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Saturday, October 01, 2011

David Roberts on Loss, Grief, and Healing

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David J. Roberts, LMSW, CASAC, became a bereaved parent after his daughter Jeannine died of cancer on 3/1/03 at the age of 18. He has been employed in the addictions field for 24 years and is an adjunct professor at Utica College. Dave is the owner of Bootsy and Angel Books, LLC, whose mission is to provide resources on grief for bereaved individuals and professionals. He has co-authored two books on navigating through grief during the holidays and pet loss and has presented at national conferences of The Compassionate Friends and Bereaved Parents of the USA.  Dave is also a contributing writer for the Open to Hope Foundation. Dave lives in Whitesboro, New York, with his wife of 28 years, Cheri, and Jeannine’s two cats, Bootsy and Angel. They have two sons as well. In our previous issue, Dave’s insightful article on loss and grieving claimed my interest in having a chat with this experienced counselor and compassionate soul about death, loss, and grieving in the context of healing. As you may see, Dave has some fresh, healing views to share with readers.

Ernest: Dave, I am thankful to you for joining me here. Please tell a little about the kind of work you do with your clients and what attracted you to take it as your profession?
 
Dave: It is a pleasure to be talking with you Ernest. I have been an addiction professional for over 24 years, and work mainly with clients who experience simultaneously chemical dependency and mental illness. Also, during the last seven plus years of my life, a major focus of my work has been grief and loss. I have taught a Death, Dying, and Bereavement course at Utica College and have worked as a volunteer for Hospice and Palliative Care, Inc. in New Hartford, New York. I was initially attracted to the addiction profession when I was a community advisory board member at a state-run alcoholism facility. My attraction to bereavement work came as a result of my ongoing journey as a bereaved parent.

Ernest: What are the main stages of loss and the associated symptoms of the bereaved?

Dave: Well Ernest, when you mention stages of loss, the first thing that usually comes to anyone’s mind is Elizabeth Kubler-Ross’s model of: Denial, Anger, Bargaining, Depression, and Acceptance. Kubler-Ross originally developed her stage model for individuals who were dying. Professionals then began to use this model to conceptualize the experiences in general of bereaved individuals. The reality is that we do not grieve loss in a linear fashion. Our grief is circular; we can experience the pain of loss at any time in our lives, depending on what is happening in our world at that moment in time. For many individuals, the grief journey lasts a lifetime.

I recently discovered this model of bereavement on a website called The Sibling Connection which represents the modern view of grief, and which resonates with my own recent experience as a bereaved parent.
Emotional response and cognitive activity

Adjustment to change with continuing connection to the deceased

Formation of a new personal story of which the sibling’s (you can substitute any other family member or friend’s name here) death is a part. 

Finding meaning in life, which takes account of the changed relationship with the deceased.

There are many associated symptoms that bereaved individuals experience after they experience the death of a loved one. Some common ones are: fatigue and loss of energy, compromised immune system due to severe stress, insomnia, loss of appetite, confusion, inability to concentrate, feelings of disorientation, shock, social withdrawal, and obsessive rumination (i.e. replaying some or all of the circumstances of a loved one’s death). As a person becomes more experienced with grief, some of these symptoms will subside while others become more manageable.
 
Ernest: Tell us a little about the main sources of support that help the bereaved in recovering better and sooner during these stages.

Dave: First of all, everyone grieves differently, so one source of support that works for one person may not work for another. With that being said, what I have found to be most helpful are support groups consisting of bereaved individuals who can identify with each other’s unique pain. For example, a parent who has experienced the death of a child would benefit most from a child loss group. It is absolutely crucial that bereaved individuals develop adequate support networks to help them adjust to their forever-changed circumstances. The Compassionate Friends and Bereaved Parents of the USA have many chapters throughout the country that assist families who have experienced the death of a child. The bereaved can also look in the community events sections of their community newspapers or search online for support groups specific to the type of loss experienced.  Also, reading books or articles on grief and in particular about individuals who have experienced loss will give the bereaved additional coping strategies. For me, reading about other bereaved parents stories helped me to not feel as isolated in my grief.

Ernest: Is professional help or therapeutic counseling a desideratum for healing from loss?

Dave: I believe that a therapist who has skills in trauma work and has an understanding of the individualized and circular nature of grief can be helpful to those who are bereaved. Above all, a skilled bereavement therapist needs to be able to listen to the stories of the bereaved so that they can get an understanding of the loss through their (the bereaved person’s) eyes. I believe that certain therapists fail to meet the needs of the bereaved because they emphasize a solution-focused approach and attempt to place a time limit on the grieving process. I have discovered that there is no time limit to grief and no solutions.  I haven’t seen specific statistics on the impact of therapeutic counseling on bereaved individuals. I do know that in addictions, the combination of effective therapeutic counseling and a supportive sober network maximizes the chances of a successful recovery in chemically dependent individuals.

Ernest: With your prior permission, let’s talk a little about your daughter’s death.  How did it happen and how did you and your family face the traumatic incident? 

Dave: First of all Ernest, thank you for asking about the circumstances of Jeannine’s death. Everyone has a story to tell, and those individuals and communities that support and validate our stories, help us find joy, purpose, and meaning again.  Jeannine was 18 years old when she was diagnosed with a rare type of connective muscle tissue cancer. She was diagnosed approximately three weeks after giving birth to her daughter Brianna and my only grandchild.  Jeannine had injured her foot during her pregnancy and it did not respond to traditional treatments. Her foot continued to swell during her pregnancy and her doctors and I all thought her swelling was edema caused by the pregnancy. An MRI done after the pregnancy revealed an undefined 8 cm mass in the bottom of her foot, which was confirmed through a biopsy as a malignant tumor.  Jeannine underwent six rounds of aggressive chemotherapy, which only put her cancer in 80% remission.  She died at home, with Hospice services on 3/1/03, at the age of 18.  Jeannine, Brianna, and her significant other moved in with me, my wife Cheri, and Jeannine’s two brothers Dan and Matt after she was diagnosed. Her significant other and Brianna stayed with us for four years after Jeannine died.  Brianna still remains a part of our lives today.

A lot of what we went through individually and as a family in the early months and years after Jeannine died was about surviving our excruciating emotional pain one day at a time, or sometimes one minute at a time, and trying to adjust to a world where Jeannine was not physically present. We eventually were able to make decisions collectively and individually to live our lives again while celebrating Jeannine’s life.

Ernest: Did you, a counselor on grief and bereavement, feel the need for professional intervention for yourself and/or your family?

Dave: Ironically, I had started to see a therapist prior to Jeannine’s illness because some grief issues related to the death of my mentor and mother. When I told him about Jeannine’s diagnosis, the focus of our sessions shifted. We continued our sessions a good three years after Jeannine died. Overall, the sessions helped because he was always willing to listen to stories about my daughter, validated my right to grieve as I saw fit, and had excellent practical suggestions. Most importantly, he was willing to be there for me for the long haul.

Ernest: Dave, you had been counseling about loss for years when Jeannine passed away and you mentioned in your article The Challenges of Grief Work with Chemically Dependent Individuals, published in Recovering the Self, that your worldview changed after her death. What essentially changed and was it for better or worse? 

Dave: First of all Ernest, all my basic assumptions about life and death changed radically. Children are not supposed to die before their parents. It is unnatural.  My predictable and safe world was no more. I had entertained the notion (and still do) that I could have another child die. I believe that these changes have been for the better, not because of my daughter’s death but because of my struggle with her death.  I do not take any day for granted and try to appreciate the beauty of the present moment as much as I can now. My focus is now on developing meaningful relationships with others and to try to be of service to those who are struggling with loss. I also believe that altered worldviews apply to other losses that defy the natural laws of the universe (young widows and widowers for example) or in situations where one person was extremely dependent on the other.

Ernest: How do familial relationships in a grieving family change?

Dave: I would like to address this question first by looking at loss from the surviving siblings’ standpoint. Many times, a surviving sibling’s pain may be overlooked or undermined because everyone else is concerned about how the parents are doing. In reality, siblings share their own unique relationships, and it is imperative that surviving siblings have an opportunity to share their stories and have their grief validated. Many times, they may not want to burden their parents with their grief. Also, there may be complications in the relationship between husbands and wives because they grieve differently. It is important for husbands and wives to communicate the differences in their grief process to each other and determine how they can be supportive of each other. My wife Cheri and I have been able to do this and it has served to strengthen our relationship in the aftermath of Jeannine’s death.

Ernest: Does the nature and intensity of loss vary with the kind/cause of death? For example, the loss following the death of a healthy person who dies suddenly in an accident or crime is different from that experienced after the death of a cancer patient who has been on deathbed for several months?

Dave: There are certain unique issues related to cause of death. Surviving families whose loved ones died as a result of homicide may experience delayed grief because of preoccupation with seeing the perpetrator caught and/or convicted in a court of law. Family members may experience extreme guilt after another family member completes suicide because they didn’t see the signs or may experience embarrassment or shame. It is important for therapists to be aware of the unique issues associated with cause of death and be prepared to address those. However it is more important for therapists to validate the pain of loss, rather than focus solely on the cause of death. There is an excellent book titled Helping Bereaved Parents: A Clinician’s Guide by Richard Tedeschi and Lawrence Calhoun that thoroughly addresses issues related to circumstances of loss.
       
Ernest: What role has Bootsy and Angel played in your and your family’s healing from Jeannine’s loss?

Dave: Simply put, pets provide a source of unconditional love and comfort that is consistent day in and day out. They are totally uncomplicated creatures. Bootsy and Angel are Jeannine’s two cats. Bootsy in particular was my shadow (and still is) after Jeannine’s death. Petting him and hearing him purr helped me deal with the stress of Jeannine’s illness and death. When Bootsy and Angel eventually go to the Rainbow Bridge, I will not only grieve their deaths, but the death of my daughter, because of their connection to her.

Ernest: Okay Dave, tell us a little about some of the points that grief counselors miss, or might miss, in taking therapeutic sessions with clients.

Dave: I believe the most important thing that might be missed is attempting to conceptualize their client’s grief using the Kubler-Ross model. There is no evidence to indicate that the bereaved grieve in stages and for a certain amount of time. Again, everyone grieves differently.  It is our job to understand that, work with it, and validate it.

Ernest: Are there any special considerations while counseling young people, like teenagers, in handling grief?

Dave: Teenagers like to stay connected to those that have died and tend to express their grief in very creative ways. They may draw, do a collage, express their feelings through musical lyrics, and do a scrapbook. Celebrate their creativity and nurture it.  It is also important for therapists to create a safe place for them to express their thoughts and to help them find a support group for other teens who have experienced the death of a loved one. It is also important for therapists to be aware of any changes in behavior, grades in school, and self-destructive behaviors (i.e. alcohol and other drug use) that typically occur with teenagers after a traumatic loss.

Ernest: Finally, do you feel any need for educating children about death in families since childhood to enable them to cope better with loss?

Dave: Absolutely! Western society does not talk about death, until it is actually upon us. There are many age-appropriate books and ways to address death with children. I further believe that we can lead a more meaningful and fulfilling life when we acknowledge the reality of death.

Ernest: Right Dave, thank you so much for taking this time to share your insight.

Dave: Thank you Ernest. It was my pleasure to speak with you.

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