An Introduction to Theory relating to Bereavement and Grief
Grief is a natural response to the death or loss of someone or something that we have valued, loved or connected with. I like to think that a persons response to grief is as unique as the relationship that they have had with the person that died. Many theorists have applied stages and models of thinking to the way in which grief is processed to help us to understand and try to make further sense of the huge array of responses- emotions, physical ailments, cognitive patterns and behaviours that can emerge following a bereavement or loss.
Here we take a brief look at some of these theories, concepts and approaches to working with those who are bereaved- however it is merely an introduction to the extensive amounts of literature available on this subject and if you are studying in this area, there is no substitute for group work, or workshops with the theorists in person if you can. We have also posted links to clips on you tube that may be of help, seeing them in action can help bring theory to life.
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, a response is inevitable if / when the physical attachment is broken, (i.e. through death, divorce or misplacement).
Colin Murray Parkes (1928-present) developed a Phases of Grief model extending upon Bowlbys attachment theory, that also takes into account our own 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 limited 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 peoples subconscious part of the brain uses to help themselves cope with a loss within their own unique experience and frame of reference. At this stage in the process people may continue to function, but usually on autopilot.
The ‘yearning and searching’ stage of grief is perhaps identifiable from the experience of feelings of restlessness, anger, guilt and uncertainty. During the yearning and searching phase, people may withdraw and want to be left alone. Alternatively they may also tend to ask a lot of questions about how and why, in trying to make sense of what has happened.
The ‘disorientation and disorganization’ phase of grief is often associated with that feeling that nothing feels ‘right’, or is surreal. There can be a real sense of feeling generally unsettled, confused and perhaps anxious or depressed. 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.
The last phase of the Bowlby/ Parkes grieving process is ‘reorganization and resolution’. During this phase there is notable increased energy, increased decision-making abilities and an increased sense of self-confidence and focus. Parkes might say that although no one ever gets over the loss of the death, a person manages to get through the process.
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’. Here the emphasis is on working through grief, rather than it being a process which happens to you, there are somethings that you can actively do to help.
–Acceptance– that the loss is a reality, and the person 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. This stage in instances of ambiguous loss is more complex.
–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 whom is avoiding consciously or otherwise being with their feelings may take longer to move through this stage.
–Adjusting– to a life without the deceased, 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).
–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 Grief in her book ‘On Death and Dying’. At the time of publication, 1969, 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, they were never intended to be linear, and that someoone might experience reoccurring stages, however that usually, 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 ………/ If only………”
Depression– “ What is the point? Nothing matters any more”.
Acceptance– “I am receptive to what has happened”.
It is widely recognised that 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 understanding that relationship 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 begin to identify patterns of the position of those we support within the grief process the more we become involved in working with loss. 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 persons reaction or state of being may be as it is, and help us to normalise and reassure them (or ourselves!)- however there is a natural instinct in some to want to help in whatever way we can, and can find ourselves asking, “but what can we do?”
There are tools that can help us with this process.
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 grief work.
Stage 1- Exploration: creating a warm, trusting relationship with the person allowing them to explore whatever they choose. Entering into their frame of reference (looking at the world from their point of view).
Stage 2 – Understanding: being alongside the person 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 person at possible ways of ‘being’ in this situation. A bit like the re-orgnanisation stage. 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 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. Many would argue that the application of core conditions alone are enough to facilitate a clients sense of being ‘held’ and truly listened to, enabling a person to find their own solutions and way through a situation.
The three main core conditions are:
Congruence– (being genuine/ real, true to self, thereby encouraging ‘client’ to feel safe enough to be themselves)
Empathy– (being able to put yourself in someone else’s shoes whilst keeping one foot firmly in your own!)
Unconditional Positive Regard– (acceptance of the individual / being non judgemental).
Rogers believed that for therapeutic change to occur, all the core conditions (there are 6) must be in place. 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.
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.
Newer theorists are building on these more traditional models and bringing them in to the 21st century.
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, 2010) as ‘Loss Orientated’ and ‘Restoration Orientated’. This model is seen as one of 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, whilst Loss restoration refers to adjustment activities such as learning to shop for oneself and identifying new roles and implementing them in practise, the theory being those grieving switch between the two processes in order to manage daily life. Although perhaps simple, it explains the importance of giving ourselves permission to grieve, and to live, – moving between the two, and the model can be applied to any culture.
Robert Neimyer talks about meaning making- how we, as humans, need to find a way to understand what has happened and give the person, the situation, the death, some meaning. It might be the song that comes on the radio, the white feather in the street, the robin in the garden, the fundraising event or support group we give time to.
Linda Machin talks about our ranges of response to loss, whereby people are usually on a continuum of a core grief reaction between overwhelmed and controlled vs our coping mechanisms of vulnerability and resilience. Understanding our ranges of response to loss helps us to target support at people who are more vulnerable and to understand why a person may have responded in a particular way.
There is so much more, – really I have only just touched the surface here- no doubt I will log back in and add more when I have time. I love theory- it helps me to validate the interventions I make, the type of support I offer, and it is evolving all the time. Im currently attending a CBT diploma course, and I’m massively interested in mindfulness and how both of these can help support the grieving process. The more we do, and the more tools we have in our tool box to help people going through a difficult time, the more likely we will be to find a fit.
I always think though- when we are with someone who is grieving- all the theory in the world can go out of the window- it is about two human beings sitting together, connecting and communicating, a space for safe expression and being without judgement. For me- this will always form the base of a therapeutic relationship from which we can understand a persons unique experience of their grief.