Module 6 grief and loss part a 30.4.13

588 views

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
588
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
16
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Module 6 grief and loss part a 30.4.13

  1. 1. CHCCS426B Provide support and carerelating to loss and griefModule 6:Learning about Grief and LossPartA
  2. 2. 2What is grief?• Grief is the experience wehave after a loss.• There are many differenttypes of losses. Death isonly one form of loss.• Grief is the adjustment to aloss is experienced as aprocess.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  3. 3. 3Overview• Grief experiences• Models of grief• Strategies to support normalgrief• Complicated grief© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  4. 4. 4The Grief Experience• Many people have tried todescribe and understandwhat happens to peoplewhen they lose someone orsomething of great value tothem in their life.• Grief is an experience thatwe all know in varyingdegrees and will know overa lifetime.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  5. 5. 5What are some of the things we can lose in life?• Family through separationand divorce• Friends• Girlfriends and boyfriends• Locations• Precious possessions• Hopes• Health• People through death© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  6. 6. 6What is impacted by grief?© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13• Body sensations?• Emotions• Thoughts• Behaviour
  7. 7. 7Activity• As a group – divide into 4.Each group should list asmany things that they canunder each of the followingheadings that might beexperienced following aloss.• Body Sensations.• Emotions.• Thoughts.• Behaviours.• As an individual. Divide anA4 sheet into 4 with theheadings.• Body Sensations.• Emotions.• Thoughts.• Behaviours.• Try and list as many as youcan of each category thatmight be experienced bysomeone following a loss.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  8. 8. 8What are some of the body sensations that mayaccompany loss? Difficulty going to sleep, orwaking in the middle of the night Weight loss or gain; over- orunder-eating Low energy or fatigue Headaches, chest pain, orracing heart Upset stomach or digestiveproblems Agitation© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  9. 9. 9What are some of the emotions that mayaccompany loss?© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13• Sadness• Shock• Anger• Insecurity/fear/anxiety• Relief• Depression• Loneliness• Numbness• Yearning
  10. 10. 10Overall Mental State/Cognition• Confusion• Interrupted thoughtprocesses• Lack of concentration© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  11. 11. 11What are some of the thoughts that mayaccompany 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.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  12. 12. 12Behaviours• Recklessness• Snappiness/’kicking the cat’• Withdrawal/social isolation• Crying• Sighing• Overspending• Gambling• Sexual promiscuity• Talking incessantly aboutthe event/or not at all• Putting on a brave face© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  13. 13. 13Grief reactions are individual and depend upon…© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13• Personality factors• Previous family history – inreacting to loss• Previous losses, multiplelosses• Shock• Other complicating factors
  14. 14. 14Guilt• When people lose a partneror child or someone closethrough death, they mayfeel guilt about having dayswhen they feel good orhappy.• They are fearful that to behappy means that theperson they have lost didn’tcount much, or they don’tcare anymore.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  15. 15. 15Sometimes a guilt trip is put on by others• Children can be especiallyvulnerable to this.• Kids move in and out of sadfeelings and cannot ‘stay’ indepression for long periodsof time.• They may be happy andplaying and then at othertimes the reality of their losshits them. Be aware of theparticular support neededfor children. Adults mightmisjudge this behaviour andthen the children might feelshame or guilt over theirvery normal reactions.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  16. 16. 16Trying to get out of the ‘pit of despair’• Sometimes people aredesperate to feel normalagain and try to hasten itsarrival by feigning normality.• “I’m alright, yes, managingfine. Thank you”.• However, at night time,when the pretence is gone,the pain of the loss catchesup.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  17. 17. 17Trying to ‘be strong for others’• Many of us feel responsiblefor young children or otherpeople we consider to bemore vulnerable thanourselves.• We can sometimes put on abrave face in order to ‘bestrong for others’, but deepinside we may becrumbling.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  18. 18. 18Strategies to support others in grief1. Education – the framework2. Letting go, sayinggoodbye… in ceremony3. Keeping connected in anew way (and usingquestioning techniques)4. Micro-losses as a way tobuild a future5. Support search6. Introduce new supports7. Check for complications© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  19. 19. 191. Education – the framework• Providing a framework forsomeone who is grieving ishelpful.• In the middle of intense painand misery to understandthat the process has beenlived through by others andwhat to expect can give anindividual bearings.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  20. 20. 20Models of grief: ideas about the stages or wayspeople go through a loss• Kubler Ross – Stages theory (1969)• William Worden – Task theory (1982)• Margaret Stroebe and Henk Schut (1999) – Dual processmodel• Seasons• Butterfly• Broken leg© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  21. 21. 21Afeminine framework• Elisabeth Kubler-Ross observedgrief in her patients and in theirfamilies.• She saw grief as a journey which hadstages. She felt that the griever waspulled by an invisible thread throughthe darkness of loss towards the light.• She put forward her theory of grief in1969 in her book ‘On death and dying’.• This ‘trusting’ framework will be veryhelpful for some individuals.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  22. 22. 22Stages theory• The stages she observed were:o Stage 1: Shock and denialo Stage 2: Anger/bargainingo Stage 3: Depression and detachmento Stage 4: Dialogueo Stage 5: AcceptanceElisabeth Kubler-Ross - On Death and Dying 1969This model has been widely adopted by grief counsellors, psychologists andsocial workers. Visit the link below to hear a Psychologist briefly explain thegrief stages.http://www.youtube.com/watch?v=fG6gJRPuW8w© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  23. 23. 23Afluid movement• Her theory was not rigid,however.• It was understood that inmoving forward at times peoplewill move backwards andforwards between stages. Forexample a person may movebetween the stages of angerand depression but eventuallywill move on to acceptance.• http://www.youtube.com/watch?v=Dbofp_bgdzI© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  24. 24. 24Amale framework• In the 1980’s Dr William Wordenformulated the ‘task model’ asan approach to grieving. He feltit was something that peoplehad to ‘do’.• This ‘power’ model whichemphasises the need for actionwill assist some individuals asthey feel more relaxed whenthey know the experience assomething that they can control.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13Dr William Worden
  25. 25. 25The Task Theory• To accept the reality of theloss• To experience the pain ofgrief• To adjust to an environmentin which the significantperson is no longer present• To reinvest emotionalenergy• J.W. Worden, GriefCounselling and Grief Therapy1982, pp 11-16© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13• In Worden’s model, grief isconsidered to consist of fouroverlapping tasks, requiringthe bereaved person to workthrough the emotional pain oftheir loss while at the sametime adjusting to changes intheir circumstances, roles,status and identity.
  26. 26. 26Worden’s Tasks of Grief• Accept the reality of the loss. Worden believes that losses are difficultand denial is strong. He believes we need to help people let go of their grip ondenial so they can deal with the loss they have encountered.• Experience the pain of grief. People are encouraged to feel the painrather than avoid it.• Adjustment to an environment with the deceased missing. Oftenthe thought of taking on responsibilities that a mate or partner has done foryears seems insurmountable. But as a person finds new ways to cope andlearn 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 needsby developing new activities and relationships. This is not dishonouring thememory of the deceased; it simply recognises that there are other things to beloved and that you are capable of loving.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  27. 27. 27Dual Process Model• Margaret Stroebe andHenk Schut (1999)• This recent model of griefand loss maintains that bothgrieving and avoiding griefare necessary forsuccessful resolution andpragmatic coping with aloss.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  28. 28. 28Dual Process• Active confrontation withloss may not be necessaryfor a positive outcome.There may be times whendenial and avoidance ofreminders are essential.• Most individuals can expectto experience ongoingoscillation between a lossorientation and a restorationorientation.Loss• Coping withloss throughgrief work• Dealing withdenial• AvoidingchangesRestoration• Adjusting tochangestriggered byloss• Changingroutines• Taking timeoff from grief© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  29. 29. 29Dual Process Model• This oscillation reflectsmovement between copingwith loss and movingforward – but the extent towhich one needs either ofthese dimensions differs foreach individual.• Read more:Loss Grief and Bereavement - CopingWith Loss - Theory, Family, History,Development, Family, Emphasis,Individual, Model, Grieving, and Illnesshttp://family.jrank.org/pages/750/Grief-Loss-Bereavement-Coping-with-Loss.html#ixzz1Iq7pcS00© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13Loss• Coping withloss throughgrief work• Dealing withdenial• AvoidingchangesRestoration• Adjusting tochangestriggered byloss• Changingroutines• Taking timeoff from grief
  30. 30. 30Visual Models• Visual models or frameworks are particularly helpful forchildren and adolescents but most of us, adults included, findit easier to remember pictures or analogies.• In some ways the following visual frameworks relate well tothe 3 Models of Grief.Theory Visual AnalogyStages theory Caterpillar to butterflyTasks theory Seasons of the yearDual processing theory Broken leg analogy© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  31. 31. 31Visual symbols are helpful for everyone• Children need concrete tools to understand concepts that arenew to them and which they can’t directly experience in thepresent.• The caterpillar/butterfly is also a great analogy for children –but adults get it too! This can be likened to STAGES theory.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  32. 32. 32Seasons of the year• Autumn – losing leaves…losing someone• Winter – cold and dark…feeling sad• Spring – new little budscoming… feeling hope,knowing change ishappening• Summer – lovely colours,sun shining… feeling happyagain• This analogy relates well toWorden’s Tasks of Grief.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  33. 33. 33 © Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  34. 34. 34The Broken Leg analogy• A broken leg once set can healbeautifully.• However if it is broken and notset in the right fashion, it canget infected or heal in awarped manner and a limpmay result and at worst deathcan happen.• Similarly, grief needs paddingand support, cleaning of thewound and time to heal withouttoo much pressure – just like abroken leg!© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  35. 35. 35Dangers of a broken leg• Some of the other dangersof a broken leg is that wedon’t get up and keep activeand walking. It is necessarydespite the pain to keepliving and functioning. Weneed blood circulation andmuscle use to aid thehealing process. In this waythe broken leg analogyrelates well to the dualprocess model of griefprocessing.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  36. 36. 36Children and grief• For some children, their loss or bereavement can be anexperience of profound abandonment. Fears may arise thatthey might be similarly abandoned again. Not all childrenunderstand that the pain they feel will subside.• In addition, they may try to protect the feelings of others byavoiding displays of emotion in front of them and, as a result,their feelings can go underground and resurface at a laterperiod in their life.• (Taken from the Australian Centre for Grief and Bereavement)© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  37. 37. 37Children express grief differently• Children may not have theability to name or expresstheir feelings because theyare not visible or concrete.• Because children haven’tdeveloped buffers to pain asadults often have, thefeelings they experiencemay be overwhelming forthem.• Children often express theirgrief through their behavioursuch as separation anxiety,crying, withdrawal,bedwetting, disinterest infood, or disruptivebehaviour at school.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  38. 38. 38Age appropriate response• Children’s age anddevelopment influence theirunderstanding of death• Very young children areoften unable to understandthe permanence of death orseparation and cananticipate the return of theperson who has gone. Asthey grow older, they willlearn to grasp the finalityand permanency of death.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  39. 39. 39Developmental Grief ResponsesAges 2-4Concept of Death• Death seen as reversibleGrief response• Intensive response butbrief• Very present-oriented• Most aware of changesin patterns of care• Asking questionsrepeatedly© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  40. 40. 40Developmental Grief ResponsesAges 4-7Concept of Death• Death still seen as reversible• Feeling of responsibility becauseof wishes and thoughtsGrief Response• More verbalisation• Great concern with process e.g.How? Why?• May act as though nothing hashappened• General distress and confusion© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  41. 41. 41Developmental Grief Responses© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13Ages 7-11Concept of Death• Still wanting to see death as reversiblebut beginning to see it as final• Death seen as punishmentGrief Response• Specific questions• Desire for complete detail• What is the right way to respond?• Starting to have ability to mourn andunderstand mourning
  42. 42. 42Developmental Grief ResponsesAges 11-18Concept of Death• Ability to abstract• Beginning to conceptualise deathGrief Response• Extreme sadness• Denial• Regression• More often willing to talk to peopleoutside of family and peer support• Risk-taking© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  43. 43. 43Seasons for Growth• Seasons for Growth is a 4-week Grief and Loss programinitially developed for children and young people – nowalso for adults. It aims to build resilience for those whoare dealing with significant loss or change.• In small groups, participants work through activities anddiscussions 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 viewthe short clip about ‘Seasons for Growth’• http://www.goodgrief.org.au/children-and-young-people© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  44. 44. 442. Letting go, saying goodbye… in ceremony• Since the beginning of timehumans have usedceremonies and symbolismto help make sense of andwork through major lifeevents.• The funeral ceremony is away that we say goodbyeand have a marker for ourmemories. But ceremoniescan be encouraged to bepersonal things for variouslosses.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  45. 45. 45Saying Goodbye• Building a garden bed or gazebo• Going for a walk on the beach andthrowing a bottle out with a message• Letting doves or balloons free• Writing a poem or letter• Even divorcees are having goodbyeparties like a ‘wake’• Encourage people to ‘say goodbye’ asmany times as they need in their ownunique ways• Saying goodbye to a body part andthanking it for the work it has done andpromising never to forget it… can beamazingly freeing© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  46. 46. 46Cultural differences in bereavement practices• It is important to understandthat across different cultures,beliefs about death and thekind of practices and ritualsassociated with grief andmourning will be significantlyvaried.• Some of these differencesmay seem rather strange tous, but we must remember torespect and support ourclients in their cultural beliefsand wishes in regard to griefand loss.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  47. 47. 473. Keeping connected in a new way(and using questioning techniques)• Losing someone or somethingprecious doesn’t mean wehave to cut them off…• Encourage people to findways of staying connected…• When you think about‘George’ where do you like toimagine he is right now?• When do you feel closest toGeorge… what are you doingwhen the pain eases?• Encouraging clients to puttogether a memory album canbe helpful.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  48. 48. 484. Micro-losses as a way to build a future• Finding out all the thingssomeone has lost whenthey lost a loved one orsomething special to themis validating and can giveclues to the helper.• “When you lost Katie whatelse did you lose, Joe?”• “I lost my best friend, myconfidant, my housecleaner, my cook, mybudgeter, my social planner,my lover, my cuddler…”© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  49. 49. 49See what can be done about someof the micro-losses…• “Well Joe, we can never replaceKatie. She was so wonderful.But I am wondering about thatcuddling… I have a friend whohas a new puppy that needs ahome. I think he will lovecuddles….Or…• I have heard that full-lengthbody pillows can really helpsomeone feel comforted at nightwhen they feel alone in the bedand miss their partner. Wouldyou like me to find out whereyou can get one of these?”© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  50. 50. 505. Support search• Who or what is out there tohelp you?• Who has offered support?• What do you know aboutsupports in the communityright now?• By questioning, you arereminding a person of theirneed for support andchecking their ownresources and knowledge.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  51. 51. 516. Introduce new supports• As a worker wanting tosupport someone throughgrief… get to know all thecommunity supportsavailable so that you cansuggest alternatives if theindividual isn’t aware ofsupports.• Grief and loss libraries,group programs, griefcounsellors, grief buddies,associations, web sites etc.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  52. 52. 52Seasons for Growth• As mentioned previously, thisfour-week program helps peoplewho have had a loss in their life.It provides skills to cope andshare with others who havebeen in a similar situation.• Many teenagers, children andadults have been helped withthe Seasons for Growthprogram.• If you feel you or someone youknow would benefit, go to theGood Grief Website and find outmore - www.goodgrief.org.au© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13JohnMaitland©TrusteesoftheSistersofStJoseph
  53. 53. 53Other 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 stressfulcircumstances while in early stages of grief© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  54. 54. 547. Check for complications• Sometimes peopleexperience reallyunpleasant things thataccompany their loss, whichcan infect the wound of griefand make it really hard toheal.• Always check for thesecomplicating factors thatmay delay or elongate thegrieving process.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13Getting stuck in the grief process
  55. 55. 556 Factors impacting grief• Let us now have a look at 6 reasons for extended grief andwhat to do about it1. Denial of grief2. Abuse of grief3. No Goodbyes4. Confusion about reasons5. Blame/shame6. Trauma© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  56. 56. 56Complications to the grief processDiscuss the following• Denial of grief – deliberate or unintentional avoidance of grief• Abuse of grief – when a person is prevented from expressingdistress and sorrow in relation to a loss• No goodbyes – sudden death, suicide, parted on bad termsbefore loss• Confusion about reasons – missing persons, unsolved crime,cant make sense of it• Blame/Shame – excessive guilt• Trauma – prevents processing of grief and emotions© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  57. 57. 57Antidotes for complications1. Denial of grief Get permission2. Abuse of grief Don’t listen, find kinder voices.3. No goodbyes Never too late…4. Confusion about reasons Answers and meaning will come… justrest5. Blame/shame Be aware – get help to stop6. Trauma Get treatment© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  58. 58. 58Helpful ideas for relieving the pain of grief(see PPPart B for more ideas on helping grieving people)1. Mind map the various areas of life and add one activity toextend 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 interestingrather than annoying. Be an interested spectator at the veryleast.7. Use a body pillow for comfort at night and hold forehead andcross feet for grounding.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  59. 59. 59Sensible 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 ofcall for any emotionaldistress, including anylosses including the deathof someone close to us.© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  60. 60. 60Thoughts to ponderQuote….Its only when we truly knowand understand that wehave a limited time on earth-- and that we have no wayof knowing when our time isup, we will then begin to liveeach day to the fullest, as ifit was the only one we had.Dr. Elisabeth Kubler-Ross© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13
  61. 61. 61ReferencesSources: The AustralianCentre for grief andbereavementhttp://www.grief.org.auExcerpts taken from ‘On deathand dying’ Elizabeth Kubler-Ross (1969) and from ‘GriefCounselling and Grief Therapy’William Worden (1982)© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13

×