Bereavement and the literature
A plethora of literature on bereavement exists, which is not surprising given that most people will be affected by it, often on multiple occasions. This is because, every day, thousands of people die, expectedly and unexpectedly; 5,000 deaths occur in England alone and, on average, every death affects at least five people.1
Grief has always existed and while there were a few researchers who came before him, it is Freud who is commonly credited with introducing grief into the psychological framework, with his paper ‘Mourning and Melancholia’ (1917) being regarded as particularly significant.2 While there have been assertions that Freud’s work was misunderstood, it is generally agreed that Freud largely saw grief as ‘normal’ and viewed recovery as requiring ‘grief work’, during which the psychological energy invested in the deceased was reclaimed. Freud’s view was that this broke the bond and detached the libido from the dead loved one, thus enabling forward movement. Since Freud, however, ‘the continuing bonds’ theory has, in opposition, argued that a continuing bond with the deceased is not only normal and healthy but also an important aspect of healing as it can help to alleviate the separation anxiety, disorganisation, distress and despair which may follow the death of a loved one.3 Certainly, there is not clear-cut evidence supported, nor any answer to the detachment/continued attachment debate, so might alternative models of understanding be helpful?
Other models of understanding
Certainly, Elisabeth Kubler Ross’s stages of denial, anger, bargaining, yearning and pining, depression and acceptance are viewed as seminal.4 Similarly, John Bowlby contributed significantly to the development of grief theory in his identification of four phases, namely numbing, yearning and searching, disorganisation and reorganisation.5 His work was supported by Colin Murray-Parke’s psychiatric perspective.6 And yet, while stages and phases undoubtedly have appealing aspects in explaining grief, key criticisms focus on the inherent suggestion that stages are experienced in a linear and set order, that there is a generalised nature to grief, that the person is passive in the grief process and that grief is time limited.
It was in reaction that William Worden developed his tasks model of accepting the reality of the loss, working through the pain and grief, adjusting to an environment in which the deceased is missing, emotionally relocating the deceased and moving on with life.7 In contrast to the alleged passivity of the stages and phases models, Worden’s work suggests that there is something that can actively be done to adjust to the death of a loved one. However, while Worden did acknowledge that grief moves backwards and forwards between tasks, which is not explicitly recognised by the stages and phases models, it is the dual process model by Stroebe and Schut which explicitly recognises the extent of fluctuation between what it calls loss focus (grief work, breaking bonds, denial/avoidance of restoration changes etc) and restoration orientation (attendance to life changes, doing new things, distraction from grief, new roles, identity, relationships etc).8 And yet, the conclusion can only be that while models can be helpful, none provides a complete understanding, being largely psychologically focused.
Spirituality – the glaring omission from models of understanding
The omission of spirituality from grief models is pertinent, given that there is a growing body of literature that highlights the positive effects of spirituality and religion on mental and physical functioning,9 and moreover, that spirituality and religion have been identified as key factors in healing among bereaved people generally and the violently bereaved in particular.10 It is also important to recognise that while a variety of definitions of spirituality exist, it is consistently considered to be a broader concept than just identification with a particular. There is a dearth of counselling literature on the influence of bereavement on spirituality, which, for me, highlights the necessity for further exploration of this area.
My personal background
Bereavement has interested me for a long time because the mystery of it all is fascinating. However, the sudden death of my maternal grandfather when I was just eight years old was devastating and confusing at the same time. Yet, even at that early age, and facilitated by my strong evangelical Christian upbringing, God clearly spoke to me through Holman Hunt’s painting of Christ knocking at the door. At eight years old, this was a strong spiritual experience as a result of that first experience of grief. However, my second bereavement of my paternal grandfather when I was 18 years old was a completely different experience and I wasn’t impacted spiritually at all. Nonetheless, in subsequent bereavements I have found my personal spirituality to be a source of strength, which has provided resilience and meaning, particularly through belief in an afterlife and the hope of seeing loved ones again. Moreover, the sudden death of my daughter’s father-in-law two-and-a-half years ago, further demonstrated how the Christian faith of a family could provide resilience in bereavement. In contrast though, I recall my rage with God at the sudden death of an 18-year-old family member back in 1985. The ensuing years consisted of raging at the Almighty while searching for answers to unanswerable questions and doubting God’s existence.
What eventually emerged was a desire to help grieving people, and I became a bereavement listener for the church and local hospice. Further on, during counselling training, my second placement was with Cruse Bereavement Care, with whom I volunteered for nine years, and consequently gained a great deal of experience of working with bereaved clients. Working since in private practice, bereaved clients still frequently enter the therapeutic space.
Further, it was in the context of private practice that I worked with several clients who found comfort and hope from their spirituality in grief as, alongside spiritual reappraisal, which included grappling, searching, questioning and doubt, spirituality was a coping resource and meaning-making system which provided them with comfort and hope. The strength that I witnessed this giving to those clients, triggered curiosity around the impact of client spirituality when bereavement is the presenting issue, hence the research topic emerged. Moreover, during the first quarter of 2017, as I embarked on this research project, I suffered multiple bereavements and, again, the certainty of bereavement and resultant grief was reiterated as, alongside spiritual reappraisal, my faith was an invaluable resource.
The question which arose therefore was whether spirituality might be the missing piece of the jigsaw for many practitioners and clients when working with bereavement as the presenting issue. This was considered to be a subject worthy of research, not only because of the substantial gap in the counselling literature on this topic, but because of the potential implications for clinical practice. All of this encouraged me to pursue this research study at a time when the counselling profession is arguably more open to the ethical and appropriate integration of spirituality than ever before.
Research question and methodological approach
It was against this background that the research question, ‘What are counsellors’ lived experiences of the impact of client spirituality when bereavement is the presenting issue?’, was addressed. The aims of my research were to explore interviewees’ experiences of working with bereavement and to understand how participants made sense of the impact of client spirituality with the presenting issue of bereavement. Five counsellors, all of whom were in clinical practice and studying at a Christian institute in the South of England at master’s level, participated in semi-structured interviews. The research data were thematically analysed within the overall framework of interpretative phenomenological analysis.
The findings of the research study
Four superordinate themes emerged: finding comfort and hope through spirituality, spirituality as a meaning-making system, spirituality as a coping resource and, finally, spiritual reappraisal triggered by the mystery of it all.
Finding comfort and hope through spirituality
The results showed that participants, from their experiences in clinical practice, understood that comfort and hope could be found from spirituality in bereavement. Belief in an afterlife was a clear subordinate theme as participants attached meaning to the comfort and hope clients found in knowing that their loved ones were in heaven, for example. This resonated with the literature, which illustrates the certainty to be found in Christian beliefs.11 Moreover, the findings and literature correlated in revealing that afterlife beliefs don’t have to be specifically about ‘heaven’, but rather, more about knowing where loved ones are, which allows for the possibility of some continuation for deceased loved ones.12 The interviewees’ beliefs in the importance of ‘continuing bonds’ in this way, was clear. Again, this resonates with the extant literature, which states that a belief in God or some sort of afterlife, provides bereaved individuals with the comforting belief they can have a relationship with their deceased loved one in the future.13
But this is unquestionably more complex than participants’ understandings suggest, because what wasn’t pinpointed in the research findings was that a black-and-white belief in heaven and hell can cause added distress if the deceased person doesn’t have Christian beliefs. Additionally, some studies, which specifically looked at beliefs in the afterlife, found no correlation with adjustment in bereavement, so belief in an afterlife is not necessarily a guarantor of comfort and hope.
Additionally, the findings demonstrated counsellors’ understanding, gained from clinical practice with bereaved clients, that comfort and hope can be found in spiritual rituals as, while this was conveyed by a couple of the interviewees, it was narrowly limited to funerals rather than being inclusive of other rituals. However, there are a variety of ritualistic expressions which can be comforting in grief and therefore the conclusion was that interviewees’ understanding on this was limited.
Spirituality as a meaning-making system
Much has been written about the importance of meaning-making by writers such as Niemeyer and Frankl.14,15 The results of this study are cognisant of the literature in that they unmistakably illustrate the importance of spiritual meaning-making in healing after bereavement. For example, making sense through beliefs emerged strongly in the findings. Additionally, the literature shows that some bereaved people were able to make sense of loss by believing that it was meant to happen as part of a divine plan. One participant conveyed understanding of the importance of this.
The second subordinate theme, namely making sense through scripture, was also highlighted by only one counsellor and it is notable that the literature about this aspect of meaning-making is also limited. The question which arose therefore is whether this element of making sense of bereavement is not as common as making sense through beliefs, or whether it has not frequently presented within the lived experiences of interviews in clinical practice, or indeed, might they not have regarded it as significant if/when it did arise?
Overall, however, the results aligned with the literature regarding the role spirituality can play in meaning-making in bereavement. What the findings failed to acknowledge though was that not everyone needs to meaning-make in grief and not all bereaved people seek to meaning-make in such circumstances or indeed are able to do so.
Spirituality as a coping resource
Both the findings and literature show that spirituality can be a coping resource in times of adversity. The first aspect of this superordinate theme was relationship with God or a Higher Being, which can enable strength and comfort to be found. Moreover, the literature suggests that a personal relationship with God can provide a kind of love or attachment, experienced (or sought) in the mother-infant relationship.16 The study findings relate to this in terms of a compensatory attachment to God being potentially important, and yet the results failed to highlight the distress caused when the experience of the grieving person is that God does not fill the gap left by the deceased.
Another emergent theme was using religious coping behaviours, such as increased prayer or attendance at a spiritual community, which the literature suggests predicts increased psychological wellbeing and spiritual growth.17 This corresponds with the research results, which showed that counsellors’ experiences were that prayer and reading the Bible could be significant coping resources.
Like the literature, the findings also showed that Christian support groups could enable hopelessness to be alleviated, faith awakened and hope return for the bereaved. Yet some empirical quantitative research showed that no statistical differences were found between Christian and secular support groups and their endorsement of hopelessness.18
A further aspect drawn out in the outcomes was that spiritual communities are not always supportive, which is an important area of omission from the literature as this felt lack of support can happen alongside a spiritual crisis triggered by the loss. So, while the literature suggests that support from spiritual groups can be a crucial coping resource, it is noteworthy that participants’ understanding was that this is not everyone’s experience.
Spiritual reappraisal triggered by the mystery of it all
The results and the literature both show how the mystery surrounding bereavement can trigger spiritual reappraisal; for example, of a benevolent God, or the existence of an afterlife. While the grappling, searching, questioning and doubt are transparently part of spiritual reappraisal in grief, what was not acknowledged was either people who experience a negative shift or those whose faith was strongly affirmed. Nevertheless, there can be little doubt that bereavement can be a challenging time of spiritual reappraisal.
Evaluation and reflexivity
This was a time-limited study over a three-month period. All participants were practising counsellors studying at a Christian Institute at master’s level. Clinical experience had been gained within a variety of settings, there was some diversity both in age and the fact that only three participants were of white British origin. However, it is acknowledged that the limited number of participants, all of whom who held a Christian worldview, combined with the restrictions of the pool from which they were drawn and the predominance of female interviewees, may have biased the findings, despite attention being given to the validity and reliability of the research process. All interviewees viewed spirituality in broad terms and were working, or willing to work, with clients of other faiths and none.
The findings support the existing literature, which shows that spirituality can be beneficial in bereavement; but spiritual reappraisal can also be triggered. As there is a dearth of counselling literature on this topic, further research is recommended.
Gill Harvey MA is a therapeutic counsellor, supervisor and trainer working mainly in private practice. She studied, for her MA, at Waverley Abbey College. She is currently a doctoral candidate at the Metanoia Institute. Gill is registered with BACP (Snr Accred) and is particularly interested in the relationship between counselling and spirituality.
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