465 - Grief

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Grief Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Objectives • Define grief • Conceptualize grief in terms of any loss • Identify how failure to deal with grief can impact a person • Explore the stages of grief

What is Grief • Grief is a label assigned to all of the emotions associated with dealing with any kind of loss • Physical (Things, abilities, freedoms) • Self-concept (Roles, values, labels) • Worldview (Innocence, safety) • Dreams (How things should be) • Social (Loss of relationships…) Stages of Grief • Denial: Numbness, dream, alternate explanations) • Anger: The unknown, loss of control, death, isolation, failure—(shouldas and couldas) • Bargaining: If I … then I will wake up and realize this was only a really bad dream • Depression: Helpless, hopeless • Acceptance: Radical acceptance that the loss occurred and determining how to proceed from there BioPsychoSocial Impact of Grief • Biological • Sleep disturbances • Changes in weight • Increased blood pressure • Increased cortisol and other endocrine changes • Muscle weakness • Social • Withdrawal/Isolation • Enmeshment

• Psychological • Depression • Anxiety • Relief • Changes in worldview • Guilt • Anger • Difficulty concentrating • Difficulty making decisions • Avoidance of triggers

Exacerbating & Mitigating factors • How people react in a crisis depends • How close the situation was to them (physical and emotional proximity) • How many other stressors them experienced in the last year • Mental health issues/Effective coping skills • Social supports • Understanding of the loss • How much control/responsibility they feel like they had in the situation • Type of loss and predictability • Age of the bereaved

Impact of Unresolved Grief • Most people get stuck in either anger (including guilt)or depression • Anger (shoulda, couldas and if onlys) • At self • At others • At higher power • Depression (Hopelessness, Helplessness—I don’t now how to go on) Denial • Denial is the mind’s way of protecting people from what lies ahead. • Denial can start before the actual loss as in the case of terminal illness (anticipatory grief) • Therapist Activities • Assess level of acceptance and denial of each person in the support system • Discuss hope and acceptance • Action strategies • Shore up resources • Gather accurate information • Facing the loss: Narrative therapy

Anger • Anger is the power play • Push people away to avoid getting hurt again • Blame others as an outlet for helplessness---somebody somewhere could have prevented this • Blame self to try to regain some control/prevent it from happening again, make themselves suffer • Question belief system and world schema • Guilt is a form of anger

Anger • Action steps • Identifying primary and secondary losses • Explore what the losses mean to the person (Ex. Job, Parent, Victimization) and how they feel about it • Angry (other losses) • Scared (which fears and why?) • Depressed (I feel helpless to… ; I feel hopeless to…) • Ventilation and Validation

Anger • Action steps • Examine the stated beliefs for • All or nothing thinking • Emotional reasoning • Fallacy of fairness • Emotional Reasoning (I feel angry therefore someone must be to blame) • Begin exploring solutions to fears and issues (What is within their control)

Bargaining • If I do x, y and z, maybe I can wake up and it will have been a nightmare • Contributes to depression because the person wakes up everyday hoping the reality is different • Hope is squelched every morning • Develop hope for the new reality • I can grief and experience this loss AND still have a RML Bargaining • Action Steps • Help clients stay in the present reality • Examine how bargaining just creates more exhaustion and frustration • Validate the wants and educate about the realities including personal responsibility Depression • Hopelessness and helplessness • Reality that the loss occurred AND it cannot be changed • Action Steps • Develop hope and empowerment • Begin exploring all aspects of the person’s life to which they are committed. • Explore how they can use their energy to continue to nurture the important things in their life (loss of a child; victimization; cancer) • Encourage knowledge acquisition • Identify what cannot be changed • Identify what can be changed

Acceptance • Accepting the reality of the loss • Action steps • Explore how life will be different (and the same) since the loss • Make a plan to change the things you can • If that loss can be prevented from recurring, take proactive steps • Advocacy groups • Personal behaviors Not a Linear Process • Most people experience grief surrounding a loss for at least a year (up to 3 years for uncomplicated grief). • Holidays • Anniversaries • Reminders (people, places, things, media, smells) • Many people will vacillate between depression and anger. • Normalize people’s experiences • Encourage them to reach out to supports • Address happiness and survivor guilt

Additional Tips • When someone is grieving they are in a state of crisis • Minimize vulnerabilities • Make lists • Minimize demands (unless staying busy helps) • Keep a normal sleep routine • Set a defined amount of time to revisit the loss each day • Be compassionate to yourself

Summary • Losses encompass more than death or a person or loss of property • Failure to acknowledge losses can cause unhelpful reactions in similar future situations • It is important to explore feelings and reactions in terms of their functionality---how are they benefitting the person • It takes at least a year to deal with significant losses • Many times there are multiple ancillary losses that need to be addressed Summary • How people deal with grief and loss varies widely. • Grieving is a form of crisis • The body is on high alert which likely impacts sleep, eating and energy to work or socialize • Minimizing vulnerabilities is important to reduce unnecessary frustration and avoid confirming helplessness • Ultimately it is hoped that the person can identify how they are stronger or better off from the experience