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.