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H. Norman Wright. Here are some losses that we begin to encounter as children that have a counterpart in adult life:  Loss of a favorite toy  Dropping.

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Presentation on theme: "H. Norman Wright. Here are some losses that we begin to encounter as children that have a counterpart in adult life:  Loss of a favorite toy  Dropping."— Presentation transcript:

1 H. Norman Wright

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3 Here are some losses that we begin to encounter as children that have a counterpart in adult life:  Loss of a favorite toy  Dropping an ice cream cone in the dirt  Not receiving an anticipated gift

4  A friend starts playing with someone else  Parents decide to move away from the familiar neighborhood  A pet gets lost or dies

5  Divorce—Mom or Dad remarries  Being promoted to an advanced class and leaving your friends behind  Having your friends promoted to an advanced class and being left behind

6  A teacher leaving in the middle of the school year  A class mate dies  A grandparent dies  Gaining weight

7  Discovering you were adopted  Loss of innocence  Losing a library book  Catching the “tooth fairy” in the act

8  Not making the Little League or soccer team  Not getting invited to a birthday party  Not getting a favorite teacher of your sibling

9  Loss of a job  Retirement  Aging  Job change that is not anticipated  Abortion  Miscarriage  Stillbirth

10  Giving a child up for adoption  Separation/divorce  Children leaving home  Move to another city  Physical illness/injury/disability

11  Terminal illness of a child, friend, lover  Death of a child, friend, parent, partner, pet

12 These can move us into crisis or trauma Crisis throws us off balance and into a state of disequilibrium and panic.

13 1. The capacity to cope is diminished as the shock overwhelms the person at the same time additional stressors are added. 2. The loss doesn’t make sense, and can’t be understood or absorbed. 3. Sudden loss or sudden death usually leaves the survivor with a sense of unreality that may last a long time.

14 4. Symptoms of acute grief and of physical and emotional shock persist for a prolonged period of time. 5. Sudden loss or death fosters a stronger-than-normal sense of guilt expressed in “if only…” statements.

15 6. In sudden loss or death, the need to blame someone for what happened is extremely strong. 7. There’s a profound loss of security and confidence in the world which affects all areas of life and increases many kinds of anxiety.

16 8. Sudden loss or death often involves medical and legal authorities. 9. Sudden loss or death often elicits a sense of helplessness on the part of the survivor.

17 10. The loss cuts across experience in the relationship and ends to highlight what was happening at the time of death, often causing these last-minute situations to be out of proportion with the rest of the relationship and predisposing of problems with realistic recollection and guilt.

18 11. Sudden loss or death leaves the survivors with many regrets a sense of unfinished business.

19 12. In the event of sudden loss or death there is the need to understand why it happened. Along with this is the need to ascribe not only the cause but the blame. Sometimes God is the only available target and it is not uncommon to hear someone say, “I hate God.”

20 13. The death tends to be followed by a number of major secondary losses because of the consequences of lack of anticipation. 14. The death can provoke posttraumatic stress responses.

21  Multiple Deaths: One death is sufficiently devastating; dealing with a set of losses overloads your emotional circuits.

22  Violent Death from Accident, Suicide, or Murder: These events are additionally weighted with overriding concerns about the possibility of the persons suffering, guilt over your inability to prevent the death, and shame about the way it occurred. You may also have to deal with distractions from law enforcement and other official agencies.

23  Questionable Deaths: Not knowing or being sure about the circumstances can lead to intense anger and frustration.  Discovering the Body: Finding the body is shocking enough; having to break the news adds additional trauma.

24  Witnessing the Death: While seeing a peaceful, tranquil death may be of some comfort, watching a person die leaves a permanent imprint. The last impression may be all the more horrific if the death were under difficult or unusual circumstances.

25  Hearing the News: Learning of the person’s death in a callous manner or getting confusing or dishonest information primes us for problematic mourning.  Notoriety: Having a loved one die in a way that generates news coverage means putting a public face on private grief.

26  A Body That’s Not Presentable or No Body: Dealing with a badly damaged body may be particularly traumatic for a child or teen. Not being able to view or positively identify the remains can also produce lingering doubts.

27  Secrets Discovered After the Death: Discovering that the person mourned as mother was actually grandmother.

28 Phase I - Impact  Time: Few hours to a few days  Response: Should I stay and face it or withdraw?  Thoughts: Numb, disoriented. Insight ability limited. Feelings overwhelmed.  Directions you take to regain control: You search for what you lost.  Searching behavior: Often reminscing.

29 Phase II – Withdrawal/Confusion Time: Days to Weeks Response: Intense emotions. You feel drained, anger, sadness, fear, anxiety, depression, rage, guilt. Thoughts: Thinking ability limited. Uncertainty and ambiguity. Directions you take to gain control: Bargaining, wishful-thinking. Detachment. Searching Behavior: Puzzled, unclear.

30 5. Trauma is a wounding.

31 I am frightened inside; the terror of death has attacked me. I am scared and shaking, and terror grips me. I said, “I wish I had wings like a dove. Then I would fly away and rest. I would wander far away and stay in the desert, I would hurry to my place of escape, far away from the wind and storm.” Psalm 55:4-8, New Century Version

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35 Commitment to Family Licking gross things Sniffing Humping Rolling Eating In itIt Love of the Putrid Selfless Devotion to Loved Ones BallsBikes CarsCats Chasing Frisbee Gland

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37 Anticipation is “to feel or realize beforehand: foresee. To look forward to or to foresee and fulfill in advance.” Trepidation—”trepidatory grief” would be a closer fit for the kind of grief people with a life-threatening illness and their loved ones go through up until the point where bad days out number the good ones.

38 Five Stages Stage 1: Denial and Isolation Stage 2: Anger Stage 3: Bargaining Stage 4: Depression Stage 5: Acceptance

39 Anticipatory grief is not just focused upon a future loss. For anticipatory grief to be healthy it’s a process of starting to now the loss of a loved one in the future without separating prematurely from them. Involvement is still important while recognizing what will occur in the future.

40 As one person said, “It’s possible to mourn the future without relinquishing the present.” Questions to Ask 1. “What is going on in your mind as you watch what is occurring?” 2. “What’s the most difficult part of this for you each day?”

41 3. “How could others be more supportive of you at this time?” 4. “Let’s look at some of the losses you’ve already experienced and how they’re affecting your life.”

42 With anticipatory grief, there are three factors which occur: (1) what occurs within the person; (2) what occurs between the person and the dying loved one; and (3) what occurs between the person and the family and friends.

43 There are four sets of psychological processes and they overlap. The first one is a growing awareness and acceptance and gradual accommodation to the loved one’s dying.

44 Questions to Ask 1. “When did you begin to grasp that could be dying?” 2. “To what extent have you been rehearsing death and what it will mean?”

45 3. “Can you describe for me some of the impact or consequences of dying?”

46 The second set of psychological process is processing the death emotionally. 1. “How would you describe your emotional response at this time?”

47 2. “Which has been the most difficult for you?” 3. “When did you come to the realization that would die while you go on living and how did that affect you?”

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49 What would you suggest?

50 The “crazy” feelings of grief are actually a sane response to grief. The following examples are all symptoms of normal grief:  distorted thinking patterns, “crazy” and/or irrational thoughts, fearful thoughts  feelings of despair and hopelessness

51  out of control or numbed emotions  changes in sensory perceptions (sight, taste, smell, etc.).  increased irritability  may want to talk a lot or not at all  memory lags and mental “short- circuits”

52  inability to concentrate  obsessive focus on the loved one  losing track of time  increase or decrease of appetite and/or sexual desire  difficulty falling or staying asleep

53  dreams in which the deceased seems to visit the griever  nightmares in which death themes are repeated  physical illness like the flu, headaches or other maladies  shattered beliefs about life, the world, and even God

54 Third are processes or thoughts that go on in the person’s mind as they await the death. 1. “At a time like this, our mind often goes into overload with so many thoughts. What’s been going through your mind?” 2. “What steps have you taken as you prepare for your life without ?”

55 3. “What have you been saying to God at this time?” 4. “Often we think about our own death at a time like this—perhaps how and when, and do I want to die like this. Tell me about your mental journey.”

56 The fourth set in this process is planning for the future. In planning for the future there are three steps that are important. A first step is giving attention and energy to the dying person.

57 A second step is resolving your personal relationship with the person. 1. “Can you think of any unresolved business between the two of you or something which needs to be said by either party?”

58 2. Mention that at this may be a time to share with them the twenty significant words which are: “I was wrong; You were right; I am sorry; I forgive you: Please forgive me; I love you; and Thank you.” Then ask, “Which of these would you like to express?”

59 A third and final step is simply helping the dying person and responding to their last washes.

60 How Do Families cope with Expected Losses First show Ball of Grief. A terminal illness creates a multitude of problems that many family members never consider. Some of the special problems include the following:

61 Numerous remissions and relapses, so loved ones are on an emotional merry-go-round.

62  Lengthy periods of anticipatory grief.  Increased financial, social, physical and emotional pressures.

63  Family disruption that goes on and on.  The varying emotional responses of each family member to the progressive decline of the loved one. Rarely is every family member on the same page when it comes to grieving.

64  Uncertainty, which continues more than anyone wants.  Various treatments, which are accompanied by their side effects and are sometimes futile.  Dilemmas over decisions such as hospital costs, treatment plans and so on.

65 How do families cope? Avoid abandonment 1. Giving brief and formal monologues. 2. Treating the person as though the disease or accident has turned him or her into a nobody. 3. Ignoring or rejecting the cues that the person attempts to give. 4. Literally abandoning the person.

66  I am not sure exactly how it works, but this is amazingly accurate. Read the full description before looking at the picture.  The picture below has 2 identical dolphins in it. It was used in a case study on stress levels at St. Mary’s Hospital.

67  Look at both dolphins jumping out of the water. The dolphins are identical. A closely monitored scientific study revealed that, in spite of the fact that the dolphins are identical, a person under stress would find differences in the two dolphins. The more differences a person finds between the dolphins, the more stress that person is experiencing.

68  Look at the photograph and if you find more than one or two differences you may want to take a vacation.

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70 The Family Unit

71 When a family member dies, the family balance or unit dies as well. There’s a hole in the fabric of the family, and not everyone will realize this. If something affects one family member, it affects the others.

72 Some of the unique problems to consider in the family system are: 1. How close was each family member to the dying person? What was the quality of their relationship or their level of attachment?

73 2. What is the grieving pattern of each person and what does each know about grief?

74 3. To what extent does each person want to be involved with the dying person at this time? 4. How does the expression of grief affect the grief of other family members?

75 5. How will the family handle “after death” issues if there are differences such as what type of funeral, disposal of remains, type of service, disposal and disbursement of clothing and personal affects, photographs shown or not shown, holidays, anniversaries, etc.?

76 6. What are the specific reasons for the grief of each family member?

77 Grieving Differences “It doesn’t help to talk about it.” “You can talk about it, but not with me.” “We’re doing fine, but thanks for asking.” “Let’s just move on.”

78 “If you’re not sharing feelings, you’re not grieving.” “Let’s let others help us grieve.”

79 2. Phases of Family Adaptation These four emotional responses of the family to the crisis of prospective loss—disorganization, anxiety, emotional liability, and turning inward—will be dramatically different at various phases in the family’s adjustment to the illness.

80 Just as a terminally ill person progresses from a state of health to disability to dying, a family’s progress in response to a fatal illness can be roughly divided into three phases:

81 (1) The preparatory phase, beginning when symptoms first appear and continuing through the initial diagnosis;

82 (2) the middle phase, which can be quite lengthy, when the family lives with the reality and caretaking tasks of the fatal illness; and (3) the final stage, when the family accepts the imminent death and concludes the process of saying farewell.

83 Four Tasks of the Grieving Family In his 1982 book Grief Counseling and Grief Therapy, William Worden first suggested the notion of specific tasks that grieving persons need to perform to heal the wounds caused by death.

84 The Four Tasks Are: 1. Shared acknowledgment of the reality of death. 2. Shared experience of the pain of grief

85 3. Reorganization of the family system 4. Redirection of the family’s relationships and goals

86 Steps to help the family member move forward 1. Embrace the fact that life will be different; it is a new life. This means realizing you have to give up some of the old routines. 2. Realize your social circle and/or support network may be drastically altered.

87 3. Work on reducing the amount of time you give to negative thoughts. Negative thinking involves thoughts about your supposed inability to cope with all your new responsibilities, roles and challenges. Negative thoughts will never create the courage needed to deal with change. They are the number one force in prolonging grief.

88 4. Look for support from knowledgeable sources. Seeking knowledge and support from credible resources is very wise. 5. All mourners need a companion, an ally, someone who will walk with you through the painful journey.

89  How do you help?

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