Best Practice in Counselling Models Relevant to Families and Friends of Missing Persons “It’s the Hope That Hurts”



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Families and Friends of Missing Persons Unit
Victims of Crime Bureau

NSW Attorney Generals Department



Best Practice in Counselling Models Relevant to Families and Friends of Missing Persons
It’s the Hope That Hurts”

Hunter Institute of Mental Health

PO Box 833

Newcastle


August 2001

INDEX
Details of Project 1

Central Reference Group 2

Hunter Reference Group 3

Project Process 4

Recommendation Summary 6

Introduction 9

The Lived Experience 13

Some Models of Grief and Loss 18

A Preferred Model of Counselling 31

Some Elements of Best Practice 33

Recommendations 40

References 43



THE BRIEF
In early June of 2001 the Families and Friends of Missing Persons Unit operating within the NSW Attorney Generals Department out of the Victims of Crime Bureau contracted the Hunter Institute of Mental Health to investigate and report on best practice model/s relevant to families and friends of missing persons.
The expected outcomes were:

1 A thorough national, international and cross-disciplinary review of the relevant literature presented in a concise and reasoned manner complete with a detailed reference listing;

2 A brief descriptive summary of the mainstream counselling models relevant to the topic under consideration complete with advantages and disadvantages apropos families and friends of missing persons;

3 A summary of consultations undertaken with primary contact organisations (tracing and supporting), clinical experts and a sample of practising clinicians;

4 Recommendations for developing best practice in counselling models relevant to families and friends of missing persons including any need for professional development training and education of service providers.

CENTRAL REFERENCE GROUP


Ms Leonie Jacques, Families and Friends Missing Persons Unit

Professor Don Byrne, Head, School of Psychology, Australian National University

Dr Geoffrey Glassock, Manager, Psychological Services, The WorkWise Group

Dr Daphne Hewson, Senior Lecturer in Psychology, Macquarie University

Dr Jac Brown, Lectures in Psychology and Coordinator, Masters in Counselling,

Macquarie University

Mr Daryle Lightfoot, Senior Social Worker, International Social Service Australia

Mr John Merrick, Senior Grief Counsellor, NSW Institute of Forensic Medicine

Ms Ros Montague, Program Director, NSW Institute of Psychiatry

Ms Iris Willoughby, NSW Missing Persons Committee Inc.

Ms Maree Dawes, NSW Missing Persons Committee Inc.

Report Senior Author:

Professor Trevor Waring

Director


Hunter Institute of Mental Health

HUNTER BASED REFERENCE GROUP - SENIOR CLINICIANS AND COUNSELLING ACADEMICS
Mr Rick Barbour, Clinical Psychologist, Child and Family Health

Mr Wayne Clarke, Senior Clinical Psychologist, Child Psychiatry

Mr Bruce Furner, Senior University Counsellor

Ms Jo Gaha, Senior Lecturer, School of Social Work, University of Newcastle

Ms Ros Gribble, Area Advisor Psychology, Hunter Health

Dr Mick Hunter, School of Behavioural Science, University of Newcastle

Dr Howard Johnson, Psychiatrist, Centre for Psychotherapy

Mr Pat Loftus, Senior Clinical Psychologist

Mr Kel Merriman, Clinical Psychologist, Upper Hunter Health

Mr Tom Pepe, Clinical Psychologist, Child and Family Health

Ms Toni Single, Senior Clinical Psychologist, Children at Risk

Dr Rosemary Webster, Lecturer in Psychology, University of Newcastle

Mr Chris Willcox, Clinical Psychologist, Centre for Psychotherapy


METHOD

DEVELOPING THE REPORT

1 A national and international literature search was undertaken searching across the disciplines most likely to be involved in the area under inquiry.


A systemic literature search was performed to identify publications relating to the experiences of families and friends of missing people.
Seven electronic databases were examined: MEDLINE (1996-2001), PsychINFO (1984-2001), SOCIOFILE (1974-2001), CINAHL (1983-2001), Dissertation Abstracts International (1861-2001), the Cochrane Library (1996-2001) and Journals@Ovid. The following keywords were used in the search, and were exploded to Medical Subject Headings (MeSH) where appropriate; “grief”, “counselling”, “models”, anticipatory”, “missing people”, “threat”, “coping”, “family”, “non-specific”, “ambiguous”, “kidnapping”, “uncertain”, “death”, “loss”, “chaotic”, “missing in action”, “pathological”, and “traumatic”. Each keyword was additionally combined with other keywords to refine the search.
Although over 180 publications in relation to grief and loss were located, only five related specifically to the experience of families and friends of missing people, indicating an area that theory and research have relatively ignored. The information presented in this summary links the experience of families and friends of missing people with the generalised grief and loss models, and incorporates information gained from consultation with those listed below.

2 Organisations* known to be involved in search and tracing activities were asked to offer their experience by way of submission.
3 Senior counselling clinicians and counselling education academics were involved in focus groups.
4 Draft copies of the report were circulated to the reference group for comment.


  1. * Families and Friends of Missing Persons Group Inc

Kids Helpline

Community Tracing Section, NSW Police Service

Link-up (NSW) Aboriginal Corp

Tracing and Refugee Services, Australian Red Cross NSW

Missing Person Committee (NSW) Inc

Gay and Lesbian Counselling Service

Counselling Services, Mission Australia

International Social Service, NSW

Family Tracing & Special Search Services, The Salvation Army


RECOMMENDATIONS

1 That the FFMPU promote the development of identified counsellors for the families and friends of missing persons to be accessed by prospective clients.


2 That the FFMPU promote the development of competencies and specific training be discussed and developed in liaison with relevant professional and/or training bodies.
3 That the FFMPU promote the development of suitable training workshops*.
4 That the FFMPU emphasise the importance of counsellors offering flexibility and long term continuity of availability in their provision of counselling to the family and friends of missing persons.
5 That the FFMPU develop a web site that includes a listing of those recognised as identified counsellors of families and friends of missing persons.
6 That the FFMPU maintain a listing of recommended readings for its identified counsellors.
7 That a pamphlet be developed for distribution to families and friends of missing persons outlining what standards and services can be expected of identified counsellors.


8 That the FFMPU issue a statement endorsing certain basic principles of counselling the families and friends of missing persons including, but not restricted to, the following: Counsellors of the families and friends of missing persons are encouraged to:
Ensure they possess well honed basic counselling skills recognising the particular importance of empathy and genuineness

Ensure they are well informed of the particular needs of the family and friends of missing persons

Avoid a dogmatic attachment to a “stage” approach to loss theory and particularly any unmodified application of grief and loss models that emphasise ‘closure’ and ‘resolution’ as end products.

Be familiar with the ‘lived experience’ of the family and friends of missing persons.

Be available for the ‘long haul’ in terms of availability.

Be familiar with developmental issues surrounding the loss/hope dilemma experienced by family and friends of missing persons.

Maintain currency in the literature surrounding loss and grief and the issues facing family and friends of missing persons.

Develop an association with local support groups for the family and friends of missing persons.

Engage in a therapeutic philosophy that assists the family and friends of missing persons helpfully redefine and reinterpret their altered status with the missing person.

* Suggested content could include:

1 Contributions by consumers on the lived experience


2 Applicability of various counselling models and theories

3 Details of various search agencies and procedures

4 Legal issues when someone goes missing

5 Information on support groups

6 The impact on relationships where a loved one is missing

7 Problems in reunions

8 Found but estranged

9 Avoiding the less helpful





INTRODUCTION
There is limited information on the actual number of those that ‘go missing’ each year in Australia and what does exist, refers only to those reported to police. Anecdotal evidence suggests far more ‘go missing’ and, for a variety of reasons, are not reported to authorities.
In Australia, one person is reported missing every 18 minutes (Henderson & Henderson, 1997). Although 99% of these people are found (85% within one week, 95% within one month), the whereabouts of 300 people are still unknown six months after their disappearance (Henderson & Henderson, 1997). In around one-third of these cases, the person had gone missing before.
The population of Australia’s missing people is divided into children/young people (55%) and adults (45%), with approximately equal numbers of males and females involved (Henderson & Henderson, 1997).
For someone to be listed as a missing person, there first need to be searchers. Thus, at the risk of stating the obvious, it is necessary for a person or persons to register as searching for a missing person for that person to be included in official counts as missing. Many individuals lose touch with family and friends and for all intents and purposes are missing. However, because no one registers an interest in finding the individual, they are not officially missing. Thus to be ‘missing’ in an official sense, three criteria need to be met:

  1. A person cannot be located,

  2. A person or persons wish the individual located, and

  1. The concern is registered with an authority - usually the police.

Examples of those not meeting the criteria and thus deflating the figures are many. Older teenagers in conflict with parents, departing spouses, absconding parents, migrating siblings, children surrendered to adoption, people in financial crisis etc are just some of those that ‘go missing’ and yet do not necessarily fulfil criteria to be counted as officially missing, largely because no one has registered a serious interest in having them located.


Another large group of people that ‘go missing’ each year and are not reported to the authorities, are those where family and friends expect the ‘missing’ person to return in the immediate future and make a decision not to report. Given that the statistics indicate almost 99% of those that ‘go missing’ are located or ‘self locate’ within a short time span, those that make such a judgment are, in all probability, relatively secure in their decision particularly when the person has a history of ‘going missing’ on prior occasions.


There are of course many others that could be described as ‘missing’ with family and loved ones interested in their location at levels of intensity ranging from curious to urgent. Situations where a person might wonder “whatever happened to Aunty Flo?”, while in a technical sense could be described as a ‘missing’ person scenario, while no one is actively searching, aside from perhaps those with genealogical interests, the matter is not reported. On the other hand, many adopted (and the mothers who surrendered them, often under social duress) continue their search also often without registering their interest with the police. To this group could be added those who search for loved ones lost in war, refugees, migrant families etc all who search through various mechanisms without inclusion in official figures but not without the pain and anguish associated with their despair.
While the reasons individuals ‘go missing’ are almost as many as the number who go missing, there are common themes in the anxiety, anguish and despair felt by those who seek their return. Almost invariably it is the suddenness and inexplicability of the disappearance that is the source of anxiety and it is these who may well seek counselling and support.
As alluded to above, at least one person disappears without trace in Australia every day. Most of the family and friends of these people will obtain support and counsel from each other and those involved in the early stages of searching. Some will require trauma counselling in the immediate days following the discovery of their loved one’s disappearance while for others there will be a need for longer term support often delivered at times when triggers unsettle their uneasy emotional balance. These people live with the pain of not knowing, hoping against hope, fearing the worst and struggling with the ambiguity of the designation afforded their loved one as ‘missing’, an ambiguity that implies the possibility of rediscovery.
The number of families and friends of missing persons seeking counselling at any one time is likely to be small relative to the more common areas of psychological need. However, the complexity of this group’s dilemma, the absence of research and the lack of fit with many of the common theoretical models touching on loss, demand that those offering counselling to the families and friends of missing persons be highly experienced and aware of the many complex issues involved.


The Henderson Report (Henderson & Henderson, 1997), based on interviews with the family and friends of missing persons and consultations with government and non-government agencies indicated priority areas for action, many relating to support and counselling needs. Some of these were:-

  1. _ Specialised training in unresolved grief counselling and missing person support needs,

  2. _ Training in missing person issues for telephone counsellors,

  3. _ Promoting understanding of missing person issues among special need support groups, and

  4. _ Establishment of specialised self-help groups for families of long term missing persons.

The recognition that family and friends of missing persons require a unique understanding by counsellors suggests the need for education and training to ensure these often vulnerable people get only the best of support and professional services to avoid adding to their already enormous burden. Unfortunately the search for support and counselling by family and friends of missing persons brings anecdotal reports of less than satisfying experiences that range from the well meaning but unhelpful to the bizarre. There thus exists the need to ensure that what can be done is done to ensure an informed pool of high quality counsellors are available to be recommended by the Families and Friends of Missing Persons Unit.




THE LIVED EXPERIENCE
When a person goes missing, the impact on those left behind is enormous. For every case of a missing person reported to police, an average of twelve people are affected in some way, be it health consequences, financial difficulties, or quality of life issues (Henderson & Henderson, 1997).
In Australia, 37% of people with missing friends/relatives experience physical or emotional problems directly related to the incident (Henderson & Henderson, 1997). These include migraines, sleep loss, cramps and other stress-related symptoms. The disappearance of a family member/friend impacts on the work or business activities of around half of the people involved, with reports of work performance suffering due to concentration problems and time off work (Henderson & Henderson, 1997).
The economic impact of being the relative of a person who is missing is substantial, with 97% of these conducting some kind of search for the missing person (Henderson & Henderson, 1997).
In addition, legal issues arise in the use and maintenance of the missing persons’ property, which are not easily resolved. Ninety-four percent of people experience a disruption in their routine activities and quality of life. This includes irregular meals, late nights, disturbed sleep, altered social and leisure activities and sometimes ignoring the emotional needs of other children in the family (Henderson & Henderson, 1997).


Further, in 57% of cases, the relationships of those people left behind are affected in terms of a breakdown of trust, arguments, and expressions of hostility and anger directed at others (Henderson & Henderson, 1997). Emotionally, people report shame, embarrassment, shock, sadness and helplessness at the disappearance of a family member or friend (Henderson & Henderson, 1997).
Case studies of parents whose child has gone missing reveal they are consumed with fear, as well as frustration with police who are unable to provide answers relating to the disappearance (Gosch & Tamarkin, 1988). Feelings of guilt prevail, with people feeling responsible for not adequately protecting the missing person from danger and, as time goes on, for re-integrating into society and enjoying some aspects of life (Brannen & Podesta, 1990). Klass and Marwit (1988-9) suggest that the loss of a child is a particularly serious challenge to the competence of a parent, such that they report the following: “I couldn’t protect him from doing one foolish thing, and that one thing cost him his life. I’m a failure as a father, I feel so hopeless”. Self-esteem relates to the success one perceives they have achieved in valued social roles, such as parenthood, and as such, mothers in particular are vulnerable to the loss of self-esteem (Riches & Dawson, 1996).
Re-integration into society presents an additional problem for some family members and friends of missing people, being branded “hysterical” and “nuisance” by police and “fanatical” by neighbours (Gosch & Tamarkin, 1988).


In addition, for the families and friends of missing people, there exists a real tension between avoiding and confronting the reality of their situation. For example, one mother reported that “nothing anybody can say will make me feel better¼I wake up in the morning and at least the worst hasn’t happened, at least they haven’t found her dead” (Brannen & Podesta, 1990). Another person, whose brother went missing, suggests “to all intents and purposes, my brother is dead – he is cut off from his family and friends. It has actually been easier for me to cope with a dead brother than a missing one, but there will always be that element of doubt” (Jones, 1988). This is where families and friends of missing people are the most vulnerable.
Although information relating specifically to the experiences of friends and families of missing people is sparse, a number of studies have been carried out to assess the health, social and other consequences associated with the death of a loved one. These consequences are magnified in the event of a sudden, traumatic and unexpected loss.
In the immediate weeks after bereavement, people experience a significant decrease in the functioning of their immune system, compromising their ability to stave of physical illness (Parkes, 1987-8). Although mortality rates do not appear to be elevated among bereaved people, one in three bereavements will lead to a morbid outcome such as depression, drug or alcohol problems and chronic anxiety (Parkes, 1987-8).


Parents who have lost a child tend to become either over-protective or neglectful of those children who remain in the family, and are often pre-occupied with memories of the deceased child (Parkes, 1987-8). Although marriage seems to have a buffering effect against the physically detrimental effects of bereavement, evidence suggests that the loss of a child is associated with an increased risk of marital and relationship breakdown compared with couples for whom such a tragedy has not occurred (Dijkstra & Stroebe, 1998). Although socially unacceptable, parents may feel anger at the child who has died/disappeared for the role they played in their own demise, or for not being able to say goodbye and express their love (Drenovsky, 1994).
Siblings of deceased people suffer from sleep disturbance, and guilt at being left behind (Parkes, 1987-8). Boys often express their grief in terms of aggression, while girls may be more passive and become “compulsive caregivers”, taking over the parental role. This is particularly the case for children aged 8-12 years, who also will suffer anxiety about their own and their parent’s ability to survive (Parkes, 1987-8). In losing a family member, children not only lose that person, but also their world of shared assumptions, including their morals and values (Rafman et al., 1996). If a family member has gone missing, a child’s normal supportive, protective network is also absent, as each member struggles to cope with the loss. Children may also develop “magical thinking” around the person’s death or disappearance. For example, they may believe “if I behave perfectly enough, mum will come back” (Waldegrave, 1999), or “if I had been a good boy, daddy wouldn’t have gone away” (McKissock & McKissok, 1995). Although these expressions are aimed at making sense of something terrible that has happened, if left unchecked, this style of thinking may lead to problems over the longer term, particularly if the person does not return.


From a developmental perspective, children are particularly sensitive to parental cues of danger and fear (Parkes, 1997). That is, children will learn what to fear from their parents, and will develop a set of assumptions about the world based on this. If parents are excessively fearful, as may be the case if a child goes missing, the children left behind may develop a somewhat distorted view of the world that, once established, is difficult to alter and makes them vulnerable to fear and anxiety in later life (Parkes, 1997).
In contrast to the loss of a child, loss of a spouse results in greater loneliness and anxiety about the future. For many, partners meet security and self-esteem needs, and when a spouse is lost, the person left behind also loses this resource (Worden, 1991).
Many family members and friends of missing people experience disenfranchisement in their social world. Disenfranchisement occurs when a person’s experience of loss is unacknowledged, socially negated, invalidated or unrecognised (Dempsey & Baago, 1998; Doka, 1989). In one mother’s experience, some people would say “you can’t hold onto him forever, you have to let him go. But it was unliveable for me to think that I was forever cut off from him” (Waldegrave, 1999). Another mother recalls that “I think of her – well all the time you do it, it just comes through your mind. On special days like Christmas and her birthday and mother’s day and all those times when children seem more special” (Kendall, Clayton-Brown & Read).
Other people rarely know how to encourage the safe expression of grief, therefore the opportunity for emotional release in everyday discourse is limited (Riches & Dawson, 1996). Families and friends of missing people may feel stigmatised and vague about their social position as they will often become the object of pity, avoidance, embarrassment, and possibly blame for what has happened (Riches & Dawson, 1996).

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