Sometimes theory can be wordy or so academic that it feels inaccessable to the reader. Here, I give an overview of grief theory, that can hopefully help inform both the ordinary bereaved person and caring professional or supportive friend understand what may be of use or happening.
Grief is a natural response to the death or loss of someone or something that we have valued, loved or connected with. Many theorists have applied stages and models of thinking to the way in which grief is processed to help us to understand and make sense of the huge array of emotions, physical ailments, cognitive patterns and behaviours that can emerge following a bereavement or loss.
This is merely an introduction to the extensive amounts of literature available on this subject and it is hoped that the interested reader will be inspired to read further into those areas which have been touched upon here, and prompt thought and interest in the topic.
Many of the models and stages relate to John Bowlby’s, (a British psychiatrist 1907 -1990) attachment research, the theory being that once an attachment has been formed with (for example) a situation, object or person, strong feelings of anger, protest, sadness and despair can emerge if the attachment is broken, (i.e. through death, divorce or misplacement) which, it is then thought, will fade once new bonds are put into place.
Colin Murray Parkes (1928-present) developed a Phases of Grief model extending upon Bowlby’s attachment theory, that also takes into account our own personal history, experiences to date and in particular the relationship with the deceased, and therefore addresses the need to adjust these accordingly following the bereavement depending on the circumstances and individual.
These four phases are:
-Shock and Numbness
-Yearning and Searching
-Disorientation and disorganisation
-Reorganisation and resolution.
‘Shock and numbness’ can bring on impaired judgment and functioning, and result in the grieving person only being able to have short periods of concentration. Shock and numbness are the, perhaps early and only, elements of the grief process that are actually visible on the outside. These are the protective mechanisms people (subconsciously) use to help themselves cope with a loss at their own pace. At this stage in the process people may continue to function, but on autopilot, often feeling disassociated from others.
The ‘yearning and searching’ stage of grief is identifiable from the experience of feelings of restlessness, anger, guilt and uncertainty. The feeling that something or nothing just isn’t quite right. During the yearning and searching phase, people may withdraw and want to be left alone. In this stage they may also tend to ask a lot of questions about how and why, in trying to make sense of and understand what has happened.
The ‘disorientation and disorganization’ phase of grief is associated with feelings of depression, guilt and unfamiliarity. This is the time when the loss becomes a “reality.” At this point, physical and functional problems may become more pronounced, and people may struggle with self care or practical issues. Imagine a jigsaw puzzle with all the pieces thrown into the air. It takes time to work out where all the pieces go. And some of the pieces may no longer be there.
The last phase of the Bowlby/ Parkes grieving process is ‘reorganization and resolution’. During this phase there is increased energy, increased decision-making abilities and an increased sense of self-confidence and focus. Parkes concludes that although no one ever gets over the loss of the death of a loved one or the loss of associated dreams, a person manages to get through the process.
J. William Worden (Professor of Psychology at Harvard University and author of many grief study books) suggests there are four tasks of grieving which, once worked through, will enable the individual to adjust to their loss and begin to ‘move forward’. Rather than a passive thing that happens to you, Worden suggested you could actively work through grief. The four stages are:
-Acceptance- that the loss is a reality, and their loved one has died. Someone working through this stage may think that they can see the deceased person from afar, only to realise it is not them at all, or may keep their possessions as they were, in hope of their return. As with all stages, the length of time taken to accept the loss can vary dependant on the circumstances in which it has occurred, and the relationship with the lost object or deceased. In instances where the death as sudden or there was no body, this stage can be more difficult and may require additional support.
-Experiencing the pain- Talking about and acknowledging the experience and how it has left the individual feeling on a physical, emotional and spiritual level will externalise, and put the bereaved in touch with the pain their loss has triggered. Someone who is avoiding consciously or otherwise being with their feelings may take longer to move through this stage.
-Adjusting- to a life without the person that has died, and all that this means for the bereaved person. Depending on the loss, this could have all kinds of implications, such as a house move, financial issues, and the loss of a role, or sense of identity (i.e. carer) who does the shopping, putting the bin out, driving, what they now do on a Sunday- the list is exhaustive………
-Letting go- ‘reinvesting’ the energy reserved for the deceased once more, perhaps emotionally or practically. Being able to say ‘goodbye’, whilst not forgetting. Allowing other relationships to develop and grow.
Elisabeth Kubler Ross (1926-2004) was a Swiss born psychiatrist who wrote about 5 Stages of dying in her book ‘On Death and Dying’ which were based on Bowlby and Parkes phases of grief. Often, when someone mentions the stages of grief- these are the ones they are referring to. Around this time the concept of stages of grief was a new one, and it has inspired many other interpretations of the ‘grief cycle’. It is emphasised that these may not always be experienced in order, and may reoccur, however that someone experiencing grief from a loss or trauma would always experience at least two of the following:
-Denial- “This can’t be / is not happening to me”.
-Anger- “Why is this happening to me?”.
-Bargaining- “ If this will go away I will ………”
-Depression- “ I give up, it doesn’t matter anymore”.
-Acceptance- “I am receptive to / ready for this”.
It is widely recognised that these dying /grief stages not only apply to grief following a bereavement, but to many other types of loss situations and personal reactions to change or trauma, and these stages have been recognised, adopted and adapted universally.
Freud (1856-1939), an Austrian neurologist, believed that by internalising the deceased person and working through our memories, emotional links and ties, ultimately, through greater understanding, we could slowly begin to reinvest in other relationships.
The four tasks that Freud termed as grief work are:
-To truly recognise and accept the loss
-To mourn the loss and give expression to the grief
-To perform the new tasks of life that loss forces us to take on
-To look to a new kind of future.
As we can begin to see, there are many similarities within the stages and phases we have touched upon, and we may well identify them with those we support within the grief process. It is imperative however that we always approach each situation, person and loss as completely unique.
Having an awareness of theory can help us understand why a reaction or state of being may be as it is, and in turn, when appropriate, we can reassure the client and normalise their range of responses to their loss.
The Dual Process model of coping with grief, as its name suggests, offers an interpretation of two aspects of response to loss which are described by Stroebe and Schut (1998) as ‘Loss Orientated’ and ‘Restoration Orientated’. This model is seen as the most up to date and current and there are various adaptations that can be used to normalise grief and identify what constitutes a healthy grieving process.
Loss orientation includes activities such crying, talking therapies, expressing anger, visiting the grave, lighting a candle………..whatever connects you to the person that has died and your feelings around this. Loss restoration refers to life, working, living, giving yourself permission to feel hope and joy, adjustment activities such as learning to shop for one, and identifying new roles and implementing them in practise, the theory being those grieving in a healthy was switch between the two processes in order to manage daily life through oscilation. This diagram can often be useful to work with and show people, as it gives explanation and permission for attending to both life and grief.
Dr Linda Machin, a social worker and counsellor, has researched extensively into bereavement needs assessment and the ranges of response someone may have following a loss. Linda developed a matrix of Range of Responses to Loss, which can be used as a measurement tool to help identify clients that might be at risk or in most need of support (RRL 2004) together with an Adult Attitude to Grief scale (AAG) which can be used as an outcome measurement tool in counselling. Linda has identified four core human responses to grief, to be vulnerable, overwhelmed, resiliant and controlled, each of which will be experienced to a lesser or greater degree depending on a whole range of circumstances individual to each person. It is useful to be aware of and understand the model for psychoeducation and to deepen awareness and understanding of the impact of grief.
The Grief wheel (Grief Education Institute, Denver,1986) can be used as a tool to assess how an individual is currently experiencing grief. It can be useful simply through its existence, by being of reassurance that others are experiencing similar emotions following a loss or bereavement.
Interestingly, Colin Murray Parkes found in one particular study that only 14 % of those he followed completed the wheel in a year, two years being much more usual. Someone may enter the ‘loss’ stage at any time following realisation or awareness of an actual or impending loss. The wheel highlights four stages:
Shock- When the reality of the loss is too much to take in.
Protest- Wondering how the loss can possibly be real (although knowing that it is)
Disorganisation- Possible loss of meaning, faith or depression
Reorganisation-Control over developing balanced memories, discovering new meaning to life.
There is a natural instinct in many to want to help in whatever way we can follwoign a bereavement- death has a way of reminding us of the imperminance of life- perhaps this is why you have been drawn to reading this article, to feel in a more informed position to help ourselves, loved ones, friends and be alongside people in their own unique processes at times of loss, and so we can find ourselves asking, “okay- we get the theory- but what can we do?”
Gerard Egan’s (1975 – The Skilled Helper), a Professor of Psychology at Chicago University developed a Three Stage Model that can be adapted and applied as a framework for supportive work.
Stage 1- Exploration: creating a warm, trusting relationship with the client, allowing the client to explore whatever they choose. Entering into the client’s reference (looking at the world from the client’s point of view).
Stage 2 – Understanding: being alongside the client as they begin to come to terms with their situation with new understanding, from different perspectives, with alternative information.
Stage 3 – Action: Looking with the client at possible ways of ‘being’ in this situation. Assessing risks and potential outcomes. Evaluating effectiveness of new strategies and behaviours.
This third stage, particularly the evaluation and assessment, would usually only take place with a clinical professional under supervision, however it is useful for us to see an overview of Egan’s model.
Person Centred skills deriving from Carl Rogers (1902-1987), an American psychologist and founder of the humanist or ‘person centred’ approach, developed the concept of ‘core conditions’ which can be considered as essential when implementing, being with and following through all of the above stages, models and processes.
The three main core conditions are:
Congruence- being genuine/ real, true to self, thereby encouraging ‘client’ to feel safe enough to be themselves. If we can be fully present with all our being with another person, and give them our time, however short, with our full attention and being, a person feels valued, heard, respected, and safe enough to be themselves with you, being able to tell you what they really need to, making best use of everyone’s time. People, especially children, can feel if you are being genuine.
Empathy- being able to put yourself in someone else’s shoes whilst keeping one foot firmly in your own. Rather than sympathy, which is more about feeling for someone based on your own perspective, empathy is about trying to gauge how that person might feel based on their individual experiences and background and unique perspective of events and the world.
Unconditional Positive Regard- acceptance of the individual / being non judgemental. This can be difficult, we all make assumptions and judgements based on our life experiences, however the key is to be aware of them, and try to position yourself in a neutral space, everyone will have reasons for the position they find themselves in and people generally do the best they can with the resources and knowledge they have available at any given moment in time.
Rogers believed that for a person in distress to be able to find a way forward, if all three core conditions are put into place, they will feel supported and safe enough to find their own solution. The skills often used to facilitate this which can include reflection, active listening, paraphrasing, asking open questions, and summarising, are recognised and adopted throughout many helping professions and theoretical models.
You do not have to be a professional to be genuine, caring, empathic and have positive regard for someone whilst employing good listening skills. Being listened to is important for us all, and especially for those who have been through something distressing or life changing, and we can never underestimate how valued and valuable ‘just’ listening’ really is.