Christmas

Christmas is a time that makes demands on our time, money and energy, and it can leave people feeling stressed, worried about what to do/ how to cope/ how to please everyone, drained, frustrated and even lonely or angry. All of which is the opposite to the social hype about how we are supposed to feel – happy, excited and full of cheer and expectations.

In my Women’s Support Group we usually had a session focussed on the difficulties that can occur over the festive season and how we might minimise or survive through these difficulties – and there are a number of areas.

Mental health/ stress

Handling this can be a combination of planning early to do some things like sending cards and buying and wrapping presents, and of making time for relaxation and stress management strategies (e.g. slowing down breathing, positive self-talk, playing relaxing background music and talking to people about our problems).

Here is a useful handout from the Better Health Channel:
https://www.betterhealth.vic.gov.au/health/healthyliving/christmas-tips-to-reduce-the-stress

 Physical exhaustion

This is a time where we need to consciously make time for rest and relaxation (despite the pressures) and to get enough sleep.

Financial

In our group we found it useful to use this table to reflect on how we could do Christmas on a budget:

And then specifically in relation to gifts, we used this table to prompt some thoughts and ideas:

It is not necessary to purchase expensive gifts (many are returned to stores after Christmas), and those that have a little more thought, effort  and personal touch put into them are often appreciated more.

There are many ideas on the internet for making and/or purchasing budget gifts. Here are some:

http://www.iheartnaptime.net/handmade-christmas-gifts/

http://greatist.com/happiness/meaningful-gifts-on-the-cheap

Exercise

It can be tempting to do a lot of sitting over the festive season and to forget our usual exercise routines. We need to try to stay active – good conversations can be had whilst walking and resurrecting the family backyard cricket game (or other outside activities) can be a useful thing to do. Better still, if conditions are suitable, why not try flying kites (guaranteed to bring lots of laughter). And for those who have snow, the possibilities are even wider still.

Food and drinks

It is possible to substitute healthier options for a number of popular foods and drinks.

Here is a list of healthy food substitutes from the Mayo Clinic:

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/healthy-recipes/art-20047195

Relationships

We need to be realistic about these – someone who has always irritated us, been a game player or been difficult will be no different at this time. We can try to avoid known triggers in conversations and use boundaries and escapes if needed. We may need to give ourselves permission not to stay in unsafe/ uncomfortable situations and it is good to plan to spend most time with people with whom we are comfortable.

Remember: if we step outside the commercial fast lane and concentrate on the real reason for the season, there we may find peace.

Complex clients

Many of our clients have complex lives, and experience complex relationships and issues within these lives, and working with these clients can be a challenge for us.

Breaking down the main issues

I have always found it useful, especially in supervision, to separate out the key issues in diagrammatic form, and to include contributing factors to these issues, and then the impact of these issues on each other as we tease them out more.

An example of key issues

The client is a 34 yr old female who has two children (an 8 yr old boy and a 5 yr old girl) and separated from her husband 6 months ago after he had an affair. Her mother, who provided a lot of support, died unexpectedly of a heart attack 1 month ago, and the client was made redundant from her employment as an administration assistant when the company folded 2 weeks ago. She was diagnosed with Type 2 Diabetes a year ago and is currently addicted to cannabis  and regularly binge drinks alcohol. Her addiction history in unclear.

Initially the key issues could be summarised thus:

Adding contributing factors

Once these are added, our diagram may look like this:

Adding connections and impacts

These would be added to the diagram above which includes the contributing factors, but for the sake of simplicity I have deleted the contributing factors from the diagram below:

Making sense of the complexities

Now we can use the diagrams to consider possible hypotheses and additional areas to explore with the client. The history of addiction may not be as important to explore at this stage when the immediate impact of grief and separation is more relevant to address. And with this client it will be vitally important to work on building a relationship of trust with her.

I hope that you find this process as useful as I have.

Mourning the demise of Community Health

On Saturday I attended an open day for the new Hospital/ Health Facility in the town in which I have spent most of my working life as a Community Health Social Worker. It was nice and shiny and full of expensive new equipment, but it was also the reason I chose to retire. Community Health will now be absorbed into Ambulatory Care (and the name will be lost) and Social Workers will be part of the Allied Health team (as they have been more recently), who will have work stations in one large room, rather than offices of their own (which they have had up until now). There is a new emphasis on Integrated Care and I predict that Social Work will become much more medically focused.

Having been a pioneer in Community Health in this town way back in 1976 (there was only myself and a Community Nurse then and our office was initially the kitchen of the Baby Health Rooms in the CWA building), I would like acknowledge some of the history.

The early days

My mother recently sent me letters I had written to her back in the 1970’s and I would like to share some quotes from these letters. Back then Community Health was a new initiative of the Whitlam Government and was Commonwealth funded. I flew out from Sydney, had a chat with the Deputy Regional Manager (referred to as Dr R in the letters), was offered a choice of about 4 towns and, a few months later, found myself picking up a brand new Ford Falcon work car to drive out, having transferred from Liverpool Community Health in Sydney (and having been promised the construction of demountable offices at the rear of the CWA Hall).

6/2/1976

I am now thoroughly exhausted after my first week here… I spent most of the week introducing myself to other people in the welfare field. I mostly got a good reception.

19/2/76

The C of E Archdeacon came up to me and told me a lady from his church would like to talk to me about some girls who are concerning her. I went the next day, but was unable to do much – still it’s another good contact…. Things are now settling down at work and I'm getting some decent cases at last … I’d just like somewhere to work … our modular office has fallen through since the council suddenly decided the CWA Hall is in an all brick zone! … I went out to T. last week and had a really nice day – I get on really well with the Community Nurse there… I'm going to P. tomorrow and I have to leave early (8.30 am.).

25/2/76

Dr R phoned me today to see how I was going – so I told him I’d like somewhere to work and that I wasn't exactly overloaded with work – he suggested I go down and talk things over with him next week, which I thought was nice of him.

14/3/76

The Regional Geriatrician said he had heard that I was very unhappy, and could still transfer to O. if I wanted to. I explained to him that is was my flat trouble that was upsetting me and that I thought it would be very bad for the town in terms of accepting future Social Workers if I just got up and left now. The work situation is now much better – I have a reasonable amount of work to do and am beginning to feel accepted by the community. I was invited to give a talk to the Primary School Mother’s Club on Tuesday… I got through my talk alright, although now I keep thinking of things I should have told them.

3/4/76

Well I can’t complain any more about not having enough work to do – after last week I feel utterly exhausted and seem to have more than I can cope with. I also did a lot of driving, which is exhausting. I went to T. on Tuesday and again on Friday, to C. on Thurs and to a farm out the back of G. also on Tues … We’re still having hassles over getting an office to work in, but there are 3 houses which are half being offered to the Health Commission for rental.

9/4/76

Grasshoppers – I think we have a plague out here – boy is my car a mess after I've driven out in the country… I have done 5 hrs overtime this fortnight but haven’t had a chance to take it off in lieu, which means I lose it as you have to take it in the same pay fortnight. I have done over 2,600 km in my Ford now … I'm becoming very suspicious about our office. I've heard rumours that after the budget comes down the Health Commission will only be given on-going funding i.e. no money to rent extra premises and all unfilled positions will be wiped.

5/5/76

Yesterday we had a visit from the staff review committee. It was horrible – they kept asking us questions but gave no indication of what they were thinking or how we measured up – we were both quite angry when they left and we feel quite determined to start putting pressure on re: getting an office. We piled our room with all the things we could find, including all the things from our cars – and they wouldn't even sit in it. I'm starting to get fed up with working conditions in the country – especially when, added to the above, people seem to think that Social Workers are Pensions and practical assistance experts, and not much else… On Monday night I had to go over to F. to talk about Social Work and Speech Therapy at a careers night … there were about 20 people who wanted to know about these 2 careers, but I think they were more interested than enthusiastic.

12/5/76

Our office furniture was delivered today and you should have seen our little room! We literally could not move. By lucky chance Dr R happened to be visiting (the area) so we asked him to come and pay us a visit as well. Probably didn't do any good, but at least we tried… The hospital is still being difficult… (this) rubs off with the Doctors, and my predecessor at the hospital has given the town a negative impression of Social Workers.

6/7/76

At the moment my Health Commission car is unregistered – they sent the registration stickers for the community Nurse and Baby Health Sister, but forgot mine! So all in all I've had a rather frustrating day and I don’t know whether to laugh or cry.

2/8/76

We have finally got our Speech Therapist, but unfortunately she has been spirited away to the hospital because of our lack of accommodation… P. now wants a playgroup – gives me something to do which I will enjoy for a change!

9/8/76

Well we’re finally moving into our new premises for work. The Speech Therapist is to move in with us and we are getting special permission to employ a part-time receptionist despite the staff freeze.

24/8/76

We spent most of toady moving to our new office – no phone, so we are going to be in the CWA rooms until 10.00 a.m. each morning until the phone is put on … it rained nearly all day today – we picked a good day for moving – everything is now in the other building, but we are by no means settled – there are boxes, files and papers everywhere.

1/9/76

I'm starting to feel almost completely drained work-wise and can understand how Social Workers become apathetic and develop “what’s the use” syndrome. I feel that I have put so much of myself into my job, but am not being refilled. I have no-one to ventilate to, although people are always ventilating to me… It was really good to spend some time with normal families in Melbourne (at my Granny’s memorial service) for a change and to be reminded that family life can be other than one big tangled mess and fouled up communication.

25/11/76

Last week we were landed with a mother and six children from F. who had to catch the midnight bus to Brisbane. They stayed in our office all afternoon and evening. The mother was absolutely exhausted and they had all spent Thurs night sleeping on the floor of the F. Health Centre… I went back at 8 p.m. to see how they were getting along – they were all just about crawling up the wall, so I took them for a drive around town, then out to the airport to see the plane take off, then back to my flat until 11 p.m. – then back to the Health Centre where they were picked up at 11.30 p.m. by the welfare officer from the hospital and the Salvation Army Officer… I’d planned to take the afternoon off as I had been going flat out all week … but instead of that I worked overtime! (Around this time I was also daily driving 4 children to school).

1977

During this year I began a local Neighbourhood Centre by researching, drawing up a proposal, recruiting volunteers and supervising them in collating information (which was stored on cards in shoe boxes). I also became engaged and married in October that year, resigning to adjust to farm life.

 Return to work

 I did not return to Community Health until the late 1980's, beginning part-time in a nearby town, and teaching the Welfare Course at Tafe as well, before becoming full-time in the current town. During the intervening years Community Health had moved several times and had increased substantially in staff. It had also been moved from the Commonwealth to the State Government, with administration from the local Hospital. In the early 1990's a new purpose built Community Health Centre was constructed in the grounds of the Hospital, and this is the building that staff will be relocating from.

During the past 25 years in Community Health I have been involved in setting up and sustaining a Youth Support Service, a Domestic Violence Committee (which was involved in numerous projects) Social Work Group Supervision, a Women's Support Group, a Bereavement Project (which included a Support Group), Rural Crisis Workshops (and a written manual for conducting them), Health Promotion projects, amongst other things, along with providing a Counselling service and Clinical Supervision. And I wonder if the scope for providing such a wide ranging service will continue.

Rest in Peace, Community Health.

Resilience

Last week a deluge of rain and hail hit our house yard and created an instant roaring creek that flowed along the edge of our back verandah over my newly established flower beds. Initially I thought they were ruined but, after the creek had subsided, I managed to unearth all of the plants from under the mud and flood debris and found that even the tiny newly emerged Alyssum seedlings had survived. This storm taught me a lesson in resilience, which I think can be applied to our lives.

Feel the trauma and the pain

When life dishes out traumatic experiences we are allowed to react emotionally (I certainly cried), and we need time to process the shock and the feelings it generates. If we don’t allow the time to do this and think we should just “bounce back”, these feelings and reactions may become buried to simmer away and emerge again later when we are less in a position to be understood.

Look for signs of survival

Once the muddy water had finally soaked away and the rain had eased, I could go out and look for signs of survival – and the more I looked, the more I found. Instead I could have focused on looking for signs of damage (of which there were lots – hail had viciously shredded leaves of vegetables and plants, tall plants were sagging and fruit had been knocked from trees) – the dominant story.

In our lives too, we need to actively look inside ourselves for the strengths that have helped us to come through a crisis and survive rather than continue to only see the damage and losses.

Look for signs of new growth

This occurs further down the track – in my garden it was new seedlings still emerging, new leaves and flowers on plants and plants reaching again towards the sun.

In our lives, survival through traumas and crises can lead to the strengthening of our characters and the learning of new skills

The resilience building river metaphor

In one of the sessions of the Women’s Support Group we used the metaphor of life being like a river that has obstacles, white water, rapids and currents, slow and shallow sections and normal sections where we can “go with the flow”.

We talked about the obstacles being the things we have to navigate around by carefully finding a way through, and in our lives these may include fear, changes, grief and loss, difficult family members, children reaching puberty and risks of emotional injury.

The rapids are the things we have little control over and the times when we have no option but to keep going, and these can be things like going to court, dealing with government departments, moving house and things that make us really anxious.

The slow and shallow sections are the times when we have felt stuck or trapped, and these may include depression, boring times, restless times and times when we feel drained of energy.

The times we have had to climb out and rest by the river may be when we are exhausted, have lost hope, have given in to negatives or when others take over.

However the things that can give us the courage to get back in the river and continue our journeys may include being positive, learning from “the choir of hard knocks”, having people help us to do things for ourselves, encouragement and knowing we are not alone and that others suffer too.

The things that have helped us to keep going despite all of this are listed below.

Things that build resilience

With acknowledgement to the wisdom of the women in my former Women’s Support Group, some of the things which can help us become resilient are:

• Finding inner strength and listening to our inner voices of nurture and encouragement
• Learning from our mistakes
• Knowing that we have learnt something from the things that have happened
• Being able to move forward to positive things and believing in ourselves and the future (hope)
• Being able to see the big picture
• Knowing when to take time out and knowing when to ask for help
• Planning and problem solving skills and having a sense of direction
• Taking control of ourselves and our lives and giving ourselves choices
• Believing it will get better
• Motivation, confidence, skill and competence
• Sense of accomplishment

 Resilient people are able to reach out to others, overcome obstacles from the past, steer through everyday adversities, bounce back from setbacks and reach towards their full potential. (Stephanie Dowrick)

Sowing seeds of insight

I have been spending a lot of time sowing seeds in the garden over the past few months (when the pollen count is not too high), and I began to think that there were parallels to working with clients to help them gain new insights and thus move towards making changes.

Clearing out the debris to make space for new seeds

There is often a lot of storytelling and offloading that needs to occur first, and attempting to sow new seeds of insight before this has occurred makes it much less likely that the “seeds” will germinate. We also need to fertilise the soil with rapport building and nurturing a relationship of trust and caring.

Germination rates and growth

In the garden some seeds never germinate, no matter how carefully we tend them, and this can be the same with some clients. I remember those who seem to stay stuck forever in offloading mode, talking about the same issues over and over again, and seemingly not moving forward to process them.

Some seeds emerge strongly, whilst others are more delicate and tiny, and all need their own ideal temperature to germinate. With clients I would liken the right “temperature” to the right context and readiness to begin to consider new perspectives and/ or work on growing. With some clients new insight emerge strongly, once they “germinate”, whilst with others we may not notice this until the new insight begins to grow in size and become more visible.

First and second order change

Some new insights are like the annuals – they bloom brightly for a time and then fade and die. I would liken these to first order change in clients. Change occurs initially but is not sustained, and is usually about short term behaviour change.

Others are like perennials, where the plants continue to grow and strengthen. These are like second order change where a new insight causes such a major change in attitude that it may be irreversible. This often occurs in the “light-bulb” moments.

Patience is needed

All of these processes take time and thus a great deal of patience is needed. We need to try not to give up when we can see no evidence of “germination”. My Carob seeds took two months to germinate and I nearly threw them out beforehand (especially as they were out of date according to the seed packet).

But we also need to be mindful of when to offer less nurturing and when to let plants survive on their own in their own environment. The same applies to our clients. 

The background contours of bereavement: Part 3

This is the final post on this segment on grief. Once again, please treat this information as something that may be used as a framework to understand a person’s grief journey, rather than as something that everyone will experience.

Neimeyer’s tasks of mourning do not occur in a linear fashion or necessarily in the order presented. Not all people will engage in all of the tasks, and this framework may be totally irrelevant for some grief journeys. However it may be useful for others.

These are Neimeyer’s tasks of mourning as he presents them in his book Lessons in Loss: a Guide to Coping (McGraw Hill, New York, 1999):

Acknowledge the reality of the loss

This is about learning the lessons of loss at a deeply emotional level and involves a series of seemingly unending confrontations with the limitations imposed by the loss. We grieve as individuals and as members of larger family systems. Children need to be included, as “protecting” them will mystify reality and deny them the chance to discuss feelings.

Open yourself to the pain

Avoiding distressing feelings may delay grieving. Feelings need to be sorted through and identified and pain embraced for long enough to learn its lessons. However focussing relentlessly on the pain may be damaging and we may need to balance “grief work” with reorientation to practical tasks and the development of new skills to cope with the changed environment. It is OK to fluctuate between feeling and doing according to need.

Revise assumptive world

Major loss undercuts the beliefs and assumptions that have been our philosophies of life. Loss invalidates our assumptive world and makes us revise it (our behaviours, commitments and values) and this will take considerable time and effort. Our assumptive world will be revised according to the personal meaning we have given to the loss, and we may be transformed by tragedy – “sadder but wiser”.

Reconstruct the relationship to that which has been lost

A continued sense of presence is common and most see this as comforting. Death transforms relationships rather than ending them, and there is a change from a relationship based on a physical presence to one that is based on symbolic connection. Reconstructing the relationship by e.g. encouraging memories, “talking” to the deceased and having cherished linking objects, gives, continuity to a life story disrupted by loss.

Reinvent self

We are social beings and construct our identities in relation to other significant persons, so part of us dies when someone we love dies. We need to rebuild an identity appropriate to new roles, whilst establishing continuity with the old. Death and loss tear vital strands that connect us to people, places and activities, and we gradually repair them by re-establishing other forms of connection. Loss diminishes us, but can also lead to renewal and wisdom.

More information on Robert Neimeyer can be found on this link, as well as access to some of his research publications:
https://dl.dropboxusercontent.com/u/66994396/home/Scholarship.html

The background contours of bereavement: Part 2

Continuing on with the background contours of mourning, here are some more to consider.

Loss orientation vs. Restoration orientation

Some bereaved alternate between feeling intense emotional upset and cognitively containing emotional upset through taking action on something to substitute for thinking about the loss. (Goodrum  S (2005) The interaction between thoughts and emotions following the news of a loved one’s murder. Omega: Journal of Death and Dying Vol 5 (2))

When working with loss orientation we need to explore the client’s experiences, feelings, hopes and fears and help them to release emotions without any pressure to move quickly beyond their pain or to find quick fixes. We need to normalise reactions, explore the significance of the loss for the client’s life and explore for related losses.

There can be multiple approaches to the expression of grief – verbal, written and artistic, and drawing and storytelling may allow trauma to be approached in the relative safety of symbolism and metaphor. Research suggests that the ability to share our feelings and stories with others is healing.

Harding says that Allowing oneself to go through the emotions that happen and accepting those emotions as part of a normal and natural process is affirming and helpful to those who grieve. (Harding D (2005) Spiritual guidance for grief: one piece of the puzzle. PsycCRITQUES  Vol 50 (51))

In Restoration orientation there is a focus on tasks and an exploration of options and possibilities. This is about external adjustment and tuning out to grief.

Meaning making/ reconstruction/ re-learning the world

On this contour we need to work at the pace of the person and pick up when they are ready to begin reconstruction (they need to be thinking beyond intense loss). We need to begin where the client is, allow the story to be heard and uncover the meanings attributed to their lives and the losses they have encountered. Our role is to act as collaborator and catalyst in the process of meaning reconstruction.

Malkinson and Bar Tur write that Grief along the life cycle is an unpatterned process with emotional and cognitive ups and downs involving a continuous search for a meaning to life. 

There are three areas of meaning-making: sense making (via communication and storytelling), benefit finding, and identity change, and we can use tools like journaling, biographies, letters, poetry and metaphoric stories to assist with meaning-making. (Malkinson & Bar Tur (2004) Long term bereavement processes of older persons: the three phases of grief. Omega: Journal of Death and Dying Vol 20 (2))

Continuing bonds

Patson and Marwit have observed that Continued contact with a loved one who has died is common in bereavement. 60% reported sensing a presence (visual, auditory or tactile) and of these, 85% found this comforting. (Patson & Marwit (1997) – but I have lost any further details, sorry)

When working on this contour we need to first explore the nature of the relationship and attachment to the deceased (some people may not want a continuing relationship with the deceased). Then, if appropriate, we may encourage the client to develop rituals that support memories, honour the dead and keep the presence/ spirit. Memories promote healing by validating grief, facilitating ritual, providing mementos and letting the bereaved tell their stories.

Some of the ways to continue bonds are to treasure objects which link to the person who has died (jewellery, clothes, photos, mementos and/or a box of memories), go to the cemetery, create memorials, continue to have thoughts of the deceased, have a relationship with them in one’s heart, have conversations with the deceased (and maybe seek guidance from them) and to write to them in letters or journals.

Music can be used to create connectedness and to facilitate rituals, and we need to encourage talk about the person who has died, as well as the observance of anniversary days.

Neimeyer’s tasks

I will elaborate on these in the next post.

Remember: All of these contours are ideas that may or may not be relevant to the individual grief journeys of our clients, and it is only appropriate to use them if they are meaningful for the client. Not every journey will follow all, or even any, of these contours, but they do give us a theoretical framework to draw on.

The background contours of bereavement

I have found that the best way to make use of these more recent theories, whilst still respecting each individual’s grief journey, is to see them as background contours (borrowing from Neimeyer’s belief that general contours of mourning exist as backdrops to individual contexts and experiences, that there are both individual and relationship contours and that ‘typical’ grief responses should be seen as general, not universal).

Reference: Neimeyer R (1999) Lessons in Loss: a Guide to Coping McGraw Hill, New York

The contours of feelings, thoughts, behaviour and physical reactions

Some feelings commonly felt by those who are grieving include numbness, sadness, anguish, anger, guilt, panic, helplessness, shock, loneliness and depression. Some members of a Bereavement Support Group that I facilitated in the past described themselves as feeling shaky, unsteady and afraid or having a hurt that is too deep for tears.

Some common thinking includes disbelief, confusion, being unable to concentrate, focusing on the loss, and disorientation. This was articulated by some members of the Bereavement Support Group as I felt there was no hope. I was confused and did not know where I was going and  I only see dark shadows and have lost sight of the light beyond.

Some common behaviour can be social withdrawal, sighing, searching and calling out, crying, restlessness and absent mindedness. Other members of the Bereavement Support Group said I have to go away to grieve – away from all the people and I've fallen off the track – my heart feels like it is outside my body.

Common physical reactions can be sleep and appetite disturbance, lack of energy, weakness and lightness in muscles, breathlessness, over-sensitivity to noise and having a dry mouth. This was described by some members of the Group as feeling like I've been through an explosion and am looking into the big black hole of space and I'm so alone – no-one is out there for me and the wheels have fallen off my cart.

The contours of common patterns of avoidance, assimilation and accommodation

Neimeyer says that these three common patterns exist in those who are mourning.

In avoidance the reality of the loss is impossible to comprehend, there is shock, panic and confusion, there is avoidance of the full awareness of too painful a reality, the mourner may act as if the person is still alive and may be unable to do normal routines, they may be disorganised and distracted, they may experience vivid emotional reactions as reality sinks in, and the sharp awareness of pain may be punctuated by the apparent denial of the reality of the death.

Neimeyer says: We accommodate loss in degrees, glancing at it, then away until it becomes undeniably real and its implications for our own future begin to be understood on an emotional level. (See reference quoted as the beginning of this post)

Assimilation is about: Learning the hard lessons of a loved one’s absence in a thousand contexts of daily living. (Neimeyer)

It is about loneliness and sorrow, longing and grief (but may also be about relief or guilt), deepening despair, withdrawal from social worlds to give more attention to ‘grief work’, there may be intrusive images and dreams, unpredictable crying spells, depressive symptoms and physical reactions and pain that comes in waves, and there may be more proneness to disease.

Accommodation is: The uneasy balancing act between remembering the past and reinvesting in the future and this continues for the rest of our lives, requiring on-going adjustments. (Neimeyer)

Accommodation includes the resigned acceptance of reality, the possible persistence of yearning and loneliness, a sense of emotional control, an improvement in concentration and functioning, reorganisation punctuated with the painful awareness of loss, possible pangs of guilt and sadness, taking two steps forward and one step back, and rebuilding a shattered social world.

Longer term contours

The grief journey can be a long climb towards reorganisation and renewal, but on a rocky path that evolves over years, not months. Deterioration may be expected on significant occasions and “grief spikes” may occur years or even decades later.

Other contours

These include loss orientation vs. restoration orientation, meaning making/ re-learning the world, continuing bonds and Neimeyer’s five tasks of mourning, and I will elaborate on these in the next post. There is so much to take on board in relation to working with grief!