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Dealing with Loss in Lay and Professional Roles

Everyone loses a loved one at some time or another. As practicing psychologists for many years, the authors have often helped others deal with loss. Maybe we should be used to it. But not so. When experiencing our own losses, we found ourselves reacting just like our patients.

Regardless of education or experience, the death of loved ones hits hard. When the sense of loss overwhelms people, they rely on help from case managers. They can depend on you for help to deal with the overwhelming details and decisions that accompany caregiving and death.

But the person closest to loss is not the only sufferer. Loss, and the accumulation of many losses over time, takes a toll on the case manager. This article offers some suggestions for caregivers and for case managers to cope when illness and death occur.

Managing Feelings

Americans tend to be doers. Getting the job done is the priority. All too often, feelings get pushed away in the effort to accomplish some goal.

Taking care of a loved one or watching a loved one die brings up all sorts of uncomfortable feelings that run the gamut from sadness, anger, guilt and even relief. Emotions that get pushed aside tend to go on for too long or become too severe. When this happens, emotions can interfere with caretaking. For example, the person burdened by sadness may have difficulty finding the energy and motivation to care for the loved one. Guilt and anger can create inner turmoil that sometimes leads to poor decision-making.

Talking, journaling, and getting those feelings “out there” help with positive expression of emotions. Once uncomfortable feelings are expressed, caretakers are better able to take in information and make decisions. This reduces the sense of being overwhelmed.

When working with feelings, stress the importance of talking with trusted family members, friends, clergy, and support groups. When these natural supports fail, caregivers need a referral to an experienced helping professional.

Living in Crisis Mode

Caring for a chronically or terminally ill family member means that emergencies will crop up. Whenever possible, caregivers need to be forewarned so that they can make room in their daily routine for crises.

When emergencies become more of a marathon rather than a sprint, the caregiver’s tactics need to change. Learning how to survive weeks or even
months in emergency mode takes energy, knowledge and skill. Caregivers need help to learn how to incorporate strategies such as taking breaks and providing time for self. Only when caregivers commit to taking care of themselves will they be able to refresh and recharge. Relaxation must be viewed as a necessity rather than an option.

Finding ways to maintain a sense of normalcy can mean the difference between burnout and severe reaction to loss and meeting caretaking responsibilities with resilience. Whenever possible, urge caretakers to call on other family members to share the burden. In time, asking for this help may aid other family members to know that everyone did the very best possible.

Good self-care and the comforting balm of routine become more important than ever during times of caretaking and loss. Diet, exercise, sleep and personal medical care are critical. A well-placed mental health day can make all the difference. Caretakers may need encouragement to take these necessary steps. The loss of a loved one doesn’t happen often and few are prepared to take time for self.

Grief: A Process

The grief process can start at any time during a loved one’s illness. The first phase consists of numbness and shock. The second is described as searching, where people experience the separation and cannot accept the reality of the loss. When the reality hits home, despair follows with feelings of depression, problems concentrating and an inability to look toward the future. The final phase is reorganization. During this time, the necessary psychological and emotional adjustments occur, allowing people to move forward.

Case managers can help caregivers by encouraging expression of feelings. Open expression helps smooth the transitions between phases through acceptance. While grieving, caregivers need reminders about planning for difficult times — birthdays, family holidays, and anniversaries of loss. Resilient people often “throw themselves” into work, be it through shopping, cleaning or yard work. These can be helpful diversions.

The bottom line? Everyone experiences loss differently. What will help varies on an individual basis. Don’t be afraid to ask the caregiver what they think will help and take an inventive approach to providing what’s needed.

When Grief Affects Case Managers

Yes, case managers feel loss and need self-care too. The principle “do no harm” includes you. No one can be a never-ending source of caring. You
can’t help people without having an empathic response to their loss, which will have an effect on you.

When the case manager fails to commit to self-care, the ability to care for clients diminishes. Studies show that stress, burnout and compassion fatigue are all common, especially when stress is not managed. This can lead to mood and anxiety disorders, impaired judgment, and addictive behavior such as self-medication. The ethical approach is to take care of yourself, to monitor your capacity to cope with loss, and to acquire supervision.

From our standpoint, the American Psychological Association states that psychologists must refrain from any professional activities when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work in a competent manner. When this occurs, psychologists are expected to take appropriate measures such as consultation or assistance, and determine whether they should alter work-related duties.

We both have been helped by consulting with colleagues when we lost loved ones. Like everyone else, we experienced natural emotional responses and moved through the grief phases when caring for an ill loved one. We took necessary steps to make sure that our feelings didn’t interfere with our work.

Take the advice you give your clients. Maintain a healthy routine to recharge your physical batteries and keep stress at a minimum. If you supervise staff, part of your job is to model resilience and that means good self-care. Another way to recharge? Keep learning — even beyond consultation and your required annual continuing education units. Acquire new information and reminders about the basic skills of your profession. Don’t be afraid to find professional help yourself if needed.

Case managers have a unique perspective on loss and grief. We care for those going through loss and we receive help when faced with our own losses. Today you may be a grieving family member. Tomorrow you may have to offer professional assistance to those experiencing loss. In both cases, good self-care will enhance your ability to care for others.