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.     

Suicide survivors' mental health and grief reactions: a systematic review of controlled studies

There has been a debate over several decades whether suicide survivors experience more severe mental health consequences and grief reactions than those who have been bereaved through other causes of death. This is the first systematic review of suicide survivors' reactions compared with survivors after other modes of death. Studies were identified by searching the PsychINFO and MEDLINE databases. Forty-one studies met the eligibility criteria. A qualitative data analysis was performed. There were no significant differences between survivors of suicide and other bereaved groups regarding general mental health, depression, PTSD symptoms, anxiety, and suicidal behavior. The results regarding the overall level of grief are less clear, depending on whether general grief instruments or suicide-specific instruments are used. Considering specific grief variables, suicide survivors report higher levels of rejection, shame, stigma, need for concealing the cause of death, and blaming than all other survivor groups.     

On‐Line Support and Resources for People Bereaved through Suicide: What Is Available?

The Internet is a potentially valuable source of information for the bereaved, but the current knowledge regarding the type and quality of online material on suicide bereavement is very limited. This study was designed to explore the types of online information and support available for people bereaved by suicide and the quality of such resources. Four popular Internet search engines were searched using terms related to suicide bereavement and support. Although a wide range of Internet resources exist for people bereaved by suicide, these resources may not meet basic quality standards. It is unknown who uses these sites, how such material is used, and whether it helps people to cope effectively with grief after suicide.     

Siblings after suicide--"the forgotten bereaved"

There is scarce research on "the forgotten bereaved"--the children and adolescents who lose a sibling by suicide. In this paper we explore their psychosocial situation and needs for assistance through a Norwegian nationwide study. The results show that particularly younger bereaved siblings are suffering from posttraumatic and grief reactions, depression, and anxiety. Most of the difficulties are not individual, but rather relational and social in nature, and largely contextually dependent. Necessary help is impeded due to the extraordinary experience leaving the siblings outside the circle of friends and parental grief community. A systematic outreach help program is presented.     

Grief experiences and expectance of suicide

Suicide is generally viewed as an unexpected cause of death. However, some suicides might be expected to a certain extent, which needs to be further studied. The relationships between expecting suicide, feeling understanding for the suicide, and later grief experiences were explored. In total, 142 bereaved participants completed the Grief Experience Questionnaire and additional measurements on expectance and understanding. Results supported the prediction of a link between expecting suicide and understanding the suicide. Higher expectance and understanding were related to less searching for explanation and preoccupation with the suicide. There was no direct association with other grief experiences. We conclude that more attention should be brought to the relation between expecting the suicide of a loved one and later grief responses in research and in clinical practice.     

Survivors of suicide do grieve differently: empirical support for a common sense proposition.

Previous empirical investigations have produced mixed results on the question of whether mode of death differentially affects grief. To further investigate the influence of suicide on grief, 350 previously bereaved university students completed a questionnaire package consisting of several standardized measures. Participants were separated into four groups based on the mode of death experienced as either survivors of suicide (n = 34), accident (n = 57), unanticipated natural (n = 102), or anticipated natural (n = 157) deaths. Hierarchical multiple regression analyses indicated that suicide survivors, compared against the other groups, experienced more frequent feelings of rejection, responsibility, "unique" reactions, and more total grief reactions. Trends indicating increased levels of shame and perceived stigmatization were also evident. Aggregate factors of death "naturalness" and "expectedness" showed less influence than mode of death in influencing grief. Overall, results support previous clinical and research findings and intuitive logic in demonstrating that the grief experienced by suicide survivors includes elements that are less frequently seen in the case of nonsuicidal deaths.     

The effects of preparedness for suicide following the death of a young adult child

Suicide deaths are often viewed as sudden and unexpected. Research examining bereavement responses to suicide are generally set within this conceptual framework. Twenty-two parents were interviewed about their bereavement experience following the suicide death of a young adult son or daughter. Data analyzed using narrative methods revealed the concept of preparedness. Three distinct preparedness narratives were identified, termed turbulent-relief, tragedy, and reflective plots. The data presented here highlights the way in which these different situations influence the resultant grief. Understanding preparedness for suicide assists in explaining the variety of grief responses in parents bereaved in this manner.     

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.     

Observing a client's grieving process: bringing logical positivism into qualitative grief counselling research

This positional paper originates from our need as researcher/practitioners to establish a meaningful epistemological framework for research into bereaved people's journey through loss and grief over time. We describe how the field of grief research has a long and established biological basis, in keeping with a positivist epistemology. However, there has been a diminution of the influence of logical positivism in twenty-first-century counselling research. We argue that in grief counselling research, naturalistic observation of the grieving process within a logical positivist paradigm, remains a valid and valuable construct. We posit an observational protocol for the grief counselling process which minimises the intrusion of research method into the therapeutic process. We offer this as a means of conducting qualitative research within a bereavement counselling service. Further, we suggest that the development of an observational protocol for a client's grieving process has potential implications for developing good practice in grief work.     

The Aging Of Grief: Parents' Grieving Of Israeli Soldiers

Abstract

This chapter examines long-term parental grief of soldiers within the context of the Israeli society. Parental grief is discussed along the life span, commencing at the immediate phase following the loss through the bereavement process in middle to late adulthood and its manifestations in aging. Interviews with a group of elderly bereaved parents whose sons were killed during military service give further support to previous findings regarding the notion that the passage of time has no diminishing effect on their grief nor does it relinquish their attachment to the deceased. With aging, there appears to be an increase in internalized involvement with the long-lost child, fears of fading memories, and the need to eternalize the deceased. In reviewing the past, parents reevaluate their coping with the loss and their relationship with the surviving children. The parents' preoccupation is twofold: On one hand, the strong attachment seems to continue in inner representations of the lost child, and, on the other, this preoccupation is enhanced externally owing to Israeli society's attitude toward dead soldiers. An intersection is therefore established between society and bereaved families. Grief is apparently a central theme in aging parents who are preoccupied with the “aging” of their grief rather than their own aging.     

“We Hardly Ever Talk about It”: Emotional Responsive Attunement in Couples after a Child's Death

Within Western cultural traditions, the idea that parents should talk about the death of their child with each other is deeply rooted. However, across bereaved parent couples there are wide variations in communication about their grief with each other. In this study, we explored the experiences of bereaved couples related to the process of talking and not talking. We used a thematic coding approach to analyze 20 interviews with 26 bereaved parents (11 interviewed as couples, four as individuals). Four main meanings emerged out of our analysis: not talking because of the inadequacy and pointlessness of words in grief, not talking as a way to regulate emotions in daily life, not talking as an expression of a personal, intimate process, and not talking because the partner has the same loss but a different grief process. In addition, we found that the process of talking and not talking can partly be understood as an emotional responsive process on an intrapersonal and interpersonal level. In this process partners search for a bearable distance from their own grief and their partner's, and attune with their relational context. A better understanding of this process is sought in a dialectical approach, emphasizing the value of both talking and not talking in a tense relationship with each other. Implications for clinical work are described.     

Innovative Moments in Humanistic Therapy II: Analysis of Change Processes Across the Course of Three Cases of Grief Therapy

The current study is an extension of a complementary investigation examining links between process and outcome within six-session psychotherapies in which three eminent psychotherapists each worked with a bereaved client, using person-centered, existential, and constructivist approaches, respectively. The Innovative Moments Coding System (IMCS) was used in both studies to examine processes of change in the moment-by-moment unfolding of grief therapy. The initial study's findings help inform theory regarding the relevance of humanistic interventions when working with bereaved clients, particularly those that help promote meaning making in the wake of loss. The current investigation extends the original by offering a fine-grained analysis of the progression of innovative moments (IMs) in the context of good-outcome grief therapy, liking specific therapy procedures with positive indicators of client functioning, while providing case illustrations of each therapy dyad. Findings highlight the promise of humanistic approaches in grief therapy, and suggest directions for further research in this area. Implications for future use of the IMCS in psychotherapy process and outcome research are also discussed.     

Suicide attempts in twins whose co-twins' deaths were non-suicides

Familial similarity for suicidal behavior has been interpreted by psychosocially oriented researchers as reflecting extreme grief following loss. This view would anticipate a higher frequency of attempted suicide among bereaved MZ than DZ twins (regardless of cause of death), given their generally increased social closeness. Alternatively, support for a genetic influence on suicidal behavior has been provided by findings of greater concordance among monozygotic (MZ) than dizygotic (DZ) twins, and among biological than adoptive relatives. This approach predicts that the occurrence of suicidal attempts among bereaved MZ and DZ twins whose co-twins deaths were non-suicides should not differ and should be low in frequency, given an absence of predisposing genetic factors. Attempted suicide was compared in 166 MZ and 79 DZ twins whose co-twins' deaths were non-suicides. Suicidal attempts (during the first two months following the loss) were recalled by 3 MZ twins (1.8%) and by 3 DZ twins (3.7%), a difference that was not significant. The present study, together with previous twin and adoption studies, supports the view that concordance for suicide among family members reflects a common genetic predisposition to suicidal behavior.     

The Clergy,the Clinician,and the Narrative of Violent Death

When death of a loved one occurs, humans use stories as a way of processing their grief and releasing their emotional attachment. In the case of traumatic and violent death, the story telling process is distorted, and focuses intensely and sometimes obsessively, on a often fantasized reenactment of the dying. Violent dying grief is often complicated further by the public and legal processes that surround violent death. The bereaved who get stuck in this dynamic may constitute a new psychiatric diagnosis called “prolonged grief disorder” and the author describes the criteria for this disorder. Clergy can play a key role in stabilizing and meditating the effects of trauma by inviting the bereaved to refocus their story telling, to a story of the loved one’s life. In a case the author illustrates many of the techniques used in this process of working with a prolonged grief disorder.     

Innovative Moments in Humanistic Therapy I: Process and Outcome of Eminent Psychotherapists Working with Bereaved Clients

This project entailed an intensive qualitative analysis of six-session psychotherapies conducted by three eminent humanistic psychotherapists working with bereaved clients. The Innovative Moments Coding System (IMCS), rooted in narrative therapy, is designed to measure change across therapy orientations. Research using the IMCS suggests that the psychotherapy change process occurs through the emergence, elaboration, and expansion of identifiable change moments for a client—innovative moments (IMs)—which present as exceptions to a client's presenting problematic narrative. There are five identified types of IMs: action, reflection, protest, reconceptualization (RC), and performing change (PC). The current study aimed to inform theory regarding the patterns of IMs across three humanistic approaches—constructivist, person-centered, and existential—when working with bereaved clients, while linking these patterns to observable change in each client's functioning. The alliance between each client and therapist was also assessed across the therapy process, showing consistently strong alliances across the three cases. Findings from the current study reinforce the salience of reflection, RC, and PC IMs in successful grief therapy cases, and also suggest the importance of meaning-making interventions in grief therapy. Clinical implications and suggestions for future research are also addressed.     

Impact of current grief on memory for past grief in spousal bereavement

This study examined the impact of changes in level of current grief over time on changes in memory for past grief. Following from previous work on the impact of current affective state on memory for past affectively salient events, bereaved individuals who underwent a greater reduction in grief over time were expected to show a similar pattern of changes in memory for past grief. A sample of conjugally bereaved participants completed measures of current grief and memory for past grief at the time of the loss of their spouse at each of the 2, 6, 13, and 30 month post-loss time periods. As predicted, those who reported greater reduction in grief over the course of the study were more likely to remember their past grief as progressively less severe relative to those who underwent less reduction in grief over time. A nonrecursive causal model analysis verified that changes in memory for past grief were explained by changes in current grief. These results were discussed in terms of contemporary reconstructive memory accounts of the effect of affective state on memory.     

Impact of current grief on memory for past grief in spousal bereavement

This study examined the impact of changes in level of current grief over time on changes in memory for past grief. Following from previous work on the impact of current affective state on memory for past affectively salient events, bereaved individuals who underwent a greater reduction in grief over time were expected to show a similar pattern of changes in memory for past grief. A sample of conjugally bereaved participants completed measures of current grief and memory for past grief at the time of the loss of their spouse at each of the 2, 6, 13, and 30 month post-loss time periods. As predicted, those who reported greater reduction in grief over the course of the study were more likely to remember their past grief as progressively less severe relative to those who underwent less reduction in grief over time. A nonrecursive causal model analysis verified that changes in memory for past grief were explained by changes in current grief. These results were discussed in terms of contemporary reconstructive memory accounts of the effect of affective state on memory.     

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。     

Suicide,Loss, and Mourning

ABSTRACT: The intensive treatment of six suicidal patients has been used to explore the relationships among object loss, the mourning process, and suicide. These relationships may be condensed in two propositions: (a) suicidal behavior stems from an arrested grief reaction in which the subject is unable to complete the process of mourning for a lost object; and (b) the suicide's pathological loss reaction is brought about by developmental defects, primarily deficiencies in self-love and individuation. The suicidal subject's mournïng reaction is arrested in one or more of the first three stages of grief: shock, protest, or detachment from the lost object.