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Family members may not quietly and peacefully accept what has happened...Family members have no choice--they must cooperate with the media, the police and sometimes the courts.
E.K. Rynearson, MD
Virginia Mason Medial Center
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| Frontline Reports: Group Intervention for Bereavement After Violent Death
Edward Rynearson, M.D., Jennifer Favell, Ph.D. and Connie Saindon,
M.A.
Recent reports have documented the vulnerability of closely attached
family members to trauma distress after the violent death of a loved one from an
accident, suicide, or homicide. Traumatic imagery recurs as an intrusive
thought, flashback, or dream that reflects the family member's preoccupation
with the terminal thoughts, feelings, and actions of the victim at the time of
death.
The reenactment story is almost always imaginary-only 5 percent
of family members witness the violent death of a loved one-and leaves an ironic
legacy, namely, that the family member must accommodate to the horror and
helplessness of their loved one who died without them. For the vast majority of
family members, the reenacted story of violent death spontaneously subsides
within weeks, but mothers and small children are at the greatest risk of
suffering from its persistence as a dysfunctional fixation.
After a
violent death, particularly after homicide, family members may also be forced to
accommodate the demands of the media, detectives and the court if someone is
criminally apprehended and tried. This social ordeal is frustrating, enervating,
and sometimes enraging.
We have developed a systematic, community-based
support project with outreach to family members after violent death. It begins
with a semi-structured interview and screening for co-morbid disorders.
Time-limited interventions are used including 10 weekly two-hour sessions, using
a structured agenda and a closed group format limited to 10 members.
The
first 10-session group, called the criminal death support group, is offered
during the early months of exposure. This includes interaction with the media
and criminal-judicial inquiries. The objectives of this intervention are to
provide resources for clarification and advocacy for the external demands of
this public retelling of the violent death. Presentations from criminal-judicial
staff members are supplemented with handouts, and co-leaders and fellow group
members are available for support during the proceedings.
The second
10-session group, called restorative retelling, is offered after the
investigation and trial have been completed. The objectives of this intervention
are to provide resources for clarification and restoration to moderate the
internalized trauma of the violent death experience. The early sessions focus on
reinforcing resilience and commemorating the living memory of the deceased to
counterbalance the reenactment imagery. Writing and drawing exercises that allow
a transcendent retelling of the violent death are also included.
Through
a training grant from the U.S. Department of Justice, service providers from 20
major U.S. cities have been trained and are beginning to implement this
community-based program. New York City was one of the training sites, and
providers there now offer group interventions that include family members
bereaved by the September 11 World Trade Center disaster.
A recent
multi-site open trial of these interventions with 64 adult family members
documented a low dropout rate (20 percent), the absence of overwhelming distress
secondary to the intervention, and a statistically significant pre-post decrease
in standardized measures of trauma and separation distress.
Manuals are
available, and we would welcome inquiries from others who are interested in
providing support to this underserved population.
Footnotes
Dr. Rynearson is clinical professor of psychiatry
at the University of Washington and medical director of the Homicide Support
Project at the Virginia Mason Medical Center. Dr. Favell is in private practice
in Seattle, and Ms. Saindon is founder and Clinical Director of the Survivors of
Violent Loss Program at the University of California’ Medical School, Department
of Psychiatry, La Jolla, CA. Send correspondence to Dr. Rynearson at P.O. Box
1930, Dl-SPL, Seattle, Washington 98111, e-mail, ryno61@aol.com
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