The impact of death on the family system

The impact of death on the family system creates a structural void that requires homeostatic adjustments. This paper describes bereavement adjustments in the family system. The author proposes that a family member may be stuck in one of the phases of grieving, which contributes to the homeostatic utilization of one or more of these adjustments. These homeostatic adjustments provide a matrix for abortive grief which may have transgenerational consequences. The author further proposes two stages of grieving in addition to those given by Bowlby (1979, pp. 82–83) and Parkes (1972); that of transformation and actualization. The family system or family-community system may hinder or help the bereaved family grieve, or make the homeostatic adjustment. Judeo-Christian values and rituals are described as relevant to this process.     

Cross-Lagged Analyses of Prolonged Grief and Depression Symptoms With Insomnia Symptoms

Prolonged grief disorder, characterized by severe, persistent and disabling grief, has recently been added to the DSM-5-TR and ICD-11. Treatment for prolonged grief symptoms shows limited effectiveness. It has been suggested that prolonged grief symptoms exacerbate insomnia symptoms, whereas insomnia symptoms, in turn, may fuel prolonged grief symptoms. To help clarify if treating sleep disturbances may be a viable treatment option for prolonged grief disorder, we examined the proposed reciprocal relationship between symptoms of prolonged grief and insomnia. On three time points across 6-month intervals, 343 bereaved adults (88% female) completed questionnaires to assess prolonged grief, depression, and insomnia symptoms. We applied random intercept cross-lagged panel models (RICLPMs) to assess reciprocal within-person effects between prolonged grief and insomnia symptoms and, as a secondary aim, between depression and insomnia symptoms. Changes in insomnia symptoms predicted changes in prolonged grief symptoms but not vice versa. Additionally, changes in depression and insomnia symptoms showed a reciprocal relationship. Our results suggest that targeting insomnia symptoms after bereavement is a viable option for improving current treatments for prolonged grief disorder.     

Families and children with hearing loss: grief and coping

Parental coping with the diagnosis of their child's hearing impairment has not received a great deal of research attention, despite the evident importance of it. Parental coping has been changing with the inception of newborn screening as we move from a parent-initiated model of diagnosis to an institution-initiated model. Coping now begins without any preparation, and without any time for parents to "enjoy" their child as "normal." The grief models, based on the death experience, usually employed to describe parental reactions to the diagnosis may also be inappropriate. Death grief is terminable whereas parental grief is chronic. There is not sufficient research on the long-term effects of chronic grief and how that impacts on parent-child bonding. There is evidence that our screening endeavors have far outstripped our habilitation efforts, leaving parents with a diagnosis but without support. This gap must be closed.     

Introduction to the Special Issue on Grief

In the Introduction I present an overview of the changes that take place in conceptualizing the psychological purpose of the grief process following death of a loved one, and their effect on defining adaptive and maladaptive outcomes of grief. One of the most significant ones is the shift from breaking bonds to continuing bonds—the process of reorganizing the inner relationship with the deceased. New models of developmental grief have evolved. These are empirically-based and evidenced-based studies within which Cognitive Behavior Grief Therapy has gained significant reputation and the collection of articles in this special issue are representative of these changes. Also, a URL link of my article “Cognitive Behavioral Grief Therapy”, published in this journal in 1996 is provided for interested readers.     

A randomized controlled trial of a coping group intervention for adults with HIV who are AIDS bereaved: longitudinal effects on grief.

The authors sought to study the longitudinal effects of a cognitive-behavioral group intervention for coping with AIDS bereavement among a diverse sample of adults who were HIV positive. Participants (N = 267) were randomly assigned to receive the 12-week intervention or individual therapy upon request. Measures were administered at baseline, postintervention, and 4-, 8-, and 12-month follow-ups. Longitudinal data were analyzed with linear mixed models to examine change in grief by condition across the study period and the effect of the intervention on grief through its interaction with psychiatric distress. The authors used the Grief Reaction Index to assess grief and the Symptom Checklist-90-Revised to assess global psychiatric distress. Participants in both conditions reported decreases in grief severity. However, among those with higher levels of psychiatric distress, participants in the group intervention had significantly lower grief severity scores compared with participants in the individual therapy condition. The long-term effectiveness of this AIDS-bereavement intervention for psychiatrically distressed people with HIV/AIDS supports the need for tailored interventions among those at risk for complicated grief responses.     

History-containing Systems

This contribution summarizes two papers about transgenerational issues published twenty years ago. The ideas and practices which remain useful and unmodified are distinguished from those which have been changed or discarded over the ensuing decades. The helpfulness of the anthropological concept of sociality in integrating narrative therapy and social construction with transgenerational concepts is also discussed.     

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.     

An Integrated Model of Outplacement Counseling

There is not a large amount of information on the subject of outplacement counseling. Although there are 3 existing models of outplacement, they do not contain the practical and theoretical elements necessary for a complete and effective model of outplacement counseling. The Aquilanti Integrated Model of Outplacement was developed from various aspects of existing grief and career theories after a literature review of these models to provide a complete approach to outplacement counseling.     

Predicting Grief Symptomatology among the Suddenly Bereaved

Social scientists have long been interested in the study of grief and bereavement, but only recently has research focused on the aftereffects of sudden loss. Theory and research alike suggest that grief is multidimensional and that specific grief reactions have a unique set of predictors. The purpose of this study is to examine the relative contribution of risk factors in explaining variations in specific grief reactions following a sudden death. Data for this study come from medical examiners' reports and mail-back surveys of survivors of sudden loss from suicide or accident. The results indicate that several characteristics of the survivor, mode of death, and social support are important determinants of grief symptomatology. This research concludes by directing future theoretical and empirical endeavors to examine more fully the role of relational factors in influencing grief experiences following bereavement.     

Memories, fantasies, archetypes: an exploration of some connections between cognitive science and analytical psychology

The value of cognitive science as a means of investigating psychodynamic theory and practice is discussed and the limitations of this approach are described. Research findings from cognitive science are drawn on to clarify the nature of memory, which is seen to be a mixture of reproduction and reconstruction and the concepts of true and false memory are explored in this light. The part played by implicit memory and internal working models in producing transference is also examined. New ways of conceptualizing fantasy, which describes it as another facet of internal working models, and the role of transgenerational transmission of attachment patterns in creating internal working models are explored. The nature of archetypes is considered in the light of cognitive science research and a minimalist model is proposed, in which they can be likened to image schemas, that is, primitive conceptual structures that exist in a form which can never be experienced directly or indirectly.     

Neither Bereavement nor Grief: Coping with the Death of a Cherished Person in the Cunda-sutta

Though bereavement and grief have been common human experience throughout recorded history, how bereavement is viewed and grief coped with varies from one philosophical tradition to another. By examining features running throughout the Cunda-sutta, this paper demonstrates a shift from the ordinary conception of bereavement to an insightful understanding of not-bereavement. If one possesses insight into how worldly convention shapes ordinary conceptions of bereavement, then one need not associate bereavement with loss and grief. For ordinary people, grief may be regarded as a natural response to loss. However, in light of the emptiness of bereavement, the emphasis can be shifted from coping with grief to the understanding of not-grief and to the cultivation of mental abilities conducive to moving forward on the right path. By examining the reasoning of neither bereavement nor grief, this paper sheds new light on a rarely acknowledged perspective on coping with the death of a cherished person.     

Grief's Rationality,Backward and Forward

Grief is our emotional response to the deaths of intimates, and so like many other emotional conditions, it can be appraised in terms of its rationality. A philosophical account of grief's rationality should satisfy a contingency constraint, wherein grief is neither intrinsically rational nor intrinsically irrational. Here I provide an account of grief and its rationality that satisfies this constraint, while also being faithful to the phenomenology of grief experience. I begin by arguing against the best known account of grief's rationality, Gustafson's strategic or forward‐looking account, according to which the practical rationality of grief depends on the internal coherence of the component attitudes that explain the behaviors caused by grief, and more exactly, on how these attitudes enable the individual to realize states of affairs that she desires. While I do not deny that episodes of grief can be appraised in terms of their strategic rationality, I deny that strategic rationality is the essential or fundamental basis on which grief's rationality should be appraised. In contrast, the heart of grief's rationality is backward‐looking. That is, what primarily makes an episode of grief rational qua grief is the fittingness of the attitudes individuals take toward the experience of a lost relationship, attitudes which in turn generate the desires and behaviors that constitute bereavement. Grief thus derives its essential rationality from the objects it responds to, not from the attitudes causally downstream from that response, and is necessarily irrational when the behaviors that constitute an individual's grieving are inappropriate to the object of that grief. So while the strategic rationality of an episode of grief contributes to whether it is on the whole rational, no episode of grief can be rational unless the actions that constitute grieving accurately gauge the change in a person's normative situation wrought by the loss of her relationship with the deceased.     

Theological and Biblical Interpretations of Current Movements and Emerging Paradigms Within Bereavement Studies

Among the predominant themes in the last few years of bereavement studies have been those around disenfranchised grief, masculine grief, spirituality and grief, and the movement from medical/hierarchical models of grief work/counseling to a more non-hierarchical model that emerges internally, inherently, and intrinsically within the bereaved. In the latter model the grief counselor becomes a facilitator or, as Alan Wolfelt noted at the Chicago ADEC conference, a companioning presence. The intent of this article is to take this conversation into the realm of theology, and/or biblical theology. The following offers theological analysis of what is already good clinical theory. Integrating theories from anthropology and theology, this article will explore the concepts of voice, etic and emic theory, and incarnational theology as they relate to emerging patterns in bereavement studies. It will also relate a model of the Kingdom of God to disenfranchised grief, as well as offer support for the theory of masculine grief from biblical sources and complementary fields of study.     

Consulting With Teachers in Two Areas: Grief and Mourning: Relaxation Techniques

Consultation with teachers remains untried by many counselors despite mandates, role definitions, and models for consultation. Barriers include the preference for the status quo and the lack of information and preparation. Involvement and training can help overcome these barriers. Two possible consultation areas are grief management and relaxation training. Grief is the normal reaction to any kind of loss. Being aware of the various stages is the first step in helping someone through the grief process. Relaxation techniques can be learned with proper guidance. Before tying any new ideas, however, counselors and teachers must have sufficient information and training.     

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.     

They that mourn

Summary Grief is a universal phenomenon. It most notably occurs following a loss by death, but may occur following any separation. It is a definite psychiatric syndrome with a characteristic onset, course, duration, and termination. The normal period of acute grief is from six to twelve weeks, and the normal grief reaction is completed within two years. The process by which the bereaved comes to accept the separation from the loved one and to readjust to the environment in which the deceased is missing is called the grief work. The more actively one engages in the grief work, the shorter the period of grief. The physican and the minister should help the bereaved to engage actively in the grief work; the principles of doing this are presented.     

Pre-Conception War Exposure and Mother and Child Adjustment 4 Years Later

Evidence is accumulating for the transgenerational effects of maternal stress on offspring. A particular increasing concern is the possible transgenerational effects of community exposure to war and terror. Here, 107 mothers that had been exposed to war, were assessed with their 3 year old children (52 % girls) who had been conceived after the end of the war, and thus never directly exposed to war. The circumscribed nature (missile bombardment) and temporal limits (34 days) of the tragic 2006 Lebanon war in the north of Israel, affords a unique methodological opportunity to isolate an epoch of stress from preceding and subsequent normal life. We find that war experience engenders higher levels of mothers’ separation anxiety, lower emotional availability in mother-child interaction, and lower levels of children’s adaptive behavior. The novelty of these findings lies in documenting the nature and strength of transgenerational effects of war-related stress on offspring that were never exposed. In addition, because these effects were obtained after 4 years of a continuing period of normality, in which the children were born and raised, it suggests that an extended period of normality does not obliterate the effects of the war on mother and child behavior as assessed herein. Despite the study limitations, the results are indicative of persisting transgenerational effects of stress.     

Exploring Maternal Grief: A Mixed-Methods Investigation of Mothers’ Responses to the Death of a Child From Cancer

This study investigated the meaning-making phenomena underlying the responses of 13 bereaved mothers to the death of a child from cancer. Using a mixed-methods research design incorporating constructivist data collection methods, we found specific characteristics, coping processes, and factors to distinguish adaptive as opposed to complicated grief responses to this type of loss. However, the findings did not distinguish the bereaved mothers themselves as “adaptive” or “complicated grievers,” as they all evidenced both types of responses to their loss within or across different datasets. Despite this finding, the mothers’ results varied in terms of the proportions of adaptive as compared to complicated grief responses to their loss, which in turn were related to features of their self-construing, change or reinforcement of their world assumptions, ongoing relationship to their child and others in their social world, and management of loss- and restoration-oriented coping. Results suggest the utility of constructivist and cognitive coping models and methods in illuminating the experience of parental bereavement.     

Ongoing: On grief’s open-ended rehearsal

Peter Goldie’s account of grief as a narrative process that unfolds over time allow us to address the structure of self-understanding in the experience of loss. Taking up the Goldie’s idea that narrativity plays a crucial role in grief, I will argue that the experience of desynchronization and an altered relation to language disrupt even of our ability to compose narratives and to think narratively. Further, I will argue that Goldie’s account of grief as a narratively structured process focus on the process having come to an end. By contrast, I will propose the idea that grief can be understood as an open-ended rehearsal of our capacity to be alone in the company of an absent other. This makes grief a relational activity that differs from composing narratives about one’s past and about one’s process of grieving. Thus, grief is not primarily a process of recollecting our past narratively; rather, it can be seen as a dedicational activity which involves a future-oriented and open-ended rehearsal of relatedness despite irrevocable absence.