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Grief & Loss

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Distress Centre

on 12 February 2018

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Transcript of Grief & Loss

REVIEW QUESTIONS

A. Relief
B. Numbness
C. Anger
D. Helplessness
E. All of the above











5. Which of the following would be considered as common feelings reaction to grief?

A. Effective grief work is done alone
B. Grief is hard work
C. The way out of grief is through denial
D. The very worst kind of grief is not yours

3. Which of the following is one of the key facts described by Diets?

A. Loss of a pet
B. Loss of important people
C. Job loss
D. Loss of health
E. All of the above

2.Identify examples of common losses

Sudden, unexpected loss for which no one was prepared
Violent death
Suicide
Occurrence of multiple losses
Death viewed as preventable
Witnessed violence or death
Grieving person unable to attend funeral/ritual
Death of a child


1. Nature of the Loss

Men may grieve by:
Remaining silent
Engaging in solitary mourning or secret grief
Taking physical or legal actions
Becoming immersed in activity

Men in Grief cont’d.

Consider how you might respond to a male caller who is openly crying, expressing need for affection, losing control of self, or being passive.

Consider how you might respond to a female caller who is not expressing emotion, immersed in activity, or remaining solitary.

LOSS AND GENDER

BEHAVIOURS

Sleep and appetite disturbances
Social withdrawal
Restless, over activity
Crying, searching and calling out
Avoiding reminders of the lost person
Seeking out reminders of the person
Dreams of the deceased
Disconnection with faith community or practices
Searching for meaning by connecting with a new faith community or practices

POSSIBLE GRIEF REACTIONS

POSSIBLE GRIEF REACTIONS


YOUR OWN FEELINGS ABOUT LOSS



EXAMINE

Learn to grieve fully so that you can live and love more fully.
Take what is inside-outside.
When words are inadequate have a ceremony.
Allow the hurt and pain to integrate the loss into life.
The grieving work softens the symptoms of loss over time.
Express it over time in small doses and find it’s way to meaning.

Grief : “Must feel it to heal it”

Active Listening
Empathy
(i.e. How are you feeling?” “You sound sad to me “)
Validation
( i.e. “It makes sense you are feeling sad because you just lost your cat”)
Paraphrasing
Summarizing

FEELINGS SUPPORT



FEELINGS ASSOCIATED WITH
GRIEF AND LOSS

BRAINSTORM

A Historical Review -
Stages of Grief

No universal timeline for reconciling grief
There is no “right way” to grieve
Grief may be hard work – figuring out who you are now without that person/place/thing/status, etc.
Often we grieve old losses with new losses
We grieve when a loss has happened or is threatened
Companioning may help those in grief*




Important Considerations

Grief

Grief has an ending point – “You should be over it by now”
Grief is like an illness, there is a known progression or “cure” (or end)
You should not speak (ill) of the dead
Not thinking about your loss helps you “get over it”
Grieving/Mourning is sign of a weakness
Hierarchy of loss – one type of loss is “worse” than another



Myths about Grief

In grief the greatest teachers are those that are grieving. We become witness and are awed by the intensity and depth of grief encountered by the human spirit and humbled by the lessons of those facing such tragedy.




A Final Thought...

EXPERIENCING LOSS

A.Sense of Presence
B. Hallucinations
C. Revenge
D. All of the above

6. What thoughts we can expected as a reaction to grief?

A. Crying
B. Shock/Denial
C. Rage
D. Bargaining

4.What are the common stages of grief described by Elizabeth Kubler-Ross

A. Greif is hard work
B. Effective grief work is not done alone
C. Grief has ending point
D. Greif is a sing of weakness

1. What are the common myths about grief?

COMPLICATED GRIEF

PHYSICAL SENSATIONS
Aches and pains with no explanation
Dizziness
Frequent illness - decreased immunity
Nausea
Weight gain or loss
Numbness
Hollowness in the stomach or feeling like a part of them is missing
Tightness in chest and throat Oversensitivity to noise
Breathlessness or shortness of breath
Weakness
Lack of energy
Dry mouth or lump in throat

POSSIBLE GRIEF
REACTIONS


PHYSICAL SIGNS ASSOCIATED
WITH GRIEF AND LOSS

BRAINSTORM

POSSIBLE GRIEF REACTIONS

Shock/Denial:
a first reaction to the awareness of the loss i.e. “No, not me, it cannot be true”
Anger:
a stronger sense of awareness of the loss i.e." Yes it is me, it was not a mistake”
Bargaining:
an attempt to postpone or to bargain for more time
Depression:
reaction to letting go of anger is followed by a sense of intense loss
Acceptance:
neither depressed or angry; an individual has found some peace

STAGES OF GRIEF Cont’d.



DIFFERENT TYPES OF LOSSES

Brainstorm Activity

How have you seen others (or yourself) react or respond to loss?


Brainstorming Activity

STAGE 2 – RAPPORT

Let them tell their story, having someone safe to talk to about their loss can be very healing and helpful.
If you do not know what to say… silence is alright.
Be careful of cliché as this can cause “secondary wounding”

ROBERTS MODEL

Loss of identity
Loss of Status
Loss of Independence
Loss of Innocence
Loss of Health
Environmental Loss
Cultural Loss
Loss of Faith
Life stage losses

Loss of important
people in our lives
Loss of a pet
Loss of objects
( i.e. a house)
Nature or human
caused catastrophes
Job loss

Examples of losses

STAGE 6 – PLAN

What the caller can do today to help themselves feel safe and more in control of the situation when they hang up the phone.
Get rid of means
Contact family and friends and make them aware of situation
SELF CARE: stress relief (walk, bath) physical relief (eat, sleep)

What resources are available for them longer term Remember: We need to provide options not advice, which means we must try to identify more than one resource so the caller can decide what will work best for them.
Counseling intake with DC or other counseling organization
Referral to MRT
Schedule appointment with physician or therapist

ROBERTS MODEL

ROBERTS MODEL

STAGE 4 – FEELINGS

Normalize feelings so caller does not feel that they are alone or that they are going “crazy”.
Fear
Self Loathing
Helpless/Hopeless/Powerless
Anger
Exhaustion
Loss of control
Uncertainty/Fear
Guilt
Failure
Sadness/Depression
Try to understand what caller is feeling
Put feelings into words
Validate those feelings

Stage 5 Options

ROBERTS MODEL

Distress Centre
MRT
Self care
Interests
Strengths
Short term plan
Counseling resources in the community (individual and group support)

STAGE 3 – IDENTIFY PROBLEMS

Clarify the problem-what concerns led them to call us today?
Prioritizing-what do we need to work on first?
What they usually do to cope with their loss or what they have tried
Ask the caller what type of assistance they would find helpful.
When we are talking about grief and loss, often times how the caller is feeling is the problem.


ROBERTS MODEL

STAGE 1 – RISK ASSESSMENT
Suicide/homicide risk assessment:
is the caller at risk of harming him/herself or someone else?
Basic needs/Are they able to proved for their basic needs?
Socializing: Are they avoiding friends and family?
Physical needs: Have they been eating?
Mental health (depression and other mental health issues) how depressed are they? Is there history of depression ( or other mental health issues)personal/family?
Addictions : are there concerns about substance use and this would include everything from using tranquilizers or sleeping pills for too long to engaging alcohol or drug abuse?


ROBERTS MODEL

Adaptive Grieving
Styles

STAGE 7 – FOLLOW UP

Is there a follow up call needed?

Would the caller benefit form the DC counseling?
Invite caller to call back and thank them for calling.

ROBERTS MODEL

Crisis Intervention
And Roberts’ Model

1

2

3

4

5

6

7

Crisis Resolution

RISK

RAPPORT

OPTIONS

FEELINGS

PLAN

IDENTIFY PROBLEMS


FOLLOW
UP

Stroebe & Schut (2013).
The dual process model of coping with
bereavement
(pg. 213). Retrieved on May 21, 2017 from http://wendyvanmieghem.com/wp-content/uploads/2012/08/dual-process-model-by-M.-Stroebe-.pdf

The Dual Process Model of
Coping with Bereavement

Wolfelt, A.D. (2003).
Understanding your grief.
Colorado: Companion Press
Prolonged grief with severe symptoms that lead to significant dysfunction*
Four conditions that enhance the possibility of complicated grief

Loss:
The real or perceived deprivation of something meaningful (both death and non-death)

Grief:
The constellation of inner thoughts, feelings and experiences following a loss

Mourning:
Grief “gone public” or outwardly expressed

Working Definitions
Types of Losses

THOUGHTS

Disbelief
Confusion
Preoccupation
Sense of presence
Hallucinations
Revenge
Intrusive thoughts about the loss
Sense of futility – “What’s the use?”
Uncertain of identify – “Who am I now without x?”
Memory loss
Difficulty concentrating
Responding sluggishly to questions*

Primary loss
– significant loss event
Secondary losses
– the losses that are the consequence of a primary loss and vary according to the individual and the context of the loss

Disenfranchised grief
– grieving a loss that cannot or is not openly acknowledged

1. The relationship is not socially recognized
2. The loss is not socially recognized as a ‘legitimate’ loss
3. The griever is not socially recognized – idea that this person isn’t capable of grief

How do people navigate grief?

Consider your own feelings about loss

Sadness Gratitude Regret
Anger Joy Fear
Guilt Helplessness Panic
Shame Shock Disbelief
Anxiety Yearning Denial
Loneliness Numbness Release Emancipation Fatigue Relief...

1. The nature of the loss
2. The nature of the relationship with the person who has been lost (or the loss is threatened)
3. The psychological characteristics of the grieving person
4. Social issues associated with the loss
2. Nature of the Relationship
Difficult relationship – a history of abuse
Challenging attachment – ambivalent, dependent, insecure relationship
Unresolved issues with deceased

3. The psychological characteristics
of the grieving person
History of mental illness
Difficulty tolerating psychological pain
Previous complex grief response
Intense feelings of inadequacy or guilt towards deceased, especially during illness
View grief as being the only strategy to maintain connection with the deceased

4. Social issues associated
with the loss

Cause of death is stigmatized
Griever feels disenfranchised by society
Lack of adequate social support
Griever is socially isolated and hesitant to express self for fear of further isolation
Concurrent crises – financial, occupational, physical, familial, spiritual, etc.

How can we help…?
Active listening
Silence
Express curiosity about their experience
Empathy
Validation
Normalize
Paraphrasing
Summarizing
Resist the urge to “fix” their situation
“Companioning is about going to the wilderness of the soul of another human being; it is not about thinking you are responsible for finding the way out” – Alan Wolfelt
Full transcript