1. Icebreaker Exercise Learning Outcomes
Basic Counselling Skills
Listening
Hearing
Reflecting back

2. What do you want from the Day?
Are there any Topics, Issues, that you would like to focus or discuss today?
Write on flip chart

3. Break

4. Preamble before Bereavement Theory
General Principles of Counselling?
Training in Bereavement Counselling – last bastion of old volunteer model? – Discuss
A way to reflect on feelings Learn about relationship with ourselves
Generic Counselling Approach

5. The Intelligent Human adult..
…knows that it fruitless to dwell on painful memories and the intrusive images of traumatic events are sometimes so painful that we will go to great lengths to avoid them. We may do this by shutting ourselves up in a safe place (usually our home), and avoiding people and situations that will remind us of the trauma and deliberately filling our minds with thoughts and activities that will distract us from the horror. But it is a paradox that -
“ in order to avoid thinking about something we have to think about it”.
That is to say, at some level we remain aware of the danger that we are trying to avoid. Hence it should not be a surprise to us if our attempts at avoidance commonly fail. In sleep and a time of relaxed attention painful memories tend to float back into our minds and we find ourselves reliving the trauma yet again.
Colin Murray-Parkes

6. Link to Counselling
“ in order to avoid thinking about something we have to think about it”.

7. Counselling is a craft, technique, or practice of
Link to Counselling
Counselling is a craft, technique, or practice of
thinking and being with feelings
which we want to avoid

8. Colin Murray Parkes
Bereavement: Studies of Grief in Adult Life
Paperback: 288 pages
Publisher: Penguin Books Ltd; 3New Ed edition (1998)
ISBN-10:

9. “Bereavement Expert”
Since 1966, Parkes has worked at St. Christopher’s Hospice in Sydenham, where he set up the first hospice-based bereavement service and carried out some of the earliest systematic evaluations of hospice care.
Parkes has also edited books on the nature of human attachments, and Bereavement
Parkes is a former chairman and now life president of the charity Cruse Bereavement Care

10. A Theory of Bereavement
For this course today:
Bereavement is a process of grieving
Loss is the person or object
Life is bereavement
 Minor bereavements all the time
Beginnings and endings: relationships, friendships, jobs, work projects, holidays, moving house
Days, weeks, years
We cope with major / minor bereavements in the same way??

11. Types of Loss Actual loss Death from old age, illness, accidents.
Old person more acceptable loss
Younger person less acceptable loss Discuss
Perceived loss
Person’s view of loss
Culture, history, family, socialisation?
Bereavement Counselling Time-limited
Focus solely on bereavement

12. Bereavement Study  
Colin Murray Parkes Psychiatrist at Royal London Hospital
Effect of the loss of husbands on group of widows in London’s East End
Discuss: limitations?
1987 Case study of Henry who survived capsized ferry in Zubbregge, Holland
Discuss: accidents/ terrorism /wartime/peacetime? 

13. The Cost Of Commitment Gain Investment in relationships: emotional,
physical, financial.
Lives enriched but there is a ……….
Cost
Risk of losing Gain

14. Process of Bereavement
Start after loss?
Fade away?
Remain repressed not allowed to begin?
Part of the process begins / Other parts held back.
Bereavement is like a tide: it flows back and forth through the stages
Individual / Personal

15. BEWARE! Comment on Bereavement Stages:
“the stages might lead people to expect the bereaved to proceed from one clearly identifiable reaction to another in a more orderly fashion than usually occurs. It might also result in … hasty assessments of where individuals are or ought to be in the grieving process”
P.351
Handbook of Bereavement, Cambridge 1993

16. Bereavement is like a tide

17. Bereavement Summary
“ in order to avoid thinking about something we have to think about it”. Link to Counselling
Bereavement is a process of grieving
Loss is the person or object this is lost
The Cost Of Commitment Bereavement is Individual and Personal The stages to do not occur in order
Bereavement is like a tide

18. Stages of Bereavement Theory
1. Alarm
2. Searching
3. Mitigation – Lessening the Impact
4. Anger & Guilt
5. Disorganisation & Despair
6. Gaining a New Identity
Theory is theory - feel able to agree or contradict it!
Discuss
Colin Murray-Parkes

19. 1.Alarm Tension, Shock, Panic, Disbelief Restlessness
Numbness – some emotions break through
Preoccupation / obsessiveness with thoughts of the lost person.
Self-care neglected  
Breakdown of customs / behaviour
Sensitive to noise, conflict, administration
Shut down to avoid feelings

20. 2.Searching Calling for the lost person Sobbing, tearfulness,
Feeling of loss / lost Discuss
Visit places of experience
Aimless searching – irrational?
Find lost person

21. 3.Mitigation–Trying to Lessen the Impact of Bereavement
Components of grief work
Pre-occupation / wish to find the person
Repeating, painful recollection of the loss
Patterns, Obsessive thoughts, PTSD
Making sense of the loss to fit assumptions - meaning
Dreams - common dream - happy interaction with the dead
Pining / Avoidance of Pining
Idealised person - forget the negative 

22. 4.Anger and Guilt Familiarity - loved ones, family members
Misdirection - Hospital staff / GPs
Blame / Self Blame
Anger guilt becomes irreconcilable - leading to family splits
Resistance to sadness, grief under the anger and guilt

23. 5.Disorganisation and Despair
Period of uncertainty 
Take on the reality of what has happened
Identifying with lost person – method of avoiding the loss of that person
Old model of the world abandoned
New set of expectations created - with time and acceptance
Other people become a support, security, & protection.

24. 6.Gaining a New Identity Taking on role/interest that lost person had
New versions of old relationships
New relationships
New interests 
New updated view of the world
Less repressed / more flexible

25. Attachment Theory John Bowlby
What is Attachment? - A Secure Base?
Attachment - emotional bond to another person.
Earliest bonds in childhood have life long impact
Attachment survival mechanism - keeps infant close to the mother

26. A Good Attachment
Primary care givers are available & responsive to infant's needs creating a sense of security.  
The infant knows that the caregiver is dependable
Creates a secure base for the child to explore the world

27. Experiment with rhesus monkeys
Monkeys offered two objects to attach to
Soft mother dummy without food
Hard mother dummy with food

28. Monkeys preferred soft dummy without food
Discuss – reaction against Freud’s Instincts Theory

29. Bereavement is an extreme broken attachment / separation from a loved one
First experience - primary care giver and child
Main Carer’s emotional state critical
around baby’s birth
Primary Carer & baby relationship
major influence on adult life