good grief: how to understand and support the bereaved...good grief: how to understand and support...

Good Grief: How to understand and support the bereaved

Marney Thompson, M.A., R.C.C.Bereavement Coordinator

Victoria Hospice

Victoria Hospice Bereavement Services

ObjectivesParticipants will:

1. Understand that grief does not

proceed in stages

2. Learn a pluralistic framework

for understanding grief

3. Be reminded of the highly undervalued skill of

deep listening and presence

What is grief?

• A natural response that helps us adjust to life after loss

• Characterized by: -Preoccupation -Yearning-Intense emotions-Isolation

How does grief impact us?xThoughtsxFeelingsxBodies

xBehaviorsxRelationshipsxPurpose/meaning & values

How does grief impact our thoughts and feelings?

Expected:• Preoccupied; mind is busy

processing loss

• Sad, lonely, depressed, fearful

Less expected, perhaps:• Counterfactual thinking;

“what if” and “if only”

• Angry, guilty, relieved, blaming

How does grief impact us physically?

Expected:• Nausea, loss of appetite• Difficulty with sleep• Fatigue• Breathlessness• Dizziness• Pain

Less expected, perhaps:• Weakened immune function• Broken heart syndrome

(Takotsubo cardiomyopathy)

• Acute episodic amnesia (transient global amnesia)

How does grief affect our behaviors?Expected:• Change in routines and

habits, such as¾ Eating, dressing, hygiene¾ Activities¾ Interests¾ Coping strategies

Less expected, perhaps:• Avoidance of reminders,

such as¾ Thoughts¾ Feelings¾ Places¾ People

• Proximity seeking, such as¾ Time spent with reminders

(photos, letters, grave)

How does grief impact our relationships?

Expected:• Brings us closer, through

¾ Funeral/memorials¾ Sharing expertise (with

financial or legal work)¾ Supportive visiting¾ Provision of meals & help

with daily life (chores and childcare)

Less expected, perhaps:• Creates distance, through¾ Unwanted advice giving¾ Insensitive comments¾ Differing needs re. physical

space, talk, emotion¾ Difficulty with strong emotion

How does grief affect our sense of purpose and values?

Expected:• Make the moments count• Don’t sweat the small stuff• Tell people you love them

(unfinished business)

Less expected, perhaps:• Life has no longer has

meaning/purpose

How does grief work?

The painful thoughts and feelings associated with loss, actually help us to adjust.

1. The intensity of the distress and disruption that we feel motivates us to want to ‘feel better’

2. The yearning and preoccupation we experience compels us to find ways to ‘feel connected’

An Instinctive Healing Process

The reality & consequences of the loss are fully understood. This includes:1. Finality of the death

2. Continued bond

3. Redefined purpose & meaning

ACUTE GRIEF

INTEGRATED GRIEF:

What is Complicated Grief?

A persistent and pervasive grief response, characterized by:• longing for the deceased, • preoccupation with the deceased

and/or the death,

• accompanied by intense emotional pain

How to know who’s having trouble with grief?

• Credulous questioning-“How are you doing with your grieving”

• Investigate integration-“Tell me about the person you lost? Tell me about the death?”

• Symptom snapshot-“What would I have seen or heard if I met you 3 months ago?”

How can we help?Consider these four models for understanding grief:

• Dual Process Model -Stroebe and Schut• Continuing Bonds -Klass, Silverman &

Nickman• 4 Tasks -Worden• Grieving Styles -Martin and Doka

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Oscillation

LOSS ORIENTATIONLOSS

ORIENTATION

Adjusting to the

reality and

consequences of

the loss

RESTORATION

ORIENTATION

Rebuilding a life of

meaning and

purpose

EVERYDAY LIFE EXPERIENCES

The Dual Process Model

Continuing Bonds• The attachment bond is not

relinquished but instead is recreated.

• The bond is a source of ongoing connection, comfort and solace.

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4 Tasks

1. To accept the reality of the loss

2. To learn to live with the pain of grief

3. To adjust to life without the deceased

4. To form an enduring connection

Intuitive Grieving Style

• Experienced as waves of emotion

• Expression mirrors inner feelings

• Focus on exploring and expressing emotions

Instrumental Grieving Style

• Experienced in more cognitive or physical ways

• Expressed in thoughts, actions & behavior

• Focus on doing

Tips for Welcoming Griefy Start conversations -about the deceased & the

death

yListen wholly -with patience, attention & presence

yBe open -suspend the tendency to prescribe or fix

y Identify resources -the person’s own and others

Grief Resources

• MyGrief.ca http://www.mygrief.ca/

• KidsGrief.ca http://kidsgrief.ca/

• BC Bereavement Helpline http://bcbereavementhelpline.com/

• The Centre for Complicated Grief https://complicatedgrief.columbia.edu/

“Beyond right and wrong is a field. I’ll meet you there.”-Rumi

Questions?