Flashcards in Understanding The Mourning Process (exam 3) Deck (60)
Refers to personal experience of the loss.
Difficulties of using this:
- people do not pass though in seriatim.
- Tendency for a novice to take these too literally. (I.e., not going through the stages of dying by lubber-Ross in exact order is found to be disappointing)
True or false:
Elizabeth Kubler- Ross' 5 stages of dying have also been used to describe the mourning process, without the same limitations.
False- with the same limitations.
An alternative approach to stages.
- As with stages, people do not approach these in the same order as they are listed.
- Imply a certain passivity, someone that the mourner must pass through.
Phase 1 - The period of numbness that occurs close to the time of the loss. This numbness (experienced by most survivors) helps them to disregard the fact of the loss for at least a brief period of time.
Phase 2: Yearning. He or she yearns for the lost one to return ad tends to deny the permanence of the loss. - Anger plays important part.
Phase 3: The phase of disorganization and despair, the bereaved person finds it difficult to function in the environment.
Phase 4: The phase of reorganized behavior, survivors being to pull his or her life back together.
Parke's 4 phases of mourning
States that the mourner must pass through a similar series of phases to Parkes before mourning is finally resolved.
2. Awareness of loss
3. Conservation withdrawal
Sander's 5 phases describing the mourning process
Provides an equally valid understanding of the mourning process and is much more useful for the clinician.
- Consonant with Freud's concept of grief work and implies that the mourner needs to take action and can do something.
- Implies that mourning can be influenced by intervention from the outside.
- Gives the mourners a sense of leverage and hope that there is something that he or she can actively do to adapt to the death of the loved one.
Developmental tasks that occur as the child grows. If the child does not complete a particular task on a lower level, then that child's adaptation will be impaired when trying to complete similar tasks on higher levels.
- Robert Havinghurst
A cognitive process involving confrontation with and restructuring of thoughts about the deceased, the loss of experience, and the changed world within which the bereaved must now live. Some would call this grief work,
Task 1: Accept the reality of the loss
Task 2: To process the pain of grief
Task 3: To adjust to a world without the deceased
Task 4: To find and enduring connection with the deceased in the midst of embarking on a new life.
Tasks of mourning
When someone dies, even if the death is expected, there is always a sense that it hasn't happened. The survivors must come full face with the reality that the person is dead, that the person is gone and will not return.
Task 1: To accept the reality of the loss
Bowlby and Parkes have written extensively on this, Directly relates to the accomplishment of task 1 of mourning.
- Many people who have sustained a loss find themselves calling out for the lost person, and/or they sometimes tend to misidentifying others in their environment.
The searching behavior
Opposite of accepting the reality of the loss. Some people refuse to believe that the death is real and get stuck in the mourning process at the first task.
Not believing due to some type of denial
Most often involves either the facts of the loss, the meaning of the loss, or the irreversibility of the loss.
- Example is the bereaved keeping the body in the house for a number of days before notifying anyone of the death.
- People experiencing this are manifestly psychotic or eccentric and reclusive.
- Mummification (long - term is abnormal).
Denial by delusion
Retaining possessions of the deceased's in a "mummified" condition, ready for use when he or she returns. This is not unusual in the short term, but becomes denial if it goes on for years.
An example is if the person sees the deceased embodied in one of his or her children. This distorted thinking may buffer the intensity of the loss but is seldom satisfactory and hinders the acceptance of the reality of death.
The loss can be seen as less significant than it actually is. May remove all reminders of the deceased (opposite of mummification) and minimizes the loss.
- protect themselves from coming face to face with the reality of loss.
- not uncommon after traumatic death
- stems from conflicted relationship with the deceased
Deny the meaning of the loss
Blocking out the reality of the deceased - even visual images- from his or her mind.
Cannot face the fact that the deceased is dead and will not return.
Deny that death is irreversible
The hope for reunion with the dead person is a normal feeling, particularly in the early days and weeks following the loss, however the chronic hope for such a reunion is not normal.
- search for the dead (in the spiritual realm)
Is both knowing and not knowing at the same time. Found in terminally ill patients who both know and don't know that they are dying.
- In mourning, the bereaved may believe and disbelieve at the same time.
Although addressing the first task of mourning takes time, traditional rituals such as this may help many bereaved people move toward acceptance.
Broad definition is appropriate to use in speaking of pain because it includes the literal physical pain that many people experience and the emotional and behavioral pain associated with loss.
The German word Schmerz
- Necessary to acknowledge and work through this pain or it can manifest itself through physical symptoms or some form of aberrant behavior.
- Not even experiences the same intensity of pain or feels it in the same way.
- some individuals don't experience pain after a death. (Do not let themselves get attached to someone)
- Society may be uncomfortable with the mourner's feelings and may make them feel as though they do not need to grieve.
Task 2: To process the pain of grief
The negation of the second task results in this. People can short-circuit task 2 in any number of ways, the most obvious being to cut off their feelings and deny the pain that is present.
Some people handle the loss my stimulating this, which protect them from the discomfort of unpleasant thoughts.
Only pleasant thoughts of the deceased
Travel from place to place and try to find some relief from their emotions, as opposed to allowing themselves to process the pain- to feel it and it know that one day it will pass.
Usually associated with an emphatic refusal to believe the death has occurred. It is often accompanied by a vivid sense of the dead person's continuing presence. Generally extremely fragile and short lived. (Parkes)
Euphoric response to death
Bowlby states that "Sooner or later, some of those who avoid all conscious grieving, break down- usually with some form of ______."
- Sadness and dysphoria (much pain of bereavement is this)
Common feelings that mourner's may experience
- External Adjustments
- Internal adjustments
- Spiritual adjustments
Task 3: To adjust to a world without the deceased.
How the death affects one's everyday functioning in the world.
- Depends on relationship or various roles the deceased played.
- must come to terms with living alone, facing an empty house, managing finances alone.
- Usually not aware of all the roles played by the deceased until some time after the loss occurs.
- Current theory by Neimeyer- meaning making.
An important process for the grieving deaths that tend to challenge beliefs about oneself, others, and the world. Important to discover and invent new meaning in the face of loss.
Adjusting to one's own sense of self.
- self- definition
- self- esteem
- sense of self- efficacy
-Not only a loss of a significant other, but also a sense of loss of self. One of the goals of bereavement is to feel like a self rather than half of a dyad.
Women internal adjustments
The person's sense of self esteem is dependent on the person to whom he or she is attached.
- If the person dies, the bereaved person may suffer real damage to his or her self esteem.
The degree to which people feel that they have some control over what happens to them.
- can lead to intense regression where the bereaved perceive themselves as helpless, inadequate, incapable, child-like and personally bankrupt.
Attempts to fulfill the deceased's roles may fail, and this can lead to increasingly lowered __________.
- personal efficacy is challenged
- people may attribute any change to chance or fate, not to their own strengths or abilities.
Internal task for the mourner to address the questions "who am I now?" " How am I different from loving him/her?"
- Over time negative images will give way to more positive ones, and the survivors are able to carry on with their tasks and learn new ways of dealing with the world.
One's sense of the world. Neimeyer writes that death can shake the foundations of one's assumptive world. Loss through death can challenge one's fundamental life values and philosophical beliefs.
- may feel that they have lost direction in life
Beliefs that are influenced by our families, peers, education, and religion as well as life experiences.
- That the world is a benevolent place
- That the world makes sense
- That the person him- or herself is worthy
Three basic assumptions challenged by the death of a loved one.
- The appropriate death of an elderly person after a well-lived life
Example of a death that fits expectations and validate assumptions.
Arresting of task 3 results in this. People work against themselves by promoting their own helplessness, by not developing the skills they need to cope, or by withdrawing from the world and not facing up to environmental requirements.
Failure to adapt to the loss
People do not decathect from the dead but find ways to develop continuing bonds with the deceased. To find a place for the deceased that will enable the mourner to be connected with the deceased but in a way that will not preclude him or her from going on with their life.
Task 4: To find an enduring connection with the deceased in the midst of embarking on a new life.
This person says that mourning ends when the mourner no longer has a need to deactivate the representation of the dead with exaggerated intensity in the course of daily living.
Then becomes not to help the bereaved give up their relationship with the deceased, but to help them find an appropriate place for the dead in the emotional lives- a place that will enable them to go on living effectively in the world.
The counselor's task
True or false:
Bereaved parents often have difficulty understanding the notion of emotional withdrawal.
Then the task for bereaved parents is to evolve some ongoing relationship with the he thoughts and memories that they associate with their child, but to do this in a way that allows them to continue with their lives after such a loss. Find an effective place for the thoughts.
One's life has stopped with the death and has not resumed. The 4th task is hindered when one holds on to the past attachment in a way that precludes one from forming new ones.
Noncompletion of task 4: not living
True or false:
Tasks cannot be revisited and worked through again and again over time.
False- they can be revisited and worked through again.
True or false:
Tasks can be worked on at the same time. Grieving is a fluid process and is influenced by the mediators of mourning.
Developed by Stroebe and Schut, created to better account for diversity of stressful experiences in bereavement. Different from the task model of mourning, but the differences are not striking.
- identify loss-oriented stressors and restoration- oriented stressors.
Dual-Process model of grieving
Focus on the deceased person and involve grief work on such issues as separation distress, appraisal of the meaning of the loss, and relocation of the deceased in a world without the deceased's presence.
Loss- oriented stressors
Involve skill mastery, identity change, and other psychosocial transitions and changes.
- rebuilding of shattered assumptions of the self and the world.
- Almost identical to task 3.
True or false:
Stroebe and Schut make the assumption that it is not possible to attend to both loss and restoration dimensions at the same time.
True - They oscillate between these two dimensions, confronting one and avoiding the other, and going back and forth.
People frequently use this notion on themselves as the amount of pain that they will let themselves experience at any one time.
Dosing notion (they dose themselves)