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Theories & Concepts of Grief


Theories & Concepts of Grief Complicated Grief Reactions (Worden, 2002) Chronic Grief Reaction Delayed Grief Reaction Exaggerated Grief Reaction Masked Grief Reaction ... – PowerPoint PPT presentation

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Title: Theories & Concepts of Grief

Theories Concepts of Grief
Auden on Grief (W.S.Auden, 1940)
Complicated Grief Reactions (Worden, 2002)
  • Chronic Grief Reaction
  • Delayed Grief Reaction
  • Exaggerated Grief Reaction
  • Masked Grief Reaction
  • Prolonged, no appropriate outcome
  • Grief at time of loss inhibited, suppressed,
  • Excessive disabling may lead to phobia
  • Symptoms or behaviors including complete absence
    of grief

Task based model for coping with dying (Coor
  • Physical
  • 2. Psychological
  • 3. Social
  • 4. Spiritual
  • Satisfy bodily need, eliminate distress, maintain
  • Maximize psychological security, autonomy, and
  • Sustain and enhance significant interpersonal
  • Address issues of meaningfulness, connectedness,
    transcendence to foster hope

Five Fears of Death (Doka, 2002)
  • Dying Process
  • After death judgment bodily disposition
  • Leaving others behind
  • Particular kind of death
  • Fear of death itself which includes
  • Loss of mastery
  • Loss of control

Look how youre grieving
  • Grief with emotion indicates grieving styles. It
    is experienced and coped with in many ways. The
    field of psychology has been pre-empted by
    affect if grief is experienced on different
    levels (cognitive, physical, behavioral), then
    the acts of busy-ness are manifestations of
  • (Doka, 2003)

Grief is a Family Process
  • When you lose your parents
  • When you lose a child
  • When you lose a spouse/partner
  • You lose the past
  • You lose the future
  • You lose the present

Four Tasks of Grief (William Wordens Four Tasks
of Grief, Lawrence Worden, 1991, NY Springer
  • Accepting the reality of the loss
  • Working through the pain of the loss
  • Define new role and adjust to life without the
  • To emotionally relocate the deceased and move on

Task I. Accepting reality of the loss (Loss-2
  • Challenges
  • Recognizing the reality of the loss
  • Blockages
  • Denial, minimization, distraction, over-activity
  • Denial through fantasy
  • Feeling unsafe
  • Over-identification with deceased

Task II. Working through pain of the loss (1
month to 2 years)
  • Challenges
  • Feeling anger at others, self, life, god
  • Wanting to distract from and avoid painful
    emotions through activity and self-medication
  • Not having emotional vocabulary or experience to
    express feelings
  • Feeling helpless, hopeless
  • Blockages
  • Stopping the feelings
  • Geographic cure
  • Euphoric response (continued feeling of presence
    of deceased)
  • Depression avoids dealing with grief\
  • Idealizing the deceased

Task III Define new roles and readjustment to
life (2-5 years)
  • Blockages
  • Remaining helpless
  • Refusing to adopt new roles
  • Staying stuck in old roles
  • Refusing to acclimate adapt
  • Refusing to redefine self and new goals
  • Challenges
  • Loss of roles played by deceased
  • New view of the world
  • Secondary losses and changes
  • Finding new patterns to replace old ones
  • Redefining new roles and SELF in new roles

Task IV. Emotionally relocate deceased and move
  • Challenges
  • Accepting loss, moving forward with life
  • Accepting loss, redefining self as whole
  • Loving again
  • Mourning is finished when loved one is thought of
    without pain
  • Blockages
  • Refusing to reinvest in new love relationships

Determinants affecting the grief process (Dougy
Center, Portland)
  • Age of survivor and person who died
  • Specific nature of death anticipated cause of
    death affecting
  • Nature of relationship between survivor and
  • Survivors support system
  • Intrapsychic health of individual griever

Unresolved Grief
  • Affects Body ulcers, cancer, depression,
    depressed immune system
  • Affects Behaviors Substance abuse, weight gain,
    sex, isolation, shopping, gambling, rage
  • Short-term energy relieving behaviors offer
    temporary relief
  • Addictions can result if one thing doesnt
    work, another might
  • R R Relief from pain and Resolution

Disenfranchised Grief (Doka)
  • Invalidated, judged, compared
  • Children are most disenfranchised grievers

Seven Stages of Grief (Robert Kavanaugh)
  • Shock
  • Disorganization
  • Volatile Emotion
  • Guilt
  • Sense of loss loneliness
  • Relief
  • Reestablishment

1. Normal Pathological Mourning (Richard C.
Simons,1985,American Psychiatric Assn.)
  • Protest, denial, shock
  • Profound sadness and survivor guilt with self
    esteem in tact
  • Multiple somatic symptoms without organic disease
  • Persistence of denial with absent grief
  • Depression, impaired self-esteem,
    self-destructive behavioral impulses
  • Medical illness

2.Normal Pathological mourning
  • Sense of unreality, withdrawal
  • Anger irritability
  • Progressive social isolation
  • Persistent anger hostility leading to paranoia
    OR suppression of anger and hostility

3.Normal Pathological Mourning
  • Disruption of normal patterns restless,
    aimlessness, automatic behavior
  • Preoccupation with memories of deceased, dreams,
    hallucinations, fear of going crazy
  • Continued disruption often with persistent
    hyperactivity unaccompanied by a sense of loss
  • Continued preoccupation with memories of
    deceased, hoping for a reunion

4.Normal Pathological Mourning
  • Identification with certain traits or abilities
    of the deceased
  • Conversion symptoms similar to the symptoms of
    the deceased

Coping with Dying A Stage-Based Model
(Kubler-Ross, 1969)
  • Denial
  • Anger
  • Bargaining
  • Depression Reactive
  • Depression-Preparatory
  • Acceptance
  • Not me!
  • Why me?
  • Yes me, but
  • Response to past present losses
  • Anticipating and responding to losses yet to come
  • Almost void of feelings

Phase-Based Interpretations of Mourning
  • Shock numbness
  • Yearning searching
  • Disorganization despair
  • Reorganization

Dual Process of Coping With Bereavement
  • Depicts the complex effort of coping with loss
    and the active nature of mourning
  • Working through loss while addressing secondary
    loss and new challenges
  • Some processes focus on loss itself while others
    focus on moving forward

Grief, Mourning, Families Two Tasks of
Mourning (Walsh McGoldrick, 1991)
  • To share and acknowledge reality of death and
    share the experience of loss
  • To reorganize the family system and to reinvest
    in other relationships and life pursuits
  • (Note each combines Wordens mourning two of
    Wordens mourning tasks for individuals)

Anticipatory Grief (Lindemann, 1944)
  • Reactions to losses that have not yet occurred
    and are not yet in process
  • Losses that have not moved from expectation to

Complicated Grief Reaction (Volkan, 1970)
  • Deviant and unhealthy
  • May include but are not limited to traumatic
    grief reactions
  • Chronic grief, delayed grief, exaggerated grief,
    masked grief
  • Results from difficulties in relationship with
    deceased (ambivalent, dependent, narcissistic)

Grief, Mourning, Gender Feminine
Grief Masculine Grief
  • Conventional method
  • Reach out and accept help
  • Experiencing and expressing emotion
  • Focus on feelings of anger and guilt
  • Hiding vulnerability
  • Emphasis on thinking about loss (vs. feeling)
  • Desire for solitude
  • Reluctant to share grief and seek help
  • Valuing self-reliance
  • Assuming role of protector
  • Seeking to solve practical problems
  • Engage in physical action

Related, but not determined by gender (Martin
Doka, 2000)
  • Intuitive
  • Emphasizes experiencing and expressing emotion
  • Instrumental
  • Focus on practice matters and problem solving