Making Sense of Loss: Meaning Making and End of Life
Currier, Holland, and Neimeyer (2008)
EOL practitioners work with dying patients to weave together changes in assumptive world to recreate a predictable, orderly existence.
Capacity to understand loss can be critical to the healing process.
Some research has looked at meaning making following problematic experiences (Clark, 1996), and others have looked at how families reconstruct meaning through “family speak” (Nadeau, 1998).
Emergence of therapeutic interventions from a meaning reconstruction framework.
How are real-world EOL practitioners helping suffering persons find meaning in the wake of loss in actual therapeutic contexts?
119 participants who work directly with individuals dealing with terminal illness or bereavement, mean age 48.
EOL questionnaire: How do you assist clients in making sense of loss? What techniques and strategies do you use?
Degree to which your practice is influenced by research and theory
Analysis – non-parametric and qualitative analysis
Presence of helping professional – emphasized comments similar to Rogers’ counselor congruency, empathic listening, and unconditional positive regard.
Elements of the process – emphasized 9 elements including storytelling, psychoeducation, and spiritual or existential significance
Therapeutic procedures – only about a third rely on these; mostly narrative techniques and rituals or memorials
Therapeutic Approaches by Occupation
Nurses – attend directly and refer to helping professionals
Chaplaincy – spirituality and religion-based
Social work – balance of approaches
Psychologists – psychoeducation and others
Master’s level therapist – narrative approaches, psychoeducational, CBT
About half were influenced by research and theory, and about half were not.
SW, psychologists, and MLT more likely than nurses to facilitate meaning making
MLT more likely than nurses to promote narrative sharing or story-telling
Narrative techniques more likely used by chaplains, social workers, and MLT than nurses
SW, psychologists, and MLT more likely than nurses to use psychoeducation
MLT more likely to use CBT than nurses, chaplains, social workers, and psychologists
Chaplains and social workers more likely than nurses to use expressive and creative therapies
Generally, approaches like cultivating a safe and supportive relationship, empathic listening, exploration of spiritual and existential concerns, affirming and expanding psychosocial resources, and implementing rituals are all helpful.
Nurses less likely to use psychologically-oriented approach but did implement approaches that were not standard for them.
MLT more likely to use CBT
Though many did not report influence of theory or research, most of them are acting consistently with current empirical knowledge.
Many practitioners endorsed strategies for meaning making beyond any particular therapeutic technique.
Many practitioners appeared to draw from their own understanding to help their clients negotiate a path toward adjustment.
What implications does this have for you as a practitioner dealing with bereaved clients?
What implications does this have for you as a practitioner dealing with dying clients?
Which types of approaches (narrative technique, rituals, CBT, psychodynamic perspective, humanistic, Christianity, practical interventions) would you be more likely to use? Why?