Clinical Aftercare Specialist OneLegacy Family Care

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Clinical Aftercare SpecialistOneLegacy Family
Care
What is This Grief Thing? How Families Grieve
The Loss of Someone Close
Michelle Post, MA, LMFT
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Outline

• What to do/not do for a grieving person
• Describe J. William Wordens Grief and Loss Model
  (4 Tasks of Mourning).
• Identify normal grief reactions and warning signs
  of Depression.

Michelle A. Post, MA, LMFT , 213-229-5687
Email mpost_at_onelegacy.org
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Quick Survey by show of hands

• How many of you have had experienced the death of
  a patient?
• How many of you have had a friend who has
  experienced the death of someone close?
• How many of you knew exactly what to say to help
  the patients family or your friend with their
  grief?

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Quick Survey

• How many of you have ever had first hand
  experience dealing with the death of someone
  close to you?
• During your grief, how many of you had someone
  tell you something (maybe in an effort to try to
  help you) that was NOT helpful, or even hurtful?

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The Platitudes/Clichés

• Time heals all wounds.
• Think about the good times.
• God needed another (angel, plumber, teacher,
  coach, etc.) in heaven.
• It was Gods will / Everything happens for a
  reason.
• Something good will come of this.
• She/he led a full life.

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Is Death a Universal Truth?
Elizabeth Kubler-Ross - 1969 Hearses vs white
vans Underused hospice
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Is Death a Universal Truth?
Who Do We Turn to? MDs (some see death as
failure) Clergy good bad Funeral Homes
Crisis Response Teams Police Firefighters
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Is Death a Universal Truth?
Who Do We Turn to?
Professional Counselors Training? DSM
Code for Bereavement gives timeframe? 2 months
(numbness wearing off) kids (23years old and
under) 6-12 mo
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Grief Statistics

• 1 in 5 kids will experience the death of someone
  close by age 18 (Kenneth Doka, Editor of OMEGA
  Journal of death and dying)

• 1 in 20 kids will experience the death of one or
  both parents by age 15 (Steen, 1998)

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Grief Statistics
Close to 2 million children receive death
benefits from a deceased worker (Social Security
Administration, 2007) And that is just the
KIDS! We serve 2200 to 2500 new families each
year just in OneLegacy
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If Death is a Universal Truth,
Grief is the Great Equalizer

Everyone is Affected!
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Possible Pitfalls for Those Who Do Not Reconcile
Their Grief

• Avoid love as a way to avoid pain
• Inability to acknowledge the pain of others
• Avoid risks

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Possible Pitfalls for Those Who Do Not Reconcile
Their Grief

• Inability to express love for their own children
• Experience a sense of searching for that which
  was lost
• Resisting school or work projects which demand
  long-term commitment

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What can we do to help with grief?
Normal Grief can last years AOPO Aftercare 2
yrs min.
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What can we do to help with grief?
What does your hospital do to support a grieving
family?
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What can I do to for personal/professional grief?
Explore Your Own Grief Attitudes J. William
Worden, Ph.D. Personal Death Awareness or Grief
Counseling Grief Therapy A Handbook for the
Mental Health Practitioner
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What Else Can I Do?
Learn a Model of Grief and Loss
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Learn a Grief Model
J. William Wordens 4 Tasks of Mourning
Task 1 To Accept the Reality of the (Death)
Task 2 To Experience the Pain of the (Death)
Task 3 To Adjust to an Environment in Which
the Deceased is Missing
Task 4 To Relocate the Dead Person within Ones
Life and Find Ways to Memorialize
the Person

• Adapted from Grief Counseling Grief Therapy
  Children Grief When a parent dies by J.
  William Worden, Ph.D

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J. William Wordens 4 Tasks of Mourning

• Task 1 To Accept the Reality of the (Death)

• Adapted from Grief Counseling Grief Therapy
  Children Grief When a parent dies by J.
  William Worden, Ph.D

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Task 1 To Accept the Reality of the (Death)

• The griever begins to grasp that the person has
  actually died.
• Even when the death was expected, there is still
  often a sense that it hasnt really happened.
• Intellectual vs. emotional acceptance of the
  death. Intellectual acceptance may come long
  before emotional acceptance.

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Task 1 To Accept the Reality of the (Death)

• Traditional rituals (funerals/memorials) assist
  the bereaved in moving toward acceptance of the
  death as real.
• Include children!

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Task 1 To Accept the Reality of the (Death)

• Belief and disbelief come and go over time.
• Examples
• Misidentify another person as the one who has
  died or think they see or hear them.
• "I still hear his keys in the door".
• "I expect to see her cooking in the kitchen".

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Task 1 To Accept the Reality of the (Death)

• Families will need to repeat their stories many
  times.
• Ask questions that that ask for details
  surrounding the death

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Task 1 To Accept the Reality of the (Death)

• The death becomes more of a reality as each
  "first" occurs without the deceased
• 1st birthdays, death markers/dates, etc.
• 1st holiday season. Ask about the last holiday
  and what they think they will do for the next one.

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Best thing you can say?

• Actually best thing is to just listen

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If you HAVE to say something DONT SAY

• I understand how you feel.
• Death was a blessing.
• Youre still young/ have whole life ahead of you.
  
• You can have other children/Find another.
• Call me when I can help.
• Its time to put it behind you.
• Be strong!

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If you HAVE to say something Try

• Im sorry/ Im sorry you are going through this.
• How are you doing with all this?
• What can I do for you?
• Im here and I want to listen.
• Whats the hardest part for you?
• Ill call tomorrow/Friday/in an hour.
• I can imagine how much this hurts.
• It isnt fair, is it?
• Take all the time you need.

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J. William Wordens 4 Tasks of Mourning
Task 2 To Experience The Pain Of The (Death)

• Adapted from Grief Counseling Grief Therapy
  Children Grief When a parent dies by J.
  William Worden, Ph.D

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What is the pain of Normal Grief?
If Normal Grief can last years, what are the
symptoms?
See Potential Symptoms of Grief Handouts
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Normal Grief is

• Symptoms?

Physical
Emotional
Behavioral/ Psychological
Social
Spiritual
See Handouts
Normal Kids/Teens Grief
and Potential Symptoms
of Grief What stands out to you or surprises you?
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Task 2 To Experience The Pain Of The (Death)

• Pain will vary in intensity from person to person
  and may come and go.
• Friends, culture, and society may interfere with
  the successful completion of this task by not
  allowing the griever to grieve.
• Think about the good times
• Be strong

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Task 2 To Experience The Pain Of The (Death)

• Avoidance drugs, alcohol, travel, relocation,
  constant work, or quickly entering into a new
  relationship.
• Avoidance hinder ones ability to heal. The
  pain will eventually reappear.

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Task 2 To Experience The Pain Of The (Death)

• WHAT IS ABNORMAL GRIEF?
• Active Suicidal/Homicidal Ideation, Plan,
  Intention, Means
• I dont know how I will go on! Normal
• I wish I could be reunited/wish my pain was
  over/wouldnt care if I died Normal
• Im going to kill myself! - Abnormal

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Task 2 To Experience The Pain Of The (Death)

• WHAT IS ABNORMAL GRIEF?
• Command hallucinations
• I thought I saw him walking down the street.
  Normal
• I felt her presence in the room Normal
• I heard him tell me to trash my mothers
  house/join her in heaven Abnormal!

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J. William Wordens 4 Tasks of Mourning
Task 3 To Adjust to an Environment in Which
the Deceased is Missing

• Adapted from Grief Counseling Grief Therapy
  Children Grief When a parent dies by J.
  William Worden, Ph.D

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J. William Wordens Task 3 To Adjust to an
Environment in Which the Deceased is Missing

• The grieving person may need to learn new skills,
  and perform functions that the person who died
  had previously taken care of. This happens just
  at a time when they are burdened with acute grief
  and the least capable of doing so.
• The bereaved tries to gain a sense of control
  over his or her life.
• Help them to brainstorm who can help with daily
  activities for themselves/family (baby sitting,
  picking up kids, cooking, etc.)

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J. William Wordens Task 3 To Adjust to an
Environment in Which the Deceased is Missing
Not only is the relationship gone, but also that
part of the grieving persons identity. Who
am I if I am no longer Johns wife? Am I
still a parent if my only child has died? What
do I say when people ask me how many children do
I have? -Give them permission to answer these
questions differently or the same as they did
before the death.
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J. William Wordens 4 Tasks of Mourning
Task 4 To Relocate the Dead Person within Ones
Life and Find Ways to Memorialize the Person

• Adapted from Children Grief When a parent
  dies by J. William Worden, Ph.D
• Michelle A. Post, MA, LMFT , [phone] ,
  Email michpost_at_ca.rr.com

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J. William Wordens 4 Tasks of Mourning Task 4
To Relocate the Dead Person within Ones Life and
Find Ways to Memorialize the Person

• Assist grievers in finding a new place,
  internally, for their relationship with the
  person who died.
• Grievers find ways to create a new "normal".
• The griever re-invests in their current life,
  while maintaining continuing bonds with the
  person who died.

• Adapted from Children Grief When a parent
  dies by J. William Worden, Ph.D
• Michelle A. Post, MA, LMFT , [phone] ,
  Email mpost_at_onelegacy.org

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J. William Wordens 4 Tasks of Mourning Task 4
To Relocate the Dead Person within Ones Life and
Find Ways to Memorialize the Person
Grievers create or continue traditions and
rituals which allow them to honor the memory of
the person Some make a pact with themselves
never to love again Many go on to form new
attachments and relationships

• Adapted from Children Grief When a parent
  dies by J. William Worden, Ph.D
• Michelle A. Post, MA, LMFT , [phone] ,
  Email mpost_at_onelegacy.org

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Help with Remembering
J. William Wordens 4 Tasks of Mourning Task 4
To Relocate the Dead Person within Ones Life and
Find Ways to Memorialize the Person

• Help the family start thinking about the legacy
  their loved one will leave
• Encourage story telling
• Opportunity to share a part of their life with
  you and to introduce you to the person they loved
  through memories
• Help facilitate the process
• strengthens rapport and trust
• comforting and reassuring
• Memory Boxes
• Hand Molds, Scrapbooks, Web-pages

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What Else Can We Do to Help?
Watch Your Language
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What else can we do to help?

See Dos and Donts Handout Child Speak Handout
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DO - Simplify Language for Grievers!
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Why is it important to simplify language?

Its okay to say dead died
death Lets practice!
Helps with Wordens First task of mourning to
accept the reality of the death
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What to Encourage for Grievers
DO Encourage choices (leads to feeling in
control)
DO Encourage routine activities. DO NOT
Encourage Change in 1st 12 months, Instead keep
home, school, work, relationships the same.

Adapted from Children Grief When a parent
dies by J. William Worden, Ph.D
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To Include or Not to Include Kids in the
Hosp/Funeral? Seeing/Touching the Body?
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DO Include them!!!!
The Harvard Study Research The picture in their
head is often worse than what is real.
- Not being involved is a risk factor
for later complicated grief
Prepare children teens adults for what they
will see, hear, feel and/or
smell.
Let them get involved. Testing in front of them
can help them accept the reality of the death.
Adapted from Children Grief When a parent
dies by J. William Worden, Ph.D
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Include them!!!!
Include children in all aspects of information
sharing, hospital visits, and family mourning
rituals.
In ICU or at a Funeral
Provide a buddy for them (1
adult per child)

Debrief with them.
Adapted from Children Grief When a parent
dies by J. William Worden, Ph.D
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Q A
Any questions? Case examples with
concerns? Something you did to assist a family in
their grief that worked well?
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What else can your hospital do to support a
grieving family?
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Clinical Aftercare SpecialistOneLegacy Family
Care
What is This Grief Thing? How Families Grieve
The Loss of Someone Close
Michelle Post, MA, LMFT