Thursday, April 29, 2010

Memory Box

One of my favorite activities with bereaved children is to make Memory Boxes.  This is a fun activity, gives the child a nice keepsake, and has a lot of possibilities for conversation and reflection.

Materials needed: a box, magazines, Mod Podge, foam brush

You can use a shoe box or cigar box but I prefer photo storage boxes.  They tend to be sturdier and can hold more items.  Just be sure to detach the metal label holder first!  Put the lid on the box and then trace under the lid with a pencil, all away around the box.  This is your guideline for how high up you can glue images.  If the images encompass the whole box, the lid does not always fit correctly or rips the images off.

Speaking of images, there are two ways of doing this.  1) Give the child a pile of magazines and have them cut out pictures and words they like.  This method will probably extend the project by at least a week.  Make sure the magazines you have are child-friendly!  2) Have a stockpile of collage materials.  I have folders with big and small backgrounds, pictures of animals, people, food, "things", and then words/sayings.  The child can then go through each folder and pick out what they like.  (Plus, you will now have numerous opportunities to create collages!)

One thing I like to do is have the child pick items for the outside of the box that are "positive", things they like, or the way they want to be seen.  The inside of the box can then be more private, i.e. how they're really feeling, things people don't know about them, etc.  They can also use pictures of their loved one on the outside or inside, depending on their preference.  The concentration will be on selecting images, creating a relaxed environment to discuss their loved one, how they're coping, and what their concerns are.

Once images are selected, it's time to start gluing!  Spread out some newspaper, pour the Mod Podge into a bowl (one you can throw away makes clean up a snap), and have the child consider where they would like to place the image. Decoupage doesn't tend to get too messy but the child will likely end up with a bunch of glue on their hands, even if they're using the foam brush. Have the child brush the Mod Podge onto the box surface and glue down the images. Use extra Mod Podge if something doesn't appear to stick quite right.  Once one side of the box is finished, seal the project with a final coat of Mod Podge. Generally we'll do the outside of the box one week and the inside of the box the next week...making this a, you guessed it, two week project.  Allow to dry thoroughly before the lid is put on the box.

If the child wants, they can discuss or show you what they'll be putting in the box.  It may be keepsakes or pictures related to their loved one or it might be a cool place for them to keep their rock collection or school papers.  It's up to them!  

Wednesday, April 21, 2010

Another Confession

I debated over when and how to tell my loyal readers the latest news in my life.  In short, I'm moving to Nashville in less than a month!  The reason why I'm moving is somewhat lengthier. It all started with a book: Crazy Love by Francis Chan.  To say that it was "challenging" is inadequate. Chan wrote that I should consider an area of my life where I was living out in faith, where if God didn't show up, I'd be in big trouble. I was shocked to realize that I couldn't come up with anything. I pray every morning that God would give me strength to do my job but I also know that I am an excellent listener and clinician.  I don't depend on God as heavily as I could or should in my day to day life.  I started praying then about how I could live with more dependence on God and it led me in the direction of Nashville. 

I've been visiting my best friend and her husband there for the past 5 years and every time, it's a little harder to leave.  I've become friends with their friends, fallen in love with their church, and been the best auntie I can be to their 14 month old daughter.  Plus the weather doesn't hurt!  I never thought I would stay in my hometown after finishing grad school but I believe it's where God intended me to be for this period of time, especially when I consider the circumstances behind my great-aunt and then grandma's times on hospice.  I have a nice life here but I've been feeling “stuck” the past couple of years, especially as I've realized hospice social work is no longer the best fit for me.  I shine when it comes to counseling, life review, goal work, and prebereavement support.  I don't like having to do respite placement, long term care planning, and anything related to case management.  I know that the latter are valuable services for families- I've just come to the point where I don't want to be the one doing it anymore.

After a lot of prayer, I've decided to move to Nashville when my lease ends next month.  This is probably the most exciting, terrifying thing I've ever done.  I've been looking for a job for the past few months and am excited to report that I'm in the interview process for a pediatric social work position.  For awhile I thought I would move in the direction of bereavement counseling and that may still be in my future.  However, I've always been interested in working with sick children.  I can hardly believe that I'm still in the running for what may be my dream job!  Because of the timing of my lease, I may end up moving without having a job lined up but that's OK.  It took me a year and a half after grad school before a hospice position opened up- I survived then and I know I'll do just fine now.  It might be nice to take a break!

So what does all this mean for this blog?  Well, I have at least a year's worth of posts I've never had time to write so I plan to continue on as always.  Depending on the position I take, there may still be a palliative component, in which case I will still have a plethora of opinions and stories to share.  I'm also hoping to become a hospice volunteer because I know I could never get out of end-of-life care completely. 

I announced my resignation to staff last week and have started telling patients.  Everyone is sad but excited about this opportunity.  I have a million things I could say about telling patients that I've resigned but since I still have another month to go, I'll save those thoughts for another post. 

Monday, April 12, 2010

Drive Safe

I was behind this truck on a recent road trip. I'm not familiar with makers of caskets but their sense of humor certainly got my attention! (In case you can't read it: under Please Drive Safely, they added "heaven can wait.")

Sunday, April 11, 2010

Everyone's Friend

I do not have much personal experience with little people. What I do know is second hand information gathered from school or shows like "Little People, Big World." And this is why I know some little people preferred to be called little people, while others prefer their specific type, such as dwarf. I now have a patient who is a dwarf and prefers to be called so. He lives at a nursing home and is well loved by the staff there. Locally he is well known for his artistic talents and has won a number of awards and has been featured in the papers several times. He has letters from presidents dating back to Ford and even an original Reagan campaign button. His room is a treasure trove of art and information. He shows visitors his memorabilia. And then he hands out a business card and a pencil that lists his name followed by "Everyone's Friend." Indeed, this patient is so gregarious that the pencil seems fitting. He has a wicked sense of humor and regaled me with stories about he used his height difference to his advantage with the ladies. He is hoping to finish a few more of his paintings, hoping he can walk again, hoping for the best. I look forward to continue getting to know him better.

Saturday, April 03, 2010

Breathing Forgiveness, Love, and Peace

Close your eyes and concentrate on your breathing.
Breathe in and breathe out.
Breathe in and breathe out.

As you are concentrating on your breathing,
bring to your awareness that which is causing you to suffer.
Bring to mind the source of your suffering.
Bring to mind the anger connected to your suffering.
Bring to mind the sadness connected to your suffering.

Imagine gently placing all of your suffering inside the very center of your being,
in the center of your body.
Your suffering is a the very center of your body.

As you are breathing, imagine the air you inhale
swirling around that suffering,
that suffering that is at the very center of your being.
Feel the air that you inhale swirl around your suffering.

With each breath you take in,
imagine the air swirling around that suffering.
Breathe in the air of forgiveness.
Imagine all of that forgiveness swirling around your suffering.
Every breath you take in is a breath of forgiveness.

Forgiveness moving through your suffering.
Breathe in the air of forgiveness.
Forgiveness coming to your suffering.

Now, with each breath you expel,
imagine the air moving out from your suffering.
It is the air of forgiveness.
You are now breathing out forgiveness.

As you continue to breathe out forgiveness,
make a smile of forgiveness.
Breathe out forgiveness.
And smile.

Now with each breath that you take in,
imagine the air swirling around that suffering at the very center of your being.
Breathe in the air of love.
Imagine love swirling around your suffering.
Every breath you take in is a breath of love.
Love moving through your suffering.

Breathe in the air of love.
Love coming to your suffering.
Now with each breath that you expel,
imagine the air moving out from your suffering.
You are now breathing out love.

As you are breathing out love,
make a smile of love.
Breathe out love,
and smile.

Now, with each breath you take in,
imagine that the air is once again swirling around your suffering.
Every breath you take in is a breath of peace.

Peace moving through your suffering.
Breathe in the air of peace.
Peace coming to your suffering.

Now with each breath you expel,
imagine the air moving out from your suffering.
You are now breathing out peace.
As you are breathing out peace,
make a smile of peace.
Breathe out peace,
and smile.

You are breathing in forgiveness.
You are breathing out forgiveness.
You are smiling the smile of forgiveness.

You are breathing in love.
You are breathing out love.
You are smiling the smile of love.

You are breathing in peace.
You are breathing out peace.
You are smiling the smile of peace.

There is forgiveness with our suffering.

There is love with our suffering.

There is peace with our suffering.


*Please read the background on Guided Imagery before using this with a client.

My Sacred Temple

While in a comfortable position, close your eyes
and center your attention upon your feelings.

Sense the particular feelings that you have when I say the following words:

Now, with those feelings in your consciousness,
imagine a special place of retreat made just for you.
This is your private, sacred temple.
Imagine this place that is characterized by peace, contentment, freedom, and safety.
Whatever place comes into your consciousness, stay there in your mind.

Do not let other places or thoughts intrude.
If they do, keep returning to that place of peace,
and safety.

Become completely absorbed in this place.
Imagine the soothing feelings that permeate your entire body.
Imagine the relaxing sounds that you hear in this place of peace.

Try to sense the soothing aromas that are present in this place.
Examine what is around you.
Examine what is below you.
Examine what is above you.
Examine what you see in the distance.
Examine what is close to you.

Examine everything that is contributing to your peace,
and safety.

This is your special place.
This place belongs completely to you,
and you may come here whenever you want to come.

Whenever you are anxious, you may close your eyes and go to this place of peace,
and safety.
This is your perfect place.

Once again, examine this place with all of your senses:
the sights,
the sounds,
the aromas.

You are about to leave this place.
But you may return whenever you wish.
All you need to do is just close your eyes and travel in your imagination.
For now, say goodbye to the soothing aromas.
For now, say goodbye to all the pleasant sights.
For now, say goodbye to the peace,
and safety.

Whenever you are ready,
knowing you can always return,
slowly open your eyes.

*This imagery illustrates how we all have a hidden internal sacred space that is with us wherever we go. This truth can be comforting to the terminally ill as well as the bereaved. Please read background on Guided Imagery before using this with a client.

Guided Imagery

Today I'm posting three guided imagery exercises I use regularly with patients and families as a means of reducing stress or anxiety. I would be remiss if I didn't review GI's effectiveness, principles, or precautions first.

Guided imagery is a two-part process. First, the user reaches a state of deep relaxation usually through breathing and muscle relaxation techniques. You might be directed to close your eyes and focus on your breathing or to release tension from your muscles, one body part at a time. Sometimes soothing music is played, although I don't do this when leading someone through an exercise. I have, however, encouraged people to purchase a CD of sounds or music they find to be soothing. I've found this to be especially helpful for people struggling with sleep.

Once the person is relaxed, imagery or visualization is introduced. Here we are only limited by our imagination. Common types are relaxation imagery, healing imagery, pain control imagery, and mental rehearsal. Guided imagery can promote relaxation, reduce stress, improve mood, control high blood pressure, alleviate pain, boost the immune system, and lower cholesterol and blood sugar levels. Not too shabby!

There are three principles behind guided imagery.
1. The Mind-Body Connection
Mind-created images can be almost as real to the body as actual, external events. It's similar to Pavlov's dog. Think of a time that you read a recipe and you started to salivate or became hungry, even though you'd just eaten. Your mind is creating images of the food described in the recipe but your body responds by drooling and becoming hungry. Your body's response will be stronger when the created image contains sight, sound, smell, feel, and taste, and even more so with an emotional component. The body understands sensory images implicitly.

2. The Altered State
We are capable of more rapid and intense healing, growth, learning and performance. We're more intuitive and creative. Our actual brainwave activity and biochemistry change, which allows us to do things we couldn't in our normal, waking state. Altered states are a part of every day life, consciously or not. You might miss your exit or wonder how you got to the other side of town, for instance. This can be a state of relaxed focus, a calm but energized alertness, a functional form of focused imagination or dreaming. Your attention is limited, or rather, concentrated on one thing. You are more sensitive to the object of your focus and less aware of whatever is going on around you. It's easier to lose track of time or miss what someone is saying to you.

3. Locus of Control
When we sense we are in control, we feel better and do better. Research has indicated that locus of control leads to higher optimism, self esteem, and ability to tolerate pain, ambiguity, and stress. Lack of control or feelings of helplessness lowers self-esteem and impacts our ability to cope as well as our optimism about the future. This describes perfectly what many patients and caregivers feel during a loved one's time on hospice and subsequent bereavement. The user is in control of guided imagery: each individual will picture and experience something unique to them. They can also decide when, where, and how to use GI, which in turn helps them feel they have some control.

Before leading someone through a GI exercise, you should assess their comfort level. They don't need to have prior experience or to even believe that this will work. However, if you're going to use The Beach, you might want to make sure they don't have any fears associated with beach, water, or drowning first. Before I begin any exercise, I let the person know that they may become sleepy or even fall asleep- and this is OK. When I have finished, they can wake up or open their eyes whenever they're ready.

Have the person get into a comfortable position, such as sitting back in a comfy chair (no stools!) or laying down in bed. Encourage them to breathe deeply, in and out. After an exercise, I will encourage the person to envision their "safe place" for a few more minutes or to describe it to me if they feel comfortable. I tell them they can go back to this place whenever they need. It might take a couple of times through the exercise before a person can do this on their own. It depends on their circumstances, strength of the GI outcome, and stress or anxiety level.

Along with The Beach, I also use Breathing Forgiveness, Love, and Peace and My Sacred Temple. Before leading someone through one of these exercises, I would encourage you read it out loud a few times to capture a soothing rhythm and cadence. Or try it out on friends and family- I'm sure they'd appreciate it!

The Beach

Close your eyes.
Let your body relax and become heavy.
Hear yourself take long, gentle cleansing breaths
until soft natural breathing takes over.

You are standing on a silent road at the edge of an empty beach.
There are no people in sight and the beach is yours.
With your eyes closed, you raise your head toward the sun,
high in the blue sky,
and feel its warmth on your face.
The sun's rays erase all of your worries, your tension, your distraction.
There is only you and the beach before you.

You slowly move forward to the edge of the sand.
You remove your shoes and are now barefoot.
As you step into the sand, feel it on your feet.
It is soft and loose and warm and dry.
It feels comforting to your skin and you sink in as you step.

You stand still for a moment to experience your surroundings.
The day is fair and bright.
There is a light, warm breeze that moves in little swirls around your body.
It moves through your hair and your clothes and allows you
to feel free and unrestrained.

You can smell the seashore and you can hear seagulls a short distance away.
Feel the sun's rays on your head and on your back,
between your shoulders.

Listen to the gentle waves as they move along the edge of the sand.
Watch them roll in and out, in rhythm with your breathing.

You move closer to the water's edge.
Feel the sand under your feet as it becomes firmer and cooler.
Your feet no longer sink into the sand
but leave little puddles as you step.
The cool wetness seeps between your toes.

You move to the edge of the water and it washes over your feet.
The water is a perfect temperature for your body.
You step slowly deeper.
The level rises to your knees and then to your waist.
Be aware of the waves caressing your body and let them move you.

You gently lay forward into the water
and realize that you can breathe and see as naturally as if you were on land.
Float, and the let the rhythm of the water rock you as you gaze under the surface.
See the light of the sun as it breaks through the water
and reflects on the bottom.

You are totally relaxed and moving with the water's motion.
Now, lean back and float effortlessly with your face to the sky.
Feel the sun's rays as they dry your forehead.
Feel the serenity in your mind and body.
You are safe.
You are supported effortlessly and you stay in this place as long as you desire.
You are at peace...

*Please read background on Guided Imagery before using this with clients.