Ayna Klinik Psikoloji Dergisi; 2014;1(1):41-59
Komplike Yas: Derleme ve Vaka Çalışması
A Maraş
Orta Doğu Teknik Üniversitesi, Ankara
Yas süreci ve depresyon, Freud’un (1915/2000) Yas ve Melankoli üzerine makalesinden bu yana, birbiri
ile ilişkili olarak değerlendirilmiş ve iki süreci ayrıştıran özellikler, kuramcılar ve klinisyenler tarafından
ilgi odağı olmuştur. Son dönemde, komplike yas kavramı, araştırmalar temelinde, kendine özgü
bazı belirtileri kapsayacak şekilde tanımlanmıştır. Literatürdeki yaygın ismi ile komplike yas, süreğen
kompleks yas bozukluğu olarak DSM-V tanı kitabına dahil edilmiştir. Bu tanının DSM-V’e dahil
edilmesi, gelecekteki çalışmaları arttırmak ve onlara yön vermek amacı taşımaktadır. Bu makalede,
literatürdeki araştırmalara paralel olarak “komplike yas” kavramı kullanılmış; kaybın inkarı, ölen kişiye
dair sürekli zihinsel meşguliyet, yoğun hasret ve kaybedilenle bir araya gelmek amacıyla intihar
düşünceleri gibi belirtileri niteleyen bu kavramın, normal yas sürecinden farkına, komplike yasa yol
açabilecek bazı faktörlere, komplike yasın bilişsel kavramsallaştırması ile bu temelde ilerleyen bir vaka
çalışmasına yer verilmiştir.
Complicated Grief: Literature Review and a Case Study
The current article covered a brief literature review on grief, the factors affecting the grief
process leading to complicated grief reactions and depressive symptoms and focused on the
psychotherapy process of an individual with complicated grief reactions. Complicated grief reactions
is a current topic in research and psychotherapy that led American Psychiatric Association
(APA) to include a diagnostic criteria named “Persistent Complex Bereavement Disorder” (PCBD)
under the heading of “Conditions for Further Study”. As the term “complicated grief” (CG) rather
than PCBD was widely used in the current literature, this term was used in this article. CG encompasses
symptoms such as separation distress (e.g., craving, yearning, intense feelings of loneliness,
desiring to die in order to reunion, preoccupation with thoughts of the deceased) and other cognitive,
emotional, and behavioral symptoms (e.g., confusion, disbelief, avoidance, anger, numbness,
difficulty moving on with life). In the literature, many precipating factors for complicated grief
reactions were reported. These factors involve the type of death, personal well-being, the relationship
with the deceased, personality characteristics, coping style, schemas and beliefs, and social
support. These factors that result in complicated grief reactions may be helpful in understanding
complicated grief and its treatment. In this article, after the literature review on complicated grief,
a treatment model and its application in the psychotherapy process of N. was mentioned. According
to this cognitive model that was suggested by Boelen and his collegues (2006), core processes
such as poor integration of the separation with existing autobiographical knowledge, negative
global beliefs and misinterpretations and anxious and depressive avoidance strategies moderate the
relationship between some background variables (e.g., individual vulnerabilty factors, characteristics
of the loss event, characteristics of the loss sequelae) and the clinical outcomes (e.g., separation
distress, traumatic distress). Boelen and his collegues (2006) state that the treatment of
complicated grief should have three targets: 1) loss needs to be conceptually processed and
integrated within the autobiographical memory 2) dysfunctional beliefs and misinterpretations
need to be identified and replaced with functional ones 3) anxious and depressive avoidance
strategies need to be replaced with helpful strategies promoting adjustment. The model does not
restrict cognitive behavioral techniques. In order to reach these goals, Boelen and his collegues
(2006) suggest using techniques such as psychoeducation, exposure, Socratic questioning and
cognitive restructuring. Therefore the psychotherapy process involved a collaborative therapeutic
relationship and cognitive behavioral techniques while focusing on the integration of loss in
memory, dysfunctional beliefs and avoidance strategies in order to replace them with more adaptive
ones.