Sibling bereavement and continuing bonds.
ABSTRACT Historically, from a Freudian and medical model perspective, emotional disengagement from the deceased was seen as essential to the successful adaptation of bereavement. A major shift in the bereavement literature has occurred and it is now generally accepted that despite the permanence of physical separation, the bereaved remains involved and connected to the deceased and can be emotionally sustained through continuing bonds. The majority of literature has focused on adults and on the nature of continuing bonds following the death of a spouse. In this article, the authors demonstrate how the continuing bonds concept applies to the sibling relationship. We describe the unique continued relationship formed by bereaved children and adolescents following a sibling loss, highlight the factors that influence the siblings continuing bonds expressions, and offer clinical interventions. In our view, mental health professionals can play an important role in helping parents encourage activities that may facilitate the creation and maintenance of continuing bonds in their children.
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ABSTRACT: Young adults experience problematic responses to loss more often than is commonly recognized. Few empirical studies have examined the contribution of intrapersonal and interpersonal characteristics to grief and depression in bereaved young adults. This study investigated the association of dependency and quality of the relationship with the deceased (i.e., depth and conflict) with complicated grief (CG) and depression. Participants were 157 young adults aged 17 to 29 years who experienced loss of a family member or close friend within the past 3 years (mean = 1.74 years). Participants completed the Inventory of Complicated Grief, Beck Depression Inventory, Depth and Conflict subscales of the Quality of Relationships Inventory, and the Dependency subscale of the Depressive Experiences Questionnaire. Relationships among dependency and interpersonal depth and conflict and CG and depression were examined through analyses of covariance. Sixteen percent of participants met criteria for CG and 34% had mild to severe depression. Dependency and depth were independently related to CG and dependency was related to depression, but the pattern of associations was somewhat different for each outcome. Greater depth was associated with CG, at both high and low levels of dependency. High levels of dependency were related to more depressive symptoms. Interpretation of the findings is limited by the relatively small sample size and cross-sectional design. CG and depression are related but distinct responses to loss. Although dependency is associated with both CG and depression after loss, relationships between the bereaved and deceased that are characterized by high levels of depth are particularly related to the development of CG symptoms.Journal of Nervous & Mental Disease 06/2014; · 1.81 Impact Factor
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ABSTRACT: We investigated longitudinally parental perceptions of siblings' bereavement after childhood cancer death. Parents were interviewed 6 months (n = 25) and 18 months (n = 75) post-death. Data are analyzed combined and over time. The following themes emerged: (a) expression of grief missing deceased child (verbally, crying), behavioral problems, difficulty understanding the meaning of death (pre-schoolers), and avoiding talking with parents about feelings (adolescents); (b) what helps siblings grief moving on, talking about deceased child and social support; (c) relationship with parents improved for most siblings; and (d) bond with deceased sibling: pretend-play (preschoolers), dreaming, and career choices (adolescents). Over time, themes reflected stability and change.Death Studies 01/2013; 37(1):25-46. · 0.92 Impact Factor
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ABSTRACT: The authors investigated longitudinally bereavement in mothers and fathers whose children died of cancer. Thirty-one parents were interviewed 6 and 18 months post-death. Analyses revealed parental differences and changes over time: (a) employment--fathers were more work-focused; (b) grief reactions--mothers expressed more intense grief reactions that lessened over time; (c) coping--mothers were more child-focused, fathers more task-focused; (d) relationship with bereaved siblings-mothers actively nurtured relationship with child; (e) spousal relationship--parents reported diversity in their relationship over time; and (f) relationship with extended family--mothers maintained contact with extended family more. Findings illustrate parental differences in bereavement over time that might be partly socially determined. These findings emphasize the need for tailoring bereavement support services in the family.Death Studies 01/2012; 36(1):1-22. · 0.92 Impact Factor
SIBLING BEREAVEMENT AND CONTINUING BONDS
Pacific Graduate School of Psychology, Palo Alto, California, USA
FDNY=Columbia University Family Assessment and Guidance Program,
Columbia University School of Social Work, New York, New York, USA
Family Health Care Nursing, University of California, San Francisco,
Pediatric Palliative Care Program, Children’s Hospital,
University of California, San Francisco, California, USA
Historically, from a Freudian and medical model perspective, emotional
disengagement from the deceased was seen as essential to the successful adaptation
of bereavement. A major shift in the bereavement literature has occurred and it is
now generally accepted that despite the permanence of physical separation, the
bereaved remains involved and connected to the deceased and can be emotionally
sustained through continuing bonds. The majority of literature has focused on
adults and on the nature of continuing bonds following the death of a spouse.
In this article, the authors demonstrate how the continuing bonds concept applies
to the sibling relationship. We describe the unique continued relationship formed
by bereaved children and adolescents following a sibling loss, highlight the factors
that influence the siblings continuing bonds expressions, and offer clinical inter-
ventions. In our view, mental health professionals can play an important role
in helping parents encourage activities that may facilitate the creation and
maintenance of continuing bonds in their children.
‘‘It has been said that death ends only a life, it does not end a relationship.
This statement is especially true when a sibling dies in childhood,
adolescence or early adulthood—an untimely death whose unhealthy
consequences can endure long after the farewell at the graveside.’’
(Bank & Kahn, 1982, p. 271)
Received 1 April 2006; accepted 29 May 2006.
Address correspondence to Wendy Packman, Pacific Graduate School of Psychology,
935 East Meadow Drive, Palo Alto, CA 94303.
Death Studies, 30: 817–841, 2006
Copyright # Taylor & Francis Group, LLC
ISSN: 0748-1187 print/1091-7683 online
History and Background of Continuing Bonds
Prior to World War I, it was universally accepted that death had a
lifelong impact on the survivors (Devita-Raeburn, 2004). Indeed,
the accepted thinking on the grief process incorporated the con-
cepts of continuing bonds and ongoing attachment to the deceased.
Victorian widows grieved literally and figuratively for years
(Neimeyer, as cited in Devita-Raeburn, 2004). A major shift in
thinking occurred in the aftermath of WWI throughout Europe.
In Britain alone, there were hundreds of thousands of war-related
deaths (Devita-Raeburn, 2004). The sheer number of deaths liter-
ally overwhelmed those left behind and ‘‘almost overnight,’’ said
Neimeyer, ‘‘there was a new posture toward loss. It became a patri-
otic duty to repress one’s grieving, and to distance oneself from it.
This model of self constraint, rather than self expression, became
the approved way of reacting to loss’’ (Neimeyer, as cited in
Devita-Raeburn, 2004, p. 140).
Since that time, emotional detachment, which included sever-
ing ties with the deceased, was seen as a critical part of the grief
process (Klass, Silverman, & Nickman, 1996). In fact, from a
Freudian and medical model perspective, emotional disengage-
ment was essential to the successful adaptation of bereavement
(Field, Gal-Oz, & Bonnano, 2003; Freud, 1917=1957; Klass &
Walter, 2001; Raphael, 1983).
Historically, the study of bereavement has been focused on
the psychology of grief as an individual, mostly internal, experi-
ence. Emphasis has been on the pathological aspects of grief and
has advocated for emotional detachment or letting go to achieve
closure. Such views were reinforced by the medical model that
compared grief to a wound that eventually heals, perhaps leaving
some scar tissue; and once it has healed, the wound is forgotten
Alternative views of grief and grief resolution have been
developed more recently—perceiving grief as ‘‘work’’ (Worden,
2004) and active coping (Attig, 2001) and as continuing bonds
(Klass et al., 1996). There has been a shift from emotional disen-
gagement and detachment to working through the loss by relearn-
ing the world in a way that helps one accommodate and live with
the loss (Attig, 2001). In the view of Neimeyer (2001) and Attig
(2001), we have a continuing relationship with the deceased:
W. Packman et al.
‘‘the premise that moving on means letting go is wrong’’ (Neimeyer
& Attig, as cited in Devita-Raeburn, 2004, p. 143).
A major shift has become evident in bereavement research as
well. Findings have supported the significance of ongoing connec-
tions with the deceased (Klass et al., 1996). There has been increas-
ing attention in the bereavement literature focusing on the function
of a ‘‘continuing bond’’ in relation to coping (Field, Nicholas,
Holen, & Horowitz, 1999; Field & Friedrichs, 2004; Field, Gao,
& Paderna, 2005; Klass & Walter, 2001; Klass et al., 1996; Stroebe,
Gergen, Gergen, & Stroebe, 1992) and adaptation following the
death of a loved one (Klass et al., 1996). It is now generally
accepted that despite the permanence of physical separation, the
bereaved can nevertheless be emotionally sustained through a con-
tinuing bond to the deceased (Field et al., 1999). The majority of
this research has focused on adults and on the nature of continuing
bonds following the death of a spouse. The concept of ‘‘continuing
bonds’’ has been discussed in relation to children’s grief but it
has occurred only in the context of parental loss (G. H. Christ,
2000, 2002; Silverman, Nickman, & Worden, 1992; Silverman &
Worden, 1992). These studies specifically describe how children
maintain a continuing bond to the deceased parent in an attempt
to preserve this relationship. The phenomenon of ‘‘continuing
bonds’’ has not been labeled as such in the sibling bereavement
literature, which in general has been quite limited to date, although
similar concepts have been described in relation to sibling bereave-
ment (Davies, 1991, 1999; Devita-Raeburn, 2004; Hogan &
DeSantis, 1992). In this article, the authors demonstrate how the
‘‘continuing bonds’’ concept applies to the sibling relationship
and we describe the unique, ongoing relationships and bonds
formed by children and adolescents following sibling loss.
Uniqueness of Sibling Relationships
‘‘Sibling relationships are the total of the interactions (physical, verbal, and
nonverbal communication) of two or more individuals who share knowl-
edge, perceptions, attitudes, beliefs, and feelings regarding each other, from
the time that one sibling becomes aware of the other.’’ (Cicirelli, 1995, p. 4)
Sibling relationships have attributes in common with all
interpersonal relationships, but in addition they have certain
characteristics that address the extent of their unique bond (Davies,
1999). Sibling relationships last a long time, essentially a lifetime.
In fact, it has been determined that siblings are likely to spend at
least 80–100% of their lifespans with each other, more time than
with any other family member (Bank & Kahn, 1982). Even when
parents divorce, the marriage relationship ends, but it does not
end the relationship between the siblings (Davies, 1999).
Sibling bonds develop because there is high access and con-
tact between siblings. Further, siblings use each other as major
influences or touchstones, in a search for personal identity (Bank
& Kahn, 1982) and understanding the world around them. Siblings
play a crucial role in identity development, by way of personal
exchanges through which they define one another (Bank & Kahn,
1982). Research also highlights the importance of the sibling bond
(Packman et al., 1997b; Wiley et al., 1984). The pediatric bone
marrow transplantation (BMT) literature has shown that the sibling
bond between the patient and sibling donor actually intensifies fol-
lowing BMT (MacLeod et al., 2003; Packman et al., 1997b; Wiley
et al., 1984) where one sibling’s provision of a life-saving measure
for a brother or sister connects them in a unique way.
The significance and uniqueness of the sibling relationship
portends the profound effect that the death of one child can have
upon brothers and sisters (Davies, 2002). The death of a sibling
means loss of a playmate, confidante, role model, and friend:
Nothing can prepare the survivor for such a myriad of losses
(Davies, 1995). Siblings’ identities are intricately connected because
they share similar histories, so that when one sibling dies, the survi-
vors essentially lose part of themselves (Devita-Raeburn, 2004).
The Concept of Continuing Bonds with Siblings
The concept of continuing bonds with regard to sibling bereave-
ment was initially examined by Davies (1991, 1999) and Hogan
and DeSantis (1992). Among the long-term effects of sibling
bereavement in childhood, bereaved siblings maintain connections
with their deceased brother or sister by engaging in specific actions
that serve to keep them in touch. Nineteen-year-old Rod, whose
brother died when Rod was 10, says, ‘‘I think about him a lot.
I’ve got a picture of him by my bed...and we’ve got pictures of
W. Packman et al.
him all over this [parents’] house, so it’s...like he’s still here.’’
Other siblings purposefully include the deceased sibling in their
ongoing lives, often by incorporating some favorite memento into
special events: Candace, for example, had her sister’s favorite
peach colored roses for her wedding: ‘‘We used peach roses for
her funeral. And for my wedding...it was just a real sense of hav-
ing her there with us.’’ Many siblings have ongoing conversations
with their sibling, or pray to them for protection or guidance dur-
ing difficult times: Janice, now 21, was 12 when her sister died and
prays to her sister ‘‘Jackie, watch over me, take care of me.’’
Although some siblings must disentangle from destructive aspects
of relationships, such as abusive or friction-filled relationships,
bereaved siblings allow their siblings’ influences to shape their
lives and characters. In fact, some have noted that their wish to stay
connected or reconnect to their deceased sibling is even stronger as
they grow older (Davies, 1999, pp. 191–193).
Hogan and DeSantis (1992) referred to continuing bonds as
‘‘an ongoing attachment.’’ The ‘‘ongoing attachment categories’’
1. regretting—desiring to have a better relationship; wishing to
continue a shared relationship;
2. endeavoring to understand—searching for reasons for the
sibling’s death; wanting to know circumstances of the death;
3. catching up—asking what heaven is like; how are things? bring-
ing the siblings up to date;
4. reaffirming—loving and missing the sibling;
5. influencing—seeking guidance from the sibling; and
6. reuniting—anticipating reunion in heaven.
Many of these categories—reaffirming, catching up, influencing,
reuniting—speak to the desire of the bereaved sibling to maintain
a continuing bond with the deceased sibling.
Batten and Oltjenbruns (1999) also reported that bereaved
siblings experienced an ongoing attachment with their deceased
brother or sister manifested in two ways: first by acknowledging
a continuing bond with the deceased, who although no longer
physically alive, seems to exert a presence felt by the survivor.
Although the relationship has changed, in a sense, it continues.
‘‘It’s...like he’s still here...It’s kinda like there is still a piece of