SPIRITUAL AND RELATIONAL DIMENSIONS OF PARENTAL GRIEVING by Derrick Wayne Klaassen A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES (Counselling Psychology) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) December 2010 © Derrick Wayne Klaassen, 2010 ii Abstract This study explored relational and spiritual dimensions of parental grieving. Five bereaved parental couples participated in three sets of interviews over the course of approximately three months. The guiding research question for this study was, “how do spiritual/religious bereaved parents grieve jointly for their deceased child?” Data was collected using the qualitative action-project method and participants were asked how they grieved together for their deceased child and how their spirituality impacted their joint grieving. Joint grieving processes were identified and monitored over approximately three months. The data analysis was informed by the qualitative action project and an instrumental case study method. Joint grieving was described and enacted as goal-directed activities, including both planned and unplanned grieving actions and intended towards the development of an ongoing, relational representation of the deceased child and towards the authentic and vibrant relationships with the partner and the Divine. Joint grieving was facilitated through engaging in joint grieving rituals, sharing individual grieving actions with one’s partner, and accepting the individual grieving style of the partner. Joint grieving was impeded by experiences of disconnection from the significant others, and by various life extraneous stressors. The joint grieving projects were irreducibly related to the spiritual lives of bereaved parents. Their faiths shaped the continuing bonds with their deceased children, offered comfort and spiritual meaning in the midst of suffering and provided an avenue to express disappointment and anger over their loss. The findings offer theoretical, empirical and clinical import for the multi-disciplinary study of parental bereavement. iii Preface This research project was approved by the University of British Columbia’s Behavioural Research Ethics Board (H07-03194, H07-03194-A001, H07-03194-A002, and H07-03194-A003). The action theory section of the literature review in Chapter 2 is based in part on a joint publication with fellow doctoral student, Matt Graham, and our joint supervisor Dr. Richard Young. I served as the first author for this publication and was responsible for its main theoretical argument and for situating it within the extant literature. Matt Graham assisted with some theoretical analysis and the write-up of the case study. The case itself came from Dr. Young’s research on transition to adulthood. Dr. Young’s research project was approved by the University of British Columbia’s Behavioural Research Ethics Board (B03-0292). Klaassen, D. W., Graham, M. D., & Young, R. (2009). Spiritual/religious coping as intentional activity: An action theoretical perspective. Archiv für Religionspsychologie / Archive for the Psychology of Religion, 31, 3-33. doi:10.1163/157361209X371456 iv Table of Contents Abstract ................................................................................................................................... ii Preface .................................................................................................................................... iii Table of Contents .................................................................................................................. iv List of Tables .......................................................................................................................... x List of Figures ........................................................................................................................ xi Acknowledgements .............................................................................................................. xii Dedication ............................................................................................................................ xiii Chapter 1: Introduction ........................................................................................................ 1 Spirituality and Health ................................................................................................. 2 Parental Bereavement .................................................................................................. 3 Limitations of the Extant Literature ............................................................................. 6 The Current Study ........................................................................................................ 8 Chapter 2: Literature Review ............................................................................................. 10 Definitions of Key Terms .......................................................................................... 10 Theoretical Approaches to Grief ................................................................................ 15 Psychoanalytic theory .................................................................................... 16 Attachment theory .......................................................................................... 18 Stage or task theories ..................................................................................... 21 Continuing bonds ........................................................................................... 22 Cognitive stress and coping theories.............................................................. 25 Religious/spiritual coping .............................................................................. 28 Integrative Models of Grief ....................................................................................... 32 v Meaning reconstruction model ...................................................................... 32 Dual-process model ....................................................................................... 35 Two-track model ............................................................................................ 38 Relearning-the-world model .......................................................................... 39 Theoretical Limitations .............................................................................................. 41 Research on Parental Bereavement ............................................................................ 43 Health complications of parental bereavement .............................................. 51 Moderators of parental bereavement ............................................................. 56 Searching for meaning ................................................................................... 61 Spirituality/religiosity and parental bereavement .......................................... 71 Empirical limitations ...................................................................................... 74 Contextual Action Theory.......................................................................................... 75 Action organization ........................................................................................ 78 Perspectives on action .................................................................................... 80 Levels of action .............................................................................................. 80 Context and process ....................................................................................... 81 Conclusion ................................................................................................................. 84 Chapter 3: Method ............................................................................................................... 85 Rationale for the Project ............................................................................................ 85 The instrumental case study approach ........................................................... 86 The qualitative action-project method ........................................................... 87 Participants ................................................................................................................. 88 Data Collection .......................................................................................................... 90 vi Initial set of interviews ................................................................................... 91 Analysis of the initial conversation .................................................... 94 Narrative feedback and member-check interviews ........................................ 96 Monitoring period .......................................................................................... 97 Final set of interviews .................................................................................... 98 Data Analysis ............................................................................................................. 99 Within-case analysis ...................................................................................... 99 Between-case analysis ................................................................................. 101 Trustworthiness and Rigour ..................................................................................... 101 Chapter 4: Findings ........................................................................................................... 106 Summary of Analysis Procedures ............................................................................ 106 Summary of Key Findings ....................................................................................... 107 Within Case Analysis ............................................................................................... 108 Couple 1 ....................................................................................................... 108 Joint grieving project ....................................................................... 109 Detailed description of the joint grieving project ............................ 110 Change in the joint grieving project ................................................. 121 Project summary .............................................................................. 125 Assertions ......................................................................................... 127 Couple 2 ....................................................................................................... 128 Joint grieving project ....................................................................... 129 Detailed description of the joint grieving project ............................ 130 Change in the joint grieving project ................................................. 140 vii Project summary .............................................................................. 147 Assertions ......................................................................................... 148 Couple 3 ....................................................................................................... 149 Joint grieving project ....................................................................... 149 Detailed description of the joint grieving project ............................ 150 Change in the joint grieving project ................................................. 161 Project summary .............................................................................. 164 Assertions ......................................................................................... 166 Couple 4 ....................................................................................................... 166 Joint grieving project ....................................................................... 167 Detailed description of the joint grieving project ............................ 168 Change in the joint grieving project ................................................. 177 Project summary .............................................................................. 181 Assertions ......................................................................................... 182 Couple 5 ....................................................................................................... 183 Joint grieving project ....................................................................... 183 Detailed description of the joint grieving project ............................ 184 Change in the joint grieving project ................................................. 195 Project summary .............................................................................. 197 Assertions ......................................................................................... 199 Cross Case Analysis ................................................................................................. 200 Commonalities ............................................................................................. 200 Magnitude of loss ............................................................................. 201 viii Compassion for bereaved parents .................................................... 202 Grieving and relationship careers .................................................... 203 Grieving and faith careers ................................................................ 205 Searching for meaning ......................................................... 206 Seeking and finding comfort in faith ................................... 207 Faith as a source of distress ................................................. 209 Faith and the relationship with the partner .......................... 211 Faith invigorated by mystical experiences ........................... 212 Planned and unplanned grieving ...................................................... 214 Grieving and vocations .................................................................... 215 Grieving changes ............................................................................. 216 Unique processes ......................................................................................... 217 Key Assertions ......................................................................................................... 222 Chapter 5: Discussion ........................................................................................................ 225 Summary of the Research Problem .......................................................................... 226 Summary of the Findings ......................................................................................... 226 Response to the Research Problem .......................................................................... 227 Illustrations of Previous Findings ................................................................ 227 The magnitude and impact of parental bereavement ....................... 228 Planned and unplanned grieving ...................................................... 229 Novel dimensions of parental grieving ........................................................ 231 Joint grieving ................................................................................... 232 Intentional grieving .......................................................................... 235 ix Multi-dimensional spirituality ......................................................... 241 Theoretical Implications .......................................................................................... 247 Clinical Implications ................................................................................................ 250 Limitations of the Study........................................................................................... 254 Future Research ....................................................................................................... 255 Conclusion ............................................................................................................... 257 References ........................................................................................................................... 260 Appendix A: Advertisement for Participants .................................................................. 286 Appendix B: Telephone Screening Protocol .................................................................... 287 Appendix C: Letter of Consent for Participants ............................................................. 289 Appendix D: Demographic Form ..................................................................................... 291 Appendix E: Researcher Telephone Monitoring Form .................................................. 293 Appendix F: Template for Participant Logbooks ........................................................... 294 Appendix G: Personal Relationship to the topic ............................................................. 295 Appendix H: Interview Guidelines ................................................................................... 298 Appendix I: Master List of Codes .................................................................................... 304 Appendix J: Overview of Study ........................................................................................ 305 x List of Tables Table 1: Purpose and Duration/Number of Research Procedures .................................................91 xi List of Figures Figure 1 Folkman’s Revised Coping Model .......................................................................... 27 Figure 2 Neimeyer’s Model of Meaning Reconstruction ...................................................... 33 Figure 3 Stroebe’s Dual Process Model of Grief ................................................................... 37 Figure 4 The Integrative Function of Action ......................................................................... 79 Figure 5 Rigour as Fidelity to Participants, Method/Theory and Scholarly Community .... 103 xii Acknowledgements Although this dissertation bears only one name on the cover, so many have contributed to its completion. My heartfelt gratitude is extended first and foremost to Holly, Aliya and Sammy, who have witnessed my efforts over the years and have supported me so sacrificially. I am also deeply grateful to other family members who have offered emotional encouragement and practical support throughout the process – Mom, Dad, Erv, Lilli, Daniel, Damara, Denise and Tom. Thank you also to my friends and research associates – Matt Graham, Carey Penner, Yaari Dyer, Celine Lee, and Hajera Rostam for your help with data gathering and analysis. I am also very grateful to those who offered their consultation along the way, Alfried Längle, Roland Balzer, Jose Domene, and Russell King. I also want to thank the two funding agencies who supported me with doctoral trainee scholarships – the Social Sciences and Humanities Research Council of Canada (SSHRC) for its Canada Graduate Scholarship and the Michael Smith Foundation for Health Research for its Senior Trainee Award. I am deeply indebted and grateful to the members of my research committee who have offered wise council and challenge throughout the duration of this project – Richard Young, Susan James and Marv Westwood. Finally, I want to offer a special ‘thank you’ to the bereaved parents in this project who opened up their lives to us all. Thank you for sharing your suffering and joy with us. You have taught us much. xiii Dedication To Jaycen Mark Kehler, who remains present with us. 1 Chapter 1: Introduction Over the past twenty years scholarly interest in the psychology of religion and spirituality has increased dramatically (Hill & Pargament, 2003; Paloutzian & Park, 2005). Notable recent contributions to this sub-discipline include the development and publication of new and innovative journals (e.g., Mental Health, Religion and Culture, the International Journal of the Psychology of Religion, and Psychology of Religion and Spirituality) and numerous comprehensive research reviews of and meta-analyses on the relationships between spirituality/religiosity and physical/mental health (e.g., Baer, 2003; Harrison, Koenig, Hays, Eme-Akwari, & Pargament, 2001; Hackney & Sanders, 2003; Koenig, McCullough & Larson, 2001; Smith, McCullough & Poll, 2003). Scholars of spirituality and religion are also finding their work more frequently included in mainstream reviews of other sub-disciplinary domains, such as stress and coping and positive psychology (e.g., Aldwin & Parke, 2004; Folkman & Moskowitz, 2004; Peterson & Seligman, 2004). Furthermore, other sub-disciplines, which share a significant thematic overlap with the psychology of religion and spirituality, such as existential, and constructivist psychologies (e.g., Frankl, 1984; Greenberg, Koole, & Pyszczynski, 2004; Raskin & Bridges, 2004; Wong & Fry, 1998) are also experiencing a resurgence in clinical and research interest. And while it may be argued that the sheer volume of research in these domains of psychology has contributed to their renaissance, wider social and cultural factors, such as a renewed interest in the understanding of faith-based worldviews following the worldwide resurgence of international terrorism, should not be discounted (Bibby, 2002; Meisenhelder, 2002; Plante & Canchola, 2004; Pyszczynski, Solomon, & Greenberg, 2003). 2 Spirituality and Health Many researchers in the social and health sciences have been particularly interested in understanding the relationships between spirituality, religiosity and health (Ano & Vasconcelles, 2005; Baer, 2003; Hackney & Sanders, 2003; Koenig, et al., 2001; Smith, et al., 2003). Within this literature, religious or spiritual coping has emerged as especially relevant to counsellors and psychologists because of its strong research foundation in the transactional model of stress and coping (Lazarus, 1999; Lazarus & Folkman, 1984). Spirituality or religiosity have been found to mediate the relationship between personality level constructs and various outcomes that are commonly of interest to psychologists – health, well-being, and pathology (Fabricatore, Handal, Rubio & Gilner, 2004; Park, 2006; Tix & Frazier, 1998). Scholars from various health disciplines and the social sciences have investigated the role of spirituality in relation to post-traumatic stress (Meisenhelder, 2002; Plante & Canchola, 2004; Smith, Pargament, Brant & Olive, 2000), depression and psychotic disorders (Bosworth, Park, McQuoid, Hays & Steffens, 2003; Reger & Rogers, 2002; Rogers, Poey, Reger, Tepper & Colemank, 2002; Taylor, 2001), hypertension (Krause, Lian, Shaw, Sugisawa, Kim, & Sugihara, 2002), dementia (Kinney, Ishler, Pargament & Cavanaugh, 2003), kidney transplant surgery (Tix & Frazier, 1998), living with HIV/AIDS (Richards & Folkman, 1997; Simoni, Martone, & Kerwin, 2002; Somlai & Heckman, 2000), end stage renal disease (Snethen, Broome, Kelber & Warrady, 2004), chronic pain (Bush, Rye, Brant, Emery, Pargament & Riessinger, 1999), mortality (Krause, 1998), cancer (Alferi, Culver, Carver, Arena, & Antoni, 1999; Gall & Cornblat, 2002; Laubmeier, Zakowski & Pair, 2004; McClain, Rosenfeld & Breitbart, 2003; Nairn & Merluzzi, 2003; Stanton, Danoff-Burg & Huggins, 2002), and bereavement (Anderson, 3 Marwit, Vandenberg, Chibnall, 2005; Murphy, Johnson & Lohan, 2003). One element that unites these diverse research foci is the fact that many research participants have, through illness or adverse life circumstances, been pushed to the limits of their existence and have had to face the finality of their lives or the lives of their loved ones. Such existential situations, so Pargament (1997), often move people to turn to and draw upon their spiritual/religious beliefs and practices. From a research perspective, these situations also be particularly enlightening about the role of spirituality in coping. Parental Bereavement One of the domains of investigation in which worldviews and coping practices have been investigated is the area of bereavement (Stroebe, Hansson, Schut, & Stroebe, 2008; Stroebe, Hansson, Stroebe, & Schut, 2001). The topic of death in general, and in particular the death of a child, is likely to invoke existential concerns in those who suffer from the loss (Center for the Advancement of Health [CAH], 2004; Klass, 1999; Pargament, 1997; Park, 2005). Qualitative and quantitative research programs have drawn attention to the suffering of bereaved parents and explored the ways in which they have attempted to cope with the loss of their child and readjust their lives to fit this new and tragic reality (Murphy, et al., 2003; Uren & Wastell, 2002). Most researchers and clinicians (Janzen, Cadell, & Westhues, 2003-04; Worden, 2004) acknowledge that the loss of a child is the most devastating loss for parents, and that this loss puts parents at significant risk for physical and mental health problems, including increased suicidal ideation (Murphy, Tapper, Johnson, & Lohan, 2003), higher levels post-traumatic stress disorder as compared to normative populations (Murphy, Johnson, Chung, & Beaton, 2003), increased risk of complicated or traumatic grief (Bennett, Litz, Sarnoff Lee, & Maguen, 2005; Murphy, 2008), increased rates of depression and 4 anxiety (Kreicbergs, Validmarsdottir, Onelöv, Henter, & Steinbeck, 2004; Znoj & Keller, 2002), higher rates of alcohol abuse for fathers (Vance, Boyle, Najman, & Thearle, 2002), marital/relational distress (Oliver, 1999) and even an increased risk of mortality (Li, Hansen Precht, Mortensen, & Olsen, 2003; Stroebe, Schut, & Stroebe, 2007). One of the main reasons for these health risks is that the loss of a child – at any age – is generally considered to be an ‘unnatural’ event, an event that reverses the biological order of death and often undermines significant portions of the parents’ assumptive worlds (Janoff- Bulman & Frantz, 1997). Given that modern societies have largely banished death from consciousness (Becker, 1973; Greenberg et al., 2004) and that modern medicine continues to chip away at the ever-declining child mortality rates (Ahmad, Lopez, Inoue, 2000), most parents do not expect to deal with the loss of a child and are thus ill-prepared to cope with such a trauma (Prigerson, Vanderwerker, & Maciejewski, 2008). Medical and spiritual communities as well, often have relatively few resources to aid suffering parents (Massey, 2000), in spite of the fact that many of the major world religions explicitly deal with the meaning of death (Rinpoche, 1992), and that for some, such as Christianity, the death of ‘the Son’ is the central, spiritual narrative (Klass, 1999). Many parents find themselves alone and at a significant loss in how to cope with such a devastating and all-encompassing crisis (D’Agostino, Berlin-Romalis, Jovcevska, & Barerra, 2008). One consistent theme that has emerged in the clinical and research literature on child loss is that many parents cope with their loss through engaging their religious and/or spiritual beliefs and practices (Attig, 1996; Pargament, 1997; Park, 2005). These grieving practices often extend beyond the participation in religious funeral services as parents find comfort in community, as well as solace and meaning in their relationship with the Divine (Klass, 5 1999). Researchers who have begun to explore the ways in which spiritual and religious resources and grieving practices may contribute to the recovery from parental bereavement have generally found them to be salutogenic in nature; that is, functioning as a protective factor against complicated grief and contributing to the adjustment and recovery process (Gillies & Neimeyer, 2006; Neimeyer, 2001; see recent reviews by Wortman & Park, 2008, 2009). Spiritual coping practices that have been demonstrated to be of particular benefit to bereaved parents include, benevolent religious reappraisal, collaborative religious coping, seeking spiritual connection, seeking support from clergy or faith community members, and finding meaning (Pargament, Koenig, & Perez, 2000). However, research on the role of spirituality/religion in coping in general (Klaassen, McDonald, & James, 2006; Pargament, 2002a, 2002b) and particularly in relation to parental bereavement (Park & Wortman, 2008, 2009) remains in its infancy. Many of the research efforts to date have attempted to bolster the support for the construct of spiritual/religious coping, while simultaneously exploring the mechanisms or strategies through which it emerges in the lives of people (Pargament, et al., 2000). This line of research has sought generally to establish the incremental validity of spiritual/religious coping and demonstrate that it cannot be explained away, that is, reduced to other social or psychological strategies. Additionally, the investigation of the role of spirituality in parental bereavement has been hampered by the oft-bemoaned isolation of research programs in the social sciences. Bereavement researchers (e.g., Stroebe et al., 2007; Gillies & Neimeyer, 2006) often fail to address spirituality as a multi-dimensional construct in their research and theoretical efforts – a point which has been argued often in the psychology of religion and spirituality (Harrison, et al., 2001; Wortman & Park, 2009). Researchers in spirituality and religiosity, on the other 6 hand, have frequently failed to take into account bereavement researchers and scholars who have addressed spiritual coping outside of the domain of the psychology of religion and spirituality (e.g., Klass, 1999; Neimeyer, 2001; Rubin, 1999; Wong & Fry, 1998). Thus, while the research on the role of spirituality in parental bereavement is growing, it remains fragmented and disorganized, with many scholars in one domain failing to cite those who do not customarily publish in their area. Limitations of the Extant Literature The upshot of the research on the role of spirituality in parental bereavement is that the literature is scattered across the social and health sciences, that few theoretical models exist that attempt to integrate the literature from these divergent domains, and that relatively little attention has been paid to the social and relational context in which it takes place (CAH, 2004; Walter, 1996). A systematic review of the literature – elaborated more fully in the following chapter – revealed several areas for further investigation. Although the vast majority of researchers and clinicians (e.g., Bowlby, 1980/1998) recognize that parental bereavement is an inherently relational trauma, and that parents cope with this event in relationships (e.g., with the deceased child, themselves, their partners and so forth), the vast majority of studies continue to conceptualize and research grieving as an intrapsychic process. From this dominant perspective, parental grieving is about the individual parents’ relinquishing or reconfiguring of the parental bond and the development of a stable ‘inner representation’ of the parent-child relationship (Klass, 1999). Researchers typically employ individual parents in their research studies and commonly are interested in the individual’s grieving process or the relationships between individual grieving and health (Stroebe, et al., 2007). 7 When scholars do investigate relational aspects of parental bereavement, they typically focus on the parent-child attachment (Uren & Wastell, 2002), the role of spiritual and/or social support for bereaved parents (Barerra, D’Agostino, Schneiderman, Tallett, Spencer, & Jovcevska, 2007) or the effects of child loss on the parental relationship (Oliver, 1999). With a few notable exceptions (e.g., Nadeau, 2001a, 2001b; Toller & Braithwaite, 2009; Wijngaards-de Meij, Stroebe, Schut, Stroebe, van den Bout, van der Heijden, & Dijkstra, 2008), few scholars have asked the question how parents grieve jointly for their child – how does parental grieving emerge in their ongoing relationship with each other? Scholars have commented on the individualistic and intrapsychic focus of grieving and have suggested that parental grieving, in particular, be also investigated as a relational process (Klass & Walter, 2001; Rosenblatt, 2000; Walter, 1996), that is, as a process embedded within the dyadic relationship of the bereaved parents. Such a reconceptualization poses theoretical and methodological challenges to the field as most theories and methods consider the individual bereaved parent to be the unit of analysis. The excessive focus on research methods that highlight the individual, intrapsychic (e.g., cognitive, emotional, behavioural) dimensions of grieving has likewise obscured contextual elements of the parental bereavement (Rosenblatt, 2001), such as spirituality/religiosity and culture. Grieving parents do not mourn for their children in a vacuum but rather embody the cultural and spiritual/religious norms and preferences in their grieving actions (Klass, 1999). A few scholars have begun to research parental grieving in diverse cultures (e.g., Klass & Walter, 2001) and this has been widely acknowledged to be important and underrepresented work (Stroebe et al., 2008). However, the context of parental grieving in dominant cultures and religious traditions in North America and Western Europe 8 has likewise been ignored. When contexts are taken into account, the vast majority of studies do so only minimally, and focus on the effect of certain moderator variables (e.g., age of the deceased, type of death, etc.) on the health and adjustment of the mourners (cf. Stroebe, et al., 2001). While it is important to understand the risk factors that may extend or complicate the grieving process, such an understanding of context is rather anaemic and ignores the more basic contextual and relational features that shape the course of bereavement (Walter, 1996; cf. American Psychological Association, 2003). Adequate attention to the context of bereavement requires researchers to pay attention to the ways in which contextual factors are woven into the very fabric of grieving (cf. Shweder, 2000) and to the ways in which such factors shape, inhibit or enhance the grieving process itself (Doran & Downing Hansen, 2006). Scholars have argued that the contextual dimensions of a given phenomenon are best explored – at least initially – through qualitative methods (Belzen, 1999; Klass, 1999). The Current Study This dissertation addresses some of the above-noted omissions in the parental bereavement literature by investigating how bereaved parents draw on their spirituality/religiosity to grieve jointly for their deceased child. The study employed contextual action theory (Valach, Young, & Lyman, 2002) as its theoretical lens and the qualitative action-project method (Young, Valach, & Domene, 2005) as its method of inquiry. The research question for this study was: How do spiritual/religious bereaved parents grieve jointly for their deceased child? Contextual action theory can be considered an integrative framework – a specific way of looking at human emotional, cognitive, behavioural and relational processes – that draws on a variety of discourses in the social sciences, including, social constructionism, 9 hermeneutics, phenomenology, and narrative studies (Valach, et al., 2002; Valach & Young, 2004). One of the chief features of this integrative framework is that it assumes action, and in particular joint action – intentional human activity – to be its central construct and unit of analysis. Thus, in contrast to much of the recent research on bereavement, contextual action theory directs the researcher to explore the ways in which grieving emerges jointly and intentionally in the actions of bereaved parents. As a construct, action serves to synthesize phenomena and contextualize them within the relationships in which they emerge over time (Young, et al., 2002; cf. Lazarus, 2000). The qualitative action-project method (Young, et al., 2005) was chosen as the strategy of inquiry for this study. As a qualitative, process-oriented method, the action project method is ideal for developing an understanding of how bereaved parents grieve together over time. The method explores intentional human activity from three perspectives – behavioural activities (what parents do), internal processes (what parents think and feel) and social meaning (what actions are about and where they lead). In light of the evident omissions in the extant literature and the chosen theory and method of inquiry, the following aims for this study were identified. The central goal for this study was to understand and describe how spiritual/religious bereaved parents grieved together for their lost child. The aim was to arrive at a rich and contextually-sensitive description of this grieving process, and to understand how this grieving emerged in the midst of the ongoing spiritual lives and dyadic relationships for each couple. Given the lack of empirical and theoretical developments in dyadic grieving, it was hoped that the findings might also offer novel theoretical constructs, which could be germane to future research endeavours and helpful in clinical practice. 10 Chapter 2: Literature Review The intention for this chapter is to provide an overview of the relevant domains of literature for a study on spirituality and parental bereavement. The literature review begins by discussing key terms for this study: spirituality, religiosity, bereavement, and grieving. Next, the area of bereavement research is explored, focusing first on key theoretical grieving models and then elaborating on the experience of parental bereavement and the research on the grieving process for bereaved parents. This section concludes with an exploration of the existing literature on the role of spirituality and religiosity in parental bereavement. The second part of the literature review introduces contextual action theory as the theoretical framework for this investigation. This section outlines action theory more fully, explains its major constructs and describes the qualitative action project method. Definitions of Key Terms At the outset of such a project, it is prudent to review key theoretical constructs in the literature. For the sake of brevity, this sections is limited to the definitions of religion, spirituality, bereavement, and grieving. It bears noting that some of these terms, such as religion and spirituality, are vigorously debated in the research literature, and that scholars have not yet (and may never) come to a consensus about their definitions. This perennial disagreement has prompted some scholars to call for the abandonment of the search for universal definitions of religiousness and spirituality and suggested that local, culturally- specific definitions may be more appropriate (Belzen, 1999). Others (e.g., Zinnbauer & Pargament, 2005) contend that there may indeed be hope for the peaceful coexistence of multiple perspectives if not the opportunity for synergistic advancement. 11 Scholars of religion (e.g., Bibby, 2002, 2008; Pargament, 1997) remind us that the term religion (as well as its derivatives, religiousness and religiosity) has a long history within the humanities and social sciences. Traditionally, religion was considered a broad- band construct (Pargament, 1999), which incorporated both public (e.g., public prayer, worship attendance) and private (e.g., private prayer, beliefs, finding hope and solace) expressions. In relative recent history, concurrent with the advancement of secularization in many western countries, religion has been reconstructed as a narrow-band construct, which includes only public and formal expressions and has fallen out of favour with academics (Zinnbauer, Pargament, & Scott, 1999). Religion, in this view, is seen as formal, stultified, and largely unrelated to authentic experience of the transcendent or the divine. Concurrently with the decline of religion, the term spirituality has gained in popularity and has been defined as separate from religion. Spirituality is understood as a broad-band construct, focused on the personal and relational, and is seen as authentic engagement with the transcendent or divine. While it behoves scholars to understand the history and development of such constructs and to examine them critically, it is nonetheless important to employ terms, such as religion and spirituality, in a contextually-sensitive manner (Belzen, 1999). One group of scholars (Hill, Pargament, Hood, McCullough, Swyers, Larson, & Zinnbauer, 2000) has proposed a solution that takes into account historical understandings of religion and spirituality and offers definitional criteria for both spirituality and religion. They suggest that it is perhaps too early to propose conclusive definitions for these constructs as they remain under-investigated and controversial. However, they propose that their description of these terms may serve to identify commonalities and unique aspects of the constructs. Accordingly, both religion and spirituality are described as “feelings, thoughts, 12 experiences and behaviors that arise from a search for the sacred. The term ‘search’ refers to attempts to identify, articulate, maintain or transform. The term ‘sacred’ refers to a divine being, divine object, Ultimate Reality, or Ultimate Truth as perceived by the individual” (p. 66). Religion, in addition, is proposed to include “a search for non-sacred goals (such as identity, belongingness, meaning, health or wellness)” (p. 66) and the “means and methods (e.g., rituals or prescribed behaviors) of the search that receive validation and support from within the identifiable group of people” (p. 66). These descriptions include both functional and substantive elements, allow for the emergence of spirituality outside of or within a religious framework, and yet also avoid the pitfall of indiscriminate spiritualization. Following Belzen’s (1999) suggestion of contextually-sensitive definitions, it is important to elaborate on the role of the spiritual in the lives of bereaved parents. Drawing on his twenty-year ethnography with a bereaved-parent support group in the United States, Klass (1999) identified three essential features of the spiritual life that are particularly relevant to those who have experienced the loss of a child. Spirituality, in this context, relates to (1) an encounter or union with transcendent reality (e.g., God or the Divine); (2) the adoption a worldview, that is, a set of beliefs, assumptions, and practices that give order and meaning the world, and (3) belonging to a community who seek to live out their lives in relation to the transcendent reality and worldview. Klass emphasizes that spirituality does not refer to other-worldly phenomena, but emerges in the day-to-day lives of bereaved parents. He notes, that, “spirituality is woven into the fabric of our world. The question is not whether spirituality is present; the question is whether we see it. The color-blind and the color-sighted see the same world; the difference is in the seer not in the seen” (p. 172). 13 In the domain of bereavement, two common terms should be explained. Bereavement is typically considered to be an umbrella term for the entire process of death and dying, including the anticipation of death, the actual experience of the death itself and the subsequent period of adjustment to the loss of a loved one (Christ, Bonanno, Malkinson, & Rubin, 2003; CAH, 2004). Grieving, by contrast, is more specific and addresses both the personal reaction to loss as well as activities that aim to restore personal wholeness. Attig (1996) has differentiated two types of grieving – active and reactive grieving. Reactive grieving has been described as an emotional reaction to a loss, which points to the felt discrepancy between the world as it is, and the world as it should be. This type of grieving typically emerges in the early phases of coping with a loss. Active grieving, by contrast, is defined as an integrative effort to reshape existing life patterns and relearning one’s personal and relational world. The main contrast, for Attig, is that this active part of grieving is a process that is imbued with personal choice, with an opportunity to live out one’s recovery in consonance with personal values and in harmony with one’s being-in-the- world (Dasein; Heidegger, 1927/1962). He notes, that Grieving is inherently a multi-faceted struggle toward renewed wholeness and restoration of personal integrity, within broader social and historical contexts that support and sustain identity and meaning in our lives. Because we are primarily practically engaged in the world and only secondarily self-reflective, bereavement reveals how much we have taken for granted as it uproots our souls, shakes our spirits, and reminds us that even the most viable posture in the world is tentative and precarious. (p. 358) 14 Since this current project draws upon contextual action theory, Attig’s (1996) differentiation between active and reactive grieving is particularly relevant. Two points about grieving are worth emphasizing: Firstly, grieving is not merely a directionless expression of pain, but rather intentional and directed towards the restoration of wholeness. Various scholars disagree on the ultimate aim for the grieving process (cf. Parkes, 2001; Klass, Silverman, & Nickman, 1996), but generally find consensus that grieving is an agentic activity, which involves turning towards the experience of the loss of someone of value in one’s life, accepting the facticity of the loss and beginning to find a new orientation, a new way of relating to the deceased, and a new way forward in our lives (Längle, personal communication, September 8, 2007). Secondly, grieving in general and especially parental grieving has been described as a holistic process that involves a relearning of one’s entire being-in-the-world (Attig, 1996; Klass, 1999; cf. Chiari & Nuzzo, 2006). Thus, while parental grieving may involve cognitive reappraisals and coping behaviours, it is more accurately understood from a holistic perspective, involving the entire person-in-context and his/her spiritual, psychic and somatic dimensions. Such a complex process calls for an ontological and epistemological openness on the part of the researcher, as well as a research method which can address this complexity. Theoretical Approaches to Grief The study of bereavement in modern society has emerged largely over the last century. Although grieving and bereavement are universal experiences, which have been explored by poets, scholars and spiritual texts throughout the ages, the modern understanding and investigation of bereavement and grieving can be dated to a landmark paper by Sigmund Freud, Mourning and Melancholia (1917/2005). Freud’s work on grieving and depression, as 15 we would translate these terms in current psychological literature, was foundational for the study of grief and remains influential in clinical practice to this date. Attachment theorists (Bowlby, 1980/1998; Parkes, 1996) subsequently shaped the psychodynamic tradition and gave rise to further stage (Kübler-Ross & Kessler, 2005) and task (Worden, 2004) based theories of grieving. Challenges emerged for the psychodynamic understanding of grieving with the rise of the cognitive revolution (Wortman & Silver, 1989, 2001), and some began to explore the experience of grieving through the lens of the transactional coping theory (Folkman, 2001; Park & Folkman, 1997). More recently, we have witnessed the rise of numerous integrative theories of grieving, such as Stroebe’s dual process model (Stroebe, Schut, & Stroebe, 2005), Rubin’s two track model (Rubin, 1999) or Neimeyer’s meaning-reconstruction model (Gillies & Neimeyer, 2006; Neimeyer, 2000). These integrative models have generally attempted to bring together traditional psychodynamic understandings of grieving with cognitive and constructivist frameworks (Bonanno & Kaltmann, 1999; Davies, 2004; Stroebe, Folkman, Hansson, & Schut, 2006). Additionally, recent challenges to traditional psychodynamic understandings of grieving have emerged from continuing bonds perspectives (Klass, 1999; Klass, et al., 1996). Psychoanalytic theory. The history of modern psychoanalytic and psychodynamic thinking on bereavement and grief finds its origins in Freud’s work (1917/2005) on grieving and depression in the context of the horrific deaths associated with World War I. Written within the wider framework of the psychoanalytic understanding of libidinal energies, Freud postulated that grieving (or mourning, as it is still known in psychoanalytic circles) served the function of withdrawing libidinal energies from a given object. The purpose of this 16 withdrawal was to free the ego from the continued attachment to the deceased and enable it to invest this energy into other objects or activities. This process of decathexis (or ‘relinquishing bonds’, as some have termed it; cf. Klass et al., 1996) and the subsequent re- investment of the energy in other objects or activities developed the fundamental psychological dynamic of grief work (or “Trauerarbeit” in German; cf. Hagman, 2001). The dynamic of disengagement and reengagement became the central process for the psychodynamic understanding of grief and finds its expressions today in modern integrative theoretical models (e.g., Rubin, 1999; Stroebe et al., 2005). And as we will see, decathexis has also become a central point of contention within the parental bereavement literature (Klass et al.), with clinicians and scholars challenging the validity of such a process for bereaved parents. A second and highly influential paper on grieving within the psychoanalytic community was published by the psychiatrist Erich Lindemann in 1944. This paper, too, was written in the aftermath of a traumatic event – the Cocoanut Grove fire in Boston – and drew upon Lindemann’s clinical observations after treating 101 patients at a local hospital. Lindemann’s observations were highly influential at the time and critical to subsequent theoretical and clinical developments (Parkes, 2001, 2002). He identified several key processes and constructs, including the differentiation between normal and pathological (or “morbid”) grieving. Normal grieving, according to Lindemann’s observations, involved ‘grief work’ or the “emancipation from the bondage to the deceased, readjustment to the environment in which the deceased is missing, and the formation of new relationships” (p. 190). Normal grief included symptoms of somatic distress, preoccupation with the image of the deceased, guilt, hostile reactions, and a loss of patterns of conduct. Pathological or 17 morbid grieving, by contrast, involved delayed or postponed grieving, or distorted reactions, such as overactivity without an emotional acknowledgement of the loss, the adoption of psychiatric symptoms belonging to the deceased, the development of psychosomatic conditions (asthma, arthritis, colitis), irritability and hostility in relation to one’s friends, a repression of rage, changes in social interactions, and agitated depression. Lindemann also claimed that normal grieving could be alleviated within eight to ten psychiatric interviews over the course of four to six weeks, thus laying the groundwork for the differentiation between normal and prolonged grief and for time-limited clinical intervention in the form of grief counselling. While the work of Freud (1917/2005) and Lindemann (1944) was highly influential on subsequent research and theoretical developments, scholars have also offered several criticisms of the early psychoanalytic perspectives on grieving (Wortman & Silver, 1989, 2001; Klass et al., 1996; Stroebe et al., 2005). While some critics focused on inadequate research methods for Freud and Lindemann, one the strongest and most enduring critiques was that both clinicians failed to take their context into account in their descriptions of grieving. Both psychoanalytic accounts were derived from work with psychiatric patients who had experienced severe traumas and whose losses were violent and, at times, unexpected. Thus, it is not surprising that both Freud and Lindemann encountered psychopathology (depression and post-traumatic stress, respectively) in their clinical work with bereaved patients, and that their descriptions of grieving tended to pathologize this process. Modern research on complicated grief has certainly sustained the claims that grieving can be associated with psychopathology (Prigerson, et al., 2008), but it has also 18 shown in many cases, particularly in ones where the deceased died a timely and peaceful death, that grieving can be unencumbered by pathology (Mikulincer & Shaver, 2008). Attachment theory. John Bowlby and his colleagues at the Tavistock Clinic in London (Bowlby, 1980/1998, Parkes, 1996) sought to enhance the existing psychoanalytic formulations of grieving through the adoption of an interpersonal perspective of this process. Drawing upon his earlier work on maternal-child relationships, Bowlby essentially conceptualized grieving as a form of separation anxiety, in which the bereaved undergoes a series of psychological reactions in adapting to the psychic reality of the permanent loss of the loved one. The phases were initially identified as protest, despair and detachment but later reformulated as, (1) numbing (with intermittent outbursts of extreme distress), (2) yearning and searching for the lost person, (3) disorganization and despair, and (4) reorganization (Bowlby; Parkes, 2001). Bowlby’s (1980/1998) phases of grieving were slightly amended in relation to the loss of a child. Drawing upon his research studies with the bereaved parents of young, fatally-ill children, Bowlby identified the grieving phases as, (1) numbing (with outbursts of anger), (2) disbelief and attempts to reverse the outcome, (3) disorganization and (4) reorganization. He acknowledged that bereaved parents frequently face numerous relational struggles, such as marital problems and divorce, as well as mental health challenges, such as substance abuse, depression, anxiety and psychosomatic symptoms. Critically, Bowlby was one of the first to comment on shared grieving between bereaved parents. Commenting on the importance of the parental relationship for the grieving process, he noted: How well or badly mourning proceeds, every study shows, turns in great degree on the parents’ own relationship. When they can mourn together, keeping in step from 19 one phase to the next, each derives comfort and support from the other and the outcome of their mourning is favourable. When, by contrast, the parents are in conflict and mutual support is absent the family may break up and/or individual members become psychiatric casualties. (pp. 120-121) It is important to note that Bowlby’s (1980/1998) research on the grieving processes of bereaved parents exclusively involved parents whose children were diagnosed with fatal illnesses. It is questionable as to whether these phases are relevant for the grieving of parents who have their children to acts of violence or sudden deaths, such as murder, suicide or accidents. Also, Bowlby’s description of parental grieving spanned the time-frame from the point of diagnosis until approximately two years after the death of the child, and thus included both the process of dying and an initial period of grieving. One of the most significant contributions from attachment theory is the identification of secure and insecure (anxious, avoidant) attachment patterns (or attachment styles) and their respective impacts on the grieving process (Bowlby, 1980/1998; Parkes, 2002). Individuals with chronic attachment insecurities are often unable to: (1) develop and maintain normal levels of autonomy, (2) soothe themselves when remembering the deceased loved one; (3) reinvest their emotional energies in new relationships. Thus, insecure attachment patterns are likely to precipitate prolonged and complicated grief. Avoidant attachment styles, typically characterized by the denial of attachment needs and the suppression of attachment-related thoughts and emotions, are likely to lead to absent or delayed grief. Secure attachments, by contrast, are predictive of the successful resolution of grieving, described by Mikulincer and Shaver (2008) as follows: 20 Psychologically successful mourners can integrate elements of their identities that were related to the lost relationship into a new reality, maintain a symbolic bond to the deceased while adjusting to real circumstances, and restore and even enhance their sense of security and well-being on the basis of the continuing attachment bond with the deceased and new attachment bonds with living companions (p. 94) In relation to the focus on parental bereavement in this current project, it is important to keep in mind that the vast majority of research which supports attachment theoretical conceptualizations on bereavement and grieving has been conducted with individuals who have experienced the loss of a partner or an adult attachment figure (Bowlby, 1980/1998; Parkes, 2002; Stroebe et al., 2005). A few studies (e.g., Uren & Wastell, 2002; Wijngaards- de Meij,et al., 2007) have explored parental bereavement from an attachment theory perspective, but prominent scholars on parental bereavement (e.g., Klass, et al., 1996; Murphy, 2008) have questioned how well dominant grieving theories map onto the experience of child loss, particularly if that loss is unexpected and violent. Stage or task theories. Influenced by Bowlby’s (1980/1998) work on attachment and loss, several scholars and clinicians have developed similar versions of the grieving process, that have either emphasized the stages of dying and grieving (Kübler-Ross & Kessler, 2005) or the tasks of grieving (Worden, 2004). While neither of these theories have emerged as a result of a systematic program of research, it is hard to deny that the work of Elisabeth Kübler-Ross and William Worden have had a significant impact on bereaved individuals and those who work with them. However, the popularity of the theories has not prevented researchers from offering poignant critiques of their work (Wortman & Silver, 1989, 2001). 21 Swiss psychiatrist Elisabeth Kübler-Ross (1969, Kübler-Ross & Kessler, 2004) initially formulated an interdisciplinary and largely theoretical account of the process of dying, which was based largely on her clinical observations and was informed by attachment theory (Parkes, 2002). Other authors saw parallels between the process of dying and that of grieving and suggested that her work had implications for models of grieving also (Bennett, 2009). In the later years of her life, Kübler-Ross co-authored a book in which she formally adopted the five-stage dying process as a five-stage grieving process. This process included the well-known stages of denial, anger, bargaining, depression and acceptance. Kübler-Ross added the caveat that the stages “are not stops on some linear timeline of grief. Not everyone goes through all of them or goes in a prescribed order” (Kübler-Ross & Kessler, p. 7). William Worden’s (2009) classic text on grief counselling is currently in its fourth edition. Drawing on Bowlby’s (1980/1998) conceptualization of grieving as a process and Freud’s (1917/2005) construct of grief work as an active process, he formulated four tasks of grieving: (1) to accept the reality of the loss, (2) to process the pain of the grief, (3) to adjust to a world without the deceased, and (4) to find an enduring connection with the deceased in the midst of embarking on a new life. Over the years, Worden’s formulations of the grieving process have changed slightly. His newer texts have included three subtasks as part of the adjustment to the world without the deceased. These have included external adjustments (e.g., learning to take over some of the tasks performed the deceased person), internal adjustments (e.g., adjustment to one’s identity and sense of self), and spiritual adjustments (e.g., finding meaning in the loss). More substantively, Worden’s fourth task has departed from his original decathexis hypothesis and has opened up the possibility of the establishment of a continuing bond with the deceased. And while Worden has acknowledged 22 the possibility that some people may not complete all tasks in the order outlined, he has held fast to the assertion, that “it is essential that the grieving person address the issue of these tasks in order to adapt to the loss” (p. 39). Continuing bonds. One of the most central questions in the grieving process relates to its purpose or intended end. Freud (1917/2005) initially posited that the purpose of grieving was the withdrawal of libidinal energies from the deceased object. This ‘relinquishment hypothesis’ was generally supported by subsequent theorists (Bowlby, 1980/1998), although some (e.g., Mikulincer & Shaver, 2008; Parkes, 2002) have argued that Bowlby has been misunderstood in this regard. Some recent critics (Klass et al., 1996; Klass, 2006), however, have suggested that Bowlby and many bereavement researchers have over- emphasized the relinquishment of bonds and ignored those who sought to maintain a continuing bond with the deceased. Klass (1999) stated this argument as follows: Grief has been defined for most of the twentieth century as breaking an attachment. The advice given to bereaved people was to mourn their loss, let go of the dead, and move on to form new attachments in the present. Clinicians assumed, with virtually no supporting data, that grief was pathological or chronic if the bereaved held on to the dead or maintained their bond. Researchers who sought to understand and not immediately pathologize these continuing bonds began to explore previously neglected contextual aspects of grieving, such as spiritual and religious beliefs and practices and cultural dimensions of bereavement (Hussain & Oyebode, 2009; Klass & Goss, 1999). This line of research is especially relevant for a study on the role of spirituality in parental bereavement, as much of research supporting these continuing bonds has emerged from studies of parental bereavement. 23 The work on continuing bonds has largely been credited to Klass and his colleagues (Klass et al., 1996; Klass & Walter, 2001). Klass (1999) conducted a 20-year ethnography as a consultant to a bereaved parent support group, which culminated in his publication of The Spiritual Lives of Bereaved Parents. While other researchers and clinicians (e.g., Bowlby, 1980/1998) have suggested that the presence of continuing bonds may at times be adaptive in the grieving process, it was Klass and his colleagues who the made the explicit case for the possibility of continuing bonds. On the basis of his research and clinical work, Klass suggested that bereaved parents do not necessarily relinquish the bonds with their children; rather, they transform the bond into an ongoing inner representation with their deceased child. He noted that “the transformation of the inner representation of the child is, I think the key to understanding the spiritual lives of bereaved parents. For their parents, when the bond is transformed, children become like angels, saints, or bodhisattvas, that is, beings who mediate between the realm of the sacred and the realm of human beings” (p. 52). It is worth noting that the term “inner representation” may be somewhat confusing, as bereaved parents frequently resist being told that their continuing bonds with their children is merely a matter of memories and emotions on the part of the bereaved (Klass, 1999). Rather, many bereaved parents experience their continuing bonds with their children as an ontological reality and not a mere mental representation thereof. While the veracity of such claims is not subject to verification in traditional social science, this author contends that we need not reduce them to psychological constructs or pathologize them by explaining them as psychotic processes (Field, 2008; Field & Filanovsky, 2010). If we want to do justice to the experience of the continuing bonds for bereaved parents, bereavement researchers and 24 clinicians must at least make room within their own worldviews for the possibility of such continuing bonds and take the experience of them seriously. Perhaps due to his work with bereaved parents rather than bereaved individuals, Klass and others (e.g., Riches & Dawson, 1996; Walter, 1996) have also challenged the intrapsychic conceptualization of grieving. Their interpersonal vision of grieving argues for a reconceptualization of this process as a dialogical exchange embedded in relationships. These include relationships with the deceased child, the bereaved parental couple, the community and, if relevant, the Divine. The purpose or goal of grieving as a dialogical process is, according to Walter, the construction of a durable biography that “enables the living to integrate the memory of the dead into their ongoing lives” (p. 51). It is critical to understand that this dialogical perspective does not require the relinquishment of grieving as an intrapsychic process, as bereaved parents maintain the capacity to be in dialogue with themselves (Längle, 2005a). Rather, this perspective can be understood as a restoration of balance to the grieving process, which may now be understood as incorporating both intrapsychic and interpersonal elements. Indeed, some philosophers have suggested that all being is irreducibly relational, a being-in-the-world (Dasein; Heidegger, 1927/1962). In addition to the relational reformulation of grieving, Klass (1999; Klass & Walter, 2001) has also suggested that parental grieving is a process that unfolds over time. In contrast to the stage or task theorists (Bowlby, 1980/1998; Kübler-Ross, 1969; Worden, 2004), however, Klass has eschewed the development of a regular process of steps and has suggested that it might be helpful to adopt the loose outline of the grieving journey employed by the bereaved parents themselves. The parents in Klass’s support group described four phases of the grieving-process: (1) newly bereaved, (2) into their grief, (3) well along in their 25 grief, and (4) resolved as much as it will be. A crucial distinction in this sequence of grieving is the absence of resolution or closure to the grieving process. Bereaved parents are frequently adamant in claiming that their grieving does not have an endpoint, however, they also note that the grieving process does not stay the same (Klass). This grieving process will be elaborated more fully in a subsequent section in this chapter. Cognitive stress and coping theories. In addition to the psychodynamic theories of bereavement and grieving, cognitive stress and coping models have had a significant impact on the grieving literature (Folkman, 2001; Lazarus, 1999; Park & Folkman, 1997). While there are some variations among current models of coping that have been applied to grieving, the central features of these models overlap significantly and find their common origin in Lazarus and Folkman’s transaction model of coping (Lazarus & Folkman, 1984). These features include an understanding of the subjective rather than objective nature of stressor, the cognitive appraisal process, and the individual’s response through problem-focused or emotion-focused coping strategies. Problem-focused strategies have an objective emphasis as they are intended to alter the source of the distress. Emotion-focused coping strategies, by contrast, are employed when the problem cannot be remedied and their intention is on shifting the person’s emotional response to the stressor. In the context of grieving, emotion- focused coping is generally considered a more appropriate response. Since their original publication, both Lazarus (1999) and Folkman and her colleagues (Park & Folkman, 1997; Stroebe, et al., 2006) have revised their coping models. Lazarus (1993, 1999, 2006) proposed the rather radical idea of abandoning the study of stress and coping entirely and suggested that researchers and clinicians instead focus on the development of an integrative theory of emotion, which would include both stressful 26 emotions and those that fall outside of this domain. Folkman (Folkman, & Moskowitz, 2000, 2004), by contrast, retained the basic structure of the original coping model, but made modifications to include the role of positive emotion and meaning-making in the coping processes. These latter amendments are particularly relevant to the grieving process as they were developed in light of Folkman’s investigation of caregiving for persons living with and dying from HIV/AIDS (Richards & Folkman, 1997; Richards, Acree & Folkman, 1999). Folkman’s (2001) (see Figure 1) expanded coping model retains the elements of primary and secondary appraisal, in which the former determines whether the event is a threat, challenge, harm/loss or benign, and the latter evaluates whether the person in the situation has the personal and social resources to manage the stressful situation. Should an event, such as a death, be appraised as harmful, the person would engage in problem and emotion-focused coping strategies to manage the situation and regulate emotional distress. If these strategies result in the reduction of distress, the person would experience a positive emotional experience as a result. In the event of the death of a child, however, problem and emotion-focused coping efforts are unlikely to ameliorate the significant distress that parents experience, especially in the immediate aftermath of the loss. In this case, Folkman (2001) postulated that the distress of unsuccessful coping is likely to engage meaning-based coping. 27 Figure 1. Folkman’s revised coping model. © American Psychological Association, 2001, by permission. Folkman and her collaborators (Folkman, 2001; Park & Folkman, 2001; Park, 2005) have differentiated between two general types of meaning. Global meaning refers to general goals, beliefs and assumptions about the world. Meaning-making coping, however, happens in response to a specific event. Situational meaning, is defined as “the meaning that is formed in the interaction between a person's global meaning and the circumstances of a particular person-environment transaction. Situational meaning encompasses an initial appraisal of the meaning of the event and the search for meaning... In terms of situational meaning, meaning refers to the significance of a particular occurrence in terms of its relevance” (Park & Folkman, 1997, p. 116). Meaning-making coping involves an ongoing comparison process between global and situational meanings (Park & Folkman, 1997). Global meanings influence initial appraisal processes, are then compared with the appraised, situational meaning, and are then implicated in the coping strategies that alleviate the distress. 28 Following the initial coping efforts, situational and global meaning structures are once again compared in terms of their congruence. In the case of congruent meaning structures, the person will be able to accept and resolve the stressful situation. Should this not be the case, it is likely to cause persistent rumination and a re-engagement of the coping and re-appraisal processes. Religious/spiritual coping. Drawing upon Lazarus and Folkman’s (1984) theory of coping, Pargament and his colleagues (Ano & Vasconcelles, 2005; Harrison et al., 2001; Pargament, 1997; Pargament, Zinnbauer, Scott, Butter, Zerowin, & Stanik, 1998) developed a theory of coping that integrated a multi-dimensional understanding of spirituality and religiosity with the cognitive appraisal and coping process. Pargament’s work is arguably one of the most well-developed theories that includes spirituality in the daily coping activities of individuals facing various life stressors. Some researchers (Park, 2005; Wortman & Park, 2008, 2009) have expanded his work and integrated it with Folkman’s (2001) revised theory of coping, focusing specifically on the role of meaning-making in the coping processes of bereavement and grieving. Pargament’s theory (1997) begins with the fundamental supposition that people are inherently motivated, that is, that much of human activity is not just simply reactive to external stimuli, but intentional and goal-directed. Equally important, Pargament suggested that human beings are not simply attracted to anything, but rather drawn towards objects of significance. It bears noting that the assumption that human beings are inherently meaning- oriented beings has been echoed by many scholars in social sciences, including Emmons (1999), Frankl (1984), and Valach and colleagues (Valach et al., 2002). Pargament’s (1997) theory postulates further that people are not simply passive recipients and processors of 29 information, but that they actively anticipate, plan, create and shape – in short – construct events to maximize their experienced sense of significance and attain their personal goals. This transaction between the person and his/her context is applicable both to positive events and to times of difficulty and stress. Similar to most prominent researchers in coping (e.g., Folkman & Moskowitz, 2000; Lazarus, 1999), Pargament (1997), too, asserted the importance of evaluating the success of coping on the basis of process and outcome. Such a claim necessarily implicated contextual elements of coping. Successful coping depended not only on whether the outcome is satisfactory but also on the process, the ‘how’ and ‘why’ of coping. Having asserted this, however, even a cursory review of the literature reveals that the temptation to evaluate coping on the basis of outcome has been difficult to resist. The vast number of spiritual/religious coping studies have concerned themselves with the relationships between spiritual/religious coping and various measures of mental health (cf. Harrison, et al., 2001). Following the exhortation of prominent scholars (e.g., Lazarus, 2000), some researchers have taken up the challenge of understanding spiritual/religious coping as a process (e.g., Butter & Pargament, 2003; Gall & Cornblatt, 2002; Mattis, 2002; Pendleton, Cavalli, Pargament, & Nasr, 2002). Crystal Park and her colleagues (Benore & Park, 2004; Park, 2005) have begun to explore the role of religious/spiritual coping in bereavement. Park’s work has largely adopted the meaning-making coping model (Park & Folkman, 1997) and sought to understand religion and spirituality in relation to global and situational meaning structures. Bereavement may give rise to a cognitive discrepancy between the bereaved person’s global meaning structures and his or her appraised meaning of the loss of the loved one. Religious/spiritual 30 meaning-making may involve the reappraisal of events or the formulation of benign attributions. Park (2005) notes that, “following the death of a loved one, a person may come to see the hand of a loving God in the event or may redefine the event as an opportunity to learn new coping skills or develop new sources of social support” (p. 710). In her review of the quantitative research on religiosity/spirituality and bereavement, Park and her colleague (Wortman & Park, 2008) found that there is a moderate amount of evidence that suggests that religiosity/spirituality may be of assistance in coping with the loss of a loved one. They also noted the importance of conceptualizing and measuring religiosity and spirituality as multidimensional constructs. A second, qualitative review of the research on bereavement and religiosity/spirituality (Wortman & Park, 2009) explored the findings through the lens of the meaning-making coping model. The authors identified bereavement studies which offered evidence that demonstrated the religiosity/spirituality assist the bereaved in coping with the loss of a loved one. At times, religiosity/spirituality offered bereaved individuals a worldview into which the meanings of the loss could be integrated. When the religious cognitive structures could not assimilate the appraised meaning, the results included a revision of personal goals, a greater appreciation for life, spiritual growth, and a revised view of God. Research in spiritual/religious coping has begun to mature theoretically and methodologically (Pargament, 1997; Pargament, Koenig, Tarakeshwar, & Hahn, 2004) and thus has drawn the attention and praise of prominent coping researchers (Folkman & Moskowitz, 2004). However, several limitations can also be identified. Firstly, in spite of the fact that both Pargament (1997) and Park (2005) emphasize that religiosity and spirituality are multi-dimensional phenomena, the vast majority of the research to date has explored 31 religious/spiritual coping through the lens of cognitive appraisal. Even meaning-making coping, which has the potential to be considered holistically (cf. Längle, 2005a; Neimeyer, 2000), has been reduced to a cognitive process involving the assimilation and accommodation of situational meanings into global meaning structures. Certainly the grieving process does involve some cognitive processes (Attig, 2004), but at its core grieving is far more than cognitive reconstruction (Attig, 1996; Klass, 1999) and cannot be reduced to cognitions, even when these involve spiritual/religious content. Secondly, spiritual/religious coping and meaning-making research largely remain focused on coping as an individualistic, intrapsychic process (cf. Wong & Wong, 2005). Although coping is an inherently contextual process and Pargament (1997) acknowledged the importance of understanding the context in which the person copes, this has rarely been explored. Personal and social resources in the coping process (e.g., congregational or spiritual support) are often considered to be relatively passive contributors to an individual’s coping process. The intentionalities of other agents in joint or collective coping efforts are generally ignored or presumed only to occur in collectivistic societies (cf. Ratner & Lui, 2001). While some scholars have begun to examine dyadic (Bodenmann, Pihet, & Kayser, 2006) and collective coping (Chen, 2006), spiritual/religious coping research remains largely focused on the decontextualized individual as the sole agent in the coping process (except for Mahoney, Pargament, Tarakeshwar, & Swank, 2001). Integrative Models of Grief In addition to the theories of bereavement and grieving based on psychodynamic conceptualizations (Bowlby, 1980/1998; Freud, 1917/2005) and cognitive stress and coping processes (Folkman, 2001; Park & Folkman, 1997), several scholars and clinicians have also 32 sought to develop new models, which synthesize existing findings and generate new perspectives. Although there are numerous proposals for such models (Bonanno & Kaltmann, 1999), this review will focus on four prominent models: Neimeyer’s meaning- reconstruction model (Gillies & Neimeyer, 2006), Stroebe’s dual process model (Stroebe et al., 2005; Stroebe et al., 2006), Rubin’s two-track model (Rubin, 1999; Rubin, Malkinson, & Witzum, 2003) and Attig’s existential-phenomenological model (Attig, 1996, 2000, 2004). Meaning reconstruction model. Drawing on his roots in personal construct theory, Neimeyer and his colleagues (Gillies & Neimeyer, 2006; Neimeyer, Herrero, & Botella, 2006; Neimeyer, Prigerson, & Davis, 2002) have developed and begun to test (Currier, Holland, & Neimeyer, 2006) a meaning-centred model of grieving. This model is integrative in that it synthesizes psychoanalytic (Freud, 1917/2005), attachment theory (Bowlby, 1980/1998), trauma theory (Janoff-Bulman & McPherson-Frantz, 1997), cognitive stress and coping theory (Folkman, 2001), and religious/spiritual coping (Pargament, 1997; Park, 2005) into one model (see Figure 2). The heart of the model is oriented around the process of reconstructing meaning, which Neimeyer argues is central to the process of grieving, and has important implications for grief counselling also (Neimeyer, 2001). 33 Figure 2. Neimeyer’s model of meaning reconstruction. © Routledge, 2006, by permission. Neimeyer’s writings initially defined meaning as a multi-dimensional construct (Neimeyer, 2000). In relation to grieving, he identified six crucial aspects of meaning reconstruction: (1) addressing meaning in the life of the survivor, as well as in the death of the loved one; (2) the integration of meaning, as well as its reconstruction (given, received, and constructed – i.e., changing over time); (3) the construction of meaning as an interpersonal, as well as personal, process; (4) the anchoring of meaning in cultural, as well as intimate, discursive contexts; (5) the tacit and preverbal, as well as explicit and articulate meanings; and (6) the processes of meaning reconstruction, as well as its products. In these 34 six key aspects of meaning, Neimeyer touched on a variety of largely omitted aspects of meaning, including the ways in which it is found or received (in addition to being ‘constructed’ or ‘made’), the social and cultural sources of meaning (in addition to the intrapsychic process), and the ways in which meaning transcends cognitive articulation through tacit and embodied avenues. In relation to this final aspect of meaning, Neimeyer stated that, “there are some meanings that are too embedded in our lives, too embodied in our actions, to be amenable to formulation in a set of ‘beliefs’ or ‘self-statements’ (p. 554). In reminding us of the tacit or preverbal dimensions of meaning, Neimeyer connects with other scholars in asserting that grieving is primarily action, something that we do, and only secondarily reflection (cf. Attig, 2004; Heidegger, 1927/1962; Längle, 2005a; Young & Valach, 2004). When returning to the meaning-reconstruction model, however, it is clear that Neimeyer focused nearly exclusively on cognitive processes. This is understandable to the extent that Gillies and Neimeyer (2006) sought to ground their model on the existing research and this research in North America does indeed focus strongly on cognitive processes (Neimeyer, personal communication, September 14, 2007). However, the exclusive focus on cognitive meaning impoverishes the model and ignores emotional, social and action-oriented avenues towards meaning. The model (Gillies & Neimeyer, 2006) postulates three primary functions of meaning-reconstruction – sense-making, benefit finding, and identity change. The model begins with the assumption that people hold core meaning structures, akin to cognitive schemas, which may or may not be conscious and articulated. These pre-loss structures include daily activities and priorities, self-perceptions, interpersonal relationships, views of 35 the future and the world, as well as spiritual assumptions and faith. Into this assumptive and experienced world comes the death and loss of a significant person – for example, a child. The model posits that such a loss is either consistent or inconsistent with such pre-loss meaning-structures. While the loss of a loved-one may be distressing, especially initially, the key factor is whether these losses can be incorporated into existing meaning structures. To the extent that the person’s assumptive world is able to assimilate such a loss, to the extent that it ‘makes sense’ to him or her, the loss may be distressing but ultimately explainable and thus manageable. However, if the pre-existing meaning structures are not able to accommodate such a loss, the death of a child will be not only severely distressing, but will also require the bereaved parent to adjust his or her meaning structures. The increased distress and cognitive dissonance, according to Gillies and Neimeyer, will precipitate and engage a search for meaning. To the extent that the meaning reconstruction strategies – sense-making, benefit- finding and identity change – are successful, that is, resulting in more adaptive and helpful worldviews and decreased distress, the search for meaning will have been successful and the bereaved person will now be able to view the world in a way that incorporates the very real possibility of death (Gillies & Neimeyer, 2006). However, there is also the possibility that these meaning-making processes are not successful. Meaning-reconstruction may result in changed meaning structures, but these new meanings may not produce the desired reduction in cognitive dissonance or emotional distress. Should this be the case, it would once again trigger a reengagement of the search for meaning. Dual-process model. One of the most prominent models of grieving in the current bereavement literature is the dual-process model of grieving developed by Margaret Stroebe 36 and her colleagues at Utrecht University (Stroebe, 2002; Stroebe et al., 2005; Stroebe et al., 2008; Stroebe & Schut, 2001). Stroebe stated that she and her colleagues found the dominant grieving process – grief work – to be too vague, too static, and insufficiently tied to the research literature on grieving outcomes. The dual-process model, on the other hand, was developed with deliberate attention to the functions and outcomes of grieving. The intention of its authors was for the model to address questions about maintaining and relinquishing bonds, as well as about what successful grieving might look like. Drawing upon constructs from attachment theory and cognitive stress theory, Stroebe and her colleagues (Stroebe et al., 2005) postulated that bereaved persons oscillate between attending to two categories of stressors – loss-oriented stressors and restoration-oriented stressors (see Figure 3 below). Loss-oriented appraisal and coping involves attending to the loss, engaging in grief work, separation distress, reappraising the meaning of the loss, and maintaining or relinquishing bonds with the deceased. Restoration-oriented appraisal and coping, on the other hand, addresses issues that come about as a result of the bereavement and are secondary to the loss itself. They involve changes to identity as a result of the loss, rebuilding shattered assumptions, the engagement in new activities and the formation of new relationships and the temporary disengagement from the grieving process. A critical component of the dual-process model is its dynamic centre, the process of oscillation between loss and restoration oriented stressors. Stroebe and her colleagues note that, “oscillation occurs in the short term (transient fluctuations in the course of any particular day) as well as across the passage of time, because adaptation to bereavement is a matter of slowly and painfully exploring and discovering what has been lost and what remains: what must be avoided or relinquished versus what can be retained, created, and built on” (p. 52). 37 Stroebe and her colleagues (Stroebe & Schut, 2001; Stroebe et al., 2005) have also suggested that certain cognitive mechanisms underlie the oscillation between loss and restoration oriented coping. They have terms these processes: (1) positive meaning (re)construction, which includes positive reappraisal, revised constructive goals, positive event interpretation and the expression of positive affect; (2) negative meaning (re)construction, which includes rumination, wishful thinking, revised unconstructive goals, negative event interpretation and ventilating dysphoria. Figure 3. Stroebe’s dual process model of grief. ©American Psychological Association, 2005, by permission. Research supporting the dual-process model of bereavement has been widely documented in the literature (Stroebe, 2002; Stroebe et al., 2005) and scholars have praised the model for its synthesis and extension of attachment theory and the transactional model of coping (Parkes, 2001). In the view of this author, however, the dual-process model suffers from some of the same shortcomings that have been suggested for the transactional model of coping. Lazarus (1999), author of this transactional model, criticized the model in his later 38 years and called for a more holistic and contextually-sensitive model, which transcends cognitive appraisal processes and addresses emotions more generally (Lazarus, 2006). Secondly, Stroebe’s strong emphasis on functionality and outcomes of grieving pushes the model towards the adoption of the binary categories of positive and negative meaning reconstruction. The cognitive orientation and positive-negative dichotomy seems ill-suited to such a complex and holistic phenomenon as grieving (cf. Attig, 1996; Neimeyer, 2000). Rather, grieving is inherently related to the expression of ‘negative’ emotions, and the absence of its expression has been related to ill-health (Parkes, 2002). Two-track model. A second, dually-oriented model of bereavement can be found in the work of Israeli psychologist Simon Rubin and his colleagues (Rubin, 1996, 1999; Rubin et al., 2003). This model parallels the traditional structure of bereavement theories since Freud (1917/2005), with the one track focusing on the relationship with the deceased and the second focusing on the functioning of the bereaved person in the absence of the deceased. Similar to the dual-process model (Stroebe et al., 2005), Rubin’s model draws on attachment theory (Bowlby, 1980/1998), but in contrast the Utrecht model, this model transcends the near-exclusive focus on cognition and offers a more holistic approach to grieving. Track one of Rubin’s (1999) model focuses on the functioning of the bereaved person across a wide range of affective, interpersonal, and somatic indicators. These include a focus on anxiety, depressive affect and cognitions, somatic concerns, psychiatric symptoms, family relationships, general interpersonal relationships, self-esteem, self-worth, meaning structures, work functioning and investment in general life tasks. Track two emphasizes the relationship to the deceased person and includes imagery and memories of the deceased, emotional distance to the deceased, positive and negative affect in relation to the deceased, 39 preoccupation with the loss and the lost, idealization of or conflict with the deceased, features of the grieving process (shock, searching, disorganization, reorganization), impact on self- perception and the memorialisation and transformation of the loss and the deceased. Rubin’s theory has likewise amassed a substance amount of empirical support (Rubin et al., 2003), although not to the same level as the dual-process model. Nonetheless, there are certain features of Rubin’s model that make it a good fit for a study on spirituality and parental bereavement. Firstly, most of Rubin’s research to date has been conducted with bereaved parents. This includes a substantive number of studies of with bereaved parents of adult deceased children who died suddenly and violently. Given the documented importance of these factors for one’s understanding of bereavement and grieving (Murphy, 2008), it would seem critical to take note of this model. Secondly, reflecting perhaps his practice in Israel and his clinical work with bereaved parents, Rubin’s model offers a more holistic understanding of grieving and greater attention to the continuing bonds with the deceased. Relearning-the-world model. The final model that will be reviewed in this summary of grieving models is Attig’s (1996, 2000, 2004) existential-phenomenological model. Although Attig’s work as a philosopher and clinician has not been subjected to empirical scrutiny, his model has drawn the attention of prominent bereavement researchers and clinicians (e.g., Gillies & Neimeyer, 2006; Klass, 1999; Worden, 2004). Additionally, Attig’s work is of importance to this specific study as his theoretical formulations draw heavily on his clinical experience with bereaved parents and his model of grieving is perhaps the most holistic conceptualization reviewed thus far, and therefore very compatible with the theoretical framework employed in this dissertation. 40 As we noted earlier in the definition of grieving, Attig (1996, 2000) draws strongly on existential-phenomenology, most notably the work of Martin Heidegger, in his formulation of grieving. He differentiates between reactive grieving (or grief), which he describes as an emotional reaction to loss, and active grieving, which involves the personal decision to engage actively with the loss. Drawing on his phenomenological analysis, Attig describes reactive grieving as follows: In grief reaction, we believe that we have lost someone valuable. We still harbor within ourselves deeply engrained dispositions to feel, act, think, expect, and hope in continuing life as if we have not lost the one who has died. And we feel the pain and anguish (typically including sadness, loneliness, helplessness, and their somatic companions) grounded in the realization that our dispositions are no longer sustainable. Grief in this sense is another something, a reactive agony, that happens to us after bereavement happens to us. (Attig, 2004, p. 343) Active grieving, according to Attig (1996), is imbued with personal choice. This process involves the decision to engage the pain of the loss directly and to begin to reshape one’s life patterns and redirect one’s life story. Attig (2004) describes this process as follows: “We exert physical energy. We work through and express emotion. We change motivations, habits, and behavior. We modify relationships. We return home to familiar meanings in life. We stretch into inevitably new meanings. And we change ourselves in the process” (p. 343). In contrast to other theoretical perspectives, such as coping models (Folkman, 2001) and task models (Worden, 2004), Attig describes this coping as a holistic relearning-the-world. Relearning-the-world, for Attig, involves four inter-related foci: (1) the physical world (the surroundings of the lives of the bereaved, (2) the social world (relationships with fellow 41 survivors), (3) the relationship with and understanding of oneself, and (4) the ongoing relationship with the deceased. This model seems particularly apt for bereaved parents, as they naturally describe their grieving as an all-encompassing, life-changing process and readily identify with reactive and active aspects of grieving (Klass, 1999). The model also fits well with the theoretical approach for this study, as contextual action theory, as we will see, likewise emphasizes the agentic and relational nature of action. Theoretical Limitations Grieving and bereavement theories date back to the work of Freud (1917/2005) and have generally focused on the relationship between the bereaved and the deceased. Grieving, for Freud, was about the withdrawal of libidinal energies from the deceased object, thereby freeing up the bereaved to invest his or her energy into other relationships. Bowlby (1980/1998) and other attachment oriented scholars framed the grieving process similarly, conceiving of it as a form of separation anxiety in which grieving served the purpose of soothing the bereaved in the process of accepting the permanent absence of the deceased. The goal for Bowlby, however, was largely the same as for Freud – the relinquishment of bonds (for a dissenting opinion see Mikulincer & Shaver, 2008). Stress and coping scholars (Folkman, 2001; Folkman & Park, 1997; Lazarus & Folkman, 1984) generally reframed the grieving process as a form of coping with loss, and emphasized emotion-focused and meaning-making coping strategies as being adaptive for the process of grieving. The cognitive focus of reappraisal has also been central in various other approaches, including Neimeyer’s meaning-reconstruction model (Gillies & Neimeyer, 2006) and Pargament’s (1997) religious coping theory. Recent theoretical efforts have sought to integrate attachment theory and cognitive coping models into the dual process model (Stroebe et al., 2005), 42 emphasizing loss-and restoration oriented coping, as well as the process of oscillation. Additionally, some (Klass, 1999) have sought to challenge the relinquishment orientation of much of grieving theory by proposing and offering evidence for the adaptive possibility of continuing bonds. Although the theoretical work to date has provided a solid grounding for the empirical efforts (Stroebe et al., 2008), several limitations are evident and have been documented in the literature. Scholars have pointed out that bereavement theories have largely focused on grieving as an intrapsychic process (Nadeau, 2001a, 2001b; Toller & Braithwaite, 2008). Grief work, as conceptualized by Freud (1917/2005), Lindemann (1944) and adopted by modern grieving scholars (e.g., Worden, 2004), is principally about the emotional working-through of a loss at an intra-individual level. Attachment (Bowlby, 1998/2008) and continuing bonds (Klass et al., 1996) have focused on the relationship between the bereaved and the deceased, but the emphasis has remained on this singular relationship. Parental bereavement challenges conventional bereavement theories in several ways (Murphy, 2008), including in its dyadic focus of grieving. When the parental relationship has been taken into account, efforts have generally focused on the important but secondary question of the relationship between parental bereavement and divorce (Oliver, 1999; Schwab, 1998). However, some researchers (e.g., Wijnsgaards-de Meij et al., 2008) have recently begun to document the ways in which the grieving processes of bereaved parents are more fundamentally related to each other. Other scholars have called for theoretical reformulations and research efforts that take the relational nature of grieving into account (Walter, 1996). To date, however, few researchers have taken up this challenge. 43 A second limitation in the literature has been the lack of attention to the religious/spiritual dimensions in the grieving processes of bereaved parents. Pargament and his colleagues (Ano & Vasconcelles, 2005; Butter & Pargament, 2003; Pargament, 1997) extended Lazarus and Folkman’s (1984) transactional model of coping to address the unique ways in which religiosity and spirituality contribute to the process of coping. Park and her colleagues (Park, 2005; Wortman & Park, 2008, 2009) have explored spiritual and religious coping within the context of bereavement. While Pargament and Park’s efforts are laudable, their research has largely focused on the same intrapsychic focus of grieving that is evident in the research efforts of cognitive stress and coping scholars more broadly. Furthermore, religious/spiritual coping and meaning-making coping scholarship has focused most centrally on cognitive appraisal and re-appraisal, with fewer studies examining the grieving process as a holistic human response to loss. Emotional and relational processes have been understood as secondary to the cognitive efforts of the bereaved, and thus grieving has been reduced from a holistic and relational response to loss to cognitive re-appraisal. Phenomenologically- oriented scholars (Attig, 1996), however, have pointed out that bereavement in general and specifically parental bereavement (Klass, 1999) cannot be reduced cognitive processes. They are important, for sure, but grieving for bereaved parents involves a reconfiguration of their entire being, as taken-for-granted assumptions and practices about the world, their lives, relationships and their children are challenged. Parental Bereavement After reviewing the dominant theoretical models of bereavement and grieving, it is important to turn towards the experience of the loss of a child and the research efforts that have sought to understand this experience. As will become evident, the death of a child is a 44 unique form of human loss, and scholars have suggested that current theoretical models do not adequately capture this experience or the grieving processes of bereaved parents (Bennett, 2009; Murphy, 2008). This section of the literature review begins by focusing on the experience of parental bereavement and the grieving process. Subsequently, we explore the consequences of child loss, including challenges to the health, mental health, and relationships for bereaved parents. The section concludes with an elaboration on the role of meaning and spirituality/religiosity in the grieving processes of bereaved parents. The untimely death of a child is a deeply painful, distressing and life-changing event for the bereaved parents (Christ et al., 2003). Most researchers have found it to be the most distressing form of loss (Stroebe et al., 2008), which precipitates one of the most intense and enduring grieving processes. Modern countries have generally witnessed declining child mortality rates in the 20th century, especially for younger children and for ‘external’ causes, such as accidents, drowning, suicide, homicide and or poisoning (Ahmad, et al., 2000; Statistics Canada, 1999). Christ and her colleagues report that the deaths of children between age one and fourteen now amount to less than five percent or approximately 57,000 annual deaths in the United States. Thus, while the death of a child is not an entirely uncommon occurrence, these indicators may explain why most parents do not expect to deal with the loss of a child and are thus ill-prepared to cope with the gravity of this trauma. An adequate understanding of parental bereavement must begin, first and foremost, by turning towards the experience of parents. This is not an easy task, even for researchers, who have sometimes been accused of avoiding the severity and permanence of this pain and turning too quickly to focus on the heroic coping efforts of parents (Klass, 1999). However, parental bereavement does not begin there. Instead, the defining experience of losing one’s 45 child is characterized first and foremost by a nearly inexpressible pain (Weed, 2007). Parents often describe their suffering in very graphic terms, likening it to an amputation of a limb or even noting its physical sensations (Klass & Walter, 2001). A significant number of qualitative studies have focused on helping researchers understand the lived-experience of parental bereavement (Janzen, et al., 2003-2004; Murphy, et al., 2003; Rosenblatt, 2000; Uren & Wastell, 2002; Wheeler, 2001). The intensity of the pain corresponds to the intimacy of the parent-child bond (Stroebe, 2002), as well as to the ‘failure’ of the bereaved parents to safeguard their child. Klass (1999), who conducted a 20- year ethnography with a bereaved parents group, noted, that “when a child dies, the parent does not just know about death, the parent knows death. Children can die. It can happen to them. Now the news is no longer pictures, but people like themselves with cameras in their faces during their worst moments. Bereaved parents are no longer protected by the illusion that death only happens to other people” (p. 47). As the reality of the death of their child and of their own pain sets in, parents begin to understand the loss of the loved child is permanent, and their pain, although changing over time, is equally enduring. Some scholars have suggested that the intensity of the agony of child loss is so severe because the death of a child – at any age – is generally considered to be an ‘unnatural’ event, an event that reverses the biological order of death and often undermines significant portions of the parents’ assumptive world (Janoff-Bulman, 1989; Janoff-Bulman & Frantz, 1997; Matthews & Marwit, 2006). This assumptive world – with its generally tacit and preverbal beliefs and experiences about the presence of order and justice in the world, is suddenly and deeply thrown off kilter, thus depriving the parents of important inner resources that are necessary to face the personal experience of bereavement (Braun & Berg, 1994; Klass, 46 1999). The violent and sudden loss of a child, particularly, calls awareness to these tacit beliefs and often casts radical doubt on the veracity of what most of us have tacitly held to be true – that children are young and healthy, that they have their entire lives before them, that parents can and should protect their children, and that death arrives at the end of a long and meaningful life. The metaphorical map has been wiped clear and parents are left to ‘relearn the world’ (Attig, 1996). With the aid of the participants in a bereaved parent support group, Klass (1997, 1999) sought to explain the process of grieving for bereaved parents. While eschewing a rigid stage approach for this grieving process, he adopted four categories of the grieving process that were developed by the bereaved parents themselves. These categories are descriptive rather than prescriptive and offer bereaved parents an overview of the grieving process that is ahead of them. The sequence is described as: (1) newly bereaved; (2) into their grief, (3) well into their grief, and (4) resolved as much as it will be. It is worth noting that other researchers have described similar developments in the grieving processes for bereaved parents (Arnold & Buschman Gemma, 2008; Malkinson & Bar-Tur, 2004-2005). The experience of being newly bereaved begins with the shock of learning of the death of one’s child (Klass, 1999). Parents describe this shock in varied ways, including initial experiences of disbelief and subsequent dissociation in response to an overwhelming pain and incomprehensible reality. As the initial shock of hearing of the death of their child begins to wane, parents begin to experience the obdurate reality of their loss – their child is truly gone and the bereaved parents are confronted by this fact daily, hourly, moment-by- moment. The absence is experienced as an emptiness and sometimes is described as a the loss of a limb, a loss of part of themselves. Like their child, bereaved parents often have an 47 initial inclination that a part of themselves has been irrevocably lost, and that their lives after this experience will never be the same. Thus, the death of a child has an immense impact on the lives of the parents, who typically will divide time into ‘before’ and ‘after’ the loss. This irrevocable loss and its felt hopelessness may also give rise to the questions of existential meaning related initially to the life and death of the child and subsequently to the ongoing life of the bereaved parents themselves (Braun & Berg, 1993). The inner turmoil for bereaved parents is also experienced in their social and relational worlds (Klass, 1999). The newly bereaved and friends and relatives engage in public events to commemorate the life and mourn the death of the deceased child. Memorials are planned at schools; wakes are held in homes; funerals planned at places of worship. While bereaved parents often experience much support in the days and weeks following the loss of their child, the support may wane over time as friends, communities and even relatives begin to ‘move on’ after the loss of their child. However, this experience is not shared by bereaved parents as they continue to experience the emotional intensity of the loss and find that all of life has come to an abrupt halt. Klass notes that, “it often seems to the parents that neither the child nor the child’s death has social reality. They find people will not mention the child’s name in their presence, that inquiries about how they are doing imply that it doesn’t hurt as bad as it does, that the child can be replaced by a new baby, or that God loves the child in heaven better than the parent could have loved the child here” (p. 59). Some bereaved parents (Kehler, 1999) have commented on the pain of receiving such well- intentioned remarks and on the consequent feelings of disconnection from the community. As the bereaved parents move into their grief the dissociative aspects of grieving tend to diminish and the grieving process becomes increasingly complex (Klass, 1997, 1999). The 48 grieving parents frequently find that the loss of their child has touched their entire existence and that they will continue to discover aspects of their inner and social worlds that have been touched by the loss. In contrast to some other forms of loss, bereaved parents, even if they have lost their only child, remain parents after the death of their child, and now must engage in the process of reconfiguring the relationship with their deceased child. However, this reconfiguration may also be extremely difficult for the parents as they discover that the most salient point of connection to their deceased child is the pain they experience in their grief. Bereaved parents have now frequently found that the world has moved on and that their child’s life and death has faded from the daily consciousness of many friends and acquaintances (Klass, 1999). However, the grieving process typically continues with great intensity for bereaved parents, who often struggle to find socially acceptable ways of continuing grieve in public. Many parents have returned to their previous places of work and are experiencing the difficulty of integrating themselves and their ongoing grieving into the world of work. To address their need to express their grief in relationship, bereaved parents may join support groups, such as the Compassionate Friends, where they find understanding and compassion for their grief and learn that they “need not walk alone” (The Compassionate Friends [TCF], n.d.). In addition to listening to the grieving stories of bereaved parents, support groups also share practical coping resources for the grieving process and validate the ongoing interactions between bereaved parents and their children. Interestingly, Klass noted that many conferences and workshops for bereaved parents will have sessions on the ongoing relationships of bereaved parents with their children, and that these sessions will frequently include descriptions of paranormal or sense-of-presence experiences (cf. Somanti & August, 1997; Steffen & Coyle, 2010). 49 Over time, bereaved parents frequently become more comfortable in their grief (Klass, 1999). Grieving experiences become familiar and predictable and the raw intensity of the initial months of grieving has slightly subsided. As parents move ‘well into their grief’, one of the central challenges is the ongoing transformation of inner representation of the child by letting go of the pain and finding a positive bond. Klass describes this challenge as follows: “The idea of letting go of the pain in exchange for a clearer, comforting inner representation of the child is on of the central insights in Bereaved Parents. Rather than identifying with the child’s pain, the parent identifies with the energy and love which was in the living child” (p. 74). Some parents may experience an ambivalence at this point, as there is a perceived risk of losing the final remaining connection with their child when letting go of the pain. Klass (1997) notes that as bereaved parents develop a clearer inner representation of their child and solidify their inner continuing bond, they also become more confident in bringing this bond into their social worlds. The continuing bond is symbolized in regular, public grieving rituals and parents may include mention of their child at public occasions. Additionally, many bereaved parents express a deep compassion for other bereaved individuals and parents, and may at this time express a desire to offer support to them. The final phase of bereavement, according to Klass (1999), is the resolution of grief “as much as it will be” (p. 82). Contrary to some bereavement theorists, the bereaved parents in Klass’ ethnographic study denied the possibility of an end to their grief. The website of the Compassionate Friends (2010) echoes this when addressing newly bereaved parents: You’ll never “recover” from your loss nor will you ever find that elusive “closure” they talk of on TV—but eventually you will find the “new me.” You will never be the same person you were before your child died. It may be hard to believe now, but in 50 time and with the hard work of grieving (and there’s no way around it), you will one day think about the good memories of when your child lived rather than the bad memories of how your child died. You will even smile and, yes, laugh again someday—as hard to believe as that may seem. Rather, so Klass, bereaved parents enter this phase of grieving when they have found an enduring and dynamic inner representation of their deceased child. This stable inner representation may give rise to an ongoing reconfiguration of a ‘better self’ as bereaved parents reorganize their values, their identities and search for an ongoing and meaningful expression of the value of their child’s life and death. Such expressions may take on the form of an activism on behalf of their child, such as joining a group against drunk driving, or by taking leadership in a bereaved parents support group. These activities also serve to imbue the ongoing lives of the bereaved parents with meaning through the identification and enacting of a value related to the life and death of their child (Braun & Berg, 1993). The section has hopefully helped the reader to come a little closer to the experience of losing a child. Since there is much variability in grieving (Stroebe et al., 2008), the goal of this section was not to describe this experience exhaustively. Rather, the intention was to bring the reader a bit closer to the pain of the loss of a child and to the intensity and breadth of the grieving process for bereaved parents. In this next section, we will turn to the implications of this loss by exploring its effects on the health, well-being, and relationships of bereaved parents. This section will also explore the crucial role of meaning and spirituality in the grieving process after the loss of a child. 51 Health and Relationship Consequences Bereavement researchers frequently remind their readers that grieving is generally considered a natural, although distressing, process, which does not inevitably result in psychopathology or necessitate psychological or pharmacological intervention (Stroebe et al., 2008; Wortman & Silver, 1989, 2001). While there is some evidence to suggest that bereaved parents may not develop complications in their grieving, a number of studies have shown significant health risks for bereaved parents, particularly those parents who have lost their children suddenly and violently (CAH, 2003; Murphy, 2008; Stroebe et al., 2007). Numerous studies to date have demonstrated that bereaved parents are more likely to suffer adverse mental health and health reactions when compared with other bereaved individuals and non-bereaved persons (CAH, 2003). In the early 1990s, Shirley Murphy and her colleagues at the University of Washington undertook one of the most significant and substantive studies of parental bereavement (Murphy, 2008; Murphy et al., 2003). The nurse researchers conducted a five-year, quantitative and qualitative study on the health consequences of parental bereavement for two-hundred-and-sixty-one violently bereaved parents and gathered data at four, twelve, twenty-four and sixty post-death. Several important health and mental-health related findings emerged. Murphy and her colleagues found that their grieving patterns for these bereaved parents frequently included elements of trauma, anxiety and depression. For example, two years post-death, the parents’ mean scores on an overall measure of emotional distress found that bereaved parents scored approximately twice as high in comparison to their non-bereaved counterparts (Murphy et al., 1999; Murphy et al., 2003). Five years post-death, 28% of bereaved mothers and 12.5% of bereaved fathers continued to meet the diagnostic criteria for post-traumatic stress disorder (PTSD), compared 52 with 9.5% of women and 6.3% of men in the general population of the United States. Additionally, many bereaved parents noted increases in depressive symptomatology and suicidal ideation (Murphy et al., 2003), which in other studies has been shown to contribute to the increased mortality rate of bereaved persons (Stroebe et al., 2007). Other studies have confirmed Murphy’s (2008) findings for bereaved parents, frequently showing increases risk for PTSD, anxiety, depression and substance abuse. Rogers and her colleagues (Rogers, Floyd, Mailick Seltzer, Greenberg, & Hong, 2008) examined 428 bereaved parents in the Wisconsin Longitudinal Study and compared them with an equal number of comparison parents with similar backgrounds. Results indicated that bereaved parents were more likely to exhibit symptoms of depression and more likely to have had a depressive episode than the comparison parents. What is striking about this study is that these results were obtained from bereaved parents an average of 18 years post-death, thus lending further support to the contention that grieving is a life-long process for bereaved parents. In their study of 219 bereaved parents, Wijnsgaards-de Meij and her colleagues at Utrecht (Wijnsgaards-de Meij et al., 2005) found that depression in bereaved parents was predicted by individual parent factors, such as gender, religious affiliation and help seeking, with mothers, religious parents and professional help seekers more likely to exhibit symptoms of depression. Kreicbergs and her colleagues (Kreicbergs et al., 2004) examined the mental health risks for 449 bereaved parents in Sweden who had lost a child to cancer, and compared them with 457 non-bereaved comparison parents. Results revealed increased risk for both anxiety and depression in bereaved parents at four to six years post-loss, although this risk decreased in subsequent years. Similar findings were shown in a study of 50 Australian bereaved parents, who had lost their child to cancer in the year preceding the 53 study. Goodenough and her colleagues (Goodenough et al., 2004) reported higher levels of stress, depression and anxiety for the parents, especially for those whose child had died in hospital rather than at home. Likewise, Znoj and Keller (2002) found that 87 bereaved parents in Switzerland showed marked increases of distress on measures of physical health, depression, and post-traumatic stress relative to the 89 comparison parents. Interestingly, however, these researchers also found that bereaved parents, like other comparison parents who had undergone a traumatic event, had increased their ability to regulate their emotions. Although less frequently examined than mental health, the question of the physical health consequences of parental bereavement has also been investigated in numerous studies. Overall, the results appear to demonstrate that the loss of a child has a slight to moderate negative impact on the health of bereaved parents, although the findings remain somewhat tentative and the effect sizes quite low (Stroebe et al., 2007). As noted above, Znoj and Keller (2002) asked bereaved parents about their general health and well-being and found some evidence of worsened health (e.g., increased visits to physicians, chronic health conditions) compared with the comparison group. Murphy and her colleagues (Murphy et al., 1999) also found indicators of worsened physical health for bereaved parents, especially bereaved mothers. Jiong Li and her colleagues in Denmark (Li et al., 2003, Li et al., 2005) conducted a series of epidemiological health studies and found that parental bereavement was associated with an increased risk, particularly for mothers, of hospitalization for a psychiatric condition, as well as an increase in mortality rates for both mothers and fathers. The increased health and mental health risks for bereaved parents, in combination with studies of traumatic grief in other populations, have led two research teams to advocate for the inclusion of complicated or traumatic grief in the next released of the Diagnostic and 54 Statistical Manual of Mental Disorders (DSM, Prigerson et al., 2008). Prigerson (Zhang, El- Jawahri, & Prigerson, 2006) and her colleagues suggested diagnostic criteria for ‘prolonged grief disorder’ based on research with a variety of groups of bereaved individuals, including bereaved parents. Prigerson’s criteria include three main criteria – the presence of chronic and disruptive yearning for the deceased, grieving related symptoms (e.g., trouble accepting death, inability to trust others, numbness or detachment), as well as marked and persistent disruption in functioning. Horowitz and his colleagues have adopted a similar model for complicated grief, based on a stress response model (Horowitz, Siegel, Holen, Bonanno, Milbrath, & Stinson, 1997). Neither group included absent or delayed grief as part of their conceptualization of complicated or prolonged grief. The estimates for the incidence rates for prolonged or complicated grief vary between nine to twenty percent in bereaved adults (Stroebe et al., 2007). The preliminary indications for bereaved parents, however, are significantly higher. In a study of 232 bereaved parents who had lost a child 18 months previously, Dyregrov and her colleagues in Norway (Dyregrov, Nordanger, & Dyregrov, 2003) found that 58% bereaved parents who had lost a child to sudden infant death syndrome and 78% of the parents who had lost a child to accidents or suicide met the suggested diagnostic criteria for complicated grief. Although the criteria for complicated or prolonged grief disorder have not yet been codified in the DSM, the preliminary results suggest that bereaved parents are highly vulnerable, particularly if their child has died suddenly and violently (Murphy, 2008). One of the issues that emerges consistently in the self-help (The Compassionate Friends, 2006) and research (Oliver, 1999; Schwab, 1998) literature for bereaved parents is the status of the parental relationship after the death of a child and the widely-held belief that 55 bereaved parents experience higher rates of relational conflict and divorce than non-bereaved parents. While researchers have certainly acknowledged that the loss of a child can certainly exact a strain on the marital relationship, the results of the research thus far do not seem to support the self-help lore that bereaved parents divorce at higher rates than non-bereaved parents. The question of the rate of divorce suffers from numerous methodological problems, most importantly the fact that all such research is likely to be retrospective and that it is difficult to extricate the impact of the death of the child from pre-existing stressors and other confounding factors post-loss. Schwab’s review of the literature found that many studies were poorly conducted or that the authors of the studies drew unwarranted conclusions about the causal relationship between the loss of a child and parental divorce. In a comparison between the recorded rates of divorce in bereaved parents and the general population at the time of the study, Schwab found that these rates generally did not differ substantively from each other. Future research, employing longitudinal designs and matched comparison groups, is needed to answer this question more conclusively. While the research on parental divorce following bereavement has not yielded strong findings, researchers have certainly found that the loss of a child may strain the parental relationship (Oliver, 1999). Numerous reasons for this strain have been suggested, such as a lack of synchronicity in the grieving patterns of the partners, or divergence in the grieving actions of bereaved parents (Gilbert, 1989). Gilbert (1996) suggested that bereaved parents may expect to grieve in the same manner or at the same time as their partner, and when this does not occur, one partner may interpret this divergence as a lack of love for the deceased child or as a disengagement from the grieving process. Clinicians (e.g., Worden, 2004) cautioned bereaved parents against drawing rapid conclusions about their partner’s 56 engagement with the grieving process and have suggested that bereaved parents need to be given the freedom to express their individuality in their grieving. In addition to divergent patterns of grieving, bereaved parents may experience relational strain after the loss of a child because of each parents’ individual preoccupation with his or her grief (Gilbert, 1996). The intensity of the grieving process for each parent may result in a decline in communication between bereaved parents (Kamm & Vandenberg, 2001) and in a lack of sexual intimacy within the relationship (Oliver, 1999). Kamm and Vandenberg found that, on the whole, women tended to value open communication more highly than men and that open communication tended to facilitate more rapid resolution of intensive grief reactions for both men and women. Oliver suggested that the loss of a child may have a serious impact on the sexual relationship of the bereaved parents. Sexual intimacy frequently declined after the loss of a child and relational problems emerged in relation to differential needs for sexual intimacy between men and women, as well as from guilt over experiencing sexual pleasure after such a painful loss. Some parents may also explore the possibility of conceiving another child rapidly after the death of their child, but clinicians and researchers (e.g., Bowlby, 1980/1998; Rubin, 1989-1990) have cautioned that such a course of action may complicate grieving and the relationship with the new child. Moderators of Parental Bereavement Researchers have found consistent and strong evidence that the experience of the loss of a child is deeply distressing to bereaved parents, that this distress is enduring and that it places bereaved parents at some risk of developing physical and mental health problems (Murphy, 2008; Stroebe et al., 2007). A natural next step is to ask what moderators, if any, influence the development of parental grieving (cf. Stroebe et al., 2006). Although the 57 research is not unanimous, there is some evidence to suggest that parent characteristics, child characteristics and the cause of death have a significant impact on the process of grieving for bereaved parents. One of the more consistent findings is that bereaved mothers tend to grieve more intensively and tend to be at higher risk for complicated grieving, depression and PTSD than bereaved fathers (Barrera et al., 2007; Li et al., 2003; Murphy et al., 2003; Stroebe et al., 2007; Znoj & Keller, 2002; see Stroebe, et al., 2001, or Gilbert, 1996, for more general reviews of gendered grieving in bereavement). Some studies have reported some variability in this generally consistent finding. For example, Murphy and her colleagues (Murphy et al., 1999) found that during the second year post-death, distress in mothers continued to decline, while fathers, who had started at lower levels of distress initially, showed a modest level of increase. Likewise, Goodenough’s study (Goodenough et al., 2004) of Australian parents found that fathers, and not mothers, showed higher levels of stress, depression and anxiety when their child passed away in hospital. Li and her colleagues (Li et al., 2003) found that bereaved fathers had higher rates of early mortality when their child died of unnatural causes. Several scholars have offered biological or psychological reasons for this observed difference. Some (Stroebe et al., 2007) have implied that bereaved mothers may be more vulnerable to intensive grief and mental health consequences for evolutionary reasons and because of more emotionally intensive bonds with their children. Another possibility is that the intensity of grieving and reported mental health problems may follow the observed pattern for anxiety and depression more generally (American Psychiatric Association, 2000). Others (Gilbert, 1996; Schwab, 1998) have suggested that parental grieving follows traditional masculine and feminine ways of expressing emotions, with mothers more prone to 58 expressing their feelings overtly and strongly and fathers more focused on the pragmatic aspects of grieving. While there may be some validity to these explanations, few studies have taken the question of gender seriously by separating sex from gender or have examined contextual dimensions in the gendered grieving patterns of bereaved parents. One issue that is worth addressing briefly in relation to the gendered grieving of bereaved parents concerns possibility of delayed or absent grief, which is typically associated with the grieving processes of men. Lindemann’s (1944) landmark paper on the grief of the Cocoanut Grove fire in Boston brought this form of complicated grief to the forefront of psychoanalytic consciousness at the time, and to this date clinicians and some researchers acknowledge that bereaved individuals, including bereaved parents, may not engage in their grief for some time after a loss (Parkes, 2001, 2002). The implication of this delayed or absent grief is that there is some psychological process which is blocking or inhibiting the grieving process, and most clinicians assert that this is suggestive of pathology. Notably, however, the notion of delayed or absent grief is absent from the current formulations of complicated or prolonged grief (Horowitz et al., 1997; Prigerson et al., 2008). Wortman and Silver (1989, 2001) claimed that there is little evidence to suggest that absent grief is little more than individual variation in grieving, while Parkes has suggested that delayed/absent grief may indeed warrant clinical attention. Returning to the focus on the moderators of grief, relatively few researchers have investigated the effect of the age of the child at the time of death on the grieving processes of bereaved parents. Wijnsgaards-de Mej and her colleagues at Utrecht University (Wijnsgaards-de Mej et al., 2005) found a curvilinear relationship between the age of the child and the intensity of the grieving process in their longitudinal study of 219 bereaved 59 parents. They reported that the parental emotional intensity of grieving was highest for deceased teenage and young adult children and comparatively lower for younger and older children. They also reported that the intensity of the grief was moderated by the number of remaining children, with those parents with more remaining children grieving less intensively. This finding has been confirmed in other studies also (Stroebe et al., 2007). Simon Rubin (1996) has also conducted some comparisons between the intensity of grief for parents who were bereaved of young children and those bereaved of young adult children. Rubin’s findings likewise confirm that the intensity of grieving for older children tended to be higher relative to the grieving for younger children. Rubin offered a developmental explanation for the greater intensity observed in the parents of adult children: In contrast to the bereaved parents of adult sons, the loss of a young child is the loss of a potential relationship. The relationship to the child may be mourned for many years, as parents have occasion to mourn additional aspects of the deceased child. At each milestone of life, they mourn the loss of the child as he or she might have been. Yet the loss of a grown child is the loss of a relationship that has in reality consumed a large amount of energy and emotional investment. Decades of interaction with the son need to be mourned and the finality of the death acknowledged (Rubin, 1989- 1990, p. 334). While the empirical findings suggest the patterns reported above, two caveats are in order at this point. Firstly, although Rubin may be correct in asserting that there is a developmental aspect to the grieving processes of bereaved parents, the comparison of younger and older bereaved children may also be confounded by the cause of their deaths. As will be explained shortly, the sudden and violent deaths more likely in adult children (and 60 certainly the case in Rubin’s investigations of deceased solider sons) are compared with the deaths of younger children, who tend to have died of non-violent causes, such as diseases. Research has definitely shown that the sudden and violent deaths of children are more traumatic to bereaved parents, and thus the cause of death may confound the observed relationship between the age of the child and the intensity of parental grief. Secondly, there is the potential for bereaved parents of younger children to find comparisons of age and intensity to be deeply hurtful and invalidating of their own grieving experiences. Thus, it is important to return to the unanimous conclusion of the research community that the death of a child, regardless of his or her age or cause of death, is a deeply distressing event, and that comparisons of grieving intensity cannot account for the subjective suffering of each parent. A very important consideration in the exploration of parental bereavement is the cause of the child’s death. Similar to the discussion on the gender differences in parental grieving, the research on the cause of death is fairly robust (Murphy, 2008). Researchers have consistently found that sudden and violent deaths of children (e.g., by sudden illness, accident, homicide, or suicide) are likely to yield a more intensive grief for bereaved parents (cf. Stroebe et al., 2007). This result appears to be fairly robust and may be explained by the fact that bereaved parents of suddenly and violently deceased children experience more drastic and immediate invalidation of core beliefs and worldview assumptions, while the bereaved parents of deceased children who die of diseases may have had time to understand the cause of their child’s death and anticipate the coming loss. Some researchers have sought to differentiate between the various types of violent death, wondering whether a suicide may be particularly harrowing for bereaved parents (Murphy et al., 2003). Contrary to clinical lore, Murphy and her colleagues found that suicide 61 was not associated with the most intensive or complicated forms of grief, when compared with homicide or accident. She explained this finding by noting that parents of children who committed suicide may have had some warning of their child’s impending death, as suicide is frequently associated with mental disorders. An investigation of grieving processes of 540 bereaved parents likewise demonstrated that the differences in the intensity of grieving between suicide and other violent causes were not substantive (Feigelman, Jordan, & Gorman, 2008-2009). Rather, the researchers found that the differences were overshadowed by the finding that the intensity of parental grieving diminished over time. While research has failed to demonstrate that one type of violent death is predictive of increased grieving intensity for bereaved parents, thematic differences in the grieving processes of bereaved parents have been found quite consistently (Murphy, 2008). Parents of children who committed suicide frequently deal with themes of guilt and shame surrounding the cause of death of their child, and wonder about the moral consequences of committing suicide (Owens, Lambert, Lloyd, & Donovan, 2008). Feigelman and his colleagues suggested that the grieving processes of bereaved parents may be complicated by stigmatization of suicide and with pre-death complications in the relationships between the deceased children and significant others in his or her life. Bereaved parents of murdered children also reveal unique themes in their grieving as they synthesize their own reactions to their child’s death and their child’s murderer with public reactions and media attention (Dannemiller, 2002). Searching for Meaning One of the most prominent themes in the parental bereavement literature concerns the issue of meaning. To date, a variety of qualitative (Braun & Berg, 1994; Klass, 1999; Matthews & Marwit, 2003-2004; Nadeau, 2001a, 2001b; Wheeler, 2001) and quantitative 62 (Anderson, et al., 2005; Davis, 2001; Davis & Nolen-Hoeksema, 2001; Davis, Nolen- Hoeksema, & Larson, 1998; Davis, Wortman, Lehman, & Silver, 2000), and mixed methods (Murphy et al., 2003; Uren & Wastell, 2002) investigations have begun to explore the process of how parents come to find meaning after the loss of a child. While the results are informative, they also point to the complexity of meaning-reconstruction, which is influenced by a myriad of personal and contextual factors. Of particular mention is the fact that many studies have suggested that religiosity/spirituality may offer important resources in the search for meaning for bereaved parents (Wortman & Park, 2008, 2009). Qualitative researchers have offered detailed insights into the phenomenology of parental bereavement and the process of finding meaning. Braun and Berg (1994) conducted one of the first studies on the meaning reconstruction efforts of bereaved parents. Interestingly, Braun and Berg found that pre-existing structures, which could accommodate the death of a child, were not as disrupted as structures which could not account for such loss, which in turn led to disorientation. Central elements to meaning structures which could not account for a child’s death included the view that a child was seen as the central source of parent’s meaning and purpose, the view of the child as an extension of parent’s self and future, the belief in life as orderly, good and basically fair, the belief that parents and children were basically immune to tragedy, and the belief that life is basically confined to one’s earthly existence. These views were aided by social factors, which reinforced the beliefs. By contrast, Braun and Berg (1994) noted that those informants whose prior meaning structures could account for the loss of a child included the following elements: (a) that the experience of the loss of child does not eradicate the basic value of life itself; (b) having experienced prior difficult experiences in the past; (c) a strong belief in an afterlife, (d) the 63 perception of self as powerless under control of an all-powerful God; (e) an ongoing belief in order in the world, and (f) the belief that God has reasons for such tragic events and the ability to accept these reasons unquestionably. Although this study did not solely include people with spiritual/religious beliefs, the phenomenology of grieving that emerged clearly pointed to the importance of such elements in the grieving experiences of bereaved parents. Wheeler (2001) explored the process of finding meaning after the death of a child through asking 176 bereaved parents (78% female; 98% white, 42% Protestant, 32% Catholic, 10% no affiliation, 7% Jewish) to respond to several open-ended questions about their experience of their child’s death and the meaning of the parent’s lives post loss. Findings revealed that many parents initially were unable to accept the reality of the death and that their focus was on their own emotional reactions of anger, bitterness, pain, fear, guilt, as well as on their preoccupation with the deceased child. However, as time progressed, parents reported that some were indeed able to accept the death of their child, while others engaged in continual questions and remained unable to accept the reality of the death of their child. In terms of the meaning, Wheeler found that parents focused on: (1) their pain and suffering; (2) the deceased child’s life and death; (3) connections with other people; (4) positive gains, such as a new appreciation for life and re-evaluation of values. In terms of meaning, ten percent of the respondents reported that nothing has given meaning to their life since the death of their child (Wheeler, 2001). Others reported that they had found meaning in connections with other people and in new and valuable activities. For some parents, beliefs and values had become significant, including faith in higher power, reunion with child, belief in greater scheme, valuing life and living more fully, accepting what cannot be changed, caring more about people, valuing the spiritual above the 64 materialistic, and finding new religious/spiritual beliefs. Another category that emerged was the connection with the deceased child – valuing time spent with child, volunteer work connected to the child, keeping the child’s memory alive, and valuing memories of the child. Finally, a minority of the parents stated that they had found meaning again through focusing on personal growth (e.g., becoming a better person, pursuing education, self-discovery). In a distinctly unique study, Nadeau (2001a) explored the meaning-making processes of ten non-clinical, multigenerational families. In contrast to the vast majority of studies, which explored these processes from an individual perspective, Nadeau’s work stands out as a systemic perspective on grieving. Nadeau found that the process of finding meaning was influenced by a variety of factors, including: (1) the in-law effect, in which in-laws fuelled the family conversation by introducing elements that members who were closely related did not; (2) meaning enhancers, which included a variety of elements that facilitated the family’s willingness to share meanings, such as the frequency of contact, rituals, tolerance for differences, nature of the death; (3) meaning inhibitors, which were factors, such as family secrets, fragile family ties, cut-off relationships, widely divergent beliefs, and implicit rules which prohibited sharing. Nadeau (2001b) reported a variety of strategies which families employed to make meaning following a loss. These strategies included family storytelling, the sharing of meaningful dreams, comparison of accounts of the deceased, using seemingly random events to make sense of the death, characterization of the deceased, and the sharing of particular insider information about the deceased family member. In terms of the results, Nadeau (2001a) noted that she found ten different types of meanings: (a) statements about what the death was not, (b) statements about how there was no sense to be made, (c) statements about 65 how the death was unfair or unjust, (d) philosophical statements, (e) religious statements, (f) statements about the afterlife, (g) statements about the nature of the death, (h) statements about the attitude of the deceased toward death, (i) statements about how the death changed the family, and (j) statements about lessons learned and truths realized. The work of Shirley Murphy and her colleagues (Murphy, 2008; Murphy et al., 2003) has been mentioned previously in this chapter. In relation to meaning, Murphy found that participants’ meaning-finding increased over time: none reported finding meaning at four months, twelve percent at twelve months and fifty-seven percent at sixty months. Murphy and her colleagues reported that the need to find meaning was a high priority for bereaved parents – 80% responded to open-ended item about meaning and early resolvers have had some indicators about the possibility of death. Numerous themes emerged from this study. Murphy and her colleagues (Murphy et al., 2003) reported that within the first four to twelve months, parents were dealing with (a) unfairness of death; (b) seeking information and explanation for death; (c) making causal attributions based on information attained; and (d) parents’ self-questioning of their responsibilities for the death. Between 12-60 months, however, the themes changed to include: (a) establishing rituals & memorials, (b) seeking justice/revenge/fear of personal safety; (c) realistic acceptance of the deceased children’s lives as they were lived. At 60 months parents grappled with, (a) gaining new insights into the meaning of life and reordering priorities; (b) existential beliefs; (c) valuing the deceased child; (d) belief that the child’s suffering had ended; (e) becoming more altruistic; (f) learning of one’s strength in the face of adversity; (f) perceived benefits. Murphy found that the process of finding meaning (which in this study was defined as ‘comprehensibility’) was a lengthy process. She noted 66 that, “as parents moved toward meaning as significance, their narratives described rituals being established, realistic acceptance of how their children’s lives were lived, and eventually were able to describe ‘what is important now’” (Murphy et al., 2003, p. 399). In a series of studies, Matthews, Marwit and their colleagues (Anderson, et al., 2005; Matthews & Marwit, 2003-2004) explored the bereavement experiences of 155 bereaved parents who had lost their children due to murder, illness, or accidents (including control group). Their focus was on the assumptive worlds of parents and the particular differences that emerged when comparing the causes of death and the implications for grieving. Results of the study supported the contention that traumatic deaths affected assumptive worlds and offered some evidence that the type of death may also affect the parents’ efforts at reconstructing meaning. Bereaved parents compared with non-bereaved parents demonstrated more negative views on all subscales of the World Assumptions Scale (WAS; Janoff-Bulman, 1989) – view of self, meaningfulness of world, benevolence of world. Additionally, parents who had lost a child to homicide reported more negative view of benevolence than those who had lost a child in an accident. These, in turn, reported lower scores on the meaningfulness subscale of the WAS, thus implying that they felt they had less control over their world. Parents who had lost a child to a homicide also reported low scores on worthiness, while those who had lost a child to illness seemed to have the hardest time making sense of loss. Regardless of the cause of death, however, the worldview of the bereaved parents predicted the emotional intensity of their grief. Davis and his colleagues (Davis, 2001; Davis, et al., 2000) conducted a series of studies on meaning-making in the face of loss. The first study was part of a large, multi-wave investigation on bereavement (Davis & Nolen-Hoeksema, 2001; Davis, et al., 1998). A total 67 of 180 family members participated in four interviews – three, six, thirteen and eighteen months post-loss. The sample was largely female (74%), white (81%), and had lost a parent, spouse/partner, child, sibling or relative to a terminal illness (e.g., cancer, AIDS, etc.). Results from this study indicated that 98% of the respondents attempted to make sense of the death (although only 68% reported that they had found meaning) and 73% had found some benefit in the loss after six months. Three factors predicted the respondent’s ability to make sense of the loss – reported religious beliefs, pre-loss distress and the age of the deceased. Respondents were more likely to be able to make sense of the loss if they reported religious and spiritual beliefs, were experiencing less distress prior to the death, and if the age of the deceased was older. The ability to find some benefit in the loss was predicted by dispositional optimism. Taken together, the results of the study lent preliminary support for a mediational model of meaning, in which the two measured aspects of meaning (sense- making and benefit finding) mediated the relationship between several pre-loss variables (age of the deceased, religious beliefs, pre-loss distress, pre-loss optimism) and the composite distress score (symptoms of PTSD and depression and positive affect). The work of Davis and his colleagues has been quite influential in shaping bereavement-related research on meaning. Two comments, however, seem appropriate at this juncture. Firstly, Davis (2001) has suggested that finding meaning may be a composite cognitive process for two distinct processes – benefit finding and sense-making. The basic structure of this process corresponds well with Freud’s (1917/2005) original suggestion that grieving moves between engagement with the loss (sense-making) and re-engagement with life post-loss (benefit finding). Existential psychologists (Längle, 2005a) have suggested something similar by noting that meaning addresses context, purpose and value. 68 Secondly, it may be worth reconsidering the strong cognitive and functionalist bias of ‘sense-making’ and ‘benefit-finding’. Längle and others (Attig, 1996; Klass, 1999; Neimeyer, 2000) have acknowledged that cognitive processes are part of grieving, but remind scholars that it cannot be reduced to a cognitive process. Grieving is fundamentally a holistic activity, an emotional engagement with the loss and a relearning of the world, and a solely-cognitive conceptualization impoverishes this process. Furthermore, benefit-finding is an overly functionalistic conceptualization of meaning-reconstruction, to which some bereaved parents have taken offense (e.g., Keesee, Currier, & Neimeyer, 2008). A more appropriate framing of this issue might be in terms of values, asking bereaved parents if, in spite of all their suffering, anything ‘good’ had emerged from this tragedy. Drawing on two separate samples – 124 parents who had lost a child to sudden infant death syndrome (SIDS), and 93 people who had lost a spouse or a child in a motor vehicle accident – Davis and his colleagues (Davis et al., 2000) explored three common assumptions regarding meaning: (1) that most people engage in a search for meaning after a loss; (2) that most people are able to find meaning in the loss; (3) and that finding meaning is critically important for successful adjustment post-bereavement. Results from these two samples indicated that the three common assumptions indeed did bear some investigation. A significant subset of participants in both studies reported that they had not searched for meaning, and if they had searched for meaning that they had not found it. Furthermore, results also indicated that those who had found meaning were not significantly better off in terms of their psychological adjustment than those who had not entertained this issue (although they were better off than those who had searched and not found meaning). It is also interesting to note that time post-loss was not predictive of finding meaning; Davis et al 69 (2000) note that parents in the SIDS study who had not found meaning one month post loss were not likely to do so at subsequent interviews (three months or eighteen months). For the current study, it is interesting to note that the worldviews of participants were indeed predictive of the ability to find meaning; those participants who reported being religious were more likely to find meaning in the first few weeks post-loss, and this was in turn associated with decreased distress and increased positive affect. However, the results of the two studies on sudden death (Davis et al., 2000; Davis & Nolen-Hoeksema, 2001), do raise significant issues about the nature of meaning and why, after the death of a close relative, some people do not appear to seek for a greater meaning in the event. Gamino and his colleagues (Gamino, Hogan, & Sewell, 2002; Gamino & Sewell, 2004; Gamino, Sewell, & Easterling, 2000) conducted a series of studies to attempt to address this matter through qualitative and quantitative methods. In their qualitative study, they asked a heterogenous sample of 85 mourners to respond to the question of how they made sense of the death of their loved one. Responses varied between themes which addressed pragmatic and instrumental responses to the loss – such as feeling the absence of the loved one – to more existential and spiritual responses – such as continuing the connection, invoking the afterlife, and going on with life. Gamino and his colleagues (Gamino et al., 2002) suggested that the discrepant meanings of the mourners in this study might explain the controversy over whether mourners search for meaning after the death of a loved one. They noted that, “those mourners who construe concretely the meaning of the death in terms of its pragmatic consequences for their lives may not so much seek meaning as they realize the instrumental meaning of the loved one’s death…Others may engage in a proactive search for meaning at a more abstract level including the pursuit of philosophical, 70 existential answers through soulful reflection” (p. 810). This explanation maps on well onto the distinction between a received, ontological meaning and the active process of finding situational or existential meaning (Frankl, 1969; Längle, 2005a). However, Gamino and his colleagues (Gamino et al., 2004) went even further and investigated which types of meaning (focusing on instrumental loss or finding existential meaning) predicted positive adjustment following the loss, and found that those mourners who focused on spiritual themes expressing hope and recovery in addition to (not to the exclusion of) negative, pragmatic themes (such as feeling the absence of a loved one). They noted, that “the key difference was better adjustment among those participants who, despite their grief, still endorsed some dimensions of hope and recovery compared with those who expressed exclusively pain and suffering in their narratives” (p. 413). In sum, the research on making and finding meaning after death has suggested that meaning-reconstruction is a central aspect for grieving generally (Davis et al., 2000) and for the grieving processes of bereaved parents (Gamino et al., 2004). Although the process of finding meaning is difficult and may at times be unsuccessful, these studies suggest that it is an activity that is central to the grieving processes of most bereaved parents. Those who do not may have consciously or unconsciously found a meaning; searching for meaning is only relevant for those whose worldviews have been challenged by a loss (Frankl, 1969). Studies have also suggested that finding or making meaning post-loss contributes positively to the well-being of bereaved parents (Keessee et al., 2008) and that meaning may buffer against the development of a complicated grieving process. Spiritual and religious worldviews and practices have been found to contribute substantively to the process of finding and making 71 meaning (Braun & Berg, 1994; Pargament, 1997), and it is to such research that we now turn our attention. Spirituality/Religiosity and Parental Bereavement While the research to date has suggested that spirituality and religiosity may contribute substantively to parental grieving (Braun & Berg, 1994), relatively few studies have sought to investigate its contribution to grieving (e.g., Anderson, et al., 2005; Klass, 1999; Matthews & Marwit, 2006; see Wortman & Park, 2008, 2009, for reviews of the role of spirituality and religiosity in bereavement more generally). This may not be entirely surprising, given the lack of research attention to religious/spiritual issues more generally (Emmons & Paloutzian, 2003), but it does point to an important gap in the parental bereavement literature. When spirituality and/or religiosity have been addressed, scholars have explored it indirectly while focusing on parental grieving more generally (Murphy et al., 2003; Nadeau, 2001) or in the context of the parents’ search for meaning (e.g., Davis, 2001; Matthews & Marwit, 2003-2004; Wheeler, 2001; Uren & Wastell, 2002). The majority of the investigations into the role of religiosity/spirituality in parental bereavement have found that spirituality and religiosity function as a positive resource during the struggle of parental loss (Wortman & Park, 2008). Spiritual/religious beliefs, communities and practices offer parents a worldview (Benore & Park, 2004; Braun & Berg, 1994), which enables them to find some meaning in their loss and solace in their grief (Davis & Nolen-Hoeksema, 2001), an understanding and caring community (Klass, 1999), which can support them in their grieving, and spiritual/religious coping activities (Pargament, 1997; Park, 2005), which provide pre-established ways of dealing with distress. 72 The death of a child typically violates the assumptive worlds of the bereaved, especially the child’s parents (Klass, 1999). Parents are frequently at a loss as to how to make sense of an event that reverses the natural order of birth and death and to find an explanation for the incomprehensible. Some spiritual/religious worldviews may be very helpful in this process as the death of the child and the subsequent suffering of the bereaved parents can be held within a wider, spiritual context. This context may support bereaved parents in finding an ontological ground for such an incomprehensible event, and this ground may assist them in finding a meaning for their loss and their lives. Importantly, the spiritual worldviews of the bereaved need to be able to accommodate the presence of suffering (Rinpoche, 1992; Rohr, 1996). Spiritual worldviews which negate suffering or explain it as a personal moral consequence are not of much use to the bereaved and may be discarded in the face of immense tragedies. Klass (1999) has suggested that spiritual worldviews need to be held personally if they are to be of value to bereaved parents. This corresponds well with research on intrinsic religiosity (see Donahue, 1985, for a review). General, impersonal or solely cognitive beliefs are too abstract to impact the grieving process for bereaved parents. Bereaved parents are not interested in abstract or metaphysical questions – they are searching for personal understandings and meanings in the aftermath of their loss. They want to know why their child has died and why they are suffering. Spiritual worldviews may offer an explanation or exhort bereaved parents to find meaning in the absence of a clear-cut answer to their question. A spiritual worldview does not prevent parents from suffering in their loss, as Klass (1999) has noted: “Bereaved parents do not escape from their grief into a purer place called the spiritual, rather the spiritual emerges in the day to day coming to terms with the death of 73 their child. Their spirituality is not a refuge from their grief, but part of their lives that develops as they grow in their grief” (pp. 19-20). Spiritual/religious worldviews and communities also offer their adherents the experience of interpersonal and Divine comfort of solace in their grief (Klass, 1999). This experience of some soothing of the pain is grounded in death-specific beliefs, such as the belief in an afterlife, but more deeply experienced in the connection to the Divine and in their continuing bond with the deceased child (Benore & Park, 2004; Klass, et al., 1996). Life, for these parents, does not end with the physical death of their child. Rather, spiritual/religious experiences and practices allow parents to continue to experience the presence of their children in this life, and may offer an opportunity for reunification in the next (Steffen & Coyle, 2010). Klass (1999) suggested that solace and comfort in the midst of the intensive process of parental grieving emerged from the ongoing inner representation of their deceased child within the context of an accommodating spiritual worldview. He noted that “for bereaved parents, solace comes in the sense of transcendent reality experienced in the midst of devastation. Solace comes into the heart of pain. Solace is found within the sense of being connected to a reality that transcends the self. Among bereaved parents, their interaction with their dead children is merged into their other experience of transcendent reality” (p. 95). Finally, parental grieving – whether spiritual/religious or otherwise – does not take place in isolation. The vast majority of the research indicates that spiritual/religious coping with parental bereavement is fundamentally relational (Klass, 1999; Rosenblatt, 2000). Two basic arguments have been put forth for the relationality of parental grieving. Firstly, most researchers have found that the grieving process for parents involves the social and spiritual support of many individuals and groups – support groups, clergy, counsellors, family, 74 members of one’s spiritual community, the Divine, and so forth (Wortman & Park, 2008). This way of conceptualizing relationality foregrounds the individual as coping with the spiritual and social support of others. However, grieving is also relational on a more profound level. In this approach to relationality, the individual is seen as fundamentally and inextricably in relationship. His or her being itself is relational, is being-the-world, being-in- relationship (Chiari & Nuzzo, 2006; Längle, 2005a; Young, et al., 2002; cf. Heidegger, 1927/1962). This conceptualization of grieving is irreducibly interpersonal, acknowledging the experience of the relationship between parents, between parent and child, and between parents and the Divine. Klass (1999) related this vision of relationality to the transformed, continuing bond between the parent and the child. He noted that, “at its core, immortality is a social reality, not an ontological reality. It is actualized in the continuing bond between parent and child, in the love that does not die. The reality of an immortal child is not in an imagined better world outside this one…In the continuing bond with the parent’s dead child, the child remains immortal in the parents’ memories, and the parent makes the child real in the life the parent now lives dedicated to the child’s memory. So long as this lives, the child lives in the Eternal Now” (p. 124). Empirical Limitations The existing research on parental bereavement has offered a rich ground on which to develop a study on parental grieving and the role of spirituality/religiosity. A critical look at the literature, however, reveals several limitations and points to important next steps in the research. Firstly, very few studies have directly investigated the role of spirituality/religiosity in the grieving processes of bereaved parents (Wortman & Park, 2008, 2009). Most scholarship in this area has explored this indirectly while investigating parental grieving 75 more generally (e.g., Murphy, 2008) or in relation to the process of making or finding meaning (e.g., Braun & Berg, 1994; Davis & Nolen-Hoeksema, 2001; Uren & Wastell, 2002). When spirituality and/or religiosity have been explored, researchers have typically focused on cognitive beliefs (e.g., Benore & Park, 2004) or meaning-making (Park, 2005) or coping (McIntosh, Silver, & Wortman, 1993). However, if we understand religiosity/spirituality as multidimensional constructs, then contextually-sensitive investigations of the various dimensions are necessary to understand them more holistically. Secondly, the vast majority of parental bereavement research to date has explored parental grieving as an individual, intrapsychic processes (Walter, 1996). This is certainly the case for coping and religious coping research (e.g., McIntosh et al., 1993; Park, 2005) as well as for studies conducted from the perspective of attachment theory (Mikulincer & Shaver, 2008) and various integrative models of bereavement (Rubin, 1996; Wijnsgaards-de Meij et al., 2005). When relationships have been foregrounded (e.g., Field, 2008; Klass et al., 1996), the focus has been on the relationship between an individual parent and the deceased child. Even Klass’ work (Klass, 1999), which explicitly acknowledges communal aspects of parental grieving, has investigated the development of continuing bonds as ‘inner representations’, thus framing them as intrapsychic processes. A few studies have begun to explore relational or dyadic levels of parental grieving (e.g., Toller & Braithwaite, 2009; Wijngaards-de Meij et al., 2008), and their authors have called for further investigation of the relational dimensions of parental grieving. Contextual Action Theory Contextual action theory may be helpful in advancing our understanding of the grieving processes of bereaved parents. Action theory can be considered an integrative 76 framework – a specific way of looking at human emotional, cognitive, behavioural and relational processes – that draws on a variety of discourses in the social sciences, including, social constructionism, hermeneutics, phenomenology, and narrative studies (Valach, et al., 2002; Young & Valach, 2008; Valach & Young, 2004). One of the chief features of this integrative framework is that it assumes action – goal-directed, human behaviour – to be its central construct and unit of analysis. Contextual action theory directs the researcher to view the ways in which intrapsychic elements, and their contextual counterparts emerge in the intentional, joint activities of human beings. As a construct, therefore, action serves principally to synthesize phenomena holistically rather than to fragment them into their individual elements (Young, et al., 2002; cf. Lazarus, 2000). Contextual action theory is based on the notion that “intentional action used by agents can be conceptualized and analyzed as oriented toward the personal and shared conception or anticipation of ends (goals, striving for end states) and toward processes occurring while attaining or attempting to attain these ends” (Young & Valach, 2004, p. 501). Contextual action theory builds on and yet sits uniquely within the wider class of philosophical and social scientific action theories. Action theory researchers have generally employed the action-project method as their method of inquiry (Young, et al., 2005). The action-project method is a comprehensive, team-based, qualitative method that uses video-based research interviews, participant journalling and telephone monitoring strategies to comprehensively monitor and describe individual and joint intentional processes over time. The method follows an interpretive hermeneutic that moves between data and the contextual action theory framework. Importantly, the action-project method was specifically designed for dyadic research and focuses not only on retrospective accounts but on current actions and joint actions. 77 To date, contextual action theory research has been employed in a variety of domains, including life transitions (e.g., career transition, transition to adulthood through studying family projects; Young, Valach, & Collin, 2002; Young, Marshall, Domene, Graham, Logan, Zaidman-Zait, Mart, & Lee, 2008) and health research (e.g., suicidality; Valach, Michel, Dey, & Young, 2002) and health behaviours (Young, Logan, Lovato, Moffat, & Shoveller, 2005). A recent study examined the process of addiction recovery as it unfolded within a close relationship (cf. Graham, Young, Valach, & Wood, 2008). The central constructs and the research method of contextual action theory offer a useful framework for researching parental grieving as an intentional and shared human activity through the integration of several different perspectives on action. While not disparaging of sophisticated quantitative research programs – especially those which have been adapted to study grieving as a process – we believe that contextual action theory and the action-project method – offer researchers a lens and research method to understand grieving as a temporal, contextually embedded process (Valach, 1995). As such, a contextual action theory perspective on parental bereavement not only avoids the well- documented pitfalls of coping research (Folkman & Moskowitz, 2004; Oakland & Ostell, 1996; Lazarus, 2000), but also stands to make substantive contribution through the examination of the personal significance of spiritual/religious grieving efforts and its relationship to individual and joint activities. Figure 4 below illustrates how contextual action theory integrates several perspectives and a hierarchical organization into a conception of action as a temporal construct (Klaassen et al., 2009). Intentional activities can simultaneously be understood as embedded within systems in time, be analyzed from the perspectives of internal processes, manifest behaviours 78 and social meaning and finally be organized hierarchically with meaningful relationships between action goals, functional steps and elements. As an integrative framework contextual action theory thus offers a way to understand human action in terms of its teleonomic, future- oriented focus (i.e. conscious goals or lived, intentional activities), rather than relying on a causal framework, which aims to understand antecedent conditions that give rise to phenomena (Young, et al., 2005). Action organization. As a framework for understanding human processes, contextual action theory offers a helpful way of organizing intentional and goal-directed activities. Within a developmental trajectory, contextual action theory posits four hierarchically organized action systems in which individual actions can cohere into larger organizing units. These include individual/joint action, project and career (Young & Valach, 2000). Joint and individual actions can be thought of as relatively short-term phenomena, conducted individually or in groups of two or more people, which are “anchored cognitively, socially and environmentally in our everyday lives” (Young, et al., 2005, p. 217). Project is considered to be a mid-range construct that organizes a variety of actions with common goal(s) or intention(s), structuring them based on shared definitions of specific tasks (Valach et al., 2002). In contrast to the term in a vocational sense, career is posited to be the most superordinate construct “that allows people to construct connections among actions, to account for effort, plans, goals, and consequences, to frame internal cognitions and emotions, and to use feedback and feed-forward processes” (Young & Valach, 2000, p. 188). The action-theoretical perspective on an otherwise isolated grieving process contextualizes the individual or joint action within a larger temporal context and relates it to other activities within the lives of the participants. 79 Figure 4. The Integrative Function of Action. © Brill, 2005, by permission. G FS E G FS E ACTION PROJECT CAREER Manifest Behaviours Internal Processes Social Meaning Goals (G) Functional Steps (FS) Elements (E) TIME A ct io n Pe rs pe ct iv es Action Organization Action over Time 80 Perspectives on action. While contextual action theory is inherently integrative and holistic, it also posits three perspectives on how action may be viewed and researched (Young & Valach, 2008; Young et al., 2005). From an external perspective, one can identify manifest behaviours, such as verbal and nonverbal behaviours, and structural resources/constraints, such as socio-economic status, gender, ethnicity, and so forth. Internal processes, by contrast, refer to the largely intrapsychic processes of emotion and cognition, which energize and direct or steer action respectively. These processes are inaccessible through objective means and require a subjective account of the participants. Finally, action can also be seen from the perspective of social meaning, that is, the personal and social value of the action that arises from the personal and social contexts within which it takes place. Levels of action. To summarize, we have discussed how actions can be examined from behavioural, cognitive and emotional perspectives, as well as understood, at a higher and integrative level of organization, from the perspective of meaning. Social and personal meaning emerge contextually when actions are understood ontologically, that is, when they are seen as ‘being about’ something (Young & Valach, 2000) and relating to values. Similarly, joint actions can be analysed temporally as projects and/or careers. The organizing principle for this temporal organization is teleonomic; actions cohere into projects and into careers on the basis of a common goal or intention. These goals may or may not be conscious to the person in action at a given time and most certainly may be fuelled also by unconscious features and enabled or limited by structural resources and constraints. However, from the perspective of the actor, even tasks which require little cognitive effort, such as dialling a friend’s phone number on one’s speed dial, are very often purposeful and can be understood, from a contextual action theory perspective, as being in 81 service of a larger goal-directed project. Young and his colleagues have designated elements to be verbal and non-verbal behaviours that form the basic behavioural components (e.g. dialing a telephone) of a larger goal. Several elements may in turn combine into a functional step, which “serve to reach a goal and represent the flow and sequence of the action” (Young et al., 2005, p. 217). Context and process. As is evident from the preceeding sections, contextual action theory is an inherently contextual approach (Young & Valach, 2008). Since contextualism is a central theme in this framework, it is important to elaborate briefly on the ways in which contextual action theory sensitizes the researchers to the context of an action, such as parental bereavement. Young and his colleagues (Young, et al., 2002) draw upon the metaphor of weaving to illustrate the ways in which several complex parts of a whole may reveal their interrelatedness. Individual threads, which in isolation may appear chaotic and without direction, gain coherence in the weave only when viewed in relation the other threads and the resulting larger patterns. Action, as the central construct of contextual action theory, serves an integrative function in weaving together intrapsychic, temporal and teleonomic elements of goal-directed, human behaviour. These integrative functions are illustrated in Figure 4. Contextual action theory understands context as the field within which action takes place (cf. Boesch, 1991). This view contrasts sharply with the ‘moderator-approach’, common in most psychological literature, including in bereavement research (Folkman, 2001; Stroebe et al., 2006). Contextual action theory does not consider context as a ‘thing’ or ‘entity’ that exists outside the individual and which is open to statistical control. Rather, context is more aptly framed as emerging in and through individuals (Radley, 1996) as they 82 act in relationship to themselves, other individuals and groups and their environments. Thus, actions themselves are inherently contextual and individual and joint action simultaneously arises out of and creates a context. Often, the language and research practices invoked when considering parental grieving serves to decontextualize actions. In contextual action theory, however, it is the grieving itself that contextualizes: given all the variables, in this time and place for this purpose, this person grieves (Young, et al., 2002). We consider action as an integrative way to conceptualize and research the ongoing relationship between the individual and context, in this case as related to parental grieving. Action perspectives offer a way of understanding action at a given point in time depending on whether the goal, functional step (strategy) or elements (operations level) is being considered at either the action, project, or career level of organization. The concept of action takes shape through simultaneous focus on its manifest behaviours, internal processes (such as cognitions and emotions) and social meaning, that is, the reflected-upon and lived value of the action. Action integrates these multiple perspectives on intentional activity into one construct and contextualizes them at the level of social meaning. Importantly, action theory does not postulate the primacy of manifest behaviours, internal processes or social meaning (Valach, Young, & Lyman, 1996). The basic human processes conceived of from a contextual action theory perspective can be analyzed at the social level, which is the highest level of organization, at a midrange level which includes individual and social cognitive steering and finally at the observable level of manifest action. Specific ways of accessing and collecting data have been conceptualized and linked to each level of process. At a social level, goals are negotiated and strategies are enacted as group action (i.e., social control) through processes such as verbal 83 and non-verbal communication. This type of information is accessed through naïve observation of social attributions both of the research participants and within the research team (Valach et al., 2002). At a middle level of organization, cognitive steering represents the role that internal processes play in the development of individual goals and the energizing and steering of individual level actions. Within the research method these conscious processes are accessed primarily (although not exclusively) through the self-confrontation interview (see Young, et al., 2005). Cognitive steering includes processes related to plans, strategies, decisions and resolve at the operations level (Valach et al., 2002). Finally, manifest behaviours unfold as observable elements, functional steps or goals that can be identified by systematic observation of at the level of action, whether individual or joint actions. Goals that organize actions serve to provide a coherent account of human behaviour, anchoring it both in one’s biographical past and the anticipated future. This has long been evident within the writings of various existential psychologists (e.g., Frankl, 1984; Längle, 2005a). Meanings do not simply arise in a vacuum; rather, they are related to and framed within personal and joint value structures. Action systems and organization elaborate on the forward-looking dimension of action. Systemically, individual and joint actions cohere into projects, which in turn can be hierarchically organized into careers. In this manner actions are integrated and contextualized over time. However, from a subjective and intersubjective perspective, human beings are intentional and goal-directed beings, who are constantly going about striving for and imagining new ends. Goals, which in action theory can be sub-divided into functional steps and elements, thus are embedded in the functional and temporal context. 84 Conclusion This chapter has sought to contextualize the current action-theoretical investigation of parental grieving within the wider parental bereavement literature. We began by reviewing definitions of key constructs, such as grieving, bereavement, spirituality and religiosity. Next followed an overview and critique of the theoretical grounding of bereavement research. Subsequently, this chapter went on to review the experience of and research on parental bereavement, including specific research address its health and relational consequences, as well as the role of meaning and spirituality/religiosity in the grieving practices of bereaved parents. Finally, this chapter gave an overview of contextual action theory, which is well- suited to address the relational and contextual limitations in the existing research on parental bereavement. The next chapter will address this issue in greater detail and argue for the value of an action-theoretical investigation of parental grieving. 85 Chapter 3: Method This chapter describes the current action-theoretical investigation of the joint grieving actions of religious/spiritual bereaved parents. It offers first a rationale for the study generally as well as for the case study approach and the qualitative action-project method in particular (Young et al., 2005). Next, it addresses the recruitment of participants and describes the five couples who chose to participate in this case study. Data collection and the process of analysis are subsequently explored. The chapter concludes with a discussion of trustworthiness and rigour in qualitative research generally and demonstrates how these principles were addressed in the current study. Following a thorough and critical investigation of the literature on parental bereavement and spirituality, the author identified the following research question as the focus of this current project: How do spiritual/religious bereaved parents grieve jointly for their deceased child? The research question addresses the relational and contextual limitations in the research on parental bereavement and focuses the researcher’s attention on a rich description of the joint grieving actions of bereaved parents. Rationale for the Study The preceding chapter reviewed the extant literature on spirituality and parental bereavement and revealed several important limitations. Naturally, no one study, including the current one, is able to address all gaps in the literature, but this study sought to address two significant ones: the relationality of parental grieving and the spiritual/religious context in which this grieving took place. The focus of this study was on the joint grieving actions of bereaved parents or the ways in which they grieved together for their deceased child. The study also sought to understand the spiritual/religious context for the bereaved parents and 86 the ways in which the spirituality or faith of the bereaved parents emerged in their grieving actions. It was hoped that this study would not only add substantively to our collective understanding of parental bereavement the grieving process, but also would offer important theoretical contributions. The focus of this study was on the joint grieving actions of bereaved parents who had lost a teenage or adult child. This limitation deserves a brief explanation and justification. While some researchers have explored the grieving experiences of older parents (e.g., Rubin, 1989-1990), most research on parental bereavement has focused on bereaved parents who have lost younger children. Thus, a study on the grieving actions of bereaved parents of older children/adults provided some balance in the literature. More substantively, however, this study was focused on the joint grieving actions of spiritual/religious parents, and scholars (e.g., Pargament, 1997) have suggested that spirituality/religiosity are more likely to emerge as necessary grieving resources when the worldviews of bereaved parents have been challenged. This challenge is most salient when bereaved parents experience a sudden, unexpected and violent loss. And this in turn tends to correspond to the deaths of teenagers and adults. As we will see, indeed all bereaved parents in this study suffered such a loss. The instrumental case study approach. This study employed an instrumental case- study approach to the action-theoretical investigation of the joint grieving actions of spiritual/religious bereaved parents (Stake, 2005). An instrumental case study offers a distinctive approach to qualitative research, as it employs specific cases in the service of understanding a given phenomenon or process – in this case joint grieving actions of spiritual/religious parents. This implies that, although individual cases are inherently 87 important, they are employed in the service of understanding the larger process and of theoretical elaboration. As is evident from the research question, this study conceptualized a case as a parental dyad, and thus the focus for this study was on the joint grieving actions of the parental dyad over time. The action-project method, as outlined below, is highly compatible with the instrumental case study, as it generates significant amounts of data from multiple sources over the duration of the study (e.g., three sets of interviews, telephone logs, participants journals, researcher analyses and self-reflections) and thus enables a rich description of the joint grieving actions of bereaved parents. The qualitative action-project method. The action-project method (Young et al., 2005) is well suited to explore the joint grieving actions of spiritual/religious bereaved parents over time. In fact, the developers of this research method developed it in concert with contextual action theory (Valach et al., 2002) as a method for conducting dyadic-level investigations, which would lead to theoretical formulations that were grounded in the actions of the research participants. Since the action-project method includes multiple sources of data, including individual interviews with participants, joint interviews with participants, joint conversations between participants, telephone conversations with individual participants and individual participants journals, it is well suited to understand the relational and contextual dimensions of the joint grieving actions of spiritual/religious bereaved parents over time. The action-project method also provides a conceptual framework within which to interpret the results and thus stands to make a theoretical as well as empirical contribution to the parental bereavement literature. 88 Participants Five bereaved parent couples were recruited through email advertisements and posters throughout the region (see Appendix A). Support groups for bereaved parents were contacted and asked to make announcements at meetings or distribute invitations to participate to their members. Additionally, an email was distributed through a list-serve for the United Church in British Columbia, since many of the bereaved parent support groups hold their regular meetings in local United Churches. Furthermore, counselling agencies, which specialize in grief counselling, and professional contacts of the author in the Greater Vancouver area and Fraser Valley were contacted. Posters and emails directed interested bereaved parents to contact the author via email or phone call. Once a bereaved parent contacted the author about the study, a time for a screening conversation was set up, or was conducted immediately on the phone. The interested participant was given a brief synopsis of and a rationale for the study. He or she was also told about the expected time commitment for participation in the study, as well as the potential risks and benefits for participating in the study. Finally, the caller was told that since this study involved research into the relational dimension of parental bereavement that the couple would need to be able to participate jointly in the research process. Screening for the inclusion in the study was conducted in a conversational manner with each individual participant. The conversation included a description of the focus of the study as well as an elaboration on the selection criteria for study inclusion. Selection criteria (see Appendix B) for the participants included the following: (1) The couple must have experienced the death of a teenage or adult child (16 years of age or older at the time of 89 death); (2) the couple had to identify that spirituality and/or religion has been an important resource in their grieving and adjustment post-loss. Five heterosexual bereaved parent couples met the screening criteria outlined above and agreed to participate in the study. The mean age of the male participants was 60 years (SD = 4.29), and the mean age of the female participants 61.5 years (SD = 7.66). At the time of the study, all parental couples were married and living together. Four of the couples had remaining biological children and one couple had two remaining adopted children (M = 1.2; SD = 0.4). Three of the couples also had grandchildren. At the time of the study, two of the couples had retired from their professions, while both partners for the other three couples remained employed in various occupations. Three of the five female participants had earned undergraduate college or university degrees, and one female participant had earned a graduate degree. Two of the five male participants had earned undergraduate college or university degrees, and one male participant had earned a graduate degree. One of the retired male participants had elected to return to seminary and was engaged in theological studies at the time of this project. All of the bereaved parents identified themselves as Protestant Christians. Two couples attended Evangelical churches and three couples attended mainline Protestant churches. One of the male participants did not attend his Mainline church regularly, and indicated that he was still exploring his spiritual commitments. One female participant stated that, in addition to attending a mainline church, she was also interested in exploring Aboriginal beliefs and practices, to which she had been exposed at her place of work. All other participants stated that they had been practicing their faith since childhood. All couples had lost one biological child (one female child, four male children). The causes of death were sudden and violent for all children, and included two motor vehicle 90 accidents, one accidental fall, one suicide and one sudden and unexpected heart attack. The mean age of the deceased children at the time of death was 21.2 years (SD = 2.56) and the average time elapsed since the time of death was 10 years (SD = 4.6). Data Collection As outlined in Table 1, the process of gathering data followed the typical pattern for the action-project method (Young et al., 2005). A visual depiction of the various stages of data collection is available in Appendix J. Following the ethical approval of the University of British Columbia’s Behavioural Research Ethics Board, the data collection for each couple included interviews, telephone calls, and journaling. The data were collected by the doctoral student and by three paid graduate students, who had received extensive training the action-project method. All in-person interviews for Couples 2, 3, 4 and 5 were conducted in research rooms on the campus of the University of British Columbia. Interviews for Couple 1 were conducted in their private work offices to accommodate the limited availability for this couple. Interview protocols are found in Appendix H and the personal reflections of the researcher on parental bereavement (bracketing) are found in Appendix G. Couples received $30 after the first two sets of interviews and $40 after the final set of interviews to assist with travel expenses and to provide a small remuneration for their efforts. 91 Table 1: Purpose and Duration/Number of Research Procedures ________________________________________________________________________ Duration/numbera Procedure Purpose M SD n __________________________________________________________________ Initial Warm Up Introduction to parents and 60.40 13.70 5 Conversation deceased child Initial Joint Conversation Record joint conversation 20.00 0.63 5 FPb Self-Confrontation Collect data on internal 76.40 4.41 5 Interviews processes accompanying action MPc Self-Confrontation Collect data on internal 87.00 9.14 5 Interviews processes accompanying action Member Check Interviews Negotiate identification of 75.00 14.18 5 joint grieving project FPb Telephone Monitoring Monitor projects, actions, 1.40d 0.80 5 Interviews and internal processes MPc Telephone Monitoring Monitor projects, actions, 1.60d 0.49 5 Interviews and internal processes FPb Journal entries Monitor projects, actions, and internal processes 4.60d 3.07 5 MPc Journal entries Monitor projects, actions, 2.60d 3.38 5 and internal processes Final Warm Up Evaluate project 11.00 2.49 5 Conversation Final Joint Conversation Record final joint 19.20 3.18 5 conversation Final FPb Self- Collect data on internal 61.20 22.82 5 Confrontation Interview processes accompanying action Final MPd Self- Collect data on internal 73.40 25.14 5 Confrontation Interview processes accompanying action Final Joint Debriefing Debrief couples 12.2 4.07 5 ________________________________________________________________________ aIn minutes, except as noted. bFemale Partner. cMale Partner. dNumber of telephone monitoring forms or journal entries completed. Initial set of interviews. The first set of interviews included four phases – an introductory phase and three phases of the interview (Young et al., 2005). The initial orientation or warm up phase was designed to orient both parents to the study and was 92 conducted jointly with two researchers and the parental couple. Following the interview (see Appendix H), the warm up began with a casual conversation about the process of coming to the study, and both participants were be reminded of confidentiality, its limits, and the rights of participants to omit any questions and withdraw at any time. Additionally, the participants were asked to complete the demographic information sheet (Appendix D) and sign the informed consent form (Appendix C). These forms had already been sent to the couple prior to this meeting for review. Following this initial part of the warm-up interview, the researchers asked the couple to share about themselves, their family and their deceased child. To encourage this process, the parents had been offered the opportunity to bring in photographs of their family and their deceased child, as well as other memorabilia. All couples brought in numerous pictures, and thus introduced the interviewers to the child and to their family. This introduction allowed research participants to become comfortable with the setting and establish an initial rapport with the interviewers. All parents spoke extensively about their family, their spiritual lives prior to the death, and their relationship with their deceased child prior to his or her death. They also spoke about the death of their child, their initial reactions to learning of this death, and their grieving in the aftermath of the death and the funerals of their children. As might be expected, most parents were deeply emotionally involved in the retelling of their child’s death, and many participants expressed their intensive emotions through words and tears. Parents also spoke about their ongoing grieving for their child, and addressed the role of their faith or spirituality1 1 The terms faith or spirituality were used interchangeably, depending upon how the couple identified their spiritual practice. Four of the five couples identified their spiritual practice as a “faith”. in this grieving process. 93 Once the parents were sufficiently oriented towards the topic and had begun to talk about their individual and joint grieving activities, the couple was asked to continue this conversation on their own for approximately 20 minutes. In particular, the parents were asked to speak about the ways in which they grieve together for their child and to speak about the role of their faith or spirituality in this grieving process. The parents were encouraged to think of themselves as sitting around the kitchen table or on the living room couch and to engage in the type of conversation that they would have in their home. This conversation was videotaped, but not simultaneously viewed by the researchers, and the participants were informed of this fact. The main purpose of this part of the interview was to facilitate a joint-conversation between both parents as an example of their joint grieving for their child. After approximately 20 minutes, the researchers knocked on the door of the interview room and inquired if this might be an appropriate time to interrupt the joint conversation. All couples agreed and elected to take a 15-minute break at this point in the interview process. Following the break, the researchers explained the individual self-confrontation interview procedure to the couple. During this phase of the interview each parent individually viewed the video of the joint conversation with one researcher (in separate rooms) and had an opportunity to comment on their internal processes, that is, what they were feeling and thinking, during meaningful units of the conversation. The researcher clarified any questions with the individual participant and then each researcher-parent dyad began viewing the tape of the joint conversation. After approximately one minute, the researcher stopped the video and asked the participant what s/he was feeling and thinking during the last viewed portion of the tape. This procedure was repeated until the entire joint conversation had been viewed. At 94 the end of the viewing, the participant was be asked about his/her overall goal or intention for this conversation as well as for what they hoped to accomplish by participating in this study. Following the individual self-confrontation interviews, the researchers and parents convened jointly in a common room, where the researchers gave the parents time to speak about their experience and ask questions. All parents commented on the emotional intensity of this first set of interviews, and several noted that this had been the most emotionally intensive experience that they had had since the initial phase of their grieving. The researchers concluded the first set of interviews by outlining the next research procedures and promising to be in touch to schedule the next set of interviews. Analysis of the initial conversation. Following the first set of interviews, the researchers conducted an initial analysis of the individual and joint grieving actions for each parental couple. The data analysis procedure followed the steps developed by Young, Valach and their colleagues in a successive series of publications (Valach et al., 2002; Young et al., 2005). The analysis for each set of initial interviews was conducted by the author in consultation with the co-researchers and the supervisors. Following the analysis, the author then drafted individual grieving narratives for each parent and a joint grieving narrative for the couple. The joint grieving narrative culminated in the joint grieving project, a sentence- long summary of the joint grieving actions for the couple. The revised version of the three narratives, as outlined below, was incorporated into the second set of interviews. To begin the analysis, all parts of the first set of interviews were transcribed by the author or a professional transcriptionist. The author then immersed himself in the data, reviewing both transcripts and video/audio recordings of the interviews. The transcriptions and video and audio-recordings were then analyzed from an action-theoretical perspective, 95 with the intention of identifiying goals, functional steps and elements for each joint conversation. This top-down analysis procedure was aided by a review and analysis of the self-confrontation interviews, as well as by additional contextual data gained from the initial warm up converations and the concluding conversations. The purpose of this immersion in the data was to develop an understanding of the overall intentional framework for the joint grieving project for each couple and how the joint grieving was enacted in their lives. The next step in the analysis inverted the process and included a detailed analysis of each minute of the joint conversation. This analysis was aided by the use of HyperResearch, a software tool designed for qualitative research. Each minute of each the observed joint action – the joint conversation between the parents – was coded in terms of its goals, functional steps and elements. The aim was to develop an understanding of the intentions of the grieving actions of bereaved parents. Supporting information for the coding was identified in the relevant sections of the self-confrontation interviews and, as relevant, from the warm-up conversations. The supporting segments of the self-confrontation interviews or warm-up conversations were then copied into HyperResearch analysis program, and served as supporting information for the identified grieving action. The supporting information pertained not only to the internal processes – thoughts and feelings – of the parents, but also included additional contextual information about the joint grieving project. The master list of codes, which had been developed through previous action theory studies, was employed in this process. This list of codes is available in Appendix I. On the basis of this analysis, the author, in collaboration with the assistants, wrote three narratives for each couple, which described their individual and joint grieving actions. The narratives were written in the linguistic style of the participants and were supplemented 96 with key quotations from the first set of interviews. The first paragraph of each narrative summarized the life situation of the research participants. Following paragraphs elaborated on key grieving processes for each parent (in the indivudal narratives) and for the couple jointly (in the couple narrative). The joint narrative identified joint grieving processes and patterns of interaction for each couple. The final paragraph of the joint narrative included a tentative written statement which summarized the joint grieving project for each couple. The individual and joint grieving narratives were approximately two to three pages in length. Narrative feedback and member-check interviews. The second set of interviews was conducted approximately two to three weeks after the first. The main purpose of this shorter set of interviews was to provide participants with an opportunity to review and provide feedback about the identified joint grieving project and to orient the participants towards the ongoing monitoring period. The meeting began with a brief orientation to its purpose and procedures. Following this introduction, each individual parent joined a researcher for the reading of the individual narratives. These readings were conducted in separate rooms and afforded the participants the opportunity to comment on or offer corrections to the individual narrative. Following this process, the parents and researchers came together in a common room and the joint grieving narrative was read. The author read the narrative out loud and paused after each paragraph to allow participants the time to respond and offer any corrections. Special attention was given to the reading of the final paragraph, which identified and summarized the joint grieving projects for each couple. Following the reading, the parents were asked to comment and discuss its accuracy and to refine the description of the joint grieving project. Each parental couple gave helpful comments, and the descriptions of the 97 joint grieving projects were modified until both researchers and parents were satisfied that they accurately represented the joint grieving actions of the bereaved parents. The second set of interviews was concluded by an explanation of the procedures for the monitoring period. Each participant was given the choice of receiving either a physical journal or a word processing template, which they could use on their personal computer. Two parents opted for a physical journal, while the others chose to employ the word processing template. The researchers explained the use of the journals, in which parents were to record joint grieving actions during the monitoring period. The researchers also oriented parents to the telephone monitoring conversations and set up the first set of phone calls with each parent. The researcher who had conducted the self-confrontation interview and had read the individual grieving narrative also contacted the appropriate parent by phone. Monitoring period. A monitoring period of approximately 4-6 weeks, depending on couple availability, followed the second set of interviews. Each participant was given a personal journal (see Appendix E) and asked to log joint grieving actions on a regular basis. Although no specified minimum number of entries was required, the participants were encouraged to journal as regularly as possible and were reminded to make use of their journals during the monitoring phone calls. The templates were focused on joint grieving activities, their meaning for the participants and the accompanying feelings and thoughts and intended goals. Although all participants had agreed to journal their joint grieving actions, only seven of the ten participants chose to do so. In addition to the participant journal, the researchers scheduled bi-weekly, individual telephone conversations to discuss the ongoing progress of the joint grieving projects and address any questions or concerns. The researchers 98 made detailed notes during and after each conversation and these were added as data for the study (see Appendix E). Final set of interviews. Following the monitoring period, the researchers and parental couple scheduled a final set of interviews. These interviews basically followed the outline of the first set of interviews. They began with a short introduction and initial warm-up interview. During this introduction the participants were oriented to the procedure for this final set of interviews and were asked to reflect retrospectively on their joint grieving actions throughout the monitoring period. The parents readily engaged in this dialogue with the researchers and were then asked to continue this conversation in the final joint conversation. As in the first set of interviews, this joint conversation took approximately 20 minutes and was video-recorded. Following a 15-minute break, the researchers reviewed the recorded joint conversations individually with each participant, stopping the video recording approximately every minute to inquire about the parent’s thoughts and feelings. The lower mean values and higher standard deviations are due to the shortened set of interviews with Couple 5. As will be elaborated in the following chapter, this couple experienced a personal crisis during the final set of interviews and elected to shorten their involvement in this set. The final set of interviews was concluded with a final meeting with both researchers and both parents. This final conversation was designed to give the couple a final opportunity to voice feedback about the research procedures or to make a substantive comment about their joint grieving project. The researchers thanked the participants for their involvement in the research project and encouraged participants to contact them with any questions or concerns that emerged. No additional communications were received from the research participants. 99 Data Analysis Following the final set of interviews, the entire data set for each couple was compiled. Relevant sections of the member-check interviews and the entire set of final interviews were transcribed by the author and a professional transcriptionist. The data set included the previously-transcribed interviews, the member-check interviews, the final set of interviews, the telephone monitoring logs, the participants’ journals and researcher reflections. In sum, the analysis for this project included a within-case analysis, which focused on an action-theoretical description of each case and the changes to the joint grieving project. A between-case analysis addressed similarities and differences across the cases. Following Stake (2005), the researcher, in consultation with the supervisors, constructed assertions for each couple and key assertions across the cases. Assertions represent a distillation of the research findings for a particular case or for the cases as a whole and have the potential to inform further theoretical developments. Within-case analysis. The purpose of the within-case analysis was to describe the identified joint grieving projects for each couple over the course of their involvement in the research project. The within case analysis generally followed the steps of analysis detailed for the analysis of the first set of interviews, including an intensive review of the video-taped joint conversations and warm up conversations, the audio-taped self-confrontation interviews and member-check interviews, and a review of all journal entries and phone logs (Valach et al., 2002; Young et al., 2005). The review was conducted through an action-theoretical lens, seeking to understand the internationalities of joint grieving actions of each couple. This top-down analysis was complemented by a minute-by-minute analysis of the final joint conversation for each couple, supported with additional information from the 100 member check interviews, the telephone monitoring logs, participant journals and researcher notes. The coding for the final joint conversation was again conducted with the aid of the HyperResearch software package. As with the analysis of the first set of interviews, the analysis of the joint conversation focused on identifying elements, functional steps and goals for manifest behaviours of the joint grieving action. This was supplemented through information on thoughts, feelings and additional contextual information that emerged from the other sources of information. In the analysis of the final joint conversation, particular attention was paid to the ways in which the joint grieving project for each couple had shifted throughout the course of their involvement in the study. Following the detailed analysis of the final joint conversation between the parental couple, an action-theoretical summary for each case was created. This summary included the following components: (1) an overview of the data sources for each couple; (2) a statement summarizing the demographic information; (3) an analysis of the interactional pattern, goals and functional steps for the initial joint conversation (supported with relevant quotations from warm-up interviews, self-confrontation interviews, member check interviews, telephone logs and participant journals); (4) a summary of the member-check interview; (5) summaries of the telephone logs (written by the researchers); (6) individual journal entries from the parents; and (7) an analysis of the interactional patterns, goals and functional steps for the final joint conversation (supported with relevant quotations from warm-up interviews, self- confrontation interviews, member check interviews, telephone logs and participant journals). The action-theoretical summaries were then written up as narrative summaries in which the author sought to demonstrate how each case answered the research question. 101 Throughout the within-case analysis process, the author consulted regularly with his doctoral supervisors and with the co-researchers. The goal of these consultations was to remain faithful to the process of analysis as well as the grieving stories and actions of the bereaved parents. Following the instrumental case study approach suggested by Stake (2005), each within-case analysis was concluded by several assertions. Assertions are considered summary statements concerning what the author has found to be important about a specific case. Between-case analysis. A between or cross-case analysis can yield additional information, including commonalities and unique processes between joint grieving projects. The between-case analysis began with a comparison of how each case had answered the research question for this dissertation project. Secondly, the analysis process at this stage then identified significant similarities between cases and also some unique aspects of the grieving actions and projects. Similarities and unique aspects of joint grieving projects were supported by quotations from warm-up interviews, joint conversations between parents, member-check interviews, participant journals, and researcher phone logs. Further assertions, described as key assertions, were distinguished on the basis of this analysis process. These key assertions represent the author’s understanding of the important findings across cases. Trustworthiness and Rigour Qualitative researchers have given serious consideration to the development of standards of rigour and trustworthiness in qualitative research (Denzin & Lincoln, 2005). Arguments have been offered that rigorous research should pay attention simultaneously to common as well as to method-specific factors that enhance the trustworthiness of qualitative findings (DeWitt & Ploeg, 2006; Morrow, 2005). 102 One way of conceptualizing rigour in qualitative research, which is very germane to the action project method, is to understand it as a four-way conversation between the researchers, the wider scholarly community, the research participants and the established method or research process (Klaassen, McDonald, & Graham, 2004). This is presented diagrammatically in Figure 5. Rigour here is viewed as fidelity to three important constituents. The researchers or research team has an obligation, first and foremost, to the participants who have willingly shared their experience in the process of research. The current project, following the action-project method (Young et al., 2005), conducted member checks at various points in the data collection process. This included in particular the member-check interview, at which point summaries of the individual and joint grieving processes were presented to research participants both individually and jointly. The telephone conversations and the process of journaling also afforded the research participants the opportunity to offer feedback about the process and content of the research project. Researchers regularly summarized their understanding of the joint grieving project to research participants on the phone and asked participants for correction/elaboration on whether this description remained viable for them and, if not, how it had shifted from the initial description at the member-check interview. The value of qualitative data depends heavily on the extent to which research participants feel open to and are enabled in expressing their thoughts and feelings. Researchers are responsible for setting a dialogical and open tone for the research process, which invites openness for research participants and encourages them to be forthright in their disagreements. 103 Figure 5. Rigour as fidelity to participants, method/theory and scholarly community Significant efforts were made during this project to encourage open feedback from research participants: (1) All researchers were trained counsellors and had been involved in counselling and qualitative research projects prior to their work on this project. (2) The study was specifically designed, with prior consultation with bereaved parents and experts on parental bereavement, to allow time for the development of rapport between researchers and participants. This is particularly evident in the initial warm-up phase of the first set of interviews, which was nearly four times as long as in most action-theory studies (Young et al., 2005). The purpose of the extended warm-up interview was to allow parents time to tell researchers about their deceased child, their individual and joint grieving actions thus far and the role of their spirituality in grieving. (3) When relevant, researchers modelled respectful disagreement with one another, which in turn also encouraged participants to voice their disagreements. This occurred typically during the member-check interviews. (4) When participants did in fact object to some portion of the individual or joint narrative, researchers openly expressed their appreciation for the correction offered. It was encouraging to the Product Researcher(s) Scholarly Community Method/Theory Participants 104 researchers that each couple offered numerous suggestions for refining the description of their joint grieving projects. (5) Finally, the research participants themselves noted frequently that they were deeply emotionally engaged with the interviews. The following quotation, taken from the first moments of the initial joint conversation for Couple 3 was a typical process comment on the intensity of the interview process. After recalling the details of the suicide of their son in the warm-up interview, the male partner, Lance, began the initial joint conversation by asking the female partner, Merle, how she was feeling. Merle responded that she was feeling exhausted and ‘full’, feelings that for both partners harkened back to their early grieving experiences. She explained: FP1: Exhausted. Brings back all those feelings of fullness. Almost as though 18 hasn't gone by [crying]. You did say that you were so glad for counselling from [therapist]. And it was, it was very important, very confirming as to when we were in those weeks, just after 3 months that we started. (FP3IJC) A brief caveat about the ethics of conducting emotionally-intensive interviews with bereaved parents might be in order at this point. Bereavement researchers (e.g., Stroebe, 2003) have explored the topic of the ethics of conducting research with bereaved individuals. A central ethical concern when conducting research on a sensitive topic and with vulnerable individuals is to approach the data gathering in a way that respects the rights of the participants to full and informed consent. Informed consent in a research project is best understood as a process in which the participant is informed about the risks and benefits about participation and which extends throughout the duration of their involvement in the study (Kitchener, 2000). As is evident from the quote above and from the findings in the following chapter, all participants were deeply engaged in the research process and emotionally-involved describing their grieving. In terms of research ethics, the action-project method (Young et al., 105 2005), appeared to be a highly appropriate method of inquiry with bereaved parents. Parents were informed about the process of research and their rights prior to their participation in the study. In addition to signing the consent form, the multi-interview research process and the bi-weekly phone calls also gave researchers the opportunity to check on the well-being of participants and, if germane, to remind them about the option of discontinuing or shortening their participation. Indeed, Couple 5 elected to shorten their final set of interviews. However, the vast majority of participants noted that they experienced personal and relational benefits from their involvement with this study and expressed their gratitude for their involvement at various points throughout the project. Secondly, researchers have an obligation to be faithful to the established method, and that choices to deviate from it are acknowledged and justified. As described in the process of analysis above, this qualitative action project method included a detailed audit trail that allows outsiders to follow each step it the research process (cf. Young et al., 2005). Data were elicited from numerous sources (conversations, interviews, telephone logs, journals, researcher notes) over time, thus yielding a rich description of the joint grieving projects of bereaved parents. Analysis strategies, as well, were rigorous, triangulating the results between top-down and bottom-up procedures and involving multiple researchers. Finally, the action-project method encourages the researchers to situate the project within the larger research dialogue on the given subject and to ensure an ongoing hermeneutic process between research findings and action theory. Thus, the analysis involves a back-and-forth process between research findings and the interpretive framework, illuminating both the findings in light of the theory and allowing for the research process to shape the framework. 106 Chapter 4: Findings The dissertation sought to explore the question: How do spiritual/religious bereaved parents jointly grieve the loss of their child? The focus of the study was to understand how the participants’ faith or spirituality emerged in their joint grieving actions. It is worth repeating that neither the grieving literature (e.g., Klass, 1999; Stroebe et al., 2008) in general nor this author deny the well-documented fact that there is an individual or intrapsychic dimension to grieving. Indeed, this perspective has been the focus for the vast majority of the research projects to date (Stroebe et al.). This study, however, was interested in the relational dimension of grieving and particularly in understanding how couples grieve jointly and how their faith or spirituality is expressed in these grieving actions. This chapter will begin by offering brief summaries of the analysis procedures and findings for this study. Then, the findings will be reviewed in greater detail, beginning with the within-case analyses for each couple. These are followed by the between-case analyses, focusing on the similarities and differences between the cases. The chapter is concluded by six key assertions, which represent a distillation of the central findings of this study. Summary of Analysis Procedures The process of the analysis was informed by Stake’s (2005) instrumental case study approach. In the case of this current study, this design served to guide the researcher to understand each case as valuable in-and-of-itself and contributing also to potential theoretical advances. As discussed in the previous chapter, the method chosen for this project was the qualitative action-project method (Young et al., 2005; Valach et al., 2002). Following the analytic procedures outlined by the method, this chapter begins with the within-case analyses for each couple. These include background information, a summary of the joint grieving 107 project and then a detailed description of the joint grieving project. This is followed by a description of the change in the joint grieving project over the course of the couples’ involvement in the study. Each analysis is then concluded by a project summary in action- theoretical terms and by several assertions, which summarize the way in which the particular case answers the research question. The within case analyses are followed by cross-case analyses, which highlight perceived commonalities and differences in the joint grieving projects and suggest tentative theoretical postulates concerning joint grieving of spiritual- religious couples. A brief comment about the terminology in this chapter might be in order at this point. Readers may be unfamiliar with the terms used in this study if they have not yet encountered other action-theoretical studies. To the author’s knowledge, this dissertation represents the first application of action theory and the action-project method to the context of grieving. In particular, readers may wonder about the term ‘grieving project’. A potential misunderstanding may emerge from the colloquial understanding of ‘project’ as a planned activity, which is designed to achieve a particular aim. It is important to note that the action- theoretical definition of “project” encompasses both conscious and unconscious action, for which the intentions may not be within the immediate grasp of the individual (Valach et al., 2002). Goals, similarly may be accessible or not to consciousness. For this reason, the author has generally elected to use the word “intention”, which connotes more of an aim or process rather than the object of a person’s pursuits. Summary of Key Findings This study explored relational and spiritual dimensions of parental grieving. An action-theoretical analysis of grieving stories and actions of bereaved parents revealed 108 patterns of joint grieving for all couples in the study. Joint grieving was described and enacted as a goal-directed activity for the participants in this study and included both planned and unplanned grieving actions. Planned joint grieving included rituals, which frequently took place on anniversaries and which marked the passage of time since the death of the child. Some planned joint grieving rituals took place on a daily basis. Unplanned grieving emerged at surprising moments in the parents’ lives and occurred more frequently than planned grieving. Joint grieving actions were intended towards the development of an ongoing representation of the deceased child within the dyadic relationships and also oriented towards the maintaining and developing relationships with the partner and the Divine. Joint grieving was facilitated through engaging in joint grieving rituals, sharing individual grieving actions with one’s partner, and accepting the grieving style of the partner. Joint grieving was impeded by experiences of disconnection from the significant others, and various life stressors. The joint grieving projects of the bereaved parents in this study were irreducibly related to their spiritual lives. These spiritual lives of the bereaved parents in this study were multidimensional and shaped the continuing bonds with their deceased children. Bereaved parents received comfort from and expressed intense emotions towards the Divine, searched for meaning and engaged with faith communities. Within Case Analysis Couple 1. Couple 1 consisted of a 57-year-old man (Tom) and a 52-year-old woman (Carole). Both partners were of Anglo-Canadian heritage with English as their first language. Both described themselves as Evangelical Christians who had practiced their faith since childhood. The couple noted that they had two children, one of whom (Sonja) was deceased. The other child (David) was married and living in the Philippines with his wife and their 109 daughter. The couple worked together as a pastoral team in an evangelical church. Carole indicated that she was also involved in municipal leadership in her community. Both Carole and Tom stated that they were considering leaving the pastorate. Their deceased child (who, according to both parents, is “in heaven”), Sonja, died at the age of 21, on May 10, 2002, in a motor vehicle accident while on vacation in Europe. Joint grieving project. Tom and Carole described their grieving as consisting of both individual and shared grieving actions. Following the first set of interviews, the interviewers analyzed and described the couples’ joint grieving project. This description was presented to the couple in the Member Check Interview (MCI) and after some discussion and minor alterations, the couple concurred with the following description. Deeply appreciating and benefiting from the partner’s individual grieving style while finding joint comfort and assurance in God’s ongoing love and goodness. During the telephone monitoring phone calls both Tom and Carole agreed repeatedly that the description of their joint project remained accurate throughout the duration of the research project. Tom participated in the joint grieving project in numerous ways. He expressed his appreciation for the ways in which his partner’s steadfast attention to the grieving process (through rituals and activities) drew him outside of his normal comfort zone and encouraged him to engage more deeply in his own grieving actions. Tom repeatedly noted an unwavering faith in God’s continual care for their deceased daughter Sonja and an anticipation and hope of being reunited with her. Throughout the research project, Tom and Carole reiterated their ongoing faith in God and Sonja’s ongoing life in heaven. They stated that this belief in Sonja’s ongoing life offered them comfort and hope. Carole was grateful for her partner’s 110 unwavering faith in the midst of emotional turmoil and his steadfast character in grieving, and stated that this had a calming and stabilizing effect on her. Carole sought to be true to her own experience of pain and sadness and expressed these freely in her individual and joint grieving. In this way, her grieving actions differed markedly from Tom’s, as Carole expressed her sadness and longing in both words and tears, while Tom’s grieving actions focused on recalling positive memories of his daughter, imagining her ongoing life in heaven, and imagining their reunification in the afterlife. The couple frequently reflecting jointly on their varied grieving actions and expressed appreciation for these differences. The grieving project for this couple was also situated within a relationship career with their remaining son and his wife, who frequently called home from the Philippines to grieve together. Over the course of the couple’s research participation, some aspects of their joint grieving project began to shift and this influenced the ways in which the couple grieved both individually and together. These changes were acknowledged by both partners in phone conversations, journals and in the final set of interviews. Tom expressed the realization that his increased attention to his grieving-related thoughts, feelings and actions revealed that he was grieving more frequently than he had previously acknowledged. Carole agreed with this assessment, but added that she believed that Tom’s increased realization of his grieving actions had been accompanied by an actual increase in individual grieving. Carole expressed joy and appreciation for Tom’s new awareness and increased grieving actions, and asserted that this had impacted their joint grieving project. Detailed description of the joint grieving project. The following section represents a detailed description of the couple’s joint grieving project. This project includes regularly 111 enacted grieving rituals, as well as unplanned and surprising grieving actions. The project is shaped by the deeply-held faith of both partners, their individual grieving styles, and by an appreciation for the ways in which each partner’s faith perspective and grieving style contributes to their individual and joint grieving projects. The joint grieving project was characterized by a variety of planned grieving actions or rituals as well as by grieving actions that emerged in everyday life and were largely unplanned. The most significant planned grieving ritual was the couple’s annual grieving ‘pilgrimage’, where they took time to cultivate their relationships with each other, their deceased daughter and with God through various joint grieving actions. Tom and Carole described this grieving ritual in the Initial Joint Conversation (IJC). MP1: One of the things I was thinking is when we go to [a town] every year. Yeah, so [the town] is just, it's kinda been our yearly thing, because it was the same and it's always on when your AGM conference is on. And one of the things, we always go for walks there. And we have one particular bench where we've always sat down on our walk. FP1: That's really good, I'm glad you remembered that. MP2:Yeah, we sit there and we pray, we pray for our son, but we also talk to Sonja there, and talk to God about Sonja and talk to Him just about the things. What Sonja's doing now, trying to have some kind of an imagination of maybe what's happening in her life now. FP2: Yeah, it feels like a pilgrimage, eh? Don't you think? [yeah] Yeah. MP3: Yeah, so that's a yearly time at least, sometimes we go to [the town] more than once a year. (MP1IJC & FP1IJC)2 Tom and Carole elaborated on the context of the significance for their annual trips, noting that, (1) this specific location was meaningful because this is where they went for a month as a couple immediately after the death of their daughter (who was killed in a motor- 2 The following abbreviations will be used throughout the rest of the chapter: MP = Male Partner; FP = Female Partner; IWU = Initial Warm-up Interviews; IJC = Initial Joint Conversation; ISC = Initial Self-Confrontation; MCI = Member Check Interview; FJC = Final Joint Conversation; FSC= Final Self-Confrontation; MPISC = Male Partner Initial Self-confrontation; MPFSC = Male Partner Final Self-confrontation; MPcall = Male Partner Call Log; MPJournal = Male Partner Journal Self-report; FPcall = Female Partner call log; FPJournal = Female Partner Journal Self-report 112 vehicle accident in Europe), and (2) because they used to take family vacations in this location with both of their children. Carole spoke about the meaningfulness of the location in the Initial Self-Confrontation Interview (ISC), noting in particular that she connected the location to their ongoing healing and grieving for their daughter. She elaborated in the ISC: FP2: Yeah…so in particular what he brought up was so...it's a lovely memory because we used to go up to [the town] with the kids too, but I think...and there are lots of memories connected to [the town]. And things like...you know, when we'd eat, we'd all go to the [restaurant]. You know, places that Sonja discovered that she took us to. But in particular I think because it just feels like a healthy healing place to both of us. And as part of our early journey in grief it feels...I was glad Tom remembered it because I don't think I would have thought of that as grieving together, but it is. And…we definitely...when he was talking, I can picture the walking up that hill to get to the bench and kind of the anticipation every year that you feel as you get closer. Thinking, oh good, that's familiar and this is what we do and, and then thinking of the many times we've sat on that bench, and…it was good. (FP1ISC) Carole also elaborated on the ways in which they, as a couple, found rituals to be helpful in their joint grieving process. In the Initial Joint Conversation (IJC) she remembered a grieving ritual that took place where Tom would find flowers and would then bring them back to the couple’s condo. These flowers – in particular daisies – were especially meaningful because Carole and Sonja had chosen to get matching daisy tattoos. Carole remembered the ways in which they as a couple had created a ritual of picking flowers and putting them out as a way of grieving for their daughter. She reported in the IJC: FP14: …And I remember that daisies became really important, because that was her tattoo. And so we'd often pick daisies and put them out. And the other thing, I think when we go up to [the town] and you get me a flower every day. Somehow, in some way, like cause you went on your walk and you'd find one and pick one and bring it back to the condo. In some way that was an observance of Sonja - don't you think? [uhumm, yeah]. Although I'm not sure we really talked about that [yeah]. (FP1IJC) The couple also elaborated on various individual and joint grieving actions which took place more regularly and which were closer to their home. Tom noted that these proximal rituals were particularly important to them because their daughter’s death in Europe 113 prevented them from visiting the site of her death on a regular basis. The couple recalled numerous joint grieving rituals, including hiking a local hill, visiting their daughter’s grave site, observing anniversary dates together, or jointly watching the video of their daughter’s funeral. Tom commented on the importance of having local and easily accessible locations for their joint and individual grieving, noting in the ISC: MP5: [Name of a hill] was such a part of Sonja and my life especially. We had talked about that event and burying the ashes...but then just as we talked more, realizing for Carole’s mom, she could probably never go up there. And for us when we got older we could never go up there so...We have adopted a bench in [a town] and a bench in [a local park]…And of course with her being killed on the other side of the world there isn't that location for us. So I guess that's maybe why we picked something here...a memory of life. (MP1ISC) While grieving rituals were clearly important to both partners, the interviews, telephone conversations and individual journaling also revealed that their joint grieving most frequently took place in everyday and frequently unexpected ways. Carole first raised this perception in the IJC, noting that there is a ‘mundane’ pattern to their grieving, and that the ways in which they remember their daughter were not just tied to significant, annual pilgrimages. She noted in the IJC: FP7: Yeah, I think our grieving is more, well, not like this of course, when you're in a structured room and people looking at videotapes and things. Obviously, but we do talk quite a bit and I think we have remembrances throughout our day. Like Sonja's name may come up once or twice in conversation with each other. We'll - like the other night, I can't even remember what it was when we were sitting on the couch and you said something. Oh, I reminded you about the time when there was a spider going across the floor and you threw a cup over top or killed it or so you thought and Sonja was terrified of spiders. And when you lifted it up it was alive and she flew up to the top of the couch screaming, right? And I don't know what brought that up – you threw a book on top of something crawling across the floor or something [a bee] - a bee, yeah. And that brought it up. And I think, it's just she's so much apart of our everyday lives, that it's not like, it's not like you set aside necessarily special - you do that, too - but it's more like everyday we'll find something to talk about her. (FP1IJC) 114 While the grieving rituals were important for their joint grieving project, Carole in particular found that her life was inextricably linked to her individual and joint grieving. In this regard, she noted that speaking about grieving as a separate ‘project’ did not feel normal to her. Rather, Carole noted in her journal that grieving “becomes a filter through which you experience the world”. Individual and joint grieving actions emerged spontaneously and unexpectedly in everyday life, and this was not something that could be planned. Tom agreed with Carole in this regard, describing how their grieving was frequently triggered through unexpected and surprising encounters with people or events that reminded them of their daughter. He stated in the ISC: MP19: I think we're just thinking about some of those reminders. Just like often you're at the mall or somewhere and you'll see a girl up in front of you and it just is Sonja, eh? That same hair, same shape and...so you just get those reminders lots of times. If you didn't know that she'd died, because even then you're almost, wow, that could be her. (MP1ISC) Throughout the various interviews, both partners indicated that their individual and joint grieving actions were not limited to their relationship but frequently included encounters with others who would remember their daughter. They attributed this public grieving to their activities as pastors and, in the case of Carole, as a municipal politician. Both partners noted that they felt a deep appreciation when people would talk about the way in which their daughter’s life had impacted them. Tom addressed this in the following way in the ISC: MP68:…Carole just ran into someone again who is going to [a church] now and it was Sonja’s testimony at [her workplace] that had started her on that path and now she's serving God. And so you kind of...love those times. You know, but we got lots of letters and stuff too of people who felt at that point anyway, there lives were really changed from Sonja's testimony and from what happened and you kind of hang on to those kind of things. Her life was a value in that way, too. (MP1ISC) 115 Both partners also perceived their joint grieving to be impacted by their strong relationship with their daughter and the ways in which their values and faith were aligned. The couple spoke about their daughter’s legacy, remembering her impact on her peers and her mission trips. Carole commented that this knowledge about their daughter’s legacy not only has personal implications for her (i.e., evoking feelings of pride), but also deeper personal and spiritual implications as she was able to witness her daughter’s actions as consistent with her Christian faith and this in return providing her reassurance about the her daughter’s ongoing life in heaven. She said in the FJC: FP11:…Just remembering her spirituality and the kind of, the things that she taught us along the way. That was cool. Thinking about the legacy that she left behind when she put her tips from [restaurant] towards the poor. I think about her in Africa, doing missions work with [a Christian mission]. Like all of that stuff...well, I know you don't get points when you get to heaven, but it sure makes you feel secure as moms and dads that she was on the right path, that she was doing the right thing. And...so that's a very big part, too. It wasn't just our spirituality that was part of this. It was her spirituality, too. I think it would have been dreadful if she had not followed our faith. That would have been difficult for us, I think. Well, I know it would have been. Not, I think. I know it would have been. (FP1FSC) Tom added his agreement and extension in the FSC, noting in particular his perception of their positive relationship with their daughter and of the importance of his spirituality for him in his grieving. He stated in the FSC: MP35: Yeah, I think just the legacy that Sonja had. She was very…our thoughts are just good thoughts about her. She definitely was a good kid and did good things and it’s nice having those memories. Cause I think for lots of parents there was years of hurts and lots of negatives that happened, where we don't have that at all. And the other one was just again that hope of our spirituality, that, as I said, I don't know how parents handle it without that. I think that would be devastating to be, to think that there wasn't that hope. You just love your kid so much, eh? To think that it's just over. (MP1FSC) Throughout their involvement in the research project, the couple repeatedly commented on the importance of their faith for them and on the ways in which this faith 116 shaped their joint grieving project. Both Carole and Tom commented in various interviews, telephone calls and journal entries that they frequently sought and found comfort through their faith. Tom spoke about the way in which their joint grieving actions included imagining their daughter’s ongoing life in heaven. Reflecting on their joint grieving project stated in the FJC, he stated: MP10: The spirituality part for me, it was again just huge. Cause, it's grieving with hope and I can't imagine, and I can't imagine grieving where there is no hope that you're not gonna see your child again or your child you believe is going to be in hell. To be able to grieve, knowing she's in heaven, and knowing one day we're gonna be in heaven. It makes it a little easier. (MP1FJC) Both partners also spoke of the way in which understood God as taking over their parental desire and duty to protect their daughter. Tom spoke about this poignantly in the ISC, reflecting on the ways in which their faith comforted them and offered them the security of knowing that their daughter could not be harmed anymore. He stated in the ISC: MP13: Yeah, it's definitely comfort for me. 'Cause I think part of your father's heart is that you want to protect you little girl. And to know that she's in a place where she can't be hurt, she can't experience pain. To me the loss is there, but that gives me huge comfort to know that she can't be raped, she can't be....have an abusive experience and...the loss is huge but to know that it's so good for her and that one day we'll join her. (MP1ISC) Throughout the study, both partners also acknowledged various contextual factors that contributed significantly to their joint grieving project. These factors included the current social and spiritual contexts for the couple, as well as their spiritual histories, both of which continued to shape their joint grieving. Carole’s first quote, from the ISC, addresses the social and spiritual context of their grieving, while her second quote, from the FSC, speaks to their shared spiritual history of being raised in a conservative, Evangelical church community. The couple noted that both current and past faith communities shaped their joint grieving project in significant ways. 117 FP16: …and the other part to that is that what I have discovered, being a pastor is that often times people are...people have some pretty defined opinions about whether you should go to a grave or not go to a grave and all those kind of things. And I remember when my...our fellow pastor committed suicide two years before Sonja died, and I remember being at his grave, and someone had written: Why seek ye the living amongst the dead? Which was of course a question that was in the Bible about Jesus resurrection and someone else said at that point and I remember with [our fellow pastor], I don't know why you go to his grave so much? Why do you, because he's not really there. And I remember saying back to them, but the part that I hugged is...you know, that shell, whatever you call it, the part that smelt so good at one time and felt so good, is there. And that's why I like to go there. So I think kind of in faith circles maybe death isn't talked about as much as it should be or could be. (FP1ISC) FP25: Well, I think I'm wanting to talk about in this part, wanting to talk about spirituality and what kind of, what is a foundation of, that brought us to that day and a, and a profound gratefulness for our relationship but also deeper than that…a thankfulness for the people that gave us our foundation. You know, because our early church experience was quite legalistic and I know we've kind of talked about that but one of the good things that that did was it taught us how to respect people and how to make a marriage work. Where I watched lots of my friends that don't have that spiritual foundation so it wasn't just a, and I think I say this, it's not just that our spirituality helped us in our grief. It kind of gave us a foundation as a couple to be able to do that…Because the early part of my faith, when it's grounded in legalism, it's really difficult to give thanks for any part of that, you know. But realizing that there, there were some things that were very helpful in that…it's maybe like wading through a pile of shit and finding a diamond, maybe. (FP1FSC) One of the important joint processes that emerged for this couple in their grieving project was the fact that each of them grieved in their own way and still they experienced their grieving as joint action. The ability to find a togetherness in their separate ways of grieving was clearly evident in all interviews. Examples of this include Tom talking non- defensively about the way in which his son and his partner were able to share their grief and the way in which Carole appreciated the Tom’s “sameness”, “stability”, “groundedness” in his grieving. Tom, in turn, spoke about the way in which the Carole’s frequent grieving actions would draw him into joint grieving with her, and how he perceived this as being “good” for him. The diversity in their joint grieving processes seemed to emerge on two separate, but related dimensions – emotional expression and perceived jointness in grieving. 118 The contrast between the Tom and Carole’s grieving styles was addressed by both partners throughout the interviews, telephone conversations and journaling. In fact, during the pre-interview screening conversations both partners wondered about their appropriateness for this study because they perceived their approaches to grieving as so divergent in terms of their emotional expression. These joint reflections on their differences seemed to be a regular part of the couple’s way of understanding their grieving and their conversations about this difference seemed to serve the purpose of helping the couple reflect on and appreciate the differences in their grieving. On the whole, Tom characterized his grieving as not as connected to emotional pain, focusing mostly on the ‘positive’ aspects of their grief, as a way of comforting both himself and his partner. He explained in the ISC: MP26: Yeah, because I think I would...I would sooner just move on because I don't like sad things so much. Like for me, or for Carole even, she loves movies and loves a tear-jerking movie. Where I only like happy movies. I kind of don't like to go to scary places, sad places. I just like to be happy so...again totally different personalities and...to see Carole there so long and so much and ya. I'm just realizing that everyone's different, eh? It takes way more time to deal and...not that you're ever done dealing with it. You are always dealing with it. But it's over 6 years. It's gotten easier for her, but still. It's still much harder for her than it is for me at this point. (MP1ISC) Carole, by contrast, described herself as a deeply emotional person, whose grieving often involved expressing these emotions through tears. This kind of emotional expression also took place during various interviews, and while Carole reported feeling comfortable in expressing her emotions in this way, Tom admitted some ambivalence about his partner’s frequent and open expression of emotion. On the one hand he noted that he felt somewhat uncomfortable with his partner’s expression of emotion as this was foreign to his own experience. On the other hand, however, Tom frequently noted his desire to remain connected to his partner during these emotional expressions of grief. He elaborated on this in the ISC: 119 MP23: I think because Carole is getting quite choked at that point, thinking of David and not having either kid here. I think...that's probably one of the harder things for me as a husband. I've got this feeling like I need to fix something. You can't fix anything. And just... over the years just wondering...how can I be a better husband. (MP1ISC) The recognition of their diverse ways of grieving is echoed also in the Carole’s perception about their grieving. She commented at various points in the research process on their different ways of grieving, but likewise expressed a deep desire to remain connected to her partner in these times. The following statement from the ISC expressed Carole’s gratitude for the difference in their grieving and acknowledged the ways in which Tom’s emotional stability and unwavering faith positively impacted her own grieving: FP32: This is really Tom. When you see this it'll look like he's preaching, but he's not. This is all the stuff he says to himself. He finds most of his comfort is in Scripture and in thinking of the afterlife. His faith is so profound, so deep, that he never even has a question of...what will happen in the afterlife…Yeah, but he's so grounded and so...his faith is so deep and so real…[And] it feels familiar. When he talks, when he does this it just feels familiar. Just sameness. Sameness, stability. It just, you know, that's one of the things I love the most about Tom is just how stable and level-headed and down to earth he is. I love it that he's not emotionally fragile. I really like that. There's a strength in that. (FP1ISC) Throughout various points in the research process, Carole elaborated on the way in which she experienced both the intense pain of the loss of her daughter, as well as the comfort that came from her faith. She elaborated most freely and poetically on this pain in her journaling: It’s deep, it’s dark and it’s ugly. Sorrow is an emotion that I’d rather live without but it seems that for these last few days memories of my daughter refuse to be locked away. It started with a simple task. I was cleaning out the nightstand by my bed. In it was a book that I had not picked up for years. As I thumbed through it a card fell out - a card from Sonja. In it she had penned “I love you so, so much and I’m thankful that God has blessed me with the bestest mom in the whole world. I can’t imagine how the world would survive without you. You’ve blessed a lot of people but especially me.” As I read these words tears poured down my face. The loss hit me once again with such force that it took my breath away. It’s amazing but the intensity is sometimes so great that my chest actually aches. I wish this could all be wrapped up in a tidy package, but after six years that hardly seems likely. (FP1Journal3) 120 A second divergence in the couple’s grieving project was related to the frequency of grieving reported by both participants and the perception of joint grieving. Carole reported frequent individual grieving– listening to music, going to the cemetery, lighting candles around the house, watching the funeral video or journaling – and indicated that she understood their grieving to be mostly separate, as these were most frequently enacted individually. Tom, however, understood their grieving to be mostly joint, as he tended to grieve most frequently with his partner. In the ISC, Tom described how Carole frequently drew him into grieving actions. He reported that he experienced this drawing-in as a process that might not be ‘natural’ for him but one that he is grateful for. He commented on his partner’s perception that their grieving happens “mostly apart” in the ISC: MP66: Where she said “mostly apart” - it's probably true that we do...talk little bits here and there, but...she would grieve so much more than I would, [so] that for her it would probably seem mostly apart. Where for me it might feel like it's mostly together because I just don't do it much. But for her...anytime she's alone, driving alone, just listening to music and...it's all a part of her grief. (MP1ISC). In spite of this divergence in the frequency of individual grieving, Tom and Carole’s joint grieving and ongoing relationship did not seem to be adversely affected by their individual styles. Tom commented on the interviewer’s perception that he did not seem to be withdrawing emotionally from Carole while she was crying in the IJC. He stated in the ISC: MP59: No, I would want to be there for her and walk through things together in whatever way we can. And I think it's probably good for me that she kind of pulls me along into some of those things because I'm not sure if I'm just avoiding things because I don't like pain. So it's probably good that I go to those things with her. (MP1ISC). Carole, too, expressed her gratitude and delight in their diverse ways of grieving at numerous points in the research process. For example, in the MCI, she responded to a description of their joint grieving project, in which the interviews had described their joint 121 grieving as including an appreciation for the other partner’s grieving style. Carole insisted that they not only “appreciated” each other’s grieving styles but in fact “delighted in” each partner’s unique way of grieving. Both partners saw this as a key to ongoing emotional in their relationship post-loss. Change in the joint grieving project. As the couple’s grieving project unfolded over the course of their research participation, two related changes became evident. These changes emerged initially in the phone conversations, journals and were confirmed in the final set of interviews. Both partners agreed that Tom gained new awareness about his own grieving- related thoughts and emotions, and Carole suggested that this in turn led to additional individual and joint grieving actions. The changes in awareness and action were enacted when, to the surprise of the couple, a friend gifted them a portrait painting of their daughter. Both Tom and Carole noticed that Tom participated very diligently in this study and that this resulted in an increased awareness of his internal processes and an increase of individual and joint grieving actions. For example, in her second phone call, Carole reported that it has been a “gift” to her to be able to see Tom participate so diligently in the study and she has been delighted for Tom to share his experiences with her. She noted that it has been “just really lovely” and that she did not know what was “down there”. She indicated that it had “been cool to watch” Tom participate in the study and that she in turn has gained more awareness about his experiences. She also noted that she felt privileged to be able to be an observer of his grieving, such as the time that he went to Sonja’s grave by himself and talked about it with Carole. (FP1Call2). Tom confirmed these changes in his phone calls and journal entries. For example, in his second phone call, he reported that this study has caused him to become increasingly 122 aware of his own interior life. He noted that this came about mostly as a result of the journaling that he had been doing. As a result of this increasing attention paid to his thoughts and emotions, Tom reported that he realized that he was indeed grieving more by himself than he had realized. Previously, he had stated that he did not believe that he grieved a lot on his own, but these exercises reportedly allowed him to come to the awareness that he was indeed grieving more than he had previously assumed. (MP1Call2). In the FJC, both partners then also talked about the way in which they had seen Tom’s grieving change over the course of the research project. Tom expressed his realization that, contrary to his previous assertion, he did grieve on his own. He stated in the FJC: MP1: Yeah, I think for me looking back over the 8 weeks it was probably, well maybe a little different than what I expected. Just cause I thought probably more of my grieving...I probably didn't think that I grieved much and more of it was when you would talk to me about something and I would get in a conversation that way. And I think we probably didn't do that much of that over this stretch. (MP1FJC) Carole expressed her support of her partner’s realization and offered additional contextual information when spoke about her understanding of Tom’s changes in the FSC: FP1: Well I guess in our, in our marriage I've always wondered why, like Tom is, seems to get things, through things fairly unscathed. He's lost both of his parents. His mom when we were newly married and, and so if I would ever ask about him missing her, his answer was always “I don't really think very much about it.” So for me this was kind of eye opening to think well maybe he does, he's just not so aware. And I think the other side of that is that maybe naturally he doesn't. But the work that he's been doing in this has kind of forced him to the place and, and I think that was really good for him. I think he, I think he really actually enjoyed doing it. (FP1FSC) Carole also challenged and Tom’s new awareness by suggesting that his participation in the research project had not only expanded his awareness but had also led directly to new individual and joint grieving actions. She explained in the FSC: FP20: Well, Tom's a high achiever and I know that part of what he's doing here wasn't for him. It was for you guys. It was to make sure that there was some journaling and some things that…so you know, he never would have done those 123 things had it not been for the work that needed to be done. So I'm kind of, you know, I'm happy for the fact that we got to do this and I guess, I'm always really proud of him. I'm proud that he wants to do things right, that he doesn't slough things off ever, that he's, yeah. So he was more aware, honestly, he's more aware of it for the project than for his own kind of grief. (FP1FSC). In the FJC, the couple commented on a novel joint grieving action towards the end of their conversation, in which both partners had noticed a rabbit had “snuggled” up to a statue in their garden that had been given to them in memory of Sonja. Both partners noted that they believed they were able to experience this because of Tom’s increased awareness of his grieving experiences. Carole commented in the FJC, noting also the fact that their motivation to participate in this study has switched from being focused externally (helping with a research cause) to an internal reward (participating in the study to receive something themselves): FP16: Yeah, it just kind of was touching, but we never would have even talked about that, or you probably wouldn't have even been aware that you were thinking when you were looking out there. Or you might not even have thought it. But because of this work and this aspect of our grief, it was kinda cool, eh? Yeah, so I guess really...while this might have been for Derrick and Carey, it really was a gift to us. (FP1FJC). One of the most significant joint grieving actions for the couple took place during the monitoring period, a few days prior to the final interviews. Both partners commented extensively on this event – in their individual journals, telephone calls and in the FJC and FSCs. Tom and Carole indicated that a professional painter in their church had painted a picture of Sonja and had given this picture to them as a gift. Tom described the picture as the artist’s portrayal of Sonja on the banks of the Jordan River. Tom understood this event as “being ordained by God” and indicated that it was deeply moving experience and a real surprise. He indicated also that he had talked to Carole about this painting and that they had decided to hang it up in their bedroom (MP1Call2). Tom also recalled this event in his 124 journaling, “we were really touched that he had taken the time to do such an amazing portrait for us”. He stated further in his journal that the painting “helped me in the grieving project because it is such a visual reminder of Sonja smiling and waiting for us on the other side. Once we join her, we will have all of eternity together. It was also a reminder that God directs other Christians to be a part of our healing process. It was amazing to us that he brought the painting over right at the end of our grieving project. It just seemed to be so set up by God” (MP1Journal4). Carole, too, commented on the receipt of this gift in the phone call and in her journaling. In the phone call, she explained that the timing of the picture was “remarkable” as they had received this picture in the midst of their anonymous participation in a research study on parental grief. She indicated that she thought it was “so cool that God connects you to other people”, noting in particular that the painter of the picture had not known Sonja. She said further that she was amazed about the timing of when the picture was delivered because it was delivered on the day after they had finished their journaling for this research project. Carole understood this as a divine intervention, noting that after they had finished the reflective part of the project that the “Holy Spirit puts nudges in his [artist’s] heart”. She noted that she felt that “the Holy Spirit is so sweet” and that she sees this picture as a gift from God who is “intimately aware of your emotional needs”. Carole noted that this experience had reinforced her understanding of God/Holy Spirit of caring about her emotional needs. Carole indicated that she had enjoyed watching the reaction of other people to seeing the picture. She noted that she loved watching Tom get “choked up” and that her mother had seen the picture, stepped back, and kept saying “oohhh”. (FP1Call2). 125 In her journal, Carole commented further on this momentous event for them in their grieving journey. She stated: I came home from a meeting this evening and was greeted by Tom who carried a rather large, flat box. He told me that one of our friends from the church had dropped by with this box and told him to wait ‘til I got home to open it so that we could do it together. I felt extremely nervous. I had suspected for sometime that this friend, who is a well-known artist, might be painting a picture of Sonja for us. I tried to brace myself for what it might look like. I am not the least bit artistic, however, I suspect it must be difficult to capture someone on canvas that you’ve never met. Tom gently cut open the box and lifted back the lid to reveal our girl. Our beautiful girl. Her eyes shine, her smile is broad and she is dressed in a simple white robe. And it is her. How did he do it? We both cried – I couldn’t stop. Such love. The hours that he must have spent pouring over pictures posted on the internet. I cried a lot tonight and I feel touched by something so beautiful. It makes me think about Sonja in heaven, and it makes me wonder if that’s what she’ll look like when we get to see her again. Somehow [the artist] seems to have added a bit of maturity to her face – and a peace. How did God ever plan something so wonderful for Tom and me? This painting is priceless. What I will treasure about this is the moment that Tom stood behind me after he opened the picture. His eyes were full of tears and we both struggled for composure. I felt strength as I realized that not only were Tom and I in this together, but people who are on the periphery of our pain are still, after six long years, trying to comfort us. What an evening, and what a beautiful ending to this time of recollection and journaling. God has been kind. (FP1Journal4) Project summary. From an action theoretical perspective, this joint grieving project emerged within the pre-existing faith and relationship careers for both partners. The grieving project included multiple related goals and intentions, which at times emerged explicitly in the grieving actions of the couple but at other times remained more implicit and unspoken. Both partners saw their grieving as related to their pre-loss personalities, social and spiritual contexts and as such the joint grieving project did not represent a radical departure from the couple’s relational career or their individual personalities, but rather was embedded within it. Both partners – and in particular Carole – also viewed their joint grieving project as related to their ongoing relationship career with their son and his wife. 126 The intentional framework for this couple could be described as seeking comfort, hope and greater intimacy with each other and God through their joint grieving. Goals and intentions in the joint grieving project included fostering an ongoing connection to their daughter, living out their vibrant faith in an authentic and hopeful way, and deepening their appreciation for the other’s uniqueness – which emerged in part in their joint grieving project – in their relationship. At times the grieving project seemed to dominate the focus of their relationship while at other times it seemed to be subsumed within the everyday activities of the couple. For Tom, the relationship between his faith career and grieving project seemed to focus on seeking personal and joint comfort and hope. His frequent remembering of the “positive” and imagining their eventual reunification as a family in heaven also seemed to serve this purpose. Carole, too, sought hope and comfort through her faith, but at times also acknowledged the pain of having lost her daughter and her longing for immediate reunification. In such moments, she experienced her faith and Tom’s steadying personality as comforting and stabilizing her in her grieving. Both partners also acknowledged that their goal for participation in the research project focused on “helping” the researchers with their project and potentially assisting other bereaved parents. As the project moved on, both partners acknowledged that they developed more intrinsic reasons for participation as they found something of value for their joint grieving in the research project, which they understood as an unexpected “gift” to them. Grieving strategies for this couple included both planned and unplanned actions. Planned strategies included grieving “pilgrimages”, engaging in grieving rituals at home (e.g., watching video of the funeral, going to the grave, commemorating important dates), and seeking to “appreciate” and “delight in” the unique personality of their partner and the 127 way in which this personality emerged in their joint grieving project. For Tom, this uniqueness was expressed in recalling positive memories of their daughter, remembering her life and its impact on others, imagining what she might be doing in heaven, and looking forward to being reunited with her in the afterlife. He also sought to offer solace and emotional support to his partner through reiterating beliefs about the veracity of their faith and the way in which he continues to hold onto it through their grieving. Carole’s unique grieving was expressed in the way in which she simultaneously acknowledged her pain and sorrow over the loss of her daughter with an ongoing faith in her daughter’s ongoing life in heaven, the hope of reunification with her in the afterlife, and the deep appreciation for the steadfastness of her partner’s faith. Manifest behaviours for both partners included describing themselves, their partner, as well as past and present situations related to their individual and joint grieving. Both partners also expressed a variety of emotions, including gratitude, sadness, joy, ambivalence and a sense of connection to the other. They also frequently expressed beliefs (often faith- related), opinions, new realizations, and asked and answered each other’s questions. Both partners at times expressed agreement and disagreement with the other, described hypothetical situations (often related to the afterlife), and made numerous making humorous statements and laughed together. At times Carole also expressed her sadness and longing through crying, and at these times Tom would sit silently with her and seek to offer emotional support. Assertions. The joint grieving project was embedded within the couple’s ongoing relationship and faith careers. Both partners described their grieving as central to their lives, and noted that it affected all aspects of their lives, including their faith and relationships. 128 Joint grieving included both planned and spontaneous actions and was facilitated by their common faith and acceptance of their individual grieving styles. As the joint grieving project unfolded, Tom became increasingly aware of his individual grieving actions, which in turn informed and energized joint grieving. Couple 2. Couple 2 consisted of a 68-year-old woman (Clara) and a 63-year-old man (Hank). Clara described her ethnic heritage as German and Scottish and Hank described his as German and Ukrainian. Both identified English as their primary language. Hank and Clara described themselves as mainline Protestant Christians who had practiced their faith for over 30 years. Clara was regularly involved with her church, where she taught in the Sunday school program. Hank had recently returned to graduate training in theology at a local seminary. He was frequently involved in his church and occasionally led worship services or delivered sermons in other congregations. Hank had previously worked as a high school principal for approximately 30 years. Clara was a retired English professor at a community college. She noted that she was involved in teaching creative writing workshops for bereaved parents and giving leadership to a local lay-support organization for bereaved parents. The couple reported that they had 3 children, one of whom was deceased. Their biological child, Max, died at the age of 17, on December 12, 1997, from an accidental fall from the roof of a tennis facility. Their other two children – Susan and James – are biological siblings and were adopted by the couple as infants. They noted that both of their adopted children struggled with mental illness and substance abuse, and that this had an effect on their ongoing parenting activities as well as their individual and joint grieving projects. According to the couple, Susan lived with her biological daughter (Julie, 7 years old) and was expecting a second child. Hank and Clara had co-parented their granddaughter since 129 birth and that she typically spent weekends with them. They felt very close to Julie, but had distanced themselves emotionally from their adopted children. Finally, the couple reported one additional loss – their daughter who died 12 hours after her birth. This perinatal death reportedly took place in the 1980s while the couple was studying in the UK. Joint grieving project. Following the first interview, the interviewers analyzed and described the couples’ joint grieving project. The following description of this project was presented to the couple in the Member Check Interview (MCI) and the couple concurred with the description. During the telephone monitoring calls, both partners agreed again that the description of their joint project remained accurate for them as a couple. The joint grieving project for this couple was described as: Striving/searching for an authentic and ongoing relationship God, each other, and their son through their individual and joint spiritual grieving practices. This joint project focused on the efforts of both partners to engage in individual and joint grieving actions that would facilitate their ongoing sense of connection to their deceased son, Max. These grieving actions were situated within several other ongoing relationship careers – primarily with each other and with God. These primary relationship projects were complicated by a variety of other complex relationship careers in the couple’s lives – with their adopted son, daughter and her daughter (their granddaughter). Both partners expressed their feelings of sadness and hopelessness about the lives of their adopted children, and the recurring crises in their lives were perceived as interfering with their joint grieving actions and their ongoing relationship with Max. For Clara, the crises were also seen as interfering with her relationship with God as they engendered “bitterness” in her. Hank, by contrast, 130 noted that his relationship with God was not affected in the same way, but generally voiced support for and understanding of the Clara’s experience. Over the course of the couple’s research participation, some aspects of their grieving began to shift and this influenced the ways in which the couple grieved both individually and together. The most notable shift in the grieving project related to news that the couple received from both of their adopted children. They reported that their son James had confessed to them that he had started to use substances again. The couple also stated that their granddaughter Julie had reportedly accused one her mother’s ex-boyfriends of sexual molestation and that they were in the middle of a criminal investigation into this matter as well as seeking to assist their granddaughter in coping with this trauma. Both partners reported that these events increasingly interfered with their ongoing grieving for and relationship with Max, and particularly Clara noted that she had become “bitter” with God for allowing these events to unfold. The couple also reported that they found that the participation in this research project increased the frequency of their joint grieving actions and thus resulted in a deepening understanding of their own and their partner’s grieving process. Detailed description of the joint grieving project. The following section represents a detailed description of the couple’s joint grieving project. The joint project was constituted by numerous actions, including engaging in joint grieving rituals, and attempts by both partner’s to draw the other into their individual grieving actions. The faith of both partners was central to their joint grieving project and also revealed the ways in which both partners engaged with each other and with God in their grieving. 131 One of the most meaningful joint grieving actions for Hank and Clara were their joint visits to ‘Max’s Post’, a wooden sign that they had placed in the location near the river where they had released his ashes. Although both partners had commented on this in the Initial Warm Up (IWU) phase of the first interview, they did not talk extensively about this joint grieving activity in the first set of interviews. However, during the monitoring period both partners spoke and/or journalled about their visit to the post for Mother’s Day. Clara recalled that they wanted to visit the post but also felt pressure to include this joint grieving action into a full schedule on Mother’s Day. She also recalled that she felt “bitter” about the way in which these other activities interfered with her grieving of her son. She described this joint grieving action in her second journal entry: On mother’s day we drove the 45 min. drive on the [highway] to bring flowers to Max’s Post by the river. As usual, it was a squeeze, church in the morning, lunch with Julie, driving her home (she cried – she wanted to come to the post, too), then having to rush back to cook supper for [friends] (& Julie). Susan is 28 now – will it ever occur to her to cook Mother’s Day supper for me? (or on any other day?) Whoops, there’s that bitterness. I guess I’d rather spend all the time I want wondering the river from Max’s Post. There’s a beautiful stillness there – the sound of the rushing river only emphasizing the quiet. And bird song, though no eagles at this time of the year. I was delighted to find a bank full of forget-me-nots in this otherwise bleak setting. I planted a little bunch the first spring after Max died. They’re in the poem “The Post”. In the early years, my life was consumed by my grief. Now I have to squeeze it in. Hank played a favourite CD of Max’s (name?________) there & back, & basically, we didn’t talk. Good. On driving trips elsewhere we discuss daily business or exchange recent happenings that occurred when the other wasn’t there. On this drive, we remain quiet, each absorbed in their own thoughts, knowing that they are about Max, or about the pain of his absence. I can add, “the pain of growing old without him”. Reading about myself as a 68-year-old female, I felt the weight of the years. Sometimes Hank has said, “who will look after us when we’re old?” We have no one. On our walk along the river bank we were spread out – Hank many paces ahead, throwing a ball for our dog. And I’m content to trail behind, observing the spring growth of leaves – it used to pain me so. Life reviving itself without Max. Now it’s more a melancholy I feel. (FP2Journal2) A second important joint grieving action for both partners were their visits to the monthly support group meeting. In the first interview, Clara indicated that they used to make 132 these visits more regularly together. However, as of late, Clara stated that she has been involved in the support group organization, while Hank joined her in the group only on occasion. As a result of the IJC, the couple decided to attend the next support group meetings jointly. In her second journal entry, Clara made the following comments about this joint grieving activity: On May 14, Hank kept his promise made at our bereavement interview and accompanied me to the [support group] meeting. It felt good to be driven there. When I drive myself, I feel lonely – it’s up to me, I think, to assure that the meeting works - & to have something to say that night helps others who are new, or at least newer, on this journey. When it was my turn to talk, I explained how I couldn’t attend last month’s meeting because I was too full of grief. There’s logic for you – can’t go to a grief meeting because of grief. What happened was that I felt the full impact of our loss again because of our interview with Derrick. And a heavy, heavy tiredness. This journey has been so long & the loneliness is so hard to bear – the longing for my beloved son. I didn’t want to show my failing or defeat with these I’m supposed to be helping. The more recent losses: the deaths of our lifelong friends [names] weigh heavily on my, too. When Hank shared he spoke of attending a Squamish Nations’ grieving ceremony & lamented that in our society we didn’t have the opportunity/invitation to grieve openly. They keen at these ceremonies. (I was remembering how Hank’s sobs over Max in the coffin shook the funeral home). I had to flee, I couldn’t take it – so maybe that’s a strange sign of togetherness – seeing/hearing the pain in the partner, on top of one’s own pain, is too hard to bear. The topic (at the meeting) of carrying the ashes of the dead child came up & I recalled in my mind how Hank offered Max’s to me as we walked to the river to scatter them. At first I refused, then I did carry them, held close to my womb – my dead child, now the weight, about, of a newborn. On the way home, from the [support group] meeting, Hank said as he holds my tummy in bed, he remembers me holding the ashes. I never knew, he never told me. Again the catalyst of being at the sharing meeting with others opened a channel. (FP2Journal2) Throughout the research process, it became evident Hank and Clara negotiated relational dimensions through their grieving. Both partners at times perceived their grieving to be “separate” – for Clara this happened when she attended support group meetings alone and for Hank when he would retreat to their cabin (“Max’s Cabin”). However, both partners also were deeply interested in and engaged with their partner’s individual grieving. Both of them regularly inquired about their partner’s individual grieving actions and made attempts at 133 drawing the other into their grieving actions. The couple enacted such a joint grieving process during their IJC. MP6: …So, you know, that kind of, there is a common point where we grieve, when people like [a friend] comes to visit and we spend some time… FP7: She phoned last night [MP: isn’t that great?], and I said, I've been feeling depressed and Hank said that I should phone you, you should phone your friend [name], she'll cheer you up and she said, well, I would try. And then she started babbling away about this and that. She had a specific reason for phoning me, it was a [support group] contact [in an area] where there was a similarity, the boy was 17, he died in a fall, the mom's name is Clara, and it's only been a year, not quite a year, and so she wondered if I would phone her... MP7: Well that was, yeah I think, so there are points even with your friend [name] when we had those discussions [yeah], around whether Jesus should be mentioned at all [FP: should be allowed...] within her earshot [laughter], when I think, those are points where we grieve…I mean, if we work at it, may be we don't spend a lot time commiserating, I think we're through the commiseration [uhumm] part of our grieving process with each other...And yet, I mean, here you are crying, I'm telling stories and you're weeping, so maybe we should spend, dedicate some time to that. You tell stories and I will weep. At various points in the study Clara expressed her desire to increase the frequency of their joint grieving. During those times, Clara would challenge the jointness of their grieving. Hank responded numerous times to Clara’s opinion about the separate nature of their grieving. One of the most elaborate responses was made in the MCI, where he spoke about the ways in which he joined in her grieving: MP5: When we have dinner parties at our place, who cooks? etc. etc. The thing is...I find Clara's involvement in [the support group] and her ongoing preoccupation with grief - whether she's doing a workshop on writing or inviting people to our home - whatever it is - a part of our corporate life. And I share in that. I don't necessarily go through a grieving process or some kind of emotional evacuation of anything. I'm supportive of it and I feel it's worthwhile and I feel it's good for me too, you know. It's not something that I'm doing - I take Julie away so that she can so she can have some people come by to do some grief writing or something. But to me I see that as a kind joint project, not balanced in any stretch, but certainly I am part of it. (MP2MCI) 134 Throughout their research involvement both the partners commented on how their joint grieving often involved actions aimed at encouraging the partner to join them in their grieving. For Clara, the typically involved asking the Hank to join her at support group meetings, while Hank would request that Clara join him at Max’s Cabin. In the following quote, Hank responded to what he believed to be the motivation behind the Clara’s comments in the IJC. In the ISC he expressed his belief that these statements were intended to persuade him to grieve more jointly with her. He stated in the ISC: MP76: Well, I think it's that lingering resentment in a way that she grieves alone that goes back to that original opening where she said, I pray…You know, there's no compulsion element on my part that I should be in the same place that she is. I honour her and her grief, and I respect her, and I'm trying to find ways to demonstrate to her that I do connect with her grieving. And then I say the first thing that comes to me is grief...I mean what am I gonna pray for today? (MP2ISC) Hank went on further to comment on his understanding of Clara’s intentions at this point in the conversation, as well as his response. He stated in the ISC: MP81: I'm feeling, that she wants to disconnect in a way, it's a dynamic where you put the couple in the room and you make them wrestle, she pushes until you push the other away. In a way it's that kind of dynamic, she's pushing me away and I'm hanging on. Yeah, I don't want to be pushed away. But at the same time, I don't want to be in a way totally enmeshed or somehow become some kind of a blend of her, I still want to be myself. (MP2ISC) Clara confirmed in the IJC and the ISC that she was indeed feeling resentful and that her comments were motivated by her longing to feel more connected to Hank in their grieving. The first quote is from the IJC, where she expressed her longing for Hank to join her in attending a play on parental bereavement. The second quote addressed the Clara’s internal processes about this statement. FP8: For instance, I would have liked you to have said, yes, I'll come to the play with you, because the play on Thursday night is about bereavement after child loss. And I know you're too busy, so I'll go with Rita now [sigh]. But you did go to your book club, we did go to your hockey night, so I feel... (FP2IJC) 135 FP49: Well it's resentment. Yeah. And since he just said, oh maybe we should do, take some time to grieve together. And I say, well you're not going to go to the play. (FP2ISC) While there was some disagreement about the frequency of individual versus joint grieving, both partners agreed that much of their grieving was undoubtedly shared. As their participation in the research unfolded, the couple identified various levels of joint grieving. During certain grieving actions, both Clara and Hank were engaged in the same grieving action and at times shared their thoughts and feelings about this action with each other or walked in joint silence. At other times, however, the couple grieved more relationally, that is, one partner engaged in a grieving action, which was witnessed by the other and in which there was an emotional connection for the partners. An example of this relational grieving emerged in the IJC. In the following quote, Hank commented on his thoughts and feelings as he recalled witnessing the Clara’s nightly ritual of praying in their bedroom in front a picture of Max. He stated in the ISC: MP1: Well - she's talking about her kneeling, I'm imagining our bedroom and where Max's picture is. There's always a candle in front of it, there's always a flower behind it in a vase, and it is...and Clara would kneel at that place every night for 12 years before she went to sleep…You know, in a way, as we age, one of the things we talk about is that we do grieve differently, every person does of course, and men and women definitively grieve differently. And in a way her preoccupation with grief has become her central…, and in a way she carries such a huge burden of it. It's like she kinda absolves me of the responsibility…And I'm watching her kneeling, right, and it's her intercessory prayer, in fact. I would be lying on the bed while I'm reading, I often read before I go to bed, and so I'm in bed, and she's kneeling at this kind of, sacred spot, it's just above where I keep my underpants in the drawer, right, it just happens to be on the top of this chest of drawers. (MP2ISC) Both Hank and Clara noted that various stressful events in their lives – such as the substance abuse/dependence of their adopted son, the ongoing interpersonal problems of their adopted daughter, the alleged sexual abuse of their granddaughter – interfered with their 136 individual and joint grieving actions. These complications were explored in the IJC, ISC, telephone calls, journal entries and most strongly in the FJC and FSC. In fact, one of the most significant ‘complications’ for this couple occurred in the midst of the research process and was, by and large, the central topic of conversation for the couple in the final interviews. The revelation of the sexual abuse of their granddaughter was such an impactful event that it arguably represented a significant shift in the grieving for this couple, a shift that further sidelined the couples’ ongoing joint grieving for Max and required most of their attentional and emotional capacities. However, even in the earlier parts of the couple’s grieving both partners acknowledged that the ongoing struggles of their adopted children complicated their grieving for Max. Clara’s following quote from the IJC is an example of the impact of such complications on their grieving. FP1: …You know the whole thing with James and our hopes for him and having our hopes dashed...and Susan having this baby which - I should love the birth of a baby - and I'm even bitter about that, but I think my bitterness, well those disappointing circumstances interfere with my simple love for Max [crying]. But you know, tomorrow night is [support group] and I'm not chairing, [name] is, so I could stay home, but I'll guess we'll go cause I feel that's kind of my duty to the newly bereaved. [sigh] [silence] And I know you shouldn't do volunteer things except for out of love, but I guess I'll go again...And the new pain with our friend [name] dying and my confusion over my role with Jordan [her daughter], where I've sorta become a substitute mom. If you've seen, I've put the picture out of Max and Jordan together, and Julie looked at it and said, who are these kids? [laughter - that's so good] And I said, that's Max and Jordan when they are four, they were younger than you are now, so in a way I feel like just [sigh] just stuck on the happiness of the past [crying]. And thank goodness for tennis, cause I was quite happy batting the ball today. [sigh] I feel worn out. [silence]. And listening to you now, talking about how wonderful he was, and you're talking with such enthusiasm, and it's just making sadder and sadder [crying more] cause he's not here. (FP2IJC) Throughout the research project, both partners repeatedly spoke about the importance of their faith for their grieving process. The first substantial discussion of the impact of their faith on their grieving occurred in the IJC. After listening to and honouring his partner’s 137 expressions of grief for several minutes, Hank then asked Clara to comment on her relationship to Jesus. Clara, laughing at this point, replied humorously and then added a more serious point about her longing for a simple and uncomplicated faith in the IJC: FP2: Oh, Jesus [laughter], Jesus, morning Jesus, Jesus in the evening, Jesus at supper time...yeah, Jesus. I don't know, I'm fed up with that, too, about all that talk about, you know, was he miraculous or not, was he a result of Mary being raped by the soldier, I'm just tired of it [sigh]...I wish I knew Anne Lamott, cause I like her simple Christianity. (FP2IJC) Clara elaborated further on her desire for a ‘simple faith’ but also analyzed her faith as being ‘distant’ and removed. She stated in the ISC: FP16: Do you hear my reference to Anne Lamott? Do you know her work? I feel very close to her and as late as she came to Christianity and as kooky as she is she could answer, oh I love Jesus. He's with me all the time. He helps me. And she turns to Jesus when she's in a tight spot and I guess I still don't have that faith, which is...quite incredible because I've been going to that church since Max was 6 and he should be 32...And I don't even question am I a hypocrite if I can't say, oh I know Jesus loves me to a friend but then I go on Sunday and tell the children that Jesus loves them. I don't think I'm being a hypocrite because I feel it. Maybe it's all my years of teaching literature, you know? 33 years of teaching literature that I'm always analyzing everything as if it's in a story and there's a certain distance for me. I stay out...I think that's a characteristic of myself is that I want to keep a distance and do analysis all the time. I'm analyzing myself. (FP2ISC) Clara noted frequently in the research process that she saw herself as the one who doubted and that she often relied on her husband’s faith to sustain her in times of doubt. She acknowledged the relational nature of their faith in the ISC, as she commented on the Hank’s faith, her doubts and how she saw these related to their joint grieving. She explained in the ISC: FP24: I think in the dynamics of our relationship he's sort of the strong guy that knows...how to make decisions and stick with them. I'm always vacillating. And I don't think that's necessarily, it's not a male/female thing. It's just our characters…Well, I'm ambivalent because...in many ways I resent Hank's strength. And so a few minutes ago I just told you that it was reassuring to hear him doubting. And now I'm beginning to think, oh oh. He's doubting. (FP2ISC) 138 Hank also spoke frequently about his faith and how he saw it related to his ongoing joint grieving project. He stated at various times that his daily activities as a student minister and theology student were intricately connected his ongoing grieving for his son. The following quote is one example of where Hank addresses his perceived relationship between his studies, his personal faith and his grieving project. He commented in the ISC: MP56: …I did a paper on Corinthians 15, which is entirely about the resurrection...My little peeve is with just the last four verses, but in order to get to the verses I had to look at the entire chapter, so it's a sustained argument for the resurrection. And one of the reason that I chose that passage is because I'm so preoccupied with the my son, with the resurrection in terms of my own life, my own grief life, the loss of my son, the loss of my daughter, that we had for less than 12 hours in [a city], and so the resurrection, of course, is absolutely central, it's a central piece to our Christian faith. Without a resurrection we are just a rotary club, right, and so, which is not a bad thing, but it's not a faith, you know, the resurrection as a central piece…And grief, last night I was writing, actually at 4:15 this morning I was writing a paper really on healing, wholeness, practices and traditions in grieving, and memorial stuff, you know, so I was actually reviewing Max's memorial, right at 4:30 this morning, his memorial service and how intentionally it was. And so it is very much part of my life at this point, it so happens coincidentally, that I'm talking about the fact that we had a casket actually at the funeral. And Max's funeral was an open casket, we had a viewing right before but then we actually had a casket there, and we had his friends carry the casket. There was a cortege of his friends and a procession, there was 6 kids carrying the casket and about 20 kids behind him, they were like honorary casket barrers, right? Placing the casket in front, and you could have wheeled it in, but they had to feel the weight of that body to say ‘good-bye’ to him. So all that, you know, has been on my mind right now. I'm very much tied, and it's also part of my faith, very much, I believe I was drawn to the place, I'm mean I'm in my spiritual autobiography. I mean death has been very central to me being drawn into my faith. Back to try and understand, not that primitive contingent faith that I was added to as a child, but a more mature and reflective and metaphoric kind of faith that I can accept as a foundational to my worldview. (MP2ISC) Part of Hank’s ongoing faith development and grieving project included at times expressing his doubts about the veracity of his faith and his son’s ongoing life after death. For example, he stated in the IJC that at times he doubted whether his faith in God and his son’s ongoing life might not just be “a bunch of crap” (MP2IJC). He elaborated on these 139 doubts in the ISC, noting an interesting parallel to Clara when he spoke about the impact of engaging with his faith on an academic level. He stated in the ISC: MP59: I'm thinking that there's a real need to hold onto hope and to give meaning to those things that are incomprehensible. And then I'm talking about preparing prayers...and then at some point it becomes a kind of academic exercise, you know, it just becomes like it's a paper you have to write or an exercise you have to complete, you know, something like that. And then I do, and then you go, this is a load of crap…I just finished this paper on Psalm 126, the first two lines are when Lord restored the fortunes of Zion we were like those who dream. And it's like and the power there is to imagine salvation, these are post-exilic Jews living, returning to Jerusalem, thinking about what it was like in Babylon. And so you think that and they were like we were, those who were dreaming of restoration, and you can hear Martin Luther King going, I have a dream. So there was a power and so there are times when that happens and it's just like, you know you just want to get up and preach it, you be able tell somebody. And there are other times when you just go, what a bunch of shit this is, you know... (MP2ISC) The joint grieving project for the partners frequently included discussions about their experience of Max’s ongoing presence in their lives and in the lives of others. These conversations seemed motivated by ongoing individual and joint efforts to live out their faith and relationship careers authentically. For both partners the presence of their son was intimately connected to their faith and their beliefs and doubts in the resurrection. This topic was most strongly addressed in the first set of interviews. Following his statement of wondering whether the resurrection could be true, Hank returned from the academic exercise of writing a paper, which elicited doubts about the ongoing life of his son, to his experience of the ongoing presence of his son. He stated in the IJC: MP3:…But then there's stuff like, like I'm working on this paper right now, and as I'm writing this stuff down and thinking about, I mean how present he is, and how I don't think I could approach this stuff without having some sense of his presence, that he's still around, you know, he's with us. I have this little picture of him wearing your tea cosy hat in front of me on my desk, right, with him on one side and [a friend] on the other, and that to me that's his continued presence, I mean, in terms of my picture, cause that used to sit on my desk at [his former school], and all the tough kids…Like I remember when [student] came in and said, whose that? And I said that's my boy. He said, that's your boy, oh man, and [the student’s] like a major criminal now, and 140 for him to have this sensitive, you know, it was that attachment, that immediate attachment. (MP2IJC) After listening to the Hank’s experience of the ongoing presence of his son for him, Clara expressed her doubt about whether their son will remain present after their death. She stated in the IJC: FP4: Isn't he around because we're still around thinking about him and feeling him? What about when we die? (FP2IJC) Hank reaffirmed his belief in the ongoing presence of his son and spoke about several incidents that were related to the ongoing memory of their son. He elaborated about how he continued to sense his son’s presence and how he viewed Clara as struggling to do so at times in the ISC: MP67: I'm [silence] in a way convinced that he is still with us and that in a very visible way...I feel like he's still with us...it's very reassuring for me. [But] with Clara's, the difference I mean with her, there's a sense that he's not there, that she has to continually hang on and reaffirm that he's there. And for me, he's there. You know, I don't have to worry about that, there's always evidence for that, like when I turn here, there's evidence that Max is there, I turn there, there's even to the point where people who never met him and know who he is, are building tributes to him, it's amazing. (MP2ISC) Change in the joint grieving project. Throughout the duration of the research interviews, several changes in the grieving actions of the couple were described by the couple in their telephone calls, journal entries and in the final interviews. The most significant occurrence, which took place between the second and third set of interviews, was the revelation of the identity of their granddaughter’s abuser. Both Hank and Clara reported that this incident was yet another loss in their life – this time not the loss of a life but rather the loss of their granddaughter’s sexual innocence. Furthermore they reported that they believed that this incident, as well as their daughter’s poor parenting decisions, were already and would continue to impact Julie’s mental health negatively. The couple reported that they 141 had previously assisted their daughter in her parenting duties, but also felt somewhat hopeless about whether they could have any significant impact on Julie. The FJC began with Hank telling Clara about a joint grieving action with their granddaughter, Julie, after she had revealed the perpetrator of her sexual abuse to a counsellor at school. In the FSC, Hank elaborated further about his reasoning for sharing this story, noting that part of his reason for sharing it was because he had not spoken to Clara in person about it. Another part of the Hank’s goal for sharing was to express his grief and sadness and disappointment over his two adopted children, who, in contrast to their deceased biological child Max, had chosen to live their lives according to vastly divergent values. He explained in the FSC: MP1:... So, what I'm thinking...I'm just going to tell this story because I only told it to her once on the phone. I think we talked on the phone and what was happening at the same time, this is always complex. You know, one of our complexities, is that we adopted these children and these adopted children have now produced children. Well, at least Susan has…I got a phone call from Susan and she was completely distraught because Julie had disclosed to the counsellor that she had been sexually molested by a friend of Susan's, during a babysitting occasion... And so what I'm reading there…Susan, she was pregnant. She was 8 months pregnant at this point. And she's just completely...just in a state of dislocation. She's crying and she's chortling and I mean, it's like, she doesn't know what to do. So, I go pick Julie up from school and bring her home with me, right? And keep her so that she, you know, because she just doesn't know how to deal with this, right? So I went to school that afternoon, just on the Wednesday and picked her up. And then, I mean she has a room at our place. It's not unusual for her to stay there. So that's, that's a very routine part of her life. We've been basically co-parenting her since she was born, right?...And so there's this....so Clara has left for [retreat centre], I'm alone with Julie and....and before Clara left, Julie was very curious about Max and wanted Clara to read the Max book to her. And talk about Max. She's been asking Clara lots of questions about her own past and about the family's past, right? And so she knows that Grandma wrote a book [about Max]. (MP2FSC) Hank then went on to reflect on his motivation for sharing this information with the interviewer and talked about how he sees all of these tragic life events as connected to his ongoing grieving for Max. He stated further in the FSC: 142 MP8: I guess numb would be a good way to put it or...you know, this is an opportunity. I mean, here I am telling you, right? And you know, and for whatever reasons this is a part of, you're getting this information whether you want it or not (laughing). It's like...it's just life is complex...and sometimes I say to myself, like am I just...why am I doing this Greek thing? Right, it is so intense, so hard. And...I'm going, do I really want? But then on the other hand...it seems important to me, it seems important. So, and it's not that I'm trying to escape anything, like I'm not running away from James or Max or anything like that. I'm not running away from anything. I just...you know, it's just that's my life, that's how complicated it is. (MP2FSC) Hank explained that Julie had requested that he read her poems from Clara’s book about their son. He stated that he had attempted to read to her from this book, but was soon unable to do so. He noted that he instead decided to read to Julie from the Bible. He described the situation in the following way in the FJC: MP2:…And I couldn't read anymore. I didn't want to be…I mean she was already under stress because…it was all about this revelation of the...abuse and stuff, right? So (sigh) I stop reading and I said what would you like to read? She said I'd like to read a Bible story...So I went and got…the Eerdman's Illustrated Bible Dictionary. And then I started looking through it and I found the story… and so eventually we got to Daniel and Nebuchadnezzar and I started reading it but it was too complicated even for her…And so I told her the story of Daniel and his...how he wouldn't give up his faith. And...he wouldn't change his story because he told Nebuchadnezzar the truth about his dreams and the true interpretation. And Nebuchadnezzar...and so he sat...and the lions didn't eat him. And so...anyway...the point there was that I found myself...not being able to read a book without being captured by emotion. So...that's what my journal entry was about. And I think part of it was my...own thoughts and part of it was also my sorrow for Julie and kind of, the kind of death in a sense that she experienced right then, you know? And how...I just didn't want to add to it. I didn't want to add the death of her uncle, a child already with a heavy burden. You know, and then the Daniel story seemed to affect her that if you trust in God then even the lion's don't eat you. So I was trying to bolster her saying, you know, give her a sermonette. [both chuckle]. (MP2FJC) Hank elaborated further on his intention for telling this story, as it related not only to conveying information about their adopted daughter and granddaughter to Clara, but also to their roles in their ongoing grieving for their son, Max. He explained in the FSC: MP12: …As I'm talking to her, she's not saying anything, but I'm sensing that she's [Clara] cognizant of the fact that I've been moved by her poem and that she's...in 143 some way responding to me emotionally even though she isn't doing very much. (MP2FSC) Hank commented further about his perceived impact on Clara in that moment in their joint conversation. He stated the following about his feelings over the Clara’s reaction in the FSC: MP13: Well, I'm feeling good about that. I'm feeling that she is a good woman…And she is the one who is the...articulator of our grief in a way. And I'm pleased about that because, you know, she's the chronicler and the voice through that [her book]. And in particular I know that poem so well because I...it was on...it's on his [Max’s] program, on the funeral program. And I just used the funeral program in one of, in this paper I did for [the professor], when I was doing this stuff on culture and grief (mm). And so it's fresh, it's very fresh...So anyway, and I'm sure that's probably one of the reasons why I'm triggered. And I have not looked at this book. I cannot say that I've read the poem for maybe 5 years and I've actually held it in my hand. So... it's fresh and I'm sharing this with her even though I know she's heard the story before. You know, and she's very attentive. And so, that's how I'm feeling. (MP2FSC) A second significant stressor in the couple’s life was their concern over their adopted son’s history of substance abuse and his reported current substance abuse. The couple reported in their final interviews that they had received a phone call from James in which he had admitted that he was once again using drugs. The couple indicated that in the past they had assisted him financially but stated that at present they were unsure about which course of action to pursue. Clara addressed this topic in the FSC: FP10: I think because we've just come from this...hurried lunch where I'm asking him questions about what James said. Because we haven't been in contact with him. He doesn't do any contacting with us and I'm trying to...visualize and be there in China with...no family, no job, no money, no passport, etc. It seems like a life thrown away. He wants us to send more money but when we send money it doesn't do anything. (FP2FSC) All of these ongoing stressors in the life of this couple seemed to have a significant impact on their ability to attend to their grieving actions for their biological child, Max. Both partners spoke about this extensively in their phone calls and wrote about it in their journals. 144 For example, in her first journal entry, Clara recorded how she had heard about the reported abuse while giving a writing workshop at a retreat centre: Travelling the Grief Road: alone and together (& faith?). Spent last week alone (well, that means without Hank) at [a retreat centre] on [a gulf island]. A writing workshop. I vowed (before I left) that I would not share my 15-year-old grief with strangers. So, guess what, at the first breakfast there, when asked if I had children, I told about my dead one. I also referred to grandchildren, 7-year-old Julie, as a source of joy…But by Wed night (I had arrived on Sun. night), I was missing Hank. I phone home to discover Julie there. Yet another crisis. Really, it’s like another death: she has revealed who her molester is. Susan is freaking out. Grandpa is babysitting. I couldn’t sleep that night, so left my beautiful restorative retreat and workshop 2 days early. When will this suffering be over? [a quote from an Ontario writer – writing from the point of a Cath. Priest in an impoverished and sickly northern town]. My faith here? Shit! I’m angry at God this time. Another destroyed child! “Damaged goods” as Hank’s brother always says of James and Susan, our adopted children, when their behaviour again outrages us. Poor Julie. Now, as I write, she is not allowed to play with the other kids at lunch or recess. She has a child care worker all the time. This last action came after, on Friday [the day after I retired) she asked a grade one boy to come for a sleepover & she would put his penis in her mouth. 10 mothers have complained, acc. to Susan. So I’m supposed to be writing about my grief as a bereaved parent. Now I’m a bereaved grandparent. Self pity – there it is again! “God, don’t let me be bitter!” was my prayer after Max died. Now it’s “God help me in my bitterness”. (FP2Journal1) Hank, too, spoke about his ongoing feelings of sadness and disappointment with his adopted children and his reason for engaging in theological studies. He stated in the FSC: MP75:…Well, I can use that analogy. You know, the fact that there's no harvest here. You know, if you think of children as the seeds which you continue to nurture. You know, cultivate. Eventually, you know overtaking the model that we live with. You know, it's sort of our biblical model is that…you sow and then as we age these trees, if you will, or these plants bear fruit, right? And they reward us with fruit, right? So, you have children who graduate from high school and they marry and they have other children and they accomplish things and so on. And you're living proof of that to your parents, right. You know? So there's this cycle of replenishment, right. Storehouses filled again. I mean you draw and sometimes you go through periods of drought and periods of need and somehow you know, it comes back. And you have...but it doesn't seem right now in our lives. It doesn't seem. It's not coming back...So I think you find ways. My theological study is one way of doing that, to say I'm really interested in...I'm curious about faith, I want to know more. And so I'm going in and I'm building in that area, right? Clara's got her [support group], she enjoys her tennis and so she's engaged in that and she's got her writing group. She's starting another writing 145 group. And so she's engaged in that. So she finds other ways to, to build some capacity where the natural cycles of capacity are not coming, right? (MP2FSC) A third notable change in the couple’s grieving actions, which was expressed in telephone monitoring calls, journal entries and in the final interviews, was the perceived increase in joint grieving actions as well as a sense of connection between both partners. In her first phone call, Clara commented on her thoughts and feelings in this regard and stated that in the past she had sometimes resented the Hank’s strength and independence, but that the participation in this research project has helped her to realize additional dimension of Hank’s relationship with Max, which he had not previously “felt the need to voice” (FP2Call1). This increased sense of connection between both partners as a result of participating in the research project was also reiterated and enacted in the final interviews. In the FJC, Clara spoke about how she felt positive about participating in the research project and noted that it afforded them the opportunity to be more explicit about their joint grieving. She stated in the FJC: FP10:…So...I think this whole process with Derrick's research...and I talked to Derrick about that on the phone, has been very good for you and I. So that we're talking to each other about our feelings instead of just buzzing around doing our own thing. (FP2FJC) As part of their joining with the other partner in grieving, Clara and Hank both shared their individual grieving actions with each other. After listening to Clara’s account of listening to and sharing her friend’s grief over her husband, Hank shared an emotionally and spiritually significant grieving experience that was for him related more directly to his grief over his deceased son Max. Hank elaborated further on the significance of this grieving experience at the cabin, connecting it again to his wife’s writing about their grieving and to 146 Max’s ongoing legacy and impact on people. He elaborated on the context for excitement over seeing the ospreys in the FSC: MP33: Once again, it's about the book. This is, the book that Clara wrote [about Max]. It sits in our cabin. It sits in the window sill. It's there for people and Clara’s written an inscription on it because...well there's quite a significant part of...this part. I mean the photographs in it are and drawings often. [The cabin] is really apart of our life, this place we have right. And Max loved it up there. He just loved it, he told us. And it was...and…he was a good artist…He used to keep a kind of a sketch book. And he drew this picture of this snag, this tall cedar snag. It's about 68 ft. high. And on the top of it was an osprey's nest. And he actually drew a picture of this osprey bringing this snake in its talons to the nest. Now osprey's are fish hawks, typically fish but in this case with a snake. And...so that is in the book…And so as we were getting in the boat, I saw a pair of ospreys out. And that's, you know, they're not as vigorous as eagles. They're rare...[and] so now 20 years later, suddenly, there's a pair of osprey. (MP2FSC) Hank then elaborated on his reason for sharing this story with Clara. He explained in the FSC: MP37: As I'm talking to Clara, I think it's important for her to know, and I think it makes her feel good and it makes me feel good to know that she feels good. That her little book can evoke those responses from a young man. Possibly, although I'm not really checking him out. I didn't…ask him any questions. I'm just observing as he's reading the book. And he stayed with the book all night. And also, I...know that, as I'm telling her, it is making her feel good to hear that her book is still enhancing people. And that it makes me feel good to know that she feels good. And it makes me feel good to know that somebody can read about Max and feel good about that or be curious about that. So it's just a way of, of cementing all that. Or kind of...galvanizing that in a way that's affirming. That this isn't...you know, that there is something eternal about this. (MP2FSC) Clara listened with some interest to the Hank’s story of his time at the cabin and the connections that he is making to their grief for their son Max. She explained the connection that she was envisioning as she was listening to Hank in the FSC: FP29: …So this is Hank introducing the young man...whose no less a stranger to us...to our innermost...loss. But it's...you know, but Hank being a principal of a high school all those years, that...he really relates well to younger people, in particular younger men. I was thinking oh, there's Hank longing for his lost son in a way, by befriending [the young man] and having a deeper relationship with [him]. (FP2FSC) 147 Project Summary. From an action-theoretical perspective, the grieving project for this couple emerged within multiple ongoing careers and projects. The careers included relationships with each other, their two adopted children, and their granddaughter, as well as their longstanding commitments to their common Christian faith. The relationship careers with their adopted children and their grandchild were frequently foregrounded throughout the research project because of various crises, and this in turn was perceived by both partners as detracting from their ongoing joint grieving project for their biological son. Both partners also viewed their grieving project as intricately intertwined with their faith careers. As an academic, Clara’s faith career frequently included questioning various aspects of the Christian faith, which seemed to parallel her wondering about the ongoing presence of her son. Hank’s faith career likewise included moments of doubt about the veracity of the Christian faith, however, these doubts were balanced by his confidence in the experienced ongoing presence of his son. Hank’s faith and grieving were also impacted his graduate theological training. The intentional framework for this couple can be described as striving for lasting and authentic relationship with each other and God, while managing commitments to other relationship careers in their lives. Goals and intentions for the couple included deepening the intimacy in their relationship careers with each other, their deceased son and with God. At various points in the research project, both partners sought to draw the other partner into their grieving actions through implicit or explicit requests. At times, these grieving-related goals were temporarily backgrounded in order to attend to various crises in the lives of their adopted children and their grandchild. For both partners, these additional challenges further 148 highlighted the immensity of the loss of their son, a son who would have been “loyal” to their values and who would have “rewarded” their investment of time and love. Grieving for this couple included both individual and joint actions. Joint grieving strategies included explicit joint grieving actions, such as visits to “Max’s Post”, attending the parental grieving support group and having conversations about both grieving actions. Additional strategies also included witnessing the partner’s grieving individual grieving actions, honouring him or her in these actions, and seeking to support the partner by inquiring about these grieving actions. For Clara, this included asking Hank to speak about his visits to the cabin and listening intently about the Hank’s spiritual experiences of sensing Max’s presence at the cabin. For Hank, this included witnessing the Clara’s nightly prayer ritual in front of Max’s picture, as well as assisting the Clara in leading the support group and inquiring about the support group activities. Manifest behaviours for this couple included a wide variety of verbal and non-verbal communications. Non-verbal communication included listening, smiling, nodding head, crying, laughing, and sighing. Spoken communication included asking/answering questions, agreeing and disagreeing with the partner, describing self, other, past situations, expressing emotions, such as sadness, anger, bitterness, uncertainty, ambivalence, joy, disappointment, expressing beliefs, opinions, perceptions, judgments, and describing hypothetical situations. Assertions. The joint grieving project of this couple was inextricably linked to multiple, complicated relationship careers, which either facilitated or hindered the grieving project. The grieving project was likewise related to the couple’s faith careers and paralleled each partner’s individual spiritual development. The grieving project began to shift over time 149 and seemed primarily affected by additional complications in the relationship careers with their adopted children and grandchild. Couple 3. This couple consisted of a 70-year-old woman and a 67-year-old man. The female partner (Gwen) was born in New Zealand, of English descent, and her first language is English. She indicated that she has lived in Canada for 43 years and came to Canada to pursue her profession of nursing. She described herself as a Christian who has been practicing her faith for most of her life. The male partner (Lance) was born in Egypt, but noted that he spent most of his childhood in New Zealand. He indicated that after completing his university studies in New Zealand, he moved away to England. He has lived in Canada for 42 years and described his ethnic heritage as Scottish. He described himself as an Evangelical Christian who has been practicing his faith for 55 years. Together, the couple had two children, one of whom was deceased. Their deceased child, Joel, died at the age of 21 on January 25, 1990, as a result of suicide. The other child, Richard, was married and living in the Lower Mainland in British Columbia. Both partners were retired from their respective professions – sales and nursing – and continued with various recreational activities in their lives. Joint grieving project. Following the first interview, the interviewers analyzed and described the couple’s joint grieving project. The following description of this project was presented to the couple in the Member Check Interview (MCI) and the couple concurred with the description. During the telephone monitoring phone calls, both partners agreed again that the description of their joint project was still accurate for them as a couple. The joint grieving project for this couple was described as: 150 Giving each other the freedom to express their individual grief freely, while finding joint comfort in the daily practice of their faith and in the spiritual experiences of ongoing connection with their son. Following the advice of their grief counsellor, both partners allowed each other to express their own manner and timing. This grieving project was characterized by a variety of ongoing joint and individual grieving actions, which were shared within the context of the marital relationship. Both partners acknowledged that their joint grieving project served not only as an ongoing connection with their deceased son and with each other, but also focused on protecting the memory of their son. Their joint grieving was likewise focused on caring for their remaining son, who, f
UBC Theses and Dissertations
Spiritual and relational dimensions of parental grieving Klaassen, Derrick Wayne 2010
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