally traumatized by the suddenness and lack of warning that preceded the death” (Rando, In Press 2016). Intrusive images, numbing and emotional and physiological dysregulation are some of the erratic symptoms that can present when the primitive brain of the most normal of persons triggers the freeze, flight or fight response. Traumatic assault also affects the survivor’s sense of reality. What they previously understood about themselves, their relationship with the deceased and the known world is impacted, sometimes nearly stripped away. Think about the tender, developmental work that children and adolescents have achieved related to identity, the security they have formed around attachments, and a sense of how the world works. Traumatic loss will shake up these reality constructions.

Dr. Rando emphasized the importance of understanding and attending to trauma both in grief therapy sessions, as well as the parent-child relationship within surviving families. In families traumatized by sudden loss, parents and caregivers may need to deepen attunement and empathic response toward their children, and this is where skills in insight and support through counseling can be helpful. Although Rando had a hopeful perspective on healing from trauma’s impact, she asserted that sudden or violent loss should not be minimized after an essential attachment relationship has been disrupted. Additionally, there are factors which can increase the level of trauma, such as exposure to the death, especially where children are concerned. We also need to consider added disturbing layers, such as police presence, screaming, even misperceptions that children can ascribe to CPR interventions. Dr. Rando described three levels of trauma, with the second and third levels including symptoms of Post-Traumatic-Stress- Syndrome. Rando described four sets of traumatic effects after a sudden loss, all contributing to dysregulation. The trauma:

• -instantly propels your brain into “survival mode,
• -overwhelms your usual coping abilities,
• -creates significant psychological distress and dysfunction,
• violates your assumptive world” (Rando 2016, In Press).

Although we may understand that trauma has implications for grief, we also learned the inverse: that grief interferes with the needed personal mastery of trauma symptoms, and that both grief and trauma can intensify and escalate symptoms that are common to both. So now we will bring our awareness to a dual process of healing for both trauma and grief. Dr. Rando stated that with level 1 traumas, grief and trauma can be addressed together. With more intense traumas, professional intervention is recommended, and trauma should be addressed prior to the grief.

Therapists will help children, teens and parents attend to the initial traumatic experience and the feelings in small doses until the trauma “is robbed of its potency” (Rando, 2016, In Press). In addition, there will be goals for:

• -mourning the loss of the deceased loved one;
• -discouraging maladaptive behaviors that may be used to cope with the trauma while developing new skills for healthy living in the world after trauma;
• -developing mastery over a sense of powerlessness / helplessness, personal worth and value;
• -developing a perspective on what happened, why, and what one was, and was not able to do to control (Rando, 2016, In Press).

These are the essential workings that promote a sense of groundedness and continued development for survivors of all ages.

So, given that untreated trauma has implications for a person’s, health and development, how should surviving parents address the impact of trauma on their children and teens? I have summarized Dr. Rando’s directives for structuring the tasks for responsible management of trauma’s impact.

• -Educate yourself about traumatic grief, its symptoms and requirements for healing.
• -Consider evaluations for you and your child by a grief or trauma specialist.
• -Ensure that structure and consistent routines are prioritized at home. Healing is supported with at least eight hours of sleep each night. Communicate with your child what happens next as you move through your day. This will create a sense of holding and security.
• -Support your child in bringing to consciousness and working through the traumatic experience, preferably with a therapist. Tell them that the details of their story of the loss are very important. Encourage and appreciate your child’s efforts to express, write or draw their story. Model for your child the release of feelings in small doses.
• -Learn flexibility regarding expectations for your child’s school performance and behaviors. Try to talk with your child about their difficulties and offer understanding.
• -Enable your child to learn new skills or to retrieve former skills to counter the sense of helplessness that accompanies trauma.
• -Create conditions for you and your child to connect to others who can provide a valuing reflection to you of your worth.

Rando’s careful guidelines offer a message of hope. When we take these steps patiently and attentively, requesting support as needed, trauma can be healed and integrated in children, teens and adults. As either parents or children, surviving the sudden loss of a loved one can lead to greater attunement and care for ourselves and others, sometimes with transformative outcomes. The LOSS Program for Children and Youth continues to provide trauma informed services. We provide individual, family and group services to children and families who are addressing the unique healing challenges of life after a loved one’s suicide.

The information in this article is a synopsis of statements provided solely by Therese R. Rando, PhD regarding her research on traumatic bereavement.