Living - PowerPoint Presentation

Slide1
Slide2

Living

with Bereavement & Loss

Monday 3

rd

June 2013

10.30 - 4pmSlide3

Administration

The BuildingFeedback Forms Slide4

Adrian Scott

MSc Senior MBACP Accreditedwww.counsellingme.co.uk07956

292 740 adrianscott@counsellingme.co.ukSlide5

Paper Free!

Pdf files on website Background Button

Please respect the copyright – Do not sharewww.counsellingme.co.ukBackground button07956

292 740

adrianscott@counsellingme.co.ukSlide6

My Experience

MBACP Senior Accredited Counsellor MBACP Senior Accredited Supervisor for Individuals and GroupsManaged Counselling services in Voluntary Sector www.phasca.com

Bereaved, Homeless, Mental health, CarersSlide7

Expert

Not a guru or Bereavement expertDo not know everythingIdeas to be Debated / Challenged Slide8

Other City Literary

CoursesIntroduction to Psychodynamic CounsellingIntroduction to the UnconsciousWorking with Bereavement and LossSlide9

My First Working

Bereavement Working

ExperienceBereavement

Counsellor at the

London Hospital in 1989

Led by

Dr. Colin Murray Parkes

Theory / Case

StudySlide10

Morning Session

10.30 Introduction10.45 Icebreaker Exercise

Break12.00 Theory and Group Discussion OBSERVATION1pm LunchSlide11

Afternoon Session

1.45pm Exercise - Reflecting on Bereavement Break2.30 pm Attachment / Counselling

Session3pm Case Examples - Video3.30 Round Up / Feedback Forms Administration4pm EndSlide12

Your Experience & Ideas

Case ExamplesSlide13

Audio Visual

Bereavement TV Programme 35 minutes Four examples of people talking about Bereavement from different cultures and social backgrounds.

 Man living in France educated in private system in the UK. Mother died, Father died.Father whose wife died of breast cancer. Description by father and his two sons about their experience of the Hospice system.

Young boy whose father died of skin cancer. Supported through bereavement process with counseling.

Group of older widowers talking about bereavement. Issues of loss, gender, being

alone

.Slide14

Learning

Outcomes

Icebreaker Exercise - Counselling

Skills

Listening, Hearing, Reflecting back

Understanding Bereavement & Loss Theory

Models and Attachment

Assessment

Exercise

- Own Experience/ Attachment

Personal Experience – Own Therapy

Understanding of Bereavement

Counselling

Criteria Methods

Video Case Examples

Seeing others

p

eoples’ reaction to Bereavement and LossSlide15

The Day

Wide range of skills in the room

Hope you all get something out of itI am not an expert on Bereavement

Encourage you to have your own viewSlide16

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.Slide17

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!Slide18

Icebreaker Exercise Learning Outcomes

Basic

Counselling

Skills

Listening

Hearing

Reflecting backSlide19

What do you want

from the Day?

Are there any Topics, Issues, that you would like to focus or discuss today?

Write on flip chartSlide20

Break Slide21

Preamble before

Bereavement Theory

General Principles of Counselling?

Training in Bereavement

Counselling

– last bastion of old volunteer model? –

DiscussA way to reflect on feelingsLearn about relationship with ourselves

Generic

Counselling

Approach

Slide22

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

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

a surprise to 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-

ParkesSlide23

Link to Counselling

“

in order to avoid thinking about something we have to think about it”. Slide24

Link to Counselling

Counselling is a craft, technique, or practice of

thinking and being with feelings which we want to avoidSlide25

Colin Murray

Parkes

Bereavement: Studies of Grief in Adult LifePaperback: 288 pagesPublisher: Penguin Books Ltd; 3New Ed edition (1998)

ISBN-10

: 0140257543Slide26

“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 CareSlide27

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??Slide28

Types of Loss

Actual loss

Death from old age, illness, accidents.  Old person more acceptable lossYounger person less acceptable

loss Discuss

Perceived loss

Person’s view of loss Culture, history,

family,

socialisation

?

Bereavement

Counselling

Time-limited

Focus

solely on bereavement

 Slide29

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

?

 Slide30

The

Cost Of Commitment

Gain Investment

in relationships: emotional,

physical

, financial. Lives enriched but there is a ……….

Cost

Risk

of losing Gain

 Slide31

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

Individual / Personal

 Slide32

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 1993Slide33

Bereavement is like a tideSlide34

Bereavement Summary

“

in

order to avoid thinking about something we have to think about it”.

Link to CounsellingBereavement is a process of grieving

Loss

is the person or

object this is lost

The Cost Of

Commitment

Bereavement is Individual and Personal

The stages to do not

occur in

order

Bereavement is like a tideSlide35

Stages of Bereavement

Theory

1. Alarm 

2. Searching

3. Mitigation – Lessening the Impact

 4. Anger & Guilt 

5.

Disorganisation

& Despair

6

. Gaining a New Identity

Theory is theory - feel able to agree or contradict it!

Discuss

Colin Murray-

Parkes

 Slide36

1.Alarm

Tension, Shock, Panic,

Disbelief RestlessnessNumbness – some emotions break through

Preoccupation / obsessiveness with thoughts of the lost person.

Self-care neglected  

Breakdown of customs /

behaviour Sensitive to noise, conflict,

administration

Shut

down to avoid

feelingsSlide37

2.Searching

Calling

for the lost personSobbing, tearfulness,

Feeling of loss / lost Discuss

Visit places of experience

Aimless searching – irrational?

Find lost person

 Slide38

3.Mitigation–Trying to Lessen the Impact

of Bereavement

Components

of grief work

Pre-occupation / wish to find the person

Repeating, painful recollection of the loss Patterns,

Obsessive thoughts, PTSD

Making sense of the loss to fit assumptions

- meaning

Dreams

- common dream -

happy interaction with the dead

Pining / Avoidance of Pining

Idealised

person - forget

the negative

 Slide39

4.Anger

and GuiltFamiliarity - loved ones, family members

 Misdirection - Hospital staff / GPsBlame / Self

Blame

Anger guilt becomes irreconcilable - leading to family splits

Resistance to sadness, grief under the anger and guiltSlide40

5.Disorganisation

and Despair

Period of uncertainty 

Take on the reality of what has happened

Identifying with lost person – method of avoiding the loss of that person

Old

model of the world abandonedNew set of expectations created - with time and acceptance Other people become a support

, security,

& protection

.Slide41

6.Gaining a New IdentityTaking

on role/interest that lost person hadNew versions of old relationships

New relationships

New interests

New updated view of the worldLess repressed / more flexible Slide42
Slide43

6 March 1987

193 people killedThe British ferry Herald Of Free Enterprise capsized off the coast of Belgium

The ferry overturned without warning only a mile outside Belgian port ZeebruggeDespite the best efforts of rescue crews, it became the worst ferry disaster in British history.Slide44

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. Slide45

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 heeled 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”.Slide46

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.

Henry - Extending the Event- Searching Slide47

Avoidance Panic

Throughout this period he exerted a rigid control on himself and

he was still not crying two months later when he was persuaded to seek psychiatric help. At this time he was

tense,

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.

Henry - no

i

nterest

in himself Suicidal

Stuck

 Slide48

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 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?”

Henry - Routine

Event re-enacts trauma

- moves

stuckness

Slide49

Post-Traumatic Stress

Disorder

The case illustrates the features of Post Traumatic StressDisorder (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. Slide50

Summary

Stages of Bereavement Theory

1

. Alarm

2. Searching

3. Mitigation – Lessening the Impact

4. Anger & Guilt

5.

Disorganisation

& Despair

6

. Gaining a New Identity

 Slide51

Summary - Henry

Saved himself – anger guilt Stayed on the boat - maintained alarm

Avoidance Panic - isolated himself to copeTrigger – overwhelmed by feelings Re-enacted trauma with counsellorSlide52

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

motherSlide53

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 dependableCreates a secure base for the child to explore the worldSlide54

Experiment

with rhesus monkeys

Monkeys offered two objects to attach

to

Soft

mother dummy without food

Hard mother dummy with food Slide55

Monkeys preferred soft dummy without food

Discuss – reaction against Freud’s Instincts TheorySlide56

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 lifeSlide57

Attachment

Theory

Conclusions  Counselling

explores attachment

figures   

Secure Base of counselling time, place, frequency  

Explore

early attachment relationships  

Notice

relationship between

counsellor

and client  

Expectations

and perceptions of attachment

figures

Reflect

on the accuracy of self

images

Holding

and

Containing