CBT for Grief: Clearing Cognitive Obstacles to Healing from Loss

There is tremendous variability in people’s ability to cope with, and adjust to, the death of someone close to them. One of the factors identified as significant in this regard is the constellation of beliefs that includes a mourner’s thoughts about the circumstances of the death, their feelings about the person who died, their reflections on the relationship with that person, and their assessment of their own ability to survive the loss. This paper considers the role of cognition in adaptation to loss, and demonstrates how maladaptive cognitions concerning the loss, the manner of death or the relationship with the deceased can interfere with adaptation and lead to complications in grief. Case examples illustrate the use of CBT with bereaved clients and the benefits of this approach as part of an overall strategy for helping grieving clients. The effectiveness of CBT with bereaved individuals is enhanced when clients understand the rationale of the treatment and are committed to carrying out the tasks specified in their treatment plan. The article presents a simple model for promoting client involvement and compliance.     

Between the idea and the reality: A study of the counselling experiences of bereaved people who sense the presence of the deceased

There have been many theories of the process of loss and bereavement, from Freud, to the present day. Early theories of bereavement described a process which, following various stages and associated tasks, ended at the relinquishment of the bond to the deceased. In more recent years theories have taken different directions, identifying how bereaved people re‐learn life, recreate biographies, and continue relationships to the deceased. Some research studies of bereavement have investigated the counsellors’ perspective, but there are very few studies of the client's experience and most studies have focussed on outcomes of counselling. This qualitative study, using semi‐structured interviews, provides an insight into the bereaved client's perspective on the content and process of their counselling experiences. Taking as its focus the client's sense of the presence of the deceased, this study aimed to identify whether or how counsellors facilitate exploration of this experience and which theories they use in client work. The main finding is that 80% of the counsellors were not perceived by participants to have worked with them satisfactorily in relation to their sense of presence of the deceased or in relation to the story of the death itself.     

中国丧亲个体社会支持体验的质性研究

本研究通过对28位丧亲者进行深度访谈,使用解释现象学分析法对质性数据进行分析,探索中国丧亲个体的社会支持体验。结果显示,丧亲社会支持的内容包括后事处理、情感支持、生活恢复帮助,经济与物资支持等。支持来源除家人和朋友之外,还包括同事、相同经历者,以及相关机构等。社会支持通过调节情绪、改变认知等方式促进个体对丧亲的适应。本研究结果为最新丧亲社会支持模型提供了支持,同时也反映出中国社会对丧亲人群的社会支持特色。     

Alternative death rituals in Switzerland: building a community of shared emotions and practices

New alternative death rituals are gaining significance in Switzerland, like in other contemporary Western societies. This article discusses how celebrants who are independent of any religious community shape alternative funerals and why such rituals may be able to function as a coping resource for a certain kind of participants. I argue that these rituals, co-produced by celebrants and the bereaved and including actively involved participants, can be seen as a re-conquest of ritual agency for lay people. By encouraging physical and mental contact with the deceased, the celebrants try to enable emotional arousal and create a temporary community of shared experiences and emotions and of the living and the dead. Elements of an individually crafted spirituality and a kind of nature religion represent both separation and continuing bonds between the living and the dead. As a consequence, such funerals serve as a resource in the face of death by integrating a singular death with the wider context.     

Community responses following suicide, homicide, and other deaths: the perspective of potential comforters

To determine whether actual responses of potential comforters in the community differ according to cause of death, 83 college students participated in a structured, individual interview. They were asked demographic questions about themselves, the bereaved, and the deceased, and then about various aspects of how they, and others in the community, responded to the death. Students were grouped by their reports of the cause of death (suicide, homicide, accident, natural anticipated death, or natural unanticipated death). When the death was by suicide or homicide, others were perceived as relatively less supportive of the bereaved person. When the death was by suicide, respondents themselves tended more to blame the bereaved person. When the death was by homicide, the bereaved person was perceived as reacting relatively worse. Potential comforters were relatively more shocked when the death was by homicide or accident.     

持续性联结及其与丧亲后适应的关系

生者与逝者的关系不会因为死亡而终止, 在逝者离世之后, 生者可能继续与逝者保持持续的、内在的联结, 这被称为“持续性联结”。持续性联结在不同文化中均普遍存在, 已有研究从联结控制点、联结的引发者等维度对其进行分类, 近年来, 持续性联结对丧亲后适应的影响成为丧亲及哀伤研究中的热点。持续性联结与丧亲后适应的关系呈现出复杂且不一致的研究结论。未来的研究应该在本土文化背景下去探索持续性联结的表现及特定意义, 思考持续性联结的分类并编制本土化的测量工具, 与此同时, 应该在理论驱动下去开展持续性联结与适应关系的实证研究。     

The management needs of the bereaved following loss of a partner

A case of death results in the formation of a social group, the group consisting of the bereaved, which remains in existence for a brief spell only, but which calls for careful attention. 124 widowed persons were questioned about their reaction to their loss, and changes in their habits after bereavement. Factors of influence are indicated, important among them dependence on the deceased, the age of the bereaved person, and physical and mental health.     

Beliefs and Experiences of Bereaved Teenagers: some spiritual and moral issues

When people die it is quite common for the bereaved to think about where they have gone and to maintain links with them in some way. Traditional Christian beliefs about ‘heaven’ and ‘hell’ may be revised and other ideas about spiritual continuity are often explored. This article will discuss responses from 94 11‐17‐year‐olds (38 males/56 females) regarding circumstances of and reasons given for a death; explanations and support; religious affiliation and belief in God; answers to the question ‘Why do people die?’ and ‘What happens after death?'; experiences of having a sense of the presence of the deceased; and personal qualities, attitudes towards other people and views of life. It will conclude by reassessing some of the moral and spiritual issues raised.     

Trauma-Focused CBT for Traumatic Grief in Military Children

Although military children are typically as resilient as the general child population, the ongoing conflict has exposed military children to unusual stressors such as repeated deployment, severe injury, or the death of a parent or sibling. U.S. forces have experienced more than 5,600 casualties during Operation Iraqi Freedom and Operation Enduring Freedom, with growing numbers of suicides among Service members. These deaths have affected thousands of military children. Most bereaved military children experience adaptive grief characterized by deep sadness, longing for the deceased person, and being comforted by positive memories of the deceased. A smaller number of military children develop childhood traumatic grief, characterized by trauma symptoms that interfere with adaptive grieving. Children with traumatic grief get “stuck” on the traumatic aspects of the death such as picturing the imagined or real details of the death; imagining the pain their loved one experienced in the moments before dying; wishing for revenge; and becoming angry at those who do not understand or share the child’s thoughts and feelings about the death. These children avoid reminders of the deceased person. Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment for children with trauma symptoms including those with traumatic grief. TF-CBT may be particularly suitable for military families. This article describes the clinical application of TF-CBT for traumatic grief in military children.     

The Induction of After-Death Communications Utilizing Eye-Movement Desensitization and Reprocessing: A New Discovery

A number of authors have described after-death communications (ADCs), in which bereaved individuals experience what they believe is actual spiritual contact with the deceased. ADCs are consistently reported as profoundly loving experiences that greatly assist the grieving process. Although most researchers have argued that ADCs can occur only spontaneously, Raymond Moody's research has indicated that we do have some control over the production of the experience. In this paper I describe a new induction technique that produces ADCs in a more reliable, rapid, and efficient manner. ADCs induced by this new technique provide a more elaborated experience that often fosters complete resolution of grief. These induced ADCs also appear to be much more like near-death experiences (NDEs) than do spontaneous ADCs, which strongly suggests that NDEs and ADCs may be essentially the same phenomenon.     

Japanese death rituals in transit: From household ancestors to beloved antecedents

The recent trend in contemporary Japanese funerals reflects changing family relationships, religious affiliation and individual values. Increasingly, Japanese people are conducting a living‐funeral or a non‐religious funeral (as opposed to a common Buddhist funeral), and dispersing ashes after cremation. Such funeral ceremonies and mortuary rites demonstrate the isolation of the elderly during the process of dying, the asymmetrical relationship between the deceased and the bereaved, and the attenuating ties between people and Buddhist temples. The fundamental change that underlies these transformation of funerary practices, I argue, is the shift from the ancestor worship that values the deceased for the purpose of household perpetuation, to the memorialism of individuals that celebrates the deceased's personal life based on the bereaved's love toward the deceased.     

Development and Validation of an Instrument for the Assessment of Dependency Among Bereaved Persons

Dependency among bereaved individuals has been hypothesized to be an important predictor of severe and enduring grief reactions. However, although there are a number of instruments that assess interpersonal dependency as a personality trait or style, no scales are available to assess bereavement-related dependency. Data from 170 widowed participants in a community-based longitudinal investigation, who had been bereaved for an average of 10.8 months, were used to investigate the reliability and validity of the Bereavement Dependency Scale (BDS), an instrument that was developed to assess dependency on the deceased among bereaved persons. Results indicated that the BDS demonstrated acceptable internal reliability and satisfactory convergent, discriminant, and construct validity. The BDS may be a clinically useful predictor of enduring and complicated grief reactions, major depressive disorder, and suicidality among recently bereaved individuals.     

Aesthetics and the Containment of Grief

My point of departure is the observation that people ubiquitously turn to aesthetic practices in response to the loss of a loved one. I argue that profound loss catapults the bereaved person into an alternate “world” that differs in marked ways from the world we usually occupy, an alternate world lacking even the basic coherence we need to function. Aesthetic practices facilitate restoration of coherence to our experience, as well as reconnection with the social world and recovery from the breakdown that profound loss involves. While the aesthetic notion of closure is frequently invoked in connection with the needs of the bereaved, I suggest that while containing the emotions experienced in connection with loss is vital if they are to be processed, unrealistic aspirations toward closure can encourage expectations that harm the bereaved. By contrast, I suggest that the aims of aesthetically punctuating experience and communicating through aesthetic gestures are beneficial for helping the bereaved adjust to their new circumstances.     

Long-term effects of the death of a child on parents' adjustment in midlife.

The death of a child is a traumatic event that can have long-term effects on the lives of parents. This study examined bereaved parents of deceased children (infancy to age 34) and comparison parents with similar backgrounds (n = 428 per group) identified in the Wisconsin Longitudinal Study. An average of 18.05 years following the death, when parents were age 53, bereaved parents reported more depressive symptoms, poorer well-being, and more health problems and were more likely to have experienced a depressive episode and marital disruption than were comparison parents. Recovery from grief was associated with having a sense of life purpose and having additional children but was unrelated to the cause of death or the amount of time since the death. The results point to the need for detection and intervention to help those parents who are experiencing lasting grief.     

Stigma-Busting,Compeer, and the Psychology Student: A Pilot Study on the Impact of Contact with a Person Who Has a Mental Illness

Stigma has been identified both by people with mental illnesses and by empirical research to be a major barrier to service use and recovery. In addition, research has suggested that the most effective strategy for reducing stigma is personal contact with a person who has a mental illness and who is contributing to the life of the community. This article reports the qualitative findings from a study of the use of the Compeer model to address stigma in undergraduate psychology students. Findings suggest that befriending a person with a mental illness, even when done as a requirement for a college course, can be a useful experience in exposing and challenging stigmatizing perceptions and expectations and in offering people insights into the humanity and life experiences of a person with mental illness. Limitations and implications of this study for future stigma-busting efforts are discussed.     

Book Review

Throughout different civilisations and historical epochs, anthropological and religious texts have been replete with accounts of persons who have reported anomalous experiences in the form of visions or voices. In these contexts, such experiences are considered to be a “gift” that can be spiritually enriching or life enhancing. One such group of individuals are mediums who claim to receive information from spirits of the deceased in the form of auditory or visual perceptions. This study explores how mediums come to interpret their experiences as mediumistic and how they describe their relationship with spirit voices. In-depth interviews were conducted with 10 Spiritualist mediums using interpretative phenomenological analysis. Three themes were identified: “Childhood anomalous experiences”, “A search for meaning: Normalisation of mediumship”, and “relationship with spirit”. These themes illuminated aspects of the mediumistic experience that have therapeutic implications for individuals who have similar experiences but become distressed by them.     

Long-term effects of losing a spouse or child in a motor vehicle crash

In this article we examine the long-term effects of the sudden, unexpected loss of a spouse or child. In the spouse study, interviews were conducted with 39 individuals who had lost a spouse in a motor vehicle crash 4 to 7 years ago and with 39 matched controls. In the parent study, interviews were conducted with 41 parents who had lost a child in a crash and with 41 matched controls. Control respondents were matched to bereaved respondents case-by-case on the basis of sex, age, income, education, and number and ages of children. Significant differences between bereaved spouses and controls were revealed on several indicators of general functioning, including depression and other psychiatric symptoms, social functioning, psychological well-being, reactivity to good events, and future worries and concerns. For the most part, these differences persisted when variables such as present family income and present marital status were statistically controlled. Comparisons between bereaved and control parents also revealed significant differences on some measures of general functioning (especially depression), but these were not as pervasive as the differences obtained in the spouse study. Responses to questions about current thoughts and feelings suggest that the deceased continued to occupy the thoughts and conversations of bereaved spouses and parents. Moreover, a large percentage of respondents (from 30% to 85%, depending on the question), continued to ruminate about the accident or what might have been done to prevent it, and they appeared to be unable to accept, resolve, or find any meaning in the loss. Taken together, the data provide little support for traditional notions of recovery from the sudden, unexpected loss of a spouse or child.     

An “Opting In” Paradigm for Kidney Transplantation

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors.

An “opting in” paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An “opting in” program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of “organ takers” who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who “opt in” would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive.

An “opting in” paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an “opting in” paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an “opting in” policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity.     

An "opting in" paradigm for kidney transplantation

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors. An "opting in" paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An "opting in" program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of"organ takers"who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who "opt in" would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive. An "opting in" paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an "opting in" paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an "opting in" policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity.