Helping Families Helping Families throughthrough

The Emotional JourneyThe Emotional Journey

Alzheimer Society of Manitoba ConferenceAlzheimer Society of Manitoba Conference

March 6, 2007March 6, 2007

Peter S. Silin, MSW, RSWPeter S. Silin, MSW, RSWDiamond Geriatrics, Inc.Diamond Geriatrics, Inc.©www.DiamondGeriatrics.comwww.DiamondGeriatrics.com

The Meaning of The Meaning of AdjustmentAdjustment

More easily said than doneMore easily said than done Patronizing and discountingPatronizing and discounting Internal process vs. external appearanceInternal process vs. external appearance

Levels/Stages of Levels/Stages of Adjustment Adjustment

I. CrisisI. Crisis II. Adjustment is habitualizationII. Adjustment is habitualization III. Acceptance III. Acceptance

AcknowledgingAcknowledging Lingering sadnessLingering sadness Lack of meaning purpose or passionLack of meaning purpose or passion

IV. Embracing is choiceIV. Embracing is choice

Adjustment as Practical Adjustment as Practical ProcessProcess

Four L’sFour L’s Landing—orientation. CrisisLanding—orientation. Crisis Labeling—getting bearings Labeling—getting bearings Learning—learning patterns and cultureLearning—learning patterns and culture Living—confidence in how things workLiving—confidence in how things work

Families learning to be “ The Family Member”Families learning to be “ The Family Member”

Crisis Theory Crisis Theory

A period of disequilibrium and decreased functioning A period of disequilibrium and decreased functioning brought on by event or situation which cannot be dealt with brought on by event or situation which cannot be dealt with by normal coping methods. by normal coping methods. (Roberts, A. Crisis Intervention (Roberts, A. Crisis Intervention Handbook 2000) Handbook 2000)

Fear, anxiety, anger, confusion, inadequacy, guilt, and Fear, anxiety, anger, confusion, inadequacy, guilt, and griefgrief are common. From the sheer intensity of the emotions, are common. From the sheer intensity of the emotions, the person becomes unable to deal rationally with the the person becomes unable to deal rationally with the situation. Usual thought processes are disrupted by feelings, situation. Usual thought processes are disrupted by feelings, and "thinking about the problem" is not only difficult, but also and "thinking about the problem" is not only difficult, but also frustrating and unproductive.frustrating and unproductive. (211bigbend.org)(211bigbend.org)

Helplessness, confusion, anxiety, shock and angerHelplessness, confusion, anxiety, shock and anger ((Golan, N. Treatment in Crisis Situations 1978Golan, N. Treatment in Crisis Situations 1978))

Difficult to process information, difficult to make decisionsDifficult to process information, difficult to make decisions

The Emotional Range of The Emotional Range of AdjustmentAdjustment

GriefGrief GuiltGuilt ShameShame Fear Fear AnxietyAnxiety LonelyLonely HelplessHelpless AngerAnger

Admission and Admission and Adjustment as CrisisAdjustment as Crisis

ShockShock Emotional systems take overEmotional systems take over Decreased information processing abilityDecreased information processing ability Decreased problem solving abilityDecreased problem solving ability

Tells us about timing and type of helpTells us about timing and type of help Be aware of/help with range of emotionsBe aware of/help with range of emotions

EmotionsEmotions

About Guilt and ShameAbout Guilt and Shame

Guilt is about what we have doneGuilt is about what we have done Normal part of being humanNormal part of being human Lack of guidelines on behaviourLack of guidelines on behaviour Conflicting need, desires, influenceConflicting need, desires, influence

About Guilt and ShameAbout Guilt and Shame

Shame is about who we areShame is about who we are Attachment theory (Attachment theory (Bowlby,John 1988Bowlby,John 1988)) Core issues of SelfCore issues of Self Differentiation and BoundariesDifferentiation and Boundaries

Guilt activates shameGuilt activates shame Shame is more difficult to deal withShame is more difficult to deal with

Grief and LossGrief and Loss

Loss is eventLoss is event Grief is emotional experience or Grief is emotional experience or

processprocess Unique Types of grief and lossUnique Types of grief and loss

Recurrent/Ongoing Recurrent/Ongoing AmbiguousAmbiguous Anticipatory Anticipatory

Kubler RossKubler Ross““On Death and Dying,” 1969On Death and Dying,” 1969

BowlbyBowlby““Loss, Sadness, and Depression,” 1980Loss, Sadness, and Depression,” 1980

DenialDenial

AngerAnger

BargainingBargaining

DepressionDepression

AcceptanceAcceptance

NumbnessNumbness

DisequilibriumDisequilibrium

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DisorganizationDisorganization

ReorganizationReorganization

GriefGrief

Bowlby: Grief Bowlby: Grief

Bowlby: Four Stages: Bowlby: Four Stages: Numbness, Numbness, Disequilibrium: yearning, searching, hanging onDisequilibrium: yearning, searching, hanging on Disorganization/Despair: recognize loss, hopeless, Disorganization/Despair: recognize loss, hopeless,

withdrawalwithdrawal Reorganization: grief recedes, new patterns Reorganization: grief recedes, new patterns

establishedestablished

Emotions and ProcessEmotions and Process

Grief and Loss can play out as:Grief and Loss can play out as: GuiltGuilt BurnoutBurnout ResentmentResentment AngerAnger

Guilt and AngerGuilt and Anger Active doing of grievingActive doing of grieving Can inhibit grievingCan inhibit grieving Kicks to shameKicks to shame

Dealing with Transitions: Dealing with Transitions: UsUs

Self awarenessSelf awareness Our own issuesOur own issues Dealing with lossDealing with loss ProjectionProjection

When we can’t helpWhen we can’t help

Dealing with TransitionsDealing with Transitions

Do they want help: PermissionDo they want help: Permission How do they want itHow do they want it The meaning of helpThe meaning of help Are they ready for helpAre they ready for help Help must fit the receiverHelp must fit the receiver

Dealing with Transitions: Dealing with Transitions: ResistanceResistance

Reinforcing resistanceReinforcing resistance Secondary gainSecondary gain Loss resulting from releaseLoss resulting from release Protection from primary emotionsProtection from primary emotions Role loss Role loss ResentmentResentment

Dealing with TransitionsDealing with TransitionsStage 1: EmotionalStage 1: Emotional

Supportive counsellingSupportive counselling ListenListen IdentifyIdentify EmpathyEmpathy relationshiprelationship

Follow-upFollow-up

Dealing with Transitions: Dealing with Transitions: Stage 1: Cognitive Stage 1: Cognitive

ResponsesResponses Information Information

How someone isHow someone is What happenedWhat happened

Education—simple to more complexEducation—simple to more complex About care, About care, SystemsSystems About decline, dementiaAbout decline, dementia Grief and other emotionsGrief and other emotions

Dealing with Transitions:Dealing with Transitions:Fear and AnxietyFear and Anxiety

Identify Identify UnderstandUnderstand Educate and explainEducate and explain ReframeReframe NormalizeNormalize

Dealing with Transitions:Dealing with Transitions:Stage 2: Cognitive and Stage 2: Cognitive and

SupportiveSupportive Therapeutic: Guilt and Grief Therapeutic: Guilt and Grief

What is underneath the feelingWhat is underneath the feeling What does it remind you of/ bring upWhat does it remind you of/ bring up Skill basedSkill based

Solution focused: Guilt and griefSolution focused: Guilt and grief Miracle QuestionMiracle Question Doing guiltDoing guilt What would you rather be doingWhat would you rather be doing

Dealing with TransitionsDealing with Transitions

Cognitive Behavioural Approaches: Guilt and GriefCognitive Behavioural Approaches: Guilt and Grief Diaries/JournalsDiaries/Journals Two chairs/VoicesTwo chairs/Voices Alternatives to the endAlternatives to the end Writing lettersWriting letters RitualsRituals Visualizing: scalesVisualizing: scales What would you have done differently and where would What would you have done differently and where would

that take you?that take you? Tell me why you should feel guiltyTell me why you should feel guilty

Transitions: Changing Transitions: Changing ThoughtsThoughts

FeelingFeeling ThoughtThought What is untrue What is untrue about thought/about thought/

Why is it untrueWhy is it untrue

New thoughtNew thought Supporting Supporting EvidenceEvidence

GuiltyGuilty I should I should be able to be able to handle this handle this

I have done it a I have done it a long timelong time

I am sickI am sick

I have many I have many responsibilitiesresponsibilities

I am doing it by I am doing it by myself myself

It is OK to It is OK to set limits set limits and say noand say no

My journalMy journal

I have done I have done a lot alreadya lot already

I still love I still love my father my father

I won’t fall I won’t fall over if I do. over if I do.

David Burns : The Feeling Good Handbook, 1999David Burns : The Feeling Good Handbook, 1999

Christine Padesky, Dennis Greenberger: Mind Over Mood: Change Christine Padesky, Dennis Greenberger: Mind Over Mood: Change

How You Feel by Changing the Way You ThinkHow You Feel by Changing the Way You Think , ,19951995

Dealing with TransitionsDealing with TransitionsGuilt and GriefGuilt and Grief BibliographicBibliographic Internet—info and chat rooms Internet—info and chat rooms Systemic approachesSystemic approaches: :

Buddies and peer systemsBuddies and peer systems Support GroupsSupport Groups

ExternalExternal Self help GroupsSelf help Groups TherapistsTherapists GodGod

Stage 3: Forgiveness*Stage 3: Forgiveness*

ForgivenessForgiveness Cheap forgivenessCheap forgiveness AcceptanceAcceptance Genuine forgivenessGenuine forgiveness

Forgiveness of selfForgiveness of self Forgiveness of otherForgiveness of other

• Janice Abrahms Spring, PhD. “ How Can I Forgive You? Janice Abrahms Spring, PhD. “ How Can I Forgive You? The Courage to The Courage to Forgive, the Freedom Not ToForgive, the Freedom Not To” Harper, 2005” Harper, 2005