FROM FREUD TO NIEMEYER. How our understanding of bereavement response has changed over the last three decades

Transcription

1 FROM FREUD TO NIEMEYER How our understanding of bereavement response has changed over the last three decades May 2012 Dr Helen Greally

2 AIMS OF DISCUSSION Offer a brief overview of the major theories of grief Consider the theoretical foundations which have contributed to designing effective clinical interventions in the present decade Consider how our personal experiences of loss influence how we respond to stories of loss

3 BEREAVEMENT THE LOSS OF A LOVED ONE THROUGH DEATH (PARKES, 1998)

4 GRIEF The feeling state or the emotional response to loss The affects of the mourning process (Stroebe, 1993) Incorporates diverse psychological and physical manifestations

5 LOSS BEING DEPRIVED OF SOMETHING INVESTED WITH EMOTIONAL ENERGY BY THE SELF (KISSANE, 2000)

6 MOURNING THE PROCESS OF ADAPTATION TO LOSS, WITH PARTICULAR REFERENCE TO THE CULTURAL AND SOCIAL RITUALS (RAPHAEL, 1983)

7 SIGNIFICANCE OF THE LOSS The significance of any loss event is comprised of factors relating to the deceased person, factors in the person grieving and finally the overall contextual environment in which the life event has occurred. There may also be a range of extraneous contributory factors

8 HISTORICAL OVERVIEW The search for a theoretical framework to appropriately understand reactions to irrevocable losses has been the major focus of researchers and theorists in the area of loss and grief for most of the last century

9 Most early writers and researchers interested in the area of loss and grief have adopted a theoretical framework involving stages and/or phases of emotional responses to grief and loss

10 THE MAJOR THEORIES EARLY MODELS (PRE 1990 s) Psychoanalytic model Attachment model Psychosocial Transitions Stage model Tasks of mourning Integrative model

11 Early Theories A series of stages, particularly including an end stage of recovery Absolute universality of the grief response Applies to all in a linear fashion A negative life event

12 Early Theories Cont d Failure to recover is pathological Necessity of severing the ties to the deceased Little or no empirical research and where it exists carried out with specific populations e.g., widows, psychiatric patients

13 GRIEF WAS SEEN AS A process A series of stages or phases requiring completion The result of a relationship that had to be relinquished A negative life experience Possibly pathological

14 Models of linearity finality and normalization, i.e. Grief eventually comes to an end and if it does not it is abnormal The griever completes the stages or phases and lets go of the deceased

15 EVOLUTION OF MODELS Prevailing models of grief up to the late twentieth century generally viewed grief in a very specific way with particular characteristics attached to the event

16 EVOLUTION OF MODELS Cont d Over time, clinicians realised that this formulation did not accurately or adequately reflect what grievers were feeling or thinking In fact, the prevailing models of grief appeared inaccurate, incomplete and even biased

17 EVOLUTION OF MODELS Cont d The primary problem was and is that the early models were unable to account for individual variability among grievers even when they had experienced similar types of bereavement In fact individual variability was labelled pathological as if this is the only explanation

18 EVOLUTION OF MODELS Cont d Beginning in the late 1980 s, researchers such as Stroebe, Wortman & Silver, Neimeyer and Klass began questioning the value of the early models

19 THE MAJOR THEORIES 1990 s Stress and Coping model Dual Process model The Two Track model

20 THE MAJOR THEORIES LAST DECADE Continuing Bonds model Meaning Making Loss of Assumptions Range of Response to Loss

21 CHANGING LANDSCAPE Shift from: Purely intrapersonal to interpersonal Clinical to biopsychosocial Descriptive accounts to mediating factors

22 CONTEMPORARY THEORIES The grief response is not universal to all Prolonged grief is not pathological Severing the bond is not necessary for healthy grief and in fact maintaining the bond may be a healthy response to grief

23 Contemporary Theories Cont d Role of resilience in coping Importance of identifying vulnerable individuals which has led to the development of scales to measure bereavement response Individual responses which differ from the norm may not be pathological

24 Contemporary Theories Cont d Importance of meaning making The role of the continuing bond Adaptation over time The role of intensity and duration in identifying at risk grief responses

25 SOME NOTES OF CAUTION Klass(2006) reminds us that continuing bonds does not guarantee beneficial outcomes A recent study by Field and Filanosky(2010) distinguished between internalised e.g. mental representations, and externalized expressions, e.g. illusions that the deceased is alive, finding that only the former is associated with better outcomes.

26 SOME NOTES OF CAUTION Cont d One size does not fit all! We should not prioritize attachment over detachment Some bereaved people like prescriptive solutions because it may help them to feel they are in control.

27 SOME NOTES OF CAUTION Cont d Perhaps one of the functions of the older models was to give meaning to some of the common behaviours in grief, e.g., Do the bereaved tell and retell their story of grief not only to make sense of their loss as proposed by Neimeyer but also as a way of compensating for the lack of physical presence of the deceased

28 SOME NOTES OF CAUTION Cont d It is probably true to say that, the majority of the bereaved who had reasonably intact relationships with the deceased, are more intensely involved with them in early bereavement than they were when the person was alive. What is the function of these thoughts, feelings and behaviours?

29 COMMON FEATURES ACROSS THE MODELS Description of grief common to all, i.e., The difficult emotions of grief That in normal grief some type of confrontation of the reality of the loss is necessary Relationship to the deceased is very important in deciding the outcome

30 TOWARDS A NEW THEORY OF GRIEVING Shift towards idiographic approaches and away from stage models of grief The growth of qualitative research Concepts such as making sense, resilience and forming a new identity

31 TOWARDS A NEW THEORY OF GRIEF Cont d Adoption of non pathological ways of viewing individual differences A focus on ways of continuing a relationship with the deceased A narrative model of grieving Active rather than passive process

32 IMPLICATIONS FOR PRACTICE Recommendations for practice in bereavement care can only be derived from empirically derived models of bereavement because evidence based practice must be rooted in evidence based theories

33 SUMMARY In summary then, we can see that there are a range of theoretical models that can be used to explain the phenomena witnessed when observing the bereaved

34 SUMMARY Cont d The contribution of social and cultural influences is clear and the family both influence these and generally form a key source of support Family functioning is obviously relevant

35 SUMMARY Cont d Central to and most distinctive about newer perspectives is that when one is grieving, there is no compelling reason to let go, or move on from either the deceased or more importantly aspects of the relationship one shared with that person.

36 ASSUMPTIONS The loss of core assumptions is one of the major and overriding tasks in adaptation to all kinds of losses What is lost in bereavement: Predictability, Control and Permanence Failure to address this issue can mean the griever is unable to make sense of the loss

37 ROLE OF INTERPETATIONS IN BEREAVEMENT RESPONSE This can be one of the most important features in the bereavement response How the bereaved choose to interpret what happens around them when they are grieving can have a significant impact on their response

38 CONCLUDING THOUGHTS How do the bereaved learn to live with the deceased in their physical absence rather than their physical presence? Is the main role of the bereavement support person to help the bereaved develop some way of accommadating this fundamental and sometimes overwhelming adjustment?

39 ESSENTIAL NEEDS OF THE BEREAVED The need for time The need for non-judgement The need to make sense The need for self-belief The need to continue the bond to the deceased in whatever way makes sense to them.

40 CHALLENGES How do we help people cope with loss? Prescriptions or do it yourself? How much bias do we bring to the work based on our own griefs

41 If you're walking down the right path and you're willing to keep walking, eventually you'll make progress. Barack Obama

42 REFERENCES Parkes, C. (1998). Bereavement: Studies of Grief in Adult Life. Madison CT. National Universities Press Stroebe, W. & Stroebe, M. (1993) Pgs in The Handbook of Bereavement Kissane, D. (2000) Death and the Australian Family. Pgs in Death and Dying in Australia

43 References Cont d Raphael, B. (1983). The Anatomy of Bereavement. Klass, D. (2006). Continuing conversation about continuing bonds. Death Studies, 30, Field, N.P. & Filanosky, C. (2010). Continuing bonds, risk factors for complicated grief and adjustment to bereavement. Death Studies, 34, 1-29.

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