Continuing Bonds, Risk Factors for Complicated Grief, and Adjustment to Bereavement

Abstract

This study examined type of continuing bonds (CB) expression in relation to risk factors for complicated grief and measures of bereavement-related adjustment. Externalized CB expressions involving illusions and hallucinations with the deceased were distinguished from internalized CB expressions involving use of the deceased as an autonomy promoting secure base. 502 bereaved participants completed over the internet a CB measure assessing externalized and internalized CB along with various known risk-factor measures that included cause of death (i.e., violent vs. non-violent death), responsibility for the death, and attachment style as well as measures of psychological adjustment that included complicated grief symptoms, perceived physical health, and personal growth. As predicted, externalized CB was positively associated with violent death and responsibility for the death, whereas internalized CB was negatively associated with these risk factors as well as uniquely positively linked to personal growth. The implications of the findings for the role of CB in adjustment are discussed.

Posttraumatic growth in bereaved parents: A multidimensional model of associated factors.

“…When examining the association between internalized and externalized continuing bonds and PTG, Field and Filanosky (2010) found that internalized continuing bonds were uniquely positively associated with personal growth, a link that has been confirmed in recent studies (Scholtes & Browne, 2015).…”

“…This study also demonstrates the complexity within the factors by testing the associations with both forms of CB (internalized and externalized), contrary to general research on continuing bonds that focus solely on CB as a whole (Field & Filanosky, 2010).…”

“…The acknowledgement of the reality of death and the use of the child as an internalized secure base in this form of CB may explain its facilitating role in PTG and, therefore, in a more adaptive adjustment to the loss (Field & Filanosky, 2010). Moreover, as suggested by Scholtes and Browne (2015), internalized CB do not interfere as much as externalized CB with bereaved parents' daily life or relationships, which may explain why internalized CB may have a more relevant role in the development of positive grief outcomes for bereaved parents, such as PTG.…”

“…One of such personal resources is resilience, with evidence showing it's positive association with growth (Bensimon, 2012) and centrality for PTG during grief (Znoj, Kruit, & Wuthrich, 2004). Continuing bonds with the child, or the continued connection after death, has been proposed as another relevant factor associated with PTG (Field & Filanosky, 2010). These authors specifically identified two forms of continuing bonds: internalized continuing bonds, which are defined as expressions involving use of the deceased as an autonomy-promoting secure base, and externalized continuing bonds, which refer to expressions involving illusions and hallucinations of the deceased.…”

“…Our findings also offer some insight into areas that might prove fruitful in a clinical setting. First, promoting a more internalized nature of the bond to the deceased child and promoting psychological proximity rather than physical proximity (which characterizes externalized continuing bonds) may be important goals in intervention (Field & Filanosky (2010).…”