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A PSYCHOLOGICAL APPROACH TO COPING WITH LOSS

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Psychoanalytic theory (Freud) Attachment theory (Bowlby) Person centred (Worden) ... Help the person to collate items of meaning from the past. ... – PowerPoint PPT presentation

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Title: A PSYCHOLOGICAL APPROACH TO COPING WITH LOSS


1
A PSYCHOLOGICAL APPROACH TO COPING WITH LOSS
BEREAVEMENT
  • DR LORNA ROBBINS DR ANNA SAMPSON
  • CLINICAL PSYCHOLOGY LEARNING DISABILITY SERVICE

2
Aims
  • To reflect upon models of loss bereavementand
    how these might apply to people with learning
    disabilities.
  • What is different in supporting those with
    learning disabilities through a grieving process,
    and what our role might be within that?
  • How Learning Disabilities Services in LPFT can
    help.

3
Bereavement
  • The loss of a loved one is one of the most
    intensely painful experiences any human being can
    suffer, and not only is it painful to experience,
    but also painful to witness, if only because we
    are so impotent to help
  • (Bowlby, 1980, p7) A normal human process

4
Loss Bereavement
  • Some definitions ...
  • Loss not having something you once had.
  • Bereavement Loss through death of someone you
    had a relationship with.
  • Grief psychological physiological reactions to
    loss
  • Mourning the process following loss (both
    conventions and emotions)

5
Different types of loss
  • External (moving house, loss of friends or
    carers)
  • Internal (feelings, ideas, adapting to changes)
  • Developmental (biological, social, aims goals)
  • Idiosyncratic (traumas, accidents)

6
What usually happens after a loss?
  • The way we actively grieve or mourn
  • is shaped by the institutions and
  • norms of our social group.

7
Factors that can affect the meaning and response
to loss
  • Past history
  • Current circumstances
  • Circumstances of the loss
  • Beliefs (Cultural, religious or social)
  • Coping styles
  • Social and cultural context
  • Cognitive development
  • Age
  • Gender

8
There is a commonality in responses to
bereavement and loss
9
Grief responses (Worden, 1991, p.21-36)
10
Kubler-RossShuchter Zisook (1993)
  • Stages of Grief /Loss

Loss
11
THE GRIEF WHEEL Grief Education Institute,
Denver, 1986
12
Disenfranchised Grief
  • Historically people with learning disabilities
    were not perceived to have individual needs, or
    to be aware of the thoughts and feelings of
    either themselves or those around them.
  • By the 1980s people such as Maureen Oswin began
    to discuss the normality of grief and argued that
    people with learning disabilities have the same
    right to grieve as anyone else and proposed some
    guidelines for facilitating this.
  • However the bereavement needs of some people with
    learning disabilities are still not recognised.

13
some research findings
  • Emerson (1997 ) reported that 50 of the people
    with learning disability who presented with
    sudden emotional and behavioural difficulties had
    experienced the recent death of a person close to
    them.
  • The death of a family member can trigger a need
    for crisis intervention and cause symptoms of
    complicated grief for people with learning
    disabilities (Bonell-Pascual et al. 1999 Dodd et
    al. 2005 Emerson 1997Kloeppel Hollins 1989
    MacHale Carey 2002).
  • 54 of people with learning disabilities do not
    attend their parents funeral (Hollins
    Esterhuyzen 1997). Additionally, people who have
    been excluded from the funeral or who have not
    been told about the death for some time after the
    event may need the professional help of a
    bereavement counsellor (Read 2000).

14
research findings cont
  • Aberrant behaviours and psychiatric disturbance
    are more evident in this population.
  • Behavioural expressions of grief can be
    inadvertently misdiagnosed as issues of disturbed
    challenging behaviour or as evidence of
    psychiatric disturbance. (MacHale Carey, 2002)
  • People with learning disability may exhibit
    reactions to grief which are labelled as
    'challenging behaviour' or 'psychiatrically
    disturbed' because of their limited comprehension
    and ability to express grief (Hollins
    Esterhuyzen 1997).
  • Sinason (1992) suggests that people with learning
    disabilities adopt what she calls a handicapped
    smile to adapt to societys need not to see
    their pain.

15
What is different about loss in LD?
  • Exposed to more loss and change events
  • Less control and choices and ways of expressing
    that pain
  • May not be told about their loss, or find out in
    an unhelpful way
  • May be excluded from the process of loss/change
  • May be encouraged to recover from the change/loss
    quickly and not be allowed the time to
    acknowledge, understand and deal with it

16
Factors which may exacerbate the grief process
of loss
17
Unacknowledged loss connected to
  • Moving home
  • Relationships attachments
  • Sexuality
  • Loss of a child
  • Loss of friends
  • Loss of staff
  • Loss of choice
  • Loss of dignity
  • Loss of autonomy
  • Loss of individuality

18
Case study
19
Sarah
  • Historical Context
  • Presenting Problems Presentation
  • Psychological Formulation
  • Theoretical Frameworks
  • Psychological Intervention
  • Discussion

20
Theoretical Framework
  • Psychoanalytic theory (Freud)
  • Attachment theory (Bowlby)
  • Person centred (Worden)
  • Cognitive Behavioural Therapy (Beck)
  • Narrative Therapy (White)
  • Systemic Approaches

21
What should I do if Im concerned about someone I
care for
22
When should you be worried?
  • When reactions are excessive, disproportionate or
    protracted
  • Inappropriate emotional reactions
  • Protracted apathy, increased irritability or
    aimless hyperactivity
  • Sudden unaccountable mood change
  • Serious suicidal intent
  • Changes in behaviour
  • Seem to be profoundly missing the deceased person
  • Social withdrawal
  • Assessed as not coping with bereavement.

23
When to refer on
  • Most grieving people cope with their loss in
    their own social circle (Worden,1991), however if
    more support is required.
  • Gain support from mainstream services.
  • If concerns remain a referral can be made to LPFT
    Learning Disability Service single point of
    access.
  • Where the bereavement is complicated in some way,
    or the bereavement occurred over one year
    previously, psychological intervention may be
    most appropriate.
  • Psychologists may work directly with the
    individual (e.g. psychotherapy), with the
    individual and their family, or indirectly with
    staff / carers (e.g. consultancy approach).

24
How can you help?
  • Preparatory and supportive work for thinking
    through issues related to death/loss/change
  • Listen to the person.
  • Where possible keep the person informed and
    involved about any changes. What do they think
    about it?
  • Build a life storybook with individuals which
    looks at changes in their lives and keep adding
    to it.
  • Help the person to collate items of meaning from
    the past.
  • Help individuals to develop an awareness of the
    normal life cycle, (i.e. birth-child-young
    adult-middle age-old agedeath).

25
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26
References
  • Bonell-Pascual E., Huline-Dickens S., Hollins S.,
    Esterhuyzen A.,Sedgwick P. et al. (1999)
    Bereavement and grief in adults with learning
    disabilities. A follow-up study. Br J Psychiatry,
    17534850.
  • Beck, A.T. (1976) Cognitive Therapy and the
    Emotional Disorders. New York International
    Universities Press.
  • Bowlby, J. (1980). Attachment and loss Loss,
    sadness and depression. Vol. 3. New York Basic
    Books.
  • Dodd P., Dowling S. Hollins S. (2005) A review
    of the emotional psychiatric and behavioural
    responses to bereavement in people with
    intellectual disabilities. J Intellect Disabil
    Res, 49 53743.
  • Emerson P. (1977) Covert grief reactions in
    mentally retarded clients. Mental Retardation,
    15 467.
  • Freud S. (1917) Mourning and melancholia. In
    Strachey J., editor. Standard edition of the
    complete psychological works of Sigmund Freud
    Vol. 14. London, Hogarth Press.
  • Hollins S. Esterhuyzen A. (1997) Bereavement
    and grief in adults with learning disabilities.
    Br J Psychiatry, 170 497501.
  • Kloeppel D. Hollins S. (1989) Double handicap
    mental retardation and death in the family. Death
    Studies, 13 31.

27
Cont
  • MacHale R. Carey S. (2002) An investigation of
    the effects of bereavement on mental health and
    challenging behaviour in adults with learning
    disability. British Journal of Learning
    Disabilities, 30 1137.
  • Read S . 2000. Bereavement and people with
    learning disabilities. Nursing and Residential
    Care, 2(5), 230-234
  • Sinason, V. (1986) Secondary mental handicap and
    its relationship to trauma. Psychoanalytic
    Psychotherapy, 2, 131 -154
  • Sinason, V. (1992) Mental Handicap and the Human
    Condition. London Free Association Books.
  • Worden, J. W. (1991). Grief counselling and grief
    therapy A handbook for the mental health
    practitioner (2nd ed.). New York Springer
    Publishing.
  • White, M. (1989) Re-authoring Lives. Adelaide
    Dulwich Centre Publications.
  • White, M Epston, D (1989). Literature Means to
    therapeutic ends. Adelaide Dulwich Centre
    Publications. (Republished 1990) as Narrative
    Means to therapeutic ends. New York Norton)
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