“Grief is like a long valley, a winding valley, where any bend may reveal a totally new landscape.”

C.S. Lewis, A Grief Observed

In this, our final post in the Grief & Loss series, we consider what might be regarded as “personalised” approaches to the subject.

New Approaches to Grief

In recent times, there has been a significant move away from structured models of grief towards more personalised perspectives, and it is now increasingly acknowledged that that the idea of completely ‘letting go’ of a loss can indeed be unhelpful.  As Attig has pointed out, letting go of a loved one can be partial, in so far as “we still hold the gifts they gave us, the values and meanings we found in their lives. We can still have them as we cherish their memories and treasure their legacies in our practical lives, souls and spirits” (Attig, 2000, xii)¹.

The Dual Process Model of Grief

The first of the new approaches to grief was what is termed the ‘Dual Process’ or ‘Oscillation Model’ of grief, developed by Stroebe and Schut (1999)².

Arguing for a need to identify and cope with specific stressors associated with loss, Stroebe and Schut identify two categories of stressor, which require coping responses in situations of loss:

• A loss-oriented coping style. This focuses on the loss of the loved one (a grief work approach), a yearning for what is gone, or of crying about the absence. There can be a wide range of associated emotional experiences, from despair and suffering, to pleasurable reminiscing, or even painful longing.
• A restoration-oriented coping style. This focuses on dealing with problems occasioned by the loss, and on developing new activities in the absence of the loved one – reorganising life on one’s own. Emotional responses involved can range from anxiety and fear of what lies ahead, to pride and relief in new achievements, to the despair of aloneness amid the void of absence.

A central component of the Dual Process model is the idea of ‘Oscillation’ – a back-and-forth dynamic process, wherein the grieving individual will at times be confronted by their loss, while at other times “they will avoid their memories, be distracted, or seek relief by concentration on other things” (Stroebe and Schut, 1999, 215 -16).

In contrast to the classic grief work (cathartic) formulations, which warn against the dangers of denial, these authors postulate that the oscillation process, is necessary for optimal adjustment to loss over time.  This approach requires the grieving individual to occasionally take “time off” from the grieving process, by voluntarily suppressing, or involuntary repressing, thoughts or feelings that may occasionally be too painful to confront. However, arguing for a dual process “dosage” approach to grieving, the authors also posit the need for meaningful engagement with the loss, citing supportive evidence to suggest that “it may be impossible to avoid grieving unremittingly without severe costs to mental and physical well-being” (Stroebe and Schut, 1999, 216).

Finally, at its core the Dual Process approach envisages grieving persons moving between the two processes of loss and restoration as they mourn their loss, with a focus on continuing to nurture symbolic connections with the deceased person as a form of ongoing attachment and as a means of honoring what remains in the memory.

Walter’s Sociological Approach to Grief

Recognising that grieving is both a social and personal process, Tony Walter (1996, 1999) argues that grieving persons often wish to talk about their losses and to construct stories that embed the losses experienced within their lives³. In doing so, grieving individuals strive to engage in conversations with others around the subject of the loss, so as to build a durable personal biography, in which the memory of the loss is integrated into their on-going lives.

Walter argues that grief is a highly personalised experience in which we internalise our loss through our life narrative, as “part of the never-ending and reflexive conversation with self and others through which we try to make sense of our existence” (Mallon, 2008, 13)⁴.  This approach acknowledges the fact that while our past is deeply woven into our present, that present is in a constant state of flux in which everything is changing and in which there is no ‘normal’ world to return to following the experience of a loss. On the contrary, Walter argues that our relationship with a loss provides legacy opportunities, in which the purpose of grief becomes one of enabling us to enrich our personal biographies by integrating our memories of the loss into our on-going lives.

Neimeyer’s Constructivist Approach

Another recent approach to grief has been put forward by Robert Neimeyer (1998, 1999)⁵.  Neimeyer argues that grief is not just a private process of dealing with loss in our lives, but rather a social means of meaning making, involving the restoration of coherence to the narrative of our lives. Neimeyer’s approach is a constructivist one, which envisages our lived “assumptive world” as being personally narrated out of our own resources – psychological, cognitive, emotional, social, and cultural.

Neimeyer argues that meaning re-construction is the central process in grieving.  He identifies several common features of contemporary approaches to grief and loss:

• A scepticism about the universality of structured responses to loss, coupled to an appreciation of the complexity of human adaptation
• A move away from the belief that successful grieving requires “letting go” of the loss, towards a recognition of the value of integrating symbolic bonds to the loss in a healthy way
• A focus on understanding the implications of loss on the individual’s sense of identity and meaning
• A recognition of the potential for “post-traumatic growth” in the absence of the loved one
• A broadening focus of attention beyond individual grievers, towards the impact on wider family and social systems

In summary, the constructivist model argues that there is no single universal pathway of grief, but rather a myriad of ways by which we respond to loss by re-constructing meaning in our lives and by weaving the loss into our altered lives.  The approach posits that each person’s response to loss is as unique as their own personal story, and notes that “The narrative themes that people draw on are as varied as their personal biographies, and as complex as the overlapping cultural belief systems that inform their attempts at meaning making” (Quoted in Mallon, 2008, 11).

Counselling Implications

As identified above, the assumption that most people respond to losses in their lives in ‘typical’ psychological and emotional ways is now seriously questioned. The contemporary view emphasises uniqueness over universality in human response to “similar” loss.

The challenges then for counselling with those experiencing grief and loss are:

• To acknowledge that the ways individuals attribute significance in their lives will be infinitely varied
• To enable each individual to assume “authorship over the narratives of their lives” (Neimeyer, 1999, 76)
• To facilitate clients in an active process of both grieving and of restoration, so as to be able to re-engage with both their personal and social lives (Stroebe and Schut, 1999), and
• To assist grieving individuals “in identifying the many choices they confront in revising their life narratives and then helping them to sift through their options and make difficult decisions” (Neimeyer, 1999, 68)

Conclusions

In this series of articles, have seen that loss occurs in many forms throughout our lives, and that the way we react to loss as individuals, is determined by many factors, life experience, attachment patterns, the culture and the social structure in which we live.

A part of the work of a counsellor can be to assist a client in viewing the different parts of themselves and assisting the client to integrate these parts.  This also includes integrating any loss experienced by the client.

Theories about loss need to be “held lightly” by the counsellor.  To do this, it may be useful to sit with a new client from a position of ‘not knowing’ and to begin from there.  However, a person is feeling and behaving, is exactly how they need to feel and behave, in order to make the loss a part of their lives.  Therefore, by viewing the person as a whole, and by respecting their individuality, culture and race, a new theory can be formed for each person.

In terms of Grief and Loss, death is the ultimate universal struggle, and as writer, psychoanalyst and sociologist Erich Fromm observed, “There is only one way – taught by the Buddha, by Jesus, by the Stoics, by Master Eckhart – to truly overcome the fear of dying, and that way is by not hanging on to life, not experiencing life as a possession……The fear then is not of dying, but of losing what I have; the fear of losing my body, my ego, my possession, and my identity; the fear of facing the abyss of non-identity, of “beinglost” (Lendrum & Syme, 1992, 69)⁶.

© Pat Lyons & Margaret Lenihan, 2016

References:

 

1. Attig, T. (2000). The heart of grief: Death and the search for lasting love. New York: Oxford University Press.
2. Stroebe, M. & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 197-224.
3. Walter, T. (1996). A new model of grief: Bereavement and biography. Mortality, 1, 7-25.  Walter T. (1999). On Bereavement: The Culture of Grief. Open University Press, Buckingham.
4. Mallon, B. (2008). Dying, Death and Grief: Working with adult bereavement.  London: Sage Publications.
5. Neimeyer, R. (1998). The lessons of loss: A guide to coping. New York:       McGraw Hill. Neimeyer, R.A. (1999). Narrative strategies in grief             therapy. Journal of Constructivist Psychology, 12, 65-85, 65-85.
6. Lendrum, S. & Syme, G. (2004). Gift of Tears. (2^nd). Hove, East Sussex: Routledge.

 

 

 

“The reality is that you will grieve forever. You will not ‘get over’ the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again, but you will never be the same. Nor should you be the same, nor would you want to.”

Elisabeth Kübler-Ross

Traditional Counselling Perspectives on Grief

The ‘Grief Work’ Hypothesis

There is a long-standing tradition in the popular and scientific literature that envisages the process of grief as one of doing ‘grief work’, as a means of coping with the distress occasioned by loss, and as a means of moderating both physical and mental detriments. Freud was the first to consider grief as a coping mechanism, by proposing that a bereaved person needed to ‘work through’ his/her grief as a means of ‘detaching’ from a loss¹. He argued that the purpose of grief was to:

• Withdraw emotional energy from the deceased (cathexis), and
• Become detached from the loved one (decathexis).

By engaging in an active, though painful, process of reviewing memories and thoughts of the lost love object, a person can achieve detachment from the ‘loved’, and attain a loosening of bonds with the past connection.

Stroebe & Schut define ‘grief work’ as a “cognitive process of confronting a loss, of going over the events before and at the time of (loss), of focusing on memories and working toward detachment” (p. 199). They further describe grief work as an “active, on-going, effortful attempt to come to terms with loss”, while emphasising how this idea of loosening ‘attachment’ has become a dominant paradigm in counselling and therapy programmes during much of the 20^th century².

Grief Links to Attachment

The most impactful theorising to build upon the Freudian ‘grief work’ approach was that of John Bowlby, who argued that secure attachment is essential for healthy emotional growth³. Bowlby regarded grief as an adaptive response, which is an inevitable consequence of our predilection to attachment and it can be experienced at physical, emotional and cognitive levels. We learn emotional resources in childhood and as we progress through life we develop a wide range of attachments in our social encounters and develop ways of managing feelings towards others. When such attachments are breached or ended, grieving is a consequence.

Mallon points out that those who have had poor attachment experiences as children may find grieving problematic, whereas those who experience bereavement in childhood may find that their grief is reactivated by loss in adulthood. Insecure childhood attachment can also be linked to complicated grief, in which painful emotions are so long lasting and severe that a person may lose the capacity for accepting an intense loss and be unable to resume normal life⁴.

Colin Murray Parkes further introduced the concept of an “assumptive world”, in which we consider the world as a secure domain with regard to relationships, expectations and future beliefs⁵. When we experience a traumatic loss, we are forced to make changes to our assumptive world as we attempt to make sense of the new landscape. This can involve dealing with matters of personal identity, meaning, and social relationships, all of which can result in psychological upheaval, or what Parkes terms “psychosocial transition”⁶.

Structured Models of Grief

Building upon Bowlby’s idea of grief as an adaptive response, Bowlby and Parkes developed a structured model of the grieving process⁷. They proposed the following stages:

1. Numbness – involving shock, denial and a sense of reality
2. Yearning & Protest – which can be associated with bouts of grief, anxiety, lack of focus. It can also involve denial of the death as well as guilt or blame and a process of frequent ‘searching’ for the person we have lost
3. Despair & Disorganisation – associated with feelings of hopelessness, anger, low mood and even depression
4. Re-organisation and recovery – which involves letting go of the attachment, and in which the loss recedes, trust in life is gradually restored, and new goals and patterns of daily life are evolved.

Elisabeth Kübler-Ross adapted this four-stage model when describing the stages she observed in those dying of terminal illness⁸. Her model proposes five psychological stages of dying:

1. Denial – an expression of disbelief at the seriousness of their situation
2. Anger – involving hostility at the “unfairness” of dying, often projected/transferred onto others
3. Bargaining – involving attempts at “deal-making” to prolong life
4. Depression – associated with (often) overwhelming feelings of grief, loss, abandonment, shame, guilt and helplessness
5. Acceptance – accompanied by an emerging, often reluctant, perhaps even stoic, sense of readiness to meet death

She argued that these are not necessarily linear and that some people may never reach the point of acceptance.

An alternative approach to the ‘trajectory’ models is the ‘task model’ that was proposed by Worden⁹. Building on Freud’s ideas, he proposed that there is a group of four tasks that persons working through grief need to engage with as they disengage with their loss.

These comprise:

1. Accepting the reality of the loss
2. Working through the pain of the grief
3. Adjusting to the new reality, from which the loved one is missing
4. Emotionally re-locating the deceased and moving on with life

Worden describes reactions to grief across four dimensions:

Emotional	Sadness, Anger, Guilt, Anxiety, Loneliness, Fatigue, Helplessness, Shock, Yearning, Emancipation, Relief, Numbness, Depression
Physical	Hollowness in stomach, Tightness in chest/throat, Breathlessness, Weakness in muscles, Dry mouth, Lack of energy, Intolerance of noise, Sense of unreality
Cognitive	Disbelief, Confusion, Preoccupation, Hallucinations, Sense of presence
Behavioural	Crying, Sighing, Social withdrawal, Absent-mindedness, Dreams of deceased, Calling out & searching, Avoiding reminders of deceased, Sleep or appetite disturbance, Restless over activity, Carrying/treasuring objects of deceased, Visiting reminder places

Critique of ‘Grief Work’ Approaches

While both the stage and task model approaches have gained credence in popular culture relating to loss, grief and dying, recent theorising has begun to question the dominance of the grief work approach. Doka, for example, has questioned the methodological soundness of the methods Kübler-Ross used to collect her data, while also pointing out that subsequent research has not supported the concept of linear stages¹⁰.

Furthermore, Silver and Wortman have argued that working through grief according to the principles laid out in the structured adaptive models may even be detrimental to recovery¹¹. In addition, Kastenbaum has argued that to accept the stage model approach as being universal, leads to a minimisation of the complexity of how individuals respond to loss, and does not take into account environmental circumstances in which the grieving person is situated¹². As a result, of these challenges, a growing questioning of the ubiquity of responses to loss has begun to emerge and this has led to the advent of new perspectives relating to the experience of grief.

In our next (and final) post in this series, we will consider more recent, and less structured, ‘personalised’ approaches to the grief experience

© Pat Lyons & Margaret Lenihan, 2016

References:

1. Freud, S. (1917). Mourning and melancholia. Reprinted in Strachey (ed. and trans.), The standard edition of the complete psychological works of Sigmund Freud. (Vol. 14), pp. 237-259). London: Hogarth Press (1957).

2. Stroebe, M. & Schut, H. (1999). The dual process model of coping with     bereavement: Rationale and description. Death Studies, 23, 197-224.

3. Bowlby, J. (1980). Attachment and Loss, Vol. 3 Loss: Sadness and depression.  London: Hogarth Press.

4. Mallon, B. (2008). Dying, Death and Grief: Working with adult bereavement.  London: Sage Publications.

5. Parkes, C.M. (1988). Bereavement as a psychosocial transition: process of            adaptation to change. Journal of Social Studies, 44, 3, 53-65.

6. Parkes, C.M. (1996). Bereavement: Studies of grief in adult life. (3^rd ed.). London: Routledge.

7. Bowlby, J. & Parkes, C.M. (1970). ‘Separation and loss within the family’. In C.J. Anthoney and C.J. Koupernik (eds.), The Child in his family. New York/Chichester: Wiley.

8. Kübler-Ross, E. (1969). On Death and Dying. New York: Macmillan.

9. Worden, J.W. (1991). Grief counselling and grief therapy: A handbook for the mental  health practitioner. New York: Springer.

10. Doka, K.J., (2103). Historical and Contemporary Perspectives on Dying, in            Meagher, D.K., & Balk, D.E. (2103). Handbook of Thanatology. New              York: Routledge.

11. Silver, R., & Wortman, C. (1980). Coping with undesirable life events. In Garber, & Seligman, M.E.P. (Eds.). Human helplessness: Theory and applications, (pp. 279-340). New York: Academic Press.

12. Kastenbaum, R. (1998). Death, Society, and Human Experience, 6th edition.  Boston: Allyn & Bacon, 1998. See also, Kastenbaum, R. (2000). The Psychology of Death. New York: Springer.

“Grief is the price we pay for love’”

Determinants of Grief

Certain circumstances of loss can affect the way we experience grief in predictable ways. These are called ‘determinants of grief’. These determinants are split into two separate, but interrelated groups: (i) external circumstances, and (ii) internal circumstances¹.

External Circumstances

1.	Place of death	When a person has died far from home, grieving will be postponed and may take longer.
2.	Coincidental deaths or losses.	Losses occurring simultaneously in a family or community. Each loss needs to be grieved individually and less support may be available for grieving persons.
3.	Successive deaths or losses.	When losses or deaths follow one after the other. The griever does not have time to grieve the first loss, as they try to deal with the next loss.
4.	The nature of the death	When death is sudden, unexpected or traumatic. Suicide is an example of this.
5.	Social networks.	a.     A good support network of family and community is particularly helpful at the time of loss. b.     Ideas, attitudes and behaviour towards death are different for different groups. c.     Groups that are more accepting of death and view it as a part of life, are less likely to deny death and to facilitate grief.

Internal Circumstances

1.	Attachment History	A person’s capacity to work through grief and express feelings is greater if securely attached as a child.
2.	Loss and death history.	When old losses have been difficult for a person to accept, a current loss may open old wounds and make the grieving process more difficult.
3.	Age and stage of griever.	Grief may be more challenging at vulnerable transition points in the life-cycle.
4.	Intimacy level	Linked to the quality of attachment is the intimacy of the relationship with the lost person.
5.	Emotional complexity.	If the relationship has been straightforward without denied feelings, the grieving process will be more straightforward.

Dimensions of Grief

The following dimensions of grief are widely referred to in the counselling literature:

Anticipatory Grief

Anticipatory grief is a term which describes the grief process that a person undergoes before a loss actually occurs.

The concept was originally introduced by Lindemann during the 1940’s, when he noted that in response to the threat of the death of their loved ones, wives of soldiers during World War II experienced patterns of grief and mourning while their spouses were still alive². On return from the war, the soldiers sometimes found that their wives had disengaged and they found themselves no longer loved. This notion, that mourning and detachment could actually exist in people prior to the death event, has stimulated a great deal of research and debate.

Some research studies support the positive effects of anticipatory grief on the recovery of the bereaved and emphasise that a period in which there is time to prepare for the upcoming loss, can result in an easier period of post-death grief for the individual. In contrast, other studies found that subjects who experienced anticipatory grief, did worse in the immediate post-loss period, and over time showed little improvement versus those who had not experienced anticipatory grief.

In the round, the outcomes of these findings on the effects of anticipatory grieving on patterns of post-loss grieving have been inconsistent and until such time as our understanding of the phenomenon of anticipatory grief is more fully clarified, the nature of support interventions to be undertaken by practitioners will remain partial.

Complicated Grief

Complicated grief, also known as prolonged grief, chronic grief, traumatic grief, or pathological grief, is an intense and long-lasting form of grief that takes over a person’s life, results in substantial distress, functional impairment and increased risk of suicide³.

The term “complicated” refers to factors that interfere with the natural healing process. Such factors might be related to characteristics of the grieving individual, to the nature of loss, the circumstances of the loss, or to other extenuating factors surrounding the loss event. Those experiencing complicated grief experience strong feelings of yearning for the loss, which do not diminish over time. These can be combined with feelings of resentment, bitterness or anger, a sense that life has lost its meaning and belief that feelings of happiness or joy can never again be experienced.

Risk factors for complicated grief include premature, sudden, violent, unexpected and traumatic losses, and can result in circumstances in which the grieving person can ruminate irrationally about what they could have done to prevent the loss or fears loss of sanity.

Treatment approaches for complicated grief often follow similar interventions to those employed with those experiencing Post Traumatic Stress Disorder, and can include the use of stress relief interventions, cognitive behavioural methods, and interpersonal techniques aimed at encouraging re-engagement with the world.

Disenfranchised Grief

The concept of ‘disenfranchised grief’ was originally articulated by Doka.  Defining disenfranchised grief as emerging when “survivors are not accorded the ‘right to grieve’”, he envisages situations in which a mourner’s right to mourn a loss is interfered with, either intentionally or unintentionally by others⁴.

Doka emphasises that it is elements of bereavement that can be disenfranchised. Such elements include:

• Relationships which are non-traditional, e.g., homosexual or extra-marital, clandestine, out of church, or disapproved
• Losses where there is a failure to acknowledge the significance of a death, e.g., perinatal deaths, abortions, deaths of prisoners, deaths of wartime enemies, death of a pet or the psychological/social deaths of those suffering from dementia
• Greivers whose capacity for grieving may no be acknowledged, e.g., the elderly, people with mental disabilities or young children
• Circumstances of death, g., suicide, deaths from AIDS, executions or deaths of addicts
• Ways individuals grieve, as for example when ways of grieving do not conform to cultural or social norms, e.g., too little/too much grieving, culturally ingrained stoicism, or wailing
• Outcomes of grieving, as when others respond negatively to mourners who may for example, take too long with their mourning, are slow to “move on” to new relationships, or try to maintain relationships with the lost love

Attig has proposed that the “right to grieve” is a matter of human dignity⁵.   He argues that disenfranchisement of grief represents a serious social failure in respect of:

• Empathy, relating to failure to understand the suffering and hurt of the bereaved,
• Abuse of power and neglect, as the discouragement, interference and sanction the disenfranchisement brings to the lives of those suffering loss adds unnecessarily to their suffering
• Ethics, in so far as denying the right to grieve is a failure of respect for the bereaved

For Attig, overcoming disenfranchisement of grief involves a process of enfranchising hope and love, in which caregivers can support those who are experiencing loss by helping them “to see that though reminders of absence are always possible, they can also open their hearts and give” their loss “a different presence in their lives by keeping memory alive and cherishing enduring legacies” (Attig, 2004, 213).

In our next post we will look at traditional counselling perspectives on dealing with grief and loss.

© Pat Lyons & Margaret Lenihan, 2016

References: 

1. Lendrum, S. & Syme, G. (2004). Gift of Tears. (2^nd ed.). Hove, East Sussex: Routledge.
2. Lindemann, E. (1944) ‘The symptomatology and management of acute grief’. American Journal of Psychiatry, 101, 141-148.
3. Robinaugh, D.J., Marques, L., Bui, E., & Simon, N. M. (2012). Recognizing and treating complicated grief. Current Psychiatry
, 11, 8, 31-35.
4. Doka, K. (Ed.). (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington, MA: Lexington. See also, Doka, K. (Ed.). (2002). Disenfranchised grief: New directions, challenges, and strategies for practice. Champaign, IL: Research Press.
5. Attig, T. (2004). Disenfranchised grief revisited: discounting hope and love.            Omega, 49, 3, 197-215

 

“The pain now is part of the happiness then”

CS Lewis

In this series of postings on Grief & Loss, we look at aspects of the grief experience that frequently visit the counselling space. And just as each counselling encounter is unique, so too will be the forms of grief and loss that are likely to be met in that space.

Definitions

Grief is a strong and sometimes overwhelming emotion that emerges as a natural reaction to loss. It is recognised as both a personal and universal experience, and can be associated with numbness, detachment from daily life, or inability to function in a normal fashion. From the Latin root meaning “to make heavy”, it is the deeply personal and subjective experience of loss, and can incorporate a complex range of emotions, cognitions and behaviours, often accompanied by feelings of guilt, anger and despair (Mallon, 2008).

Loss is a similarly common experience. When we speak of grief as being a reaction to loss we generally think in terms of an association with bereavement. However, at a general level, we may regard loss as being caused by the removal of some object, experience or person with which we have an emotional connection – a ‘lost love’.

Dimensions of Loss

There are many forms of loss and it is possible for some level of grief to emerge in association with any of these.

Intense forms of Loss	Subtle forms of Loss
·       Death of a partner ·       Death of a colleague ·       Serious illness of a loved one ·       Relationship breakup ·       Death of a family member ·       Death of a pet	·       Leaving home ·       Personal illness/loss of health ·       Change of job ·       Redundancy ·       Retirement ·       Move to a new home ·       Graduation from college ·       Loss of a physical ability ·       Loss of financial security

 

Unpredictable Loss

Some losses are unpredictable and can be shocking. Examples include suicide, accidents, events associated with crime, or job loss. It is not possible to prepare for sudden loss, and a persons’ sense of stability or security can be threatened when faced with such losses. A sense of certainty is lost and confidence in the future can be questioned. Sudden loss can cause a person to experience a range of responses that may include sleep disturbance, nightmares, distressing thoughts, depressed mood, social isolation, or severe anxiety. Grief response to unpredictable losses may be subtle and experienced in a private fashion with limited exhibition of emotional response.

Predictable Loss

Some losses, such as those due to terminal illness, or retirement, can allow a person more time to prepare for the loss. However, they create two layers of grief, (a) the grief related to the anticipation of the loss (anticipatory grief), and (b) the grief related to the loss itself.

Circumstantial Losses

Circumstantial losses may not happen to everyone and some may not even appear as obvious losses. Following is a list of some of these losses:

Separation Burglary Stillbirth Miscarriage Abortion Moving House Imprisonment Retirement Serious illness Emigration

Blindness Deafness Disfigurement Mastectomy Infertility Death of a pet Bankruptcy Loss of job Menopause Rape

Some of the feelings associated with such losses are, loss of control, loss of trust, loss of self-esteem, loss of dreams, loss of security, loss of faith and loss of hope. These losses can occur throughout our lives and how we manage the grief associated with these losses is very personal and individual.

In our next posting, we examine the circumstances of loss which regulate how grief is determined at an individual level and also consider some of the principal dimensions of the experience of grief.

© Pat Lyons & Margaret Lenihan, 2016

Reference: Mallon, B. (2008). Dying, Death and Grief: Working with adult bereavement. Sage Publications: London

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