Tag Archives: social work

a new way to handle infant loss

So dang important. As a hospital social worker I faced this horrible situation way too often – the middle of the night, a groggy chaplain, teams of residents and nurses silently sobbing, the cries of a mother’s grief that don’t even sound human.

There’s no way to ease the pain they’re feeling, the ongoing grief they’ll feel…the going home to a finished nursery or the telling of friends or the baby gifts they won’t get to use. For some reason one of the most vivid images I have is of sitting in the room holding a mom and looking over to the table where this expensive camera sat, waiting to take pictures of a newborn…a toddler…the first day of kindergarten….it was awful.

We try to give the family as much time as they need with their child, with their little family that won’t ever leave this hospital. But this article is right: 2-4 hours often isn’t enough. In fact, the first couple of hours the mother may even refuse to see the child, saying she can’t do it. But most of the time she changes her mind, and we try to anticipate it – keeping the baby in another room until mom is ready. We take footprints even when mom says she doesn’t want to see them, create a memory box just in case. Sometimes family takes it and we hear later that mom/dad were so grateful later on when they had these keepsakes. I love this idea of slowing down, of letting the family have extra time to make decisions. We try to never tell the family there is a time limit, and honestly my families rarely use the whole time we’ve given them….but I think if the staff knew we had extra time we could aid in this slowing down process rather than feel the pressure of the clock and worry that we’d have to tell the family it’s time to physically let the child go.

I love these little suggestions, the colorful blanket or the recording family members. But this….this has changed the way I will handle infant loss forever:

It’s all about taking the time to say hello to their child before saying goodbye.

What a profound and incredible statement. Thank you, Megan, for the work you do and for taking time to share it with us.

Mandy Maneval faced infertility for years. Finally, three years ago, she became pregnant with twins. At a routine ultra sound, she was faced with the news that Aaron was lost at 20 weeks. Her little girl, Abigail (Abby), was healthy.

At 30 weeks, Mandy went into labor. She called her sister, Megan Shellenberger, a nurse at Penn State Milton S. Hershey Medical Center, located in Hershey, Pennsylvania. Megan spends most of her time working in labor and delivery, and she was quick to reassure Mandy that everything would be O.K.

Suspecting that baby Abigail had a heart defect, Mandy came to Penn State Milton S. Hershey Medical Center, the home of a leading neonatal cardiologist. The physicians were able to stop Mandy’s labor, but she would remain an inpatient until delivering Abby at 35 weeks.

Abby was born with two very complex heart defects. So rare, that her doctors described it…

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Aha! Moments

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

Okay, heads up: this entire post is a re-blog from PESIinc., a company that provides continuing education for a variety of professions. I kind of love them, even when they spam me four thousand times a day with courses I might like to take.

10 Ways to Help Stuck Clients Move Forward

posted Nov 24, 2015.

“I know it’s irrational, but I can’t stop the extreme anxiety I feel around people because I’m a 6’3” tall woman and fear they’ll think I’m a freak,” said Natalie, a 35-year old nurse. Though she was comfortable working with patients, was happily married, and had two very close friends, she couldn’t shake the anxiety she felt around colleagues and large groups of people.

“My last therapist taught me relaxation exercises, how to talk back to my negative thoughts, and encouraged me to get out socially with small groups,” Natalie added. “But none of that seems to work. The anxiety just hijacks my brain.”

She’s right. Sometimes, no matter how we try to outsmart it, our emotional brains are primed to override the rational mind with patterns that persist until we intervene with something this feeling brain can understand: a compelling emotional experience that completely changes how we feel, not just how we think.

Orchestrating such felt experiences with your clients is easier than you think. In this post, I’ll share 10 strategies from my book, “The Therapeutic ‘Aha!’” that you can use to engage the emotional brain and help stuck clients move forward.

Strategy #1: Align, Lift, and Lead

Most of us were taught to validate our client’s feelings. However, if you spend too long merely validating your client’s pain, it can amplify negative feelings in the emotional brain. To help your client access positive states of mind, you have to find a way to lift and lead them emotionally. To make this transition, I recommend a language pattern that I call “Align, Lift, and Lead.”

You align with the client by reflecting your understanding of the problem, and then you lift the client by affirming her strengths, and lead her by suggesting her desired response to the situation. Here is how I used this language pattern with Natalie:

 “Natalie, I understand that you’ve had these experiences where you’ve not felt comfortable around large groups of people because you’ve not been sure how they would react to your height. Being a nurse, you’re obviously an empathic person and are probably pretty good at helping people feel at ease. I’m seeing you using these people skills in other social situations, too, realizing that a person’s reaction just tells you something about them, and you can sense how to put them at ease.”

Reframing her problem in this way helped Natalie feel more socially competent and encouraged.

Strategy #2: Visualize the Desired Response

Because the emotional brain learns better through metaphor and imagery than it does through words, another strategy you can use is to have your client visualize her desired response. I suggested Natalie visualize herself successfully navigating a social situation and imagine feeling curious, secure, and calm. Then, I asked her to imagine something in nature that could represent her mind working this way. Natalie smiled and said, “Muir Woods with the redwood trees.” Visualizing the peacefulness of the tall trees in this forest helped her feel calmer and gave her a sense of belonging.

Strategy #3: Identify Inspiring Goals

Instead of setting dry, lifeless goals like, “Client will practice relaxation skills and talk to two new people per week,” explore potential goals that have real value and meaning for your client.

When I explored inspiring goals with Natalie, she began talking about her desire to have lunch with a group of colleagues. They’d been inviting her to lunch for several weeks, and she liked the idea of connecting with fellow nurses. Targeting a small group of people she wanted to be around felt more intriguing and doable to her and less like a task.

Strategy #4: Locate the Root of an Emotional Conflict

Even though Natalie felt encouraged by this goal, she still felt a knot in her stomach at the thought of going out to lunch with these colleagues. I asked Natalie to follow the sensations in her stomach back to the first time she could remember having a similar feeling. Her eyes widened as she recalled being teased during lunchtime in middle school by a group of kids who called her names like “Amazon” and “Sasquatch.”

She had coped by avoiding the school cafeteria and doing her homework in the library during lunch. As a result, she avoided her bullying classmates and was praised by her teachers for being studious. Natalie gasped as she realized she was doing the same thing at her job­—skipping lunch with peers to avoid fears of being ridiculed and getting praised by her boss for being so dedicated.

Once Natalie made this connection, she understood her emotional brain had simply continued the pattern because it had been adaptive for her in the past.

Strategy #5: Reverse Traumatic Memories

Natalie was excited to have made this connection, but just having cognitive insight into the cause of her social anxiety didn’t change it. In fact, recent neuroscience discoveries have shown us that in order for the emotional brain to change a response that was once adaptive, we have to recall the old memory while eliciting a new experience that invalidates the beliefs that got attached to the disturbing memory.

Strategy #6: Change Beliefs With Imagery and Metaphor

To change Natalie’s negative self-concept, we revisited her imagery of the redwood tree­—tall, beautiful, and majestic. I suggested she imagine the smaller trees laughing at the redwoods for being so tall and see the absurdity of it. Imagining this scene made Natalie laugh and realize every tree had its natural place in the world, and so did she.

Strategy # 7: Conjure Up Compelling Stories

Another way you can reverse the meaning of a traumatic event is to have your client finish her story with a new ending. For instance, she can finish it with a later moment in her life when she was out of danger, in a better situation, or felt competent or empowered.

The first time Natalie told her story about being bullied at school, she ended the story with an incident where a boy asked her to dance, then brought out a chair to the dance floor and stood on it so he could be as tall as she was. Everyone laughed, which made Natalie cry.

When I prompted her to consider a new ending to this story, she said, “Well I’ve been happily married for 15 years, and my husband said he was attracted to me because I was tall. He thought I looked like a graceful dancer.” She smiled and realized that ending her story this way suddenly caused the experiences she had with the boys in her youth to seem trivial.

Strategy #8: Prime With Play and Humor

Using play and humor are also great ways to dissipate anxiety and trigger new perspectives on events. Natalie and I acted out a role-play in which I let her play a woman with a snobby attitude teasing her while I played Natalie. She began the role-play by wrinkling her nose and saying,

“Who invited you to lunch with us, Amazon lady?”

I answered by simply saying, “Linda invited me.”

“Well I hope you don’t think I can be seen walking next to you, Sasquatch,” Natalie continued. And you should really consider doing something different with your hair.”

I smiled and replied, “Oh, what a shame. I fixed my hair this way just for you.”

Natalie laughed and we continued the role-play for a few more minutes. Letting Natalie play the character she feared reduced her anxiety because she realized how insecure a person would have to be to make such insensitive comments.

Strategy #9: Rouse With Rhythm and Music

Music can influence mood and neurochemistry, and it can entrain the brain to calmer states. One activity many clients enjoy is creating a playlist of tunes that evoke desired responses. Natalie started her playlist with “Creep” by Radiohead, which reflected her fears of being a social reject. Then we added “Everyday People,” by Sly and the Family Stone, which was more upbeat and affirmed that humans come in different colors, shapes, and sizes. Natalie ended her playlist with “Can’t Keep a Good Woman Down,” by Mary J. Blige, which helped her feel empowered.

Strategy #10: Integrate Mindful Movement

Movement can also engender desired states of mind. Dancing to her playlist helped Natalie shake off anticipatory anxiety, but I also suggested she could place her hand on her abdomen to calm her stomach and invoke a sense of self-compassion. She practiced this gesture while she slowed her breathing and imagined the beautiful redwood trees. Over the next several weeks, Natalie reported that her anxiety completely dissipated and she was able to comfortably enjoy lunch with her co-workers and other social situations.

Closing Thoughts

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

I hope this post has given you ideas for new techniques you can use, and that it leads to many “Aha!” moments for you and your clients.

Courtney Armstrong, LPC, MHSP, is a licensed professional counselor in Chattanooga, Tenn., and the author of “The Therapeutic ‘Aha!’: 10 Strategies for Getting Your Clients Unstuck.” She also offers training and free resources for therapists at her website: www.courtneyarmstrong.net.

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financial intimacy: a reblog + thoughts

Once we got engaged and the ring sat on my finger, it seemed that problems were not always handled effectively. One of us was compromising to the point we were dismissing potential landmines so that we could get married. It was about the wedding and getting through to that day so we could live blissfully ever after.

I would also add to this article from Be Like Water that financial collaboration and intimacy is unbelievably important even after accounts become joined, credit cards become shared, and incomes are combined. After my own divorce ended in a financial disaster for me, I have found that many, MANY people share my story. We trusted each other, we were both financially independent and secure when we entered into our marriage, and we were open with each other about every piece of debt, loans, open credit, etc. BUT that trust led to my own downfall – I didn’t keep checking our accounts, didn’t look at bills or make sure they were paid, didn’t check my credit or look at our taxes. We tried doing our budget together but since we both had such different ways of doing the physical budget (I like pen and paper, he liked Excel – my Excel spreadsheet went from top to bottom, his went from left to right) that I eventually entrusted the whole process to him. Like I said, we were both capable adults who had spent years in charge of our own finances – I thought I had no reason to double check everything.

So eventually I had no idea that our bills weren’t paid or our debts grew. I didn’t know he lost his job until the pharmacy told me I no longer had insurance. I thought we were fine. I knew we were on a budget, sure, but we still went out to eat with our friends and bought new things when we wanted them.

I didn’t realize our “$200” car repair actually cost us $2,000. I didn’t know that he added himself to an old credit card of mine and charged thousands of dollars to it. I didn’t know he spend hundreds of dollars buying everyone rounds of drinks at the bar each night.

I had already left him by the time I discovered all of the debt. I had no money to pay anything; my paycheck went into our joint account for which I didn’t even know the log-ins or passwords.

So my advice is this: even if you don’t check often, make sure you CAN check. I speak about this with all of my friends, clients…heck even friends of friends I’ve just met. People who say, “oh I’m bad with money, I just let [my partner] handle everything.” Or “he/she has me on a budget because I just don’t pay attention to that stuff.”  Make a note to check your accounts,  at least every quarter. I’m not accusing your partner of fraud or anything, I’m suggesting that he or she may get into a bind and think “well, I’ll pay the savings account back next month” or “I want her to have a good Christmas, I’ll put this on the credit card.”

If I had known how stretched we were financially I would have stopped spending money! I’m sure pride and depression and alcohol and the fear that he was losing me all contributed to my ex-husband not telling me what was going on. When I finally did leave I had no idea the mess that we were in financially.

But I honestly take some of the blame for our financial burden. By being lazy and stubborn (“fine! If your way is so much better, you can just do it!”), I put the entire responsibility on him. We should have been a team when it came to budgeting and spending. 

I am positive he thought he was doing the right thing to try to make me happy. Maybe at the end some of his spending was spiteful, but I am 100% it didn’t start out that way.

Pay attention. Be a team. And – I say this with the experience of many, many people I’ve met – protect yourself. I promise you, ALL of us at one point said, “that will never be me. My partner would never do that to me.” Please be safer and not sorry.

__

PS: Shout out to the many, many people who have helped me survive (literally) since that time. From the one buying me mac & cheese and SunChips in bulk at Costco (lived on that for months), to the one who let me live in her guest room for free, to the ones taking me out or to shows or to dinner, to the one replacing the broken things and sending me beauty for no reason other than believing I should have it. I may be living paycheck to paycheck, but I wouldn’t be here at all if it weren’t for the incredible people who have picked me up along the way. Which is a whole different blog: can we be friends with the people who save us? 

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The Abortion Pill and the Attack on Women

“The medical abortion–a non-surgical procedure that induces a miscarriage through a cocktail of pharmaceutical drugs–is both widely legal and increasingly hard to obtain. To understand the limits of what could be a breakthrough in making abortions easier to access, Broadly hears from both sides of the debate. We travel to the front lines of the battle in Texas, where religious protesters camp outside rapidly closing clinics, as well as to an abortion spa in Washington, DC, where employees are working to de-stigmatize the stupidly controversial procedure. Internationally, we talk to Dr. Rebecca Gomperts from the charity Women On Waves, the physician who recently began using drones to deliver the abortion pill to countries where the procedure is illegal, and we visit a pharmacy in Mexico to see how easy it is to access the abortion pill just across the border. What we really want to know is: Why is it so hard to get a medical abortion when so much research has shown that it’s a safe, effective way to terminate a pregnancy?”

Take half an hour and watch this video, “The Abortion Pill,” at Vice channel Broadly. It’s great – in the first few minutes I learned new things about a subject about which I thought I was pretty well educated.

“The only thing I will tell you is I am a gynecologist, and I often have patients who tell me, “I am against abortion…but I need one.” So in case you are against abortion, but you need one, know that there are safe medications that you can use to have a safe procedure. I wish you all the best.”

Check it out, it’s worth it.

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white shooters.

So many points in this article and I’m not sure how I feel about them all, but this…this is incredible:

The reality of America is that White people are fundamentally good, and so when a white person commits a crime, it is a sign that they, as an individual, are bad. Their actions as a person are not indicative of any broader social construct. Even the fact that America has a growing number of violent hate groups, populated mostly by white men, and that nearly *all* serial killers are white men can not shadow the fundamental truth of white male goodness. In fact, we like White serial killers so much, we make mini-series about them.

White people are good as a whole, and only act badly as individuals.

People of color, especially Black people (but boy we can talk about “The Mexicans” in this community), are seen as fundamentally bad. There might be a good one- and we are always quick to point them out to our friends, show them off as our Academy Award for “Best Non-Racist in a White Role”- but when we see a bad one, it’s just proof that the rest are, as a rule, bad.

Read the rest of I, Racist on Huffington Post.

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The Importance Of Gender Neutral Toys – A Reblog.

This is an article published originally on the New York Family by Dr. Joe Taravella, a licensed clinical psychologist at NYU Langone Medical Center–Rusk Rehabilitation. His personal website is: drjoetaravella.com. I love it. Gender identity – especially gender fluidity/flux/queer/etc. are finally being given conscious attention, which is good considering it subconsciously affects every facet of our lives. Dr. Joe’s article teaches parents to give their kids a chance to learn who they are without [this one aspect of] society’s programmed expectations.

“While our society has moved away from traditional and antiquated gender roles, such as the model of a mom who is a homemaker (not that there’s anything wrong with that) and a dad who works outside of the home, how far have we really advanced in the area of gender segregation with children’s toys and clothes? Children learn early on in their development that certain toys and particular colors are intended for specific genders, and the princess fantasy culture becomes enmeshed with girls’ playtime in the blink of an eye. And while we all prefer to make choices and have control in our lives, do we really to want put a pink or blue stamp on our child’s forehead and limit their choices of toy and play preferences?

In this ever-changing world, we are seeing an increase of families with diverse family structures, two-income households, and all family members sharing in household responsibilities. So why are we still stuck on trucks for boys and dolls for girls?  We need to move away from the notion of gender-specific toys and create a nurturing environment for children to freely discover and play that’s aligned with their innate interests.

Outdated gender roles hinder exploratory play, stifle creativity, create a roadblock to sharing among boys and girls, and deny children the opportunity to develop skills across genders.  And while the well-intentioned parent may believe they are saving their children from being teased by their peers, over time, children believe they are not allowed to express themselves and that who they are is not as important as how they compare to others in society’s eyes. So if we look at life with ‘gender-goggles,’ are we truly giving our children equal opportunities in life during their formidable years? As we fast-forward to adulthood, we see women thriving in their careers but not earning equal pay, and men become more lonely and depressed (resulting in higher rates of suicides compared to women), so how do we counteract traditional gender roles?

Creating a gender-neutral environment can foster gender identity and gender expression. According to a 2005 study by Judith Blakemore and Renee Centers, “Characteristics of Boys’ and Girls’ Toys,” the authors concluded that, “children of both genders would benefit from play with toys that develop educational, scientific, physical, artistic, and musical skills.”

Parents can foster and support a gender-neutral environment in their home and encourage their children to be anything they want to be. Parents can be as creative as wish and include gender-neutral toys into their homes such as play-doh, toy telephones and cash registers, building blocks, play kitchens, tossing games, puzzles, sock puppets, musical instruments, and board games to name a few. Children should be allowed to discover and explore their gender preferences, gender identity, and gender expression. Developing this strong sense of self will enhance their overall self-esteem and allow them to be creative, imaginative, and feel capable. As parents, we want to give our children the key to the world; so giving children the opportunity to play across all gender roles helps them develop skills they may ‘traditionally’ not be encouraged to explore. In doing so, boys can be more nurturing and verbally expressive, which can lead to having better interpersonal relationships with girls and women and being better fathers. Girls can develop spatial skills when engaged in non-traditional roles and grow up feeling more confident in careers relating to science, technology, engineering, math, and construction.  Ultimately, fostering your child’s innate preferences of what interests them will be most beneficial to their overall growth and development. And kudos to those companies who organize children’s toys and apps by category of play or age, instead of gender in an effort for children to develop their own identity regardless of their gender.

So, are boys and girls different? Sure, but so are girls from other girls and boys from other boys. What I tell each child is that they are unique and special in their very own way, as there’s no other ‘you’ in this entire world; so just be your special ‘self’ and reach for the stars, no matter what color of the rainbow they happen to be.”

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I HATE SEXUAL ASSAULT SO MUCH.

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The Physiology of Mindfulness

The business world is abuzz with mindfulness. But perhaps you haven’t heard that the hype is backed by hard science. Recent research provides strong evidence that practicing non-judgmental, present-moment awareness (a.k.a. mindfulness) changes the brain, and it does so in ways that anyone working in today’s complex business environment, and certainly every leader, should know about.

Not sure how I missed this article in January, but I guess it’s never too late. Read more about mindfulness and its positive effects on the brain in the Harvard Business Review.

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the bad guys

At one point in life I believed that there were good guys and bad guys, and that I could trust the authority figures in my life to give the “good” and “bad” designations to the right people.

That belief led to the belief that bad people are in jail – and that people in jail are bad.

I think most of the people who taught me those ideas still believe themselves. It’s easier to ignore prison conditions when you believe that all the people in there deserve whatever punishment they get.

But that’s just not true.

“Although black people make up just 13 percent of the overall population, they account for 40 percent of US prisoners. According to the Bureau of Justice Statistics (BJS), black males are incarcerated at a rate “more than 6.5 times that of white males and 2.5 that of Hispanic males and “black females are incarcerated at approximately three times the rate of white females and twice that of Hispanic females.”

Michelle Alexander points out in her book The New Jim Crow that more black men “are in prison or jail, on probation or on parole than were enslaved in 1850.” Higher rates of black drug arrests do not reflect higher rates of black drug offenses. In fact, whites and blacks engage in drug offenses, possession and sales at roughly comparable rates.”

Debtor’s prison? Chain gangs? For-profit prisons? Guaranteed capacity in private prisons? How is this even a thing??

“Oil companies have been known to exploit prison labor as well. Following the explosion of the Deepwater Horizon rig that killed 11 workers and irreparably damaged the Gulf of Mexico for generations to come, BP elected to hire Louisiana prison inmates to clean up its mess. Louisiana has the highest incarceration rate of any state in the nation, 70 percent of which are African-American men. Coastal residents desperate for work, whose livelihoods had been destroyed by BP’s negligence, were outraged at BP’s use of free prison labor.”

Oh good. Finally someone we believe less worthy than Mexicans:

“Private companies have long understood that prison labor can be as profitable as sweatshop workers in third-world countries with the added benefit of staying closer to home. Take Escod Industries, which in in the 1990s abandoned plans to open operations in Mexico and instead “moved to South Carolina, because the wages of American prisoners undercut those of de-unionized Mexican sweatshop workers,” reports Josh Levine in a 1999 article that appeared in Perpective Magazine.”

I never realized just how much people would lose if we reformed prisons and incarcerations. I thought people were lazy or just didn’t care. Now I see the investment so. many. people have in keeping things the way they are, or even increasing the number of inmates across the country. Horrifying.

“Even politicians have been known to tap into prison labor for their own personal use. In 1994, a contractor for GOP congressional candidate Jack Metcalf hired Washington state prisoners to call and remind voters he was pro-death penalty.”

And:

“In an unsettling turn of events lawmakers have begun ditching public employees in favor of free prison labor. The New York Times recently reported that states are “enlisting prison labor to close budget gaps” to offset cuts in “federal financing and dwindling tax revenue.” At a time of record unemployment, inmates are being hired to “paint vehicles, clean courthouses, sweep campsites and perform many other services done before the recession by private contractors or government employees.” In Wisconsin, prisoners are now taking up jobs that were once held by unionized workers, as a result of Governor Scott Walker’s contentious anti-union law.”

I realized as I kept reading that I also have held the belief that people who have been to jail in the past are bad people. It sounds so childish, and for good reason – it’s something I was taught so early on that I never even noticed it was a part of my psyche. But you know what? If they’ve served time, supposedly we believe their debt is paid. So why continue to punish prisoners by not granting them qualifications (electrician, plumber, etc) upon release? By paying them 11% less just because they have prison time in their background? Why are they forced to work 50 hours a week while incarcerated, but can’t find work when they are released? We have to do better.

Read the whole article on alternet.

*Note: this article was published in 2011.

Also read this.

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phantom ghosts

Here’s a very interesting approach to grief and grief counseling based on “mirror therapy” in adults with phantom limb pain. What a cool connection this blogger has made between the two – I’m excited for both the development of the therapy for amputees as well as the implications the idea has for mental health practice!  (The article has more than a few typos, sorry)!

“I find myself thinking: is this so much different from phantom limb pain? There is a loss of connection between the afferent circuitry in the brain and the efferent circuitry emanating from the limb. When this disruption in the previously existing give and take is recognized, there is a painful experience as a consequence, when the limb is felt to still be present, even if it is an illusion, the pain miraculously subsides. Can we learn from research and innovation in phantom pain to help ease the suffering of those who have tragically lost loved ones? Can we apply this type of understanding to practical tools to help people with grief pain?”  Read more at Beyond Estate.

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