Setting specific goals with patients who may be impacted by complicated grief can be challenging. Because complicated grief is more complex than “typical” bereavement, it can leave a person feeling trapped in their own pain, feeling lost, hopeless, or unable to move past the experience(s) leading up to their grief.
Grieving is specific and unique to each person experiencing it so goals should be established that are equally specific to their situation and in line with their individual growth and needs.
Risk Factors and Common Symptoms
Specific risk factors for a client experiencing complicated grief can include experiencing death in the immediate family, financial stressors (job loss, etc.), emotional betrayal of a loved one, experiencing two or more deaths in a short amount of time, financial or emotional dependency on the person who passed away, a pre-existing history of mental illness, or a combination of several traumatic events within a short timeframe.
Symptoms of complicated grief may differ for each person, however some common themes include: trouble sleeping, nightmares, inability to fall or stay asleep, weight fluctuations, obsessive rumination of the traumatic event or the person involved, pessimistic attitude, fear of people or open spaces, a lack of motivation, irritability, mood and affect problems (depression, anxiety, anger, sadness), social withdrawal, a worsening of behavioral symptoms, self-sabotaging behavior, or feeling hopeless/suicidal.
Some patients who are experiencing complicated grief may fit criteria for a diagnosis of PTSD especially if they witnessed a traumatic event, ongoing trauma or abuse, or experienced emotional betrayal from a loved one. Awareness of the client’s specific type of grief and where they are emotionally, psychologically, and behaviorally can assist a clinician with setting appropriate goals in helping a client move past their pain and help them to heal from their traumatic experience(s).
Recognizing Strength, Limitations is Important
When assessing patients for specific goals in their personal development journey, it is important to recognize their strengths and limitations in order to create goals that are in line with their baseline behavioral data and their ultimate outcome criteria. For example, baseline data may include examining personal strength for a client who wants to become more self-reliant and self-directed in helping themselves overcome emotional triggers or painful intrusive memories. Similarly, the outcome criteria could be based on a client’s overall ability to independently redirect themselves to a calming strategy or remove themselves from an environmentally “emotionally triggering” situation.
One of the biggest challenges for clinicians is ensuring that goals are not perceived as too overwhelming or unachievable for a client. A healthy challenge for them should consider factors such as their baseline behavioral data and their motivation in goal setting. They may feel stuck in their situation wanting to see progress with healthy goal-directed behavior, yet may feel discouraged when they are still moving through the grieving process.
Flexibility in working with a client’s needs is important for helping keep clients motivated and on track in their healing while continuing to track behavioral data during times where they may feel discouraged.
Ensuring that mastery is reached with each behavioral goal set is important in helping clients become more self-reliant and empowered. If behavioral data show that goals are not being reached within the projected timeframes based on behavioral objectives, it is important to modify the goals, often breaking them down into smaller, independent goals that can be reached to a predetermined mastery which can then help foster reaching the ultimate goal.
For example, if an ultimate goal is “new social possibilities,” smaller independent goals such as “re-engaging socially” may have to be broken down into smaller goals such as “re-engaging in self-trust,” “re-engaging in trust of others,” and “engaging with friends/family/new prospects,” from very specific to broader contexts until mastery is reached.
An important consideration is to ensure that as new healthy goals are being gradually integrated into a clients’ lifestyle that unhealthy or self-defeating behaviors (unhealthy relationship dynamics, self-sabotaging beliefs, etc.) are being reduced. Educating the client on the importance of self-monitoring is also an important consideration to help ensure they gain self-awareness and empowerment skills along their healing journey.
Kent, M., Rivers, C. T., & Wrenn, G. (2015). Goal-Directed Resilience in Training (GRIT): A biopsychosocial model of self-regulation, executive functions, and personal growth in evocative contexts of PTSD, obesity, and chronic pain. Behavioral Sciences, 5(2), 264–304.
Kent M., Davis M.C., Reich J.W. (2014). The Resilience Handbook: Approaches to Stress and Trauma. Routledge; New York, NY, USA.
Nalipay, J. N., Mordeno, I. G. (2018). Positive metacognitions and meta-emotions as predictors of posttraumatic stress disorder and posttraumatic growth in survivors of a natural disaster. Journal of Loss and Trauma, 23(5), 381 – 394.
Taku, K., & McLarnon, J. W. (2018). Posttraumatic growth profiles and their relationship with HEXACO personality traits. Personality and Individual Differences, 134, 33 – 42.
Dr. Annie Tanasugarn is a Psychologist, Board Certified Behavior Analyst and certified life coach specializing in positive habit-change and skills-building. Annie is a trauma informed clinician with experience in PTSD. She works with adults seeking empowerment through goalsetting, skills building and awareness into their habits. She specializes in providing strategies and techniques to promote a healthy and positive self-image and in relationships with others.