 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. I'd like to welcome everybody to today's presentation on grief, and we're really going to be talking about how to help clients work through the stages of grief and why it's important. A lot of times we just assume people want to deal with their grief, and that's not exactly or always true. So we want to look at what happens if people either aren't able to or don't want to deal with their grief. So we'll define grief, conceptualize it in terms of any loss. Now, a lot of times we only think about grief in terms of death, but there are a lot of losses that need to be grieved, both existential as well as tangible. Well, identify how failure to deal with grief can impact a person, explore the stages of grief, and review activities and interventions to help people grieve. So what is grief? It's a label assigned to all of the emotions associated with dealing with any kind of loss. Now, when I think of grief, I think of Kubler-Raw's denial, anger, bargaining, depression, and acceptance. Done. And that's not it. There are pretty much, well, there's all of the emotions that can be involved in the grieving process. I mean, there can be guilt, there can be resentment, there can be anger, but there can also be happiness when they think about the memories of that person. It's sort of bittersweet. So there are a lot of different emotions that are kind of tied up with that. People can lose different things. Physically, they can lose tangible things. I mean, I don't grieve. Well, I might grieve if I lost my mobile device. But, you know, you can lose tangible things. A pet, you know, a pet's not, whether you think of that as a family member or a tangent, whatever, you can lose abilities. People who are in a car accident who lose, you know, the ability to walk, for example, or people who start developing Parkinson's who lose the ability to do fine motor tasks that may have been important. Or even as we get older, we lose the ability to see so well, and we start having to wear readers and focus a little bit harder. So there are abilities that we need to grieve. And when we work with older adults, if you do that a fair amount, you know that that's a common issue that people start feeling frustrated because their body's not doing what they used to be able to do when they were 20 years old. We can also lose freedoms. You know, that's another thing that needs to be grieved if people go to jail or lose certain liberties or ability, freedom type abilities. We can lose self-concept in terms of our roles. So think about empty nest syndrome when somebody, when somebody's children move out, you know, they're still mom or dad, but it's not the same thing at all. And that role becomes much smaller since junior has, you know, fledged and left the nest. So people have a difficult time sometimes adjusting to that. You can lose values. You know, if you thought honesty was important and, you know, all of a sudden you're looking around and you feel like everybody's dishonest, you can become sort of disenfranchised or disenchanted with life. Your worldview, people can lose their sense of safety or innocence. If they are a survivor of some sort of victimization, then all of a sudden, you know, that's changed. You used to think of the world and think about these kids in some of these schools where there's been mass shootings or even ones where there haven't been mass shootings, but they've heard about the mass shootings. You know, they used to feel safe at school. Now they don't. So there's a whole process of coming to terms with this loss of innocence and sense of safety. Dreams, how things should be. You know, you have your dream that you're going to maybe grow up and get married and have 2.4 children and a dog and a white picket fence. That's supposedly the average American family. And things don't work out that way. So sometimes people have to grieve that what they thought they were going to do didn't happen or maybe they thought they were going to be CEO of a company by the time they were 24 or go to Harvard or be a pro football player. And if that doesn't happen, they need to grieve it. I mean, I know a lot of high school athletes and even college athletes that for one reason or another weren't able to go on to do pro either because they weren't good enough or because they had a devastating injury, usually a knee injury that cut that dream short. And it was something that they had to figure out how to deal with and come to terms with. They had to grieve that loss. We can also have and when I talk in terms of dreams and the way things should be, sometimes people look backwards and they wish they would have had a childhood that was more like beaver cleaver. You can't change the past. So they need to grieve that and come to terms with, okay, you know, that kind of was not a good time, but what can I do now? And then socially, we can grieve the loss of relationships. Sometimes people lose relationships, you know, especially in that college and late 20s sort of time when people are actively going from college and starting new careers and getting married and having families. And you may have had this really close knit group of friends in college or in high school. Then all of a sudden priority shift and y'all aren't hanging out three, four, five days a week now. You're lucky if you can get together two or three days a month. So that type of loss, maybe it's not completely lost, but that type of loss and change of that role, because they're not the center of your kind of social world anymore, can be something that people may need to grieve and come to terms with. Primary losses also produce secondary losses, which also need to be acknowledged and grieved. So for example, if you lose a spouse, you know, that person's not there anymore. Okay, but what does it mean that that person is not there anymore? All of a sudden now you are not married anymore. You are a widower. And you know, what does that mean in terms of your roles, your identity, your security, your chosen lifestyle? So there are all kinds of things that can be lost. So let's think for a second and please chime in about what secondary losses might occur for these events. The death of a parent, you know, when a parent dies, obviously they're not there anymore. You can't call them up and go, Hey, how you doing, mom? But you also may lose that sense because that's your primary and your first attachment relationship. So that's your home base, your safety for a lot of people. And when the parent dies, even though we may have left the nest and be living on our own, it kind of rocks our world a little bit because there's not that safe home base to go back to anymore. The death of a parent may also cause, you know, frustrations in other areas of life. Separation or divorce. Again, we go back to, you know, maybe you're not a spouse anymore. Now you're a divorcee and that could also have its own feelings and connotations associated with it. Your finances are probably going to change. Your child visitation may change. You may be a single parent now or you may be the one that has to visit your kids on the weekends or, you know, that's going to change. And you need to come to terms with the fact that you're not a 24-7 parent anymore. A loss of financial security, a loss of somebody to come home to talk to sometimes because kids are great and that's wonderful. But every once in a while you want to come home and talk to a grown-up. So you have to change how you do things and you probably are going to have to rearrange your life a little bit to be single. You also may lose common friends and that's a really good point because sometimes it's, okay, are you going to be, are you going to side with him or with her instead of going, you know, we have these common friends and maybe we'll socialize at different times, but we don't have to divvy them up like we divvy up the stuff. That's another thing, stuff. And it may seem petty at times, but sometimes stuff is very meaningful. You know, the first living room set you bought together or whatever, or maybe somebody wants to hold on to the other person's favorite chair to be vindictive. I've seen all kinds of things in separation. So there are things like that. Extended family members, that's another good point that are following the divorce and you may lose extended family members. If you were really close with your in-laws, then you may not be as comfortable socializing with them anymore. With miscarriages, there's not only the loss of the baby, but for a lot of women, they go through this questioning phase of did they do something wrong? Were they not a good enough mother? Or would, you know, what happened that caused that miscarriage that they weren't able to bring this life into the world? And there's a lot of grief and trauma that goes along with that, not being able to do something that women have been doing for millions of years in this particular case. You can also lose friendships when others don't understand the struggle related to miscarriages. True, Brittany. Because miscarriages, some people say, well, how far along were you? And if you weren't far enough along in their mind, they're like, oh, well, you know, so sad. But if you were, you know, in your third trimester, then they may give you a little bit more empathy when in reality, it was a life in your mind and in your body. And it's hard to adjust to that. And, okay, injury or disability, you wake up and in the hospital, you've had a car crash and you're paralyzed from the waist down or you have some sort of accident and you've got chronic pain from now on. Or you have a stroke and half your body is partially paralyzed. You know, any of these things can happen. And for all of those, there may be secondary losses in terms of relationships. Some people may not be able to deal with it. There may be secondary losses in terms of what types of stuff you used to do. For any of those, you know, if you used to like to rock climb or roller blade or something, you may not be able to do those anymore. So you'll have to grieve those. There's the loss of control over your own body. There is potentially loss of occupation if you, you know, maybe you were a cop. And, you know, now you're not going to be chasing down people. You might be reassigned to death's duty. But for many cops, that doesn't go over so well. So thinking about all the different secondary losses that might occur, maybe a lot of your friends used to go camping and hiking together. And now you're wheelchair bound. So that's not something that you can do. Losses of jobs. When you lose your job, you lose a source of income. Some people lose a sense of self-esteem when they lose their job. You also lose your work friends. And there are, there's a lot of benefit of socialization in the workplace. So if you don't have those people, and especially if you're like a lot of people and you don't have a lot of friends outside of work, then you lose not only your job, but your primary social support system can be a real ding. Moving to a new place. Yeah, if you're moving half a block away, it's one thing. If you're moving three states away, yes, we've got the internet. We can communicate now. But it's not the same thing as being able for the person who used to be your neighbor to come in and sit down and have a chat. A child leaving home, we've kind of talked about and house fires, tornadoes, you know, there's been a lot of wildfires this year and people lose houses and houses are stuff. That's true. But there's also a sense of safety that goes along with that when you lose your stuff. Now you're financially strapped, trying to get together and start life over again, new house, whatever. But there's also a sense of safety and security. Is it safe to go to sleep? Is it, you know, when it storms again, are we going to have another tornado? So people need to deal with the trauma issues as well as the grief and loss issues. So types of grief, anticipatory grief, experiencing anticipatory grief may provide time for the preparation of loss, acceptance of it, the ability to finish unfinished business, review life and resolve conflicts. So people who are terminal, for example, can go through anticipatory grief as can their loved ones. Older adults typically go through anticipatory grief. As they're getting older, it's kind of a slower process. But they prepare and they start figuring out, you know, when they may peace with what's going to happen. Normal grief, and I don't like that term, but it's the one that was used. Regular feelings, what is expected, reactions and behaviors to a loss. Grief reactions can be physical, upset stomach, headaches, difficulty sleeping, lack of energy, psychological, sadness, depression, anxiety, but also some happiness. If the person may have been suffering for a while, then you may have a sense of relief. Cognitive, difficult to concentrate when you're going through this grief reaction, because you're in a state of threat, so to speak, you're in a state of shock and turmoil. And behavioral reactions, people may eat more, they may drink more, they may want to sleep more. There are a lot of different behavioral reactions. And we want to watch those in terms of making sure the person's not developing clinical depression. A lot of times they will self-resolve, and these feelings are perfectly normal. So it's not necessarily something we got to watch out for, but remember in the DSM-5, they took out that exclusion in major depressive disorder for being during a period of bereavement. So you can have major depressive disorder co-occurring with grief and bereavement issues. Complicated grief is just what it says. It takes longer. People get stuck somewhere in the process. And there are a couple different kinds. There's disenfranchised grief and chronic grief. Normal grief reactions that do not subside and continue over very long periods of time. We're talking three, five, seven years. We've got to look at the magnitude of the loss. We've got to look at what happened. Some people are going to continue to grieve for a long time, but the grief, the overwhelming grief experience should get smaller. You know, the number of days that are bad in a year should get fewer. There may still be occasional bad days, and it should get less intense as we're watching this person get further away from it. And if it doesn't, then that's what we want to think about in terms of complicated grief. Delayed grief are normal grief reactions that are suppressed or postponed. The survivor consciously or unconsciously avoids the pain of the loss. I've done this. You know, when my father died, I didn't want to think about it. I didn't want to face it. I didn't want to acknowledge that it happened, and it took me a long time before I could go back down to where he lived to his house. And, you know, get the stuff that my stepmother wanted me to get. So delayed grief is when people push it off. They're like, I'm not going to go there. I'm going to pretend it doesn't exist. Mast grief, the survivors not aware that behaviors interfere with normal functioning are the result of a loss. So somebody may experience a loss and then start experiencing a lot of anxiety or depression and not make the connection. They just start trying to attribute it to other things. And then we go back and we start talking about, you know, have you experienced any significant losses? And it again, it's not necessarily just a death. And that's what I want people to really wrap their heads around is the fact that it can be other types of losses. The grief encountered when a loss is experienced and cannot be openly acknowledged socially sanctioned or publicly shared is different disenfranchised grief kind of messed that up a little on the PowerPoint. Anyway, so for example, if somebody is in a extramarital affair and they break up with that person or that person passes away, that can cause the significant amount of grief, but they may not feel like they can openly acknowledge that because nobody was supposed to know about that relationship. And there are a lot of other different things that may not be socially sanctioned that people may grieve. So we want to be as open as possible and receptive to what's bothering them. Another thing that I've seen a lot and you know, I'm a big old softy when it comes to animals. And a lot of people feel like they shouldn't grieve that much over their pets. And you know, our pets are we live on a farm, but our pets are part of our family. And every single one of them has a name. So when they pass on, you know, if the chicken passes on, it's less impactful than if one of our dogs passes on. But there is some sort of connection and encouraging people to acknowledge. And for some people, their four-legged fur babies are their children. It's what they do on. And so when that creature passes, it's devastating to them. And there's this big hole that's kind of left like, well, what do I do now? So we want to make sure that we don't minimize and we encourage them to not minimize their reaction. Stages of grief, you know, this is the Kubler-Ross thing, denial. Going through numbness, they may dream about the person and try to find alternate explanations. Anger, this is a lot of times due to the unknown. What am I going to do now? Loss of control. How dare that person leave me? Or how dare God for taking that person from me? They may fear death. You know, it could bring to the forefront, you know, this person died of breast cancer or whatever. And so maybe I'm at higher risk of cancer now. And maybe I might die. And then they can start going down that rabbit hole. Isolation. If you lose a relationship, you may feel like you'll never get into another one. Or failure. Should as and could as. I should have been a better spouse. I should have been a better parent. I should have. I could have done this differently. And maybe this wouldn't have happened. So there can be a lot of anger itself as well. So anger takes a while to get through. And remember, grief is not a linear process. It's kind of wibbly wobbly all over the place. So people will bounce back and forth. Bargaining. And bargaining is more common in anticipatory grief, where the person starts saying, if this goes away, then I will do this, that and the other, you know, if this happens, if I get better, then I will go to church every day for the rest of my life or whatever people want to say. But they start trying to bargain with themselves, with their higher power, with the universe, with anybody or anything that they think might be able to impact it. Depression sets in next when the person develops a realization of hopelessness and hopelessness to change the situation. It is, it is. And they start realizing that. And a lot of times I see people bounce back and forth between anger and depression. They get angry at being feeling helpless and hopeless. And then they go back to feeling depressed. So getting them out of this back and forth leapfrog can be really important to moving to acceptance. And we're really looking at radical acceptance, that the loss occurred and determining how to proceed from there. I'm not huge on on narrative therapy, but I do do when we talk about grief and life changes. I encourage people to sort of write their autobiography in terms of this problem, you know, in terms of this event. So tell me the story about you and your spouse and how you met and, you know, write it out from there. And then this chapter ends with this person dying. And then how are we going to begin the next chapter? So I have them write out that autobiography and then start writing the next chapter. How do they pick up from there? Because if they can put it in something that's a little more distance, they're writing a story instead of affecting their own life, then they might sometimes they are able to step back from it enough to say, okay, what would I have this character do? I'll have them do this, these three things. All right, well, that might be something you can do too. So exacerbating and mitigating factors, how people react in a crisis depends upon six factors, how close the situation was to them, physical and emotional proximity and how important that person was in your life. If it was your spouse or your child or a family member, you know, that may have different impacts or a close family member that may have different impacts than your mother's second cousin twice removed if that even exists. I was never good at that. You know, you'll feel sad when when that person passes potentially, but it's probably not going to be as intense as if you lost somebody that was crucial in your support system. How many other stressors they experienced in the last year? So if the client has had a pretty good year, and then all of a sudden has a death, it's going to be it's hard, no doubt, but it's not the same. When right after when my father passed, my father passed away, then my grandfather passed away, and then my uncle passed away, all within about nine months of each other. So it was just when when daddy passed, it was one thing, but then couple the other two on top of it by the time we got down to my uncle, I was just, I was done. I was tired. So we want to look at the stressors and not just losses. I mean, if they've been having difficulty in their marriage or maybe they've got young children at home and they're not sleeping or whatever the case may be, if the person was vulnerable emotionally and physically, then grief can be complicated to a certain extent. We want to look at mental health issues and coping skills. Do they have a history of major depressive disorder or generalized anxiety, PTSD, anything that might be triggered again for this person? What are their social supports? If they've got good social support, they're more likely to move through this easier than someone who doesn't have social supports. What's their understanding of the loss? Do they get it? Do they can they comprehend what's going on? Kids may not quite understand what's going on. Adults, if they have somebody taken from them by crime or something, they may not understand where it came from or what happened exactly and they may be searching for answers. And other losses, people may not understand what happened or why it happened. You know, why did I lose my house in that tornado and the person five doors down was unscathed or relatively unscathed? So they may have a lot of existential stuff. They also need to come to terms with. And how much control or responsibility they feel like they had in the situation? And this can go one or two ways. You know, if they think they had ultimate control, but then they still had a loss, then they may feel defeated. If they feel felt like they had no control and they had that loss, then they may feel anxious that it's going to happen again, because they were completely powerless. So we want to have them look at what parts of it did you have control over? Taking tornadoes, for example, when people prepare around here, we have a tornado plan in place and we know what we're going to do, where we're going to go if there's a tornado warning. And that's as much as we can control. We can't control the storm. All we can do is make sure we follow our tornado plan. So helping people look back, and this is part of the cognitive processing therapy thing, to look at the big scope of things, you know, what parts of this did you and did you not have control over? And that can help people start moving towards dealing with some of the, especially the underlying feelings of guilt and anxiety and anger that may be coming up. The impact of unresolved grief, most people get stuck in either anger or depression. The anger often comes out as should have, could have, and if onlys. I should have done this or I shouldn't have. I could have done this, but I didn't. And we want to look, hindsight's 2020 and remind people of that. When you're in the moment, you know, you've got 17 things going on, you're trying to remember to get all the cats in the bathroom and that's our house, try to get all the cats and dogs in the bathroom and figure out where the birds are going to be and get the kids down there and make sure you've got the weather radio. You're focusing on, you know, all these different things. And when you're outside of that, after the crisis has passed, you know, you don't have the time pressure and you're not juggling all those things. And you can look and go, Oh, you know, it would have been nice to remember to do something else. But we need to make sure that clients can look back and realistically appraise the situation. So they're not beating themselves up with should as and could as and if they find something that realistically, they think they should have done, how can they make sure that if the situation happens again, that they're prepared. They can get direct anger at themselves. They can direct anger at others you should have, you could have, but you didn't why didn't you do this? And this can even be directed at emergency management for not sending out warnings quickly enough or not having the right storm track at their higher power. You know, if there's a higher power, then why did he or she let this happen? So we want to really thoroughly encourage clients to explore anger so they can address it. You know, if they have that thought, then let's talk about it and figure out what to do with it. Depression is the hopelessness and helplessness. I don't know how to go on. And the person can feel hopeless and helpless. I don't know how to go on. I don't know how to exist without these other people or without this job or this house or whatever it is. They may have depression in terms of a sense of hopelessness that others or their higher power will be there to help them and they might feel resigned or abandoned. So let's go through these stages real quick. Denial is the mind's way of protecting people from what lies ahead. So the action strategies here are facing the loss and this will happen in its own time. Sometimes people are not ready to face the loss and they just can't quite fathom it. It all still seems very surreal, especially if the loss is either unexpected like a car accident. You just kind of keep waiting for the person to walk through the door or if it's an expected loss when you first find out about it and you're just kind of reeling for a few minutes. Facing the loss doesn't happen right away and people aren't going to do it right away for the most part. They may go into crisis mode trying to fix and solve and bargain but they may also just kind of try to bury their head in the sand and go, this isn't happening. So we want to encourage clients to get to the point where they can face the loss over time and everything will happen for clients in a different time table. This denial phase can last anywhere from one to three months so you want to take that in mind. It's not a two-day sort of thing. They may deny certain aspects of what happened. They may deny it's impacting them. They may deny you can keep going on with what might be denied but it's their mind's way of protecting them from kind of what lies ahead and they want to believe that it didn't happen. So we want to identify some of the dialectics which might accompany each loss. If there's a death of a loved one and remember dialectics is looking at the positives and the negatives when my grandmother died she had a wonderful wake and it was very very sad when she died. However I am so blessed that she was in my life and I focus on that and she wasn't in pain anymore because she had had three bouts of breast cancer. So it was you know there were positives and negatives that I looked at and going through the wake was actually very uplifting the way the way my grandfather did it. After separation or divorce you know okay that person's gone that part of your life is done can't have it back not going to change. What can you look forward to? You know it's a new chapter you might be able to explore new goals encouraging people to look at it as yes it is a loss and we're not going to minimize that and getting them to the point where they're acknowledging it also to the point where they don't feel like it's going to suffocate them like they don't feel like it's just going to hold them down hold them down underwater where they can't breathe. You know okay um with separation and divorce you may not even look at the positives of the separation you may look at how strong the person is that this has happened but look how well you're dealing with it and look at the strengths you have and what supports you have to get you through it. Look how many people who have kind of come to your come to your aid miscarriages you know same sort of thing this is unfortunate that it happened let's look at you know embracing the moment right now what is good in this moment the miscarriage is bad what is good in this moment injury or disability loss of a job property pet moving to a new place or even a child leaving home can all have a significant impact so encouraging clients to just keep asking themselves what is good in this moment will help them broaden their scope instead of having this tunnel vision on the one thing they lost. Anger is the next step once you realize it happened you can get really ticked off and remember anger is our response to a threat you either fight get angry or flee anxiety so we have anger here and and people are getting upset that they couldn't control the situation they don't want to admit that it happened they don't want to give into it they want to hold strong so sometimes people push others away to avoid getting hurt um if they were divorced or lost a relationship of some sort or if somebody died they may be like you know what that hurt way too much i don't ever want to be that close to anybody again and risk feeling this way they may blame others as an outlet for helplessness somebody somewhere could have prevented this and they look for somebody to blame and if they can't find somebody out there then they may look at blaming themselves they may blame themselves to try to regain some control or prevent it from happening again or just maybe they feel like they need to make themselves suffer so they may blame themselves for you know not doing something and anger may also cause them to question their belief system and world schema so they can start looking at the world as being a hostile and scary place it makes sense people's responses make sense in the big scheme of survival you know anger when when you lose something you're out of control you know for whatever reason it's gone you had no control over it you can't make it come back as humans we don't like to be out of control so it makes sense that they're trying to find an understanding they're trying to find a way to put blame or get control of it so it doesn't happen again action steps identify what the loss means to the person if they're angry you know what other losses might they have experienced if they're scared what are they afraid of and why and if they're depressed have them finish the sentence I feel helpless to or I feel hopeless to or that some of these sentence completion things if you just give them a worksheet with for example I feel helpless to written 10 times and I feel hopeless to written 10 times or I'm afraid of written 10 times and have them complete the sentence sometimes that helps people start to process and really dig deep the next thing we need to do is validate people we help them identify what the loss means to them then validate how hard that must be and how scary it must be and examine all of the stated beliefs for the anger the fear and the depression in terms of cognitive distortions are they using all or nothing thinking maybe they're scared that they're never going to find anybody and they're going to be alone forever okay well that's kind of all or nothing thinking and that's also possibly emotional reasoning so you want to just kind of go through their statements and help them look at them and see is their basis in fact what part of this do you have control over is there any way to kind of soften it and take away the look for exceptions instead of the all or nothing thinking you know what are you looking at bargaining if I do x y and z maybe I can wake up and it'll all help all have been a nightmare I think all of us have done that at one time or another bargaining either because of grief or we had a test coming up or whatever bargaining contributes to depression because the person wakes up every day hoping the reality is different and it's not hope is squelched every morning they get up and realize that person's not laying beside them anymore or they're not in the house they're in a shelter somewhere because their house burned down action steps help the person stay in the present reality and point out how bargaining creates frustration and and more exhaustion for them so we want to help them focus again on how can you make this moment better can't change that can't predict the future how can we stay present in this reality as it is and and start moving forward and it's hard and it hurts no doubt depression hopelessness and helplessness have set in the reality that the loss has occurred and it can't be changed you know not trying to bargain not trying not trying to bully our way through it so the action steps here are helping clients identify what can't be changed you know when when my father died obviously I don't have the power to bring him back what can be changed henceforth and how you deal with that loss for example you know I had to figure out you know am I just going to push that back here and sort of pretend he never existed or am I going to share memories of him with my kids how am I going to handle that and so the action steps become how what do you do with this loss this loss has impacted your life and whatever it was before it was a loss impacted your life what are you going to do with that acceptance is accepting the reality of the loss it doesn't mean liking it it means accepting it is what it is and there's nothing you can do to change it so how can you improve the next moment how you how can you continue working toward a rich and meaningful life action steps include exploring how life will be different and the same since the loss too often we focus on the differences one of the things people need after a loss is stability so let's look at what what stuff is the same what didn't you lose what do you still have sometimes that makes people feel more settled and this is a time we can really focus on strengths as well and resources that the person has what friends do you have what resources do you have and they can see that okay maybe their whole world didn't fall apart make a plan to change the things that you can you know maybe if your spouse died and you're living in a house that you can't afford on your salary now you have to move to a smaller house okay so let's make a plan for how you're going to make that happen if that loss can be prevented from recurring take proactive steps a house fire for example you know can you prevent that from recurring maybe having fire alarms that are make sure the batteries are good or moving from a place where there's a high risk of wildfires some people choose not to because they love their their view and they're willing to take the risk same thing with hurricanes you know some people love to live on the beach and they're willing to take the risk of a hurricane but taking those proactive steps developing a hurricane or tornado preparedness plan and looking at ways that you can prevent that loss from happening again grief's not a linear process most people experience grief surrounding a loss for at least a year and usually it's close to 18 months to two years holidays anniversaries and reminders including people places and things and britney commented that one thing that can be challenging is clients sometimes look at those preventative steps as reasons to blame themselves and that is very very true so we want to look at addressing any of that self-blame or any of that grief when we're working on helping them develop a plan for feeling safe and moving forward we don't know everything we don't you know things that you never thought you should have to plan for sometimes come up and you're like oh i didn't see that coming so making sure that we normalize what people did and didn't do and we point out that they've got more knowledge now than they may have had before and moving into creating that prevention plan that's farther much farther down the line you know you're not going to be working with a rape victim and go okay well how can you prevent this from happening again that was would be so callous you want to look further down the line and you know increasing your awareness of your surroundings for example could be something if if somebody was attacked maybe walking to their car after work and and figuring out what steps they can take and there's a fine line and between really hitting this hard and you know keeping them from going into too much self-blame so very good point so grief comes up with holidays anniversaries and reminders many people will vacillate between depression and anger especially on these holidays we want to normalize their experiences and i'm going to talk about it later they can be called grief bursts sometimes where people will just suddenly have this bubble of grief that comes up and bursts and there may not even be any perceptible trigger but it happened encourage people to reach out to supports and address happiness and survivor guilt because sometimes people feel guilty for being happy after someone dies or they feel guilty for surviving um when you know other people didn't self-care for grief emotionally encourage people to express their feelings ask for and accept help and don't let anyone tell them how they should feel likewise and we forget this part make sure they're kind to themselves and they don't try to tell themselves how they should feel i should feel worse about this or i shouldn't feel so bad about this you feel how you feel be patient encourage people to be patient with themselves it hurts but believe it or not it will get easier over time um add happiness triggers and be kind to yourself encourage people to remember that grieving is an exhausting process so they're not going to get as much done for the first few months as they typically do and and that's okay they need to be kind to themselves because they're recovering from a trauma and they if they broke their arm they would be kind to themselves well their their heart got broken so they need to be kind while their heart bends add happiness triggers whether the person removes all the paraphernalia that reminds them of the loss or not that's up to them but i do encourage them to add things in their environment that trigger happiness things that make them smile um i just recently filled the bird feeder because we've got the spring birds coming back and i don't know why but chickadees and titmice make me happy as do cardinals um so that's something that i look at when in in the afternoon when i'm coming home and kind of settling down is watch the birds eat it's a happiness trigger encourage them to put up pictures sounds songs whatever that's going to help them feel happy it might push that happiness button each day have them embrace the dialectic um whatever it is it's gone but i have the memories or what i learned from it um or i cannot change it but i can impact how it continues i can change how it continues to impact me so we may not be able to change what happened however we can choose how we let it impact us henceforth and and forevermore have people identify feelings which might occur with each loss and this you can do in a group if you're talking about grief in general or you can um have them focus on the one specific for them but for you guys i want you to think about different feelings when there's a death of a loved one um we experience a sense of loss we experience a sense of sadness and depression that that person's gone we may experience a sense of guilt for not doing things before they died we may experience a sense of relief because we don't we're not worried that they're hurting anymore um you know the list can go on we also may experience a sense of happiness that that person is at peace and it really depends on your spiritual connection and where you think things are and how you come to terms with loss what feelings might be and and the circumstances of the loss itself that people need to deal with separation or divorce miscarriages injury or disability loss of a job property pet moving to a new place and a child leaving home you know i'll take child leaving home for 400 alex but um my son is getting ready to go off to college in august and i'll admit you know there's some worry and concern and there's also some happiness in elation and all kinds of emotions that are kind of going on with that so it's important to address all of it and look at it and instead of looking at it as a loss looking at it as a job well done and you know he's moving off and on that's how i deal with it but knowing that there are multiple layers of feelings and they're not all dysphoric and i don't want people to feel guilty for feeling happy or elated or relieved i want them to just identify how they feel physically people need to get plenty of quality rest so their body can rest and rebalance they don't reduce their immunity yada yada unfortunately after a loss a lot of times it's hard because people lay down and they're quiet and they're alone with their thoughts we need to talk to clients about what can you do to help you deal with being alone with your thoughts when you start remembering saying goodbye to that person or you start remembering whatever the loss is and the anger comes up or whatever you do how can people lay down and be quiet and be still without getting themselves emotionally charged we can talk about progressive muscular relaxation we can talk about meditation we can talk about a variety of different things that techniques people can use to help them get to sleep so they don't dread going to bed knowing that as soon as they close their eyes they're going to go into an unhappy place encourage them to exercise eat a healthy diet avoid alcohol alcohol disrupts quality of sleep it's also a disinhibitor and it messes with the neurochemicals which can increase people's depression and have them pay attention to persistent changes in eating sleeping mood or energy levels anything that could indicate the onset of major depression psychologically grief is a crisis period so it's a time for people to not try to remember everything write it down simplify your life this kind of goes along with being kind to yourself encourage them to set short-term goals you know when things are in flux it's hard to know what's going to be happening three years from now so short-term goals what are we going to get accomplished this month what do we need to do next month and work in small chunks until things sort of settle down encourage people to distract themselves and engage in pleasurable activities at least once a week preferably every day 15 minutes of happiness for every day start writing the next chapter in your story we talked about that you know now that you've experienced this loss that closes a chapter so what is your protagonist going to do in the next chapter and plan ahead for grief triggers knowing that you know holidays are going to come up knowing that there's an anniversary or driving past where the car accident happened or whatever it is maybe a trigger plan ahead for those plan a way to deal with those triggers so the person doesn't get stuck in their thoughts again myths and facts and I the reason I included this in here a lot of this is second nature to us you know we wouldn't even think about it but a lot of clients do so we want to remember to think about grief from their perspective not things that we know are myths because they may not realize that they're myths so myth number one the pain will go away faster if you ignore it no ignoring your pain or keeping it from servicing only makes it worse in the long run for real healing it's necessary to face grief and actively deal with it in their own time you know it's not time to say okay you're in here let's rip off the band-aid and start talking about it people will move through it in their own time but just ignoring it and expecting it to spontaneously resolve isn't probably going to be effective myth number two it's important to be strong in the face of a loss you know feeling sad frightened lonely angry it's normal crying doesn't mean people are weak and for a lot of families it's important for children to see normal expression of emotion not you know well mom and dad aren't crying and they're pretending everything's okay so maybe i'm not supposed to that's not okay well it can be okay for certain families let me take that back but you don't have to be strong in the face of loss being strong can also mean showing your emotions it's important to understand or for clients to understand that they don't need to protect their family or friends by putting on a brave front if they are depressed they can say you know what i am really depressed right now myth number two if you don't cry it means you're not sorry about the loss well crying is a normal response to sadness but it's not the only response people some people don't cry some people go to the gym and work on a punching bag some people go on a run some people write some people sing not everybody is going to weep and it's just how you experience and how you express sadness grief should last about a year there is no right or wrong time frame for grieving how long it takes differs from person to person what makes it complicated grief is it if it seems like the person gets stuck in a phase and quits moving forward but sometimes especially depending on um how important that relationship was how critical it was if it happened out of order you know there are a lot of things that can complicate grief and it may take longer to get through moving on with your life means you're forgetting the one you lost no the fact is moving on means you've accepted the loss but that's not the same as forgetting you can create the next chapter in your life and still keep the memories of whatever that thing was as a part of you myth number six i think friends can help by not bringing up the subject the fact is people who are grieving usually want and need to talk about their loss and bringing up the subject can make it easier to talk about their loss um my aunt had cystic fibrosis and uh when when i was little i think i was eight when she passed away but for the long time you know i kept wanting to talk about the loss and what happened and i was trying to make sense of it i think i don't remember back that far but i remember when i was going through my grief class in in college a speaker came in and talked we started talking about how many times does a person need to tell their story before they finally you know can quit telling it and she said however many times they need to tell it till they don't feel like they need to tell it anymore so sometimes people need to keep telling that story for a little while so it's important for friends to ask you know you may think well this person's already talked about it with 17 different people they don't need to rehash it again with me ask and if they want to they will comments to avoid and this goes for us too because sometimes we can mistakenly make some insensitive comments i know how you feel well we hopefully we wouldn't make this decision but or this statement um but instead we want to ask the person to tell us how they feel you know i'm wondering how you feel about the loss of your grandmother it's part of god's plan this can make people really angry even if it is a expected in time loss like my grandmother was 86 when she died it can sound trite to people if they don't believe in god or have a higher power it can also make them angry look at what you have to be thankful for well yeah but that's not where i'm focused right now i'm focused on the loss so instead of we don't want to minimize people's feelings of grief he's in a better place now well the bereaved person may or may not believe in heaven or a better place so it's better if we keep our beliefs to ourself unless we're asked this is behind you now and it's time to get on with your life sometimes the bereaved are resistant to getting on with life because they feel like this means forgetting their loved one so they may not be ready to put it behind them so to speak and we want to avoid statements that begin with you should or you will and instead say things like have you thought about or you might such as you might start feeling better in a couple of weeks or you might experience bursts of grief the timetable varies depending on the person's age their cognitive development pre-existing mental health or addiction issues the significance of the loss and the number of secondary losses during the second year and this is normal or uncomplicated grief most grieving people agree it takes at least two years to start feelings if they've established workable new routines and a new identity that incorporates the loss many of the tasks of the second year have to do with their reassessing their goals discovering their new identity and creating a different lifestyle and i mean think about our parents when we left the house you know probably took our parents about two years to start getting into a new flow of not you know toting us all around the timetable just in general month one is denial can last up to month three month three people start getting back to their routine their supports are gone people aren't asking about the loss all the time so they may feel a little bit abandoned months four to twelve the grieving period continues to work through many of the tasks of learning to live with the loss there begins to be more good days than bad days and if people chart this they can start seeing it but we want them to reflect if they don't chart it you know each week when they come in say how many good days did you have and or maybe how many good hours did you have if you're at that point difficult periods will crop up and sometimes with no obvious trigger even late into the last half of the first year still just getting through with stuff and this is where those grief bursts may come out complicated grief is characterized by intense longing and yearning for the deceased intrusive thoughts or images of the loved one or the loss situation denial of the loss or a sense of disbelief imagining that your loved one is still alive or that it didn't happen like imagining that you can still walk searching for the person in familiar places or insisting that you can do things that you just can't do anymore avoiding things that remind you of the loss extreme anger or bitterness over the loss feeling that life is empty or meaningless and any symptoms of major depressive disorder and you'll probably see on here that a lot of these symptoms are really close to or very overlap with symptoms of PTSD so just being aware that a loss can be traumatic not that people are going to develop PTSD but we do want to pay attention to the fact that it can trigger prior traumas if we're going from a trauma informed perspective so the bill of rights for grief you have the right to know the truth about the loss have questions answered honestly people have the right to need other people and be heard with dignity and respect they also have the right to be silent and not talk about grief emotions and thoughts you know we don't sometimes people need to be with their own thoughts for a while they do have the right to talk about the loss as much as needed and to not agree with your perceptions and conclusions they have the right to see the person who died and the place of death if we're talking about a death to grieve any way they want that doesn't involve hurting themselves or others to feel all the feelings and to think all the thoughts of his or her own unique grief to not have to follow the stages of grief as outlined in a book because too often we get stuck in that with moving forward no to grieve in their own unique and individual individual way without censorship to be angry at death at the person who died at god itself and at others to have grief bursts you have the right to do that to be involved in the decisions about rituals related to the loss to not be taken advantage of and you also have the right to have guilt about what you think you could have or shouldn't have done and you know we can we can work through that but you have the right to all of those feelings and then you know we'll figure out what to do from here so activities there are some really awesome activities I think most of us have done a goodbye letter for people or with people before where they write a letter to their loved one and either read it to the sky or empty chair or something a letter to god or their higher power if they're angry at their higher power or don't understand what happened the invisible string this is one that I love tarot you can use terracotta pots and make a wind chime with and you can use a lot of different things terracotta pots hearts shells keys pipes whatever the person finds significant and on each of the items that you put on your wind chime you write something about the loved one that you want to remember and then when it when the wind makes it jingle you remember the good things about that person so the terracotta pots ones looks kind of like this and it's a really easy DIY and the nice thing with the terracotta pots is they're bigger so you have more room to write than say if you were writing on the side of a pipe or a spoon or a fork or something but they're all connected with fishing wire which is the invisible string and that represents the invisible string between your heart and their heart wherever they are and you can get creative with what you use for the wind chimes you can have little pipes so you have something that makes the noise and then you can have like a ceiling fan the little cute little decorative ceiling fan things at the end of it so you have almost like a little charm bracelet wind pipe or wind chime have the person create a book of memories or a photo album you can have a heartbreak pot you take a big terracotta pot and you break it into large pieces don't smash it because you're going to have to glue it back together using paint pens and markers have each family member right on the inside of the broken pieces what they're grieving what their loss is what they're afraid of and write that on the inside on the outside of the pieces write about or draw the sources of their support and their happiness from that person or or whatever and then you glue it back together and the glue obviously represents putting back together a broken heart on the outside we're seeing the strengths and the supports and to help deal with what's on the inside which is the fear and the anxiety jenga this is awesome i found this activity on pinterest today somebody took jenga blocks because recovery is a building process and they wrote a question on each block like what is your favorite memory about the person what's the hardest part of the loss what is something you learned from the loss or from the person what's something you did to make yourself laugh this week because we want to focus not on the great not only on the grieving process but on the recovery process so each time somebody pulls a jenga block they have to answer the question that's on it and then they set it on the tower in order to continue to build the tower of recovery and in order to continue to make that strong foundation um and this is obviously you're building it up instead of doing the typical seeing how many you can pull out but i guess you could do it either way so losses encompass more than death of a person um it can be loss of property loss of hope loss of dreams failure to an failure to acknowledge losses can cause unhelpful reactions in similar future situations so it's important to explore feelings and reactions in terms of their functionality how are they benefiting the person if the person gets is really angry how is that protecting them what is the source of their threat what is their source of their their sense of hopelessness or powerlessness that we need to help them look at it takes at least a year usually to to deal with significant losses many times there are multiple ancillary losses that also need to be addressed so you know you can have this be an art project if you want to you can do mind mind mapping where you just have them start writing and draw a circle and align research has found that if you keep your hand moving that your mind will be more free associating than if you stop and you start to think so it does less censoring if you're keeping that hand moving um but you can also do a project where you have a sunflower or a rose or a onion or whatever you want anything with layers that you can have the person write on in order to identify any ancillary losses that they may be going through that might need to be addressed how people deal with grief and loss varies widely grieving is a form of crisis for anybody so the body is on high alert which likely impacts sleep eating energy and wanting to work or socialize that's normal you know I don't want to pathologize that if it becomes to it gets to the point where it's causing significant distress and significant impairment and functioning then we need to look at um intervening minimizing vulnerabilities is important to reduce unnecessary frustration and avoid confirming helplessness so encourage people to get enough sleep and because it's harder to deal with life on life's terms when you're exhausted eat a good diet so your body can make the neurotransmitters and rebalance and help keep you from getting sick which again can make you seem make you feel run down and make it harder to deal with life on life's terms ultimately it's hoped that the person can identify how they're stronger or better off from the experience from knowing the person from the job they had that they lost from you know whatever they can remember some of the good times do your clients need a little help staying on track between sessions are you looking for a great aftercare resource look no further than docsnipes.com for as little as $15 per week Dr. Snipes provides concierge coaching services to clients through online weekly groups chat availability seven days a week and members only resources learn more at docsnipes.com