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Read, Moving Through Grief (Kessler, 2017).  In 1-2 pages, please explain the five stages of grief. Include the following information in your discussion. · Who is the nurse theorist we associate with the five stages of grief? · Name the five stages of grief and describe the manifestations we would expect to see with each one. · Are the five stages of grief considered to be a healthy coping mechanism? Why or why not? · What can nursing do to help support the families and the clients during this time? · How do we provide our clients dignity in dying? Please use proper APA formatting to include title page, in-text citations, and at least 2 references. BY DAVID KESSLER dead,” denial doesn’t mean denial of the actual death. Instead, it means the death is just too much for a person’s psyche to take in. In this stage, the world can seem meaningless and overwhelming. Life makes no sense. We may wonder how we can go on, if we can go on, why we should go on. These feelings are important: they’re the psyche’s protective mechanisms. Letting in all the feelings associated with loss at once would be overwhelming emotionally. Still, it’s important not to get stuck in this stage, which is what happened to Mary. Mary mentioned to her therapist on multiple occasions that she couldn’t visit her husband’s grave even though it had been 14 months since he’d died. She also shared that her friends and family were worried that she wouldn’t give away any of his clothes and that his bathroom items were still in place, as if he could walk in at any moment. Her response was that she just couldn’t believe he was gone, but her denial was turning into guilt for not visiting his grave. Already Mary’s therapist had had multiple discussions about what keeping her husband’s possessions intact meant to her and why her daughter might be pushing her to get rid of them. In the course of the discussions, however, Mary always got defensive, refusing to discuss the issue. So realizing that she was stuck in the denial stage and unable to move forward, her therapist decided gently to increase the reality of the loss. First, he asked if she’d be willing to walk around the perimeter of the cemetery. “Are you hoping I’ll go in?” Mary asked skeptically. “No, I’m just hoping you’ll walk around the parameter,” her therapist responded. Mary agreed. In her next session, after walking around the cemetery, she reported that she felt relieved there wasn’t pressure to go in. Her therapist simply commended her for taking the walk and asked if she’d be willing to do it again. After the second time, she was much more relaxed and even reported a feeling of calmness. “Would you be open to walking a third time?” her therapist asked. “Now you want me to try to walk in,” Mary guessed. “No,” he replied, “I’m just asking you to walk around it again.” Mary agreed and returned for her next session holding back tears. She said, “As I walked, I began to think about why you’re having me do this. Then it hit me. I’m walking around a cemetery every Sunday because he’s dead. He’s gone.” The therapist sat and witnessed her grief. Mary asked, “Now what?” The therapist said, “That’s it, nothing more. You did well.” The next week, she threw away her husband’s razor and toothbrush. A few weeks later, without any prompting, she went to his grave. The simple act of having her walk around the cemetery opened her connection to her loss and helped her face her feelings about it. Helping people nd therapists. Get referrals. Grow your practice. Unlimited continuing education. www.GoodTherapy.org 888-563-2112 ext. 2 GoodTherapy.org is a leading online therapist directory with a mission to demystify therapy and help consumers recognize the differences between healthy and unhealthy therapy. Therapist members of GoodTherapy.org receive referrals, access to online continuing education events, publication and media relations opportunities, discounts on therapy-related products, and more. Discover why millions of people turn to GoodTherapy.org to nd the right therapist. using the promotional code: JOIN today and get a FREE 60-DAY TRIAL TRIAL602016PNJULY PSYCHOTHERAPYNETWORKER.ORG 15 Anger: Express Anger, Pain, and Fears In the process of grieving, it’s important to help clients find ways to express their anger without hurting other people or themselves. If they can’t express their anger or if they misdirect it, they might become stuck in this stage, and often it’s because they can’t get angry with the person who died or, for some, with God. But anger serves a purpose in grieving, giving temporary structure to the feeling of nothingness that often comes with loss. For instance, grief may at first feel like being lost at sea, with nowhere to drop an anchor, no connection to anything. But getting angry at someone—maybe a person who didn’t attend the funeral—becomes something solid to hold onto, and experiencing this kind of strength through anger often feels better than feeling unmoored. Therapy during this time can help give structure to the expression of anger. As clients feel and explore the feelings that come up in the wake of their loss, they usually find that the basic source of their anger is the fact their loved one has died. It’s important to help grieving clients explore their anger without judgment and then to find ways of safely expressing it. Sometimes it helps to have them share what they’re feeling with friends and family, or maybe just to scream into a pillow. In any case, you’ll want to help people find ways to get the anger out without hurting themselves or someone else. Once they’ve done so, they often come to see the anger as another indication of the intensity of their love for the one they lost. Bargaining: Work Through the What-Ifs Before the death of a loved one, bargaining is often an internal plea, such as, “Please, God, let my wife live five more years and I’ll be a better husband.” After death, bargaining involves what-ifs and regrets. We want to go back in time: find the tumor sooner, recognize the illness more quickly, stop the accident from happening. Guilt is often the bargainer’s companion—the ifonlys cause us to find fault in ourselves and what we think we could’ve done differently. But as we move through the bargaining process, the mind eventually comes to recognize the sad reality that our loved one is truly gone. When John’s wife died, for instance, he began to see billboards for all the other hospitals in his area at which his wife hadn’t been treated. One billboard read, “We have the answer for cancer,” and John became obsessed with the thought, What if I’d just taken her to another hospital? Understanding that John was stuck in the what-if stage of bargaining, his therapist had him write down all the what-ifs that plagued him around his wife’s death. The first one was “What if we’d gone to the hospital on the billboard? Then she might’ve been cured of cancer.” After they discussed the reality of whether a change of hospital would really have prevented his wife from dying, the therapist had John make a line through each of his what-if statements and write “even if” instead. So his statement became “Even if we’d gone to that hospital, she wouldn’t be cured of cancer.” They then spent time discussing how the even-ifs were just as true as the what-ifs. For example, did the other hospitals really have a cancer cure that they didn’t share with his wife’s hospital? Or was that just a marketing stance? Once John began to let go of the idea of a magical missed cure, he found a certain kind of peace. Depression: Allow and Validate Situational Depression For many people, grief can lead to intense feelings of depression. They withdraw from life, lost in a fog of sadness, wondering, perhaps, if there’s any point in going on. Though depression is a common issue in the mental health world, when it comes to grief, depression is situational. Someone has died, and we’re depressed: that’s the situation. In our modern world, we try to stamp out depression at all costs, but sometimes we need to recognize it as a natural response to loss in order to move past it. Jeanette told her therapist that she wanted to get over the depression she was feeling after her friend had died, three months before. She said she was doing everything she could to move past it: keeping busy, distracting herself, not thinking of her friend. The therapist asked her, “What would happen if you just felt your feelings, even if they’re sad and depressing? Can you allow yourself to just feel sad?” “My family and friends would disapprove,” Jeanette responded. “They all want me to snap out of it.” Since the therapist didn’t hear any harmful thoughts or signs of clinical depression in Jeanette, she said, “What would happen if you just allowed yourself to feel your feelings without judging them?” For the next few weeks, Jeanette explored each and every one of her feelings of sadness in her sessions, giving her depression its due, even though she sometimes felt that discussing the sadness was pointless. But as she allowed herself to feel whatever came up, she said the sadness lessened. The therapist supported her willingness to give herself permission to grieve, pointing out that resisting sadness and depression in grief can take more energy than feeling it and moving through it. Acceptance: Find a “Good” Bye A client may say, “You don’t know what my husband was like in his last year with cancer. I keep thinking about his body deteriorating and all those horrible memories are frozen in my mind. I’ll never accept his death: it was too horrible.” This is an indication of a “bad” bye—when the client is fixated on the last year, hour, or moments 16 PSYCHOTHERAPY NETWORKER n JULY/AUGUST 2016 that were so hard. But therapists can help clients find a “good” bye by helping them zoom out of that painful timeframe and inquiring about the whole course of the relationship with the loved one. So a therapist might say to a client, “You told me about your dad’s last hour. Tell me about your earliest memory of your dad.” Or “Tell me your favorite memory of your dad.” Or “You’ve told me about your husband’s last year. Tell me about your first year together.” This helps the person say a “good” bye to the whole relationship, instead of focusing too narrowly on those last challenging days or hours. Of course, people usually go through all the stages of grief without any therapeutic guidance or direction, but it’s helpful for clinicians to know the stages of loss in order to understand the fluid feelings of grief and offer structure to clients who need more support. After a loss, some clients may look as if they’re running Talk Is Not Enough Essential Skills in Comprehensive Energy Psychology, Level 1 Activate Deeper & Broader Levels of Healing with Your Clients • Use more holistic methods • Earn 12 CE hours for mental health professionals • Learn specific tools to positively influence the body-mind interaction Portland, OR: Sept 24-25 | Chicago, IL: Oct 15-16 | Seattle, WA: Oct 15-16 St. Louis, MO: Oct 22-23 | Nashville, TN: Nov 5-6 | Phoenix, AZ: Nov 12-13 This broad-based program is a two-part series designed to give you skills in combining conventional psychotherapeutic modalities with meridian interventions, chakra techniques and biofield practices. Register Now! energypsych.org | 619-861-2237 Save up to $80 when you register at least 6 weeks early. Save $40 with code PNET40. Join ACEP and save even more! Training workshops designed for mental health professionals. Science of Energy Healing – Online course coming this fall for a limited time. Sign up at SOEH2016.com to receive an alert about the full course and free miniseries. Plus, get a FREE keynote by Stephen Porges, PhD – “The Polyvagal Theory.” from grief, but they’re really running from the pain that comes with it. In fact, the journey through grief, with all the stages that Kübler-Ross captured so indelibly in her model, are the stops along the way that help us heal. David Kessler, MN, RN, is the founder of grief.com. His books include On Grief and Grieving and Life Lessons, coauthored with Elisabeth Kübler-Ross; You Can Heal Your Heart, coauthored with Louise Hay; The Needs of the Dying; and Visions, Trips and Crowded Rooms: Who and What You See Before You Die. Contact: [email protected] Tell us what you think about this article by emailing [email protected] Want to earn CE hours for reading it? Visit our website and take the Networker CE Quiz. Want to submit an In Consultation piece for an upcoming issue? Please see Submission Guidelines on our website. PSYCHOTHERAPYNETWORKER.ORG 17 Copyright of Psychotherapy Networker Magazine is the property of Psychotherapy Networker Magazine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holders express written p