Grief : Its Simple & Complex - Kilkenny Bereavement Support

Report
Recovering from Loss & Grief
Dr Timothy Dunne
Consultant Clinical Psychologist
Public Lecture delivered on behalf of Kilkenny
Bereavement Support Group
Wednesday 10th September 2014
Outline
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Introduction
Definition of terms
Models of Grief
Grief & Complex Grief
Grief & Loss
Myths about Grief
Suicidal Ideation
Healing & Recovery
Terms
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Grief = Emotion
Loss = Experience
Mourning = Process of Grieving
Bereavement = Social & Cultural Processes
Complex Grief = Any loss which is
accompanied by obstacles to psychological
healing
Simple / Complex Grief
• Young V Older person
• Natural causes V Man made (murder/suicide)
• Natural disaster V Man made (train/plane crash)
• Sudden death V Gradual decline
• Ambivalent Loss – where there are no remains to
bury
Losses
• Permanent physical injury or disability
• Any change in health status (eg) diagnosis of
long term condition such as diabetes, cancer
• Any major Life Event, even positive ones such
as house move, new job, marriage & divorce,
emigration
• Ageing & retirement
• Financial losses & reduced standard of living
Models of Grief
• Kubler – Ross (1969)
• Warden (1990)
• Dual Process model (2010)
Kubler-Ross’ Model
• Shock/Denial
• Anger
• Bargaining
• Depression
• Acceptance
Some Difficulties
• The model was first used to describe stages in
acceptance in the dying not in the bereaved
• Not everyone goes through every stage
• The stages are iterative rather than
progressive
• “Is” can become “ought”
• Too prescriptive, rigid and passive
Warden’s Tasks of Mourning model
• To accept the reality of the loss
• To experience and process the pain of grief
• To adjust to life without the loved one
• To relocate the dead person emotionally and find
an enduring connection with him/her & embark
on a new life
Some difficulties
• Perhaps too prescriptive also
• Can appear to minimize the individual
experience of grief
• Fails to recognize that the powerful nature of
grief which may only be handled in
manageable chunks
• People can get “stuck” on a particular task or
stage
Dual Process model (DPM) of Grief
(Stroebe & Shear, 2010)
• Based on concept of “Oscillation” whereby the
bereaved person confronts the loss at times and at
other times avoids it
• The person “swings” between facing the loss and
restoration or rebuilding their life
• “Time out” is an essential feature of this model as
continuously facing grief is “arduous & exhausting” –
“defensive exclusion” is vital at times
• This model takes account of other stressors in the
person’s life such as bringing up children or financial
pressures
Cultural Assumptions
• Our Western culture (and helping professions)
have arrived at a “common wisdom” that it is
generally healthy to focus on pain of grief and
distress and to express it openly
• Suppression of same is thought to be
unhealthy & not to be encouraged (“stiff
upper lip”)
• However, research (White, 2013) does not
support this “common wisdom”
Cultural Assumptions
• In addition to the need to face grief & pain there
is also a natural tendency to avoid the reality of
death
• This should be factored in to any intervention
process
• Avoidance can have a valuable protective effect
for someone struggling to make sense of an
overwhelming loss
• This is now standard procedure in Trauma
treatment (ie) a “titration” approach
Cultural Processes
• Irish Wake/ Month’s Mind
• Used to have outward signs/symbols such as
wearing black for a certain period or diamond
on a jacket sleeve
• Jewish Shivah (7 days); Shloshim (30 days) and
Shneim asar Chodesh (12 months)
• Most people underestimate how long it takes
to fully get over the death of a loved one
“The Deal”
• In complex or traumatic grief the person may
often, unconsciously, make a deal with the loved
one which goes like this:
• “I will continue to suffer pain and loss in order to
prove my love for you because if I don’t feel this
pain, it means I don’t love you or if I let go of my
grief it means I have forgotten you”
• The same can occur with self-blame especially if
the survivor believes that they somehow are
responsible for the death of the loved one
Complex Grief
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Long lasting
Intrusive images or thoughts of the loved one
Pre-occupation with the deceased
Social withdrawal & detachment
Pining or yearning for the deceased
Have trouble accepting the death
Inability to trust others
Excessive bitterness
Prolonged feeling that life is empty &
meaningless
Complex Grief
• Are you having trouble accepting the death?
• Does grief interfere with your life?
• Are you having troublesome thoughts /images
of the deceased?
• Do you avoid doing the things now that you
used to do with your loved one?
• Are you feeling cut off or distant from others
since the death?
Myths of Mourning
• Grief declines steadily after the death
• All deaths and losses produce the same type
of grief reaction
• The intensity of emotions experienced and
the length of time spent grieving is testimony
to how much love there was for the deceased
• Grief & loss are only about death
• Time heals all wounds
Suicidal Ideation
• Suicidal ideation or wanting to die occurs in up to
65% of those bereaved
• Complex grief produces 5 times as many suicidal
thoughts
• Some people see suicide as a way of gaining
control over the pain
• Sometimes people put themselves at risk or
neglect themselves or act with less concern for
themselves or in a way which increases the
likelihood of accidents or death
Thoughts & Beliefs
• I didn’t do enough for her
• He died without knowing how much I loved
him
• I cant stand not knowing if he suffered pain
• It was unfair how she died
• I don’t know if he is at peace
• Its not right for me to enjoy life without her
Healing & Letting go
• Not everyone needs Bereavement
Counselling!
• Social support is important – find one person
who you can talk to without embarrassment
and who is a good listener
• Compassion for yourself is also important
• Anniversaries, birthdays, weddings, Christmas
are all occasions which can trigger strong
emotions of sadness & loss
Healing & Letting go
• How has life changed since your loss?
• What never happens now as a result of the loss?
• What do you miss most about your life since the
loss?
• What do others comment on since your loss?
• What has surprised you most about your
thoughts & feelings?
• How has this impacted on your view of yourself,
others, relationships, life or the world in general?
Healing & Letting go
• If you feel that it is taking you a long time to
recover, then consider seeking professional help
• Use your memories and memorabilia of the loved
one to support yourself
• Create a lasting memorial to the loved one such
as planting a tree, make a donation or start your
own charity/fundraising
• Choose a significant picture/image and have it
commissioned by a professional artist

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