Laurie A. Burke

Grief Therapy and the Reconstruction of Meaning: From Principles to Practice

Viewed from a constructivist perspective, grieving is a process of reconstructing a world of meaning that has been challenged by loss. Although most people successfully navigate bereavement and retain or return to pre-loss levels of functioning, a significant proportion struggle with protracted grief, and are unable to find meaning in the wake of an unsought transition. For these individuals, constructivist therapists have a number of strategies at their disposal that foster meaning making and help clients reestablish a coherent self-narrative that integrates the loss, while also permitting their life story to move forward along new lines. After reviewing theory and evidence that scaffolds this constructivist conceptualization, this article draws on excerpts of therapy with two bereaved clients to illustrate how narrative retelling, therapeutic writing, a focus on metaphorical language, and the use of visualization can all be viable strategies in helping individuals reconstruct meaning in the wake of bereavement.

African American Homicide Bereavement: Aspects of Social Support That Predict Complicated Grief, PTSD, and Depression

Psychological adaptation following homicide loss is challenged not only by the violent nature of the death itself but also by the bereaveds relationships with would-be supporters. Recruiting a sample of 54 African-American homicidally bereaved individuals, we examined perceived and actual support, the size of the support network, family- versus non-family support, and number of negative relationships to gauge the role of social support in bereavement outcomes such as complicated grief, PTSD, and depression. Results of quantitative assessments revealed that size of available network, quantity of negative relationships, and levels of grief-specific support were correlated with bereavement outcome. Clinical implications and suggestions for future research on the role of social support in adaptation of African Americans to traumatic loss are discussed.

Faith in the Wake of Homicide: Religious Coping and Bereavement Distress in an African American Sample

Mourners often rely on faith following loss, but not all find spirituality comforting. Some grievers engage in negative religious coping (NRC), signaled by behaviors and thoughts such as anger toward God or their faith community, feeling spiritually abandoned, or questioning Gods power. Our longitudinal study of 46 African American homicide survivors explored the relation of both positive religious coping (PRC) and NRC to complicated grief (CG) and investigated whether religious coping more strongly predicted psychological distress or vice versa. Results indicated that NRC was associated with CG, whereas PRC was substantially unrelated to bereavement outcome. Significantly, CG prospectively predicted high levels of spiritual struggle 6 months later, both in terms of CG and NRC composite scores and at the individual-item level. Clinical implications regarding spiritually sensitive interventions are noted.

Inventory of Complicated Spiritual Grief: Development and Validation of a New Measure

Although spirituality often has been associated with better outcomes following bereavement, it can be significantly challenged by loss as well. Studies have shown that some bereaved individuals suffer profoundly not only in relation to the death of their loved one but also in their relationship with God and their faith community, a condition known as complicated spiritual grief (CSG). However, to date, in the absence of a simple, multidimensional, and well-validated measure of spiritual crisis following loss, investigators have measured CSG with nongrief-specific instruments. In this study, the authors tested the reliability and validity of a newly developed measure of CSG, called the Inventory of Complicated Spiritual Grief (ICSG). With 2 diverse samples of bereaved adult Christians (total n = 304), the authors found that the ICSG had strong internal consistency, and high test-retest reliability for both subscales in a subsample of participants. Analyses of both samples supported a 2-factor model, with one factor measuring Insecurity with God and the other assessing Disruption in Religious Practice. Analyses further supported the convergent and incremental validity of the 18-item ICSG relative to other theoretically similar instruments and measures of poor bereavement outcome, suggesting its usefulness in clinical research and practice.

Responses to Loss and Health Functioning Among Homicidally Bereaved African Americans

This investigation of homicidally bereaved African Americans (N = 47) aimed to describe changes in levels of posttraumatic stress disorder (PTSD), depression and complicated grief (CG), and physical and mental health functioning over a 6-month interval. Results showed a significant decrease in depressive and CG symptoms over time, but no significant changes in PTSD symptoms or health functioning. We also found no significant, synchronous relations between any form of bereavement distress and physical health. Depression was related to functional mental health such that a temporal increase in depression was associated with a decrease in mental health functioning. Research and clinical implications are discussed.

Risk Factors for Anticipatory Grief in Family Members of Terminally Ill Veterans Receiving Palliative Care Services

Anticipatory grief is the process associated with grieving the loss of loved ones in advance of their inevitable death. Because anticipatory grief has been associated with a variety of outcomes, risk factors for this condition deserve closer consideration. Fifty-seven family members of terminally ill, hospice-eligible veterans receiving palliative care services completed measures assessing psychosocial factors and conditions. Elevated anticipatory grief was found in families characterized by relational dependency, lower education, and poor grief-specific support, who also experienced discomfort with closeness and intimacy, neuroticism, spiritual crisis, and an inability to make sense of the loss. Thus, in this sample, anticipatory grief appears to be part of a cluster of factors and associated distress that call for early monitoring and possible intervention.

Domains of Social Support That Predict Bereavement Distress Following Homicide Loss Assessing Need and Satisfaction

Psychological adaptation following homicide loss can prove more challenging for grievers than other types of losses. Although social support can be beneficial in bereavement, research is mixed in terms of identifying whether it serves as a buffer to distress following traumatic loss. In particular, studies have not parsed out specific domains of social support that best predict positive bereavement outcomes. Recruiting a sample of 47 African Americans bereaved by homicide, we examined six types of social support along with the griever’s perceived need for or satisfaction with each and analyzed them in relation to depression, anxiety, complicated grief, and posttraumatic stress disorder outcomes. Results of multivariate analyses revealed that the griever’s level of satisfaction with physical assistance at the initial assessment best predicted lower levels of depression, anxiety, and posttraumatic stress disorder levels 6 months later, while less need for physical assistance predicted lower complicated grief at follow-up. Clinical implications and suggestions for future research are discussed.

Disenfranchised grief following African American Homicide loss: an inductive case study.

Disenfranchised grief is experienced when a mourner’s grief response is socially invalidated, unacknowledged, or discouraged. When the circumstances of death or the emotional reactions of the griever violate social norms, empathic failures can occur within the bereaved individual’s support systems. This study used conventional content analysis, an intensive and inductive qualitative research method, to analyze the experience of one African American woman who lost her only son to homicide, a particularly distressing and marginalized form of loss. Results elucidate both the empathic failings and resiliencies within the social systems of this griever and emerged from the perspectives offered by the bereaved mother and her primary supporter. Clinical implications and suggestions for future research are discussed.

Prospective Risk Factors for Intense Grief in Family Members of Veterans Who Died of Terminal Illness

Many bereavement researchers focus on predicting and preventing complicated grief, a psychologically crippling, sometimes life-threatening response to loss that persists for lengthy periods, often with serious health consequences. Reviews of studies have identified specific risk factors (e.g., low social support, insecure attachment style) that predict high levels of complicated grief symptomatology. However, studies rarely investigate multiple risk factors in combination, and still more rarely trace factors observable during the end-of-life period and their predictive power for identifying intense grief in family members following the death. We therefore investigated several pre-loss risk factors for post-loss bereavement distress in 35 family members of Veterans who died of a terminal illness after receiving palliative care. Results revealed that being female, Caucasian, losing a spouse, and experiencing high anticipatory grief prior to the death, all predicted high levels of grief 6 to 10 weeks following the death. Moreover, psychosocial factors such as being highly dependent upon the Veteran, displaying high neuroticism, reporting low levels of social support, and being unable to make sense of the prognosis or death predicted more intense post-loss grief reactions.

Comfort Following Loss: Using the Psalms as a Balm

Dee Brestin is a writer, speaker, and teacher who has written 20 Bible studies and several books, one of which, The Friendships of Women, has sold over a million copies. She has a weekly radio program on Moody Radio and speaks to twenty large women’s conferences each year. Dee is a graduate of Northwestern University and has studied with Covenant Seminary in St. Louis, Missouri. She lives in Wisconsin and is the mother of six grown children. Laurie A. Burke is a clinical psychology Ph.D. student at the University of Memphis. Her program of research surrounds various aspects of complicated grief, including the social and spiritual experiences of the bereaved. She is the Project Coordinator for Project BRAVEHearts, a study examining how African Americans who are bereaved by the homicide of a family member respond to traumatic loss, and Project INSPIRIT, a study exploring spiritual struggles following loss.