MentalHealthCE Course Page: trkNDAbb306

In the last section, we discussed aspects of clients who are suffering from unresolved anger: how they deal with their anger, the targets at which they direct their anger, and forgiving their targets.

Commonly, after a client has experienced severe trauma, he or she has also experienced several losses. However, because the common conception of grief is mourning for losses of life, many clients never truly complete the grieving process.

In this section, we will examine the three levels of grieving losses which include: grieving specific losses, grieving the realization of powerlessness, and grieving mortality. We will address PTSD resulting from natural disasters.

3 Levels of Grieving Losses

♦ #1 Grieving Specific Losses
The first level, grief over specific losses, is the most well-known type of grief, one in which people, objects, or physical, emotional, or spiritual losses are defined and grieved for.

To help my clients recognize these specific losses, I give them four categories to consider when identifying their losses:

Financial Losses. Obviously, money, though not as important as other losses, can be a great blow to anyone who has experienced economic troubles. I tell my clients that there are two types of financial losses: direct and indirect. Direct refers to those items that had a price sticker at one time such as: cars, medical bills, legal fees, damaged property and so on. Indirect losses refer to the cost of lost opportunities such as career opportunities that were out of bounds due to physical or psychological wounds.
Emotional Losses. These include emotional symptoms that the clients have suffered such as: anger, fear, and anxiety. It can also refer to limitations resulting from trauma such as: social, vocational, and other aspects of their life. I also ask my clients to consider how the trauma affected his or her family and include that in their emotional losses.
Medical and Physical Losses. Obviously, these include any injuries and handicaps, either physical or mental, resulting from the trauma. I also ask my clients to list how these losses have affected their lives such as their job, relationships, sex life, creative pursuits, etc.
Philosophical, Spiritual, and/or Moral Losses. Many times, traumatic events spark skepticism in people about the kindness of humanity or the existence and benevolence of God. I ask my clients to list the many groups, organizations, religions, or beliefs that they have since ceased believing or have at least begun to doubt as a result of their traumatic experience.

By dividing losses into these four categories, clients have a much easier time naming their losses and thus a much easier grieving process.

♦ #2 Grieving the Realization of Powerlessness
The second level of grieving, grieving the realization of powerlessness, involves the client realizing that what they have lost maybe gone forever and will never be regained. This takes a great action of the will from the client to admit that they have no control over what’s happened to them.

Many survivors of natural disasters struggle with this due to their hesitancy to accept the severe feelings of helplessness that overwhelmed them during the catastrophe.

Caleb was nine years old when his mother and father died in a fire from a freak lightning bolt. Even though Caleb was relatively young at the time of the incident, he still acutely felt the feelings of helplessness.

From that moment on, Caleb suffered from highly developed survivor’s guilt, stemming from the belief that if he had been present, he might have woken up his parents and saved them. As we discussed in section 6, survivor guilt results from the refusal to accept powerlessness as a fact of life. Now, at 16, Caleb still feels responsible somehow for the death of his parents.

♦ Technique: Percentage of Responsibility
To help Caleb accept his powerlessness in the situation, I found the "Percentage of Responsibility" technique helpful.

I asked Caleb to answer and complete the following questions and commands that I put to him truthfully:

Verbalize the details of the event in the first person.
What percentage of the event are you responsible for? Are you sure? Is it possible that the percentage is more than that; or less?
Who else shared responsibility? Others at the scene, people distant from the scene? Societal influences?
Recalculate responsibility so that the total is 100 percent, and accurately focus on what you did and did not do.
Describe how much you have suffered for the responsibility you have assigned yourself.

Caleb stated, "The lightning struck our house, and caught the roof on fire first. I wasn’t there, but I saw it afterwards and I saw the fire alarm that hadn’t gone off that could have saved my parents. I guess I give myself about 35 percent responsibility." I asked him, "Did you cause the storm?" Caleb responded that, no, he hadn’t. I then asked him, "Oh, then you destroyed the fire alarm that didn’t go off?"

He responded, "No, I didn’t!" I said, "Well, then was it your responsibility to change the batteries?" Caleb said, "No, I couldn’t even reach that high." Then I asked him, "Did you know in advance that the lightning was going to choose your house on the same night that you spent the night at your friend’s house?" Caleb stated, "No." I then asked him, "How much percentage do you give yourself now?"

Caleb recalculated, "I guess I give myself…5 percent." I asked him, "Why five percent Caleb?" He responded "Because if I had been there, I could have woken them up." I stated, "Caleb, do you really think that you would have woken up at all yourself?" He said, "No, I guess not." I then asked him to recalculate again his percentage of responsibility which he now calculated as zero percent. As you can see, Caleb had finally realized and accepted his powerlessness in stopping the fire.

♦ #3 Grieving Own Mortality
In addition to grieving for personal losses and grieving for a realization of powerlessness, the third level of loss involves the client grieving their own mortality. Obviously, the idea that one day they are going to die is a client’s ultimate expression of powerlessness. In Caleb’s case, at the same time that he was grieving the loss of his parents, he was grieving the fact that someday he too will die. Therefore, while Caleb undergoes the five stages of grief for his parents, simultaneously, he will also be grieving his own mortality.

In this section, we discussed the three levels of grieving losses which include: grieving specific losses, grieving the realization of powerlessness, and grieving mortality.

In the next section, we will examine exercises to help clients gain a feeling of empowerment: Taking Inventory, Refinding Yourself, and Accentuating the Positive.
Reviewed 2023

Peer-Reviewed Journal Article References:
Allen, B., Oseni, A., & Allen, K. E. (2012). The evidence-based treatment of chronic posttraumatic stress disorder and traumatic grief in an adolescent: A case study. Psychological Trauma: Theory, Research, Practice, and Policy, 4(6), 631–639.

Assink, M., van der Put, C. E., Meeuwsen, M. W. C. M., de Jong, N. M., Oort, F. J., Stams, G. J. J. M., & Hoeve, M. (2019). Risk factors for child sexual abuse victimization: A meta-analytic review. Psychological Bulletin, 145(5), 459–489.

Captari, L. E., Riggs, S. A., & Stephen, K. (2020). Attachment processes following traumatic loss: A mediation model examining identity distress, shattered assumptions, prolonged grief, and posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.

Taylor, S., Charura, D., Williams, G., Shaw, M., Allan, J., Cohen, E., Meth, F., & O'Dwyer, L. (2020). Loss, grief, and growth: An interpretative phenomenological analysis of experiences of trauma in asylum seekers and refugees. Traumatology. Advance online publication.

QUESTION 6
What are the three levels of grieving losses? To select and enter your answer go to Test.

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