What are the emotional challenges faced during the three stages of the transition journey (Endings, Neutral Zone, and New Beginnings), and what does the family have to accomplish in each (Pages 194-208)?
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The pages from the textbook for this assignment are attached in a word document, the citation is at the bottom of the document. Endings: The Impact
The Greek poet Euripides (480?406 BC) said, ?There is something in the pang of change. More than the heart can bear. Unhappiness remembering happiness.? The first experience of the healing journey is called, ironically, the Endings. Something has come to an end. Whether clients have chosen to make a change and now have to face a loss or a loss has occurred in their life that demands change, the journey has begun. For members of military families, these Endings are regular experiences in their lives: a new school, a new town, a new country, new friends, a new community. But add the obvious, as well as the natural, developmental transitions that families cannot ignore: the deployment of the military parent or spouse, the fear of uncertainty, the wonder and concern for the future.
The Endings begin when the change actually occurs: the day of the move, the withdrawal from school, the news of a family member?s death, the military spouse leaves home on temporary duty orders, or the news that a deployed parent or spouse is returning with major injuries. We know, however, for those changes that are planned or expected, there is often a significant portion of the transition made prior to any actual physical change. The planning, organizing, training, and communicating about the upcoming event, often called anticipatory grief, could be described much like the predeployment stage described in Chapter 7. This can be a time when a lot of healthy grief work can be done, or it can be a time when emotions are denied and the family members believe they have to maintain their stoicism and deny their feelings.
When it comes, whether through a forced crisis or a planned change, the actual Endings usually start with a physical change: some thing or person or place is lost or has changed. ?Intense emotions, including sadness, anger, longing, guilt, fear and sorrow, accompanied by somatic sensations in the stomach, shortness of breath, profound fatigue, agitation, difficulties in swallowing and perceived helplessness are common in the first few months of grieving? (LaMorie, 2012, p. 183). It is a time of intense emotion, of confusion, and of what seem like never-ending painful days. As with the deployment stage, the initial experience in this journey is filled with uncertainty, heightened emotions, and often contradictory thoughts. Military families often hide behind their mask of stoicism to live up to the model of the strong military family instead of allowing each member to experience the emotions, confront the confusion, and feel the pain. Those who have been through many moves or many other transitions, and have recognized that planning for these times needs to include the expression of loss, fears, and hope, and have had support and the courage to experience the Endings can move on in a healthy way. Those who hide often suffer greatly, but no one can make changes in their life without some consequence?negative or positive.
Focus
One way to understand this phase of the journey and also to facilitate the grief of others is to understand that what we might describe as psychic energy (energy of the soul) will initially be focused on the past. A person?s dreams, thoughts, and stories seem to all be about what used to be. Clients talk about dreaming of what was and constantly tell stories of how things used to be. Children in my schools would repeatedly talk about how their former school was better, the teachers were nicer, and there were more things to do in their former community, forgetting they felt the same way when they made the last move. Parents talk about the services that were available at their last installation, how much more helpful the people were at the former base or post, and how the former school was more open to meeting the needs of their children. After a death, the deceased is constantly on the survivors? mind and often in their dreams as if he or she is still present, and depending on the manner or cause of death, the actual event can be almost overwhelming in the minds of the survivors. Upon learning of the possible or very real disability of a parent or a spouse, the image of that person whole and fully functioning remains for everyone.
It is only when people begin to see the present situation for what it is, without comparing it to the past, and can evaluate the past from both positive and negative perspectives that they seem ready to move on. Depending on the loss, this can take days, weeks or months. This is a normal part of a healthy transition; if we attempt to persuade them otherwise, or if we try too early to get them to be realistic about the present, we are only encouraging the mask of denial. The feelings and thoughts get stifled only to reoccur later in more harmful and destructive ways.
Tasks
During the Endings stage, there are four tasks that are usually necessary to accomplish before one moves on. These tasks are the need to grieve, to find support, to deal with practical issues, and to come to an acceptance that the loss has occurred. The first is simply the need to grieve or experience all the emotions of grief, whatever those are for that person. This is where the work of K?bler-Ross (1975) is so important. It is working with the clients to go through the five emotions of grief, including denial, bargaining, depression, anger, and acceptance. Dass-Brailsford (2007) said that denial protects the individual from the intense emotions and allows the mind to exclude the pain. Denial is usually accompanied by numbness and shock, which are normal reactions and should not be viewed as a lack of feelings or a lack of care. As clients begin to acknowledge the impact and the accompanying feelings, the denial and disbelief begin to diminish. Bargaining seems to be necessary for individuals to evaluate the past and perhaps find ways that they could have responded differently or perhaps have prevented the loss; sometimes clients can get caught up in imagining all kinds of things that will never and could never have happened. Researching and questioning every aspect of a potential disability in order to make sure the family has all the answers is often a way to accept the future of living with a disabled family member.
As the numbness begins to wear off, individuals start to realize the extent of the loss and may experience depressive symptoms, including sleep and appetite disturbances, changes in energy and concentration, and frequent crying and tearfulness. One mom who had lost her son noticed that for months she couldn?t find her car in shopping center parking lots; it was as if nothing seemed relevant any more, even something as simple as finding her car that she had parked only a few minutes previously. Sometimes loneliness, emptiness, and self-pity are prevalent, but, for most, this is a necessary part of the process before they can begin to rebuild their lives. These depressive symptoms need to be assessed differently from a DSM diagnosis of clinical depression, and, in most cases, medication or other intrusive procedures may prolong these feelings by masking the reality. This is not to suggest that a mild sleeping aid or other short-term medication should not be used but caution is advised as to how long or how much medication is given.
When anger begins to surface, clients can feel helpless and powerless to the frequency and intensity of the rage and anger they feel. This rage can be overwhelming and frightening as it seems, at times, to be never-ending. These feelings are often the secondary emotions to feelings of abandonment, hurt, frustration, resentment, and guilt, or even result from feelings of relief and hope as burdens are sometimes lifted by the loss. Finally, enough of the feelings are expressed, and individuals can begin to integrate the loss into their lives, so there is a sense of acceptance that the loss has occurred.
It is important, however, to understand that this hardly means that the transition is over; in fact, the hard work has just begun. Although K?bler-Ross defined these emotions in terms of stages, we know that most people don?t go through the stages in a sequential or linear manner and that these stages are better understood as important emotions to be experienced. This first task corresponds to Worden?s (2002) second task of mourning, which is to work through the pain of grief. We have all experienced or have worked with clients who have experienced all of these emotions, sometimes at the same time and often in a different sequence than outlined by K?bler-Ross.
The second task is the need for support, which is often provided by family, friends, or a religious or military community. When a military family moves to a new community, the support services, including counseling, need to be available and easy to access. It is through the support of others, provided either personally or professionally, that the first and third tasks seem to be accomplished with the least amount of pain and agony. Often, however, just getting someone to ask for help is difficult as it is more comfortable to be alone. When families in transition have a sense of isolation, they often remain in this early stage of the healing journey for much longer than necessary. Also, if the family tradition or traditional military culture promotes the stigma against asking for help, the family may be left to sink further in its pain and sorrow, with little hope for healing.
The third task is to take care of all the practical problems and needs of everyone involved in the family. These problems and concerns often come when people have little capacity to make these decisions that may have long-term or lifelong consequences. With an impending move, a new school, and a multitude of decisions to be made, all members in the family are forced to make choices at a time when they need to be grieving, when they need support, and when they might, ideally, want to be taking time to say good-bye. With all the work that has to be done, no wonder military kids learn early how to say good-bye easily, as was mentioned in an earlier chapter. Most people going through a transition don?t have that luxury. When the disabled parent or spouse returns home, the home may need major adjustments and refurbishing to accommodate the disability. These are the practical problems that take planning, time and money to address but these are required when people are least likely to have the capacity for them. This is also a time when support is needed; whether it is to plan a memorial service, empty the apartment of the deceased, or pack for an upcoming move, having others there to help make decisions is vital.
When the loss is of a more traumatic nature, for instance, the death of a loved one or a divorce, the decisions become that much more difficult for everyone in the family. In these cases, the military support system also has much to do with the decisions that are required. After Kate Blaise (2006) lost her husband, she lamented that post housing was available only to married couples, and in the eyes of the world, she was no longer married. Yet she wrote,
In my heart I still was. How did I make that feeling stop? When would I feel no longer married? I took those vows with forever in mind; marriage had always been more than a ring and a new last name. I had embraced the idea of being half of a complete whole. What did I do now that my other half was gone?
The fourth task is the ability to say good-bye and to come to an acceptance of the loss, accepting another change that may be perceived as being forced on them rather than chosen?but accepting nonetheless. This fourth task corresponds to Worden?s (2002) first task of mourning, which is to accept the reality of the loss. How do we get to this point as we experience any loss? As I noted previously when defining K?bler-Ross?s emotional stages, when some of the other difficult emotions are expressed and worked through, acceptance can be the natural next step in the process. However, as mentioned earlier, this has to be an individual decision and not something forced. When a group of friends got together after many had experienced recent losses, they decided to have a short ceremony; when asked to contribute, one member in tears simply said, ?I can?t let him go yet,? which was honored by the others.
When reflecting on difficult transitions, people often share that there is a sense that this acceptance ?just happened.? Many people have told me that it was like they woke up one morning and the world seemed different, or a dream they had was particularly significant, or a comment made by another person helped them consider the world in a different way. Then, unexpectedly, they realized that the sun was shining, that there was indeed a future, and that the past was, in fact, the past. Thomas Moore (2004) said, ?You must have a similar story of a decisive moment, perhaps ? a turning point that made all the difference in your life? (p. 24). It was time to move on?not without sorrow, not without memories, and not without fear, but it was time to move on. It truly is not time that heals loss but what one does with the time that leads to the healing, and it appears, for most people, that the work they do in accomplishing these tasks and in living through the emotions of grief prepares them for the next step.
Therapeutic Assessment and Support
I have been describing a process known as normal or uncomplicated grief (Worden, 2002). For people who are starting one of the many Transition Journeys of their life, the appropriate kinds of interventions will be of a more client-centered nature. Providing unconditional positive regard, empathic understanding, and narrative work and simply being present as they work through the pain are the primary therapeutic interventions. Worden suggested that using evocative language, for instance, ?your son died? versus ?you lost your son? (2002, p. 68); using symbols such as pictures or letters; writing journals or letters; creating art if it is a comfortable medium; role-playing; using cognitive restructuring; using a memory book or directed imagery; and using metaphors are often useful intervention techniques.
In addition, particularly in helping someone deal with the practical issues, it is also necessary to help families and individuals set very short-term and practical goals, defining the needs of everyone concerned and making sure assistance is available in solving problems and finding practical solutions. It is also of primary importance that people have a plan to take care of their physical, emotional, and spiritual needs so they have the energy to accomplish what they must and, when necessary, take care of those who depend on them.
On the other hand, not all people so neatly go through this process, and it is imperative that families, family support personnel, primary care physicians, and mental health professionals have the ability to assess the process made by someone who is experiencing a loss or traveling through the healing journey. If the grief is significantly affecting a client?s, a family?s, or a child?s ability to function; if the typical symptoms of the Endings are still being experienced after a reasonable amount of time; or if one gets stuck in a single exaggerated emotion, such as depression, anger, fear, or guilt then we are no longer talking about the normal grief process and have to look at some of the possible antecedents or causes for what Worden defined as complicated grief. LaMorie (2012) reports that ?research suggests that 10?20 percent of bereaved persons suffer from more complicated grief reactions? (p. 183).
The mediators of mourning (Worden, 2009) are those aspects of the loss that can help us determine the extent of the grief, to some extent the length of the process, and the intensity of the grief. These mediators include the following:
1.Who or what is lost? Losing a child is obviously very different from losing a job.
2.What is the nature of the attachment? For instance, a parent?s death is very different from a friend moving away.
3.What is the mode (or cause) of death or loss? For example, the ambiguous loss of a person missing in action is different from the murder of a close friend or the passing away of an 80-year-old neighbor in his or her sleep.
4.Historical antecedents might include a child who had a fight with the parent the day before the parent was killed or the loss of someone who was in a close, personal, and open relationship.
5.Personality variables might include a survivor who is unexpressive, closed and angry or one who is open, expressive, and thoughtful.
6.What are the social variables? For instance, a suicide, HIV, an abortion, or a military training accident?and what is the acceptability within cultural or religious contexts of the person grieving?
7.Concurrent stresses can include a military move after a divorce or parents being transferred to Germany, after their daughter goes off to college.
These mediators are very similar, with a few exceptions, to Dass-Brailsford?s (2007) factors that influence the recovery from trauma, which are intensity, chronicity, preexisting conditions, personality and cognitive style of the survivor, the relationship to the victim or the perpetrator, social support, continued exposure, and the possibility of physical injury. LaMorie (2012) points out that ?[t]he literature suggests that those affected by sudden, violent deaths caused by accidents, suicide, homicide, acts of terrorism, and war are highly exposed to [psychological trauma and] the potential of developing complicated grief? (p. 183).
Complicated grief (Worden, 2009) is most often defined as the failure to grieve. In addition to considering the previous mediators of mourning, one or more of the following factors may be present when people are either unable to grieve or have difficulty healing. First are the relational factors, in which old wounds might be reopened, unfinished business is present, or the relationship was of an ambiguous, hostile, or highly dependent nature. The second factors include the circumstantial situations, such as the ambiguous loss of a missing person or the difficulty of multiple losses, from the perspective of both numerous people suffering the loss and one person suffering multiple losses. The third factors include the historical issues, including unfinished previous losses, particularly those losses suffered early in life, leaving the bereaved with an insecurity in their childhood attachments. The fourth factors include the personality differences, including those personalities that do not tolerate dependency feelings or those that are unable to tolerate extremes of emotional distress. The last group of factors include the social situations, including those losses that might be culturally unspeakable such as HIV, suicide, or abortion. The presence of any of these factors may be cause for concern and, upon assessment, require more intense or long-term interventions. The choice of interventions would then depend on the underlying concern and may include medication, long-term therapy, hospitalization, or a combination of these.
Neutral Zone: Turbulent Adjustment
Sam Keen (1975) called this time the ?empty center? and writes that this time is ?between who you were and might yet be ? a vacuum, nothing at all except a chance to begin again? (p. 54). The Neutral Zone begins when people accept the reality of the loss or change. This in no way suggests that they are happy or glad that they have had to go through the turmoil. The agony, obviously, does not immediately disappear, and the confusion often returns, but slowly people realize there are also times when living in the present seems the right thing to do. One of the misconceptions about grief is a belief that once the intense feelings of the Endings subside, then the grief, the transition, is over. What most people don?t understand is that following the agony of the Endings, there must be a quiet time, a centering time, a time in which people need to reconstruct their identities, as well as their psyches. How does a mom no longer be a mom; how does a spouse no longer be a spouse; how does a child no longer be someone?s child?
Thomas Moore (2004) said that this part of the journey may ?put you in touch with an unfamiliar realm, perhaps a new kind of existence altogether, and it may make you feel you are living in-between two places, the known and the unknown? (p. 39). Those who take the time to become aware of who they are, in their new reality, and make the necessary adjustments in their definition of who they are will be able to finish the journey with a high degree of self-confidence. Those who either skip or are encouraged to bypass this essential part of the journey by moving on too soon may have to return at some point to be prepared for the next loss. The difficulty for most military family members is that they are constantly in the midst of multiple transitions and they often simply don?t have the time, the necessary resources, or the awareness to plow through each difficult valley. This is also a time that requires a great deal of introspection that may be foreign in the warrior society of stoicism and denial. As with the sustainment stage of the deployment process, this is the time for people to find their own strengths, to grow individually and as a family, and to put in practice those new skills that they discover about themselves.
Focus
The focus or the energy of the Neutral Zone moves from the past to the present, away from what is lost and back to the present and the self. It is during this time that a new kind of grief occurs, the grief over the loss of a part of oneself that no longer exists. If a relationship has ended, the role of girlfriend, boyfriend, parent, child or best friend is gone. If a marriage has ended, the role of a wife, friend, or partner no longer exists. For the students I described who lost a friend to a tragic accident, they had to face the loss of their innocence, the loss of the belief that ?nothing bad will happen to us,? and the loss of the role of being a friend. I remember after I had lost both of my parents that someone called me an ?orphan.? It seemed so silly to be called an orphan when I was in my fifties, but it did describe that lost sense that I was feeling of not having parents and of no longer being someone?s daughter. The loss I have felt over the last 18 months after losing my son and of no longer being his mom is indescribable, even though my role now as the grandmother to his girls has strengthened.
This is the time of role loss, even if the transition was the result of a choice, as in the case of a divorce or change of career. Whereas the Endings is a time to focus on the loss, this is the time to begin focusing on the internal change that must occur in oneself, rediscovering what is personally important, discovering our inner strengths, and perhaps re-creating our identity. People in this phase tend to need time alone, but they realize it doesn?t necessarily feel lonely, as they might have experienced during the Endings. Often people start writing journals, making plans, and wondering what the future will bring. It can be a very productive time of chosen solitude. This is when people begin to find new associations and new relationships, and they begin to be excited about new ideas and the chance to make a commitment to and identification with something new, even though this is somewhat frightening to begin with. This is very similar to those who retire successfully and go on to have fulfilling and enriching lives after leaving their career.
Tasks
There is a kind of surrender to this new reality, not in the sense that one is out of control, but rather a belief in one?s ability to take on the new challenge and the realization that denying the change will only make it worse. In this sense, there is also a need for forgiveness, whether it is forgiving the parents who forced them to move, the military who is always in charge, or God who allowed the tragedy to happen. It is also forgiveness of ourselves for what we believe we could have done differently that might have prevented the loss. Joan Borysenko (2003) said,
Forgiveness is not the misguided act of condoning irresponsible hurtful behavior. Nor is it the superficial turning of the other cheek that leaves us feeling victimized and martyred. Rather it is the finishing of old business that allows us to experience the present, free of contamination from the past.
(Borysenko, 2003)
How does a mom know that there was nothing else to be done or one more intervention that could have impacted the outcome?
In addition to the tasks of surrender and forgiveness, there is also a need for self-evaluation and reconnection with our inner self through the grief work one does in the loss of the roles that no longer exist and the beginning of making plans and setting goals for the future. Moore (2004) said that our dark night forces us to consider alternatives and offers us our own approach to life, where we can sit with it and consider who we are and what we want to be. We can be born again not into an ideology but ?into yourself, your uniqueness ? the life destined for you? (Moore, 2004, p. 20). This gives the bereaved the chance to make the necessary external, internal, and spiritual adjustments to the new environment, which is Worden?s (2002) third task of mourning. This often misunderstood experience is perhaps the most important, as it is the time when internal adjustments can be made, healthy attitudes can be developed, and new patterns of living can be established that will carry people into the last experience of the journey. The disabled person will always need more assistance but becoming capable of as much as possible is essential for the health of both the disabled and the family members.
Those people in military families who remain angry, frustrated, and hurt by their experiences and find themselves stuck in the secrecy, stoicism, or denial of the Fortress may find it very difficult to do the work necessary to get through the journey. This time is also one where interventions through individual or group work can be both productive and exciting. While in the midst of her grief after the loss of her military husband, Kate Blaise (2006) wrote,
It was the small, unpredictable moments that got to me the most?. Part of the gift of knowing and loving him was finding the confidence to go on?. He would have demanded that I find the strength and purpose to navigate my new life.
Therapeutic Assessment and Support
Although this time of the healing journey often includes rich rewards, it takes a lot of courage to risk looking at oneself, forgiving oneself and others, and learning new skills to move on. This part of the journey does not feel comfortable but instead a little like shedding old comfortable skin and growing new. Knowing when people are beginning to reach this experience is usually pretty easy; they find themselves bored with feeling bad, wanting something to change, and realizing that they have to move on, but they often just don?t know how to change. If people have spent a considerable amount of time in the Endings, counselors may want to nudge them forward and begin to suggest that there are other possibilities. If it appears the client or student is stuck in anger or depression and appears unwilling to take any steps, we have to reconsider whether this is what we call complicated or uncomplicated grief, and, as stated in the Endings section, more in-depth evaluation and interventions would be necessary.
Sometimes people who get through the first part of the journey only to arrive in a place of what feels like nothingness start believing they need therapy. Everyone knows that the first few months after a loss is full of tears, uncertainty, and confusion, but most don?t understand that there is a time of fallowness that follows. For mental health professionals, chaplains, school counselors, or others attempting to assist someone through this time, focusing on small growth steps and on self-awareness is the key.
Coming from a cognitive-behavioral, narrative, solution-focused, or Adlerian approach where the focus is on building strengths, identifying new ways of being, and moving forward seems to work the best. Sometimes all people need is a little encouragement to take things one step at a time and not get discouraged when things don?t happen immediately. Those people who work in the addiction field will recognize that this is the time that relapse often happens, because to many former users the world begins to seem terribly boring. One young man in his early thirties, after being clean and sober for about eight months and finally holding down a job for the first time in years, asked, ?Is this all there is? You just go to work every morning and come home every evening; surely there is more to life than this?? Without new associates and someone to help him evaluate who he was and where he wanted to go, this man was ripe for a relapse. The same thing happens with military families when they get through the chaos of the Endings only to find that the new environment looks frightening or boring. They might need the military support people, the school counselor, or a civilian counselor to help them reevaluate who they are and what they want to accomplish in this new environment and help them make the plans to meet those goals.
New Beginnings: Rebuilding
As the crisis ends, I emerge into a new world of possibility and action. Time is a gift, no longer something to resent, or grasp, or dread. I remember the past with gratitude because it brought me to this moment. I look to the future with excitement because it allows me an open space in which I am free to become. I take pleasure in the present moment because it is the meeting point of all that has been and might yet be. Healing restores memory, hope, and the capacity for joy.
(Keen, 1975, p. 123)
Although the future may be still unknown, most people get to a point where they begin to find the courage to give it a try, even if the steps are small and the movement is slight. The pain may still be just under the surface, and memories of the past may still fill us with agony, but the agony and the pain seem less intense and less frequent. Laughter occurs, and it feels good; making plans and carrying them out may cause people to remember that only a few weeks or months in the past they couldn?t have accomplished that. That mom finally realized she now could find her car in the parking lot! Those who risk taking baby steps and who make short-term decisions to see how they work eventually find themselves right with the world again. ?Distress and an adaptive course of adjustment is often a common response to loss, as is the ability of the majority of survivors to integrate the loss into their lives and to accommodate with resilience? (LaMorie, 2012, p. 183). Those who hang on to a lot of anger and try to push forward without doing the necessary work find themselves constantly resenting their new life.
One of the points mentioned earlier made by Doka (2005) challenges the old notion of grief work of detaching from the past and reinvesting in the present and future. There seems to be a need instead for the bereaved to often maintain some kind of contact with that which was lost, as long as this process does not delay their a
