Catherine Bruce, LCSW, VIA Health Partners With recommendations to practice social distancing in this uncertain time, many people are left feeling afraid and lonely. Social distancing is thought to slow the spread of COVID-19 and requires people to stay at home as much as possible (Pearce, 2020). In our community we are seeing closures of schools, churches, and restaurants. For many of us, these are spaces where we connect with one another and build a sense of community. Unfortunately, at this time we have been told those spaces are not safe especially for older adults, people with chronic illnesses, and those who are immunocompromised. However, staying at home and away from other people can lead to feelings of loneliness and isolation which can also be associated with poor health outcomes (“Social Isolation,” 2019). In order to combat feelings of loneliness, we will need to be more intentional than ever to engage with our support network and practice self-care. While we are all staying at home as much as possible to slow the spread of COVID-19, here are some ideas to stave off loneliness: Make phone calls and/or video-chat with friends and family daily. A phone call can give us a feeling of deeper connection than texting or emailing and video-chatting feels even more like a visit! For an even more authentic social experience, consider having a standing video-chat or phone call at meals times with a loved one. Spend time outside. Go outside and notice the natural world going on regardless of the state we are in. Feel the sun, breeze, or chilly air on your skin and be reminded that you are an important part of a big world. Engage in physical activity. Exercise is associated with improved mood (Hamer et al, 2012). If you need some ideas for exercising while you remain socially distant, consider going for a walk outside or doing a quick internet search for at-home workouts. For those with functional limitations, consider typing “chair workouts” into your internet search bar to see what is accessible for you. Continue to engage with your hobbies or learn about a new hobby. Many hobbies including gardening, reading, cooking, and crafting can be done at home alone, but if your hobby requires others, turn again to the internet to find blogs and online communities of people who share your hobby. Express yourself! Journaling and expressive art is healing and helps us understand and shape our stories (Nobel, 2018). It is normal to feel disappointed, angry, or afraid about the disruptions in social life. Journaling can help you understand and maybe even reframe those feelings. If you need a place to start, consider these journaling prompts: Describe your feelings of loneliness and how you currently manage them. When do I feel less lonely? What plan can I make to feel less lonely? Who is in my support network? What do these people offer me socially and what do I offer them? What am I grateful for today? What can I do to express that gratitude? Remember that our relationships, connections, and sense of community have NOT been cancelled. As we make accommodations to protect our physical health, let us remain committed to protecting our emotional health as well. References Hamer, M., Endrighi, R., & Poole, L. (2012, July 24). Physical Activity, Stress Reduction, and Mood: Insight into Immunological Mechanisms. Retrieved March 16, 2020, from https://www.researchgate.net/profile/Romano_Endrighi/publication/230762949_Physical_Activity_Stress_Reduction_and_Mood_Insight_into_Immunological_Mechanisms/links/571a2da208ae408367bc8453/Physical-Activity-Stress-Reduction-and-Mood-Insight-into-Immunological-Mechanisms.pdf Nobel, J. (2018, September 11). Writing as an Antidote to Loneliness. Retrieved March 16, 2020, from https://www.health.harvard.edu/blog/writing-as-an-antidote-to-loneliness-2018091414807 Pearce, K. (2020, March 13). What is social distancing and how can it slow the spread of COVID-19? Retrieved March 16, 2020, from https://hub.jhu.edu/2020/03/13/what-is-social-distancing/ Social Isolation, Loneliness in Older People Pose Health Risks (2019, April 23). Retrieved March 16, 2020 from https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks

By Larry Dawalt, M. Div., BCC, Senior Director of Spiritual & Grief Care Services ...don’t be afraid to admit that you are sad, lonely and hurting- especially if your loss is new. These are difficult days, and we are not all in the same boat. But we are in the same storm... In a conversation with a survivor a few weeks ago, we were talking about everyone being in the same boat regarding quarantining and social distancing during this stage of the COVID-19 pandemic. As we reflected together, though, we came to the conclusion that we may all be in the same storm, but we aren’t all in the same boat. Some people still have their jobs, with regular income, social interaction- even though it may be virtual rather than in person- and companionship at home. Others may have companionship, but they have little to no income and may be having trouble making ends meet. Others are simply alone, with limited social contact and a house full of memories instead of the presence of their loved one. At VIA Health Partners, we have made some significant adjustments in the way we provide grief care. Instead of office or home visits, we are making phone calls and also making visits using technologies that permit virtual communication. Actually, we are just as busy as before because many of our survivors need support now more than ever, and our counselors are wonderful people to talk with during these difficult days. But group support is more difficult because not everyone has access to the technology that enables them to be a part of a virtual gathering, and our grief groups and workshops are currently suspended until contact precautions are lifted. So, how do we reach those who can’t reach us but still need support? That’s where you come in. Look around. Do you know anyone who may be struggling during these times- someone with minimal or maybe even no support? If you do, reach out and check on them. Give them a call. You don’t have to offer any sage advice. Just let them know that you care about them and wanted them to know it. See if they need any supplies or if it’s okay for you to call every now and then and see how they are doing. If you’re someone who needs support, reach out. Call us at VIA Health Partners (704.375.0100) and a grief counselor will call you back. Or call a friend or neighbor and see how they are doing. Even though you may be the one who needs conversation, it will help them as well. Many people are spending the majority of their days at home, so it’s a good time to communicate. Lastly, don’t be afraid to admit that you are sad, lonely and hurting- especially if your loss is new. These are difficult days, and we are not all in the same boat. But we are in the same storm, so reach let’s reach out and keep each other comforted until the storm passes by.

In her book, Help, Thanks, Wow, spiritual writer Anne Lamott observes that when you think about it, there are really three prayers we offer up to the Divine. Help pretty much speaks for itself, doesn’t it? It’s that SOS signal that throws up a flair to the Almighty or Universe saying “Hey, if You can hear me, I really could use some help down here!!!” I believe that has been a universal prayer this past year, as our initial introduction to Covid 19 in March slowly turned into a long-term relationship, one that we still are trying to manage. On an individual level, our prayers for Help have included loss of loved ones, opportunities to mourn as a community, and in some instances even saying a last goodbye. We haven’t included the loss or change in jobs, our children’s schooling mostly going remote, and cancelled plans for weddings or vacations. The tension of our country this election year, and the realization that a November election result has turned up the heat (if that were possible), leaving us feeling deeply divided and disillusioned. By the time you read this, we will probably be past our first Covid Thanksgiving, Christmas and Hanukkah. What a strange family photo this year, right? (Masks on or off, and does that include the dog?) Sigh, and by the way, HELP!!! So, this may feel like a stretch, but is there something we can find to be Thankful for in these difficult times, as we step into 2021? As I have listened to survivors over these difficult months, I have frequently heard thanks for family and friends. Covid 19 has tested our creativity, as we have had to find unique ways of finding connection. I have appreciated hearing about outdoor suppers, neighborhood driveway visits, and even ‘Zoom happy hours.’ People have been more thankful for the intentional phone call that has reminded them they are not alone, even if living by themselves. People’s pets have been providing comfort, care and companionship, interrupting Zoom meetings with enthusiastic barks. Perhaps having to look for things to be thankful for ‘even during a pandemic’ has become a new habit worth keeping in 2021. And lastly, what does a WOW prayer possibly sound like? In her book, Anne gives us a hint with the following description, “Awe is why we are here. And this state is the prayer: “Wow.” As we head into 2021, I believe our universal exclamation might be, “Wow, we made it!” Somehow, we have survived what many will look back on as the most difficult year in memory. With perhaps ‘Holy’ help (in the form of friends, family, and Netflix) we have stepped bravely, yet war weary, into a new year. As only Anne Lamott can write, “When we are stunned to the place beyond words, we’re finally starting to get somewhere…when an aspect of life takes us away from being able to chip away at something until it’s down to a manageable size and then to file it nicely away, when all we can say in response is ‘Wow,’ that’s a prayer.”

By Larry Dawalt, M. Div., BCC, CT Dr. Smith and I agree that grief ‘is as individual as the relationship that brought it about.’ It’s not one size fits all. Unless they come right out and tell you, how do you know a person is grieving? Are there some relevant signs? What part does grief play in the overall wellness of a person? I’ve been asked some of these questions over my years as a grief counselor, but in order to consider these questions from the perspective of a physician, I sat down for a conversation with Hospice & Palliative Care Charlotte Region Medical Director, Dr. Bob Smith, to get his perspective from his years as a family physician. “If I was a physician and someone came to my office whose spouse had just died but I didn’t know it, and I asked them how they are doing, nine times out of 10 they would say fine,” Dr. Smith said. “So that question may not get a lot of information. But if a person comes in and you ask them how many times in the past week have you missed your medication, and they say a few times, four times, maybe five or six times in the past week, they’re telling you they’re okay, but not showing it. What they may be saying is that I am neglecting my health because I am in the grieving process.” There are other physical indicators as well that Dr Smith says a physician may observe. “I look for changes in a patient’s blood pressure, blood sugar levels and other lab results that may indicate distinct changes, especially if they have been a caregiver. Being a caregiver is very difficult because sometimes a person may have neglected their own health while they are caring for a loved one.” Dr. Smith emphasizes that it may be harder to get details because times have changed when it comes to the physician/patient relationship. “In our modern medical world, when you’re seeing 20-plus patients a day and doing all the documentation and orders that go with that, it’s not as easy to have a relaxed, personal conversation. You may find yourself in a situation where you have to actually take ‘fine’ at face value and go on. And it’s different when you’re not seeing patients in the hospital, or in a place where you know their family members. You don’t always get the information you maybe used to get,” he stated. As a patient who is also a grief counselor, when I visit a physician, I look for screening questions that may indicate the potential for grief and loss. One question I look for is, ‘Have you had any specific life changes in the last year?’ This question, followed by a long blank line or two for elaboration, may give a physician the opportunity to get some news without having to probe. What a physician does with that news can help a patient make the physical adjustments necessary to have the strength to carry on as they grieve. But Dr. Smith reminds us that physicians don’t have to go it alone. “I would suggest that physicians acquaint themselves with the resources available in their community. We are fortunate in this area to have our hospice grief counselors and others who are trained in grief care. But it’s also important to allow a person to help you help them find the right fit. Support groups or even grief counseling may not be part of their family culture or of their psychic make up. That may not be who they are. I think grief is very normal and natural and I think we need to embrace that and not try to rush the process, or make it something pathological. We can walk with them and offer them some insights that we’ve discovered as we’ve helped others.” Lastly, Dr. Smith and I agree that grief ‘is as individual as the relationship that brought it about.’ It’s not one size fits all. Also, during these pandemic days, traditional social support is not as readily available; which means more people may be struggling. This makes caring, compassionate care from a physician even more valuable- and appreciated.

By: Melissa Francis, M.A., LPCA, NCC The lyrics eventually lead us to hope, with a tiny voice that whisper’s inside of us, a voice that says, “you must go on.” But how? Where do we even begin? Recently, a client shared with me a song from the movie Frozen II and as she read the lyrics to me, I could see the impact and connection they had to her grief. A simple song that can connect everyone I sit with, each line representing how dark, empty, cold, and hopeless you feel after someone you love dies. The lyrics eventually lead us to hope, with a tiny voice that whisper’s inside of us, a voice that says, “you must go on.” But how? Where do we even begin? In the beginning, we feel disconnected, cold, numb, as if we are walking through a mine field of emotions, never knowing which one is going to appear. Desperately we look to the future, trying to imagine a different life, sometimes avoiding our grief because it is hard work. We accept that our life will never be the same and it is important for us to acknowledge this. Avoiding our grief may be harmful, however taking a break from it and finding new ways to begin to move forward is part of the healing. Where is it that we begin to envision a new life? It begins by first taking a breath and moving forward, take a step, and step again. You will have moments you feel as if you are going backwards; this is part of the healing and the love we shared, start again. Step outside, breath, listen to music, take a walk, be kind to yourself, don’t rush it, and you will find life again. Remember you don’t have to go through this alone, so reach out to others for support. Contact a grief counselor. Hospice & Palliative Care Charlotte Region can provide additional support, including individual counseling and groups to help you navigate the many feelings associated with grief. Your life will never be the same, and as the poem Shipwreck reminds us, we don’t want it to. The time we shared with our loved one is special and can never be replaced. So we must learn to go on, and this is how we honor them.

By Beth Brittain Morrie Schwartz, in 'Tuesdays with Morrie,' said “Death ends a life, not a relationship.” Your loved one will always be with you, just not necessarily as you prefer. You hold them forever in your heart and memory, and no one can take that from you. I believe that grief happens in the ordinary times of our life. It is in the day to day moments of life that we get some of the most intense grief experiences. It’s the doing laundry and finding one more of his tee shirts in the bottom of the basket and the tears come. It’s cooking a meal that has been the norm for years and realizing she is not there to eat with you. It is getting in the car and seeing a tote bag in the back that was hers. All these little grief moments are what really make up our grief experience. We can ‘plan’ for the big times: the holidays, family reunions and vacations, but the ordinary things just sort of hit us out of nowhere and the memories, tears and pain come to the forefront of our thoughts and experience. Along with the ordinary times, I think grief happens in seasons. We somehow unconsciously mark time as the seasons change and pass (this is getting a bit harder in North Carolina as we really seem to have only two seasons now—wet and dry!). My favorite time of year is winter. I love cold weather and snow and really miss that in North Carolina now. I think it is a time to snuggle in and read, create art or music or just rest. Fall is a nice season too because nature puts on a show with the colors of leaves and the crispness in the air. Summer is my least favorite season as I don’t like the heat. Sure, it’s a time of vacation for some, but since I have no children, I can vacation any time and I try to avoid the crowds at the coast in the summer. People get out and about more until the heat and humidity become intolerable and then we air condition ourselves to keep from becoming grumpy and irritable. Spring, now that’s a lovely time. New life is bursting forth and everyone seems to have a bit more energy. It’s a time of hope and promise and we begin to see others outside because it’s not too hot yet and there are flowers to be planted and tended and animals to walk and often we are greeting neighbors more often in the spring. Grief comes in seasons, too. It seems that the fall of grief may be when the changes are coming to our loved one as their health declines and they become more and more distant and dependent. We sometimes forget that grief doesn’t start with death; it starts with diagnosis. So, Fall grief often happens as the decline becomes more obvious. The Winter of grief for many is the actual time of death and memories linger of the days and weeks surrounding that event. We want to snuggle in and close out the world, but unfortunately, we have to continue living and being responsible, even though we are in the fog of grief. The Spring of grief is likely when we are beginning to emerge from the fog of grief and perhaps resume a somewhat ‘normal’ life. We are able to join others for a meal without the rawness of our grief overshadowing everything. We can attempt new activities and learn new things and begin to emerge, not unlike a butterfly emerges from the cocoon or a flower from a bud. We may not be fully whole yet, but we are functional and contributing. The Summer of grief is when we begin to enjoy (in a different way) aspects of life that we once thought we would never enjoy again. The meal we now are accustomed to eating alone, the daily work around the house, the time with family and friends that no longer makes us feel so isolated and odd are new realities. It sounds simple, doesn’t it? Doesn’t grief just come in periods and we move through them somewhat like the seasons of the year and poof, we are through our grief? It is so NOT like that. And it certainly is not as orderly as the seasons of the year. Grief takes as long as it takes and each season may last a different amount of time for different individuals. Each season of grief brings its own work and challenges and yet, as we work to move through our grief with intention and purpose, we do emerge, ever changed but no less beautiful and maybe even wiser than before. So, what does it mean to do ‘grief work?’ It means allowing our feelings to come and to feel and express them as needed. It means talking about our loved one as much as we need to and to whomever will listen. It means talking with a grief counselor or trusted clergy or friend to get additional support. It may mean participating in a group that includes others on the journey of grief, so we all learn together what works for us. Mostly, it means holding close the memories of your loved one and honoring the way they lived their life by living your life to the fullest. Morrie Schwartz, in Tuesdays with Morrie, said “Death ends a life, not a relationship.” Your loved one will always be with you, just not necessarily as you prefer. You hold them forever in your heart and memory, and no one can take that from you.

by Beth Brittain, M. Div., LCMHCS As I reflected on the survivor’s experience, I realized that her world view must be very similar to being inside of a snow globe; her world was shaken by circumstances outside of her control, and she reported feeling that ‘everything is spinning around me’ as I stand still. She felt ‘frozen.’ Since childhood, I have been drawn to snow globes. I have been known to spend quite a bit of time in stores shaking up globes and watching the changes. It is just mesmerizing to me. Recently, as a grief survivor was talking about a particularly difficult aspect of their grief journey, I thought of snow globes again. This time, however, my perspective was different. As I reflected on the survivor’s experience, I realized that her world view must be very similar to being inside of a snow globe; her world was shaken by circumstances outside of her control, and she reported feeling that ‘everything is spinning around me’ as I stand still. She felt ‘frozen.’ That pretty well summarizes how my world and that of those I serve feel as a result of the COVID-19 pandemic. It has shaken up the normal routine and sent us all spinning while we are trying to cope with grief and loss. I began to listen to others describe their experience and realized that snow globe grief is very real. When you watch a snow globe, there is usually something in the center that is fixed. That may represent us before our world was shattered by loss. After a loved one’s death, we may feel more like the objects that are floating around when shaken; and they always float differently. It reminds me of the uniqueness of grief and that there is no right or wrong way to grieve. For some, when loss shakes our world, we are sort of ‘frozen in place,’ unsure of what to do, feel or think. From the outside, we may appear okay or normal. In fact, though, we are far from our norm and are not even sure what is normal anymore. We fill our roles, but we are often doing so by rote; just going through the motions. Those who feel like the objects being tossed around due to being shaken by grief often struggle to get things done. They may not return to work as soon as others would like and are not as quickly able to finalize tasks. These folks are the ones who can’t seem to make decisions early on and are carried by the help of others who provide support, ideas, and suggestions. These grieving folks often struggle when the support begins to evaporate and they are forced to function more fully and independently. They are usually able to make the transition; it just may take them longer than others would prefer. That might be an important lesson for all the world amidst the COVID-19 pandemic; we will make the necessary transitions to cope with a different way of being in the world, but it may take us longer than expected and we may need to find different and creative ways to accomplish things. Living out our grief in a snow globe is difficult. However, if we work hard to find the balance of feelings, support and growth, the shaking is not so traumatic and we are able to find peace. That is not to say grief will not ‘shake up’ our lives again. But if we do the grief work, tell the story, feel and express our feelings, we are better equipped to find peace and settle into the new ways of being.

By Ken Grano, MDiv., CFBPPC-A, BCC When she arrived at the funeral wearing climbing gear, she was pleasantly surprised at how well she was received by those attending the service. In her article ‘Death Acceptance Through Ritual,’ author Nancy Reeves recalls speaking with a man who was planning on attending a funeral for someone she met through a hiking club. Apparently, members of the club were avid climbers and she wanted to honor the man who died by wearing climbing gear to his funeral. However, she feared this would be disrespectful to the family. She advised this man to reach out to the family prior to the funeral to get their thoughts on what she was planning. When she arrived at the funeral wearing climbing gear, she was pleasantly surprised at how well she was received by those attending the service. She reported that people told her how much it meant to them that she wore hiking/climbing attire as this represented the gentleman who died so well. Another way to say that would be to say that the gentleman who had died was re-presented well by the woman wearing the climbing gear. The power of re-presenting a loved one through symbols is where I would like to draw our attention. In this story the symbols are the climbing rope, shoes, helmet, belays, or whatever was worn to point beyond the symbols themselves to the gentleman being honored. In his Psychology Today article ‘The Power of Rituals to Heal Grief,’ Dr. David Feldman makes the important point that symbolism gives ordinary, everyday acts or objects their power. He goes on to comment about rituals stating that ‘particular acts, with particular objects will yield particular meanings.’ Walking up to the foot of a mountain in climbing gear means something different than wearing the same climbing gear walking into a funeral. As this fellow climber came to honor her friend, she added a ritual within the ritual already taking place in the funeral service. Fortunately, it enhanced the funeral ritual and is a reminder that we can create meaningful rituals through symbols that can provide us with comfort. But how do we do this? Again, Dr. Feldman is helpful: What would you like the ritual to mean? For example, you may want to emphasize a memory, a character trait, words of wisdom, or a life transition. When and where would you like to perform the ritual? You may want to perform them on important dates (birthdays, anniversaries, etc.). It can also be important to consider the environment that could enhance the ritual (a religious setting/building, the mountains, by the ocean, etc.). Who will be there? Perhaps you do not want anyone there. Or maybe it is close friends or family only. There is of course no right or wrong here. It is simply a matter of what will make this the most meaningful. What will be done? What kinds of items/objects and actions will be most meaningful? What can you do that will best re-present your loved one or aspects of their life you want to emphasize? What objects do you have of theirs or what items would help you construct the meaningful connection you are looking for? There is a unique power in ritual in general and in our grief. I hope that you discover meaningful rituals through powerful symbols that bring comfort amidst the pain of your loss.

By Larry Dawalt, M.Div., BCC, Senior Director of Spiritual & Grief Care Services I am not the only one who is tired- especially when I think of some of our grieving survivors. . . Some days I feel like I have just had enough. I am tired of ‘eating groceries’ instead of going out, I am tired of wearing a mask, I want to be closer to people than six feet away, and I would really like to hug my grandchildren or even just see them since it’s been over a year now for the boys in Texas, since the spring trip got cancelled. I can think of other things I’m tired of. I can go on and on and on. Then, I catch myself. Whining. Ungrateful. I am making it all about me. But I am not the only one who is tired- especially when I think of some of our grieving survivors. I know one who is tired of not having her husband around. She has so many important items on her ‘to-do’ list and doesn’t have the physical strength, nor the emotional and mental energy to get things done. She is facing more than one surgery and weeks of convalescent time- alone, without him. The list isn’t going away. It’s actually getting longer. But it wouldn’t be that way if he had not died. She alone. She’s scared. She’s tired. Two other women come to mind that are tired. They are tired of suddenly being thrust into the role of a single parent of young children. They need their ‘co-tutor, co-driver, co-parent, co-everything, etc.’ to be by their side during these difficult days. But their husbands are gone; and gone too soon. A wonderful hospice volunteer comes to mind who couldn’t be at the assisted living facility when her mother died because of the pandemic. She’s tired of wondering why things happened that way and she can’t stop thinking about it- day after day. I am a survivor, too, and even though it’s been over two years now, every now and then I am reminded that I am tired of not being able to call up my Dad to see if he cut the grass today, or if he heard the owl last night, or if he found an auction to go to and look for treasures on Saturday. I feel better when those thoughts come because I am beginning to whine about something permanent instead of the things that are probably not going to last. This year has brought about a lot of changes. The world is different than it was just six months ago, and not just from the pandemic. There is so much unrest and volitivity. Times are difficult for millions. In the midst of this, there are those who are also experiencing fresh grief and spending their days discovering the harsh realities and sufferings of unbearable loss. They need texts, emails, visits, calls, cards, hugs and other forms of contact, but are instead dealing with their losses in isolation, or with minimal support. So, if you have times when you feel like whining, go ahead and do it. I understand. But set a timer; and when the timer goes off, make a call, send a card, whisper a thought or prayer, bake cookies and set them on the doorstep, text or email- whatever it takes to leap outside of yourself and into the world of those who are coping with loss during this difficult time. And for you who are trying so desperately to cope with your grief, please know that you are not alone. Reach out- to family, to friends, to us at VIA Health Partners. We’ll be tired together.

by Brad Sachs “Information brings knowledge, but stories bring wisdom.” These words guide my clinical work more than any others, for I have learned that it is the power of the patient’s story, rather than that of the patient’s dogged data, that defines and informs psychotherapy’s curative properties. Or, as Mark Twain once put it, “Never let the truth get in the way of a good story.” Stories breathe, and the storytelling process keeps us alive and psychologically oxygenated. The patient’s tales convey to us everything that we need to know about who they are and what they need. Human beings naturally follow the river of narrative impulse and when the therapist bravely joins them in navigating these currents, treatment is inaugurated. Our most sacred and potent mission is to help them to recover or re-discover their story, and to re-animate their passion for telling it. I find myself most worried about the patients of mine who can no longer tell their story — whether their story is rich or impoverished, elegant or clumsy — or worse, those patients who appear to have lost interest in their story. Our most sacred and potent mission is to help them to recover or re-discover their story, and to re-animate their passion for telling it. Something crucial is invariably lost when unconscious thoughts and ideas are dragged, sometimes kicking and screaming, into consciousness. There is an unavoidable collapse of one’s personal lexicon at the moment of attempted articulation. But more is gained than lost when the story is told, and the therapist’s primary function is to be the midwife who supports the labor that ushers their epic into the waiting world. And labor it is, because there is a deep-seated fear that all of us experience when thought and feeling are funneled into language. Telling one’s story means acknowledging the mountainous iceberg of experience that lies beneath that story, an iceberg that mutely lurks underneath enduring and fathomless depths. So I am interested in the patient’s story, but I become just as interested in what the patient leaves out of the story — which, of course, is its own story. I am tuning in to both what the conscious mind allows to be spoken, and what it has disallowed, what remains, for whatever reasons, unspeakable. As noted above, we are all driven by the narrative impulse, but we are simultaneously driven by the fear of that impulse, the terror of the anarchic shadow story that, like a dream, resists comfortable formats and inevitably illuminates the darkened shadows of the troubling unconscious. So our work entails listening to what is said, and listening for the unsaid that lies outside of or on the margins of the story, the “anti-story” that simultaneously conceals and reveals itself in the language of plangent silence. Meaningful therapy depends upon a careful exploration of the patient’s determined effort to deploy certain words while eschewing others, to articulate certain phrases while muting others, to recount certain tales while silencing others. This complex calculation results in the series of linguistic choices that govern the nature and texture of the therapeutic conversation. In that context, the meaning of the patient’s told and untold story and the meaning of the patient’s lived and unlived life are terminally bound up with each other and cannot and should not be disentangled. There is a transcendent wisdom to the patient’s language that, when recognized, is unsurpassed when it comes to finding ways to be more fully human, to once again feel whole. The most important request a small child makes is, “Tell me a story.” When we make the same request of our patients, the story of their healing is summoned and finally allowed to begin. Brad Sachs PhD is a psychologist, educator, consultant and best-selling author specializing in clinical work with children, adolescents, couples, and families, in Columbia, Maryland. He lectures and conducts workshops nationally and internationally He is the author of numerous books including, most recently Family-Centered Treatment with Struggling Young Adults: A Clinician’s Guide to the Transition from Adolescence to Autonomy, and many books for parents, teens and families, including: The Good Enough Teen: Raising Adolescents With Love and Compassion (Despite How Impossible They Can Be). Brad is also a poet and musician, whose most recent projects include In In The Desperate Kingdom Of Love: Poems 2001-2004, and the CD Hard Tales To Tell, a cycle of original songs based on stories his patients have shared. Additional information is available on his website.

By Larry Dawalt, Senior Director of Spiritual & Grief Care Services ‘Can you tell me about grief’ is a question I hear often, especially since I have been a grief counselor for a very long time. It is a sincere question, asked at times out of exasperation because people generally want to know, and are desperate for relief from the suffering they are experiencing. Without getting into the basics of grief theory, my first answer would be that grief is about relationship and that makes grief as individual as the relationship that brought it about. I recently read an article by Emily R. Long that describes it well: “Every relationship between any two people is completely unique and individual. That also means that every experience of loss and grief is also completely unique and individual. Everyone grieves in their own unique way. There is no right or wrong way to grieve, no set timeline, and no clear-cut path to walk on one’s journey with grief.” So, what does that mean in terms of day-to-day functioning? It means that while there are certainly some observable commonalities in grief such as initial shock and numbness, sadness and sorrow, anger, loneliness, and maybe even a situational depression, there are also feelings of relief, gratitude, and even celebration and joy for a life well lived that people also express.. To say ‘my grief is not like theirs’ is not only true, but also logical because the relationship was different, and the survivors are unique individuals who grieve in unique ways. What we want is for it to be easily explainable, with simple instructions and a workable action plan so we can feel better and get on with our lives. Unfortunately, it doesn’t work that way. I attended a memorial service in September for a young man who died tragically in a vehicular accident. His mother and girlfriend both gave eulogies and five of his friends went to the microphone to share remembrances as well. Some could barely talk at times while others were able to deliver their words with strength. But you never know exactly what is going on because all we could see and hear was the exterior- on the surface. That brings me to my other answer to the question, and the reason I keep a little duck figurine in my office. Grief is like a duck swimming across the water. The duck may look majestic, serene and in control, but you have no idea how hard it is paddling underneath. I occasionally run across the quote that basically says, ‘treat everyone with kindness, because you have no idea what they are going through. Those words are especially true as to how we should treat those who are grieving. We just don’t know the whole story because grief is as individual as the relationship that brought it about. So, we extend kindness, listen to the stories, and never forget that we have no idea how hard they are paddling underneath.

By Carrie Barto, MA, LPC, NCC with Paula Patterson Grief is the last act of love we have to give to those we loved. Where there is deep grief, there was great love. ~Unknown In my experience, the journey through grief often brings tremendous internal conflicts. Physical, emotional, spiritual, and mental are some of the most prominent, but there are others as well. There is conflict between the head saying the person is gone and the heart saying no, it’s not possible. There is conflict between moving forward in life, and on the other hand wanting everything to stay exactly the same. There is conflict as one reviews the loved one's illness and death questioning, "Did I do everything possible to keep him/her alive? Could I have done more?" when the truth is everything was done as the healthcare professionals directed. The most distressful conflict for many comes in the form of emotions. Experiencing moments of happiness while feeling sad is a common conflict in grief. Perhaps you have been filled with joy watching a new granddaughter take her first steps while being overcome with sadness that your spouse is not present to share the joy. Or, you find yourself laughing with friends, then feeling guilty for being happy. Another example of grief's emotional conflict presented itself to me a few months ago. I received a message from my cousin letting me know their twelve-year-old family dog had died. He asked me for advice about how to help his two young sons deal with their grief, as they were both pretty upset. Later, my cousin shared that his five year old said, "I didn't know I could be sad and angry at the same time." Our society tends to believe that sadness is the only emotion one feels while grieving. If only this were true! Because of this erroneous view, many grievers feel confused by the mixture of emotions they experience. Not only can one feel multiple emotions at the same time, they can experience a variety of feelings many times within a day, or even an hour. For example, a widow may find herself waking up to overwhelming sadness as she faces another day alone. Then, anger may surface as she struggles to learn how to complete a task that used to be her spouse's responsibility. When she is successful, she smiles knowing her husband would be so proud of her. Then, sadness breaks through again. When evening falls, loneliness settles in as she begins to prepare dinner and faces this sacred time of their relationship alone. She feels hungry and nauseous at the same time. She feels like leaving home, like running away, but knows once she leaves, all she will want to do is return. Then, she hears a song on the radio that they used to dance to and feels like she's been hit by a tsunami-sized wave of grief. As she recovers, a smile crosses her face and she laughs out loud, remembering a funny exchange she and her spouse had not long ago. And so the emotions surface and change during grief. Being caught off guard and thrown off balance when your emotions change rapidly, intensify, then subside only to return later without warning is scary but normal. As you move through your grief, it is common to feel confused, overwhelmed and exhausted; not like yourself at all. The conflicting emotions that surface in grief can cause you to feel like you are losing your mind. This can often lead to a feeling of loneliness and isolation because you believe no one understands how you feel or even worse, may judge you for those feelings. Be assured, there is nothing wrong with you. You are not losing your mind; you are grieving. In time, the storm of emotions will lessen as you acknowledge what you are feeling and process your grief. It will be helpful to learn about the grief process through books, support groups or counseling. Allow yourself to feel the many emotions of grief and consider them a tribute to your loved one. Grief is normal and healthy. Don't deny yourself this sacred process. In time, the conflicting emotions you experience will be less painful. You will always sense your loss, but you can feel joy with it, too. Grief is the last act of love we have to give to those we loved. Where there is deep grief, there was great love. ~Unknown