Art Therapy with Grieving Female Inmates

Kelsey Thomas
PennWest: Edinboro
COUN 7550 Introduction to Research in Art Therapy
Dr. Sheila Lorenzo de la Peña
August 9, 2024

ART THERAPY WITH GRIEVING FEMALE INMATES

Abstract
Grief is something that everyone experiences and for different reasons. The prevalence of grief
rises exponentially when looking at those who are incarcerated. However, these facilities do not
provide adequate mental health support for those working through grief. Out of the incarcerated
population, women have been looked over and their mental health pushed aside. The aim of this
curriculum is to provide these women a place and way to creatively process their grief.

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Section I: Introduction
A study done in 2021 found that “offenders suffer bereavement at significantly higher
rates than the general population” (Hunt, 2021). The incarcerated population must process the
grief of losing their freedom, identity, and connections to loved ones on the “outside”.
Furthermore, female inmates encounter the loss of their maternity. The environment or social
setting in correctional facilities do not allow for proper grief processing which can result in
inmates further suffering with complicated grief. Aspects such as the Convict Code, improper
counselor training, and lack of privacy lead to disenfranchised and suspended grief.
Art therapy is continuously being studied on its success rates with grief and with the
incarcerated population. It provides space for emotional processing without verbalization. The
correctional facility environment has potential for Art Therapy to have great feats.
Problem to be Investigated
The incarceration system has a lack of support or help while imprisoned and processing
through grief. Inmates suffer from the bereavement of losing their freedom, identity, and
physical loss. Incarcerated women process the loss of their maternity. Their kids are taken away
from them, they are not able to support them, or the women give birth while serving their
sentence.
Purpose Statement
The purpose of this research is to create an art therapy curriculum for women who are
incarcerated and experiencing grief. This curriculum is to be used with women going through
different avenues of grief and at different places in their healing journey.

Justification

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A study done in 2019 found that “the U.S. incarcerates 30% of the world’s population of
female inmates” (Paynter et al. 2019). These rates of women being incarcerated are continuously
increasing. Yet, most of the mental health research within the incarcerated population focuses on
male inmates. There is an abhorrent lack of research focused on incarcerated women and the
need for sufficient grief support.
Terms Related to the Study
Art Therapy: creative process to help/encourage emotional processes
Beck Depression Inventory: 21 self-report question survey used to assess the presence or
severity of depression
Bereavement: physical/act of loss
Complicated Grief: an ongoing, heightened state of mourning that keeps one from healing
Dignity: the quality or state of being worthy
Insider Art: art created by inmates while incarcerated (Gussak, 2020)
Grief: emotional response to loss
Disenfranchised Grief: form of grief that is not acknowledged by others or society
Locus of Control: degree of belief a person has about external forces, opposed to themselves,
have over their life
Physical Loss: no longer having something tangible
Psychological Loss: no longer having a sense of control, safety, or something intangible
Term
Inmate: a person confined to an institution such as a jail or prison
Loved Ones: anyone of importance to the inmate- family, friend, mentor, etc.
Outside: not within the walls of the correctional facility
Women: cis gender/assigned at birth female adult

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Conclusion
Within the Art Therapy research environment, there is a severe lack of information on
female inmates. Despite the number of women who are arrested continue to rise, any research
with this specific population has been neglected. Grief is an ongoing complication to inmates’
mental health and proper support is not provided. Art Therapy is an expressive therapy that can
help process grief in a way accepted in prison culture. When one is incarcerated, they deal with
substantial bereavement. Women also have the added psychological loss of motherhood.
However, there is a deficiency of research on the mental health of female inmates specifically.
Art Therapy is a form of therapy growing in popularity within the correctional system.

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Section II: Review of Literature
There is bereavement everywhere in the world and it creates grief with those it effects. Openly
processing these emotions is crucial in the healing process. Some populations do not have the
ability or circumstances to safely process. One of these populations includes the inmate
population. However, there is an accepted (by inmates) therapeutic method within prison systems
– Art Therapy. The following literature review will look at different aspects of incarceration, art
therapy, and bereavement/grief.
Prison culture
From television shows to podcasts, books, and documentaries, criminal behavior and life
in prisons has captured the attention of our society. Life behind bars is difficult, negatively
affecting a person’s mental health and that of their family/community. Prison culture does not
change because “prison codes typically entail prescriptions and proscriptions for how
incarcerated individuals should behave, thereby shaping interpersonal and organizational
dynamics behind prison walls... to survive prison, inmates must learn to reject the norms of free
society and adopt the new normative order” (Bucerius et al., 2023).
In society there is generic knowledge of the Convict Code. It is a term given to the
unwritten rules, created by inmates, of how inmates are expected to behave. From interviews and
observations, Convict Code can be condensed into “key features that define the code [such as]
social role adaptation, inmate solidarity, and manipulation of staff... [the five rules are], 1. don’t
interfere with inmate interests, 2. don’t lose your head, 3. don’t exploit inmates, 4. don’t weaken,
5. don’t be a sucker” (Clark, 2021). These rules are enforced by physical and mental
repercussions from the other inmates. To leave incarceration unscathed, inmates must comply
with the Convict Code. For many, this means “they need to keep a mask in place, to keep hidden
from everyone around them the real person underneath” (Gussak, 2019, pg. 10). The process of

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shutting everyone out also includes shutting out emotions. With rules 4 and 5 of the Convict
Code in place, “inmates are reluctant to admit issues that make them appear weak” (Gussak,
2019, pg. 65). Life on the “inside” requires a constant alpha mentality and living in a perpetual
state of survival.
One of the most challenging parts of living life confined to the prison system is the loss
of identity that inmates experience. In his work within the incarcerated system, David Gussak
saw how “their identity [was] stripped away, and they [were] given a number and uniform. This
reinforces their loss of self and disempowers them” (Gussak, 2019, pg. 52). Inmates report how
this is a “loss of dignity” and “loss of power over your life” (Testoni et al., 2020). Not to mention
the labels that inmates are given. They begin to become known for the crime they committed and
seen as a threat no matter the situation. They become outcasts in society, the “labels become
internalized, and the convicts begin to see their identity as antithetical to cultural and societal
norms” (Gussak, 2019, pg.62). In interviewing correctional officers, Higgins witnessed how
“staff generally depicted incarcerated people as highly dangerous ... [stating] ‘I work in
corrections to keep the nightmares in their cages’ ... categorizing all incarcerated people as
capable of horrific violence at any time” (Higgens et al., 2022).
Women Prison Culture
While most prison systems are home to the detrimental behaviors discussed above, there
are differences between men and women prison cultures. When looking at the population of
women who have been arrested, their crimes are often emotionally charged. They were acting in
self-defense or protection. These women are entering the prison system already under heightened
emotional distress. Granted, the Convict Code is still enforced, however, there are specific
behaviors unique to this population.

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Compared to their male counterparts, female inmates tend to have higher rated of having
External Locus of Control (LOC). Locus of Control refers to the degree of belief a person has in
causes of events in their life. There is External LOC and Internal LOC. Having an External LOC,
means that a person holds external forces (ex. Fate, luck, God) responsible for the circumstances
of their life. In contrast, people with an Internal LOC believe that they are in control of what
happens to them. Those with an external LOC don’t accept responsibility for their actions. Yet,
they are more willing to accept support from others. This is highlighted by Gussak in a study on
LOC in inmates in 2009. He found that “incarcerated women openly demonstrate needs for
affiliation and support” (Gussak, 2009). Women inmates are inclined to gather and support each
other, instead of trying to prove Alpha mentality.
Despite showing increased support, “women were more asocial and had difficulty
adjusting emotionally to imprisonment” (Gussak, 2009b). While male inmates turn to violence to
prove dominance, women tend to play more psychological mind games to show who is toughest.
To prevent providing ammunition for other inmates to use against them, female inmates build
even more walls up around their emotions or weaknesses. They are likely to be extremely
guarded and not show a shred of emotion.
Another situation that an increased amount of women inmates' face is assaults on the
inside. They live in an emotionally charged environment where behaviors (of staff and inmates)
can be questionable. Within the U.S. prison system, sexual assault of female inmates runs
rampant. However, “facilities do not create environments where survivors feel comfortable
enough to report victimization” (Ervin et al., 2020). With the conditions of these facilities,
victims cannot escape their abuser and are constantly re-traumatized.
Grief in Prison

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At the same time as adjusting to incarceration, “offenders suffer bereavement at
significantly higher rates than the general population” (Hunt, 2021). There are various causes of
loss that one experiences throughout life and inmates experience even more. They have
bereavement from losing their freedom, losing their identity, and losing loved ones. While all
experience these losses, the grieving process is unique to each inmate. Not only does grief have
to be from a physical loss, but a psychological loss can also have just as heavy of an impact.
When a person experiences grief, therapy can be a beneficial tool to help processing. Yet, there
is a severe lack of mental health resources available for inmates. The limited opportunities that
are offered are often described as poor and “viewed by many as useless... getting appointments
was difficult and [inmates] were angered that the main concern was suicide risk” (Harner et al.,
2011). One prison report that the “average time referral to receiving a service was 28 days... but
ranged up to 86 days” (Vaswani, 2019). Inmates that did receive services reported that there was
a “lack of privacy and space... [we were] unexpectedly interrupted for route moves, or conflicts
and arguments” (Vaswani, 2019). Correctional facilities are often short staffed, resulting in
uniformed officers standing in for trained counselors. Along with that, when inmates do receive
appointments, they last all 10-15 minutes and follow-up appointments are more than a month
apart. This is not an effective amount of time to properly work through any grief inmates might
be experiencing. This lack of proper mental health support can result in inmates suffering with
disenfranchised grief. This is best described as grief that is not fully processed due to not being
able to be publicly expressed, not socially accepted, or not acknowledged.
Working through grief in a culture run by the Convict Code can make it nearly
impossible to divulge or speak of any emotions. In fact, “tears are not culturally acceptable, and
the overall inmate code of behavior is antithetical to the grieving process” (Wilson et al., 2022).
Inmates must be mindful of the Convict Code and how guards perceive their behavior. Inmates

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find it “difficult to express [emotions] in secure environments without negative
consequences...those who reacted violently were much more likely to be segregated for 23 hours
a day. Acts of misconduct potentially increase the length of one’s sentence, emotional reactions
must be suppressed” (Hunt, 2021). These conditions prevent healthy coping with/processing
grief.
An important aspect of grief, when brought on by death, is closure. A common way for
families to receive closure is through memorials, funerals, or any traditional rituals to celebrate
and honor the one they lost. Inmates going through loss are seldom allowed to attend those
services. The few that are permitted to attend describing it as a “humiliating experience of
attending a funeral in handcuffs with a police escort.” This leads to “many preferring not to
attend at all than to arrive in chains” (Hunt, 2021). Not being able to witness this closure can
leave an inmate with grief that is suspended in time, quickly becoming disenfranchised grief. For
the fortunate inmates authorized to go to services, they can only attend to immediate family
members or those the facility has familial record of. One example of this is that “if they [the
inmate] said ‘I’ve lived with them’... but we can’t find in their files any mention of them living
with the grandparents, then it’s a ‘no’ straightaway” (Wilson et al., 2022). This makes it
especially hard for inmates who lose a loved one, who may not be immediate family. It is
common for friends, mentors, neighbors, etc. to be considered family and just as, if not more
intense of a loss for inmates. Yet, they are denied the opportunity for closure.
A unique loss for female inmates is the loss of maternity or motherhood. Mothers who
are arrested often lose parental rights or do not receive visits from their children. They are taken
out of their role of motherhood, a role that can be a keystone to her identity. One inmate
expressed that her “identity was strongly based in her role as a mother, so she allowed herself to
punish herself for not being the mother that she desperately wanted to be” (Hunt, 2021). Then,

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there are those who are arrested when pregnant which, “between 5 and 10% of women enter a
penal institution pregnant” (Hunt, 2021). Very rarely, in the United States, do facilities have
nurseries or mother/child units. So, those women who give birth while incarcerated have their
baby taken away from them. Women described this action as “having their newborn ‘ripped’
from them” (Abbott et al., 2021). Without their individuality- on top of pregnancy, incarcerated
women are having to cope with “depression, helplessness, and feelings of marginalization and
dehumanization being further exacerbated when contending with pregnancy, giving birth, and
losing their families while incarcerated” (Hunt, 2021). These are complicated feelings of grief
that are specific to female inmates.
Art Therapy
Art therapy is a trailblazing method of expressive therapy that allows clients to create art
as a way of expression. It encourages the creative process and provides an emotional release
through art making. David Gussak, a notable researcher and art therapist/professor, highlights
“Art therapy, as a mental health intervention, [that] works despite organicity, a low educational
level, poor cognitive development, illiteracy, and other obstacles to verbal communications”
(Gussak, 2019, pg. 69). The success of art therapy with many of these populations is one of the
perks of this method. Art therapy consists of multiple theories developed throughout the years.
The following paragraphs expand upon three theories used to create this specific curriculum.
The Expressive Therapy Continuum (ETC) is a theory that was developed by Vija
Lusebrink and Sandra Graves-Alcorn. It looks at a person’s level of cognitive functioning using
a range of creative processes. In the Wiley Handbook of Art Therapy, it is defined as looking at,
“different areas and functions of the brain associated with different levels of visual information
processing and visual expression” (Gussak & Rosal, 2016, pg. 57). There are three levels of the
continuum, each having two poles of functioning. The first or “bottom” level is the Kinesthetic /

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Sensory level. Those who are functioning at this level strive for a more tactile high sensory input
experience. It focuses on sensorimotor skills allowing for deeper memories/emotions to be
expressed without verbalization or language. The middle or “second” level is the Perceptual /
Affective. Those on this level focus on the intention of art making and the final product. There is
emphasis on how the client perceives their reality. The final or “top” level of the ETC is
Cognitive / Symbolic. Clients functioning at this level are concentrated on the planning and
strategy of creating their piece. These processes pinpoint problem solving and insight of the self.
The transition through the levels coincides with a client’s progression through their emotional
healing.
A second prevalent theory is Cognitive Based Art Therapy (CBAT). It is founded in the
ideas of Cognitive Behavioral Therapy but with the intertwining of art practices. CBAT
“embraces concepts of envisioning new and adaptive patterns of thinking, behaving, problemsolving, and coping”. Art making is used in “visualizing and reframing stressful, traumatic,
disturbing thoughts, actions, and events” (Gussak & Rosal, 2016, pg. 74-75). Art therapists using
CBAT focus sessions on re-examining problems, attention shifting to better adapt, and/or
changing perspectives of emotionally significant situations.
Psychoanalytic Art Therapy is the third theory that supports this curriculum. It promotes
free media and subject choice. The therapist focuses on observing the client’s behavior while
creating. Throughout creating and after, the therapist will conduct informal open interviews to
promote free association. Margaret Naumburg, a pioneer of Art Therapy, describes that this
theory is “stressed in the release of unconscious imagery spontaneous art expression, believed to
prevent emotional problems through catharsis” (Gussak & Rosal, 2016, pg. 27). The emphasis is
on supporting clients to grow by providing a space for them to feel safe and free to fully express
themselves.

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Art Therapy and Community
Art therapy is successful with copious diverse populations. Expressing thoughts and
feelings through art is a way for communication to extend past verbal speaking. This act of
creating provides a level playing field for all participants. Language barriers are not a hindrance
to treatment between therapist to client, client to client, etc. Art therapy can be well adapted to
people who are differently abled as well, further expanding its reach to even more clients. Social
and economic statuses are dissolved with the motivation to have a creative release as the focus.
Not only is art therapy powerful in individual sessions, but it can also create attunement
with groups. Group art therapy sessions allow “people with similar needs to provide mutual
support for each other and help with mutual problem solving” (Liebmann, 2004). This fosters the
group support from others, that inmates often desire. In creating art together, or in group unison,
an automatic, mutually understood level of trust is formed. Some prison systems have created a
mural program. A group of inmates work together to draw/ paint murals on walls within the
facility or even on other buildings throughout the community. This team's effort towards one
cohesive piece cultivates bonding and solace (Gussak, 2019). Being part of a group can also
elicit feelings of inclusion and promote healthy social relationships. In a 2019 study, Emily
Nolan describes the group she leads as one that “strives to foster a sense of personal and
collective agency through expression and feelings of belonging and purpose while furthering
healthy connections within the group.” Building these foundational social needs while
incarcerated helps inmates to assimilate to society.
Art Therapy with Inmates
Art in correctional facilities is highly respected amongst inmates, along with those who
created it. It is an accepted form of self-expression that “provides the prison inmate an
opportunity to express him or herself in a safe and acceptable manner, can relabel the identity

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from that of inmate, instills a sense of hope, self-value and humanity in an environment that
otherwise suppresses it” (Gussak, 2019, pg. 39). When inmates create, they can transform the
reality around them and experience a temporary mental getaway. In Gussak’s follow up study in
2019, he illustrates how “art therapy has the advantage of bypassing unconscious and conscious
defenses, including pervasive dishonesty... [and] supports creative activity in prison and provides
necessary diversion and emotional escape.” Art therapy satisfies the human need to make things
special and to focus on something that is productive.
In line with the Convict Code, inmates often shut out emotionally those around them.
They put up mental walls to prevent appearing weak and will not open to counselors or other
inmates. That is where art therapy can be successful. It has the “ability to bypass these survivalbased defenses... a means to bypass such selective dishonesty and address the real issues”
(Gussak, 2019, pg. 39). Putting the emotion into the artwork provides distance that allows the
inmates to reflect and process the vulnerability that they cannot express verbally. This distance
also allows inmates to remain protected from the others and prevents exposing themselves to
physical ridicule for breaking the Convict Code.
While the presence of art therapy in penal facilities continues to be rare, a few clinicians
strive to bring thoughtful opportunities for expression to inmates. One of the more popular ones
is called Inside Outside Boxes. Inmates are given cardboard boxes and a variety of collage
materials, paints, markers etc. The directions are to decorate/ enhance the box in two different
ways. The inside of the box is to be representative of themselves when they are not “behind
bars.” It should show parts of themselves that they admire or are proud of, but don’t want other
inmates to see. While the outside of the box should show who they are as inmates. What aspects
of themselves do they show the other inmates and guards, how they protect themselves or
survive (Gussak, 2019). Another intervention that is popular with inmates is called a Self-symbol.

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Inmates are asked to “create a self-symbol" and have access to various supplies to create with.
This intervention provides reflection on their self-awareness and provides enough reflective
distance for the inmates to further process how they view themselves (Gussak, 2006). The third
intervention is called Name Embellishment. This intervention is commonly done in the beginning
of the therapeutic process, while the therapist is still building rapport and getting to know the
inmates. They are given drawing/coloring supplies and paper, then asked to draw out their name.
Then, decorate and adorn the paper with images, symbols, patterns, etc. that they feel represent
them (Levy, 1978). All three of these interventions have something in common- helping inmates
to establish a sense of self and identity. They give the participants a chance to freely express
themselves, in a way that is respected and allowed while incarcerated.
One of the struggles of art therapy programs in correctional facilities is the materials. All
penal institutions require strict security and security protocols, art therapy sessions are no
exception. There is a succinct list of materials allowed in, and all materials must be thoroughly
checked and continuously accounted for. Art therapists need to be particularly creative and think
on their feet when materials are confiscated or go missing. In Gussak’s book, Art and Art
Therapy with the Imprisoned, he shares unique materials inmates have used to create. Some of
these items include “Kool-Aid powder, bars of soap, shoe polish, hair, M&Ms, napkins, twigs,
etc.” (2019). Nonetheless, art therapists and inmates continue to find artistic ways to express
themselves.
Materials can have significance in art making. For example, using a piece of sentimental
fabric can help keep memories present while creating something with new meaning. However,
art therapy with inmates puts more distinction on the process.
“Simply by interacting with the art materials and the subsequent product can facilitate a
new definition of the person. Such redefinitions become internalized from which emerges

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a new identity, reinforced with interacting with others... creating a bridge between the
inside and outside cultures, art has the power to rehumanize the dehumanized” (Gussak,
2019, pg. 54-55).
The process of recreating self-identity is one that can determine how an inmate adjusts to their
life while incarcerated. Reinforcing the connection between the inside and outside “worlds” is
what can keep inmates from fully losing themselves to their criminal label.
Art Therapy with Grief
Everyone experiences grief and processes it uniquely. However, there is a framework that people
work through. In her book, On Grief and Grieving, Elisabeth Kübler-Ross discusses the 5 Stages
of Grief. The 5 Stages include – Denial, Anger, Bargaining, Depression, and Acceptance. It is
important to note that “not everyone goes through them [the 5 Stages] or goes in a prescribed
order” (Kübler-Ross, 2005). While the stages are listed in-order, that does not mean they occur
sequentially. A person may weave in and out through different stages, or skip one etc. The
benefit of acknowledging the 5 Stages is to help prepare those grieving and normalize the
emotions they are going through. There also is not a timeline for how long one stage will be
experienced. For example, it may take someone months to move on from their denial but then it
takes years before they can accept the loss. However, the reverse could happen for someone else.
It is important to be aware of what each stage could entail to understand how one may respond
while in that stage. Kübler-Ross goes through each stage in detail and explains what may occur
in them.
“When we are in denial, we may respond at first by being paralyzed with shock or
blanketed with numbness... The first stage of grieving helps us survive the loss. Anger
surfaces once you are feeling safe enough to know you will probably survive whatever
comes. It is important to feel the anger without judging it, without attempting to find

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meaning in it. Bargaining may take the form of a temporary truce... we want life to return
to what it was... Guilt is often bargaining's companion. Depression is a way for nature to
keep us protected by shutting down the nervous system so that we can adapt to something
we feel we cannot handle. It makes us rebuild ourselves from the ground up. Acceptance
is about accepting the new reality and recognizing that this is the new reality is the
permanent reality. Acceptance is a process we experience, not a final stage with an
endpoint” (Kübler-Ross, 2005).
While each stage has a general understanding of what emotions are occurring, how people
process those emotions is very different, as is the path through grieving. The 5 Stages should not
be looked at as checkpoints along a timeline but rather as cycles that will come and go.
It should also be noted that there is a difference between experiencing grief versus
depression. Commonly, these two go hand in hand but they are not in tandem. Dr. John
Schneider goes through the detailed reasoning in his journal Clinically Significant Differences
Between Grief, Pathological Grief, and Depression. He makes the crucial distinction of grief and
depression as the following - “Grief is a normal reaction to a significant loss and is characterized
by sadness, loneliness pangs, and exhaustion” (Schneider, 1980). However, depression is defined
as “a clinical syndrome characterized by negativism, helplessness, lowered mood, and reduced
self-esteem" (Schneider, 1980). This separation is important for treatment purposes. Those
experiencing grief will respond to openness and warmth, while those experiencing depression
may require the intervention of clinical professionals and medication. Through his grief focused
career, Schneider developed an inventory to better assess symptoms and more accurately
diagnose. The inventory he created is the Grief / Depression Assessment Inventory. It was
developed in 2001 and focuses on the distinction between the two diagnoses. The inventory is

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also applicable to those suffering from a non-physical loss and fully encompasses the range of
grief that exists.
One emotional process that can highly benefit from art therapy is grief. Art making holds
space for clients to create a “powerful sense of bond with the deceased [and] create a tangible
connection as well as an emotional connection... the artwork works as an internal and external
form of expression of bereavement” (Bogan, 2019). Those who are working through grief can
use art therapy in a few ways. They can channel their emotions into the physical act of creating,
they can forge artwork that serves as a physical reminder of what they lost – a physical memory,
or they can also compose works that represent the emotions they are experiencing. Any of these
practices can be of great help when working through grief and bereavement.
Experiencing grief means that one has experienced loss. This can cause people to lose
sight of themselves or who they are. Using “creative activity as a means to not only process grief
symptoms, but also to inspire new developments in personal meaning and self-awareness to the
benefit or bereavement” (Arnold, 2019). Art therapy cultivates safety for those who are
rebuilding themselves along with dealing with grief. Making art creates a “sense of connection
with the person who was lost... a deeper understanding of and connection with themselves and
their relationship with grief...being an outlet for externalization of their grief” (Nelson, 2022).
Externalizing grief provides distance between the person and their emotions. This distance
promotes healthy conversations and separation which gives the grieving space to process what
they are working through.
Art Therapy with Grieving Women Inmates
The amount of grief that a female inmate goes through can be paramount- loss of
freedom, loss of identity, loss of contact/connection to those “outside”, potential of a loved one
passing away, losing their child(ren), and more. When looking at male inmates compared to

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female, “female inmates are believed to be more prone towards mental illness” (Gussak, 2009).
This specific population is one that art therapy can have a positive impactful influence on.
Bonnie Erickson published a dissertation in 2008 focused on these effects. In her dissertation she
reflects on why art therapy has this effect with female inmates. She states that
“Art therapies can provide a non-threatening approach to ease into a verbal dialogue...
creative activities allow inmates to experience autonomy, self-expression and selfexploration, and provide a non-threatening approach to ease into a verbal dialogue”
(Erickson, 2008).
This method of therapy presents the inmates with opportunities to work in a supportive
environment and express their emotions – without breaking the Convict Code, continuing to
protect themselves.
There are only a handful of studies on the effectiveness of art therapy with female
inmates. Gussak is one of the researchers who is making the most headway. In his 2009 study,
Gussak found that the women had, based off their score from the Beck Depression Inventory
(BDI), “a significantly great decrease in depression” (2009). However, some of the best support
for art therapy comes from the inmates themselves. Studies from multiple researchers provided
quotes from some of the participants. The following is what some of them had to say “I began to identify and grieve the multiple losses in my life” (Ferszt et al., 2004)
“It also has made me feel loved and wanted when I thought I wasn’t” (Erickson, 2008)
“Recognizing I was part of a larger group” (Gussak, 2019, p. 50)
“Experienced a sense of relief and comfort” (Ferszt et al., 2004)
These statements further exemplify the effects that art therapy can have on female inmates. It is
an accepted way of emotional release that promotes self-expression. Behaviors of inmates
improved, and signs / symptoms of depression and grief dwindle.

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Conclusion
Female inmates battle multiple deterrents to their mental health. They suffer with the losses of
their freedom, identity, maternity, and physical loss of loved ones. Living in a correctional
facility makes processing grief nearly implausible. Having said that, art therapy is becoming an
effective form of therapy with this population. It allows for an externalization of harbored grief
and creates an indissoluble connection to what / who they have lost.

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Section III: Methodology
Using the research and information above, a specific curriculum has been developed. Below are
the details of the curriculum itself and its intended use. While some curriculum can be in a
workbook style, this one was created to work with a specialized therapist in a group setting.
Creating a week-based curriculum helps ensure the inmates feel safe and can gain the most
benefits from attending the sessions.
Target Audience
The target audience for this curriculum is adult female inmates experiencing grief. While
grief is experienced outside prison systems too, these specific interventions are designed for
those currently incarcerated. It is intended for group session use, facilitated by a Licensed Art
Therapist or a Licensed Professional Counselor with specific art therapy training. The group is
designed for 10-12 members. Inmates can qualify for joining the group by meeting all the
following criteria; participants must be currently incarcerated, identify as a woman, 18 years or
older, at least two months from being released, non-violent, compliant, presently experiencing
symptoms of grief (see Appendix A for grief inventory), and willing to be an active participant.
Curricular Structure
The curriculum is based on the Psychoanalytic, ETC, and Cognitive Based Art Therapy
theories of art therapy. Interventions are structured to increase vulnerability and build upon
identifying and processing grief. While the beginning interventions are focused on exploring
identity, as the sessions develop, the topic of grief will be deeply explored. The group will meet
for 14 sessions. The framework of the sessions will be guided by the 5 stages of grief- denial,
anger, bargaining, depression, and acceptance. Each stage will have two sessions dedicated to it

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22

(10 sessions total). The remaining four sessions will be utilized to promote trust building and
then closure (two sessions at the start and two at the end of the 14 sessions).
Curricular Outline
Sessions will be held every week, lasting 90 minutes (about 1 and a half hours). Each
intervention corresponds with the week it is to be used. However, if a client is unable to meet one
of the weeks, there is no penalty or consequence of missing a step besides the emotional
processing that took place during the session. Each session will begin with a check-in and
grounding exercise. Then members will complete the intervention for that session. The final part
of the session will be for closing reflection and clean-up.
Conclusion
This group-based curriculum has been specifically designed for female inmates working through
grief. It was based on theories and is to be used by a specialized counselor. While attending all
sessions is encouraged, missing one will not result in a consequence. During treatment, inmates
will learn, explore, and process their grief, identity, and support system.

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23

Section IV: Curriculum

Curriculum Structure
The curriculum designed is guided by the 5 stages of grief. There are 14 sessions in total,
two for building trust within the group, two sessions per each stage of grief (10 sessions total),
then the final two sessions for closure and reflection (see Appendix B). While the sessions are
focused on a particular stage, group members do not have to be currently experiencing that stage
of processing. The aim of this curriculum is to provide the women the tools they need for when
they are in the corresponding stage. Grief is not a rigid timeline. Everyone processes differently
and for different lengths of time. These interventions will prepare the inmates for what they may
experience and build up their processing strategies while they are grieving.
Conclusion
This curriculum was made for women who are currently incarcerated and working through grief.
It follows the foundation of the 5 Stages of Grief- denial, anger, bargaining, depression, and
acceptance). While each session is dedicated to a specific stage, group members may not be in
that stage. The curriculum is designed to give the women healthy coping skills and processing
tools that they can use to help while they are struggling in a specific stage. After the 14 sessions,
members may still experience symptoms of grief, however, they will have a better understanding
of what they are experiencing.

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24

Section V: Discussion
The following discussion is focused on the research that has been done to create an art therapy
curriculum for incarcerated women processing grief. It considers the issues that are unique to this
demographic and the obstacles involved in providing and obtaining therapy. The benefits of art
therapy in this population are outlined and discussed about the limitations and future
considerations.
Summary of Research
The number of incarcerated women in the U.S. continues to rise. With this influx of
female inmates, acute awareness of the lack of provided mental health resources is climbing.
Women who are incarcerated tend to have an external Locus of Control. They blame outside
sources for circumstances they find themselves in and often struggle to accept responsibility for
their actions. They are emotionally charged, and their dignity is taken away. They become
known as a number or known for their crime; they have no individuality. Inmates also experience
a paramount amount of grief. However, the Convict Code and fear of repercussions keep these
inmates from expressing their emotions.
For inmates that do wish or require mental health support, resources are extremely
limited. Therapy rooms are often in view of others or have windows. This provides no privacy
and allows for easy interruptions. When help is received, it is often quick and focused on
suicidality and medication. Short staffing also means that officers are often the “therapists”
however, do not have the proper training. The lack of mental health support can lead to
prolonged/complex grief and more mental health illnesses.
Art therapy is a creative expression that provides emotional processing. Art in prison
facilities is treated with respect. It is an allowed form of individuality and safe self-expression.
Art therapy gives reflective distance between the inmate and their emotions. This leads to easier

ART THERAPY WITH GRIEVING FEMALE INMATES

25

processing and shows healthy coping skills. When used with grief work specifically, art therapy
is used to create a tangible connection to what or whom has been lost. It is a creative emotional
outlet that can also provide an “escape” for these women. Being used in prison facilities, art
therapy does have the challenge of strict regulations about what materials are allowed. However,
this gives inmates a chance to expand their creativity.
Discussion
Prision facilities are pressure cookers of emotional build up. Inmates must mask their
emotions to survive. This leads to high tensions and an abundance of mental health struggles.
These women are not provided the support they can greatly benefit from. Art therapy can give
them that support. The curriculum that was designed, intends to teach these women healthy ways
to cope with their grief. As well as encouraging a non-threatening approach to processing
emotions.
Limitations
There are a few limitations that are important to keep in mind. Accessibility can be
challenging with the incarcerated population. There are strict rules and regulations about
visitation that must be followed. There are also regulations about what materials can be
used within the facility. This can create unique limitations on what can be used in sessions.
With female inmates having a high rates of mental health illnesses, comorbid diagnoses can
hinder any participant’s contribution the group. Finally, this curriculum only looks at a
small part of the incarcerated population.
Future Research
This curriculum is focused on a specific group of the incarcerated population. Future
research looking at the effectiveness with juvenile or the male population could be beneficial.

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26

There are also the lasting effects of the curriculum to consider. It is designed to be only 14
sessions; however, grief and emotional processing can take place throughout a person’s
life. A post-curriculum group or meeting held after completing the curriculum can give
important insight to its effectiveness. A final future application of this research can be
applied to expanding the curriculum. It can provide a chance for inmates to be more
involved, take initiative, or even lead classes/sessions themselves.
Conclusion
The world of incarceration is intense and filled with emotionally charged inmates. When these
inmates experience grief, there is a lack of mental health services offered to help process and
cope. Female inmates are often overlooked, when they are more likely to develop mental health
illnesses. They experience physical and psychological losses, that when not properly grieved can
lead to further mental health struggles. Art therapy provides a non-threatening, acceptable way of
grieving and processing emotion. This curriculum allows for an externalization of harbored grief
and creates an indissoluble connection with what or who they lost.

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27

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APPENDIX A
GRIEF / DEPRESSION INVENTORY

32

www.seasonscenter.com

Grief / Depression
Assessment Inventory
© 2001 John M. Schneider. All rights reserved. Please do not reproduce without prior permission.

There are a series of paragraphs below that are paired: One describes how a person who is depressed might respond, the other a person
who is actively grieving an important loss or life change. For each paragraph, check the statement that best describes your response. Not
all the statements will apply. You may wish to underline statements within a question that do apply.
At the end choose which of the two paragraphs comes closer to describing your present state: grieving, depression, both, or neither.
Sometimes you’ll choose neither. Sometimes, it might be both. By the end of the inventory, you’ll have an idea whether you are
grieving, depressed, or experiencing some of both.
This inventory should NOT be used in place of more comprehensive diagnostic methods, nor is it intended to provide a professional
diagnosis.

If there has been a loss or a significant change in
your life, how long ago did it occur or begin to
affect you?
■
■
■
■
■
■
■
■

The loss(es) were:
■
■
■
■

A week or less.
Less than a month.
One month to six months.
Seven months to a year.
Less than two years.
Two to five years.
More than five years.
It happened while I was growing up.

One(s) I could anticipate.
Sudden and unexpected.
Due to a chronic situation / condition.
Caused by a traumatic event(s).

1. How have you experienced this loss or a significant change?
Grief: The way I am feeling makes sense in light of what has happened. These losses or changes are the sources of what I am going
through. Others have validated my losses.
Depression: I don’t understand why I am feeling this way. Nothing makes sense. No one considers what has happened as deserving of a
second thought or any feelings on my part. I am not sure myself whether a loss has occurred.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

1

© 2001 John M. Schneider

www.seasonscenter.com

2. How have you been behaving since this began?
Grief: I am easily distracted. I wish I looked better. Sometimes I look better than I feel. Sometimes I feel better than I look. Some
people have avoided me since this loss. Others have been insensitive. I am more cautious. I am aware of life’s fragility as a result of
what has happened.
I have tried to lose myself in my job, hobbies, and sports or in caring for my children but it doesn’t always work. At times I prefer to be
alone. At times, I feel lonely even when I am with others. Being with others can wear me out. It is an effort to do things.
Depression: I am often preoccupied. I don’t care how I look—or, I have to look perfect or else I feel terrible. Nobody suspects or for
that matter really cares how I am really doing. Danger makes me feel real or I don’t take any risks. I refuse to take antidepressants. I
don’t always take my antidepressants or I can’t function without my antidepressants.
Work/my children is/are my life. I keep busy all the time or I can’t find anything to occupy me. I constantly watch television. I hate
being alone or I hate being with others. I don’t see the point in trying.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

3. How has your thinking been affected?
Grief: It’s hard to concentrate but I can if I have to. Sometimes I don’t know how I got somewhere. Time drags. There are times when I
am startled that time has passed. I avoid listening to the radio or watching TV, for fear it will remind me about what happened. At times,
I can think about other things than this—only to find myself right back in it. I’ve lost the best part of me. If only I had been able to do
something different, this would not have happened.
Nothing can ever bring back what I have lost. I am often aware of what I have lost or what has changed. I am often preoccupied with the
thoughts and memories associated with my loss. Just when I think it couldn’t get any worse, it does.
Depression: I am so preoccupied I can lose days or weeks . The newspaper/TV seems unreal, like I am in another world from it. I can’t
stop thinking about why this has happened to me. This proves how worthless I am. I am to blame for what has happened. Someone must
be punished for this. I will not rest until that happens.
I operate as if nothing has changed. I don’t think about it if I can help it. Thinking makes me feel worse. Things always get worse.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

4. How have your feelings been affected?
Grief: My heart feels broken. I can get very angry about this. I can be very sad. The tears are hard to stop. At times I am so upset I
could throw up. I yearn to be able to love again. There are times when I can laugh. I can feel joy. There are times when my feelings
overwhelm me. There are times when I feel better. Sometimes my feelings are so intense I’m not sure I can stay with them. I am
ashamed because of what happened and how I reacted to it. I feel numb. I have a hard time being around others. There are times when I
feel terrific. There are times when I feel love.
Depression: I am not angry. I shouldn’t feel angry. I don’t cry. I don’t feel sad. I have no right to feel sad. It’s best not to get upset.
There’s nothing to be upset about. I know I will never be able to love again. I feel down when others seem happy. I wouldn’t know what
joy or happiness is. I avoid feeling anything about this. I never feel better. If I let myself I would get so upset I couldn’t stand it. I could
never admit how badly I’ve reacted to all this. I feel nothing. I never feel terrific. I never feel love.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

2

© 2001 John M. Schneider

www.seasonscenter.com

5. How do you feel physically?
Grief: I can start out a day feeling OK, and get wiped out during the day. Any sustained effort exhausts me. I feel lethargic, totally
drained, lacking in energy. I have a hard time concentrating for more than a few minutes at a time. It’s hard to go to sleep. I have trouble
staying asleep. My heart hurts. I can’t get enough rest. I feel better after I exercise. I do better when I’m active. I’ve never felt/looked
better.
I don’t pay attention to what I’m eating. Sometimes I don’t feel like eating. I’ve felt nauseous after I eat. I don’t feel like eating but make
myself at times. Eating helps me escape. How well I eat makes a difference. I have lost weight since this loss. I have gained weight since
this loss.
Drinking can give me temporary relief. I watch how much I drink. I’d rather not be taking drugs. The escapes I find are only temporary
sources of relief. Prescription drugs for depression give me clarity about what I am dealing with.
Depression: I have no energy. I am in always in a fog or twilight zone. I can’t seem to sleep more than four hours a night. I sleep more
than ten hours every night. I always feel exhausted. I exercise constantly (more than two hours a day) or I don’t exercise at all. I’ve
never looked/felt worse.
I don’t care if I eat too much. I don’t care if I don’t eat. I throw up what I eat. I weigh less than I ever have. I weigh more than I ever
have.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

6. How do you feel pain and pleasure?
Grief: The pain comes and goes. When it is bad, it has never been worse. There are times when I don’t seem to enjoy anything, but at
other times I’m OK. There are times when something that is ordinarily pleasurable gives me pain. I feel more relief from the pain than
real pleasure.
Except when I am reminded of my loss, I can enjoy life. I have a sense of humor. My sense of humor can be pretty dark these days. I can
laugh. I enjoy being in nature. I watch sunsets and/or sunrises. Sometimes a time of joy produces tears and sadness.
Depression: I drink alcohol to drown the pain. I use drugs to escape. The only time I feel OK or can escape the pain is when I’m
drinking/ taking drugs. I’m sick a lot. I am in pain a lot. I can’t remember the last time I really enjoyed anything. When I have sex it
feels like I can escape my problems temporarily.
Pleasure is not a part of my life. I feel numb. Nothing seems funny. I have an especially hard time when others have fun.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

7. How has this affected you spiritually?
Grief: I pray for strength to get me through this. I wonder if there is any hope for me. This loss seems so unfair. I am angry with God. I
was naive to think this couldn’t happen. I have lost my sense of innocence. I am confused by what this means. I have lost something
essential. My life story has lost its thread of meaning. It’s hard to imagine life ever having meaning again. My religious faith (God) is
getting me through this or I’m changing (or know I must change) some of my most cherished beliefs—perhaps even my religion.
I don’t know if I can ever be forgiven for this—or—if I can ever forgive others. I do believe forgiveness is possible. Forgiveness would
require the grace of God—or something equally miraculous. I feel connected to something beyond me —e.g., a Higher Power, God (or
love). Getting through this will heal me—something better lies ahead. Being in nature restores my soul. Sometimes I lose sight of my
faith—but I am sustain by knowing others believe in me. I don’t yet know what meaning this loss has.
Depression: My life is hopeless. I am a broken person. I am being punished. This proves how worthless I am. Nothing meaningful can
come from this. What has happened is totally unfair. God is punishing me. I deserve to go to hell. I had it coming or I don’t deserve this.
I find no comfort in prayer or religion.
I can never forgive. I can never be forgiven. I can’t accept why this has happened to me. My beliefs have not given me any answers.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

3

© 2001 John M. Schneider

www.seasonscenter.com

8. What are your dreams like?
Grief: I dream a lot but I don’t usually remember them. I long to dream of the one I lost but can’t. I’ve been too tired to dream. It’s only
in my dreams that I seem to be dealing with this. My dreams since the loss are vivid and clear, and they are often comforting. They make
it easier to understand what has happened. In my fantasies, I remain connected to the person/object I lost. I have “imaginary”
conversations (daydreams) with the one I lost.
Depression: I don’t dream. When I do dream, I have nightmares. My dreams about the loss are disturbing. I dream of the destruction of
the one I lost. My dreams actually keep me from sleeping. Voices from my loss can tell me to do things I ordinarily wouldn’t do.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

9. How has this affected how you feel about yourself?
Grief: This loss has put me in touch with my “best self.” It has caused me to question some of my values and beliefs. There are things
about this loss that I need to process. There are some things I need to rectify. I’ve alienated people I wish I could reconnect with. I have
been hurt by other’s insensitivity. I have hurt others by being preoccupied. This loss has more meaning to me than others acknowledge. I
am doing the best I can. I have been deeply moved by how some people have supported me.I am at peace with myself.
Depression: I don’t care what happens. I’ve not been myself—I can’t seem to do what I need to do. I can’t seem to snap out of it. People
have injured me since this loss. Those I have injured could never forgive me. There is nothing meaningful about this. I can’t deal with it.
Generally, other people don’t affect me. If people really knew me, they wouldn’t like me. I resent people trying to get me to feel better or
to give up what they think are my bad habits or my self-destructiveness. Life is sheer torture to me.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

10. What kinds of support do you have?
Grief: I feel comforted when I’m with sympathetic people. I get uncomfortable when the conversation centers on me. I respond when
someone is warm, persistent, and reassuring. I enjoy listening to others. Sometimes I feel like I talk too much. Sometimes I am
vulnerable in ways I wouldn’t be otherwise. At times I appreciate being left alone.
If someone has a good heart, I can overlook faults. I have lost some old friends. I am reassured by the presence of friends who will listen
to my story. I feel connected to people with similar losses. I’ve made new friends who accept me as I am. I miss being loved or
opportunities to love. I am in love again.
Depression: I say things to get others off my back. I never talk about what happened. I deliberately hurt others. I want others to suffer as
much as I have. Others take advantage of me. When I’m alone, I feel frightened and abandoned. I hate being around people who are
optimistic and superficial. I find it impossible to tolerate mistakes or incompetence.
Others don’t care. I wear people out—they get irritable with me. People get angry with me. I have been assaulted verbally and/or
physically. No one listens to my story. I feel disconnected. I’ve worn out my support system. I don’t have a support system. I feel
unloved. It’s better to be punished than ignored. I feel incapable of loving anyone.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

11. How has this affected your will to live?
Grief: If life were to continue like this, it wouldn’t be worth living. I have thought of what it would take to not to have this pain. I
would not commit suicide because of this: My religious beliefs, the effect my death would have on the people who love me or having a
something to live for keeps me going.
Depression: I’m looking for a way out. I cannot say I wouldn’t commit suicide. I have nothing to live for. Life isn’t worth living. Others
would be better off without me. I deserve to die.
For me this item is most like:
■ Grief
■ Depression

■ Both

■ Neither

4

© 2001 John M. Schneider

www.seasonscenter.com

How To Calculate Your Profile

How To Interpret Your Scores

Repeat below your respondes to each of the items above. Total
your checks in each section and find the total below:

Uncomplicated grief: If you scored “grief” in all areas, you are
clearly grieving normally, and probably do not need professional
help, although you may wish to talk with someone.

Grief

Depression

Both

Complicated grief: If you score mostly for “grief,” but also have
some “depression” items checked in any area, you should consult
with your family doctor, therapist, or clergy.

Neither

1. Loss

___

___

___

___

2. Behaving

___

___

___

___

3. Thinking

___

___

___

___

4. Feeling

___

___

___

___

5. Physical

___

___

___

___

6. Pain and Pleasure

___

___

___

___

7. Spiritual

___

___

___

___

8. Dreams

___

___

___

___

9. Self

___

___

___

___

10. Support

___

___

___

___

11. Will-to-Live

___

___*

___

___

Totals

___

___

___

___

Depression: If most items are checked as “depression,”
professional help is highly recommended.
Notes:
* Item 11: If you checked “depression” on “Will to Live,”
professional help is urgently recommended.
If this way of responding to your loss(es) has lasted less than six
months, it is natural for both grief and depression to be present. If
your loss and your reaction to it has lasted longer than six
months, depression items should have diminished.
These guidelines usually apply only to losses that were
anticipated. Traumatizing losses will take longer (multiply by
years). Also multiple losses will take longer as well (each loss x
six months or more, though time is not an accurate measure.)
Sudden losses also can take much longer. Chronic health
conditions produce chronic grief, so little diminishing will be
seen over time. However, in any of these situations, being able to
“look good” to others can begin to appear after six months, and
some progress can be noted in moving from the “depression”
items even if it’s at a slower pace.

5

© 2001 John M. Schneider

ART THERAPY WITH GRIEVING FEMALE INMATES

APPENDIX B
GRIEF THROUGH ART CURRICULUM

33

Art Through Grief

An Art Therapy Curriculum for Incarcerated Women
Experiencing Grief
Created by: Kelsey Thomas
PennWest University
August 9, 2024

Table of
Contents
1. Dedication
2. How To Use
3. Check-ins
4. Grounding
5. Interventions
6. Adaptations

This curriculum is dedicated to the women
who are incarcerated and struggling with
grief. These women have lost their sense
of identity, their freedom, their
connection to loved ones, and their
maternal role. Not only is there a lack of
mental health support in facilities, but
emotional reactions are often punished. This
fear and “tough inmate” stereotype
prevents these women from asking for
help.
This curriculum should be used to support
these women as they are struggling. It is
to give them the tools to work through
their grief and allow them to be able to
help themselves and rebuild their identity.

Thank you for helping,

Kelsey

How To Use
This curriculum was designed to teach coping skills as well as
encourage healthy emotional processing for the women
participating in the group. Each session is structured the same;
they begin with an opening check-in and grounding exercise, then
move into the intervention and discussion on the topic of that
session. Finally, the group will participate in a closing reflection
and closing questions along with clean up. Provided below are
various check-in sheets that counselors can choose to use, or they
may have their own. There is also a sheet that provides a few
grounding techniques that are often used and enjoyed by those
who need them.
Open conversation is highly encouraged during sessions. The
opening hook can be used to start conversation and set the
intention of that day. However, while creating, members are
welcome to discuss amongst themselves, being mindful that they
are in a group, supportive, setting. On days where there is
extreme focus, calming / relaxation music playing softly can help
the women get into their flow state (given it is allowed in the
facility).
Group members do not have to be currently be working through
the stage that is of focus. However, participating in each
intervention provides awareness of what to expect as well as
positive coping techniques. Members must meet all of these
requirements in order to join the group; must be currently
incarcerated, identify as a woman, 18 years or older, at least two
months from being released, non-violent, non-defiant, presently
experiencing symptoms of grief (see next pages for grief
inventory), and willing to be an active participant. There should
be no penalty for missing a session, besides missing the tools
learned that day.

Grief / Depression
Assessment Inventory
© 2001 John M. Schneider. All rights reserved. Please do not reproduce without prior permission.

There are a series of paragraphs below that are paired: One describes how a person who is depressed might respond, the other a person
who is actively grieving an important loss or life change. For each paragraph, check the statement that best describes your response. Not
all the statements will apply. You may wish to underline statements within a question that do apply.
At the end choose which of the two paragraphs comes closer to describing your present state: grieving, depression, both, or neither.
Sometimes you’ll choose neither. Sometimes, it might be both. By the end of the inventory, you’ll have an idea whether you are
grieving, depressed, or experiencing some of both.
This inventory should NOT be used in place of more comprehensive diagnostic methods, nor is it intended to provide a professional
diagnosis.

If there has been a loss or a significant change in
your life, how long ago did it occur or begin to
affect you?

The loss(es) were:
One(s) I could anticipate.
Sudden and unexpected.
Due to a chronic situation / condition.
Caused by a traumatic event(s).

A week or less.
Less than a month.
One month to six months.
Seven months to a year.
Less than two years.
Two to five years.
More than five years.
It happened while I was growing up.

1. How have you experienced this loss or a significant change?
Grief: The way I am feeling makes sense in light of what has happened. These losses or changes are the sources of what I am going
through. Others have validated my losses.
Depression: I don’t understand why I am feeling this way. Nothing makes sense. No one considers what has happened as deserving of a
second thought or any feelings on my part. I am not sure myself whether a loss has occurred.
For me this item is most like:
Grief
Depression

Both

Neither

1

© 2001 John M. Schneider

2. How have you been behaving since this began?

Grief: I am easily distracted. I wish I looked better. Sometimes I look better than I feel. Sometimes I feel better than I look. Some
people have avoided me since this loss. Others have been insensitive. I am more cautious. I am aware of life’s fragility as a result of
what has happened.
I have tried to lose myself in my job, hobbies, and sports or in caring for my children but it doesn’t always work. At times I prefer to be
alone. At times, I feel lonely even when I am with others. Being with others can wear me out. It is an effort to do things.
Depression: I am often preoccupied. I don’t care how I look—or, I have to look perfect or else I feel terrible. Nobody suspects or for
that matter really cares how I am really doing. Danger makes me feel real or I don’t take any risks. I refuse to take antidepressants. I
don’t always take my antidepressants or I can’t function without my antidepressants.
Work/my children is/are my life. I keep busy all the time or I can’t find anything to occupy me. I constantly watch television. I hate
being alone or I hate being with others. I don’t see the point in trying.
For me this item is most like:
Grief
Depression

Both

Neither

3. How has your thinking been affected?

Grief: It’s hard to concentrate but I can if I have to. Sometimes I don’t know how I got somewhere. Time drags. There are times when I am
startled that time has passed. I avoid listening to the radio or watching TV, for fear it will remind me about what happened. At times, I can think
about other things than this—only to find myself right back in it. I’ve lost the best part of me. If only I had been able to do something different,
this would not have happened.
Nothing can ever bring back what I have lost. I am often aware of what I have lost or what has changed. I am often preoccupied with the
thoughts and memories associated with my loss. Just when I think it couldn’t get any worse, it does.
Depression: I am so preoccupied I can lose days or weeks . The newspaper/TV seems unreal, like I am in another world from it. I can’t
stop thinking about why this has happened to me. This proves how worthless I am. I am to blame for what has happened. Someone must
be punished for this. I will not rest until that happens. I operate as if nothing has changed. I don’t think about it if I can help it. Thinking
makes me feel worse. Things always get worse.
For me this item is most like:
Grief
Depression

Both

Neither

4. How have your feelings been affected?

Grief: My heart feels broken. I can get very angry about this. I can be very sad. The tears are hard to stop. At times I am so upset I could throw
up. I yearn to be able to love again. There are times when I can laugh. I can feel joy. There are times when my feelings overwhelm me. There
are times when I feel better. Sometimes my feelings are so intense I’m not sure I can stay with them. I am ashamed because of what
happened and how I reacted to it. I feel numb. I have a hard time being around others. There are times when I feel terrific. There are times
when I feel love.
Depression: I am not angry. I shouldn’t feel angry. I don’t cry. I don’t feel sad. I have no right to feel sad. It’s best not to get upset.
There’s nothing to be upset about. I know I will never be able to love again. I feel down when others seem happy. I wouldn’t know what
joy or happiness is. I avoid feeling anything about this. I never feel better. If I let myself I would get so upset I couldn’t stand it. I could
never admit how badly I’ve reacted to all this. I feel nothing. I never feel terrific. I never feel love.
For me this item is most like:
Grief
Depression

Both

Neither

2

© 2001 John M. Schneider

5. How do you feel physically?

Grief: I can start out a day feeling OK, and get wiped out during the day. Any sustained effort exhausts me. I feel lethargic, totally drained,
lacking in energy. I have a hard time concentrating for more than a few minutes at a time. It’s hard to go to sleep. I have trouble staying asleep.
My heart hurts. I can’t get enough rest. I feel better after I exercise. I do better when I’m active. I’ve never felt/looked better.
I don’t pay attention to what I’m eating. Sometimes I don’t feel like eating. I’ve felt nauseous after I eat. I don’t feel like eating but make
myself at times. Eating helps me escape. How well I eat makes a difference. I have lost weight since this loss. I have gained weight since
this loss. Drinking can give me temporary relief. I watch how much I drink. I’d rather not be taking drugs. The escapes I find are only temporary
sources of relief. Prescription drugs for depression give me clarity about what I am dealing with.
Depression: I have no energy. I am in always in a fog or twilight zone. I can’t seem to sleep more than four hours a night. I sleep more
than ten hours every night. I always feel exhausted. I exercise constantly (more than two hours a day) or I don’t exercise at all. I’ve
never looked/felt worse. I don’t care if I eat too much. I don’t care if I don’t eat. I throw up what I eat. I weigh less than I ever have. I weigh
more than I ever
have.

For me this item is most like:
Grief
Depression

Both

Neither

6. How do you feel pain and pleasure?

Grief: The pain comes and goes. When it is bad, it has never been worse. There are times when I don’t seem to enjoy anything, but at other
times I’m OK. There are times when something that is ordinarily pleasurable gives me pain. I feel more relief from the pain than real pleasure.
Except when I am reminded of my loss, I can enjoy life. I have a sense of humor. My sense of humor can be pretty dark these days. I can
laugh. I enjoy being in nature. I watch sunsets and/or sunrises. Sometimes a time of joy produces tears and sadness.
Depression: I drink alcohol to drown the pain. I use drugs to escape. The only time I feel OK or can escape the pain is when I’m
drinking/ taking drugs. I’m sick a lot. I am in pain a lot. I can’t remember the last time I really enjoyed anything. When I have sex it
feels like I can escape my problems temporarily. Pleasure is not a part of my life. I feel numb. Nothing seems funny. I have an especially hard
time when others have fun.
For me this item is most like:
Grief
Depression

Both

Neither

7. How has this affected you spiritually?

Grief: I pray for strength to get me through this. I wonder if there is any hope for me. This loss seems so unfair. I am angry with God. I
was naive to think this couldn’t happen. I have lost my sense of innocence. I am confused by what this means. I have lost something
essential. My life story has lost its thread of meaning. It’s hard to imagine life ever having meaning again. My religious faith (God) is
getting me through this or I’m changing (or know I must change) some of my most cherished beliefs—perhaps even my religion.
I don’t know if I can ever be forgiven for this—or—if I can ever forgive others. I do believe forgiveness is possible. Forgiveness would
require the grace of God—or something equally miraculous. I feel connected to something beyond me —e.g., a Higher Power, God (or
love). Getting through this will heal me—something better lies ahead. Being in nature restores my soul. Sometimes I lose sight of my
faith—but I am sustain by knowing others believe in me. I don’t yet know what meaning this loss has.
Depression: My life is hopeless. I am a broken person. I am being punished. This proves how worthless I am. Nothing meaningful can
come from this. What has happened is totally unfair. God is punishing me. I deserve to go to hell. I had it coming or I don’t deserve this.
I find no comfort in prayer or religion.
I can never forgive. I can never be forgiven. I can’t accept why this has happened to me. My beliefs have not given me any answers.
For me this item is most like:
Grief
Depression

Both

Neither

3

© 2001 John M. Schneider

8. What are your dreams like?

Grief: I dream a lot but I don’t usually remember them. I long to dream of the one I lost but can’t. I’ve been too tired to dream. It’s only in my
dreams that I seem to be dealing with this. My dreams since the loss are vivid and clear, and they are often comforting. They make it easier to
understand what has happened. In my fantasies, I remain connected to the person/object I lost. I have “imaginary” conversations (daydreams)
with the one I lost.
Depression: I don’t dream. When I do dream, I have nightmares. My dreams about the loss are disturbing. I dream of the destruction of
the one I lost. My dreams actually keep me from sleeping. Voices from my loss can tell me to do things I ordinarily wouldn’t do.
For me this item is most like:
Grief
Depression

Both

Neither

9. How has this affected how you feel about yourself?

Grief: This loss has put me in touch with my “best self.” It has caused me to question some of my values and beliefs. There are things about this
loss that I need to process. There are some things I need to rectify. I’ve alienated people I wish I could reconnect with. I have been hurt by
other’s insensitivity. I have hurt others by being preoccupied. This loss has more meaning to me than others acknowledge. I am doing the best I
can. I have been deeply moved by how some people have supported me.I am at peace with myself.
Depression: I don’t care what happens. I’ve not been myself—I can’t seem to do what I need to do. I can’t seem to snap out of it. People
have injured me since this loss. Those I have injured could never forgive me. There is nothing meaningful about this. I can’t deal with it.
Generally, other people don’t affect me. If people really knew me, they wouldn’t like me. I resent people trying to get me to feel better or
to give up what they think are my bad habits or my self-destructiveness. Life is sheer torture to me.
For me this item is most like:
Grief
Depression

Both

Neither

10. What kinds of support do you have?

Grief: I feel comforted when I’m with sympathetic people. I get uncomfortable when the conversation centers on me. I respond when
someone is warm, persistent, and reassuring. I enjoy listening to others. Sometimes I feel like I talk too much. Sometimes I am
vulnerable in ways I wouldn’t be otherwise. At times I appreciate being left alone.
If someone has a good heart, I can overlook faults. I have lost some old friends. I am reassured by the presence of friends who will listen
to my story. I feel connected to people with similar losses. I’ve made new friends who accept me as I am. I miss being loved or
opportunities to love. I am in love again.
Depression: I say things to get others off my back. I never talk about what happened. I deliberately hurt others. I want others to suffer as
much as I have. Others take advantage of me. When I’m alone, I feel frightened and abandoned. I hate being around people who are
optimistic and superficial. I find it impossible to tolerate mistakes or incompetence.
Others don’t care. I wear people out—they get irritable with me. People get angry with me. I have been assaulted verbally and/or
physically. No one listens to my story. I feel disconnected. I’ve worn out my support system. I don’t have a support system. I feel
unloved. It’s better to be punished than ignored. I feel incapable of loving anyone.
For me this item is most like:
Grief
Depression

Both

Neither

11. How has this affected your will to live?

Grief: If life were to continue like this, it wouldn’t be worth living. I have thought of what it would take to not to have this pain. I
would not commit suicide because of this: My religious beliefs, the effect my death would have on the people who love me or having a
something to live for keeps me going.
Depression: I’m looking for a way out. I cannot say I wouldn’t commit suicide. I have nothing to live for. Life isn’t worth living. Others
would be better off without me. I deserve to die.
For me this item is most like:
Grief
Depression

Both

Neither

4

© 2001 John M. Schneider

How To Calculate Your Profile

How To Interpret Your Scores

Repeat below your respondes to each of the items above. Total
your checks in each section and find the total below:

Grief

Depression

Both

Complicated grief: If you score mostly for “grief,” but also have
some “depression” items checked in any area, you should consult
with your family doctor, therapist, or clergy.

Neither

1. Loss

___ ___

___

___

2. Behaving

___ ___

___

___

3. Thinking

___ ___

___

___

4. Feeling

___ ___

___

___

5. Physical

___ ___

___

___

6. Pain and Pleasure

___ ___

___

___

7. Spiritual

___ ___

___

___

8. Dreams

___ ___

___

___

9. Self

___ ___

___

___

10. Support

___ ___

___

___

11. Will-to-Live

___ ___*

___

___

Totals

___

___

___

___

Uncomplicated grief: If you scored “grief” in all areas, you are
clearly grieving normally, and probably do not need professional
help, although you may wish to talk with someone.

Depression: If most items are checked as “depression,”
professional help is highly recommended.
Notes:
* Item 11:

If you checked “depression” on “Will to Live,”
professional help is urgently recommended.
If this way of responding to your loss(es) has lasted less than six
months, it is natural for both grief and depression to be present. If
your loss and your reaction to it has lasted longer than six
months, depression items should have diminished.
These guidelines usually apply only to losses that were
anticipated. Traumatizing losses will take longer (multiply by
years). Also multiple losses will take longer as well (each loss x
six months or more, though time is not an accurate measure.)
Sudden losses also can take much longer. Chronic health
conditions produce chronic grief, so little diminishing will be
seen over time. However, in any of these situations, being able to
“look good” to others can begin to appear after six months, and
some progress can be noted in moving from the “depression”
items even if it’s at a slower pace.

5

© 2001 John M. Schneider

CHECK-IN
DRAW IN A STICK FIGURE THAT
REPRESENTS YOUR MOOD

CHECK-IN
Rose- What is something
positive that happened ?

Leaf- What is something
you are looking forward to?

Thorn - What is something you
have been struggling with?

CHECK-IN
What made you...

sad

’s mood..
y
a
.

in

fi

ll

ey

eb

ro w s

.

I am proud of...

angry

To
d

happy

Best
Moment

Worst
Moment

w it h

m o ut

I am thankful for...

n
ha

d

4 things
you hear

3 things
2 things
you smell you taste

1 thing
you feel

for

for

ld
Ho

4s
ec

on
ds

Get up. Walk around. Stretch.
Move your body.

ec
4s

in

5 things
you see

ds
on

Br
ea
th

Name...

GROUND
YOURSELF

Breath out for 4 seconds
Toss a ball or small object back and forth from
your hands while keeping focus on the empty
hand in front of you

Session 1
Topic: Introduction - Self Collage
Objective/s:
To introduce the concept of art therapy, establish trust within the
group, and begin the process of attunement.

Materials needed:
~ blank paper, 12x18, (1 per member)
~ glue sticks
~ magazines, newspaper, collage
materials, scrap pieces of fabric, etc
~ various coloring supplies/ paint
pens

Hook/intro:
Discuss process of Art
Therapy and set group
norms/rules.

Intervention:
1. Ask group members to think about aspects of themselves/
their personalities that they feel represent who they are.
(5 min.)
2. Invite members to look through the collage and color supplies
and pull out anything that sticks out to them. If they can’t
find a specific image, encourage them to draw it or a way to
represent it in their collage. (30 min.)
3. Use all the gathered supplies to create a collage that they
feel represent who they are. Encourage mark making or
painting within the collage. (20 min.)

Closure:
1. Take turns sharing aspects of their collage and how it represents
them
2. Were their any unexpected feelings that came up while creating?

Session 2
Topic: Introduction - Emotion Tri-fold
Objective/s:
Gain understanding of expressing emotions in healthy ways and in
safe places

Materials needed:
~ blank white paper, (8x11) one per
member
~ glue sticks
~ magazines, newspaper, collage
materials, scrap pieces of fabric, etc
~ various coloring supplies/ paint
pens

Hook/intro:
Emotions of grief can be
challenging to process, it is
important to express these
emotions in safe and healthy
ways

Intervention:
1. Ask members to fold their paper, horizontally, into thirds,
with the edges meeting in the middle (like double doors), see
graphic below (5 minutes)
2. On the outside flaps, draw/collage aspects of themselves /
emotions that they allow others to see (25 minutes)
3. On the inside panel(s), draw/collage aspects of themselves /
emotions that they keep to themselves (35 minutes)

Closure:
1. Invite any members to share about any elements they included on
their tri-fold
2. Why is it important to process our emotions in safe, healthy
ways?

Session 3
Topic: Denial - Roller Coaster of Grief
Objective/s:
To recognize the non-linear, inconsistent pattern of grief and
normalize the disorganized emotional processing

Materials needed:

~ large piece of paper, 12x18,
(one per member)
~ pencil
~ eraser
~ markers

Hook/intro:
Discussion surrounding the
feelings of denial and the
challenges of accepting that
they loss something/someone

Intervention:
1. Ask group members to reflect on their loss, paying attention
to how they are currently feeling, how they felt in the past,
what feelings or struggles they anticipate (5 mins)
2. As reflecting, ask members to write a list on their paper on
what thoughts/feelings are coming up - positive or negative (5
mins)
3. After looking at their list, invite members to flip their paper
over and draw a roller-coaster that matches the ups-anddowns of their journey (10 mins)
4. Using markers, color and label their coaster with the
corresponding thoughts/feelings (20 mins.)
Closure:
1. Do people’s coasters match or look similar?
2. How can thinking about the ups-and-downs help navigate the
grief?
3. Reflect on the part of the coaster members feel they are on
presently

Session 4
Topic: Denial - Hold Onto/ Let Go Of Hands
Objective/s:

To gain an understanding of the new perspectives on aspects of
their loss/new reality

Materials needed:
~ heavy weight paper (8x11), one
per member
~ pencils
~ chalk pastels
~ paint pens

Hook/intro:
Open conversation about what
their new reality looks like,
what aspects are harder to
accept?

Intervention:
1. invite each group member to trace their hands, open faced,
palm down, onto the piece of paper, leaving some space
between the hands (5 minuets)
2. in one hand, ask members to write aspects of their “old
reality” that they find themselves thinking about most
(positive or negative), on the other hand, aspects of their “new
reality” that they are able to embrace or have struggled with
(20 minuets)
3. connect the hands by drawing bridges/paths, ask members to
label these paths with ways that can help embrace their new
reality (10 minuets)
4. Finally, members can color/decorate their hands if not done
so already (30 minuets)
Closure:
1. Ask members to share about what aspects of their new reality
they are struggling with
2. Share and discuss what bridges they thought of/ ways to accept
their new reality

Session 5
Topic: Anger - Wreck This Zine
Objective/s:
Identify sources of anger and other emotions that are
experienced along with anger

Materials needed:
~ heavyweight paper (8x11), one per
member
~ writing and color supplies
~ paint pens
~ collage materials: magazines,
newspaper, collage materials, scrap
pieces of fabric, etc
~ glue and/or tape
~ scissors

Hook/intro:
When thinking about losses,
what brings anger up? Is it
something you wish didn’t
happen or should’ve done?

Intervention: *intervention continues next session*
1. Using the instructions on the next page, have each member create
a zine (20 minuets)
2. on each page, ask members to create a mixed media collage
relating to one aspect/source of anger - the work can be text,
symbolic, representational etc. (45 minuets)

Closure:
1. Did any other feelings besides anger come up?
2. How did it feel to put these feelings onto paper?
3. Can any of your anger be replaced/restructured into something
positive?

Zine Instructions

Session 6
Topic: Anger - Wreck This Zine
Objective/s:
Identify sources of anger and other emotions that are
experienced along with anger

Materials needed:
~ heavyweight paper (8x11), one per
member
~ writing and color supplies
~ paint pens
~ collage materials: magazines,
newspaper, collage materials, scrap
pieces of fabric, etc
~ glue and/or tape
~ scissors

Hook/intro:
Where in the body is anger felt?
How can anger be managed?

Intervention: *continued from last session*
1. give members time to finish any pages from the session before
(30 minuets)
2. using the suggestions below (or any other ideas members can
come up with) - ask members to “destroy/wreck” their zine (45
minuets)
a. poke holes all over the page using a pencil
b. pour coffee all over the page / allow it to stain
c. paint over a page with a solid color
d. stand on the page, jump on it, wipe your feet
e. create a non-stop line that covers the page

Closure:
1. How did it feel to wreck your zine?
2. Reflect on your anger before and after destroying your zine

Session 7
Topic: Bargaining - Band-aid Heart
Objective/s:
To understand that past can’t be changed or fixed, the new reality
can be accepted

Materials needed:
~ red construction paper
~ various band-aids or sticky
labels
~ markers

Hook/intro:
In grief, bargaining is looking
for ways to change the past,
anything you can do to go back
to how things were.

Intervention:
1. Ask members to cut out a large heart shape from their red paper
(10 minuets)
2. Take turns having members share an aspect of their loss that
upsets them or “breaks their heart” and tear a piece of their heart
off. Write what the aspect was on the ripped piece
3. Continue until each member’s heart is in pieces (30 minuets)
4. Using the adhesive labels or band-aids, ask group members to but
their hearts back together (30 minuets)

Closure:
1. After the heart is put back together, is it the way it was before
ripping it?
2. How can the new heart be accepted and appreciated?

Session 8
Topic: Bargaining - Water Color Design
Objective/s:
To reflect on past events and acknowledge what could have been done
differently, but also appreciate the present reality

Materials needed:
~ watercolor paper (8x11), one
per member
~ liquid watercolor paints
~ pipette droppers
~ white crayon
~ paper towels

Hook/intro:
Open conversation about
changing the past and what
could be done differently

Intervention:
1. Ask members to draw a design, abstract or pictorial, that
fills their paper with the white crayon (30 minutes)
2. Using the pipettes, drop colors of paint all over their paper
and tilt the paper around to spread the paint (30 minutes)
3. Dab any wet spots or puddles of water/paint that remain on
the paper (10 minutes)

Closure:
1. Ask members to reflect on their final painting, is there anything
they wish they did differently?
a. Since the past can’t be changed, how can they appreciate what
they did create?
2. How did it feel to not be able to see the drawing while working on
it?
a. how about not being able to have full control over the paint?

Session 9
Topic: Depression - Memory Collage
Objective/s:
Externalize the feelings of realizing the loss is truly gone and
isn’t returning

Materials needed:
~ blank paper, 8x11, (1 per
member)
~ glue sticks
~ magazines, newspaper,
collage materials, scrap pieces
of fabric, etc

Hook/intro:
Engage in a conversation
around the memories of what
they loss and the emotions
that are coming up

Intervention:
1. Invite group members to think about their loss - happy
memories, different experiences, any challenges, things they
miss etc. (5 min.)
2. As they reflect, ask members to start looking through the
collage materials, rip out or out aside anything that reminds
them of what they loss. It could be pictures, different words
or phrases, fabrics, etc. (30 min.)
3. Then have them create a collage on the blank piece of paper
and arrange their materials in any way they feel happy about.
(20 min.)

Closure:
1. What feelings came up while thinking about the memories of your
loss?
2. How do the images/materials remind you of that?

Session 10
Topic: Depression - Affirmations
Objective/s:
To identify and recognize how to stay positive in difficult situations

Materials needed:
~ 5x7 blank index cards or card
stock, 10 per group member
~ pencils, coloring supplies
~ paint pens
~ blank piece of paper (8x11), one
per member

Hook/intro:
Sadness is a natural emotion to
feel while, grieving. How can we
find ways to remind ourselves
to be positive?

Intervention:
1. Using the blank sheet of paper, ask members to write down at
least 10 different positive sayings, quotes, or affirmations (15
minuets)
2. If members are struggling to think of 10, open conversation for
the group to share theirs or come up with ideas (10 minuets, if
needed)
3. Invite members to create decorated index cards with their
affirmations on them, one per card. (45 minuets)

Closure:
1. Reflect on what members wrote and how they remind themselves
of the positives in life

Session 11
Topic: Acceptance - Grief Journal
Objective/s:
Gain comfortability identifying and “verbalizing” thoughts and
emotions

Materials needed:

Hook/intro:

~ heavyweight paper (8x11), one
sheet per member
~ writing utensils
~ scissors

Acceptance is the final stage,
but that doesn’t mean the
emotions of grief go away. It is
important to continue to
recognize your emotions and
express them in healthy ways.

Intervention:
1. Using the zine instructions below, have each member create their
own zine (15 minuets)
2. Ask members to pick some of the prompts from the page of
prompts (following the zine instructions)- one prompt per zine
page (10 minuets)
3. Once prompts have been chosen, members should go through and
write their responses for each prompt (40 minuets)

Closure:
1. Ask if any group members would like to share any of the prompts
they chose or their responses
2. How did it feel to put your thoughts into words?

Zine Instructions

Journal Prompts
1. To be more compassionate towards myself, I will try ...
2. Whenever I begin to feel overwhelmed by grief, I will ...
3. I am grateful for ...
4. When I let my mind wander, I start thinking about ...
5. Sometimes I feel guilty because ...
6. My greatest internal struggle has been ...
7. What has surprised you in the midst of your grief ...
8. Write down every emotion you’re feeling right now ...
9. What have you learned about yourself in your time of grief ...
10. What is something you want others to understand on days
that you are struggling ...
11. What new worries have developed since your loss ...
12. What things are you able to still find joy in ...
13. Today, I miss ...
14. One thing I want to remember is ...
15. How can you take care of your physical health today ...
16. Who else do you know is grieving, how can you support each
other ...
17. What emotions am I feeling in my body... what sensations
am I noticing in my body...
18. What words of kindness can I offer myself ...
19. My favorite memory is ...
20. What do I need to have closure ...

Session 12
Topic: Acceptance - Goodbye Letter
Objective/s:
Embrace and accept your loss
Gain closure from a formal goodbye

Materials needed:

Hook/intro:

~ blank notebook paper, 2-3
sheets per client
~ writing utensils

The hardest stage of grief, is
acceptance. However, it is
important to acknowledge and
accept your loss and continue to
move on

Intervention:
1. Ask members to reflect on what changes/losses they have
experienced (10 minuets)
2. Invite them to write goodbye letters to what or who they are
grieving (50 minuets)

Closure:
1. If members are comfortable, ask them to share their letter
2. How does it feel to be able to say goodbye to what/who you loss?

Session 13
Topic: Closure - Grief House
Objective/s:
Reflect on what was lost and how to move forward

Materials needed:

Hook/intro:

~ blank paper (8x11), one sheet
per member
~ house template (see next
page)
~ coloring/ writing supplies

Grief is an individual experience,
being able to identify aspects of
what happened and knowing
what helps you is pertinent to
healing

Intervention:
1. Ask members to draw a house on their paper following the
template (10 minuets)
2. Following the prompts from the template, members should
fill in their house accordingly (30 minuets)
3. Members can color and decorate their house as they wish (15
minuets)

Closure:
1. Invite members to share about different parts of their house
a. Are there any that members have in common?
b. How does it feel to explore your grief journey?

Grief House Template

Session 14
Topic: Reflection - Tool Box
Objective/s:
Identify skills and tools to continue to use when not in session

Materials needed:

Hook/intro:

~ sheet of heavy paper (12x18),
one per member
~ box template (see next page)
~ writing and coloring supplies

Reflect on the skills and
interventions done the past 13
sessions. Which ones stick
out to you?

Intervention:
1. On their paper, ask members to draw an open box or
container (see example below) (20 minuets)
2. Then, have members fill in the page with words or drawings
about the work they have done over the past sessions (50
minuets)
a. they can focus on what they learned, how it helped, or the
end product of the interventions

Closure:
1. Discuss what they learned from the sessions
2. Reflect on the skills they learned and how they can continue to
use these skills

Tool Box Template

My Cop ing Too l Box

ADAPTATIONS
This curriculum was design with the population and location in
mind. The materials have remained more conservative with hopes
that all materials will be allowed in facilities. However,
regulations can differ depending on the facility. All of the
interventions can be altered to fit the materials allowed.. Any
counselor using this curriculum should check the regulations for
their facility and adjust materials accordingly.
There are also time suggestions on each step of the
interventions. These are provided to help keep the session within
the 90 minute timeframe. However, these are suggestions. Group
members may take more or less time on steps. This is no
problem, as long as the counselor leading the group is aware of
the session time.

REFRENCES
Counselingadventures@gmail.com. (2022, July 13). Grief selfexploration House. Counseling Adventures.
https://counselingadventures.com/grief-self-exploration-house/
Mutiara, S. (n.d.). Book folding template - 10 free PDF Printables.
Printablee. https://www.printablee.com/post_book-foldingtemplate-printable_327947/
Schneider, J. (2001). Grief/ Depression Assessment Inventory.
http://www.integraonline.org/assessments/grief_depression_inven
tory.pdf