Dealing with the loss of a loved one can become even more difficult during the holidays. Bereavement Counselor, Elizabeth Schandelmeier, LCSW from Family Hospice, Part of UPMC, discusses ways to cope and how to help someone who’s grieving.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. Dealing with the loss of a loved one can be difficult any time of year, but particularly during the holidays. So what can you do to cope? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Elizabeth Schandelmeier. She’s a bereavement coordinator counselor with Family Hospice, part of UPMC. Thank you so much for joining us.
– I’m really glad to be here today. Thank you.
– This is such an important topic, and I want to start with, you call this supportive counseling, not therapy. And what is the difference?
– There’s a lot of differences, actually. Usually, when a person is going to seek therapy, they might have a particular problem that they’re trying to solve, or work on, or fix, and when it comes to grief, we don’t really see grief as a mental health issue in the same way that we might see depression or clinical anxiety. So, with supportive counseling, it’s more a way of companioning a person through the experience that they’re having. We’re not trying to fix, we’re not trying to change. We’re simply trying to support and be with them and help, perhaps, guide them along in the process that they’re going through themselves.
– So, that’s what I was going to ask. Does that mean, then, there aren’t things that you can do to help?
– Oh, no, absolutely, there’s a lot that we can do to help. Oftentimes, if a person’s not feeling supported, either they don’t have their network, or perhaps the person that they would turn to to talk about their things is the person who died, and they’re feeling quite alone. Sometimes, a person feels like maybe their friends have already heard enough, and they don’t want to keep burdening their friends with conversations. Or even in situations where perhaps the people that they want to talk about are the people that they would typically be talking to. So, we’re sort of the safe, and protected, and confidential source for sifting through a lot of the really complicated issues that can come up with grief in that experience.
– Right, and so much to talk about, and I know you say that one of the important things is to normalize grief. And what do you mean by that?
– Well, so often when people are calling us, one of the things they want to know is, “Am I normal? Is it OK? Is what I’m going through within the broad range of what we might call OK?” And the answer is, almost always, absolutely yes. There’s such a stigma around grief: how long it should last, how it should feel, what it should look like. And so, coming to a counselor is one space that you can go to better understand where you are in your own process and whether or not it’s something that should be a cause for concern.
– Obviously, everyone is different in how they deal with things, so if someone is listening to this and has recently lost someone or is a friend of someone who has lost someone, when do you know it’s time to seek professional help? And what are those signs? And then we’ll get into things we can do on our own.
– First and foremost, if it feels like it would be nice to talk to somebody about the experience that you’re having, call. Just call and see what that’s like. If your friends are showing concern, worried about you, wondering, call. Because even if everything’s fine, we can at least give you some words of wisdom to share with your friends to help get them off your back. But even in addition to that, if you’re really finding that you have absolutely lost all joy in life, that you can’t get out of bed day, after day, after day, after day, if you feel that you’re thinking about hurting yourself, killing yourself, or hurting others, get help immediately, please.
– Grief is difficult any time, but as we said in the beginning, particularly around the holidays. And what about the holidays magnifies this so much?
– Especially with the winter holidays, we’re also talking about the darkest days; the cold is coming, the clouds are coming, the snow, a lot of us are stuck indoors and not able to get outside and move our bodies. There’s a lot of expectations that we should be out socializing and having a good time. Also, a lot of the winter holidays are focused on family and gathering, and so if the person that has died is at all involved in those holiday activities, there can be huge gaps that feel like they’ve changed the holiday forever and maybe make you feel like you’ll never be able to enjoy this time again. You don’t know how to approach it, you don’t know if you should continue the traditions or do something different, and is it OK to stay home from the parties? All of these kinds of questions arise, and it’s also something that people worry about for about six months before it ever even arrives, so sometimes it’s the anticipation and the dread that people need help sort of working through.
– Right, like the anticipation of the bang is worse than the bang itself.
– Generally speaking, that’s what we find is that a person can feel a real weight of dread for, you know, four, six months before a 24-hour holiday actually occurs. And moving through that 24 hours may be uncomfortable, but it’s typically not as bad as the six months that you’ve spent worrying about it.
– Are there any wrong and/or right answers? What should someone’s approach be? Do I want to be distracted the whole time, or do I need to take this time and be sad?
– Right. It’s a great question. I think the answer is attempting to find balance. And there’s lots of physical symptoms of grief. One of them absolutely is exhaustion. So, allowing yourself the space to have your internal time and feel your emotions and be with your grief, especially at a time that these things often come up, is really important. We don’t want to distract ourselves so much that we’re not in our own experience. Because the truth of the matter is, if you try to distract yourself from your grief 24 hours a day, it will come find you, usually in very inconvenient ways. So, on the other hand, we also don’t need people to be in their deepest, most intense grief 24 hours a day, seven days a week, because it’s just too much. Our heart can’t take it. So, trying to find a balance, you know, perhaps you can get yourself to go to the intimate gathering of friends that are trusted where you feel safe and try to have, you know, find a little bit of joy, have a little bit of fun, a few laughs. But that might be as much energy as you have for the next week, and so maybe the next couple days you stay home and be quiet, sipping tea, being with your emotions and yourself. Again, it’s about finding the balance that works for you.
– Is there often some sort of guilt associated when you do start to have a good time?
– Very often. Very often people report that they feel guilty that they are even able to find any joy in life, and they wonder if it’s OK, actually. I would say more than the guilt, they wonder what kind of person am I to feel any kind of happiness after this person that I love has died? But the truth of the matter is, when you’re still in the world, the world is full of sad occasions, of course, but also lots of joy. And so it’s very important to find that space and to be alive as long as we’re here. What else are we going to do at this time?
– As a friend or a loved one of someone who has lost someone, what’s the appropriate thing to do, let’s say, at a holiday party and someone comes through the door? You don’t want to ignore this grave loss that they’ve just had, but isn’t there also a part of them saying like, “Oh geez, I don’t want to be that person at the party that everybody’s looking at like, ‘Oh, I’m so sorry.'” So where is the balance there?
– Right. This is a tricky question because the truth of the matter is there’s not a right answer, and this is a part of the reason that people are so confused about what they should or shouldn’t say. When we have lists of things to say and things not to say, you’ll find there’s a lot of overlap on the two lists. So, folks who are grieving, when they’re trying to get themselves sort of amped up to go to a holiday party, they’re thinking, “OK, I’m going to try and have fun, I’m going to try and celebrate. I’m going to take a shower, I’m going to put some makeup on, and I’m going to wear something pretty for the first time in eight months. And I’m going to go to this party, and I’m not going to cry a single time.” And then they walk in the door and somebody says, “Oh, how are you?” And then they’re like, “Oh, well, I was OK until you said that, and now I’m going to sit in the corner.” On the other hand, if you walk into a party and nobody even acknowledges the loss, the thought is, “Gosh, doesn’t anybody care?” So, this is, again, it’s a bit of a trick question. There’s not really a right or wrong thing. However, what I would advise for the person responding to another person who is grieving is to provide them with a safe space and allow them to lead the conversation. You could say something along the lines of, “Wow, I know you’ve had a tough couple of months. I’m really glad to see you.” And that gives them an opportunity to let you know whether or not they want to talk about their person or not. But in the end, it lets them also know that you love them, and that they’re welcome, and that you’re glad that they’re there.
– So, is it appropriate as the host when you invite this person, this person is a good friend of yours, to say like, “Hey, you know, do you want me to tell people, ‘Don’t drill this home a million times and talk about it’?” Even in that case, it could be case-by-case, day-by-day, minute-by-minute feelings.
– Right. Well, so that’s a great question. For the hosts, I think the host can really do a lot to help their friends who they’re inviting. Certainly ask the person who’s grieving, say, “Gosh, you know, I hope this isn’t an awkward question, but is there something that I can do to make this more comfortable for you?” More often than not, I’m talking to the person who’s grieving, and what I find is it’s often, I won’t say their responsibility because it’s not necessarily fair, but it’s in their interest to perhaps reach out to the host and say, “You know, I’m really grieving here. I’m having a hard time with this. I’m not quite sure what kind of, you know, how do you feel about me coming to your party?” And if the person says, “Oh, you’re still sad?” Then you know it’s probably not the right party for you. But if the person says, “What’s really important is just getting to see you, and we want to surround you with friends, so please come, and be however it works out for you,” then you know it’s probably a safe party for you to go to.
– From parties to, and you mentioned early on, traditions and family traditions. Again, I feel like case-by-case basis, but what are the two sides of, carry on those traditions because that’s what we always have done, or we need to start something new because sometimes if you’re looking at a tradition and the loved one who was gone was the center of it, does that make it worse?
– It can feel very empty. Particular for folks who are in their first year of grieving, each of these occasions is an opportunity to learn what that feels like to go through that day or through that holiday. So, it’s impossible to be able to anticipate exactly how you’re going to feel at any moment about any of these things until you’ve at least been through it once. So, what I try to advise people is to not worry this particular year. This year, they get a pass. If they want to continue the tradition of before, that’s fine. But if they don’t want to do anything, that’s also fine. Whatever it is that you do that first year has nothing to do with what you do for the rest of your life. This is a chance for you to learn about, what does Christmas feel like without this person that I love, or Hanukkah, or any of the other various holidays that come at this time of year. And so until you have some idea of how that feels, it can be hard to try to establish a new tradition. Typically, this is not the time to try to set something in stone because you get to that moment and you’re just not quite sure. Maybe it works out that way, maybe it doesn’t.
– Thoughts about doing something completely different? “I’m not going to be home, I’ve never been on vacation during Christmas or Hanukkah, but I’m going now.”
– I think that if that sounds comfortable and inspiring to you, then go for it. Again, it’s just this one year. It doesn’t have to be what you do every year. Maybe you go away and you find, “You know what? I really miss being home.” Maybe you go away and you say, “You know what? I’m so glad I don’t have to deal with all of that at home.” So, yes, I think wherever your heart is going with it, listen to that. Listen to that inner voice and pay attention to what you yourself are telling you that you need. Because a person knows themselves better than any counselor ever could. So, yes, absolutely, you can switch it up or you can try to keep things the same. My encouragement is mostly just to be flexible about it and to not be hard on yourself if it doesn’t turn out the way you thought it might.
– What if you’re a parent and you’ve lost a spouse, and you have young kids? Does that sometimes make it easier for a spouse in terms of it pushes them forward to do things? Or is it worse because everything’s magnified even more, and you’re not only worried about yourself but your children as well?
– Right. So a lot of this, again, depends on the kind of relationship that you’re talking about. But if it’s a parent whose spouse has died and they have children, that’s always a very, very complicated time because not only is the spouse grieving themselves, but any parent who has children typically is also grieving on behalf of their children. And, so it’s amplified and exponential what those feelings can bring, and this idea that we have to keep everything normal for the kids and keep everything the same, but what parents often outside of that don’t remember is that nothing is normal, and it’s not the same. And so, it’s very important, especially when working with children, to acknowledge the truth, to acknowledge the facts that things are different. Engage them in trying to decide, “What kind of tradition should we follow this year? Should we have the family meal? Should we do something different? Would you rather go away? Do you want to go to the party?” And engaging your children in this process and allowing them to understand that you’re grieving, too. We certainly don’t want to lean on our children; they’re not there to be our parent. However, this is our opportunity to teach them how to live in a world that does contain sad and hard emotions, and so by modeling that, and including them, and allowing them the opportunity to display empathy and give you a little bit of support, it’s good for them to learn how to do that for another person.
– You have often said to me that people need to be gentle with themselves. And explain a little bit more about what you mean by that.
– I definitely ask people to be gentle with themselves because this is a very hard time of year, and there’s so many expectations. We have expectations of ourself, what we should be able to do, what we should want to do, even. Other people have expectations of us. We have expectations of the people around us. And these expectations are almost never met entirely. And so it can really have us feeling that we are less than: less than what we used to be, less than who we should be, less than who we could be. And the truth of the matter is that when you’re grieving, nothing is normal, nothing is regular. No, you’re not your irregular self, and you are in the process of change. So, don’t be so hard on yourself. Allow yourself those moments of saying, “My goodness, you know, yeah, I’m in a completely new place. This person who died, I’ve never been through that before. I don’t know what this is like, I don’t know where I am, I don’t know what I’m doing.” So, allow yourself some grace.
– Is it OK if you hate the world or at least cannot watch one Christmas movie because everyone is so happy in those movies and you’re dealing with such pain?
– Absolutely. Especially when it comes to these winter holidays. They are introduced to our society long before the holiday even occurs, so by the time you get to something like Christmas or Thanksgiving or Hanukkah, you could be entirely sick and tired of all of the hoopla that comes along with it. So, yeah, if you get to that point and you really just feel inundated, sometimes people feel really sort of called out that the whole world is against them, that the music is playing specifically to make them miserable. And it can absolutely feel that way. Hopefully you’ll have a good night’s sleep, have a little perspective, and understand that it’s not personal. However, it is exhausting, again, going back to those physical symptoms of grief. And when we’re exhausted, it’s our body calling for rest. And if you need to take a break from all of the festivities, and the movies, and the songs, and all of the baking, and all of this kind of stuff, then absolutely, take a rest.
– So, talking about food and drink, you say there are some things that you should be mindful of no matter if you’re at home in a family dinner or if you are at a party.
– Absolutely. So, along with the physical symptoms of grief, those can be accompanied by changes in your digestive system, either speeding up or slowing down. Our appetite can change, either decreasing or increasing. And so, a lot of times we are not really paying attention. We’re also very foggy-minded and lose a lot of focus, so we’re not necessarily paying attention to what we eat, or when we eat, or how we eat. So, one part of that is just bringing some attention and awareness to what we’re eating and how it makes our body feel, knowing that our body is in a sensitive state to begin with. And so, eating a lot of foods that make our body not feel great, whether it’s too much sugar, too much alcohol, too much fatty foods, things that don’t promote a feeling of healthiness in your own body can really weigh on you very heavily. There’s been a lot of research lately about the connection between the digestive system and our mood, in the brain connection, this direct line. And that’s real. So, if you’re already feeling down, having your system be upset can absolutely bring your mood down. And we should also always remember that alcohol is a depressant, so when you’re feeling down, alcohol is not likely to lift your spirits.
– Tell me a little bit more about supportive counseling. Talk about the approach and sort of the journey that people go on when they come to see you.
– One of the most important things, I think, about how we handle supportive counseling is that we allow people to tell us that they would like to speak with us. We don’t reach out to people and say, “You know, we’ve heard you need somebody to talk to, let’s set an appointment.” We ask people to come to us, and when they come to us, they can then let us know what it is that they’re having trouble with. This is very much centered on the needs of the individual. Every homework assignment I get is very personal and tailored specifically for that situation in an effort to start to get the mind thinking again. So often, again, that brain fog can help make us feel very stuck in a moment. And so a lot of the homework is about opening up the mind and getting the different parts of the brain working again. So, my first question to folks is, “Well, tell me a little bit about why you’re here, and tell me a little bit about how you think I might be able to be helpful.” And they say, Oh, I don’t know, where should I start?” I say, “Well, you start where you think is important.” And that’s always a really beautiful thing. And people start in very, very different places, and that tells you a lot about what they’re going through and how they’re moving through their own process.
– So, in general, really is meeting them where they are.
– Absolutely. Absolutely. That’s the primary goal.
– Are there stages of grief, or is that a cliche?
– That’s a difficult question. Those stages of grief were initially written to actually speak about the person who is dying rather than the grief process itself. However, that misconception, there’s been a lot of efforts to sort of clear that up. But we all have that in our mind, the stages of grief. So, it’s not that they’re incorrect or that the emotions that they talk about are wrong. We all go through all of those things, absolutely. But when people ask me about that, and they often, often do, the issue is that when we think of stages, we think of a linear progression and moving through something in a certain order. And what people mostly find is that grief is chaos. It’s very chaotic, and it is not a series of steps, and it’s not a forward line. In fact, in my counseling, I really never use the words forward, or backwards, or up, or down, or better, or worse, because it implies a certain progression. When we talk about stages, people feel like, “OK, I can check off the acceptance,” or, “I can check off the anger,” and then they wonder later, if they feel angry at another time, “What’s wrong with me? Why am I moving backwards?” But it’s not moving backwards, it’s moving through the chaos.
– So, obviously, lots of conversation and really being easy on yourself and being gentle and sort of not upset with yourself if you don’t want to do something a day. Are there other things that can help along the way? Do you tell people to go exercise? Or what are some things that might even be misconceptions that, you know, if you’re dealing with grief, you should also be doing this?
– Well, one of the things I really encourage people to do is get outside. Not only is it good for the breathing, you know, getting more oxygen to our body, getting more oxygen to our brain, also calming. But there’s so much science right now that talks about the interaction between nature and our mood, particularly trees. Trees have been proven to be very calming for brainwaves, so when we are feeling very much out of control of our emotions, of our thoughts, of our mind, taking a walk in a forested area or even down the street if you’ve got some trees on the street, is a really wonderful exercise and helps to calm. Moving your body at any time is always a healthy choice. The hormones that it produces will help cheer you up. But I think that those times when we can’t be outside, you know, when it’s very, very cold or too rainy, whatever it is, if we can bring any of that green inside of the house, actually – house plants or surrounding yourself with other kinds of things that need a bit of nurturing that are also living, that can be helpful.
– Right. And would you say, baby steps all the time, or do you see people make giant leaps?
– I would say that through grieving, this is one of the hardest parts of it. At each progression, people start to stabilize. Again, it’s that chaos: Things can feel so out of control, and then you start to adjust, and things are a little bit more manageable. But then what can happen is that when you get to a place of stability, you start to understand the magnitude, how big your loss is, and how permanent it is. And as you digest that along the way, those leaps are extremely painful. So, yes, people take big leaps and it feels very much like you’re moving backwards, but it’s actually a very healthy thing. It means that you’re moving through your grief and you’re beginning to find acceptance – not that you like it, not that you’re happy about it, but that you’re accepting. But that acceptance is very, very painful. So, yes, there are big leaps, but they don’t usually feel good.
– What do you want to say, too, about when it comes to being gentle and timeframes. Do people tend to put timeframes on things? We hear time heals all wounds, and then someone might say, “It’s been five years, I’m still stuck.” Can you talk a little bit about that?
– Absolutely. “Time heals all wounds.” In fact, that’s something I think I say to every person that I speak to. Not that time heals all wounds, but that time does not heal all wounds. In fact, time doesn’t do anything other than provide space for you to have your experiences. Basically what’s happening is that you’re learning to live in a world without this person who is significant to you. And there’s no way for us to know in advance how many ways our world has changed. Time allows you to go through life and learn about the ways that the world is different without your person in it. So there’s no time limit to it. We grieve probably for the rest of our life because our grief is our love, and our grief is our way of carrying our person forward through time. We’re not wanting to put this person behind us or move on. We want them to come with us, and that’s a very healthy thing. Now, sometimes people are very upset ’cause they say, “Oh my gosh, I’m going to feel like this forever.” And the answer is “No, no, you’re not going to feel this way forever because everything changes.” You will adapt, you will change. The goal is to integrate your grief into your life in a way that’s manageable rather than having it dominate your life. But we’ll always have those moments where, “Oh gosh, I wish my mom was here for that,” or, “Oh my goodness, I wish my husband was here for that,” or my child, or whatever the relationship is. You don’t stop missing them, you don’t stop loving them, you learn how to live with that missing of them, and that’s a very different thing. So there is a certain pattern to grief, and there are things that we might look for along the way, but as long as you’re able to, you know, do the things that you have to do, are you able to get out of bed, are you able to go to work? Because your mortgage has to be paid, you know, you have to pay for your car, these kinds of things. We don’t have typically the option to just put life on hold completely. There’s practical matters that have to be taken care of. As long as you’re able to move through those things and find some joy in life, then the time that you take to process your loss is your own.
– So, in closing, what do you want people to keep in mind?
– It won’t always be like this. Things change, your life will change, you’ll get it figured out, you will find a normal again, your normal will not look like the normal that you had, but there will be a normal again. And there is joy and beauty in the world, and unfortunately, this sorrow is the price that we pay for being human.
– Well, Elizabeth Schandelmeier, such great information. We thank you so much for coming in and spending time with us today.
– Thank you so much. I really appreciate the opportunity.
– You’re welcome. I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.
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