1. THE REAPER HAS LOTS OF FRIENDS: THE MANY FACES OF LOSS Christian J. Billington, MA, LMFTC, NCC Colorado Employee Assistance Program Presentation 8 th May, 2015

2. OBJECTIVES  Discuss grief & loss  Understand historical loss and contemporary loss models  Generate ideas on how to be/work with loss  Guidelines for supporting client’s who have experienced a loss  Discuss complicated grief & loss

3. PERSONAL LOSS  Loss line  Who am i?  Personal experiences of loss

4. OLD LOSS MODELS  Freud (1917) Stage  Kubler-Ross (1969) Stage  Bowlby & Parkes (1970) Stage  Worden (1982/2002) Task  Marone (1999) Phase

5. CONTEMPORARY LOSS MODELS  Rando’s Six ‘R’ Model (1993)  Strobe & Schuts Dual Process Model (1999)  Le Poidevin’s Multidimensional Model  Walsh & McGoldrick (2004) Task

7. TYPES OF LOSS  Primary & secondary  Multiple losses  Ambiguous loss  Obscured loss  Stigmatized loss  Sudden, unexpected, or gradual loss  Cultural loss

8.  Normal  Complicated  Anticipatory  Chronic  Delayed  Traumatic  Abbreviated  Frozen TYPES OF GRIEF  Distorted  Cumulative  Prolonged  Exaggerated  Masked  Disenfranchised  Collective  Inhibited  Absent (Whatsyourgrief.com)

9. DISENFRANCHISED GRIEF (DOKA, 1989) Loss is not socially recognized Loss is not socially recognized as legitimate Griever is not socially recognized as capable of grief

10. GUIDELINES FOR MANAGING GRIEF &LOSS  Grief is unique to the individual  Multiple fluid contexts  Nonlinear grief models over universal stage/phase models  Promote “Continuing bonds.”  Recognize grieving as a normative process  Grieving clients are active agents of process of loss adaptation

11. GUIDELINES CONT.  Meaning reconstruction as a critical aspect of loss adaptation  Recognize grief does not end, but it does change  Tailor treatment to uniqueness of the grieving clients (Humphrey, 1999)

12. CONSIDERATIONS  Strategies; affective, cognitive, behavioral & spiritual  Attachments  Disrupted meaning structures  Personal history of loss & separation  Developmental considerations  Social supports  Sociocultural influences(Humphrey, 1999)

13. THE SHORTEST WAY TO THE ‘OTHER SIDE’ OF GRIEF ‘IS THROUGH.’ - UNKNOWN

14. TOOLS  Witness client’s experience & story – Be with them  ‘Normalize’ & Validate experience  Psychoeducation  Rituals  Journaling  Support groups  Retelling/sharing loss  Spiritual/faith examination  Re-connect with friends and families  More ideas…

15. SIGNS OF CHANGE AFTER LOSS  Meaning reconstruction  Sharing loss  More manageable/predictable emotions  Softening and noticing that grief is changing  Reintegration/rebalancing of life post loss  Re-establish routines  Post loss growth

16. COMPLICATIONS  DSM IVTR  DSM V  Impaired functioning in life  Destructive behaviors  Poor coping  Safety concerns  Differentiation from depression  Isolation

17. PHYSICAL REACTIONS  Continued sleep disturbances from frequent nightmares and intrusive memories  Physical symptoms or psychosomatics related to the loss  Significant weight loss or gain

18. EMOTIONAL REACTIONS  Inhibited or absent grief  Prolonged hostility and aggression  Panic attacks, phobias, or irrational fears  Constant yearning for what was lost

19. BEHAVIORAL  Progressive isolation and withdrawal from social contact  Self-destructive behavior  Prolonged avoidance of tasks reminiscent of what was lost  Continued loss of interest in activities (Sharecare.com 7/2009)

20. QUESTIONS? Take Aways…