Grief and loss theory in social work practice: All changes involve loss,just as all losses require change

Working with and recognising grief and loss issues have long been identified as one of the core skills of social work practice. Despite its centrality, the exploration and application of grief and loss theory from a perspective other than death and dying has received sporadic attention in social work literature. This paper begins with a personal reflection from practice, which provided the catalyst writing in the first place. The concepts of grief and loss are then discussed in relation to losses other than death and dying. An analysis of historical and contemporary theories of grief and loss will then be explored, with the author advancing a theoretically expansive approach to grief and loss. This theoretical approach is one that is consistent with social work practice and is committed to diversity of experience and clients' strengths, as it adopts a framework for practice, which is constantly mindful of the context and meaning systems of social work clients.     

The social regulation of grief

This article explores the social regulation of grief as a function of normative criteria that assign differential social merit to different kinds of major relationship losses. Grief scholarship has been built largely on conventional assumptions about intimate attachment and its loss that overlook the possibility that the loss of an intimate other may not confer a socially legitimate right to grieve. This suggests the importance of understanding both the grief role and the subjective experience of grief itself as socially constructed. The social regulation of grief is examined in terms of the loss of de-moralized intimate relationships — those that are socially undervalued as well as those that are socially devalued, or stigmatized.     

The Effects on Family Members and Functioning AFter the Death of a Pet

A pet's death can precipitate a grief as intense as that precipitated after the loss of a human. Because the pet is considered a family member, its death disrupts the lives of family members and family functioning. This article describes the family disruption that results from feelings of loss in four specific areas. It also discusses how a pet's death can lead to disorganization of family functioning. The nature and extent of family members' grief responses to pet death are described. Because of these losses, and the disruption and nature of the grief response, the need for counseling is established.     

Social work intervention with bereaved children

Abstract

Bereavement in childhood can seriously affect a child's development. There is a tendency to diminish the child's experience of loss because bereaved parents are often less sensitive to their children and because children express their grief in a more discreet manner than is typical of adult grief. This tendency leads to the child's needs being underestimated and under-reported. A model of social work intervention which advocates short-term involvement has been shown to have a significant effect upon the well-being of the child and his family. The paper begins with a brief review of the literature on mourning, which highlights various perspectives on the role and nature of the process. A model of mourning which embraces the differences between adult and child mourning will be proposed which is informed by the principles of attachment theory and defined as a continuing process of adjustment rather than a resolvable experience of loss. This model of mourning has implications for social work intervention and is the foundation of the practice model. The practice model involves six bereavement counselling sessions with the parent, six play sessions with the child and formal and informal involvement with the child's teacher. It has four aims: (I) to enhance sensitivity in the parent to the child's experience of loss and mode of mourning, (2) to develop an improved pattern of communication within the child-parent relationship, (3) to develop resources for the child in his personal environment and (4) to enhance the child's resourcefulness within his mourning thus enabling him to feel more competent in the longer term. The model is founded upon an awareness of the need for short-term intervention within the context of a long-term issue and seeks to address both perspectives simultaneously. Some of children's commoner responses to bereavement will be outlined within the context of the play sessions and methods for resolving the problems associated with them will be discussed. Finally the nature of reasonable outcomes for the work will be considered.     

Preparing Social Workers for the Inevitable

Despite the centrality of grief as a universal response to loss, and its prevalence in the social work domain, little empirical attention has been given to the impact of grief instruction in social work courses. This article presents results of a study examining the impact of a multimethod grief course on graduate social work students' level of death acceptance and sense of preparedness to respond to personal and professional losses. A quasi-experimental, nonequivalent control group design was used. Findings suggest that the grief course assisted students to perceive greater competence in their knowledge, skills, and sense of preparation for working with grieving clients, and that the course increased cognitive and affective dimensions of death acceptance in students. Implications for future research and for social work education are discussed in light of the study limitations.     

Understanding loss: The origins and value of current theories of loss

Abstract

This article discusses the origins of concepts concerning the nature of loss and its consequences for mental health. It suggests that, while the experience of loss is self-evidently of importance for individuals, the view that loss represents a major risk factor in mental health has led to unwarranted professional intervention in the belief that grief must be 'resolved' in order to prevent a negative psychological impact. It is suggested that this view has not been sufficiently explored theoretically and that professional helpers, such as social workers and counsellors, should use models which purport to facilitate mourning with some caution.     

Searching for a Narrative of Loss: Interactional Ordering of Ambiguous Grief

In this article I analyze the collective management of ambiguous emotions in the case of grief arising from perinatal loss/stillbirth. Based on a content analysis of selected Polish discussion lists for bereaved parents and interviews with moderators of these lists, I conceptualize the experience of grief arising from miscarriage/stillbirth as both culturally “disembedded”—not regulated by a coherent set of feeling and display rules, and interactionally “disenfranchised”—framed by the immediate social surrounding of the bereaved as illegitimate. This study then focuses on subsequent social processes surrounding the collective management of such emotions through interactions within online bereavement communities, leading to the creation of local definitions of the situation of loss and formation of subcultural feeling and display rules of grief. I posit that in a wider perspective these community processes can be seen as grassroots mechanisms that agents use to transform the existing emotional culture of grief.     

Braving Human Suffering: Death Education and its Relationship to Empathy and Mindfulness

Social workers are likely to encounter clients dealing with traumatic grief and death in their practice. Though death education has gained in popularity and acceptance, few social work students receive coursework in this area and many are unprepared to deal with their clients' and their own emotions regarding death and grief. Though death-related content may evoke provider avoidance, mindfulness and empathy may help regulate provider emotions and responses. This United States-based study evaluates the effectiveness of experiential death education on mindfulness and empathy. Measures in three separate cohorts were given at the beginning and end of the course. Results show statistically significant increases on the Five Facet Mindfulness Questionnaire and the Questionnaire of Cognitive and Affective Empathy, indicating that such a course may be effective in increasing both mindfulness and empathy in social work students and those in related fields.     

Ethics at the End of Life: A Teaching Tool

ABSTRACT

Social workers rarely receive education and training in the areas of grief, bereavement, and death and dying, which may lead to difficulties in compassionately and ethically addressing concerns in end-of-life or grief-related contexts. This article presents actual and potential outcomes from three challenging end-of-life case studies using Mattison’s ethical decision-making model as a framework. The case studies were drawn from student interviews with experienced master’s-level social workers. This pedagogical article helps to promote self-reflection and consideration of ethical issues in grief and death-related situations as well as supplement death education and ethics curricula to include end-of-life content.     

Grieving sexual abuse: The therapist's process

Clinicians working in the area of sexual abuse often experience grief as a direct result of the trauma they encounter in their therapeutic endeavors. This article explores the stages of grief that transpire in reaction to treating sexual victimization and examines the behavioral indicators which surface during each phase of the therapist's process. The author's personal account is included as a means of chronicling this experience and offering suggestions as to more effective resolution. As a final note, certain preventative measures which are aimed at diminishing the potential for negative countertransference and personal conflict are presented for consideration.     

Talking Feelings: The Collaborative Construction of Emotion in Talk Between Close Relational Partners

This article reports findings from recent investigations into emotional talk between close relational partners. These findings are based upon 44 half-hour videotaped and transcribed conversations of interactants discussing an emotionally influential issue. It was found that interactants' emotional experiences were interactively constructed through (1) downgrading and upgrading emotional expressions, and (2) developing characteristics of the situation seen to have produced the emotion so as to justify it. These collaborative constructions of emotional experience were found to be guided by a complicated system of constraints which takes into account both the great utility of emotional attributions in the construction of selves and relationships and their likelihood of survival in the interactional environment. Face-to-face interaction with close relational partners was, therefore, seen to play a significant role in the social construction of human emotion.     

“She was more than a friend”: Clinical intervention strategies for effectively addressing disenfranchised grief issues for same-sex couples

This article focuses on grief experienced by same-sex couples with attention to the distinct factors that influence same-sex grieving partners within all social work system levels. An actual case narrative—the first author's lived experience—guides the reader through a powerful, personal journey to gain a greater perspective and connection on the impact of grief and loss. The concept of disenfranchised grief is applied to same-sex couples focusing on the grieving process. The authors delineate effective strategies for practitioner intervention for those working with individuals experiencing grief due to the loss of their same-sex partner. Particular emphasis is placed on cultural competence and cultural humility for enhanced effectiveness while working with same-sex-partner grief issues.     

Visualising the ends of identity: pre-birth and post-death on Instagram

This paper examines two ‘ends’ of identity online – birth and death – through the analytical lens of specific hashtags on the Instagram platform. These ends are examined in tandem in an attempt to surface commonalities in the way that individuals use visual social media when sharing information about other people. A range of emerging norms in digital discourses about birth and death are uncovered, and it is significant that in both cases the individuals being talked about cannot reply for themselves. Issues of agency in representation therefore frame the analysis. After sorting through a number of entry points, images and videos with the #ultrasound and #funeral hashtags were tracked for three months in 2014. Ultrasound images and videos on Instagram revealed a range of communication and representation strategies, most highlighting social experiences and emotional peaks. There are, however, also significant privacy issues as a significant proportion of public accounts share personally identifiable metadata about the mother and unborn child, although these issue are not apparent in relation to funeral images. Unlike other social media platforms, grief on Instagram is found to be more about personal expressions of loss rather than affording spaces of collective commemoration. A range of related practices and themes, such as commerce and humour, were also documented as a part of the spectrum of activity on the Instagram platform. Norms specific to each collection emerged from this analysis, which are then compared to document research about other social media platforms, especially Facebook.     

‘Sitting on the Mourning Bench’: Mental Health Workers and an Elderly Client

Abstract

The present article documents the experience of a first year social work student on fieldwork placement in an Aged Persons Mental Health Service. The student was part of a team providing service to a long-term client of the service when he was diagnosed with a life-threatening illness. The student's compassionate response to the client raises questions about grief and professionalism, which she explored through a journal and in discussion with her supervisor and other team members working with the client. As part of their reflective practice, the student, her supervisor and the client's mental health workers formed a collective to document their experience and present a staff education session. This article is the outcome of these processes and explores important grief issues in Aged Psychiatry and demonstrates the valuable contribution made by a student to the work of the team in the rich learning environment of a fieldwork placement in aged psychiatry. It is published with the kind permission of the client's next of kin.     

The body as existential midpoint—the aging and dying body of nursing home residents

The human body has been the object of extensive attention in the social sciences, recently receiving increasing interest from social gerontology as well. However, the issue of old bodies and particularly the body in the fourth age of life remains relatively under-researched. The need to give emphasis to the subjective experiences of the oldest old during their final phase of life has been pointed out. This article is based on data obtained from ethnographic fieldwork carried out on a nursing home ward, and explores and analyses how the residents talk about and regard their own aging and dying bodies. The focus is on the link between the disintegrating body, aging and death in an institution-based care context. It was found that the body is the central entity through which the residents experience daily life, through pain, through the caring process, through diminished physical and cognitive functions, and as such constitutes the existential nucleus of their being. The article includes a discussion on how these experiences also elucidate the way in which the body is a mediator for issues seldom acknowledged such as existential needs.     

The Impact of Childrens' Divorce on Parents:

Little has been written to date concerning the impact of an adult child's divorce on his or her parents-their anguish, grief, concern, humiliation or even occasional elation. The senior parent's reactions affect their own life cycle development. And within the context of a cybernetic circular systems model of conceptualization about family relations which we adhere to, it is posited that their reactions impact upon their childrens' (and grandchildrens') post divorce readjustment. This article is written to attempt to begin to address this issue and to fill this gap in the literature. It is primarily on the author's combined clinical observations with hundreds of clients and friends and their experiences living through their childrens' divorces. The next step is process and outcome research about this issue.     

The Making of Childhood Mortality in Modern South Africa

This article examines the ways in which childhood mortality as an ideological tool is constituted as a shared moral order in modern society. The examination of record‐keeping as an ideological practice that produces a governable and self‐regulating population allows us to identify how and where it is incorporated into social life as an everyday morality. Under this moral order, death must be constituted as a medical necessity, rendering it culturally relevant, in order for social life to continue to be considered a meaningful and purposeful endeavour. The child's status in society as a sacred citizen ensures that children's deaths are constituted in even more particular ways, so that the possibility of medically ‘unnecessary’ child death remains morally unthinkable and thus does not expose the ideological underpinnings that continue to produce social life as a moral and thus meaningful affair.     

The revival of death: expression,expertise and governmentality

This paper discusses Walter's (1994) assertion that death in the West has recently undergone a revival. In particular it focuses on his claim that this revival is composed of two different strands: a late modern strand and a postmodern strand. The former, according to Walter, is driven by experts who seek to control death, the latter by ordinary people who seek to express their emotions freely. Describing the history and work of Cruse Bereavement Care, the largest bereavement counselling organization in the UK, we question Walter's distinction. We then problematize Walter's suggestion that the revival of death is caused by general social transformations. In contrast we evoke Rose's (1996) work on 'subjectification' and seek to link recent changes in the management of death and grief to permutations in governmental rationality.     

Drawing from experience.

The journey through grief after exposure to a sudden traumatic death is a painful and personal experience for children. This requires therapeutic interventions that explore and facilitate the healing potential within each child. Drawings are an expressive method that can provide a conduit for identifying and understanding issues requiring therapeutic intervention and follow up.     

When a Baby Dies: Ambiguity and Stillbirth

ABSTRACT

Stillbirth, or sudden intrauterine death, is in many ways an invisible death. A stillborn infant is one mature enough developmentally to have lived outside the womb but for some reason, or perhaps multiple reasons, was born dead. Stillborn infants are often demarcated from other types of child death and are rarely legitimized as a real loss. When a baby is stillborn, mothers, fathers, surviving siblings, and grandparents may struggle for years to find answers to a series of complex and inherently unanswerable questions. The family members' profound feelings of grief and ambiguity loss are borne in a social environment that denies this reality because the child's death was invisible to most of the world. Boss's framework for understanding ambiguous loss proves quite helpful in thinking about stillbirth.