The Basics of Grief. Worden (1991) What should we expect from someone who is grieving?

Transcription

1 The Basics of Grief What is grief? After the death of someone close to them, most people experience grief and go through a period of mourning. How people grieve is affected by a number of factors, such as their relationship with the dead person, the way the person died, personality and coping style, age, gender, religious beliefs, cultural background, previous experience of loss, other stresses and the type of support available. Although everyone grieves in their own way, it has been suggested that there are four tasks of mourning. Accepting the reality of the loss realising that the person is dead and won t be coming back. Seeing the body and rituals like the funeral can make this easier. Working through the pain of grief allowing time to experience the feelings and emotions. Trying to avoid or suppress feelings may make grieving harder in the long run. Learning to live without the dead person this may involve taking on new roles or learning new skills. Moving on with life finding a new place in your emotional life for the person who died so that you can adapt to a different future without their physical presence. Worden (1991) What should we expect from someone who is grieving? As outlined above, everyone grieves in their own way, but as they undertake the four tasks of mourning, there may be certain reactions, behaviours and emotions which we shouldn t be surprised to see occur. 1. Dealing with a loss can often seem an unreal experience and it may take time for the reality of the situation to sink in. Someone who is grieving may find it difficult to adjust to the loss in their life, and therefore may keep referring to the deceased in the present tense. Talking to others about the loss, and attending the funeral and/or memorial will help to embed the reality of the loss, and allow the bereaved to accept it. 2. When someone dies, our initial response is usually a range of emotions. If the death is unexpected then we may be numb, shocked and unable to comprehend or take in the reality of the situation. Other emotions we may experience can include disbelief, anguish, pining, sadness, anger, guilt, relief, despair and fear. These emotions can flood us all at once leaving us feeling overwhelmed and confused, and/or we may experience the emotions in the

2 form of a process that we work through. Working through the emotions of grief can be externally demonstrated, rather than just being an internal process. For example, a bereaved person may act out of character (i.e. displaying anger for no real reason) whilst they work through their emotions. 3. A key element of dealing with bereavement is restructuring and redefining life following the loss. If a death of a family member occurs, the family structure will be altered. Initially this will feel like a void that can t be filled, but with time the relationships will adapt and restructure as we adapt to life without the deceased person. In a physical sense, this may mean that we have to take on some responsibilities or activities that the deceased person used to do. 4. Moving on with life doesn t mean forgetting the person who has died. In order to move on, we need to go through the process of redefining the relationship we have with the deceased, so they are still a part of our lives but not in the here and now.

3 Determinants of grief Relationship... How was the deceased related to the child and what do we know about the attachment? We can understand more about depth of grief response if we understand the intensity of the relationship and the type of attachment. Grief at losing a parent may manifest differently than the grief expressed at losing a less pivotal relative. Security of the attachment...did the deceased provide a security for the bereaved child which is now lost? Were there feelings of ambivalence within the relationship between the deceased and the child? Alternatively was there conflict in the relationship which felt unresolved at the time of death? Mode of death...how someone has died contributes to the grief response. According to NASH categories there are four types of death; natural, accidental, homicidal, and suicidal. Determinants such as whether the child played any part in the deceased s accidental death, or whether the griever was able to say, goodbye at the conclusion of a protracted terminal illness have a profound psychological and emotional affect on children and young people. Personal variables and historical events...factors such as prior unresolved grief as a result of death, divorce, relationship breakdown or illness also play a part in determining how individuals respond to loss and grief. Similarly personal variables such as age, sex, ability to communicate feelings, ability to manage stress and anxiety, and ability to access support also impact on the individual s style of coping with bereavement. Social variables...ability to access support, perceived level of social support and actual levels of social support are huge determinants in whether individuals are able to grieve in a healthy way. Studies have shown that if bereaved individuals feel that they are supported during their grief journey they are more likely to have better outcomes. Concurrent stressors...additional daily life stressors such as loss or reduction of family income due to parental death, or concern over school performance can further contribute to feeling overwhelmed by the loss and grief experience. Rituals and religious beliefs...has the child or young person played any part in the decision making process concerning burial or committal? Have they been given an opportunity to see the deceased after death? Does the child have any beliefs that would either bring comfort or hinder their bereavement experience? (Adapted from Parkes and Weiss 1983 in Worden 1996: pp31-34).

4 All of these variables have huge implications on the type of support offered to the child or young person, and especially in relation to the type of therapy offered. For some clients it is more important to challenge feelings of guilt and shame surrounding the death, whereas for others the emphasis might be on unravelling confusion about the death and beginning the journey of saving memories about the deceased. Stokes (2004) argues that no matter what the pre-determinants of grief are, and no matter what the psychological antecedents, there are a number of realities for grieving children. Grief is unique to the individual and the situation Supporting someone through the grieving process is challenging, particularly because it is such a unique experience. There is no magic formula, no cure to fix everything and you may find yourself having to try a variety of techniques in your supportive role. One constant element that you can provide is to be human, caring and responsive to the needs of the bereaved individual. The grief that a bereaved person experiences will reflect the relationship they had with the deceased, leading to a number of variables in the individual journey of bereavement that they will take. It is important to remember that grief is vital as it is the process of saying goodbye to the person who has died. Key points to remember The raw feelings of grief and overwhelming emotions don t last forever, but the sadness may always be there There is no time limit to getting through the grieving process and feeling better it takes as long as it takes Talking helps to get through bereavement talk about the deceased and don t shy away from saying their name or encouraging reminiscence about them The experience of loss and grief can impact upon all areas of a person s life including physical, emotional and mental health, including their ability to learn and function normally.

5 Secondary Losses The concept of grief as a personal phenomenon is not new. In 1917 Sigmund Freud described loss as an injury to the individual. McCabe (2003) defines grief as being concerned with, injury, suffering, trouble, or disaster; the injury or suffering is as a result of that trouble or disaster. These definitions are significant in understanding the grief which might be experienced by children. It is not only the loss of a parent or loved one that impacts on the child s life, but also the ramifications of that loss. The child who experiences the death of a parent may then experience secondary losses associated with losing a primary care giver. Secondary losses are evident in practical day to day activities which can totally change the bereaved child s way of life. For example, if the deceased was the only person in the household who could drive, this could transform the way of life for the child. If the deceased was the only person in the household who could cook, then the child may take on some of the cooking duties, meaning that part of their childhood has been lost as they are having to take on adult responsibilities. This type of secondary loss can be experienced to an extreme level where the deceased was the only parent, meaning that the child loses their home, maybe has to move out of the area they live in, change schools and potentially go into foster care or live with another relative. Secondary losses are also evident through the loss of hopes, dreams and expectations for the future. No longer being able to think about having your dad teaching you how to drive or picking out your wedding dress with your mum are rites of passage for your future which are no longer possible. Another type of secondary loss is when the surviving parent meets a new partner, and this person becomes part of the redefined family. If the new partner has children who become part of the family, the child will have lost their original role within the family setting. This will also be the case when a sibling dies, leaving the remaining sibling as an only child and no longer with the role of brother or sister. Secondary losses could be the loss of a gender role model. This is where the child or young person has lost the primary care giver who was their main male or female role model. Finally, secondary losses are also evident when children are with their peers who are being supported by their parents. For examples, when other mothers are able to help make the costume for the school play or bake cakes for the school fair, or when the other dads take part in sports day.