5/23/2011

Overview

Terminology
Dealing with Grief & Loss
Personal Awareness

Grief Theories

Grief Reactions
Theory, Personal Awareness,
What Helps
Grief Reactions, & What Helps

5/23/2011 Janice Firn, L.M.S.W., Clinical Social 2

Worker, UofM Hospital

“Grief”

Loss?
Stages?
What’s the first thing you think
Sadness?
Tasks?

Separation?
Symptoms?
of when I say the word “grief”?
Anguish?
Adaptive?

Change?
Normal?

Ache?
Complicated?

Hurt?
Pathological?

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Worker, UofM Hospital Worker, UofM Hospital

Why talk about Grief? Why talk about Grief?

Change happens! “Working through our endings

“Little deaths” allows us to redefine our
relationships,

To live is to experience loss
to surrender what is dead and to

Grief is: emotional,
emotional, social, spiritual, and
accept what is alive,
physical response
and to be in the world more fully to
face the new situation.

“Change is Inevitable—Growth is Optional.
Inevitable— Optional.””
- Stanley Keleman
- Walt Disney
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Worker, UofM Hospital Worker, UofM Hospital

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Substance Use & Grief Substance Use, Recovery & Grief

Substance Use and Dependence contribute to problems in:
Loss of relationships

Family
Legal
Loss of dreams, future, fairness of life, “not

Medical/health
Economic the plan”

Psychiatric
Psychological
Loss of what was “normal”

Social
Interpersonal
Substance use as maladaptive coping

Recreational
Work/school

Grief of “losing using”

Emotional
Spiritual

Suspended animation

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Worker, UofM Hospital Worker, UofM Hospital

Why do we feel Grief? Personal Awareness of Grief & Loss

Attachment Theory: attachments to people,
Life Events Scale
animals, things, rituals, etc. Handout

Perception is key

Types of Attachments
Individual Response

Secure
Frequency of exposure

Avoidant

Anxious

Ambivalent

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Worker, UofM Hospital Worker, UofM Hospital

Myths About Grief Facts About Grief

Fact: Trying to ignore your pain or keep it from

Myth: The pain will go away faster if you
surfacing will only make it worse in the long run.
ignore it.

Fact: Feeling sad, frightened, or lonely is a normal

Myth: It’s important to be “be strong” in the reaction to loss. Showing your true feelings can help
face of loss. you and others deal with the grief.

Myth: If you don’t cry, it means you aren’t
Fact: Crying is a normal response to sadness, but
sorry about the loss. it’s not the only one.

Myth: Grief should last about a year.
Fact: There is no right or wrong time frame for
grieving.
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Kubler--Ross
Kubler J. William Worden
The five stages of grief:
Healing is necessary in the physiological realm
to bring the body back into physical health, a
1. Denial: “This can’t be happening to me.”
period of time is likewise needed after a loss to
2. Anger: “Why is this happening? Who is to
return to a similar state of emotional well-
well-
blame?”
being.
3. Bargaining: “Make this not happen, and in
return I will ____.”
The four tasks of mourning are an essential art
4. Depression: “I’m too sad to do anything.” of the healing process.
5. Acceptance: “I’m at peace with what
No specific order, but still must each be
happened.” worked through during the time of grieving.
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Worker, UofM Hospital Worker, UofM Hospital

The 4 Tasks of Mourning Accept the Reality

1. Accept the reality of the
To come full face with the fact that your loss is real
loss and will not return, i.e. that immediate reunion or
2. Experience and work regaining it is impossible.
through the pain of grief
3. Adjust to the new
Obstacles:
“normal”; life without
Denying the facts of loss.
what was lost
Denying the meaning of the loss, e.g. “It wasn’t a

4. Emotionally relocate the good job anyway, or I don’t miss him,” or “I’m
loss and move forward just as healthy as I ever was.”
in life
Minimizing the loss. “It’s not that big of a deal.”

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Worker, UofM Hospital Worker, UofM Hospital

Experience & Work

The New “Normal”
Through the Pain  Coming to terms with being without (maybe raising children
 It is impossible to lose something or someone you alone, facing future unemployment or handicap, redefinition of
have been deeply attached to without experiencing self, etc.).
some level of pain. A. External Adjustments : how the loss affects your everyday
functioning in the world
B. Internal Adjustments: how the loss affects your sense of self
 Obstacles: C. Spiritual Adjustments: how the loss affects your beliefs,

Not allowing yourself to feel. values and assumptions about the world

Cutting off your feelings and denying that pain is
present.
Obstacles:

Promoting your own helplessness.

Avoiding reminders of the loss – e.g., trying to

Not developing the skills you need to cope or to function in
find a ‘geographic cure’ by moving to another new roles.
location, or travelling

Withdrawing from the world. Refusing to see yourself or the
world differently.
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Moving Forward When is Grieving Over?

To find a place for what was lost that will enable us to remain
 When a person can think of what was lost without
connected with them/it but in a way that will not keep us from pain.
going on with life.  When the tasks of mourning have been accomplished.
 When one can think of the deceased without physical

Obstacles: manifestations such as crying or feeling tightness in

Withdrawal from others and life. Not living. the chest.
Unwillingness to love.  When the bereaved can reinvest his/her emotions into

Unwillingness to risk; making a vow to never invest life and the living.
yourself again.  When one can regain an interest in life, feel more

Holding on so tight to the past that you’re unable to form hopeful, experience gratification again, and adapt to
new relationships or develop new skills. new roles.
 Is there a time limit? 1 year? 4 seasons? 2 years? It
depends.
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Worker, UofM Hospital Worker, UofM Hospital

Grieving is Necessary! Normal Grief Reactions

Emotional
“Man, when he does
not grieve,
Physical

hardly exists.”
Cognitive

- Antonio Porchia

Behavioral

Spiritual
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Grief vs. Depression Tensions for Families

Grief is a roller coaster. Hope Despair
Denial Acceptance
Meaninglessness Meaningfulness
Independence Accepting Interdependence
Family Burden Opportunity to Serve
Ambiguity Certainty of Outcome
Making Plans Experiencing Emotions
Holding On Letting Go
Speaking Openly Not Talking

Depression is dead end. Family as it Was Family as it is Becoming
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When Grief Isn’t Healing When Grief Isn’t Healing

Chronic, ongoing grief

Relational Factors

Circumstantial Factors

Historical Factors
Delayed grief reactions

Personality Factors

Social Factors
Avoiding grieving

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Worker, UofM Hospital Worker, UofM Hospital

Grief WORK

Grief therapy: goal is not about forgetting but
remembering with less pain. “Grief heals when it is received by

Developing adaptive coping mechanisms. a caring other.”

Finding meaning.

AA and Al-
Al-Anon, NA and Nar Nar--Anon = grief work - Wendy Lustbader

5/23/2011 Janice Firn, L.M.S.W., Clinical Social 27 5/23/2011 Janice Firn, L.M.S.W., Clinical Social 28
Worker, UofM Hospital Worker, UofM Hospital

Getting Support When Helping Someone who is Grieving

You Are Grieving

Do not grieve alone

Listen

Turn to friends and family members
Acknowledge the

Join a support group Uniqueness of Grief

Talk to a therapist or grief counselor

Offer Practical Help

Face your feelings

Make Contact, Write a

Express your feelings in a tangible
Personal Note
or creative way.

Look after your physical health.
Be Aware of Holidays

Plan ahead for grief “triggers”. and Anniversaries

5/23/2011 Janice Firn, L.M.S.W., Clinical Social 29 5/23/2011 Janice Firn, L.M.S.W., Clinical Social 30
Worker, UofM Hospital Worker, UofM Hospital

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Resources

J. William Worden, Grief Counseling & Grief Therapy,
Therapy, 2008.
Grief and Loss in

Lynne A. DeSpelder & Albert. L. Strickland, The Last Dance:
Encountering Death and Dying,
Dying, 1998. Addiction and Recovery

Judith Viorst, Losses,, 2002.
Viorst, Necessary Losses

Holmes--Rahe Social Readjustment Rating Scale. Journal of
Holmes Matt Statman, LLMSW, CADC
Psychosomatic Research, (1967). Vol. 11, pp. 213-
213-218.

Lynn, J. and Harrold,
Harrold, J. (1999). Handbook for Mortals:
Guidance for People Facing Serious Illness, p.41. Dawn Farm May

Al-
Al-Anon Dist. 5, http://www.hvcn.org/info/afg5/griefloss.htm

HelpGuide.org, http://71.6.131.182/mental/grief_loss.htm Education 2011

Dennis C. Daley & G. Alan Marlatt,
Marlatt, Overcoming your
Alcohol or Drug Problem,
Problem, 2006.

Wolfet,, A. (2009). The Handbook for Companioning the
Wolfet Series
Mourner. Companion Press: Colorado.

Drugs.. NASW, 2010.
Abbot, A., Alcohol, Tobacco, and Other Drugs
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Worker, UofM Hospital

Grief experiences in the

"To spare oneself from grief at all
culture of addiction …
cost can be achieved only at the
price of total detachment, which
excludes the ability to experience
happiness." - Dr. Erich Fromm

The Disease of Addiction Causes…

o Feelings unfreeze, feel
o Unresolved grief, loss & trauma overwhelming
o Losses in the culture of addiction o Unable to feel unable, to identify
o Use of AOD is primary coping skill feelings
o Little support for healthy grieving o May present as a whole range
o Grief is not processed feelings that are seemingly
o Losses are not fully grieved unrelated
o Complicated by
o Feelings are medicated
guilt/shame/stigma

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Abstinence alone does not equal

recovery or health – Inability to grieve losses
there is work to do ! and move through grief
People may not know how to verbalize can be a barrier to
what they are feeling, may lack coping recovery/getting well.
skills and may tend to seek immediate
relief through other compulsive behaviors
such as cutting, food, sex, relationships,
etc.

Losses occur not only in the culture

of addiction – losses are also
Loss of the “drug of choice” …
incurred in moving from addiction to
recovery…

o Relationship with substance is Grieving for the loss of the

primary
substance needs to be
o Constant reminders of this loss in
early recovery
acknowledged and worked
o Important loss that can easily be through
minimized
-

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Loss of important o Lost relationships with family/friends

o May have lost the experience of
relationships … having “true” friends
o Loss of important relationships that
present threats to sobriety – Using
relatives
o Grief over loss of companionship and
shared experiences
o Loss of socialization opportunities

Recovery will offer Loss of self…

opportunities for developing
new relationships, and often to
heal old relationships

o Identity may have been formed around Recovery offers opportunities

AOD
o Addiction requires people to live outside
to find meaning and purpose,
their values for survival. This contributes to rediscover and redefine
loss of identity as well as immense guilt and
shame (Ideal self/actual self).
oneself, and find true
o Loss of hopes, plans, aspirations and belonging in a supportive
dreams can be even more painful than community
practical losses.
o Loss of innocence, dignity, self-
self-esteem,
choice, control of one’s body.
These things are not lost forever!

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Loss of time and

opportunities … o Missed parenting time/ family
milestones/ deaths
o Recovering person may feel
time spent high is “lost”
o Time spent incarcerated

Spiritual Losses …
Recovery offers the
opportunity to make meaning
of past experiences and to use
them to help others

Recovery offers the opportunity to

o Loss of meaning and purpose connect / reconnect with one’s
o Loss of connection to a Higher spiritual self and to grow spiritually
Power
o The person who once believed
in a God may have lost that
belief, and lost faith
o Loss of hope

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Loss of rituals, beliefs and practices

from the culture of addiction…
o Loss over rituals
o Loss of coping mechanisms and
survival techniques
o Loss of illusions (e.g. illusion of
“control” over substance.)
o Ignorance is bliss!

In recovery, when one door Tangible losses …

closes another opens –
in time, lost rituals etc. will
be replaced by rituals and
practices of recovery.

o Loss of Money Recovery will provide opportunities

o Loss of shelter/housing to move forward, regain security
o Loss of material items/wealth and improve health
o Loss of job/career, educational
opportunities
o Loss of health
o Etc
o Etc
o Etc

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Grief work in recovery is tough,

Perinatal losses … necessary and ultimately rewarding

“The reaction to loss that is widely experienced

by friends and family members of persons who
are addicted to mind altering substances is
Grief and loss profound grief. It has characteristics of flawed
interactional patterns because the loss is
ambiguous. If a person dies, the grief is
experienced by unambiguous: the social role the deceased
played is no longer occupied and the deceased
family and friends cannot fulfill obligations or promises. The
spouse who becomes addicted to mind altering
substances often ceases to fulfill obligations or
promises, but physically the social role is still
occupied.”
-Vicki Loyer
Loyer--Carlson, Ph.D., LMFT

Family members/friends may

experience loss of relationships,
financial security, homes, jobs, health,
hopes, dreams, self-
self-esteem, dignity,
emotional support, “presence” and
other important tangible and intangible
things.
o There may be complete loss of contact
with a loved one - by (often difficult)
choice of the family member, or choice
of the person with addictions, or due to
circumstances (e.g. prison, death.)
o Sometimes addiction ends tragically,
in death from the disease or related
conditions.

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Grief may be complicated by When the person with addiction

painful experiences and enters recovery - family/friends may
feel they want their loved one to
memories; complex feelings recover more than they want
and emotions; and stigma, ANYTHING else – but ….
secrecy , shame and
misunderstanding associated
with addiction.

o Family/friend may experience loss of Grief feels lonely for family and friends
the role they had assumed while their and circumstances may be especially
loved one was using substances, challenging - but help, support and
and/or loss of their sense of purpose understanding is available, and
and healing
in “taking care of” people/things. is possible
o Recovery may not bring everything
the family member/friend thought it
would – and there may be a sense of
loss from this
o Expectations

RECOVERY…
“Grief is a natural part of life; but for an
Grief recovery is hard work addict it provides an extra set of
challenges to get through… If you're an
for family and friends too – addict on the road to recovery, be
but it is worth the effort! prepared to experience emotions in a
new way – the good and bad; and be
sure to have a plan in place to fight off
the cravings while you're in that
vulnerable state.” –Michael Bloch

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“The best therapy for grief is
time and community.” -Michael
S. Logan
o Environment is key
o A person must feel safe and supported.
o It is important not to “open up” issues
until/unless adequate support is available.
o Residential treatment provides a safe,
supportive environment
o A person in treatment may need additional
support e.g. from a grief group or grief
counseling
o Recovering people can receive very helpful
support from the recovery community –
meetings, sponsors, supports –sometimes
professional help is also needed
In recovery people
acknowledge, understand,
and accept losses and move
through grief
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Recovery is a Process
not an Event
Grief recovery is not a linear
process - it is experienced in
cycles. Grief may be compared
to climbing a spiral staircase,
where it may look and feel like
you’re going in circles, yet
you’re making progress
“Tasks” of grief recovery
when in recovery from
addiction …
o Develop skills to cope with
what they are feeling
o Learn to identify what they
are feeling
o Learn to verbalize what
they are feeling
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o For family/friends - recognize and
grieve losses; “reorganize” such that
the addicted loved one is no longer
central to the person’s well being.
(This does NOT mean “forgetting” the
person, but involves remembering
with less pain.)
o Identify, then "wrap up" or bring a
satisfactory degree of closure to
"unfinished business."
Social support
Help from community …
Support from
family/friends/others …
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“Promises” of grief recovery …
o Healthy grieving enables the
recovering person to confront and
accept the reality of the loss, and
find purpose and meaning for life
o Losses are eventually remembered
with less pain.
Things will get better
o A safe placed to be open about feelings
and experiences, without shame
o Step work helps people express grief,
gain perspective and acceptance,
forgive and move on with their lives
o Provides opportunities to give back to
others and make meaning
o Peer grief support groups can be
helpful
o People who want to help may feel uncomfortable –
it’s OK/ important to just be there
o People may want to help but not know how - let
family/friends/coworkers/others know what you
need
o Often family/friend support dissipates over time -
it’s important to continue to ask for support when
needed
o Helpers should avoid platitudes (its all right,
everything is going to be fine, everything happens
for a reason etc…) It’s ok to say “this sucks!” “I am
so sorry”
o If family/friends are unavailable or unsupportive
(including well-
well-intentioned but misguided efforts
to be supportive) –seek support elsewhere
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Spiritual support
o Participation in faith community
activities/rituals
o Faith
Faith--based support groups or prayer
groups
o Prayer, mindfulness, meditation
o One’s chosen spiritual practices and
rituals

Rituals …
Grief rituals and ceremonies acknowledge the Tributes …
pain of loss while offering social support and a
reaffirmation of life … o Creating a tribute, legacy
or memorial to honor and
remember a loved one
can provide comfort
o People often find comfort
in donating to a related
cause and/or becoming
involved in volunteer or
service work, or other
ways of helping others

Anniversaries, holidays, and

“special” dates – grief can
resurface and be very strong This is normal and OK
Grief recovery, like addiction
recovery, is ongoing

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o Grief can recur with anniversaries of ANY kind

Experiential techniques …
of loss, not just a death - experiential therapies engage areas of
the brain involved in grief, memory,
o Grief can also resurface when events remind healing, recovery
the person of their loss (e.g. national
tragedies, others having a similar experience.)
o Holidays often accentuate feelings of grief and
loss
o Have a plan for dealing with grief
anniversaries and for getting through holidays
o If in recovery - identify sources of support, a
plan of action to avoid relapse

o Music/art expression - “right brain” techniques

o Journaling, poetry writing, scrapbooking, other
creative written expression Self care …
o Goodbye letters: these may be kept private or
shared
o Somatic approaches to grief resolution –
breathing techniques, massage, body work
o Experiential practices may help with grief work:
drumming, voice techniques, guided meditation
, work with crystals or gemstones,
“singing”/vibrating bowls, shamanic journey,
other “complementary/ alternative” techniques

o Participation in mutual aid groups

o Literature, books and self-
self-help workbooks
o Internet resources , including on-
on-line peer Professional help …
support groups
o Nutrition
o Exercise, balanced with adequate rest and
sleep
o Find physical and emotional outlets that help
reduce the tensions in mind and body
o Find activities to engage in that help with
healing and regaining a feeling of purpose
and meaning in one’s own lives and from the
life of the loved one

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Sometimes professional help is needed,

especially when grief is complicated,
prolonged or seems stuck.
Sources of professional help include:
o Grief counseling THE END
o Professionally
Professionally--facilitated grief
support/recovery support/family
groups, referrals to hospice and
bereavement groups for support

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