Unresolved Grief and Continuing Bonds: An Attachment Perspective

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  • This article was downloaded by: [University of Stellenbosch]On: 05 October 2014, At: 09:19Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

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    Unresolved Grief andContinuing Bonds: AnAttachment PerspectiveNigel P. Field aa Pacific Graduate School of Psychology , Palo Alto,California, USAPublished online: 23 Nov 2006.

    To cite this article: Nigel P. Field (2006) Unresolved Grief and ContinuingBonds: An Attachment Perspective, Death Studies, 30:8, 739-756, DOI:10.1080/07481180600850518

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  • UNRESOLVED GRIEF AND CONTINUING BONDS:AN ATTACHMENT PERSPECTIVE

    NIGEL P. FIELD

    Pacific Graduate School of Psychology, Palo Alto, California, USA

    Much of the contemporary bereavement literature on the continuing bond to thedeceased (CB) has emphasized its adaptiveness and given limited attention towhen it may be maladaptive. The attachment literature on disorganizedunresolved attachment classification in relation to loss, or unresolved loss, isinformative in identifying CB expressions that are indicative of failure tointegrate the death of a loved one. In this article, an important linkage is ident-ified between a prominent indicator of unresolved loss that involves a lapse in themonitoring of reasoning implying disbelief that the person is dead and the clinicalwritings of J. Bowlby (1980) and V. D. Volkan (1981) on maladaptive variantsof CB expression. The aim is to highlight the value of the attachment literature onunresolved loss in clarifying the conditions under which CB is likely to bemaladaptive.

    There is increasing agreement among bereavement theorists andpractitioners that an ongoing attachment to the deceased can bean integral part of successful adaptation to bereavement (Klass,Silverman, & Nickman, 1996). This position, commonly knownas the continuing bonds perspective, is counter to that presentedby Freud (1917=1957) in his classic work Mourning and Melan-cholia, in which he proposed that successful adaptation to lossrequired the bereaved to detach his or her psychic investment inthe deceased, or relinquish his or her attachment to thedeceased, in order to complete the mourning process.

    Much of the bereavement literature on the continuing bond tothe deceased (CB) has emphasized its adaptiveness while payingminimal attention to conditions under which it may be maladap-tive (Fraley & Shaver, 1999). Despite its value in identifying CBas a normative aspect of bereavement adjustment, and its positive

    Address correspondence to Nigel P. Field, Pacific Graduate School of Psychology, 935East Meadow Dr., Palo Alto, CA 95006. E-mail: nfield@pgsp.edu

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    Death Studies, 30: 739756, 2006Copyright # Taylor & Francis Group, LLCISSN: 0748-1187 print/1091-7683 onlineDOI: 10.1080/07481180600850518

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  • impact in drawing attention to the importance of interventions thatserve to promote such an inner bond (e.g., Neimeyer, 2001), theCB literature also may have had some unfortunate consequencesin ignoring possible maladaptive variants of CB expression. In fact,there is a tendency among those who advocate the adaptiveness ofCB to summarily dismiss classic work in the bereavement literaturethat identify maladaptive CB expressions, such as the writings ofVolkan (1981) and Bowlby (1980), on grounds that these theoristshave embraced the Freudian (1917=1957) relinquishment perspec-tive (Silverman & Klass, 1996). In this article, I will attempt to showhow there is noteworthy overlap between some of the clinicalinsights of these classic writings with empirical findings in contem-porary adult attachment literature on unresolved=disorganizedstates of mind with respect to loss, hereafter referred to as unre-solved loss, in terms of their implications for the maladaptiveuse of CB.

    In a previous paper, my colleagues and I introduced anattachment theory-based framework for distinguishing adaptiveversus maladaptive CB expressions (Field, Gao, & Paderna,2005). Here, we attempted to point out how this perspective isinformative in identifying the kinds of changes that occur in therepresentation of the relationship with the deceased in the norma-tive course of bereavement that allows for a continuing tie to thedeceased while satisfying what is required in accommodating tothe loss. This work also provided a means for distinguishing suc-cessful versus maladaptive ways of maintaining CB. The presentarticle extends this previous work in introducing the reader tothe attachment literature on unresolved loss and its relevance inidentifying maladaptive CB.

    Attachment Theory Perspective on SuccessfulMourning

    According to Bowlby, healthy mourning occurs when an individ-ual accepts both that a change has occurred in his external worldand that he is required to make corresponding changes in his inter-nal, representational world and to reorganize, and perhaps reori-ent, his attachment behavior accordingly (Bowlby, 1980).Implied here is that successful mourning is more accurately con-ceptualized as a process of transformation, or reorganization,

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  • rather than detachment per se. In this context, Bowlby recognizedthat CB could be an integral part of successful adaptation tobereavement: In his words, For many widows and widowers itis precisely because they are willing for their feelings of attachmentto the dead spouse to persist that their sense of identity is preservedand they become able to reorganize their lives along lines they findmeaningful (p. 98). As elaborated below, Bowlby also pointedout, however, that certain CB expressions may indeed be indica-tive of failure to adapt to the loss.

    Even among bereavement theorists who emphasize the role ofCB in successful adaptation to bereavement, it is understood thatthe nature of the bond is different from what it was when thedeceased was alive (e.g., Klass, 2001). Following the death, the con-nection is exclusively internal and no longer a bond involving thephysical existence of the other. Accommodation to bereavementrequires revising the mental schema of attachment to the deceasedin accord with the reality of this new life situation (Horowitz, 1990,1991). Such revision may encompass changes in the representationof the self through internalization of valued attributes of thedeceased into the ego-ideal. As well, changes will occur in the rep-resentation of the relationship with the deceased so as to adhere tothe reality of the permanence of the physical separation (Baker,2001). Despite the fact that the deceased now exists exclusivelyas an internal bond, the transformed inner representation of thedeceased nevertheless may continue to provide importantemotionally sustaining attachment functions. For example, thebereaved can mentally evoke the representation of the deceasedas a safe haven, or comforting presence, when under duress(Field et al., 2005). Likewise, they may continue to make use ofthe inner relationship with the deceased as a secure base in aproblem-solving capacity, imagining their viewpoint on practicalmatters and using this as a basis for making decisions (Field et al.,2005). CB also plays an important role in sustaining identitythrough enabling the bereaved to maintain a sense of continuityamidst the flux of change required in accommodating to the newlife situation without the deceased. CB thus can serve as an auto-nomy promoting inner resource in enhancing the bereavedscapacity to function on their own (Baker, 2001). In this respect,CB is an integral part of successful adaptation to bereavement.What is also clear, however, is that the bereaved has fully accepted

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  • the reality of the ending of the physical attachment. In fact, asargued below, it is the failure to differentiate the past from the presentand recognize that the deceased exists exclusively at the representa-tional levelor failure to recognize a clear boundary between theliving and the deadthat establishes CB as maladaptive.

    An Attachment Perspective on Complicated Mourning

    Integrating the loss of a loved one is a gradual and emotionallypainful process (Horowitz, 1990, 1991). According to attachmenttheory, news of the death leads to activation of the attachment sys-tem goal of which is to re-establish physical proximity to thedeceased (Bowlby, 1980). Because the attachment system hasevolved to respond to loss as though the separation were revers-ible, initially following the death the bereaved will engage in theeffort to achieve the attachment system goal of recovering thedeceased (Archer, 1999; Shaver & Tancredy, 2001). Hallucinationsand illusions of the deceased as well as the urge to visit placesformerly frequented by the deceased are CB expressions thatreflect such an attempt to search out the deceased (Field et al.,2005; Parkes, 1998). Given the permanence of the loss, attemptsto reclaim the deceased are met with failure; such behavior there-fore is said to be disorganized in the context of this changedenvironment (Main, Goldwyn, & Hesse, 2002). The bereavedscapacity to tolerate the emotional turmoil precipitated by suchfailed attempts at physical reunion provides the impetus for revis-ing the schema of attachment to the deceased (Horowitz, 1990,1991). From an attachment perspective, resolution of mourningis marked by termination of search behavior in recognizing theimpossibility of finding the lost figure and reorientation to every-day life and its tasks (Bowlby, 1980; Parkes, 1998).

    Although in certain respects the bereaved is said to never getover the loss (Tait & Silver, 1989), even so, the goal to reestablishphysical proximity eventually becomes disengaged in the normalcourse of bereavement (Bowlby, 1980; Parkes, 1998). It is alsothe case, however, that the bereaved may fail to integrate thelossor fail to revise the goal of reestablishing physical proxim-ityif the emotional pain precipitated by the failed searchingefforts is too overwhelming (Horowitz, 1990, 1991). The loss islikely to be particularly fear-invoking when it involves the death

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  • of a caregiver such as the death of a parent during childhood, or atraumatic event in which the bereaved directly witnessed the deathor whose life was also under threat (Green, 2001). Such circum-stances are inherently frightening in alerting the bereaved to thefact that they are helpless to protect the self or loved ones fromdanger.

    The quality of the past attachment to the deceased may alsoplay a role in the bereaveds ability to integrate the loss. Forexample, emotional turmoil may be more pronounced in bereave-ment involving an ambivalent attachment (Horowitz et al., 1984).In knowing that it is not possible to reconcile the conflict withthe other now that he or she is dead, the bereaved may experienceintense anger and guilt toward the deceased. Such unfinishedbusiness involving the deceased can be difficult to manageemotionally. Similarly, those who were highly dependent in theformer relationship with the deceasedparticularly those whorelied on the deceased for self-esteem regulationare under threatof becoming dysregulated following the death (Hagman, 1995).

    Under such conditions, the bereaved is prone to resort to anextreme form of avoidance in which the implications of the lossbecome defensively excluded from experience (Bowlby, 1973).Although functional in the short term in serving to ward off dyspho-ric affect, this defensive process will have longer term detrimentalimpact in preventing the bereaved from revising their schema ofattachment to the deceased to accomodate the permanence of theloss (Horowitz, 1990, 1991). As elaborated below, certain types ofCB may be indicative of this. Such CB expressions reflect both acontinuing search to reclaim the deceased and a defense againstacknowledging the finality of the separation. As a searching phaseexpression, CB is dissociatedor, to use Bowlbys (1980) term,segregatedfrom the knowledge that the deceased is truly dead.As an avoidance-motivated expression, it serves to ward off the painaroused when reminded of the loss. Although searching-related CBexpressions may be common early on after the death, their promi-nence at a later point after the death suggests that they are beingused defensively to ward off full appreciation of the loss. To theextent that they impede the bereaved from revising their schemaof attachment to the deceased, they can be said to be maladaptive.

    Bowlby (1980) identified various maladaptive adjustments tobereavement that are indicative of such failure to acknowledge

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  • the loss. He noted Gorers (1965) concept of mummification asone such example. As a metaphor of the Egyptian practice ofembalming the body and burying it with various provisions in prep-aration for the afterlife, mummification involves maintaining thedeceaseds possessions as they were when they were alive is anexpression of the fantasy of their continuing existence and eventualreturn. For example, bereaved parents may keep their deceasedchilds room exactly as it was when the child was alive, despite con-siderable time having elapsed since the loss. In effect, it constitutes adefensive fantasy of the deceaseds continued existence that servesto deny their death in order to ward off the pain of the loss.

    Bowlbys (1980) reference to mislocation is anotherexample that illustrates failure to integrate the loss, which involvesan attempt to inappropriately locate the deceased somewhere thatfails to acknowledge the reality of the death. One common form ofthis involves treating a new person as a substitute for the deceased,such as attempts by parents to impose characteristics of a deadsibling on a new child. This can have far-reaching negative inter-personal consequences through the distorted perceptions of theother. In the case of a surviving sibling, this can lead to majorpsychological disturbances if the parents treat the surviving childas a replica of the deceased child; in not allowing them to havean identity of their own, such children are likely to grow up witha poorly developed sense of self and lacking self-esteem in neverbeing able to live up to the idealized image of their deceasedsibling in their parents eyes. This form of mislocation implies acontinuing search to reclaim the deceased that denies the finalityof the loss.

    Volkans (1981) reference to depersonification failure in com-plicated mourning addresses a similar phenomenon. He defineddepersonification as a shift from the total human context of theobjects personality to certain of its specific functions so necessaryfor effective identification (p. 101). To reiterate, in the course ofsuccessful mourning, the representation of the relationship withthe deceased undergoes transformation in accommodating to thenew life situation brought on by the loss. This will include interna-lization of valued aspects of the deceased into the bereaveds newidentity structure precipitated by the death. An outcome of thisprocess is the instating of a clear boundary between the innerrelationship with the deceased and the former relationship as it

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  • existed prior to the death. Volkan described how in complicatedmourning this reorganization process has been stymied, such thatthe bereaved maintains an illusion of continuing contact with thedeceased in a more literal sense. This may be expressed in theform involving a wholesale ascription or projection of a personifiedrepresentation of the deceased onto another individual. Alterna-tively, it may involve a personified investment in a linking objectthat represents the totality of the deceased in an unmodified form,such as an item of clothing of the deceased. In possessing such anitem, the bereaved maintains an illusion of external contact withthe deceased. These linking objects are different from items thatsimply function to preserve a memory of the deceased divestedof any kind of magical quality found in the former that serve toembody the deceased in a personified form. Excessive involve-ment with certain items connected with the deceased at a pointwell on after the death may be indicative of this.

    Finally, mislocation can take the form of an introject whereinthe deceased is experienced as lodged within the bereaved as aforeign presence. For example, if the bereaveds prior relationshipwith the deceased was ambivalent, the latter may be experiencedas a harsh or alien presence. This is very different from the CBexpression in which the deceased is experienced as an importantrole model or guide that the bereaved emulates and identifies withas a part of their better self. Again, common among all forms ofmislocation is the personified representation of the deceased that issegregated from the knowledge that the other is truly dead.

    Unresolved Loss Attachment Classification and CB

    These types of maladaptive CB expression that are indicative offailure to integrate a loss resemble those identified in the adultattachment literature as evidence for unresolved loss. Extrapolat-ing from these empirical findings in the attachment literature onthe negative psychological implications of unresolved loss, it canbe argued that this literature at least indirectly supports that thetypes of CB expressions described above indeed are maladaptive.This literature therefore is valuable toward gaining a better under-standing of the conditions under which CB is maladaptive.

    The Adult Attachment Interview (AAI; Main, Goldwyn, &Hesse, 2002) serves as the basis for assessing unresolved loss.

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  • The AAI is a semi-structured interview designed to elicit a personsrecollections about relationships with parents and other attach-ment figures during childhood and their effects on later years.Unresolved loss classification is determined exclusively on thebasis of the interviewees discussions of loss experiences duringchildhood and adulthood. Each childhood and adult loss experi-ence is probed as follows: what the circumstances of the deathwere; how old the interviewee was at the time; what they felt aboutthe loss at the time; whether those feelings have changed; whetherthey attended the funeral; whether the loss has had any effect ontheir adult personality; and whether the loss has had any effecton their parenting. A person is classified as having unresolved lossif he or she shows marked lapses in reasoning or discourseinother words, disorganized or disoriented thoughts or beha-viorwhile discussing previous losses (Main et al., 2002). A lapsein reasoning involving disbelief that the other is dead is one of themost prominent markers of unresolved loss identifying a type ofCB expression that represents failure to integrate the loss. This isillustrated in the following examples taken from a study by Turton,Hughes, Fonagy, and Fainman (2004) on mothers unresolved lossfollowing stillbirth, described in more detail at a later point. Theselapses were significant enough to classify these women as havingunresolved loss: I used to go to the cemetery every day becauseI felt that if I didnt then she would feel like I didnt care abouther any more. But she knows were getting married on her birth-day; I wish we could have taken her home, thats the one thingI wish wed taken her inside so she couldve seen where she wasgoing to live . . . Its hard at the moment, shes (the dead baby)gonna be a year soon (Turton et al., 2004, p. 246).

    Each of these examples represent a form of unresolved loss atthe level of thinking involving failure to fully register the realityof the loss. Here, the mother continues to relate to her baby asthough the baby were still alive with needs that she must continueto be attentive toward. In effect, it represents an expression of herattachment-based caregiving system function whose goal is to pro-tect the child (for more on the caregiving system, see George &Solomon, 1999). The continued activation of her caregiving systemgoal of attempting to protect her child despite the knowledgethat they are dead attests to her failure to revise her model ofattachment to accommodate the loss, and thus identifies her as

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  • unresolved. A way of understanding the function of such CBexpressions as they are used here is that they serve as a defenseagainst the pain of the loss in keeping the pre-loss relationship alive(Turton et al., 2004). These expressions also reflect a lapse in meta-cognitive monitoring insofar that the bereaved appears to fail toappreciate that a contradiction exists between her mental represen-tation of her child as conscious with her knowledge that her childindeed is dead (for more on lapses in metacognitive monitoring,see Main, 1991).

    The AAI unresolved loss classification grew out of an attemptto explain disorganized attachment in early childhood. In fact, thenegative psychological consequences on the child has been themain focus of research attention on the effects of unresolved loss(see Hesse, Main, Abrams, & Rifkin, 2003). Disorganized attach-ment is identified via Ainsworths Strange Situation procedure(Ainsworth, Blehar, Waters, & Wall, 1978). This is a stressful situ-ation for the 12-year-old child in which in they are separated fromthe mother and left alone in a room. This separation experienceserves to activate the childs attachment system reflected in theirdisplay of distress. The childs behavior upon reuniting with themother provides a means for classifying their attachment status.Disorganized attachment is identified when the child exhibits lackof a coherent attachment strategy shown in their disoriented beha-vior indicative of conflicting motivations such as freezing, appear-ing dazed, or rapidly shifting between approach and avoidance ofthe caregiver (Main & Solomon, 1990). Because a childs disorga-nized behavior in the Strange Situation at ages 12 is predictiveof subsequent problems in their development, such as maladaptivecontrolling behavior toward the parent in middle childhood(George & Solomon, 1996) and dissociative behavior at age 16(Carlson, 1998), it can have long-term detrimental implications.

    Main and her colleagues discovered that mothers of these disor-ganized children were more likely to show the characteristic lapses inreasoning and discourse when discussing previous losses in the AAI(Main & Hesse, 1990). It appeared that these mothers were showingsimilar disorganization at the mental representational levelineffect, disorganized ideation, such as the incompatible beliefs thatthe other can be both dead and alive at the same timethat theiryoung child was showing at the behavioral level. These transgenera-tional effects have been replicated across a number of studies (for a

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  • review, see van IJzendoorn, Schuengel, & Bakermans-Kranenburg,1999). Therefore, it is a robust phenomenon.

    The aforementioned study by Turton et al. (2004) on unre-solved loss in women who suffered stillbirth and its effect on achild born subsequent to the stillbirth highlights these intergenera-tional effects. Because this study controlled for the type of loss byfocusing only on women who experience a stillbirth and also con-trolled for time since the loss, it demonstrates important methodo-logical improvements over previous research examining theintergenerational effects of unresolved loss. This study involved agroup of women whose previous pregnancy ended in stillbirthand their next-born infants along with a control group of mothersand first-born infants. A group of pregnant women who had a pre-vious stillborn child were administered the AAI during the thirdtrimester of their pregnancy. The AAI provided a means for asses-sing unresolved loss in the context of the stillbirth. A control groupconsisting of women who were similarly in the third trimester oftheir pregnancy were also administered the AAI. At 12 monthsafter the birth of their child, the infants and their mothers in boththe stillbirth and control groups were run through the Strange Situ-ation procedure. This provided a means for assessing disorganizedattachment in the child and for determining intergenerationaleffects.

    The results indicated that the infants of mothers who had aprevious stillbirth were significantly more likely to be classifiedas disorganized in their behavior in the Strange Situation relativeto infants in the control group. More importantly, in a mediationalanalysis, the effects of the mothers stillbirth experience on herchilds disorganized attachment status were explained by theeffects of the former on the mothers AAI unresolved loss classi-fication status. In other words, it was not the stillbirth per se thatled to disorganized attachment in the child, but rather whetheror not the mother was unresolved with respect to the stillbirth thatexplained the transgenerational effect. On the other hand, motherswithin the stillbirth group who were not unresolved with respect totheir previous stillbirth were no more likely to have a disorganizedinfant than mothers in the control group.

    Other work has attempted to identify the mechanism underly-ing the transgenerational effects of unresolved loss. There ismounting evidence that parents who are unresolved with respect

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  • to past losses as assessed in the AAI are more likely to exhibitmomentary frightened or frightening behavior in their interactionwith their child (see Hesse et al., 2003). It is believed that traumaticmemories linked to past losses are evoked in parents while interact-ing with their child. This results in parental behavior indicative ofdissociation that is frightening to the child. The childs fright willlead to activation of their attachment system, thus motivating thechild to seek protection from the parent. However, because theparent is the source of alarm, the child is placed in an unresolvabledilemma in which no coherent strategy can be used to cope withthe situation. Therefore, a childs disorganized behavior in theStrange Situation is an expression of an approachavoidance con-flict involving activation of fear system evoked by the presence ofthe mother motivating avoidance of her in the context of thechilds activated attachment system goal of moving toward andre-establishing proximity with the mother (Hesse et al., 2003).

    Busch (2005) has recently extended this work on maladaptiveinterpersonal functioning in the caregiver with unresolved loss inrelating to her infant to the larger family system. She examinedthe effects of mothers unresolved loss on their interpersonal func-tioning in their relationship with their 5-year-old child as well astheir husband. In a play situation involving their kindergarten-agedchild, the women with unresolved loss as assessed in the AAI weremore controlling in their parenting style and expressed greaternegative emotions in interacting with their child relative tomothers who were not unresolved. In a separate marital interactiontask that involved discussing stressful topics with their spousesuch as the division of labor, the sexual relationship, and moneymanagementthe women who were classified as unresolved inthe AAI expressed less positive emotion and were less collabora-tive with their husbands in attempting to resolve their marital con-flicts relative to women who were not unresolved. Buschs studythus highlights the negative interpersonal consequences of unre-solved loss beyond the motherinfant dyad at the larger familysystem level.

    Implications for Determining the Adaptiveness of CB

    Following from an attachment perspective on unresolved loss,determining whether CB is indicative of unresolved loss requires

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  • knowing if the given CB expression represents a lapse in the moni-toring of reason. To reiterate, cognitively, such lapses in the moni-toring of reason are understood as involving failure to recognizethat what is being said cannot be true in the external worldnamely, that a person cannot be both dead and alive at the sametime (Main, 1991). An important aspect of this is failure to recog-nize the distinction between the present and past and failure toacknowledge the permanence of the physical separation. As pre-viously mentioned, CB expressions that are indicative of unre-solved loss, such as the aforementioned examples provided byTurton et al. (2004) in their stillbirth study, also appear to be moti-vated; they are motivated insofar that the bereaved are using themdefensively to ward off the emotional pain of the loss. Thus, CB isnot simply an expression of lack of integration as understood at apurely cognitive level.

    It follows from the above that the type of CB expression islikely to be an important factor in determining whether it is indica-tive of unresolved loss. Illusory CB expressions of seeing the faceof the deceased pop out of the crowd or mistaking sounds forthe deceaseds presence, or hallucinatory images of the deceased,constitute segregated or dissociated perceptual experiences that failto appreciate the finality of the separation. They also do not dis-tinguish the past from the present in treating the deceased asthough still alive. Although early on after the death, CB expres-sions indicative of an attempt to reclaim the deceased are norma-tive, given that during this early searching phase of grief thebereaved has not fully registered the finality of the separation, suchexpressions would be expected to diminish notably in frequencyafter the initial months post-loss. Thus, if prominent at a later pointafter the death, they are indicative of unresolved loss (see Fieldet al., 2005). In fact, the attachment classification of unresolved lossis not made for deaths occurring less than one year previouslysince an unresolved state of mind is considered normative earlyon following the death of a significant other (Main et al., 2002).On the other hand, unlike illusory or hallucinatory CB expres-sions, the use of the deceased as a role model is a type of CBexpression that can fully accommodate the reality of the perma-nence of the physical separation.

    Although the type of CB expression may provide a usefulguidepost for determining whether it represents unresolved loss,

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  • it should be noted that there is unlikely to be a simple invariantrelationship between type of CB expression and grief resolution.For example, the sense of the deceased as an ongoing comfortingpresence or constant inner companion that is often reported bywidows and widowers well on after the death of their spouseappears to be part of good adaptation to bereavement (Bowlby,1980). It might be argued however that when experienced in thisway the sense of presence is more akin to memory than percep-tion. On the other hand, when the sense of presence involvesexperiencing the deceased at a discrete location and time, in whichthey are construed as an external presence, the boundary betweenthe living and dead is no longer maintained. Here, the experienceof the deceased is segregated from the knowledge that they aredead, and therefore is indicative of unresolved loss.

    An important consideration here is the bereaveds religiousbeliefs. Belief in the continuing existence of the deceased, suchas being in heaven or belief in eventually being reunited withthe deceased is not evidence for unresolved loss as long as it isrecognized that the nature of the relationship with the deceasedis qualitatively different from what existed prior to the death. Inthe case of religious rituals that function as a conduit to the worldof the dead, such as ancestor rituals, although the bereaved holdsthe belief that the deceased continues on as a spirit who has influ-ence on and can be influenced by the bereaved, there neverthelessis a clear bracketing between the world of the living and dead. InJapanese ancestor worship, during the ritual the bereaved stepsinto the world of the dead; the bereaved evokes the deceasedspresence by positioning him- or herself in front of the home alter,clapping hands and lighting candles (Goss & Klass, 2005). Theritual closes with the bereaved bowing out or stepping away fromthe land of the dead back to the world of the living. Thus, thebereaved maintains a clear boundary between the world of theliving and dead and does not confuse the two.

    A study by Yamatoto, Okonogi, Iwasaki, and Yoshimura(1969) on the process of mourning following the death of a hus-band in Japanese widows clarifies this distinction between senseof presence phenomena that adhere to the boundary betweenthe dead and the living and those that do not. They showed howthe Japanese custom of ancestor worship enabled these widowsto maintain an ongoing connection with their deceased husband

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  • that appeared to be adaptive. Although the sense of being in directcommunication with the deceased was felt when performing theritual, it nevertheless occurred in the context of the ritual settingin which the bereaved crossed the boundary from the living tothe dead and then returned to the land of the living with the endingof the ritual. This culturally prescribed deliberative enactment is inmarked contrast to other experiences reported by the same widowsinvolving unbidden illusions of seeing her husband or hearing hisvoice or footsteps, or engaging in brief searching attempts torecover her husband such as going to the streetcar stop at the timethe husband previously returned from work, that more clearly con-veyed intrusion of segregated representations of her husband asstill alive.

    In addition to its implications for identifying maladaptive CBbased on type of expression, the attachment literature on unre-solved loss has implications for identifying ways in which CBexpressions indicative of unresolved loss exert their negativeeffects beyond the individual. As reviewed above, the main focusof research attention in the attachment literature on unresolvedloss has been its intergenerational and family system effects. Thisliterature implies that an important index of whether CB is adapt-ive is if it occurs in the context of healthy communication amongfamily members. Rubins (1993) work on the effects of an adultchilds death on family functioning has shown that parents whomaintain a highly idealized CB with their deceased son that isnot shared with other family members are often overly critical oftheir other children, comparing them unfavorably to the deceasedchild. In effect, these parents may be attempting to relocate theirdeceased son in their other children at the expense of the latter.Similar to the unresolved loss attachment literature, Rubins workthus addresses the importance of assessing broader family systemeffects in determining the adaptiveness of CB.

    Limitations and Future Directions

    Despite the robust findings for the maladaptive intergenerationaleffects of unresolved loss, there has been no research assessingthe relationship between unresolved loss and complicated griefas a psychiatric syndrome. Complicated grief is characterized byextreme affective response to an interpersonal loss that is beyond

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  • what is normative in terms of extent and duration of separationdistress-related and traumatic distress-related symptoms that inter-fere with daily functioning (see Prigerson & Jacobs, 2001). In thefew studies that have assessed the relationship between unresolvedloss and subjective stress, surprisingly the results suggest that thetwo at best are only weakly related. For example, Turton et al.(2004) found no clear support for a relationship between unre-solved loss following stillbirth and PTSD despite the significantlink between unresolved loss and disorganized attachment in theirinfant born subsequent to the stillbirth. One would think, however,given that CB expressions indicative of unresolved loss are knownto have such a major effect on caregiving as to cause disorganizedattachment in the child, they should also be associated with elev-ated complicated grief symptoms. Clearly, this needs to beaddressed in future research.

    Although the AAI literature on the effects of unresolved lossappears to provide compelling empirical support for the maladap-tive consequences of CB expressions that are indicative of segre-gated systems, it should be cautioned that the findings are notconclusive; unresolved loss classification is based on other criteriain addition to lapses in reasoning involving failure to acknowledgethe reality of the death. It is possible that the findings on the mala-daptive consequences of unresolved loss are due to indicatorsother than CB expressions. It is noteworthy, however, that a signifi-cant proportion of those identified as having unresolved loss in theTurton et al. (2004) stillbirth study were based on the dead versusnot dead criterion. Nevertheless, it would be important in futureresearch to verify that similar results would be obtained if unre-solved loss was determined exclusively on the basis of thiscriterion.

    Finally, an important direction in future research would be todevelop a CB measure that could identify CB expressions indica-tive of unresolved loss. This would require going beyond simplydetermining whether the bereaved made use of particular typesof CB expression. For example, in regard to sense of presence ofthe deceased, it would be important to know whether such experi-ence had a more hallucinatory or dissociative quality to it asopposed to being more memory-like. This would entail a morein-depth enquiry addressing such things as whether the experiencewas unbidden, was of a sensory-perceptual nature, and whether the

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  • bereaved believed that the deceased was actually present. Suchenquiry would provide the information needed to determine ifthe sense of presence experience indeed was indicative of failureto acknowledge the reality of the death.

    References

    Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns ofattachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum.

    Archer, J. (1999). The nature of grief: The evolution and psychology of reactions to loss.New York: Routledge.

    Baker, J. E. (2001). Mourning and the transformation of object relationships: Evi-dence for the persistence of internal attachments. Psychoanalytic Psychology, 18,5573.

    Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger.New York: Basic Books.

    Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. New York:Basic Books.

    Busch, A. (2006). Unresolved loss: Links with observed and self-reported individ-ual, marital, and parenting adaptation. Dissertation Abstracts International, 66,pp. 4475.

    Carlson, F. A. (1998). A prospective longitudinal study of disorganized=disorientatedattachment. Child Development, 69, 11071128.

    Field, N. P., Gao, B., & Paderna, L. (2005). Continuing bonds in bereavement: Anattachment theory based perspective. Death Studies, 29, 123.

    Fraley, R. C. & Shaver, P. R. (1999). Loss and bereavement: Bowlbys theory andrecent controversies concerning grief work and the nature of detachment. InJ. Casssidy & R. R. Shaver (Eds.), Handbook of attachment theory and research(pp. 735759). New York: Guilford Press.

    Freud, S. (1917=1957). Mourning and melancholia. In J. Strachey (Ed.), Standardedition of the complete psychological works of Sigmund Freud (pp. 152170).London: Hogarth Press.

    George, C. & Solomon, J. (1996). Representational models of relationships:Links between caregiving and attachment. Infant Mental Health Journal, 17,198216.

    George, C. & Solomon, J. (1999). Attachment and caregiving: The caregivingbehavioral system. In J. Casssidy & R. R. Shaver (Eds.), Handbook of attach-ment theory and research (pp. 649670). New York: Guilford Press.

    Gorer, G. (1965). Death, grief and mourning. New York: Doubleday.Goss, R. E. & Klass, D. (2005). Dead but not lost: Grief narratives in religious tradi-

    tions. New York: Altamira Press.Green, B. L., Krupnick, J. L., & Stockton, P. (2001). Psychological outcomes asso-

    ciated with traumatic loss in a sample of young women. American BehavioralScientist, 44, 817837.

    754 N. P. Field

    Dow

    nloa

    ded

    by [

    Uni

    vers

    ity o

    f St

    elle

    nbos

    ch]

    at 0

    9:19

    05

    Oct

    ober

    201

    4

  • Hagman, G. (1995). Death of a selfobject: Toward a self psychology of the mourn-ing process. In A. Goldberg (Ed.), The impact of new ideas. Progress in selfpsychology (Vol. 11; pp. 189205). Hillsdale, NJ: Analytic Press.

    Hesse, E., Main, M., Abrams, K., & Rifkin, A. (2003). Unresolved states regardingloss or abuse canhave second-generation effects: Disorganization, roleinversion, and frightening ideation in the offspring of traumatized, non-maltreating parents. In M. Solomon & D. Siegel (Eds.), Healing trauma:Attachment, mind, body, and brain (pp. 57106). New York: W.W. Norton & Co.

    Horowitz, M. J. (1990). A model of mourning: Change in schemas of self andothers. Journal of the American Psychoanalytic Association, 38, 297324.

    Horowitz, M. J. (1991). Person schemas. In M. J. Horowitz (Ed.). Person schemasand maladaptive interpersonal patterns (pp. 1331). Chicago: The Universityof Chicago Press.

    Horowitz, M. J., Marmar, J., Krupnick, N., Wilner, N., Kaltreider, & Wallerstein,R. (1984). Personality styles and brief psychotherapy. New York: Basic Books.

    Klass, D. (2001). The inner representation of the dead child in the psychic andsocial narratives of bereaved parents. In R. A. Neimeyer (Ed.), Meaning recon-struction and the experience of loss (pp. 7794). Washington, DC: AmericanPsychological Association.

    Klass, D., Silverman, P., & Nickman, S. L. (Eds.) (1996). Continuing bonds: Newunderstandings of grief. Washington, DC: Taylor & Francis.

    Main, M. (1991). Metacognitive knowledge, metacognitive monitoring, andsingular (coherent) vs. multiple (inhoherent) model of attachment: Findingsand directions for future research. In C. M. Parkes, J. Stevenson-Hinde, &P. Marris (Eds.), Attachment across the life cycle (pp. 127159). London:Tavistock=Routledge.

    Main, M., Goldwyn, R., & Hesse, E. (2002). Adult attachment scoring and classi-fication systems (Version 7). Unpublished manual.

    Main, M. & Hesse, E. (1990). Parents unresolved traumatic experiences arerelated to infact disorganized attachment status: Is frightened and=or fright-ening parental behavior the linking mechanism? In M. T. Greenberg, D.Cicchetti, & E. M. Cummings (Eds.), Attachment in the preschool years(pp. 161182). Chicago: University of Chicago Press.

    Main, M. & Solomon, J. (1990). Procedures for identifying infants as disorgani-zed=disoriented during the ainsworth strange situation. In M. T. Greenberg,D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the preschool years(pp. 121160). Chicago: University of Chicago Press.

    Neimeyer, R. A. (2001). Reauthoring life narratives: Grief therapy as meaningreconstruction. Israel Journal of Psychiatry and Related Sciences, 38, 171183.

    Parkes, C. M. (1998). Bereavement: Studies of grief in adult life (3rd ed.). Harmonds-worth, England: Pelican Books.

    Prigerson, H. G. & Jacobs, S. C. (2001). Traumatic grief as a distinct disorder: Arationale, consensus criteria, and a preliminary empirical test. In M. S.Stroebe, R. O. Hansson, W. Stroebe, & H. Schut (Eds.), Handbook of bereave-ment research: Consequences, coping, and care. Washington, D.C.: AmericanPsychological Association.

    Unresolved Grief and Continuing Bonds 755

    Dow

    nloa

    ded

    by [

    Uni

    vers

    ity o

    f St

    elle

    nbos

    ch]

    at 0

    9:19

    05

    Oct

    ober

    201

    4

  • Rubin, S. (1993). The death of a child is forever: The life course impact of childloss. In M. Stroebe, W. Stroebe, & R. Hansson (Eds.), Handbook of bereave-ment: Theory, research, and intervention (pp. 285299). New York: CambridgeUniversity Press.

    Shaver, P. R. & Tancredy, C. M. (2001). Emotion, attachment, and bereavement:A conceptual commentary. In M. Stroebe, R. Hansson, W. Stroebe, &H. Schut (Eds.), Handbook of bereavement research: Consequences, coping, and care(pp. 6388). Washington, DC: American Psychological Association.

    Silverman, P. R. & Klass, D. (1996). Introduction: Whats the problem? InD. Klass, P. R. Silverman, & S. Nickman (Eds.), Continuing bonds: New under-standings of grief (pp. 327). Washington, DC: Taylor & Francis.

    Tait, R. & Silver, R. C. (1989). Coming to terms with major negative life events. InJ. S. Uleman & J. A. Bargh (Eds.), Unintended thought (pp. 351382).New York: Guilford Press.

    Turton, P., Hughes, P., Fonagy, P., & Fainman, D. (2004). An investigation intothe possible overlap between PTSD and unresolved responses followingstillbirth: An absence of linkage with only unresolved status predicting infantdisorganization. Attachment and Human Development, 6, 241253.

    van IJzendoorn, M. H., Schuengel, C., & Bakermans-Kranenburg, M. J. (1999).Frightening maternal behavior linking unresolved loss and disorganizedinfant attachment. Journal of Consulting and Clinical Psychology, 67, 5463.

    Volkan, V. D. (1981). Linking objects and linking phenomena. New York: Inter-national Universities Press.

    Yamamota, J., Okonogi, K., Iwasaki, T., & Yoshimura, S. (1969). Mourning inJapan. American Journal of Psychiatry, 125, 16611665.

    756 N. P. Field

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