Module 6 grief and loss part a 30.4.13

CHCCS426B Provide support and care

relating to loss and grief

Module 6:

Learning about Grief and Loss

Part A

2

What is grief?

• Grief is the experience we

have after a loss.

• There are many different

types of losses. Death is

only one form of loss.

• Grief is the adjustment to a

loss is experienced as a

process.

© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13

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Overview

• Grief experiences

• Models of grief

• Strategies to support normal

grief

• Complicated grief


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The Grief Experience

• Many people have tried to

describe and understand

what happens to people

when they lose someone or

something of great value to

them in their life.

• Grief is an experience that

we all know in varying

degrees and will know over

a lifetime.


5

What are some of the things we can lose in life?

• Family through separation

and divorce

• Friends

• Girlfriends and boyfriends

• Locations

• Precious possessions

• Hopes

• Health

• People through death


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What is impacted by grief?


• Body sensations?

• Emotions

• Thoughts

• Behaviour

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Activity

• As a group – divide into 4.

Each group should list as

many things that they can

under each of the following

headings that might be

experienced following a

loss.

• Body Sensations.

• Emotions.

• Thoughts.

• Behaviours.

• As an individual. Divide an

A4 sheet into 4 with the

headings.

• Body Sensations.

• Emotions.

• Thoughts.

• Behaviours.

• Try and list as many as you

can of each category that

might be experienced by

someone following a loss.


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What are some of the body sensations that may

accompany loss?

Difficulty going to sleep, or

waking in the middle of the night

Weight loss or gain; over- or

under-eating

Low energy or fatigue

Headaches, chest pain, or

racing heart

Upset stomach or digestive

problems

Agitation


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What are some of the emotions that may

accompany loss?


• Sadness

• Shock

• Anger

• Insecurity/fear/anxiety

• Relief

• Depression

• Loneliness

• Numbness

• Yearning

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Overall Mental State/Cognition

• Confusion

• Interrupted thought

processes

• Lack of concentration


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What are some of the thoughts that may

accompany loss?

• It’s my fault.

• It’s not fair.

• I can’t go on.

• I have been abandoned.

• Life sucks.

• There is no God.

• This always happens to me.


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Behaviours

• Recklessness

• Snappiness/’kicking the cat’

• Withdrawal/social isolation

• Crying

• Sighing

• Overspending

• Gambling

• Sexual promiscuity

• Talking incessantly about

the event/or not at all

• Putting on a brave face


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Grief reactions are individual and depend upon…


• Personality factors

• Previous family history – in

reacting to loss

• Previous losses, multiple

losses

• Shock

• Other complicating factors

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Guilt

• When people lose a partner or child or someone close through death, they may feel guilt about having days when they feel good or happy.

• They are fearful that to be happy means that the person they have lost didn’t count much, or they don’t care anymore.


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Sometimes a guilt trip is put on by others

• Children can be especially

vulnerable to this.

• Kids move in and out of sad

feelings and cannot ‘stay’ in

depression for long periods

of time.

• They may be happy and

playing and then at other

times the reality of their loss

hits them. Be aware of the

particular support needed

for children. Adults might

misjudge this behaviour and

then the children might feel

shame or guilt over their

very normal reactions.


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Trying to get out of the ‘pit of despair’

• Sometimes people are

desperate to feel normal

again and try to hasten its

arrival by feigning normality.

• “I’m alright, yes, managing

fine. Thank you”.

• However, at night time,

when the pretence is gone,

the pain of the loss catches

up.


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Trying to ‘be strong for others’

• Many of us feel responsible

for young children or other

people we consider to be

more vulnerable than

ourselves.

• We can sometimes put on a

brave face in order to ‘be

strong for others’, but deep

inside we may be

crumbling.


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Strategies to support others in grief

1. Education – the framework

2. Letting go, saying

goodbye… in ceremony

3. Keeping connected in a

new way (and using

questioning techniques)

4. Micro-losses as a way to

build a future

5. Support search

6. Introduce new supports

7. Check for complications


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1. Education – the framework

• Providing a framework for

someone who is grieving is

helpful.

• In the middle of intense pain

and misery to understand

that the process has been

lived through by others and

what to expect can give an

individual bearings.


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Models of grief: ideas about the stages or ways

people go through a loss

• Kubler Ross – Stages theory (1969)

• William Worden – Task theory (1982)

• Margaret Stroebe and Henk Schut (1999) – Dual process

model

• Seasons

• Butterfly

• Broken leg


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A feminine framework

• Elisabeth Kubler-Ross observed

grief in her patients and in their

families.

• She saw grief as a journey which had

stages. She felt that the griever was

pulled by an invisible thread through

the darkness of loss towards the light.

• She put forward her theory of grief in

1969 in her book ‘On death and dying’.

• This ‘trusting’ framework will be very

helpful for some individuals.


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Stages theory

• The stages she observed were:

o Stage 1: Shock and denial

o Stage 2: Anger/bargaining

o Stage 3: Depression and detachment

o Stage 4: Dialogue

o Stage 5: Acceptance

Elisabeth Kubler-Ross - On Death and Dying 1969

This model has been widely adopted by grief counsellors, psychologists and social workers. Visit the link below to hear a Psychologist briefly explain the grief stages. http://www.youtube.com/watch?v=fG6gJRPuW8w


http://www.youtube.com/watch?v=fG6gJRPuW8w

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A fluid movement

• Her theory was not rigid, however.

• It was understood that in moving forward at times people will move backwards and forwards between stages. For example a person may move between the stages of anger and depression but eventually will move on to acceptance.

• http://www.youtube.com/watch?v=Dbofp_bgdzI


http://www.youtube.com/watch?v=Dbofp_bgdzI

http://www.youtube.com/watch?v=Dbofp_bgdzI

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A male framework

• In the 1980’s Dr William Worden

formulated the ‘task model’ as

an approach to grieving. He felt

it was something that people

had to ‘do’.

• This ‘power’ model which

emphasises the need for action

will assist some individuals as

they feel more relaxed when

they know the experience as

something that they can control.


Dr William Worden

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The Task Theory

• To accept the reality of the loss

• To experience the pain of grief

• To adjust to an environment in which the significant person is no longer present

• To reinvest emotional energy

• J.W. Worden, Grief Counselling and Grief Therapy 1982, pp 11-16


• In Worden’s model, grief is considered to consist of four overlapping tasks, requiring the bereaved person to work through the emotional pain of their loss while at the same time adjusting to changes in their circumstances, roles, status and identity.

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Worden’s Tasks of Grief

• Accept the reality of the loss. Worden believes that losses are difficult

and denial is strong. He believes we need to help people let go of their grip on

denial so they can deal with the loss they have encountered.

• Experience the pain of grief. People are encouraged to feel the pain

rather than avoid it.

• Adjustment to an environment with the deceased missing. Often

the thought of taking on responsibilities that a mate or partner has done for

years seems insurmountable. But as a person finds new ways to cope and

learn new skills, they manage the changing roles.

• Withdraw emotional energy and reinvest it in other relationships. People learn to rebuild ways of satisfying social, emotional and practical needs

by developing new activities and relationships. This is not dishonouring the

memory of the deceased; it simply recognises that there are other things to be

loved and that you are capable of loving.


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Dual Process Model

• Margaret Stroebe and

Henk Schut (1999)

• This recent model of grief

and loss maintains that both

grieving and avoiding grief

are necessary for

successful resolution and

pragmatic coping with a

loss.


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Dual Process

• Active confrontation with

loss may not be necessary

for a positive outcome.

There may be times when

denial and avoidance of

reminders are essential.

• Most individuals can expect

to experience ongoing

oscillation between a loss

orientation and a restoration

orientation.

Loss

• Coping with loss through grief work

• Dealing with denial

• Avoiding changes

Restoration

• Adjusting to changes triggered by loss

• Changing routines

• Taking time off from grief


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Dual Process Model

• This oscillation reflects

movement between coping

with loss and moving

forward – but the extent to

which one needs either of

these dimensions differs for

each individual. • Read more:

Loss Grief and Bereavement - Coping

With Loss - Theory, Family, History,

Development, Family, Emphasis,

Individual, Model, Grieving, and Illness

http://family.jrank.org/pages/750/Grief-

Loss-Bereavement-Coping-with-

Loss.html#ixzz1Iq7pcS00


Loss

• Coping with loss through grief work

• Dealing with denial

• Avoiding changes

Restoration

• Adjusting to changes triggered by loss

• Changing routines

• Taking time off from grief

http://family.jrank.org/pages/750/Grief-Loss-Bereavement-Coping-with-Loss.html























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Visual Models

• Visual models or frameworks are particularly helpful for

children and adolescents but most of us, adults included, find

it easier to remember pictures or analogies.

• In some ways the following visual frameworks relate well to

the 3 Models of Grief.

Theory Visual Analogy

Stages theory Caterpillar to butterfly

Tasks theory Seasons of the year

Dual processing theory Broken leg analogy


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Visual symbols are helpful for everyone

• Children need concrete tools to understand concepts that are

new to them and which they can’t directly experience in the

present.

• The caterpillar/butterfly is also a great analogy for children –

but adults get it too! This can be likened to STAGES theory.


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Seasons of the year

• Autumn – losing leaves…

losing someone

• Winter – cold and dark…

feeling sad

• Spring – new little buds

coming… feeling hope,

knowing change is

happening

• Summer – lovely colours,

sun shining… feeling happy

again

• This analogy relates well to

Worden’s Tasks of Grief.


33 © Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13

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The Broken Leg analogy

• A broken leg once set can heal

beautifully.

• However if it is broken and not

set in the right fashion, it can

get infected or heal in a

warped manner and a limp

may result and at worst death

can happen.

• Similarly, grief needs padding

and support, cleaning of the

wound and time to heal without

too much pressure – just like a

broken leg!


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Dangers of a broken leg

• Some of the other dangers

of a broken leg is that we

don’t get up and keep active

and walking. It is necessary

despite the pain to keep

living and functioning. We

need blood circulation and

muscle use to aid the

healing process. In this way

the broken leg analogy

relates well to the dual

process model of grief

processing.


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Children and grief

• For some children, their loss or bereavement can be an

experience of profound abandonment. Fears may arise that

they might be similarly abandoned again. Not all children

understand that the pain they feel will subside.

• In addition, they may try to protect the feelings of others by

avoiding displays of emotion in front of them and, as a result,

their feelings can go underground and resurface at a later

period in their life.

• (Taken from the Australian Centre for Grief and Bereavement)


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Children express grief differently

• Children may not have the

ability to name or express

their feelings because they

are not visible or concrete.

• Because children haven’t

developed buffers to pain as

adults often have, the

feelings they experience

may be overwhelming for

them.

• Children often express their

grief through their behaviour

such as separation anxiety,

crying, withdrawal,

bedwetting, disinterest in

food, or disruptive

behaviour at school.


38

Age appropriate response

• Children’s age and

development influence their

understanding of death

• Very young children are

often unable to understand

the permanence of death or

separation and can

anticipate the return of the

person who has gone. As

they grow older, they will

learn to grasp the finality

and permanency of death.


39

Developmental Grief Responses

Ages 2-4

Concept of Death

• Death seen as reversible

Grief response

• Intensive response but

brief

• Very present-oriented

• Most aware of changes

in patterns of care

• Asking questions

repeatedly


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Ages 4-7

Concept of Death

• Death still seen as reversible

• Feeling of responsibility because

of wishes and thoughts

Grief Response

• More verbalisation

• Great concern with process e.g.

How? Why?

• May act as though nothing has

happened

• General distress and confusion


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Ages 7-11

Concept of Death

• Still wanting to see death as reversible

but beginning to see it as final

• Death seen as punishment

Grief Response

• Specific questions

• Desire for complete detail

• What is the right way to respond?

• Starting to have ability to mourn and

understand mourning

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Ages 11-18

Concept of Death

• Ability to abstract

• Beginning to conceptualise death

Grief Response

• Extreme sadness

• Denial

• Regression

• More often willing to talk to people

outside of family and peer support

• Risk-taking


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Seasons for Growth

• Seasons for Growth is a 4-week Grief and Loss program

initially developed for children and young people – now

also for adults. It aims to build resilience for those who

are dealing with significant loss or change.

• In small groups, participants work through activities and

discussions which teach that grief is like the seasons –

cyclical in nature, and a natural part of life.

• Access the link below to visit the Good Grief website and view

the short clip about ‘Seasons for Growth’

• http://www.goodgrief.org.au/children-and-young-people


http://www.goodgrief.org.au/children-and-young-people







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2. Letting go, saying goodbye… in ceremony

• Since the beginning of time

humans have used

ceremonies and symbolism

to help make sense of and

work through major life

events.

• The funeral ceremony is a

way that we say goodbye

and have a marker for our

memories. But ceremonies

can be encouraged to be

personal things for various

losses.


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Saying Goodbye

• Building a garden bed or gazebo

• Going for a walk on the beach and throwing a bottle out with a message

• Letting doves or balloons free

• Writing a poem or letter

• Even divorcees are having goodbye parties like a ‘wake’

• Encourage people to ‘say goodbye’ as many times as they need in their own unique ways

• Saying goodbye to a body part and thanking it for the work it has done and promising never to forget it… can be amazingly freeing


46

Cultural differences in bereavement practices

• It is important to understand

that across different cultures,

beliefs about death and the

kind of practices and rituals

associated with grief and

mourning will be significantly

varied.

• Some of these differences

may seem rather strange to

us, but we must remember to

respect and support our

clients in their cultural beliefs

and wishes in regard to grief

and loss.


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3. Keeping connected in a new way

(and using questioning techniques)

• Losing someone or something precious doesn’t mean we have to cut them off…

• Encourage people to find ways of staying connected…

• When you think about ‘George’ where do you like to imagine he is right now?

• When do you feel closest to George… what are you doing when the pain eases?

• Encouraging clients to put together a memory album can be helpful.


48

4. Micro-losses as a way to build a future

• Finding out all the things someone has lost when they lost a loved one or something special to them is validating and can give clues to the helper.

• “When you lost Katie what else did you lose, Joe?”

• “I lost my best friend, my confidant, my house cleaner, my cook, my budgeter, my social planner, my lover, my cuddler…”


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See what can be done about some

of the micro-losses…

• “Well Joe, we can never replace Katie. She was so wonderful.

But I am wondering about that cuddling… I have a friend who has a new puppy that needs a home. I think he will love cuddles….Or…

• I have heard that full-length body pillows can really help someone feel comforted at night when they feel alone in the bed and miss their partner. Would you like me to find out where you can get one of these?”


50

5. Support search

• Who or what is out there to

help you?

• Who has offered support?

• What do you know about

supports in the community

right now?

• By questioning, you are

reminding a person of their

need for support and

checking their own

resources and knowledge.


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6. Introduce new supports

• As a worker wanting to support someone through grief… get to know all the community supports available so that you can suggest alternatives if the individual isn’t aware of supports.

• Grief and loss libraries, group programs, grief counsellors, grief buddies, associations, web sites etc.


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Seasons for Growth

• As mentioned previously, this four-week program helps people who have had a loss in their life. It provides skills to cope and share with others who have been in a similar situation.

• Many teenagers, children and adults have been helped with the Seasons for Growth program.

• If you feel you or someone you know would benefit, go to the Good Grief Website and find out more - www.goodgrief.org.au


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Other things people can do for support

• Attend support groups such as ‘Compassionate Friends’

• Access a Grief Counsellor or Psychologist

• Try to eat well and avoid using AOD as a coping tool

• Physical exercise

• Get enough rest

• Consult with a GP

• Find supportive friends/people/family members

• Try to avoid workplace pressure and stressful

circumstances while in early stages of grief


54

7. Check for complications

• Sometimes people

experience really

unpleasant things that

accompany their loss, which

can infect the wound of grief

and make it really hard to

heal.

• Always check for these

complicating factors that

may delay or elongate the

grieving process.


Getting stuck in the grief process

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6 Factors impacting grief

• Let us now have a look at 6 reasons for extended grief and

what to do about it

1. Denial of grief

2. Abuse of grief

3. No Goodbyes

4. Confusion about reasons

5. Blame/shame

6. Trauma


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Complications to the grief process

Discuss the following

• Denial of grief – deliberate or unintentional avoidance of grief

• Abuse of grief – when a person is prevented from expressing

distress and sorrow in relation to a loss

• No goodbyes – sudden death, suicide, parted on bad terms

before loss

• Confusion about reasons – missing persons, unsolved crime,

cant make sense of it

• Blame/Shame – excessive guilt

• Trauma – prevents processing of grief and emotions


57

Antidotes for complications

1. Denial of grief Get permission

2. Abuse of grief Don’t listen, find kinder voices.

3. No goodbyes Never too late…

4. Confusion about reasons Answers and meaning will come… just

rest

5. Blame/shame Be aware – get help to stop

6. Trauma Get treatment


58

Helpful ideas for relieving the pain of grief (see PP Part B for more ideas on helping grieving people)

1. Mind map the various areas of life and add one activity to

extend life again.

2. Write to the one you have lost (to finish the conversations).

3. Stretching and rocking to get the body moving to start with,

extend into more vigorous activity later on.

4. Laughter, meditation, relaxation exercises.

5. Examine all 5 senses, get in touch with nature, the ocean,

rain-forest walks.

6. Try to enjoy people, finding their differences interesting

rather than annoying. Be an interested spectator at the very

least.

7. Use a body pillow for comfort at night and hold forehead and

cross feet for grounding.


59

Sensible emotional first aid

• Good education

• Good friends

• Good food

• Good rest

• Good work

• Good exercise

• Good fun

• Good touch

• Good drink

• Good faith

• These are the first ports of

call for any emotional

distress, including any

losses including the death

of someone close to us.


60

Thoughts to ponder

Quote….

It's only when we truly know

and understand that we

have a limited time on earth

-- and that we have no way

of knowing when our time is

up, we will then begin to live

each day to the fullest, as if

it was the only one we had.

Dr. Elisabeth Kubler-Ross


61

References

Sources: The Australian

Centre for grief and

bereavement

http://www.grief.org.au

Excerpts taken from ‘On death

and dying’ Elizabeth Kubler-

Ross (1969) and from ‘Grief

Counselling and Grief Therapy’

William Worden (1982)


http://www.grief.org.au/

Module 6 grief and loss part a 30.4.13

Documents

Transcript of Module 6 grief and loss part a 30.4.13