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Making Sense of Loss: Meaning Making and End of Life
Currier, Holland, and Neimeyer (2008)

 

Introduction
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?

Methods
119 participants who work directly with individuals dealing with terminal illness or bereavement, mean age 48.

Measurements
EOL questionnaire: How do you assist clients in making sense of loss? What techniques and strategies do you use?
Demographics
Degree to which your practice is influenced by research and theory

Analysis – non-parametric and qualitative analysis

Qualitative Results
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.

Quantitative Analysis
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

Discussion
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.

Discussion Questions
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?