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HIV-Related Losses and Grief

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Module developed by Jennifer Hendrick, Ph.D. Queen Elizabeth II Health Sciences Centre ... Psychotherapy. Personal rituals. Facilitate social support ... – PowerPoint PPT presentation

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Title: HIV-Related Losses and Grief


1
HIV-Related Losses and Grief
  • PHASE, Canadian Psychological Association and
    Health Canada
  • Module developed by Jennifer Hendrick, Ph.D.
  • Queen Elizabeth II Health Sciences Centre
  • Halifax, Nova Scotia

2
HIV is still about lossand grief.
3
HIV-related possible losses
  • Health
  • Future
  • Control
  • Hope
  • Independence
  • Status
  • Employment
  • Financial security
  • Relationships
  • Anonymity
  • Immortality
  • Dignity
  • Roles
  • Mobility
  • Sex
  • Etc..

4
People with HIV think about death and dying.
  • How does this fit with a focus on wellness and
    survival?

5
Do theories help guide us?
6
Kubler-Ross
  • 1. Denial
  • 2. Anger
  • 3. Bargaining
  • 4. Depression
  • 5. Acceptance

7
Stage theories ...
  • Dont allow for individual differences
  • May not be accurate
  • May be harmful.

8
Possible issues for those confronting death
  • Self-acceptance
  • Resolution (or acceptance of non-resolution) of
    relationships
  • Legal arrangements
  • Medical arrangements, including pain management,
    where and when to die
  • Dealing with losses
  • Control, independence, abandonment.

9
We can help
  • Life review
  • Create a legacy
  • Increase control
  • Pain management.

10
We can help with pain management
  • Distraction
  • Imagery
  • Pain redefinition
  • Relaxation
  • Self-hypnosis
  • Contingency management
  • Biofeedback

11
We can speak for those who need pain relief
  • PWHAs with previous intravenous drug use may not
    receive adequate pain management for fear of
    fostering addiction.

12
Dying is hard for loved ones.
  • Acceptance of PWHAs identity
  • Acceptance of wishes for medical care and death
  • Reviewing everyones life together
  • Saying goodbye.

13
We can help to make it easier for loved ones of
dying individuals
  • Facilitate open communication
  • Stimulate anticipatory grief
  • Help finish unfinished business
  • Educate about dying
  • Refer to support groups
  • Encourage their own self-care.

14
Children are affected too.
  • Childrens psychological needs depend on their
  • age
  • developmental level
  • parents coping abilities
  • family structure
  • relationship to the dying person
  • previous experience with loss and death.

15
AIDS-Related Bereavement
  • Because people are still dying of AIDS

16
Grief
  • The subjective experience occurring after
    psychological recognition of loss

17
Common grief reactions
  • Shock
  • Numbness
  • Sadness
  • Loneliness
  • Anger
  • Guilt
  • Anxiety
  • Helplessness
  • Yearning for the deceased
  • Relief
  • Confusion
  • Cognitive problems
  • Loss of energy
  • Shortness of breath
  • Disrupted sleep
  • Poor appetite

18
Influences on Grief Processes
  • Identity, role that deceased occupied in family
  • Quality of relationship with deceased
  • Gender, intellect, maturity
  • Previous deaths or other losses
  • Coping skills
  • Sociocultural, religious/spiritual values
  • Causes, circumstances of death
  • Concurrent stresses.

19
Mourning
  • The process by which individuals strive to adapt
    to their loss and attenuate the state of grief

20
Bereavement
  • Encompasses both mourning and grief
  • Refers to the emotional and behavioural reactions
    to death

21
AIDS bereavement is different.
  • The differences can lead to problems in mourning.

22
AIDS deaths are unique.
  • Stigma
  • Lack of social support
  • Disenfranchisement
  • Unresolved negative feelings
  • Caregiver stress
  • Conflicts between biological and chosen families
  • Multiple, serial loss
  • Survivor guilt
  • Mourners who are HIV

23
AIDS deaths are unique.
  • Stigma
  • Lack of social support
  • Disenfranchisement
  • Unresolved negative feelings
  • Caregiver stress
  • Conflicts between biological and chosen families
  • Multiple, serial loss
  • Survivor guilt
  • Mourners who are HIV

24
Bereavement is work.
  • Randos 6R Processes of Mourning
  • 1. Recognize the loss.
  • 2. React to the separation.
  • 3. Recollect and re-experience the deceased and
    the relationship.
  • 4. Relinquish old attachments to the deceased.
  • 5. Readjust, adopt new ways of being in world.
  • 6 .Reinvest energy bound up in deceased.

25
We can help.
  • Psychotherapy
  • Personal rituals
  • Facilitate social support
  • Psychoeducation normalize and validate
  • Community rituals
  • Support groups
  • Bibliotherapy

26
Case study Bill
  • Bill, Age 41, in-patient, HIV with wasting,
    neuralgia, esophagitis, memory deficits
  • Anxious, tearful about pain, ruminating about
    wifes AIDS-related death three months ago
  • Former injection drug user
  • No social or family support.

27
Questions for Discussion Re Case Study
  • 1. What issues or difficulties could be
    contributing to the clients symptoms ?
  • 2. How would you and your client determine
    therapeutic goals ?
  • 3. How would you intervene or work with the
    client ?
  • 4. What referrals would you suggest or offer?

28
Case study Judy
  • 53-year-old mother of Peter, who died of
    AIDS-dementia six months ago in hospital
  • He disclosed HIV status only 18 months ago when
    sick told others he had cancer.
  • Judy is having difficulty coping with her grief.
  • Family members are unwilling to discuss Peter.
  • No one outside the family knows cause of death.

29
Questions for Discussion Re Case Study
  • 1. What issues or difficulties could be
    contributing to the clients symptoms ?
  • 2. How would you and your client determine
    therapeutic goals ?
  • 3. How would you intervene or work with the
    client ?
  • 4. What referrals would you suggest or offer?
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