Talk to Yourself Like You Would to Someone You Love

Self compassionate people handle difficult life events (like major illness or grief) really well.  Here's a brief summary of  a comprehensive study on self-compassion and why you would likely benefit from more of it:

  • Are you having trouble engaging with an experience of grief? Self-compassion can help you effectively face the reality of your internal experience.
  • Grievers often wrestle with conflicts around responsibility, blame, and regret that lead to feeling guilty.  Self-compassion is an effective tool for managing this.
  • Are you low on self-compassion?  If so, you're likely being unnecessarily hard on yourself, viewing your behavior as worse than it would be viewed by an outside observer. 
  • Are you afraid that the worst is yet to come? Practicing self-compassion now will prepare you to more effectively handle future difficulty.

Do you want to feel better by learning how to be more self-compassionate?  Give me a call at 720-515-9427 and let's schedule a meeting.

Birds & Bees

"While it’s hard to explain to kids how babies come into the world, it might be harder to explain that people leave the world too."  Want to learn more about helping children in your life grieve?  Listen to a thought-provoking and informative This American Life's podcast.

Want to learn about a great resource for grieving kids in Colorado?  Watch this local news story about last year's Camp Erin. They are already taking applications for new campers for this upcoming summer's camp (August 18th-20th).  You can also get involved in fundraising for this free camp.

What is “healthy” grief?

When it comes to mental health there are few hard and fast rules, and grief is no different. Between differing genetics and life experience, no two people are exactly alike, and so we each grieve in a unique way. This may be a difficult idea to digest – after all, humans are literally wired to categorize (“good” & “bad,” “safe” & “unsafe”) and we tend to bring this same heuristic to grief (“healthy” & “unhealthy,” “over it” vs. “still affected”). I encourage you, though, to take a less heavy-handed view. An individual’s history (their genetics and life experience) determines how grief occurs, not some pre-determined list of “should’s.”

So rather than prescriptions, I will share what I have found to be some useful ideas about grief. First are two ideas that I’ve already written about: the stages of grief is largely myth and the risk-factors that increase the chance someone will have a complicated course of grief. The two I will write about here focus on grief over time.

Main

The first is William Worden’s “Four Tasks of Mourning.” Like the stages, these are not linear steps.  Instead, they are abstract processes. When talking with someone about their experience of grief I might be wondering: How much time and attention have they given each of these steps? How much are each of these tasks sources of distress, or sources of comfort, for them? The four tasks are:

  • To Accept the Reality of the Loss
  • To Work Through the Pain of Grief
  • To Adjust to an Environment in Which the Deceased is Missing
  • To Find an Enduring Connection With the Deceased While Embarking on a New Life

The second idea is Margaret Stroebe and Hank Schut’s “Dual Process Model.” While the content may look familiar, unlike the previous two, this model has no list of stages. Instead, it highlights two types of activities:

  •  Loss – activities that are directly related to grief. These may include thinking about the person who has died and/or experiencing a range of emotions
  •  Restoration – activities that represent adapting to the loss. These may include developing new activities that the loss requires (i.e. finding companionship in others, if the deceased was the primary companion).

The “Dual Process Model” posits that in “healthy” grief, people oscillate back and forth between “loss” and “restoration” activities. That is, in the morning someone may be crying in bed (loss) while later that afternoon that same person may be applying for a new job (restoration). The time period surrounding the oscillation (i.e. loss to restoration in one day in this example) varies by person and circumstances, but the general idea is that the more flexibly someone can oscillate between loss and restoration throughout their daily life, the better they will feel.

With all that said, “completing” the Four Tasks of Mourning or “becoming flexible” at shifting between loss and restoration activities does not necessarily mean “healthy” grief. It may, but in my experience, individual factors are just as (if not more) important than any of these ideas.

Interested in learning more about the possible benefits of individualized grief counseling? Give me a call at 720-515-9427.

Poetry

Two inspiring poems on looking at the end of life.  Mary Oliver writes:


When Death Comes

When death comes
like the hungry bear in autumn;
when death comes and takes all the bright coins from his purse

to buy me, and snaps the purse shut;
when death comes
like the measle-pox

when death comes
like an iceberg between the shoulder blades,

I want to step through the door full of curiosity, wondering:
what is it going to be like, that cottage of darkness?

And therefore I look upon everything
as a brotherhood and a sisterhood,
and I look upon time as no more than an idea,
and I consider eternity as another possibility,

and I think of each life as a flower, as common
as a field daisy, and as singular,

and each name a comfortable music in the mouth,
tending, as all music does, toward silence,

and each body a lion of courage, and something
precious to the earth.

When it’s over, I want to say all my life
I was a bride married to amazement.
I was the bridegroom, taking the world into my arms.

When it’s over, I don’t want to wonder
if I have made of my life something particular, and real.

I don’t want to find myself sighing and frightened,
or full of argument.

I don’t want to end up simply having visited this world


The Fourth Sign of the Zodiac

Why should I have been surprised?
Hunters walk the forest
without a sound.
The hunter, strapped to his rifle,
the fox on his feet of silk,
the serpent on his empire of muscles—
all move in a stillness,
hungry, careful, intent.
Just as the cancer
entered the forest of my body,
without a sound.

The question is,
what will it be like
after the last day?
Will I float
into the sky
or will I fray
within the earth or a river—
remembering nothing?
How desperate I would be
if I couldn't remember
the sun rising, if I couldn't
remember trees, rivers; if I couldn't
even remember, beloved,
your beloved name.

I know, you never intended to be in this world.
But you're in it all the same.

so why not get started immediately.

I mean, belonging to it.
There is so much to admire, to weep over.

And to write music or poems about.

Bless the feet that take you to and fro.
Bless the eyes and the listening ears.
Bless the tongue, the marvel of taste.
Bless touching.

You could live a hundred years, it's happened.
Or not.
I am speaking from the fortunate platform
of many years,
none of which, I think, I ever wasted.
Do you need a prod?
Do you need a little darkness to get you going?
Let me be urgent as a knife, then,
and remind you of Keats,
so single of purpose and thinking, for a while,
he had a lifetime.

Late yesterday afternoon, in the heat,
all the fragile blue flowers in bloom
in the shrubs in the yard next door had
tumbled from the shrubs and lay
wrinkled and fading in the grass. But
this morning the shrubs were full of
the blue flowers again. There wasn't
a single one on the grass. How, I
wondered, did they roll back up to
the branches, that fiercely wanting,
as we all do, just a little more of
life?

Community Partners

Elevated Insights Assessment provides psychological evaluation services in Denver, Colorado. They offer insight into your child’s ability to function across settings, highlighting attributes to promote while identifying areas of concern that may require intervention.  They provide Cognitive/IQ, Academic/Achievement, ADHD, Memory/Learning, Autism Spectrum, Social Emotional/Behavioral, and Child Welfare Testing.  Learn more by calling 303-756-1197 or visiting http://www.elevatedinsights.org/

Sasha Mizrahi, Psy.D. is a psychologist in private practice in Denver, CO. She specializes in treating individuals and couples struggling with depression, anxiety, and relationship issues. Learn more at http://www.denvertherapyservices.com

Alex McDermott, Psy.D. is a psychologist in private practice in Denver, CO.  She specializes in psychological testing for children and teenagers for learning disabilities, ADHD, personality, and IQ testing.  She also provides individual psychotherapy.  Learn more by calling 720-485-4194 or visiting http://www.denvertherapyassessment.com/

Grief Counseling Effectiveness Depends On Your Interest

A quick Google search might indicate that grief counseling is not very effective. This well publicized idea, though, is incomplete and harmful.

The caution against grief counseling is a benevolent one.  It is based in the well-established finding that many people don’t need professional help to effectively work through their grief.  However, this warning stigmatizes the minority (which, mind you, is still a large number of people!) who do in fact need help.  Let me explain:

Grief

  •  10-20% of people who experience a death loss develop what’s called complicated grief. All of the same research that cautions against grief counseling explicitly recommends grief counseling for people with complicated grief.  I would go one step further and recommend grief counseling to a person at risk for complicated grief.  You can read more about complicated grief here.
  • Most studies actively recruit their participants. This method distorts findings because research includes many people who never would have sought grief counseling on their own. This contrasts with my experience: nearly every client I work with has sought me out. It turns out this is a key difference! A less well publicized review found that grief counseling is effective for people who self-select to receive treatment (Effectiveness of Grief Therapy: A Meta-Analaysis, Allumbaugh & Hoyt, 1999).  So if you’re considering grief counseling, your mere interest will improve its ability to help you.

I could say much more about research on the effectiveness of grief counseling, but to be brief I will stop here.  Grief is ultimately an individual process, and a difficult one (like most psychological phenomena) to understand. If you’d like to talk through whether grief counseling would help you, give me a call at 720-515-9427.

Do Unemotional Grievers Need Counseling?

Some people appear unaffected by grief. Their life quickly returns to normal and they don’t seem to be upset following a death. Many well-meaning people, including therapists, might interpret this as repressed grief. These caring people fear that there will be a significant cost (substance abuse, withdrawal from others, disconnection from themselves, etc.) to avoiding emotions. Many times there can be, but sometimes this concern is misguided. Consider a few more factors before you tell a seemingly unaffected person to seek out grief counseling:

Site Image 3

  • How did they adapt to past losses? Past behavior is one of the best predictors of future behavior. If they previously experienced a major death or loss of relationship, consider how that went. If well, they will likely benefit from following the same steps (i.e. exercising regularly, talking about it vs. not talking about it, etc.). If it went poorly, they will likely benefit from trying something new like counseling.
  • How emotionally expressive are they normally? People who are typically unemotional will likely continue to appear unemotional, even in the face of catastrophe. Sometimes appearing unemotional is, and has always been, a maladaptive coping mechanism for a sensitive person who has never learned how to communicate their feelings (this person is likely to benefit from counseling). But don’t forget to imagine that it might just be their normal, well-adjusted temperament to be unemotional.  It does not have to be an indication that something is wrong.
  • Do they want to go to grief counseling? This question isn’t always so obvious. Have you asked? Can you respect their autonomy if the answer is no? Careful: forcing or guilt-tripping someone into counseling can actually make them get worse. Can you be patient if they don’t want to talk about it? How about providing some education about the impact of complicated grief (see my other post) if they aren’t sure?

Want some expert help assessing whether you, or someone you care about, would benefit from grief counseling? Give me a call at 720-515-9427 and let’s sort it out.

The Stages of Grief Myth

Pop psychology can be harmful.  The way most of us understand the “five stages of grief” (denial, anger, bargaining, depression, & acceptance) is a great example. A few cautions:

  • Elizabeth Kubler-Ross, who developed it, was not studying the experience of grieving loved ones but rather the experience of dying people themselves. Therefore, it’s relevance to grieving family members and caregivers is, at best, limited.
  • She repeatedly stated that people might not go through all the stages and that they are not linear (i.e. one stage does not neatly follow the next).
  • The stages may be most useful as a list of common grief experiences. Recent research replaced bargaining with yearning (intense longing to reconnect with the dead person) and found yearning to be the most dominant negative grief experience many people have.  This list, though, is anything but complete.  Grieving people experience a wide range of physical, cognitive, and emotional consequences.

Grief


At the end of her own life, Kubler-Ross summarized the myths born out of her model.  She wrote:

“The stages have evolved since their introduction, and they have been very misunderstood over the past three decades. They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grief is as individual as our lives.”

When Facing Death, Words Can Do a Lot.

In this podcast, Dr. Ira Byock highlights the importance of healing old relational wounds.  I am excited to share this because many of the people I see for grief counseling would be in far less pain today had they had the opportunity to have these sorts of conversations with their loved ones.  While still very possible, it's much harder to reconcile old wounds when the other person is no longer here.  Should you have the opportunity now, consider your future grief and don't wait.

Grief

Dr. Byock advises four statements that can guide these conversations.  I think they can also be a useful way of understanding about what grieving people need to reconcile before they can move forward following a death.

  • Please forgive me
  • I forgive you
  • Thank you
  • I love you

Listen to this fantastic podcast, or give me a call 720-515-9427 if you would like help mending or clarifying your relationships before you or a loved one dies.

Can Hospice Care Actually Lengthen Life?

The typical debate about hospice care vs. aggressive medical treatment is one of quality vs. quantity.  Hospice care emphasizes symptom management and emotional support, ideally leading patients and families to have a higher quality of life.  Aggressive medical treatment emphasizes curing or stalling an illness, ideally leading patients and families to have more quantity of life.  Research shows, though, that's not always the case.

Site Image 2

This preliminary study examined these ideas and found that hospice was not associated with shorter survival.  In fact, for some illnesses (CHF, lung cancer, and pancreatic cancer) hospice enrollment was actually associated with longer survival. Perhaps the conventional wisdom associating hospice with quality while aggressive treatment is associated with quantity is too limited of a view?  There may be cases where hospice care can increase both the quality and quantity of a patients life.

Furthermore, this (false?) dichotomy between quality or quantity at the end of life disregards a little known, and important, third option I will write about at another time: palliative care.