Cognitive-Behavioural and
Constructivist Strategies for
Loss Adaptation
Cognitive Behavioural
Strategies
•
Focus on altering irrational or maladaptive thoughts,
assumptions, and beliefs that impair a functional
adaptation to loss.
•
The goal is to help clients identify and evaluate
beliefs and thoughts that keep adaptation to loss in
a state of impasse.
•
Examples anyone?
Underlying Assumptions
•
What is the story behind an individuals grieving or not grieving? CBS clinicians
assume that there are faulty assumptions behind why an individual is not adapting
to their loss
I should have been a better wife/husband
I should have not let her/him drive
I don’t have the love I want, then I am nothing
Life is not worth living without her/him
I should be able to control my emotions
I deserve this pain because...
If they loved me they wouldn’t have left me
If I forget them or if I stop grieving I will forget them
It is terrible and awful that I have to experience this
“IF I...” and Self Blame
Statements
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CBS, and the Philosophy
Behind Emotional Distress
• Grief is normal and even necessary, but there is
a distinction between healthy and unhealthy
emotional responses
•
Really?
• Normal = sadness, sorrow, and pain
• Dysfunctional = anxiety, fear, and selfdeprecation
Dysfunctional beliefs...
•
Distort an accurate perception of reality
•
Make absolute demands
•
Assert low frustration tolerance
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Catastrophize circumstances
• Thus dysfunctional beliefs are responsible for our
symptoms (i.e., anxiety, fear) not our loss per se
• As a result CBS clinicians hold that people can choose
different beliefs which aid in loss adaptation
Entrenched Beliefs: There is
No GOing Back...
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Using the CBT approach with
loss and grief
•
Fully elucidate the loss and grief story (tell and
retell)
•
Identify “discomfort anxiety cognitions”
•
Help clients establish a sense of control over
overwhelming feelings/thoughts
•
Detect avoidance behaviours (too little / too much)
Managing Repetitive
Thoughts and Ruminative
Coping
•
Grievers are sometimes burdened by a flood of repetitive
intrusive and distressful thoughts / emotions
•
Bringing about a snowball effect that people feel
powerless to stop
•
Impeding restoration loss adaptation
•
Strategies to Deal with Ruminative Coping
Refocusing - we all do this
one!
• Simply catching ourselves involved in a
stream of thought
• Redirecting attention toward thinking about
something else
• Goal is to crowd out repetitive and or
intrusive thought and emotions
Thought Stoping With
Refocusing
• Use startling action to interrupt stream of
thoughts and then use refocusing to switch
thinking in another direction
• Let’s try the
method
•Constructivist Strategies
Introducing the Kinesthetic Swish
Preparation: Cue Feeling
a.Remember an upsetting feeling from your
past, or
b.Think of an upsetting feeling associated with
your future, or
c.Recall an upsetting experience and let that
experience become a feeling you can locate in
or on your body.
•
•
Step 1
Identify the Cue Feeling: an upsetting feeling
on or within your body (associated). This
feeling should be a sensation, not an emotion.
Step 2: Break State
• What
is your telephone number
backwards?
•
Step 3: Instruct Clients
• In
front of you, physically sculpt your
Desired State Feeling within or on an
evolving, future you. A you who has
already solved your felt issues. You are
being different, but not perfect, but feel
confident, resourceful and you have a
sense of humor.
•
Step 4
•
Now, gently press the evolving, future you with Desired
State Feeling down into the ground in front of you, as
though you were setting the spring in a "Jack-in-theBox."
Step5: Break State
• What
is your telephone number
backwards?
•
Step 6
•
Now, as you begin to sense the Cue Feeling, allow that
feeling to rapidly diminish as it moves down your body
and into the ground (as though it were being drained or
squeezed from you, like toothpaste from a tube).
Step 7
•
Simultaneously, sense the evolving, future you (which
has the Desired State Feeling) spring up from the
ground in front of you. And as the evolving you is
coming up, place your finger-tips on his or her
shoulders, feel him or her facing you, and feel the
radiating sense of internal confidence, resourcefulness
and humor coming from within him or her.
Step 8
•
Now, feel a gentle rain coming from the sky and
washing over you (break state).
•
The gentle rain washes away the wonderful, evolving
you and your arms return to your sides.
SLowly Step 9
as you begin to sense the Cue Feeling, allow that
g to rapidly diminish as it moves down your body
nto the ground (as though it were being drained or
ezed from you, like toothpaste from a tube).
Slowly Step 10
•
Simultaneously, sense the evolving, future you (which
has the Desired State Feeling) spring up from the
ground in front of you. And as the evolving you is
coming up, place your finger-tips on his or her
shoulders, feel him or her facing you, and feel the
radiating sense of internal confidence, resourcefulness
and humor coming from within him or her.
SLowly step 11
•
Now, feel a gentle rain coming from the sky and
washing over you (break state).
•
The gentle rain washes away the wonderful, evolving
you and your arms return to your sides.
Fast Step 12
•
Now, as you begin to sense the Cue Feeling, allow that
feeling to rapidly diminish as it moves down your body
and into the ground (as though it were being drained or
squeezed from you, like toothpaste from a tube).
Fast Step 13
•
Simultaneously, sense the evolving, future you (which
has the Desired State Feeling) spring up from the
ground in front of you. And as the evolving you is
coming up, place your finger-tips on his or her
shoulders, feel him or her facing you, and feel the
radiating sense of internal confidence, resourcefulness
and humor coming from within him or her.
Fast Step 14
•
Now, feel a gentle rain coming from the sky and
washing over you (break state). The gentle rain
washes away the wonderful, evolving you and your
arms return to your sides.
Final step - 15
•
Test: Try to get the upsetting feelings.
•
If there are no upsetting feelings, the process is
complete.
•
If you can still get the upsetting feelings, ask for the
positive intention of the upsetting feelings, satisfy them
with reframing and, when ecologically sound, repeat
the Kinesthetic Swish.
A Letting Go Meditation
A Letting Go Meditation (cont).
A Letting Go Meditation (cont).
A Letting Go Meditation (cont).
Use of Metaphor to Establish
Acceptance and Challenge Ruminative
Coping
Leaves on a Stream
Metaphor
Objects of Connection
•
Are special item(s) a griever has which facilitates
and maintains a connection with that which they
have lost.
•
Provides a powerful and meaningful ongoing bond
with the lost person, relationship, or situation.
•
They are often carried with or placed in a specific
place within the grievers environment (location is
known)
Objects of Connection
(cont.)
• Objects of connection can be positive or
• Maladaptive... revealing attachment clinging,
avoidance of reality of loss, or disruptive
meaning structures
• Counsellors need to explore the adaptation
behind objects of connection
Symbolic and Linking Objects
•
Symbolic objects represent a former or current
meaning connected to the lost person or situation in
the grievers life.
•
Examples: Airliner ticket / concert ticket, vacation
photograph, written letter/poem, etc.
•
Symbolism of object changes over time, may
represent the grieving process itself or act as
a symbol for the transition of loss flowing into
present time
Linking Object
•
Differ from the symbolic in that they are used to
invoke the presence of the diseased
•
Linking objects (i.e., teddy bear) are active symbols
in that they activate the real experience of the
deceased in the bereaved’s life
•
Inner representation creates both solace and is
way to continue a bond with the deceased
•
But also permits investment in new
relationships and in rebuilding one’s life or
redefining one’s identity
Implementation of Object
Connections
• Step 1: ask about objects, increase therapeutic alliance,
assessment tool
• Step 2: validate, get client to bring object to session,
normalizes experience, facilitates meaning
• Step 3: explore meaning and function, understand it’s
significance (is it a linking object, how is used - restoration
coping), connect loss to the hear and now, how does it
provide a continuing bond, does it interfere with new
relationships, does it reveal cultural influences, etc.
• Step 4: Address resolution problem areas and facilitate
transitions, (challenge where might continuing bonds be
unhealthy, how has the object changed in meaning, what
does it say about who are where they are today
Using Photographs to
Facilitate Meaning
Reconstruction
• Photographs provide a factual record and
symbolic reference point around concerns and
issues about the bereaved’s grieving and
adaptation process
•
Photographs help clients to tell their story, used
to evoke emotions, reconstruct past, reminisce
with laughter and honour their loss, encourage
meaning reconstruction, expose maladaptive
thinking/avoidance, family structure, etc.
Facilitating Growth via Photograph
• Our job as a counsellor in using photographs
is to assist clients in encountering images
anew by examining them critically
• We raise questions that explore assumptions
and beliefs, encourage reflection, and honor
client experience
• Some questions we might ask:
• What is happening in this picture?
• What does this picture say about the people
in it and the person taking the picture?
• What feelings are coming up right now as
you look at the photo?
• What do you see now, as you look over
these photographs form the perspective of
wisdom and experience in light of adapting to
your loss?