Grief and Loss Activities

Foreign. I'd like to welcome everybody. Today's presentation on grief and loss activities. You know, a lot of people deal with grief on a regular basis and sometimes it's difficult to think about, you know, what are some ways, what are some things I can do to help people process their grief. So the first part of this class, we're going to talk about what grief is and conceptualize it in terms of any loss, not just loss of a person or, or death. We'll identify how failure to deal with grief can impact people, explore the stages of grief, and review activities and interventions to help people grieve. Grief is a label assigned to the emotions associated with dealing with any kind of loss. When we have a physical loss, such as abilities, if you are in a car accident and you become a paraplegic, if you have a stroke, if you are gradually losing your sight, there are a lot of different physical issues or areas where we may lose some of our abilities and that may need to be grieved. We also can lose our freedoms. Now that can be lose our freedoms in terms of our ability to go out, like in quarantine. But also what I'm talking about is losing our ability, our mobility as we get older. For example, some people have more difficulty being mobile because their body's just not cooperating as much or their vision has gone down or whatever. So, so there can be some complications or multiple losses associated, for example, with declining vision, because, you know, that impacts people's ability to read, to read directions, to read, recipes, to, you know, read so they can pay their bills, to drive. You know, there's a lot of things that, that impacts. So we want to consider, when people experience life changes, does this represent in some way a loss? Self concept is also something that we can lose. We can lose our roles as, you know, empty nest syndrome is one that we've talked about for many, many years that, you know, as our children grow up and leave the nest, we don't have as much obligation. It doesn't take as much of our time. Am I still mom? Yes, but I'm not mom. Every day who has to do the laundry and make meals and check homework and do those sorts of things. So that changing role can leave people kind of going, ah, you can also have, you know, when you retire, some people have to grieve, retiring because they're losing that role as a employee, as a colleague. Um, you can also lose roles, for example, when you have a baby. Not just empty nest, but adding to the nest some. When people go from being for Example, single or, you know, not having children to having children. It is a big old change. And some people need to grieve that. Even if they were looking forward to having that child and everything that goes with it, there also may be a part that they have to grieve that they miss being able to just, you know, drop whatever and going out or they miss being able to sleep through the night. And we want to talk to people about any guilt associated with that because some people, some parents, caregivers, feel significant guilt when part of them is angry or resentful towards their young child because of, you know, the life changes they're going, they're having to make. We can lose things in terms of values. You know, if we have value, honesty and we look around and people are not honest, we feel like everybody's lying or we fe, we start doing things that go against our values, we may grieve that we can lose things in terms of worldview. And, and that's kind of the more meta concept of innocence and a sense of safety. And a lot of people experience that if they are trauma survivors, they may feel a loss of innocence if they, you know, a lot of people right now are experiencing a loss of safety not because of necessarily an overt aggressor. They're, they're not being mugged or something, but a lot of people don't feel safe leaving their house. They're afraid they're going to get sick. Sick. It changes their worldview. Instead of looking around and seeing the birds and the trees and, you know, all that stuff, they're looking around and going, where are the bugs? Where can I, where are the viruses sitting? And you know, so I make sure not to touch those. And that can change people's feelings about life and about what they're going through. Because, you know, if you're constantly looking around, if you're not feeling safe, you know, that's been a theme for the past few class. If you're not feeling safe, it puts you in a hyper vigilant state. When we're hypervigilant, we're noticing more of the negatives because we're feeling like we need to protect ourself. And we tend to do more overlooking of the positives. We can lose dreams. And that's another one of those meta concept, sort of esoteric things. But if you grew up thinking that you were going to have this storybook marriage like you saw in the Disney movies or Leave it to Beaver, whatever you idealize as the perfect relationship, and that's not how it is. If you think you are going to grow up and, you know, have a partner and 2.4 kids, a dog, and a white picket fence, and that's just not in the cards for you. Or even maybe you thought you were going to grow up to be a doctor and turns out calculus is not your thing. You know, that is a dream. That is something that you had out there that you thought for sure was going to happen, that you were looking forward to, and all of a sudden it's not there anymore. We do need to help people explore those things and grieve those losses if they feel that they need to. And yes, I realize Leave it to Beaver is dating us quite a bit, and it is so replete with misogynistic messages. But, you know, there are still people that are old enough to really resonate with that because that's what their home life was like when they grew up. And we can also lose relationships. We can lose relationships because people move away. When we're in college, for example, you know, we have what seems like all the time in the world. We're going out with our friends, yada, yada. And then people start pairing off and getting married and having kids. And one day you look up and you're like, nobody has time to do anything anymore. That is a huge issue in that transition period between like 21 and 28, depending on the person that. That a lot of young people face because, you know, things have changed. Even if they haven't gotten married and have had kids, a lot of their friends may have, or a lot of their friends may be off doing other things, traveling and gallivanting so they're not around to go hiking or go bar hopping or whatever it is that they did. And we need to encourage people to recognize that there may be some losses, but we also want to help them recognize what they still have and that we want to. We don't want to take away their grief. We don't want to invalidate their grief. We want to let them process their grief and move to acceptance. And one of the ways that. And I think I'm going to talk about it later in the class. One of the ways that I do this with a lot of clients is I talk about life in terms of a story or a mini series or a television series. You know, each chapter of our life, each season of our life, if you want to think of it in terms of television series, each season of our life, has a certain storyline that goes through it. You know, elementary school, middle school, high School, college, you know, starting your career, There are different chapters. And as things change, as we move to the new chapter, some things will disappear. You know, that storyline is going to change. And when something happens, for example, empty nest, when your kids move out, you know, that's closing that chapter on having to be a full time parent. So let's look at the next chapter. How is that going to influence what you do in the next chapter? How do you see a rich and meaningful life? How do you see that impacting the main character now that this change has happened in their life and have letting people write it down and sort storyboard, it helps them put it out there so it doesn't feel quite as personal to them sometimes. And it gives them the opportunity to examine what's going on and embrace that notion of change can happen and any change causes a crisis. However, with change, we can still still have a rich and meaningful life. Primary losses can also produce secondary losses which also need to be acknowledged and grieved. Like I talked about with vision, for example, our primary loss may be vision. What else do we lose when we can't see anymore? I know for me, you know, my vision's just now starting to go in, in sort of a big way and I can't read directions, I can't read boxes, I can't read labels at the grocery store anymore without my glasses on. And yes, having reading glasses, having glasses is not that big of a deal. But there's a little element of frustration when I inadvertently and usually forget my glasses and I get to the store and I'm sitting there trying to figure out what it says. And so, so that's an issue there. What else? Am I not able to do the same or as well or without assistive devices now? And encouraging people to recognize that that can be frustrating. Even if you can correct it with assistive devices like glasses, there there's still an element that it's like, oh crap, you know, I wish I could see without having to make sure I had my glasses all the time. Loss of identity can, you know, cause a lot of secondary losses. When we are parents, for example, we have a certain group of friends that are the caregivers of our children, of our children's families, of our children's friends. That's it. Wow, I need to slow down a little bit. So when my kids were in Taekwondo, for example, all of the parents that were in Taekwondo, we would always sit in the lobby and hang out and connect with one another. And you know, now that my kids are, you know, in college and not going to taekwondo. And I'm not a full time parent anymore. I don't have that identity as full time mom and I don't necessarily have all the same friends and do. I definitely don't do the same things that I did when I was a full time parent. Now in some ways that's good because it frees me up to do other stuff. But there is, there are secondary ramifications of every change. And you want to explore that with people if they're having difficulty understanding especially why is this hitting me so hard? Why am I so frustrated about this? When people have their midlife crisis, you know, that is largely associated with, you know, several of these different losses. And people try to regain their youth, they try to. A lot of times when people have their midlife crisis, they're feeling less attractive, they're feeling less desirable, they're feeling less useful, they're feeling less of a lot of things. So you hear less equates to losses. And that midlife crisis may be one last push to try to get the recognition and validation and acceptance back that they're afraid they're missing. We want to look at what is motivating their behaviors. If we have a loss of a chosen lifestyle, maybe somebody was a full time stay at home caregiver, you know, person, and all of a sudden their significant other dies or leaves or goes away for some reason and they suddenly have to get a job and work outside of the home. And you know, not only are they having to work outside of the home, they're doing it by themselves. So they viewed themselves as part of a team. Now they're independent and it's completely changed their lifestyle. Loss of security or a sense of safety, you know, just really makes us hyper vigilant and it can make us want to avoid people, places and things because we feel safer in our own little world. And loss of dreams. When people have dreams and they go away, it can make them feel frustrated and angry, it can make them feel like failures, it can make them fear rejection and maybe even sometimes create a self fulfilling prophecy. Because it was like, well, I figured that this person would, people would like me if I fill in the blank. And now that I know I can't fill in the blank, you know, how am I going to know if people are going to how am I going to know if people are going to like me? And as Denise points out, loss of a sense of security or safety is huge for a lot of people. Remember, that is our, when we look at our maslovian needs. That's not number one, because we've got biological down there, but it's number two. Before love and belonging, before self esteem, before self actualization, we need to feel physically, emotionally, cognitively and interpersonally safe. And for a lot of people, whether they have fetal alcohol spectrum issues, whether they have depression, anxiety, if they're on the autism spectrum, there are a lot of or. Or they have a history of trauma. There are a lot of reasons that it can be difficult for people to be willing to connect because they're afraid of abandonment, they're afraid of rejection. So they don't even want to connect because they don't feel safe. And, and that's what we really need to look at. Why is it that this person is resistant to developing rapport, is resistant to opening up? Well, opening up means being vulnerable. What's happened to that person in the past when they have been vulnerable, that is discouraging that behavior right now. So we do want to go back to kind of a trauma informed perspective and say, what is this behavior saying? And figure out how to work backwards from there. When we have, for example, a death of a parent, you know, there are a lot of secondary losses. People may, if a parent dies, they may have to go live with a different caregiver, which may mean they transfer schools. There's obviously not the parent in the house. But even if they stay with the other caregiver, they stay with their parent, their other surviving parent. They may still have to sell the house that they live in because they couldn't afford it. They may, you know, have to adjust to not having a mom to bring to, you know, the Mother's Day dance or whatever it is. So there are some secondary losses that can occur for everything. Miscarriages. This is another one that we really want to look at. You know, separation and divorce. I'm just going to skip over that one because it kind of goes along with just loss of a couple. Well, I guess I won't. Separation and divorce. When you lose your partner for whatever reason that is, you know, really stressful, can be really agonizing. But you also a lot of times lose mutual friends. You often al. Also a lot of times lose mutual activities. Things that you used to do with your partner you may not want to do anymore. So you're trying to reestablish, you know, sort of a new lifestyle with miscarriages or abortions, with losses of fetuses. There are a lot of secondary losses. You know, obviously you lose the baby if it is a miscarriage you, the person may beat themselves up thinking, you know, this is something women have been doing for, you know, thousands of years. Why can't I do this very basic thing, thing? Why is my body rebelling against me? I want this, I want a child so bad. Why am I not? Why is my higher power, if they believe in one, not letting me have one? So they can lose their faith, they can lose their hope, they can lose self esteem because they feel like it's their fault that they can't carry a baby to term. They may feel, you know, a lot of things and as Denise points out, and it's very true, if they have a miscarriage, it is, can be very difficult to be in. Especially if you're on the L and D floor and you're hearing other babies cry, you're hearing other women give birth and have that beautiful, wonderful moment. The same thing can be very true for, for prematurity. And I have a class on the YouTube channel about prematurity and that's near and dear to my heart because both of my kids were preemie. But there is a fair amount of grief that goes along with that as well, because it's not. You have this dream of this, you know, perfect pregnancy and beautiful labor and delivery and, you know, like they do on tv. And if it's not like that, you, you know, give birth to a baby and they whisk them out and put them in an incubator and you can't touch them for the first two months. It is agonizing infertility, the same way injury or disability, you know, you lose a loss of some physical function, it may prevent you from doing other things that are meaningful. So let's talk about types of grief really quick. I want to get down to the interventions. Anticipatory grief. Experiencing anticipatory grief may provide time for the preparation of loss, acceptance of loss, the ability to finish unfinished business, life review and resolve conflicts. Oftentimes you see anticipatory grief in people who have been diagnosed with a terminal illness. You also may see anticipated anticipatory grief in parents as they are getting ready to send their kids off to college. You may see anticipatory grief before somebody retires, you know, the weeks leading up to that retirement. Anytime somebody can foresee a loss, they know that there's a loss in their future. It is their anticipatory grief, and it doesn't even have to be death. For people who have conditions that are progressive, like Parkinson's, there may be some anticipatory grief or Alzheimer's, because they know at a certain point that they're going to lose a lot of the things that are important to them. Normal grief. I hate that word normal. But typical grief refers to normal feelings, reactions, and behaviors to a loss. Grief reactions, it's important to remember, can be physical, psychological, cognitive, or behavioral. And in children especially, we need to remember that since they don't have the affective vocabulary that we do as adults, we may see more of their grief reactions come out in forms of physical reactions. Headaches, stomach aches, sleep problems, and behavioral reactions. When children act out, you know, think about what is the meaning of this behavior. Sometimes when children act out, they are basically screaming, you know, asking for a parent to reassure them that that parent is there, that that parent will set limits and boundaries, that that parent will maintain some semblance of normality, whatever that looks like in that person's. In that child's family. We do want to recognize that reactions can be very different. Not everybody cries when they grieve. Not everybody gets depressed when they grieve. And some people feel really guilty if they don't cry or get depressed when someone. When someone passes away or they have any other loss, well, it could be that there's a sense of relief. And helping people radically accept their feelings as it relates to a loss is really important. And then you can explore, okay, why am I feeling this way? And what is. What. What does that mean to me? Complicated grief can come in a bunch of different forms in terms of disenfranchised grief. This is when your usual grief reactions don't subside and continue over very long periods of time. It's important to remember, well, two things. One, that grief, the usual grieving process, takes between one and three years. So giving people, you know, normalizing it for them, letting them know that, you know, two years after you have a significant loss, there may be occasions where you're still feeling twingy about it, and that's okay. But if it's all day, every day, or most of the day, every day, then we're, you know, looking at something that's more of a problem. You want to see the grief reactions and the grieving periods subside in duration and intensity and frequency over the years. So, you know, the first year may be agonizing, the second year may be difficult, but we want to see where the person is being able to come up and have periods of, you know, okayness, maybe not happiness yet. Delayed grief is when the typical grief reactions are suppressed or postponed, and the Survivor consciously or unconsciously avoids the pain of the loss. I can tell you, when my daddy died, I did this. I was there when he passed away and, you know, was able to say my goodbyes or whatever. But then we left and I was. It's somewhere in my mind. It was kind of written in there that if you don't go to the funeral, then he's not really dead. And I knew that wasn't true, but it was one of those things that I just. I didn't want to see, I didn't want to hear, I didn't want to deal with. And that is sort of that delayed grief reaction. So, you know, at the point that, you know, something happened and I wanted to pick up the phone and call him, and I realized, oh, he ain't there. Then it kind of hit me like a ton of bricks. And that is that delayed grief process. Masked grief occurs when the survivor is not aware that the behaviors that interfere with normal functioning are the result of. Of loss. So somebody may be grieving and they are engaging in substance misuse. They are having difficulty sleeping. You know, they're having a variety of physical, psychological, cognitive, or behavioral symptoms, and they're not sure where it's coming from and may not even associate it with a loss. So we want to help them look, just like we do in trauma informed care, to help them look back and see if it's associated with some kind of a trauma. We want to encourage them to just explore what may be precipitating these feelings that you're having. One of the ways that I have, I help clients work with this is to identify, you know, proactively when they start feeling more sad or their symptoms get worse, what's on, going, going on, what triggers that. And then those triggers often lead us back to explore what they might be going through in terms of, you know, what the loss, what loss they may be needing to grieve. The grief encountered when a loss is experienced and cannot be openly acknowledged, socially sanctioned or publicly shared is also very complicated because the person is sitting there with that grief, and often they can't process it. You know, and this can be a variety of things. One of the things that y' all talked about a little while ago is abortion. When someone has an abortion, sometimes they don't feel like they can tell anybody. So they have. They sit with that, and they don't know what to do with it. Alicia asks, how do you define a person who lost a parent as a child and has now become obsessed with death, funerals and Mourning all family members close or distant. And we really want to look at that parental relationship. And what is that inner child saying? In what way is this behavior that they're exhibiting now as. As adult, representative of that child, trying to regain some control, trying to feel safe, trying to feel protected? You know, I would really kind of look at again, what is this behavior saying? If they are needing to mourn those family members so intensely, it's my first guess would be that they were never given the opportunity to mourn the loss of their parent. Or maybe they were too young and didn't have the ability to state those things. Stages of grief. We all remember these from counseling 101, denial, anger, bargaining, depression and acceptance. Not everybody goes through all of these, you know, despite what they want you to believe. It's. It's important to remember that we don't want people to feel pathologized if they don't, for example, go through bargaining. You know, there's a lot of things that have happened in my life that I've looked back and I'm like, I don't really remember that whole bargaining thing. We also want to remind people that it's not linear. You don't go through denial, then anger, then depression, then bam, you're in acceptance. You may bounce back and forth like a pinball through a lot of these stages for a while. You know, it's not uncommon to get angry and then feel depressed and then go back to denial, trying to just ignore the fact that it even happened and then get angry when it's that issues poked again. That is not uncommon. And helping people recognize kind of what's underlying these feelings. Feelings are normal. It's our body's reaction to help us survive. So denial is sometimes our brain's way of going, I don't know what to do with this. This does not fit. It does not compute. So I'm just going to, you know, 404 error it. If you want to talk in computer language. Anger comes because of a lot of those threats that we've talked about over the past few weeks. The unknown. What am I going to do now? Without this dream, without this ability, without this person. Person. Loss of control. When we experience a loss, there is a certain amount of loss of control. Even if we're the ones doing it. Like we decide that we are retiring. We can't control the fact that, you know, our former colleagues, you know, just don't have as much time to spend with us. There are things we are not in control of. Death. You know, if it makes us fear our own death or if we are angry that someone else died. Isolation can come when we lose dreams. For example, you always dreamed of being in this sorority. That's a huge thing that I see in, you know, August and September with a lot of young men and women who are pledging sororities and fraternities. They always envisioned that they would be a legacy and at. In one of. One of the Greek organizations. And then they don't get a bid, and all of a sudden they feel this sense of isolation, and they're very angry, but they're also, you know, just taken aback. And they can feel angry and depressed and hopeless all at the same time. Bargaining. If I do xyz, then I'll wake up and realize it was only a really bad dream. Now, a lot of times, or sometimes we do bargain. If this happens, then how many times have you heard kids or other people say, if. If this happens, if you will grant me this, then I will go to church every single day. Or if you do, if the world. If the universe grants me this, then I will, you know, not lose my patience ever again? Um, a lot of times we engage in this, you know, somewhat unrealistic bargaining because we're trying to figure out, you know, how can we buy the result that we want, thinking, you know, everything has a price, and so maybe our higher power or the universe is able to be bribed. It's just one of those human reactions. Again, not everybody goes through bargaining, but a lot of us, you know, hope that it's really a dream. So whether you want to call that denial or bargaining or sometimes you may go back and forth, Depression is that realization that, crap, this is really happening, and I have really lost this, whatever it is. And I feel helpless and hopeless and defeated. Defeated and sad. Depression is our body's way of saying that we lost something that was meaningful. If we didn't sometimes feel sad or depressed, then we wouldn't know what's important to us as much. If. If everything, you know, we had it was great when we had it, and then we didn't care if we lost it. You know, that's just not how we're wired. So depression does tell us that we lost something that was important, that we failed, feel a little hopeless and helpless. The question is, all right, it happened. It is what it is. What can we do to improve the next moment? After my daddy died, you know, I had always wanted my kids to grow up and. And know my dad because he was a really cool dude. And that wasn't in the cards and but what I have done, you know, I felt helpless and hopeless and very depressed at the fact that they weren't going to have a that particular grandfather. But I was able to work really hard over the years and talk about my father and keep his memory alive. I wasn't able to keep his body alive, but I could keep his memory alive and you know, give to them some of the lessons that he gave to me. So, you know, it's not uncommon to hear my kids talk about Paparan even though they never really knew him. And acceptance is when we get to that final stage. It's when you're writing that narrative and you're closing out the chapter, you're closing out this season, you know, and there's that cliffhanger. All of a sudden something happens and you're like, da da da da. How is the next season going to start? How are we going to resolve this issue? And then, you know, you figure out, okay, what are we doing next season or in the next chapter? Acceptance doesn't mean saying it's okay. Acceptance means saying I can't change is what it is. How can I have a rich and meaningful life and experience the pain of this loss? And that is a real acceptance and commitment therapy, psychological flexibility, sort of tool called living in the and where they are saying, and I can experience this pain and still have a rich and meaningful life. Exacerbating and mitigating factors how people react in a crisis depends on a lot of things. But there are six factors that are particularly prominent. How close the situation was to them, both physical and emotional proximity. And you know, how do you, what did it happen in their house? Did it happen in their community? Did it happen next door? That can affect how people feel. If the situation it was them retiring, you know, obviously that's affecting them directly. If the situation was, you know, somebody in the next department retiring, they probably wouldn't experience that much of a loss. So we want to look at how much does this loss impact the person? How much does it affect their day to day life? How many other stressors did they experience in the last year? Remember we talk about the fact that when people's HPA axis is constantly or frequently hyperactivated because of chronic stress or frequent episodes of intense acute stress, they may develop a condition called hypocortisolism where the body is just, you know, it's, it's worn down, you know, to make it very overly simplistic. And when people are have hypocortisolism, it Makes them more vulnerable to reacting extremely to a crisis. We talked about this on, on Tuesday, the Flat and the Furious. A lot of times they feel kind of flat, kind of like Eeyore. But when something does trigger their threat, does trigger their stress, when they experience a loss, they may all of a sudden go, you know, from 0 to 250 and it is the worst crisis and they feel like they're falling apart. Also, when we've experienced a lot of stressors, a lot of times our reserves are just worn down and our neurochemicals are out of balance because of that HPA axis hyperactivation. If the person has existing mental health issues, this may trigger a relapse. Even if that those mental health issues are under control. We want to be aware of that and explore what effective coping skills they have. You know, you can have a history of depression or bipolar disorder and deal with loss as long as your coping skills are effective. If they don't have social support, there's been significant research that has shown that social support within the first 72 hours after a crisis or after a loss is really important. Their understanding of the loss, how they make meaning out of it. If they're being, are they being punished for something? Is it fate? Is it something that they did? What does this loss mean about them? And only the client can answer that. We want to have them ask why this is happening. What does it mean about them? What does it mean to them? And how do they potentially see this resolving? And finally, how much control or responsibility the person feels like they had in the situation. If they felt completely powerless, then they may not experience as much grief as if they feel like it's their responsibility if they did it. You know, miscarriages and premature infants, for example. You know, a lot of times as birth mothers, we feel very guilty because we feel like, what did I do that made this happen? You know, there are other things you may not feel like you had control over, but those are some factors that we want to explore with people and help them understand why it may be affecting them differently than it's affecting their, their significant other, their children, or their best friend. When people are stuck in unresolved grief, they may get stuck in either that anger or depression phase or both. And you know, it's really tough if somebody is angry and depressed at the same time. That's exhausting for them. Remember, the anger comes out as shoulda couldas and if onlys at themselves. I should have done this. I could have done this differently, or if only I would have it comes out, you know, those same things at other, other people and their higher power. If you, you should have protected me. It, you know, you could have done this differently if only you would have. I remember one time after, unfortunately we experienced a loss of an entire litter of kittens that had been abandoned. The foster kittens, failure to thrive, whatever. I remember my daughter crawling up into bed with me and, and saying, you know, Mommy, why did St. Francis take the kittens from us? I love them so much, you know, and she was angry and depressed and confused all at the same time because she felt like St. Francis should have let these innocent little kittens survive. And I couldn't really argue with her. And explaining life and death to a, to a seven year old can be a little bit challenging. But I do remember, you know, her articulating that. People may feel hopeless and helpless and depressed and just not know what to do, not know how to go on. They may be depressed within themselves. They may be resentful of other people and feel like nobody else can help them and they can't help themselves. Remember, denial is, and numbing is the mind's way of protecting people from what lies ahead. Sometimes it's just more than we can process when we are in, you know, crisis mode, strong HPA axis response. We actually have chemicals in our brain that prevent the formation of certain memories to protect us for a little bit, which is kind of interesting. Anyhow, we need to help people as they move out of denial, gradually start facing the loss and when, when somebody's ready to do it varies from person to person and it's not necessarily helpful to prod somebody and go, okay, this happened, so let's get out of denial and let's deal with it. Everybody has their own rhythm. People need to recognize that they will eventually need to understand the events of their lives and reconcile the losses they have experienced and clarify what's going on. But that may be too much to deal with right now. Just to think about everything that I've lost and oh my gosh, how do I start over? How does this next chapter start? Initially, that may just be overwhelming. Let people have time to get into their wise mind, you know, get out of that emotional mind where they're just, you know, for clumped with, with anguish. And they may wonder about, you know, what happened to me. And denial is sometimes will, will go a long way. Sometimes people have, you know, blank periods in their life where they don't remember what happened or it may be, you know, three hours ago, something happened and it Feels like a dream or they don't remember parts of it. And that can be agonizing and frustrating and just exasperating for people. We want to let. Let them realize that the brain is trying to protect them and it will come. It doesn't make them feel better, but letting them know that that is a. An expected reaction. Anger is the power play reaction. People want to use anger to protect themselves, to fight or flee, and anger is the fight. We want to help people, quote, break down the walls. Sometimes you can get the. I get the big Legos. The little Legos are too hard to work with, but get the big Legos like preschoolers work with and build a wall. And you can let them symbolically smash the wall. Or if you know of somewhere that has demolition that needs to be done, they can go do that or whatever it is. I've also taken people out to a handball court or a racquetball court and just let them throw a ball. And as they're talking about their anger, you know, visualizing that anger sort of as a target on the wall, something that allows them to use some muscle and. Oh, Van der Kolk has a book called the Body Keeps the Score. Beautiful book. Wonderful book to read. If you work with trauma, which often accompanies loss, bargaining and pining is the next issue that we'll talk about. Not necessarily the next in a line of phases, but we want to help people develop mindfulness, awareness of what's going on in the moment, awareness of what they do and don't have control over in order to help them move through that bargaining situation. Depression, disorganization, and despair. We want to help people address hopelessness and helplessness by focusing on what can be changed. Death, for example, does not have to mean complete disappearance. You may not see that living organism again, but you can have pictures of them, you can talk about them. You can keep their memory alive. Loss does not necessarily mean nothing will ever be okay again. Loss means that things are going to change, and change is an inevitable part of life. So what does loss mean? What is to that person? What does it look like? And how is life going to change for them? And how is it not going to change? Failure can, you know, equate to a lot of things, but it doesn't mean failure at everything. When we fail, it means that we tried something and did not succeed. Okay? It means we learned a way not to do it again. But it doesn't mean that we are a failure. It means we failed at a task. When bad things happen, it doesn't mean that it has to happen again. So we want to help people recognize that, okay, this happened and it was horrible and you never dreamed it would happen. It doesn't mean it has to happen again. So helping them move out of that denial, to. To start moving towards acceptance, you know, get angry about whatever happened, that's okay. You know, right after the tornadoes, you know, a lot of people were in shock and denial for a while because it was like, you know, 20 minutes, and all of a sudden people were dead and, you know, thousands and thousands of people were homeless, and it was just unimaginable. But it doesn't mean that that's necessarily going to happen again. It's okay to get angry. It's okay to feel depressed when you're looking around at, you know, the desolation. However, we want to help people reorganize and recognize what they do have control over in this situation, that they are not going to be unsafe and vulnerable forever. Acceptance, reorganization. We help people redefine their worldview, integrating new experience, experiences and strengths. What has changed since this happened? When you think about, you know, the past, let's think about your strengths and other times that you've worked through losses and what you've done. How does this change your worldview? And how can you integrate it into what you see as a rich and meaningful life? You know, integrating cancer, for example, into my worldview, it has been prominent in my family. And how do I integrate that into having a rich and meaningful life as opposed to being afraid every time I turn around? Because it seems like all over the news, everything causes cancer, which is not true, but it just. It seems that way. That's one of those cognitive distortions. So we want to help people redefine their worldview, you know, recognizing that, okay, you know, I may not live my entire life without getting cancer. However, cancer is treatable, so that helps me redefine my worldview into something that is less threatening to me. Have them visualize a positive future. Who am I? You know, now that this has happened, who am I? How does it affect me? Where am I going? You know, what am I attached to? Who am I attached to? Who are my friends? How will I get there? You know, what can I. What strengths, what resources do I have to help me along my journey to this new definition of a rich and meaningful life? And when will I know that I belong? When will I feel safe and be able to claim what is going on and go, okay, this is. Okay, this is. This is a rich and meaningful Life, I've kind of arrived. We want to help people visualize, you know, again that next season or that next chapter in the book, what does it look like? How has this loss changed the main character? Hopefully for the better in some ways, you know, but how has it impacted the main character and how is that going to impact the storyline? Grief is not a linear process. We need to remember that. Holidays, anniversaries, and just simple reminders like friends, people, places, things the media can, you know, rip open those wounds even a couple of years. Smells too. Yes, can, can bring back those memories and we want to help people understand, understand and just be aware of that. You know, it could be three years later and all of a sudden somebody walks by and they're wearing your mom's perfume and you're like, oh, I miss my mommy. That's okay. Many people will vacillate between depression and anger. So we need to normalize their experiences, encourage them to reach out to supports and remember to address happiness and survivor guilt. Sometimes people feel guilty for being happy. Sometimes they feel guilty for not being the one who got injured or who died or whatever. There, there's can be a lot of different causes of guilt. Remember, guilt is anger at self. I feel guilty, I feel anger at myself for something. Self care for grief. Have people emotionally express their feelings, ask for and accept help. And I have this handout that I give people that has all these things on it so they can remember, you know, tips and tools to help them get through grief. Don't let anyone tell you how to feel and don't tell yourself how you should feel. Just work on acknowledging how you feel, radically accepting it and saying, okay, what can I do to improve the next moment? Or what is the best next step for me? Be patient and kind with yourself. Some days are going to be better than others. And you know, don't think that you are any on any timeline to deal with this grief. Be aware of your grief triggers. You know, knowing that ahead of time can prepare you. For example, you know, when the first time you go Christmas shopping after a loved one dies can be very triggering, or the first Thanksgiving. Being aware of that, you can prepare yourself ahead of time. Embrace the dialectic, encouraging people to recognize that whatever this thing is, whatever the loss happened, happened. But I have the memories or I have what I learned from it, or I can't change it, but I can impact how it continues to impact me. You know, if you were a survivor of crime, I can't change the fact that that happened, but I can Change how it continues to impact me in the future. I can choose whether I want to feel afraid all the time or I can choose how I react to stimuli physically. Encourage people to get plenty of quality rest, which is difficult for a lot of people when they're grieving because when they lay down to go to sleep, they're alone with their thoughts. And that's when those woulda, coulda, shouldas and all the memories come flow flooding back and they have a hard time sitting still. It's really important for us to help them figure out how to use thought stopping, guided imagery and you know, a variety of different tools to help them be able to sit down and be alone with their thoughts or relax enough where they can get to sleep. Encourage them to exercise, eat a healthy diet, avoid too much alcohol, and pay attention to persistent changes in eating, sleeping, mood or energy levels. All of those things may indicate that the grief is becoming an issue psychologically. Have people write things down. They're not, when, when we're grieving, we are not use using those higher order cognitive processes as well. We're not going to remember things as well. Write it down, simplify things. You know, if it doesn't have to be complicated, don't make it complicated. Have people set short term goals and this could be, you know, for the next hour or the, you know, today, not six months from now. What are your short term goals? My first goal for today is to get out of bed. All right, score, got that one down. My next goal is to get a shower. Okay, knock that one off. It sounds silly sometimes, but when people are really grieving sometimes those basic self care activities need to be prominent goals so they can say, hey, I actually, you know, took a shower and got changed today. Encourage people to distract and engage in pleasure pleasurable activities to give their brains a break. It doesn't mean that they don't hurt hurt, but it means that they're allowing themselves to experience the grief and have a rich and meaningful life. Have them start writing the next chapter in their story and again, plan ahead for those grief triggers. Interpersonally. It's important to rebuild relationships, remembering that you know, after a loss there may be changes in who, who you're friends with. You can be members of more than one family. For example, after a divorce, you know, you have multiple step parents and things so there are multiple families and you know, that's, that's new but it can be okay. I also have clients. This is a fun one to do in grief in group. I think we talked about this the other day in. In class, I have them construct a Bill of Rights for grief and I do the same thing for guilt. But the Bill of Rights for Grief says things like, I have the right to know the truth about the loss, have my questions answered honestly, be heard with dignity and respect, to be silent and not talk about grief, emotions and thoughts. Sometimes we just don't want to talk about it at all. I have the right to talk about the loss as much as needed and to not agree with your perceptions and conclusions. I have the right to see the person who died and the place of death. I have the right to grieve any way I want as long as I'm not hurting myself or others. I have the right to feel all of my feelings and to think all of the thoughts that I have that are unique to my own grief. I have the right to not follow the stages of grief as outlined in some silly book. I have the. I have the right to grieve in my own unique individual way without censorship. I have the right to be angry at death, to be angry at the person who died, to be angry at God or my higher power, to be angry at myself and to other and angry at others. I have the right to have grief bursts. You know, those little. You're going along, you're feeling okay, and all of a sudden you're boohoo. Crying or angry because you were triggered. And that's okay. You may not even know what the trigger was, and that's okay. I have the right to be involved in the decisions about the rituals related to the loss. I have the right to not be taken advantage of. And I have the right to have guilt about what I could have done, couldn't have done, or should or shouldn't have done. Activities that we can do. Work with people to figure out how they can create safety. Not only physical safety, but also emotional safety. Emotional cognitive safety is when they can have downtime and not be assaulted by memories and angry thoughts all the time. You can have them create an invisible string. My aunt did this before she died. She had cystic fibrosis and she told me that there would always be an invisible string from my belly button to hers. I was 6. That would connect us even when she wasn't here anymore. And I remembered that to to this very day. You could also do something similar by making a wind chime with hearts, shells, keys, pipes, or Those little tiny 1 inch terracotta pots and use invisible string to connect those. But every time that it jingles, the person remembers the lost One, you can have them create a book of memories. You can have them create a heartbreak pot. And we've talked about this before. You take a big terracotta pot and you gently, if you can, break it into some large pieces using paint, pens and markers, have each family member or child write on the inside of the broken pieces, identifying their feelings about being alone in their grief. On the outside of the pieces, write about or draw sources of support and happiness and then glue them back together so they can see, you know, even use, you know, glue that kind of poofs out so you can see where the glue lines are. Recognizing that it's a little bit different. You can have them write a goodbye letter to the person and either read it and burn it, which is something we do sometimes, or, or put it in a box somewhere. You can have them write a letter to their higher power. They can create a memory garden. And this is actually going outside and planting plants in memory of that person. You can have a jar of memories or even a jar of regrets or both about that person. So when you're feeling melancholy, you can go to that jar of memories and pull out, you know, something out of the, out of the jar that reminds you of that person and brings a smile to your face. You can create a memory mural or you can even do it on comforters. Now you can take the, all the pictures and you can send them to somewhere like Walgreens and they'll print it on a comforter so you've got a blanket. You can create a timeline of change beginning when you met that person or started whatever it was to the loss, to the future. So they can. You can see how you've changed knowing that person or engaging in that activity or whatever. You can create a family flag that helps reunite the surviving family members or reconstruct the. The family like after a, after a kids leave the nest. You know, what does that look like? An Alphabet of gratitude? You know, going through each level letter of the Alphabet. Think of something that you're grateful for, and you can raise and release butterflies. That's another one of those symbolic things that people can do in order to release the anger or the anguish. Jenga write discussion prompts on cards, not on each block, because that way you can use the Jenga blocks for different things, but any of these different questions. What's your favorite memory? What's the hardest part of the loss? What's something that you learned? As people pull blocks, they have to pick a card and then answer whatever's on that card. Losses Encompass more than death of a person or loss of property. Failure to acknowledge losses can cause unhelpful reactions in similar future situations. It's important to explore feelings and reactions in terms of their functionality. How are they benefiting the person? What is this saying? What is it communicating? Remember, it takes at least a year, sometimes three, to deal with significant losses. And with most losses, there are other ancillary losses that also need to be addressed. All right, everybody, have a wonderful day. I saw a couple questions, so I'm going to spend a little time going back and answering those. If you've got time to hang around, that's wonderful. And if not, then, you know, have a great weekend. Let's see. And remembering. With labor and delivery, it's not only miscarriages. And I've shared in in other groups. When I had to have my hysterectomy, I had to go to the ob gyn who was going to do that, but I had to sit in the waiting room with 30 other women who were, like, busting pregnant. And it was. It was agonizing for me because I was having to accept the fact that I was never, ever going to be able to have another baby. So there are a lot of things. And whether you want to put that with, you know, miscarriage or you want to put that with loss of physical abilities, we do want to recognize that, you know, some things that we don't really think much of can be very agonizing for people. Some children who go through foster care still have a lot of grief that is related to the loss of their birth parents. Even if they were put up for adoption when they were infants, they struggle with the anger and depression that they never had the opportunity to grow up with that parent. And with people with terminal diseases and issues, cancer, aids, Lou Gehrig's disease, you know, the list goes on. There are a lot of physical, social, emotional losses that accompany a diagnosis like that. And sometimes when we have successive losses, you start to get numb. It's more than your. Your brain and your body can take. It's like, oh, my gosh. And they say bad things happen in threes, you know, and recognizing that, but it can feel. It can feel overwhelming. And I can empathize with that. That person in our family, you know, my father died a couple months later. His brother died. And a few months after that, my grandfather, their father died. And it was all within a year that we had, you know, three people in that family die. And by the time we got to the last one, it was just I couldn't hardly even feel. It was like, okay, another person died. And, and some, some people, like Jessica points out, may grieve the the successive loss is harder because they feel progressively more out of control, progressively more helpless and hopeless, and that threat of loss is progressively more in their face. It feels like they just things keep getting yanked from them and they have. They can't count on anything being there. The name of the book was the Body Keeps Score, and it was Bessel van der Kolk. And Patricia shared for those of you who are still here, there's a book called the Invisible String, which is about grief. So I guess my Aunt Kris knew something ahead of time that, you know, we still talk about. So, you know, there are, there's so much to learn about grief and grieving and how it relates to trauma and HPA access, dysregulation and all that kind of stuff. But, you know, hopefully this gives you a few places to start and a way to sort of reconceptualize grief and help clients start reconceptualizing it themselves. Okay, everybody, have a fabulous weekend. Stay warm, stay safe, whatever you're doing, and I'll see you next week. Between writing notes, filing insurance claims, and scheduling with clients, it can be hard to stay organized. That's why I recommend TherapyNotes. Their easy to use platform lets you manage your practice securely and efficiently. Visit therapynotes.com to get two free months of TherapyNotes or by just using the promo code CEU when you sign up for a free trial at therapynotes.com. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastce that's allce.com podcastce to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to Allce. Com sponsor. Thank you.