'Loss, Grief and Bereavement Coping with Loss and Grief'

3/3/2018 1Dr Geoffrey Wango, Psychology Department, University of Nairobi
Dr. Geoffrey Wango
Senior Lecturer
Counselling Psychology
University of Nairobi
Coping with Loss and Grief
Loss, Grief and Bereavement

The expectation that we can be immersed in
suffering and loss daily and not be touched by it is
as unrealistic as expecting to be able to walk
through water without getting wet.
Remen,1996

Name some
of the things
you have
ever lost in
life:
Lost things

How
significant
was the
loss?…
Lost thing Significance

Preamble
 Definitions: Loss, Grief, Bereavement
 Common Types of Loss
 Coping with Loss
 Grief and the Grieving Process
 Symptoms of Grief
 Bereavement
 Grieving and Coping after a Loss: Overcoming
Disappointment and Intervention Strategies
 References

Loss
Loss is the fact or process of
losing something or someone. It
also refers to failure to obtain or
gain something or opportunity that
had been previously anticipated.
Loss implies that you no longer
have something or someone, or
have less of something
(substantial loss).

Loss
Loss occurs when something
valued such as a person, an
object, or situation is missing or
altered. The loss may be:
 Actual (definite)
 Physical (forfeited)
 Psychological (emotional)
 Apparent (perceived)
 Anticipated (probable, predictable)

Active Familiarity
with the Loss Process:
- Become familiar with
types of loss
(including the grief
process).
- Explore experiences
in life in which we
undergo loss in order
to find out how
meanings in life can
be understood.
- Search for unique
and novel ways of
resolving loss.
Search for Meanings
and Purpose in Life:
- Search for meanings
of our lived
experiences in order
to live life in its
entirety.
- Mark meanings and
attach them to
activities of daily
living (ADL).
- Reorganise meanings
and experiences in
patterns of our lives
even after a loss.
Organisation and
Meaning Wholeness:
- Life is organised into
(positive) meanings
even after a loss.
- Meaningfulness and
purposefulness
recreate life
experiences amidst
the difficulties /
challenges such as
loss (coping).
- Lived experiences are
explicitly expressed
in actual context of
activities of daily
living.

Loss is definite, can be concretised,
and/or even recognised by others,
including the person sustaining the loss,
such as loss of a job, spouse, house, pet,
body part or valued object, break up of
a romantic relationship, divorce/
separation.
Actual loss
Anticipatory loss
Perceived loss
Physical loss
Loss
Psychological loss
9
Dr Geoffrey Wango, Psychology Department, University of Nairobi3/3/2018

Loss involves physical forfeiture such as
property, body parts such as a leg, an
arm or other body parts or senses
(sight, sound, smell).
Anticipatory loss
Perceived loss
Physical loss
Loss
Psychological loss
10
Actual loss

Loss leads to psychological and
emotional trouncing. This is caused by
an altered self-image and self-concept.
This can lead to perceived and
psychological loss of self-image.
Anticipatory loss
Perceived loss
Physical loss
Loss
Psychological loss
11
Actual loss

Loss is apparently felt by the person but
is often intangible to others such as loss
of youth, financial dependence,
bankruptcy or emotional support.
Anticipatory loss
Perceived loss
Physical loss
Loss
Psychological loss
12
Actual loss

The person is aware that the loss is
probable but has yet to take place, for
example, a terminally ill patient,
amputation of a leg, ageing leading to
retrenchment/retirement and loss of
job privileges. Anticipation of loss can
serve to lessen the impact of actual
(eventual) loss.Anticipatory loss
Perceived loss
Physical loss
Loss
Psychological loss
13
Actual loss

Loss and Grief
 Grief is the emotion that people feel when they
experience a loss. Individuals are highly unique and they
will respond in diverse ways in how they experience a
loss, depending on the loss and circumstances.
 Loss may involve someone or something such as a loved
one (child, spouse, parent, relative, friend, colleague),
job, opportunity, business, item or property, divorce or
separation, suffering such as poor health or infirmity, or
possibly a role or responsibility (leadership, social status,
position).
 Anyone can experience loss and hence grief. The loss can
be sudden, gradual, expected or unexpected.
 Grief occurs in response to the loss of someone or
something valuable to us.

Loss and Grief
 Grief is a natural reaction to the loss of someone
important to you. It is also the healing process
that a person goes through after someone close
has died.
 Grief in itself is a normal and natural response to
the loss. There are a variety of ways that
individuals respond to loss. Some are healthy
coping mechanisms while certain others may
hinder the grieving process, and thus
inadvertently affect our health and well-being.
 The grieving process takes time, and the healing
usually happens gradually.

 Bereavement is the state of having suffered a loss, such as the
death of someone with whom one has had a close
relationship. A person may experience psychological, social,
and / or physical stress as a result of the loss that is valued
(death of a parent, child, sibling, relative, friend or colleague,
loss of a pet, relationship or item).
 There are three elements viewed as essential in defining
bereavement:
(1) That it includes a relationship with a person or thing that
is valued;
(2) That there is a loss of that relationship; and,
(3) That a survivor is deprived by the loss.
 Thus, while bereavement is the loss, grief refers to the
psychological and physical responses resulting from the loss.

 Bereavement includes a range of grief and mourning
responses. Grief follows bereavement and is both an
individual and a social / community process.
 It is important to realise that part of grieving is to
acknowledge the loss. This includes undergoing the
grieving process in a healthy way.
 Individuals experiencing grief may consciously or
unconsciously adopt a variety of ways of expressing it. It is
possible that people will respond differently to the same or
similar loss (at the same time, age or circumstances). This
is because human personality and character are different
just as we are similar and hence the intensity of feelings.
 Appropriate grieving enhances a healthy healing process.
That healing is a process and it takes time.

Loss and Grief: Bereavement Challenges and
Adjustment to Loss
Several factors influence our grieving. These include:
 Personality (individual and personal characteristics).
 Culture/community (traditions, philosophy of life).
 Individual experience of loss.
 Kind of loss (sudden or expected, and intensity of loss). Whether loss is
sudden or gradual (anticipated loss allows an opportunity to
appropriately process).
 Time and timing of loss such as death.
 Age and life experience/s.
 Gender; females and males may react differently to a loss.
 Support mechanism and services (significant others, therapy).
 Ability to deal with stress (facilitating the grieving process).
 Emotional intelligence.
 Period of mourning the loss.
 Religion /spirituality (faith).
 Expert (professional) services.

Loss and Grief: Stages of Grief
Everyone responds differently to a
loss. Grief is the normal process
of reacting to a loss.
The SIX stages of grief are as
follows:
(1) Shock
(2) Denial
(3) Anger
(4) Bargaining
(5) Depression
(6) Acceptance

This model is extended slightly from the original Kubler-Ross model,
which does not explicitly include the Shock and Testing stages. These
stages however are often useful to understand and to facilitate change.

 The stages of grief do not always occur in
order or sequence. People grieve in different
ways and at different rates of time.
 Delayed grief can occur when a person
suppresses the emotions of the loss but
sometime later, they may experience the loss
and at times get even depressed.
 There are cultural, religious and personal
differences, including age, gender, ethnicity/
race, and personality in the way people
experience loss and hence grieve.
 Persons who have been bereaved tend to
experience higher rates of depression and
are also at greater risk for illness than the
non-bereaved.
It is not ok
for a loss to
occur

Shock is the initial paralysis after
hearing or witnessing a loss or bad
news. Shock is characterized by
numbness or emotional pain. A person
is obviously surprised and astounded by
appalling news, events or situation. The
person may be upset or distressed.
Shock
Anger
Acceptance
Bargaining
Depression
Denial
The individual does not accept the
reality of the loss. Emotional pain
often lacks (visible) emotional
reaction unless expressed through
crying. Shock and numbness evoke
a feeling of unreality. This may last
from a few seconds, minutes, hours
to several days.
3/3/2018
Dr Geoffrey Wango, Psychology Department, University of Nairobi
22

Shock
Anger
Acceptance
Bargaining
Depression
You can help others face loss by:
(1) Being available for them to talk
about it
(2) Understanding that it takes time for
the loss to be conceptualized.
Denial
You can reduce your shock by:
(1) Being aware of certain events in our
lives (surroundings).
(2) Seeking understanding of events/
situations that affect us.
(3) Being realistic.
3/3/2018
23

Refusing to believe a loss such as a
probable death will occur, or has
occurred.
Denial
Anger
Acceptance
Bargaining
Depression
You need to accept with time what has
happened, talk about it if and when you
can and deal with it over time.
You can help others face loss by:
(1) Being available for them to talk
about it in order to accept it.
(2) Understanding that it takes time for
the loss to be conceptualised
(3) Allowing them to express loss.
NB: Do not force them to talk about it.
Shock
3/3/2018
24

Once the loss or predicament
sets in and/or is accepted as
true or real, anger, bitterness
and hostile feelings may set in.
One may feel bitter against
those who caused the loss (thief,
murderer, terrorist, driver who
caused accident etc.) or others
who failed to do something or
you feel did not do enough to
prevent the loss. This includes
God who you may feel did not
hear your prayers, doctors,
family and others.
Denial
Anger
Acceptance
Bargaining
Depression
Shock
3/3/2018
25

The following are important to note on
anger:
(1) The anger may be justified, or
unjustified (framed).
(2) The person at a loss has a right to
be angry at the loss or misfortune.
(3) Allow the person to express
himself/herself; this is part of
therapy and will allow them to
move on in the grieving process.
(4) It takes time for the anger to
subside.
(5) Try not to take the loss personally;
instead, take into consideration the
circumstances.
Denial
Anger
Acceptance
Bargaining
Depression
Shock
3/3/2018
26

The following are important:
(1) Be careful with your anger (real or
unreal (framed).
(2) You have a right to be angry with
persons in the wrong, not blaming
everyone and everything for the loss or
misfortune.
(3) Though your way of expression may
have been emotional at the beginning,
allow yourself to take in the
circumstances.
(4) Allow yourself to move on in the
grieving process by allowing the anger
to subside. Forgiveness is part of
healing.
(5) Do not personalise the loss.
Denial
Anger
Acceptance
Bargaining
Depression
Shock
3/3/2018
Dr Geoffrey Wango, Psychology Department, University of Nairobi 27

A major part of the grieving
process is bargaining. This is
because you feel the action was
not justified. Thus, you seek for a
bargain – ‘This is the wrong
timing!’, ‘She or he should, or
should not have driving / drinking
/ left alone’, ‘I wish this had not
happened but instead..’ , ‘I wish...’
‘I would have preferred..’. This is
part of coming to terms with the
loss and involve our cognition
and perception, our construction
of our world.
Denial
Anger
Acceptance
Bargaining
Depression
Shock
3/3/2018
28

Bargaining is part of our
negotiation with the loss; we
are saying this should not have
happened but instead … It
involves our emotions and
thought processes (How I wish
my spouse lived till our child
was old enough!, I wish my
lived long enough till my old
age! I would have done
anything to save her / him ).
Bargaining also enables us to
express our deep yearning as
we express it.
Denial
Anger
Acceptance
Bargaining
Depression
Shock
3/3/2018
29

Bargaining is an important process
that is inbuilt in us but it requires
careful moderation; it is not surreal
as the loss has already occurred.
Thus, with time, there is need to
understand that there are not as
many choices at this moment in
time. Instead, this is a good stage
of negotiation between reality and
dreams. Start to accept the loss
and negotiate how to cope with it.
Effective negotiation is a part of
acceptance and very significant to
avoid other negative effects such
as depression overwhelming you.
Denial
Anger
Acceptance
Bargaining
Depression
Shock
3/3/2018
30

The reality of a loss soon sets in. The
realism can be so devastating that a
person gets stressed to the point of
being disheartened and can be
depressing. This is because of the
following three reasons:
(1) Fear of the unknown;
(2) Guilt (due to inability to do
anything); and,
(3) Sense of helplessness.
Denial
Anger
Acceptance
Bargaining
Depression
Shock
3/3/2018
31

Start getting back on track with
regular activities of life. This
allows the loss to set in and life
picks up. In addition, it reduces
the anxiety and unhappiness.
Note that things will not be
‘normal’ as you suffered a loss –
it is not the typical day.
Therefore, you learn to cope
and have to adjust in various
(several) ways. This enables
you to have some inner peace.
Denial
Anger
Acceptance
Bargaining
Depression
Shock
3/3/2018
32

The loss soon becomes a part
of your new way of life; you lost
someone or something. You
were grieving because of a
loss. The acceptance of the
loss is what provides inner
peace and harmony. This does
not mean that you will forget;
instead, you are coping with
the loss.
Denial
Anger
Acceptance
Bargaining
Depression
Shock
3/3/2018
33

Provide as much support as
possible to enable a person deal
with his or her loss. Also, do not
ridicule them or belittle the loss
however distant or unimportant the
matter appears to you (statements
such as, ‘she or he was suffering
and it is good they rest’, ‘the
situation was becoming
hopeless!’). In addition, be
empathetic, not advisory (avoid
telling the person unnecessary
things such as: ‘do not keep
crying’, ’a pet is nothing’, ‘you will
get another child or spouse, etc.).
Denial
Anger
Acceptance
Bargaining
Depression
Shock
3/3/2018
34

3/3/2018
35
Death and dying have long been studied in Medicine,
Philosophy, Psychology, Theology and other fields. Death is
also studied under various topics such as ‘death anxiety,’
‘thanatophobia,’ or ‘mortality salience.’ Death and dying are
both important and interesting because prior studies have
shown that the fear of death is among other anxieties linked to
many human behaviours. Behaviours range from the more
obvious and positive reactions (such as taking precautions to
prevent death and other anxieties arising thereafter [such as
preparing a will], seeking safety in health and insurance, as well
as seeking healthy habits such as improved medication,
nutrition and exercises). However, there are certainly more
surprising and less helpful reactions (such as panic attacks,
unnecessary aggression and violence, hoarding, and
prejudice). Evidence abounds that death anxiety is nearly
universal. Loss and bereavement are real.

It is important to note that
psychologists outline various phases of
grief. However, they do not necessarily
depict a regular pattern or specific way
to respond to various losses. Rather,
the stages of grief reflect an
assortment of possible reactions that
may surface as an individual (attempts)
makes sense of how the loss affects
him or her. This is the process of
coping.
3/3/2018
36

Immediately Thereafter
Hour/s
-
Acceptance
Depression
Bargaining
Anger
Denial
Shock
Coping
Day/s Week/sMinutes Year/sSeconds
AfterwardsInstantly
Shock
Denial
Anger
Bargaining
Depression
Acceptance

Hour/s
-
Acceptance
Depression
Bargaining
Anger
Denial
Shock
Coping
AfterwardsInstantly
Shock
Denial
Anger
Bargaining
Depression
Acceptance

Hour/s
-
Acceptance
Depression
Bargaining
Anger
Denial
Shock
Coping
AfterwardsInstantly

Grieving: Signs and Symptoms of Grief
Withdrawal > Seeking support of others
Loneliness > Expressing your feelings

 A person may feel angry and bitter at the loss. This
may include feelings of sadness, crying, sleep
disturbance (loss of sleep, turning in bed,
nightmares), loss of appetite, experiencing motor
restlessness and difficulty in memory (loss of
memory, has difficulty remembering).
 The person may also refuse to attend to regular
chores such as bathing or going to work because
he or she is irritated or do not consider activities of
daily living (ADL) as significant. The person may
at times blame himself/herself or others for not
having done enough to prevent the loss.

3/3/2018 Dr Geoffrey Wango, Psychology Department, University of Nairobi 42
Y
O
U
A
R
E
H
E
R
E
Healing
Behavioural
Cognitive
Spiritual
Emotional
Physical
How to get up
there

- Low self-confidence
- Lack of energy
- Little social interest
- No interest in communicating
- Absence of friends or affection
- Decreased ability to make plans or
to do anything
Behavioural
3/3/2018
43
Cognitive
Spiritual
Emotional
Physical

Behavioural
3/3/2018
44
Cognitive
Spiritual
Emotional
Physical
- Grieving influences our
mental and analytical abilities
- Decreased ability to
concentrate
- Unimaginable future
- Forgotten past
- Triviality of everyday life
- Overwhelming by finality of
the loss
- Inability to understand what
happened or why

Behavioural
3/3/2018
45
Cognitive
Spiritual
Emotional
Physical
- Emptiness and meaninglessness
- Loss of faith or questioning beliefs
- Need to reassess life`s
significance
- Sensing loss as part of self
- Loss of desire to live and
bottomless despair
- Inability to see positives (good or
worth in life or anything)
- Awareness of life's fragility
- Profound feelings of aloneness

Behavioural
3/3/2018
46
Cognitive
Spiritual
Emotional
Physical
- Sadness
- Longing / yearning
- Absence of positive feelings
- Helplessness
- Emptiness / loneliness
- Feeling unconnected to
anyone / anything
- Guilt / shame associated with
feelings of powerlessness

Behavioural
3/3/2018
47
Cognitive
Spiritual
Emotional
Physical
- Difficulty going to sleep
- Waking up in the middle of the night
- Weight loss or gain; over-or under-
eating
- Low energy or fatigue
- Headaches, chest pain, or racing heart
- Upset stomach or digestive problems
- Hair loss
- Crying, sobbing, sighing (may include
crying uncontrollably, or crying for no
apparent reason)
- Multiple symptoms of ailments
- Restlessness (general anxiety)
- Yearning to be shown affection
(comforted) or to be touched

Loss and Grief: Coping with Feelings
The different feelings, thoughts, behaviours and actions people
express during grief can be categorized into two main styles:
instrumental and intuitive. Most people display a blend of these two
styles of grieving:
(1) Instrumental grieving involves focusing primarily on problem-
solving tasks such as the funeral arrangements and life
thereafter, while controlling or minimizing emotional
expression.
(2) Intuitive grieving is based on a heightened emotional experience
that leads to sharing feelings (crying, expressing the shock),
exploring the lost relationship, considering mortality (what
happens after this), and identifying meaning in life
(implications of loss).
There is no right or wrong way to experience grief, though some
thoughts and behaviours after a loss can be more helpful or benign
than others.

Gender: Grieving and Coping after a Loss
Women
 Express outwardly their
feelings early after loss (such
as crying).
 Reach out for social support
(support group, chatting and
sharing with others).
 Are seen to express more
sorrow, depression, and
guilt.
 More willing to talk about
their loss, including deep
fatalities such as child or
only child.
Males
 More likely to hide their
feelings, including failure to
express sadness (crying).
 Take on a managerial role
and tend to intellectualize
their emotions.
 Indicate that they feel more
anger, fear, and loss of
control.
 Use denial more and tend to
grieve in private, thus often
leaving them more anxious
and susceptible to depression

Grieving and Coping after a Loss: Children
- Experiencing the death of a person is a potentially disruptive experience, and
may engender feelings and reactions of many children. Death of parent/s,
sibling, relative/s, teacher or friend/s is a relatively new and difficult
phenomenon. In that case, death is a rather odd, thought-provoking and
challenging experience in the lives of children and adolescents.
- Bereaved children experience lasting grief and mental health ramifications
irrespective of: (1) the cause of death; and, (2) kinship or relationship with the
deceased. Children deeply struggle with several questions, such as: ‘what is
death’; ‘what happens’; ‘what happened’; ‘why did it have to happen’; ‘why
does it happen to me / us’; ‘why the death’; and, ‘what happens next?’ Worst is
when the child is living in difficult circumstances such as a child who had
already lost another person through death such as a parent, relative, friend or
classmate. Other children may already be experiencing disturbing relations such
as parental divorce/separation. As a result, the child may experience life as
difficult and/or impossible, thus leading to anxiety and negative thinking and
rumination that life is hopeless and feelings of helplessness.
- The psychological closeness to the deceased person (parent [father, mother],
sibling, friend / playmate / classmate, relative [grandparent, auntie, uncle],
teacher) is an important factor.

Grieving and Coping after a Loss: Teenagers
and Young Adults
- Bereaved adolescents are usually very selective in sharing their
experiences with a few specific confidants only (parent, friends, teacher,
relative, peer / classmate). This tendency suggests the relevance of
attachments as well as caring for young people so that they can find in
the adult a confidant in terms of intensive emotions.
- Experiencing a death, especially of a parent, is the most stressful event in
the life of children and adolescents. There are feelings of guilt, shame,
stigma, or rejection. This can also be associated with personal growth in
terms of increased appreciation of life, of others, and emotional
strengths. Subsequently, persons working with young people including
teachers, counsellors and health providers need to identify and provide
targeted help. Despite its devastating effects, experiencing a death can be
a catalyst for positive mental health. There is need to encourage young
people in order to experience personal growth, increased maturity, and
capacity to deal with personal mental health / suicide.

Grieving and Coping after a Loss: Teenagers
and Young Adults
- Bereavement is a potentially disruptive life event with consequences in
physical and mental health, relationships, and social functioning. The death of
a relative (parent/s, sibling) or friend is a potentially disruptive event in the
lives of teenagers and adolescents, just as it is for children. This is because the
adolescent is now learning about being there for others while sacrificing
themselves, yet they have just been abandoned by the departed person.
- Teenagers and adolescents experience feelings of guilt and ‘why’ questions are
more pronounced. Such feelings may contribute to sentiments of being
overlooked and thus disregarding their own grief, which can have serious and
mental health implications. It is crucial to understand their grief and mental
health experiences.
- Adolescents tend to have marked feelings of guilt, (self-) blame, anger,
depression, at-risk behaviours (risky behaviours if event uncontrolled such as
smoking, alcohol, drugs and sexual indulgence), suicide, and changes in
relationships. Also, high levels of self-reliance and wanting to manage the
situation for themselves are highly common.

Grieving Pupils and Students
The school should provide help and support to pupils and students at all
times, and particularly during difficult circumstances in their lives. A major part
of the trials and tribulations is when a loss occurs and the child is bereaved
and thus is hurting and in utmost pain. Loss is a notable experience that has
the potential of long-lasting effects on the live of the learner in all spheres
including educational, psychological, spiritual and social and health effects as
a result of bereavement. Pupils and students are not immune to loss, and
hence the grief that follows it. They too end up losing relatives, classmates,
friends, teachers and members of support staff. A major problem is that
learners are often subsumed in the process as they are children, or because
they are expected to concentrate on their schooling. Yet, the effect that death
or a painful loss can have on a learner can be as varied as the many forms of
loss that can occur. Learners who have experienced the bereavement of a
significant relationship will react differently depending, for example, age,
gender, home environment and socio-economic background, religion, level of
support (family and others), school, and support systems. Subsequently, grief
management and support must be part of the school’s components. The child
is a part of the school and wider community. Hence, learners require a lot of
supportive, caring, and helpful environment especially at such times.

Grieving Pupils and Students
Common reactions to loss which may affect pupils and students include:
 Marked hindered functioning in daily activities (such as poor
concentration in class [looking blank, day dreaming], failure to take part in
class activities, inadequate performance in class or lack of interest in
hitherto exciting activities).
 An increase in daily fears (such as fear of loud noises or certain objects).
 Lowered activities (such as failure to take a shower, missing pen or book,
poor dressing, failure to complete class assignment).
 A (marked) decline in academic performance.
 Social withdrawal (isolation, loneliness).
 Regression in age appropriate behaviour.
 Eating and sleeping disorders (lack of sleep, poor appetite).
 Reaction formation such as smoking, alcohol or substance abuse.
 Disturbing memories or flashbacks of the deceased.
 Significant or sudden changes in behaviour (such as aggression,
persistent anxiety).
 Psychosomatic complaints.
Positive relations with pupils and students on a day-to-day basis enables
preventative support services that can help avoid long-lasting harmful effects.

Grieving Child, Pupils and Students
 Be straightforward with loss, especially when talking to children.
Distortions and lying can do lasting harm, such as ‘your father/ mother
is gone to sleep, or sleeping’, or ‘God took her, him.’ This can lead to fear
of sleep, or hate for God (misconceptions in faith and religion).
 Reassure children and adolescents that they are not to be blamed and
that they will be taken care of. The death of an adult (parent or
teacher) makes them feel abandoned and they need reassurance.
 Let the child or teen participate in the sorrow and grief. Silence and
sidelining of children and teenagers in family and school makes a bad
situation much worse. Instead, the child or teen should be granted
permission from school to participate in burial at home and class
(classmates) invited to the burial of a friend.
 Give as much attention to the child who cries as to the one who doesn’t
cry. This is because they are both mourning in various ways.
 Do not threaten the child or teen with immediate and unforeseen
responsibilities such as, ‘you are now the man/woman of the house’,
‘you are the eldest and must take care of the other children’, ‘stop crying
be brave, you are a man/big woman.’

Adults: Grieving and Coping after Loss of a Child
Majority of the parents consider the death of a child as the most
devastating incident in their lives. Even if the child is an adult at the time
of death, bereaved parents are likely to experience the death as unnatural
and untimely, and are faced with the seemingly incomprehensible task of
trying to find some way of adjusting to live without their child. Bereaved
parents must address the rupture of a widely shared concept of what is
perceived to be the natural course of life and are forced into
reconstructing meaning. The gender, cause of death, and age at death of
the child have been examined in numerous studies. Nonetheless, to the
parent a child is a child and loss of child is devastating. The death of a
child can lead to parents experiencing long-term negative psychological
responses, such as increased depressive symptoms, anxiety, and
complicated grief. Bereaved parents have also been found to experience
relationship difficulties and poorer physical health. This situation may
cause severe and long-lasting grief. Posttraumatic growth (PTG) is also
an issue for bereaved parents. PTG is considered to be the positive
psychological change experienced as a result of the struggle with highly
challenging life circumstances.

Adults: Grieving and Coping after Loss of a Child
Among the major groups of adults that are highly affected (and in many
ways greatly traumatized) are parents with an only child, the Only-Child-
Lost family (OCL family). An OCL family is a family in which the parents
have had only one child but now have no living biological or adopted
child/ren. Parents who have lost their only child experience a variety of
emotional responses, such as anxiety, depression, suicidal thoughts, and
prolonged pain, which may border on mental disorder. Another group
includes parents, especially mothers who lose their firstborn infant.
Overall, adults, particularly parents have a longing and grieving, as natural
emotional responses to a loss. However, it is acceptable that adults have
adaptive strategies of coping, since they tend to internalize the meanings
of life and realize that loss including death is inevitable. Hence, there is
coping with loss as people move forward but with a scar. The memories
are often unforgettable. Bereavement and counselling support services are
vitally important to adults, just as for children and adults. Palliative care
nurses and other healthcare providers should give careful attention to the
meanings that adults attach to the loss and provide support, particularly
social support, spiritual and effective coping mechanisms.

Grieving and Coping after a Loss: Family Caregivers
Family members experience heightened levels of psychological
distress during the period of anticipated death. The relationship
between the caregiver and the patient is highly significant such as
spouse/partner, parent, child, sibling, relative, friend or just an
acquaintance in a patient client relationship. There are the obvious
challenges associated with care of ailing patients, such as cancer and
other chronic illnesses in the family. Soon, caregiving gives way to
bereavement. In that case, there are mixed feelings with regard to
the cause of death. Nonetheless, bereaved family members often
search for new hope, meaning, and purpose in life. In all, bereaved
family members need time to construct the meaning of the person
they so much cared for upon their demise. While it is acceptable
that searching for meaning among bereaved spouses decreases with
time, other studies indicate that positive appraisal of the loss
increased with time. Yet, other studies indicate no significant effect
of time since bereavement.

Grieving and Coping after a Loss
- A noted effect of loss is separation anxiety disorder. Separation
anxiety disorder often develops after life stress, especially
following a loss (such as the death of a relative [child, parent,
sibling, friend or colleague], death of a favourite pet; an illness of
the individual or a relative; a change of schools; parental divorce;
a move to a new neighbourhood; immigration; a disaster that
involved periods of separation from attachment figures).
- Separation anxiety disorder includes an intense yearning or
longing for the deceased. This includes intense sorrow and
emotional pain (though at times it may include physical pain
such as persistent headache, constant cold as well as constant
complaints of pain in other parts of the body). There is a
preoccupation with the deceased or the circumstances of the
death. In many instances, there are (intense) fears of separation
from other attachment figures especially in children, teenagers
and older adults.

Coping after a Loss: Post-traumatic Growth
- In addition to experiencing adverse reactions to grief or negative
outcomes, positive personal changes are possible. Positive Post-
Traumatic Growth (PPTG) has been identified in many populations of
individuals who have experienced a traumatic event. The identification
of growth does not mean that distress is eliminated and, often, both
experiences, that is discomfort and growth will co-occur. Although grief
and suffering may persist, it becomes easier to manage over time.
- Potential mediators in coping with loss and bereavement and the
emergence of growth, included age, social support, time since death,
religion (faith and spiritualism), anticipation and acceptance of death as
well as the development of and active cognitive coping strategies.
Mothers in particular often continue to experience enduring sadness
though there is recognisable personal growth.
- Post-traumatic growth can manifest over five domains. These are: (1)
self-perception; (2) relating to others; (3) new possibilities; (4)
appreciation of life; and, (5) existential change.
- Still, there are experience of ongoing sadness as well as many grief
symptoms, including sorrow, anger and despair.

When you lose someone, you tend to ultimately realise
how interconnected everybody is with each other. And
certainly, you also realise that everyone is so special in
their own ways. Also, nobody can replace anyone –
everyone is unique and significant in their own special
ways.
Dr. Geoffrey Wango
The Ultimate Realisation: The Truth
About Death …

Family Involvement and Assistance during
Bereavement
Family members need to understand the importance taking part in
burial ceremonies. They must recognize that they are active
participants in the bereavement process. There are other decisions
and enactments such as care givers and other persons involved in
critical resolutions, for instance, assisting the dying. Assisted dying
is a complex decision, and mostly results from negotiations between
the patient, the physician and the family members involved. It is
significant that family members be included in clinical and
psychological consultations and the needs of both the patient and
family members are addressed. Issues must be given attention with
the same care for the patient as well as family members, as death and
dying are highly sensitive issues. Family needs are important and
there should be various interventions to support their needs in
relation to the different models of caring for the patient as well as
assisting the dying.

Coping after a Loss: Behavioural responses
that can obstruct the expression of grief
- A distinction is made between grief and a major depressive episode
(MDE); in grief the predominant effect is feelings of emptiness and loss,
while a major depressive episode is marked by persistent depressed
mood and often an inability to (accept and/or) anticipate the bliss
associated with happiness or pleasure.
- Psychologists insists that the dysphoria in grief tends to decrease in
intensity over days to weeks, months and years. This does not necessarily
imply disremembering the deceased. In the end, there occurs only the
waves, the so-called pangs of grief. Successively, these waves tend to be
associated with thoughts or reminders of the deceased. However, the
depressed mood associated with the major depressive episode is more
persistent and not tied to specific thoughts or preoccupations.
- The pain of grief may be accompanied by positive emotions and humour
as it may include good and great memories shared with the deceased.
However, major depressive episode has a characteristic marked by
pervasive desolation, unhappiness and misery.

In addition to several factors that influence the grieving process, a
person may experience bereavement challenges as a result of various
prevailing circumstances. These include:
 Sudden, unexpected event/s or loss following bereavement such
as an accident, another death, loss of a job or retrenchment.
 Lengthy illness resulting in terminal illness or death.
 Extreme loss such as death of a child, only child or a loved one,
or body function such as loss of movement or blindness.
 Perception that the event (loss or death) was preventable, for
example, homicide, accident, divorce/separation.
 Unsteady or break-up in a relationship.
 Poor or lack of intimacy with the deceased.
 Mental illness (including depression).
 Lack of social support services including non-religiousness.

- It has been noted that the thought content associated with loss and grief
generally features a preoccupation with thoughts and memories of the
deceased, rather than the self-critical or pessimistic ruminations seen in a
major depressive episode.
- Grieving is a process and in grief, self-esteem is generally preserved, whereas in
a major depressive episode, feelings of worthlessness and self loathing are
common. If self-derogatory ideation is present in grief, it typically involves
perceived failings vis-a-vis the deceased (such as not visiting frequently enough,
not telling the deceased how much he or she was loved (and valued) or not
being in time before the death). If a bereaved individual thinks about death and
dying, such thoughts are generally (positively) focused on the deceased and
possibly about ‘being linked’ with the deceased (in another world, or in future),
whereas in a major depressive episode such thoughts are focused as physical
(literally joining – a sort of piecing together that is rather delusional) and may
be extended to anticipation of death such as expression of ending one's own life
because of feeling left out, sentiment of worthlessness, expressions of
undeserving of life (hopelessness, desperation), and/or inability to cope with
the pain of loss.

Scholars are in consensus that bereavement may induce great suffering,
but it does not typically induce an episode of major depressive disorder.
Therefore, careful consideration should be accorded so as to delineate
‘normal’ sadness and ‘regular’ grief from a major depressive episode. If
and when they do occur together, the depressive symptoms and
functional impairment tend to be more severe and the prognosis is
often much worse as compared with bereavement that is not
accompanied by major depressive disorder. In the case of bereavement
following a death that occurred in traumatic circumstances (such as
homicide, accident, only child, suicide, terrorist attack), the symptoms
of acute stress disorder can involve acute grief reactions. In such cases,
a person may report re-experiencing, dissociative, and arousal
symptoms as a reaction to the loss. These include intrusive memories of
the circumstances of the individual's death, doubts that the individual
has died, and the obvious resentment about the death.

Religion and Spiritualism: Faith, Religious
affiliation and meaning making
Religion has the ability to provide influential and prevailing
meaning to life. In that case, religion and spiritualism tend to have a
lasting order in the life of a believer, and certainly, this is highly
significant when dealing with loss and grief. Religious adherence
and faith are frequently linked to good mental health, and faith is
highly acknowledged as a positive coping mechanism. Additionally,
religion is linked to good health; both physical and mental
(psychological and emotional). Persons who are religious and
adhere to a faith have been noted to possess better everyday
psychological adjustments, and greater well-being. The positive
impact of religiosity is also a basis on coping processes and mental
health. Religion can play a particularly important role in loss and
grief and bereavement where meaning (life now and in future and
our own existence) is often unclear and questions about our
existence and life are being explored.

Traditions and Cultural orientation of Death
In most traditional societies, death was discussed in invariably
dramatic lowered tones. Children could tell from the faces of the
adults that got into some soft hushed discussion that something was
terribly wrong, but you dare not listen or worse still ask what it was.
Even today, that sinister aura has not gone away entirely, though it
can be assumed that people have more information and presumably
are more knowledgeable about death. Education and information
are major ways to achieve a positive orientation to grief and
bereavement. The change in perception can be attributed to
increased information on health, illness and death. But, the
condition of death in its many forms and the word itself have been
assumed to be ill fortuned. Medicine as well as other fields such as
Psychology, Philosophy and Religion could be assumed to have
altered our ability to make meaning of life situations, including
death. There are also markedly improvement in health and medicine
including living conditions.

Bereavement

Bereavement Challenges …
The death of a loved one such as a child, spouse, parent, family member,
colleague or close friend is among the most stressful life events. Loss
through death is associated with numerous poor physical, social and
psychological outcomes. Bereaved individuals are at an increased risk
for serious physical and psychological illnesses relative to ordinary
persons (non-bereaved individuals). Bereaved individuals also often
report higher rates of healthcare utilisation, such as: (1) greater number
of visits to primary care; (2) increased incidence of stress, anxiety and
cases of depression; and, (3) higher rates of hospitalisation. Bereavement
has serious negative implications and this is noted in the fact that
bereaved individuals tend to report worse quality of life, such as
disturbed (interrupted or lack of) sleep, lack of appetite, poor
concentration, inability to recall basic information and general reduction
in effectively dealing with activities of daily living (ADL) such as taking
part in leisure (entertainment) and enjoyment activities. This can
inevitably lead to distress and declined mental health.

Bereavement Challenges and Psychological Wellness
- Bereaved individuals have recorded more visits to general health
and mental health providers than persons living more ordinary
lives (since death occurs across board and everyone has
experienced a loss). This includes use of psychotropic medication
at higher rates as compared with non-bereaved individuals.
Subsequently, it has been noted that bereaved individuals tend to
be at risk of mental disorders. In addition, bereaved individuals
are also more likely to report higher incidents of suicidal ideation
than the non-bereaved.
- Various studies aim to identify the process by which appropriate
as well as inappropriate (negative) mental health outcomes
develop following loss. For example, a number of studies suggest
that there are risk factors for Prolonged Grief Disorder (PGD),
especially after a violent loss. Yet and admittedly so, only a few of
people who have been bereaved tend to experience Prolonged
Grief Disorder (PGD).

- PGD is characterised by intense yearning for the deceased and
related impairment that persists more than six months after the
loss. PGD also predicts a host of additional health problems,
including heart disease, high blood pressure, cancer, suicide,
alcohol and substance abuse, depression, anxiety, and overall life
disruption. Increased symptoms of PGD tend to hinder meaning
making such that the bereft are unable to ‘make sense’ of the
death or its aftermath.
- Prolonged grief has been associated with increased risk for
anxiety, depression and in several instances resulted in major
depressive disorder (MDD). Major depressive disorder is linked to
suicidal ideation. Prolonged grief is also associated with worse
physical health over time, including the following: (1) more
frequent headaches; (2) flu symptoms; (3) greater pain (often
unexplained and persistent); (4) elevated systolic blood pressure;
and, (5) complicated grief.

It is estimated that between one and two people in a sample of ten
bereaved people could develop pathological or complicated grief
(CG). Complicated grief is characterised by intense and prolonged
feelings of yearning, that are accompanied by separation anxiety
symptoms and difficulties to continue living. Although complicated
grief may be more prevalent among children and adolescents due to
the missing parent, it is possible that adults too can develop
sustained longing for a loved one. This is because of the difference
in both intensity and grief reactions among bereaved persons
(children, adolescents or adults). However, it is possible that the
death of a child may lead to higher intensity than the death of a
spouse/ romantic partner, while the loss of a spouse/romantic
partner is likely to be associated with higher intensity of grief
reactions than the death of a sibling, parent, grandparent, other
relatives, friend, colleague/partner, other persons, though not
necessarily in that logical order. This may be explained from a
relationship perspective.

Violent Bereavement
- Death is challenging, but certain circumstances can make it a profoundly
challenging life event. High levels of distress are documented among
persons grieving a loss due to homicide, suicide, or fatal accident. These are
collectively referred to as violent bereavement. Persons grieving a violent
death are more likely to experience Prolonged Grief Disorder (PGD) as
compared to those grieving a non-violent death. The major explanations
offered against violent death are its uniquely disturbing features, such as
the untimeliness, the grotesque quality of the death, violation of the
deceased’s will to live and/or voluntary action on the part of the perpetrator
or the deceased to end a life.
- All these circumstances are unacceptable and may in several ways prevent
the bereft from making meaning of the death. For instance, there is the
obvious anger as well as apparent blame and in any case these feelings tend
to prolong the grieving process. Violent death becomes an event for which
there was some preparation (premeditation) and hence uncalled for, which
leads to imagined and uncalled for imagination of the violent suffering of
the dying, uncertainty and deprivation of the bereft. All these tend to
overshadow memories of the deceased’s life and hence the obvious intense
suffering on the part of the bereft.

Bereavement Challenges
There are several challenges following
bereavement including the obvious physical and
psychological adjustment following a substantial
loss. These are:
- Psychosocial
- Functional
- Psychological
- Cognitive
Psychologists need to continuously design ways
to identify intervention strategies in order to
reduce the likelihood of prolonged grief.

Bereavement involves a loss. There are several
psychosocial challenges following
bereavement, including the obvious financial
burden, directly or indirectly including the
monetary crisis following a prolonged illness.
The deceased may have been the sole
breadwinner such as a parent. Additionally,
there is the obvious pressure to ‘move on.’
Sometimes the bereaved individual is getting
ready or learning to cope with the loss,
including socialising as a single person within
a social network of couples or getting
acquainted with someone dear to them.
Psychosocial challenges greatly impede
adjustment in the wake of a significant
interpersonal loss.
Psychosocial
Functional
Psychological
Cognitive
3/3/2018
76

There are also functional challenges.
This may include the assumption of
new responsibilities that had been
performed by the deceased (such as
parenting the child, taking child/ren to
and through school, housing, cooking,
role as both father and mother,
parenting role for a child).
Psychosocial
Functional
Psychological
Cognitive
3/3/2018
77

Psychological challenges have been
noted following bereavement. These
include identity conferred by the
relationship with the deceased (single
without a spouse/partner) as well as
the financial implications.
Psychological challenges can prove a
big barrier to bereavement
adjustment.
Psychosocial
Functional
Psychological
Cognitive
3/3/2018
78

Cognitive challenges such as negative
beliefs about the self, others, and
one’s own grief are associated with
worse mental health in bereaved
individuals. Understanding how these
challenges relate to bereaved
individuals’ physical and mental
health has significant clinical
implications.
Psychosocial
Functional
Psychological
Cognitive
3/3/2018
79

Tops
Tips

Loss and grief are among the most pervasive
challenges of our time. Death is not confined
to any age, gender, group or community.
Children and young people, the sick and the
aged as well as persons already in distress are
particularly vulnerable to grief and
bereavement. In the face of such threats,
various people need relevant and timely
assistance in order to develop the knowledge,
skills and (positive) attitudes that can help
them build their resilience to distress. These
competencies can be developed with the
acceptance of loss as well as identification of
various intervention strategies to deal with
loss and grief.

 Healing is a process. Time allows us to
heal. This is because it gives us an
opportunity to resolve the range of
feelings that immediately surface after a
sudden event such as loss.
 However, there is no actual time limit to
the grieving process. Each individual,
depending on the loss and
circumstances takes their own time.
 It is significant to note that grieving
should not go on forever. Again, this
will depend everyone’s personality and
situation and this in turn defines the
healing process.

 Allow adequate time to experience thoughts
and feelings openly to self. Depending on the
loss, you can take a break (or even a holiday).
 Acknowledge and accept your feelings, both
positive and negative. This enables you to
process your thoughts appropriately.
 Develop stress management techniques to deal
with life issues including loss.
 Confide in a trusted individual; tell the story of
the loss in your own time and at your pace.
 Express your feelings openly to a person you
can trust. Crying offers a release (it is also not
compulsory for you to cry. Likewise, it is not a
weakness. Also, avoid crying or mourning
endlessly).
 Forgive if the loss particularly death involves
someone and you are bitter with them.

 Leisure and exercises greatly help to reduce
distress. Take up interesting activities in life such
as your family and/or hobbies (such as games /
sports, cooking / baking, taking a walk or
gardening) to minimise loneliness and apathy. You
can include additional activities such as:
swimming, gym and other recreational activities,
reading a book / magazine / favourite column,
listening to music, watching your favourite
programme or movie) or going out for a picnic.
 Prayer and scriptures can help immensely in
several instances.
 In all, identify any unfinished businesses in your
life and try to come to an amicable resolution.
 Various (appropriate) support groups (formal and
informal) provide an opportunity to share grief
with others who have experienced similar loss.
 If the healing process becomes too overwhelming,
seek professional help.

 Allow yourself to grieve through several
activities such as looking at pictures,
playing nostalgic music, and reading old
letters.
 Use music and dance as a way of
expressing your feelings.
 Use poetry/reading of books.
 Read a spiritual book to nourish
yourself.
 Use painting/drawing to express your
feeling.
 Funerals, ceremonies, and rituals help
people with the grieving process.

Loss, grief and bereavement is a complex process. It is necessary to
recognise that there are several limitations in the adjustment process. First,
cross-sectional studies often include a sample of persons, and it is not
possible to generalise the results to other persons across age, gender and
cultures. Secondly, there are other significant factors such as understanding
of loss, as well as social support services. This includes therapeutic
services and persons in the more developing countries may be highly
deprive different healthcare conditions, the availability of medical resources
and the access to different treatment regimens. Thirdly, many scholars fear
that it is possible that there is an over-reporting of therapeutic services and
that other factors such as religion (spiritualism/faith) and culture are much
more significant. Finally, several studies have only been conducted in
specialised clinics such as in cases of cancer which makes it possible to
gather detailed and updated information, but not possible in other
circumstances. Additionally, medication and other behaviours such as the
overall grieving process require to be integrated in future studies. Ultimately,
we must identify healthy ways of coping with loss and grief and these
should be personalised reflecting individual differences.

References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders
DSM - 5. Washington, D C: American Psychiatric Association.
Anderson, K. L., & Dimond, M.F. (1995). The experience of bereavement in older adults. Journal of
Advanced Nursing, 22, 308 - 315.
Andriessen, K., Draper, B., Dudley, M., & Mitchell, P. B. (2016). Pre-and post loss features of
adolescent suicide bereavement: A systematic review. Death Studies, 40, 229 - 246.
Asai, M., Akizuki, N., Fujimori, M., et al. (2013). Impaired mental health among the bereaved
spouses of cancer patients. Psychooncology, 22, 995 - 1001.
Balk, D. E. (2014). Dealing with dying, death, and grief during adolescence. New York: Routledge.
Becker, E. (1973). The denial of death. New York: Free Press.
Bone, R. C. (1997). Benediction: A farewell to my medical colleagues. Consultant, 37 (9), 2505 -
2507.
Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human
capacity to thrive after extremely aversive events? American Psychologist, 59, 20 - 28.
Buckley, T., Spinaze, M., Bartrop, R., et al. (2015). The nature of death, coping response and
intensity of bereavement following death in the critical care environment. Aust Critic Care, 28, 64 -
70.

References
Burns, D. M. (2010). When kids are grieving: Addressing grief and loss in school. California:
Corwin.
Byock, I. (2002). The Meaning and Value of Death. Journal of Palliative Medicine, 5 (2), 279 - 288.
Calhoun, L. G., & Tedeschi, R. G. (2013). Posttraumatic growth in clinical practice. New York:
Routledge.
Calhoun, L. G., Tedeschi, R. G., Cann, A., & Hanks, E. A. (2010). Positive outcomes following
bereavement: Paths to posttraumatic growth. Psychologica Belgica, 50, 125 - 143.
Cook, J., Gold, S., & Dalenberg, C. (Eds.), (2016). APA handbook of trauma psychology.
Washington, DC: American Psychological Association.
Corr, C. A., Nabe, C. M., & Corr, D. M. (2000). Death and dying, life and living. Belmont, CA:
Wadsworth.
Dowdney, L. (1999). Childhood bereavement following parental death. Journal of Child Psychology
& Psychiatry, 7, 819 - 830.
Dowling, M., Kiernan, G., & Guerin, S. (2007). Responding to the needs of children who have been
bereaved: A focus on services in Ireland. The Irish Psychologist, 33, 261 - 262.
Field, N. P., Gao, B., & Paderna, L. (2005). Continuing bonds in bereavement: An attachment
theory based perspective. Death Studies, 29, 277 - 299.

References
Firestone, R. E., & Catlett, J. (2016). Beyond death anxiety: Achieving life-affirming death
awareness. New York: Springer Publishing Company.
Glickman, K., Shear, M. K., & Wall, M. M. (2017). Mediators of outcome in complicated grief
treatment. Journal of Clinical Psychology, 73, 817 - 828.
Kastenbaum, R. J. (1997). Death, society, and human experience (7th Ed.). New York: Merrill.
Kramer, K. (2005). ‘You cannot die alone: Dr. Elisabeth Kübler-Ross’ (July 8, 1926–August 24,
2004). OMEGA-Journal of Death and Dying, 50 (2), 83 - 101.
Kübler-Ross, E. (1969). On death and dying. New York: MacMillan.
Kübler-Ross, E. (2009). On death and dying: What the dying have to teach doctors, nurses, clergy
and their own families. Taylor & Francis.
Kübler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of grief through
the five stages of loss. New York: Scribner.
Li, J., Johansen, C., Hansen, D., & Olsen, J. (2002). Cancer incidence in parents who lost a child: A
nationwide study in Denmark. Cancer, 95, 2237 - 2242.
Li, J., Stroebe, M., Chan, C.L., & Chow, A.Y. (2014). Guilt in bereavement: A review and conceptual
framework. Death Studies, 38, 165 - 171.

References
Mallon, B. (2011). Working with bereaved children and young people. London, England: SAGE
Publications Ltd.
Milman, E., Neimeyer, R. A., Fitzpatrick, M., MacKinnon, C.J., Muis, K.R., & Cohen, S.R. (2017).
Prolonged grief symptomatology following violent loss: the mediating role of meaning, European
Journal of Psychotraumatology, 8, sup 6, 1503522,
Mikulincer, M., Florian, V., & Tolmacz, R. (1990). Attachment styles and fear of personal death: A
case study of affect regulation. Journal of Personality and Social Psychology, 58, 273 - 280.
Mostofsky, E., Maclure, M., Sherwood, J. B., et al.: (2012). Risk of acute myocardial infarction after
the death of a significant person in one’s life: The Determinants of Myocardial Infarction Onset
Study. Circulation, 125, 491 - 496.
Neimeyer, R. A. (Ed.). (2012). Techniques of Grief Therapy. New York: Routledge.
Neimeyer, R. (2016). Meaning reconstruction in the wake of loss: Evolution of a research program.
Behaviour Change, 33 (2), 65 - 79.
Neimeyer, R. A., Klass, D., & Dennis, M. R. (2014). A social constructionist account of grief: Loss
and the narration of meaning. Death Studies, 38, 485 - 498.
Perlman, L. A., Wortman, C. B., Feuer, C. A., Farber, C. H., & Rando, T. (2014). Treating traumatic
bereavement: A practitioner’s guide. New York: Guilford.

References
Plaut & Roark (2004). ‘Grief Process, Death and Dying.’ [PowerPoint Presentation].
https://www.slideserve.com/miles/grief-process-death-and-dying Uploaded 17/12/2017.
Root, B. L., & Exline, J. J. (2014). The role of continuing bonds in coping with grief: Overview and
future directions. Death Studies, 38, 1 - 8.
Routledge, C., & Juhl, J. (2010). When death thoughts lead to death fears: Mortality salience
increases death anxiety for individuals who lack meaning in life. Cognition and Emotion, 24, 848 -
854.
Steger, M.F., Frazier, P., Oishi, S., & Kaler, M. (2006). The meaning in life questionnaire: Assessing
the presence of and search for meaning in life. Journal of Counseling Psychology, 53, 80 - 93.
Stroebe, M., Schut, H., & Stroebe, W. (2007). Health outcomes of bereavement. Lancet, 370: 1960
- 1973.
Tedeschi, R., & Calhoun, L. (2008). Beyond the concept of recovery: Growth and the experience of
loss. Death Studies, 32, 27 - 39.
Thompson, B. E., & Neimeyer, R. A. (2014). Grief and the expressive arts: Practices for creating
meaning. New York: Routledge.
Trisel, B. A. (2015). Does Death Give Meaning to Life? Journal of Philosophy of Life, 5 (2), 62 - 81.

References
van der Kloot Meijburg, H. H. (2005). The significance of dying well. Illness, Crisis & Loss, 13 (1),
49 - 62.
Van Manen, M. (2016). Phenomenology of practice. New York: Routlege.
Wheeler, I. (2002). Parental bereavement: The crisis of meaning. Death Studies, 25, 51 - 66.
Wong, P. T. P. (Ed.) (1998), The human quest for meaning: Theories, research, and applications.
New York: Routledge.
Yalom, I. D. (1980). Existential psychotherapy. New York: Basic Books.
Yalom, I. D. (2008). Staring at the sun: Overcoming the terror of death. San Francisco, CA: Jossey-
Bass.
Yalom, I. D., & Lieberman, M. A. (1991). Bereavement and heightened existential awareness.
Psychiatry, 54, 334 - 345.
Ylitalo, N., Valdimarsdottir, U., Onelov, E., et al. (2008). Guilt after the loss of a husband to cancer:
Is there a relation with the health care provided? Acta Oncologica, 47, 870 - 878.
Zhang, W., Wang, A-n., Yao, S-y., Luo, Y-h., LiZ-h, Huang, F-f., et al. (2016). Latent Profiles of
Posttraumatic Growth and Their Relation to Differences in Resilience among Only-Child-Lost
People in China. PLoS ONE 11 (12): e0167398.

'Loss, Grief and Bereavement Coping with Loss and Grief'

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Similar a 'Loss, Grief and Bereavement Coping with Loss and Grief'

Similar a 'Loss, Grief and Bereavement Coping with Loss and Grief' (12)

Más de Dr Wango Geoffrey

Más de Dr Wango Geoffrey (10)

Último

Último (20)

'Loss, Grief and Bereavement Coping with Loss and Grief'