Helping a Client Experience Grief After the Death of a Loved One

THE CHALLENGING BEHAVIOR SERIES

Basic Self-Instructional Training

Module #5 of 7

All Grief is like …

all other grief

some other grief

no other grief 1

Revised November, 2006

Introduction To the Challenging Behavior Series

The Challenging Behavior Series is a set of self-instructional modules for persons who provide services to individuals with developmental disabilities and mental health problems. The Series offers a basic set of techniques for dealing with challenging behaviors. The seven modules in the Series will give you fundamental skills.

The Series is self-instructional. The responsibility for learning the concepts and skills in each module is yours. The core information you need is in the modules. Applying that information to specific clients and situations is up to you. Adapting the techniques to your own circumstances is something only you can do. Asking professionals and colleagues about the concepts and skills in the Series will broaden your skills. Challenging Behavior Series Facilitators can help you.

Your Objectives in the Helping Clients Heal After the Death of a Loved One Module

A client may show grief in a variety of ways, some of which you might not easily recognize as being related to the death of a loved person. We need to support clients whenever this happens, and we need to provide special supports when they express their grief with challenging behaviors. The help you can give is likely to be more than you may think. The present module will provide ideas and suggestions for you to use.

You should learn to do the following in the Helping Clients Heal After the Death of a Loved One Module:

Be able to explain what is done and why it is done for each of the suggested steps,

Complete a Worksheet for Developing a Plan to Help a Client Heal After the Death of a Loved One,

The exercises on the following pages will help you achieve those objectives.

The following quotes set the stage for helping a client heal after the loss of a loved one:

People with disabilities have a right to participate fully in the grief and mourning process and in all of society’s support systems and rituals associated with these losses. 2

Grief for all people has both physical and psychological manifestations. 3

Grief is the constellation of internal thoughts and feeling we experience when someone loved dies. Mourning is the outward expression of our grief. Mourning is necessary for healing to take place. 4

Grief is physical. Sweating, crying, sleeplessness, sleeping, eating, not eating; grief need physicaloutlets: crying, safe yelling, safe hitting, walking, running, cleaning, singing, etc. 5

Not long ago, mental health professionals believed that resolving grief involved breaking the bonds between the griever and the deceased. They thought grieving people could not “move on” with their lives until they did so. Many still use the language reflecting this philosophy, counseling, “It’s time to let go.” Today we know that grievers never “let go” of a loved one completely and never “get over” the death fully. In fact, most mental health professionals knowledgeable about grief suggest that it’s unhealthy to try to detach completely from your loved one. 6

A professional counselor often carries out grief counseling. However, anyone who works with a client day to day can help with the healing process. The next few pages present some ideas about what may happen and what you can do to help.

1.What may have happened:

How you can help:

2.What may have happened:

How you can help:

Ray’s mother died two years ago. He was in the hospital at the time, and did not go to the funeral services. He will tell you that she is dead, but he also says that he wants to visit her. Place a check by each item below that is a correct example of how to help Ray with his grieving based on items 1 and 2 from the previous page.

1. _____ Whenever Ray mentions his parents, a staff member will say, “Well, you can’t visit them right now.”

1. _____ A staff member used reflective listening to allow Ray to talk about his parents. When Ray mentioned his mother, the staff member paraphrased several statements, then, focused on Ray’s feelings to see what Ray meant by saying that she was dead.

1. _____ When Ray seems to be sad, staff try to redirect him to some of his favorite activities so that he will not start talking about his mother.

1. _____ A staff member used the death of his dog (that Ray knew) to explain about death and the ritual of burying deceased beings.

1. _____ When Ray said that his mother was not buried, the staff simply reflected back his statement. Ray said it again, and the staff paraphrased Ray’s statement, “If I understand you, you are saying that your Mom is dead, but she is not buried.”

1. _____ Following the sequence just above, another staff member came along and asked, “Well, was she cremated?” When Ray did not answer, the staff member walked away.

1. _____ Staff arranged for Ray’s father to tell Ray about the funeral, and the cemetery where Ray’s mother was buried.

1. _____ Ray is aware that his mother is dead. When Ray mentions his mother, staff ask if he would like to visit her burial site.

1. _____ Staff insisted that flowers were the only appropriate thing for Ray to take to “give to his mother” at the gravesite.

3. What may have happened:

How you can help

4. What may have happened:

How you can help:

Place a check by the staff statements below that show an understanding of items 3 and 4 on the previous page.

1. _____ (to another staff member) “I don’t understand how Jimmy (client) can get so agitated about his dead brother that he didn’t like anyway.”

1. _____ (to client) “Jimmy, you told me once before that you hurt here in your heart. You were really sad. That feeling went away after a while didn’t it? This will get better too.”

1. _____ (to client) “Susan, I know you would feel better if you went shopping with me this afternoon.”

1. _____ (to client) “Harold, did you know that Sam’s oldest cat died last summer, but Slick, his younger cat didn’t die, did he? We aren’t going to die just because your aunt did.”

1. _____ (at a staff meeting) “We need to help Alice see that she will feel better again sometime. She is so sad now, and grieving so much.”

1. _____ (at a staff meeting) “Joyce is just playing up this thing about her old foster mom dying. I don’t think she feels anything at all. She never mentions it.”
   
2. _____ (at a staff meeting) “George (client) asked me today if we were all going away. Do you think he meant ‘Are we all going to die?’”

1. _____ (to client) “Sarah, do you know that everyone dies at some time? But, I won’t die just because your Dad did. I will be OK.”

1. _____ (to client) “Maybe you should think about the things you like instead of sad things like people dying. It’s not good for people to think about death all the time.”

5.What may have happened:

How you can help:

6.What may have happened:

How you can help:

7.What may have happened:

How you can help:

The examples below relate to items 5, 6 and 7 on the previous page. For each example put the number of the item that it relates to in the blank at the start of the example. If an example seems to relate to more than one item, select the item to which it most relates.

1. _____ Ellen’s uncle (who she lived with for 6 years) died 8 months ago. Over the past three weeks she has increasingly been asking if the staff for the next shift are coming. She will begin about an hour before shift change, and ask as many as 12 more times before the change of shift.

1. _____ Evelyn’s grandmother, who used to visit Evelyn every week, died 15 months ago. Recently Evelyn has been leaving her residence at all times of the day and night. Since she has few traffic safety skills and cannot find her way home from more than two blocks away, staff are concerned. When they locate Evelyn, she appears to be simply wandering. She is generally alert and fully aware that she has left her home. Staff have agreed that they will simply ask her if they can stay with her, and not mention that she is away from the house or that she needs to go back.

1. _____ Timmy’s older brother died nearly two years ago. For approximately the last year Timmy has spent two hours or more each afternoon standing by the window that has a view of the main street through town. Staff remember that the first time he did it, he was at the window for almost 5 hours. He carefully watches each vehicle that goes by and can tell you whether a male or female was driving. A staff member asked him if he was looking for his brother, and Timmy got embarrassed and said, “No.”

1. _____ Staff have agreed that they will try to state the question Rochelle seems to be asking about her deceased sister when she brings magazines to them. At various times she will look through a magazine and select a picture that she will show to staff. Sometimes she will not say anything, but once or twice she has pointed to the picture and said her sister’s name. Staff will say, “Are you asking me if your sister looked like that?” or a similar question.

1. _____ Since Amos, a staff member, was killed in a car accident, Sam does not seem to trust that activities will happen. He will ask about scheduled activities again and again, even those that he had done for years, like going to work. Staff have posted his schedule in an obvious place. When he asks a question about his schedule, they will take him to the communication board. They generally ask him what the board says and reassure him it will happen.

8.What may have happened:

How you can help:

9.What may have happened: Grief may be a physical experience.

How you can help:

1. What may have happened: The feelings of grief may cause fear.

How you can help: Listen to their fears. Don’t contradict or deny

them. Simply reflect them.

The examples below relate to items 8, 9 and 10 on the previous page. For each example put the number of the item that it relates to in the blank at the start of the example. If an example seems to relate to more than one item, select the item to which it most relates.

1. _____ Gregg’s father took him to high school football, basketball and baseball games regularly for years. When Gregg’s father died, Gregg repeatedly refused the opportunity to go to games with staff. Lately he has been looking through Sports Illustrated magazines and tearing out pictures of athletes. He wads the pictures up and throws them in the wastebasket. He told one staff member that they were “…pictures of him…” Some staff have interpreted that as being pictures of his father. They do not interrupt this activity.

1. _____ Sylvia used to go shopping at the mall. Since her mother died three months ago, she has not gone to the mall at all. The last week she has been found often in her room in bed with covers over her head. When asked, she will not say anything about her behavior or emotions.

1. _____ Elmer will often abruptly take off running. He will run as hard as he can for a couple blocks. When he stops, he will stand or sit for several minutes feeling his heart and staring off into space. He does not appear to enjoy the running because he will have a pained expression on his face. Also, he does not appear to be running from anything that staff can identify. The stimulus for running seems to come from within. Since he does not watch for traffic when this happens, he is in some danger of an accident. Staff are encouraging him to run in safe places.

1. _____ Staff have been surprised to find that Terry’s undershirts are all torn. He never tore them before now. Staff first noticed the damaged undershirts about two months ago. Shortly before that his grandfather died.

1. What may have happened: Grief can cause anxiety.

How you can help: Use relaxation techniques.

1. What may have happened:

How you can help:

1. What may have happened: Recognize that rituals provide security.

How you can help:

Place a check by the staff statements below that show an understanding of items 11, 12 and 13 on the previous page.

1. _____ Staff will wait patiently as Louie closes the curtains, clears the top of his dresser, puts the picture of his deceased mother in the top drawer of his dresser and locks his door before leaving the house.

1. _____ Edwina paces a lot since her mother died. Also, she bites her fingernails (which she did not do before the death.) She complains of stomach pains. She only picks at her food. Staff are trying to teach her deep breathing.

1. _____ When Orville started to talk about his deceased aunt and cry more frequently, staff thought that it was not caused by grief because his aunt had died nearly seven years ago. To most staff he appeared to be “over it” almost three years ago.

1. _____ Each Sunday William insists on getting to church early, and he immediately sits in the pew where his deceased father sat. He will hold the psalm book as if he is reading (he does not read). If someone else is sitting in his particular seat, he will yell at them. Staff help him to set his alarm and get to church early so he will always have his “favorite seat.” Staff will also help him to meet the pastor after the service so that William can tell him what he says every Sunday, “My father knows you.” The pastor always smiles knowingly and says, “Yes, He does, my son.”

1. ____ Staff thought Frank was over-reacting when he had a tantrum over losing his deceased twin brother’s ball cap. He always wore the ball cap to eat a Burger King where is brother worked. The cap was always put in a special spot on Frank’s pillow when not in use.

1. _____ Lori, a program coordinator, helped Diane, a client, try several different activities during the week of the 4th of July, which was the time of year when Diane’s mother died. Putting out the American flag each morning of that week was the activity that seemed meaningful to Diane.

1. What may have happened: Clients may need to observe anniversaries.

How you can help: Help them carry out a ritual on anniversaries.

1. What may have happened:

How you can help:

Place a check by the examples below that show staff understanding of items 14 and 15 on the previous page.

1. _____ On the anniversary date that her widowed mother died, staff drive Julie past the house in a nearby community where Julie lived with her mother. Julie asks to do this.

1. _____ During the week before and the week after the anniversary date when Teresa’s stepmother died, staff are especially careful not to mention her relatives or death.

1. _____ Staff will not take Charlie in the van when he wears his mother’s lace sweater. He says that the sweater reminds him of her and their good times. Staff say he is inappropriately dressed.

1. _____ Before bedtime Ralph puts his gold cross necklace on the framed picture of his father that he has in a cardboard box on its side on his shelf. Staff have told him that it is a healthy thing to do.

1. _____ On the anniversary of the death of John’s father, staff pick up John’s elderly mother (who does not drive), and take her and John to the cemetery where his father is buried.

1. _____ Sarah would cry whenever Jim (staff member) would wear a Notre Dame sweatshirt like the one Sarah’s father often wore on weekends before he died. Jim does not wear the sweatshirt around Sarah anymore.

1. _____ Staff are reluctant to brush Peggy’s long hair because Peggy says that it reminds her of the times her deceased mother brushed her hair. Peggy will get quiet and a little melancholy when staff brush her hair.