1. Crises of Loss

2. Kubler-Ross Five Stages of Death and Dying Denial and Isolation- Denial is a healthy and common reaction to loss. It helps with the initial shock, and allows you to deal with both their hope and despair. Anger- Helps with the acceptance of the reality of death. You may feel rage, envy, resentment, etc. Bargaining- Are secret packs with God. Even if parents were not religious earlier in life. Depression- When death is accepted the feelings of loss are overwhelming and depression sets in. You may feel sadness, feeling of guilt, worthlessness, etc. Acceptance- Work though your mourning and depression of loss and comes to accept the loss.

3. Other Theories of Loss Sigmund Freud- defined mourning as a period of gradual withdrawal of libido from now-missed loved object. Reactions- dejection, disinterest with surrounding, and detachment from others. Self-limiting The libido has completed its withdrawal form the loved object and is reinvested in a new object.

4. Other theories  John Bowlby- Proposed four phases of mourning:  Numbing  Yearning and Searching for the lost figure  Disorganization and despair  Reorganization

5. Other Theories  Charles Darwin- Separation reaction results from the loss of a loved one were innate. There are similar body movements in grieving individuals regardless of cultural background.

6. Worden’s Tasks of Mourning

7. Task I: Accepting the Reality of the Loss  The person grieving needs to accept that the loss is real  Denial can become pathological  Permanent loss must be replaced by realization that loss has happened and that the person can survive the loss  Anger shows there is some acceptance that the loss is real

8. Task II: Experiencing the Pain of Grief  Next step: fully experience the feelings associated with the loss  Ways of showing grief: crying, yelling, or meditations  Pain may be more intense for some then others  Everyone needs to experience the pain left in his/her life from a loss

9. Task III: Adjusting to an Environment from Which the Deceased is Missing Widows and widowers take several months to cope on their own About 3 months after the loss they realize that they can manage their new environment Must find ways to cope with new roles that once were their loved one’s role At first they often resist developing new skills, but eventually become proud of their newfound abilities…new self-esteem!!

10. Task IV: Withdrawing Emotional Energy from the Deceased and Reinvesting It in Another Relationship and Reinvesting It in Another Relationship  Withdrawing their emotional energy from the dead loved one is often seen as betrayal  Guilt must be overcome  Mourning can be considered finished when the tasks of mourning are over  Mourning is an individual process  Usually takes a year to pass by before the loss is fully resolved

11. Task IV Continued  At least a year is needed to let go of old memories and begin to build new ones  Holidays, seasons, and family events all must come and go during the mourning period before resolution is complete  Does not mean the expression of grief will be strong for the entire year

12. How might you know the mourning has come to an end???  The person is able to think and talk about the deceased without pain.  The sadness at this point lacks the tearing quality of loss  Studies show widows often need 3-4 years to find stability in life again  MOURNING IS A LONG TERM PROCESS!

13. Manifestations of Normal Grief  Sadness, anger, guilt, anxiety, including death awareness and phobia; loneliness, fatigue, helplessness; shock-particularly with sudden death; yearning and pining; emancipation, which can be a positive response; relief, particularly from suffering; and numbness

14. Manifestations of Normal Grief Physical Sensations: Hollowness in the stomach, tightness in the chest and throat, sense of depersonalization, breathlessness, weakness in the muscles Cognitions: Disbelief, confusion, preoccupation, sense of presence, hallucinations Behaviors: sleep disturbances, appetite disturbances, social withdrawal, dreams of the deceased; sighing or crying; fear of losing memories; treasuring objects

15. Determinants of Grief  Relation to the one loss  Nature of the attachment  Mode of death; Natural, accidental, suicide, or murder  Prior grief experiences and mental health  Religious beliefs

16. Intervention  If worker is on alert because of symptoms they must refer client to a physician if symptoms cause moderate to severe dysfunction.

17. Counseling Principles and Procedures 1. Help survivor actualize the loss. Talk about the loss. What happened? Ask. 2. Help them identify and express feelings. 3. Help survivor live without the deceased. 4. Facilitate emotional withdrawal from the deceased. Encourage survivors to go on. 5. Provide time to grieve. Crucial time include 3 months and 1 year after the death, anniversaries of the death and holidays. Help client prepare in advance.

18. Procedures continued 6. Educate clients about customary grieving reactions of the other individuals to help normalize the experience. 7. Allow for individuals differences. Be sensitive to individual styles. 8. Provide for continuing support. Encourage clients to join support group.

19. Separation and Divorce  Approximately 50% of American marriages end in divorce.  The split of a relationship is often seen as a loss, even if wanted initially.  Divorce can be seen as a “failure”.  If children are involved, the loss becomes more complex.  Rage is a common reaction when arranging custody matters – crisis workers often act as mediators.

20. Children and Divorce  Approx. 26% of children under 18 live with a divorced parent in the U.S.  In 1991, 39% of divorced women with children lived in poverty.  Intervention may be child or family oriented; the goal is to alleviate emotional/behavioral problems connected with divorce.

21. Crises in Blended Families  Many crises occur when one or the other divorced parent moves on and starts dating again.  In some situations, the person who is dating the divorced person has never had children.  Loyalty issues often come into play when children are presented with a divorced parent’s new partner.

22. Losing a Child

23. The affects of losing a Child  Parents who are married at the time of lost of a child. Their relationship is usually weakened.  Most couples have troubles getting along with each other, as well as their other children.  They no longer feel like the same people before the tragedy

24. Work  Employment allows only 3 days of leave for a death  Not enough time considering the attention span of a grieving parent is about a minute and a half  Most parents lose their jobs, making their crisis state even higher

25. The outcome of Receiving no Help SuicideDivorce

26. The outcome of Receiving no Help  Ninety percent of couples who don’t receive some kind of help, usually ends in divorce  Extreme depression  Suicide thoughts come into play

27. The outcome of Receiving Help  According to Nancy Ludt, she said that of the 1,500 people who attended her support group over the last 16 years, only two couples had later divorced.  When the depression and suicide thoughts are strong, a support group gives some hope and help to the grieving parents

28. Why Attend Support Groups  Gives couples the chance to say things that they usually wouldn’t say at home  Father gets to express his feelings as openly as the mother  In our society, the man is supposed to be strong.  He can’t cry but instead must be strong and go to work even after the death of a child.

29. Some Reasons why Parents prefer Support Groups  It’s a place of safety, where it is all right to say anything.  It fills that need to be with people who understand.  It’s their child’s space  It has no time frame

30. Continued  It allows the parents to laugh or cry and not hurt anyone’s feelings  They can express their thoughts with no need to explain them  It can save a parents life

31. Crisis Worker What can a crisis worker do to help?

32. Crisis Worker continued  Crisis worker can ease the pain by listening  Let the grieving parent do most of the talking  This where we use our educational and supportive comments

33. What a Crisis Worker Shouldn’t do  Structure is not good  Parents have changing needs, which can shift from one minute to another  No guest speakers  Same on an individual basis

34. Video  http://www.youtube.com/watch?v=19mLHD Q68wE http://www.youtube.com/watch?v=19mLHD Q68wE

35. Outside sources for Loss  The Compassionate Friends For loss of a child http://www.compassionatefriends.org/  Grief Share http://www.griefshare.org/