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Thursday, June 9, 2005

According to an article in the newest edition of the Journal of the American Medical Association, modified psychotherapy eases severe grief.

A team of therapists worked with people who were experiencing complicated grief:

Complicated grief has specific symptoms," she noted, which include "a sense of disbelief, anger and bitterness about the death, episodic pangs of painful emotion and very prominent longing for the person that died, with recurrent images of the death itself and avoidance behavior."
That's an apt description of post-abortion grief/trauma. The therapeutic intervention these therapists tried, in addition to standard interpersonal therapy, is called "treating the loss". I want to say that "treating the loss" ought to have been, or to be, an obvious way to work with people who are suffering from complicated grief, but I'm not going to jump on these therapists for coming up with a term and techniques that might help.

This is their brief description of what it means to "treat the loss":

Patients are encouraged to retell the story of the death using a procedure called "revisiting." They are also instructed to carry on an "imaginal conversation" with the deceased. During the treatment sessions the patient is also helped to identify personal life goals and to develop plans to meet those goals.
In most post-abortion ministry programs, people are asked to retell the story of the abortion (the death), which is often very difficult for people to do. It is also suggested that people name the child and, frequently, it is suggested that they write a letter to the child. In the comments at this post, we learn that the idea of writing a letter to the child is also a part of what Exhale's counselors are willing to suggest to women who are grief-stricken after an abortion.

I suppose that writing a letter could be thought of as one way of carrying on an "imaginal conversation" with the deceased.

The statistics in the article about the good outcomes achieved by this form of grief counseling are heartening.

Update: I was very curious about how the "imaginal conversation" part of this therapeutic treatment went, so I paid up the $12.00 required to read the full JAMA article online. This is how it describes that part of the treatment:

The imaginal conversation was conducted with the patient’s eyes closed. The patient was asked to imagine that he/she could speak to the person who died and that the person could hear and respond. The patient was invited to talk with the loved one and then to take the role of the deceased and answer. The therapist guided this "conversation" for 10 to 20 minutes.
I was also interested to learn in the article that complicated grief is not included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Nevertheless, the authors say:

Complicated grief is a source of significant distress and impairment and is associated with a range of negative health consequences. Prevalence rates are estimated at approximately 10% to 20% of bereaved persons. Approximately 2.5 million people die yearly in the United States. Estimates suggest each death leaves an average of 5 people bereaved, suggesting that more than 1 million people per year are expected to develop complicated grief in the United States.
Can anyone else identify a common mental health problem in the United States that is not included in the DSM IV? Anyone? Anyone?

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