By Dr Lauren Breen MAPS, School of Psychology and Speech Pathology, Curtin Health Innovation Research Institute, Curtin University

The majority of significant bereavements throughout our lives occur within the family unit, as every person who dies was someone’s parent, sibling, child or other relative. Despite this, the growing body of bereavement literature focuses on grief as an individual and intrapsychic phenomenon and there is scant attention to the social context of the loss (Breen & O’Connor, 2007). The description of grief ‘symptoms’ and risk factors as well as debates concerning the distinction between ‘normal’ and ‘disordered’ grief (Prigerson et al., 2009) are obvious examples. There is little research on the effects of bereavement on the family unit, nor on appropriate family-oriented interventions for those requiring additional support.

Families are typically a primary source of social support during our lives. However, in order for support to be effective, the need for such support must be acknowledged and it must be readily available and perceived as helpful by those receiving it. These processes do not always go smoothly in families, and this may not change following bereavement. The dynamics between family members can serve to help or hinder each member’s experiences of grief and depend upon the roles and responsibilities of each member, the extent to which the family members are close to one another, and the family’s emotional expression and communication patterns. Issues of family function and conflict have been established following deaths in the family that are both anticipated and unexpected (Breen & O’Connor, 2011).

Challenges for bereaved families

A number of reasons explain why families are not always supportive at times of bereavement. Differences in the experiences of grief between individuals within the same family may be a challenge, especially in terms of emotional expression, remembering and talking about the deceased loved one, and seeking professional help. It is more socially acceptable for women to show their emotions, and as such, it can be easy to assume that men are not as affected by bereavement as women or that women are more willing to support family members and be better at this. However, some bereaved people say that support is more likely to come from people who are willing and able to be compassionate, irrespective of gender (Breen & O’Connor, 2011).

Conflict can also occur if family members do not feel supported or understood. Some family members, including children and adolescents, may feel overlooked, excluded and unheard, and this can lead to resentment. Depending on the circumstances of the death, some family members may blame other members, or be blamed, for the death or its antecedents. In circumstances where a child dies, step-families may experience conflict if the new partner seems unable to understand and/or unwilling to talk about the deceased child or their partner’s experiences of grief (Gerrard, 2002). However, it is important  to note that research does not support the idea that a death of a child is a catalyst for marital separation and divorce (Schwab, 1998).

Finally, family celebrations are important in maintaining cohesive relationships within families. Certain times and activities typically shared with family and loved ones such as Christmas and other religious holidays, birthdays, weddings, Mothers’ Day, Fathers’ Day, as well as the food and music associated with them, may no longer be enjoyed with the same resonance following bereavement and may even become times
of distress.

Family functioning in bereavement

Families have been shown to differ in the ways in which they manage bereavement. One study based in Melbourne identified patterns of family functioning six months following anticipated bereavement (Kissane et al., 1996). Based on scores from measures of family functioning completed by all family members, the researchers characterised 53 per cent of families as having good functioning with high levels of cohesion and conflict resolution (28% were ‘supportive’ and 25% were ‘conflict-resolving’), and 30 per cent as dysfunctional with high levels of conflict, low levels of cohesion, and poor expression (18% ‘sullen’ and 12% ‘hostile’). The remaining 17 per cent were ‘intermediate’ with moderate cohesion that could tend to deteriorate under the strain of bereavement. Based on these patterns of family functioning identified by Kissane and colleagues, a family-focused grief therapy using a systemic approach that can be applied preventively in palliative care emerged (Kissane & Bloch, 2002). The intervention aims to prevent the complications of bereavement by enhancing the functioning of the family through attention to communication and conflict resolution, and sharing of the story of the illness. The intervention is brief (consisting of four to eight sessions), manualised and shows some efficacy.

Nadeau (1998) took a ‘family meaning-making’ approach to understanding how families adapt to, and cope with, bereavement through studying in-depth interviews with members of bereaved families. She described the communication processes by which families attempt to make sense of their losses to arrive at a meaning about the death. Families engaged in several strategies including storytelling about the loved one, the use of 'family speak' (a shared form of short-hand language) to arrive at a meaning about the death, and attempts to find the meaning and purpose of the loved one’s life before beginning to make sense of the death. In supporting bereaved families it may therefore be important to explore and facilitate these accounts of how the family is making sense of the death (Nadeau, 1998).

Supporting the bereaved family

There is a need for greater sensitivity to, and recognition of, the diversity of experiences and needs of bereaved people within a family unit in order to provide them with appropriate support. There are some important considerations when attempting to support a bereaved family, which are outlined below.

There are a range of responses to bereavement; most people do not experience a considerable and long-term grief reaction following the death of a loved one (Bonanno, Boerner, & Wortman, 2008) and only a small proportion benefits from professional intervention (Currier, Neimeyer, & Berman, 2008).

Bereaved people may experience changes in their social support networks, including the loss of friends and family supports, particularly if the death is socially-stigmatising (e.g., death of a child, death from suicide). Losing access to these supports can be an additional devastating loss at a time when an increase in social support would be helpful.

It is important to listen and ‘be there’ and recognise that bereaved people may require more time in consultations. They might feel a need to talk about their losses and may repeat themselves. It is important to avoid platitudes (“time’s the great healer,” “come on, chin up,” “you’ll be right,” “he/she’s in a better place,” “it was meant to be,” and so on) as they show a lack of understanding and empathy.

It is necessary for psychologists to be skilled in death and dying issues, including bereavement. Studies have shown that counsellors and other health professionals experience significantly higher levels of discomfort and display low empathy in dealing with dying and bereavement when compared to other sensitive issues (Kirchberg, Neimeyer, & James, 1998). Furthermore, grief education in the university training for health professions, including psychology, tends to be limited and is often out-dated (Breen, Fernandez, O’Connor, & Pember, 2011) and grief counsellors do not always have access to adequate continuing professional development opportunities (Breen, 2011).

It is often assumed that bereaved people will keep information on bereavement (e.g., brochures and pamphlets) that is provided to them. In contrast, research shows that bereaved people often do not have the forethought to keep such information for future reference, not do they always share information with others in their family (Breen & O’Connor, 2011). The latter may be a particular problem if we assume that information provided to the next-of-kin will be passed on to the rest of the family.

Conclusion

In summary, families may change irrevocably following bereavement. A death might bring a family closer together or magnify pre-existing tensions and issues. It is important to recognise that families are not always characterised by strong connections and open lines of communication before the deaths of their loved ones, and, in situations where family members are connected and supportive, a death can damage these links. It is quite possible for members of the one family to have very different reactions and needs; such dynamics might need to be addressed in the context of bereavement intervention. Psychologists are well-placed to be aware of the potential for family conflict following bereavement and to provide appropriate individual and family therapies, if and when they are required.

Acknowledgements: The author would like to thank Dr Moira O’Connor, Professor Alison Garton, and Dr Dawn Darlaston-Jones for their comments on an earlier draft.

The author can be contacted at Lauren.Breen@curtin.edu.au

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