Transcript The City Lit: Bereavement & Loss Saturday 8th October

Living with
Bereavement & Loss
• Monday 3rd June 2013
• 10.30 - 4pm
Administration
• The Building
• Feedback Forms
Adrian Scott
• MSc Senior MBACP Accredited
• www.counsellingme.co.uk
• 07956 292 740
• [email protected]
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• www.counsellingme.co.uk
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• 07956 292 740
• [email protected]
My Experience
• MBACP Senior Accredited Counsellor
• MBACP Senior Accredited Supervisor for
Individuals and Groups
• Managed Counselling services in Voluntary Sector
www.phasca.com
• Bereaved, Homeless, Mental health, Carers
Expert
• Not a guru or Bereavement expert
• Do not know everything
• Ideas to be Debated / Challenged
Other City Literary
Courses
• Introduction to Psychodynamic Counselling
• Introduction to the Unconscious
• Working with Bereavement and Loss
My First Working
Bereavement Working
Experience
• Bereavement Counsellor at the
• London Hospital in 1989
• Led by Dr. Colin Murray Parkes
• Theory / Case Study
Morning Session
• 10.30
• 10.45
•
• 12.00
• 1pm
Introduction
Icebreaker Exercise
Break
Theory and Group Discussion
OBSERVATION
Lunch
Afternoon Session
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1.45pm
Exercise - Reflecting on Bereavement
Break
2.30 pm Attachment / Counselling Session
3pm
Case Examples - Video
3.30
Round Up / Feedback Forms
Administration
4pm
End
Your Experience & Ideas
Case Examples
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.
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 peoples’ reaction to Bereavement and Loss
The Day
• Wide range of skills in the room
• Hope you all get something out of it
• I am not an expert on Bereavement
• Encourage you to have your own view
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.
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!
Icebreaker Exercise
Learning Outcomes
Basic Counselling Skills
Listening
Hearing
Reflecting back
What do you want
from the Day?
• Are there any Topics, Issues, that you
would like to focus or discuss today?
Write on flip chart
Break
Preamble before
Bereavement Theory
• General Principles of Counselling?
• Training in Bereavement Counselling – last bastion of old
volunteer model? – Discuss
• A way to reflect on feelings
Learn about relationship with ourselves
• Generic Counselling Approach
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-Parkes
Link to Counselling
“ in order to avoid thinking
about something we have to
think about it”.
Link to Counselling
Counselling is a craft, technique,
or practice of
thinking and being with feelings
which we want to avoid
Colin Murray Parkes
• Bereavement: Studies of Grief in Adult Life
• Paperback: 288 pages
• Publisher: Penguin Books Ltd; 3New Ed edition
(1998)
• ISBN-10: 0140257543
“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 Care
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??
Types of Loss
• Actual loss
• Death from old age, illness, accidents.
• Old person more acceptable loss
• Younger person less acceptable loss
• Perceived loss
• Person’s view of loss
• Culture, history, family, socialisation?
• Bereavement Counselling Time-limited
• Focus solely on bereavement
Discuss
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?
The Cost Of Commitment
• Gain
Investment in relationships: emotional,
physical, financial.
Lives enriched but there is a ……….
• Cost
Risk of losing Gain
Process of Bereavement
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Start after loss?
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Fade away?
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Remain repressed not allowed to begin?
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Part of the process begins / Other parts held back.
•
Bereavement is like a tide: it flows back and forth through the stages
•
Individual / Personal
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 1993
Bereavement is like a tide
Bereavement Summary
“ in order to avoid thinking about something we have to think about
it”. Link to Counselling
Bereavement 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 tide
Stages of Bereavement
Theory
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1. Alarm
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6. Gaining a New Identity
2. Searching
3. Mitigation – Lessening the Impact
4. Anger & Guilt
5. Disorganisation & Despair
Theory is theory - feel able to agree or contradict it!
Discuss
Colin Murray-Parkes
1.Alarm
• Tension, Shock, Panic, Disbelief Restlessness
• Numbness – some emotions break through
• Preoccupation / obsessiveness with thoughts of the lost
person.
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Self-care neglected
Breakdown of customs / behaviour
Sensitive to noise, conflict, administration
Shut down to avoid feelings
2.Searching
• Calling for the lost person
• Sobbing, tearfulness,
• Feeling of loss / lost Discuss
• Visit places of experience
• Aimless searching – irrational?
• Find lost person
3.Mitigation–Trying to
Lessen the
Impact of Bereavement
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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
4.Anger and Guilt
• Familiarity - loved ones, family members
• Misdirection - Hospital staff / GPs
• Blame / Self Blame
• Anger guilt becomes irreconcilable - leading to family
splits
• Resistance to sadness, grief under the anger and guilt
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 abandoned
• New set of expectations created - with time and
acceptance
• Other people become a support, security, &
protection.
6.Gaining a New Identity
• Taking on role/interest that lost person had
• New versions of old relationships
• New relationships
• New interests
• New updated view of the world
• Less repressed / more flexible
6 March 1987
193 people killed
• The British ferry Herald Of Free Enterprise
capsized off the coast of Belgium
• The ferry overturned without warning only a
mile outside Belgian port Zeebrugge
• Despite the best efforts of rescue crews, it
became the worst ferry disaster in British
history.
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.
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”.
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
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 interest in himself Suicidal Stuck
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
Post-Traumatic Stress
Disorder
The case illustrates the features of Post Traumatic Stress
Disorder (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.
Summary
Stages of Bereavement
Theory
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1. Alarm
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2. Searching
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3. Mitigation – Lessening the Impact
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4. Anger & Guilt
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5. Disorganisation & Despair
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6. Gaining a New Identity
Summary - Henry
Saved himself – anger guilt
Stayed on the boat - maintained alarm
Avoidance Panic - isolated himself to cope
Trigger – overwhelmed by feelings
Re-enacted trauma with counsellor
What facilitated the
Bereavement process? CMP
• Traditional family
• Good family support
• Predictability of death
• Practical tasks of funeral arrangements
• Supportive people making few demands
• Social Networks
• Mutual Self Help Groups
• Bereavement Counselling
• Support Groups – Group Counselling
What determines how a
Bereavement affects a person?
Stressors
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• The Trauma
Stress & Trauma of the Bereavement
• Type of stress - multiple deaths, violence, age of deceased
• The Person
Coping strategies - avoidance /drink /drugs /isolation
• Perception – world view /core values / emotional intelligence
• Capacity to tolerate strong feelings
• Self Esteem
High /Low
Processing feelings
Who is the Bereaved?
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Situation and Environment of the Bereaved
Age /Gender
Personality
Proneness to Grief
Inhibition of Feelings
Expression of grief
Socio-economic Status (Social Status /Class)
Nationality Cultural Factors of Grief UK?
Religion Community /Over arching belief
Before the Bereavement
• Relationship to the Deceased Good /Bad
• Type of Relationship Fixed Role /Flexible
• Strength of Attachment
• Security of Attachment
• Degree of reliance
Dependence / Independence
Secure/ Ambivalent / Involved
Reason to live
• Childhood Experiences
• Other Bereavement Experiences Coping?
• Previous mental health
• Life Crises prior to the Bereavement
• Type of Death
After the Bereavement
• Social Support
• Prevention of Isolation
• Secondary Stresses: financial
• Life Opportunities – Options open to Bereaved
Summary
• Facilitates the Bereavement – Situation and
support of bereaved
• Type of Trauma
• Type of person – ability to cope – background
• Before the Bereavement - relationships
• After the Bereavement – support / resilience
Theory and Counselling
Skills Link
The way we react to bereavement is linked to
the way we have been taught how to deal with
bereavements in the past
Mourning and Melancholia (1917)
Freud's psychoanalysis of loss
• Mourning comes to an end when emotional attachment is
broken to the lost one
• Normal grieving is overwhelming and unending
• Bereaved must break the unconscious bond with the
deceased
• Healthy response to grief is suspect and interpreted as
unresolved grief in the unconscious.
• Linking previous losses to the current loss
Dr Elisabeth Kübler-Ross
• Pioneer of personal trauma, grief and grieving,
associated with death and dying
• Improved the understanding of bereavement in
hospice care
• Her five stages of grief model:
• Personal change model beyond death and dying.
• Grief model applies to less serious traumas
• redundancy, relocation, crime, disability and
injury, relationship break-up, bankruptcy, etc.
• Model to understand personal reaction to
general trauma.
1 - Denial
• Denial is a conscious or unconscious refusal to
accept
• Natural defence mechanism
• Can be locked in this stage
2. Anger
• Angry with themselves and Others,
• Especially those close to them.
3. Bargaining
• Bargaining for people facing death can involve attempting
to bargain with whatever God the person believes in.
• Bargaining in relationships: "Can we still be friends?.."
when facing a break-up.
• Bargaining rarely provides a sustainable solution
• Also preparatory grieving
• Dress rehearsal or the practice run for the 'aftermath'
• Means different things depending on whom it involves. It's
a sort of acceptance with emotional attachment.
4. Depression
• Natural to feel sadness and regret, fear,
uncertainty
• Shows person beginning to accept the reality
5. Acceptance
• Varies according to the person's situation,
• Broadly an indication that there is some
emotional detachment and objectivity.
• People dying can enter this stage a long time
before the people they leave behind
Grief Cycle Model first published in On Death & Dying
Elisabeth Kübler-Ross, 1969
Kübler-Ross Summary
• Some similarities to CMP model
• 1. Denial – refusal to accept
• 2. Anger with anger loved ones
• 3. Bargaining
• 4. Depression
5. Acceptance
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 mother
• 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
dependable
• Creates a secure base for the child to explore
the world
Experiment with
rhesus monkeys
• Monkeys offered two objects to attach to
• Soft mother dummy without food
• Hard mother dummy with food
• Monkeys preferred soft dummy without food
• Discuss – reaction against Freud’s Instincts
Theory
• 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 life
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
Mother and Baby
D.W.Winnicott
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Attachment between Mothers and Babies
Studied mother baby interactions
Potential space between mother and baby
How does primary relationship enable separation to be tolerated by
the baby?
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• Good enough parenting and mothering
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• Culture originating in Potential Space as experience of relationship
• (Face studies conducted by Brazelton & Cramer)
Different Perspective
• The Other Side of Sadness.
What the New Science of Bereavement Tells
Us About Life After Loss
George Bonanno Basic Authors 2009
• Review in Weekly blog 21st September 2012
Different Perspective
• George Bonanno
• Psychologist
• Focusing on behaviours
• Statistics
• CBT Cognitive Behavioural Therapy
• IAPT Improving Access to Psychological Therapies
How Humans Cope with
Bereavement
Equipped - hard wired
In-born psychological processes that help us do the
job
Optimistic, flexible, resilient
Self-serving bias telling us we are stronger than we
are.
Positive experience
Evidence Gathering
Freud’s work based on interviews with no basis for
theory
Kubler- Ross studied people who were dying- not
bereaved people
Bowlby studied attachment issues of children and
parents not bereaved people.
Sadness
Grief not overwhelming but partly intense sadness
Normal and natural
Sadness makes people more reflective: a forced time out.
Oscillation between pain and sadness important:
Bereaved temporarily reconnects with others
Then continues the process of mourning.
Resilient People
• In Western Culture
• Normal not exceptional.
• Expectation for bereaved people to feel
constant sadness and grief
• Individualistic cultures based on peoples’
feelings
No trauma
• Majority of people in Nagasaki no trauma
symptoms
• New York residents after 9/11 had no trauma
symptoms.
Coping Strategy
• Resilient people do not use avoidance as a coping strategy
• Think a lot about the loss or avoid the pain - Positive emotions and
memories keep them stable
• Is there a resilient type? Evidence shows that some people cope with
adversity better: but not specifically grief work.
• No clear pattern emerges in the way bereaved people describe their past
that might account for their resilience.
• No general rule to the type or quality of the relationship to the lost person
that promoted the healthiest forms of grieving.
• Relationships to others do not determine whether people cope with their
loss
Memory
• Comfort from memory
• Resilient people find comfort from the memory of the relationship.
The relationship is not completely gone
• Share relationship experience with others
• In traditional theory comfort from memories is not dealing with the
reality of loss.
• Comforting memories are just a fantasy substitution
• Resilient people are confident, more flexible with a broader
repertoire of behaviours.
• Resilient people express emotion, but can also keep their feelings to
themselves when appropriate.
10-15% of people
• Do not fare do well with Bereavement
• The bereaved feels as if everything is missing, they are
unable to hold onto positive relationships.
• Pain of grief can block all memories of the good.
• Prolonged grief is dominated by yearning for the lost
person. Depression is global and has no object.
• All thoughts circle back to the lost person.
• Safety and happiness turn to fear and dread.
• link between prolonged grief and emotional dependency
Other Cultures
• Other cultures think more about the
interactions between people and what they
do
• Individual and their feelings are not so
important
Chinese Culture
• In research Chinese people better at getting over grief that
US. More grief work
• Memoires, feelings, thoughts about the deceased searched
for meaning and how to make sense of the loss.
• In Chinese not related to suffering: grief work not related to
level of distress.
Chinese Culture
• Chinese mourning rites focused on deceased
• is on the imagined experience of the deceased: to help them to the land
of the dead and find a good life.
• Crying at Chinese funerals is more deliberate: tightly orchestrated so that
it occurs at the right moment of the ritual. Professional mourners and
musicians hired to help.
• Crying sends a message to the deceased loved one. Focusing on the
deceased rather than the bereaved apes the continued bond. For the
Chinese the continued bond was more common with Chinese and more
healthy.
• The more early bond made to the deceased the less distress they felt.
Chinese Culture
• In Asia continuing bond is sewn into the
culture.
• Many towns have ancestral temples to honour
the dead, and commune with them
Chinese ceremony – about honouring loved
ones and particularly family and connection.
US Culture
• In the West for some this bond is healthy and for
others not.
• If you are anxious about engaging in rituals that
might not be accepted they lose their power
• Crying in the West when we cannot hold back the
pain.
• The more Americans experienced grief work early
on: the more difficult it was for them.
US Culture
• In US continued bond caused more distress for
some and less distress for others
• Continuing bond is more adaptive in an
culturally supported environment
Bonanno Conclusions
• Past evidence poorly collected
• 85% of bereaved recover well
• Hard-wired
• Most people are resilient
• Culturally resistant to Bereavement
Lunch
John Montagu, 4th Earl of Sandwich
Bereavement Exercise
Ten Key Points of Bereavement
Counselling
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• 1. Clinical Boundaries: – Space / Time / Frequency
Continuity, Beginning, Endings, Breaks
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• 2. Confidentiality: Counsellor-Client Relationship
• 3. Listening and Hearing
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• 4. Reflecting and Empathising
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• 5. Creating Acceptance / Trust
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Ten Key Points of Bereavement
Counselling
• 6. Focus of the Bereavement
• 7. Bereavement / Attachment Theory
• 8. The Client’s Feelings/Our own reaction to
the Client’s Feelings / Own Bereavement
• 9. Hidden / Unknown Feelings
Working with Bereavement
& Loss
The Bereavement & Loss
Worker
• My own experiences
• Not definitive
• Able to be challenged
The Bereavement & Loss
Worker
• Your Own Bereavement
• History
• Experience
• Attachment
Your Resources
• Work Life
• Personal Life
• Social Life
• Balance
Support
Organisation
• Cultural Environment
• Management Support / Clinical Supervision
• Links to other services internal / external
Role
• What is your role?
• Is it clear? To you? To Managers? To others?
• Has it developed by creeping from another
role?
• Is it recognised?
Protect yourself
• Bottom Line Thinking
• Have you evidenced what you have done?
Risk reporting
• Look after yourself
Take breaks
• Insurance? Accountability?
• Clinical Responsibility
• Saving the World
Who is helping Who?
• Motivation?
• Altruism?
• Our agenda?
• Two Bereaved people in the room?
Other Workers
• Assumptions
Organisation / Other workers understand your
role?
• Sensitivity – taking over other workers’ roles
• Status -
Paid workers / Volunteers
Precious
• Avoid
• Similar to other services
• Be open
• Have a sense of humour about
counselling ‘peculiarities’
Envious Attack!
•
Your role might be envied
• You are perceived as: • Special?
Secretive?
• Doing something nobody else can do?
Contracting
• Boundaries
• Space / Room
• Privacy / Confidentiality
Risk
• Clarity
• Who do you report risk to?
• Person’s perception of actions around risk
Skills
• Listening
• Hearing
• Reflecting back – demonstrating you have
done the above
Role Model
• Nurturing, caring, available
• Tough, Boundaries, limits
• Copy what you do / are - Not what you say
• Be professional person/organisation
“Being with”
• Trying to be with the person
Showing you are trying to be with the person
• Comments and Interpretations
Beginnings, Breaks,
and Endings
• Importance?
How? – notice, repeat
• Beginning and ending of contract / sessions
Goals
• To establish
• Acceptance
• Trust
• Empathy
• What happens if you cannot?
Resistance / Avoidance
• Respect it - it is there for a good reason
• Is the person ready to talk
• Timing – too near bereavement
• Be available
Hidden
• Be aware of what might be unknown
To you and the bereaved person
• Comfortable with not knowing
Actions
• Is what you are saying precipitating an action?
• Is this your role?
• What message?
• Separate “being with” / actions
Administration
• Policies and Procedures
• Health and Safety
• Lone working
• Forms - attendance, recording, risk
Case Examples
Audio Visual
• St. Christopher’s Hospice
Bereavement Group – 20 minutes
people with terminal illness
Tavistock Institute
Couple whose son has died 40 minutes
poor quality
Dr Anthony Crouch
5 minutes
Attachment Statistics
Julia Buckroyd 2010
Emeritus Professor of Counselling
University of Hertfordshire
• Population:
• 65%
Secure Attachment
• 20%
Ambivalent Attachment
• 15%
Avoidant Attachment
• 2%
Disintegrated Attachment
• Counsellors / Therapists?
Attachment Exercise
• You are child in a family environment
• Recall an incident when you did something
wrong
• What was the reaction from the primary
care giver?
Comment
• Attachment begins in baby / childhood
• Adolescence a good study –
• Major attachment – separation – attachment
period of life
Successfully Attached 12 year old
• Independent
• Separation
• Work / Study
• Words to feelings
Tasks of Attached Adolescent
• Independent
• Separation
• Sexuality Choice
• Sense of Self
• Compulsion dodges, delays development
Developing emotional management
How ?
• Baby cannot regulate emotions alone
• Implications for brain development
• Secure attachment – person can self soothe /
trust other people
• Insecure attachment – person needs external
substances
• Deficit in developing sense of self
The Attachment Counsellor Tasks
• We all manage feelings with thoughts
at 2 Levels:
• Conscious / Unconscious
• Cognitive (the behaviour) / Emotional
The Healing Relationship
• Active – Interactive
• Attuned (Daniel Stern)
• Accepting
• Reflective
• Modelling Nurture
Sitting in silence doesn’t work!
Sometime later………
• Repair by:
• Teaching Skills
• Encouraging Experiment
• Containing Anxiety
• Encourage Reporting
• Change Internal Dialogue
• Restrain Critical Parent
• Taking Care of Child
• Develop the Adult
• …………easy to say!
• Attentive and responsive to the client’s
needs
• See and feel the client’s world through the
client’s eyes
• These points are transferred to the
counselling session
Mother and Baby
D.W.Winnicott
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Studied a lot of mother baby interactions
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Potential space
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How does primary relationship enable separation to be tolerated by the
baby?
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Transitional Object
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Must be allowed to have rights over the object
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Good enough parenting and mothering
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Play negotiation between inner psychic reality and outer worldly reality
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Culture originating in Potential Space as relationship of experience
Case Study: Ethnic Differences –
Dealing with Grief and Loss
• WASP Culture - psychologies emotional pain
• Ethnic Groups – somatise emotional pain
• WASP culture might struggle to support non WASP
grief
• Differences unrecognised until major loss occurs
• Individuals might lack focus, energy, flexibility to deal
with loss
• 1st major Loss – 1st experience of mortality Existential
P.105 Handbook of Bereavement, Cambridge 1993
Edit from here!
• One person’s grief can seem inappropriate to
another
• Individuals who attempt to assimilate a
different culture’s norms
• Struggle – self control, Silence, Guilt,
Depression, Unable to resolve loss.
• People in transit between cultures struggle to
find an appropriate grieving process.
Case Study: Kibbutz – Children’s
Homes
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Collective sleeping arrangements
Starts a few months after birth
Infant mother attachment
59% compared to 75% in Israeli day centres
possible environment for insecure attachments
Ambivalent attachment experience encouraged
by national security environment
• (P.721 Handbook of Attachment Guildford 1999)
Case Study: Attachment in One
Child Families in China
• Chinese culture favours Interdependence rather
than individuality Comparable to Japan
• Chinese parents emphasise Harmony and control
• Western parents emphasise individuality and
spontaneity
• Beijing study evaluated secure attachment
• (P.719 Handbook of Attachment Guildford 1999)
{Goa and Wu (Posada et al. 1995)]
• Emotional interdependence did not feature
highly.
• Valuing interdependence not incompatible
with individuality
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• Age of child – attitude towards child changes
in adulthood – presume responsibility for
themselves.
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Assessment Visit
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Report on Assessment Visit
Client:
Address:
Session No:
Date of Visit:
Tel No:
Relationship to Deceased:
Name of Deceased:
Brief History
AT TIME OF LOSS
Describe the events around the death.
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What do you miss. What do you not miss?
LIFE EVENTS
Do you have any other major/minor bereavements
FUTURE
Do you see the future still in terms of the Bereaved or are you ready to move on
FAMILY NETWORK
What support do you have?
INTELLECTUAL
Do you think you should be getting over it?
IDENTITY Have you changed? What identity did the deceased give you if any?
EMOTIONAL
How did you feel about the deceased. How do you feel now?- Counselling Expectations?
HEALTH
On Medication
SEXUAL
Any close relationships to deal with the bereavements
PHILOSOPHY
Religion: how are they coping with bereavement.
LIFESTYLE
Any Addictions
PRACTICAL
Housing, Benefits, Money.
COUNSELLING DECISION / CONTRACT:
NEXT APPOINTMENT:
DATE:
DAY:
TIME:
www.counsellingme.co.uk
07956 292 740
PRE-LOSS
SINCE LOSS
Counsellor:
Date of Death:
What kind of relationship did you have to the Deceased. Was it good / bad?
How are you coping? What are your feelings towards the Deceased?
PLACE:
Ten Key Points of Bereavement
Counselling
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1. Clinical Boundaries: – Space / Time / Frequency Continuity, Beginning, Endings, Breaks
2. Confidentiality: Counsellor-Client Relationship
3. Listening and Hearing
4. Reflecting and Empathising
5. Creating Acceptance / Trust
6. Focus of the Bereavement
7. Bereavement / Attachment Theory
The Client’s Feelings/Our own reaction to the Client’s Feelings / Own Bereavement
Hidden / Unknown Feelings