Living Joyfully In RecoveryA Healing Journey
 San San Juan Macias Pastoral and
Transitional Living Center 2602 S. Richey
#303 Artesia NM 88210 575-708-0033
maciasmissioners @gmail.com
www.maciasmissioners.com
Subtitled—”How to
Avoid Burn Out”!
Objectives:
 1.Id how the beatitudes can promote healing and change
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in the context of hierarchy of needs.
2.Learn the basic concept and history of the 12 steps of
recovery.
3.Id types of 12 step groups and effectiveness of 12 step
therapy
4. Id types of mental illness and appropriate treatment
responses in the counseling process.
5. Learn how to id and respond to crisis.
6.Learn self-care practices
Bio-Psycho-Social Model
 Bio----genetic and certain physical aspects of
the environment dispositions
 Psycho---thoughts, behaviors and choices
 Social---nurturing—abuse, trauma, loss, world
events
 Spiritual—beliefs about one’s sense of meaning
and purpose in the cosmos
Happiness-what is it for
you?
 Positive vs Negative Attitude-is the glass half
full or half empty
 Contentment Vs Addiction
 Experience of life and feeling vs. stifling and
numbing
The basic
concept of
recovery is to
Re- CONNECT
with a power
greater then
oneself, as the
addict is
POWERLESS
over the
addiction,
How it can be done: The Beatitudes hold a
basic concept of recovery and happiness
 The text of St. Matthew from Jesus’ Sermon on the Mount:
 1Blessed are the poor in spirit: for theirs is the kingdom of heaven.
(Verse 3)
 2Blessed are the meek: for they shall possess the land. (Verse 4)
 3Blessed are they who mourn: for they shall be comforted. (Verse 5)
 Blessed are they that hunger and thirst after justice: for they shall
have their fill. (Verse 6) creating positive energy through compassion to the marginalized as Jesus did: homeless,
mentally ill, disabled the banquet of a just life
 5Blessed are the merciful: for they shall obtain mercy. compassion for those who
may not deserve it-substance abusers, anti social, abusers (Verse 7) as we forgive-we shall be forgiven, freedom from anger
 6Blessed are the clean of heart: for they shall see God. (Verse 8) –
being virtuous
 7Blessed are the peacemakers: for they shall be called the children
of God. (Verse 9) pro-peace –society, peace of mind and body,
 8Blessed are they that suffer persecution for justice' sake, for theirs
is the kingdom of heaven. (Verse 10) Jesus suffered as God’s child, as we may do at times, but
we like him can live resurrected lives in the here and now.
The Concept of 12 Step Recovery
 The Washingtonians-temperance and politics
 The Oxford Group—6 steps of recovery and
religion
 Bill Wilson-12 steps and AA
 Non religious but spiritual and ANONYMOUS
 The spiritual foundation of 12 traditions.
 Relief from alcoholism through a “higher
power”—a non definable concept to provide
support and relief from the obsession of drinking
 Alcoholism now seen as a “disease” instead of
stigma
#1 In Life and Death, we have an
Inheritance - the Kingdom of God (a
Power greater then us)
 Materialism and addiction lead us further from the
source of our joy and happiness—rendering us
powerless
 Focusing on the Kingdom of God ( the Power-however
you may experience it)—the very source and genesis of
our existence leads to limitless love, wisdom, healing
and joy. The very presence of God. Jesus is telling us
that this Kingdom is not far away, in fact, it is in our
very grasp. Step 1 and 2
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
All we have to do is reach out and claim it by visualizing it, feeling it and living in it. This is prayer and meditation. Often, we turned to the vices of materialism and addiction-even relationships to
fill a need within ourselves but joy comes only when we love ourselves and accept God’s love for us. We do this through tuning out these negative things and envision the Kingdom. If we dwell in
the vacuum of the negative, of vices and addiction, of violence and poverty, war, anger, depression, illness, that is what we will reap in our lives. Conversely, if we focus on the Kingdom-all of the
splendor, glory, joy and abundance of God-that’s what will reap. Focus your mind on what you really want in life, live like you have already achieved it, feel what it feels like. Imagine the prodigal
son-and what it would feel like in the arms of God and unconditional love.
The Kingdom is in your
midst Jesus compares the Kingdom to the wind “it
is neither here no there” it is all
encompassing and obtainable
Ready To Change
 Often, a person reaches this stage of
readiness by hitting “bottom”. They know
there is no where to go but up.
Moreover, if we prevent a person from reaching
this state readiness, we could impede their success. We often do this through enabling addicts or alcoholics by covering up for them or someone
protecting them from consequences. Bill Wilson, the founder of AA was a desperate alcoholic on the verge of death. No amount of help was able to
change him, whether hospitals or other treatment –preaching or advice, until he hit this state of being at bottom. Then, the flood gates opened and he
melted into the Divine Light of God.
How It Worked For Alcoholics
Anonymous and Other 12 Step Groups
 *1990’s -1 million individuals treated
each year within the U.S. alcohol and
drug treatment system. Adolescents approximately 12% (Substance Abuse
and Mental Health Services
Administration, 1993, 1999(Kelly,
Myers, and Brown).


 *In the United States, AA is the most
commonly accessed source of help for an
alcohol-related problem, with an estimated
9% of the U.S. population having attended
an AA meeting. Three percent attended for
help with their own problems (Room and
Greenfield, 1993).
 *12-step philosophy has been incorporated
into the vast majority of substance-use
disorder treatment programs in the U.S.
(Humphreys, 1997; Roman and Blum, 1998).
*From 1953-1990 there was an 18-fold
increase in AA world membership (Makeal25).
Currently, there are over 2 million AA
members in 150 countries around the world
(AA.org).. 1.
Bill Wilson and Dr. Bob
 They found release in GIVING OF THEMSELVES
 Bill Wilson and the May Flower Hotel
 *The basic program consists of the 12-steps (
based on non religious spirituality-consistent
with teaching from the Beatitudes)written in
1938 and several core literature items: Big Book,
12 and 12 1953, Grape Vine (1944) AA Comes of
Age (1957), The Service Manual, and 12 Concepts
for World Service.
AA. 2.


All literature of AA is approved and labeled as conference approved by the General Service Conference of
The First 3 Steps
 Create a foundation based on a safe
environment where the can visualize
and realize the solution to their
problem of addiction. This solution
being God or A Power Greater then
themselves and closeness with
others who know what they are
going through. (Parker, and Guest 92).
 steps 1-3
 —Powerlessness and Anonymity .AA
believes that "anonymity is the spiritual
foundation", (AA Tradition 12), of the
program and exists at the level of press,
radio films—
 dismantling the ego brings
freedom to know God and one’s
true self through humility.
Being Free From Resentment
and the Past
 *In Step Four; the recovering person is
asked to write a history of actions and
feelings associated with the addictive
behavior that has caused harm to self and/or
others. Often, the 4th step contains and
inventory of resentments, fears, shame and
possible abuse issues.

 *(Step Five) is to share the written history
with a carefully selected person and with the
individual's concept of a higher power. Most
commonly utilized.
 often the sponsor is the one chosen to hear
Step Five, but therapists and clergy are also
common.
 *(Step Five) is to share the written history
with a carefully selected person and with the
individual's concept of a higher power. Most
commonly utilized.
 often the sponsor is the one chosen to hear
Step Five, but therapists and clergy are also
common.
Continued Action
 *Steps 6 and 7 deal with coming to a deeper
awareness of one’s character and personality traits
which contribute to their addictive process.



.
* According to the spiritual philosophy and
practice of most 12-step recovery groups, every
member is free to define for themselves their own
conception of what his/her "Higher Power" is.
“Many people use "God" but others use the power
of the
 group or other concepts” (Parker, and Guest 20).
 An important part of the healing process is to
take responsibility for actions that have
damaged another person in some way.
Apologizing for hurtful behavior can be the
first step in repairing relationships that have
been impacted by the addiction. (Parker, and
Guest 20). *The other party’s response to the
amends is not as important as the recovering
person’s work in healing their own past.

 Steps Eight and Nine help to resolve the guilt
and shame associated with past behavior.
Parker explains:
 * Steps 10-12 -practice daily inventory,
prayer, meditation and service work to
maintain their sobriety on a daily basis. Many
continue to repeat taking the steps from the
first –twelfth step. Critical to this process is a
connection to God, as one understands him,
and carrying the message of recovery to
others in need
Why this the model?…
 Research from Finney et. al. concludes,
"Patients in 12-step programs likewise
exhibited significant changes over time on
almost all of the proximal outcomes
commonly implicated in C-B treatment".

 These changes include significantly increased
sense of self-efficacy, decreased positive
expectancies for substance use and acquired
more substance-specific and general coping
skills, as indicated by increased scores on all
the Processes of Change subscales.
 They also show increases in positive
reappraisal and problem-solving and
decreases in cognitive avoidance and
emotional discharge coping(Finney, Noyes,
Coutts, and Moos). 11
 Overall, patients in the 12-step and eclectic programs show
significant increases on both the cognitive and behavioral (activity)
12-step proximal outcomes. In contrast, patients in the C-B
programs exhibited modest decreases or no change on the cognitive
12-step outcomes (disease model beliefs, adherence to an
abstinence goal and acceptance of an alcoholic or addict identity),
even though they showed increases in attending 12-step meetings,
having a sponsor, having close friends involved in 12-step groups,
reading more 12-step materials and taking the steps. The changes
reflect some 12-step participation among patients in C-B programs,
but suggest that their participation did not result in an
internalization of 12-step beliefs. (Finney, Noyes, Coutts, and Moos)
In addition, TSF therapy was more effective than the other two
treatments in promoting abstinence.
 Overall, patients in the 12-step and eclectic programs show
significant increases on both the cognitive and behavioral (activity)
12-step proximal outcomes. In contrast, patients in the C-B
programs exhibited modest decreases or no change on the cognitive
12-step outcomes (disease model beliefs, adherence to an
abstinence goal and acceptance of an alcoholic or addict identity),
even though they showed increases in attending 12-step meetings,
having a sponsor, having close friends involved in 12-step groups,
reading more 12-step materials and taking the steps. The changes
reflect some 12-step participation among patients in C-B programs,
but suggest that their participation did not result in an
internalization of 12-step beliefs. (Finney, Noyes, Coutts, and Moos)
In addition, TSF therapy was more effective than the other two
treatments in
promoting abstinence.
Cont.
 For example, at the 3-year follow-up, 36 percent
of TSF patients in the outpatient group reported
being abstinent for the previous 3 months,
compared with about 25 percent of outpatients
in the CB therapy and MET treatment conditions.
This result is consistent with the goals of TSF
therapy and with AA, neither, of which view
moderate drinking as an acceptable or attainable
goal for alcohol dependent people.14


12 Step compared w/ CBT

1 year after treatment, 45 percent of patients treated in 12-steporiented programs reported abstinence from alcohol and other drugs
during the previous 3 months, compared with 36 percent of patients
treated in CB programs.15

*Gilbert (1991) found that working the 12-steps predicted abstinence,
whereas a simple measure of attendance at meetings did not. A metaanalytic review of 107 studies on AA (Emricket al., 1993) evinced better
outcomes for "more active members". Having a sponsor, for example,
had the largest favorable impact on drinking outcomes. Snow and
colleagues (1994) revealed that the perceived importance of attendance
to recovery and social aspects of attending recovery meetings was
related more to behavioral change processes than a simple measure of
attendance; and Montgomery et. al. (1995) revealed that the frequency
of 12-step attendance did not predict outcome, but involvement (i.e.,
working the steps) did (Kelly, Myers, and Brown).

 *Findings, overall, supported the role of 12-
step cognitions in mediating outcomes in 12step treatment. However, as Moos et. al.
show, much of the change in cognitions
appeared to occur prior to patients entering
treatment and that most of the variance in
outcome was not explained. They conclude
that post treatment events are likely to be
critical factors, especially with regard to
maintaining a core set of beliefs over time.
(Moos et. al., 1990). 14
 *Findings, overall, supported the role of 12-
step cognitions in mediating outcomes in 12step treatment. However, as Moos et. al.
show, much of the change in cognitions
appeared to occur prior to patients entering
treatment and that most of the variance in
outcome was not explained. They conclude
that post treatment events are likely to be
critical factors, especially with regard to
maintaining a core set of beliefs over time.
(Moos et. al., 1990). 14
Therapy Approaches

*Although 12-step recovery programs are not considered psychological
treatment, there are proven therapeutic approaches contained within the 12steps. All 12-step programs also embrace the central tenets of client centered
therapy:
unconditional positive regard, empathy,
and genuineness. Twelve-step programs utilize
all three of these concepts. (Parker, and Guest 26).

*All of the aspects of psychodynamic theory that are incorporated into 12step programs are related to object relations theory. This model includes
concepts of how the self is developed in relationship to the primary
attachment object, resulting in the achievement of object constancy. Object
Relations further explains how object constancy allows for the ability to use
the image of the caretaker to self-soothe. Parker asserts that here-in lies the
main problems of the addict-their ability to self soothe. Through the concept
of the "Higher Power", 12-step programs help members achieve a higher
level of object constancy (Parker, and Guest 28).


*Parker asserts that no client with an addiction has enough
capacity to self-soothe or s/he would not be addicted in the first
place. People who have well-developed object constancy do not
need to alter their moods with addictive behavior. They also use
higher-level defense mechanisms so they are not as prone to denial
or rationalization as clients with an addictive process are. Members
are encouraged to develop the ability to use their sense of
spirituality to self-soothe. The new member is not expected to do so
right away; therefore it is suggested that s/he go to meetings
frequently in order to develop a concept of higher power (Parker,
and Guest 28).
 *Findings, overall, supported the role of 12-
step cognitions in mediating outcomes in 12step treatment. However, as Moos et. al.
show, much of the change in cognitions
appeared to occur prior to patients entering
treatment and that most of the variance in
outcome was not explained. They conclude
that post treatment events are likely to be
critical factors, especially with regard to
maintaining a core set of beliefs over time.
(Moos et. al., 1990). 14
*Reinforcement
 in behavior change: Twelve-step programs use both
positive and negative types of reinforcement. For
example, when a person has a certain amount of time
being free from the addictive behavior their progress is
celebrated and they receive a coin marking the amount
of years or months that they have been clean and sober.
The person is also seen as a role model for others who
have not abstained from chemicals for as long as s/he
has. When a person uses a mood-altering substance,
other than for a true medical problem, they have to start
their sobriety count over. This includes identifying
him/herself as a "newcomer" in meetings, which means
that the member can't hide the relapse from the group
(Parker, and Guest 32). 15


Morgenstern et. al. (1997) and Kelly et. al., (2000) examined models based in socialcognitive learning theory(Bandura, 1986) for the effects of 12-step meeting
attendance on substance use outcome following inpatient substance use disorder
treatment. Both studies supported the use of social-learning-based constructs,
(e.g., self-efficacy, motivation and coping), to help explain therapeutic effects of
12-step involvement. The study tested a multivariate process model of adolescent
12-step affiliation and its influence on substance use during the initial 6 months
following treatment for alcohol and drug problems. Using social-cognitive
learning theory, (i.e., self-efficacy, coping and motivation), summarized in
Marlattand Gordon (1985), it was found that more severe users affiliated more
readily with 12-step groups. It was also concluded that creating an environment
with social activities as part of the meetings helped create a greater sense of
affiliation to the groups and sponsors (Kelly, Myers, and Brown).
*Attendance at 12-step and other recovery meetings can help to break the sense of
alienation and isolation that addicts usually exhibit. They learn to develop
relationships with others that attend the same meeting consistently. They are able to
from deepening bonds from the experience of connection, which can facilitate their
progress in recovery (Parker, and Guest 36). This sense of common bond stems from
the various types of 12-step groups extending their experience, strength and hope
with each other. This is why it is beneficial for many addicts to have groups narrowly
focused
on particular addiction and problems.





*C-B patients (n = 1,185-1,186 for the analyses reported here) who had longer in-patient stays
scored significantly higher on the Processes of Change scale (r = .15), and its stimulus control (r =
.11), self-reevaluation (r = 10) and reinforcement management (r = .20) subscales. Surprisingly, C-B
patients who stayed longer tended to have higher positive substance use expectancies (r = .10)
than patients with shorter stays. They concluded that there was no relationship between length of
stay and the other C-B/general proximal outcomes (self-efficacy, outcome expectancies and
general coping responses).
*Patients who remained in C-B treatment longer showed significant increases on some of the 12step proximal outcomes, specifically, disease model beliefs (r = .17), attendance at 12-step
meetings (r = .56), and number of steps taken (r = .21) (Finney, Noyes, Coutts, and Moos):12
Overall, patients in the 12-step and eclectic programs show significant increases on both the
cognitive and behavioral (activity) 12-step proximal outcomes. In contrast, patients in the C-B
programs exhibited modest decreases or no change on the cognitive 12-step outcomes (disease
model beliefs, adherence to an abstinence goal and acceptance of an alcoholic or addict identity),
even though they showed increases in attending 12-step meetings, having a sponsor, having close
friends involved in 12-step groups, reading more 12-step materials and taking the steps. The
changes reflect some 12-step participation among patients in C-B programs, but suggest that their
participation did not result in an internalization of 12-step beliefs. (Finney, Noyes, Coutts, and
Moos)
 *(Moos et al. 1999) Although both 12-step-oriented and CB
treatment patients experienced substantial reductions in
substance use, substance abuse-related problems, psychological
problems, criminal behavior, and unemployment, the 12-steporiented treatment was more effective in promoting abstinence.
1 year after treatment, 45 percent of patients treated in 12-steporiented programs reported abstinence from alcohol and other
drugs during the previous 3 months, compared with 36 percent of
patients treated in CB programs.15
 *Findings, overall, supported the role of 12-step cognitions in
mediating outcomes in 12-step treatment. However, as Moos et.
al. show, much of the change in cognitions appeared to occur
prior to patients entering treatment and that most of the
variance in outcome was not explained. They conclude that post
treatment events are likely to be critical factors, especially with
regard to maintaining a core set of beliefs over time. (Moos et.
al., 1990). 14
AA was just the spark of
this model…
 Addiction Specific Programs
 The list of such groups appear endless. All
subsequent 12-step programs, developed out of
the AA model, are similarly structured. Al-Anon
began in 1951, and Narcotics Anonymous (NA) in
1953. Additional programs, such as Adult
Children Anonymous (ACA), Overeaters
Anonymous (OA), and Gamblers Anonymous
(GA), were founded during the last twenty years.
While the programs developed in the 1980s and
1990s have subtle differences, the core principles
remain the same (Parker, and Guest 2)
Some of the difficulties
with the model…
 , the client may be unable to form any
attachment with others, thereby making it
impossible to obtain any benefit from
attending the program. This may be true for
clients with a severe anxiety disorder such as
Agoraphobia or Post-Traumatic Stress Disorder
(PTSD) who will have extreme difficulty in a
group setting (Parker, and Guest 66).
Alternatives To 12 Step
Groups


*SMART recovery’s goal is to empower
substance abusers by teaching them to identify
and counter negative thought patterns that
contribute to their substance use. By doing this,
people in SMART recovery can learn to abstain
and develop a positive lifestyle during their
course of recovery. SMART believes that
addiction begin in the mind. It relies primarily on
a cognitive approach and helps offenders take
control of their lives by targeting their thought
patterns in very specific ways. 22
 *Unlike AA and NA, SMART’s goals are accomplished in groups led
by volunteer coordinators, who are trained to guide the group
process and assist participants in recognizing irrational thought
patterns. SMART recovery consists of a 4-point program, which
helps participants build personal skills in: enhancing and maintaining
motivation to change, coping with urges, problem-solving, and
maintaining lifestyle balance. Because SMART defines addiction in
broad terms that include alcohol, prescription and illegal drugs,
nicotine and caffeine, as well as behaviors such as gambling,
compulsive eating and violent activity, it potentially could help a
broad range of offenders (Konopa, Chiauzzi, Portnoy, and
Litwicki).22
Effectiveness of 12 step
therapy
 Prior to treatment, participants, on average,
were abstinent only 1 out of 3 days. After
completing treatment, participants, on
average, were abstinent 85%-90% of days.
These gains were maintained across the 12month outcome period. Outcomes in terms
of percent days abstinent are similar to those
reported in other studies of 12-step
treatments (Morgenstern et al., 2001; Project
MATCH Research Group, 1997). 24
 Success in recovery depends not on using
strength or will power but by humility,
meekness and open mindedness.
#2. Humility Gives Way to
True Nobility
 The anawim, (the poor seeking God for deliverance) they
who humbly and meekly bend themselves down before
God and man, shall "inherit the land" and possess their
inheritance in peace. This is a phrase taken from Psalm
36:11, where it refers to the Promised Land of Israel, but
here in the words of Christ, it is of course but a symbol of
the Kingdom of Heaven, the spiritual realm of the
Messiah.
 Step 7-”Humbly asked him to remove our shortcomings”
thus we increase positive energy in our lives and go from
vice to virtue.
 Steps 8-10-The recovering person maintains
a this cycle of humble practices through the
‘maintenance steps’ where they continue to
experience a freeing from anger and
resentment by cleaning the past, making
amends, admitting our wrongs
 (Steps 11, 12 Create Change in our lives by focusing our
thoughts and energy on our Source and living in positive
relationships with others and by carrying the message of
recovery we solidify it that much more in our own lives.
In step 12 we reinvest our energy back into the beginning
steps of recovery to work them in all of our affairs and life
challenges whether they be addiction, relationship
issues, finances, or loss. The steps will help us face or
feelings with courage and strength instead of resorting
to our addiction or other mal adaptive coping tool.)
Let’s Re-cap….
 1.Poor in spirit=being rich
 2.Being Humble is the key to this new
freedom and richness
 3.12 step program is the example –
emphasizing the positive
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Part Two—Peeling Away The
Onion Layers and Deepening
the Journey of Recovery

Regardless if you are in recovery, we all have to face some sort of loss and often
practice “avoidance coping” which is counter-productive. Spiritual growth is a life
long endeavor and involves an ever deepening awareness of our emotions and how to
cope with them. Like peeling away the layers of an onion.
12 Step Groups dealing with
emotional issues: Emotions
Anonymous, Family Anonymous,
#3 Blessed are they who
mourn: (facing our feelings
brings comfort and growth)
(Verse
 Two types of Grievers
 Intuitive-feelings are dominant, crying
lamenting.
 Instrumental-thinking is dominant.
Reluctant to talk about feelings.
5)
The Inherit Risk of Grief
 To avoid true mourning by avoiding feelings
of loss and disappointment through
addictions and over activity instead of facing
the feelings. Like the first Beatitude-facing
them gives us Power over them.
 It is a painful and difficult journey we all will
eventually have to face, but taking that path
leads to joy—avoiding it compounds the pain
into increased difficulties.
Psychosomatic complaintsSymptoms that Grief may be
maladaptive.
 When we avoid the mourning process, use maladaptive
coping or are newly facing the shock of loss, we often
experience psychosomatic complaints. This may include:
aches and pains resulting from muscular tension such as
headaches, dizziness, neck stiffness and back pain. There
may be changes to eating patterns with appetite
suppression or overeating, such as 'comfort eating' of
sweet foods like biscuits and chocolate. Other gastrointestinal changes may occur such as nausea, vomiting,
feelings of choking, perceptions of a lump in the throat or
abdominal fullness, constipation or diarrhea. (Payne,
Horn, and Relf 22)
More clinical symptoms
 Suicidal wishes, withdraw from others and be
preoccupied with their loss, intrusive, painful
thoughts about their loss. Slowed thinking psychic
numbness, crying, physical numbness, disorganized
thinking, blunting, weeping, sobbing, feeling of
unreality, suicidal ideation, euphoria, outbursts,
feeling outside body, disbelief, hysteria,
talkativeness, dizziness, appears unaffected,
hyperactivity, general physical distress, unaware of
others, passivity, sighing. (Payne, Horn, and Relf 22)
 (Larson, and Nolen-Hoeksema 3)
Symptoms cont.
 Gradually the numbness is replaced by the
'pangs of grief', episodes of intense pining
interspersed with periods of anxiety, tension,
anger and self-reproach. The desire to recover
what has been lost is intense and may be
characterized by restless searching, vivid
dreams, auditory and sensory awareness of the
deceased and a preoccupation with memories.
Crying aloud and sobbing is common, as is the
suppression of emotions although anguish may
be displayed. (Payne, Horn, and Relf 71).
How difficult the road can
be…
 (Payne, Horn, and Relf 84).
 There is also some evidence that bereaved
people have an excess mortality in the first six
months following the death. This is due to stress
reactions and the effects on neuroendocrine and
immune functioning. This allows existing
diseases such as coronary heart disease to be
potentiated by biochemical changes such as
increased blood viscosity. Also immunosuppression may make people more vulnerable
to infections and possibly to cancers (Payne,
Horn, and Relf 37).
Other effects of grief
 Include: depression - sadness, loss of pleasure
response, low mood, intense distress, anxiety fearfulness, hyper-vigilance, inability to relax, anger
- may be expressed as hostility to friends, family,
health care workers or God. Guilt, feelings of selfblame, loneliness, lack of concentration and
attention, memory loss for specific events or general
problems in recalling information or attending to
new information, repetitive thoughts especially
about the deceased, sometimes needing to talk
constantly about certain events like a traumatic loss,
helplessness/hopelessness, pessimism about the
future, feeling of distance/detachment, irritability,
expression of anger and hostility, suspiciousness.
Effect cont.
 In addition, some people experience repetitive thoughts
although this should be differentiated from the 'flashbacks',
night- mares and overload of distressing cognitions characterized
by post-traumatic stress disorder (PTSD). Experiencing the
deceased by seeing or hearing the person is relatively common
and should not be con- strued as abnormal (Conant 1996; Young
and Cullen 1996). At one time such halluncinations were thought
to be uncommon and indicative of pathology but there is now
evidence that they may well be helpful. Behavioral expressions of
distress include agitation or restlessness with constant searching
for the deceased, despite cognitive awareness of the loss.
Feelings of anger and hostility may present themselves as
irritability, phys- ical or verbal attacks on others or objects, social
withdrawal and self mutilation. These behaviors may be socially
sanctioned in some cultures (Payne, Horn, and Relf 25).
Effects cont.
 As the loss is accepted, the intensity and
frequency of grief lessens and are replaced by
despair and apathy. This often includes social
withdrawal and an inability to concentrate or
to see anything worthwhile in the future.
Furthermore, one can be left with the
challenge of rebuilding identity and purpose
in life and acquiring new skills (Payne, Horn,
and Relf 71) .
Kubler Ross and Stage Theory
 Applied to grief as well as being terminally ill: The initial
reaction is denial- a natural coping mechanism that helps
people manage their shock and take in the news. They
often ignore the emotional impact while maintaining a
cognitive understanding of their situation. Next, once the
truth of the diagnosis begins to be accepted, angry (Payne,
Horn, and Relf 72) . Bargaining, often with God, in order to
negotiate a cure, more time or greater relief from
symptoms(73). This may include promising to attend
Church regularly or become better people in return for
being cured. Depression- Such feelings can be come so and
intense and lead to self-blame. In the final stage,
terminally ill people come to accept the reality of their
death, or loss in the case of grief (Payne, Horn, and Relf
 73),
Phases of Grief

Wahlhaus :“A transition period during which it is necessary to experience
loss in practical terms, express it in emotional terms, integrate it and
adapt to it in order to recover sufficiently to continue with hope and a
sense of future. 'Grief is a process not a state'. (2) (Wahlhaus)
 Stages: 'numbness‘, which is the natural reaction to stress. ‘Pining', then
'disorganization and despair' and finally 'recovery‘. Feeling: guilt, selfreproach, anger, sadness, ambivalence, relief, fear and anxiety . He
asserts that these feeling are natural symptoms of grief-work.
(Wahlhaus)
 MIDDLE PHASE Preoccupation with thoughts of deceased. General
physical distress, idealizing the deceased.
 RESOLUTION- Realistic memory of de-ceased, return to normal range
of emotions, return to normal functioning, pleasure in remembering,
new or renewed social relationships, new meaning in life, new or
renewed activities (Larson, and Nolen-Hoeksema 4) }
Grief Work
 The second phase of grief work begins when the
death is acknowledged cognitively and
emotionally. This phase of acute mourning
includes intense feelings of sadness, despair,
loneliness, anxiety, and anger. The full syndrome
of depression may occur, with loss of interest in
life, disruptions in sleep and appetite, inability to
concentrate or make decisions, a sense of
hopelessness and helplessness, and (Larson, and
Nolen-Hoeksema 5) }
Worden’s Tasks of Grief
 (1982, 1991) Draws on Freud's concept of grief
work, Bowlby's attachment theory,
developmental psychology and Engel's concept
of grief as an illness. Four overlapping tasks:
bereaved people need to accept the death both
intellectually and emotionally; they need to work
through the emotional pain of loss while
simultaneously adjusting to changes in
circumstances, roles, status and identity ; and
they need to integrate the loss and let go of their
emotional attachment to the deceased, so that
they can invest in the present and the future
(Worden 1982, 1991). (Payne, Horn, and Relf 74)
Other grief perspectives
 Bowlby- describes grief in terms of an infant
separated from his mother: 'His initial response ... is
one of protest and of urgent effort to recover his lost
mother ... Sooner or later, however, despair sets in.
The longing for mother's return does not diminish,
but the hope of it being realized fades' (p. 9). Marris
(1992) takes a more specifically human perspective
in arguing that grief is provoked not merely by the
loss of a significant relationship itself but by 'the
disintegration of the whole structure of meaning
centered upon it' (p. 18), and that it is the enormity
of this threat that provokes (Payne, Horn, and Relf
8)
Effects of Grief on Marriage

Larson et. al.- Conflicting grief styles and how it can disrupt
the marriage:
 We witnessed a couple in therapy whose teenage son had been
killed in an automobile accident. The wife coped by expressing her
emotions. Although she had family and friends around each day
who were supportive of her expression, she still needed to talk
about the loss with her husband each day. He, on the other hand,
wanted to avoid thinking about it and move on, and used work and
golf to distract himself from the loss. Two weeks after the son's
death, the husband announced unexpectedly that he had arranged
for the couple to go to Hawaii to "get away." The trip was a disaster
because the pain went right along with the wife, and the husband
felt frustrated in his attempts to "distract" her from her grief. This
couple's different coping strategies continued to clash until they
dropped out of therapy unable to accept their differences. (Larson,
and Nolen-Hoeksema 73) 7
*.
Factors in how the loved one
died
 Sudden death- the mourner often shows
more anger, guilt, and a sense of
helplessness, shock, confusion, and somatic
complaints.
long-term chronic illness,grief is found to manifest
itself in more social
isolation, loss of emotional
control vigor, and rumination
(Larson, and Nolen-Hoeksema
48).
Suicide- there is often
feelings of guilt involved
with the grief process.
.(Payne, Horn, and Relf 25).2.
*Cleiren's (1991) study Bereavement after various types of deaths
including: death from road traffic accidents,
suicide or long-term illness. No long-term impact
on adaptation, however, he did show that people
facing multiple stressors in their lives such as
other losses and low income, have been found to
be at greater risk of maladaptive grief patterns,
(Parkes 1975; Sanders 1988). These types of
stressors can lead to increased clinical problems
such as Major Depression or other psychiatric
disorders 3.
Mother's grief vs. father's
How parents respond to loss
 *Data shows mixed reviews-some say
mother’s have higher distress, some say no
difference in the grief reactions of fathers and
mothers--both parents suffer greatly (
Florian, 1989; Lieberman, 1989).
 Parents who lose an adult child to illness,
accidents, or in war, often have heightened
levels of anxiety, depression, and physical
illness years after their loss (Larson, and
Nolen-Hoeksema 36) .5
 Individuals differ in grief response *People who are more dependent on others for
 their self-esteem will be more at risk for poor adjustment to
loss.
 *(Sanders, 1993) Women were more likely than the men to
report using rumination and support seeking, whereas men
were more likely than women to be using distraction (11).
 *(Larson)“ Men may have a greater propensity than
women to depression and physical health problems
following loss of a spouse because men are less likely than
women to have strong social support networks of people to
whom they feel emotionally close” (Larson, and NolenHoeksema 40).
Avoidance Coping
 Men who lost their wives found that those who
suppress thoughts of their loss were more depressed
months later than those who did not suppress (
Stroebe (Larson, and Nolen-Hoeksema 65).
 People who were engaging in more avoidance
coping were more depressed and distressed than
those who were not.
 People who engaged in more avoidance coping at
the interview 1 month after their loss were more
depressed and distressed at all other interviews. The
study also took into account avoidance coping using
alcohol or drugs to cope, as well as questions about
denying or avoiding thinking the loss.
Women and grief *Report more symptoms than men (Parkes and Brown
1972)
 *More than 40% of the widows in their sample still had
significant symptoms of anxiety, depression, and problems
in everyday functioning 2 to 4 years after their loss.
 *(Vachon et. al. 1982) 38% of widows still were
experiencing a high level of distress one year after their
loss, and 26% were experiencing high distress 2 years after
their loss.
 *Zisook and Shuchter ( 1986) Even 4 years after a loss, at
least 20 % of widows and widowers assessed their own
adjustment as "fair or poor," whereas only 44% assessed it
as excellent.
Young children who loose a
parent *Are also faced with complex grief issues.
 *They are suddenly faced with the loss of a
caregiver and primary attachment figure.
 * The meaning of parental loss depends greatly
on the child's age. However, losing a parent as
an adult can still have a great impact on an
individual.
 One's primary caregiver remain one's primary
attachment figures throughout life. Thus, the
loss of a parent still severs the critical
attachment bond, even if that loss occurs when
one is 50. (Eiser 1990)
Children's understanding of
death.
 Shaped by stages of cognitive development
and experience.
 Worden and Silverman (1996) present evidence
of acute depression-like symptoms in bereaved
children soon after a loss.
 While the grief reactions typically lessen by the
first anniversary, some children had significant
emotional and behavioral problems, such as
social withdrawal, anxiety, and social problems,
which did not become apparent until two years
after the death. 9
Resolving the pain of loss
entails
 *Confronting the pain in order to reach a successful resolution.
Distress is necessary in grief work and not showing distress is
thought to be an important indicator of complicated grief.
(Vachon et al. 1982b; Parkes and Weiss 1983).
 *Stephenson (1985) describes the grieving process in three
phases: reaction (involving shock, numbness and anger),
disorganization and reorganization (stopping old actions then
replacing them with new actions or resuming actions that
contribute toward closure of the process), and reorientation and
recovery (resolution of previous strong felt emotions).
 *Brunelli) Pessagno (2002) four tasks of grief that are described as
follows: accepting the reality of the loss, experiencing the pain of
the loss, adjusting to the environment from which the deceased is
missing, and withdrawing energy from the relationship with the
deceased and reinvesting in other relationships (Brunelli).
Loss related to a failed
pregnancy:
 *More than 1,000,000 couples in the U.S.
alone each year grieve a pregnancy loss.
 *Bereaved parents experience more intense
and longer lasting grief symptoms than any
other group of bereaved people ( Littlefield"
(Larson, and Nolen-Hoeksema 34).4
Parents who loose a pregnancy

* Need to be given the choice to see their baby, no matter how small.*
Have all medical procedures explained to them and be offered the one
that best suits their needs.* Have their baby tested and examined, even
if the loss occurs at home.* Be given a keepsake of their baby to take
home or for the hospital or physician's office to retain on file, such as a
sonogram picture or a positive pregnancy test result.* Receive pastoral
care if they desire.* Name their baby if they wish to.* Have the grieving
process explained and be provided with writ ten information on
bereavement, especially the telephone number of a local pregnancy loss
support group.* Receive information on burial or memorial services and
the options concerning the disposition of the baby's remains.* Receive
guidance on how to help their children al home cope with the loss.*
Have a phone number of a staff person to call if medical questions arise
or if they need emotional support or referral information for further
help.* Receive follow-up appointments for medical tests and genetic
counseling or to review lab test results.* Be asked about their feelings
concerning their loss, which encourages bereaved couples to talk about
their situation."After my miscarriage, one of the nurses asked me if I
wanted anything," ("Parental Grief over a" 16) 10
Pregnancy loss cont.
 In addition, studies have shown that when families
are denied the opportunity to express their sorrow
over a pregnancy loss, their grief goes underground,
only to resurface as complex grief later (Moffitt). If
they have suffered a midterm or late pregnancy loss,
parents may want mementos, such as photographs,
footprints, the baby's blanket, or a lock of hair.
Couples who suffer an early miscarriage may wish to
have positive pregnancy tests or copies of sonogram
photos as keepsakes. Mothers and fathers also
should be given the chance to see their baby and,
depending on the gestational age, to hold their child
as well. They should have access to grief counseling,
pastoral care, and options for rituals (Moffitt).
Larson’s research on parent’s
grief
 More than 60% of bereaved parents
interviewed just 1 month after their loss said
they had gained something positive in their
loss and nearly all interviewed 6 and 13
months after their loss (Larson, and NolenHoeksema 39). However, negative feelings
also ensue and should be addressed by health
care professionals.
If parents sense that their
needs are neglected during
their hospital stay
 It can be therapeutic for them to write a letter
to a patient representative, social work
department, director of obstetrical nursing,
or hospital chaplain with a copy to the
chairman of the hospital's board of trustees,
requesting a follow-up meeting to discuss
their experiences (Moffitt).
Complex grief and pregnancy
loss
 When families are denied expression of grief their
grief goes underground, only to resurface as
complex grief later (Moffitt).
 Parents may want mementos, such as photographs,
footprints, the baby's blanket, or a lock of hair.
 Couples who suffer an early miscarriage may wish to
have positive pregnancy tests or copies of sonogram
photos as keepsakes.
 Mothers and fathers also should be given the chance
to see their baby and, depending on the gestational
age, to hold their child as well. They should have
access to grief counseling, pastoral care, and options
for rituals (Moffitt).
Returning to work
 It can be difficult for a parent to return to work after
a pregnancy loss and face a myriad of questions only
to have to report the sad new to all who may ask.
Moffit cites the following of how a parent’s boss
effectively dealt with the delicate situation:
 One mother who worked in a large advertising agency
was relieved to discover that her boss had sent out a
letter to all of their clients after her baby was stillborn.
"I actually appreciated it very much," she confirms.
"Not only was I spared having to tell the news myself,
I got so many letters of condolence in return. People
really poured their hearts out to me in those letters."
(Moffitt)
Freud proposed three criteria
in complex grief:
 1 the presence of hatred for the lost object
which is expressed through self- reproach ; 2
identification with the lost object through
internalization; 3 the disposition of the libido
in melancholia to withdraw into the ego,
instead of being transferred to a new love
object as happens in 'normal' mourning.
Freud and Identification
 A central feature of Freud's theory of
pathological mourning. He originally believed
that identification only occurred in pathological
grief, but by 1923, he proposed that it was an
important aspect of all mourning.
 In pathological grief, he suggested that the
aggressive component of the ambivalent state
turns inward and causes depression. However,
the repression of aggressive thoughts causes
some aspects of grief work to be carried on in
also in the unconscious. (Payne, Horn, and Relf
60).
Isolation
 Larson’s study found that isolation was the most
strongly related to depression and distress
(Larson, and Nolen-Hoeksema 96) .
 Factors leading to isolation and poor social
support: lack of support for bereaved people,
geographical mobility, loss of support provided
by the deceased, impact of bereavement on
social network, changes in role and status,
anxiety experienced by others when interacting
with bereaved people and personality factors
(Payne, Horn, and Relf 92).
How everyday practicalities are
being managed.
 Loss may affect the ability of daily tasks are
managed. These include: cooking, shopping,
self-care, child care and housework.
 Loss may also cause people to question their
beliefs about the world affected religious or
other spiritual and lead to a loss of meaning
and belief systems, identity, esteem and
feelings of self-worth individual's self-concept
and self- esteem as well as sexual problems
(Payne, Horn, and Relf 84).
"The psycho-social transition
theory (Marris 1974; Parkes
1993)
 Bereavement in terms of the need to adopt
new roles, skills and identities and to review
one's world-view. " (Walter 104) and Freud
asserted that “when the work of mourning is
completed the ego becomes free and
uninhibited again. (Freud 1917/1984: 253
Rituals in grief


The events of 9/11 occasioned feelings of loss shared by the nation and much of the world. This
unifying grief first appeared spontaneously through individual or small group rituals. In New York City,
for example, relatives and friends created shrines with pictures of the missing, messages for them,
personal possessions, and poems of lamentation about them. These sites have been well documented
photographically by Martha Cooper and others ("Hallowed Ground"). In the dust that clung to
surfaces near Ground Zero, individuals used their fingers to trace dismay, hope, anger, or regret.
Groups gathered in parks or in church settings to meditate, pray for the dead and injured, and implore
for peace. The folklorists Steve Zeitlin and liana Harlow evocatively described the scenes they
witnessed in (Lawrence)
Manhattan's parks, where "New Yorkers recreated the towers in miniature using tin, papier-mâché,
and paint. Red, white, and blue candles flickered alongside Christian votives, Jewish memorial
jabrtzeit, and offertory candles petitioning intercessors. ... New Yorkers came together in a public
ritual that in its transcendence of any single belief system represented all of them. The magnitude of
the expression of grief approached the enormity of the loss." Across the country, church bells chimed,
candlelight prayer vigils were held, and doves were released in ceremonies noted by numerous
journalistic organizations (Shipp; Anderson; "How the States Will Mark"; "Victims to be
Remembered"). Transmitted around the world by television, images of these folk rituals doubtless
amplified the global sympathy felt for America's loss. (Lawrence)
Function of Rituals
 They provide us acts to engage in for the
purpose of meaning making (Neimeyer)
 Provides symbolic connection to the lost
person.
Four Functions of Ritual-Dr.
Kenneth Doka
 Continuity-the person is still part of my life
and a bond exists (cooking a memorial meal)
 Transition-a change has taken place in the
grief response-(cleaning out a room at an
acceptable time)
 Affirmation-One writes a letter or poem to
the deceased thanking them
 Intensification-identification among a group
(War Memorials)
Planning for the Date
 Certain dates can be troubling and anxiety
proving such as birthdays, anniversaries,
holidays, religious celebrations, anniversary
of the death. These are best dealt with
through ritual rather then avoidance.
Counseling Process
 ASSESSMENT- Observe and collect information Define and
agree the problem. HYPOTHESIS Make your best guess as
to the root of the problem. TREATMENT PLANNING
Decide what any intervention needs to achieve. Choose the
course of action most likely to be effective most quickly and
simply.
 INTERVENTION EVALUATION Assess whether the
intervention has been successful. Discuss with the person
and decide whether further help is needed If so, decide how
it can most appropriately be given If not, help the person
back to their own support systems (Adapted (Payne, Horn,
and Relf 104)

Become a skilled listener
 True listening connects you to grieving people in a way that
can bring a sense of acceptance and healing into the
process. Make eye contact, maintain an attentive posture,
and match the volume and speed of your voice to theirs.
Refrain from asking too many questions and let them steer
the conversation. Nod and affirm, uttering words of
encouragement. Provide a sounding board by reflecting
back to them the meanings and feelings you hear them
saying-empathy.
 People in grief and distress from illness want to be heard.
They may need to tell their story over and over again, and
sometimes the care provider may be the only one who still
is a willing listener. (Jeffreys)
Suicide /risk Assessment--intent and plan

Risk factors—going through a crisis

-isolation and lack of resources

-loss of coping

-has a history of suicide or homicide attempts

Threatening to harm self or others

-has a history of mental illness of substance abuse

-has access to weapons—or things that could be used as weapons

-beyond sib or personality disorder

-call 911 don’t let the person out of sight

CRISIS EVENT-----ESCALEATION -----LOSS OF COPING------RISK

INTERVENTION---DESCALATION-(reasons to live, ways to cope—relaxation,
breathing---LINK TO RESOURCES---(hospitalizations, separate from weapons, pc,
financial coping resources—food, shelter, safety)
 Basic of CBT0r RET—correcting errors in
thinking
 A (activating event) B (beliefs) C ( effect)
 Once you find out the B you can help them
change it in order to change C
 ERRORS IN THINKING
 Catastrophizing—take one issue at a time
 All or nothing—see the in be tweens
 Magical thinking—a does not always lead to B
 It or I “should” be this way—where is it
written
 Approval seeking—others opinions don’t
make it true
Motivational Interviewing—eliciting person’s own
reason for change
Engadging
Focus,
Evoke
Planning
Avoid crisis of the day—focus on real issue
Open questions
Affirmations
Reflective listening’
summary
More on counseling in grief
 Normalize their feelings of: confusion, helplessness, hopelessness, a sense of dread,
and a feeling of being stuck in an endless nightmare. They worry that they are going crazy. Say things like, "It's
okay to feel this way," "Of course you're angry," "I would feel this way, too," and "It's good to let those tears out."
However, self-destructive, suicidal, or homicidal comments are to be taken seriously and referred for professional
evaluation. (Jeffreys)
 Avoid judgment and to keep the "'whys" or "shoulds" out of the conversation. As Jeffreys
states, “do not allow your facial expressions, body language, or gestures to give away your thoughts. Be careful of
the telltale "raised eyebrow," which signals judgment. Instead, acknowledge the person's expressions of
helplessness and continue to listen”. (Jeffreys)
allowing people in grief to remain active

Moreover,
is an
excellent coping skill. They can write obituaries, plan the funeral, create other mourning rituals, block out
schedules, send out acknowledgment cards, fill a vase with flowers, invite special friends over to reminisce, make a
donation in honor of the deceased, get into an exercise routine, or take a class. “People grieving due to a serious or
life-threatening diagnosis can research the latest developments concerning their illness, make a list of all the
medical specialists who are conducting studies or research on their disease or condition, and locate local support
groups related to their illness or loss situation. Doing "something" gives individuals a sense of control and purpose;
it is a perfect antidote for feelings of helpless despair” (Jeffreys).

Grief counseling also entails
identifying social, spiritual, and
health care resources. This includes family, friends, clergy, neighbors, colleagues,
other care providers, and community services that can become part of the "team." Clergy and congregational
members can be invaluable sources of support for the grieving-healing process. It is also important to discern
which issues require attention and which are better left on their own (Jeffreys).
“Timeouts" from grieving
 Various activities such as an outdoor walk, working out at a
health club, finding time for a hobby, watching a funny
video or television show, scrubbing the kitchen floor, and
even retail therapy at a nearby shopping mall. “Sometimes
people need permission not to grieve--to do or think about
something else” (Jeffreys)
 People in grief can also benefit greatly from the mutual aid
model. In this framework, bereaved people who are no
longer experiencing acute grief themselves provide support
to other bereaved people by sharing experiences, talking
about their loss and what helps, coping strategies are
nurtured and inner strengths developed. (Payne, Horn, and
Relf 106)
Faith

Religion also provides community social support through
companionship, practical help and supporting self-esteem via shared
values and beliefs. Prayer ministry can also provide comfort and increase
self worth. However, people may also feel let down and angry towards
their religion or God, and a loss of faith may result if their church does
not provide the anticipated help or support.

A study found that people who were spiritual and attended
religious services were more likely to use social support and active
problem solving to cope. They also were more likely to engage in
positive reappraisal of their situation Larson, and Nolen-Hoeksema 14.
Those spiritual or religious people who did attend religious services at
least occasionally had lower levels of depression at 13 and 18 months
following their loss than those who never attended religious services.
(15) These individual seemed to cope more adaptively with their loss
and had lower levels of distress after their loss (Larson, and NolenHoeksema 75).
Why are they “Blessed”?

transforms relationships
yields vitality and creativity. The discovery of one's personal truth halts
repetition compulsion as destructive patterns inherited from previous generations lose their
chokehold. Confronting one's own history increases empathy and
compassion for others as well as discernment of their festering wounds. In particular,
Living one's grief
with one's self, one's sexual
(marriage) partners, children, and society. The release of repressed emotions and memories
according to Miller (1997), grief-work sensitizes clients to the emotional exploitation of children
and reduces the risk of unconsciously manipulating their own children to meet their own unmet
childhood needs for mirroring and unconditional love. Especially pertinent to our current socio-
assist the flourishing
of human life in a given society by diminishing individual
cultural context, Miller suggests that grief-work can
proclivities toward racism, sexism, homophobia, and oppression of all sorts (p. 114). In this regard,
grief-work may be essential to the maintenance of democratic freedoms. When hate is
externalized and projected onto others, rather than de-repressed, it creates factions among
groups of people, polarized groups who seek annihilation of the other, which can only occur after
trampling upon the other's human rights and dignity. (Latini) }
 “Grief-work moves a person from shame to
esteem, from depression to hope, from bitterness
to forgiveness, from victim to survivor, from
emotional paralysis to creative, spontaneous, vital
living.”
On the psychological level, it is the "one thing that is needful" in response not only to personal but also communal tragedy. “In the practice of pastoral care and
counseling, such grief-work may be interpreted and experienced as one form of subjective participation in the Cross of Jesus Christ. Besides providing parishioners and clients with
the theology of the CROSS may transform the identity
and ministry of the pastoral care-giver and counselor as well. For dependence
upon the Cross enables her to hear the seemingly unbearable pain of others and
continue her own personal process of healing through mourning (Latini) “.
comfort and hope in the face of unbearable pain,

3) The avoidance of one's own suffering through intellectualization, grandiosity, denial, etc., is antithetical to both grief-work/faith and the way of the cross in human existence. (4)
The
full and complete actualization of reconciliation between God and
humanity and the eradication of sin and suffering occur only in
eternity. (5) Compassion toward others is a natural consequence
of both grief-work and participation in the Cross of Jesus Christ.
As the Apostle Paul wrote,For just as the sufferings of Christ are
abundant for us, so also our comfort is abundant through Christ. If
we are being afflicted, it is for your comfort and salvation; if we
are being comforted, it is for your comfort, which you experience
when you patiently endure the same sufferings we are also
suffering. Our hope for you is unshaken; for we know that as you
share in our sufferings, so also you share in our comfort. (2 Cor.
1:5-7) (Latini)
Just as grief-work may be a life-long process, so is the way of the cross for the Christian. Sorrow and joy, woundedness and healing exist together in the temporal realm.
Part Three-Carry the Message
 Just as Bill Wilson found release in helping
others, we also can find the same release
whether it is helping the homeless, the
addicted, the mentally ill or the poor.
Hungering for justice and mercy satisfies.

disrupts people’s ability to carry out
essential aspects of daily life, such as self care and
Serious mental illnesses
household management. Mental illnesses may also
prevent people from forming and maintaining stable
relationships or cause people to misinterpret others’
guidance and react irrationally.
 Poor mental health may also affect physical health,
especially for people who are homeless. Mental
illness may cause people to neglect taking the
necessary precautions against disease. When
combined with inadequate hygiene due to
homelessness, this may lead to physical problems
such as respiratory and skin infections
Maslow’s Hierarchy of Needs
Types of Mental Illness and Treatment
Approaches
 Causes: genetic, abuse, environment, birth
problems, medical problems or brain injury,
substances
 Treatment: behavior therapy, medication,
play and cognitive therapy
 Childhood: autistic spectrum disorder,intellectual impairment disorder (MR) behavioral
*Mood: Anxiety, PTSD, depression, bipolar
*Psychotic—hearing or seeing things,
delusions-false beliefs, paranoia-”they are out
to get me”, disorganization
*Cognitive/dissociative—amnesia, delirium /dementia
*Addiction and eating
*Adjustment
*Sexual*Sleep

Lionel Aldridge
Buzz Aldrin
Woody Allen
Adam Ant
Roseanne Barr
Ludwig van Beethoven
Irving Berlin
Marlon Brando
Art Buchwald
Drew Carey
Jim Carrey
Dick Cavett
Winston Churchill
Agatha Christie
Dick Clark
Rosemary Clooney
Kurt Cobain
Shawn Colvin
Judy Collins
Calvin Coolidge
Jean-Claude Van Damme
Rodney Dangerfield
John Denver
Princess Diana
Charles Dickens
Kitty Dukakis
Patty Duke
Kirsten Dunst
Richard Dreyfuss
T. S. Elliot
William Faulkner
Carrie Fisher
Harrison Ford

Connie Francis
Paul Getty
Mel Gibson
Vincent Van Gogh
Macy Gray
Peter Green
Linda Hamilton
Ernest Hemingway
Abbie Hoffman
Janet Jackson
William James
Billy Joel
Samuel Johnson
John Keats
Jack Kerouac
Margot Kidder
Vivien Leigh
Abraham Lincoln
Mary Todd Lincoln
Jack London

Mrtin Luther
Henri Matisse
Kristy McNichol
Burgess Meredith
Michelangelo
Bette Midler
Spike Milligan
Wolfgang Mozart
Edvard Munch
John Nash
Isaac Newton
Friedrich Nietzsche
Florence Nightingale
Sinead O'Connor
Eugene O'Neill
Ozzy Osbourne
Marie Osmond
Jane Pauley
Jimmy Piersall
Sylvia Plath
Edgar Allen Poe
Jackson Pollock
Charlie Pride
Anne Rice
John D. Rockefeller
Theodore Roosevelt
Axl Rose
Mark Rothko
J. K. Rowling
Charles Schultz
Peter Sellers
Brooke Shields
Robert Shumann

Sarah Silverman
Britney Spears
Rod Steiger
Ben Stiller
James Taylor
Peter Illyich Tchaikovsky
Leo Tolstoy
Ted Turner
Mark Twain
Tracy Ullman
Kurt Vonnegut
Mike Wallace
Walt Whitman
Tennessee Williams
Jonathon Winters
Brian Wilson
Owen Wilson
Virginia Woolf
Boris Yeltsin
#4 Spiritual Hunger Brings
Spiritual Fulfillment
Life is a banquet of plenty that we bring our appetite to. Jesus himself
referred to himself as the “bread of life”. Moreover-Justice and peace is
his central theme. As we hunger for these virtues we begin to touch the face
of God. If we settle on the material-we distance ourselves from God.
Moreover, as we work through life’s challenges in our own experiences, we
begin to have greater empathy for our brothers and sisters. Jesus did this
by healing the leper, the blind the lame and mute, feeding the hungry
multitude.
We can do this today through these acts as
well as advocating for the poor, the
mentally ill and the outcast. Society has
marginalized and even committed great
acts of unspeakable cruelty against such
people throughout history. They were
though of has demon possessed and
should be beaten and caged. However,
Jesus shows us how to be understanding,
kind, supportive. We are often put to the
test of how we will respond to God when
he appears as the alcoholic, the
depressed, dirty, wondering, lonely talking
to themselves or dying cold and naked in
the street. We then get a wonderful feeling
when we share our seed faith with them
and God multiples and grows these seeds.
What things help you refresh and revive your self?
What attitudes can you change to prevent burnout?
Who is you your support network?
In Sum…
 No matter what our religious background is, we find
the Beatitudes embody this spiritual laws through
following a few simple spiritual principles. They can
empower us to live beyond our wildest dreams and
cope with life challenges such as mental and
emotional problems, losses, stress, financial
problems and addiction. I would like to focus on
specially three challenge areas and how they apply
to the Beatitudes: Recovery from addiction and how
12 step groups use the Beatitudes, Healing from
Losses, and recovery from mental health issues.
Jesus is telling us to focus on abundance, joy and
prosperity through the Beatitudes-

1.The Kingdom of Heaven-Imagine Heaven is, what is it like? Who is there? Behold it
now, feel the emotion of being there now.

2.Possessing “the land”- Ancient people survived off the land. It gave them everything
they needed to live. Visualize, feel and grasp what success would look like for you.
Live as if you have it now.

3.Comfort-Not simply physical comfort but peace of mind and wholeness in body.
Focus on healing and that is what you will attract, focus on illness and stress, what
you don’t have, your problems –and that is what you will attract.

4.Fulfillment- What do you imagine to be a fulfilling life. Express gratitude for what
you already have. Not just materially, but relationally, in your occupation and
character. Visualize , feel and live as if you have it now.

5.Mercy- As you forgive others-so shall you be forgiven. Do away with anger and
resentment that erodes the body and mind.

6. GOD- Focus your life on the Source of all goodness, love, healing and power.
Meditate on God and live in conscious contact with God. Share him with others using
your unique, God given
talents—what are they?
As the Apostle Paul wrote,For just as the
sufferings of Christ are abundant for us, so
also our comfort is abundant through Christ. If
we are being afflicted, it is for your comfort
and salvation; if we are being comforted, it is
for your comfort, which you experience when you
patiently endure the same sufferings we are also
suffering. Our hope for you is unshaken; for we
know that as you share in our sufferings, so
also you share in our comfort. (2 Cor. 1:5-7)
What you did to the least of
mine, you did unto me..come
and enter your rest.