LIVING & WORKING WITH LOSS
Eileen Scott
eileenscottnally@gmail.com
LIVING AND WORKING WITH LOSS
Explore the crisis of
impending death, sudden
death or grief comes, as it
can be overwhelming for
children, adults and
professionals
Loss is universal indiscriminate
Youth, independence, innocence, a
parent, mobility, health, home,
purpose, love, work, financial
security, sexual drive, privacy,
dignity, freedom
Supporting Resilience Empowering Lives
How can you identify
those students in
particular need of
assistance or support?
How can you remain resilient
in the midst of this work and
all the other demands at work
and at home?
How can you support
students who are
dealing with
experiences of loss?
What language, strategies and
coping mechanisms do you
have
WORKSHOP PLAN
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Theoretical Framework
Anticipatory Grief
Grief Work Murray Parkes
Case Study
Motivational Interviewing
Active, Empathic and Reflective
Listening
Strengths-based practice
Defence/Coping Mechanisms
Enhance existing skills
and resilience by
exploring ways of
engaging with students
experiencing Loss
Resilience?
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The capacity to cope with change and challenges and to bounce
back during difficult times – get flak from a colleague bounce
back after a short while
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Seeing defenses as coping mechanisms/strategies rather than as
obstacles to be overcome
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Look at how we perceive resistance
- transforming resistance into resilience
From Resistance to Resilience
 Reluctance
– not committed to change
 Resignation – too late for change
 Rebellious – don’t tell me what to do
 Rationalisation – over intellectualise
Theoretical Perspective
Anticipatory Grief
What is anticipatory grief?
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Anticipatory grief is what happens when we know there
will be a loss, but it has not yet occurred.
Applies to illnesses like end stage Parkinson’s or when a
person’ cancer is no longer curative,
It can be a time for families to experience and witness
the joys and struggles associated with illness, dying and
death.
Anticipatory grief allows time
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To resolve any regrets,
To make amends,
To let go of anger or guilt or
To continue as before.
Phase I Anticipatory Grief
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In this stage, an individual and their family start to
realise that death is inevitable and there is no
expectation for a cure/recovery.
It can be a time of questioning, of reviewing life, as
well as a time of uncertainty, isolation and loneliness
for all the family.
Sadness and depression are often associated with
this first stage of grief.
Phase 2 What’s going on at home?
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For the person who is sick, their insight and awareness may
be increased or intensified, they may have their own fears
of death, dying and the future for themselves and their
family and friends.
The person who is sick may be very astute to emotions
expressed verbally or non verbally by those around them,
be they health care professionals, family, friends,
neighbours…...
Family members may have regrets about arguments or time
not spent together or guilt about their own good health or
old age.
Phase 3 Family may rehearse the death.
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The physical process of death and what may happen
after death is discussed, such as laying out the body,
the funeral and the burial arrangements. It may be the
first “big” death in the family.
The person who is sick may have to make tough
decisions i.e. about their children's’ future, their own
belongings, their home, making their will.
The sick person will be saying goodbye to life, to family
and friends….. How is this for your student?
Phase 4 Anticipatory Grief
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In the last phase, family members may be imagining what their lives
are going to be like without the person that is dying.
When a child is dying parents may think about the unused toys left
behind, missed graduations, birthdays, or the wedding and grand
children that will never be.
The person dying may think about life after death, review their own
spiritual and religious beliefs.
They may also try to imagine what it will be like for their family to
live without them.
What questions might they ask you?
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Will he get better?
Its not looking good for him?
I don’t think he is getting any better?
Has he long?
Its time for him to go.
How will we cope without him?
I need to sort things out.
Empathic Opening Responses?
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I would like to help you
From what you have told me your dad sounds very
ill, and has been getting weaker over the last few
weeks
From what you just said it seems your dads condition
has gotten worse
You seem worried that he is getting weaker
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I would like to talk to you about that but I really
don’t think I am skilled enough to, can I ask someone
else to join us
You sound really worried………..
I would like to talk to you about that, can I come
back to talk to you when I have finished..
I don’t know, how is your dad today…
Analysis
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What is he going through emotionally, spiritually and
physically?
What is important to the student
What do you know about him, his parents, his siblings, the
family, the illness, their past crisis’ and how they coped?
What might you not know?
Who can help/support them?
What do you know about their discussions with other
professionals and family members?
Analysis
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Why did they ask you?
What time of the day is it, 3pm, 8am 9pm; is this
significant for them, for you?.
Do they want support as opposed to being alone with
their thoughts
Where are they asking - in a busy corridor, in car park,
in your office, after school, how does the environment
impact on them and on you?
Colm Murray Parkes Models of Grief
Alarm & Numbness
This is the initial reaction to the
news of the loss which can persist
for sometime.
Acts as a “defense mechanism”
Alarm can be related to “how will
I cope”
SEARCHING:
Trying to retrieve what has been
lost.
In ‘pangs’ of grief, the bereaved
may call out for the
deceased.
May physically search for the
lost person in places
associated with the person
Colm Murray Parkes Models of Grief
MITIGATION:
What will make the pain
less
Bereaved may avoid
people/places that will act
as reminders
Most people idealise the
deceased, society
encourages it.
ANGER AND GUILT
“Why did you do this to me”?
May see pain of grief as a punishment.
Often seek someone to blame e.g. God,
hospital.
Anger not always directed towards what
gives rise to it – can result in isolation or a
withdrawal of support.
Self reproach – “ I should have made him
go to the doctor sooner”
Colm Murray Parkes Models of Grief
GAINING A NEW IDENTITY:
Loss of identity inherent in bereavement
“I feel as if part of me is missing’
Change of roles can make one feel insecure/inadequate
Identification with the deceased (behaving and thinking like the
person who has died)
Factors that complicate grief
Children or adolescents in the immediate
family.
Dependant family members- disabled, elderly,
sick
Loss of primary care giver/constant
companion/emotional support.
Loss of financial provision.
Loss of home, feared or actual
Anxiety about making decisions.
Family unable to share feelings.
Reluctance to face facts of illness or death.
Marital or family discord.
Memories of uncontrolled pain, nursing
difficulties or emotional distress during
the individuals illness.
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Presence of concurrent life crises.
Difficulty in dealing with previous loss
Excessive or prolonged emotional reaction, mental
illness or suicide risk.
Self-care difficulties.
Lack of spiritual support.
Lack of community support.
Distress over changed body image or personality
before death.
Absence at time of death: did not say goodbye.
Violent death or suicide.
Factors that influence the grief process
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Who the person was.
The nature of the Attachment.
The Mode of death.
Patterns of communication already in the
family
Personality variables of the bereaved.
Level of support people have.
What are their strengths
Case Study
Motivational Work
In order to face up to problems people usually
feel that they have more to gain than to lose
by doing so, and that there are effective
solutions
There are three main reasons we do things
1.
Because we must do them
2.
Because we think we ought to do them,
3.
Because we want to do them
Aims
The aim of motivational work is to help the
student move from “must attend” to “want
to change and be a better person”
Motivate or encourage students to engage, to
find hope and support and to strive for
achievable goals
To achieve this we must listen
The Basics of Reflective Listening
Give up all your preconceived ideas and your subjective opinions.
Put little or no emphasis on right and wrong or good and bad.
Usually when you listen to a statement, you hear it as a kind of echo of
yourself.
You are actually listening to your own opinion.
If it agrees with your opinion you may accept it, but if it does not, you
will reject it or may not even really hear it.
Zen Mind Beginner’s Mind Suzuki
The Basics of Reflective Listening
To listen all you have to do is quieten the mind
Listening, following, is not jumping ahead of what you are hearing, nor is
it reading your own conclusions, imagining solutions to potential or real
problems.
It is hard not to offer advice or suggestions, especially if you care about
the student.
It can be difficult to listen when you hear something unsettling, that
threatens you, when your brain seems hardwired in a fight or flight
response. Harriet Lerner
LISTENING, FOLLOWING …
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Active: summarising, repeating, paraphraising, clarifying,
checking out, validation – to acknowledge and try to understand
their unique perspective, reflecting back – it sounds like your feeling
really….
Empathic is freeing yourself up inside enough to see, understand
and experience life through anothers’ being. Become aware of the
persons’ private inner world of perceptions, conscious and blocked
feelings, and the meanings and significance they ascribe to these
perceptions and feelings.
Reflective question, allows the student space and time to reflect
and challenge himself. How did you feel about yourself being angry
so much of the time
Questions: problems to avoid
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Asking several questions at once
Making statements when it would be better to ask a question
Telling someone what their problem is
Asking leading questions – gives away your thinking
Vague or meandering questions
Making value judgments or statements about the value of his insight e.g. you have been
brave to say what you have said or that must make you feel bad. The focus needs to be
on his own evaluation.
Avoid the word honest, use you have been more open today – leaves the door open
Jargon or phrasing
Asking a question without first thinking of how you will phrase it
The labeling trap – you are in denial
Criticising, shaming or blaming – implied or explicit
Confusing therapeutic conversation with the rules and habits of social conversation
Bad habits e.g. would it be fair to say… isn’t it the case that.. Are you happy with that
Motivational Questioning Technique
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Simple repetition – allows the person to go on and say the next thing
Silence, pausing and waiting
Partial repetition with probe – say more about…
Unfinished repetition- because.. and…
Simple reflection – I notice that you talk a lot about how you were feeling angry..
Amplified reflection – it sounds like you are saying that you had no choice at all, that you had
to steal the car
Verbal underscoring – lets pay attention to that important point that you just made.
Shifting focus, gives you more control over the process and helps keep on track. Helps keep
the student focused on the task, and helps them to structure their thinking- I’ll ask you to
pause there so that we don’t lose track of something important you said a moment ago. When
you said…
Colombo Technique / Socratic Questioning
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Asking naive questions that lead from one step behind:
can you help me understand…? Withhold your
expertise and allow the person to fill in the blanks of
your understanding.
What are the other options that you could think about?
What was the effect of that thinking/behaviour?
The next time you are angry what would be a better
strategy for you?
Colombo Socratic Examples
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Socratic questions are those designed to lead the individual to make his
own discoveries and insights based upon a series of incremental questions
and answers.
Like invitational questions. Participants are more likely to integrate
knowledge they come to through their own thought process rather than that
which is delivered or imposed upon them
Which way do you think is the best way?
What might be a different way to see that?
How might other adults see that problem?
What might X think if he /she heard you say that?
What went well recently?
START FROM A PRINCIPLE OF STRENGHT
Principle start from Your Strengths
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Internal Strength: Quality that you value
in yourself
Interpersonal Strength: Who gives you
strength – family, alive or dead
Transpersonal Strength: Bigger than
humanity –spiritual, religious, nature,
music, art
Other Strengths : Past accomplishments,
things you like to do, sense of place,
belonging