Presented by: Crystal Hartman MA, LPC Coral Carosone-Link BS, CBIS

Transcription

1 Presented by: Crystal Hartman MA, LPC Coral Carosone-Link BS, CBIS

2 What is Grief How People Grieve How Grief Effects You Ways to Cope Finding New Meaning and Sense of Purpose

3 Loss: the real or perceived deprivation of something deemed meaningful Grief: an emotion, generated by an experience of loss and characterized by sorrow and/or distress Mourning: socially prescribed practices or outward expressions of grief and can apply to both death and non-death related circumstances Loss Adaptation: aka Coping, refers to the process of adjusting to loss and grief

4 Grief is a natural response to loss We grieve many things: Loss of a job Physical disability Loss of relationships Change in social status Death of a loved one

5 Primary loss is a significant loss event, such as a death or life long disability Secondary loss is losses that are a consequence of a primary loss which vary by the individual and context in which the loss happened Examples: financial security, sexual intimacy, family role, self-esteem and social status

6 Ambiguous Loss occurs when a person is physically present but is perceived as psychologically absent (emotionally or cognitively changed). Ambiguous loss is the most stressful Affects both family and person with brain injury Stigmatized Loss Landau & Hissett, 2008

7 Longing for what was lost Sadness for the loss Crying for what was lost Wishing for the time before the loss Upset by reminders of the loss Angry or anxious at the loss A need to talk about the loss

8 . Kubler-Ross (1969): Most well know model Developed from working with terminally ill patients Viewed grief as an internal process where all grievers go through a set of predictable stages ending in a final stage of resolution Not appropriate for grieving after a brain injury as model is made for terminal illness as opposed to lifelong disability Denial Anger Bargaining Depression Acceptance

9 Dual Process Model (Stroebe & Schut, 1999): Views grieving as highly individual process Coping involves fluctuating between confronting and avoiding stressors. For example, the griever will express sadness to friends and family (confront) but actively distract themselves from this while at work (avoid). Confront Avoid

10 While a person copes by confronting and avoiding, they also work on restorative coping which means moving forward For example, the griever will confront and avoid dealing with loss of cognitive abilities while identifying new career to meet current abilities Viewed as normal and natural process of loss adaptation (coping) Stroebe & Schut, 1999

11 INSTRUMENTAL GRIEVING STYLE Experience grief in terms of thoughts and behaviors Thinking dominates over emotions, emotional expression is private Focuses energy on analyzing loss, problem solving and doing activities Can be viewed by others as cold, insensitive, and in denial of loss INTUITIVE GRIEVING STYLE Experience grief through intense emotion, expression of feelings and affective language Shows outward emotional expressions including crying, depressed mood and anger May seek assistance from support groups and counseling Can have difficultly managing emotions and resuming daily tasks

12 Instrumental Grieving Style Intuitive Grieving Style Blended Grieving Style Martin &Doka, 2002

13 Changes to our Self-Concept and Feelings Self-concept: how we perceive ourselves based on our beliefs, feelings and values After an injury a person evaluates their self-concept Compares themselves to self before the injury Doubts self-efficacy: our own beliefs about our abilities Disruption of beliefs, assumptions, values, and expectations Frustration increases with cognitive problems and loss of skills

14 Injury/Loss Grieve loss, try to make sense and new meaning Evaluate abilities, compare to past Decreased perception of worth, value, confidence Disruption in beliefs, assumptions and values

15 Others include family, friends, partners, coworkers, employers, neighbors, etc. Range of Emotions Relief and gratitude to sadness, fear and anger Others Re-Grieve While survivor grieves During anniversary dates Reminders

16 Faith Family Leisure Friends Community Work

17 Adaptive Strategies are methods people use to address distress and reduce symptoms to manage grief. Affective Strategies Cognitive Strategies Behavioral Strategies Spiritual Strategies Martin & Doka, 2002

18 Affective Strategies Emotional expression: crying, ventilation Sharing and connecting with others Affective regulation Martin & Doka, 2002

19 Cognitive Strategies Information seeking Thought restructuring analysis, reframing, redefining Avoidance or Denial Martin & Doka, 2002

20 Behavioral Strategies Physical Activity Problem Solving Goal Setting Seeking out info and support from others Acting out behaviors Martin & Doka, 2002

21 Spiritual Strategies Prayer and Meditation Surrender to a higher power Meaning reconstruction Revising, reaffirming, discarding beliefs and assumptions Martin & Doka, 2002

22 Step 1. Change how we define ourselves How do we do this?

23 We grieve loss of abilities May feel lower self-esteem, worth and value to others/society Use negative self-statements to reflect feelings I am damaged Im not good at anything anymore This leads to self-defeating thinking

24 1. Compare ourselves to our pre-injury self 2. Compare ourselves to others 3. Have unrealistic expectations 4. Think of the worst that can happen Niemeier & Carol, 2011

25 To reduce negative self-talk be aware of using language such as: should, ought to, supposed to Reframing our thinking to a positive manner can improve how we feel Negative Thought: I am supposed to work. I am a failure if I am not working. Positive Thought: I d like to work but there are other things that are also important in my life. I can be productive an useful in other ways. My self-worth is not only defined by working. Niemeier & Carol, 2011

26 Not an end point Does not require forgetting It s ok to hate the injury Acceptance involves managing two conflicting ideas: I don t like this, and I can have a good life anyways Niemeier & Carol, 2011

27 Stop viewing yourself as a Brain Injured Person

28 Integrating Past and Present Self = Identity Not an either/or, instead a mix of both Determine skills you have retained Make a list of priorities Integrating yourself can have positive

29 Independence/self-sufficiency is a myth New roles can re-define yourself and create purpose Evaluate your strengths, challenges and interests Modify your roles Set new goals, create new purpose

30 Questions? Opportunity to Share

31 Humphrey, K. (2009). Counseling Strategies for Landau, J., & Hissett, J. (2008). Mild traumatic brain injury: impact on identity and ambiguous loss in the family. Family Systems & Health, 26(1), Loss and Grief. American Counseling Association. Niemeier, J. & Karol, R. (2011). Overcoming Grief and Loss after Brain Injury. New York: Oxford. Karol, R. (2011). Appreciating Grief and Loss After Brain Injury [PowerPoint slides].