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Grief is the personal experience of loss. However, it is not just the loss experienced through the death of a loved one. Change, illness, or the loss of hopes, plans, and dreams can trigger the emotions associated with grief. Seldom, however, is the sorrow of caregivers acknowledged by caregivers themselves or by others. By developing an awareness of the emotions inherent in care giving we can develop creative healing strategies to help caregivers work through their grief experiences.


The Many Faces of Grief
We experience grief in more ways than just sadness or crying. It can impact us physically, emotionally, socially, intellectually, and spiritually. Physical manifestations often include exhaustion, tension headaches, tightness in the chest, and a wide variety of stress-related illnesses such as ulcers or colitis.

The many emotions of loss can take on a "roller coaster" quality in our lives and can include feelings such as anger, depression, fear, anxiety, helplessness, and guilt. Socially, we may find ourselves withdrawing from friends and loved ones, unable fully to take part in social activities or activities that formerly brought us joy and meaning.

Intellectually, grief can impact our ability to think clearly, to make critical and even everyday decisions, and to remember details. And it can affect us spiritually. We may find ourselves questioning our very beliefs and values and the meaning and purpose of our life and work.

 

The Nature of Caregivers' Grief
The loss that caregivers experience is unique to each caregiver. However, most caregivers will acknowledge experiencing the emotions of grief when

  • they witness the pain, sadness, and difficulties of others on a regular basis
  • the painful experiences of others tap into their own reservoirs of unresolved grief and pain
  • they are emotionally "attached" to a child or adult who dies or becomes ill

When Things Get Too "Heavy"
Caregivers need to care for themselves with the same sensitivity, compassion, and empathy they give to others. It is as if within oneself there is a "bank" of wisdom, love, compassion, concern, and emotional energy to give to the job each day, and one cannot continually "withdraw" from this bank without making some regular "deposits" to replenish one's own innermost being.

Nurturing oneself physically, emotionally, and spiritually can often prevent occupational "burnout." Graciously allow others to give help and support in the course of one's own care giving. Become comfortable receiving help. Also critical to healthy care giving are setting limits and clear boundaries and learning when to say "no."

On a regular basis it helps to ponder "What have I learned from this situation/person?" as well as, "What has this family/child/colleague learned from me?" Seeing care giving from this perspective offers meaning to our daily efforts, particularly on days that seem futile or when we feel helpless. Many caregivers find themselves becoming too attached to the outcome of their efforts, trying too hard to "fix" things or "make them better." By focusing only on the end results, they lose sight of their gifts of caring and compassion. Learning to be satisfied with the offering of your gifts, rather than being concerned with how others receive them, can make caregiving more rewarding for many people. As caregivers, it may be helpful for us to reflect on the idea that a moment of love shared with another human being can be our greatest gift.

Unfinished Business
Dr. Elisabeth Kubler-Ross, renowned for her work on death and dying, has defined "unfinished business" as "something that is incomplete in our lives that deprives us of a sense of peace." It is almost always about relationships and includes things said or unsaid, done or not done. Unfinished business is often reflected in statements that begin with "if only" ("If only I had said `I love you' before he died...."; "If only we had taken that trip we dreamed about...."). This is classic unresolved grief.

One can also "collect" unfinished business in daily interactions with others by not expressing honest feelings at the time the feelings arise. Sometimes unfinished business is centered around painful physical and emotional trauma, such as child abuse or incest, and the healing process usually requires professional assistance.

Continuously tapping into one's own unfinished business can deprive a caregiver of the psychological energy necessary to be fully present for others on the job. This depletion of psychological or emotional energy is a large part of what is typically experienced as "burnout."

It is helpful to develop an awareness of which particular losses or family/work dynamics are more difficult to handle emotionally than others. This can be a clue to things in one's personal life that still may need closure. For example, if a caregiver experienced physical or sexual abuse as a child, working with a child or children who have been abused may be particularly painful to that individual caregiver. Creating healing rituals may be useful. It is never too late to begin healing past wounds. In addition, sharing feelings honestly and when they are fresh can often prevent unfinished business between colleagues from accumulating.

When Someone Dies
As caregivers, it is natural to become "attached" to some people; realize that it is also natural to grieve for people when they die or otherwise go away. Create personal or group rituals to say "good-bye." This is critical to healthy grieving and to putting closure on the loss.

Rituals can include releasing balloons, lighting candles, debriefing or reminiscing regularly with colleagues, playing someone's favorite song, sharing written or verbal memories with the survivors or with each other, creating a memory book or quilt, or planting a special flower, tree, or shrub, such as a rosebush. Attending a funeral, wake, or memorial service, when possible, can also offer some closure for individuals. Sometimes simply visualizing the individual in a peaceful setting, such as on a cloud or in a hot-air balloon, can help the heart find comfort. Writing a letter to the deceased can also be healing.

Healing Strategies
The emotions brought on by continually working with others who are suffering can cover a wide range of difficult feelings, including anger, frustration, depression, despair, helplessness, and discouragement. These emotions can often build to painful proportions unless a variety of tools and techniques are developed for the healthy release of these feelings. Some healing strategies for ongoing emotional releaseinclude:

A regular practice of "debriefing." Vital to ongoing emotional release and to gaining perspective, this can be a formal process for all staff members at a staff meeting, for example, or an informal process between colleagues who regularly support one another. A debriefing should be considered a safe time and place to "vent" without judgment or fear of retribution from others. It is important for people to release the feelings of grief in healthy ways rather than to "stuff" them inside, only to have them surface later in unhealthy manifestations, such as illness, depression, substance abuse, and strained relationships. Support should be ongoing and genuine.

Journal writing. A form of debriefing on a personal level, journal or letter writing is another healing tool for emotional release. Writing letters to clients or families to share sadness or pain (even if they are not sent) can be healing too. Burning the letters or in some way letting them go can also be a form of release.

Laughter, play, and music
. Regular "doses" of these can help caregivers regain perspective and a sense of balance. Develop a "humor" bulletin board where cartoons and jokes can brighten a difficult time. Start and end staff meetings with a funny or tender story or compliments.

Regular, ongoing appreciation. Feelings of being valued and important, which are critical to a healthy working staff, can diminish at stressful times. Appreciative gestures, such as compliments, smiles, hugs, notes, flowers, and small surprises, can help restore meaning and purpose to caring efforts.

Exercise, diet, and relaxation. The importance of exercise, a healthy diet, and periodic "time outs" to relax and renew should never be underestimated. These time outs need not be lengthy and time-consuming but can be simply a few moments out of each hour to breath deeply, smile at someone, or spend quietly in nature.

Professional assistance. When feelings of grief become overwhelming and significantly impact one's personal and professional lives, do not hesitate to seek assistance. Asking for help is a sign of strength, character, and self-esteem.
Summary

The grief of caregivers is real and a natural part of working in the helping professions. Indeed, many people enter these professions because of their compassion and deep concern for others. Therefore it is important for caregivers to develop techniques for the healing expression of grief as it naturally occurs. It is also important for caregivers to continually nurture themselves as well as to take care of their own personal unresolved grief (unfinished business) in order to remain psychologically and emotionally healthy.
References

Berry, Carmen. When Helping You Is Hurting Me. San Francisco: Harper and Row, 1988.

Brussat, Frederic. 100 Ways to Keep Your Soul Alive. San Francisco: Harper and Row, 1994.

Colgrove, Melba, et. al. How to Survive the Loss of a Love. New York: Bantam, 1976.

Freeman, A. Woulda, Coulda, Shoulda. New York: Silver Arrow Books, 1989.

Larson, Dale. The Helper's Journey: Working with People Facing Grief, Loss and Life-Threatening Illness. Champaign, Illinois: Research Press, 1993.

Muller, Wayne. Legacy of the Heart: The Spiritual Advantages of a Painful Childhood. New York: Simon and Schuster, 1992.

Sell, Charles. Unfinished Business: Helping Adult Children Resolve Their Past. Multanomah, Oregon: Multanomah Press, 1989.

Viorst, Judith. Necessary Losses. New York: Simon and Schuster, 1986.
Resources

Kathleen Braza, M.A. Bereavement Consultant, Healing Resources, P.O. Box 9478, Salt Lake City, Utah 84109. 1-800-473-HEAL.

Center for Loss and Life Transition, 3735 Broken Bow Road, Fort Collins, Colo. 80526. (303) 226-6050.

About the author: Kathleen Braza, M.A., is a bereavement consultant and national speaker on issues of grief and loss in adults and children. She is Adjunct Clinical Faculty at the University of Utah, teaching courses in death, dying, and bereavement, and has recently completed a video on grief, entitled "To Touch a Grieving Heart," designed to teach others healing ways to respond to the bereaved.

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