Grief : Its Simple & Complex - Kilkenny Bereavement Support

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Transcript Grief : Its Simple & Complex - Kilkenny Bereavement Support

Recovering from Loss & Grief
Dr Timothy Dunne
Consultant Clinical Psychologist
Public Lecture delivered on behalf of Kilkenny
Bereavement Support Group
Wednesday 10th September 2014
Definition of terms
Models of Grief
Grief & Complex Grief
Grief & Loss
Myths about Grief
Suicidal Ideation
Healing & Recovery
Grief = Emotion
Loss = Experience
Mourning = Process of Grieving
Bereavement = Social & Cultural Processes
Complex Grief = Any loss which is
accompanied by obstacles to psychological
Simple / Complex Grief
• Young V Older person
• Natural causes V Man made (murder/suicide)
• Natural disaster V Man made (train/plane crash)
• Sudden death V Gradual decline
• Ambivalent Loss – where there are no remains to
• Permanent physical injury or disability
• Any change in health status (eg) diagnosis of
long term condition such as diabetes, cancer
• Any major Life Event, even positive ones such
as house move, new job, marriage & divorce,
• Ageing & retirement
• Financial losses & reduced standard of living
Models of Grief
• Kubler – Ross (1969)
• Warden (1990)
• Dual Process model (2010)
Kubler-Ross’ Model
• Shock/Denial
• Anger
• Bargaining
• Depression
• Acceptance
Some Difficulties
• The model was first used to describe stages in
acceptance in the dying not in the bereaved
• Not everyone goes through every stage
• The stages are iterative rather than
• “Is” can become “ought”
• Too prescriptive, rigid and passive
Warden’s Tasks of Mourning model
• To accept the reality of the loss
• To experience and process the pain of grief
• To adjust to life without the loved one
• To relocate the dead person emotionally and find
an enduring connection with him/her & embark
on a new life
Some difficulties
• Perhaps too prescriptive also
• Can appear to minimize the individual
experience of grief
• Fails to recognize that the powerful nature of
grief which may only be handled in
manageable chunks
• People can get “stuck” on a particular task or
Dual Process model (DPM) of Grief
(Stroebe & Shear, 2010)
• Based on concept of “Oscillation” whereby the
bereaved person confronts the loss at times and at
other times avoids it
• The person “swings” between facing the loss and
restoration or rebuilding their life
• “Time out” is an essential feature of this model as
continuously facing grief is “arduous & exhausting” –
“defensive exclusion” is vital at times
• This model takes account of other stressors in the
person’s life such as bringing up children or financial
Cultural Assumptions
• Our Western culture (and helping professions)
have arrived at a “common wisdom” that it is
generally healthy to focus on pain of grief and
distress and to express it openly
• Suppression of same is thought to be
unhealthy & not to be encouraged (“stiff
upper lip”)
• However, research (White, 2013) does not
support this “common wisdom”
Cultural Assumptions
• In addition to the need to face grief & pain there
is also a natural tendency to avoid the reality of
• This should be factored in to any intervention
• Avoidance can have a valuable protective effect
for someone struggling to make sense of an
overwhelming loss
• This is now standard procedure in Trauma
treatment (ie) a “titration” approach
Cultural Processes
• Irish Wake/ Month’s Mind
• Used to have outward signs/symbols such as
wearing black for a certain period or diamond
on a jacket sleeve
• Jewish Shivah (7 days); Shloshim (30 days) and
Shneim asar Chodesh (12 months)
• Most people underestimate how long it takes
to fully get over the death of a loved one
“The Deal”
• In complex or traumatic grief the person may
often, unconsciously, make a deal with the loved
one which goes like this:
• “I will continue to suffer pain and loss in order to
prove my love for you because if I don’t feel this
pain, it means I don’t love you or if I let go of my
grief it means I have forgotten you”
• The same can occur with self-blame especially if
the survivor believes that they somehow are
responsible for the death of the loved one
Complex Grief
Long lasting
Intrusive images or thoughts of the loved one
Pre-occupation with the deceased
Social withdrawal & detachment
Pining or yearning for the deceased
Have trouble accepting the death
Inability to trust others
Excessive bitterness
Prolonged feeling that life is empty &
Complex Grief
• Are you having trouble accepting the death?
• Does grief interfere with your life?
• Are you having troublesome thoughts /images
of the deceased?
• Do you avoid doing the things now that you
used to do with your loved one?
• Are you feeling cut off or distant from others
since the death?
Myths of Mourning
• Grief declines steadily after the death
• All deaths and losses produce the same type
of grief reaction
• The intensity of emotions experienced and
the length of time spent grieving is testimony
to how much love there was for the deceased
• Grief & loss are only about death
• Time heals all wounds
Suicidal Ideation
• Suicidal ideation or wanting to die occurs in up to
65% of those bereaved
• Complex grief produces 5 times as many suicidal
• Some people see suicide as a way of gaining
control over the pain
• Sometimes people put themselves at risk or
neglect themselves or act with less concern for
themselves or in a way which increases the
likelihood of accidents or death
Thoughts & Beliefs
• I didn’t do enough for her
• He died without knowing how much I loved
• I cant stand not knowing if he suffered pain
• It was unfair how she died
• I don’t know if he is at peace
• Its not right for me to enjoy life without her
Healing & Letting go
• Not everyone needs Bereavement
• Social support is important – find one person
who you can talk to without embarrassment
and who is a good listener
• Compassion for yourself is also important
• Anniversaries, birthdays, weddings, Christmas
are all occasions which can trigger strong
emotions of sadness & loss
Healing & Letting go
• How has life changed since your loss?
• What never happens now as a result of the loss?
• What do you miss most about your life since the
• What do others comment on since your loss?
• What has surprised you most about your
thoughts & feelings?
• How has this impacted on your view of yourself,
others, relationships, life or the world in general?
Healing & Letting go
• If you feel that it is taking you a long time to
recover, then consider seeking professional help
• Use your memories and memorabilia of the loved
one to support yourself
• Create a lasting memorial to the loved one such
as planting a tree, make a donation or start your
own charity/fundraising
• Choose a significant picture/image and have it
commissioned by a professional artist