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mubeen anwar
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You are on page 1/ 56

11/8/24

Introduction to Grief &


Bereavement Counselling
Toolkit

EDF5062
Grief and Trauma Counselling

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Do not remove this notice.

1
11/8/24

The work may cause us to confront our


own mortality and that of our loved ones,
reawaken previous losses and cause us
to anticipate future losses.

Agenda
• Introduction to Grief Theories and Models

• Mediators and Tasks of Mourning

• The Dual Process Model of Coping with Bereavement

• The Assumptive World

• Meaning Reconstruction

• Bereavement Counselling Toolkit

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Common elements of the new approach to


grief and bereavement

1. Scepticism about the universal and


predictable “emotional pathway”
that leads from distress to
“recovery”. Grief is a more complex
process of adapting to loss.

Common elements of the new approach to


grief and bereavement

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Common elements of the new approach to


grief and bereavement

2. A shift away from the idea that successful grieving requires “letting
go” of the one who has died, and toward a recognition of the
potentially healthy role of maintaining continued symbolic bonds
with the deceased

3. Attention to broadly cognitive processes involved in mourning,


adding to the traditional focus on the emotional consequences of
loss

Common elements of the new approach to


grief and bereavement

4. Greater awareness of the implications of major loss for the


bereaved individual’s sense of identity. Grief often produces a
deep revision in the bereaved persons sense of self.

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Identity Reconstruction
Neimeyer, R. A. (2001). Reauthoring life narratives: Grief therapy as meaning
reconstruction. Israel Journal of Psychiatry & Related Sciences.

Common elements of the new approach to


grief and bereavement

4. Greater awareness of the implications of major loss for the


bereaved individual’s sense of identity. Grief often produces a
deep revision in the bereaved persons sense of self.

5. Increased appreciation of the possibility of life-enhancing


“post-traumatic growth” as one integrates the lessons of loss

10

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Common elements of the new approach to


grief and bereavement

6. Broadening the focus of attention to include not only the


experience of individual grievers, but also the impact of loss on
families and broader cultural groups.

11

Grief is…
…our response to loss

a multi-faceted experience:
• Feelings
• Physical
• Cognitions
• Behaviour
• Interpersonal
• Spiritual or philosophical

12

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Losses are the shadow of


all possessions — material
and immaterial.

Carlos Sluzki, family therapist

13

Health Consequences of Bereavement


• Higher risk of developing health conditions such as cardiovascular
problems, immune dysfunction, increased inflammation, and higher
mortality rates.
• Impaired immune function: leaving individuals more susceptible to
infections and other health complications.
• Sleep disturbances: Grief can significantly affect sleep patterns, leading
to difficulties falling asleep, frequent awakenings, or insomnia. Sleep
disturbances, in turn, can contribute to a variety of health issues,
including impaired cognitive function, weakened immune system, and
increased risk of chronic diseases.

14

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Sleep Disturbance in Prolonged Grief

• May be related to night-time rumination about the loss and dreaming


of the deceased (Hardison et al., 2005)
• CG associated with shorter sleep duration and poorer sleep quality
(Milic et al., 2019)

15

Sigmund Freud

Publication of
Trauer und Melancholie
Mourning and melancholia (1917)

Both normal mourning and pathological


melancholia arise in “reaction to the
loss of a loved person, or to the loss of some
abstraction which has taken the place of
one, such as one’s country, liberty, and
ideal, and so on” (p. 251-2)

16

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Sigmund Freud

Three main tasks:

1. Freeing the bereaved from bondage to the


deceased;

2. Readjustment to new life circumstances


without the lost person;

3. Building new relationships.

17

Sigmund Freud

“In the instance of the loss of a very


significant object, the total
mourning process, may never be
completed.

The Ego and the Id (1923)

18

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Attachment Theory
• We are naturally motivated to develop and maintain attachments to others
for whom we provide and from whom we receive care.

• Attachments behavioural system lasts “from cradle to the grave”.


John Bowlby

• Caregiving behavioural system as important to adults as attachment is to


children.

• An infants’ attachment to a caregiver differs in the degree of security in the


attachment.

• Differences in security of attachment influence personality and social


relationships in infancy and beyond.
Mary Ainsworth

19

Attachment Theory
Attachments vary in:
• Strength
• Security

Two primary functions:


• Safe haven in times of stress
• Secure base from which to
explore the world

Give rise to “working models” of


close relationships stored in
memory

20

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The Impact of Early Attachment

Patterns of early attachment profoundly influence:

• How people view themselves and the world at large

• How people form connections with others

• How people deal with the loss of connections

21

Patterns of Attachment

Mary Ainsworth (1971) Four patterns of infant attachment. The strange situation
test. Separation/reunion with mother at 12-18 months
• Secure attachment – confident of available parent
• Anxious resistant – uncertain if parent will be helpful or responsive –
separation anxiety
• Anxious avoidant attachment – expects to be rebuffed – tries to be
emotionally self sufficient
• Disoriented/Disorganised attachment – link to physical/emotional abuse –
erratic unpredictable parenting
Early patterns of attachment as predictors of later development

22

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Elisabeth Kübler-Ross (1969)

Interviewed dying patients in


hospital.

Exposed neglect and isolation.


Author of On Death and Dying.

Adapted from Bowlby via Parkes,


Kübler-Ross conceptualised
“The Five stages of receiving catastrophic news” (anticipatory
grief).

Mutated into “The five Stages of Grief”.

23

William Worden (2018)

Author of Grief Counseling


and Grief Therapy: A
Handbook for the Mental Health
Practitioner (2018) - 5th Ed.

24

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Mediators of Mourning

1. Who the person who died was


2. Nature of the attachment (Relationship Factors)
Strength of Attachment
Security of Attachment
Ambivalent Relationship
Conflicts with the deceased
Dependent relationships

25

Mediators of Mourning

3. How the person died


Proximity
Suddenness or unexpectedness
Violent/traumatic deaths
Multiple losses
Preventable deaths
Ambiguous deaths
Stigmatised deaths

26

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Mediators of Mourning

4. Historical Antecedents
What Has Gone On Before
How Was It Dealt With
5. Personality Variables
Age and Gender
Coping Style
Attachment Style
Cognitive Style

27

Mediators of Mourning

5. Personality Variables (cont.)


Self-Esteem and Self-Efficacy
Assumptive World: Beliefs and Values

6. Social Mediators
Support Satisfaction
Social Role Involvements
Religious Resources and Ethnic Expectations

28

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Mediators of Mourning
7. Concurrent Stresses
(Accumulative Stressors)
Financial Difficulties
Life Change Events, Job Loss etc.

29

Tasks of Mourning

1. To accept the reality of the loss

30

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Dead
Why is it such a difficult word to use?
Ashes to ashes, dust to dust Deceased In Hell (or Heaven) Shuffled off the mortal coil
Asleep Defunct In repose Six feet under
At room temperature Demised In the grave Sleeping with the fishes
Be taken Departed Inanimate Snuffed
Become living-challenged Destroyed, as in “to destroy dogs” Joined the choir invisible Snuffed out
Belly up Dirt Kicked off Sprouted wings
Bereft of life Dirt nap Kicked the bucket Stiff
Bloodless Done for Late Stone dead
Bought the farm Eat it Lifeless Succumbed
Bump off Erased Liquidated T.U./Toes up/tits up/tango uniform
Buried Ex- Lost Terminated
Buy a pine condo Executed Mortified That good night
Buy it Expired No longer with us Whacked
Cadaverous Extinct No more Wandering the Elysian Fields
Carked (it) Finished Off the twig Wasted
Cash in (or out) Fragged Offed With the ancestors
Ceased to be Gathered to his people On the wrong side of the grass Worm food
Check out Get your wings Paid Charon's fare
Checked out Give up the ghost Passed...(over, on, away, etc)
Cold “going to the big ___(whatever) in Perished
Conk the sky” Popped off
Croak Go into the fertiliser business Pushing up the daisies
Crossed over Gone Put down
Crossed the bar Gone into the west Resting in peace
Crossed the River Styx Gone to meet their maker Return to the ground
Cut off Got a one-way ticket Rubbed out
Dance the last dance In a better place Run down the curtain

31

The Language of Euphemism

therapeutic misadventure,
diagnostic misadventure of the
highest magnitude,
substantive negative outcome
the patient failed to fulfil his
wellness potential.

32

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33

Tasks of Mourning

1. To accept the reality of the loss


2. To process the pain of grief

34

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11/8/24

“First You Survive,


Then You Grieve”

The body is saying:


“You have survived, now grieve”

The rest of society is saying:


“You have grieved, now survive”

35

Tasks of Mourning

1. To accept the reality of the loss


2. To process the pain of grief
3. To adjust to a world without the deceased

36

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11/8/24

Tasks of Mourning

1. To accept the reality of the loss


2. To process the pain of grief
3. To adjust to a world without the deceased
4. To find a way to remember the deceased while embarking on
the rest of one’s journey through life
(Worden, 2018, pp. 41-53)

37

Klass, Silverman & Nickman (1996)

Identify a key process of grieving as the need to establish and maintain


continuing bonds with the deceased or absent person.

Klass, Silverman & Nickman (1996) Klass & Steffen (2017)

38

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Disenfranchised Grief

Grief that persons experience when they incur a loss that is


not or cannot be openly acknowledged, publicly mourned,
or socially supported.

The concept of disenfranchised grief recognises that


societies have sets of norms—in effect, “grieving rules”—
that attempt to specify who, when, where, how, how long,
and for whom people should grieve.

(Doka, 1989, p. 4)

39

Systemic Contexts of Grieving

Social System
Cultural, religious & linguistic discourses that shape private
and public mourning

Family System
Myths, rules & hierarchies that
constrain and enable grief

Self System
Coping styles, resources, narratives
of bereaved individual

40

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The Dual Process Model

43

Everyday life
experience
Loss- Restoration-
Oscillation:
oriented Normal grief oriented

Attending to life changes


Grief work
Doing new things
Intrusion of grief
Distraction from grief
Relinquishing-continuing-
Denial/avoidance of grief
relocating bonds/ties
New roles/identities/
Denial/avoidance of
relationships
restoration changes

Absent or
Chronic grief inhibited grief

Figure 1
Dual Process Model of Coping with Bereavement: Normal & Complicated Grief

44

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Everyday life
experience
Loss- Restoration-
oriented oriented

Attending to life changes


Grief work
Doing new things
Intrusion of grief
Distraction from grief
Relinquishing-continuing-
Denial/avoidance of grief
relocating bonds/ties
New roles/identities/
Denial/avoidance of
relationships
restoration changes

In the early period of bereavement

45

Everyday life
experience
Loss- Restoration-
oriented oriented

Attending to life changes


Grief work
Doing new things
Intrusion of grief
Distraction from grief
Relinquishing-continuing-
Denial/avoidance of grief
relocating bonds/ties
New roles/identities/
Denial/avoidance of
relationships
restoration changes

In the latter period of bereavement

46

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The Assumptive World

• Initially proposed by Parkes as part


of the attachment system. Forms the
foundation for how people navigate
their world and feel safe and secure

47

48

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The Assumptive World

• Each of us has formed a way of seeing things and interpreting


events that makes sense to us.
• The way we see the world helps us to feel a sense of predictability,
consistency, and safety as we go through our daily activities.

• Most of our assumptions about the world, others, and ourselves


are established when we are very young.

49

The Assumptive World

The assumptions or beliefs that ground, secure, or orient people,


that give a sense of reality, meaning or purpose to life. It is a
conceptual system, developed over time, that provides us with
expectations about the world and ourselves.

(Janoff-Bulman, 1992)

50

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The Assumptive World

• Expanded by Janoff-Bulman, who identified


three main aspects of the assumptive world,
all of which create a sense of equilibrium in
daily life.

51

Loss and the Assumptive World

Our Assumptive World includes three basic assumptions centred around:

1. How we view the world and others - the world is benevolent

2. How we believe the world should work - the world is meaningful

3. Our view of ourselves - the self is worthy

Janoff-Bulman (1992; 2004)

52

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Examining Our Assumptions


1. How we view the world and others.

(i.e., The world is basically a good place and people are generally
trustworthy)

2. Our sense of how things should work; sense of justice/


meaning and cause effect.

(i.e., If you work hard, you will succeed)

3. Our view of ourselves.


(i.e., I am basically a good person, competent, and I have intrinsic
worth and value)

53

Shattered Assumptive World

• The death of a loved one has great potential to cause such a


disruption.

• Other types of losses that may not involve death can also trigger
the need to re-build and re-learn one's assumptions about the
world in a way that preserves a sense of coherence and safety.

54

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Significant losses can cause the


shattering or crumbling of one's
assumptions about the world.

55

At the core of significant losses is the potential to lose our


assumptive world—what gives us meaning and coherence in our
lives.
It is this loss of meaning and coherence that is the main
overarching trigger for the grief response.

56

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How one perceives and interprets an event determines the


significance of its impact upon the assumptive world.

This appraisal is different for each individual. The same


experience may have many meanings to different
individuals.

57

Neimeyer and Meaning Reconstruction


(Neimeyer, 2001)

• The focus here is on the client’s struggle with


finding meaning in the loss.
• This model allows for the client to tell their story
as a means of making sense of what has
happened.
• By allowing the client to tell their story they may
be able to find words to explain and then
understand their experience.

58

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Grieving entails reconstructing a world of


meaning that has been challenged by loss.

(Neimeyer)

59

What is meant by meaning?

…as an explanation for an event that renders it consistent with one’s assumptions
or understanding of the nature of the social world.

That is, an event “makes sense” or “has meaning” when it does not contradict
fundamental beliefs about justice, order, and the distribution of outcomes.

One may make sense of an event by interpreting the event as consistent with
existing views of the self or of the world or by changing self or worldviews to be
consistent with the interpretation of the loss.

60

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Two Conflicting Streams of Information

Memory of the death Attachment belief


or funeral through bonding

Grieving as a form of learning


1. Attig - Relearning the world
2. Neimeyer - Reconstructing a world of meaning
O'Connor, M. F., & Seeley, S. H. (2022). Grieving as a form of learning: Insights
from neuroscience applied to grief and loss. Current opinion in psychology, 43,
317–322. https://doi.org/10.1016/j.copsyc.2021.08.019

61

Understanding grief means


understanding bonding and
attachment

62

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“The formation of secure attachment in the first two years of life (usually involving
mutual gaze and episodes of play) triggers elevated levels of endogenous opioids and
dopamine in both mother and the child and appears to be essential to the
development of right prefrontal orbital mediated capacities for emotional self
regulation”.
Schore, A. N. (2003). Affect dysregulation and disorders of the self. New York: Norton.

63

Our brain is forever shaped


by our loved ones.

64

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The primitive’s brain’s need for survival is paramount


The advanced brain’s need for coherence is paramount

In times of trauma, there is a persistent tension

What makes
something Brain’s priority Brain’s priority
emotionally to keep us safe for coherence
traumatic?

The threat to our identity


the story that we tell ourselves about who we are
emotional trauma scrambles our life narrative

65

“Although mourning involves grave departures from the normal attitude toward life, it
never occurs to us to regard it as a pathological condition and to refer it to a medical
treatment. We rely on its being overcome after a certain lapse of time, and we look upon
any interference with it as useless or even harmful”
— Freud, 1917

66

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Best practice bereavement support for resilient individuals:

identifies and reinforces their coping and positive achievements


avoids interfering with their innate capacity for recovery
avoids undermining or replacing their family and community as sources
of social support.

67

68

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Bereavement Counselling Toolkit

69

Integrating grief theories

1. Accepting the reality


of the loss.

Loss orientation Restoration orientation


3. Adjusting to an
2. Working through the
environment in which
pain of grief.
the deceased is missing.
oscillation

Establishing a continuing bond

4. Remembering the deceased


while embarking on the rest of
one’s journey through life

70

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There is no single set of stages or tasks in adapting to loss,


but instead qualitatively distinct paths through bereavement
that call for a closer understanding of both patterns of
complication and resilience.

71

Why Not to Intervene?

Stroebe’s, Walter and others concerned that professional intervention:


• Thwarts natural assistance from family and friends
• Inhibits bereaved person’s self-esteem and sense of efficacy
• Implies certain forms of grief are not socially acceptable;
intervention gets unruly grief in line with cultural expectations
• Wastes resources

72

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Why Intervene?

Vast majority fine and gradually . . .


• Move from very upset, disturbed to diminished distress, eventual
adjustment
• Questionable whether would benefit from intervention

Significant minority not fine and at risk for enduring distress and dysfunction
• Interventions improve their quality of life; potentially reduce adverse
outcomes:
• Social withdrawal, suicidality, alcohol abuse, high blood pressure,
functional disability, loss of productivity

73

Worst case scenario scenario


(Schut, Stroebe, van der Bout & Terheggen, 2001)

Unsolicited, routine referral, shortly after


bereavement for no other reason than that the
person has suffered a bereavement.

74

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The Narrative Impulse


Why people tell us their stories of loss -
• They seek safe and intimate contents of disclosure
• They believe that we can hear what others cannot
• They hope that we will validate their pain as real
• They seek a meaningful account of their experience in the
telling

(Neimeyer)

75

We serve the bereaved by listening differently -

• Allow time for telling without interruption


• Explore the pain without over-identification
• Respond to metaphors and themes as well as audible
content
• Prompt retelling in emotional and reflective, as well as
factual forms
• Avoid superficial reassurance

76

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What do bereaved clients need?

Therapeutic Common Factors - International Work


Group on Death, Dying and Bereavement Working
Group

77

What do most bereaved people want from from another


person?

• A witness to their grief and pain


• Escape from people who inflict cheeriness
• Support; time; space
• An outsider to accompany them through grief
• Validation of their feelings
• Reflection on their coping and solutions

78

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Although bereavement may be a choiceless event, the


grieving experience understood as an active coping
process is permeated by choice.

— Thomas Attig

79

Creative Ideas
One of the hardest things about grief is the feeling of helplessness - doing something
often helps

• writing personal story/experiences


• journals
• unsent letters
• drawing and painting
• memory boxes
• making a personal pilgrimage
• photo collection
• poetry - writing and/or reading
• reading other people’s stories
• ritual - personal/specific
• music that is relevant/expressive

80

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Strategies for self-help or intervention


• Be intentional - understand what one is attempting to
accomplish by the strategy that is used

• Choose comfortable modalities - e.g. expressive therapies,


creative arts, storytelling

• Build from strengths - thereby illuminating and amplifying the


strengths of a given grieving pattern

(Martin & Doka, 2000)

81

Working with emotion

82

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83

Compassion and Loving-Kindness Meditation

Contemporary research indicates that that compassion meditation,


including metta, may increase resilience, reduce stress-induced immune
and behavioural responses and enhance traditional mental health
interventions.

Believed to have been taught by the historical Buddha as an antidote to


fear.

Stang, H. (2016). Compassion and loving-kindness meditation In R. A. Neimeyer (Ed.), Techniques of grief
therapy: Assessment and intervention (pp. 161-164). New York, NY: Routledge.

84

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The Grief Drawer


Gather together objects, pictures, written work and any other
reminders of the loss and place them in a drawer. The draw is then shut.

Set aside a specific amount of time each day (use a timer, a collection of
music) to open the drawer, go through its contents, and enter their grief
as fully as they need to.

At the end of the allocated time things are returned to the drawer.

Harris, D. (2016). Compassion and loving-kindness meditation In R. A.


Neimeyer (Ed.), Techniques of grief therapy: Assessment and
intervention (pp. 173-175). New York, NY: Routledge.

85

Continuing Bonds with


the deceased

86

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Linking Objects

Preserving objects that belonged to the person we have lost.

87

“He's with me. He's looking over my shoulder". (2003)

Angela Dark, sister of deceased Bali victim Anthony Cachia in her brother's bedroom in Melbourne.
Angela has had her brother's portrait tattooed on her shoulder.
© The Age

88

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The Continuing Bond


Adaptive Grieving commonly involves:

• Reclaiming rather than relinquishing our connections to


those who have died.
• Having access to consoling, proud and inspiring
memories.
• Projecting our loved ones into the future rather than
leaving them behind in our past.
• Recruiting them as active participants in the story of our
lives.
• Being able to speak their names.
• Accessing their voice and values.
• Honouring them in cultural and personal rituals of
remembrance.

89

Letters to the Lost

•Write with intent to say “hello again,” rather


than to send a final goodbye.
•Speak deeply, from the heart, about what is
important in the relationship.
•Consider what the other has given you of
enduring value.
•Address the words that remain unspoken,
questions that remain unasked
•Respond in the voice of the other.
90

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Memory Books

My first memory of you was…


My favourite times with you were…
What I love most about you is…
I keep your memory alive by...
What I most regret about our relationship is…
What I never heard you say was…
What I wish you could hear is …

91

Recruiting Ritual

92

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Ritualisation

• Ritual refers to special acts that offer sacred meaning to events.


• “Rituals make mountains out of moments” (Grollman,1997). Ritual
provides a space for grievers. A container to hold grief (Golden, 1994)
• Effective grief rituals may be private or public, spiritual or secular,
but they have in common some form of symbolic action that helps us
reaffirm our relationship to that which we have lost, and understand
our new identity.

93

Ritualisation

• providing an ongoing sense of connection to the loss, allowing space to safely confront
ambivalent or confused feelings or thoughts
• generating social support, and
• offering opportunities to find meaning in the loss by applying spiritual frameworks to that
loss.
Rituals of:
• Continuity
• Transition
• Reconciliation
• Affirmation

94

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Four Principles in Planning Ritual

1. Rituals always arise from the story.


2. The elements used in a ritual should be both visible and
symbolic.
3. Rituals should be planned and processed.
4. Rituals can be planned at any time.

95

Emotional
Dysregulation

96

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Window of Tolerance
Use mindfulness, Overreactive, unclear
Use mindfulness,
breath work,
Hyper-aroused thought, emotionally
breath
physical work,
activity distressed
physical activity
Flight / Fight Response
Flight / Fight Response

Comfort Zone

Ability to self-soothe
The body is in it’s optimal state, Can access both reason and emotion, Mentally engaged

Use mindfulness,
Use mindfulness,
Depressed,
Depressed, lethargic, Hypo-aroused
numb, unmotivated
lethargic, numb, breath
breath work,
work, physical
Freeze Response activity
physical activity
unmotivated Freeze Response

97

Finding Meaning

98

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Meaning Reconstruction Interview

99

Metaphors and Meaning Making

Speaking of our loss metaphorically can help us speak in


a more personal way and draw on terms that are rich in
resonance and meaning.

How would you describe your grief, if you tried to


picture it as some form of image or object? What would
it look like?

100

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Metaphors and Meaning Making


(Martin, Constructions of Psychotherapeutic Change)

Established that therapeutic events considered important by


clients:
• focus on enhancing awareness and changing self theories
• are higher in depth of meaning, figurative language and clarity
• are accurately recalled six months later by 73% of clients
• involve the collaborative co-construction of metaphors by clients
and therapists

101

Difficult Memories

102

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Memory Books

My first memory of you was…


My favourite times with you were…
What I love most about you is…
I keep your memory alive by...
What I most regret about our relationship is…
What I never heard you say was…
What I wish you could hear is …

103

Photo Gallery

• Can provide vivid ways of memorialising


the lives of loved ones. A private
function of fostering our symbolic
connection and a public function of
prompting shared memories.
• A calendar
• A videotape

104

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Reflective Reading

Reading about others’ experiences


of mourning is a way that helps
interpret and comfort it. It can also
help structure the experience.

When bad things happen to good


people - Rabbi Harold Kushner

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Cinema-therapy

Cinema-therapy is a therapeutic intervention allowing clients to visually


assess a film’s characters interaction with others, their environment and
personal issues, thereby developing a bridge from which positive
therapeutic movement may be accomplished.

By referencing movie characters and familiar dramatic vignettes, a young


client may reveal his/her own internal process while having the
opportunity to keep a necessary emotional distance from stressful or
frightening topics.

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Cinema-therapy

Good Will Hunting We Bought a Zoo Extremely Loud &


(1997) (2011) Incredibly Close
(2012)

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Re-authoring life narratives:


Grief therapy as meaning reconstruction

Find or create new meaning in the life of the survivor, as well as


the death of the loved one

Relationships with intimate others provide repository of shared


memory, and their loss undermines our self-narrative, and with it,
our identity. Grieving therefore entails “relearning the self”, as well
as “relearning the world” (Attig).

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Re-authoring life narratives:


Grief therapy as meaning reconstruction

Seek strands of continuity in the relationship to the


deceased, as well as points of transition.

1. Maintaining the thematic integrity of the survivor’s self-narrative


often implies cultivating a continuing bond with the lost loved one
(Silverman, Klass), rather than “saying goodbye” or seeking “closure.”

2. Keeping the connection: Marwit & Datson’s study of the sense of


presence.

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Metaphors and Meaning Making

Speaking of our loss metaphorically can help us speak in a


more personal way and draw on terms that are rich in
resonance and meaning.

How would you describe your grief, if you tried to picture it as


some form of image or object? What would it look like?

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Drawing and Painting

• Symbolic drawing, painting or other forms of artistic


expression can articulate the losses and the possibilities for
the future.

• They can provide a bridge into feelings and issues that are
difficult to speak to in a more direct fashion.

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Journals

Indications
• Especially when losses are traumatic they may be
difficult to discuss or even disclose to another. Writing
can have positive impact upon a sense of well-being and
an increase in immune functioning.

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Journals

• Write about aspects discussed least adequately with others,


perhaps aspects you could never imagine discussing with anyone
• Talk about events and reactions to them
• Abandon all concern with grammar, spelling and neatness.
• Write for at least fifteen minutes per day, for at least four days.
• Schedule a transitional activity after the writing, before resuming
life as usual.

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