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Home , Emotional intimacy, Grief

CALIFORNIA STATE UNIVERSITY, NORTHRIDGE

Sexual Intimacy After Child :

An 8 Week Psycho-Educational Group for Grieving

A graduate project submitted in partial fulfillment of the requirements

For the degree of Master of Science in Counseling,

Marriage and Therapy

By

Nelson Mayen

August 2019

This graduate project of Nelson Mayen is approved by:

______Alberto F. Restori, Ph.D. Date

______Bruce Burnam, Ph.D. Date

______Diana Losey, MS Date

______Stanley Charnofsky, PhD., Chair Date

California State University, Northridge

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DEDICATION

This is dedicated to all of us that have lost so much, regardless of the type.

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ACKNOWLEDGEMENTS

This acknowledgement goes first and foremost to my mom and dad who probably still do not fully understand what my profession consists of. Thank you for being so understanding of my absence for the past couple of years. To Mayra, you have been a true blessing and a source of strength and through difficult times in my life. To the rest of my friends that I cherish dearly, I suppose I now have the free time that you have all been asking for. I love you all.

This is also for those that have provided the guidance that has helped me in being a better clinician. Clovis, thank you so much for instilling and humanity within this work. The dialogue we have shared about therapy and life in general is exactly what my soul was searching for when considering this field. For Janet, thank you for always allowing me the emotional space that I needed. Also, thank you for constantly reminding me that I am where I am supposed to be.

I would also like to thank my project committee. For Stan, thank you for all the help. For

Bruce, I am so grateful for the time you took to provide constructive feedback on my project.

Your excitement for films and the quest for never-ending knowledge is truly admirable. For

Diana, I could never make up for all the help you have given me. I know I said this countless times in my emails, but thank you for all the times you put up with me. I would also like to add that your class was among the most impactful courses I took while in graduate school due to the sincerity and necessary tangents about life that you allowed us to be a part of.

Lastly, I want to thank all the coffee shops that I frequented while in graduate school.

This one is for Cafe Aficionado, Coffee Commissary, and Moby’s Coffee & Tea Company.

Thank you for supplying countless gallons of coffee that I consumed throughout this journey. I consistently overstayed my welcome at these locations, so much so that it probably wasn’t worth having me as a customer based off of the electricity bill alone. Nevertheless, thank you so much.

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TABLE OF CONTENTS

SIGNATURE PAGE ii

DEDICATION iii

ACKNOWLEDGEMENTS iv

ABSTRACT vii

CHAPTER I: INTRODUCTION 1

Introduction 1

Statement of Purpose 2

Statement of Significance 3

Terminology 4

Summary 5

Chapter II: Literature Review 6

Beliefs About Sexual Intimacy After Child Death 6

Gender Differences in Intimacy Response After Child Death 7

Gender and Reactions 7

How and Why Intimacy Varies After Loss 8

Grief Theories and Models 10

Kubler-Ross’ Stages of Grief 11

Worden’s Four Tasks of 12

Stroeb and Schut’s Dual Process Model 13

Effects of Grief on Bereaved Parents 15

Grief and Attachment 16

The Maternal and Paternal Experience After Child Loss 18

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Adjustment to Loss and the Return to Intimacy 20

Honoring the Loss 21

Focusing on the Grief 22

Adjusting Pace of Therapy 23

Encouraging Storytelling 23

Providing Psycho-Education 23

Dual Control Model of Sexual Function 24

Efficacy of Grief Therapy and Grief Work 25

Conclusion 27

Chapter III: Group Application 29

Target Population 29

Group Format 29

Group Rules 30

Group Outline 30

Chapter IV: Summary and Recommendation 31

REFERENCES 32

APPENDIX A 36

vi

ABSTRACT

SEXUAL INTIMACY AFTER CHILD DEATH:

AN 8 WEEK PSYCHO-EDUCATIONAL GROUP FOR GRIEVING PARENTS

By

Nelson Mayen

Master of Science in Counseling,

Marriage and Family Therapy

The process of grieving one’s child is an awful experience. To lose a child seems out of order with the general trajectory of life. Whether through illness, violence, or , a child’s death can leave parents’ with an uncertainty regarding their role as people, their role within a relationship, and their role in life. In addition to these uncertainties, the return or failure of return to sexual intimacy and that lack of social acceptability in openly discussing these issues causes additional stressors for grieving parents. This literature review will specify a need and significance for a grief-processing group catered towards parents who which focuses on the theme of sexual intimacy as it is affected by the child’s death. Within a typical relationship, effective is already a difficult quality to learn. By creating a that focuses on psycho-education, grief models, and strategies to connect with one’s partner, parents are given the potential opportunity to regain purpose, connect with one’s partner, and have space to process grief. In order to assist both parents and facilitators to understand some of the research on the topic of sexual intimacy after child death, the following literature review includes beliefs on sexual intimacy after child death, gender differences in intimacy response after child death, grief theories, the role of attachment after loss, paternal and maternal experience after child death, adjustment after loss, and the efficacy of grief therapy.

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Chapter 1

Introduction

The grieving process of losing a child is something that most parents will never experience. Whether the child is lost to , , or another reason, to endure such a loss is a painful reminder of life’s cruelties. While the topic of childhood death has been extensively researched, information regarding sexual intimacy between grieving parents is not as available. Discussing sexual intimacy after a child’s death might be determined as ill-timed or inappropriate given the circumstances, however it is crucial to remember that even after a child’s death, many parents remain in relationship with a or partner and with the everyday work that is needed for any relationship to thrive.

In addition to the complications of navigating the relationship after the loss of the child, grief and bereavement are managed differently both individually and culturally. More specifically, grief is a personal experience and there is simply no right way of processing that grief. It is, however, sometimes these differences in the grieving process that can cause difficulty in the couples’ ability to connect after the loss of the child. Hagemeister and Rosenblatt (1997) state that often men and women respond in different ways to a child’s death. Most importantly, each member of the couple will have different ways needing help to process that grief. Empathic listening, surrounding oneself with family members, avoiding the issue, isolating oneself, or even engaging in sexual intimacy are some of the different ways in which people cope with a child’s death. According to Hagemeister (1997), women most often want to talk about the loss and explore their emotional more frequently than men. A study by Johnson (1987) explains that the reason some grieving men prefer sex as a mechanism is due to the of comfort that eases grief-related pain. This is not to say that men do not have associated with loss,

1 but rather, some men have different ways of coping with grief. When couples have two divergent grieving processes, many difficult issues may surface in the relationship (Hagemeister &

Rosenblatt, 1997).

It is important at this point, to add that in this project, that there is no agenda regarding sexual intimacy. The purpose of this project is not to instruct couples how to regain sexual intimacy after a child’s death. Such an idea would be counter to the grieving process and may promote the idea that there is a correct way of grieving, when it is the belief of this author that there is not. The purpose of this project is to discuss the various issues that arise with couples who are dealing with a child’s death and to assist them in approaching common concerns. These issues include effects of grief, grief and attachment, the maternal and paternal experience of losing a child, adjustment after tragedy, honoring the loss, as well as intimacy after loss.

Statement of Purpose

This project focuses on sexual intimacy for couples following the death of a child. The purpose of the project is to develop a support group for grieving parents who have experienced the loss of a child. Again, the purpose of this project is not to instruct couples how to regain sexual intimacy after a child’s death, but to discuss the various issues that arise with couples who are dealing with a child’s death and to assist them in approaching common concerns. The discussion topics for the support group will consist of the beliefs surrounding the issue of child death, while also providing evidence for what many parents might expect from the death of a child. The discussion will also shed light on how gender differences may each member of the couples response to sexual intimacy after the loss of a child. These gender differences include the manner in which both partners grieve, how they interpret the loss, and how they expect their partner or spouse to fulfill their needs after losing the child. The grieving process itself will also

2 be explored, as will the adjustment to life after the loss. Lastly, both the experience of the and the and the meaning that they attach to the experience of losing a child will be discussed. The workshop will provide a broad perspective of sexual intimacy issues that often come up when grieving for a child.

Statement of Significance

The significance of this project lies in the psychoeducation that can be provided to grieving parents. While there are many workshops and support groups for grieving parents, there are not many groups that focus on the issue of sexual intimacy during or after the loss of a child.

For some , exploring issues of sexual intimacy may be a difficult topic to address; loss is already a complicated process for families and to address sexual intimacy difficulties may seem unbearable for some parents. Therefore, the issue of sexual intimacy after losing a child is significant because it may help others navigate through the grief process by at least understanding that they may not be alone in the relational experiences that often arise after losing a child. Among couples, some may not understand why a partner is not grieving in the way that they are; the knowledge alone that a partner grieves differently could be of tremendous help for couples who feel lost during their loss. Through psychoeducation in a support group setting, couples can learn differences in bereavement styles among males and females as well as the function of those different bereavement styles. Schwab (1992) discusses how common it is for a couple to differ in their bereavement style, which has the potential of creating within the couple due to lack of communication and understanding of each partner’s bereavement style.

Couples can also understand how and why various grief models such as the dual process model of bereavement are more efficacious in processing grief than other grief models (Neimeyer &

3 Currier, 2009). Individuals in a proposed support group will also be taught evidenced-based interventions and techniques which can be used in and outside of the group setting.

Terminology

Depression: Characterized by feelings of inadequacy and hopelessness, a lowering of psychophysical activity, loss of self-esteem, and self-accusation (Pietromonaco, 1985)

Dual Control Model of Sexual Functions: A model based on the interaction of sexual excitation and inhibition in the brain (Bancroft et. al, 2009).

Emotion-Focused Therapy: A psycho-therapeutic approach that focuses on John

Bowlby’s theory regarding attachment and bonding (Johnson, 2004).

Grief: A sort of longing and rumination for the deceased along with symptoms of , , and sleeplessness (Wayment & Vierhaler, 2002).

Grief Process: The process of adapting to a significant loss which varies based on a person’s background, beliefs, and relationship to what was lost. (GoodTherapy, 2019a)

Honoring the Loss: The therapist giving special to the loss of the child (Brown,

2016).

Insecure Attachments: Insecure attachments lack the constructive relational components of secure attachment and can be categorized into three attachment styles: anxious attachment, avoidant attachment, and fearful (disorganized) attachment (Bowlby, 1988).

Psycho-Education: Referring to the process of providing education and information to those seeking or receiving mental health services (GoodTherapy, 2019c).

Secure Attachments: Characterized by one’s ability to be comfortable in creating closeness with others and to reach out to others when in need (Bowlby, 1988).

4 Sexual Inhibition System: A two-factor system that inhibits sexual response ((Bancroft et. al. 2009).

Sexual Intimacy: When people engage in sensual or sexual activities (GoodTherapy,

2019b).

Social Support: A care resource which can have either a positive or negative effect on a person's health and well-being (Laakso & Paunon-Ilmonen, 2002).

Somatization: When psychological concerns are converted into physical symptoms

(GoodTherapy, 2019d)

Summary

For a better understanding of the issue of sexual intimacy after losing a child, it is necessary to review the previous literature on the topic, which will be covered in the following chapter. Therefore, chapter 2 mentions beliefs about the topic of sexual intimacy after child death. The chapter will also discuss gender differences as it relates to sexual intimacy after child death. Various grief models will be explained as well as the effects of grief on parents. Later, grief will be explored within the context of attachment and -focused therapy. The maternal and paternal experience of adjustment after tragedy will also be analyzed. The chapter also contains a section on returning to intimacy after loss. Lastly, chapter 2 will explain the purpose of the Dual Control Model of Sexual Function. Chapter 3 of the project discusses the target population, the group format, the group rules, and the group outline to be used by prospective facilitators of this group. Chapter 4 contains a summary of this project as well as recommendations for future considerations.

5 Chapter 2

Literature Review

The following is a review of the literature on the topic of sexual intimacy after the death of a child. This chapter will begin with some of the widely held beliefs around the topic of sexual intimacy after child death. Then, the chapter will discuss gender differences in relation to sexual intimacy after the death of a child. Later, several grief models and the effects of grief will be analyzed. Grief will also be explored through the lens of attachment and emotion-focused therapy and both the maternal and paternal experience and adjustment after tragedy will then be examined. Discussion will also take place regarding adjusting to loss which will include discussions on honoring the loss as well as the return to intimacy after loss.

Beliefs About Sexual Intimacy After Child Death

Although many studies indicate that there is a high-correlation between in bereaved couples, Schwab (1998) states that this is not the case, noting that although cases do exist in which married couples experience a divorce as a direct result of losing a child, but that divorce is still not necessarily likely. Although the loss of a child can create on the relationship, the relationship between the couple can also become even stronger given the loss.

For example, each member of the couple can be more present in the partner’s life during the grief process, thus drawing them together and creating tighter bonds based on mutual love and support. Schwab notes that the amount of time needed for the relationship to be restored to the same level of functioning as before the loss depends on factors such as the circumstances of the loss and the relationship dynamic of the couple (Schwab, 1998).

6 Gender Differences in Intimacy Response After Child Death

Gender and Grief Reactions

Hagemeister and Rosenblatt’s (1997) study analyzes the gendered differences in a couple’s response to a child’s death. After interviewing 24 heterosexual couples, the researchers note crucial differences in the way each member of the couple responded to their child’s death.

More than half of the reported serious problems with their sexuality. Mainly, the mothers expressed that they had diminished in sex. Comparatively, less than half of the reported serious issues with their sex life after the child’s death. Instead, fathers in the study expressed concerns for the lack of sex in the relationship after the death occurred. Issues in sexuality among these couples are evident, for while more than half of the females report drastic changes in their sexual drive and , more than half the males do not. Along with diminished interest in sex, some couples reported cessation of all sexual practices due to both and physical and . Other couples reported adultery following the death, likely as a result of the diminished interest of one of the partners. Hagemeister and Rosenblatt state that the suddenness of the death of a child contributes to an even longer period in which the couple refrains from sex; sudden death affecting the sexual relationship more so than when death is expected (1997).

In a similar study, Schwab (1992) interviewed 20 heterosexual couples who had lost children within the previous four years. In Schwab’s study, women generally reported less interest in any sexual activity after the death of a child than they experienced prior to the death.

Some women reported feelings of in response to their spouse’s desire for sexual intimacy. Other women participants felt that their ’ sexuality was inappropriate given the circumstances. Due to differing attitudes about sexual intimacy, many women reported

7 feeling lonely in their grieving process. Conversely, many men felt that the lack of sexual intimacy was now a comfort factor of the relationship that was no longer available. As a result of these gender based differences in how grief is experienced and how each partner reacts to sexual intimacy during the process of grief, both men and women generally experienced feelings of in their grief as a result of intimacy in different ways (Schwab 1992).

Lang and Gottlieb (1993) state that the intensity with which a couple may experience grief is based on whether or not they are able to be comforted by one another, either by sexual or . Their study results indicate that the intensity of grief is higher among the study’s female participants who had partners with low intellectual intimacy (ability to share and opinions). Their study also indicates that the intensity of grief was higher among men participants who felt that the emotional, sexual, recreational, and social features of the relationship were no longer available following the death of the child. The men in this study also reported considering divorce more often than women based on the lack of sexual, recreational, and social aspects of the relationship. The relational dynamic of distressed couples highlights the complex factors such as gender, miscommunication, and with partners when it is perceived by one or both partners that the other partner does not care. The rejection and felt by both men and women after the loss of a child is ironic given that both partners often share similar feelings of and hurt by the partner’s reaction to their individual grieving processes, whether through or sexual intimacy (Lang &

Gottlieb, 1993).

How and Why Intimacy Varies After Loss

Just as each member of the couple may view intimacy differently during the grief process, couples also vary one from another in how and why they engage or refrain from

8 engaging in intimacy following the loss of a child. Sexual intimacy can look different for couples experiencing the loss of their child. Johnson (1987) indicates that there is often a broad range of sexual ways in which couples may react to the death of a child. For instance, sexual intimacy is not always diminished, some couples immediately took to engaging in sexual activities following to death of their child for the purpose of reproduction, wanting to conceive another child as a sort of replacement. Among these couples, many experienced a sense of regarding this desire to quickly have another child. Of course, the bereavement process for any is a personal journey (Johnson, 1987) and no guilt need be placed upon couples by themselves or others regarding how they choose to grieve and cope with the death. Nadeau (2001) makes the point that each couple may create their own personal meaning concerning both the sexual intimacy and the loss of their child. Such meanings are often shaped by small incidents such as daily interactions with others rather than large events. Also, some meanings are constant and non- negotiable (Nadeau, 2001).

Hagemeister and Roseblatt (1997) posit that for many couples, any discussion of is put in the context of the deceased child. Although some parents in the study did engage in sexual activity, other parents that any sexual was too close to the death of the child, since these parents associated sexual intimacy to the very act which creates a child. Therefore, any likeness, any activity that remotely reminded the parents of their child was immediately rejected. Simply having sexual intercourse with a partner was seen as an activity that would reignite the process of having children all over again and for some parents, the pain from the loss is almost inseparable from intercourse as a form of . Other parents in the study report still engaging in sexual intimacy for pleasure, despite being overcome by feelings of sadness and guilt. Even when feelings of sexual interest resurfaced, some couples reported

9 feeling afraid of having sex and therefore made a conscious effort to avoid sexual intimacy

(Hagemeister & Roseblatt, 1997).

It is clear that couples vary in how they respond to sexual intimacy after the death of the child. Despite this variation, feelings of guilt often seem to be associated with intimacy after loss.

Hagemeister and Rosenblatt (1997) state that many couples could not fathom the idea of sexual intimacy as pleasure existing simultaneously as the grief and bereavement process. For example, some parents in the study believed that they did not deserve to derive feelings of pleasure given the loss that they had endured. For these couples, guilt was an immediate response to the feelings of . As a result, some couples substituted touch for sexual intimacy in order to feel physically closer to each other. The researchers found that the touching serves as a form of connection, support, bonding, and comfort (Hagemeister & Rosenblatt, 1997).This provided the bereaved parents with feelings of comfort without the guilt that sex produced. The touching consisted of hugging, holding, and spooning. Although there were certain sexual elements to the touching, it was often well received by both parents.

Grief Theories and Models

Many grief models have been proposed by various professionals in the field of grief and bereavement. The purpose of such models is to assist grieving individuals to conceptualize grief as a process, thereby providing both understanding while they move through the grief and hope that because it is a process, the pain of grief will eventually diminish. The following section includes a review of models such as Kubler-Ross’ stages of grief, Worden’s four tasks of mourning, and the dual control model of grief and bereavement by Stroeb and Schut. Due to the personal nature of grief and loss, the following models may offer a guide for individuals as they process their grief, but are not to be taken as objective truths.

10 Kubler-Ross’ Stages of Grief

The Kubler-Ross (1969) model of grief is pivotal in understanding and analyzing the grieving process that a couple can experience. According to Kubler-Ross, the stages of bereavement include , , bargaining, depression, and . The denial stage of grief can be characterized by doubting and rejecting the truth of the events that have occurred.

The anger stage can be identified by angry outbursts or even just a specific state of mind. The bargaining stage begins when people start to contemplate the different events and decisions that could have prevented the death in the first place. The depression stage of grief is often the state of sadness that many people stay at for long periods of time. The acceptance stage is often seen as that point in time when the person has the ability to come to terms with the events and the loss that occurred. Many people have difficulty reaching this last stage due to the incredibly challenging emotional work that is often required to reach acceptance (Kubler-Ross, 1969).

In accordance with the Kubler Ross model, Sanders (1989) asserts that anger is an integral part of a parent’s bereavement process. A person experiencing anger following a child’s death may experience an intense period of , frustration, and irritation. Unfortunately, many couples suffer blame from family and friends for the death of their child, even though there is no one to legitimately blame for the death of a child. Blame for a child’s death may also be aimed towards oneself, the spouse, economic circumstances, family members, professional staff, God, fate (or lack of fate), or even the deceased child. Anger after the death of a child can ultimately create self-, feelings of worthlessness, , and dishonor (Sanders, 1989).

Although the Kubler-Ross model is often interpreted as a step-by-step indicator of everyone’s grief process, Lang, Gottlieb, and Amsel (1996) argue that the grieving process is not linear. In fact, certain stages of grief may recur long after other stages of grief have taken place.

11 Some stages of grief may even occur simultaneously. Certain circumstances may trigger a response that cause a grieving person to revert back to a previous stage of grief. Nevertheless, the

Kubler-Ross model continues to be an effective guide in determining an individual’s stage in the grief process (Lang et. al., 1996).

Worden’s Four Tasks of Mourning

Psychologist William Worden (2018) developed what would be known as Worden’s four tasks of mourning. While Kubler-Ross’ model is based more on particular stages of grief, the

Worden model is focused more on the actual process of healing after loss (Kubler-Ross, 1969).

The four tasks of mourning are as follows: (a) to accept the reality of the loss, (b) To process the pain of grief, (c) To adjust to a world without the deceased, and (d) Finding an enduring connection with the deceased in the midst of embarking on a new life. Although there is no particular order to these tasks, William Worden did stress that they are necessary in processing grief (Worden, 2018).

The first task of the Worden model theoretically begins at the end of Kubler-Ross’ stages of grief as evidenced by the fact that the Worden model begins with the acceptance and acknowledgement of the loss (Worden, 2018). Worden explains that there is the intellectual acceptance and acknowledgement of loss, however notes that full acceptance also involves

“taking it in” with one’s whole being. The second step of the Worden model involves the actual processing of pain and grief. This process is the enduring and experiencing of expressing all reactions of grief on an emotional, cognitive, physical, and spiritual level. Although people may often hear others say that they should “get over” their grief, Worden explains that this is a necessary task in one’s journey through the grief process. The third task, according to Worden, is to adjust to a world without the deceased. This adaptation may involve learning new skills and

12 responsibilities that were once controlled by the deceased person/s, such as managing finances.

A more internal component of this task may include having to adjust to one’s new identity. On a spiritual level, one can adjust their interpretation of their role or purpose in life and even their meaning in this world now that the deceased person/s are no longer physically present. The fourth and last task of the Worden model includes finding a connection with the deceased person/s while also on the journey of a new life. This can mean making an effort in holding an emotional, cognitive, physical, and or spiritual space for the deceased throughout the week

(Worden, 2018)

Stroeb and Schut’s Dual Process Model

Margaret Stroeb and Henk Schut’s (1999) grief model was created to provide solutions to the critique of other grief models. Regarding the criticism towards other grief models, Stroeb and

Schut claim that other models place huge emphasis on the grief model hypothesis. That is, the belief that one must have a direct confrontation towards one’s loss by constant grief processing in an effort to come to terms with the loss (Stroeb & Schut, 1999). Stroeb and Schut believe that these models pathologize one’s willingness to avoid and suppress memories and other aspects of grief processing. They believe that the grief model hypothesis caters more towards western values of confronting loss and is therefore not inclusive of other cultures and that value suppression and avoidance related to grief. Stroeb and Schut claim that the grief model hypothesis is also more female-oriented as females are more likely to confront grief-related emotions. Conversely, some men tend to allow for more moments of avoidance, distraction, and suppression, which Stroeb and Schut claim is perfectly natural and legitimate. For this reason, they believe that their model is more inclusive of both men and women as well as different cultural values (Stroeb & Schut, 1999).

13 Stroeb and Schut’s dual process model (DPM) of grief indicates that there are two types of stressors related to coping with grief which are largely absent in other grief models (Stroeb &

Schut, 1999). The first stressor is a loss-oriented stressor which emphasizes the processing of the loss which can mean ruminating about the deceased, looking at photos of the deceased, and even contemplating the events surrounding the loss. The grief process that is evident in most other grief models falls under the loss-oriented stressor of the DPM. The second type of stressor is called the restoration-oriented stressor. Much like Worden’s third task of grief, the restoration- oriented stressor focuses on developing one’s new identity and responsibility as the person begins to move forward in life without the deceased. An example may be a person taking over domestic roles that the deceased person was in control of and dealing with arrangements in an effort to reach a new homeostasis without the deceased person (Stroeb and Schut, 1999).

Stroeb and Schut believe that one of the unique qualities of the DPM is that there is an emphasis on the constant oscillation between the loss-oriented and restoration-oriented stressors depending on one’s own grief process (Stroeb and Schut, 1999). That is, there is no particular emphasis on how long one should stay in either the loss-oriented stressor or the restoration- oriented stressor given that grief is a personal journey with no single correct way of processing grief. The researchers believe that another feature of the DPM is that the model normalizes respite from either stressor. That is, they believe that what sets their model apart is that they feel distraction mechanisms and moments of respite are perfectly normal forms of dealing with one’s own grief. In other words, coping mechanisms such as watching television as a distraction would be a legitimate form of coping through loss. Stroeb and Schut believe that this feature of the DPM is what allows for more inclusivity of diverse cultures that may want to avoid

14 confrontation of grief and also more inclusivity of male populations that prefer more distraction or solution-based practices of processing grief (Stroeb and Schut, 1999).

Effects of Grief on Bereaved Parents

It is important to analyze the differences in the types of loss an individual may experience. According to Sanders (1979), the loss of a child is a much more intense level of grief for the parents than the loss of a , a partner, or parent. Christ, Bonanno, Malkinson, and

Rubin (2003) suggest that for many parents, the ability to even have children is often tied to the meaning of life. Klass (1986) found that for some people having children and watching those children grow and prosper is often the sole purpose of living. Klass (1986) further states the three emotional experiences that seem to occur among parents who have lost a child: the feeling of losing power and self-efficacy, the feeling of losing the self altogether, and the feeling of losing someone who contributed to the overall quality of the family (Klass, 1986).

Christ et al. (2003) posit that for grieving parents, the loss of a child is something that may stay with them for the rest of their lives, more so than any other family member who passes away. The unique and severe impact of losing a child can make it difficult for parents to move toward the stage of acceptance. Various longitudinal studies suggest that parents never truly experience closure after the loss of a child and that the parents’ and feelings about the death when it first happens may be the same during future assessment (Christ et al., 2003).

There are a variety of physical and psychological symptoms that may appear for parents who lose a child (Christ et al., 2003). Psychological symptoms of loss can include despair, helplessness, loneliness, sadness, abandonment, and a wish to die (Sanders, 1989). Physical symptoms of loss can include insomnia, loss of appetite, obsessive thinking (i.e. bargaining), , and difficulty in concentrating (Bowlby, 1980). The feelings of sadness alone can

15 cause a parent to have heightened feelings of vulnerability, , , and hypervigilance

(Bowlby, 1980).

Grief and Attachment

Sue Johnson (2004) is the creator of emotion-focused therapy (EFT). EFT is a psycho- therapeutic approach that focuses on John Bowlby’s theory regarding attachment and bonding.

One of the main goals of this theoretical orientation is to create secure attachments in relationships. Regarding couples who have lost a child, the goal would be to create a bond amongst the couple in order to develop a healthier connection while they each grieve the loss of a child. Attachment styles are broken into two models of attachment, secure and insecure attachment (Johnson, 2004).

Secure attachment. Secure attachment is characterized by one’s ability to be comfortable in creating closeness with others and to reach out to others when in need (Bowlby,

1988). With children, secure attachment can look like a child who feels threatened when a parental figure is not present, but returns to a state of happiness when that parental figure re- enters the room once again. People with a secure attachment style tend to have higher levels of satisfaction in relationships since they embrace being emotional, vocalize their needs, and are understanding of difficult situations in their relationships (Bowlby, 1988).

Insecure attachments. Insecure attachments lack the constructive relational components of secure attachment and can be categorized into three attachment styles: anxious attachment, avoidant attachment, and fearful (disorganized) attachment (Bowlby, 1988).

Anxious attachment. A person with an anxious style of attachment actually can allow themselves to be intimate and vulnerable with their partner (Bowlby, 1988). However, this is different from a secure style of attachment as evidenced by often fearing that their partner may

16 leave them or that their partner may not feel the same way about the relationship (Bowlby,

1988). A partner of a person who has an anxious style of attachment may perceive their partner as being clingy.

Avoidant attachment. A person with an avoidant style of attachment often has difficulty in creating intimacy and closeness in a relationship (Bowlby, 1988). They may keep their distance from their partner in order to protect themselves from feeling rejected or suffocated.

Although someone who is avoidant may actually crave closeness, they may be quick to disregard those feelings and highlight their partner’s negative behaviors in order to justify not wanting to further their intimacy in a relationship (Bowlby, 1988).

Fearful attachment. Someone with a fearful attachment style may want to build a close relationships with others, but may sabotage the relationship when they feel that they are getting too close to their partner (Bowlby, 1988). In some instances, when that partner begins to pull away as a result, the person with a fearful style of attachment may abandonment and then repeat the cycle (Bowlby, 1988).

Attachment and grief reactions. In a study by Heidi Wayment and Jennifer Vierthaler

(2002), the researchers sought to understand the relationship between attachment styles and bereavement reactions. The three reactions they tested for were grief, depression, and somatization. Although grief and depression appear to be similar, the researchers highlight the difference. They view grief as a sort of longing and rumination for the deceased along with symptoms of sadness, crying, and sleeplessness. However, this differs from depression which is often pathologized and may include feelings of hopelessness, decreased physical activity, and loss of appetite. The researchers explain that grief is a feeling of in the world, and

17 depression is feeling emptiness within oneself. Lastly, somatic reactions are health-related problems such as headaches, in the lower back, and nausea (Wayment & Vierhaler, 2002).

Just as they Wayment and Vierhaler hypothesized, the people in the study with an anxious style of attachment reported higher levels of grief and depression (2002). Individuals with avoidant styles of attachment reported more somatization as a grief reaction. The researchers believe that the reason for this reaction amongst avoidant individuals is a result of wanting to avoid emotional distress, and thus, these individuals may harbor their pain in their body. Lastly, people in the study with a secure style of attachment experienced less depression than their anxious counterparts (Wayment & Vierhaler, 2002). This information regarding the bereavement reactions can be useful for the reason that therapists can utilize the client’s bereavement reaction as a predictor of their attachment style. This information has the potential of helping the therapist address specific needs based on the individual’s attachment style. This information can also help the therapist identify potentially concerning reactions such as depression.

The Maternal and Paternal Experience After Child Loss

According to Laakso and Paunon-Ilmonen (2002), social support is a resource that can affect a person’s health and well-being in either a positive or negative way. When bereaved mothers experience the death of a child, they can receive a mixture of responses from those around them. Positive and negative reactions are shared by friends, colleagues, family, and even the spouse. In the study, positive help for a grieving mother was typically recorded as anything that helped the mother cope with the grief of losing a child. Negative help was recorded for any lack of support. The study indicates that the majority of positive help for bereaved mothers is often from the spouse and from any remaining children (Laakso & Paunon-Ilmonen, 2002).

18 Laakso and Paunon-Ilmonen (2002) indicate that according to the mothers’ account, the most prevalent source of support is often from the spouse. In many cases, the grieving process brings the couples closer. However, there are also couples who distance themselves from each other as a result of the process of grief. Concerning the support of the spouse, the manner in which the spouse is able to communicate about the loss determines the quality of the mother’s bereavement. The mothers more often report having a greater need to discuss the loss than do the fathers. More often than not, families that do not properly deal with the loss often suffer from an imbalance in wanting to communicate about their child’s death. For this reason, many fathers are often blamed by the mothers for not engaging themselves enough to discuss the loss (Laakso &

Paunon-Ilmonen, 2002).

While spousal support is primary, Laakso and Paunon-Ilmonen (2002) argue that other forms of bereavement support are also helpful. Other forms of help consist of emotional support, such as a grieving person’s mother who provides advice and comfort. Discussing the loss of one’s child with friends while those friends provide words of comfort and overall can also serve as support for the grieving mother. Among the various types of bereavement support are informational support and instrumental support. Informational support might be a friend who spends time with the grieving mother while providing words of . Instrumental support might be when a friend, relative, or colleague buys flowers or helps pay the cost of a coffin for the deceased child; a friend or family member might even take care of the arrangements to ease the mother’s responsibilities and leave her free to grieve (Laakso & Paunon-Ilmonen,

2002).

Conversely, according to Laakso and Paunon-Ilmonen (2002), the reasons that may attribute to the father’s style of grief may be due to the fact that many men process grief

19 differently. Many fathers suffer from psychological and physical pain as a result of losing a child. Many men resume work life more quickly than mothers. Because of this, many mothers feel alone through their grieving process and therefore may have feelings of resentment towards their . The mother’s sense of abandonment can be exacerbated by the fact that some friends are often hesitant to approach the mother out of fear of making the situation worse. Once again, the research indicates that couples often struggle with communicating their needs, or even their difference in needs as previously stated (Laakso & Paunon-Ilmonen, 2002).

This information regarding how men grieve differently, substantiates and relates to the research conducted by Schwab (1992). As mentioned earlier in the discussion regarding

Schwab’s study on sexual intimacy, most women were often disgusted by the spouse’s sexual desire given that the mothers felt as if the loss had not been dealt with. In these instances, the more in which a husband initiates any sexual contact, the more likely it is that the mother may want to distance herself from the husband. No evidence was found suggesting that the father’s ability to discuss the loss somehow affected the likelihood of the mother reciprocating any form of sexual activity. The research suggests that the mothers in the study were able to cope more effectively with the loss when the husband showed enough concern, as determined by the mother

(Schwab, 1992). It is these differences in the processing of grief that can for some couples be misunderstood, leading to feelings of alienation, loneliness, disgust, anger, and hurt all based on how one spouse perceives and interprets the action of the other.

Adjustment to Loss and the Return to Intimacy

Christ et al. (2003) highlighted the fact that most parents understand that they will never

“get over” the loss of their child. “Getting over” the loss of a child conveys the idea of being able to function in a way much like how they were prior to the loss. Assuming that someone can

20 function just as they once did may be an oversimplification of the grief process given that many people may never come to terms with the loss of their child. Parents might not fully accept the loss of a child, but they may create a new narrative about the meaning of losing a child. Rather than focusing on functioning as they did prior to the loss, it is helpful for parents to understand that life does not get better, but rather, becomes different. That difference in approach may help the parents navigate themselves through the world with the hardship of losing a child. (Christ et al., 2003).

Despite the undeniable tragedy of the loss, many parents report that the death of their child is not a completely negative experience. Some report positive, perspective or life changing outcomes due to the loss (Christ et al., 2003). For example, the loss may trigger newfound appreciation for life in those that have survived, and the loss can help to redefine what is important in one’s life (Christ et al., 2003).

Specifically regarding changes in intimacy, Benfield, Leib, and Vollman (1978) suggest that while low intimacy due to loss of a child can cause distance between couples, some members of the bereaved parent population experience a type of closeness that actually strengthens the couple’s bond. Specifically, some studies suggest that up to 25% of couples who lose a child experienced an increased level of closeness with their partner. This suggests that while the death of a child is inarguably devastating and life-altering, couples can benefit from the understanding that relationships can survive the painful experience of losing a child (Benfield,

1978).

Honoring the Loss

Prigerson and Jacobs (2001) indicate that couples continuously report that their preferred way of addressing the loss of a child is by allowing space for a discussion of that loss. By

21 seeking therapy or support groups for people who have gone through similar circumstances, bereaved couples can voice their experience with someone who listens and provides empathy.

Once again, every grief process is unique to the person experiencing that grief. By understanding the uniqueness of grieving, families may start to recognize that there is no one way of healthy grieving (Prigerson & Jacobs, 2001). According to Forrest, Standish, and Baum (1982), whether through therapy or support groups, the earlier that a couple receives grief services, the more effective they can be in their grief process.

In a study by Emily Margaret Brown (2016), five emotion-focused therapy (EFT) therapists who incorporate EFT in grief therapy were interviewed. The therapists state that it is imperative that grief work allows for a space in which all members can honor the loss. They express that minimizing the loss and focusing solely on the marital relationship will only

“hinder” the therapeutic process. These therapists feel that by honoring the loss, clients in the group felt heard and validated. Through these therapist interviews, Brown (2016) identifies four themes that came out of the task of the honoring the loss task. These themes include: focusing on the grief, adjusting the pace of therapy, encouraging storytelling, and providing psycho- education (Brown, 2016).

Focusing on the grief. By helping the clients focus on the grief, the therapists use this opportunity to dissect and explore emotions and conversations amongst the couple (Brown,

2016). This facilitates the process of having these difficult discussions that in some cases may be ignored. Focusing on the grief allows for the therapists to help in troubleshooting behaviors and interaction patterns that are not conducive to couples building safe and secure attachment patterns. For example, if a spouse is indicating that they he or she is slowly detaching from the

22 conversation, the therapist can help redirect him or her towards the partner who is willing to be open (Brown, 2016).

Adjusting pace of therapy. Given the heavy nature of grief and bereavement, the pace of therapy is often a lot slower than in typical EFT (Brown, 2016). As explained by Sue Johnson

(2002) regarding the topic of and dealing with trauma,

“The multidimensional nature of the after effects of trauma implies that to effectively

treat trauma, we need to use different interventions to hit different targets. The

therapist’s goal must be not to just lessen the distress in a survivor’s relationship, but to

create a secure attachment that promotes active and optimal adaptation to a world that

contains danger and terror, but is not necessarily defined by it” (page 10).

By pacing the of therapy, the therapist allows for safety and to grow amongst members in the group (Brown, 2016). Doing so helps the therapist meet their clients where they are at in terms of their grief process.

Encouraging storytelling. By encouraging couples to tell their story, the therapist provides a space for the couple to connect to the respective spouse’s experience (Brown, 2016).

Therapists report that it is helpful for the client to talk about favorite memories of the deceased as a way to invite the deceased’s presence into the room. By discussing stories about the deceased, the couple can be able to reflect on the importance of their attachment to the deceased.

Lastly, by encouraging the clients to tell stories about the deceased, the client allows the therapist to build greater rapport, which can help the therapist in understanding and validating the individuals experience (Brown, 2016).

Providing psycho-education. Providing psycho-education is also critical for EFT therapists as it is a way to help clients understand typical grief reactions, what can be expected

23 during the haphazard journey of grief, and typical stressors on a relationship following loss

(Brown, 2016). Psycho-education helps clients who feel isolated in their grief experience by normalizing common issues, thinking patterns, and behaviors. For example, psycho-education can help an individual understand their avoidant partner might emotionally detach from a situation when the individual him/herself vocalizes the needs of connection and intimacy

(Brown, 2016).

Dual Control Model of Sexual Function

In an effort to understand how context and events can affect sexual function, the dual control model (DCM) of sexual function will be discussed. John Bancroft, Cynthia Graham,

Erick Janssen, and Stephanie Sanders (2009) created the DCM, which is considered to be a conceptual device that researchers may use in order to develop other questions and hypothesis.

This model posits that the result of sexual response is dependent on two factors, both sexual inhibition and sexual excitation. In other words, a sexual “go” system interacts with a sexual

“stop” system which then determines sexual response. Within the context of a relationship in which both partners have contradictory sexual needs, the needs of one partner may be stronger than that of the other partner, which can create an imbalance of sexual desire (Bancroft et al.,

2009).

The sexual inhibition system (SIS) is divided into two factors. Factors that inhibit sexual function are both “inhibition due to threat of performance failure” (SIS1), and “threat of performance consequences” (SIS2) (Bancroft et. al., 2009) . For the SIS, even low-threat levels are sufficient in order to retain an inhibition response (Bancroft et al., 1999). One of the benefits of a high SIS is that it keeps people safe from unwanted , pain, reputation damage,

24 and contraction of STDs. In contrast, a low SIS response may result in the presence of the aforementioned risks (Bancroft et al., 1999).

Helen Kaplan created a similar model prior to the development of the DPM by Bancroft and his colleagues (Perelman, 2012). Her model shows that sexual motivation is governed by sexual incitors and sexual suppressors. Sexual incitors, as Kaplan describes, are both physiological and psychological factors such as testosterone, physical , an attractive partner, love, and . Sexual suppressors are physiological and psychological factors such as hormone disorders, drug side-effects, depression, an unattractive partner, negative thoughts, negative emotions, and stress (Perelman, 2012).

In the context of people that are interested in increasing sexual , researcher Emily

Nagoski (2018) explains, “the process of becoming aroused is the dual process of turning on the

“ons” and turning off the ‘offs”.

Efficacy of Grief Therapy and Grief Work

Regarding the results of grief therapy and grief work, the efficacy of grief therapy has largely remained ambiguous. As a response, researchers Neimeyer and Currier’s (2009) meta- analysis study highlights the efficacy of grief interventions. The research focuses on an accumulation of 60 controlled studies. The findings in this meta-analysis study reflect most of the conclusions of these studies, which indicates that there is limited support of most grief therapies. It is important to add that the majority of these studies have limited information of grief work among minority populations which may grieve vastly different than people within the majority of the population. In Neimeyer and Currier’s study, the researchers compare general psychotherapy with randomized and nonrandomized grief therapy. The study includes results both immediately after therapy and after an 8 month follow-up. Immediately following therapy,

25 general psychotherapy clearly outperforms grief therapy and results show only moderate support for grief therapy. Eight months after treatment, a follow-up indicates a clear decline in efficacy with little to almost no support for grief therapy, whereas general psychotherapy maintains similar levels of efficacy during the follow-up as it did immediately after treatment (Neimeyer &

Currier, 2009).

Upon further analyses of their research, Neimeyer and Currier (2009) isolated interventions and grief models that yielded good outcomes. A good outcome is determined as reaching a level of well-being similar to how the individual felt prior to the loss. The researchers find that the most effective interventions focus on helping individuals face the adaptation after the loss. Similar to the researcher’s results, recent research has been focusing on theories, models, and interventions that focus on adaptation after loss rather than on the process of grief itself. For example, the dual process model of bereavement by Margaret Stroebe and Henk Schut is based on processing the grief and processing a future without the deceased. Other interventions that the researchers deem helpful include written and oral interventions that focus on the adaptation process. This includes interventions that focus on constantly retelling or rewriting the event details surrounding the loss as well as writing prompts that help the individual heal. Another intervention would be a scenario where a therapist can guide the individual in having a dialogical encounter with the deceased in order to offer closure. Lastly, another intervention may be to set new life goals that are reflective of a new life without the deceased (Neimeyer & Currier, 2009).

Neiymeyer and Currier’s (2009) research offers hope by indicating a general trajectory of improvement among all groups in the study, including those who received general psychotherapy, grief therapy, and even those that received no treatment. The researchers add that

26 a recent review of quantitative studies on the topic of grief claims that addressing the loss from a cognitive-behavioral therapy approach is imperative. Neimeyer and Currier state that although it is crucial to dissect the loss by addressing relevant emotions, it would help the healing process by confronting the traumatic imagery associated with the loss as well as reconstructing negative thought patterns that cognitive-behavioral therapy provides. As previously mentioned, the researcher’s emphasize that future studies on grief therapy should focus on the adaptation-after- loss aspect of grief therapy. This approach, according to the researchers, should provide a guide in effective approaches that address the shortcomings that are evident in many grief therapies

(Neimeyer & Currier, 2009).

Conclusion

The purpose of this chapter was to provide current information related to the topic of sexual intimacy after child death. This chapter included beliefs about sexual intimacy after child death. Although some parents may think that their relationship may never be repaired after the loss of their child, this chapter provides information which illustrates that while a relationship may be fractured after loss, a couple can learn that they may eventually reach a point in which they can process the grief in a way that helps them create a stronger relationship together. The review also provides information on how gender differences can impact sexual intimacy after a child’s death. This information can be helpful for people that may benefit from understanding why their partner’s sexual behaviors may have changed as a result of losing a child. The chapter also provides various theories and models of grief and sexuality. Grief and sexuality are not linear concepts. Various theories and models apply differently to different people. This section can be helpful for parents that may feel lost in their process of grief and intimacy needs. Later, the chapter provides information on the effects of grief on bereaved parents. This section

27 incorporates the work of John Bowlby and emotion-focused therapy creator Sue Johnson as it relates to attachment styles and grief reactions. The literature review also provides a section that focuses on the adjustment to loss and return to intimacy. This section provides a guide for parents that actively want to process the grief that they have endured and to find a way to honor the loss of their child. Lastly, this chapter provides a section that outlines the efficacy of grief therapy and grief work. There is also an outline of the interventions that are more efficacious in helping parents grieve the loss of their child.

28 Chapter 3

Group Application

Target Population

The purpose of this project is to provide a space for information, care, and community for parents that are grieving the loss of a child. Due to the nature of the discussion, parents in the group will need to be 18 years and older. There is no limit regarding how long ago the loss must have taken place; any parent who has experienced the loss of a child may participate. There are also no restrictions based on the sexual orientation of parents. Unfortunately, due to the group material and format, individual and or single parents will likely be referred out as determined by the counselor and or facilitators since the group is designed for couples. It is, however, important to mention that there are also certain issues that would require the group counselor and or facilitator to refer the client to a more appropriate resource, such as a diagnosed or undiagnosed mental illness that could potentially hinder the goals of the group process. Lastly, since the purpose of the group is founded on grief and trauma, parents will be assessed for suicidality. Any individuals or couples that may be at risk of suicide will be properly assessed. Afterwards, they may be referred elsewhere as determined by the client’s risk of suicide. For this reason, all assessments would be conducted prior to the group start date.

Group Format

The proposed group would be held once a week for two hours each session over the course of 8 weeks. Due to the personal nature of the group topic, the group will allow for a maximum of 4 couples. Each session will present different information within the topic of sexual intimacy after the death of a child. For this reason, parents would be allowed two absences before services are terminated. All sessions will begin with a check-in discussion and end with a

29 check-out discussion, in order for individuals and couples to discuss relevant feelings about the group and their grief process as well as other issues. Every group session will have a psychoeducational component intended to inform clients about models, studies, and information on the topic of grief and sexuality. Couples will also have a chance to engage in interpersonal activities, since a portion of the project focuses on building intimacy outside of sexuality alone.

Counselors will also dedicate a portion of the session for clients to discuss their own experience as well as the information being presented so as to normalize feelings and create understanding by learning about other people’s process.

Group Rules

Typical occurrences within a group setting require a therapist to intervene when they feel that certain client practices or behaviors may deviate session goals or even create concerns for other clients in the group. For this reason, therapists are asked to stop clients from cross-talking while session is in progress. Therapists will also stop clients if they feel that a client’s account of events may be triggering to other clients in the group. The therapist is also allowed to self- disclose if they feel it could benefit the group discussion.

Group Outline

Appendix A contains the structure of the group. There is no specific time which the therapist dedicates to each step, but the creator of this project suggests being mindful of timing so as to allow time for psychoeducation, activities, and discussions.

30 Chapter 4

Summary and Recommendations

Summary of Project

As stated in the literature review, the topic of sexual intimacy after the loss of a child is unfortunately a complex experience that some parents have lived through. The purpose of the project is to provide current information on the topic of sexual intimacy after child death and to provide a place to process this information with a facilitator in a group setting. The group outline utilizes information from the literature review regarding beliefs about sexual intimacy after child death, gender differences in response to intimacy, theories and models related to grief and sexuality, the effects of grief on grieving parents, methods of adjusting after loss, honoring the loss, and information regarding the efficacy of grief therapy.

Recommendations for Future Considerations

Due to the specificity of sexual intimacy after child death, there is limited research on the effects of child loss on sexual intimacy in minority groups such as the Latino, Black/African-

American, and Asian populations. This author recommends that future researchers have these minority groups in mind in order to account for the various cultural differences in how intimacy is affected by grief. This information is imperative as some of these minority groups often feel isolated from resources that do not take into account the lived experience of being a minority.

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35 Appendix A

Session 1.

1. Group session will begin with an introduction of each person’s name and

information that the client feels is relevant such as the experiences of functioning

after the loss of one’s child. During the introduction, clients are not required to

disclose information that they do not feel comfortable in sharing.

2. After the check-in, the group will be encouraged to share some of their beliefs on

the topic of sexual intimacy, loss, or both.

3. The facilitator will use this opportunity to dispel myths and even present useful

psycho-educational information that the clients can expect to learn in the coming

sessions.

4. Group facilitator will discuss what is to be expected as far as group overview,

group goals, and group topics over the course of ten weeks.

36 Session 2.

1. The group session will continue with a check-in for the clients to discuss thoughts

and feelings that might have been brought up during the initial session.

2. After the check-in, the facilitator will begin the discussion by providing

psychoeducation on the topic of intimacy after loss.

a. This portion of the group will allow an opportunity for people to disclose

how the information relates to their experience after loss or in which ways

their experience differed from the information. Before beginning with this

discussion, the facilitator must emphasize that disclosure is not required.

3. After the discussion, the facilitator will introduce the concept of Kubler-Ross’

stages of grief.

a. The group will once again have an opportunity to share their thoughts on

the concept, in which stage they believe they may be in, and or if this

concept is helpful in any way.

4. Afterwards, the group will begin a check-out to discuss parts of the session that

were helpful, part of the group that were not as helpful, or any relevant

information regarding their bereavement process.

5. After the check-out, the group will begin a 3-3-6 breathing exercise in order to

possibly help regulate feelings of anxiety or distress.

37 Session 3.

1. The group session will continue with a check-in for the clients to discuss thoughts

and feelings that might have been brought up since previous session.

2. After the check-in, the facilitator will provide psychoeducation on the Maternal

and Paternal experience after the loss of a child.

a. After introducing information on the Maternal and Paternal experience

after the loss of a child, the facilitator will open a discussion on how

clients relate to the information provided or how they do not relate to the

information provided.

3. The facilitator will then follow-up with the group about any thoughts surrounding

Kubler-Ross’ stages of grief that were discussed during the previous week as it

relates to the psychoeducational information that was just presented.

4. After the discussion, the facilitator will once again provide an overview of what is

to be expected during the next few weeks.

5. The group will continue with a check-out to discuss parts of the session that were

helpful, part of the group that were not as helpful, or any relevant information

regarding their bereavement process.

6. Session will end with a meditation exercise

38 Session 4.

1. The group session will continue with a check-in for the clients to discuss potential

concerns as well as thoughts and feelings that might have been brought up since

the previous session.

2. After the check-in, the facilitator will open a discussion on the effects of grief on

bereaved parents while also providing psychoeducation.

a. During this discussion, parents will have an opportunity to discuss their

experience with the topic presented, discuss how their experience may

have differed, and even discuss techniques and practices that they have

engaged in to help alleviate some of the symptoms of their grief.

3. After the discussion, the facilitator will introduce Stroeb and Schut’s Dual Process

Model of Bereavement.

b. After introducing the model, the group will have a chance to discuss

model as a different perspective in processing grief.

4. The group will continue with a check-out to discuss parts of the session that were

helpful, part of the group that were not as helpful, or any relevant information

regarding their bereavement process.

5. Session will end with a meditation exercise

Homework:

Take attachment test and bring to following meeting.

https://yourpersonality.net/attachment/

39 Session 5.

1. The group session will continue with a check-in for the clients to discuss potential

concerns as well as thoughts and feelings that might have been brought up since

the previous session.

2. After the check-in, the facilitator will begin discussion on Attachment styles.

3. After the discussion on attachment styles, the group will discuss how their

attachment styles relate to grief reactions.

4. The group will then discuss “Attachment Test” results.

a. Facilitator will use this time to provide space for clients and or couples to

possibly share their feelings and interpretations about their results.

5. The group will continue with a check-out to discuss parts of the session that were

helpful, part of the group that were not as helpful, or any relevant information

regarding their bereavement process.

40 Session 6.

1. The group session will continue with a check-in for the clients to discuss potential

concerns as well as thoughts and feelings that might have been brought up since

the previous session.

2. After the check-in, the facilitator will begin psycho-education on the “Dual

Control Model of Sexual Function” as a concept.

3. The facilitator will provide space for the clients to share what factors contribute to

their excitation and inhibition. The facilitator will remind the group that these

factors do not have to be sexual in nature.

4. Afterwards, clients and or couples will have an opportunity to discuss how the

“Dual Control Model of Sexual Function” relates to themselves. The group will

also be able to discuss how the information on the model relates to the

information from previous sessions.

5. The group will continue with a check-out to discuss parts of the session that were

helpful, part of the group that were not as helpful, or any relevant information

regarding their bereavement process.

41 Session 7.

1. The group session will continue with a check-in for the clients to discuss potential

concerns as well as thoughts and feelings that might have been brought up since

the previous session.

2. After the check-in, the facilitator will provide a psycho-educational handout on

“Worden’s four tasks of mourning”.

3. After the psycho-education, the facilitator will provide a space for clients to

discuss the information such as where they are along Worden’s tasks, what issues

they foresee, and what their feelings are regarding Worden’s tasks.

4. The group will continue with a check-out to discuss parts of the session that were

helpful, part of the group that were not as helpful, or any relevant information

regarding their bereavement process.

42 Session 8.

1. The group session will continue with a check-in for the clients to discuss potential

concerns as well as thoughts and feelings that might have been brought up since

the previous session.

2. After the check-in, the facilitator will provide a space for clients and couples to

discuss the issue of adjustment after tragedy.

3. After the discussion, the group will discuss their practices and experiences in

honoring the loss of their loved one.

4. As part of the final session, the group will have an opportunity to discuss their

experience within the group. Client’s will be encouraged to share what was

helpful throughout the group process, what was difficult, how their bereavement

process has changed (if at all), and what they plan on taking into the future.

5. Facilitator will provide relevant resources on bereavement and discuss the

possible benefits of continuing to receive trauma-focused therapy as an individual

and as a couple.

43