Death, Dying and Bereavement: Helping Individuals and Families Navigate the Challenges of Loss

1. Death, Dying and Bereavement: Helping Individuals and Families Navigate the Challenges of Loss H. Norman Wright

3. Shaelyn

5. Norm and Tess

8. Case Study The parents as well as three siblings of a twenty-three-year-old woman came in for grief counseling. All were neat, well dressed and fairly quiet. The parents were first to speak about their daughter. They began with a description which characterized her as a quality young woman, their first born in the family. She was gifted in every area of her life and had a bright future ahead of her.

9. Case Study The parents went into great detail about her abilities and accomplishments, stopping every now and then because of their inability to talk. Often all five were in tears. Two weeks prior she and her seven-month old unborn child and her mother-in-law were driving on a freeway when a truck struck and killed all of them. Since that time every member of this family has been struggling.

10. Case Study Questions 1. How would you begin this session? Describe your exact words. 2. What would be your goal in this initial session? 3. What would you say or ask to engage the three siblings?

11. Case Study 4.What would you want them to take away from this session in a tangible way? 5. Based on this information identify all the possible grievers. 6. What are the factors which contribute to this loss being a complicated grieving process?

12. Case Study 1. After greeting each person I would validate the fact they have experienced a great loss in their life. If I didn’t know already I would ask the name of the daughter as well as the mother-in-law and whenever I made reference to either I would use their name rather than refer to them in a general way. One of the first questions I ask is, “Tell me about (the daughter) and have each of the family respond.

13. Case Study Too often children are left out of the interaction. After each has responded my next question is, “Would you describe for me what the last two weeks has been like” so each has a chance to tell their story. Within this I often ask how they heard the news and to describe their reaction.

14. Case Study 2. My goal is to have them tell their story and then normalize for them what they are experiencing and educate them about grief and what to expect in the future (using the handout on the “Crazy Feelings of Grief”). I’d also want to find out about their support system as well as giving some suggestions to eliminate the pressure of other individuals.

15. Case Study I also mention that each of them may grieve in a different way and with a different intensity. That’s all right and it’s not a sign that the other person doesn’t care if their grief is less intense. I ask, “How can the other family members support you at this time?”

16. Case Study 3. Some of the questions directed toward the parents could be asked of the siblings. I also let everyone know that I would be willing to meet with each one individually. One reason for this is the deceased was described as a “special gifted” individual but was she in the eyes of the siblings? Sometimes even in the initial session I ask for a favorite memory from siblings.

17. Case Study Some may have a mixture of feelings. At some point I would ask the parents and siblings alike if there was any unfinished business or issues between them and the deceased or if there was something they wished they could have said to her before she died. If so, I would suggest writing a detailed letter and reading it aloud at the place of internment.

18. Case Study 4. I would like each one to believe there will be help for all of them during the months and years ahead of them. Any suggestions or recommendations made need to be put in writing such as the list of “Crazy Feelings of Grief,” etc. I would give each one a copy of Experiencing Grief as well, and suggest they read it when they’re ready.

19. Case Study I also let them know that it is normal not to remember what they read at this time. I send home a DVD called Tear Soup and ask them to watch this together.

20. Case Study 5. There are two other family members who were lost as well. It would be easy to ignore them and gloss over this loss. I would ask about them as well as the effect this loss is having. For the parents, the loss is a grandchild which is major.

21. Case Study The possible grievers would include aunts, uncles, cousins, friends, fellow workers, pastors, church, ob gyn, husband’s family, grandparents, truck driver, and similar group of individuals. It’s important to consider who will minister to them and how.

22. Case Study One of our tasks is to identify neglected grievers and reach out to them as well. Sending or giving them Experiencing Grief as well as making available copies of Tear Soup has been helpful.

23. Case Study 6. Not only was this a sudden death but it was multiple tragedy involving someone’s child and unborn grandchild. There could be the possibility of legal complications because it was a vehicular accident. The way in which the notification was made could be a factor as well. (Refer to the section on sudden death for additional information).

24. Georgianna G: Sometimes I, even now I feel myself smiling when I’m talking about it and it’s just like a cover up. I can feel it in my gut. N: So you’re smiling on the outside but on the inside there’s still tremendous pain. G: There is… N: I’m wondering, I guess I’m wondering have you really said goodbye to Harold and Tommy.

25. Georgianna G: No… (crying, dabbing eyes). No (quietly). N: This really is a very sensitive area. G: I just feel really bad for them because their life was so rough and then they didn’t get a chance to straighten it out. (sniffle) I’m sorry. N: It’s all right (quietly). In addition as to what you just said about them the other factor is you blame yourself. I should have been able to get them straightened out.  G: For some reason I really feel like, “I should, the shoulds, I should have been there.”

26. Georgianna N: Georgianna, who has put that responsibility on you. Do you have other people who have said that or is it your owned heightened sense of responsibility? G: I think it’s probably it’s just my own sense of responsibility. When I was young and my parents divorced almost instantly I started taking care of myself. And my father was out of the picture and I think it’s something I acquired along the way. I could understand things more than my sisters could. I was more forgiving. I just adopted the feeling that I was stronger and I could take care of them.

27. Georgianna N: And could it be that part of the reality that no matter what you did and what you suggested Harold and Tommy still might have continued to go their own way? G: I think so…yeah. I don’t think it really didn’t matter what I said. It was just the fact to be there. I felt obligated. N: The tension that we’ve got here is on one hand, “I really couldn’t have helped,” but the feeling is overwhelming of “I should have.” G: Yeah.

28. Georgianna N: And the struggle is how do we let loose of that having it’s hold on you. G: That’s what I need to know. N: What do you think might work? What’s your sense? G: I’m not sure. Maybe just take it to the Lord and saying goodbye like you said. I haven’t really done that. And not holding on – I have a tendency to hold on to things. And that’s probably the biggest deal right there. I just need to let go and move on.

29. Georgianna N: If you were to let go, what would that say? G: It would say I would probably start thinking that I probably never cared at all. (laughter) N: Classic. G: Why is that?

30. Georgiana N: That’s the fear. That’s the fear that many people have. If I say goodbye, if I let go and if I move on in my life could it mean that I didn’t love them as much as I thought I loved them. Does it mean that I didn’t care as much? And it’s the struggle that so many go through, but they are able to come to the place where they say no, that has nothing to do with my care for them, my love for them. It just means that my emotional memory is moving more towards a historical memory and they will not be forgotten, my love will always be there. But I have freedom now.

31. Georgianna N: I’m wondering if at some point in time it would be good to be able to say goodbye to that sense of responsibility. G: I would love that. I would absolutely love to not think that I have to be responsible for everybody. N: That’s a hard burden to carry feeling, “I’m responsible for my entire family.” G: Yeah, yeah you’re right. Especially, when I’m the youngest.

32. Georgianna N: I’m wondering if at some point in time it would be good to be able to say goodbye to that sense of responsibility. G: I would love that. I would absolutely love to not think that I have to be responsible for everybody. N: That’s a hard burden to carry feeling, “I’m responsible for my entire family.” G: Yeah, yeah you’re right. Especially, when I’m the youngest.

33. Georgianna N: It’s kind of a burden. G: Yeah. I think so. N: Well the goodbye aspect, I want to bring that back to Harold and Tommy. Because after you’ve written and processed this story I’m wondering what you would think about writing a goodbye letter to each one. G: I could do that.

34. Georgianna N: Now were they cremated or buried? G: No they are buried out in Arvin, under a tree next to each other. I went out there a couple of times, but it wasn’t to say goodbye. It was to talk to them to get some strength in an area that I was in, in my life. And that’s it. It’s been over 20 something years and I’ve only been out there twice. N: How do you feel about going back?

35. Georgianna G: I think now after talking with you I may go back. I may go back with my letters and spend a little bit of time and let some stuff go so I can move on and live my life. N: So you’re thinking of reading the letters there? G: I’m thinking maybe yeah. Yeah, I think that may be healing.

36. Georgianna N: Something other people do and I don’t know if you’d be comfortable with this, but sometimes they will write the letter and then they’ll put it in plastic cover and after they’ve read it they symbolically leave it there. They have it laminated and just leave it as a means of saying goodbye. G: At the grave? N: At the gravesite.

37. Georgianna G: I was thinking that as you said that. N: I know a few minutes ago I heard you say you have a concern about family members knowing about some of this, but it’s pretty doubtful. G: Doubtful. My dad’s not able and my sisters don’t go out there. I think it will work. N: Something to keep in mind is that for some folks doing it once is sufficient but for others they may have to repeat it again and again. But at least you’re facing the issue and doing something about it. But in a sense, you’ve allowed it to have a hold on you all these years.

38. Georgianna G: I can feel it, I can feel it right now, I’m tense in my body just talking about it and it has. N: Since you’ve mentioned it and brought that up. There’s a tension in you right now. G: I can feel it right now. N: On a scale of 0 to 10, 0 being no tension just totally relaxed and a 10 being really wired, where would you be. G: I am probably about a 9, I feel like I have a box of rocks on my back.

39. Georgianna N: That’s quite an apt description. G: I can feel it all on my shoulders just talking about it. N: I’d like to do something right now that you can do on your own. I’d like you to breathe in and do it for about 2 ½ seconds and then I will have you breathe out. So let’s do it now Inhale, exhale, inhale, exhale, inhale, exhale, inhale, exhale, and inhale, exhale. G: Breathing slowly.

40. Georgianna N: Now on the same scale of 0-10 where might you be at this point? G: I’m probably at about a 5, my chest is loosening up my shoulders are relaxing. N: So in just about 20 to 30 seconds you’re able to breathe more. G: It’s not as heavy. N: Okay. G: Just getting that breath, that life in there.

41. Georgianna N: Is this what usually occurs when you start thinking about your brothers? There’s that heaviness and tension. N: And maybe you could rate it on your own on the scale of 0 to 10 and see where it is. G: I’ really relaxed right now, it’s really coming down. N: That’s one thing to discover is I don’t have to stay this tense – there are things I can do to lower this. G: I feel really relaxed right now and I wasn’t. It’s better. Wow.

42. Georgianna N: Being that tense what sort of message does that say to you. What does that say to you? G: I felt closed up. I felt maybe frightened and didn’t realize it. I was closed up. It was almost Withdrawn didn’t want to face it. Like I was shutting down, didn’t want to face it. N: Could that be what you have been doing for the past 20 years. G: I would imagine so in a lot of areas in my life. N: So your response to the deaths of Tommy and Harold, have constricted you in some way.

43. Georgianna N: It sounds like you are walking on egg shells in a way. G: My whole life, my whole life. N: How has that felt? G: Not good. Not good at all. I fel like I have to put a reason out there for the things I do or the things I don’t do. I don’t get it. I just feel it. My sister from Cincinnati that wall is broken a little bit with her. I don’t know if it ever will be with my other family members. I just don’t know.

44. Georgianna N: A few minutes ago you talked about that box of rocks on your back and how tense you were feeling. And I just wondering if that doesn’t happen when you interact with your family. G: It does. It very much does. It will happen when there’s a family gathering. They don’t happen very often. Instead of sitting and just talking with everybody I just sit off to the side. N: I guess I’m hearing a fear. G: Yeah, it is a fear. N: What is the fear?

45. Georgianna G: I just can’t be who I am. I am a more forgiving person. I just want to live my life, I just have things I want to do in my life and it may not be a big money thing, and my family why am I doing all my schooling, why am I doing what I’m doing and they N: And you’re afraid to just show and tell them, “Here I am.” G: Yeah. Yeah. N: And if you were to do that your fear is they wouldn’t like you, wouldn’t accept you, wouldn’t understand?

46. Georgianna G: It’s probably acceptance. They don’t get me, I don’t get them. N: In your heart and mind have you ever given them permission to. G: Explain that to me. What do you mean? N: There are certain people in our lives that we just want to like us, accept us and understand, but they never will. But we just keep trying and caring and trying. It’s like going up against a brick wall. It never works.

47. Georgianna G: Yes. I just came across that quote yesterday, If you’re doing something and it’s not working and it’s repetitive you have to go a different direction. You have to go a different direction. N: If in your heart and mind you said I wish they would just accept me and understand me, but chances are pretty good that maybe they won’t. but if they don’t I release them, I relinquish the. I am accepted in God’s sight, I am loved by God I can move on from there. G: I think that would be great. I think it might bring me closer to them.

48. Georgianna N: I might be wrong. I’m just sort of sensing that you’ve not let them see who you really are and what you want to do. G: No because everybody has always had what they wanted me to be what they wanted me to do. N: So you’ve tried to perform for them. G: You’re right. I’ve tried to keep up the persona of what they wanted me to do, but it did not do me any good. It led me down a lot of wrong roads.

49. Georgianna N: So you’ve tried that and you know the results of that. So you really don’t have much to lose by going this other way. G: No, no. And family is really important to me. So it’s really much more important to let it go and be. N: You might discover a new freedom. G: A freedom. It sounds wonderful because I feel like I’ve been bound for so long. N: Do you have any thoughts on how you might do this? G: No. other than just … Whatever comes up. Just be there.

50. Georgianna G: Yeah, I believe so. When mom passed a couple of years ago it started bringing the family a little closer, in her passing and that’s part of it everybody kind of for a moment laid down everything they were displeased with. Everyone started bonding. it hasn’t come easy, but I see it happening. But you’re saying I was holding on to stuff. Mom’s death, if you can die with dignity I see that in my mother, even though I’m sad to see her go I never saw so much dignity from a woman in my life to handle the cancer she had. On her deathbed I saw so much amazing stuff and I released we all took from that woman go be with her Savior. N: It’s like she taught you how to die.