Recovering from Loss & Grief

1. Recovering from Loss & Grief Dr Timothy Dunne Consultant Clinical Psychologist Public Lecture delivered on behalf of Kilkenny Bereavement Support Group Wednesday 10th September 2014

2. Outline • Introduction • Definition of terms • Models of Grief • Grief & Complex Grief • Grief & Loss • Myths about Grief • Suicidal Ideation • Healing & Recovery

3. Terms • Grief = Emotion • Loss = Experience • Mourning = Process of Grieving • Bereavement = Social & Cultural Processes • Complex Grief = Any loss which is accompanied by obstacles to psychological healing

4. Simple / Complex Grief • Young V Older person • Natural causes V Man made (murder/suicide) • Natural disaster V Man made (train/plane crash) • Sudden death V Gradual decline • Ambivalent Loss – where there are no remains to bury

5. Losses • Permanent physical injury or disability • Any change in health status (eg) diagnosis of long term condition such as diabetes, cancer • Any major Life Event, even positive ones such as house move, new job, marriage & divorce, emigration • Ageing & retirement • Financial losses & reduced standard of living

6. Models of Grief • Kubler – Ross (1969) • Warden (1990) • Dual Process model (2010)

7. Kubler-Ross’ Model • Shock/Denial • Anger • Bargaining • Depression • Acceptance

8. Some Difficulties • The model was first used to describe stages in acceptance in the dying not in the bereaved • Not everyone goes through every stage • The stages are iterative rather than progressive • “Is” can become “ought” • Too prescriptive, rigid and passive

9. Warden’s Tasks of Mourning model • To accept the reality of the loss • To experience and process the pain of grief • To adjust to life without the loved one • To relocate the dead person emotionally and find an enduring connection with him/her & embark on a new life

10. Some difficulties • Perhaps too prescriptive also • Can appear to minimize the individual experience of grief • Fails to recognize that the powerful nature of grief which may only be handled in manageable chunks • People can get “stuck” on a particular task or stage

11. Dual Process model (DPM) of Grief(Stroebe & Shear, 2010) • Based on concept of “Oscillation” whereby the bereaved person confronts the loss at times and at other times avoids it • The person “swings” between facing the loss and restoration or rebuilding their life • “Time out” is an essential feature of this model as continuously facing grief is “arduous & exhausting” – “defensive exclusion” is vital at times • This model takes account of other stressors in the person’s life such as bringing up children or financial pressures

12. Cultural Assumptions • Our Western culture (and helping professions) have arrived at a “common wisdom” that it is generally healthy to focus on pain of grief and distress and to express it openly • Suppression of same is thought to be unhealthy & not to be encouraged (“stiff upper lip”) • However, research (White, 2013) does not support this “common wisdom”

13. Cultural Assumptions • In addition to the need to face grief & pain there is also a natural tendency to avoid the reality of death • This should be factored in to any intervention process • Avoidance can have a valuable protective effect for someone struggling to make sense of an overwhelming loss • This is now standard procedure in Trauma treatment (ie) a “titration” approach

14. Cultural Processes • Irish Wake/ Month’s Mind • Used to have outward signs/symbols such as wearing black for a certain period or diamond on a jacket sleeve • Jewish Shivah (7 days); Shloshim (30 days) and ShneimasarChodesh (12 months) • Most people underestimate how long it takes to fully get over the death of a loved one

15. “The Deal” • In complex or traumatic grief the person may often, unconsciously, make a deal with the loved one which goes like this: • “I will continue to suffer pain and loss in order to prove my love for you because if I don’t feel this pain, it means I don’t love you or if I let go of my grief it means I have forgotten you” • The same can occur with self-blame especially if the survivor believes that they somehow are responsible for the death of the loved one

16. Complex Grief • Long lasting • Intrusive images or thoughts of the loved one • Pre-occupation with the deceased • Social withdrawal & detachment • Pining or yearning for the deceased • Have trouble accepting the death • Inability to trust others • Excessive bitterness • Prolonged feeling that life is empty & meaningless

17. Complex Grief • Are you having trouble accepting the death? • Does grief interfere with your life? • Are you having troublesome thoughts /images of the deceased? • Do you avoid doing the things now that you used to do with your loved one? • Are you feeling cut off or distant from others since the death?

18. Myths of Mourning • Grief declines steadily after the death • All deaths and losses produce the same type of grief reaction • The intensity of emotions experienced and the length of time spent grieving is testimony to how much love there was for the deceased • Grief & loss are only about death • Time heals all wounds

19. Suicidal Ideation • Suicidal ideation or wanting to die occurs in up to 65% of those bereaved • Complex grief produces 5 times as many suicidal thoughts • Some people see suicide as a way of gaining control over the pain • Sometimes people put themselves at risk or neglect themselves or act with less concern for themselves or in a way which increases the likelihood of accidents or death

20. Thoughts & Beliefs • I didn’t do enough for her • He died without knowing how much I loved him • I cant stand not knowing if he suffered pain • It was unfair how she died • I don’t know if he is at peace • Its not right for me to enjoy life without her

21. Healing & Letting go • Not everyone needs Bereavement Counselling! • Social support is important – find one person who you can talk to without embarrassment and who is a good listener • Compassion for yourself is also important • Anniversaries, birthdays, weddings, Christmas are all occasions which can trigger strong emotions of sadness & loss

22. Healing & Letting go • How has life changed since your loss? • What never happens now as a result of the loss? • What do you miss most about your life since the loss? • What do others comment on since your loss? • What has surprised you most about your thoughts & feelings? • How has this impacted on your view of yourself, others, relationships, life or the world in general?

23. Healing & Letting go • If you feel that it is taking you a long time to recover, then consider seeking professional help • Use your memories and memorabilia of the loved one to support yourself • Create a lasting memorial to the loved one such as planting a tree, make a donation or start your own charity/fundraising • Choose a significant picture/image and have it commissioned by a professional artist