COGNITIVE MODEL OF BEREAVEMENT

Cognitive Model of Bereavement

Cognitive Model of Bereavement

Introduction

Grief following loss through death is considered a universal, normal human reaction as well as a highly individual one. Death of a loved one constitutes a major life cycle event encountered frequently by social workers whose roles inherently include close involvement in family and individual interventions. Treatment with bereaved persons has undergone significant changes related to development in both theoretical and applied fields. A wealth of literature has described in detail the course of grief as stages (Bowlby, 1980), phases (Ramsay, 1979; Sanders, 1989), components (Bugen, 1977), tasks (Worden, 1991), or tracks (Rubin, 1981, 1993). In the normal grieving process, reactions are expected to intensify immediately following the loss and to decrease over time (Parkes, 1975; Rando, 1993; Sanders, 1989, 1993). Grief has traditionally been seen as a healthy process that is aimed at diathesis, abandoning or letting go of commitment to one's relationship to the deceased, a process known as “grief work” (Freud, 1917/1957).

Characteristic to the grief work model is its identified sequence of stages, through which the bereaved person goes toward recovery, resolution, and acceptance of the reality of the loss. According to these models, successful grief work refers to a gradual detachment (breaking the bonds) from the deceased and reestablishing new relationships with others. More recent approaches of bereavement are reexamining the necessity of finality as a component of successful bereavement resolution. The bereavement process is viewed from these perspectives not as one leading to recovery, closure, or resolution but rather as an accommodation, whereby one continually adapts one's preexisting knowledge, emotions, and experiences to the new reality. Rather than breaking the bonds with the deceased, the idea of “continuing bonds” is proposed (Malkinson&Bar-Tur, 1999; Rubin&Malkinson, 2001; Silverman, Klass, & Nickman, 1996). The latter approaches have shifted from expecting a predetermined course and outcome of bereavement to emphasizing that there is no one predictable pathway through grief and regarding it as an idiosyncratic process (Neimeyer, 1999; Neimeyer, Keese, & Fortner, 2000). Similarly, the time framework of what is considered normal grief work has shifted from the “mythological” 12-month period resulting in individuals resuming “normal life” on its completion, and it is now recognized as a far more complicated process. Complicated grief is described as the intensification of grief that does not lead to assimilation of the loss but instead to repetitive stereotypic behavior as well as impaired functioning (Malkinson & Witztum, in press). Risk factors connected to complicated grief include traumatic circumstances of the death, which in turn can result in additional reactions such as depression, anxiety states, and post-traumatic stress disorder. Often, these coexist and overlap, stressing the importance of assessment prior to applying treatment. Research studies have set the stage for differentiating complicated grief (obsessional preoccupation with the deceased, crying, persistent yearning, and searching for the lost person) from depression (clinical signs of depression with preoccupation with self) (Prigerson et al., 1995). The implications of these findings lend themselves to differential treatment interventions for grief (psychotherapy with ...