Contemporary influences shaping our
understanding of grief, loss and
bereavement
Anita Sargeant PhD.
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 (p336 2006) The
Salvation Creek (in Mallon 2008)
Edvard Munch 1896: The Sick Child
“How people die remains in the memory of
those who live on”
Dame Cicely Saunders (1918-2005)
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
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
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
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
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
Tasks of mourning
Worden (1982, 2001) Grief Counselling and
Grief Therapy
– Provided a practical approach to address the
tasks of grieving
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Accepting the reality of loss
Working through the pain of grief
Adjusting to changed environment
Emotionally relocating the deceased
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
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
Dual Process model
Oscillation
Loss orientation
Restoration
orientation
Grief work
Breaking bonds,
intrusion of grief
Avoidance of restoration
changes
Controlled distraction
Doing new things
Attending to day to day needs
Avoidance of grief
Range of Response to Loss model (Machin)
Conceptualises patterns in grief
• Overwhelmed
• Balanced/Resilient
• Controlled
Range of response to loss (Machin p74. 2009)
Social Constructs
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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’
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
‘The tension between powerlessness and
attempts to regain power’ (Machin 2009)
• Vulnerability
Overwhelming
Feelings are
powerful and
persistent
Tension between the
Control
Overwhelmed feelings
Mechanisms for
which can not be subdued and
subduing distressing
the pull of control
emotion fail and
action becomes
difficult
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)
Continuing bonds
• Influenced by sociological concepts of
constructivism
• Maintaining or reinterpreting emotional
bonds with the deceased is normal
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
When grief gets complicated
• Attachments
• The nature of the death
• Unable to make sense or meaning of the loss
• Rumination
What shapes our understanding of grief,
loss and bereavement?
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Personal development over the lifespan
Nature of attachments and relationships
Capacity to cope
Belief system
Culture
Thank you