Grief and the Expressive Arts

Practices for Creating Meaning

Barbara E. Thompson, Robert A. Neimeyer, Barbara E. Thompson, Robert A. Neimeyer

• Publisher: Routledge
• Year: 2014
• Print ISBN:
  9780415857185
• eBook ISBN:
  9781135088064
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The use of the arts in psychotherapy is a burgeoning area of interest, particularly in the field of bereavement, where it is a staple intervention in hospice programs, children's grief camps, specialized programs for trauma or combat exposure, work with bereaved parents, widowed elders or suicide survivors, and in many other contexts. But how should clinicians differentiate between the many different approaches and techniques, and what criteria should they use to decide which technique to use—and when? Grief and the Expressive Arts provides the answers using a crisp, coherent structure that creates a conceptual and relational scaffold for an artistically inclined grief therapy. Each of the book's brief chapters is accessible and clearly focused, conveying concrete methods and anchoring them in brief case studies, across a range of approaches featuring music, creative writing, visual arts, dance and movement, theatre and performance and multi-modal practices. Any clinician—expressive arts therapist, grief counselor, or something in between—looking for a professionally oriented but scientifically informed book for guidance and inspiration need look no further than Grief and the Expressive Arts.

Part I Building the Frame

DOI: 10.4324/9780203798447-1

1 Meaning Making and the Art of Grief Therapy

Robert A. Neimeyer and Barbara E. Thompson

DOI: 10.4324/9780203798447-2

Grief, understood in human terms, has existed as long as humanity itself, standing as it does at the intersection of attachment and separation, of love and loss. And for nearly as long the anguish and hope uniquely associated with the death of members of the community have found expression in art, from Paleolithic cave paintings to ritual chants, music and dances across cultures, and from religious art in innumerable spiritual traditions to secular poetry and prose. Our intent in compiling this volume was to explore this conjunction in the contemporary context of grief therapy, where a lively acquaintance with expressive arts modalities can make a profound contribution.

Like the reader, we have often found ourselves standing with bereaved clients in or near the existential void conjured by losses of many kinds, as they strive to symbolize a deeply emotional experience, share it with others, affirm life-sustaining bonds and meanings, and find orientation in a changed world. In this process of exploration, articulation, validation, and transformation, the bereaved and those who walk with them naturally reach beyond the constraints of public language, and into the figurative, musical, performative, and visual vocabularies of the arts, even in the context of psychotherapy.

CHANGING THEORIES OF GRIEF

Ironically, the timelessness and universality of grief are not matched by the theories with which it has been understood by psychology and related professions. Indeed, contemporary conceptualizations of grief are in a state of ferment, as fresh models and methods have been promulgated by an interdisciplinary array of scholars, researchers and clinicians (Neimeyer, Harris, Winokuer, & Th ornton, 2011). Only yesterday, it seems, time honored conceptions of grieving as a painful process of “letting go” predominated in the mental health professions, often buttressed by the simplifying assumption that people grieve in “stages” ushered in by some form of denial, shock, or numbness, which gradually yield to bargaining, anger, or protest, before moving through a state of depressive resignation on the way to acceptance or recovery. Now, however, buttressed by findings that cast considerable doubt on the cogency of this model as an adequate description of the bereavement trajectory (Holland & Neimeyer, 2010), grief theorists and researchers are embracing a great range of models that better account for the variegated courses by which people adapt to loss. It is clear, for example, that roughly one-third of mourners experience few of the turbulent feelings associated with the classic stage model, instead responding with considerable resilience or even relief from the earliest weeks of bereavement (Bonanno, 2004). In stark contrast, roughly 10–15% struggle with intense, prolonged and complicated grief, characterized by extreme separation distress, preoccupation with the loss, and inability to function in major life roles across a period of many months or years (Prigerson et al., 2009). And between these extremes fall a large number of adaptive grievers who come to terms with their losses after a period of upheaval, often without the benefit of professional therapy (Currier, Neimeyer, & Berman, 2008). The burgeoning of recent research and scholarship in the field of bereavement has arisen partly to account for these dramatic differences in outcome, as well as to test new therapeutic interventions for those mourners who struggle with their loss when drawing only on their own resources and those of their families and communities.

GRIEF AND THE QUEST FOR MEANING

One recent model to attract growing attention views grieving as a process of reaffirming or reconstructing a world of meaning that has been challenged by loss (Neimeyer, 2001; Neimeyer & Sands, 2011). Viewed through this lens, the death of a loved one, or even “nonfinite” loss in the form of relational betrayal, personal injury, loss of career, or relinquishment of life-defining goals (Harris, 2011), can undermine the basic storyline of our lives, launching an anguished attempt to make sense of what we have suffered and who we are in its wake. A great deal of evidence now supports a link between a struggle to find meaning in loss and complicated, intense, prolonged and preoccupying grief, whether encountered by bereaved parents (Keesee, Currier, & Neimeyer, 2008), older widows and widowers (Coleman & Neimeyer, 2010) or those who have lost loved ones by violent means such as fatal accident, suicide, or homicide (Currier, Holland, & Neimeyer, 2006). Moreover, inability to make sense of the death may be the critical link between the spiritual struggles many of the bereaved report and complicated grief (Lichtenthal, Burke, & Neimeyer, 2011), contributing to a vicious cycle in which acute separation distress arising from the death of the loved one erodes one’s sustaining religious or spiritual beliefs, further challenging one’s ability to find orientation in the experience (Burke, Neimeyer, McDevitt-Murphy, Ippolito, & Roberts, 2011).

Viewed as a coping resource, meaning making in its various forms also has been associated with more favorable bereavement outcomes in several populations (Holland, Currier, & Neimeyer, 2006; Lichtenthal, Currier, Neimeyer, & Keesee, 2010). For example, older bereaved spouses who are able to make sense of their loss in the early months of their bereavement report higher levels of pride, satisfaction, and wellbeing 18 months and a full four years following the death (Coleman & Neimeyer, 2010). Moreover, integration of the loss experience over time into survivors’ meaning systems is associated with gradual reductions in levels of complicated grief for bereaved people, and with gradual recovery from symptoms of general psychological distress for people experiencing other forms of trauma and transition (Holland, Currier, Coleman, & Neimeyer, 2010). There is even evidence that therapeutic interventions such as directed journaling that are designed to enhance sense making and benefit finding in the loss (Lichtenthal & Neimeyer, 2012) can bring about significant and sustained reductions in prolonged grief symptomatology (Lichtenthal & Cruess, 2010), providing encouragement for the use of other creative practices for fostering meaning making with the bereaved.

But what does it mean to make meaning of the loss? In the context of bereavement, one answer might be that it involves two overarching narrative processes: The ability to process the event story of the death itself, and the ability to access the back story of the relationship to the deceased in a healing fashion (Neimeyer & Sands, 2011). In the first instance, we search for a way to make sense of the loss, perhaps by seeking to understand why it happened, what it means for us, and how it fits into the larger story of our lives or our existential sense of how the world operates. Of course, some losses pose a more profound challenge than others in this respect, as when we are confronted by the deaths of children or young people, contend with the reality of senseless violence, grapple with the trauma of suicide, or experience the sudden demise of a loved one without warning. In such cases, meaning reconstruction can be deep going, in effect prompting us to “re-learn the self” and “re-learn the world” (Attig, 2001), as both may be changed fundamentally in light of the loss. In other circumstances, as with the anticipated death of an older person after a long period of illness, meaning reconstruction in grief may be more subtle, as this transition may largely reaffirm our beliefs about how life “should” be. Even in this case, however, we may be faced with the need to sort through with ourselves and others what the loss means to us emotionally, and how it fits into the evolving narrative of who we are, who we love, and how we live. In the terms of the Dual Process Model of coping with bereavement, stitching together a cherished past with an altered future entails oscillating between orienting to the loss and orienting to restoration of our daily lives, as we revise our roles and goals in light of our changed circumstances (Stroebe & Schut, 2001). Table 1.1 offers some of the typical questions that clients and therapists engage as they work to make sense of the event story of the death in clients’ ongoing lives.

The second major narrative strand by which we knit together the torn fabric of our lives involves re-accessing and reconstructing the “back story” of our relationship with the deceased. Especially when the person lost was a trusted witness to our past (such as a parent or grandparent), an intimate partner in our present (as with a soul mate or sibling), or a projected companion in or extension of our future (such as a child or grandchild), the death can rend the web of bonds and meanings that sustains our most fundamental sense of being-with-others. Evidence suggests that mourners with a basic sense of insecure attachment may be especially vulnerable to depression and complicated grief in the wake of such losses

Table 1.1 Sample of implicit questions entailed in processing the “event story” of the death

• How do I make sense of what has happened, and what is the meaning of my life now in its wake?

• What do my bodily and emotional feelings tell me about what I now need?

• What is my role or my responsibility in what has come to pass?

• What part, if any, did human intention, inattention or wrongdoing have in the dying?

• How do my spiritual or philosophic beliefs help me accommodate this transition, and how are they changed by it in consequence?

• How does this loss fit with my sense of justice, predictability, and compassion in the universe?

• With what cherished beliefs is this loss compatible? Incompatible?

• Who am I in light of this loss, now and in the future? How does this experience shape or reshape the larger story of my life?

• Who in my life can grasp and accept what this loss means to me?

• Whose sense of the meaning of this loss is most and least like my own, and in the latter case, how can we bridge our differences?

(Meier, Carr, Currier, & Neimeyer, 2013), perhaps because they struggle to reorganize their continuing bond to the deceased in a way that is sustainable in their physical absence (Field, Gao, & Paderna, 2005). This effort to reconstruct rather than relinquish a connection to the deceased is recognized in contemporary theories such as the Two-Track Model of Bereavement (Rubin, 1999), which accords equal importance to the conservation of the relationship through memory, ritual, and emotional and spiritual bonds as it does to biopsychosocial symptomatology. It is also consonant with a narrative therapy emphasis on “introducing the deceased” to one’s social world through continued storytelling and preservation of legacy, thereby “re-membering” them in the sense of reclaiming their membership in the club of significant figures in our life (Hedtke, 2012). Table 1.2 offers some representative questions that clients and therapists address when they strive to access and accommodate the continuing bond with the loved one in light of the death.

As many of the implicit questions entailed in processing the event story of the loss and accessing the back story of the relationship suggest, engagement with meaning making in bereavement can function as more than a “coping strategy” for “reframing” the loss in a more positive fashion. Instead, a quest for meaning may yield a more ambivalent, ironic, or philosophic recognition of the frailty of life, and move survivors toward greater humility, appreciation, compassion, presence or spirituality as a result (Calhoun & Tedeschi, 2006). And indeed, research documents the common emergence of such posttraumatic growth in the wake of loss, particularly when grief is substantial enough to foster profound processing of the experience, but not so overwhelming as to make review and revision of one’s life premises impossible (Currier, Holland, & Neimeyer, 2012).

Table 1.2 Sample of implicit questions entailed in accessing the “back story” of the relationship to the deceased

• How can I recover or reconstruct a sustaining connection to my loved one that survives his or her physical death?

• Where and how do I hold my grief for my loved one in my body or my emotions, and how might this evolve into an inner bond of a healing kind?

• What memories of our relationship bring pain, guilt or sadness, and require some form of redress or reprieve now? How might this forgiveness be sought or given?

• What memories of our relationship bring joy, security or pride, and invite celebration and commemoration now? How can I review and relish these memories more often?

• What were my loved one’s moments of greatness in life, and what do they say about his or her signature strengths or cherished qualities?

• What lessons about living or loving have I learned in the course of our shared lives? In the course of my bereavement?

• What would my loved one see in me that would give her or him confidence in my ability to survive this difficult period?

• What advice would my loved one have for me now, and how can I draw on his or her voice and wisdom in the future?

• Who in my life is most and least threatened by my ongoing bond with my loved one, and how can we make a safe space for this in our shared world?

• Who can help me keep my loved one’s stories alive?

THE ART OF THERAPY

What role might expressive arts modalities have in grief therapy, as viewed through the lens of meaning reconstruction and related contemporary models of mourning? In a sense, the remainder of this book represents an extended answer to this question. But here we will offer some personal and p...

Table of contents

• Cover Page
• Half Title Page
• Series Title Page
• Title Page
• Copyright Page
• Dedication
• Epigraph
• Table Of Contents
• List of Figures
• List of Tables
• Acknowledgments
• Foreword
• Preface
• Introduction
• Part I Building the Frame
• Part II Doing the Work
• Part III Art and Reflexivity
• Part IV Programs
• Part V Research
• List of Contributors
• Name index
• Subject Index