Bereavement and Loss

Question 1

Define: bereavement

Answer 1

Loss usually through death

Question 2

Define: grief

Answer 2

Psychological and bodily reaction to loss

Question 3

Define: mourning

Answer 3

Observable expression of grief as well as social conventions such as funerals and clothing

Question 4

What are the traditional approaches to normal grief?

Answer 4

Normative stages and phases
Have to work through tasks of grieving
Avoidance is to be discouraged
Resolution involves emotion disinvestment e.g. Worden task 4: “to withdraw emotional energy and reinvest it in another relationship”

Question 5

What are John Bowlby/Colin Murray Parkes phases of grief?

Answer 5

1) numbness (hours to weeks)
2) yearning (months)
3) disorganisation and despair
4) reorganisation

Question 6

What is the grief wheel (Goodall, Drage and Bell)?

Answer 6

Shock to protest to disorganisation to reorganisation and back to shock again

Question 7

What did Colin Murray Parkes mean by disorganisation and despair?

Answer 7

Feelings of sadness and despair
Feelings of guilt and self-blame 
Feelings of anger
Psychosomatic symptoms 
Illusions

Question 8

What are Ramsay and de Groot 9 components of grief?

Answer 8

1) shock
2) disorganisation
3) denial
4) depression
5) guilt
6) anxiety
7) aggression
8) resolution
9) reintegration

Question 9

What are William Worden’s 4 tasks?

Answer 9

1) To accept the reality of the loss
2) To work through the pain of grief
3) To adjust to an environment in which the deceased is missing
4) To emotionally relocate the deceased and move on with life

Question 10

What are the more recent developments in the stages and phases of grief?

Answer 10

• greater acknowledgment of individual differences in adaptive responses
• greater acknowledgement of wider processes, at family and cultural levels
• More emphasis on meaning -making
• emergence of multi-facetted, flexible models

Question 11

What does it mean by continuing bonds?

Answer 11

role of the deceased continues to play in the life of the bereaved
Schuter & Zisook, 1993: the relationship for the survivor is transformed from a relationship that operated on several levels (actual, symbolic, internalised and imagined) to be one in which the actual relationship is lost but the other forms still remain or may even develop in more elaborate forms

Question 12

What are the functions of continuing bonds?

Answer 12

To anchor to past:

• memories
• reminders (places, children, special moments)
• social presence

To help stay on course:

• personal presence
• social presence
• consulting the deceased

Setting a new course?

Question 13

What is the dual process model (Stroebe and Schut)?

Answer 13

An attempt to integrate ideas through a stress and coping model
- its a dynamic process that fluctuates and changes over time

Question 14

What are the two main types of stressors?

Answer 14

Loss orientated
- grief work, intrusion of grief, bonds, denial/avoidance of restoration changes

Restoration orientated
- attending to life changes, doing new things, new roles/identities/relationships, denial/avoidance of grief

These stressors provoke distress and anxiety

Question 15

What are the positive constructions of the dual process?

Answer 15

positive reappraisal
revised constructive goals
positive event interpretation
expressing positive affect

Question 16

What are the negative constructions of the dual process?

Answer 16

rumination, wishful thinking
revised (unconstructive goals)
negative event interpretation
ventilating dysphoria

Question 17

What is the meaning making (neimeyer) social constructionist approach?

Answer 17

1) recreating meaning - search for meaning in the death and existential consideration of the continuing meaning of life for the survivor
- meanings related to bereavement are in integrated with/extended to wider frameworks for living - fundamental process, shift aspects of worldview
- meanings are often personal but constructed in social context
2) reconstruction influenced by cultural discourses as well s personal and familial context
- meaning may not be accessible on a rational, cognitive level it may be accessed through less directive strategies
Meaning making = more an activity than an achievement - dynamic process that changes over time and combines aspects of reality and subjectivity

Question 18

What are some differing cultural means of mourning?

Answer 18

Navajo indians - mourn for 4 days
Hindus - mourn for 10-16 days
Orthodox jews - several stages but officially 30 days except for parents which lasts 12 months

Question 19

How is secure attachment linked to bereavement?

Answer 19

Overall parenting is good and childhood vulnerability is low
Harmony in adult attachments
- overall coping is good
- bereavement: grief

Question 20

How is avoidant attachment linked to bereavement?

Answer 20

Parents intolerant of closeness - child intolerant of closeness
Adult relationships conflicted
Copes by inhibition/distrust/assertion
Bereavement: inhibited

Question 21

How is anxious ambivalent (clinging) attachment linked to bereavement?

Answer 21

Parents insensitive/overprotective - child timid and / or precious
Adults relationships conflicted
Copes by clinging and/or detachment
Bereavement: clinging to past relationships, seeks substitute to depend on

Question 22

How is disorganised/disorientated attachment linked to bereavement?

Answer 22

Family rejection/violence, dangers and/or depression
Child unhappy, tearful, wishes self-dead
Adult lacks trust in self and others, when at end of tether turns inward and may harm self
Bereavement: anxiety/panic, suicide risk

Question 23

What are the factors associated with straightforward adjustment?

Answer 23

Gamino 2000

1) saying goodbye prior to the death - finding a means of saying a delayed goodbye
2) ability to see some good resulting from the death - constructing a meaningful narrative
3) intrinsic spirituality - exploring and strengthening spirituality
4) having spontaneous positive memories of the deceased - stimulating positive and continuing bonds

Question 24

What is pathological grief?

Answer 24

Delay/denial or absent grief - mummification 
Intense or distorted grief - intensification of components of normal grief such as sadness, guilt, anger, psychosomatic symptoms 
Chronic grief (extension in duration)

Question 25

What is Bonnano et al patterns of response?

Answer 25

1) resilient (45.9%)
2) chronic grief (15.6%)
3) common grief (10.7%)
4) chronic depression (7.8%)
5) depressed-improved (10.2%)

Also delayed grief (3.9%)

Question 26

What are the factors associated with pathological grief?

Answer 26

Circumstances of loss

• sudden and unexpected
• traumatic or witnessed loss
• suicide or homicide
• absence of corpse
• loss resulting from failure in others

Who is lost?
- children

Who is bereaved?
- age and life cycle status of bereft

Quality of relationship

Question 27

What is complex grief?

Answer 27

Pathological, traumatic, complicated

Failing to move through a stage or phase

Avoiding addressing a task

Lack of balance between grief oriented and restoration oriented

Question 28

When is it a time to intervene ?

Answer 28

15-16% - high levels of grief and/or depression 13-18months following bereavement

Early signs of complex grief may be linked with development of worse mental health and general functioning

Among those referred to specialist mental health services, bereavement is often significant - therefore include as part of the assessment