Grief Psychology Exam 4

is a grief reaction that is prolonged, excessive in duration, and never comes to a satisfactory conclusion

• (a.k.a. inhibited, suppressed or postponed grief)
• a reaction that does not occur in a normal timeframe but occurs at a later time.

occurs when a person experiences symptoms and behavior which causes them difficulty but they do not recognize the fact that these are related to the loss

occurs when the reactions to the loss are excessive and disabling.

a loss that society believes does not deserve mourning. The loss is not openly acknowledge, socially sanctioned, or publicly shared.

• a)  Socially unrecognized relationships
•   i)   Homosexual relationships
•   ii)  Extramarital affairs
•   iii)  Cohabitation

• b)Not a genuine loss
•   i)   Abortion / miscarriage
•   ii)  Pets
•   iii) Former Spouse

• c)Grievers are unrecognized
•   i)  Friends, schoolmate, co-  worker
•   ii)  Those mentally disabled

• d)  Death is socially unacceptable
•   i)  Suicide
•   ii) AIDS
•   iii) Erotic asphyxia
•   iv) Legal execution

• i)  Suicide
• ii) AIDS
• iii) Erotic asphyxia
• iv) Legal execution

• a.  Main Symptoms (Provided by the American Cancer Society)
• 1)  Difficulty speaking of the deceased without experiencing renewed and intense grief.
• 2)  They constantly bring up themes of death and loss in even the most casual conversations.
• 3) Ongoing sleep issues (too much or too little) that last for more than 6 weeks
• 4)  Sudden and radical lifestyle changes
• 5)  Exhibit self-destructive behavior (promiscuity, excessive drinking, or substance abuse)
• 6) Develop some of the same symptoms of the deceased (psychosomatic issues).
• 7)  Continued disbelief in the death of the loved one.
• 8)Inability to accept the death
• 9)Persistent flashbacks, nightmares, intrusive memories.
• 10)  Magnified and prolonged grief symptoms; anger, sadness or depression
• 11)Maintenance of a fantasy relationship with the deceased with feelings that he/she is always present and watching
• 12)  Continuous yearning and searching for the deceased
• 13)  Unusual symptoms that seem unrelated to the death (physical, or strange and abnormal behavior).
• 14)  Breaking off all ties to social contacts

• b. Other Symptoms:
• 1)  Avoid anyone or anything associated with the deceased including friends, family, and previously shared activities.
• 2)  Minor events trigger an intense grief reaction.
• 3)  They exhibit consistent symptoms of depression, guilt, hopelessness and lowered self-esteem.
• 4)  Ability to manage everyday responsibilities are significantly impaired.

infants show only a non-specific distress reaction to the absence of their mother.

1)  6 months to 2 years infants begin to experience normal grief reactions in response to the absence of their mother.

2)  Continued separation will cause the child to manifest despair, sadness and detachment unless a constant caring person takes over.

• a.  Do not understand the permanence of death
• (since they have little understanding of time.)
• b.  The child is aware that someone is missing due to the change of routine.
• c.  May worry about the well-being of the deceased (food, clothing, toys)
• d.  Unable to comprehend things outside their own experience.
• e.  Normal responses
•   1)  Continually asking if the deceased will be at school, church or other activity (The reassurance of the same answer over and over is comforting to the child)
•   2) Discussing the death with strangers (supermarket, playground).
•   3) Guilt, feeling responsible for the death
•   4)  Withdrawal or aggression

• a.  More complex understanding of death and dying.
• b.  Realize that death is irreversible and universal (except to them).
• c.  Reactions
•   1) Death personified as monsters, ghost, creatures which they can hide from or run away.
•   2)  “Magical Thinking” stage in which a child may “wish” someone dead, and upon death, there will be guilt.
•   3)  Lack of vocabulary will cause a child to express how he feels. Crying, withdrawal, frightening dreams, aggressiveness, and misbehavior are not uncommon.
•   (Boys will often exhibit aggressive responses in play).
•   4)  These children need “permission” to grieve.

• a.  This age group has the cognitive understanding to comprehend death as a final event.
•   b.  Excepting of a mature, realistic explanation of death as final and inevitable.
•   c.  Reactions
•      1)  Due to their short attention spans it is not unusual for a child to cry and then resume play as though nothing has happened.
• (Adults need to be aware that this “switch” in behavior does not mean the child is not upset)
•      2) If not discussed, there may be behavioral problems
•      3) School disturbances, lack of concentration and a drop in grades is their cry for help.
•          a)  ”Children at this age must be encouraged over and over again to talk about the loss and express their deep inner feelings in order to allow mourning to result in a positive outcome.”
•          b)  There is also an interest and curiosity about the physical and metaphysical aspects of death.
•      4) This age group may identify with the deceased and imitate his mannerisms. (Boys will be more aggressive in how they act out their feelings).

• a.  Have an adult meaning of understanding and realize that death happens to everyone.
• b.  “Losses such as death affect the total life of the high school student involved, their work at school, their part-time jobs, their leisure activities, their relationship with friends and family and their concepts about themselves.”
• c.  The “death experience” adds to the anxieties and confusion of normal puberty and intensifies their grief.  Adds to feelings of unattractiveness, insecurity, not belonging, not being in control of self and surroundings.

• a)  Searching for the answer to the question “Am I OK”
• b)  In acting as though they are “being watched” and “judged” they may have a more difficult time expressing grief.
• c)  They may also be confused if others do not grieve or act in the same manner as they do.

• a)  Belief that they are indestructible and cannot be harmed.
• b)  Express grief by risk taking.

• a)  Teens are searching for meaningful relationships. 
• b)  Able to understand complex relationships and more interested in the other points of view.
• c)  Grieve as adults do.

• a.  Find out what they already believe about death.
•   1) Holding and touching is good during this talk.
•   2) If you do not know the answer, do not make things up.
• b.  It is acceptable for you to feel sad and cry
• in front of children
•   1) Everyone responds to death differently
•   2)  Be honest with children (they are more resilient than we think)
•   3)  Use simple, clear language that a child can understand
• c.  Be aware of confusing stories or euphemisms.
•   1)  “The deceased went on a long trip”, child will anticipate return. (Although children may still long for the return of the individual)
•   2)  “The deceased is asleep”, child may develop fear regarding sleep
•   3) “They died because they were sick”, child may equate illness and going to the hospital with dying. Illness and death are separate issues. Assist the child’s understanding.
•   4)  Reassure them that they were not responsible for the death of the individual.

age of 7 go attend funerals

• a)  Attending or not attending the service
• b)  Selecting the casket
• c) Deciding on whether or not to view the body
• d) Choosing special objects to put in the casket
• e) Choosing which clothes the deceased will wear
• f)  Choosing the grave marker and what will be written on it
• g)  Picking out the urn for cremated remains
• h)  Choosing the location to spread the ashes
• i)  Selecting the burial site
• j)  Selecting flowers, music, and readings for the service
• k)  Participating in the service
• l)  Closing the casket for the last time or being involved in this process

• a) Explain what will occur at the visitation and funeral. (Unfamiliar situations or surprises can complicate the grieving process).
• b) “Tell it like it is”
•     1)  Who will be at the funeral or memorial service?
•     2)  Where will the service take place?
•     3)  When will the funeral happen?
•     4)  What is going to happen?
•     5)  Why are we doing this?

1.  Who the person (deceased) was.  “The functional position or role the deceased played in the family can affect grief in family members. To the extent that the deceased had a significant funeral position, his death is going to create a corresponding disturbance of functional equilibrium.”

2.  Historical Antecedents – How did the survivor grieve previous losses?  “An emotionally well integrated family may show minimal grief reaction at the time of death, but members may respond later with various physical or emotional symptoms or some type of social misbehavior.”

3.  Personality variables – “The value families place on emotions and the kinds of communication patterns that give a person permission to express feelings or not express feelings can affect mourning.  Families that conspire to feelings of suppression may ultimately keep the individual from an adequate resolution of grief”

Aftercare (post-funeral counseling)

Alienation

Altruistic Suicide

Anomic suicide

Anticipatory grief

At-need counseling

Complicated grief (abnormal, unresolved)

Bereavement

Client centered (person centered) counseling

Counseling (Webster)

Counseling (Jackson)

Counseling (Rogers)

Counseling (Ohlsen)

Communication

Congruence

Delayed grief (Inhibited, Suppressed or Postponed) (Worden)

Denial

Directive counseling

Disenfranchised Grief (Kenneth Doka)

Disaster

Horror

Terror

Egoistic Suicide

Emovere

Euthanasia (right to die)

Exaggerated grief (Worden)

Facilitate

Fatal Suicide

Grief

Grief counseling

Grief syndrome (Lindermann)

Guilt

Hospice

Informational counseling

Involuntary active euthanasia

Living will

Masked grief (Worden)

Passive Euthanasia

Persuasion

Psychology

Physician-assisted suicide

Rapport

Regression

Shame

Sudden infant death syndrome (S.I.D.S. or crib death)

Sublimation

Thanatology

Voluntary active euthanasia – Mercy Killing