Discuss the psychological and physical effects of loss and grief. How might an ethical therapist incorporate this knowledge into his/her work? Base your answer on the theories and models presented in Module 7
Grief is a normal yet complex phenomenon, which has been broadly explained through the Descriptive and Process theories. The former depict the phenomenology of the grief process in a basic and descriptive way, but lack an explanation as to why or how grief responses occur. The latter, provides a model for the psychological mechanisms underlying grief and investigates the purposes behind these mechanisms (Barbato & Irwin, 1992). This refers mostly to Bowlby’s Attachment Theory a specific Process theory, which considers the reasoning behind grief in response to death and major losses and the various factors that impact on the intensity of the response that is experienced.
The meaning of attachment furthers our ability to comprehend grief. Throughout human development, continual attachments to others are formed. According to Bowlby’s Attachment Theory, attachments develop from needs for security and safety which are acquired through life, and are usually directed towards a few specific individuals (Worden, 1991). The goal of attachment behaviour is to form and maintain affectionate bonds, throughout childhood and adulthood. Bowlby proposed that grief responses are biologically general responses to separation and loss. Throughout the course of evolution instinct develops around the premise that attachment losses are retrievable. Similarly, behavioural responses making up the grieving process are pro-survival mechanisms geared towards restoring the lost bonds (Worden, 1991).
The process of grief is multifaceted, with bereaved individuals experiencing major physical, emotional, and cognitive changes. Barbato and Irwin (1992) suggested that grief is a state in which the bereaved person has lost someone or something of personal value. When faced with this loss, the most powerful forms of attachment behaviour are activated in an attempt to reinstate the relationship. Worden (1991) described the vast repertoire of behaviours under four general categories; emotional response, physical sensations, altered cognitions, and behaviours.
Grief is fundamentally an emotional response to loss, the expression of which can include sadness, sorrow, fatigue, depression, relief, shock, anger, guilt, and anxiety (Barbato & Irwin, 1992). Grief behaviours frequently have a similar profile to those found in people suffering from depression. Although grief and depression do share a number of similar aspects including sleep and appetite disturbances, and intense sadness, these behaviours are only evident for a short time in a grief reaction. In addition, those experiencing a grief reaction do not always experience the loss of self esteem that is commonly found in most people who are clinically depressed (Worden, 1991). However, intense feelings of loneliness and isolation, following the death of a loved one, may 2
become so overwhelming that the bereaved may withdraw from social contact, thereby isolating themselves from support. Such reactive depression following a significant loss is not abnormal and usually dissipates over the first year of bereavement.
Anger is a frequently experienced emotion following a loss and is often confusing for the bereaved. The anger may be directed at the deceased for leaving the bereaved or may result from a sense of frustration that the bereaved couldn't prevent the death (Worden, 1991). If the anger is not addressed complications in the grieving process may arise. There is a risk that the anger will be directed towards others through attributing blame, or turned inwards. Grief not only elicits emotional disturbances, but also physical symptoms such as: tight feelings in the throat and chest, over-sensitivity to noise, breathlessness,...
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