PAOC BEREAVEMENT COURSEPAOC BEREAVEMENT COURSE

Rev. Bob GlasgowRev. Bob Glasgow

glasgowb@telus.netglasgowb@telus.net

www.soulconsolation.comwww.soulconsolation.com

Common societal myths about griefCommon societal myths about grief

The grief experience has predictable, linear The grief experience has predictable, linear

stages.stages. One can “get over” the loss,accept it and One can “get over” the loss,accept it and

return to normal .. there is (should be) an return to normal .. there is (should be) an

ending to grief ending to grief Private process rather than a social/relational Private process rather than a social/relational Grief “bursts” are a sign of weakness or Grief “bursts” are a sign of weakness or

indicate “not coping”indicate “not coping” Relinquishes ongoing attachmentRelinquishes ongoing attachment

Contemporary Grief TheoryContemporary Grief Theory

Grief is varied and uniqueGrief is varied and unique To grieve means to relearn To grieve means to relearn

the worldthe world Full range of affectFull range of affect Continuing bondsContinuing bonds On-going processOn-going process

Avoidance/Avoidance/Healing ModelHealing Model

ADVOIDANCE ROUTEADVOIDANCE ROUTE

Resentment and GuiltResentment and Guilt

(Secondary Emotions)(Secondary Emotions)

Avoidance Behaviors:Avoidance Behaviors:- Social Isolation Social Isolation - Drugs/AlcoholDrugs/Alcohol- WorkaholicWorkaholic- Extensive TravelExtensive Travel- Beliefs used as defenseBeliefs used as defense

HEALING ROUTEHEALING ROUTE

Steps of Healing:Steps of Healing:- Acts of accommodationActs of accommodation- Re-telling of lossRe-telling of loss- Exploring lost relationship in detailExploring lost relationship in detail- Dealing with change in identityDealing with change in identity- Being aware of secondary lossesBeing aware of secondary losses- Working at emotional closure in Working at emotional closure in

what felt unexpressed with our what felt unexpressed with our loved oneloved one

- Celebrate learning about self and Celebrate learning about self and lifelife

- New directionsNew directionsResult:Result:Repress pain, avoid being vulnerable againRepress pain, avoid being vulnerable again

Result:Result:Pain expressed, vulnerability Pain expressed, vulnerability

re-establishedre-established

WELL BEING

LOSS

SADHURT

SCARED

SadHurt

Scared

developed by Bob Glasgow

Cycles of GriefCycles of Grief Therese RandoTherese Rando

TasksTasks William Worden William Worden

Avoidance

-Desire to avoid acknowledgment of the loss

-Shock, denial, numbness, disorganization

-Denial allows the person to absorb reality slowly

-A need a to know why the death occurred may appear

Task: To recognize and acknowledge the loss

Integration

-Waves of intensity get farther apart

-Decline of grief

-Beginning of emotional and social re-entry

Task: Re-investing energy in

relationships and pursuits

Confrontation

- Intense grief

- Emotional extremes

- Anger and guilt are common

- Yearning and despair

- Symptoms of depression may be evident

- Waves of acute grief may occur

- Repeated review of the loss experience is common

Two Tasks: 1. Experiencing the pain

2. Beginning to integrate the loss

COGNITIVECOGNITIVE FEELINGFEELINGFeelings are limited or toned downFeelings are limited or toned down Feelings intensely experiencedFeelings intensely experienced

Grief experienced primarily cognitively or Grief experienced primarily cognitively or physicallyphysically

Grief experienced primarily emotionallyGrief experienced primarily emotionally

Grief expression is cognitive and behavioralGrief expression is cognitive and behavioral Grief expressed emotionallyGrief expressed emotionally

Thinking and doing precedes and dominates Thinking and doing precedes and dominates feelingsfeelings

Feelings precede and dominate thinking and Feelings precede and dominate thinking and doingdoing

Grief energy may be converted into physical Grief energy may be converted into physical symptomssymptoms

Grief energy expressed emotionallyGrief energy expressed emotionally

Focus on problem solvingFocus on problem solving Focus on expression of emotion and meaningFocus on expression of emotion and meaning

Outward expression of emotion tends to Outward expression of emotion tends to emphasize angeremphasize anger

Emotional expression primarily sadness, Emotional expression primarily sadness, despair, lossdespair, loss

Internal adjustment to loss expressed through Internal adjustment to loss expressed through activityactivity

Internal adjustment to loss expressed through Internal adjustment to loss expressed through feelingsfeelings

Intense feelings tend to be experience and Intense feelings tend to be experience and expressed privatelyexpressed privately

Intense adjustment to loss experienced and Intense adjustment to loss experienced and shared with othersshared with others

Intense grief more likely to be expressed Intense grief more likely to be expressed immediately after the loss, often during post immediately after the loss, often during post death ritualsdeath rituals

Intense grief expressed long after the loss, Intense grief expressed long after the loss, often spontaneouslyoften spontaneously

Can discourage and confuse potential Can discourage and confuse potential supporterssupporters

Depends heavily on supporters, may even Depends heavily on supporters, may even alienate themalienate them

Adaptation uses thought or activityAdaptation uses thought or activity Adaptation uses expression o f emotion in Adaptation uses expression o f emotion in supportive relationshipsupportive relationship

Doka

Empathetic ListeningEmpathetic Listening

Empathy is the ability to understand Empathy is the ability to understand another person’s ideas and feelings. another person’s ideas and feelings.

It is gaining an understanding It is gaining an understanding (through listening) and (through listening) and

demonstrating that understanding demonstrating that understanding (by responding).(by responding).

The EISPU Response SystemThe EISPU Response SystemE – E – EvaluationEvaluation A response which indicates the counselor has made a A response which indicates the counselor has made a

judgment of relative goodness, appropriateness, effectiveness, judgment of relative goodness, appropriateness, effectiveness, rightness. He has in some way implied what the client MIGHT or rightness. He has in some way implied what the client MIGHT or OUGHT to do: grossly or subtly.OUGHT to do: grossly or subtly.

I – I – InterpretiveInterpretive A response which indicates the counselor’s intent is to A response which indicates the counselor’s intent is to teach, to impart meaning to the client, to show him. He has in some teach, to impart meaning to the client, to show him. He has in some way implied what the client MIGHT or OUGHT TO THINK: grossly or way implied what the client MIGHT or OUGHT TO THINK: grossly or subtly. subtly.

S – S – SupportiveSupportive A response which indicates the counselor’s intent is to A response which indicates the counselor’s intent is to reassure, to reduce the client’s intensity of feeling, to pacify. He has in reassure, to reduce the client’s intensity of feeling, to pacify. He has in some way implied that the client NEED NOT FEEL AS ANXIOUS AS HE some way implied that the client NEED NOT FEEL AS ANXIOUS AS HE DOES.DOES.

P - P - ProbingProbing A response which indicates the counselor’s intent is to seek A response which indicates the counselor’s intent is to seek further information, provoke further discussion along a certain line, to further information, provoke further discussion along a certain line, to query. He has in some way implied that the client OUGHT or MIGHT query. He has in some way implied that the client OUGHT or MIGHT PROFITABLY DEVLEOP OR DISCUSS A POINT FURTHER.PROFITABLY DEVLEOP OR DISCUSS A POINT FURTHER.

U – U – UnderstandingUnderstanding A response which indicates the counselor’s intent is A response which indicates the counselor’s intent is to so respond as in effect to ask the client whether the counselor to so respond as in effect to ask the client whether the counselor understands correctly what the client is “saying”, how the client is understands correctly what the client is “saying”, how the client is “feeling” about it, how it “strikes” the client, how the client “sees” it.“feeling” about it, how it “strikes” the client, how the client “sees” it.

PatientPatient: “I could accept it when this disease cost me my : “I could accept it when this disease cost me my eyesight and to be bedridden, but how can God possibly eyesight and to be bedridden, but how can God possibly want me to live in an institution and away from my want me to live in an institution and away from my husband.”husband.”

Response:Response:Evaluative:Evaluative: You have adjusted to a lot of physical losses and You have adjusted to a lot of physical losses and

now you need to make another difficult adjustment.now you need to make another difficult adjustment.

Interpretive:Interpretive: Chronis illnesses have a way of forcing one to Chronis illnesses have a way of forcing one to continually change dreams and expectations.continually change dreams and expectations.

Supportive:Supportive: You have amazed me with your spiritual strength You have amazed me with your spiritual strength in accepting so many physical losses. I am pulling for you as in accepting so many physical losses. I am pulling for you as you face this crisis. you face this crisis.

Probing:Probing: What do you think helped you with the other What do you think helped you with the other challenges you have faced in accepting physical losses?challenges you have faced in accepting physical losses?

Understanding:Understanding: Your husband has been so important to you. I Your husband has been so important to you. I would be questioning God as well.would be questioning God as well.

Responding to GriefResponding to Grief

““I can’t stand the fact that people have I can’t stand the fact that people have withdrawn from me since my wife withdrawn from me since my wife

died. Some that I thought were really died. Some that I thought were really good friends haven't called once.”good friends haven't called once.”

Caregiver might say…..Caregiver might say…..

Responding to GriefResponding to Grief

I can’t seem to get over that night and I can’t seem to get over that night and the memory of the policeman coming the memory of the policeman coming

to the door. The experience was to the door. The experience was horrible and I can hardly think of horrible and I can hardly think of

anything elseanything else..

Caregiver might say….Caregiver might say….

Responding to GriefResponding to Grief

““I feel so bad about the last words I I feel so bad about the last words I spoke to Jim. We fought over how spoke to Jim. We fought over how much he used the car. I wish I had much he used the car. I wish I had

told him I loved him.”told him I loved him.”

A caregiver might say….A caregiver might say….

Specific Circumstances of Specific Circumstances of DeathDeath

Sudden, Unanticipated

Violent, Mutilation, Destructive

Random and / or Preventable

Multiple Deaths

Mourners Personal Encounter with Death

Death is Traumatic

Higher Risk for Complicated Mourning

Eleven Issues of Traumatic Eleven Issues of Traumatic LossLoss

1.1. Capacity to Cope DiminishedCapacity to Cope Diminished

2.2. Assumptive World is Assumptive World is ShatteredShattered

3.3. No Sense to LossNo Sense to Loss

4.4. No Chance for Good-byesNo Chance for Good-byes

5.5. Symptoms Persist LongerSymptoms Persist Longer

6.6. Obsessive Thoughts of DeathObsessive Thoughts of Death

7.7. Anxiety Replaces Security and Anxiety Replaces Security and ConfidenceConfidence

8.8. Last Minute Involvements Last Minute Involvements with Deceased Emphasized with Deceased Emphasized MoreMore

9.9. More Tendency to Determine More Tendency to Determine Blame and Affix Blame and Affix ResponsibilityResponsibility

10.10. Sometimes More Secondary Sometimes More Secondary LossesLosses

11.11. Post Traumatic Stress Post Traumatic Stress ResponsesResponses

Therese RandoTherese Rando

Post Traumatic StressPost Traumatic Stress

Visual 58%, Smell 25%, Auditory 18%Visual 58%, Smell 25%, Auditory 18%

Mental and Emotional sides separatedMental and Emotional sides separated

Very sensitive to stimuliVery sensitive to stimuli

TestingTesting

Traumatized person frozen in pastTraumatized person frozen in past

THERAPYTHERAPY

1.1. Create Safety (They set boundaries)Create Safety (They set boundaries)

2.2. Ego Building – Strengthen SelfEgo Building – Strengthen Self

3.3. Widen Field of PerceptionWiden Field of Perception

4.4. Relive TraumaRelive Trauma

5.5. Have Safety Restored (Systematic Have Safety Restored (Systematic Desensitization)Desensitization)

Goal:Goal: Integrate all emotions, thoughts, and actions related to Integrate all emotions, thoughts, and actions related to particular event with existing schemaparticular event with existing schema

Signs of Complicated GriefSigns of Complicated Grief Intense fresh grief long after Intense fresh grief long after

the lossthe loss

Intense grief triggered by a Intense grief triggered by a minor eventminor event

Holding on to all possessionsHolding on to all possessions

Radical lifestyle changesRadical lifestyle changes

A history of depressionA history of depression

Self-destructive thoughts and Self-destructive thoughts and behaviorsbehaviors

Physical symptoms or Physical symptoms or hypochondriahypochondria

Substance abuseSubstance abuse

Talking about as past loss as if Talking about as past loss as if it just happenedit just happened

Inability to talk about or Inability to talk about or remember the deceasedremember the deceased

Preoccupation with thoughts of Preoccupation with thoughts of the deceasedthe deceased

Talking or acting as if the Talking or acting as if the person were still aliveperson were still alive

Inability to form new Inability to form new relationshipsrelationships

Feelings of helplessness and, or Feelings of helplessness and, or meaninglessnessmeaninglessness

Assisting the Grieving PersonAssisting the Grieving Person

1.1. Reminisce: Explore meaning of loss in detailReminisce: Explore meaning of loss in detail2.2. Listen to the storiesListen to the stories3.3. Encourage expression of emotionsEncourage expression of emotions (Validate, Normalize)(Validate, Normalize)4. 4. Give permission to take a break from their Give permission to take a break from their

grief workgrief work5. 5. Encourage meaningful ritualEncourage meaningful ritual6. 6. Gently challenge irrational perceptionsGently challenge irrational perceptions7. 7. Be real and open with your own feelingsBe real and open with your own feelings

Assisting the Grieving Assisting the Grieving Person Person Continued…Continued…

8.8. Address any prolonged social isolationAddress any prolonged social isolation9.9. Honor physical and spiritual needsHonor physical and spiritual needs10.10. Help complete unfinished businessHelp complete unfinished business11.11. Do not try to explain loss in philosophical Do not try to explain loss in philosophical

or religious termsor religious terms12.12. Your challenge is to sit with the suffering Your challenge is to sit with the suffering

not to try and take the pain awaynot to try and take the pain away13.13. As active grief subsides, help search for As active grief subsides, help search for

new directionsnew directions

Ongoing ConnectionsOngoing Connections1.1. MemoriesMemories

2.2. Special dates, Holiday timesSpecial dates, Holiday times

3.3. Special projectsSpecial projects

4.4. Communicating from our heartCommunicating from our heart

5.5. Spiritual experiencesSpiritual experiences

6.6. Customs of loved oneCustoms of loved one

7.7. Heritage of loved one’s qualitiesHeritage of loved one’s qualities

8.8. Commitment to our own healingCommitment to our own healing

Mourning Cloak Butterfly

Large butterfly, with a wingspan of up to three and a half inches.

It is easy to identify by its markings. No other butterfly looks like this one.

““Accepting suffering, disease and loss does not mean Accepting suffering, disease and loss does not mean

taking pleasure in them or hoping that distractions taking pleasure in them or hoping that distractions

or the passage of time will make us forget them.or the passage of time will make us forget them.

It means offering our suffering up to God to that It means offering our suffering up to God to that

God can help bring forth something productive. God can help bring forth something productive.

One does not arrive at this through reasoning, nor One does not arrive at this through reasoning, nor

is it understood through logic; it is an experience is it understood through logic; it is an experience

of the grace of God.”of the grace of God.”

Paul TournierPaul Tournier