Helping Families Helping Families throughthrough
The Emotional JourneyThe Emotional Journey
Alzheimer Society of Manitoba ConferenceAlzheimer Society of Manitoba Conference
March 6, 2007March 6, 2007
Peter S. Silin, MSW, RSWPeter S. Silin, MSW, RSWDiamond Geriatrics, Inc.Diamond Geriatrics, Inc.©www.DiamondGeriatrics.comwww.DiamondGeriatrics.com
The Meaning of The Meaning of AdjustmentAdjustment
More easily said than doneMore easily said than done Patronizing and discountingPatronizing and discounting Internal process vs. external appearanceInternal process vs. external appearance
Levels/Stages of Levels/Stages of Adjustment Adjustment
I. CrisisI. Crisis II. Adjustment is habitualizationII. Adjustment is habitualization III. Acceptance III. Acceptance
AcknowledgingAcknowledging Lingering sadnessLingering sadness Lack of meaning purpose or passionLack of meaning purpose or passion
IV. Embracing is choiceIV. Embracing is choice
Adjustment as Practical Adjustment as Practical ProcessProcess
Four L’sFour L’s Landing—orientation. CrisisLanding—orientation. Crisis Labeling—getting bearings Labeling—getting bearings Learning—learning patterns and cultureLearning—learning patterns and culture Living—confidence in how things workLiving—confidence in how things work
Families learning to be “ The Family Member”Families learning to be “ The Family Member”
Crisis Theory Crisis Theory
A period of disequilibrium and decreased functioning A period of disequilibrium and decreased functioning brought on by event or situation which cannot be dealt with brought on by event or situation which cannot be dealt with by normal coping methods. by normal coping methods. (Roberts, A. Crisis Intervention (Roberts, A. Crisis Intervention Handbook 2000) Handbook 2000)
Fear, anxiety, anger, confusion, inadequacy, guilt, and Fear, anxiety, anger, confusion, inadequacy, guilt, and griefgrief are common. From the sheer intensity of the emotions, are common. From the sheer intensity of the emotions, the person becomes unable to deal rationally with the the person becomes unable to deal rationally with the situation. Usual thought processes are disrupted by feelings, situation. Usual thought processes are disrupted by feelings, and "thinking about the problem" is not only difficult, but also and "thinking about the problem" is not only difficult, but also frustrating and unproductive.frustrating and unproductive. (211bigbend.org)(211bigbend.org)
Helplessness, confusion, anxiety, shock and angerHelplessness, confusion, anxiety, shock and anger ((Golan, N. Treatment in Crisis Situations 1978Golan, N. Treatment in Crisis Situations 1978))
Difficult to process information, difficult to make decisionsDifficult to process information, difficult to make decisions
The Emotional Range of The Emotional Range of AdjustmentAdjustment
GriefGrief GuiltGuilt ShameShame Fear Fear AnxietyAnxiety LonelyLonely HelplessHelpless AngerAnger
Admission and Admission and Adjustment as CrisisAdjustment as Crisis
ShockShock Emotional systems take overEmotional systems take over Decreased information processing abilityDecreased information processing ability Decreased problem solving abilityDecreased problem solving ability
Tells us about timing and type of helpTells us about timing and type of help Be aware of/help with range of emotionsBe aware of/help with range of emotions
About Guilt and ShameAbout Guilt and Shame
Guilt is about what we have doneGuilt is about what we have done Normal part of being humanNormal part of being human Lack of guidelines on behaviourLack of guidelines on behaviour Conflicting need, desires, influenceConflicting need, desires, influence
About Guilt and ShameAbout Guilt and Shame
Shame is about who we areShame is about who we are Attachment theory (Attachment theory (Bowlby,John 1988Bowlby,John 1988)) Core issues of SelfCore issues of Self Differentiation and BoundariesDifferentiation and Boundaries
Guilt activates shameGuilt activates shame Shame is more difficult to deal withShame is more difficult to deal with
Grief and LossGrief and Loss
Loss is eventLoss is event Grief is emotional experience or Grief is emotional experience or
processprocess Unique Types of grief and lossUnique Types of grief and loss
Recurrent/Ongoing Recurrent/Ongoing AmbiguousAmbiguous Anticipatory Anticipatory
Kubler RossKubler Ross““On Death and Dying,” 1969On Death and Dying,” 1969
BowlbyBowlby““Loss, Sadness, and Depression,” 1980Loss, Sadness, and Depression,” 1980
DenialDenial
AngerAnger
BargainingBargaining
DepressionDepression
AcceptanceAcceptance
NumbnessNumbness
DisequilibriumDisequilibrium
----
DisorganizationDisorganization
ReorganizationReorganization
GriefGrief
Bowlby: Grief Bowlby: Grief
Bowlby: Four Stages: Bowlby: Four Stages: Numbness, Numbness, Disequilibrium: yearning, searching, hanging onDisequilibrium: yearning, searching, hanging on Disorganization/Despair: recognize loss, hopeless, Disorganization/Despair: recognize loss, hopeless,
withdrawalwithdrawal Reorganization: grief recedes, new patterns Reorganization: grief recedes, new patterns
establishedestablished
Emotions and ProcessEmotions and Process
Grief and Loss can play out as:Grief and Loss can play out as: GuiltGuilt BurnoutBurnout ResentmentResentment AngerAnger
Guilt and AngerGuilt and Anger Active doing of grievingActive doing of grieving Can inhibit grievingCan inhibit grieving Kicks to shameKicks to shame
Dealing with Transitions: Dealing with Transitions: UsUs
Self awarenessSelf awareness Our own issuesOur own issues Dealing with lossDealing with loss ProjectionProjection
When we can’t helpWhen we can’t help
Dealing with TransitionsDealing with Transitions
Do they want help: PermissionDo they want help: Permission How do they want itHow do they want it The meaning of helpThe meaning of help Are they ready for helpAre they ready for help Help must fit the receiverHelp must fit the receiver
Dealing with Transitions: Dealing with Transitions: ResistanceResistance
Reinforcing resistanceReinforcing resistance Secondary gainSecondary gain Loss resulting from releaseLoss resulting from release Protection from primary emotionsProtection from primary emotions Role loss Role loss ResentmentResentment
Dealing with TransitionsDealing with TransitionsStage 1: EmotionalStage 1: Emotional
Supportive counsellingSupportive counselling ListenListen IdentifyIdentify EmpathyEmpathy relationshiprelationship
Follow-upFollow-up
Dealing with Transitions: Dealing with Transitions: Stage 1: Cognitive Stage 1: Cognitive
ResponsesResponses Information Information
How someone isHow someone is What happenedWhat happened
Education—simple to more complexEducation—simple to more complex About care, About care, SystemsSystems About decline, dementiaAbout decline, dementia Grief and other emotionsGrief and other emotions
Dealing with Transitions:Dealing with Transitions:Fear and AnxietyFear and Anxiety
Identify Identify UnderstandUnderstand Educate and explainEducate and explain ReframeReframe NormalizeNormalize
Dealing with Transitions:Dealing with Transitions:Stage 2: Cognitive and Stage 2: Cognitive and
SupportiveSupportive Therapeutic: Guilt and Grief Therapeutic: Guilt and Grief
What is underneath the feelingWhat is underneath the feeling What does it remind you of/ bring upWhat does it remind you of/ bring up Skill basedSkill based
Solution focused: Guilt and griefSolution focused: Guilt and grief Miracle QuestionMiracle Question Doing guiltDoing guilt What would you rather be doingWhat would you rather be doing
Dealing with TransitionsDealing with Transitions
Cognitive Behavioural Approaches: Guilt and GriefCognitive Behavioural Approaches: Guilt and Grief Diaries/JournalsDiaries/Journals Two chairs/VoicesTwo chairs/Voices Alternatives to the endAlternatives to the end Writing lettersWriting letters RitualsRituals Visualizing: scalesVisualizing: scales What would you have done differently and where would What would you have done differently and where would
that take you?that take you? Tell me why you should feel guiltyTell me why you should feel guilty
Transitions: Changing Transitions: Changing ThoughtsThoughts
FeelingFeeling ThoughtThought What is untrue What is untrue about thought/about thought/
Why is it untrueWhy is it untrue
New thoughtNew thought Supporting Supporting EvidenceEvidence
GuiltyGuilty I should I should be able to be able to handle this handle this
I have done it a I have done it a long timelong time
I am sickI am sick
I have many I have many responsibilitiesresponsibilities
I am doing it by I am doing it by myself myself
It is OK to It is OK to set limits set limits and say noand say no
My journalMy journal
I have done I have done a lot alreadya lot already
I still love I still love my father my father
I won’t fall I won’t fall over if I do. over if I do.
David Burns : The Feeling Good Handbook, 1999David Burns : The Feeling Good Handbook, 1999
Christine Padesky, Dennis Greenberger: Mind Over Mood: Change Christine Padesky, Dennis Greenberger: Mind Over Mood: Change
How You Feel by Changing the Way You ThinkHow You Feel by Changing the Way You Think , ,19951995
Dealing with TransitionsDealing with TransitionsGuilt and GriefGuilt and Grief BibliographicBibliographic Internet—info and chat rooms Internet—info and chat rooms Systemic approachesSystemic approaches: :
Buddies and peer systemsBuddies and peer systems Support GroupsSupport Groups
ExternalExternal Self help GroupsSelf help Groups TherapistsTherapists GodGod
Stage 3: Forgiveness*Stage 3: Forgiveness*
ForgivenessForgiveness Cheap forgivenessCheap forgiveness AcceptanceAcceptance Genuine forgivenessGenuine forgiveness
Forgiveness of selfForgiveness of self Forgiveness of otherForgiveness of other
• Janice Abrahms Spring, PhD. “ How Can I Forgive You? Janice Abrahms Spring, PhD. “ How Can I Forgive You? The Courage to The Courage to Forgive, the Freedom Not ToForgive, the Freedom Not To” Harper, 2005” Harper, 2005
Top Related