Working with
Bereavement & Loss
• Saturday 15th November 2014
• 10.30 - 4.30pm
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
• 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
• 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
• Living through Bereavement
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
• 10.40
• 10.55
• 11.40
Introduction
Icebreaker Exercise
Break
• 12.00
• 1pm
Theory and Group Discussion
Lunch
Afternoon Session
• 2pm
Working with your own
Bereavement & Loss
2.45pm Break
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3pm
3.30
4.10
4.30
Working with Bereavement & Loss
Case Examples – Video
Round Up / administration
End
Your Experience & Ideas
Case Examples
Audio Visual
• St. Christopher’s Hospice
Bereavement Group – 20 minutes
people with terminal illness
Tavistock Institute
Couple whose son has died 40 minutes
poor quality
Dr Anthony Crouch
5 minutes
Learning Outcomes
• Icebreaker Exercise - Counselling Skills
• Understanding Bereavement & Loss Theory
• Assessment Exercise -Own Experience/
Attachment
• An Understanding of Working with Bereavement
& Loss
• Case Examples - Video / Suggestions from you!
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!
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
10-15 minute Break
Preamble before
Bereavement Theory
• General Principles of Counselling?
• Training in Bereavement Counselling –
last bastion of old model? - Discuss
• Generic Approach
Learn about relationship with ourselves
• A way to reflect on feelings
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
“ 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 surprise 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 Handout
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
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
Process of Bereavement
• Start after loss?
• Fade away?
• Remain repressed not allowed to begin?
• Part of the process begins / Other parts held back.
• Bereavement is like a tide: it flows back and forth through the
stages
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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
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–Lessening
Impact of Bereavement
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Components of grief work
Pre-occupation / wish to find the person
Repeating, painful recollection of the loss
Discuss: patterns, PTSD
• Making sense of the loss to fit assumptions Discuss:
meaning?
• Dreams
• Common dream: happy interaction with the dead
• Pining / Avoidance of Pining
• Idealised person - forget the negative
4.Anger and Guilt
• Familiarity
• Misdirection
• Blame / Self Blame
• Family Split
• Resistance
5.Disorganisation and
Despair
• Period of uncertainty
• New set of expectations Time / Acceptance?
• Old model of the world abandoned
• Other people: support, security, protection.
• Take on the reality of what has happened
• Identifying with lost person – method of
avoiding the loss of that person
6.Gaining a New Identity
• Taking on role/interest that lost person had
• New relationships
• New versions of old relationships
• New interests
• New updated view of the world
• Less repressed.
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.
Be Aware of Your Reaction!
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Feelings
Images
Perceptions
Thoughts
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.
Be Aware of Your Reaction!
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Feelings
Images
Perceptions
Thoughts
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 keeled 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”.
Be Aware of Your Reaction!
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Feelings
Images
Perceptions
Thoughts
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.
• Extending the Event- Searching
Be Aware of Your Reaction!
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Feelings
Images
Perceptions
Thoughts
Avoidance Panic
Throughout this period he exerted a rigid control and
he was still not crying two months later when he was
persuaded to seek psychiatric help. At this time he
was tense and tremulous, 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.
No Interest in himself Suicidal
Stuck
Be Aware of Your Reaction!
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Feelings
Images
Perceptions
Thoughts
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 the 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?”
• Routine Event re-enacts trauma - moves stuckness
Be Aware of Your Reaction!
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Feelings
Images
Perceptions
Thoughts
Post-Traumatic Stress
Disorder
The case illustrates the features of 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.
Colin Murray-Parkes
Conclusions
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What helped the bereavement process was:Traditional family
Good family support
Predictability of death
Practical tasks of funeral arrangements
Supportive people making few demands
Social Networks
Mutual Self Help Groups
Bereavement Counselling
Support Groups – Group Counselling
This case study poses a
question………??
• What determines how a Bereavement
affects a person?
Stressors
• Stress & Trauma part of Bereavement
• Wide variations
• Type of stress
• Coping strategies
• Perception
• Capacity to tolerate strong feelings
• Self Esteem
Key Determinants of the
Affect of Bereavement
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Situation and Environment of the Bereaved
Age
Gender
Personality
Proneness to Grief
Inhibition of Feelings
Expression of grief
Socio-economic Status (Social Status)
Nationality
Religion
Cultural Factors of Grief
Before the Bereavement
• Relationship to the Deceased
• Type of Relationship
• Strength of Attachment
• Security of Attachment
• Degree of reliance
• InvolvementIntensity of Ambivalence
• Childhood Experiences
• Later Bereavement Experiences
• Previous mental health
• Life Crises prior to the Bereavement
• Type of Death
After the Bereavement
• Social Support
• Prevention of Isolation
• Secondary Stresses: financial
• Life Opportunities – Options open to
Bereaved
Theory and Counselling
Skills Link
The way we react to bereavement is linked
to the way we have dealt with or been taught
how to deal with bereavements in the past
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
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Notice relationship between counsellor and client
Expectations and perceptions of attachment figures
• Reflect on the accuracy of self images
• Holding and Containing