Complicated Grief: Literature Review and a Case Study

Year 2014, Volume: 1 Issue: 1, 41 - 59, 01.03.2014

Ayşen Maraş

https://doi.org/10.31682/ayna.470560

Cited By: 2

Abstract

The current article covered a brief literature review on grief, the factors affecting the grief process leading to complicated grief reactions and depressive symptoms and focused on the psychotherapy process of an individual with complicated grief reactions. Complicated grief reactions is a current topic in research and psychotherapy that led American Psychiatric Association (APA) to include a diagnostic criteria named “Persistent Complex Bereavement Disorder” (PCBD) under the heading of “Conditions for Further Study”. As the term “complicated grief” (CG) rather than PCBD was widely used in the current literature, this term was used in this article. CG encompasses symptoms such as separation distress (e.g., craving, yearning, intense feelings of loneliness, desiring to die in order to reunion, preoccupation with thoughts of the deceased) and other cognitive, emotional, and behavioral symptoms (e.g., confusion, disbelief, avoidance, anger, numbness, difficulty moving on with life). In the literature, many precipating factors for complicated grief reactions were reported. These factors involve the type of death, personal well-being, the relationship with the deceased, personality characteristics, coping style, schemas and beliefs, and social support. These factors that result in complicated grief reactions may be helpful in understanding complicated grief and its treatment. In this article, after the literature review on complicated grief, a treatment model and its application in the psychotherapy process of N. was mentioned. According to this cognitive model that was suggested by Boelen and his collegues (2006), core processes such as poor integration of the separation with existing autobiographical knowledge, negative global beliefs and misinterpretations and anxious and depressive avoidance strategies moderate the relationship between some background variables (e.g., individual vulnerabilty factors, characteristics of the loss event, characteristics of the loss sequelae) and the clinical outcomes (e.g., separation distress, traumatic distress). Boelen and his collegues (2006) state that the treatment of complicated grief should have three targets: 1) loss needs to be conceptually processed and integrated within the autobiographical memory 2) dysfunctional beliefs and misinterpretations need to be identified and replaced with functional ones 3) anxious and depressive avoidance strategies need to be replaced with helpful strategies promoting adjustment. The model does not restrict cognitive behavioral techniques. In order to reach these goals, Boelen and his collegues (2006) suggest using techniques such as psychoeducation, exposure, Socratic questioning and cognitive restructuring. Therefore the psychotherapy process involved a collaborative therapeutic relationship and cognitive behavioral techniques while focusing on the integration of loss in memory, dysfunctional beliefs and avoidance strategies in order to replace them with more adaptive ones.

Keywords

Complicated Grief, Grief, Psychotherapy, Cognitive Model

Komplike Yas: Derleme ve Vaka Çalışması

Abstract

Yas süreci ve depresyon, Freud’un (1915/2000) Yas ve Melankoli üzerine makalesinden bu yana, birbiri ile ilişkili olarak değerlendirilmiş ve iki süreci ayrıştıran özellikler, kuramcılar ve klinisyenler tarafından ilgi odağı olmuştur. Son dönemde, komplike yas kavramı, araştırmalar temelinde, kendine özgü bazı belirtileri kapsayacak şekilde tanımlanmıştır. Literatürdeki yaygın ismi ile komplike yas, süreğen kompleks yas bozukluğu olarak DSM-V tanı kitabına dahil edilmiştir. Bu tanının DSM-V’e dahil edilmesi, gelecekteki çalışmaları arttırmak ve onlara yön vermek amacı taşımaktadır. Bu makalede, literatürdeki araştırmalara paralel olarak “komplike yas” kavramı kullanılmış; kaybın inkarı, ölen kişiye dair sürekli zihinsel meşguliyet, yoğun hasret ve kaybedilenle bir araya gelmek amacıyla intihar düşünceleri gibi belirtileri niteleyen bu kavramın, normal yas sürecinden farkına, komplike yasa yol açabilecek bazı faktörlere, komplike yasın bilişsel kavramsallaştırması ile bu temelde ilerleyen bir vaka çalışmasına yer verilmiştir.

Keywords

Komplike yas, yas, psikoterapi, bilişsel model

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