Grief Is an Emotion That All Human

Grief is an emotion that all human beings are likely to feel at some time in their lives. For many the grief process can be lonely, confusing and prolonged. For this reason, psychologists have long sought ways to ease this process. Early on researchers found that various forms of art proved effective in aiding individuals in the grief process. This realm of treatment became known as "Expressive art therapies" and allows patients to express feelings through various methods related to the arts. These methods include music therapy, art therapy and writing therapy. Expressive therapies have been essential in helping people cope with loss, particularly in the case of an unexpected death.

Historical Background

There has long been a connection between bereavement and the power of art to heal. In most cases people focused on music in particular, the use of music to calm the bereaved is even present in the Bible. More recently, researchers have sought to understand more about this phenomenon. Preliminary research into this topic suggests that people benefit greatly form bereavement counseling that incorporates expressive art therapy. This expressive art may come in the form of letter writing, music or photography. The research indicates that such therapy allows people to examine the relationship that they had with the lost loved one and bring closure to that relationship. In addition, expressive arts allows people to express their feeling without being judged. In addition expressive arts is effective because it allows people to express through are what they may not be able to communicate verbally. The preliminary research suggests that expressive art therapy is here to stay and that counselors desire to improve the approach to expressive writing.

Thesis/Research Questions

For the purposes of this discussion, the researcher will focus on the expressive writing realm of the expressive arts therapies. The researchers will demonstrate how expressive writing affects the grief process by allowing patients to express exactly how they feel through such things as poetry and journal writing. Empirical research will be provided that details the research that has been conducted concerning this topic. The researcher will demonstrate that thought processes involved in such activities gives the patient the opportunity to understand and accept their loss. The research questions will include the following;

Does grief effect everyone in the same manner?

How does expressive writing aid people in the grieving process?

What are the common forms of expressive writing?

How do counselors measure the success of expressive writing therapies?

This particular topic is of interests because grief can be debilitating and impede upon an individual's ability to properly care for themselves or their families. Grief is also a universal emotion that can impact anyone. In addition, in the light of the recent natural disaster in which thousands of people died unexpectedly, researchers must find innovative and universal ways of helping people deal with grief.

Review of Literature

Grief

Grief can occur for different reasons but the most pronounced grief is usually caused by the loss of a loved one. This grief is particularly difficult if the loss was unexpected. Larson and Nolen-Hoeksema (1999) assert that people cope with grief differently and for different lengths of time. The authors explain, "there are wide differences in the specific strategies people use to cope with the emotional and practical consequences of a loss. These differences may be tied to the type of loss people have experienced, their age or gender, and their basic personality characteristics (Larson and Nolen-Hoeksema 1999; pg 62)." Arnason (2001) explains that grief is thought of as some sort of path with a beginning and an end. The metaphors of 'journey' and 'process' structure grief and emphasize its ordinariness (Arnason 2001)." For some this process can be prolonged and prevent them from participating in everyday activities. Thompson (2003) asserts

"Daily habits are disrupted, activities associated with valued roles are lost, and life plans are de-railed in the wake of significant loss. Intimately linked to these tangible experiences is the realm of the imagination, from which symbols and meaning emerge. Significant loss undoes the ways we have imagined ourselves in the world, uprooting us from the ground of meaning that has supported our sense of interconnected whole-ness (Thompson, 2003).

In his book The Heart of Grief: Death and the Search for Lasting Love Attig (2000) asserts that the very things that are painful to remember during the bereavement period are actually the things that will provide the most comfort once the grief is confronted (Attig, 2000). The author explains that "When we come to terms with our feelings of hurt, we tame them somewhat; we loosen their grip on us and gain some control over them. Rarely do we make them go away entirely or render ourselves immune to them. As we learn to carry these feelings, we realize there is room in our hearts for more than the pain and anguish of separation. We find that we can open our hearts to other experiences (Attig, 2000)."

Indeed grief can be a destructive force in ones life and lead to other problems such as depression and anxiety. There are several reasons why the death of a loved one can cause an adverse reaction in people. For the purposes of this discussion, we will focus on two of these reasons; attachment theory and sudden or unexpected death. Over the next few paragraphs these topics will be explored in further detail.

Attachment Theory

Fast (2003; pg 484) Grief is a difficult emotion to deal with because of the bonds that are formed. This bond is defined as the attachment theory and is most common in the parent/child relationship. According to fast (2003) much of the current knowledge pertaining to grief is derivative of research formulated by Bowlby (1977), a British psychiatrist. Through his research on animal and human behavior, he discovered the "attachment theory" in describing the connection between human beings and the emotional problems that occur when this connection is broken. Fast (2003) explains that such connections occur because of the need for security which are developed in childhood and usually involve close family members or guardians.

Hazan and Shaver (1994) argue that every healthy human infant becomes attached to their main caregiver, during the first 8 months of life. The researcher insists that secondary attachments to other people are also formed simultaneously (Hazan and Shaver 1994). However, researchers have come to no consensus about when secondary attachments form (Hazan and Shaver 1994). Nevertheless, they do concede that both children and infant have multiple attachments (Hazan and Shaver 1994). The bonds that are usually considered attachments include immediacy maintenance and safe-haven and secure-base behaviors and are usually developed with other adults and older siblings (Hazan and Shaver 1994). Fast (2003) explains that 'In normal maturation, the child becomes ever more independent, moving away from the figure of attachment, and returning periodically for safety and security. If the bonds are threatened, the individual will try to restore them through crying, clinging, or other types of coercion; if they are destroyed, withdrawal, apathy, and despair will follow (Fast 2003; pg 484)."

Fast (2003) asserts that when someone looses a person who is a "figure of attachment" the grief that occurs is often compared to a disease (Fast 2003). The author explains that just as a burn is painful for the body, the loss of the figure of attachment is painful for the psyche (Fast 2003). The author also explains that grief requires the same type of healing as a physical wound (Fast 2003).

The attachment theory suggests that the grief that is observed in bereaved individuals is indicative of a bond that is formed in early childhood. The research asserts that this bond is so great that the loss of the loved one changes the bereaves entire outlook on life. In addition, the loss of the figure of attachment may cause the bereaved to feel insecure and unsafe.

Sudden or Unexpected death

As most people assume sudden or unexpected death can prolong the grief process. According to Fast (2003) both sudden and unexpected deaths have unique characteristics that are difficult for patients and practitioners to confront. The author explains that this type of death places unique demands on the survivors. The author also posits that sudden death is different from a death caused by prolonged illness in relation to the intensity of the grief. Fast (2003) points to a groundbreaking study performed by Lindemann (1944). The research involved the families of 101 college students who were killed and a nightclub. The research found that 'The majority of those counseled exhibited some type of somatic or bodily distress, preoccupation with the image of the deceased, guilt relating to the deceased, hostile reactions, and the inability to regain their preloss level of functioning. Lindemann found that the survivors of sudden death were more likely to experience what he characterized as abnormal or pathological grief ... And that the grief would endure longer and be more difficult to resolve (Fast (2003; pg 484)."

For many years researchers believed that, expected deaths gave people the opportunity to prepare for grief (Fast 2003). However, more recent research suggest that sudden death overwhelms people so much that they are not capable of even beginning the mourning process, which means the grieving process is postponed (Fast 2003). Additionally, research has found that grief caused by sudden death is more likely to cause the bereaved to feel helpless, guilty and to blame someone for the death (Fast 2003). Fast (2003) also explains that in cases where the decease has been murdered there are also legal issues that the bereaved must attend to that may further postpone grief. In his research, Worden (1991) found four tasks involved in the resolution of grief,

"(1) accept the reality of the loss; (2) Work through to the pain of grief; (3) Adjust to an environment in which the deceased is missing; (4) emotionally relocate the deceased and more on with life. The first step refers to overcoming the denial that often accompanies loss, an effect even more pronounced in sudden death. The second step involves experiencing and processing the sadness that comes with the loss of a loved one. The third group of tasks involves accepting and learning the different roles, skills, and ideas necessary to live without the deceased. The fourth step refers to the need to find a realistic way of thinking, emotionally and cognitively, about the deceased, so that the mourner can go on with his or her life and form new relationships (Worden, 1991; Fast 2003)."

This research demonstrates that practitioners and grievers are faced with a unique situation when addressing grief caused by the sudden death of a loved one. The research suggests that this type of grief is more intense and prolonged than the grief that occurs with an expected death. The research also insists that people confronting this type of grief often delay the grieving process to deal with legal matters.

With these things being understood, it may be necessary for bereaved individuals to receive some kind of counseling. Such counseling may include expressive therapies, which will allow the individual to express their feeling in an unconventional manner. For the purposes of this discussion we will focus on expressive writing as a form of expressive art therapy.

Expressive Writing

According to Sommer and Williams (1994), "Expressive therapy refers to the group of modalities based on visual, literary, and performing arts that includes art, dance / movement, music, poetry, and drama therapy/psychodrama (Sommer and Williams 1994)." The authors assert that Expressive therapist clinicians exist at the master's and doctoral levels and are specifically trained and registered in these modalities. Bowman (2003) asserts that the expressive arts have become essential to treating grief.

The form of expressive therapy that is often used is expressive writing. Cook and Dworkin (1992) assert that writing during the grieving process has been proven therapeutic. The authors insist that writing has the ability to decrease "the intensity of feelings through "giving grief words" and helping the person gain a different perspective on a disturbing event ( McKinney, 1976; Cook and Dworkin 1992)." Other researchers seem to agree with this assessment. In his book Opening Up" The Healing Power of Confiding in Others, James W. Pennebaker 1990), asserts that writing can assists in sorting through the emotions that are present during the grieving process. The author explains that talking is actually one of the best therapies for grief (Pennebaker 1990). However, he reports that writing can serve some of the same purposes and ease the grieving process (Pennebaker 1990). Pennebaker contends that writing and other expressive therapies are able to bring the individual closure by providing organization of thought (Pennebaker 1990).

Likewise, Lepore and Smyth (2002) assert that writing is an activity that facilitates healing. The authors assert that writing expressively about the problems that one faces produces advantageous outcomes (Lepore and Smyth 2002). In their book the authors explore expressive writing as it relates to many different scenarios in life including, relationships, illness and grief (Lepore and Smyth 2002). The authors insist that expressive writing can greatly ease the pain of grief and is beneficial to the various systems of the body including the immune system (Lepore and Smyth 2002).

Cook and Dworkin (1992) argue that expressive writing is particularly useful for adolescents dealing with grief. According to the authors, "Adolescence is a period in which writing skills are developing as advanced cognitive skills are acquired, and many teenagers keep journals, try writing poetry or songs for the first time, or correspond with a friend or relative. They are experimenting with putting thoughts and feelings in written form, making it a natural avenue to explore one's feelings of loss (Cook and Dworkin, 1992)."

These researchers insist that expressive writing is a key component in facilitating the healing of bereaved persons. The authors insist that writing presents the bereaved with the opportunity to organize and document their feelings. In turn, they are able to perform self-examination and analyze the relationship that was lost.

Letter Writing

Cook and Dworkin (1992) suggest that expressive writing can be administered in different ways. The authors explain that writing a letter to the deceased is the most common approach that practitioners use (Cook and Dworkin, 1992). This technique allows the person who is grieved to focus on unexpressed feelings (Cook and Dworkin, 1992). Muller and Thompson (2003) also report that this method proved effective with subjects that were partaking in bereavement counseling. Montgomery et al. (2001) assert that there are

"many uses for the technique of letter writing in conjunction with traditional counseling interventions. For example, issues of grief, mourning, and forgiveness have been addressed via letter writing in which clients use this exercise to express feelings of grief, perform leave-taking rituals, communicate with a lost person or object, or develop empathy with a transgressor (Montgomery et al. 2001; pg 295)."

In addition, this technique allows the person to say goodbye, this is especially important if the person died unexpectedly (Cook and Dworkin, 1992). The authors insist that this form of expressive writing can also allows the grieving individual to make peace with the deceased person if their relationship was in conflict before the death (Cook and Dworkin, 1992).

Letter writing is essential because it brings about closure. One of the serious problems with treating grief, especially when the death was sudden, is that the bereaved did not have the opportunity to say goodbye. Letter writing gives the bereaved the opportunity to say good-bye and clarify any conflict that may have been present in the relationship.

Journaling

In addition to writing a letter to the deceased, counselors may encourage the bereaved to keep a diary or journal. Ballou (1995) reports that journal writing encourages clients to record their personal thoughts, these thoughts can be current feelings, plans for the future or past experiences (Ballou, 1995). The author explains that these entries become a tool through which understanding, healing and self-discovery take place. Ballou, (1995) asserts that over a period, the journal can be reviewed, analyzed, reflected upon, or simply acknowledged as an accurate reflection of self (Ballou, 1995).

Drake et al. (1996) assert that journaling can be a challenge for clients because it forces them to live in the present. The authors explain that journaling encourages the bereaved or depressed "to get out of automatic pilot -- off cruise control" that masters their thoughts and behavior. They believe the journaling allows the patient to embrace the truth and choose to participate again in daily life. The authors contend that "Without awareness, clients are dragged around by past beliefs, desires, expectations, and history to which they cling, unconscious of what is happening (Merzel, 1991). Awakening to the choice to be fully present is the client's first step to freedom from the bondage of the past and freedom to reclaim personal power (Drake et al., 1996)."

Cook and Dworkin, (1992) point out that journal writing can allow for the expression of feelings without the threat of judgment. The author also insists that the nature of writing is therapeutic. The author explain

"The translation of experience into language helps the person assimilate and integrate it, since the process of writing is slower than talking and gives more opportunity to get at the core of feelings. It also provides documentation of a mood or feeling state. When adolescents are encouraged to keep a journal during the course of therapy, they are often impressed with their growth when they go back and read entries made several months earlier. This reinforces their sense of progress and validates the difficult journey they have taken in their recovery from bereavement (Cook and Dworkin, 1992)."

Journaling is a form of writing that dates back to ancient times. In recent years, counselors have recognized the benefits of journaling in various areas of mental health. Journaling is significant in treating grief because it allows the bereaved to track their progress. It also allows them to reflect on the event that caused the grief.

Poetry

In addition, some therapists utilize literary resources as a means of treating grieving patients. According to an article entitled Using Literary Resources in Bereavement Work; Evoking Words for Grief, the author asserts that both reading poetry and writing poetry can be essential to easing the grieving process. Bowman (2003) asserts that incorporating literary works into expressive writing can expand the clients' vocabulary when writing about the grief they feel. Bowman (2003) argues "Greater use of literary resources can therefore aid grieving people in giving voice to their own stories of loss. Skilled writers have an ability to find words and phrases that capture the human condition and spirit (Bowman 2003)."

Indeed some case studies demonstrate the impact of expressive writing upon bereavement. In one such study Isis (2002) demonstrated that power of poetry in treating bereaved patients in her dissertation "A qualitative study demonstrating the impact of the expressive therapies on the grief process for three women through case studies," Isis (2002) explains how expressive arts helped participants in the study. Two of the participants "ellen" and "Laura" used poetry as a way of dealing with their grief. Isis (2003) reports that 'Ellen" began to write poetry for the very first time, had music written to accompany it and performs the songs with the band she created called Legacy in memory of her husband. "Laura" ended up sitting at the piano the night she received the horrendous news of her daughter's murder and she still plays the songs for many audiences, receiving support from strangers and friends alike. In each case, these individuals had not engaged in this form of art expression before and had not ever believed that they had talent or competence with their chosen medium. Rather, without forethought, specific intention, or external guidance, these women found themselves immersed in, and literally compelled to take part in art-making following the death of a loved one (Isis 2003).

The dissertation concluded that there were four categories that emerged with each of the subject. These categories included storytelling, connectedness, repetition, and containment. The researcher concluded that these bereaved women turned to art to cope with the grief that they experienced after losing loved ones. Isis (2002) asserts that personal imagery gave subjects an increased insight into self. The author writes that 'Symbolic imagery, whether in a poem, song, or image, provides a container for unspeakable pain in response to grief. In addition, the repetitive act of creation and storytelling in response to the imagery -- sharing one's story of loss through enhanced connectedness -- is critical to healing. Thus, my conclusion was that art making in response to grief strongly contributed to and facilitated the reconciliation with loss for these women (Isis 2003)."

Barnes (2001) reports that poetry is often used in grief therapy because it opens the person up and allows them to explore another dimension (Barnes 2001). The author explains the experiences of a certified poetry therapist named Judy Slack, who works at the Center for Creativity in Silver Spring, Maryland (Barnes 2001). Slack confirms the conclusions made by Isis (2002) saying, "It taps into the inner self. A line in a poem can trigger our inner reality. And it's most effective when a poem gives words to the inner experience that a person didn't have the words for - but the poem gives words to," ... "Something clicks. The connection happens; the outer reality confirms the inner reality (Barnes 2001). " Barnes (2001) goes on to explain that even if the client is not artistic, if they are given the opportunity to write expressively they find comfort in the activity. Barnes also asserts that poetry therapy can be used in congruence with more traditional forms of therapy.

Indeed poetry appears to be effective in treating grief because it allows the bereaved to express their thought in a fashion that is artistic. In the aforementioned cases, the women that were studied had never used this form of expression before. The grief that they experienced was so profound that it could only be expressed through a vehicle with which they were not familiar. The researcher concluded that this art form was somewhat comforting to the women.

Preliminary Outline

I. Introduction

Thought Processes involved in expressive writing gives patients the opportunity to understand and accept their loss. Research questions include

Does grief affect everyone in the same manner?

How does expressive writing aid people in the grieving process?

What are the common forms of expressive writing?

How do counselors measure the success of expressive writing therapies?