Module 2: Grief & Coping Part 1: The Dying Process Trajectories of Dying (Glaser, Strauss, & Benoleil (1966, 1968) • Considered caregivers predictions of certainty of death and timing of death • Four types of death expectation based on certainty and time: • Certain death at a known time • Certain death at an unknown time • Uncertain death but a known time when certainty will be established • Uncertain death and an unknown time regarding when the question will be resolved Awareness Contexts • Closed Awareness: when the person who is dying doesn’t realize it • Suspected Awareness: person may begin to suspect their situation • Mutual Pretense: everyone knows, but no one shares or communicates regarding the knowledge of death • Open Awareness: willingness to discuss the fact that death is near Stages of Dying by Kubler-Ross • Example of Western Theory of Dying • Five stages • Denial – “It can’t be true.” • Anger – “Why me?” • Bargaining – “If you just let me live I promise I will ________.” • Depression – The person is less responsive and thoughts are pervaded by a sense of loss • Acceptance – A final state of rest and letting go, void of feelings and emotions Shortcomings of Stage Theory, Applied to the Stages of Kubler-Ross • The existence of the stages has not been demonstrated • No evidence has been presented that people actually do move from Stage 1 through Stage 5 • The limitations of the method have not been acknowledged • The line is blurred between description and prescription • The totality of the person’s life is neglected in favor of the supposed stages of dying • The resources, pressures, and characteristics of the immediate environment can also make a tremendous difference Copyright © Allyn & Bacon 2007 Corr’s Developmental-Coping Model of the Dying Process • Primary focus: empowerment for the dying person and those who are intimately involved in caregiving • Four challenges • Physical – satisfy bodily needs, reduce stress) • Psychological – feeling secure and in control • Social – keep attachments to individuals, groups and causes • Spiritual – meaning, connection, transcendence, and hope Phases of Dying • The Pre-diagnostic phase – many will ignore indicators of dying • The acute phase – try to understand the disease and cope • The Chronic Phase : managing symptoms, prevention and management • Recovery Phase- If death does not occur, coping with the crisis • Terminal Phase-new decisions such as preparing for death, discontinuing interventions, face ongoing challenges Partial Models of the Dying Person’s Situation • Restricted Activity • Limited Energy • Damaged Body Image • Contagion • Disempowerment • Attributional Incompetency • Ineffectuance • Stress Response Overload • Time Anxiety • Performance Anxiety • Loss and Separation • Disengagement • Journey • Closing the .

1. Module 2: Grief & Coping
Part 1: The Dying Process
Trajectories of Dying
(Glaser, Strauss, & Benoleil (1966, 1968)
• Considered caregivers predictions of certainty of
death and timing of death
• Four types of death expectation based on
certainty and time:
• Certain death at a known time
• Certain death at an unknown time
• Uncertain death but a known time when certainty will
be established
• Uncertain death and an unknown time regarding
when the question will be resolved
Awareness Contexts
• Closed Awareness: when the person who is

2. dying doesn’t realize it
• Suspected Awareness: person may begin to
suspect their situation
• Mutual Pretense: everyone knows, but no
one shares or communicates regarding the
knowledge of death
• Open Awareness: willingness to discuss the
fact that death is near
Stages of Dying
by Kubler-Ross
• Example of Western Theory of Dying
• Five stages
• Denial – “It can’t be true.”
• Anger – “Why me?”
• Bargaining – “If you just let me live I promise I will
________.”
• Depression – The person is less responsive and
thoughts are pervaded by a sense of loss
• Acceptance – A final state of rest and letting go, void
of feelings and emotions
Shortcomings of Stage Theory, Applied

3. to the Stages of Kubler-Ross
• The existence of the stages has not been demonstrated
• No evidence has been presented that people actually do
move from Stage 1 through Stage 5
• The limitations of the method have not been
acknowledged
• The line is blurred between description and prescription
• The totality of the person’s life is neglected in favor of the
supposed stages of dying
• The resources, pressures, and characteristics of the
immediate environment can also make a tremendous
difference
Copyright © Allyn & Bacon 2007
Corr’s Developmental-Coping Model
of the Dying Process
• Primary focus: empowerment for the dying
person and those who are intimately involved in
caregiving
• Four challenges
• Physical – satisfy bodily needs, reduce stress)
• Psychological – feeling secure and in control
• Social – keep attachments to individuals, groups and
causes

4. • Spiritual – meaning, connection, transcendence, and
hope
Phases of Dying
• The Pre-diagnostic phase – many will ignore
indicators of dying
• The acute phase – try to understand the disease
and cope
• The Chronic Phase : managing symptoms,
prevention and management
• Recovery Phase- If death does not occur, coping
with the crisis
• Terminal Phase-new decisions such as
preparing for death, discontinuing interventions,
face ongoing challenges
Partial Models of the
Dying Person’s Situation
• Restricted Activity
• Limited Energy
• Damaged Body Image
• Contagion
• Disempowerment

5. • Attributional
Incompetency
• Ineffectuance
• Stress Response
Overload
• Time Anxiety
• Performance Anxiety
• Loss and Separation
• Disengagement
• Journey
• Closing the Book
• Endangered Relationship
• Struggling Brain
• Storying
GRIEF, BEREAVEMENT & MOURNING
Part 2
Defining Terms: Bereavement
• An objective fact:
• We are bereaved when someone close to us dies
• “Close” is not easily defined
• A change in status:

6. • Such as when a child becomes an orphan, a wife
a widow, a husband a widower
• An outcome of a large-scale social phenomena:
• Those surviving a natural disaster or a war
Defining Terms: Grief
• Grief is one response to bereavement; how one survives
• Grief affects all spheres of life
• On a physical level
• Acute grief: tightness in throat, shortness of breath,
lack of muscle power, empty feeling in abdomen
• Prolonged stressor: Increased risk of cardiovascular,
infectious, & inflammatory disorders, & weakened
immune system
• On a personal and interpersonal level
• Confusion, attention, concentration, memory, anxiety,
and rage which may repeatedly return in waves
Defining Terms: Mourning
• Mourning is the culturally patterned expression of the
bereaved person’s thoughts and feelings
• Can reflect local, regional, national, ethnic, and

7. religious cultures at particular points in history
• Examples:
• During World War I widows dressed in black with veils
covering their heads
• During World War II families put a gold star in their
window if they had lost a loved one
Types of Grief
• Normal Grief – stays within the bounds of a particular
culture
• Complicated Grief – once called “pathological” or
“abnormal,” the most common feature is that the
bereaved person does not move from the shock and
pain of loss toward a return to a fulfilling life
• Traumatic Grief – severe and disabling responses to
sudden and often violent death
• Anticipatory Grief – how people cope with expected loss
Types of Grief

8. • Resolved Grief – movement toward recovery from the
most debilitating effects of grief
• Unresolved Grief – the debilitating effects of grief have
continued longer than would be expected (difficult to
define)
• Hidden Grief – hiding any signs of grief in order to
appear as “normal” as possible
• Disenfranchised Grief – occurs when society does not
recognize a person’s right to grieve. Examples: health
care professionals, foster parents, gay partner
Examples of Disenfranchised Grief
• The grieving individual is not regarded as having the
right to grieve (at this time or under these
circumstances) and must keep the sorrow hidden
• When at work, school, or in public places
• Nurses and caregivers
• Lover or companion of an AIDS victim
• When the lost companion was an animal
• When the loss was a stillborn baby
• When the bereaved person or the individual who died is
developmentally disabled

9. Freud’s Grief-Work Theory
• Grief is an adaptive response to loss
• The work of grief is difficult and time-consuming
• The basic goal is to accept the reality of death and
thereby liberate one’ self from the strong attachment one
had to the “lost object”
• Grief-work is carried out through a long series of
confrontations with the reality of the loss
• The process is complicated by the survivor’s resistance
to letting go of the attachment
• Failure results in continued misery and dysfunction
Interpersonal Applications of
Grief-Work Theory
• Bowlby’s Attachment Theory
• Our basic goal is to maintain the security provided by
the significant relationship
• Stress comes as we try to re-establish the lost
relationship
• In grief-work we must overcome our attachment
• Parkes’ Three Basic Components of Grief-Work
• Preoccupation with thoughts of the deceased person
• Repeatedly going over the loss experience
• Attempts to explain the loss

10. Other Theoretical Approaches
• Rando’s Task Theory
• Accept the loss
• React to the separation
• Remember and re-experience the lost person and
relationship
• Give up the attachment to the person and the life
that used to be
• Move into the new life but remember the old
• Reinvest emotions and energies in other
relationships and activities
Other Theoretical Approaches
• Stage Theories (such as Kubler-Ross)
• Most agree on the beginning and ending points, but
the middle stages vary by theory
• Little independent evidence to verify the application of
universal stages to the grieving process
• Dual-Process Model (Stroebe and Schut)
• Must work on both:

11. • Emotional working through the grief
• Adapting to roles and situations in the altered world
Other Theoretical Approaches
• Integrated Individual-Family Model (Moos)
• Considers symptoms of family grief, such as family
isolation, confusion in family roles, changes in who
talks to whom, and cut-off, reconnection or
overprotection of certain family members
• Evolutionary Biology Model of Grief (Archer)
• Views grief in all mammals and social birds
• Views social bonds as advantageous for survival, but
grief as maladaptive
How Do People Recover?
Spousal Bereavement
• Immediate Impact of Spousal Bereavement
• Most women experienced anticipatory grief
• After the death women felt a sense of abandonment
• After the death men felt a sort of dismemberment
• Emotional & Physical Reactions Soon After Bereavement
• Physical symptoms lingered for weeks (pains, poor

12. appetite, loss of stamina, headaches, dizziness)
• Women had trouble at night, wanted someone to rely on,
and felt the situation was “not fair”
• Men felt guilty and were less likely to express emotions
How Do People Recover?
Spousal Bereavement
• Leave-Taking Ceremonies
• Women found them important and helpful
• Men found them less important and too expensive
• Grief and Recovery: The Widow’s Response
• Obsessional reviews of the circumstances
• Tendency to idealize the husband
• Strong sense that he is still with her
• Grief and Recovery: The Widowers’ Response
• Cuts off obsessional reviews quickly
• Faster social recovery, slower emotional recovery
How Do People Recover?
Spousal Bereavement
• Types of Recovery
• People who did not have the opportunity to prepare
for the spouse’s death suffered more distress

13. • Time by itself will not facilitate recuperation
• Those who were most disturbed a few weeks after the
death usually were the ones who continued to be
disturbed a year later
• The quality of the marital relationship influences the
grief and recovery process
How Do People Recover?
Spousal Bereavement
• Three Types of Unresolved Grief
• The unexpected grief syndrome (when death comes
without warning, leaving disbelief and intense anxiety)
• The conflicted grief syndrome (when death occurs in
a troubled relationship)
• The chronic grief syndrome (marked by dependency
on deceased spouse)
• Psychosocial Transition
• Vulnerable place of change
• Rites of passage can be helpful
The Family That Has Lost a Child:

14. Perinatal Death
• Perinatal death – 20 weeks after conception to one month
after birth
• Health care systems are more responsive
• Shadow grief – stays with parents for years (like a shadow)
• Contact the “inner representation” of the dead child may be
experienced for years (keeps parents’ worldview intact)
• Memories, hallucinations, a presence or incorporation of
the child’s characteristics into their own personalities
• Most surviving parents do not divorce
• Grandparents grieve as well
Bereavement in Later Life
• Most older adults cope as well as anyone
• Some deal with bereavement overload
• Accumulation of experience with many losses (family,
friends, pets, lifestyle)
• Risk of illness and death increases following the death of
a loved one (often within 6 months)
• Risk is greater for widowers than widows
• Risk is greatest for young adult widowers
• Higher risk for violent death and suicide
• Stress of grief can weaken immune system

15. Meaningful Help for
Bereaved People
• Silverman established the Widow-To-Widow Program
prior to the development of professional grief counselors
or peer-support groups
• Grief does not have a final outcome
• Grief can most usefully be regarded as a life transition
• People can help each other
• Helpful things to say to the bereaved
• “He/she will always be alive in your memories.”
• “I’m here if you need somebody to talk to”
• “Tell me how you are feeling”
COPING WITH DEATH
Part 3:
What is coping?
• Emotional reactions to stressful situations
• Cognitive and behavioral efforts to manage
external or internal demands

16. Types of Coping
• Appraisal-focused coping: how one
understands a stressful situation
• Emotion-Focused Coping: Trying to control
one’s emotional reactions to the stressful
situation
• Problem-Focused Coping: Managing or
remedying the distressing situation
• Religious-based coping: Using God or a higher
power to help understand and react to stressful
situations (ie turning to God, working through
with God’s help)
Who Copes?
• The dying person
• Family members and friends
• Caregivers
Module 2: Grief & CopingSlide Number 2Trajectories of
Dying�(Glaser, Strauss, & Benoleil (1966, 1968)Awareness
ContextsStages of Dying �by Kubler-RossShortcomings of
Stage Theory, Applied to the Stages of Kubler-RossCorr’s
Developmental-Coping Model of the Dying ProcessPhases of
DyingPartial Models of the �Dying Person’s SituationGrief,
Bereavement & MourningDefining Terms: BereavementDefining
Terms: GriefDefining Terms: MourningTypes of GriefTypes of
GriefExamples of Disenfranchised GriefFreud’s Grief-Work
TheoryInterpersonal Applications of �Grief-Work TheoryOther
Theoretical ApproachesOther Theoretical ApproachesOther

17. Theoretical ApproachesHow Do People Recover? �Spousal
BereavementHow Do People Recover? �Spousal
BereavementHow Do People Recover? �Spousal
BereavementHow Do People Recover? �Spousal
BereavementThe Family That Has Lost a Child: �Perinatal
DeathBereavement in Later LifeMeaningful Help for �Bereaved
PeopleCoping with Death �What is coping?Types of
CopingWho Copes?
Death and Dying Psychology
20
15
10
5
Synthesize your research topic it
Writing shows high degree of attention to logic and reasoning
of points well developed thoughts. The writing clearly leads the
reader to the conclusion and stirs thought regarding the topic.
Content indicates synthesis of ideas, in-depth analysis of
original thought and support for the topic.
Writing is coherent and logically organized with transitions
used between ideas and paragraphs to create coherence. The
writing sufficiently expresses coherent ideas from original
thinking supported by firm evidence. Main points well
developed with quality supporting details and reflects.
Writing is coherent and logically organized, but some points are
misplaced or stray from the topic. Some transitions are used
inconsistently. Main ideas reflecting some critical thinking is
presented without detail or development.
Writing lacks logical organization. It shows some coherence but
ideas lack unity. Many or serious errors are present. Main ideas
reflect little critical thinking is presented without detail,
development, or ideas are vaguely presented.
Explain why you chose the topic
Writing shows high degree of attention to logic and reasoning

18. of points well developed thoughts. The writing clearly leads the
reader to the conclusion and stirs thought regarding the topic.
Content indicates synthesis of ideas, in-depth analysis of
original thought and support for the topic.
Writing is coherent and logically organized with transitions
used between ideas and paragraphs to create coherence. The
writing sufficiently expresses coherent ideas from original
thinking supported by firm evidence. Main points well
developed with quality supporting details and reflects.
Writing is coherent and logically organized, but some points are
misplaced or stray from the topic. Some transitions are used
inconsistently. Main ideas reflecting some critical thinking is
presented without detail or development.
Writing lacks logical organization. It shows some coherence but
ideas lack unity. Many or serious errors are present. Main ideas
reflect little critical thinking is presented without detail,
development, or ideas are vaguely presented.
Analyze the significance of this research
Writing shows high degree of attention to logic and reasoning
of points well developed thoughts. The writing clearly leads the
reader to the conclusion and stirs thought regarding the topic.
Content indicates synthesis of ideas, in-depth analysis of
original thought and support for the topic.
Writing is coherent and logically organized with transitions
used between ideas and paragraphs to create coherence. The
writing sufficiently expresses coherent ideas from original
thinking supported by firm evidence. Main points well
developed with quality supporting details and reflects.
Writing is coherent and logically organized, but some points are
misplaced or stray from the topic. Some transitions are used
inconsistently. Main ideas reflecting some critical thinking is
presented without detail or development.
Writing lacks logical organization. It shows some coherence but
ideas lack unity. Many or serious errors are present. Main ideas
reflect little critical thinking is presented without detail,
development, or ideas are vaguely presented.

19. Analyze the benefits of this research
Writing shows high degree of attention to logic and reasoning
of points well developed thoughts. The writing clearly leads the
reader to the conclusion and stirs thought regarding the topic.
Content indicates synthesis of ideas, in-depth analysis of
original thought and support for the topic.
Writing is coherent and logically organized with transitions
used between ideas and paragraphs to create coherence. The
writing sufficiently expresses coherent ideas from original
thinking supported by firm evidence. Main points well
developed with quality supporting details and reflects.
Writing is coherent and logically organized, but some points are
misplaced or stray from the topic. Some transitions are used
inconsistently. Main ideas reflecting some critical thinking is
presented without detail or development.
Writing lacks logical organization. It shows some coherence but
ideas lack unity. Many or serious errors are present. Main ideas
reflect little critical thinking is presented without detail,
development, or ideas are vaguely presented.
Usage of correct grammar, usage, and mechanics in APA
format. (1 page)
Essay is free of distracting spelling, punctuation, and
grammatical errors; absent of fragments, comma splices, and
run-ons. Meets most criteria of APA formatting requirements.
Essay has few spelling, punctuation, and grammatical errors
allowing reader to follow ideas clearly. Very few fragments or
run-ons. Meets some of APA formatting requirements.
Essay has several spelling, punctuation, and grammatical errors
allowing reader to follow ideas clearly. Very few fragments or
run-ons. Meets few of APA formatting requirements.
Spelling, punctuation, and grammatical errors create distraction,
making reading difficult; fragments, comma splices, run-ons
evident. Errors are frequent. Fails to follow APA formatting
requirements.