Q: How do I help my older clients face the particular kinds of losses associated with aging?
A: In the bereavement groups I facilitate with people over 55, I’m always struck by the myriad losses they’re experiencing. Walt, divorced for many years and estranged from his adult son, is grieving the accidental death of his daughter, who he expected was going to care for him. Elena joined the group because many of her friends had died in the last year, and she’s worrying incessantly about whether she or her spouse, or someone else close to her, might be next. Maurice came to the group because a recent back injury had slowed him down, foreshadowing the physical challenges he believes lie ahead as he gets older. Several others in the group are bereft over the recent loss of a close friend or a life partner.
I’m a grief survivor myself, having lost my husband, father, mother, only sibling, and dog in the last decade. Sitting with my bereavement group and listening to their stories each week is a tonic for me, as I find there’s something sacred about the emotional undulations generated by deep grief. For many of the group members, however, encounters with their waves of loss are too painful to endure, and they just want their grief erased. It’s too soon for them, in the words of poet May Sarton, “to be lavish with riches made from loss.” Being with them where they are is crucial, so I don’t push my growing understanding of the transformative nature of loss. I try instead to strike a delicate balance between showing empathy for their feelings and helping them process their emotions in ways that will help them grow and expand.
It may seem simple, but one thing we do to help with this in our groups is a sentence-completion activity. It’s a good way to help people get to know one another more deeply and to identify and share feelings that may seem too overwhelming to explore. I often suggest these open-ended sentence stems to start: “Right now, I feel. . . .” “The thing that scares me the most is. . . .” “What makes me feel the saddest is. . . .” “One thing I’ve discovered since this loss is. . . .”
Another thing we do in initial group sessions is talk about “the four tasks of grief,” from J. William Worden’s book Grief Counseling and Grief Therapy. They are to accept the reality of the loss, experience the pain of the loss, adjust to the new situation, and reinvest in the new reality. This is sometimes referred to as the TEAR model of grief, which I prefer, because the word tasks implies work, and grief survivors already feel burdened. I like using Worden’s model as a conceptual base for grief survivors because it emphasizes the nonlinear nature of healing from grief. It’s a flexible approach that can be used as a map or guidepost for all survivors of grief, but when working especially with aging survivors, I’ve found three other areas of focus particularly useful.
Identify and Manage Obsessive Worry
Many people in groups share that their biggest concern is dwelling on the loss and worrying about its effect on their life. There are several simple ways to help them hit pause when this happens.
The first is for them to identify a “worry chair” in their home. Using a timer, they can sit in the chair for a prescribed amount of time, say 20 minutes. When the alarm goes off, it’s time to get up and turn off the worry. The worry chair has its origins in stimulus control, an approach designed to interrupt an ingrained habit by intentionally arranging environmental conditions that hamper the undesired behavior, like anxiety.
A second possibility is to find a word, such as delete, that clients can say aloud like a mantra when worry overtakes them. Another option is to initiate some action or movement in these moments. Since worry is primarily cognitive, one way to interrupt the “monkey mind” is to start doing something, such as sweeping the floor, potting a plant, or cooking some food. A related strategy is to engage in some form of movement like taking a walk, doing some yoga, or practicing a new dance move. These strategies may seem simple, but they help when presented at the right time and with empathy.
Create New Patterns to Cope with Grief
Sadness can erupt for bereaved survivors when old routines become new triggers for grief. For example, Anna, who lost her spouse of 40 years and considered herself a devout Christian, mentioned her difficulty in going to church alone because she and her spouse had gone there together for decades. She couldn’t get through a service without collapsing into tears and having to leave the sanctuary. Although staying at home on Sunday mornings meant she could cry in private, she felt even more bereft without church, and didn’t know what to do.
I often hear lamentations like this from grievers. Life as they knew it has been turned upside down. They long for familiarity, yet familiar things feel extremely painful. One way to address this catch-22 is to encourage them to become courageous explorers and create new patterns in their lives. What could Anna do on Sunday mornings other than go to church or sit at home? After listening to others in the group describe activities they engaged in on Sundays, she eventually developed an altered routine. Instead of going to the church sanctuary for the service, she went to the social hour afterward, then an adult Sunday school class. This satisfied her need to connect with her community, but it felt new enough not to trigger the sobbing.
Learning something new is one of the best antidotes to grief. Much as relaxation is incompatible with anxiety, curiosity is incompatible with grief. If grievers are hesitant to do a new activity alone, encourage them to do something new with a friend. The Sufi poet Rumi said, “There is a secret medicine given only to those who hurt so hard they cannot hope. It is this: look as long as you can at the friend you love.”
Develop Social Networks and Connections
With the loss of so many in-person social rituals and gatherings, the COVID-19 pandemic has made loneliness an even greater issue for grief survivors. And the grief process becomes especially hard for survivors whose loved ones have died of the coronavirus, alone in hospitals, or in nursing homes deprived of visitors, and with funerals online instead of in person. But even when we’re not in the midst of a pandemic, connecting with friends may not be easy for grievers. Burdened by the “heaviness” of grief, they often don’t feel motivated to reach out to others. It may be because they perceive others to be less than patient and understanding of their struggles, or because the spouse they lost was the hub of their social network.
Contributing to the challenge for many people is the fact that our social networks tend to diminish in size as we age. So beyond utilizing existing connections, the members of our support group often need help developing new ones. Brainstorming ways we can do this is a helpful activity and sometimes even produces laughter, a healing balm in itself. “Join the swim club and wear your new Speedo,” one member suggested, eliciting chuckles. Other ideas included volunteering at an art museum, joining a public school read-aloud program, and signing up for a virtual choir.
Animal companions can also help heal grief. When I felt most alone after the passing of my husband, I rescued a three-year-old golden retriever named Abbey. Until her recent death, Abbey was a constant companion, who held my emotions, putting her head and paws on my lap when I was most distressed. If it’s impossible to adopt a pet, fostering an animal or walking dogs from a shelter can be very therapeutic.
The word healing means to make whole, but coming to a sense of wholeness after a significant loss is a difficult process, which can’t be rushed. For many, it’s a journey without a definitive end, but when there’s hope about the future, grievers know they’re on the path to healing—and instilling hope is one of the primary tasks of a bereavement support group.
How do we help grief survivors restore hope when hopelessness abounds? It’s challenging to envision new possibilities when you’re undernourished, sedentary, and sleep deprived, so hope is intrinsically tied to self-care. Once a self-care plan is in place, we explore what hope means for each person. I often ask things like, “What has hope looked like to you before, and what does it look like now?” Or “What’s one small step you can take toward building hope?” People have said things like spending time in nature and identifying a tree or a plant as a symbol of hope, reaching out to someone else who’s suffering and being a force for good, becoming mindful of what and who sustains us—and expressing gratitude for that.
In the most challenging of times, hope is how shards of ourselves can be pieced back together. For Maurice, his back injury led to additional physical issues, as he’d feared. But as a result, he enrolled in chair yoga and modified tai chi classes, which, much to his surprise, spurred a new interest in Eastern meditative practices, allowing him to be present with his grandson in a new way. Anna found new friendships in the church social hour, which inspired her to begin a program there for other grief survivors.
While aging and loss bring unique challenges, these are not devoid of opportunities for healing. As Desmond Tutu said, “Hope is being able to see that there is light despite all of the darkness.”
PHOTO © ISTOCK / FATCAMERA
CategoriesClinical Practice & Guidance In the Therapy Room Issues & Developments Aging Anxiety & Depression Families
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