Journal of Mental Health Counseling: Jul 1998: 20, 3; Academic Research Library pg216 Death and Bereavement: What Counselors Should know Stephen J. Freeman Sharon Ward Death, it has been said, is the last stage of developent: one we all must face. In doing deceased leaves behind the task of grief for the survivors. Training in death education and gri counseling is not typically a part of a counselors'curriculum, yet the odds of a counselor seeing le in vanous stages of the grievin ss are great. Beginning with Bowlby s attachment the Edward Rynearson, in his foreword to the June issue of Psychiatric Annals(1990), told of a client any counselor might encounter. This client was a woman with small children who was still dealing with the death of her husband, which had happened the previous year. She was referred to Rynearson by her physician because of a "pathologic grief reaction When she came to therapy. she was feeling guilty because she had been told she was not grieving properly. Upon further investigation. Rynearson learned that her energies were spent doing everything possible to help the children cope with this tragedy. When Rynearson explained what she might expect in the future and gave her encouragement that she was doing well under difficult circumstances, she began to cry and grieve the death of her husband for herself, not just for her children Lewis Thomas(1974)wrote in The Lives of a Cell, Notes of a Biology Watcher. s tell us of the news that we are dying away. while the birth finer print, off at the side of the page. inform us of our replace ents grasp from this of the enormity of the scale. There are 3 billion and all 3 billion must be dead, on a schedule. within this lifetime. the va volving something over 50 million of us each year, takes place in ephen /. Freeman, Ph. D, is an associate professor of Connseling and the program coordi ator of the Counseling Program in the Department of Family Sciences at Texus woman's uiversity, Denton, TX. Sharon Ward is a counseling intern ar the Ridgley Counseling Center nd a volunteer at Warm Place, a bereavement counseling center in Fort Worth, TX 2l6 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Death and bereavement: What counselors should know Stephen J Freeman; Sharon Ward Journal of Mental Health Counseling; Jul 1998; 20, 3; Academic Research Library pg. 216
Freeman and Ward/ DEATH AND BEREAVEMENT 217 Not one of us can escape the certainty that grief will live within our hearts It some time during our lives In the absence of, or often in addition to, perceived social support some of the bereaved will turn to counseling professionals to guide them through the most painful moments in their lives(Lenhardt, 1997; Ruskay 1996: Worden, 1991). Yet, training in grief counseling is not typically part of a counselor's education This article provides an overview of the griev- ng process and what counselors should know Bowlby's Attachment Theory and ideas on loss and grieving provide a framework for the counselor to use in assessing grief reactions Using Bowlby's Attachment Theory as a basis to look at the grieving process is in line with the york of a number of prominent grief researchers J. William Worden( 1991). Beverly Raphael (1983), and Colin Parkes(1990) are among the many who have drawn upon his ideas in the formulation of their own theories of grieving. Attachment behaviors are instinctive behaviors that have as their goal maintaining contact with another individual (in children thereby insuring survival). It is the purpose of attachment behavior to maintain an affe tional bond. Situations that threaten this bond give rise to certain ver specific behaviors. The greater the potential for loss the more intense the behavioral response(Bowlby. 1977) Konrad Lorenz(as cited in Parks, 1972) described grief-like behavior n the separation of a goose from its mate The first response to the disappearance of the partner consists in the anxious attempt to find him again. The goose moves about restlessly by day and night, flying great dis tances and visiting places where the partner might be found. uttering all the time the penetrating trisyllabic long-distance call. The searching expeditions are extended arther and farther and quite often the searcher itself gets lost, or succumbs to an ccident.. All the objective observable characteristics of the goose's behavior on losing its mate are roughly identical with humans (p. 40) NORMAL GRIEVING Within normal grieving, there is a wide range of behaviors. Clayton, Desmaris, and Winokur (1968) found that common reactions included depressed mood, sleep disturbance, crying, and difficulty concentrating Worden(1991)expanded the list of normal reactions to include anxiety loneliness, fatigue, helplessness, shock, yearning, emancipation, relief. numbness, disbelief, confusion, preoccupation, sense of presence. halluci ations, sleep and appetite disturbance, dreams, and overactivity It is important to remember that what may be dysfunctional in one individ ual may not be in another. Conway(1988)describes a son who thought his mother was going crazy. The woman said that on occasion, her husband Reproduced with permission of the copyright owner. Further reproduction prohibited without permission
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2l8 JOURNAL OF MENTAL HEALTH COUNSELING deceased 2 years previously, still visited her at night in her dreams, and that dur- ing his visits she found sexual satisfaction. The woman was well adjusted in her work,social, and family life and active in the community. When the son under stood that seeing a deceased loved one and sexual satisfaction in dreams are normal, he saw his mother's experience in a different and more positive light Phases of grief a death loss is a disruption in the attachment bond a person has with a significant other in his or her environment. As such, the system must reorganize to a different level and that process generally follows in four phases(Bowlby. 1980) Phase I is characterized by emotional numbing and an initial disbelief that the death has actually occurred. This usually lasts from a few hours to a weck and may be interrupted by outbursts of extreme emotion Phase II includes yearning and searching. Survivors may be restless, preoccupied with thoughts of the deceased and prone to initially inter pret events(phone ringing, door opening) as coming from the deceased person. Crying, calling to the person, and paying attention to stimuli that suggest the presence of the person are also common Bereaved persons may or may not be aware of their yearning and searching Phase III is the experience of disorganization and despair. It will become apparent that attachment behaviors that were effective in main taining the attachment bond while the deceased was alive are no longer working. The bereaved person begins to wonder if any part of their sub sequent life is salvageable Phase IV involves a greater or lesser degree of reorganization. Now that the bereaved individual has come to a realization that life must go on, various changes may begin to take place. Thoughts of the deceased begin to take a dif ferent place in the bereaved's life Social relationships and responsibilities may also be changing to accommodate a world without the person who was lost It should be understood that grief is fluid and most people do not begin with stage one and proceed in an orderly fashion to completion. There is a great deal of movement among and within the stages The Experience of grief In addition to Bowlby's phases Westberg(1962)describes ten fairly common experiences for people in grief. 1. Shock. The shock of death is to be expected even after a long terminal illness and months of anticipatory grief. People often describe the first few Reproduced with permission of the copyright owner. Further reproduction prohibited without permission
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Freeman and Ward/DEATH AND BEREAVEMENT ks of grief as having been on auto-pilot. There is little actual memory of ific details. merely the knowledge that one did what had to be done 2. Emotional Release. It is not uncommon to see intense emotional lease at the time of the death and then have it seem to dry up for a num r of weeks. When the shock finally dissipates. the bereaved will often find strong emotions such as anger, fear remorse and extreme loneliness 3. Depression. Depression adds feelings of helplessness and hopeless ness to already existing emotions. There may be fears of suicide from riends and family, but the bereaved will usually express it as " I won't do anything to myself, but if death comes for me tonight I won t fight it 4. Physical Symptoms of Distress. This is a very common phenomenon especially in children. If the deceased died of a heart attack. the survivor(s) may experience tightness in the chest. pain radiating to the jaw and down the left arm, and other symptoms aled with a heart attack 5. Anxiety. The bereaved experience vivid dreams. waking and sleep- ing in which they see and or hear their loved one. There is also spiritual anxiety that is expressed as: Where is my loved one now? Is he or she happy? There is also the fear that the anger being felt toward God will bring about punishment in the form of additional losses. 6. Hostility. anger usually surfaces 6 or S weeks after death. Thi metimes random: sometimes specific. God, medical professionals, clergy, and the deceased are frequent targets. Usually the individual is confused by the intensity of the anger, seeing it as inappropriate, but feels unable to defuse it 7. Guilt. Guilt is sometimes real. often imaginary or exaggerated Death amplifies whatever problems existed in the relationship and little issues that were virtually ignored in life are now insurmountable obsta- cles for the survivor. The shoulds seem to rule the world of the bereaved (I should have done this: I should not have done that) Fear. Fear wears many faces with the bereaved There may be a fear of sleeping in the same bed or room. Ther fc may be a fear of leaving the house or staying in it. People are afraid of aloneness which comes after a death. There is a fear of never knowing joy again or not being able to laugh without guilt 9. Healing Through Memories. The bereaved's memories fluctuate between good and bad. At times it seems that there is a need for self-punish ment and so all the negative aspects of the relationship are resurrected and elived. The happier moments often seem too painful, and it may take many months before these can be faced but there is healing in remembering 0. Acceptance. There is a difference between accepting the reality of death (thereby letting go) and forgetting the person who has dicd. As with the lealing of any serious wound, there will always be a scar to remind one of the njury. With time will come a lessening of the pain, until finally the injury can be touched. remembered, and accepted as a new part of the life being lived Reproduced with permission of the copyright owner. Further reproduction prohibited without permissio
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JOURNAL OF MENTAL HEALTH COUNSELING Within the grief experience there is a continuum of behaviors for the person who is grieving that ranges from normal to abnormal or dysfunc- tional In differentiating normal from abnormal, it is important to note that grief contains the emotional illusion of regression. In this illusion movement appears to go back wards when in fact movement is forward At worst usually one is merely standing still. As long as the grieve process is not diluted or interrupted there is progress. FACILITATING THE NORMAL GRIEF EXPERIENCE A concept helpful to both the mourner and the caregiver is that of the tasks of mourning. The mourner's awareness of these tasks of grief work can give a participative action-oriented outlook to the experience of grief as opposed to a perception of grief being a phenomenon that is experi enced in a passive manner. This also provides a framework for outlining a significant portion of the helper's role Tasks of Mourning The first task of mourning is to expericnce and express outsi self the reality of the death(Lindermann, 1944: Parks Weiss. 1983 Worden, 1991). This involves confronting the reality that the person has died and will not be coming back Questions to ask yourself as a counselor working with the bereaved Where is this person in terms of confronting the reality that their loved one has died? Do I need to respect this persons need to avoid the full reality of the loss for a period of time while attempting to help him or her cautiously confront this new reality? The second task of mourning is to tolerate the emotional suffering that is inherent in the grief while nurturing oneself both physically and emo- tionally(Parks Weiss., 1983: Shuchter Zisook. 1990: Worden, 1991) The thoughts and feelings(pain of grief)resulting from this encounter with death must be absorbed Questions to ask yourself as a counselor working with the bereaved Has this person allowed himself or herself to experience the pain of grief? If so, with whom has he or she shared the grief? Was the person provided with a sense of feeling understood in the expression of grief he third requisite of mourning is to convert the relationship with Lindermann, 1944: Parks Weiss. 1983: Rando, 1987. 1993: Ruskay, 1996 Sable. 1991; Worden. 1991). This requires the bereaved to develop a new relationship with the deceased. The mourner works to modify and detach Reproduced with permission of the copyright owner. Further reproduction prohibited without permissio
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