Violent Loss Resources

After a murder, the family unit undergoes permanent changes that are difficult for the surviving members to accept. As each member of the family struggles with their own pain and grief, being a source of emotional support and comfort to other members in the family network can be problematic. Not only must each member navigate their feelings of loss of their loved one; they must also deal with the way they died. Familial roles undergo major transformations; family members' relationship will face challenges for reconstruction. The murder may trigger other types of losses a family has had that may need to be reprocessed. No other experience has prepared the family or its members with how to deal with homicide. There is a sudden uninvited intrusion in their lives that changes their existence from private to public.

Coping with so many unknowns may put previously "at-risk" family members at more risk and take in new casualties. Murder can invite suicide, homicide and alcohol or substance abuse? Careful assessment for these risks is needed along with enlisting the family to watch out for each other.

There is abundant clinical evidence indicating that following a homicidal death, family members are at risk for developing sustained and dysfunctional psychological reactions. And since the nearly 30,000 homicides annually in the United States affect between 120,000 and 240,000 relatives and other survivors, the magnitude of these numbers suggests that homicidal bereavement represents a major public health problem. Each year's statistics can be added exponentially to the proceeding years' numbers of under treated co-victims. According to the Department of Justice Uniform Crime Report released October 16, 1996, the city of San Diego had 91 homicides and the number of homicides reported in the county of San Diego for 1997 by the Medical Examiners Office was 155.

Influential variables that impact the family:

• A. RELATIONSHIP TO THE VICTIM - were they close, conflictual, distant or cutoff?
  

• B. ROLE OF THE VICTIM IN THE FAMILY - was this an estranged family member, the head of the household, the only child, a gang member, and an infidel?
  

• C. FAMILY & INDIVIDUAL MEMBERS DEVELOPMENTAL STAGE- a newly formed family, young children, teenagers, empty nest, and seniors, etc.?
  

• D. FAMILY HISTORY OF LOSS AND TRAUMA-another recent death, previous divorce, illnesses?
  

• E. RESILIENCE FACTORS-Risk and protective factors
  

• F. SUPPORT NETWORKS-work groups, community, mental health services, and religious/spiritual involvement.
  

• G. BELIEFS ABOUT DEATH-they will see their loved one someday, reincarnation, there is no afterlife.
  

• H. THE FAMILY TEMPLATE-employment, leisure activities, hopes, plans, divided loyalties, power, rules, and rituals.
  

• I. DRUGS/ALCOHOL ISSUES-present involvement?
  

• J. HISTORY OF MENTAL ILLNESS
  

• K. NATURE OF THE MURDER-raped, tortured, age, witnessed.
  

Specialized Treatment is needed in the aftermath of a homicide to lessen the long-term psychological impact for survivors and help co-victims cope with their grief and devastation while restoring control in their lives. Collaboration with professionals and agents from both public and private crime victim's agencies is required to coordinate services and find more efficient ways to assist this fragile population. The rewards and challenge for family therapists in fostering individual and family resilience while healing wounds after homicide is tremendous. The need for family therapists is increasingly evident in both prevention of violence and treatment after homicide.

Treatment strategies that have shown success with this population are the use of rituals and ceremonies to compartmentalize reviewing of the trauma. Ceremonies provide symbolic enactments of transformation of previously shattered relationships, and reestablish connections among family and society in general. Ceremony is enhanced if participants are at the aesthetic distance of being both emotionally engaged and yet aware of its symbolic nature. This is what is meant by "containing" (as opposed to suppressing) emotions.

Most rituals have the therapeutic properties of strengthening the bonds of individuals to their community and in giving reassurance against the anxieties and fears of life. However, for rituals to be therapeutic they must help individuals manage their distressing emotions.

Patients suffer from the shifts between flooding and numbing of emotion (Horowitz, 1976). Therefore ceremonies with allow for the arousal of distressing emotions within a safely contained structure. This needs to be done for each disturbance in their lives such as the fundamental break in the relationship between them and society. Like the effect of a structural change in structural family therapy (Minuchin, 1981), in which the family is shown that it can interact in a new way, the ceremony re-organizes participants into a healthier relationship, providing a model for identification.

Therapeutic ceremonies can have significant effects:

First: ceremonies compartmentalize the review of the trauma, giving it respectful expression while freeing it up from everyday life.
Second: They provide symbolic enactments that can become metaphors for transformation, greatly needed for trauma survivors who struggle with feelings of hopelessness and the chronicity of their situation.
Third: These ceremonies are designed to reestablish connection to the community of family and society. The structure and process is representative of attachment.

Dr. Rynearson's' model involves strategies such as:

1. Pacification techniques foster natural resilience in calming or distracting oneself.

2. Partitioning strategies that help differentiate the tendency that many have in merging with their loved one.

3. Perspective strategies that help integrate a "new normal" after homicide with integration that this event has changed them forever.


In California, a coordinated and comprehensive victim/witness program provides support for victims of crimes who sustain loss due to homicide. However, the program offers little in the way of funding for survivors who do not meet eligibility criteria and has limitations regarding follow-up ability. Research has shown that the effect of homicide goes on for years and the request for supportive services may be initiated many months and/or years after initial notification of a homicide. There are only three other programs in California that have specialized programs for co-victims of homicide.

Several cities have been setting up programs based on two successful programs that have received funding from the national Office for Victims of Crime (OVC) to provide training on their model to various states. One training is based on a program based in Seattle, Washington that has been developed for 15 years at the Virginia Mason Clinic, Separation and Loss Services. This program has been under the direction of Ted Rynearson, MD a leading expert on homicidal bereavement. The second training is based is from the Anti-Violence Project in Philadelphia under the direction of its founder Deborah Spungen, MSS, MLSP, CTS. She promotes the term Co-victims of homicide to better describe the impact on family members. Ms Spungen's daughter was murdered in 1978. Both the synergism and replication of these programs for co-victims of homicide has begun in cities that have been recipients of these trainings. Future training will help other cities replicate these services as well.

Connie Saindon, MA is a licensed marital and family therapist in private practice in San Diego. She is also an AAMFT clinical member and Approved Supervisor. She is also the Executive Director, Homicide Support Project, San Diego. Steven Shuchter is Medical Director of UCSD Outpatient Psychiatric Services, San Diego, California and this effort. For further information about this project call: (619) 685-0005 or contact us.


References

Horowitz, M., (1976). Stress response syndromes. New York, Jason Aronson.
Johnson, D., Feldman, S., Lubin, H., Southwick, M. (1995). The therapeutic use of ritual and ceremony in the treatment of post-traumatic stress disorder. Journal of Traumatic Stress, Vol. 8, No. 2, 1995.
Minuchin, S., Fishman, C., ( 1981) FamilyTherapy Techniques. Harvard Univerisity Press, Cambridge, Mass.
Rynearson, MD (1996). Psychotherapy of bereavement after homicide; be offensive. Psychotherapy in Practice, Vol. 2, No. 4, 47-57. John Wiley & Sons.
Rynearson, MD (1994) Psychotherapy of bereavement after homicide. Journal of Psychotherapy Practice and Research, 3(4), 341-347. John Wiley & Sons.
Spungen, D, (1998). Homicide: The hidden victims- a guide for professionals. Thousand Oaks, CA: Sage Publications, Inc.
Thompson, M., Norris, F., Ruback, B. (1998). Comparative distress levels of inner-city family members of homicide victims. ISTSS, Vol. 11, No. 2, P 223-242.
U.S. Department of Justice, Office of Programs. Criminal Victimization 1993; Murder in the United States, Bureau of Justice Statistics Bulletin, May 1995, NCJ-151658 pg.3.
Walsh, F. (1998). Strengthening family resilience. Guilford Press New York, NY.