GRIEF

GRIEF

1. DEFINITIONS

   • Bereavement: objective situation of loss
   • Grief: affective response to loss
   • Mourning: acts of expression of grief (culturally defined)

2. Models of Grief

   • Normal Grief
     • Phase Model (Stroebe)
       • Four phases that need to be progressed through
         • Shock and Disbelief
         • Yearning and Protest
         • Despair
         • Recovery and Restitution
     • Task Model (Worden)
       • Four tasks that need to be achieved
         • Accept reality of loss
         • Experience pain of grief
         • Adjust to environment where deceased is absent
         • Withdraw emotional energy and reinvest in new relationships
     • Dual Process Model (Stroebe)
       • Loss orentation
       • Restoration orientation
   • Pathological grief
     • Parkes
       • Chronic grief
       • Delayed grief
       • Inhibited grief
     • Parkes and Weiss
       • Unexpected grief syndrome
       • Ambivalent grief syndrome
     • Persistent Complex Bereavement Disorder (DSM5)
     • Pathological Grief Outcomes
       • Mortality rate increase - OR men 1.87/women 1.47 (3 months post widowhood)
         • OR men 1.16/women 1.07 12 months post widowhood
       • Psychiatric and other disorders
       • Elderly - unexpected bereavement mortality OR 1.61 / known morbidity OR 1.21

3. Trajectories through grief (Bonanno)

   • Stable low distress/resilience (46%)
   • Chronic grief 16%
   • Common grief or recovery 11%
   • Depression followed by improvement 10%
   • Chronic depression 8%

4. Determinants of Grief Outcomes (Worden)

   • L A D A V S Loss, attachment, death, antecedent. variables, social, stressors
   • Extent of the loss
   • Nature of attachment
   • Mode of death
   • Historical antecedents
   • Demographic and personality variables
   • Social variables
   • Concurrent stressors

5. Theories of Grief

   • Psychoanalytic
     • Grief frees the person from libidinal attachment to the deceased
   • Attachment Theory
     • Detachment from unavailable figure (as in childhood attachment)
   • Assumptive World (Parkes)
     • Relinquishing assumptions about future and building new ones
   • Behavioural
     • Loss of reinforcement
   • Learned Helplessness
     • Loss of control/nothing can produce desired outcome
   • Stress and Crisis Models
     • Adapting and developing new coping strategies to manage the loss

6. Grief Couselling

   • Roles
     • Normalise experience
     • Support expression of feelings
     • Provide time to grieve
     • Assist living in presence of loss
     • Exposure therapy
     • Continuing support
     • Identify pathological grief responses
   • Efficacy
     • helpful for self-referred clients and recently bereaved