Lesson 11 Bereavement and Loss NCFE Level 3 Diploma in Counselling Skills

Learning Objectives 2.3.1 Explain the role of theory in relation to helping relationships Bereavement and Loss How bereavement impacts on us and our clients Complex bereavement Lifeline Bereavement - Models by: Stroebe & Schut Kubler-Ross Worden Rubin (additional model)

What is bereavement? Bereavement is the process of grieving and letting go of a loved one who has died. Definition Bereavement is the state of loss when someone close to you has died. The death of someone you love is one of the greatest sorrows that can occur. Feelings of bereavement can also accompany other losses, such as the decline of your health or the health of someone you care about, or the end of an important relationship. Grief is a normal, healthy response to loss. Source: https://www.psychologytoday.com/conditions/bereavement

What is bereavement? Definition continued Everyone feels grief in his or her own way, but there are certain stages to the process of mourning. It starts with recognizing a loss and continues until that loss is eventually accepted. People's responses to grief will vary depending upon the circumstances of the death. If the person died of a chronic illness, for example, the death may have been expected. The end of the person's suffering might even come as a relief. If the death was accidental or violent, coming to a stage of acceptance could take longer. Source: https://www.psychologytoday.com/conditions/bereavement

What is complex bereavement? Symptoms of complicated grief are nearly identical to those of acute grief, and again, the length of time it takes for a person to grieve is highly variable and dependent on context. But when symptoms are interminable without improvement, lasting for at least one year or more and interfering with one’s ability to return to routine activities, complicated grief may be implicated. Prolonged symptoms may include: Intense sadness Preoccupation with the deceased or with the circumstances surrounding the death Longing or yearning Feelings of emptiness or meaninglessness Difficulty engaging in happy memories Avoidance of reminders of the deceased Lack of desire in pursuing personal interests or plans Bitterness or anger http://www.goodtherapy.org/learn-about-therapy/issues/grief The DSM-5 includes diagnostic criteria for “persistent complex bereavement disorder” in the section of conditions requiring further study. Models of Grief Psychologists and researchers have outlined various models or phases of grief. In 1969, Elisabeth Kubler-Rossidentified five linear stages of grief that most people are now familiar with: Denial Anger Bargaining Depression Acceptance Kubler-Ross originally developed this model to illustrate the process of grief associated with death, but she eventually adapted the model to account for any type of grief. Kubler-Ross noted that everyone experiences at least two of the five stages of grief, and she acknowledged that some people may revisit certain stages over many years or throughout life. Psychologist J. W. Worden also created a stage-based model for coping with the death of a loved one. He called his model the Four Tasks of Mourning: To accept the reality of the loss To work through the pain of grief To adjust to life without the deceased To maintain a connection to the deceased while moving on with life As an alternative to the linear stage-based model, Margaret Stroebe and Hank Schut developed a dual process model of bereavement. They identified two tasks associated with bereavement: Loss-oriented activities and stressors are those directly related to the death. These include crying, yearning, experiencing sadness, denial, or anger, dwelling on the circumstances of the death, and avoiding restoration activities. Restoration-oriented activities and stressors are associated with secondary losses with regard to lifestyle, routine, and relationships. These include adapting to a new role, managing changes, developing new ways of connecting with family and friends, and cultivating a new way of life. Stroebe and Schut suggest that people will invariably oscillate between the two processes.

Possible effects of bereavement – small groups Extended learning opportunity: Age UK: Coping with Breavement https://www.ageuk.org.uk/information-advice/health-wellbeing/relationships-family/bereavement/ Marie Curie: When someone dies https://www.mariecurie.org.uk/help/support/bereaved-family-friends The following is from: https://www.recover-from-grief.com/effects-of-bereavement.html "I'm exhausted!"-- the physical signs and symptoms of grief "Are you sure I'm not going crazy?"-- emotional and mental symptoms "Where are all my friends?" -- social changes "So where was God during all of this?" -- spiritual challenges "Is this bizarre, or what?" -- unusual experiences "Do I need help?" -- warning signs that professional help is needed

Your lifeline Drawing a lifeline

Kubler-Ross pre-reading activity In 1969, Elisabeth Kubler-Ross identified five linear stages of grief that most people are now familiar with: Denial Anger Bargaining Depression Acceptance Kubler-Ross originally developed this model to illustrate the process of grief associated with death, but she eventually adapted the model to account for any type of grief. Kubler-Ross noted that everyone experiences at least two of the five stages of grief, and she acknowledged that some people may revisit certain stages over many years or throughout life. Source: https://www.goodtherapy.org/learn-about-therapy/issues/grief

https://slidemodel.com/templates/kubler-ross-change-curve-powerpoint/ Image credit: https://slidemodel.com/templates/kubler-ross-change-curve-powerpoint/ https://slidemodel.com/templates/kubler-ross-change-curve-powerpoint/

Dual Process – Model by Stroebe & Schut Pre-reading activity As an alternative to the linear stage-based model, Margaret Stroebe and Hank Schut developed a dual process model of bereavement. They identified two tasks associated with bereavement: Loss-oriented activities and stressors are those directly related to the death. These include crying, yearning, experiencing sadness, denial, or anger, dwelling on the circumstances of the death, and avoiding restoration activities. Restoration-oriented activities and stressors are associated with secondary losses with regard to lifestyle, routine, and relationships. These include adapting to a new role, managing changes, developing new ways of connecting with family and friends, and cultivating a new way of life. Stroebe and Schut suggest that people will invariably oscillate between the two processes. Source: https://www.goodtherapy.org/learn-about-therapy/issues/grief

Dual Process – Model by Stroebe & Schut Image credit: https://www.researchgate.net/figure/46664149_fig1_Figure-1-The-dual-process-model-of-coping-with-bereavement Image credit: https://www.researchgate.net

Worden’s 4 tasks – pre-reading Psychologist J. W. Worden also created a stage-based model for coping with the death of a loved one. He called his model the Four Tasks of Mourning: To accept the reality of the loss To work through the pain of grief To adjust to life without the deceased To maintain a connection to the deceased while moving on with life Source: https://www.goodtherapy.org/learn-about-therapy/issues/grief

Extra: Rubin’s 2-track model of bereavement Extended learning opportunity: for a better description of each track visit: https://whatsyourgrief.com/rubin-two-track-model-of-bereavement/

Bereavement-models and me How do you recognize the bereavement models in your own life? For instance, what is the balance between the bereavement and picking back up your life? Do you recognize the 4 tasks by Worden? Note: Choose a safe enough topic to reflect on.

1 Case with 3 different models: in class activity You are a counsellor working for Cruse Bereavement Care. You get a referral for a new client, a 19-year old young woman named Carla. About a month ago she has lost her father, and she feels she is really struggling. She never had a good relationship with him and she wishes she had spend more time with him, rather than spending their time arguing. She has lived on her own for about a year, and is unsure how to support her mum through this. Carla is studying at the college in Southend-on-Sea, but wonders if this might be too difficult for her at the moment to continue. She often feels she cannot concentrate in class anymore, as she thinks about her dad a lot. At the same time she does not want to think about him, as it makes her feel feels low. She cannot believe he is gone. She struggles to talk about this with anyone, as she tends to keep things to herself. COMPLETE 2.3.1 Worksheet – Bereavement Case-Study (hand-in at end of class)

Did we cover this? Bereavement and Loss Lifeline How bereavement impacts on us and our clients Complex bereavement Lifeline Bereavement - Models by: Stroebe & Schut Kubler-Ross Worden Rubin (additional model)

Homework Week 11: Reflective Journal (Moodle): How did you cope with your bereavements, using any or all three different bereavement models studied, what did you learn?

Coming up: Week 12: Attachment and Process We will be exploring attachment and group process Maybe useful to review attachment styles; try: https://www.simplypsychology.org/attachment.html For those new to group process, consider the following general reading: https://www.sdsmt.edu/uploadedFiles/Content/Campus_Life/Student_Activities/Organi zations/Understanding%20Group%20Process.pdf Process – processing your group experience to date Assignment 7 will be issued.

Closing