BEREAVEMENT IN ADULT LIFE

Colin Murray Parkes, consultant psychiatrist.

St Christopher's Hospice, Sydenham, London SE26 6DZ

Taken from: http://www.bmj.com/cgi/content/full/316/7134/856

cmparkes@aol.com

Series editor: Colin Murray Parkes

Doctors are well acquainted with loss and grief. Of 200 consultations with general practitioners, a third were thought to be psychological in origin; of these, 55a quarter of consultations overallwere identified as resulting from types of loss.¹ In order of frequency the types of loss included separations from loved others, incapacitation, bereavement, migration, relocation, job losses, birth of a baby, retirement, and professional loss.

After a major loss, such as the death of a spouse or child, up to a third of the people most directly affected will suffer detrimental effects on their physical or mental health, or both.² Such bereavements increase the risk of death from heart disease and suicide as well as causing or contributing to a variety of psychosomatic and psychiatric disorders. About a quarter of widows and widowers will experience clinical depression and anxiety during the first year of bereavement; the risk drops to about 17% by the end of the first year and continues to decline thereafter.² Clegg found that 31% of 71 patients admitted to a psychiatric unit for the elderly had recently been bereaved.³

Despite this there is also evidence that losses can foster maturity and personal growth. Losses are not necessarily harmful.

Yet the consequences of loss are so far reaching that the topic should occupy a large place in the training of health care providersbut this is not the case. One explanation for this omission is the assumption that loss is irreversible and untreatable: there is nothing we can do about it, and the best way of dealing with it is to ignore it. This attitude may help us to live with the fact that, despite modern science, 100% of our patients still die and that before they die many will suffer lasting losses in their lives. Sadly, it means that, just when they need us most, our patients and their grieving relatives find that we back away.

Summary points Losses are a common cause of illness; they often go unrecognised Conflicting urges lead to a variety of expressions of grief; even so there is a pattern to the process of grieving A knowledge of the factors that predict problems in bereavement enables these to be anticipated and prevented Grief may be avoided or it may be exaggerated and prolonged Doctors can help to prepare people for the losses that are to come People may need permission and encouragement to grieve and to stop grieving

	Recent approaches to loss

A 1944 study of bereaved survivors of a night club fire focused attention on the psychology of bereavement, and led to the development of services for the bereaved and to other types of crisis intervention services.⁴ It established grief as a distinct syndrome with recognisable symptoms and course, amenable to positive or negative influences. This, in turn, fuelled interest in the new fields of preventive psychiatry and community mental health. Elizabeth Kubler Ross's studies extended this understanding to dying people,⁵ and helped to provide a conceptual framework for the humanitarian work of Dame Cicely Saunders and the other pioneers of the hospice movement.

More recently the improvements in palliative care have led to improvements in home care for the dying. Home care nurses have bridged the gap and general practitioners have had a central role, not only in caring for dying patients and their families but also in supporting people through many other losses. This is the main theme of this series, which draws together authorities with special knowledge of the losses which afflict our patients and their families and looks at the practical implications for doctors.

	The components of grief

Three main components affect the process of grieving. They include the urge to look back, cry, and search for what is lost, and the conflicting urge to look forward, explore the world that now emerges, and discover what can be carried forward from the past. Overlying these are the social and cultural pressures that influence how the urges are expressed or inhibited. The strength of these urges varies greatly and changes over time, giving rise to constantly changing reactions.

View larger version (103K): [in this window] [in a new window]

Most adults do not wander the streets crying aloud for a dead person. Bereaved people often try to avoid reminders of the loss and to suppress the expression of grief. What emerges is a compromise, a partial expression of feelings that are experienced as arising compellingly and illogically from within.

Much empirical evidence supports the claims of the psychoanalytic school that excessive repression of grief is harmful and can give rise to delayed and distorted griefbut there is also evidence that obsessive grieving, to the exclusion of all else, can lead to chronic grief and depression. The ideal is to achieve a balance between avoidance and confrontation which enables the person gradually to come to terms with the loss. Until people have gone through the painful process of searching they cannot "let go" of their attachment to the lost person and move on to review and revise their basic assumptions about the world. This process, which has been termed psychosocial transition, is similar to the relearning that takes place when a person becomes disabled or loses a body part.

The course of grief Numbness Pining Disorganisation and despair Reorganisation

	The normal course of grief

Human beings can anticipate their own death and the deaths of others. Unlike the grief that follows loss, anticipatory grief increases the intensity of the tie to the person whose life is threatened and evokes a strong tendency to stay close to them.

Although the moment of death is usually a time of great distress, this is usually quickly repressed and, in Western society, the impact is soon followed by a period of numbness which lasts for hours or days. This is sometimes referred to as the first phase of grieving.⁶ It is soon followed by the second phase, intense feelings of pining for the lost person accompanied by intense anxiety. These "pangs of grief" are transient episodes of separation distress between which the bereaved person continues to engage in the normal functions of eating, sleeping, and carrying out essential responsibilities in an apathetic and anxious way.

All appetites are diminished, weight is lost, concentration and short term memory are diminished, and the bereaved person often becomes irritable and depressed. This eventually gives place to the third phase of grieving, disorganisation and despair. Many find themselves going over the events which led up to the loss again and again as if, even now, they could find out what went wrong and put it right. The memory of the dead person is never far away and about a half of widows report hypnagogic hallucinations in which, at times of drowsiness or relaxation, they see or hear the dead person near at hand. These hallucinations are distinguished from the hallucinations of psychosis by the circumstances in which they arise and by their transiencethey disappear as soon as the bereaved arouse themselves. A sense of the dead person near at hand is also common and may persist.

As time passes the intensity and frequency of the pangs of grief tend to diminish, although they often return with renewed intensity at anniversaries and other occasions which bring the dead person strongly to mind. Consequently the phases of grief should not be regarded as a rigid sequence that is passed through only once. The bereaved person must pass back and forth between pining and despair many times before coming to the final phase of reorganisation.

After a major loss such as the death of a loved spouse or partner, the appetite for food is often the first appetite to return. By the third or fourth month of bereavement the weight that was lost initially has usually returned, and by the sixth month many people have put on too much weight. It may be many more months before people begin to care about their appearance, and for sexual and social appetites to return. Most people will recognise that they are recovering at some time in the course of the second year.

	Assessing the risk

Much research, in recent years, has enabled us to identify people at special risk after bereavement either because the circumstances of the bereavement are unusually traumatic or because they are themselves already vulnerable (box). These risk factors can give rise to complicated forms of grief that can culminate in mental illness. A clear understanding of these factors will often enable us to prevent psychiatric disorder in bereaved patients.

Factors increasing risk after bereavement Traumatic circumstances Death of a spouse or child Death of a parent (particularly in early childhood or adolescence) Sudden, unexpected, and untimely deaths (particularly if associated with horrific circumstances) Multiple deaths (particularly disasters) Deaths by suicide Deaths by murder or manslaughter Vulnerable people General: Low self esteem Low trust in others Previous psychiatric disorder Previous suicidal threats or attempts Absent or unhelpful family Specific: Ambivalent attachment to deceased person Dependent or inter-dependent attachment to deceased person Insecure attachment to parents in childhood (particularly learned fear and learned helplessness)

	Complicated grief

Bereavement has physiological as well as emotional effects (lower box). It also affects physical health: after bereavement, the immune response system is temporarily impaired ^{7 8} and there are endocrine changes such as increased adrenocortical activity and increases in serum prolactin and growth hormone,² as in other situations that evoke depression and distress.

Complications of bereavement Physical Impairment of immune response system Increased adrenocortical activity Increased serum prolactin Increased growth hormone Psychosomatic disorders Increased mortality from heart disease (especially in elderly widowers) Psychiatric Non-specific: Depression (with or without suicide risk) Anxiety or panic disorders Other psychiatric disorders Specific: Post-traumatic stress disorder Delayed or inhibited grief Chronic grief

A variety of psychiatric disorders can also be caused by bereavement, the commonest being clinical depression, anxiety states, panic syndromes, and post-traumatic stress disorder. These often coexist and overlap with each other, as they do with the more specific morbid grief reactions. These last disorders are of special interest for the light that they shed on why some people come through bereavement unscathed or strengthened by the experience while others "break down."

It is a paradox that people who cope with bereavement by repressing the expression of grief are more likely to break down later than are people who burst into tears and get on with the work of grieving. The former are more liable to sleep disorders, depression, and hypochondriacal symptoms resembling the symptoms of the illness that caused the bereavement ("identification symptoms"). Not all psychogenic symptoms, however, are a consequence of repressed or avoided grief. Some reflect the loss of security which often follows a major loss and causes people to misinterpret as sinister the normal symptoms of anxiety and tension.

At the other end of the spectrum of morbid grief are people who express intense distress before and after bereavement. Subsequently they cannot stop grieving and go on to suffer from chronic grief. This may reflect a dependent relationship with the dead person, or it may follow the loss of someone who was ambivalently loved. In the former case the bereaved person cannot believe that he or she can survive without the support of the person on whom they had depended. In the latter, their grief is complicated by mixed feelings of anger and guilt that make it difficult for them to stop punishing themselves ("Why should I be happy now that my partner is dead?").

Some degree of ambivalence is present in all relationships. To some degree its effects can be assuaged by conscientious care during the last illness, and many people will recall "We were never closer." If members the family have been encouraged and supported so that they have been able to care, and the death has been peaceful, anger and guilt are much less likely to complicate the course of grieving.

These two patterns of grieving often seem to occur in "avoiders" (people with a tendency to avoidance) and "sensitisers" (those with a tendency to obsessive preoccupation), respectively.⁹

	Preventing and treating complicated grief

Doctors are in a unique position to help people through the turning points in their lives which arise at times of loss. In order to fulfil this role we need information and skills. One of our problems as caregivers is our ignorance of our patients' view of the world. Not only do we seldom know what they know or think they know about the situation they face, we do not even know how that situation is going to change their lives. It follows that we need to find out these things and, where possible, add to their knowledge or correct any misperceptions, taking care to use language that they can understand. (This is easier said than done when words like "cancer" and "death" mean different things to doctors than they do to most patients.) Above all, we should spend time helping them to talk through and to make sense of the implications of the information we have given. If need be, we should see them several times to facilitate this process of growth and change. General practitioners, because they are likely to know the person, are often well placed to provide this "trickle" of care. For most bereaved people the natural and most effective form of help will come from their own families, and only about a third will need extra help from outside the family.

Anticipatory guidance
Members of health care teams can often prepare people for the losses that are to come. People need time to achieve a balance between avoidance and confrontation with painful realities, and we need to take this into account when we impart information that is likely to prove traumatic. One way is to divide the information that needs to be confronted into "bite sized chunks." Doctors do this when we break bad news a little at a time, telling a patient as much as we think he or she is able to take in. Patients seldom ask questions unless they are ready for the answers, and they will usually ask precisely what they want to know and no more. It follows that we should invite questions and listen carefully to what is asked rather than assuming that we know what the patient is ready to know. By monitoring the input of information, a person can control the speed with which they process that information.

Although a little anxiety increases the rate and efficiency with which we process information, too much anxiety slows us down and impairs our ability to cope, our thought processes become disorganised and we "go to pieces." Anything that enables us to keep anxiety within tolerable limits will help us to cope better with the process of change. If we are breaking bad news (box) it helps to do so in pleasant, home-like surroundings and to invite the recipient to bring someone who can provide emotional support. A few minutes spent putting people at their ease and establishing a relationship of trust will not only make the whole experience less traumatic for them but it will increase their chance of taking in and making sense of the information which we then provide.

Breaking bad news Consider social support (who to ask to be present) Consider setting (where to meet) Try to establish a relationship of mutual respect and trust Discover what the patient or the family knows or think they know already Invite questions Give information at a speed and in a language that will be understood Monitor what has been understood Recognise that it takes time to hear and understand bad news Give the patient or the family time to react emotionally Give verbal and non-verbal reassurance of the normality of their reaction Stay with the patient or the family until they are ready to leave Offer further opportunities for clarification, information, or support

Supporting bereaved people
A visit from the general practitioner to the family home on the day after a death has occurred enables us to give emotional support and to answer any questions about the death and its causes that may be troubling the family. Newly bereaved people often feel and behave, for a while, like frightened and helpless children and will respond best to the kind of support that is normally given by a parent. A touch or a hug will often do more to facilitate grieving than any words.

During the next few weeks bereaved people need the support of those they can trust. We can often reassure them of the normality of grief, explain its symptoms, and show by our own behaviour and attitudes that it is permissible to express grief. If we feel moved to tears at such times there is no harm in showing it. Bereaved people may need reassurance that they are not going mad if they break down, that the frightening symptoms of anxiety and tension are not signs of mortal illness, and that they are not letting the side down if they withdraw, for a while, from their accustomed tasks. As time passes people may also need permission to take a break from grieving. They cannot grieve all the time and may need permission to return to work or do other things that enable them to escape, even briefly, from grief. It is only if they get the balance between confrontation and avoidance wrong that difficulties are likely to ensue. The first anniversary is often a time of renewed grieving, but thereafter the need to stop grieving and move forward in life may create a new set of problems. People may need reassurance that their duty to the dead is done, as well as encouragement to face the world that is now open to them. The most important thing we have to offer is our confidence in their personal worth and strength. We should beware of becoming the "strong" doctor who will look after the "weak" patient for ever, but this does not mean that we become angry and dismissive, reprimanding the patient for becoming "dependent." In the end, most bereaved people come through the experience stronger and wiser than they went into it. It is rewarding to see them through.

Appendix
In the acute stages it is usually best to give support by personal contact, preferably in the client's home. Later the help of a group in which bereaved people can learn from each other, as well as a counsellor, may be helpful. Organisations such as Cruse Bereavement Care and the member organisations of the National Association of Bereavement Services may be able to provide either of these types of help. The Compassionate Friends (for bereaved parents), Lesbian and Gay Bereavement, Support after Murder and Manslaughter (SAMM), and the Widow-to-Widow programmes that exist in the United States and other parts of the world provide mutual help by bereaved people for others with the same types of bereavement.

The articles in this series are adapted from Coping with Loss, edited by Colin Murray Parkes, which will be published in May.

10 Tanda Menerima Diri Sendiri

1. Selalu bahagia
Bahagia disini dalam pengertian tidak membandingkan dirinya dengan orang lain. Para ahli mengatakan, dengan membandingkan diri berarti matinya rasa kepuasan diri yang sejati.
Pada orang yang menerima diri apa adanya, tidak banyak hal yang membuatnya tidak bahagia. Jika ada orang yang mengkritik, orang yang menerima diri akan menganggap, bahwa itu adalah masukan yang berguna bagi pertumbuhan pribadinya. Dia akan berpandangan bahwa kritik yang sehat adalah sarana untuk memajukan diri sendiri menjadi pribadi yang lebih bijak dan berwawasan

2. Mudah bergaul dengan orang lain
Semakin besar rasa menerima diri sendiri, semakin senang kita berada di tengah orang lain karena kita merasa orang-orang itu juga menerima kita, dan senang bersama kita. Perasaan ini mambuat kita masuk ke ruang yang penuh orang dengan rasa percaya diri. Kita menganggap diri kita sebagai pemberian untuk diterima orang lain dan orang lain sebagai pemberian untuk kita terima dengan lemah lembut.
Tapi, disaat sendiri, orang yang menerima diri apa adanya juga tetap gembira. Keadaan yang tidak ada orang lain itu terasa damai dan tenteram baginya. Sebaliknya, bagi yang tidak menerima diri sendiri, keadaan sendiri itu berarti sepi dan menyedihkan. Orang yang sendiri, kesepian, kosong, akan mencari penangkal-penangkal kesepian.

3. Terbuka untuk dicintai dan dipuji
Kalau kita menerima eksistensi kita sendiri sebagai pribadi, maka kita seyogyanya juga berpikiran terbuka, tidak merasa curiga kalau seseorang dengan tulus memuji kita. Karena dalam hidup ini, kita semua belajar untuk mengatasi kelemahan2 diri sendiri, tapi sebaliknya juga terbuka untuk pujian atas kelebihan2 kita.

4. Mampu menjadi diri sendiri yang sejati
Jika kita benar-benar menerima diri sendiri apa adanya, kita akan memancarkan keunikan yang hanya dapat memancar dari penerimaan diri sejati. Dengan kata lain, sebelum mampu menjadi diri sendiri, kita harus bisa menerima diri sendiri dulu. Contohnya, jika kita mencintai atau mengagumi orang lain, maka kita akan bersikap tulus, menyampaikan kesukaan dan kekaguman secara wajar padanya. Kita tidak usah takut salah paham atau salah tafsir dengan ke-terus terangan kita

5. Mampu menerima saya yang saat ini, hari ini
Saya yang kemarin adalah sejarah. Saya yang hari esok belum diketahui. Saya terlepas dari masa lalu. Saya adalah siapa saya hari ini. Sekarang ini. Siapa saya dimasa lalu, termasuk semua kesalahan saya, sudah tidak penting.
Mengingat secara terus menerus kesalahan yang kita buat dimasa lampau hanya akan membuat kita menghakimi diri sendiri dengan keras.

6. Dapat menertawai diri sendiri dengan mudah
Terlalu serius dengan diri sendiri merupakan pertanda kita merasa tidak aman. Ada pepatah Cina kuno yang mengatakan, "Berbahagialah mereka yang dapat tertawa kepada diri mereka sendiri. Mereka tidak akan pernah berhenti dihibur." Orang yang mampu menertawai diri sendiri akan bisa menerima dan mengakui kelemahan dan kebodohanya.

7. Mampu mengenali dan mengurusi kebutuhan-kebutuhannya sendiri
Orang yang menerima dirinya sendiri mengenal kebutuhan-kebutuhannya, baik kebutuhan fisik, emosional, intelektual, sosial, dan spiritual. Mengabaikan kebutuhan diri sendiri adalah langkah bunuh diri. Kita bisa mengenali kebutuhan diri sendiri kalau kita mencintai dan sayang pada diri sendiri. Rasa sayang ini akan membuat kita juga mampu menyayangi dan menghormati orang lain secara wajar.

8. Mampu menentukan nasib sendiri
Orang yang menerima diri sendiri mengambil petunjuk dari dalam dirinya sendiri. Bukan dari orang lain. Jika kita benar-benar bergembira dengan diri sendiri, kita akan melakukan apa saja yang kita pikir baik dan selaras. Bukan menurut apa yang dikatakan atau dipikirkan orang lain.

9. Bisa berhubungan dengan kenyataan
Sikap menerima diri sendiri membuat kita tidak suka melamun atau mengkhayalkan seandainya hidup kita seperti orang lain. Kita menerima dengan tabah kenyataan2 dalam hidup ini dengan tetap berpegang pada logika kita

10. Bersikap tegas
Orang yang menerima dirinya sendiri tegas dalam menyatakan sesuatu. Kita dengan tegas menyatakan hak2 kita untuk dipandang secara serius. Hak untuk berpikir dan memilih. Kita juga tidak merasa terpaksa mengalah atau terpaksa menjadi penolong orang yang tidak berdaya. Banyak orang enggan bersikap tegas karena takut keliru. Kita pendam semua pendapat dan keinginan kita. Menerima diri dengan gembira menantang kita bersikap tegas dalam menyatakan sesuatu. Menghormati diri sendiri. Menyatakan diri secara tulus dan berani bersikap terbuka.

RESEP KUE PERKAWINAN

Bahan:

• 1 pria sehat
• 1 wanita sehat
• 100% komitmen
• 2 pasang restu orang tua
• 1 botol kasih sayang murni

Bumbu:

• 1 balok besar humor
• 25 grm rekreasi
• 1 bungkus doa
• 2 sendok teh telpon-telponan
• Semuanya diaduk hingga merata dan mengembang

Cara memasak:

1. Pria dan wanita dicuci bersih, buang semua masa lalunya sehingga tersisa niat yang murni.
2. Siapkan loyang yang telah diolesi dengan komitmen dan restu orang tua secara merata.
3. Masukkan niat yang murni ke dalam loyang dan panggang dengan api merata sekitar 30 menit di depan penghulu.
4. Biarkan di dalam loyang tadi dan sirami dengan bumbunya.
5. Kue siap dinikmati.

Catatan:
Kue ini dapat dinikmati oleh pembuatnya seumur hidup dan paling enak dinikmati dalam keadaan hangat. Tapi kalau sudah agak dingin, tambahkan lagi humor segar secukupnya, rekreasi sesuai selera, serta beberapa potong doa kemudian dihangatkan lagi di oven bermerek "Tempat Ibadah". Setelah mulai hangat, jangan lupa telpon-telponan bila berjauhan. Selamat mencoba, dijamin semuanya halal kok!

MENGAJARI DENGAN TELADAN

Ajari aku untuk mencintai dan menyayangi diri sendiri

lewat keteladananmu yang positif.

Aku akan belajar dari semua tindakanmu

dan tumbuh dengan memiliki perhatian diri yang baik.

Ralph Waldo Emerson pernah mengatakan, "Kamu berteriak terlalu keras di telingaku, aku tidak bisa mendengar apa yang kamu katakan." Kata-kata tanpa tindakan hanya sedikit berpengaruh atau sama sekali tidak berpengaruh. Namun, ketika kata-kata didukung oleh teladan nyata, mereka punya kekuatan untuk membentuk keyakinan dan kebiasaan yang berumur panjang.

Mengucapkan, "Lakukan yang saya katakan, bukan yang saya lakukan" jarang memberi dampak. Seorang anak hampir selalu bertindak berdasarkan apa yang terlihat olehnya. Saya teringat ketika saya meminta putra saya untuk menonton televisi dalam jarak yang cukup. Tiap kali dia menonton televisi, apalagi dengan menatapkan wajahnya persis di depan layar kaca, maka saya selalu mengingatkan dan kadangkala mendisiplinnya. Suatu ketika saya menerima telepon yang letaknya di sebelah televisi yang sedang menayangkan sebuah film. Seusai menerima telepon, tak terasa saya menonton televisi terlalu dekat. Putra saya langsung berkata, "Papa dekat-dekat televisi." Spontan saja saya malu. Saya terkejut dan berkata, "Oh iya, Papa salah ya. Terima kasih ya sinyo (panggilan akrabnya)." Memang benar bahwa anak belajar banyak dari teladan, ketimbang perkataan orangtuanya. Ada satu fakta yang dicatat oleh kedua psikolog, Diana Loomans dan Julia Godoy, bahwa lebih dari 75% narapidana puya satu atau lebih anggota keluarga yang dipenjara. Saya tidak tahu survei tersebut diambil dari konteks mana, tapi fakta ini tentu memberikan indikasi tentang peran sebuah keteladanan.

Lantas, bagaimana caranya agar kita sebagai orangtua merasa lebih mudah untuk senantiasa memberikan teladan bagi anak-anak? Dengan baik Loomans dan Godoy menjelaskan bahwa cara pertama dan terpenting menjadi teladan bagi anak-anak terletak pada kasih sayang yang sehat dan konsisten dari kita sendiri. Maksudnya, kita perlu memerhatikan kondisi diri sendiri dahulu. Gambaran tentang mengenakan masker oksigen di pesawat sangat sesuai--hanya orang dewasa yang menghirup cukup oksigen terlebih dahululah yang dapat menolong anak kecil yang bergantung padanya agar bisa tetap hidup.

Orangtua kadang terperangkap dalam kebiasaan memenuhi semua kebutuhan anak sebelum memenuhi kebutuhannya sendiri, dengan keyakinan bahwa anak harus selalu didahulukan. Dalam lingkungan yang normal, sangatlah bermanfaat bagi orangtua untuk memberi perhatian yang berkualitas pada kehidupan mereka sendiri terlebih dahulu. Perhatian diri sehari-hari merupakan oksigen untuk jiwa. Atau dengan kata lain, sejumlah perhatian diri dapat membawa keseimbangan dan ketenangan yang luar biasa bagi orangtuanya.

Ada seabrek cara untuk memerhatikan diri sendiri. Ada yang melakukan meditasi pribadi. Ada yang memanjakan diri dengan pijatan. Ada yang melakukan hobi tertentu. Inilah yang salah satu saya lakukan. Hobi saya adalah bermain bulutangkis. Saya selalu meluangkan waktu untuk bermain bulutangkis setiap hari Senin. Dalam waktu itulah saya bisa melepaskan banyak ketegangan batin/stress. Setelah pulang, saya tidak langsung menyambut keluarga dengan hangat. Saya masih perlu menenangkan diri alias reorientasi, dari suasana lapangan masuk ke suasana rumah. Biasanya, untuk beberapa waktu saya menonton televisi, dan terkadang sambil menikmati french fries buatan istri. Setelah cooling down selesai, maka saya bergegas mandi dengan air hangat. Nah baru setelah itu, saya bermain bersama istri dan anak dengan perasaan yang lebih siap. Dari pengalaman ini, saya kira memang benar bahwa kita perlu memerhatikan diri dalam jumlah tertentu untuk menyehatkan suasana pikiran dan emosi. Bila suasana pikiran dan emosi telah sehat, maka tentunya kita sebagai orangtua lebih mudah memberikan keteladanan bagi anak-anak tercinta kita.

Selamat mencoba!

(Disarikan dari Loomans & Godoy, Positive Parenting, 1-13)

BAD MEN YOU SHOULD AVOID WHEN DATING

by: Nicholl McGuire
http://www.articlecity.com/articles/relationships/article_1653.shtml

Women always say, “I didn’t know he was like that” when their boyfriends perform acts that cause everyone around them shame. In some cases they really weren’t aware of the boyfriend’s mischievous deeds, but in other cases women knew well in advance they just hoped he would stop.

Most women are not stupid, gullible, dumb, or any other name critics choose to call them for the selections in men they make. For some, they truly had no idea their boyfriend meant bad news for them. The ever-popular question of, “Why did she get herself involved with him anyway?” continues to loom over their heads and the reasons vary depending on whom you ask. Some women may have found out about their problem boyfriend and stayed because of love, status, money and/or power. Others may have stayed because they didn’t want to carry the guilt of leaving their children’s father over issues they feel could be resolved. Still many women feel they can change him. As long as women continue to believe that the power of sex, money, counseling, personal sacrifice or a host of other strategies to change a bad man will work, they will continue to subject themselves to mental and physical abuse. These strategies simply will never work for some men. There comes a time when women will have to get off their knees whether she is praying to God or pleading to her mate to change. She will have to stand up carrying her self-respect in hand and walk right through the door of “end the relationship now.”

The following advice is written for women who haven’t yet made a commitment or a baby with a “bad boy.” She may be struggling with whether she is ready to settle down with him, distance herself from him or keep him as a friend. Although the best advice is not to offer to carry him or his burdens and just leave him alone, there will be those women who will still stay. If those women choose to stay, they have committed themselves to a hard life of many restless nights, aches and pains at times mentally and/or physically and they most likely will past negative behaviors to their future children and their children.

The Liar – In the beginning of the relationship, you caught him in a few white lies. He had what seemed like convincing excuses; therefore you let him get away with them. Now the lying has increased and the excuses have become minimal if not at all. Actions you may want to consider are the following: Approach him not only with what you think, but what you know; in other words have proof. Stop taking his lying lightly. Let him know that this behavior you will not accept any longer. If he chooses to continue lying, then tell him you will have to end the relationship for good. Once you have made a decision that you are leaving, begin to make efforts to not be contacted by him (change your cell phone number, block his email address, put places you hang out frequently on hold, and avoid telling mutual friends about your personal whereabouts, thoughts and feelings. You must not leave and then go back to him, he will only get better about lying to you over time.

The Player also known as The Pimp – This man is obsessed with being contacted or making contact with the opposite sex. He will use cell phone, email, your house phone or friends to make contact with whomever he meets. He will leave a trail of evidence whether it is the popular piece of paper that slips out of his pocket with a phone number without a name, restaurant receipts, hotel charges, cologne or jewelry gifts, read and sent email that sits in his account that he forgot to delete. He begins to create a pattern in his actions when you have become old and someone else becomes new. Look out for this repetitious pattern. He may develop his pattern after work on a daily basis working later and later nights at the office then when he comes home he is providing almost too much detail about what happened at work or not at all. Another pattern he may create may be choosing a hobby or interest that is very unusual to his personality and attending this faithfully, what you can do to find out if he is sincere is offer to pick him up from the pottery class on some nights. Watch his reaction. There may also be the weekend pattern of always “needing to get away, have some time to myself, or I’m so busy with errands.” All the while making little or no time for the two of you to go out and be seen together. When you suggest new places to visit, he finds an excuse to take you to the same area you both are familiar to keep from running into the other woman or women. He finds a way, anyway, to travel to places without you regularly using an excuse such as “I’m going to my mother’s house or hanging out with Rick, Joe or someone you never heard of Frank.” Be careful family and friends will cover for him. He will call you, at times when he knows you are out and about to see if you will be in the proximity where he will be entertaining the other woman or women. He is protective of his cell phone and his computer; if you tried to check either it maybe password protected. You may want to consider whether having to worry over your man’s whereabouts is worth all of this aggravation. In time, you will become insecure, angry for no apparent reason, and develop a since of distrust toward everyone you meet. This is baggage you don’t need.

The Thief – He has been around when things go missing. At first you didn’t suspect him and thought items had just been misplaced or he blamed someone else for taking them. Yet, you have always had a funny feeling in your gut that he was the one who made off with your dad’s tools, took your favorite CD, helped himself to some cash sitting around, and other important items. It is time to come up with a plan, set him up. The kind of plan you come up with can’t be easily figured out by him and if you sincerely want your restless conscience to be at peace, then go to great lengths to figure out whether he is trustworthy. Time is money and the longer you stay with him, the more items will go missing.

The Hustler – He is always thinking of a way to separate people from their money illegally. From identity theft to standing on the street corner selling drugs, he always has a knot of money and doesn’t mind living lavishly. Now you may think that what he has told you about his daytime job is paying the bills, but the truth of the matter that job didn’t pay for the designer clothing and expensive jewelry you wear; instead it was the second one you may or may not know about. This man is dangerous. He has enemies and one day some one will catch up with him, you or anyone who associates with either of you, and the sight won’t be pretty. You must ask yourself this question, is he worth putting your life and everyone else’s lives around you in danger?

The Abuser/Controller – You can never do anything right. He is often critical, walks around with an attitude and every opportunity he has alone he wants you to stop living your world to be with him. In the beginning of the relationship, you justified his negative personality with excuse after excuse. Whether he is physically ill, illiterate, disabled or mentally disturbed and on medication, you have a right to explain how you feel about him to him. You may have done this already and got knocked to the ground whether verbally or physically. You may have told yourself that things will get better and he is making an effort to change. Well that is good if he is sincere about becoming a better man; however, he can make those strides without you living with him and subjecting yourself to his name calling, mood swings, choking, punching, and grabbing. There are no rewards in heaven given to women who allow themselves to be abused by men. There was only one Christ in the Holy Bible and you are not He. (Read more about the abuser in an article I wrote entitled, “How To Know Your Boyfriend Is Abusive” at this site.)

The Mooch – You have invited him once again on an outing and he never has any money in his wallet. During inopportune times, he says he needs to stop at the ATM and you know there is none even close to where the two of you are located. When he offers to take you out, he usually picks a place that he doesn’t have to pay much (despite the fact that when it was on your tab he ordered steak and another time lobster!) He drives your car and doesn’t fill it up, when you mention it; he finally puts some gas in the tank -- a measly $5 or $10. Holidays come and go with very little if any acknowledgement from him. Yet, you bought him (and possibly his relatives) really nice gifts whether it was a holiday or not. He displays affection, says all the right things, and listens to your concerns only when he knows he needs something from you. If you choose to continue a relationship with this man you have options and they are as follows. You could stop being so generous and treat him how he treats you. For example, when you invite him out, treat him to the kind of places he takes you. Put a limit on how often he drives your car. Avoid helping him when he is in a bind since you know he won’t help you. Make yourself unavailable to run errands for him and anyone associated with him (that includes his children by a previous relationship, his mother, sister or brother.) If he begins to see you are no fool, he won’t continue to run over you and will grow to appreciate you. However, if he doesn’t you will be making it easy for him to walk away from you without you having to break up with him.

The Drunk/ Drug Abuser – How many times have you seen him intoxicated or using drugs? Is he fun, angry, disgusting or depressed afterward? Are most of the relationship problems you have been facing associated with this type of behavior? If so, then you will have to consider whether or not you will help him get counseling from a distance, continue to live with him and endure the abuse, leave him alone altogether or create an intervention for him that includes a professional counselor, family and friends who have all been affected by his negative ways. If he consistently refuses help, then for your own sanity and safety, leave him alone.

Language Lessons

By Gary Chapman

http://www.christianitytoday.com/mp/2004/spring/15.18.html

"I'm desperate," Mark told me when he entered my office. "My wife told me she doesn't love me, and she wants me out of her life. I don't understand. I've been a good husband. We have a nice house and wonderful children. I love Suzanne: I tell her how beautiful and special she is. How can she throw away 17 years of marriage?"

"Has Suzanne ever complained to you?" I asked.

"She says we don't spend enough time together and that we don't talk. But my business is demanding, and when I get home I need down time."

I knew their problem: Suzanne's love language (the way she best understands and receives love) was Quality Time, and Mark hadn't spoken that language. His compliments weren't enough; Suzanne needed his time and attention.

Feeling loved is our deepest emotional need. When that need goes unmet, it weakens our love for our spouse. Then the negative behavior patterns we once overlooked begin to annoy us. That's why Suzanne could say, "I don't love you."

After 30 years of marriage counseling, I'm convinced there are only five languages of love. Each person uses all the languages, but really thrives on one. The better you speak your spouse's love language, the stronger your emotional love life will be. For those unfamiliar with love languages, here's a brief course:

Words of Affirmation. Proverbs 18:21 says, "The tongue has the power of life and death." This language uses words to honor and appreciate your spouse. "You look nice in that outfit." "Thanks for taking out the trash. I really appreciate all the hard work you do."

Gifts. A gift says, She was thinking about me. Look what she got for me. Gifts don't need to be expensive. Haven't we always said, "It's the thought that counts"? With gifts, it isn't what you give, but how often you give that communicates love.

Acts of Service. The Bible tells us to love not only in word but in action (1 John 3:18). Acts of service include: washing the car, walking the dog, changing the baby, or whatever needs doing.

Quality Time. This means giving your spouse undivided attention. Maybe it's a picnic, a weekend away, or just muting the TV. The important thing is the two of you are focused on each other.

Physical Touch. We've long known the emotional power of physical touch. Holding hands; embracing; a back rub; even putting your hand on your mate's leg while you drive.

Revealing questions

So how do you discover your spouse's love language? Answer the following:

"How does my spouse most often express love to me?" If they give you words of affirmation, that may be their love language. They're giving you what they wish to receive.

"What does my spouse complain about most often?" Our complaints reveal our deepest desires. Suzanne complained, "We don't have time for each other. We don't talk." Quality Time was her love language.

"What does my spouse request most often?" If your spouse routinely asks, "Would you help me make the bed?" "Would you give the children a bath tonight?" then Acts of Service may be his or her primary love language.

You need three things to be a successful lover.

1. Information. What is your spouse's love language?

2. Will. Love is an active choice.

3. Frequency. Use your spouse's primary language to express love regularly.

It took Suzanne nine months of counseling to work through the hurt, neglect, and lack of empathy she felt from Mark. But eventually their marriage was reborn.

"If anyone told me I could have loving feelings for him again, I would have never believed it," Suzanne told me. "But I do. He's speaking my language," she said, smiling. Learn to speak your spouse's love language and you too can live with a smiling mate!

Gary D. Chapman, Ph.D., a marriage and relationship expert and best-selling author of numerous books, including The Five Love Languages (Moody) and Covenant Marriage (Broadman & Holman), lives in North Carolina.

Copyright © 2004 by the author or Christianity Today International/Marriage Partnership magazine. Click here for reprint information on Marriage Partnership.

I THINK I CAN. I THINK I CAN. CAN I?

by: Michele Wahlder
http://www.articlecity.com/articles/self_improvement_and_motivation/article_6378.shtml

I think I can. I think I can. Can I?

Your mental train ticket to self-empowerment

We all find ourselves at certain points in our lives holding first class tickets to negative mental trains of thought. Michele Wahlder (MS, LPC, PCC), a two-time cancer survivor and Dallas, Texas-based Certified Life Coach and Psychotherapist, has placed thousands of people on the right track to self-empowerment via a plan she calls the 5 C Process. The journey challenges individuals to:

One

Clarify Current View – Where are you now- honestly?

Conscious awareness of your current view is the first step in becoming the best you can be. Getting clear about how your life aligns with your values, talents and unique gifts is vital to your happiness. You need to know where you are in order to learn where you want to go.

You can clarify your current view by completing a review of eight life areas. Be honest with yourself about how happy are you with your profession, finances, health and overall well-being, primary relationships, personal development, spirituality, environment, hobbies, etc.

Two

Connect with Your Highest Vision – Where do you want to be?

Example: A client of mine, a yoga instructor, decided she was happy teaching but wanted to contribute to the world on a larger level. She wasn’t happy with the quality of the yoga clothing that was accessible to her and her fellow yogis. Her vision was to design and create fun, hip and timeless yoga clothes using eco-conscious fabrics.

You have to get really clear about what you want. It is crucial that you connect to your highest vision of yourself because you can’t create it unless you are clear about what it looks like. If you don’t have a vision of where you want to go or what you want to be, you will most likely NOT get there. To quote Henrietta Klauser, “If you have a connection to what you want, take the next step and write it down.” If you don’t have any idea about what you want, or how you want to be in life to bring about greater happiness, begin looking through magazines and create a Vision Board/Collage of what attracts you. You may also want to consider getting an outside perspective from a friend or a professional coach. I take my clients through a guided imagery that gives them a glimpse of what their future could look like. There are also books that can help guide you. Just get help assessing your talents, divine gifts and abilities and then determine how you want to use them more fully in the world. We can’t help others as fully, if we are not aware of how we can best serve. So instead of thinking of it as selfish to engage in knowing yourself better, I would suggest you consider it selfish to hold back and not be the best you can be. Only in this way, can we help the world and others.

Three

Create Inspiring Goals – How will you get there?

Example: My client created a tiered plan of what needed to happen step by step – outer goal. All of this was influenced by her inner goal of keeping a measured pace and a balanced life. Her goal was to enjoy the process.

You have to create a plan and take specific actions to get you from where you are now to where you want to be. When most people write goals, they just write a list of action steps, usually external actions. I believe it is more powerful to have inner and outer goals. An outer goal is what you want. For instance, you might think, “I want a new house”. An inner goal is more focused on the how. How will a new home benefit me and my family? Will it offer more common gathering areas, a larger kitchen so that we can cook together, etc.? How can I appreciate what I have now until I get this home? How can I make this a joyful experience rather than a stressful one? If you can not be grateful for what you have now, then when you get a new home, it will only create very short-term happiness for you. Then, you will be focused on the next external illusion of happiness. For 2008, I suggest taking at least three of the life areas I mentioned earlier and jot down how you couldbenefit from living your highest vision in each area. Next, add action steps toward your desired achievements along with completion dates.

Four

Clear Obstacles – How will you remove obstacles in your way?

We all have dreams and visions for our life, but frankly, there are many things that can get in the way. The two most common obstacles I see with my clients are:

The inability to say NO— In order to bridge the gap from your current view to your highest vision, you have to make room for what “Could Be”. If your life is full and you want to add more of the things that are truly important in your life, you should start the change process by making room first. You must say no to some things in your life, so you can say yes to what is most important. You have to give up the destructive habits, behaviors and activities to make room for new ones.

A metaphor would be a water hose watering a flowering plant. The water in the hose is your life force and the flowering plant is what you are trying to grow in your life. If the water hose has leaks, it will not have enough water or life force/energy to reach its desired outcome or vision (to grow the plant into full bloom). Examples of leaks might include toxic friendships, unrealistic expectations, watching too much television, eating sugar, overspending, negative relational patterns with your spouse or working on an outdated job.

Example: A client’s obstacle here was that her 8- year-old daughter needed caring for and she was afraid she wouldn’t be able to be a good mother plus jumpstart a successful, new business. We remedied this issue by getting clear on the proper definition of a good mother. Also, practically speaking, she needed help picking up her daughter from school. So she got her husband to assist her in this area so she would have time to create this new business.

Negative self-talk—Research shows we have approximately 50,000 internal messages we say to ourselves daily. We are constantly walking around having conversations with ourselves. And it is what we say that makes all the difference in the overall quality of our lives.

Example: I was once in Starbucks, and I watched this woman spill her coffee while reaching for a sugar packet and I heard her say out loud, “I’m so stupid. I can’t believe I did that.”

Now, I just happen to hear her, but this is an example of something you might say internally as well. You might think, “No big deal. I say things like this to myself all the time.” Well, IT IS A BIG DEAL as our subconscious hears these messages and acts on them as if they were real. Don’t say anything to yourself that you wouldn’t want someone else saying to you.

Think of self-talk like mental fuel. Now, imagine filling your car with dirty water. We all know you wouldn’t get very far. Now, take that same car and fill it with high quality gasoline. You’ll most likely reach your destination. It is the same with people and the words we use. If the words are negative and toxic, we will sputter along with low energy and our performance suffers. If our words are positive and tender, we will feel confident, energized, encouraged and will most likely meet our goals faster and easier. Here are some key things to remember if you ever find yourself preparing to board the train of BAD self-talk:

B– stands for belittling self-talk. Stop telling yourself, “I am not good enough.” If your dream is to have a healthy self-confidence, which of the following examples is more likely to get your there:

A. “I’m so stupid. I can’t believe I did that.”

B. “Whoops, mistakes happen.”

Can you see how the Answer B is much kinder?

A – stands for awfulizing. Stop predicting a future filled with gloom and doom, and dwelling on scary thoughts. If you dream of obtaining a career you love, which of the following will move you closer to your vision:

A. “I did terribly on my interview, I’ll never find a job I like.”

B. “I will answer that question on past employment differently next time and I will ace it! I know I will one day have the job I love.”

Can you see how Answer B places you in the mindset of a successful job search?

D – stands for deceiving. This is when you deceive yourself into thinking you are a victim, and that other people are to blame for your circumstances. If we want a happy relationship which will of the below responses will aid in achieving this goal:

A. “If my spouse would only do more around the house, then I would be happy.”

B. “I can and will choose happiness today, no matter what my spouse does.”

Answer B is the right choice, wouldn’t you agree?

S – stands for shoulding – This is when you give yourself a lot of shoulds, musts, and ought tos, then beat yourself up for not living up to unrealistic standards. Say your dream is to be in top physical condition, which will further that:

A. “I should have eaten a salad for lunch instead of that big ol’ hamburger. I’m such a pig!”

B. “I could have eaten a salad, but I chose not to. Tomorrow I will make healthier choices.”

The second choice is so much more inspiring, don’t you think?

Five

Commit to Action – Are you willing to do what it takes?

The final step of the 5 C Process is to commit to action. How many times have we all made plans and never carried them out, or started off excited and lost motivation? No one ever does anything great alone. We all need encouragement and support from others including an accountability partner who is willing to help hold the vision of the person you want to be. In the previous example of my client, her biggest negative self-talk was how to be a good mom and a good business woman. Her thoughts were, “If I don’t pick up my child every day from school, I am a bad mother.” Instead, we replaced it with, “Picking up my child from school daily is not what makes me a good mother. I am, indeed, a fabulous mother.”

Here are the four action steps that have been proven to help you eliminate your negative self talk:

• Become aware of your negative messages –listen to voice in head

• Stop! You have to stop immediately if you find yourself dwelling on any negative thoughts

• Replace negative thoughts with a kinder alternatives

• Practice. It takes a commitment of time in order to turn a pattern of negative thinking into a more positive train of thought.