Healing From Loss This Thing We Call Grief
Alive Hospice Grief Support Services David Neese, Director
8/29/2017 Cameron Park Zoo—Waco, TX
Batari Mei Grief
The set of responses that accompanies the loss of something or someone important to us
• Emotional • Mental • Physical
• Behavioral • Social • Spiritual Fundamental Truths
Grief is the normal, natural, universal response to major loss
No one “normal” way or length of time to grieve
Not an ordered, predictable, or linear process Factors That Affect the Grief Response
The Relationship Coping style
Circumstances Resilience
Family/cultural norms Social Support
Life changes Caregiving experience Manifestations of Grief
Emotional Mental
• Sadness • Preoccupied
• Yearning • Distracted
• Anxiety • Impaired ability to concentrate
• Loneliness • Forgetful/Absent-minded
• Anger • Heightened sensitivity
• Guilt • Fear of abnormality Manifestations of Grief
Physical Behavioral
• Poor sleep • Crying
• Loss of appetite • Comfort eating/drinking
• Fatigue • Irritability
• Restless • Lack of interest/motivation
• GI symptoms • Searching Manifestations of Grief
Social Spiritual
• Avoidance • Comfort/Meaning
• Relationships • Search for Meaning Models of Grief Process
The (5) Stages (Kubler-Ross)
Denial
Anger
Bargaining
Kubler-Ross, E. (1969). On death and dying. Macmillan, New York. Kubler-Ross, E. (1972). On death and dying. JAMA: The Journal of the American Medical Association, 221(2), pp.174-179. The “Grief Process” (the myth)
Acceptance
Depression 1 yr. Bargaining 9 mos. Over it!!!! Anger 6 mos. Almost Denial There!!! 3 mos. Even Better!! 0 “It’s Bad” Better! No Models of Grief Process
The Four Phases (Bowlby/Parkes)
Shock and Numbness
Yearning and Searching
Disorganization and Despair
Reorganization
Bowlby, J. and Parkes, C.M. (1970). Separation and loss within the family. In E.J. Anthony and C. Koupernik (eds), The Child and His Family (pp. 197-216). New York and London: Wiley. Models of Grief Process
The Four Tasks (Worden)
Accept the reality
Work through the grief
Adjust to the changes
Redefine the relationship
Worden, J. W. (2002). Grief counseling and grief therapy: A handbook for the mental health practitioner. New York: Springer Pub. Models of Grief Process
The Dual Process (Stroebe & Schut)
Loss-oriented coping
Restoration-oriented coping
Oscillation between the two
Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 197–224. Uncomplicated Grief vs. Complicated vs. MDD
Uncomplicated (Normal) Grief – Recovery may happen in fits and starts, but manifestations and course generally within range of normal and moving in positive direction
Positive Adaptation to Loss Uncomplicated Uncomplicated Grief vs. Complicated vs. MDD
Uncomplicated (Normal) Grief – Recovery may happen in fits and starts, but manifestations and course generally within range of normal and moving in positive direction
Complicated Grief The symptoms and intensity of grief are prolonged and cause substantial impairment in important areas of functioning Uncomplicated Grief vs. Complicated vs. MDD
Uncomplicated (Normal) Grief – Recovery may happen in fits and starts, but manifestations and course generally within range of normal and moving in positive direction
Complicated Grief The symptoms and intensity of grief are prolonged and cause substantial impairment in important areas of functioning
Persistent Complex Bereavement Disorder DSM-5 Condition for Further Study
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Major Depressive Disorder (DSM-5)
1. Depressed mood* Five or more most of day nearly every day for 2 weeks 2. Anhedonia* Significant distress or impairment 3. Weight loss or gain
4. Insomnia or hypersomnia
5. Psychomotor changes
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Diminished ability to think, concentrate, or make decisions
9. Recurrent thoughts of death or suicide Depression vs. Grief
Normal Grief Depression
Sadness tied to specific loss Source of sadness ambiguous
Can feel, identify, express feelings Difficulty naming/expressing feelings
Can experience positive emotions Negativity prevails, no joy
Sadness comes in waves Sadness more pervasive & unrelenting
Sense of humor mostly intact Loss of humor or marked by sarcasm Depression vs. Grief
Normal Grief Depression
Responds to comfort and support Less responsive to offers of support
Hopeful regarding future More hopeless in general
Self-esteem mostly intact Self-loathing, low self-worth
May feel guilt over specific aspects Guilt feelings generalized, excessive
Passive thoughts of dying common Frequent suicidal thoughts, intent, or plan What Grief Needs
Emotional
• Allow and accept feelings
• Express self as it suits you
• Stay connected
• Balance grief and respite
• Honor your expressive style Expressive Styles
Intuitive Instrumental (Feeling) (Thinking/Doing)
• More expressive • Less expressive • Feelings • Thinking • Talking • Doing • Female stereotype • Male stereotype What Grief Needs
Emotional Mental
• Allow and accept feelings • Expect diminished functioning
• Express as it suits you • Make lists
• Stay connected • Be careful
• Balance grief and respite • Go easy on self
• Honor your expressive style • Inform others if needed What Grief Needs
Physical Behavioral
• Eat sensibly • Learn about grief
• Plenty of fluids • Go easy on self
• Rest/sleep/exercise • Inform others if needed
• Proper medical care • Self-awareness What Grief Needs
Spiritual Social • Use your faith/beliefs in your way • Balance solitude & connection
• Allow the hard questions • The right support—right people
• Allow the search for meaning • Be willing to set limits
• Growth? • Accept limitations of others What Not to Say to Someone in Grief
The “Just” Comments
“It just takes time”
“Just remember the good times”
“It was just his time”
“Just be thankful/glad that _____” What Not to Say to Someone in Grief “At least….
…he’s not suffering anymore”
…she lived a long life”
…you had a long life together”
…you can have another child/have other children” The God Cliches
“He’s in a better place”
“You just need to have more faith”
“It’s God’s will”
“God doesn’t give us more than we can handle”
“Everything happens for a reason” Other Unhelpful Cliches
“It could always be worse”
“Be strong…..” messages
“You should….” messages
“I know how you feel” ALIVE HOSPICE - CONFIDENTIAL Types of Support
Emotional Expressions of love, empathy, encouragement, listening
Instrumental More concrete (meals, transportation, tasks) Intuitive Instrumental (Feelers) (Think/Do) Informational Advice or information about resources (financial, legal)
Appraisal Constructive feedback about lifestyle, self-care, behavior Social Support
3 Questions
1. Who is there for you?
2. What do these people do that’s most helpful?
3. Would you like more or different kinds of support? Beyond Emotional Expression
• The power of an intentional conversation
• The power of telling the story
• Feeling questions vs. thinking questions
• Grief is not fundamentally about emotional expression
• Meaning-making “To live is to suffer; to survive is to find meaning in the suffering; if there is a purpose in life at all, there must be a purpose in suffering; but no one can tell another what that purpose is” ― Gordon Allport (foreword in Frankl, 1984, p. 9).
Frankl, V. (1984). Man’s search for meaning. New York: Simon & Schuster. Grief Support Services at Alive Hospice
WHO WE ARE: A team of Masters level, licensed, and highly experienced grief counselors dedicated solely to working with the bereaved
WHO WE SERVE: Anyone who has recently experienced the loss of a significant loved one—adults and children
OUR GOAL: To help people heal well from the pain of loss and grief
SERVICES: Individual counseling; support groups; grief camps for children and teens; grief in the workplace; grief in the schools; education on grief and loss to the community
Most services free to families of Alive Hospice patients; nominal charges for some services and for individuals whose loved one was not a patient with Alive; no person or service is denied based on ability to pay