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Article Excerpt
As a result of the events of September 11, 2001, older adults have experienced a multitude of death-related and non-death losses. Mental health counselors who interact with older adults have a crucial role in identifying individuals who may be at risk for experiencing a subsequent, temporary, upsurge of grief Following a review of basic concepts and underlying philosophies that can be utilized to inform work with bereaved older adults, interviewing strategies and standardized measures available for use with older adults experiencing trauma and grief are described. Then using Corr's (2003) task-based approach as a framework, strategies for identification of need and intervention are presented.
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During her 85 years, Sophia had experienced many losses and challenges, including the death of her husband, Bill, in France during World War II; raising a child alone until her remarriage; watching her second husband's health deteriorate as he battled cancer; and losing her independence in December, 2002, following a stroke that forced her into an assisted living community. When she woke up on Thursday, September 11, 2003, she knew that this would not be an ordinary day. Sophia vividly remembered the powerful feelings that she experienced 2 years ago upon hearing about the destruction and death that had resulted from the terrorist attacks. She had relived the agony of not knowing if Bill had survived the invasion of Normandy, particularly while watching media coverage of the families who were waiting to confirm that a loved one was safe or to receive confirmation of a loved one's death. However, on the second anniversary of the terrorist attacks, she suspected that her emotions would be more focused upon her friend Mary, whose grandson, Jeffrey, had died in one of the towers on that fateful day.
Because she had decided not to join her family on their pilgrimage to New York City for the memorial service at Ground Zero, Mary was planning to spend some time quietly reflecting upon her grandson's life rather than thinking about how and where he died. She had asked Sophia if she would be willing to accompany her on a trip to the local museum, a place that she and Jeffrey had visited frequently during his summer visits. This was a place where Mary hoped that she could focus upon the laughter and joy that she had shared with Jeffrey as a child rather than on the tears that had been shed over the past 2 years following his death. Perhaps, she told Sophia, they could help each other through what was likely to be a bittersweet day.
On September 11, 2001, many lives were changed in ways that will be difficult to fully comprehend for years to come. Within hours of the attack on the World Trade Center, the Pentagon, and the crash of United Flight 93 in Pennsylvania, the nation was forced to grapple with the reality that life as people knew it would never be the same. The older adults (ages 40-85) who worked and/or lived near ground zero experienced intense reactions that were understandable and natural, as was their concern about family and friends. However, many older adults who were not directly involved in or impacted by the events in New York City, Washington, D.C., or Pennsylvania have also experienced a multitude of loss-related reactions to this unprecedented series of events.
This article examines strategies for assessing the reactions of older adults to the death and non-death losses experienced as a result of the events of September 11, 2001. In addition to examining potential changes in adults' assumptive worlds (e.g., perceptions of safety and security), factors contributing to potential subsequent, temporary, upsurges of grief (STUG) reactions (Rando, 1993) are identified. Assessment and treatment strategies used for identification of older adults at risk of a normal resurgence of grief during the aftermath of this national tragedy are discussed.
BASIC CONCEPTS AND UNDERLYING PHILOSOPHIES
Within 6 months of the terrorist attacks, Figley (2002) noted that the collective struggle to understand the implications of this trauma had only begun. In understanding older adults' reactions, it is helpful to remember that people struggle both individually and collectively to interpret their experience. This experience is shaped by many factors. Therefore, prior to examining strategies for assessing older adults' reactions to September 11, basic concepts and underlying philosophies that are relevant to the current discussion are briefly summarized.
Defining Loss
Literature published early in the thanatology movement focused largely on the meaning of death (Feifel, 1959), the process of dying (Kubler-Ross, 1969), and reactions to the death of a loved-one (Kutscher, 1969; Lindemann, 1944). As the thanatology movement has progressed, other forms of losses have been acknowledged. These physical or tangible losses, such as the unexpected and inconceivable loss of the workplace as occurred on September 11, are referred to as symbolic or psychosocial losses (Rando, 1993) or nonfinite losses (Bruce & Schultz, 2001). Nonfinite losses, according to Bruce and Schultz, are defined as being "contingent on a lack of synchrony with hopes, wishes, ideals, and expectations" (p. 7). For example, plans for travel or other activities during retirement may have been altered due to concerns about the safety of air travel or travel to particular foreign countries. These authors also describe nonfinite losses as being continuous and invariably insidious, frequently preceded by a negative life event that retains a vivid psychological presence, for example, "the disappearance of a family member in an impossible-to-reconcile circumstance" (p. 8). Ambiguous loss (Boss, 1999) involves uncertainty and doubt about the reality of the loss due to the nature and circumstances of the loss event, such as the time period immediately following the terrorist attacks when many older adults could not ascertain whether friends/family were alive.
The Assumptive World
Parkes (2002) asserted that we begin to develop a set of assumptions about the world from the moment of our birth. These early assumptions tend to be core assumptions that shape the way in which people recognize the world and act within it. In addition to assumptions about the outside world, we also develop assumptions about the consequences of our own and others' actions. These core assumptions include (a) self-trust, one's ability to cope with daily experiences; (b) other-trust, when necessary, being able to count on others to maintain our safety; and (c) world-trust, "the assumption that the world is a reasonably safe place" (Parkes, p. 238). When individuals are confronted with new information or new experiences, they must refine the aspects of their assumptive world that are now obsolete.
Needless to say, the events and aftermath of September 11 challenged the core assumptions of many people to varying degrees. For some older adults, challenges to these core assumptions may have seemed all too familiar in light of their need to overcome the challenges previously experienced during large-scale historic events (e.g., the Depression, the Holocaust, World War II). However, exposure to terrorism on American soil and the resulting challenge to their sense of world-trust may have been a very new experience for some life-long American citizens. As Joe, 68 years old, said, "I always thought we were safe here ... but ... now, there is no safe place ... not anywhere in the world."
The struggle to revise one's assumptions, labeled by Parkes (2002) as a psychosocial transition, can be painful and protracted. Individuals are challenged to relearn their ways in the world in a range of dimensions: emotional, psychological, behavioral, physical, social, intellectual, and spiritual (Attig, 2002). Finding ways to understand an individual's assumptive world prior to a life-altering event as well as supporting an individual during the process of relearning the world from a holistic perspective are important tasks. As Landsman (2002) noted, the trauma and loss literatures have "only fairly recently, and somewhat tentatively" (p. 25) addressed the subject of good outcomes. Yet, reorganizing assumptions following loss is truly a process of reconstructing meaning (Neimeyer, 2001) and relearning the world (Attig, 1996). Concepts such as resilience (e.g., Bonanno et al., 2002; Nolen-Hoeksema, 2000; Reivich & Shatte, 2002) and transcendence (e.g., Landsman; Prend, 1997), rather than pathology, incorporate a strengths-based perspective (Saleebey, 1997) into the assessment and intervention process.
ASSESSING REACTIONS: PROCESS AND STRATEGIES
Although, ideally, a comprehensive loss history would be conducted with each and every individual with whom a mental health counselor interacts, there are many factors that influence the mental health professional's ability to gather this type of detailed information. Some specific factors include the mourner's state of mind, the mental health counselor's counseling orientation, and the specific situation during which an assessment is required (see Rando, 1993). For instance, if the individual is seeking assistance during a time of crisis, the mental health counselor must focus specifically on information that is required to help the person achieve a state of safety and stability. In addition, if the individual has limited coverage for mental health care, the mental health counselor will be able to focus only on the issue(s) that are immediately relevant. In using limited resources wisely, the mental health counselor must also evaluate the appropriateness of gathering loss history information. Has the mental health counselor successfully established the rapport that is required to facilitate this process, that is, allowed the individual to feel comfortable discussing his...
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