HLSC 3127

The [blank_start]tripartite model of suicide bereavement[blank_end] is a meaning-making model that focuses on distinctive themes with which those bereaved by suicide struggle after the death. Includes 3 phases: 1) trying on the shoes, 2) walking in the shoes, and 3) taking off the shoes.

The [blank_start]Dual Processing Model[blank_end] includes not only confrontation with loss (LOSS ORIENTATION), but also avoidant coping strategies as necessary mediators of health and well-being (RESTORATION ORIENTATION)

Attachment theorists have identified 2 dimensions of attachment:

The DSM proposes that the exclusive use of either loss-or-restoration-oriented strategies would lead to pathological grief reactions such as chronic grief in the first case and absent or inhibited grief in the second.

Sensorimotor therapy utilizes somatic awareness as the entry point, which might allow for a way to engage clients that move beyond their inability find words to describe their grief-related stress.

A [blank_start]window of tolerance[blank_end] is the secure place where both thoughts and feelings can occur simultaneously. They are tolerable and responses are appropriate within a given situation. Being outside of this can result in anxious clients experiencing an increase in rumination that becomes more difficult to contain and thus requires more therapeutic support. Avoidant clients outside of this tend to seek out additional ways to remain distracted from their grief when.

Sensorimotor psychotherapy can be especially helpful in individuals with avoidant attachment individuals.

A continuing bond with the deceased is an integral part of successful adjustment to the bereaved.

The [blank_start]2 Track Model of Bereavement[blank_end] understands the process of adaptation to interpersonal loss as linked to the disruption of homeostatic functioning and as relating and reconfiguring aspects of the relationship to the deceased. Advocates for the assessment of both functioning and the nature of the continuing attachment to the deceased when the significant others die.

The [blank_start]2 Track Model of Bereavement[blank_end] includes a questionnaire, TTBQ, that we can use to evaluate the relative and absolute state of their bereavement as well as compare their response to other bereaved individuals at different points of time.

The problem with stage/phase theories is their rigidity and assumption of a sequential time trajectory. Task theory presents a much more fluid understanding of the mourning process... they can be addressed with no special ordering, and can be visited/reworked over time.

There are 4 tasks of mourning...

The [blank_start]feminization of grief[blank_end] stresses that expressing emotion and seeking social support and help from others are critical in effectively coping with loss. This is 1 of 3 perspectives of the relationship between gender and grief.

Counsellors should not challenge the way that men cope, but rather find ways to deal with loss congruent to their 'masculine inclinations'.

Gender determines grieving style

Instrumental grieving is to [blank_start]masculine[blank_end] as intuitive grieving is to [blank_start]feminine[blank_end]

[blank_start]Blended[blank_end] grievers are both instrumental and intuitive grievers.

[blank_start]Dissonant[blank_end] grievers are people that experience cognitive dissonance, a contradiction, between their experience and expression of grief. They are truly at war with themselves.

Instrumental grievers = [blank_start]head grievers[blank_end] Intuitive grievers = [blank_start]heart grievers[blank_end] Blended grievers = [blank_start]head & heart grievers[blank_end] Dissonant grievers = [blank_start]head VS. heart[blank_end]

In regards to late-life spousal loss, clinical depression is the exception rather than the norm.

4 important influences on spousal grief...

[blank_start]Complicated grief[blank_end], or prolonged grief disorder or traumatic grief, is a painful and impairing condition under consideration for inclusion in the DSM-V. Typical symptoms are intense/persistent feelings of yearning, shock, disbelief, and anger; having difficulty to care/trust for others; and impairing behaviour to try to avoid reminders of the loss/feel closer to them. Risk factors include 3 categories: 1. [blank_start]Personal psychological vulnerability[blank_end] 2. [blank_start]Circumstances of the death[blank_end] 3. [blank_start]Context in which the death occurred[blank_end]

What are the best interventions or treatments for Complicated Grief (aka Prolonged Grief Disorder/Traumatic Grief)? They are all heuristic models...

[blank_start]Ambiguous loss[blank_end] is a particularly stressful kind of loss because it is no typically officialy acknowledged, and there is no possibility of closure. Of 2 types.

[blank_start]Chronic sorrow[blank_end] is pervasive sadness that is permanent, periodic, and progressive in nature. Often overlaps with ambiguous loss.

Both ambiguous loss and chronic sorrow are akin to [blank_start]complicated grief[blank_end] or [blank_start]prolonged grief disorder[blank_end].

3 Part Model Addressing Trauma...

The psychological purpose of the [blank_start]attachment narrative[blank_end] is that the stories maintain psychological security, continuity, and durability in the context of past and present as well as promise future relational fulfillment.

There is no neurobiological diagnosis, pill, or biological treatment for prolonged grief.

The sudden death of a loved one (whether it's accident, natural disaster, homicide, or suicide) carries with it an ever greater risk of a [blank_start]complicated bereavement[blank_end] trajectory.

[blank_start]Suicide[blank_end] bereavement is the most different from mourning after death from natural causes.

[blank_start]Nonfinite loss[blank_end] is characterized by a continuing presence of the loss itself, and not simply the ongoing presence of the individual's grief.

It's advisable that clinicians screen for distress related to death losses sustained in war that may take the form of [blank_start]complicated grief[blank_end], as treatments targeted at PTSD symptoms may not be sufficient.

Losing a pet is not nearly as devastating as losing a human companion.

The concept of continuing bonds has not been labeled as such in the pet bereavement literature, although similar phenomena have been described in relation to pet loss.

It is not whether a person experiences CB that is most important, what matters is the degree of comfort or distress that is experienced from a particular CB.

[blank_start]Disenfranchised grief[blank_end] is a term describing grief that is not acknowledged by society.

Family therapy process is consistent with theoretical constructs of dual process (oscillation between loss orientation and restoration orientation), attachment theory, social-cognitive reframing of assumptive worlds, and process of group adaptation.

Traditional principle of family therapy are represented by:

It's best to do counselling individually as opposed to family-counselling because the various perspectives can make it difficult to cast judgments.

Bereaved individuals seeking family therapy should not choose random family members because that could create a biased atmosphere for the therapist, rather, all family should be invited.

The goal of joint story telling in family-therapy is to create an experience of [blank_start]shared grief[blank_end].

[blank_start]Expressive art therapy[blank_end] is effective by "making" and "sensing" ("sense making") are ways of knowing, shaping, and storying grief & loss so that experiences do not remain senseless.

Expressive arts therapy is mainly concerned with direct interpretation of the symbolic material presented.

The creation of legacy is not confined to the time frame of the traditional funeral.

Virtually all hospice standards have included an expectation that bereavement services be provided to families usually for a minimum of one year after the death of the patient.

-[blank_start]Complicated grief[blank_end] is expressed at a greater or less intensity over a significantly longer or shorter time than is culturally expected -[blank_start]Acute grief[blank_end] is initial and intense response to loss -[blank_start]Chronic sorrow[blank_end] is grief in response to ongoing loss -[blank_start]Delayed grief[blank_end] is grief that is not expressed or experienced until well after the loss -[blank_start]Anticipatory loss[blank_end] is grief that is experienced before the loss/death

A [blank_start]good death[blank_end] is when the individual is in control, comfortable, has closure, has trust in caregivers, has recognition of impeding death, beliefs and values are honoured, burden is minimized, relationships are optimized, a legacy is left, and included family care.

A [blank_start]bad death[blank_end] is when the death was not in accordance with one's wishes, it was not in their location of choice, they were alone, prolonged/suffering, traumatic/fearful/angry, cognitively impaired, unprepared, disorganized care, family burdened, alone, young

[blank_start]Loss[blank_end] is a natural part of existence. Real or perceived deprivation of something meaningful. Can be tangible or intangible.

[blank_start]Grief[blank_end] is the natural reaction to loss- psychological, social & somatic reactions

[blank_start]Bereavement[blank_end] is the period after a loss when grief occurs

-[blank_start]Erich Lindemann's Crisis Theory[blank_end]: coined the term "grief work" with 3 taks: 1. Relinquish attachment to loved one 2. Adapt to life without loved one 3. Establish new relationship. Also identified 6 characteristics of 'acute grief': physical distress, rumination, survival guilt, anger, decreased function, internalization -[blank_start]Park's model[blank_end] consists of 4 phases: 1. Numbness 2. Yearning 3. Disorganization and despair 4. Reorganization -[blank_start]Elizabeth Kubler-Ross[blank_end]- identified the 5 stages of dying (later applied to grief experience with depression an integral component)- denial, anger, bargaining, depression, acceptance -[blank_start]Freudian Theory of Loss[blank_end]- the theory of mourning and melancholy distinguished between "normal" (reilnquishes ties and redirects emotional attachment) and "pathological" mourning (complicated grieving) -[blank_start]Worden's model[blank_end]: consists of 4 tasks: 1. Accept the reality of the loss 2. Experience the pain of grief 3. Adjust to environment without deceased 4. Withdraw emotional energy and reinvest in another relationship -[blank_start]Rando's model[blank_end] consists of 3 phases: 1. Avoidance phase 2. Confrontation phase 3. Reestablishment phase

-[blank_start]Grief within a constructivist[blank_end] framework is when mourners actively search to understand the loss and attach symbolic significance to the loss. 'Meaning making' influences transition, integrating loss into a 'personal narrative'. This is especially relevant for traumatic loss. May include personal endeavours such as projects etc. -[blank_start]Strength-based[blank_end] framework for grief and loss emphasizes that grief is a natural, expectable, and potentially health producing process (NOT pathological). Everyone has individual & envn'tal strengths that can assist them through their grief to facilitate the process of psychological separation from the deceased. Grief evolves over time and is expressed at varying levels of consciousness. -[blank_start]Continuing bonds[blank_end] framework of grief reduces detachment from the deceased. The focus is on an internalized, ongoing relationship (NOT pathological). The idea is to maintain an inner representation of the deceased that is normal rather than abnormal.

[blank_start]Bowlby's attachment theory[blank_end] says that the lifespan development of attachment involves formation of bond, maintenance of the attachment, and disruption of the bond. Grief is a reflection of basic attachment dynamics and includes 4 phases: 1. Numbness & denial 2. Yearning & searching 3. Disorganization & desolution 4. Gradual movement to reorganization

When a loved one dies from disease/natural causes, there is time, space & opportunity to share a dying narrative. In unforeseen deaths, the bereaved are traumatized because there was no time, space, or opportunity for them to include in narrative. This narrative is retold as an alienated event, because they played no role in the unfolding.

Suicide can be understood as containing elements from 1. suicide 2. violent deaths 3. unexpected deaths and 4. all deaths. Suicide bereavement therefore often entails complicated grief.

What are the best interventions in suicide bereavement?

Our [blank_start]self-narrative[blank_end] is an overarching cognitive-affective-behavioral structure that organizes the micro narrative of every day into a macro narrative for our self-understanding.