Session 5 - psychological management of medical patients 2: the grief process

Question 1

List 6 feelings that occur as a normal manifestation of grief.

Answer 1

sadness
anger
anxiety
loneliness
fatigue
helplessness

Question 2

List 5 physical sensations that occur as a normal manifestation of grief.

Answer 2

hollowness in the stomach
tightness in the chest
tightness in the throat
oversensitivity to noise
dry mouth

Question 3

List the cognitions that occur as a normal manifestation of grief.

Answer 3

disbelief
confusion
preoccupation
sense of presence

Question 4

List 5 behaviours that occur as a normal manifestation of grief.

Answer 4

sleep disturbances
appetite disturbances
absent-minded behaviour
social withdrawal
dreams of the deceased

Question 5

what is grief?

Answer 5

the personal experience of one who has lost a loved one to death.

Question 6

what is mourning?

Answer 6

the process that occurs after a loss

Question 7

Name the stages of grief.

Answer 7

Stage 1 - Denial
Stage 2 - Aggression
Stage 3 - Negotiation
Stage 4 - Depression
Stage 5 - Acceptance

Question 8

Briefly explain the Denial stage of grief.

Answer 8

It serves as buffer against the initial shock. The person intellectually and/or emotionally denies the reality of the loss.

Question 9

Briefly explain the Anger stage of grief.

Answer 9

The patient’s aggression can be aimed against other people, God or themselves. The patient may ask questions such as: ‘why me?’ and ‘why did it happen?’.

Question 10

Briefly explain the Negotiation stage of grief.

Answer 10

The patient tries to negotiate or make a compromise in order to redress the loss. The negotiation is usually with God.

Question 11

Briefly explain the Depression stage of grief.

Answer 11

It does not include a real mental disorder that can be diagnosed. It is characterised by a strong feeling of loss, grief, helplessness and fear of the future.

Question 12

Briefly explain the Acceptance stage of grief.

Answer 12

It is the point where the person experiences that they have intellectually and emotionally ‘made peace’ with the loss and that they begin to reinvest their energy in the future.

Question 13

Name the tasks/goals of grief counselling .

Answer 13

1. Acceptance of the reality of the loss.
2. To process the pain of grief
3. To adjust to a world without the deceased
4. To find an enduring connection with the deceased in the midst of embarking on a new life.

Question 14

Explain the first task/goal of grief counselling.

Answer 14

A person can and will often not accept the reality and then deny the facts and/or the emotional impact it has on them.

It is therefore necessary for a person to recognise and not to suppress, deny or rationalise about the finality of what has happened.

Question 15

Explain the second task/goal of grief counselling.

Answer 15

Losing a loved one causes intense grief and the experience cannot be shortened or mitigated.

many survivors struggle with one or more feelings of anger, guilt, anxiety, helplessness and sadness. the person must then be given the opportunity to experience and express these feelings.

Question 16

Explain the third task/goal of grief counselling.

Answer 16

After a loss a whole new life pattern must be structured. Dependent persons experience strong helplessness and struggle to adjust to the new situation.

Question 17

Explain the forth task/goal of grief counselling.

Answer 17

The person needs to find a way to remember their loved one while still continuing with their life.

the counsellor’s task is to help the person find an appropriate place for the dead in their emotional lives - a place that will enable them to go on living effectively in the world.

Question 18

Name the factors that play a role in the course of the grieving process.

Answer 18

personality traits
nature of interpersonal relationships
cause of death
availability of support

Question 19

when is mourning finished?

Answer 19

when the tasks of mourning have been accomplished. The person is able to think of the deceased without pain and without the physical manifestations such as intense crying or feeling tightness in the chest.

Question 20

What characterises complicated grief?

Answer 20

Chronic grief
Delayed grief
Exaggerated grief
Disguise grief

Question 21

Name 5 clues that help diagnose complicated mourning.

Answer 21

1. Person still cannot speak about the deceased without having intense ‘fresh’ sadness many years after the loss
2. A small insignificant event triggers an intense grief reaction
3. The loss, or its themes, are repeated during the interview
4. The person wants to keep the environment of the deceased as such
5. The person makes radical lifestyle changes or excludes family and friends and/or activities associated with the deceased from their life.

Question 22

What does terminal illness entail?

Answer 22

It entails a slow death. Dying can take place over the course of a few days or several months. The patient typically suffers a progressive deterioration in the feeling of well-being and experiences chronic pain.

Question 23

List the points of grief compared to depression.

Answer 23

1. predominant affect is feelings of emptiness and loss.
2. self-esteem is generally preserved
3. the pain of grief may be accompanied by positive emotions and humour.
4. the thought content generally features a preoccupation with thoughts and memories of the deceased.
5. thoughts about death or dying are generally focused on the deceased and possibly about ‘joining’ the deceased.
6. dysphoria occurs in waves (pangs of grief) and is likely to decrease in intensity over days to weeks. The waves tend to be associated with thoughts or reminders of the deceased.

Question 24

List the points of depression compared to grief.

Answer 24

1. there is a persistent depressed mood and the inability to anticipate happiness or pleasure.
2. feelings of worthlessness and self-loathing are common.
3. the depressed mood of a Major Depressive Episode is more persistent and not tied to specific thoughts or preoccupations.
4. thought content generally features a preoccupation with self-critical or pessimistic ruminations.
5. Pervasive unhappiness and misery is characteristic of a MDE
6. thoughts about death and dying are focused on ending one’s own life because of feeling worthless or underserving of life, or inability to cope with the pain of the depression

Question 25

Explain children and terminal illness

Answer 25

Parents opt not to tell their terminally ill child about their impending death, however dying school age children seem to realise the seriousness of their illnesses even without being told.

Children under 5yrs don’t grasp the irreversibility of death, it occurs to most children by 8yrs.

children should be informed in an honest, open and sensitive manner relative to their stage of development.

Question 26

Explain adolescents and terminal illness.

Answer 26

They realise how unlikely dying at their age is and often experience anger about the senselessness and injustice of it and of not having the chance to develop their lives futher.

Question 27

Explain young adults and terminal illness.

Answer 27

when they have children they seem to experience more anger and emotional distress than older adults and they feel guilty about not being able to care for their children or see them develop into adulthood.

Question 28

Explain middle-aged and elderly adults and terminal illness.

Answer 28

In this time period the likelihood of developing a high mortality chronic illness sharply increases.

elderly people have an easier time than younger adults facing impending death.

Question 29

What are some of the reasons why elderly adults have an easier time facing impending death?

Answer 29

1. it is less shocking as they know their remaining years are few.
2. they discuss illness and death more frequently
3. most of their peers have died or suffer from declining health
4. they are often financially prepared for terminal care/funerals

Question 30

What are the 3 types of stress terminally ill patients experience according to Hinton?

Answer 30

1. coping with the physical effects of their worsening condition.

2.dependency on others and a restricted lifestyle due to their medical condition.

3. loss of intimacy or fear of never going home when they are hospitalised or in hospice facilities.

Question 31

Name 5 needs of terminally ill patients.

Answer 31

1. accurate and continuing information about the illness, its course and its treatment.
2. adjustment to body image and self-image
3. learning to express emotions
4. maintaining hope
5. cultivating a significant relationship with loved ones

Question 32

What is the background to conveying unpleasant news?

Answer 32

the patient wants to know

provide facts before uncertainty

doctors wants to inform their patients

most patients react favourably to infromation

human beings can usually come to terms with the worst pain

Question 33

What are some practical guidelines to divulging unpleasant information?

Answer 33

1. show empathy
2. choose the right moment
3. choose the correct place
4. convey the facts honestly
5. create the opportunity for questions

Question 34

How do personality traits play a role in the course of the grieving process?

Answer 34

The type of personality that a patient has has a direct influence on the bereavement process. Some personality types are going to cope worse than other types e.g a person with dependency- or borderline traits/disorder is going to have more difficulty coping with the grieving process.

Question 35

How does the nature of interpersonal relationships play a role in the course of the grieving process?

Answer 35

The more personal a relationship, the more difficult it is going to be to work through the grieving process.

The more dependent the relationship was, the bigger the chance that problems are going to arise in the working through of the grieving process.

Question 36

How does cause of death play a role in the course of the grieving process?

Answer 36

Death due to unnatural causes or sudden, unexpected death can lead to complicated grief, especially with suicide.

Question 37

How does availability of support play a role in the course of the grieving process?

Answer 37

Support from family, friends and the community increases self-worth and positive relationships with others. It helps the patient to work though the grieving process and lessen any problems, which can occur.

Question 38

Explain Chronic grief.

Answer 38

When the person is stuck in a certain phase of the grief process and can therefore not complete the grief process

Question 39

Explain Delayed grief.

Answer 39

Grief was experienced emotionally but not in correlation with the loss. The person may in a later stage with another lesser loss, experience exaggerated grief.

Question 40

Explain exaggerated grief

Answer 40

The duration and intensity of grief are indicators of abnormally. Anxiety, phobias, as well as depression and helplessness is seen here. Irrational despair can occur.

Question 41

Explain disguised grief.

Answer 41

Repressed grief reactions can sometimes manifest as physical symptoms or abnormal behaviour. People who don’t allow themselves to experience the pain of the loss can develop psychosomatic pain.