Keywords

FormalPara Learning Objectives

This chapter presents a postmodern approach to grief and bereavement, emphasizing experiences that disrupt people’s worlds of meaning, which then propels them to search for a sense of significance in their lives. Meaning is associated with the construction of one’s life narrative and the retention of important relationships (Neimeyer et al., 2010). When social workers realize that a resilient trajectory can be maintained following loss through storytelling and connections to others, they are better able to help clients in the aftermath of loss. On completing this chapter, you should be able to use therapeutic strategies for helping clients integrate loss and demonstrate resilient social functioning.

You should be prepared to answer the following questions:

  • What is a narrative approach to bereavement?

  • How does constructing a narrative help clients redefine their lives?

  • Why does sharing one’s story help affirm life’s meaning?

  • What is collective loss?

Clinical social work practice with people experiencing loss and grief has evolved over time, shifting from an emphasis on stage theory to “a process of reconstructing a world of meaning that has been challenged by loss” (Neimeyer et al., 2009, p. 455). In 1969, the well-known psychiatrist Elisabeth Kübler-Ross identified grief as an emotional and psychological reaction to the loss of a significant other that may engender psychological distress, necessitating a progression through therapy stages to reach a resolution (Maciejewski et al., 2007). However, since that time, the field of grief therapy appears to be shifting from the use of stage theories to a view of recovery from loss that embodies a pattern of resilience (Bonanno et al., 2006; Rasouli et al., 2022).

Although between 5% and 25% of people may experience long-lasting distress following great adversity, most people successfully navigate bereavement, with the majority demonstrating a resilient trajectory (Bonanno & Diminich, 2013; Bonanno et al., 2002, 2006). The death of a loved one is a universal experience, and bereavement is a natural process people engage in to understand and make sense of loss. However, each person explores grief and makes sense of loss differently (Flesner, 2013), which has larger implications for the collective.

One contemporary approach in such therapeutic endeavors “emphasizes how individuals construct meanings about the self and about the world through relationships and narratives” (Flesner, 2013, p. 2). This process of reconstructing a new narrative that integrates loss is illustrated here through the practice example of Janet, who lost her single mother to the opioid epidemic.

10.1 The Opioid Epidemic and Child Welfare

The decrease in life expectancy in the United States between 2000 and 2015 was due to drug poisoning largely attributable to opioids (Dowell et al., 2017). Recent data show a small decline in opioid-related mortality following a decade during which it more than doubled to nearly 53,000 in 2018. Dependency on opioids remains one of the most urgent challenges confronting public health officials in the United States.

The unprecedented rates of drug misuse and overdose deaths, in particular opioid-related incidents, in the United States have had very harmful effects on child health and safety. Among the difficulties are impaired parenting and attachment, inadequate child supervision and care, and diminished financial resources (Feder et al., 2019). Another damaging effect has been the placement in foster care of children whose parents are addicted to opioids or died of an overdose (Ghertner et al., 2018; Quast et al., 2018).

The opioid crisis is placing even more demands on the already overburdened child welfare system. For example, West Virginia, the state with the highest rate of opioid overdose death, also has the highest rate of foster care placements at 41 per 1000 births compared to 5 per 1000 births in neighboring Virginia (Patrick et al., 2019). Updated data can be retrieved online from the National Center for Health Statistics (https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm).

10.2 Engagement

Engaging with a client following the death of a loved one requires that the social worker acknowledge the pain of the loss. Pain may also be accompanied by anger, depression, or confusion. Nonetheless, the narrative approach to recovering from grief suggests that the practitioner quickly unites with the client on a journey of healing, as seen in Box 10.1.

Box 10.1: Practice Example: Parental Opioid Misuse, Janet, and the Child Welfare System

Malinda was a social worker at a state-sponsored foster home. She had been assigned to work with Janet Taylor, a 12-year-old middle schooler who had just been placed in foster care because her single mother, Beverly, had died of an opioid overdose 3 months ago. Janet, who was making all A’s in school, was not talking to anyone at the home. Her Aunt Cassie visited her every other day. However, Janet pretended to ignore her. Malinda, who had long tried to engage Janet, decided to reach out to her again to involve her in the home’s storytelling project.

The storytelling project is based on the postmodern idea that an individual can resolve the grief that follows the death of a significant attachment figure by engaging in a meaning-making process. It also requires “recruiting ongoing support and validation from other familiar figures in one’s social world or from those who have experienced similar losses” (Neimeyer et al., 2009, p. 454). As seen in the interview in Box 10.2, Malinda’s attempt to engage Janet was finally successful.

Box 10.2: Practice Example: Janet Starts Her Story

Malinda::

Remember I said I would come by to see you again. I want to tell you about the home’s storytelling project. It is an English class project. The three winners receive an A in English for the year. There is also a list of prizes.

Janet::

Okay! What do I have to do to get an A? I could get one anyway. What are the prizes?

Malinda::

Here is the list. What do you want to win?

Janet::

No question there. I will win the fingernail design manicure. What do I have to do?

Malinda::

You have to write the best family narrative.

Janet::

What is that?

Malinda::

The history of your family in this county.

Janet::

Oh, gee. I guess I may have to talk to Aunt Cassie.

10.2.1 Practice Example Analysis: Steps Taken

The stress that results from grief can be reduced by lowering risk and bolstering protective factors. Malinda started that process as she addressed Janet’s self-isolation. Malinda hoped that Janet would re-enter some form of social life while living at the foster home. Malinda was also aware that for Janet to begin to resolve the death of Beverly, her mother, Janet needed to seek new meaning in life that was grounded in her own action plans (Armour, 2010).

10.3 Multiple Systemic Loss

10.3.1 Collective Stress

Loss does not just affect the individual who has lost a loved one. Rather, loss is a multisystemic collective phenomenon connected to people’s sense of others and place (Abramovitz & Albrecht, 2013). When people lose the sense that they can depend on others and that their community is safe, is receptive, or serves as an anchor for them, family and community connections seem to disappear.

Events like epidemics create shared experiences that disrupt people’s sense of safety and security and cause confusion and uncertainty. However, according to Neimeyer et al. (2010), the narrative “organizes the ‘micro-narratives’ of everyday life into a ‘macro-narrative’ that consolidates our self-understanding, establishes our characteristic range of emotions and goals, and guides our performance on the stage of the social world” (pp. 73–74). Said another way, the person in mourning comes to see that his or her “personal lifestory is nested in a set of larger stories,” as seen in Box 10.3 (Kenyon & Randall, 2001, p. 17).

Box 10.3: Practice Example: Janet and Malinda Recruit Aunt Cassie

Malinda::

Are you ready to start writing your story?

Janet::

I am looking up facts on the Internet. But I want to give a firsthand account. That way, I am even more likely to get an A.

Malinda::

Doesn’t Aunt Cassie come today? She may know something.

Janet::

She should be here any minute. Maybe we can convince her to help. There she is now.

Aunt Cassie::

Did I hear my name? That’s unusual!

Janet::

I need a favor. I want to win the storytelling project, and I need information about the family.

Aunt Cassie::

No problem. I may have some interesting old stuff in the attic you can use.

10.4 Assessment

10.4.1 Sociocultural Historical Context

Individual and family narratives consist of sociocultural and historical information. Janet Taylor learned that her family had been part of Logan County for more than 100 years. Logan County was founded in 1824 and became part of the then-new state of West Virginia in 1864. This Appalachian area was home to multiple coal mines that produced coal and coal slurry, a combustible mixture of fine coal particles suspended in water sold as low-grade fuel. Mountain top mining was also done in the area to obtain coal above ground. Surface mining involved altering the topography of the countryside by removing hills or ridges to retrieve buried coal seams (see Box 10.4).

Box 10.4: Practice Example: Great-Grandpa Taylor, the Coal Mines, Labor Abuses, and Ecological Degradation

Great-Grandpa Taylor and his family lived in Logan County, West Virginia. The family consisted of Great-Grandma Taylor and six grown children. Coal miners were divided between union and nonunion workers. Great-Grandpa Taylor was a nonunion worker. If he joined the union, he could face immediate termination from his job and eviction from his company-owned home. In 1921, Logan County was the scene of the Battle of Blair Mountain, the largest labor uprising in U.S. history, in which up to 100 people were killed. Great-Grandpa Taylor fought on the side of the nonunion organizers along with his brother Jester, who was killed during the battle. Great-Niece Frances had kept the Washington Post newspaper account of the event, which Aunt Cassie found in her attic and brought to the foster home for Janet to read. Aunt Cassie also found old family photographs of barbeque reunions.

10.4.2 Practice Example Analysis: Steps Taken

As Janet experienced the past events recounted in her family narrative, Malinda introduced additional strategies to help Janet mourn her mother. These included looking at photographs of family reunions to discover her mother as a child. Malinda and Janet then reflected on the fact that Janet was coming to appreciate the benefits of looking at family photographs (see Box 10.5).

Box 10.5: Practice Example: Janet Explores Her Thoughts About Her Mother Beverly

Malinda::

What did you think of the pictures Aunt Cassie brought in for us to see?

Janet::

I never thought my mother looked so much like me.

Malinda::

Do you want to say how that makes you feel?

Janet::

I guess we were really close. But she made me so mad with all those drugs.

Malinda::

Do you want to write a letter to her about it?

Janet::

I do and I don’t. I also feel so sad. I cry late at night so no one can hear me.

Malinda::

Would you be surprised that a lot of people feel just like you do?

Janet::

Well, they seem to just walk around minding their business.

Malinda::

You would hear those feelings a lot if you attended Dr. Cantor’s Monday night group on grief ceremonies.

Janet::

I would rather put it all in my letter and bring it to you next week.

10.4.3 Creating an Assessment Profile: Balancing Risk and Protection

The content in the narrative interview leads to a client assessment profile and to an intervention plan mutually developed by the client and social worker. The goal for Malinda was to set in motion a change process to help Janet revise negative meanings of events, find solutions, and develop a greater sense of agency (Greene, 2008). To facilitate this process, Malinda invited Janet to reflect on three questions that contributed to her assessment profile (see Box 10.6; see also Table 5.2 in Chap. 5):

  1. 1.

    What was it like living in Logan County during the opioid epidemic?

  2. 2.

    What was Janet’s reaction to the stress of the crisis?

  3. 3.

    How did Janet’s family react to Beverly’s addiction and death?

Box 10.6: Practice Example: Establishing an Assessment Profile and Goals

Malinda::

I see you are ready to have a conversation about some serious things.

Janet::

Yes, I want to be part of the goal-setting process. The staff should know what I think.

Malinda::

That’s great. We want to know what you have in mind. Let’s start with the news reports about the epidemic. Did you follow them?

Janet::

Yeah, our gym teacher put us on to it. I then watched the news on TV. I was watching the reporter and thought she was wonderful. Maybe I will try to be a journalist now that I am an award-winning writer.

Malinda::

You could begin by journaling about your stay here.

Janet::

What is journaling?

Malinda::

It’s when you write about what we do here and what you think about it.

Janet::

Do I get to expose it like the reporter on TV?

Malinda::

It’s not the same, but if you decide to you could come to one of our staff meetings.

Janet::

That sounds scary.

Malinda::

Why don’t you decide what you want to share and with whom.

Janet::

Maybe I’ll test you out first.

Malinda::

That sounds good. What else do you want to share about the opioid crisis and your family?

Janet::

When Mom got addicted, we barely had enough money for food. The family in Logan started to ignore us. The only family I care about is Aunt Cassie. But I don’t know what she thinks about me.

Malinda::

Would you want to invite her to a family meeting with us?

Janet::

Let’s think about it.

Malinda told Janet about the foster home’s policy of inviting the residents to write their own progress notes and goals. As seen in the conversation in Box 10.7, Janet was encouraged to read and comment on her person–environment assessment profile (see Table 10.1).

Table 10.1 Person–environment (P-E) assessment chart: the Taylor family
Full size table

Box 10.7: Practice Example: Janet Reflects on Death

Malinda::

Do you want to comment on your assessment chart? It is only a draft until you add what you want.

Janet::

I don’t think people realize how frightening it is to watch your mother just get worse and worse. I didn’t know what to do.

Malinda::

I feel like it would be almost impossible to know what to say or do.

Janet::

Right. You are just afraid. And then my family just walked away. Maybe Great-Grandpa Taylor who fought in the battle would have been brave.

Malinda::

Do you think he was a family hero?

Janet::

He must be if Aunt Cassie kept the newspaper all these years.

Malinda::

You may be making sense of an old family story.

10.5 Intervention

10.5.1 Situational Meaning-Making

Situational meaning is the meaning given to a particular stressful environmental event. A narrative approach to grief work creates an opportunity for clients to revisit and rewrite their stories by describing an occurrence and its foreseeable outcome. The conversations between social workers and clients help clients recognize that a problem can have environmental influences and sociocultural and historical meaning. For example, as the interviews progressed, Janet gained a new context in which to frame the meaning of her mother’s death. She increasingly saw her mother’s death as an outcome of bad influences she could not have prevented. Janet’s appraisal of her mother’s death involved overcoming seeing the event as controllable and beginning to envision ideas for her future. This personal growth meant that she was learning how to see the problem outside herself and was becoming someone who could carry the weight and move forward from her distress (Gillies & Neimeyer, 2006).

10.5.2 Reconstructing a Narrative

As Janet saw new meaning in the forces that accounted for her mother’s death, she was able to reconstruct her story of grief. This turning point—the restoration of meaning—eventually led to a reconstructed narrative and a positive evaluation of future events.

10.6 Evaluation

Janet appeared to use her time with Malinda to get to know better and reexamine her attitudes about her intergenerational family. As meaning was transformed, Janet decided she would consider a meeting with Aunt Cassie to reflect on her living situation.

10.7 Summary and Conclusion

As Janet reflected on her personal feelings within a family collective sociocultural, societal context, she was able to gradually construct her story of loss. Her story illustrates that when a social worker and a client coconstruct a micro- and macrolevel narrative, this process contributes to the client’s recovery in bereavement.

Summary of Learning Outcomes

Keep in mind the following:

  • Social workers can help clients mourn through mutual reflection on their narratives.

  • Social workers help clients resolve grief as they reconstruct narratives and social connections.

Discussion Questions

  1. 1.

    What were the benefits of Malinda and Janet exploring Janet’s family history?

  2. 2.

    How would you define collective grief?

Chapter Exercise

Write a letter to a significant person in your life to whom you did not get to say goodbye.