“Normal” Grief is
- Our understanding of normal grief comes from many research studies and theorists
- Concepts of “normal” or expectable grief are influenced by culture
- Studies of grief have primarily focused on bereavement, or grief in reaction to death
- Not in reaction to symbolic loss
Our understanding of normal grief comes
from many research studies and theoristsOur understanding of normal grief comes
from many research studies and theorists
Early Psychodynamic Theories
- Sigmund Freud (1917), “Mourning and melancholia”
- Identified cathexis as the process through which the infant develops attachments
- Decathexis is the process of “letting go” of the emotional attachment
Later Psychodynamic Theories
- John Bowlby (1973), elaborated on Freud’s theory of attachment and loss
- Observed that infants and children display “searching” behaviors when separated
- From attachment figures
- Grief is the reaction of the bereaved to the loss of the significant other
Research on Grief
- Lindeman studied bereaved who lost family in the Coconut Grove nightclub fire
- Common reactions in the acute period following the death included physical
- Or bodily distress, preoccupation with the image of the person who had died, anger
- Or hostility, guilt, and impaired functioning
- Elizabeth Kubler-Ross (1969) studied individuals diagnosed with terminal illnes who were facing (anticipating) death
- Identified “stages” people experienced as they adjusted to the knowledge that they would die
Elizabeth Kubler-Ross (1969) studied
individuals diagnosed w
Elizabeth Kubler-Ross (1969) studied
individuals diagnosed with terminal illnes
Kubler-Ross’s Stage Model
• Individuals go through 5 stages in anticipation of their own death
–Denial
–Anger
–Bargaining
–Sadness
–Acceptance
Contemporary Grief Practitioner/Theorists
Therese Rando (1984) “Grief, dying and death”
- Posits that grief results in reaction to symbolic loss & in reaction to death
- Notes that many individuals and families seeking psychotherapy have grief
– In reaction to unresolved loss from the past
William Worden (2009). “Grief Counseling and Grief Therapy”
- Distinguishes between “normal” and “complicated” grief
- Recommends Counseling for normal grief
and Grief therapy for “complicated” grief
Worden’s Task Model of Grieving
- Accepting the loss
- Experiencing the pain of loss
- Adjusting to the new environment without the deceased
- Finding an enduring connection with the deceased in the midst of a new life
Complicated Grief
• Complicated grief can take many forms
– Absent grief (i.e., grief and mourning processes are totally absent)
– Inhibited grief (a lasting inhibition of many of the manifestations of normal grief)
– Delayed grief
– Conflicted grief; chronic grief
Risk Factors for Complicated Grief
- The circumstances surrounding the loss (Disenfranchised losses- stigmatized)
- Perceived lack of social support (unacknowledged losses)
- High profile losses
- Multiple stressors (financial, dislocation, change in employment status)
Risk Factors for Complicated Grief in Children and Adolescents
- Suddenness of loss
- Gender of the bereaved child and the deceased parent
- The existence of an intense, overly close relationship to the deceased or
- A highly ambivalent relationship to the deceased
Families at Risk
Kissane (1998) classified 5 types of family responses to death & labeled maladaptive
– Responses as those involving hostile or sullen reactions characterized by high family conflict,
– Low expressiveness & poor expressiveness
– 12-item Family Relationships Index was found to be an effective risk screening tool
Diagnosis of Complicated Grief
• No complicated grief in the DSM (IV-TR)
– Depression is the diagnosis used if grief is more complicated than “normal”
– Bereavement is identified under the V codes (a focus of clinical attention)
– Complicated grief is under consideration for the next edition of DSM (V), expected in 2013
Complicated Grief Symptoms
• Criteria being considered for the diagnosis include:
– Feeling that part of oneself has died
– A shattered worldview (e.g., lost sense of security, trust, control)
– Excessive irritability, bitterness, or anger related to the death
Interventions for Complicated Grief
• It is important to make referrals to mental health specialists for grieving clients
– Whose functioning is impaired and might be at serious risk as a result of complicated grief
• Professionals who provide these grief interventions can be identified through
– A hospital, hospice, or mental health agency
