HSC384 Grief and loss

Course Author: Malcolm Woods

(Masters in Social Work)

Facilitators: Astell Evans & Jennifer Roy.

Haringey Male Foster Carers Support Group

(17th March 2016)

Slides design and TSDS reference links by:

Astell Evans (2008, updated 2016)

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“Grief is the price we pay for

love”

(John Bowlby)

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Transitions

Some children may have to face very particular and personal transitions not necessarily shared or understood by all their peers. These include: family illness or the death of a close relative; divorce and family break-up; issues related to sexuality; adoption; the process of asylum; disability; parental mental health; and the consequences of crime. All looked after children and young people will experience loss, separation and varying degrees of trauma when they come into foster care.

Course Author: Malcolm

Woods (Masters in Social

Work)



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Exercise one

(1) How many different

kinds of loss can you

think of?

(2) Do these have anything

in common?

(3) What was the first loss

you can remember?

(4) (4) How did this loss

impact on your life?



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Learning Outcomes

To discuss how:

You seek and access information and support to help you understand, deal and cope with the likely consequences of the individuals being told about bereavement

You take action to ensure that individuals are in an appropriate place which allows them privacy when they first hear about bereavement

You seek and access additional supportfor individuals where you are unable to provide appropriate support



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Learning objectives (2)

To discuss how:

You work with individuals to enable you to understand their thoughts, feelings and distress and to help them through the bereavement and mourning

You allow individuals private time to adjust to the bereavement, taking account of any risks to the individual

You observe changes to individuals that are not normally found with bereavement and mourning, and that may give cause for concern

You seek additional support for yourself and individuals where you are unable to respond to the individuals’ needs

You work with the individuals, key people and others to identify whether the individuals need additional or specialist support and who will take responsibility for doing this



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Learning objective (3)

To discuss how:

You work in ways that are sensitive to the individuals’ distress, grief and mourning

You support individuals to:

A communicate and explore their experiences of bereavement and mourning, taking into account their preferences and beliefs

B understand any changes that might have to be made because of bereavement

C identify their needs and preferences regarding their options for change due to loss and bereavement

D deal with any changes positively, encouraging them to recognise and focus on their strengths and building towards the future

E access additional and specialist support when this is needed

TSDS Standard 5

1 a: Understand the basic

principles of how children and

young people of all ages form

attachments, how these

attachments affect their

development, and the impact of

interrupted development,

trauma, separation and loss



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TSDS Standard 5

2.a: Understand how Foster

carer can help children and

young people develop resilience

and self-esteem.

3.b: Understand how to support

individual children and young

people through significant life

changes and challenges



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TSDS Standards

5.6.c: Understand the impact of

abuse, separation and loss on

the behaviour of children and

young people

7.1 b: Understand how being a

foster carer may affect you

personally and where you can

get support



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At management level, you may

want to consider the following

areas

Design and implement a service which addresses the needs of individuals experiencing significant life events

Ensure the service responds effectively to individuals experiencing major life changes or losses

Develop and support practice which acknowledges and helps children and young people to address losses, dilemmas and conflicts they are, and have been faced with



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ATTACHMENT

An attachment is an emotional bond

with another person. It is important

that everyone involved in working

with adults and children has a basic

understanding of attachment theory.

Working with issues of attachment

and separation are at the heart of the

work done by foster carers and other

social care professionals.



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Vera Fahlberg, an American

psychiatrist, whose work on

attachment, separation and loss

has greatly influenced child care

practice in the UK, says that

healthy attachments are the

foundation for healthy physical

and emotional development as

well as the ability to learn



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She says:

“When children have a strong

attachment to a parent, it allows

them to develop trust for others and

self reliance. These earliest

relationships influence both physical

and intellectual development as well

as forming the foundation for

psychological development. The

child’s earliest attachments become

the prototype for subsequent

interpersonal relationships”



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Exercise 1

Think of someone that you are significantly attached to:

(1) What makes that attachment special for

you and for them?

(2) What benefits have there been to you from knowing that person as well as their benefits?

(3) What would be the impact on your life if you no longer had that person around or you become deceased?



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Anticipatory Grief

Anticipation can be an exciting thing

e.g. anticipating a holiday that we

have been looking forward to for

some time. But anticipation also

magnifies the possibility of reality of

a loss. Knowing that we and all our

loved ones will die one day creates

anxiety. We see this early on in life.

This is the beginning of our

anticipatory grief, the pain we will

one day experience.



Woods (Masters in

Social Work)



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A deeper anticipatory grief occurs

when someone we love – or we

ourselves – have a terminal

illness. Anticipatory grief is the

“beginning of the end” in our

minds. We now operate in two

worlds. The safe one that we are

used to and the unsafe one in

which a loved one might die.



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Anticipating a loss is an

important part of experiencing

that loss. We often think of it

as part of the process our

loved ones go through as they

face their own death

themselves. Yet for those who

will survive the loss of a loved

one it is the beginning of the

grieving process.



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Forewarned is not always forearmed. Experiencing anticipatory grief may not make the grieving process shorter or easier and we may also experience the limbo of loss in anticipatory grief – when our loved one is not getting better and not dying yet but in a state of poor health with little quality of life.



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Elizabeth Kubler-Ross a

worldwide leading authority

on grief and loss, identified

five stages of grief. Not

everyone will go through all

of them or in a set order but

can be useful tools for

helping us to frame and

identify what we may be

feeling



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1. DENIAL

In a person who is dying, denial may

look like disbelief. They may be

going about life and actually denying

that their illness exists. For a person

who has lost a loved one this doesn’t

mean that literally you don’t know that

your loved one has died. It means

you come home and can’t believe

they aren’t going to walk in any

minute. It is not denial of the death

it’s more like “This is too much for me

to take in at the moment”.

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This first stage of grieving helps us to

survive the loss. As we try to just get

through each day, a common reaction after

someone has just died, we are protecting

ourselves by only letting in as much as we

can handle. Letting in all the feelings

associated with a loss at once would be

overwhelming emotionally. We can’t believe

what has happened because to fully believe

it at this stage would be too much.



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2. ANGERThis can take many forms –

anger at your loved one for

leaving you behind, angry

that you couldn’t prevent

them from dying, angry at

doctors for not making them

well again, angry that you

and your loved one didn’t

have more time together etc.




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Anger comes along when

you are feeling safe enough

to know that you will

probably survive whatever

comes. It often appears at

the same time as other

feelings such as sadness,

panic, hurt and loneliness.



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Anger is a necessary stage of

the healing process. There are

many other emotions underneath

the anger and we have to be

able to first let ourselves

experience the anger if we are to

tackle those underlying feelings

eventually.

Letting in anger

Letting in the anger first allows us to

go deeper about other feelings later.

At first grief can make you feel lost –

like you have no connection to

anything. Then you get angry at

someone- e.g. a person who didn’t

attend the funeral and suddenly you

have a structure, your anger towards

them.



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Anger means you are progressing, that you are allowing all those feelings that were too much before to come to the surface.

You may also experience feelings of guilt, which is anger turned in on yourself. Anger affirms that you canfeel, that you did love, that you have lost.



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3. BARGAINING

Before a loss you will

probably do anything if only

our loved one would be

spared e.g. “Please God, I’ll

never be angry at my

husband again if only you let

him live”.



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We become lost in a maze of

“If only…” or “What if…”, guilt

often accompanies bargaining.

The “If onlys” cause us to find

fault with ourselves and what

we “think” we could have done

differently. We even bargain

with the pain – we’ll do

anything not to feel the pain of

this loss.



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Bargaining is about our need to have

life returned to what it was before our

loved one became ill or died. We

want them restored to life. We want to

go back in time – it’s the “If only that

accident hadn’t happened” or “If only

they hadn’t got ill”.



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4. DEPRESSION

Usually comes along after

‘bargaining’ is over. Our

attention moves into the

present and we feel a sense

of emptiness and grief,

deeper than we imagined. It

feels as if it will last forever.



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It’s important to remember that

this depression is not a sign of

mental illness. It is an

appropriate response to a great

loss. Many people see it,

however, as an unnatural state,

something to be “fixed” or to snap

out of. This overlooks the fact

that to not feel depression after a

loved one dies would be unusual.



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A bereaved person should

“allow” themselves to feel

depression. Elizabeth Kubler-

Ross says “it will leave as soon

as it has served its purpose in

your loss”. It can be helpful in

grief by allowing us to take

stock of our loss. It makes us

rebuild ourselves from the

ground up.



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5. ACCEPTANCE

This is not about feeling “o.k.” about

the loss of a loved one, it’s about

accepting the reality that, that person

is physically gone and recognizing

that this new reality is the permanent

reality. We will never like this reality

but we will accept it – we’ll learn to

live with it. This is where our final

healing and adjustment can take

place.



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As we heal we learn who we are and who our loved one was in life. As we move through grief healing brings us close to the person we loved. A new relationship begins. We learn to live with the loved one we lost. We start the process of putting back the pieces. Some people feel a sense of guilt if they begin to enjoy life again in some way they feel that this is betraying the person who had gone. It’s not. We can’t replace that person but we can make new relationships or friendships. It’s about changing, evolving, growing.



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Some other feelings associated

with grief.

RELIEF

This may be the relief that a

loved one’s suffering has

ended and is perfectly

normal. It is not relief that

someone has gone.



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EMOTIONAL REST

Bereaved people experience a broad

range of emotions after a loss –

angry, sad, anxious etc. They often

have mood swings that can be quite

alarming for those around them.

Eventually the bereaved person has

to “back away” from these feelings

for a while, perhaps by devoting

themselves to their work, to give

themselves some ‘rest’ from the

intensity of it all



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REGRETS

This is a common reaction when someone dies – we think about all the things we wish we had said to the person who is gone, all the things we wish we had done

(or not done). This is a reflection of the fact that life is usually shorter for those we love than we hoped for. It is natural that things will feel unfinished because often we simply don’t have the time to do all the things that we hoped to do.



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TEARS

These can be one of the many ways we release our sadness although the natural instinct for many people in this situation is to say “I must stop crying, I must pull myself together”. Often others feel concerned and tell us the same thing. Our perceptions about crying may be cultural – in some societies not crying is a sign of dignity, in others a sign of dishonour. What we personally feel about open expressions of distress may depend on our own upbringing or the ‘culture’ of our family.



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DREAMS

Dreams commonly embody our hopes and fears. In bereavement it’s not unusual to dream that your loved one is still alive. After a loss the need to feel that the person you loved still exist somehow, somewhere, can be very important. Dreams are a private way to find some reassurance when the real world can offer us none. Some people find dreams of a loved one upsetting. Some people worry when they can’t dream about that person. Eventually in most cases the dreams subside and become less frequent.



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HAUNTINGS

Some bereaved people

report “seeing” their loved

one when they’re out,

hearing them speak, feeling

their touch etc. These are

normal and common an a

reflection of the ‘unfinished

business’ that we mentioned

earlier.



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ROLES

All of us play many roles in our live – wife, husband, parent, child, sibling etc. When a loved one dies all the roles they fulfilled are left open. Sometimes we take on these roles ourselves, sometimes we might assign them to others (e.g. a wife who relied on her husband’s financial organisation may want a son to take over this role in her life). Bereavement brings changes to the lives of the survivors. You lose not only the person you loved but the life, the routines etc that you had with that person.



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RECOUNTING THE LOSS

Bereaved people often have a need to talk time and time again about the loss they have been through. This is their attempt to make some sense of the enormity of what has happened to them and to try to ‘put it into place’. Often for their family and friends it can be wearing to hear the same story once again but it is a process that the bereaved person needs to go through and it will help them.



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FAULT AND BLAME

Many bereaved people criticise

themselves for not having done

something that might have

prevented their loved one from

dying. This is a natural reaction to

being in situations that are beyond

their control. In time most bereaved

people come to realise that

whatever had been done the

outcome would probably have been

the same anyway.



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RESENTMENT

Often bereaved people resent being left alone or resent their loved one dying. If they had been angry with that person in life the loss may awaken and reinforce these ‘old’ feelings. However we can still grieve even for those who were unkind or unfeeling towards us and we need to recognize that those feelings are real and have to be worked through in the same way as for any other loss.




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OTHER LOSSES

One loss may reawaken memories of

an earlier one and for a time all of

the feelings this arouses can be

overwhelming for the person

experiencing them. However a late

loss can be an opportunity to put into

place any remaining parts of an

earlier experience and can be part of

a general healing process.



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PARTICULAR KINDS OF

LOSSSuicide

Individuals who contemplate suicide are often at a point in their lives where they feel that there is no hope left. They don’t want death but they want a release from their pain. But even when someone leaves a note for their loved ones explaining why they are doing what they’re doing it often doesn’t bring them much comfort, although it may be better than having no note at all.



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Relatives and friends feel a sense of

guilt and anger at the suicide but also

a sense of shame too (there is still a

stigma to suicide). “Healing” after a

loved one’s suicide is complicated -

before working through the grief you

have to first work through the guilt.

You have to be able to understand that

you weren’t responsible for them

taking their life. Only then will you be

able to forgive them and yourself.



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ALZHEIMER’S DISEASE

Often here the grief doesn’t begin when someone dies but when they are diagnosed with this condition. Many people feel that they lose their loved one piece by piece. Losing someone is always difficult but seeing them lose their personality whilst remaining physically well can be even worse. Some people call Alzheimer’s “the long goodbye”. For others it is “death in slow motion”. For many loved ones what they feel most of all when the sufferer has gone is a sense of relief that this suffering is over, although relief can also, of course, produce feelings of guilt too.



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SUDDEN DEATH

This gives loved ones no time to prepare and

when the person is gone their overwhelming

initial sense will be of unreality – they just

can’t believe that the person they love is gone

so suddenly. They will need time to come to

terms with this shock before they can begin

the ‘normal’ grieving process. Very often too

sudden death means we don’t have time to

say goodbye to someone and the pain of

losing them is intensified by losing them in the

midst of life.



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HELPING CHILDREN COPE

WITH A DEATH

Children react differently than adults in these

circumstances. Their response will depend on:

1. What type of relationship they had with the person who

has died. Death of a Mother for example, will be much

harder than the death of an Uncle.

2. Age and level of understanding – for infants they may feel

the loss in terms of how it affects their day to day routine.

Pre-school children usually see death as temporary and

reversible. Older children have realised that death

involves a permanent separation. Sometimes children

may feel that they “caused” the death – e.g. by being

naughty. They will show their feelings about the loss

usually in terms of their behaviour or presentation.



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Death & Children

3.

Circumstances

of the death – a

traumatic death

may be hardest

of all for

children to cope

with sudden

death will also

be very hard for

children.




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HELPING A CHILD COPE

A lot of adults try to shield

children from what has

happened by withholding

information from them. But

research tells us that children

benefit from knowing what has

happened as soon as possible.

Children also need to be

listened to and have their

questions answered.




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Sometimes a child many not be able to clearly recall their loved one’s face and this can be very distressing for them. A photograph may be a source of comfort here. Most of all they need to be given a way of saying goodbye –if for example they’re considered too young to attend the funeral they might be able to say a prayer for the person they’ve lost. As time goes on they’ll need permission from the adults around them to show their feelings in whatever way helps (anger, sadness etc)



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WARNING SIGNS (Risk Indicators: 1)

An extended period of depression in

a child may be a warning sign that all

isn’t well following a bereavement.

Inability to sleep, loss of appetite

Acting like a much younger child for

long periods

Denying that the person has died

Imitating the dead person

excessively


Warning signs (Risk Indicators: 2)

Repeatedly stating that they want to

join the dead person

Withdrawal from friends

Drop in school performance



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