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  1. 1. Course Author: Malcolm Woods (Masters in Social Work) Facilitators: Astell Evans & Jennifer Roy. Haringey Male Foster Carers Support Group (17th March 2016) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 1 Grief is the price we pay for love (John Bowlby)
  2. 2. Transitions Some children may have to face very particular and personal transitions not necessarily shared or understood by all their peers. These include: family illness or the death of a close relative; divorce and family break-up; issues related to sexuality; adoption; the process of asylum; disability; parental mental health; and the consequences of crime. All looked after children and young people will experience loss, separation and varying degrees of trauma when they come into foster care. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 2
  3. 3. Exercise one (1) How many different kinds of loss can you think of? (2) Do these have anything in common? (3) What was the first loss you can remember? (4) (4) How did this loss impact on your life? Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 3
  4. 4. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 4 Learning Outcomes To discuss how: You seek and access information and support to help you understand, deal and cope with the likely consequences of the individuals being told about bereavement You take action to ensure that individuals are in an appropriate place which allows them privacy when they first hear about bereavement You seek and access additional support for individuals where you are unable to provide appropriate support
  5. 5. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 5 Learning objectives (2) To discuss how: You work with individuals to enable you to understand their thoughts, feelings and distress and to help them through the bereavement and mourning You allow individuals private time to adjust to the bereavement, taking account of any risks to the individual You observe changes to individuals that are not normally found with bereavement and mourning, and that may give cause for concern You seek additional support for yourself and individuals where you are unable to respond to the individuals needs You work with the individuals, key people and others to identify whether the individuals need additional or specialist support and who will take responsibility for doing this
  6. 6. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 6 Learning objective (3) To discuss how: You work in ways that are sensitive to the individuals distress, grief and mourning You support individuals to: A communicate and explore their experiences of bereavement and mourning, taking into account their preferences and beliefs B understand any changes that might have to be made because of bereavement C identify their needs and preferences regarding their options for change due to loss and bereavement D deal with any changes positively, encouraging them to recognise and focus on their strengths and building towards the future E access additional and specialist support when this is needed
  7. 7. TSDS Standard 5 1 a: Understand the basic principles of how children and young people of all ages form attachments, how these attachments affect their development, and the impact of interrupted development, trauma, separation and loss Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 7
  8. 8. TSDS Standard 5 2.a: Understand how Foster carer can help children and young people develop resilience and self-esteem. 3.b: Understand how to support individual children and young people through significant life changes and challenges Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 8
  9. 9. TSDS Standards 5.6.c: Understand the impact of abuse, separation and loss on the behaviour of children and young people 7.1 b: Understand how being a foster carer may affect you personally and where you can get support Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 9
  10. 10. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 10 At management level, you may want to consider the following areas Design and implement a service which addresses the needs of individuals experiencing significant life events Ensure the service responds effectively to individuals experiencing major life changes or losses Develop and support practice which acknowledges and helps children and young people to address losses, dilemmas and conflicts they are, and have been faced with
  11. 11. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 11 ATTACHMENT An attachment is an emotional bond with another person. It is important that everyone involved in working with adults and children has a basic understanding of attachment theory. Working with issues of attachment and separation are at the heart of the work done by foster carers and other social care professionals.
  12. 12. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 12 Vera Fahlberg, an American psychiatrist, whose work on attachment, separation and loss has greatly influenced child care practice in the UK, says that healthy attachments are the foundation for healthy physical and emotional development as well as the ability to learn
  13. 13. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 13 She says: When children have a strong attachment to a parent, it allows them to develop trust for others and self reliance. These earliest relationships influence both physical and intellectual development as well as forming the foundation for psychological development. The childs earliest attachments become the prototype for subsequent interpersonal relationships
  14. 14. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 14 Exercise 1 Think of someone that you are significantly attached to: (1) What makes that attachment special for you and for them? (2) What benefits have there been to you from knowing that person as well as their benefits? (3) What would be the impact on your life if you no longer had that person around or you become deceased?
  15. 15. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 15 Anticipatory Grief Anticipation can be an exciting thing e.g. anticipating a holiday that we have been looking forward to for some time. But anticipation also magnifies the possibility of reality of a loss. Knowing that we and all our loved ones will die one day creates anxiety. We see this early on in life. This is the beginning of our anticipatory grief, the pain we will one day experience.
  16. 16. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 16 A deeper anticipatory grief occurs when someone we love or we ourselves have a terminal illness. Anticipatory grief is the beginning of the end in our minds. We now operate in two worlds. The safe one that we are used to and the unsafe one in which a loved one might die.
  17. 17. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 17 Anticipating a loss is an important part of experiencing that loss. We often think of it as part of the process our loved ones go through as they face their own death themselves. Yet for those who will survive the loss of a loved one it is the beginning of the grieving process.
  18. 18. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 18 Forewarned is not always forearmed. Experiencing anticipatory grief may not make the grieving process shorter or easier and we may also experience the limbo of loss in anticipatory grief when our loved one is not getting better and not dying yet but in a state of poor health with little quality of life.
  19. 19. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 19 Elizabeth Kubler-Ross a worldwide leading authority on grief and loss, identified five stages of grief. Not everyone will go through all of them or in a set order but can be useful tools for helping us to frame and identify what we may be feeling
  20. 20. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 20 1. DENIAL In a person who is dying, denial may look like disbelief. They may be going about life and actually denying that their illness exists. For a person who has lost a loved one this doesnt mean that literally you dont know that your loved one has died. It means you come home and cant believe they arent going to walk in any minute. It is not denial of the death its more like This is too much for me to take in at the moment.
  21. 21. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 21 This first stage of grieving helps us to survive the loss. As we try to just get through each day, a common reaction after someone has just died, we are protecting ourselves by only letting in as much as we can handle. Letting in all the feelings associated with a loss at once would be overwhelming emotionally. We cant believe what has happened because to fully believe it at this stage would be too much.
  22. 22. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 22 2. ANGER This can take many forms anger at your loved one for leaving you behind, angry that you couldnt prevent them from dying, angry at doctors for not making them well again, angry that you and your loved one didnt have more time together etc.
  23. 23. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 23 Anger comes along when you are feeling safe enough to know that you will probably survive whatever comes. It often appears at the same time as other feelings such as sadness, panic, hurt and loneliness.
  24. 24. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 24 Anger is a necessary stage of the healing process. There are many other emotions underneath the anger and we have to be able to first let ourselves experience the anger if we are to tackle those underlying feelings eventually.
  25. 25. Letting in anger Letting in the anger first allows us to go deeper about other feelings later. At first grief can make you feel lost like you have no connection to anything. Then you get angry at someone- e.g. a person who didnt attend the funeral and suddenly you have a structure, your anger towards them. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 25
  26. 26. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 26 Anger means you are progressing, that you are allowing all those feelings that were too much before to come to the surface. You may also experience feelings of guilt, which is anger turned in on yourself. Anger affirms that you can feel, that you did love, that you have lost.
  27. 27. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 27 3. BARGAINING Before a loss you will probably do anything if only our loved one would be spared e.g. Please God, Ill never be angry at my husband again if only you let him live.
  28. 28. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 28 We become lost in a maze of If only or What if, guilt often accompanies bargaining. The If onlys cause us to find fault with ourselves and what we think we could have done differently. We even bargain with the pain well do anything not to feel the pain of this loss.
  29. 29. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 29 Bargaining is about our need to have life returned to what it was before our loved one became ill or died. We want them restored to life. We want to go back in time its the If only that accident hadnt happened or If only they hadnt got ill.
  30. 30. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 30 4. DEPRESSION Usually comes along after bargaining is over. Our attention moves into the present and we feel a sense of emptiness and grief, deeper than we imagined. It feels as if it will last forever.
  31. 31. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 31 Its important to remember that this depression is not a sign of mental illness. It is an appropriate response to a great loss. Many people see it, however, as an unnatural state, something to be fixed or to snap out of. This overlooks the fact that to not feel depression after a loved one dies would be unusual.
  32. 32. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 32 A bereaved person should allow themselves to feel depression. Elizabeth Kubler- Ross says it will leave as soon as it has served its purpose in your loss. It can be helpful in grief by allowing us to take stock of our loss. It makes us rebuild ourselves from the ground up.
  33. 33. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 33 5. ACCEPTANCE This is not about feeling o.k. about the loss of a loved one, its about accepting the reality that, that person is physically gone and recognizing that this new reality is the permanent reality. We will never like this reality but we will accept it well learn to live with it. This is where our final healing and adjustment can take place.
  34. 34. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 34 As we heal we learn who we are and who our loved one was in life. As we move through grief healing brings us close to the person we loved. A new relationship begins. We learn to live with the loved one we lost. We start the process of putting back the pieces. Some people feel a sense of guilt if they begin to enjoy life again in some way they feel that this is betraying the person who had gone. Its not. We cant replace that person but we can make new relationships or friendships. Its about changing, evolving, growing.
  35. 35. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 35 Some other feelings associated with grief. RELIEF This may be the relief that a loved ones suffering has ended and is perfectly normal. It is not relief that someone has gone.
  36. 36. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 36 EMOTIONAL REST Bereaved people experience a broad range of emotions after a loss angry, sad, anxious etc. They often have mood swings that can be quite alarming for those around them. Eventually the bereaved person has to back away from these feelings for a while, perhaps by devoting themselves to their work, to give themselves some rest from the intensity of it all
  37. 37. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 37 REGRETS This is a common reaction when someone dies we think about all the things we wish we had said to the person who is gone, all the things we wish we had done (or not done). This is a reflection of the fact that life is usually shorter for those we love than we hoped for. It is natural that things will feel unfinished because often we simply dont have the time to do all the things that we hoped to do.
  38. 38. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 38 TEARS These can be one of the many ways we release our sadness although the natural instinct for many people in this situation is to say I must stop crying, I must pull myself together. Often others feel concerned and tell us the same thing. Our perceptions about crying may be cultural in some societies not crying is a sign of dignity, in others a sign of dishonour. What we personally feel about open expressions of distress may depend on our own upbringing or the culture of our family.
  39. 39. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 39 DREAMS Dreams commonly embody our hopes and fears. In bereavement its not unusual to dream that your loved one is still alive. After a loss the need to feel that the person you loved still exist somehow, somewhere, can be very important. Dreams are a private way to find some reassurance when the real world can offer us none. Some people find dreams of a loved one upsetting. Some people worry when they cant dream about that person. Eventually in most cases the dreams subside and become less frequent.
  40. 40. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 40 HAUNTINGS Some bereaved people report seeing their loved one when theyre out, hearing them speak, feeling their touch etc. These are normal and common an a reflection of the unfinished business that we mentioned earlier.
  41. 41. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 41 ROLES All of us play many roles in our live wife, husband, parent, child, sibling etc. When a loved one dies all the roles they fulfilled are left open. Sometimes we take on these roles ourselves, sometimes we might assign them to others (e.g. a wife who relied on her husbands financial organisation may want a son to take over this role in her life). Bereavement brings changes to the lives of the survivors. You lose not only the person you loved but the life, the routines etc that you had with that person.
  42. 42. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 42 RECOUNTING THE LOSS Bereaved people often have a need to talk time and time again about the loss they have been through. This is their attempt to make some sense of the enormity of what has happened to them and to try to put it into place. Often for their family and friends it can be wearing to hear the same story once again but it is a process that the bereaved person needs to go through and it will help them.
  43. 43. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 43 FAULT AND BLAME Many bereaved people criticise themselves for not having done something that might have prevented their loved one from dying. This is a natural reaction to being in situations that are beyond their control. In time most bereaved people come to realise that whatever had been done the outcome would probably have been the same anyway.
  44. 44. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 44 RESENTMENT Often bereaved people resent being left alone or resent their loved one dying. If they had been angry with that person in life the loss may awaken and reinforce these old feelings. However we can still grieve even for those who were unkind or unfeeling towards us and we need to recognize that those feelings are real and have to be worked through in the same way as for any other loss.
  45. 45. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 45 OTHER LOSSES One loss may reawaken memories of an earlier one and for a time all of the feelings this arouses can be overwhelming for the person experiencing them. However a late loss can be an opportunity to put into place any remaining parts of an earlier experience and can be part of a general healing process.
  46. 46. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 46 PARTICULAR KINDS OF LOSS Suicide Individuals who contemplate suicide are often at a point in their lives where they feel that there is no hope left. They dont want death but they want a release from their pain. But even when someone leaves a note for their loved ones explaining why they are doing what theyre doing it often doesnt bring them much comfort, although it may be better than having no note at all.
  47. 47. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 47 Relatives and friends feel a sense of guilt and anger at the suicide but also a sense of shame too (there is still a stigma to suicide). Healing after a loved ones suicide is complicated - before working through the grief you have to first work through the guilt. You have to be able to understand that you werent responsible for them taking their life. Only then will you be able to forgive them and yourself.
  48. 48. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 48 ALZHEIMERS DISEASE Often here the grief doesnt begin when someone dies but when they are diagnosed with this condition. Many people feel that they lose their loved one piece by piece. Losing someone is always difficult but seeing them lose their personality whilst remaining physically well can be even worse. Some people call Alzheimers the long goodbye. For others it is death in slow motion. For many loved ones what they feel most of all when the sufferer has gone is a sense of relief that this suffering is over, although relief can also, of course, produce feelings of guilt too.
  49. 49. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 49 SUDDEN DEATH This gives loved ones no time to prepare and when the person is gone their overwhelming initial sense will be of unreality they just cant believe that the person they love is gone so suddenly. They will need time to come to terms with this shock before they can begin the normal grieving process. Very often too sudden death means we dont have time to say goodbye to someone and the pain of losing them is intensified by losing them in the midst of life.
  50. 50. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 50 HELPING CHILDREN COPE WITH A DEATH Children react differently than adults in these circumstances. Their response will depend on: 1. What type of relationship they had with the person who has died. Death of a Mother for example, will be much harder than the death of an Uncle. 2. Age and level of understanding for infants they may feel the loss in terms of how it affects their day to day routine. Pre-school children usually see death as temporary and reversible. Older children have realised that death involves a permanent separation. Sometimes children may feel that they caused the death e.g. by being naughty. They will show their feelings about the loss usually in terms of their behaviour or presentation.
  51. 51. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 51 Death & Children 3. Circumstances of the death a traumatic death may be hardest of all for children to cope with sudden death will also be very hard for children.
  52. 52. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 52 HELPING A CHILD COPE A lot of adults try to shield children from what has happened by withholding information from them. But research tells us that children benefit from knowing what has happened as soon as possible. Children also need to be listened to and have their questions answered.
  53. 53. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) 53 Sometimes a child many not be able to clearly recall their loved ones face and this can be very distressing for them. A photograph may be a source of comfort here. Most of all they need to be given a way of saying goodbye if for example theyre considered too young to attend the funeral they might be able to say a prayer for the person theyve lost. As time goes on theyll need permission from the adults around them to show their feelings in whatever way helps (anger, sadness etc)
  54. 54. Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 54 WARNING SIGNS (Risk Indicators: 1) An extended period of depression in a child may be a warning sign that all isnt well following a bereavement. Inability to sleep, loss of appetite Acting like a much younger child for long periods Denying that the person has died Imitating the dead person excessively
  55. 55. Warning signs (Risk Indicators: 2) Repeatedly stating that they want to join the dead person Withdrawal from friends Drop in school performance Course Author: Malcolm Woods (Masters in Social Work) Slides design and TSDS reference links by: Astell Evans (2008, updated 2016) www.emptlondon.com 55