Author Response to Reviews of Grief: Contemporary Theory and the Practice of Ministry

The purpose of this article is to respond to three reviews in Pastoral Psychology of the author’s text, Grief: Contemporary Theory and the Practice of Ministry (Kelley 2010). This article considers in particular the grief born of injustice, the need for pastoral caregivers to cultivate skills and sensitivities for grief ministry in multicultural and multireligious settings, and the centrality for many of a secure relationship with the Divine as a primary source of hope after loss.     

Promoting Meaning-Making to Help our Patients Grieve: An Exemplar for Genetic Counselors and Other Health Care Professionals

Genetic counselors and other health professionals frequently meet with patients who are grieving a loss. It is thus helpful for medical professionals to be familiar with approaches to bereavement counseling. Grief theory has evolved over the last few decades, from primarily stage theories of grief such as Kübler-Ross’s “five stages of grief” to frameworks that promote more complex and long-term ways to cope with a loss. Herein I present one recent grief theory – meaning-making - and describe how it can be applied to help parents of children with disabilities grieve the loss of the child that they expected. In particular, I describe a scenario that many genetic counselors face - meeting with the parents of a child with Down syndrome. I outline the research done on the reactions, grief and coping experienced by parents in this circumstance, and I present suggestions for encouraging healthy coping and adjustment for parents, based on the meaning-making perspective. The meaning-making theory can also be applied to many of the other losses faced by genetic counseling patients.     

Family Bereavement and Cultural Diversity: A Social Developmental Perspective

This article offers an integrative, interdisciplinary model of bereavement as a family developmental process that unfolds in cultural context. A critique of cultural assumptions highlights the culture-bound nature of prevailing North American practices, which view grief as an isolated individual experience and emphasize detachment from the dead as a way to promote recovery. Death and grief precipitate two kinds of family change, both guided by culture yet uniquely experienced and interpreted by individual families: 1) recreating the family without a key family member; but capable of coping with both existing and new tasks; and 2) incorporating the death into an ongoing but irrevocably altered family life-cycle developmental process. In supporting family change after a death, family therapists need to collaborate with grieving families in examining the goodness of fit between their unique circumstances and the bereavement expectations of their community and culture. Four case examples are presented, two of which will apply this social developmental model to emphasize transformations of attachment to the deceased — rather than detachment — that will support the ongoing family development of grieving families.     

Teacher Perspectives on Grief Among Children with Intellectual Disabilities

The death of a parent can have a profound impact on a child. However, little is known about how children with intellectual disabilities demonstrate grief or how teachers respond to student grief. Constructivist grounded theory methods were used to analyze data collected from five special education teachers of elementary students with intellectual disabilities. Categories related to grieving, loss, support, coping, and emotion were found. Teachers reported a range of grieving behaviors displayed by children with intellectual disabilities in the classroom and used various strategies to provide support. Grief in surviving caregivers and assistance from other school personnel were also described. The need for additional training of teachers and counselors about grief in children with intellectual disabilities is highlighted.     

Fracturing drive or fracturing connections—relational considerations commentary on paper by Paul Williams

We tend to conceive of mourning primarily in intrapsychic terms. In this commentary I highlight how Harvey Peskin’s paper (this issue) helps us to appreciate that grief is not only the product of the individual mind but is also constituted relationally. Both what we experience in our grieving and how we express it is shaped by and through those around us whose grief we bear witness to, as we ourselves grieve and are witnessed by them.

I elaborate further on Peskin’s view of the role of witnessing during grieving and mine another profound implication in his discourse by pointing to the bidirectional influence between mourning and relationality. Not only is mourning fostered through relational engagement, but our grieving together can provide the mortar for the building and sustaining of community.     

A short-term grief and loss therapy group: Group members' experiences

Abstract

This article is an evaluative study of a short-term grief and loss therapy group conducted at a large Midwestern university's counseling center. The group was held for students who had experienced loss through death of a significant person. The author examines brief group psychotherapy, special considerations of the college student's grief experience, an adaptation of the brief group model for grieving students, and data gathered from the members of the therapy group. Students' scores on a grief instrument showed mixed results. Group members made journal entries at four times during the group experience. They reported that the group was a supportive and helpful experience; five of Yalom's (1995) eleven therapeutic factors could be discerned. Recommendations regarding the treatment of grieving students in a group setting are made.     

Toward an integrative perspective on bereavement

For nearly a century, bereavement theorists have assumed that recovery from loss requires a period of grief work in which the ultimate goal is the severing of the attachment bond to the deceased. Reviews appearing in the 1980s noted a surprising absence of empirical support for this view, thus leaving the bereavement field without a guiding theoretical base. In this article, the authors consider alternative perspectives on bereavement that are based on cognitive stress theory, attachment theory, the social-functional account of emotion, and trauma theory. They then elaborate on the most promising features of each theory in an attempt to develop an integrative framework to guide future research. The authors elucidate 4 fundamental components of the grieving process--context, meaning, representations of the lost relationship, and coping and emotion-regulation processes--and suggest ways in which these components may interact over the course of bereavement.     

Grief's Rationality,Backward and Forward

Grief is our emotional response to the deaths of intimates, and so like many other emotional conditions, it can be appraised in terms of its rationality. A philosophical account of grief's rationality should satisfy a contingency constraint, wherein grief is neither intrinsically rational nor intrinsically irrational. Here I provide an account of grief and its rationality that satisfies this constraint, while also being faithful to the phenomenology of grief experience. I begin by arguing against the best known account of grief's rationality, Gustafson's strategic or forward‐looking account, according to which the practical rationality of grief depends on the internal coherence of the component attitudes that explain the behaviors caused by grief, and more exactly, on how these attitudes enable the individual to realize states of affairs that she desires. While I do not deny that episodes of grief can be appraised in terms of their strategic rationality, I deny that strategic rationality is the essential or fundamental basis on which grief's rationality should be appraised. In contrast, the heart of grief's rationality is backward‐looking. That is, what primarily makes an episode of grief rational qua grief is the fittingness of the attitudes individuals take toward the experience of a lost relationship, attitudes which in turn generate the desires and behaviors that constitute bereavement. Grief thus derives its essential rationality from the objects it responds to, not from the attitudes causally downstream from that response, and is necessarily irrational when the behaviors that constitute an individual's grieving are inappropriate to the object of that grief. So while the strategic rationality of an episode of grief contributes to whether it is on the whole rational, no episode of grief can be rational unless the actions that constitute grieving accurately gauge the change in a person's normative situation wrought by the loss of her relationship with the deceased.     

Enacting memory and grief in poetic landscapes

Much geographical work has focused on sites of memory, where memories and grief are inherently tied to particular places, monuments and landscapes. Memories and grief can also, however, be spatially and temporally dispersed and fragmentary, creating landscapes in which things are simultaneously present and absent. In this paper I trace the creation of a memorial poem - a marwnad - for my great aunt, who lived her entire life on the margins of Cors Goch, a lowland bog in rural south-west Wales, as part of a long tradition in Welsh-language poetry. Like many Welsh marwnadau, the poem highlights spatial and temporal complexities of memory, emotion and grief. They are both inherently tied to shifting, ephemeral, fluid landscapes and politicised in changing regional and national cultural landscapes, speaking to challenges faced by rural communities and the changing geographies of the Welsh language. As well as reflecting the temporality and seasonality of site-specific memory and grief, the poem contributes to that temporality as memories resurface and intensify during composition and in subsequent personal readings. I discuss the place of such performative poetry in mapping grief and the implications of poetic grieving and memory-making for absence and presence and relationships with the landscape.     

Emotionally Focused Couple Therapy with Couples Facing Terminal Illness

Research on effective therapeutic interventions for couples dealing with terminal illness is scant. Changes in daily routine, added responsibilities, role changes, and the grief process are all contributors to the enormous stress and emotional strain felt by these couples. Couples where one partner is terminally ill may experience anger, depression, guilt, and anxiety. The authors propose that emotionally focused couple therapy (EFT), originally developed by Greenberg and Johnson (Emotionally focused therapy for couples, Guilford Press, New York, NY, 1988) may be effective in addressing this distress and in facilitating the grieving and support process in couples dealing with terminal illness. EFT is a systemic, experiential form of therapy that builds upon Bowlby’s (Attachment and loss: Volume I: Attachment, Basic Books, New York, NY, 1969) attachment theory. By exploring the emotional experience of both partners it may be possible to re-structure the couple’s emotional partnership and support the grief process for both partners.     

The Use of Rituals in Grieving for a Miscarriage or Stillbirth

Abstract

Preparation for their changing roles in family and society, as well as readying their intimate space for the arrival of an infant, totally engage expectant parents. Miscarriage or stillbirth may bring on a grief storm that strips away many tender roots and branches of new life in the community that the parents have been nurturing. Creation and participation in a grief ritual can bring the grieving parents to a healing resolution. This article describes the healing efficacy of ritual, its elements, and how a compassionate therapist can create one in collaboration with grieving clients.     

Behind Our I’s: Grief and Loss in the Poetry of Li-Young Lee

This article uses Kenneth R. Mitchell and Herbert Anderson’s (1983) six modalities of grieving as presented in Donald Capps’ (1993) The Poet’s Gift to bring a pastoral theological perspective to bear on Li-Young Lee’s Behind My Eyes (2008), a collection of thirty-nine poems. In specifically focusing on Lee’s poem “To Hold,” it makes the case for a seventh grieving modality, that of preemptive loss. Employing Mitchell and Anderson’s distinction between faithful and unfaithful grieving, it argues that preemptive loss is an unfaithful form or expression of grieving, and notes the irony and sadness in this regard, as this unfaithful response to grief is informed by what is widely considered to be a faithful Judeo–Christian perspective, rooted in the inescapable sinfulness of humanity.     

Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief

Background: Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA’s negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study’s objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG.

Design: An online, retrospective survey was conducted with 161 women.

Methods: Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses.

Results: Moderate levels of PTG were observed for “relating to others,” “personal strengths” and “appreciation of life.” “Positive reframing” was a significant predictor of PTG. Despite using mainly “adaptive” coping strategies, women’s grief levels were high.

Conclusions: “Adaptive” coping strategies such as, “positive reframing” are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women’s experience, may be beneficial.     

Soup,Stitches, and Song

Abstract

This article discusses ways that clinical practitioners can utilize creative strategies in working with clients who are experiencing grief following the death of their adolescent child. It presents a brief literature review regarding this specific type of parental grief as well as practical and helpful ways to utilize books, songs, and tangible projects in the grieving process.     

Using Multidimensional Grief Theory to Explore the Effects of Deployment, Reintegration, and Death on Military Youth and Families

To date, the US military has made major strides in acknowledging and therapeutically addressing trauma and post-traumatic stress disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (multidimensional grief theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death—especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD.     

Mental ghosts and the process of grief

Abstract

Grieving the death of a loved one is an experience that many people will face at least once in their lifetime, but the lack of widely accepted guidelines as to what constitutes “normal” grieving results in mourning being a common experience with little universality. Memories may keep the deceased alive in the minds of the survivor and may even interfere with the formation of new relationships. This article considers the process of grieving the loss of a spouse and some of the individual factors, such as age, sex, and personal beliefs, that may account for variability in grief experiences. While several modeh detailing the grief process are discussed, the inappropriateness of establishing expectations for the nature and duration of grief is argued for.     

Restoring Dyadic Connection in the Face of Multiple Disruptions: Accounting for Vicissitudes in the Therapist’s Capacity for Reflective Functioning

This article describes the working method of our study group comprised of former Chestnut Lodge Hospital therapists and focusing on understanding therapeutic work with severely disturbed adolescents. Using process material from one therapy session, the therapist’s commentary on her feelings and reactions in the session, and the group’s discussion of the work, we explore factors disrupting the therapist’s moment-to-moment capacity to maintain a theory of her own and the patient’s minds. We then discuss what allows her to refind her theory of mind in the face of the patient’s aggressive nihilism and her own sense of loss. Salutary factors included the therapist’s empathy for the patient’s shared sense of grief, the patient’s offering the therapist cues to his inner state, and the dyad’s capacity to tolerate the therapist’s vulnerability in the patient’s presence.     

Observing a client's grieving process: bringing logical positivism into qualitative grief counselling research

This positional paper originates from our need as researcher/practitioners to establish a meaningful epistemological framework for research into bereaved people's journey through loss and grief over time. We describe how the field of grief research has a long and established biological basis, in keeping with a positivist epistemology. However, there has been a diminution of the influence of logical positivism in twenty-first-century counselling research. We argue that in grief counselling research, naturalistic observation of the grieving process within a logical positivist paradigm, remains a valid and valuable construct. We posit an observational protocol for the grief counselling process which minimises the intrusion of research method into the therapeutic process. We offer this as a means of conducting qualitative research within a bereavement counselling service. Further, we suggest that the development of an observational protocol for a client's grieving process has potential implications for developing good practice in grief work.     

Ongoing: On grief’s open-ended rehearsal

Peter Goldie’s account of grief as a narrative process that unfolds over time allow us to address the structure of self-understanding in the experience of loss. Taking up the Goldie’s idea that narrativity plays a crucial role in grief, I will argue that the experience of desynchronization and an altered relation to language disrupt even of our ability to compose narratives and to think narratively. Further, I will argue that Goldie’s account of grief as a narratively structured process focus on the process having come to an end. By contrast, I will propose the idea that grief can be understood as an open-ended rehearsal of our capacity to be alone in the company of an absent other. This makes grief a relational activity that differs from composing narratives about one’s past and about one’s process of grieving. Thus, grief is not primarily a process of recollecting our past narratively; rather, it can be seen as a dedicational activity which involves a future-oriented and open-ended rehearsal of relatedness despite irrevocable absence.