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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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