Icebreaker Exercise Learning Outcomes

Basic Counselling Skills

Listening

Hearing

Reflecting back

What do you want from the Day?

• Are there any Topics, Issues, that you would like to focus or discuss today?

Write on flip chart

Break

Preamble before Bereavement Theory

• General Principles of Counselling?

• Training in Bereavement Counselling – last bastion of old volunteer model? – Discuss

• A way to reflect on feelingsLearn about relationship with ourselves

• Generic Counselling Approach

The Intelligent Human adult..

…knows that it fruitless to dwell on painful memories and the intrusive images of traumatic events are sometimes so painful that we will go to great lengths to avoid them. We may do this by shutting ourselves up in a safe place (usually our home), and avoiding people and situations that will remind us of the trauma and deliberately filling our minds with thoughts and activities that will distract us from the horror. But it is a paradox that -

“ in order to avoid thinking about something we have to think about it”.

That is to say, at some level we remain aware of the danger that we are trying to avoid. Hence it should not be a surprise to us if our attempts at avoidance commonly fail. In sleep and a time of relaxed attention painful memories tend to float back into our minds and we find ourselves reliving the trauma yet again. Colin Murray-Parkes

CMP Quote.wma

Link to Counselling

“ in order to avoid thinking about something we have to think about it”.

Link to Counselling

Counselling is a craft, technique, or practice of thinking and being with feelings which we want to avoid

Colin Murray Parkes

• Bereavement: Studies of Grief in Adult Life

• Paperback: 288 pages

• Publisher: Penguin Books Ltd; 3New Ed edition (1998)

• ISBN-10: 0140257543

“Bereavement Expert”

• Since 1966, Parkes has worked at St. Christopher’s Hospice in Sydenham, where he set up the first hospice-based bereavement service and carried out some of the earliest systematic evaluations of hospice care.

• Parkes has also edited books on the nature of human attachments, and Bereavement

• Parkes is a former chairman and now life president of the charity Cruse Bereavement Care

A Theory of Bereavement

• For this course today: • Bereavement is a process of grieving

• Loss is the person or object

• Life is bereavement

• Minor bereavements all the time• Beginnings and endings: relationships, friendships, jobs, work projects,

holidays, moving house

• Days, weeks, years

• We cope with major / minor bereavements in the same way??

Types of Loss• Actual loss• Death from old age, illness, accidents. • Old person more acceptable loss• Younger person less acceptable loss Discuss • Perceived loss • Person’s view of loss • Culture, history, family, socialisation?

• Bereavement Counselling Time-limited • Focus solely on bereavement 

Bereavement Study

• Colin Murray Parkes Psychiatrist at Royal London Hospital

• Effect of the loss of husbands on group of widows in London’s East End

• Discuss: limitations?

• 1987 Case study of Henry who survived capsized ferry in Zubbregge, Holland

• Discuss: accidents/ terrorism /wartime/peacetime? 

The Cost Of Commitment

• Gain Investment in relationships: emotional, physical, financial.

Lives enriched but there is a ……….

• Cost Risk of losing Gain 

Process of Bereavement

• Start after loss?

• Fade away? • Remain repressed not allowed to begin? • Part of the process begins / Other parts held back.

• Bereavement is like a tide: it flows back and forth through the stages

• Individual / Personal

BEWARE!

Comment on Bereavement Stages: “the stages might lead people to expect the bereaved to proceed from one clearly identifiable reaction to another in a more orderly fashion than usually occurs. It might also result in … hasty assessments of where individuals are or ought to be in the grieving process”

P.351 Handbook of Bereavement, Cambridge 1993

Bereavement is like a tide

Bereavement Summary

“ in order to avoid thinking about something we have to think about it”. Link to Counselling

Bereavement is a process of grievingLoss is the person or object this is lost

The Cost Of Commitment

Bereavement is Individual and Personal

The stages to do not occur in order

Bereavement is like a tide

Stages of Bereavement Theory

• 1. Alarm• • 2. Searching• • 3. Mitigation – Lessening the Impact• • 4. Anger & Guilt• • 5. Disorganisation & Despair

• 6. Gaining a New Identity• • Theory is theory - feel able to agree or contradict it!• Discuss Colin Murray-Parkes

1.Alarm

• Tension, Shock, Panic, Disbelief Restlessness

• Numbness – some emotions break through• Preoccupation / obsessiveness with thoughts of the lost person.

• Self-care neglected • Breakdown of customs / behaviour • Sensitive to noise, conflict, administration• Shut down to avoid feelings

2.Searching

• Calling for the lost person

• Sobbing, tearfulness,

• Feeling of loss / lost Discuss

• Visit places of experience

• Aimless searching – irrational?

• Find lost person 

3.Mitigation–Trying to Lessen the

Impact of Bereavement

• Components of grief work• Pre-occupation / wish to find the person• Repeating, painful recollection of the loss • Patterns, Obsessive thoughts, PTSD

• Making sense of the loss to fit assumptions - meaning• Dreams - common dream - happy interaction with the dead • Pining / Avoidance of Pining

• Idealised person - forget the negative

4.Anger and Guilt

• Familiarity - loved ones, family members • Misdirection - Hospital staff / GPs

• Blame / Self Blame

• Anger guilt becomes irreconcilable - leading to family splits

• Resistance to sadness, grief under the anger and guilt

5.Disorganisation and Despair

• Period of uncertainty

• Take on the reality of what has happened• Identifying with lost person – method of avoiding the loss

of that person

• Old model of the world abandoned• New set of expectations created - with time and

acceptance• Other people become a support, security, & protection.

6.Gaining a New Identity• Taking on role/interest that lost person had

• New versions of old relationships

• New relationships

• New interests

• New updated view of the world

• Less repressed / more flexible

Attachment Theory John Bowlby

• What is Attachment? - A Secure Base?

• Attachment - emotional bond to another person.

• Earliest bonds in childhood have life long impact

• Attachment survival mechanism - keeps infant close to the mother

• A Good Attachment

• Primary care givers are available & responsive to infant's needs creating a sense of security.

• The infant knows that the caregiver is dependable

• Creates a secure base for the child to explore the world

Experiment with rhesus monkeys

• Monkeys offered two objects to attach to

• Soft mother dummy without food

• Hard mother dummy with food

• Monkeys preferred soft dummy without food

• Discuss – reaction against Freud’s Instincts Theory

• Bereavement is an extreme broken attachment / separation from a loved one

• First experience - primary care giver and child • Main Carer’s emotional state critical around baby’s birth Primary Carer & baby relationship major influence on adult life