Module 6 grief and loss part a 30.4.13

CHCCS426B Provide support and care
relating to loss and grief
Module 6:
Learning about Grief and Loss
PartA

2
What is grief?
• Grief is the experience we
have after a loss.
• There are many different
types of losses. Death is
only one form of loss.
• Grief is the adjustment to a
loss is experienced as a
process.
© Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13

3
Overview
• Grief experiences
• Models of grief
• Strategies to support normal
grief
• Complicated grief

4
The Grief Experience
• Many people have tried to
describe and understand
what happens to people
when they lose someone or
something of great value to
them in their life.
• Grief is an experience that
we all know in varying
degrees and will know over
a lifetime.

5
What are some of the things we can lose in life?
• Family through separation
and divorce
• Friends
• Girlfriends and boyfriends
• Locations
• Precious possessions
• Hopes
• Health
• People through death

6
What is impacted by grief?
• Body sensations?
• Emotions
• Thoughts
• Behaviour

7
Activity
• As a group – divide into 4.
Each group should list as
many things that they can
under each of the following
headings that might be
experienced following a
loss.
• Body Sensations.
• Emotions.
• Thoughts.
• Behaviours.
• As an individual. Divide an
A4 sheet into 4 with the
headings.
• Body Sensations.
• Emotions.
• Thoughts.
• Behaviours.
• Try and list as many as you
can of each category that
might be experienced by
someone following a loss.

8
What are some of the body sensations that may
accompany loss?
 Difficulty going to sleep, or
waking in the middle of the night
 Weight loss or gain; over- or
under-eating
 Low energy or fatigue
 Headaches, chest pain, or
racing heart
 Upset stomach or digestive
problems
 Agitation

9
What are some of the emotions that may
accompany loss?
• Sadness
• Shock
• Anger
• Insecurity/fear/anxiety
• Relief
• Depression
• Loneliness
• Numbness
• Yearning

10
Overall Mental State/Cognition
• Confusion
• Interrupted thought
processes
• Lack of concentration

11
What are some of the thoughts that may
accompany 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.

12
Behaviours
• Recklessness
• Snappiness/’kicking the cat’
• Withdrawal/social isolation
• Crying
• Sighing
• Overspending
• Gambling
• Sexual promiscuity
• Talking incessantly about
the event/or not at all
• Putting on a brave face

13
Grief reactions are individual and depend upon…
• Personality factors
• Previous family history – in
reacting to loss
• Previous losses, multiple
losses
• Shock
• Other complicating factors

14
Guilt
• When people lose a partner
or child or someone close
through death, they may
feel guilt about having days
when they feel good or
happy.
• They are fearful that to be
happy means that the
person they have lost didn’t
count much, or they don’t
care anymore.

15
Sometimes a guilt trip is put on by others
• Children can be especially
vulnerable to this.
• Kids move in and out of sad
feelings and cannot ‘stay’ in
depression for long periods
of time.
• They may be happy and
playing and then at other
times the reality of their loss
hits them. Be aware of the
particular support needed
for children. Adults might
misjudge this behaviour and
then the children might feel
shame or guilt over their
very normal reactions.

16
Trying to get out of the ‘pit of despair’
• Sometimes people are
desperate to feel normal
again and try to hasten its
arrival by feigning normality.
• “I’m alright, yes, managing
fine. Thank you”.
• However, at night time,
when the pretence is gone,
the pain of the loss catches
up.

17
Trying to ‘be strong for others’
• Many of us feel responsible
for young children or other
people we consider to be
more vulnerable than
ourselves.
• We can sometimes put on a
brave face in order to ‘be
strong for others’, but deep
inside we may be
crumbling.

18
Strategies to support others in grief
1. Education – the framework
2. Letting go, saying
goodbye… in ceremony
3. Keeping connected in a
new way (and using
questioning techniques)
4. Micro-losses as a way to
build a future
5. Support search
6. Introduce new supports
7. Check for complications

19
1. Education – the framework
• Providing a framework for
someone who is grieving is
helpful.
• In the middle of intense pain
and misery to understand
that the process has been
lived through by others and
what to expect can give an
individual bearings.

20
Models of grief: ideas about the stages or ways
people go through a loss
• Kubler Ross – Stages theory (1969)
• William Worden – Task theory (1982)
• Margaret Stroebe and Henk Schut (1999) – Dual process
model
• Seasons
• Butterfly
• Broken leg

21
Afeminine framework
• Elisabeth Kubler-Ross observed
grief in her patients and in their
families.
• She saw grief as a journey which had
stages. She felt that the griever was
pulled by an invisible thread through
the darkness of loss towards the light.
• She put forward her theory of grief in
1969 in her book ‘On death and dying’.
• This ‘trusting’ framework will be very
helpful for some individuals.

22
Stages theory
• The stages she observed were:
o Stage 1: Shock and denial
o Stage 2: Anger/bargaining
o Stage 3: Depression and detachment
o Stage 4: Dialogue
o Stage 5: Acceptance
Elisabeth Kubler-Ross - On Death and Dying 1969
This model has been widely adopted by grief counsellors, psychologists and
social workers. Visit the link below to hear a Psychologist briefly explain the
grief stages.
http://www.youtube.com/watch?v=fG6gJRPuW8w

23
Afluid movement
• Her theory was not rigid,
however.
• It was understood that in
moving forward at times people
will move backwards and
forwards between stages. For
example a person may move
between the stages of anger
and depression but eventually
will move on to acceptance.
• http://www.youtube.com/watch?v=
Dbofp_bgdzI

24
Amale framework
• In the 1980’s Dr William Worden
formulated the ‘task model’ as
an approach to grieving. He felt
it was something that people
had to ‘do’.
• This ‘power’ model which
emphasises the need for action
will assist some individuals as
they feel more relaxed when
they know the experience as
something that they can control.
Dr William Worden

25
The Task Theory
• To accept the reality of the
loss
• To experience the pain of
grief
• To adjust to an environment
in which the significant
person is no longer present
• To reinvest emotional
energy
• J.W. Worden, Grief
Counselling and Grief Therapy
1982, pp 11-16
• In Worden’s model, grief is
considered to consist of four
overlapping tasks, requiring
the bereaved person to work
through the emotional pain of
their loss while at the same
time adjusting to changes in
their circumstances, roles,
status and identity.

26
Worden’s Tasks of Grief
• Accept the reality of the loss. Worden believes that losses are difficult
and denial is strong. He believes we need to help people let go of their grip on
denial so they can deal with the loss they have encountered.
• Experience the pain of grief. People are encouraged to feel the pain
rather than avoid it.
• Adjustment to an environment with the deceased missing. Often
the thought of taking on responsibilities that a mate or partner has done for
years seems insurmountable. But as a person finds new ways to cope and
learn 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 needs
by developing new activities and relationships. This is not dishonouring the
memory of the deceased; it simply recognises that there are other things to be
loved and that you are capable of loving.

27
Dual Process Model
• Margaret Stroebe and
Henk Schut (1999)
• This recent model of grief
and loss maintains that both
grieving and avoiding grief
are necessary for
successful resolution and
pragmatic coping with a
loss.

28
Dual Process
• Active confrontation with
loss may not be necessary
for a positive outcome.
There may be times when
denial and avoidance of
reminders are essential.
• Most individuals can expect
to experience ongoing
oscillation between a loss
orientation and a restoration
orientation.
Loss
• Coping with
loss through
grief work
• Dealing with
denial
• Avoiding
changes
Restoration
• Adjusting to
changes
triggered by
loss
• Changing
routines
• Taking time
off from grief

29
Dual Process Model
• This oscillation reflects
movement between coping
with loss and moving
forward – but the extent to
which one needs either of
these dimensions differs for
each individual.
• Read more:
Loss Grief and Bereavement - Coping
With Loss - Theory, Family, History,
Development, Family, Emphasis,
Individual, Model, Grieving, and Illness
http://family.jrank.org/pages/750/Grief-
Loss-Bereavement-Coping-with-
Loss.html#ixzz1Iq7pcS00
Loss
• Coping with
loss through
grief work
• Dealing with
denial
• Avoiding
changes
Restoration
• Adjusting to
changes
triggered by
loss
• Changing
routines
• Taking time
off from grief

30
Visual Models
• Visual models or frameworks are particularly helpful for
children and adolescents but most of us, adults included, find
it easier to remember pictures or analogies.
• In some ways the following visual frameworks relate well to
the 3 Models of Grief.
Theory Visual Analogy
Stages theory Caterpillar to butterfly
Tasks theory Seasons of the year
Dual processing theory Broken leg analogy

31
Visual symbols are helpful for everyone
• Children need concrete tools to understand concepts that are
new to them and which they can’t directly experience in the
present.
• The caterpillar/butterfly is also a great analogy for children –
but adults get it too! This can be likened to STAGES theory.

32
Seasons of the year
• Autumn – losing leaves…
losing someone
• Winter – cold and dark…
feeling sad
• Spring – new little buds
coming… feeling hope,
knowing change is
happening
• Summer – lovely colours,
sun shining… feeling happy
again
• This analogy relates well to
Worden’s Tasks of Grief.

33 © Copyright CTA CHCCS426B, MODULE 6 Version Date: 30.4.13

34
The Broken Leg analogy
• A broken leg once set can heal
beautifully.
• However if it is broken and not
set in the right fashion, it can
get infected or heal in a
warped manner and a limp
may result and at worst death
can happen.
• Similarly, grief needs padding
and support, cleaning of the
wound and time to heal without
too much pressure – just like a
broken leg!

35
Dangers of a broken leg
• Some of the other dangers
of a broken leg is that we
don’t get up and keep active
and walking. It is necessary
despite the pain to keep
living and functioning. We
need blood circulation and
muscle use to aid the
healing process. In this way
the broken leg analogy
relates well to the dual
process model of grief
processing.

36
Children and grief
• For some children, their loss or bereavement can be an
experience of profound abandonment. Fears may arise that
they might be similarly abandoned again. Not all children
understand that the pain they feel will subside.
• In addition, they may try to protect the feelings of others by
avoiding displays of emotion in front of them and, as a result,
their feelings can go underground and resurface at a later
period in their life.
• (Taken from the Australian Centre for Grief and Bereavement)

37
Children express grief differently
• Children may not have the
ability to name or express
their feelings because they
are not visible or concrete.
• Because children haven’t
developed buffers to pain as
adults often have, the
feelings they experience
may be overwhelming for
them.
• Children often express their
grief through their behaviour
such as separation anxiety,
crying, withdrawal,
bedwetting, disinterest in
food, or disruptive
behaviour at school.

38
Age appropriate response
• Children’s age and
development influence their
understanding of death
• Very young children are
often unable to understand
the permanence of death or
separation and can
anticipate the return of the
person who has gone. As
they grow older, they will
learn to grasp the finality
and permanency of death.

39
Developmental Grief Responses
Ages 2-4
Concept of Death
• Death seen as reversible
Grief response
• Intensive response but
brief
• Very present-oriented
• Most aware of changes
in patterns of care
• Asking questions
repeatedly

40
Ages 4-7
Concept of Death
• Death still seen as reversible
• Feeling of responsibility because
of wishes and thoughts
Grief Response
• More verbalisation
• Great concern with process e.g.
How? Why?
• May act as though nothing has
happened
• General distress and confusion

41
Ages 7-11
Concept of Death
• Still wanting to see death as reversible
but beginning to see it as final
• Death seen as punishment
Grief Response
• Specific questions
• Desire for complete detail
• What is the right way to respond?
• Starting to have ability to mourn and
understand mourning

42
Ages 11-18
Concept of Death
• Ability to abstract
• Beginning to conceptualise death
Grief Response
• Extreme sadness
• Denial
• Regression
• More often willing to talk to people
outside of family and peer support
• Risk-taking

43
Seasons for Growth
• Seasons for Growth is a 4-week Grief and Loss program
initially developed for children and young people – now
also for adults. It aims to build resilience for those who
are dealing with significant loss or change.
• In small groups, participants work through activities and
discussions 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 view
the short clip about ‘Seasons for Growth’
• http://www.goodgrief.org.au/children-and-young-people

44
2. Letting go, saying goodbye… in ceremony
• Since the beginning of time
humans have used
ceremonies and symbolism
to help make sense of and
work through major life
events.
• The funeral ceremony is a
way that we say goodbye
and have a marker for our
memories. But ceremonies
can be encouraged to be
personal things for various
losses.

45
Saying Goodbye
• Building a garden bed or gazebo
• Going for a walk on the beach and
throwing a bottle out with a message
• Letting doves or balloons free
• Writing a poem or letter
• Even divorcees are having goodbye
parties like a ‘wake’
• Encourage people to ‘say goodbye’ as
many times as they need in their own
unique ways
• Saying goodbye to a body part and
thanking it for the work it has done and
promising never to forget it… can be
amazingly freeing

46
Cultural differences in bereavement practices
• It is important to understand
that across different cultures,
beliefs about death and the
kind of practices and rituals
associated with grief and
mourning will be significantly
varied.
• Some of these differences
may seem rather strange to
us, but we must remember to
respect and support our
clients in their cultural beliefs
and wishes in regard to grief
and loss.

47
3. Keeping connected in a new way
(and using questioning techniques)
• Losing someone or something
precious doesn’t mean we
have to cut them off…
• Encourage people to find
ways of staying connected…
• When you think about
‘George’ where do you like to
imagine he is right now?
• When do you feel closest to
George… what are you doing
when the pain eases?
• Encouraging clients to put
together a memory album can
be helpful.

48
4. Micro-losses as a way to build a future
• Finding out all the things
someone has lost when
they lost a loved one or
something special to them
is validating and can give
clues to the helper.
• “When you lost Katie what
else did you lose, Joe?”
• “I lost my best friend, my
confidant, my house
cleaner, my cook, my
budgeter, my social planner,
my lover, my cuddler…”

49
See what can be done about some
of the micro-losses…
• “Well Joe, we can never replace
Katie. She was so wonderful.
But I am wondering about that
cuddling… I have a friend who
has a new puppy that needs a
home. I think he will love
cuddles….Or…
• I have heard that full-length
body pillows can really help
someone feel comforted at night
when they feel alone in the bed
and miss their partner. Would
you like me to find out where
you can get one of these?”

50
5. Support search
• Who or what is out there to
help you?
• Who has offered support?
• What do you know about
supports in the community
right now?
• By questioning, you are
reminding a person of their
need for support and
checking their own
resources and knowledge.

51
6. Introduce new supports
• As a worker wanting to
support someone through
grief… get to know all the
community supports
available so that you can
suggest alternatives if the
individual isn’t aware of
supports.
• Grief and loss libraries,
group programs, grief
counsellors, grief buddies,
associations, web sites etc.

52
Seasons for Growth
• As mentioned previously, this
four-week program helps people
who have had a loss in their life.
It provides skills to cope and
share with others who have
been in a similar situation.
• Many teenagers, children and
adults have been helped with
the Seasons for Growth
program.
• If you feel you or someone you
know would benefit, go to the
Good Grief Website and find out
more - www.goodgrief.org.au
JohnMaitland©TrusteesoftheSistersofStJoseph

53
Other 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 stressful
circumstances while in early stages of grief

54
7. Check for complications
• Sometimes people
experience really
unpleasant things that
accompany their loss, which
can infect the wound of grief
and make it really hard to
heal.
• Always check for these
complicating factors that
may delay or elongate the
grieving process.
Getting stuck in the grief process

55
6 Factors impacting grief
• Let us now have a look at 6 reasons for extended grief and
what to do about it
1. Denial of grief
2. Abuse of grief
3. No Goodbyes
4. Confusion about reasons
5. Blame/shame
6. Trauma

56
Complications to the grief process
Discuss the following
• Denial of grief – deliberate or unintentional avoidance of grief
• Abuse of grief – when a person is prevented from expressing
distress and sorrow in relation to a loss
• No goodbyes – sudden death, suicide, parted on bad terms
before loss
• Confusion about reasons – missing persons, unsolved crime,
cant make sense of it
• Blame/Shame – excessive guilt
• Trauma – prevents processing of grief and emotions

57
Antidotes for complications
1. Denial of grief Get permission
2. Abuse of grief Don’t listen, find kinder voices.
3. No goodbyes Never too late…
4. Confusion about reasons Answers and meaning will come… just
rest
5. Blame/shame Be aware – get help to stop
6. Trauma Get treatment

58
Helpful 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 to
extend 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 interesting
rather than annoying. Be an interested spectator at the very
least.
7. Use a body pillow for comfort at night and hold forehead and
cross feet for grounding.

59
Sensible 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 of
call for any emotional
distress, including any
losses including the death
of someone close to us.

60
Thoughts to ponder
Quote….
It's only when we truly know
and understand that we
have a limited time on earth
-- and that we have no way
of knowing when our time is
up, we will then begin to live
each day to the fullest, as if
it was the only one we had.
Dr. Elisabeth Kubler-Ross

61
References
Sources: The Australian
Centre for grief and
bereavement
http://www.grief.org.au
Excerpts taken from ‘On death
and dying’ Elizabeth Kubler-
Ross (1969) and from ‘Grief
Counselling and Grief Therapy’
William Worden (1982)

Module 6 grief and loss part a 30.4.13

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