Dealing with Grief & Loss Personal Awareness, Theories, Grief Reactions, & How we can Help

Overview Terminology Personal Awareness of Loss & Grief Grief Theories Grief Reactions What Helps 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Terminology

Personal Awareness of Loss & Grief

Grief Theories

Grief Reactions

What Helps

06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital “ Working through our endings allows us to redefine our relationships, to surrender what is dead and to accept what is alive, and to be in the world more fully to face the new situation. - Stanley Keleman

Addiction & Grief Substance abuse as maladaptive coping mechanism Grief of “losing using” Suspended animation creates complicated grief reaction Loss of relationships, of future plans, fairness of life, “not the plan” 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Substance abuse as maladaptive coping mechanism

Grief of “losing using”

Suspended animation creates complicated grief reaction

Loss of relationships, of future plans, fairness of life, “not the plan”

Attachment Theory A framework for understanding emotional reactions, love, loneliness, and grief in infants and adults. A tie that one person forms between him/herself and another specific person or thing. Attachments to people, animals, things, rituals, etc. Secure Avoidant Anxious Ambivalent 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

A framework for understanding emotional reactions, love, loneliness, and grief in infants and adults.

A tie that one person forms between him/herself and another specific person or thing.

Attachments to people, animals, things, rituals, etc.

Secure

Avoidant

Anxious

Ambivalent

Grief Terminology Human growth and development across the lifespan “ Little deaths Grief Anticipatory grief Mourning 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Human growth and development across the lifespan

“ Little deaths

Grief

Anticipatory grief

Mourning

Personal Awareness of Grief & Loss Life Events Scale Handout Perception is key Different response in different individuals Frequency of exposure can affect a person’s perception, response, ability to cope & adjust 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Life Events Scale Handout

Perception is key

Different response in different individuals

Frequency of exposure can affect a person’s perception, response, ability to cope & adjust

Grieving is Necessary! “ Man, when he does not grieve, hardly exists.” - Antonio Porchia 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

“ Man, when he does not grieve,

hardly exists.”

- Antonio Porchia

Worden Worden: Tasks of Mourning Accept the reality of the loss Experience and work through the pain of grief Adjust to a world where the deceased is missing Emotionally relocate the deceased and move forward in life 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Worden: Tasks of Mourning

Accept the reality of the loss

Experience and work through the pain of grief

Adjust to a world where the deceased is missing

Emotionally relocate the deceased and move forward in life

Normal Grief Reactions Emotions Physical Sensations Cognitions Behaviors Spiritual Emptiness Depression 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Emotions

Physical Sensations

Cognitions

Behaviors

Spiritual Emptiness

Depression

Tensions for Families Hope Despair Denial Acceptance Meaninglessness Meaningfulness Independence Accepting Dependency Family Burden Opportunity to Serve Ambiguity Certainty of Outcome Making Plans Experiencing Emotions Holding On Letting Go Speaking Openly Not Talking Family as it Was Family as it is Becoming 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Hope Despair

Denial Acceptance

Meaninglessness Meaningfulness

Independence Accepting Dependency

Family Burden Opportunity to Serve

Ambiguity Certainty of Outcome

Making Plans Experiencing Emotions

Holding On Letting Go

Speaking Openly Not Talking

Family as it Was Family as it is Becoming

Normal vs. Complicated Grief Uncomplicated, “normal” grief leads to some kind of re-integration into life Complicated grief leads to stagnation, dis-integration from life, mal-adaptive behaviors 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Uncomplicated, “normal” grief leads to some kind of re-integration into life

Complicated grief leads to stagnation, dis-integration from life, mal-adaptive behaviors

Why People Fail to Grieve Relational Factors Circumstantial Factors Historical Factors Personality Factors Social Factors 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Relational Factors

Circumstantial Factors

Historical Factors

Personality Factors

Social Factors

Complicated Grief Reactions Chronic grief reactions, Ex: Cathy Delayed grief reactions, Ex: Ally Exaggerated grief reactions. Ex: Tom Masked grief reactions, Ex: Paul 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Chronic grief reactions, Ex: Cathy

Delayed grief reactions, Ex: Ally

Exaggerated grief reactions. Ex: Tom

Masked grief reactions, Ex: Paul

“ Fixing It”: Grief WORK Grief therapy vs. grief counseling Goal: not about forgetting but remembering with less pain. Developing adaptive coping mechanisms Evaluation Recovery = grief work 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Grief therapy vs. grief counseling

Goal: not about forgetting but remembering with less pain.

Developing adaptive coping mechanisms

Evaluation

Recovery = grief work

Helping Someone who is Grieving Listen Avoid Cliches Understand the Uniqueness of Grief Offer Practical Help 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Listen

Avoid Cliches

Understand the Uniqueness of Grief

Offer Practical Help

Helping Someone who is Grieving Make Contact Write a Personal Note Be Aware of Holidays and Anniversaries Understand the Importance of the Loss 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Make Contact

Write a Personal Note

Be Aware of Holidays and Anniversaries

Understand the Importance of the Loss

Discussion & Questions 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Resources Grief Counseling & Grief Therapy , J. William Worden, 2008. The Last Dance: Encountering Death and Dying , Lynne A. DeSpelder & Albert. L. Strickland, 1998. Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511-524. Necessary Losses , Judith Viorst, 2002. Holmes-Rahe Social Readjustment Rating Scale. Journal of Psychosomatic Research, (1967). Vol. 11, pp. 213-218. Lynn, J. and Harrold, J. (1999). Handbook for Mortals: Guidance for People Facing Serious Illness, p.41. http://www.hvcn.org/info/afg5/griefloss.htm 06/17/09 Janice Firn, L.M.S.W., Clinical Social Worker, University of Michigan Hospital

Grief Counseling & Grief Therapy , J. William Worden, 2008.

The Last Dance: Encountering Death and Dying , Lynne A. DeSpelder & Albert. L. Strickland, 1998.

Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511-524.

Necessary Losses , Judith Viorst, 2002.

Holmes-Rahe Social Readjustment Rating Scale. Journal of Psychosomatic Research, (1967). Vol. 11, pp. 213-218.

Lynn, J. and Harrold, J. (1999). Handbook for Mortals: Guidance for People Facing Serious Illness, p.41.

http://www.hvcn.org/info/afg5/griefloss.htm

Veronica Smith, LMSW, CAAC, Therapist Dawn Farm 6/16/2009

Veronica Smith, LMSW, CAAC, Therapist

Dawn Farm

6/16/2009

“ An illness of this sort – and we have come to believe it an illness – involves those about us in a way no other human sickness can.” The BIG BOOK of Alcoholics Anonymous (page 17) Emphasis added

The addict’s grief is not simply about using drugs/alcohol to cope with the loss of someone to physical death For the addict, grief can result when losing a way of life, a view of self, or a drug Codependency: For the family, grief can result when losing roles and familiarity with “status quo” Veronica Smith, LMSW, CAAC, Therapist Dawn Farm

The addict’s grief is not simply about using drugs/alcohol to cope with the loss of someone to physical death

For the addict, grief can result when losing a way of life, a view of self, or a drug

Codependency: For the family, grief can result when losing roles and familiarity with “status quo”

Veronica Smith, LMSW, CAAC, Therapist

Dawn Farm

Loss of the substance/behavior itself – addict will lose drug & “easy” way of escape Rituals – addict will lose patterns, places, and secret activities “ Using” Relationships – addict will lose relationships with those in addictive lifestyle Freedom – addict will lose ability to avoid responsibility & accountability Veronica Smith, LMSW, CAAC, Therapist Dawn Farm

Loss of the substance/behavior itself – addict will lose drug & “easy” way of escape

Rituals – addict will lose patterns, places, and secret activities

“ Using” Relationships – addict will lose relationships with those in addictive lifestyle

Freedom – addict will lose ability to avoid responsibility & accountability

Veronica Smith, LMSW, CAAC, Therapist

Dawn Farm

Relationship Roles – loss of caretaking role Predictability – loss of emotional and situational predictability “ Scape Goat” – loss of ability to blame addict for personal and family problems Time – loss of normal schedule; more time spent in recovery-related activities Veronica Smith, LMSW, CAAC, Therapist Dawn Farm

Relationship Roles – loss of caretaking role

Predictability – loss of emotional and situational predictability

“ Scape Goat” – loss of ability to blame addict for personal and family problems

Time – loss of normal schedule; more time spent in recovery-related activities

Veronica Smith, LMSW, CAAC, Therapist

Dawn Farm

(Based on Kubler-Ross Stages of Grief) Denial – addict doesn’t want to accept responsibility for behavior; family makes excuses and/or minimizes addicts behavior Anger – addict blames others and/or creates conflict to avoid focus on self; family blames professional/intervention Bargaining – lack of “surrendering” and attempt to maintain control without real change; family may except “empty” promises and accept responsibility for addict behavior Depression – beginning of “true” surrender for addict; family begins to understand depth of addiction & loss for addict Acceptance – addict engages in recovery and family joins

(Based on Kubler-Ross Stages of Grief)

Denial – addict doesn’t want to accept responsibility for behavior; family makes excuses and/or minimizes addicts behavior

Anger – addict blames others and/or creates conflict to avoid focus on self; family blames professional/intervention

Bargaining – lack of “surrendering” and attempt to maintain control without real change; family may except “empty” promises and accept responsibility for addict behavior

Depression – beginning of “true” surrender for addict; family begins to understand depth of addiction & loss for addict

Acceptance – addict engages in recovery and family joins

Denial : How did you deny it? (lying, minimizing the effects, rationalizing) Anger : Who were you angry at? How did you show it? Bargaining : What bargains, compromises did you make and with whom? Did you blame yourself thinking if you had been different it would not have happened? Depression : How did/does it feel? How did you act, describe behavior(s). (isolate, yell or take it out on others, cry, punish yourself in some way?) Moving to acceptance : What are or did you do to move away from the pain and into accepting life as it is now? Do you have fear about more loss and so decide to withdraw from everyone as not to take another chance at being hurt? This is not acceptance, acceptance means acknowledging life is full of losses and changes, with a willingness to accept that people may let you down.

Denial : How did you deny it? (lying, minimizing the effects, rationalizing)

Anger : Who were you angry at? How did you show it?

Bargaining : What bargains, compromises did you make and with whom? Did you blame yourself thinking if you had been different it would not have happened?

Depression : How did/does it feel? How did you act, describe behavior(s). (isolate, yell or take it out on others, cry, punish yourself in some way?)

Moving to acceptance : What are or did you do to move away from the pain and into accepting life as it is now? Do you have fear about more loss and so decide to withdraw from everyone as not to take another chance at being hurt? This is not acceptance, acceptance means acknowledging life is full of losses and changes, with a willingness to accept that people may let you down.

Avoid Common Misperceptions About Treatment/Recovery No guarantee of immediate change. Recovery is a lengthy process. May not feel better . This is painful and difficult work. Stress may not decrease . Stress can often increase.

Avoid Common Misperceptions About Treatment/Recovery

No guarantee of immediate change. Recovery is a lengthy process.

May not feel better . This is painful and difficult work.

Stress may not decrease . Stress can often increase.

Key Components: admitting that one cannot control one's addiction or compulsion; recognizing a greater power that can give strength; examining past errors with the help of a sponsor (experienced member); making amends for these errors; learning to live a new life with a new code of behavior; helping others that suffer from the same addictions or compulsions.

Key Components:

admitting that one cannot control one's addiction or compulsion;

recognizing a greater power that can give strength;

examining past errors with the help of a sponsor (experienced member);

making amends for these errors;

learning to live a new life with a new code of behavior;

helping others that suffer from the same addictions or compulsions.

“ This too shall pass” “ Trust the process” “ One day at a time” Veronica Smith, LMSW, CAAC, Therapist Dawn Farm

“ This too shall pass”

“ Trust the process”

“ One day at a time”

Veronica Smith, LMSW, CAAC, Therapist

Dawn Farm

Articles: “ Overcoming Stages of Grief and Loss” ( http://www.hopelinks.net/addiction-treatment/grief-loss/overcoming.html ) “ The Role of Grief and Loss in Addiction Recovery” (http://oxbowexpeditions.net/articles/grief_add_recov.php)

Articles:

“ Overcoming Stages of Grief and Loss”

( http://www.hopelinks.net/addiction-treatment/grief-loss/overcoming.html )

“ The Role of Grief and Loss in Addiction Recovery”

(http://oxbowexpeditions.net/articles/grief_add_recov.php)