Counting Our Losses: Reflecting on Change, Loss, and Transition in Everyday Life

Counting Our Losses THE SERIES IN DEATH, DYING, AND BEREAVEMENT ROBERT NEIMEYER, CONSULTING EDITOR Beder—Voices of Bereavement: A Casebook for Grief Counselors Berger—Music of the Soul: Composing Life Out of Loss Buckle & Fleming—Parenting After the Death of a Child: A Practitioner’s Guide Davies—Shadows in the Sun: The Experiences of Sibling Bereavement in Childhood Doka & Martin—Grieving Beyond Gender: Understanding the Ways Men and Women Mourn, Revised Edition Harris—Counting Our Losses: Reflecting on Change, Loss, and Transition in Everyday Life Harvey—Perspectives on Loss: A Sourcebook Katz & Johnson—When Professionals Weep: Emotional and Countertransference Responses in Endof-Life Care Klass—The Spiritual Lives of Bereaved Parents Jeffreys—Helping Grieving People – When Tears Are Not Enough: A Handbook for Care Providers Jordan & McInotsh—Grief After Suicide: Understanding the Consequences and Caring for the Survivors Leenaars—Lives and Deaths: Selections From the Works of Edwin S Shneidman Leong & Leach—Suicide Among Racial and Ethnic Minority Groups: Theory, Research, and Practice Lester—Katie’s Diary: Unlocking the Mystery of a Suicide Martin, Doka—Men Don’t Cry…Women Do: Transcending Gender Stereotypes of Grief Nord—Multiple AIDS-Related Loss: A Handbook for Understanding and Surviving a Perpetual Fall Roos—Chronic Sorrow: A Living Loss Rogers—The Art of Grief: The Use of Expressive Arts in a Grief Support Group Rosenblatt—Parent Grief: Narratives of Loss and Relationship Rosenblatt & Wallace—African-American Grief Tedeschi & Calhoun—Helping Bereaved Parents: A Clinician’s Guide Silverman—Widow to Widow, Second Edition Werth—Contemporary Perspectives on Rational Suicide Werth & Blevins—Decision Making Near the End of Life: Issues, Developments, and Future Directions FORMERLY THE SERIES IN DEATH EDUCATION, AGING, AND HEALTH CARE HANNELORE WASS, CONSULTING EDITOR Bard—Medical Ethics in Practice Benoliel—Death Education for the Health Professional Bertman—Facing Death: Images, Insights, and Interventions Brammer—How to Cope With Life Transitions: The Challenge of Personal Change Cleiren—Bereavement and Adaptation: A Comparative Study of the Aftermath of Death Corless, Pittman-Lindeman—AIDS: Principles, Practices, and Politics, Abridged Edition Corless, Pittman-Lindeman—AIDS: Principles, Practices, and Politics, Reference Edition Curran—Adolescent Suicidal Behavior Davidson—The Hospice: Development and Administration, Second Edition Davidson, Linnolla—Risk Factors in Youth Suicide Degner, Beaton—Life-Death Decisions in Health Care Doka—AIDS, Fear, and Society: Challenging the Dreaded Disease Doty—Communication and Assertion Skills for Older Persons Epting, Neimeyer—Personal Meanings of Death: Applications for Personal Construct Theory to Clinical Practice Haber—Health Care for an Aging Society: Cost-Conscious Community Care and Self-Care Approaches Hughes—Bereavement and Support: Healing in a Group Environment Irish, Lundquist, Nelsen—Ethnic Variations in Dying, Death, and Grief: Diversity in Universality Klass, Silverman, Nickman—Continuing Bonds: New Understanding of Grief Lair—Counseling the Terminally Ill: Sharing the Journey Leenaars, Maltsberger, Neimeyer—Treatment of Suicidal People Leenaars, Wenckstern—Suicide Prevention in Schools Leng—Psychological Care in Old Age Leviton—Horrendous Death, Health, and Well-Being Leviton—Horrendous Death and Health: Toward Action Lindeman, Corby, Downing, Sanborn—Alzheimer’s Day Care: A Basic Guide Lund—Older Bereaved Spouses: Research With Practical Applications Neimeyer—Death Anxiety Handbook: Research, Instrumentation, and Application Papadatou, Papadatos—Children and Death Prunkl, Berry—Death Week: Exploring the Dying Process Ricker, Myers—Retirement Counseling: A Practical Guide for Action Samarel—Caring for Life and Death Sherron, Lumsden—Introduction to Educational Gerontology, Third Edition Stillion—Death and Sexes: An Examination of Differential Longevity Attitudes, Behaviors, and Coping Skills Stillion, McDowell, May—Suicide Across the Life Span—Premature Exits Vachon—Occupational Stress in the Care of the Critically Ill, the Dying, and the Bereaved Wass, Corr—Childhood and Death Wass, Corr—Helping Children Cope With Death: Guidelines and Resource, Second Edition Wass, Corr, Pacholski, Forfar—Death Education II: An Annotated Resource Guide Wass, Neimeyer—Dying: Facing the Facts, Third Edition Weenolsen—Transcendence of Loss Over the Life Span Werth—Rational Suicide? Implications for Mental Health Professionals Counting Our Losses Reflecting on Change, Loss, and Transition in Everyday Life Edited by Darcy L Harris New York London Routledge Taylor & Francis Group 270 Madison Avenue New York, NY 10016 Routledge Taylor & Francis Group 27 Church Road Hove, East Sussex BN3 2FA © 2011 by Taylor and Francis Group, LLC Routledge is an imprint of Taylor & Francis Group, an Informa business This edition published in the Taylor & Francis e-Library, 2011 To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk International Standard Book Number: 978-0-415-87528-8 (Hardback) 978-0-415-87529-5 (Paperback) For permission to photocopy or use material electronically from this work, please access www copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400 CCC is a not-for-profit organization that provides licenses and registration for a variety of users For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe Library of Congress Cataloging‑in‑Publication Data Counting our losses : reflecting on change, loss, and transition in everyday life / [edited by] Darcy Harris p cm (Series in death, dying, and bereavement) Includes bibliographical references and index ISBN 978-0-415-87528-8 (hbk : alk paper) ISBN 978-0-415-87529-5 (pbk : alk paper) Loss (Psychology) Adjustment (Psychology) Change (Psychology) I Harris, Darcy II Title III Series BF575.D35C68 2010 155.9’3 dc22 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the Routledge Web site at http://www.routledgementalhealth.com ISBN 0-203-86073-X Master e-book ISBN 2010031851 For Brad and Lauren Contents Series Editor’s Foreword Acknowledgments Introduction About the Editor About the Contributors Grief From a Broader Perspective: Nonfinite Loss, Ambiguous Loss, and Chronic Sorrow xiii xv xvii xxv xxvii Darcy L Harris and Eunice Gorman The Social Context of Loss and Grief 15 Darcy L Harris Section I  Loss of the View of the World or Others Section IA  Loss of Safety and Security Are You Safe? Understanding the Loss of Safety for Women and Children Who Experience Abuse 29 Susan Abercromby Traumatic Events and Mass Disasters in the Public Sphere 37 M Thérèse Modesto Vicarious Trauma and Professional Caregiver Stress: Occupational Hazards or Powerful Teachers? 47 Eunice Gorman ix 23 Concluding Thoughts Darcy L Harris W hen thinking about the experiences that would be represented in this book as examples of nondeath and nonfinite losses, it was apparent that this could, indeed, become a very large project In fact, when I described the subject matter of this book, I encountered many individuals who asked if they could share their loss experiences with me In reading through these chapters, it is apparent that loss is a frequent companion to life, and letting go is something that we must learn, even as we attempt to hold on tighter to what we know, value, and love We lose those that we love through normal milestones, transitions, relational change and dissolution, distance, and death We can lose objects that we value and bestow with meaning We can lose a sense of connection to our community, our country, and our beliefs We can even lose ourselves The language of loss, expressed in the stories, associated feelings, and outgrowth of these experiences, makes up a large part of our human experience, albeit often unacknowledged as such Each of the chapters of this book offers insight into loss experiences that not result from a death per se and that may be ongoing in nature These events often result in profound grief, which is the adaptive process whereby individuals begin to rebuild their assumptive world after such experiences This rebuilding process may involve adaptation, accommodation, or integration into a new way of living and being It is important to recognize the significance of these experiences and to keep in mind the adaptive aspects of grief rather than pathologizing this response due to the influence of result of rigid social norms that focus on narrowly defined rules As a clinician, I often identify aspects of my clients’ nondeath loss experiences within the context of various theories of bereavement that are widely known and accepted I have framed my clients’ experiences in different ways, depending on the aspects of the process that they share with me For example, the dual process model of grief, which was posited by Stroebe and Schut (1999), describes the 247 248 Counting Our Losses grieving process as one in which bereaved individuals oscillate between focusing on the loss and then changing the focus to the restorative activities of daily life and then back to the loss again This theory is readily applicable to nondeath losses An example of the application in a nondeath context would be with individuals who are struggling with the loss of an intimate relationship, in which there are times when they feel deep grief and pain at the loss of this relationship and what happened to cause it to end and at other times may focus on learning new skills and interests, seeking new relationships, and redefining themselves as single again Further to the dual process model, it is possible to identify where attachment theory comes into play in experiences that involve change, loss, and significant transition As indicated in the introduction to this book, attachment is often identified as a key element in grief, and the attachment model provides an ethological element to the grieving process In his research, Bowlby (1988) found similar behaviors in young children when they were separated from their mothers that were present in primate studies involving separation Parkes (1996) expanded Bowlby’s work into the area of adult bereavement, suggesting that the attachment system, and the resulting grief when that system is threatened by separation, is an extension of a process that has evolved over time to optimize feelings of safety and to enhance the chances for survival of the individual If grief and attachment are thus interrelated, then to what are we attached when we grieve a nondeath loss, such as loss of a sense of safety, or loss of our homeland, or loss of employment? It could be that these defining, overarching losses involve either the loss of an aspect of ourselves to which we are attached or to our place in the world, which makes us feel safe and secure For example, it would be common for immigrants to a new country to yearn for their family and friends who are still present in their homeland, to search for what is familiar in their new environment, and to look for commonalities with their known culture in the new country of their arrival The well-known term comfort food implies that identification with foods that are associated with our family and cultural roots provides a sense of comfort when we are stressed or in unfamiliar territory In another example, individuals who have lost their jobs may pine for their old lives or self to return to them, reminiscing about what they used to or who they used to be The disequilibrium that results from these types of losses can activate the attachment system, motivating us to draw us closer to what is familiar and safe, and the grieving process enables us to adapt to some part of ourselves or our lives that is markedly different from what it was before As discussed in the introduction, Janoff-Bulman (1992) draws a connection between one’s assumptive world and one’s attachment system, stating that how one relates to and views the world, others, and oneself is an extension of the attachment system that is formed at a very young age Thus, it would make sense that threats to the assumptive world resonate back to the attachment system on which that world was built Stroebe (2002) describes how various attachment styles may shape the grieving process in ways that are congruent with individuals’ previous ways of relating to the world and other individuals Yalom (2009) alludes to the therapeutic encounter as a microcosm of clients’ ways of interacting with individuals in their world In my clinical practice, I frequently see glimpses of clients’ attachment styles from their Concluding Thoughts interactions with me and descriptions of their interactions with others How these individuals process their loss experience is often consistent with how they form their close relationships and how they interact with others, which is an extension of their attachment style I can identify many different normative responses to loss, as there are many different patterns of attachment and ways of being in the world as a result Being informed by such insight and research in this area may help clinicians to normalize the diverse responses and processes of clients who are facing nondeath and nonfinite losses, even though this theorizing was initially based on grief after the death of a loved one Doka’s (1989, 2002) concept of disenfranchised grief is highly applicable to the exploration of nondeath losses, as the lack of recognition of the losses leads to a tendency to deny their potential significance or to not recognize the degree to which these losses can affect an individual In most of the experiences included in this book, there is often a social message of so what? that accompanies the experience or a sense of just get over it and get on with your life that many individuals feel when these losses are encountered It is hoped that, in offering these descriptive chapters, there will be a greater awareness of the significance of these experiences and a heightened sensitivity to individuals facing these types of losses There are obvious differences between death-related and nondeath losses, which are readily highlighted by Boss’s (1999) descriptions of ambiguous loss and Roos’s (2002) elaboration of the concept of chronic sorrow In situations of ambiguous loss or nonfinite loss, typically there are no socially accepted rituals that would give acknowledgment or credence to the experience of an individual in the way a funeral might provide for a bereaved individual The absence of a body does not mean the absence of grief; however, in the absence of an overt or outward manifestation of the loss, the level of social recognition and support is often minimal or absent The example given in the discussion of ambiguous loss relates the grief of a wife whose husband is physically present in the home but who is emotionally absent through his continued distraction and unavailability to her when he is there Should her husband die in a car accident, much support and concern would be extended to this same woman, yet in both situations she is grieving the loss of her husband’s presence As previously described, most of the current bereavement literature focuses on death-related losses, and many of the measures used in bereavement research are rooted in the identification of “separation distress” from another individual as the primary feature that distinguishes grief from other responses and states, such as posttraumatic stress, depression, and anxiety (Prigerson et al., 1999) Separation distress is characterized by yearning, longing, preoccupation, and searching for the deceased individual (Jacobs, Mazure, & Prigerson, 2000) However, the emphasis of grief being seen primarily as a response to the death of a person does not allow for the possibility of recognizing grief as the same adaptive process that allows individuals to integrate significant losses that are perhaps not as tangible In reflecting on this aspect of bereavement theory and research, I believe we need to consider the possibility that the separation distress resulting from the death of a loved one is only one manifestation of the broader picture of loss and grief, which encompasses the distress that occurs when individuals’ existing assumptive world is lost due to 249 250 Counting Our Losses a significant life-changing event, or what Tedeschi and Calhoun (2004) refer to as a “seismic” life event Indeed, Bowlby’s (1977; 1988) descriptions of yearning, pining, longing, and searching (which are all considered hallmarks of separation distress over the loss of a significant attachment figure) could be recognized in the responses to many of the nondeath loss experiences described in this book As stated in the introduction and the chapter on meaning making and the assumptive world, these life-changing events can cause us to feel deeply vulnerable and unsafe, as the world we once knew, the people we relied on, and the images and perceptions of ourselves are no longer relevant in light of what we have now experienced As a process that helps us to rebuild our assumptive world after it has been shattered, grief is both adaptive and necessary It would certainly follow that the process of making meaning, which is now seen as very much a part of the grief response, is applicable to both death-related and non-death-related losses I hope to see research in the future that addresses the process of grief after the experience of nondeath and nonfinite losses, as there are presently very few studies that explore grief after such events and very few measures that would be appropriate to nondeath loss events Finally, this book has been an exploration of the innate resilience that can be found in the human spirit Each of the descriptive chapters explores a loss experience that can be felt as initially overwhelming, and even devastating, but that still has great potential for increasing awareness, growth, and depth in those who integrate these experiences into the fabric of their lives May we, and those we accompany on their life’s journey, be continually reminded that in the midst of our grief and painful life experiences there is often much to be discovered that we could not have possibly imagined in our previous way of being References Boss, P (1999) Ambiguous loss Cambridge, MA: Harvard University Press Bowlby, J (1977) The making and breaking of affectional bonds British Journal of Psychotherapy, 130, 421–431 Bowlby, J (1988) A secure base: Parent-child attachment and healthy human development New York: Basic Books Doka, K J (1989) Disenfranchised grief: Recognizing hidden sorrow Lexington, MA: Lexington Books Doka, K J (2002) Disenfranchised grief: New directions, challenges, and strategies for practice Champaign, IL: Research Press Jacobs, S., Mazure, C., & Prigerson, H (2000) Diagnostic criteria for traumatic grief Death Studies, 24, 185–199 Janoff-Bulman, R (1992) Shattered assumptions: Towards a new psychology of trauma New York: Free Press Parkes, C.M (1996) Bereavement: Studies of grief in adult life London: Routledge Prigerson, H G., Shear, M K., Jacobs, S.C., Reynolds, C.F., Maciejewski, P.K., Davidson, J.R., et al (1999) Consensus criteria for traumatic grief: A preliminary empirical test British Journal of Psychiatry, 174, 67–73 Roos, S (2002) Chronic sorrow: A living loss New York: Brunner-Routledge Concluding Thoughts Stroebe, M (2002) Paving the way: From early attachment theory to contemporary bereavement research Mortality, 7(2), 127–138 Stroebe, M., & Schut, H (1999) The dual process model of coping with bereavement: Rationale and description Death Studies, 23(3), 197–224 Tedeschl, R.G., & Calhoun, L.G (2004) Posttraumatic growth: Conceptual foundations and empirical evidence Psychological Inquiry, 15, 1–18 Yalom, I (2009) The gift of therapy New York: Harper Collins 251 Index A Abandonment issues adoptees and, 83 maternal neglect, 143–150 Abercromby, S., 25, 29 Abuse survivors, 29–34, See also Safety loss for abuse survivors Accommodation, xviii, 2, 3, 65, 212, 240, 244, 247 Acculturation, 152, 154, 156 Adaptation, posttraumatic growth and resilience, See Posttraumatic growth (PTG) and resilience Adaptation to brain injury-related functional impairments, 211–212 Addiction, 6, 121, 144, 200 Adoption and loss, 75–88 adopted children’s psychological/emotional issues, 81–86 an adoptee’s personal reflections, 77–81 adoptive parents, 76–77 biological family search and reunion, 80–81, 82, 85–86 birth-origin fantasies, 82–83 identity issues, 84 suggested resources, 89–91 therapeutic interventions, 86–87 triad of grief, 75 Advocacy, 16, 22–23 Aging-related losses, See Older adults Ainsworth, M., 98 Ambiguous loss, 5–7, 249 therapeutic implications, 7–10 Andersen, S H., 166 Arnold, E W., 172 Art therapy, 158 ASK method, 231 Assimilation, xviii, 240, 244 Assumptions categories of, xviii letting go of, 10 meaning making and, 240–243 Assumptive world, xvii–xviii attachment and, 244, 248–249 caregiver turnover and, 109 disaster and critical incident effects, 37 meaning making and, 239–244 repeated assaults on, 244 shattering of, xix, 39, 240–241, 244 types of disaster and safety worldviews, 39–43 unemployment and, 167–168 Attachment, 16, 244, 248 adoption issues, 83 assumptive world and, 244, 248–249 intimate partner relationships, 69 postparental transition and, 98 working models, xvii Attig, T A., xviii, 117, 119, 190, 242, 243 Autonomy in decision making, 219 Avoidance-confrontation model of coping with grief, 241, 244, 247–248 B Baltes, M., 217 Baltes, P., 217 Baram, D., 172 Barron, S., 18 Beauty, search for, 130 Beck, E., Becker, E., 127 Benefit finding, 106 in chronic illness and disability, 201–202 posttraumatic growth, 227–228 Benefits in helping roles, 54 Benevolent world assumptions, xviii Bereavement and social expectations, 19–20 Bereavement counseling and identity conceptions, 186–187 Berg, M., 175 Birth-origin fantasies, 82–83 Blame, self-, 144, 146, 242 Blame and marriage failure, 66 Blaming the victim, 200, 241 Blau, G., 167 Body awareness exercise, 128 Bookends, 32 Boss, P., 5–7 Bowlby, J., xvii, 69, 98, 248, 250 Brain injury, See Traumatic brain injury Bredow, T S., Brewington, J O., 167 Bruce, F J., Bubble blowing, 33 Burgard, S A., 166 Burke, M I., Burnout, 47–48, 52–53, 56, See also Professional caregiver stress Burns, L H., 172, 177 Butterfly hug, 33 C Calhoun, L G., 240, 243, 250 Campbell, L H., 85 Capitalist society, 18–19 253 254 Index Career counselor training, 164 Caregiver consistency and infertility treatment, 177 Caregivers and chronic sorrow, Caregiver stress, professional caregivers, See Professional caregiver stress Caregiver training, 204 Caregiver turnover in transitional communities, 103–115, See also Transitional communities cultural norms, 109–110 dimensions of grief moderation, 110–114 L’Arche as a salient case, 106–107, See also L’Arche community caregiver turnover staff turnover and grief, 105–109 Care-giving organizations, 57 Celebrations, 82, 87, 94, See also Rituals of departure, 112–114 Cherokee, 43 Child neglect effects, 143–150 Children’s coping mechanisms, 31 Chronic illness, 195–205, See also Disabilities assessment and things to consider, 203 associated losses, 199 becoming a “patient,” 199–200 benefit finding, 201–202 chronic sorrow and, clinical considerations, 203–205 complexity in, 196–197 key terms, 195–196 loss narrative, 201 normality and stigma, 200–201 support issues, 203–204 systemic changes, 204–205 trajectory framework and stages, 197 uncertainty, 198–199 Chronic loss and identity, 154 Chronic sorrow, 3–5, 249 Church community, loss of, 133–137 Clayton, K., 187 Client-professional relationship, safety in, 33 Clinical language and jargon, 21 Cognitive conservatism, xix Cognitive psychotherapy, 186 Comfort food, 248 Coming out, 183–190 Comino, E J., 166 Communication defects, 210 Community care setting, caregiver turnover in, See L’Arche community caregiver turnover Community-related factors supporting resilience, 228 Compassion fatigue, 48–49 Compassion satisfaction, 54 Complexity in illness, 196–197 Compulsive behaviors, 19 Constructivist psychology, 239 Contextualization of loss, 168 Continuing bonds theory of bereavement, 65 Control adoptee helplessness perceptions, 85 chronic illness and, 198–199, 203, 204 locus of, xviii managing fear of death, 129 mastery, 217 older people and, 217–218 posttraumatic growth and resilience, 232 unemployment and, 169 Coombs, A., 55 Cooper, R., 76 Corbin, J M., 197 Core aspects of life, 165 Cott, C., 215–216 Coventry blitz bombings, 40 Covington, S N., 177 Crawford, R., 231 Crisis as opportunity, 226 Critical incidents, See Disasters and critical incidents Crowley, B., 98 Cultural/ethnic identity issues, 151–160 culture and identity, 152–153 finding balance in juggling cultures, 157–158 identity and chronic loss, 154 identity and grief, 155 language and identity, 154 Culture and postparental transition, 97–98 Currier, J M., xix Cushing, P., 26, 103 D Daniluk, J C., 176, 178 Daudet, A., 202 Davidson, J., 197 Davis, 243 Davis, C G., 242 Death anxiety management, 127–131 body awareness exercise, 128 control, 129 loss of self and other, 129–130 search for beauty and meaning, 130 the unknown, 128–129 Death versus divorce, 70–71 Decision-making autonomy, 219 Deep-breathing exercises, 33 Degenerative disease and loss, 195–205, See also Chronic illness Deinstitutionalization of marriage, 68 Delp, K J., Denial and brain injury-related impairment, 212 Dependency, 215–216, 219 Depreciation, posttraumatic, 229–230 Index Depression infertility treatment and, 172 unemployment and, 165–167 Developmental disabilities, 3, 103 Developmental milestone celebrations, 82, 87, 94, 112 Developmental milestones and loss, 93–94, 174, 196, See also Postparental transition Diagnostic labels, 21 Dignity and chronic illness or disability, 204 Dignity and existential suffering, 124 Dillon, P., 71 Disabilities, See also Chronic illness; Persons with intellectual disabilities benefit finding, 201–202 brain injury-related, 209–214 existential suffering and, 121 key terms, 195–196 loss narrative, 201 normality and stigma, 200–201 parents of children with, Disaster amnesia, 41 Disasters and critical incidents, 37–44 assumptive world changes, 37 existential suffering and, 122 research limitations, 38–39 security and safety assumptive worldviews, 39–43 “victim” versus survivor terminology, 38 Disease, defined, 196 Disenfranchised grief, 184–186, 244, 249 Divorce- or separation-related loss, 65–73, See also Intimate relationship loss Divorce statistics, 66 Doka, K., 197, 240, 243, 249 Dolan, Y., 232 Domar, A D., 172 Domestic violence survivors, 29–34, See also Safety loss for abuse survivors Dostoyevsky, F., 129 Dual process model of grief, 241, 244, 247–248 “Dumb Polacks,” 153 Dunning, W., 187 E Edward, K L., 56 Ego illusions and existential suffering, 122–123 Ellis, K., 198 Emergency service personnel, 42, See also Professional caregiver stress vicarious trauma, 49 Emery, R E., 71 Emotional labor, 49–50 Emotions, identifying and validating, Empathy, 15, 157 Employment loss, 163–169, See also Unemployment Empowerment, 21, 22, 218 Empty nest transition, See Postparental transition Eriksen, K., 173 Erikson, E., xviii Errera, Y., 39 Existential suffering, 119–125 alternative approaches to, 124–125 defining, 120 dignity and, 124 integrity and, 122–124 meaning making, 242 occasions for, 120–122 F Faith community loss, 133–137 Family law, 73 Family life cycle, See Postparental transition Family resilience, 228 Family systems theory, xviii, 188–189 Family values rhetoric, 67 Fassinger, R., 183 Financial losses intimate relationship loss and, 72 unemployment, 163 First responders, 42 Flach, F., 229, 230 Folkman, S., xviii Forced emigration, 43 Fostering hope, 204 Fowler, James, 136 Frankl, V., 44, 124, 216, 242 Freud, S., 186 Freudenberger, H J., 48 Friedman, R., 172 Frost, D., 183, 185 Functional impairments age-related, 215–220, See also Aging-related losses brain injury, 209–214, See also Traumatic brain injury G Garner, C H., 172, 174 Gary, R., 216 Gender and postparental transition, 95–97 Gender socialization and bereavement, 20 Gignac, M., 215–216 Goals, realistic, God’s will, 117 Goffman, E., 201 Goldman, L., 229 Gorman, E., 1, 25, 26, 47, 93, 140, 195, 225 Grandin, T., 18 255 256 Index Gray, H., 172 Grief, disenfranchised, 184–186, 244, 249 Grief and adoption, 83 Grief and attachment, See Attachment Grief and identity, 155 Grief and loss, social context of, See Social contexts Grief and unemployment, 165–167 Grief Experience Inventory, 167 Grieving loss of faith community, 135–136 Grieving process, dual process model, 241, 244, 247–248 inappropriateness of time frame, 10 meaning making, 239, 242 stages of grief, 167 Grounding technique, 33 Group homes for persons with intellectual disabilities, See L’Arche community caregiver turnover Group work mezzo practice, 16 older adults and, 219–220 safety issues, 32–34 Growth and loss, 9, 225–234, 243, See also Benefit finding; Posttraumatic growth (PTG) and resilience Guilt adoptees and, 79, 81, 83, 84, 85 intimate relationship loss and, 67, 73 maternal neglect survivor case study, 145–149 Guzlowski, John, 153 H Hagemeyer, S., 70 Handicap, defined, 196 Hardison, H., xix Harris, D L., 1, 15, 65, 163, 171, 239, 247 Hartling, L., 232 Harvey, D., 117, 133 Harvey, J H., xvi–xvii Hatzenbuehler, M., 183 Hayslip, B., 98 Health-care professional training, 204 Health insurance coverage loss, 165 Health issues complexity in illness, 196–197 degenerative disease and loss, 195–205, See also Chronic illness infertility, See Infertility and infertility treatment influenza pandemic, 41 traumatic brain injury, 209–214 unemployment, 165–167 Helgeson, V S., 202 Helplessness issues for adoptees, 85 Helplessness perceptions and infertility treatment, 173 Hemingway, E., 225 Heterosexual privilege loss, 184–190 Hierarchy of needs, 33 Hipolito-Delgado, C P., 20 HIV diagnosis, 226 Hobdy, J Y., 98 Hoffman, E., 158 Hoggman, E., 154 Homophobia, internalized, 183, 185 Honoring strengths, 10 Hoopes, J L., 87 Hope, fostering or supporting, 204, 230 Hopelessness and brain injury-related impairment, 211–212 Howell, E., 187 Huang, K., 172 Humphrey, G M., 105 Hunter, B., 117, 127 Hurley, D., 229 Hurwitz, N., 174 I Identity adoption issues, 84 bereavement counseling theory, 186–187 chronic loss and, 154 coming out and sexual orientation issues, 183–190 culture and, 152–153 grief and, 155 infertility and, 171 intimate relationship loss and, 72 language and, 154 migration-associated loss and reconstruction, 151–160, See also Cultural/ethnic identity issues older adults and reconceiving of, 217 personal story telling and, 158 postparental transition and, 95–96 power relations and, 17 Illness, chronic, See Chronic illness Illness, defined, 196 Immigrant identity issues, 151–160, 248 Impairment, defined, 196 Imperfections and fallibility awareness, 122 Independence issues for older adults, 215–216, 218–219 Infertility and infertility treatment, 171–179 adopted parents and, 76 caregiver consistency, 177 clinical implications and recommendations, 176–178 experience of loss, 174 identity issues, 171 Index lifetime effects, 175–176 psychological effects, 172–174 therapeutic implications, 9–10 unrecognized losses, 175 Influenza pandemic, 41 Information resources, Integrity and chronic illness and disability, 204 Integrity and existential suffering, 122–124 Internal family systems (IFS) model, 188–189 Internalization of social messages, 19–20 Internalized homophobia, 183 Intervention, micro, mezzo, and macro practice, 16 Intimate partner abuse survivors, 29–34, See also Safety loss for abuse survivors Intimate relationship issues for adoptees, 84 Intimate relationship loss, 65–73 attachment theory, 69 clinical implications, 72–73 divorce versus death, 70–71 dual process model of grief, 248 existential suffering and, 121–122 financial issues, 72 layers of loss, 71–72 social changes and marital relationships, 66–70 support issues, 66 Intrapersonal loss and coming out, 183–190 In vitro fertilization (IVF), 172, 174, 175 Isenor, J., 163 J Janoff-Bulman, R., xix, xvii, xviii, 184, 240–242, 243, 244, 248 Jargon, 21 Job loss, See Unemployment Johansson, M., 175 Johnsonius, J R., Jones, S J., K Kalus, A., 76 Kaminski, P., 98 Kaplan, S., 84 Kashubeck-West, S., 183 Kauffman, J., 33, 139, 143, 186, 187, 189 Kearney, M., 58 Keefer, B., 87 Kierkegaard, S., 127 Kirkman, M., 175 Knowledge and uncertainty, 128–129 Kosminsky, P S., 140, 209 Kübler-Ross, E., 167 L Labels, 21 Langer, K G., 212 Langer, N., 140, 215 Language and identity, 154 L’Arche community caregiver turnover, 103–115 celebrations and rituals, 112–114 cultural norms, 109–110 dimensions of grief moderation, 110–114 landscape of turnover, 107–109 loss and opportunity, 105–106 mentoring model, 111–112 Larson, J., 243 Laurie, A., xix Lazarus, R., xviii Lee, C C., 20 Leon, I G., 84 Lesbian, gay, and bisexual (LGB) identity issues, 183–190 Letting go of time-bound assumptions, 10 Lewis, C S., 120 Lewis, L., 26, 93 Life expectancy for women, 67 Life grief and infertility, 175–176 Life-sharing, 107 Lindgren, C., Locus of control, xviii Loss, 1–3, 247 ambiguous, 5–7 ambiguous or nonfinite, therapeutic implications, 7–10 chronic, and identity, 154 contextualization, 168 definitions of, xvi–xvii general clinical reflections, 243–244 identifying what is not lost, 8–9 nonfinite, 2–3 nonfinite, chronic sorrow and, 3–5 validating experience of, 7, 21, 176–177 “why” questions, 243–244 Loss, social context of, See Social contexts “Loss line” exercise, Loss narrative chronic illness/disability, 201 meaning making, 242 migration, 158 posttraumatic growth and resilience, 231 Loss-of-self and maternal neglect, 143–150 M Maass, V S., xvi–xvii Mack, R., 216 MacMillan, C., 26, 103 Macro practice, 16 Male parenting roles, 96–97 257 258 Index Marital relationships, social changes in, 66–70, See also Intimate relationship loss Marriage failure, 66, 97, See also Intimate relationship loss Martin, T L., 71 Maslow, A., 33 Mass disasters, See Disasters and critical incidents Mastery, 217 Materialism, 130–131 Maternal identity, 171 Maternal neglect, 143–150 Zoe’s grief, 145–150 Maternal role transitions, 95–96 Meaning finding, 243 Meaningful world assumptions, xviii Meaning making, 9, 130, 216–217, 239–244 assumptions and, 240–243 Media influences, 67 Medical terminology, 21 Mehta, T., xix Mental health effects of coming out, 183, 185 Mental illness ambiguous or nonfinite losses, chronic sorrow and, diagnostic terminology, 21 existential suffering, 121–122 film resources, normality and stigma, 200–201 positive aspects of loss, 106 psychological absence, Mentoring, 111–112 Meyer, I., 183, 185 Meyer, J., 183 Mezzo practice, 16–17 Micro practice, 16–17 Migration-associated loss, 43, 151–160 Milestone celebrations, 82, 87, 94, 112 Miller-Havens, S., 82 Miscarriage, 76 Mishel, M H., 198 Missing persons, 5–6 Modesto, M T., 25, 37 Mohr, J., 183 Moradi, B., 183 Moral and ethical workplaces, 57 Moran, R A., 86 Mortality awareness and existential suffering, 120–121, See also Existential suffering Mothers Against Drunk Driving (MADD), 22 Movie therapy, Muechler, E., 172 N Narrative therapy, 158 Native American forced emigration, 43 Natural disasters, 37–44, See also Disasters and critical incidents Needs hierarchy, 33 Neglect effects, 143–150 Zoe’s grief, 145–150 Neimeyer, R A., xix, 239, 242 New York emergency service personnel, 42 Nickman, S L., 81–82, 87 Nolen-Hoeksma, S., 242, 243 Nonfinite loss, 2–3, See also Loss ambiguous loss and, chronic sorrow and, 3–5 therapeutic implications, 7–10, 21 Normality versus chronic illness/disability, 200–201 North, G., 48 Nosek, M A., 201–202 Nouwen, H., 114 Nursing Consortium for Research on Chronic Sorrow, O Obama, B., 15 Object relations theory, 143, 187 Older adults, 215–220 clinical recommendations, 216–220 control issues, 217–218 group services, 219–220 independence and dependency issues, 215–216, 218–219 reconceiving identity, 217 search for meaning, 216–217 support issues, 218–219 Olshansky, S., Ongoing losses and meaning making, 239–244 Oppression, 19–20 transcending through social action, 22–23 Orientation groups, 111 Osborn, C., 211–213 P Papadaton, D., 56 Parents of children with developmental disabilities, Parkes, C M., xvii–xviii, 248 Paternal role transitions, 96–97 Patriarchy, 18 Pavone, T., 175 Pearlin, L., 217 Pentagon, 42 Personal narrative of loss, See Loss narrative Persons with intellectual disabilities, 103, 107 caregiver turnover and grief, 107–109, See also L’Arche community caregiver turnover Peterson, S J., Index Phoenix phenomenon, 225 Physiological response to stress, 51 Piaget, J., xviii Political change and social change, 16–17 Popular culture and intimate relationships, 70 Porter, E., 216 Positive illusions, 114–115 Postparental transition (empty nest), 94–95 attachment, 98 case study, 99 clinical recommendations, 100–101 culture, 97–98 gender, 95–97 identity issues, 95–96 Posttraumatic depreciation, 229–230 Posttraumatic growth (PTG) and resilience, 225–234 benefit finding, 227–228 clinical considerations, 230–234 meaning making, 243 multiple assaults and, 244 posttraumatic depreciation, 229–230 posttraumatic growth, 227 resilience and protective factors, 228–229 Posttraumatic stress disorder (PTSD), 5, 229–230 Powell, B., 96 Power relations, 17–18 adoption issues, 85 clinical implications, 21 maternal role transitions, 95 oppression, 19 Professional caregiver stress, 47–58 burnout, 47–48 clinical recommendations, 56–57 compassion fatigue, 48–49 emotional labor, 49–50 personal safety, 50–51 physiological responses to stress, 51 positive aspects, 54 signs and symptoms, 52–53 training and preparation for practice, 58 vicarious resilience, 54–55 vicarious trauma, 47, 49 workplace factors, 53 Protective factors, 228–229 Psychological absence, 5–6 Puppets, 33 Q Queer identity and coming out issues, 183–190 R Ramirez, M., III, 185 Rando, T A., xviii Realistic aims, Reality testing, 22 Relearning the world, 242 Religious faith community, 133–137 Reproductive loss, 76, 171, See also Infertility and infertility treatment Resilience, 22, 225, 228–229, 250, See also Posttraumatic growth (PTG) and resilience vicarious benefits for professional caregivers, 54–55 Richardson, G E., 232 Riggs, S., 98 Rituals, 9–10, 33, 87, 94, See also Celebrations of departure, 112–114 posttraumatic growth and resilience, 232–233 Robinson, E., 84 Rogers, D W., 133 Role investment, 95 Roos, S., 4, 5, 249 Rowan, J., 187 Rumi, 130 S Safety, 30–31 client-professional relationship, 33 disaster security and safety assumptive worldviews, 39–43 rituals, 33 therapeutic environment, 32–33 threats for professional caregivers, 50–51 Safety loss for abuse survivors, 29–34 experiential context, 32 social context, 30–31 Safety loss for disaster or critical incident survivors, 37–44, See also Disasters and critical incidents Safety plans, 30, 31, 34 Safety uncertainty and existential suffering, 120–122 Saleebey, D., 218 Salmoni, A., 216 Same-sex intimate relations, 69–70 Samuels, G M., Sartre, J., 242 Sawicki, W., 139, 151, 156 Schachter, J A., 26, 75, 77–81 Schachter, S R., 26, 75 Schemas, xviii Schooler, J., 87 Schultz, C L., Schut, H., 241, 244, 247–248 Schwartz, R., 188–190 Scott, D., 140, 183 Self acculturation and reconstruction of, 156 brain injury and, 209 259 260 Index fear of death and losing, 129–130 internal family systems model, 188–189 maternal neglect and loss of, 143–150 polypsychic model, 187–190 psychoanalytic theory, 187–188 world assumptions, xviii Self-awareness, 56 Self-blame, 144, 146, 242 Self-efficacy, xviii, 203 Self-esteem, 72, 84, 87 Self-soothing, 33 Self-talk, 16, 231 Self-trust, 169 Separation distress, 249 September 11, 2001, attacks, 41–42 Sexually transmitted diseases, 171 Sexual orientation-related identity issues, 183–190 Shalev, A., 39 Shame, 33, 146, 188 ambiguous or nonfinite losses and, 7–8 disenfranchised grief, 184–186, 190 internal family systems model, 188–189 maternal neglect and, 144–150 oppression, 20 postparental transition and, 98 relationship loss and, 70–73 slighting, 143 traumatization, 33 unemployment and, 148–149 Shaming manager, 189–190 Shared living, 107 Shattering of one’s assumptive world, xix, 39, 240–241, 244 Silverstein, D N., 84 Skaff, M., 217 Slight, 143 Social action, 22–23 Social contexts, 15–23 existential suffering and, 122 internalization of social messages, 19–20 intimate relationship loss, 66–70 micro, mezzo, and macro practice, 16 norms and rules, 18–20 power relations, 17–18 safety loss for abuse survivors, 30–31 social awareness in clinical work, 20–23 unemployment, 164–165 Social norms and social rules, 18–20 Social pain theory, xviii–xix Social support, See Support Sontag, S., 37 Spanish flu, 41 Spirituality, loss of faith community, 133–137 Spirituality, search for meaning, 217 Staff turnover and grief, 105–109, See also L’Arche community caregiver turnover; Transitional communities dimensions of grief moderation, 110–114 Stages of grief, 167 Steenbarger, B N., 185 Stein, L M., 87 Stigmatized identity acquisition and intrapersonal loss, 183–190 Stoics, 124 Story telling, 158 Strauss, A., 197 Strengths, 10, 22, 168, 218, 231–232 Stress, physiological responses to, 51 Stress and professional caregivers, See Professional caregiver stress Stroebe, M., 241, 244, 247–248 Stuffed animals, 33 Subjective truths, 119 Suicidal ideation, 172 Suicide, 121 Support, 56–57 chronic illness or disability, 203–204 for infertile women, 176–178 information and resources, non-death intimate partner loss issues, 66 older people and, 218–219 posttraumatic growth and resilience, 232 Survivors of violence and abuse, 29–34 Survivor versus “victim” terminology, 38 Swanson, K., 210 Szymanski, D., 183 T Tedeschi, R G., 240, 243, 250 Teel, C S., Terrorist attacks, 41–42 Terror management theory, 127 Therapeutic environment, safety in, 32–33 Therapist self-awareness, 20 Therapy diary, 145–150 Tomich, P L., 202 Tourtelot, E., 172 Transcendence, 40 Transitional communities, 103–105, See also L’Arche community caregiver turnover landscape of caregiver turnover, 107–109 L’Arche as a salient case, 106–107 loss and opportunity, 105–106 moderating grief due to turnover, 110–114 staff turnover and grief, 105–109 Transvaluation, 42 Trauma of neglect, 143–150 Traumatic brain injury (TBI), 209–214 adaptation and coping, 211–212 clinician’s role, 212 continuing bonds, 212–213 denial, 212 first-person accounts, 210–211 Index meaning of recovery, 213–214 Traumatization and the unnamable shame, 33 Trust issues and unemployment, 169 U Uncertainty ambiguous loss, chronic illness and, 198–199 existential suffering, 120 nonfinite loss, 2, “Relinquishment of Certainty,” 127–131 resilience and tolerance of, 229 terror management, 127 the unknown, 128–129 Unemployment, 163–169, 248 clinical recommendations, 168–169 grief and, 165–167 loss of assumptive world, 167–168 social context, 164–165 Ungar, M., 229 Unknown, the, 128–129 V Validation of emotions, Validation of loss experience, 7, 21, 176–177 Vanier, J., 106–107, 109, 112–113 Vicarious resilience, 54–55 Vicarious trauma, 47, 49 “Victim” versus survivor terminology, 38 Violence and power, 17–18 Viorst, J., xvi Virtual safety maps, 39 Viverais-Dressler, G., 216 W Wainrib, B R., 225 Walsch, N D., 165 Walsh, F., 228 Watson, R I., 172 Weenolsen, P., xv, xvi Weiner, I., 6–7 Weiss, R., 69, 72 Wellness in disability, 201–202 “Why” questions, 243–244 Wierzbicka, A., 154 Wittgenstein, L., 127 Wolin, S., 202 Wolin, S J., 202 Women’s life expectancy, 67 Working models, xvii Working relationship loss, See Staff turnover and grief; Unemployment Workplace factors and caregiver stress, 53, 57, See also Professional caregiver stress Worthington, R., 183 Wounded healers, 9, 53 Y Yalom, I D., 189, 198, 248 York, C., 98 Z Zimpfer, D G., 105 Zoe’s grief, 145–150 Zuttermeister, P., 172 261 [...]... from our reflection Introduction and memory easily In fact, we hang on to them intentionally and memorialize their value in our lives (p 5) In his discussion of the losses that are encountered in everyday life, Harvey (2002) describes the importance of experiences that demonstrate our lack of ability to control our world or exposure to experiences that confront our view of the world and shatter our. .. the self, which is confidently maintained and used as a means of recognizing, planning, and acting” (p 132) and that it is “… the only world we know, and it includes everything we know or think we know It includes our interpretation of the past and our expectations of the future, our plans and our prejudices” (Parkes, 1971, p 103) Parkes (1971) stated that the assumptions that individuals form about... postparental transition (i.e., “the empty nest”) The second descriptive section examines the loss of meaning or a sense of justice in the world Topics in this heading include existential losses pertaining to one’s belief system, the realization of the human condition and existential suffering, the recognition that life has very little certainty, and the loss of one’s faith community as a result of changes in one’s... in the Department of Interdisciplinary Programs at King’s University College at the University of Western Ontario, in London, Ontario, Canada, where she is the coordinator of the thanatology program She also maintains a private clinical practice with a focus on issues related to change, loss, and transition She serves as a consultant for the Southern Ontario Fertility Treatment Program in London, Ontario,... the culmination of many years’ worth of clinical practice and personal reflection Along the way, there have been numerous individuals to whom I owe a great deal of gratitude for how they encouraged me in my thinking and practice regarding nondeath and nondefinite loss First and foremost, I wish to thank the clients in my clinical practice and those who participated in my research for entrusting me with... around us, and how we live in an environment that requires us to adapt and adjust to change on a regular basis In response to the realization of how loss experiences of all types can have an impact on our lives, we introduced a new course in our thanatology program entitled Change, Loss, and Transition The intention of this course is to explore different aspects of loss and the role that loss plays in human... symptomatology, or blandly generalized “stressful life events.” Common to all of these unsought transitions—whether as normative as aging and launching our children or as particular as immigrating or struggling with infertility—is the need to revise our assumptive worlds, and in doing so, to relinquish an aspect of ourselves and a life once familiar or desired The rich description of the many contexts in which... incorporates both loss and its overcoming (p 3) Harvey (2002) discussed the role of emotional investment and attachment in the loss experience, stating that a major loss is … the loss of something in a person’s life in which the person was emotionally invested… By “emotional investment” I mean that we imbue these events with emotional meaning and in reaction to them we behave in ways that reflect the... process of living our lives, we do encounter losses on a regular basis, but we often do not recognize their significance because we tend to think of loss in 1 2 Counting Our Losses finite terms, mainly associated with death and dying, and not in terms of adaptation to life- altering change In the exercise described in the previous paragraph, our students create a “loss line,” where they draw a line on a piece... Woman Abuse in London, Ontario She has worked in the field of violence against women and children for 10 years She offers training and workshops on violence against women and children to audiences including teachers, child protection workers, students, and various community groups both locally and internationally Tom Attig, PhD, applied philosopher, is professor emeritus in philosophy at Bowling Green