An overview of the theories and practice principles relating to loss and bereavement. Content has kindly been provided by Barbara Beard, senior lecturer at Sheffield Hallam University, specialising in supportive and palliative care.

1. Part of the “Enhancing Prostate Cancer Care” MOOC
Catherine Holborn
Senior Lecturer in Radiotherapy & Oncology
Sheffield Hallam University

2. Introduction
People living with and supporting people with prostate
cancer may experience many different emotions
throughout their journey and react in a way that is
different from how they would usually.
This presentation highlights some of the theories
surrounding loss and bereavement, but always
remember that everyone's grief is individual.

3. Grief - not a new phenomenon
'Well everyone can masters grief, but he that has it'
Much Ado about Nothing
Shakespeare (1564 -1616)

4. Walter (1999) On Bereavement:
The Culture of Grief
Grief is like sex. It can be done on your own, it is best
done with other people and is disapproved of if done in
public’.
Talking about dying is not an easy subject. If you are
facilitating another person's grief you have to be able to
hear and acknowledge what they are saying.

5. Bowlby's Theory of Attachment
Bowlby a psychiatrist
Important to understand this theory before
comprehending the impact of loss and bereavement on
individuals (Worden, 2009)
Theory developed nearly 40 years ago but still relevant
(Harris, 2009)

6. Theory of Attachment (1980)
Originally concerned the attachment between a mother
and child

7. Theory - Parkes (2006)
When a child is separated for more than a few minutes
from their mother the following reactions occur
Protest - may be exhibited by crying

8. Despair
Feelings of hopelessness

9. Detachment
May seem as though the child has recovered, but he/she
has withdrawn from surroundings
Not playing with other children
Not seeking attention

10. Relevance to loss and grief
There is no loss without an attachment.
Sometimes a person may not know how much they were
attached to e.g. a part of the body, fertility, sexual
activity or person until it has been taken away.
The theory can be applied to experiences in adult life. For
example, an adult may avoid or deny the reality of the
situation (Walsh, 2012).

11. Facilitating Loss and Bereavement
Before being able to explore the loss experience of a carer
prior to the death of a loved one or the person's own death,
consider the following about your own mortality.
Also, it is useful to know about the different reactions people
may experience in relation to their loss or bereavement.
Sometimes people may feel they are 'going mad' so
understanding that these are 'normal' grief reactions can be
helpful.
Worden (2009) uses 4 different categories to explore these
reactions. A person may experience some of the following...

12. Individual reactions to loss and bereavement
(Woodhouse, 2011, Worden, 2009)
Feelings
ANXIOUS, ANGRY, BITTER, DEVASTATED, RESENTFUL, EMPTY,
INFERIOR, GUILTY, REMORSE, HAPPY, HIGHTENED SEXUALITY,
ABANDONED, RELIEVED, EMOTIONAL MOOD SWINGS,
EXAUSTED, USELESS, FRUSTRATION, HELPLESS, LOST IDENTITY,
MISUNDERSTOOD
Cognitions
QUESTIONING, CHAOTIC THINKING, INABILITY TO COPE WITH
DECISION MAKING, LOSS OF USUAL ABILITIES, FEAR, ISOLATION,
MEMMORY LOSS, IRRATIONALITY, LOSS OF FOCUS, CONSCIENCE

13. Cont...
Behaviours
CRYING/WAILING/SHOUTING,WITHDRAWAL,ANGER/VI
OLENCE, REGRET, EUPHORIA, RELIEF, BEING
PRACTICAL,BECOME HYPERACTIVE/LETHARGIC,
SEARCHING
Physical Sensations
APPETITE CHANGES, DIGESTIVE DISORDERS, SLEEP
DISTURBANCE, EXAUSTION, NUMBNESS,
BREATHLESSNESS, HEADACHE, CHEST CONSTRICTION,
MORE PRONE TO INFECTION, MIRROR SYMPTOMS OF
PERSON WHO HAS DIED, LETHARGY, CRYING, PAIN,
HAIR LOSS; CHILDREN – REGRESSIVE BEHAVIOUR e.g.
SOILING, ENURESIS

14. Facilitating Grief
How may we respond to people who are experiencing a
loss or bereavement?
The next slides give some models that can be utilise to
aid this process

15. Worden's Tasks of Mourning
(2009)
Task I: To accept the reality of the loss
This can be very difficult to achieve
Give the person shortly to be bereaved the opportunity to be with
the person who is dying. If possible, inform the person that death is
approaching
Have a chair near the bed so that they can sit with the person who is
dying or has just died
Give them the opportunity to hold the person e.g. their hand, kiss
the person who has died, hold them in their arms
Stay as long as they wish or is practicable
Give them the opportunity to see the person who has died between
death and the funeral
Use the terms e.g. 'has died', rather than euphemisms for death e.g.
passed away
Talk about the person who has died in the past tense

16. Task II: To process the pain of grief
Give the newly bereaved person the opportunity to express
how they are feeling if they wish to
To do the above, you need to be able to hear and
acknowledge what the person is saying by using
communication skills e.g. empathy
Give them the opportunity to cry, show anger, shout etc... if
they wish to
Facilitate them to talk about the death, the funeral, what its
like now for them
A tissue sometimes gives permission to cry
Although painful talking about what arrangements need to be
made can help facilitate this task

17. Task III: To adjust to a world
without the deceased
This is a more practical task although new activities can
be difficult. Enable the bereaved person to make their
own decisions and do what is right for them
Make new friends
Learn a skill that the person has never done before
Take on activities that the deceased person has
previously done e.g. financial issues, cooking a meal
Choose to go on holiday to a new place
Allow self to laugh or have a good time without feeling
guilty

18. Task IV: To find an enduring connection with
the deceased in the midst of embarking on a
new life
Visit the cemetery as part of other activities
Be able to include mentioning the deceased person in
conversations
Share experiences of the deceased person with new
acquaintances
Allow time to think about the deceased person
Develop new activities

19. The Dual Process Model of Coping
with Loss (Stroebe and Schut, 2008)
As a result of their research, these authors found that
people oscillated between the emotional aspect of grief
and a more restorative approach
Therefore they recommend that the bereaved can be
supported in doing just this
Wilson (2014) acknowledges that this is a useful model
for practitioners

20. The Dual Process model of coping with
loss Stroebe and Schut (2008) cont...
Loss Oriented
Grief work
Intrusion of grief
Breaking bonds/ties
Denial/avoidance of
restoration changes
Restoration oriented
Attending to life changes
Doing new things
Distraction from grief
Denial/avoidance of grief
New role
New identities or
relationships

21. Biography of Grief, Walter 1996
Walter challenges the dominant contemporary model of
grief, which he believes to be the working through of emotion,
with the eventual goal of being able to move on and live
without the deceased.
By analysing his own experience of loss, and drawing from
recent related research, he suggests an alternative, more
sociological model.
Survivors typically want to talk about the deceased,
particularly to those who knew the person. Together they are
then able to construct a story which places the dead person
within their lives, and is, thus, able to endure through time.

22. How may this be facilitated?
By talking about the person who has died, or if a loss,
what it means to the person
Looking at photographs of the deceased
Sharing happy and sad times
 Responding to the bereaved when they broach the
subject of the person who has died, rather than changing
the subject.

23. And finally
We have only just touched on the complex aspects of
loss and bereavement. If you want to learn more about
this important, but often neglected area, or other aspects
of supportive and palliative care; please contact me at;
b.a.beard@shu.ac.uk for more details about a MSc
modules in this area

24. References
 HARRIS T (2009) John Bowlby revisited - a retrospective review Bereavement Care 28(1)
 MACHIN L (2006) The landscape of loss Bereavement Care 25(1): 7-11
 STROEBE MARGARET, SCHUT, HENK (2008) The dual process model of coping with
bereavement: overview and update Grief Matters 11(1): 4-10.
 STROEBE M, STROEBE W, SCHUT H (2003) Does ‘grief work’ work? Bereavement Care
22(1): 3- 5
 STROEBE M, SCHUT H (1999) The dual process model of coping with bereavement:
rationale and description Death Studies 23:197-224
 STROEBE M, SCHUT H (1998) Culture and grief Bereavement Care 17(1): 7- 11
 TONKIN L (1996) Growing around grief – another way of looking at grief and recovery
Bereavement Care 1591): 10
 WALTER T (1996) A new model of grief: bereavement and biography Mortality 1(1): 7-
24
 WALSH Katherine (2012) Grief and Loss - Theories and skills for the helping professions,
London, Pearson
 WILSON, John (2014) Supporting people through loss and grief - an introduction for
counsellors and other caring practitioners. London, Jessica Kingsley
 WOODHOUSE, Jan (2011) Loss, grief and bereavement in (Eds) Moyra Baldwin and Jan
Woodhouse, Key Concepts in Palliative Care, London, Sage
 Worden W (2009) Grief Counseling and Grief Therapy: a handbook for the mental health
practitioner 4th Ed. Hove, Brunner-Routledge