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Grief Perspectives
Research that Matters
Professional Bookshelf

Preparing Grieving People

for the Holidays


William G. Hoy

As the air turns crisp in autumn, we inevitably begin to think toward the holidays coming at the end of the year. In my experience with bereaved people, the weeks between Thanksgiving and New Year’s Day pose the most challenging period for most people during the first year or two of bereavement. Wise counselors and group leaders look for ways to get bereaved clients ready for the almost certain difficulty that accompanies Christmas and the other end-of-year holidays.
Here are some ways I have found helpful as the year ends.

Inquire about holiday plans early.
Simply asking about holiday plans in the early fall helps signal bereaved people that it is okay to feel a sense of sadness or dread as the season approaches. Remember that many bereaved individuals are receiving clear messages from family members to “move on,” and your questions create a climate where grief is acceptable, even during the time of year when social expectations are to be happy. Early in the fall, I try to ask groups and individuals with whom I am working, “Most grieving people dread some part of the approaching holidays; what concerns you the most?” Fruitful conversations in groups and with individuals also grow out of questions like, “How do you think the holidays will be most different for you this year?”
 
Encourage plans that include both self and others. Early in my career, I counseled grieving people to “Do as much celebrating as you like…and no more.” Through the years, I have adapted that approach, realizing it creates more stress for some grieving people than it alleviates. Following that advice may actually damage relationships. Many of our clients are part of families where some level of holiday observance is expected and necessary. I have never found the practice of total withdrawal to be adaptive. Instead, we must coach group members and individual clients to anticipate the events of which they are expected to be a part. Some of these may be obligatory family gatherings where absence causes more stress than presence, and many clients are better off at least participating minimally.
 
Instead of saying to the extended family, “I’m not coming to the family Christmas Eve dinner this year,” many clients will find it more useful to say to the hostess, “You know, my energy level just hasn’t returned to the level it was before Bob died and the experts all say that is normal. Will it hurt your feelings if I come but feel the need to leave before the evening is over?” This acknowledges the tradition and the family expectations while setting appropriate boundaries around the bereaved person’s own needs.
 
Talk about expected pitfalls. Ask clients and group members, “What do you expect to be the hardest part of the holidays this year?” Especially in support groups, talking about a few of these and devising plans together for managing the pitfalls actually helps everyone adapt better. In both individual and group work, you will want to do some grief education in the period leading up to the holidays. Talk about trigger points and the unexpected waves of sadness some people feel at hearing a favorite song, seeing the shopping mall transformed into a holiday wonderland, and smelling a favorite holiday food cooking. I try to remind bereaved people that we are sensory beings and our senses are bombarded during the holidays, contributing to the difficulty of this period. The sights, sounds and smells that used to bring such joy now harbor incredible sadness, but talking about those possibilities in advance and making a plan to address them can be a huge help in handling the holidays.
 
Assess spiritual support as holidays approach. The winter holidays of Hanukkah and Christmas are rooted in religious belief and practice, so it makes sense to address the role faith and spiritual support might play in the holiday season. Reflecting together on the ways the client makes spiritual meaning of the holidays is important. Sometimes, this discussion leads to new discoveries of support afforded by beliefs and community; sometimes, the discussion exhumes old spiritual hurts that create roadblocks in the grieving person’s experience.
 
The widow of one minister seemed particularly troubled by the approaching holidays even five years after her husband’s death; she sought counsel because the ongoing difficulty with the holidays perplexed her. As she and her counselor talked, she shared the difficulty she had with “sharing” her husband with the congregation all of those years. She had grown up in a family where extended family was always together from Christmas Eve afternoon until the evening of Christmas Day. Because their congregation held several church services on Christmas Eve and another on Christmas morning, her husband was only home to sleep from early Christmas Eve morning until nearly noon on Christmas Day. He had died at an early age with school-aged children and his widow felt the church had robbed her and them of those experiences she had so treasured from her own childhood.
 
Affirm the importance of physical fitness. Few things are more important for bereaved people in the early months of loss—and especially during holidays—than getting adequate rest, exercise, and nutrition. The stresses of bereavement make these both vitally important and easily overlooked. In both groups and individual counseling, I inquire of clients early and often about how they are eating and sleeping. While insomnia can be indicative of clinical depression, bereavement-related insomnia is often the body’s simple response to lack of time for cognitive and emotional processing during the waking hours. The bereaved person who tries to “stay busy so I don’t think about it” seems especially prone to this night waking. The heart and mind are not so easily fooled.
 
I ask about how sleeping and eating habits have “most changed” since the loss and I watch for signs of weight changes (tight- or loose-fitting clothing is a possible indicator). Of course, clients will usually point these changes out anyway. Nutritional suggestions such as increasing fresh vegetable intake, reducing salt and paying close attention to sugar, alcohol and caffeine intake may help clients begin paying closer attention to these factors but a consultation with the client’s own healthcare provider is also important.
 
When possible, I think it is necessary to counsel clients about normal bereavement “symptoms” before they visit the doctor. I explain the apparent preference some providers have for dispensing antidepressant and sleeping medication with little provocation and no clinical evidence of true depression. These are rarely warranted and generally carry significant and often distressing side effects. We have a rather elaborate clinical decision-making matrix to diagnose clinical depression and while many of these symptoms are mimicked in bereavement, it is rare to find a bereaved person who truly meets the criteria
 
Of course the good news is that bereaved people who do receive antidepressant therapy from their primary care provider have better overall outcomes when they also receive good psychosocial support including counseling and mental health follow-up (O’Connor, Whitlock, Bell & Gavnes, 2009, p. 801).


References:
O’Connor, E.A., Whitlock, E.P., Bell, T.L., & Gavnes, B.N. (2009). Screening for Depression in Adult Patients in Primary Care Settings: A Systematic Evidence Review. Annals of Internal Medicine, 151, 793-803.

Author:
William G. (Bill) Hoy is an educator, counselor and author who has specialized in end-of-life and bereavement care for more than 25 years. Dr. Hoy’s passion is equipping the next generation of physicians and other healthcare professionals through his research, writing and teaching responsibilities on the Medical Humanities at Baylor University. His newest book is Do Funerals Matter? The Purposes and Practices of Death Rituals in Global Perspective (Routledge, 2013).

Dyregrov, K., Dyregrov, A. & Johnsen, I. (2013). Participants’ Recommendations for the Ideal Grief Group: A Qualitative Study. Omega: Journal of Death & Dying, 67 (4), 363-377.
 
This unique study lends an important scientific basis to the value derived by bereaved people from the support groups in which they participate. The pool of interview subjects included 4 men and 17 women, all of whom had suffered the death of a loved one in the previous seven months to 14 years. After interviewing, the research subjects, the researchers used a qualitative method to analyze the interview data. The method was “designed to condense expressed opinions in order to find (a) basic units of meaning, (b) categories, and (c) themes in relation to the issues under investigation. After specifying the main themes, the analyzed material was (d) interpreted in relation to the issues under investigation, relevant theory, and previous research” (p. 367).
 
What Dyregrov, Dyregrov and Johnsen found is not particularly surprising. Besides hopes that groups would have been better advertised, and therefore, easier to find, informants indicated they wanted communication about their group’s structure and purpose as well as some information about the background training and experience of the group leader.
 
Contrary to common practice in many groups, attendees showed a marked preference for homogeneous groups (similar loss, similar age cohort, etc.) with attendees feeling this homogeneity helped develop group cohesion. Furthermore, participants indicated that they embraced “semi-structured” content that was customized for the group. This likely means that group leaders should arrive prepared with an agenda that is customized, probably during the group meeting itself, to the group participants’ expressed needs.
 
This journal article is available for free download for members of the Association for Death Education &  Counseling at www.adec.org.


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Weymouth, K.F. (2013). What Obituaries Don’t Tell You: Conversations About Life and Death. Bloomington, IN: Balboa Press.
 
Kathryn Weymouth was a young physician when she got her “wake up call” about the importance of talking with patients about dying. After days of avoiding the discussion, she finally entered the room of the young man about her age at the bidding of his wife, only to find him in a grand mal seizure. Though he lived another two weeks, he never regained consciousness and the opportunity was lost forever for a caring dialogue about living and dying between patient, family and healthcare professional. She meaningfully writes, “I took a very long path to understanding how death affects the living. I finally became more fully aware of how important it was to know the whole story in which death is embedded in order to be the compassionate guide who can journey with the companions of persons dying and recently dead. It is possible, and ought to be imperative, to educate every healthcare professional about the extended effects of death upon those who grieve for the dead” (p. xvii).
 
The unique contribution of this book is its collection of 35 first-person stories told from the viewpoint of those whose loved ones have died. In poignant terms, they describe the ways these deaths have had a profound, life-altering impact on them. We often talk about the normalcy of grief and it is true that the vast majority of bereaved people move adaptively through the experiences of loss in a couple of years or less. However, for virtually all, life is altered. And for some, life is altered in earth-shattering ways. This book is an excellent reminder of just how much work we have to do in adequately supporting bereaved people by fully em


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