Grief and Loss - Literature review Example

MichelleUnderwood ResearchReflectionPaper:GriefandLoss Liberty This paper reviews literature in an Internship Program.The objectives of the internship is to observe human behaviors and reactions to bereavement and loss and applying them to theory.The review also looks at literature that reflects how these experiences affect therapists personally and professionally. In order to have a holistic, elaborate and flexible view of loss, this acknowledges the on existing theories of bereavement. The paper ends with recommendations for possible future research in the area and personal growth experience of theinternship program. Introduction The loss is are current theme that is always present and bound in human life. There has been extensive research conducted on bereavement and grief; however, there seems to be paucity in the area of therapists’ significant loss experiences. Beutler, Malik, Alimohamed, Harwood, Talebi, Noble, and Wong (2004) have also noted the dearth of research on being a therapist. This type of negligence probably occurs because of the therapists’ professional role, where attention is fixed on the clients’ difficulties and well-being. This paper generally agrees that research on therapists’ bereavement calls for greater attention due to the increased frequency and endomorphic characteristics of the losses that mental health practitioners experience. Therapists encounter losses both in their personal and working environments. Some types of losses may be “complicated” since they might refer to non-kin or professional relationships that aren’t usually socially or individually sanctioned as losses (Doka, 1989). Personal losses can have an enormous impact not only on therapists, but also on any individual’s belief system, away of thinking, feeling, acting, and relating to self and others. However, this impact becomes even more crucial and important in the case of the therapist where one’s self seems to be a therapeutic tool. Hopefully, more research on therapists’ significant loss experiences is conducted to facilitate the reflection in one’s losses and their possible impact on clinical practice, thus contributing to the improvement in quality of counseling services. Nouwen, in his Enfranchisement/Disenfranchisement research, stated: “A deep understanding of one’s own pain makes it possible to convert weakness into strength and to offer one’s own experience as a source of healing to those who are often lost in the darkness of their own misunderstood sufferings.” (p.87;1972) as cited in Hayes, Yeh and Eisenberg, 2007). The aim of this paper is to review the relevant literature on therapists’ experiences of significant losses and how these may affect them personally and professionally. For the purpose of this review, the terms psychotherapist, therapist and mental health practitioner are used to describing any individual who offers psychotherapeutic services. To have a holistic and flexible view of the losses in a therapist’s life, this paper will review the main existing theories of bereavement. It uses a lot of the theories since it seems that each one looks at this complicated and unique process from a different angle, and different studies have used different theories to present their findings. Grief is a response to loss. People grieve because they have lost someone to whom they were firmly emotionally attached. A griever’s response to can be emotional, behavioral, physical, cognitive, philosophical, spiritual and social. These many dimensions of grief make it a multifaceted affair. The terms grief and bereavement will always go together and are sometimes, albeit erroneously, used to mean the same thing. Bereavement is a state of loss, whereas grief is a response to the loss. It is healthy to go through all the stages of the grieving process, or it can be destructive, dangerous and unhealthy for one to get stuck in any of the stages for along period. Behaviors Observed During the Internship People go through different situations of loss but that never changes the process of loss and grief. As a counseling intern, I handled a number of cases where individuals were reeling in the loss they just experienced. Most of them still lived in denial of their loss, but this is a mere defense mechanism of trying to convince one’s system that death did not really happen. This, by the way, is beneficial because it acts as a buffer from a situation that would otherwise be extremely distressing. Some of the people in denial were hardly ever talking about their loss, maybe because of refusal to believe that they actually went through a loss. They were acting as though they were oblivious of it all, but it did not last long. Another notable thing about people in denial was that they wanted to be alone and in isolation. They seemed so detached from reality of the loss they just had. There another ot of mourners who were angry at everyone and everything they felt caused their loss. Some were cursing and expressing their hate for what caused them to lose their loved one. There are others who expressed their resentment of the doctors they felt did not do enough to save the life of their loved one. At this point, the reality of a loss began to sink; and it sank so deep. Such people were irritated by people and things around them. They did not seem to trust anybody anymore; one would think that everything or everyone was responsible for their loss. in their state of anger, this group of people kept asking questions for which they never got answers, such as ‘why me?, why would God let this happen to me?, How can this happen to me?, it is unfair!’. A counselor’s role was to help them resolve their emotions. There were cases of depression as well. Depressed people seemed so resigned to an idea that life was meaningless after their loss of a loved one. They were extremely sad and irritated by almost everything going on around them. They would spend days in a mourning state, an indication that they were constantly reminded of the deceased. Some people were sullen and wanted to be alone. They never wanted to talk to anyone concerning their loss. There were people in this lot who suddenly felt that life was meaningless and expressed their feelings of wanting to take their own lives. In a few other cases, people expressed how much they missed their departed loved ones, and that they experienced unexpected grieving moments that occurs from time to time. Also, there werepeople who were on the recovery path after enduring long periods of stress. Some of the people in this category had undergone grief therapy at some point after their loss. There were people who resigned to the fact that the death was inevitable they could not have done anything better than they did to avoid the loss. They seemed convinced that they did their best to prevent or avoid it, fate hate took its course. They looked calmer and more stable in their emotions. Many people felt the need to be emotionally strong for others and made the statements like, ‘it is okay’, ‘I can fight it’, and ‘all will be well’. They got to accept their loss, and a part of life that we all must face one day. The result of counseling allows the client to make sense of why God allowed the death, and why He did not intervene. Moreover, that reality is sometimes too hard to understand or too difficult to trust God for the outcome (Clinton, Hart, & Ohlschlager, 2002). The human behaviors observed also included inability to concentrate, insomnia, fatigue, appetite loss, helplessness, hopelessness, periods of intense distress, weight gain, longing for the deceased, crying, dreaming about the deceased, disinterest and more. The people encountered have losses such asa child, spouse, sibling, parent, classmate, best friend,a long-time business partner and more. Everyonewas going througha period of grief, the support group and other professional counselors are capable of helping them to recover. The process of grief is just that, a process. As a counselor, its important to allow the bereaved to inform where they are and what they need. Although grief is universally similar, it can also very personal. It continues to be impact by an individual as well as systemic dynamics. The entire grief process normally takes from one to three years to resolve, and must be respected as part of living (Clinton, Hart, & Ohlschlager, 2002, p. 366). Bowlby reacted to the orthodox psychoanalytic thinking and viewt he mourning reactions of grievers as natural components of the attachment system. Rather than viewing the grieving process as detachment or the severing of the emotional bond, Bowlby viewed grief as the process of readjusting the attachment bond and reorganizing life in light ofthe loss. Continuing a bond with the deceased loved one is “a natural result ofthe dynamics of the attachment system designed to ensure proximity” withthe lovedone whether or not the loved one is available.In a nutshell, attachment theory as opposed to psychoanalytic thought, views loss and its resultant grief not as something primarily to “get over”but as a natural part of life that requires adjustment to a new reality (Clinton, Hart, & Ohlschlager, 2002, p. 363). Different grief theorists give varied versions of the grief process, but the difference is always minimal. Kubler-Ross (1969, p. 18) five-stage model is the most commonly applied. The five stages ofgrief in thismodel include denial and isolation, anger, bargaining, depression, acceptance/recovery. During the internship, Berger’s (2009, Pp. 68-74) five categories of grievers were evident.There were those who had lost an important person in their lives and hadn’t found a way of resolving their grief. They seemed not to understand the loss. Berger refers to this identity of grievers as nomads.There was this class of grievers that were keento do things asa way of keeping their loved ones in memory. Berger refers this group as memorialists. Memorialists had philosophies, and and created rituals, for a memorial remembrance of their loved one. Rituals for staying connected as a family are important. Exploring rituals of remembrance with your client can help them stay connected totheir loved one (Clinton, Hart, & Ohlschlager, 2002, p. 378). All these cases were unique and had to be dealth with uniquely by the counselors.Psalm 23 has been a favorite verse to grieving hearts throughout history, for it invites God to come alongside and walk with us “through the dark valley of death..” (v4) God never abandons us.He never fails us,even in the worst hours (Clinton, Hart, & Ohlschlager, 2002, p. 379). The third group of grievers included those that wanted to created a sense of community and family, referred to by Berger as normalizers.There grievers who, despite not having gone through the entire grieving process, had the determination to raise awareness about the disease that had cost them the life of loved ones. They were focused on helping families deal with issues similar to those that had caused the death of their loved one. Berger refers to thisgroup as activists. Bonnano (2006) gives four trajectories of grief as: Resilience: The ability of a person to maintain stable and healthy levels of physical and psychological functioning,as well as the capacity for positive emotions and generative experiences. Recovery: Recovery involves adaptation to the loss situation and eventual return to the pre-loss emotional state. Chronic dysfunction: This is when a loss causes prolonged suffering and results in an inability to function. It may last more than a few years. Trauma or delayed grief: This is a case where a person has healthy adjustments to their loss situation but gets distressed more months later. Connecting behaviors to theory Attachment theory In life, people get to spend a considerable length of time with other people. Take the example of an infant. A child at a very young age becomes used to people they keep seeing around, like the mother or a caregiver (Bowlby, 1973, Pp. 163-184). A very strong relationship develops between the child and the mother and/or the caregiver. As time passes,the child gets overly dependent on themother or caregiver, so muchthattheyfeel theycannot do without them. This is just an example ofhow human attachment develops. It takes time, but can be very difficult to undo. Bowlby, is the person behind this theory. A lot of behavioral theorists posited that human attachment isa learned process, but Bowlby believes that children are born with a natural drive and a tendency for attachment. As people grow from childhood to adulthood, they get more and more attached to people that they feel give them the comfort and protection they need. In childhood, it is mostly the mother and other caregivers. With time, the spectrum broadens to include many other people they get to interact with and love along the way.They make friends and identify other relations that they get close.Where the attachment was a very strong one, the impact of a loss will be very substantial. There is always the feeling that it would be impossible to get some other person to fill the void (Bowlby, 1980, p. 128). The attachment theory developed over a long time, and that makes it difficult to take away the impact of a loss in a few days. Sigmund Freud Sigmund Freud (1957) argues that grief as a process involves libidinal reinvestment. According to Freud, grief is a painful process of disinvesting from the deceased, allowing the griever to divert their libidinal energies to new attachments. John Archer (1999) and Bowlby are other researchers who also linked grief to the attachment. Bowen’s Family Systems Theory Murray Bowen came up with an assertion that a family is a system in which no one can be understood or be looked at in isolation from the rest of the family members. He also posited that the kind of relationship that exists among members of a family is an emotional relationship that results from interconnectedness among the family members. He further assumes that none of the family members are independent of the others. Bowen’s theory, just like the Bowlby’s attachment theory, explains some of the griever behaviors observed during the internship. In cases where someone had lost their family member, it feltas though the deceased would be irreplaceable. Accordingto Bowen’s theory, in some family systems, people play different roles, and losing any one family member results in a feeling that there will never be anyone that could replace them and play their role the way they used to. Benefits of internship and supervision Although the counseling field lacks consensus about approaches to the and practices of supervision (Rudes et al., 1997), some common processes can be identified. Worthington (1987) observes that supervisors are to teach the process skills (how the counselor acts during session), conceptualization skills (how thecounselor thinks about counseling), and personal skills (how thecounselorreacts tocounsel). Carroll (1996) elaborates on seven specific supervisory tasks: establishing a learning relationship, teaching, counseling, monitoring professional and ethical issues, evaluating, consulting, and administrating (Clinton, Hart, & Ohlschlager, 2002, p. 661). Supervision of an intern is imperative because it enables one to adjust and improve as a grief counselor professionally. There has been an improvement in communication and listening skills. Providing an environment where confidentiality and privacy are vavalued andnot violate itby sharing a clientsissue or problem with others outside of counseling supervision. Creating a safe place in regards to a client’s feeling and emotions expressed without judgment.The ethical standards fora Christian counseling supervisor are to ensure supervision programs integrate theory and practice and train counselors to respect clients rights, promote client welfare, and assist clients in theacquisitionof mutually agreed goals in the counseling process (Clinton, Hart, & Ohlschlager, 2002, p. 286). . Counseling programs are to havestandards to the baseline program, exposure to various counseling experience, Supervisors who ensure the intern, professional and ministerial standards. Also, timely and informative feedback concerning the counselor performance and effectiveness.The Supervisor should also be aware oflice ensure and certification requirements standards (Clinton, Hart, & Ohlschlager, 2002, p. 287-288). At the end of this internship, Therewill be continued reflections and application of the knowledge and traiing received. Having great impressions of the people among the grief ministry support group life transformation from the results of the theraupeutic treatment plan. A good treatment plan is helpful for the counselor during a counseling session. Losing a loved one is a unique experience. Death impacts people in different ways, and the internship has given the opportunity to observe people’s different behaviors as well as processing the losses in life. There are different reactions to grief and loss, and people who are under the capacity of a grief counselor should be patient and flexible to unravel the processes of grieving.An effective treatment plan will include therapeutic parameters, assessment, diagnosis, and interventions (Clinton & Ohlschlager, 2002, p. 374). The effectiveness will bring about spiritual maturity, an intimaterelationship with God, foster healing, andwholeness within the soulsof those who lost a loved one (Clinton & Ohlschlager, 2002, p. 384). Recommendations for future interns and professionals in the setting Many legitimate challenges that must be addressed as Christian counseling matures in the twenty-first century.The Psychotherapy Networker, for example, sees the larger field of counseling being swallowed up in vertically integrated health care, with all patient decisionscontrolled by physicians and managed care organizations (Cummings, 2001).. Competent Christian Counseling is in the stage of development best described as an “emerging profession” (Barber, 1965) ; Intentional profession and ministerial development is one necessary and honorable response to the many challenges and assaults we currently face and is essential to both the overall development and defense of this movement; Envisioning a systematic and structural program for directing that development is a pragmatic say to put it in front of our colleagues and friends in proposal form (Clinton & Ohlschlager, 2002, p. 695).Counseling grieving individuals is not an easy exercise because it involves connecting with them emotionally and supplying a secure environment forthem to narrate their feelings before administering the befitting therapy. It is important for an intern and professionals in the field to understand the benefits of putting God first and always being prayerful about a client’s situation (Clinton, Hart,& Ohlschlager, 2005, p. 202). The time has come for an assertive response to the various assaults on the missions of competent Christiancounseling to develop with intentionality and purpose, workingtoward goals that are both necessary and doable (Clinton & Ohlschlager, 2002, p.771).The existing bereavement theories andthe relevant studies ontherapists’ experiencesof the death of a close related kin, of the death of a client and of other significant personal losses were used as a framework in order to give a panoramic view of a neglected but ever present and life transforming theme in mental health practitioners’ lives. It pinpointed the multiple ways in which a significant loss may affect one’s personal well-being, development, and clinical practice. Thus, it is hoped that it will draw more attention from the academic and clinical community for further contribution and exploration since up till now;the relevant researches limited. One of the aims of future research should be in the field of scientific research, including biblical insights into the topic, the historical development of the the scientific method, the research process and the values and limitations of research on Competent Christian Counseling. The challenge for the Christian counselors is to take advantageof the resources at our disposal. The encouragement of contributing to the development of the ministry of counseling at both personal and collective level with the community of faith. Rather than leaving the field of research to secular social scientist, Christian counselors need to be actively searching for the truths of God as revealed in his creation, and formal research methods provide the tools for examination and discovery.Primaryresearch and evaluation techniques need to be practiced by every Christian counselor. We must treatscientific research as a servant, not a master; a tool, not a tyrant. Use it wisely and always operate according to biblical revelation and under the guidance of the Spirit (Clinton & Ohlschlager, 2002). Personal Growth Experienced Christian counseling is about Caring for people God’s Way, in a grief and loss ministry it is important to educate yourself in understanding the task of Grief The Grief and Recovery ministry I’m involved in as an intern, has been beneficial to me as a grieving client who’s suffered many recent losses. A therapists can be clients as well, it becomes evident that if therapists acknowledge and “work through” their loss of health and own mortality, then their therapeutic practices can develop and improve (Konstatinos, n.d, p. 26) The impact of this ministry has sanctioned me in healings fromthe effects of my personal losses, spiritual and emotional wounds, and paths to remain in recovery, so that I may become an effective counselor to others professionally. Worden (2009) argues that exploring one’s history of losses makes one a more effective therapist. Research indicated that a therapist’s unresolved losses may negatively affect the therapeutic process and pinpointed the importance of one being self-aware especially when the clients’ difficulties are also loss related. Rosenberg and Hayes (2002), have also showed in their case study that when therapists’ unresolved issues upon therapy, avoidance behavior and disruption of the working alliance may ineffective. Therapists can only go as far into the emotional depths of their clients as they have gone themselves. It seems that where there is a lack of recognition and acknowledgment there also lies the greater potential for growth and development. Self-reflections deems as one of the most powerful “tools” in a psychotherapist’s personal and professional development. The disenfranchised theme of therapists’ loss experiences may offer the most fruitful ground for such growth (Konstatinos, n.d, 18). Interning in this ministry has given me the Spirit of God to minister to those who are hurting, suffering and set the example of Christ to promote healing and restoration to souls.I am in the process of developinga ministry thatwill enlighten others in Find New Meaning in Life and “ New and Better Ways of Living” in Christ. Blossom’s Ministries will be in honor and memory of my father Lloyd E. Underwood Sr. who one of the humblest men I knew, besides Christ that lived. Before his passing, two months prior to the birth of my only child at 42 years of age, He named her “Blossom”. his name was inspired by God because the goal of this meaning is helping one’s life Blossom is in all areas of their life that is in accordance to the Will of God. My father understood the importance of the meaning of names. Names were also important to God, and it carries the tendency to manifestit iscalling.I will be able to create a Purpose, Misson Statement, and Vision that will derive from it is meaning and encourage others to strive towards its goal. Blossom’s Purpose, Mission, and Goals are under the process of development and will soon be revealed. The internship program has been an inspiration in helping others find a New Way of Living for Spiritual Maturity. Financial Prosperity and Encourgements Teaching those who are in need of a new start and adjusting life without the ones who may be the one everyone one depended on and respected. I’m inquiring information from the University of Alabama where I plan to pursuemy MSW focusing on children, adolescence and families. My studies with Liberty University has put me on the right pathway in building a strong Christian foundation. The grief and loss experiences I’ve suffered, such as my recent miscarriage , the death of my father on August 17, 2012, and other losses of all kinds, has been a test of my faith.However, the faith and biblical knowledge that I’ve gained throughout my studies, has encouraged me as a child of God in knowing how to respond to the storms of life. My connection with God is spending time alone with Him in prayer. My communication with God has developed our relationship in an intimate and personal relationship. My relationship with Him is the source of my strength which enables me to endure the challenges of life. Conclusion According to Bonnano (2004), resolving emotional issues that result from loss may be easy for some people, and not easy for others depending on the degree of attachment to the deceased and the griever’s resilience. Loss of a loved one creates a new environment because the bereaved have to learn to live without the deceased. Grief counselors and therapists help the griever regain emotional stability after serious emotional imbalances that come with theloss of dear ones (Anderson, 2003). The role of counselors and therapists is to help the griever with the answers to the unending questions that a griever have about their loss. The professionals will not have answers to each of the numerous questions the grievers tend to have. Rather, they will need to listen keenly to the griever, and then be able to come up with a single comprehensive response that goes on to act as a solution to the griever. Lastly, the griever and the therapist must know the differentiated roles they play in the therapist-mediated recovery (Anderson, 2003). A griever needs an environment in which they feel emotionally safe in order to narrate their story. Emotional safety includes a number of issues such as confidentiality and privacy. The therapist is their only confidant who should never share their situation with anyone outside the system. References Anderson, D. N. (2003). Discipleship Counseling. Ventura: Regal Books. Berger, S. A. (2009).The Five Ways We Grieve: Finding Your Personal Path to Healing after the Loss of Loved One. Boston: Shambhala Publications. Bowlby, J. (1973). Attachment&loss :Vol.2. Separation: Anxiety and anger. London: Hogarth Press & Institute of Psychoanalysis. Bowlby, J.(1980). Attachment & loss:Vol.3 .Loss: Sadness and Depression .London: Hogarth Press & Institute of Psychoanalysis. Bonnano, G. A. (2004). Loss, Traumaand Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events? American Psychologists Association, 59 (1): 20-28. Clinton, T., Hart, A, & Ohlschlager, G. (2005). Caring for People Gods Way. Nashville: Thomas Nelson,Inc. Feist, J., Feist, G. J., Tomi-Ann, R. (2013). Theories of Personality (Eighthed.). NewYork, NY, USA: McGraw-Hill. Freud, S. (1957). Mourning and Melacholia. In J. Strachey (Ed andTrans.), The Standard Edition of the Complete Psychological Works of Sigmund Freud (vol.14, pp.157-170). London, England: HogarthPress. Mcdonald, P. C. (1985). Grieving: A Healing Process .Centre City, MN: Hazelden Foundation. Read More