Finally, some recommendations for the development of bereavement counselling in relation to social policy, service delivery, education and training, workers' personal development, as well as future research were presented. / In--depth interviews were conducted with 12 social workers working in palliative care. This figure was nearly half of the total number of palliative care social workers in Taiwan, so the research findings may reflect the general situation of bereavement counselling in Taiwan. Their stories revealed the endeavours of these social workers in the past years and showed the development of the services from nothing to multifarious. / The narratives of the workers reflected the required individual characteristics of a bereavement counsellor, such as stability in emotion, resilience, creativity, psychic energy. Due to the nature of their work they often encountered death and sufferings, as well as feeling of helplessness. In facing different obstacles and challenges, some of them might retreat themselves at times, especially for those who were still entangled in their personal bereavement. Their emotional state would affect the establishment of effective helping relationship and subsequently the effectiveness of their service. / The research revealed that most of the social workers did not apply any specific theories, or techniques in working with the bereaved. Their narratives reflected that they worked with the bereaved by establishing a meaningful working relationship. They respected and accepted their clients' needs; their empathic support helped the bereaved face the pain of losing their loved ones. Their encouragement and assurance helped them develop and change. Their skills and methods matched well with those of humanism and existentialism. They also tended to adopt postmodernism approach of storytelling in helping the bereaved. Through narration, the workers helped the bereaved re-construct the meaning of their relationship with the deceased in their life. / The study revealed that the social workers considered most of the bereaved had the ability of self-healing, but for some, due to personal or environmental factors they might be entangled in their grief and might need assistance. Their work reflected the emphases of bereavement counselling in Taiwan. Besides counselling service, they also provided assistance in medical related matters, emotional support, enhancement of family members' communication, social adjustment and religious support. Due to the socio-cultural backgrounds of Taiwan, their tasks also included special arrangements at death and discussion of funeral services and rituals. The social workers also stressed the importance of the traditional value of harmony among Heaven, Earth and Man. They paid special attention to the emotional harmony of the bereaved, harmony between the bereaved and their relatives, and harmony among the social environment, the spiritual and the bereaved. / This study is a narrative analysis of the palliative care social workers' experiences in bereavement counselling in Taiwan. It explored the characteristics of bereavement counselling, the social workers' interpretation of their experiences and the cultural and contextual factors that affected the palliative care social workers and bereavement counselling. / 李閏華. / Adviser: Mong Chow Amy Lam. / Source: Dissertation Abstracts International, Volume: 73-03, Section: A, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (p. 277-305) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Li Runhua.

This dissertation is an exploration of the putative mediators of complicated grief treatment (CGT) in an effort to gain a better understanding of the mechanisms by which the treatment exerts its effects. This three-paper dissertation utilizes data from an NIMH-funded randomized controlled trial of CGT (Shear et al., 2005), which showed that CGT is more effective than Interpersonal Psychotherapy (IPT) in reducing symptoms of complicated grief (CG). The first paper examines a broad range of ancillary outcomes including symptoms of anxiety, depression, complicated grief and sleep disturbance due to bad dreams. Antidepressant use is examined as a possible moderator since half the sample was taking antidepressants and those taking antidepressants had a marginally better response rate in CGT than those not taking them (59% vs. 42% in CGT and 40% vs. 19% in IPT). CGT was more effective than IPT in reducing cognitive symptoms of anxiety, depression as measured by the Hamilton Rating Scale for Depression (HRSD), somatic symptoms of depression, guilt/self-blame, negative thoughts about the future, avoidance and poor sleep due to bad dreams. The difference in treatment effect on the HRSD for CGT over IPT was more pronounced for participants not taking antidepressants where CGT reduced depression but IPT did not. Paper two examines possible mediators specific to the model of CGT including: guilt/self-blame specific to the death or deceased; negative thoughts about the future; avoidance of reminders of the loss; anxiety and depression (intense negative emotions). Antidepressants are also examined as a potential moderator to explore whether their use affects the mediating role of the identified variables. All of these variables emerged as either full or partial mediators of CGT. Antidepressant use had no effect on the mediating role of these variables. Paper three examines whether alliance (measured at week 4) predicts subsequent change in grief symptoms (controlling for early symptom change) and if so, whether it accounts for the difference in treatment effect between CGT and IPT (mediation). Working alliance emerged as a mediator of CGT, accounting for 28% of the treatment effect found between CGT/IPT and grief symptoms. Discussion sections for each paper summarize study findings, limitations and implications for future research.

Grief is a life changing and universal experience, expressed through individual sets of responses and behaviours. Society and health workers’ interpretation and beliefs regarding grief and bereavement have changed throughout the decades. This is a continually evolving process. As we move into a new century, so too does grief move into a new era where a new postmodern paradigm is arising. We are thus deviating away from stage theories that are time limited, linear and predictable. Emphasis in this new wave of thought is placed upon grief as an oscillating and highly unique experience, one that encourages a continuation of a bond and lifetime relationship with the deceased. This current qualitative study explores the new phenomenon in relation to both the grief process and bereavement support programs, by extensively reviewing the literature and analysing data from a number of interviews with the bereaved. Furthermore the supports offered by society, with particular focus on a Melbourne Community Bereavement Follow Up Program, are reviewed. By observing and discussing expressions of grief it was found, although unique and varying, some patterns or common behaviors emerged. Supports and comforts that assisted the bereaved are explored. Issues, including inappropriate comments and problems with bureaucratic departments, are also developed and discussed. There is an emphasis placed upon the need of health care staff and the community in general to increase their understanding of the grief process and bereavement support, so as to enhance care and practice when working with people who have suffered loss.

<p><strong>Abstract</strong></p><p>In this work, I have chosen to write about children in grief. Since children in grief is a large area, I have chosen to focus on how preschool handles and works with children who has loosed a parent, siblings or a play-mate by death. The aim of this work is to contribute knowledge about how you in preschool can handle and work with children in grief. To get answers to my questions, I have studied the current literature in the field. I have also interviewed five people with experience and knowledge of work with preschool-children affected by grief.  In my work, I have come to the conclusion that preschool has a great influence to children affected by grief. The preschool-child can get the everyday routines that are important for the child confidence. It is also important that as a preschool teacher be there for the child and to really listen and show understanding when the child tells about their experiences and feelings.</p><p> </p>

Abstract In this work, I have chosen to write about children in grief. Since children in grief is a large area, I have chosen to focus on how preschool handles and works with children who has loosed a parent, siblings or a play-mate by death. The aim of this work is to contribute knowledge about how you in preschool can handle and work with children in grief. To get answers to my questions, I have studied the current literature in the field. I have also interviewed five people with experience and knowledge of work with preschool-children affected by grief.  In my work, I have come to the conclusion that preschool has a great influence to children affected by grief. The preschool-child can get the everyday routines that are important for the child confidence. It is also important that as a preschool teacher be there for the child and to really listen and show understanding when the child tells about their experiences and feelings.

The aim of this qualitative study was to examine bereaved individuals’ experiences of support from their social networks and participation in support groups. The theoretical framework is based on theories about social support and parts of the attachment theory. Data were collected from four interviews and analysed by the study’s theoretical framework. The results have shown that the interviewed persons found emotional, instrumental and informative support from their own social networks important after their loss. Receiving constructive feedback from the social networks, and or various support groups, were also important factors. The interviewed persons expressed that the perceived and offered support was not satisfying and that they would have appreciated further help. The results also showed that most of the inter-viewed persons found their participation in support groups important as the groups made it possible for them to express their inherent feelings and thoughts. They also found it important to be able to talk with individuals who had experienced similar losses. My findings support earlier research that states the importance of social support and the possibility to express grieving reactions after a loss.

Many adolescent girls experience the death of a peer, which is often sudden and at times violent. These deaths are typically viewed as preventable, which can complicate the grief reactions of adolescent girls. The impact of peer death on adolescent girls involves a number of physical, emotional, social, and cognitive grief responses. Negative outcomes include school problems, depression, substance abuse, and suicidal ideation. This study examines the efficacy of the Adolescent Grief and Loss (AGL) group, a six-week group designed to address the needs of adolescent girls who have experienced the death of a peer within the past two years. The goal of the AGL group was to reduce or lessen physical, emotional, social, and cognitive responses to grief, and to foster mutual support and connection to others via various tasks associated with each group session. The AGL group was conducted in four different public high schools in Central Texas, with a sample size of 20 girls. A mixed methods design was utilized for this study, integrating both quantitative and qualitative research designs. The quantitative component employed a non-experimental simple time-series design, using two pre-test and three post-test time points. The qualitative component was based on a phenomenological analysis of adolescent grief and loss response, which included open-ended questions developed to capture each adolescent girl’s individual experience of peer death. Questions were also asked to elicit the girls’ experience of participating in the AGL group. The quantitative results of the study indicate that adolescent girls benefited from participation in the AGL group as evidenced by significantly reduced scores on the Loss Response List for all domains of physical, emotional, social, and cognitive grief responses. The qualitative findings yielded five overarching themes of experience of peer death: the story, physical reactions, emotional reactions, social reactions, and cognitive reactions. Integration of the quantitative and qualitative findings of this research study strongly support the benefits of providing a grief and loss group to adolescent girls who have been impacted by the experience of peer death. / text

This qualitative research project is a narrative inquiry into the loss experiences of four bereaved individuals who have lost an immediate family member; one of them is myself. In particular, the meanings assigned to the losses and how those meanings impacted the grieving process were explored by listening to in-depth narratives of the participants’ experiences of loss and grief. A narrative methodology was used, based on a constructivist epistemology that describes a human tendency to put events in narrative forms in order to give them a sense of continuity and meaning. Four narratives, along with their respective analysis, were presented in separate chapters, with my own narrative presented as the last narrative chapter. Of the four of us, two are males: one from Jewish-American and the other from German-Romanian descent, and two are females: both from Persian descent. The four participants ranged from 39 to 71 years of age at the time of the interviews, with the losses occurring 3 to 25 years before the interviews. Findings of this research reveal the unique and complex grieving processes of the participants. A variety of meanings were assigned to the losses with each meaning having its own possible impact on the course of bereavement. Each participant expressed her/his own personal assumptions about the nature of life, love, suffering, human vulnerabilities, and death stemming from their life experiences and culture. We all expressed in our own unique way that the loss of a special person, a loving bond, and a significant relationship will always remain painful, but their memories, legacies, and love will continue beyond their deaths, which can help us in finding meaningful, productive, and hopeful paths. Hopefully this research project will provide some validation and inspiration for other grieving individuals and contribute to the current understanding of bereavement and grief.

This qualitative research project is a narrative inquiry into the loss experiences of four bereaved individuals who have lost an immediate family member; one of them is myself. In particular, the meanings assigned to the losses and how those meanings impacted the grieving process were explored by listening to in-depth narratives of the participants’ experiences of loss and grief. A narrative methodology was used, based on a constructivist epistemology that describes a human tendency to put events in narrative forms in order to give them a sense of continuity and meaning. Four narratives, along with their respective analysis, were presented in separate chapters, with my own narrative presented as the last narrative chapter. Of the four of us, two are males: one from Jewish-American and the other from German-Romanian descent, and two are females: both from Persian descent. The four participants ranged from 39 to 71 years of age at the time of the interviews, with the losses occurring 3 to 25 years before the interviews. Findings of this research reveal the unique and complex grieving processes of the participants. A variety of meanings were assigned to the losses with each meaning having its own possible impact on the course of bereavement. Each participant expressed her/his own personal assumptions about the nature of life, love, suffering, human vulnerabilities, and death stemming from their life experiences and culture. We all expressed in our own unique way that the loss of a special person, a loving bond, and a significant relationship will always remain painful, but their memories, legacies, and love will continue beyond their deaths, which can help us in finding meaningful, productive, and hopeful paths. Hopefully this research project will provide some validation and inspiration for other grieving individuals and contribute to the current understanding of bereavement and grief.

Background: The death of a spouse is among the most distressing life events faced by older adults and frequently follows long periods of providing extensive care and support. Although many spouses are resilient following loss, a number of bereaved spousal caregivers have poor psychological well-being and may benefit from clinical services. However, it can be difficult to determine who may most benefit from bereavement services and why some individuals are at greater risk for poor bereavement; thus, there is a need for greater understanding of the process of bereavement. Therefore, the purpose of this dissertation was to investigate a number of theoretically relevant factors within the context of bereavement after caregiving as possible predictors of psychological well-being following loss. Specifically, former caregivers' perceptions of loved ones' end-of-life suffering, rumination, and feelings of relief were investigated as possible predictors of caregivers symptoms of depression, grief, and complicated grief following loss. Method: Participants included 61 former spousal caregivers of hospice patients 50 years of age or older who lost a spouse in the last 6-18 months. Individuals completed an interview that included retrospective recall of perceptions of loved ones' physical, emotional, and existential suffering, current frequency of thoughts about loved ones' suffering, stress-reactive rumination, and feelings of relief following the death. Participants also completed measures assessing current symptoms of depression, present feelings of grief, and complicated grief. Descriptive information about care recipients was obtained via retrospective review of hospice electronic medical records following participant interview. Several regression analyses were conducted to investigate the relationship of possible predictor variables to bereavement outcomes and interactions among predictor variables. Results: Findings revealed important relationships between rumination, feelings of relief, and former caregivers' psychological well-being follow loss. Higher rumination and less feelings of relief were associated with worse bereavement outcomes. In addition, interaction analyses revealed that rumination and feelings of relief moderated the relationship between participants' perceptions of their spouses' emotional end-of-life suffering and psychological distress. Other descriptive predictors of depression, grief, and complicated grief were identified. Discussion: Participants were highly distressed former caregivers who were highly engaged in caregiving duties prior to loss. About 40% reported no feelings of relief following the loss, and over one-fourth of participants still had frequent ruminations about their loved ones' suffering. High stress-reactive rumination was an important predictor of bereaved spouses' psychological distress. Clinical interventions, such as cognitive behavioral therapy, could focus on identifying, redirecting, and reducing distressing thoughts or the negative feelings associated with them, such as ruminations associated with loved ones' end-of-life suffering. Future longitudinal research should examine the relationships between rumination, feelings of relief, perceived suffering, and bereavement outcomes in order to identify patterns that may inform clinical interventions.