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Exorcising Ghosts: The Counting Method and Traumatic Death Imagery
FRANK M. OCHBERG, MD
FUNDAMENTALS OF INTERVENTION
The visual image of the reenactment of a violent dying may become an agonizing icon of terror and helplessness for bereaved loved ones. When the image persists for months, intruding upon daily thoughts and interrupting sleep with its terrifying recurrence, it may become a primary source of trauma distress and a first priority for intervention. The clinical management of traumatic imagery has produced a multitude of treatments - usually followed by some degree of positive response. The introduction to this book emphasized that the "mechanism" of an effective intervention is most probably nonspecific; that is, various treatments of trauma and grief are successful not so much from their unique model or technique(s), but because they are based upon common principles of stress moderation, reconstructive and imaginal exposure, and meaningful reengagement. The author of this chapter developed a remarkably parsimonious intervention model (neurobiological encoding of trauma memory) and procedure (The Counting Method) with documented effectiveness; however, its effectiveness is presumably not only associated with the procedure of counting, but is based also upon a trusting relationship and the three common principles of stress moderation, reconstructive and imaginal exposure, and meaningful reengagement.
O, answer me.... why the sepulcher Wherein we saw thee quietly inurn'd Hath op'd his ponderous and marble jaws To cast thee up again.- (Shakespeare, Hamlet, Act I, Scene iv)
Unnatural death has, too often, an unnatural life. The image of the lost one returns with haunting and disturbing intensity - hence belief in ghosts and other fantasies, reified into enduring myth. The reality of posttraumatic imagery is no myth, however. To lose a loved one to murder, suicide, or frightful accident, to the butchery of war and genocide, is to risk obsessive rumination on the death itself - its causes, its pain, its immediate consequences - rather than to remember, albeit mournfully, the one who once lived. How are we posttraumatic therapists to help our clients and patients dislodge this demon - the reappearing image of a loved one's death?
This chapter draws upon an illustrative case and explains a particular method to modify and ameliorate traumatic death imagery. Elsewhere, I have discussed a general philosophy of posttraumatic therapy (Ochberg, 1988, 1993a) and the application of a measured reexperiencing technique within this framework (Ochberg, 1993b). Many others have elaborated concepts and theories to explain why traumatic memories are so indelible and debilitating (van der Kolk & Fisler, 1995). Two concepts strike me as particularly helpful when considering the legacy of unnatural death. First is Edward Rynearson's discussion of reenactment, which he variously calls reenactment fantasy, imaginary reenactment, or the reenactment story. This applies to loved ones who learned of, but did not witness, the murder. Based upon hundreds of direct observations and a theory that is both descriptive and dynamic, Rynearson (2001) explains the survivor's preoccupation with the murder scene.
In my experience, it is most often the male of our species who nurses this image, allowing it to motivate a search for evil with a focus on the perpetrator. Our criminal justice system builds on this male preoccupation, relegating surviving kin to the role of witness for the state. Little attention goes to rights and remedies for victims; so much to apprehending, prosecuting, and punishing offenders (Herman, 2000).
Visit a chapter meeting of Parents of Murdered Children (Tedeschi & Calhoun, 2003). It is 90% female. Fathers and brothers, husbands and boyfriends come for a session or two, but the mothers and sisters return months and years later, sharing stories, nurturing newcomers, focusing on the emotionally wounded rather than on the murderer, and the crime itself. This gender generality is not absolute. Many mothers focus on the killer who stole a life. Many fathers help other fathers grieve. My point is not the gender difference, but rather that there is a difference between the work of grief and the work of comprehending and apprehending criminals. Grief interferes with detection and prosecution. Dedication to the work of criminal justice interferes with grief. We drift toward specialized roles and concentrate on one process or the other.
In sum, Rynearson explains the phenomenon of obsessive reenactment in close kin and significant others who experience unnatural death. This reenactment serves a function - assuring attention to crime; increasing the probability that crime will not pay; extending the "long arm of the law" through space and time. Whether the crime scene is communal or individual, we never forget. We remember the Maine, the Alamo, 9/11; we remember the context of the death of the individual we lost. The image of death is a biological and a cultural icon. It illuminates the path toward justice - often in biblical terms, "an eye for an eye," and it obscures the path through grief toward emotional acceptance, equilibrium, and health.
A second construct, best explained by Chris Brewin (2003), illuminates a different but related dimension. Brewin posits that the human brain contains two separate memory systems, situationally accessible memory (SAM) and verbally accessible memory (VAM). The verbally accessible memory system is the set of pathways that connects our speech center, our forebrains, both hemispheres, and, in moderation, our limbic systems, so that we can voluntarily recover a piece of personal history. We can replay it for our own consumption, explain it to another, and do so without suffering an attack of overwhelming anxiety, rage, or depression. VAM is coherent, it contains autobiographical memory. SAM is, by definition, unattached to language. It is aroused by sensation and situation such as the Musak in an elevator that played during a rape or an assault. Without conscious recognition and without words to describe the connection, a sound or a smell can evoke a deadly image. Sometimes the image is unseen but the feeling of dread and horror is elicited. The body remembers. Much of Freudian psychology is based upon similar theory: unconscious "memory" drives neurotic behavior. Therefore, making the unconscious conscious breaks the chain. But posttraumatic therapy is not usually Freudian because most of our patients have memories that are all too conscious. These memories burst into awareness and shatter one's equanimity, one's sense of security. The memory has accurate intensity. Our job is to help our patients make these conscious memories less conscious - not so frequently and so unexpectedly the focus of awareness.
Does this mean converting SAM to VAM? According to Brewin (personal communication, September 2005) it is not entirely appropriate to think of trauma memories literally moving from SAM to VAM, or as one memory system converting to the other. Rather he proposes that both systems coexist, and that the act of focusing attention deliberately on a traumatic image copies information from the SAM to the VAM system. In the presence of trauma reminders, there is a contest between the two systems. When VAM succeeds in dominating SAM, a person experiences control over traumatic memory. The memory still has strong meaning and disturbing feelings are remembered, but the PTSD symptoms of flashback and dysphoric, intrusive recollection are not present to a disabling degree. When, conversely, SAM dominates, clinically significant episodes of intrusive reexperiencing symptoms are, indeed, present and profound. Some form of therapy to modulate and master this overactive SAM is needed.
A previously traumatic memory, copied from SAM to VAM, is less likely to spring forth unbidden with disturbing intensity.
How does one copy a trauma memory from SAM to VAM? Verbalization
- talking it through - is not necessarily the way. But the ability to speak of the trauma without disabling emotion is a goal, and is evidence of significant progress. The concept is attractive because it directs the therapist and the client toward acceptance rather than denial. It confirms a line in The Survivor Psalm (Ochberg, 1993a): "I may never forget but I need not constantly remember."
SUE AND BRANT
I met Sue and Brant in November 2001, two weeks after their 20-yearold son, Alex, was murdered. His death was particularly brutal, with multiple stabbings and near beheading. The killer was an older, unstable, ne'er-do-well who shared a rental home in Lansing, Michigan with Alex and one or two others. Alex left high school in his senior year and was taking a detour through late adolescence with odd jobs and overuse of alcohol. His dad described him as good natured, whimsical, strong, slightly lost, yet closely connected to a loving family. Brant was the last person, other than the murderer, to see Alex alive.
He had stopped by the rental home at 9 p.m. on November 10, to deliver a message, while Sue sat in the car. Alex had been drinking but was not drunk. Within an hour the phone rang at Brant and Sue's house and a policeman told them their son was dead.
The leader of the local Parents of Murdered Children group referred Brant and Sue to me. Both saw me together 14 times and I saw Brant alone once, Sue alone twice. On one occasion the family of four came to my office
- mother, father, a daughter in college, and one in high school. Eventually Sue and Brant joined the Michigan Victim Alliance, telling their story to students of journalism, medicine, and criminal justice. Sue helped me introduce third- and fourth-year psychiatry residents to issues discussed in this chapter.
In the beginning both Sue and Brant were consumed by their son's murder. They learned from police investigators about the crime scene and the reconstruction of motive: a long simmering argument erupting into rage. They absorbed the actual method: a sudden attack with a kitchen knife, multiple stabbings and slashes, a throat wound, and probably a postmortem attempt at decapitation.
We did not dwell on these details, but spoke instead about the impact on Alex's sisters, about insomnia and nightmares, of Sue's deep depression, and Brant's concern for her. The couple sat together on a small sofa, husband always comforting wife. They spoke openly about the loss of sexual interest, not as a problem but as a fact. He had images of the murder scene, but not flashbacks. She had horrifying flashbacks to the moment of notification and then to the sequence of images that formed in her mind at the time. These images changed as she learned more and were accompanied by palpitations and shortness of breath.
I wanted to see Brant alone to probe for symptoms, but he revealed nothing beyond grief and combinations of anger and self-blame that seemed proportional to the extreme circumstances. He felt he should have done more to help Alex concentrate on studies, make better choices, and avoid a lifestyle that placed him at risk. But Brant overcame self-blame soon enough. With Sue, he established a scholarship for C students in honor of his C-student son.
Sue had full-blown PTSD. She read about the diagnosis and appreciated my instruction on the nature of the disorder. "It made me feel normal," she later explained to a class of medical students. She readily accepted and clearly benefited from Celexa®, 20 mg a day, Trazodone®, 50 mg at night, and Xanax, 1 mg three times a day. The Celexa® helped alleviate black moods that kept her in bed. The Trazodone allowed her to sleep through the night without nightmares or early morning wakening. The Xanax diminished the frequency and intensity of panic-laced intrusive recollections. She had intrusive recollections six weeks after the murder, so I offered a form of modulated reexperiencing called The Counting Method. This exposure technique has been described in articles and videotapes (Johnson & Lubin, 2005; Ochberg, 1993b, 1996; Ochberg, Johnson, & Lubin, 1996), and evaluated in comparison with EMDR and prolonged exposure (Johnson & Lubin, 2006). Although not as thoroughly investigated and promulgated as those other techniques, I find it simpler and as effective.
USING THE COUNTING METHOD
First, I explained to Sue that we had reached a point of comfort with each other, of trust and familiarity, and we could now schedule a time for her to deliberately "turn on the tape." She would remember, without words, that horrible moment of receiving the news of Alex's death. I told her that I would count out loud to 100 and while I was counting, she would remember. "When I am counting in the 40s and 50s and 60s, you will go through the worst of your recollection and feelings," I said. "When I get to the 90s, you should be sure to be remembering a time when you felt more secure," I added.
I explained that after she finished this silent memory we would talk about what she just remembered. She agreed and we set a date: December 20, 2001.
Sue arrived punctually, and sat in a comfortable chair in subdued light. After five minutes of relatively pleasant catching up, I reviewed the instructions for The Counting Method and we began. During my counting to 100 she did not cry, but by the count of 60 she had a grimace on her face and her lids drooped. Her body seemed tense.
After the counting I took these notes as she spoke:
Home that night ... pajamas on ... washed face...
The phone rang ...
Alicia from the basement ...
Voice on the other end panicky.
Alex not breathing!
Another call about crime scene tape.
I thought BAD ...
Brant ran upstairs.
Instinctively BAD ...
Policeman on the phone, "I don't like to do things this way. Your son died."
We just ran around the house.
What do we do? Didn't know what to do.
Youngest daughter heard.
Should we call our other daughter? Family?
Leslie knew something was wrong.
Seemed so long.
Alicia and I were staring and waiting on the front porch. No shoes or socks.
Police car screaming up the street, three more behind.
I wanted him to tell me, "We are still working on him," but he had an
Advocates were very nice.
Called my sister (who lived) on the other end of the block. She came down.
Called the rest of the family.
All there. A blur.
Police took us to the station.
Statement. 2 A.M.
Came back. Family left 3:30.
Fell asleep 5.
Awake 6 to 6:30.
Next couple of days a blur. Family, people coming and going. Funeral
arrangements. Surreal. Unbelievable.
Not being able to see Alex was hard.
Saturday to Tuesday was a long time not seeing him.
Then we did. Girls screamed.
I felt a little peace come over me. He looked nice. Peaceful. I could hug
him. Healthy. Young. That night, peaceful.
Then visitation, funeral.
So many people. Nice tribute to Alex and to us. Blur. So much going on.
That day at the funeral they closed the casket. I didn't want that. That
was the hardest moment - other than finding out.
Funeral, sermon, nice service. Church almost full. Walked across the
street to the cemetery. 65 degrees. Sunny.
There was more. Sue went on, adding thoughts that came to mind as she spoke, not necessarily thoughts that came during the 100 seconds of counting. For example, her sister-in-law brought 25 colored balloons and one white balloon, off by itself. "That was Alex," she smiled. A cousin brought firecrackers (that was Alex, too). Sue recalled seeing one little scratch on the side of Alex's face, but no other signs of violence.
She told me then of the detective describing Alex's wounds to Brant, including a gash six inches long and two inches deep that severed both jugular veins and the esophagus. "All I can picture is this man over him, making sure he did the job, standing there with a bloody knife."
The Counting Method has four distinct phases. We had completed three. First, we had discussed the method, reviewed how and why it could help, and scheduled a session at a time that suited her and that came after she had made some progress in therapy. Second, I had counted to 100 while she allowed herself to remember the worst of the traumatic experience, closing with the comfort of seeing Alex at peace, touching him, and walking from funeral to cemetery in the sun. Third, she recounted what she remembered (and more). During this phase, she did cry.
Now it was my turn to read back to her what she had said and what I had managed to capture in a furious scribble on a yellow pad. This is a phase not just of rote recounting, but of adding words of respect and comfort. I have no record of what I said, but it probably included the fact that she was able to do this difficult task. "You turned the tape on and you ran it through the worst memories," I would have observed. I usually comment on the points in the trauma story that are disturbing and the parts that carry hope, meaning, and connection to others. I would have pointed out, one way or another, that Sue was on her way to grieving the loss of her son, enjoying the memory of his personality, and overcoming the horror of his final few minutes alive.
AFTER THE COUNTING
A visit with Brant alone, Christmas, New Year, and a family visit came next, with conversation about a raft of issues including minor physical ailments and the emotional problems of Sue's parents. Of course we spoke of the holiday season without Alex, but the family did manage to generate some holiday spirit, using the idea that "Alex would want it that way."
On January 11, 2002, I noted, "Good!! She (Sue) has overcome trauma imagery and PTSD but has empty feeling and deep sadness - I'd call it normal grief, profound ...."
Technically, Sue had PTSD, with anxiety, numbing, and at least one unwanted memory per month for several months. But she didn't feel that her mind had a mind of its own, as many of my traumatized patients feel. She was extremely sad, not haunted or obsessed. As the trial loomed ahead and she knew she would be in the same room as the killer, she became angry. I liked the anger. It was clear, reasonable, and better than depression or confusion.
Did the counting make a large difference in Sue's progress? It is never easy to tell just what element of therapy makes the most impact, and therapy itself is just one part of the healing process. Sue felt the counting did matter significantly. Before, she doubted that she would ever be free of visions of Alex's violent death. She thought that she would hear what some call "the death knock"- the moment of notification - over and over and over.
I believe that we, Sue and I together, shared the experience of her SAM
- her situationally accessible memory - and we shared it in silence as I counted. She could tolerate a self-induced replay of her worst moments because the experience of therapy had become familiar. Sue later said that she loved to come to my office because it felt safe and comforting. Not all trauma patients feel that way. Therapy and therapists can symbolize forced encounters with personal demons. Many PTSD patients avoid therapy for that reason.
The timing of The Counting Method is very important. It requires clinical judgment, not just the consent of the client. In Sue's case, we got there quickly for several reasons. Brant was such a source of security during the initial visits that the therapy room became an oasis for all of us. We made progress with appropriate use of education about PTSD, and about the criminal justice system (it didn't hurt that I had been an adjunct professor of criminal justice and knew quite a lot about the county court procedures). We used humor when it was tasteful and reasonable. Just thinking about Alex's sense of humor could make all of us smile. I prescribed medication and that ameliorated some symptoms.
So by the time we engaged in the Method, Sue was on an upward course, improving her mastery of her own condition.
The themes uncovered during the counting and the following discussion were interesting and, in some ways, typical. Three peaks of negative experience stand out: First, she had the terror of learning her son was murdered. This caused shock and dissociation. She used words such as blur, incredible, and surreal. Second, she learned of his death struggle and his antemortem and postmortem wounds. This caused horror. Third, she saw the casket close and left his sight and touch forever. This caused grief and emptiness.
With some patients, repeat counting sessions are helpful, focusing on such individual peaks of experience until they are mastered and diminished. Sue didn't need that.
Several peaks of positive experience were revealed. Family and friends came in large numbers and Sue felt she and Alex were well regarded, embraced by so many caring people. The white balloon remains an image of Alex's individuality. The firecrackers, brought to his funeral, elicit a smile for Alex and for those who were able to introduce some sparkle into a somber ceremony. Alex at peace, restored to an image of health and youth, was seen during counting, and is now more vivid than Sue's imagined "memory" of his mortal wounding.
In Brewin's terminology, Sue did copy her trauma memory from one mental system to another. It didn't happen all at once during a Counting Method session. It happened over time for many reasons, one of which was a technique of moderated memory.
At the time of this writing, three and a half years later, Sue and Brant have enough time and distance from those terrible weeks at the end of 2001 and the beginning of 2002 that they can help other victims of violence contend with the impact of human cruelty. We have become friends and colleagues through this work. An encounter with a student or a peer who seeks information about violent death, will stir up some bad feelings in Sue or Brant. But they find the gratification of helping others is worth the price of feeling reexposed to trauma. Sue does not have PTSD now.
ADDITIONAL APPLICATIONS OF THE COUNTING METHOD
In several additional instances, I have observed patients use The Counting Method to explore and assimilate traumatic memories of violent death. These involve suicide, accident, war, and murder.
The mother of a young police officer found her son in his apartment after he had shot himself following a break-up with his fiance. In the counting session, the mother focused on her view of her son's bare heel, the first thing she saw upon pushing open his door. This image led to all the rest, including her shock and grief.
A trucker, forced over the center line by a drunk driver of an oncoming car, collided with an SUV and six passengers died, including children. He still has PTSD, but flashbacks to the scene are now less frequent and intense.
A veteran of the first Gulf war, during his second Counting Method, recovered a hitherto unremembered sensation of stepping on the body of an Iraqi soldier he had killed. He cried during the counting and during the discussion immediately afterward, expressing horror and anger. "Why did the lieutenant order me into the bunker (wearing night vision goggles) to kill the sleeping soldiers?" he said.
Another member of the Michigan Victim Alliance retold, after counting, the terrible day when intruders held him and his fiance at gunpoint, executing her and sparing him. His images of death have abated but he still cannot sleep through the night without Trazodone.
As in Sue's case, each of these survivors had intrusive, debilitating reexperiencing symptoms. In several instances, my patient felt he or she was going to die, but the haunting image was (and, for some, remains) the death of another. The "other" was a stranger to the soldier and the long distance hauler, but a loved and cherished one to the mother and the fiance. All claimed some mastery, some relief after the counting. None wanted more than three sessions. Few (including others not mentioned here) came close to Sue in depth of support from marriage, family, and community. Sue's community included a large, active extended family, her church, and the Michigan Victim Alliance.
It troubles me when too much is made of the use of a specific therapeutic technique, after a literally life-shattering experience. Neither counting nor EMDR nor prolonged exposure transforms the witness from one who feels haunted and disabled, sometimes dehumanized, to one who is sadder, wiser, and restored to emotional health. But these guided journeys through traumatic memory do transform the memory from a personal demon that strikes with little warning and overtakes the theater of private thought, to a manageable, bitter truth.
The question as to what form of therapy best modulates traumatic memory has interested and perplexed clinicians and investigators in the trauma sciences for decades. Two of the most thoroughly researched approaches are Edna Foa's method of prolonged exposure (Foa & Kozak, 1986; Foa, Molnar, & Cashman, 1995; Foa, Rothbaum, Riggs, & Murdock, 1991) and Francine Shapiro's EMDR (Shapiro, 1989). As this chapter goes to press, so does an article by David Johnson and Hadar Lubin (2006), documenting their research at Yale, in which they compared prolonged exposure, EMDR, and Method Counting. Johnson and Lubin brought Foa and me to the Yale-New Haven Veteran's Administration Hospital in 1994 where we trained trauma therapists in each technique. Therapists attended official EMDR training sessions sponsored by Shapiro. Later, these therapists were randomly assigned to treat outpatients in a trauma clinic. Each clinician used each method, again by random assignment, one method to one patient at least three times in a brief, six- to nine-session course of treatment. Patients were also placed on a waiting list, untreated. Using objective and subjective outcome measures, all treatments provided improvement significantly better than placement on a waiting list. There were no meaningful differences in outcome due to the treatment technique that was applied. The authors concluded that, by the law of parsimony, The Counting Method is simplest and therefore preferable. But simplicity seldom sells: Complex theories and methods have long lives and fervid adherents. One relatively small study will not and should not change the field.
I recall a lively debate during the revision of the PTSD diagnosis from DSM-III to DSM-III-R in the mid-1980s. Some thought PTSD belonged in the chapter on dissociation, because the cardinal feature was an alteration in consciousness, short of psychosis, changing the subjective nature of the experience of self and environment. Others, a majority, held for inclusion with the anxiety disorders, since extreme arousal was such a profound element of the original experience and the episodic aftershocks. Now we have evidence of a memory distortion at the heart of PTSD: a failure to apply the correct measure of distance to personal recollection, so that terrible events are too close, too present, too frightening in their apparent proximity and power.
The surviving witness of another's violent dying is subject to all of these dimensions of disability and more. They have endured biological reality and often human cruelty.
They are, for a period of time, free of the fantasies we mortals use to insulate ourselves from inevitable loss and death. We therapists work with the tools our patients grant us to exorcise their ghosts:
Their connections to others who love them.
Their humor, spirit, and character.
Their biological resilience.
Their trust in us to sit with them as they have a sharp look at what they wish they'd never seen.
Brewin, C. R. (2003). Posttraumatic stress disorder: Malady or myth. New Haven, CT: Yale University Press.
Foa, E., Molnar, C., & Cashman, L. (1995). Change in rape narratives during exposure therapy for posttraumatic stress disorder. Journal of Traumatic Stress, 8, 675-690.
Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715-723.
Foa, E. & Kozak, M. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35.
Herman, S. (2000). Seeking parallel justice: A new agenda for the victims movement Washington, D.C.: National Center for Victims of Crime monograph.
Johnson, D. R. & Lubin, H. (2005) The Counting Method as exposure therapy: Revisions and case examples. Traumatology, 11(3), 189-198.
Johnson, D. R. & Lubin, H. (2006). The Counting Method: Applying the rule of parsimony to the treatment of posttraumatic stress disorder. Traumatology, 12 (1), 83-99.
Ochberg, F. (1988). Post-traumatic therapy and victims of violence. New York: Brunner/Mazel.
Ochberg, F. (1993a). Posttraumatic therapy. In John P. Wilson & Beverley Raphael (Eds.), International handbook of traumatic stress syndrome, 773-783. New York: Plenum Press.
Ochberg, F. (1993b). The counting method. Videotape. (Reviewed by John Wilson., Psychotherapy, 30 (4), 705, 1993; Janet Bell, Journal of Traumatic Stress, 8 (1), 197-199, 1995. Available from Gift from Within, 800-888-5236)
Ochberg, F. (1996). The counting method. Journal of Traumatic Stress, 9, 887-894.
Ochberg, F., Johnson, D., & Lubin, H. (1996). The counting method: Training manual. (Available from Post Traumatic Stress Center, New Haven, CT).
Rynearson, E. K. (2001). Retelling violent death. Philadelphia: Brunner-Rutledge.
Shapiro, F. (1989). Ef?cacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-233.
Tedeschi R. & Calhoun, L. (2003). Helping bereaved parents: A clinician's guide. Philadelphia: Brunner-Rutledge. See also http://www.pomc.org
van der Kolk, B. & Fisler, R. (1995). Dissociation and the fragmentary nature of traumatic memories: Overview and exploratory study. Journal of Traumatic Stress, 8, 505-526.
Edited by Edward K. Rynearson
This book pulls together a definitive collection of work on the theory and practice of clinical, spiritual, and emotional support after the experience of violent death - counseling beyond the crisis.
Over the past decade, there have been countless publications devoted to crisis response, crisis intervention and counseling, disaster mental health services, and support for victims of traumatic events, but almost none devoted to the response planning and community care for those individuals who continue to struggle with trauma and grief issues for more than a few months after a violent death. The chapters in this volume, written by national and international experts in the field, will provide the reader with the theoretical and clinical bases necessary for planning and implementing clinical and spiritual services to meet the needs of survivors, witnesses, family and community members of violent death.
Copyright: 2006 Taylor & Francis Group, LLC
Routledge Website: www.routledgementalhealth.com
Taylor & Frances Website: www.taylorandfrancis.com
Chapter 8 "Reproduced on www.giftfromwithin.org with permission of the copyright holder. Further reproduction prohibited without permission."
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