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404 c Schneider presentation

  1. 1. THE UNBREAKABLE BONDThe Theory and Practice of Continuing Bonds<br />Lauren Schneider, LCSW<br />Clinical Director <br />Child & Adolescent Programs <br />OUR HOUSE Grief Support Center<br />
  2. 2. History & Mission of OUR HOUSE Grief Support Center<br /><ul><li>Founded in 1993 by Jo-Ann Lautman
  3. 3. Largest Non-profit Grief Support Center serving Los Angeles County
  4. 4. Mission: To provide our community with grief support services, education, resources, and hope
  5. 5. This year provided grief support in over 50 locations
  6. 6. Services available in English and Spanish for Adults</li></li></ul><li>Services include:<br /><ul><li>Support groups for Children ages 4-18 and for Adults across the lifespan
  7. 7. School-based support groups in 5 districts in Los Angeles County
  8. 8. Professional education for mental health clinicians, medical students, clergy and educators
  9. 9. Post-crises grief interventions
  10. 10. Referrals & resources </li></li></ul><li>Agenda<br />The Evolution of the Theory of Continuing Bonds<br />Helping Children Maintain Connection with their person who died <br />Interventions which promote Continuing Bonds<br />
  11. 11. Five Stages of Death & Dying,Elisabeth Kubler-Ross<br />Denial <br />Anger<br />Bargaining<br />Depression<br />Acceptance<br />
  12. 12. “Begin at the Beginning”Neolithic Period – 9,000 B.C.E. - 1,500 B.C.E.<br />Archeologists uncovered funerary finds around the world<br />Evidence of man’s need to honor and love the deceased<br />
  13. 13. EGYPTIAN PYRAMIDS:massive monuments to the dead<br />
  14. 14. Taj Mahal - 1632<br />
  15. 15. Romanticist Period: 19th Century<br />
  16. 16. In Western culture, grievers publicly identified themselves by wearing black<br />Queen Victoria wore black for the rest of her life after the death of her beloved husband<br />
  17. 17. Core Beliefs<br />Intensity of the grief is an indicator of the strength of the bond with the deceased<br />To dissolve the bond would render the relationship insignificant<br />
  18. 18. We look before and after,<br /> And pine for what is not. <br />Our sincerest laughter With some pain is fraught. <br />Our sweetest songs are those that tell of saddest thought.  <br />~~ Percy Bysshe Shelley<br />
  19. 19. In the popular film “Ghost”, the widow, played by Demi Moore, experiences the presence and communicates with the spirit of her deceased husband.<br />
  20. 20. The Lovely Bones shows a father’s longing to make contact with his daughter after her murder<br />
  21. 21. Is it magical thinking, mental illness or something else?<br />
  22. 22. Different styles of grieving are shown following the sudden death of George<br />
  23. 23. The 20th Century & Modernism<br />Grief theory evolved along with modern psychological theories<br />Western world view valued autonomy & individuation over dependency & connection<br />
  24. 24. Modernist perspective arose out of the writings of Sigmund Freud<br />Psychoanalytic school believed in the importance of breaking bonds with the deceased<br />They viewed grief as a “bothersome interruption” that must be “worked through”<br />Reflected in statements such as: “move on” or “get over it”<br />
  25. 25. “If your Dad died would you get over it?”<br />
  26. 26. Freud on Grief<br />“The sad process by which each single one of the memories and situations of expectancy which demonstrates the libido’s attachment to the lost object is met by the verdict that the object no longer exists.”<br />
  27. 27. Jacqueline Kennedy epitomized the Modernist Style of Mourning in Western Culture<br />
  28. 28. Freud on Grief (continued)<br />The libidinal energy remained attached to the thoughts and memories of the deceased <br />Since energy is limited, cathexis to the lost object must be withdrawn in order for the person to have full access to the source of energy<br />Those who fail to withdraw that energy, or hyper-cathect ,were viewed by the psychoanalysts as emotionally stunted<br />
  29. 29. Freud on Grief(continued)<br />Grief serves the function of freeing the ego from the attachment to the deceased <br />When the work of mourning is completed the ego becomes free and uninhibited again<br />The severing of the bond frees the libidinal energy allowing the person to form new bonds<br />
  30. 30. Psychoanalysts failed to recognize how hard it is to sever bonds.<br />
  31. 31. “It is the only way of perpetuating that love that we don’t want to relinquish it”<br />Freud on Grief (continued)<br />
  32. 32. Freud’s Legacy<br />The primary goal of grieving is seen as the cutting of the bond with the person who died so that new attachments can be formed.<br />
  33. 33. Application of Freud’s Oedipal Theory to Grief Work<br />An internalization of the lost object allows for a continuing attachment to the deceased<br />The mourner identifies with aspects of the deceased, assuming certain characteristics<br />Result: An ego that has been enriched<br />
  34. 34. Erick Lindemann - 1942<br />Three Tasks of Griefwork<br />Emancipation from the bond to the deceased<br />Readjustment to the environment in which the deceased is missing<br />3. Formation of new relationships<br />
  35. 35. Lindemann (continued)<br />Grief ends when the person is able to “let go”<br />
  36. 36. Erick Erickson on Grief <br />Viewed dependence as “bad”<br />Felt that the survivor must relinquish the bond with the deceased so that new bond can be formed <br />The adoption movement of the 20th Century embraced this theory. Birth parents must relinquish the bond to their newborn and carry on as if the baby did not exist.<br />
  37. 37. John Bowlby - 1969Attachment Theory of Grief <br />Purpose of grief: to sever the bond with the deceased<br />Viewed grief as a type of separation anxiety<br />Attempts to be reunited with the deceased seen as nonfunctional<br />The yearning and searching behavior is extinguished gradually over time<br />
  38. 38. Griever moves through 4 phases: PROTEST, DESPAIR, YEARNING, DETACHMENT<br />
  39. 39. Eventually the griever gives up hope that the person will ever return<br />
  40. 40. South Park’s foul mouthed characters build a stairway to heaven so they can visit their deceased friend Kenny.<br />
  41. 41. Dr. Collin Murray Parkes :<br />Grief is “a preprogrammed series of behaviors aided by specific environmental stimulus”<br />“Getting through the grief” means breaking the attachment to the deceased<br />
  42. 42. Monica McGoldrick<br />Five Therapeutic Goals <br />for Grieving Families<br />1. Shared acknowledgment of the reality of the death<br />2. Shared experience of the loss<br />3. Revising the family narrative to include the death<br />4. Reorganizing the family system<br />5. Reinvesting in other relationships<br />
  43. 43. McGoldrick & Walsh (1991)<br />Roles are reassigned rather than internalized.<br />The mourner who holds on to the bond is in danger<br />Views visits to the gravesite as compulsive repetitions tying up family energy<br />
  44. 44. Sharing a meal at the gravesite leaves the griever with the pleasurable feeling of having shared a meal with their person who died.<br />
  45. 45. Therese Rando: 1992 <br />“In all forms of complicated mourning there are attempts to do two things<br />deny, repress, avoid aspects of the loss, it's pain and the full realization of the implications for the mourner<br />2. to hold onto, and avoid relinquishing the lost loved one”<br />
  46. 46. J William Worden: “Grief Counseling and Grief Therapy” <br />Original Version of Task 4:<br />“To reinvest in new relationships”<br />Revised Version of Task 4 (2009)<br />“To Find an Enduring Connection with the Deceased in the Midst of Embarking on a New Life”<br />
  47. 47. POST MODERNIST PERSPECTIVE<br />Interdependence is sustained even in the absence of one of the parties<br />Grievers construct an inner representation of the deceased as part of the normal grieving process<br />
  48. 48. Gerry Doran and Nancy Hansen (2002)<br />Eight ways Mexican American families maintain bonds after the death of a child:<br />Dreams <br />Storytelling <br />Keepsakes <br />Sense of presence<br />Faith based connections<br />Proximity Connections<br />7. On-going rituals<br />8. Pictorial remembrances<br />
  49. 49. Dia de los Muertos Celebration<br />
  50. 50. Doran & Hansen (continued)<br />Maintaining bonds helped families:<br />Cope<br />2. Gave them comfort and support<br />3. Enabled them to transition from the past to the future<br />
  51. 51. No such thing as “Closure”!<br />
  53. 53. “Death ends a life, not a relationship”<br />Robert Benchly<br />
  54. 54. Psychoanalysts:<br />1. Recognized that child maintained a connection or inner representation with the deceased parent<br />2. Allows the child to keep the deceased with them<br />3. Aids in understanding and accepting the reality of the death<br />3. Viewed inner representation as static and unchanging<br />
  55. 55. Harvard Child Bereavement Study<br />J William Worden, PhD & Phyllis Silverman, PhD<br />Studied Parentally Bereaved Children aged 6-17<br />Boston area<br />Silverman: Cross Cultural Perspective<br /> Studied Children in Israel<br />
  56. 56. Children Maintained a Connection with the Parent who Died<br />
  57. 57. COPING INVOLVED PROCESS OF ADAPTATION & CHANGE<br />Two Aspects to the Process<br />1. children learn to remember<br />find ways to maintain a connection<br />“CONSTRUCTIONS”<br />Memories, feelings and behaviors that help them remain close with the deceased”<br />Not static but changes as child matures<br />
  58. 58. Administered the Child’s Understanding of Death questionnaire<br />Responses suggested that efforts to connect were due to a lack of understanding of the finality of death<br />Found instead that bereaved children understand younger than non-bereaved children<br />
  59. 59. 5 TYPES OF ACTIVITIES THAT ENABLED CHILDREN TO MAINTAIN BONDS<br />1. Locating the Deceased<br />2. Experiencing the Deceased<br />3. Reaching Out<br />4. Waking Memories<br />5. Linking Objects<br />
  60. 60. LOCATING THE DECEASED<br />“Where is your parent now?”<br />“What can they do there?”<br />
  61. 61. EXPERIENCING THE DECEASED<br />“Who feels that their parent is still with them?”<br />“When does that happen?”<br />“Do you ever dream of your parent who died?”<br />
  62. 62. REACHING OUT <br />“Where do you go to feel close to your parent who died?”<br />“Have you been back to the cemetery or scattering site”<br />“When do you talk to your parent?” <br />“What would your parent say about that__- if they were alive? <br />“Can you still hear your parent’s voice and what do they say to you?” <br />
  63. 63. WAKING MEMORIES <br />“When you think about your parent is there a specific memory/image that comes to mind?”<br />
  64. 64. LINKING OBJECTS<br />Ask children to bring in something special to share that reminds them of their parent who died.<br />Where do you keep it at home?<br />
  65. 65. Summary<br />1. Grief is not a psychological state with a beginning and an end<br />2. Intensity may lessen<br />3. Child becomes more future oriented over time<br />4. Child maintains a connection or construction which changes over time<br />5. Accommodation is subject to the external environment<br />
  66. 66. Summary cont’<br />1. Over time the child comes to understand and constructs meaning of the deceased in his/her life.<br />Family supports process with discussion about the deceased and by allowing the child to participate in on- going rituals that encourage both the discussion and the connection<br />3. Grief work should support this connection and how the relationship changes over time.<br />
  67. 67. Ways Adults Can Help<br />1. Mention the deceased during family time<br />2. Give children linking objects or keepsakes that belonged to the person who died<br />3. Keep photos, home movies in an accessible place<br />4. Encourage children to communicate their feelings.<br />
  68. 68. Suggested Activities<br />1. Connected for Life<br />My Memory Book …for grieving children<br />My Grief Journal…for grieving teens<br />Life Links<br />My Memorial CD<br />A Letter from______to Me.<br />