A Review of Loss,Trauma and Resilience: Therapeutic Work With Ambiguous Loss

Book reviewed in this article: Pauline Boss (2006). Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss.     

Circumstances of Death and Complicated Grief: Indirect Associations Through Meaning Made of Loss

Losses by violent means and the loss of primary attachment figures may increase the likelihood of developing a chronic and severe grief response (referred to as complicated grief, or CG). Path analysis was used to examine the relationships between these risk factors and CG symptoms. College student participants filled out online questionnaires relating to their bereavement. Analyses provided support for statistical models whereby meaning made of the loss fully mediated the association between cause of death and CG symptoms and partially mediated the association between relationship to the deceased and CG symptoms. Although based on cross-sectional data, these findings provide additional support for meaning-oriented understandings of adaptation to loss.     

Grief and Recovery: The Prevalence of Grief and Loss in Substance Abuse Treatment

Grief from various losses can underlie the process of recovery from substance abuse disorders. This study identified losses that clients encountered prior to abusing substances, losses that occurred as a result of addiction, and losses that occurred upon entering treatment.     

Yearning and Its Measurement in Complicated Grief

Persistent intense yearning for the deceased is a core clinical feature of complicated grief (CG) that distinguishes it from other mental disorders that develop following loss. The Yearning in Situations of Loss Scale (YSL) is a recently developed assessment of yearning. To assess the psychometric properties of the YSL in those with CG, we administered the YSL, Inventory of Complicated Grief, and Quick Inventory of Depression Symptomatology to 303 treatment-seeking bereaved adults with CG. Our results suggest the YSL is a reliable assessment with acceptable convergent and discriminant validity as a measure of yearning in those with CG.     

Complicated Grief: An Evolving Theoretical Landscape

The bereavement literature has proliferated in recent decades, generating a shift from conceptualizing grief as a stepwise, uniform process to an idiosyncratic experience that varies among individuals. Among the most notable developments is the empirical exploration of complicated grief—a protracted, debilitating, sometimes life‐threatening response to the death of a loved one—and the testing of novel interventions to treat it. This article provides counselors with recommendations for identifying and treating complicated grief.     

Suicidal Ideation in Elderly Bereaved: The Role of Complicated Grief

This study examined whether symptoms of complicated grief at baseline predicted suicidal ideation during a depressive episode in elderly bereaved individuals. Over a 17-month period, serial ratings of suicidal ideation, hopelessness, and symptoms of depression, anxiety, and complicated grief were obtained from 130 elderly participants who had lost their spouses within the past 2 years. Groups of active and passive suicidal ideators, as well as nonideator controls, were compared via analysis of variance (ANOVA) with respect to levels of complicated grief, depression, and anxiety. Elderly bereaved with both active and passive suicidal ideation were found to have higher symptomatic levels of depression, hopelessness, complicated grief, and anxiety, as well as lower levels of perceived social support, than nonideators at study entry. Fifty-seven percent of the patients with high complicated grief scores were found to be ideators during the follow-up versus 24% of the patients with low complicated grief scores. Patients with any suicidal ideation had higher symptom levels of depression, anxiety, and complicated grief when they were ideators as compared with periods when they denied ideation. Fifteen out of the 39 ideators had recurrent depressive episodes versus 5 of the 91 nonideators. Patients with a history of suicide attempts were more likely to be ideators after loss than other bereaved. Thus, the condition of having high levels of complicated grief symptoms and depressive symptoms appears to make bereaved individuals vulnerable to suicidal ideation. Detection of high levels of complicated grief could help clinicians identify patients who may be at heightened risk for suicide.     

The Loss and Grief in Immigration: Pastoral Care for Immigrants

Immigration is common in this increasingly globalized world. Immigration is a psycho-social-geographical transition that involves a series of losses and changes, most of them obvious and expected, but some of them hidden and unexpected. Immigration also involves changes in one’s identity, as inner change tries to match outer change. The original story of immigration—by Abraham in the Bible—highlights some of the issues immigrants typically confront. A survey of Taiwanese immigrants in San Francisco and Vancouver, Canada illustrates some of the most troubling of these issues. Congregations, particularly bicultural congregations, are especially well-equipped to minister to the needs of the newly immigrated. Pastors need to be sensitive to the issues and needs of immigrants in a world where we are all foreigners in one sense or another.     

Loss of Humanness: The Ultimate Trauma

This paper is about chronic illness and its impact on the chronically ill and their loved ones who live through the illness and the eventual death. A new concept is introduced, the concept of "passing": physically ill people may pass as healthy even though they are physically ill. In addition to a discussion about why people choose to pass, two major paradoxes are considered. One concerns the paradox that results from "passing." The paradox is that while the falseness of "passing" keeps the self alive, it also deadens it before death. Specifically, "passing" enables the person with a physical illness to keep his well self alive with others, but results in one feeling dead, disconnected, detached, and inauthentic, before death. The second paradox involves the pressure on the chronically ill person to be heroically agentic in fighting the illness and overcoming it and, also, the pressure for this same person to be totally submissive and compliant with treatment. While in analytic treatment, the ill person can be helped to access authentic emotions and aliveness and to feel the power of authenticity.     

Divergent and Convergent Validation of the Complicated Grief Prototype Narrative

Although there is a prototype narrative for complicated grief (CG), there are neither divergent nor convergent validity studies of its clinical value. We evaluated the CG prototype narrative using a sociodemographic questionnaire and the Clinical Interview for Complicated Grief Diagnosis. We first conducted a convergent validation analysis followed by a divergent validation analysis. Results showed that participants with CG identified significantly more with the complicated grief prototype narrative than participants without CG.     

The Role of Avoidance in Complicated Grief: A Detailed Examination of the Grief-Related Avoidance Questionnaire (GRAQ) in a Large Sample of Individuals with Complicated Grief

Grief-related avoidance is a significant component of complicated grief, yet has rarely been formally measured in a validated fashion. Further, more work is needed to understand the impact of grief-related avoidance on symptom severity and functional impairment among individuals with complicated grief (CG). The Grief-Related Avoidance Questionnaire (GRAQ; Shear, Monk et al. 2007) was created to assess grief-related avoidance and the present analysis aimed to further develop this measure and construct by confirming the GRAQ’s psychometric properties and examining loss-related predictors of avoidance. In a sample of 393 adults with CG, we found the GRAQ had high internal consistency, with a Cronbach’s alpha of 0.89 and good convergent validity. While the EFA results suggest that the GRAQ may be unidimensional, a 3-factor model generally corresponded with the findings by (Shear, Monk et al. 2007), which suggested the presence of 3 subscales. Loss-related variables age, relationship to the deceased, and cause of death were all significant predictors of GRAQ scores. Our findings support that among individuals with complicated grief, avoidance is common, measurable and an important contributor to impairment.     

Elegiac Poetry: A Pastoral Resource with Complicated Grief

This essay argues that elegiac poetry, the poetry of mourning, may be a resource for pastoral care with complicated grief. It builds on Freuds distinction between mourning (normal grief) and melancholia (complicated grief), particularly as appropriated by French literary critic and psychoanalyst Julia Kristeva. It makes the case for elegy as a locus for externalizing a lost object which, in complicated grief, has been internalized as part of the bereaved persons self and which is not only grieved but also treated ambivalently if it is not hated. Drawing on the suffering God motif in Christian theologies of the cross, theological reflections supplement psychological arguments.     

Complicated Grief in Canada: Exploring the Client and Professional Landscape

Complicated grief (CG) is one of the central themes in bereavement research and advanced clinical practice today. Using a mixed-methods approach, we wanted to learn (a) what tools Canadian practitioners used to identify or diagnose CG and (b) what interventions or strategies they used to address CG. Sixty-three professionals responded to our survey. There were no straightforward answers to these questions: the state-of-the art of CG in Canada is, in fact, complicated. Practitioners used a wide assortment of tools and strategies with no consensus on any one approach or tool. Building a Canadian CG community of practice was recommended.