1. We help you develop yourself Bereavement and Loss Adults Deborah Boys Learning and Development West Sussex County Council 1

2. We help you develop yourself Aims The aim of this course is to help inform your practice when working with adults who have experienced bereavement and loss. 2

3. We help you develop yourself Learning & Development Outcomes By the end of this course you will be able to:  Discuss bereavement and loss and what these terms mean  Describe the grieving process  Make links to theory and experiences  Reflect on how bereavement affects different people  Use and signpost to resources to support people who are bereaved 3

4. We help you develop yourself A Grief Observed by C.S. Lewis “ There is something new to be chronicled every day. Grief is like a long valley, a winding valley where any bend may reveal a totally new landscape. As I’ve already noted, not every bend does. Sometimes the surprise is the opposite one; you are presented with exactly the same sort of country you thought you had left behind miles ago. That is when you wonder whether the valley isn’t a circular trench. But it isn’t. There are partial recurrences, but the sequence doesn’t repeat ” (Lewis, 1961:47) 4

5. We help you develop yourself Terminology  Bereavement Refers to the state of having lost someone, or indeed something, significant  Grief Usually means the emotional experience that accompanies a significant loss  Mourning Applies to the activities associated with bereavement  Loss applies to the feelings associated with all of the above which may be significant or less so… 5

6. We help you develop yourself Bereavement and Loss  Describe the different types of loss that you have experienced  Identify which types of loss were significant to you and why 6 Significant Loss?

7. We help you develop yourself Different types of loss… What are the different types of loss that a person might experience? 7 Friend(s) A parent As a result of divorce or separation A pet Workplace Transition/ milestones Home Sibling Grand parent Loss of…

8. We help you develop yourself The grief process  Bereavement can occur when there is a significant loss to that person  The significance of the loss is individual to each person  The ways in which people deal with their feelings surrounding loss will also be different 8

9. We help you develop yourself Factors that can influence bereavement and loss  The timing of the loss  The occurrence of several losses or of loss with other major lifecycle changes  A history of traumatic loss and unresolved mourning  The nature of the death  The significance and function of the person 9

10. We help you develop yourself Current theories of grief and bereavement  The following theories about bereavement highlight the way that each person’s experience is unique.  There is no fixed theory that fits exactly but they do serve to help our understanding about the process. 10

11. We help you develop yourself Freud, S. The notion that a satisfactory outcome in loss or bereavement depends upon emotional expression of grief Sigmund Freud 11

12. We help you develop yourself Worden (2003) The process of adjustment to loss commonly known as ‘ grief work ’ using grief counselling and grief therapy (Worden, 2003) 12

13. We help you develop yourself The four tasks of grieving  To accept the reality of the loss  To work through the pain of grief  To adjust to the environment without the deceased  To emotionally relocate the deceased and move on with life Worden, 1991 13

14. We help you develop yourself  Theories of counselling intervention through creation of a safe base in which to explore feelings and concerns.  Attachment theory which promotes security (Holmes, 1993); Person centred approach (Rogers, 1961, 1980), (Ainsworth, 1978) 14

15. We help you develop yourself Attachment Theory  Anxious/ Ambivalent attachment  Secure attachment  Avoidant attachment  Overwhelmed loss response and anxious  Balanced/resilient loss response  Controlled loss response 15

16. We help you develop yourself Grief theories cont.  The characteristics of grief, particularly as they relate to bereavement are founded in the work of Bowlby (1980); Kubler Ross (1970) and Parkes (1996) collectively known as stage and phase models of grief 16

17. We help you develop yourself Stage and phase models  Anger  Denial  Despair  Guilt  Hopelessness  Bargaining  Acceptance  Mourning 17

18. We help you develop yourself Sugarman (2001)  Dealing with death and bereavement often obscures the reality that multiple losses are experienced across the life cycle e.g. those that come with developmental change  Some of these ‘ little losses ’ are rehearsals for more profound encounters with loss and provide a strengthening of emotional and cognitive capacities 18

19. We help you develop yourself Sugarman (2001) cont./ …  Coping demands are fully tested when relationships or health are damaged or disintegrate and where deeply held aspirations are thwarted or unexpected or traumatic death occurs 19

20. We help you develop yourself Stroebe and Schut (1999) Grief as a two dimensional process:  Loss orientation – dealing with the distress of grief  Restoration orientation – focus on diversion from grief and attention to ongoing life demands Successful movement between these two grief modes is necessary to adapt to loss 20

21. We help you develop yourself Lazarus and Folkman (1984)  Where internal resources and external sources of support are inadequate for the meeting of loss, vulnerability will result  Recognising loss and the vulnerability it may produce is central to the process of helping a person overcome bereavement and loss 21

22. We help you develop yourself Reflection: How might an adult’s experience differ from a child’s experience? 22 Make links to the people you are supporting

23. We help you develop yourself Children and their grief experience Factors to consider  The age of the child  Their experience of loss  The child’s coping strategies  The presence and support of family, friends, carers  The child’s mental health and well-being  The child’s understanding about what has occurred 23

24. We help you develop yourself The experience of bereavement Bereavement causes a great intensity and variety of emotions which may be felt for many months, if not years, after the death or loss of connection with someone close. In children sometimes these feelings do not manifest until later adulthood. 24

25. We help you develop yourself Helping relatives and clients  Acknowlede the feelings and wishes of the client and relatives  Acknowledge your own feelings  Observe religious and spiritual practice of client who has died  Deal with possessions sensitively  Anticipate that reactions to news of a death will vary from person to person

26. We help you develop yourself Helping relatives Practical help and support  What to do when there is a death  The death certificate  The funeral/memorial service  Remembrance  Further support and advice

27. We help you develop yourself Helping staff cope with loss Practical help and support Acknowledgement of caring role and grief  Opportunity to attend funeral if appropriate  Make a remembrance book/garden/space  Remembrance/memorial service in setting  Policy and information guidance  Further help and advice

28. We help you develop yourself Don ’ t forget …  Other residents who may have formed friendships with deceased person  That residents may be feeling anxious about their own death  To create opportunities for listening and open communication

29. We help you develop yourself Remembering It is important that people are able to talk about and remember the person after they have died Opportunities to remember can assist in maintaining a person’s sense of identity 29

30. We help you develop yourself Activities to promote remembering…  Talk about the person you are missing with someone who knows them or who is willing to listen  Write a letter  Take some flowers or a card to the memorial or special place  Have an album of favourite photos  Plant a tree or shrub, bulbs, flowers  Listen to favourite music you shared  Visit places that evoke happy memories  Keep a memento that reminds you of them 30

31. We help you develop yourself Who supports you?  Someone to talk to?  Professional advice and guidance  Further training and development  Developing Policies with staff and professionals

32. We help you develop yourself Resources West Sussex County Council End of Life Pathway page  http://www.westsussexcpd.co.uk http://www.westsussexcpd.co.uk  Information and guidance –http://www.endoflifecareforadults.nhs.u k/http://www.endoflifecareforadults.nhs.u k/ –http://www.bereavementadvice.org/ind ex.phphttp://www.bereavementadvice.org/ind ex.php