246 Helping Clients Deal with Grief
Counselor Toolbox

 
 
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Grief
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs

Find CEUs for this podcast on the Counselor Toolbox CEU spreadsheet

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
~ Review activities and interventions to help people grieve

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…)
What is Grief
~ Primary losses also produce secondary losses which also need to be acknowledged and grieved.
~ Loss of a part of ourselves
~ Loss of identity
~ Loss of self confidence
~ Loss of a chosen lifestyle
~ Loss of security or a sense of safety
~ Loss of dreams

What is Grief
~ What secondary losses might occur for these events?
~ Death of a parent
~ Separation or divorce
~ Miscarriages
~ Injury or disability
~ Loss of a job
~ Moving to a new place
~ A child leaving home
~ House fire/tornado

Types of Grief
~ Anticipatory Grief: Experiencing anticipatory grief may provide time for the preparation of loss, acceptance of loss, the ability to finish unfinished businss, life review and resolve conflicts
~ Normal Grief: Normal feelings, reactions and behaviors to a loss; grief reactions can be physical, psychological, cognitive, behavioral
~ Complicated Grief:
~ Disenfranchised Grief: Chronic Grief: Normal grief reactions that do not subside and continue over very long periods of time
~ Delayed Grief: Normal grief reactions that are suppressed or postponed. The survivor consciously of unconsciously avoids the pain of the loss.
~ Masked Grief: Survivor is not aware that behaviors that interfere with normal functioning are a result of the loss.
~ The grief encountered when a loss is experienced and cannot be openly acknowledged, socially sanctioned or publicly shared.
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
Exacerbating & Mitigating factors
~ How people react in a crisis depends upon 6 factors
~ 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

Impact of Unresolved Grief
~ Most people get stuck in either anger 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)
~ At self
~ At others
~ At higher power
Denial
~ Denial is the mind’s way of protecting people from what lies ahead.
~ Action strategies
~ Facing the loss
Denial
~ Identify the dialectics which might accompany each loss
~ Activity
~ Death of a loved one
~ Separation or divorce
~ Miscarriages
~ Injury or disability
~ Loss of a job, property, or pet
~ Moving to a new place
~ A child leaving home

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

Anger
~ Action steps
~ Identifying what the loss means to the person (Ex. Job, Parent, Victimization)
~ Angry (other losses)
~ Scared (which fears and why?)
~ Depressed (I feel helpless to… ; I feel hopeless to…)
~ Validation
~ Examination of the stated beliefs for
~ All or nothing thinking
~ Emotional reasoning
~ Fallacy of fairness
~ Emotional Reasoning

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
~ Action Steps
~ Help clients stay in the present reality
~ Point out how bargaining just creates more exhaustion and frustration
Depression
~ Hopelessness and helplessness
~ Reality that the loss occurred AND it cannot be changed
~ Action Steps
~ Identify what cannot be changed
~ Identify what can be changed henceforth
~ Parent
~ Job
~ Victimization

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.
~ Holidays
~ Anniversaries
~ Reminders (people, places, things, media)
~ Many people will vacillate between depression and anger.
~ Normalize people’s experiences
~ Encourage them to reach out to supports
~ Address happiness and survivor guilt

Self Care for Grief
~ Emotionally
~ Express feelings
~ Ask for and accept help
~ Don’t let anyone tell you how to feel—and don’t tell yourself how you “should” feel
~ Be patient
~ Be kind to yourself
~ Add happiness triggers
~ Embrace the dialectic
~ It is gone but I have the memories/what I learned
~ I cannot change it but I can impact how it continues to impact me
Self Care for Grief
~ Emotionally
~ Activity: Identify the feelings which might occur with each loss
~ Death of a loved one
~ Separation or divorce
~ Miscarriages
~ Injury or disability
~ Loss of a job, property, or pet
~ Moving to a new place
~ A child leaving home

Self Care for Grief
~ Physically
~ Get plenty of quality rest
~ How to handle being alone with your thoughts….
~ Exercise
~ Eat a healthy diet
~ Avoid alcohol
~ Pay attention to persistent changes in eating, sleeping, mood or energy levels

Self Care for Grief
~ Psychologically
~ Write things down
~ Simplify
~ Set short term goals
~ Distract/engage in pleasurable activities
~ Start writing the next chapter in your story
~ Plan ahead for grief triggers

Myths and Facts
~ MYTH: The pain will go away faster if you ignore it.
~ Fact: Trying to ignore your pain or keep it from surfacing will only make it worse in the long run. For real healing it is necessary to face your grief and actively deal with it.
~ MYTH: It’s important to be “be strong” in the face of loss.
~ Fact: Feeling sad, frightened or lonely is a normal reaction to loss. Crying doesn’t mean you are weak. You don’t need to “protect” your family or friends by putting on a brave front. Showing your true feelings can help them and you.
~ MYTH: If you don’t cry, it means you aren’t sorry about the loss.
~ Fact: Crying is a normal response to sadness, but it’s not the only one. Those who don’t cry may feel the pain just as deeply as others. They may simply have other ways of showing it.
Myths and Facts
~ MYTH: Grief should last about a year.
~ Fact: There is no right or wrong time frame for grieving. How long it takes can differ from person to person.
~ MYTH: Moving on with your life means you’re forgetting the one you lost.
~ Fact: Moving on means you’ve accepted your loved one’s death. That is not the same as forgetting. You can create a new life and still keep your loved one’s memory a part of you.
~ MYTH: Friends can help by not bringing up the subject.
~ Fact: People who are grieving usually want and need to talk about their loss. Bringing up the subject can make it easier to talk about.

Comments to Avoid
~ “I know how you feel.“ Instead, ask the person to tell you how he or she feels.
~ “It's part of God's plan.“ This phrase can make people angry
~ “Look at what you have to be thankful for.”
~ “He's in a better place now.“ The bereaved may or may not believe this. Keep your beliefs to yourself unless asked.
~ “This is behind you now; it's time to get on with your life.“ Sometimes the bereaved are resistant to getting on with because they feel this means “forgetting” their loved one.
~ Statements that begin with “You should” or “You will“ are too directive. Instead say : “Have you thought about. . .” or “You might. . .”

Time Table
~ Varies depending on the person’s age, cognitive development, pre-existing mental health or addiction issues, the significance of the loss and the number of secondary losses
~ The second year: Most grieving people agree that it takes at least two years to start feeling as if they have established workable new routines and a new identity that incorporates the loss.
~ Many of the tasks of the second year have to do with
~ Re-assessing goals
~ Discovering a new identity
~ Creating a different life style

Time Table
~ Month 1: Denial
~ Month 3: Getting back to routine / supports are gone
~ Months 4-12
~ The grieving person continues to work through the many tasks of learning to live with the loss.
~ There begins to be a more good days than bad days.
~ Difficult periods will crop up sometimes with no obvious trigger, even late into the last half of the first year.
~ Anniversaries

Complicated Grief
~ Intense longing and yearning for the deceased
~ Intrusive thoughts or images of your loved one
~ Denial of the loss or sense of disbelief
~ Imagining that your loved one is alive or that it didn’t happen (i.e. you can still walk)
~ Searching for the person in familiar places or insisting you can do things you cannot do anymore
~ Avoiding things that remind you of the loss
~ Extreme anger or bitterness over the loss
~ Feeling that life is empty or meaningless
~ May also have symptoms of major depression

Bill of Rights for Grief
~ To know the truth about the loss
~ To have questions answered honestly
~ To need people and be heard with dignity and respect
~ To be silent and not talk about grief emotions and thoughts.
~ To talk about the loss as much as needed
~ To not agree with your perceptions and conclusions
~ To see the person who died and the place of the death.
~ To grieve any way she/he wants without hurting self or others.
~ To feel all the feelings and to think all the thoughts of his/her own unique grief.
~ To not have to follow the “stages of grief” as outlined in a book.
~ To grieve in one’s own unique, individual way without censorship.
~ To be angry at death, at the person who died, at god, at self, and at others.
~ To have “griefbursts”
~ To be involved in the decisions about the rituals related to the loss
~ To not be taken advantage of
~ To have guilt about what he/she could have done or shouldn’t have done
Activities
~ Goodbye letter
~ Letter to God
~ Invisible string (Windchime (heart, shells, keys, pipes, terra cotta pots )
~ Book of memories
~ Heart-Break Pot (break into large pieces)
~ Using paint pens and markers, have each family member or child write on the inside of the broken pieces.
~ Instruct them to identify their feelings about being alone in their grief.
~ On the outside of the pieces write about or draw their sources of support.
~ Glue back together

Activities
~ Jenga (write discussion prompts on each block)
~ What is your favorite memory
~ What is the hardest part of the loss
~ What is something you learned
~ What is something you did to make yourself laugh this week
~ Who is your support
~ What are 2 things that help you most right now
~ The hardest time of day is…
~ When I am alone, I can…
~ Some things I enjoy
~ Changes in my family because of the loss
~ I am feeling…
~ 3 ways to release feelings of sadness
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