brid carroll copy - cruse bereavement care · brid carroll keynote address carrollbrid@hotmail.com...

Brid Carroll Keynote Addresscarrollbrid@hotmail.com

Conference at Riddel Hall Belfast, 19-9-19

Family life

Death Impacts

Transition

Chaos

Life Adjustment

Impact of Death on the Family

•Confusion • Difficulty communicating • Sense of isolation • Silence • Different coping styles • Different relationships with the deceased • Different life experiences • Age differences

What is needed?

• Information on grief• Supports • Normalising what is happening…not going mad • Finding a road-map for the journey through grief • Opening communication

Understanding of:

Coping styles Gender difference Impact on identity

Unique meaning of the loss Difference in adult and children’s grief

Nature of Mourning in Children

• Intermittent

• Intense

• Overwhelming

• Triggered by:

Activities / Time of day / Music / Lack of an event

• Appear unaffected in the interim

• Function at a much deeper emotional level

• Often disenfranchised

Difficulties can be seen in some of the following ways:

•Difficulties in school •Persistent self blame •Over activity •Risk taking behaviour •Suicidal thoughts •Self harming

•Loss of interest in the daily activities •Loss of appetite and the ability to sleep •Regressive behaviour • Imitation of the person who died •Constant statements of wanting to be with the dead •Withdrawal from friends

The Journey of Grief

LOSS

PROTEST

FEELINGS

LONELINESS

REORGANISATION

NEW ROLES

ACCOMODATION

D U A L P R O C E S S M O D E L

L O S S - O R I E N T E D

( L O S S )

R E S T O R A T I O N - O R I E N T E D

( D AY T O D AY L I F E )

grief work

Intrusion of grief

Breaking Bonds

Relocation of deceased

attending to the changes

avoidance of grief

doing new things

new roles

S T R O E B E & S C H U T

Dual Process Model

• Loss and restoration go on at the same time

• Person moves from one to the other

• Different pace for individuals

• Need to take time out from grief

• Grieving does not just happen it is actively done by the individual

Where are the road blocks?

• The merry go round of feelings • Behaviours/beliefs that leave us

stuck • Feeling we should be further

along the road • Believing others are tired

listening to us • Feeling worse in the 2nd and

later years of grief • Feeling disloyal in moving

forward

Review Date/ October 2016

The ICBN Pyramid

www.childhoodbereavement.ie/pyramid

Tim

e an

d D

evel

opmenta

l Stage

Fam

ily Context

FEW

SO

ME

MO

ST

le

vel 1

lev

el 2

level 3

level 4

MENTAL HEALTH &

PSYCHOTHERAPY

PROFESSIONALCOUNSELLING

● specialist service

● meeting others with similar experience ● helps develop coping strategies● preferably community based

● appropriate child centred

● accurate and honest ageappropriate information● easily accessible via websites, leaflets, bereavement helplines● family and community based

INFORMATION & GUIDANCE

ORGANISED BEREAVEMENT SUPPORT SERVICES

● experience in childhoodmental health

● knowledge of children’s / young people’s reaction to loss● knowledge of bereavement theory● assessment, listening & empathy skills

ADVANCE KNOWLEDGE

& SKILLS

● understanding of children’s / young people’s reaction to loss● understanding levels of need● awareness of how to access services

● appropriate qualification and/or experience● substantial clinical experience

EXPERT KNOWLEDGE

& SKILLS

KNOWLEDGE & BASIC SKILLS

AWARENESS THAT GRIEF IS A NORMAL REACTION TO LOSS

● suicidal ideation● self harming

● symptoms over time● impacts on day to day functioning

● occasional physical symptoms● questioning● to have routine and schedules

● regressive behavior● constantly questioning● dimished coping● feeling isolated

EXPLANATION & REASSURANCE

NORMALISE &ENHANCE COPING

ADDITIONALNEEDS

COMPLEX NEEDS

NEEDS SERVICE/SUPPORT COMPETENCIES

This pyramid was created by the Irish Childhood Bereavement Network and they must at all times be acknowledged as the authors.

• Standard 1: Child & Young Person

• Standard 2: Family

• Standard 3: Local Community

• Standard 4: Service Provision

• Standard 5: National

The Irish Childhood Bereavement Pyramid

• Children will feel heard and understood and their bereavement needs are being addressed

• Children’s grief will be recognised within the family context

• Bereaved children can believe that the adults they encounter in their day to day activities understand their bereavement

• Children and their family can be confident that the services provided are safe and adhering to best practice standards

• Childhood Bereavement is normalised as part of life

Moving From Trauma to Growth

1. Despair in a shattered world 2. Collecting my pieces 3. Remembering and moving forward

Themes:

• Move from social withdrawal to reconnection • Shift from avoidance to exposure • Shift from inactivity to constructive action and resource

development • Construction of a personal story about the loss

Collecting my pieces

Need to:

• Story the event

• Story the relationship

• Story the adjustment

• Story the legacy

• We create a SAFE SPACE • We CONTAIN or HOLD their grief • We provide a SECURE BASE for exploration of their behaviours in

grief • We open the POSSIBILITIES to be EXPLORED

What is our role?

Advantages of a Shared Community

• Reduces isolation

• The kindness of strangers

• Shared experience

• Finding hope and resilience

• Helps to improve family communication

• Helps in recognising different coping styles

• Learn to negotiate milestones

Interventions • Telling the story

• Exploring the relationship

• Examining the multiples of loss?

• Discovering the meaning of loss

• Exploring self-esteem

• What are their goals in life?

• Who are their supports?

• Rituals for remembering

• Continuing the bonds

Bereavement requires:

Adolescents to cope behaviourally, cognitively and emotionally with five core issues that vary with age:

• Predictability of events (Routine)

• Mastery/control (sense of power)

• Belonging (support) • Fairness/justice • Self-image (identity) It needs:

Supportive relationships Group activities

Meaningful rituals

Fleming and Adolph 1986

Work is underpinned by:

• Creative Family Play.

• Empathetic & Safe Connections.

• Exploring awareness of how grief

and trauma are held in the body.

• Dual Process Model.

• Continuing Bonds Model.

• Work on Identity Information

• Meaning reconstruction.

Don’t walk before me I may not follow Don’t walk behind me I may not lead Walk beside me And show me the way Walk beside me today Listen And I’ll show you the way