What is Complicated Grief?
Losing someone close to you can invoke many complex emotions like sadness, pain, loss, and hurt. These feelings are natural and a part of life, but with complicated grief, or complicated bereavement disorder, such feelings don’t fade with time or improve. Their emotions might be so intense that it disrupts their daily life.
Living with complicated grief can bring up dysfunctional behaviors and unconventional thoughts. This chronic form of suffering can make it impossible to return to a healthy state of life. When normal grief does not go away, complicated grief occurs.
Think of complicated grief like being in a heightened state of mourning that prevents you from accepting and moving forward. Often this looks like intense sorrow and pain and constantly thinking about the loss of your loved one. You may find it challenging to think about anything else but your loved one’s death. But also, complicated grief could also arise from separation as well as life transition such as loss of job.
Complicated grief can arise from any type of loss
Losing someone close to you is a distressing and natural event that everyone faces at one point or another throughout their lives. It is entirely normal to go through a period of sadness, numbness, regret, guilt, or even anger. However, these feelings eventually fade and are replaced with acceptance and the ability to get on with life.
For most people, the grieving experience follows a natural sequence and timing of events:
- Acceptance of loss
- Experiencing the pain and grief of your loss
- Adjusting to a new reality without your loved one
- Having new relationships
Complicated grief does not allow you to move through these stages in a healthy time frame.
Examples and Signs of Complicated Grief
Complicated grief can look like normal grief, except that symptoms usually fade over time with normal grief.
Examples of complicated grief may include:
- Avoiding thinking of their loss
- Obsessively thinking of their loved one
- Intense longing for their loved one
- Feeling a loss of purpose in life
- Constantly reminding themselves of their loved one
- Suicidal thoughts
- Unable to accept their loss that occurred at least six months ago
- Feelings of loneliness
- Insomnia
- Lack of interest in taking care of one’s self
- Reckless and self-destructive behavior
- Inability to resume their regular routine
- Avoiding activities or places that remind them of their lost one
- Loss of appetite
- Stress and anxiety
If these symptoms persist for more than a month and significantly impair your life, then it may be time to seek help.
Please contact the National Suicide Prevention Lifeline at 1-800-273-8255 if you have suicidal thoughts to receive support and assistance from a compassionate, trained professional.
Healthy Ways to Cope
The best way to cope with complicated grief is by seeking out professional counseling and therapy. Treatment can help you focus on your condition and begin the process of healing.
The most common treatment option is called bereavement therapy. A bereavement counselor will show you ways to monitor your grief and stabilize your emotions. You can also join a bereavement support group to talk about your feelings of sorrow, pain, and loss. It’s important to know that you are not alone and that other people experience the same emotions.
Other forms of therapy can help you cope with your situation, such as traumatic grief therapy. Help is always available, and you can find ways to find happiness and peace again.
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PTSD in the Black Community
Recent events have some people scared. This makes sense. People are clamoring for change, and tensions are high. Not to mention, the nation is still in the middle of a worldwide pandemic that has left millions unemployed and our economy teetering on the edge of a cliff. All of these disasters and injustices have disproportionately affected minorities. Some people will be traumatized by the happenings of today. So in light of that fact, I decided to examine Post Traumatic Stress Disorder (PTSD), as it relates to the black community.
Let’s start by describing this mental health disorder. Post Traumatic Stress Disorder, or PTSD as defined by the American Psychological Association is a mental illness and specifically an anxiety disorder where an individual struggles with recovery from witnessing or experiencing a terrifying event. Unlike the commonly held belief, PTSD is not limited to wartime veterans, and it can manifest due to several different ordeals such as domestic abuse, sexual assault, or even natural disasters. The disorder can last several months to several years, when a person sees, hears, or remembers something that they relate to that event, they are ‘triggered,’ this can happen often and be debilitating for a person who holds or qualifies for the diagnosis of PTSD as triggers can come up often within everyday life leaving them struggling with a feeling that they are back in that traumatizing event. Remember, a trigger is a memories that evokes an extremely intense emotional and physical reaction.
Other symptoms of PTSD often include nightmares and unwanted memories, flashbacks, heightened reactions to otherwise non -threatening stimuli, avoidance of triggering situations, PTSD can even lead to anxiety, depression, and make a person more vulnerable to developing substance abuse. Treatment for PTSD is available in the form of different types of trauma-focused therapy models. Some of these models might include the use of medication to relieve symptoms of PTSD as they allow individuals to work toward a better quality of life.
So how does this relate to the black community? It’s easy to see that the black experience in the United States is rife with traumatic events. From the desperation that arises through the effects of poverty, to the overt systematic racism that permeates our justice system. Minorities are repeatedly traumatized by the witnessing of the murders of innocent men and women. Trauma is experienced when we read about the number of black men in the prison system (many for nonviolent offences). We become anxious every time we see a video of a woman threatening to call the police on citizens minding their own business. But the worst part about it, is that we have been exposed to it over, and over, and over again, allowing the traumatic cycle to continue.
As a member of the black community, I want to emphasize that this trauma is real, and that it’s impact has lasting consequences. If this resonates with you, you’re not alone, and this does not mean you’re weak. This is the result of our community collectively experiencing PTSD. As mentioned earlier, there are resources to help individuals make sense of it all. I want to encourage you to take the steps necessary to take care of yourself, even as we all work to make these sources of trauma a thing of the past. Reach out to your local therapist at Counseling and Wellness Center of Pittsburgh, as well as to your support groups. Be aware of your triggers and learn positive ways to cope with them. Remember, your voice is your ally, do not stop talking about this!
Learn MoreTrauma; Honor For Your Healing Journey
Honor your healing journey
The four things your therapist wants you to know about your healing journey. When you’re healing from a grief, trauma, or resultant PTSD, you must be thinking about ‘how will I ever move on from this horrible, unexpected, agonizing reaction to the traumatic situation that I have experienced?’ Remember, PTSD is a reaction to witnessing or experiencing a sudden and unexpected event which caused one to feel powerless by delivering, threatening, or witnessing harm. How can I rise above these feelings and thoughts and create meaningful and complete healing? Maybe you want to go backwards in time and undo all of the harm that you have experienced. A common and reasonable response to all of these above disorders, particularly PTSD, is to try to avoid all triggers associated with the situation which evoked the trauma, hypervigilance, intrusive memories, nightmares, flashbacks and an increased risk for anxiety and depression. This disorder presents a mountain to ascend, and whether you have spend years in therapy or are only beginning to acknowledge the depth of the effects this has had on you, these are some points to keep in mind. These are the 4 things that your therapist wants you to know about healing that are not immediately evident.
Healed but not Forgotten
Some people have the unrealistic expectation that when they reach the end of their healing journey they shouldn’t have any emotional reaction to their memories of the traumatic event which led to grief and loss. That is not how healing works. It is quite likely that you will always have some sort of reaction to the memories and thoughts associated with your grief or trauma. In fact, according to a 2011 study published in NIH by Sherin and Nemeroff, and according to all of science and psychology support the fact that there is potential for long term neuroanatomical and neurochemical changes to the central nervous system resulting from trauma. These changes are especially evident in the way we respond to triggers or trauma associated stimuli. What we should be striving for in the healing from trauma is a ‘new normal.’ Healing means that you are able to function in professional or personal settings and that you are practicing resilience and positive coping when waves of thought and emotion do come.
Healing means Acknowledging Feelings
One of the ways that therapy works is by creating an intentional space for healing warriors to be honest with themselves, to create an understanding of their emotions. After an awareness has been formed adaptive responses to feelings and thoughts can be generated. We create psychopathology by being critical and attempting to repress our internal honest responses. For some people like first responders, police, and paramedics, there may be an extra layer of difficulty and stigma attached to acknowledging ones feelings and seeking mental health support to manage trauma. This can cause further damaging denial of the effects of traumatic experiences, One of the core tenets of psychological theory present in every form of therapy is that the more we repress, judge or avoid our feelings, the more we cause problems. Repression elicits tangled feeling constellations, blocked energies, incomplete and unintegrated shadows. Mindfulness based stress reduction, EMDR, and Cognitive Behavioral Therapy, and Exposure Therapy, have shown efficacy in treating PTSD. Our feelings can turn into psychopathology that are bigger and sometimes socially unacceptable forms of the original emotional response.
Healing Happens in Relationships. Find your Healing Tribe.
It is especially true for trauma that happens in relationships, that this same trauma is healed in relationships. When trauma survivors open up to those people who they consider to be safe, there is an incredible potential for healing to happen. Healing relationships are those that resonate compassion, gentle acceptance, warmth, and non-judgement. Think about it, we become close to those who we can be really honest with, those who ask about our feelings and can share in a compassionate interchange, (Mgrath, 2001). Sharing trauma should be exercised with caution. However well-intentioned our healing tribe may be, its members may inadvertently respond in less constructive ways that judge, shame, or put down the survivor for having the pain or scars of trauma. Another risk is not being able to hear or understand what is being shared. What is really needed is non-judgmental acceptance, understanding, and compassionate warmth.
Find your healing tribe
Positive Psychology, Pop Culture and Non-Reality
You may have survived a trauma but that doesn’t mean you have to fall victim to meme reality. Scroll through a social media forum and you will see many posts and memes which declare that everyone should be happy all the time. That isn’t honest or possible. The healthiest among us are those who are honest with themselves about what they experience and then respond to their vulnerable reality in a constructive way. According to a 2016 study by Elizabeth Kneeland, pop cultures layman positive psychology is damaging. When pop culture got its hands on positive psychology its representatives distorted the message, and now laymen perpetuate unrealistic and uninformed messages which imply that we can think our way into a good mood. It suggests that if we blink our eyes we can make trauma and psychological distress evaporate. Your therapist knows differently. Its ok to be outraged, disgusted, sad, hurt, angry, confused, and it is important to acknowledge where you are in your healing journey today.
No matter where you are today, the best we can do is to risk opening to ourselves, to create an honest internal dialogue that we are eventually able to share with others. We should unabashedly honor our own processes, giving relentless permission to feel, think and be; in reverence of joy, in honor of glorious fury, to the fullest expression of gaiety, to the utterance of insuperable hurt, to fully hone in on repugnant disgust. Keep developing your divine awareness, and eventually you will have created the unique meaning which understands with a lens of compassion, acceptance, and self love all that has happened to you.
With love and hope for resilience,
Stephanie Wijkstrom, MS, LPC, NCC
- Counseling and Wellness Center of Pittsburgh
830 Western Avenue Pittsburgh PA 15233
- Counseling and Wellness Center of Pittsburgh
2539 Monroeville BLVD, Monroeville PA 15146
Accepting new clients, our therapists accept UPMC, Highmark BCBS, United, Cigna, Magellan, Aetna, HSA, Self Paying and Sliding Scale.
Thank you to our Editor, Dr. Stellan Wijkstrom for his ever helpful alterations and contributions.
For More Reading
Kneeland, Elizabeth et al, Positive thinking Newsweek, 2016
https://www.newsweek.com/2016/09/23/positive-thinking-myth-498447.html
McGrath, Ellen. Psychology Today, published November 1, 2001
https://www.psychologytoday.com/us/articles/200111/recovering-trauma
Post-traumatic stress disorder: the neurobiological impact of psychological trauma
Sherin, Jonathan E, Charles B. Nemeroff
Dialogues Clin Neurosci. 2011 Sep; 13(3): 263–278.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/
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Hands off-Please Do Not Touch My Body, Yoga and Consent.
Consent, Please Do Not Touch My Body
Hands off-Please Do Not Touch My Body.
Closeness is sacred and powerful, and we should share it however we would like with a partner or partners with whom we have provided consent. Personally, I am a ‘toucher’, meaning I am a person who enjoys touch with my partner, someone who hugs family and friends and genuinely savors safe closeness. As we all know, touch can feasibly happen in many contexts. A recent trip to a local yoga studio has spurned some inspiration for considering consent and what exactly that means within the context of yoga. Consent is one of the topics of the century, the importance of asking for it, and heeding to it are championed issues with personal, psychological, and legal context. When we are on our yoga mat, we are presumably in a safe zone, we practice yoga to be well, to relax, to be inside of our bodies, to give life and expression to what our physical selves need in the moment to create our highest expression of safety, openness, and comfort. We rely upon the professionalism, understanding, and care of our yoga instructors while we are on the mat. When others take liberties with our bodies, reactions can range from uncomfortable to traumatic, yet we shouldn’t need to rely upon trauma informed yoga instructors to be the only providers who can offer a style of instruction which provides opportunity to say “No thank you, please do not touch my body.’ From chaturanga to shavasana, we find our bodies configuration of the posture as the yoga instructor cues. Without making space for hands off adjustments, one well-intentioned yoga instructor can inadvertently have a negative impact upon his or her student’s practice, day, overall wellness by taking liberties with his or her student’s bodies.
Consent means that one has asked for permission to approach another person in any way, whether that be to touch, to enter an intimate encounter, or even to provide unsolicited verbal feedback, we should always ask before encroaching upon others. After asking for consent, we wait and pause for that person to respond with their response of approach or avoid. A key component of consent is that the other person is truly able to say ‘no,’ if we are in a position of power, or if we are asking a person who is intoxicated, a minor, or incapacitated in any way, then the other can not provide for their own consent. Under normal circumstances, then, if and after we have been given permission to ‘approach’ we take it a step further to check in to be completely sure that non-verbal permission has been granted to continue or deepen the exchange. Physical space, proximity, and closeness are very special, they are exchanges which can lead to bliss, warmth, bonding, relaxation and even orgasm in the right time. When touch is used subversively, to coerce, to control, to harm, physical connection can become shrouded in horror, it also has the potential to instill anxiety, fear, terror, panic, and pain.
Consensual sexual intimacy is the gold standard, we should always be sure that we are well within the green zone of any boundaries of any person who we are touching and to also always note that we are creating safety for others as we strive for mutual enjoyment and pleasure. There are many contexts or situations where touch happens from fitness instruction, personal training, yoga instruction, little league coaching, physical therapy, massage, and medical settings. While there are many of the medical and physical instructors listed above who do check in and ask, ‘is it ok for me to adjust you.’ The best ones who follow this question by ‘does this feel ok for you’ and to them I applaud their insight and wisdom to always, in all settings, to ask first and wait for an enthusiastic ‘yes’ or a clear non-verbal head nod which unambiguously encouraging procession. For other yoga and fitness instructors, it may be less obvious that they should ask for consent before breaking the touch barrier with students. Let us examine consent from a trauma informed perspective and look at some ways that we can be sure we are always providing supportive and caring touch.
Regardless of the setting or context, we do not have permission to touch another person until we have asked for it and they have given it. For a trauma survivor it can be very triggering and alarming to feel a person, even a coach or instructor grabbing at them, or tapping on their body, for another person to move ones legs or touch ones hands. Feeling safe and giving permission for these things to happen is vital and walking into a yoga studio to practice does not provide consent for one’s physical boundaries to be violated. Just as walking into a bar or nightclub in a low-cut blouse is not the same as providing consent for someone to touch our breasts. Being a woman out late having drinks is not an invitation to have sex, we need a society which is built upon making space for ‘Yes’, or ‘No’ by always ask first. Yoga and fitness instructors, we are here, we want to participate in a fun and fulfilling way but ask before touching please. Additionally, for some instructors who may have a style of delivering their teaching that is very directive and assertive, it may feel punitive to some students.
Recently, in an all levels class, the instructor was someone I had never practiced with before. The class was much less than an all level class, it was more of an intro in my experience, we were cued to move into postures without much attention to how we flow through the sequencing. In any event, after 15 minutes or so warming up, we were cued to do some Sun A’s. When forward folding the instructor told everyone to grab a two blocks in anticipation of their hands not hitting the ground. I have long arms, and have been doing forward folds for many, many, years, it does not tax my body to fold forward and I find it delicious and restorative. The teacher stomped back to me and said ‘No! get your blocks, do not go into your deepest fold!’ In knowing my body, and knowing that I did not need the blocks I started to reach for them to appease her as she began grabbing my leg and tapping rapidly and harshly onto the front of my quad with her pointed finger tips and squinted eyes, ‘Move! Move! Move!’ she commanded. What started as a day of wellness, mindfulness, and an attempt to let myself feel peace, quickly became a source of discomfort and anxiety.
Being a yoga instructor is a big responsibility, it is a pathway to open ones consciousness, those blissed out happy vibes and chakras can really open up and make others aware of themselves, their feelings as well as anything happening with the instructor. We should encourage yoga instructors to have a higher level of insight into their style of relating to others so that the instructor is not unconsciously projecting their own unmet needs or style onto all of those who they come into contact with. The yoga instructor should be very aware of how of tone and content of speech particularly as adjustments are being made. If an instructor is simultaneously speaking in a critical or cold tone ‘move!’ ‘faster!’ ‘in, in, in;’ in a style that feels like they are spitting commands to the students, if the instructors speak this way while grabbing at a students body, it may become even more likely that they are making others feel tense, uncomfortable for anyone, and furthermore this kind of tone and motion can even be panic inducing for some trauma survivors.
More than ever, we must seek to create safety, to speak with love, to be sure that we are providing physical touch which is tender, and warm, and supportive or not tender and warm, if that is the kind of touch which is consensual and agreed upon by those who can legally and actually provide consent. Speak and act with awareness and care for other people’s feelings, doing fitness, pilates, doing a forward fold or downward facing dog, or even having a suspicious mole removed from our bodies are things that must happen peacefully and respectfully, and always with particular attention to any person’s ability to state, ‘No thank you- please do not touch my body’.
Be well,
Stephanie Wijkstrom, MS, LPC, NBCC
Counseling and Wellness Center of Pittsburgh
830 Western Avenue Pittsburgh Pa
and
Counseling and Wellness Center of Pittsburgh – In Monroeville
2539 Monroeville Blvd Monroeville Pa 15146
For more reading on the ethics of touch in yoga;
https://www.yogajournal.com/teach/the-ethics-a
Learn MoreTrauma Informed Care; We Have Evolved to be at risk for Trauma; Here is Why
Trauma Informed Care
We have fantastic and astonishing memory abilities, the human mind and its processes, particularly in the way we store and retrieve the effective memories which then effect the way that we store and respond to our other memories and sensory input. Evolutionary psychology examines the way some things that can be problematic are often helpful to us in the past and as we evolved. This is especially true for trauma survivors. According to the American Psychological Association, Trauma is an emotional response to a event like an accident, rape, or natural disaster, abuse or assault. Immediately after the event, shock, emotional upheaval, loss of ability to function, and denial are typical. Trauma is especially present in situations where a person feels powerless and their sense of control are taken. Long term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea, nightmares, inability to rest or calm down, feeling tearful, experiencing fear and heightened startle response. While these feelings are very universal response to the paralyzing fear that is associated with trauma even if the survivor reports feeling neutral in the moment. Biology offers some rational for how we can feel afraid but work through it in the moment of the traumatic situation, but it is later when we are safe and comfortable that the panic can emerge, generally emotions are something that can be seen and felt most when everything is alright around us, meaning the traumatic event is over and we are safe. Some people have difficulty moving on with their lives because trauma can result in long term effects such as post traumatic stress disorder, acute stress disorder, anxiety, depression, and addiction.
There are so many events that we experience which are traumatic, whether these develop into the more complex constellation of behaviors which we identify as PTSD, really depends on an interplay of biological, social, and other environmental factors. Some of the situations which can cause a trauma response include, domestic violence, sexual violence or assault, car accidents, national tragedies, serving in war, robberies. It is possible that we can experience a traumatic response my witnessing these events even if we are not the direct recipient of the threatening attack.
People who later feel the emotional and physical effects of trauma may wonder, what is wrong with me? Also, even if the event seemed manageable in the moment, it seems bizarre that they keep seeing flashes of it months or years later. The answer is while the effects of trauma can be debilitating, our cognitive processes are primed to be traumatized. Evolution explains that we and our ancestors are wired to hold tight to frightening or threatening experiences, imagine what happened to all of the humans who did not startle and produce massive amounts of cortisol and adrenaline at the sight of the saber toothed tiger just through the northern passage on the savannah. They died and did not evolve to have offspring in our gene pool. Having memory of dangerous events, people, situations, and gearing up to flee or protect one’s self is a sign of an evolutionarily healthy adaptation, it allows us to stay safe by avoiding possibly dire situations. In fact, our Vagal nerve which communicates directly to our bodies, without having to yield the advice of our logic, there are long term changes in the way that our Vagal nerve responds to triggers after we have experienced trauma. The vagal nerve is what allows healthy people to experience the ‘startle response’ for example when someone sneaks up behind you, usually we respond with a physical jerking motion in our bodies, and literally jumping. In domestic violence survivors, being ‘jumping’ and easily startled when a person raises their hand, is a well noted phenomenon that may last an entire lifetime.
We are wired to remember traumatic events. Survivors of trauma know that the sight of the perpetrator of their violence, even a coat that’s the same color as the one their attacker had worn can evoke the fear response. ‘Triggers’ are any stimuli which we associate with the traumatic event. These triggers and their associated memories can and do produce a jolt to the vagal nerve resulting in heightened, panicked, and anxious response in the person who is perceiving them. The biological response when we encounter a trigger are a plenty, our bodies enter a state of hyper-arousal, respiration becomes more shallow, heart beat rises, and fear settles in, even cognitive function is impaired as our higher order reasoning is impeded and all neurological resources are yielded to the hind brain and its motor and autonomic functions. The one and only thought becomes fight, flight, survive, and in some cases freeze. Remember, just like on the savannah in the seat of civilization, the extra energy our bodies create allow us to escape danger.
Cognitive behavioral therapy, systematic desensitization, and exposure therapy, and some therapies which aim to change the tone of the vagal nerve are recommended ways to work through the trauma and empower the survivor to be able to withstand exposure to triggers and regain emotional wellness. It is recommended that trauma survivors do their best to limit exposure to triggers as they heal from the event and associated memories. If you feel that you may be experiencing long term effects from a traumatic situation, it is recommended that you work with a therapist who is specifically trained in trauma informed care. Healing will allow the processing of the entire event, client and therapist will identify triggers, developing the capacity to respond to triggers with mindful balance, and work through the effects of any other psychological effects from the trauma.
Counseling and Wellness Center of Pittsburgh, Serving Western Pennsylvania with Individual Therapy, Couples Therapy, Family Therapy and Wellness Services.
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Post Traumatic Stress Disorder Therapy and Counseling
Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder is a form of anxiety disorder which stems from exposure to a traumatic event or situation which caused real or threatened injury to and this can also be caused by the witnessing of an event or situation which injured or threatened injury to another person. According to the DSM IV, there is a lifetime prevalence rate of about 8% for the development of PTSD. Muggings, rape, terror, hostage attacks, natural disasters, car accidents, are situations that can increase the likelihood that a person may develop PTSD.
As a therapy practice which also specializes in marriage and family counseling, we support the research which suggests that individuals who have experienced an infidelity in their relationship may also go on to develop symptoms of PTSD or Acute Stress Disorder.
There are certain occupations which put people at risk for developing Post Traumatic Stress Disorder by exposing them to frightening and dangerous situations. Those who work as military/armed forces, policeman, fireman, and detectives may be particularly vulnerable for developing PTSD. Finally, there is a second form of PTSD, Vicarious or Secondary trauma, this form of trauma is caused by exposure to information related to traumatic events and is commonly seen in therapists, social workers, attorneys, judges and persons who offer support and services to those who have had trauma.
The Diagnostic Criteria for PTSD are;
- The person has witnessed, was confronted with or in some way threatened with death or serious injury to the self or others.
- The response to this event or threat was intense fear, horror, anxiety, and or helplessness.
- The events is then continually and persistently re-experienced in the form of imagery, thoughts, perceptions, the person may also experience frightening and recurrent dreams related to the traumatic event. The person will then attempt to avoid any associated triggers of the event and have an over all numbing and or a hyper-vigilance meaning they become hyper-aroused when exposed to triggers for the trauma. They also may have difficulty falling asleep, concentrating, regulating mood, and have an increased startle response. Individuals exposed to trauma may too are also at increased risk to develop mood disorders such as depression and are also at increased risk for developing substance abuse.
Treatment for Post-Traumatic Stress Disorder often involves Trauma Focused therapy with a licensed professional counselor or therapist as well as medication therapy in certain instances. Another form of therapy which has proven effective in clinical models is EMDR.
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