Understanding Grief and Loss and Associated Anger and Depression

Understanding Grief and Loss and Associated Anger and Depression


this episode was pre-recorded as part of
a live continuing education webinar on demand CEUs are still available for this
presentation through all CEUs register at allceus.com/counselortoolbox I’d like to welcome everybody to today’s
presentation on grief today we’re going to be talking about the consequences of
grief and interventions that we might be able to use to help people move through
the grieving process I am your host dr. Donnelly snipes we’re going to define
grief conceptualize it in terms of any loss identify how failure to deal with
grief can impact a person and explore the stages of grief
and interventions that might be appropriate and this is not gonna be a
super creative art therapy sort of thing we’re really talking about tasks today I
did recently put out two videos on our YouTube channel
I’ll see you use education that explores a variety of different art therapy
techniques that you can take a look at if you’re interested in you know trying
to stoke those creative juices grief is a label assigned to all of the emotions
associated with dealing with any kind of loss and a lot of times when we talk
about grief we think about death and yes death is definitely something we grieve
but we also grieve other things and that grief may be lesser on an intensity or
greater in intensity depending on what the thing is or was and how important it
was to us we can lose things and we can grieve if you lose your grandmother’s
wedding ring that you had you may grieve the loss of that and be upset about it
for you know awhile I don’t know how long you would be upset but and that’s a
thing but that also represents a memory and something important to you we can
lose abilities as we get older we lose certain abilities I can’t do some of the
things I did when I was 20 anymore and it really frustrates the heck out of me
I’m stuck in that anger stage I’ll admit but it’s important to recognize that we
do lose abilities and people who experience injuries and they may lose
functioning if they have strokes that may cause a loss of abilities any
sort of physical functional or cognitive abilities we’re going to grieve the loss
of as people develop symptoms or become more symptomatic in Parkinson’s I
watched it with my grandfather he was still cognitively sharpest attack but he
began shaking a lot he had the tremors and his best favorite hobby was making
miniature dollhouse furniture and you can’t do that when you’ve got the
tremors and that really was devastating to him his other hobby or and career was
painting he was a house painter and obviously with tremors you can’t paint
and get those sharp clear lines like he was oh he drilled that into my head we
can also lose freedoms our ability to get from one place to another when
people go on oxygen and they’ve improved B oxygen delivery systems a lot but you
know back in the day if somebody had to be on 24-hour oxygen it would reflect in
their freedom their ability to move around we also when we talk about
freedoms and this is more under social than physical but since it triggered in
my memory when we lose particular freedoms you know the freedom to vote
the freedom to whatever when we feel like we lose particular cultural
freedoms we can also experience grief in terms of self concept we can grieve when
we lose a role think about empty nest you don’t become when your children move
out you’re not not a caregiver anymore you’re still a caregiver but it’s in a
different way and that role of being a 24/7 caregiver has changed when people
retire and they are no longer going to that job every day they see themselves
as a retiree now not as a whatever they used to do for their career and they may
grieve the loss of that role they’re not sure
they are when people get divorced or whatever happens and they lose one of
their roles they are no longer that they no longer have that function I don’t
want to say they’re no longer that person because each one of our roles is
only a part of who we are but it’s something to be grieved from a worldview
we can lose our innocence and we can lose our sense of safety when we are
victimized when things happen that we feel powerless against and this can be
victims of crime this can be natural disasters there are a lot of different
things that can affect our worldview that may kind of shock us and we lose
our sense of safety and security in our where we’re at or it may alter our
worldview by changing our sense of innocence in terms of you know you may
have thought of everybody as good and forward moving and benevolent and
something happens and all of a sudden you’re like crap well that doesn’t work
and you’re having to grieve the loss of your worldview dreams how things should
be yeah a lot of us have dreams we had dreams when we were little we have
dreams now and if something happens and we get to the point where we recognize
that that dream is just not going to come true
then we may have to grieve it I remember when I was from the time I was knee-high
to a grasshopper I thought I was going to be a doctor a medical doctor and you
know lo and behold I got into college and I recognized that calculus and
organic chemistry were not my thing and that probably was not going to be the
path that I was going to end up being successful on and that took a while that
was a bitter pill to swallow for me and you know I grieved the loss of that
dream I took it and I moved into acceptance and funneling that energy
into something else and socially we can lose relationships we can lose
best friends we can lose loved one you know relationships with with significant
others you know we can break up there are a lot of things that can happen that
aren’t death specifically we also want to grieve and this isn’t as much of an
issue now with the internet but it is still somewhat of an issue when we move
you may have that best friend that lives in your neighborhood or down the street
that you just hang out with all the time that’s the person that you rely on you
enjoy spending time with and then you get transferred well that can be grief
provoking because not only are you leaving that neighborhood and that
community that you know but you’re leaving your best friend people who are
in the military experience this a lot because they transfer about every two
years and they learn to deal with it but there is a grief process when life
changes stages of grief now we’re going back to the old basic stages of grief
denial anger bargaining depression and acceptance in denial people often feel
numb they feel like it’s a dream they feel sort of surreal and they try to
find alternate explanations or engage in some magical thinking this isn’t
happening it’s it’s a bad dream I’ll wake up tomorrow and everything will be
fine anger well people get angry when things happen when their worldview
changes when they lose something they don’t know what to expect next
and generally the loss was not expected so you know there’s the unknown a sense
of loss of control even in when somebody is diagnosed with a terminal illness for
example when they are diagnosed they often feel a sense of anger and terror
and grief about what’s happened what the unknown is the loss of control you know
yada yada and there’s also anger towards fears of death isolation and failure and
important to recognize that anger has a protective function you know suddenly
your world is out of control that’s what happens when whatever
occurred that’s causing the grief grieving process anger is one way that
fight or flight that you are trying to regain control and regain mastery and
get reground ‘add anger makes sense you know it
some people feel more anxiety than anger but either way it makes sense from a
functional point of view bargaining is the next step if I do this that in the
other then I’ll wake up and realize this was only a bad dream if I followed that
all of the doctors directions and I go to church every single day while I’m in
chemo then this cancer will be gone you know there’s a lot of bargaining that
can happen with parents if they have a child who is sick a lot of times parents
bargain and they’re like if I could only have that and spare my child then people
move into depression and this is not necessarily linear you know I see a lot
of people jump around we don’t want to assume that this is gonna be a nice
linear one-way thing they’ll hit depression and may bounce back to anger
and then bounce back up to depression for a while until they finally move on
into that acceptance depression is characterized by a sense of hopelessness
and helplessness this is when it really hits the person this really happened
there’s nothing I can do about it something that was meaningful to me is
now gone and I can’t get it back I’m powerless to get that back and we need
to help people during this phase regain their sense of hope about something as
well as their sense of personal power about what they do have control over
we’re going to talk about that more and finally acceptance is the final stage
and acceptance is such a challenging word for a lot of people that are
experiencing grief radical acceptance involves realizing that the loss
occurred and determining how to proceed from there
this is happening it is what it is it’s real now how do I proceed from here
acceptance also means recognizing what happened and still being able to
envision the future again we’re going to talk about that a little bit later in
the presentation the biopsychosocial impact of grief there are articles in
your classroom that go over in depths on all this stuff but basically let’s hit
the highlights biologically when people are grieving their HPA axis is ramped up
because all of a sudden something was taken from them their grieving and
they’re feeling stress so they’re gonna experience sleep disturbances changes in
weight increased blood pressure increased cortisol and other endocrine
changes and potentially muscle weakness this is not surprising the increased
cortisol and other endocrine changes I do want to focus on for just a second
because especially people who have diabetes they can find it more difficult
to control their blood sugar during times of stress and grief because their
cortisol levels are higher which means that their body’s trying to secrete more
glucose into their system on a regular basis when that happens when that
glucose is constantly being drawn out of the muscles to are drawn into the system
the muscles may not have enough glycogen stores and they may that may contribute
to feelings of just muscle weakness like oh my gosh I don’t feel like I can lift
that forty pound bag of dog food like I used to
there are other changes that happen chronic headaches and are another thing
to remember a lot of times stress causes headaches and when people are grieving
they’re under stress another impact of grief and I know this
is out of order but it looked better on the PowerPoint to do social next is
social when people are experiencing grief they tend it doesn’t always happen
but they tend to go to one of two extremes there may be withdrawal
withdrawal and social isolation I don’t want to get close to anybody I am
overwhelmed I can’t deal with anything anymore I don’t want to be reminded of
it too the other aspect or the other end of the spectrum of what I call in
measurement where people are so worried are so fearful that their loved ones are
going to disappear or their stuff is going to disappear or whatever it was
that happened that they’re grieving that they consume themselves with looming
over what they still have it’s like I’m going to keep an eye on you if it’s a
child you know they may want to stay real close to that child to make sure
that nothing bad happens to to him or her if it’s stuff you know if they their
house is broken into they may become abscessed is not the word I’m really
looking for but they may become extremely focused on keeping their house
safe and trying to make their world safe again and that may be an almost singular
focus that they experience for a while psychologically people run the gamut
depression is one obviously we talked about that denial anger bargaining
depression and acceptance anxiety people anxiety is the flight part of the
fight-or-flight reaction people have a lot of fears when things happen not
necessarily because of the primary loss but sometimes because of secondary
losses if a person’s been married for my grandmother went through this she was
married to my grandfather for 30-some odd years and he always took care of
everything and he paid the bills and that was what he did and when he passed
away not only did she lose her best friend and her confidant and the person
who’d been by her side for you know 40 years but she also lost the person who
took care of the bills and took care of making sure that there was money coming
in and you know balance did all the stuff you know she was very she embraced
that very traditional 1950s female role and that’s what she
knew how to do and she felt comfortable doing and all of a sudden she’s having
to do what he did to and she felt very anxious about that she lost so much in
that one incident when he passed away people may also experience a sense of
relief and a lot of times they don’t want to talk about this because they
feel guilty for feeling relieved and you know I mentioned this in a couple
classes ago that when both of my parents passed away they both had cancer and
towards the end they were both suffering greatly and it was a relief to me in
many ways when they finally did pass because they weren’t hurting anymore but
nobody wants to talk about relief they want to talk about grief and sadness and
devastation and it’s important to tell people it’s okay to feel a sense of
relief there are changes in worldview when grief happens even if it’s
something like cancer you can see you know good people get cancer and pass
away and you’re like why did this happen that doesn’t make any sense in my
worldview good people are supposed to be able to be around and populate the earth
when bad things happen to you you know maybe your house burns down and you’re
like I have done everything right I am a nice person I turned off all the elect
you know I turned off the burners and stuff how could this happen my worldview
that life was predictable is suddenly obliterated hmm people can have lots of
different types of guilt and we’re going to talk about a few there’s the general
guilt of I should have done this for that person or I should have done this
or I shouldn’t have done this or I regret not saying something to somebody
before they passed away but there’s also survivor guilt and when I say survivor
guilt that can happen with with death of course but that can also happen in
situations where someone is injured maybe you’re in a car accident and
someone is injured and loses some sort of functional ability they experience
losses as a result of that car accident and you don’t and the other people in
the car who didn’t experience such devastating injuries may feel guilty
that they are still as functional as they were before the car accident and
the other persons not so there can be a survivor or survivability guilt that
people experience especially if they perceive that they are the cause of the
other person’s injuries such as they were driving the car when they got into
that car accident and the passenger was injured the driver of the car may feel
high levels of guilt for not only causing the problem but also for
remaining able-body there can be difficulty concentrating when our HPA
axis is activated when we’re not sleeping well we’re not going to
concentrate well people are in crisis when they’re in grief they are trying to
adjust to their new normal encourage them to write things down give
themselves time eliminate distractions as much as possible when they do have to
concentrate and take advantage of those times when they do feel alert and able
to focus right after my mom died there was about three months there where you
know it was kind of hit or miss when I came to the office if I felt like I was
gonna be able to focus long enough to write a course or do something and it
was important for me during that time for me it helped to chunk things and say
okay I’m gonna work on this for twenty or thirty minutes and then I’m gonna go
do something else because I knew I didn’t have the cognitive wherewithal to
do a two or three hour writing session people may have difficulty making
decisions because they’re not sure I mean this
life was turned upside down and they’re not sure of the impact of their
decisions now so they may be challenged if they’re moving you know they got
transferred and they’re moving somewhere making a decision about where to live
next you may not think of that as a grief reaction but they’re moving to a
new place and they may have to make decisions about what they’re how they’re
gonna find new friends and there’s lots of stuff they need to do and they may
just not be ready to do that because they’re afraid since they can’t
anticipate anything right now that they may make the wrong decision and that’s
okay encouraging them to get social support
for those decisions that have to be made and delaying any decisions that they
don’t have to make right now and recognizing that in large part most
decisions are not permanent you know there are some that are permanent but a
lot of times if you make a decision like you know where you’re gonna live you can
always move it’s a headache but you could move if you make a decision about
you know how you’re gonna handle certain things okay you know you maybe try to
implement those strategies right now and if they don’t work out so well that’s
fine you know you can regroup and go a different way and avoidance of triggers
some people after a grief after they lose something they may avoid triggers
and there’s lots of them you know you want to think with all your senses
visual triggers auditory triggers smells you know if it’s a person that you lost
you may smell their cologne on somebody else and it may trigger you different
things I know for myself over the past year getting used to my mom not being
here my daughter started driving she’s graduating high school at the end of
this semester there are a lot of big milestones in my daughter’s life that my
mom’s not going to be around for that every time one of those happens
I’m like I keep wanting to call her and I’m like I can’t do that and I didn’t
anticipate that I anticipated the anniversaries I anticipated the holidays
but I didn’t anticipate milestones in my kids lives remind being a trigger for
the grief of the loss of my mom it’s important for people to be mindful and
aware of what is triggering for them so they can address it doesn’t mean you can
avoid it but it can allow you to understand or can allow the person to
understand why they are feeling more emotional and and we do want to let
people know or educate them about grief bursts some sometimes it’s called so you
may be thinking that you’re doing fine and you know 2-3 months goes by and
you’re not having any problems and you feel like you got this you’ve coped with
it you’ve dealt with it and then all of a sudden something happens and you
become really emotional and that’s okay that’s your body is still adjusting and
they say that uncomplicated grief usually takes two to three years for the
person to actually fully work through and integrate and move on to acceptance
the first year is generally the toughest and then after about three years if the
person is still having difficulty integrating it we’re looking at more
complicated grief exacerbating and mitigating factors how people react in a
crisis when something bad happens how close the situation was to them if it is
a co-worker at work who gets diagnosed with cancer then the grief there may be
some shock and some sadness and some grief but it may not be the same
intensity as if your child or your parent was diagnosed with cancer or if
the situation happened to you your house burned down
your grief reaction and your trauma reaction would probably be more intense
than if a family member’s house burned down you know hopefully that would
wouldn’t happen but we know fires occur the person’s grief and their ability to
integrate the grief and move through those stages also is affected by how
many other stressors the person experienced in the last year if they are
already worn down and their cortisol levels are already bottoming out then
they are more likely to develop trauma symptoms in reaction to a grief
promoting event if they had mental health issues and ineffective coping
skills then that may impact their ability to deal with the grief if they
have adequate social supports that is gonna go a long way to helping people
work through the grief but what adequate looks like for people differs not
everybody wants to be surrounded by 15 family members for the first month after
a loss you know we need to identify what that looks like for them their
understanding of the loss is going to also alter their reaction to the grief
process if they understand it as something that was anticipated or if
they see it in a way that makes sense in their worldview that’s gonna be a lot
easier than if it’s something that just hits them out of left field how much
control or responsibility they feel like they had in the situation also can
affect their grief when you’re working with parents who’ve experienced sudden
infant death syndrome there is a lot of grief that goes around and the parents
often feel a whole lot of guilt and responsibility because they feel like
they should have hear those words their emotional reasoning and the should they
feel like they should have been able to prevent it and the
can make it a lot harder if they’re they keep going over it a hundred times or a
child that gets abducted you know that’s another problem or another grief
promoting thing because the person’s sense of safety in their environment is
lost they have to grieve the fact that even if they get their kid back that
this happened and they may not feel as a result of it they may have lost their
sense of being a good parent they may have lost their sense of being safe in
their environment they may have lost you know there’s probably lots of losses and
we need to help them examine those things the type of loss and the
predictability of the loss also affects it if somebody is diagnosed for example
with a terminal illness a lot of times that starts out as anticipate or grief
because you find out and then you’ve got a while while they’re going through you
know treatment or or whatever they decide to do before the person actually
dies so there’s a time for people to put their proverbial ducks in a row if you
will and that can make it easier because people have a loved ones have a chance
to say goodbye and come to terms with it in a certain manner as opposed to if
somebody has a heart attack in their sleep you know that’s a oh my gosh you
know wasn’t expecting that and it may feel a lot scarier to people and the age
of the bereaved children have a whole different concept of life and death and
loss and grief and all this stuff we need to help children move through these
stages and especially address their any symptoms of magical thinking you know if
I say my prayers every night then this will make mommy better or whatever the
case may be we need to work with children to help them understand what
they can and cannot control most people if
they have unresolved grief may get stuck in anger guilt or depression they don’t
usually get stuck in bargaining sometimes they’ll jump back all the way
to denial and they will just pretend it didn’t exist with anger the person may
be repeating to themselves and their internal voices may be going through a
lot of shoulda couldas and if onlys if only I would have encouraged him to go
to the doctor sooner if only I would have double-checked the stove if only I
would have you see where we’re going with this they may be angry at
themselves for things they think they should have or shouldn’t have done they
may be angry at other people for things that they think those other people
should or shouldn’t have done and when something happens that causes us a loss
a lot of times we want to assign blame because that helps us get control if
it’s that person’s fault then that’s easier to control than to say wrong
place wrong time so there can be angry at others there
can be angry at the person who died for leaving them for abandoning them there
can be anger at a higher power if the person believes in higher powers for
letting that happen there’s a plenty of anger to go around and we want people to
explore that and recognize it and not pathologize it who are you angry at what
do you feel guilty for who do you resent you know let’s use all those different
anger terms and get those things out there there can also be the jealousy
that comes out and you know that’s another form of anger if you are a
survivor and survivor of a car accident I’m gonna try to keep away from as many
death metaphors as possible because we talk about death all the time in terms
of grief but if you’re a survivor of a car accident and you have lost physical
abilities as a result of that car accident you may be
Ellis of other people who still have those abilities so that anger is still
there that anger that you lost your physical capabilities and depression you
know people who feel hopeless and helpless and they don’t know how to go
on they’re kind of stuck they’re like I don’t know I I don’t know what to do
with this I have this grief I have this loss I have this stuff that I’m sitting
here holding and I don’t know what to do with it and we want to help people as I
said earlier work toward developing hope and personal empowerment with what they
can change denial is the minds way of protecting people from what lies ahead
and what lies ahead is the awareness that crap
that I couldn’t predict that that means there are other things in this world
that I can’t predict and that means that’s scary that’s terrifying to me and
as Joseph brings up unfortunately this fall comes right on the heels of Kobe
Bryant’s death he had gone to church that morning and had his daughter in the
helicopter and they were getting going off to some something I don’t know what
they were doing but he had no idea that this was gonna happen and you know by
all rights he was a really good human being and you’re looking at it going why
what is the sense in that and so that can make it really hard to
accept that that really happened it’ll you know right now you keep seeing the
stories online and on the TV looking at this crash and trying to figure out how
to blame someone or something for this happening denial
hey let’s get back to denial can start before the actual loss is in the case of
a terminal illness when you’ve got anticipatory grief so what do we need to
do or what can we do we need to assess the person’s level of acceptance and
denial or sorry assess the level of acceptance
denial of each person in the support system you have your theoretical
identified patient who’s grieving but you also have all of their supports and
those people are also probably grieving and it’s important to understand where
people are in their grief process because they’re going to interact
differently with one another if one person’s acceptance and the other person
is in anger then they may end up clashing and have some animosity with
each other when the person who’s accepted the loss is going why can’t you
just let it go and move on and the person who’s angry is saying how can you
possibly let it go this is so unjust you want to assess you know the whole
support system as much as you can we want to also discuss hope and acceptance
we can’t have hope in our life and accept that a loss is has occurred I can
accept that I’ve had a an injury that has taken away some of my physical
abilities and I can have hope for a rich and meaningful life even though I have
that disability now I can accept that my loved one has died but I can have hope
or and I can add hope that I can have a rich and meaningful life without them
being physically there but still present in my memories yeah so you want to
discuss that radical acceptance and in acceptance and commitment therapy he
talks about the living in the and you can grieve you can experience this loss
and you can still have a rich and meaningful existence action strategies
we want to help people shore up their resources you know social supports
whatever they need at that point in time when people are in the really early
stages of grief they are going to need all kinds of
resources we need to make sure think of Maslow but they’re getting their
biological needs met and they may have all the food in the world
old in the house but if they’re not eating it it ain’t doing any good
my stepfather after my mother passed he didn’t doesn’t cook at all and there was
all this food and he would just forget to eat he wasn’t hungry he’d forget to
eat he also you know wasn’t a grocery
shopper so when food started running low you know it was he didn’t know where to
go what to get he felt very flummoxed at just the concept of trying to have to
take that over very bright man but he was so overwhelmed with his grief at
that point he wasn’t able to engage in a lot of those very basic activities to
keep himself functioning so it’s important to shore up resources what do
you need to make sure that you are feeling as safe as you can eating as
well and as nutritiously as you can getting sleep the best quality that you
can you know see where we’re going we’re not looking for perfection we’re looking
to try to mitigate those vulnerabilities and what other things do you need people
after a fire you know they may need all new clothes because their clothes are
done they’re their ashes they may need housing they may need assistance
enrolling in a new school because the shelter that they’re staying at not in
the same district we also need to pay attention to those things we need to
gather accurate information for the person if they are diagnosed with a
terminal disease help them get accurate information to help them move through
this denial so it’s not so scary and they can start peeking and going okay
maybe I can take a quick look if it is after a fire you know accurate
information might be information about what happened in that fire after someone
passes away sometimes people want to know did they suffer that’s one of the
first questions that a lot of people ask and accurate information can help people
get through that don’t give them information they don’t want people will
ask for the information that they want you don’t want to overwhelm them and
kind of rip the band-aid off for them that’s not cool
and when they are ready they can start looking at facing the loss and narrative
therapy is super helpful for this because it puts it out there it’s not me
telling you about what’s going on but it is me the the client writing about okay
this is what happened this is the story and you can use the same names you can
use different names but you want them to you know write out what happened and
since they’re doing that is it it just helps them separate from those emotions
and get out what’s going on then they can go back and read it trauma focused
cognitive behavioral therapy is a perfect example of narrative therapy and
helping people start telling their story and
integrating it into their lives anger remember is a power play it pushes
people away to avoid getting hurt again it pushes people away to keep them from
overwhelming you it may blame others as an outlet for helplessness somebody
somewhere could have prevented this there’s no reason this had to happen so
I need to blame somebody they may blame themselves to try to regain some control
or prevent it from happening again or make themselves suffer people who
have that survivor guilt may blame themselves for what happened because
they feel guilty for coming out unscathed we want to explore that with
them and anger may encourage people to
question their belief system and world schema they need to make sense of it so
they’re not threatened again so they are safer than they were before they need to
learn from this remember guilt as a form of anger we’ve
talked about that action steps have people identify their primary and
secondary losses the primary loss was you know the loss of the person or the
loss of the house or the loss of the pet that was the primary thing but what else
did you lose as a result of that and going through all of those losses that
we talked about on the first slide did you lose anything else physically you
know maybe if the breadwinner yeah 45 year old father of five has a heart
attack and passes away and he is the primary breadwinner the his spouse
stayed home home schooled the children and hadn’t had a job in 15 years okay so
after that happens not only did mom lose her partner her spouse the love of her
life but she also lost the primary breadwinner which means they may not be
able to afford that house anymore so they may lose the house which means they
may need to move they lose their community which also
means they may have to switch schools you know you can follow this out to its
final conclusion but you can see that it’s not just the loss of a person it’s
the loss of a whole bunch more and that has a lot of ripple effects because
community for example is what’s there for social support so if as part of the
losses as a result of the primary loss you lose your social support oh my gosh
that’s like a double whammy right there we want to explore what the losses mean
to the person if they lose their job you know they get fired from a job and it
was they thought that that was the career that they were going to you know
have for the rest of their life that can be devastating to them when people
retire or when they’re forced to retire even worse that’s even more of a grief
promoting thing you know exploring what that means to them that they are no
longer a you know a couple of my friends just recently retired from the military
so they are no longer active duty soldiers they will always be soldiers
but they are no longer active duty soldiers and that is huge to them cops
go through the same thing a lot of cops when they retire they’re like I don’t
know I’ve been a cop for 20 years I don’t know what I am if I’m not out
there on patrol or doing whatever I did we want to explore that with them how do
they feel about that loss what are they angry about because of that loss what
are they scared about because of that lost and what do they feel helpless and
hopeless about because of that loss we also in this stage want to allow time
for ventilation and validation anger is a natural emotion and I’m not gonna tell
people they shouldn’t have anger so it’s important to help them identify that
feeling and if they feel like they want to scream for a second ok I had a client
when I was in in Florida who was in treatment with us and unfortunately she
was diagnosed with a really aggressive form of breast
and she was very angry very very angry and I get it but she wasn’t expressing
that anger she was very buttoned down about it and in anyway long story short we ended up
having a talk and she says I can’t I am just enraged and I can’t let it go
because I have no privacy around here and I don’t want to overwhelm anybody
scare anybody and I don’t want anybody’s pity okay so I ended up making a a call
over to our crisis stabilization unit where they had rooms that they used for
seclusion and restraint and it would be a safe place for her to go and yell and
scream and do whatever she wanted to do for a few minutes and just get it out
and I said is this something that you think might be helpful and she said yes
and I said alrighty so we made it happen and yeah she let it let it rip for about
15-20 minutes until she was just exhausted and she sat down on the floor
and she finally started to cry not everybody Christ when they grieve
she happened to but it was important for her to get past that anger and in order
to get down to those more threatening feelings for her ventilate validate it
is okay to scream sometimes and you know it’s just all about when and where you
do it going back to that whole context thing we want to examine any of their
cognitive distortions like all-or-none thinking you know everybody I know gets
cancer nobody that I know has ever gone through anything this bad you know
looking for those and helping them challenge that reasoning with facts
emotional reasoning I am angry that this is happening therefore somebody must be
able to be blamed if I feel angry then I means that I should be there’s somebody
to be angry at there’s something to be angry at the fallacy of fairness and we
talked about that a couple of times the fact that you know sometimes it can be
the best person in the whole world who has you know eaten a nutritious diet
never smoked never drank never cussed and they have an aneurysm I mean it just
happens life is not fair sometimes and we want to help people understand that
but at the same time once they start exploring that that can also increase
their anxiety because they’re like well you know if I if I lived my life by
fairness then if I’m a good person then good things will happen to me and I’ll
live a long and happy life and get it out it doesn’t happen so that’s really
scary to me to anticipate or to know that I can’t anticipate what might
happen and begin exploring solutions to fears and issues what is within their
control with my kids you know using the example of my mother passing away I am
sad that that happened my father passed away before my daughter was even born
and you know that was that’s very disheartening and devastating to me that
she didn’t get to know him as a person but she still gets to know him as
through what he taught me and when things come up around the house I’ll say
something like you know Papa Ron would have said or Papa Ron you stew and we
talked about my father and my memories of my father to help instill in them the
things that I think are important but he instilled in me and they get a sense of
who he was I can’t bring him back but I can keep his memory and his lessons and
his legacy alive but that’s you know how I do it we do want to help people
explore what’s within their control if their house burned down well they can’t
get their house back but they can they eventually will get a new house they can
choose weird to live you know they don’t want to stay in a shelter forever so the
first step that’s within their control might be figuring out okay how do I move
from this temporary shelter to the next permanent the next permanent step bargaining if I do X Y & Z maybe I can
wake up and it’ll have been a nightmare I think we’ve all been there before
contributes to depression because the person wakes up every morning hoping
that the reality is different and every morning their hope is squelch just like
crap this is real we want to encourage people to start developing hope for the
new reality living in the and accepting that they can grieve and experience the
loss and still have a rich and meaningful life if they’re diagnosed
with cancer you know they don’t know if the chemo is gonna work they don’t know
what the prognosis is necessarily or maybe they do but they’re not dead yet
and they can grieve having this diagnosis and still have a rich and
meaningful life for as much time as they’ve got and a lot of you know
treatments for diseases not just cancer have come so far whether it’s
Alzheimer’s or Parkinson’s or or cancer and it’s important for people to be able
to grieve that diagnosis and you know what that means to them but also
recognize what time they have left and try to figure out how they want to
embrace it how do they want that narrative to work help clients stay in
their present reality not get too far ahead of them not thinking about you
know months from now when I am on confined to
the bed we want them to stay in the present what can you do to use your
energy to have the richest most meaningful life today examine how
bargaining just creates more exhaustion and frustration you know it’s not doing
you any good to sit there and try to make deals what can you do what is
within your power some people feel like if they make a deal with their higher
power that you know things will happen okay you know if you want to do that but
what else can you do in addition to that that can help you have that life that
you want validate people’s wants you know I want to not have cancer I want to
have whatever I lost back that is you know I get it we want to validate those
wants but we also want to educate them about their realities including personal
responsibility and what I mean by that is sometimes we don’t have the ability
to change anything children often feel a great amount of responsibility for their
parents they think that if their parents are ill or depressed or anxious or
whatever that somehow it’s their fault and we need to make sure that people
understand what if anything their part was was in this and a lot of times its
they’re taking on more responsibility and more self blame than is accurate so
we do want to make sure especially with children to educate them about what’s
going on and what they do have control over a child cannot make cancer go away
a child with cancer cannot make that cancer go away but they can’t follow the
doctor’s orders and get a good night’s sleep and eat the food they’re supposed
to and take their medicine and whatever hopelessness and helplessness occurs
when the reality that the loss has occurred sits in and it can’t be changed
you’re just like wow that that happened and that Wow
we want to help people develop hope and empowerment exploring all aspects of the
life to which they are committed if you lost this aspect you were forced into
retirement and now you lost that aspect of your life you’re no longer a soldier
or a cop or whatever it was you can grieve that you know you have that to
grieve what else in your life makes it rich and meaningful
my guess is that was not your soul and entire life
explore how they can use their energy to continue to nurture the important things
in their life after the loss of the child we see a lot of people experience
you know intense grief and you know I can’t imagine the grief that they’re
experiencing in some cases you know if you’ve got a family that has lost a
child and there are two other children in the household they also still need to
devote they have energy and they can be committed to those remaining children
they can be committed to their relationship with their partner they can
be committed to other things that are important to them yes
the loss of that child is devastating and some energy is going to go there
encouraging them to also look at the things that they still are able to
experience positively again encourage knowledge acquisition identify what can
and cannot be changed you know have them make a list of things if they need to in
order to get clear in their head what their responsibility is and what will do
any good you know using their energy to do something you know will it do any
good acceptance means accepting the reality
of the loss we want people to explore how life will be different and the same
since the loss when we experience a loss it generally doesn’t mean we lose
everything always everywhere so we want to look at what’s gonna be the same your
house burned down that is devastating you lost all your possessions you lost
your memories you lost your house you may have to move there’s a lot of losses
however you still have your friends you still have your family you still have
your job you still have you know the car that you were in whatever it is
encourage people to look at some of the things that are the same because that
helps them reground to recognize that my entire life is not torn up like a
tornado there are still some things that I have that anchor me have them make a
plan to change the things that they can you know here’s where you’re at right
now where do you want to be and how do we get there if that loss can be
prevented from recurring encourage the person to take proactive steps like
engaging in advocacy groups and looking at personal behaviors somebody who has a
stroke for example maybe they had a stroke because their blood pressure got
too high well that might be preventable in the future and they’re gonna have to
deal with guilt about you know not preventing it sooner but they can also
be empowered to prevent having another stroke by learning to keep their blood
pressure under control and those sorts of things
grief is not a linear process most people experience grief surrounding a
loss for at least a year up to three years for uncomplicated grief holidays
anniversaries and reminders are going to trigger that experience and even for
people remember who have been survivors of crime there are a lot of triggers
when USA was running I think it was USA it was one of the channels that I watch
they were running these commercials and I think they still are I always turn
them off that I find very triggering because it’s just a bunch of male actor
saying boys will be boys and dismissing you know what happens in when someone is
sexually assaulted and those are the things that survivors here right after
they’re assaulted right after they’re victimized so hearing that you know not
once but like 15 times in the same 30 seconds you know yes they end up with a
different message like things need to change or something but that entire
thing just puts people back in that place where they may have been right
after they were victimized and hearing that experience invalidated so it’s
important to remember that even things like television shows and commercials
and music and smells can trigger memories
many people will vacillate between depression and anger it’s important to
normalize their experience and let them know you know you’re gonna have good
days and you’re gonna have really bad days
that’s okay let’s make a plan to help you deal with the bad days and you know
focus as much as you can on the good ones encourage them to reach out to
supports not only their family or social supports as they define them but also
support groups you know there are a lot of support groups of people who’ve gone
through similar things and that can be very helpful and validating to not feel
quite so isolated make sure to address happiness and survivor guilt it’s okay
to be happy even though something bad has happened you know and a lot of times
people feel guilty not only for the relief that they experienced if somebody
passes on when they’re suffering but sometimes kids feel guilty for being
happy if their family is going through something and it’s okay to be happy you
don’t have to be devastated all the time and people experience grief in different
ways not everybody’s gonna cry we do want to validate that and use their the
individuals language just as Andrew points out when you’re talking to them
if they’re talking about sadness then we’ll talk about that if they’re talking
about devastation or trauma or whatever words they’re using we want to try to
join them in their expression when someone’s grieving they’re in a
state of crisis encourage them to minimize vulnerabilities by making lists
they’re not gonna be concentrating and remembering things well right now make
lists write things down just accept that all your energy is going to coping with
this grief and all the other stuff is gonna have to be written down minimize
demands unless staying busy helps some people would rather throw themselves
headlong into something at first and that’s the way their way of getting from
their emotional mind into their rational mind keep a normal sleep routine set a
defined amount of time to revisit the loss each day now this doesn’t mean you
have to but for people who tend to stay stuck and they’re mulling it over and
thinking about this loss all day every day encouraging them at a certain point
to say okay I need to start devoting some of my
energy to these other areas of my life that are meaningful I will allow myself
an hour or thirty minutes each day to sit with this feeling of grief and then
I will move on and that’s very helpful for some people so they have some
parameters they don’t feel guilty for not grieving but they also are able to
give themselves permission to do something besides grieve encourage
people to be compassionate with themselves losses encompass more than
death of a person or property failure to acknowledge losses can cause unhelpful
reactions in similar future situations it’s important to explore feelings and
reactions in terms of their functionality how are they benefiting
the person how does anger benefit the person how does depression benefit the
person in terms of helping them survive that moment and helping them try to
protect themselves henceforth it takes at least a year to deal with significant
losses and many times there are multiple ancillary losses that need to be
addressed how people deal with grief and loss
varies widely but we need to remember that grieving is a form of
the body is on high alert which impacts people’s ability to sleep their appetite
and their energy to work or socialize minimizing vulnerabilities is important
to reduce unnecessary frustration and avoid confirming that sense of
helplessness we want to help people have the tools that they need to keep going
and feel empowered and successful ultimately it is hoped that the person
can identify how they’re stronger or better off from the experience between writing notes filing insurance
claims and scheduling with clients it can be hard to stay organized that’s why
I recommend therapy notes they’re easy to use platform lets you manage your
practice securely and efficiently visit therapy notes com2 get two free months
of therapy notes by just using the promo code CEU when you sign up for a free
trial at therapy notes com if this podcast helps you help your
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