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Abstract

The argument developed in this paper can be outlined as follows: relationships are vital for growth, for adults and especially for children; to ensure that we work to maintain relationships, evolution provided for pain on separation, which stimulates behaviours designed to restore the relationship. If the separation is permanent, it is necessary to form other relationships. This requires modifying the attachment to the lost object, a process which involves unlearning of emotional bonds and then learning new bonds to new objects. The process of mourning and the affective state of grief, I believe, assist in this unlearning and new learning. The stages of mourning involve cognitive learning of the reality of the loss; behaviours associated with mourning, such as searching, embody unlearning by extinction; finally, physiological concomitants of grief may influence unlearning by direct effects on neurotransmitters or neurohormones, such as cortisol, ACTH, or norepinephrine. Besides losses occasioned by bereavement, life and normal development include many other kinds of losses. Mourning for these losses is as necessary as mourning after a death. Failure to adequately mourn can result in psychopathology or psychosomatic illness. In comparison, appropriate mourning is adaptive, and parallels can be drawn between it and healing in psychotherapy. The psychoanalytic and psychotherapeutic literature supports the notion that mourning and grief in therapy act to heal. Given that there may be a biological basis for this healing through the effects of mourning on learning, psychotherapists might actively seek to encourage identification of losses and their adequate mourning in therapy. Various approaches are discussed. Two case reports of mourning occurring in psychotherapy are given, followed by suggestions for research.
Mourning
and
Grief
as
Healing
Processes
in
Psychotherapy*
OLDERS,
MD, FRCPCI
in
this paper can be outlined
as
are vital
for
growth,
for
adults and
, to ensure that
we
work
to
maintain
relationships, evolution provided pain
on
which stimulates behaviours designed
to
restore the
relationship,
If
the separation
is
permanent,
it
is necessary 10 form
other relationships, This
modifyinf.?
the attachment
10 the lost object, a process which involves
of
emotional bonds
and
then new bonds 10 new
The process mourning and the affective state
I believe, assist in this unlearning and new learning,
The stages
of
mourning involve cognitive
of
the
reality the loss: behaviours associated with mourning,
such as searching, embody unlearning
bv
extinction;finally,
physiological concomitants
of
grief
may influence unlearn-
by direct
on
neurotransmitters or neurohor-
mones, such as cortisol, ACTH, or norepinephrine.
Besides losses occasioned by bereavement, life and nor-
mal include many other kinds Mourn-
ingfor
these losses is as necessary as mourning death.
Failure 10 adequately mourn can result
in
psychopathology
or illness, In
mourning
is
and parallels can be drawn between
it
and
healing
in
psychotherapv.
The psvchoanalwlc and psychotherapeutic literature sup-
ports the notion that and
grief
in
act to
heal. Given thai there may a biological basis for this
healcng through the mournint;; on learning, psv-
chotherapists mighr seek
to
encourage identificlltion
losses and their mourning
in
therapy. Various
approaches are discussed.
Two case
of
mourn in
'?
occurring in psychotherapy
are bv for research.
T nfams need caretakers simply to survive.
Older
children
.!.and
adults benefit from relationships for
John Bowlby
(I)
wrote that attachment
behaVIOUr,
while at its most obvious in childhood. can be observed
* Manuscnpt recelved
December!
987: revised April 1988
I Di.recteur climque des soins conti nus du Centre
de
Ps¥chlatne Commu-
nautau'e. Douglas Verdun. Quebec: Umversity' Lecturer. Depart-
ment
of
PSYChlatrv.
University.
Montreal
Address reprint r;quesls to: Dr. HenrY Olders. Dtrecteur clinique des
sOlns
conti nus du Cemre de Communautalre. Douglas Hospital. 687'
BouL LaSaile, Verdun. H4H
lR3.
Can.
J.
Psychiatry
Vol.
34. May 1989
throughout the life cycle, It
is
as an pari
of
human nature.
Parkes
(2)
the necessity for secure attach-
ments, without which a
person's
ability to modify
hIS
assumptive world
in
the face
of
is impaired,
who have few "available
attachments"
are
at
developing neurotic symptoms under adversity.
are believed to
playa
critical role
in
regu-
lating the behaviour. maturation. and
of
mind.
brain. and body (3.4).
Given the importance
of
relationships, what has evolution
provided to ensure that organisms remain attached" For
what causes mothers to with infants and look
after them?
One factor
is
the that indIviduals
In
Just
as
strong affects serve to communicate
(5
communicates both internally and to others
(10)
to
act in ways
to
reduce it.
Thus
we search for the lost
and others reach out to us to help, One
of
the
(11), which elicits autonomic system arousal
and Ainsworth (10) concluded: '
IS
of
early attachment behaviours,
",
It
. promotes more effectively than other early sig-
nailing
What happens if pain and crying fail to restore the rela-
tionship')
OUf
need for relationships for survival and
dictates that we overcome the exclusive ties to the lost per-
son.
so
that we can put
our
into new attachments.
Breaking these ties.
or
investments.
to
the lost
object, may involve disconnecting memory traces and asso-
ciations
in
a process
of
"unlearning,"
recath-
exis
to
a new object that new
affective ones, be laid down as memory traces in a
process.
Since a pernlanent loss usually results in a mourning pro-
cess which may include affects such as
or
sad-
ness.
it
may be that mourning and grief are involved
in
this and new learning. through physiological
mechanisms.
Mourning. Learning,
and
Memory
Before dealing with the evidence mourning to
learning and memory. some caveats are necessary. First.
it
IS important to distinguish a normal mourning from
depression, differ in a number
of
ways; example.
psychomotor retardation and suicidal ideas are absent
in
mourning
(12).
and the dexamethasone suppressIon test
271
272
CANADIAN
JOURNAL
OF
PSYCHIATRY Vol 34,
No,
4
is
usually nonnal
(13-1
Effects
on
immune system func-
tioning differ (17),
Another caveat
has
to
do
with
the
belief
of
a number
of
wnters that infants and children are constitutionally incap-
able of a nannal process
(]
8-20)
Others feel. however.
that
children can mourn,
but
in
a dif-
ferent
way
from adults (21.22).
If
infants and children cannot mourn. this apply also
to
infant monkeys and rats, Thus research on mother-Infant
in
animals, referred
to
below.
may
to
nonnal mourning and only
in
an
indirect
way,
With these caveats
in
mind.
we
can look
at
the
several
ways
in
which mourning
and
grief
may
influence unlearning
and learning. These ways include conditloning. cognitive
and possibly through
for
on
neurotransmillers or neurohonnones.
Affects include
an
or inclination
to
act The
affect of almost always stimulates behaviour
(23).
In
the
absence of
the
reinforcement which would
be
afforded
by
either finding
the
lost or
by
maintaining
real
links with
behaVIOur
would decrease
in
intensity
and
because of extinction.
In
regard
to
aspects.
the
stages of
as
described
by
Zisook and
De
Vaul
(25)
contribute
to
the
indi-
vidual'S testing:
"The
first stage. shock. includes ele-
ments of disbelief and denial. It lasts for hours
to
weeks
Funeral rites and rituals facilitate passage
this
by
helping
the
bereaved
to
the
real-
ity of the loss."
The second stage. acute includes
an
"intense
. phase. which
they
described
as:
"Painful aware-
ness of
the
loss occurs
in
waves of intense emotional
and often somatic discomfort. These waves bring on uncon-
trollable and and are often attended a
of
in
the
throat. a shortness of breath,
an
in
the
abdomen. fatigue. restlessness. pur-
and a sense of stress
enced
as
exhaustion, weakness, and sadness."
places. music. smells. sounds.
and memories which include associations
to
what
has
been
lost. Each occurrence
etc.
will
no
longer
be
able
to
invoke the lost object
as
a real.
person. but only
as
a memory.
The third stage, resolution heralds
the
return of
the
of
and the ability
to
get on with living.
as
the
bereaved what the loss has meant
to
them.
and
feel
able
to
seek
the
companionship and love of others.
Although direct examples of the influence of affect
on
and memory can
be
found (26).
mOst
of
the
evi-
dence
is
indirect.
affects mduce physiological
An
obvious
example
is
the'
or ' response turned
on
by
fear
or anger. Neurotransmitters such
as
are
cen-
tral
to
these Examples related
to
grief include
the
Immune functiomng found
in
bereaved people
and thelf 10 ' " which seems to
be
caused
in
the
control
mechanism
(29).
Affects associated with loss
may
also result
in
sub-
tIe
and long-tenn effects
on
the
central nervous system
(4.30).
to
and
memory, there are several candidates:
In
sleep
patterns. changes
in
brain cortisol. and cortIcal norepineph-
rine levels.
Infant
(31
and a
REM
latency time after
mothers.
REM
and catecholamines interact
moreover.
REM
seems
to
be
involved
in
maintaining
Jong-tenn memories ,36), This
that
after a loss.
"forgetting"
the
lost object
is
aided
by
decreased
REM
becomes elevated
in
infant monkeys, and
in
their
mothers. when separated from each other (37). Other exper-
iments
have
shown that cortisol helps extinction
and
relearn-
(37).
In
"f'f1nrMPrl
from their mothers, there was a
increase
in
plasma cortisol levels which was sus-
tained over
two
weeks. Although distressed. these
infants tended
not
to
show depressive symptoms, but rather
and adaptation Their mothers also showed
cortisol elevations. although not
as
marked. This
that
cortisol
may
play
an
adaptive role
in
loss .
"Active ' responses
to
stress. including
one's (38), or anticipating the death of a spouse from
tenninal cancer (39), cause Increased catecholamine output
in
the
urine
On
the
other hand. brain
NE
IS thought
to
be
low
in
enous depression
(41).
When separated monkeys receive
drugs which increase
NE
levels, they less despair,
while which reduce
NE
levels result
in
increased
(42).
seems
to
playa very central role
in
facilitating
memory (43-46), and lowered
NE
is asso-
ciated with impainnents
in
and memory
It
is
thought
to
be
particularly important
in
the
fannation of
associations and
in
neural plasticity (50),
It
may
be
that
the
elevated
NE
levels which
to
occur
in
bereavement
(51).
but
not
in
in
the extincllon of memory
traces
to
the
lost
A recent review
of
the
effects of stress. including
bereavement.
on
the
Immune suggests that norad-
from
the brain influence immu-
and immune system competence
also appear to
be
linked: can
be
con-
ditioned
in
mice.
may
decrease norepinephrine turnover
in
the brain.
Losses in
normal
development
Losses occur
in
ways other than
by
death or separation:
for
example, losses occasioned
up
chlldhood
273
May, 1989
MOURNING
AND
GRiEF
AS
HEALING
PROCESSES
IN
PSYCHOTHERAPY
attachments can
be
considered part of nonnal growth
during can
be
as
losses,
for
which
is
According
to
and
Altschul .. PartIal and temporary separations
from
libi-
dmal which
from
birth possess
nificance as activators of the mechanisms of the
ego. To a extent these separation influence
the rate and direction of and a part
in
the ego structure. Thus the process of
maturation can be
to
mourning work
in
that every
step towards maturation involves some adaptation
to
sepa-
ration. and therefore some
work."
Losses themsel ves can
be
considered developmental
Brice wrote: "'The road of life
is
paved
with
occasional There
is
no
in
life without loss."
as
a process of adaptation.
an
undo-
of the previous adaptational equilibrium established with
the lost and the re-e<:tablishment of
new
rela-
tionships. can be viewed
(53)
as
phylogenetically evolved.
as
it
appears
to
occur
in
certain mammals and birds. but
not
In
or fish. Grief
work
facilitates a per-
son's emancipation from
his
or her attachment
to
the
deceased, readjustment
to
an
environment without the
deceased. and fonnation of
new
The
to
fonn secure
new
relationships which can
through a process of nonnal after
may
be
essential
in
pennitting
the
person
to
in
his paper "\1ourning and Melancholia" (57)
that carry out
the
task of over-
the object loss
In
the following
way:
"Each one of the memones and situations of expect-
ancy which demonstrate
the
libido's attachment
to
the lost
object
is
me!
the verdict of reality that
the
object
no
eXIsts:
and the ego. confronted
as
It
were with
the
question
whether
it
shall share this fate.
is
the
sum of
the narcissistic satisfactions
It
denves from alive to
sever liS attachment
to
the obiect that has been abolished."
Bowlby that processes of healthy
effect a withdrawal from the lost and commonly pre-
pare for a relationship with a new object.
Altschul
(59)
felt that failure
to
leads
to
an
arrest
in
ego development. Alice Miller.
in
her landmark book
"Prisoners of " makes the that
"the
achievement of freedom from
....
narcissistic disturbance
in
analysis
is
possible without deeply felt
(60). She believes that real can occur
patient mourns for what
he
has missed
at
the crucial time
in
his childhood.
can
be
Sudden and
death leads
to
more pronounced reactions
in
relatives than if the death
is
more expected (61).
A number of authors have remarked that failure of ade-
quate appears
to
be
a precursor of psychopathol-
ogy later on It has also been suggested that inade-
quate mourning leads to psychosomatic !Ilness (67-72).
Mourning
and
Psychotherapy
Mourning processes are
an
integra! par! of many psy-
and
have
been remarked a number of
and (53.
60.63.65.
73-76) There
is
also some research which bears
on
this
question.
Parkes
(77)
reviewed eight studies of bereavement coun-
selling. Five of the eight ;tudies showed significant differ-
ences between and unhelped groups. favoring
the
group that
had
been
in
their bereavement. More
recent studies also this
conclUSion.
Mawson
et
al
(78)
studied twelve into
two
groups. The exper-
imental received mourning therapy (in the ses-
sions. was exposed to avoided or painful mem-
ories. ideas or situations, both
in
Imagination
and
in
real
life
.
related
to
loss of
the
deceased. Events
the
loss
or
its
consequences were discussed and
the
therapist then
focussed on areas that the patient found difficult
to
describe.
for
a situation associated with great sadness or
The
was
encouraged
to
describe repeatedly these sit-
uations until the initial distress was diminished)
In
the con-
lrol
therapy. the
to
avoid
about the therapy
.,..,,.,,,.,,,:,,,11
significantly more than controls
at
two weeks of
an
improvement that
was
maintained
at
10
and
at
28
weeks
In
a of time-limited psychotherapy with :'2
bereaved patients
(79).
it
was
that therapist
real
from fantasized meanings of
the
stress
and
led
to better OUI-
comes
for
well motivated patients with a stable self-concept.
Preventive intervention
has
been shown
to
be
effective
in
postbereavement morbidity.
In
64 widows
at
risk
a randomly allocated group of 3 I who were
support
for
and encouragement of
mournmg three months. there
was
significantly less
morbidity
at
a
13
month followup.
to
the control
group who received
no
intervention (
Brief psychotherapy with recently bereaved adults
who
were also felt to
be
vulnerable because of
borderline or narcissistic was useful
In
stem-
ming a downhill course (81), and
in
some cases a
bridge
to
an
indicated longer-tenn psychotherapy.
Cabral
et
al
reported on a of psychoth-
erapy,
in
which assessment of process variables
was
related
to
outcome. A consistent, although not statistically
relationship was found between improvement
and the amount of abreaction. defined as
the
of
pent-up material relevant
to
the mam complaint. occumng
m the therapy.
Of
the process variables studied, only accept-
ance (as the wann and
which
to
express one's main complamt)
was
significantly
correlated with
Gunnan (83) reviewed 26 studies conducted between
1954
and 1974. of the 26 studies reported a
ciatlon between patients' of the
relationship and outcome, which
the
hypotheSIS
that
10
274
CANADIAN
JOURNAL
OF
PSYCHIATRY
Vol. 34.
No.4
the
therapist 's warm and accepting attitude towards
the
patient 's expression
of
affect
is
helpful.
In
a study of brief cathartic psychotherapy (84)
43
uni-
versity students were randomly assigned
to
emo
tlv
e or non-
emotive therapy with six experienced therapists.
All
sessions
were tape-recorded and rated.
It
was
found that emotive
techniques were effective
in
generating catharsis , and
that
high catharsis patients changed significantly more
on
a mea-
sure of behavioural target complaints. The amount of emo-
tional discharge
was
highly correlated with change on a
rat-
ing form
to
gauge patients' personal satisfaction.
Given this connection between mourning and psychoth-
erapy, what can the therapist do
to
enhance mourning
and
thereby
aid
in
the process of healing? First, the therapist 's
warm and accepting attitude permits
the
patient
to
express
feelings associated with
an
awareness
of
his loss (for exam-
ple. anger and sadness). Strupp et
al
(85)
in
their question-
naire study
of
patients who
had
received outpatient therapy
indicated that therapist warmth and acceptance were corre-
lated with improvement.
Lindemann
in
his
classic paper
on
bereavement (56)
expressed
his
belief that morbid grief reactions could
be
transformed into normal ones and then resolved,
by
helping
the patient
to
accept the pain
of
the bereavement and
to
express the sorrow
and
sense
of
loss which
he
has
been trying
to
avoid. Bowlby (73) emphasized the similarities between
psychotherapy and assisted mourning: " When helping a
psychiatric patient
the
tasks
to
be
undertaken
and
the tech-
niques for achieving them are, I believe,
no
different
in
kind
to
counselling the bereaved." The techniques
he
describes
include encouraging the client
to
recall
in
detail
the
loss
and
the
circumstances leading
up
to
it, so that feelings of regret ,
despair, anxiety, anger.
and
guilt can
be
sorted out.
Working with
the
patient
to
achieve
an
understanding of
nonverbal communications, bodily and dream phenomena ,
is
helpful
in
activating a grief process
and
"thawing"
of
psychological and muscular armoring leading
to
increased
vitality (71 )
Selma Fraiberg
and
her coworkers (74) believe that
re-
experiencing of early affects
is
important. What
is
repressed
is
not
the early memories. but the associated affective expe-
rience ,
in
parents who themselves were abused or deserted
as
children. Access
to
childhood pain , enabled
in
therapy,
becomes a powerful deterrent against repetition
in
parenting .
According
to
Homey's theory (86), helping the patient
to
become aware
of
anger
and
sadness experienced
in
the trans-
ference. will assist the patient
to
recall early memories of
sadness and anger, which may
have
been experienced
in
sit-
uations of actual or intrapsychic loss: such recall
is
necessary
to
mourn those early losses.
The therapist can assist the patient
in
becoming aware of
what
he
or she has lost or
has
never had,
by
offering trans-
ference interpretations. For example. a patient who contin-
ually presses
for
gratification from the therapist.
may
learn
of
his
lack
of
an
internal gratifying or self-soothing object
through the therapist 's actions.
In
those patients who lost a
parent
as
children. early denial of the meaningfulness
of
the
loss (i.e. incomplete mourning) may manifest itself
as
resis-
tance (59)
to
the
formation of a usable . interpretable trans-
ference neurosis. Analysing this resistance leads
to
grief
being experienced
in
the analysis.
Another
way
in
which the therapist can help
the
patient
to
undergo a mourning process
is
by
offering himself
as
a
new,
real object
to
which
the
patient can cathect even
as
he
decathects from
that
which
he
has
lost (65).
In
all
psychotherapies , the termination phase provides
an
opportunity
for
the
therapist
to
assist the patient
in
experi-
encing a real loss
and
mourning
it
adequately,
in
this
way
allowing the patient
to
practise coping with other losses. both
past
and
future . The importance
of
the ending phase
is
emphasized particularly
in
brief psychotherapies,
in
which
the
therapist
may
actively introduce the impending separa-
tion
and
loss
at
a relatively early point. Termination
and
the
subsequent working through, which
was
likened
to
a process
of mourning
by
Fenichel (75), allows the patient
to
continue
to
use
the
therapeutic endeavour
to
mourn future losses.
Harold Searles emphasizes that therapy
with
borderline
patients, who
are
continually faced with
the
threat of loss .
involves the therapist's deeper working through of
his
own
losses (76). Loss of
the
therapist due to terminal illness can
also
be
"therapeutically useful
in
relieving previous losses
and
abandonments
and
completing unfinished mourning"
(87).
Clinical Examples
Ms.
A ..
in
her thirties when seen. had brought her s
on
Johnny
for
an
assessment
by
the
child psychiatry team . The
child
had
been behaving aggressively towards a younger sib-
ling.
and
was
also self-destructive.
Ms.
A.
has
two
other children.
all
of mixed race. and
all
from
different fathers. Johnny
is
the only one who
has
no
contact with
his
father.
Mother described a chaotic home situation. She shared a
three-bedroom
flat
with another single mother with
two
chi
1-
dren. The older one.
an
adolescent
boy.
terrorized
the
house-
hold.
to
the point where Ms. A. was afraid
to
enter
the
other
side of
the
apartment. Both mothers were
on
welfare.
but
the
other woman failed
to
pay
her share of
the
bills.
At
one
point. their electricity
was
cut off
for
three weeks
for
nonpayment.
Ms.
A.
came
to
get help with her son. who she feared
was
becoming Just
like
her.
She offered the child ' s self-
destructiveness
as
evidence
for
this. Her reason
for
seeking
help
was
to
"break
the
cycle."
When Johnny
felt
unfairly blamed
for
something,
he
would bite himself
and
choke himself with a belt. Aggre s-
sion towards
the
younger sister included setting her hair
on
fire
. Mother maintained. however. that Johnny
was
unable
to
express anger. keeping
it
bottled
up
inside. like herself.
Mother herself
had
been treated
for
a suicidal depression
when
in
her twenties .
She
described a very deprived childhood.
As
a pre-
schooler. her father
had
taken her out
of
the house and
had
her placed
in
a foster home .
He
wanted
to
protect her.
he
said. from continuing
to
be
accidentally hurt
by
her own
mother. who became very careless when drunk. Ms. A. was
1989 MOURNING AND
GRIEF
AS
HEAUl'G
PROCESSES
IN
PSYCHOTHERAPY 275
in a dozen different foster homes. She did
nOI
hear from her
father anymore; he died a number
of
years ago. Her mother
visited monthly while
:\1.5.
A. was growing up. but
abandoned also when she turned eighteen.
Ms.
A.
believes she was for her mother 10 leave.
We
contracted that would
be
seen in
one member
of
the team. and I would see
Ms.
A. in time-
limited
In the more historical details.
about her father's death.
session brought sadness. anger. and
bitter tears.
as
A. related her mother's mdifference to
taken out
of
the house social workers.
sessions. Ms. A. expressed fear
of
me. that
take her children away from her: I connected this
with her refusal to marry. and linked her distrust to her early
with her mother. who had alternated between
and maudlin displays
of
affection
when drunk. and anger accompanied
Ms.
A.·s sad
of
the events
of
her childhood.
demonstrate significant improvement after ter-
mination. as she had
in
the final session. She was
able to move out
of
shared flat into a large apartment
in
with a pool for her kids. She found a
to her welfare. and became an
member
of
a single parent association.
Johnny's
as did his schoolwork, reflecting moth-
er's
interest in her mothering role.
The
second case IS that
of
Mr.
B . a married man with
one child. in his thirties. who was seen once weekly for two
He had been referred for medication follow-
after a hospitalization for a psy-
student. but had a
His father. an alco-
after him when he was
to
his father. the
got married.
to
""''';w''''
....
from the home into her
with his father improved when the
latter became
ill
with
cancer
of
the bowel. and
Me
B.
resumed a nursemaid role towards When the father
died.
Mr.
B.
wondered why he shed no tears.
he abdominal pains. for which
of
times. Gastroenterological
mcJuding multiple laparot-
omies.
were
On
the last
of
these hospitalizations.
he
became acutely
delusional while from surgery. He believed him-
self to be eviL and was that the doctors and nurses
to
operate on him to "'remove the
evil."
He
was and suicidal.
He recovered with medications. and was dis-
In therapy. a supportive approach ini-
tially focussed on the with
hiS
wi
fe
and mother. in which he was
role as caretaker.
He
started to his anger at his par-
ents. and the resultant After one very emotional ses-
to recall the memory
foster care for several months
at
started to abdominal
sessions.
this
as
a resistance led
to
his
more anger at parents. but he also
to
become aware
of
his underlying sadness and sense loss. His abdominal
pain disappeared. and he became more assertive in his deal-
ings with friends and
At
thIS
Mr."
s wife became
pregnant
Mr.
B.
expressed a determmation to shield the baby from what
he
felt would be an and
the connection between his earlier
his fear
of
his mother. This led to
of
more
anger and sadness. and an acceptance
of
mother's liml-
birth.
he
became able to set limits on
attitude towards the infant, and he
was
to
leam that his mother. too. was able to
change.
Their
relationship lost its sense
of
strain. and
Mr
B.
was able
to
appreciate his
mother's
('(),"n.·I"'nr"p
grandmother at the same time as he mourned
unavailability his own childhood.
Did
Ms.
A.'s
for
passive
event she could control? As
A's case. even three
of
mastery. instead
forces outside
of
her control. It was when she
in therapy. to how she had transferred her
and anger away mother onto her son
Johnny. and 10 mourn her childhood that
she became able to her life and become a more
effective parent.
Mr.
B. may have been usmg his abdominal
erect a form
of
autonomy from his mother.
tially appeared that this independence would be
through a paranoid rejection
of
his own mother's overtures
to the new baby.
Mr.
B.'5 ability to mourn his own missed
childhood allowed him to lose his fear
of
his mother's power
over him. He was able to move from his psychotic
to a
"depressive
position"
in
which he had the opportunity
to make reparations
by
allowing his mother access to her
grandchild.
Research Directions
The hypothesis that mourning and are
healing processes in psychotherapy
to
a number
of
test-
able component hypotheses. These include:
I.
Does the expression
of
sadness in
(where the affect
of
sadness is differentiated from both
the syndrome and symptom
of
depresslOn) correlate
with
outcome'
For for
276
CANAD1AN
JOURNAL
OF
PSYCHIATRY
VoL
34.
No.4
duration and intensity
of
and sadness
could
be
rated observers; patients and therapists
could also quantify this variable.
2.
Does the or tolerance
of
a
patient's or sadness correlate with
outcome') This variable. agam, could be rated
by
the
by
independent observers.
or
patients.
3.
Are therapeutic techniques which specifically encour-
age the
of
and sadness more effective
in terms outcome than techniques which encourage
any expression
of
The hypothesis that
and unlearning is also to verification.
While the influence
of
Slales
of
affective arousal on subjects'
in laboratory measures
of
learning and recall-
ing has been studied. the effects
of
the affective
states
of
grief
or
sadness on such measures needs clarifica-
tion.
Other
aspects
of
the hypothesis which could be exam-
ined in the laboratory include:
1.
Are there any biochemical
or
hormonal in the
brain which correlate with the affect
of
sadness? This
could be studied
in
higher animals (those capable
of
reactions) as well.
2. Are these biochemical related to the
processes of learning
or
unlearning?
It would be importam to distinguish
of a normal mourning process. from
the issue
of
whether infants. animal infants. are
able to mourn older animals who have had a
normal previous development can be
rr.'''''
.....
'''·".,.,
to infants
in
studies
of
the paradigm.
Conclusions
There
is
little doubt that a normal mourning process
is
necessary after a bereavement
to
promote and enable
growth to continue. In psychotherapy of
bereaved persons. the therapist's active promotion
of
mourn-
ing
is
associated with better outcome.
In this paper. I put forward the that
are important promoters
of
in
All have suffered losses
of
one
and have accommodated to these losses with
of
success
or
failure.
The
therapist plays an
role
in
the mourn: he encourages
of
the loss. and the associated affects which
have frequently been
he
draws the
by transference
enced in the therapy. to losses m object
relationships: at termination.
he
the patient to antici-
pate appropriate grief for the new loss.
Although research
on
is with many
the hypothesis that as
a process may involve alterations. for
example in brain chemistry. which affect cognitive processes
such as leads to the possibility that we may one
be able 10 examine some aspects
of
psychotherapy in
the
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de
fa
Jar;on
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sance; pour que l' homme maintienne des relations,
l'
evo-
lution a cree
la
douleur au moment de
La
separation,
slimule
Ie
comportement social. 5i
La
separation est per-
maneme, de nouveaux contacts sont essentiels. Ceci mices-
site
un
changement vis-a-vis de
l'
objet de
l'
attachement
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Ie
denouemem
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d' autres objets. Le deuit
ell'
eta!
affectif
du chaRrin,
je
crois.
Jacilitem ce processus.
Le deuil
fa
conscientisotion de
La
de
l'
objet; les comportements connexes
La
nation du ' ,
par
l' extincrion: et finale-
ment. les aspects physiologiques concomitants du chagrin,
qui
peuvem
exercer une influence sur
Ie
en directement sur
fes
mediateurs chimiques ou les
neurohormones
comme
Ie
cortisol,
l'
ACTH
au
la
noradrenaline.
Outre les
penes
occasionnees
par
Ie
deuit,
La
vie
et
fa
croissance comprennent de nombreuses
penes
d' un
aUire
genre dans leur cours normal. Pleurer ces
penes
eSI
un
mal
aussi necessaire que
Ie
chagrin un deces.
Ne
pas pleu-
rer de
Jar;on
pew
naitre une ps)'chopmho-
ou une psychosomarique. Comparativement.
est une mecanisme d' adaptatin el [' on peUllracer
un
parallete
entre ce
mecamsme
et
la
guerison
en
psychothirapie.
Les traites de
et
de
appuient
Ie
principe du deuil et du comme instru-
ments de ta guerison. Puisqu'il est possible que ce meca-
nisme ait un
par
les effets du deuil
sur
{'
apprenrissage.
pourraiem
encourager activement l'identification des
penes
er
recourir
aux manifestations de deuil adequates durant
Ie
trailemenr.
Pour cela. on examine diverses approches.
On deux rapports sur
Ie
recours
cette approche en pvschotherapie
et
Journit des
pour
La
recherhce,
... We use the term "mourning" rather than "grieving" given that the former tends to be the broader process that may include grief (e.g.,Olders, 1989). As such, mourning may also involve a broader range of emotions beyond sorrow or grief. ...
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Focusing on the post-bankruptcy reactions of former Lehman Brothers’ bankers, we build a model of organizational mourning that depicts the thoughts, feelings, and actions of individual members dealing with the loss of their organization. We argue that organizational mourning is a process comprised of five interrelated phases, namely: (1) “experiencing the death event,” (2) “remembering the organization,” (3) “assessing loss,” (4) “salvaging: evaluate and restore,” and (5) “creating continuity and detaching.” Our empirical case suggests that at its core, organizational mourning involves both holding on and letting go of a defunct organization. Understanding how former members mourn is crucial to appreciate how they may ultimately find continuity after an organizational death, including how they enact their subsequent career paths. We conclude by discussing implications for theory of our research—notably, for literatures on post-death organizing, and personal mourning—as well as implications for practice.
... Psychotherapeutic literature supports the premise that mourning is essential in the therapeutic process to cope with loss [19]. We believe that mourning caused emotional relief that enabled the patient to accept his cognitive limitations. ...
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von Wild KRH, Kemper B. Emotional adjustment after stroke: The role of early neuropsychotherapeutic interventions in patients following brain damage. Jpn J Compr Rehabil Sci 2011; 2: 42-47. Objective: Post-stroke depression has been considered the most common neuropsychiatric consequence of stroke, even in the presence of successful neurological recovery and good health-related quality of life. This report describes a patient’s catastrophic reactions to his unexpected illness, with a focus on the therapeutic process, to provide an understanding of managing denial and how to approach and engage brain-damaged patients. Methods: This is a case study of a 65-year-old businessman with mental-cognitive and behavioral impairments following hypertensive cerebellar massive hemorrhage and secondary hydrocephalus, who made a complete recovery following psychotherapeutic intervention. Results: Our supportive psychotherapeutic approach combined with cognitive interventions enabled this patient overcome moderate mental-cognitive and behavioral deficits and extreme defensive coping strategies, and facilitated his successful social re-entry. Conclusions: Brain-damaged patients with preserved self-awareness and a high level of independence in activities of daily living (ADL), who do not have pre-existing psychiatric conditions, can benefit from individualized psychotherapy over time. Attention needs to be focused on a recovery beyond functional outcomes, with understanding of holistic neurorehabilitation as a (an )method of reconstructing lives within a social context. Further research and education is needed for the development of proper psychotherapeutic approaches to address aspects such as emotional coping and finding sense in life following brain damage.
... The literature on the psychotherapy of grief, mourning, and bereavement is replete with articles that address various stages of grieving (Axelrod, 2006;Friedman, 2009;Kübler-Ross, 1969), complications in the natural process of grieving (Bowlby, 1980;Wetherell, 2012), the treatment of despair and anger (Greenwald, 2013), grieving as an attachment disruption (Parkes, 1972), how grieving may potentiate other mental health issues (Greenwald, 2013), various treatment models (A. Clark, 2004;Hensley, 2006), and the need for supportive relationships in the family and community and in therapy (Olders, 1989). In general, authors have tended to focus the treatment of grief on accepting the loss, understanding the necessity for supportive and caring relationships, providing a suitable amount of time for healing from the loss, and developing new interests and activities (Wetherell, 2012). ...
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Full-text available
Relational loss, death, and mourning are all part of life and human relationships. Protracted and compounded grief occurs when something interferes with the normal grieving process. The psychotherapy of grief is described and two primary relational approaches are emphasized: face-to-face psychotherapy and the use of internal imagery via the empty-chair technique. In both approaches, the aim is to provide a balanced expression of affect, including emotional pain, anger, resentment, appreciation, and love. Several case examples are provided.
Book
Full-text available
Grief is a natural part of life and it is always individual. In the absence of immortality, the human species has over the millennia developed rituals and customs to help in the passing of life to honor the person who is dying or has died or in some way demonstrate their "courage" and perseverance as well as duty even in the face of almost certain death The present research examines rituals and customs of mourning dealing with various aspects of these issues from a contemporary perspective.
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Child loss in pregnancy and childbirth period is a sexual and physical experience. Its consequences are essential clinical problem often, catchying multifarious complications and influencing on totality of partnership. There are not clear criterions of proceeding in such situations unfortunately. The elaboration objective is to promote awareness among different school experts for women after child loss and their partners for responding experience difficulties. Argumentation showed can focuss on more precise necessary intervention supporting persons after child loss directly after.
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In Girls in Trouble with the Law, sociologist Laurie Schaffner takes us inside juvenile detention centers and explores the worlds of the young women incarcerated within. Across the nation, girls of color are disproportionately represented in detention facilities, and many report having experienced physical harm and sexual assaults. For girls, the meaning of these and other factors such as the violence they experience remain undertheorized and below the radar of mainstream sociolegal scholarship. When gender is considered as an analytic category, Schaffner shows how gender is often seen through an outmoded lens. Offering a critical assessment of what she describes as a gender-insensitive juvenile legal system, Schaffner makes a compelling argument that current policies do not go far enough to empower disadvantaged girls so that communities can assist them in overcoming the social limitations and gender, sexual, and racial/ethnic discrimination that continue to plague young women growing up in contemporary United States.
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Full-text available
Explored the time aspect of grief, the extent to which early reactions to bereavement predict the later development of the grieving process, and whether bereavement can cause lasting changes in personality traits, especially anxiety. 39 Norwegian women (aged 44–79 yrs) who had lost their husbands after a terminal illness were interviewed 4–6 wks after the death and 1 yr later. Instruments included the State-Trait Anxiety Inventory, the General Health Questionnaire, and H. Dupuy's (1973) General Well-Being Schedule. A majority of the widows experienced less anxiety, regarded themselves as better copers, and found themselves in a better mood after 1 yr of bereavement. These changes were greatest in self-evaluated coping and emotional well-being. Results support the idea that 1 yr of bereavement is sufficient for a considerable degree of grief resolution. Five Ss suffered from prolonged reactions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Within the context of their grieving families, this grounded theory study explored survivors' experiences of healing following youth suicide. The major theme developed in this study, Journeying Toward Wholeness, is conceptualized as a process involving the inter-relationships among three sub-themes: Grieving in Response to Youth Suicide, Mourning in Response to Youth Suicide, and Healing in Response to Youth Suicide. Initially, grieving, mourning, and healing occur within individual and family realms. Theoretically congruent with systems theory, this mid-range grounded theory suggests that grieving, mourning, and healing are embedded within a broader social context. This theory purports that grieving, mourning, and healing are related, dynamic, and seamless processes influencing each person's journey toward wholeness following youth suicide. This theory supplements the basis of holistic practice, directs us to accept a broad range of survivors' expressions of movement towards wholeness and health, stresses the importance of working with survivors' stories, and encourages us in relational practice.
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This review aims to: (1) discuss the reasons for the limited focus in the literature on the loss experiences of patients in rehabilitation; (2) highlight the importance of increasing our understanding of the loss reactions of these patients; and (3) offer suggestions for appropriate incorporation of bereavement issues into clinical practice and research. The authors review articles and books from several disciplines to reveal and provide suggestions for overcoming limitations in application of current bereavement theory and practice with disabled populations. The paper identifies problems with the descriptive and diagnostic language' of bereavement, a lack of empirical support for popular theory and assumptions about the grieving process and bereaved persons, disagreement among bereavement and rehabilitation clinicians on most appropriate interventions for facilitating adjustment, and compelling reasons to focus on bereavement issues with the disabled patient. The review reveals the need to clarify loss issues and terminology, develop appropriate measures of the loss experiences of patients with disability, identify variables affecting the process and outcome of grieving in this population, develop guiding theory and select interventions that meet the needs of these patients.