Avoiding the Cliches of Grief

Try open ended statements. Try to avoid telling people what they should or should not be feeling, doing, etc. Do not assume to know what someone is going through or experiencing. 1. Clich: You must be strong for your children (spouse, relatives, friends, etc). Instead, try: Why not share your feelings with your children? Perhaps you can lean on one another and help support each other. 2. Clich: Youve got to get hold of yourself. Instead, try: It must be so hard to keep going when youre hurting so much. 3. Clich: You are holding up so well. Instead, try: Would it help to talk about how youre feeling? 4. Clich: Time will heal. Instead, try: You must feel as if this pain will never end. 5. Clich: Youre young, and you will be able to make a new life for yourself. Instead, try: You must miss your loved one and the life you had together; I do, too. What to Say Im sorry. Im sad for you. How are you doing with all this? I dont know why it happened. What can I do for you? Im here and I want to listen. Please tell me what you are feeling. This must be hard for you. Whats the hardest part for you? Ill call tomorrow. You must really be hurting. It isnt fair, is it? You must really feel angry. Take all the time you need. What Not to Say I understand how you feel. Death was a blessing. It was Gods will. It all happened for the best. Youre still young. You have your whole life ahead of you. You can have other children. You can always remarry. Call me when I can help. Something good will come of this. At least you have another child. She/he led a full life. Its time to put it behind you. Be strong!

Courtesy, Archdiocese of Omaha, Family Life Office

Janice Firn, LMSW UMHS Clinical Social Worker

Children & Grief

Childrens experience of loss and grief can differ from an adults experience. Knowing how childrens developmental stage affects their understanding of and ability to cope with loss is important. This knowledge will help you provide the most meaningful and effective support to the child. Speaking with your childs health care provider regarding your childs response to loss and how to best to support your child through this experience can be a helpful place to start. Pediatricians can help assess whether a childs response is normal or if professional support/counseling is needed. Additionally, it can be beneficial to involve the school counselor or social worker; they can also assess for coping and identify support/counseling resources. Below is a list of resources for helping adults to better understand childrens grief, and how to support children through the grieving process. American Academy of Child and Adolescent Psychiatry http://www.aacap.org/cs/forFamilies Arbor Hospice http://www.arborhospice.org/services/GriefSupport/Childrenandfamily.html Barr-Harris Childrens Grief Center http://www.barrharris.org/ The Center for Grieving Children, Teens, and Families http://www.grievingchildren.org/resources.html The Childrens Room http://childrensroom.org/ Eles Place http://www.elesplace.org/ The Grieving Child http://www.grievingchild.org/ Hospice Net http://www.hospicenet.org/html/child.html Michigan Mental Health Networker, Washtenaw County Child & Adolescent Services http://www.mhweb.org/index.html http://www.mhweb.org/washtenaw/child_index.html Psychology Today Find a Therapist http://therapists.psychologytoday.com/rms/prof_search.php

Janice Firn, LMSW UMHS Clinical Social Worker

Grief: Suggestions for finding a support group and/or therapist Receiving support from others who have experienced a loss and are going through grief, and professional support can help us cope. It can sometimes be a daunting task to find the appropriate support group and/or therapist. Often local religious leaders or places of worship (churches, mosques, and temples), hospitals, treatment centers, hospices, and funeral homes have lists of specific support groups. Even if you or your loved one has not been a patient or client of these organizations/agencies most are open to community members and are willing to assist you with identifying support/therapy options. Most conditions or types of loss have specific web sites (ex: Suicide, Miscarriage, Substance Use); these sites often have helpful suggestions for support groups, agencies, and networks. Ask friends, family or peers who are also experiencing the same loss or condition for recommendations of groups or therapists. Another way to identify therapists in your area is to contact your health care provider (doctor/clinic) or health insurance provider (ex: Blue Cross Blue Shield, BCN, HAP), or County Mental Health Entry Number (for Medicaid recipients or those without insurance coverage). In the Ann Arbor area there are several community agencies and groups that may be able to assist you with finding the best group and/or therapist for you and/or your familys situation, below are a few of these agencies: Washtenaw County Mental Health Single Entry Service Number: 734-544-3050 or 800-440-7548 (24 hours) Ann Arbor Area Therapeutic Resources http://www.therapeuticresources.com/supportmichigan.html Arbor Hospice http://www.arborhospice.org/services/GriefSupport/braveheartofmichigan.html Community Support and Treatment Services http://www.ewashtenaw.org/government/departments/community_mental_health/programsand-services Eles Place http://www.elesplace.org/ - Children Groups & Support Grief Net http://griefnet.org/support/sg2.html - Adult Groups http://www.kidsaid.com/k2k_support.html - Childrens Groups Michigan Mental Health Networker, Washtenaw County http://www.mhweb.org/washtenaw/selfhelp_index.html http://www.mhweb.org/washtenaw/therapist_indx.html Psychology Today Find a Therapist http://therapists.psychologytoday.com/rms/prof_search.php St. Josephs Mercy Behavioral Health - 734-786-2301 or 800-289-0014 University of Michigan Hospital Psychiatry - 734-764-0231

Janice Firn, LMSW UMHS Clinical Social Worker

Students, Teenagers, Young Adults Life Event Getting married Unwed pregnancy Death of parent Acquiring a visible deformity Divorce of parents Fathering an unwed pregnancy Becoming involved with drugs or alcohol Jail sentence of parent for over one year Marital separation of parents Death of a brother or sister Change in acceptance by peers Pregnancy of unwed sister Discovery of being an adopted child Marriage of parent to step-parent Death of a close friend Having a visible congenital deformity Serious illness requiring hospitalization Failure of a grade in school Not making an extracurricular activity Hospitalization of a parent Jail sentence of parent for over 30 days Breaking up with boyfriend or girlfriend Beginning to date Suspension from school Birth of a brother or sister Increase in arguments between parents Loss of job by parent Outstanding personal achievement Change in parents financial status Accepted at college of choice Being a senior in high school Hospitalization of a sibling Increased absence of parent from home Brother or sister leaving home Addition of third adult to family Becoming a full fledged member of a church Decrease in arguments between parents Decrease in arguments with parents Mother or father beginning work

Life Change Units 100 92 87 81 77 77 76 75 69 68 67 64 63 63 63 62 58 56 55 55 53 53 51 50 50 47 46 46 45 43 42 41 38 37 34 31 27 26 26

Adapted from Holmes-Rahe Social Readjustment Rating Scale. Journal of Psychosomatic Research, (1967). Vol. 11, pp. 213-218.

Adult Life Events Death of a spouse Divorce Marital separation Imprisonment Death of a close family member Personal injury or illness Marriage Dismissal from work Marital reconciliation Retirement Change in health of family member Pregnancy Sexual difficulties Gain a new family member Business readjustment Change in financial state Change in frequency of arguments Major mortgage Foreclosure of mortgage or loan Change in responsibilities at work Child leaving home Trouble with in-laws Outstanding personal achievement Spouse starts or stops work Begin or end school Change in living conditions Revision of personal habits Trouble with boss Change in working hours or conditions Change in residence Change in schools Change in recreation Change in church activities Change in social activities Minor mortgage or loan Change in sleeping habits Change in number of family reunions Change in eating habits Vacation Christmas alone Minor violation of law

Life change units 100 73 65 63 63 53 50 47 45 45 44 40 39 39 39 38 35 32 30 29 29 29 28 26 26 25 24 23 20 20 20 19 19 18 17 16 15 15 13 12 11

Adapted from Holmes-Rahe Social Readjustment Rating Scale. Journal of Psychosomatic Research, (1967). Vol. 11, pp. 213-218.

Life Events Scale This stress assessment measures the amount of change, using Life Change Units, a person experienced and adjusted to in the previous 12 months. It was designed to predict the likelihood of disease and illness following exposure to stressful life events. Each life event is given a score that indicates the amount of readjustment a person has to make as a result of the event. Not all of the events in the scale are necessarily negative events. This scale indicates that change in one's life requires an effort to adapt and then an effort to regain stability. Stress and feelings of loss are natural by-products of adapting and trying to regain homeostasis. This assessment considers only the events that occured, not individual perception of these events in life. Perception is a key part of the total grief and loss experience, so while the Life Events Scale has value in increasing awareness of potential losses and life changing or stressful events, an individuals perception of the event is an important variable which needs to considered in the overall assessment. For a more complete picture of how loss has affected a persons life consider all the dimensions of health: physical, mental, emotional, spiritual, and social. Directions For each event that occurred in your life within the past year, record the corresponding score. If an event occurred more than once, multiply the score for that event by the number of times the event occurred and record that score. Total all the scores: Score of 300+: At risk of illness. Score of 150-299+: Risk of illness is moderate (reduced by 30% from the above risk). Score 150-: Only have a slight risk of illness.

A modified scale has also been developed for students (teenagers and university aged young adults). This scale is included in the handout. Similar to the adult scale, life events are totaled and provide a rough estimate of how life changes may affect health.

Adapted from Holmes-Rahe Social Readjustment Rating Scale. Journal of Psychosomatic Research, (1967). Vol. 11, pp. 213-218.

Here is a comparison of characteristics of both helpers and rescuers:

The Helper
1. 2. 3. 4. 5. Listens for request Presents offer Gives only what is needed Checks periodically with person Checks results a. Functioning better? b. Meeting goals? c. Solving problems independently? d. Using suggestions successfully? 1. 2. 3. 4. 5.

The Rescuer
Gives when not asked Neglects to find out if offer is welcome Gives help more and longer than needed Omits feedback Doesnt check results and feels good when accepted, bad when turned down 6. Does the greater share of the talking

Excerpt from Wellness Workbook by Regina S. Ryan & John W. Travis, MD.

Being responsible TO others is FREEING to self and others

1. Listening, empathy

Being responsible FOR others is CONTROLING for self and others

1. Telling, sympathy, pity; reassurance only, positive feedback only

2. Separate from the other at least a minimal 2. Immersed or over-involved emotionally or degree of objectivity coldly detached 3. Personal (focus on the other as a person rather than a thing or object 3. Depersonalizing, stereotyping, labeling (the case, the problem in room 303, the sociopath, the discipline problem) 4. Smothers 5. Hostility (active or passive), Incongruent/Phony, Denies or ignores body, denies or distorts feelings, avoids confrontation

4. Loves 5. Congruent/Genuine, hears body, deals with feelings constructively (especially anger), confronts constructively, constructive feedback (positive & negative) 6. Respects the other person a. Provides freedom to choose (considers options) b. Allows freedom to succeed or fail c. Confident of other

6. Lacks confidence a. Only my answer or decision is OK (persuade, sweetly coerce, bribe, blame, increase guilt, withdraws affection, etc.) b. Stays awake nights, worries, takes problem home c. Failure is tragic 7. Super-helper, savior, must save everyone, perfectionist, super-giver

7. Helper can fail

Excerpt from Pancrazio & Zeller 1982

Rescuers Checklist
Completing the checklist can help you become aware of the ways you may be rescuing people without realizing it. It is taken, with permission, from the Transactional Checklist. Mark each of the statements below as it applies to you according to this code: 0 = seldom or never; 1 = sometimes or occasionally; and 2 = frequently. X = significant others in your life such as a spouse, boss, parents, friend, or colleague. ____ 1. Is it hard for you to take time for yourself and have fun? ____ 2. Do you supply words for X when he/she hesitates? ____ 3. Do you set limits for yourself that you then exceed? ____ 4. Do you believe that you are responsible for making (keeping) X happy? ____ 5. Do you enjoy lending a shoulder for X to cry on? ____ 6. Do you believe that X is not sufficiently grateful for your help? ____ 7. Do you take care of X more than you take care of yourself? ____ 8. Do you find yourself interrupting when X is talking? ____ 9. Do you watch for clues for ways to be helpful to X? ____ 10. Do you make excuses, openly or mentally, for X? ____ 11. Do you do more than your share, that is, work harder than X? ____ 12. When X is unsure or uncomfortable about doing something do you do it for X? ____ 13. Do you give up doing things because X wouldnt like it? ____ 14. Do you find yourself thinking that you really know what is best for X? ____ 15. Do you think X would have grave difficulty getting along without you? ____ 16. Do you use the word we and then find out you dont have Xs consent? ____ 17. Do you stop yourself by thinking X will feel badly if you for or do something? ____ 18. Is it hard for you not to respond to anyone who seems hurting or needing help? ____ 19. Do you find yourself being resented when you are only trying to help? ____ 20. Do you find yourself giving advice that is not welcome or accepted? ____ Total: More than 10 points rescuing is possible, more than 20 points rescuing is probable.