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| Introduction and Overview | |
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| The purpose of this book | |
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| Terminology | |
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| Facts and figures | |
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| Relevant UK legislation and policy | |
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| Context of the work | |
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| The focus of different practitioners | |
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| Routine as safety | |
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| Is talking therapy the appropriate treatment? | |
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| Problems that may be faced | |
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| Associated losses | |
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| Physical sensations | |
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| Psychic or spirit sensations | |
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| Collective grief | |
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| Witnessing other people's illness | |
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| Conclusion | |
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| How Bereavement and Loss can be Different in Learning Disabilities | |
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| Introduction | |
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| Why the experience of bereavement might be different for someone with a learning disability | |
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| Self-blame | |
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| Not knowing when grieving 'stops' following bereavement | |
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| Stages of Loss | |
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| Introduction | |
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| Shock | |
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| Denial | |
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| Bargaining | |
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| Searching | |
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| Anxiety | |
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| Anger | |
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| Guilt | |
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| Depression | |
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| Grief and mourning | |
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| Acceptance | |
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| How we can help this process | |
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| Assessment | |
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| Introduction | |
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| Background to risk | |
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| Care plans | |
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| Managing greater risks posed to the individual | |
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| Relevance to bereavement and loss | |
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| Depression | |
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| Anger | |
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| Physical manifestations of grief | |
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| Self-esteem | |
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| Assessment of behaviours that may be seen as attention seeking | |
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| Factors to consider when assessing for any therapeutic work | |
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| History of attachments | |
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| Factors to consider in grief work | |
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| Unresolved grief | |
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| Developing Understanding around Bereavement and Loss | |
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| Context of the work | |
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| Practical considerations | |
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| Blocks to understanding | |
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| Building on previous understanding | |
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| Autism and understanding of bereavement and loss | |
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| Developing an understanding of illness | |
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| Developing an understanding of what death is | |
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| Breaking news of sudden illness or death in residential settings | |
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| Reading social cues | |
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| Different attachments in residential care | |
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| Difficulty in locating the body | |
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| Explaining change to people with learning disabilities | |
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| Health education and awareness | |
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| Specific illness | |
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| Impact of a death within a shared supported house | |
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| Avoiding euphemisms | |
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| Thinking about funerals and attending funerals | |
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| Finding it hard to move on from worry | |
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| Growing older | |
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| Therapeutic Tasks | |
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| Introduction | |
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| Types of referrals | |
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| Establishing a good therapeutic relationship | |
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| Consent | |
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| Contract | |
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| Confidentiality | |
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| Boundary setting | |
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| Environment and room setting | |
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| Goal setting | |
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| Tasks of counselling | |
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| Endings | |
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| Working with Families | |
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| Introduction | |
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| Life cycle issues | |
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| Beliefs and customs | |
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| Loss felt by parents | |
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| Loss of being parents | |
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| Issues for older parents | |
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| Preparing for the future | |
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| Being honest about health needs | |
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| Managing the effects of moving home | |
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| Managing when parents become ill or hospitalized | |
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| Dealing with structural change | |
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| The Carer's Role in Bereavement | |
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| Introduction | |
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| Knowing someone's history | |
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| Who is a carer? | |
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| Staff training needs | |
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| Supporting a client who is facing a bereavement | |
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| Systemic implications of a loss | |
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| The role of carers | |
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| National Service Framework for Mental Health and the Carers Act | |
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| Caring for someone with learning disabilities | |
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| Long-term foster placements | |
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| Supporting people in residential care facing loss and bereavement | |
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| End of an adult fostering relationship | |
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| Working with Clients who have Additional Communication Needs | |
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| Language and meaning | |
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| Identifying non-verbal change | |
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| Behavioural changes | |
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| Echolalia | |
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| Involving speech and language therapy | |
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| Makaton� | |
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| Using Makaton to communicate emotions around loss and bereavement | |
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| Talking Mats� | |
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| Hearing loss | |
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| Sight loss | |
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| Creative therapies | |
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| Dementia and learning disabilities | |
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| Role of Supervision | |
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| Introduction | |
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| Why supervision work in learning disabilities is essential | |
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| Establishing the contract | |
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| Functions of supervision | |
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| Issues that often present in learning disabilities supervision | |
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| Difficulties in obtaining appropriate supervision around bereavement and loss | |
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| Encouraging self-reflection | |
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| Working with trainees | |
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| Supervising trainee counsellors | |
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| Supervising residential staff | |
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| Supervising day care staff | |
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| 'Death and loss' for trainees | |
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| Working with Terminal Illnesses | |
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| Introduction | |
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| Why terminal illness is a difficult area | |
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| Delays in diagnosis | |
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| Assumptions made by others | |
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| National Strategy for End of Life Care 2008 | |
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| The concept of death | |
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| Knowledge of what a terminal illness is | |
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| Maintaining identity | |
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| Specific issues for adults with learning disabilities facing end of life illness | |
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| Explaining a terminal diagnosis | |
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| Palliative care | |
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| Health education | |
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| Supporting people with learning disabilities who have terminally ill relatives and friends | |
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| Remembering and Anniversaries | |
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| Introduction | |
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| Functions of remembering | |
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| Recalling the past | |
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| Recognizing attachments | |
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| Problems with remembering | |
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| When remembering is not helpful | |
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| Managing unpleasant memories | |
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| Unwelcome reminding | |
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| Loss felt by a centre or home | |
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| Continuity | |
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| Problems with anniversaries | |
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| Doubts about memory and relationships | |
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| Creating a focus | |
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| Unresolved grief appearing some time after a loss | |
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| Seasons and festivals | |
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| Voices, accents, smells and sounds | |
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| Dementia | |
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| Managing change | |
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| When to end mourning and remembering | |
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| References | |
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| Useful Organizations and Resources | |
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| Index | |