crisis counseling ii chapter 8 - deth and dying
TRANSCRIPT
Loss, Grief, Dying, and Death
Prepared and Presented ByGlen Christie, MS, EdS,
ThD, LPC, CASACFaith Bible College
Crisis Counseling II
Loss, Grief, Dying, and DeathLoss
An aspect of self no longer available to a person
DeathCessation of life
GriefPattern of physical and emotional responses to bereavement
Grief WorkAdaptation process of mourning a loss
MortalityThe condition of being subject to death
Historical Overview Not all losses are obvious or immediate
Obvious Losses Death of a loved one Divorce Breakup of a relationship Loss of a job
Not-So-Obvious Losses Illness Aging Changing schools, jobs, or neighborhoods
Historical Overview
Losses may be actual or perceived
Actual loss is easily identified A woman who has a mastectomy
Perceived loss is less obvious Loss of confidence A women who hopes to give birth to a female child
delivers a male child instead Perceived losses are easily overlooked or misunderstood,
yet the process of grief involved is the same as an actual loss
Historical Overview
Maturational Loss
Loss resulting from normal life transitions Loss of childhood dreams, the loss felt when adolescents
when a romance fails, loss felt when leaving family home for college or marriage and establishing a home of one’s own
As an individual ages, they experience menopause and loss of hair, teeth, hearing, sight, and “youth”
Historical Overview
Situational Loss A loss occurring suddenly in response to a specific external
event Sudden death of a loved one, or the unemployed person who
suffers low self-esteem
Personal Loss Any loss that requires adaptation through the grieving
process Loss occurring when something or someone can no longer be
seen, felt, heard, known, or experienced; individuals respond to loss differently
Implications for Crisis Counseling PracticeWhen helping someone deal with the loss of a loved one the social worker should:
- assess the impact of loss the deceased has on the bereaved- be informed about the available formal and informal
resources to help minimize grief and isolation from family, friends and supporters
- be aware of their own feelings about death, dying, and the grieving process, so that they may become more comfortable being physically and emotionally present with clients and their loved ones
- identify literature, cultural experiences, and other ongoing education about the ways in which your client(s) deal with death. Remember, the client may be your best teacher
DeathAbsolute cessation of vital function Not all vital functions terminate at the same time
Good Death
Free from avoidable distress and suffering for patients, families, and caregivers
Bad Death
Needless sufferingDishonoring of
patient or family wishes or values
Offending norms of decency
Dying
Losing vital functionsNatural process of birth-to-death
continuum
Stages of Loss, Death and Dying
Kubler-Ross ModelDenial
-”I feel fine.” “This cannot be happening to me.”Anger
-”Why me? It’s not fair!”Bargaining
-”I’ll do anything, can you stretch it out just a few more years.”
Depression-”I’m so sad, why bother with anything?”
Acceptance-”I can’t fight it, I may as well prepare for it.”
BehaviorsThe most commonly reported behaviors include:
-sleep disturbance-altered appetite (over/under eating)-absent mindedness-social withdrawal-dreams of the deceased-avoidance behavior-restlessness-searching or calling out for the deceased-crying, which is believed to relieve emotional stress
Shock and DenialStage 1
initial shock , disbelief, and denial “No, not
me”
After the initial shock has worn off, the next stage is usually one of classic denial, where they pretend that the news has not been given. They effectively close their eyes to any evidence and pretend that nothing has happened.
Interventions: a.) Do not interfere unless it becomes destructive b.) Do not support denial; conversations should include reality c.) Continue to teach and encourage self-care and activities
Denial
AngerStage 2
“Why me!”
This stage often occurs in an explosion of emotion, where the bottled-up feelings of the previous stages are expulsed in a huge outpouring of grief. Whoever is in the way is likely to be blamed .
Interventions:
a.) Give them space, allowing them to rail and bellow. The more the storm blows, the sooner it will blow itself out. b.) Try not to respond in “kind” c.) When anger becomes destructive, it must be address directly. Remind person of appropriate and inappropriate behavior
BargainingStage 3
“Yes me, but”
In this stage, the patient attempts to negotiate a postponement, usually with God and is generally kept a secret
Interventions:
a.) Spend time with patient b.) Discuss importance of valued objects and people
DepressionStage 4
The inevitability of the news eventually (and not before time) sinks in and the person reluctantly accepts that it is going to happen
Interventions: a.) Be available and don’t attempt to cheer patient b.) Find out about any religious support
AcceptanceStage 5
Restful time, but not necessarily happy. Often begin putting their life in order, sorting out wills and helping others to accept the inevitability.
Interventions: a)Plan care to allow person with
whom patient is comfortable to care for him/her
b)Important that you don’t withdraw.
Griefsubjective
feeling precipitated
by the death of a loved one
Stages of Grief
Shock and disbeliefYearning and protest
Anguish, disorganization, and despair
Identification in bereavementReorganization and restitution
Unresolved, Dysfunctional Grief
Bereavement is a state of great risk physically, as well as emotionally and socially.
Unresolved Grief
There have been some disturbances of the normal progress toward resolution.
Dysfunctional Grieving
There is a delayed or exaggerated response to a perceived, actual, or potential loss.
Unresolved, Dysfunctional Grief
* Dysfunctional grief occurs when an individual* Gets “stuck” in the grief process and becomes depressed * Is unable to express feelings* Cannot find anyone in daily life who acts as the listener he or she needs* Suffers a loss that stirs up other, unresolved losses* Lacks the reassurance and support to trust the grief process and fails to believe that he or she can work through the loss
Signs, Symptoms, and Behaviors of Dysfunctional Grieving
a) Acquisition of symptoms belonging to the last illness of the deceasedb) Alteration in relationships with friends and relativesc) Lasting loss of patterns of social interactiond) Actions detrimental to one’s social and economic well-beinge) Agitated depression with tension, insomnia, feelings of worthlessness, bitter self-accusation, obvious needs
for punishment, and even suicidal tendencies
Signs, Symptoms, and Behaviors of Dysfunctional Grieving (continued)
a) A feeling that the death occurred yesterday, even though the loss took place months or years agob) Unwillingness to move the possessions of the deceased after a reasonable amount to timec) Inability to discuss the deceased without crying, particularly more that 1 year after the lossd) Radical changes in lifestylee) Exclusion of friends, family members, or activities associated with the deceased
Duration of Griefthe bereaved is expected to return to work or school in a few weeks
to establish equilibrium within a few months
to be capable of pursuing new relationships within 6 months to 1 year
Mourning
process by which grief is resolved
There is “a time to weep, and a time to laugh; a time to mourn, and a time to dance” (Eccl 3:4, ESV).
“I walked a mile with Pleasure, She chattered all the way, But left me none the wiser
For all she had to say.
I walked a mile with Sorrow, And ne'er a word said she,
But, oh, the things I learned from her
When Sorrow walked with me!”
Bereavement
deprived of
someone by
death
Feelings of bereavement can also accompany other losses
the loss of your health the health of someone you care aboutthe end of an important relationship,
through divorce
Phenomenology of Grief
social withdrawal
Intense feelings of loneliness and isolation, following the death of a loved one, can sometimes become so overwhelming that the bereaved may withdraw from social contact, which may mean isolating themselves from support
restitution
Dying, and the individual's awareness of it, imbues humans with values, passions, wishes, and the impetus to make the most of time