Monday, February 15, 2016

Prolonged and Complicated Grief

I am currently investigating the role of neuro-psychological interventions for loss and bereavement clients who are seeking relief from the clawing devastation of never-ending misery.

I believe that any loss experiences, including the multiple losses so prevalent along the journey from diagnosis to death, have the potential to set prolonged and complicated grief  (PACG) into motion with indications of post-trauma stress symptoms. Interventions which directly impact neurons have been shown to eliminate traumatic stress symptoms as well as those of PACG  
(van der Kolk, B., Porges, S., Doty, J.)

When various methods suited for a client do not realize the desired shifts in level of symptom control, physical discomfort, extent of dysfunction in area of life -- exploration of other intervention options are indicated. I have found that meditative and relaxation exercises, structured physical activity, Gestalt/ forgiveness systems, journal writing, medication, and education are useful when adapted to the specific receptivity and needs of clients.

J. Shep Jeffreys, EdD, FT

Friday, December 5, 2014

Exquisite Witness Grief Care Provider

The Exquisite Witness Grief Care Provider

I am repeatedly reminded by my own clients of the importance of being a witness and companion for their painful travels in the strange new world they find themselves in. Sometimes the grieving person simply wants to affirm that they were good, loyal and loving to their lost loved one. Other times they wish to know that they are not crazy for all of the feelings and thoughts they are having. For much of the time spent together in early sessions, grieving clients want to be heard – telling the story of their loss and events leading up to and including the time of death, diagnosis or other loss.

The Exquisite Witness Grief Care Provider[1] will listen more than talk, observe more than act and follow more than lead. I do not use a checklist to gather information but gather what history I need initially from the conversation. I will at some point clarify any impeding misconceptions about the human grief reaction and what can be expected from this difficult part of life’s streaming.  Foremost among these is the importance of knowing that there is no one right way to grieve. This is especially useful when working with a bereaved couple or a family or other group. Styles of grieving range from a very structured, intellectual and problem solving approach to a more relational and feelings orientation to grieving.[2]

The Exquisite Witness will be closely attuned to his or her own loss history to the extent that this material does not reduce therapist availability to the client.  This Provider will be well grounded in the knowledge base of the complexities and dynamics of the human grief response. Further, the Exquisite Witness will be skilled in a variety of strategically determined interventions. These will be summarized in a future Grief Corner writing.

[1] Jeffreys, J.S. (2011). Helping grieving people —When tears are not enough. New York: Routledge.
[2] Doka, K. & Martin, T. (Eds.). (2010). Grieving beyond gender (rev. ed.). New York: Routledge.

Thursday, July 24, 2014

"Cowbells Ring... are you listening?"

Hello -- after a long, long, long absence.
I have just completed my 19th summer session offering of Loss and Bereavement in the Pastoral Counseling Department, Loyola University Maryland. I have been offering the course for 17 years in the fall semester as well.  This course always brings to mind my story of  “Cowbells.”
When I was four years old, my mother enrolled me in a post-depression era pre-school at a community center across the street from my Brooklyn apartment house. We started the day with a large spoonful of cod liver oil …all of us from the same spoon. After some games and stories we went downstairs to the playground.  It was a partly grassy and partly muddy piece of land between two buildings and a chain link fence looking out to the street across from my home. I recall making a run for that fence, sticking my little fingers and my nose through those chain links. I looked longingly, yearningly and achingly towards the building where I knew my mommy was. 
At that time each morning a man with a pushcart piled high with old clothes, pots, pans and dishes came through the street calling out to the housewives, “old clothes, old things.” To be certain that everyone knew he was there with good bargains in used merchandise, he rang a large cowbell tied to the handlebar of the pushcart. The clanging of that bell and my aching, grieving feelings got tangled up so strongly that when ever I have had any recall of loss and grief, my wife would look my sad face and ask softly, “Cowbells?” — and I always answer, “Yes, “Cowbells.” A symphony of “Cowbells” ringing throughout my life. We all have our “Cowbells” and we carry them into every interaction we have – day after day – into counseling sessions, hospital bedsides, parish offices, staff meetings and the checkout stations in the super market.
As I usually do, I take a week of beach time following the summer session and also, as I usually do, I reflect on the individuals who just shared the 35 hours of course activities with me. An emphasis -- and one of three primary objectives of our course, is on personal awareness of stored and unfinished loss material. I refer to these as our "Cowbells." My thoughts turn to the people in the class. Each of us with known and unknown "Cowbells." I have deep respect and a sense of privilege with each group as we share some of the pain stored and held back for months and years. I learn much about human grief, including my own.

Each class teaches me again and again the importance of grasping the reality of unfinished loss and the role this counter-transferential content plays on our availability to grieving clients. The goal is to manage, process, do something with this material, so our ringing "Cowbells" do not drown out our clients. While loss is not the only content stored as unfinished business, it is a major focus of our course.

Our closing ritual over the 19 years typically includes the sharing of what we each are taking home with us from this class. To a person, our comments are associated with "Cowbells" identified, and a plan to engage them for further personal growth. This can be done in conversation with a trusted colleague, friend, counselor, spiritual advisor, and/or by journaling, artwork, meditation and prayer. 
Ask not for whom the “Cowbells” toll. They toll for thee . . . and me.  We never know when our "Cowbells" will ring. Are you listening?
This column will be directed at persons who will be working with grieving people in some capacity – counselors, psychotherapists, clergy, chaplains, physicians, nurses, pharmacists, physical and occupational therapists, psychologists, social workers, healthcare/hospice volunteers, home caregivers and of course … for many grieving persons as well.  In future GriefCorner Blogs I intend to identify the basic components of the “exquisite witness” grief care provider and what goes into the training and preparation of this highly skilled and caring provider.­­ We will also look at some of the challenges to the grief care provider: self-care methods, new research defining grief and treatment, clinical depression/anxiety vs complicated grief, special needs of various groups of bereaved/grieving people, training and certification opportunities I recommend.

I will present my case for the view that: The Standard of Care is The Provider of Care. (Any thoughts on this?. . .)
I look forward to your questions and my own as well.

Sunday, February 10, 2013

GriefCorner: New Healing Through Loss Workshop March 15, 2013.

New Healing Through Loss Workshop March 15, 2013.

I’m very excited about a new workshop on “best practices for working with grieving children, adolescents and adults” that I will be presenting with several colleagues on March 15th in Columbia, MD. 6 CE’s will be available for psychologists, social workers, licensed professional counselors and certified professional chaplains (APC).

For details:   Click on New Workshop link.

This workshop is an opportunity to expand and  explore some of our best practices for helping children, adolescents and adults and also look at the role of the Internet in serving the needs of grieving people. A look at self as griever, the underlying function of human grief and some illustrative cases will be included. I will be joined in this presentation by Dr. Alison Dunton - child psychologist and Dr. Erin Stoll - adolescent and young adult psychologist. 

This workshop is co-sponsored by our new Jeffreys Institute For the Study of Loss and Bereavement and the Maryland Psychological Association. The Maryland Psychological Association is approved by the American Psychological Association to offer continuing education for psychologists and by the Maryland Board of Social Work Examiners as a sponsor of continuing education.  The Maryland Psychological Association maintains responsibility for the program and its content.
In addition to the CE's I mentioned earlier, The Association For Death Education and Counseling has deemed this program as counting towards the continuing education requirements for the ADEC CT and FT programs.

The Jeffreys Institute For the Study of Loss and Bereavement is a training program for licensed mental health practitioners which will concentrate self awareness, grief knowledge base and clinical skill development. More on the future Institute programs in a future blog.

Tuesday, August 21, 2012

"The Standard of Care Is the Provider of Care"

When I write about what it takes to be an effective grief care provider I come back again and again to the above statement. When I train people to be grief counselors I view this as covering three tracks.
(1) Who am I as a person who has had losses and has grieved them and knows that somewhere inside there still is material which can be brought to the surface by external cues and signals -- words, sounds, sights, smells, and touch. These are my "Cowbells" and they are vulnerable to recall into my conscious awareness at anytime and drown out whoever I am speaking with. Therefore, I must develop a keen sense of this material and engage in some processing in order to limit their sudden surging into the space between myself and clients.

I have found that strong knowledge of what grief is and the range of behaviors we can expect from grieving people, as well as a good repertoire of intervention skills to be absolutely necessary but must be accompanied by a clarity of my own countertransference material associated with grief. The knowledge and skills will be partially or not used at all when the "Cowbells" ring and limit my availability. The standard of care truly is the provider of that care.
(2) What to expect from grieving people is a critical part of the training. Here we give the trainees not only the origin and functions of human grief but also the typical and atypical variations of grieving behaviors.
(3) How to help grieving people is the other area of focus. There are several ways to organize the learning of intervention skills. Many students and trainees want to go here first without a grounding in why and how we grieve and why it is more comfortable for them to work with the death of an older person versus a young mother or . . . a child!

We will talk more about the complexities and dynamics of human grief -- its variations and changing nature --  in our next blog.

Thursday, July 5, 2012


“Cowbells” ring – Are you listening?"

     "Sometimes, I feel like a motherless child." Sometimes I really do! There are still resurging memories and thoughts and accompanying feelings that return me to griefpain and ... "sometimes I do feel like a motherless child." Grieving for me continues to be a lifelong process and after almost 33 years of helping grieving people, I know that the revisiting of loss and grief is as much a reality for them as it is for me. Normal, unresolved leftovers of the unfinished business of past loss and grief is stored in a space just out of conscious awareness and can be triggered into consciousness by external cues. This can happen when you or I are with a grieving person and can limit our availability to that individual,

The way unfinished business is stored and its subsequent effects on a helping person's own grief experience is illustrated by the following personal "Cowbells" story.*
When I was 4 years old, I attended a preschool program in a community center just across the street from the apartment building where my family lived. After some indoor games, we were sent outside to the playground. This was an area with a chain link fence separating us from the sidewalk and the street beyond. I could see our apartment building across the street and as soon as we got outside, I would run directly to the fence, stick my little fingers and nose through the fence, and look longingly, yearningly toward my home. The image of my “Mommy” was clearly in my mind, and I missed her and ached to be back with her.
At that same time every day, a junkman with a pushcart filled with old clothes and items he had been collecting, came by ringing a cowbell roped to the handlebar of the cart in order to announce his presence in the neighborhood. The sound of that cowbell and my yearning, grieving feelings became connected.
   Throughout my life when I have had aching, grieving feelings come up, the look on my face prompts my wife to ask, "Cowbells?" And I answer—“Cowbells.”
 Throughout the years, a symphony of Cowbells has rung out; and . . . every one of us has our own Cowbells.
They accompany us to every interaction with  friends and family, counseling or pastoral clients, parishioners, into staff meetings, treatment planning, and ... to every human contact we engage in. Anyone who steps up to help a grieving person can be more helpful, more available, when we are aware of our own Cowbells. We do not want our  own Cowbells to drown out the people we're helping!—ask not for whom the Cowbells toll; they toll for thee and me!
*Excerpt from: Jeffreys (2011). Helping Grieving People. (See also: Katz & Johnson (2006). When Professionals Weep. New York: Routledge.)
I am currently on deadline for a chapter I am writing on "Family Centered Approach to Helping Grieving Older Adults" – for a volume to be published next year.  A future blog will tell you about their special needs and how to help them cope with loss and change.