Thinking about Losses and Grief Differently

1. Thinking about Losses and Grief Differently • Universal phenomena • Is challenging and distressing • But it can be transformational, and most of us overtime develop skills and attitudes that assimilate our losses in our lives in a functional manner

2. Psychotherapy and Psychotherapist’s • Often miss or fail to identify the presence of loss and grief – unless of course the intake tells us the person is coming for bereavement counselling • However, grieving a death of a loved one – is similar to other losses and may invoke similar responses

3. Loss Responses: Non-Death and Death • We experience: • Sadness, we confront and avoid painful emotions, we attempt to reorganize our world, we struggle with connection and disconnection • Our new losses trigger material from our old world (attachment theory) we year to return to these preloss circumstances • We try to make sense of losses, or make meaning, we are paralyzed, we are transformed, and struggle to integrate losses into our lives

4. Loss and Grief Terminology • Bereavement: period of sorrow following the death of a significant other • Loss: real or perceived deprivation of something deemed meaningful (death or non-death related) • Grief: an emotion generated by an experience of loss characterized by sorrow and/or distress, and the personal and interpersonal experience of loss. • Coping: Time limited reaction in which an event is endured or momentarily managed with coping skills • Loss Adaptation: Process of adjusting to loss/grief (active process of modification, revision, reorganization, and assimilation over time

5. Changing Ideas • Not linear - there is not necessarily a characteristic set of processes that each griever experiences or phases he / she must pass through • Not abnormal – don’t necessarily need to detach/sever from object we are grieving over • Grief doesn’t necessarily end • We are not passive victims over our grieving • We must assume personal, social, familial, historical, and culture, influences our grieving and healing – but not necessarily get caught by them and all grievers are the same! Not all losses, all grief…

6. Grief is an individual phenomena! Moving Away from Linear Models

7. Let’s Chat about these Cases • Kito • Elena • Jane • Billy

8. The Counseling Professional Working with Loss and Grief • What loss and grief loss requires the counselor to do: • Prioritize uniqueness of our clients and their experiences within the context of their lives • Recognize normality of grief, empower clients to be actively involved in their adaptation to loss, support clients without attempting to cure or fix them • Respect clients as experts on themselves • Let’s talk about the last one… Humphrey Chapter 9 pgs. 213 – 219

9. Three Roles • Witness • Facilitator • Collaborator

10. The Witness • To observe, to listen, to hear, to remember, and to understand at the deepest level the powerful narratives of loss and grief • We bear witness • Thus as a witness we: • Listen more than we talk • Employ respectful silence • Fully attend (see what is here) • Exhibit comfort • Allow grief (don’t fix even when clients request rescue) • No judgment

11. Facilitator Role • Provide a framework conducive to functional loss adaptation • Focus and structure • Typical questions and framework • How can I be of help? How is the session going thus far? Where should we be spending our time? • We facilitate the clients work, but we don’t do the work for them!

12. Facilitator Medicine: • Encourage recognition and use clients strengths, resources and abilities • Respect the natural ebb and flow of the grieving journey, including periods of disorder, impasse, resistance, and confusion as part of the loss adaptation process • Consult with clients regularly as to direction of therapy, and usefulness of various techniques / activities • Assist clients where they are - not where the counselor wants them to be

13. Collaborator Role • Collaborative counselors are more interested in client perspectives than they are in preconceived notions about grief based on expertness of others • Neither directive nor nondirective • Fellow explorer • Help clients educate themselves about themselves and their world past, present, future

14. Collaborator Medicine: • Respect clients as narrators of their own stories • Encourage and attitude of exploration and discovery • Rely and what and how questions to encourage reflection and ownership • Encourage divergent thinking (ideas) • Promote client resiliency

15. Key Technique in Working With Loss, Grief, and Bereaved Clients • Master the Art of Silence • Respectful silence is bearing witness • Silence punctuates moments, prompts reflection, provides support, deepens process, and is healing • We are creating a space for coping, holding, adapting • We do not solve grief • We do not rescue grief

16. Video Emersion: Practicing The Three Roles

17. Listening To and Listening For Loss and Grief • Listen to this song…? • What do you think is going on?

18. Let’s not Get Ahead of ourselves? • Why do we grieve? • Love somebody? • What is love?

19. Why Loss / Grief Clients • Some clients specifically come for counseling due to loss and as a result of • Bereavement • Divorce • Separation • Loss of livelihood • Because they believe they are not adjusting well

20. Why Loss / Grief Clients (cont.) • However, most loss and grief experiences appear far more often in therapy not as the presenting problem, but as an underlying cause or contributing factor to client troubles. • As we explore client anger often we reveal core losses that have never been addressed or were adequately grieved for. • Refer to text pg. 19

21. Primary and Secondary Losses • Primary Loss: significant loss event such as death • Secondary Loss: come about as a result of a primary loss

22. Secondary Losses • Acts a dominoes: and can arise as a chain of events from primary loss • Death of spouse brings about loss of companionship, financial security, sexual intimacy, family role, social status • Job loss: self-esteem, identity, financial security, sense of future • Childhood sexual abuse: loss innocence, trust, sense of control, etc. • Mental illness: loss of control over emotions, thoughts, family role, loss of occupation All these losses bring grief

23. The question to ask then or to understand in facilitating adaptation to loss that we must ask our clients? • WHAT HAVE YOU LOST? Primary Loss = Relationship • Questions we need to know:

25. Ambiguous Loss (AL) • Two types • Physically absent / psychologically present (e.g. kidnapping, people missing from natural disaster, divorce situations, baby put up for adoption, etc.) • Physically present / psychologically absent:person is emotionally and cognitively missing (Alzheimer’s, traumatic brain injury, addictions) • The uncertainty characteristics of (AL) can bring about long term dysfunctional coping often contributing to complications in the grieving process

26. Stigmatized Losses • Losses that reveal transgressions of societal norms or go against norms, mores, and folkways • These include losses related to HIV/AIDS, suicide, violence (e.g., homicide, genocide, domestic violence, homelessness, sexual abuse, addictions, to name a few) • Stigma attached to the loss, should they be allowed to grief? Family hides “the secret” • These sufferers usually experience and have a difficult time getting over guilt, shame, blame and their support networks can often be limited Disenfranchised Grief

27. Cultural losses • Historical oppression • Racism • Residential school • Immigration

28. Psychosocial Factors: Facing Our Loss • Now that we have seen that grief and loss are unique to the sufferer and that different losses bring with them different obstacles to adaptation let’s look at psychosocial factors that impact grief and healing. • Adaptive strategies • Affective (emotional response / regulation) • Cognitive (analysis, reframing, distraction or avoidance • Behavioral (problem solving, activity, behavioral distraction) • Spiritual (prayer, meditation, rituals)

29. Adaptive Strategies • Can be used both positively and negatively • Everyone has their own combination of adaptive strategies based on personality and life experience • The idea is for the counselor and client to use which ones that are most helpful

30. Attachment Theory • Definition of Attachment: • An enduring emotional tie to a special person, characterized by a tendency to seek and maintain closeness, especially during times of stress. • Healthy and unhealthy attachments can predict duration and intensity of bereavement

31. Disrupted Meaning Structures • Basic truths about the world = assumptive world • Loss can shatter our assumptive world • I don’t know who I am anymore “shakes us to our foundations” • An important job of the grief counselor is to help clients deal with disruption of their pre-loss meaning structures

32. Meaning Reconstruction 3 Phases • Sense or meaning making • Begins with exploring the “why” • And maybe ends with “letting go of the why” • Moreover, the counselor’s aim here is to examine the meaning structures that once made one’s world comprehensible, then renewing, redefining, or revising them to so as to restore balance

33. Benefit Finding: Phase 2 • Learning to find personal growth in loss • We may find a greater faith • Transform our identity • Develop competence or independence • Its not above moving on – its about thriving in the aftermath of a reality we can’t change

34. Identity Change • Process of reorganizing and rebuilding a sense of self fragmented by loss • Help client revise one’s self narrative in a way that maintains continuity of a person while also incorporating altered aspects of the self • We are always becoming

35. Video Emersion: Shattered Assumptive Word

36. Video II: Disrupted Meaning Structures

37. Other Psychosocial factors • Personal history of Loss and Separation • Developmental considerations • Women’s / Womanist development • Racial Identity development • Homosexual Identity development • Faith Development

38. Social Support • The better the quality of the grievers support network, the more functional is her or his loss adaptation • Sometimes our notions of who will support us does not happen or our initial grief reactions, or deficits in our interpersonally functioning limit our reaching out to others. • The latter support mechanisms and tendency’s need to be explored by counselors

39. Uncomplicated and Complicated Grief • Uncomplicated grieving • Self-limiting • Common symptoms gradually diminish (e.g. sadness, yearning, confusion, numbing, and loneliness) • There is an increasing acceptance of the reality of death • Steady integration of loss • Grief is seen as normal • Easing of symptoms can be observed 6 months to a year following the death

40. Complicated Bereavement Grief (Prigerson et al. 1995) • Used to denote specific symptoms and level of distress due to a death (distinguishing primary disorder) • Grief is prolonged • Grief symptoms intensify rather than diminish • Disability of death lingers, and loss is not observed to have been integrated

41. Toward Diagnosis: Four Proposed Criterions • Symptoms must last for 6 months • Symptoms cause marked dysfunction in social, occupations or other important domains • Yearning, pining, longing for deceased must be experienced at least daily over past month to a distressing or disruptive degree • 4 symptoms of 8 must be experienced in the past month as extreme These are:

42. Trouble accepting death • Inability to trust others since the death • Excessive bitterness about the death • Feeling uneasy about moving on with one’s life • Feeling emotionally numb/detached from others since death • Feeling life is meaningless without the deceased • Feeling the future holds no meaning without the deceased • Feeling agitated, jumpy, or on edge since the death

43. Let’s talk about pathologizing grief

44. Contemporary Models of Loss Adaptation • Martin and Doka’s Adaptive Grieving Styles • Dual Process Model of Coping

45. Adaptive Grieving Model • Model focuses on: • Specific patterns of grieving that is natural to the person, and • The preferred cognitive, behavioral, affective, and spiritual strategies an individual uses to manage our innate response to loss

46. Continuum: 3 Basic Grieving Styles

47. A Closer Look at The: Intuitive and Instrumental…

48. Adaptive Grieving Styles • Our style can shift along the continuum, but for the most part is generally consistent across time • The model’s grieving styles reflect and respect innate differences among individuals that result from personality, culture, familial, developmental, and social influences

49. Preferred Coping Strategies • Affective • Cognitive • Behavioral • Spiritual • Any adaptive strategy may be used by an individual person, but there appears to be a clear preference for each grieving style • Thus, an instrumental griever and intuitive griever may employ the same strategy, but it’s use will be put in action for different means • Sharing a story for an intuitive is done to express emotion and connect on emotional level with others, whereas an instrumental tells a story to to gather info, organize a response, or solve problems

50. Affective Strategies