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

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

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

Page 1: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

Contemporary influences shaping our understanding of grief, loss and bereavement

Anita Sargeant PhD.

Page 2: 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

Page 3: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

Dame Cicely Saunders (1918-2005)

Page 4: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

Page 5: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

Page 6: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

Page 7: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

Page 8: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

Page 9: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

Page 10: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

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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

Page 12: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

Page 13: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

Range of Response to Loss model (Machin)

Conceptualises patterns in grief

• Overwhelmed

• Balanced/Resilient

• Controlled

Page 14: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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’

Page 15: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

Page 16: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

‘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

Page 17: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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)

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Continuing bonds

• Influenced by sociological concepts of constructivism

• Maintaining or reinterpreting emotional bonds with the deceased is normal

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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

Page 20: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

When grief gets complicated

• Attachments

• The nature of the death

• Unable to make sense or meaning of the loss

• Rumination

Page 21: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

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

Page 22: Contemporary influences shaping our understanding of grief, loss and bereavement Anita Sargeant PhD.

Thank you