Other influences on attachment
and loss
Today’s Agenda
PPT and Discussion Exercises
Break
Finish Good Will
Chat about Exam
Separations from Parents
Introducing Marie Waida, aged 31, was
referred to Parkes after losing both her
father and her mother, two years later.
In light of Marie’s bereavement, she
was comfort eating and was overweight.
She presented with severe grief and also
felt depressed and became frightened
that this might mean she was following
in her depressive father’s footsteps.
Separation from parents
Separation from parents in childhood appear to play a role in developing a
vulnerability for persistent and chronic grief in adulthood (disorganized / avoidant).
It is not known whether the experience of separation creates the
(disorganized/avoidant attachment) or whether type of parenting develops such an
attachment style.
Whatever the case, there appears to be a connection between separation, parenting,
and marital conflict, attachment development and later vulnerability to chronic grief.
Results revealed that losing or separation from one’s mother (in childhood) creates a
greater vulnerability to grief in later life than fathers.
Let’s Return to Marie
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Marie Waida had been born in England, the eldest of six children of a Polish shopkeeper
who was subject to episodes of depression. Times were hard and several occasions the
family was evicted from their home for nonpayment of rent. Marie’s father had left his
legal wife to live with Marie’s mother after she came pregnant with Marie; they never
married. Although he worry excessively about her, Marie also saw him as insensitive to
her needs. Her mother always maintained a close relationship with her much loved sister,
Julie, who died on the day on which Marie was born. Marie was seen as replacing her.
She responded by attempting to emulate this aunt, whom she never met. Unsurprisingly
she was unable to live up to her mother’s expectations. Mother seldom showed warmth
towards her and Marie admits to feeling closer to her father...She showed me a snapshot
of her mother with her arm around Bill, Marie’s husband, but added bitterly, “I can never
remember her cuddling me.” Experiences of separation fed into and aggravated Marie’s
insecure attachment to her parents and distrust of other children. Her mother had another
baby each year for the first five years of Marie’s life. As the birth approached Marie
would be sent to a children’s home until it was over, an experience that she dreaded.
Marie continued...
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During this time she suffered nightmares and walked in her sleep.
Another Separation took place when Marie was aged nine and mother
was sick. She was 14 years of age when her mother had another “love
affair” and, shortly thereafter, developed a deep–vein thrombosis and
was admitted to a hospital. Marie was terrified that her mother would
die and leave her, the eldest daughter, to bring up her siblings.
She grew up an anxious youngster who lacked self-confidence and was
afraid to be left alone. She was “bossy” towards other children, found
it difficult to ask them for help and was seen as independent and
tougher than she felt. She got into trouble for pulling out her hair and
for hiding; this behaviour was dismissed as “attention seeking”.
Separations from Parents & Relationships in Adult Life
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Adult in the present day
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Already Insecure / (Person marries - needs comfort)
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But Fears Closeness
Prepare’s during marriage for spousal death (avoids intimacy with entire family)
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May cling / panic during bereavement / para-suicidal behaviour / or deny loss
Persistent and chronic grief?
Marie concluding...
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Despite her childhood difficulties Marie did quite well at school and left at 18. In her twenties She
met and cohabited with Bill. This was an insecure attachment in which she saw him as unusually
close and dependent on her neither seems to have been able to meet the others need for support and
they had numerous quarrels. Marie is aware of the fact that she held back from getting close to Bill
or to the two children whom she bore. “I’m afraid of letting them love me too much,” she said.
Marie’s first experience of childbirth was traumatic. Labor continued for 23 hours and “I felt I
was going to die”. She was much helped by her mother at this time. Subsequently she was able to
redress the balance when her mother became ill.
Shortly after her father died Marie’s mother was found to have a pancreatic cancer. Despite her
grief, Marie was able to repay her mother for her support during her pregnancy by looking after
her. But she was apprehensive when, four years after her first pregnancy, she became pregnant
again. Her anxiety increased greatly when, in the course of her pregnancy, her mother died. Just
as Marie’s aunt’s death during her mother’s pregnancy had caused her mother to identify with
Marie the aunt, so during the course of this pregnancy Marie became convinced that she would
have a girl. She intended to name the child after her mother. The birth itself was uncomplicated but
she felt numb “as a part of me had died”. Contrary to expectation she had a boy, but this did not
prevent her from identifying him with her mother. Her ambivalence is reflected in the way she
subsequently described her 16-month-old son as “stronger than me... A tyrant, wins all the time”.
She alternated between angry quarrels with the boy and inability to set limits to his demands.
Summary
It would appear that
bereavement in adult life
reflects and opens wounds
of early losses giving rise
to grief for the person lost
and for their earlier losses.
Thus the therapist must
gain the trust of the client
so that they may repair the
damage done in childhood
and then work on grief
that is causing difficulties
in the present.
Marie Concluded
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Within three sessions of psychotherapy, focused on her
attachment problems, Marie began to feel much better. She said
that she was now able to accept her mother’s death instead of
relocating her inside her son. She become much less aggressive
towards him and found that she could smile at him. She told me,
“I’m a terrific mom”. When last seen she was undertaking a
sponsored diet aid of her local hospice. She missed her
appointment during the Christmas holiday and subsequently
decided that she did not need to come again. However, when
followed up some months later she reported that she had recently
got the end of her tether and was again depressed and anxious.
Despite this she decided that she did not need another
appointment.
Trauma and Bereavement
All bereavements are traumatic, but
some are more traumatic than others.
This maybe scientifically true... But
not so phenomenologically.
Trauma, Grief, and Details..
People who experience multiple losses or who suffer traumatic bereavement deal with both:
Grief and its accompaniments
Added to this, their assumptive world is often shattered...
Crippling the function of attachment (whose function is to create an intra/interpsyhic safe world).
Trauma and Parkes’ Study
People with high trauma
scores were more severely
distressed
80% of the traumatized
group received a clinical
diagnosis of anxiety
Post-traumatic Stress
Disorder was diagnosed in
15 persons (these persons
were present at the death).
Psychiatric Bereaved and Losses Suffered
Insecure Attachment and Traumatic Bereavement
Highest distress after bereavement in the study are those who
had high trauma and insecure scores.
On the other hand, statistical analysis did not reveal that
insecure attachments act solely by increasing vulnerability to
trauma.
Nor is my way of “coping with loss” and “my distress”
predicted because I have experienced a traumatic loss...
However, results revealed that those with avoidant
attachment were found to use alcohol as a means to escape
the pain of a traumatic loss.
Trauma and the Disorganized
Most notably, was the
connection between
childhood disorganized
attachment, traumatic
bereavement and overall
distress score.
These folk appear to be
most vulnerable to
problematic bereavement if
the death is traumatic.
Interestingly, multiple
traumatic deaths do not
signal greater distress that
single losses!
The Case of Brenda
After the breakup of her second marriage Brenda was left with her two sons, Glenn
and Adam, now aged 22 and 18. Adam was the closest and she saw him as dependent
upon her. Three years before he saw her, Adam had gone out with his friends for a
drink at the pub. He was late returning and Brenda was alarmed when after midnight
there came a knock at the door. The policeman and woman asked if they could come
in. They told her that Adam had been stabbed to death in a fight. For long after she
recovered from the shock of this news Brenda remained tense, anxious, depressed
and haunted by visual images of her son’s death. She missed him intensely and used
alcohol as an anaesthetic. Alcohol consumption increased and she began to go on
binges for days on end. This behaviour undermined her relationship with her
remaining son, Len, who threatened to leave her if she did not get help. Brenda
reports being an unwanted child. Her mother she describes as an insecure worrier
who was unable to express affection and tended to drink too much. When Brenda was
only seven years of age her father was killed in the war and her mother and maternal
grandparents subsequently brought her up. Often her mother would become
depressed and cling to Brenda who felt that she had to be a parent to her own
mother. At such times her mother was threatened to commit suicide or give Brenda
away.
The Case of Brenda (contd).
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Brenda’s greatest fear was her mother would die, she became fearful of any separation. She grew
up and anxious, unhappy and insecure child who performed poorly at school and was often tearful.
Although she describes herself as lacking in self-confidence and unable to cope, she could not ask
others for help. Indeed she was seen by them as tough, stubborn, aggressive and bad tempered.
Brenda’s insecure, close but ambivalent relationship with her mother persisted during her adult
life and interfered with other relationships. Two marriages ended in divorce and her own
relationship with her 2 children [now aged 22 and 18] was stormy. She described her older son,
Adam as close but dependent on her. In many ways she seems to have repeated with Adam her
relationship with her mother and he was always jealous of his grandmother’s clinging relationship
with Brenda. He was also critical of Brenda’s tendency to drink too much. She found this
oppressive and from time to time needed to get away from him. In recent years she developed an
equally insecure relationship with Len, with whom she was still living at the time when she was
referred to me. Brenda’s replies to the RAQ confirmed the clinical impression of a deeply
disturbed lady who had few resources that might have enabled her to cope with stress. Reply to the
question of how she would behave at the end of her tether she checked all the boxes except those
concerned with seeking help from friends or family. She then said that she would take an overdose
or otherwise harm her self although she did not think she would succeed in killing herself. It seems
to have been Len’s threat to leave her that persuaded Brenda to attend an appointment with me
and she was able to tell me her story and agreed to accept my offer of further therapy. But I was
not altogether surprised when she failed to turn up for subsequent appointments. Therapeutic
relationships based on coercion are unlikely to endure, particularly when patients lack trust in
themselves or others.
Shattering of Basic Assumptions
Basic Assumptions and those whose life
has been mainly positive.
And then suffer losses...
Examples from folks in class?
Shattering of Basic Assumptions
Basic Assumptions and those whose life
has been mainly negative.
And then suffer losses...
Examples from folks in class?
Conclusions to Traumatic Bereavement
Despite our losses life and love
continue...
Understanding our assumptive world’s
“what is it that must be retained and
what is it that must be relinquished is the
task for therapy”!
The Influence of Gender on
Attachments and Bereavements
What we know
about sex
differences!
Women display and express
more signs of grief than men,
but men appear to take
longer to recover from
bereavement!
One reason is that men tend
to inhibit and avoid natural
expression of grief.
Thus impairing the process
of grief.
Women, Men, and Grief
During bereavement men tend to gravitate toward
restorative coping
While women tend to gravitate toward loss orientation
coping.
Ultimately, past research suggests that gendered and
grieving is a learned, cultural, and psychological
phenomena - mitigated - somewhat by predisposition.
Results from the Current Study
Bereaved men scored higher on Emotional Inhibition / Distrust then women.
The key component of emotional inhibition was men’s inability to
express sadness and grief (2/3).
These same men also scored high with respect to finding it hard to
show affection to those they love.
Meanwhile, only 1/3 of women reported having a difficulty expressing
and showing affection.
Why Don’t Men Express Grief or What is Going on Here?
26 % of men in the study were diagnosed with a personality disorder.
It is understood that personality disorders are created via genetic
endowment / childhood experience (bereavement does not cause)
personality disorders.
Insecure attachment can be linked to origins, but more importantly,
personality disorders create enduring patterns of inflexible behaviour
that impair / inhibit both social, psychological and occupational
functioning.
Ultimately, bereavement can aggravate personality disturbances and
trigger other stressors making grief more unbearable and harder to
treat.
Loss of Parent in Adult life
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Most people who reach the age of 50 are orphans;
they will have lost one or both parents.
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Parkes asks the question - “are these folk at risk
for a psychiatric disorder”?
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Interestingly research is conflicted a) some
bereaved adults who lose a parent suffer
lasting distress, while others; b) find their
emotional state improved.
Why the Difficulty
Long life clinging to mom (by men /
who never marry) who then commit
suicide after the mother passes.
For others, including both unmarried
men and unmarried women
Death of parent results in chronic grief because of intense clinging relationship throughout life (fused
self)
Dementia related bereavement
Death of older parent sparks “ones own mortality issues”
Parental Loss in Current Study
Participants who lost
parents in this study
happen to be younger than
societal norms (suggesting
untimely deaths)
Participants who lost
parents reported being
unusually close to the
deceased, who was more
often the mother.
Attachment’s in adult life
The majority of bereaved who were grieving the loss of a
mother were unmarried.
The statistics hold for the general UK population
Meanwhile, 66% of bereaved males who lost a father
were married.
When seeking help for grief related to a father’s death, participants often report
marital stress and an ambivalent relationship with the father!
Conclusions
Ultimately it appears that bereavement and its persistence for
adults who lose parents has its roots in childhood clinging and
unusual closeness which continues into adulthood.
These persons appear to have not achieved autonomy in
childhood, adolescence or adulthood and now in light of death the
separation anxiety is worsened or...
The adult-child now has the opportunity to grow and mature
because they are no longer trapped by a parental imago.
Loss of a Child
To most people in the west, the death of a child is the most agonizing and
distressing source of grief. It results in more intense, or more persistent, grief and
depression than the loss of a spouse, parent or sibling.
Tears in Heaven
QuickTime™ and a
decompressor
are needed to see this picture.
Loss of a Child: What Do We Know
In the event of losing a child, most parents still do
not seek help for their bereavement.
Losing a child is the acid test of the family - some
are drawn together some are pulled apart in the wake
of a child’s death.
Seeking help for grief in these circumstances (by one
party) is tantamount to infidelity.
Results from Current Study
16% of study participants came for the help with the death
of a child.
Interestingly, these participants scored high on
rejection/violence by and separations from mother than any
other type of loss.
Half of the child bereaved had been separated from their
mother and or their father between ages 6 to 10 and 11 to
16 years of age (double other bereaved separations)
Is this a Vulnerability?
Yet statistically, when we
look at distress after
bereavement, distress scores
were not greater in
comparison to other losses.
Level and persistence of grief
was not greater than other
losses either.
And yet our reactions to
bereavement paint a picture.
Case Study
The Case of Ms. Dee -
Let’s Finish the Movie
• Good Will Conclusions