Dynamics of experience during losses and crisis situations. Stages of grief.. Discussion on LiveInternet

First stage: denial

Denial is a natural defensive reaction of the psyche to traumatic information.

Denial is a natural defensive reaction of the psyche to traumatic information.

Just as there is shock when receiving serious injuries, when a person does not feel pain, denial makes the person immune to what is happening for some time.

An example is a person who has learned of a fatal diagnosis. After the news, he will go to other clinics, resort to traditional medicine or go to a fraudulent magician, but will not begin to work with the current situation.

At this time, the person is detached from the problem. It is no coincidence that at the funeral the relatives seem indifferent to what is happening.

About the signs

There are several typical phenomena that allow one to suspect that a person cannot independently survive all the normal stages of grief after death, separation or loss, and the person needs outside help. The first observation that allows one to suspect such a development of events is the person’s inability to talk about what happened without showing signs of acute grief, despite the large time period that separates the current moment from what happened. If a similar event occurs in the life of another person, the person stuck in grief begins to experience what happened as his own misfortune. For example, a woman who was unable to overcome grief due to an unsuccessful pregnancy finds it difficult to tolerate her friend’s abortion - as if it had happened to her.

It is possible to notice that there has been a failure in the stages of grief and a person cannot cope if he very often returns to the topic of what was lost or to his lack of rights and opportunities to change life circumstances. So, for many years, he tells everyone who is willing to listen about the difficult conditions in which he had to live, how early he had to part with his parents, what illnesses tormented him, what losses took place.

Second stage: anger

It is easier for a person to redirect unwanted feelings. At the end of the first stage, you have to face reality. Aggression is the simplest emotion that people experience in a state of grief.

It’s easy to find the culprit: loved ones who didn’t pay enough attention, doctors who didn’t provide proper attention. Even a dog with a distracting presence can become extreme.

The very fact that despite a person’s grief, life continues around, people are happy, causes negative feelings and anger.

Sometimes anger is directed at the person experiencing grief - self-flagellation and constant thinking about what could have been done differently. The person begins to feel guilty about what happened.

First stage. The stage of shock and withdrawal from reality.

Even if the departure or death of a loved one was expected, whether due to an impending breakup or a long-term illness, the moment of loss will always be sudden. The shock stage is characterized by a stunned state and a lack of full contact with the outside world. During this period, a person seems to be not in the “here and now,” but in the past, where he and the object of loss were still together. This moment can be called denial and refusal, however, here we are dealing with the fact that what is being denied is not the fact that the object of loss no longer exists, but the fact that I am still here grieving.

During this period, a person can engage in vigorous activity, say that everything is fine and even seem indifferent, but such a command will most likely hide a strong shock and resistance to meeting an unbearably painful reality. In essence, the shock stage is a kind of refuge where you can hide from difficult feelings while the body prepares to face reality.

Third stage: bargaining

Grief usually occurs in a situation that cannot be corrected. At the same time, the person has resources that he is ready to direct to solve the problem that has arisen.

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A person begins to bargain: with doctors, relatives or with fate. At one point he resembles a child trying to beg for his favorite candy.

Rich people spend money on charity and family, in the hope that fate will have mercy on them. Someone turns to others, asking if they made a mistake, if they were played.

In extreme cases, people create some kind of signs: walk around a chair before sitting down, or eat at exactly 3 o'clock. Getting stuck in the bargaining stage can lead to mental disorders.

The second stage of confrontation with reality and the fact of loss.

During this period, a person lives, as it were, in two planes, “both there and here.” It is difficult for him to maintain attention in reality, since the sensations of the presence of a loved one penetrate into it (a telephone call - what if it is him, an image in the crowd - his face, a similar figure or voice). During this period, consciousness resides in two dimensions - 1) the present at the request of reality and 2) with a loved one at the request of pleasure.

Gradually, the absence of a loved one nearby comes to the fore. It happens that upon waking up in the morning, a person asks the question, “Was it a bad dream or is everything that happened true?” In this way, “probing” reality occurs.

In addition, questions and thoughts may be “scrolling” in your head: “If we had taken care of our relationship earlier, we could have been together” “Why did they go down that particular road? If everything had happened differently, nothing would have happened.”

Here, we are also dealing with denial, but in this case, it is not the very fact of loss that is denied, but its constancy and finality. Such “testing” (probing) of reality helps the bereaved person to face the permanence of loss and the irrevocability of relationships with a loved one. The main goal of this stage is awareness of the fact of loss and the transition from the reality where the loved one is nearby to the reality where the loved one is no longer there, but there is the grieving person and his grief.

Stage four: depression

If the previous stages presupposed active actions and struggle, here one gives up, apathy sets in, and a feeling of futility of actions arises.

There is a sharp deterioration in mood, a decrease in social activity, and sometimes complete isolation.

Grief usually occurs in a situation that cannot be fixed

For the first time, a person truly faces sadness, loses all meaning in life, and stops caring about both his family and himself. Of all the stages of grief, the depression stage accounts for the greatest number of suicide attempts.

More often than not, a person lingers at this stage.

Grief psychotherapy

Author: Olga Malinina – psychologist, psychodramatist, art therapist, trainer at the Moscow Institute of Gestalt and Psychodrama.

To begin with, we should talk about the stages of development in psychology of theoretical ideas about grief and how we worked with losses before.

First wave. Of course, psychoanalysis and Freud with his work “Sadness and Melancholia”. The essay was published in 1917, and from that moment the scientific study of grief began. The author considered grief separately from depression and considered it a special mental state. He also coined the term “grief work.” Z. Freud considered the experience of grief through the attachment of libido to a lost object and the loss of this object. He believed that the personality at this moment is doing the work of sadness. It creates severe mental pain, but thanks to it, the “I” becomes free again. Once this work is completed, the person can rebuild new relationships and resume daily life. Libido energy is thus transferred to a new object to replace the lost one. Grief work was seen as an emotional catharsis in which the griever had to free himself from his grief and move forward, leaving the past behind. At this moment, the concept arose and was supported for a long time that the grieving person must express and live his emotions associated with the loss, as well as separate from the deceased for a new life.

Second wave . Erich Lindemann and his work “Clinic of Acute Grief”, published in 1944. He did a tremendous amount of work on studying the reactions of people in a state of acute grief, identified its different forms and was the first to introduce into use the stages of experiencing loss.

He highlighted the following provisions in his writings:

Acute grief is a specific syndrome characterized by certain psychological and somatic symptoms.
Acute grief usually occurs immediately after a crisis event, but can also be delayed in time. It may also not manifest itself overtly or may manifest itself as an overreaction.
It may happen that instead of the typical syndrome, the person experiencing grief experiences a distorted picture. But each of them may represent one aspect of the syndrome.
These distorted experiences of grief can be changed and transformed into a normal grief reaction, which is accompanied by resolution, the release of unlived emotions.

E. Lindemann identified the main signs of grief: physical suffering, absorption in the image of the deceased, guilt, hostile reactions, loss of behavior patterns. He also discussed and presented five forms of grief:

Distorted grief reactions. These are severely painful reactions that are defensive in nature. They are associated with reluctance or subjective inability to realize the reality of the loss, to accept painful feelings and experiences in connection with what happened.
Chronic or exaggerated grief. This is a condition where symptoms intensify or drag on over time.
Delayed or delayed grief. It appears when, for some reason, a person cannot openly experience his grief and the symptoms of grief are recognized and experienced by him after some time according to a normal scenario.
Suppressed or suppressed grief. The grief process is masked, suppressed, and therefore after some time it manifests itself in psychosomatic diseases.
Anticipating grief. The grieving process in this case begins before the actual loss due to fear of death or loss of a loved one.

E. Lindemann also identified 4 stages of grief:

Shock: The bereaved person does not understand or has difficulty understanding what happened. He feels numb, dazed, shocked.
Protest and longing: the bereaved person feels tension and irritation. Everything nearby reminds you of the past. Sometimes at this stage the phenomenon of “false recognition” can be observed, when an illusory experience of the presence of the deceased, recognition of him among others, etc. arises.
Disorganization and suffering: a clear awareness of the fact of loss and the experience of mental pain in connection with it, depressive symptoms may be present.
Separation and Reorganization: Separation from the lost object, the ability to create new relationships and the restoration of the old life.

At this time, the idea of “normal” and “pathological” grief is reinforced. The latter occurs when grief is suppressed, so the involvement of a counselor or therapist can help facilitate the client's expression of his feelings. This helps, according to Lindemann, to cure the pathological state of inability to live through the grieving process to the end.

Third wave . During this period, the main emphasis is on the stages of grief. Representatives: E. Kübler-Ross, J. Bowlby, J. Warden, and here we can also include our Vasilyuk F.E. So let's look at them all. J. Bowlby had similar views on grief as S. Freud. He believed that when a loved one is lost, the object of attachment is lost, and the process of experiencing grief will be similar to the childhood experience of relationships with a significant adult. Bowlby developed attachment theory, in which he introduced the concept of “attachment behavior.” It is an instinctive behavior that develops during infancy and has the goal of gaining closeness with a maternal figure. Therefore, in his opinion, those who have lost a feeling of anger appear in the first time after the loss of the object of attachment. Like Freud, he introduces the concept of sadness, calling it “chronic sadness,” which passes over a certain period of time. The entire process of grief is a reflection of the phenomenon of losing the object of attachment - from attempts to return it to reconciliation with the irretrievability of loss.

J. Worden described the symptoms of the physiological experience of grief. He identified them and described them in the process of examining a large number of his clients. The main symptoms are: a pulling feeling in the stomach, compression of the chest, constriction in the throat, increased sensitivity to noise, everything seems unreal, short breathing, muscle weakness, lack of strength, dry mouth. In his book “Counseling and Grief Therapy,” J. Worden offers his way of working with loss. He believes that the griever must experience grief through four tasks, the completion of which can indicate the completion of the work of mourning:

Acknowledge the fact of loss;
Experience the pain of loss;
Establish an environment in which the absence of the deceased is felt;
Build a new attitude towards the deceased and continue to live.

In Russian psychology, the problem of grief was studied by Fedor Efimovich Vasilyuk. He proposed two paradigms in this context:

The paradigm of oblivion. This is the need for maximum separation and separation from the image of the departed person.
Mindfulness paradigm. This process includes two components: transformation and restructuring of relationships with the deceased and the creation of a new image of the “I” of the one experiencing the loss.

Vasilyuk F.E. identified five stages of grief:

Shock and numbness.
Search
Acute grief.
Residual shocks and reorganization.
Completion.

He defined the work of grief as the gradual transition of the griever from the stage of being in the past, where the object of loss is alive, to the present. This process is determined by the search for new symbolic roles for the departed and the building of a different meaning of relations with him in the current moment. Grieving helps to analyze past relationships, rebuild memories of the image of the deceased, find new meanings and generate the relevant role of the deceased in the present.

Also an important milestone in the study of the grief process was the study of E. Kübler-Ross. She explored the peculiarities of the process of a person’s experience of his own passing, as well as the reactions of his relatives and loved ones to dying. As a result, she proposed the concept of psychological stages of dying. There are five stages:

Negation.
Anger, bitterness.
Stage of negotiations, bidding.
Depression.
Adaptation, acceptance.

Later, this concept was expanded to describe the experience of loss in general, not necessarily related to death. These periods are now considered as a consistent solution to spiritual and psychological problems when experiencing a crisis, loss, etc., up to the task of waking up early in the morning: denial, anger, bargaining, humility, coffee.

At the moment, modern foreign researchers do not divide the grieving process into any stages, but consider separately a certain type of loss: the loss of a child, spouse or partner, parent, friend, sibling, pet, suicide. Also now, great importance is attached to research into individual styles of grief, the importance of maintaining connections with the deceased, and the characteristics of personal reactions determined by cultural, social and other contexts.

The fourth wave agrees in some ways with the constructions of the previous three, but in others it does not. If we say in one phrase what is the difference between the new wave and the previous ones, then the slogan will be “everything is individual.” That is, researchers talk about the complex and at the same time unique nature of grief in each person. It is believed that a person in the process of experiencing loss is influenced by:

socio-cultural characteristics of the environment (in our country it is customary to bury the deceased, and in some cases to burn them; for funerals they usually dress in black or, in some cases, white);
past experience (this is my first loss or I buried almost all my loved ones, usually when I lost, exercise helped me cope, but someone needs to dig in the garden);
personal characteristics (some people react very exultantly to loss, some are unemotional at all, some need to constantly talk about their grief, some are silent);
a system of beliefs and values (some people believe in life after death and know that they will still meet the deceased, while others believe that death is the end of everything);
close environment (in our family it’s customary to grieve, gather at the wake and remember the deceased, but for some it’s not customary, for some people their loved ones say: “you need to move on with your life, don’t give up and hold on”, and for others they ask: “what is happening to you and how to help you");
etc.

Therefore, a psychologist in his work must take into account multiple contexts and build work with the griever, understanding that there are different reactions to grief based on individual and socio-cultural differences.

So, what concepts of loss psychotherapy are there now:

Grief is a person’s individual reaction to loss or acute crisis. There is no point in talking about the pathology of grief; there is a specific person with his own special process of grief, which for some reason is lived this way. In his situation, this is the norm, perhaps very different from other cases.
There are individual styles of grief. Some people benefit from reacting to their emotions, but others don’t. The consultant looks at which client helps what and suggests working that way.
The stages of grief exist as an abstract construct that does not affect the actual grieving process. Some people go through them exactly as researchers once said, some do it partially, some several times, and some experience something of their own and feel completely different states. That is, the consultant proceeds from the fact that there are no universal and consistent phases of grief, but there is an individual experience of grief.
Continuing a relationship with the deceased is a normal practice in the grieving process, an option for adapting to loss. A return to normal life is possible without final separation from the departed.
The grieving process can vary greatly depending on the person being lost and how they are leaving. Suicide of a loved one, chronic illness of a child, sudden death of a partner, expected funeral of parents - each situation has its own characteristics in the work of a consultant.

Grieving styles . This issue is studied by Terry Martin (TL Martin) and Kenneth Doka (KJ Doka). In their work, they introduced the concept of “individual grief style,” which involves a person’s use of cognitive, behavioral and emotional strategies to adapt to loss. They believe that there is a continuum with an “intuitive style” at one end and an “instrumental style” at the other, with “mixed styles” of grief in between in varying proportions. These states differ in the internal characteristics of experiencing loss and external manifestations.

The intuitive style is an affective way of experiencing grief. The grieving person expresses his emotions fully, experiences the loss acutely, and tries to share it with other people in order to cope with his pain. People with this style of grief can express their feelings for quite a long time after the fact of loss.
Instrumental style: A cognitive-behavioral way of experiencing grief. The grieving person is restrained in his emotional manifestations and does not express them openly. They experience the loss through specific actions, thus trying to cope with the event. People with this style of responding to loss are not helped by focusing on the emotional pain; they tend to be focused on the future rather than experiencing grief in the present time. They manage their emotions and prefer not to experience them openly.
Mixed style: a combination of intuitive and instrumental styles. This is the most common grieving style. With it, a person simultaneously demonstrates being in one state or another, making a transition depending on the situation. Either he suffers unbearably from the pain of his loss and says that he cannot stand what is happening, then he discusses how he will dispose of the inheritance, then after many years he blames someone for the loss, becoming emotional, or he tells funny stories about the deceased at a funeral.

How can these styles help us, psychologists working with grief in clients?

Usually we deal with people who have come to express their emotions because of their loss, and usually this catharsis happens. For some it is stormy: with streams of tears, threats, exclamations, for others it is quiet and almost unnoticeable. Some people need to express accumulated emotions over and over again in a psychologist’s office, while for others one session is enough. People with an intuitive grieving style will have a lot of experiences and they can also take a long time to process. The conditional norm of “one or two years” is not suitable for them. Such clients sometimes come with the request that they need somewhere to cry from time to time and experience their grief. Relatives are already tired of the constant expression of emotions, and the grieving person still has the need to experience the loss.
But there are people who do not want such catharsis; they only feel worse from constantly focusing on their experiences. They can tell stories about a past life with the deceased, remember him, and solve problems that arose after the loss without diving into emotional layers. Not all clients need emotional catharsis to release difficult internal experiences. Simple participation and attentive listening are enough for them. This is their way of coping with the loss: focusing on the future and managing their emotional state. Such clients may come based on someone’s tip: “I was told that there was something wrong with me because I didn’t cry at the funeral.” They will believe that they need to feel something, and since there are no such feelings, then they need to be awakened and expressed.
The most difficult thing is to understand what a person with a mixed type needs at the moment. He may need either an emotional response or conversations about what interesting things await him ahead. With him, one may get the feeling that a person “jumps” and does not plunge into his grief to the end, but in fact, he experiences the loss in this way: now this way, now this way. Such clients are most common and their requests for grief can be anything: from depressive reactions to the desire to end everything and move on with their lives.

Help for the Suffering

It is important for a grieving person to experience pain, cry and suffer through emotions. The worst help would be the phrase: “Pull yourself together, stop crying.”

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Minimizing grief is not the best way to help: in the subjective picture of the world, what happened can be the most terrible event.

It is more important to demonstrate involvement in the situation, the value of the suffering itself and a serious attitude towards the loss: “I understand you, I feel your pain.”

Important! You cannot leave a grieving person, no matter how difficult it may seem. The feeling of loneliness can significantly increase the time of grief.

You should be ready to help, but not force it.

The best option is periodic offers to come or calls with the question : “How are you?”

You can’t leave a grieving person, no matter how difficult it may seem.

It is important to be prepared to hear a negative answer and not to be offended; repeat the offer of help a little later.

A feature of Russian culture is the different attitude towards grief among men and women. The latter can be forgiven for tears and fears; moreover, after a tragedy, this is expected from a woman.

A man must be stern and firm in any situation. Accepting your own pain and living through it is a difficult stage on the path to healing from grief for a man.

The task of loved ones is to give the stronger sex the opportunity to express accumulated emotions.

In the last phase of experiencing loss, it is important to help a person find new meanings of existence, return to reality, old hobbies and friends.

It is important to choose the future path together: some shocks completely change the usual course of life.

We must not forget about the physical condition of a person. During grief, chronic diseases worsen or new ones appear.

And when a person is incapacitated, it is important to help him maintain an adequate daily routine: eat, go out into the fresh air, maintain hygiene.

Performing familiar monotonous actions is a good way to calm down and come to your senses a little.

In general, a suffering person simply needs a reliable shoulder and support, sympathy and understanding nearby. Advice, instructions and clever conclusions can only harm or ruin relationships forever.

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Signs: what else?

If a loved one has died, a person who cannot cope with grief keeps his things for too long, and this goes beyond what is reasonable. Some assemble huge collages from photographs that they literally pray to, while others completely preserve the deceased’s room in its original form, without allowing any changes. From the outside it looks like a museum. Having noticed this in the life of a loved one or friend, in order to help him cope with the loss, it is necessary, if possible, to recommend talking to a qualified psychotherapist, otherwise the person’s condition will gradually only get worse.

There are known cases when, at some stage of grief, a person began to demonstrate symptoms similar to those characteristic of a deceased loved one shortly before death. Psychologists talk about people who attend appointments and complain that they previously experienced the death of a loved one due to a pulmonary disease, and at times they themselves suffocate, although an examination of the body demonstrates absolute health. This is possible, in particular, if a loved one died due to lung cancer. Even if the event happened several years ago, the person, if unable to cope with it, still feels grief, exists in a state of crisis and cannot figure out on his own what is happening. Often, working with a psychologist makes it possible to understand that the root cause of this condition is the fear of death. For example, if a person is the same age as a loved one who has died from a serious illness, the condition can be very serious. This is also observed in the presence of other parallels.

Taking a Responsible Approach: The Importance of Grief and Coping with It

By the way, in the past, special rituals were even practiced, designed specifically to formalize grief. Traditional societies support the experience. And today, in some nationalities, mourners are invited to say goodbye to the deceased. Such send-offs make it easier for others to experience grief and overcome it.

The stage of dealing with grief, called petrification, is not surprising or doubtful to anyone. At this step, the person resembles a robot, and his emotions, if expressed, are weak. Normally, the condition in the event of the death of a loved one lasts no more than three days. You should not bother the sufferer until the phase passes on its own. If it drags on for more than three days, you can consult a psychologist.