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Mental Health

Interview with Dr. Allen Frances on the DSM 5

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Approximately a week ago, I wrote an article asking Will Clinical Social Workers Embrace the New DSM 5 in light of the National Institute of Mental Health withdrawing its support for the publication. Then, Dr. Allen Francis wrote an article making a case for social workers not to embrace the DSM 5.

Responses by social workers on different social media outlets varied, but one unifying question remained….Why now? Historically, social workers have not been included in the developmental process of the DSM by the American Psychiatric Association (M.D.’s) despite being the largest provider of mental health services. I decided to email Dr. Frances and asked if he was available to answer some follow-up questions about his article on social workers.

He responded, “Sure…Let’s have a telephone call today. The week is very busy”.  Dr. Frances spoke with me for almost a hour in order to help me relay the likely long term implications of the DSM V and why social workers being the largest stakeholders should be concerned too. This article is packed with resources because I independently verified every statement made by Dr. Frances in order for you to make your own assessment.

Before I dive into the interview with Dr. Frances, I would like to bring you up to speed with some background information on this not so new controversy.

What makes Dr. Allen Frances an authority on the DSM?

Dr. Allen Frances was chair for the DSM IV task force and the Department of Psychiatry at the Duke University School of Medicine, and he is currently a professor emeritus at Duke University. In late 2010, Dr. Frances did an in depth interview with Wired Magazine who had unlimited access to him as he reflected on almost two decades in the past when he authored the DSM IV. Here is an excerpt from Wired Magazine:

In its first official response to Frances, the APA diagnosed him with “pride of authorship” and pointed out that his royalty payments would end once the new edition was published—a fact that “should be considered when evaluating his critique and its timing.”

Frances, who claims he doesn’t care about the royalties (which amount, he says, to just 10 grand a year), also claims not to mind if the APA cites his faults. He just wishes they’d go after the right ones—the serious errors in the DSM-IV. “We made mistakes that had terrible consequences,” he says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs.  Read Full Article

The article in Wired Magazine was indeed an eye opener. It discusses how an influential advocate for diagnosing children with bipolar disorder failed to disclose money received from the makers of the bipolar drug Resperdal. When viewed with a wider lens, it not really all that surprising considering the recent revelations on Attention Deficit Disorder as discussed in the New York Times.

History of Social Work Involvement with DSM

Back to the interview with Dr. Allen Frances, the first order of business was to gain some insight on the sudden outreach to the social work profession, and I didn’t anticipate learning something new. However, this was not the case.

Dr. Frances went on to tell me about Social Worker Janet B. Williams who was the text editor on the DSM III. Additionally, he also notes that she has been the only social worker ever to be included in the DSM development process. Currently, Janet Williams is the Vice President of Global Science at MedAvante. As stated in a 2011 PRNewswire Press Release, “MedAvante solutions help sponsors achieve enhanced assay sensitivity for increased drug effect and reduced trial failure rates, enabling them to bring better drugs to market faster.”

Dr. Frances acknowledged that social workers have not been represented in the development process despite being the largest provider of mental health services. However, he did state, “Social Workers have a huge stake in improving care for the really sick and should not be distracted by the expansions of the DSM V.”

DSM 5 Impact on Consumers 

Dr. Frances expressed concerns for military service men and women being overly diagnosed with PTSD in lieu of allowing time for transitional services. Dr. Frances gives another example of how unemployment causes depression which is the result of environmental factors and not a mental illness.

Once someone regains employment and the situational stressors have abated, should this individual retain the label of a psychiatric disorder for seeking counseling as a coping mechanism? Do practitioners really want to label someone as a major depressive because they are unemployed or have been diagnosed with Cancer? Here is a video where Dr. Frances goes more in depth on the potential problems this will cause:

Unintended Consequences of DSM V

Dr. Frances stated one of the major issues with the DSM series is that its primary authors are research academics who are making suggestions and recommendations based on controlled research studies conducted in University clinics which are not helpful in everyday practice. By expanding the DSM 5 to cover challenges of everyday living, it will mislabel medical illness as a psychiatric disorder.

Dr. Frances also stated it will continue to foster an environment that diverts attention and resources away from the severely mentally ill and uninsured. As an example, Dr. Frances referenced the 1 million inmates in prison as a result of an undiagnosed and untreated mental health disorders due to poor resources and health care. Apparently, the Bureau of Justice Statistics agrees with him, and you can view their report here.

Dr. Frances quotes President Obama when he stated, “It’s easier to get a gun than an outpatient appointment.” Although gun control was not apart of our discussion, it should be noted that the National Rifle Association (NRA) is using its powerful lobbying efforts to change mental health thresholds and reporting laws in all 50 states.

Couple this type of legislation with over diagnosis by mental health professionals, the outcomes for children and families could be devastating. The New York Times does a great job of summarizing the presenting issues with current NRA proposals in an article entitled, The Focus on Mental Health Laws to Curb Violence is Unfair, Some Say. You can also view this video of Dr. Allen Frances speaking on the over diagnosis of mental illness:

Common Misconceptions About the DSM V

The interview with Dr. Allen Frances gave me an opportunity to ask him for clarification on some of the concerns expressed by social workers and their reasons for embracing the anticipated DSM 5. I made of a list of the main key points that he wanted Social Workers to know:

  • The DSM is a copyrighted manual by the APA with no official authority with public or private health insurers.
  • The ICD Codes are the only required codes necessary for billing mental health services. He states these codes are free of charge from the government with accompany resources and guides available. Here is the link found on CMS.Gov.
  • The APA is motivated by earnings for publishing a new manual to cover budgetary shortfalls.
  • Unless your institution demands use of the DSM V, Don’t buy it, don’t use it, and don’t teach it.

“The ICD is the global standard in diagnostic classification for health reporting and clinical applications for all medical diagnoses, including mental health and behavioral disorders. The United States will be one of the last industrialized countries to adopt the ICD-10, even though it was published in 1990.

Every member state of the World Health Assembly is expected to report morbidity and mortality statistics to the World Health Organization (WHO) using the ICD codes, but countries are allowed to modify the ICD for use within their own country.” ~Practice Central

https://twitter.com/AllenFrancesMD/status/335927445326802944

Dr. Frances provided his twitter feed where he disseminates information on his current projects. He also stated to tweet your questions, comments, and concerns to @AllenFrancesMD as seen above.

Recommendations

Dr. Frances states that he believes there should be a government arm similar to the FDA to help regulate, provide guidance for mental health providers, and make recommendations for public policy. He believes it should be comprised of an interdisciplinary team of psychiatry, social workers, and public health in order to create a holistic approach to treatment and diagnoses. Dr. Frances stated the APA should no longer have a monopoly on mental health especially with increasing influence from drug companies manifesting in their policies.

Also View:
Dr. Francis Op-ED in the New York Post
Don’t Buy it, Don’t Use it~Mother Jones
Find Him on Huffington Post

Deona Hooper, MSW is the Founder and Editor-in-Chief of Social Work Helper, and she has experience in nonprofit communications, tech development and social media consulting. Deona has a Masters in Social Work with a concentration in Management and Community Practice as well as a Certificate in Nonprofit Management both from the University of North Carolina at Chapel Hill.

15 Comments
Keith Owens says:

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Rachel West says:

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Rachel West says:

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Child Welfare

Systems Perspective and the Myth of the Self-Made Man

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As a social worker, we spend a good deal of time looking at systems, and systems work means we can’t only focus on what’s “wrong” with the individual in our office. Our focus can’t simply be what can this person do to move toward more emotional happiness? We need to always be considering how living in the world and engaging in relationships with other systems and other people play a large role in what this client does, how they think, and how they feel.

My job isn’t to just locate the unhelpful belief my client has about their self-esteem or retrain how they respond to a negative thought. When doing systemic work—even with just one person—I need to look at how race, ethnicity, age, sexuality, and gender play a role in my client’s life. I need to look at how that client’s family system, school system, government system, community systems, and more played a role in shaping my client.

As basic as this is, it’s important to note that It’s a fairly un-American way of going about things.

The Big Lie of Individualism

We’re taught that we should hold up the self-made man. We celebrate that guy to no end in movies, plays, songs, and stories. It’s our enduring myth.

We, social workers, see the monstrosity in that idea—pleasant and attractive though it is. We know that human beings can only grow and thrive within relationships, not apart from them. We know that nothing is self-made. We know that we are working from day one of life to attach to others.

We need to push back on the “self-made man” myth because it’s racist. It’s sexist. It’s heteronormative.

And it’s killing us.

And since I work mostly with men I want to be very direct because it’s literally killing us as the suicide rate for men is incredibly high: five times greater than for women. And we apply words like “strong” and “hard” when we’re describing masculinity? Something is missing. The weaker sex, the special snowflakes, are the ones who are supposed to need help. Not us.

Social workers disagree about many things and we have lots of ways we think are the best way to help any given client, but one thing we can all agree on when it comes to healing is that the relationship does a great deal of the work. It can begin to heal trauma, mental illness, and the “worried well.” It’s the way in, it’s the way through, and it’s the way out of suffering. It’s not the only thing, but it’s part of everything. Death is in the separateness, the lack of relationship.

And name your –ism because that’s about separateness too. We can’t fully heal a white person without moving through white supremacy together and we can’t help men without addressing the patriarchy. We may not call it out or by these names, but to connect with someone in their suffering is to refuse white supremacy and masculinity.

We need to keep doing what we’re doing, but we need to go further. We’re healing the people without healing the system and we can only thrive so much within a sick system.

Moving Ourselves Toward an Ego Dystonic State With the World

In a mental health session, our work is often to connect our client with other people. Often this happens through the therapeutic relationship with us first, but ultimately, it’s done so they can connect with the other people in their life. Doing this on an individual level is important, and as difficult as it is (and it is difficult), it’s really the bare bones of our work. Because what we’re doing, if we stop there, is helping people build up coping strategies to survive in a broken system.

So we have to stop and ask ourselves if in our work we are challenging the system that our clients live in and, not for nothing, that we’re living in too. Now, this can be a controversial stance for some people. It sounds “agenda-driven” and done unskillfully it is just that. But for those who feel they are thriving in this patriarchal, white supremacist world, do we have any choice, ethically, but to aid them in shifting their lens?

For too many of us, we have come to see this world as ego syntonic and we need to push toward discomfort in ourselves to see the world as it is. And that will move us toward change.

A Child Welfare Example

Let me take my work in child welfare as an example. Most of the parents I’ve worked with over the years are well-meaning and loving people. Many of them are involved in child welfare because they had hit their children in order to discipline them. Many of them feel this is ok. Many of the child welfare workers think it’s ok to physically discipline a child. We even have different words so we separate “abuse” from “physical discipline” and we jump through hoops to try to define “excessive corporal punishment” as separate from “physical discipline”. Many parents have no hesitation telling me that when their child gets out of line they need a slap, a spanking, a something that lets them understand limits, but that this is discipline and not abuse.

And in the course of this conversation, I usually hear the inevitable, “It happened to me and I turned out ok.”

And right there is the thing that I’m talking about with these systems. You “turned out” in such a way that you think it’s ok to hit a child, your child. And this is the proof that you didn’t turn out as “ok” as you think. You grew up with something violent being normalized.

But that’s our society. That’s the society that collectively calls sexual assault “locker room talk” and elects a president. That’s the society where powerful, talented men are allowed to produce and direct movies for years without consequence for their sexually abusive behavior.

Systems work is helping people see that things they take for granted could be wrong. Knowing

  • That there are not simply two genders.
  • That race is not encoded in our DNA.
  • That women are not genetically more nurturing.
  • That there are no such things as boy and girl toys.

Knowing all that means we have to fundamentally shift our way of thinking, our way of feeling, our way of living—day to day—in this world. And we may need to fundamentally, though not radically, change the way we approach therapy.

Merging the Therapist and the Advocate

Great things can come from our work with individuals, couples, and families. We can support people in relieving a lot of pain and finding healthier ways to interact. We move people through trauma, out of depression and anxiety, and to better navigate relationships. We help people live within our broken world—which is no small feat. Part of our happiness can only come by becoming more open to uncertainty which is all we really can be certain about.

But can we do more or does our job end there?

I believe we can. Not by “pushing an agenda” or preaching, but by becoming grounded in a strong analysis of the patriarchy, in racism, and in anti-oppressive work. With this analysis, we understand ourselves differently and we understand others in a new way. We see more easily how reactive our clients can be while not realizing they’re being reactive. We are so skilled at reaching for feelings or for picking out the latent content. We see through all of the mental healthy stuff, and we bring it into our work. But, we can see through the racism, the gender norms, the patriarchy, the homophobia and bring that into the work as well? The stronger we are in our own analysis the more able we are to help clients see when they’re reacting to a system instead of their own desires or someone else’s needs.

Most of us just aren’t so good at doing it yet. So many of us separate this work: “I’m a therapist in the office, and I’m an activist when I’m outside.”

That’s great. It is. But we need to find a way to merge the two. To make them inseparable.

Can we repair an airplane while we’re flying it? Can we change our systems while living in them?

Well, first off, we have no choice. We can’t step outside of it because it’s the air we breathe.

With everyone we meet, whether client, friend, lover, or family we need to be grounded in our awareness. We need to support the people we care about, our clients or otherwise, and do all the great engagement and interventions we learned in social work school and beyond—but we have to have an eye on the system. The system they’re in. The one we’re in. The whole shebang.

We need to not preach. We need not be so agenda driven that we miss the humanity of the client or clients sitting in our offices and their suffering. Our need to end the patriarchy cannot be at an individual client’s expense, of course!

But in session and out, we need to be on the lookout for moments to open our own and others’ eyes to the sickness that we are living in. The sickness that lies and says this is the only way to be.

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Ninety-Two Percent of Caregivers Are Financial Caregivers

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A Merrill Lynch study, conducted in partnership with Age Wave, finds that the 40 million family caregivers in the U.S. spend $190 billion per year on their adult care recipients. Despite the financial, emotional and functional challenges in this life stage, preserving the dignity of their loved one is their primary goal. The vast majority of caregivers (91 percent) are grateful they could be there to provide care, and 77 percent say they “would gladly do so again.”

“As tens of millions of people take on caregiving responsibilities each year, supporting those caring for our aging population has become one of the most pressing financial issues of our lifetime”

Family caregivers are America’s other social security, providing the bulk of long-term care today. The aging of the baby boomers will result in unprecedented numbers of people in America needing care. As a caregiving crunch is upon us, “The Journey of Caregiving: Honor, Responsibility and Financial Complexity” offers an in-depth look at Americans’ financial and emotional journeys during this life stage. This study marks the beginning of a new, multiyear research series from Merrill Lynch and Age Wave that will examine five distinct life stages: early adulthood, parenting, caregiving, widowhood, and end of life.

As the first of the series, this study examines the responsibilities, sacrifices, and rewards of caregiving – a life stage that nearly all Americans will participate in, as a caregiver, care recipient or both. This study comprehensively explores the topic of financial caregivers – a role largely unexamined, yet held by 92 percent of caregivers. Financial caregiving involves contributing to the costs of care and/or coordinating or managing finances for a care recipient.

The study is based on a nationwide sample of more than 2,200 respondents, including 2,010 caregivers. Key findings about their caregiving journey include: Paying bills from their recipient’s account (65 percent), Monitoring bank accounts (53 percent), Handling insurance claims (47 percent), Filing taxes (41 percent), Managing invested assets (21 percent).

  • Much more than hands-on care. Providing emotional support (98 percent), financial caregiving (92 percent), household support (92 percent) and care coordination (79 percent) far outweigh physical care (64 percent).
  • Financial costs – with little discussion of their ramifications. Seventy-five percent of financial contributors and their care recipients have not discussed the financial impacts of these contributions.
  • Caregiving for a spouse vs. for a parent. A spouse is 3.5 times more likely to be the sole caregiver looking after a care recipient and is more likely to spend more out of pocket on care-related costs. Their caregiving journey is also different in terms of the obligations and financial interdependencies they hold with their loved one.
  • Caregiving gender gap. Both for cultural and biological reasons, women are more commonly caregivers for spouses and parents, averaging six years of caregiving in their lifetime versus four years for men. As a result, women are disproportionately impacted by the challenges of caregiving, including struggling to balance responsibilities and making career sacrifices. And then, more find themselves alone and without someone to care for them when needed.
  • Responsibilities extend beyond the care recipient’s life. Sixty-one percent of the time, caregivers expect their role will end with the death of their loved one. However, the complexities of financial, legal, and other aspects of caregiving often continue for months or even years.

“As tens of millions of people take on caregiving responsibilities each year, supporting those caring for our aging population has become one of the most pressing financial issues of our lifetime,” said Lorna Sabbia, head of Retirement and Personal Wealth Solutions for Bank of America Merrill Lynch. “Greater longevity is going to have a profound impact on the caregiving landscape and calls for earlier, more comprehensive planning and innovative solutions to address the health and long-term care needs of our loved ones.”

Financial caregiving: Navigating complexity and responsibility
The study finds that 92 percent of caregivers are also financial caregivers, and are contributing to and/or coordinating finances for their loved one. In fact, after two years of receiving care, 88 percent of care recipients are no longer managing their finances independently.

Financial caregiving is often far more complex than simply contributing to the recipient’s care. Financial caregivers are responsible for a wide variety of tasks, including:

  • Health care rises as top challenge. Respondents find that navigating health insurance expenses is the top challenge of financial caregiving (57 percent).
  • Uncharted territory. An estimated 49 percent of financial caregivers don’t have the legal authorization to perform their role.
  • Guidance and resources lacking. Sixty-six percent of caregivers feel they could benefit from financial advice.

Costs and compensations of caregiving
While some aspects of caregiving may feel like a burden, those surveyed also tell us it is a blessing. Contrary to all we hear about the stress and sacrifices of caregiving, for many caregivers, the role is also often associated with a range of positive experiences and rewards. Caregivers describe a complex, demanding yet often nourishing journey – defined by honor, gratitude, fulfillment, purpose, and strong family bonds.

Costs:

  • Nearly three quarters of respondents say they’ve made numerous sacrifices as a caregiver – whether familial or professional.
  • Fifty-three percent have made financial sacrifices to compensate for caregiving expenses. Thirty percent of caregivers say that they have had to cut back on expenses, and 21 percent have had to dip into personal savings.
  • Two in five caregivers under the age of 64 have made sacrifices at work due to caregiving responsibilities, including reducing their hours (17 percent) and leaving the workforce (16 percent).

Compensations:

  • Caregivers feel rewarded knowing they are doing something good for someone they love – 61 percent say the greatest benefit of providing care is the sense that they have “done the right thing.”
  • Seventy-seven percent say they would gladly take on being a caregiver for a loved one again.
  • Forty percent report a strengthened bond between themselves and the care recipient, and 24 percent say caregiving brought their family closer together.
  • Eighty-six percent say watching their loved one’s health struggle was a motivator that caused them to place more value on taking care of their own health.

“Caregiving is one of today’s most complex life stages, throughout which hard work, high stress and heavy obligations intertwine with honor, meaning and resilience,” said Ken Dychtwald, Ph.D., CEO and founder of Age Wave. “This experience becomes even more emotionally complex and financially challenging when caring for loved ones suffering from dementia or Alzheimer’s. Even with that added burden, this study reveals that 65 percent say that being a caregiver brought purpose and meaning to their life.”

The crucial role of employers
Employers can play an integral role in supporting caregiving employees during this demanding life stage. While 84 percent of employers say caregiving will become an increasingly important issue in the next five years, only 18 percent strongly agree that their workplace is currently “caregiving-friendly”– underscoring the need for new approaches and solutions across the workforce.

“Meaningful, well-designed employer benefits can make a crucial difference in helping caregivers navigate the high stress of caring for a loved one and help them balance these responsibilities with the rest of their working and financial lives. Just as child care has been an issue in the past that led to revolutionizing HR benefits, the aging of the population means we need to consider how caregiving is becoming an increasingly important issue for employers and employees,” said Kevin Crain, head of Workplace Solutions for Bank of America Merrill Lynch. “These should include resources and programs focused on addressing caregiving complexities and employee networks that facilitate support from experts and peers.”

According to Crain, “Bank of America Corporation is committed to meeting the needs of caregivers in today’s transforming world. Companywide initiatives dedicated to addressing the needs of our country’s aging population and those of their caregivers include combatting elder financial fraud, increased awareness of cognitive decline and Alzheimer’s disease, and implementing caregiving best practices through training and resources for its financial advisors and corporate clients. The company supports our employees who are caregivers through a variety of resources including access to emergency back-up care for adults and children, professional elder care assessments, elder care law services, and an internal Parents and Caregivers employee network.”

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Health

How to Develop an Individual Grief Plan

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Story’s Angel of Grief

My Mother always said that my Daddy was “a fool born on April fools”. This was the running joke all of my life.  April 1 came along this year and it was not a joking matter. I was heartbroken and devastated that I could not hear my father’s voice or see his smiling face on his birthday.

Earl, My Pearl, was diagnosed with pancreatic cancer June 20, 2016, after suffering several months of abdominal pain, significant weight loss and limited mobility. He passed away peacefully on September 9, 2016, 4:30 am. This process was very difficult for all of us to watch, yet, we were there every step of the way and handled it a gracefully as possible.

I worked as a hospice social worker for several years prior to my father’s diagnosis. Our journey was still difficult but I was familiar with the language and processes pertaining to the end of life which afforded me the opportunity to assist my mother in talking with our team of doctors and making decisions. She found comfort and security in that and this made me proud. I saw this as an attempt to make this living nightmare a little less scary and slightly bearable.

My hospice experience also somewhat prepared me for being around death. I spent time with my Daddy after he passed away and I combed his hair prior to his wake with an unusual calm.  These were tender moments that I will forever cherish.

I faced a dilemma as my Daddy’s birthday approached. My 8th wedding anniversary was a few days prior to Daddy’s birthday.  My husband wanted us to go away to celebrate the weekend of April 1st.  My plan had been to spend the morning at the cemetery with my mother.

After discussing it with my spouse and my mother (my voices of reason) I came to the conclusion that my father would not want me weeping at his grave on his birthday. He would prefer me to go away, live life and celebrate with my husband whom he was very proud of and admired. So, we continued with our anniversary plans although I did not know what April 1st was going to be like.

I was committed to getting through my Daddy’s first birthday in Heaven without ruining this special weekend that my husband had so thoughtfully planned.  So, I allotted uninterrupted time and space for my grief and I planned activities to pull me out of those dark places that have the ability to consume us if allowed.  I planned for my grief.  Sound weird; keep reading.  I hope my experience assists you in your process.

On the morning of April 1st, I woke up, attempted to post a memorial birthday wish to My Pearl on my Facebook page and the tears began.  I went into the bathroom and cried hard for at least an hour if not more.  I wasn’t simply misty eyed or a little teary; this was the ugly cry that people try not to do in public.

My husband tried to console me but I asked him to allow me to handle this on my own.  I allowed the tears and emotions to flow without beating myself up for crying like a 37-year-old baby.  I did not attempt to suppress my feelings which is typically our natural response.  I went through the sadness of being Daddy’s little girl without her Daddy.  I experienced the “maybe I could have done more” routine that we wallow in sometimes.  I felt the guilt of not choosing to be graveside on his 75th birthday.

I felt horrible for abandoning my mother in her grief even though I knew she wanted me to continue with my celebration.  It went on and on and I allowed it until it ran its course naturally. Once I was completely done, I sat in silence for a while then cleaned myself up.  I felt weak, somewhat limp yet refreshed. My husband and I went to a lovely breakfast at our hotel; we changed our clothes and went to the gym together.

After that, I took a long hot shower, allowed myself to air dry across the crisp white comforter on our king size fluffy bed.  I then turned on some relaxing beautiful music.  I did not sleep, I simply allowed myself to be in total and complete relaxation for the remainder of the afternoon.  Our friends met us for cocktails and a show and it turned out to be an amazing and wonderful trip overall.  I planned for my grief, I executed and came through my Daddy’s first birthday relatively unscathed and empowered.

Make an appointment to grieve.

When we go to the doctor, we have an appointment.  You have called ahead, maybe weeks in advance, to make the appointment.  You have your appointment time, you see the doctor to discuss your health, meds, etc within your allotted amount of time (usually not over an hour) you say your goodbyes and you leave.  Think of your grief in that way.

I set my grief appointment for first thing in the morning because we were on vacation. We had nothing pressing planned that morning and we had guests meeting us in the evening. Whatever your day is going to look like, carve out space and time to be alone with your grief and make it happen.

This is important because if you allow the grief to have its way, it will show up throughout the day and consume you for the better part of that day and possibly beyond.  Take control of your grief by making an appointment, letting it present as it may, then, as you do with other appointments, say your goodbyes and leave it.

Don’t take “walk-ins”.

It is very difficult to walk into your doctor’s office and see them without an appointment. Apply this to your grief.  Say you had your appointment, you successfully followed all of the steps and are moving on with your day.  If grief shows up outside of its appointment time, turn it away:  “Look grief, your appointment was 8 am. We saw you and dealt with you then.  I will see you at your next scheduled appointment.” Acknowledge your grief but do not allow it to consume you outside of your appointment.  Commit to having power and control over the grief.

Plan to grieve alone.

Our family members and close friends mean well in trying to assist us in our grief, especially around holidays and special events that we would normally share with our deceased loved one.  Unintentionally, they can often be a hindrance, sometimes a crutch in our process. Additionally, we may subconsciously modify our grief in order to accommodate them and their level of comfort.

This appointment is not the time for such modifications.  Maybe we will cry but suck it up and move forward prematurely because they might feel like we have cried long enough.  Or maybe they, meaning well, will say the cliché things that people say when one is grieving in an effort to help ease the pain and stop the flow of tears:  “it will be ok” or “time heals all wounds” and my all-time favorite “he’s in a better place”.  We know that those things are true.

However, do we want to hear those things in our time of grief?  NO!!!  We are thinking “it won’t be ok because I can’t live without him”, “nothing will heal these wounds” and “the best place is here with me”.  None of those clichés are needed or welcomed for that matter, at this point in the process.  Again, you have to allow space and time for this process without guidance from well-meaning family members and friends.   It has to run its own natural course.  Friends and family have a more appropriate role in the next steps of this process.

Plan activities that you enjoy.

I knew that if I had grieved and simply remained still, I would have wallowed in a sad, hurtful place all day.  Therefore, I moved on to an enjoyable breakfast then a workout with my husband to take my mind to better places.  It’s not that you’re getting busy to suppress your feelings. Because of your grief appointment, you have dealt with your feelings and emotions head on and very appropriately.

You’re merely creating a beautiful welcomed distraction in order to move on with your day.  After the grief appointment, it is imperative to get up and get busy living.  This has to be planned for and executed.  At this point, your family and social support system could play a huge, meaningful role without hindering your process.  Remember, do not take walk-ins!

Take some time for relaxation and self-care.

My self-care was a long hot shower followed by resting to nice music.  Your self-care may look like a spa day, a long jog through your favorite park, a scenic hike, cooking an elaborate meal or a shopping trip.  Whatever makes you feel well, do it!  Think of this as a special gift from your loved one on this special day; it’s your reward for bravely facing your grief and taking control of your grief process.  I firmly believe that the ones that we loved and lost enjoy seeing us live happy and well despite their absence.

Be Grateful.

My father was here for all of my major life events: all of my graduations and performances, he moved me into my first apartment, he walked me down the aisle at my wedding, he was there during my pregnancy and formed a sweet relationship with my daughter…with all of that being said, how can I wallow in sadness?  I am so grateful for having a father that was present until he passed away.

Others have not been as fortunate and I acknowledge that. For that reason, I choose on his birthday, holidays and any day of the week to be grateful for him and his life rather than focus on his absence.  I am also grateful that he did not suffer long after his diagnosis.

As a hospice social worker, I saw patients and families suffer months and months; having their hopes of recovery dashed with the horrible news that their cancer had spread and there were no further options.  This was not our case.  We had our ups and downs but God was merciful and ended my father’s battle 3 months after he was diagnosed.  For that I am grateful. My gratitude list could go on and on.  My point is that in our sadness and on those birthdays and holidays, we have to immerse ourselves in gratitude in order to make it through.

The preceding technique is not the catch all or fix all for your grief issues around holidays and special occasions. This is merely a formula that worked for me and I was compelled to share it with the hopes of helping others.  If you are experiencing complicated, ongoing grief issues, please, seek help from a mental health professional.

Individual sessions, grief support groups, and other therapeutic interventions to deal with grief may be necessary depending on your individual needs.  Remember, death is inevitable for all of us.  However, being proactive in our grief process and planning for the same may assist and make facing holidays without your loved one bearable and beautiful.  It happened for me; that’s my hope for you!

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