The complexity of couple communication in bereavement: an illustrative case study

I occasionally wear his huge sweaters… but I often prefer not to think about it: Bereaved children talking and not talking about parental loss

The unique perspective of children communicating about the loss of a parent has rarely been studied. In this qualitative research, we interviewed 12 children aged 7-12 and asked them about their experience communicating their loss. The children's verbal and non-verbal communication was characterized by constant movements away from and closer to various aspects of their loss, illustrated by three main themes: (a) children either talking about the loss or not talking about it; (b) first talking about the loss and then stopping to talk about it; and (c) simultaneously talking and not talking about the loss. Based on Stern's interpersonal relational thinking, our findings indicate that children wish to talk about the loss but also to avoid talking about it. The possibility of choosing to talk and not to talk with themselves and close individuals about the loss allows children to think about and articulate their feelings and thoughts.

"I never told my family I was grieving for my mom": The not-disclosing-grief experiences of parentally bereaved adolescents and young adults in Chinese families

In bereavement literature, the significance of open communication within the family is often highlighted. However, in recent years, scholars have noticed the complexity of grief communication in the family, especially challenges and obstacles to sharing grief. Our study seeks to contribute to the research by offering a deeper understanding of the grief-sharing experiences of parentally bereaved adolescents and young adults from China, a family-centered society with strong traditions of treating bereavement and grief as taboo. We used a narrative approach to analyze 82 interviews with 44 participants. We found that almost all the participants, regardless of their gender, parent's gender, cause of death, or time since loss, indicated that they never shared grief with other family members. Specifically, three themes emerged from the analysis. "Holding back tears during the funeral" reflects participants' struggle to protect the family (especially the surviving parent) through hiding their grief during the family crisis. "Pretending no grief at all after loss" shows how participants intentionally avoided any grief conversations within the family to not trigger others' grief. In addition, "Keeping grief secret as a family rule" indicates how Chinese families powerfully guided and influenced participants in avoiding the open expression of their grief. Our findings have drawn attention to the not-disclosing-grief experiences of bereaved adolescents and young adults in the Chinese context and the role of the family in it, therefore, calling for further support for bereaved young people, either within the family or through professional services.

What happens when romantic couples discuss personal loss? Relational, emotional, and physiological impacts

Does talking about loss with a romantic partner have salutary personal and relationship effects? Prior evidence reveals the benefits of emotional disclosure in couple relationships, yet disclosure about loss has been overlooked in research on couple communication. Using a novel communication paradigm with young-adult heterosexual romantic partners (N = 114 couples), we investigated emotions, physiological arousal (skin conductance responses [SCR]), and relationship closeness when narrating a personal loss and listening to the partner's loss, and compared these loss discussions to discussions about desired relationship changes. Based on partners' self-reports, narrating loss elicited more vulnerable and, unexpectedly, more antagonistic emotions. Both narrating and listening to loss produced higher self-reported partner closeness, compared to discussing change. In support of the physiological benefits of disclosure, women's SCRs decreased over the discussion when they narrated their own loss. However, both women and men as listeners show a general trend of increasing SCRs over the discussion, suggesting the challenges of being a responsive partner. Moreover, in line with the putative protective effects of partners' biological interdependencies, partner closeness also was higher when both partners showed synchronous decreasing SCR as women narrated their loss. Although limited to young couples in relatively short relationships, these findings reveal some potential benefits of talking about loss in the context of romantic relationships. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Meaning Co-Construction: Facilitating Shared Family Meaning-Making in Bereavement

Meaning-oriented approaches to grief therapy have made substantial contributions by defining the internal processes of meaning-making and, more recently, clinical scholars have introduced relational approaches as means for continuing bonds with the deceased and increasing social support for the bereaved. However, the complicated interactive processes of interpersonal meaning-making pose added challenges as family members attempt to coregulate each other's grief experiences. While systemic therapists have consistently emphasized the essential role of familial relationships in fostering resilience through interpersonally constructed meaning, there remains a need for clarity in terms of the specific processes by which this occurs. The Meaning Reconstruction Model and Emotionally Focused Therapy provide process-oriented therapeutic strategies for facilitating interpersonal interactions that foster deep relational connection and self-identity transformation. In this article, we explore how these models can be integrated and applied to the dynamic needs of families who are adjusting to loss. Future clinical and research directions are also discussed.

Bereavement in political conflict: Ideological meaning-making and dialogue

In this research article we explored the dialogical mechanisms of ideological meaning making in the aftermath of traumatic loss, via descriptive phenomenological qualitative research. Thirty-three individuals who lost a close family member in the Israeli-Palestinian conflict were interviewed regarding the dialogues they had about their ideology in the aftermath of their loss. Analysis identified four types of dialogues that assisted in ideological meaning making: dialogue with political figures, dialogue with and through the media, dialogue with the deceased, and dialogue with radicalized bereaved individuals. Applications of our findings to the constructivist theory of bereavement are discussed.

"Remarried military widows" grief in light of social policy upheavals

Military widows' remarriages and their consequences have scarcely been studied. We examined how legal changes enacted on behalf of remarried war widows, who regained their official rights after many years without them, impacted their life experience. Based upon 29 qualitative interviews, we found that the reinstatement of official recognition of widowhood validated participants' personal longitudinal grief but also revived painful loss-related feelings, which were expressed in interpersonal spheres. Policy changes allowed some widows a higher measure of independence, alongside upsetting the current couple's power balance. Social and clinical implications of such interruptions in the longitudinal grief course are discussed.

Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases

Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.

Pain without reward: A phenomenological exploration of stillbirth for couples and their hospital encounter

Stillbirth constitutes a unique form of grief related to the death of an unborn child. This study explores the experiences of eight couples who lost a child to stillbirth, from the time they suspected something was wrong to their release from the hospital and beyond. Couples were interviewed conjointly and data were analyzed qualitatively using a phenomenological approach. Analysis revealed themes of positive and negative encounters with hospital staff, grief and loss, relationships with spouse and family, and long-term impacts. Implications for clinicians are discussed, including gender differences in the grief process for fathers and mothers.

"It is not simply the loss of a child": The challenges facing parents who have lost their only child in post-reproductive age in China

The death of one's only child in post-reproductive age (in Chinese, shidu) is a traumatic event that has specific cultural implications in China. This study investigates the experience of a changed life and emerging challenges amongst Chinese shidu parents. Thematic analysis of 36 interviews revealed four main life consequences following shidu: impairment of psychological and physical health, weakening of social networks and interactions, loss of meaning in life, and lack of care and security. We suggest that health monitoring and mental health intervention, adequate social and community support, and improved social security are the critical needs in this vulnerable group.

Families grieving together: Integrating the loss of a child through ongoing relational connections

This study explored the relational dimensions of grieving within the family unit. Three families bereaved of a child, participated. Using the Qualitative Action-Project Method, individual and joint interviews were conducted with family members. Data analysis illuminated family grieving processes and demonstrated that grieving was an interactive process with individual, dyadic, multi-adic, and community levels of processing. The family grieving process included intentionality in grieving together and separately, recognition of differing grieving styles, and meaning came through the incorporation of ongoing rituals and remembrances. A finding emerged of family connection facilitated through an ongoing, shared, continuing bond with the deceased child.

Matching response to need: What makes social networks fit for providing bereavement support?

The objectives of this study were to explore the goodness of fit between the bereaved peoples’ needs and the support offered by their social networks; to ascertain whether this support was experienced as helpful or unhelpful by bereaved people; and to explore both the types of social networks that offer effective support and the characteristics of the communities that encourage and nurture such networks. This study was based on qualitative interviews from twenty bereaved people, in Western Australia, interviewed in 2013. A framework analysis of these interviews was undertaken using a deductive approach based on the goodness of fit framework. Much of this support is provided informally in community settings by a range of people already involved in the everyday lives of those recently bereaved; and that support can be helpful or unhelpful depending on its amount, timing, function and structure. Improving the fit between the bereaved person’s needs and the support offered may thus involve identifying and enhancing the caring capacity of existing networks. An important strategy for achieving this is to train community members in mapping and developing these naturally occurring networks. Some such networks will include relationships of long standing, others may be circles of care formed during a period of caring. Peer support bereavement networks develop from these existing networks and may also recruit new members who were not part of the caring circle. The findings endorse social models of bereavement care that fit within a public health approach rather than relying solely on professional care. As exemplified by Compassionate Communities policies and practices, establishing collaboration between community networks and professional services is vital for effective and sustainable bereavement care.

Parenting school-aged children after the death of a child: A qualitative study on victims' families of the Sewol ferry disaster in South Korea

This study aims to identify parenting experiences after the death of a child. Using interpretive phenomenological analysis, we mapped the experiences of 16 parents with school-aged surviving children after the death of their sibling to the 2014 Sewol ferry disaster in South Korea. Interviews illuminate five master themes of parenting surviving children following a child's death: (a) parental anxiety, (b) conflicts and obstacles in the parent-child relationship, (c) changes in parenting style, (d) striving to support children's grief, and (e) seeking outside help for parenting. Implications for supporting grieving parents and their children are discussed in light of the findings.

The dynamics of spousal relationships after the loss of a child among bereaved Malay parents

The purpose of this study is to explore the dynamics of the relationship between bereaved parents after the loss of their child. Literature has attempted to understand how coping mechanisms related to gender characteristics, communication, and intimacy influence the spousal relationship after the loss of a child. However, this area is scarcely explored in a Malaysian context. This qualitative study involved 11 bereaved parents. These parents had lost their children due to accidents (n = 9) and homicide (n = 2). Open-ended questions that focused on the patterns of the spousal relationship were administered to the parents. The data were analysed using thematic analysis. Some of the main themes found were that constructive communication and intimacy are interrelated in helping bereaved parents to cope better. Nonverbal intimacy is helpful. Avoidance or limited communication and intimacy are influenced by religion and cultural beliefs. The bereavement responses influenced the spousal relationship, causing it to become stronger, weaker, or causing the parents to act like nothing had happened. This study helps us to understand the effects of the loss of a child on the spousal relationship of the bereaved parents. This study makes recommendations related to the adjustment and maintenance of a healthy spousal relationship after the loss of a child.

Invitation to grief in the family context

Grief is a family affair, yet it is commonly viewed as an individual phenomenon. As an international, interdisciplinary team, we explore grief within a family context across theoretical, research, practice, and educational domains. Families are complex and working with this complexity is challenging but necessary for a holistic view of grief. We therefore encourage an increased focus on theorizing, researching, practicing, and educating using innovative approaches to address the complexities of grief within the context of families. Learnings from within each domain will affirm and enhance the development of family-level thinking and approaches.

"We Hardly Ever Talk about It": Emotional Responsive Attunement in Couples after a Child's Death

Within Western cultural traditions, the idea that parents should talk about the death of their child with each other is deeply rooted. However, across bereaved parent couples there are wide variations in communication about their grief with each other. In this study, we explored the experiences of bereaved couples related to the process of talking and not talking. We used a thematic coding approach to analyze 20 interviews with 26 bereaved parents (11 interviewed as couples, four as individuals). Four main meanings emerged out of our analysis: not talking because of the inadequacy and pointlessness of words in grief, not talking as a way to regulate emotions in daily life, not talking as an expression of a personal, intimate process, and not talking because the partner has the same loss but a different grief process. In addition, we found that the process of talking and not talking can partly be understood as an emotional responsive process on an intrapersonal and interpersonal level. In this process partners search for a bearable distance from their own grief and their partner's, and attune with their relational context. A better understanding of this process is sought in a dialectical approach, emphasizing the value of both talking and not talking in a tense relationship with each other. Implications for clinical work are described.

"You either need help…you feel you don't need help…or you don't feel worthy of asking for it:" Receptivity to bereavement support

OBJECTIVE

Although the needs of the bereaved have been identified widely in the literature, how these needs translate into meaningful, appropriate, and client-centered programs needs further exploration. The application of receptivity to support is a critical factor in participation by the bereaved in palliative care bereavement programs. Receptivity is a complex multifactorial phenomenon influenced by internal and external factors that ultimately influences engagement in psychosocial support in bereavement. This study explored factors that influence receptivity to bereavement support from palliative care services in rural, regional, and remote Western Australia.

METHOD

The study comprised a qualitative descriptive research design using semistructured interviews with 24 bereaved individuals, nine palliative care health professionals, and four Aboriginal Health Professionals. Participants were recruited via palliative care services in country Western Australia. Interviews were transcribed verbatim and thematically analyzed.

RESULT

Findings revealed that a range of individual, social, and geographical factors influence receptivity to bereavement support and can impact on utilization of bereavement support services.

SIGNIFICANCE OF RESULTS

Receptivity provides a frame of reference to enhance understanding of factors influencing engagement in psychosocial support in bereavement. Receptivity promotes a shift of service provider perspectives of effective supportive care to consumer-centric reasons for engagement.

Meaning Reconstruction in the Wake of Loss: Evolution of a Research Program

As theories of bereavement have evolved, so too have evidence-based interventions to mitigate complications in post-loss adaptation. This article reviews one line of programmatic research grounded in a conceptualisation of grieving as an attempt to reaffirm or reconstruct a world of meaning challenged by loss. Anchored in therapeutic encounters with the bereaved, a meaning reconstruction approach to loss has grown over the past 15 years to generate an increasingly substantial research base, as well as to develop and refine a wide array of contributions to psychological assessment and therapy. By summarising the major models, measures and methods resulting from this collaborative work, it offers an introduction to meaning reconstruction for those unfamiliar with it, noting its contributions to date, its areas of future development, and its relevance for clinical practice.

Looking Through the Lens of Receptivity and Its Role in Bereavement Support: A Review of the Literature

Receptivity is a new concept within the area of scholarship on bereavement. There is a dearth of research that specifically focuses on individuals' receptivity in relation to bereavement support. This is particularly the case within the context of rural, regional, and remote locations. There is also a noticeable absence in the literature on bereavement support to Aboriginal families. Understanding receptivity in relation to bereavement in rural areas is important, particularly as bereavement support is an important area of service to the community by palliative care services. Receptivity to bereavement services has been identified as a critical factor in participation in bereavement support programs. This review provides a starting point by outlining the present literature on receptivity and bereavement.

Dyadic coping of parents after the death of a child

This article explores the grief process of parents following the death of a child due to a life-limiting illness, putting particular focus on dyadic coping. Participants included 46 married parents (23 couples). A mixed-methods design was used with in-depth interviews and standardized questionnaires. All parents were interviewed separately. Aspects of common dyadic coping (e.g., sharing emotions or maintaining bonds to the child) helped them work through their grief as a couple but also individually. The authors conclude that dyadic coping plays an important role in grief work and adjustment to bereavement.

Competing discourses surrounding primary caregivers of hospice patients

This study helps facilitate health care chaplains' awareness of end-of-life communication experienced by primary caregivers. Relational dialectical theory was used to examine the discourse of twenty primary caregivers of hospice patients. The research questions guiding the study were: what competing discourses do primary caregivers experience during end-of-life care, and how do primary caregivers communicatively manage competing end-of-life discourse? In-depth interviews revealed five major competing discourses which were connected physiologically to the patient's dying trajectories: care versus cure; prolong-life versus end-life; open versus hidden; theodicy; and move-on versus don't-move-on discourse. The primary caregivers negotiated these competing discourses through educating the family, by the use of black humor, spiritualizing, ignoring opposing views, and regulating conversations. Theoretical and practical implications for interventions during end-of-life communication are discussed that may help the Chaplain and families of patients negotiate issues such as signing DNRs, impromptu visits to the hospital, and family conflicts about treatments.

The no conclusion intervention for couples in conflict

Dealing with difference is central to all couple therapy. This article presents an intervention designed to assist couples in handling conflict. Central to this approach is the acceptance that most conflicts cannot be solved. Couples are in need of a different understanding of couples conflict. This understanding is found in the analysis of love in context and in relational dialectics. Couples are guided through different steps: deciding on the valence of the issue as individuals, helping them decide which differences can be resolved and which issues demand new ways of living with the inevitable, and the introduction in the suggested no conclusion dialogue. This article briefly describes the five day intensive couple therapy program, in which the no intervention is embedded. The theoretical foundation of the intervention, followed by the step by step description of the intervention forms the major part of the article. A case vignette illustrates this approach.

A social constructionist account of grief: loss and the narration of meaning

In contrast to dominant Western conceptions of bereavement in largely intrapsychic terms, the authors argue that grief or mourning is not primarily an interior process, but rather one that is intricately social, as the bereaved commonly seek meaning in this unsought transition in not only personal and familial, but also broader community and even cultural spheres. The authors therefore advocate a social constructionist model of grieving in which the narrative processes by which meanings are found, appropriated, or assembled occur at least as fully between people as within them. In this view, mourning is a situated interpretive and communicative activity charged with establishing the meaning of the deceased's life and death, as well as the postdeath status of the bereaved within the broader community concerned with the loss. They describe this multilevel phenomenon drawing first on psychological research on individual self-narratives that organize life experience into plot structures that display some level of consistency over time, whose viability is then negotiated in the intimate interpersonal domain of family and close associates. Second, they explore public communication, including eulogies, grief accounts in popular literature, and elegies. All of these discourses construct the identity of the deceased as he or she was, and as she or he is now in the individual and communal continuing bonds with the deceased. Finally, they consider different cultural contexts to see how expressions of grief are policed to ensure their coherence with the prevailing social and political order. That is, the meanings people find through the situated interpretive and communicative activity that is grieving must either be congruent with the meanings that undergird the larger context or represent an active form of resistance against them.

Complicated spiritual grief II: a deductive inquiry following the loss of a loved one

Recent studies have revealed an association between complicated grief-a severe, prolonged response to the loss of a loved one-and complicated spiritual grief-a spiritual crisis following loss. Furthermore, bereavement research has benefitted from a number of studies using qualitative inquiry as a means of examining the experiences of individuals grieving a variety of types of losses. However, a gap in the literature remains in terms of the qualitative investigation of spiritual struggle following loss. Thus, using participants' written responses to open-ended questions along with systematic exploration of this topic with a five-member focus group, we designed this qualitative study to better understand the firsthand experiences of bereaved individuals who have suffered a crisis of faith after the death of a loved one. Specifically, our directed content analysis of bereaved focus group members' responses revealed 17 different common and salient themes subsumed in an overarching narrative of resentment and doubt toward God, dissatisfaction with the spiritual support received, and substantial changes in the bereaved person's spiritual beliefs and behaviors. Thus, our study clarified the construct of complicated spiritual grief, and laid the groundwork for development of more specific assessment and treatment of this condition.

The long-term impact of early parental death: lessons from a narrative study

OBJECTIVE

To explore the individual experiences of those who had experienced the death of a parent(s) before the age of 18, and investigate how such experiences were perceived to impact on adult life.

DESIGN

An exploratory qualitative design using written (n = 5) and oral (n = 28) narratives and narrative analysis was adopted to explore the experiences 33 adults (7 men and 26 women) who had experienced parental death during childhood.

SETTING

UK participants: Individuals living in the North West of England who had lost a parent(s) before the age of 18.

MAIN OUTCOME MEASURES

Views of adults bereaved of a parent before the age of 18 of impact of parental loss in adult life.

RESULTS

While individual experiences of bereavement in childhood were unique and context bound, the narratives were organized around three common themes: disruptions and continuity, the role of social networks and affiliations and communication and the extent to which these dynamics mediated the bereavement experience and the subsequent impact on adult life. Specifically they illustrate how discontinuity (or continuity that does not meet the child's needs), a lack of appropriate social support for both the child and surviving parent and a failure to provide clear and honest information at appropriate time points relevant to the child's level of understanding was perceived to have a negative impact in adulthood with regards to trust, relationships, self-esteem, feeling of self-worth loneliness and isolation and the ability to express feelings. A model is suggested for identifying and supporting those that may be more vulnerable to less favourable outcomes in adult life.

CONCLUSIONS

The findings suggest that if the negative consequences are to be minimized it is crucial that guidelines for 'best practice' that recognize the complex nature of the bereavement experience are followed.

"Cycling around an emotional core of sadness": emotion regulation in a couple after the loss of a child

In contrast to the traditional view of working through grief by confronting it, recent theories have emphasized an oscillating process of confronting and avoiding the pain of loss. In this qualitative study, we sought a better understanding of this process by conducting a detailed case study of a bereaved couple after the loss of their infant daughter. We employed multiple data collection methods (using interviews and written feedback) and an intensive auditing process in our thematic analysis, with special attention to a recurrent metaphor used by this bereaved couple in describing their personal and relational experience. The findings suggest the presence of a dialectic tension between the need to be close to the deceased child and the need for distance from the pain of the loss, which was evidenced on both individual and relational levels. For this couple, the image of "cycling around an emotional core of sadness" captured their dynamic way of dealing with this dialectic of closeness and distance.