Welcome to the close the chapter podcast. I am Kristen Boice a licenced Marriage and Family Therapist with a private practice Pathways to Healing Counselling. Through conversations, education, strategies and shared stories. We will be closing the chapter on all the thoughts, feelings, people and circumstances that don't serve you anymore. And open the door to possibilities and the real you. You won't want to miss an episode, so be sure to subscribe.

Kristen Welcome to this week's Close the Chapter podcast. I get a little teary-eyed because I am beyond grateful to have this guest here with me today. We have known each other how long has it been?

Dr. Lott: A little over two years?

Kristen: 2 years. That's what I was gonna say. Yeah, a little over two years. And there's just an instant connection that I can't explain in words, but our souls know that we are just meant to meet and kind of be on this journey together. So it is a true honour and privilege to have her on the podcast here today. So without further ado, let me introduce you to my guests. Sonya has been a licenced psychologist for 31 years. She maintains a multi-state online private practice specialising in diagnosis and treatment of prolonged grief disorder. In addition, Sonya is the founder and CEO of Sem psych LLC that offers continuing education for mental health professionals focused on increasing awareness of what it means to be multicultural being in a commitment to cultivating a multicultural orientation.

What a gift you are to the world and welcome to the Close the Chapter podcast, my dear friend.

Dr. Lott: Thank you, Kristen. I'm so grateful to be here.

Kristen: It is with so much just heartfelt love that you're here because we were in a group together. And we were talking about an article that Sonya is working on and I was like, “will you please please come on the Close a Chapter podcast and share what you know about the five myths of grief.” And I cannot wait to jump into the conversation. So tell us kind of a little bit more about you, things that we might not have gotten in the bio. And then how did you start exploring the five myths of grief?

Dr. Lott: I'm physically located in the Philadelphia metropolitan area, as it's known currently, formerly was la Napa Linna. Peel valley land, actually. And so that's where I'm located. What else can I tell you about me? Well, I'll tell you how I got into specialising in grief, particularly prolonged grief disorder. I knew when I was nine years old that I had to be a psychologist because that's what I was. So I was really clear about that. And then my little nine-year-old mind, I thought that being a psychologist was only being a clinician. I didn't know there was a whole world out there. And so I used to save my allowance and buy books written by Freud. I don't know what since I made up them, but they were whatever. And I would, without permission, write letters. This is my former therapy. I would write letters to family and extended family and friends, letting them know my love for them first, and then my concern for their well-being. I had a couple of diagnoses, either too anxious, too sad, or something like that. And I really thought that the prescription the healing was recommending a book. So I would recommend one of the books in my library for them.

So anyway, folks played along and I got my credentials and really became a psychologist. But when I was 21, and I just started my graduate programme, I was like, just take it as a download. I don't know what else to call it, that I was supposed to do this work related to grief. And I thought that it was a mistake that the university like check in with the wrong person. Because I had lived yet. I hadn't like leaned into my fear of living, my fear of dying and any of that. So I just thought it was crossed-wired message. But I did sign up. I did take a death dying and bereavement course and I cried the entire semester. After that, I lived a bit and practice and taught and did a lot of other things. And it was the day that my mother died in April 2015 that she told me that I was now ready to do this work, and that she and my other ancestors and or spiritual guides were going to work with me. And so that was, I don't know 40 years later, no sorry like 35 years later or something. And I said, yes, I knew that that was true.

I went back into private practice. I've been teaching tenured professor and had been teaching and doing academic writing. And I came back to clinical work really as a way of being obedient to what I'm here to do. That's a long story to how I got to doing this work.

Kristen: What I pictured you as little Sonya. Just wanted to just take her in a hugger because you had this in you, you came in with it? Yes. That's what I got from what you said.

Dr. Lott: Absolutely did.

Kristen: And just the knowing that, yes, this is what I'm supposed to do when your mom passed, and she was delivering this message and the ancestors like you are like, Yes, I know, this is what I'm supposed to do.

Dr. Lott: and here I am. And I trusted that I was ready, where I hadn't before.

Kristen: That's big. When you trust you're ready. Tell us what are the five myths of grief. Let's jump into how you develop these.

Dr. Lott: There's so many myths. And so this five, this idea of five just works well. So I don't want to. I've selected five that I think are most important to talk about, and most impactful for people to be exposed to a different way of thinking about it. But there's so many myths. 5 seems to be a number that works for us as humans, I don't know. It's just to limit it, again, to the ones I think that are most impactful in a negative way, and that I think are most helpful for people to have a different frame around.

Kristen: That's helpful. So when you came up with these because I know there's parts of you that are like, there's some misnomers out there. There's a lot of people that focus on grief. And when you're talking about grief, what type of grief before we get into the five are you referring to? Can you define it?

Dr. Lott: So I wanted to do that to be clear, because particularly with the pandemic, which none of us have lived through before, well save a few posts, 100-year-old souls who are still with us. With the pandemic, we've experienced so many types of losses. Many what are referred to as disenfranchised, those that society don't deem appropriate to grieve. So we've experienced a lot of non-death-related losses. So I want to be really clear that what I'm talking about today are grief related. deaths related losses, okay? And death related, meaning not just somebod we know who dies, or not even the multiple deaths that our healthcare professionals have experienced, for example, like work in the pandemic, but death related in the sense of somebody that we have a very close relationship with who dies before us is what I'm talking about today.

Kristen: It's a helps frame and just again, narrow down exactly what we're talking about. It's the loss of are you saying a person?

Dr. Lott: A person. Yes, yes, yes. The person, that family members, which is also very significant form of loss. And I do work with people dealing with the loss, grief around a dog or a cat, particularly dogs. We're talking about humans. Thank you, Kristen. Humans with whom we have a close relationship, emotional relationship with who die, that helps clarify, just to kind of narrow this.

Kristen: that helps clarify, just to kind of narrow this. So that's what we're gonna be wrapping the five myths around today. Yeah. Right. So what is the first one that comes through? Is the first and in no particular order? I'm guessing. We'll kind of Yeah, but it's okay. Go in the order that it's of importance.

Dr. Lott: Yes. So the first one is that grief is only speaks to emotions, particularly sadness. That's how grief is defined just the sadness we feel after the death of a loved one. And grief or the grieving process is so much more than that. It impacts every aspect of our being. It impacts us, of course, emotionally. But sadness isn't just even the only emotion can be frustration, confusion, anger, bitterness, regret. They're just a multitude of feelings that we can have all at the same time. But it's also cognitive. There are ways of thinking particularly what we call counterfactual thinking, that if I had said to him, If I would have insisted he went, he would have gone to the doctor, I should have loved him more. I should have been there with her. All of the things that we think that maybe had ridden them, and of course we can't but had we done them then maybe they'd still be alive. So there are ways of thinking that are impact, that are part of the grief process, the sense of who am I now without this person? Am I still a mom?

If my only child dies, what am I still a wife, if my spouse dies, what is my purpose? What is my reason for waking up in the morning? It can also be spiritual, what type of God would have, allowed this to happen to me, or for my loved one to have died in this way or for me to have lost three family members due to COVID. What type of God allows this, and then their physical manifestations. We know that there's no separation between mind and body, even though we talk is it and that there is but there isn't. And so headaches and difficulty sleeping, and we become the suppression of the immune system, sometimes directly, but also indirectly through difficulty sleeping, not eating, like we typically would, and so on that we end up becoming more susceptible to every acute and chronic illness that there is. So it's just every aspect of our being is impacted. So when we think about grief, we need to widen our perception about what it is that it involves,

Kristen
I love all these pieces that you're bringing in because I've walked so many people through death have children, or they've lost all their children, or Yes, tragically, in traumatically. And to walk people through whether it's children or loved or any type, any person you've lost, that you love and care about me and the impact that it has, especially if you're not processing, like the shame, the guilt, fear, the sadness, the anger, the disgust, the rage, all of it, and getting trapped in the body. How important is it for people to process but when I say process, it's to acknowledge the pain and start naming it start noticing it in the body,

Dr. Lott

it's really important to do at some point. Sometimes, in order to survive emotionally, you need to delay that. You need to try to, and I say this very tentatively but to suppress the comprehensiveness if you will, of grief, because you can literally end up on the floor for a while. And if you have other children, or if you're still needing or trying to work, that can be overwhelming. And it's something that's happening with the pandemic that many people are just trying to survive, and so many ways, can't really lean into the grief. And I see that where it's not necessarily prolonged grief, it's delayed grief, that there hasn't been emotional space to lean into all of that. So sometimes that's a good decision. It's just if it but it's the awareness, though that we have Kristen that the body is still holding it while the person's delayed and trying to survive. Sometimes we don't get a choice. The emotions, for example, can be so overwhelming. And so that's why I'm talking about delaying tentatively because sometimes what we will do is begin to numb in the interim because alcohol

Kristen:
Alcohol or food

Dr. Lott:
Right, All of the above. That's right.

Kristen
So what's the difference? Before we get to number two? What's the difference between prolonged grief? Like how do you get a prolonged grief diagnosis?

Dr. Lott:
That's myth number five, but I want to talk about what's

Kristen
hidden until we get to number five. Okay, okay. Number two.

Dr. Lott:
So this is, I think, one of the most harmful, it's one of the most, it's woven into the fabric of our society, this particular myth, and that's a grief occurs in stages, particularly five stages. And I know you know that one, and it's woven into the fabric and it's very heavily promoted today. And a lot of therapists believe that too. Unfortunately, it's it comes from Elisabeth Kubler Ross, who was a very influential psychiatrist, who offered us so much just a wealth of knowledge around the needs of the dying, which is where she first proposed after interviewing a small number of people who had been given a terminal diagnosis around their process of coming to terms with impending death. It's where the stages came from, and it was more than five. But anyway, she offered does so much about palliative care, hospice near-death experiences. And so because she offered so much anything connected to her name was also revered. And so when we propose anybody can create a theory, whether you're a mental health professional or not, but once the theory is put to quote, the scientific test and clinical practice, and it's repeatedly, then typically, we just set it aside and move on to more plausible theories of whatever it is. And in this case, grief. And there are many more plausible theories around grief, and how to intervene appropriately when people are grieving. But because of her, influence people's love for her and the people that she also worked with, who are very actively promoting the theory, it's just woven into the fabric of so much. And so people think that there's something wrong with them when they don't go through the stages, that they're not stages. And so one of the ways that people try to justify still using is to say, well, it's not necessarily linear, you don't go through all of the stages. Well, then why is it considered a stage theory? stage theories indicate that they're distinct stages, phases, steps, it's the progression. So it's sort of circular reasoning. But many people will come to me and say, you know, I feel like my, I'm not grieving, right? I didn't go through those stages, or I just felt this or I felt that, and I can talk about so many of the criticisms of the model, but it's woven into the fabric of our society. Everywhere you see it on television, it's everywhere. And it's very harmful.

Kristen:
Yes, because I think you put it you honed in on why it's so confusing, because it's a stage and people think, Well, I didn't go into shock and denial, we can go through all the stages. Some people, like you said, it's not just one builds on the other.

Dr. Lott:
Right. And the other thing too, when she when Elisabeth Kubler Ross proposes for people who are dying, they were dying, their life was ending. And so it may make more sense there. But when you're talking about people who are just beginning to live to start a process of living without their loved one, it just doesn't. It's totally different. It's for the rest of our life. While we're breathing, we are going to have to deal with the realities of that person who we loved, and who had so much to do with us being who we are, is no longer with us in the physical. That's a lifelong thing. It is. Yeah.

Kristen:
So it just does sending there's no trend.

Dr. Lott:
So it's everywhere. It is

Kristen:
We kind of grabbed hold of it and ran with it as what we did.

Dr. Lott:
Right. And I think one of the things that happens is that it I don't believe that this was intended by Elisabeth Kubler Ross. I don't know David Kessler's intentions, who co-authored two books with their end is a person who promotes it most and promotes himself as a grief expert, the world's most renowned grief expert. And many people believe that I don't even know if it's his intention, though I don't know for sure that it makes therapists think we have this abbreviated path to understanding grief. And so if we believe that there are five stages, how does that help us to know how to appropriately intervene? How do we know what the stages looks like? How do we know when somebody sends in now versus, quote, depression? How do we distinguish depression from the normal sadness that accompanies grief? How do we recognise that there might be a major depressive episode happening in addition to the grief? What do we do to help people heal, there's nothing in that. But just seeing their five stages, somehow makes it seem like we now know what to do. Because going into the third myth gonna talk a little bit more about this is that we don't get training around grief and what it is and how to intervene and what's quote, normal, what isn't in our programmes. Even if we have a PhD, it's not a part of our curriculum. So we will know

Kristen:
What would you want people to know? That's not I mean, this is a big question. Maybe give me the top three things, but what would you want people to know that isn't being taught? Besides the stages besides our three myths we have so far, what would you want to be more well known?

Dr. Lott:
Wow, that's it. There's so much the one I want people to know that there is so much research, so many theories, and so much clinical application or practice or research around the most effective therapies for grief, if you will, there's a whole field of knowledge that's at our at the ready for us only, we just have to be just have to look for it. We just have to go to it. You just have to ask. So yeah, that's what I'm gonna stop there. When I talk about the third myth, I'll say a little bit more about that. To know that they're just scholarly, um, discipline debt. dying and bereavement and are ready if we know to look for it, that we don't have to depend on what people who are not grief experts. I mean, the grief scholars really say might be true. It's there for us hundreds of 1000s of peer reviewed journal articles around every aspect of grief.

Kristen:
Yes, I think the one of the biggest things I hear you saying, and maybe I'm not getting it, but I want to just see if I go a little bit another layer deeper is that there is no timeline or deadline, there is no end, then if you reach this stage, it's over.

Dr. Lott:
It's more helpful to think about, rather than grief occurring in stages, thinking about it in terms of phases or tasks or milestones, that we need to move through or approach to adapt to profound loss, or to re integrate our profound loss into our living again. And so there are many theories, Bill, or William warden has the four tasks of mourning, accepting the reality of the loss, processing the pain of it, adjusting to living without the loved one, and then also, continuing bands, finding a way to recognise for whatever it means to you that you're still connected to that person, if it's just the memories that are imprinted in your heart, mind and soul. And or if it's an I believe this, but so not everybody does, the ongoing connection, the energetic connection, and communication that can happen with our loved one through eternity. So that's one theory. Katherine shear who is the creator of the prolonged grief disorder therapy protocol that I use, can be very transformational talks about healing milestone seven healing milestones. Teressa Randall talks about the six R's process of mourning. And so there's significant overlap from all of these theories and talking about acceptance and reconnecting recognising the ongoing connection. And being able to Robert Niemeyer, who is the world's foremost expert on finding meaning after loss psychologist who's now in Portland, the loss and grief and loss Institute talks about three R's, the retelling the story, the importance of that re storing the relationship in this new way, and rebuilding one's sense of purpose and living without the loved one. So there are many different theories. There's another the dual processing model, which is really, really important, that looks at there some task of meaning to lean into the emotional aspects or the grief aspects leaning into that, but also leaning into the types of tasks moving toward restoration, the family new meaning and live in that type of thing. There are many really, really wonderful ways of understanding what grief is for each of us, and how to appropriately intervene.

Kristen:
Those are so helpful. Just even you say I wanted to dive in more to each of them. Because yeah, those are so helpful. Is that part of your third myth like? These were taught more? Well, the third well known? Yeah. What about the third myth? Yeah,

Dr. Lott:
it's the idea that our lived experience with grief are sufficient to make us experts, whether or not we're mental health professionals, okay. It's sort of like parents who survive adolescents. Nobody goes to jail, the kids are still breathing, maybe they've gone off to college, and say, you've had three children, adolescents, three adolescents in the same house, and all goes well, and they survive, then there's a tendency to think that you're an expert now on parenting, because everybody survived. And so one of the things that I talk about is that grief is quote, normal, okay. And as a reaction to the traumatic break, and a very significant emotional connection we have with the loved one, all right, even if we expect it for them to die. But adolescence is normal also. And so adolescents can get really crazy, but still be quote, normal, to effectively help to die parents who may be going bananas because they're concerned about their adolescence, or their adolescence, we're doing things that the parents are taking personally, we have to understand normal, quote, adolescent development. And we also have to understand when that normal, quote, development can get derailed. And as clinicians, we need to be able to offer assistance to the adolescents and also to the parents, so that this really important period of adolescence, the initial sort of question around who am I and what do I want gonna be when I grow up, right in every way that we can possibly be, we need to be able to set a foundation, that's going to have implications down the road. And so grief is the same way, even though it's, quote normal, we need to know what grief is just like we need to understand our lesson development. We need to understand movement through grief, the process of grief, to be able to effectively intervene, quote, when it's normal, or when it's about to be or possibly can be, or has gotten derailed. So we still need to have this body of knowledge about relationships, attachment, about trauma, about the emotional side of grief about the comprehensive impact of grief, what are some of the risk factors, what types of ways of thinking and feeling might get the person derailed and how can we appropriately intervene. So and then to the thing about grief is that for each of us, each time we experience it, it's different, the experience is different. And so we have to be able to have this body of knowledge that helps us to generally understand grief within the context of this very individualised expression of grief in the individual that we're sitting with, or the family, whatever the constellation is, of who we're working with. So what happens is that, because we don't learn anything about grief in our programmes, is that therapist particularly believe, because they a lot of credentials, right? A lot of knowledge. If we survive a death in that we're experts, we don't know that there's just whole discipline over here to guide us. And so it becomes really very harmful, because people who are mental health professionals, but not trained in grief, think that they're qualified to work with people in grief. And then there are people who are not even mental health professionals, who claim to be grief experts, and are believed to be and are listened to. And it just feeds the misinformation.

Kristen:
Where do people find the information about what normal quote unquote grief looks like? And what falls outside of that? ‘

Dr. Lott:
Just go to the literature there.I mean, there's so many books, and I'll just say, can we add some resources in the show notes, please? The best place for mental health professionals is a DAC the association of death education and counselling. It's also referred to as the association then ontology is that so largest professional orientation for mental health and other related professionals. That's a largest organisation. There's a code of ethics, there are trainings all of the time by the experts in the field, the grief scholars and practitioners, and so on. And it's a wonderful networking opportunity. The other thing is like, wherever you are, whatever university you graduated from, you got your graduate degree. Most colleges allow us to have access to the library databases for the rest of our existence. Just look up grief, look up phases of grief or stages of grief or whatever it might be. It's all there been there many, many books that are written by the quote, Masters anything, Robert Niemeyer. He's published over 30 books co authored over 500 peer reviewed journal articles, just Google or search. I mean, that's a Google search in a research database, the names Robert Niemeyer, William Ward, and Katherine share, Holly per Goodson, there's so many, it's their force in those places,

Kristen:
and non clinicians. So someone that's really wanting to know more about their own grief that they're not clinicians, they're going through therapy, or maybe they're in a grief support group, or maybe they don't know where to start and kind of trying to do it on their own.

Dr. Lott:
I'm gonna suggest starting the Centre for prolonged grief. There's a lot of information there for the general public, not just about, quote, prolonged grief, but also about the pandemic and how to support a loved one in grief, a lot of comprehensive handouts, or white papers for people who aren't in the field also, and we can include that in the show notes.

Kristen:
That'd be wonderful. Yeah, this is so helpful. Okay, what's myth number four?

Dr. Lott:
Okay. Myth number four is that grief is equivalent to the love that we feel for the person who died. That's a big man. And you know, there's I want to be like really clear, like people talk about that grief is the form that love takes after someone leaves their body when they leave the physical plane. I agree with that. It's the we don't grieve too, as deeply for someone who we didn't have a significant emotional relationship with, even if it's somebody Unlike an absent parent or loved one we had a really problematic relationship with even though we may grieve the idea that the opportunity is lost to heal, it's a very different type of grief when it's somebody who we've had many years with, if it's a parent, if it's a partner, if it's a sibling, and very close friend, someone who literally helps co regulate our being, that when you're in their presence, you feel more calm, where you don't have to talk, but you can just sort of touch put your hand on their shoulder and they feel everything's okay in the world or hug or the person you trust the most of the person who has supported you most who loves you unconditionally. Those are the people. That's the huge loss, because they helped us to live. And now what do we do? How do we figure out? How do we keep living now, without that person?

Kristen
And so live, you just said something I want to repeat, okay, helped us to live?

Dr. Lott
That's right.. Absolutely. And even though intellectually, we know that there's a cycle of life and all of that, and just like we're born, we die, none of us want our loved ones to die, we just don't, right. And so it gets a little tricky, because what happens and this happens in some of the paraprofessional led grief support groups that grief is a form of that stain in the grief becomes the expression of loyalty, or how much you love them in their living by staying in the suffering. And they feel guilty if they That's right. They'll feel guilty if they have a good day, or let a little bit of joy in Yes, or laughed at all right. And so it gets really tricky, because we don't grieve so deeply if we don't love deeply. But we're going to miss that person for the rest of our life. That never changes. That's the there is no timeline on grief, you will never stop missing that person, you will never stop being surprised by minding your business and driving down the street, you hear a song that you hadn't heard in 20 years, it takes you right back to a specific memory with them. And you have to pull out inside the role because you're so broken open, that never stops. But what can happen as we're adapting to living without them is there's greater space in between when those breakdown happen. And there's less intensity in the breakdown. And we can regroup faster. So there's like mercy in the process. And so as we find new meaning in our lives and taking our loved one with us everywhere we go, because be there in our heart, mind and soul. And if you believe some of us do around us to everywhere we go, there they are. So if we can hold that awareness and take them with us, everywhere we go, then we can let go of the suffering while holding on to the connection. And any clinical intervention should include when the person is ready. And once we understand that they're ready, some sense of helping them in their own way, in a way that's meaningful for them to reconnect, to recognise the ongoing connection they have still with that person. So that's part of our work in quote, normal grief. But it's important to make a distinction because this is what happens. It's one of the derailleurs of the adaptation to grief that we see with, quote, prolonged grief, as you're moving toward myth number five, is that people get stuck and they think they have to continue to suffer. Or there's this fear, even though it's really unrealistic, that they're going to forget the person. Yes, we know it's not possible. But when you're sitting in that grief, that's a fear. Like if you have a couple of good days and you don't, you're not really thinking about the loved one in a painful way. It's not front and centre, we're afraid we're going to forget them. So it's really important to understand that it makes sense to think of grief as a form of love. A shift in the way we love after person leaves their physical body, you know, their body tempo, but not that grief. It's the same. And there are a lot of support groups and a lot of people who call themselves grief experts who don't aren't really clear about that distinction.’

Kristen:
And I think people long for that feeling of the space in between and less intensity, and they're afraid to give they're afraid of that changing at the same time.

Dr. Lott:
Right and it's our job as the professionals are sitting with if they not everybody who's dealing in grief sits with us. It's not always required either. But if they are sitting with us, that becomes our job to help them to navigate that

Kristen:
That’s why I love brainspotting, EMDR, somatic experience. There's lots of modalities that can help with that piece to sit with it, be with it, start exploring that in a safe way.

Dr. Lott:
I found speaking with brainspotting, sometimes one or two sessions will clear. And I'm talking about people who are dealing with prolonged grief, which I'm going to talk about in just a minute, clear, with one or two sessions. And it makes me think, and I know this isn't true when we talk about this, that the the pointer that we often use in brain spotting in many of our setups is not a magic wand. But sometimes it's like, Oh, my goodness, that was like, magic, that it just clears the pain so that they can get to dealing with finding giving themselves permission and having an emotional space to find new meaning in their living without this loved one. present in the physical sense.

Kristen:
Yes, it's powerful. Yeah. Okay. Take us to myth number five,

Dr. Lott: Myth number 5. That prolonged grief disorder, which was added to the ICD 11. First, was published earlier this year. And the decision to include it as an official quote, diagnosis happened before the DSM five TR treatment revised version that was released a few months ago. So there's a lot of conversation that's happening now, amongst the self-referred grief experts and mental health professionals to mental health professionals, that the disorder offering a diagnosis is an attempt to pathologize quote, normal grief. And so there's a lot of misinformation that's happening from people who have very large audiences can't say if it's intentional or not, but it's very misleading. So let me just talk about quickly what prolonged grief disorder refers to. First of all, in the DSM, any version,

Kristen:
This Diagnostic and Statistical Manual, that's how we, as clinicians, diagnose have to depending on if you're working with insurance or not give a diagnosis to a client.

Dr. Lott:

Right. Or even if you're not working with insurance, the DSM is not without many disadvantages, or flaws, many but having it's just like with the, quote, physical diagnosis, and I'm doing air quotes, you can air quotes, you can't see that bike as but it gives us as mental health professionals, a common language in which to speak about something, recognise if it's prolonged grief disorder, here's what it means. And here's what it doesn't mean. And so there's stigma around diagnose, I understand that. But if it's in the DSM, even if it's a, quote, adjustment disorder, it's still deemed a disorder. That's problematic, but it's possible. And I know that as a clinician specialised in prolonged grief disorder, it's possible to use that label and work with people while normalising their experience, while understanding that from a trauma perspective. It's not what's wrong with you. It's what it let's talk about what's happened to you. Right? And how can we help you to lean into that and to reintegrate into living in a very different, but new way? So what is prolonged grief disorder? First and foremost, we don't consider this disorder, quote, until at least 12 months have passed, the ICD 11 says six months, DSM, we say 12 months, at minimum before we even consider this diagnosis, because prolonged grief disorder is thought to be a continuation of acute grief. It's just that we believe based on all that we know about attachment about trauma about post-traumatic stress disorder, resilience and hardiness. And the impact of appropriate social support is that we all have the potential the ability to adapt to even profound loss. So the idea is that something goes wrong or something isn't in place, or something happens to increase the complexities of this process. So people get stuck. So we wait at least a year before we consider it. And so when we do consider it, it's really important to understand that we are saying that there are symptoms that must have been in place almost every day, since the person died almost every day, if not every day, and certainly every day in the past 30 days. To the degree that an interfere sick clinic, it's clinically significant. It interferes with the person's ability to function in some way. I work or if it's a child school and we do say six months for children and adolescents, okay? Personal relationships, physical health, there has to be some interference. So one of the things that's happening is that people who are against this diagnosis are saying that the people who helped to do the research and bring the proposal to the DSM committee for approval, saying that anybody who's still missing their loved one a year after they die, has prolonged grief disorder. That's just absolutely false. Okay. So it's were these symptoms that are happening daily, to the degree they're interfering with functioning. It's an intense yearning still, for the deceased loved one. It's a preoccupation often rumination with thoughts or memories about how they died or that if I could have would have should us. And in addition, there are three of eight more possible symptoms that include identity disruption, who am I now my still wife? Am I still a mom? What is my purpose? I'm mother and child. I'm parentless. Who am I now, I can still be a market sense of disbelief about the death, there's a lot of energy, this is very common, being put into avoidance of reminders, like you may see. And again, let me say this, we believe that less than 10% of people end up with prolonged grief disorder. Even with the pandemic, there's so many conditions from the pandemic that make it more likely. But even with that, we think there may be approximately 10%. So we're talking about very few people who are dealing with the grief of a loved one that they had a very close relationship with. So it can be the avoidance of reminders not being able to go through their belongings, this is very common with children leaving their room exactly, you know, this, I know exactly as it was exactly right, when they left, like if they left my clothes in the hand. That's right. And that can go on for years. So it's avoidance of reminders, not being able to look at photos, not being able to go into certain rooms of the house, or if you didn't live together not to be able to go certain places used to go or to be around people used to be around all of that. It can be the intense emotional pain, the grief still feels like it just happened.

Again, every day it feels you wake up with the first thought my child is still dead, my husband's still dead, my best friend is still dead, waking up another day without them difficulty in relationships with other people not feeling safe or that people understand. And that's really true. Because our idea of grief, like goes out the window after a really short time. We can't like why are you still grieving? It's been three months, it can also be numbness, still feeling numb around it. Or the big, big thing is, and I find people have the most difficulty in finding, like reconstructing Robert Niemeyer talks about this, reconstructing their living without its loved one, who am I now? How do I find purpose? What do I do what's going to wake me up in the morning, and then intense loneliness. So again, these are symptoms that are present, at least a year out, and almost every day, and certainly for the last 30 days. These are people who have difficulty working. And it looks like major depression. And that's a whole other podcast in a different day, Christian, hopefully, but we have to be able to set major depression can coexist with it. But they're still different. And any of that. And that's one of the reasons why prolonged grief disorder is so important to know about. Because there's so many people who end up getting diagnosed with major depression, when this is what it is, and there's no medication that's going to deal with this. There's no medication is going to make this better. There's CBT in and of itself is not sufficient. So knowing what it is, there's often a relief and knowing that there's even though it's a label, that there's something and there's treatment available.

Kristen:
What's the preferred treatment for those listening that say, Well, I want? I know we mentioned a few.

Dr. Lott:
It's the prolonged grief disorder therapy protocol, which I'll just say really quickly, and I'm going to give you for the show notes, the website, the Cener for Prolonged Grief at Columbia University. It's through the school of social work there, but it's a prolonged the PGDT, prolonged grief disorder therapy protocol. It's very much like CBT. It's a combination of some CBT principles, motivational interviewing, a lot of different um, some exposure therapy, but it's a 16 to 20 years session, quite structured in the first half treatment protocol that looks at a number of things of helping the person to meet the milestones, if you will, of movement through or toward adaptation. On telling the story again, Honouring the loved one, dealing find a way to deal with reminders. finding peace with however the person die or peace with never understanding why being able to reintegrate in relationships that find a new meaning in your living, and the very specific tasks that are built in its seat that are offered in a sequence to help the person to integrate their loss. So, as I said, maybe that's another podcast, but that's our five. That's about today.

Kristen:
Okay, can you go through just naming the Five Do you have yes, that we could just Yes, just recap the five because I know it's a lot if you are grips to take this then you may need to listen to this a couple of times. Okay, when you need it. So let's recap the five.

Dr. Lott:
Number one grief involves only emotions, particularly sadness, okay? To grief occurs in stages. Three, our life experience degrees makes us an expert. Whether or not we're mental health professional, for grief is equivalent to the love we feel for the person who died. And five prolonged grief disorder is an attempt to pathologize normal grief. So those are all the false beliefs. Okay, but things that are not true.

Kristen:
This is so helpful. Thank you so much. I could keep going. Yes, absolutely. Talk about like, yes, yes. There's so much to dive into that there is full. Yeah. And I'm so grateful for the work you're doing in the world. It is so needed. I got emotional just because I know your heart is so big, and you care so much. And it comes through and just our conversation now. Where can people find you if they want to know more about you?

Dr. Lott
You can find me the best the easiest places on my website, which is www.drsonyaltt.com

Kristen
Oh, I'm so thankful for you. Thank you, Is there anything else you wanted to add?

Dr. Lott:
I'm so grateful that you extended the invitation. And just that I love you. And I'm so grateful that we're our souls. Are we found each other.

Kristen: I love you,

Dr. Lott: Y
Yes. And so let's do this again at another time.

Kristen:
Yes, because I have earmark major depressive disorder and the difference between prolonged grief disorder and there's a lot to deconstruct. There is and there's more miss. I know you just had the five more on the list. So we will do a part two

Dr. Lott
I would love later this year. I would love that so much.

Kristen
So thank you so much.

Dr. Lott
Thank you so much.

Kristen
Thank you so much for listening to the Close the Chapter Podcast. My hope is that you took home some actionable steps, along with motivation, inspiration and hope for making sustainable change in your life. If you enjoyed this episode, click the subscribe button to be sure to get the updated episodes every week and share it with a friend or family member. For more information about how to get connected visit kristendboice.com.

Thanks and have a great day.