A family systems approach to grief

This article blends two important viewpoints on grief: a stage theory on the individual's grief and the family systems literature on grief. A case study is examined from both the individual and systemic viewpoints. Pastoral implications for intervention with the case study family as a system are noted. The theological questions which the family and pastor face are also discussed.     

Youth Mental Illness and the Family: Parents’ Loss and Grief

Parents and family members whose adult child or relative has a mental illness endure significant losses, to which they respond with grief. Such grief may negatively affect family members’ physical and psychological health and also the relationship with their relative. Yet, research in this field is sparse. Very few studies have examined parents’ loss and grief in the context of the patient being a child or teen. It is not clear the extent to which parents’ loss and grief in response to their child or adolescent’s mental illness is similar or different to the accounts of older parents and family members caring for an adult relative with major psychopathology (e.g., Schizophrenia, Bipolar disorder). Parental loss and grief is not often addressed in child and adolescent mental health services’ provision of care; alarmingly, little is known about how best to support parents who access these services. The present study aimed to bridge this knowledge gap and identify the therapeutic needs of this younger parent population. Comprehensive interviews were conducted with 14 parents and one custodial grandparent of a youth aged 18 years or younger who was currently attending a child and adolescent mental health service. An inductive thematic analysis identified six themes; parents’ narrative of finding out, profound and pervasive loss, complex grief, waning support, the challenges of caregiving and a call for assistance. It can be inferred from these results that youth mental illness can constitute a source of loss and grief for parents. Participants’ loss and grief was largely consistent with the experience of families caring for an adult relative with major psychopathology. Opportunities for mental health practitioners to support families’ loss and grief were identified. Further studies are needed to enhance understanding of this complex and, to a large extent, ignored familial experience. Results do underscore the importance of clinicians acknowledging parents’ loss and grief and working directly with this experience over the course of youths’ treatment, perhaps in conjunction with family psychoeducation approaches.     

Sudden Death and Bereavement Outcomes: The Impact of Resources on Grief Symptomatology and Detachment

The study of sudden bereavement focuses almost exclusively on its impact on psychological well-being. This research broadens our understanding of bereavement outcomes by exploring the effect of grief on family detachment following sudden bereavement. Moreover, this study examines the relative contributions of resources in alleviating grief symptoms and reducing detachment. Data are collected from medical examiner records and mail-back surveys from family members of victims of suicide and accidental deaths in a large metropolitan area of the United States. A covariance structural equation model allowing for correlated measurement error is estimated using LISREL VII. The results indicate that the most grief-stricken survivors are more detached from family than those who are least grief-stricken. Examination of the direct and indirect influences of resources on bereavement outcomes reveals that self-esteem is the strongest predictor of grief and that it also plays a decisive role in mediating the influences of religious participation and exercise on grief. Expressive support exerts direct effects on both grief and detachment. This research concludes by directing future research to examine more fully the impact of sudden bereavement on marital and family relationships.     

On the Reclaiming of Denied Affects in Family therapy

A central developmental task of the family is to help its members develop the capacity to cope with the grief attendant on separation and loss. In order to work through such feelings, each member must first be able to acknowledge the affect as present, internal, and belonging to the self. Depending on the degree of intrapsychic differentiation, and the dread of abandonment, family members may seek to avoid awareness of such feelings within themselves. The disclaimed emotions remain powerful unconscious motivators of behavior, exerting their influence despite their denial. Some typical clinical illustrations of this are provided. Excerpts from conjoint family therapy are then presented to illustrate the therapeutic interventions made in assisting a family to acknowledge denied grief over the separation of one of its members along with unspoken tender feelings within the family. This paper affirms the continued relevance of a psychodynamic, interpretative approach for families struggling with unresolved grief.     

Death in the Family: Adapting a Family Systems Framework to the Grief Process

This paper presents a framework for adapting a family systems approach to the grief process. The framework places the bereaved and therapist in the larger context. The therapist builds a relationship around each family member's unique experience with death, and uses the grief timeline to facilitate timely systemic interventions. This perspective helps the therapist navigate pitfalls and remainstrategically positioned to address grief sensitively and effectively in psychotherapy.     

Common Grief,Complex Grieving

In this article, the author reflects on the changes during the last 25 years in our understanding of grief and on the emerging new issues in the field of loss and grief studies. He identifies several significant issues, including the implications of violent death for public and private grief, the increased attention upon the family as a mourner, and new ritual patterns emerging out of changes in funeral practices in recent years. The essay concludes by briefly considering a number of issues shaping grief and our care for those who mourn.     

Parental reactions to the loss of an infant child: A review

This article examines methodological problems, and describes and evaluates commonly explored variables regarding research on the effect of an infant's death on the family. The components of parents' and siblings' grief reactions, and the similarities and differences in parental grief are reviewed. The research shows marked differences between mothers' and fathers' reactions--the grief reactions in mothers being stronger and more prolonged. Different explanations for this are put forward. The effect of different types of loss as well as the effect of the child's life span before death are also reviewed and discussed. Further knowledge is needed to single out the influence of these factors' on the families' reactions. It is concluded that the death of an infant makes the family prone to develop short-term and/or long-term problems in their adaptation to the loss. An integrated effort by health professionals is needed to develop systematic ways of helping families to cope with the death of a child.     

Family and social networks after bereavement: experiences of support,change and isolation

The role of family and social support networks on grief experiences following the death of a family member in a road traffic accident is explored. Twenty‐one bereaved informants were interviewed and the data analysed using grounded theory methodology. We outline the ways in which a crash fatality impacts upon familial and social relationships. The data clearly demonstrate that although the death of a loved one precipitated closer familial and social bonds in some instances, it was more common that those relationships deteriorated and collapsed. Implications for service delivery, grief education and research are discussed.     

复杂哀伤丧亲女孩的箱庭疗法个案研究

通过19次个体箱庭和2次家庭箱庭治疗,对一名12岁复杂哀伤的丧亲女孩W进行了个案研究。发现:(1)箱庭治疗能提高丧亲青少年的个体和家庭功能,促进青少年个体和家庭哀伤任务的完成;(2)W的个体箱庭经历了在混乱重复中寻找秩序、重建自我、转化与整合、自我治愈力展现四个阶段;(3)W的哀伤经验经历了在治疗者促进下分享—象征性表达—主动地象征性表达—直接而主动地表达哀伤经验最终获得哀伤任务完成的变化过程。     

Goodbye,Daddy: An Autoethnographic Journey Through the Grief and Mourning Process

The purpose of this article is to present an autoethonographic study in how I experienced and communicated parts of the mourning process when my father died at the age of 73. The article highlights the stages of grief experienced during the first year. Autoethnographic means are used chronologically to explore how the loss of a family member impacts the stages of grief that are present and how they overlap. In particular, I highlight the events that carried meaning or provided an outlet to express one of the stages of grief. It is hoped that this article can be used to understand why grieving is not an overnight process, but rather is drawn out through the highs and lows of remembering a loved one.     

Predictors and correlates of bereavement in suicide support group participants

A sample of 210 survivors of suicide, all participants in suicide support groups, was studied. Associations between demographic factors, circumstances surrounding the suicide, and overall levels of grief (using the Grief Experience Questionnaire) were calculated. Results showed that seeing the body at the scene of the death was the most significant predictor of high levels of distress, and support from family and friends was the strongest protective factor. Time since the death (for women) and attendance at Alcoholics Anonymous meetings (for those participating in nonsuicide support groups) were also significantly related to level of grief. For men, a moderate level of participation in other support groups, as compared with none, was associated with higher levels of grief. All other variables were not significant. Results suggest that a model that combines posttraumatic reactions and grief is most appropriate for the aftermath of suicide.     

Daughters' dilemma: grief resolution in girls whose widowed fathers remarry early

This paper explores how a widower's early remarriage might complicate his bereaved daughter's grief resolution. In some families the emotional and domestic responsibilities of the deceased mother may be shouldered by an elder daughter on behalf of the surviving males in the family. Utilizing some of the propositions in recent 'new models' of grief, we explore the particular problems of 'conversational remembering' among daughters whose fathers remarry soon after their wives' deaths. Major difficulties may arise over conflicting perceptions of the role of the deceased mother within the new family system.     

Family Bereavement and Cultural Diversity: A Social Developmental Perspective

This article offers an integrative, interdisciplinary model of bereavement as a family developmental process that unfolds in cultural context. A critique of cultural assumptions highlights the culture-bound nature of prevailing North American practices, which view grief as an isolated individual experience and emphasize detachment from the dead as a way to promote recovery. Death and grief precipitate two kinds of family change, both guided by culture yet uniquely experienced and interpreted by individual families: 1) recreating the family without a key family member; but capable of coping with both existing and new tasks; and 2) incorporating the death into an ongoing but irrevocably altered family life-cycle developmental process. In supporting family change after a death, family therapists need to collaborate with grieving families in examining the goodness of fit between their unique circumstances and the bereavement expectations of their community and culture. Four case examples are presented, two of which will apply this social developmental model to emphasize transformations of attachment to the deceased — rather than detachment — that will support the ongoing family development of grieving families.     

Constructions of Mexican American family grief after the death of a child: an exploratory study

Using a collective case study ethnographic approach, nine individuals comprising three Mexican American families were interviewed about their family bereavement experiences after the death of a child. All families were Catholic, had surviving siblings, and had had three or more years to grieve their loss when interviewed. The deceased children ranged in age from 3 to 14, and all experienced sudden, traumatic, nonsuicide deaths. To provide a broader, contextual picture of their grief experiences, four individuals who supported these family members after the loss were also interviewed. Unique grief experiences were identified, and eight common themes emerged, reflecting the ways in which family members maintained their bond to the deceased: dreams, storytelling, keepsakes, sense of presence, faith-based connections, proximity connections, ongoing rituals, and pictorial remembrances. The cultural implications of family bereavement are highlighted.     

Parents’ Grief in the Context of Adult Child Mental Illness: A Qualitative Review

Research indicates that parents and other family members often grieve their child or relative’s mental illness. This grief appears resultant from a profound sense of loss, which has been described as complicated and nonfinite (e.g., Atkinson in Am J Psychiatry 151(8):1137–1139, 1994; Davis and Schultz in Soc Sci Med 46(3):369–379, 1998; Jones in Br J Soc Work 34:961–979, 2004; MacGregor in Soc Work 39(2):160–166, 1994; Osborne and Coyle in Couns Psychol Q 15(4):307–323, 2002; Ozgul in Aust N Z J Fam Ther 25(4):183–187, 2004; Tuck et al. in Arch Psychiatric Nurs 11(3):118–125, 1997). This paper reviews existent research in this emerging field, with a focus on parents’ grief experience in relation to their adult child’s mental disorder. Studies that explore parents’ and family members’ grief, using both qualitative and quantitative methodologies, are considered. Research evidence for the association between parents’ and family members’ grief and other outcomes are discussed. Findings concerning the prediction of grief in parents and family members who have a child or relative with a mental disorder will be reviewed. Finally, this paper considers methodological and theoretical issues associated with existent research and presents options for further study.     

Identity continuity and loss after death,divorce, and job loss

This paper examined the relationship of constructs identified by identity continuity and attachment theories of grief to adjustment to loss from the framework of identity theory. Connections between loss salience, identity construal, and balance of identity construal on grief intensity via their association with post-loss identity disruption were examined across three types of self-relevant losses; death of a family member, job loss, or divorce. We hypothesized that lower salience, higher endorsement of identity attributes represented by relational and individualistic self-construals, and an overall balance across identity attributes would be related to decreased grief severity across all types of loss. Results supported hypotheses with the exception that the hypothesized ameliorative effect of increases in relational self-construal was only seen in the bereaved group.     

Protection and loss: working with learning-disabled adults and their families

This paper describes a method of working with learning-disabled adults and their families when they encounter entrenched difficulties. Two significant themes are identified: the patterning of life-cycle transitions and the recurrence of grief. Therapy consists of joining the family members to evolve and develop hypotheses about what is preventing them moving to the next family life-cycle stage.     

Parental Mourning and Children's Behavior

This article alerts professionals to sibling death as a possible reason for behaviors exhibited by young clients. Aside from their own grief, children are affected by parental mourning over a child's death and accompanying changes in the family environment. Children show their distress in a variety of behaviors, some of which appear to be unrelated to the loss. Four areas of concern are presented with case illustrations: cognitive distortions, reactions to parents' distress and preoccupation with the loss, being a replacement child, and effects of parents' failure to work through their grief. Suggestions for helping children and parents include using a genogram for identifying loss, helping the family talk about the death, and providing a support group for children.