When we
experience the death of someone we love, there are many emotions that we can
experience – indeed, they may seem to be contradictory, even in in the same
grieving journey.
It is important
to recognise that everyone has their own journey bereavement, compared to other
people experiencing the loss of the same person and compared to themselves in
grieving for another person.
In trying to
understand what is going on in our lives, there have been numerous theories and
models of grief, some which I have described in this article.
Elizabeth
Kübler-Ross
This theory is
one of the more recognisable ones. Her book, On Death & Dying: Finding
the Meaning of Grief through the Five Stages of Loss published in 1969,
states that there are five stages of grief, which are:
1.
Denial
– is a conscious or unconscious refusal to accept facts, information, reality,
etc., relating to the situation concerned. The world and its consequences look
messy and cannot be comprehended. It is a natural defence and perfectly natural
for it can help us pace our feelings of grief and allows us to handle as much
grief as we are able at that moment. This stage allows people to ask questions
and so the healing process is actually initiated. It is at the weak points that
we become stronger; it is our doubts that we can become more certain. Some
people can become locked in this stage when dealing with a traumatic change
that cannot be ignored. Death, of course, is not particularly easy to avoid or
evade indefinitely.
2.
Anger
– can manifest in different ways. People dealing with emotional upset can be
angry with themselves, and/or with others, especially those close to them. Anger
can seem to have no limits but it can be the anchor that underpins their
feelings, giving a structure to the emotions that are whirling around like a
maelstrom within them. It can be positively viewed as an indicator of the depth
of the person’s love for the person who has died – it is the bridge that
connects the two people. Knowing this helps us keep detached and non-judgemental
when experiencing the anger of someone who is very upset.
3.
Bargaining
– is traditionally the stage for people facing death that involves attempting
to bargain with whatever God the person believes in. People facing less serious
trauma can bargain or seek to negotiate a compromise. For example, ‘Can we
still be friends?’ when facing a break-up. Bargaining rarely provides a
sustainable solution, especially if it is a matter of life or death. The two
common expressions become ‘If only….’ and ‘What if…’ as people want life to
return to what is was, a restoration to the version that they were happy with
as they want the dying person to be healed and for things to be as they were
before. In this stage, guilt is often the driving force as the person finds fault in themselves and
consider how they could have acted differently.
4.
Depression
– is also referred to as preparatory grieving although it often feels as though
there is no end in sight. In a way, it is the dress rehearsal or practice run
for the ‘aftermath,’ although this stage means different things depending on
whom it involves. It is a sort of acceptance with emotional attachment. It is
natural to feel sadness and regret, fear, uncertainty, etc. It shows that the
person has at least begun to accept the reality.
5.
Acceptance
– is a stage that again varies according to the person’s situation, although
broadly it is an indication that there is some emotional detachment and
objectivity. It does not mean that people have come to full terms with what has
happened because they will always feel the acute loss of the person that they
have loved. It is a matter of adjusting to the new situation where the hopes
and dreams for the future are having to be adjusted because the loved person is
no longer there. It could be simply
having more good days than bad days. We can never replace the person but life
goes on with the influence and character of the deceased person still in our
hearts as we make new connections, new meaningful relationships and new
interdependences. People who are dying can enter this stage much sooner before
the people they leave behind, who must necessarily pass through their own
individual stages of dealing with their grief.
The stages of
grief are not meant to be neat packages, but an explanation of what people may
be going through. It is not a system where people go through the stages in
order because everyone deals with grief in different ways in different
circumstances.
However, these
stages will be recognisable to those people who mourn as emotions that they
will identify with. It is not a linear course; indeed, these stages may be
revisited throughout the bereavement journey on numerous occasions.
William
Worden – Four Tasks of Mourning
In his book Grief
Counselling and Grief Therapy, Worden lists the tasks as being:
Task 1 – To
accept the reality of the loss
There can be
basic steps of achieving this task, such as attending a funeral or memorial, or
beginning to think about the deceased person in the past tense. On a more
complex level, it is understanding and accepting the loss of the relationship
that was present, with the impact that it will have on those who mourn.
The matter
could be complicated if the grieving have to try to comprehend how the person
died, especially if it was by means that is socially unaccepted or awkward like
suicide or substance abuse.
Task 2 – To
work through the pain of grief
This task is
purposefully broad because it is acknowledged that everyone’s bereavement is
unique to them with the whole gamut of emotions. It is when heartache is felt
as the person is usually numb before this task. It is important to acknowledge
these emotions, to talk about them and attempt to understand why these feelings
are present. It is imperative that there is no denial and avoidance of them,
seeking specialist assistance if required.
Task 3 – To
adjust to an environment in which the deceased person is missing
The task can
mean different things to different people depending on the relationship that
was present, as well as the roles that are impacted by the death of the person.
The readjustment will occur over a long period of time.
Task 4 – To
find an enduring connection with the deceased person while embarking on a new
life
The bereaved
person is to find an appropriate, ongoing connection with the deceased person,
whilst allowing the person left behind to find a new normal whilst
acknowledging the impact that the loved person has had on their lives. It is to
encourage those who are mourning to seek a new meaningful life that will be
different to the one that they had before or had envisioned.
William Worden
stated that mourning will be complete when all four of these tasks had been
accomplished.
Margaret Stroebe
and Henk Schut - Dual Process
This process
deals with two aspects of the response to a bereavement described as ‘Loss
Orientated’ and ‘Restoration Oriented.’ It recognises that that grief is more
dynamic in that a person’s personal circumstances and character may mean that
the grieving person may not choose or find it convenient to work through the
pain of grief immediately.
‘Loss
Orientated’ includes such activities such as yearning/crying, talking
therapies, intrusive thoughts, expressing anger.
‘Restoration
Orientated’ includes activities such as learning to shop for oneself,
identifying new roles and implementing them.
The theory
states that the grieving person oscillates between the two responses in order
to manage daily life, which is wild in the early weeks and months (as is
normal) before it is less pronounced and settles down. If it continues to
oscillate wildly or is stuck on either side, specialist help will be needed.
Dennis
Klass, Phyllis R Silverman and Steven Nickman – Continuing Bonds
The maintenance
of an ongoing attachment/connection with the deceased person is an integral
part of the successful adaptation to loss. The ongoing attachment may be
experienced through linking objects, symbolic conversations, meaningful
rituals, reminiscence work, etc.
The three areas
that could be considered are:
·
Remembering
special times with fondness
·
Remembering
the loved one’s personality and characteristics (both good and bad)
·
Remembering
the impact that they had on the bereaved person’s life
The ‘continuing
bond’ recognises that the person has died and will not be returning, so it is
not the avoidance or idealisation of the situation but it is rather a mechanism
for internalising or relocating the deceased person.
Lois Tonkin
– Growing around Grief
As the bereaved
person adjusts to their changed circumstances, there is the potential; for
‘growing around grief.’ Rather than the pain of grief deceasing over time and
so becoming neat and manageable, the facts is that the pain remains potentially
as powerful as in the acute stage (as experienced on significant anniversaries,
etc.), but the grieving person’s grief can grow to accommodate the pain,
without the pain dominating day to day as it did in the early days of the
bereavement.
Robert
Neimyer – Meaning Reconstruction
Neimyer tells
of meaning-making, whereby we try to find a way of understanding what has
happened and give the person, the situation, the death, some meaning.
Such meanings
can be sought and obtained in a number of contexts (individual, family,
community) and often have a particular spiritual and/or cultural significance.
Examples that
are given are the song that is played on the radio, the white feather in the
street, the robin in the garden, the fundraising event or the support group we
give time to.
Linda Machin
– Reminiscence Work
Machin tells of
the ranges of response to loss, whereby people are usually on a continuum of a
core grief reaction between overwhelmed and controlled against our coping
mechanisms of vulnerability and resilience. Understanding the ranges of
response to loss helps the bereaved person to understand why they reacted in a
particular way.
Colin Parkes
– Phases of Grief
This process
builds upon the Bowlby attachment theory, that takes into account our individual
history, experiences and particularly the relationship with the deceased
person, which will result in the adjustment to our lives.
The four phases
are:
1.
Shock
and numbness – can initiate impaired judgement and so result in short periods
of concentration. This aspect is perhaps the first and only manifestations of
grief that are apparent externally. It is a protective process that the
subconscious utilises in order that the grieving person can cope with the loss
using their own experience and frame of reference. At this point, people will
still be able to function, but it will probably be on autopilot.
2.
Yearning
and Searching – is identifiable with the feelings of restlessness, anger, guilt
and uncertainty. During this phase, people may want to withdraw and left alone.
Alternatively, they may want to ask many questions about how and why, so trying
to make sense of what has happened.
3.
Disorientation
and disorganisation – is often associated with the feeling that nothing seems
‘right’ or appears to be surreal. The context is the real sense of feeling
unsettled, confused and perhaps anxious or depressed. It is at this stage that
the loss is realised. It is also the time when physical and functional problems
may become more pronounced, with people possibly struggling with self-care and
practical issues.
4.
Reorganisation
and resolution – is the phase where there is notable increase of energy,
decision-making abilities and sense of self-confidence and focus. Parkes makes
the point that no-one gets over the death of the person, but the person manages
to get through the process.
Sigmund
Freud
Freud believed
that by internalising our relationship with the deceased person and working
through our memories, emotional links and ties, the bereaved person would
understand their relationship and could slowly reinvest in other relationships.
The four tasks
that he identified were:
a.
To
truly recognise and accept the loss
b.
To
mourn the loss and give expression to the grief
c.
To
perform the new tasks of life that loss forces us to take
d.
To
look at a new kind of future
The journey is
emphasised as being unique to each grieving person and each situation.
Gerard Egan
– The Skilled Helper
Egan developed
a three stage model that can adopted when walking with the bereaved person:
Stage 1:
Exploration – creating a warm, trusting relationship with the person, allowing
them to explore whatever issue they choose. It is important to approach the
issue from their perspective and worldview.
Stage
2:Understanding – be alongside the person as they come to terms with the
situation with a new understanding, from different perspectives, with
alternative information.
Stage 3: Action
– look with the person at the possible ways of ‘being’ in the situation. It is
similar to Parke’s reorganisation stage. There would be an assessment of risks
and potential outcomes, and the evaluation of the effectiveness of the new
strategies and behaviours.
Carl Rogers
– Person Centred
This theory can
also be used by people walking with the bereaved person.
It has the
essential ‘core conditions’ that enables the grieving person to feel that they
are being cared for and being listened to, enabling that person to find their
own solutions and way through the acute grief.
The three core
conditions are:
Congruence –
(being genuine/real, true to self, so enabling the grieving person to feel safe
enough to be themselves)
Empathy –
(being able to put yourself in someone else’s shoes whist simultaneously
remaining rooted)
Unconditional
Positive Regard – (acceptance of the individual/being non-judgemental)
In order for
change to occur, all the core conditions (of which there are six) must be in
position. The instruments used to obtain this objective include reflection,
active listening, asking open question and summarising.
Denver Grief
Institute - The Grief Wheel
This simple
tool can help those bereaved person as it is simple to use. Its advantage is
that it reassures that person that others are going through similar emotions
after a bereavement.
The process can
take one year, although typically it will take two years. A person may enter
the ‘loss’ stage at any time after a bereavement following the realisation or
awareness of an actual or impending loss. The wheel highlights four stages:
·
Shock
– when the reality of the loss is too much to comprehend
·
Protest
– wondering how the loss can be real (even though it is)
·
Disorganisation
– with the possible loss of meaning or faith, or experiencing depression
·
Reorganisation
– control over the balanced memories, discovering new meaning to life.
Kenneth J Doka
– Disenfranchised Grief
Some losses are
not or cannot be openly acknowledged, publicly mourned or socially supported,
with the result that the bereaved person can feel isolated and so a complicated
grief reaction occurs.
Examples of
‘disenfranchised grief’ might include:
·
Death
through murder or suicide
·
People
with learning difficulties
·
Secret
or private relationships not based on recognisable kin-ties
·
Stigmatised
deaths (AIDS, drink-driving, alcohol/drug abuse, miscarriage/stillbirth/child
death, abortion)
Ted Bowman –
Shattered Dreams
An important
challenge for many bereaved people concerns ‘shattered dreams’ – the loss of an
imagined future, or the need to re-evaluate certain assumptions about
relationships, roles, beliefs, security in the light of the recent death.
Michael
White – Saying Hello
Instead of
‘saying goodbye,’ the bereaved person’s task is the opposite – to say ‘hello.’
By reclaiming their relationship with the person who has died, the bereaved
person can help resolve the sense of emptiness that they feel, can re-find
themselves in a changed world and can re-position themselves in relation to the
death of a loved one, so generating new meanings in the process.
Nancy Moos,
Gordon Riches and Pamela Dawson – Family Systems Theory
Through social
interaction, families develop enduring stories and beliefs which represent the
group collectively and offer a degree of continuity and normality. The loss of
the family member impacts on a number of inter-related levels including:
·
Communication
patterns
·
Status
and hierarchy
·
Decision-making,
power and control
·
Collective
belief systems and coping strategies
·
Individual
relationships
‘Systems
models’ stress the influence of the family on how the death is perceived,
whether the grief can be openly expressed and shared, and the continued
involvement of the deceased person on the family’s future functioning and
development.
W R Butler
and K V Powers – Solution-Focused Grief Therapy
The bereaved
person who chooses to change can have the resources to do so and so can set
achievable goals. ‘Solution-focused’ ideas and techniques can serve to assist
the change process and include:
·
Future-orientated
questions
·
Exceptions
(occasions when the problem is absent or less)
·
Scaling
questions
·
Task
setting
Tony Walter
– Bereavement and Biography
The bereaved
person’s goal is to construct a ‘story’ or narrative that places the deceased
person within their ongoing life – a ‘story’ capable of enduring through time,
hence the deceased person is lost and then re-found, rather than clung onto
before being ultimately relinquished.
Examples from
other cultures and societies are highlighted where the notion ‘no-one is truly
dead if we remember them’ is prevalent. By constructing this story, the
deceased person has a number of ongoing roles:
·
As
a role model
·
As
a sage and mentor
·
As
a clarifier of the individual and family’s values/belief
·
As
a valued part of the bereaved biography
Therese A Rando
– Anticipatory Mourning
Anticipatory grief
occurs when there is the opportunity to anticipate the death of a loved one.
Preparing for the loss offers the potential benefits of;
·
Improving
family communication
·
Dealing
with unfinished business
·
Reinforcing
the reality of the situation
·
Saying
goodbye
·
Seeking
and obtaining a wider range of support options
·
Planning
for the future
Susan Le
Poidevin – Multi-dimensional Adjustment to Loss and Change
Adjustment to
loss relates to different time frames, is multi-dimensional and is individual
in nature.
The following
is suggested:
·
The
bereaved person will strive to strike a healthy balance between ‘functioning
work,’ ‘grief work’ and ‘growth work’ with the balance of the three changing
over time.
·
In
adjusting to the loss, the bereaved person will also strive to strike a healthy
balance between ‘learning from the past,’ ‘living in the present’ and ‘planning
for the future.’
·
The
grief exploration takes place in five time periods
-
Adjustment
to previous loss and change
-
Adjustment
in preparation for the loss
-
Adjustment
at the time of loss
-
Adjustment
since the loss
-
Adjustment
to future loss and change
In
each time period, there are nine dimensions of adjustment to consider
(intellectual, psychological, emotional, spiritual, physical, behavioural,
social/cultural, sexual and practical).
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