As a funeral celebrant, I hold an affiliate membership with the Alberta Funeral Service Association. Recently, I attended a daylong Dealing with Grief conference in Edmonton; the keynote speaker was the Australian-born psychiatrist David Kissane. Dr. Kissane is Chairman of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center, professor of psychiatry at Weill Cornell Medical College of Cornell University, and author of Family Focused Grief Therapy. In short, the man knows his stuff.
I attended hoping I could do some networking with funeral directors. Wrong. Though I did get to meet two Edmonton celebrants, most of the attendees were therapists, social workers, or chaplains. Following my belief that no learning is ever wasted, I stayed and absorbed as much of the information as I could as a non-therapist.
Dr. Kissane believes that there are real benefits to engaging entire families in grief therapy sessions?from the point of diagnosis, through palliative care, to finally the bereavement stage following death. While a particular individual is sick and dying, the entire nuclear family is affected by the event.
He uses a 12-point questionnaire to assess the family relationship by measuring the degree of cohesiveness, communication, and conflict management present. Despite what you may deduce from observing TV families, there are five family types. Roughly half of all families fall into either the supportive or conflict resolving sub-groups that make up the well-functioning group. The sullen and the hostile fall into the dysfunctional group. There is also an intermediate group breaching the two extremes. A genogram, or psychological family tree, is also completed; it essence, it shows generational patterns of behaviour.
Prolonged grief disorder (or complicated grief) is diagnosed using a set of criteria which includes bereavement longer than six months, symptoms of separation distress, functional impairment (socially, occupationally, and domestically), and other symptoms, including loss of trust, bitterness, numbness, and role confusion. Some of the risk factors of complicated grief include unexpected loss, controlling parents, childhood separation anxiety, early parental death, and ambivalent relationship with the deceased. The cost to individuals and society is high, with increased risk for suicide, poor quality of life, post traumatic stress disorder (PTSD), and depressive or other anxiety disorders.
Through sessions of role playing, we observed Kissane’s preferred circular questioning method. So rather than ask the dying father directly how he is doing, the therapist would ask the wife or children how they perceive dad is coping, and so on until all the dynamics and feelings are teased out. This style encourages reflection. Strategic questions that hold potential solutions and stimulate problem solving are also introduced.
I felt myself drawn into this family drama. There’s dad saying, ?I’m dying and the thing I need most is to know that you three will be there for each other when I’m gone.? Mom is trying to be strong. The teenage son is sullen and saying, ?I don’t know what’s going on.? An adult daughter has come back home to help but doesn’t know how.
In a later post-death session, with dad’s empty chair front and centre, we see the wife coping with her anger and her ambivalence to the death of her philandering husband and with the fact the children knew nothing of the problems in the marriage.
This role playing was so real, it was spooky. It reminded me of the secrets, verboten topics, and ?elephant in the room? gatherings that characterize most families. It reminded me that we seriously harm ourselves and others with lies, omissions, and avoidance. It reminded me that we need healthy, truthful, supportive relationships with our loved ones, day in and day out. And if we do that, we’re well-positioned to weather the storm of grief. All good reminders, from where I sit.