Transcript SHADOW GRIEF: HOW MIGHT MUSIC THERAPY ASSIST …

‘Shadow grief: how might music therapy
assist bereavement following miscarriage or
stillbirth?’
Margaret Broad B.A. MSc
With heartfelt thanks to the participants who made this study possible,
for their openness in sharing their personal narratives and for their
interest in music therapy.
It was a privilege to enter their journey through the valley of the shadow
and to learn from them about their role in supporting bereaved parents.
Conception
‘There are words to describe all kinds of
bereaved people – widow, widowers,
orphans – but none for a parent who has
lost a child: it’s a fate too terrible for even
language to contemplate.’ (Aslam , 2004)
Common grief
• Stages of grief
– numbness
– yearning
– disorganisation and
despair
– reorganisation
(Bowlby, 2005; Worden, 1991; Parkes, 1996;
Kűbler-Ross, 2009)
• Manifestations of grief
– loss of appetite
– sleeplessness
– anger especially towards
health professionals
– guilt, self blame (Penson, 1990)
sadness, despair,
confusion, low self
esteem (Staudacher, 1988)
Specific issues
• Grief for an unlived life
(Miscarriage Association, 2009)
• ‘A stillborn is someone who did not exist, a
nonperson with no name. It is an empty
tragedy and a painful emptiness difficult to
talk about...’
(Hockey 1990, pp.40-1)
‘Unable to find legitimate avenues of
expression, the need to remember
becomes paramount. The mothers believe
that if they do not remember, no one else
will; the memory of their child must be
kept alive at all costs.’ (Peppers and Knapp 1980, p.49)
• Miscarriage - pregnancy loss < 24 weeks
gestation (NHS, 2009)
• Stillbirth - pregnancy loss > 24 weeks
gestation, UK legal age of viability
• Neonatal death - birth to 28 days (SANDS, 2009)
Support Organisations
• ARC (ARC, 2009)
termination of pregnancy
• Babyloss (Babyloss, 2010)
October 15 International Pregnancy and Infant Loss Awareness Day
• International Stillbirth Alliance (2009)
research to raise awareness of the issues surrounding infant death
• Tamba BSG (TAMBA BSG, 2009)
loss of a child from a multiple pregnancy
• Miscarriage Association (Leroy, 1988)
founded by bereaved mothers 1982
• Stillbirth and Neonatal Death Society (SANDS, 2010)
reduction of age of viability from 28 to 24 weeks
Training for health professionals
(Riches and Dawson, 2000; Schott, Henley and Kohner, 2007; Hindmarch, 1993; Scottish Office Department of Health, 1996)
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SANDS guidelines
Qualities of music therapist
(Schott, Henley and Kohner, 2007)
(Bunt and Hoskyns, 2002)
empathy
clear communication
good listening skills
sensitivity to individual
needs and cultural
differences
• respect and
acknowledgement of
parental loss
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tolerance
sensitivity
empathy
flexibility
ability to listen and
communicate intuitively
‘Stillbirths - a forgotten problem’
(The Independent, 14 April 2011)
• Global:
– 3.2 million stillbirths per annum
– 8700 stillbirths per day (The Lancet, 14 April 2011)
• UK:
– 1/4 pregnancies results in miscarriage (NHS, 2009)
– 3.5 stillbirths per 1000 births (ranks 33rd globally)
– 17 stillbirth/neonatal deaths per day (Why17, 2010)
• > 70% of stillbirths occur in women with no significant
medical condition
• Stillbirth 10x more common than cot death (The Independent 14 April 2011)
Music Therapy
• intervention in maternity care
(Browning 2000; Allison, 1991 ; Chang and Chen , 2004 ; Kaiming, Shuping and Xiaofen ,1997)
• bereavement:
– death of spouse (Smeijsters, 1999)
• parent (Turry, 2005)
• terminally ill child (Lindenfelser, Grocke and McFerran, 2008)
– expression of feeling states (O’Callaghan, 1996 ; Hudson Smith, 1991)
– reminiscence (Bright, 2007)
– grief-related support groups (Krout, 2005)
• palliative care (Bright, 2007 ; Aldridge, 2003)
• ‘The Tonic’ APMT/BSMT News (Bruce 2009)
Gestation
Research aims
• How might music therapy assist bereaved
parents who have experienced loss through
miscarriage or stillbirth?
• Which musical therapeutic strategies might
be appropriate to assist the grief process of
this population?
• At which stage of the grief process might
music therapy
be an appropriate
intervention?
Methodology
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phenomenological-orientated approach
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purposive sampling
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video footage (Nordoff-Robbins, 2010 ; Harpkit, 2010)
‘Every Note Counts’ (Simpson, 2007)
content analysis
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participant re-traumatisation (counselling sheet)
researcher vulnerability (personal therapy)
semi-structured interviews
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befrienders recruited from a bereavement support organisation (themselves bereaved mothers)
n=4
ethical considerations
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Examine life experience
categories and sub categories
coded manually
trustworthiness and reflexivity
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Peer debriefing
reflexive journal
verification of accuracy
Birth
Data analysis : categories
Key findings
• context of the support organisation
• nature of the need for support
• factors which may inhibit support
• how support is currently facilitated within the
organisation
• role of music within current support system
• befriender perceptions of the therapeutic value
of music in bereavement
• befriender receptivity to music therapy
• potential strategies for implementing music
therapy
• stages of grief when music therapy might be an
appropriate intervention
Organisational context
• Open door policy
• Befriending
• Meetings
• Attendees
• Patterns of attendance
Parental need for support
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Need for expression of feeling states
– “It’s quite amazing the full spectrum of emotions that can be around at a meeting. But,
yes, a lot of tears and a lot of emotional depth and they’re difficult. They’re very
draining”.
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Need for social inclusion
– “ I think they feel supported because a lot of people, up until they come along, feel that
it’s just them. They are on their own”.
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Need for coping strategies
– “I lived for that meeting every month. It was like a pressure cooker building up and then
you had your meeting and you got a chance to talk and you know, you sort of simmered
down again for another month”.
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Intrinsic need for remembrance
– “I think at the beginning I was worried I would forget. That was a fear. I think a lot of
people have the fear of forgetting. But I know now, that you don’t forget”.
Creating memories
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memory boxes
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scan photographs / photos of the dead baby
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scrapbooks
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certificates of birth / hospital appointment cards (Schott, Henley and Kohner 2007)
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‘Wave of Light’ services
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naming ceremony (Jenkins and Merry 2005)
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balloon releases (Babyloss 2010)
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web pages to post on-line messages expressing loss
– ‘Forget-me-not Meadow’ / ‘Lights of Love Tree’ (Miscarriage Association 2010)
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body art / tattoos
Facilitation of support
• Bereavement lifeline (Scottish Office Department of Health 1996)
• Gauging level of support
• Befriender supervision and support needs
Support inhibitors
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Bereaved parents may experience:
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dilemma in acknowledging bereavement
fear of losing emotional control
denial of subsequent pregnancy/ unresolved grief in subsequent pregnancy
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Gender differences in grieving
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Cultural differences in grieving
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Lack of social awareness about acknowledgement of bereavement
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Family restraints on expression of grief
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Lack of understanding by health professionals
Music
• Activities
– Music valued in remembrance service
– Support product CD of remembrance service
– Song-writing by bereaved parent
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Genre
Music for expression of feeling states
Conscious / unconscious use of music
Background music in support meetings
Potential for Music Therapy
• Befriender perspective towards music therapy
• lack of awareness about availability of music therapy
“If there was another channel in which they could have said –
‘Look, there’s some music therapy open to you here’ - I
absolutely would have taken it but there wasn’t”.
• awareness of music therapy as concept
• receptivity to music therapy to assist bereaved parents
Befriender suggestions for Music Therapy
• as a non-verbal intervention for
grief
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• to facilitate communication
• introductory music therapy
sessions for bereaved parents
• to match intensity of grief
• for empathic attunement
• to interact with current support
services
• for referral by health
professionals to music therapy
introductory DVD about music
therapy for bereaved parents
• group / individual sessions
• to facilitate expression of feeling
states
– drumming as outlet for anger
• for support at different stages of
grief
Feeling States
Stage of grief
Newly bereaved
Subsequent pregnancy
Later stages of grief
Shadow grief
Feeling state
Potential for
Music Therapy
Numbness
For comfort
Shock
To trigger emotion
Self absorption with
grief
To offer sensitive support
without words
Anxious preoccupation
Stress
Guilt
For relaxation
Laughter
Comedy
Joy
To support parents trying
to conceive another baby
To induce calmness
To open a channel for
grieving
Future development
Future development
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consider :
– the effects of specific music therapeutic strategies on the mourning process
of this population
– their un/conscious mourning processes
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support :
– gender differences in grieving
– grandparents’ grief
– bereaved mothers with PTSD (Hughes and Cockburn 2007)
– supervision and support needs of befrienders
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collaborative working with health professionals to assist bereaved parents
policy changes to include music therapy
References
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