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© 2007 Baylor College of Medicine

Introduction to Grief

and Bereavement

Teen Club Community Partners Training Programme

© 2007 Baylor College of Medicine

Definitions

� Bereavement: to have suffered the

death of a loved one

� Grief: emotional distress caused by

or as if by bereavement

� Mourning: an outward sign of grief

for a person’s death

© 2007 Baylor College of Medicine

Simplified…

Grief / Bereavement

The internal process

experienced after a loss

Mourning

The external process or outward

expression of grief/

bereavement

© 2007 Baylor College of Medicine

Four Tasks of Grieving / Grief Resolution (J.W. Worden)

1. Accepting the reality of the

death

2. Experiencing the pain of grief

3. Adjusting to life without the

deceased

4. Withdrawing emotional energy

from the deceased, and

reinvesting in others

© 2007 Baylor College of Medicine

Determinants that Effect the Grief Process

� Age of the survivor, and age of the

deceased

� Children express grief through behavior

�Talking evokes energy

� Teens need confidentiality and respect

�Focus is on current issues

�Often prefer discussion, infused with light conversation and humor

© 2007 Baylor College of Medicine

Determinants that Effect the Grief Process

� Nature of the relationship

� All relationships are unique and not equal

� Can be different even within the same family

� Unique relationship = unique grief process

� Survivor support system

� Resiliency dependent upon quality

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© 2007 Baylor College of Medicine

Determinants that Effect the Grief Process

� Resources of the survivor

� Mental, physical, support…

� Nature of the death

� Anticipated or unanticipated

�If anticipated may begin grief tasks sooner

� Cause and circumstances

© 2007 Baylor College of Medicine

Nature of the Death

� Illness

� Evokes issues around body and health

� Suicide

� Issues around abandonment, shame, social stigma

� Need to know they are not alone

� May want to share beliefs around why

person suicided

© 2007 Baylor College of Medicine

Nature of the Death

� Murder

� Issues around safety, loss of control, rage, powerlessness

� May include media coverage, legal investigation

� Feelings of desire for revenge

� Trauma symptoms

� Accident

� Issues around safety, loss of control

� Desire to share what they’ve been told and what they think happened

© 2007 Baylor College of Medicine

Violent Death

� Question their own belief system

� Guilt for not protecting deceased

� Stigma

� Postpone grief for legal proceedings to end

� Revictimized by the media

� Possibility of no body, or mutilated

remains

� Loss of support system

© 2007 Baylor College of Medicine

Complicated Grief (R.C. Simmons)

� Extended persistence of denial or

delayed/absent grieving

� Depression accompanied by

impaired self esteem and suicidal thoughts

� Develop medical illness/symptoms (vs. only somatic complaints)

© 2007 Baylor College of Medicine

Complicated Grief (R.C. Simmons)

� Progressive social isolation

� Persistent anger and hostility,

leading to often paranoid

reactions

� Preoccupation with memories of

deceased, to the point of searching for reunion

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© 2007 Baylor College of Medicine

Disenfranchised Grief

� Grief that is not openly acknowledged, socially validated, or publicly observed (K. Doka)

� Can pertain to:� Relationships

� Losses

� Grievers

� Deaths © 2007 Baylor College of Medicine

Disenfranchised Relationships

� Related to the “type” of

relationship

� If outside immediate family, not

afforded the “right” to grieve

� Unrecognized relationships

� “You hardly knew them.”

© 2007 Baylor College of Medicine

Disenfranchised Losses

� Unwilling to recognize a loss has

occurred for an individual

� “It wasn’t your child.”

� Alzheimer’s and Dementia

� Loss of body parts

� Selective abortion

© 2007 Baylor College of Medicine

Disenfranchised Grievers

� The griever is excluded from the

greater grief process

� Young children

� Mentally handicapped

� Elderly

� Unrecognized relationships

© 2007 Baylor College of Medicine

Disenfranchised Deaths

� Involves circumstances

surrounding the death itself

� Stigma

� AIDS, suicide, execution

© 2007 Baylor College of Medicine

Effects of Disenfranchised Grief

� Exacerbates bereavement

� Precludes social support

� Reinforces denial and avoidance

Death is not the ultimate tragedy –

the ultimate tragedy is dying

alone and grieving alone.

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© 2007 Baylor College of Medicine

THANK YOU

� Thank you to all our Partners