Cognitive-Behavioural and Constructivist Strategies for Loss

Adaptation

Cognitive-Behavioural and Constructivist Strategies for Loss

Adaptation

Cognitive Behavioural Strategies

Cognitive Behavioural Strategies

• Focus on altering irrational or maladaptive thoughts, assumptions, and beliefs that impair a functional adaptation to loss.

• The goal is to help clients identify and evaluate beliefs and thoughts that keep adaptation to loss in a state of impasse.

• Examples anyone?

• Focus on altering irrational or maladaptive thoughts, assumptions, and beliefs that impair a functional adaptation to loss.

• The goal is to help clients identify and evaluate beliefs and thoughts that keep adaptation to loss in a state of impasse.

• Examples anyone?

Underlying AssumptionsUnderlying Assumptions• What is the story behind an individuals grieving or not grieving? CBS

clinicians assume that there are faulty assumptions behind why an individual is not adapting to their loss

I should have been a better wife/husband

I should have not let her/him drive

I don’t have the love I want, then I am nothing

Life is not worth living without her/him

I should be able to control my emotions

I deserve this pain because...

• If they loved me they wouldn’t have left me

• If I forget them or if I stop grieving I will forget them

It is terrible and awful that I have to experience this

• What is the story behind an individuals grieving or not grieving? CBS clinicians assume that there are faulty assumptions behind why an individual is not adapting to their loss

I should have been a better wife/husband

I should have not let her/him drive

I don’t have the love I want, then I am nothing

Life is not worth living without her/him

I should be able to control my emotions

I deserve this pain because...

• If they loved me they wouldn’t have left me

• If I forget them or if I stop grieving I will forget them

It is terrible and awful that I have to experience this

“IF I...” and Self Blame Statements

QuickTime™ and a decompressor

are needed to see this picture.

CBS, and the Philosophy Behind Emotional Distress CBS, and the Philosophy

Behind Emotional Distress •Grief is normal and even necessary, but there

is a distinction between healthy and unhealthy emotional responses

•Really?

•Normal = sadness, sorrow, and pain

•Dysfunctional = anxiety, fear, and self-deprecation

•Grief is normal and even necessary, but there is a distinction between healthy and unhealthy emotional responses

•Really?

•Normal = sadness, sorrow, and pain

•Dysfunctional = anxiety, fear, and self-deprecation

Dysfunctional beliefs...Dysfunctional beliefs...

• Distort an accurate perception of reality

• Make absolute demands

• Assert low frustration tolerance

• Catastrophize circumstances

• Thus dysfunctional beliefs are responsible for our symptoms (i.e., anxiety, fear) not our loss per se

• As a result CBS clinicians hold that people can choose different beliefs which aid in loss adaptation

• Distort an accurate perception of reality

• Make absolute demands

• Assert low frustration tolerance

• Catastrophize circumstances

• Thus dysfunctional beliefs are responsible for our symptoms (i.e., anxiety, fear) not our loss per se

• As a result CBS clinicians hold that people can choose different beliefs which aid in loss adaptation

Entrenched Beliefs: There is No GOing Back...

QuickTime™ and a decompressor

are needed to see this picture.

Using the CBT approach with loss and grief

Using the CBT approach with loss and grief

•Fully elucidate the loss and grief story (tell and retell)

• Identify “discomfort anxiety cognitions”

•Help clients establish a sense of control over overwhelming feelings/thoughts

•Detect avoidance behaviours (too little / too much)

•Fully elucidate the loss and grief story (tell and retell)

• Identify “discomfort anxiety cognitions”

•Help clients establish a sense of control over overwhelming feelings/thoughts

•Detect avoidance behaviours (too little / too much)

Managing Repetitive Thoughts and Ruminative

Coping

Managing Repetitive Thoughts and Ruminative

Coping• Grievers are sometimes burdened by a flood of

repetitive intrusive and distressful thoughts / emotions

• Bringing about a snowball effect that people feel powerless to stop

• Impeding restoration loss adaptation

• Strategies to Deal with Ruminative Coping

• Grievers are sometimes burdened by a flood of repetitive intrusive and distressful thoughts / emotions

• Bringing about a snowball effect that people feel powerless to stop

• Impeding restoration loss adaptation

• Strategies to Deal with Ruminative Coping

Refocusing - we all do this one!

Refocusing - we all do this one!

•Simply catching ourselves involved in a stream of thought

•Redirecting attention toward thinking about something else

•Goal is to crowd out repetitive and or intrusive thought and emotions

•Simply catching ourselves involved in a stream of thought

•Redirecting attention toward thinking about something else

•Goal is to crowd out repetitive and or intrusive thought and emotions

Thought Stoping With Refocusing

Thought Stoping With Refocusing

•Use startling action to interrupt stream of thoughts and then use refocusing to switch thinking in another direction

•Let’s try the method

•Use startling action to interrupt stream of thoughts and then use refocusing to switch thinking in another direction

•Let’s try the method

Constructivist Strategies Constructivist Strategies

Introducing the Kinesthetic Swish

a.Remember an upsetting feeling from your past, or

b.Think of an upsetting feeling associated with your future, or

c.Recall an upsetting experience and let that experience become a feeling you can locate in or on your body.

Step 1

Identify the Cue Feeling: an upsetting feeling on or within your body (associated). This feeling should be a sensation, not an emotion.

Preparation: Cue Feeling

What is your telephone number backwards?

Step 2: Break State

In front of you, physically sculpt your Desired State Feeling within or on an evolving, future you. A you who has already solved your felt issues. You are being different, but not perfect, but feel confident, resourceful and you have a sense of humor.

Step 3: Instruct Clients

Step 4

Now, gently press the evolving, future you with Desired State Feeling down into the ground in front of you, as though you were setting the spring in a "Jack-in-the-Box."

What is your telephone number backwards?

Step5: Break State

Step 6

Now, as you begin to sense the Cue Feeling, allow that feeling to rapidly diminish as it moves down your body and into the ground (as though it were being drained or squeezed from you, like toothpaste from a tube).

Step 7

Simultaneously, sense the evolving, future you (which has the Desired State Feeling) spring up from the ground in front of you.  And as the evolving you is coming up, place your finger-tips on his or her shoulders, feel him or her facing you, and feel the radiating sense of internal confidence, resourcefulness and humor coming from within him or her.

Step 8

Now, feel a gentle rain coming from the sky and washing over you (break state). 

The gentle rain washes away the wonderful, evolving you and your arms return to your sides.

SLowly Step 9

Now, as you begin to sense the Cue Feeling, allow that feeling to rapidly diminish as it moves down your body and into the ground (as though it were being drained or squeezed from you, like toothpaste from a tube).

Slowly Step 10

Simultaneously, sense the evolving, future you (which has the Desired State Feeling) spring up from the ground in front of you.  And as the evolving you is coming up, place your finger-tips on his or her shoulders, feel him or her facing you, and feel the radiating sense of internal confidence, resourcefulness and humor coming from within him or her.

SLowly step 11

Now, feel a gentle rain coming from the sky and washing over you (break state). 

The gentle rain washes away the wonderful, evolving you and your arms return to your sides.

Fast Step 12

Now, as you begin to sense the Cue Feeling, allow that feeling to rapidly diminish as it moves down your body and into the ground (as though it were being drained or squeezed from you, like toothpaste  from a tube).

Fast Step 13

Simultaneously, sense the evolving, future you (which has the Desired State Feeling) spring up from the ground in front of you.  And as the evolving you is coming up, place your finger-tips on his or her shoulders, feel him or her facing you, and feel the radiating sense of internal confidence, resourcefulness and humor coming from within him or her.

Fast Step 14

Now, feel a gentle rain coming from the sky and washing over you (break state).  The gentle rain washes away the wonderful, evolving you and your arms return to your sides.

Final step - 15

Test:  Try to get the upsetting feelings. 

If there are no upsetting feelings, the process is complete. 

If you can still get the upsetting feelings, ask for the positive intention of the upsetting feelings, satisfy them with reframing and, when ecologically sound, repeat the Kinesthetic Swish.

A Letting Go MeditationA Letting Go Meditation

A Letting Go Meditation (cont).

A Letting Go Meditation (cont).

A Letting Go Meditation (cont).

A Letting Go Meditation (cont).

A Letting Go Meditation (cont).

A Letting Go Meditation (cont).

Use of Metaphor to Establish Acceptance and Challenge

Ruminative Coping

Use of Metaphor to Establish Acceptance and Challenge

Ruminative Coping

Leaves on a Stream Metaphor

Leaves on a Stream Metaphor

Objects of Connection Objects of Connection

•Are special item(s) a griever has which facilitates and maintains a connection with that which they have lost.

•Provides a powerful and meaningful ongoing bond with the lost person, relationship, or situation.

•They are often carried with or placed in a specific place within the grievers environment (location is known)

•Are special item(s) a griever has which facilitates and maintains a connection with that which they have lost.

•Provides a powerful and meaningful ongoing bond with the lost person, relationship, or situation.

•They are often carried with or placed in a specific place within the grievers environment (location is known)

Objects of Connection (cont.)

Objects of Connection (cont.)

•Objects of connection can be positive or

•Maladaptive... revealing attachment clinging, avoidance of reality of loss, or disruptive meaning structures

•Counsellors need to explore the adaptation behind objects of connection

•Objects of connection can be positive or

•Maladaptive... revealing attachment clinging, avoidance of reality of loss, or disruptive meaning structures

•Counsellors need to explore the adaptation behind objects of connection

Symbolic and Linking Objects

Symbolic and Linking Objects

•Symbolic objects represent a former or current meaning connected to the lost person or situation in the grievers life.

•Examples: Airliner ticket / concert ticket, vacation photograph, written letter/poem, etc.

•Symbolism of object changes over time, may represent the grieving process itself or act as a symbol for the transition of loss flowing into present time

•Symbolic objects represent a former or current meaning connected to the lost person or situation in the grievers life.

•Examples: Airliner ticket / concert ticket, vacation photograph, written letter/poem, etc.

•Symbolism of object changes over time, may represent the grieving process itself or act as a symbol for the transition of loss flowing into present time

Linking ObjectLinking Object

•Differ from the symbolic in that they are used to invoke the presence of the diseased

• Linking objects (i.e., teddy bear) are active symbols in that they activate the real experience of the deceased in the bereaved’s life

• Inner representation creates both solace and is way to continue a bond with the deceased

•But also permits investment in new relationships and in rebuilding one’s life or redefining one’s identity

•Differ from the symbolic in that they are used to invoke the presence of the diseased

• Linking objects (i.e., teddy bear) are active symbols in that they activate the real experience of the deceased in the bereaved’s life

• Inner representation creates both solace and is way to continue a bond with the deceased

•But also permits investment in new relationships and in rebuilding one’s life or redefining one’s identity

Implementation of Object ConnectionsImplementation of Object Connections

Step 1: ask about objects, increase therapeutic alliance, assessment tool

Step 2: validate, get client to bring object to session, normalizes experience, facilitates meaning

Step 3: explore meaning and function, understand it’s significance (is it a linking object, how is used - restoration coping), connect loss to the hear and now, how does it provide a continuing bond, does it interfere with new relationships, does it reveal cultural influences, etc.

Step 4: Address resolution problem areas and facilitate transitions, (challenge where might continuing bonds be unhealthy, how has the object changed in meaning, what does it say about who are where they are today

Step 1: ask about objects, increase therapeutic alliance, assessment tool

Step 2: validate, get client to bring object to session, normalizes experience, facilitates meaning

Step 3: explore meaning and function, understand it’s significance (is it a linking object, how is used - restoration coping), connect loss to the hear and now, how does it provide a continuing bond, does it interfere with new relationships, does it reveal cultural influences, etc.

Step 4: Address resolution problem areas and facilitate transitions, (challenge where might continuing bonds be unhealthy, how has the object changed in meaning, what does it say about who are where they are today

Using Photographs to Facilitate Meaning

Reconstruction

Using Photographs to Facilitate Meaning

Reconstruction•Photographs provide a factual record and

symbolic reference point around concerns and issues about the bereaved’s grieving and adaptation process

•Photographs help clients to tell their story, used to evoke emotions, reconstruct past, reminisce with laughter and honour their loss, encourage meaning reconstruction, expose maladaptive thinking/avoidance, family structure, etc.

•Photographs provide a factual record and symbolic reference point around concerns and issues about the bereaved’s grieving and adaptation process

•Photographs help clients to tell their story, used to evoke emotions, reconstruct past, reminisce with laughter and honour their loss, encourage meaning reconstruction, expose maladaptive thinking/avoidance, family structure, etc.

Facilitating Growth via Photograph

Facilitating Growth via Photograph

•Our job as a counsellor in using photographs is to assist clients in encountering images anew by examining them critically

•We raise questions that explore assumptions and beliefs, encourage reflection, and honor client experience

•Some questions we might ask:

•Our job as a counsellor in using photographs is to assist clients in encountering images anew by examining them critically

•We raise questions that explore assumptions and beliefs, encourage reflection, and honor client experience

•Some questions we might ask:

•What is happening in this picture?

•What does this picture say about the people in it and the person taking the picture?

•What feelings are coming up right now as you look at the photo?

•What do you see now, as you look over these photographs form the perspective of wisdom and experience in light of adapting to your loss?

•What is happening in this picture?

•What does this picture say about the people in it and the person taking the picture?

•What feelings are coming up right now as you look at the photo?

•What do you see now, as you look over these photographs form the perspective of wisdom and experience in light of adapting to your loss?