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Section 5
Ineffective Grief Counseling

CEU Question 5 | CEU Test | Table of Contents | Grief
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed Shattering Assumptions.  As you may know, grieving clients may be forced to reconsider three assumptions about themselves.  They are the loss of invulnerability, the loss of an orderly world, and the loss of a positive self-image. 

On this track, we will discuss Secondary Wounding.  As you may already know, secondary wounding occurs when the people the client turns to for support respond in a way that further injures the client.  In my practice, I have found five basic types of secondary wounding experiences. They are disbelief, discounting, ignorance, labeling, and cruelty.  As I describe the five types of secondary wounding, you may want to use this as a checklist to evaluate a client you may be treating.

Five Basic Types of Secondary Wounding

#1 Disbelief
Sarah, age 23, was sexually assaulted by a stranger.  Sarah stated tearfully, "After I was attacked, I felt really alone.  My boyfriend dumped me because he thought I was making up stories to get attention.  He actually called me a liar."  Clearly, Sarah was experiencing secondary wounding through disbelief.  Her boyfriend’s disbelief led to Sarah feeling as though she could not relate to anyone regarding her trauma.  I stated to Sarah, "Disbelief is a form of denial.  Do you think he disbelieved you because he was afraid to face the reality of the attack?"   
Sarah stated, "Yeah, but so what?  Maybe it would be easier to pretend it never happened."  As you can see, Sarah’s secondary wounding experience was in danger of preventing her from continuing the healing process.

#2 Discounting
Sarah also suffered from the secondary wound of discounting.  Sarah’s sister made statements minimizing the effect of the trauma and the magnitude of the event.  Sarah explained her sister’s discounting when she stated, "It seems like no one cares that I was attacked.  After my boyfriend called me a liar, my sister told me I was overreacting.  I feel like shit about myself!!  Maybe I deserved what I got!"  As a client experiences discounting of the trauma, he or she may begin to feel that it is their fault that the event had such a profound impact.  Would you agree that this type of secondary wounding can result in low self-esteem?

#3 Ignorance
In addition to disbelief and discounting, the third type of secondary wounding is ignorance.  As you know, ignorance plays a major role in secondary wounding experiences.  Would you agree that people who have no experience with trauma often do not know what to say or how to respond to a client?  As with disbelief, secondary wounds caused by ignorance can result in clients feeling unable to relate to anyone regarding their trauma. 

#4 Labeling
As you may be aware, one of the social consequences for clients who are traumatically victimized is being labeled a victim.  You are well aware that once clients become so labeled, others have a tendency to interpret most, if not all, of the client’s actions in terms of that label.  Furthermore, once labeled, it may be difficult to escape from that label.  It may also be assumed that because clients suffer ill effects from trauma that those effects are irreversible. 

For example, prior to the sexual assault, Sarah worked as a department manager.  Her supervisor assumed that because Sarah had taken a few days off work and attended a rape crisis group, she would be unable to function as a department manager.  Sarah stated, "When I went back to work, my boss asked me to serve as a receptionist instead of department manager.  When I asked why I was being demoted, my boss said it was because she didn’t know if I could emotionally handle a management position."  Would you agree that Sarah’s boss had labeled her a victim?  Do you have a client you are currently treating that is being labeled as a victim.

#5 Cruelty
In addition to disbelief, discounting, ignorance and labeling, cruelty is the fifth type of secondary wounding.  As you probably know, almost all secondary wounding experiences are cruel.  Therefore, it may be difficult to determine whether the person involved is trying to cause pain or whether the pain is the result of disbelief, discounting, ignorance or labeling.  Would you agree that sometimes cruelty is combined with the other types of secondary wounding?

3-Step "Dealing with Secondary Wounding Experiences" Technique
To help Sarah, who suffered from a sexual attack, identify and heal her secondary wounds, I decided to try the "Dealing with Secondary Wounding Experiences" technique. 

--The first step is to identify specific secondary wounding experiences.  Sarah identified three distinct secondary wounding experiences.  The three Sarah identified were disbelief from her boyfriend, discounting from her sister, and labeling from her boss. 

--The second step in the "Dealing with Secondary Wounding Experiences" technique is to identify specific emotional responses.  I asked Sarah what feelings she experienced from each of her secondary wounds.  Sarah stated, "I feel anger, pain, disgust, and sorrow.  I also want to get back at all of them for hurting me even more." 

-- In addition to identifying specific secondary wounding experiences and identifying specific emotional responses, the third step is to consider the effects of the secondary wounding.  I asked Sarah if her secondary wounds altered her self-image, relationships, or ability to participate in groups. 

Sarah stated, "I always thought I was a good person.  So why would everyone close to me try to hurt me more?  I thought friends and family were supposed to support each other."  I stated to Sarah, "They are, but your friends and family are just as hurt as you by the attack.  They are afraid to acknowledge that you were hurt.  If you can forgive them for not knowing how to react to you, you can take away the power of these secondary wounds." 

Would you agree that  Sarah’s ability to forgive others while experiencing her own pain and grief may help her through the healing process?  In a later session, Sarah stated, "I don’t feel so bad now.  I know why my friends and family said the mean things they said.  I forgave them and they apologized.  Now we can actually talk about what happened and I don’t feel like such an outsider."

On this track, we discussed  five basic types of secondary wounding experiences. They are disbelief, discounting, ignorance, labeling, and cruelty.

On the next track, we will discuss Healing Self-Statements.  In the version I use, there are three steps in helping clients to create healing self-statements.  They are considering grief neutrally, identifying needs, and identifying strengths.

Peer-Reviewed Journal Article References:
Bonanno, G. A., & Lilienfeld, S. O. (2008). Let's be realistic: When grief counseling is effective and when it's not.Professional Psychology: Research and Practice, 39(3), 377–378.

Delelis, G., & Christophe, V. (2018). Motives for social isolation following a negative emotional episode. Swiss Journal of Psychology, 77(3), 127–131.

Diminich, E. D., & Bonanno, G. A. (2014). Faces, feelings, words: Divergence across channels of emotional responding in complicated grief. Journal of Abnormal Psychology, 123(2), 350–361. 

Jordan, A. H., & Litz, B. T. (2014). Prolonged grief disorder: Diagnostic, assessment, and treatment considerations.Professional Psychology: Research and Practice, 45(3), 180–187. 

Smith, K. V., & Ehlers, A. (2020). Cognitive predictors of grief trajectories in the first months of loss: A latent growth mixture model. Journal of Consulting and Clinical Psychology, 88(2), 93–105.

Taylor, S. (2020). Transformation through loss and grief: A study of personal transformation following bereavement. The Humanistic Psychologist. Advance online publication. 

Online Continuing Education QUESTION 5
What are the five basic types of secondary wounding experiences? To select and enter your answer go to CEU Test.

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