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Exploring the Many Faces of Loss and Grief

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Exploring the Many Faces of Loss and Grief Dr Linda Machin Cheshire Hospices Education Annual Conference October 2010 4. Culture and context as issues of diversity in ... – PowerPoint PPT presentation

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Title: Exploring the Many Faces of Loss and Grief


1
Exploring the Many Faces of Loss and Grief
  • Dr Linda Machin
  • Cheshire Hospices Education
  • Annual Conference
  • October 2010

2
Exploring grief
  • 1. A model for recognising diversity in response
    to loss (attending to resilience)
  • 2. A template for exploring grief in practice
    (attending to coping)
  • 3. A measure for mapping individual grief
  • (attending to individuality and vulnerability)
  • 4. Culture and issues of diversity in loss
    response (attending to context)

3
1. A model for recognising diversity in response
to loss
  • The Range of Response to Loss model (Machin
    2001 2009)
  • Overwhelmed - a state dominated by distress
  • Controlled - a state dominated by a need to
    suppress emotion and focus on day to day
    functioning
  • Resilience - a capacity to balance the emotional,
    social and practical consequences of loss (accept
    the loss, make sense of its consequences, an
    optimistic life perspective and an ability to
    make use of social support)

4
Conceptual links with other theories
5
The RRL model of grief (introducing a fourth
dimension)

  • vulnerability

  • (tension)
  • overwhelmed
    controlled
  • (balance)
  • resilience

6
Exploring the core dimensions of grief
  • overwhelmed
    controlled

focus on feelings- sadness, anger, guilt,
despair, desolation etc bringing a sense of
powerlessness
focus on thinking action - restoring a sense
of agency
7
Images as grief stories Overwhelmed
8
Images as grief stories - Controlled
9
Resilience
  • A capacity to balance and accept the competing
  • forces of grief

Overwhelmed focus on feelings
Controlled focus on thinking and action
10
Images as grief stories - Resilient
11
Factors which contribute to resilience in
bereavement
  • Personal resourcefulness
  • - flexibility, courage, perseverance, sense of
    self worth
  • A positive life perspective
  • - optimism, a capacity to make sense of
    experience
  • Social embeddedness
  • - availability of support, capacity to access
    support

12
Vulnerability
  • An inability to balance the competing forces of
    grief - tension between feeling, thinking and
    acting

Overwhelmed focus on feelings
Controlled focus on thinking and action
13
Images as grief stories - vulnerability
14
Risk factors which contribute to vulnerability in
bereavement
  • Circumstantial risk factors - unexpected death,
    untimely death, horrific death, multiple losses,
    stigmatised death etc and concurrent stresses
    e.g. caring for others, financial problems etc
  • Personal risk factors - insecure attachment with
    with the deceased, young children, adolescents
    etc and physical, psychological problems, past
    history of difficulty in coping with stressful
    situations etc
  • Interpersonal risk factors -lack of social
    support, and /or makes poor use of support, loss
    of a child etc

15
The RRL model showing the interaction between
grief and coping
  • vulnerable
  • overwhelmed
    controlled
  • resilient
  • Core grief impact responses
    Coping mechanism

16
2. A template for exploring grief in practice

  • vulnerable
  • Debilitating

  • personal and / or

  • circumstantial factors

  • socially - isolated and / or disconnected
  • Overwhelmed
    Controlled

  • Enabling

  • personal and / or

  • circumstantial

  • factors
  • socially
    integrated and / or support felt to be adequate
    to needs
  • Resilient

Feelings of loss ( grief) dominate are
disabling
A sense of loss of control undermines the
capacity to deal with life demands
Life demands are effectively managed
Emotions of loss are accepted
17
Creating a revised practice matrix from the RRL
model (Relf, Machin Archer 2010) (using scales
of always, most of the time, sometimes , never,
NK)
  • Factors (personal, circumstantial and social)
    contributing to vulnerability
  • Overwhelmed vulnerable Vulnerability
    Controlled vulnerable

  • struggle to manage
  • Strong emotions
    competing forces
    loss of control undermines
  • dominate disable
    Inability to make
    capacity to deal with
  • day to day functioning
    sense of experience
    life demands
  • Comments

    Comments
  • Overwhelmed resilient Resilience
    Controlled resilient
  • Able to face and accept
    Reconciliation between Able to think
    act clearly
  • emotions of grief
    feelings and functioning manage life
    demands


  • effectively
  • Factors (personal, circumstantial and social)
    contributing to resilience

18
Exploring the dimensions of vulnerability and
resilience - an alternative to the matrix
  • Overwhelmed vulnerable
  • Overwhelmed controlled
  • Struggle to manage grief
  • Difficult personal circumstantial factors
    Always
  • Difficult social factors
    most of the time
  • Overwhelmed resilient
    sometimes
  • Controlled resilient
    never
  • Ability to cope with grief
    NK
  • Positive personal circumstantial factors
  • Positive social factors

19
Exploring the spectrum of dimensions from
vulnerability to resilience- an alternative to
the matrix
  • Overwhelmed
    Overwhelmed
  • vulnerable resilient
  • Controlled
    Controlled
  • vulnerable
    resilient
  • Struggle
    Able
  • to make sense of loss

    to make sense of loss
  • Difficult personal
    Positive
    personal
  • circumstantial factors
    circumstantial factors
  • Difficult social Positive
    social factors
    factors

20
Examples of narrative indicators of responses to
loss
21
Typical statements indicating type of response to
loss (based on the Adult Attitude to Grief
Scale, Machin 2001)
  • Response Type of statement
  • Overwhelmed I cant stop thinking
    about x
  • Ill
    never get over this awful experience
  • Life
    seems pointless
  • Controlled I think I just have to
    be brave
  • I cant
    let other people see how sad I am
  • I think
    you just have to get on with life
  • Resilient Its only natural
    to feel sad in this situation
  • Its
    hard but I can cope with this situation
  • Its bad
    at the moment but I think things will get better
  • Vulnerable I cant face the
    (emotional and physical ) pain in this situation
  • I feel I
    have no strength to cope with all that is
    happening

  • Everything, even the future looks bleak

22
3. A measure for mapping individual grief
  • The Adult Attitude to Grief scale
  • Nine item scale
  • Presented as self-report statements
  • On a five point scale from strong agreement to
    strong disagreement

23
Adult Attitude to Grief Scale
  • Overwhelmed items
  • 2. For me, it is difficult to switch off thoughts
    about the person I have lost.
  • 5. I feel that I will always carry the pain of
    grief with me.
  • 7. Life has less meaning for me after this loss.

24
Notions of grief contained in the overwhelmed
items on the scale
  • Stressful
  • irreversible
  • uncontrollable
  • (Mikulincer
    and Florian 1998)

25
Adult Attitude to Grief Scale
  • Controlled items
  • 4. I believe that I must be brave in the face of
    loss
  • 6. For me, it is important to keep my grief under
    control
  • 8. I think its best just to get on with life
    after a loss

26
Notions of grief contained in the controlled
items on the scale
  • Restricted acknowledgement of distress
  • a need to be self reliant
  • (Mikulincer
    and Florian 1998)

27
Adult Attitude to Grief Scale
  • Resilient items
  • 1. I feel able to face the pain which comes with
    loss
  • 3. I feel very aware of my inner strength when
    faced with grief
  • 9. It may not always feel like it, but I do
    believe that I will come through this experience
    of grief.

28
Notions of grief contained in the resilient items
on the scale
  • The capacity to face grief with
  • courage
  • resourcefulness
  • optimism
  • (Greene 2002
    Seligman 1998)

29
The AAG scale as a tool for practice- looking at
the complexity of individual grief.
overwhelmed
controlled
OC
OCR
OR
CR
resilient
30
Two studies (2004, 2007) exploring the clinical
usefulness of the AAG scale
  • The scale worked well for clients i.e. face
    validity
  • It was an effective tool for the initial
    appraisal of clients grief
  • It provided a structure for telling the grief
    story
  • It provided a way of exploring (mapping) the
    complex and sometimes contradictory aspects of
    grief
  • It showed changes in grief response taking place
    over time
  • It indicating the therapeutic focus necessary
    for nurturing resilience

31
he need to identify VULNERABILITY The
need to identify
VULNERABILITY
  • the need for service providers and practitioners
    to target help to those who are most vulnerable
  • the need for therapeutic intervention to
    recognise the variable manifestations of
    vulnerability and resilience
  • the need for service providers and funders to
    have a measure of the appropriateness and
    effectiveness of care

32
Calculating a vulnerability score
  • The method (proposed formula)
  • overwhelmed and controlled scores combined, and
    resilient scores deducted vulnerability score
  • O C - R V

33
Proposed hierarchy of vulnerability
  • Severe vulnerability
  • High vulnerability
  • Moderate vulnerability
  • Low vulnerability
  • Minimal vulnerability
  • Resilience

34
4. Culture and context as issues of diversity in
loss response
  • Variations in
    Variations in
  • individuals
    how groups
  • within groups
    model grief
  • Families
  • cultural identity
  • religious perspectives
  • professional perspectives

35
Diverse contexts of working with loss in practice
  • A
  • anticipated loss B C
  • breaking bad news/
    working D
  • discussing life-
    alongside loss
    retrospective
  • changing events

    reflection on


  • loss

36
Our task working to facilitate resilience -
where pain and possibilities are reconciled
37
  • Email linda_at_machin10.fsnet.co.uk
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