Welcome
Hi, and welcome to the Center for Integrated Grief. I'm Carolyn the founder and director former hospice social worker. I am now a therapist in private practice and a fellow in thanatology. Thanatology is the academic study of death dying and bereavement; though when we pause to think about it it should be dying death and bereavement. It is good to pause and think about things to process them, and kind of examine them. That's part of the therapeutic process. I just took us on a little journey, but we can always go back, so let's go back to our welcome video. What I wanted to convey is that I have a holistic understanding of the whole process. I created the Center for Integrated Grief so that we could serve more people from a place of function and intuition, it's science and art. We have a clinical skill set and and we connect and attune with our clients from a very human place. So welcome, and we're here to support you and serve you.
Thank you
Grief Assessment Part I
Grief assessment factors
Hello and Welcome
Grief therapist Carolyn here. Founder of The center for Integrated Grief
Part I of the Assessment Series
This video is going to give you an idea of what to expect in your 1st session with us if you are
coming to us for grief therapy.
I’ll talk about the factors that affect grief. This is separate from the bio-psycho-social-spiritual
that is standard in a mental health evaluation. I’ll talk about those in another video.
Here, we will focus on grief factors only. Not in any particular order. I’m going to name all of
them and then go back and explain In the next video.
-age of griever, age of their person
-how the person died and how does the griever perceive the death? traumatic? peaceful?
-How long ago did the person die?
-the relationship of the griever to their person. Parent/child, siblings, romantic partner. Grew up
together
-the quality of the relationship
-complex feelings: blame, shame, resentment or intrusive thoughts. Then we get into
Prolonged Grief Disorder, which I’ll talk more about in another video.
Thank you for listening. And please watch part II
Grief Assessment Part II
Explanation of grief factors
Hello
Grief therapist Carolyn here. This is part II of grief assessment series to explain the factors:
-age of griever, age of their person
We apply the theory of Grief Across the Life Span
This isn’t just kids versus adults. When we are working with adults a
25 year old is in a very different life stage then a 45 year old versus a 65 year old.
We fold in the modalities The 3 R’s: Retelling, Reinventing and Rebuilding your life and Erik
Erikson’s 8 Psychosocial stages of development.
-how the person died and does the griever perceive the death as traumatic?
Examples of this: Accidents are violent. Accidents - we don’t know what happened but imagine
the person suffered- are very upsetting to grievers,
young person caring for their person and having to do medical care or medical trauma from the
hospital, taking someone off of life support, decision to stop giving liquids. What was the end
of life process like and how does the griever perceive this?
-How long ago did the person die?
If it has been over a year we assess for Prolonged Grief Disorder, which is not pathologizing
and I’ll tackle that big topic in another video.
-the relationship of the griever to their person. Parent/child, siblings, romantic partner,
Someone I grew up with and it’s shaking my sense of security, safety and mortality. Or was this
someone they always looked up to and “had it all.” How could this happen?
We all get that
-the quality of the relationship:
was there abuse? Was this person their main support? Was there co-dependence? I have seen
a few cases where a woman flourishes after her husband dies because he was emotionally
abusive or even just shut her down over and over for 30 years.
-complex feelings:
blame, shame, resentment or intrusive thoughts that block productive grieving.
So those are the factors we assess during our evaluation.
Thank you for watching. Please watch Video 3 in the series: our general assessment.
Clinical assessment for all clients
What to expect in your first session
Hello and Welcome
Grief therapist Carolyn here.
This is Part III of the Assessment Series. This video covers how we conduct all initial
assessment for all clients, not just folks who come to us for grief.
Our initial assessments are informed by our work as hospice social workers. All social workers
are taught how to do a bio-psycho-social-spiritual and in hospice we add financial.
In therapy we don’t add the financial part.
Biological - Not biography. Certainly true for chronically ill folks. So, what is their level of
functioning, pain, etc. And this is important for everyone, I had a client referred to me by his
primary care physician. He was at home and thought he was having a heart attack and called
911 - it a panic attack. However, he does have high blood pressure. In addition to exercise, I
was part of the prescription from his doctor..
Pscyho- For psychological - history of depression, anxiety, grief, suicide, eating disorder,
substance abuse. Family hx too.
Social - support systems or lack of support. Part of this is PIE - a very social worker theory -
person in environment. This can also be a clue to disenfranchised grief - for our grievers.
Spiritual or religious- does the person have a belief system? Has it been helpful? Is there
religious dissonance within the person or within the family?
All mental health assessments should include religion or spirituality. In hospice and in grief it’s
particularly important. I also ask people what do they believe happens to us after we die?
Heaven + Hell? Reincarnation? Or just go into the ground? We use that in work as well.
We are listening for the
1) interpersonal: relationships, work, family, social media
2) intrapersonal: your internal
We want to pull it all together to support you here at The Center for Integrated Grief
Thank you.
Therapist Leslie introduces herself
Hello and Welcome
I’m Leslie, a therapist at the Center for Integrated Grief.
I’d like to introduce myself.
I have several years of hospice experience under my belt— end of life is a passion for me.
My background is that I was trained as an actor-I graduated from NYU.
My acting experience taught me to sit with big emotions.
I loved the storytelling aspect and how people’s stories affect how they behave and move
through the world.
In fact,
it was when I had to study sides for a part of a young mother who lost a child,
I embraced the part so well,
a classmate suggested I would be really good for this work.
Additionally, Compassion for self and others was an important lesson I learned through my
experiences.
I bring that to my work with clients.
(do you want to mention the Institute for Contemporary Psychotherapy or keep it personal?)
Thank you for listening.
We’re here for you.
Clip from American Tributaries Interview
The New York Times did an article about a funeral home, the one they interviewed which was one of many, or one of some that had no place to put people's dead bodies. so that was a funeral home I knew really well. I had them on speed dial, they had me on speed dial. They had done me favors before with clients. I knew them and so it was just really terrible and it was really hard because it was a job that I had loved so much and had felt- you know when you have a job that you're good at and you feel good about and you feel you're helping people and it was really- and then that just so quickly turned into just a really hard time.
Tips for Caregivers: Tech Adverse Parents
Hello,
Grief therapist Carolyn here, this is a video about how to ground your parents or not to ground them. Usually when I talk about grounding it's from this kind of calming rooted meditation place. This is about grounding your parents so this is a video for caregivers or almost caregivers, which I'll go into in a second. It also tends to be for our kind of Gen X or it could be our older Millennials but people who are shifting into that caregiving stage of taking care of older elderly parents. So I had a client she shared a story with me and she gave me permission to share it here, we started a session and she said “I want to ground my parents” so when she was 17 before cell phones she was supposed to call and check in with her parents when she was out with her friends and when she didn't do that she'd come home and they'd want to ground her now so that's when she was 17 now now her parents are 87 and they don't call when they don't pick up the phone when she calls to check in and now she wants to ground them here's what happened she went to visit Mom and Dad on a Saturday Dad is the caregiver for Mom who has more health problems the daughter was there and at one point Dad wasn't feeling well so they took his blood pressure and it was low the daughter stayed hung out his blood pressure came up to a normal level so she left she had to go back to her family this was on like a Saturday the next day was Sunday she called no answer she called all day no answer she was starting to get worried but then she's like you know it probably nothing so Monday the day starts she's at work she calls no answer throughout the day she's worried she's trying to work but now she's like oh my gosh but if something happens catastrophizing a little bit uh at the end of the day in fact that evening she calls cuz she's been calling all day finally Dad picks up the phone oh everything's fine she wanted to ground her parents so she came into our therapy session with ah can I ground my 87y old parents and this is what therapy or caregiver support groups are for a place for us to kind of talk and vent about some of these things right so we're talking about role reversal here right where does this shift happen where we feel we have to really be responsible or start taking care of our parents and it's not usually a delineation right it it happens slowly over time certainly we're talking about safety we want our parents to be safe right but there's often this kind of Middle Ground where it's hard to know where sometimes the parent feels like their kids are just being bossy and it is true that the parents functioned all these years and raised really high functioning kids so where is the place where okay things are going to start to shift and change and that can be really hard feelings can be hurt sometimes conversations need to be had right I also just want to talk about three technology pieces I'm not getting paid to promote these although maybe I should, but I wanted to share these because these could be helpful so what this daughter was saying was helpful is her parents only have a flip phone they don't want a smartphone and she's encountered other people whose parents do not want a smartphone they only want a flip phone but on a flip phone you can't do find my iPhone or you can't do Life 360 or one of these apps right so what she did and what other people have done is they put an air tag on the phone so the air tag will help you track your Mom or Dad are they at home did they go to a store have they been out for a long period of time it can just give you a sense of where they are there's also this phone called Jitterbug it's supposed to it's a SmartPhone bigger print and supposed to be very helpful for older adults something to look into the other thing is that this doesn't have to do with the phone but it has to do with iPads there are some iPads who run who can run on the 5G Network and not on Wi-Fi this daughter was saying her parents don't have Network at all they don't have Wi-Fi so if you can get or you can get on a 5G Network because the Dad in this case had a sibling who actually had a cancer diagnosis and the only way they they couldn't see each other in person but they could see each other over the iPad so those are some tech ideas and I wanted to touch on the role reversal and when things shift it's an ongoing challenge so hope this was helpful.
Thanks for listening
End of life Signs and Symptoms: A Caregivers Guide
End of Life Care, a caregiver's guide. Dying is a natural part of life but many people do not have experience caring for someone during the dying process and find themselves navigating through new and unfamiliar territory. It is not uncommon to experience a wide range of emotions and a sense of uncertainty. At times you may feel that you are on a roller coaster not knowing what to expect next. This video is designed to help you feel more confident in knowing what to expect and what you can do to care for someone in the final weeks and hours of life possible signs and symptoms of approaching death because each person's dying process is unique to him or her. The outline is only a general guide, people may exhibit some or all of these signs and symptoms at varying times. 1 to 2 weeks: disorientation and confusion, use of symbolic language such as I want to go home, I'm getting on the airplane, and talking to others not present in the room. Physical changes: increase or decrease in pulse, decrease in blood pressure, changes in skin color, irregularities in breathing, changes in body temperature hot or cold, not eating taking little or no fluids, days to hours sleeping most of the time, a surge of energy, restlessness, difficulty swallowing, further discoloration of skin, ongoing changes in breathing such as long pauses between breaths rattling breath sounds, weak pulse, further decrease in blood pressure, decreased urine output or no urine, and eyelids no longer able to close completely. Minutes: shallow breaths with longer pauses, mouth open, and unresponsive. Moment of death: it is important to discuss with family members, caregivers, and friends, what to do if they are present at the time of death. No one can accurately predict when death may occur, some people die when others are present some take their last breaths when they are alone. What you can do: please contact hospice a nurse will visit, please note that other team members may provide assistance as needed. When the person has died there will be no breathing or heartbeat there will be no response to your voice or touch. Each person's dying experience is unique, and no one can fully predict what it will be like or when it will occur. We hope the information contained in this video will provide some landmarks to help guide the way. It is our goal to respect the dignity of each person by providing quality comfort care
The Tools- The Black Sun
Free yourself from impulses like overeating, using alcohol or drugs, or compulsively checking your phone with the Black Sun.
Cues to Use the Tool
• Use this tool at the moment Part X (your inner enemy) floods you with any kind of self-defeating urge—to reach for ice cream or potato chips, check your email, lose your temper, etc. Used repeatedly, this tool will train you to stop giving in to these impulses and turn inward instead.
• Most of the time we're not indulging our impulses; instead, we're looking forward to the moment we will give in, like having that drink or smoking a joint at the end of the day. Use the Black Sun the moment you feel yourself slipping into one of these anticipatory fantasies.
The Tool in Brief
1. Deprivation Feel the deprivation of not getting what you want, as intensely as possible. Then let go of the thing you want. Forget about the outside world as a source of anything that will fill you up inside; let it disappear.
2. Emptiness Look inside yourself. What was a feeling of deprivation is now an endless void. Face it. Remain calm and still.
3. Fullness From the depths of the void, imagine a Black Sun ascends, expanding inside until you become one with its warm, limitless energy.
4. Giving Redirect your atten5on to the outside world. The Black Sun energy will overflow, surging out of you. As it enters the world, it becomes a pure, white light of infinite giving.
This is your headline
This is your sub-headline
The Tools- Sacred Observation
BACKGROUND - based on the idea that deep down buried in each person's unconscious is a babyish part of you that wants what it wants and can’t tolerate being denied, everyone has this part, Part X, the negative Ego, whatever you call it, it experiences boundaries as a personal affront. You can learn a lot about this by observing little kids. When you say this to a little kid they act as if they’re going to die. And that’s what Part X is saying to us on a deep level, I cannot survive this boundary. Now here is where things get interesting. To reach full adulthood, every human being must master this part of themselves, if they don’t master this part of themselves they remain 2 years old emotionally forever, what does mastery mean, despite the babyish part of myself, I am not going to get what I want, I am disappointed, but I’m not destroyed. That’s mastery. When you say no, you trigger the babyish part of the other person, and the other person has to learn to master that, which leads to a really strange conclusion, when you say no, you’re giving the other person an opportunity to grow and to gain true mastery, but that can’t happen if you don’t maintain the boundary. If you go back, supply them with explanations, and try to win the battle for him, you’re depriving them of an opportunity for them to learn and grow and to learn that no is survivable, you’re actually impeding the maturation process that they need to go through in order to flourish. You can observe the struggle, you can hope that they overcome the demon, but if you open the boundary, and try to win the struggle for them or if in any way vibe out that you are responsible, you’re keeping them in a child-like position dependent on you instead of on themselves. That’s why the tool is called Sacred Observation, it’s not called Sacred Rescuing or Sacred Helping or Sacred Saving, you are watching the sacred struggle in the other person and the babyish entitled part of themselves, but you are observing not participating in that struggle. It’s a weird wacky upside-down part of life, if you try to help them, you are actually harming them, you are taking the victory away from them and keeping them young and immature and dependent on you.
GOAL - observe the struggle without intervening in the struggle or even being invested in its outcome. It's their struggle to win or lose not yours.
3 STEPS
1. DISTANCE - observe the other person struggling with their demon from a distance. Just enough distance that you’re not in the struggle with them.
2. AWE - in this step, you will acknowledge and feel how much of an honor it is to witness someone else’s struggle with their demon.
3. GOODWILL - you’re just going to send them love and support in the struggle regardless of the outcome.
To teach you the tool I need you to think about a situation where you should be seeing a boundary. It could be a situation where you need to say no and the other person is not going to like or you’ve already said no and you’re tempted to go back on it, bc you can see that the other person is angry or in pain, take a moment, choose a situation and then close your eyes. Every time you feel this feeling after setting a boundary or going back on a boundary (guilt, anger, shame, disappointment, letting someone down) use this tool. Make them as intense as if they were happening right now.
NOW USE SACRED OBSERVATION
1. DISTANCE - imagine that they are struggling with their inner demon that struggle is there for them to win or lose, accordingly, I want you to keep your distance, I suggest you see yourself in the upper row of an operating theater, so you are in an elevated position to see the other person down there in the pit struggling with their demon, you can observe but you must not intervene. A little sense of elevation like you’re not there in the pit with them.
2. AWE - try to feel a sense of wonder that you have been allowed to observe this deep, sacred, inner struggle. It’s like being given a front-row seat to a life-changing battle that this person is engaging with the worst part of themselves and it's an honor to witness this struggle. It would be intrusive to affect its outcome.
3. GOODWILL - feel your heart expand with love and goodwill toward the other person. Wish them well. Surround them with love. Your sole responsibility is to honor their struggle with Part X. And you want to send them love even if they lose even if they don’t fight as much as you think they should.
Poem
By Moe Phillips
Grif Stands Vigil
in hollowed out hearts.
Everything thrown into question.
Condolences mean-
There is nothing more to say.
Comfort comes offering
the gift of memory.
Past tense is about to be
the new now
Grief Counseling: The Benefits of Talking
By Carolyn Gartner
Grief stands vigil in hollowed-out hearts
Everything is thrown into question
Condolences mean-
There is nothing more to say
Comfort comes offering the gift
Of memory.
Past tense is about to be
the new now.
Poem ©2024MoePhillips
Grief is love with nowhere to go. It can feel like an overwhelming darkness, a profound
sadness that envelops your every moment. Yet, it is a natural and universal response to
loss, whether through the death of a loved one or other significant life changes. While
the journey through grief is intensely personal, the support of a therapist or a group can
offer a transformative path forward. Sharing your experiences with others who
understand can significantly lessen feelings of isolation, and engaging with a therapist
who specializes in grief can provide the guidance needed to navigate this challenging
terrain.
In grief therapy, we recognize that every individuals experience is unique, and we
approach each client not just as someone who is grieving, but as a whole person with a
rich tapestry of experiences and emotions. We work from a strengths-based
perspective, aiming to support post-traumatic growth when the time is right. This
approach is not about moving past grief but integrating it into your life in a way that
allows you to continue living fully.
Therapists help individuals to articulate their feelings and give structure to the seemingly
chaotic experience of grief. It is common for people to seek grief therapy particularly in
the second year after a loss, a period when the initial shock has worn off and the reality
of the new normal begins to settle in. This phase often brings a visceral recognition of
the permanence of loss, marked by the painful milestones of experiencing all the firsts
without the loved one— the first birthday, the first spring, and other significant firsts that
remind us of the absence.
A key model used in grief therapy is known as The Three Rs: Retelling the story,
Rebuilding your life, and Reinventing yourself. This model guides you through the
process of narrating your experience, which can be therapeutic in itself. It helps in
reconstructing a life that feels shattered and assists in redefining ones identity in the
wake of a significant loss. A grief therapist supports you in this journey, facilitating a
space where you can honor your loved one and establish continuing bonds in new and
meaningful ways.
Meaning-making is another crucial aspect of grief therapy. It involves finding or creating
significance in the wake of loss that is deeply personal and resonant. This can manifest
in simple yet profound activities such as cooking a loved one’s favorite meal on their
birthday or preserving items that hold sentimental value, like a movie poster that
symbolizes a special memory. These acts of remembrance play a vital role in the
healing process, offering comfort and connection to the past while supporting ongoing
life engagement.
Many clients report feeling a sense of relief even after just an initial consultation, before
formal therapy begins. This relief often comes from understanding that there is a
supportive path forward, that there is someone who acknowledges their pain and offers
not just sympathy but strategic support. The very act of making time for grief, of
acknowledging its impact, is itself a healing gesture.
The overarching goal of grief counseling and therapy is to integrate the experience of
loss into one’s life. We often speak of this process as integrating grief love. It’s not
about forgetting the loved one or moving on in a way that implies leaving them behind.
Instead, its about weaving the love and sadness into the fabric of your heart, enabling
you to remember your loved one while continuing to live a meaningful and fulfilled life.
Therapy addresses the dual needs of dealing with deep emotional pain and developing
day-to-day coping strategies. Accessing and expressing deep-seated emotions like
sadness is essential—it’s important to allow these feelings to surface and to experience
them fully. At the same time, we also focus on how clients are managing from one day
to the next, providing tools and techniques to help them cope with the practicalities of
everyday life.
Remember, the potential for healing lies within you. Your grief therapist is there to help
you access it.
