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

2. 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)

3. 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:

4. 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:

5. 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
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.

6. Possible effects of bereavement – small groups
Extended learning opportunity:
Age UK: Coping with Breavement
Marie Curie: When someone dies
The following is from:
"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

7. Your lifeline
Drawing a lifeline

8. 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:

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

10. 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:

11. Dual Process – Model by Stroebe & Schut
Image credit:
Image credit:

12. 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:

13. Extra: Rubin’s 2-track model of bereavement
Extended learning opportunity: for a better description of each track visit:

14. 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.

15. 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 Worksheet – Bereavement Case-Study (hand-in at end of class)

16. 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)

17. 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?

18. Coming up: Week 12: Attachment and Process
We will be exploring attachment and group process
Maybe useful to review attachment styles; try:
For those new to group process, consider the following general reading:
zations/Understanding%20Group%20Process.pdf
Process – processing your group experience to date
Assignment 7 will be issued.

19. Closing