Grief and Loss slides - Janice Firn & Matt Statman

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5/23/2011 1 Dealing with Grief & Loss Dealing with Grief & Loss Theory, Personal Awareness, Theory, Personal Awareness, Grief Reactions, & What Helps Grief Reactions, & What Helps 5/23/2011 5/23/2011 Janice Firn, L.M.S.W., Clinical Social Janice Firn, L.M.S.W., Clinical Social Worker, UofM Hospital Worker, UofM Hospital 2 Overview Overview Terminology Terminology Personal Awareness Personal Awareness Grief Theories Grief Theories Grief Reactions Grief Reactions What Helps What Helps What’s the first thing you think of when I say the word “grief”? 5/23/2011 5/23/2011 Janice Firn, L.M.S.W., Clinical Social Janice Firn, L.M.S.W., Clinical Social Worker, UofM Hospital Worker, UofM Hospital 3 “Grief” “Grief” Loss? Loss? Sadness? Sadness? Separation? Separation? Anguish? Anguish? Change? Change? Ache? Ache? Hurt? Hurt? Stages? Stages? Tasks? Tasks? Symptoms? Symptoms? Adaptive? Adaptive? Normal? Normal? Complicated? Complicated? Pathological? Pathological? 5/23/2011 5/23/2011 Janice Firn, L.M.S.W., Clinical Social Janice Firn, L.M.S.W., Clinical Social Worker, UofM Hospital Worker, UofM Hospital 4 5/23/2011 5/23/2011 Janice Firn, L.M.S.W., Clinical Social Janice Firn, L.M.S.W., Clinical Social Worker, UofM Hospital Worker, UofM Hospital 5 Why talk about Grief? Why talk about Grief? Change happens! Change happens! “Little deaths” “Little deaths” To live is to experience loss To live is to experience loss Grief is: emotional Grief is: emotional, social, spiritual, and , social, spiritual, and physical physical response response Change Change is is Inevitable InevitableGrowth Growth is is Optional. Optional.- Walt Disney Walt Disney 5/23/2011 5/23/2011 Janice Firn, L.M.S.W., Clinical Social Janice Firn, L.M.S.W., Clinical Social Worker, UofM Hospital Worker, UofM Hospital 6 “Working through our endings “Working through our endings allows us to redefine our allows us to redefine our relationships, relationships, to surrender what is dead and to to surrender what is dead and to accept what is alive, accept what is alive, and to be in the world more fully to and to be in the world more fully to face the new situation. face the new situation. - Stanley Stanley Keleman Keleman Why talk about Grief? Why talk about Grief?

Transcript of Grief and Loss slides - Janice Firn & Matt Statman

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Dealing with Grief & LossDealing with Grief & Loss

Theory, Personal Awareness, Theory, Personal Awareness,

Grief Reactions, & What HelpsGrief Reactions, & What Helps

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OverviewOverview

�� TerminologyTerminology

�� Personal AwarenessPersonal Awareness

�� Grief TheoriesGrief Theories

�� Grief ReactionsGrief Reactions

�� What HelpsWhat Helps

What’s the first thing you think

of when I say the word “grief”?

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“Grief”“Grief”

�� Loss?Loss?

�� Sadness?Sadness?

�� Separation?Separation?

�� Anguish?Anguish?

�� Change?Change?

�� Ache?Ache?

�� Hurt?Hurt?

�� Stages?Stages?

�� Tasks?Tasks?

�� Symptoms?Symptoms?

�� Adaptive?Adaptive?

�� Normal?Normal?

�� Complicated?Complicated?

�� Pathological?Pathological?

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Why talk about Grief?Why talk about Grief?

�� Change happens!Change happens!

�� “Little deaths”“Little deaths”

�� To live is to experience lossTo live is to experience loss

�� Grief is: emotionalGrief is: emotional, social, spiritual, and , social, spiritual, and

physical physical responseresponse

�� ““ChangeChange is is InevitableInevitable——GrowthGrowth is is Optional.Optional.” ”

-- Walt Disney Walt Disney

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“Working through our endings “Working through our endings

allows us to redefine our allows us to redefine our

relationships, relationships,

to surrender what is dead and to to surrender what is dead and to

accept what is alive,accept what is alive,

and to be in the world more fully to and to be in the world more fully to

face the new situation.face the new situation.

-- Stanley Stanley KelemanKeleman

Why talk about Grief?Why talk about Grief?

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Substance Use & GriefSubstance Use & Grief

�� FamilyFamily

�� Medical/healthMedical/health

�� PsychiatricPsychiatric

�� SocialSocial

�� RecreationalRecreational

�� EmotionalEmotional

�� LegalLegal

�� EconomicEconomic

�� PsychologicalPsychological

�� InterpersonalInterpersonal

�� Work/schoolWork/school

�� SpiritualSpiritual

Substance Use and Dependence contribute to problems in:Substance Use and Dependence contribute to problems in:

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Substance Use, Recovery & GriefSubstance Use, Recovery & Grief

�� Loss of relationships Loss of relationships

�� Loss of dreams, future, fairness of life, “not Loss of dreams, future, fairness of life, “not

the plan”the plan”

�� Loss of what was “normal”Loss of what was “normal”

�� Substance use as maladaptive copingSubstance use as maladaptive coping

�� Grief of “losing using”Grief of “losing using”

�� Suspended animation Suspended animation

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Why do we feel Grief?Why do we feel Grief?

�� Attachment Theory: attachments to people, Attachment Theory: attachments to people,

animals, things, rituals, etc. animals, things, rituals, etc.

�� Types of AttachmentsTypes of Attachments

�� Secure Secure

�� Avoidant Avoidant

�� Anxious Anxious

�� AmbivalentAmbivalent

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Personal Awareness of Grief & LossPersonal Awareness of Grief & Loss

�� Life Events Scale Life Events Scale

HandoutHandout

�� Perception is key Perception is key

�� Individual Response Individual Response

�� Frequency of exposureFrequency of exposure

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Myths About GriefMyths About Grief

� Myth: The pain will go away faster if you

ignore it.

� Myth: It’s important to be “be strong” in the

face of loss.

� Myth: If you don’t cry, it means you aren’t

sorry about the loss.

� Myth: Grief should last about a year.

Facts About GriefFacts About Grief

�� Fact:Fact: Trying to ignore your pain or keep it from Trying to ignore your pain or keep it from

surfacing will only make it worse in the long run. surfacing will only make it worse in the long run.

�� Fact:Fact: Feeling sad, frightened, or lonely is a normal Feeling sad, frightened, or lonely is a normal

reaction to loss. Showing your true feelings can help reaction to loss. Showing your true feelings can help

you and others deal with the grief. you and others deal with the grief.

�� Fact:Fact: Crying is a normal response to sadness, but Crying is a normal response to sadness, but

it’s not the only one. it’s not the only one.

�� Fact:Fact: There is no right or wrong time frame for There is no right or wrong time frame for

grieving. grieving.

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KublerKubler--RossRoss

The five stages of grief:The five stages of grief:

1.1. Denial: Denial: “This can’t be happening to me.”“This can’t be happening to me.”

2.2. Anger:Anger: ““WhyWhy is this happening? Who is to is this happening? Who is to blame?”blame?”

3.3. Bargaining:Bargaining: “Make this not happen, and in “Make this not happen, and in return I will ____.”return I will ____.”

4.4. Depression: Depression: “I’m too sad to do anything.”“I’m too sad to do anything.”

5.5. Acceptance:Acceptance: “I’m at peace with what “I’m at peace with what happened.”happened.”

J. William WordenJ. William Worden

�� Healing is necessary in the physiological realm Healing is necessary in the physiological realm

to bring the body back into physical health, a to bring the body back into physical health, a

period of time is likewise needed after a loss to period of time is likewise needed after a loss to

return to a similar state of emotional wellreturn to a similar state of emotional well--

being. being.

�� The four tasks of mourning are an essential art The four tasks of mourning are an essential art

of the healing process. of the healing process.

�� No specific order, but still must each be No specific order, but still must each be

worked through during the time of grieving.worked through during the time of grieving.

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The 4 Tasks of MourningThe 4 Tasks of Mourning

1.1. Accept the reality of the Accept the reality of the

lossloss

2.2. Experience and work Experience and work

through the pain of griefthrough the pain of grief

3.3. Adjust to the new Adjust to the new

“normal”; life without “normal”; life without

what was lost what was lost

4.4. Emotionally relocate the Emotionally relocate the

loss and move forward loss and move forward

in lifein life

Accept the RealityAccept the Reality

�� To come full face with the fact that your loss is real To come full face with the fact that your loss is real

and will not return, i.e. that immediate reunion or and will not return, i.e. that immediate reunion or

regaining it is impossible.regaining it is impossible.

�� Obstacles:Obstacles:

�� Denying the facts of loss.Denying the facts of loss.

�� Denying the meaning of the loss, e.g. “It wasn’t a Denying the meaning of the loss, e.g. “It wasn’t a good job anyway, or I don’t miss him,” or “I’m good job anyway, or I don’t miss him,” or “I’m just as healthy as I ever was.” just as healthy as I ever was.”

�� Minimizing the loss. “It’s not that big of a deal.”Minimizing the loss. “It’s not that big of a deal.”

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Experience & Work Experience & Work

Through the PainThrough the Pain�� It is impossible to lose something or someone you It is impossible to lose something or someone you

have been deeply attached to without experiencing have been deeply attached to without experiencing some level of pain. some level of pain.

�� Obstacles:Obstacles:

�� Not allowing yourself to feel.Not allowing yourself to feel.

�� Cutting off your feelings and denying that pain is Cutting off your feelings and denying that pain is present.present.

�� Avoiding reminders of the loss Avoiding reminders of the loss –– e.g., trying to e.g., trying to find a ‘geographic cure’ by moving to another find a ‘geographic cure’ by moving to another location, or travellinglocation, or travelling

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The New “Normal”The New “Normal”�� Coming to terms with being without (maybe raising children Coming to terms with being without (maybe raising children

alone, facing future unemployment or handicap, redefinition of alone, facing future unemployment or handicap, redefinition of self, etc.). self, etc.).

A.A. External Adjustments External Adjustments : how the loss affects your everyday : how the loss affects your everyday functioning in the worldfunctioning in the world

B.B. Internal Adjustments: Internal Adjustments: how the loss affects your sense of selfhow the loss affects your sense of self

C.C. Spiritual Adjustments: Spiritual Adjustments: how the loss affects your beliefs, how the loss affects your beliefs, values and assumptions about the worldvalues and assumptions about the world

�� Obstacles:Obstacles:

�� Promoting your own helplessness.Promoting your own helplessness.

�� Not developing the skills you need to cope or to function in Not developing the skills you need to cope or to function in new roles.new roles.

�� Withdrawing from the world. Refusing to see yourself or the Withdrawing from the world. Refusing to see yourself or the world differently.world differently.

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Moving ForwardMoving Forward

�� To find a place for what was lost that will enable us to remain To find a place for what was lost that will enable us to remain connected with them/it but in a way that will not keep us from connected with them/it but in a way that will not keep us from going on with life. going on with life.

�� Obstacles:Obstacles:

�� Withdrawal from others and life. Not living. Withdrawal from others and life. Not living. Unwillingness to love.Unwillingness to love.

�� Unwillingness to risk; making a vow to never invest Unwillingness to risk; making a vow to never invest yourself again.yourself again.

�� Holding on so tight to the past that you’re unable to form Holding on so tight to the past that you’re unable to form new relationships or develop new skills.new relationships or develop new skills.

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When is Grieving Over?When is Grieving Over?

�� When a person can think of what was lost without When a person can think of what was lost without pain.pain.

�� When the tasks of mourning have been accomplished.When the tasks of mourning have been accomplished.

�� When one can think of the deceased without physical When one can think of the deceased without physical manifestations such as crying or feeling tightness in manifestations such as crying or feeling tightness in the chest.the chest.

�� When the bereaved can reinvest his/her emotions into When the bereaved can reinvest his/her emotions into life and the living.life and the living.

�� When one can regain an interest in life, feel more When one can regain an interest in life, feel more hopeful, experience gratification again, and adapt to hopeful, experience gratification again, and adapt to new roles.new roles.

�� Is there a time limit? 1 year? 4 seasons? 2 years? It Is there a time limit? 1 year? 4 seasons? 2 years? It depends.depends.

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Grieving is Necessary! Grieving is Necessary!

“Man, when he does “Man, when he does

not grieve, not grieve,

hardly exists.”hardly exists.”

-- Antonio PorchiaAntonio Porchia

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Normal Grief ReactionsNormal Grief Reactions

�� EmotionalEmotional

�� PhysicalPhysical

�� CognitiveCognitive

�� BehavioralBehavioral

�� SpiritualSpiritual

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Grief vs. DepressionGrief vs. Depression

�� Grief is a roller coaster. Grief is a roller coaster.

�� Depression is dead end.Depression is dead end.

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Tensions for FamiliesTensions for Families

Hope Hope DespairDespair

Denial Denial AcceptanceAcceptance

MeaninglessnessMeaninglessness MeaningfulnessMeaningfulness

IndependenceIndependence Accepting InterdependenceAccepting Interdependence

Family BurdenFamily Burden Opportunity to ServeOpportunity to Serve

AmbiguityAmbiguity Certainty of OutcomeCertainty of Outcome

Making PlansMaking Plans Experiencing EmotionsExperiencing Emotions

Holding On Holding On Letting GoLetting Go

Speaking Openly Speaking Openly Not TalkingNot Talking

Family as it WasFamily as it Was Family as it is Becoming Family as it is Becoming

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When Grief Isn’t HealingWhen Grief Isn’t Healing

�� Relational FactorsRelational Factors

�� Circumstantial FactorsCircumstantial Factors

�� Historical FactorsHistorical Factors

�� Personality FactorsPersonality Factors

�� Social FactorsSocial Factors

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�� Chronic, ongoing griefChronic, ongoing grief

�� Delayed grief reactionsDelayed grief reactions

�� Avoiding grievingAvoiding grieving

When Grief Isn’t HealingWhen Grief Isn’t Healing

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GriefGrief WORKWORK

�� Grief therapy: goal is not about forgetting but Grief therapy: goal is not about forgetting but

remembering with less pain.remembering with less pain.

�� Developing adaptive coping mechanisms.Developing adaptive coping mechanisms.

�� Finding meaning. Finding meaning.

�� AA and AlAA and Al--Anon, NA and NarAnon, NA and Nar--Anon = grief workAnon = grief work

“Grief heals when it is received by “Grief heals when it is received by

a caring other.”a caring other.”

-- Wendy Wendy LustbaderLustbader

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Getting Support When Getting Support When

You Are GrievingYou Are Grieving

�� Do not grieve alone Do not grieve alone

�� Turn to friends and family members Turn to friends and family members

�� Join a support group Join a support group

�� Talk to a therapist or grief counselor Talk to a therapist or grief counselor

�� Face your feelings Face your feelings

�� Express your feelings in a tangible Express your feelings in a tangible

or creative way. or creative way.

�� Look after your physical health. Look after your physical health.

�� Plan ahead for grief “triggers”. Plan ahead for grief “triggers”.

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Helping Someone who is GrievingHelping Someone who is Grieving

�� ListenListen

�� Acknowledge the Acknowledge the

Uniqueness of GriefUniqueness of Grief

�� Offer Practical HelpOffer Practical Help

�� Make Contact, Write a Make Contact, Write a

Personal NotePersonal Note

�� Be Aware of Holidays Be Aware of Holidays

and Anniversariesand Anniversaries

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ResourcesResources�� J. William Worden, J. William Worden, Grief Counseling & Grief TherapyGrief Counseling & Grief Therapy, 2008., 2008.

�� Lynne A. Lynne A. DeSpelderDeSpelder & Albert. L. Strickland, & Albert. L. Strickland, The Last Dance: The Last Dance: Encountering Death and DyingEncountering Death and Dying, 1998., 1998.

�� Judith Judith ViorstViorst, , Necessary LossesNecessary Losses, 2002., 2002.

�� HolmesHolmes--RaheRahe Social Readjustment Rating Scale. Journal of Social Readjustment Rating Scale. Journal of Psychosomatic Research, (1967). Vol. 11, pp. 213Psychosomatic Research, (1967). Vol. 11, pp. 213--218. 218.

�� Lynn, J. and Lynn, J. and HarroldHarrold, J. (1999). Handbook for Mortals: , J. (1999). Handbook for Mortals: Guidance for People Facing Serious Illness, p.41.Guidance for People Facing Serious Illness, p.41.

�� AlAl--Anon Dist. 5, http://www.hvcn.org/info/afg5/griefloss.htmAnon Dist. 5, http://www.hvcn.org/info/afg5/griefloss.htm

�� HelpGuide.org, http://71.6.131.182/mental/grief_loss.htmHelpGuide.org, http://71.6.131.182/mental/grief_loss.htm

�� Dennis C. Daley & G. Alan Dennis C. Daley & G. Alan MarlattMarlatt, , Overcoming your Overcoming your Alcohol or Drug ProblemAlcohol or Drug Problem, 2006., 2006.

�� WolfetWolfet, A. (2009). The Handbook for Companioning the , A. (2009). The Handbook for Companioning the Mourner. Companion Press: Colorado. Mourner. Companion Press: Colorado.

�� Abbot, A., Abbot, A., Alcohol, Tobacco, and Other DrugsAlcohol, Tobacco, and Other Drugs. . NASW, 2010. NASW, 2010.

Grief and Loss in Grief and Loss in Addiction and RecoveryAddiction and Recovery

Matt Statman, LLMSW, CADC Matt Statman, LLMSW, CADC

Dawn FarmDawn Farm

Education Education

SeriesSeries

May May

20112011

"To spare oneself from grief at all "To spare oneself from grief at all

cost can be achieved only at the cost can be achieved only at the

price of total detachment, which price of total detachment, which

excludes the ability to experience excludes the ability to experience

happiness." happiness." -- Dr.Dr. Erich FrommErich Fromm

Grief experiences in the culture of addiction …

The Disease of Addiction Causes…The Disease of Addiction Causes…

oo Unresolved grief, loss & trauma Unresolved grief, loss & trauma

oo Losses in the culture of addiction Losses in the culture of addiction

oo Use of AOD is primary coping skillUse of AOD is primary coping skill

oo Little support for healthy grieving Little support for healthy grieving

oo Grief is not processedGrief is not processed

oo Losses are not Losses are not fullyfully grieved grieved

oo Feelings are medicatedFeelings are medicated

oo Feelings unfreeze, feel Feelings unfreeze, feel overwhelmingoverwhelming

oo Unable to feel unable, to identify Unable to feel unable, to identify feelings feelings

oo May present as a whole range May present as a whole range feelings that are seemingly feelings that are seemingly unrelatedunrelated

oo CComplicated by omplicated by guilt/shame/stigmaguilt/shame/stigma

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Abstinence alone does not equal Abstinence alone does not equal recovery or health recovery or health ––

there is work to do !there is work to do !

People may not know how to verbalize People may not know how to verbalize what they are feeling, may lack coping what they are feeling, may lack coping skills and may tend to seek immediate skills and may tend to seek immediate relief through other compulsive behaviors relief through other compulsive behaviors such as cutting, food, sex, relationships, such as cutting, food, sex, relationships, etc. etc.

Inability to grieve losses Inability to grieve losses and move through grief and move through grief can be a barrier to can be a barrier to recovery/getting well.recovery/getting well.

Losses occur not only in the culture Losses occur not only in the culture of addiction of addiction –– losses are also losses are also

incurred in moving from addiction to incurred in moving from addiction to recovery…recovery…

Loss of the “drug of choice” … Loss of the “drug of choice” …

oo Relationship with substance is Relationship with substance is

primary primary

ooConstant reminders of this loss in Constant reminders of this loss in

early recoveryearly recovery

oo Important loss that can easily be Important loss that can easily be

minimizedminimized

Grieving for the loss of the Grieving for the loss of the

substance needs to be substance needs to be

acknowledged and worked acknowledged and worked

through through

--

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Loss of important Loss of important

relationships …relationships …

oo Lost relationships with family/friendsLost relationships with family/friends

oo May have lost the experience of May have lost the experience of having “true” friends having “true” friends

oo Loss of important relationships that Loss of important relationships that present threats to sobriety present threats to sobriety –– Using Using relativesrelatives

oo Grief over loss of companionship and Grief over loss of companionship and shared experiences shared experiences

oo Loss of socialization opportunitiesLoss of socialization opportunities

Recovery will offer Recovery will offer opportunities for developing opportunities for developing new relationships, and often to new relationships, and often to heal old relationshipsheal old relationships

. .

Loss of self…Loss of self…

oo Identity may have been formed around Identity may have been formed around

AODAOD

oo Addiction requires people to live outside Addiction requires people to live outside

their values for survival. This contributes to their values for survival. This contributes to

loss of identity as well as immense guilt and loss of identity as well as immense guilt and

shame (Ideal self/actual self).shame (Ideal self/actual self).

oo Loss of hopes, plans, aspirations and Loss of hopes, plans, aspirations and

dreams can be even more painful than dreams can be even more painful than

practical losses.practical losses.

oo Loss of innocence, dignity, selfLoss of innocence, dignity, self--esteem, esteem,

choice, control of one’s body. choice, control of one’s body.

These things are not lost forever! These things are not lost forever!

Recovery offers opportunities Recovery offers opportunities

to find meaning and purpose, to find meaning and purpose,

rediscover and redefine rediscover and redefine

oneself, and find true oneself, and find true

belonging in a supportive belonging in a supportive

community community

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Loss of time and Loss of time and

opportunities …opportunities … ooMissed parenting time/ family Missed parenting time/ family

milestones/ deathsmilestones/ deaths

oo Recovering person may feel Recovering person may feel

time spent high is “lost”time spent high is “lost”

oo Time spent incarcerated Time spent incarcerated

Recovery offers the Recovery offers the opportunity to make meaning opportunity to make meaning of past experiences and to use of past experiences and to use them to help othersthem to help others

Spiritual Losses …Spiritual Losses …

oo Loss of meaning and purpose Loss of meaning and purpose

oo Loss of connection to a Higher Loss of connection to a Higher PowerPower

oo The person who once believed The person who once believed in a God may have lost that in a God may have lost that belief, and lost faith belief, and lost faith

oo Loss of hopeLoss of hope

Recovery offers the opportunity to Recovery offers the opportunity to

connect / reconnect with one’s connect / reconnect with one’s

spiritual self and to grow spiritually spiritual self and to grow spiritually

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Loss of rituals, beliefs and practices Loss of rituals, beliefs and practices

from the culture of addiction…from the culture of addiction… oo Loss over ritualsLoss over rituals

oo Loss of coping mechanisms and Loss of coping mechanisms and

survival techniques survival techniques

oo Loss of illusions (e.g. illusion of Loss of illusions (e.g. illusion of

“control” over substance.)“control” over substance.)

oo Ignorance is bliss!Ignorance is bliss!

In recovery, when one door In recovery, when one door closes another opens closes another opens ––

in time, lost rituals etc. will in time, lost rituals etc. will be be replaced by rituals and replaced by rituals and practices practices of recovery.of recovery.

Tangible losses …Tangible losses …

oo Loss of MoneyLoss of Money

oo Loss of shelter/housingLoss of shelter/housing

oo Loss of material items/wealth Loss of material items/wealth

oo Loss of job/career, educational Loss of job/career, educational opportunities opportunities

oo Loss of healthLoss of health

oo EtcEtc

oo EtcEtc

oo EtcEtc

Recovery will provide opportunities Recovery will provide opportunities to move forward, regain security to move forward, regain security and improve healthand improve health

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Perinatal losses …Perinatal losses …

Grief work in recovery is tough, Grief work in recovery is tough,

necessary and ultimately rewardingnecessary and ultimately rewarding

Grief and loss Grief and loss

experienced experienced by by

family and friendsfamily and friends

““The reaction to loss that is widely experienced The reaction to loss that is widely experienced by friends and family members of persons who by friends and family members of persons who are addicted to mind altering substances is are addicted to mind altering substances is profound grief. It has characteristics of flawed profound grief. It has characteristics of flawed interactional patterns because the loss is interactional patterns because the loss is ambiguous. If a person dies, the grief is ambiguous. If a person dies, the grief is unambiguous: the social role the deceased unambiguous: the social role the deceased played is no longer occupied and the deceased played is no longer occupied and the deceased cannot fulfill obligations or promises. The cannot fulfill obligations or promises. The spouse who becomes addicted to mind altering spouse who becomes addicted to mind altering substances often ceases to fulfill obligations or substances often ceases to fulfill obligations or promises, but physically the social role is still promises, but physically the social role is still occupied.”occupied.”

--Vicki LoyerVicki Loyer--Carlson, Ph.D., LMFTCarlson, Ph.D., LMFT

Family members/friends may Family members/friends may experience loss of relationships, experience loss of relationships, financial security, homes, jobs, health, financial security, homes, jobs, health, hopes, dreams, selfhopes, dreams, self--esteem, dignity, esteem, dignity, emotional support, “presence” and emotional support, “presence” and other important tangible and intangible other important tangible and intangible things.things.

oo There may be complete loss of contact There may be complete loss of contact with a loved one with a loved one -- by (often difficult) by (often difficult) choice of the family member, or choice choice of the family member, or choice of the person with addictions, or due to of the person with addictions, or due to circumstances (e.g. prison, death.)circumstances (e.g. prison, death.)

oo Sometimes addiction ends tragically, Sometimes addiction ends tragically, in death from the disease or related in death from the disease or related conditions. conditions.

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Grief may be complicated by Grief may be complicated by

painful experiences and painful experiences and

memories; complex feelings memories; complex feelings

and emotions; and stigma, and emotions; and stigma,

secrecy , shame and secrecy , shame and

misunderstanding associated misunderstanding associated

with addiction.with addiction.

When the person with addiction When the person with addiction

enters recovery enters recovery -- family/friends may family/friends may

feel they want their loved one to feel they want their loved one to

recover more than they want recover more than they want

ANYTHING else ANYTHING else –– but …. but ….

oo Family/friend may experience loss of Family/friend may experience loss of

the role they had assumed while their the role they had assumed while their

loved one was using substances, loved one was using substances,

and/or loss of their sense of purpose and/or loss of their sense of purpose

in “taking care of” people/things. in “taking care of” people/things.

oo Recovery may not bring everything Recovery may not bring everything

the family member/friend thought it the family member/friend thought it

would would –– and there may be a sense of and there may be a sense of

loss from thisloss from this

oo ExpectationsExpectations

Grief feels lonely for family and friends Grief feels lonely for family and friends

and and circumstances may be especially circumstances may be especially

challenging challenging -- but help, support and but help, support and

understanding is available, aunderstanding is available, and healing nd healing

is possibleis possible

Grief recovery is hard work Grief recovery is hard work

for family and friends too for family and friends too ––

but it is worth the effort! but it is worth the effort!

RECOVERY…RECOVERY…“Grief is a natural part of life; but for an “Grief is a natural part of life; but for an addict it provides an extra set of addict it provides an extra set of challenges to get through… If you're an challenges to get through… If you're an addict on the road to recovery, be addict on the road to recovery, be prepared to experience emotions in a prepared to experience emotions in a new way new way –– the good and bad; and be the good and bad; and be sure to have a plan in place to fight off sure to have a plan in place to fight off the cravings while you're in that the cravings while you're in that vulnerable state.” vulnerable state.” ––Michael BlochMichael Bloch

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“The best therapy for grief is “The best therapy for grief is

time and community.”time and community.” --Michael Michael

S. LoganS. Logan

Recovery is a Process Recovery is a Process not an Eventnot an Event

Grief recovery is not a linear Grief recovery is not a linear

process process -- it is experienced in it is experienced in

cycles. Grief may be compared cycles. Grief may be compared

to climbing a spiral staircase, to climbing a spiral staircase,

where it may look and feel likewhere it may look and feel like

you’re going in circles, yet you’re going in circles, yet

you’re makingyou’re making progressprogress

oo Environment is key Environment is key

oo A person must feel safe and supported. A person must feel safe and supported.

oo It is important not to “open up” issues It is important not to “open up” issues

until/unless adequate support is available.until/unless adequate support is available.

oo Residential treatment provides a safe, Residential treatment provides a safe,

supportive environment supportive environment

oo A person in treatment may need additional A person in treatment may need additional

support e.g. from a grief group or grief support e.g. from a grief group or grief

counseling counseling

oo Recovering people can receive very helpful Recovering people can receive very helpful

support from the recovery community support from the recovery community ––

meetings, sponsors, supports meetings, sponsors, supports ––sometimes sometimes

professional help is also neededprofessional help is also needed

“Tasks” of grief recovery “Tasks” of grief recovery

when in recovery from when in recovery from

addiction …addiction …

In recovery people In recovery people acknowledge, understand, acknowledge, understand, and accept losses and move and accept losses and move

through griefthrough grief

oo Develop skills to cope with Develop skills to cope with what they are feelingwhat they are feelingoo Learn to identify what they Learn to identify what they are feelingare feelingoo Learn to verbalize what Learn to verbalize what they are feelingthey are feeling

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oo For family/friends For family/friends -- recognize and recognize and grieve losses; “reorganize” such that grieve losses; “reorganize” such that the addicted loved one is no longer the addicted loved one is no longer central to the person’s well being. central to the person’s well being. (This does NOT mean “forgetting” the (This does NOT mean “forgetting” the person, but involves remembering person, but involves remembering with less pain.)with less pain.)

oo Identify, then "wrap up" or bring a Identify, then "wrap up" or bring a satisfactory degree of closure to satisfactory degree of closure to "unfinished business." "unfinished business."

“Promises” of grief recovery …“Promises” of grief recovery …

oo Healthy grieving enables the Healthy grieving enables the recovering person to confront and recovering person to confront and accept the reality of the loss, and accept the reality of the loss, and find purpose and meaning for lifefind purpose and meaning for life

oo Losses are eventually remembered Losses are eventually remembered with less pain. with less pain.

Things will get better

Social support Social support Help from community …Help from community … oo A safe placed to be open about feelings A safe placed to be open about feelings

and experiences, without shameand experiences, without shame

oo Step work helps people express grief, Step work helps people express grief,

gain perspective and acceptance, gain perspective and acceptance,

forgive and move on with their livesforgive and move on with their lives

oo Provides opportunities to give back to Provides opportunities to give back to

others and make meaningothers and make meaning

oo Peer grief support groups can be Peer grief support groups can be

helpfulhelpful

Support from Support from family/friends/others …family/friends/others …

oo People who want to help may feel uncomfortable People who want to help may feel uncomfortable ––it’s OK/ important to just be thereit’s OK/ important to just be there

oo People may want to help but not know how People may want to help but not know how -- let let family/friends/coworkers/others know what you family/friends/coworkers/others know what you need need

oo Often family/friend support dissipates over time Often family/friend support dissipates over time --it’s important to continue to ask for support when it’s important to continue to ask for support when needed needed

oo Helpers should avoid platitudes (its all right, Helpers should avoid platitudes (its all right, everything is going to be fine, everything happens everything is going to be fine, everything happens for a reason etc…) It’s ok to say “this sucks!” “I am for a reason etc…) It’s ok to say “this sucks!” “I am so sorry”so sorry”

oo If family/friends are unavailable or unsupportive If family/friends are unavailable or unsupportive (including well(including well--intentioned but misguided efforts intentioned but misguided efforts to be supportive) to be supportive) ––seek support elsewhere seek support elsewhere

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Spiritual supportSpiritual supportooParticipation in faith community Participation in faith community

activities/ritualsactivities/rituals

ooFaithFaith--based support groups or prayer based support groups or prayer

groups groups

ooPrayer, mindfulness, meditation Prayer, mindfulness, meditation

ooOne’s chosen spiritual practices and One’s chosen spiritual practices and

ritualsrituals

Rituals … Rituals … Grief rituals and ceremonies acknowledge the Grief rituals and ceremonies acknowledge the pain of loss while offering social support and a pain of loss while offering social support and a reaffirmation of life …reaffirmation of life …

Tributes …Tributes …oo Creating a tribute, legacy Creating a tribute, legacy

or memorial to honor and or memorial to honor and

remember a loved one remember a loved one

can provide comfortcan provide comfort

oo People often find comfort People often find comfort

in donating to a related in donating to a related

cause and/or becoming cause and/or becoming

involved in volunteer or involved in volunteer or

service work, or other service work, or other

ways of helping othersways of helping others

Anniversaries, holidays, and Anniversaries, holidays, and

“special” dates “special” dates –– grief can grief can

resurface and be very strongresurface and be very strong This is normal and OKThis is normal and OK

Grief recovery, like addiction Grief recovery, like addiction recovery, is ongoingrecovery, is ongoing

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oo Grief can recur with anniversaries of ANY kind Grief can recur with anniversaries of ANY kind

of loss, not just a deathof loss, not just a death

oo Grief can also resurface when events remind Grief can also resurface when events remind

the person of their loss (e.g. national the person of their loss (e.g. national

tragedies, others having a similar experience.) tragedies, others having a similar experience.)

oo Holidays often accentuate feelings of grief and Holidays often accentuate feelings of grief and

loss loss

oo Have a plan for dealing with grief Have a plan for dealing with grief

anniversaries and for getting through holidays anniversaries and for getting through holidays

oo If in recovery If in recovery -- identify sources of support, a identify sources of support, a

plan of action to avoid relapseplan of action to avoid relapse

Experiential techniques … Experiential techniques … -- experiential therapies engage areas of experiential therapies engage areas of the brain involved in grief, memory, the brain involved in grief, memory, healing, recoveryhealing, recovery

oo Music/art expression Music/art expression -- “right brain” techniques“right brain” techniques

oo Journaling, poetry writing, scrapbooking, other Journaling, poetry writing, scrapbooking, other

creative written expression creative written expression

oo Goodbye letters: these may be kept private or Goodbye letters: these may be kept private or

sharedshared

oo Somatic approaches to grief resolution Somatic approaches to grief resolution ––

breathing techniques, massage, body workbreathing techniques, massage, body work

oo Experiential practices may help with grief work: Experiential practices may help with grief work:

drumming, voice techniques, guided meditation drumming, voice techniques, guided meditation

, work with crystals or gemstones, , work with crystals or gemstones,

“singing”/vibrating bowls, shamanic“singing”/vibrating bowls, shamanic journey, journey,

other “complementary/ alternative” techniques other “complementary/ alternative” techniques

Self care …Self care …

oo Participation in mutual aid groups Participation in mutual aid groups

oo Literature, books and selfLiterature, books and self--help workbookshelp workbooks

oo Internet resources , including onInternet resources , including on--line peer line peer support groupssupport groups

oo NutritionNutrition

oo Exercise, balanced with adequate rest and Exercise, balanced with adequate rest and sleepsleep

oo Find physical and emotional outlets that help Find physical and emotional outlets that help reduce the tensions in mind and bodyreduce the tensions in mind and body

oo Find activities to engage in that help with Find activities to engage in that help with healing and regaining a feeling of purpose healing and regaining a feeling of purpose and meaning in one’s own lives and from the and meaning in one’s own lives and from the life of the loved onelife of the loved one

Professional help …Professional help …

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Sometimes professional help is needed, Sometimes professional help is needed,

especially when grief is complicated, especially when grief is complicated,

prolonged or seems stuck.prolonged or seems stuck.

Sources of professional help include:Sources of professional help include:

oo Grief counselingGrief counseling

oo ProfessionallyProfessionally--facilitated grief facilitated grief

support/recovery support/family support/recovery support/family

groups, referrals to hospice and groups, referrals to hospice and

bereavement groups for supportbereavement groups for support

THE ENDTHE END