Mourning and Meaning: The Narrative Arc of Tragic Loss

Tragic Loss 1Mourning and Meaning:The Narrative Arc of Tragic LossRobert A. Neimeyer, Ph.D.Department of PsychologyThe University of MemphisMemphis, TN 38152http://web.mac.com/neimeyerCase Study: A Tragic AccidentPart I: Shattering the StoryA. Adaptive Grieving1. When grief moves forward, the survivor gradually integrates the “eventstory” of the death into his or her life narrative, while drawing attachmentsecurity from the “back story” of a loving relationship with the deceased.2. “Bouts” of anguish alternate with “moratoria” that offer a “time out” from thework of grieving. (Bowlby)3. As loss is integrated, the person:acknowledges the reality of the deathretains access to bittersweet emotionsrevises the mental representation of the deceasedformulates a coherent narrative of the lossredefines life goals

Tragic Loss 64. Sense-making was the most potent mediator of complicated grief,greatly outweighing objective factors such as whether death wasnatural or violent and length of time since loss6. Extension by Lichtenthal et al. established that spiritual and secularsense making, and religious and relational benefit-finding, wereassociated with less complicated griefB. Efficacy of Narrative Interventions (Lichtenthal & Cruess, Death Studies)Assigned 68 bereaved young adults to one of 4 conditions: Emotional disclosure (ED) Sense-making (SM) Benefit-finding (BF) Control (writing about room)Improvement was observed in all three therapeutic conditions, reducingcomplicated grief and other symptomsGains not only held, but also increased over next three monthsBenefit-finding narratives seemed especially healingClinician’s Toolbox: Guidelines for Therapeutic Journals Find a private place where you will not be interrupted Focus on one of the more traumatic experiences of your life Write about those aspects that are most difficult to acknowledge Shift between external event and your deepest thoughts and feelings Abandon a concern with grammar and syntax: Write only for yourself Write 20 minutes a day, for at least four days Schedule a “transitional activity” to return to life as usual Have a support person or professional available in case of needVariations:Dream journalsDialogues with selfDialogues with deceasedLetters to a “friend” with a similar lossDirected journaling to enhance (spiritual) sense-making and benefit-findingNote: if used as an adjunct to therapy, integrate into session through reading selectedpassages aloud, rather than as material for therapist to read between sessions.

Tragic Loss 8 Live for the day, make moments count 5% More aware and accepting of death 3% Financially better off 3% No benefits, only losses 39%Clinician’s Toolbox: Virtual Dreams (Smith & Neimeyer)Stories told in language can be figurative as well as literal, freeing people from thetyranny of the obvious. Not everyone can recall dreams, but all of us can constructdream-like stories that can convey, explore, integrate and extend meanings ofanalogical relevance to our own losses.Assign a set of six elements (settings, figures and objects) of the virtual dream, havingthe writer construct a story that includes them, tailoring the elements to the loss that hasbeen suffered. For example, a virtual dream concerning the death of a child mightinclude an empty room, a broken toy, an overheard song, a wise woman, a faded photo,and a clearing in the wood. In contrast, one bearing on the death of a spouse mightinclude an empty bed, a thunderstorm, a tarnished ring, a mysterious stranger, an innervoice, and a remote beach. Other illustrations of elements are offered below.Limit writing to 8-10 minutes to promote spontaneity and to keep task manageable.Optionally, share stories in small groups, exploring group observations and insights.Research on VD stories by Neimeyer, Torres & Smith (Death Studies) indicates thatthey typically are self-relevant to the author’s own losses, include encounters withbenevolent beings or forces, progress toward preferred outcomes and feature themes ofhope rather than despair.Techniques for further processing:Write down 3-5 feeling words associated with each element (e.g., an empty bed:lonely, comforting, safe)Construct a practical goal that addresses one or more of these feelings and a plan toreach it (e.g., I will reduce by loneliness by taking weekly walks with a friend).Identify the most sympathetic and most troubling virtual dream element and re-writethe story from its perspective.“Interview” the virtual dream element about its role in your life, why it is visiting you,and what it has to teach you.Re-write the story as a spiritual lesson, taking a “God’s eye view” of the action andintent of the narrativeImagine a sequel to the story, and search for emerging benefits or learning

Tragic Loss 10Recommended ReadingsBonnano, G. A., Wortman, C. B. & Nesse, R. M. (2004). Prospective patterns ofresilience and maladjustment during widowhood. Psychology and Aging, 19,260-271.Berger, J. (2006). Music of the soul. New York: Routledge. [Sophisticated and practicaldiscussion of music therapy in end-of-life and bereavement care.]Currier, J.M., Holland, J.M. & Neimeyer, R.A. (2006). Sense-making, grief, and theexperience of violent loss: Toward a mediational model. Death Studies, 30, 403-428. [Demonstrates that a failure in sense making accounts for the impact ofsuicide, homicide and accident]Harris, D. (Ed.) (2011). Counting our losses. New York: Routledge. [Broad coverageof grief arising from “non-finite” loss, other than the death of a loved one, such asloss of marriage, ability, beliefs, work and much more.]Jeffreys, J. S. (2011). Helping grieving people [2 ed.]. New York: Routledge. [Practicalhandbook for care providers.]Jordan, J. & McIntosh, J. (Eds.). (2010). Grief after suicide. New York: Routledge.[Thorough coverage of research and practice issues in working with thosebereaved by suicide. Comprehensive and readable.]Katz, R. & Johnson, T. (Eds.) (2006). When professionals weep. New York: Routledge.[Thorough and thoughtful coverage of “contertransference” issues in end-of-lifeand bereavement care.]Keesee, N. J, Currier, J. M. & Neimeyer, R. A. (2008). Predictors of grief following thedeath of one’s child: The contribution of finding meaning. Journal of ClinicalPsychology, 64, 1145-1163. [Documentation of sense-making as leadingpredictor of intensity of parental grief]Nadeau, J. (1997). Families making sense of death. Thousand Oaks, CA: Sage.[Qualitative research on meaning-making as interactive process in families]Neimeyer, R. A. (Ed.) (2012). Techniques of grief therapy: Creative practices forcounseling the bereaved. New York & London: Routledge. [Comprehensivedescription of 96 specific bereavement interventions, with detailed instructions, acase example, and further resources; a substantial toolbox for grief therapists]Neimeyer, R. A. (2009). Constructivist psychotherapy. London & New York:Routledge. [Brief and readable manual for constructivist, meaning-orientedtherapy, with many practical techniques and case illustrations].

Tragic Loss 11Neimeyer, R. A. (2009). The art of longing. Charleston, SC: Booksurge. [Originalcontemporary poetry on grief with color illustrations from various artists]Neimeyer, R. A. (2008). Constructivist therapy over time. Washington, DC: AmericanPsychological Association. [Six full sessions of videotaped therapy featuringmeaning making interventions in grief therapy with an African American mothergrieving the loss of a child in stillbirth, complete with conceptual introduction tothe approach and post-session discussion]Neimeyer, R. A. (2006). Rainbow in the Stone. Memphis, TN: Mercury. [Originalpoetry on themes of loss and human resilience.]Neimeyer, R. A. (2006). Re-storying loss: Fostering growth in the posttraumaticnarrative. In L. Calhoun and R. Tedeschi (Eds.), Handbook of posttraumaticgrowth: Research and practice (pp. 68-80). Mahwah, NJ: Lawrence Erlbaum.[Exploration of interface of PTG and narrative]Neimeyer, R. A. (2004). Constructivist psychotherapy. Washington, DC: AmericanPsychological Association. [Full length video featuring meaning makinginterventions in grief therapy with a bereaved mother, complete with conceptualintroduction to the approach and post-session discussion]Neimeyer, R. A. (2002). Lessons of loss: A guide to coping. Memphis, TN: Center forthe Study of Loss and Transition. [Written for professionals and clients or layreaders, presents research-grounded new models of grieving and practicalapplications to grief counseling and psychotherapy]Neimeyer, R. A. (Ed.) (2001). Meaning reconstruction and the experience of loss.Washington, D. C.: American Psychological Association. [Multifaceted scholarlyand applied contributions to bereavement theory, research, and practice,including considerations of post-traumatic growth]Neimeyer, R. A., Baldwin, S. & Gillies, J. (2006). Continuing bonds and reconstructingmeaning: Mitigating complications in bereavement. Death Studies, 30, 715-738.[Demonstrates interaction of attachment and meaning making in predicting griefoutcomes]Neimeyer, R. A., van Dyke, J. G. & Pennebaker, J. W. (2008). Narrative medicine:Writing through bereavement. In H. Chochinov & W. Breitbart (Eds.), Handbookof psychiatry in palliative medicine. New York: Oxford. [Review of research onexpressive writing paradigm with special emphasis on bereavement]Neimeyer, R. A., Harris, D., Winokeur, H. & Thornton, G. (Eds.) (2011). Grief andbereavement in contemporary society: Bridging research and practice. NewYork: Routledge. [Comprehensive handbook covering grief and itscomplications, including death of a child, violent death, children’s grief, family

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