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Living Joyfully In Recovery- A Healing Journey  San San Juan Macias Pastoral and Transitional Living Center 2602 S. Richey #303 Artesia NM 88210 575-708-0033.

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Presentation on theme: "Living Joyfully In Recovery- A Healing Journey  San San Juan Macias Pastoral and Transitional Living Center 2602 S. Richey #303 Artesia NM 88210 575-708-0033."— Presentation transcript:

1 Living Joyfully In Recovery- A Healing Journey  San San Juan Macias Pastoral and Transitional Living Center 2602 S. Richey #303 Artesia NM  Mark A. Silla LPCC, MAPS

2  Subtitled—”How to Avoid Burn Out”!

3 Objectives:  1.Id how the beatitudes can promote healing and change in the context of hierarchy of needs.  2.Learn the basic concept and history of the 12 steps of recovery.  3.Id types of 12 step groups and effectiveness of 12 step therapy  4. Id types of mental illness and appropriate treatment responses in the counseling process.  5. Learn how to id and respond to crisis.  6.Learn self-care practices

4 Bio-Psycho-Social Model  Bio----genetic and certain physical aspects of the environment dispositions  Psycho---thoughts, behaviors and choices  Social---nurturing—abuse, trauma, loss, world events  Spiritual—beliefs about one’s sense of meaning and purpose in the cosmos

5 Happiness-what is it for you?  Positive vs Negative Attitude-is the glass half full or half empty  Contentment Vs Addiction  Experience of life and feeling vs. stifling and numbing

6 The basic concept of recovery is to Re- CONNECT with a power greater then oneself, as the addict is POWERLESS over the addiction,

7 How it can be done: The Beatitudes hold a basic concept of recovery and happiness  The text of St. Matthew from Jesus’ Sermon on the Mount:St. Matthew  1Blessed are the poor in spirit: for theirs is the kingdom of heaven. (Verse 3)poorspiritkingdom of heavenVerse 3  2Blessed are the meek: for they shall possess the land. (Verse 4)Verse 4  3Blessed are they who mourn: for they shall be comforted. (Verse 5)Verse 5  Blessed are they that hunger and thirst after justice: for they shall have their fill. (Verse 6) creating positive energy through compassion to the marginalized as Jesus did: homeless, mentally ill, disabled the banquet of a just lifejusticeVerse 6  5Blessed are the merciful: for they shall obtain mercy. compassion for those who may not deserve it-substance abusers, anti social, abusers (Verse 7) as we forgive-we shall be forgiven, freedom from angerVerse 7  6Blessed are the clean of heart: for they shall see God. (Verse 8) – being virtuousGodVerse 8  7Blessed are the peacemakers: for they shall be called the children of God. (Verse 9) pro-peace –society, peace of mind and body,GodVerse 9  8Blessed are they that suffer persecution for justice' sake, for theirs is the kingdom of heaven. (Verse 10) Jesus suffered as God’s child, as we may do at times, but we like him can live resurrected lives in the here and now.persecutionjustice'kingdom of heavenVerse 10

8 .. The path to wholeness

9 The Concept of 12 Step Recovery  The Washingtonians-temperance and politics  The Oxford Group—6 steps of recovery and religion  Bill Wilson-12 steps and AA  Non religious but spiritual and ANONYMOUS  The spiritual foundation of 12 traditions.  Relief from alcoholism through a “higher power”—a non definable concept to provide support and relief from the obsession of drinking  Alcoholism now seen as a “disease” instead of stigma

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12  Materialism and addiction lead us further from the source of our joy and happiness—rendering us powerless  Focusing on the Kingdom of God ( the Power-however you may experience it)—the very source and genesis of our existence leads to limitless love, wisdom, healing and joy. The very presence of God. Jesus is telling us that this Kingdom is not far away, in fact, it is in our very grasp. Step 1 and 2  All we have to do is reach out and claim it by visualizing it, feeling it and living in it. This is prayer and meditation. Often, we turned to the vices of materialism and addiction-even relationships to fill a need within ourselves but joy comes only when we love ourselves and accept God’s love for us. We do this through tuning out these negative things and envision the Kingdom. If we dwell in the vacuum of the negative, of vices and addiction, of violence and poverty, war, anger, depression, illness, that is what we will reap in our lives. Conversely, if we focus on the Kingdom-all of the splendor, glory, joy and abundance of God-that’s what will reap. Focus your mind on what you really want in life, live like you have already achieved it, feel what it feels like. Imagine the prodigal son-and what it would feel like in the arms of God and unconditional love.  #1 In Life and Death, we have an Inheritance - the Kingdom of God (a Power greater then us)

13 The Kingdom is in your midst-  Jesus compares the Kingdom to the wind “it is neither here no there” it is all encompassing and obtainable

14 Ready To Change  Often, a person reaches this stage of readiness by hitting “bottom”. They know there is no where to go but up. Moreover, if we prevent a person from reaching this state readiness, we could impede their success. We often do this through enabling addicts or alcoholics by covering up for them or someone protecting them from consequences. Bill Wilson, the founder of AA was a desperate alcoholic on the verge of death. No amount of help was able to change him, whether hospitals or other treatment –preaching or advice, until he hit this state of being at bottom. Then, the flood gates opened and he melted into the Divine Light of God.

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16 How It Worked For Alcoholics Anonymous and Other 12 Step Groups  *1990’s -1 million individuals treated each year within the U.S. alcohol and drug treatment system. Adolescents - approximately 12% (Substance Abuse and Mental Health Services Administration, 1993, 1999(Kelly, Myers, and Brown). 

17  *In the United States, AA is the most commonly accessed source of help for an alcohol-related problem, with an estimated 9% of the U.S. population having attended an AA meeting. Three percent attended for help with their own problems (Room and Greenfield, 1993).

18  *12-step philosophy has been incorporated into the vast majority of substance-use disorder treatment programs in the U.S. (Humphreys, 1997; Roman and Blum, 1998). *From there was an 18-fold increase in AA world membership (Makeal25). Currently, there are over 2 million AA members in 150 countries around the world (AA.org).. 1.

19 Bill Wilson and Dr. Bob  They found release in GIVING OF THEMSELVES  Bill Wilson and the May Flower Hotel  *The basic program consists of the 12-steps ( based on non religious spirituality-consistent with teaching from the Beatitudes)written in 1938 and several core literature items: Big Book, 12 and , Grape Vine (1944) AA Comes of Age (1957), The Service Manual, and 12 Concepts for World Service. All literature of AA is approved and labeled as conference approved by the General Service Conference of AA. 2. 

20 The First 3 Steps  Create a foundation based on a safe environment where the can visualize and realize the solution to their problem of addiction. This solution being God or A Power Greater then themselves and closeness with others who know what they are going through. (Parker, and Guest 92).  steps 1-3

21  — Powerlessness and Anonymity.AA believes that "anonymity is the spiritual foundation", (AA Tradition 12), of the program and exists at the level of press, radio films —  dismantling the ego brings freedom to know God and one’s true self through humility.

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23 Being Free From Resentment and the Past  *In Step Four; the recovering person is asked to write a history of actions and feelings associated with the addictive behavior that has caused harm to self and/or others. Often, the 4th step contains and inventory of resentments, fears, shame and possible abuse issues. 

24  *(Step Five) is to share the written history with a carefully selected person and with the individual's concept of a higher power. Most commonly utilized.  often the sponsor is the one chosen to hear Step Five, but therapists and clergy are also common.

25  *(Step Five) is to share the written history with a carefully selected person and with the individual's concept of a higher power. Most commonly utilized.  often the sponsor is the one chosen to hear Step Five, but therapists and clergy are also common.

26 Continued Action  *Steps 6 and 7 deal with coming to a deeper awareness of one’s character and personality traits which contribute to their addictive process.  .  * According to the spiritual philosophy and practice of most 12-step recovery groups, every member is free to define for themselves their own conception of what his/her "Higher Power" is. “Many people use "God" but others use the power of the  group or other concepts” (Parker, and Guest 20).

27  An important part of the healing process is to take responsibility for actions that have damaged another person in some way. Apologizing for hurtful behavior can be the first step in repairing relationships that have been impacted by the addiction. (Parker, and Guest 20). *The other party’s response to the amends is not as important as the recovering person’s work in healing their own past. 

28  Steps Eight and Nine help to resolve the guilt and shame associated with past behavior. Parker explains:

29  * Steps practice daily inventory, prayer, meditation and service work to maintain their sobriety on a daily basis. Many continue to repeat taking the steps from the first –twelfth step. Critical to this process is a connection to God, as one understands him, and carrying the message of recovery to others in need

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31 Why this the model?…  Research from Finney et. al. concludes, "Patients in 12-step programs likewise exhibited significant changes over time on almost all of the proximal outcomes commonly implicated in C-B treatment". 

32  These changes include significantly increased sense of self-efficacy, decreased positive expectancies for substance use and acquired more substance-specific and general coping skills, as indicated by increased scores on all the Processes of Change subscales.

33  They also show increases in positive reappraisal and problem-solving and decreases in cognitive avoidance and emotional discharge coping(Finney, Noyes, Coutts, and Moos). 11

34  Overall, patients in the 12-step and eclectic programs show significant increases on both the cognitive and behavioral (activity) 12-step proximal outcomes. In contrast, patients in the C-B programs exhibited modest decreases or no change on the cognitive 12-step outcomes (disease model beliefs, adherence to an abstinence goal and acceptance of an alcoholic or addict identity), even though they showed increases in attending 12-step meetings, having a sponsor, having close friends involved in 12-step groups, reading more 12-step materials and taking the steps. The changes reflect some 12-step participation among patients in C-B programs, but suggest that their participation did not result in an internalization of 12-step beliefs. (Finney, Noyes, Coutts, and Moos) In addition, TSF therapy was more effective than the other two treatments in promoting abstinence.

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36 Cont.  For example, at the 3-year follow-up, 36 percent of TSF patients in the outpatient group reported being abstinent for the previous 3 months, compared with about 25 percent of outpatients in the CB therapy and MET treatment conditions. This result is consistent with the goals of TSF therapy and with AA, neither, of which view moderate drinking as an acceptable or attainable goal for alcohol dependent people.14 

37 12 Step compared w/ CBT  1 year after treatment, 45 percent of patients treated in 12-step- oriented programs reported abstinence from alcohol and other drugs during the previous 3 months, compared with 36 percent of patients treated in CB programs.15  *Gilbert (1991) found that working the 12-steps predicted abstinence, whereas a simple measure of attendance at meetings did not. A meta- analytic review of 107 studies on AA (Emricket al., 1993) evinced better outcomes for "more active members". Having a sponsor, for example, had the largest favorable impact on drinking outcomes. Snow and colleagues (1994) revealed that the perceived importance of attendance to recovery and social aspects of attending recovery meetings was related more to behavioral change processes than a simple measure of attendance; and Montgomery et. al. (1995) revealed that the frequency of 12-step attendance did not predict outcome, but involvement (i.e., working the steps) did (Kelly, Myers, and Brown). 

38  *Findings, overall, supported the role of 12- step cognitions in mediating outcomes in 12- step treatment. However, as Moos et. al. show, much of the change in cognitions appeared to occur prior to patients entering treatment and that most of the variance in outcome was not explained. They conclude that post treatment events are likely to be critical factors, especially with regard to maintaining a core set of beliefs over time. (Moos et. al., 1990). 14

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40 Therapy Approaches  *Although 12-step recovery programs are not considered psychological treatment, there are proven therapeutic approaches contained within the 12- steps. All 12-step programs also embrace the central tenets of client centered therapy: unconditional positive regard, empathy, and genuineness. Twelve-step programs utilize all three of these concepts. (Parker, and Guest 26).  *All of the aspects of psychodynamic theory that are incorporated into 12- step programs are related to object relations theory. This model includes concepts of how the self is developed in relationship to the primary attachment object, resulting in the achievement of object constancy. Object Relations further explains how object constancy allows for the ability to use the image of the caretaker to self-soothe. Parker asserts that here-in lies the main problems of the addict-their ability to self soothe. Through the concept of the "Higher Power", 12-step programs help members achieve a higher level of object constancy (Parker, and Guest 28).

41  *Parker asserts that no client with an addiction has enough capacity to self-soothe or s/he would not be addicted in the first place. People who have well-developed object constancy do not need to alter their moods with addictive behavior. They also use higher-level defense mechanisms so they are not as prone to denial or rationalization as clients with an addictive process are. Members are encouraged to develop the ability to use their sense of spirituality to self-soothe. The new member is not expected to do so right away; therefore it is suggested that s/he go to meetings frequently in order to develop a concept of higher power (Parker, and Guest 28). 

42  *Findings, overall, supported the role of 12- step cognitions in mediating outcomes in 12- step treatment. However, as Moos et. al. show, much of the change in cognitions appeared to occur prior to patients entering treatment and that most of the variance in outcome was not explained. They conclude that post treatment events are likely to be critical factors, especially with regard to maintaining a core set of beliefs over time. (Moos et. al., 1990). 14

43 *Reinforcement  in behavior change: Twelve-step programs use both positive and negative types of reinforcement. For example, when a person has a certain amount of time being free from the addictive behavior their progress is celebrated and they receive a coin marking the amount of years or months that they have been clean and sober. The person is also seen as a role model for others who have not abstained from chemicals for as long as s/he has. When a person uses a mood-altering substance, other than for a true medical problem, they have to start their sobriety count over. This includes identifying him/herself as a "newcomer" in meetings, which means that the member can't hide the relapse from the group (Parker, and Guest 32). 15

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45  Morgenstern et. al. (1997) and Kelly et. al., (2000) examined models based in social- cognitive learning theory(Bandura, 1986) for the effects of 12-step meeting attendance on substance use outcome following inpatient substance use disorder treatment. Both studies supported the use of social-learning-based constructs, (e.g., self-efficacy, motivation and coping), to help explain therapeutic effects of 12-step involvement. The study tested a multivariate process model of adolescent 12-step affiliation and its influence on substance use during the initial 6 months following treatment for alcohol and drug problems. Using social-cognitive learning theory, (i.e., self-efficacy, coping and motivation), summarized in Marlattand Gordon (1985), it was found that more severe users affiliated more readily with 12-step groups. It was also concluded that creating an environment with social activities as part of the meetings helped create a greater sense of affiliation to the groups and sponsors (Kelly, Myers, and Brown).  *Attendance at 12-step and other recovery meetings can help to break the sense of alienation and isolation that addicts usually exhibit. They learn to develop relationships with others that attend the same meeting consistently. They are able to from deepening bonds from the experience of connection, which can facilitate their progress in recovery (Parker, and Guest 36). This sense of common bond stems from the various types of 12-step groups extending their experience, strength and hope with each other. This is why it is beneficial for many addicts to have groups narrowly focused on particular addiction and problems.

46  *C-B patients (n = 1,185-1,186 for the analyses reported here) who had longer in-patient stays scored significantly higher on the Processes of Change scale (r =.15), and its stimulus control (r =.11), self-reevaluation (r = 10) and reinforcement management (r =.20) subscales. Surprisingly, C-B patients who stayed longer tended to have higher positive substance use expectancies (r =.10) than patients with shorter stays. They concluded that there was no relationship between length of stay and the other C-B/general proximal outcomes (self-efficacy, outcome expectancies and general coping responses).  *Patients who remained in C-B treatment longer showed significant increases on some of the 12- step proximal outcomes, specifically, disease model beliefs (r =.17), attendance at 12-step meetings (r =.56), and number of steps taken (r =.21) (Finney, Noyes, Coutts, and Moos):12  Overall, patients in the 12-step and eclectic programs show significant increases on both the cognitive and behavioral (activity) 12-step proximal outcomes. In contrast, patients in the C-B programs exhibited modest decreases or no change on the cognitive 12-step outcomes (disease model beliefs, adherence to an abstinence goal and acceptance of an alcoholic or addict identity), even though they showed increases in attending 12-step meetings, having a sponsor, having close friends involved in 12-step groups, reading more 12-step materials and taking the steps. The changes reflect some 12-step participation among patients in C-B programs, but suggest that their participation did not result in an internalization of 12-step beliefs. (Finney, Noyes, Coutts, and Moos) 

47  *(Moos et al. 1999) Although both 12-step-oriented and CB treatment patients experienced substantial reductions in substance use, substance abuse-related problems, psychological problems, criminal behavior, and unemployment, the 12-step- oriented treatment was more effective in promoting abstinence. 1 year after treatment, 45 percent of patients treated in 12-step- oriented programs reported abstinence from alcohol and other drugs during the previous 3 months, compared with 36 percent of patients treated in CB programs.15  *Findings, overall, supported the role of 12-step cognitions in mediating outcomes in 12-step treatment. However, as Moos et. al. show, much of the change in cognitions appeared to occur prior to patients entering treatment and that most of the variance in outcome was not explained. They conclude that post treatment events are likely to be critical factors, especially with regard to maintaining a core set of beliefs over time. (Moos et. al., 1990). 14

48 AA was just the spark of this model…  Addiction Specific Programs  The list of such groups appear endless. All subsequent 12-step programs, developed out of the AA model, are similarly structured. Al-Anon began in 1951, and Narcotics Anonymous (NA) in Additional programs, such as Adult Children Anonymous (ACA), Overeaters Anonymous (OA), and Gamblers Anonymous (GA), were founded during the last twenty years. While the programs developed in the 1980s and 1990s have subtle differences, the core principles remain the same (Parker, and Guest 2)

49 Some of the difficulties with the model… , the client may be unable to form any attachment with others, thereby making it impossible to obtain any benefit from attending the program. This may be true for clients with a severe anxiety disorder such as Agoraphobia or Post-Traumatic Stress Disorder (PTSD) who will have extreme difficulty in a group setting (Parker, and Guest 66 ).

50 Alternatives To 12 Step Groups  *SMART recovery’s goal is to empower substance abusers by teaching them to identify and counter negative thought patterns that contribute to their substance use. By doing this, people in SMART recovery can learn to abstain and develop a positive lifestyle during their course of recovery. SMART believes that addiction begin in the mind. It relies primarily on a cognitive approach and helps offenders take control of their lives by targeting their thought patterns in very specific ways. 22 

51  *Unlike AA and NA, SMART’s goals are accomplished in groups led by volunteer coordinators, who are trained to guide the group process and assist participants in recognizing irrational thought patterns. SMART recovery consists of a 4-point program, which helps participants build personal skills in: enhancing and maintaining motivation to change, coping with urges, problem-solving, and maintaining lifestyle balance. Because SMART defines addiction in broad terms that include alcohol, prescription and illegal drugs, nicotine and caffeine, as well as behaviors such as gambling, compulsive eating and violent activity, it potentially could help a broad range of offenders (Konopa, Chiauzzi, Portnoy, and Litwicki).22

52 Effectiveness of 12 step therapy  Prior to treatment, participants, on average, were abstinent only 1 out of 3 days. After completing treatment, participants, on average, were abstinent 85%-90% of days. These gains were maintained across the 12- month outcome period. Outcomes in terms of percent days abstinent are similar to those reported in other studies of 12-step treatments (Morgenstern et al., 2001; Project MATCH Research Group, 1997). 24

53  Success in recovery depends not on using strength or will power but by humility, meekness and open mindedness.

54 #2. Humility Gives Way to True Nobility  The anawim, (the poor seeking God for deliverance) they who humbly and meekly bend themselves down before God and man, shall "inherit the land" and possess their inheritance in peace. This is a phrase taken from Psalm 36:11, where it refers to the Promised Land of Israel, but here in the words of Christ, it is of course but a symbol of the Kingdom of Heaven, the spiritual realm of the Messiah. GodmanPsalm 36:11IsraelChristKingdom of Heaven Messiah  Step 7-”Humbly asked him to remove our shortcomings” thus we increase positive energy in our lives and go from vice to virtue.

55  Steps 8-10-The recovering person maintains a this cycle of humble practices through the ‘maintenance steps’ where they continue to experience a freeing from anger and resentment by cleaning the past, making amends, admitting our wrongs

56  (Steps 11, 12 Create Change in our lives by focusing our thoughts and energy on our Source and living in positive relationships with others and by carrying the message of recovery we solidify it that much more in our own lives. In step 12 we reinvest our energy back into the beginning steps of recovery to work them in all of our affairs and life challenges whether they be addiction, relationship issues, finances, or loss. The steps will help us face or feelings with courage and strength instead of resorting to our addiction or other mal adaptive coping tool.)

57 Let’s Re-cap….  1.Poor in spirit=being rich  2.Being Humble is the key to this new freedom and richness  3.12 step program is the example – emphasizing the positive

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account –$10.09 Nov 28 Tucumcari Ranch Supply Uncategori zed –$5.35 Nov 28Lowe'sGroceries–$89.23 Nov 27Lowe'sHousehold–$18.36 Nov 27AmazonShopping–$21.01 Nov 27County TaxTaxes–$36.22 Nov 27County TaxTaxes–$30.13 Nov 27County TaxTaxes–$30.25 Nov 27County TaxTaxes–$ Nov 26 Chaseepay Mark A Uncategori zed –$1, Nov 26 Transfer to WAY2SAV E® SAVINGS Transfer–$1, Nov 26 ATM Cash Deposit Income$ Nov 26 ATM Deposit 1st Income$6, Nov 26 Transfer from WAY2SAV E® SAVINGS Transfer$ Nov 26 Transfer from BUS CK Transfer$1, Nov 26 Transfer to BUS CK Transfer–$ Nov 26Lowe's Home Improveme nt –$20.98 Nov 26 Teamfansh op Com Uncategori zed –$32.19 Nov 26AmazonShopping–$24.29 Nov 26AmazonShopping–$45.24 Nov 25Circle KGas & Fuel–$34.89 Nov 25 Family Dollar Shopping–$7.00 Nov 22 Interest Charge Finance Charge –$25.63 Nov 22Netflix Movies & DVDs –$8.50 Nov 22Alco Home Improveme nt –$21.61 Nov 21Lowe'sGroceries–$70.51 Dec 24CVS director account –$23.36 Dec 25JCPenney director account –$20.00 Dec 24 Grove Newark Qps Food & Dining –$2.66 Dec 24Famiglia director account –$3.02 Dec 24 McDonald' s director account –$5.87 Dec 23Netflix Movies & DVDs –$8.50 Dec 21 Interest Charge Fees & Charges –$25.16 Dec 21ATM 1st St Cash & ATM –$19.44 Dec 21 Teambuild ers Coudirect Dep counseling fees $ Dec 21 ATM Deposit 1st private donation $37.98 Dec 20Check 1659Charity–$35.00 Dec 20cash Cash & ATM –$20.00 Dec 20Hfma director account –$35.30 Dec 19Lowe'sGroceries–$37.49 Dec 19 Bob Upholstery Household–$32.00 Dec 19 Chaseepay Mark A Credit Card Pay… –$45.11 Dec 19 Farmers Insurance Financial–$59.62 Dec 19 private donations private donation $72.00 Dec 18 Clines Corners director account –$25.94 Dec 18 Transfer to WAY2SAV E® SAVINGS Transfer–$1, Dec 18 Transfer from BUS CK Transfer$1, Dec 18 Clines Corners Home–$2.12 Dec 18 Cottam Ski Shop director account –$15.99 Dec 18Jalapenos director account –$13.17 Dec 18Alco Uncategori zed –$32.42 Dec 17 Wf Loan Line Mortgage & Rent –$ Dec 17 ATM Cash Deposit contb 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59 Part Two—Peeling Away The Onion Layers and Deepening the Journey of Recovery  Regardless if you are in recovery, we all have to face some sort of loss and often practice “avoidance coping” which is counter-productive. Spiritual growth is a life long endeavor and involves an ever deepening awareness of our emotions and how to cope with them. Like peeling away the layers of an onion.

60 12 Step Groups dealing with emotional issues: Emotions Anonymous, Family Anonymous,

61 #3 Blessed are they who mourn: (facing our feelings brings comfort and growth) ( Verse 5) Verse 5  Two types of Grievers  Intuitive-feelings are dominant, crying lamenting.  Instrumental-thinking is dominant. Reluctant to talk about feelings.

62 The Inherit Risk of Grief  To avoid true mourning by avoiding feelings of loss and disappointment through addictions and over activity instead of facing the feelings. Like the first Beatitude-facing them gives us Power over them.  It is a painful and difficult journey we all will eventually have to face, but taking that path leads to joy—avoiding it compounds the pain into increased difficulties.

63 Psychosomatic complaints- Symptoms that Grief may be maladaptive.  When we avoid the mourning process, use maladaptive coping or are newly facing the shock of loss, we often experience psychosomatic complaints. This may include: aches and pains resulting from muscular tension such as headaches, dizziness, neck stiffness and back pain. There may be changes to eating patterns with appetite suppression or overeating, such as 'comfort eating' of sweet foods like biscuits and chocolate. Other gastro- intestinal changes may occur such as nausea, vomiting, feelings of choking, perceptions of a lump in the throat or abdominal fullness, constipation or diarrhea. (Payne, Horn, and Relf 22)(Payne, Horn, and Relf 22)

64 More clinical symptoms  Suicidal wishes, withdraw from others and be preoccupied with their loss, intrusive, painful thoughts about their loss. Slowed thinking psychic numbness, crying, physical numbness, disorganized thinking, blunting, weeping, sobbing, feeling of unreality, suicidal ideation, euphoria, outbursts, feeling outside body, disbelief, hysteria, talkativeness, dizziness, appears unaffected, hyperactivity, general physical distress, unaware of others, passivity, sighing. (Payne, Horn, and Relf 22)(Payne, Horn, and Relf 22)  (Larson, and Nolen-Hoeksema 3) (Larson, and Nolen-Hoeksema 3)

65 Symptoms cont.  Gradually the numbness is replaced by the 'pangs of grief', episodes of intense pining interspersed with periods of anxiety, tension, anger and self-reproach. The desire to recover what has been lost is intense and may be characterized by restless searching, vivid dreams, auditory and sensory awareness of the deceased and a preoccupation with memories. Crying aloud and sobbing is common, as is the suppression of emotions although anguish may be displayed. (Payne, Horn, and Relf 71).(Payne, Horn, and Relf 71).

66 How difficult the road can be…  (Payne, Horn, and Relf 84). (Payne, Horn, and Relf 84)  There is also some evidence that bereaved people have an excess mortality in the first six months following the death. This is due to stress reactions and the effects on neuroendocrine and immune functioning. This allows existing diseases such as coronary heart disease to be potentiated by biochemical changes such as increased blood viscosity. Also immuno- suppression may make people more vulnerable to infections and possibly to cancers (Payne, Horn, and Relf 37).(Payne, Horn, and Relf 37)

67 Other effects of grief  Include: depression - sadness, loss of pleasure response, low mood, intense distress, anxiety - fearfulness, hyper-vigilance, inability to relax, anger - may be expressed as hostility to friends, family, health care workers or God. Guilt, feelings of self- blame, loneliness, lack of concentration and attention, memory loss for specific events or general problems in recalling information or attending to new information, repetitive thoughts especially about the deceased, sometimes needing to talk constantly about certain events like a traumatic loss, helplessness/hopelessness, pessimism about the future, feeling of distance/detachment, irritability, expression of anger and hostility, suspiciousness.

68 Effect cont.  In addition, some people experience repetitive thoughts although this should be differentiated from the 'flashbacks', night- mares and overload of distressing cognitions characterized by post-traumatic stress disorder (PTSD). Experiencing the deceased by seeing or hearing the person is relatively common and should not be con- strued as abnormal (Conant 1996; Young and Cullen 1996). At one time such halluncinations were thought to be uncommon and indicative of pathology but there is now evidence that they may well be helpful. Behavioral expressions of distress include agitation or restlessness with constant searching for the deceased, despite cognitive awareness of the loss. Feelings of anger and hostility may present themselves as irritability, phys- ical or verbal attacks on others or objects, social withdrawal and self mutilation. These behaviors may be socially sanctioned in some cultures (Payne, Horn, and Relf 25).(Payne, Horn, and Relf 25).

69 Effects cont.  As the loss is accepted, the intensity and frequency of grief lessens and are replaced by despair and apathy. This often includes social withdrawal and an inability to concentrate or to see anything worthwhile in the future. Furthermore, one can be left with the challenge of rebuilding identity and purpose in life and acquiring new skills (Payne, Horn, and Relf 71).(Payne, Horn, and Relf 71)

70

71 Kubler Ross and Stage Theory  Applied to grief as well as being terminally ill: The initial reaction is denial- a natural coping mechanism that helps people manage their shock and take in the news. They often ignore the emotional impact while maintaining a cognitive understanding of their situation. Next, once the truth of the diagnosis begins to be accepted, angry (Payne, Horn, and Relf 72). Bargaining, often with God, in order to negotiate a cure, more time or greater relief from symptoms(73). This may include promising to attend Church regularly or become better people in return for being cured. Depression- Such feelings can be come so and intense and lead to self-blame. In the final stage, terminally ill people come to accept the reality of their death, or loss in the case of grief (Payne, Horn, and Relf(Payne, Horn, and Relf 72)(Payne, Horn, and Relf  73), 73)

72 Phases of Grief  Wahlhaus :“A transition period during which it is necessary to experience loss in practical terms, express it in emotional terms, integrate it and adapt to it in order to recover sufficiently to continue with hope and a sense of future. 'Grief is a process not a state'. (2) (Wahlhaus)(Wahlhaus)  Stages: 'numbness‘, which is the natural reaction to stress. ‘Pining', then 'disorganization and despair' and finally 'recovery‘. Feeling: guilt, self- reproach, anger, sadness, ambivalence, relief, fear and anxiety. He asserts that these feeling are natural symptoms of grief-work. (Wahlhaus) (Wahlhaus)  MIDDLE PHASE Preoccupation with thoughts of deceased. General physical distress, idealizing the deceased.  RESOLUTION- Realistic memory of de-ceased, return to normal range of emotions, return to normal functioning, pleasure in remembering, new or renewed social relationships, new meaning in life, new or renewed activities (Larson, and Nolen-Hoeksema 4) }(Larson, and Nolen-Hoeksema 4)

73 Grief Work  The second phase of grief work begins when the death is acknowledged cognitively and emotionally. This phase of acute mourning includes intense feelings of sadness, despair, loneliness, anxiety, and anger. The full syndrome of depression may occur, with loss of interest in life, disruptions in sleep and appetite, inability to concentrate or make decisions, a sense of hopelessness and helplessness, and (Larson, and Nolen-Hoeksema 5) }(Larson, and Nolen-Hoeksema 5)

74 Worden’s Tasks of Grief  (1982, 1991) Draws on Freud's concept of grief work, Bowlby's attachment theory, developmental psychology and Engel's concept of grief as an illness. Four overlapping tasks: bereaved people need to accept the death both intellectually and emotionally; they need to work through the emotional pain of loss while simultaneously adjusting to changes in circumstances, roles, status and identity ; and they need to integrate the loss and let go of their emotional attachment to the deceased, so that they can invest in the present and the future (Worden 1982, 1991). (Payne, Horn, and Relf 74)(Payne, Horn, and Relf 74)

75 Other grief perspectives  Bowlby- describes grief in terms of an infant separated from his mother: 'His initial response... is one of protest and of urgent effort to recover his lost mother... Sooner or later, however, despair sets in. The longing for mother's return does not diminish, but the hope of it being realized fades' (p. 9). Marris (1992) takes a more specifically human perspective in arguing that grief is provoked not merely by the loss of a significant relationship itself but by 'the disintegration of the whole structure of meaning centered upon it' (p. 18), and that it is the enormity of this threat that provokes (Payne, Horn, and Relf 8)(Payne, Horn, and Relf 8)

76 Effects of Grief on Marriage  Larson et. al.- Conflicting grief styles and how it can disrupt the marriage:  We witnessed a couple in therapy whose teenage son had been killed in an automobile accident. The wife coped by expressing her emotions. Although she had family and friends around each day who were supportive of her expression, she still needed to talk about the loss with her husband each day. He, on the other hand, wanted to avoid thinking about it and move on, and used work and golf to distract himself from the loss. Two weeks after the son's death, the husband announced unexpectedly that he had arranged for the couple to go to Hawaii to "get away." The trip was a disaster because the pain went right along with the wife, and the husband felt frustrated in his attempts to "distract" her from her grief. This couple's different coping strategies continued to clash until they dropped out of therapy unable to accept their differences. (Larson, and Nolen-Hoeksema 73) 7(Larson, and Nolen-Hoeksema 73)

77

78 *. Factors in how the loved one died  Sudden death- the mourner often shows more anger, guilt, and a sense of helplessness, shock, confusion, and somatic complaints.

79 long-term chronic illness,- grief is found to manifest itself in more social isolation, loss of emotional control vigor, and rumination (Larson, and Nolen-Hoeksema 48). Suicide- there is often feelings of guilt involved with the grief process..(Payne, Horn, and Relf 25).2. (Larson, and Nolen-Hoeksema 48)(Payne, Horn, and Relf 25).2.

80 *Cleiren's (1991) study-  Bereavement after various types of deaths including: death from road traffic accidents, suicide or long-term illness. No long-term impact on adaptation, however, he did show that people facing multiple stressors in their lives such as other losses and low income, have been found to be at greater risk of maladaptive grief patterns, (Parkes 1975; Sanders 1988). These types of stressors can lead to increased clinical problems such as Major Depression or other psychiatric disorders 3.

81

82 Mother's grief vs. father's- 

83 How parents respond to loss  *Data shows mixed reviews-some say mother’s have higher distress, some say no difference in the grief reactions of fathers and mothers--both parents suffer greatly ( Florian, 1989; Lieberman, 1989).  Parents who lose an adult child to illness, accidents, or in war, often have heightened levels of anxiety, depression, and physical illness years after their loss (Larson, and Nolen-Hoeksema 36).5(Larson, and Nolen-Hoeksema 36)

84  Individuals differ in grief response-  *People who are more dependent on others for  their self-esteem will be more at risk for poor adjustment to loss.  *(Sanders, 1993) Women were more likely than the men to report using rumination and support seeking, whereas men were more likely than women to be using distraction (11).  *(Larson)“ Men may have a greater propensity than women to depression and physical health problems following loss of a spouse because men are less likely than women to have strong social support networks of people to whom they feel emotionally close” (Larson, and Nolen- Hoeksema 40).(Larson, and Nolen- Hoeksema 40)

85 Avoidance Coping  Men who lost their wives found that those who suppress thoughts of their loss were more depressed months later than those who did not suppress ( Stroebe (Larson, and Nolen-Hoeksema 65).(Larson, and Nolen-Hoeksema 65)  People who were engaging in more avoidance coping were more depressed and distressed than those who were not.  People who engaged in more avoidance coping at the interview 1 month after their loss were more depressed and distressed at all other interviews. The study also took into account avoidance coping using alcohol or drugs to cope, as well as questions about denying or avoiding thinking the loss.

86 Women and grief-  *Report more symptoms than men (Parkes and Brown 1972)  *More than 40% of the widows in their sample still had significant symptoms of anxiety, depression, and problems in everyday functioning 2 to 4 years after their loss.  *(Vachon et. al. 1982) 38% of widows still were experiencing a high level of distress one year after their loss, and 26% were experiencing high distress 2 years after their loss.  *Zisook and Shuchter ( 1986) Even 4 years after a loss, at least 20 % of widows and widowers assessed their own adjustment as "fair or poor," whereas only 44% assessed it as excellent.

87 Young children who loose a parent-  *Are also faced with complex grief issues.  *They are suddenly faced with the loss of a caregiver and primary attachment figure.  * The meaning of parental loss depends greatly on the child's age. However, losing a parent as an adult can still have a great impact on an individual.  One's primary caregiver remain one's primary attachment figures throughout life. Thus, the loss of a parent still severs the critical attachment bond, even if that loss occurs when one is 50. (Eiser 1990)

88

89 Children's understanding of death.  Shaped by stages of cognitive development and experience.  Worden and Silverman (1996) present evidence of acute depression-like symptoms in bereaved children soon after a loss.  While the grief reactions typically lessen by the first anniversary, some children had significant emotional and behavioral problems, such as social withdrawal, anxiety, and social problems, which did not become apparent until two years after the death. 9

90 Resolving the pain of loss entails  *Confronting the pain in order to reach a successful resolution. Distress is necessary in grief work and not showing distress is thought to be an important indicator of complicated grief. (Vachon et al. 1982b; Parkes and Weiss 1983).  *Stephenson (1985) describes the grieving process in three phases: reaction (involving shock, numbness and anger), disorganization and reorganization (stopping old actions then replacing them with new actions or resuming actions that contribute toward closure of the process), and reorientation and recovery (resolution of previous strong felt emotions).  *Brunelli) Pessagno (2002) four tasks of grief that are described as follows: accepting the reality of the loss, experiencing the pain of the loss, adjusting to the environment from which the deceased is missing, and withdrawing energy from the relationship with the deceased and reinvesting in other relationships (Brunelli). *Brunelli)(Brunelli)

91 Loss related to a failed pregnancy:  *More than 1,000,000 couples in the U.S. alone each year grieve a pregnancy loss.  *Bereaved parents experience more intense and longer lasting grief symptoms than any other group of bereaved people ( Littlefield" (Larson, and Nolen-Hoeksema 34).4 (Larson, and Nolen-Hoeksema 34)

92 Parents who loose a pregnancy  * Need to be given the choice to see their baby, no matter how small.* Have all medical procedures explained to them and be offered the one that best suits their needs.* Have their baby tested and examined, even if the loss occurs at home.* Be given a keepsake of their baby to take home or for the hospital or physician's office to retain on file, such as a sonogram picture or a positive pregnancy test result.* Receive pastoral care if they desire.* Name their baby if they wish to.* Have the grieving process explained and be provided with writ ten information on bereavement, especially the telephone number of a local pregnancy loss support group.* Receive information on burial or memorial services and the options concerning the disposition of the baby's remains.* Receive guidance on how to help their children al home cope with the loss.* Have a phone number of a staff person to call if medical questions arise or if they need emotional support or referral information for further help.* Receive follow-up appointments for medical tests and genetic counseling or to review lab test results.* Be asked about their feelings concerning their loss, which encourages bereaved couples to talk about their situation."After my miscarriage, one of the nurses asked me if I wanted anything," ("Parental Grief over a" 16) 10After my miscarriage, one of the nurses asked me if I wanted anything," ("Parental Grief over a" 16) 10

93

94 Pregnancy loss cont.  In addition, studies have shown that when families are denied the opportunity to express their sorrow over a pregnancy loss, their grief goes underground, only to resurface as complex grief later (Moffitt). If they have suffered a midterm or late pregnancy loss, parents may want mementos, such as photographs, footprints, the baby's blanket, or a lock of hair. Couples who suffer an early miscarriage may wish to have positive pregnancy tests or copies of sonogram photos as keepsakes. Mothers and fathers also should be given the chance to see their baby and, depending on the gestational age, to hold their child as well. They should have access to grief counseling, pastoral care, and options for rituals (Moffitt).

95 Larson’s research on parent’s grief  More than 60% of bereaved parents interviewed just 1 month after their loss said they had gained something positive in their loss and nearly all interviewed 6 and 13 months after their loss (Larson, and Nolen- Hoeksema 39). However, negative feelings also ensue and should be addressed by health care professionals.(Larson, and Nolen- Hoeksema 39)

96 If parents sense that their needs are neglected during their hospital stay  It can be therapeutic for them to write a letter to a patient representative, social work department, director of obstetrical nursing, or hospital chaplain with a copy to the chairman of the hospital's board of trustees, requesting a follow-up meeting to discuss their experiences (Moffitt).

97 Complex grief and pregnancy loss  When families are denied expression of grief their grief goes underground, only to resurface as complex grief later (Moffitt).  Parents may want mementos, such as photographs, footprints, the baby's blanket, or a lock of hair.  Couples who suffer an early miscarriage may wish to have positive pregnancy tests or copies of sonogram photos as keepsakes.  Mothers and fathers also should be given the chance to see their baby and, depending on the gestational age, to hold their child as well. They should have access to grief counseling, pastoral care, and options for rituals (Moffitt).

98 Returning to work  It can be difficult for a parent to return to work after a pregnancy loss and face a myriad of questions only to have to report the sad new to all who may ask. Moffit cites the following of how a parent’s boss effectively dealt with the delicate situation:  One mother who worked in a large advertising agency was relieved to discover that her boss had sent out a letter to all of their clients after her baby was stillborn. "I actually appreciated it very much," she confirms. "Not only was I spared having to tell the news myself, I got so many letters of condolence in return. People really poured their hearts out to me in those letters." (Moffitt)

99 Freud proposed three criteria in complex grief:  1 the presence of hatred for the lost object which is expressed through self- reproach ; 2 identification with the lost object through internalization; 3 the disposition of the libido in melancholia to withdraw into the ego, instead of being transferred to a new love object as happens in 'normal' mourning.

100 Freud and Identification  A central feature of Freud's theory of pathological mourning. He originally believed that identification only occurred in pathological grief, but by 1923, he proposed that it was an important aspect of all mourning.  In pathological grief, he suggested that the aggressive component of the ambivalent state turns inward and causes depression. However, the repression of aggressive thoughts causes some aspects of grief work to be carried on in also in the unconscious. (Payne, Horn, and Relf 60).(Payne, Horn, and Relf 60)

101

102 Isolation  Larson’s study found that isolation was the most strongly related to depression and distress (Larson, and Nolen-Hoeksema 96). (Larson, and Nolen-Hoeksema 96)  Factors leading to isolation and poor social support: lack of support for bereaved people, geographical mobility, loss of support provided by the deceased, impact of bereavement on social network, changes in role and status, anxiety experienced by others when interacting with bereaved people and personality factors (Payne, Horn, and Relf 92). (Payne, Horn, and Relf 92)

103 How everyday practicalities are being managed.  Loss may affect the ability of daily tasks are managed. These include: cooking, shopping, self-care, child care and housework.  Loss may also cause people to question their beliefs about the world affected religious or other spiritual and lead to a loss of meaning and belief systems, identity, esteem and feelings of self-worth individual's self-concept and self- esteem as well as sexual problems (Payne, Horn, and Relf 84). (Payne, Horn, and Relf 84)

104

105 "The psycho-social transition theory (Marris 1974; Parkes 1993)  Bereavement in terms of the need to adopt new roles, skills and identities and to review one's world-view. " (Walter 104) and Freud asserted that “when the work of mourning is completed the ego becomes free and uninhibited again. (Freud 1917/1984: 253(Walter 104)

106 Rituals in grief  The events of 9/11 occasioned feelings of loss shared by the nation and much of the world. This unifying grief first appeared spontaneously through individual or small group rituals. In New York City, for example, relatives and friends created shrines with pictures of the missing, messages for them, personal possessions, and poems of lamentation about them. These sites have been well documented photographically by Martha Cooper and others ("Hallowed Ground"). In the dust that clung to surfaces near Ground Zero, individuals used their fingers to trace dismay, hope, anger, or regret. Groups gathered in parks or in church settings to meditate, pray for the dead and injured, and implore for peace. The folklorists Steve Zeitlin and liana Harlow evocatively described the scenes they witnessed in (Lawrence)(Lawrence)  Manhattan's parks, where "New Yorkers recreated the towers in miniature using tin, papier-mâché, and paint. Red, white, and blue candles flickered alongside Christian votives, Jewish memorial jabrtzeit, and offertory candles petitioning intercessors.... New Yorkers came together in a public ritual that in its transcendence of any single belief system represented all of them. The magnitude of the expression of grief approached the enormity of the loss." Across the country, church bells chimed, candlelight prayer vigils were held, and doves were released in ceremonies noted by numerous journalistic organizations (Shipp; Anderson; "How the States Will Mark"; "Victims to be Remembered"). Transmitted around the world by television, images of these folk rituals doubtless amplified the global sympathy felt for America's loss. (Lawrence)(Lawrence)

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108 Function of Rituals  They provide us acts to engage in for the purpose of meaning making (Neimeyer)  Provides symbolic connection to the lost person.

109 Four Functions of Ritual-Dr. Kenneth Doka  Continuity-the person is still part of my life and a bond exists (cooking a memorial meal)  Transition-a change has taken place in the grief response-(cleaning out a room at an acceptable time)  Affirmation-One writes a letter or poem to the deceased thanking them  Intensification-identification among a group (War Memorials)

110

111 Planning for the Date  Certain dates can be troubling and anxiety proving such as birthdays, anniversaries, holidays, religious celebrations, anniversary of the death. These are best dealt with through ritual rather then avoidance.

112 Counseling Process  ASSESSMENT- Observe and collect information Define and agree the problem. HYPOTHESIS Make your best guess as to the root of the problem. TREATMENT PLANNING Decide what any intervention needs to achieve. Choose the course of action most likely to be effective most quickly and simply.  INTERVENTION EVALUATION Assess whether the intervention has been successful. Discuss with the person and decide whether further help is needed If so, decide how it can most appropriately be given If not, help the person back to their own support systems (Adapted (Payne, Horn, and Relf 104)(Payne, Horn, and Relf 104) 

113 Become a skilled listener  True listening connects you to grieving people in a way that can bring a sense of acceptance and healing into the process. Make eye contact, maintain an attentive posture, and match the volume and speed of your voice to theirs. Refrain from asking too many questions and let them steer the conversation. Nod and affirm, uttering words of encouragement. Provide a sounding board by reflecting back to them the meanings and feelings you hear them saying-empathy.  People in grief and distress from illness want to be heard. They may need to tell their story over and over again, and sometimes the care provider may be the only one who still is a willing listener. (Jeffreys)

114 Suicide /risk Assessment-- -intent and plan  Risk factors—going through a crisis  -isolation and lack of resources  -loss of coping  -has a history of suicide or homicide attempts  Threatening to harm self or others  -has a history of mental illness of substance abuse  -has access to weapons—or things that could be used as weapons  -beyond sib or personality disorder  -call 911 don’t let the person out of sight  CRISIS EVENT-----ESCALEATION -----LOSS OF COPING------RISK  INTERVENTION---DESCALATION-(reasons to live, ways to cope—relaxation, breathing---LINK TO RESOURCES---(hospitalizations, separate from weapons, pc, financial coping resources—food, shelter, safety)

115  Basic of CBT0r RET—correcting errors in thinking  A (activating event) B (beliefs) C ( effect)  Once you find out the B you can help them change it in order to change C

116  ERRORS IN THINKING  Catastrophizing—take one issue at a time  All or nothing—see the in be tweens  Magical thinking—a does not always lead to B  It or I “should” be this way—where is it written  Approval seeking—others opinions don’t make it true

117

118 Motivational Interviewing—eliciting person’s own reason for change Engadging Focus, Evoke Planning Avoid crisis of the day—focus on real issue Open questions Affirmations Reflective listening’ summary

119 More on counseling in grief  Normalize their feelings of: confusion, helplessness, hopelessness, a sense of dread, and a feeling of being stuck in an endless nightmare. They worry that they are going crazy. Say things like, "It's okay to feel this way," "Of course you're angry," "I would feel this way, too," and "It's good to let those tears out." However, self-destructive, suicidal, or homicidal comments are to be taken seriously and referred for professional evaluation. (Jeffreys)  Avoid judgment and to keep the "'whys" or "shoulds" out of the conversation. As Jeffreys states, “do not allow your facial expressions, body language, or gestures to give away your thoughts. Be careful of the telltale "raised eyebrow," which signals judgment. Instead, acknowledge the person's expressions of helplessness and continue to listen”. (Jeffreys)  Moreover, allowing people in grief to remain active is an excellent coping skill. They can write obituaries, plan the funeral, create other mourning rituals, block out schedules, send out acknowledgment cards, fill a vase with flowers, invite special friends over to reminisce, make a donation in honor of the deceased, get into an exercise routine, or take a class. “People grieving due to a serious or life-threatening diagnosis can research the latest developments concerning their illness, make a list of all the medical specialists who are conducting studies or research on their disease or condition, and locate local support groups related to their illness or loss situation. Doing "something" gives individuals a sense of control and purpose; it is a perfect antidote for feelings of helpless despair” (Jeffreys).  Grief counseling also entails identifying social, spiritual, and health care resources. This includes family, friends, clergy, neighbors, colleagues, other care providers, and community services that can become part of the "team." Clergy and congregational members can be invaluable sources of support for the grieving-healing process. It is also important to discern which issues require attention and which are better left on their own (Jeffreys).

120 “Timeouts" from grieving  Various activities such as an outdoor walk, working out at a health club, finding time for a hobby, watching a funny video or television show, scrubbing the kitchen floor, and even retail therapy at a nearby shopping mall. “Sometimes people need permission not to grieve--to do or think about something else” (Jeffreys)  People in grief can also benefit greatly from the mutual aid model. In this framework, bereaved people who are no longer experiencing acute grief themselves provide support to other bereaved people by sharing experiences, talking about their loss and what helps, coping strategies are nurtured and inner strengths developed. (Payne, Horn, and Relf 106)(Payne, Horn, and Relf 106)

121 Faith  Religion also provides community social support through companionship, practical help and supporting self-esteem via shared values and beliefs. Prayer ministry can also provide comfort and increase self worth. However, people may also feel let down and angry towards their religion or God, and a loss of faith may result if their church does not provide the anticipated help or support.  A study found that people who were spiritual and attended religious services were more likely to use social support and active problem solving to cope. They also were more likely to engage in positive reappraisal of their situation Larson, and Nolen-Hoeksema 14. Those spiritual or religious people who did attend religious services at least occasionally had lower levels of depression at 13 and 18 months following their loss than those who never attended religious services. (15) These individual seemed to cope more adaptively with their loss and had lower levels of distress after their loss (Larson, and Nolen- Hoeksema 75).(Larson, and Nolen- Hoeksema 75)

122 Why are they “Blessed”?  Living one's grief transforms relationships with one's self, one's sexual (marriage) partners, children, and society. The release of repressed emotions and memories yields vitality and creativity. The discovery of one's personal truth halts repetition compulsion as destructive patterns inherited from previous generations lose their chokehold. Confronting one's own history increases empathy and compassion for others as well as discernment of their festering wounds. In particular, according to Miller (1997), grief-work sensitizes clients to the emotional exploitation of children and reduces the risk of unconsciously manipulating their own children to meet their own unmet childhood needs for mirroring and unconditional love. Especially pertinent to our current socio- cultural context, Miller suggests that grief-work can assist the flourishing of human life in a given society by diminishing individual proclivities toward racism, sexism, homophobia, and oppression of all sorts (p. 114). In this regard, grief-work may be essential to the maintenance of democratic freedoms. When hate is externalized and projected onto others, rather than de-repressed, it creates factions among groups of people, polarized groups who seek annihilation of the other, which can only occur after trampling upon the other's human rights and dignity. (Latini) }(Latini)

123  “Grief-work moves a person from shame to esteem, from depression to hope, from bitterness to forgiveness, from victim to survivor, from emotional paralysis to creative, spontaneous, vital living.” On the psychological level, it is the "one thing that is needful" in response not only to personal but also communal tragedy. “In the practice of pastoral care and counseling, such grief-work may be interpreted and experienced as one form of subjective participation in the Cross of Jesus Christ. Besides providing parishioners and clients with comfort and hope in the face of unbearable pain, the theology of the CROSS may transform the identity and ministry of the pastoral care-giver and counselor as well. For dependence upon the Cross enables her to hear the seemingly unbearable pain of others and continue her own personal process of healing through mourning (Latini) “.(Latini)  3) The avoidance of one's own suffering through intellectualization, grandiosity, denial, etc., is antithetical to both grief-work/faith and the way of the cross in human existence. (4) Just as grief-work may be a life-long process, so is the way of the cross for the Christian. Sorrow and joy, woundedness and healing exist together in the temporal realm. The full and complete actualization of reconciliation between God and humanity and the eradication of sin and suffering occur only in eternity. (5) Compassion toward others is a natural consequence of both grief-work and participation in the Cross of Jesus Christ. As the Apostle Paul wrote,For just as the sufferings of Christ are abundant for us, so also our comfort is abundant through Christ. If we are being afflicted, it is for your comfort and salvation; if we are being comforted, it is for your comfort, which you experience when you patiently endure the same sufferings we are also suffering. Our hope for you is unshaken; for we know that as you share in our sufferings, so also you share in our comfort. (2 Cor. 1:5-7) (Latini)(Latini)

124 Part Three-Carry the Message  Just as Bill Wilson found release in helping others, we also can find the same release whether it is helping the homeless, the addicted, the mentally ill or the poor. Hungering for justice and mercy satisfies.

125  Serious mental illnesses disrupts people’s ability to carry out essential aspects of daily life, such as self care and household management. Mental illnesses may also prevent people from forming and maintaining stable relationships or cause people to misinterpret others’ guidance and react irrationally.  Poor mental health may also affect physical health, especially for people who are homeless. Mental illness may cause people to neglect taking the necessary precautions against disease. When combined with inadequate hygiene due to homelessness, this may lead to physical problems such as respiratory and skin infections

126 Maslow’s Hierarchy of Needs

127 Types of Mental Illness and Treatment Approaches  Causes: genetic, abuse, environment, birth problems, medical problems or brain injury, substances  Treatment: behavior therapy, medication, play and cognitive therapy  Childhood: autistic spectrum disorder,- intellectual impairment disorder (MR) behavioral *Mood: Anxiety, PTSD, depression, bipolar

128 *Psychotic—hearing or seeing things, delusions-false beliefs, paranoia-”they are out to get me”, disorganization *Cognitive/dissociative—amnesia, delirium /dementia *Addiction and eating *Adjustment *Sexual- *Sleep *Factious

129  Lionel Aldridge Buzz Aldrin Woody Allen Adam Ant Roseanne Barr Ludwig van Beethoven Irving Berlin Marlon Brando Art Buchwald Drew Carey Jim Carrey Dick Cavett Winston Churchill Agatha Christie Dick Clark Rosemary Clooney Kurt Cobain Shawn Colvin Judy Collins Calvin Coolidge Jean-Claude Van Damme Rodney Dangerfield John Denver Princess Diana Charles Dickens Kitty Dukakis Patty Duke Kirsten Dunst Richard Dreyfuss T. S. Elliot William Faulkner Carrie Fisher Harrison Ford

130  Connie Francis Paul Getty Mel Gibson Vincent Van Gogh Macy Gray Peter Green Linda Hamilton Ernest Hemingway Abbie Hoffman Janet Jackson William James Billy Joel Samuel Johnson John Keats Jack Kerouac Margot Kidder Vivien Leigh Abraham Lincoln Mary Todd Lincoln Jack London

131  Mrtin Luther Henri Matisse Kristy McNichol Burgess Meredith Michelangelo Bette Midler Spike Milligan Wolfgang Mozart Edvard Munch John Nash Isaac Newton Friedrich Nietzsche Florence Nightingale Sinead O'Connor Eugene O'Neill Ozzy Osbourne Marie Osmond Jane Pauley Jimmy Piersall Sylvia Plath Edgar Allen Poe Jackson Pollock Charlie Pride Anne Rice John D. Rockefeller Theodore Roosevelt Axl Rose Mark Rothko J. K. Rowling Charles Schultz Peter Sellers Brooke Shields Robert Shumann

132  Sarah Silverman Britney Spears Rod Steiger Ben Stiller James Taylor Peter Illyich Tchaikovsky Leo Tolstoy Ted Turner Mark Twain Tracy Ullman Kurt Vonnegut Mike Wallace Walt Whitman Tennessee Williams Jonathon Winters Brian Wilson Owen Wilson Virginia Woolf Boris Yeltsin

133

134 #4 Spiritual Hunger Brings Spiritual Fulfillment Life is a banquet of plenty that we bring our appetite to. Jesus himself referred to himself as the “bread of life”. Moreover-Justice and peace is his central theme. As we hunger for these virtues we begin to touch the face of God. If we settle on the material-we distance ourselves from God. Moreover, as we work through life’s challenges in our own experiences, we begin to have greater empathy for our brothers and sisters. Jesus did this by healing the leper, the blind the lame and mute, feeding the hungry multitude.

135 We can do this today through these acts as well as advocating for the poor, the mentally ill and the outcast. Society has marginalized and even committed great acts of unspeakable cruelty against such people throughout history. They were though of has demon possessed and should be beaten and caged. However, Jesus shows us how to be understanding, kind, supportive. We are often put to the test of how we will respond to God when he appears as the alcoholic, the depressed, dirty, wondering, lonely talking to themselves or dying cold and naked in the street. We then get a wonderful feeling when we share our seed faith with them and God multiples and grows these seeds.

136 What things help you refresh and revive your self? What attitudes can you change to prevent burnout? Who is you your support network?

137 In Sum…  No matter what our religious background is, we find the Beatitudes embody this spiritual laws through following a few simple spiritual principles. They can empower us to live beyond our wildest dreams and cope with life challenges such as mental and emotional problems, losses, stress, financial problems and addiction. I would like to focus on specially three challenge areas and how they apply to the Beatitudes: Recovery from addiction and how 12 step groups use the Beatitudes, Healing from Losses, and recovery from mental health issues. Jesus is telling us to focus on abundance, joy and prosperity through the Beatitudes-

138  1.The Kingdom of Heaven-Imagine Heaven is, what is it like? Who is there? Behold it now, feel the emotion of being there now.  2.Possessing “the land”- Ancient people survived off the land. It gave them everything they needed to live. Visualize, feel and grasp what success would look like for you. Live as if you have it now.  3.Comfort-Not simply physical comfort but peace of mind and wholeness in body. Focus on healing and that is what you will attract, focus on illness and stress, what you don’t have, your problems –and that is what you will attract.  4.Fulfillment- What do you imagine to be a fulfilling life. Express gratitude for what you already have. Not just materially, but relationally, in your occupation and character. Visualize, feel and live as if you have it now.  5.Mercy- As you forgive others-so shall you be forgiven. Do away with anger and resentment that erodes the body and mind.  6. GOD- Focus your life on the Source of all goodness, love, healing and power. Meditate on God and live in conscious contact with God. Share him with others using your unique, God given talents—what are they?

139 As the Apostle Paul wrote,For just as the sufferings of Christ are abundant for us, so also our comfort is abundant through Christ. If we are being afflicted, it is for your comfort and salvation; if we are being comforted, it is for your comfort, which you experience when you patiently endure the same sufferings we are also suffering. Our hope for you is unshaken; for we know that as you share in our sufferings, so also you share in our comfort. (2 Cor. 1:5-7)

140 What you did to the least of mine, you did unto me..come and enter your rest.


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