Intervention Strategies for Life Trauma Issues & Death

On the last track we discussed The Positive Side of Grief.  In my practice I have found three positive sides of grief.  They are the appreciation of life, strengthening of family ties, and finding meaning in suffering. 

On this track we will discuss The Three ‘D’s of Grief.  The Three ‘D’s of Grief refer to forms of emotional and physical numbing I have found to be common among clients experiencing grief.  The Three ‘D’s of Grief are dissociation, de-realization, and depersonalization.  As I describe The Three ‘D’s of Grief, you may want to evaluate clients you are treating for susceptibility to these forms of hypo-arousal. 

As you may know, episodes of dissociation, de-realization, and depersonalization may vary in intensity and duration.  I have found that though some cases last only a few hours, other cases can last several years. 

The Three ‘D’s of Grief

#1 Dissociation
As you are well aware, there are many kinds of dissociation.  However, I have found that, fundamentally, dissociation refers to a disconnection between experience and emotion, or between mind and body. See if any of these dissociative remarks sound familiar:

Here is grieving client observation
-- Number One:
"It’s like I’m outside of my body looking in."
-- Number Two:
"I have no idea what I’m feeling"

Dave, age 17, made a third dissociative observation when he stated, "I knew I should have felt something, but I didn’t feel anything."  Dave was referring to an accidental cut to his hand which happened several days after his best friend, Jeremy, died from a drug overdose.  Dave stated, "It was a deep cut.  The doctor gave me 9 stitches.  At first, I just watched the blood flowing out.  I didn’t feel any fear or pain.  I knew what was going on,  I just didn’t care.  Then my mom saw it and she freaked.  Her scream sort of woke me up, I guess."   Later on this track, I will describe a technique I suggested Dave use to avoid similar dissociation.

#2 De-realization
The second D of grief is de-realization. As you may already know, de-realization refers to another manifestation of mental disconnection.  In my experience, grieving clients who suffer from de-realization don’t feel as if they are real.  I have also found that clients may feel as if events and circumstances are not real. 

Susan, age 32, experienced residual grief from a childhood trauma of being beaten by an uncle who was her baby sitter.  Susan experienced periodic moments of de-realization through an altered perception of time and a general feeling of detachment.  Susan stated, "I feel like I’m in a dream or a play or something when I think about what he did to me.  I don’t even know if the play is real.  Most of the time, I hope it’s not." 

#3 Depersonalization
In addition to dissociation and de-realization, the third ‘D’ is depersonalization or the client’s feeling of  detaching from humanity.  Have you treated a client who feels less like a person and more like a robot?  I have found that clients who suffer from depersonalization may have little or no motivation to take care of themselves.  Susan also suffered from depersonalization.  Susan explained her depersonalization experiences when she stated, "Sometimes life feels mechanical.  I’ll take a shower or brush my teeth, but not because I care about how I look.  It’s like I’m just going through the motions." 

To find out more about how depersonalization and de-realization affected Susan, I asked,  "Do you find it very hard to relate to the other people in your life?"  Susan stated, "Yeah.  It’s hard for me to talk to other people because I feel so dead inside.  I try to relate anyway, but I get so confused."  Like other grieving clients I have treated, Susan had to work hard to overcome the confusion and apathy that can accompany the three ‘D’s of grief.  I asked Susan how she felt when mechanical feelings affected her ability to think, respond, or even talk.  Susan stated, "I feel determined to concentrate, but it takes a lot of energy.  I get more and more tired when I try to interact with others.  It doesn’t take long before I’m ready to just go home and be alone." 

Technique: Partial Involvement
I showed Susan, as well as Dave who was experiencing dissociation, the Partial Involvement technique.  I find that the Partial Involvement technique is useful for clients when they become overwhelmed in social situations like Susan often did.  As you may already know, the Partial Involvement technique provides clients with a method for restructuring social interactions.  Restructuring her social interactions to better suit her ability to interact with others helped Susan to overcome her phases of depersonalization.  I explained to Susan that there are three factors to consider when implementing the Partial Involvement technique.

3 Factors of the Partial Involvement Technique
--The first factor is Limiting Time.  Susan began to attend social functions in which she could limit the time of her involvement.  Susan stated, "Limiting my time lets me stay only as long as I feel right.  As soon as I start feeling dreamy or mechanical, I can go." 

--The second factor is Structuring Activities to Meet Your Needs.  I stated to Susan, "Some social activities are more demanding than others.  For example, it’s easier to go to a movie or attend a play than to go to a party or have a deep conversation."  When Susan was feeling numb, she began to structure activities that were relatively non-demanding.

--The third factor in the Partial Involvement technique is Having an Exit.  Regardless of the activity Susan was attending, she had an exit.  Susan stated, "It’s pretty simple to leave without lying to anyone.  If I start feeling numb, I just say ‘I’m sorry, but I’m not feeling well and need to leave.  I’d hoped to stay longer, but I can’t.  Thanks for having me, though.’" 

Susan’s experience with two of the three ‘D’s of grief was minimized through the Partial Involvement technique.  After several sessions of grief-processing work, Susan had fewer and shorter phases of depersonalization and de-realization.  I encourage you to play this track for your client, if he or she could benefit from hearing about Susan’s experience with the three ‘D’s of grief.

On this track, we discussed The Three ‘D’s of Grief.  The Three ‘D’s of Grief are dissociation, de-realization, and depersonalization.

On the next track we will discuss replacement children.  The case study on the next track represents grieving clients who chose adoption shortly after beginning their grief-processing work with me.

Online Continuing Education QUESTION 10
What are the three ‘D’s of grief? To select and enter your answer go to CEU Answer Booklet.