Practice in Action: Guidance in Grief

Join us for the latest episode of the Psyched to Practice podcast! Hosts Ray and Paul dive into an insightful conversation about grief—a universal experience that we all face, but in deeply personal ways. From navigating grief tied to death, loss of opportunities, or even changes in relationships, they break down the difference between grief and depression and explore how both clinicians and individuals can understand these powerful emotions. Join them as they share clinical insights and strategies to guide you through the emotional process of grief, offering practical tips for those in need. Listen in to this Practice in Action episode: Guidance in Grief

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Transcript

 Hey everyone, welcome to the Psych to Practice podcast, your one-stop for practical and useful clinical information, masterful insights from experts in the field, and a guide to daily living. I'm your host, Ray Christner, and with me, Paul Wagner. So, Paul, today is... Kind of a new endeavor for us in that we're now being able to offer continuing education credits for those practitioners out there who are listening. And we're going to start with the topic of grief. And, you know, I think it's a good topic really because it's something that can be so applicable and, you know, throughout our lives. Everyone experiences grief in some way, shape or form. And so, you know, being able to offer something that hopefully has some, you know, some universal applicability to our listeners and hopefully able to, you know, get them a CE credit. You know, it's a it's a win win. That's right. A win win. And Yeah, I think I'm glad you mentioned the point about everyone going through it at some point in life. And I mean, I think when we talk about grief, oftentimes we tie that to possibly death and You know, I think grief can come in a lot of different ways. And, you know, we're probably maybe going to lean a little bit on Their relationship to death and dying. But we also have grief with things like maybe we move and there's a grief process or losing a job or whatever, you know. parents that have gone through a divorce and there's a grief process maybe for kids. So I think it's important to realize that brief can happen for a lot of different reasons. And because we all go through it, it doesn't necessarily mean that it's a mental health condition. And I think that's that's an important thing to recognize. And I think, you know, so often we can really kind of make this comparison of depression. And, you know, don't get me wrong. There's a lot of overlap there, especially if we're looking at the symptomology, but really the experience of grief and how it's linked to these reminders of whether it's the deceased undesired changes. And actually, I wanted to even throw in when you were talking earlier about like those different pieces, you know, even things that just didn't happen, like lost opportunities and grieving what could have been. And like, you know, oh, I was planning this and now things got upended. And so, um, when there's these undesired change and, um, It's really tied and kind of integrally linked with that where we are talking about depression. It has this more kind of persistent and pervasive quality to it. And we see it really kind of being established in a longer form. where when we're thinking of grief, grief is intense, but grief isn't the only experience that's occurring for those individuals. Yeah. I, you know, I, and I, I think that, you know, again, we, we do, we kind of tie this to depression and yeah, I think I've given this story when we've talked about this topic in other forums, but you know, it's, You know, my many several years ago, my grandmother died and, you know, the day she lived, you know, four hours away from where I live. So we kind of knew this was going to happen at some point. And when we got the news, That morning, I actually had a doctor's appointment. So it just happened to have like a physical like it was not out of the ordinary. And so, you know, we got the news, talked to my my family and said, you know, hey, we'll be in this evening. I figured, okay, I'm going to, I might as well just get my day going. So I go to the doctor and loved my family doctor at that time. Great, great guy. And, um, He was like, I said, hey, yeah, I'm going to be out of town. This happened. He's like, well, you know, hey, you know, just in case, you know, would you think you'd, you know, want me to write you a script for Prozac just in case? And I'm like, ah, now I'm okay. Like my grandmother was, you know, in her late nineties, um, you know, she lived a wonderful life and yeah, sad, um, grieving, but she, No, I don't think there's a clinical reason. And that was a real wake up call for me because I thought like, OK, wow, here we have clinicians and health care professionals who see the tie of grief and depression being this this link. And um not saying that that can't happen i mean we've seen those those individuals in therapy But I think it's an assumption that we make that there's something wrong with the sadness that comes with grief. And for me, I, I wanted to be sad at that moment. Um, you know, it was, it was the right thing for me. And I, I wanted to process that emotion and, um, You know, and I'm not afraid of my emotions. I mean, I think that's an important piece of it. So we do have to differentiate it. And we have to kind of say, OK, yeah, you may be down for a little while. And that's that's not necessarily meaning you're in a depressive episode. It is that depression. that thought and experience of a loss that's there. So yeah, I think clinically we can't jump to that. We have to be very cautious of that it's not depression. And even people who have depression going through grief doesn't mean they're having a depressive episode. And so often, if I'm working with individuals that are experiencing that loss, and I'm maybe jumping a little bit ahead in something I'd like for us to make sure we're attending to even more fully, but I think off the bat, it's important to kind of recognize like, I think more than anything, grief allows us to assign significance. And like, if we don't allow ourselves to have that experience and the intensity and the discomfort of those emotions, we can really recognize the significance of that loss, whether it's an individual opportunity movement, you know, relationship, whatever that may be. And, you know, It's been a few weeks, but there's a conversation that comes to mind where, you know, working with a kiddo we're talking about, he's really pushing back. And even like, you know, initially at the beginning of the session, we just bring up it. word grief and there's like this reaction in a sense. And, you know, we're going through and we're talking about it and kind of going into it. And one of the things that really kind of caught him off guard and I think really kind of built this buy-in to allow for the discomfort was like, you know, for me, like if I'm thinking about my losses and my experience of grief, I see it as significance. I don't want to think of that person and not feel this way. It almost feels like it does a disservice to that relationship. And I don't want that to be the only emotion. But I want there to be a significance there. And significance often isn't just assigned to the happy, positive emotion. Significance is like that. And I think grief allows for that depth. Yeah, I agree. And I think, you know, the other thing I would kind of point out with this is, you know, there's a lot of overlapping symptoms. You know, I mean, I think, you know, so someone going through grief may have things you know appetite disruption sleep issues that might come up they may have low energy they may be fatigued And and that's just all part of it. You know, and I think when we're differentiating, you know, it's easy to look at the symptoms. So if we go down the DSM checklist, it's like, oh, yeah, they meet all of these criteria. But I think the part of going, you know, what creates that emotional experience? And, you know, so, you know, with depression... you know, even in those of us that are into cognitive therapy, there are, there are days that we can't recognize the link or the thought that might be tied to that, or maybe the, the, the thought process is much more global. And in grief, it's very specific to that situation. So You know, maybe they're not sleeping because they're having dreams about someone who died or whatever that undesired change in their life was. there's a real direct link with the emotions and the thought process and the kind of, you know, reliving the experiences with that person that are coming up. So, you know, when we're differentiating it, so even if we have someone who has depression and I have many individuals that I've worked with, who i saw for depression and then there was loss along the way and that's how we differentiated it you know if you're having that those significant emotions Because you're sitting and you're, you know, you're in in the thought about that person or that loss and it's triggering those emotions. That doesn't mean we're necessarily going into a grief or a depressive episode. It's just part of our grief cycle. And the other side of that, like the I guess where they don't overlap, that ability to experience positivity and that ability to. really kind of form those other connections within the reality, so to speak. And so, you know, where depression does have this pervasive like almost undercurrent for us. Grief is that targeted piece. And when we're there, it's intense. But when we're not, we can experience connection. We can experience joy. And I think that's an important marker to look out for as well. What are the other emotions experienced when we're not attending to that loss? And maybe even in grief, there's times that we have positive and negative emotions simultaneously. You know, it's, uh, yeah, I, I, a recent, you know, experience in my life was my father-in-law and, um, You know, I remember being sad and that kind of just, you know, the heavy emotion. But also... hearing stories about him and, you know, and, and laughing and crying almost at the same time, which, you know, it, you know, so I think that's another piece that we got to pay, really pay attention to. Yeah, we, we will, we'll have positive emotions and, and, it's important that we tell people it's okay to roll with the emotions, you know, that there's, you know, you don't have to be sad the whole time and you, you can have those good memories. And, it might you know gosh you may go through you know three or four uh experiences in in a minute where it's happy sad and all of those that's okay i mean i think and normalizing the idea that Yeah, we're going to have a mix of emotions. And I think we can even want the experience while experiencing grief. Like I'm thinking some individuals I've worked with where, you know, they're going through a separation out of a relationship that was a longstanding relationship. And all in all, the separations... they view it as a positive thing. Sure. And yet they're grieving the change. And, you know, they're not, when they're saying that, like, that I want it back, but it's, again, it's significant. It's something that, and I'm recognizing that significance. So I, I can actively be wanting this to be happening, you know, the change to be going on, but it's The experience of loss of what that change represents, that's the discomfort. There's the grief there of like kind of the stability or the consistency that that offered. Yeah, I think that's a great example. I mean, you said that it cued me to, you know, I have a young guy that I'm working with whose parents are divorcing. And in some ways, he's actually... I don't say happy about it, but there's a positive piece to it. Separated, his parents are both better people. when they're separated than when they're together, the conflict has decreased, but yeah, you know, he's grieving the change and he's, and he'll say, he's like, how can I be sad about it? But also know, wow, this is like, my relationship with each parent's better now because they're not so stressed out. So I'm glad you brought it up with, I think, you know, those kind of like divorce, I think is one where, yeah, we'll see those positive and negatives kind of simultaneously. And I think that's why it's so important to think of grief as like an individual experience and an expression. And there can be variations even for the individual and an individual. It's something that I think can often be informed, you know, culturally or societally. And so we have to kind of recognize as clinicians, like there's these two, potentially even three different like you know, maybe they're all aligned or maybe they're conflicting roles. You know, if there's a, a strong emotion, but you know, almost an expectation of stoicism or, you know, if there's an expectation of emotional, like, you know, outpouring, but it's, I'm at, you know, at a loss or, you know, the emotion I have is relief. You know, I might not feel like I can express that. And so, you know, making sure that we're really tailoring our experience and our, you know, our support of the individuals we're working with to their experience of grief. And we can't I think grief is what we're seeing. Grief is universal. Grief is also very individual. And so it's a universally experienced individual experience. Yeah. Wow. That was a complex sense. Yeah. It's no, I mean, yeah, I think the, you know, we do, we, you know, the idea of understanding, you know, and learning about their culture. I mean, I've, you know i've had people that i've seen where you know part of our discussion about grief is to really understand what their family's process is or their their cultural you know i've i've worked with you know jewish families that they sit shiva for seven days and what that process is like for them and You know, that's not something that in my life I experienced, but hearing that process and the the respect and reverence that that that brings in the process and that's what when you said that it reminded me of that where You know, there was, you know, the staying home, we're caring for ourselves, keeping our thoughts with, you know, the person who had died and just such a powerful thing. cultural process and then you know i i think i probably going to say it wrong but you know the 12-month process i think yarzat is how it said something maybe close to that where then you know at that 12 month mark you know it's that that idea of you know kind of celebrating the person and it's kind of like an anniversary that we we recognize that may be very different for somebody who's agnostic absolutely but understanding that i think is really you know and and not assuming i mean i think sitting down and just listening i've had Patients who are Catholic, I happen to be Catholic, their family's process is different than mine. um you know i i had a gentleman a few years ago who um is his latinx and his family are catholic but there's a lot of cultural pieces we're very different so i think we have to ask in and that we shouldn't have expectations of a person's reaction You know, it's where, you know, we, we may have somebody who they don't crop. Yeah. They, they don't. And it's, it's part of their personality. Yeah. And I think there's an assumption that can get made that we're not grieving if we don't. And yeah, I... That's, you know, that's definitely not the case. I mean, we're all going to do it a certain way. I've had, you know, people who said, oh, my gosh, I thought I would be really upset. And. I'm not, I'm sad, but like, I haven't cried. And everybody's telling them, you know, oh, you have to cry it out. You have to cry it out. And they're like, No, like I'm sad of the loss, but the time was right for this to happen. And there was an acceptance, which we're going to talk about a little bit later, but they accepted it where. The emotional level wasn't necessarily high, but it's a misconception to think they're grieving. And I'm going to say grieving wrong, because I think that's what people, we expect people to grieve a certain way. We have to think about that different. And... I think one of the most valuable things that we can then, you know, offer in the therapy setting is really working to bring this kind of like I think the first part is self-awareness to grief, to the emotional expression that it is. And, you know, through that working to normalize the grieving process. And, you know, I think there's a variety of ways of doing both of those, but you know, especially, you know, for self-awareness, like when we know differences, you know, well, one recognizing the change. And so if it's, you know, if it's a death, that one's, that one can be pretty apparent, but so for some of those other ones that maybe we don't put as much significance on, you know, culturally, you know, if it is a you know, a lost job or something like that, like that's going to have a huge impact. But we might not think of that as, oh, I'm grieving the loss of this or I'm grieving the loss of stability. I'm grieving, you know, again, this this change that's occurring. And so really working to identify with them, like, what are these changes that we're noting in terms of like, again, this strong attachment to the change itself? And building this ability to kind of be self-aware. And so whether we're promoting mindfulness, if it's journaling, even just kind of sitting and being, you know, like, And really working to be more self-aware and self-reflecting. I think that, you know, we're going to do our clients a service by encouraging that time and them taking that time so they can grieve rather than it maybe being something that it's just kind of brushed over. Yeah, and I like the idea, you know, using the term self-awareness. It's what I use often with people because we're being aware of multiple aspects of our life. So we kind of highlighted emotions here in this kind of first part of this. But we might have people that have a thought process that's involved in their grieving that could be intense, where journaling can be really kind of helpful. um but there's also a self-awareness of our behavior you know are they becoming maybe a little self-destructive afterward or um or or maybe they they change their behavioral patterns completely I've had, you know, I've had people who, you know, stop hanging out with their friends and they, you know, so this idea of self-awareness, we really need to, I think, as we're working with individuals to, getting them to be aware of not only the emotional piece, but what are the thoughts that go through? What are your worries about the change and what that might bring? And also monitoring you know, how are we acting different? You know, socially, are we eating different? Are we, you know, maybe for somebody who they would exercise, we're not, All of those factors are, I think, part of that self-awareness piece and important to address. And then that gets us, you know, kind of back to what we said before. Everybody's going to do it differently, you know. I don't know that there's a normal way to grieve. I think that, you know, there's ranges that we we all kind of fall into. So that self-awareness is a great technique to get get people to find out what is their process. And, you know, one of the, I think I mentioned this individual earlier, but the one who was really resistant to even the word grief. And, you know, I noticed that when I, it has first brought up that they've experienced a loss. And parents are kind of telling me about there's a struggle with talking about grief and reactivity. There was this outburst in the office. And one of the first things, you know, It's kind of left and like kind of processing. I was like, it's like, what was that about? Like, oh, well, like this thing was annoying me. Okay. Like I get, yeah, that thing traditionally annoys you. It hasn't annoyed you to the point where that's been the reaction. And to me, I'm thinking that this is related. And so, again, just bringing that reflecting and there was an acknowledgement, like, yeah, you're probably right. Didn't want to say, yes, that is what's going on, but at least kind of acknowledging and recognizing there's this change in my behavior. So yeah, I think... Knowing our clients well lets us be better at self-reflect or helping them self-reflect and even maybe pointing out things that we're noting or hearing differences in those reactions there. Yeah, it's a great point. I think that it's, you know, being able to really just kind of highlight what we're seeing or what we're hearing and then letting them really kind of connect the dots i think is is you know again kind of a helpful process so And, you know, I think going into like that with the self-awareness piece and like when we can build off of that, how we can then really work to normalize it. And There's not a normal way of experiencing grief, but grief is because it's, again, I think a universal experience, something that we can really be empathic with. And so being able to share, you know, if an individual is sharing about a time. that they've experienced loss. I don't know the individuals that they've lost. I don't know the opportunities that they've lost. I know the individuals I've lost. I know the individual or the experiences that I've lost. And while certainly they're not the same, we can, I think, apply some of that empathy. And in doing so, bringing awareness to, you know, this process being a normal experience and almost in inviting it in in a healthy way that can say like really recognize. So I think empathy in this moment is such a valuable tool and being able to share a sense of understanding without saying, oh, I know what it is that you're experiencing, but I don't know what it is to lose that person, but I know what it's like to experience loss. And so I can connect with you on that level. And I think that ends up being a really valuable tool there for the individuals we're working with. Yeah, I mean, I think as a therapist, empathy is, you know, there's just such a valuable piece that they have. that brings to, I mean, not only grief, I mean, I think a lot of, a lot of areas, but it also, I think by doing that, it, it lets people feel, be in the grief a little bit. And, you know, I, you know, I find that it's, you know, in, in therapy, you know, we're trying to decrease symptoms, right? We're trying to, and, and I, my belief, and I think there's, you know, some research that would kind of support this as well as, This is not one of those things that we're trying to necessarily take away. We're trying to be empathetic and understand and to be honest to have people stay in it for a little and not rush through it and be okay with the fact that they have these emotions and they have these thoughts You know, there's this and, you know, when when we had our time on the Hey Kiddo podcast, we kind of hit on some of this. But, you know. we oftentimes hear people say, you know, it's okay. You know, you're going to move on. And, you know, even something as simple as those words, um, you know, really difficult kind of, uh, I think, interpretations, you know, you know, I oftentimes will tell people, you know, in time, you're going to move forward, but we're probably not going to move on. I don't know that that's, you know, and I think moving forward is different. The loss that we have does carry with us. I brought up my grandmother at the beginning of the show here. You know, she died in 2009. I still know the day that she died. I still on that day, I'm a bit heavy hearted and I have that that piece. I have moved forward. Like, I don't live in that space, but I carry part of that with me. And I think the idea of moving forward does have, I think, a better connotation. Something I oftentimes talk about with people is you're going to you don't have to rush through and all of a sudden be, OK, I'm going to. Get back on into life. You're going to you're going to move forward. You're going to do what you need to do. And some of this is going to stick with you for a little bit. And that's OK. And I forget the individual that, and it may have been a training or a class, but they brought up the idea of brief doesn't shrink. We just grow around it. And I like that idea because it's, yeah, it's always there. And even the idea of it shrinking kind of means like, Oh, it's going to go away or, you know, we're not going to recognize it. It, But if we're wanting to, we can go and steep ourselves in it. And I don't know that that's always a bad thing, but there's so much more room that we can also explore that isn't that. And that's the growth that we can experience when we're grieving. Right. And I think, you know, these these ideas or these techniques of having people be self-aware and us being empathetic and, you know, creating a safe space for them to be in and discuss their issues. the grief process they're going through. I think that's how we help people move forward with it and kind of let it grow around them. You know, it's, you know, we're, Again, we're not trying to take it away. It's an okay process to go through. And I don't really necessarily have research to support this, but I have found with individuals I've worked with, When we take that approach, that process of moving forward seems to happen faster when we let them be there and we let them be in it. And I say, listen, it's OK. Like, feel that way. Let yourself go. be there and experience the emotions it it's not that they get stuck there it's just their they need time to process it and we will see that you know over time we'll see them kind of Go, OK, like, yeah, it's still with me, but. My life's getting to what my new normal is going to be. And if you think like if we have a major surgery, we don't go into physical therapy the next day. Right. We need the time to be able to recover before we can start then putting in the effort to renormalize and like regaining some of that footing. Yeah. And we'll still have the scar again, but it will then be a scar and it won't be as painful. Yeah, that's great. It's a great kind of analogy for that. So. And, you know, I think when we're talking about this, like. Brief can be such a nebulous thing that I think at times, especially earlier on when I would work with individuals in my career, like I was overwhelmed that I didn't really quite know like, you know, is this grief or is it not? And, you know, in doing preparation for this episode, you know, there are assessments out there, like assessment tools that I do think are, you know, do have value and do have a place because while grief isn't, you know, There's no normal grief. There are markers for grief that we can recognize. And so, you know, there are tools like the Inventory for Complicated Grief or the ICG, on the prolonged grief disorder scale the pgd as well as other tools such as grief experience questionnaire or the texas revised inventory for grief and You know, I think that these are important pieces that can kind of quantify or give us a bit more like that more specific data. And I think this is a really important thing for things like research on grief, because We need a way for it to be, you know, reliable and valid. And we're talking about the symptoms. I do think that individual experience is also a piece of it. And, you know, I'm thinking back to a I pull on the episode quite often, but with Michael Alcee and he talks about, you know, we as clinicians are both scientists and artists and, you know, we need to kind of marry some of that research with also the art of therapy. Yeah, I think it's a key. And, you know, I would say I don't believe that everybody we see with grief, we need a standardized measure to use. I find them useful. For people who are trying to understand their grief a little better and where, you know, maybe it goes back into that psychoeducation a little bit, right, where it's like they they're trying to to understand where they're at and. And while we can get a lot of that through a clinical interview, sometimes that objective kind of measure to go through and answer these kind of true and false or Likert scale type measures, it gets them thinking. And, you know, I don't use them often, but when I have, it's, you know, I always ask people afterward, you know, so what was that like? Like to see, to kind of go through all of those kind of items that are kind of different aspects of grief. And, you know, I think the part that's really helpful is I've had many people who will say, you know, things like, gosh, I've been doing this for the last month and I didn't realize it was tied to my grief. I was, you know, yeah. making it an assumption it was something else. So it's a great way, you know, I don't think we need tools to say someone's grieving or not, but tools to understand it and then to utilize those not just from hey you have a score here you're grieving but to have a discussion with the person and help provide a good psychoeducation about their grieving process. That's where I think those tools have incredible therapeutic value. But the art of it comes back to our clinical interview. Yeah. And, you know, talking about like that, those objective measures, I know that There are models out there. And actually, there's, I think, some very popularized ones. And I think that, you know, some pros and cons to the models. You know, I think the one that I was most familiar with was the Kubler-Ross, you know, talking about the five stages. And so we have denial, anger, bargaining, depression and acceptance. And, you know, actually, again, a little bit later on in my career, being exposed to the warden's tasks of mourning. So that acceptance of the reality of the loss. process the pain, adjust to a world without the deceased and find an enduring connection. And, you know, I think both of these aim at really working to identify like, where's the point of this process that I'm in? And I think it's a worthwhile effort, but you know, I'm building a lot of callbacks, but I believe, um, our episode with Sandy and Brian on treatment planning, um, I think it was Brian who said, uh, Phases, not stages. And I think especially when we're talking about Reef, Reef is such a fluid experience. You know, I think you said we can go through. three different emotional experiences within a minute. And so to think about, oh, well, I'm in one static stage, I think is challenging. So I actually like to draw it almost like as a I have different points on my whiteboard and we talk about, hey, you know, you could be here and then jumping around and identifying, like, what are the ones that tend to fall off a little quicker? What are the ones that kind of hang out a little bit more? And, you know, I think that helps to kind of normalize that it's not just this goes through each stage and then we're at our acceptance point or, you know, we're at our connection point, but rather how we can kind of ebb and flow throughout these phases of grief. Yeah. And I, I, I like the, I love the term phase definitely better than stage. Cause I, the more I get in my career, I find there's less stages that really have. And we really do kind of, you know, and the piece I like about it is that, again, kind of tying all this back into the kind of how do we educate individuals? You know, I talk with people and say. you know, we may go through these, you know, Kubler-Ross stages and say, yeah, okay, you had this anger stage that, you know, kind of happened after. And we've kind of gone through and we moved through that process. And maybe that person's even in this phase of acceptance at the point that we're having this conversation. But it's a great point for me to say, you know what? It's this is kind of like skiing, right? Like it's when we're really good at skiing, we can slalom down the hill pretty well. And, you know, we're going back and forth and it's really simple. But when it becomes too difficult, we start snow plowing to stop the same way we did when we were starting. And these grief phases kind of work the same way. We may be at a point of acceptance and then the stress in our lives go up and all of a sudden we're snapping and our anger comes back. And, you know, when we process it, they'll go, my gosh, like this, this brought up this, you know, this thing with, you know, my father passing away or whatever it might be. So when we understand these phases and the fact that developmentally we're Yes, it gets easier, but yeah, we might fall back sometimes and we might even get that depression piece. We may even bargain again at some point in that process. You don't have to go through them one after the other. Not a linear process by any means. Not a linear process. what a kind of a reference I'll bring up. It's an old school reference. Probably people, some people have read it, but one of the books that, that I actually think's really interesting about grief is, uh, when bad things happen to good people, um, Harold Kuchner, he's a rabbi, wrote the book many years ago. And there is some religious kind of pieces to it, but not necessarily, it's not necessarily just kind of ideas of Jewish religion, it really is good for really, I think, anyone and even people who wouldn't be who have no religious affiliation. But that book, I think he does a really good job of kind of talking about Kubler-Ross's work in a way that's not stage specific. So something that if you haven't read, I think it was published in maybe early 80s. I guess it's pretty old resource. Still relevant today. Great, great book to look at. And, you know, as we're talking and especially with bringing up, you know, Cooper Ross and really that phase or stage of acceptance, I oftentimes find myself when I'm working with clients, I really want to kind of sit in that idea of acceptance and talking about you know, what does it actually mean? So like, you know, we're sitting there, I'm like saying acceptance. I try to ask, I'm like, when I'm saying that word acceptance in this context, what does it mean for you? And I was like, I don't even know. Like, and it's like, you know, I'm good with what's going on. I'm like, OK, like, let's step back. Do you think you're ever going to be good with, you know, the loss of a loved one or, you know, this lost opportunity? And are we really setting that up as a realistic expectation or going back? And this is kind of the, when I was talking about what grief does for us in, you know, Creating significance. I think it also helps us kind of like creating significance or meaning in circumstances. And so trying to challenge that more of like, oh, I'm willfully wanting this to happen in versus like I'm recognizing it has happened. And I'm also then working to recognize the significance of what that transition means. And I think in doing that, it allows us to kind of maybe make new narratives for ourselves of like, OK, if this defined me previously, what now defines me? Or, you know, if this individual was my role model, how do I then still kind of bring them into my life in a different way? And so, you know, many conversations with individuals where we talk about like you know anxiety triggers you know just thoughts of like oh when my loved one passed away and i'm viewing them there on their deathbed and like it's like yeah no like that that is such a hard moment and yet if we can think about also the grieving process and like that ability to make meaning and significance, you know, we're bringing them into this present moment. So, you know, they're living a life beyond that life. And, you know, they're now here influencing your thoughts and you're able to then carry them into this new circumstance. And so really trying to help redefine some of those pieces of what acceptance means. And I think it can be also a very culturally, you know, significant piece we're thinking about. religion or we're thinking about, you know, beliefs about the afterlife or even beliefs about like why things happen, we can again, we can work to place significance and work to make meaning. Yeah. Yeah. And it's, you know, I think the idea of the acceptance piece specifically, you know, it's, you know, there's that, that kind of two pronged, kind of aspect you know it is the acknowledgement of what's happened and we know it happened but you know it really is kind of again i keep using the word sitting with but it's like you know, really bringing it into our reality and letting ourselves truly process what happened. but the other piece that you really talked up is that that how do we integrate it in the rest of our life and you know so acknowledgement and integration are really key aspects of acceptance you know it's um You know, we said it earlier, you know, it's not this moving on. It's not that piece of it. It's, you know, how do we how do we bring it into our life and And I, you know, I use a word similar to what you do. I tell people, you know, it's, you know, their their life carries on with us. You know, there's there's pieces that everybody and when we're not talking about death. I even say experiences. You know, I think we've all heard somebody say, oh, I wouldn't change my life, even the bad things that happened in it, because we're all, I think, shaped by them when we do accept them. Like, you know. Yeah, maybe we didn't get in the college that we wanted to get into. It could be a grief piece. But maybe the college we went to, we connected with a professor that let us do different things and pushed us to a different level. And while we were grieving the fact that we didn't get into the ideal school, there's that part that cause of it. It actually helped us kind of move forward. We accepted the fact that didn't happen. And we, we, took advantage and moved forward with the opportunity that was presented to us. So we can do that, I think, with a lot of aspects. And I think to that, like one of the things that I think I do it both actively and passively, but this is actually something I try not to actively name, but rather passively encourage and build recognition of it for themselves is like, recognizing resilience and like, you know, how we are resilient in the experience of grief, you know, going throughout the process of it. And, you know, in doing so, how we're able to get moving forward is resilience. recognizing it, you know, this hard moment is a moment that's resilience, you know, not getting to that college you wanted and persisting further. It wasn't a stopping point. And, um, you know, it's one of the things that, uh, I like to talk about and use a lot of metaphors is, you know, if we're in a in a maze, even if we take a wrong turn, That's still progress. You know, that's still us moving forward. Really, the only way we don't is if we stop. Like eventually, if we take every wrong turn we can, we'll find our way out of a maze. We need to be able to have that persistence and the resilience when we hit a dead end. All right. How do I view this as helpful information and a helpful experience rather than feeling defeated? And I think if we can work to empower our clients or those individuals we work with to foster that resilience, I think we're doing them a good service. Oh yeah. And I, I, I always, the word resilience is, is always kind of a mixed thing for me because it got so popular. It was like, we, we actually, I was, everything was resiliency and I, But, you know, the root of that term is is so meaningful because I think sometimes we forget how we how resilient we are just naturally as human beings and that. in at the end of the day we we have this capacity to do it i mean kids are the greatest example yeah i just they amaze me like i see kids overcome difficulties especially at a young age. They don't even think about not finding ways around them. So yeah, resiliency is, I think, a great piece when we're talking about this idea of grief. And And maybe it's not something we really have to teach people. We just have to make sure they're aware that part of who they are. You know, it's we all have it. And sometimes we forget it. And sometimes we get into a sense of going. How am I going to get through this? And at the end of the day, we do. And I love your metaphor because, yeah, maybe we're We're driving a road that looks like, you know, twists and turns and off ramps and roadblocks. Yeah. And I think one of the important distinctions in talking about grief and even like that resiliency, resiliency isn't resignation. You know, and acceptance isn't resignation. You know, it's not something where we are just kind of like passive and it's like, well, you know, it is what it is. And like, I think it is what it is, is such a. important and also like I have a love hate relationship with that statement because like yes but also no like if we're allowing it to be it is what it is and so I'm stopping what's the point That's the resignation. And that's the piece I think, you know, again, as clinicians, we need to be aware of and looking out for, because if we just hear that statement, we're not kind of questioning further. Well, what does that mean for you then? Well, what's the point? okay, well like let's maybe push and, you know, try to explore that a bit more, but it's like, Hey, it is what it is. Like, It's not going to change. I got to do something different. Okay. Yeah. No, there's some resiliency. You know, we're creating movement. We're creating change for those individuals and helping to foster that. Yeah. And I, I, I actually, I'm with you. The is what it is kind of, again, one of those words for me, I'm like, are those phrases? But I, I, I tend to move people past that terminology. I actually will say, let's just acknowledge that what happened, happened. Let's just, it's not, it is what it is because it's, But it is an experience that we've had. And let's just stay there right now. And again, acknowledge it, accept it. And then take a second and go, okay, now what? You know, it's, it, it's, We have to figure the next, you know, again, back to your metaphor. We hit a roadblock. What's the next turn that we're going to take? It's going to help us through this. And in some ways, not only resiliency, I think it creates a problem solving for people. You know, where it's, you know, I've had people who go, I don't know what I'm going to do. Like, I relied on this person for all of these things and, you know, I'm stuck. And you go, okay, this is a problem-solving process. You know, it's... This has happened. This is where you're at right now in your life. And what are the things that we can start going through? And I'm not saying that we do this week one after somebody's grieving, but it's it could be throughout a year's process that things are happening that they're trying to get through. But, yeah, I think, you know, we do have to get that. It is an experience that we have to acknowledge and then move forward on it. And I love that you brought up the problem-solving piece because I think, again, that's an area where we as clinicians can really... Flex your muscles a little bit. You know, that's that's what we're there for is to help, you know, someone with problem solving in a sense. And so how can we work to sit with them? And I think, you know, there's so many different even therapeutic modalities out there, you know, cognitive therapy. huge influence with problem solving, being able to attend to these thoughts and, you know, whether it's in reframing or restructuring thoughts or even, you know, taking different approaches, working to experience exposure, like all of those different pieces. It allows us to have problem solving. Really, another great one, I think that is very applicable here is acceptance and commitment therapy, you know, and, you know, with that ability to kind of blend the mindfulness, the behavior strategies and like really working to have that like, OK, how do I accept my grief while still working to be committed to what my resolve is, whether that's based on my values or my goals? And yeah, it doesn't let us kind of hit doesn't let us stop fully at that roadblock. We're stopping. We can get angry. You know, we can sit in our car for a while and be really frustrated with the construction or whatever that may be. But it helps us kind of make that U-turn and, you know, find the new path. Yeah. And I think, you know, you mentioned two things there, the ACT piece of it, the mindfulness piece. I'm going to throw the CBT piece in the kind of basket here as well. And I think when we're talking about kind of research and why are these techniques full with grief, Um, it it's because they, they both have two components that we've repeated probably 10 times here. Be present, be right in, right in the moment that, you know, Let's stay here for a little bit. Let's sit with it. And then what's next? And what is, you know, maybe what's next is, going to take a week off and do nothing because that's what i need and maybe what's next is i want to get back to work because that gives me a routine that i like and again no right or wrong answers but all of these are those three really i think when we look at research on it why are they beneficial and it goes back to those components um we're we're not trying to you know solve every aspect of it. We're trying to just help people. What's the next step that you feel that you're in the moment? And addressing again, Talk about emotional or self-awareness and thought awareness and behavioral awareness. All of those aspects all kind of fit in with these. So the research, I think, is pretty consistent that they they work. But I'll say that they're not the only ones. I mean, I think there's, you know, I think ones that I'm probably not as experienced in is, you know, different types of narrative therapies and expressive therapies. Uh, you know, I, I, I know there is some research around art therapy being very effective in both children and adults. Um, my stick figures don't work well in that, in the world of art therapy. Yeah, but yeah, I mean, I think that, Again, it's those modalities of therapy, they can possibly be not effective, but if we're using them in the same way, again, hitting those key pieces that we've talked about throughout this episode, Any of those therapies can also bring a great value. And, you know, when we're talking about this, like, promoting resilience, like, you know, encouraging our clients to meet their own needs, you know, through that, you know, what's next. I think also really working to inform the psychoeducation because like, what are the barriers? Like, what are those things that are gonna make it hard for us to be able to experience what's next? And like, you know, there's so many different pieces with grief, but I think two of the more common ones are like, And we feel guilty over, you know, over the loss, whatever that loss may be. And, you know, it's maybe even kind of like there's some cognitive distortions occurring with that guilt. encouraging some of that reframing and, you know, Hey, are we magnifying and minimizing here? What's going on? And, you know, we can, I like to encourage like, I want you to feel guilt, but I want it to be a helpful or productive guilt. Like if it's, all or nothing guilt, oftentimes that's just not going to be effective for us. And, you know, it can then also then lead to that anger. You know, it's maybe not a fuel in the best direction, whether it's anger at, you know, especially anger at ourselves. And, you know, as a Kubler-Ross, anger is a part of the process. It's a phase. But also recognizing, while it can be a great tool to help promote change. It can also be one that if we don't allow it to promote change, it can turn into resentment. And I think resentment then is and it keeps us stuck. Yeah, I think those, you know, addressing those barriers are absolutely necessary. And You know, with with the idea of of anger and guilt, it's, you know, really trying to get to talk about restructuring, but really understanding where those thoughts coming from. Yeah, that's. You know, maybe they're not angry at the person, the deceased. Maybe they're angry at God. Maybe they're angry at whatever. Maybe the guilt is, man, the last conversation I had with this person was X, Y, or Z. So it's it really is trying to to utilize those cognitive strategies to get where that thought starts. Yeah. People because it's not often like I find with anger and. with guilt. It's not related necessarily to the death itself. It's usually something that happened earlier. You know, gosh, like, you know, I wasn't around for the last year because I just kept working too much. And, you know, so the days they said, hey, why don't you join me for dinner? I said, I got to work late. And there's that regret that kind of happens. So making sure that we're using those techniques to, to get to kind of the root of that, I think is important. Yeah. I want to, I want to bring up one last piece as we're kind of wrapping up here too, is, you know, We didn't really necessarily at this point talk about the fact that, you know, the recent addition of DSM-5-TR, we now have grief in there as... Yes, we're going to call it a diagnosis. I'm not sure. I love the term that grief is a diagnosis. But really specifically, DSM has talked about prolonged grief. Yeah. you know much of what we've talked about so far are strategies to deal with grief i think more in the the immediate time frame and i'm saying immediate 12 months, so maybe the first two months. But when we're talking about prolonged grief, we're talking about really those significant and maybe at times severe kind of still reactions that happen over a long period of time and and you know while some of these same strategies can be helpful you know i think we have to also acknowledge there there are some um you know people doing things like short-term dynamic therapy, that when we're seeing prolonged grief, that type of an approach might have a greater impact for people. Again, it really just depends on the person, but I think in the short term where we see these therapies under the cognitive behavioral umbrella being helpful, when we start talking about prolonged grief, that there may be some other options where we need to explore as well. And, you know, it's such an important piece because like grief is a diagnosis. I think I'm in the same boat as you where it's, I like the idea of a diagnosis being like a common group of symptoms that we can identify and work to like, you know, distinguish and giving someone a name for something. But when we're taking it on, is that... label and labeling something that truly is a universal experience, it does feel like there's a concern there. And I think a piece of that is, oh, well, we know our clients and they know. So again, even going back to like back to you know one of our other episodes that actually we're going to be offering as a you know for ce credits the case conceptualization like you know when we're doing that you know clinical interview when we're kind of gathering that information like understanding what are some of the fundamental aspects that are crucial in this impairment and being able to then offer support. And so if it is prolonged grief, how does that differ then from how we're treating a depression diagnosis? vice versa. Yeah. And I wish we could maybe this is an episode down the line, but I wish we had more time to really talk about when we're saying the idea of maybe not agreeing with the diagnosis of grief. you know, I, I'm going to go back to, it's a, it's a normal process and, and that's, that's my concern, but I, I will throw a reference to people. So to, you know, because we may not get to that for a while um i encourage people to read alan francis's book saving normal and so for those who don't know alan francis He was the head of the DSM-IV committee who, during DSM-V, resigned his position because he was not in agreement with the fact of pathologizing what he saw as normal behavior and normal experiences. And his book is, I think, really great and so for those that wonder maybe you know hey why are they kind of saying they're questioning the idea of diagnosis um not questioning that there are people that go through prolonged grief but It's a very delicate idea of pathologizing normal experience. And so I'll defer to Alan Francis for those interested in kind of digging in that a little deeper. And maybe we'll tackle it down in another session. Well, and with this being one of our first episodes that we are working to offer CEUs with, we're still in process. And so if you're listening to this episode at drop.com, Um, I don't want to promise that the, you know, the exact link is going to be up, but please check out our social, because if you're listening to this, you're like, Oh yeah, no. Once you try with some credit for it, you know, check out our website, you know, being able to sign up for that and then being able to register for the course. And then, you know, we have. 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So we're excited about this. I think it's, you know, it's a great opportunity for those who do listen to, you know, take it, take it a step further for themselves. Well, and with that, we hope you enjoy this episode. We'll be back in two weeks, but until then, be well, stay psyched. All right. All right. All right. The information contained in this podcast and on the site to practice website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, educational, or medical advice.com. diagnosis, or treatment. Please note that no professional patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the hosts, guests, and listeners of this podcast. If you need the qualified advice of a mental health professional or practitioner, please contact services in your area. 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