 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. So I'd like to welcome everybody today's presentation. We're going to be talking about grief. Now that doesn't sound like the most cheery presentation for a Thursday, getting ready to go into a weekend and coming up on the holiday season. But unfortunately for a lot of people, grief is a really big issue during the holiday season. So we're going to talk about some ways we might be able to help our clients and people we know that don't happen to be clients, deal with grief and get through the holidays and all that kind of stuff. So over the next 45 minutes, we're going to define grief, conceptualize grief in terms of any loss. It's not just about death. Identify how failure to deal with grief can impact a person and explore the stages of grief. So grief is a label assigned to all of the emotions associated with dealing with any kind of loss. And when I talk with patients who are dealing with grief and most everybody by the time they get to be grown ups, we've had a lot of losses. Now that may not be a lot of deaths, but we've had a lot of things kind of change. And some of those things can be physical. You may lose physical things. You can lose, you know, a pet can die. You can lose maybe your favorite car. Maybe that's a big deal to you. I remember when I got rid of my first car and it was just like, oh, but it was my first car. You can lose abilities, whether it's eyesight, your ability to walk, any physical ability you may lose. And this is true too with an aging population as they lose some of the abilities they had when they were younger. I know right now I'll go to the gym and I expect to perform at the level that I performed at when I was 20. And my husband's like, no, your heart rate is not supposed to go the same rate it did when you were 20 years old. Your body can't handle that anymore. And I look at him like he's got three heads and I'm like, oh, yes, it can. Don't tell me that. I'm not ready to accept that loss yet. My grandfather, when as he was getting older, developed Parkinson's disease and one of his hobbies was making miniature dollhouse furniture. And he made beautiful furniture. But as his Parkinson's got worse, he couldn't control the small movements that he needed to do in order to make the itty bitty parts to the itty bitty furniture. And that was huge for him because he didn't have a lot of skills. He had a sixth grade education. He was a painter by trade. And once the Parkinson's set in, he couldn't do that either. So he had a lot to deal with as far as his life was changing and he had no control over it. And we can also lose freedoms. I'll just kind of leave that for discussion later. Some things we can lose in terms of self concept, your roles change. And it's not necessarily that you lose them. They just go away. When children leave the house, people go through emptiness because you're not doing the same thing anymore. And for some people, it's a big deal for other people. They're just like, I can't wait for the kids to get out of the house. But depending on your attachment to that role and how much it changes, there could be a huge sense of loss when that happens. The same thing happens when people are going through recovery. And that's one of the reasons I try to encourage a lot of my patients not to say, I am an addict or I am a bulimic or I am something else. Because if you are that, then when you get rid of that symptom or condition or whatever it is, then you're essentially getting rid of part of yourself. And that's hard to grieve or hard to deal with. Yes, it can be grieved. And because people have identified with it for so long, and it has been part of who they are for a while. Sometimes people have to go through that grieving process to say, okay, I'm not doing that anymore. I'm not the same person I was six years ago. Your values can change. And there can be a grieving process associated with that as you go from being optimistic about everything and just wide-eyed and bright-eyed and bushy-tailed every morning to, okay, you know, it's going to be a good day. But I know that everything's not going to go right. So those rose-colored glasses have come down a little bit. I try not to take them off completely. Your worldview can change. People lose innocence. And you don't have to just be a victim of crime to lose innocence. I'm not saying that. But I'm saying as we grow older, and it kind of dovetails on what I just was talking about, we realize that things aren't as cut and dry as we thought. We realize people that we idolized aren't perfect. Oh my gosh. We realize that, you know, there are a lot of things in life that aren't fair. And dealing with the accepting the fact that life isn't fair is a big issue for a lot of people. People can lose their sense of safety. Now, this can be because of victimization. This can be because of being in the military, being in law enforcement, or for some people, it can just be from watching too much news and television. And, you know, you're kind of going, what? They've done a lot of studies, especially after 9-11 and after Katrina. They found that there was a lot of secondary traumatization of children who were watching the news and it was repeatedly showing this for weeks and months on end. So the children felt like the world was a lot scarier than it really was because they weren't conceptualizing that this is a tape that was made three weeks ago. And, you know, I know that the aftermath of 9-11 and Katrina went on for a long time. But for the children that were watching it, it just seemed like the world was falling apart. So as parents, we needed to work with them on helping them understand that they were safe. But we also needed to help them kind of fit that into their world view and fit that into their schema about the fact that, you know, yeah, the world is not just this perfect happy place. There are dangerous things. Dreams. How things should be. How many times have you worked with a client or heard somebody say, you know, I should have had a better father or that person was not the kind of mother I should have had. Or I deserve to have this, that or the other thing. Well, it didn't happen. So we need to take that hope, that dream that you were holding on to and talk about it and help you figure out how to integrate it into future life. This can really be triggered if you have two parents, maybe you grew up in a two-parent household and one parent dies. And all of a sudden you're like, okay, you know, I'm 35 years old. I was still hoping for Warden June Cleaver and it never materialized. And now my dad's dead. So there's no way it can materialize. And that can be sort of the proverbial straw that broke the camel's back. And socially loss of relationships, whether it's an intimate relationship or a friendship, or even coworkers. When you move and you have to change your neighborhood, you have to change the people you work with. There are going to be some people that you're going to miss, but it's also developing a whole new social circle. There's a lot of stress that goes along with that change. You've lost the familiarity. Maybe you moved to a whole new city and you've lost the familiarity with everything that you used to do. All the places you used to go, you have to learn new routes. There's a lot of stress associated with accommodating to new situations. So all of these things can prompt sort of a grief reaction. Now the level of grief is going to be more for some and less for others. But we don't want to minimize the stress or grief associated with these losses. So briefly the stages of grief as Kubler-Ross identified them. Most of us probably went through this in beginning counseling denial. People look at it and feel numb. It's just like, no, this isn't happening. It's a dream or they're trying to find alternate explanations for it. Then anger, because they have no control over the situation. Remember, we've talked about anger as being a reaction to a threat trigger. So the person starting to realize it happened, but they're also realizing that there was a threat, some threat of loss of something. Then you move on to bargaining. If I fill in the blank, then I'll wake up and realize this was only a bad dream. Depression is when the person realizes that they're awake and it's not a bad dream. It's reality and a sense of hopelessness and helplessness that's in. Followed by, which is where we hope to get them, acceptance, which can be radical acceptance that the loss occurred and determining how to proceed from there. We're not saying you have to be okay with it. We're not saying you have to be happy that it happened. Sometimes things really stink, but at a certain point you have to decide whether you are going to move on or you're going to be stuck. One of the key points in going through the stages of grief and maybe we should call them phases instead of stages, because people don't go through them linearly and then poof, they're done. People go through them sort of circularly. Denial. Usually people don't go through that a whole bunch, but I know after my father passed, we had already moved and I would see him maybe once a year, once every other year, and then after my kids were born a little bit more often than that. But as long as I wasn't going down to South Florida, you know, in my little happy world somewhere, he was still alive. So I was still in this world of denial. Now rationally, I knew he wasn't, but as long as I wasn't confronted with the reality, I'd like to stay in my happy little world. So I would go back and forth between denial. Anger. Like we've talked about before, if anger works for people, if it's been effective, then they may go back to anger more often. They may stay angry that they didn't have control. They may stay angry at themselves for things they think they should have done or could have done. They should have said or could have said. Bargaining may come, may go, and depression. So some people aren't as comfortable with anger and they stick in that depression area where they're hopeless and helpless because they don't have the energy or they don't feel it's worth the effort or they don't want to put forth the effort to fight or flee the anger anxiety thing. So they get stuck in helplessness and hopelessness. Then we move on to acceptance. Does that mean the person's done? No. Oh, I'm sorry. Hate to break it to you. They're not. Why? Because they'll get to acceptance and then all of a sudden they'll be reminded of it again. Have you ever gotten an injury and, you know, it really stinks. You're icing it, heating it. You're going through whatever you need to do to get it better for a while. And then you start to get the point where it's feeling better and you don't really notice it much. You know, you've just accepted that it hurt and you're starting to get back to doing your normal thing. And then somebody comes along and pokes you right where you got hurt and you're like, okay, not healed yet. That's the best analogy I can kind of give for when we're dealing with grief. People may be able to accept it in a general level, but every once in a while there's going to be a poignant reminder like a holiday or an anniversary, or maybe even a smell of somebody's perfume or cologne or something that will throw them back into the stages of grief. Is it going to be as bad as the first time? Usually not. Usually it gets a little bit better every time they work through it. But helping clients understand that they are going to feel grief again and helping them understand that that's okay. They're not going to be stuck there forever. And every time they go through it, it'll get a little bit easier. Again, it may never be okay, but they're going to figure out how to make it work in their life so they can move on without feeling guilty or feeling depressed about the situation forever. Exacerbating and mitigating factors. How people react in a crisis depends on six things in general. How close the situation was to them. Physical proximity. If something happens to me, it's going to affect me a lot more than if something happens on TV and I see it. True. The other thing that may be at play in here is emotional proximity. Something that happens to someone who's really close to your heart may have more grief power, if you will, than something that happens to someone that you know may be your neighbor next door. But it's not your best friend in the whole world. How many other stressors the person experienced in the last year? So why do we care about that? And at this point, most of you are probably muttering under your breath, vulnerabilities, and that's it. If you have already sort of spent your energy reserves on 18 other stressors up until now, then when this one happens, it's going to feel a lot more overwhelming because you're out of gas. Mental health issues and or effective coping skills. If someone has current mental health issues, then obviously it's probably going to exacerbate those. If someone had mental health issues and they're in remission or they're under control or whatever you want to call them, and they have effective coping skills to deal with it, then they're going to be better off. It doesn't necessarily mean they're going to have a full blown relapse of their mental health issue or substance abuse, but it's important to understand that even if they're in remission or doing well, unless their coping skills are really, really spot on, they're probably going to need more social support and they're probably going to need more feedback on what's going on, which takes us to social supports. If you have them, it's going to help. It's going to help buffer. Social supports can be there to help you make meals when you don't have the energy to make meals. Social supports can be there to help you get out of the house if you just you're depressed and you can't get moving. Social supports can be there to go, hey, I've been there too, or maybe I haven't been there, but let me hear, let me understand how you feel. Why don't we talk about it and I'll be here for you. I can't make it better, but I'll be here for you. Understanding the loss. If the person understands what happens, it may make more logical sense. If someone is, you know, I talked about emptiness earlier, as parents, we know that's going to happen. And like I said, as parents, sometimes we're going, I can't wait till he's 18. Other times as parents, we're just kind of holding on. I was going through baby pictures today and, you know, I'm really not eager for my kids to move out. But I understand that it's coming and I can prepare for it and it's a natural course of things. My stepfather, when back in, you know, when he was a young man, very young man on Christmas Eve, the Christmas lights caught fire and his entire family died in a house fire on Christmas Eve. Now, how can you understand that loss? That's not one you can predict. It's not even in the normal order of things. So that one's a lot harder to deal with because you don't even see it coming. You get blindsided. And how much control or responsibility they feel like they have in a situation. You know, again, with my stepfather, he feels an immense amount of guilt because he hung the Christmas lights. And, you know, he goes back and thinks of all those shoulders and coulders and all that kind of stuff. And it's been 60 years since this happened, but it still hurts a lot. And I'm not saying that it shouldn't, which is why, you know, again, I don't want my clients to think that, you know, you go through it once, you deal with it and you're going to be good with it. Because sometimes that's just not how it happens. But you get to the point where it's not ripping you up inside. The impact of unresolved grief. So what about the people who never get to acceptance? And, you know, every time they're thrown back into the, into the grief cycle, they get all the way up to depression. And then they just stay there. And then they get thrown back into the grief cycle. What happens? A lot of anger. Shoulders, coulders, and if onlys at theirs themselves for what they could have done to prevent it. Or what they should have done, you know, maybe I should have told them I loved them before I left the house. So we need to look at that. What, what kind of self-talk are you saying to yourself about this situation? At others for things they should have done to prevent it or things they should have done to help. And at their higher power. A lot of people when they go through a grief situation, or maybe they have multiple losses. And at a certain point, they're just like, really? How can this be happening? I don't understand. I don't get it. And at that point, sometimes they turn to their higher power and they're just like, how can you let this happen? Then they feel guilty about being angry at their higher power. So there's a whole set of things to deal with in terms of anger at self, at others, and at their higher power if there is one that they believe in. Now, one of the things that I have seen is a lot of clients, not the majority. But I've had a lot of clients who've had so many losses that they just give up and they're like, there cannot be a higher power. There cannot be a controlling force if this is happening. Therefore, I am going to doubt the existence and or become atheist. So I've seen people go from being spiritual or religious to atheist to agnostic or spiritual or religious again. It doesn't always happen. But figuring out where the change and why the change in belief system happened if they want to go there can be helpful for some people, especially if they're working a 12 step program. Depression, the hopelessness and helplessness and I just, I don't know how to go on. You know, I know I can't control it. I've gone through the anger. I don't have the energy to be angry anymore. I just, I'm depressed. So I'm hopeless that I can fix anything. I'm hopeless that you can fix anything. And I'm hopeless that my higher power is going to do anything about it either. Think about being in that person's mind for a minute, not for very long because it's not a not a good place to be. But I get it. One of the things as clinicians we can do is help them focus on what things about that they can control, you know, as far as, you know, when my father passed, I couldn't control the fact that he passed away. It's just the way it was. But I do have control over whether I remember him, whether I talk about him, whether I make sure my kids know who he was and have them exposed to his pictures and memories and all kinds, kinds of stuff like that. I do have control about whether his memory lives on. So at a certain point, and when the nerves are raw is not the time to do it to say, All right, well, let's look at the positive side of this. But once a person gets to that point where they've been in, they've gone through some depression, and they're ready to move on, then we can start look at looking at What does this loss mean to you? And what parts of it do you want to carry on with you? What are the good parts? Because obviously you're, if something isn't meaningful to you, if you don't care about it, you're going to let it go. And it's not going to trigger this huge grief process. So what is it that is important to you that you either want to carry on or learn or remember denial is not just a river in Egypt had to say it. Sorry. Denial is the mind's way of protecting you from what lies ahead. And I've had a lot of clients over the years. And when they come in, especially for residential and IOP, one of the first things they do in phase one of treatment is an autobiography. And I've had clients come to me before and go, I've done my autobiography before. Can I just bring it in? And my answer is always, No, no, you need to start over again. And they look at me kind of quizzically. And I tell them a story that one of my favorite supervisors told me at one point, and it goes something like this. There was a counselor in training. And he went into his supervisor's office one day. And he said, I'm here for supervision. I just, I don't know what to do with this client. And told told the supervisor the story. And the supervisor sat back and folded his hands over his belly and said, hmm, okay, goes fidgets in his desk and pulls out a picture. Hands to the guy, the picture, it's a picture of a fish. And the therapist is like, what? Why are you giving me the picture of a fish? And the supervisor says, go home and draw that for me and bring it back. Dutifully, the therapist walks out of the office and says, all right, I trust this guy. There's got to be a reason behind this, but I think it's kind of out in left field. I'll do it. So he did it. He came back the next week. Same thing. Still having the same problems with the client. Told the supervisor, the supervisor takes the guy's drawing, looks at it, puts it in his desk. Says, go home and draw the fish again. What? Okay. So this happens two or three more times. And finally, the therapist is like, you know, Mr. Supervisor, I have been trying to be very patient and I've been trying to understand what I'm supposed to be getting out of this in terms of helping me help my client. Are you trying to teach me patience or I don't understand. And the supervisor pulls out all five pictures that the guy had drawn of the fish. And you know what he saw? Five very different fish. Because every time the therapist drew it, he saw something different or saw it in a different light. The take home from that is the fact that our mind protects us or our mind lets us see what we're in the zone to see. And sometimes, you know, in terms of like doing an autobiography, clients will write their autobiography and their minds will let them remember what they can handle. There's some stuff that is going to still stay locked away back here because it's just too much right now. And if we go there, it's going to feel overwhelming. So I have my clients write their autobiography all over again from scratch. I don't want them to add on to something they already have because they'll get stuck in whatever framework that was, which is why the supervisor didn't say, go add on to this drawing for me. Tell me what else you see. He wanted to see all the different perspectives. Now, autobiographies are long, so I wouldn't suggest making clients write them and rewrite them if in the same treatment episode. But it is interesting to have them bring in their old autobiographies and compare them and talk about why it is that they're remembering different pieces. Or you'll have clients that'll come back in the middle of a session and they'll be like, I don't know why I didn't remember that until now. That's ripe for discussion. Well, let's talk about that. What part of that situation that you just remembered is meaningful to you? And in what way do you think you weren't ready to know it until now? What kind of revelations are you going to have from this? So the action strategies in denial when you're working with a client who is recently, recently had some kind of a loss is facing the loss. And reminding themselves that it happened. And this isn't something that they want to get up and do like every hour and go, okay, you know, my, my such and such passed away or I lost this or I lost my house. No, you know, let's not throw them into depression. But when we're talking to them in therapy, it's important to make sure they maintain a present focus. And if it's something that they lost, they talk about it as something that they lost. If it's someone, for example, who passed away, they don't talk about that person in the present or future tense, like he does this or he will do this. He used to do this, helping people start to change their vocabulary to integrate the concept that that person or that thing or that dream is gone. So then we move on to anger. And sometimes if you push them too hard and denial, you will hit a wall of anger. Be aware of it. If they start getting irritable, back off preferably before you hit full blown anger. Anger is people's way to push other people away to avoid getting hurt again. If they were in a relationship and it broke up, that's a loss. So they may be angry. They may be angry at the other person. They may be angry at themselves. They may be angry at a lot of people or things. Why? What is the purpose? What's the function? Anger is protecting them. It says don't do that again. That was awful. We don't want to do that again. Before they can get into another relationship and accept the fact that this one is gone, that anger is going to have to come down. But right now they are on high alert. When people are angry, they may blame others as an outlet for their own helplessness. Somebody somewhere could have prevented this. I need to find somebody to blame for it. They may blame themselves to try to regain some control or prevent it from happening again or make themselves suffer. And they may start questioning their belief system and world schema. If there's a tragic loss. If maybe they are, you know, John Smith and John Smith goes to work every day. John Smith works his butt off. John Smith tries to do every right thing. And then John Smith one day is handed a pink slip. He's laid off which sets off a cascade effect of things where he lost his job. And then he ultimately lost his house. And, you know, now he's living in a homeless shelter. And he's sitting there going, wait a minute, wait a minute, wait. I was always taught if I did the next right thing and I was a hard worker and I did, you know, did my part that everything would be okay. What happened? So John Smith may have a lot to think about in terms of reconceptualizing life. Action steps. Identify what the loss means to the person. If they lost their job. What does it mean to them? Now part of that can be how the job was lost. If they were laid off, if they were fired or if they retired and voluntary retirement can be just as grief provoking as involuntary termination. There are a lot of law enforcement officers and soldiers who do not do well when they retire because they are not moving past that grief. They get stuck in that phase of I don't know who I am now. If I'm not a soldier or if I'm not a cop, what am I? Because that was their life. So they may be angry. So what other losses come with losing your job? Losing financial independence possibly. Losing your social supports from that job. You know, maybe you had friends there and you don't have them anymore. You know, you can make a list of what ancillary losses happen, the cascade effect. If a person loses a parent, what does that mean? That means they may have lost a parent. It also means that they may have lost a best friend. It may mean they have lost any hope that they could have that Warden June Cleaver family that they always hoped would happen. It could mean that they've lost financial security. Maybe the parent was financially supporting them. So we need to look at what losses are happening. And victimization. When somebody is victimized, they lose a sense of safety. Now it can be momentary or it can be long term, but they lose a sense of safety. There are a lot of things that people who are victimized may be angry about. So, you know, again, it's important to ask the client, what does this mean to you? What effect does this loss have on your life? What are you angry about? What are you scared about? You know, if you lose your job, and I'm not going to go through all three again for time's sake, but if you lose your job, you may be scared that you won't be able to pay the bills. You may be scared that people are going to think less of you because you don't have as much money anymore. You may be scared that you won't find another job. And those are all terrifying. And again, even if it's a voluntary separation because of retirement, it's terrifying if maybe you're retiring and you're like, I can't live on my pension, so I'm going to have to find another job. But I've never done anything else but put on a uniform. And finally, depression. A person may have anger, fear and depression going on all at once. If you're angry and scared for long enough, you're going to run out of gas and you're just going to like lay down and go, I can't deal. So we don't want to assume that because someone's depressed, they've worked through all the other stuff. They may just have run out of energy to feel that upset anymore, you know, turn down that sensitivity knob. So we want to ask them, you feel helpless to do what? You feel hopeless to do what? Tell me this depression, you wake up in the morning, what is your first thought? What has changed in your life? And what is it that you look forward to? Likewise, what is it that you used to look forward to that's gone now? And what do you think you can change? What is it about this situation that you might be able to change? We need to validate people's feelings of anger, fear and depression. You know, maybe their loss doesn't seem like a big deal to you. It's like, okay, fine, you retired, get another job, sit on the couch and eat bonbons. Hey, I'd love to retire. That's not helpful. For a person who is turning their entire life upside down, it's overwhelming. So we need to validate what their feelings are and where they are. But we also want to help them examine their beliefs about what's going on, what they're angry about. For all or none thinking, emotional reasoning, fallacy of fairness, and oh, I have emotional reasoning twice. Hey, score for me. Just because they feel like something's hopeless. Does that mean it's hopeless? Just because they feel helpless right now. They wake up every morning and that's the first thing they think about whatever the loss is. Yeah, that is, it really stinks. I am not going to invalidate that. However, maybe there's some things we can try. So it doesn't, it's not the first thing you think of when you get out of bed in the morning. So there are alternatives. So we can start looking at some of that emotional reasoning and looking to see if it's based on fact. We can also look at the all or nothing thinking. Everybody always leaves. Or every time I get my hopes set on something, it all goes wrong. So I'm just not even going to try anymore. And then we move on to hopelessness and helplessness and depression. Yes, I skipped right over bargaining because bargaining seems to be in my experience working with people. It comes and it goes, but it's not a place people generally stay stuck. If the bargaining is going to happen, a lot of times it happens before the loss. If I do these things, maybe I will be able to get hired again. If I do these things, maybe there will be some divine intervention or a miracle and my child will spontaneously recover. A lot again, a lot of the bargaining comes happens at the diagnosis where the impending loss is coming. But once the loss has happened, my experience has been that a lot of people don't go back to that bargaining as nearly as much and for nearly as long. There are days they keep hoping that it's going to be a dream, but then they realize it's not. So hopelessness and helplessness under helping them understand that reality has happened and it can't be changed. That's true. What can we do? What cannot be changed? Like I said, I couldn't bring my daddy back, but I could make sure that his memory lived on. So if you've lost a parent, what else can be carried on? And how can you carry that on it? Through pictures, through memorials, through... There's a whole host of things to help remember a person that's been lost. Now, if you've lost a job, maybe you can't change that, but what can you do henceforth and forevermore? Let's talk about retirement because if you've been terminated a lot of times, you can go back into the same field and Bada Bing is just a different company. If you've retired, a lot of times that means you've reached the end of that career path. So you need to find a different career or maybe just a different job, something to do to fill some of the hours during the day so you're not sitting at home watching TV in your easy chair all day. So what is it that you want to do? So let's look at how much money do you have to make and how much time do you want to spend? And then let's look at what options you have and see if there's something exciting out there you might be able to get engaged in. If you're victimized, you know, if you are a victim of assault, whatever kind of victimization, burglary, you know, your sense of safety is going to be kind of gone. If you think, you know, I'm never going to feel safe again, I'm never going to feel safe walking to my car again. Well, never is that all or none thinking. And there's some emotional reasoning in there because you're scared, you're terrified right now and you have every right to be. Let's start keeping a log of every day that goes by that nothing bad happens or that nobody breaks into your house. Let's start looking at some objective facts about safety in your neighborhood. And, you know, is somebody going to break into your house again? How likely is that? A lot of times giving people objective information helps them feel a little bit better. It doesn't do a lot because they're saying, Oh, great, I was the one house out of 42 in my neighborhood to be burglarized in the five years. But it can give them a bit of a different perspective about how likely it is to happen again. Having them see that generally, you know, and even look back over their life, you know, this one incident happened and it was awful. I'm not taking that away. But leading up to that, and yeah, I said the bad word, didn't I? Leaning up to that. How many times did you walk to your car safely without getting assaulted? You know, more times than not, you were just fine. So this was a really awful situation and we've got to deal with it. Does it mean that you need to live in fear? Henceforth and forevermore. And acceptance. Accepting the reality of the loss means exploring how life is going to be different and the same since the loss. Again, when I think about my father, things are different now. You know, we don't get out of his house for Christmas. And yes, I can't pick up the telephone and call him and go, Daddy, I got a problem. What's your opinion? Not how it works anymore. But all the things that he taught me over the 20-some odd years that I did have him, I've got stored up here. So I kind of go back into that. Well, what would he say if he were here? We can explore ways, you know, if people lost their job, how's life going to be different now? Yeah, you might have to play your finances a little closer to the vest. But how's it going to be the same? How likely is it that you're going to start losing all the things that are important to you? Make a, for some clients, they want to do it on paper and pencil over time. For other clients, a whiteboard, I like using a whiteboard in session when we're talking about pros and cons and making lists. A, because I'm visual, so it helps. But B, because it gives them something to look at, and as they see the list of good things building and the list of drawbacks or whatever you want to call it, not building as quickly, then they start getting a visual representation of what might be happening. So the laws that can be prevented from occurring take proactive steps. So maybe you were, somebody was assaulted when they were walking to their car in the parking garage at night after work by themselves. Okay, well, they can have one of those pepper spray or an alarm thing on their key chain. They can be more alert when they're walking to their car. They can have someone walk them to their car. There are a lot of different steps they can take. They can also get involved in advocacy groups like rape prevention, take back the night. There are a variety of groups out there for people who have experienced some type of victimization that help them not only feel less isolated, but it also helps them feel empowered to be able to tell their story and help other people not have to experience the same thing. Like I said earlier, grief is not a linear process. Most people experience grief surrounding a loss for at least a year. Holidays, anniversaries and reminders. So you go through one year starting in January and we'll see how I remember my holidays now. You have Valentine's Day. You have Fourth of July. Then you have Halloween Thanksgiving, Christmas, birthdays, anniversaries thrown in there. And for some people, other holidays like Memorial Day may be especially poignant. But it's important to understand that that lasts an entire 12 months before you even hit that anniversary or trigger period again. So one year at least before the person gets into a better rhythm. Anniversaries and it can be, you know, the anniversary that you met can be the anniversary of the breakup. It can be the anniversary that someone was diagnosed with a terminal illness. There's a lot of different anniversaries, especially for people who tend to be more sentimental. It may be more poignant for them and there may be more periods or anchor points along the timeline. You can have them draw out a timeline in counseling and go, okay, let's talk about what might be triggering for you. Or what might be, which days might be difficult for you over the next year and put them on the timeline. And if you notice there are two or three or four clustered together, then you can talk about the fact that, all right, you're getting ready to go into a really tough period. So how are you going to prepare for that? What can you do to eliminate vulnerabilities? What can you do to be kind to yourself? What can you do to make this as easy as possible? You know, for a lot of people going into Thanksgiving and Christmas if they've lost a loved one is really difficult. Whether it's through a relationship breakup or a death, holidays are times when families get together. So if you're not getting together with that person, it's kind of like rubbing salt in a wound. And they come kind of back to back. So you've got to say, all right, how are you going to deal with this? What are you going to do so you are happy and you can keep moving forward? Yes, it's going to be unpleasant. Is sitting alone by yourself on Thanksgiving or Christmas or Hanukkah. How you really want to spend that time. And, you know, let's talk about that, but let's talk about what you want your life to look like during that period. Other things that might trigger people in a grief situation. People, they see other people, you know, maybe a friend of a friend who was, you know, your ex-boyfriend's best friend can be a trigger. You may see that person out if it was a relationship breakup. If you used to work somewhere and, you know, you left that place and you miss working there. There was some grief associated with that termination and you see one of your old coworkers. It can be a reminder and it can kind of take you right back there. And it'll hurt. It'll sting. Helping people develop some basically emergency coping mechanisms. If all of a sudden there's a trigger there and they're like, oh, this is this painful. Places, places you used to go with someone. Places that, you know, maybe you drive past your old workplace and it makes the pity your stomach hurt. Okay, how do you deal with that? Things, you know, you can think of all kinds of things that are going to remind you of losses and the media. The media can be news reports, but it can also be something in a benign television show you're watching. One of my dogs passed away. Golly, I think it's been about five years now. But, you know, he was hit by a car and so it was a really sudden, tragic, oh my gosh, loss. And it took a while for me to kind of wrap my head around that. And every once in a while we'll be watching a show and there will be a yellow lab on it that looks just like Kenny. And I'm just like, oh, I miss Kenny. And, you know, it's just some silly TV show. Helping people understand that that may happen. So how do they deal with that reminder? How do they deal with that trigger without getting sucked into it? Because I can look at it and, you know, I see the dog that reminds me of Kenny. And it's like, okay, that really sucked when that happened. But then I remember what a good dog he was. And then I distract myself. I'm like, okay, we're not staying stuck there. We're not going to unpack and stay for the weekend. Many people will vacillate between depression and anger or kind of present them concurrently. They may be a very angry depressed person. And that's okay. You know, we don't have to say, well, you're supposed to be depressed. And that's not one of the criteria for the diagnosis of depression. So can't be doing that. If they're angry, they're angry. Let's talk about it because that's probably sucking a ton of their energy. Normalize people's experiences. It wasn't for some people and, you know, I'm one of those people. It's not just a dog. It's a family member. For some people, it's not just a job. It was part of who they were. And again, for some people, it wasn't just a condition or a disorder. It was part of who they were. And they're not sure what life's going to be like or who they're going to be if they're not an addict or a bulimic or whatever it is anymore. Encourage people to reach out to social supports. People who've been there. Most people have been there. There are even therapists that specialize in resolving pet loss issues. And address happiness and survive for guilt. Sometimes people get stuck in depression because they feel guilty for being happy. It's like, it's only been three months since this happened. I shouldn't be happy. That's that's not okay. I'm supposed to still be grieving. I'm supposed to still be upset. I'm supposed to still be angry. Who said, um, so we want to talk about that. If it's the loss of a person, you can ask them, well, would so and so want you to still be unhappy. Um, when Katrina happened, I worked with a lot in a lot of the relief shelters and I was helping people get access to their FEMA resources and other things that they might need. And you would see a lot of sort of resentment coming from some people at the other people, especially the children who are happy. They were just playing. They were like, okay, well, this, this is different to be living in a, you know, a great big shelter, but we're going to make the best of it. Um, and, and the adults would be very stymied with that. And understanding it's okay to be happy even in the midst of a bad situation. It's okay to be happy because there are likely some things that you want to be happy about every once in a while, you're going to want to smile. Um, if you've got kids and something bad has ever happened, um, you know, they've had a fight with their best friend or whatever it is and they're upset and you start talking to them. And at a certain point, if you say, tell them a joke or do something silly and you might get a crack of a smile and you're like, I saw that, saw that crack of a smile. Um, and it's okay. And my point in pointing that out to them is it's okay to be happy. It's okay to laugh and it's okay to be happy about some things and angry about this thing over here. You know, it doesn't have to control your entire life. And then survivor guilt. If something happened, whatever it is, and one person survived and the other person didn't. Um, and this can even be true when there's a terminal illness. If a mother survives and, you know, her child has terminal cancer, there may be some survivor guilt. You know, I made this child and I couldn't save him or her. Um, or I was driving the car and the passenger died and I survived. So I need to repent for the entire rest of my life talking with them about where their guilt is coming from. And again, not taking it away, not going, well, you shouldn't feel guilty because that doesn't help anything. That's how they feel. But talking about what their guilt means and what surviving means to them and the ways that in their minds, surviving their survival is unfair can help them start working through some of those issues. Additional tips. When someone's grieving, they're in a state of crisis. So regardless of what the grief was about, if they're upset about something, they're not going to remember the itty bitty minuscule details of things. So just like you would do with anybody in crisis, minimize any vulnerabilities you can. If they need to remember to do things, make lists. It drives me a little bonkers when I go on scene of, um, if there's a rape victim and law enforcement officers are like, okay, you need to do this and you need to call the court in the morning and you need to do this, that and the other. And the person's just kind of sitting there looking at them like, I see your lips are moving, but I'm not registering a dagum thing you're saying. In crisis, we don't. So make, write it down. Minimize demands unless staying busy helps. Sometimes it's just better to stay busy, but sometimes that's a method of avoiding dealing with the grief. So there's a fine line. But you don't have to continue to make five course meals for everybody if you're tired and you don't feel like cooking or a pizza or whatever your family likes. So try to look at ways that you can minimize time demands because your energy is devoted right now to trying to deal with this grieving process and move through it. Keep a normal sleep routine way easier said than done. Talk with clients about the importance of getting up out of bed every day and the importance of opening the blinds so they can get some light in and get their circadian rhythms going. Yeah, they may not be sleeping well at night and they may need to do some meditation, do some exercise. There are a lot of interventions that can be done to help people sleep up to and including short term medication for sleep. Now that's not something I generally like to throw out there right away because I've seen clients just become really reliant on that. But at a certain point people need to sleep. Set a defined amount of time to revisit the loss each day. Half an hour or an hour. Okay, during this hour it's okay for me to sit there and think about this and feel okay about it, feel bad about it, feel however I'm going to feel. But then when the hour's up, when the timer goes off, I'm going to get up. Some people spend that hour journaling about the loss or to the person that was lost or to their higher power. But the time limited is the important part because we don't want them to unpack and get stuck there for two weeks. And be compassionate to yourself as both as a clinician working with somebody who's grieving, it can be really draining and it can push a lot of your buttons. But encourage clients to be compassionate with themselves and we need to model this as clinicians. We need to help them see how to be self compassionate and we need to encourage them to not push themselves if it's going to make their treatment kind of go backwards. Losses encompass more than death of a person or loss of property. Failure to acknowledge losses can cause unhelpful reactions in similar future situations. So if you lost a job once and it had a cascade effect, you know, you lost, you lost your job. So then you lost your house and you lost your car and then you ended up moving in with your adult children. You get another job and things start going a little bit wonky there and they start talking about layoffs. And all of a sudden that grief from the past comes back. So it's really important to understand how that loss is impacting you. It's really important to understand and reflect on am I reacting to this current loss or this current situation or is this stuff from the past coming up and compounding everything. It's important to explore feelings and reactions in terms of their functionality. How are they benefiting the person? How is guilt benefiting the person? What's that doing for them? Remind people it takes at least a year to deal with significant losses and I say at least for some people two years and then they start really getting into the groove. We look at complicated or prolonged grief or, you know, some other diagnoses once we start going past two years for what we call your average losses. But when we're talking about complicated grief, things that happen out of the natural order like a child dying before a parent, you know, it's hard to say what a timetable really would be. Many times there are multiple ancillary losses that need to be addressed. So we don't want to just say, all right, we're dealing with this rape. We're dealing with this death. We're dealing with this job loss. There are a lot of things associated with that with loss of self-esteem or loss of sense of control loss of their perception of the safety of the world. How people deal with grief and loss varies widely. It is a form of crisis and the body is generally on high alert, which is going to likely impact sleep, eating, energy to go to work, to socialize, to do all that other kind of stuff. Remember grieving? You've lost something. We know we grieve when there's a loss. Your body goes, I don't like losses. Losses are a threat. We need to be on high alert. So all the energy goes to dumping cortisol and keeping people hypervigilant. Hypervigilance prevents good sleep. It prevents a lot of other things and it just uses a ton of energy. Minimizing vulnerabilities is important to reduce unnecessary frustration and avoid confirming helplessness. If you give somebody a laundry list of stuff to do and you don't write it down and they're like, okay, I got it. I'm going to go handle it and they walk out and they get five steps down the sidewalk and they're like, wait a minute, what am I supposed to be doing? It compounds their sense of helplessness. It compounds their sense of frustration that nothing will ever be right again. So put in those little buffers anywhere you can to help out. Ultimately, it's hoped the person can identify how they are stronger or better off from the experience, but that comes way down the road. You know, that's not something I'm going to ask someone in the first two or three sessions of, all right, now we're going to look at this from a survivor's mentality. How are you stronger from this? I'm going to wait until the person has moved to the stage of acceptance and then we may talk about that. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceuse.com slash counselor toolbox. This episode has been brought to you in part by allceuse.com, providing 24-7 multimedia continuing education and pre-certification training to counselors, therapists, and nurses since 2006. Use coupon code, Counselor Toolbox, to get a 20% discount off your order this month.