Post on 12-Mar-2022
Webinar session 6:
Hints for providing quality bereavement care
Guest SpeakerMs Jeanne ChaseClinical Supervisor and bereavement counsellorPrivate Practice
11th June 2019
• 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
www.palliativecareqld.org.au/celc
What will we discuss
www.palliativecareqld.org.au/celc
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
www.palliativecareqld.org.au/celc
SociallyPhysically
Spiritually
EmotionallyCognitive
Mentally
Financially
Grief
Culturally
Socially
Grief impacts on our whole Person
www.palliativecareqld.org.au/celc
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?
www.palliativecareqld.org.au/celc
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
www.palliativecareqld.org.au/celc
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
www.palliativecareqld.org.au/celc
• 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
www.palliativecareqld.org.au/celc
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
www.palliativecareqld.org.au/celc
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
www.palliativecareqld.org.au/celc
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.
www.palliativecareqld.org.au/celc
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
www.palliativecareqld.org.au/celc
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)
www.palliativecareqld.org.au/celc
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
www.palliativecareqld.org.au/celc
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
www.palliativecareqld.org.au/celc
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
www.palliativecareqld.org.au/celc
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)
www.palliativecareqld.org.au/celc
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.