Grief and Bereavement

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Grief and Bereavement

• What is it and how to help

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Definitions

• Bereavement
• State of being deprived of something. Doesnt
  have to refer to death but usually does.
• Grief the reaction to bereavement. Many
  dimensions. A normal and healthy reaction.
• Feelings
• Cognitions (preoccupation, disbelief)
• Physical sensations
• Behaviors (sleep, eating disturbances)
• Social difficulties
• Increased risk of illness?
• Spiritual searching

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Variables that influence Grief

• Nature of prior attachment/perceived value of
  loss.
• Way in which the loss occurred e.g., shocking,
  gradual, young.
• Coping strategies of the bereaved.
• Age of bereaved.
• Social support available.

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Mourning

• Process of coping with loss and grief
• Bowlby and Parkes 4 Phase Model
• Shock and numbness usually the initial reaction
  to loss. Difficulty in taking care of basic
  needs.
• Yearning and searching effort to return to
  things as they once were.
• Disorganization unable to concentrate on
  challenges. Death has interfered with life.
• Reorganization begin to reshape a new life
• Similar critiques as with Kubler-Ross model.
• Makes mourning a passive process.

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Tasks of the Mourning Process

• William Worden makes mourning an active process.
• Accept the reality of the loss includes funeral
  process, social validation, sharing of memories,
  talking about the death, maintaining security and
  routine.
• Experience the pain of the loss permit grief,
  allow to express feelings, permit respite from
  grief. Problem occur when grief is hidden by
  drug use and denial.

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Wordens Grief Tasks

• Adjust to the environment with the deceased.
• Use of social support network.
• Help in dealing with problems.
• Be aware of unasked questions and concerns.
• Problems sense of helplessness and dependency.
• Moving on
• Commemoration
• Enhance old relationships and form new ones
• Challenge unrealistic beliefs
• Reconstruction of a new identity
• New activities and traditions

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Disenfranchised Grief

• Grief that persons experience when they incur a
  loss that can not be openly acknowledged or is
  not socially supported.
• Relationship is not recognized non-traditional
  relationships, non-essential relationships.
• Loss is not recognized miscarriage, abortion,
  loss of limb.
• Griever is not recognized young, old, persons
  with mental disabilities.

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Complicated Grief Reactions

• Although grief is normal and appropriate, like
  everything else it can become unhealthy.
• Excessive
• Distorted
• Unproductive

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How Can You Help?

• Five fundamental needs
• Social support main variable in determining high
  vs. low grief.
• Nutrition
• Hydration
• Exercise
• Rest

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Tasks in Mourning

• Cognitive need for information. Often helps to
  make it real.
• Affective a need to express emotions.
• Behavioral need to mark or take notice of the
  death through an external event or action (e.g.,
  tree, funeral, scrapbook).
• Valuational make sense of the loss, find meaning.

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Unhelpful Messages

• Dont try to minimize the loss e.g., you can get
  married again.
• Suggestions that strong grief reactions are
  inappropriate e.g., be strong, youll be fine.
• Suggestions to get back to living and disturb
  others with your grief.

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Constructive Suggestions for Bereaved

• Dont blame self.
• Dont try to be brave and strong.
• Dont try to run away.
• Dont feel you owe it to deceased to stay where
  they lived.
• Dont feel sorry for yourself.

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Constructive Suggestions for Helpers

• Do something specific to help.
• Respect preferences to be alone.
• Do not avoid contact with bereaved.
• Act normally and naturally in referring to the
  deceased.
• Allow bereaved to determine when they want to
  talk about the deceased.
• Dont force your beliefs on the grieving.
• Dont say I know how you feel.

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Societal Programs

• One on one intervention peer counseling.
• Hospice follow-up transitional. Usually lasts
  12-18 months.
• Support groups help from others who have had
  similar experience.
• Some are practical groups, some provide social
  support (of course, some do both!).

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Support Groups

• Helping Factors
• Degree of universality you realize that
  reactions are not unique or bizarre.
• Allows catharsis.
• Provides guidance through example.
• Instillation of hope.
• Creation of a safe and caring environment.
• Altruism as you move on, you can help others.