Melissa A. Smigelsky

Risk Factors for Anticipatory Grief in Family Members of Terminally Ill Veterans Receiving Palliative Care Services

Anticipatory grief is the process associated with grieving the loss of loved ones in advance of their inevitable death. Because anticipatory grief has been associated with a variety of outcomes, risk factors for this condition deserve closer consideration. Fifty-seven family members of terminally ill, hospice-eligible veterans receiving palliative care services completed measures assessing psychosocial factors and conditions. Elevated anticipatory grief was found in families characterized by relational dependency, lower education, and poor grief-specific support, who also experienced discomfort with closeness and intimacy, neuroticism, spiritual crisis, and an inability to make sense of the loss. Thus, in this sample, anticipatory grief appears to be part of a cluster of factors and associated distress that call for early monitoring and possible intervention.

Innovative Moments in Humanistic Therapy I: Process and Outcome of Eminent Psychotherapists Working with Bereaved Clients

This project entailed an intensive qualitative analysis of six-session psychotherapies conducted by three eminent humanistic psychotherapists working with bereaved clients. The Innovative Moments Coding System (IMCS), rooted in narrative therapy, is designed to measure change across therapy orientations. Research using the IMCS suggests that the psychotherapy change process occurs through the emergence, elaboration, and expansion of identifiable change moments for a client—innovative moments (IMs)—which present as exceptions to a clients presenting problematic narrative. There are five identified types of IMs: action, reflection, protest, reconceptualization (RC), and performing change (PC). The current study aimed to inform theory regarding the patterns of IMs across three humanistic approaches—constructivist, person-centered, and existential—when working with bereaved clients, while linking these patterns to observable change in each clients functioning. The alliance between each client and therapist was also assessed across the therapy process, showing consistently strong alliances across the three cases. Findings from the current study reinforce the salience of reflection, RC, and PC IMs in successful grief therapy cases, and also suggest the importance of meaning-making interventions in grief therapy. Clinical implications and suggestions for future research are also addressed.

“My heart is in his hands”: The lived spiritual experiences of Congolese refugee women survivors of sexual violence

ABSTRACT The Democratic Republic of Congo (DRC) has experienced widespread violence, including sexual violence. Sexual violence toward women includes rape, genital mutilation, and sexual slavery. Many Congolese have sought to escape such conditions as refugees in the USA. In the present study, we examined lived spiritual experiences of nine Congolese refugee women survivors of sexual violence. Overall, this study provides new insights into participants’ experiences of spirituality in the aftermath of sexual trauma and in living as a refugees. Consensual qualitative research (CQR) methods were used to analyze participants’ responses to a semistructured interview protocol. Participants endorsed faith that God was in control, reliance on prayer, gratitude toward God, and difficulty practicing their faith in the USA relative to Africa. Results indicated that religion/spirituality is an integral part of the women’s lives and that it appears to facilitate coping. Clinical and community mental health implications are discussed.

Performing the Peace: Using Playback Theatre in the Strengthening of Police–Community Relations

Abstract:Background: Police–community relations have catapulted onto the national stage after several high-profile instances of alleged police brutality. Blame and hostility can be barriers to positive police–community relations. Playback is a form of audience-inspired, improvisational theater designed to promote connectivity and empathy through storytelling.Objectives: We tested the feasibility and acceptability of an arts-based intervention, bringing together police officers and formerly incarcerated individuals from the same community in Memphis, Tennessee.Methods: We collected pre/post quantitative data from five police officers and five ex-offenders who took part in the intervention, as well as qualitative data to provide contextual information.Results: The project was feasible and acceptable to participants. Participants showed gains in their ability to make meaning of stressful life experiences. The officers and ex-offenders showed parallel gains in their increased positive attitudes toward the other group.Conclusions: This study demonstrates that creating contexts of safety and understanding necessary to address relational problems is both feasible and acceptable to law enforcement and ex-offenders.

Closeness and Conflict With the Deceased: Exploring the Factor Structure of the Quality of Relationships Inventory in a Bereaved Student Sample.

With mounting empirical evidence that interpersonal closeness and conflict with the deceased prior to death are significant predictors of grief reactions following loss, accurate empirical examination of these two constructs is of high importance. Despite the utility of the Quality of Relationships Inventory (QRI) in numerous domains of research, the original instrument was not constructed with a predeath, mourner–decedent relationship in mind. Therefore, this study clarified the factor structure of a modified QRI focusing on major dimensions of the predeath relationship with the deceased—dynamics that could have strong implications for the survivor’s bereavement trajectory. An exploratory factor analysis of 386 bereaved adults revealed two salient factors, deemed closeness and conflict. These results suggest that the modified bereavement version of the QRI, designated the Quality of Relationships Inventory–Bereavement version, is well positioned to advance research in thanatology, with possible limitations noted in the range of relationships to which it is applicable.

Prospective Risk Factors for Intense Grief in Family Members of Veterans Who Died of Terminal Illness

Many bereavement researchers focus on predicting and preventing complicated grief, a psychologically crippling, sometimes life-threatening response to loss that persists for lengthy periods, often with serious health consequences. Reviews of studies have identified specific risk factors (e.g., low social support, insecure attachment style) that predict high levels of complicated grief symptomatology. However, studies rarely investigate multiple risk factors in combination, and still more rarely trace factors observable during the end-of-life period and their predictive power for identifying intense grief in family members following the death. We therefore investigated several pre-loss risk factors for post-loss bereavement distress in 35 family members of Veterans who died of a terminal illness after receiving palliative care. Results revealed that being female, Caucasian, losing a spouse, and experiencing high anticipatory grief prior to the death, all predicted high levels of grief 6 to 10 weeks following the death. Moreover, psychosocial factors such as being highly dependent upon the Veteran, displaying high neuroticism, reporting low levels of social support, and being unable to make sense of the prognosis or death predicted more intense post-loss grief reactions.

Innovative Moments in Humanistic Therapy II: Analysis of Change Processes Across the Course of Three Cases of Grief Therapy

The current study is an extension of a complementary investigation examining links between process and outcome within six-session psychotherapies in which three eminent psychotherapists each worked with a bereaved client, using person-centered, existential, and constructivist approaches, respectively. The Innovative Moments Coding System (IMCS) was used in both studies to examine processes of change in the moment-by-moment unfolding of grief therapy. The initial studys findings help inform theory regarding the relevance of humanistic interventions when working with bereaved clients, particularly those that help promote meaning making in the wake of loss. The current investigation extends the original by offering a fine-grained analysis of the progression of innovative moments (IMs) in the context of good-outcome grief therapy, liking specific therapy procedures with positive indicators of client functioning, while providing case illustrations of each therapy dyad. Findings highlight the promise of humanistic approaches in grief therapy, and suggest directions for further research in this area. Implications for future use of the IMCS in psychotherapy process and outcome research are also discussed.

Distinguishing the meaning making processes of survivors of suicide loss: An expansion of the meaning of loss codebook

Abstract Suicide loss represents particularly a difficult form of bereavement due to the challenges that volitional death poses to survivors. Understanding these challenges requires recognition of the idiosyncratic processes of meaning reconstruction for this specific group of grievers. The current study investigates such processes in survivors of suicide loss (SOSL) by utilizing the Meaning of Loss Codebook (MLC) to analyze the narratives of eight SOSL. The findings contribute to a broader understanding of meaning making following suicide, strengthen the validity of the MLC by demonstrating its appropriateness for SOSL, and illuminate unique challenges faced by SOSL, resulting in the proposal of supplemental MLC codes. Research and clinical implications are discussed.

Performative retelling: Healing community stories of loss through Playback Theatre

ABSTRACT Restorative retelling (RR) is an evidence-based procedure for facilitating adaptation following traumatic bereavement. In this paper, we introduce performative retelling (PR), a variation on RR, which fosters healing from personal losses and portrays personal reactions to collective tragedy. We describe our collaboration with an ex-offender reentry program, the Memphis Police Department, and Playback Theatre to use improvisational community theatre to bridge the gap between law enforcement and the citizens they serve. We review program outcomes to-date and illustrate its impact using participant stories. We argue that training police and citizens in PR can potentially transform broken narratives of police-community relations.

Mental Health Symptomatology and Exposure to Non-Fatal Suicidal Behavior: Factors That Predict Vulnerability and Resilience among College Students

Despite efforts to identify risk factors following exposure to completed suicide, research has paid less attention to the associations between exposure to non-fatal suicide behavior (NFSB) and mental health symptomatology—factors that may underlie one’s susceptibility to future suicidal thoughts and behaviors. This study examined differences in mental health symptomatology among 192 college students exposed to NFSB and 202 exposed to general stressors. Results indicated that students exposed to NFSB had significantly higher levels of depression and anxiety compared to those exposed to a variety of other stressors but not NFSB. Furthermore, among those exposed, a number of risk and protective factors emerged in relation to psychological sequelae, such as emotional stability, social support, and the quality of the relationship between the exposed and suicidal individual. These findings highlight the importance of enhancing provisions of support for those exposed to NFSB.