Grief

Axis I Disorders include the following: “adjustment disorders, anxiety disorders, dissociative disorders, eating disorders, impulse-control disorders, mood disorders, personality disorders, psychotic disorders, sleep disorders, as well as, somatoform disorders” (American Psychiatric Association et. al., 2000, pp. 345 – 730).

“Axis II”, on the other hand, covers the following conditions: “personality disorders, mental retardation, as well as, autism” (American Psychiatric Association et. al., 2000, pp. 27 – 134 & 679 – 730).

Furthermore, “Axis II” disorders may already emerge during an individual’s childhood life while “Axis I” disorders usually present itself during the stage of adulthood (American Psychiatric Association et. al., 2000, pp. 1 – 744).

Moreover, “Axis II’s” symptoms linger awhile longer than the clinical manifestations of “Axis I” and that “Axis II” disorders may negatively impact ones’ life since interaction may be more difficult as compared with “Axis I” (American Psychiatric Association et. al., 2000, pp. 1 – 744).

In addition to that, “medical attention is necessitated when it comes to principal disorders” which are covered in “Axis I” (American Psychiatric Association et. al., 2000, pp. 1 – 744). “Axis II” on the other hand, are those “shaping the current response to the Axis I problem” (American Psychiatric Association et. al., 2000, pp. 1 – 744). It may also influence the individual to the “Axis I” dilemma (American Psychiatric Association et. al., 2000, pp. 1 – 744).

Differences in Treatment Approaches

The differences in treatment approaches are as follows: “Anxiety and phobic disorders” may be treated through the following techniques: “desensitization, flooding, relaxation” (De Jongh et. al., 1999, pp. 69 – 85). “Obsessive-compulsive disorder” may be address through the following techniques: “relaxation and relapse-prevention” (McKay, 1997, pp. 367 – 369). “Depressive disorders” are treated the “cognitive behavioral technique, as well as, relaxation” (Ackerson, 1998, pp. 685 – 690).

“Conduct disorders” are addressed through “positive reinforcement” and “extinction” (Bailey, 1996, pp. 352 – 356). “Hyperactivity syndromes” are treated by the following techniques: “time out, positive reinforcement, and extinction” (Quay, 1997, n.p.). “Pervasive developmental disorders” are addressed by the following techniques as well: “time out, positive reinforcement, and extinction” as well as, “aversive techniques” (Bristol-Power et al., 1999, pp. 435 – 438).

“Encopresis/enuresis” is treated through “positive reinforcement” (Boon et. al., 1991, pp. 355 – 371). The treatments for “Mental Retardation” are the following: “positive reinforcement, extinction and time-out, prompting and shaping, as well as, aversive techniques” (Jones, 2006, pp. 115 – 121). “Tics” are treated by massed practice (Sand et. al., 1973, pp. 665 – 670).

Working with Different Children from Axis I, Axis II, or Both

In case I would need to address a child’s case wherein Axis I and Axis II Disorders both occur at the same time, I will make sure to consider the “development of cognitive, social, and motor skills” (American Psychiatric Association et. al., 2000, pp. 1 – 744). In addition, “the one that initiated evaluation or clinical is regarded as the principal diagnosis” (American Psychiatric Association et. al., 2000, pp. 1 – 744).

Most Important Things to Consider when Working with Children

The most important things to take into consideration when working with children are the following: first of all, the ethical and professional issues that emerges in mental health work with children; second, the culture that the child and his or her family believes / practices / grew up in; third, the proper treatment/intervention; fourth include the following contemporary structure of “services, evidence-based practice, and psychopharmacology” (American Psychiatric Association et. al., 2000, pp. 1 – 744).

References

1. Ackerson, J. et. al., (1998). Cognitive Bibliotherapy for Mild and Moderate Adolescent
2. Depressive Symptomatology. Journal of Consulting and Clinical Psychology, 66: 685 – 690.
3. American Psychiatric Association, American Psychiatric Association, American Psychiatric
4. Association Task Force on DSM-IV. (2000). Diagnostic and Statistic Manual of Mental Disorders: DSM-IV-TR. VA: American Psychiatric Publishing.
5. Bailey, V.F.A. (1996). Intensive Interventions in Conduct Disorders. Archives of Disease in Childhood, 74: 352 – 356.

Joyce Maguire Pavao, the author of “The Family of Adoption” has been successful in capturing the essence of adoption, the challenges it brings as well as the necessities that would help in handling these challenges.  Being an adopted child herself, she has a great understanding of the challenges and needs, not only of the adopted child, but the adoptive parent and birth parent as well.

The book has a more practical and realistic feel since the author willingly shared her own experiences as an adopted child. One characteristic of the book that should be noted is the way the author categorized the whole book.  Covering the essentials not limited to the adopted child alone.

The author also generously shared insights about the needs of the birth and adoptive parent.  It is very important to know the rationale behind her principle that the whole process of adoption does not only include the adopted child but the other individual surrounding her as well.  Her book has admirably captured and discussed this principle.

In the book, the author well discussed the processes that the birth parent and the adoptive parents.  This part recognizes the fact that even the parents (birth and adoptive) may go through the process of grief and experiences dilemmas as well.

In line with this, the book stated that the parents (birth and adoptive) may also need to go through the process of healing.  To further strengthen this fact, the author mentioned that there is a need for the adoptive parent to undergo counseling since this will help the adoptive parent to better understand and have a healthy relationship with the adoptive child.

The book mentioned that an adopted child may go through “developmental stages” such us feelings of loss, experiencing problems in school and the wanting to know about their past.  The author mentioned that the adopted child have every right to know as much about his or her past.

The adoptive parents should be open to this fact.  Apart from this, the author was able to clarify the different challenges and developmental stages that the adopted child goes thru.  She said that these are normal.  They may be challenging, but they are a normal process that the adopted child goes thru.

In the book, it is stated that adoption “is not about finding children for families, but about finding families for children.”  The items discussed in the book are somehow a reminder that the best interest of the adopted child should always be the priority of the parents.

  In the first part of Chapter 1, the author said that “There have always been mothers and fathers who have not been able to, or not chosen to, or not been allowed to, parent their children…”  This is a sad fact that Joyce Maguire Pavao has beautifully placed into proper perspective.

The birth parents have had their share of criticism from many because they gave up their child.  But it is important to remember that the birth parents have reasons as to why they chose to give up their child for adoption.  Birth parents need the same understanding, perhaps, as that of the adopted child.

This book presented us with the reality that adoption is a commitment more than anything else.  It is a process that needs the cooperation of both the birth and adoptive family of the child.

Openness of both families is essential to the growth and better development of the child.  It is important to accept that the adopted child will go thru confusing stages that may prove to be a challenge for the parents.

But because of the commitment that the parents choose to make, these challenges, when faced properly, may prove to be the cause of a better relationship with the child.   While the family (parents and child) are going through the different challenges that the process of adoption brought about, it is critical for the parents to remind themselves that the best interest of the child should always be the main concern.

A lot of people have different opinion with regards to adoption.  Some may even have negative notions about it.  Apart from the usual challenges that an adoptive parent may face while going through the process of adoption, the opinions and reactions of the people around them is another thing that they would need to deal with.

It is not enough that the adoptive couple alone understand and is happy about adopting.  It is vital that they have the support and understanding of the people they care about.

The book “Adoption is a Family Affair” is perfect for the families and friends of the adoptive couple.  Patricia Irwin covered the different areas that families of the adoptive parents should know about.  Areas such as who can adopt, reasons behind the decision of adopting, kids understanding adopting and much more.

She made the whole adoption process something that can be and should be shared amongst family members and even close friends.  This book is a helping hand to the families and close friends of the adoptive couple, for them to better grasp then reality of and better understand the decision made by their loved one.

Patricia Irwin herself is an adoptive parent, given this, she may as well have experienced the confusions of her family and friends about her decision to adopt.  She has a clearer understanding of the need for the people who the adoptive couple cares about to know as much fact as possible with regards to adoption.

It is important that the author pictured in the very beginning of her book that there can be a negative reaction from the people the adoptive parents care most about when the couple decides to share the information of adoption to them.

  Like most of us, of course we would love for it for the people we equally love to feel the happiness and excitement we feel when we decide to adopt.  And as the author clearly illustrated, this is not always the case.

The book acknowledges valid fears and concerns of the families and friends of the adoptive parents.  Some of the valid concerns that the author discussed were the permanence of adoption, whether the child will be different from them or will not fit, the racial difference, should grandparents include the adopted child in their will, how can the family have deeper bonds with the child, etc.

These are all valid concerns and important.  In fact, the adoptive couple may have thought about all these things themselves.

Patricia Irwin was great in giving solutions or suggestions on how to deal with these fears and concerns.  Some of her solutions were as simple as the family members spending time with the child to create a deeper bond, giving assurance to the family members that adoption is permanent, and the like.

One interesting part of the book is where the author gave examples of the possibly irritating comments given by friends and relatives of adoptive couples upon knowing of the couples’ decision to adopt.  These comments show how uninformed some people are about adoption.  It illustrates how some people, no matter how closely related they may be to the adoptive couple, can be insensitive about the whole adoption process.

There were financial related comments where it appears as if the child is someone the adoptive couple picks from a shelf display of children and pays for it at the counter.  Some comments were just downright insensitive and would not be expected to have come from well educated individuals.

Of course, we cannot expect everyone to be knowledgeable about adoption.  As the book illustrated, the families and relatives of the adoptive couple may be confused and misinformed about adoption.

This book has truly been informative and is useful for the family and friends of the adoptive couple.  It plainly made clear the issues that the adoptive couples may go through in connection with the possible reactions, confusions and hesitations of the people around them who they wish to be a part of the adoption process.

Reference List

Pavao JM. The Family of Adoption. Boston: Beacon Press; 2004

Johnston PI. Adoption is a Family Affair. Indianapolis: Perspective Press;

Like Pauline we could have told God many times you created me without my knowledge about it and will take my life at your convenience.  The statement implicates that everyone knows that humans are immortal but still many are not ready to face death.  Many are afraid to die because that is leading someone to the unknown or simply the end of non-being.  Very few accept that death as a sister or a brother that will accompany us to the next life.

In the case of Pauline it will be very difficult in the beginning for an existential therapist to argue with her the meaning of life when it is the reason that aggravates Pauline’s situation.  The twenty year old woman is just finding meaning in her life and the promise of an eminent death brings all her plans to a halt. Though she is filled with rage, her initiative to ask for counseling is a sure sign that she will be able cope with her anxiety.

To help Pauline, first is to understand her fear that is to be able to penetrate her emotions, her will and dispositions.  Many people are afraid to die because we die alone just like when we were born when we came to this world without anything.

Next is to encourage her to face death by preparing well for it and telling her the advantage that life is not being taken away but it is simply what happens to everyone.  If she’s  been given sometime to live, it would be to her advantage to live fully the times that are still available unlike those people whose life were taken by surprise say for example the 9/11 catastrophe.  The victims did not even have the time to say goodbye or leave something pleasing for their loved ones.

Making Pauline realized that there is still time left behind for everything no matter how short life is will certainly increase her hope.  In one of the book written by Josemaria Escriva he said that” it is hope in God which sets us “marvelously ablaze with love, with a fire that makes the heart beat strong and keeps it safe from discouragement and dejection, even though along the way one may suffer and at times suffer greatly (Scheffczyk, 2006).”

References

Scheffczyk, C. L. (2006). Grace in the spirituality of St. Josemaria Escriva [Electronic Version]. Retrieved 09 April 2008, from http://en.romana.org/art/43_8.0_2

This essay describes and evaluates the contributions of Bowlby, Ainsworth, Murray-Parkes, Kubler-Ross and Worden, as well as later theorists, to their respective fields. I demonstrate how I already work with some of these models, highlighting my strengths and areas for development. I emphasise some influences on Bowlby’s work, leading to his trilogy Attachment 1969; Separation 1973; and Loss, Sadness and Depression 1980; demonstrating how attachments in infancy may shape our attachment styles in later life.

Pietromonaco and Barrett posit “A central tenet of attachment theory is that people develop mental representations, or internal working models that consist of expectations about the self, significant others and the relationship between the two. ” (Pietromonaco and Barrett, 2000, 4:2, p156). I illustrate how this internal working model is developed via the relationship between infant and primary caregiver, demonstrating that maternal deprivation can create a ‘faulty’ internal working model, which may lead to psychopathology in later life.

I also demonstrate how these internal working models influence our reactions to loss and bereavement in adulthood and their potential impact on the counselling relationship. In addition, I explore the multi-layered losses experienced by HIV+ gay men and finally draw some conclusions. Freud’s view on the infant’s attachment to its mother was quite simple “the reason why the infant in arms wants to perceive the presence of its mother is only because it already knows by experience that she satisfies all its needs without delay.” (Freud, 1924, p188 cited in Eysenck, 2005, p103).

In contrast, behaviourists believed that feeding played a central role in the development of attachment. (Pendry, 1998; Eysenck, 2005). These theories were termed ‘secondary-drive theories’. In 1980, Bowlby recalled “this [secondary drive] theory did not seem to me to fit the facts…. but, if the secondary dependency was inadequate, what was the alternative? ” (Bowlby,1980, p650 cited in Cassidy and Shaver, 1999, p3).

Bowlby’s theory was influenced by his paper “Forty Four Juvenile Thieves”, where he concluded a correlation exists between maternal deprivation in infancy, leading to affectionless psychopathology and subsequent criminal behaviour in adolescents. (Bowlby, 1944, 25, p19-52). This led to him researching the impact of loss on children displaced through war and institutionalisation, resulting in ‘Maternal Care and Mental Health’ (1952), where he confirms a link between ‘environmental trauma’ and resultant disturbances in child development.

As a result of this research, Bowlby concluded “it is psychological deprivation rather than the economic, nutritional or medical deprivation that is the cause of troubled children. ” (Bowlby in Coates, 2004, 52, p577). He was further influenced by Lorenz who found that goslings would follow and ‘attach’ themselves to the first moving object they saw. This following of the first moving object was called ‘imprinting’. (Lorenz, 1937 cited in Kaplan, 1998, p124).

Clearly babies cannot follow at will – to compensate for this, ”Bowlby noted that ‘imprinting’ manifested itself as a spectacularly more complex phenomenon in primates, including man, which he later labelled ‘attachment’. ” (Hoover, 2004, 11:1, p58-60). He also embraced the work of Harlow and Zimmerman who worked with infant rhesus monkeys demonstrating that not only did the need for attachment give them security, but that this need took priority over their need for food. (Harlow and Zimmerman 1959 cited in Green and Scholes, 2003, p9).

Dissatisfied with traditional theories, Bowlby embraced new understandings through discussion with colleagues from such fields as developmental psychology, ethology, control systems theory and cognitive science, leading him to formulate his theory that the mechanisms underlying the infant’s tie to the mother originally emerged as a result of evolutionary and biological pressures. (Cassidy and Shaver, 1999; Green and Scholes, 2003).

Defining his attachment theory as “a way of conceptualising the propensity of human beings to make strong affectional bonds to particular others.” (Bowlby, 1979 cited in Green and Scholes, 2003, p7), he posited “that it is our affectional bonds to attachment figures that engage us in our most intense emotions. ” and that “this occurs during their formation (we call that ‘falling in love), in their maintenance (which we describe as ‘loving) and in their loss (which we know as ‘grieving’), (Green and Scholes, 2003, p8), thereby replacing the secondary-drive theory with a model emphasising the role relationships play in attachment and loss. (Waters, Crowell, Elliott et all, 2002, 4, p230-242).

Disregarding what he called Freud’s ‘cupboard love’ theory of attachment, he believed instead that a child is born ‘biologically pre-disposed’ to become attached to its mother, claiming this bond has two essential features: the biological function of securing protection for survival and the physiological and psychological need for security. (Green and Scholes, 2003; Schaffer, 2004). Sonkin (2005) describes four features to this bond: secure base, separation protest, safe haven and proximity maintenance.

The concept of a secure base is fundamental to attachment theory and is used to describe a dependable attachment to a primary caregiver. This secure base is established by providing consistent levels of safety, responsiveness and emotional comfort from within which the infant can explore his or her external and internal worlds and to which they can return, thus providing a sense of security. Separation protest is exhibited as a sign of the distress experienced upon separation from an attachment figure, who may also be used as a safe haven to turn to for comfort in times of distress.

When safety is threatened, infants attract the attention of their primary caregiver through crying or screaming. Maintaining attention and interest, e. g. vocalising and smiling, and seeking or maintaining proximity, e. g. following or clinging, all serve to promote the safety provided by the secure base (providing of course that parents respond appropriately). (Holmes, 1993; Cassidy and Shaver 1999; Becket, 2002; Green and Scholes, 2003).

Proximity seeking is a two way process, for example child seeking parent or parent seeking child. (Weiss in Murray-Parkes, Stevenson-Hinde and Marris, 1991; Becket, 2004; Sonkin, 2007). Bowlby also recognised ‘unwilling’ separation caused by parents who were phsycially present but not able to respond, or who deprived infants of love or ill-treated them, left them with a sense of immense deprivation and that this unwilling separation and resultant loss leads to deep emotional distress. (Green and Scholes, 2003).

At a recent conference, the Centre for Attachment based Psychoanalytical Psychotherapy (CAPP) asserts “Early interactions with significant others in which there are fundamental failures of empathy, attunement, recognition and regulation of emotional states, have been shown to cause the global breakdown of any coherent attachment strategy, thus engendering fears of disintegration and threatening psychic survival. In the face of such experiences, powerful dissociative defences may be employed, encapsulating overwhelming feelings of fear, rage and shame. ” (CAPP, 2007).

Together with Robertson and Rosenbluth, Bowlby demonstrated that even brief separation from the mother has profound emotional effects on the infant. Their research highlighted a three stage behavioural response to this separation: protest – related to separation anxiety; despair – related to grief and mourning; and detachment – related to defences. (Robertson, Rosenbluth, Bowlby, 1952 in Murray-Parkes, Stevenson-Hinde and Marris, 1991). Ainsworth, Blehar, Waters and Wall (1978) later established the inter-relatedness between attachment behaviour, maternal sensitivity and exploration in the child.

Under clinical settings, they sought to observe the effects of temporary separation from the mother, which was assessed via the ‘strange situation’ procedure. This study involved children between the ages of 12 to 18 months who experienced separation from their mother, introduction to an unfamiliar adult and finally reunion with their mother. Ainsworth et al reasoned that if attachment was strong, mother would be used as a secure base from which the infant could explore, thereby promoting self-reliance and autonomy. Upon separation, infants usually demonstrated separation anxiety.

Upon re-union, the mother’s maternal sensitivity and the child’s responses were observed, thus providing a link between Bowlby’s theory and its application to individual experience. The trust/mistrust in the infant’s ability to explore their world from the secure base is re-inforced by Erikson’s (1965) examination of early development and the child’s experiencing of the world as a place that is nurturing, reliable and trustworthy (or not). Influenced by Ainsworth’s previous work in Uganda, the ‘strange situation’ led to the classification of secure or insecure attachment styles in infants.

Insecure styles were further grouped into insecure/avoidant and insecure/resistant (ambivalent). (Pendry, 1998; Holmes, 2001; Eysenck, 2005). Main and Solomon later added a fourth attachment style – insecure/disorganised. (Main and Solomon, 1986 in Cassidy and Shaver, 1999, p290). Throughout all of these interactions, an ‘internal working model’ is developed, the cultivation of which relies on the dyadic patterns of relating between primary caregiver and infant (Bretherton, 1992, 28, p759-775), comprising the complex monitoring of internal states of primary caregiver and infant. (Waters, Crowell, Elliott et al, 2002, 4, p230-242).

According to Schore “These formative experiences are embedded in the developing attachment relationship – nature and nurture first come together in mother-infant psychobiological interactions. ” (Schore, 2001, 17, p26). Over time, this leads to the infant’s ability to self-monitor their emotions (affect regulation), but until such time, Bowlby posited the mother acts as the child’s ego and super-ego ”She orients him in space and time, provides his environment, permits the satisfaction of some impulses, restricts others.

She is his ego and his super-ego. ” (Bowlby, 1951, p53 cited in Bretherton, 1992, 28, p765). Bowlby concluded a healthy internal working model is “a working model of an attachment figure who is conceived as accessible, trustworthy and ready to help when called upon”, whilst a ‘faulty’ model is “a working model of an attachment figure to whom are attributed such characteristics as uncertain accessibility, unwilllingness to respond helpfully, or perhaps the likelihood of responding hostilely. ” (Bowlby, 1979, p141).

Ainsworth suggests that positive attachment is more than explicit behaviour “it is built into the nervous system, in the course and as a result of the infant’s experience of his transactions with the mother. ” (Ainsworth, 1967, p429), thus supporting Bowlby’s theory. Later descriptions of attachment styles describe secure attachment as “the development of the basic machinery to self-regulate affects later in life”, (Fonagy, Gergely and Jurist, 2002 cited in Sarkar and Adshead, 2006, 12, p297), whilst insecure attachment “prevents the development of a proper affect regulatory capacity.” (Sarkar and Adshead, 2006, 12, p297).

This is supported by Schore (2003) who alludes to developmental affective neuroscience to set out a framework for affect regulation and dysregulation. Based on research into the development of the infant brain, he reviews neuro-scientific evidence to confirm the infant’s relationship with the primary caregiver has a direct effect on the development of brain structures and pathways involved in both affect regulation and dysregulation.

The research and evidence suggests the internal working model begins as soon as the child is born and is the model upon which future relationships are formed. The quality of the primary caregiver’s response to infant distress provides the foundation upon which behavioural and cognitive strategies are developed, which in the longer term influence thoughts, feelings and behaviours in adult relationships. (Cardwell, Wadeley and Murphy, 2000; Pietromonaco and Barrett, 2000, 4:2, p155; Madigan, Moran and Pederson, 2006, 42:2, p293).

A healthy, secure attachment to the primary caregiver would therefore appear essential for a child’s social, emotional and intellectual development, whilst interruption to this attachment would appear to promote the premise of psychopathology in later life. Whilst some evidence exists to demonstrate internal working models can be modified by different environmental experiences, (Riggs, Vosvick and Stallings, 2007, 12:6, p922-936), the extent to which they can change remains in question.

Bowlby himself postulated “clinical evidence suggests that the necessary revisions of the model are not always easy to achieve. Usually they are completed but only slowly, often they are done imperfectly, and sometimes done not at all. ” (Bowlby, 1969, p83). Whilst change may be possible, the unconscious aspects of internal working models are deemed to be specifically resistant to such change. (Prior and Glaser, 2006). We can safely assume therefore, that in the majority of cases, internal working models tend to persist for life.

I concur with Rutter’s criticism of Bowlby’s concept of ‘monotropy’, i.e. Bowlby’s belief that babies develop one primary attachment, usually the mother, (Rutter, 1981 cited in Lucas, 2007, 13, p156 and in Eysenck 2005), accepting instead that infants form multiple attachments. This is supported by a study by Shaffer and Emmerson (1964) who concluded infants form a ‘hierarchy’ of attachments, often with the mother as the primary attachment figure, although nearly a third of children observed highlighted the father as the primary attachment figure. (Schaffer and Emmerson, 1964 in Cassidy and Shaver, 1999, p44-67).

Collins, Dunlop and Chrysler criticise Bowlby’s ‘lens’ in that it was “limited by his own cultural, historical and class position. Bowlby’s culturally biased assumptions and empiricist methods of inquiry concentrated on individualised detachment and loss as part of the normal course of mourning loss, which perpetuated the Western tradition of preserving the autonomous individual self as the normal goal of development. ” (Collins, Dunlop and Chrysler, 2002, p98), leading them to conclude Bowlby’s assumptions ignored other cultural practices (as did Ainsworths), with which I agree.

They also suggest Bowlby’s concept of maternal deprivation was perhaps exploited to get women to return to the home post World War II – “Characterised as a choice, this ‘homeward bound’ movement was supported by the various governments, whose maternalist and pronatalist ideology of the 1930s continued into the post-war period to provide a rationale for sending women home to reproduce … maternalism and the maternal deprivation hypothesis provided one conceptual framework for pronatal ideology as it intersected with the demands of governments and industrialists. ” (Collins, Dunlap and Chrysler, 2002, p102).

We must also remember that Bowlby’s observations “were based on children who had been separated from their primary caregivers during the Second World War” (Lemma, 2003 cited in Lucas, 2007, 13, p156), and that these procedures “were based on behaviours that occurred during stressful situations rather than under normal circumstances. ” (Lucas, 2007, 13, p156) [this latter criticism also applies to Ainsworth’s work].

Nonetheless, in highlighting the damaging effects of institutionalised care on young children, Bowlby’s strengths lie in drawing attention to the role attachment, attachment behaviour and attachment behavioural systems play in a child’s development and the subsequent potential consequences of disruption to the bond between infant and primary caregiver. I concur with Cassidy and Shaver’s (1999) criticisms of the strange situation in that there are too many unconsidered variables for a firm theory to be established at the time of Ainsworth’s writings, accepting their view that she did not consider the mood nor temperament of the child.

Nonetheless, Ainsworth et al have provided a tool with which to measure attachment styles in infants, which is still in use today. Later research by George, Kaplan and Main assesses adult internal models through the use of the Adult Attachment Interview. This classification of adult attachment styles promotes the idea of models extending into adulthood as a template for future relationships. (George, Kaplan and Main 1985 cited in Pendry, 1998).

Hazan and Shaver continued this line of research identifying patterns of attachment behavior in adult romantic relationships, concluding the same four attachment styles identified in infancy remain true for adult relationships. (Hazan and Shaver 1987 in Cassidy and Shaver, 1999, p355-377). Although theoretically rooted in the same innate system, adult romantic attachment styles differ from parent-child bonds to include reciprocity of attachment and caregiving, as well as sexual mating. (Hazan and Zeifman, 1999 in Cassidy and Shaver, 1999, p336-354).

The literature on bereavement has become inseparable from Bowlby’s theory of attachment and, following from this, the way in which people react to the loss of this attachment. On reflecting on losses in adult life, Weinstein (2008) observes Bowlby’s persistence of formative attachments and how the pattern of protest, despair and detachment that follows a baby’s separation from its primary caregiver is re-activated and presented in full force in adult loss.

Weinstein writes “The ability of the adult to cope with attachment in intimate relationships to negotiate independence, dependency and inter-dependency; and to manage loss is all about how successfully they coped with separation as an infant. As a baby they had to retain their sense of their mother even in her absence and now as adults, as part of the mourning process, they strengthen their own identity with the support of the internalised object. ” (Weinstein, 2008, p34).

According to Murray-Parkes (1996), the intensity and duration of this grief is relative to what is lost and the grief process is an emotional response to this loss. Murray-Parkes joined Bowlby at the Tavistock Centre in 1962. Together they presented a paper linking the protests of separation highlighted by Robertson, Rosenbluth and Bowlby (1952) in young children separated from their mothers, to grief in adults. (Bowlby and Murray-Parkes, 1970 in Murray-Parkes, Stevenson-Hinde and Marris, 1991, p20).

Around the same time, Murray-Parkes visited Kubler-Ross who was conducting her own research into death and dying. This work was later published in ‘On Death and Dying’ (1969) which examines the process of coming to terms with terminal illness or grief in five stages: denial; anger; bargaining; depression and acceptance. Murray-Parkes later produced a four-phase grief model consisting: shock or numbness; yearning and pining; disorganisation and despair; and re-organisation.

In contrast to the passive staged/phased approaches by Kubler-Ross and Murray-Parkes, and perhaps more in line with Freud’s concept of having ‘to do grief work’, Worden developed a four-staged, task-based grief model: “to accept the reality of the loss; to work through the pain of grief; to adjust to an environment in which the deceased is missing; and to emotionally relocate the deceased and move on with life. ” (Worden, 2003). All three models are deemed to be therapeutically useful in that they recognise grief as a process and provide a framework of descriptors for ‘normalising’ grief reactions.

That said, they are clearly prescriptive and caution should be exercised in taking any of these prescriptive stages, phases or tasks literally. It is equally important to recognise the uniqueness of individual responses to loss and to avoid prescribing where a client ‘ought’ to be in their grieving process. Since these models were never designed as a linear process, it is likewise important not to steer clients through these stages. This is supported by Schuchter and Zisook (1993), who assert “Grief is not a linear process with concrete boundaries but, rather, a composite of overlapping, fluid phases that vary from person to person.” (Schuchter and Zisook, 1993 in Stroebe, Stroebe and Hansson, 1993, p23).

I agree with Servaty-Seib’s observations “the stage/phase approaches emerged solely from a death-loss focus … Worden’s work was an important development in the understanding of the process of coping adaptively with bereavement as each task is clearly defined in an action-oriented manner. ” (Servaty-Seib, 2004, 26:2, p125). Stroebe and Schut’s dual process model brings together death-loss focus and task-based models. (Stroebe and Schut, 2001 cited in Servaty-Seib, 2004, 26:2, p125).

In my work at Positive East, I work with HIV+ gay men experiencing multi-layered loss. My philosophy is to build and maintain a therapeutic relationship within a safe, confidential, contained space where clients can explore their issues. The archetype ‘working towards a model of gay affirmative therapy’ (Davies and Neal, 1996, p24-40) provides me with a framework within which to explore gay culture and to apply an assenting approach to the work, which I believe promotes empathy and helps me to work in the best interests of the client.

Conducting my own assessments, I complete a full client history, genogram and timeline, which provides a comprehensive insight into clients attachments and losses. It is important to acknowledge the social context within which multi-layered loss takes place (e. g. heterosexism, homophobia, HIV-related stigma) as well as recognising that individual attachment styles may influence individual reactions to these losses and may also impact on the counselling relationship.

Losses experienced by HIV+ gay men include loss of identity, health, appearance, mobility, self-respect, career, financial security, relationships and intimacy. (Riggs, Vosvick and Stallings, 2007, 12:6, p922-936; Koopman, Gore-Felton, Marouf et al, 2000, 12:5, p663-672; Fernandez and Ruiz, 2006, p356). Corr, Nabe and Corr (1997) describe these losses as the cognitive, affective and behavioural responses to the impact of the loss. In identifying attachment styles in HIV+ adults, Riggs, Vosvick and Stallings (2007) found that 90% of gay and bisexual HIV+ adults recruited into their study demonstrated insecure attachment.

They suggest the diagnosis of HIV produces a strong trauma reaction, impacting on adult attachment style. In the same study, they found that HIV+ heterosexual adults were more likely to be secure, whereas gay and bisexual adults were more likely to be fearful, preoccupied, avoidant; or dismissing, respectively. This led them to conclude that gay and bisexual people must therefore contend with societal forces that their heterosexual counterparts do not.

They hypothesise “A diagnosis of HIV may be reminiscent of the coming out process, particularly with respect to concerns regarding stigma and disclosure, and thus may provoke similar fears about rejection by loved ones and society as a whole that contribute to greater attachment insecurity. ” (Riggs, Vosvick and Stallings, 2007, 12:6, p931). This is supported by Koopman, Gore-Felton, Marouf et al (2000) who cite attachment style as a contributing factor associated with the high levels of stress experienced by HIV+ individuals.

They comment “From this perspective, perceived stress is likely to be greater among [HIV+] persons having a highly anxious attachment style because their hypervigilance in interpersonal relationships leads to misinterpreting others’ behaviours as rejecting or critical of themselves. ” (Koopman, Gore-Felton, Marouf et al, 2000, 12:5, p670). This would suggest that HIV+ gay men with insecure attachment style may experience difficulties in developing and maintaining relationships, which, in turn, may impact on the therapeutic relationship.

Additionally, according to Kelly, Murphy, Bahr et al “Dependable and supportive attachments play a crucial role in adjusting to HIV infection. Lack of such attachments and social support has been shown to be a significant predictor of emotional stress among HIV+ adults. ” (Kelly, Murphy, Bahr et al, 1993, 12:3, p215-219). This has significant implications for the psychological well being of HIV+ gay men whom, considering their perceived attachment difficulties, may experience difficulties in forming such supportive relationships.

In examining the suitability of the common grief models when working with this client group, I accept Copp’s criticism of the Kubler-Ross model for its focus on psychosocial dynamics “to the exclusion of physical, and to a lesser extent, spiritual dimensions. ” (Copp, 1998, 28:2, p383). I also agree with Knapp’s criticisms of the staged/phased grief models espoused by Kubler-Ross and Murray-Parkes. Knapp observes “while both of these models may be applicable to those experiencing a singular loss, neither model takes into consideration the multiplicity of losses thrust upon the seropositive gay male population.

These men experience overlapping losses, resulting in them being at differing stages with respect to different losses. ” (Knapp, 2000, 6:2, p143). Knapp offers a similar criticism of the Worden model in that “task models fail to account for the continuity of loss in the lives of seropositive gay men. ” (Knapp, 2000, 6:2, p143), with which I also concur. In addition, all three models incorporate an end point, which suggests the completion of a cycle, thereby pre-supposing some sort of finality.

These models are therefore limited in their application to my own work, since, as new losses take the place of old, my clients find themselves in a continual cycle of loss without the comfort of such an end point. Processing the loss of the ‘pre-infected self’ and re-defining the ‘HIV+ self’ often means working with the stage of identity vs role confusion in Erikson’s (1965) psychosocial model. Additionally, where partners stay together, a revisiting and re-negotiation of the adult stage of intimacy may be required since intimacy is often disrupted and sometimes lost due to HIV infection.

This stage is also revisited by clients where a partner chooses to end the relationship with a HIV+ partner. Working through the loss of the partner (usually due to fear of infection); as well as other significant relationships (usually due to HIV related stigma); is also key to the work. To support this work, I use the ’multi-dimensional’ grief model by Schuchter and Zisook (1993), adopting four of their five dimensions: emotional and cognitive responses; emotional pain; changes in relationships and changes in identity. (Schuchter and Zisook, 1993 in Stroebe, Stroebe and Hansson, 1993, p26-43).

I have also used Worden’s grief model in supporting a HIV+ client whose HIV infected partner committed suicide. This work is clearly demanding and is informed by the client’s internal working model of self and other. Due to perceived stigma and fear of rejection, it is not unusual for the client’s attachment behavioural system to be activated throughout the therapeutic relationship. Recent research highlights the mirroring of Bowlby’s theory within such a relationship.

Parish and Eagle (2003) and Sonkin (2005) draw attention to the manifestation of clients seeking proximity maintenance to the therapist; experiencing distress when the therapist is not available; seeking a safe haven when in distress; and using the therapist as a secure base. To cater for this, I strive to provide a secure base in therapy, ensuring I remain boundaried, punctual and professional, informing clients of any breaks and provide opportunities for clients to explore their anxieties. Clients in particular distress may also contact the agency, who in turn may contact me.

My experience has taught me that clients with avoidant attachment styles take time to build trust in the therapeutic relationship. I have also found the avoidant attached usually need permission/re-assurance to grieve their losses, whilst the anxiously attached require permission/re-assurance to stop grieving their losses. I am cognisant that the therapeutic relationship promotes attachment yet at the same time acknowledge the paradox in severing this attachment at the end of therapy. Ending sensitively is therefore crucial. I recognise that clients may develop co-morbid conditions such as alcohol and recreational drug abuse.

In line with the BACP ethical principles of beneficence, non-maleficence and self-respect (BACP Ethical Framework, 2007), I use supervision to monitor any emerging signs of such abuse, where a decision may be reached to refer these clients to external agencies or other, suitably experienced, internal counsellors. In assessing my strengths and areas for development, I am now much more aware of how early attachment experiences and internal working models impact on how clients process their losses as well as their potential impact on the counselling relationship and process.

I have extensive experience of working with loss and bereavement, which is underpinned by my specialist training and practice at Positive East, as a bereavement counsellor with the Bereavement Service and as a counsellor providing support to those bereaved through homicide at Victim Support. I believe a healthy, secure attachment to a primary caregiver is necessary for a child’s social, emotional and intellectual development. In turn this promotes the development of a healthy internal working model, disruption to which may lead to psychopathology in later life.

Whilst the internal working model tends to persist through the life course, I believe it can be modified by divergent experiences, but acknowledge this change may be difficult. Whilst I have extensive experience of working with loss, I now appreciate how early formative attachments influence our reactions to such loss and how these reactions may impact on the therapeutic relationship. Popular grief models clearly fall short in addressing the multi-layered losses experienced by this client group, demanding instead the integration of what is currently available.

The high level of insecure attachment style demonstrated in HIV+ gay men may be due in part to the unique challenges they face within the context of HIV related stigma and negative social experiences. Finally, I believe my knowledge of theory and sensitive application of skills has proved to be an effective strategy in working competently, sensitively and safely with this client group. Nonetheless, I recognise the need for continuous professional development and aim to attend workshops on attachment; and mental health and HIV during the summer.

The aim of the essay is to show an understanding of the value of effective multi-agency working in supporting children and families. It is mentioned in the department of education (2012) that multi – agency working is a way of bringing together practioners from different professions to give additional support to children and family who need it. Because children and their family needs can be very different it is ensured that right professionals are involved in the service provided, which might involve people from social work, health, education, early years, youth work, police and youth justice etc.

When providing support for the children and their families it is important that practioners have an ability to provide a child centred and a holistic approach to contribute to the best support possible. Holistic approach means considering the physical, emotional, social, psychological and spiritual development and as well looking at it in a wider context. (FdA Early Childhood Studies 2012a)

Department of Education (2012) mentions Multi-agency working as a generic term and is organised differently in every place, For Example it can be a team of professionals working around particular needs of a child or family, based on an area or just an establishment. The services work together within a unit or with other services and also have regular meetings for improvement of services.

Multi-agency working provides benefits for children, young people and families because they support in the most efficient way, needs of the children and families are addressed more appropriately because of better quality services.. For example it provides with early identification and intervention, and keeping in mind the holistic needs, it provides better support for parents. Helping children leads to improved achievement in education and better concentration in education.

Worden (1996) states that in situations where a child has lost a parent can be a very hard time for the children, because parents are the most important people in children’s life. This can affect them both physically and emotionally. Penny (2005) states the community based figures on parent’s report of their children, aged five to sixteen who have experienced bereavement of a parent or a sibling is 3.5 %. Parkes (1993) in Machin (2009) implicates that sometimes loss takes place suddenly leaving no time for preparation.

And the impact of loss always exists. Erikson (1980) mentioned in Machin (2009) says that the psychosocial developments occurring across the child’s life p has changes such as losses and gains. The losses cause emotional distress, give grief. It is clear that from his life p theory from birth to death, challenges contribute to personal and social development. To this developmental process relationships or people form an important part of the life p. Littlejohn (2013) refers to Bowlby’s Theory of Attachment (1960) who believed that when the primary carer or the important figure of the child is unavailable, they respond in detachment and also may affect their ability to form caring relationship in life.

Bowlby states that the children go through three stages of separation response: children might show anxiety, Show hopelessness due to the grief and feel detached. Bowlby also mentions that children and adults go through four phases of grieving process. Stage a: Shock, Stage b: Searching, protesting and yearning, Stage c: Anger or depression and Stage d: Accepting and re- adjustment. Parke, Gauvain (2009) mentions that Urie Bronfenbrenner (1979) suggests that whatever happens in the microsystem that is an individual’s experience in one particular setting, which is the family, in the case of children experiencing loss when one of the parent dies, the experience is very direct and the other settings in the microsystem are home, school and church etc.

The mesosystem is the connection and relationships between microsystems, e.g. home/school, and church/family. Thus Bronfenbrenner states that the environment & emotions of the family can have direct effect on the child. (FDA Early Childhood Studies 2012 b). Penny (2005) mentions that Wendy Stainton Roger’s three main ways of determining the best children bereavement services as a ‘needs discourse’, a ‘rights disclourse’ and a ‘quality of life disclourse’. In the ‘needs’ disclourse Worden (1996) cited in Penny (2005) gives two alternative approaches to provide the children’s bereavement service.

One is to wait till the child is showing difficulties with bereavement, which means waiting for the child to show emotional/behavioural distress and then to intervene. Stokes (2004) cited in Penny (2005)argues that this type of intervention could result in some children missing out the service that could be helpful to them. The other method would be to measure the children at risk by using a screening instrument. Stokes again argues that this may not accurately reflect the experience of the family. Thus ‘needs’ disclourse alone cannot be used for child’s bereavement service.

The ‘rights’ disclourse is an approach where the children’s needs must be met. Children’s right in the UN Convention of the Rights of the Child (1989) says the children have the rights to be protected from abuse and exploitation, have services to promote their healthy development and participation in decision making .the problem with children’s rights is that it conflicts with needs, and hence require careful balancing. For example where the child’s right to be protected from what an adult considers as harmful for the children.

The ‘quality of life’ discourse is about the best interest of the child, as it meets the ‘needs’ and the ‘rights’ discourse.in this approach the children’s welfare is taken into account with the concerns, values, resources and families and community in which children are brought up. This holistic approach is to support resilience, which is to help children overcome whatever the life challenges they face. Every Child Matters (2003) aim to support the child to be healthy, stay safe, enjoy and achieve, Make a positive contribution and achieve economic well-being.

In this it supports the services for bereaved children and families, which include early intervention and prevention, having support in transition and for the family. The Children’s trust brings together police, health and the voluntary sector, and the other agencies to be involved in community based bereavement services. For example The End of Life Care strategy makes provision for bereavement care, which helps children cope with the death of their close ones.

Children who experience grief are support by services such as Hospice movement which support the dying and the children and the families of those who are experiencing loss. The Winston’s wish in Gloucestershire in 1992 gives a good support to children and families who have a hard time experiencing loss. These services help children through listening, doing activities, which help them talk about their lost loved ones and also form bond with the other family members. Penny (2005) mentions Rolls and Payne (2004) that identified objectives leading to interventions, which are
followed by the children bereavement services and additional training, supervision are often offered.

The interventions offered to children are to help make sense of what has happened and the how they feel; it helps provide a secure environment for exploring, help with expressing feelings, improve communication between family members and help bonding. It helps the children to manage their emotions and feelings, thus help create memories, reduce the feeling of isolated and help move forward in life and have hope for the future. There are two types of service. Restricted and open access. Restricted service is mainly for group children who have experienced bereavement because of particular causes such as life threating illness.

Open access service offer service and support to children and families whatever type and circumstances of death, the only restriction in that would be the age of the child and the area they live in. In this type of service when death is anticipated, information, guidance and support is given to the family and children before and afterwards. I the death is sudden or tragic, additional support is offered may be offered by hospital, police, victim support, social work team etc. If children show difficulties at a late stage, help can be offered through school counsellor, educational psychologist and in extreme situation can be referred to child and adolescent mental health services.

Multi agency team thus improve children and their families’ quality of life and make sure the child bereavement service is available to all children and as professionals it is important to take into account different and changing situations. Professionals work in partnership with the children, their families, the school the child goes to and community the children are from to the best interest of the children.

I have been very lucky in that I have not suffered the loss of an immediate family member or significant other; however, I have suffered the loss of a family member that was incredibly important to me during my childhood and with whom I was particularly close: my aunt. In this paper, I discuss this loss and my own process of grief.

I present this process more-or-less chronologically, bringing up relevant theories of loss along the way. When I was young, my family lived a short distance away from my aunt and her family. Her son, my cousin, was about the same age as me, and we spent a lot of time together.

During the summers, I was at their house every day, and we took extended vacations together every summer. During the school year, weekends were spent at her house, and it was often she who picked me up from school. Because we spent so much time together, we developed quite a close relationship. Later on, my family moved, but I called my aunt at least once a week, and I spent as much time as possible with her. In addition to being my godmother, she easily became my confidant, someone who I could talk to about anything, and I loved being able to spend time with her.

The bad news about her diagnosis with cancer (a rare form of leukaemia) came when I was 13. The entire family rallied behind her. When she tried a macrobiotic diet, we all joined her. When doctors suggested a bone marrow transplant, everyone who was eligible got tested to see if they were a match. When she needed frequent blood transfusions, we all got our blood tested to see if our blood would be better for her than the supply in the blood bank. Throughout this whole process, the thought that my aunt could die never crossed my mind.

I never even considered it as a possibility: even when she lost all her hair from chemotherapy, even when she lost too much weight, even when she was incredibly pale from anaemia. It is quite possible that my uncle, her primary caregiver, suffered from anticipatory grief, or grief suffered in anticipation of death. Mallon (2008) remarked that this type of grief can be experienced by the person who is dying as well as their family. When I moved away from home, I still talked to my aunt frequently. Every time I talked to her, she sounded in such good health.

The last time I talked to her, she was being very active and had taken up playing tennis. I called her for her birthday, but she wasn’t home, so I left her a message on her answering machine wishing her happy birthday and saying that I would call her back. My life was very hectic at that time, and I didn’t get a chance to call her for a couple of days. Three days after her birthday, my mom called me and told me that my aunt was in the hospital with internal bleeding. She told me that it was serious and that I should try to come home to see my aunt. I got off the phone and bought a plane ticket for the next day.

I called my mom back to tell her when I would arrive, and as I was talking to her, she received the news that my aunt had died. I was in complete shock. I could not understand how this could have happened. I was on the phone with my mom, and I couldn’t say anything. One of my first reactions was feeling guilt. I felt so guilty for thinking that all my little stresses were so important that I couldn’t take five minutes to call my aunt and wish her a happy birthday. I wondered if my aunt knew how much I loved her and how much she meant to me. My mom stayed on the phone with me as long as she could, but she had other phone calls to make.

I was geographically distanced from my family, and all I wanted to do was be with people who had known my aunt, who understood what a wonderful person she was, and who knew how much she meant to me. I called some friends, and they came over to keep me company. I am very grateful that they were there for me, but at the time, all I could think about was how much I wanted to be with my family. The next day, I flew to my aunt’s home town for the funeral. The whole extended family was there as were about a hundred of the people who knew her well. Because she was cremated, there was no visitation.

While I respect this decision for cremation, I would have very much appreciated the chance to see my aunt one last time. At the church, in place of the coffin, there was a framed picture of my aunt in front of the urn carrying her ashes. The service was very personalized. Even if I had not considered the fact that my aunt might die, she and my uncle had put a lot of thought into her memorial service. They had chosen music that had meaning for them, including the song they first danced to at their wedding. This personalized service falls in line with a characteristic of modern-day Western memorials cited by Valentine (2006).

The author mentions qualitative research that has shown that these memorials are “often creative and highly idiosynchratic [sic], reflecting the tastes and the emotions of the family involved” (Bradbury, 2001, p. 221; cited in Valentine, 2006). During the service, I noticed a lot of different grieving styles. Some, like myself, cried a lot. Others, like my grandmother, made a concerted effort not to cry (or at least not to let anyone see them cry). My grandmother actually wore sunglasses in the church so that no one could see her tears. At the time, I wondered why she did not want anyone to witness her sorrow.

After all losing a child (even one who is grown up) must be one of the greatest losses one could experience. Immediately after the service, there was a reception at the church. All of my aunt’s friends and colleagues from her work came and introduced themselves to the family and spoke about how wonderful a person my aunt was. At the time, I found this ritual to be a bit strange. I wanted to go back to her house and be with my family. Looking back on this experience, however, I see that these people wanted us to know how influential a person my aunt was outside of the context in which we best knew her.

They also wanted to be there to support us in our time of sorrow. Now, I am very appreciative of their kind thoughts. When we returned to my aunt’s house, I noticed a huge collection of butterflies flying around her front porch. This was such an odd occurrence that I now always associate butterflies with my aunt. Whenever I see a butterfly, I think of my aunt and imagine that she is watching over me. This association came later in the grieving process and is an example of what has been termed continuing bonds. At the house, someone had laid out plates and plates of food.

There was even more food (including seven hams) in the refrigerator and freezer. At the time, the last thing any of us could think about was eating, and I thought how bizarre it is that when someone dies, friends and neighbours rush over with casseroles and hams. After reflecting upon this experience, it seems that this is their way of showing they care. While they cannot really do anything to ease our suffering, they can at least ensure that the family has all of their material needs so that they can focus their attention on the grieving process.

The family gathered around albums of photos. We told stories about my aunt. This reminiscing meant a lot to me. At last, I had a chance to talk to people who knew my aunt. We told stories about all of the great summer vacations, about all of the times my aunt caught us kids doing things we weren’t supposed to be doing, about all of her volunteer work, about all of the kids she had mentored, about what she was like as a young girl, about how she met my uncle, and about how she and my mom became best friends. All of these stories were very therapeutic for me.

They gave me further knowledge about my aunt and solidified my conception of her as being a defining influence on my life. Although I wasn’t quite ready to accept the fact that she was gone, I was beginning to realize that she would never really be gone because her existence had marked me as a person. How I lived my life was a reflection of her. Without her, I would not be who I am now. The way in which I look at this is another example of a continuing bond, though this one is more intangible than the butterflies mentioned above.

Now that I am fully able to embrace this idea, I feel that I have moved through the grieving process, at least for the primary loss of my aunt. I still have not, however, fully dealt with the secondary loss. After my aunt’s death, my uncle (my godfather) distanced himself from our family. Perhaps we remind him too much of his wife. Perhaps he feels that he has no connection to us without her as she was our blood relative. I, however, will always consider him to be part of my family, and I am a bit angry that he doesn’t want to continue having a relationship with me.

Valentine (2006) remarks that bereavement has been traditionally marginalized and that the primary goal of grief counselling has been the severing of ties and attachments with the deceased. This is the type of thought that underlies many of the different “stages of grief” theories. One example of a “stages of grief theory” is that of Kubler-Ross. Kubler-Ross (1997) developed a five-stage model for the grief process: denial, anger, bargaining, depression, and acceptance. Another example is Parkes’s three phases of grief, modelled on the four-phase model of Bowlby.

Each of these theories seems to conceive of grief as a linear process: there are stages that an individual must pass through on the way to accepting, or adjusting to, their loss. For me at least, these theories do not describe my own experience of dealing with grief. For example, I never passed through the denial, anger, and bargaining phases of Kubler-Ross’s model. One model that resonates well with my own experiences is Bowlby’s four stages of grief (1980). In an earlier work, Bowlby outlined his theory of attachment, whereby individuals develop emotional bonds with others.

Death disrupts this attachment bond, and the bereaved then passes through four phases: numbness and disbelief, yearning and searching, disorganization and despair, and reorganization (Bowbly, 1980). In my experience, I had definitely developed an attachment bond with my aunt. When my mom first told me that my aunt had died, I was in disbelief. I began to pass through the second stage immediately after the funeral. At first I was not able to sit still, I simultaneously wanted to be in my aunt’s home with my family and to walk in the woods around her house alone.

All of the reminiscing my family did gave me an outlet for my preoccupations with thoughts of my aunt. Once I returned home, her death really hit me (stage three). I was once again geographically distanced from my family, and I was beginning to realize that I would never have the chance to talk to my aunt again, to ask for advice, and to go for walks on the beach. Eventually, I was able to get to stage four through the acknowledgment of continuing bonds. Klass, Silverman, and Nickman (1996) presented the idea of continuing bonds.

This model contrasts traditional notions of bereavement in that it does not emphasize completely detaching oneself from the deceased. By creating continuing bonds, the bereaved can continue to have a sort of relationship with their loved one after death. For me, I have developed two continuing bonds with my aunt. The first is whenever I see a butterfly, I think of my aunt and imagine her looking out for me. These moments allow me to reflect, at least briefly, on the course of my life and question whether I am holding to the ethical and moral principles she instilled in me.

The second continuing bond is related to the first. I acknowledge the fact that part of who I am is a result of her influence. I know the kind of person she was, and I turned to her so many times for advice, that I can still hear her voice inside my head and I know what she would say to me. Both of these continuing bonds illustrate Klass, Silverman, and Nickman’s (1996) concept of continuing bonds as active relationships, as opposed to static memories. In conclusion, grieving is a complex process that every individual will experience differently.

An individual’s process will be determined by their relationship with the deceased, the support of family and friends, cultural and societal factors, and how they are able to re-interpret their relationship with the deceased. Scholars from many different fields have developed different models for the grieving process. For me, the model that fit the best was Bowlby’s attachment theory and four phases of grief. Continuing bonds, as described by Klass, Silverman, and Nickman, was essential for me to move through the grieving process.

References

• Bowlby, J. (1980). Loss: Sadness & Depression. London: Hogarth Press. Hooyman, N. R. & Kramer, B. J. (2006).
• Living through Loss: Interventions Across the Life Span. New York: Columbia University Press. Klass, D. , Silverman, P. R. , & Nickman, S. Continuing Bonds: New Understandings of Grief. London: Taylor & Francis. Kubler-Ross, E. (1997).
• On Death and Dying. New York: Scribner. Mallon, B. (2008).
• Dying, Death and Grief. Thousand Oaks: Sage Publications. Valentine, C. (2006).
• Academic constructions of bereavement. Mortality, 1 (11), 57-78.

What is loss? What is grief? Loss is most often equated to death but generally, “loss occurs when an event is perceived to be negative by individuals involved, and it results in long-term changes in one’s social situations, relationships, or way of viewing the world and oneself” (Marriage and Family Encyclopedia 2008). One tends to experience loss in one’s lifetime. Children usually experience loss through a death of a pet or a parent. Adults likewise experience loss through death of a spouse or because of divorce; they may also experience job or health losses.

When we value something or someone that we lost, we experience grief. “Grief is the psyche’s natural healing response when faced with change and loss” (PsychCentral 2008). This suggests that grief is a normal and natural experience to a person who has experienced personal loss. Furthermore, it is said to be a “process, not an event” (PsychCentral 2008) which means that grief should be allowed and given time to completely take place. Strayhorn enumerates the characteristics of grief (PsychCentral 2008). First, he says that pain is a natural part of grieving.

One may choose to repress or ignore the pain but he says that further losses in life can always trigger it and eventually, the hurt only doubles. Second, he maintains that ‘grieving is a highly individualized process’ (PsychCentral 2008). This demonstrates how different each person is while in grief. Though grief is said to be a universal and a natural occurrence, the way one person grieves differs from another. Furthermore, being aware of the five stages of grief: “shock, anger, bargaining, depression, acceptance” (PsychCentral 2008) helps one to cope with grief.

Lastly, Strayhom states that “grief has no timetable” (PsychCentral 2008). Grief therefore should be allowed to take its own course. However, each individual in the process of grieving should also do activities to help them heal. Constantly sharing ones deepest sentiments to a trusted friend is always beneficial to a person in grief. There have been known grief responses, “such as a yearning for the lost person or state of affairs, a need to think repeatedly about past events, a sense of guilt, or even thoughts of suicide.

(Death Reference 2008)” According to the Death Reference website (2008), Terry Martin and Kenneth Doka formulated 3 basic patterns of grief. First is the Intuitive Pattern, where the griever freely manifests his/her feelings. He/She can display intense emotions such as outbursts and crying. Any means to allow the griever to vent out his/her emotions is beneficial for coping. Second is the Instrumental Pattern where the griever would recall memories of the dead person and doing something in relation to those thoughts.

An example cited by Martin and Doka (1999) where a man who has lost his daughter in a vehicular accident fixed the fence which his daughter has ruined during the accident. He said that it was the only thing he could repair. Third is the Dissonant Pattern. “Dissonant grievers are those who experience grief in one pattern but who are inhibited from finding compatible ways to express or adapt to grief that are compatible with their experience” (Death Reference 2008). For instance, when a man loses his wife, he can feel the urge to cry with his daughters and to show weakness.

However, he chooses to keep it, as it is inappropriate for a man to do so. Women who lose spouses can experience the same situation, when she inhibits emotions and puts up a strong stance to protect her children. Loss and Grief on Different Perspectives There have been various studies about grief and prove that its characteristics are individualized and unique. On the one hand, children, grieve differently from adults (PsychCentral 2008). Young kids often think that the person who died will soon come back as seen in cartoon shows.

Meanwhile, there are signs which tell whether the child is experiencing significant grief. He/She tends to become immature for his/her age and there is also a considerable decrease in school performance. When these are present, Cohen advises the child be seen by a child psychologist (PsychCentral 2008). On the other hand, men and women also have distinct characteristics of grief. In an article written by Karen Carney in PsychCentral (2008), she enumerates the key points on how men grieve basing from Tom Golden’s book entitled ‘Swallowed by a Snake: The Gift of the Masculine Side of Healing’ (1997).

Golden mentions that counselors tend to use approaches similar to what they use towards women, which was later on found to be ineffective to men. Men usually cope by busying themselves with any activity that would either use the mind or the body (PsychCentral 2008). Moreover, men try to go on living their lives as normal as possible like going on their usual routine. In contrast, women are attached to their feelings. They have the tendency to recall memories of the loved one who died (Linda-Angel 2005).

It is significant to note that there are differences between the characteristics of the male and female human brain, which can be a cause of the distinction on how each sex grieves (PsychCentral 2008). In a study by Buchebner-Ferstl (2002), she mentions the differences between how a woman and a man deal with loss of a loved one (death). She said that women have broader social networks than men, and that women are often the source of social support between the couple. Being the case, she says that some experts would conclude that because of this, women cope better with loss.

Moreover, “women are said to have a more emotionally-oriented behaviour, and men are said to be more problem-oriented” (Buchebner-Ferstl 2002). This means that women are more geared than men to grieve and share their emotions with other people. In addition to this, she mentions that research shows that women are said to have a “stronger sense of survivability … [and] men are biologically more susceptible to the negative effects of stressors” (Buchebner-Ferstl 2002). This demonstrates that women are more apt to survive loss than men.

Also, it was mentioned in the Death Reference website (2007) that men were socially conditioned to hide their emotions. In contrast, women can openly share their feelings to other people, allowing grief to take its course. Further, Louis LeGrand states that the gender difference “does not mean that men are not grieving; it does indicate that they may not accomplish the task as successfully as women” (LeGrand 1986:31). In a research conducted by Martin and Doka (1999), the differences between how women and men grieve were tackled.

There are societies where the sight of a man crying in grief is as acceptable as when a woman does (Death Reference 2008). Additionally, cultures differ in valuing relationships and attachment towards people and things, thus they also differ in grief experiences. Models of Loss and Grief There have been a number of loss and grief models that is based on the notion that every person in grief goes more or less in ‘the same sequence of stages in the recovery from grief, and at relatively the same speed’(Slap-Shelton 2008).

This model appears to define the stages of dying, phases of grief and is applicable not only to death but in other losses such as divorce or a break up. In the University of Kentucky website, Kastenbaum criticizes Kubler-Ross’s model, saying that these are not supposed to be stages as they do not happen chronologically (1998).

In addition, he says that all these five stages are not necessarily undergone by a person dying or grieving. He further maintains that grief is unique to every individual (University of Kentucky 1998). This demonstrates that these stages limit the process of grieving which is supposed to be individualized. Following this, various theoretical models on loss and grief were formulated. Charles Corr, specifically believed in the individuality of coping with death (University of Kentucky 1998). People differ in values therefore they also differ in need and coping mechanism for the same experience of loss.

Meanwhile, Worden, Leick & Davidsen-Nielson (1991) proposed four means to understand loss and help accept its reality. First, one should recognize the fact that someone died or left for good. Second, one should not suppress the emotions but let them take their course. According to Slap-Shelton, (1998) among the intense emotions that one can feel during loss include “sadness, despair, anger, guilt, fear, loneliness, shame, jealousy. ” Furthermore, to allow feeling these and letting these manifest will help in recovering over the loss.

Third, it is advisable to let in something new in your life. For instance, one can learn a new skill or find a new set of friends. Through the process the person who experienced loss can grow despite the circumstance. Lastly, one ought to “reinvest emotional energy into the present” (Slap-Shelton 1998). This means that the bereaved person should focus on what is ahead and what he/she can do to live this new life without the person who died. Some, for example, do activities that commemorate and celebrate the goodness of the dead person.

Furthermore, grief can be more understood in two other perspectives: psychoanalytic and attachment perspectives Basing from psychoanalysis, grief stems out of the griever’s uncertainty of where his/her relationship stands, now that the partner died. At the same time, “the psychological function of grief is to free the individual of the tie to the deceased and allow him or her to achieve a gradual detachment by means of a process of grief work” (Death Reference 2008). Many counselors and therapists have been influenced by this however such theory has also been criticized.

On the other hand, Bowlby’s theory was based on the biological aspects of grieving. He maintains “that the biological function of grief was to regain proximity to the attachment figure, separation from which had caused anxiety” (Death Reference 2008). This means that when humans are separated from a figure whom or which they had attachment to, this results to reactions of grief. Conclusion According to the Marriage and Family Encyclopedia (2008), more recent models on loss and grief are now focused on “identifying symptoms [rather than] the process of grieving” (Marriage and Family Encyclopedia 2008).

Stroebe and Schut (1990) formulated the Dual Process Model of Coping. Humans cope with grief with a combination of both “loss orientation” and “restoration orientation”. Loss orientation is allowing grief to take place for instance crying and reaching out to others while restoration orientation is “adjusting to the many changes triggered by loss” by engaging in new activities. Such dual model recognizes grief as a “dynamic and fluctuating process, labeled ‘oscillation,’ that incorporates confrontation and avoidance of different components at different times, and includes both positive and negative reappraisals” (Death Reference 2008).

For instance, a man who lost his wife learns how to paint and takes pleasure in the activity (restoration orientation). However in the process, he is asked to paint a memorable place and thus reminded of the wife who has died and feels sad about it (loss orientation). Basing from the literature reviewed, grief can be described as universal since all humans at one point in their lives experience grief. Grief is natural since it is said to be an inevitable response to loss. However, there has not been an encompassing theory that can gauge grief; perhaps due to its vastness and complexity.