contemporary influences shaping our understanding of grief, loss and bereavement anita sargeant phd
TRANSCRIPT
Contemporary influences shaping our understanding of grief, loss and bereavement
Anita Sargeant PhD.
Anticipatory loss“I want to run away from this
all. I don’t want to go through it all again, the sense of helplessness, the drawn-out wait for death, the grief that grinds, through every day even while a loved one is still alive…”
Susan Duncan (p336 2006) The Salvation Creek (in Mallon 2008)
Edvard Munch 1896: The Sick Child
“How people die remains in the memory of those who live on”
Dame Cicely Saunders (1918-2005)
Changes in our understanding
• Foundational theories (1950’s-1990’s) – Attachment theory– Grief work– Stages– Tasks of mourning
• Contemporary theories (1990’s-date)– Continuing bonds– Narrative/meaning making– Dual process model– Range of Response to Loss model
Psychoanalytical concepts
Freud (1917) Mourning and Melancholia
• Introduced grief work hypothesisWithdraw from the emotional bond with the deceased
to reinvest the emotional energy in the formation of new relationships
The influence of Attachment Theory in children
• Bowlby (1969, 1973,1980)– Separation anxiety identified– Closeness of relationship increases intensity of
the grief
• Ainsworth et al (1978)– Avoidant attachment– Secure attachments– Ambivalent attachments
Development of stage and phase theories
• Parkes (1971,1993,1996)– Quality of attachment in childhood affects
bereavement in adulthood– The loss challenges the assumptive world of
the bereaved person– Bereavement requires psychosocial transition
Development of stage and phase theoriesKubler-Ross (1969) On death and Dying
• Influential as the first model of its kind– Opened up discussion around death– Easily understandable by healthcare professionals
• Emotional processes interpreted by millions as linear in progression when they are cyclical and interchanging
Tasks of mourning
Worden (1982, 2001) Grief Counselling and Grief Therapy – Provided a practical approach to address the
tasks of grieving • Accepting the reality of loss • Working through the pain of grief • Adjusting to changed environment • Emotionally relocating the deceased
Criticisms of stage/phase based models• Phase models may have been used prescriptively
• tendency for models to be interpreted as linear and prescriptive, leading to perceptions of normal and abnormal
• Have not been seen to accept diversity in response– expressions of grief, timing and duration are variable and shaped by culture
• The expectation of recovery and a return to normal psychological and social functioning.
• Parkes, Kubler-Ross and Worden have modified their theories in light or recent research
Coping – The Dual Process Model (Stroebe and Schut 2001)
• Defines two types of stressor that the bereaved have to manage:– Loss orientated stressors– Restoration orientated stressors
• The dynamic process of grief requires the oscillation between the two stressors
Dual Process model
Loss orientation
Grief workBreaking bonds, intrusion of grief
Avoidance of restorationchanges
Restoration
orientationControlled distraction
Doing new things
Attending to day to day needs
Avoidance of grief
Oscillation
Range of Response to Loss model (Machin)
Conceptualises patterns in grief
• Overwhelmed
• Balanced/Resilient
• Controlled
Range of response to loss (Machin p74. 2009)Social Constructs 1 2 3
Perspective on loss An experience of loss is likely to be Overwhelming
An experience of loss can be met with Resilience
An experience of loss can beControlled
Identification with loss perspective
‘I can not deal with loss and change’
‘I can face loss and change’
‘I can control the consequences of loss and change’
Personal narrative account of loss
‘This loss has taken over my life’
‘Although it is difficult, I know that I have the strength and other people support to help me through this loss’
‘If I divert from this loss I can manage perfectly well’
Response to other peoples losses
‘I have suffered much more than you have’
‘I recognise your pain and hope that, like me, you will find the support you need’
‘Don’t trouble me with your loss. You need to get on with life, as I have’
Common elements of resilience (Machin 2007)
• Personal resourcefulness– Qualities such as flexibility, courage and perseverance
• Positive life perspective– Optimism, hope, a capacity to make sense of
experience and motivation in setting personal goals
• Social embeddedness– Availability of support and a capacity to access it
‘The tension between powerlessness and attempts to regain power’ (Machin 2009)• Vulnerability
Tension between the Overwhelmed feelings
which can not be subdued and the pull of control
OverwhelmingFeelings are powerful and
persistent
Control Mechanisms for
subduing distressing emotion fail and action becomes
difficult
Key objective of working with vulnerability and encouraging resilience (Machin 2009 p149)
Resilience
Confronting pain(Facing overwhelmed feelings etc)
Appraising the possibilities(Realistic use of control)
Support(Accessing and effective use of social
resources)
Continuing bonds
• Influenced by sociological concepts of constructivism
• Maintaining or reinterpreting emotional bonds with the deceased is normal
Continuing Bonds - Neimeyer et al (2001, 2006), Klass (2006)
• Emphasise adaptive function of retaining bonds with the deceased– Culturally sensetive
• Meaning reconstruction – the effort to make meaning of the loss– Complex relearning of connections– Social and communal process
When grief gets complicated
• Attachments
• The nature of the death
• Unable to make sense or meaning of the loss
• Rumination
What shapes our understanding of grief, loss and bereavement?
• Personal development over the lifespan
• Nature of attachments and relationships
• Capacity to cope
• Belief system
• Culture
Thank you