Jennifer Stevens MA, CT

Going Public with someone else's grief

For people who haven't been effected by grief, dealing with the pain, isolation, embarassment, regret, and devastation of a loss can be unfathomable.

I've been in situations where I found others' actions and words, especially in the workplace, to be almost cavalier about someone's experience of loss.

Think about this... case manager coming into work and hasn't had her morning coffee and is rushing to an 8 am meeting... Someone rushes by and says, "Hey, David died last night. . . took a turn for the worst and was dead before dawn.  Oh, and Sue brought doughnuts in... their at Anita's desk."

This case manager had worked with David for 9 months, having weekly visits where, as he became sicker and sicker, opened his life and heart to her.  She's supported him through doctor's visits, fighting insurance companies, and often sat down for a cup of coffee while coloring with his kids.  She was present and engaged, wanting to know about David and his family's experiences.  She was there during crying days and celebrating days.

Now, this case manager hasn't had time to put down her brief case and stands silently, not realizing that the coffee was scalding her hand.  She's shocked awake and numbed at the same time.

When a death occurs in the workplace, the "facts" spread like wildfire in the undercurrents of office life, weaving in and out of cubicles.  If their lucky, someone sends out a memo as soon as possible to get everyone on the same page or holds a meeting, giving space for people to react and be supported.

But sometimes management begrudgingly takes on the responsibility of informing everyone before speaking to the bereaved person. 

In an ill-worded statement, everyone was told that "Ben's wife went in to premature labor and after hours, she miscarried."  The news of the "blessed event", the upcoming anticipated birth, had already been publicized in a memo. 

Another memo is sent out not too long after and it reads, "We are excited to hear that Ben and his wife Georgia are expecting their first child.  The baby is due in about 6 months."  To Ben and his wife, that first pregnancy was their first child; it was their unborn child.

The new baby is now considered high-risk.  Stories fly around.  Someone uncomfortably explains in a board report why Ben has been away from work for so long.  It emphasized is that a second funeral had taken place four days ago, almost 14 months from the date the first baby was due, and it is unclear why Ben isn't back to work, placing undue burden on the rest of staff.

Sounds like fiction to some of you, I'm sure.  Who could be so blaze about a client's death or an employees loss?  It's harder to grasp that these events have occurred in two different organizations whose missions are to care compassionately for people at the end of life. 

It seems rather mindless that staff can be compassionate to clients, deliver bad news professionally to families but not to or about  a colleague.  It seems ridiculous to think that an employee's loss can be trivialized or that an employee might actually care and be effected by the loss of a client. 

We can easily take for granted that it's understood that someone might want to ask an employee what needs the family has after a loss or ask if an employee can take time away from a staffing to allow the reality of her client's death to sink in.  We can exclaim to be the experts in the field and yet somehow that "expertise" gets lost when it is one of our own. 

Can we truly help churches, businesses, and other medical professionals understand how to support bereft people when we can't support the person we park next to every day? 

It might be worth a look to see if training needs to start where we live 8 hours a day before we go out and sell what we can't buy.

JAMA Statement Response

This is in response to the ADEC concern over the news coverage that accompanied an article that was published in JAMA...

In a subsequent e-mail Dr. Holly Prigerson, one of the authors of the JAMA article, took issue with the ADEC statement. ADEC invited her to post her response on our website. Here is that response in its entirety:

No place in the JAMA piece did we state or imply as mentioned in the ADEC statement:'that everyone experiencing negative emotions beyond six months of a death loss from natural causes needs psychotherapy.' We do not say anything about psychotherapy for everyone or even anyone. The statement that those with higher than average scores beyond 6 months are "likely to reflect a more difficult than average adjustment and suggests the need for further evaluation of the bereaved survivor and potential referral for treatment." (p 722) is not saying everyone needs psychotherapy. We would like to assume we share an interest in trying to advance understanding and to ease the pain and suffering of bereaved individuals. An accurate reflection of our study results would seem a good place to start.

ADEC has issued the following response to Dr. Prigerson’s statement:
ADEC did not assert that the authors stated or intentionally implied that everyone experiencing negative emotions beyond six months of a death loss from natural causes needs psychotherapy. It was ADEC's point that those reading the article as well as the news coverage about the article could come away with an understanding that this was one take-home message, and it was ADEC's intent to address that impression in its statement.

ADEC has invited Dr. Prigerson to participate in a panel discussion of this article at the ADEC annual conference in Indianapolis, April 12-15. This discussion will take place on Saturday, April 14, 2007 at 8:30 a.m.

"She seemed to be handling it well."

"She seemed to be handling it really well," said our staff nurse.  "I think she did everything before hand and won't need our services"..... I sat in awe... How do we think these things?  How many times have mindful grief support staff/volunteers heard "I don't remember these people being at the service, even though they signed the book?"  They talk about going through the motions, just getting it done, doing what has to be done.....

Sometimes we need to take a long slow deep breath and step back.  Sometimes we need to see with our hearts, not just our eyes, hear with not just our ears.  All too often I have staff tell me that this family is going to need you afterward (after the death that our staff can't even say the word) because they're freaking out.  This family, who expresses their emotions in a timely, authentic way, don't ever call.  They did what they needed to.  And the opposite is true, as in the paragraph above... "Don't worry about so and so, she/he is strong" and they appear to be so strong that three weeks later they are utterly alone and can't remember how to breathe without that special other person.

We can't always "eyeball" a situation and guess right, especially when it comes to the public and private worlds of grieving.  Grief isn't a time to think we have the special ability to read minds -- it's a time to bear witness, to be gentle, to tread lightly, and to be of service.  Most of all, it's not a time to make snap decisions based on one glimpse or snap shot of a person's being. 

We grieve as many ways as there are stars in the heavens... maybe more.  We have no idea how we will feel from one minute to the next on a "normal" Wednesday, let alone the day I say goodbye to my brother, my lover, my best friend... let alone the day I put on a face to the world, the same day I put on my black dress and have no idea what dream I have just stepped in to, or out of.....

Please, listen with your whole being.  And don't just assume because someone isn't upset that they are "grieving appropriately" or that if they are displaying emotions, that they "will need bereavement help asap".  Ask, maybe not right then and there, but ask.... we don't have all the answers to the riddle of someone else's heart.....

ADEC Makes a Statement on JAMA Article

For further information on the Association for Death Education and Counseling, please go to:

www.adec.org  I think that if you have the time and you are in this field, it could be very helpful to share this with your local newspaper....

ADEC Response to JAMA Article on Grief

The Feb. 21, 2007, issue of the Journal of the American Medical Association (JAMA) included an article titled An Empirical Examination of the Stage Theory of Grief. This article has garnered much attention in the popular press.(Reuters, Chicago Tribune, NPR Web site). In response to the article, ADEC has issued the following statement:

ADEC welcomes this new research focused on examining stages of grief, while recognizing that the study is part of a large and growing body of research in the field of thanatology. As noted by Maciejewski, Zhang, Block and Prigerson, their study is a beginning step in examining stage models. More dynamic assessments (e.g., instruments with > 1 item, measurement of severity in addition to frequency, broader sampling) are needed before firm conclusions can be made regarding the presence of specific stages of grief.

The acknowledgement of yearning and acceptance as perhaps the primary aspects of grieving is an important finding. Unfortunately, it has been common for the experience of grief to be equated with depression and/or sadness--a misconception often held by the general public, mental health practitioners, and researchers alike.

Although sadness and depression are experienced in grief, this study indicates that they are likely not the defining features of the grief experience. However, in contrast to conclusions drawn by the study authors, ADEC does not support the implication that everyone experiencing negative emotions beyond six months of a death loss from natural causes needs psychotherapy. Such need depends on many more factors, including the intensity as well as frequency of negative emotions.

Updated: February 26, 2007

Ten Things I Will Never Tell You (Introduction Again)

In my group work with the bereaved, we often spend the whole first group sharing who we are and talking about what reactions we are having that don't make sense.  I would say in 3/4 of the groups, we also spend that first night talking about the things that people have told the bereaved since the death, most of which has hurt and angered my group members.

We have so little grief etiquette in our society today, people don't seem to know what to say and do when we have experienced a loss.  Many also want to avoid the subject of death at any cost.  People are uncomfortable with our grief.  Maybe they think that they will hurt us if they say the wrong thing?  Maybe they think they will hurt if they say anything?  What I do know is that the bereft often asking why professionals, family, friends, and co-workers can be so hurtful.

This was my rational for these articles -- The Ten Things I Will Never Tell You.  I thought this would be a short article and I could pass on the wisdom that my clients, friends, and family have shared with me.  What I realized is that there is a lot to say about this subject.  Therefore, I am writing this article in multiple sections, allowing the reader to take in the information slowly and mindfully. 

If you are a professional or if you have a someone close to you who is grieving, the most helpful thing we can do is to tell them you love them and offer a hug.  The rest is about listening and learning to become okay with our lack of comfort.  These are themes that will be repeated throughout many of the articles because I don't think it can be emphasized enough. 

The next topic:  You should feel happy that they are in a better place and no longe suffering.

Upcoming ADEC Conference

The 29th Annual ADEC Conference is going to be held in Indianapolis, IN,  this year from April 11-15. I am going to be presenting two different topics in breakout sessions:

Understanding The Transformative Power of Secondary Losses -- Bereaved individuals are often times disenfranchised by the closest people to them, their family and friends.  Those that "support" the bereaved do not understand the complexity of the grief that often includes secondary losses that can be physical or symbolic.  In this presentation, attendees will understand the effects of secondary losses and how they affect meaning reconstruction on their grief journey.  Attendees will work on experiential processes to help them understand the life altering and healing effects of working with secondary losses.

Existential/Humanistic Therapies and the Grief Process:  Creating New Meaning Out of Loss -- For many clients, the grief process is a time of tremendous seeking and trying to make their way in an unfamiliar world -- the world after bereavement.  Clients often feel alienated, lonely, anxious, and have difficulties holding the sometimes paradoxical feelings, thoughts, and experiences that they encounter after becoming bereaved.  Often this process is a path of discovery and finding the meaning of reconstructin their lives after their losses.  This presentation will share theory, practical applications, and provide understanding in the benefits of existential-humanistic therapies in the practice of working with grieving clients.

Please let me know if you have come to the growthhouse blog to find out more about ADEC if you are at the conference.  If you have questions about the presentations, please contact me at:  [email protected].

Thanks, Jennifer

How We Disenfranchise Those Who Grieve

Personal Experience

I was 24 years old, working with AIDS patients and tending to a dying brother at home.  I would walk into work in the morning, exhausted and depleted.  My coat would not even be off and someone would inadvertently tell me that so and so died last night.  They had no idea that they shot me with daggers each morning.  Some of the patients, mostly men at that time, I had grown to have deep bonds with simply because they were a human being that was in pain and suffering.

I'm now 35 and have learned a lot along the way in working with clients who are ill (physically, spirituality, or emotionally) and those who are dying.  I'm not quite as naive as I once was, thinking I could help the world and make huge differences globally.  I know now that I can make a huge difference in the heart and spirit of one person and if that happens, my life has been worth living. 

Have Things Changed?

But 11 years later, I see the same callousness in the workplace, mine and others.  I can still walk in the door and be told that so and so has died or that another has been sent to the psychiatric unit as if someone were telling me that they were having turkey on rye for lunch. 

Someone who works in our agency said that she had never seen such compassionate people be so ugly to each other despite the love they give to families and clients.  I was furious at this at first.  I've sat with this statement for a long time now and see that, although it was not said in this manner, there was a pearl of wisdom in it.

Disenfranchisement

We disenfrachise each other at work when we take for granted that telling someone difficult news will not hurt them, no matter how much professional distance we think we hide behind.  We talk unkindly about families in team meetings, forgetting that one of those families could have deep connections to someone around the table.  Worst of all, we forget that patients and families would be devastated to hear how we calliously talk about them during their most wounded time.

We think of disenfranchised grievers, according to the literature, as those for whom society does not expect or sanction bereavement experiences.  Often we site a significant other of a gay couple, a sibling, a grandparent, a child.  I think we, even as caregivers in the field, disenfranchise people from their grief when we are not mindful.   

Mindfulness About the Experience of Others

We forget that a client who calls and is broken hearted about the loss of a dog is still grieving.  I don't understand this; I've never been a pet person but I hear the pain in their voice and the look in their eyes as they enter my office.  We forget that although we work in the field of dying and grieving, it is our friends, neighbors, former classmates, families that are those whom our facility or agency has served.  We are not the judge of what losses are valid or not just as we are not the adjudicator of what feelings or ideas are wrong and right. 

Our jobs are difficult there is no doubt.  And so are the lives of those we work with, for, and next to.  But no one has the training to tell someone that they should not grieve or that they should not "still" be grieving.  My clients ache to tell their stories, to find a safe place to whisper their loved ones name.  Whether the loved one was a soul mate or an abuser, there is still grief and it is not our job to judge it or by any means take it away from our client. 

In the simplest of terms, are responsibility is to listen and be mindful of how people are interconnected and what the meaning of a loss is to our client, our chaplain, our office mate, ourselves.  Yes, even to ourselves, we can disenfranchise our bereavement by telling ourselves that it's only work and can be put into a drawer at 4:30.  The reality is that people touch our lives and that needs to be honored, in and of itself.      

 

Questions to Ask Yourself

Which Group is right for you?

     Before the first group:

1.  Can you meet with a group that meets in a funeral home, hospital, church, or will those places be too painful for where you are right now?

2.  Can you meet the facilitator before the first group?

3.  Can they provide someone who is familiar with the group (maybe a former or current group member) that can meet you for tea so that you don't have to go into a group of unfamiliar faces on the first night?

4.  Is this group aligned with who you are (is it a religious group if you need one?  Is it for a specific group (widowers, parents of young children, etc.) if you feel you need that?

5.  Ask yourself if you have any expectations of how the group may benefit you or how you may bring your gifts to the group.

     After the first group:

1.  How did you feel about the facilitator?

2.  Even if you experienced sorrow, frustration, ambiguity, intimidated in sharing your story in front of other witnesses, did you feel that the group's purpose serves your needs? 

     Please remember that it is common to feel more sorrow a day or two after sharing your mourning consciously in front of people who are listening.  That will change with time and give yourself permission to be okay with the discomfort.  Make sure that the facilitator is available for calls and questions between groups.  If you felt sadder, don't give up, this happens, and just like our grief over all, it will change in time.  Please don't believe the myth that goes like this "why should I sit around with a bunch of sad people?  I already feel horrible".  It is a myth and a common feeling but it is also a reason to keep from feeling and to keep from getting the support you need.  Coming to counseling or a group takes risks, courage, openness, and trust that there is solid ground even when you feel like you are sinking.

3.  Did the facilitator follow up with you by phone or a letter?  Did you feel welcomed?

4.  Were there educational resources available if you needed them?

5.  Did you feel included, listened to, and seen for the beautiful person you are?

6.  Did the facilitator (or any of the group members) monopolize the group with their story, going beyond making a point?  Did it become her/his support group session?

Seeking the Support of a Group

So, What Should I look for:  Finding a group that fits you!

     There are many kinds of grief groups and some of you will have preferences to one and maybe not another.  Groups are usually open-ended or a "walk-in" group (they may meet once or twice a month) or they are closed-ended group, (time specific).  As a facilitator and educator, I prefer close-ended groups.  They provide a safe space for you to participate more fully in becoming a community and in your own grief process. 

     Walk in groups can be inconsistent and if you are a consistent member, you may feel like your group never gets past telling their stories to new people.  Other people like the walk-in groups because if they are panicked, sorrowful, angry, or in a confused state, you probably won't want to hear that you have to wait weeks or months to get in to a new group. 

     Groups are facilitated in different ways as well.  Some are facilitated by professionals, such as myself.  What I offer my groups is my formal education in psychology, my training in grief counseling and death education, and my experience (both personal and professional) with loss.  Some groups are facilitated by a kind-hearted person who has had a loss or who has time to do a group.  The general wisdom that I share with people I work with is this; know your rights.  It's your right to know whose hands and heart you are placing yourself as you are mourning.

Seeking Support On the Journey

Where Do I Go From Here?  Seeking the Support of a Group

     Our hearts are aching, are mind wanders to a thousand places and nowhere at all.  We long to be with our loved one and we push away those who are still around.  We have questions; we don't know where to search for answers.  We feel fragile, angry, lonely, hurt, crazy, broken, confused, frantic, nervous, and numb...

     We don't want to open ourselves to new people we might have to say goodbye to.  We don't want to open our hearts again to another loss.  So why support groups?  I find there are so many benefits to support groups that I could spend a day just relating how they have touched the lives of people who come to share their stories, their mourning, and their healing.  In seeking out a support group, we search for people we have a commonality with -- being bereft of someone we love.  We seek new people who will hear our stories with fresh ears and hearts, and will not hold us back from the catharsis that comes with genuine mourning.

     We have questions and groups provide a place to ask them, to benefit from the facilitator and group education and even if the only answer we receive in return is, "we hold you in our hearts", we have been given a gift.  Sometimes we're seeking someone to share our frustrations with, to help us problem solve, or just to listen.  That's what good groups do, meet you where you are "at" and care for you as you figure out what you need. 

     You are the greatest teacher and you alone know how to heal your grief.  A group celebrates your triumphs and hold you when you need comfort.  A group is a place to try out life, to learn what being empowered and mindfully participating in living and grieving is about as you seek and find meaning and purpose.

     Above all, a group should feel safe to you, should have set guidelines, and should adhere to the universal wisdom of confidentiality so that members feel they can share their journey.  If you don't feel safe with other group members or the facilitator, you are less likely to explore our experiences and feelings, and be open to feedback.

     You will less likely want to fully involve yourself in growing and transforming, continuing bonds of love that death could not take away, and transform our sorrow by finding new meaning in life as it is today, here and now, not how it was.