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Tuesday with Morrie (1997) is a memoire written by author, Mitch Albom about the time he spent and the lessons he learned from his 78-years-old sociology professor, Morrie Schwatz as Morrie was dying from amyotophic lateral sclerosis (ALS). Throughout the memoire, Morrie provided Mitch with importantly life lessons that he learned throughout his life over the 14 Tuesday they spent together before Morrie’s imminent death. Although the memorize was based on death, but the lessons it provide is more than just grief and loss on death, but also the loss on one’s identity.
As a grief counselor intern, a future clinical social worker and as a human being, this memoire took me through an emotional journey that elicited many tears. The lessons I have learned and the emotions I felt while reading this memoire, have not only provided me with knowledge on how to become a better clinician, but also a better person.
Bereavement When Morrie was diagnosed with ALS and was given two years to live, not only did he have to anticipate for his own death, but his friends and family, such as Mitch had to as well.
According to Kubler-Ross & Kessler (2014), the patients themselves and their family can experience the same five stages of grief as they are preparing for the imminent death, and those five stages are denial, anger, bargaining, depression and acceptance. As a grief counselor, while I didn’t have many opportunities in working with clients on their anticipatory grief as the clients I see are all family members who had already lost their loved ones.
However, I do believe it is very important to look at social work implications for working with both anticipatory grief and normal grief as it requires different interventions Social Work Implications Although I’ve never worked with clients with anticipatory grief before, however as my agency orientation, I was arranged to go on home visits with a social worker that were working with patients and their family on that, therefore I was able to see firsthand what interventions works best with these type of client. In conjunction with my experience and with the suggestions provided by Costello & Hargreaves (1998), there are three interventions that can best assist patients and their family on preparing for the death and overcoming these difficult times. These three interventions are AG counseling, empathic communication and multi-disciplinary intervention. First, AG counseling allows the client and their family to gain an understanding that their emotional reactions are normal and it will also allow the patients and their families to resolve any negative emotional they might have. This is a restorative part of their grieving process as it allows them to understand that their feelings are normal and they will be able to coping strategies to deal with such emotions. Secondly, during this process, a social worker’s empathic communication is really important as both patients and family can feel really vulnerable at this time, and a social worker’s emotional and psychological support can allow them a better transition during this difficult time. Third, patients and their families can have many things that they will need to take care while they are preparing for their loss of their loved ones; these can include coordinating end-of-life care, acquiring important medical information, and some time even financial assistance if the dying patient was the sole provider for this household. By handling these for the patients and families will not only assist them in coping with the client’s death a little easier, it will also allow the dying patient to know that their families are being taken care of, so they can feel a sense of peace and acceptance.
While working with clients on their grief after the loss, I found that many of them are still experiencing the denial, anger, bargaining and depression that were proposed in Kubler-Ross theory before they are finally able to reach to the acceptance stage. Therefore, when working with bereaved clients, it is very important for social workers to assess which stage the client is in in order to help client facilitate the grieving needs that fits the stage.
According to E. Altmaier (2011), the goal of grief counseling is to assist the client in “acknowledging the reality of the death, embracing the pain of the loss, remembering the person who died, developing a new self-identity, searching for meaning and receiving ongoing support from other”. In order to assist the client to achieve these, the relationship between the counselor and the client is very important, and the relationship is built by empathic presence, gentle conversation, available space, and engaging trust. During grief counseling, it is important to provide empathic listening, and use gentle conversation to encourage and provide space for clients to express their emotions and pain freely. Counselors should also establish trust by letting clients know that recover and grow is possible, and although the process can be overwhelming, the counselor will be available and continue to engage the client in the task of grief.
Aside from the above qualities, I also think that embracing the silence is very important during grief counseling. Counselors have to understand that grief counseling maybe the only time the client can express their emotions freely and that these emotions can be really difficult to talk about. Therefore, allowing clients the space and time to feel their emotions and to gather their thoughts will also help build a trusting relationship between the counselor and the client.
Complicated Bereavement Grief and loss is something that everyone will have to experience one day, but the reason why grief and loss is such an important mental issues to address is because unresolved grief can eventually lead to complicated bereavement. According to M. Shear, M.D., (2015), complicated grief is a prolonged and persistent grief disorder that is characterized by intense grief that involves intense yearning and sadness, insistent thoughts or images of the deceased and inability to accept. People with complicated grief often feel shocked, emotionally numb, and depress, a diminished sense of self and isolation. Complicated grief can cause impairment in daily functioning and is often time associated substance abuse and suicidal ideation, therefore it is really important to assess the level and duration of grief that the bereaved person is in, as well as history of mood or anxiety disorder, and alcohol or drug abuse, as people with these history can gave a higher chance of complicated grief. During the intake process of grief counseling, it is mandatory for our agency to ask prospective clients if they are using any psychotropic medications, drugs and alcohol, as well as if they have any suicidal ideation. These information will not only help the grief counselor better prepare for their first session with the client, it will also help to determine if the client is suitable for grief counseling at all. I completed an intake recently where the prospective client who was interested in phone counseling reported that he has many previous suicidal attempts and a few include “jabbing a knife into his chest”, therefore a suicide risk assessment was immediately done and he was deemed not suitable and safe for phone counseling Countertransference I cannot personally experience what Morrie had experienced as he anticipate his own death, but I was able to relate to Mitch, especially the sadness and guilt he felt for not contacting Morrie earlier. While working with grieving clients requires empathic skills, social workers who have experienced such lost before may encounter countertransference issues as I have personally experienced it recently.
My grandmother who I was really close to and was one of my primary caregiver when I was younger died when I was 11 years old. I was abnormally peaceful and didn’t exhibit any sadness when she died. In my family, we don’t talk about grief or our emotions. We all know that we were saddened by my grandmother’s death, but we just didn’t talk about it. I also remembered that my dad was really sad, so I told myself I had to be strong for him, therefore since my grandmother was really sick for a long time, I kept on telling everyone and myself that her death was a good thing because she didn’t have to suffer anymore. I always thought that I had already overcome the grief until I first started grief counseling. When I first started grief counseling, I often times became very emotional and draining after sessions, especially if clients talked about the sadness and guilt there were experiencing because it elicited the same feelings in me. As it was presented in class materials that “loss reverberate loss”, when I started analyzing what was causing me these feelings, I realized that the sadness and guilt that I felt was because of my grandmother. I realized that I never dealt with my grief of losing my grandmother and that I felt very guilty for not being by her side when she died as I was being sent to school by my parents that morning. I also realized that I was guilty for not showing emotions and never cried once for losing such an important person in my life. After I realized all these, I was finally able to able to grieve after 20 years and I finally understand what a grieving process entails. I experienced every symptoms of grief; the physical symptoms of body aches; the emotional symptoms of sadness and guilt; the cognitive symptoms of wishing my grandmother was still alive and for the first time, I cried for the loss.
Before all these, when I was doing grief counseling, I often times took a problem solving approach to my clients’ feelings, such as if they are feeling sad, I suggested my clients to engage in activities that will make them happy, because I didn’t want their feelings to affect me.
However, after experiencing grieving myself, I was able to assist my clients in really expressing their feelings and working through it with them by allowing them to really talk about. I was able to do this because I was able to detach myself from their experience. That is why it really resonated with me when Morrie said “If you hold emotions—if you don’t allow yourself to go all the way through them—you can never get to being detached” (pg. 104). With this experience and this lesson from Morrie, I was able to become a better clinician by not only avoid getting emotional drain by detaching myself from their experience by telling myself that their experience does not equal mine while still be able to empathize with their experience. I was also able to use my grieving experience to better connect with my client and assist them by developing coping strategies that fits their need and the emotions they are feeling. This experience has also allowed me to become a better person by understanding that it is normal for a person to express their emotions and be vulnerable at times, because not dealing with emotions can result in long-term negative effects.
Loss of Identity A person’s behavioral and personal characteristic is what makes up one’s identity. During the final weeks that Mitch spent with Morrie, the topics that Morrie talked about each week is what makes up a person’s identity, these includes regrets, family, emotions, love, etc. Many people have different perception on what makes up their identity; some believe it’s their family while some may believe their job is their identity, especially when the person is really invested in their work, such as the case of Mitch. When Mitch lost his job during the strike, he became really lost as his job makes up his everyday lives, and therefore when he lost it, he suddenly didn’t know what to make of himself. Mitch was also very surprised and sad at the same time that the everyone in the world can still goes on without his articles. One might wondered how Morrie was still able to maintain his identity and help others when he’s experiencing something so much bigger in life that Mitch and that is largely because if one overcome their developmental stages. Erikson’s Stages of Psychosocial development According to Erikson, the mastery of developmental task in not required to move on to the next stage, however each stages builds from previous stages and can affects later stages.
Morrie, who was 78 years old when he was diagnosed with ALS was in the last stage in the Erikson’s developmental stage, which is integrity vs. despair stage. The task for this stage is to accept that death is inevitable and that it’s a time to detach all concerns with life and care for themselves (J. Berzoff, 2011). Morrie had reached identity achievement at an early age by deciding that he did not want a career hat exploit people and decided that he would become “a teacher to the last”. He had a loving relationship with his wife; he cares for himself and the people around him; he gives back to the society. Morrie overcame every crisis in his developmental stages, and therefore in the end, although Morrie did experience some denial, anger, bargaining and depression at times, he was able to accept that his death is inevitable and use his remaining time to teach one final lesson.
Mitch, on the other hand, who was 37 years old and was in the generativity vs. stagnation stage in Erikson’s stages of development, was unable to overcome the crisis of stagnation prior to reconnecting with Morrie. During this stage, in order to reach generativity, the virtue is the ability to extend care and concerns to both self and others, which includes younger generations, community, friends and family (J. Berzoff, 2011). Mitch only cares about work in his life, he rarely have time to care for himself, let alone for his wife and the community. Although Mitch cared for Morrie, but that was originated from guilt. Mitch unsuccessfulness in overcoming the crisis in this stage had a lot to do with his identity foreclosure during his adulthood when he suffered the loss of his uncle decided that money is more important in life than his wish of being a pianist, because he did not want to end up like his uncle. Mitch made the commitment of furthering personal achievements in life but didn’t really explore if more money and bigger houses can really fulfill what he wanted in life. The fact that Mitch completely changed his identity after the death of his uncle may also be a sign of unresolved grief.
Identity Crisis & Depression Individuals who have a clear sense of self and direction in life are more likely to engage in caring relationships, while people who struggle with a clear sense of self can experience difficulties in self-esteem and well-being, and depression and anxiety (Journal of Youth and Adolescence, 2011). According to Teasdale (1983), low self-esteem and negative outlook are seen as the result of depression; however the negative thinking in depression can also lead to problems in self-esteem. Therefore, identity status can be an important mental health issues to address when social worker works with client as people who are experiencing difficulties in self esteem due to their identity status can develop depression.
Social work implications While identity crisis usually occurs during one’s adolescent year to early adulthood, adults can experience it as well as evident by Mitch. According to Robinson, Wright & Smith (2013), a crisis occurs when the commitment within a life structure is no longer desire and a rebuilding of a new commitment is required. People in identity crisis will need to experience 4 phases—locked in, separation and time out, exploration before reaching the final phase of rebuilding. The phases start with people becoming stressful and trap in their authentic sense of self and then start to distance themselves mentally and physically from that identity but often time become confuse as they have not find a new identity to replace the previous one. During the time-out stage, people will start questioning “who they are” as they detach themselves from their previous identity. After that, people will start exploring new commitments and identity in an found it really important as a social worker to assess clients’ stages in Erikson’s stages of development and their identity status no matter what their initial concerns are, because whether they are able to overcome their crisis in each stage can largely determine how they deal with loss in their life, especially how to deal with the death of their loved ones and their own death.
As for myself, I become more self-aware after this reflection. I become more aware of why I am who I am today; why I suffered through depression and self-harm during my identity confusion years, but importantly I become more aware of what is more important and valuable to me in life.
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