Title: A PSYCHOLOGICAL APPROACH TO COPING WITH LOSS
1A PSYCHOLOGICAL APPROACH TO COPING WITH LOSS
BEREAVEMENT
- DR LORNA ROBBINS DR ANNA SAMPSON
- CLINICAL PSYCHOLOGY LEARNING DISABILITY SERVICE
2Aims
- 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.
3Bereavement
- 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
4Loss 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)
5Different 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)
6What usually happens after a loss?
- The way we actively grieve or mourn
- is shaped by the institutions and
- norms of our social group.
7Factors 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
8There is a commonality in responses to
bereavement and loss
9Grief responses (Worden, 1991, p.21-36)
10Kubler-RossShuchter Zisook (1993)
Loss
11THE GRIEF WHEEL Grief Education Institute,
Denver, 1986
12Disenfranchised 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.
13some 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).
14research 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.
15What 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
16Factors which may exacerbate the grief process
of loss
17Unacknowledged 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
18Case study
19Sarah
- Historical Context
- Presenting Problems Presentation
- Psychological Formulation
- Theoretical Frameworks
- Psychological Intervention
- Discussion
-
20Theoretical Framework
- Psychoanalytic theory (Freud)
- Attachment theory (Bowlby)
- Person centred (Worden)
- Cognitive Behavioural Therapy (Beck)
- Narrative Therapy (White)
- Systemic Approaches
21What should I do if Im concerned about someone I
care for
22When 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.
23When 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).
24How 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).
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26References
- 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.
27Cont
- 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)