In fiction the deaths of characters that people like may be a way to process grief or to understand it

People may cheer the demise of evil villains in fiction, but the deaths we most remember are the meaningful and sad endings of the characters we loved, research suggests.

In a new study, researchers found that when people were asked to recall the death of a fictional character, they were more likely to mention deaths perceived as “meaningful” than those seen as “pleasurable.”

“We remember the deaths that made us cry and think more than those that made us cheer,” said Matthew Grizzard, co-author of the study and assistant professor of communication at The Ohio State University.

“It seems that when we recall death, even in the relatively consequence-free spaces of media entertainment, we experience it as a meaningful, reflective experience.”

Grizzard conducted the research with Kaitlin Fitzgerald, a doctoral student at the University at Buffalo, and C. Joseph Francemone, a doctoral student at Ohio State, both in communication.

The study was published recently in Omega — Journal of Death and Dying.

The study involved 506 people who participated online. They were placed in three groups. One was asked to think of a death scene from a narrative they found particularly meaningful. Another group was asked to think of a death they found pleasurable. The third group was simply asked to think of a death scene from a narrative.

Most people in all groups chose death scenes from visual media, the most common being movies and TV shows. But some chose scenes from video games or comic books.

Participants were asked a variety of questions about their emotional responses to the death scenes, their appreciation and enjoyment of the scenes, and perceptions about the characters who died.

As the researchers expected, people who were asked to recall a character death they found particularly pleasurable tended to choose villains, like Joffrey from “Game of Thrones.”

Those who were asked to recall meaningful deaths tended to go with sympathetic characters, but not necessarily ones who were always heroes. Snape in the “Harry Potter” movies and Walter White in “Breaking Bad” both were mentioned often.

“When asked to think of meaningful deaths, many people chose characters who went through some sort of redemption. For example, Roy Batty, who was the antagonist in most of “Blade Runner,” but in the end has this redeeming action,” Grizzard said. “Darth Vader from “Star Wars” even came up a few times.”

Results showed that action, horror and thriller movies were less likely to be associated with meaningful character deaths and more likely to be linked to pleasurable character deaths.

Dramas and tear-jerkers were more likely to be associated with meaningful character deaths.

Some movie genres — comedy, documentary, romance and science fiction — weren’t linked to one type of character death over another.

But what was notable in the study, Grizzard said, was that those who were just asked to recall any character death most often gave answers like those who were asked to name “meaningful” deaths, rather than those who recalled “pleasurable” deaths.

Grizzard noted that the deaths people were most likely to recall were closely associated with “appreciation” in the study rather than “enjoyment.”

“People recalled deaths that were meaningful, moving and thought-provoking. It provides more confirmation that people don’t consume fiction just for enjoyment,” Grizzard said.

The deaths of characters that people like may be a way to process grief, or to understand it.

“Film and art in general can expose us to these experiences that we may not want to go through, but we know that we will someday. It can help us learn what that experience will be like,” he said.

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Constructivist theories recently have begun to inform understandings of grief, emphasizing the role of meaning making in adaptation to bereavement. In this article we review empirical studies using qualitative, quantitative, and mixed methods, investigating how three activities of meaning reconstruction are involved in the grieving process: sense making, benefit finding, and identity change. In particular, we consider how critical processes have been operationally defined and how study methods and designs have constrained what can be concluded from this burgeoning field of research. We conclude by positing an integrated model of meaning reconstruction pathways as a heuris- tic guide to further research and briefly note the implications of this model for clinical practice.

Victor Frankl’s (1962) seminal work, Man’s Search for Meaning, asserted that people are driven by a psychological need to find or create a sense of meaning and purpose in their lives, and that this drive can facilitate their capacity to face and transcend even the most horrific of experiences. This theme has struck a deep chord not only in psychology, but also in philosophy, art, literature, and

other fields, and has been applied to numerous experiences of human suffering, including the experience of bereavement. Ac- cordingly, research in the areas of grief and loss has begun to examine the ways in which bereaved persons search for meaning in the aftermath of losing loved ones.

Our goal in this article will be to review this literature in order to advance a model of bereavement as an active process of meaning reconstruction in the wake of loss (Neimeyer, 2001a; 2005). We will begin with an introduction to the theories that drive this area of research, each of which posits that reaffirming, finding, or reconstructing meaning helps the bereaved adapt to a changed world, an adaptation that is reflected in social, behav- ioral, psychological, and physiological domains.

We will then turn to the empirical research on meaning- making processes in response to loss. Here, we will examine both qualitative and quantitative research and evaluate the strengths and weaknesses of each. To organize the review, we will consider how bereavement affects the meaning structures or “assumptive worlds” of bereaved people in day-to-day functioning, values and priorities, identity, social and interpersonal relationships, and spiritual, religious, or philosophical views. We will further summarize em- pirical findings concerning three distinct mechanisms through which bereaved individuals have been theorized to engage in processes of meaning reconstruction in response to their loss. These mechanisms, derived from a review of cognitive, trauma, attachment, and constructivist theories, are (a) making sense of the death, (b) finding benefit in the experience, and (c) under- going identity change. Based on this review, we will propose a model of meaning reconstruction pathways in the experience of bereavement as a heuristic guide to further research and clinical practice.

Theories of Meaning Reconstruction

As documented in the early 20th century by Freud (1917/1953), grief may resemble other syndromes such as depression, anxiety, and posttraumatic stress, but often presents additional unique symptoms, which have led some researchers (e.g., Prigerson & Jacobs, 2001; Prigerson & Maciejewski, 2006) to distinguish se- vere responses to bereavement as a distinct disorder. Although

recent research offers clear evidence that many of the bereaved cope in a resilient fashion with their distress, displaying only transitory disruption in their mood and functioning (Bonanno, 2004), the distress of loss is substantial for many. Commonly the bereaved experience missing, longing, and yearning for the deceased; in- trusive thoughts, memories, and images of the deceased; intense emotional episodes of sadness, crying, loneliness, and fear; de- creased energy and activity; loss of pleasure; social withdrawal and isolation; and feelings of meaninglessness and hopelessness (Burnett, Middleton, Raphael, & Martinek, 1997; Parkes, 1996). Most of the theories reviewed below contend that the process of meaning reconstruction is set in motion in reaction to these feel- ings of distress.

Attachment Theory

Bowlby (1980) placed primary importance on the adaptive at- tachment behavioral system by which people react to the threat of separation, whether temporary or permanent, from a security enhancing attachment figure. Attachment theorists, accordingly, have documented the progression of young children separated from their caregivers through the phases of protest (crying, call- ing out, and clinging), despair, and detachment, a process Bowlby posited was mirrored by grieving adults. In this respect, Bowlby’s model has been viewed by some (Klass, Silverman, & Nickman, 1996; Stroebe, Gergen, Gergen, & Stroebe, 1996) as paralleling the “grief work” model laid out by Freud (1917/1953), which held that “working through” grief entails an initial attempt to maintain attachment followed by a gradual withdrawal of emo- tional energy from the deceased in a process of “decathexis.” Although some contemporary grief theorists (e.g., Attig, 2001; Klass, Silverman, and Nickman, 1996) suggest that death requires a transformation rather than relinquishment of emotional bonds with the decedent, the reorganization of one’s “working models” of self and other in the wake of loss can be viewed as one con- text of meaning reconstruction.

A further critical implication of attachment theory for be- reavement research is that styles of attachment developed in child- hood relationships—secure, anxious/ambivalent, dismissing, and

unresolved/disorganized—can affect one’s response to subse- quent losses (Shaver & Tancredy, 2001). Thus, early childhood attachment patterns can affect responses to bereavement by con- figuring the meaning of the loss, in such a way that it is more radically threatening for individuals with less secure attachment histories. For these bereaved persons, the loss of a security-en- hancing other can radically undermine their sense of self, life fulfillment, and even basic maintenance functions, predisposing them to prolonged and complicated grief (Neimeyer, Prigerson, & Davies, 2002). Thus, attachment theory can also be relevant to a meaning reconstruction model by suggesting which bereaved persons are at greatest risk for negative outcomes as they struggle to reorganize their lives and move forward following the loss of the “safe haven” provided by the relationship (Field, Gao, & Paderna, 2005; Neimeyer, 2006; Stroebe & Schut, 2005).

Cognitive, Trauma, and Coping Theories

To understand how meaning is reconstructed, one must under- stand how a sense of meaning can be lost when a loved one dies. Janoff-Bulman (1989, 1992) described how traumatic events and losses can shatter a person’s “assumptive world,” the network of cognitive schemas that bear on the benevolence and meaningful- ness of the world and the worthiness of the self. To the extent that losses undermine these assumptions, leading us to believe that the world is malevolent, that life is meaningless, or that we ourselves are unworthy or undeserving of good things, they cause us profound distress. Janoff-Bulman (1992) explained, “Over- whelming life experiences split open the interior world of vic- tims and shatter their most fundamental assumptions. Survivors experience ‘cornered horror,’ for internal and external worlds are suddenly unfamiliar and threatening. Their basic trust in their world is ruptured” (p. 63). On the other hand, this theory pre- dicts that many losses will not shatter peoples’ assumptive worlds, either because the loss is not significant enough to disrupt a firmly grounded assumptive world or because the assumptions held by the bereaved person are capable of accommodating the loss and thereby protecting the bereaved individual from distress. Many of the symptoms of traumatic loss can be understood

as an attempt to adapt to a new reality exposed by the loss (Janoff- Bulman, 1989, 1992). By denying traumatic information and numbing themselves emotionally, people attempt to buffer themselves from overwhelming shock; but the reality of the loss often intrudes in the form of unwanted thoughts and memories, and invokes cog- nitive processes to explain the change in the assumptive world. According to Janoff-Bulman (1992), the most important process  in successful cognitive adaptation is finding benefit in the experi- ence: “By engaging in interpretations and evaluations that focus on benefits and lessons learned, survivors emphasize benevolence over malevolence, meaningfulness over randomness, and self-worth over self-abasement. Such interpretations are extremely impor- tant components in the successful rebuilding of nonthreatening assumptions, and contribute significantly to the resolution of the survivor’s existential dilemma” (pp. 132–133). Other cognitive theorists, such as Thompson and Janigian (1988), similarly stress people’s need to reassert a sense of purpose and control in the face of disrupting events, through changing their life schemes to accommodate the negative event, seeing it in a positive light, or as a catalyst for new, positive goals. This cognitive strategy is ulti- mately hopeful as “otherwise meaningless suffering can be im- bued with meaning and purpose, for example, by a personal decision to face the situation with dignity” (p. 277).

Taylor’s (1983) cognitive adaptation model similarly stresses the flexibility of cognitions in maintaining personal themes of mastery, self-enhancement, and the search for meaning. Accord- ing to this theory, adaptive cognitions may be optimistic illusions (Taylor & Armor, 1996) that enable the individual to maintain    a positive attitude about herself or himself in the face of dis- turbing events, to continue to care for and about others, to be creative and productive in work, and to grow, develop, and self- actualize. Folkman (2001) further stressed the importance of finding benefit in the negative experience, stating that successful coping and positive affect are made possible by “positive reap- praisal,” a cognitive reframing of the situation to see it in a posi- tive light. In her revised model, she described this reframing as a function of meaning-based coping (Folkman, 2001), and stressed that further research ought to examine the content, the specific meanings attributed to the situation and how these emerge over time.

Dual Process Model of Coping with Bereavement

According to the Dual Process Model (Stroebe & Schut, 1999, 2001), a bereaved person faces tasks in two distinct domains. The first, loss-oriented coping, refers to those activities that deal with separation from a lost attachment figure, and includes cry- ing, missing, yearning, remembering, and all activities dealing with the loss itself—challenges often referred to as “grief work.” Restoration-oriented coping, on the other hand, refers to the activi- ties by which one begins to build a new life and identity in which the lost person may be present in a spiritual and symbolic, but not physical way. Adaptation involves oscillating between these two opposing orientations in a dynamic give-and-take, until a point of satisfaction can be achieved and maintained in both areas. Stroebe and Schut (2001) recognized the central drive that mo- tivates these tasks is the search for meaning, both in the lost relationship and in a newly (re)constructed life.

Constructivist Theory

The theories described above each contribute insights into the grief experience, offering partial perspectives on a larger, as yet- unrealized integrative model of grieving (Bonanno & Kaltman, 1999). We propose that the effort to find, create, or reconstruct meaning is the core element linking these theories (Neimeyer, 2001a). Drawing on the theories reviewed above, we propose that people engage in three major activities by which they reconstruct meaning in response to loss: sense making, benefit finding, and iden- tity change (Neimeyer, 2001b; Neimeyer & Anderson, 2002). Im- plicit in this view of meaning reconstruction is the proposition that adaptation to loss frequently involves constructing a new reality, in which survivors’ assumptive worlds and their view of themselves are forever changed (O’Connor, 2002–2003).

Sense making. Cognitive and trauma theories, such as those of Janoff-Bulman (1992), Thompson and Janigian (1988) and Folkman (2001), propose that the most difficult losses are the ones that fail to make sense, throwing everything that once had meaning into doubt and turmoil. To protect ourselves from the

pain and restore the order, security, and predictability we felt in our lives, we strive to find reasons for what has happened. We find ourselves asking what caused the death, why it happened to our loved one, why the burden of grieving came to us, why such deaths occur, and what the experience means about the life we thought we knew. We may or may not find answers to any of these questions; or we may never ask one or any of these ques- tions (Davis & Nolen-Hoeksema, 2001; Davis, Nolen-Hoeksema, & Larson, 1998; Davis, Wortman, Lehman, & Silver, 2000). Construc- tivist theories propose that the process by which bereaved per- sons question, find, and make sense of their bereavement is central to the experience of grief (Neimeyer, 2000).

Benefit finding. As described in the cognitive and coping theories, the ability to find benefits in an experience, whether seen as “positive reappraisal” (Folkman, 1997; Janoff-Bulman, 1992; Tay- lor, 1983; Thompson, 1985) or “illusion” (Taylor, 1983), can play a significant role in adapting to the event. From a constructivist perspective, finding benefits is a means of building new meaning structures, incorporating—sometimes even founded on—the raw materials offered by the loss. However, Neimeyer and Anderson (2002) caution that benefits are not typically seen soon after the death but arrive months or years later, and that “the mining of life lessons from the vein of grief is by no means a certain out- come, and when it occurs, it is likely dependent on a host of maturational, personal and social resources” (p. 50).

Identity change. Informed by models of coping proposed by cognitive theories such as Taylor (1983) and the Dual Process Model of Stroebe and Schut (2001), constructivist theory posits that by reconstructing meaning in our lives in response to a loss, we necessarily reconstruct ourselves. Although pain and anguish are to be expected in the experience, Tedeschi, Park and Calhoun (1998) have argued that positive changes can also occur, a phe- nomenon they term “posttraumatic growth,” which is especially prevalent in those who respond to the loss in adaptive ways. People who experience such growth report developing a changed sense of self, saying they became more resilient, independent, and con- fident; they also take on new roles, develop a greater awareness of life’s fragility, and are more vulnerable to subsequent losses.

They change in social relationships, increasing their capacity for empathy and becoming emotionally closer to others. They also often experience a spiritual or existential growth (Tedeschi, Park, & Calhoun, 1998), becoming “sadder but wiser” in the process (Janoff-Bulman, 1992). Below, we review the empirical literature examining these meaning reconstruction processes, clustering studies by those using qualitative, quantitative, and mixed methods.

Qualitative Research

Qualitative research employs a broad variety of methods of in- quiry that respect the subjective, open-ended, and creative nature of human experiencing (Carverhill, 2002). This section intro- duces the narrative approach to gathering data and reviews recent qualitative studies of the grieving process.

The Narrative Approach

Constructivist theories commonly frame human experience in terms of our life stories because “we live in stories, not statistics” (Gilbert, 2002). We continually author our own life stories as we reflect, interpret and reinterpret what happens in our lives, and we tell and retell our stories to other people and ourselves. Meaning, then, is embedded in our life stories, and can be evoked by ac- cessing people’s stories in their own words.

The most basic qualitative designs ask open-ended questions about specific aspects of the grief experience and meanings found, and then tabulate and report responses. An advantage of such studies is that questionnaires containing open-ended prompts can be administered to large samples (Frantz, Farrell, & Trolley, 2001; Miles & Brown Crandall, 1983). Thus, these studies have elicited numerous specific meanings, benefits found, and personal changes as a result of the loss, but their disadvantage is that they have provided relatively shallow exploration of the processes by which these outcomes emerge. Other studies have sought greater depth through interviews in which participants were able to tell their own stories. These studies are time-intensive, both in time spent interviewing and in transcribing and analyzing the data, and they therefore tend to have much smaller samples, ranging from as

few as six (Danforth & Glass, 2001) to as many as 60 participants (Rosenblatt, 2000). For example, Calhoun and Tedeschi (1989– 1990) directed participants to describe personal changes in 13 areas, evoking expressions of positive identity changes that were consistent with personal growth theories. In the same way, Folkman (1997) found support for the coping strategies of positive reap- praisal and benefit finding in semistructured interviews asking bereaved men how they had coped with their loss and Normand, Silverman, and Nickman (1996) found support for continuing bonds in interviews with children who had lost a parent. Richards (2001) makes the point that of male partners of AIDS victims, 68 out of 125 participants spoke of spiritual phenomena in their experiences, without being specifically asked about faith or spiri- tual matters. Such spontaneously expressed data should carry con- siderable weight.

Relatively unconstrained description of grief experiences has been prompted by researchers who used in-depth interviews, fol- lowing the direction taken by the storyteller while probing for full, explicit naming and explication of themes and meanings. Using content analysis (Glaser & Strauss, 1967), the researchers identify common themes and categories of content that emerge in the participants’ narratives. A pioneering study using this open in-depth interview format with bereaved participants (Kessler, 1987) identified themes that are central in existential approaches to personal experience: the transience of life, the finality of death, and the importance of personal responsibility and growth. A more recent such study in which widows were interviewed in depth (Danforth & Glass, 2001) identified themes that closely resembled the activities identified by constructivist theory, including change in life attitudes, perspectives, ways of knowing, and sense of self. Two intriguing studies examined the continuing bond with the lost loved one, the way references to the deceased were woven through the bereaved person’s stories (Conant, 1996), and how the role of deceased parents in their bereaved children’s lives progressed in a general pattern, from the unsettling image of a ghost to a more reassuring and inspirational presence that guided the children as they grew up (Normand, Silverman, & Nickman, 1996).

Illustrating the richness of narrative research, Rosenblatt (2000) presented observations of in-depth interviews, ranging from two

to four hours in length, with 58 parents from 29 couples who had lost a child. Qualitative data gleaned from their narratives were organized into 12 “domains,” which Rosenblatt described as “frames of reference” that enabled the parents to make sense of “certain areas of meaning and understanding” (Rosenblatt, 2000, p. 2). The first domain was the story of the death, a story that the parents constructed and reconstructed—on their own and together—in the weeks and months following the loss. Fol- lowing the death story were rituals that held religious, secular, and personal meanings. Other domains addressed such areas as their relationship to the changed world, the metaphors they used for their process of adaptation, and the ways they continued to relate to their dead child. Echoing findings noted above, parents also concentrated on searching for positive meanings in the loss (such as seeing reduced suffering for the child or seeing them- selves as having changed for the better). The final domain Rosen- blatt observed was that of God and faith.

Grounded Theory

Whereas most of the empirical studies presented in this article were designed to examine extant theories, grounded theory is a means of developing theory or a model directly out of empirical observations and qualitative data (Glaser & Strauss, 1967). Narra- tives are first divided into meaning units and coded by their con- tent into categories that are each related to a core or “axial code” (Strauss & Corbin, 1990); for example, “meaning making” might be an axial category to which the other categories relate. Through a process of “constant comparison,” new categories are gener- ated until saturation is reached, when all newly analyzed mean- ing units fit into existing categories without altering the meaning of the category or necessitating formation of new categories. The method grants the researcher license in creating meaning cat- egories and the theory that is induced from them (Rennie, 2000), and it necessitates careful notation of the coding process (Strauss & Corbin, 1990). Hogan, Morse and Tason (1996) used a grounded theory approach to work toward an “experiential theory of be- reavement” that identified common situational, emotional, cog- nitive, and existential challenges in the process of grieving. They

observed that experiencing grief engaged the grievers in the task of making sense of their situations, resulting in their report that “they had grown less judgmental and more caring, tolerant, and compassionate. It was a process of becoming more caring and connected to others. [It] made the survivor live more intention- ally and deliberately with regard to people they love” (Hogan et al., 1996, p.58).

In a rare systemic application of this method, Nadeau (1998) presented a grounded theory of “family meaning making,” a study of how members of 10 different families interactively construct meanings together in the wake of a loss. The categories that emerged in relation to family meanings were causal conditions of the death; feeling a need to make sense of the death; the contextual conditions of the death; intervening conditions that affect meaning making; actions, inactions, and failed actions that steer the meaning making process; and consequences, the mean- ings that families come to hold as products of the meaning mak- ing process (Nadeau, 1998, p. 55).

Nadeau found that certain general patterns of family life enhanced the meaning making process, such as the “in-law effect” by which the entrance of in-laws into the family conversations opened up topics that were previously avoided (Nadeau, 2001, p. 101). Additional meaning enhancing patterns were family mem- bers’ willingness to share meanings, tolerance of differences, fre- quency of contact, family rituals, and the nature of the death. But other family patterns inhibited meaning making. These included the keeping of family secrets, fragile ties and infrequent contact between family members, cutoffs between members or groups of the family, differing beliefs, and family rules against sharing. Nadeau (1998) observed that “true family consensus was shown to be less likely than agreement among some groups of family mem- bers.” (p. 243). This description of varying meanings among fam- ily members underscores Nadeau’s point that meaning making progresses at all levels of family structure, from the individual, to couples and other dyads, up to the collective family group.

Nadeau (1998) observed that families used a set of strategies in making meaning, which included storytelling (the most fre- quent strategy observed, as meanings were found embedded in family narratives), dreaming, comparison of the death with other deaths, characterization of the lost family member, “family speak”

(the way in which family members interweave their stories and meanings, literally finishing each other’s phrases and sentences, interrupting, questioning, agreeing, and disagreeing with each other) and “coincidancing” (the way in which “coincidences” occurring around the death are attributed meaning). An example of this “coincidancing” was observed in a family’s explanation for the light rain that began to fall at the close of their lost one’s funeral ceremony: “It was kind of like the Lord let us have that little bit of sunshine and now we can shed a few little tears because it didn’t rain heavy. It was just a few little sprinkles” (127). Thus, Nadeau’s study provided a rare glimpse of the interactive pro- cesses by which loss is typically given meaning behind the closed doors of people’s homes.

This collection of qualitative studies reveals a number of strengths and weaknesses. Strengths of such studies include their emotional resonance as the participants are allowed to frame their stories in their own words and the insights they provide into how meanings evolve. But the limitations of the qualitative studies must also be recognized. Viewed from the standpoint of generalizability, samples are often problematic, not only because they are relatively small, but also because of the self-selection arising from the volun- tary nature of participant recruitment. In many of these studies participants were recruited from support groups, and the mourn- ers who chose to participate may have been drawn to such settings because their experiences were particularly compelling or their stories exceptional. In less demanding questionnaire studies, many participants tend to indicate that meaning making was not a sig- nificant part of their experience, whereas the relative rarity of this outcome in in-depth interview studies suggests that the latter may “pull” for a level of meaning-making that otherwise might not take place. Although this “healing” through storytelling is itself an important process to understand and study (Pennebaker, 1997), from a purely methodological standpoint the “reactivity” of such designs in fostering the very process they attempt to study suggests the relevance of triangulation of results through other research methods.

Quantitative Research

Qualitative studies of meaning reconstruction leave many ques- tions unanswered, including those concerning the proportions of

bereaved persons who struggle for meaning, over what period of time they do so, and with what impact on their psychosocial functioning. Such questions are more likely to be addressed by quantitative studies bearing on sense making, benefit finding, and identity change among the bereaved, the focus of this section.

The disruption of meanings. A recent longitudinal study of hun- dreds of elderly bereaved spouses (Bonanno, Wortman, & Nesse, 2004) identified five distinct trajectories in their postloss adapta- tion, identified as “chronic depression,” typified by clinically sig- nificant depression before the loss that remains relatively un- changed until at least 18 months after the loss; “chronic grief,” in which distress is low before the loss, but is significantly higher at six and 18 months after the loss; “depressed-improved,” in which distress is clinically significant before the loss but drops to normal levels and remains normal after the loss; “common grief,” in which distress rises from normal to a significantly higher level at six months but returns to normal by 18 months after the loss; and “resilient,” in which distress levels are low before and throughout the aftermath of the loss. Significantly, the chronic grief group was distinguished by a prolonged and agonizing “search for meaning” in the loss, as well as a more dependent attachment bond in relation to the deceased. As Neimeyer (2005) argues, such find- ings are congruent with a constructivist model that views loss as disrupting the coherence of the individual’s self-narrative, the life story in which the deceased was a central figure. Presumably, resilient survivors were able to assimilate the loss into their preloss meaning structures, preserving a sense of continuity in identity and purpose. In contrast, those whose self-narratives could not integrate the reality of loss were prompted to accommodate their meaning systems to be more adequate to the realities of their changed lives, and their variable success in doing so could ac- count for much of the variation in their subsequent bereavement trajectories. This conceptualization also accords with the findings of Schwartzberg and Janoff-Bulman (1991), who found that the bereaved college students relative to nonbereaved students were less likely to believe in a meaningful world, that lower perceived meaningfulness was associated with higher grief-related distress, and that greater grief was correlated with a perception of the world as random and uncontrollable. In structured interviews, 90% of the bereaved students reported that they had asked “Why

him/her?” about the death, and those who could not come up with a reason other than fate or chance expressed the highest levels of grief. These findings suggest that meaning structures are indeed disrupted by trauma and loss and the disruption is associated with psychological distress.

The Effects of Meaning Making Processes in Response to Loss

Janoff-Bulman and McPherson (1997) theorized that when the bereaved strive to find meaning in loss they

experience the pain of shattered assumptions and increased awareness of their own vulnerability; they know human outcomes can be random and meaningless. Yet they also experience the pleasure of a newfound appreciation of life and sense of value and meaning in their daily exist- ence. . . . Against the backdrop of a meaningless world, survivors create a life of meaning. (Janoff-Bulman & McPherson, 1997, p. 103).

In addition to sense making and benefit finding, this description implies the constructive process of identity change, as survivors are changed forever by their newfound wisdom. Here we review quantitative work examining these processes.

Making sense of the loss. One form of sense, which appears common in the first weeks and months after a loss (Davis et al., 1998; Davis et al., 2000; Neimeyer, 2000), is to be able to at- tribute a cause or reason to the death, such as to understand the illness or suicidal intent that ended a loved one’s life. Reporting on their longitudinal study of bereaved parents of SIDS victims, Downey, Silver and Wortman (1990) discussed the effects of at- tributions on psychological distress. By the second week after the loss, 45% of participants rated the importance of knowing the cause as “just a little” or less, and at every stage of the study parents who were concerned with making attributions were more distressed than those who were not. Moreover, parents who at- tributed responsibility to themselves or someone else were espe- cially distressed, while attributions to God or chance were not associated with higher distress. Davis et al. (1995) further exam- ined the tendency of bereaved persons to ruminate on the deaths, make causal attributions, and engage in “counterfactual” think- ing, in which they attempt to “undo” the event by focusing on

ways the death could have been avoided. Over both studies, counter- factual thinking was common, reflecting an attempt to retain a sense of order and controllability in the world. But when sense and control were unattainable or elusive, as in the cases of acci- dental deaths and SIDS, personal attributions of responsibility failed to be adaptive and only served to cause the bereaved greater distress (Davis et al., 1995).

Other forms of “sense,” to which the bereaved tend to turn their attention after the urgency of making attributions dissipates, (Davis et al., 1998; Davis et al., 2000; Neimeyer, 2000), concern larger worldviews that maintain order in their lives such as, “Why did this occur? Why did it happen to me? And where is the sense in life when things like this happen?” Historically, one source of answers to these questions has been in religious faith (Pargament & Park, 1995). Studying the SIDS parents sample, McIntosh, Silver, and Wortman (1993) found that religious participation was positively associated with finding meaning and cognitive pro- cessing of the loss. Additionally, in a study of bereaved mothers, Uren and Wastell (2002) found that over 80% struggled with finding sense or meaning in this experience of their child’s death. In this one-time survey, 26% of the mothers reported that they had found significant meaning, but 33% reported they had never found any meaning whatsoever in the loss. Sense making, opera- tionalized as having found meaning and retaining a sense of coherence, was associated with decreased grief severity, but be- ing currently engaged in a search for meaning was associated with increased grief distress.

In a longitudinal study Davis et al. (1998) reported that by six months into bereavement, nearly 70% of participants reported having made sense of the loss, almost 20% had not, and the remaining were ambivalent. Sense making, which usually entails seeing the loss as predictable, as part of the natural order, or according to God’s plan, at the 6-month point predicted lower distress at that point and at 13 months postloss. But from 6 to 13 months after the loss, over 30% changed their response so that sense making at 13 months no longer predicted distress scores at that point or thereafter. Hence, it appeared that making sense in the first months of the grief was important to adjustment, but doing so after six months or longer did not alleviate distress (Davis et al., 1998).

Finally, research by Currier, Holland, Coleman, and Neimeyer (2006) on over 1,700 bereaved adults demonstrated that the in- ability to make sense of the loss was the most significant factor distinguishing survivors of violent loss (through suicide, homi- cide or accident) from nonviolent loss (through disease), out- weighing in importance even complicated grief symptomatology. Taken together, these studies demonstrate that a struggle to find significance in the loss is especially acute when deaths are trau- matic or “off time” in the life cycle, and that an inability to find answers to existential questions—at least early in bereavement— is a risk factor for less favorable grief outcomes.

However, this research leaves many questions unanswered. One constraint of these studies has to do with their implicit causal reasoning. That is, the relationship between distress and sense making may not be unidirectional. It is likely that distress must increase before sense making is initiated, and that the distress continues to drive sense making activities—which seems to be indicated by the consistent finding that those who are presently trying to make sense are in greatest distress—until some sense is made and the distress dissipates. However, it might also be that the reduced distress (possibly caused by some other factor) makes it easier for people to find sense. Evaluating these competing hypotheses will require more sophisticated longitudinal designs than have been used to date. Furthermore, future research should examine whether certain types of individuals (such as those with problematic attachment histories) are predisposed to exhibit a crisis of meaning in response to bereavement. To this point, it is not clear whether the need to make sense, what Frankl called “the will to meaning,” is an enduring trait within people throughout their lives, or a state that arises at certain critical points, a topic to which we will return below.

Finding benefits in tragedy. In keeping with the trauma and cognitive theories, Davis and colleagues have found that “deriv- ing benefits from the loss or trauma is a key means of assigning positive value or significance to the event for one’s own life” (Davis et al., 1998, p. 562). At each wave of their study (Davis et al., 1998), 70%–80% of respondents  reported  some  benefit  in  the experience, which ranged from personal growth and changed outlook to better interpersonal relationships and support. Whereas event characteristics predicted sense making, the only predictors

of benefit finding were personality factors of the bereaved indi- vidual, such as degree of optimism or pessimism (Davis & Nolen- Hoeksema, 2001), a finding that accords with the generally weaker relationship of benefit finding to cause of death reported by Currier and his colleagues (2006). Moreover, Davis reported that benefit finding and sense making were not significantly corre- lated. Unlike sense making, which only predicted distress at the 6-month point, benefit finding predicted grief at every point af- ter the loss and the relationship actually grew stronger over time. The authors concluded that making sense is an effective means of coping only in the early months of the loss, whereas benefit finding seems to be a better ongoing means of coping that strengthens adjustment over time.

Despite the general support for the salutary effects of ben- efit finding, some studies have yielded more equivocal results. A study by Lehman et al. (1993) examined the relation of changes in self-perceptions, social relations, and life orientation to long- term adjustment in bereaved adults, whose losses had occurred four to seven years previously. While it was found that perceiving negative changes were related to higher distress, finding positive changes was not related to alleviations of distress. The authors suggested that the positive appraisals might be “defensive illu- sions” or that the negative changes, especially when they were still perceived after such a long period of time, were associated with maladjustment that effectively blocked resolution of distress, negating the expected positive effects (Lehman et al., 1987).

The criticisms noted regarding treating distress as an out- come but not a predictor in studies of sense making apply to these studies as well. Most studies implicitly adopt a medical model, in which meaning making is investigated as a possible “cure” for the “illness” of grief. From a constructivist point of view the pro- cess of grieving may have much more to teach us than how to avoid distress. In the model below we will propose a broader view of the functions of distress and meaning reconstruction during bereavement. Accordingly, future studies might investigate in greater depth the kind of benefits that are discovered, motives for find- ing them, and processes by which they are found.

Identity change. The activities by which bereaved persons en- gage new goals, and in so doing develop new identities, are theo- rized by Thompson and Janigian (1988) and Stroebe and Schut

(2001) to be effective coping strategies in the process of mean- ing reconstruction. Some studies have investigated identity change as an independent variable, an active process like sense making and benefit finding. Identity change is often operationalized as having a “purpose,” or a “meaning” in life that causes a change in the bereaved person’s distress. In a study of bereaved adults, purpose in life was associated with greater life satisfaction, stron- ger reasons for living, more social support, and lower impact of loss (Ulmer, Range, & Smith, 1991). These results were repli- cated in a study of bereaved college students, in which purpose in life was associated with reduced distress (Edmonds & Hooker, 1992).

A good deal of the literature has treated personal growth as an outcome variable and an end in itself, often as the outcome  of sense making and benefit finding processes, rather than as an independent variable and a means to some other end. In addi- tion to Hogan, Greenfield and Schmidt’s (2001) Personal Growth factor on the Hogan Grief Reactions Checklist, Calhoun, Tedeschi, Park, and their colleagues have developed two scales for assess- ing “posttraumatic growth”: the Stress-Related Growth Scale (Park, Cohen, & Murch, 1996) and the better studied Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996). The Posttrau- matic Growth Inventory, or PTGI, assesses change in five do- mains: (a) relating to others, (b) new possibilities, (c) personal strength, (d) spiritual change, and (e) appreciation of life. As an outcome, posttraumatic growth has been predicted by personal- ity factors of optimism, extraversion, and openness to internal experience (Tedeschi & Calhoun, 1996) and environmental fac- tors of social, family, and community support and a stress-free posttrauma environment (Schaefer & Moos, 1998).

A study by Gamino and his colleagues (2000) compared an adaptive model of grief, in which personal growth (as measured by the HGRC) was conceptualized as a positive outcome variable that indicated adjustment, to a pathogenic model in which grief distress was conceptualized as a negative outcome variable indi- cating maladjustment. It was found that personal growth was in- versely related to distress, at least partially justifying the authors’ conceptualization of personal growth as at the “other end” of the spectrum in relation to grief-related distress. Consistent with con- structivist themes, predictors of personal growth included finding

benefit in the loss, having a chance to say goodbye, having spon- taneous positive memories, and reporting intrinsic spirituality. Interestingly, the four factors together only accounted for 36% of personal growth, leaving open the question of what other pro- cesses stimulate personal development in the wake of loss (Gamino, Sewell, & Easterling, 2000).

But there is a problem with the operational definition of posttraumatic growth as the polar opposite of grief distress, as the empirical evidence is inconclusive on the relationship be- tween the two constructs (Tedeschi & Calhoun, 2004). Although some studies suggest that posttraumatic growth is associated with decreases in distress (e.g., Park et al., 1996), others suggest that growth and distress rise together (e.g., Calhoun, Cann, Tedeschi, & McMillan, 2000), and others have found no relationship be- tween the two (e.g., Cordova, Cunningham, Carlson, & Andrykowski, 2001). This has led Tedeschi and Calhoun (2004)  to  conclude that posttraumatic growth and distress are conceptually distinct dimensions. The observation that survivors emerge “sadder, but considerably wiser” (Janoff-Bulman, 1992, p. 175) might be inter- preted to mean that the two are indeed separate, though often- related, constructs. But, as with the processes of sense making and benefit finding, it does not appear that the relationship has been sufficiently examined in terms of its temporal sequence. It is possible that meaning making and personal growth processes are initiated when a certain level of distress is experienced and discontinued when the distress is reduced. At what levels the process begins and ends and whether postloss distress levels ever return to preloss levels may differ among individuals. As is the case regarding sense making and benefit finding, what is called for is longitudinal research that efficiently monitors the process by which distress and personal growth begin, progress over time, and end (if they do truly “end”), and compares the experiences of those who engage in the process to those who never do.

Studies that Combine Qualitative and Quantitative Methods

“Methodological pluralism” can be especially informative in bridg- ing gaps between qualitative and quantitative results and in build- ing theory (Neimeyer & Hogan, 2001). Studies using both types of methods are relatively rare, however, resulting in only a few

pioneering explorations to review as a way of suggesting their value.

Yalom and Lieberman (1991) examined the narratives of bereaved spouses of cancer victims, rating their levels of “existen- tial awareness,” based on active exploration of questions surrounding life’s fragility, brevity, preciousness, and meaning; death’s fini- tude; their loved one’s fate; their personal responsibility, and their sense of the “unbridgeable isolation inherent in existence” (Yalom & Lieberman, 1991, p. 336). Quantitative comparisons indicated that the existentially aware participants experienced no appreciable amelioration of grief distress, amount of stress, and perceptions of stigma due to being a widow as assessed by objec- tive measures. However, they exhibited significant subjective in- dications of personal growth, as seen by taking on new activities and new roles, engaging in creative expressions like writing and painting, struggling to find a new identity, identifying themselves as individuals rather than couples, exploring new relationships, and taking better physical care of themselves. The authors de- scribed the existentially aware as:

those who look into, rather than away from, death . . . they were able or willing to bear and experience their aloneness . . . they showed less grief and less guilt and anger toward their spouse. They did have more anxi- ety and depression, but their dysphoria may be linked not to grief but  to death, their own death, to questions about life meaning, and to the opportunity and challenge of freedom. . . . Existentially aware individu- als had higher self-esteem and were more prone to change their self- image by taking new elements into the self. (Yalom & Lieberman, 1991, p. 344)

Maercker, Bonanno, Znoj, and Horowitz (1998) gathered narratives through semi-structured interviews from bereaved adults along with quantitative measures of grief, depression, and anxiety. They coded the narratives according to whether they expressed positive or negative experiences along eight dimensions: trust/ mistrust, autonomy/shame, initiative/guilt, competence/inferior- ity, identity/identity problems, intimacy/isolation, generativity/ stagnation, and integrity/despair (Erikson, 1982). The investiga- tors found that participants’ expression of positive themes at six months predicted lower grief at 14 months, but expression of negative themes was not additionally predictive of higher grief at 14 months. The authors concluded that being able to generate

positive themes is central to effective coping with grief, whereas not being able to generate positive themes is a risk for greater grief complications (Maercker, Bonanno, Znoj, & Horowitz, 1998).

In a similar study, Bauer and Bonanno (2001) coded 6-minute narratives by positive and negative valence and also by whether self-evaluations were “behavioral” or “characterological,” that is whether bereaved participants told their stories in terms of what they did or in more identity-bound terms of who they were. Comparing these ratings to quantitative measures of distress measured at 6, 14, and 25 months after the loss, it was seen that participants who reported positives and negatives in their self-evaluations in a ratio of 5:1, rather than those who expressed only positive self- evaluations, showed the best adjustment to grief. Those who saw themselves in this ratio probably represented optimal personal growth in that they were realistic about their suffering but uti- lized positive reappraisal, focusing more on the benefits they perceived in the challenge their suffering posed. In the “doing versus be- ing” coding scheme, it was found that the tendency to focus on what one was doing predicted better adjustment than focusing on being. But those who integrated doing- and being-based self- evaluations within the same narrative units showed the best ad- justment over time (Bauer & Bonanno, 2001). This conceptualization of personal growth as the integration of self in being and behav- ior is sophisticated and potentially valuable in further investiga- tions.

Williams, Gamino, Sewell, Easterling, and Stirman (1998) performed a content analysis of the narratives of 74 bereaved adults, assessed their distress levels with the Grief Experience Inventory (Sanders, Mauger, & Strong, 1985), and their ratings of the loss’s importance compared to other life events, using the Life Events Repertory Grid, or LERG (Sewell, 1997). Higher levels of grief were associated with explicit content expressing anger and the absence of a higher power, and with implicit content suggesting negative emotions, negative evaluations, anger, denial, age con- sistency (the perception that older adults should die while chil- dren and younger adults should not), dependence, and absence of a higher power. Lower grief levels were associated with ex- plicit content of positive evaluation and low suffering, and im- plicit content suggesting positive evaluation, acceptance, and positive emotions. Quantitative ratings of personal experiences reported

in the Life Events Repertory Grid suggested that those who char- acterized the loss in extremes and those who evidenced denial were likely to experience significant distress (Williams, Gamino, Sewell, Easterling, & Stirman, 1998).

In another study of 85 mourners Gamino, Hogan, and Sewell (2002) gathered written narratives of bereaved adults. Using con- tent analysis and constant comparison, they gleaned nine mean- ing categories. The dominant category, which was observed in 81% of the participants’ essays, was called by the authors “feeling the absence,” a category encompassing negative feelings such as longing, yearning, depersonalization, loss of companionship, lost dreams, and finality. Other categories included “hope and recov- ery,” “pain and suffering,” “experiencing relief,” “changing rela- tionships,” and “focusing on negativity,” “experiencing meaning- lessness,” “continuing the connection,” “invoking the afterlife,” and “going on with life” (Gamino, Hogan, & Sewell, 2002). These qualitative findings were then compared (Gamino & Sewell, 2003) with quantitative measures, with results indicating that “hope and recovery” themes predicted lower grief levels on the GEI, lower grief misery on the HGRC, higher personal growth on the HGRC, and perception of benefits in the experience. The “experiencing relief” category was associated with lower grief distress levels, but not associated with personal growth. Overall, “feeling the absence” did not predict distress levels, but focusing on negativity was as- sociated with higher grief levels on both quantitative measures of distress and less personal growth (Gamino & Sewell, 2003).

An interesting multiple methods study provided support for the continuing bonds theory (Bonanno, Mihalecz, & LeJeune, 1999). A total of 66 conjugally bereaved adults’ narratives, col- lected between three and six months after the loss, were coded for core relational themes. “Interpersonal affirmation themes” consistent with continuing bonds, emotions of pride and con- tinuing affection for the deceased, predicted reduced somatic complaints 14 months after the loss, whereas themes of personal discord predicted increased somatic complaints. The interper- sonal affirmation themes in bereaved persons’ narratives were associated with themes of positive self-identity, such as personal safety, personal growth, and positive expectations for the future. In this study, then, continuing bonds and identity change ap- peared to work hand-in-hand.

Taken together, these studies have begun to bridge the gaps identified between the results of qualitative and quantitative studies, elucidating some of the complexity of the meaning reconstruc- tion process. Some of these studies, such as those of Maercker, Bonanno, Znoj, and Horowitz (1998), Gamino, Hogan, and Sewell (2002) and Bonanno, Mihalecz, and LeJeune (1999), by con- ducting content analyses of narratives and then making quantita- tive comparisons to outcomes, have found greater support  for the effectiveness of meaning reconstruction activities of sense making, benefit finding, and personal growth than many of the strictly quantitative studies reviewed above. One unresolved issue raised in the review of quantitative literature is the relationship between distress and meaning reconstruction, which, it appears, is not a unidirectional cause and effect relationship. Studies such Yalom and Lieberman (1991) show us how those who suffer and exam- ine the meanings in their distress grow in character, and how the benefits of the growth are not always—or not only—the reduc- tion of distress. Often the meanings realized by the bereaved are that life is more painful and challenging and that goals will be more difficult to achieve than they had previously believed; so personal growth often does not mean becoming less distressed, but learning how to become someone who can carry the weight of her or his distress. In fact, Gamino and Sewell (2003) found that without distress, personal growth did not occur. Further evi- dence concerning the nature of personal growth (Bauer & Bonanno, 2001) suggests that the persons who most fully adapt are able to integrate images of what they do and who they are, and they are able to recognize the positive and negative themes in their life stories, facing the distress of grief with a positive outlook. The model proposed below is sensitive to the possibility of a recipro- cal relationship between distress and meaning reconstruction that emerges from such interpretations.

A Model of Meaning Reconstruction in Response to Bereavement

The model proposed in Figure 1 is the product of a constructivist integration of the works reviewed in this article. In this model, it is assumed that every person holds a core of meaning structures akin to Kelly’s (1955) “personal constructs,” Janoff-Bulman’s (1992)

or Parkes’s (1996) “assumptive worlds” or Thompson and Janigian’s (1998) “life schemes,” that inform her or his understanding of the world in six domains: (1) daily activities and priorities (Folkman, 1997; Stroebe & Schut, 2001); (2) their perceptions of them- selves and their personal identities (Emmons et al., 1998; Lopata, 1973; Tedeschi et al., 1998); (3) their interpersonal relationships (Bowlby, 1980; Nadeau, 1998); (4) their outlook on the future (Taylor & Armor, 1996; Thompson, 1985); (5) their view of the world, in terms of spiritual or philosophic beliefs (Janoff-Bulman & McPherson, 1997; McIntosh et al., 1993; Pargament & Park, 1995; Richards, 2001); and (6) their meaningful actions in their social communities (Armour, 2003).

The model posits that the death of a loved one is an occur- rence that may be consistent or inconsistent with one’s preloss meaning structures (Neimeyer, 2005). Losses that make sense or are explainable to the bereaved may be distressing, but in com- parison to losses that are inconsistent with preloss meaning struc- tures they are less disruptive because they do not challenge the bereaved to reexamine their preloss meaning structures. In fact the consistency of an event—even a distressing event—with one’s existing meanings will reinforce these structures because they help to explain the difficult event and usually bring some degree of comfort. On the other hand, losses that are inconsistent with preloss meanings provoke a dissonance, forcing the bereaved to recognize that those meanings can no longer be “true,” mean- ingful, or helpful (Braun & Berg, 1994). It is in these cases that the model proposes that bereaved persons engage in a search for meaning.

The key meaning making processes proposed in the model are sense making, benefit finding, and identity change. By these processes the bereaved engage in meaning reconstruction, through which preloss meaning structures may be reviewed, reevaluated, renewed, and/or rebuilt. According to the model, the recon- struction process produces new postloss meaning structures through which the bereaved come to view the world in a new way. To the extent that these new structures are helpful to the bereaved in making sense of their experience, they may alleviate distress and become integrated into the individual’s worldview; but if these structures are not helpful in finding meaning and leave the be- reaved in distress, they are subject to further reconstruction.

The two points in the model that depict diverging pathways marked by the word “OR” are so depicted for conceptual simplic- ity. In real grief situations these junctures usually pose “and” sce- narios, by which meaning structures are helpful and upheld to some degree and are unhelpful to some degree and not upheld,thereby (re)initiating meaning reconstruction in some domain(s).

This may help explain why persons who find some meaning in a loss often continue their search ( Davis et al., 2000; Downey et al., 1990; Schwartzberg & Janoff-Bulman, 1991), and why they may find new meanings but also continue to feel distress (Davis et al., 2000; Emmons et al., 1998; Lehman et al., 1993; Lehman et al., 1987; Neimeyer, 2000).

It also points out that distress plays a double role in this process. In this model, changes in distress are not perceived as an outcome per se, but rather are important because of their function in the process of meaning reconstruc- tion. Distress is viewed as a trigger that can initiate the search for meaning or signal the provisional completion of successful re- construction.

The focus of this constructivist model, then, is on meaning structures and the process by which they operate and transform our experiences. From this perspective, distress is not necessarily the enemy to be evaded or even the symptom to be alleviated. Rather, it is to be faced openly and honestly in the spirit of Frankl’s (1962) fundamentally existential stance, which he called “tragic optimism.”

Clinical Implications

From a clinical point of view the relationship between meanings and grief-related distress is of critical interest. The meaning re- construction model presents a conceptual “road map” of move- ment through the grieving process, potentially helping the be-

reaved gain insight into their distress and their meaning struc- tures as they travel. The ability to locate the individual on the map and determine her or his direction also could have clinical utility for purposes of predicting complications in the grieving process, diagnosis, treatment planning, and progress monitor- ing. This is not to imply a “one size fits all” prescription for grief treatment. Quite the contrary. With its diverging and cyclical path- ways, the constructivist model provides for the unique course that every griever ultimately follows; in terms of structure, the model provides a scaffold that facilitates the construction of mean- ings whose ultimate forms are unique to their makers.

What the model could do for clinicians and their grieving clients is to make the process and content of meaning structures explicit. In so doing, alternate meaning structures and alternate means of reconstructing them may arise through the client’s own insight or at the gentle prompting of the clinician. A word of caution is necessary. Sometimes the informed clinician should know when not to intervene. For example, if an individual does not seem to be engaging issues of meaning but neither is she or he suffering distress, there is no clinical utility in disturbing present meaning structures and doing so might prove more harmful than helpful. But, in many instances, a clinician who is mindful of the model may intervene by facilitating new meaning reconstruction activities at critical points when different interventions might be most beneficial. For example, evidence provided by Davis and colleagues (Davis & Nolen-Hoeksema, 2001; Davis et al., 1998) suggests that in the first weeks and months grievers attempt to attribute responsibility or reason for the death, but as the months pass they tend to turn to benefit finding activities. Thus, a clini- cian could effectively intervene by facilitating that transition in activities, listening for and exploring a client’s newly voiced sense of purpose or possibility (Neimeyer, 2000). The clinician might also guide the client to reflect on how the experience has changed her or him as a person. Or, if it appears that the bereaved per- son shared a special bond with the deceased, the clinician might encourage her or him to continue her or his dialogue with the deceased, in the form of letters or inner speech or prayer or meditation. Several narrative exercises (Neimeyer, 1999) have been developed that tap into the various meaning reconstruction ac- tivities outlined in the model, which can be used as self-help

strategies by the bereaved or in the context of professional grief therapy. The potential value of such methods is suggested by a recent randomized controlled trial by Shear and her colleagues (2005) that demonstrates the efficacy of evocative retelling of the story of the death and promoting a sense of connection with the deceased (as through the use of imaginal conversations), in com- bination with reformulating life goals. From the standpoint of the present model, this intervention for complicated grief seems well designed to promote new narrative meaning making regard- ing the death, reconstruction of the mourner’s sense of self, and reworking of the continuing bond with the deceased, and de- serves wider application.

In closing, the clinician’s role in working with a bereaved client is to facilitate a constructive process in which meanings can be found or developed that help the client reshape her or his shattered world, restore a sense of order, promote new in- sight and personal growth, guide meaningful actions in response to the loss, and bring some degree of relief from the common and undeniable pain of grief. We hope that the present model provides some useful guidance in further studying and facilitat- ing this process.

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Source: Ohio State University