Techniques of Grief Therapy: Assessment and Intervention
The Book Brigade talks to psychotherapist Robert A. Neimeyer.
Posted Sep 03, 2015
Source: Robert A. Neimeyer, used with permission of the author.
Everyone experiences loss of some kind. ItÕs often the hidden element behind the way we cope with relationships and transitions all our lives. Throw out the idea that youÕre destined to experience specific stages of grief. New research suggests there are many ways we experience grief, and many sources of wisdom on the subject.
What was your main purpose in working on this book?
Ever since the work of Elizabeth Kbler-Ross on the "stages of grief" in the late 1960s, many clinicians have taken it for granted that bereaved clients need three things, all of them fairly vaguely defined: support, a chance to express their feelings, and a "normalizing" of their experience. Contemporary theory and research seriously challenge the adequacy of a stage model of grieving and offer in its place much more solid and nuanced models for understanding mourning: as a process of reconstructing a world of meaning challenged by loss, reworking the nature of attachment to the deceased, realigning family roles, engaging the realities of a changed social sphere, and more.
Significantly, these new models also imply new methods for working with grief, suggesting a great range of increasingly research-informed procedures for helping clients to deal with the profound psychological, social, and sometimes spiritual issues that the death of a loved one can raise, especially when that death is premature or traumatic. One goal of the book was to make these new ideas and methods much more readily available to practicing clinicians.
Another was in some sense the opposite: to share the clinical wisdom of therapists "in the trenches" not only with one another, but also with researchers who are rarely privy to the actual practices of grief therapy in field settings. In the dozens of workshops I conduct annually with literally thousands of therapists around the world, I am constantly struck not only by the compassion and commitment of my clinical colleagues but also by their creativity. By offering a book packed with 66 short chapters conveying specific techniques in clear detail and illustrating them in a brief case study, I hope to convey these practices in the voices of their originators. The result is a cornucopia of clinical tools that can assist therapists dealing with trauma and loss of many kinds, and also invite the attention of clinical researchers to a great range of promising procedures that deserve greater documentation.
Who would most benefit by reading it?
Well, I'm tempted to say that Techniques of Grief Therapy: Assessment and Intervention belongs on the shelf of both experienced clinicians and those just beginning to delve into the field of grief therapy. But I'll leave that ambitious statement for the back cover! Perhaps it is enough here to say that it is most relevant to therapists who find that their clients are presenting with themes related to profound loss, either imminently, as they face the looming death of a loved one, or as they continue to deal with the complicated implications of a loss for their ongoing lives, maybe many months or years after the death itself. The therapeutic goals the book addresses include assessing bereavement, attending to the body, working with emotion, reconstructing the self, re-storying narratives of loss, reorganizing the continuing bond, mobilizing systems, and facilitating group work. In other words, therapists interested in any of these aims in therapy should find the book a good companion.
Why is it so important to integrate various viewpoints and experiences—from theorists and researchers to hospital workers and other care professionals?
Taking an integrative view of grief therapy is important because loss, in its many forms, is a pervasive dimension of human life. When we pause to think about it, every person, every place, every project, and every possession that we love, we will lose, at least in an earthly sense. By the time they arrive in our offices, most of our clients have already lost many and much, whether these losses feature as the presenting problems they bring us or the yet-to-be-discovered backstory that has shaped how they have coped with relationships and transitions for a lifetime. Given the ubiquity of loss, it is not surprising that it is a focal issue in many clinical contexts, ranging from hospital settings to children's bereavement centers, and from faith-based grief support groups to psychotherapists' private practices. It only makes sense, then, to harvest the contributions of thoughtful and innovative practitioners in all of these settings.
Could you describe one or more of the contributors to whom you turned first to provide his or her perspective?
With 75 contributors, most of whom I am privileged to call friends, I'm hard pressed to single out a handful as representative. But I'll play rather than pass. Clinical scholars like Kathy Shear, Camille Wortman, Simon Rubin, and Laurie Ann Pearlman are among the several prominent theorists and researchers who are pushing the boundaries of grief therapy by deeply mining the implications of attachment theory, experiential therapies, and traumatology to offer novel insights and procedures to guide therapists working with prolonged, complicated grief. Equally, creative clinicians like Lara Krawchuck, Gail Noppe-Brandon, Anthony Papa, and Yasmine Iliya offer original and in some cases research-vetted techniques for facilitating client resilience, self-discovery, resolution of ambivalence, behavioral activation, and strengthening of bonds with the loved one, while embracing the necessity to change. Basically, I used the "wow" factor to guide my choices of who to approach: If someone was doing something that wowed me, as a seasoned therapist who has practiced for 35 years, I invited them to join the party.
You wrote or co-wrote several of the bookÕs chapters. Can you tell us a bit about some of these and what you hope readers will take away from them?
Sure. In the opening chapter, I joined my colleague Joanne Cacciatore in pushing my work in meaning reconstruction in new directions by positing a model of grief as a developmental challenge in adult life. We traced the trajectory of adaptation after a profound loss from the early weeks of "reacting" to the questions posed by the death through the subsequent months of "reconstructing" a viable connection with the loved one and ultimately to the years of "reorienting" to the new sense of self and world that life transitions often entail. At each point, we conceptualized a characteristic "crisis" faced by the bereaved (e.g., connection vs. isolation, meaning vs. meaninglessness) and attempted to spell out the existential questions with which mourners wrestle, as well as their associated psychosocial needs and illustrative therapeutic techniques of relevance to each crisis. Our intent was to help other practitioners grasp a given client's need and readiness more clearly, and have a sharper intuition about how this might focus subsequent therapy.
In other chapters I joined colleagues like Laurie Burke, Jane Milman, and James Gillies in describing different scales for assessing client's struggles with meaning in both secular and spiritual spheres, offering these validated scales and scoring instructions freely for the use of both practitioners and researchers. Elsewhere, writing on my own or with Diana Sands, I described my preferred procedures for helping clients disentangle multiple losses suffered in a short period, leaving them in a fog of bereavement overload, or for helping support groups contain the sometimes re-traumatizing stories of a loved one's violent death that can otherwise overwhelm other group members. Like the dozens of other contributors offering specific tools for addressing specific problems, I found these chapters especially satisfying in providing "news you can use" in the concrete context of clinical practice.
Is there any topic or set of topics that you think grief therapists and researchers have misconceptions about?
Actually, I think that grief therapists are a pretty savvy group: They've typically stood close to the existential void of tragic loss with countless clients, and developed a sense of presence, process, and procedure that helps clients integrate profoundly unwelcome life transitions. Researchers I'm not so sure about! All kidding aside, there are plenty of intelligent developments in the academic study of bereavement as well, but also some shared blind spots. All of us, clinicians and researchers, can fall prey to thinking of grief as simply a negative emotion to be expressed or regulated, rather than deeply explored, valued, and used to prompt a deeper sense of compassion for ourselves and others, or a clearer sense of what has meaning in life. One of the things I value about many of the chapters in the book is their affirmative approach to grieving as something that is not only painful but also potentially productive.
What do you hope readers will gain from the book as a whole, relative to other (or older) works on grief therapy?
I hope readers will become wiser, more incisive, and more effective therapists to clients struggling with life-vitiating loss. Period.
What is the most surprising or profound thing you discovered in working on the book?
The most surprising thing was not so much a discovery as a rediscovery: the recognition that as human beings we are wired for attachment in a world of impermanence. What became clear to me in compiling this book was that this same recognition animates countless clinicians to reach deeply into their preferred theories, personal intuitions and accidental innovations to craft creative responses to our universal encounter with anguishing loss. Ultimately, I hope that sharing these practices with readers will enrich their engagement with loss and grief, as it has my own.
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Source: Courtesy of Routledge