Clinical Aftercare Specialist OneLegacy Family Care

Clinical Aftercare SpecialistOneLegacy Family Care

Michelle Post, MA, LMFT

What is This Grief “Thing”? How Families Grieve The Loss of Someone Close

Outline

• What to do/not do for a grieving person

• Describe J. William Worden’s Grief and Loss Model (4 Tasks of Mourning).

• Identify normal grief reactions and warning signs of Depression.

Michelle A. Post, MA, LMFT , 213-229-5687 Email: [email protected]

Quick Survey by show of hands

• How many of you have had experienced the death of a patient?

• How many of you have had a friend who has experienced the death of someone close?

• How many of you knew exactly what to say to help the patient’s family or your friend with their grief?

Quick Survey

• How many of you have ever had first hand experience dealing with the death of someone close to you?

• During your grief, how many of you had someone tell you something (maybe in an effort to try to help you) that was NOT helpful, or even hurtful?

The Platitudes/Clichés

• Time heals all wounds.• Think about the good times.• God needed another (angel,

plumber, teacher, coach, etc.) in heaven.

• It was God’s will / Everything happens for a reason.

• Something good will come of this. • She/he led a full life.

Elizabeth Kubler-Ross - 1969

Hearses vs white vans

Underused hospice

Is Death a Universal Is Death a Universal Truth? Truth?

Who Do We Turn to? MDs (some see death as

failure)

Clergy good & bad

Funeral Homes

Crisis Response Teams

Police & Firefighters


Who Do We Turn to?

Professional Counselors: Training?

DSM Code for Bereavement gives timeframe?

2 months (numbness wearing off)

kids (23years old and under): 6-12 mo


Grief Statistics:

•1 in 5 kids will experience the death of someone close by age 18 (Kenneth Doka, Editor of OMEGA Journal of death

and dying)

•1 in 20 kids will experience the death of one or both parents by age 15 (Steen,

1998)

Grief Statistics:

Close to 2 million children receive death benefits from a deceased worker (Social Security Administration, 2007)

…And that is just the KIDS!

We serve 2200 to 2500 new families each year just in OneLegacy

If Death is a Universal Truth, If Death is a Universal Truth, Grief is the Grief is the

Great Equalizer… Great Equalizer…

Everyone is Affected!Everyone is Affected!

Possible Pitfalls for Those Who Do Not Reconcile Their Grief:

•Avoid love as a way to avoid pain

•Inability to acknowledge the pain of others

•Avoid risks

• Inability to express love for their own children

• Experience a sense of ‘searching’ for that which was lost

• Resisting school or work projects which demand long-term commitment

Possible Pitfalls for Those Who Do Not Reconcile Their Grief:

What can we do to help with grief?‘Normal’ Grief can last years

AOPO: Aftercare ~ 2 yrs min.

What does your hospital do to support a grieving family?

What can we do to help with grief?

Explore Your Own Grief Attitudes

J. William Worden, Ph.D.: Personal Death Awareness; or Grief Counseling & Grief

Therapy: A Handbook for the Mental Health Practitioner

What can I do to for personal/professional grief?

~Learn a Model of Grief and Loss

What Else Can I Do?What Else Can I Do?

Learn a Grief ModelLearn a Grief Model

J. William Worden’s 4 Tasks of J. William Worden’s 4 Tasks of MourningMourning

Task 2: To Experience the Pain of the (Death)Task 3: To Adjust to an Environment in Which the Deceased is Missing

Task 4: To Relocate the Dead Person within One’s Life and Find Ways to Memorialize the Person

Task 1: To Accept the Reality of the (Death)

•Adapted from Grief Counseling & Grief Therapy; Children & Grief: When a parent dies by J. William

Worden, Ph.D

J. William J. William Worden’s Worden’s 4 Tasks of 4 Tasks of MourningMourning

Task 1: To Accept the Task 1: To Accept the Reality of the Reality of the

(Death)(Death)


Worden, Ph.D

Task 1: To Accept the Reality of the (Death)• The griever begins to grasp that

the person has actually died. • Even when the death was expected,

there is still often a sense that it hasn’t really happened.

• Intellectual vs. emotional acceptance of the death. Intellectual acceptance may come long before emotional acceptance.


Traditional rituals (funerals/memorials) assist the bereaved in moving toward acceptance of the death as real.

** Include children!

Task 1: To Accept the Reality of the (Death)Belief and disbelief come and go over

time.Examples:

Misidentify another person as the one who has died or think they see or hear them.

– "I still hear his keys in the door". – "I expect to see her cooking in the

kitchen".


• Families will need to repeat their stories many times.

• Ask questions that that ask for details surrounding the death


• The death becomes more of a reality as each "first" occurs without the deceased

- 11stst birthdays, death birthdays, death markers/dates, etc.markers/dates, etc.

- 1st holiday season. Ask about the last holiday and what they think they will do for the next one.

Best thing you can say?

Actually best thing is to just listen…

If you HAVE to say something… DON’T SAY:

• I understand how you feel.• Death was a blessing.• You’re still young/ have whole life

ahead of you. • You can have other children/Find

another. • Call me when I can help.• It’s time to put it behind you.• Be strong!

If you HAVE to say something… Try…

I’m sorry/ I’m sorry you are going through this.

How are you doing with all this?What can I do for you? I’m here and I want to listen. What’s the hardest part for you? I’ll call tomorrow/Friday/in an hour.I can imagine how much this hurts. It isn’t fair, is it? Take all the time you need.

Task 2: To Experience Task 2: To Experience The The Pain Of Pain Of The (Death)The (Death)



Worden, Ph.D

What is the pain of “Normal” Grief?

If ‘Normal’ Grief can last years, what are the

symptoms?

See “Potential Symptoms of Grief”

Handouts

Symptoms?

Emotional

Social

Physical

Spiritual

Behavioral/

Psychological

“Normal” Grief is…

See Handouts: Normal Kids/Teens Grief and Potential Symptoms of Grief

What stands out to you or surprises you?

•Pain will vary in intensity from person to person and may come and go.

•Friends, culture, and society may interfere with the successful completion of this task by not allowing the griever to grieve.

-“Think about the good times”-“Be strong”

Task 2: To Experience The Pain Of The (Death))

•Avoidance = drugs, alcohol, travel, relocation, constant work, or quickly entering into a new relationship.

•Avoidance hinder one’s ability to heal. The pain will eventually reappear.

Task 2: To Experience The Pain Of The (Death))

WHAT IS ABNORMAL GRIEF?

•Active Suicidal/Homicidal Ideation, Plan, Intention, Means

•I don’t know how I will go on! – Normal•I wish I could be reunited/wish my pain was over/wouldn’t care if I died – Normal

•I’m going to kill myself! - Abnormal

Task 2: To Experience The Pain Of The (Death)

WHAT IS ABNORMAL GRIEF?

=Command hallucinations

•I thought I saw him walking down the street. – Normal•I felt her presence in the room – Normal

•I heard him tell me to trash my mother’s house/join her in heaven – Abnormal!

Task 2: To Experience The Pain Of The (Death)

Task 3: To Adjust to an Environment in Which the Deceased is Missing



Worden, Ph.D

•The grieving person may need to learn new skills, and perform functions that the person who died had previously taken care of. This happens just at a time when they are burdened with acute grief and the least capable of doing so. •The bereaved tries to gain a sense of control over his or her life. •Help them to brainstorm who can help with daily activities for themselves/family (baby sitting, picking up kids, cooking, etc.)

J. William Worden’s Task 3: To Adjust to an Environment in Which the Deceased is Missing

Not only is the relationship gone, but also that part of the grieving person’s identity.

“Who am I if I am no longer John’s wife?” “Am I still a parent if my only child has died?” “What do I say when people ask me how many children do I have?”

-Give them permission to answer these questions differently or the same as they did before the death.

J. William Worden’s Task 3: To Adjust to an Environment in Which the Deceased is Missing

Task 4: To Relocate the Dead Person within One’s Life and Find Ways to Memorialize the Person

•Adapted from Adapted from Children & Grief: When a parent diesChildren & Grief: When a parent dies by J. William by J. William

Worden, Ph.D Worden, Ph.D

Michelle A. Post, MA, LMFT , (310) 927-5611 , Email: Michelle A. Post, MA, LMFT , (310) 927-5611 , Email:

[email protected]@ca.rr.com


•Assist grievers in finding a new place, internally, for their relationship with the person who died. •Grievers find ways to create a new "normal".•The griever re-invests in their current life, while maintaining continuing bonds with the person who died.




[email protected]@onelegacy.org

J. William Worden’s 4 Tasks of MourningTask 4: To Relocate the Dead Person within One’s Life and Find Ways to Memorialize the Person

Grievers create or continue traditions and rituals which allow them to honor the memory of the person

Some make a pact with themselves never to love again

Many go on to form new attachments and relationships




[email protected]@onelegacy.org


Help with Remembering

Help the family start thinking about the “legacy” their loved one will leave

• Encourage story telling– Opportunity to share a part of their life with

you and to introduce you to the person they loved through memories

– Help facilitate the process• strengthens rapport and trust• comforting and reassuring

• Memory Boxes• Hand Molds, Scrapbooks, Web-pages


What Else Can We Do to What Else Can We Do to Help?Help?

~ Watch Your ~ Watch Your *#$%&*

LanguageLanguage

What else can we do to help?

See Do’s and Don’ts Handout&

Child Speak Handout

~DO - Simplify Language for ~DO - Simplify Language for Grievers!Grievers!

~Why is it important to simplify language?

It’s okay to say dead…

died… death…

Let’s practice!

Helps with Worden’s First task of mourning – to accept the reality of the death

What to Encourage for What to Encourage for Grievers Grievers

Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D

DO: Encourage choices (leads to feeling in control)

DO: Encourage routine activities.

DO NOT: Encourage Change in 1st 12 months, Instead: keep home, school,

work, relationships the same.

To Include or Not to Include Kids in the Hosp/Funeral? Seeing/Touching the Body?

DO Include them!!!!DO Include them!!!!


Prepare children & teens & adults for what they will see, hear,

feel and/or smell.

The Harvard Study Research: The picture in their head is often worse than what is real. - Not being involved is a risk factor for later complicated grief

Let them get involved. Testing in front of them can help them accept

the reality of the death.

Include them!!!!Include them!!!!


Include children in all aspects of information sharing, hospital visits,

and family mourning rituals.

Debrief with them.

In ICU or at a Funeral: Provide a buddy for them (1 adult per child)

Q & AQ & A

Any questions?

Case examples with concerns?

Something you did to assist a family in their grief that worked well?

What else can your hospital do to support a grieving family?

Clinical Aftercare SpecialistOneLegacy Family Care

Michelle Post, MA, LMFT

What is This Grief “Thing”? How Families Grieve The Loss of Someone Close

Documents

Clinical Aftercare Specialist OneLegacy Family Care