Anna Lagerdahl Macmillan Clinical Psychologist Grief and loss Anna Lagerdahl Macmillan Clinical Psychologist

What is loss and grief? Different kinds of loss - Losing a loved one - Anticipatory loss - Divorce - Amputation/mutilation - Unemployment, etc…

Why is it important to grieve – what does the loss of a loved one actually mean to us? Split into pairs or groups of three and think about above question. - Loss of a part of self  we attach part of ourselves to the people we have around us. - Loss of security  takes away security of the world as we know it. - Loss of meaning - May bring up old losses - Cultural differences/function of grieving

Why is it important to grieve? Pairs or groups of three again. - Allows us to process the loss of the person and express feelings associated with loss. - Allows us to reflect on the relationship with the person. - Allows us to move on and form new relationships.

How do people grieve? Kubler-Ross model  shock, denial, anger, bargaining & acceptance. More recent models and people’s clinical or personal experiences suggest grieving is not as straightforward an experience as this. Instead, it seems to be a cyclical experience in which people experience a range of feelings at different levels of intensity, sometimes several time over. Some people may never fully accept the loss.

‘Normal’ vs. ‘Abnormal’ grieving Important to be aware of the difference. Grieving is an important part of the process of loss and can in some ways be considered a series of tasks. - Accepting that grief is hard work. - Accepting the reality of the loss. - Accepting and experiencing the pain of the grief. - Adjusting to an environment where the diseased is missing. - Start forming and investing in new relationship. BUT  no right way of grieving

‘Normal’ vs. ‘Abnormal’ grieving There may be varying reasons you think someone’s grieving process in unhelpful to them but to summarise, the following may be an indicator: - Absence of grief or delayed grief. - Distress only comes out in physical symptoms. - Distorted grief (e.g. expressed as anger or guilt). - Prolonged grief: Extends well over the first few months and doesn’t seem to decrease in intensity (can serve a function in helping person feel connected to loved one). - Reluctance to dispose of belongings. - Talks about loss as if it happened yesterday. ‘Normal’ vs. ‘Abnormal’ grieving

‘Normal’ vs. ‘Abnormal’ grieving (continued) - Continued excessive focus on person who has died. - Similar symptoms of illness as deceased. - ‘Phobic’ reaction to illness. - Extreme sadness. - Taking on aspects of deceased person’s personality. - Other people’s losses may trigger their own loss. - Radical immediate changes (almost as a distracter from coping) ‘Normal’ vs. ‘Abnormal’ grieving

Things that can influence the process of grieving Unnatural death Length of illness Where and how death occurred Timeliness Quality of relationship with deceased Arguments ‘Unfinished business’ Previous losses Etc…

How can I help? Validation of difficulty Just asking how it’s going – fear about opening can of worms? The feelings are there anyway!!! Normalisation of feelings/difficulties Suggestions about support groups/services Referrals to appropriate services

Where can I refer patients for support? GP counselling service Primary care service groups (http://www.awp.nhs.uk/templates/Page____821.aspx) CRUSE BEREAVEMENT CARE 01793 619933 Helpline for young people (12 - 18) 0808 808 1677    S.A.N.D.S - Stillbirth & Neonatal death Society) 020 7436 5881 (Helpline)   MISCARRIAGE ASSOCIATION 01924 200799   CHILD BEREAVEMENT TRUST 01494 446648   Children's Information Service 01793 541786   Survivors of Bereavement by Suicide National Helpline 0870 241 3337 DOWNS SYNDROME ASSOCIATION 0845 230 0372    T.A.M.B.A - twins and Multiple Birth Association. Support Group0870 7703304

Any questions?