How To Move Forward After Loss – The Tasks of Grief

Moving beyond the stages of grief

As a culture, we seem to be very familiar with the stages of grief: denial, anger, bargaining, depression, and acceptance. What we are less familiar with is the tasks of grief, or how to process our grief and move forward after a loss.

Grief is an active process – it requires us to work in order to move forward

We hear that “time heals” and “you need to grieve” but no one tells how to go about grieving except to cry. How do you begin to really move on? Grief requires that we actively engage with our pain, which is why a lot of people get stuck in their grief and find it difficult to truly move forward. In this week’s video, we talk about the tasks of grief which is the work of J. William Worden, PhD, ABPP, author of Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner, now in its fourth edition.

Caregivers may find it most difficult to move forward after loss

In my professional experience, those who have been caregivers for a family member find it most difficult to “reinvest in the new reality” which is one of the tasks of grief. So much of a person’s life is put on hold when caring for someone who has a chronic illness that moving forward is especially difficult because it can be difficult to remember what you used to spend your time doing before your ill loved one became the center of your life.

The tasks of grief help you begin to truly move forward

By participating in the active process of grieving you will be able to move on and begin your life again, even if the loss is unwelcome.

Grief is more than just death

Don’t forget that we grieve many losses, not just death! The loss of a marriage through divorce, the breakup of a relationship, a friend moving away, a child growing up and beginning their life, the loss of a job, retirement, all of these things can be accompanied by a natural feeling of grief.

All About Mindfulness

Mindfulness Made Easy

What is mindfulness? It seems like it’s such a popular word to throw around, everyone’s talking about being mindful but what IS mindfulness? Why should we care? The most important question might be, what is in it for me? Why should I spend my precious time practicing mindfulness – it’s ok to want to know the benefits of something new before we start it. Most of us live really busy lives and we don’t have time to waste on a bunch of mumbo-jumbo.

All About Mindfulness

In my first YouTube video, I introduce mindfulness to those of you who might have heard about it and be interested but don’t really know what it is or why you want to try it.

How To Practice Mindfulness

If you like what you hear, check out my new daily videos on mindfulness, Your Mindfulness Minute, where we have small challenges and suggestions for you to integrate mindfulness into you daily life in very easy ways.

Your Criticism Isn’t Helpful

Amanda and Janet are sisters and close friends. They spend much of their free time together and often attend events that they both enjoy. Tonight, they are going to a cocktail party thrown by an old friend and Amanda has purchased a new dress that she is excited to wear. When Janet arrives at Amanda’s house, she looks her over and says, “That dress makes you look like you’ve gained a few pounds.” Amanda is crestfallen. Her excitement about the dress and the party begins to fade away as she questions her appearance. Seeing the upset look on Amanda’s face, Janet says: “What? I’m just being helpful. You don’t want people to think you’ve gotten fat do you?”

The story of Amanda and Janet is something that happens millions of times a day between friends, relatives, lovers, and coworkers. There is one thing that these types of interactions have in common: one person is expressing a negative, unsolicited opinion to the other person. Sometimes, the person being critical truly believes that they are helping the other and other times they are intentionally setting out to damage the other person’s self-esteem, but in both cases damage is done. If you are someone who often offers advice to people and they seem to never react well to it, you should know: your criticism is not helpful. In some cases, whether you intend it to be or not, your criticism is actually emotionally abusive.

There are some relationships where constructive criticism is appropriate and expected. When you have a professor, a mentor, or a boss who offers you tangible suggestions on how to improve your performance, this is to be expected. Such criticism is instructional, it is meant to allow you to become better at whatever task the criticism is related to. Think back to a time in school when you received a paper back from an instructor. Most of the time, he or she would leave comments in the margin, some positive, some negative. Suggestions like, “your focus becomes loose in this paragraph, try editing unnecessary comments” are meant to improve your writing. Imagine if that paper instead said: “Wow, you’re not a great writer. You should try to work on being better at that.” How would you feel? Offended perhaps, or hurt, and you would have no direction in which to go, no idea of what was needed to become a “great writer” but the knowledge that you are not one.

In relationships with family members, friends, and romantic partners, criticism is rarely constructive. For one thing, these relationships are not intrinsically instructive, they are mostly supportive. We look to our loved ones to provide us emotional comfort and warmth. Let’s go back to the comment that Janet made to Amanda. It is not constructive because there is nothing specific that Amanda is able to do about “looking like she gained a few pounds in that dress.” Tonight, before the party, she is not able to assess her fitness and eating to determine if she has, in fact, gained weight. You might say, “she could change her dress though, so that comment was constructive.” Unfortunately, it is not. While Janet’s comment does say “dress” the implication is that Amanda has probably gained weight. Whether or not Janet intended this, Amanda now feels self conscious about herself and her body. Simply changing into another dress won’t change Amanda’s insecurity that she does not look good enough to attend the party. Amanda will not enjoy the party as much as she would have if Janet had simply smiled and they had gone to the party. What would have happened if Janet had kept her opinion to herself?

There’s no way to know. Perhaps nothing. Perhaps a few people at the party would think that Amanda had gained a few pounds since the last time they had seen her. It’s doubtful that any of them would have expressed it to her. Likely Amanda would be none the wiser and remain unhurt. Janet’s “helpful” comment served only to hurt Amanda. If Janet was seriously concerned about Amanda’s health, she could have chosen a more appropriate time to discuss it with her. Some of you might protest at this point and say something like, “Janet just wanted to spare Amanda embarrassment!” But where would embarrassment come from if no one expressed any criticism of Amanda? People are going to judge and to have opinions, but the vast majority of the time they do not express them to the person they are judging.

The one exception to this, is when one is asked for their opinion. The story would be very different if Amanda had put on the dress, felt uncomfortable, and asked Janet, “How do you think this dress looks?” Then, Janet is free to give her opinion on Amanda’s dress because Amanda solicited it.

If you notice that you are a frequent opinion-giver; if you are protesting as you read this saying that Janet was trying to be helpful, ask yourself the last time your unsolicited opinion was met with thanks. Think back over all of these “helpful” criticisms you have shared. Did the person react positively? Were they happy once you shared it? Did it strengthen your relationship? I suspect that the answer to those questions is “no.” Whether you are a frequent critic or not, the next time you feel the need to criticize something someone you care about is saying, wearing, or doing, ask yourself the following questions:

  1. Does this need to be said?
  2. Does this need to be said right now?
  3. Does this need to be said by me?

I have seen this simple yet effective test attributed to spiritual leaders and writers such as Don Miguel Ruiz, author of “The Four Agreements” and Eckhart Tolle, but it was actually said by late-night talk show host Craig Ferguson. If you find yourself being criticized by a loved one on a regular basis, talk to them about it. How they respond will tell you a lot about whether or not your relationship is healthy and sustainable.

Star Wars, the Dark Side, and Anger

b6b60673bc5aecef8610fce23150f321If you are like millions of Americans, you went to see the new Star Wars film “Rogue One” this holiday season. Star Wars has made billions of dollars over the years and one of the most iconic and favorite characters of the sci-fi series is Yoda. A small, green, ancient creature, Yoda teaches Luke Skywalker about the force. Yoda tells Luke: “Fear is the path to the dark side. Fear leads to anger. Anger leads to hate. Hate leads to suffering.” 

Anger, oddly enough, is one of my favorite topics to cover in group therapy. I enjoy telling group members “anger is one of my favorite subjects!” Because that usually gets a laugh. Laughter is an important part of therapy, just like it’s an important part of all things we do in life. Most people don’t realize that a lot of the philosophies of Star Wars and the force are similar to Buddhist principles. One of the most famous quotes about anger actually comes from the teachings of the Buddha! Perhaps you have heard “holding onto anger is like drinking poison and expecting the other person to die”? This is an interpretation of the Buddha’s statement: “Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned.” Buddha knew that of all of the gamut of emotions that human beings experience, anger has the ability to damage us in deep and unique ways. Anger is an active emotion, but when we hold onto anger, when we take care of it, when we tuck it away so that it glows inside of us like that hot coal, it turns into something else: resentment. So, similar to what Yoda told Luke, Anger it seems, is the path to deep, enduring pain.

Anger leads to resentment. Resentment leads to bitterness. Bitterness eats us alive, tainting all of our experiences, even those that have little or nothing to do with whatever caused our anger in the first place. It’s a gradual process. For example, someone might say “all men are liars.” This kind of generalization is not accurate, it’s related to a personal experience that has seethed inside that person and turned into bitterness. The situation that caused this was likely a person being lied to by a man that was close to and important to that person – perhaps they were habitually lied to. Still, that doesn’t mean that all men are liars, but the person who was hurt hangs onto that hot coal of anger. Soon, it becomes resentment. Resentment is less fresh and active than anger – resentment is the creek that runs underneath the foundation of the house, washing the concrete away so slowly that we do not realize that it is a problem until it has damaged the home beyond repair.

In anger, I might yell at you, cry “how could you do this to me?” but in resentment I am passive. I might make passive aggressive comments to you, or try to hurt you in small ways to get revenge for the way that you hurt me. The coal of anger remains, and resentment can morph into bitterness. Bitterness is what makes a person say “all men are liars” instead of “that important person lied to me.” Bitterness takes the resentment that you feel for that one lying man and transfers the responsibility to all men. Bitterness is what would make us distrust someone we barely know, or predetermine an outcome we cannot possibly predict. The wonderful thing about this is that this is not the only possible outcome! We actually get to choose what we do with our anger.

When I do a therapy group on anger, I typically start by asking “is anger bad?” I like to do this because people usually disagree with one another. Some will say “no” a few will say “yes.” The answer is it’s neither – anger is a normal, human emotion. We will all experience anger because that is part of who we are. It is what we decide to do with (or about) our anger that causes us problems. A mentor of mine used to tell a humorous story about anger, she would say:

If my husband tells me that he is working late, and I decide to go down to the Red Lobster with my girlfriends, and I walk in and see that he’s in there with another woman, having dinner, I am going to be angry. It’s ok to be angry. I should be angry! Now, if I go outside, and I find his car, and I take my keys and I scraaaaaatch down the side of his car, that’s not ok. 

Ultimately, we get to decide how we will handle our anger. Will we allow it to control us? To effect our relationships and become a part of our daily lives, will we be tormented by our resentment? Will we allow it to turn into bitterness? Or will we take our power back and express our anger in a healthy way and move on? The choice is ours. Resentment, bitterness, they are the path to the dark side, as Yoda might say. If we let go of the coal, that’s the only way that we “win.” Because the sad truth is that the people we are resenting move on. They may not even know that we resent them! They likely do not care that we resent them so hard that we have become bitter – it doesn’t hurt THEM it hurts us. If your anger, resentment, or bitterness seem impossible to let go of; if they are related to pain so deep that you can’t remember a time when it didn’t hurt, I urge you to seek out a mental health professional. We are not made to hurt, and with resentment and bitterness we hurt no one but ourselves.

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PMDD and Depression

There are several physical illnesses that tend to be more common in women with a mental illness. One is Premenstrual Dysphoric Disorder (PMDD). Similar to Premenstrual Syndrome (PMS) which most people are familiar with, PMDD has been colorfully described as “PMS on crack” or an extreme version of PMS. Many of the same symptoms that are associated with PMS are associated with PMDD but to the extreme – mood swings, food cravings, irritability, bloating, depression, trouble motivating yourself to do things, tiredness, feeling easily overwhelmed or hopeless, crying spells, and conflict in close relationships. WebMD estimates that between 2% – 10% of menstruating women have PMDD. PMS, which can include milder but similar symptoms occurs in a staggering 30% – 80% of menstruating women according to Massachusetts General Hospital.

There is no definitive research on the cause of PMDD; serotonin deficiency, and hormonal changes are two widely accepted causes. According to a 2000 study, serotonin levels are affected by ovarian steroid levels. [3] Risk factors include having a mood disorder, a family history of mood disorders, as well as environmental and relationship factors like a history of sexual abuse and/or a history of abusive relationships. [2]

How do you know if you have PMDD? PMDD can only be diagnosed by a medical professional, however, if you only experience these symptoms in the 7-10 prior to your period and they become significantly better 1-2 days after your period begins, it is likely PMS or PMDD. How do you know if it’s PMS or PMDD? One really easy way is to ask your friends or loved ones about both their experience with PMS and those close to you how they would describe your mood swings and mood changes during that time. If they seem to think that your symptoms are severe, consulting with your doctor couldn’t hurt. If you have already been diagnosed with Major Depressive Disorder or another mood disorder, try to “tune-in” to your body and your emotions during this time. Do you feel out of control or like your reactions may be extreme? I believe that we are the best person to know what is going on with our own bodies. If you want, you can use an app like menstrual calendar that allows you to track your period as well as symptoms like your mood. It is a free app with more customization if you buy the upgrade which is just a few dollars. You can also track your mood manually on a calendar.

Treatment of PMDD includes anti-depressant medicine as well as holistic lifestyle changes. Acupuncture, yoga, relaxation techniques, light therapy, aerobic exercise, healthy eating, [1], [2] There is some research, but very little, showing that calcium, magnesium, and B6 may help with PMDD symptoms, it never hurts to take a daily multi-vitamin. Mass General also reports that herbal supplements chasteberry, ginko biloba, black cohash, St. John’s wort and kava kava have shown some success in reducing symptoms. If you decide to try herbal remedies, go with a brand that you are familiar with, as these supplements are not regulated by the FDA and in 2015 major retailers including GNC, Target, Walmart and Walgreens were selling herbal supplements that were not what was on the label. Walmart was the worst, with only 4% of the supplements tested containing what the label said that it was! I am not anti-supplement by any means, I take many myself, but I think it is important to make sure that these items are coming from a manufacturer that you trust.

It is heartening to see so many sources including holistic treatments as best for something, instead of only encouraging the use of pharmaceuticals. What has your experience with PMDD been? Have you found something that works well for you? Comment and share!

Are mental health professionals immune from institutional racism?

I was reading a recent and very disturbing article on PsychCentral this morning, entitled: “What’s In A Name? It May Determine If You Can Get Therapy” by Janice Wood. I was already familiar with the 2003 study that found those with black-sounding names were less likely to receive call-backs for job interviews than those with white-sounding names but I never dreamed that might be a factor in receiving mental health services! A very small scale (but still disheartening) study by the University of Vermont published in The Counseling Psychologist found that while callback rates for black-sounding and white-sounding names were the same, clinicians were more likely to tell those with black-sounding names that their case loads were full and that they would not be able to see them. They found “Allison” was invited to speak to the therapist 12% more often than “Lakisha.”

Institutional racism is the: “…societal patterns that have the net effect of imposing oppressive or otherwise negative conditions against identifiable groups on the basis of race or ethnicity.” –Tom Head*, CivilLiberties. About.com. Rather than the individual prejudice of one person, or in this case one clinician, institutional racism has to do with the prevailing ideas a society has about a race or ethnicity that lead to widespread negative ideas that can be so insidious we do not recognize them. I doubt that any one clinician says to themselves: “I won’t call Lakisha back.” or “I don’t want a black client” but they may have preconceived notions about the class of a potential client based on race. For example, they may assume that “Lakisha” has Medicaid or less attractive insurance that perhaps has a lower reimbursement rate than “Allison.” The may assume that “Lakisha” works a menial job with less flexibility to have daytime appointments that “Allison” might. While they might not realize that these stereotypes and assumptions are racist – they are. In fact, NAMI the National Alliance on Mental Illness reports that African American males “are more likely to receive a misdiagnosis of schizophrenia when expressing symptoms related to mood disorders or PTSD.” In fact, African Americans as a whole are overdiagnosed with Schnizophrenia according to William B. Lawson, MD, PhD, professor and chair of psychiatry at Howard University College of Medicine in Washington, DC. [1]

It is troubling that in 2016 that an individual in need of mental health services might suffer for their race. It is especially upsetting when you take into consideration that “according to the Health and Human Services Office of Minority Health, African Americans are 20% more likely to experience serious mental health problems than the general population.” [2] It is important, as professionals, that we strive to give the same quality of care to all those who seek our services. It is equally important for people of color who are seeking mental health services to advocate for themselves as they seek treatment for themselves. Learn more about self advocacy at NAMI.org. For more on Racial Disparities in Mental Health Treatment visit SocialWork at Simmons’ blog

* You will have to forgive me using an old friend as the source of my material, he also happens to be one of the most-read authors on civil liberties on the internet!

Love and control

Some things in life are mutually exclusive; control and love are two of those things. Love is surrendering to faith in the unknowable and belief in the good that resides within us all. We fool ourselves into thinking that when we have the upper hand we have security. You can control yourself, but try to control another person or a situation and you will find that you have nothing. Love is not the absence of fear, but the knowledge that there is something greater that can be found in trust.

-Sea

© 2010 Stacey E. Aldridge