COUNSELING

Counseling



Counseling

Grief is the 'cost of commitment', as Colin Murray Parkes entitles the opening chapter of his seminal work Bereavement: Studies of Grief in Adult Life (Jacobs Mazure Prigerson 2000 185-199). Just as close attachment relationships (which may not always be loving) are a near-universal human experience, so grief following the permanent loss of such a relationship is a normal part of being human. It is also one of the most intensely painful of all human experiences. What is the role, if any, of professionals in contact with people who are going through an intensely painful but natural process? What are the indications that the process of bereavement is not pursuing a natural course, and what can mental health professionals offer in these circumstances? To address these questions, we need first to turn to what is known about the natural process of grief.

The Case

The young lady is grieving from the loss of maternal grandfather and a close cousin. She finds that she can no longer concentrate on her studies or life. She believes that her parents are unable to understand her grief.

Psychodynamic Viewpoint

Freud's paper Mourning and Melancholia (1917) (Wolfe Jordan 2000 569-584) laid the foundation for viewing grieving as an intrapsychic process that can lead either to resolution or depression. Though an individualistic theory, Freud emphasized the relational nature of the psyche in how persons invest psychic energy in significant others. In this process the other becomes part of one's own identity (identification). When the other person dies, the identification with the deceased is intensely revived and examined, with the desired outcome that an abiding human bond to the deceased person is forged. With this inner connection, the bereaved person can begin to let go of the other person's physical presence, accept the reality of the loss and establish new attachments for ongoing life.

Developments in object relations theory gave further thought to dysfunctional grief responses. While identification serves a healthy grieving process, a pathological path is followed when the loss of the deceased significant other is not assimilated in the personality. With introjection the lost person is not integrated into one's own personality, but left apart, a stubborn, insistent obstacle resisting life to move on. (Worden 1991)

Psychodynamic theories have shaped some common expectations about the nature, process and duration of the healthy, normal grieving process. These include the following:

The goal “to let go” of the dead in order to establish new attachments in life.

The process of going through predictable stages including denial and depression.

The timeline of no longer than two years for recovery and resumption of a full life.

The necessity of working through the loss towards resolution.

Humanistic theories

The Humanistic Approach began in response to concerns by therapists against perceived limitations of Psychodynamic theories, especially psychoanalysis. Individuals like Carl Rogers and Abraham Maslow felt existing (psychodynamic) theories failed to adequately address issues like the meaning of behavior, and the nature of healthy growth. However, the result was not simply new variations on psychodynamic theory, but ...