Adult Treatment Planner

Objectives and Interventions

• Tell in detail the story of the current loss that is triggering symptoms.
  • Actively build the level of trust with the client in individual sessions through consistent eye contact, active listening, unconditional positive regard, and warm acceptance to help increase his/her ability to identify and express thoughts and feelings.
  • Using empathy and compassion, support and encourage the client to tell in detail the story of his/her recent loss.
  • Ask the client to elaborate in an autobiography the circumstances, feelings, and effects of the loss or losses in his/her life.
• Read books on the topic of grief to better understand the loss experience and to increase a sense of hope.
  • Ask the client to read books on grief and loss (e.g., Getting to the Other Side of Grief: Overcoming the Loss of a Spouse by Zonnebelt-Smeenge and De Vries; How Can It Be All Right When Everything Is All Wrong by Smedes; How to Survive the Loss of a Love by Colgrove, Bloomfield, and McWilliams; When Bad Things Happen to Good People by Kushner); process the content.
  • Ask the parents of a deceased child to read a book on coping with the loss (e.g., The Bereaved Parent by Schiff); process the key themes gleaned from the reading.
• Identify what stages of grief have been experienced in the continuum of the grieving process.
  • Ask the client to talk to several people about losses in their lives and how they felt and coped. Process the findings.
  • Educate the client on the stages of the grieving process and answer any questions he/she may have.
  • Assist the client in identifying the stages of grief that he/she has experienced and which stage he/she is presently working through.
• Watch videos on the theme of grief and loss to compare own experience with that of the characters in the films.
  • Ask the client to watch the films Terms of Endearment, Dad, Ordinary People, or a similar film that focuses on loss and grieving, then discuss how the characters cope with loss and express their grief.
• Begin verbalizing feelings associated with the loss.
  • Assign the client to keep a daily grief journal to be shared in therapy sessions.
  • Ask the client to bring pictures or mementos connected with his/her loss to a session and talk about them.
  • Assist the client in identifying and expressing feelings connected with his/her loss.
• Attend a grief/loss support group.
  • Ask the client to attend a grief/loss support group and report to the therapist how he/she felt about attending.
• Identify how avoiding dealing with loss has negatively impacted life.
  • Ask the client to list ways that avoidance of grieving has negatively impacted his/her life.
• Identify how the use of substances has aided the avoidance of feelings associated with the loss.
  • Assess the role that substance abuse has played as an escape for the client from the pain or guilt of loss.
  • Arrange for chemical dependence treatment so that grief issues can be faced while the client is clean and sober. (see Chemical Dependence chapter in this Planner).
• Acknowledge dependency on lost loved one and begin to refocus life on independent actions to meet emotional needs.
  • Assist the client in identifying how he/she depended upon the significant other, expressing and resolving the accompanying feelings of abandonment and of being left alone.
  • Explore the feelings of anger or guilt that surround the loss, helping the client understand the sources for such feelings.
• Verbalize and resolve feelings of anger or guilt focused on self or deceased loved one that block the grieving process.
  • Encourage the client to forgive self and/or deceased to resolve his/her feelings of guilt or anger. Recommend books like Forgive and Forget (Smedes).
  • Support and assist the client in identifying and expressing angry feelings connected to his/her loss.
• Identify causes for feelings of regret associated with actions toward or relationship with the deceased.
  • Assign the client to make a list of all the regrets he/she has concerning the loss; process the list content.
• Decrease statements and feelings of being responsible for the loss.
  • Use a Rational Emotive Therapy (RET) approach to confront the client's statements of responsibility for the loss and compare them to factual reality-based statements.
• Express thoughts and feelings about the deceased that went unexpressed while the deceased was alive.
  • Conduct an empty-chair exercise with the client where he/she focuses on expressing to the lost loved one imagined in the chair what he/she never said while that loved one was alive.
  • Assign the client to visit the grave of the lost loved one to "talk to" the deceased and ventilate his/her feelings.
  • Ask the client to write a letter to the lost person describing his/her fond memories, painful and regretful memories, and how he/she currently feels. Process the letter in session.
  • Assign the client to write to the deceased loved one with a special focus on his/her feelings associated with the last meaningful contact with that person.
• Identify the positive characteristics of the deceased loved one, the positive aspects of the relationship with the deceased loved one, and how these things may be remembered.
  • Ask the client to list the most positive aspects of and memories about his/her relationship with the lost loved one.
  • Assist the client in developing rituals (e.g., placing memoriam in newspaper on anniversary of death, volunteering time to a favorite cause of the deceased person) that will celebrate the memorable aspects of the loved one and his/her life.
• Attend and participate in a family therapy session focused on each member sharing his/her experience with grief.
  • Conduct a family and/or group session with the client participating, where each member talks about his/her experience related to the loss.
• Report decreased time spent each day focusing on the loss.
  • Develop a grieving ritual with an identified feeling state (e.g., dress in dark colors, preferably black, to indicate deep sorrow) which the client may focus on near the anniversary of the loss. Process what he/she received from the ritual.
  • Suggest that the client set aside a specific time-limited period each day to focus on mourning his/her loss. After each day's time is up the client will resume regular activities and put off grieving thoughts until the next scheduled time. For example, mourning times could include putting on dark clothing and/or sad music; clothing would be changed when the allotted time is up.
• Develop and enact act(s) of penitence.
  • Research with the client the activities, interests, commitments, loves, and passions of the lost loved one, then select a community-service-connected activity as an act of penitence for the feelings of having failed the departed one in some way. (Period of time should not be less than one month, with intensity and duration increasing with the depth of the perceived offense.)
• Implement acts of spiritual faith as a source of comfort and hope.
  • Encourage the client to rely upon his/her spiritual faith promises, activities (e.g., prayer, meditation, worship, music), and fellowship as sources of support.