webinar session 6: hints for providing quality bereavement

Webinar session 6:

Hints for providing quality bereavement care

Guest SpeakerMs Jeanne ChaseClinical Supervisor and bereavement counsellorPrivate Practice

11th June 2019

Lets Begin…

www.palliativecareqld.org.au/celc

• Acknowledgement of country• Palliative Care Queensland priorities • Introductions• The best care happens when personal values and meanings are better

understood• This session is interactive – an opportunity to discuss aspects of working

with people who are experiencing grief and loss/bereavement


What will we discuss


GRIEF AND LOSS IS PART OF THE CURRICULUM OF LIFE

• Loss is at the heart of our lives• It is a response to life• It is inevitable and unavoidable• It is a process• It is normal, natural and inevitable

‘Grief work is an ongoing process…. Life changing and a life long experience.Grief changes us forever – at various times we visit our losses – its normal.’Ben Wolfe

‘Grief is not a disorder, a disease or a sign of weakness. It is an emotional,physical, and spiritual necessity, the price you pay for love.The only cure for grief is to grieve’ Earl Grollman


SociallyPhysically

Spiritually

EmotionallyCognitive

Mentally

Financially

Grief

Culturally

Socially

Grief impacts on our whole Person


The D Word

We long for permanence in a universe of constant change

• The dominant culture is avoidance of Death and Dying• Dying is not what happens to you. Dying is what you do• Do we need to wonder about death and dying?• Is our society better at being angry than being sad?


Bereavement

Bereavement is severe life event that most of us can expect to experience.

People who are bereaved can express their grief in a number of ways.

Lost-overwhelmedDrowningUtterly alone and unsure of what to do So much painParalysedThought I was preparedSO ANGRYRobbedOn auto pilotPhysical Agony


Grief Styles

Grief styles are different. We all experience things differently and express things differently.

• Grief is an individual process• There is no right or wrong way to grieve. • Some people are open and expressive with their grief,

crying, and wanting to talk, whilst others are more private and may be reluctant to talk and prefer to keep busy.

• Gender differences –socially constructed?• Children’s grief - (curious, eager, quick and attentive)• Often there is surprise and shock at the response of others


• Importance of cultural awareness and cultural sensitivity • Take the time to research beliefs and practices• Practices at the time of death • Practices and ritual after time of death• Ask what is appropriate, ask about traditions and rituals relevant

to clients culture

Cultural Difference


Complicated Grief

Grief is not a mental disorder. There are however factors which we knowCan make the process of grief extremely difficult and when it becomes problematicAnd interferes with the daily life specialist intervention is required.10 -20% of people experience complicated grief.

DSM V while not including it as a diagnosis has termed this condition Persistant Complex Bereavement Disorder and the ICD 11 Prolonged Grief Disorder.Factors that may warrant further assessment. • Attachment • Mental Health history• Multiple losses• Environmental factors (social isolation)• Age and gender• Coping and resilience


A Word on Depression

GRIEF:• Responds to comfort and support• Talking about feelings usually helps• Depressed and sad feelings are directly related

to the loss• Still enjoys moments of enjoyment• Exhibits feelings of sadness and emptiness• May have transient physical complaints• Can experience guilt over some aspect of the

loss• Temporary impact on self-esteem

DEPRESSION:• Does not respond to comfort• Talking about feelings can result in deeper

despair• Irritable and complains – unlikely to express

overt anger• Depressed and sad feelings not related to a

particular life event• Exhibits an all pervading sense of doom• Projects a sense of hopelessness and chronic

emptiness• Chronic physical complaints• Generalised feelings of guilt• Loss of self-esteem is of great duration


Some Theorists

Elizabeth Kubler Ross - Stages of griefStephen Jenkinson –Die WiseNeimeyer – Meaning and Reconstruction

Continuing bonds Klass, Silverman & Nickman – Continuing BondsWorden - Four Tasks of Mourning(1991)Bowlby Attachment Theory

“Learn your theories well but put them aside when

You touch the miracle of a living person”

Allan Wolfeit states that grief is a dimension of life that cannot be approachedby rational thought, so he invites us to open our heart to whatever experiencefollows.


Good practice

• To acknowledge that grief is not an illness. We don't 'get over' profound grief -we are changed by the experience and our response to the experience

• It is not linear• Grief follows no particular pattern or formula• A Phenomena of waves-comes when we least expect it• Can be an opportunity for growth and change• To know that we can reconstruct our world – with our memories in tact• That our grief can become part of us• Grief can be felt over an extended period of time• Grief is not a problem to be solved• Aspects of our grief can appear at different stages of life and development


Sitting with Grief can feel Overwhelming


Awareness of Empathetic Distress

Empathy is always perched precariously between gift and

invasion. - Leslie Jamieson

Empathy our ability include another’s experience into our own, it is a fundamental human capacity. It has been described as being at the heart of bereavement work.Yet balance is delicate on the edge, and empathy can easily tip toward distress. If we fuse too strongly with another’s physical emotional or mental states, or over identify with our patients/clients we can easily fall over the edge into the murky swamp of empathic distress. We are all together navigating the boundless space of life, not attached yet intimate -(Joan Halifax Standing at the Edge)


The Three Tenets

The practice of not knowing – and still sit alongside the bereaved, with respect and genuineness

Bearing witness – Sometimes the suffering was so obvious and palpable, my ability to relieve it was NIL

Compassionate Action - being able to ground ourselves, coming back to our own body. This helps to be able to discern which action might best serve the situation.Sometimes doing nothing can be the most compassionate response. Stopping and getting grounded can give ourselves time to let go of ourselves


STRATEGIES and APPROACHES

• Slow Down and gather our attention , getting grounded - mindfulness /body awareness – learn to be present with ourselves

• Be honest and caring• Become familiar with death, dying and loss and bereavement• Recall our intention• Attune to self and the other person – a clear distinction about what is

going on with the other person and what is going on inside of me.• Consider what will serve – assume nothing, respect what we can never know• Engage and then end the interaction


Being with Grief

• Being acquainted with your own experience of grief and sadness• Being present to yourself and your client• Explore the narrative• Be aware of your own need for therapeutic reward• Invite possibility• The more work you have done with your own stuff the better• Be Authentic – we will never be an expert on another persons grief• Grief is Normal• Grief is universal• Grief is unpredictable• Become familiar with grief, loss, death and dying• Wonder about life and death• Have no expectations –Grieving is hard work• Be open to learn


THE INVITATION

….It doesn't’t matter what planets are squaring your moon. I want to know if you have touched the centre of your own sorrow,

if you have been opened by life’s betrayals or have become

shriveled and closed from fear of further pain I want to know

if you can sit with pain, mine or your own, without moving to

hide it or fade it or fix it.

It doesn’t interest me who you know or how you came to be here.

I want to know if you will stand in the centre of the fire with

me and not shrink back.

It doesn't’t interest me where or what or with whom you

studied. I want to know what sustains you, from the inside,

when all else fades away. I want to know if you can be alone

with yourself and if you truly like the company you keep in the

empty moments.

(Oriah Mountain Dreamer, 1999)


USEFUL RESOURCES

Stephen Jenkinson The Meaning of Death https://www.youtube.com/Tim WilsonGrief Walker https;//www.nfb.ca/film/griefwalkerStephen Jenkinson Die Wise(A Manifesto of Sanity and Soul)Irvin D. Yaloum The Gift of Therapy (Reflections on being a therapist)Dr. Ranjana Srivastava Dying for a chat(the communication breakdown between doctors and patients)Joan Halifax Being with the Dying.Joan Halifax Standing at the EdgeKlass, Silverman, and Nickman Continuing Bonds (New understandings of grief) Dr Ranjana Srivastava Tell me the truth.Stephen Levine Meetings at the Edge.

https://www.youtube.com/

webinar session 6: hints for providing quality bereavement

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