What is This Grief “Thing”?
How Families Grieve The Loss of
Someone Close
Michelle Post, MA, LMFT
Clinical Aftercare Specialist
OneLegacy Family Care
Outline
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•
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What to do/not do for a grieving person
Describe J. William Worden’s Grief and Loss
Model (4 Tasks of Mourning).
Identify normal grief reactions and warning
signs of Depression.
Michelle A. Post, MA, LMFT , 213-229-5687 Email: mpost@onelegacy.org
Quick Survey
by show of hands
• How many of you have had experienced
the death of a patient?
• How many of you have had a friend
who has experienced the death of
someone close?
• How many of you knew exactly what to
say to help the patient’s family or your
friend with their grief ?
Quick Survey
• How many of you have ever had first
hand experience dealing with the death
of someone close to you?
• During your grief, how many of you had
someone tell you something (maybe in
an effort to try to help you) that was
NOT helpful, or even hurtful?
The Platitudes/Clichés
• Time heals all wounds.
• Think about the good times.
• God needed another (angel, plumber,
teacher, coach, etc.) in heaven.
• It was God’s will / Everything
happens for a reason.
• Something good will come of this.
• She/he led a full life.
Is Death a Universal Truth?
Elizabeth Kubler-Ross - 1969
Hearses vs white vans
Underused hospice
Is Death a Universal Truth?
Who Do We Turn to?
MDs (some see death as failure)
Clergy good & bad
Funeral Homes
Crisis Response Teams
Police & Firefighters
Is Death a Universal Truth?
Who Do We Turn to?
Professional Counselors:
Training?
DSM Code for Bereavement gives timeframe?
2 months (numbness wearing off)
kids (23years old and under): 6-12 mo
Grief Statistics:
• 1 in 5 kids will experience the death of
someone close by age 18 (Kenneth Doka, Editor of OMEGA
Journal of death and dying)
• 1 in 20 kids will experience the death of
one or both parents by age 15 (Steen, 1998)
Grief Statistics:
Close to 2 million children receive death
benefits from a deceased worker (Social Security
Administration, 2007)
…And that is just the KIDS!
We serve 2200 to 2500 new families each
year just in OneLegacy
If Death is a Universal Truth,
Grief is the Great Equalizer…
Everyone is Affected!
Possible Pitfalls for Those Who
Do Not Reconcile Their Grief:
• Avoid love as a way to avoid pain
• Inability to acknowledge the pain
of others
• Avoid risks
Possible Pitfalls for Those Who Do
Not Reconcile Their Grief:
• Inability to express love for their own
children
• Experience a sense of ‘searching’ for that
which was lost
• Resisting school or work projects which
demand long-term commitment
What can we do to
help with grief ?
‘Normal’
Grief can
last years
AOPO:
Aftercare ~
2 yrs min.
What can we do to
help with grief ?
What does your
hospital do to
support a
grieving
family?
What can I do to for
personal/professional grief ?
Explore Your Own Grief Attitudes
J. William Worden, Ph.D.: Personal Death Awareness;
or Grief Counseling & Grief Therapy: A Handbook
for the Mental Health Practitioner
What Else Can I Do?
~Learn a Model of Grief and Loss
Learn a Grief Model
J. William Worden’s 4 Tasks of Mourning
Task 1: To Accept the Reality of the (Death)
Task 2: To Experience the Pain of the (Death)
Task 3: To Adjust to an Environment in Which the
Deceased is Missing
Task 4: To Relocate the Dead Person within One’s
Life and Find Ways to Memorialize the Person
•Adapted from Grief Counseling & Grief Therapy; Children & Grief:
When a parent dies by J. William Worden, Ph.D
J. William Worden’s
4 Tasks of Mourning
Task 1: To Accept the
Reality of the
(Death)
•Adapted from Grief Counseling & Grief Therapy; Children & Grief:
When a parent dies by J. William Worden, Ph.D
Task 1: To Accept the
Reality of the (Death)
• The griever begins to grasp that the person
has actually died.
• Even when the death was expected, there is
still often a sense that it hasn’t really
happened.
• Intellectual vs. emotional acceptance of the
death. Intellectual acceptance may come
long before emotional acceptance.
Task 1: To Accept the
Reality of the (Death)
Traditional rituals (funerals/memorials)
assist the bereaved in moving toward
acceptance of the death as real.
** Include children!
Task 1: To Accept the
Reality of the (Death)
Belief and disbelief come and go over time.
Examples:
Misidentify another person as the one who has
died or think they see or hear them.
– "I still hear his keys in the door".
– "I expect to see her cooking in the kitchen".
Task 1: To Accept the Reality
of the (Death)
• Families will need to repeat their stories
many times.
• Ask questions that that ask for details
surrounding the death
Task 1: To Accept the Reality
of the (Death)
• The death becomes more of a reality as
each "first" occurs without the deceased
- 1st birthdays, death markers/dates, etc.
- 1st holiday season. Ask about the last
holiday and what they think they will do for
the next one.
Best thing you can say?
Actually best thing is to
just listen…
If you HAVE to say
something… DON’T SAY:
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•
•
•
•
•
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I understand how you feel.
Death was a blessing.
You’re still young/ have whole life
ahead of you.
You can have other children/Find
another.
Call me when I can help.
It’s time to put it behind you.
Be strong!
If you HAVE to say
something… Try…
I’m sorry/ I’m sorry you are going through this.
How are you doing with all this?
What can I do for you?
I’m here and I want to listen.
What’s the hardest part for you?
I’ll call tomorrow/Friday/in an hour.
I can imagine how much this hurts.
It isn’t fair, is it?
Take all the time you need.
J. William Worden’s
4 Tasks of Mourning
Task 2: To Experience The
Pain Of The (Death)
•Adapted from Grief Counseling & Grief Therapy; Children & Grief:
When a parent dies by J. William Worden, Ph.D
What is the pain of
“Normal” Grief ?
If ‘Normal’ Grief can last
years, what are the symptoms?
See “Potential Symptoms of
Grief ” Handouts
“Normal” Grief is…
Symptoms?
See Handouts:
Normal Kids/Teens Grief
and Potential Symptoms of Grief
What stands out to you or surprises you?
Task 2: To Experience The Pain Of
The (Death)
•Pain will vary in intensity from person to
person and may come and go.
•Friends, culture, and society may interfere
with the successful completion of this task
by not allowing the griever to grieve.
-“Think about the good times”
-“Be strong”
Task 2: To Experience The Pain Of
The (Death)
•Avoidance = drugs, alcohol, travel,
relocation, constant work, or quickly
entering into a new relationship.
•Avoidance hinder one’s ability to heal. The
pain will eventually reappear.
Task 2: To Experience The Pain Of
The (Death)
WHAT IS ABNORMAL GRIEF?
•Active Suicidal/Homicidal Ideation, Plan,
Intention, Means
•I don’t know how I will go on! – Normal
•I wish I could be reunited/wish my pain
was over/wouldn’t care if I died – Normal
•I’m going to kill myself ! - Abnormal
Task 2: To Experience The Pain Of
The (Death)
WHAT IS ABNORMAL GRIEF?
=Command hallucinations
•I thought I saw him walking down the
street. – Normal
•I felt her presence in the room – Normal
•I heard him tell me to trash my mother’s
house/join her in heaven – Abnormal!
J. William Worden’s
4 Tasks of Mourning
Task 3: To Adjust to an Environment
in Which the Deceased is Missing
•Adapted from Grief Counseling & Grief Therapy; Children & Grief:
When a parent dies by J. William Worden, Ph.D
J. William Worden’s
Task 3: To Adjust to an Environment
in Which the Deceased is Missing
•The grieving person may need to learn new skills,
and perform functions that the person who died had
previously taken care of. This happens just at a time
when they are burdened with acute grief and the
least capable of doing so.
•The bereaved tries to gain a sense of control over
his or her life.
•Help them to brainstorm who can help with daily
activities for themselves/family (baby sitting,
picking up kids, cooking, etc.)
J. William Worden’s
Task 3: To Adjust to an Environment
in Which the Deceased is Missing
Not only is the relationship gone, but also that part
of the grieving person’s identity.
“Who am I if I am no longer John’s wife?”
“Am I still a parent if my only child has died?”
“What do I say when people ask me how many
children do I have?”
-Give them permission to answer these questions
differently or the same as they did before the death.
J. William Worden’s
4 Tasks of Mourning
Task 4: To Relocate the Dead Person within
One’s Life and Find Ways to Memorialize
the Person
•Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D
Michelle A. Post, MA, LMFT , (310) 927-5611 , Email: michpost@ca.rr.com
J. William Worden’s 4 Tasks of Mourning
Task 4: To Relocate the Dead Person within One’s Life
and Find Ways to Memorialize the Person
•Assist grievers in finding a new place, internally, for
their relationship with the person who died.
•Grievers find ways to create a new "normal".
•The griever re-invests in their current life, while
maintaining continuing bonds with the person who
died.
•Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D
Michelle A. Post, MA, LMFT , (310) 927-5611 , Email: mpost@onelegacy.org
J. William Worden’s 4 Tasks of Mourning
Task 4: To Relocate the Dead Person within One’s Life
and Find Ways to Memorialize the Person
Grievers create or continue traditions and rituals
which allow them to honor the memory of the
person
Some make a pact with themselves never to love
again
Many go on to form new attachments and
relationships
•Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D
Michelle A. Post, MA, LMFT , (310) 927-5611 , Email: mpost@onelegacy.org
J. William Worden’s 4 Tasks of Mourning
Task 4: To Relocate the Dead Person within One’s Life
and Find Ways to Memorialize the Person
Help with Remembering
Help the family start thinking about the “legacy”
their loved one will leave
• Encourage story telling
– Opportunity to share a part of their life with you and to
introduce you to the person they loved through memories
– Help facilitate the process
• strengthens rapport and trust
• comforting and reassuring
• Memory Boxes
• Hand Molds, Scrapbooks, Web-pages
What Else Can We Do to Help?
~ Watch Your *#$%&* Language
What else can we do to help?
See Do’s and Don’ts Handout
&
Child Speak Handout
~DO - Simplify Language for Grievers!
~Why is it important to
simplify language?
It’s okay to say
dead…
died…
death…
Let’s practice!
Helps with Worden’s First task of mourning
– to accept the reality of the death
What to Encourage for Grievers
DO: Encourage choices (leads to feeling in control)
DO: Encourage routine activities.
DO NOT: Encourage Change in 1st 12 months,
Instead: keep home, school, work, relationships the
same.
Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D
To Include or Not to Include Kids in the
Hosp/Funeral? Seeing/Touching the Body?
DO Include them!!!!
The Harvard Study Research: The picture in their
head is often worse than what is real.
- Not being involved is a risk factor for later complicated grief
Prepare children & teens & adults for what they will
see, hear, feel and/or smell.
Let them get involved. Testing in front of them can
help them accept the reality of the death.
Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D
Include them!!!!
Include children in all aspects of information
sharing, hospital visits, and family mourning
rituals.
In ICU or at a Funeral:
Provide a buddy for them (1 adult per child)
Debrief with them.
Adapted from Children & Grief: When a parent dies by J. William Worden, Ph.D
Q&A
Any questions?
Case examples with concerns?
Something you did to assist a family in their grief
that worked well?
What else can
your hospital
do to support
a grieving
family?
What is This Grief “Thing”?
How Families Grieve The Loss of
Someone Close
Michelle Post, MA, LMFT
Clinical Aftercare Specialist
OneLegacy Family Care