Living with
Bereavement & Loss
• Monday 3rd June 2013
• 10.30 - 4pm
Administration
• The Building
• Feedback Forms
Adrian Scott
• MSc Senior MBACP Accredited
• www.counsellingme.co.uk
• 07956 292 740
• adrianscott@counsellingme.co.uk
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• www.counsellingme.co.uk
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• 07956 292 740
• adrianscott@counsellingme.co.uk
My Experience
• MBACP Senior Accredited Counsellor
• MBACP Senior Accredited Supervisor for
Individuals and Groups
• Managed Counselling services in Voluntary Sector
www.phasca.com
• Bereaved, Homeless, Mental health, Carers
Expert
• Not a guru or Bereavement expert
• Do not know everything
• Ideas to be Debated / Challenged
Other City Literary
Courses
• Introduction to Psychodynamic Counselling
• Introduction to the Unconscious
• Working with Bereavement and Loss
My First Working
Bereavement Working
Experience
• Bereavement Counsellor at the
• London Hospital in 1989
• Led by Dr. Colin Murray Parkes
• Theory / Case Study
Morning Session
• 10.30
• 10.45
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• 12.00
• 1pm
Introduction
Icebreaker Exercise
Break
Theory and Group Discussion
OBSERVATION
Lunch
Afternoon Session
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1.45pm
Exercise - Reflecting on Bereavement
Break
2.30 pm Attachment / Counselling Session
3pm
Case Examples - Video
3.30
Round Up / Feedback Forms
Administration
4pm
End
Your Experience & Ideas
Case Examples
Audio Visual
• Bereavement TV Programme 35 minutes
• Four examples of people talking about Bereavement from different
cultures and social backgrounds.
• Man living in France educated in private system in the UK.
Mother died, Father died.
• Father whose wife died of breast cancer. Description by father and his two
sons about their experience of the Hospice system.
• Young boy whose father died of skin cancer. Supported through
bereavement process with counseling.
• Group of older widowers talking about bereavement. Issues of loss,
gender, being alone.
Learning Outcomes
• Icebreaker Exercise - Counselling Skills
• Listening, Hearing, Reflecting back
• Understanding Bereavement & Loss Theory
Models and Attachment
• Assessment Exercise - Own Experience/ Attachment
Personal Experience – Own Therapy
• Understanding of Bereavement Counselling
Criteria Methods
• Video Case Examples
Seeing others peoples’ reaction to Bereavement and Loss
The Day
• Wide range of skills in the room
• Hope you all get something out of it
• I am not an expert on Bereavement
• Encourage you to have your own view
Boundaries
• Look after yourselves Bereavement can be a
difficult and emotive subject
• Do not say anything you do not want to say.
This is not a therapy group!
• Confidentiality Agreement All information should be kept to this room
and with this group of people.
Icebreaker Exercise
Ask Your Colleague:
1. What brought you here?
2. What is your interest and experience of the
subject?
3. What do you want from the day?
You will be asked to briefly and concisely to report back what
your colleague has told you to the group, and check with your
colleague how you did!
Icebreaker Exercise
Learning Outcomes
Basic Counselling Skills
Listening
Hearing
Reflecting back
What do you want
from the Day?
• Are there any Topics, Issues, that you
would like to focus or discuss today?
Write on flip chart
Break
Preamble before
Bereavement Theory
• General Principles of Counselling?
• Training in Bereavement Counselling – last bastion of old
volunteer model? – Discuss
• A way to reflect on feelings
Learn about relationship with ourselves
• Generic Counselling Approach
The Intelligent Human adult..
…knows that it fruitless to dwell on painful memories and the intrusive images of
traumatic events are sometimes so painful that we will go to great lengths to avoid
them. We may do this by shutting ourselves up in a safe place (usually our home),
and avoiding people and situations that will remind us of the trauma and
deliberately filling our minds with thoughts and activities that will distract us from
the horror. But it is a paradox that -
“ in order to avoid thinking about something we have to think about it”.
That is to say, at some level we remain aware of the danger that we are trying to
avoid. Hence it should not be a surprise to us if our attempts at avoidance
commonly fail. In sleep and a time of relaxed attention painful memories tend to
float back into our minds and we find ourselves reliving the trauma yet again.
Colin Murray-Parkes
Link to Counselling
“ in order to avoid thinking
about something we have to
think about it”.
Link to Counselling
Counselling is a craft, technique,
or practice of
thinking and being with feelings
which we want to avoid
Colin Murray Parkes
• Bereavement: Studies of Grief in Adult Life
• Paperback: 288 pages
• Publisher: Penguin Books Ltd; 3New Ed edition
(1998)
• ISBN-10: 0140257543
“Bereavement Expert”
• Since 1966, Parkes has worked at St.
Christopher’s Hospice in Sydenham, where he set
up the first hospice-based bereavement service
and carried out some of the earliest systematic
evaluations of hospice care.
• Parkes has also edited books on the nature of
human attachments, and Bereavement
• Parkes is a former chairman and now life
president of the charity Cruse Bereavement Care
A Theory of Bereavement
• For this course today:
• Bereavement is a process of grieving
• Loss is the person or object
• Life is bereavement
• Minor bereavements all the time
• Beginnings and endings: relationships, friendships, jobs, work projects,
holidays, moving house
• Days, weeks, years
• We cope with major / minor bereavements in the same way??
Types of Loss
• Actual loss
• Death from old age, illness, accidents.
• Old person more acceptable loss
• Younger person less acceptable loss
• Perceived loss
• Person’s view of loss
• Culture, history, family, socialisation?
• Bereavement Counselling Time-limited
• Focus solely on bereavement
Discuss
Bereavement Study
• Colin Murray Parkes Psychiatrist at Royal London Hospital
• Effect of the loss of husbands on group of widows in
London’s East End
• Discuss: limitations?
• 1987 Case study of Henry who survived capsized ferry in
Zubbregge, Holland
• Discuss: accidents/ terrorism /wartime/peacetime?
The Cost Of Commitment
• Gain
Investment in relationships: emotional,
physical, financial.
Lives enriched but there is a ……….
• Cost
Risk of losing Gain
Process of Bereavement
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Start after loss?
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Fade away?
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Remain repressed not allowed to begin?
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Part of the process begins / Other parts held back.
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Bereavement is like a tide: it flows back and forth through the stages
•
Individual / Personal
BEWARE!
Comment on Bereavement Stages:
“the stages might lead people to expect the
bereaved to proceed from one clearly identifiable
reaction to another in a more orderly fashion than
usually occurs. It might also result in … hasty
assessments of where individuals are or ought to be
in the grieving process”
P.351
Handbook of Bereavement, Cambridge 1993
Bereavement is like a tide
Bereavement Summary
“ in order to avoid thinking about something we have to think about
it”. Link to Counselling
Bereavement is a process of grieving
Loss is the person or object this is lost
The Cost Of Commitment
Bereavement is Individual and Personal
The stages to do not occur in order
Bereavement is like a tide
Stages of Bereavement
Theory
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1. Alarm
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6. Gaining a New Identity
2. Searching
3. Mitigation – Lessening the Impact
4. Anger & Guilt
5. Disorganisation & Despair
Theory is theory - feel able to agree or contradict it!
Discuss
Colin Murray-Parkes
1.Alarm
• Tension, Shock, Panic, Disbelief Restlessness
• Numbness – some emotions break through
• Preoccupation / obsessiveness with thoughts of the lost
person.
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Self-care neglected
Breakdown of customs / behaviour
Sensitive to noise, conflict, administration
Shut down to avoid feelings
2.Searching
• Calling for the lost person
• Sobbing, tearfulness,
• Feeling of loss / lost Discuss
• Visit places of experience
• Aimless searching – irrational?
• Find lost person
3.Mitigation–Trying to
Lessen the
Impact of Bereavement
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Components of grief work
Pre-occupation / wish to find the person
Repeating, painful recollection of the loss
Patterns, Obsessive thoughts, PTSD
• Making sense of the loss to fit assumptions - meaning
• Dreams - common dream - happy interaction with the
dead
• Pining / Avoidance of Pining
• Idealised person - forget the negative
4.Anger and Guilt
• Familiarity - loved ones, family members
• Misdirection - Hospital staff / GPs
• Blame / Self Blame
• Anger guilt becomes irreconcilable - leading to family
splits
• Resistance to sadness, grief under the anger and guilt
5.Disorganisation and
Despair
• Period of uncertainty
• Take on the reality of what has happened
• Identifying with lost person – method of avoiding the
loss of that person
• Old model of the world abandoned
• New set of expectations created - with time and
acceptance
• Other people become a support, security, &
protection.
6.Gaining a New Identity
• Taking on role/interest that lost person had
• New versions of old relationships
• New relationships
• New interests
• New updated view of the world
• Less repressed / more flexible
6 March 1987
193 people killed
• The British ferry Herald Of Free Enterprise
capsized off the coast of Belgium
• The ferry overturned without warning only a
mile outside Belgian port Zeebrugge
• Despite the best efforts of rescue crews, it
became the worst ferry disaster in British
history.
Colin Murray Parkes –
Case Study
• Henry - An Extreme Example
• The case of Henry who consulted me two
months after several members of his family
had been killed in the Herald of Free
Enterprise, illustrates these bereavement
stages.
The Event - Alarm
He recalled how he had left his family below and was smoking
a cigarette on the top deck of the Herald of Free Enterprise
when the boat suddenly heeled over and then capsized
outside Zeebrugge harbour.
His immediate reaction was to save his own life. He managed
to smash a window and escaped onto the outside of the boat
that was now lying on its side and half submerged.
Only now did he realise that his family were still below. In his
alarm, he tried to climb back into the ship but was deterred by
a fellow survivor who warned him “You’d never get out of
there alive”.
Maintaining alarm
• Henry remained on board for five hours, helping
with the rescue operation and watching anxiously
as each new survivor emerged from the ship. But
none of his own family came out alive and, in the
course of the next two weeks he was to identify
the bodies of four of them as, one by one, they
were recovered from the wreck.
Henry - Extending the Event- Searching
Avoidance Panic
Throughout this period he exerted a rigid control on himself
and he was still not crying two months later when he was
persuaded to seek psychiatric help.
At this time he was tense, chain smoking to control his nerves
and feeling numb and depressed. He was easily upset by loud
noises and was particularly sensitive to the sound of rushing
water.
He had shut himself up at home and seldom went out. His
surviving daughters feared that he might kill himself.
Henry - no interest in himself Suicidal Stuck
Re-Enactment
Three months after the disaster a heavy thunder storm took place and,
when I saw him the following day, Henry appeared haggard and
exhausted.
“It was the thunder,” he said, “it was the same noise that the boat
made as it turned over. I heard the children screaming”. He then
related, in great detail and with tears pouring down his cheeks, his
memories of the disaster.
The experience was so vivid that I too felt caught up in the situation.
After a while I said, “You’re still waiting for them to come out aren’t
you?”
Henry - Routine Event re-enacts trauma - moves stuckness
Post-Traumatic Stress
Disorder
The case illustrates the features of Post Traumatic Stress
Disorder (PTSD)
As long as Henry succeeded in avoiding the thoughts of
what had happened he could not escape from the
memories that were constantly threatening to emerge.
The thunderstorm acted as a trigger to his memories and
allowed him to begin the process of grieving.
Summary
Stages of Bereavement
Theory
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1. Alarm
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2. Searching
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3. Mitigation – Lessening the Impact
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4. Anger & Guilt
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5. Disorganisation & Despair
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6. Gaining a New Identity
Summary - Henry
Saved himself – anger guilt
Stayed on the boat - maintained alarm
Avoidance Panic - isolated himself to cope
Trigger – overwhelmed by feelings
Re-enacted trauma with counsellor
Attachment Theory
John Bowlby
• What is Attachment? - A Secure Base?
• Attachment - emotional bond to another
person.
• Earliest bonds in childhood have life long
impact
• Attachment survival mechanism - keeps infant
close to the mother
• A Good Attachment
• Primary care givers are available & responsive
to infant's needs creating a sense of security.
• The infant knows that the caregiver is
dependable
• Creates a secure base for the child to explore
the world
Experiment with
rhesus monkeys
• Monkeys offered two objects to attach to
• Soft mother dummy without food
• Hard mother dummy with food
• Monkeys preferred soft dummy without food
• Discuss – reaction against Freud’s Instincts
Theory
• Bereavement is an extreme broken
attachment / separation from a loved one
• First experience - primary care giver and child
• Main Carer’s emotional state critical
around baby’s birth
Primary Carer & baby relationship
major influence on adult life
Attachment Theory
Conclusions
• Counselling explores attachment figures
• Secure Base of counselling time, place, frequency
• Explore early attachment relationships
• Notice relationship between counsellor and client
• Expectations and perceptions of attachment figures
• Reflect on the accuracy of self images
• Holding and Containing