Expressive Writing Therapy for Grief and Bereavement

Introduction

Grief is an emotion that all human beings are likely to feel at some point 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 researchers found that various forms of art proved effective in aiding individuals through grief, and this realm of treatment became known as expressive art therapy. It allows patients to express feelings through various art-related methods, including music therapy, art therapy, and writing therapy. Expressive therapies have been essential in helping people cope with loss, particularly in cases of unexpected death.

Preliminary research into this topic suggests that people benefit greatly from bereavement counseling that incorporates expressive art therapy. This expressive art may come in the form of letter writing, music, or photography. Research indicates that such therapy allows people to examine the relationship they had with the lost loved one and bring closure to that relationship. In addition, expressive arts allows people to express their feelings without being judged, and to communicate through art what they may not be able to express verbally.

For the purposes of this discussion, the focus is on expressive writing within the broader expressive arts therapies. The central argument is that the thought processes involved in expressive writing give patients the opportunity to understand and accept their loss. The research questions addressed are as follows:

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

Grief and Its Psychological Dimensions

Grief can occur for different reasons, but the most pronounced grief is usually caused by the loss of a loved one, and is particularly difficult when 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, p. 62).

Arnason (2001) explains that grief is thought of as a kind of path with a beginning and an end: "The metaphors of 'journey' and 'process' structure grief and emphasize its ordinariness." For some, this process can be prolonged and prevent them from participating in everyday activities. Thompson (2003) describes this disruption vividly:

"Daily habits are disrupted, activities associated with valued roles are lost, and life plans are derailed 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 wholeness" (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 most painful to remember during bereavement are actually those that will provide the most comfort once the grief is confronted. He explains: "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).

Grief can be a destructive force in a person's life and lead to other problems such as depression and anxiety. For the purposes of this discussion, two key factors that intensify grief are explored: attachment theory and sudden or unexpected death.

Attachment Theory and Sudden Loss

Grief is a difficult emotion to manage because of the deep bonds that are formed between people. This bond is defined through attachment theory and is most commonly studied in the parent-child relationship. Much of the current knowledge pertaining to grief is derivative of research formulated by Bowlby (1977), a British psychiatrist who, through his research on animal and human behavior, discovered the attachment theory to describe the connection between human beings and the emotional problems that occur when this connection is broken. Fast (2003) explains that such connections arise because of the need for security, which is developed in childhood and usually involves close family members or guardians.

Hazan and Shaver (1994) argue that every healthy human infant becomes attached to their main caregiver during the first eight months of life, and that secondary attachments to other people are also formed simultaneously. They acknowledge that researchers have reached no consensus about when secondary attachments form, but concede that both children and infants have multiple attachments. The bonds usually considered attachments include proximity maintenance, safe-haven, and secure-base behaviors, and are typically developed with other adults and older siblings (Hazan and Shaver, 1994).

Fast (2003) elaborates: "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, p. 484).

When someone loses a person who is a "figure of attachment," the grief that follows is often compared to a disease. Just as a burn is painful for the body, the loss of a figure of attachment is painful for the psyche, and grief requires the same type of healing as a physical wound (Fast, 2003). The attachment theory suggests that the grief observed in bereaved individuals is indicative of a bond formed in early childhood so powerful that its rupture through death changes the bereaved person's entire outlook on life and may cause them to feel deeply insecure and unsafe.

Sudden or unexpected death can further 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, placing unique demands on survivors and creating a more intense form of grief than that associated with an anticipated death. Fast (2003) points to a groundbreaking study by Lindemann (1944) involving the families of 101 college students killed in a nightclub fire. 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 pre-loss 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, p. 484).

For many years, researchers believed that expected deaths gave people the opportunity to prepare for grief. However, more recent research suggests that sudden death overwhelms people so completely that they are not capable of even beginning the mourning process, effectively postponing it. Research has also found that grief caused by sudden death is more likely to cause the bereaved to feel helpless and guilty, and to assign blame for the death. In cases where the deceased was murdered, there are also legal issues the bereaved must attend to that may further postpone grief (Fast, 2003).

In his research, Worden (1991) identified four tasks involved in the resolution of grief: "(1) accept the reality of the loss; (2) work through the pain of grief; (3) adjust to an environment in which the deceased is missing; (4) emotionally relocate the deceased and move 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 loss. The third involves accepting and learning the different roles, skills, and ideas necessary to live without the deceased. The fourth refers to the need to find a realistic way of thinking, both emotionally and cognitively, about the deceased so that the mourner can go on with life and form new relationships (Worden, 1991, as cited in Fast, 2003).

Given the intensity and complexity of grief—particularly grief caused by sudden death—bereaved individuals may require counseling that allows them to express their feelings in unconventional ways. Expressive writing is one such approach.

Conclusion

The researcher demonstrated that the thought processes involved in expressive writing give the patient the opportunity to understand and accept their loss. The empirical research discussed grief as it relates to attachment theory and the sudden loss of a loved one. The research suggests that attachment theory describes the bond formed in early childhood that causes severe trauma when broken through death, and that the loss of a loved one is intensified when the death is sudden.

The research indicates that grief can be debilitating and that, in some cases, counseling is required. The form of counseling examined here is expressive writing, which comes in various forms including letter writing, journaling, and poetry. Letter writing is the most common form and allows patients to bring closure to their relationship with the deceased. Journaling is another common form that allows the writer to express feelings without being judged. Poetry, meanwhile, allows some bereaved persons to cope by writing and performing their own creative works.

Overall, the research supports the conclusion that expressive writing is effective in healing grief. As researchers and practitioners continue to refine these approaches, expressive writing remains a promising and accessible therapeutic tool for counselors working with bereaved individuals across a wide range of circumstances.

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