Bereavment and Care - Assignment Example

CFS 617 Exam I CFS 617 Exam I What impact do historical, sociological, and legal events have on our understanding of grief and loss. In your answer, cite specific examples for the assigned reading in chapter one of Leming and Dickinson. The adult grief researchers have developed a set of Bereavement Related Disorder criteria. The suggested conceptual domains can be identified as separation distress, reactive distress and behavior, disruptions in personal and social identity, and preoccupation with the circumstances of the death (Kaplow et al 2012, p. 246). Out of the said primary domains, the studies have identified the presence of persistent separation distress in bereaved children. In addition, some studies have identified symptoms of reactive distress and identity disturbances. Along with this, it is found that one of the most significant contributing factor to the persistence stress circumstance-related distress or the distress over the circumstances of the death. It is found that in the case of children, loss become traumatic even without the presence of objectively traumatic elements as they are more likely to be extremely dependent on a caregiver or a primary attachment figure. Thus, the physical absence of the caregiver leads to disorganizing and destabilizing effects on children. Another important issue addressed is the challenge of measuring multidimensional grief. The new instrument developed for the purpose is called Multidimensional Grief Reactions Scale. This is based on the Bereavement Related Disorder criteria; which include separation distress, reactive distress, existential related distress, ad distress over circumstances of the death (Kaplow et al, 2012, p. 248). In fact, the instrument works based on the underlying principle that each conceptual domain can lead to both maladjustment and positive adjustment. Also, there is the claim that they are not fully mutually exclusive. As this instrument is perfected, the traditional Extended Grief Inventory will be replaced. Another important development is the inclusion of distress over circumstances and identity related disturbances in treatments for grieving children and adolescents. One study investigated the effectiveness of a multi-tiered adolescent treatment of distress over the circumstances of the death and identity related distress brought about by a war. It was found that the ones who got treatment for circumstance related and identity related grief had more improvement than the ones who only received school milieu intervention which included psycho-education regarding the common distress reactions, trauma reminders, loss reminders, problem solving skills, and emotional regulation skills. Another important area of development is the understanding of the interplay between responses to trauma and responses to loss. It is found that they both, in fact, influence each other and coexist resulting in severe persisting distress. In addition, traumatic circumstances have a moderating effect. To illustrate, a child who has witnessed a gruesome murder will have recurrent intrusive images which will prevent the development of positive images about the deceased. Similarly, a child who has not witnessed the death may generate frightening fantasies about the way the person was killed. Thus studies identified that in the case of children and adolescents, the key focus should be on developing a non-traumatic image of the deceased which will help them reminisce in a comfortable manner. Though a period of twelve month is stipulated before considering pathologizing normal grief seen in adults, the new studies suggest that the possibility of maladjustment can be observed in children very early, that is in six months of the onset of the stressor. So, the new studies suggest that in the case of children, observation and intervention should be started in six months instead of after twelve months. Studies prove that the traditional debriefing methods are unsuccessful in improving the situation in the case of prolonged grief. This is so because prolonged grief is a complex situation which is marked by the presence of yearning, loneliness and dependency. Thus, even debriefing does not help improve the situation. One way to deal with the problem is to make the patient narrate the story about the loss and then identify the most distressing areas for the patient. After that, these areas should be regularly dealt in every session. Another way of dealing with the problem involves educating the patient about the irrationality involved in some of the beliefs about the loss. Moreover, it is found that working with the patient in setting and achieving concrete goals in real life helps them come back to normal life (Bonnano, p. 109). 2. Analyze “A Grief Observed” using Kubler-Ross’s stage model of grief. Cite examples in C.S.Lewis’s writing that illustrate Kubler-Ross’s theory. The kubler-Ross model theory or ‘simply five stages of fear’ was introduced by Kübler-Ross (1969) in his book On Death and Dying, which refers to a series of emotional stages people undergo when they confront the reality of death or some extreme dreadful fortune. The five stages are denial, anger, bargaining, depression, and acceptance. These stages exclusively address the subject of death and dying. According to the theory, every person who confronts with the reality of awaiting death or similar feeling of loss tends to show these five symptoms of bereavement. C. S. Lewis’ reflections on grief obviously assert the assumptions of the kubler-Ross model theory. In other words, in his collection of articles “A grief Observed”, Lewis’ description of his grief over the death of his wife involves almost all the stages of kubler-Ross model. To illustrate, the first stage ‘denial’ involves the temporary defense of the individual. Through this defense mechanism, people knowingly or unknowingly refuse to accept the real event. They tend to convince themselves that the death/misfortune will not cause to their beloved for any reason. Lewis states that there was something inside him that assured him ‘not to mind so much, not so very much’ (Chapter 1). However, soon the person realizes that the defense mechanism does not help them escape the situation, and subsequently they may enter another phase of grief, that is anger. Here the person may be taken by great anger. Though Lewis does not specify a fuming outburst he experiences toward his lower, evidently, he has passed through similar or more intense experiences. According to Kubler-Ross, bargaining refers to the person’s earnest promise to the Supreme Being that he would lead a better life in future if the loss is averted. For instance, see what Lewis felt when he reached this phase, “I soon learned not to talk rot to her unless I did it for the sheer pleasure” (Chapter 1). Depression is the next stage where the individual identifies that the event is inevitable, and thus loses hope. He might think that the adversity was the result of his deeds which could be avoided otherwise. As Lewis felt, “not only writing but even reading a letter is too much” (Chapter 1). This is the stage when the person cares little about his health or appearance. Acceptance is the final stage when the person identifies that the event was real and could hardly be avoided. He normally comes back to the normal course of daily life. 3. What is complicated grief in intrapsychic models? How would you help someone referred for “grief counseling” using these models of grief? Complicated grief or prolonged grief is a relatively recently explored form of grief. It can be explained in simple terms as a grief that lasts longer than normal. It is estimated that nearly 10 to 15 percent of people are likely to suffer from this situation (Bonnano, p. 96). In the normal course of action, people can be helped to come back to normalcy by helping them to reflect on their loss, take stock of the situation and accept the inevitable. However, when there is prolonged grief, this effort is not helpful as the grief makes such people withdraw from the world and become isolated. One important point that has become evident from studies is that prolonged grief is mainly controlled by yearning, or the repetitive and useless search for the lost loved one. Such people are unable to think about anything else other than getting the lost person back. Other forms of grief and depression are marked by various indicators like fatigue, lack of concentration, reduced interest in activities, difference in appetite, abnormal sleep patterns, and the feeling of worthlessness. On the other hand the yearning seen in prolonged grief is fully focused on finding the lost loved one. In fact, this is in contrast with the everyday experiences in which the memories of the loved ones bring comfort. In the case of prolonged grief, what happens is that when the grief persists for longer times, the image of the deceased starts withering away and it becomes fragmentary and disturbing. Thus, instead of offering comfort, the image gives worry and fear. Thus, prolonged grief presents a combination of yearning, emptiness, and isolation. These various factors are bound together by dependency. Admittedly, prolonged grief is a difficult situation to deal with as most of them do not need treatment. The best option available at this point is to determine as precisely as possible as to what the specific problem is and they adopting the most appropriate psychological treatment or intervention. One approach is to ask the patient to narrate the story about the loss and identify the most distressing areas. These areas are regularly addressed in the treatment. Yet another important strategy involves making the patient aware about the irrationality involved in some of their beliefs about the loss. Another important strategy is to work with the patient in setting and achieving concrete goals in life so that they are encouraged to move back to a normal life. Also, the dependency exhibited by the patients can be a useful tool in making them compliant and responsive to the suggestions. Another way is to encourage debriefing. It involves asking the patient to review the traumatizing experience in detail. The patient details the experience. The patient is encouraged to express the emotional reactions they had. In each session, the practitioner provides the patient information about the different ways people show common emotional reactions to traumatic experiences. In addition, the patient is made aware about the importance of talking about the experience rather than suppressing the feeling. However, recent studies show that these debriefing sessions have only negative effect on the patients. 4. How does children’s’ understanding of grief mirror cognitive development in general? In the case of adults, a loss becomes traumatic when they actually witness the situation. However, in the case of children, it is found that a loss is likely to become traumatic even without the presence of objectively traumatic elements, as they are more likely to be extremely dependent on a caregiver or a primary attachment figure. Thus, the physical absence of the caregiver leads to disorganizing and destabilizing effects on children (Kaplow, 2012, p. 249). Another important development is the inclusion of distress over circumstances and identity related disturbances in treatments for grieving children and adolescents. One study investigated the effectiveness of a multi-tiered adolescent treatment of distress over the circumstances of the death and identity related distress brought about by a war. It was found that the ones who got treatment for circumstance related and identity related grief had more improvement than the ones who only received school milieu intervention which included psycho-education regarding the common distress reactions, trauma reminders, loss reminders, problem solving skills, and emotional regulation skills (Kaplow, p. 250). In addition, it is found that in the case of children, there is interplay between responses to trauma and responses to loss. It is found that they both, in fact, influence each other and coexist resulting in severe persisting distress. In addition, traumatic circumstances have a moderating effect. To illustrate, a child who has witnessed a gruesome murder will have recurrent intrusive images which will prevent the development of positive images about the deceased. Similarly, a child who has not witnessed the death may generate frightening fantasies about the way the person was killed. Thus studies identified that in the case of children and adolescents, the key focus should be on developing a non-traumatic image of the deceased which will help them reminisce in a comfortable manner. 5. In the article, “DSM-V Diagnostic Criteria for Bereavement-Related Disorders in Children and Adolescents: Developmental Considerations, by Kaplowet. al., what factors do the authors cite that increase the risk for complicated or prolonged grief in children? What specific rationale do the authors give for not waiting the usual 12 months before providing counseling services for children who appear to be struggling with grief? There are various factors acknowledged as increasing the risk for complicated grief in children. The first among them is secondary adversities. The term ‘secondary adversities’ means the adverse life events and situations which are generated as a result of the death or loss. An example of this situation is the financial problems a child faces as a result of its parent. Another important factor is the loss reminders. Loss reminders include such situations and objects which remind the child of the absence. Such objects may include the deceased’s name, pictures, or belongings. The third important risk factor is the trauma reminders. They include the cues which remind the child of the traumatic circumstances of the death. In fact, children’s fear and negative emotions can be substantially reduced if they get support of an attachment figure. In addition, children’s emotional responses are to a great extent decided by the way their primary attachment figures respond. So, when the caregiver facilitation of grief and mourning is disrupted, the children are likely to suffer from psychological distress. This can happen due to parental depression or the loss of the surviving caregiver (Kaplow et al, 2012, p. 251). Some other important factors are death within the family, and the inability of the caregiver to maintain positive communication with the child will all have a negative impact on reminiscence. It is pointed out by the scholars that many children face serious issues like problems, parental divorce and so on. Such events are sometimes more or less equal to the ones which follow the loss. The scholars suggest that it is likely that the symptoms will occur within three months from the onset of the stressor, and that the stressor will occur at least 12 months from the death of a close relative or a friend. In fact, this twelve month period is suggested to avoid pathologizing the normal course of bereavement for adults. Thus, the problem with children’ grief reactions is that according to studies, children’s depressive symptoms diminish over time. Based on these points, the scholars suggest that duration of 6 months will be appropriate for Adjustment Disorder Related to Bereavement for children and adolescents. Firstly, a considerable proportion of bereaved children show adjustment and behavioral problems and they normally exhibit the same within the first several months. Secondly, studies show that prolonged intense grief reactions at 6 months can effectively predict the onset of depression at a later stage. Thus, effective assessment is possible even before the twelve months. Most importantly, one year is a considerable period in the developmental span of children. So, prolonging the period only results in late remediation. Most importantly, children depend heavily on their caregivers to facilitate adaptive grief responses. So, if it is possible to identify the symptoms of maladjustment, it will be possible to introduce effective and timely intervention in order to ensure proper adaptation to death. References Bonnano, G. A. The Other Side of Sadness. Levis, C. S. A Grief Observed. Harper Collins-e bokks. Kaplow, J. B., Layne, C. M., Pynoos, R. S., Cohen, J. A & Lieberman, A. (2012). DSM-V Diagnostic Criteria for Bereavement-Related Disorders in Children and Adolescents: Developmental Considerations. Psychiatry, 75 (3): 243-265. Read More