Objectives. Why do we need to be aware of grief reactions? Grief associated with disability

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1 Sigh...I wish they understood: Helping clients with the emotional aspects of hearing, speech and language disorders Barbara Kopp Miller, Ph.D. Associate Dean for Research and Quality Judith Herb College of Education, Health Science and Human Service Administrative Director Center for Successful Aging University of Toledo Objectives Discuss the clinical and therapeutic significance of grief and bereavement Define grief, bereavement, grief work Discuss the four tasks involved in grieving Recognize grief reactions Describe strategies to aid adults with their grieving Why do we need to be aware of grief reactions? We are with clients on a daily basis We are a minimal personal threat We spend a great deal of time with out clients Dying and loss are natural events and reactions The occurrence of dying and loss events increase as we get older Understanding what happens to us during the grief process won t alleviate the PAIN, but it might help stop the PANIC! (Sims, 1993) Possible grief reactions Physical health Cognitive health Mental health Relationships Roles Control over (communication) body Expectations Self Body image Grief associated with disability Difference between death and other losses: dying sequence ends in closure grieving sequence for other losses means a reintegration of one s life secondary losses Geographic location Intimacy issues Independence 1

2 Defining grief, bereavement and the tasks of grief work bereaved person anyone who has sustained a loss grief process of personal accommodation to loss choosing how to grieve you don t get over a significant loss it changes you, you choose whether the change is for the better Four tasks of grieving (William Worden, 1991) Task One To accept the reality of the loss/change Involves an intellectual acceptance as well as an emotional acceptance How do we make loss real? What could complicate making the loss real? Task two: To work through to the pain of grief Need to feel the pain so that they can get through the pain Difficulties around completing this task Positive aspects to negative emotions Task three: Adjust to an environment in which the deceased is missing relearning the world All elements and dimensions on one s world need to be relearned physical surroundings cultural and social contexts relationships with others relationship with self The trick is to learn to live with what we ve got instead of wishing something else had happened Task four: To emotionally relocate the loss and move on with life For many people, task four is the most difficult one to accomplish Regain an interest in life Begin to live competently and comfortably in a changed world 2

3 The impacts of bereavement Manifestations of normal grief (Worden, 1991) feelings physical sensations behaviors social impacts Psychological responses to loss Sadness Anger Guilt Anxiety Loneliness Fatigue Fear of going crazy Abandonment Feelings (continued) Cognition Shock Yearning Numbness Feeling as if something is about to happen Feelings of unreality Disbelief Bewilderment Disorganization Confusion Distractibility Impaired concentration Memory Mental functioning Decreased interest Pessimism Preoccupation with deceased Feelings of inadequacy Behavioral responses Searching behavior Restless hyperactivity Social withdrawal Disorganized activity Loss of patterns of social interaction Crying and tearfulness Anorexia or appetite disturbance Sleep disturbance Tendency to sigh Decreased interest, motivation i Decreased effectiveness Avoidance of people Self destructive behaviors Lack of interest in usual activities Social withdrawal Boredom Loss of patterns of social interaction Feeling alienated Jealousy of others Dependency Social responses 3

4 Other physiological of distress Hair loss Gastrointestinal Cardiopulmonary Pseudoneurologic WHOLE PERSONS GRIEVE!! Helping the bereaved (Attig,1996) Persons cope with loss on at least three levels: intellectually psychologically behaviorally/socially Take the person s perspective Is his or her response reasonable given the reality of his or her situation? Remember the meaning of the experience We never really know what the experience really means to the person Allow the person to feel the uniqueness of his or her experience Specific suggestions Specific suggestions (cot.) Become knowledgeable about what is normal Help the person actualize the loss Help the person to identify and express feelings Provide time to grieve Allow for individual differences Identify pathology and refer Encourage and support persons Realize you cannot grieve for another Deferred judgment Acknowledge that other losses have happened Avoid the use of clichés 4

5 I can t say I know how you feel because I don t, But I can say that I care, because I do Specific suggestions (cont..) Allow grieving persons to talk Encourage or invite them to talk Help persons to live alone Know about self-help groups Allow personal control References Attig, T. (1996). How we grieve: Relearning the world. New York, NY: Oxford Press. Sims, D. (1993). Footsteps through the valley. Wenatchee, WA: Big A and Company. Worden, J.W. (1991). Grief counseling and grief therapy: A handbook for the mental health practitioner. New York, NY: Springer Publishing Company. 5