Dream Work and Grief Work

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Dream Work and Grief Work

• Rochelle Perper, Ph.D.
• November 3, 2008

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• "Needed 
• A strong, deep person wise enough to allow me to
  grieve in the depth of who I am,
• and strong enough to hear my pain
• without turning away. 
• I need someone
• who believes that the sun will rise again,
• but who does not fear my darkness. 
• Someone who can point out the rocks in my way
• without making me a child by carrying me. 
• Someone who can stand in thunder
• and watch the lightning,
• and believe in a rainbow.
• -Fr. Joe Mahoney

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Reactions Following a Loss

• Affective reactions
• Depression, anxiety, loneliness, guilt, anger
• Cognitive manifestations
• Disbelief, confusion, hallucinations, lowered SE,
  helplessness
• Physiological/somatic reactions
• Changes in sleep and appetite, fatigue, physical
  complaints
• Behavioral manifestations
• Social withdrawal, restlessness, crying

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Dreams of the BereavedPrevalence

• Strongest predictor of recurrent dreams
• Bereaved individuals are particularly inclined to
  reminisce about these dreams when awake (Kuiken,
  1993)
• Dreams of the bereaved are typically vivid,
  filled with emotion, and affect the world of the
  dreamer in meaningful ways (Garfield, 1997)
• However, clients may feel that they are going
  crazy or abnormal when confronted with dreams

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Dreams of the BereavedThe Function of Dreaming

• When a person is unable to tolerate the emotional
  and psychological reactions that come with the
  death of a loved one in their conscious lives,
  they may revert to the dream world (Barret, 1992
  Cookson, 1990).
• Dreams offer alternative realities in which the
  dreamer has the opportunity to explore feelings
  surrounding the loss in a safe place (Hartmann,
  1995)
• Dream Messengers Dreamer receives visits from
  the deceased through their dreams (Garfield,
  1997)

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• Trust the dreams, for in them is hidden the gate
  to eternity
• Kahlil Gibran (1883-1931),
• On Death, The Prophet, 1923

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Dreams of the BereavedResearch

• Hill (2000) Participants who had recently
  experienced a loss by death, loss of employment,
  or loss of relationship received brief therapy
  either with or without a focus on dream
  interpretation
• Decrease in the impact of their loss utilizing
  the Impacts of Events Scale.
• Participants who engaged in the dream
  interpretation intervention gained more insight
  and understanding and overall higher levels of
  satisfaction with therapy

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The Effect of Dream Interpretation
Intervention on Grief for Bereaved
IndividualsParticipants

• 63 bereaved adult individuals from the San Diego
  County area who voluntarily seeking bereavement
  therapy services at the Center for Grief Care and
  Education at SDHPC
• Time since death 1-129 months (M 10 months)
• Actively grieving (Average TRIG score 47.83)
  and more distressed than normative counterparts
• Non-distressed families (Average FES scores)

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The Effect of Dream InterpretationProcedure

• 37 Participating Therapists
• Randomized sequence by which to assign
  participants to treatment condition
• Control Condition without focus on dream
  interpretation
• Experimental Condition focus on dream
  interpretation
• Intervention period included eight 50-min therapy
  sessions, ranging from 8 to 33 weeks
• (M 11.78).

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The Effect of Dream InterpretationMethods

• Confidential Information Sheet
• Texas Revised Inventory of Grief
• Past Behavior past adjustment to the loss
• Present Feelings degree of grief
• Family Environment Scale
• Therapeutic Realization Scale- Revised
• Gains from Dream Interpretation
• Therapist Adherence Measure

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The Effect of Dream InterpretationFindings

• Overall significant decrease in participants
  current distressful grief symptoms and past
  adjustment to the loss over time
• No noted improvement on measures of family
  environment
• Overall significant increase in therapeutic
  realizations over time
• Participants in experimental condition reported
  overall higher ratings of Unburdening and
  Present-Focused Insights
• Medium correlation noted between Therapeutic
  Realization scores at post-treatment and grief at
  post-treatment
• No relationship between DIQ scores and grief at
  post-treatment in experimental condition

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Dreams of the Bereaved Dream Content

• Dream content has been found to mimic waking life
  struggles
• The content of bereaved individuals dreams does
  not always include images of the deceased

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Dreams of the BereavedCommon Dream Themes
(Barret, 1992)
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Dreams of the BereavedDream Content

• Dream content been correlated to phases of
  mourning (Barret, 1992 Garfield, 1996 Hill,
  1996)
• Dreaming of the deceased may be the minds way
  of validating the reality of the death, through
  the sharp contrast that occurs when one awakes
  from such a dream Worden (2002) p. 30

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Dreams of the BereavedConceptual Framework

• Working with bereaved persons dreams is grounded
  in Wordens (2002) tasks of mourning and Hills
  (1996) cognitive-experiential model of working
  with dreams

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Grief Work and Dream Work

• Grief Work A cognitive process of confronting
  the loss, restructuring thoughts about the
  deceased and the loss experience, and adapting to
  life without the deceased
• Dream Work Relevant schemas are activated by
  events of waking life, experiences are
  assimilated into existing schemas, and schemas
  are reorganized to accommodate the new
  information

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Wordens (2002) Tasks of Mourning

• Accepting the reality of the loss
• Working through the pain and grief
• Adjusting to the environment without the deceased
• Emotionally relocating the deceased and moving
  on with life
• Worden asserted that tasks imply an active
  process by which the bereaved persons can take
  action and therapists can more effectively
  intervene in the
• grief process

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Wordens (2002) Tasks of Mourning Task 1
Accepting the reality of the loss

• After the loss of a loved one, a bereaved person
  often may find themselves enacting searching
  behaviors (Parkes, 2001)
• The first task includes helping the bereaved
  individual realize that the deceased is really
  dead, and will not be coming back
• This also includes adjusting to the change in
  their assumptive world, that is, the world as
  they once knew it

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Wordens (2002) Tasks of Mourning Task 2 Work
through the pain and grief

• Following the loss of a loved one, the bereaved
  experience emotional and physical pain
• If the bereaved avoid or suppress the pain in
  their waking lives, such feelings may confront
  them in their dreams

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Wordens (2002) Tasks of Mourning Task 2 Work
through the pain and grief

• People must be given the opportunity to
• hurt out loud
• -Lady Bird Johnson
• In a society which is much more included to
  help you hide your pain rather than to grow
  through it, it is necessary to make a very
  conscious effort to mourn.
• -Henri Nouwen

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Wordens (2002) Tasks of Mourning Task 3
Adjust to the environment

• Three areas of adjustment often encountered by
  grieving individuals
• External how the death affects ones everyday
  functioning in the world
• Internal how the death affects ones sense of
  self
• Spiritual how the death affects ones beliefs,
  values, and assumptions about the world

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Wordens (2002) Tasks of Mourning Task 3
Adjust to the environment

• People do not get over grief. My personal and
  professional experience tells me that a total
  return to normalcy after the death of someone
  loved is not possible we are forever changed by
  the experience of grief.
• -Alan D. Wolfelt

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Wordens (2002) Tasks of Mourning Task 4
Emotionally Relocating

• Moving on vs. Going on
• Worden (2002) stated that people do not give up
  the relationship they find an appropriate place
  for the dead in our emotional lives (p.36)

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Wordens (2002) Tasks of Mourning Task 4
Emotionally Relocating

• One benchmark of a completed grief reaction is
  when the person is able to think of the deceased
  without pain. There is always a sense of sadness
  when you think of someone that you have loved and
  lost, but it is a different kind of sadness it
  lacks the wrenching quality it previously had.
• - J. William Worden

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Losing a loved one

• "Where there is pain, let there be softening.
  Where there is bitterness, let there be
  acceptance. Where there is silence, let there be
  communication. Where there is loneliness, let
  there be friendships. Where there is Grief, let
  there be Hope."