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

2. 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 (p ) The Salvation Creek (in Mallon 2008)
Edvard Munch 1896: The Sick Child

3. “How people die remains in the memory of those who live on” Dame Cicely Saunders (1918-2005)
Introduce the notion that grief , loss and bereavement are shaped by approaching death, sudden death and by how we are told and what we are about the death.

4. 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

5. 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

6. 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

7. 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

8. 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

9. Worden (1982, 2001) Grief Counselling and Grief Therapy
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

10. 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

11. 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

12. Dual Process model Oscillation Restoration Loss 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

13. Range of Response to Loss model (Machin)
Conceptualises patterns in grief
Overwhelmed
Balanced/Resilient
Controlled

14. 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 be
Controlled
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’

15. 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

16. Feelings are powerful and persistent
‘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
Control
Mechanisms for subduing distressing emotion fail and action becomes difficult
Overwhelming
Feelings are powerful and persistent

17. (Accessing and effective use of social resources)
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)

18. Influenced by sociological concepts of constructivism
Continuing bonds
Influenced by sociological concepts of constructivism
Maintaining or reinterpreting emotional bonds with the deceased is normal

19. 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

20. When grief gets complicated
Attachments
The nature of the death
Unable to make sense or meaning of the loss
Rumination

21. 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

22. Thank you