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Space and Presence

I hear many stories of traumatic loss and profound sadness, often so deep that nothing I say could make any real difference.  It’s a challenge not to take it on and try somehow to help fix or make it better for them.

I’ve come to understand that the best I can do is to simply offer a safe nonjudgmental space that can bear witness to their pain.  To be a caring presence offering unconditional acceptance of their person and sorrow, exactly where they are without trying to fix or change it.

Many tell me how hard it is when people try to give answers, telling them how to grieve; or how disconnected and awkward they feel when others simply turn away from their pain, changing the subject to something more cheerful so they won’t hurt so much.  To tolerate that much pain with them is a real gift we can offer at such a difficult time.

That awareness has been so freeing for me. Not only that I don’t do anything to fix, but in leaving space there’s room for movement, their grief shifts and there’s room for something new to be created. Space leaves room for the sacred and divine rather than my agenda, my solutions. 

It’s always a risk for me to trust that creative process, but at a very real level it’s letting them know I trust in their ability to heal and find their own way. In that space of safety and care, sadness becomes more bearable, often shifting to something transformative.  Bearing witness to that transformation is energizing and restorative for them as well as for me. 

In groups, my job is to ensure a safe space, a container to hold the pain.  They find strength in being together, realizing that they are not alone and that their crazy-making symptoms of grief don’t necessarily make them crazy. That in itself lowers anxiety.  Groups are a safe space to honor their grief, to honor their loved one, to pause and honor this life-defining time in their lives. 

I often remind the group not to take anyone else’s grief home.  That yes, we share and bear one another’s grief, but that each of us must ultimately carry our own load, and take responsibility for our own healing. 

And so it is for me, as facilitator, and for us as caregivers; we don’t take anyone else’s grief home; we are simply companions, offering support and courage because it’s their work to do, not ours.   

As they work and space is given, I watch and bear witness to their story changing.  I often ask them what’s hard or what’s changing for them.

One gal came to Parent Group one evening.  Noticing she had a lighter expression than the deep sadness she usually carried, I wondered if anyone had sensed a shift.   

She shared how her sister had insisted she come visit her across the world.  She had no energy or motivation as she described herself “being only in her own tunnel” of profound sadness that she could see no way out of since the traumatic loss of her son. 

At her sister’s insistence, she took the trip across the world to a completely different space. 

Her sister had booked a river cruise where she found herself out in the middle of an open sky, a beautiful river, and a place of extreme beauty in nature.  

For the first time since her son’s death, she had a sense of his presence, stirring within her a deep and profound peace that he was OK and that somehow, he was with her.  

She sensed a shift deep inside of her like she could go on and live.  She heard an inaudible voice say that she can “accept what’s good in life,” and she knew this was good.  

Since that experience, she is allowing herself to live outside of her “tunnel of grief.”  Feeling lighter inside, her mantra waking up each day is now, “Accept the good that comes to you today.”

It’s stories like this that sustain and nurture me in my work and give me the wherewithal to continue simply offering “space and presence.”

 

Written by:
Celeste Miller, MA, LPC, Porter Loring Bereavement Coordinator

 

Counting Your Losses

In our culture and community, when someone experiences the death of a loved one, we reach out offering consolation, care, and support. We grieve because we form attachments and connections with one another. We are therefore naturally “wired” to feel a sense of connection and loss.

The word bereavement comes from a Latin derivative which means “to be robbed.” The term “robbed” creates a strong emotional reaction suggesting that grieving isn’t something we do willingly or easily. 

The grief journey is an adjustment period. It involves the painful work of mind, body, emotions, and spirit. That is why we refer to it as “grief work”.

From the time that we were born, we are constantly experiencing losses. Some of them are so subtle they go unnoticed. Others are so overwhelming they seem unbearable. 

Grief losses are often associated with a terminal illness, death of a family member, friend, or colleague. These finite losses are devastating and overwhelming.  

Notwithstanding, there are non-finite losses that are also demanding and challenging.  

Struggling with infertility, leaving or losing a job, and facing the decline of a loved one’s physical or cognitive ability are such losses. And like other grief reactions, processing them is essential if healing is to materialize.

Unlike a death loss, there is no funeral to acknowledge and honor these losses—no grave to visit, no covered dishes dropped at the door, no sitting in the company of fellow mourners and supporting each other through the tears. 

Because people so often feel out of sync with the world around them, these “hidden sorrows” are difficult for individuals to share. Those who are struggling aren’t sure others will understand or want to hear their story. When this happens, individuals can be disenfranchised in their grief. So, they tend to push pain and loss downward rather than allowing it come up and out.    

Normal grief has a dignity that allows the griever the freedom to experience and express emotions and feel accepted and understood by others. As healthcare givers, we can help others by normalizing their grief and finding ways for them to embrace their pain and surrender to the process of grief. 

As bereavement companions, we can not only support others as they “count their losses,” but also help them live with integrity and perhaps even empower them to convert their losses to gains.

Every person, every place, every project, and every possession we love we will lose, someday, at least in a physical sense. How we adapt in these innumerable losses shape who we will become.”                                

“Counting Our Losses”, Darcy L. Harris 

 

Submitted by Darwin L. Huartson, M.Div. BCC, Porter Loring Community Coordinator

Why Aren’t You Crying? Understanding Grieving Styles

Grief comes when we experience separation from someone or something we love or have an emotional connection to.

While we most often think of grief as related to death, the pain of grief is also experienced in life circumstances such as divorce, a miscarriage, the loss of a job, or the loss of place that we call home. The grief symptoms we experience related to these types of losses is normal, natural, and necessary—without them, we would not heal. Finding a way to process these responses is crucial if we are going to adjust and adapt to life’s challenges. When it comes to resolving issues, there is no “one size fits all.” Some of us like to “talk” it out and others like to “work” it out. We all have our own, unique ways of dealing with life situations, including grief.

Grief specialist Dr. Ken Doka and psychiatrist Dr. Terry Martin have contributed much to our bereavement culture. Some years ago, at an ADEC conference (Association for Death Education and Counseling) presentation, they challenged the stereotype that men and women grieve differently.  They proposed that styles of grief are influenced, not determined by gender. In their book, “Grieving Beyond Gender: Understanding the Ways Men and Women Mourn,” Doka and Martin suggest that there are many ways people grieve but propose there is a continuum of grief with two different patterns on either end.

On one end is the intuitive grievers—individuals who are more apt to be emotive and affective in displaying their grief. They are usually more expressive and would be more likely to seek out people to talk to about their loss. At the other end of the continuum is the instrumental grievers.  These grievers are more likely to be cognitive and/or physical in their approach and tend to be more “action” or “thought” centered. They can be easily misunderstood and sometimes labeled as “just not dealing with their grief,” which is not necessarily the case. Intuitive and instrumental grieving are two extreme styles located on a continuum. Because of this, it is rare to find people who belong purely to one style of a grieving pattern.

The middle area between extreme intuitive and extreme instrumental grieving is called blended grieving. Those who exhibit qualities of both the intuitive and the instrumental style are identified as blended grievers. Through blended grieving, a person naturally expresses in both cognitive (instrumental) and affective (intuitive) ways; however, one style of grief is usually more dominant than the other.

The most significant contribution that Doka and Martin give is permission to grieve in a way that is meaningful and helpful for each individual.

The uniqueness of grieving styles can be seen in the following examples:

A middle-aged gentleman states, “My daughter doesn’t understand why I don’t want to talk about my wife. I feel closer to her when I am outside working in the yard.”

A bereaved father shares that his wife finds comfort in making regular trips to their son’s gravesite; However, he finds it helpful to attend a support group with other parents who have experienced the loss of a son.

A woman comes to a bereavement support group and is upset with herself. Perplexed and concerned she says, “Everybody else cries. What is wrong with me?”

The question, “What is wrong with me?” captures the notion of what people experience when they don’t feel they fit the mold of grief others may be experiencing or what they think others expect of them.

Understanding the continuum of grief helps us recognize that when we are connecting with someone, we can listen for what is helpful for them. In the first scenario, the middle-aged gentleman is revealing that he wants to do something about his grief other than talk about it.  The second situation exposes that the husband and wife find two different ways to remember and honor their son. The third situation describes someone who feels bad she can’t be more emotive. Giving her permission to not cry might open up the door to find what will bring her healing and wholeness.    

Is your grieving style more intuitive or instrumental? Many of us, no doubt, will find a blend of the two ends of the continuum in ourselves.  Remember, what helps YOU process and experience healing is the best style for you.

Submitted by Darwin L. Huartson, M.Div. BCC, Porter Loring Community Coordinator

Resilience in Aging

A few years ago, I was invited to give the annual Lehman Lecture in Medical Ethics at Allegheny College in Meadville, Pennsylvania. Allegheny is a small liberal arts college dedicated to providing its undergraduates with a well-rounded education, one that encourages interdisciplinary study and community service.

It just so happened that the evening before I flew out of San Antonio on my way east, I attended a lecture at Trinity University given by Former President George H. W. Bush.  His talk was titled, “Life After The Presidency,” and one of the key moments of his speech for me was when he made reference to his skydiving avocation, begun in his eighth decade of life. Even older now, he continues to jump out of airplanes. “People ask me why I do it,” he said. “I tell them there are many reasons but one of the more important ones is that I want to demonstrate that old people can still do things!” 

My visit to Allegheny coincided with “Senior Day”-an annual event sponsored by the college for the benefit of the senior citizens of their community. I had been asked to address this gathering as well and what a special privilege this was for me. I had the pleasure to observe firsthand a working model of seniors being valued in their community. 

Here they were: hundreds of folks, the husbands and wives arm and arm for mutual support, the widows and widowers, some with canes or walkers, others in wheelchairs.  In the foyer of the auditorium, bright young students with smiles on their faces served them coffee. I watched as the seniors made their way down the aisles, laughing and talking with each other, the youngsters among them. 

They were being feted for their age and their wisdom. They were being honored not because they are like the celebrities pictured on the glossy cover of the AARP magazine each month. Not because they were “beautiful seniors” all done up and plasticized. They were being celebrated for just who they are –our parents, our grandparents, our mentors. And this day—Senior Day –was a tribute to their ongoing commitment to their families and to their community.

I told them what President Bush said about why he jumps out of airplanes with a parachute strapped to his back now that he is an octogenarian. And I had many more stories to tell about my own patients: the 75-year-old woman who continues to care for foster children; the 88-year-old man who organizes senior education classes in a program now with over 500 enrollees; the 76-year-old grandmother who hasn’t missed her weekly turn at her church’s soup kitchen in 15 years; the woman who at age 81 turned her sun porch into a studio and whose paintings sell all over the South.

I can go on and on: seniors who have gone into politics, who care for their grandchildren full time in the absence of parents, who have written moving memoirs of their life experiences, who attend writing workshops and poetry readings, who give generously of their time and money to community events and non-profit organizations.

The word gerontologists use to describe these folks is “resilient.” In recent years, the study of resilience in aging has come into its own. A recent book (to which I have made a contribution)—”Resilience in Aging: Concepts, Research, Outcomes,” edited by Resnick, B., et al—defines resilience as “a dynamic process of maintaining positive adaptation and effective coping strategies in the face of adversity…or challenge, whether it be physical, psychological, economic, political, environmental, or social.”

Whether or not resilience is process or character trait—or both—is still being studied, but, in the main, resilient individuals are self-confident and know their own strengths and limitations. Five themes arise when interviewing resilient individuals:

–Equanimity: maintaining a balanced perspective on life.

–Perseverance: continuing to strive and cope in spite of adversity.

–Self-Reliance: belief in one’s abilities.

–Existential Aloneness: reveling in one’s own uniqueness and the belief in the continuity of the self across time.

–Spirituality/Meaningfulness: enabling the individual to draw conclusions as to why events occur and embrace the need for change, flexibility and growth.

One application of the scientific literature may be to identify interventions such as life review or reminiscence—or other creative processes such as art and music and dance—that tap into resilience, and thus might stimulate or enhance it in order to facilitate successful aging. What I witnessed on Senior Day at Allegheny College was a wonderful example of this.

At the end of my talk, twenty or more Allegheny College students stood up at the front of the auditorium holding signs. “Come with me if you want to attend a class on Romantic Poetry,” said one. Another read, “Come learn about Molecular Biology.”  Another, “Learn more about Bioethics.” The choices were many, rich, and varied. The folks in attendance were thrilled as they talked excitedly among themselves to decide where to go, whom to follow. I wanted to stay, to learn, to be a part of this vibrant community. But my trip was over.

What a different place America would be if every small town, every city throughout this land had a Senior Day like the one I was privileged to be a part of in Meadville, Pennsylvania. Perhaps this is something all of us—citizens, businessmen, medical professionals, politicians and educators—can strive to facilitate.

 

Written by: Jerald Winakur, MD, F.A.C.P., C.M.D

JERALD WINAKUR, M.D., F.A.C.P., C.M.D. practiced internal and geriatric medicine for 36 years  and is a Clinical Professor of Medicine and an Associate Faculty member at the Center for Medical Humanities and Ethics at the University of Texas Health Science Center at San Antonio. He speaks and lectures on ethical caregiving in aging America. His book, “Memory Lessons: A Doctor’s Story,” is about the trials and joys of caring for his father with Alzheimer’s disease.

 

Doing Something For the Soul: Compassion Fatigue

Lyndon Johnson was fond of telling a story about a job applicant for switchman on a railroad. Asked, “What would you do if you saw a train coming from the west at 60 miles an hour?” answered, “I would switch that train to the eastbound track.” “Well, what would you do if you saw a train coming from the east at 60 miles per hour?” He answered logically, “I would switch that train to the westbound track.”

The interviewer heightened the situation. “What would you do if you saw an eastbound train coming at 60 mph and a westbound train at 60 mph? Could you handle that pressure? What would you do?”

“I would run and get my brother.”

“What! Why would you do that?” the interviewer sputtered.

“Because my brother ain’t never seen a train wreck before!”

The field of compassionate caring is littered with “train wrecks.” Good people who have experienced, seen, heard “too much.” Some are quick to explain, “I love working with the clients but…it’s the paperwork, the office bureaucracy, the regulations, the turf battles that undermine my compassion.”

Many in death, dying and bereavement have heard, “Oh, I could never do what you do!” What gets subtly communicated is that I must have some “gift” or “specialness” that undergirds my work with the bereaving. Unfortunately, this notion can lead to an assumption, “Well, I am gifted!” which can cause me to ignore critical warning signals. Given how electronic automobile dashboards are these days, a particular warning can be threatening or challenge my priorities for the day. So, I may just ignore a warning signal to get on down the road.

Compassion wornness is epidemic throughout the community of care giving. One too many yeses leads to an ambush, “I cannot do this anymore.” Suddenly, working in some big box store seems appealing. Indeed, in some caring organizations, more and more work—particularly paperwork and documentation—is spiritually and emotionally draining and threatens our effectiveness and our personal relationships. The ubiquitous cell phone and other electronic “machines” which are, admittedly, so helpful can become intrusive and oppressive. Many working in the field of compassionate care have no “off” button. Thus, one can be on a well-deserved vacation or day off and never vacate the electronic office. Ever said, “Oh, I’m just going to check my email….” and look up an hour later?

What are some warning signals of intrusion?

Electronic density. E.M. Hallowell at Harvard warns, “Never before in history has the human brain been asked to track so many data points. Everywhere, people rely on their cell phones, email, and digital assistants in the race to gather and transmit data, plans, and ideas faster and faster.” The latest intrusion “trumps” the previous latest intrusion.

Rebooted personal woundedness. All of us have psychological material we have stuffed into “baggies” to deal with “later.” Thus, as we receive the narratives of the bereaving, some words and phrases sound so familiar to our realities that it takes great discipline to concentrate on listening.

David Crenshaw reports that repeated exposure to these narratives triggers our own pasts (and not-so-pasts), personal wounds and traumas, and reminds us of our own worst fears: “My God, this could happen to me!”

Defusing attention deficit trait. Hallowell insists that the average employee or professional today wrestles with three “hot buttons”: distractibility, inner frenzy, and impatience. That inner frenzy can be driven by the “Employee of the Year” app—the continuous reminders that we are being evaluated and, if a staff cutback should prove necessary, the amount of work we produce keeps us valued by management. Seldom do we have adequate time to complete one task, without a request of directive interfering. Or a colleague asking, “Do you have a minute?” (And that will mean thirty minutes minimum.) Not surprisingly, some come in early or stay late to “catch up” or “to get things done” only to wish that those items would stay “done”!

Hallowell convinces me that he has been investigating my work day. “When you are confronted with the sixth decision after the fifth interruption in the midst of a search for the ninth missing piece of information. . .and the twelfth impossible request has blipped unbidden across your computer screen, your brain begins to panic!” Humans juggle so many electronic interruptions that our souls are being depleted. Not surprisingly, a sense of chronic exhaustion is second nature in this field. Some “forget” things but laugh it off as a “senior moment.” Research, however, suggests that we experience numeric overload. We are keeping track of too many numerals. Think of all the phone numbers you keep on the edge of your brain, all the security codes you must punch in before an alarm sounds, and all those endless passwords. We offer compassion despite a nagging hum in our brains.

Diffusing noise and racket. Compassionate humans are bombarded with noise, racket and sound. Pause at an intersection and the airwaves we share with others is overwhelmed by the volume of another’s radio, particularly the “Boom-thumpa-boom!” variety. Never have I groaned, “That is the loudest Chopin I have ever heard!” More problematic is noise that is impossible to decipher. For too many, silence is an impossibility.

I may be “preaching to the choir.” You may counter, “I knew all this before I read this far” or “He sounds like he’s been snooping in my office. What can a caring human do about these intruders?

Deliberately and intentionally make silence. Between appointments or in traffic, what “sounds” are coming from your dashboard? Even if you are not consciously listening to talk show patter or the news of disasters here or somewhere, your brain soaks in the noise like a thirsty sponge! Suppose for an hour or a day you did not immediately reach for your radio dial. I once drove 600 miles back to Kansas City without turning on the radio. I arrived so much calmer than after previous trips. After I come home from leading grief groups, I “make” silence. Often the only noise is the ticking of a clock.

Fast from electronic intrusion. Fewer Americans can go to dinner—whether fast food or higher dollar meals—without electronic gadgets. As I ate dinner recently in a wonderful Thai restaurant, the three individuals at the next table were “working” their electronics. I overheard no conversation. (I also noticed they were shoveling in their meal, apparently to match their electronic surfing.)

While leaders in the field of spirituality insist that we need more time free of electronic intrusion, there always seems to be a new update on the electronic horizon that promises more speed and more accessibility.

Show up with 100 percent you! It is challenging to be present 100 percent to a client or a counselee or a committee. Confession: I am so schedule-focused, and spend so much time mentally checking off “to do’s” of the morning or afternoon, that I am not listening closely to the spaces between the griever’s words. Did I notice what had not been said because I am already thinking about my next appointment or place I need to be in an hour? One therapist friend described meeting Eleanor Roosevelt; her intention was to quickly shake Eleanor’s hand. Instead, Eleanor held on to her hand, despite the crowd, and asked, “And what are you planning to do with your life?” For two minutes, my friend recalled, “it was like I was the most important person in her world. She listened with her eyes. I have never forgotten that moment.”

Before rushing from our car, office, cubicle, or electronic device, take a moment to borrow one of Anne Lamott’s three essential prayers: “Help!” “Thanks” or “Wow.” Whatever your spirituality, these brief prayers communicate: “Help me to be fully present to this individual who has a claim on my time!” I have come to believe individuals have something to say that I need to hear either for my professional work or for my personhood.

Go ten! I attended an intriguing presentation by a geriatric psychiatrist who asked participants to think about our childhoods, particularly age ten. We were instructed to think about what we had enjoyed doing. What brought us delight? Then we were asked, “Is there any hint of that delight or activity in your life now?” As a compassion dispenser, what are you doing (at age 30, 40, 50, or 60) that you did when you were age ten? Why did you “delete” that activity? How might you resurrect that? Simply, at age ten, we spent a major portion of the day nourishing our minds, souls, and our bodies—and we miss that.

Jackie Kennedy, late in her career as a book editor, was asked why she invested so much time on book projects that would never become bestsellers. Jackie thoughtfully responded, “Every so often it is good to do something for the soul.”

What have you done for your soul lately?

 

Written by:
Harold Ivan Smith, DMin, FT

 

Additional Non-Death Bereavement Resources – All Losses Need Support

It is essential to our wellbeing for us to process a loss, whether it be after a lingering illness or a sudden death. When other non-death losses are suffered, individuals often do not have a support system to share their sorrow. As with other grief reactions, processing these emotions is necessary if healing is to happen.

Professor of Gerontology Dr. Kenneth Doka routinely explains in books and lectures on grief management that “there are circumstances in which a person experiences a sense of loss but does not have a socially recognized right, role, or capacity to grieve. In these cases, the grief is disenfranchised.” Unlike a loss to death, when these losses happen there is no funeral to acknowledge and honor the loss, no grave to visit, no covered dishes dropped at the door, nor sitting in the company of fellow mourners and supporting each other through the tears.

Often people do not receive the support and comfort they need in order to grieve properly, and can be vulnerable to loneliness and serious, long-term depression.

Examples of bereaved persons who may feel disenfranchised include couples who have miscarriages, given up a child for adoption, women or men whose spouses are missing in military action, and those whose loved ones have died from difficult-to-accept deaths like suicide.

Those struggling with Alzheimer’s and dementia also may feel disenfranchised. The bereaved in these situations may not be grieving loss of physical life, but of crucial intangibles, without which their lives and families will never be the same.

No matter the type of loss, grief is grief and it needs to be heard and validated.

 

Submitted by Darwin L. Huartson, M.Div. BCC, Porter Loring Community Coordinator

Connecting with Those Who are Grieving in the Digital Age

The digital age has brought many changes to our world and we now live in a time when many people are dependent on mobile devices.

Recently I was on a layover at the airport and snapped a picture (with my cell phone camera, of course) of three individuals who were sitting in a small restaurant alone at separate tables. Each person was riveted to a mobile device.

Technology seems to be evidence of the six degrees of separation theory, which is the concept that everyone is six or fewer steps away, by introduction, from any other person in the world. The internet is a great tool and, in some ways, has made many things in our life easier, more accessible, and enjoyable. Parents, day school teachers, students and grandparents reach out daily with emails, texts, and Instagram pictures!

However, when we are grieving, there is a need to connect with people face to face. When experiencing grief, being in the presence of others brings comfort, hope, and healing. Dr. Alan Wolfelt writes about the importance of being a companion to others when they are grieving. He writes, “Companioning is being present to another person’s pain, it is not about taking away the pain. It is about walking alongside of, it is not leading, but instead it is listening with the heart, not analyzing with the head.”

Compassion for fellow San Antonians has been a part of Porter Loring since the doors opened in 1918. This includes bereavement support to anyone in the community (at no charge) who is struggling with the loss of a loved one, as well as a commitment to providing grief education to those in the professional community. The support is made available through our staff, educational resources, in-services and workshops.

As we move into 2019, Porter Loring trusts that we will continue to be a resource and collaborate with you in being companions to those who are grieving. If you are affiliated with a hospice, hospital, or faith community, know that we can provide educational resources and in-services for you and your staff.

Listed below are Professional Caregivers Trainings that we can provide on-site for you and your staff. CEUs can be made available if there is interest.

Professional Caregiver Trainings

  • Working Together to Make a Meaningful Transfer
  • Taking Care of Ourselves When Caring for Those Who Are Grieving
  • Connecting with Those Who are Grieving
  • Difficult Conversations: “What Matters Most”
  • Heartfelt Word®

 

Submitted by Darwin L. Huartson, M.Div. BCC, Porter Loring Community Coordinator

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