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Part of the “Enhancing Prostate Cancer Care” MOOC 
Catherine Holborn 
Senior Lecturer in Radiotherapy & Oncology 
Sheffiel...
Introduction 
People living with and supporting people with prostate 
cancer may experience many different emotions 
thro...
Grief - not a new phenomenon 
'Well everyone can masters grief, but he that has it' 
Much Ado about Nothing 
Shakespeare...
Walter (1999) On Bereavement: 
The Culture of Grief 
Grief is like sex. It can be done on your own, it is best 
done with...
Bowlby's Theory of Attachment 
Bowlby a psychiatrist 
Important to understand this theory before 
comprehending the impa...
Theory of Attachment (1980) 
Originally concerned the attachment between a mother 
and child
Theory - Parkes (2006) 
When a child is separated for more than a few minutes 
from their mother the following reactions ...
Despair 
Feelings of hopelessness
Detachment 
May seem as though the child has recovered, but he/she 
has withdrawn from surroundings 
Not playing with ot...
Relevance to loss and grief 
There is no loss without an attachment. 
Sometimes a person may not know how much they were...
Facilitating Loss and Bereavement 
Before being able to explore the loss experience of a carer 
prior to the death of a l...
Individual reactions to loss and bereavement 
(Woodhouse, 2011, Worden, 2009) 
Feelings 
ANXIOUS, ANGRY, BITTER, DEVASTA...
Cont... 
Behaviours 
CRYING/WAILING/SHOUTING,WITHDRAWAL,ANGER/VI 
OLENCE, REGRET, EUPHORIA, RELIEF, BEING 
PRACTICAL,BEC...
Facilitating Grief 
How may we respond to people who are experiencing a 
loss or bereavement? 
The next slides give some...
Worden's Tasks of Mourning 
(2009) 
Task I: To accept the reality of the loss 
This can be very difficult to achieve 
G...
Task II: To process the pain of grief 
Give the newly bereaved person the opportunity to express 
how they are feeling if...
Task III: To adjust to a world 
without the deceased 
This is a more practical task although new activities can 
be diffi...
Task IV: To find an enduring connection with 
the deceased in the midst of embarking on a 
new life 
Visit the cemetery a...
The Dual Process Model of Coping 
with Loss (Stroebe and Schut, 2008) 
As a result of their research, these authors found...
The Dual Process model of coping with 
loss Stroebe and Schut (2008) cont... 
Loss Oriented 
Grief work 
Intrusion of g...
Biography of Grief, Walter 1996 
Walter challenges the dominant contemporary model of 
grief, which he believes to be the...
How may this be facilitated? 
By talking about the person who has died, or if a loss, 
what it means to the person 
Look...
And finally 
We have only just touched on the complex aspects of 
loss and bereavement. If you want to learn more about 
...
References 
 HARRIS T (2009) John Bowlby revisited - a retrospective review Bereavement Care 28(1) 
 MACHIN L (2006) The...
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Loss and bereavement

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An overview of the theories and practice principles relating to loss and bereavement. Content has kindly been provided by Barbara Beard, senior lecturer at Sheffield Hallam University, specialising in supportive and palliative care.

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Loss and bereavement

  1. 1. Part of the “Enhancing Prostate Cancer Care” MOOC Catherine Holborn Senior Lecturer in Radiotherapy & Oncology Sheffield Hallam University
  2. 2. Introduction People living with and supporting people with prostate cancer may experience many different emotions throughout their journey and react in a way that is different from how they would usually. This presentation highlights some of the theories surrounding loss and bereavement, but always remember that everyone's grief is individual.
  3. 3. Grief - not a new phenomenon 'Well everyone can masters grief, but he that has it' Much Ado about Nothing Shakespeare (1564 -1616)
  4. 4. Walter (1999) On Bereavement: The Culture of Grief Grief is like sex. It can be done on your own, it is best done with other people and is disapproved of if done in public’. Talking about dying is not an easy subject. If you are facilitating another person's grief you have to be able to hear and acknowledge what they are saying.
  5. 5. Bowlby's Theory of Attachment Bowlby a psychiatrist Important to understand this theory before comprehending the impact of loss and bereavement on individuals (Worden, 2009) Theory developed nearly 40 years ago but still relevant (Harris, 2009)
  6. 6. Theory of Attachment (1980) Originally concerned the attachment between a mother and child
  7. 7. Theory - Parkes (2006) When a child is separated for more than a few minutes from their mother the following reactions occur Protest - may be exhibited by crying
  8. 8. Despair Feelings of hopelessness
  9. 9. Detachment May seem as though the child has recovered, but he/she has withdrawn from surroundings Not playing with other children Not seeking attention
  10. 10. Relevance to loss and grief There is no loss without an attachment. Sometimes a person may not know how much they were attached to e.g. a part of the body, fertility, sexual activity or person until it has been taken away. The theory can be applied to experiences in adult life. For example, an adult may avoid or deny the reality of the situation (Walsh, 2012).
  11. 11. Facilitating Loss and Bereavement Before being able to explore the loss experience of a carer prior to the death of a loved one or the person's own death, consider the following about your own mortality. Also, it is useful to know about the different reactions people may experience in relation to their loss or bereavement. Sometimes people may feel they are 'going mad' so understanding that these are 'normal' grief reactions can be helpful. Worden (2009) uses 4 different categories to explore these reactions. A person may experience some of the following...
  12. 12. Individual reactions to loss and bereavement (Woodhouse, 2011, Worden, 2009) Feelings ANXIOUS, ANGRY, BITTER, DEVASTATED, RESENTFUL, EMPTY, INFERIOR, GUILTY, REMORSE, HAPPY, HIGHTENED SEXUALITY, ABANDONED, RELIEVED, EMOTIONAL MOOD SWINGS, EXAUSTED, USELESS, FRUSTRATION, HELPLESS, LOST IDENTITY, MISUNDERSTOOD Cognitions QUESTIONING, CHAOTIC THINKING, INABILITY TO COPE WITH DECISION MAKING, LOSS OF USUAL ABILITIES, FEAR, ISOLATION, MEMMORY LOSS, IRRATIONALITY, LOSS OF FOCUS, CONSCIENCE
  13. 13. Cont... Behaviours CRYING/WAILING/SHOUTING,WITHDRAWAL,ANGER/VI OLENCE, REGRET, EUPHORIA, RELIEF, BEING PRACTICAL,BECOME HYPERACTIVE/LETHARGIC, SEARCHING Physical Sensations APPETITE CHANGES, DIGESTIVE DISORDERS, SLEEP DISTURBANCE, EXAUSTION, NUMBNESS, BREATHLESSNESS, HEADACHE, CHEST CONSTRICTION, MORE PRONE TO INFECTION, MIRROR SYMPTOMS OF PERSON WHO HAS DIED, LETHARGY, CRYING, PAIN, HAIR LOSS; CHILDREN – REGRESSIVE BEHAVIOUR e.g. SOILING, ENURESIS
  14. 14. Facilitating Grief How may we respond to people who are experiencing a loss or bereavement? The next slides give some models that can be utilise to aid this process
  15. 15. Worden's Tasks of Mourning (2009) Task I: To accept the reality of the loss This can be very difficult to achieve Give the person shortly to be bereaved the opportunity to be with the person who is dying. If possible, inform the person that death is approaching Have a chair near the bed so that they can sit with the person who is dying or has just died Give them the opportunity to hold the person e.g. their hand, kiss the person who has died, hold them in their arms Stay as long as they wish or is practicable Give them the opportunity to see the person who has died between death and the funeral Use the terms e.g. 'has died', rather than euphemisms for death e.g. passed away Talk about the person who has died in the past tense
  16. 16. Task II: To process the pain of grief Give the newly bereaved person the opportunity to express how they are feeling if they wish to To do the above, you need to be able to hear and acknowledge what the person is saying by using communication skills e.g. empathy Give them the opportunity to cry, show anger, shout etc... if they wish to Facilitate them to talk about the death, the funeral, what its like now for them A tissue sometimes gives permission to cry Although painful talking about what arrangements need to be made can help facilitate this task
  17. 17. Task III: To adjust to a world without the deceased This is a more practical task although new activities can be difficult. Enable the bereaved person to make their own decisions and do what is right for them Make new friends Learn a skill that the person has never done before Take on activities that the deceased person has previously done e.g. financial issues, cooking a meal Choose to go on holiday to a new place Allow self to laugh or have a good time without feeling guilty
  18. 18. Task IV: To find an enduring connection with the deceased in the midst of embarking on a new life Visit the cemetery as part of other activities Be able to include mentioning the deceased person in conversations Share experiences of the deceased person with new acquaintances Allow time to think about the deceased person Develop new activities
  19. 19. The Dual Process Model of Coping with Loss (Stroebe and Schut, 2008) As a result of their research, these authors found that people oscillated between the emotional aspect of grief and a more restorative approach Therefore they recommend that the bereaved can be supported in doing just this Wilson (2014) acknowledges that this is a useful model for practitioners
  20. 20. The Dual Process model of coping with loss Stroebe and Schut (2008) cont... Loss Oriented Grief work Intrusion of grief Breaking bonds/ties Denial/avoidance of restoration changes Restoration oriented Attending to life changes Doing new things Distraction from grief Denial/avoidance of grief New role New identities or relationships
  21. 21. Biography of Grief, Walter 1996 Walter challenges the dominant contemporary model of grief, which he believes to be the working through of emotion, with the eventual goal of being able to move on and live without the deceased. By analysing his own experience of loss, and drawing from recent related research, he suggests an alternative, more sociological model. Survivors typically want to talk about the deceased, particularly to those who knew the person. Together they are then able to construct a story which places the dead person within their lives, and is, thus, able to endure through time.
  22. 22. How may this be facilitated? By talking about the person who has died, or if a loss, what it means to the person Looking at photographs of the deceased Sharing happy and sad times  Responding to the bereaved when they broach the subject of the person who has died, rather than changing the subject.
  23. 23. And finally We have only just touched on the complex aspects of loss and bereavement. If you want to learn more about this important, but often neglected area, or other aspects of supportive and palliative care; please contact me at; b.a.beard@shu.ac.uk for more details about a MSc modules in this area
  24. 24. References  HARRIS T (2009) John Bowlby revisited - a retrospective review Bereavement Care 28(1)  MACHIN L (2006) The landscape of loss Bereavement Care 25(1): 7-11  STROEBE MARGARET, SCHUT, HENK (2008) The dual process model of coping with bereavement: overview and update Grief Matters 11(1): 4-10.  STROEBE M, STROEBE W, SCHUT H (2003) Does ‘grief work’ work? Bereavement Care 22(1): 3- 5  STROEBE M, SCHUT H (1999) The dual process model of coping with bereavement: rationale and description Death Studies 23:197-224  STROEBE M, SCHUT H (1998) Culture and grief Bereavement Care 17(1): 7- 11  TONKIN L (1996) Growing around grief – another way of looking at grief and recovery Bereavement Care 1591): 10  WALTER T (1996) A new model of grief: bereavement and biography Mortality 1(1): 7- 24  WALSH Katherine (2012) Grief and Loss - Theories and skills for the helping professions, London, Pearson  WILSON, John (2014) Supporting people through loss and grief - an introduction for counsellors and other caring practitioners. London, Jessica Kingsley  WOODHOUSE, Jan (2011) Loss, grief and bereavement in (Eds) Moyra Baldwin and Jan Woodhouse, Key Concepts in Palliative Care, London, Sage  Worden W (2009) Grief Counseling and Grief Therapy: a handbook for the mental health practitioner 4th Ed. Hove, Brunner-Routledge

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