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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