Grief Through the Life-Cycle

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Grief Through the Life-Cycle. Kenneth J. Doka, PhD Professor of Gerontology, The College of New Rochelle Senior Consultant, The Hospice Foundation of America. Goals. Understand how orientation toward death changes through the life-cycle Discuss how development affects mourning - PowerPoint PPT Presentation


Grief Through the Life-Cycle

Grief Through the Life-CycleKenneth J. Doka, PhDProfessor of Gerontology, The College of New RochelleSenior Consultant, The Hospice Foundation of America

1GoalsUnderstand how orientation toward death changes through the life-cycleDiscuss how development affects mourningDescribe developmentally expected loss and indicate the ways unexpected loss complicates griefDiscuss interventive techniques at each stage of the life-cycle2Loss through the LifecycleThree Critical ConceptsDevelopmental LevelDevelopmental ExpectationOther VariablesCultureGender or Style3Developmental Perspectives on Death4Developmental LevelsThroughout life, our orientation toward death changes

Recognition Realization Reconciliation

5The Kingdom Where Nobody DiesThe myth of children and loss

6Children Historically Dealt with Death and LossFairy TalesGamesBooks and StoriesJokesSongs

7Children Are Constantly Exposed to Death NowTelevisionNewsMoviesVideo GamesLife Experiences

8Death Images and ChildrenKastenbaum notes that children now are habitualized to death That means that violent images are so widespread, it takes much more to shock

9Yet, Children Are Constantly DevelopingCognitivelyEmotionallySociallySpiritually

10Young ChildrenAnimisticArtificialisticBlur boundaries between life and deathYet, all gone an early concept

11Children Develop in Their Cognitive Mastery of DeathConceptualizing DeathUniversalityAll encompassingInevitableUnpredictableNonfunctionalityIrreversibilityCausalityContinuation(Brent and Speece)

12Young Children Have a Short Feeling SpanThey can sustain intense emotions for a short time (Crenshaw)Implications for counseling

13Children Develop SociallyCooleys Play and Game StageThe Development of Empathy

14Children as Spiritual PioneersR. Coles, The Spiritual Lives of Children

15Development Continues Through AdolescenceYoungMiddleOld

16Death is a Significant Undercurrent in AdolescenceThe Three Is Independence, Identity, IntimacyTime of critical evaluationSignificant separationsProblematic experiences of deathDefended against by present orientation

17Early AdulthoodFocused on ExternalsYet, Spirituality and Mate SelectionChild-Raising and Spiritual Values

18Middle AdulthoodThe Awareness of MortalityDeath of ParentsEvidence of AgingDeath of PeersThe Additive Effect40 + 40 = 8055 + 55 = 110

19The Awareness of MortalityImplicationsRise in Death AnxietyPreparation for DeathConcern for HealthRenewed Zest in LifeRe-evaluation of PrioritiesRenewed Spirituality

20Awareness of MortalityTo suspect you are mortal is the beginning of terror; to know beyond doubt that you are mortal is the end of terror.F. Herbert

The Awareness of Finitude As individuals move into later life, they begin to acknowledge the closeness of deathLanguageThis creates both a need to make sense of life and death(Marshall)

The ParadoxOlder adults may want and need to talk about death just at the time it is most difficult for their adult children

23Understanding the Grieving Process24Loss and Grief in Children and Adolescence25Children Are Embedded in Webs of RelationshipsFamilyFriendsNeighborsTeachersCoachesSchoolFaith Communities

26Children Experience Many LossesDeathDivorceSeparationLoss of DreamsRelocation

27Some Losses May Be CatastrophicAbandonmentFoster Care PlacementFire, DisasterHomelessness, Eviction, Rapid Relocation28At What Age Can Children Mourn?With object constancy (around 3 years-old)Only with adolescent development of identity

29Wordens AnswerChildren mourn at any age but different from adults30My CommentChildren mourn at any age but different from and similar to adults

31Grief May Be Manifested in Many WaysPhysicallyEmotionally CognitivelySpirituallyBehaviorally32The Grief ProcessA Roller Coaster of Reactions

33Grief is a very individual reactionThe need to assess34Assessing GriefThe nature of the relationshipThe nature of the attachmentCircumstances of the lossPersonality and history of the individualSocial supportConcurrent stresses Health and coping abilities

35Grief is not a time-bound process that ends in detachment36AmeliorationIntensity of grief reactions diminishIndividuals function as well as they did (sometimes better) prior to the lossYet, grief has a developmental effect37Yet, there are also differencesEarly loss and the crisis of impending connection (Crenshaw)Manifestations may include acting out, sleep disturbances, regressive behaviors, accidents, changes in behavior or gradesChildren may re-grieve earlier losses

38Children and Adolescent GriefThus children and adolescents may experience periods of grief throughout the life-cycleIn early loss, the re-grief phenomenonAs the struggle with identityDevelopmental surges

39Grief takes place in a family context

The Harvard Bereavement Study isolated a number of risk factors for both the child and the family. Yet, these are best summarized as the best predictor of the childs adjustment is the ability of the surviving parent to function.40Adolescents Often Experience Difficulty as They GriefDiscomfort with differencesAbility to seek support from adultsLimits to peer supportTime of spiritual questioning41Adolescent GriefActing Out (including behaviors, substance abuse, sexual, eating disorders)School PerformanceChanges Yet, Note DevelopmentSelf-EsteemAnxiety

42Adolescent GriefThe Internet as SupportTechnology as differenceAdolescents as Digital Natives (rather than Digital Immigrants)93 % use the Internet, 79 % of 15-17 year-olds have cell phonesPrevalence of MySpace and Facebook

4343Adolescents and the InternetThe Internet allows experimentation with different personasInternet relationships can offer a sense of belongingThe Internet can offer the possibility of validation without riskThe Internet offers information independent of asking adults

4444Adolescent GriefThe Internet as SupportThe Internet offers information about griefThere are opportunities to memorialize onlineOne can express grief to peers and others in blogsOne can offer and receive support including in online support groups

4545The Internet and Adolescent Grief SupportPoints for the CounselorAsk adolescents about the Internet and if and how they are using it as they cope with their griefCreate an ongoing dialogue about their Internet use

4646Grief in AdulthoodDevelopmentally expected lossesThe trauma of developmentally unexpected loss

47Perinatal LossA potential loss for adolescents and young adultsDisenfranchised grief and perinatal loss emerging awareness of loss for mothers, continued disenfranchisement for fathers, siblings and others

48The Loss of a ChildThe Unanticipated TraumaReality unreality of lossAffective issues of injustice, guilt, angerAdjusting to a worldImpaired systemThe myth of divorceThe child and relations with othersThe issue of meaningSpiritual distress

49The Death of a ParentFilial maturity, generational stakes, the ongoing connections between parents and childrenPotentially the first significant lossDevelopmental pushAwareness of mortalitySecondary losses family relationships and family rituals, placesChildren and grandparent lossThe issue of inheritance

50Developmental ExpectationsOlder PersonsWe exist as on a battlefield amidst the dead and dyingMuriel Sparks, Momento Mori

51Older Persons May Experience Unique Issues as They Face DeathThe lack or limits of a primary caregiverImplications for hospice and discharge planningAge, ageism and ethicsWould you make the decision if the patient were younger?52Loss is a Significant Issue in Later LifeIntangible LossesTangible Losses53Significant Losses in Later LifeDeath of PeersDeath of SiblingsDeath of Spouse54Death of a SiblingKin yet peerIdentityLoss of continuity of perception and memory55The death of a spouse or life partner can have a profound impact in later life56The death of a spouse or life partner can endanger the precarious balance between the older person and his or her environment57Older SpousesPsychological and Physical MorbiditySignificantly higher rates of depression at 6 and 12 monthsSignificantly higher rates of anxietySignificantly higher rates of Cardio-Vascular DiseaseMediated by strong social support, spirituality and a sense of meaning and purposeWilliams

58Possible Health Effectscan be pronounced in older widowsJoint unfavorable environmentStress of griefChanges in lifestyle or adherence to regimen

59Age is both a facilitating and complicating factor in grief60Illustration:Older WidowsFacilitating FactorsSociety of WidowsExperience with GriefAwareness of Finitude

61Older WidowsComplicating Factors (3 Fs)FrailtyFinancesFamily and Friends (Isolation and Multiple Loss)

62WidowersThe myth of early researchStrengths include finances, ability to purchase services, opportunity for replacement/ remarriageWeakness wife as keeper of kin

63Sensitivity to Grief in Persons with DementiaValidation TherapyMrs. J and her lost babies

64How to Help65Counseling IndividualsThe Tasks of GriefAcknowledge the lossExpress manifest and latent emotionAdjust to a changed lifeRelocate the lossReconstitute faith and philosophical systems challenged by the lossWorden (Modified)66Let individuals utilize their historic strengths67Empower Natural Support Systems Through the Life-Cycle68Effective Support for ChildrenThe Value of Family Centered CounselingProvide Support for ParentsProcess their griefSkill-building including teaching them how to assist their children with secondary lossProvide Support for ChildrenGrief supportAdjusting to a new life

69Schools Can Play a Critical RoleAcademicSocial and Developmental ArenaSources of For