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Contemporary influences shaping our understanding of grief, loss and bereavement . Anita Sargeant PhD. Anticipatory loss.

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contemporary influences shaping our understanding of grief loss and bereavement

Contemporary influences shaping our understanding of grief, loss and bereavement

Anita Sargeant PhD.

anticipatory loss
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

slide3

“How people die remains in the memory of those who live on”

Dame Cicely Saunders (1918-2005)

changes in our understanding
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
Psychoanalytical concepts

Freud (1917) Mourning and Melancholia

  • Introduced grief work hypothesis

Withdraw 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
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
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 theories8
Development of stage and phase theories

Kubler-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
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

Criticisms of stage/phase based models
coping the dual process model stroebe and schut 2001
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
Dual Process model

Restoration

orientation

Controlled distraction

Doing new things

Attending to day to day needs

Avoidance of grief

Loss orientation

Grief work

Breaking bonds,

intrusion of grief

Avoidance of restoration

changes

Oscillation

range of response to loss model machin
Range of Response to Loss model (Machin)

Conceptualises patterns in grief

  • Overwhelmed
  • Balanced/Resilient
  • Controlled
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

Common elements of resilience (Machin 2007)
the tension between powerlessness and attempts to regain power machin 2009

Vulnerability

‘The tension between powerlessness and attempts to regain power’ (Machin 2009)

Tension between the Overwhelmed feelings which can not be subdued and the pull of control

Control

Mechanisms for subduing distressing emotion fail and action becomes difficult

Overwhelming

Feelings are powerful and persistent

key objective of working with vulnerability and encouraging resilience machin 2009 p149
Key objective of working with vulnerability and encouraging resilience (Machin 2009 p149)

Appraising the possibilities

(Realistic use of control)

Confronting pain

(Facing overwhelmed feelings etc)

Resilience

Support

(Accessing and effective use of social resources)

continuing bonds
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
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
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
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