Thursday's Therapy Writing About Grief? Closure, Schmozure!

Thursday's Therapy

Writing About Grief? Closure, Schmozure!

~Tommy and Angie Prince

Many therapists today often have it wrong about this notion of "saying 'Goodbye'" to a loved one, portraying that such an exercise could be helpful in that it would bring "closure" to the bereaved. Closure can't be packaged and wrapped up for the bereaved! Closure is something you do to a closet door (or to a therapist's mouth)! It is not something that can be attained, grabbed, or fulfilled by a bereaved parent! How can you wrap up the tiniest of memories that pop up in one's head at any given time of the day, the week, the month, or the year?

Some therapists would even argue that continuing to struggle with grief is because the griever hasn't adequately "said 'Goodbye'" to their loved one. Some suggest writing a letter to one's bereaved as a therapeutic intervention to provide such "closure."

But current research does not back up such a theory...

"Research so far has shown little evidence that written disclosure facilitates recovery from bereavement."

~(2009) Researchers* (highlights mine)

So, why is there even so much concern for "resolving" one's grief over a loved one?

Why is there so much concern that we "recover" from bereavement anyway?

In medicine, the dictionary says "resolve" means "to cause a symptom to disperse, subside, or heal."

Why does a therapist want to "resolve" someone's grief...like grief is a toxic symptom whose extinction would result in a "healthy" person?

I probably made that mistake (in my pre-Child-Loss days) when clients talked about their loved ones years after their loss and teared up while talking about them. I think I concluded,

"Oh, they didn't effectively grieve this years ago, so perhaps I can help them to get this grief out."

For me today, now that I am a grieving mother, I see that someone who might try to "bring closure" to my grief over my baby, essentially trying to "stop" my grief, is cruel!

Expecting "closure" for my grief would definitely be doing more harm than good to my aching soul. I do not think my grief will ever completely resolve this side of heaven; there will always be a longing for my baby until I see her again, until I can once again hold her in my arms.

All my intentions as a therapist (pre-Child-loss) for helping clients to "get their grief out" were not bad. I do think getting the grief out, meaning to get their grief expressed, was very good for them. But thankfully, I did not push the expectations on them that NOW, this grief should be done, over, caput.

However I probably did naively think that now they would be "much further along in their grief process." Maybe. Maybe not. But the expressing of the grief was still good. And I am so very glad that I did not push for a "successful conclusion" to the grief.

Though writing will not bring "closure" to our life-time grief process, I do think writing can be a comfort for us grievers. Our job as grievers is unfortunately that we must learn to "accept the unacceptable," or as Dr. Therese Rando, grief expert, says,

"We must continually bump up against the reality of their absence to begin to learn that they are not coming back."

We are put in the awful position of having to adapt to a harsh reality. But instead of "recovering" from grief, we are continually in a process of "integrating that harsh reality" into the fiber of our life today or else we couldn't cope with day-to-day life at all. The big key is we are having to "adapt" - we are NOT forcing ourselves to "recover" by "expecting our grief 'symptoms' to disperse, subside, or heal." So if our writing about our grief is helping us to express our grief, get in touch with our grief, and adapt our "new normal" lives to our unwanted loss, then the writing can be helpful. However, if we are seeking "closure" to our child-loss grief through writing, it's not going to happen.

The researchers' results did show some positive results to grievers writing out their grief as the results "showed that writing decreased feelings of emotional loneliness and increased positive mood, in part through its effect on rumination."

But in analyzing the results of their research, the researchers also readily concluded that regarding "written disclosure" of one's grief, such "writing DID NOT affect grief or depressive symptoms."

Longing for our child will continue, and that is normal. Don't let a therapist tell you that such grief or longing is unhealthy! Grief over our precious child will continue at varying levels for the rest of our lives.

Writing about our grief? Yes.

Expecting "closure"? No.

Picture thanks to photobucket.com

Current Research (2009) in Grief Therapy: http://bit.ly/bKTuHt ~

The efficacy of a brief internet-based self-help intervention for the bereaved,

* 2009 Researchers: Karolijne van der Houwen, Henk Schut, Jan van den Bout, Margaret Stroebe and Wolfgang Stroebe

Wednesday's Woe - Grief's Insurrection

Wednesday's Woe

Grief's Insurrection:

Grief's Relief Map

to

Heart-Welfare's Insurrection

It seems Grief provides a certain "relief,"

A relief that provides a sure reprieve.

People you once treated kind, would bring Grief...

Grief's Clarity of Mind would bring reprieve.

Grief's Clarity of Mind would seem to show

Flaws in Character you once would ignore.

Fragility of Heart demands to Know,

Not allowing Denial anymore....

For just as one learns on his Sickness Bed,

Allowing sickness germs would leave one...Dead,

So Character Germs...once tolerated,

Intensive Care deems...be Decimated.

For Emotional Health to be resurrected,

Demands Character-Germs be detected,

Else one becomes further Germ-Infected...

Grief's Clarity provides Germ Detection

To deter Heart-wrenching Germ-Infection...

Germ-Warfare yields Heart-Welfare's Insurrection!

Picture: Thank you to Hoang Nguyen http://bit.ly/cqVhGe

Poem - Grief's Insurrection - Angie Bennett Prince - 3/31/10

Tuesday's Trust - THE DOCTOR IS OUT

When It Comes To Treating a Grieving Parent,

THE DOCTOR IS OUT

Or

Be Careful Entrusting Yourself To Just Any Ole Counselor…

by Tommy and Angie Prince

Although there are many problems and disorders that folks have that can be treated successfully by a physician or counselor, iohooc (in our humble opinion, of course!),

Some problems cannot be effectively treated by just any ole counselor...

A physician using medication can manage many physical problems. A physical therapist can assist in the recovery of broken bones and torn muscles. Surgery can often correct internal problems. The removal of tumors, gall bladders, appendix, and part of the stomach can relieve damaged tissues.

In each of these situations the treating physician or physical therapist does NOT have to personally experience the disorder to successfully treat the disorder.

But if you are a grieving parent and find yourself stuck in some part of your grief and want to seek professional help, in our opinion,

Do Not Entrust Yourself to Any Doctors or Therapists Who Have Not Lost a Child Themselves!

In our own “wars of grief,” we find it is rare that any “civilian” to that war ever fully “gets it” in regard to the depth, length, or breadth of our pain. It is our opinion that neither will you find any professionals who will “get it” fully if they themselves have never suffered through the loss of their own child.

Even Sigmund Freud thought parental grief had an end to it until he lost his own daughter and grandson. After his great loss, he wrote in a note to a friend, that although the acute stage of grief eventually subsides, a parent’s grief never fully resolves. (Talbot, 2002)

So we say,

Do Not Entrust Yourself To Any Doctors or Therapists Who Have Not Lost a Child Themselves. The odds are great they simply will not “get” the extent of your pain, nor the normalcy of such depth of pain with this kind of loss.

******

Counselors generally can successfully help someone who is experiencing emotional problems. Talk therapy is good for people experiencing depression, anxiety, obsessions, marital problems, and relational problems. In each of these areas the counselor does not have to have personally experienced these problems to successfully treat the client. The outcome can be positive even though the counselor has not gone through a similar experience.

There are some situations where unless the physician or counselor has had personal experience with a particular problem, the treatment will be unsuccessful.

One area in which this is true is with addictions. Those who have been through the process of recovery and rehab seem to be the only ones who can treat alcoholism and drug addiction.

In terms of addiction, it “takes one to know one”!

The research is indicating that an addict may be required to go through rehab multiple times. (This is one of the few areas of treatment where failure is “acceptable.”)

But for the addict to have a chance at success, it is generally agreed upon by the professionals in the field that a fellow “recovering” addict must conduct the treatment.

When it comes to helping a grieving parent,

it takes one to know how to help one.

The process of grieving the loss of a child is unlike any other form of grief. It is different from the death of a spouse, the death of a parent, or the death of a sibling. It does not follow the same path of the other losses. The loss-of-a-child grief is more enduringly intense than any of the other kinds of losses. It is more severe than the other losses.

Though much grief-work can be done effectively, the full meaning, trauma and complexity of bereaved parents’ grief is something that will never be “fully integrated” into their lives. Any professional working with you in your grief needs to understand this dilemma.

******

Psychologists are proposing a “traumatic grief” category for the next diagnostic manual for psychological disorders which seems "to do a better job of clarifying the debilitating symptoms often experienced by bereaved parents." (Talbot, 2002)

(We will show this proposed category of grief in all of its detail in another blog post coming soon.) This improved categorizing of different types of grief is indeed progress.

Complicated grief or traumatic grief seems to be more of the norm for grieving parents, and that needs to be understood, particularly for any therapist or doctor who works with these grieving parents.

******

Kay Talbot is a Ph.D. psychologist who has lost a child. She comments on this upcoming grief category proposed for the Diagnostic and Statistical Manual for psychological disorders and how important it is to distinguish that

the deep grief for the grieving parent is not a disorder for this child-loss grief.

She also gives her input on the unique nature of child-loss grief and how undergoing grief therapy in the wrong manner sets a parent up for “secondary injury”:

But when putting the diagnostic categories into practice, it is vitally important to convey to bereaved parents that they are not ‘disordered.’

Their grief is extreme, traumatic, debilitating, and frequently requires professional intervention. But it is not abnormal for this loss.

Bereaved parents who seek or are sent for counseling are at risk for secondary injury when they are subjected to assessment and diagnosis.

Interestingly, we do not know how often bereaved parents leave a professional’s office feeling unheard, misunderstood, and/or judged and never return….

We (do) know that establishing rapport and trust with bereaved parents is critically important. Asking how we can best help (bereaved parents who do come in for help) and what we need to know in order to understand their grief conveys our interest in and respect for each unique parent.

~Kay Talbot, Ph.D., and grieving mother, 2002 What Forever Means After the Death of a Child: Transcending the Trauma, Living with the Loss (highlights ours)

Thursday’s Therapy - 5 Emotional Vampires and How to Combat Them

Thursday’s Therapy

5 Emotional Vampires and How to Combat Them

A Post from Therese Borchard of Beyond Blue: A Spiritual Journey to Mental Health

In the spirit of halloween, I thought you'd all appreciate some vampire talk. In her new book, "Emotional Freedom," UCLA psychiatrist Judith Orloff identifies five kinds of vampires that are lurking around and can zap our energy if we're not careful. Here is an excerpt adapted from her book.

Emotional vampires are lurking everywhere and wear many different disguises--from needy relatives to workplace bullies.

Whether they do so intentionally or not, these people can make us feel overwhelmed, depressed, defensive, angry, and wiped out.

Without the self-defense strategies to fend them off, victims of emotional vampires sometimes develop unhealthy behaviors and symptoms, such as overeating, isolating, mood swings, or feeling fatigued.

Here are five types of emotional vampires you're likely to encounter, and some "silver bullet" tips for fending them off.

Vampire 1: The Narcissist.

This vampire is grandiose, self-important, attention hogging, and hungry for admiration. She is often charming and intelligent--until her guru status is threatened.

Self-defense tips: Enjoy her good qualities, but keep your expectations realistic. Because her motto is "me-first," getting angry or stating your needs won't phase her. To get her cooperation, show how your request satisfies her self-interest.

Vampire 2: The Victim.

This vampire thinks the world is against him, and demands that others rescue him.

Self-defense tips: Don't be his therapist, and don't tell him to buck up. Limit your interactions, and don't get involved in his self-pity.

Vampire 3: The Controller.

This vampire has an opinion about everything, thinks he knows what's best for you, has a rigid sense of right and wrong, and needs to dominate.

Self-defense tips: Speak up and be confident. Don't get caught up in bickering over the small stuff. Assert your needs, and then agree to disagree.

Vampire 4: The Criticizer.

This vampire feels qualified to judge you, belittle you, and bolster her own ego by making you feel small and ashamed.

Self-defense tips: Don't take what she says personally. Address a misplaced criticism directly. Don't get defensive. Express appreciation for what's useful. Bounce back with a massive dose of loving-kindness.

Vampire 5: The Splitter.

This vampire may treat you like his BFF one day, and then mercilessly attack you the next day when he feels wronged. He is often a threatening rageaholic who revels in keeping others on an emotional rollercoaster.

Self-defense tips: Establish boundaries and be solution-oriented. Avoid skirmishes, refuse to take sides, and avoid eye contact when he's raging at you. Visualize a protective shield around you when you're being emotionally attacked.

Judith Orloff, MD (www.judithorloff.com), is an assistant clinical professor of psychiatry at UCLA. Her new book, upon which these tips are based, is "Emotional Freedom: Liberate Yourself from Negative Emotions and Transform Your Life."

**********

Thank you to Therese Borchard for such a fun post to combat some difficult situations!

picture: http://media.photobucket.com/image/vampires/LolliLolliGirl476/Vampires.jpg?o=200

http://blog.beliefnet.com/beyondblue/2009/10/5-emotional-vampires----and-ho.html

Wednesday’s Woe - The Phone Call...

Wednesday's Woe

The Phone Call...

You want me to call back dear friend, sister?

I cannot. Can I tell you why? I’ll try.

You haven’t lost your baby girl to death…

You haven’t lived through th’ roiling twister

That turns your life upside-down and awry,

Spoiling till it snakes ‘way your ev’ry breath,

Reaches in your chest t’ wrench your broken heart,

Wringing out its last drop of blood till drained

Of ev’ry sign o’ life, squashed, then pulled apart.

You finally pull yourself up to seek help…

Folks look away; are you disdained, bloodstained?

Folks fear the grieved who’s deigned to come unchained,

So you crawl back home to find quiet, peace,

To tend your heart, to nurse each gash and welt.

Some wounds heal but th’ heart’s pain won’t find surcease…

You go t’ bed, it’s gone—or sleep is, that is,

For the nightmares come to tamper with th’ brain.

So you drag yourself out o’ bed t’ start again.

The phone rings; there’s nothing left in life’s vein

To feign, complain, explain, so you abstain…

http://www.telephoneart.com/fonpic/page_05.htm

Poem – The Phone Call – Angie Bennett Prince – 1/6/09

Thursday’s Therapy - Complicated Grief: Does Any Professional "Get It"?!

Thursday’s Therapy

Complicated Grief:

Does Any Professional "Get It"?!

Mayo Clinic’s Definition of Complicated Grief:

Mental health experts are still analyzing how complicated grief symptoms differ from those of normal grief or other bereavement reactions. During the first few months after a loss, many signs and symptoms of normal grief are the same as those of complicated grief. However, while normal grief symptoms gradually start to fade, those of complicated grief get worse or linger. Complicated grief is like being in a chronic, heightened state of mourning.

Complicated grief treatment hasn't been standardized because mental health providers are still learning about the condition. Research studies testing various types of treatment have had mixed results. That isn't to say that treatment isn't helpful, though. More study is needed to help determine which treatment options may be best for complicated grief.

American Psychiatric Association's Evolution of Assessment of "Complicated Grief":

One group of researchers... is examining factors that identify people at risk for complicated grief, (Robert) Neimeyer (of the University of Memphis) says. The researchers are objectively assessing risk factors by reviewing the circumstances surrounding deaths.

Chronic and unremitting grief is typically associated with sudden, unexpected and traumatic death, the loss of children or young people, and the relative closeness of the bereaved person to the deceased, the report says. Particular risk factors include excessive dependency in the relationship with the decedent or a history of mental illnesses such as depression in the bereaved, Neimeyer says.

In the past, the mental health community defined varying reactions to grief, such as delayed onset of grief, as disorders, Neimeyer says. In particular, people who grieved in ways uncharacteristic for their cultural background were labeled as disordered.

But new research and a growing understanding of grief has prompted psychologists to use different diagnostic factors for complicated grief, such as changed relationships with family and friends, feelings of meaninglessness and ruptured beliefs, which are more apt to spur health-threatening grief, he adds.

In fact, says Neimeyer, the American Psychiatric Association has formed a panel of experts under (Yale University psychologist, Holly) Prigerson to consider including "complicated grief" in the next version of the Diagnostic and Statistical Manual of Mental Disorders.

**********

In my opinion, the norm for any grieving parent who has been thrown into a parent’s worst nightmare of the loss of one’s child is a state of grief that physicians would call “Complicated Grief.”

Any loss of a loved one will throw a person into grief for weeks, months, and to a milder degree through the years.

But the loss of a child is a whole different kind of loss.

My husband and I are trained at the master’s level in mental health counseling; we are trained at the master’s level in Christian counseling. We are rock solid in our faith. Our marriage of thirty years is intimate and sweet. Our years of raising our children were steeped in love and endearing intimacy with our precious three children. Each of our children asked God into their heart when they were age six or younger. Our lives have been blessed. Yes, we have had many traumas; we live in a fallen world. But the trauma of losing our precious youngest child, our only daughter has just about taken us off the map in terms of grief, trauma, sadness, debilitation, life-stopping, career-stopping complicated grief. In my humble opinion (of course), I would challenge you to find two healthier people to be your normal, healthy specimens to walk into such a severe loss to report back to you “normal” grief reactions in a loss such as this.

So I am telling you, I am going on record to the medical community and the psychological community to say COMPLICATED GRIEF is to be considered the norm for child-loss grief-struck parents.

So please do not call this depth and degree of grief a “disorder.”

Please do not say these parents are people who are “stuck” in their grief.

Please do not call this “prolonged grief.”

Complicated Grief in the case of grieving the death of a child IS JUST parent-grief, normal, ordinary parent-grief when parents lose the heart and soul of their life in the loss of a precious child.

So when you are busy “analyzing how complicated grief symptoms differ from those of normal grief or other bereavement reactions" (Mayo Clinic), I would ask you to reconsider and take it from another professional colleague in your field who has been there,

COMPLICATED GRIEF DOES NOT DIFFER FROM “NORMAL” GRIEF FOR CHILD-LOSS PARENTS. COMPLICATED GRIEF IS THE NORM FOR CHILD-LOSS PARENTS.

Please rewrite your books.

Please rewrite your manuals.

Please revamp your antiquated studies.

Child-loss brings a whole different kind of grief to a person.

The closest description I can find to date that best captures this grief might align somewhat with what you would call “complicated grief.” And yes, it is complicated. And yes, many times, it can also be called "traumatic grief" because it very often brings its own trauma into a parent’s life.

BUT THIS TRAUMATIC GRIEF, AND THIS COMPLICATED GRIEF, IS NOT ABNORMAL FOR ANY HEALTHY GRIEVING PARENT!

And none of these symptoms should be signals of anything “unhealthy” or “problematic” for the grieving parent; in child-loss, they just ARE.

You might better use these “symptoms” of Complicated Grief in your manuals as “landmarks along the way” for the "grief of child-loss" to help that grieving parent know they are not crazy; they are not losing their minds; they are not abnormal – they are just dealing with the worst loss life could throw them, and these symptoms are just hurdles along the way that they might expect to undergo…

Now that I’ve gotten a little of that disgust out of the way, I would like to go back to your manuals that aren’t all bad because they do tend to capture some (a small portion of) a child-loss parent’s grief. Of course, I will give my responses along the way just to remind you professionals of our very real reality!

**********

(Mayo Clinic)

Signs and symptoms of complicated grief can include:

Extreme focus on the loss and reminders of the loved one (You know what? That is what it takes to work through a grief of this nature! You professionals just need to deal with it!)

Intense longing or pining for the deceased (We love our children! We miss them! We want to hug them again! We want to talk to them again! We are normal human beings who miss our children deeply. This is a healthy component to parenting! And therefore, this is a healthy part of processing through our grief of losing our precious child!)

Problems accepting the death (Who can immediately accept their child’s death? Having trouble accepting the unacceptable seems pretty normal to me.)

Numbness or detachment (Well, you try having a 2-ton weight on your heart all day, and see if you don’t get a little numb or feel a little detached every once in awhile for at least a little breather! You aren’t really numb, you just don’t have anything left over for anybody else, so you may just appear to be numb and detached while you are very attached to your own need for healing, thank you very much!)

Preoccupation with your sorrow (Yup, that’s just the nature of the beast. Sorrow over your child’s loss is there, waiting to be dealt with, like it or not. To NOT focus on it in order to help to relieve it would be abnormal and unhealthy in my opinion.)

Bitterness about your loss (Well, you and I might have a different definition for bitterness. Bitterness is anger that never gets resolved; can you give us a little longer than 2-3 months, or 2-3 years, or maybe even 2-3 lifetimes if need-be to get our hurt and anger resolved?)

Inability to enjoy life (Are you telling me you could? Then I would say maybe you aren’t in touch with your emotions!)

Depression or deep sadness (You’d better believe it, and it ain’t going away any time soon, I can promise you that. Three years now…for us. I would just have to ask you, “Do you even have a child? Are you emotionally connected to them at all? Do you feel a responsibility for their love and safety and health?" Well then you should understand our depression setting in and staying for quite awhile…quite a long while, if not for an entire lifetime!)

Difficulty moving on with life (See description for next symptom below)

Trouble carrying out normal routines (Well, yes, these "normal routines" have been pushed aside to make room for the heart to find some way to survive and breathe, much less thrive in the midst of pure hell being dropped in your lap. "Trouble carrying out normal routines" would be like saying to the tsunami victim, "You just can’t seem to move on with life in any normal way!” Of course not! He simply cannot! Life is NOT normal!)

Withdrawing from social activities (This is perfectly normal I would say. When your heart is so raw, it would be tantamount to walking around in public with no skin on; wouldn’t you as a physician wisely recommend “withdrawal from social activities” so as to avoid any potential toxins along with affording yourself private intensive care to heart, soul, mind, spirit, and body in the privacy of one’s own home? I certainly would hope so; that is what you do for a patient in the hospital when all of his skin is ripped off!)

Feeling that life holds no meaning or purpose (Well, come on now, our hearts have been shot out of us—a little difficult to ascertain life’s meaning or purpose when you’re trying to find your heart, get it repaired, and get it put back into place, knowing it will take a lifetime of comfort to even approach some healing for it.)

Irritability or agitation (You better believe it – and you professionals might want to watch out for our irritability and agitation.)

Lack of trust in others (Pardon me, but would you not be somewhat mistrustful of others when you know they may, and I say may, be able to sympathize (feel pity or sorrow) with your grief, but they can in NO WAY empathize (understand and share the feelings of another) with your grief because they have never "been there"; they cannot possibly "get it" – I know, because we as well-trained mental health counselors would not have gotten it either before having been thrown into it hook, line, and sinker ourselves (mostly sinker...).

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May God bless all child-loss grieving parents as you walk through the Land of Mourning to the best of your ability. I pray that you would have others who "get it" to come by your side on the journey. May God comfort your broken hearts,

http://www.mayoclinic.com/health/complicated-grief/DS01023/DSECTION=symptoms

http://www.apa.org/monitor/nov04/grief.html