Searching for the meaning of meaning: Grief therapy and the process of reconstruction

“…This contrast between the majority of grievers who seek meaning in the death and the minority who apparently do not might re¯ ect their di erential emphasis on what Stroebe and Schut (1999) have referred to as ‘‘loss-oriented’’ and ‘‘restoration-oriented’’ processes in adjustment to bereavement.”

“In summarizing these findings, Neimeyer (2000) concluded that “such interventions are typically ineffective, and perhaps even deleterious, at least for persons experiencing a normal bereavement” (p. 541).”

“In regard to the latter, this strong association is consistent with the emphasis placed on restoration of meaning in theories of natural grief resolution (Stroebe & Schut, 1999) and in prominent psychotherapies for CG (e.g., Neimeyer, 2000; Shear et al., 2005).”

“Neimeyer (2000) reported the results of a meta-analysis of 23 RCTs of grief therapy.”

“In fact, in a recent meta-analysis, Fortner, Neimeyer, Anderson, and Berman (reported in Neimeyer, 2000) found that grief treatments produced only a small positive effect, and that an alarming 38% of those receiving grief treatment actually got worse relative to notreatment controls.”

“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…”

“Together, these findings suggest that interventions with individuals who were not depressed prior to the loss but exhibit relatively acute and enduring grief reactions should focus on fostering the processing and the construction of new meanings around the loss ( Neimeyer, 2000, 2001 ).”

“Work on the development of narratives following loss and other stressful life events suggests that individuals who are able to construct an organized and coherent account of a painful event benefit because thoughts and feelings can be more fully integrated (Capps & Bonanno, 2000; Neimeyer, 2000; Pennebaker, Mayne, & F…”

“…many of the bereavement interventions with low treatment effects reported in meta-analyses (Forte et al., 2004; Kato & Mann, 1999; Litterer Allumbaugh & Hoyt, 1999; Neimeyer, 2000), most of which were aimed at normal and uncomplicated grief reactions or implemented too early in the grief process.”

“Implicit in this account is an expanded view of the concept of meaning, one that transcends the often limiting discourse that equates it with cognitions in the minds of individuals (Neimeyer, 2000).”

“In part, this may reflect a significant gap that exists between researchers who study interventions for the bereaved, and the majority of caregivers who provide direct services to them (Jordan, 2000; Neimeyer, 2000; Silverman, 2000).”

“Efforts are under way to refine a targeted intervention for CG, and in contrast to the overall lack of efficacy usually observed for grief therapies (Jordan & Neimeyer, 2003; Neimeyer, 2000), initial results are promising (Shear et al.”

“Such expressions should endure after the death of a valued relationship and thus constitute a central part of grief resolution in enabling the bereaved to preserve a sense of identity and meaningful connection with the past (Attig, 2001; Fraley & Shaver, 1999; Marwit & Klass, 1995; Neimeyer, 2000).”

“Consequently, there is a growing consensus in the field that interventions aimed at redressing normative grief reactions are contraindicated (e.g., Bonanno & Lilienfeld, 2008; Neimeyer, 2000).”

“In Journal of Clinical Psychology: In Session DOI 10.1002/jclp contrast to the generally robust effect sizes typically observed for psychotherapeutic outcomes, grief-specific therapies produce only small and relatively inconsequential effects (Neimeyer, 2000).”

“meaning” (Neimeyer, 2000), particularly around the way in which these interact in adaptation to loss.”

“received treatment [26], although this analysis is controversial [27].”

“Bereavement experts have proposed that finding meaning in the loss experience and restoring a sense of purpose in a world without the deceased loved one may be therapeutic and reduce suffering for many persons (Davis et al., 1998; Neimeyer, 2000).”

“For example, it may be that concerted grief processing exerts a salutary effect primarily for severely grieved individuals (Bonanno, Notarius, Gunzerath, Keltner, & Horowitz, 1998; Neimeyer, 2000 ).”

“Indeed, there is some evidence that learning resilience may be even more relevant for people who are having difficulty adapting to their circumstances than for those who are adapting well (Neimeyer, 2000).”

“Bereaved persons who believe their loved one’s death came too quickly, too young, or unjustly due to a lack of appropriate care, may experience anger and a desire to cast blame, in order to make sense of or seek retribution for their loss (Carr, 2009; Neimeyer, 2000).”

“This result corresponds to the effect sizes of two meta-analyses based on controlled studies with bereaved adults (d¼ 0.11; Kato & Mann, 1999; d¼ 0.13; Fortner, 2000; see Neimeyer, 2000).”

“Jordan and Neimeyer 16,21 summarized some of the above qualitative (narrative) and quantitative (meta-analytic) reviews of the literature on the efficacy of individual and group interventions, primarily for adults, including a report of an unpublished meta-analytic review by Fortner and Neimeyer.”

“Not all bereaved parents search for meaning but for those who do, finding meaning is an important aspect of their post-loss adjustment (Davies, Wortman, Lehman, & Cohen Silver, 2000; Keesee, Currier, & Neimeyer, 2008; Matthews & Marwit, 2003; McIntosh, Cohen Silver, &Wortman, 1993; Neimeyer, 2000; Uren & Wastell, 2002…”

“Neimeyer (2003) also questioned the past theoretical assumptions because of the incongruence of counselors’ experiences with their clients.”

“A gap exists between information in the literature and the use of that information by service providers (Bridging Work Group, 2005; Center for the Advancement of Health, 2004; Jordan, 2000; Neimeyer, 2000a).”

“Generally speaking, research that explores the role of meaning in adaptation to life transitions has distinguished between meaning as a process and meaning as an outcome (Bonanno, Wortman, & Nesse, 2004; Mackinnon et al., 2013; Neimeyer, 2000; Park, 2010; Steger, Frazier, Oishi, & Kaler, 2006; Stroebe & Schut, 1999).”

“Additionally, there is now considerable empirical evidence to suggest that variability in coping efficacy after a major loss or trauma is a function of the degree to which meaning could be attributed to the event (Neimeyer, 2000; Schwartzberg, 1993; Tait & Silver, 1989). The intensity of the ongoing search for meaning…”

“…responses (Bonnano et al., 2002; Maciejewski et al., 2007), how individuals cope with bereavement (Stroebe & Schut, 1999) and the ways in which bereaved individuals find meaning and adapt to the death of their loved one (Lichtenthal, Neimeyer, Currier, Roberts, & Jordan, 2013; Neimeyer, 2000).”

“Rosenblatt (2001) has suggested aspects of the bereavement experience that can be used to identify cultural differences: understanding of what has been lost with a death, death rituals, constructions of a survivor’s ongoing and future relationship with the deceased, as well as the expression of grief itself.”

“…(Evans, 2005; Masten, 2001; Nyamukapa et al., 2008), and that, in some instances, inappropriately targeted interventions can be harmful (Neimeyer, 2000) and may undermine resilience acquired through effective responses to adversity including access to community support (Summerfield,…”

“Concepts concerning attachment working models and plans enhance multiple types of plans, namely: internal plans such as personal plans which may help a person understand their environment [27, 28]; relational plans such as how the self relates to others [26, 28, 30], and; attachment plans such as those created in earl…”

“…in the bereaved, including an adapted sense of identity, the ability to be comforted by the thoughts and memories about the deceased without yearning for their physical presence, and a more stable affect (Attig, 2001; Field et al., 2005; Fraley & Shaver, 1999; Marwit & Klass, 1995; Neimeyer, 2000).”

“…family grief therapy (Kissane, 2002) B complicated grief treatment (Shear et al., 2005) B meaning reconstruction approaches to grief therapy (Neimeyer, 2000) B online support (Wagner, 2009) B bereavement support groups In general, the more complicated the grief process, the greater the…”

“Examples of these concepts are ‘resistance’ in the work of Alan Wade (1997, 2000, 2007) and Liz Kelly (1988) and the construction of meaning in the work of Neimeyer (1995, 1998, 2000a, 2000b).”

“There have been many indications in the bereavement literature that making meaning of one’s loss experience is therapeutic for grieving individuals (Davis & Nolen-Hoeksema, 2001; Neimeyer, 2000; Neimeyer, 2005; Neimeyer, Prigerson, & Davies, 2002; Stroebe & Schut, 2001; Tedeschi & Calhoun, 2004).”

“Unfortunately, recent meta-analyses have shown that grief treatments have generally been ineffective and can possibly do harm to those who participate in them (Allumbaugh & Hoyt, 1999; Jordan & Neimeyer, 2003; Kato & Mann, 1999; Neimeyer, 2000).”

“Because of the potential therapeutic value of enhancing meaning in bereaved parents (Neimeyer, 2000, 2001a, in press; Stroebe & Schut, 2001), we developed a manualized intervention, Meaning-Centered Grief Therapy (MCGT), designed to enhance bereaved individuals’ sense of meaning and reduce PGD…”

“Deterioration Effects in Grief Counseling Probably the major impetus for the rash of cautionary messages regarding bereavement interventions has been the striking finding, first published by Neimeyer (2000), that such treatments may be harmful.”

“Despite attempts to develop, deliver, and evaluate effective interventions for bereaved parents and children, interventions may be underutilized, and their efficacy has been debated (Larson & Hoyt, 2007; Neimeyer, 2000).”

“Additionally, Neimeyer (2000) points out that the models often lack empirical foundation.”

“In summary, although existing evidence suggests that grief therapy for normal bereavement is typically ineffective, interventions are likely beneficial to those experiencing traumatic or complicated grief (Neimeyer, 2000).”

“25 Although some of the specialized services described below are the province of trained professional and para-professional grief counselors, health care workers of many disciplines can play a crucial role in identifying bereaved individuals to whom such services might be offered.”

“A recent review suggests that grief counseling and therapy are ineffective and potentially deleterious in normal bereavement but that grief therapy is more beneficial for traumatic grief (Neimeyer, 2000 ).”

“The concept of meaning making is also well supported by the bereavement literature (Neimeyer, 2000).”

“Chronic grievers, in contrast, may benefit from an intervention that acknowledges the centrality of their loss and helps them in processing the loss, in developing a new identity, and in restructuring their life so that it gradually becomes more meaningful and rewarding (Neimeyer, 2000).”

“Neimeyer (2000) defines this ‘‘meaning reconstruction,’’ as sense-making, benefitfinding, and identity-change (Gillies & Neimeyer, 2006).”

“…on developing and testing specific strategies for meaning-making is recommended for grief intervention (Davis, Wortman, Lehman, & Silver, 2000) “beyond the well-intended but vague assumption that a sharing of feelings in a supportive environment will promote ‘recovery’” (Neimeyer, 2000, p. 548).”

“A number of other authors have proposed various strategies and techniques to use in work with bereaved patients (Acierno et al., 2012; Asukai, Tsuruta, & Saito, 2011; Boelen et al., 2007; Neimeyer, 2000; Rosner, Pfoh, & Kotoucova, 2011; Rynearson, 1987; Wagner, Knaevelsrud, & Maercker, 2006; Worden, 2018).”

“In a later meta-analysis of 23 studies of bereavement interventions, the average e¡ect size was 0.13 ( Fortner & Neimeyer, 1999; Neimeyer, 2000 ).”

“While theorists have examined the relevance of making meaning for survivors of homicide victims (Armour, 2002; Neimeyer, 2000; Peterson, 2000), an examination of populations (e.g., African Americans) of survivors having already experienced a dissolution of their belief system brought on by…”

“Certainly, as elaborated on by Neimeyer (2000, 2001), the process of ‘‘meaning-making’’ may facilitate coping with grief through a complex reorientation to the world.”

“…the UK’s biggest bereavement care organisation, reveals that while early training sessions focus extensively on arguably outdated models of grief (Neimeyer, 2000) in the ‘‘breaking-bonds’’ paradigm such as stages, phases and tasks of grief, a handout distributed only towards the end of training…”

“Neimeyer (2001a) has argued that meaning reconstruction is, in fact, the central process of mourning and is a dynamic process with multiple facets (Neimeyer, 2000 ).”

“” In a recent publication, Neimeyer and Hogan (2001) commented favorably on the CBI’s reliability and validity and named it the best suited measure to study “normal” grief responses due to its focus on “core,” uncomplicated, bereavement phenomena.”

“This search for meaning and personal growth associated with the bereavement process has been described by a number of grief authors (Davis, Wortman, Lehman, & Silver, 2000; Fleming & Adolph, 1986; Gamino, Sewell, & Easterling, 2000; Neimeyer, 2000).”

“Meaning can be misunderstood as being something that one searches for and finds; in fact, rituals provide the opportunity to create meaning (Neimeyer, 2000).”

“Several authors have suggested that crises and difficulties can serve as vehicles for change and development (Mattingly, 1998; Neimeyer, 2000; Znoj, 2006).”

“Lyrics that fit into the category of ‘‘growing’’ described adolescents’ concern with finding some sense of meaning or personal growth through the loss.This search for meaning and personal growth associated with the bereavement process has been described by several grief authors (Davis, Wortman, Lehman, & Silver, 2000;…”

“Neimeyer, 2000 ), it is increasingly important to have standards in the field ensuring the basic competence of practitioners who work with the dying and the bereaved (Doka, 2003 ).”

“…on cognitive processing (Park & Helgeson, 2006), such as rumination (Tedeschi, Park, & Calhoun, 1998a, 1998b), accommodation and assimilation (Joseph & Linley, 2005), meaning reconstruction (Gillies & Neimeyer, 2006; Neimeyer, 2000, 2001), and positive appraisal and coping (Schaefer & Moos, 2001).”

“…complex, and useful narratives that accommodate the reality of the loss and its implications for the mourner (Bonanno, Wortman, & Nesse, 2004; Gillies, Neimeyer, & Milman, 2014; MacKinnon et al., 2013; Neimeyer, 2000; Neimeyer & Sands, 2011; Park, 2010; Steger, Frazier, Oishi, & Kaler, 2006).”

“of a meaningful narrative – a process that tends to facilitate emotional recovery [43–46].”