“Theory affects the work of practitioners in the area of loss to varying degrees. Some are quite ignorant of theory and work almost exclusively from personal instinct and experience; others find that theory guides significantly their approach to dealing with loss, attitudes towards those for whom they care, communication with other practitioners, and the interventions employed in situations of loss. Different theoretical positions that have evolved throughout the 20th century have contributed positively to the knowledge and work of practitioners in the area of loss.
However, while recognizing potential benefits provided by theory, it is important to also recognize the potential negative effects of strict adherence to a particular theoretical position in this work in the area of loss. Hence it may be the use of theory, rather than theory alone, that we must consider more carefully in improving the care of those facing loss”. Throughout the 20th century theoretical models of loss and grief have been based predominantly on bereavement (Murray, 2003).
However, studies have found that the personal experience of bereavement does not always follow the precepts of theoretical models (Silverman & Klass, 1996). Furthermore, “in the field of death and dying, loss is the central topic” (Harvey & Weber, 1998, p. 321) and loss and grief has also been associated with a broad range of tangible and intangible losses (Maguire & Parkes, 1998, Parkinson, 1997; Lenhardt, 1997; Solomon, 1997).
Researchers have pointed out the inadequacy of the dominant theoretical models to address the broad range of factors associated with loss and grief (Stroebe, Schut & Finkenauer, 2001; Green, 2000) and proposed alternative theories (Moos, 1995). However it has been argued that many theoretical models merely present a different facet of the grief response (Stroebe & Stroebe, 1987a). The purpose of this paper is to explore theoretical perspectives on loss and grief and their significance when developing a practice framework for working with people experiencing loss and grief.
139 Two of the dominant models of grief have been Freud’s psychodynamic perspective and Bowlby’s attachment theory (Barbato & Irwin, 1992; Stroebe & Stroebe, 1987b). Freud pointed out in his paper on “Mourning and Melancholia” (1917) that mourning enables the individual to withdraw their feelings or libido invested in the lost object and make these feelings available for other relationships (Skolnick, 1979).
However, the bereaved needed to “work through” intrapsychic conflicts such as their attachment to the lost object, inhibitions about becoming a person separated from the lost object, and conflicts of ambivalence over the lost object (Murray, 2003). Grief work is successful when the bereaved person has detached their libido’s energy to the lost object, along with every single one of the memories and situations of expectancy that bound the object to the ego, through the psychological process of “hypercathexis” and then “decathexis” (Raphael, 1984).
The concept of “working through” the grief, central to Freud’s theory (Murray, 2003), was designed to help the bereaved gain insight (both intellectual and emotional) and bring repressed material to the surface so that it can be dealt with consciously (Corey, 1996). 200 Freud (1917) viewed grief as a normal psychological function that freed the individual of ties to the deceased however pathological or morbid grief reactions could arise if the person’s feelings towards the deceased were ambivalent (Barbato & Irwin, 1992).
“The hostile side of the ambivalence towards the lost object becomes directed inwards against the bereaved person’s own ego resulting in depression” (Murray, 2003, p. 54). According to Freud, clinical depression was the only form of pathological grief, a point he revised in later years, however it has been argued that by focusing on only one form of pathological grief Freud offered a limited theory of pathological reactions to loss (Stroebe & Stroebe, 1987a).
However, since Lindemann’s (1944) description of acute grief as a constellation of “symptoms” that constitutes a syndrome (a significant factor in the development of disease models of grief) there has been further research, albeit hindered by the lack of semantic agreement and consensual validation (Rando, 1992-93), supporting the occurrence of pathological grief reactions such as delayed grief, chronic grief, absent grief, unresolved grief and inhibited grief (Middleton et al. , 1991, cited in Middleton, Raphael, Martinek & Misso, 1993) which appears similar to Doka’s (1989) disenfranchised grief.
The concept of grief work, and Freud’s emphasis on the bereaved severing bonds with the deceased, has also been questioned (Wortman & Silver, 2001). Wortman and Silver’s (2001) conclusion as to the importance of grief work appears somewhat ambiguous. They discuss the findings of several studies on the outcome of grief work to support their argument and then suggest that these same studies may not have been methodologically sound. Furthermore, they believe that two programs used to work through trauma hold great promise for application to bereaved individuals.
Stroebe, Van Der Bout and Schut (1994) did note that the benefits of grief work had not been confirmed empirically and that there was good reason to doubt that they were as beneficial as theorists and clinicians assume. Wortman and Silver (2001) do however appear to provide indisputable evidence that maintaining bonds with the deceased is common. It should be noted that Wortman and Silver state that Freud emphasized the importance of breaking down, not severing, the affective bonds to the deceased.
Steiner argued that Klass and Silverman (1996) were guilty of the literal interpretation of the word “reality”. In the Freudian sense, it is the reality of the loss, not the reality of the person, and as the reality of the loss is applied the painful recognition of what belongs to the object and what belongs to the self is differentiated and in the process the lost object is seen more realistically. This may be a plausible argument given that there is no evidence to suggest that Freud instructed the bereaved not to attend the gravesite of the deceased. Freud’s approach has also been criticized bereaved.
have misinterpreted Freud’s , albeit a positive or negative The debate of Freud’s emphasis on the bereaved severing the bonds with the deceased has also been suggestion that they It seems that they don’t agree with the Furthermore, question the offer a plausible working through article Stroebe, Van Der Bout and Schut (1994) ) that Studies reviewed by Wortman and Silver (2001) on the effects of “working through” grief reported mixed results were criticism of “working through” came to the conclusion that current methods that it found working through lsuggest that working throucentral to Freud’s theory (Murray, 2003) has also been challenged along with the emphasis on the bereaved severing bonds with the deceased (Silverman & Klass, 1996).
Freud concept of working throughhas also been challenged on the need for bereaved individuals to “work through” until Lindemann (1944) referred to grief as a “definite syndrome with psychological and somatic symptomology: (Stroebe & Stroebe, 1987a). has been It should be noted however that it wasn’t until Lindemann classic study on the Coconut Grove disaster (27years later) that symptomatic reactions to bereavement became categorized into , 1944 that pathological grief reactions such as acute, . Freud’s psychodynamic approach to mourning , and his use of the normal/pathological dichotomy, was did not distinguish between bereaved individuals who experienced grief due and those confronted with sudden unexpected circumstances, bereavement due to traumatic events (e. g. , murder).
Suffering from consider the possibilities of Freud’s (1917) concept of “working through” one’s grief has had a persistent influence on subsequent theories and therapeutic interventions (Stroebe & Stroebe, 1987b), especially in relation to traumatic events (Parkinson, 1997, 2000) Solomon,1997). Freud also identified the role of psychological defense mechanisms (e. g. , denial) associated with pathological grief, and the significance of ambivalence towards pathological grieving, a point noted by other theorists such as Bowlby (1960), and Parkes (1972) (Small, 2001). Freud’s approach to grief, the normal/pathological dichotomy, failed to account for It has, however, been argued that not everyone Freud’s approach could have misdiagnosed did not demarcate.