Building Resilience in End of Life Care and Bereavement. Dr Gemima Fitzgerald Clinical Psychologist and Bereavement Lead

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1 Building Resilience in End of Life Care and Bereavement Dr Gemima Fitzgerald Clinical Psychologist and Bereavement Lead

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3 Background Professional Training Research / TEDx Talk / clinical practice

4 What is Resilience? Resilience is the phenomenon of coping and doing well in the face of adversity. Better than expected outcomes. An individual s ability to cope with stress and adversity. Ability to bounce back to a previous state of normal functioning following a trauma. Resilience is about survival and growth. Understanding how resilience can be built helps me as a professional to always have hope.

5 Resilience Theory Secure attachments High self esteem Social empathy Easy-going temperament Problem-solving skills Self-efficacy and a feeling of competence Absence of early loss and trauma

6 My Research Resilience Can it be developed? How is it developed? How are resilient traits/qualities developed? Processes involved. Looked at the experiences of adolescents who had witnessed domestic violence (adversity) and then received therapeutic support. Explored the experiences of those who were doing better than expected. How? What were their stories?

7 Learning about the self, more personal reflection Personal growth, improved psychological health Understanding how resilience is built Development of a resilience story Feeling more secure in important relationships this helps ability to regulate emotions Feeling connected to others Having a secure base (safe haven in times of distress) Having a voice that s heard Developing the true self Findings what helps build resilience Empathy / mentalising (key component when feel safe enough)

8 Mentalising Keeping one s own state, desires and goals in mind as you reflect on your experience; and keeping another s state, desires, and goals in mind as you interpret his or her behaviour Scenario: It is Sarah s birthday. She is planning to celebrate with Mike, her boyfriend, and has invited him home for dinner. She has purchased wine to go with the food, and is looking forward to him coming after work. When Mike arrives, he does not have a gift with him, and he says to her wow, what a dinner you have made, and on a Tuesday. During dinner Sarah is quiet and drinks most of the wine herself. What happened? Why do you think Sarah behaves the way she does?

9 Exercise Identify a previous difficult experience you have had in your life that it feels safe to think about Write down some bullet points of how you got through this time

10 Reacting or Responding Reflex reactions v more mindful response You can choose your response Take a step back, breathe

11 How you tell your story

12 Dual Process Model of Coping with Loss

13 Tips for Building Resilience Deliberately place yourself in situations that are outside of your comfort zone, making yourself tense but knowing this can be resolved. Exposing yourself to this discomfort. Self care Develop the authentic you and build this within some relationships Develop your relationship with your story Reflect on your strengths / resources Self compassion / acceptance

14 Resilience is about our tolerance for adversity and our ability to move on from it with strength. By understanding how resilience is built, we can then make choices to behave and think in some of the ways we have looked at today in order to strengthen our resilience.

15 Supporting Children to Build Resilience Before and Through Bereavement

16 Uncertainty What s it like for a child? Worry about rest of the family Helplessness Exhaustion Financial concerns Fear Intrusion of professionals Role changes Facing loss of a future Guilt Feeling different friends don t understand am I normal?

17 How resilience is built Basic needs must be met (housing, money, safety, diet, play) Belonging Development Coping Sense of self

18 How resilience is built Being heard and having a voice: Communication (appropriate level what is right for the child/young person) Belonging and feeling connected Safe haven Learning about themselves & developing a resilient story Help the child to understand the feelings/behaviour of others Highlighting achievements Instilling a sense of hope Learning to self-soothe Humour Develop a kind internal voice

19 Specifically in Bereavement Adequate information Fears and anxieties addressed Reassurance they are not to blame Careful listening and watching Validation of child s feelings Help with overwhelming feelings Involvement and inclusion Continued routine activities Modelled grief behaviours Opportunities to remember

20 Talk to children if you think they re struggling Encourage conversations, ask questions, listen carefully New information is best given by a parent/guardian Use books to help with difficult conversations Validation of individual s feelings Children can dip in and out of emotions, this is okay Keep language clear Children need to know they re not to blame If you can t answer a child s question immediately, always make sure you come back to them Feel the fear and do it anyway!

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23 Any Questions?