Ruth Malkinson

TRAUMA AND BEREAVEMENT: CONCEPTUAL AND CLINICAL ISSUES REVOLVING AROUND RELATIONSHIPS

The article re-examines trauma and bereavement and the category of loss considered to be traumatic bereavement. It is argued that the perspective of the relation to the deceased is an insufficiently acknowledged source of traumatic disruption following bereavement. The significance of the relational aspect in bereavement is present in the paradigm of the Two-Track Model of Bereavement (S. Rubin, 1981, 1999). The implications of this approach are examined in the case of a soldier exposed to trauma and death. The case is examined from a traditional trauma perspective stressing exposure to life threat and again from a perspective stressing the significance of the relationship to the deceased. An examination of the different intervention strategies and their outcome lends support to the importance of the relational aspects in this case of trauma and supports the use of the Two-Track Model of Bereavement. The location of trauma as basic to the experience of all bereavement for its impact on the reorganization vis á vis the representation of the loved one now deceased is considered as fundamental to the trauma of all bereavement. Theadditional contribution of bereavement occurring under conditions of life threat (traumatic situations) is an important feature potentially impacting the bereavementprocess, but it is not what makes bereavement traumatic per se. An additional source of trauma in bereavement, occurring when the previous representation or introject of the deceased is shattered, is considered for its status as an additional source of complication in the traumas of bereavement.

The Two-Track Model of Bereavement Questionnaire (TTBQ): Development and Validation of a Relational Measure

The Two-Track Model of Bereavement Questionnaire (TTBQ) was designed to assess response to loss over time. Respondents were 354 persons who completed the 70-item self-report questionnaire constructed in accordance with the Two-Track Model of Bereavement. Track I focuses on the bereaveds biopsychosocial functioning and Track II concerns the bereaveds ongoing relationship to the range of memories, images, thoughts, and feeling states associated with the deceased. Factor analysis identified 5 factors that accounted for 51% of the variance explained. In accord with the theoretical and clinical model, 3 factors were primarily associated with the relationship to the deceased (Track II): Active Relational Grieving, Close and Positive Relationship, and Conflictual Relationship; and 2 factors with aspects of functioning (Track I): General Biopsychosocial Functioning and Traumatic Perception of the Loss. Construct and concurrent validity were examined and were found satisfactory. Differences by kinship, cause of death, gender, and time elapsed were examined across the 5 factors, the total TTBQ, and the ITG. The new measure is shown to have both construct and concurrent validity. Discussions of the results and implications for the measurement of response to loss conclude the article.

Long Term Bereavement Processes of Older Parents: The Three Phases of Grief

This study is based upon personal interviews with 47 elderly bereaved parents. These interviews provided us with detailed and extensive information on the bereavement processes that parents experience over a long period of years. From an in-depth content analysis of the interviews and the way the parents described bereavement, it seems that it is a central motif in their lives affecting their relationships with each other, with the living children, with friends, at work and with others. Although enduring grief along the life cycle is an un-patterned process with emotional and cognitive ups and downs, involving a continuous search for a meaning to life, we observed a development in this process throughout the years. As we proposed in a previous study (Malkinson & Bar-Tur, 2000) there are three main identifiable phases in the bereavement process: the immediate, acute phase; grief through the years until aging; and bereavement in old age. We propose to refer to them as the three main phases in the development of parental grieving process and name them “young grief,” “mature grief,” and “aging grief.”

Therapeutic Issues and the Relationship to the Deceased: Working Clinically with the Two-Track Model of Bereavement.

Psychological intervention with the bereaved can provide critical assistance to individuals, families, and communities contending with the loss of significant others. In the organizational paradigm of the Two-Track Model of Bereavement, the outcome of both successful and problematic mourning are manifest along two distinct but interrelated tracks of functioning and relationship to the deceased. Reworking relationships to the deceased can help people resume authorship of their life narratives following loss. Two cases of spousal death are presented and significant features of the treatments discussed. The Two-Track Model of Bereavement emphasizes that the dimensions of a persons functioning reflect only part of the response to loss. The ongoing relationship with the complex of memories, thoughts, emotions, and needs associated with the person who has died is no less important. Although the domains of general functioning and relationship to the deceased are related, they are far from identical. Attending to the memories and emotions bound up with the deceased should continue to demand our sustained attention as therapists.

A RATIONAL-EMOTIVE GROUP INTERVENTION FOR PREVENTING AND COPING WITH STRESS AMONG SAFETY OFFICERS

A stress management and prevention workshop for nonclinical industrial workers using rational-emotive principles with 18 months followup is reported. Twenty-two senior safety officers participated in an intervention program of five weekly meetings aimed at improving cognitive skills and assertiveness mainly by decreasing irrational thought processes. We hypothesized an increase in assertiveness, and a decrease in irrational beliefs, and emotional and cognitive stress symptoms (manifested in somatic complaints and cognitive weariness). Assertiveness improved and somatic complaints and irrationality decreased in the short term. Eighteen months later, cognitive weariness was also reduced. The other improvements were still evident, but not to the same extent as short-term effects. Although the workshop improved rationality, further practice would be needed in the behavioral aspect of stress prevention to achieve long-term improvements in assertiveness.

Stress management and burnout prevention in female blue-collar workers: Theoretical and practical implications

Occupational stress is a pervasive problem among blue-collar workers, and women employees are especially vulnerable, yet this population is rarely addressed. The study concerns a stress management training program developed for female production workers with little formal education, based on the cognitive approach of Rational-Emotive-Behavioral Training (REBT). Several strategies and teaching aids suitable for such a population are suggested. Twenty-seven women participated in the program. Fourteen of them comprised the waiting-list control group. Burnout, tension, listlessness, cognitive weariness, and work/home conflict were assessed before, at the end, and at 12 months follow-up. At the end of the six-session program, four of the five measures in the experimental group were significantly reduced compared to the control group. At the 12 months follow-up, tension and burnout were still reduced compared to baseline suggesting that REBT can be successfully taught to such participants but booster sessions are required.

Terror, trauma, and bereavement : Implications for theory and therapy

Abstract How is interpersonal loss incurred in a terror event similar and different from loss under non-terror conditions? Because terror and bereavement are located in the individuals experience of the event, this has important implications for assessment and intervention. In the Two-Track Model of Bereavement (TTMoB), the relationship between life threat, symptomatic response, and the ongoing relationship to the deceased allow therapy to target difficulties in functioning as well as relationship to the deceased. Two case vignettes are presented to ground the discussion.

“Therapeutizing” research: The positive impact of family‐focused research on participants

Abstract The therapeutic potential of family‐oriented research has hardly been examined or conceptualized. This paper addresses seven aspects of the research process which may have therapeutic effects on participants. Examples from published research are used to provide empirical evidence of the therapeutic‐like responses of research participants. A perspective on the ethical responsibilities of doing family‐oriented research is offered, as are cautions about possible unintended negative effects.

Work absence as a function of a national traumatic event: the case of Prime Minister Rabin's assassination

Most research on absenteeism has focused on the effects of individual and work-related factors, to the exclusion of the effects of societal and political events external to the individual and his/her specific work conditions. The purpose of this study was to investigate the relationship between the emotional reaction to the assassination of Prime Minister Rabin in Israel and work absenteeism during the period following the assassination. It was hypothesized that: (1) emotional reaction is positively related to absenteeism; (2) this relationship is stronger among female employees than among male employees; and (3) this relationship is stronger for individuals who are pessimistic about the future as opposed to those who are optimistic. These hypotheses were supported by data collected from a random sample of 199 working adults.

Bereavement Customs, Grief and Rituals among Ethiopian Immigrants to Israel:

Based on clinical experience with Ethiopian patients referred to a Mental Health Center the authors observed a “double” cultural discrepancy: On one hand discrepancy between cultural and mourning practices as practiced by Jews in Ethiopia and Israel, and on the other between the professional team and their Ethiopian patients. The article discusses social displacement related to death, mourning customs and rituals as experienced by Ethiopian Jewish immigrants. A number of culturally sensitive elements pertinent to professionals intervening with displaced and bereaved individuals and families are identified and elaborated. Mourning rituals and customs as practiced by the Jewish community in Ethiopia, in particular, breaking bad news and purity customs are compared with those practiced in Israel which often appear to be different, and at times exemplify cultural insensitivity. Case vignettes describing the Ethiopian community in Israel are presented to illustrate complications resulting from a lack of cultural sensitivity. The importance of introducing culturally sensitive procedures involving an Ethiopian Jewish community member or a cultural broker who will similarly arrange to break the bad news to members of the community is proposed.