The expanded day in the life of a bereaved parent, 30 years on.
This is an empirical qualitative, hermeneutic phenomenological study. The study centres upon an hour long recorded in depth interview, revealing the events that unfolded thirty years ago when the participant, now a sixty year old pharmacist, father of five children, revealed the lived experience of losing a three and half year old child to Tay-Sacs, a genetic disease. The Participant, is a bright man who attended both Cambridge and Bradford Universities, he is an observant Jew. The conversation is heuristic in nature as the questions were open ended in order to gather information and discover the lived in experience, which emerged into consciousness. As the story unfolded, many interesting areas emerged, from which three main themes were developed and analysed by using a relation-centred phenomenological research design. However, other methods are considered, (Fig 1.3) in order to develop a much larger future piece.
Keywords: Tay-Sachs. Lived in Experience, Phenomenology (GF and P) Interview transcription.
Different authors show various bias for the explanation of relation-centred phenomenology research design. ’Where the dialogue is fulfilled, there is brought into being a memorable common fruitfulness which is to be found nowhere else’ Finlay (2015) goes on to describe how through discursive interaction data emerges as a result of co-created conversation between the researcher and the co-researcher, (Participant). It is the Participants data, his thought and feelings, which are gathered. The dialogical encounter influences that which is explores both the emerging information but also the very relationship between researcher and the co-researcher, Participant is of importance. This method of research is not a technical or scientific. The aim is to unpack, in context the available information. This method allows a story to be told. The same story told again between the same people is likely to be slightly different every time it is told.’ Its interpretations will also inevitably change. The fluidity of the story telling is not just permitted but promoted. It is pragmatic, interpretist view, which is heuristic in nature allowing for freedom of expression within the room where there is a subjectivity in the experience. The participant is heard and feels heard. Great care was take to listen and watch, intently creating a research ripe environment.
The methodology allowed the research interview to take on a life of its own, as it seemed to ‘grow’ organically through the course of an hour. I allowed the participant to direct, in an ethnomethological style, I merely shaped the conversation to extract themes for this paper. Thus, the conversation allowed the participant to share his feelings and existentially existential experience. There is an intrasubjectivity as the choice of subject is a result of my recent training in bereavement counselling at the Royal Oldham Hospital, here is the focus. Here is the focus, the quest to understand innately, the ‘day in the life’ of a bereaved parent. How this affected the participant and his relationships both with his family and with others. How the family interacted, and how did the death effect the family members. I fortunately was offered so much more.
The piece has the word expanded in its title reflecting the fact I set out to centre on the day of the death and the funeral, all occurred in a twenty-four hour period. My participant did not want to centre on the day, thus the information is ‘expanded’.
Being mindful of the feelings of my Participant, ethical consideration and ethnicity issues. Tay-Sacs is a genetic disorder, prevalent in Jews thought to have come from The Pale, an area of Poland where Jews married other local Jews. There is a gap in research knowledge within this minority community, which is of personal interest, to be developed in another piece. By researching such issues, the information will enable a greater empathic approach in my development as a familial Bereavement Psychotherapy. My interests, experience, interpretations, influence and critical, analysis is evident in shaping the account, but the lived in experience, unfortunately, was truly my participants.
As a result of the interview, and the chosen methodology I decided to use the ‘The Research Onion’ approach to detail further the emerging themes thus having the ability to unpack the experience of the participant and approach further and gain greater understanding and analysis in preparation for a larger and more detailed piece. Due to the brevity of this piece, there are more detailed lines of study.
The methodology meant there was an organic development of the piece. I have included another methodology, which would enhance in detail the information and resulting transference. The Research Onion allowed a cross matrix to develop which plotted out the participants unpacking of information. The three themes in the area of bereavement, which quite naturally evolved where:
- Loss and grief, which is closely linked with the next point.
- Attachment and loss, looking at participant’s attachment to his close family members and his
- Avoidance behaviour. The difficulty of getting the participant to centre on the day itself of his account and other avoidance issues.
In order to illustrate key issues academic literature is used to, substantiate findings. Offering a small sample of the literature available in this area and provide ‘Further discussion and critical evaluation with a heightened detail reflection upon the significance of each area,’ (Saunders, Lewis 2012).
Therefore, helping to develop clear argument to contextualise and justify the information unpacked by the interview. The interview is about behaviour. Regarding the actual writing of the work there is a moral behaviour, and philosophical system of principles and rules that specify what constitutes good behaviour. This is an ethical consideration
Ethical regard is a strict consideration both with my participant and in the writing of the piece. Indeed the participant can veto the information, stop the interview and even remain anonymous. All the information gathered is confidential. All materials are encrypted. Paper work is locked in a filling system and all information will remain available to the participant, in a transparent and informative way. Much is placed upon the researcher to get it right and to be trusted, this a central for the BACP in their Ethical Framework. Bond (2012), goes on to say that ethics are ‘designed to help but no statement of ethical intent can totally alleviate the difficulty of making professional judgments in circumstances that may be constantly changing and full of uncertainty.’ There will always be a heuristic challenge If all else being trustworthy: honouring the trust placed in the practitioner,’ (Bond 2012). I made the promise to provide support both during the one hour interview and after by offering the Participant two session of psychotherapy, with a psychotherapist of choice. Explaining to the Participant that this was an investigative research not psychotherapy. With all of these considerations set in place due to the relational centred phenomenological design, the human ‘rule of thumb’ can interfere precision, hence Bond’s (2012) premise of change and uncertainty.
Despite all care taken and ethical protocol being observed in bereaved parental research, parents are often traumatised by research participation as further pain is caused in the interview process.
‘Over the years many researches have expressed concerns about vulnerable populations from harm when participating in research,’ (Dyregrov 2013).
Despite this work being research, orientated Dyregrov talks positively of the ‘therapeutic effect’ of the research interview. One-parent reports,
‘It is very important for me to talk about all that happened from when my daughter was borne until her death. This has been therapy for me’.
Some parents reported that the interview had facilitated the working out of common grief between spouses after they had participated in the interview together. They regretted that people in their social network could not tolerate to listen to their accounts of what had happened (1988 Klass), focuses on bereaved parents here the common denominator was good support networks, such example were the bereaved parents groups which helped them move through their grief toward solace and resolution. Klass believed the shared experience was important. The sharing and finding the common denominators. Indeed Bowlby (1969), agreed that the suppression of grief has a negative consequence and he claim recovery form loss entails arriving at a state of ‘’detachment’’. Time is a great healer, as it provides chronological detachment.
Worden (1992) points to the need to break bonds with the deceased person in order to invest in a new life. The participant had mentioned that he had said his goodbyes and indeed, towards the end went to visit him, regrettably, infrequently,(P89). This view that the bereaved must disengaged with the deceased thus allowing their life to start with permission to enjoy life again but in reality as Kübler-Ross (1969), said ‘The reality is that you will grieve forever.’ Her famous emotional stages are ‘Denial, ‘isolation, anger, bargaining, depression and acceptance’. These stages are present in the Participant’s experience. As for the Participant, Kubler Ross did make it clear that not all people experience these stages and not in the same order but the stages were assembled in an the order seen below and were commonly used in the area of bereavement.
|Stage||Interview information contextualised||Interpretation|
|1 – Denial||Thirty years after the death. The only denial witnessed was a form of avoidance behaviour. The Participant denying after the interview there had been initial avoidance in talking about the day of his son’s death (P11 and P15) The recording was rerun to evidence the findings||Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It’s a defence mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored.|
|2 – Anger||The participant was angry with people around him P26, P38, P38, P39, P97, P98The participant was angry with the doctor, the Rabbi, The health service the Jewish community for not looking after itself||Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps keep detached and non-judgemental when experiencing the anger of someone who is very upset.|
|3 – Bargaining||I did not experience this of the Participant as this interview is many years after the death.||Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example|
|4 – Depression||The diagnosis, real grief – P15 three years later the death P23 ‘He’s got a death sentence and not even really a quick one’ and the family lived with this death sentence, Its going to be 2 or 3 years’.||Also referred to as preparatory grieving. In a way, it is the dress rehearsal or the practice run for the ‘aftermath’ although this stage means different things depending on whom it involves. It’s a sort of acceptance with emotional attachment. It’s natural to feel sadness and regret, fear, uncertainty, etc.|
|5 – Acceptance||P33 The death brought ‘a degree of relief to know that it’s all over’. Here acceptance but still very painful||Again this stage definitely varies according to the person’s situation, although broadly it is an indication that there is some emotional detachment and objectivity.|
|The 5 stages above are associated with a close bereavement occurrence. I have used the above as a theoretical lens to analyse a bereavement post thirty years. Contextualising the research information to the model from the interview, yields a different interpretations and data, which will be used in the future due to the brevity of this piece.|
Fig 1.1 Based upon ‘The Grief Cycle’ model first published in On Death & Dying, Elisabeth Kübler-Ross, 1969. Interpretation by Alan Chapman (2006 and 2013).
Kübler-Ross, (2014) eloquently and poetically amplifies all the above. ‘The reality is you will grieve forever. You will not “get over” the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same nor should you want to’.
Kübler-Ross’s ideas have now become synonymous with emotional response to trauma, and to grief support and counselling, much like Maslow (2013) is fundamentally associated with motivational theory (1943); Kolb(2005) original work (1984), with learning styles, and Gardner (2000), his first multiple intelligence rational publication published (1983).
The Participant is observant of his religion; he displays strong attachment to his religion. The above theorists were all Jews, although noted there is no comment upon their degree of observance of practice but there is nuance of common identity. Which goes much further than the laid out rituals noted by Lamb, (1969) and Rich, (2001). Here the rituals according to the Jewish belief are that all people descend from just one person and therefore to destroy one is to destroy all. Jews perceive themselves as not just a religion but as a racial traditionalist transnational society.
My participant might not have been aware of the content of the above academic literature review but his thoughts, feelings, and innate processing seemed to display accurate ‘attunement’ with it. The participant has no pre knowledge of such information. This is not to say a non-Jew would not do the same but it is prudent to raise this observation, which was not evident at the outset of the research.
Great effort was taken to watch and listen what is said. Despite the Participant showing a surprising empathy with the literature, I noted his initial avoidance to answering question.
I believe it was not intended or in the participants, conscious behaviour as he was most surprised when we reviewed the interview. Fraley and Shave, (1999) and Servaty-Seib, 2004 talk of mourners with an avoidant style may not have a strong bond to the deceased. The death being enquired about? was thirty years ago. The Participant when interviewed, was reminded that the motivation for the work was research and not therapy and we were centring upon the day of his son’s death but initially every time we came to the subject, he avoided talking about the day of death. There was a clear understanding before the interview this is what we would centre around. I sensed a ‘Trap Door’ type of avoidance behaviour through which the participant heads in order to avoid the central interview issue despite his conscious willingness to aid the research. In the room the Participant did not show any sign of stress as the reason for the avoidance indeed he showed himself as an’ independent and strong , self-sufficient person, quite a paradox, to the displayed behaviour, i.e. what I witnessed and what was not being said. Muler (2009), says in this case it might be due to a ‘Deep rooted vulnerability, hidden hurt and an under lying yearning for love and care. Sable,(2001) agrees that a therapeutic relationship provides an’ opportunity to review experiences relevant to current distress in order to affirm emotional reactions and come to terms with distressing events.’ I concur with Sable because of my experience of the participant. I do believe that at a time in the future the Participant would benefit from therapy.
The data gathered from the interview considers. I will be looking at three themes main themes, which seemed to naturally surface.
- Loss and grief, which will be closely linked to….
- Attachment, looking at participant’s attachment to his close family members and his community.
- The issues of avoidance behaviour. The difficulty of getting the participant to centre on the day itself.
- Grief and Loss
‘Individuals respond differently to Grief due to the death of a person, especially where there is a bond of affection. An emotional reaction can be not only metal but also physical, incorporating many other dimensions such a spiritual, behavioural, social, and philosophical dimensions. Grief is usual the emotional reaction to loss, it is a natural response. It is the emotional suffering one feels when something or someone the individual loves is taken away. Grief is also a reaction to any to a variety issues from unemployment to ill health but the grief and resulting loss dealt with here is the grief associated with death which is familiar’ Rando, (1991).
The loss of close family member especially a child is a total disruption of our attachment bonds, it questions the very nature of our generational order. The expectation that the parent will die before the child. There was grief expressed at the time of the diagnosis
GF 23 :’How did you cope with the diagnosis’?
P 23: ‘It was awful. We’d had three kids, all have been healthy, and all have developed normally. And now all of a sudden we find that the kid that we’ve got isn’t going to develop normally. Isn’t even going to retain the micro level he’s achieved of a 10 month old, because he was already 2 months behind. And he’s got a death sentence. And not even a really quick, it’s going to be 2 or 3 years. Could be a lot less, could be a bit more. Very few, if any, live beyond 5 years old. And this was our little boy, three girls and a little boy, what more could you want? And we were both totally distraught and we went to see the GP. I forget the exact details, but I’ll never forget the way he handled it. He essentially said, “Well I’ve never seen it before, how am I supposed to have recognised it?” It was all about him. He was sorry that he had failed and not, there didn’t appear to be a single thought as to how we might be. Unbelievable’!
The sense of grief heightened by shock was not addressed by the doctor who was dealing with parents who knew a little more than the average parent did. The participant, a pharmacist regarding the correct drug therapy, the doctor omitted to made comments.
‘If people have, a death I would expected them to become anxious. I wold have expected the GP to suggest that some
Diazepam would be a sensible thing for you to have at hand. I would have expected him, (the GP), to s say, ‘I’ll send the nurse round so she can have a look at him(……) He was a bloody good doctor, except when push came to shove, he didn’t appear to show any emotion. He just tret it, selfishly I thought and we left the practice virtual immediately’. P24
The participant also reveals how utterly stunned he is;
‘Stunned when we left, angry, it was like what we going to do? How’s it going to pan out? The first thing I did was start researching to find out what we were going to be involved with. And at the same time we had to consider the other children’. P26
‘Overwhelmed, and we have to consider all of the other children as well’.
In the last comments, words like, distraught, Unbelievable P23,
‘Selfish, stunned, distraught and ‘angry’ with the doctor who the participant treated his own remorse due the lack of recognition of the decease. The Participant felt that ‘When push came to shove he didn’t appear to show any emotion’ for Participant or his family. The doctor had put himself first and was tending to his own needs. The doctor had been up until now a ‘A bloody good doctor’ P24. At this point, the participant feels abandoned as the appointment was ‘late afternoon. Friday afternoon.’ P25. The participant reports with such a heightened perception enough to leave ‘that practice virtually immediately’
The doctors’ lack of holding the Participants family in ‘Unconditional and positive regard according to Rogers (1956). The doctor, who is not a psychotherapist, did not realise at the time, negative dealings with the Participant that influence the departure of the participant from the practice, ‘almost immediately,’ despite the previously perceived as a ‘Bloody good doctor’. The Participant felt a lack of applied empathy, unconditional positive regard, congruence, and attitude versus technique applied by the doctor. The doctor, despite apologising
Three years later, there is also grief and loss but now with an added sense of relief
‘Yes, there were tears. We were holding each other. But once we’d got to Dan’s death, there was a certain degree of relief and release. Because we’d been working up to his death, we’d been grieving for three and half years’. (Kübler-Ross, 1969 stage five of the Grief Cycle model).
‘And there was this definite sense of well thank goodness that’s all over. Now we can get on with our lives. And it may sound callous to be thinking now we can get on with our lives, but that’s the way it was. We have had lots and lots of tears for many, well for 3 years or so. And we’d been trying our best to do something for the community because we appeared to have that strength. We had met another couple who had a Tay-Sachs baby and they’d done exactly the same. It was just time and place’. (P.49).
Klass (1988), identifies bereaved parents support networks, such example were the bereaved parents groups which helped them move forward. Klass believed the shared experience was important.
Although there was a grieving process this had changed, to have a more pragmatic approach. The Participant was fully aware of grief and the change in the grief. The attunement to the day in day out grieving process, for three years, how much can your mind take?
‘We’re talking about getting a phone call, knowing essentially that this is bad news and when we got there he was dead. And the initial shock wasn’t followed by huge amounts of emotional grieving, because his death has been coming for, well, three years. He was diagnosed at ten months, then it was three years, ten months when he died. And the real grief had come out at the diagnosis, because it was made clear that it was a one-way street and the only thing that would differ would be the timeline, the length of it. There had been ups and downs all the way. At one point when he was losing weight quite seriously and he was bony and it was awful, but when he’d gone onto a nasogastric feeding he’d put some of the weight back , from then on it was a just a nursing operation or even a not nursing operation or possibly avoidance behaviour, by shunting he care onto others’.P15
Even if the participant and his had wife had prepared themselves for the inevitable, they were fully conscious the death was going to happen, there had been three years between diagnosis and death, still there was grief. The grief became even harder after the death. After thirty years and recounting the theme of the interview a number of times, the participant was fully aware that I have wanted to focus upon the day of the day of the death his son but due to the grief still being experienced, in a lessened form, less intense, thirty years on, it was still difficult, still apparent.
‘I saw it on my participants face. I think what I’m seeing on your face is the fear that you felt, I can see that. GF28.
We were about a quarter of the way through the interview when the participant was really ready and by this stage I was ready for the interview to centre more around the time of the diagnosis. I decided not to ‘push’ my participant too hard, being mindful of Dyregrov’s (2013) findings, I did not wish to unnecessary give the Participant even more stress when he finally stated.
‘I can move very rapidly on to the final day, I want to, and yourstress my Part are giving me the opportunity to talk about this final day’. P28.
This statement surprised me. I felt an air of excitement. The participant was ready to deliver information regarding requested. I proceeded with care, very aware of all ethical considerations and my position of trust, (Bond 2012). In fact, the interview was yielding even more then I imagined.
The participant stated that the Rabbi who was thought to be
‘Too young and inexperienced a little diverted away from the grief but he was attentive, this was his first job. And I got the feeling all along that he felt he had to do the pastoral bit, the ‘Can I help you, how are you?’ P31 The Participant goes on to note his feelings are diverted from, ‘my sorrow and helplessness into trying to make it easier for him to do what he was trying to do’. P32.
This is avoidance to the grief, which was, at that point necessary just to get through the day.
The Participant perceives great difficulty with the Doctor and the Rabbi. When there is ‘Unconditional and positive regard, (Rogers 1956), shown by the Rabbi, the participant responds similarly towards the Rabbi.
The Rabbi, facilitating the grief process in practical terms The Rabbi…. ‘Came, offered his condolences, but then it move into the practical realms P36 You have to prepare for a funeral in very short space of time P33 He (Dan), died at about 10 or 11pm at night and he was buried at 3pm the following afternoon. P34. It feels callous, but … as you’re going through it…well no when you look back on it your realise what it does…. (diversion), to the immediate feeling of helplessness and sadness and anger. P35.
I asked about the day of the funeral. Transference with the participant made me feel this was not going to be easy. The Participant ‘flew’ through the trap door.…the funeral, and what do you remember? GF 38.
The Participant blocked me with a reply about lack of Tay-Sachs information.
I WAS ANGRY THAT NOBODY, in the medical profession had told us that we were personally at risk.P38
The funeral a difficult topic of discussion. It had taken the participant about a quarter of the interview to talk about the day his son dies and he had lots of warning, but the participant had forgotten the possibility that we would talk about the funeral, and it was suddenly brought up. Mindful of this and Dyregrov’s findings (2013), I did not wish to cause my participant any stress so I left the subject of the funeral
However, stress entered the room, as he suddenly, flew back through the ‘trap door’ to target door as without me realising the participant started to talk about the funeral and how the Rabbi made the grief worse taking the service.
‘Our Rabbi brought forward one of the little stories that that they have for such occasions and he was a lucky that I am generally quite calm because really I wanted to just punch his light out. He told us that every human has a Neveah, a soul which when you die leaves the body but it’s recycled, the highest grade of Nefesh is from a person who has been pure…the purest soul has to be from a baby. ….I might have gone along with it but at that time it was,…I found it insulting because the explanation that had been given might have been acceptable to somebody who was very observant and agreed with all of these principles. I am observant but have I have never heard of it before, we were too rational to really accept it and he should have known that…I suppose it was about his innocents and lack of ability. He was very lucky to get away without physical damage’.P39
I noticed the Participants face was red, he was angry as he relived the event of thirty years ago. Here we return to the lack of ‘Holding’ the other in the highest and most total regard. The Rabbi, had not bothered to communicate with the participant over his basic philosophies. According to the participant, the The Rabbi had moved away from personal centred according to Rogerian theory, the Participant was responding by moving in the fantasy of hitting the Rabbi. It was not so much the story but the fact the Participant had been ‘missed’ by the Rabbi and the participant was fantasises about hitting the Rabbi. His grief was expressing itself through anger, at the funeral only 15 hours after the death had occurred and the Participants also notes his wife falls silent.
….There was a lot of silence P47 ….
There was a degree of relief and release
I think she grieved inwards, She did not feel the need to share it with everybody, P48
Yes, there were tears. We were holding each other. Once wed got to his death…Thank goodness that was all over,…there was a certain degree of relief and release Because we’d been working to his death
I think we made the biggest mistake of our live. We were advised to shield the kids from this all. P52 There was only a few hours between the death and the funeral and the first night of Shiva. Prayers said for the deceased for seven days. P33
Members of the community who made it even easier to exclude the children. This exclusion will have been done out of kindness. There were people volunteering.
‘ “Oh well we’ll take them for the day and we’ll look after them” what pity!” I’ve got the picture in my mind of Sue especially, the youngest who was really close with Dan. My wife describes Sue, (the youngest), beforehand, (before Dan’s death), as being a bubbly happy child. And then afterwards it was like the lights went down, (with Sue)’. P54 After she got married, she wrote an article for one of the front Jewish magazines in which she talked about how unhappy she had been for 20 years. Because she never grieved for her brother and how didn’t find happiness until she got married. That was like a stab in the heart, it was awful To know that for the best reasons in the world we’d taken a course of action that had screwed her up. Jen and Anne handled it better but I don’t know why Anne has been, ….a miserable sod for many, many years. You could never do right by her and she always seemed unhappy until she got married….It could have been Tay – Sachs. Could be the divorce. We were advised that the children shouldn’t go and that with the best will in the world that was the thing I curtailed their grieving well not curtailed it, it stunted it, it stopped the girls having a chance for closure’. P55.
The content of the above is multi stranded with many themes running throughout. The information used in Fig 1.3, page 27, notes the varied themes. The table plots the Participants findings within the three main themes noted in this paper. The table then indicates for further research other suitable methodologies, thus indicating that it cannot be hoped to cover in great depth the richness of data supplied. Figure 1.3 show that the interview touches upon procedures, time horizons choices strategies approaches and philosophies. It also shows that most transaction is phenomenological, promoted by the methodology.
Please note that P28 and P55 are the only notes placed in more than one area in Figure 1.3. At this stage a decision to simplify the detail and yet understand the information is not hold just one theme but can be place in more them one theme column and be analysed by more the one methodology.
The psychological inferences are also multifaceted. For instance, the Participant imparts what his daughter, Sue missed not being involved with the mourning process. In his view, her segregation lead to her, ’lights going down’
When a Jew dies, the community around the family plays is supportive. There has to be a fast burials and prayers and the part of the community. Indeed, ‘Jewish mourning practices can be broken into several ‘periods of the living, in Hebrew nihum avelim meaning who will miss the deceased. The rules for mourning cover the careful care of the dead. As they too must not be left alone until burial. The mourners cannot make even the first meals of the grieving. After the burial, a close relative, ear neighbour prepares the meals for the mourners the se’udat havra’ah. Hebrew for meal of condolence the meal is for the family not for visitors. Only after this time condolence, calls are permitted. The immediate family of the deceased observes Shiva, preferably all together in the deceased home, until the seventh day post burial. The family are all together and stay together. The prayers require 10 men, a minyan. Hebrew for minion. This is the intense grieving process, which alters and relaxes intensity.
Cultural ritual, are integrative and have ‘regulatory goals by providing a structure for the emotion chaos of grief conferring a symbolic order to events, the construction of shared meaning among members of the family Neimeyer et all (2002). The participant is aware his children denied the comfort of the intense formal comfort of the family and the close community. They were removed from the symbolic part of the, intense grief therapy process. With its artefacts, for example books, chairs for shiva and Temimah. The children in some way were denied closure. Indeed the Jewish religion lets it be known to others, you wear the, symbol of grief on your outer garment, worn for seven days the act of tearing, done just before the funeral. This is called is called Temimah, (Deuteronomy 25:10).
The most striking Jewish expression of grief is the rending of garments by the mourner known as Temimah, prior to the funeral service.
In the Torah there many recorded instances of rending the clothes after the news of death. ‘When Jacob saw Joseph’s coat of many colours with what he thought to be his son’s blood, he rent his garments’. David tore his clothes upon hearing of the death of King Saul. The rending is an opportunity for psychological relief from grief. It allows the mourner to give vent to his pent-up anguish by means of a controlled, religiously sanctioned act of destruction. According to Epstein (1979). Epstiene noted the Torah regarding Temimah in Lev. 10:6), Parshat כי תצא Deuteronomy 25:10
2.Attachment , looking at participant’s attachment to his close family members and his community
The three themes identified cannot be considered separate but inter related as
‘Grief is the price we pay for love without attachment there would be no sense of loss’ (Queen Elizabeth II in her message of condolence to the American people following the attack on the Twin Towers, 9th September, (2011).
Attachment is the human need to form bonds with a significant other or others. The ties are of emotional and physical closeness in the world, Wallin (2007), says of Bowlby (1969), our lives from the cradle to the grave, revolve around intimate attachments. The attachments are shaped by our fist relationship. If our early involvements have been problematic then ‘subsequent relationships can offer second chances, perhaps affording us the potential to love, feel, and reflect with the freedom that flows from secure attachment’. The Participant did state that his daughter did not feel happy ‘until after she married. (P55), according to Wallin, this was her second chance, with a subsequent chance to love, as Sue was the closest to Dan, as the Participant remembers
‘Sue especially, the youngest, who was really close with Dan. I have scenes where we’re pushing the buggy and he’s in the buggy with his hand dangling out the side and she’s walking by him holding his hand’, P 54.
Clearly Sue missed a lot, being denied the ability to mourned with the rest of the family and truly engaging in the grief process. The Participant believes his other children did not suffer with the same type of melancholia. Sue, however experience was different a detachment with her brothers and sisters but also her mother and father. When children are allowed to engaging in the grieving process the experience allows them to develop and even greater appreciation of life. According to Neimyer et al, (2002), these children have witnessed at a young age the mortality of life. They usually develop a positive interaction with others who are not ill; they have a confidence and have a great appreciation of them even if they are ill. He goes on to remind us that ‘our implicit working models of self and world are anchored in our attachment bonds to significant others.
Parkes, (1988) state that the ‘assumptive world is changed in bereavement,’ of having a much loved securely placed younger brother, and everything is thrown into complete disarray. All of what you presumed changes. The next chance of real love has come with marriage. Another significant attachment, with a significant other
The Participant feels the pain of the attachment with his daughter expressed earlier, like a stab in the heart. (P55) as he could not ever make his daughter, Sue, happy. This feeling could only be achieved in the next significant male relationship, but even his own relationship with his wife as he describes as having a very good marriage,(P60) I asked if there a connection between what happened with Dan and the demise of your relationship, your marriage? (GF 59) ‘Oh, yes. It’s not quite as direct as people might expect, but it is entirely as a result of Tay-Sachs. Up until, well certainly up until Dan’s diagnosis and possibly even a year or two later…..I always said this is a wonderful marriage and it just gets better year by year. It was good, it worked really well’. P 59
‘Oh I feel good about it. I never want to forget what we had. And life just came along. It wasn’t Dan’s illness and death itself that caused the marriage problems. In my opinion it’s that it left my now ex-wife with an unfulfilled need to have a son(…..) But essentially I gave in to her needs and she had another daughter, Sally, and so she was still unhappy. And I loved my wife, who I divorced, some years ago and I wanted to make her happy at that time, I didn’t want any more kids. And I did my Faustian deal as I put it. I eventually gave in and said “If you want to have another baby fine, but I don’t want to be involved in the (…)the very young looking after a baby stage.”’ (P60)
The Participant at one point felt he had sold his soul to the devil this time he had sold his soul to his wife who would never be happy until she had a son again, to replace the one she had lost. Another baby arrived sadly for her it was another girl. They then went on to have a son.
‘I was saying to my wife, (now ex-wife), that you are unhappy and I want to make you happy but, the price of that is just a bit too much for me. I don’t want any more children Four kids was plenty for me.(….). It moved on from there and I started feeling(….) unhappy and I had no idea why’. (P66).
It is because the Participants wife wished to maintain a status quo, of having a son and did not want to change as Parkes,(1988) stated that ‘The assumptive world is changed in bereavement,’ and where a loss is ‘Taumatic bereavement then the assumptive world may be utterly shattered’ Mallon quotes Trickey (2005). Where the loss has been traumatic the trauma will impede grief, but the ‘price’ of having another baby and maintain the status quo was a high price as gaining the son cost her the marriage. The participant agree buy stating:
‘The price of that is just a bit too much for me. I don’t want any more children. And I’m not too pleased about it with grandchildren either for that matter’. (P66)
There is another type of significant attachment experienced by the Participant, the attachment to his religion. His wife being mindful of what the Rabbi had said at Dan’s funeral of the principle that every human being has a Nefesh.
‘When you die your soul leaves the body and goes to wherever it goes. But it’s recycled and you often or they often believe that when a parent dies and at the same time you have a child born that that’s possibly the same Nefesh inhabiting the child ‘(P39).
The same will be true between children of the same family; the Nefesh staying close to the family will leave the dead child to inhabited the newly borne sibling. Thus retaining a deep and significant status quo.
At this point the Participant and I had been talking for some time, it was clear that the Participant felt ‘safe’ with me, my interjections elicited, a ‘freeness’ of information. The Participant noted afterwards that he knew he was not only herd but felt ‘supported’. I was giving the Participant permission to state what he really felt. Transactions, feelings and emotions of not only the information but how this work was really impacting me. Target door contact was available here. Amazing, this interview was beginning to move. The Participant became very honest, I felt it, and very expressive of his feelings as he recanted his deep annoyance of the Rabbi and his Nefesh story, (P39). The Participant expressing that which is not normally by an observant Jew.)
.’…he’s lucky,(the Rabbi), that I am generally quite calm, because really I wanted to just punch his lights out’. (P39).
Attaching importance to the religion is significant upon many levels. The participant shows his unshakeable beliefs because after all his suffering he states God only brings trouble to people in the degree he believes they can cope with. He does not want you to go topping yourself. P99
Rich (2001) supports the Participant by stating,
‘In Judaism, death is not a tragedy, even when it occurs early in life…..Our deaths, like our lives have meaning and are all part of G-d’s plan’.
The situation was awful but mindful of the community and most being ignorant of Tay – Sachs, the participant and his wife wanted people to know what had happened.
‘For the next few years I felt that we’d been dealt this terrible blow and it had enabled us to stand up on the biggest soap box in the world and shout it to everybody this is what happens if you don’t (Get screened)’,.(P100)
The participant did not want to stay silent He wanted to educate the community. This was Participant gave himself the permission to educate the community. He did not see the ‘Permission’ coming from himself but views this as a divine ‘Permission’. Even if it came at a personal price.
‘You’d have your real friends who would come round and share with you, you’d have strangers as well. Then you’d have friends who you thought were friends who would cross the road to avoid you’, (P49).
The Participant called a Tay-Sachs information meeting, held at Leeds University where an elderly couple they said:
‘We had a Tay-Sachs baby 40 years ago, never spoken about it to anybody. Thank you for making that possible now. (P49) And I thought what a dreadful burden that must be, to have to hide it away’.
This statement summarises the Participants attachment and mindfulness toward his family, his religion and his community.
He felt great attachmet to Martin House who looked after Dan and his family, even after Dan’s death. ‘They would phone on his birthday just to see how we were doing.P95 He raised money to educate, wrote, recorded and sold a song to fund raise, publicised held events to educate. Made it possible to have a test, I personally got a blood test to know if I was a carrier. I breathed a private, great sigh of relief when I found, I was not a carrier. Both parents have to carry the faulty gene to create a Child with Tay-Sachs and then there is only about a one in four chance the off spring will have the decease. On a public level, there was no avoidance for the Participant and his wife. You are admitting to the world you are a carrier. Note thirty years ago, to admit genetic problems and in small Jewish community is brave. The participant displayed personal courage however on a very personal and private level there was, as Ware (1983) notes, much avoidance. Trap door script issues linked with the next theme.
- Avoidance behaviour, the difficulty of getting the participant to centre on the day itself, his account, his avoidance of issues.
All themes are closely linked: 1. Grief and loss 2. Attachment As with grief, individuals respond differently to grief. When attachment of a loved one, is disrupted, by death, in this case. The mental stress can cause a need to avoid ‘thoughts, feelings, memories, physical sensations, and other internal experiences—even when doing so creates harm in the long-run, Hayes, Strosahl, Wilson (1999).
An avoidance strategy, will often adopted as being, necessary to procure a state of mental survival. This is often due to the bereaved perceiving a decisive and temporarily irreconcilable loss of a loved one. Therefore a dramatic change in the usual and ongoing relationship with the deceased. Those that are left can develop a strong sense of yearning and longing for the deceased this is triggered thoughts and memories of the person. Shear’s states there is a disrupted leading to loss of regulation of emotions like attention and physiological process. She adds ‘Grief can be preoccupying’ When the interview began my participant looked pre occupied. I started to think I should make a decision to abandon the target day of the death to whatever information came . However, after twenty-eight transaction into the interview the Participant stated. ‘I can move very rapidly to the final day, I want to and your giving me the opportunity to talk about this.’ (P28).
I was not sure if asking about the funeral was necessary because of the Participant’s avoidance to recanting the day of death but the participant was now begging to start talking about the focused day. And started quite freely to talk about the funeral. ‘What do you remember’? GF37 but got an avoidant, trap door reply, ‘A blur’ (P37), was the reply and the conversation diverted to Tay-Sachs awareness, but the participant did stay with his feelings of anger (he felt toward the medical profession).
My participant displayed avoidance to answering the questions in the interview. Displaying an almost schizoid behaviour, which was completely out of his awareness.
‘We’re looking at the lived in experience of the day that your son GF 6, GF 11, P 11, The day, yes of could he died, sorry …we are going back to the day. P13 Okay, yes absolutely, the days all really blur into one. ‘Sorry, yes I know I am wanting to come to the final day and can move very rapidly to the final day’. (P.28).
The Participant had gone into the Child Ego State. He was being ‘told’ what to do by my ‘adult’. I did not want to tell him to refocus yet again he might see this as an admonishment by my annoyed ‘Parent’ ego state. It was at this point I decided to revise the original focus, just to listen to the Participant taking whatever information came, the day of Dan’s death was of secondary importance to my Participants preference. (P15) the participant started to describe the day, he seemed to get back on track. (By P27), ‘Sorry, yes I know Iam wanting to come to the final day’.
I pointed out, after the tape had stopped. The participant’s total denial of having initial inability to talk about the day of his son’s death. His incredulity prompted me to replay the tape as proof. The Participant was amazed. He believed when asked he answered all questions on the primary request. He stated, ‘Well, I had agreed to answer questions about the day of Dan’s death so why did I avoid answering the question initially?
According to Shear et al.(2007),With grief-related avoidance behaviour the bereaved avoid that which renders strong emotions. The bereaved avoid ‘confronting the painful reality of the death.’ In the case of the interview According to Shear the Participant avoided questions with which could have intensified sadness and yearning or the person who died’ In this case. My questions at some level may have ‘trigged painful memories from the past’ as Boyes (2013), cites this as being the first, out of nine types of Avoidance – Coping strategies to note. Number six, you avoid feeling awkward. The participant did not look awkward there was uncertainty and awkward behaviour about not focusing on the day of Dan’s death. Upon Boyes eighth point to ‘avoid starting a task if you don’t know how you’re going to finish it’. The Participant could have felt awkward to begin with over not knowing where this interview was going to take him. Perhaps reading Boyes article had procured my transference, to be noted later in the ‘Discussion’.
The participant is aware of Avoidance – Coping strategies. With his family, on the day of the funeral, a few hours after his Dan’s death, the participant notes,
‘you are going to tell a load of people the same thing because they are all going to ask the same questions and (….). What they, (the questions) will have in common is, they are partially diverting you from the mediated feeling of hopelessness and helplessness and sadness and anger’. P35.
The deviating is a therapeutic, its immediate and necessary and absolutely necessary to get you through the day.
‘The participant understood how others around would use an avoidance strategy. ‘You’d have friends who you thought were friends who would cross the road to avoid you.’ Because they wouldn’t know what to say and they didn’t want the discomfort of that’. P 49 Added to you discomfort though…. GF 51. Yes well it does, it does’. P51
I did ask the participant if he felt raising the awareness of Tay-Sachs was a means of deviation GF39, he replied Yes Definitely P39, but then avoided by alluding onto another subject.
To make greater sense of the information gathered, there has to be a dialogue between the information given by the participant and the academic literature used. The literature is used to ‘underpin’ academically the story told to a greater extent this has been done but what about the intersubjectivity, the relational and truly, co-creational part of the piece? This is not a separate issue but part of the same. I am greatly aware of my personal influences upon the participant, the paper and literature. I am aware of my great responsibility both personally, professionally and ethically towards the Participant. Keeping his best interest a priority. Always mindful at all times to hold my Participant in ‘Unconditional and positive regard according to Rogers, (1956). Key Transactional Analysis theory and other psychotherapeutic models are examined. Key areas here are professional relevance, transactional analysis, academic methodology and a general reflexive overview.
Relevant Transactional Analysis
My family have engaged with psychotherapy as both academics and practitioners for three generations, it is therefore very familiar and natural way for me. When I read Rogers, (1961), it made perfect sense, he defined his unconditional positive regard as having, ‘No conditions of acceptance…It is at the opposite pole from a selective evaluating attitude.’ He wrote that positive means,
‘A warm acceptance of the person. A genuine caring for the client…. In reference to regard, One regards each aspect of the client’s experience as being part of that client. It means a caring for the client, but not in a possessive way or in such a way as simply to satisfy the therapist’s own needs. It means caring for the client as a separate person, with permission to have his [or her] own feelings, his [or her] own experiences.’
The feelings experienced at this level with a client I have felt an almost mediatory effect.
You do not have to be instructed upon how to care for the client when you have an instinctive feeling, to care for the client. Put the client first, an unconditional regard. (GF 12 and GF 58). Here despite wanting to focus on the theme I was more than happy to accommodate the participant despite the great importance of the information for the research. I felt he did not want to talk about the actual day of the his son’s death as agreed. I was proved wrong, (P28).
The participant for this piece was aware of my positive regard. (P28). I have known him for most of my life. (GF 100). There is transference. (GF 93-P96). I just felt there was more the Participant wanted to say, as he added his ‘Postscript’. Again My feeling of Is anger, second stage of the table by
Alan Chapman after Kübler-Ross’s ‘grief cycle model (1969), see I could see it and feel the emotion, (GF97 – P99) The intention here is usually a positive attempt through enactments to heal historic confusion and impasse. In the child or parent and is found between either P-C or C-C or P-P. Erskine (1991.) talks about in any psychotherapeutic relationship the satisfied childhood need will be projected onto the therapist who will be experienced by the client as the source of the possible satisfaction to the need as well as its frustration. In every transference, there is the presence of both poles. The Participant, when he eventually talked of the day of the death, he talked about his anguish, I in turn really felt it his pain (P23). I talked with him with the greatest of care and then he recognised and thanked me for being treated with care.
My Participant was well aware of the subject of the interview and yet avoided the focus. I became nervous. I believe by, centering myself and trying to be as prepared, as possible, if it were possible for a relational centred piece of phenomenology primary sourced interview, I would have catastrophised, but I felt grounded. (GF1 – GF 13 I owed it to my Participant to get it right, not to upset him. If I upset him, I felt I would upset me.
I recognised he had gone through his ‘trap door’ according Ware (1983). He had moved away from the target door. Ware, describes the respective approaches for making contact with a client (the Open Door) and those to avoid (the Trap Door) with the Participant. He also suggests the ongoing direction for change (the Target Door) with each of the personality adaptations. .
The influence of injunctions and counter injunctions (Joines and Stewart 2002), plays a large part but due to the brevity of the piece this element must be left.
Was the stress of the conversation too much for the Participant? Was it proving too much for me? Or was he just wanting to be heard, I am giving him the opportunity to talk (P28)? I decided, after several attempts to keep the Participant on the main focus of the day of the death, that whatever the participant wanted to give would have to suffice (GF 28) and that is where my research would focus laid. I decided this as when I initially became aware of my anxiety, (GF and P 10), I asked more questions, instead of just allowing the information to flow. The Participant then went off topic. When I decided just to listen to what was off the focus of the title of the proposal the Participant came back on focus. In some unconscious way I had set up a transaction, perhaps in some small way there was a ‘game’ Berne (2004). Perhaps the participant sensed my anxiety and responded by going off track. I was concerned about this point. Taking the point to therapy a third reason, an admirable point did arise. The Participant felt ‘heard’ He states in the interview that after everything he went through; the death of his son, raising money for screening, etc., he feels nothing has happened. Jews have historically been subjected to a history of persecution and marginalisation the Participant requires to be empowered by being heard,P39, P46, P100). The Participant needs others to be listen to and be ‘held’ as he in turn holds onto his views, as they are very precious to him. In the room, there was a transference, (Stewart and Joines 1987), between the Participant and myself, for example (GF80 – P83), which became symbiotic. Some transactions started by one and finished by the other,(GF 74 – P84), at this point it was as though we, just knew what the other was going to say and meaning simply conveyed with just a look or a smile.
I think the conversations made us both go into ‘Script’ Steiner (1935), for different reasons. I felt, it were possible, momentarily our scripts ‘held hands’ during the interview. (GF 97 – GF100) The script, an unconscious life pattern based on early decisions made usually out of awareness in childhood. Tilney (1998) Indeed I was very young when my Participant lost his son my participant knew me then and knows me now so perhaps I am representing a transferential replay, in part, of unresolved life issues, (P101), the drama being cast form me, and others, now available who tranferentially represent significant happenings in the past. Because of being taken to a meeting about Tay-Sachs, I was tested, and later my daughter (GF 100), because of the Participant, but the ultimate ‘Discount’ (Joines and Stewart, 2002) did so much at the time. The Participant discounts right at the end.
‘It was almost as if God had said you have been given this problem because only yon will stand on the soap box. You are my tool for saving many other lives (…….. )30 years later, there is no screening going on , there is no promotion of screening. I t is as though I did nothing had happened’.(P101)
The topic appeared, just last week, by a journalist in a local Jewish paper by Michael Paysden. The article talks of Tay – Sachs screening made available as a in a one of nine other ailments blood test. Jews number only 0.4% of the UK population. Therefore, the NHS will not fund the screening. The test is £190, ruling out many people; therefore, it is still not universally available. Hence, my Participant views are even more precious and even more lost on the ears of the population
Throughout the piece, great care is taken to correctly substantiate findings by academic fact. Theoretical construct, relation-centred phenomenology research design is used as a lens to illicit information from the participant and unpack the information to present relevant thematic discourse. The themes identified are substantiated by academic citation and information taken directly from a one long interview to yield the information directly from the Participant. The methodology, its choice of use and implementation are defined. Due to the brevity of the piece, further thought regarding Academic Methodology will be examined under the next heading.
A general reflexive overview
Reflexivity is not just the examination of personal action or experience it is an activity to procure strong and stable scripts. It is a support process which examines doubts and uncertainty. I have always been aware of the fact, I do not know, what I do not know. Through family and the study of psychotherapy in the last four years, I understand that I should not be uncertain about being uncertain, as uncertainty is a good philosophy, promoting enquiry, questioning and re-examination. It is possible that with the chosen methodology, or another methodology, or even a combination of other methodological enquiry will yield a different set of interpretations.
Despite many areas, being curtailed due to the brevity of the piece there is much information, which could be extended into a longer piece of research. Other methodologies yield different findings. Below a model onion ring, Saunders et al., (2008) plots, form outer core ideas to the inner focus. I have mapped the comments made in the interview within a cross matrix. The next step would be to focus upon which methodologies could be use. Although there are several headings across the top, I have noted separately exactly which one is most popular. Overall most conversation does lie in the ‘Strategy Column’ including the phenomenolical area prevalent in this piece. I have simultaneous built research for the next course of study and developed the cross matrix further for implementation for future research.
Fig 1.2 The Research Onion after Saunders, Philip Lewis and Adrian Thornhill (2008)
Data collection and analysis
Mono methods mixed methods
Ethnography Phenomenology Grounded theory
|P15 P33 P34 P55||P55||P25 P28 P36 P49 P48 P55||P49 P24 P26 P52 P54 P55||P23 P35 P39
|Relational needs attachment||P66 P55||P54 P60 P95||P49 P32 P59 P49||P66 P99|
|P15 P28 P39 P49 P51||P28 P37
Fig. 1.3 The Research Onion after Saunders, Philip Lewis and Adrian Thornhill (2008) showing interview dialogue
The research and the writing has had a great impact upon me. Not just the active reading and active academic activity but the emotional, ‘standing with the Participant and then again, by myself and ‘in my own head’. My thoughts and feeling about this piece. The in depth guidance from Linda Finlay to the personal formulation and selection of the Participant his articulation, his story, his perspicacity. I have lived with this piece for a long time I know the interview well, although I have known the participant for most of my life, suddenly I know him better and his story, his attitudes his mental map. What an experience!
The contextualising of the information in order to deliver an assignment displaying interpretation and applying information from my four years of training to include topics covered, such as grief and loss, attachment and avoidance behaviour.
Approaches such as personality adaptations and ‘Contact Doors’ to condensing psychopathology and how to avoid the Trap Door, with the Participant, how he initially tried to avoid feeling emotion. The trap door represented thinking and using in factual evidence, even when the Participant kept running to the ‘trap door’ in the interview, ( P68) he did eventually find the Target door, and he did feel emotion (P59) as I felt the emotion of his memory, he was reliving the momment. There was so much more then what is evident upon the tape. Perhaps I needed a video camera, but a camera would not feel what I felt. The influence of injunctions, of not being good enough. The Participant did not feel good enough, regarding what ‘God had given him to do’ (P101). He had not done the task, but thirty years ago and flowing forward to 24.2.15 the newspaper article previously discussed, shows that the Participant did raise a maintained awareness his discounting of himself is yet another issue, dealt with in another piece.
I did not feel frustration when the participant deviated, Instead I was mindful of permissions with supportive interjections providing a forum for the Participant to feel safe, by allowing the conversation to gently proceed. Finding deviation provided more insight. It was such a learning experience, I felt quite excited by the research.
My goal was to try to understand the phenomenological uniqueness of the experience, and how the Participant really felt. Some information took much longer to impart, one paragraph taking many hours others seconds. This experience will live with me, making sense of my world and that of my Participants experience.
Berne, E. & Berne, E., (2004). Games people play: the psychology of human relationships, United States: Random House Publishing Group.
Bond, T, et al., (2012), ‘Ethical Framework for Good Practice in Counselling and Psychotherapy’. BACP Leicester
Bowlby, J. (1969), Attachment: Volume one: of the Attachment and Loss Trilogy. New York Basic books. New York
Boyes,A. (2013). Avoidance- Coping plays an important role in common psychological problems, Psychology Today, https://www.psychologytoday.com/blog/in-practice/201305/avoidance-coping.
Cassidy,J. and Shaver, P.R. (1999). (Eds.) Handbook of attachment: theory, research and clinical applications. New York; Guilford Press.
Dyregrov, Kari. “Bereaved parents’ experience of research participation.” Social science & medicine 58.2 (2004): 391-400. Fraley, R. Chris; Shaver, Phillip R.
Erskine, R. & Moursund, J., 1988. Integrative psychotherapy in action, United States: Newbury.
Epstein,B.H. (1970).Torah Temimah. Lev 10:6. Hotza’at sefer. Israel.
Finlay,L. http://www.lindafinlay.co.uk/about- me/[Acessed February 26,2015].
Fraley, R.C., and Shaver P.R.(1999) Loss and Bereavement: Attachment theory and recent controversies concerning “grief work” and the nature of detachment. In Cassidy,J. and Saver, P.R. (Eds.) Handbook of attachment: theory, research and clinical applications. New York; Guilford.
Gardner, Howard E.(2002) Intelligence Reframed: Multiple Int. Perseus Books Group. New York.
Hayes, S. C.; Strosahl, K. D.; Wilson, K. G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press
Joines, V., Stewart, I. & Stewart, I., 2002. Personality Adaptations: A New Guide to Human Understanding in Psychotherapy and Counselling, United Kingdom: Lifespace Publishing
Journal of Analytic Social Work Vol 2, Issue 4. Routledge. Saunders, MNK,
Klass, D. (1988). Parental grief: Solace and resolution. The Springer series on death and suicide, Vol. 9 New York, NY, US: Springer Publishing Co.New York, NY,US.
Kolb, Alice Y.(2005). “The Kolb learning style inventory—version 3.1 technical specifications.” Boston, MA: Hay Resource Direct 200.
Kübler-Ross,E. (1969). On Death and Dying. NY. Scriber
Lamb, M. (1969). The Jewish Way in Death and Mourning. Middle Village, New York. Jonathan David Publishers, Inc.
Lewis, P, Thornhill, A & Wang, UK 2012, ‘Analysing …
In Research Methods for Students’ Thornhill. 5th. ed.Prentice. U.K.
Mallon,B. (2008). Dying, Death and Grief: Working with Adult Bereavement.United Kingdom, Sage
Maslow, A.H.(2013). A Theory of Human Motivation, United States Marino Fine Books.
Muller,T.R. (2009) Psychotherapy Theory, Research Practice Training . Vol46 American Psychological Associating.
Neimeyer,R. Prigerson,H.Davies,B(2002). Mourning and Meaning. American Behavioural Scientist, Vol 46, No. 2. Sage. USA
Parkes, C.M.(1988). Bereavement as a Psychosocial Transition: Processes of Adaptation to Change Blackwell US.
Paysden, M. (20.2.15). ‘Screning for Genetic Disorders, Manchester England. Jewish Telegraph Newspaper.
Rando, Therese A. (1991). How to go on living when someone you love dies. Lexington Books. New York.
Rich,T. (2001). Life Death and Mourning Judism journal. Vol 101, USA
Rogers, Carl (1956). Client-Centered Therapy (3 edt.). Boston: Houghton-Mifflin.
R, R., Carl, 1961. On becoming a person: a therapist’s view of psychotherapy, Boston: Boston : Houghton Mifflin.
Sable,P. (2001). Attachment and Adult Psychotherapy: Post traumatic stress disorder. England Jason Aronson
Steiner, C.(1935). Scripts People Live: Transactional Analysis of Life Scripts, United States: Avalon Travel Publishing.
Shear, K. et al., (2007). An attachment-based model of complicated grief including the role of avoidance. European Archives of Psychiatry and Clinical Neuroscience, 257(8), pp.453–461.
Stewart, I. & Joines, V., 1987. Transactional Analysis Today: A New Introduction to Transactional Analysis 19870601st ed., United Kingdom: Lifespace Publishing.
Tilney,T and Dryden,W.,1998. dictionary of transactual Analysis. UK. Whurr Publishers Ltd.
Trickey,D. (2005). Young people bereaved what hinders and what helps. Bereavement care Journal, Spring. Routledge Uk.
Wallin, (2007). D.J. (2007). Attachment in Psychotherapy. New York, N.Y., Guilford Press NY.
Ware, P.(Jan 1983). Personality Adaptations: (Doors to Therapy) Transactional Analysis Journal vol. 13 no. 1 11-19
Worden, J.W.,(1989). Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner, (2nd edt.), Tavistock/Routledge, London