MH3.pdf

10/24/23, 5:55 PM Realizeit for Student Theories of Grieving Among well-known theories of grieving are those posed by Elisabeth Kübler-Ross, John Bowlby, George Engel, and Mardi Horowitz. Kübler-Ross’s Stages of Grieving Elisabeth Kübler-Ross (1969) established a basis for understanding how loss...

10/24/23, 5:55 PM Realizeit for Student Theories of Grieving Among well-known theories of grieving are those posed by Elisabeth Kübler-Ross, John Bowlby, George Engel, and Mardi Horowitz. Kübler-Ross’s Stages of Grieving Elisabeth Kübler-Ross (1969) established a basis for understanding how loss affects human life. As she attended to clients with terminal illnesses, a process of dying became apparent to her. Through her observations and work with dying clients and their families, Kübler-Ross developed a model of five stages to explain what people experience as they grieve and mourn: 1. Denial is shock and disbelief regarding the loss. 2. Anger may be expressed toward God, relatives, friends, or health care providers. 3. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. 4. Depression results when awareness of the loss becomes acute. 5. Acceptance occurs when the person shows evidence of coming to terms with death. This model became a prototype for care providers as they looked for ways to understand and assist their clients in the grieving process. Bowlby’s Phases of Grieving John Bowlby, a British psychoanalyst, proposed a theory that humans instinctively attain and retain affectional bonds with significant others through attachment behaviors. These attachment behaviors are crucial to the development of a sense of security and survival. People experience the most intense emotions when forming a bond, such as falling in love, maintaining a bond such as loving someone, disrupting a bond such as in a divorce, and renewing an attachment such as resolving a conflict or renewing a relationship (Bowlby, 1980). An attachment that is maintained is a source of security; an attachment that is renewed is a source of joy. When a bond is threatened or broken, however, the person responds with anxiety, protest, and anger. Bowlby described the grieving process as having four phases: 1. Experiencing numbness and denying the loss 2. Emotionally yearning for the lost loved one and protesting the permanence of the loss 3. Experiencing cognitive disorganization and emotional despair with difficulty functioning in the everyday world 4. Reorganizing and reintegrating the sense of self to pull life back together Engel’s Stages of Grieving George Engel (1964) described five stages of grieving as follows: 1. Shock and disbelief: The initial reaction to a loss is a stunned, numb feeling accompanied by refusal to acknowledge the reality of the loss in an attempt to protect the self against overwhelming stress. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IetnHmRY1md1CtRnQeNY%2brWCRNLakkO6eu8lPN0Va2… 1/4 10/24/23, 5:55 PM Realizeit for Student 2. Developing awareness: As the individual begins to acknowledge the loss, there may be crying, feelings of helplessness, frustration, despair, and anger that can be directed at self or others, including God or the deceased person. 3. Restitution: Participation in the rituals associated with death, such as a funeral, wake, family gathering, or religious ceremonies that help the individual accept the reality of the loss and begin the recovery process. 4. Resolution of the loss: The individual is preoccupied with the loss, the lost person or object is idealized, and the mourner may even imitate the lost person. Eventually, the preoccupation decreases, usually in a year or perhaps more. 5. Recovery: The previous preoccupation and obsession ends, and the individual is able to go on with life in a way that encompasses the loss. Horowitz’s Stages of Loss and Adaptation Mardi Horowitz (2001) divides normal grief into four stages of loss and adaptation: 1. Outcry: First realization of the loss. Outcry may be outward, expressed by screaming, yelling, crying, or collapse. Outcry feeling can also be suppressed as the person appears stoic, trying to maintain emotional control. Either way, outcry feelings take a great deal of energy to sustain and tend to be short-lived. 2. Denial and intrusion: People move back and forth during this stage between denial and intrusion. During denial, the person becomes so distracted or involved in activities that he or she sometimes isn’t thinking about the loss. At other times, the loss and all it represents intrudes into every moment and activity, and feelings are quite intense again. 3. Working through: As time passes, the person spends less time bouncing back and forth between denial and intrusion, and the emotions are not as intense and overwhelming. The person still thinks about the loss, but also begins to find new ways of managing life after loss. 4. Completion: Life begins to feel “normal” again, though life is different after the loss. Memories are less painful and do not regularly interfere with day-to-day life. Episodes of intense feelings may occur, especially around anniversary dates but are transient in nature. Table 10.1 compares the stages of grieving theories. TABLE 10.1 Stages of Grieving: Comparison of Theorists Theorist/Clinician Phase I Phase II Phase III Phase IV Stage IV: Stage V: depression acceptance Stage II: anger Kübler-Ross (1969) Stage I: denial Stage III: bargaining https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IetnHmRY1md1CtRnQeNY%2brWCRNLakkO6eu8lPN0Va2… 2/4 10/24/23, 5:55 PM Realizeit for Student Emotional Bowlby (1980) yearning for the Cognitive Cognitive Numbness; loved one; disorganization; reorganization; denial protesting emotional despair; reintegrating sense permanence of the difficulty functioning of self loss Restitution—rituals Engel (1964) Shock and disbelief Developing awareness; crying, Resolution— frustrated, angry preoccupied with Recovery loss Outcry— outwardly Horowitz (2001) expressed or suppressed feelings Denial and intrusion— Working through— Completion—life fluctuate between begins to find new feels normal again, not thinking about ways of managing but different than loss and total life and the loss before the loss immersion in loss Tasks of Grieving Grieving tasks, or mourning, that the bereaved person faces involve active rather than passive participation. It is sometimes called “grief work” because it is difficult and requires tremendous effort and energy to accomplish. Rando (1984) describes tasks inherent to grieving that she calls the “six Rs:” 1. Recognize: Experiencing the loss, understanding that it is real, and that it has happened 2. React: Emotional response to loss, feeling the feelings 3. Recollect and re-experience: Memories are reviewed and relived 4. Relinquish: Accepting that the world has changed (as a result of the loss) and that there is no turning back 5. Readjust: Beginning to return to daily life; loss feels less acute and overwhelming 6. Reinvest: Accepting changes that have occurred; reentering the world, forming new relationships and commitments Worden (2008) views the tasks of grieving as the following: 1. Accepting the reality of the loss: It is common for people initially to deny that the loss has occurred; it is too painful to be acknowledged fully. Over time, the person wavers between belief and denial in https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IetnHmRY1md1CtRnQeNY%2brWCRNLakkO6eu8lPN0Va2… 3/4 10/24/23, 5:55 PM Realizeit for Student grappling with this task. Traditional rituals, such as funerals and wakes, are helpful to some individuals. 2. Working through the pain of grief: A loss causes pain, both physical and emotional, that must be acknowledged and dealt with. Attempting to avoid or suppress the pain may delay or prolong the grieving process. The intensity of pain and the way it is experienced varies among individuals, but it needs to be experienced for the person to move forward. 3. Adjusting to an environment that has changed because of the loss: It may take months for the person to realize what life will be like after the loss. When a loved one dies, roles change, relationships are absent or different, lifestyle may change, and the person’s sense of identity and self-esteem may be greatly affected. Feelings of failure, inadequacy, or helplessness at times are common. The individual must develop new coping skills, adapt to the new or changed environment, find meaning in the new life, and regain some control over life to continue to grow. Otherwise, the person can be in a state of arrested development and get stuck in mourning. 4. Emotionally relocating that which has been lost and moving on with life: The bereaved person identifies a special place for what was lost and the memories. The lost person or relationship is not forgotten or diminished in importance but rather is relocated in the mourner’s life as the person goes on to form new relationships, friends, life rituals, and moves ahead with daily life. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IetnHmRY1md1CtRnQeNY%2brWCRNLakkO6eu8lPN0Va2… 4/4