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73131 Psychology Of Grief

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  • Course Code: 73131
  • University: Open Polytechnic
  • Country: New Zealand

Question:

  • Appropriate choice of person, location, etc.?
  • Ethical obligations met, including informed consent?
  • Evidence of good preparation and appropriate interviewing?

The person’s grief and their grief journey

  • Includes description and discussion of how they have grieved?
  • Includes description and discussion of changes over time, where they are today in their journey?

The person’s communication with you

  • Verbal communication:  Describes the person’s life experience, sharing stories, other verbal reports?
  • Non-verbal communication:  Includes observations on eye contact, tone of voice, tears, etc.?

Relate the person’s grief and grief journey to what you have learned in the course

  • Do this person’s grief reactions and personal journey fit with the theories/models you have read?
  • Do this person’s grief reactions and personal journey reflect the person’s culture/community/family and their roles there?
  • Do this person’s grief reactions and personal journey reflect their developmental stage?

Coping skills

  • What aspects of the person’s thinking, behaviour or ability to communicate made the grieving process easier?  What aspects made it harder?
 

Answer:

Introduction

The following essay aims to critically analyze the interview conducted on bereaved person who had experienced significant grief within last three years but has eventually recovered from it. The essay will initiate with a brief description about the interview set-up followed by a discussion of the interviewee’s journey of grief and how it has changed over time and their current condition. The analysis of the affect of grief on the interviewees’ life will be done based on his/her verbal and non-verbal communication skills and relating their passage of grief with the available theories or models of grief. At the end, the essay will highlight the coping skills in relation to their behavioural aspect and communication skills.

 

The process of setting up interview

The first and foremost task behind the process of setting up of interview is the selection of the interview candidate.  I opted for the person who gone through tenure of grief in their life within the last 3 years but have gradually recovered from the same during the course of time. I approached by immediate neighbour (Mrs. X : name changed) as I was aware about his past life history of life. Initially I approached her verbally stating the reason for the conduction of the interview and why I am selecting her. She first was reluctant to agree because no person wants to rehearse the process of grief once recovered.When Mrs. X agreed finally, I forwarded her the mail of “Informed Consent” along with concept of the “Data Protection”. Comi, Bischof and Eppler (2014) stated that informed consent is an indispensible part that must be accomplished before the initiation of any interview process. The informed consent facilitates the Human Rights of “rights towards decision making” and ethical principle of autonomy. The mail of the informed consent sent of Mr. X highlighted scope and the rational of the interview. The mail also stated that questions for the interview will be devoid of any controversial questions that might harm her feelings and his family. Moreover, in the mail it was written that he is compelled to take part in the interview and can leave the process at any-point of time without prior notifications and his personal details will be kept strictly confidential. When Mrs. X gave informed consent after reading the mail, I approached her personally to get the informed consent letter signed manually. The time and the place for the conduction of the interview were selected by Mrs. X (65 years old) only. According to Comi, Bischof and Eppler (2014) while conducting face-to-face interview, the comfort of the interviewee the foremost priority. Mrs. X wished to give the interview at her own residence after 5 pm in the evening and accordingly the interview set-up was done. Mrs. X was notified that overall process of interview will be of 30 minutes (10 questions) and will be recorded with an audio-recorder. I ensured minimum disturbance during the interview conduction thus switched of my phone and proceeded with the questionnaires. In the process I learnt a lot about her experience.

Discussion of the Process for setting up the interview

The summary of the interview highlighted that Mrs. X lost her husband 2 years back when they went on holidaying in a hill station. During their journey over wheels, their driver lost the control of the car and the car fell down through the steep ridges of the hill. Mrs. X managed to get out of the car, but Mr. X was stacked inside. As they car rushed to downhill, Mrs. X saw in her own eyes that the car caught fire and explored. Both the driver and Mr. X died on the spot. Mrs. X experienced minor injuries and after one day he was released from the hospital. After two days, she returned to his home-town over plan with the dead-body of his wife in the coffin. That 2 hours journey in the plane seemed longer than a century. For the next one year, Mrs. X went onto depression. She was unable to sleep at night, no can be concentrate in his work and can able to do his daily living activities. Mrs. X told, “Every day that scenes of that traumatic accident used to haunt me”. I used to feel that it was my fault when resulted in a terminal outcome to my wife’s life. Had I dragged her hand out of the car, the things might have been totally different he would have been alive”. My depression went on to such an extreme level that I developed suicidal tendencies in an attempt to punish myself and finding a way out to reach to my husband anyhow. I used to cry whole morning and at used to think of committing suicide. I locked myself inside the house. My sister lives nearby she took me to psychiatrist and regular counselling and healthy lifestyle activity helped to recover me gradually.  Mrs. X told that she visited the psychiatric counselling regularly for 6 months at a stretch and also attended group discussion group sessions with persons with lived experiences. These counselling and group discussions made her realise that she is not the sole unfortunate one, there are many others like her. These realization helped me to recover from the sense of “why me” and I gradually started indulging in normal lifestyle. Throughout the interview I could feel her bottled up emotions that were coming out and felt a bit unnerved and sad to hear about his loss and realised what she had suffered. At present she is leading a normal life, socializing and doing the basic daily living activities. Though while discussing about the past incidence, tears were rolling down from her eyes but her emotions are within controlled showing that she has recovered significantly.

 

Verbal and non-verbal behaviour

Mrs. X responded to my initial questions of the interview like “how are you” quite spontaneously with direct eye-contact and attentive listening while responding with perfect articulation. According to Arnold and Boggs (2015) maintenance of proper eye-contact, active listening are signs of non-verbal communication skills and answering with perfect articulation comes under verbal communication skills. Thus it can be said that initially Mrs. X displayed proper inter-personal communication skills during the interview. However, as I asked her to narrate that traumatic past incidence, I saw that her eyes are fillings with tears, voice getting chocked and she is refusing to make eye contact. I noticed that she is not making direct eye contact and staring through the windows while narrating the incidence. Her face was firmed and her answers were short as she was trying her to hide her crack voice but soon tears rolling down through her eyes. According to Worden (2018) when a person is asked to recall recent traumatic memory, execution of inter-personal communication skills becomes difficult. The effective communication skills are hampered with chocking or cracking of voice and blurry vision and improper maintenance of eye-contact. When she was in verge of breaking down in tears, I saw her sister rushing out from the next room. Her presence just beside her till the end of the interview process helped Mrs. X to control her emotions and to conduct the interview process properly. Fowler et al. (2013) stated that the there is a strong association between anticipatory grief problem and the presence of family members. The presence of the close family members helps to assist the person in grief to feel secured and thereby helping in the execution of proper communication. Throughput the conduction of the interview, I felt that Mrs. X though breaking from inside but trying really hard to manage her emotions and to be normal.

Journey of grief

Theories of grief

Grief cycle of Kubler – Ross is consists of five different stages. The first stage includes denial, followed by anger, bargaining, depression and acceptance (Koenig & Mccall, 2014). The initial stage of grief of Mrs. X also started with denial. She was unable to accept the sudden loss of her husband as she said that that her plane journey with her husband's dead body seems to decade long. This followed by a mixture of the anger and depression. Mrs. X told that she used to cry during morning and at night she use to attempt suicide. Crying can be highlighted as an indication of depression (Kinser & Masho, 2015). Mrs. X was depressed due to loss of her husband and in order to cope up with it, she used to cry. At night, when she was tired of crying and was unable to cope up with her depression, her anger used to increase. The sense of anger along with the depressive disorder cumulates to suicidal tendency. Mrs. X also reported that while she used to cry, she used to request God to do some miracle and bring her husband back. This can be highlighted at the signs of bargain. Lim (2013) stated that older adults generally conduct futile bargain with almighty in order recover from the sense of grief. However, counselling with the mental health physicians helped her accept the present and gradually helped her to come back to normal life. Lim (2013) stated that acceptance of grief is the main path towards recovery.

 

Bereavement model of Sigmund Freud

According to this theory, grief is directly related to personal attachment. The theory mainly emphasize over the searching for an attachment in order to compensate the loss. The theory also states that mourning occurs as a sense of detachment from the loved ones. Mourning is a state of melancholia and suggests that when mourning goes wrong, the sense of melancholia escalates (Parkes & Prigerson, 2013). In case of Mrs. X it can be said that she was mourning was in grief due to sudden loss of her husband. Since she no children, her husband was her only attachment. However, during the course of time she was successful in inventing her old attachments like in this case her sister. Thus in presence of her sister, she is consolable and was able to control her emotions, as reflected in the interview process.

Culture/Community/Family

The case study or the interview process does not provide a detailed overview of the community reference. It however, the case study provides a detailed focus about the reference to family in the management of the personal emotional well-being of the person. According to Compas et al. (2015) family plays an important role in determining the mental health and well-being of the person. The family members act as a pillar of strength and thereby helping the person to recover from the mental health depression. Compas et al. (2015) stated that family based interventions helps in improving the coping skills of a person suffering from depressive disorder. In life of Mrs. X, her only member to close family was her husband, sudden loss of her husband made her weak mentally and she passed on to depression. However, she gradually recovered from her sense of grief when another family member, her sister came for her rescue. The influence of Mrs. X sister over her current state of mind is reflected in the interview as well. The presence of her sister helped her to fight against her emotions.

Developmental stage

The stage through which Mrs. X has gone through coincide that the last and the final stage of the Erikson’s stages of psycho-social development: Integrity Vs Despair (age 65 and over). According to the Erickson model, this stage involves reflecting on life either through the eyes of satisfaction or through a sense of regret (Cherry, 2017). Mrs. X look through her life with a sense of regret. She still feels that had she taken any added initiates in pulling her husband from the care, the things might have been different. Her husband would have been alive.

Coping Skills

The coping with grief was not easy. Mrs. X went through the process of cognitive therapy and had to narrate entire incident of grief to the psychiatric consultant, in order to avail person centered intervention. She has narrated to me that she was not willing to even take food during the initial stage of the incident and could not sleep well. Her sister used to care for her regularly by giving her meals in the right time. Pharmacological interventions were delivered under the supervision of doctors. She was charged with anti-depressants like serotonin reuptake inhibitors (SRIs). However, when the pharmacological therapy alone failed to fetch successful outcomes, the home physician vouched for additional non-pharmacological interventions. Baune and Renger (2014) are of the opinion that the combination of both pharmacological intervention and non-pharmacological intervention like family based intervention and cognitive behaviour therapy is found be provide better results in mental health recovery. Application of both pharmacological and non-pharmacological interventions assisted in speedy recovery of Mrs. X.

The aspect of the Mrs. X behaviour that made grieving process easier was her ability to explain the sad story in detail to the mental health counsellor. Baer (2015) are of the opinion that, in order to generate the person-centred cognitive based behavioural therapy, it is important to take into account a detail aspect of the person’s thought process and their needs. Getting a detailed account of Mrs. X need helped the mental healthcare professional in framing person-centred non-pharmacological intervention.

Aspect of communication or thinking which made the entire process harder for the generation of the coping skills is, she was refusing to think her life in absence of her husband. It is due to this reason she was refusing to take food, refusing to sleep and was attempting to commit suicide. Refusal of the proper uptake of food also restricted to the administration of the SRIs medications for depression management, complicating the entire scenario. She also refused to entire into the normal daily living activities, which hampered the speedy recovery of the mental health and well-being.

 

Conclusion

Thus from the above discussion, it can be concluded that Mrs. X sense of depression is directly associated with the grief theory of Kubler-Ross and Sigmund Freud. The relation to the theories helped in understanding the different process of the grieving cycle which a person passes through and how a sense of strong attachment helped to manage the scenario. The grief analysis also highlighted that Mrs. X still misses her husband as that incident still disturbs her as evident from her cocking of voice and breaking down in tears. However, her coping skills and ability to communicate her needs properly to the mental healthcare professionals helped in framing of the proper cognitive based behavioural therapy. Person-centred CBT therapy along with proper combination of the pharmacological intervention helped her recover from her sense of grief and depression. Her sister also played a vital role assisting her. She was her pillar of strength source of attachment which further helped in speedy recovery. The interview process also highlighted that how comfortable interview atmosphere help of achieve successful interview outcome. It also highlighted the importance of informed consent in drafting the proper interview plan.

 

References

Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.

Baer, R. A. (Ed.). (2015). Mindfulness-based treatment approaches: Clinician's guide to evidence base and applications. Elsevier.

Baune, B. T., & Renger, L. (2014). Pharmacological and non-pharmacological interventions to improve cognitive dysfunction and functional ability in clinical depression–a systematic review. Psychiatry research, 219(1), 25-50.

Cherry, K. (2017). Erik Erikson's Stages of Psychosocial Development. Psychology. Psychosocial Theories. Päivitetty, 14, 2017.

Comi, A., Bischof, N., & J. Eppler, M. (2014). Beyond projection: using collaborative visualization to conduct qualitative interviews. Qualitative Research in Organizations and Management: An International Journal, 9(2), 110-133.

Compas, B. E., Forehand, R., Thigpen, J., Hardcastle, E., Garai, E., McKee, L., ... & Bettis, A. (2015). Efficacy and moderators of a family group cognitive–behavioral preventive intervention for children of parents with depression. Journal of consulting and clinical psychology, 83(3), 541.

Fowler, N. R., Hansen, A. S., Barnato, A. E., & Garand, L. (2013). Association between anticipatory grief and problem solving among family caregivers of persons with cognitive impairment. Journal of aging and health, 25(3), 493-509.

Kinser, P., & Masho, S. (2015). “I just start crying for no reason”: the experience of stress and depression in pregnant, urban, African-American adolescents and their perception of yoga as a management strategy. Women's Health Issues, 25(2), 142-148.

Koenig, H. G., & Mccall, J. B. (2014). Grief education for caregivers of the elderly. Routledge.

Lim, W. M. (2013). Revisiting Kubler-Ross's five stages of grief: Some comments on the iPhone 5. Journal of Social Sciences, 9(1), 11.

Parkes, C. M., & Prigerson, H. G. (2013). Bereavement: Studies of grief in adult life. Routledge.

Santiago-Menendez, M., & Campbell, A. (2013). Sadness and anger: Boys, girls, and crying in adolescence. Psychology of Men & Masculinity, 14(4), 400.

Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner. Springer Publishing Company.

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