悲傷輔導

授課教師：李菁蓉
 沒有一個所謂合適的時刻，能夠減輕喪
親的打擊。
喪親衝撞著日日夜夜、分分秒秒，它狂
暴的引起內心最強烈的情感和衝動。

～ Rata Robinson
If I can stop one Heart from breaking

If I can stop one Heart from breaking

I shall not live in vain
If I can ease one Life the Aching
Or cool one Pain

Or help one fainting Robin

Unto his Nest again
I shall not live in Vain.

by Emily Dickinson
Loss is happening
and
grief is on its way.
 Loss is defined as a “separation from, a
detachment from something or someon
e of value.”

 Grief : 是指一個人遭遇失落或被奪去心愛的人
或物時所產生的一種悲哀、憤怒和罪惡感的感覺
。

Loss-> Grief
Grief is universal but unique.
 悲傷反應
一、生理：神經質、憂鬱、害怕會發瘋、持續的恐懼
、夢魘、失眠、工作能力減退和疲勞等症狀。

二、認知：不相信、健忘、混亂、精神不集中。

三、情緒：憂鬱、悲傷、痛苦、困難和負擔的減輕、
罪惡感與憤怒、否認。

四、行為：失眠、驚醒、食慾反常、恍惚、心不在焉
、從社會人群撤退、哭泣 常探氣、過度活動、避開
死者的遺物。
 Bowlby- Bereavement stages
 第一階段：麻木、衝擊時期（ numbing a
nd impact ）。
 第二個階段：渴念、退縮和尋找的時期（ y

earning and searching ）。

 第三個階段：解組和絕望的時期（ disorga

nization and despair ）。

 第四個階段：重組和回復時期（ reorganiz

ation or recovery ）。
Grief counseling
 What grief counseling is ?
 Assisting people to change or to cope with
change that has occurred
 Helping people to express of emotion and
thought about the loss, including sadness,
anxiety, anger, loneliness, guilt, relief, isol
ation, confusion, or numbness.
 Facilitateing the process of resolution in th
e natural reactions to loss.
 Thinking creatively about the challenges th
at follow loss, and coping with concurrent
changes in their lives.
 Why grief counseling?
 Individual and family geographic
living arrangements are changed.
 Technology has altered the lifespan
 Survives are eroded
 The health care decisions are
becoming more prevalent and
difficult.
 Cost and legal issues
 Traumatic and violent deaths
 Purpose
 To offer a place to feel and
experience grief and other untouched
feelings.
 Helping people facilitate
uncomplicated, or normal, grief to a
healthy completion of the tasks of
grieving within a reasonable time
frame.
 治療目標
 增加失落的現實感。
 協助當事人處理已表達的或潛在的情感。
 協助當事人克服失落後再適應過程中的障
礙。
 鼓勵當事人向逝者告別，以健康的方式，
並坦然地重新將感情投注在新的關係裏。
 Who needs it?
 Individuals
 Families
 Schools
 Agencies
Abnormal
 Organizations normal

 Communities
 Effectiveness in Counseling
 The basic characteristics of a helping
relationship are:
• Accurate empathy
• Non-possessive warmth
• Inherent genuineness
Character Qualities of counselors

• Humility
 accurate self-assessment, flexibility of spirit
• Love
 encouragement & hope, servant attitude
• Faithfulness
 dependability, discipline
• Spiritual Maturity
 personal holiness, Biblical/theological wisdom
Functional Qualities of Counselor
• Building relationships
 gentleness, kindness, sensitive, peacemaking

• Understanding the counselee’s environment

 data gathering, uncovering heart issues, Biblical

interpretation
• Communicating
 listening, other-centeredness, clarity presenting

gospel
• Planning Action
 application, oversight/accountability,

encouragement/admonition
 Ministry
 Caught = the condition (sinfulness)
 Restore = the mission (heart
transformed)
 Gently = the attitude/character (do no
harm)
 Watch = the protection (watch self &
ministry)
 Carry = daily goal (help bear burdens
in personal relationships with people)
Context for Effective Counseling
 Safe environment - safe, “holding” environment
 Comfortable - lighting; air; furniture; tissues
 Confidentiality - “white” noise; not alone
 Non-distracting Clock(s)
 Furniture Arrangement - extra chairs & couch
 Forms & Record-keeping
 Lending Library
 Referral Network in place
 When does it take place?
 When people are grief, as a normal r
eaction to loss.
 When people not able to cope with l
oss as they have in the past or are in
dividuals not being provided the sam
e type of support they received in pr
evious generations.
 Where Is Counseling Done ?
 Hospitals
 Mental health clinics
 Churches
 Synagogues
 Chemical dependency inpatient and out-patient
programs
 Schools
 Funeral home aftercare programs
 Employee assistance programs
 Programs that serve chronically ill or terminally ill
persons
 Adult or juvenile service locations for criminal
offenders
 Private practice.
 In What Format?
 Sessions are approximately one hour in length, or
longer for individual sessions.
 Groups are either closed or open
 A fee is paid by the person utilizing the grief
counseling or grief therapy service and is either
paid on a sliding scale or by self-pay, third-party
insurance, victim assistance programs,
community charitable care programs, or some
other type of financial arrangement.
 Assessment
 Distinguish between:

•CONTENT
•PROCESS
 Assessment
 The psychosocial domains: with a view to optimizi
ng control of symptoms, maintaining psychologic
al integrity and finding meaning in the chaos.
 What did the illness mean to them ?
 What are their coping styles ?
 What is the extent of the social network ?
 What are the strengths and weaknesses of major
relationships with health care providers ?
 What are the major stressors ?
 What spiritual resources are available ?
 Are there psychiatric vulnerabilities ?
 Are there financial issues ?
 Assessment
 CONTENT: “laundry list” of items or
complaints

 PROCESS: the dynamics of the major

issues;
the source of the “laundry list”

 Need to focus on both; especially

process.
 Immediate need
 Compassionate attention
 Validation of their loss
 With time and permission to grieve
 The Phases of Counseling
 Beginning

• Middle

 Ending
 The Phases of Counseling 2
 Beginning: joining; establishing
rapport; & assessment

 Middle: changing; ebb & flow of

progress

 Ending: consolidating changes;

blessing; termination
Assessment: The “Magic” ???s
1

• These questions are “magic” in the sense that “they pro

vide focus and perspective on almost any situation, ena
bling one to know at least something about how to deal
with it.”

 Question #1 - “What are you looking for?”

• Focus: communicates it’s their responsi

bility
• Perspective: helps identify their needs
Assessment: The “Magic” ???s
2

 Question #2 - “Why now?”

• Focus: identifies the urgency

• Perspective: sense of
hopefulness/possibility*

 Things have changed and, thus, can change again

Assessment: The “Magic” ???s
3

 Question #3 - “Why me and this

place?”

• Focus: acknowledges the importance of

the relationship
• Perspective: identifies unrealistic
expectations
Assessment: The “Magic” ???s
4

 Question #4 - “What hurts?”

• Focus: the person’s problem or concern

• Perspective: listening stance

 協助哀慟者渡過悲傷期
一、悲傷者必須接納失落的事實 (To Accept the Reality of the Los
s)

二、悲傷者必須接納哀慟是痛苦的 (To Experience the Pain of Grie

f)

三、悲傷者需要適應那已無死者存在的環境 (To Adjust to an Enviro

nment in Which the Deceased is Missing)

四、悲傷者需要把過去投入在死者的情感轉移到新的其他關係 (To Wit

hdraw Emotional Energy and Reinvest It)

-Worden
 Approaches Used
 Art and music therapy
 Meditation
 Creation of personalized rituals
 Bibliotherapy
 Journaling
 Communication with the deceased (through writing, conver
sations, etc.)
 Bringing in photos or possessions that belonged to the pers
on who has died
 Role playing
 Bearing witness to the story of the loved one
 Confiding in intimates
 Participating in support groups.
 The "empty chair" or Gestalt therapy technique
 措施
一、強化死亡的真實感
二、鼓勵悲傷者適度地表達悲傷情緒
三、幫助悲傷者適度地處理依附情結
四、從短期危機處理到長期悲傷療程
 一、強化死亡的真實感
 生者必須接納「死不復生」的事實
 鼓勵生者面對死亡和談論失落。

例如：事件發生時你在哪裡？當時的情況
怎樣？如何發生的？是誰告知你的？葬禮
怎麼舉行的？親友們是如何談這件事？
二、鼓勵悲傷者適度地表達悲傷情緒
 認識悲傷情緒和行為是一種「正常的」，進而鼓勵做適度
地表達以紓解不安。
 察覺失落對悲傷者的意義及衝擊。

例如：憤怒的情緒對象是誰？愧疚的具體內涵是什麼？幻
聽、幻覺、幻想的內容是什麼？

 適當且有效地予以評估，檢定出較為明確的問題焦點。
 引導悲傷者表達悲傷情緒時，談到與逝者的往事最好從鼓
勵正向的回憶開始。
 輔導再經驗對逝者的矛盾情緒。
三、幫助悲傷者適度地處理依附情結
 瞭解悲傷者在處理與逝者的依附關係所面對的問題。
 幫助生者適度地處理與死者的依附情結（ attachment c
omplex ），讓他確認與逝者之間過去所扮演的依附關係
已經結束。
 幫助生者扮演新的角色、建立新的關係。
 協助生者面對生存或生活上的質疑。

＊＊＊不要鼓勵還處在劇痛期的悲傷者做任何重大改變生活
的決定，如變賣財產、改行、換工作、領養孩子、或很快
跳入一個新的親密關係中。
-> 當他準備好時，自然就有能力做決定並採取行動。
四、從短期危機處理到長期悲傷療程
-> 「休克危機」（ shock crisis ）：因為環境在非常急速中改變
，以致生者無足夠的時間、精力與資源來應變，造成一種情緒上
的休克

-> 源盡危機（ exhaustion crisis ）：生者可能在一段時間內有效

地適應一些緊急的情境，但當他竭盡他的適應資源（能力）。

 運用『危機處理』的方式，來發掘並協助因為危機直接受影響的
生者之內在、外在資源，以增強其處理及運用資源的能力，解決
目前的困擾問題。

 協助生者在短期內減除危機障礙和促進生活適應能力。

 個別輔導是及團體輔導方式。
 五、輔導者應有能力辨認「正常
的」與「病態的」的悲傷行為
 正常的」與「病態的」的悲傷行為分野
-> 常態的悲傷期間所表現而定。

 如果悲傷者過了正常的悲傷期，還有下列的不良
防衛或適應型態，例如：退縮、拒絕正視逝者遺
像，表示悲傷者還停留在不真實感，而採取不健
康的心理防衛機轉來減輕其焦慮。

 必要時需要轉介。
 六、輔導者不要採用陳腔爛調
來撫慰悲傷者
 例如：「做個勇敢的男孩！」、「生活是為了活下去」、
「一切很快就會結束」、「你會站起來的」、「一切將在
一年內過去」「你會變好的」；「堅忍到底」．．．．等
等太過籠統卻毫無幫助的「安慰話」。
　
 人們必須藉由表達悲慟來哀悼失落，宣告分離，並且重新
建立新關係。

 否則，必會造成身心的不適和疾病，而無法走過悲傷。
 Ten Helpful Guidelines
 Accept emotions.
 Express feelings.
 Don’t expect miracles overnight.
 If you have children, bring them into the grieving process.
 Don’t escape into loneliness.
 Keep in touch with your friends.
 Join a support group.
 Counseling may be very beneficial.
 Be nice to yourself.
 Turn pain into growth.
 Remaining active in social roles.
 Evaluation of changes
(1) Subjective experience
(2) Behaviors
(3) Symptom relief.
 When to referral?
 When grief is present more than 2
months after a loss, a diagnosis of
major depression should be
considered.

 Dysfunctional grief accompanied by

severe depression and suicidal
intent.
 Never Underestimate
the Effectiveness of . . .
the Ministry of
Listening
 結論
 協助人們在合理時間內，引發
正常的悲傷。
 健康地完成悲傷任務，以增進
重新開始正常生活的能力。
 以協助生者處理與逝者之間因
為失落而引發的各種情緒困擾
並完成未竟事務。