Grief

Grief

Update: 2020-02-051
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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

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