Presented by:
Crystal Hartman MA, LPC
Coral Carosone-Link BS, CBIS
What is Grief
How People Grieve
How Grief Effects You
Ways to Cope
Finding New Meaning and Sense of Purpose
Loss: the real or perceived deprivation of something deemed meaningful
Grief: an emotion, generated by an experience of loss and characterized by sorrow and/or distress
Mourning: socially prescribed practices or outward expressions of grief and can apply to both death and non-death related circumstances
Loss Adaptation: aka Coping, refers to the process of adjusting to loss and grief
Grief is a natural response to loss
We grieve many things:
Loss of a job
Physical disability
Loss of relationships
Change in social status
Death of a loved one
Primary loss is a significant loss event, such as a death or life long disability
Secondary loss is losses that are a consequence of a primary loss which vary by the individual and context in which the loss happened
Examples: financial security, sexual intimacy, family role, self-esteem and social status
Ambiguous Loss occurs when a person is physically present but is perceived as psychologically absent (emotionally or cognitively changed).
Ambiguous loss is the most stressful
Affects both family and person with brain injury
Stigmatized Loss
Landau & Hissett, 2008
Longing for what was lost
Sadness for the loss
Crying for what was lost
Wishing for the time before the loss
Upset by reminders of the loss
Angry or anxious at the loss
A need to talk about the loss
Kubler-Ross (1969):
Most well know model
Developed from working with terminally ill patients
Viewed grief as an internal process where all grievers go through a set of predictable stages ending in a final stage of resolution
Not appropriate for grieving after a brain injury as model is made for terminal illness as opposed to lifelong disability
.
Denial
Anger
Bargaining
Depression
Acceptance
Dual Process Model (Stroebe & Schut, 1999): Views grieving as highly individual process
Coping involves fluctuating between confronting and avoiding stressors. For example, the griever will express sadness to friends and
family (confront) but actively distract themselves from this while at work (avoid).
Confront
Avoid
While a person copes by confronting and avoiding, they also work on restorative coping which means moving forward
For example, the griever will confront and avoid dealing with loss of cognitive abilities while identifying new career to meet current abilities
Viewed as normal and natural process of loss adaptation (coping)
Stroebe & Schut, 1999
INSTRUMENTAL GRIEVING STYLE
INTUITIVE GRIEVING STYLE
Experience grief in terms of thoughts and behaviors
Thinking dominates over emotions, emotional expression is private
Focuses energy on analyzing loss, problem solving and doing activities
Can be viewed by others as cold, insensitive, and in denial of loss
Experience grief through intense emotion, expression of feelings and affective language
Shows outward emotional expressions including crying, depressed mood and anger
May seek assistance from support groups and counseling
Can have difficultly managing emotions and resuming daily tasks
Martin &Doka, 2002
Blended Grieving
Style
Instrumental Grieving
Style
Intuitive Grieving
Style
Changes to our Self-Concept and Feelings
Self-concept: how we perceive ourselves based on our beliefs, feelings and values
After an injury a person evaluates their self-concept
Compares themselves to self before the injury
Doubts self-efficacy: our own beliefs about our abilities
Disruption of beliefs, assumptions, values, and expectations
Frustration increases with cognitive problems and loss of skills
Injury/Loss
Evaluate abilities,
compare to past
Disruption in beliefs,
assumptions and values
Decreased perception of worth, value,
confidence
Grieve loss, try to make sense
and new meaning
Others include family, friends, partners, co-workers, employers, neighbors, etc.
Range of Emotions
Relief and gratitude to sadness, fear and anger
Others Re-Grieve
While survivor grieves
During anniversary dates
Reminders
Family
Friends
Work Community
Leisure
Faith
Adaptive Strategies are methods people use to address distress and reduce symptoms to manage grief.
Affective Strategies
Cognitive Strategies
Behavioral Strategies
Spiritual Strategies
Martin & Doka, 2002
Affective Strategies Emotional expression:
crying, ventilation
Sharing and connecting with others
Affective regulation
Martin & Doka, 2002
Cognitive
Strategies
Information seeking
Thought restructuring analysis, reframing,
redefining
Avoidance or Denial
Martin & Doka, 2002
Behavioral Strategies
Physical Activity
Problem Solving
Goal Setting
Seeking out info and support from others
Acting out behaviors
Martin & Doka, 2002
Spiritual Strategies Prayer and
Meditation
Surrender to a higher power
Meaning reconstruction
Revising, reaffirming, discarding beliefs and assumptions
Martin & Doka, 2002
Step 1. Change how we define ourselves
How do we do this?
We grieve loss of abilities
May feel lower self-esteem, worth and value to others/society
Use negative self-statements to reflect feelings
“I am damaged”
“ Im not good at anything anymore”
This leads to self-defeating thinking
1. Compare ourselves to our pre-injury self
2. Compare ourselves to others
3. Have unrealistic expectations
4. Think of the worst that can happen
Niemeier & Carol, 2011
To reduce negative self-talk be aware of using language such as:
“should”, “ought to”, “supposed to”
Reframing our thinking to a positive manner can improve how we feel
Negative Thought: “I am supposed to work. I am a failure if I am not working.”
Positive Thought: “I’d like to work but there are other things that are also important in my life. I can be productive an useful in other ways. My self-worth is not only defined by working.”
Niemeier & Carol, 2011
Not an end point
Does not require forgetting
It’s ok to hate the injury
Acceptance involves managing two conflicting ideas: “I don’t like this”, and “I can have a good life anyways”
Niemeier & Carol, 2011
Stop viewing yourself as a Brain Injured
Person
Integrating Past and Present Self = Identity
Not an either/or, instead a mix of both
Determine skills you have retained
Make a list of priorities
Integrating yourself can have positive
qualities
Independence/self-sufficiency is a myth
New roles can re-define yourself and create purpose
Evaluate your strengths, challenges and interests
Modify your roles
Set new goals, create new purpose
Questions?
Opportunity to Share…
Humphrey, K. (2009). Counseling Strategies for
Landau, J., & Hissett, J. (2008). Mild traumatic brain injury: impact on identity and ambiguous loss in the family. Family Systems & Health, 26(1), 69-85.
Loss and Grief. American Counseling Association.
Niemeier, J. & Karol, R. (2011). Overcoming Grief and Loss after Brain Injury. New York: Oxford.
Karol, R. (2011). Appreciating Grief and Loss After Brain Injury [PowerPoint slides].