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.     

A Poetic Path from Melancholy to Mourning: Robert Lowell's Elegies as Case Study

This essay builds on a previous one in this journal (Cole, 2005) that details how reading elegiac poetry, the poetry of mourning, may be a pastoral resource for complicated grief or what is classically termed melancholia. A study of elegies by poet Robert Lowell (1917–1977), which depict a progression from melancholia to more “typical” mourning, demonstrates how thinking and writing in elegiac terms may offer a similar resource, whether for one's own melancholia or that of persons in one's care. Allan Hugh Cole, Jr. is Assistant Professor of Pastoral Care at Austin Presbyterian Theological Seminary.     

Guilt in bereavement: Its relationship with complicated grief and depression

This study investigated the relationship between guilt and well‐being of bereaved persons, and explored potential differences in the associations between guilt‐complicated grief (CG) and guilt‐depression. In total, 1358 Chinese bereaved adults were recruited to fill out questionnaires. Participants (N = 194) who had been bereaved within 2 years of the first survey, filled out the same questionnaires 1 year later. Higher guilt was associated with higher degrees of both CG and depression. The level of guilt predicted CG and depression symptoms 1 year later. Bereavement‐related guilt has a closer association with CG than depression. Responsibility guilt, indebtedness guilt and degree of guilt feeling are more prominent aspects of guilt in CG than in depression. These findings demonstrate the significant role of guilt (perhaps a core symptom) in mental health of the bereaved, having implications for identifying persons with grief complications and depression.     

The New York Inferno: Taking Solace from the Stories

The sudden destruction of the World Trade Center on 9/11 created an instant scenario of panic and horror. It was followed by post-traumatic shock that spread across New York. Psychoanalysts and other therapists were mobilized to provide emergency counseling for survivors, families of victims, firemen, police, rescue workers and others who had been scarred. One of the most effective techniques was to encourage the telling of personal stories as a method of working through trauma. It emerged as the most powerful tool in our therapeutic arsenal.     

Teacher Perspectives on Grief Among Children with Intellectual Disabilities

The death of a parent can have a profound impact on a child. However, little is known about how children with intellectual disabilities demonstrate grief or how teachers respond to student grief. Constructivist grounded theory methods were used to analyze data collected from five special education teachers of elementary students with intellectual disabilities. Categories related to grieving, loss, support, coping, and emotion were found. Teachers reported a range of grieving behaviors displayed by children with intellectual disabilities in the classroom and used various strategies to provide support. Grief in surviving caregivers and assistance from other school personnel were also described. The need for additional training of teachers and counselors about grief in children with intellectual disabilities is highlighted.     

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.     

The Underlying Structure of Grief: A Taxometric Investigation of Prolonged and Normal Reactions to Loss

Recent studies have supported the distinctiveness of complicated and prolonged forms of grief as a cluster of symptoms that is separate from other psychiatric disorders. The distinction between prolonged and normal reactions to loss remains unclear, however, with some believing that prolonged grief represents a qualitatively distinct clinical entity and others conceptualizing it as the extreme end of a continuum. Thus, in this study a taxometric methodology was used to examine the underlying structure of grief. Participants included 1,069 bereaved individuals who had lost a first-degree relative. Each participant completed the Dutch version of the Inventory of Complicated Grief–Revised, which was used to create indicators of prolonged grief. The mean above and mean below a cut (MAMBAC) and maximum eigenvalue (MAXEIG) tests supported a dimensional conceptualization, indicating that pathological reactions might be best defined by the severity of grief symptoms rather than the presence or absence of specific symptoms.

Catastrophic Conditions in Couple Systems

SUMMARY

A presentation of case studies forms the focus for an exploration of the discovery of an abortion or adoption used as the management of an unwelcome pregnancy which occurred in the context of the marital system. Managing an impasse in the middle phase of therapy in each case led to the emergence of information which then allowed the therapist to work with the couple system to alleviate the core situation out of which presenting problems emanated. In these cases the unwelcome pregnancy had the potential to be cataclysmic to the couple system. Therefore, the possibility that a couple is concealing an abortion or an adoption should be considered by couples' therapists when there is little or no response to usual strategies for change. The reason for concealment is immaterial. What is paramount is that the therapist bring the event to the fore of treatment and work with a couple to put closure on what is generally an unresolved issue.