Sunteți pe pagina 1din 30

MANAGING GRIEF AND

LOSS IN OUR PERSONAL &


PROFESSIONAL LIVES

COURSE A302
ICASSI 2019
SIBUI, ROMANIA

JULY 14-JULY27, 2019

COURSE LEADER:
MARION BALLA, M.ED., M.S.W., R.S.W.

1729 Bank St., Suite 205, Ottawa, Ontario, Canada K1V 7Z5
Phone: (613) 737-5553, Fax: (613) 523-7148, e-mail: info@adleriancentre.com
www.adleriancentre.com

0
Some losses are trivial in the
grand scheme of things…

Others, not so…

But loss is a universal experience


1
Early attachment patterns between the child and its primary caregiver affect how
an adult grieves. A person with a secure base of attachment will generally
process well. Those with anxious/ambivalent/avoidant or disorganized
attachment experience, may find the process more difficult.

Bowlby & Parks

In grief the world looks poor and empty while in depression the person feels poor
and empty

Sigmund Freud

Grief as a life-long process is not abnormal but something that is dipped into and
out throughout life, always present at every level.

We are frequently triggered into an unresolved grief response when faced with a
new response.

Grief work requires an enormous amount of energy therefore, it spreads out over
time.

Grief work is a process of neutralizing each hope and memory, not forgetting.

2
The Experience of Loss

SEPARATION is the change that occurs when there is a breakup in a relationship.

LOSS is the effect on people when something important is withdrawn.

GRIEF is the process that helps people work through the pain of separation and
loss.

Separation, loss and grief are painful experiences to think about and to share with
others.

Other people’s experiences can trigger our own personal losses which can help or
hinder the way we may respond to the situation.

It is helpful to understand our own losses and assess how much of our own grief
work has been completed.
(P.R.I.D.E. Training Manual
Child Welfare League of America

What are some of the things that cause us to grieve?

We grieve many things,


loss of significant relationships,
loss of sense of belonging,
loss of things that are important to us,
loss of a belief system,
loss of a world view,
loss of hope,
loss of trust,
loss of the familiar,
loss of safety and security, . . .

3
Expressions of Grief and Loss

Depression
Shock Fatigue
Disorganization Hope

Anger Bargaining
Denial Numbness
Rage Physical
Symptoms
Release
Acceptance
Panic

4
Your Life Losses

Make a list of all the significant losses you have experienced in your life. Note, as
closely as you can, the year in which each occurred. There are many ways to chart
or draw your lifetime experience with loss so that you will be able to see it over
your whole lifetime. Be creative and feel free to choose a way that works best for
you. Your chart might look something like this:

Dad sister got first adoptive


died born married child father died
moved dog left friend
away died home died
mother job
sick phased
out

When you are finished, look for patterns on your chart. What is the first loss you
remember? Notice if there are any periods when more than one loss occurred
about the same time or were grouped in the same segment? You also might like to
add any major decisions or changes in your life at the time of, or as a result of, a
particular loss.

(Sandi Caplan and Gordon Lang,


Grief’s Courageous Journey)

5
Two Losses

Choose two losses that you are facing at present.

Loss #1

What was my first reaction?

What did I think?

What did I feel?

What did I do?

Losses:

Gains:

Loss#2

What was my first reaction?

What did I think?

What did I feel?

What did I do?

Losses:

Gains:

6
Picturing Your Loss

To prepare for this exercise, find a quiet place and comfortable position. If you
find it difficult to concentrate, try spending some time with your eyes closed. Let
your mind empty of thoughts.

What image comes to you when you think of your loss? Use the space below to
draw your image. Feel free to use words, pictures, lines, coloured pencils, or
markers to draw what your loss looks like to you.

7
Picturing Your Loss

To prepare for this exercise, find a quiet place and comfortable position. If you
find it difficult to concentrate, try spending some time with your eyes closed. Let
your mind empty of thoughts.

What image comes to you when you think of your loss? Use the space below to
draw your image. Feel free to use words, pictures, lines, coloured pencils, or
markers to draw what your loss looks like to you.

8
Exercise

Loss # 1

How has this experience changed my life?

How has it influenced my life purpose and belief system?

What positive action have I taken or could I take as a result of this lesson?

9
Exercise

Loss #2

How has this experience changed my life?

How has it influenced my life purpose and belief system?

What positive action have I taken or could I take as a result of this lesson?

10
Loss & Grief Exercise

A. Think of one of your family members/clients/friends. Outline all the losses you
know this person has experienced throughout his/her life.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

11
Life Tasks

Intimate
Relationships
(Love)

Spiritual Occupation
(Meaning SELF (Work)
of Life)

Social
Relationships
(Social)

Source: Alfred Adler


12
Adlerian Counselling and Consulting Group Inc.
Stages of Grief

Shock

Panic

Denial

Release

Depression

Guilt

Anger

Hope

Acceptance

Physical Symptoms

13
The Pathway Through the Grieving Process

Loss

Health Self Esteem Significant


Persons

Shock/Denial

Bargaining

Anger

Acting Out Depression

Understanding

Coping

Managing Loss

14
THE CRUCIAL C’S

CONNECT
I need to believe I have a place. I Belong.

CAPABLE
I need to believe I can do it.

COUNT
I need to believe I can make a difference.

COURAGE
I need to believe I can handle what comes.

WHEN WE FEEL CONNECTION WE: WHEN WE DON’T FEEL CONNECTION WE:


FEEL: Secure FEEL: Insecure, Isolated
DO: Reach out DO: Susceptible to peer pressure
Make friends May try to get attention in
Cooperate negative ways

NEED: Communication Skills

WHEN WE FEEL CAPABLE WE: WHEN WE DON’T FEEL CAPABLE WE:


FEEL: Competent FEEL: Inadequate
DO: Exhibit self-control DO: Try to control others
Develop self-reliance and/or become defiant
May become dependent
Seek power

NEED: Develop Self-discipline

WHEN WE BELIEVE WE COUNT WE: WHEN WE BELIEVE WE DON’T COUNT WE:


FEEL: Valuable FEEL: Insignificant, hurt
DO: Contribute DO: May try to hurt back or show
own pain
Seek revenge

NEED: Assume Responsibility

WHEN WE HAVE COURAGE WE: WHEN WE DON’T HAVE COURAGE


WE:
FEEL: Equal, confident, hopeful FEEL: Inferior, defeated, hopeless
DO: Face challenges DO: Give up
Willing to try Use avoidance
Develop resiliency
NEED: Good Judgement

(Copyright© 1998 Amy Lew and Betty Lou Bettner. The authors grant permission to reproduce this
chart for educational purposes only, providing that the authors and publisher are15
credited.)
William Worden’s Tasks and Goals of Grieving
(Linked to Social Interest and 4C’s)

To accept the loss - How can I make meaning of my life without the person?

To experience grief - How can I work through all the emotions of grief which
distance me from life?

How can I connect to adjust to without the deceased? How can I learn new
patterns of living?

How can I be capable and manage my life?

How do I redefine myself?

How can I count?

To withdraw energy from the past and reinvest in relationships – How can I move
towards social interest again? How can I have the courage to engage with life
again?
Grief and Loss Course
ICASSI 2011
Margaret Nimmo-Smith

A person has the ability to help another only when there is a constant willingness
to feel one’s pain and suffering knowing that this rises from the depth of the
human condition which all of us share.

(Sandi Caplan and Gordon Lang,


Grief’s Courageous Journey)

It is not a sign of weakness to have a personal or professional support person or


group. It is a sign of intelligence.

Ruth Swain

16
Children’s Bereavement – 0 – 3 years

 Only awareness by absence of deceased.


 React by disruption of normal behavioral patterns.
 May react to adults
 Searching behaviour
 Helped by routine and sensitivity to needs and security

3 – 7 years

 Magical thinking – don’t realize the permanence of death


 Fear of abandonment
 Questions about what has happened
 Changes in behaviour
 Helped by routine and questions answered honestly and simply.

7 – 12 years

 Black and white thinking but becoming able to understand the permanence of death
 May appear to cope well but may have psychosomatic symptoms of depression
 Helped by taking symptoms seriously
 Allow expression of feeling, inform the school

Teenager

 Difficulty in recognizing personal implication of death


 May exhibit emotional and/or physical symptoms
 Loneliness, despair, joking/ sarcastic behaviour
 Helped by involvement in decision making, group work, privacy and respect, avoidance of
idealization of deceased.

Charter for Bereaved Children


1. Adequate information given clearly and simply
2. Being involved in decisions
3. Family involvement
4. Meeting others with similar experiences
5. Telling the story
6. Expressing feelings
7. Not to blame
8. Established routines
9. School cooperation Grief and Loss Course – ICASSI 2011
10.Right to remember Margaret Nimmo-Smith
17
Stages of Grief

Stages of Grief Duration Characteristics Needs Developmental


Task

Stage One: Several weeks or Mechanical Emotional distance. To protect self


NUMBNESS months functioning. from feeling
Insulation impact of loss.

Stage Two: Many months. Painful feelings: Intimacy, Acknowledge


DISORGANIZATION loneliness, depression, ventilation of impact of loss
weeping. feelings.
Sleep and appetite
difficulties.
Sorrow for self,
hallucinations.

Stage Three: Several weeks/ Occasional Encouragement to Create emotional


REORGANIZATION months/years peacefulness. face life tasks. relationship with
Less intensity of significant others
feelings. in new ways.

18
Unresolved Grief

1. Unresolved grief may be caused by :

 denying the loss


 geographical separation
 maintaining a false image of strength
 ambivalence toward the loss
 not identifying the loss
 emotional inability to handle the loss

2. Signs of unresolved grief::

 the person still has difficulty talking about the loss


 new grief symptoms are obvious in the anniversary of the loss
 the person refuses to visit the grave or a place which reminds him/her of the loss
 the person is experiencing persistent guilt, depression or low self-esteem
 the person continues to look for or expect the return of the lost person
 the person overreacts to minor events, acting as though they were major losses
 the person puts other relationships in jeopardy

3. Signs that grief has been masked:

 the person continues with unidentified depression


 the person continues with extreme overwork
 there is an excessive amount of giddiness or flippancy
 the person remains withdrawn
 the person continually lacks energy
 the person continually denies that anything is wrong
 the person acts with bravado and insists, “That doesn’t bother me.”

19
Some Things to Think About
When Working with Grief and Loss

Self-awareness:

• Know when you are grieving


• Know how you grieve
• Know your loss/grief “triggers”

Team and family support:

• Know when a team/family member is grieving


• Know how to support your team/family members
• Know how to accept/ask for help from your
team/family

20
Rituals Which Can Help You to Resolve Grief

 Telling the untold story in detail, noting the feelings as the story
unfolds, and recording thoughts and feelings in a journal.

 Looking at losses in your past that may have remained unresolved.

 Releasing unshed tears, the outward expression of your deep inner


feelings.

 Unlocking blocked anger, especially that is directed at the deceased


for having left you.

 Speaking unspoken words, saying unsaid goodbyes.

 Writing a letter to (or from) the deceased.

 Marking significant anniversaries, birthdays, and so on.

 Drawing a picture of your relationship(s).

 Forgiving the deceased for having abandoned you. Forgiving God


for having taken your loved one from you. Forgiving yourself.

 Visiting the cemetery to say goodbye or to talk things over with the
deceased.

 Letting go of the deceased, but honouring his or her memory with a


symbol.

21
Supporting Through the Stages of Grief

Shock

Be near the person and available to help. Do not take away tasks that she can do herself.
Encourage her when this experience recurs from time to time. Remember, complete acceptance
is a slow process.

Griever I don’t know what’s wrong with me. I just don’t feel anything.
Helper: Perhaps it’s good not to feel so much right now.

Griever: I’m just numb. I don’t believe what has happened.


Helper: It is really hard to accept this, isn’t it?

Panic

Assure the griever that his feelings of panic are normal, that he is not “cracking up.” Answer
only the necessary requests - keep everything simple. Encourage him in his movement toward
the reality that grief work is hard but that he will survive. It may be necessary in time of panic to
simply tell the person what to do with clear instructions. Talking things over may need to come
at a later time.

Griever: (Crying Desperately)


Helper: (Hold the person steadily and let the tears flow. Words are not necessary.)

Griever: Help me! Help me! I can’t stand to lose him.


Helper: You feel desperate right now. (Hold the person gently.)

Denial

Stand by and help the person face the reality in small doses. Be observant of times when
readiness appears on the surface. While denial should not continue for a lengthy period, we don’t
want to force the griever through this stage before she is ready. And remember, denial is often
mistaken for bravery.

Griever: Oh, this kind of thing doesn’t bother me.


Helper: You feel that everything is going to be all right.

Griever: Well, we’ll make it through without difficulty.


Helper: It’s hard to think about this right now.
22
Release

Sit quietly and allow the person to release pent-up feelings. Show approval for this display. Do
not try to stop this natural expression with “you mustn’t cry, your loved one wouldn’t want to see
you this way

Griever: I just can’t stop crying.

Helper: That’s okay, tears can sometimes be great healers.

Griever: I’m so tired, but I just can’t seem to give up my morning run.

Helper: Exercise can be a healthy form of release, if you don’t overdo it

Depression

Help the griever accept the naturalness of this feeling. Remind her that “this too will pass.”
Express genuine concern but confidence in her ability to make it through this difficult time.
Permission to experience depression in itself can make this stage of grieving more bearable.

Griever: I feel so lonely. I hate being alone.

Helper: Loneliness is a very painful part of losing.

Griever: I am so depressed. I shouldn’t feel this way.

Helper: Feeling depressed is normal when you have lost something so important.

Guilt

Encourage the person to talk about her feelings of guilt. Let the griever know that these are
natural feelings. Avoid any judgment such as “you shouldn’t feel that way.”

Griever: I wish I hadn’t said that.

Helper: We all say things we don’t mean.

Griever: If I had just studied harder, I might have passed that last test.

Helper: You must feel really disappointed about that.


23
Anger

Help the person realize that these feelings are part of the grieving process. Create an atmosphere
of acceptance in which the griever can comfortably ‘talk out’ his anger and resentment. Avoid
implying that he shouldn’t be angry, and try not to defend the person or thing which is lost.

Griever: I am so angry. I don’t understand why this had to happen this way.

Helper: Sometimes it’s okay to be angry, really angry, about things we cannot control.

Griever: I resent being left this way.

Helper: It hurts to have somebody leave you.

Returning

Allow the person to continue to talk about the loss. Do not avoid mention of the loss as though it
never happened. Demonstrate a personal interest in the returning process. welcome the person
“back”.

Griever: I am finally feeling better. I don’t feel so angry anymore.

Helper: It is good to feel that you are making it.

Griever: It seems that sometimes I see a little light coming through.

Helper: You’re feeling good about that.

Hope

Give warm affection, encouragement and support as the person begins experiencing life as
meaningful again.

Griever: I think I’ll take that trip in the spring.

Helper: Life is starting to come together for you again.

Griever: It’s been tough, but I think I’m going to make it.

Helper: You have learned to survive.


24
Acceptance

People should not try to carry the burden of grief alone. They must be encouraged to grieve.
Commend the person who has gotten to this stage of acceptance and discovered that he can live
again and love again. Walk with him as he discovers the rays of sunshine becoming steadier.
Affirm his grasping of reality and movement toward wholeness.

Griever: I wish it had never happened, but now that I have made it through, I have really
learned a lot about life.

Helper: It must feel good to be able to go on.

Griever: If I could have changed things, I would have. But I’ve learned that I can’t
control everything.

Helper: You will never forget the experience, but you have certainly taken it and made
it meaningful to yourself.

Physical Symptoms

Although not one of the 10 stages, you will want to be aware of this. Accept the reality of the
illness. The body does break down under excessive stress. Encourage medical care. Keep
listening as the person works his way through the barriers. Counselling may be indicated.

Griever: I feel so sick. I. I just don’t know what to do. I have a headache all the time.

Helper: Your body may be telling you that it’s time to take care of yourself right now.
You may want to see your doctor.

Griever: I am exhausted all the time.

Helper: You have been under a lot of stress. Perhaps you need to give your body some
time off.

Windows: Healing and Helping Through Loss


Mary Joe Hannaford and Michael Popkin.

25
The Grieving Letter

1. ANGER AND BLAME

I resent…
I’m outraged by…
I’m fed up with…
I can’t stand…
I hate…
I can’t forgive…
I needed…

2. HURT AND SADNESS

I feel hurt by…


I feel sad when…
I am disappointed because…
I feel awful because…
I want…

3. FEAR AND INSECURITY

I am anxious because…
I am afraid that…
What scares me is…
I’m worried about…
I want…

26
4. GUILT AND RESPONSIBILITY

I regret…
I may be to blame for…
I feel sympathy for…
I didn’t mean to…
Forgive me for…
I wish…

5. FORGIVENESS, UNDERSTANDING, DESIRE AND LOVE

I appreciate…
I realize…
I forgive…
I value…
I love…
I want…
I hope…

27
The Value of Time

To realize the value of one month,


Ask the mother who gave birth to a premature baby.

To realize the value of one week,


Ask the editor of a weekly newspaper.

To realize the value of one hour,


Ask the lovers who are waiting to meet.

To realize the value of one minute,


Ask the person who missed the train.

To realize the value of one second,


Ask the person who just avoided an accident.

To realize the value of one millisecond,


Ask the person who own a silver medal at the Olympics.

Treasure every moment that you have!


Yesterday is history,
Tomorrow is a mystery,
Today is a gift-
That’s why it’s called the Present!

Unknown

28
Bibliography

Stephen Jenkinson. How It Could All Be: A workbook for dying people and for those who
love them. Impression Printing, Canada. 2009.

Doreen Virtue and James Van Praagh. How to Heal a Grieving Heart. Hay House, Inc.
Carlsbad, California. USA. 2013.

Judith R. Bernstein. When the Bough Breaks: Forever after the death of a son or daughter.
Andrews McMeel Publishing: Kansas City. 1998.

John W. James and Russell Friedman. The Grief Recovery Handbook: The Action Program
for Moving Beyond Death, Divorce, and other Losses (Rev. ed.). Harper Perennial: New
York. 1998.

J. William Worden. Grief Counselling and Grief Therapy, Fourth Edition: A Handbook for
the Mental Health Practitioner. August 2008.

Elisabeth Kubler-Ross and David Kessler. On Grief and Grieving : Finding the Meaning of
Grief Through the Five Stages of Loss. June 2007.

Elisabeth Kubler-Ross. On Death and Dying. June 1997.

Elisabeth Kubler-Ross and David Kessler. Life Lessons : Two Experts on Death and Dying
Teach Us About the Mysteries of Life and Living. November 2001.

Elisabeth Kubler-Ross and Todd Gold. The Wheel of Life : A Memoir of Living and Dying.
June 1998.

Elisabeth Kubler-Ross. Death : The Final Stage of Growth. June 1997.

Elisabeth Kubler-Ross. Questions and Answers on Death and Dying. June 1997.

Elisabeth Kubler-Ross. To Live Until We Say Goodbye - Paperback. June 1980.

Elisabeth Kubler-Ross. Working It Through. June 1997.

John Bowlby. A Secure Base: Parent Child Attachment and Healthy Human Development.
1988.

John Bowlby. Separation: Anxiety And Anger (Basic Books Classics) Volume Two.
December 1976

John Bowlby. A Secure Base: Clinical Applications of Attachment Theory. August 1998

Colin Murray Parkes, Pittu Laungani and William Young. Death and Bereavement Across
Cultures. January 1997

29