Helping families through the guilt and anger of losing a loved one can be gruelling for practitioners. Esther Harries looks at how to be prepared
The Bereaved Through Substance Use Guidelines were launched in June 2015 and represented the culmination of joint research between the Universities of Bath and Stirling on the experiences of families bereaved through substance use.
In the introduction, the guidelines invite practitioners to seek effective clinical supervision while working with family members following bereavement.
Although the focus is on practitioners who come into contact with substance-related deaths, the research could be equally valid for family support practitioners – particularly if they are working with the family and the client in treatment, where family meetings are integrated into the care plan.
McAuley & Forsyth (2011) conclude that ‘when someone dies of a DRD it is not only the needs of friends, family, or witnesses that need to be taken into account. The presence of grief-related reactions in almost 90 per cent of this sample suggests that staff who were involved in the care and treatment of the deceased also need to be considered when dealing in the aftermath of the event.’
Their study of the impact of a drug-related death on those who have experienced it as part of their caseload found that 65 participants were identified as having experienced at least one drug-related death on their caseload and 88 per cent identified at least one reaction: ‘The most common feelings identified were sadness (83 per cent); guilt (40 per cent) and anger (37 per cent): 26 per cent reported feeling helpless; 21.5 per cent had cried and 18.5 per cent had difficulty in concentrating.’
As a counsellor and clinical supervisor, I have witnessed the following thoughts and feelings from both family members and practitioners:
Guilt – ’I should have…’
Grief
Disbelief: ’They were doing so well…’
Anger – Perhaps directed towards the treatment system for its perceived failures.
Sad reflection: ‘What if..?’
Practitioners can also be supporting families with a loved one’s addiction as they experience a series of losses, ‘a living bereavement’, that includes the fear that their loved one may die. The intensity of this work can, without proper support, have considerable impact on the psychological well-being of the practitioner, particularly if they are involved in a serious case review and/or an appearance at the coroner’s court.
The trauma therapist Michael Gavin (www.embodiedtherapy.net) acknowledged in 2015 how challenging working with trauma can be: ‘People tell you stories of unbearable experience, and you have to listen’.
He states that the aim of supervision is to make therapy as safe and effective as it can be for both practitioner and clients or patients. For example, practitioners might be helped to improve their skills in specific ways (see box).
McAuley and Forsyth (Journal of Substance Use, February 2011) add that ‘providing a debriefing session and one-to-one support, like that proposed by Redinbaugh et al (2003), on both the events leading up to death, and staff feelings and emotions in its aftermath, should be available to those who need it and, therefore, should be considered for future policy and practice. It can also deter any notion of a ‘blame culture’ being developed and promote a working environment where each death can be used as an opportunity to reflect and learn lessons for the benefit of future practice’.
Practitioners might be helped to:
Master the skills of self-awareness, mindfulness, and of managing both their own arousal, and that of clients.
Find and cultivate their own reliable sources of safety and resilience, both internal and external.
Build a capacity for a calm yet assertive personal presence.
Foster their individual talents, style and insights as a basis for a sense of personal authority.
Find a way back to common sense (not so common!) and a sense of humour in the face of the unbearable and ‘unspeak-about-able’.
Esther Harris is an independent practitioner in counselling and clinical supervision