Recovering from Loss & Grief Dr Timothy Dunne Consultant Clinical Psychologist Public Lecture delivered on behalf of Kilkenny Bereavement Support Group Wednesday 10 th September 2014

Outline Introduction Definition of terms Models of Grief Grief & Complex Grief Grief & Loss Myths about Grief Suicidal Ideation Healing & Recovery

Terms Grief = Emotion Loss = Experience Mourning = Process of Grieving Bereavement = Social & Cultural Processes Complex Grief = Any loss which is accompanied by obstacles to psychological healing

Simple / Complex Grief Young V Older person Natural causes V Man made (murder/suicide) Natural disaster V Man made (train/plane crash) Sudden death V Gradual decline Ambivalent Loss – where there are no remains to bury

Losses Permanent physical injury or disability Any change in health status (eg) diagnosis of long term condition such as diabetes, cancer Any major Life Event, even positive ones such as house move, new job, marriage & divorce, emigration Ageing & retirement Financial losses & reduced standard of living

Models of Grief Kubler – Ross (1969) Warden (1990) Dual Process model (2010)

Kubler-Ross’ Model Shock/Denial Anger Bargaining Depression Acceptance

Some Difficulties The model was first used to describe stages in acceptance in the dying not in the bereaved Not everyone goes through every stage The stages are iterative rather than progressive “Is” can become “ought” Too prescriptive, rigid and passive

Warden’s Tasks of Mourning model To accept the reality of the loss To experience and process the pain of grief To adjust to life without the loved one To relocate the dead person emotionally and find an enduring connection with him/her & embark on a new life

Some difficulties Perhaps too prescriptive also Can appear to minimize the individual experience of grief Fails to recognize that the powerful nature of grief which may only be handled in manageable chunks People can get “stuck” on a particular task or stage

Dual Process model (DPM) of Grief (Stroebe & Shear, 2010) Based on concept of “Oscillation” whereby the bereaved person confronts the loss at times and at other times avoids it The person “swings” between facing the loss and restoration or rebuilding their life “Time out” is an essential feature of this model as continuously facing grief is “arduous & exhausting” – “defensive exclusion” is vital at times This model takes account of other stressors in the person’s life such as bringing up children or financial pressures

Cultural Assumptions Our Western culture (and helping professions) have arrived at a “common wisdom” that it is generally healthy to focus on pain of grief and distress and to express it openly Suppression of same is thought to be unhealthy & not to be encouraged (“stiff upper lip”) However, research (White, 2013) does not support this “common wisdom”

Cultural Assumptions In addition to the need to face grief & pain there is also a natural tendency to avoid the reality of death This should be factored in to any intervention process Avoidance can have a valuable protective effect for someone struggling to make sense of an overwhelming loss This is now standard procedure in Trauma treatment (ie) a “titration” approach

Cultural Processes Irish Wake/ Month’s Mind Used to have outward signs/symbols such as wearing black for a certain period or diamond on a jacket sleeve Jewish Shivah (7 days); Shloshim (30 days) and Shneim asar Chodesh (12 months) Most people underestimate how long it takes to fully get over the death of a loved one

“The Deal” In complex or traumatic grief the person may often, unconsciously, make a deal with the loved one which goes like this: “I will continue to suffer pain and loss in order to prove my love for you because if I don’t feel this pain, it means I don’t love you or if I let go of my grief it means I have forgotten you” The same can occur with self-blame especially if the survivor believes that they somehow are responsible for the death of the loved one

Complex Grief Long lasting Intrusive images or thoughts of the loved one Pre-occupation with the deceased Social withdrawal & detachment Pining or yearning for the deceased Have trouble accepting the death Inability to trust others Excessive bitterness Prolonged feeling that life is empty & meaningless

Complex Grief Are you having trouble accepting the death? Does grief interfere with your life? Are you having troublesome thoughts /images of the deceased? Do you avoid doing the things now that you used to do with your loved one? Are you feeling cut off or distant from others since the death?

Myths of Mourning Grief declines steadily after the death All deaths and losses produce the same type of grief reaction The intensity of emotions experienced and the length of time spent grieving is testimony to how much love there was for the deceased Grief & loss are only about death Time heals all wounds

Suicidal Ideation Suicidal ideation or wanting to die occurs in up to 65% of those bereaved Complex grief produces 5 times as many suicidal thoughts Some people see suicide as a way of gaining control over the pain Sometimes people put themselves at risk or neglect themselves or act with less concern for themselves or in a way which increases the likelihood of accidents or death

Thoughts & Beliefs I didn’t do enough for her He died without knowing how much I loved him I cant stand not knowing if he suffered pain It was unfair how she died I don’t know if he is at peace Its not right for me to enjoy life without her

Healing & Letting go Not everyone needs Bereavement Counselling! Social support is important – find one person who you can talk to without embarrassment and who is a good listener Compassion for yourself is also important Anniversaries, birthdays, weddings, Christmas are all occasions which can trigger strong emotions of sadness & loss

Healing & Letting go How has life changed since your loss? What never happens now as a result of the loss? What do you miss most about your life since the loss? What do others comment on since your loss? What has surprised you most about your thoughts & feelings? How has this impacted on your view of yourself, others, relationships, life or the world in general?

Healing & Letting go If you feel that it is taking you a long time to recover, then consider seeking professional help Use your memories and memorabilia of the loved one to support yourself Create a lasting memorial to the loved one such as planting a tree, make a donation or start your own charity/fundraising Choose a significant picture/image and have it commissioned by a professional artist