ON LOSS, GRIEVING, FACILITATING & INTERVENING
Notes on Helping & the Dynamics of Change
Presented by:
Gwen Whiting
2005 NTAC/Hilton-Perkins Family Specialist Workshop
HelenKellerNationalCenter
Sands Point, NY
May 11-12, 2005
Foreword
The following collection of ideas is offered in conjunction with a workshop, and is not intended to be a freestanding, complete presentation of the theory, methods or techniques of my approach to facilitating growth in the light of loss. Further, although these notes accurately reflect my ideas, beliefs and way of being, Robert Kearney, PhD. was (and continues to be) an immeasurable help in conceptualizing my work into a “teachable” form. For this I wish to offer him my special thanks.
To guide you through these notes I want to make you aware that whenever the term “bereaved individual” and/or “client” is used, it refers to anyone (past the age of five) who has sustained a loss that has shattered a core level dream. This includes, but is not limited to:
People with terminal illness
People with chronic illness
People with a disability
Parents of impaired children
Survivors of the deaf of a “significant other”
Family members of any of the above
Prof./helper
It is my hope that you will find these notes to be a helpful reminder and organizer of the concepts offered during the workshop.
Ken Moses
PSYCHOSOCIAL IMPACT OF LOSS
Feel, Think, Act, Believe and the Maintenance of Congruency
When considering the variables that are affected by a loss, four aspects that make a person who or what he or she is are considered: Feelings, Thoughts, Actions and Beliefs (FTAB). When a person “feels whole,” that is, experiences a oneness with the world, an inner equilibrium, in a word, joy, it grows out of a balance or congruence between feelings, thoughts actions and beliefs. When one is out of balance with one or more of these core elements, one can experience stress, hypocrisy, anesthesia, anomie, loneliness, meaninglessness, and any one of the myriad of other psychosocial distresses.
When a person confronts a loss, the congruence between their feelings, thoughts, actions and beliefs is disrupted. This occurs through the phenomenon of denial, which requires disconnecting one or more core aspects of FTAB. This is immediately experienced at the onset of a crisis with the concomitant stresses. There are basically three ways that people deal with the stresses associated with recent loss: dissociation, acting-out or grieving (denying). When one chronically uses the mechanisms of dissociation or acting-out, the person is on a pathogenic path, a dead-end. If such people are to deal with their lives constructively, they must re-establish equilibrium by giving up the dissociation or acting-out, and then permitting the grieving process to run its course. Psychotherapeutic intervention is often required to accomplish this difficult reintegration.
When one disconnects feelings, thoughts, actions and beliefs, basic elements of self become dysfunctional. Specifically, depending on how one “disconnects,” the sense of ownership, expression, choice, meaning, morality and attachment are impaired. The figure below depicts the relationship between feelings, thoughts, actions and beliefs, and the concomitant basic elements of self.
THE GRIEVING PROCESS
People attach to other people, values, ideals and beliefs through dreams, fantasies, illusions or projections into the future. Losses are defined as occurrences or events that shatter dreams that are core to a person’s existence. Grieving is the process whereby an individual separates from a significant lost dream illusion, fantasy, or projection into the future. It is an unlearned, spontaneous, feeling process that facilitates both the letting go of old, shattered dreams and the acquisition of new, more attainable dreams.
Significant core level losses have to do with attachments and relationships with other people. For this reason, the feeling states of grieving must be shared with significant others for the grieving process to work. Since some or all of these feelings are often unacceptable to bereaved individuals and those who might support them, the sharing of such feelings is difficult and commonly a point where the process can easily get blocked.
The feeling states of grieving are: denial, anxiety, fear, guilt, depression and anger, with each serving positive growth functions that help to bring feelings, thoughts, actions and beliefs into congruence.Denial and anxiety serve to prepare the bereaved individual for the change task that lies ahead, while fear, guilt, depression and anger impel a person to make profound internal and external changes that the loss demands. The coping process is the behavioral enactment of the philosophic changes that grow out of the grieving process. Although there is no prescribed order to the grieving states, the following illustration graphically represents the order of function that the grieving/coping processes serve:
THE FEELING STATES OF GRIEVING
Culturally, and therefore clinically, helpers have historically believed that the feeling states of grieving serve a negative function, and therefore are “the problem” that needs to be addressed. Clinicians are often taught techniques to confront the denying, calm the anxious, reassure the fearful, dissuade the guilty, uplift the depressed and defuse the angry. Such “interventions” are based on the premise that the reaction to a loss is the problem, not the loss itself. The fact is that the feeling states of grieving, i.e., denial, anxiety, fear, guilt, depression and anger are, in fact, the solution, not the problem! Therefore, the helper’s role would be to facilitate the sharing of such feelings. In so doing, the function of each feeling state could more likely be actualized, and therefore truly help the bereaved individual more through a growthful transformation precipitated by a core level loss.
In reviewing the functions of the feeling states of grieving, it should becomemore evident that the feeling states cluster together in two groups. The first, consisting of denial and anxiety, serves the functions that prepare a person for the major changes that loss demands; the second, consisting of fear, guilt, depression and anger, facilitates the existential changes that must occur when one faces a core level loss. Within those two clusters, each feeling state serves the specific function as follows:
Denial:
Buys time to discover the internal strengths, and to assemble the external supports needed to face the facts, conclusions, implications and feelings associated with the loss.
Anxiety:
First mobilizes, and then focuses the energy needed to enact the internal and external changes imposed and demanded by the impact of the loss.
Fear:
Facilitates recommitment to attachment, to loving, in spite of the vulnerability, sense of abandonment, and pain brought on by the loss.
Depression:
Acts as a medium for redefining competency, capability, value and potency, concepts that are violated by core level loss.
Guilt:
Facilitates resolution of the basic existential question, “Of what meaning, significance or impact are my feelings, thoughts, actions or beliefs on the important events or occurrences in my life?”
Anger:
Acts as a medium for redefining one’s sense of universal fairness and justice, a sense often violated by the impact of a profound loss.
THE COPING PROCESS
Coping is the behavioral (or functional) enactment of the attitudinal and philosophic changes that grow out of the grieving process. Although grieving is a prerequisite of coping, in truth both are evident shortly after the onset of a loss. There are four facets of coping that are not evidenced in any particular order. What follows are the four issues of coping as postulated by B. Wright and K. Moses.
Contain the Impact of the Loss
When a person sustains a core level loss their wholelife is impacted. There appears to be a natural tendency to generalize the impact of the loss in such a way as to create an immobilizing attitude that implies that “everything” is lost, ruined or meaningless. Coping with loss requires a careful and accurate assessment of what is actually impacted (lost), what is salvageable and what aspects of one’s life have been unscathed by the loss. Such a sorting process occurs through “containing the impact of the loss.”
Devalue “Normal” Standards
Societal denial is manifested through a pervasive “message” that implies that loss is a “low incidence” occurrence that only affects certain people in our culture. It is not considered “normal” to come from a divorced family, lose your parents, have an impaired child, be wheelchair bound, struggle with a manic-depressive disorder or suffer a terminal illness. Integrating into “normal society” is often prohibited when one sustains a loss. The true inhibitor is the attitude of the bereaved or afflicted person who believes that he or she is an inferior person. In truth, loss is the most “normalizing” of all human experiences, cutting across all socio-economic lines. Coping requires that one confront, behaviorally, the restrictive, insulting and arrogant impact that the maintenance of a set of “normal standards” causes.
Enlarge Scope of Values
As people grow and develop, they ironically often become more narrow around the values that they hold. When one sustains a substantive loss, often the value system that one held is fundamentally shaken. To cope with a loss that has shaken ones basic values, one needs to enlarge one’s scope of values to deal with things as they now are.
Shift from Comparative to Asset Values
People appear to be more concerned about how they stand in relation to others, than what assets they are acquiring or accomplishing. That is uncomfortable for most people, but becomes intolerable when a loss precludes comparative success. In truth, there are no meaningful comparative successes, and ultimately all people come to understand that all we have are asset values. Therefore, coping with the loss includes making changes that reflect the shift from comparative to asset values.
RELATING TO PEOPLE IN CRISIS:
An Introduction to Grief Counseling
The following is an amalgam of theories, methods and techniques based on the primary concepts of Carl Rogers, and specifically modified and organized by Ken Moses and Robert Kearney (refer to recommended readings).
Professionals and other advocate/helpers who have a basic understanding of grieving often ask if there are specific things that they can do to facilitate the growth of the people that they are trying to help. Historically, the answer was that all they need do is to “relate” to their feelings. The most common response to that advice was “are you sure that’s enough?” Further, it became evident that there were many disparate definitions of “relating.” It was for these, and many other reasons, that the concept of ENUF was formulated to answer the question “when is enough ENUF?”
ENUF
Empathy
Non-judgment
Unconditionality
Feeling-focus
Empathy is the concerted effort to gain an accurate perception of another’s experience, and then to share that perception in one’s own words.
Non-judgment is achieved through the helper maintaining a focus that removes the element of judgment, positive or negative. It is not the task of helpers to determine if clients are functioning “good” or “bad,” rather their task is to gain an accurate perception of the client’s experience.
Unconditionality is the name given for the beliefs that helpers hold for the people that they are helping. An unconditional posture basically holds that a person cannot earn respect, value or caring, nor can they lose it. People are respected, valued and cared for simply because they exist!
Feeling-focus is a way of looking at the experiences that clients share. This focus is contrasted with the content orientation that professional specialties often demand. Facilitative responses must focus on client feelings as a prerequisite to any content focused work that might ultimately be required.
Commonly, helpers have defined success around the reduction of a seemingly noxious feeling that a bereaved person brings to them. Simply stated, one was to uplift the depressed, calm the anxious, soothe the guilty, and so forth. This approach has many flaws; mainly being that it is based on wholly inaccurate premises, does not work, and leaves everyone frustrated! Since the feeling states of grieving are the media for working through important issues, it is counter-productive to inhibit the expression of those feelings.
Instead of using approaches that are aimed at making the bereaved feel better; the professional might consider the practice of ENUF, to help the person feel better. When practicing ENUF, the criteria for success are markedly altered. It is not measured through the “dissolution of bad feelings,” but through a more clear and accurate sharing of feelings. Further, such an interaction is complete when a rotation of grief feeling states is evidenced, e.g., a client moves from depression to fear. At that point it is appropriate to switch from ENUF back to the content focus that one’s professional specialty dictates.
LEVELS OF DENIAL
On Surviving Dream/Reality Collisions
The basic function of denial, as it relates to grieving, is to buy time to find inner strengths and external supports. The actual mechanisms of denial are complex and multilevel. Simply stated, denial is first experienced as a unified buffer between the person and a grievous reality that she or he is not yet ready to experience. On closer examination, it becomes evident that denial consists of four distinct levels that serve to gradually ease the person into experiencing as much reality as the gradual accumulation of inner and outer strengths and resources permit. The four levels of denial, in order, are as follows: facts, conclusions, implications and feelings.
Denial of facts is bluntly evidenced through straightforward avoidance of reality, often accomplished through conscious distortion. Any occurrence, event or intervention that confronts a person who experiences this level of denial, is discounted, deflected, ignored, or nullified, period.
The person who is employing denial of conclusions acknowledges the fact that there is something amiss, but denies the cause, permanence and/or diagnosis. Denial of implications is a subtle and stressful process that often eludes all concerned and is seldom seen as denial. Basically, it is denial that the lost dream has changed the entire life of the bereaved person. It is manifest through a passive or active resistance to doing anything that might imply that the impact of the loss might alter one’s life. People who manifest this level of denial will promise anybody anything, don’t deliver, are terribly apologetic and seemingly cooperative, but at all costs, they fight change, sometimes “to the death.”
Lastly is denial of feelings. Actually, the main function of all the levels of denial is to keep the person from experiencing (feeling) the impact of the loss of a core level dream. Once the other three levels are peeled off, all that is left between the person and the awful reality that they face is the denial that what has happened does not have meaning on a feeling level. People at this level “feel” like they are fighting for their lives and that if the feelings are acknowledged, they will go crazy, or worse.
DENIAL INTERVENTION:
Helping with Stuckness
Although denial is part of a normal, necessary and healthy process of grieving, sometimes it is advantageous for all concerned to facilitate the process. When contemplating such an intervention, it is important to remember that one does not give up denial unless it is replaced with something that will work better. A genuine, meaningful relationship often outweighs the benefits of denial. Therefore, all of the following interventions are done within the context of ENUF.
Level of Denial/Intervention
Level of DenialIntervention
FactsGather behavioral observations from the bereaved individual and other first-hand sources, and restate these facts without imposing conclusions or judgments.
ConclusionsProvide bereaved individuals with impersonal, unbiased exposure to experts through books, films, or, preferably, in-person presentations commonly offered through information groups.
ImplicationsProcess and confront resistance to change by requiring a commitment and follow-through on a helpful task or action; i.e., Late Interventions
FeelingsIntensify the practice of ENUF
LATE INTERVENTION
Confronting Self-Destructive Stuckness
Late Intervention is an effective and powerful combination of methods and techniques that intervene on denial of implications. It is most applicable for people who do not follow through on activities that are central to their well being or the well being of an afflicted family member. It should be used after careful practice, and onlywithin the context of ENUF, and then only when a genuine relationship exists between the professionaland the client. The reason for all these prerequisites is that Late Intervention really works; that is, it will enable a professional to break through denial of implications, and therefore, the client must get something in return that is better than what the denial offered, notably a genuine relationship. The procedure is worked through as follows:
- Professional is to obtain a concrete, measurable, time limited commitment to enact a useful task that will in some way benefit the bereaved individual or afflicted family member.
- If the task is completed as agreed, all is well. Obtain a new commitment for a new beneficial task, and practice ENUF. If, however, the task is not completed as agreed, and the client offers excuses, instead of reasons with a recommitment to accomplishing the task, it is likely that the client is manifesting denial of implications. Go to the next step.
- Within the context of ENU (no F), elicit all the excuses, one at a time, stating “Is there anything else?” after each excuse is shared, and cumulatively repeat all previous excuses each time a new one is added. Continue this process until no more excuses are elicited.
- Now state something like, “Gee, it sounds as though you’ve run into a lot of problems this week, what solutions did you consider to solve them?” No matter what the client answers at this point, go on to the next step.
- Now state (specifically_ “How did you pick the solution of “fill in the specific, e.g., not following through on the doctor’s recommendations?”)
- No matter what the answer to “E” is, ask “What does any of this have to do with your committing to (fill in specific).”
- Repeat steps “A” through “F” until you obtain a feeling breakthrough, or a new commitment that meets all of the criteria described in “A.” If a feeling break through is obtained at any point, immediately discontinue Late Intervention and practice ENUF. Once the feeling is processed through ENUF, go back to obtaining a new commitment.
- Leave enough time to be present for the client throughout this process. It is effective, very uncomfortable, and requires genuine caring on the part of the professional. If you hurry or push this process, you will be accurately perceived as abusive and insensitive.
GROWTH, DEVELOPMENT