PLAGIARISM FREE

These group sessions for a grief counseling situation is based on and adapted from the course and booklet entitled “Good Grief: A Workbook Designed to Help Those Who Are Grieving” by Cecil W. Fike. He published his workbook initially in 1998. Fike did much of his work based on Granger Westberg’s book of the same title “Good Grief.” Westberg also happened to write the forward to the workbook. The original program outlines eight sessions, but a couple of those can be eliminated depending on the makeup of the group.

-BTH

Good Grief:

A guided group therapy for those experiencing grief

Introduction. This is a group therapy of six weeks/meetings, to help move people through the grieving process and aid in a better understanding of their grief. This support group is designed primarily to help those who have experienced the loss of a loved one. Of all the stresses experienced by human beings, the loss of a loved one can be one of the most devastating. The process of grieving takes the bereaved through a series of emotions with the hopeful outcome of returning back to functioning in life again, but without the one lost. Unfortunately, society has placed time limits on this process, and it is often not enough to adequately go through each emotion. Further, friends might try to “help” the bereaved by protecting that one from the pain of such loss. This is a most futile effort. A grieving individual cannot reinvest in their future unless the past is dealt with. Those that face the reality of their new situation and mourn their loss will find it easier to continue living. No amount of counseling will take away the pain of losing a loved one but getting help of working through the process will give strength to cope with one’s new reality.

Session One – The Grief Process Getting back into the mainstream of life following the death of a loved one is no easy task. For lack of a better term to describe the task, the phrase “grief work” has been coined and the process one goes through to complete the work has been called the “grief process.” However, the term “process” can be misleading since it implies that there is a step-by-step set of stages or phases which one must complete to successfully arrive at the desired destination. Perhaps a more descriptive term would be “facets” of grieving. The process of grief work includes many stages, phases or facets, and feelings which one will encounter. Erick Lindeman, a former professor of psychiatry at Harvard University, was first to define the normal workings of grief in an article entitled, “Symptomatology and Management of Acute Grief.” It was published in The American Journal of Medicine in 1941. He defines five things which can be observed in the “struggle to extricate oneself from bondage to the deceased and find new patterns of rewarding reaction.” He describes them as 1) somatic distress (physical symptoms), 2) preoccupation with the image of the deceased, 3) guilt, 4) hostile reactions, and 5) loss of normal patterns of conduct. Granger Westberg in his book Good Grief further defines the process to include ten steps, or phases, of grief work to be dealt with during the healing process of grief. They are:

1. Shock and denial 2. Show of emotion 3. Depression 4. Physical symptoms 5. Anxiety and panic

6. Anger 7. Guilt 8. Resistance to change 9. Hope gradually comes through 10. Reaffirm reality in the absence of the deceased

It is important to note that the journey from birth to death has many ups and downs, growth spurts, and plateau’s. the valleys of life are most often caused by the losses one encounters with the most dramatic falls occurring as a result of a major loss of a loved one, either through death, divorce, or other traumatic event. While as a representation of the process it might seem like a linear process, the truth is that grief sometimes skips and often reverts back to previous aspects. These largely depend on the circumstances of the bereaved. It is also difficult to clearly define the steps of grief work, precisely because one seldom moves neatly from one to the other and can quite often be in more than one phase simultaneously at any given time. J. William Worden, in Grief Counseling and Grief Therapy, has listed manifestations of normal grief. The four areas are 1) Feelings, 2) Cognitions, 3) Physical sensations, and 4) Behavior. It is interesting to note that these manifestations can sometimes be contradictory such as the mixed feelings of relief and anger or the behaviors of avoiding reminders of the deceased while at the same time carrying objects which remind one of the loved one. Here are some normal grief characteristics.

Manifestations of Normal Grief Feelings Sadness Anger Guilt & Self reproach Anxiety Loneliness Fatigue Helplessness Shock Yearning Emancipation Relief Numbness Cognitions Disbelief Confusion Preoccupation Sense of presence Hallucinations

Physical Sensations Hollowness in stomach Tightness in the chest Tightness in the throat Oversensitive to noise Feeling of “unrealness” Breathlessness, short of breath Weakness in the muscles Lack of energy Dry mouth Behavior Sleep disturbance Appetite disturbance Absent-mindedness Social withdrawal Dreams of the deceased Avoiding reminders of deceased Searching or calling out Sighing Restless over activity Crying Visiting places or carrying objects to remind the survivor of the deceased Treasuring objects that belonged to the deceased

Homework Throughout the week write down your experiences of normal grief Feelings Thoughts Physical sensations Behaviors Write down anything you experience you feel might not be normal. Feelings Thoughts Physical sensations Behaviors Write a letter to your loved one. Your letter should include your feelings at the time and immediately following their death. You may want to tell them things which you wish you had said or wanted to do before they passed away. You can tell them if you are upset over their leaving. You might want to tell them what you miss about them the most. Let them know you are working on your grief in this class. Please Note: You will not be required to read this letter in class unless you want to share with others.

Session Two: The Four Tasks of Grieving J. William Worden, in his book, Grief Counseling and Grief Therapy, lists four tasks of mourning. Unlike the grief process as defined by Westbrook, these tasks must be completed in the order they are listed as each task is dependent upon the completion of the preceding task. For instance, one will not fully experience and learn to deal with the pain of grief until they have accepted the reality of the loss. Likewise, a grieving person must learn to cope with and constructively deal with that pain before they will be able to begin developing new skills in order to adjust to their new environment.

TASK 1 To accept the reality of the death

TASK 2

To experience the pain of grieving

TASK 3 To adjust to your changed environment

TASK 4

To withdraw the emotional energy from the deceased Task 1. To accept the reality of the loss is the first, and often, one of the most painful tasks that grieving loved ones must complete in order to begin the long journey toward healing. To accept the reality means that one must grasp and accept the true meaning of the loss. It means realizing that their loved one is not going to return as if they were on an extended trip. It involves fully knowing the circumstances of the death if possible. The real meaning of death is that it is not reversible. Until one fully understands and accepts that, the loved one will not return, there is little need or desire to adjust to the loss. Task 2. To experience the pain is only fully accomplished after one is aware of the finality of the loss. The pain which is caused by the loss of a beloved family member or friend is real pain and must be experienced and handled in a healthy manner. It is impossible to lose someone you have been deeply attached to without experiencing pain. Well-meaning friends, and society in general, will go to great lengths to protect you from experiencing this pain. Doctors will often give sedatives or tranquilizers as a means of taking off the edge of the pain. Friends, family members and even clergy will change the subject if they become aware that you are beginning to tear up during a conversation fearing that it may be too painful for you to talk about the death. Others, honestly thinking that they are helping, will avoid using the name of the deceased even though you may try repeatedly to talk about your loved one. Mourners do not need to be masochists, inflicting unnecessary pain upon themselves, however it is impossible to avoid this pain and sadness. To deny it or try to escape it will only postpone a necessary part of grief. The true friend is that person who will allow you to express your feelings and talk about your loss, even though it may hurt and bring on tears. Never be

ashamed of your tears! They are appropriate and need to be shed. Task 3. To adjust to the changed environment from which the loved one is missing. For many this adjustment will involve major role changes and responsibilities for the grieving family These changes may be in the form of the new roles to be acquired or learned such as assuming responsibilities for the care of children, handling finances, or taking care of the automobile or plumbing problems. Changes may include the loss of the familiar role as "caretaker* for a loved one before their death or the role of "parent" following the death of a child. These forced changes influence the grief reaction and affect the difficulty of one's grief. The greater the changes, the more adjustments that one must make. It is a difficult task to learn new skills and adjusting to new lifestyles. There are several suggestions which you may find helpful as you complete Task 3: 1. Realize that it sometimes takes several months before you will be aware of all of the changes resulting from the loss. 2. Learning new roles and acquiring new skills may be a long and slow process. Be patient with yourself. Allow yourself time to learn and develop the necessary skills. 3. Learning new skills is difficult. Don't be afraid or ashamed to ask for help. If you were learning to use a typewriter or computer, you would ask for help. Learning new roles in life following a death is much more difficult. 4. Keep in mind that you may learn to like the new skills and roles acquired in adjusting to your changed environment, even if you hated the changes in the beginning. For instance. the person who must learn to handle the family finances may reach the point where they actually enjoy the freedom and control which it brings them. Task 4. To withdraw the emotional energy from the deceased and reinvest it in another person or cause. This is not to say that we stop loving the person who has died nor do we want to forget them. This task simply means that we have healed to the extent that we are free to live life to its fullest once again. We now know that we can love another person and not love the person who has died any less. The love may, and most likely will, be different from the previous love. The relationship may begin more as a friendship than the love we had for the one who has died. Some people find that they withdraw the energy from the deceased and invest it in a cause or task which has meaning for them. An example of this would be the mother who lost a teenage daughter because of a drunk driver, devoting her energies to the founding of M.A.D.D. (Mothers Against Drunk Drivers). Again, it is important to remember that one must complete these tasks as Worden has defined them. There are no short cuts to the grief process. Sometimes, in an attempt to shorten the time needed to get through the grief work or to escape some of the tasks, a survivor may move ahead to a more comfortable task. For instance, a young mother may try to complete Task IV (establish a new relationship) before Task IlI (adjusting to the changed environment). She may be heard saying something to the effect of, "I am not interested in a new mate for myself as much as I am in finding a father for my children. Another example would be the person who quickly moves into a new relationship (Task 4) as a way of avoiding the pain of being alone (Task 2).

Homework Write a paragraph about the Tasks of Grieving and try to locate the task you are working on at the present time. Reflect on which task you believe has been the most difficult for you, or which one you fear the most. If you have completed Task 1, Accepting the reality of the death, what experiences “helped” you. What experiences “hindered” you in completing this task? If you are working on Task 2, who were the people or groups who “helped” or “hindered” you in dealing with the pain in a constructive manner? List some “adjustments to your changed world” which were or are the most frightening or difficult for you to accomplish.

Session 3 Individual Factors in Grieving

In looking at the overall pattern of grieving, even though there is much similarity, each person's response will quite likely be different from others around him or her. This difference is created by a number of factors influencing the bereaved person. The degree of difficulty which one has in adjusting to their loss can often be seen in the circumstances surrounding the death and the relationship between the deceased and the mourner. The following factors will influence the difficulty of the grief work. 1. Relationship to the deceased. While it does not always hold true, often the closer the relationship between the deceased and the mourner the more difficult the grieving process will be. The person living in the same household and having daily contact with the deceased will have many more adjustments to make than the distant relative who only saw the deceased on limited occasions. Likewise, the person who is more dependent on the deceased will need to make more changes in their life than the person who is independent and living on their own. 2. Attachment to the deceased. The stronger the attachment between the deceased and the survivor, the more difficult the adjustment will be following the death. For instance, the grandchild who visits frequently and is considered the favorite grandchild will experience a greater loss than the child who lived some distance away and rarely saw the deceased. 3. Personality of the deceased. It can sometimes be seen that the person who was known as being loving, and kind may be missed more than the person who was abusive, unkind or even one who was less outgoing. However, it must quickly be added that one should be slow to make judgements, either about the deceased or the bereaved, based on the apparent difficulty or lack of difficulty in the grief process. 4. Mode of death. The type of death will greatly influence the severity of the grieving A sudden death resulting from an accident, suicide or murder is especially hard. Such deaths leave no time to complete unfinished business with the deceased. Whenever there are legal investigations, court proceedings, or unanswered questions the grief process can be prolonged over an extended period of time. 5. Timeliness of death. The difficulty of grief work resulting following the death of a child or teenager will be quite different from the grief brought on by the death of one who has lived a long happy life and dies following an extended illness. 6. Availability of a body to view. Deaths which result in there being no body to view, such as death from drowning or war, are very difficult. The denial stage is extended when there has not been the opportunity to view the deceased. Even though it is a painful task to see the body of a loved one, most experts believe that it is an important task. It is hard to accept the reality

of the death when one has not seen it first-hand. 7. Personality traits of the mourner. The survivor who is well adjusted to life may find his or her grief experience less difficult than the person who is usually pessimistic about life. When the bereaved person is already suffering with depression it can be expected that the depression may be increased. 8. History of previous losses. There are several factors resulting from one's history with previous deaths which will influence future grief experiences. If it is one's first grief experience it may be more difficult for them as compared to the person who has experienced and survived several other losses. Likewise, if there are unresolved losses or a history of several reseat deaths one can expect the process to be lengthened. The "grief work* for each loss must be completed in the order which the losses occurred. When one has not finished grieving a previous loss the impact of the death can be doubled. 9. Mobile society. With today's mobile society the grieving individual may live many miles from their circle of intimate supporting friends and family. The Irish Catholic from the New England area who is living in rural Georgia will not have the familiar rituals and customs available to them and it may feel as if they have not had an opportunity to grieve properly. 10. Society puts pressure on us to heal quickly. It is not unusual to have well-meaning friends tell us that it is time to get back to normal long before we have had the necessary time to complete our grieving A mother who buried her son on Tuesday was told on Friday that she had been "down in the mouth long enough." Grief takes time and it cannot be hurried. When we try to hurry the process, it is too easy to skip over or limit much-needed healing. 11. Pressure to suppress or deny emotions. Because family or friends are uncomfortable with the expression of emotions, especially anger or tears, we may be tempted to deny or hide them. If we do not express these emotions when they are appropriate, they usually come out at a later, less appropriate time. Feelings that are denied or hidden do not go away. They will grow and become stronger until they are expressed. Just as there are factors which can generally be expected to increase the difficulty of the grief work, there are also factors which influence the grief process in a positive way. There are several attributes or personality traits which are noted in persons who appear to have less difficulty in their bereavement. 1. Persons who meet their basic human needs. Those persons who have an understanding of their basic needs and strive to meet those needs often have less difficulty in grief. These basic needs include food, rest, exercise, and social interaction. These persons will make an effort to provide for their nutritional requirements and need for rest even though they do not feel like eating or sleeping. Healthy persons are quite often the ones who know what is healthy and make sure that these needs are met whether they feel like it or not. It is easier to act one’s way into new feelings than to feel one's way into new actions. Actions precede feelings in

most cases! 2. Persons who maintain personal esteem. Those individuals who continue to have hope that they will survive this experience just as they have survived previous difficult times will have an easier time than the ones who lost hope. These persons are often the type who continue to set goals and develop a plan to accomplish them. 3. Persons who have or develop the ability to relate to others. Grief work is accomplished much more readily with the help of others. When compared to a person who isolates himself from caring friends, the one who seeks out and shares his grief with others will have less difficulty. A sorrow shared is a sorrow cut in half! 4. Persons who desire to improve their coping skills. Those individuals who seek to deepen their understanding of life and their own response to their experiences will usually be better than the person who displays a defeatist attitude. This person will try to develop new coping skills when more familiar ones fail them. 5. Persons who have a mature religious faith. One's faith will not make them immune from the pain and heartache of losing a loved one, however, it often enables them to see beyond the grief to a time of healing. For many their faith helps them to reach out to a source of strength and comfort which can carry them through difficult periods. It is important to remember that the presence or absence of tears and pain must not be seen as an indicator of the depth of one's faith. A "mature faith" is a faith in which one's God or Supreme Being is seen as loving, forgiving, non-judgmental, understanding and accepting of genuine human emotions, feeling and thoughts which are very often a major part of one's reaction in times of crises or tragedy.

Homework

Describe the relationship you had with the deceased and write a sentence stating how it has influenced your grief. Our relationship was ______________________________________________________________________________ ______________________________________________________________________________ This relationship made my grief ______________________________________________________________________________ ______________________________________________________________________________ List any unusual circumstances surrounding your loved one’s death and tell how it has affected your grief. What are the personality traits of the deceased? When faced with new and difficult situations I most often will___________________________________________________________________________ ______________________________________________________________________________ List past losses which you have had in your life and tell how these deaths affect your present grief experience