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But it can be transformational, and most of us overtime develop skills and attitudes that assimilate our losses in our lives in a functional manner
Often miss or fail to identify the presence of loss and grief unless of course the intake tells us the person is coming for bereavement counselling
However, grieving a death of a loved one is similar to other losses and may invoke similar responses
Our new losses trigger material from our old world (attachment theory) we year to return to these preloss circumstances
We try to make sense of losses, or make meaning, we are paralyzed, we are transformed, and struggle to integrate losses into our lives
Coping: Time limited reaction in which an event is endured or momentarily managed with coping skills
Loss Adaptation: Process of adjusting to loss/grief (active process of modification, revision, reorganization, and assimilation over time
Changing Ideas
Not linear - there is not necessarily a characteristic set of processes that each griever experiences or phases he / she must pass through Not abnormal dont necessarily need to detach/sever from object we are grieving over Grief doesnt necessarily end We are not passive victims over our grieving We must assume personal, social, familial, historical, and culture, influences our grieving and healing but not necessarily get caught by them
Kito
Elena Jane Billy
Three Roles
Witness Facilitator Collaborator
The Witness
To observe, to listen, to hear, to remember, and to understand at the deepest level the powerful narratives of loss and grief We bear witness Thus as a witness we:
1. Listen more than we talk 2. Employ respectful silence 3. Fully attend (see what is here) 4. Exhibit comfort 5. Allow grief (dont fix even when clients request rescue) 6. No judgment
Facilitator Role
Provide a framework conducive to functional loss adaptation Focus and structure
Typical questions and framework
How can I be of help? How is the session going thus far? Where should we be spending our time?
We facilitate the clients work, but we dont do the work for them!
Facilitator Medicine:
1 2 Encourage recognition and use clients strengths, resources and abilities Respect the natural ebb and flow of the grieving journey, including periods of disorder, impasse, resistance, and confusion as part of the loss adaptation process Consult with clients regularly as to direction of therapy, and usefulness of various techniques / activities Assist clients where they are - not where the counselor wants them to be
Collaborator Role
1. Collaborative counselors are more interested in client perspectives than they are in preconceived notions about grief based on expertness of others 2. Neither directive nor nondirective
3. Fellow explorer
4. Help clients educate themselves about themselves and their world past, present, future
Collaborator Medicine:
1. Respect clients as narrators of their own stories 2. Encourage and attitude of exploration and discovery 3. Rely and what and how questions to encourage reflection and ownership
Key Technique in Working With Loss, Grief, and Bereaved Clients Master the Art of Silence
Respectful silence is bearing witness Silence punctuates moments, prompts reflection, provides support, deepens process, and is healing We are creating a space for coping, holding, adapting
Why do we grieve?
Love somebody? What is love?
Secondary Losses
Acts a dominoes: and can arise as a chain of events from primary loss
Death of spouse brings about loss of companionship, financial security, sexual intimacy, family role, social status Job loss: self-esteem, identity, financial security, sense of future Childhood sexual abuse: loss innocence, trust, sense of control, etc. Mental illness: loss of control over emotions, thoughts, family role, loss of occupation
The question to ask then or to understand in facilitating adaptation to loss that we must ask our clients?
The uncertainty characteristics of (AL) can bring about long term dysfunctional coping often contributing to complications in the grieving process
Stigmatized Losses
Losses that reveal transgressions of societal norms or go against norms, mores, and folkways These include losses related to HIV/AIDS, suicide, violence (e.g., homicide, genocide, domestic violence, homelessness, sexual abuse, addictions, to name a few) Stigma attached to the loss, should they be allowed to grief? Family hides the secret
These sufferers usually experience and have a difficult time getting over guilt, shame, blame and their support networks can often be limited
Disenfranchised Grief
Immigration
Cultural losses
Now that we have seen that grief and loss are unique to the sufferer and that different losses bring with them different obstacles to adaptation lets look at psychosocial factors that impact grief and healing.
Adaptive strategies
Affective Cognitive Behavioral Spiritual (emotional response / regulation) (analysis, reframing, distraction or avoidance (problem solving, activity, behavioral distraction) (prayer, meditation, rituals)
Adaptive Strategies
Can be used both positively and negatively Everyone has their own combination of adaptive strategies based on personality and life experience The idea is for the counselor and client to use which ones that are most helpful
Attachment Theory
Definition of Attachment:
An enduring emotional tie to a special person, characterized by a tendency to seek and maintain closeness, especially during times of stress.
Healthy and unhealthy attachments can predict duration and intensity of bereavement
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Sense or meaning making Begins with exploring the why And maybe ends with letting go of the why Moreover, the counselors aim here is to examine the meaning structures that once made ones world comprehensible, then renewing, redefining, or revising them to so as to restore balance
Identity Change
Process of reorganizing and rebuilding a sense of self fragmented by loss Help client revise ones self narrative in a way that maintains continuity of a person while also incorporating altered aspects of the self We are always becoming
Social Support
The better the quality of the grievers support network, the more functional is her or his loss adaptation Sometimes our notions of who will support us does not happen or our initial grief reactions, or deficits in our interpersonally functioning limit our reaching out to others. The latter support mechanisms and tendencys need to be explored by counselors
A. The preferred cognitive, behavioral, affective, and spiritual strategies an individual uses to manage our innate response to loss
Intuitive
Blended
Instrumental
Respond to loss:
Respond to loss
Respond to loss cognitively Modulate emotion Express grief in terms of thoughts and activity
Our style can shift along the continuum, but for the most part is generally consistent across time
The models grieving styles reflect and respect innate differences among individuals that result from personality, culture, familial, developmental, and social influences
Thus, an instrumental griever and intuitive griever may employ the same strategy, but its use will be put in action for different means
Sharing a story for an intuitive is done to express emotion and connect on emotional level with others, whereas an instrumental tells a story to to gather info, organize a response, or solve problems
Affective Strategies
Counselors must what to make sure clients are utilizing their primary adaptive strategies Its good to have secondary strategies, but the secondary strategies may be ineffectively applied Counselors job to root this out
Dissonant Responses
Common for grievers to initially use secondary strategy and go against their natural style of grieving This can further complicate grief The discrepancy is resolved when the client/individual moves into innate response or in counseling when we fetter out clients primary strategy Reasons for dissonant responses include: personality, gender role socialization, type and intensity of grief, image management, substance abuse, etc.
Use alcohol / drugs to suppress emotion, overuse physical exercise to deny reality of loss, focus on everyone but themselves
This type of strategy can lead to physical / emotional exhaustion, psychosomatic illness, estrangement from others, complications may also from risky behaviors
Counseling Implications?