DIANNE McKISSOCK OAM, B.Soc.Sci., A.A.M.F.C., C.G.T., C.D.E.

Dianne McKissock is a sociologist, Marriage & Family Therapist, specialist Grief Therapist and Death Educator, who in 1996 was awarded a Medal of The Order of Australia for her services to the bereaved.

She began her counselling career in 1969 as a relationship therapist and since that time maintained a private psychotherapy practice for 25 years, and worked in a variety of educational, counselling and administrative roles in Drug & Alcohol Services (Dept. Of Health, NSW). She was a member of a Ministerial Task Force identifying the training needs of health, welfare and educational professionals in relationship to alcohol and other drug issues, and acted as a consultant to a variety of Government and private organisations in planning and implementing educational and training programs.

In 1981 Dianne, with her husband Mal, co-founded The Bereavement C.A.R.E. Centre and in 1996 co-founded The National Centre for childhood Grief.

Currently, most of her professional attention and energy is focused on the needs of bereaved and dying people, with a special interest in the needs of bereaved children. Dianne also provides training, clinical supervision and mentoring for a number of professionals working in clinical and educational settings throughout Australia, New Zealand and Asia.

She has published a variety of books which are currently used in professional training courses in Australia and overseas, and has published a number of articles in professional journals.

Interview with Dianne McKissock OAM

DO YOU SEE YOURSELF AS A LEADER?  WHAT VISION ARE YOU WORKING TOWARDS?

To be a leader means that one has to have followers, a linear concept that doesn’t really fit with my philosophy of life, which  is probably a rather strange response from someone who has agreed to participate in a leadership for women project.  I think life is complex and can often present  difficulties  that necessitate each of us needing, however temporarily, the help and guidance of others.  In some areas of life, and at some times, I am in a position to help and to provide guidance;  at others I find myself on the receiving end.   In the sense that I am willing to fight for the rights of those who experience prejudice, inequality, lack of compassion or social deficits, I guess I commit myself to a leadership role. 

The vision I am currently working towards is for all bereaved people, adults and children,  to experience the kind of compassionate support that enables them to live meaningful lives despite the pain of grief.  

HOW DID YOU BECOME INTERESTED IN THE FIELD OF LOSS AND GRIEF, HAVING ORIGINALLY WORKED IN THE AREA OF RELATIONSHIP COUNSELLING AND EDUCATIONAL TRAINING?

In all my previous counselling roles – relationship counselling, drug and alcohol counselling and psychotherapy, I  found issues of loss and grief to be the most commonly presented problems.  When I became interested in bereavement counselling as a result of my husband’s involvement in the area, it didn’t seem a difficult transition to make.  The style of counselling involved appeals to me because it feels honest, direct and compassionate, the kind of genuinely loving care that we are meant to provide for each other in times of profound distress. 

WHAT WOULD YOU DESCRIBE AS THE MOST COMMON REACTIONS TO GRIEF?   IS GRIEVING A STAGED PROCESS?

Stage theories of grief have fairly wide appeal because they are simple, linear, easy to teach, and have clear markers of ‘progress’.   But they don’t accurately or adequately describe the complicated, passionate turmoil that is most people’s experience after the death of someone they love.  Chaos theory provides us with a much more comprehensive framework for understanding the nature of grief and the energy consuming struggle to accommodate an experience that changes the bereaved person’s perception of themselves and their world. 

Some of the most common reactions bereaved people may experience are initial feelings of numbness and a sense of unreality, heightened fight/flight response, agitation, sleeplessness, chaotic emotions, inability to concentrate, loss of appetite, memory loss, nausea, palpitations, sweaty palms, and feelings of anxiety.  While internal grief responses are universally similar, outward expressions of grief are determined by gender, culture, age, mental and physical health and behaviour modelled or sanctioned in family of origin.  Grief doesn’t change our personality, we just tend to become for a time, a more exaggerated version of our selves. 

WHAT ARE THE FACTORS THAT COMPLICATE THE BEREAVEMENT PROCESS?

There are a number of ‘Risk Factors’ that have the potential to complicate the grief process.  Briefly, they are:

·        Death of a child

·        Sudden death

·        Traumatic witness (manner of death that causes sensory assault)

·        Ambivalence in the relationship

·        Pre existing psychopathology (including unresolved losses, alcohol and other drug Dependence, history of depression, personality disorder etc.)

·        Concurrent crises

·        Centrality

·        Perceived preventability

·        Decreased (or lack of) role diversity

·        Decreased (or absence of) social support

·        Overly prolonged dying

·        Lack of reality (eg. when the body of the deceased is not found)

HOW DO YOU DIFFERENTIATE BETWEEN NORMAL AND ABNORMAL GRIEF?

It is often difficult even for experienced professionals to agree on what is ‘normal’ and ‘abnormal’ grief and the longer we (at our Centre) work with bereaved people, the greater the range of grief behaviour we consider to be normal.    It is important to understand what is normal for this person, in this culture, as a response to this experience, rather than measure everyone, everywhere against some rigid definition or expectation. 

HOW HAS WORKING WITH THE DYING PERSONALLY AFFECTED YOU AND HOW DID YOU COPE WITH YOUR EXPERIENCES AND THOSE OF THE DYING INDIVIDUAL?

Working with dying people has increased my awareness of the importance of each day, each experience and each relationship.  It has helped me identify what I should fight for, and what I should just let be.  

I am not afraid to enter the world of the dying person, to hear and understand their story.  I think that being unashamedly expressive has helped me to process each experience at the time rather than bottling up feelings so that they become destructive., and because I am not afraid of my own emotions, I am not afraid of the pain or passion that others experience. 

 I also ensure that I have good clinical supervision on a regular basis, something which is essential for all people involved in providing care for others because we can only give what we ourselves receive.

WHY DID YOU BECOME PARTICULARLY INTERESTED IN WORKING WITH BEREAVED CHILDREN?

My husband and I did a lot of pioneering work in establishing services for bereaved adults and in the process encountered many grieving children.  It became evident that few people really understood the language of children’s grief, in fact it was often assumed that children didn’t really grieve, or if they did , that their grief  was short lived.  We believe that bereaved children need caring adults to act as their advocates in the community, and that the existence of a specialist children’s service is one of the most effective ways of raising awareness of their needs. 

For as long as I can remember I have known about and understood some of the long term effects of childhood grief.  My mother and her siblings were bereaved children and I often listened to their stories and asked questions about their experiences, gaining much understanding and compassion in the process. 

WHAT ARE THE NEEDS OF BEREAVED CHILDREN THAT PARENTS AND CARERS NEED TO BE ALERT TO, AND HOW CAN THE ADULT HELP THE BEREAVED CHILD?

Children’s needs in many ways are the same as those for adults.  They need to be included, told the truth in language appropriate for their age and development, and have their experience and reactions validated, their story heard and understood.  When adults in their environment are also grieving, it is important for the child to have someone less affected by grief to be their advocate, to provide them with familiar structure so that they feel safe in the midst of chaos.    

Children need adults to empower them, to model for them how to live with grief, rather than give them the idea that it has to be ‘fixed’,  They need to be reassured that sadness is normal and healthy even though it is painful; that it is OK to cry or not cry;  just to be and do what is right for them, as long as their ‘being’ or ‘doing’ causes no harm to themselves or to others. 

It can be difficult for adults to recognise children’s grief,  often expressed in behaviour which makes the child appear to be unaffected, or uncaring.  Like adults, they need to convince themselves that they can survive, that they can control their grief rather than be controlled by it.  Also like adults, they feel the need to protect their vulnerability from insensitive comments and ‘well meaning’ advice by quickly learning to hide their grief in public, waiting till they reach the safety of their bedroom where they can cry into their pillow undisturbed.  At other times, when physically or emotionally hurt, they may show reactions which appear disproportionate to the event – the event providing a useful opportunity to express stored emotion. 

It’s really very hard for bereaved people, and bereaved children in particular, to ‘get it right’.  If they show emotion, most people want to take away their pain, to ‘fix’ everything;  if they don’t show feelings outwardly, they are often seen as cold at worst, or with putting it all behind them and getting on with life at best.  For the rest of their lives they are likely to dream about the person who died, or have moments when grief is stimulated by everyday experiences and emotions are once again close to the surface.  All this is normal and healthy and if the child (or adult) is able to fulfil important roles, achieve things that are important to them and experience happy as well as sad moments, then that is simply ‘living with grief’.  

HAVING COUNSELLED MANY BEREAVED PEOPLE FOR MORE THAN TWENTY YEARS, WHAT ARE SOME OF THE BROADER VIEWS YOU HAVE ARRIVED AT IN RELATION TO SOCIETY’S UNDERSTANDING AND REGARD FOR THE DYING, THE BEREAVED AND THE GRIEVING CHILD? 

TO WHAT DO YOU ATTRIBUTE THE COMMONLY EXPERIENCED PRESSURE ON THE BEREAVED TO ‘LET GO’ OF THEIR LOVED ONE AND TO ‘RESOLVE’ THEIR GRIEF?

The broad views I hold about death, dying and bereavement have been confirmed over and over again as a result of many years involvement in counselling dying and bereaved people, and through my own life experience.  Grief is such a painful process that it initially seems inconceivable that survival is possible.  Yet somehow most of us do survive, with or without help, though of course the right kind of help has the capacity not only to enhance our survivability but the quality of our life after the death of someone we love. We slowly learn to live with grief, to build new life around pain,to find new meaning in a life that is forever changed by loss, sometimes becoming more creatively expressive as a result. 

Many people are ambivalent about addressing the subject of death, dying and bereavement, understandable perhaps because most of us want to avoid pain.  When we are afraid we often use superstitious beliefs to defend  vulnerability, to reassure ourselves of our own death immunity by blaming victims.  For example, we may convince ourselves that it is the sufferer’s fault if they develop cancer or some other life threatening illness, at times even believing it is the victim’s fault if they are killed accidentally.  

On the other hand, whenever people learn about the field that my husband and I are involved in, and can see that we are not afraid of discussing the subject, they will talk passionately and uninhibitedly about their personal losses and fears, as if they had waited for this moment for a long time.  A lot of energy is expended in denying finiteness,  energy which could be more productively and enjoyably invested in living. 

Fear of death is evident in many of the aggressive ways in which we strive to prolong life, to overcome death through science and technology, almost as if eternal life as we know it, is our right.   Fear is evident in the way we often avoid bereaved people, afraid of saying and doing the wrong thing, disempowered by feelings of helplessness when in fact that is the right and sensitive way to feel in the presence of another’s passionate grief. 

I think that fear also plays a part in the social tendency to encourage bereaved people to ‘let go’ of the deceased, to ‘put it all behind’ and get on with life.  Many clichés are used for this purpose.  If we have a profound fear of death, if we doubt our ability to survive, we may need to see others dealing with ‘it’ quickly and effectively to reassure ourselves that it is indeed possible.  The idea of ‘letting go’, of resolving grief, is part of a linear, masculine model, that is far from the truth of most bereaved people’s experience.  In fact, the reverse is usually what helps us learn to live with the pain of separation; that is, to re-attach, to gradually replace the tangible, external relationship that we yearn for, with a symbolic, internal representation of the deceased.  It can take up to five years, for some people even more, to develop the kind of relationship I am referring to, but when this happens, the bereaved person has a sense of the deceased’s presence as part of themselves, and part of their ongoing life.  People die but relationships live forever. 

All that I have said equally applies to bereaved children.  They experience the same social pressures, the same lack of understanding as bereaved adults.  As a society we have little tolerance for passion of any kind, and even less of passionate grief.  We erroneously teach children that life is an either/or experience.  That is, that we are either sad OR happy when we should be teaching them that it is possible for us to live life fully with all emotions co-existing.  The either/or idea encourages the use of chemicals whenever we experience strong emotions - to fix, treat, or control reactions that are unfortunately unfamiliar to many people. 

MUCH HAS BEEN WRITTEN ABOUT THE ‘AFTER-LIFE’ BY ELIZABETH KUBLER-ROSS FROM HER WORK IN PALLIATIVE CARE.  DO YOU HAVE ANY PERSONAL BELIEF ABOUT WHAT HAPPENS AFTER A PERSON DIES?

What happens after death doesn’t seem nearly as important as what is happening in life.

These days, life after death to me means bereavement, the focus of my thoughts and energy, though when I was younger, like most people, I pondered the meaning of life and the nature of death.  Questions were important.  Answers were important. 

 I no longer ask those questions or worry about the answers – I am much more concerned with living and appreciating each moment, each experience, each relationship, here and now.  If I give back to life all that I have received,  if I live life fully while remaining true to my own ethics and values, then whatever death is, whatever life after death is or isn’t, will take care of itself. 

HOW WOULD YOU DESCRIBE THE OPPORTUNITIES FOR WOMEN IN THE BEREAVEMENT INDUSTRY?   WHAT ADVICE WOULD YOU GIVE TO THOSE WHO ARE INTERESTED IN WORKING IN THIS FIELD?

It really depends on what women want to give and receive.  For example, opportunities for paid employment in the field of death, dying and bereavement are still fairly limited, although that is likely to change in the future.  

For any woman wanting to make a career from this field, particularly if they want to be involved in bereavement counselling, I would encourage them to first gain appropriate academic qualifications, then gain as much experience as possible through voluntary work before applying for a salaried position.  Good training and educational opportunities are now available in most states and I would be happy to give more information about appropriate courses to anyone who contacts me on my e-mail address (dianne@bereavementcare.com.au ). 

When working with adults, age is an advantage because it is difficult for many bereaved people to express the passionate intensity of their grief to a professional who lacks life experience, no matter how competent the professional may be. 

On the other hand, bereaved children usually relate well to people of all ages, as long as those involved in their care are young at heart.  

There are opportunities to work with bereaved children in a voluntary capacity in a number of states and information can be obtained by contacting The National Association for Loss and Grief in each state, or contacting the Bereavement C.A.R.E. Centre or The National Centre for Childhood Grief Australia Ltd. Via our e-mail address, or our website which is www.bereavementcare.com.au