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- Emotions are feelings and feelings just are
- Feelings are not good or bad
- All ways people feel are valid – we are not responsible for how we feel, but we are responsible for the way that we act
- Are a loss, and
- Losses evoke emotion
- Losses involve deep pain
- How pain is displayed is unique to the individual
- Pain may not be taken away
- Pain can always be validated
- Grief is a response when enduring a significant loss
- Persons who grieve are in the process of trying to understand and adjust to a loss and how the loss will alter their life
Tanner’s Grief study reinforces
- Loss is a fundamental aspect of living around a disability
- Grief is a natural and predictable reaction to loss
- How clinicians handle patients’ grief influences these persons’ feelings about their disability,
- A = acceptance of the condition,
- M = motivation to get help and
- I = desire to improve (AIM)
- Uninformed clinicians who ignore or disrupt the grief process can interfere with optimal chances for desired change
Factors that facilitate normal grieving
- Permits the patient to have some control (which rooms to use, time of therapy, activities used in therapy)
- Provide perspective (ex. conveying that the pain will end and healing will occur
- Acknowledge the reality of a loss
- Listen to the patient, their feelings, need not be explained or defended, but must be validated.
Coping with Grief
- One model or stage of coping
- Denial, anger, bargaining, depression, acceptance
- Fluid, not linear boundaries
- Recurring loss of core dream
- Symbolic loss
Success with Grief
- The overt expression of pain is usually a good marker of success. It indicates to me that the parent/patient/client is not buttressed by denial and has psychologically owned the disorder. It requires a great deal of strength to cry in public.
- Is a reaction to feeling frustrated, afraid, or threatened
- It is also a common reaction to feelings of discomfort, desperation, or powerlessness.
- People have different ways of showing/dealing with anger
- Persons may or may not be aware of their anger
The clinician can be a source for angry feelings
- When they are perceived as being brusque, sarcastic, condescending, uncaring or even thoughtless
- Also, patients anger may be generated elsewhere, and the clinician just happens to be the first person available for its ventilation
- A pervasive feeling by the families (especially mothers) of clients with disabilities
- Occurs when parents/spouses/siblings feel that they have created problem by something they did or did not do
- Closely related to emotion of anxiety
- May be related to religious or culturally beliefs
Sometimes clinicians engender guilt
- Where else has your child been seen?
- Has your child seen a physician lately?
- What have you done to try to help the other therapist?
- When did you notice the problem?
- Where you dependent on drugs or alcohol during pregnancy?
- Why did you discontinue therapy?
Clinicians need to provide reassurance to
counter feelings of guilt, by...
- Remaining objective
- Listening to feelings of the client and the family members
- Correcting any misperceptions they have or inaccurate information they may have received, and,
- Generally helping these persons work through their guilty feelings
- Does not typically disappear after the first reassurance that “it is not your fault” or that “it is OK”
- The reduction of guilty feelings takes time and sometimes requires gaining a more complete understanding of the situation
- One of the major tasks of clinicians encountering clients with guilt is to help these individuals gain better perspectives on their situations so they can move forward with the tasks at hand
- Feeling overwhelmed be inadequate to deal with the new challenges imposed by dealing with disability/change related to the disability
- Reinforces external locus of control and promotes the desire of the patient/family to be rescued
- Sometimes the most helpful thing we can do for our clients is to not help or at least to not help in an overt manner. Overt assistance, although often appreciated, is also a statement that the recipient is inadequate and needs aid. Very often the overt aid leads to resentment on the recipients part and also to diminished self confidence
- Our goal in helping is to create independent people who no longer need help. When we have an independent client, we will have a superior therapeutic outcome.