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Coping with bereavement and loss

We will all, at some point in our life, experience the death of someone close to us, as well as other losses.

Some losses may be less spoken about in society such as the loss of a baby in pregnancy through miscarriage or abortion.

Other losses bring similar feelings too; the break up of a relationship; loss of health.

Following a bereavement or loss we may experience many powerful, sometimes frightening, feelings such as:

  • Shock
  • Disbelief
  • Numbness
  • Anger
  • Pain
  • Hurt
  • Sadness
  • Guilt and regret
  • Loneliness
  • Despair and depression
  • Relief

    You may find that the bereavement brings other issues to the surface that make it harder to cope.
    Sometimes you may feel that people are wanting you to ‘get over it’ but it is normal for the feelings of grief to come and go over a very long period of time. It is different for everyone.
    Grief also has an effect on our behaviour and how we function. You may find yourself affected by:

  • Sleep problems
  • Loss of appetite
  • Anxiety
  • Finding it hard to cope
  • Feeling restless and irritable
  • Thinking constantly about the person who has died, even imagining you have seen or heard them
  • Loss of interest
  • Tearfulness
  • Exhaustion
  • Physical symptoms such as palpitations, nausea, dizziness

    These are all normal reactions to bereavement and a part of the grieving process.

  • What can help me cope?

    You will need to give yourself time to grieve. Be kind to yourself, these feelings are normal.
    There is no right or wrong way to grieve or a set amount of time by which you should be 'over it', it is more about finding a way to live with the loss.
    Allow yourself to express your feelings, through talking or writing. Listening to music can be helpful.
    Keep mementoes of the person. Remembering may be painful at first but will eventually be a comfort and pleasure.
    Try to keep up a regular routine of eating, sleeping, exercise and relaxation.
    Avoid trying to block your feelings with drugs or alcohol, this only tends to postpone the grieving process.
    Take each moment as it comes, don’t think too far ahead and give yourself credit for getting through each day.

    What if it’s still hard to cope?

    When the normal process of grief does not resolve after many years, it is called "complicated mourning". With complicated mourning, the impact of the loss may be denied, or you may be frozen in anger, depression, shame or guilt, and unable to make the transition into a peaceful new life.

    Talking about how you are feeling can help. You may find it easier to talk to an ‘outsider’ like a counsellor rather than friends or family about how you are feeling.

    Sometimes you may be left with a feeling of reliving the events around your loved one's death particularly if there has been a traumatic incident. A specific therapy; EMDR, can help process these memories. EMDR stands for Eye Movement Desensitisation and Reprocessing. It is a psychotherapy that has been proven to be effective in treating trauma, and is recommended by the UK's National Institute of Health and Clinical Excellence (NICE) for Post-Traumatic Stress Disorder. Research is showing that EMDR is also effective in facilitating the natural grieving process.
    For further explanation about EMDR, click here and here.

    Counselling can help ease the pain and loneliness of grief and give you the opportunity to resolve any lingering emotional problems and find more helpful ways of coping. Please contact me to find out how I can help.

    What you can do for a person who is bereaved

    Please click here to visit the Griefwatch website for helpful advice.

    What not to say to a grieving person

    Please click here to visit the Griefwatch website for helpful advice.

    What is the Adaptive Information Processing (AIP) Model?

    If you have been in counselling before, you may have been asked about your family or early childhood experiences. Some clients get annoyed by this question, thinking that the past is irrelevant or that therapy is just about blaming their parents for current-day problems. But we are not asking about this to assign blame or to ruminate on the past. Most parents (of course, there are exceptions) have good intentions and are just humans doing the best they are able to. However, the past is present in our daily interactions with others. This is the basis of the Adaptive Information Processing (AIP) model.

    What is AIP?
    First developed by Dr. Francine Shapiro, the AIP model suggests that the way past experiences were stored in the brain may impact one’s belief about ourself and others. It also suggests that based on these beliefs, people have adapted certain behaviors and attitudes that influence their daily life. During a trauma, the event can become trapped in the emotional part of the brain. If something similar to the original trauma comes up again, this memory gets activated in the same way and can cause the person to apparently overreact or freeze much like they did originally.

    Traumatic experiences get stuck in the neural networks with the original perceptions and sensations of the trauma that are triggered by internal or external stimuli. As a result, they become the basis for future unhelpful responses when current events are connected with associated neural networks.

    For example, imagine a young child was left at a hospital in the middle of the night due to a medical crisis. Her parents had to leave her and she had this overwhelming sense of abandonment and terror. Because of the stress on her body and the absence of her caregivers, she began to organize her experience to the best of her ability. But she presented with somatic (bodily) symptoms and severe anxiety at any sign of separation from her mother. As she came into adulthood, this and other life experiences continued to shape her fear of abandonment in romantic relationships.

    One of the principles of the AIP model is that the failure of unpacking and resolving these stored memories leads to a range of symptoms when the memories are activated. These could include reactions that intrude and lower quality of life. These are called flashbacks.

    For that little girl in the hospital, unprocessed childhood trauma was stored with automatic survival reactions of freeze and dissociation (disconnection from feelings) in any situational association with the danger. As an adult, this may not be a helpful reaction in situations which are getting associated with the trauma memory. Through EMDR, she can begin to reprocess these memories and see that the past is truly in the past and that she was not abandoned but had a medical crisis. She can then relate that she no longer needs to fear this same abandonment from her husband or children.

    How can it help?
    Out of place emotions and negative behaviours that may be bothering a person can be recognised and connected to past experiences.
    The model can help uncover exactly what memories trigger the reactions and attitudes one exhibits. With that information, a client and their therapist can use EMDR to process these memories and triggers and transform unhelpful beliefs and perceptions. Isolated memory networks can link up with more adaptive helpful networks so the memory feels in the past and negative self- beliefs are converted to more helpful beliefs.

    What is EMDR?

    What happens during EMDR?
    How will I feel after EMDR?

    EMDR stands for 'Eye Movement Desensitisation and Reprocessing'.

    It was discovered accidentally by Francine Shapiro Phd as she was walking in a park in the late 1980s. As she was walking, She noticed that some distressing feelings she was having about a particular situation suddenly ceased. When she reflected back on what happened, she remembered that she had experienced some spontaneous eye movements (kind of rapid blinking). This led her to experiment further and discover that when thinking and talking about a memory at the same time as stimulating both sides of the brain eg by following hand movements from side to side with the eyes, the distressing memory seems to become less distressing in a long-term way.

    This discovery led to the development of EMDR. As a Senior Research Fellow at the Mental Research Institute (in Palo Alto, USA), she published the first research data to support the benefits of the therapy in the 1989.Since then a wealth of research has been conducted demonstrating its benefits in treating psychological trauma arising from experiences as diverse as war related experiences, childhood sexual and/or physical abuse or neglect, natural disaster, assault, surgical trauma, road traffic accidents and workplace accidents. Since its original development, EMDR is also increasingly used to help individuals with other issues and performance anxiety.

    Often, when someone is involved in a distressing or traumatic event, the memory seems to get locked in the nervous system with the original picture, sounds, thoughts, feelings and so on. The brain seems to be overwhelmed and unable to process the experience like a normal memory.

    Since the experience is locked there, it continues to be triggered whenever a reminder comes up. It can be the basis for a lot of discomfort and sometimes a lot of negative emotions such as fear and helplessness that we can’t seem to control.

    These are really the emotions connected with the old experience that are being triggered.

    In EMDR, alternating left-right stimulation of the brain with eye movements or sounds or taps is used.

    These seem to unlock the nervous system and allow the brain to process the experience. This is similar to what happens in REM or dream sleep: the eye movements may be involved in processing the unconscious material.

    Disturbing events can be stored in the brain in an isolated memory network. This prevents learning from taking place. The old material just keeps getting triggered over and over again.

    In another part of your brain, in a separate network, is most of the information you need to resolve it. It’s just prevented from linking up to the old stuff. Once processing starts with EMDR, the two networks can link up. New information can come to mind and resolve old problems.

    In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, "I survived it and I am strong."

    What happens during EMDR?

    Your Therapist will spend some time doing some relaxation exercises with you, which could include 'safe or pleasant place' exercises, guided visualisation, deep muscle relaxation, breathing retraining, imagining resources etc.
    Once you and your therapist feel that you are sufficiently prepared, you can then target a distressing memory with the eye movements or other forms of left-right alternating stimulation, such as sound or taps.

    Your therapist will ask you to select an image that represents the distressing event.
    You will then be asked to think about negative thoughts in relation to the memory and to think of an alternative positive thought that you would like to believe about yourself.
    You will also be asked about your feelings, the amount of distress you feel and where you feel it in your body.

    Your therapist will then begin the eye movements while you bring to mind the picture, feelings and bodily sensations and the negative thoughts or beliefs.
    The therapist will move their fingers rapidly from side to side while you allow you eyes to follow the movement or may gently tap on either side of your knees or on your hands. While following the movements you allow your thoughts to follow where they need to and just let whatever comes up, come up without censoring.

    After each set of eye movements your therapist will ask you what came to mind or what you noticed during the eye movements. During the eye movements you may experience the distressing event quite intensely to start with, but this distress generally reduces as the memory is processed with EMDR. You are free to stop at any time, just raise your hand to indicate you want to stop.

    Your therapist will continue with the eye movements until your distress is reduced as much as possible. Your therapist will then ask you to think about your positive thought and also check whether there is any part of your body where you still feel distress. Before the end of the session, your therapist will give you time to feel calm again, using the safe-pleasant place exercise or relaxation techniques.

    The important thing to remember is that it is your own brain that will be doing the healing and that you are the one in control.

    You might like to watch this Animation explaining what happens in EMDR therapy

    How will I feel after EMDR?

    EMDR treatment generates a certain amount of 'momentum' to your thinking and conscious awareness. In other words the treatment does not just stop immediately after your session.
    During your eye movement session a lot of memories may come to mind and people find that after the session they may think about these memories. Your therapist will work with you to ensure that you reach a calm place before leaving the session.

    It is recommended that you do not do anything too stressful straight after your EMDR session, such as write an exam. You may feel quite tired.
    Some people report that after the session they seem to recall more aspects of the events that they hadn't thought about for a while.

    Some report that they dream more. Everybody is different so keep a note of your experience after the session and discuss this with your therapist.
    As the distress decreases with EMDR, people report feeling a relief. At the end of EMDR therapy, many people report feeling no distress at all when recalling a distressing event.

    Dealing with bad dreams and nightmares

    Dr Justin Havens has very kindly shared this Dream Completion Technique animation which can help eradicate, overnight, nightmares and bad dreams with a simple technique that can be learnt in five minutes

    Articles about EMDR

    Here are some links to articles in the media about EMDR:
    Irish Times: My Health Experience: Freedom from trauma

    Daily Mirror: A woman suffering from PTSD following the birth of her baby was able to recover with the help of EMDR

    BBC Woman's Hour Interview Sally and Gemma, the mother and sister of murdered schoolgirl Milly Dowler, talk about how they have both found new hope for the future thanks to EMDR therapy
    and in an interview with the Evening Standard

    Counselling and coping with cancer

    A cancer diagnosis can be a shock for the patient and their family.

    It can produce worry, anxiety, depression, lack of confidence or self-esteem and an inability to concentrate, as well as triggering anxiety and problems from the past.

    Counselling is a process of self-exploration that may help an individual to manage problems more effectively through increased self-awareness.
    Sessions provide a safe place in which to explore emotional issues in confidence.

    You may find it easier to talk to an ‘outsider’ like a professional counsellor rather than friends or family about some issues.
    Counselling aims to provide individuals with an opportunity to understand their experiences in a way that helps them feel more in control. It can help people deal more effectively with problems such as:

  • worries about the future
  • body image issues
  • fear of treatment (eg, needle phobia)
  • stress
  • anger
  • relationship difficulties
  • sleep disturbance
  • panic attacks
  • anticipatory nausea and vomiting

    If you have difficulty making sense of your feelings or can relate to any of the above or other such experiences, you may find it helpful talking it through with a trained counsellor

  • Managing Stress by learning relaxation techniques

    Stress is the emotional and physiological effect of feeling we are faced with a situation or threat with which we perceive we cannot cope or have insufficient resources to manage.

    The good news is that we can combat the stress response by learning to relax which will stand down the threat response system in our body. It is really worth practising every day, even if only for a few minutes so that the ability to calm and relax yourself becomes easy.

    Here you can find links to audio files of relaxation techniques that can help relieve stress and gain a sense of well-being.:

    Relaxation techniques 1
    Relaxation techniques 2
    Downloadable Seashore Visualisation Relaxation audio
    Body Scan Meditation
    Progressive Muscle Relaxation
    Peaceful Place Visualisation

    Perimenopause and menopause - how are women affected?

    In a recent BBC survey 48% of women say the menopause had a negative impact on their mental health.

  • 41% said it had affected their work

  • 25% said it made them want to stay at home

  • Approximately 1 in 4 women consider leaving the workplace.

    Peri menopause is described as the time in a woman’s life when she is experiencing menopausal symptoms but still having periods. It can be difficult for any woman to know when peri menopause started for her until she is able to look back.
    Post menopause is entered once a woman has experienced twelve consecutive months without periods she is postmenopausal for the rest of her life.
    The average age of menopause is 51 but it usually happens between 45 -55 years of age. It can occur later or earlier. Symptoms can last up to 15 years

    So what happens to the female brain?
  • Oestrogen fluctuates and depletes
  • Neuro chemicals become disturbed
  • Sleep and mood and concentration can suffer

    Research shows many women are being failed by their GP due to lack of knowledge around symptoms and treatments

    Women are being incorrectly diagnosed as depressed and given antidepressants.
  • Approximately 38 per cent of women seek help from a GP
  • One quarter of those who visited a GP say the possibility of the symptoms being menopause related is missed
  • Many women are mistakenly denied HRT due to existing or family health concerns
  • Women still feel very confused about HRT
  • Many women are unaware of NHS menopause clinics, you can ask your GP to refer you. Find your nearest BMS-recognised menopause specialist

    NICE guidelines on menopause state that blood hormone tests are not indicated to diagnose menopause in a woman over 45 years of age experiencing menopause symptoms. Here is a menopause symptom checker

    Many women say
  • I feel like I’m going mad
  • I feel so alone/sad/angry/lost
  • I don’t know who I am anymore
  • I have lost my joy
  • I feel like I’m going mad
  • My brain feels foggy, I can't think and feel slow

    Menopause can affect women's relationships with partner, family, friends and colleagues. It can help to talk to a sympathetic listener who can signpost you to medical help if needed. You don't have to suffer in silence. Please have a look at the resources linked to here.

    Thanks to Diane Danzebrink for providing this information at the BACP Private Practice Conference

  • Helpful Information and Resources. BACP Logo22

    For general counselling, bereavement counselling, cancer counselling and EMDR by a Registered BACP Accredited counsellor in Muswell Hill N10, North London

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