1. Adrian Scott MSc Senior MBACP Accredited www.counsellingme.co.uk

2. Paper Free! Pdf files on website Background Button
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3. My Experience MBACP Senior Accredited Counsellor
MBACP Senior Accredited Supervisor for Individuals and Groups
Managed Counselling services in Voluntary Sector
Bereaved, Homeless, Mental health, Carers

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

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

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

7. Living through Bereavement & Loss

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

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

10. Your Experience & Ideas Case Examples

11. 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

12. 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

13. 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.

14. 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!

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

16. 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

17. Break

18. 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

19. 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

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

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

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

23. “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

24. 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??

25. 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?

26. 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? 

27. 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

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

29. 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

30. Bereavement is like a tide

31. 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

32. 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

33. 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

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

35. 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 

36. 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

37. 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.

38. 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

39. Recovery
So what factors that
aid or hinder bereavement recovery?

40. 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

41. 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

42. 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

43. 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  

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

45. 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

46. 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.

47. 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.

48. 1 - Denial Denial is a conscious or unconscious refusal to accept
Natural defence mechanism
Can be locked in this stage

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

50. 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.

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

52. 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 

53. 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