Tuesday, November 28, 2006

The Use of Rituals - KISS

Rituals are used quite often, not only during bereavement, but in our everyday lives.  Rituals specifically used in bereavement offer the griever an opportunity to feel connected to their lost loved ones.  Rituals can also offer a sense of peace and comfort to the griever, even if it's only for a little while.  Often, a griever may have problems working through their grief process because they interpret that if they stop grieving their loved one, they will forget them.  NOT TRUE!  We all come to know that eventually, but when someone is in the middle of their grief, it is very hard to convince them of that fact.  That is when we can use rituals as a way for the griever to honor and remember their loved one. 

The key to making rituals a powerful, healing and symbolic action is in the KISS principle.  Keep It Simple Silly!  Ok, that last word wasn't supposed to be "silly,"  but I don't like the other word, and this is my blog, so I'm taking artistic freedom here.  Rituals can be as complicated or as easy as you want them to be.  However, I have found that the less complex a ritual is, the more likely a griever will use it.  Let's face it - when you're grieving, it can be a chore just to get out of bed in the morning and take a shower.  Who would want to participate in a complicated ritual?  On Thanksgiving, my family has the ritual of everyone around the table taking a turn and saying what they are grateful for.  Pretty simple, right?  Well, it is - but my niece showed me that it could be made even simpler and the power of the ritual was not diminished, in fact, it made it even more special and memorable.  As each person took their turn, most said they were grateful for their family and health.  When it was her turn she said, "I'm grateful for my fish!"  You can't get more simple than that! 

Rituals can be as varied as your imagination and creativity allow.  Here are some common ones that people seem to enjoy. 

Sharing memories of the loved one with others who knew the loved one as well.

Sharing the loved ones favorite food or drink and helping others to know the loved one better.

Light a candle.

Plant a tree.

Play a song.

Release balloons - with or without messages to the loved one.

Build a bouquet of flowers.

This last ritual we actually use a lot in our children's groups and our adult groups as well.  It is very simple and yet very powerful and effective.  I have included the instructions here for your use.  This ritual can even be used with family members. 

Build a Bouquet

Supplies:  Flowers, vase


Lay flowers out on a table.

Have each person approach the table, pick a flower and place the flower in the vase.

As they place the flower in the vase, they can think to themselves, or say out loud, something they would like to convey to their loved one. (I miss you.  I love you.)

The person goes back to their seat and allows the next person to go up to the table.

Once the bouquet has been built, everyone sits quietly for a few moments and observes the beautiful bouquet that was put together with loving thoughts.

Remember, rituals don't have to be complicated.  They just have to feel meaningful to you.  Remember KISS! 

Until next week, please be gentle with yourself.


P.S.  If you have found this posting or previous postings helpful, please consider making a donation to The Bereavement Center.  We are a non-profit organization that serves the community, and we operate solely on donations from families, clients and the community.  As always, your donation will be greatly appreciated and acknowledged.


Tuesday, November 21, 2006

Getting Back in the Saddle - Part 2

A couple of weeks ago we discussed “getting back in the saddle again.”  This week, I would like to explore that a little more.  Clinically, the term for “getting back in the saddle” is “reinvestment.”  Many people are familiar with Elizabeth Kubler-Ross’ Stages of Grief, but a similar concept is Therese Rando’s Tasks of Mourning.  The final task is “reinvestment.” 


Therese Rando proposes that a person who has experienced a loss will have to work through these tasks.  These tasks are similar to the stages of grief, in that there is no set way a person goes through these tasks.  It is highly individual and a person can go through them in a step by step fashion, they can bounce back and forth between the tasks or they can even become stuck at a particular task for a very long time.  We typically use these tasks to help an individual in grief recognize where they are in their grief process. 


Tasks of Mourning


1.         Recognize the Loss:  An individual needs to acknowledge and understand the    



2.         React to the Separation:  Experience the pain of grief and offer it a release.   

            Learning to accommodate the loss of the person into their lives.  This period can

            be an emotional roller coaster.


3.         Recollect and Re-experience:  Share stories and relive memories of the

            relationship that was lost. 


4.         Relinquish Old Attachments:  Release the hold on the loved one that has

            passed. It is difficult to hold on and move on at the same time. 


5.         Readjust:  To adapt to a new world without the lost loved one, but not

            forgetting the loved one. 


6.         Reinvest:  To have a renewed energy and interest in life. 


This last stage represents more than just showing a renewed energy and interest in life.  It also represents the ability of the griever to put their heart and emotions into another relationship knowing that there is a possibility of feeling this intense pain again.  If you are a gambler by nature, you might feel more comfortable taking this chance.  For some people, this is a HUGE risk.  But unless you want to face a life of loneliness and without companionship or friendship, this is your only choice.  


When you are faced with making this choice, you find yourself weighing the options of putting your heart out there once again.  If you take the leap, how many years will you get with this relationship?  Chances are you may have many wonderful years with this relationship and have many gifts of happiness along the way.  Surely that is worth taking the risk, because if you do happen to lose this relationship again, the happy memories can outweigh the pain of the ending, right?  It sounds logical at the time, but anyone who has experienced a significant loss knows that is not true.  In time perhaps one can remember the happy memories with less pain, but at the moment of loss, the pain obliterates all and the pain is all there is. 


So let’s not get emotionally involved in any more relationships.  It’s much safer that way, right?  It’s also boring, lonely, miserable, unhappy and most importantly, not a very honoring way to live your life without your loved one.  I don’t know one person that I have loved and has left me, that has wanted me to remain miserable and lonely.  We all know that our loved ones want us to go on living the best life that we can and to continue to offer our gifts to others along our life’s journey.  The experiences we gained from knowing our loved ones are experiences we can give to others as well. 


To me, the most honoring thing I can do for my lost loved ones is to take the lessons they offered me from their life experiences and use them to make future relationships I may be lucky enough to have feel vibrant and fulfilled.  Most lessons people take away are not to take loved ones for granted, to appreciate every single moment we have with them because we never know when it will be our last.  Then when we take the leap again, and if, God forbid, they leave us – we will know in our hearts that we gave them everything we had to give, and with time, when the pain has diminished and we are able to focus on the happy memories again, they will be abundant.


Until next week, please be gentle with yourself.


Happy Thanksgiving!




P.S.  If you have found this posting or previous postings helpful, please consider making a donation to The Bereavement Center.  We are a non-profit organization that serves the community, and we operate solely on donations from families, clients and the community.  As always, your donation will be greatly appreciated and acknowledged.


Tuesday, November 14, 2006

Coping with the Holidays

Well, it's hard to believe it's that time of year again, but I have already given a lecture on "Coping with the Holidays" for a local residential home and passed out some info at our support group last night, so I think it's fair to share the same info here.

The holiday season can be a difficult time of year for people who are grieving the loss of a loved one.  Instead of the bustling happiness that may seem to surround you, you may be experiencing feelings of dread, anxiety and overwhelming sadness.  Here are some suggestions and tips that you may find helpful in getting you through this time of year.


Prepare yourself.  Try to give some thought to the challenges that may await you in the holiday season.  Think about what you will say when an invitation to a party comes your way.  Plan an answer for when the family asks if you will still host the traditional holiday feast at your home.  You may want to participate in holiday events and you may want to continue with holiday family traditions; but it perfectly acceptable for you to not want to participate as well.  You may want to suggest making new family traditions.


Know your limitations.  Don’t give in to family and social pressure.  Learn to say no.  You are the only one that knows how much energy you have to deal with, “going to a party”, “baking cookies”, “decorating the house”, “keeping up with family traditions.”  Again, doing these things may make you feel better, but be kind to yourself – if you don’t think you’re up for it – say “no.”  Or say “yes”but make it clear that it will be tentative, based on how you feel when you wake up that morning!


Holiday emotions.  It’s ok to feel sad during this holiday season and it’s ok to feel happy.  Go with the flow.  If you want to cry – cry.  If you need to talk about your loss with someone – find that someone.  If you find yourself having fun – go with it, don’t guilt over it.  Laughing is healing. 


Holiday chores.  If you must do some of these chores, here are some suggestions:


Shopping – Pick a time when there are less crowds.  If you don’t want to go alone, take a friend or family member with you.  Try catalog or on-line shopping.


Sending cards or letters – Try to shorten the mailing list.


Getting a Tree – If you decide to get a tree, try getting a smaller one, or a tabletop version.


Consider participating in a ritual.  Rituals can be healing and a therapeutic way to honor our loved ones.  Rituals can include lighting a candle, playing a special song or listening to special music, reading or writing poetry, etc.  Other ideas are to give gifts on behalf of your loved one as a way of honoring and remembering them.  You can also spend some time reflecting on the "gifts" your loved one has given you in the past. 


If you find that you are alone for the holidays and would like to do something meaningful, there are always volunteer opportunities where you can focus on the spiritual and giving aspects of the season.


Just remember that you know yourself better than anyone else.  You know what you can and cannot handle.  Please be gentle with yourself.


Until next week,




P.S.  If you have found this posting or previous postings helpful, please consider making a donation to The Bereavement Center.  We are a non-profit organization that serves the community, and we operate solely on donations from families, clients and the community.  As always, your donation will be greatly appreciated and acknowledged.









Wednesday, November 8, 2006

Compassion Fatigue

Last week we talked about Caregiver Stress and Strain, which focused on someone who is caring for a loved one.  This week let's talk a little bit about Compassion Fatigue, which is focused on people who work in the helping professions. 

Compassion Fatigue is a concept that has been around for awhile, but seems to be more accepted and recognized as a valid danger for people who work in the helping professions.  Some may be more familiar with other terms such as Vicarious Trauma, Grief Overload or Secondary Traumatic Stress Disorder.  The definition for Secondary Traumatic Stress Disorder is "the state of tension and preoccupation with the individual or cumulative trauma of clients as manifested in one or more ways including reexperiencing the traumatic event, avoidance/numbing of reminders of the event, and persistent arousal."  Some at risk professions are Emergency Care Workers, Counselors, Mental Health Professionals, Medical Professionals, Clergy, Volunteers and Human Service Workers.  Even people who aren't in the helping professions can fall prey to Vicarious Trauma through the daily intrusions of the media regarding violent crimes and traumatic events.  By being constantly subjected to these images, it can create a persistent arousal state within us and we may not even be aware that it is happening.  Some examples are being an overly protective parent, a hypervigilant female, or the complete inability to trust people. 

The symptoms of Compassion Fatigue are important to discuss, because a lot of them are symptoms that people can experience on a daily basis and just explain them away as being due to the stress of daily living.  However, if you are in the helping profession please be aware that if you have these symptoms, these are warning to practice self-care and prevent burn-out.  The symptoms can be found in these seven areas, Cognitive, Emotional, Behavioral, Spiritual, Personal, Physical and Professional.  Let's discuss some of the more common symptoms in each category.

Cognitive:  We  may begin to feel apathetic about our work, clients or patients.  We may become preoccupied with the disease process, illness or trauma.  Professionals often talk about the occupational hazards of working in the health field.  For example, it is common to hear someone saying they have a pain in their abdomen and they are convinced it's cancer because a client of their's had similar symptoms and that's what they were diagnosed with.  We can live in perpetual fear of what's going on in our body and can begin to question the medical community if we perceive they are not on top of their game. 

Emotional:  Anxiety, depression or overly sensitive.  We may become guilty because we feel we should have or could have done more for our client/patient.  We may become shut down where our patient's and their families can no longer elicit emotional responses from us.

Behavioral:  Irritable or sleep disturbances.

Spiritual:  We can start questioning the meaning of life and our religious beliefs.

Personal:  We can become withdrawn from our loved ones, and have decreased intimacy with our significant others.  This may be done in an effort to not become emotionally available to anyone, or we have given so much of ourselves through work that we have no more to give to our family.  We may become intolerant of others.  We may become overprotective parents.

Physical:  We may have a lowered immune system because of the stressors we encounter on a daily basis, and much like Caregivers, people in the helping profession usually sacrifice their own needs for the needs of others.

Professional:  Our work may suffer because we have low morale, low motivation, staff conflicts, unusual or high absenteeism, fatigue and irritability.

So it's easy to see how mundane some of these symptoms can be, so it's particularly important for us to pay attention to these symptoms, especially if they are compounded.  One way to keep track of how we are doing in our work is by doing check-ins with ourselves.  There are several tests out that very quick and easy that one can take to see if they are in danger of Compassion Fatigue, or worse - Burnout.  These tests can be found on-line.

The Compassion Fatigue Self Test - can be found at www.ace-network.com/cftest.htm.  It's a simple, ten minute test that will rate your level of Compassion Fatigue and your risk for Burn-out.

The Compassion Satisfaction and Fatigue Test - can be found at www.isu.edu/~bhstamm.  Even though this test has been simplified, it is a little more time consuming, but it will not only rate your level of Compassion Fatigue and Burnout, but also assess your current satisfaction with continuing in the helping profession.

The Caregiver Strain Index - can be found at www.medscape.com/viewarticle/488917.  This is a simple test that is used by Caregiver's but it has the same principles for knowing your level of Compassion Fatigue.  I call it the quick and dirty test to do an occasional check-in.

Now the next thing is you know if you are in at risk category, you know the symptoms you may have, you know how to evaluate yourself to see if you are heading into trouble, but what can you do prevent it?  You have to practice self-care.  We all know this, however it is easier said than done.  I realize this, but seriously - if you want to continue to help people and do the good work that you do, then it is necessary and vital that you take care of yourself.  The first lesson is to practice saying "no."  People in the helping profession have a very difficult time with this.  You may  find it easier to start practicing saying "no" on family members or friends.  You also have to find what is meaningful to you.  Develop your own self-care plan.  What will your plan contain?  You  have to develop the same coping strategies that you would if you were suffering the loss of a loved one.  One of the main tenets for coping strategies in grief, is the value of the support system.  So what are your supports?  I have an earlier blog that can help with this is more detail, but if you are in the helping profession, what about your work environment or agency - use them as your supports.  Who will better understand the pressures you are under at work, than a peer or supervisor? 

Here are some other key strategies that you may find helpful:

Know your own triggers and areas of vulnerability.  Learn how to avoid them and diffuse them.  For example, if your case involves a terminally ill child that is similar in age to one of your own children, then you know that this case may be an emotional trigger for you.  What are your alternatives in dealing with this and preserving yourself?  Can another professional handle the case?  Can you talk to your supervisor about your concerns?  Can you summon a strong support system to help you through the case?  It's important to explore and discuss your options.  You don't have to tackle this alone.

Allow yourself to grieve.  People in the helping profession are expected to respond to the human loss, emotion and tragedy that surrounds them everyday as part of their work, but they are not expected to react as a human.  Impossible!  The fact is there will be clients you become attached to, there will be clients you lose, there will be clients that you grieve their loss.

Set boundaries for yourself.  Boundaries are in place as protective measures.  It is very common to have the boundary line blurred from time to time when you are working in the helping profession, that is only natural, but learn to recognize when you are getting ready to cross the line and why - this will help you keep those boundaries in place in future situations.

Alter irrational beliefs.  There are many different reasons why people are drawn to the helping professions.  A lot of us are perfectionists and don't want to be judged.  We need to know that we can't do it all and we don't have all the answers.  Replace your irrational beliefs with affirmations, such as "I am capable," "I am competent," or "I am good." 

If you still need convincing that you need to take the time to practice self-care, there are a lot of sites on the Internet regarding this topic.  Please explore them and convince yourself that you need to fit yourself in to your schedule in order for you to continue doing the good work that you do for your patients, clients and the community.

Until next week, please be gentle with yourself.


P.S.  If you have found this posting or previous postings helpful, please consider making a donation to The Bereavement Center.  We are a non-profit organization that serves the community, and we operate solely on donations from families, clients and the community.  As always, your donation will be greatly appreciated and acknowledged.