Presented by:

Crystal Hartman MA, LPC

Coral Carosone-Link BS, CBIS

What is Grief

How People Grieve

How Grief Effects You

Ways to Cope

Finding New Meaning and Sense of Purpose

Loss: the real or perceived deprivation of something deemed meaningful

Grief: an emotion, generated by an experience of loss and characterized by sorrow and/or distress

Mourning: socially prescribed practices or outward expressions of grief and can apply to both death and non-death related circumstances

Loss Adaptation: aka Coping, refers to the process of adjusting to loss and grief

Grief is a natural response to loss

We grieve many things:

Loss of a job

Physical disability

Loss of relationships

Change in social status

Death of a loved one

Primary loss is a significant loss event, such as a death or life long disability

Secondary loss is losses that are a consequence of a primary loss which vary by the individual and context in which the loss happened

Examples: financial security, sexual intimacy, family role, self-esteem and social status

Ambiguous Loss occurs when a person is physically present but is perceived as psychologically absent (emotionally or cognitively changed).

Ambiguous loss is the most stressful

Affects both family and person with brain injury

Stigmatized Loss

Landau & Hissett, 2008

Longing for what was lost

Sadness for the loss

Crying for what was lost

Wishing for the time before the loss

Upset by reminders of the loss

Angry or anxious at the loss

A need to talk about the loss

Kubler-Ross (1969):

Most well know model

Developed from working with terminally ill patients

Viewed grief as an internal process where all grievers go through a set of predictable stages ending in a final stage of resolution

Not appropriate for grieving after a brain injury as model is made for terminal illness as opposed to lifelong disability

.

Denial

Anger

Bargaining

Depression

Acceptance

Dual Process Model (Stroebe & Schut, 1999): Views grieving as highly individual process

Coping involves fluctuating between confronting and avoiding stressors. For example, the griever will express sadness to friends and

family (confront) but actively distract themselves from this while at work (avoid).

Confront

Avoid

While a person copes by confronting and avoiding, they also work on restorative coping which means moving forward

For example, the griever will confront and avoid dealing with loss of cognitive abilities while identifying new career to meet current abilities

Viewed as normal and natural process of loss adaptation (coping)

Stroebe & Schut, 1999

INSTRUMENTAL GRIEVING STYLE

INTUITIVE GRIEVING STYLE

Experience grief in terms of thoughts and behaviors

Thinking dominates over emotions, emotional expression is private

Focuses energy on analyzing loss, problem solving and doing activities

Can be viewed by others as cold, insensitive, and in denial of loss

Experience grief through intense emotion, expression of feelings and affective language

Shows outward emotional expressions including crying, depressed mood and anger

May seek assistance from support groups and counseling

Can have difficultly managing emotions and resuming daily tasks

Martin &Doka, 2002

Blended Grieving

Style

Instrumental Grieving

Style

Intuitive Grieving

Style

Changes to our Self-Concept and Feelings

Self-concept: how we perceive ourselves based on our beliefs, feelings and values

After an injury a person evaluates their self-concept

Compares themselves to self before the injury

Doubts self-efficacy: our own beliefs about our abilities

Disruption of beliefs, assumptions, values, and expectations

Frustration increases with cognitive problems and loss of skills

Injury/Loss

Evaluate abilities,

compare to past

Disruption in beliefs,

assumptions and values

Decreased perception of worth, value,

confidence

Grieve loss, try to make sense

and new meaning

Others include family, friends, partners, co-workers, employers, neighbors, etc.

Range of Emotions

Relief and gratitude to sadness, fear and anger

Others Re-Grieve

While survivor grieves

During anniversary dates

Reminders

Family

Friends

Work Community

Leisure

Faith

Adaptive Strategies are methods people use to address distress and reduce symptoms to manage grief.

Affective Strategies

Cognitive Strategies

Behavioral Strategies

Spiritual Strategies

Martin & Doka, 2002

Affective Strategies Emotional expression:

crying, ventilation

Sharing and connecting with others

Affective regulation

Martin & Doka, 2002

Cognitive

Strategies

Information seeking

Thought restructuring analysis, reframing,

redefining

Avoidance or Denial

Martin & Doka, 2002

Behavioral Strategies

Physical Activity

Problem Solving

Goal Setting

Seeking out info and support from others

Acting out behaviors

Martin & Doka, 2002

Spiritual Strategies Prayer and

Meditation

Surrender to a higher power

Meaning reconstruction

Revising, reaffirming, discarding beliefs and assumptions

Martin & Doka, 2002

Step 1. Change how we define ourselves

How do we do this?

We grieve loss of abilities

May feel lower self-esteem, worth and value to others/society

Use negative self-statements to reflect feelings

“I am damaged”

“ Im not good at anything anymore”

This leads to self-defeating thinking

1. Compare ourselves to our pre-injury self

2. Compare ourselves to others

3. Have unrealistic expectations

4. Think of the worst that can happen

Niemeier & Carol, 2011

To reduce negative self-talk be aware of using language such as:

“should”, “ought to”, “supposed to”

Reframing our thinking to a positive manner can improve how we feel

Negative Thought: “I am supposed to work. I am a failure if I am not working.”

Positive Thought: “I’d like to work but there are other things that are also important in my life. I can be productive an useful in other ways. My self-worth is not only defined by working.”

Niemeier & Carol, 2011

Not an end point

Does not require forgetting

It’s ok to hate the injury

Acceptance involves managing two conflicting ideas: “I don’t like this”, and “I can have a good life anyways”

Niemeier & Carol, 2011

Stop viewing yourself as a Brain Injured

Person

Integrating Past and Present Self = Identity

Not an either/or, instead a mix of both

Determine skills you have retained

Make a list of priorities

Integrating yourself can have positive

qualities

Independence/self-sufficiency is a myth

New roles can re-define yourself and create purpose

Evaluate your strengths, challenges and interests

Modify your roles

Set new goals, create new purpose

Questions?

Opportunity to Share…

Humphrey, K. (2009). Counseling Strategies for

Landau, J., & Hissett, J. (2008). Mild traumatic brain injury: impact on identity and ambiguous loss in the family. Family Systems & Health, 26(1), 69-85.

Loss and Grief. American Counseling Association.

Niemeier, J. & Karol, R. (2011). Overcoming Grief and Loss after Brain Injury. New York: Oxford.

Karol, R. (2011). Appreciating Grief and Loss After Brain Injury [PowerPoint slides].