Bereavement is the state of loss when someone close to you has died. The death of someone you love is one of the greatest sorrows that can occur. Feelings of bereavement can also accompany other losses, such as the decline of your health or the health of someone you care about, or the end of an important relationship. Grief is a normal, healthy response to loss. (“Bereavement | Psychology Today UK”, 2018). There are many different types of grief and disenfranchised grief through adoption will be the focus of this assignment. Dr. Kenneth Doka, first coined this term in the 1980s. He describes this as grief that is often ignored and denied public support on three levels; the grief that is not acknowledged, a loss that is not recognized and grievers who are not acknowledged. (“Disenfranchised Grief”, 2018). He also suggests that the grief can be ignored or denied for a number of reasons and that the grief, for most, falls into one or more of the following categories:
1. The loss isn’t seen as worthy of grief, for example, non-death losses, such as adoption or the loss of a job.
2. The relationship is stigmatised such as the partner of a spouses extramarital affair.
3. The mechanism of death is stigmatised such as death by suicide or accidental overdose.
4. The person grieving is not recognised as a griever for example ex-partners or co-workers.
5. The way someone is grieving is stigmatised such as an extreme response to the grief or not appearing to grieve enough. (Doka, 2002)
This has been echoed throughout the works of Evelyn Robinson, who discovered that the nature of the loss felt by the birth mother was also felt by the adopted child. Robinson felt that this grief experienced from the separation from their families and being issued with a replacement birth certificate has also traditionally not been acknowledged or understood (Robinson, 2018). Robinson goes on to say that by replacing the birth certificate for a child we do not value that child’s actual heritage and identity. (Robinson, 2018). Robinson (2018) also states that most of the adopted children have extended family and adoption denies that those relationships exist. It is clear from Robinson’s work that she takes a lot from her own personal experience and while it is interesting it is somewhat anecdotal, that being said there is little literature available that disputes her claims. Doka (1989) states that most of the losses we experience are not due to physical death and that the feelings of bereaved people (sadness, guilt etc) can be complicated when grief is disenfranchised (Doka 1989) (Robinson 2007).
I currently have two clients (C and N) that have experienced children being adopted, neither client had a choice in their adoption as social services stepped in to remove the children from a violent and somewhat toxic (drug and alcohol use) family dynamic. Both clients were pregnant at the beginning of therapy, and are able to keep their babies with them once they are born. The client I will be focusing on first (C) will have her baby soon. This particular client had to have a termination of her first baby (girl) due to the baby having Edwards Syndrome a genetic disorder, also known as Trisomy 18, caused by the presence of all or part of an extra 18th chromosome. The majority of people with the syndrome die during the fetal stage; infants who survive experience serious defects and commonly live for short periods of time (Weiss, 2014). She shut down emotionally after the baby died and went on to have another daughter very quickly and has often mentioned that she wanted to have another baby to fill the void that the terminated baby left. She often suffers nightmares where her surviving daughter either dies or is abused and feels immense guilt upon waking. She is worried about social services involvement and postnatal depression which she developed after her first baby. When her baby was diagnosed with Edwards syndrome she had 12 hours to make a decision, she chose to terminate the pregnancy and feels that she made the right choice at the time. During her first pregnancy, she was involved in a domestic violence relationship with the father of her children, who then went to prison with she was pregnant with her son. She feels guilty about staying in the relationship but at the time felt it was important that the children had their father in their life. She had a drinking habit and was eventually arrested for abandonment after she left the children with a neighbour to get drunk. After the children were adopted she felt that she couldn’t stay in the house due to the painful memories and she found somewhere else to live. The children are subject to open adoption and receive letters once a year. Our sessions focus on the guilt she feels about how she behaved after her daughter died and that her children were taken. This particular client is currently residing in a mother and baby housing unit where she has twenty-four hour support should she need it.
The second client (N) has now had her baby and with support has her baby with her. This particular client has an older child living at home with her and her partner, her two middle children were placed with social services and have been adopted separately, she has many conflicting feelings, mostly around anniversaries, birthdays and Christmas. In the events that led up to her children being adopted, she was in a domestic abuse relationship while she had her daughter and was pregnant with her second, the relationship was very violent, controlling and both financially and emotionally abusive, it was when her partner locked her in the kitchen and attacked her that she stabbed him, ending up being arrested and charged, and given a suspended sentence, it was when she was pregnant with her third child that the abuse continued to such an extent that she attempted to stab him again and was subsequently jailed for a period of time, a section 20 (c) agreement was signed for the baby, Section 20 (c) of the Children’s Act 1989 states that every local authority shall provide accommodation for any child in need within their area who appears to them to require accommodation as a result of (c) the person who has been caring for him being prevented (whether or not permanently, and for whatever reason) from providing him with suitable accommodation or care. (The Children’s Act 1989, 2018). She stated that she found prison a positive experience and it made her realise that she could cope without her partner, and eventually left him in 2016.
An adoption support agency is defined as an undertaking, the purpose of which, or one of the purposes of which, is the provision of adoption support services (BACP 2018). The law states that no services may be provided by an adoption support agency before it is registered by Ofsted. An adoption support agency might include a government or non-government organisation, a partnership or an individual therapist in private practice (BACP 2018).
The BACP states that local authorities have a statutory duty to provide post-adoption support (BACP 2018). It is lawful, however, to provide therapy to these clients as long as the focus is not on the adoption but on the disenfranchised grief itself.
In order to understand the impact of loss and the feelings and behaviour that follow a bereavement, we must have some knowledge of attachment. Bowlby’s attachment theory allows us to understand the human tendency to create strong bonds and the emotional reaction presented when these bonds are broken. Bowlby’s thesis is that these attachments come from the need for security and safety; they develop early in life, are usually directed towards a few specific individuals and tend to endure throughout a large part of the life cycle (Worden, 1991). These attachments can be seen in Darwin’s 1872 work around the expression of emotion in men and animals where he states Children, when wanting food or suffering in any way, cry out loudly, like the young of most other animals, partly as a call to their parents for aid, and partly from any great exertion serving relief. His work would suggest that attachment is imprinted at an early age and this notion is echoed in Lorenz’s 1935 work with goslings. Lorenz believed that A breakdown in the relationship with its mother led to a disruption in the development of a bird’s normal social behaviour, supporting his theory that the first relationship a bird experiences determines the bird’s future. Likewise, John Bowlby claimed that a disruption in the child’s attachment to its mother had grave consequences for his or her adult personality (Vicedo, 2009). It is my understanding that in Bowlby’s attachment theory, an anxious attachment style has a prolonged, more complicated effect upon grieving, a person with an anxious style of attachment may experience deeper levels of depression, contrary wise a secure attachment to the deceased, may indicate less depression and aid the transition through grieving and the recovery from it. This may be that in an anxious state of attachment the deceased may not have been emotionally available to the bereaved, and therefore the bereaved person may over-activate their grief response. There are several limitations to Bowlby’s attachment theory the first being that the model was based upon young children utilising momentary separations, which were stressful for the child, more understanding could come from an observation of how parents interact with the child and what they provide for each other during natural, non-stressful situations. How children interact with their parents in a non-stressful situation may provide more information on how the attachment model works than how the child acts when the mother leaves and then returns. Secondary to this the observations took place utilising only the primary caregiver, for example, the mother and other family attachments may not be characterised by similar reactions. Finally, the father or a sibling may have the same attachment with the child at the same time, relating directly to adults having more than one primary attachment, such as significant other and their children. This shows that attachment is not merely confined to infancy but experienced countless times throughout life including adolescence, early adulthood and beyond.
There are several models of grieving that can be explored in relation to disenfranchised grief, firstly the five stages of grief Kubler-Ross (2005) states that the five stages of grief, have evolved since their introduction and have been very misunderstood over the past decades. She goes on the say that they were never meant to help tuck messy emotions into neat packages. We can apply some of the stages of grief to C in that she has experienced anger, mainly at herself for putting her children in a position where violence was occurring in her relationship and being in a place emotionally where she felt she needed drugs and alcohol to cope but mainly not being the parent that her children deserved. She has experienced an initial denial when the children were first placed with social services and again when they were put up for adoption and she has experienced depression. In relation to the baby that died the stages of grief can be seen although not in their entirety, some denial or disbelief may have been present when she received the diagnosis of Edwards syndrome, however, from her disclosures it seems quite matter of fact, the baby was ill and a decision had to be made and while she moved forward quickly, I am unsure if she has truly accepted the loss yet. It is also possible to relate the five stages of grief to N as she too experienced an initial denial when the children were first placed with social services and again when they were put up for adoption. Anger is also evident and she has expressed that she felt angry at herself for allowing herself to stay in a violent and controlling relationship she also feels guilt in relation to this. It is not clear however that bargaining took place nor acceptance and this is an area for further exploration and work.
The dual processing model also referred to as the Dual Process Model of Coping with Bereavement by Stroebe and Schut (Death Studies, 1999), is a natural process that helps us to find a balance between facing the reality of the loss (loss-orientation) and learning to re-engage with life after the loss (restoration-orientation). It is in finding the balance may explain why grief is often described as an emotional roller coaster. Many people experience a back and forth between both loss-orientation and restoration-orientation responses, for example moving between classic grief reactions, crying, anger, depression etc. and learning how to manage finances, form new relationships and taking on roles that the dead person may have done, for example looking after the children. It is in the restoration-orientation phase that grieving people may focus on day-to-day tasks and get temporary relief from the emotional drain of the loss. It is possible to get a sense of the dual processing model when working with C as she is angry and depressed but has days where she is able to focus on the new baby’s imminent arrival. With further work once the baby has arrived, as so not to put any unnecessary stress or upset upon C before the baby is born, it may be possible to encourage her to explore her own dual process of grief, alongside learning how to care for her baby with the support of the staff at the mother and baby unit. N has experienced a normal dual process of grieving as she has days where she is feeling low especially when it comes to significant events such as birthdays, anniversaries and holidays, but has expressed that she is more positive towards Christmas this year as she has her daughter and the new baby living at home with her, therefore she is able to focus on them rather than her losses. It is my intention to work alongside N to encourage her to explore her own dual process.
Therese Rando (1993) developed the six R’s of grieving and according to Rando, in order to achieve the six R’s, a person must Recognise the loss by acknowledging and understanding the death, React to the separation by experiencing the pain, give some form of expression to the psychological reaction of the loss and identify the secondary losses, Recollect the relationship with the loved one by remembering them realistically and re-experience the feelings they had for them, Relinquish the old attachments to the deceased, Re-adjust and adapt to their new world without forgetting their old one by developing a new relationship with the deceased, adopt new ways of being in the world without their loved one and form a new identity and finally Re-invest. Rando stated that complicated mourning is present whenever there is some compromise, distortion, or failure of one or more of the six “R” processes of mourning. It is clear from working with C that her grief is complicated and so some sort of compromise in one or more of the six R’s is probable, I don’t agree that one of the stages could be failed, it may just not be achieved in the way they are described. I feel that C recognises the loss, she has acknowledged her losses and understands why her surviving children were adopted, however, she blames herself, and was blamed by her ex-partner for the death of her baby but struggles to understand why her baby had Edwards Syndrome, which, ultimately, was the reason she chose to terminate her pregnancy, she has reacted to the separation by experiencing the pain of her losses, she has experienced normal grief reactions and psychological reactions to her losses by experiencing re-occurring nightmares and has identified the secondary loss being loss of identity as a mother as her children are no longer with her. She has begun to recollect the relationships she had with her surviving children, but feels that she didn’t have a relationship with her baby as the baby died in utero, however, with support, it is entirely possible that she will come to the realisation that she had a relationship with her baby before she died, in session we have created a safe space for her to re-experience the feelings she has for her surviving daughter, however, I am mindful that while she is still pregnant, to approach this area of our sessions sensitively and remain aware of her stress levels, to ensure she does not become too upset. It is difficult for C to attempt the stage of relinquishing the old attachments to the deceased, as two of her children are still living, as with adoption, it is difficult to mourn the loss in the traditional sense as the children are still living, and it is at this point in the six R’s model, that we will have to make a compromise in her way of approaching this particular stage. I do not yet know how this will be accomplished as we are working at C’s own pace. I feel that C has, to some degree, re-adjusted and adapted to her new world without forgetting her old one but has not yet developed a new relationship with her losses, she has however adopted new ways of being in her world and is currently forming a new identity as a mother and she is re-investing herself in her role as a new mother again.
As N has not experienced the death of her children an adjustment to recognising the loss by acknowledging and understanding the death must be undertaken, in this instance working with N to understand and acknowledge the events that led up to her children being placed for adoption. I feel that she has reacted to the separation by experiencing the emotional pain of losing her children to adoption, she has to some extent achieved this stage, however, she has not yet identified the secondary losses, for example, she has not lost her identity as a mother as she has other children remaining with her, with further work I will encourage her to recollect the relationship with her sons by remembering them realistically and re-experience the feelings that she had for them, I feel that she has begun to re-adjust and adapt to her new world without her sons without forgetting her old one with them in it, however, due to the adoption she is not able to develop a new relationship with them and finally I feel that she is re-investing herself in her relationship with her new baby.
In relation to Worden’s tasks of grief, while C says that she has accepted the loss of her children, both in death and through adoption, I feel she may not have accepted the reality of the loss. In our sessions we have been working together to help her tell her story, how the baby died and how the children came to be adopted, I have encouraged her to tell me about her children, describing their appearance, their mannerisms and their personality. We have discussed the events that lead up to the children’s adoption, which was evidently difficult for her to recall. She is displaying a lot of shame around her behaviour in this instance and a lot of guilt with regards to her parenting, however, it is clear that she feels remorse around the events that lead to her children’s adoption. She is, however, confident that she made the right decision to terminate her pregnancy, as the baby may not have survived,due to her diagnosis, but she is also questioning if the baby would have survived. Through further reading around the subject of Trisomy 18, it was found that the median survival time for live births with full trisomy 18 was 14 days. Although median survival for these children is 2 weeks or less. (Wu, Springett & Morris, 2013). In relation to the last time the children were seen or contacted, C receives letters occasionally however has not disclosed if she is allowed to send letters, this is a cause of both distress and contentment as she knows they are having a good life but the letters arrive sporadically so she does not receive regular updates, it is unclear if this is the conditions of the adoption and this is an area for further work. C’s feelings around her last contact with her children are distressing for her as she remembers her daughter holding out her arms and calling out to her, I feel that this was a very confusing situation for both mum and children and again is an area for further work to be done.