GRIEF

1. Bereavement: objective situation of loss
2. Grief: affective response to loss
3. Mourning: acts of expression of grief (culturally defined)

1. Normal Grief
   1. Phase Model (Stroebe)
      1. Four phases that need to be progressed through
         1. Shock and Disbelief
         2. Yearning and Protest
         3. Despair
         4. Recovery and Restitution
   2. Task Model (Worden)
      1. Four tasks that need to be achieved
         1. Accept reality of loss
         2. Experience pain of grief
         3. Adjust to environment where deceased is absent
         4. Withdraw emotional energy and reinvest in new relationships
   3. Dual Process Model (Stroebe)
      1. Loss orentation
      2. Restoration orientation
2. Pathological grief
   1. Parkes
      1. Chronic grief
      2. Delayed grief
      3. Inhibited grief
   2. Parkes and Weiss
      1. Unexpected grief syndrome
      2. Ambivalent grief syndrome
   3. Persistent Complex Bereavement Disorder (DSM5)
   4. Pathological Grief Outcomes
      1. Mortality rate increase - OR men 1.87/women 1.47 (3 months post widowhood)
         1. OR men 1.16/women 1.07 12 months post widowhood
      2. Psychiatric and other disorders
      3. Elderly - unexpected bereavement mortality OR 1.61 / known morbidity OR 1.21

1. Stable low distress/resilience (46%)
2. Chronic grief 16%
3. Common grief or recovery 11%
4. Depression followed by improvement 10%
5. Chronic depression 8%

Annotations:

• L A D A V S Loss, attachment, death, antecedent. variables, social, stressors

1. Extent of the loss
2. Nature of attachment
3. Mode of death
4. Historical antecedents
5. Demographic and personality variables
6. Social variables
7. Concurrent stressors

1. Psychoanalytic
   1. Grief frees the person from libidinal attachment to the deceased
2. Attachment Theory
   1. Detachment from unavailable figure (as in childhood attachment)
3. Assumptive World (Parkes)
   1. Relinquishing assumptions about future and building new ones
4. Behavioural
   1. Loss of reinforcement
5. Learned Helplessness
   1. Loss of control/nothing can produce desired outcome
6. Stress and Crisis Models
   1. Adapting and developing new coping strategies to manage the loss

1. Roles
   1. Normalise experience
   2. Support expression of feelings
   3. Provide time to grieve
   4. Assist living in presence of loss
   5. Exposure therapy
   6. Continuing support
   7. Identify pathological grief responses
2. Efficacy
   1. helpful for self-referred clients and recently bereaved