Viewing Volume 7 Issue 4 Winter 2004
Does ‘ grief work ’ work?
Abridged article from Bereavement Care 2003 by W. Stroebe; M. Stroebe; H Schut.
One of the truisms widely accepted by bereavement researchers and practitioners is that in order to adapt to loss, and to avoid suffering from lasting mental and physical health consequences, we must confront and speak of our feelings and reactions to the death of a loved one. In the terminology of theories of grief, we must do our grief work. But what evidence to we have that this is so?
The concept of grief work was introduced by Freud in his important paper, ‘Mourning and melancholia’, in which he talked of the ‘...work which mourning performs...’. Since then, the concept has been central to the major theoretical formulations on grief and bereavement (see for example, Bowlby, Lindermann, Parkes ). Used in slightly different ways depending on the theoretical orientation, grief work implies a cognitive process of confronting the reality of the loss, of going over events that occurred before and at the time of death, and of focusing on memories and working towards detachment from the deceased.
Principles of counselling and therapy also assign a central role to grief work in adjustment to loss. Bereavement counselling and therapy programs are often aimed at helping the bereaved to adapt to life without the loved one by facilitating grief work. In his influential book Grief Counselling and Grief Therapy, Worden described ‘tasks of mourning’ that must be accomplished and without which grieving remains incomplete. The goal of counselling is to assist the bereaved to complete those tasks which may have remained unfinished, that is, to ‘...help the client work through an acute grief situation and come to a resolution’. Avoidance of the reality of the loss is considered maladaptive and as placing the individual at high risk of suffering lasting health impairment.
The grief work hypothesis (i.e. the idea that we have to confront and express our grief in order to come to terms with a loss) had been so widely accepted that for a long time there was little motivation to put it to direct empirical test. The few studies that had been conducted were methodologically problematic and resulted in contradictory evidence. Some studies (for example Mawson et al ) had been interpreted as showing that working through grief is associated with good adjustment, whereas others supported the opposite conclusion.
The lack of empirical support for the grief work hypothesis was highlighted by Wortman and Silver in a classic paper in which it featured prominently as an example of the ‘The myths of coping with loss’. Two studies were used to test empirically the grief work hypothesis. The Utrecht Longitudinal Study of Bereavement and The Tubingen Longitudinal Study of Bereavement. The findings from our two studies do not support the grief work hypothesis, or at least not unequivocally. The research suggests that extreme avoidance of grief work is detrimental to adjustment for them, thus partially confirming the grief work hypothesis. However, the absence of a relationship between grief work and outcome on depression for widows suggests that the view “Everyone needs to do grief work” is an oversimplistification. Some people may not feel a need to grieve, or may have already done their grieving in the course of a protracted period of illness preceding the death of a loved one. And those who do grieve, oscillation between loss-and restoration orientated coping is necessary for optimal adjustment over time.
By:W. Stroebe; M. Stroebe; H Schut.
Suicide.
Death as a result of suicide is one of the hardest trials anyone has to face. Maybe, friends and family say to themselves, we did not love him enough, maybe we should have listened more, done more – the list goes on and on. These thoughts can torture the bereaved. Guilt is intensified if we also thing that those around us, our wider circle, secretly or openly blame us for not preventing the suicide.
Sudden death for whatever reason is often harder to take than one which has been anticipated for a long time. Having had no time to prepare for the shock, those who are bereaved are often overwhelmed and traumatised. For children this shock is brutal.
When a child has been touched by the suicide of someone they love, then all the caring strategies we have are needed. In particular, all efforts must be made to ensure the feelings of guilt and rejection are clearly addressed, because those who are left behind frequently blame themselves. We need to emphasise whilst ensuring that the child understands that suicide is a personal choice, either because the person felt their life was not worth continuing; and that choice is not the responsibility of anyone else, least of all the child.
There is a strong link between severely stressful life events and suicide attempts. Life crisis such as death in the family, separation, illness and so on cause major emotional upheaval. Being too vulnerable under stress may lead to suicidal behaviour because it is a way of escape from unbearable pressure.
Extract from Chapter 7
Helping Children to Manage Loss
By:Brenda Mallon
RESOURCES
‘Living With Dying’
Edited by
Joan Berzoff & Plyllis R.Silverman
This first resource on end-of-life care for healthcare practitioners who work with the terminally ill and their families, living with dying begins with the narratives of five healthcare professionals, who, when faced with overwhelming personal losses altered their clinical practices and philosophies. The book provides ways to ensure a respectful death for individuals, speaks to families, groups and communities, and is organised around theoretical issues in loss, grief and bereavement.
ISBN 0-231-12794-4
By:
‘ Brief Interventions with Bereaved Children.’ Oxford University Press.
This book addresses and explains the theoretical concepts and practical implications behind the idea of brief work with bereaved children and families. Two of the chapters are written by Bereavement Research Forum members.
By:By Monroe & F. Kraus (Eds) 2005
‘Mourning Has Broken — A Collection of Creative Writing about Grief and Healing.’
This anthology contains 50 original submissions about healing from the pain of losing a loved one. The writers share their thoughts and make the reader cry and laugh, but they always express their inner strength and insights about coping.
Pearl who specialises in psychogeriatirics, expressive art therapies and adult education, says that she and Koven ’firmly believe that creative writing can be an expressive and therapeutic medium of healing from grief’.
By:By Koven. M & Pearl L. 2005
DIARY DATES
Committee Meetings.
AGM Tuesday 17th May 2005
Tuesday 30th August 2005
Tuesday 22nd November 2005
6.30 pm for 7 pm
At the Droylsden Office.
By:
ANNUAL CONFERENCE
‘Family Grief’
Thursday 8th September 2005
At
Hough End Centre,
Mauldeth Road WestChorlton – cum – Hardy
Manchester
Speakers for the day include:
Dr. Marilyn Relf
Gordon Riches
John Peters
Jayne Handford
Prof. Stephen Wright
Dr. James Kuykendal
The Conference will be Chaired by:
Brenda Mallon (Vice Chair MABF)
Conference Price:
MABF Member 2004 £150
Non members £195
New Members 2005 £175
All delegates after 31st July £225
For information and booking please contact
The Grief Centre –MABF
Tel: 0161-371-8860
or
grief@ mabf.org.uk
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