Family Stressors

Interventions for Stress and Trauma

Don R. Catherall

• Publisher: Routledge
• Year: 2005
• ISBN:
  9781135931438
• Edition: 1
• Topic: Psicología
• Subtopic: Asesoramiento psicoterapéutico

This book is aimed at practitioners working with couples and families dealing with the impact of a traumatic/stressful event, with chapters considering events such as the loss of a child, infertility in a couple, sexual abuse of a partner, traumatization of a parent, traumatization of a child, impact of a homicide, and the impact of health problems of aging parents. Therapists are continually faced with these issues in their practices, and cases involving these situations are often among the most intense and emotionally demanding that they will confront. One of the supports a therapist can have available when confronted with such a situation is a practical guide to effective intervention. This book would provide the practitioner with just that -- a hands-on, practical guide that deals with how to appropriately respond to each specific stressor that is outlined in the book. Because each chapter is devoted to a different stressor, the practitioner is able to easily reference the desired material, in order to anticipate relevant issues, and plan for an intervention that will be based on the solid experience these authors will bring to the book.

1
When a Couple Loses a Child

KATHLEEN R. GILBERT

It is difficult to conceive of a loss that is more painful and overwhelming than the death of a child. The death of one’s child has been described as fundamentally different from any other loss (Kagan Klein, 1998), the worst loss that one can experience in adulthood (Rando, 1986; Sanders, 1980), and one of the losses most likely to lead to profoundly overwhelming and life-changing grief (Rosenblatt & Burns, 1986; Walsh & McGoldrick, 1991). Compared to other adulthood losses, the death of a child produces the most intense grief and the widest range of emotions (Sanders, 1980). With the death of one’s child “a significant portion of the parent’s life energy can effectively die with the child” (Rubin & Malkinson, 2001, p. 219). Deeply held beliefs are confronted with a child’s death: Children should outlive their parents and serve as a bridge to the future. Parents should be able to guide, protect, and keep their children from harm, and their inability to do so is devastating. Children are part of their parents, who sometimes use metaphors of amputation to describe the impact such a loss has on them (Gilbert & Smart, 1992).

The bereaved couple is defined broadly in this chapter as two individuals who have maintained a committed, intimate relationship and are the parents of a child who has died. Much of the literature cited here is based on studies of married couples. Little research has been conducted on unmarried heterosexual couples who have lost a child and even less on same-sex bereaved parents. Because marital status is not essential to the experience of couple bereavement, the terms spouse and partner will be used interchangeably, and, for the most part, marital status will not be assumed.

PARENTAL GRIEF: RESPONSE TO A DEVASTATING LOSS

Grief has been defined in many different ways. For purposes of this chapter, grief is seen as an internal process in which a person progressively reconciles him- or herself from a reality in which a loved one was a living part of his or her life to a reality in which that person can only exist as a concept or memory. This process is progressive but not linear, particularly when the desire to return to the earlier, more desirable reality is triggered. For parents, this often occurs at life events that they had long anticipated. For example, triggers might involve other children reaching significant milestones, such as 16th birthdays, graduations, first dates, proms, and weddings.

This process of grief is evidenced outwardly by a variety of somatic, psychological, social, and behavioral phenomena typically recognized as grief. Inwardly, the process is a progressive reconciliation to the revised reality. For parents, the cause of this grief can range from the death of an adult child to the progressive death of hope for a couple who is struggling to conceive. This process is ongoing, and the elements of the reality that is being constructed are changeable and “fuzzy” (Hagemeister & Rosenblatt, 1997). As Attig (1990) noted, grief involves a type of “relearning of the world.” For parents, this involves piecing together a world that has some coherence in which their child is no longer a living, breathing individual (in the case of the death of a living child) or the loss of a dream (where the loss is related to fertility).

The death of a child precipitates a severe crisis of meaning and a related search for meaning (Wheeler, 2001). If the child’s death is sudden and unanticipated with little or no time for parents to prepare, the impact of the loss is especially intense (Figley, 1989), and bereaved parents feel out of control, helpless, and confused (DeFrain, 1991; Gilbert & Smart, 1992). The death of a child results in disruption of the normal order of things (Shapiro, 1994); bereaved parents report feeling out of sync with normal life (Gilbert & Smart, 1992), almost as if real life is taking place in a parallel reality as they struggle, sometimes for the rest of their lives, to come to terms with the fact that they have survived their child.

To lose one’s child is traumatic regardless of the age of the child (Shapiro, 1994; Rando, 1986) and will result in a loss that is difficult to come to terms with and to resolve (Rubin & Malkinson, 2001). Because the death is out of sequence, it is accompanied by a sense of untimeliness and a perception of injustice that such a thing happened (Janoff-Bulman, 1992).

Bereaved parents may question their competency as parents and the legitimacy of their right to that identity (Gilbert, 1997; Rubin & Malkinson, 2001). They typically report a strong sense of guilt for their inability to protect and nurture their child (Sanders, 1980; Rando, 1986). Questions about their responsibility for the child’s death and about their personal identity as parents commonly follow the death of a child (Rosenblatt, 2000).

Normality of Parental Grief

In parenting, important aspects of the parents’ selves are invested in their children, thus what are considered to be normal bereavement processes, such as relinquishing the tie to the deceased, are not realistic for parents (Shapiro, 1994). These are people who are now the parents of a child who has died—abandoning that parental role and the parent-child relationship will be difficult, if not impossible. The common expectation that the bereaved will let go and move on will not be a realistic one for many parents. What looks like pathology for other forms of loss may be normal for bereaved parents, and the use of such models of bereavement as spousal bereavement for understanding and predicting parental bereavement may produce a diagnosis of pathology where none exists (Kagan Klein; 1998; Rando, 1986).

Conflicting Inner Realities

Children are as much a conceptual reality as a physical reality in their parents’ lives, and parental bereavement reflects this. In the two-track model of parental grieving (Rubin & Malkinson, 2001), parents are seen as conceptualizing and remembering their deceased children both in terms of (a) their actual deaths and (b) what they would have become had they lived. Parents are seen as grieving simultaneously along two tracks. The first track is a more external track that involves “how people function naturally and how this functioning is affected by the cataclysmic life experience that loss may entail” (Rubin & Malkinson, p. 223). This track takes into account the classic, observable characteristics associated with grief. The second involves how people go about “maintaining and changing their relationships with the memories and mental representations of the deceased” (Rubin & Malkinson, p. 223). This track is tied to the unique, idiosyncratic features of the relationship the bereaved parent had with the deceased child. These sometimes conflicting tracks involve what Klass (1993) called the “inner representation of the child,” that is, (a) the image of the child that is the concrete representation of the child at the time of death and (b) the imagined child, growing and aging with time.

In a private conversation, a bereaved mother whose daughter died as an infant told me, “I find myself reacting to kids who would be her age. So, babies don’t bother me anymore. It’s the kids who are the age she would have been. She’d be learning to drive now and I hate the parents who complain about teaching their kids to drive. I want to shout, ‘at least you have them to teach. Be glad for what you have.’ But it’s funny. I still picture her as a baby.”

The Readjustment Model of Parental Bereavement: Inward and Outward Steps (Kagan Klein, 1998) focuses on an ongoing process of dealing with the loss. “Inward steps originate and are acted on only in reference to one’s self. Outward steps originate with the self but are intended and taken toward some component of the outside world” (p. 126). Inward steps can only be assumed by others, and when the parent is focusing on inward steps, he or she may appear to be withdrawn, even catatonic. Outward steps are much like the first track in Rubin and Malkinson’s model, while in this model inward steps may involve internal images of the child but may also include internally directed self-work.

Although these models differ, what is clear is that bereaved parents are, at any point, working on their grief in observable and unobservable ways, and this grief may be a lifelong process of reevaluating and reconstructing their view of reality as it relates to their deceased child. What also is apparent is that the couple probably will not be at the same place in their grief, and spouses may not have the internal resources to be available to each other, wherever the other may be in the grief process.

The Assumptive World

The grief response of parents is an active, dynamic process that is centered on regaining control and predictability in their lives while also working to make sense of the loss and integrate it into their interpretive structures (Attig, 1996; Gilbert & Smart, 1992). These interpretive structures are a generalized set of beliefs within which one operates on a day-to-day basis, allowing the individual to organize information encountered in the environment and to reasonably anticipate future events, and will be referred to as the assumptive world (Janoff-Bulman, 1992; Parkes, 1972). Such basic beliefs as personal invulnerability, a positive view of oneself, and an orderly and predictable world (Janoff-Bulman, 1992) are affected by a significant loss. Due to the nature of the parentchild relationship, similar beliefs are extended to one’s child or one’s wished-for child (Davidson, 1979). Many other beliefs are also affected and include the sense of who and what they have lost, the idea that innocence will protect the young, and the view parents hold of themselves as individuals and as partners (Gilbert & Smart). In order to make sense of the death of their child, parents must consider and reconsider these and other beliefs. This process of questioning results in psychological upheaval for parents (Janoff-Bulman, 1992) and can lead to disruption of the dyadic grief processes.

In the time immediately surrounding their child’s death, parents are faced with a senseless event and feel a strong need to attribute meaning to what has happened and reconcile the effects on the assumptive world (Gilbert, 1998; Janoff-Bulman, 1992; Wheeler, 2001). Grief for them is “a form of psychic energy . . . results from the tension created by the individual’s strong desire to (a) maintain their assumptive world . . . as it was before their loss, (b) accommodate themselves to a newly emerging reality resulting from their loss, and (c) incorporating this new reality into their assumptive world” (Martin & Doka, 1998, p. 134). In a process of meaning making and reality construction, the bereaved parents may adjust their view of the loss so that it becomes consistent with existing assumptions or they may modify existing assumptions to accommodate to their new view of the world in which children die before their parents and there is nothing that parents can do to stop it (Fowlkes, 1991; Janoff- Bulman, 1992; Parkes, 1972).

In order to reconcile oneself to a loss, meaning must be attributed and some sort of explanation—a personal or healing theory (Figley, 1983, 1985) or personal loss narrative (Rosenblatt, 2000) —must be developed. By constructing such a narrative, bereaved parents modify their assumptive world to incorporate the loss, thereby achieving a new sense of normalcy and purpose. In this way, they are able to reestablish some of the sense of control and predictability felt prior to the death of their child, to find some sort of understanding, and to gain a sense of mastery with regard to the death and surrounding events (Rosenblatt). After a loss, bereaved parents report commonly being told to get on with their lives or to get back to normal. They typically perceive this as a demand that they abandon the memory of their child. Their lives have become, in a very real sense, meaningless, and there is nothing they can call normal to which they can return (Gilbert & Smart, 1992). Pressured to stop grieving, they may “go underground” with their grief, hiding it from all but a select few (Dyregrov & Dyregrov, 1999). This pressure can also add a layer of complexity to their grief, disenfranchising them and isolating them from support (Doka, 1989).

GRIEF AS A DYADIC PROCESS

The couple serves as the basic building block of the family, the basic unit of reproduction, intimacy, and love (Blumstein & Schwartz, 1983), and partners are in a unique position to provide support and affirm each other’s beliefs and perceptions (Berger & Kellner, 1964). Bowlby (1980) has identified the spousal relationship as critical to overall grief resolution following the death of a child within the family:

How well or badly mourning proceeds . . . turns in great degree on the parents’ own relationship. When they can mourn together, keep in step from one phase to the next, each deriving comfort and support from the other, the outcome of their mourning is favorable. When, by contrast, the parents are in conflict and mutual support absent, the family may break up and/or individual family members become psychiatric casualties. (pp. 120—121)

The relationship the couple shares can be an important resource after the death of a child, but the loss can also leave the partners profoundly estranged (Shapiro, 1994). The loss of a child results in what Klass (1988) has called a paradoxical bond between parents in which each partner simultaneously experiences his or her own loss while also sensing that the spouse may be experiencing the loss in very different ways. As bereaved parents, they struggle with their own pain, confusion, and anger; at the same time, they must also cope with the impact of the loss on their relationship. Their roles as parents and as spouses are forever changed by the death (Raphael, 1983). The death of their child affects them in so many ways: Each is a parent who has lost a child, their spouse may no longer seem to be the same person, and the comfortable relationship they once shared with their spouse may now be strained (Gilbert, 1996, 1997, 1998). Bowlby’s view may be overly optimistic, as couples frequently find themselves unable to support each other and vary widely in their response to the loss.

Individual and Relational Concerns

The couple is an interactive grieving system in which partners cope with individual and relational concerns that result from the death of their child. Each partner exists as a part of the couple system, reacting to relational pressures, but also as an individual responding idiosyncratically to the loss (Broderick, 1993; Nichols & Schwartz, 1998). These simultaneous self and partner identities are particularly important, especially in light of the effects of the loss on the assumptions, perceptions, and beliefs of bereaved couples (Broderick).

Relational as well as personal assumptions are affected by the trauma (Gilbert & Smart, 1992). Partners may find that in trying to make sense of their spouse’s experience, interactional patterns that facilitated their relationship in the past no longer can fulfill this function. Areas of conflict that had relatively little effect in the past may become overwhelmingly difficult to manage after the loss. At the same time, abilities that were ignored or derided in the past may come to be seen as strengths, both personally and relationally. The partners’ assumptions about their relationship and related role behavior can be destabilized or can be reinforced by their interactions after their child’s death.

Constructing a Loss Narrative

As they work to make sense of their loss and construct a personal loss narrative, bereaved parents turn to others around them for help. By confirming the subjective views of the bereaved parents, these views come to be seen as taking on an objective reality (Berger & Luckman, 1966). However, if partners do not receive confirming external views, they question their own or each other’s perceptions, and the formation of an objective reality is made more difficult.

Spouses serve as the primary source of support in this narrative formation, functioning in a role Rosenblatt (2000) called the primary conversation partner. As he found, even when couples engage in little or no talk, there is some consistency in their grief narratives, and even when couples talk a great deal, there can be disagreement. But serving as primary conversation partner may be overwhelming. Both partners have lost the same child, and their shared lives, with their common history and established pattern of interaction, are seen as natural resources in facilitating understanding. Unfortunately, the emotional baggage of negative elements in their shared history, combined with the overwhelming nature of the death of a child, may prevent them from being available to each other (Gilbert & Smart, 1992). If partners do not get direct feedback from each other, they each may resort to interpretation of the other’s behavior, leading to greater confusion (Israelstam, 1989). The behavior of one’s spouse may not be interpreted in the same way it was intended. For example, a husband might avoid showing strong emotion in order to keep his wife from being upset by his tears. Rather than perceiving this as helpful, she might see it as evidence of his cold and uncaring nature, resulting in avoidance and isolation for the couple (Gilbert & Smart).

Clashes in Coping Style

Another area of conflict for couples centers around the need for a continuing bond between the bereaved and the deceased (Klass, Silverman, & Nickman, 1996). In a study of the use of photographs by bereaved parents, Riches & Dawson (1998) found that artifacts that represent the reality of the child’s existence brought great comfort to some parents, while not to others. Consider the impact of one parent finding great comfort in such physical reminders while the other might find them to be too overwhelming to bear. These artifacts can contribute to the development of shared meaning, or they can serve to push the partners farther apart as one partner works to manage the secondary effects of his or her grief being triggered by items that bring comfort and make the grief of the spouse more manageable.

According to Wheeler (2001), meaning for bereaved parents comes from their connection with others, activities in which they are involved, their personal beliefs and values, personal growth, and continued involvement with their child. Marital partners are able to develop a shared view of their loss by reducing their ambiguity and uncertainty about who and what has been lost, how they are to cope with that loss, and how they are to go on with their lives (Gilbert, 1996, 1997; Gilbert & Smart, 1992). By validating each other’s subjective views of the loss, these views come to be seen as more real (Gilbert, 1996; Fowlkes, 1991).

The loss of a child will have a ripple effect through aspects of parents’ lives that extend beyond the death and its immediate effects. Couples may find themselves questioning the nature of their marriage as a whole. They may need to reassess their roles and the way in which they view each other (Raphael, 1983). Thus, the loss of their child can result in spouses question...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• About the Editor
• Contributors
• Introduction
• 1: When a Couple Loses a Child
• 2: When a Family Member Is Murdered
• 3: When Children’s Parents Are Traumatized: The Din and the Dearth
• 4: When a Child Is Traumatized or Physically Injured: The Secondary Trauma of Parents
• 5: When One Partner Has Been Sexually Abused as a Child
• 6: When a Couple Cannot Conceive: Traumatic Consequences of Infertility
• 7: When Parents Age: Unique Stressors of Adult Children
• 8: When Terrorism Threatens Family Functioning