Adrian Scott MSc Senior MBACP Accredited www.counsellingme.co.uk 07956 292 740 adrianscott@counsellingme.co.uk

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My Experience MBACP Senior Accredited Counsellor MBACP Senior Accredited Supervisor for Individuals and Groups Managed Counselling services in Voluntary Sector www.phasca.com Bereaved, Homeless, Mental health, Carers

My First Working Bereavement Working Experience Bereavement Counsellor at the London Hospital in 1989 Led by Dr. Colin Murray Parkes Theory / Case Study

Expert Not a guru or Bereavement expert Do not know everything Ideas to be Debated / Challenged

Other City Literary Courses Introduction to Psychodynamic Counselling Introduction to the Unconscious Working with Bereavement and Loss Psychology of Attachment

Living through Bereavement & Loss

Morning Session 10.30 Introduction 10.45 Icebreaker Exercise Break 12.00 Theory and Group Discussion 1pm Lunch

Afternoon Session 1.45pm Exercise - Reflecting on Bereavement Break 2.30 pm Attachment / Counselling Session 3pm Case Examples - Video 3.30 Round Up / Feedback Forms Administration 4pm End

Your Experience & Ideas Case Examples

Learning Outcomes Icebreaker Exercise - Counselling Skills Listening, Hearing, Reflecting back Understanding Bereavement & Loss Theory Models and Attachment Assessment Exercise - Own Experience/ Attachment Personal Experience – Own Therapy Understanding of Bereavement Counselling Criteria Methods Video Case Examples Seeing others peoples’ reaction to Bereavement and Loss

The Day Wide range of skills in the room Hope you all get something out of it I am not an expert on Bereavement Encourage you to have your own view

Boundaries Look after yourselves Bereavement can be a difficult and emotive subject Do not say anything you do not want to say. This is not a therapy group! Confidentiality Agreement - All information should be kept to this room and with this group of people.

Icebreaker Exercise Ask Your Colleague: 1. What brought you here? 2. What is your interest and experience of the subject? 3. What do you want from the day? You will be asked to briefly and concisely to report back what your colleague has told you to the group, and check with your colleague how you did!

Icebreaker Exercise Learning Outcomes Basic Counselling Skills Listening Hearing Reflecting back

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

Break

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 Integrative

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

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

Link to Counselling Counselling is a craft, practice of - “being with and containing feelings” Thinking / Avoiding - Discuss

Colin Murray Parkes Bereavement: Studies of Grief in Adult Life Paperback: 288 pages Publisher: Penguin Books Ltd; 3New Ed edition (1998) ISBN-10: 0140257543

“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

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??

Types of Loss Actual loss Death from old age, illness, accidents   Old person - more acceptable loss? Younger person less acceptable loss? Hierarchy of Loss Different countries value of life? Discuss   Perceived loss Person’s view of loss Determined by? Culture, history, family, socialisation?

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? 

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

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

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

Bereavement is like a tide

Summary so far “ 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 can be like a tide ebb and flow  

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

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

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

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 

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

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.

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

Recovery So what factors that aid or hinder bereavement recovery?

Who is the Bereaved Person? Age Gender Personality positive negative Proneness to Grief Inhibition of Feelings Openness / Flexibility to Vulnerability Expression of grief Situation and Environment of the Bereaved Socio-economic Status (Social Status /Class) Nationality Cultural Factors of Grief UK? Religion Community /Over arching belief system

What facilitated the Bereavement process? Traditional family Good family support Predictability of death Practical tasks of funeral arrangements Supportive people making few demands Social Networks Mutual Self Help Groups Bereavement Counselling Support Groups – Group Counselling

What determines how a Bereavement affects a person? Stressors The Trauma Stress & Trauma of the Bereavement Type of stress - multiple deaths, violence, age of deceased The Person Coping strategies - avoidance /drink /drugs /isolation Perception – world view /core values / emotional intelligence Capacity to tolerate strong feelings Processing feelings Self Esteem High /Low

Before the Bereavement Relationship to the Deceased Good /Bad Type of Relationship Fixed Role /Flexible Strength of Attachment Dependence / Independence   Security of Attachment   Secure/ Ambivalent / Involved Degree of reliance   Reason to live Childhood Experiences   Other Bereavement Experiences   Coping? Previous mental health   Life Crises prior to the Bereavement   Type of Death  

After the Bereavement Social Support Prevention of Isolation Secondary Stresses: financial Life Opportunities – Options open to Bereaved

Summary Facilitates the Bereavement – Situation and support of the bereaved Type of Trauma Type of person – ability to cope – background Before the Bereavement - relationships After the Bereavement – support / resilience

Dr Elisabeth Kübler-Ross Pioneer of personal trauma, grief and grieving, associated with death and dying Improved the understanding of bereavement in hospice care Her five stages of grief model: Personal change model beyond death and dying.

Grief model applies to less serious traumas redundancy, relocation, crime, disability and injury, relationship break-up, bankruptcy, etc. Model to understand personal reaction to general trauma.

1 - Denial Denial is a conscious or unconscious refusal to accept   Natural defence mechanism Can be locked in this stage

2. Anger Angry with themselves and Others, Especially those close to them.  

3. Bargaining Bargaining for people facing death can involve attempting to bargain with whatever God the person believes in.   Bargaining in relationships: "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution  Also preparatory grieving Dress rehearsal or the practice run for the 'aftermath' Means different things depending on whom it involves. It's a sort of acceptance with emotional attachment.

4. Depression Natural to feel sadness and regret, fear, uncertainty   Shows person beginning to accept the reality

5. Acceptance Varies according to the person's situation, Broadly an indication that there is some emotional detachment and objectivity. People dying can enter this stage a long time before the people they leave behind Grief Cycle Model first published in On Death & Dying Elisabeth Kübler-Ross, 1969 

Kübler-Ross Summary Some similarities to CMP model 1. Denial – refusal to accept 2. Anger with anger loved ones 3. Bargaining 4. Depression 5. Acceptance