Making SENSE of traumatic bereavement: A trauma informed approach
Recognising the widespread impact of trauma and stress, and the potential for re-traumatisation is key to supporting individuals who have experienced a traumatic bereavement. In this blog, psychological trauma consultant and clinical adviser to Sudden, Nicola Lester discusses the SENSE trauma-informed approach to support, which she originally developed in collaboration with the Tim Parry Johnathan Ball Peace Foundation.
The SENSE model is a trauma-informed approach to support suddenly bereaved people and was first developed in response to the Manchester bombing in May 2017, as a way of structuring the delivery of support in the immediate aftermath of the attack. Since then it has been adapted and used across a variety of different contexts both in the UK and overseas in the Middle East and Afghanistan.
The SENSE model is underpinned by an understanding of best practice in the field of psychological trauma and informed by the six principles of trauma informed practice to create a structured approach to the delivery of support as part of an early intervention approach. Adopting a ‘trauma informed’ approach to bereavement care provides a framework for organisations and professionals providing support to bereaved families in the aftermath of a traumatic loss.
Fostering resilience and coping
A trauma informed approach is one which recognises the widespread impact of trauma and stress and the potential for re-traumatisation. It actively seeks to reduce this possibility by understanding what is needed to foster resilience and coping and by promoting opportunities for recovery.
It is comprised of six key guiding principles to underpin practice:
- Safety – ensuring physical and emotional safety
- Choice – restoring choice and control
- Facilitating connections
- Supporting coping
- Responding to identity and context
- Building strength
Bereavements which occur under external traumatic circumstances may be regarded as traumatic. This is a term indicating the interface between trauma and loss, where in such circumstances grief symptoms are overlaid with trauma symptoms. In fact, because the impact of sudden, traumatic loss is so devastating, it may result in symptoms of post traumatic stress disorder (PTSD), meaning that the bereaved are faced with the dual task of mourning the loss as well as coping with the trauma that accompanied the death.
In addition there is growing recognition that the processes which occur after a bereavement may also leave the bereaved family susceptible not just to the effects of primary grief but may also serve to exacerbate their distress, as they are required to navigate a myriad of medical, legal and criminal processes, which may prioritise organisational procedures and requirements over the needs and wishes of the bereaved family.
Supporting bereaved families to navigate such processes, increasing their sense of voice and capacity to actively participate is essential and a key part of the support which is provided by the Sudden service and the SENSE model provides an effective way to structure the delivery of this care. In addition, the five stages of the SENSE model are designed to respond to the immediate practical and emotional needs of those who are bereaved, support their coping, mobilise and strengthen their access to social support and identify and address their longer-term support needs by engaging them with relevant services and professionals.
The five interventions of the SENSE model
The SENSE model is comprised of five interventions: Stabilisation, Education, Normalisation, Social support and Engagement; all of which have been recommended as best practice by both the National Institute for Health and Care Excellence and the broader trauma literature.
In creating the word ‘SENSE’, the order of the letters in turn reflect the chronology in which the interventions should be offered. For example, as part of an early intervention approach the emphasis is on stabilisation to ensure the physical and emotional safety of the person affected and that their immediate needs are met.
This is followed by providing information and education about the signs and symptoms of trauma and promoting an understanding of how trauma may affect someone as a way of ‘normalising’ or validating their experiences and offering reassurance. We recognise that for many in our society death and loss remain taboo subjects shrouded in both secrecy and judgment about how people should be coping and grieving when they are bereaved.
Helping people to understand how they feel and validating their experiences by providing a non-judgemental space in which to access support is intended to shift the focus from how someone should be coping to instead to support and enhance how they are coping recognising their resilience.
Empowering the bereaved person
The normalisation of symptoms coupled with education, introduces the idea of empowering the person and their wider social support network to monitor their symptoms and where necessary to facilitate early referrals to formal psychological services, which is known to improve outcomes over the longer-term. The importance of social support in both reducing the impact of stressful life experiences and in protecting those affected from going on to develop PTSD and other mental health difficulties is well established, suggesting that it is essential to assess the presence and availability of social support as the fourth stage of intervention.
The final stage is engagement; either encouraging engagement with specialist support services; promoting the individual’s engagement with their wider social support network or assisting them to re-engage with their own values and goals and to regain a sense of purpose and control. At this final stage we plan for the longer-term to ensure access to relevant and appropriate services capable of providing the right support, at the right time based on an understanding that everyone is unique and affected by traumatic bereavement in different ways.
Delivering the SENSE model
The five stages of the SENSE model can be delivered in a variety of different ways, including face to face, via email, telephone and online. Whilst it is suggested that the five stages are implemented in chronological order to provide a sense of structure and purpose, each stage can be delivered as a standalone intervention, depending on the needs of those you are working with. It may be beneficial to explain the stages, as this will help the person to feel that they are making progress, particularly if you build in regular opportunities for review.
About the author
Nicola Lester is a psychological trauma consultant and clinical adviser to Sudden and Brake, the road safety charity.