Understanding Grief (With Dr. Paul Thomas Clements)
Hello and welcome to vital views podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing on August 30th is national grief Awareness Day. It's an annual recognition of the grieving process and the many different ways people can cope or heal, which is far easier said than done. To talk about how powerful griefs impact can be, and the techniques to help process it, we are joined remotely by Dr. Paul Thomas Clements. He's a professor in residence at UNLV nursing, a forensic psychiatric clinical specialist and an expert on areas like grief, bullying, and workplace violence.
We're talking about national grief Awareness Day, we're talking about raising awareness for the grieving process, is there a right or wrong way to grieve?
Actually, that's a very good question is, a lot of people tend to think that they may be grieving in the wrong way. And what I'd rather reframe that is that people should either think of it as grieving adaptively or maladaptively. And the difference between that is, is that grief is a process that is going to be painful for many, and it is going to be long distance running, if you will, for that period of time. But it's how we go about it, when we are looking at Adaptive grief, these are the people who are able to acknowledge that it is going to hurt and that they are going to miss the person that is gone. And that they're going to have to learn to live one day at a time without that person. But that over time that they're able to reinvest into daily living with maladaptive grief, which we also sometimes call complicated grief. This is where the grief becomes so profound, that the way that people cope is actually just the opposite, instead of building support structures with family, friends, co workers or other things is that they turn to other situations, such as self medicating with alcohol, or with substances, which can be either street drugs, but also can be over the counter or can also be prescribed medications. One of the things that really confound a lot of people is that there is no pill that is going to make grief go away, there is no pill or using alcohol that's going to ever make you really forget what happened. The goal of good grief is is not to forget the person who died, it's to actually remember them, and to put it into their life history.
One of the topics when we talk about grief, and you and I have talked about this, on another occasion, is acknowledging the grief. And you said that was possibly the most critical aspect of that process. Whether you're grieving or you know, someone that's grieving, can you elaborate a little more on what that means?
Sure. So in order to move forward with a loss, we have to acknowledge what the loss is. And actually, we need to understand not only who it was or what it was that we lost, but the implications that it's going to have for our daily lives. And so by realizing that the loss has occurred, then we can start to figure out how we need to reframe our lives in order to get back into living a daily life. Work, doesn't stop family doesn't stop school doesn't stop when someone loses somebody. And when we think about it from others and support systems, acknowledging the loss is also very important. Job grief is something that a death are still things that are talked about in shadows, and with stereotype and stigma is a lot of times people don't know what to say. And so they either say nothing out of fear that they may say the wrong thing. Or they do say what the survivors and family members think are the wrong things such as plications, or sort of patronizing things, such as he's in a better place now, or we never get more than we can bear those types of things is that even though these might be beliefs that people have is when they hear that kind of thing, it often feels as though it's being brushed aside. Some of the best things that we can do and we acknowledge grief is to just let people know that we are there for them, and that we really can understand what they're going through, but that we're there to listen, if they ever feel like they need to talk to us.
When we talk about ways to console someone to help them heal. And you mentioned placating terms I see a lot and I'm sure a lot of people would agree you see thoughts and prayers that phrase continuously in the news on social media. I would like to believe that in most cases, there is some type of genuine attempt to try and be nice to try and be respectful for people that are trying to connect, what are some better ways to to discuss that with people that are in grief?
That's a very, very important topic when you're trying to help somebody who is grieving. And actually, I'm going to share something that a recently grieving person shared with me when they were tired of people saying, you have my thoughts and prayers, as they said, first you think about me, and then you pray for me, but then you need to do something to help make. And I just thought how powerful is that is, is that it's really about that doing that operationalization. And in the end, it can be a win win situation for everybody, is a lot of times well intentioned people who don't know what to say or don't know what to do, we'll say, You're in my thoughts and prayers. And what that basically often is heard by the the surviving family members is, is that you're uncomfortable, and you don't know what to say, and you don't really intend to do anything to help me. One of the things that I encourage family members who are grieving to do is if anybody says, Is there anything I can do to help? Let's make it something concrete? Such as I'm just so exhausted, could you make dinner for my family on Friday night, since their father died? My kids are having a hard time getting to soccer practice because I'm just too exhausted or I have to work or I'm dealing with other things. Could you take the boys to soccer practice on Tuesday and Thursday this week. This gives everybody something measurable and concrete to do. Not only does it help the people who are really want to help, and don't know what to say, or do to grab onto something that they can measurably do. And it also does take some of the responsibility and burden during that time of grief from the grieving family members. The person I was referred to earlier, she she referred back to that comment, she said thoughts and prayers don't make dinner on Tuesday night. And I thought absolutely so powerful. So as somebody who wants to share their thoughts and prayers, if there's anything they say they want to do to help, then make sure that you give them something measurable to do. This also leads me to something else that is a common pitfall. Over many years that I've worked is when people say if you need anything, call me, I think that we need to be very mindful that if we make a statement like that, we need to be prepared to do that as the person calls. Grief is not on a timetable. And sometimes it's at three o'clock in the morning when you're falling apart. And you remember that friend who says if you need me Call me. So if they call at three o'clock in the morning, we have to be willing and able to at least listen when they call because we did make that offer. Otherwise, if they call and we sort of poopoo them or don't respond or don't answer, it just sort of sends a message that it was just words once again, not actions.
Now this year, you started co hosting virtual grief sessions with a local nonprofit here in Southern Nevada. They're called Adams place. They help families they help grieving families and grieving children for these virtual sessions. Now that you're now we're going into eight months of the session, they do it once a month, what have been your impressions overall?
Well, my impressions as one of the the support staff is that people are extremely engaged and that they feel as though this is a safe place to share from the commentary that we have gotten from the participants is very similarly reflective is that the one thing about virtual groups is that even though it is quote, unquote, in person, in other words, people are live and they are all there at the same synchronous time. There is a somewhat subtle form of anonymity that also comes with anything virtual, in other words, is that if somebody really feels like they're going to fall apart, or they feel like that they need a breather, they can turn their camera off, they can sort of control if and when they're going to participate many times is just listening to others is some of the most powerful things that early participants find is that if it's their first or second time, they just listen. And so they're there but they also have sort of that that safe boundary of being in their own home or their own safe place in case the emotions get too overwhelming. Believe it or not, one of the very first things that we still see in grief groups is people apologizing when they cry, and it's very interesting because that you would expect to be a normal reaction and yet society still sort of seems to set up this unconscious standard of is please don't cry. Please don't cry. You know, it'll upset me if you're upset. Even in person, when we see somebody crying, we often see somebody go up and give them a hug and say, Don't cry, it'll be okay. But actually crying can be a very cleansing and healing thing. So what I would say that I've see in this group, virtually as I've seen in live groups, is that as people become more comfortable with the group dynamic, and the setting, and now with the virtual platform, as time goes on, they do allow their emotions to to show on their TV screen, and also learning to live with silence in the virtual arena is that we don't always have to fill in the words when somebody cries, sometimes we can all just be quiet together with them on camera. Also, there's really nothing that we have not been able to do online and virtually, that we haven't been able to do in person, except anything that involves touch, obviously, such as holding hands. But in the COVID era, that's something that most people would not necessarily want to do anyway. But we show educational videos, there are many of these wonderful videos online now that address various topics, we currently have somebody coming in that is going to run an entire session on mindfulness. So we're going to be actually teaching yoga techniques, and meditation and breathing techniques for the upcoming group, which can all be done virtually. And people can do that sitting in the comfort of their own chair or standing and in front of their computer screen. We also do I do mindfulness close out every month is I have a mindfulness bowl that I chime, and I walk them through mindfulness with their eyes closed their feet planted on the floor. And, of course, I keep my eyes open to get a barometer of how the group is doing this, and everybody participates 100% It's such a joy, to literally as we ended the group, and we've talked about some stressful topics, I spend eight to 10 minutes, with the ringing bowl, and walking people through shrugging shoulders, rolling their neck around breathing to the bowl, listening to the chime. And you can actually see the stress sort of melting off their bodies and off their face. So the virtual platform and especially in light of COVID has become a wonderful safe place, both psychologically but also physiologically, so there's no transmission of disease or anything like that.
And for the participant who's in a virtual grief session, they can do it from the comfort of their own home. So there is no added pressure of having to leave their room to leave their house to go somewhere and physically be with people they probably don't know. And you feel almost like you're you're in an environment where you're forced to speak. But at least that virtual option gives you that privacy and that moment where if you need to step away, you just turn off your camera or turn off your mic, and you can actually just walk away.
Exactly. And if you want to even go one step further than that. It avoids having having to drive home after being so as effectively charged is that you come to a grief group. And I used to experience this when I ran live grief groups for many years, is that people really were excited to come but then then they would come and they would let out a lot of emotion and feeling and whatever they were exhausted about thinking about having to drive home. And so the nice thing about the virtual group is is it's sort of a self contained thing is it's easy to access. You don't have to get into a car and drive. You don't have to drive home. I mean, wouldn't it be great if you could do that with going to the gym? I think a lot more of us would be a better health if we could do it. All.
Right, for sure. I want to go back to Adams place for a second, we mentioned that they specialize in helping children and families coping with loss. We talked about children specifically, when they express their grief, it can be formidable to understand because obviously they can't show it as an average adult what I would say but that doesn't mean it's any less emotional. And we shouldn't underestimate what a child's feeling and how they show it correct.
Absolutely. The general rule to think about with children is the younger they are the less verbal repertoire or less words that they have. But words are only a manifestation of what they're feeling. It doesn't mean that if they don't have the words that they're not feeling it so if I haven't learned the word anxious because I'm only five years old, that doesn't mean that I don't have that aspect of state of anxiety actually, our limbic system is the thing that controls our emotions and responses and filters out environments is with us from the time were born. And so otherwise I mean that's why children laugh and cry and and they're afraid from noises is that it's a protective mechanism. So with children well, we have three Remember is is that the younger they are, the less, they're going to be able to tell us in words, or in a social context, they're going to show us some behaviors. So what we're going to see with children is either the onset of new behaviors that weren't there that are problematic, such as temper tantrums, crying, being afraid to go to sleep, or we're going to see a regression in older children, for example, is if they're seven or eight years old, and they've never had a problem sleeping or eating, or anything like that, we're going to see a regression to earlier times. And this can be everything from sleep to eating to younger children, again, who may have been traumatized by a loss as they start to now pee the bed again, or they start to not use the bathroom on a regular basis. So what we what we really are looking for is, is behaviors that are on time, and are there any changes in that, and even for older children who do have verbal repertoires, we still may see a behavioral regression is, it's always important to remember that what children can express in words, they will express some behaviors. And this is often with very young children, how we know if they have been traumatized by a death or a loss, depending especially on the nature is of the loss, whether it was a natural death, or whether it was a suicide, or whether it was a homicide, we start to see behavioral changes in children. The three big things I would also say that are very noteworthy in children, but I want to put in parentheses, but this happens to adults too. But especially with children, since that's the question we're on is the three major signs that I've seen over my career that tend to tell me that children have been traumatized, especially including by loss, you start to see a sleep disturbance, a dietary disturbance, or you start to see behavioral, like anger disturbances. So you either have children who aren't eating way too much now, or they're not eating enough or at all, they're either sleeping too much, such as avoiding things or they are not sleeping at all, or they're having nightmares and night terrors. And then with behavioral things is that they become extremely isolated, or they become extremely aggressive. So we call this a biphasic response energy, your psychic energy can only go one of two ways, you're either going to externalize anxiety, or those types of issues, or you're going to internalize them. And it's sort of a natural coping mechanism. And so if you think back to what I just described, that's exactly what we see. externalizing would be eating too much, sleeping too much or becoming too aggressive and internalizing would be avoidance, not eating and not sleeping.
When we talk about to tie this back into nursing, as we're kind of wrapping up here. What are your expert tips for nursing students, when you're trying to teach them how to deal with grieving patients grieving families, what are the main points they should remember?
So the first is acknowledging the loss if if you know that somebody lost somebody, regardless of the method, that it occurred, the mode that it occurred, again, natural death, suicidal death, homicide death, somebody that was killed by a drunk driver, is we need to put a name to it. Obviously, most people, most nurses will immediately say I'm sorry for your loss. But we want to make sure that we give it a name such as I'm sorry, that you Your son has died or that your son was killed in this accident is that families are looking to us is that if we're afraid to acknowledge how somebody died, and maybe the horrible nature of how they did die, especially when you get into violent crimes, is it sort of sends a an unconscious message of is, well, you're uncomfortable with me talking about this. So in all honesty, grief is no different than talking to somebody about their diabetes or talking to them about having cancer, to talk to them about their blood pressure is that grief is a it is an emotional and physiological state. Number two is don't be afraid to validate that this must be hard for any family is that we don't want to say I understand or I've been there, those are those placating types of things. What I recommend is making an affirmative statement such as this must be very difficult for you or I can imagine how hard this is for you. This leaves an open in for them to express themselves. And what we have to remember is, the response is going to be different from different families, as if I say this must be very difficult for you. I may have a family that burst into tears and says thank you for saying that to a family who curses me out and says Yeah, well you have no idea how hard this is for us and It's your it's your fault, the hospital's fault that we're here that this happened. In any case, it's better that they verbalize regardless of what mode it is in sadness, relief anger, than we don't talk about it at all. The third thing I want to say to all nurses that may be listening to this is that nurses cover a wide variety of age, and experience and culture and ethnicity that we all bring with us. So we all see death through different lenses, and we have to be mindful of how does loss affects us is that for some people, as nurses, we may have been nurses for 25 years, and we've seen a lot of deaths. And so we have to be careful that we don't become callous to what families are going through. Conversely, on the other side, as I've worked with younger nurses over the years as a both a professor and a clinical instructor, but also in the field, as a, as a therapist, we have nurses who have never seen anybody die. And so they really, not only are dealing with trying to comfort the family, but that they are struggling with touching and seeing their first dead body, which may be a patient, but it's still somebody who has died. I recently had a nurse, we have had the wonderful experience of having some leadership nurses from our program at UNLV School of Nursing come with me to Adams place, and when we do the debrief afterward, but also the preparation before but mostly I see this in the debrief afterward, is one of the most common statements across all the students. And this is not just nursing students, but we've had social work interns over at Adams place and, and other interns, they're always afraid they're gonna say the wrong thing, upset the family and possibly do some damage. And actually, just the fact that they're mindful of that is unlikely that they ever would do something like that. But we're going to make mistakes. Sometimes we say the wrong thing. And it happens. But I think the wrong thing is to say nothing is when any of our families have experienced a loss that somebody is gone, and they can never come back, I think is part of our job as nurses to acknowledge that number one, number two I'll close with this part about this is it is also part of the nurses role to facilitate a good death or integration of a death for families is that it is just as important that we pay therapeutic attention to the birth of a new baby and all the joy and everything that comes with it, to bring that baby into the world is on the other end of that spectrum is that we want to make sure that that the person who dies to the best of our abilities that we're able to help those families integrate that into a good place and their life eventually and a lot of times that may start even right at the emergency room. Is that may be where it occurred is that making sure that we help the family get connected? Is there anybody we can call? Is there anything? A glass of cold water can go a long way? Anything that that shows that there's that human connection of us not just as professional nurses, but as people.
Thank you Dr. Clements, I appreciate you talking to us all the way from the East Coast. We will have information for Adams place in this episode when it launches, just so people can see what it's all about. And if they want to register for these virtual sessions, they can do so
and they have other services. I would encourage them to go to the website if we can list that as they have a lot of other services besides our monthly grief group and for children as well. But it is a wonderful nonprofit agency that is very well established in the Las Vegas area. So I would encourage people to use them to help them in their grief process.
Transcribed by https://otter.ai