Bereavement and Loss Flashcards
Define: bereavement
Loss usually through death
Define: grief
Psychological and bodily reaction to loss
Define: mourning
Observable expression of grief as well as social conventions such as funerals and clothing
What are the traditional approaches to normal grief?
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”
What are John Bowlby/Colin Murray Parkes phases of grief?
1) numbness (hours to weeks)
2) yearning (months)
3) disorganisation and despair
4) reorganisation
What is the grief wheel (Goodall, Drage and Bell)?
Shock to protest to disorganisation to reorganisation and back to shock again
What did Colin Murray Parkes mean by disorganisation and despair?
Feelings of sadness and despair Feelings of guilt and self-blame Feelings of anger Psychosomatic symptoms Illusions
What are Ramsay and de Groot 9 components of grief?
1) shock
2) disorganisation
3) denial
4) depression
5) guilt
6) anxiety
7) aggression
8) resolution
9) reintegration
What are William Worden’s 4 tasks?
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
What are the more recent developments in the stages and phases of grief?
- 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
What does it mean by continuing bonds?
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
What are the functions of continuing bonds?
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?
What is the dual process model (Stroebe and Schut)?
An attempt to integrate ideas through a stress and coping model
- its a dynamic process that fluctuates and changes over time
What are the two main types of stressors?
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
What are the positive constructions of the dual process?
positive reappraisal
revised constructive goals
positive event interpretation
expressing positive affect
What are the negative constructions of the dual process?
rumination, wishful thinking
revised (unconstructive goals)
negative event interpretation
ventilating dysphoria
What is the meaning making (neimeyer) social constructionist approach?
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
What are some differing cultural means of mourning?
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
How is secure attachment linked to bereavement?
Overall parenting is good and childhood vulnerability is low
Harmony in adult attachments
- overall coping is good
- bereavement: grief
How is avoidant attachment linked to bereavement?
Parents intolerant of closeness - child intolerant of closeness
Adult relationships conflicted
Copes by inhibition/distrust/assertion
Bereavement: inhibited
How is anxious ambivalent (clinging) attachment linked to bereavement?
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
How is disorganised/disorientated attachment linked to bereavement?
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
What are the factors associated with straightforward adjustment?
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
What is pathological grief?
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)
What is Bonnano et al patterns of response?
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%)
What are the factors associated with pathological grief?
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
What is complex grief?
Pathological, traumatic, complicated
Failing to move through a stage or phase
Avoiding addressing a task
Lack of balance between grief oriented and restoration oriented
When is it a time to intervene ?
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
