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CONSTRUCTIONS OF DEATH AND LOSS:
EVOLUTION OF A RESEARCH PROGRAM
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Robert A. Neimeyer
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Department of Psychology, University of
Memphis, USA |
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Abstract
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As historians of science have noted,
scientific careers are characterized by "networks of enterprise",
multiple,
sustained, and mutually reinforcing programs of research that yield not
only
answers but also further questions across a period of many years. This article traces one such long and
multifaceted network of projects, one concerned with death attitudes,
suicide
intervention, and grief and loss, which has benefited from periodic
infusions
of constructivist concepts and methods since its inception.
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Key words: Death
attitudes, suicide, grief and
bereavement, constructivism |
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Writing about the psychology of scientific
creativity, Howard Gruber (1989) introduced the concept "networks of
enterprise" to explain how scientists organize a program of purposeful
work across a period of many years, and frequently a lifetime. As he
elaborated:
"I use
the term "enterprise" to
cover groups of activities extended in time and embracing other
activities such
as projects, problems, and tasks. Commitment to an enterprise is
exhibited by
the recurrent reappearance of activities belonging to it. The key point
is that
the creative completion of a project leads not only to satisfaction and
relaxation but also to the replenishment of the stock of projects and
problems within
the enterprise in question, and to reinvigoration for further work"
(Gruber, 1989, p. 246).
While making no pretense that the
creativity of my own work over the last few decades bears comparison to
that of
Darwin or Piaget, the subjects of Gruber’s analysis, I nonetheless can
resonate
to his depiction of "the protracted
hard and unremitting work" (p.
247) that yields conceptual and methodological innovations. Likewise,
his
depiction of the branching and grafting of such networks over time
strikes a
responsive chord for me, as "the
periods of dormancy which each enterprise
in such a network must necessarily undergo allows… room and time for
creative
forgetting, mutual assimilation of distinct schemata, and serendipitous
encounters with the real world" (p. 262), all of which carry the
work
forward in partly predictable, partly unpredictable directions.
Finally, the
sheer "duration, difficulty, and
complexity of the work combine to promote
development of all sorts of relationships of collaboration and
communication among
workers in the same vineyards" (p.262), reflecting the
importance of the
social psychology, as well as the cognitive psychology of science
(Neimeyer et
al., 1989). My goal in the present
article is to reflect on one
of my own central networks of enterprise across the years, specifically
on that
concerning the place of death in human life. Although this selective
rendering
of my long-term interests neglects some of the other major branches of
my
investments over time (especially those concerned with constructivist
theory
and pychotherapy [1], it is sufficient to convey several of the
features of
such networks as described by Gruber, including their longevity, cross
fertilization,
social organization, and the way in which their evolution reflects the
personal
evolution of the scientist. The reflexivity inherent in this sort of
retrospection on a career in the course of pursuing it seems
appropriate to an
orientation like personal construct theory, which blurs the dividing
line
between the personal and professional, while recognizing that the
self-narrative so constructed cannot claim to be a wholly veridical
account of
life events (Neimeyer, 1995).
At a substantive level, I also hope that
this review will help summarize a widely dispersed literature for those
readers
sharing my interest in thanatology, the study of death and dying, and
acquaint
other personal construct theorists around the globe with a thriving
research
program that takes some of its inspiration from the theory we share. As
this
network of enterprise has unfolded over the last 30 years, it has
naturally
developed three distinguishable emphases, on (a) death threat and
anxiety, (b)
suicide intervention, and (c) grief and loss. I will therefore review
each of
these areas in turn.
DEATH THREAT
AND ANXIETY
The historical core of my interest in
personal constructs and thanatology originated in research being
conducted at
the University of Florida in the early 1970’s by Franz Epting, Seth Krieger, and
Larry
Leitner. Prompted in part by the upsurge of popular and professional
interest
in issues of death and dying (Kübler-Ross,
1969),
the Florida group brought to bear the conceptual and methodological
resources
of personal construct theory on the problem of assessing people’s
attitudes
toward their own eventual mortality, a nascent area of research
cluttered with
psychometrically shabby instrumentation and poorly designed studies.
The result
of this effort to upgrade the death attitude literature was the Threat
Index
(or TI) (Krieger, Epting, &
Leitner, 1974),
a repertory grid-based measure that operationalized
Kelly’s (1955)
concept of threat as the "awareness of imminent,
comprehensive change in one’s core role structure." Specifically, the
TI
required eliciting a significant sample of death-relevant constructs
(e.g.,
painful vs. painless, familiar vs. unfamiliar, meaningful vs.
meaningless) from
the respondent through a triadic comparison of situations involving
death
(e.g., a tornado kills three children in an elementary school, your
grandmother
dies in her sleep). The respondent was then asked to rate the elements
self,
preferred self, and (personal) death on these constructs, and the
number of
"splits" in which both self-elements were aligned with one construct
pole, and death with its contrast, served as the index of the
subjective threat
that would be required to construe the death of self as a personal
reality. As
an undergraduate research assistant, I joined the research effort at
the point
that TI was being developed into a standardized measure to circumvent
the
rather cumbersome administration of full repertory grids to
individuals, which
limited the measure’s use in research. Thus, my first task was to
assist in the
administration of grid-based interviews, in order to elicit thousands
of
death-relevant constructs and then winnow these to the 30 or 40 most
commonly
occurring dimensions to comprise the items for the standardized
paper-and-pencil form of the instrument. The work was initially
fascinating,
offering me a glimpse of people’s views of life and death within the
mutually
reassuring format of a structured interview. I fell in love with the
work and
the theory behind it, and soon devised several studies of my own that
helped
establish the psychometric soundness of the resulting measure (Neimeyer, 1986; Neimeyer, Dingemans,
& Epting, 1977; Rigdon, Epting, Neimeyer, & Krieger, 1979).
As this research proceeded over the decade of the
80’s, the TI consolidated its place as the most valid and reliable
instrument
in the broad but checkered death anxiety literature (Neimeyer,
1994a; Neimeyer, 1994b).
But despite the initial thrill of the
research, the fairly compulsive methodological focus of the early work
also generated
a certain amount of restiveness on the part of the younger members of
the Florida research
team. I recall strolling along a lake on the University of Florida campus
in 1975 with Peter Dingemans, my principal co-investigator and graduate
exchange student from the Netherlands, lamenting and laughing about the possible irony of
spending our
careers on picayune issues like the internal consistency of the TI,
when our
imaginations led us to far broader horizons. This intermittent
dissatisfaction
with a psychometric preoccupation yielded a handful of substantively
interesting articles on such topics as the death threat experienced by
suicide
intervention workers (Neimeyer
& Dingemans, 1980; Neimeyer & Neimeyer, 1984)
and on the link between death anxiety and the
completion of one’s existential projects (Neimeyer,
1985a; Neimeyer & Chapman, 1980),
but for the most part, research with the TI and its
derivatives remained rigorously methodological until about 1990. It was
chiefly
this psychometric research that was summarized in my earlier review of
the TI
literature (Neimeyer, 1994b).
This focus continued briefly into the 90’s,
producing a massive study of the TI with my student, Marlin Moore, that
yielded
a confirmatory factor analysis of the measure (Moore
& Neimeyer, 1991),
still to the best of my knowledge the only one of
its kind done on a death attitudes instrument.
Eventually, however, the psychometric
properties of the TI were established even to our scientific
satisfaction,
allowing my students and me, now at the University of Memphis, to
begin applying it—and a few other soundly developed death anxiety
scales (Neimeyer & Gillies, 2001; Neimeyer
& Moore, 1994)—to
a host of substantive areas. Our first target was
the frequently noted finding that women report greater fear of personal
death
than men, across dozens and perhaps hundreds of studies in the vast
death
anxiety literature (Neimeyer &
Fortner, 1997; Neimeyer & Van Brunt, 1995).
Although this finding was typically explained in
terms of the greater emotional expressiveness of women, our findings
led us to
call this interpretation into question, as this result held in a large
sample
of men and women even when we controlled for their level of
self-disclosure (Dattel & Neimeyer, 1990).
We also began to examine the personal anxieties
about death experienced by vulnerable groups, such as a large group of
gay and
bisexual men living in the shadow of the AIDS epidemic (Bivens,
Neimeyer, Kirchberg, & Moore, 1994).
Here again, our findings were surprising and
informative: HIV positive men (half of whom had developed AIDS
symptomatology)
and the caregivers who worked with them were actually far less
threatened and
anxious about the prospect of death than were G/B men who were HIV
negative and
uninvolved in caregiving. Further scrutiny of our data suggested a
possible
explanation for this pattern of results, as the former two groups
reported
significantly more intrinsic religious faith than their less directly
affected
peers. This study, and my ongoing treatment of gay men in therapy, led
to a
broader review of the role of death awareness and anxiety in the
psychosocial
adjustment of persons with AIDS, and how it might be worked with in the
context
of counseling (Neimeyer &
Stewart, 1998; Neimeyer, Stewart & Anderson, 2004).
A second vulnerable population to
attract
our attention in the early 90’s was older adults, whose age and health
status
placed them at elevated risk of death. Together with my student, Barry
Fortner,
I first undertook a qualitative review of research on death anxiety in
the
elderly, trying to make sense of the often contradictory studies
pointing to
various markers of elevated fear of death (e.g., gender, health status)
in an
aging population (Neimeyer &
Fortner, 1995).
This effort convinced us of the need for a more
systematic approach to integrating the literature, leading us to
undertake a
major quantitative review of all published and unpublished studies of
death
attitudes in older adults. The results were clarifying: across nearly
50
studies including over 4,500 participants, older adults’ fears of
personal
death were found to be unrelated to gender and religiosity, departing
from the
modal finding in the death anxiety literature on younger populations.
Instead,
the most powerful predictors turned out to be their level of "ego
integrity" or life satisfaction—the feeling that they had lived long
and
well—in combination with their level of institutionalization and
physical
health problems (Fortner &
Neimeyer, 1999).
Reflecting on these findings, we placed them into
the context of life-span developmental theory, and considered those
dehumanizing aspects of institutional care and medical difficulties
that could
exacerbate fears of death at the end of life (Fortner,
Neimeyer, & Rybarczeck, 2000; Neimeyer & Fortner, 2000).
A recent elaboration of this same
research
program stemmed from its fusion with the studies of attitudes toward
aging
spearheaded by my ex-student, student Steve DePaola, reviewed below.
Specifically, we investigated the relationship between death anxiety,
attitudes
toward older adults, and personal fears of aging in a group of nearly
200 older
men and women (DePaola, Neimeyer, Griffin & Young, 2003). As
predicted, we
found that respondents with greater personal anxieties about their own
aging
and death—and especially the unknown implied by the latter—displayed
more
social derogation of elders, a group to which the respondents
themselves
belonged. Other intriguing findings pointed to ethnic differences in
the
character of death attitudes, with American whites reporting greater
fears of a
protracted and painful dying process, whereas American blacks were more
fearful
about what transpired after death itself, including fears of being
buried
alive, of bodily deterioration, and the fate of their souls in an
afterlife.
A complementary prong of this research
effort in connection with older adults entailed examining not the
elders
themselves, but the health care professionals who work with them most
frequently, at least in the United States. Thus, Depaola and I began to study the psychosocial
context of
nursing homes, where dismissive, avoidant, or infantilizing attitudes
on the
part of staff toward residents is an all-too-common occurrence.
Comparing a
large group of nursing home staff to demographically similar controls
from the Memphis community,
we discovered that staff as a group had comparable levels of death
threat to
controls, and the comparison group actually was more fearful of contact
with
dead bodies, perhaps as a function of their lesser exposure. However,
we
additionally discovered that increasing levels of death concern were
associated
with greater personal anxiety about aging, especially among nursing
home
workers, who also displayed significantly more negative attitudes
toward the
elderly (DePaola, Neimeyer, Lupfer,
& Fiedler, 1992).
Subsequent research extended these findings by
providing evidence that nursing assistants, the least trained
caregivers in
elder care facilities, had higher levels of personal death anxiety than
registered nurses and licensed practical nurses in these same
facilities (DePaola, Neimeyer, & Ross, 1994).
This enhanced my concern over the possible linkage
between personal death attitudes and suboptimal caregiving practices,
especially among less trained and less experienced helpers—a concern
that found
expression in the studies of counselors and suicide interventionists
reviewed
below.
A final line of work on death attitudes
concerned the reactions of counselors to situations involving death and
loss,
testing the assumption—widely held in thanatology circles—that such
situations
trigger more discomfort and avoidance on the part of caregivers than
other
potentially serious problems. Providing masters level counselors a set
of 15
written descriptions of both death-related counseling scenarios (e.g.,
grief,
life-threatening illness, suicide risk) and non-death-related
situations (e.g.,
rape, spouse abuse), Tom Kirchberg and I found that five of the eight
problems
they rated as most uncomfortable were in the former category. In
contrast, none
of the 7 least distressing situations concerned death or loss. However,
our
attempts to link these reactions to levels of personal death threat or
years of
experience proved unsuccessful (Kirchberg
& Neimeyer, 1991).
Having discovered evidence of discomfort with death
among these neophyte counselors, Marie Terry, Alex Bivens and I then
sought to
test the generality of this effect by recruiting a large group of
highly expert
grief therapists (averaging 14 years experience). Both in their ratings
of
brief presenting problems and in their written responses to detailed
"transcriptions" of opening statements by clients, these expert
counselors reversed the earlier finding, finding death and grief issues
more
comfortable to respond to than other serious non-death-related problems
(Terry, Bivens, & Neimeyer, 1995).
Moreover, counselors responded with greater empathy
to clients presenting with grief and loss issues, a tendency that was
enhanced
with more years of training and practice in death education and
counseling.
However, neither comfort nor empathy was related to personal death
fears in the
counselors, who were characteristically quite death accepting and
typically
religious.
Practical as well as theoretical
concerns
drew my attention once again to beginning counselors, as this was the
group
that was visibly death and grief-avoidant, not only in our first study,
but
also in my supervision of doctoral trainees in psychotherapy in our
departmental clinic. I therefore welcomed further collaboration with
Tom
Kirchberg, my co-investigator in the original study, in conducting a
more
tightly controlled and more realistic study of counselor responses to
death and
grief situations with clients. For this study, we enlisted the help of
actors,
carefully counterbalanced for gender and race, to enact the part of
clients
presenting with death-related (e.g., grief, AIDS) or non-death-related
problems
(e.g., marital discord, physical handicap), videotaping their
performances.
Counselors then watched one set of videos, rating their discomfort and
recording their responses to the clients’ self-presentations. As we
hypothesized, we found greater discomfort in responding to the death
than
non-death enactments, a response that proved to be mediated by the
personal
death fears of the counselor. Contrary to our predictions, counselors
were
actually slightly more empathic in relation to death and grief
situations,
although the level of empathy was surprisingly small in absolute terms (Kirchberg, Neimeyer, & James, 1998).
The least empathic responses were provided by
counselors who construed death in fatalistic terms on the Threat Index,
suggesting that working with death and loss can prove especially
challenging
for those neophyte counselors whose personal death anxieties leave them
vulnerable to such work.
My present work in death attitudes has
taken the form of joining with my American and German colleagues Rick
Moser and
Joachim Wittkowski to synthesize and interpret the substantive findings
of the
vast and uneven literature on death anxiety and death acceptance
(Neimeyer,
Wittkowski & Moser, 2004) and to evaluate its best-developed and
most
frequently used measures and methods (Neimeyer, Moser & Wittkowski,
2003).
In addition, I have joined with fellow theorist and methodologist
Adrian Tomer
to undertake a large grant-supported study of death attitudes and
quality of
life at the end-of-life, developing a comprehensive model of factors
affecting
the adjustment of a substantial cohort of hospice patients, a project
that is
just getting underway. Thus, a recurrent pattern of methodological
development
followed by practical application seems to characterize my network of
enterprise in the study of death attitudes across time, with each
branch of the
program periodically intersecting with and enriching the others.
Viewed in hindsight, my substantive
research on death threat and anxiety over the decades has reached
toward a kind
of symmetry, stemming from a focus on the death concerns of vulnerable
populations (e.g., persons with AIDS, the elderly), and then broadening
to
include the potentially problematic role played by the personal death
fears and
concerns of those who work with them (e.g., caregivers, nurses,
counselors).
Although this complementary research strategy was at best only
half-conscious
at the time, a roughly parallel pattern was evident in my research in a
second
death-related area, namely, suicide intervention.
SUICIDE
INTERVENTION
My early work with Dingemans had left
more
questions than answers about the death concerns of suicide intervention
workers, as some findings had pointed to elevated death threat in this
group (Neimeyer & Dingemans, 1980),
while later work contradicted this conclusion (Neimeyer
& Neimeyer, 1984).
As an undergraduate, my research focus on crisis
intervention services had been partly a matter of convenience, and
partly a
matter of personal curiosity, as I found myself working with
life-threatening
callers weekly in my role as a paraprofessional in one of the
pioneering
suicide and crisis intervention centers on the east coast of the United States. What role, I wondered, might staff anxieties about
death and dying
play in affecting their responses to clients who often were quite
literally
presenting with life-threatening situations? However, as I contemplated
this
question in light of our initial studies, I soon confronted a more
basic
problem: the dearth of credible assessments of suicide prevention
skills that
could make an empirical answer to this question feasible. Thus, I began
as we
had with the Threat Index research, constructing the first self-report
instrument for the assessment of suicide prevention competencies—the
Suicide
Intervention Response Inventory or SIRI (Neimeyer
& MacInnes, 1981)—and
then marching it through a series of validational
studies through the 1980s that collectively supported its psychometric
soundness (see Neimeyer &
Pfeiffer, 1994a for a review)
[2]. The logic of the SIRI was straightforward, consisting of 25
responses
on the
part of a potentially self-destructive client (e.g., veiled suicide
threats,
perturbation, depressive helplessness), to which the respondent could
choose
one of two possible replies, one constructive and the other neutral to
negative
from the perspective of crisis intervention theory. The score on the
SIRI was
simply the number of preferred responses.
By the late 80’s the SIRI was ready to
be
used in substantive research, which initially took the form of
attempting to
catalogue the ten most frequent errors of medical and non-medical
suicide
interventionists (Neimeyer &
Pfeiffer, 1994b).
Surveying over 200 professional and paraprofessional
staff, we found a tendency toward superficial reassurance, avoidance of
strong
feelings, professional distancing, inadequate assessment of suicidal
intent,
failure to identify precipitating problems, and passivity to be
relatively
common responses. Medically trained interventionists in the sample
tended to
err in ways that were distinctive from the psychologically trained
counselors:
whereas the former tended toward defensive, distancing, advice-giving,
and
dismissive interactions, the latter displayed excessive passivity and
failure
to structure interactions with a potentially suicidal client. This
rekindled
old concerns about the personal factors that could contribute to such
suboptimal responses among interventionists. As a result, Barry
Fortner, Diane
Melby and I studied a large and heterogeneous group of respondents
likely to
have contact with people in the midst of a suicidal crisis, who varied
from
untrained peers, through crisis paraprofessionals, to masters level
psychologists and counselors (Neimeyer,
Fortner, & Melby, 2001).
The results were illuminating: level of training,
experience with suicidal clients, and death acceptance were positively
associated with suicide intervention skills, whereas a personal history
of
suicidality and a casual, permissive stance toward suicide as a
"personal
right" were negatively associated with appropriate responding.
Moreover,
among the most highly trained professional interventionists, a personal
history
of suicidality was even more strongly associated with poorer suicide
counseling
skills. One "spin-off" of this research was our decision to use the
SIRI as a screening device to ensure a minimum level of suicide
management
competency in our ongoing randomized controlled trial of mutual support
groups
and cognitive therapy for depression (Bright,
Baker, & Neimeyer, 1999).
These findings also informed my attempt to develop a
more coherent training agenda for counseling psychologists in suicide
and
hastened death, one that gave attention to the experiential exploration
of
personal attitudes toward death and suicide, as well as systematic
training in
professional ethics and crisis management (Neimeyer,
2000b).
A final feature of our research program
in
suicide intervention also deserves brief mention, namely, my work with
Steve
Hughes to elaborate a model of suicidal behavior (Hughes
& Neimeyer, 1990)
that integrated a number of constructivist features
(e.g., constriction and disorganization of the personal construct
system) with
other compatible cognitive processes (e.g., foreshortened future time
perspective, impaired problem solving). This provided not only a
heuristic
framework for clinical assessment, but also spawned one of the few
genuinely
prospective studies of suicide risk, in which risk factors assessed at
one
point in time were used to predict escalating suicidality in the weeks
that
followed. Tracking nearly 80 patients admitted to psychiatric
hospitals, we
discovered that their relatively common reports of suicide ideation
across the
course of hospitalization were best predicted by their level of
assessed
hopelessness at intake. However, the prediction of those patients
likely to be
placed on 15-minute checks by staff because of elevated suicide risk
was improved
by the additional consideration of other, more fundamental factors:
their shift
toward self-negativity within their own systems of meaning, and the
deterioration of their ability to define and resolve critical life
problems.
Finally, the emergence of extremely high risk behaviors, such as actual
acts of
self-injury sufficient to mandate one-on-one observation, was predicted
not
only by hopelessness, not only by self-negativity and impaired
problem-solving,
but also by the unique impending disorganization of patients’ construct
systems
regarding the social world as assessed by repertory grid technique (Hughes & Neimeyer, 1993).
These findings seemed to carry practical as well as
theoretical import, suggesting the necessity of attending to
qualitatively
different indices of risk at the level of people’s construct systems as
the
suicidal crisis deepened. By implication, the projection of a more
hopeful
future that might be a minimum sufficient intervention to mitigate risk
of
self-injury among suicide ideators might be woefully inadequate for a
high-risk
client facing abject self-hatred, helplessness, and the disintegration
of
perceived order in the social world. In such a case, more than simple
crisis
intervention is called for, as the therapist and client must grapple
with a
more basic assault on the latter’s world of meaning that can make the
planned
or precipitous abdication of life seem like the most logical choice.
Recently I
have collaborated with my British colleague, David Winter, in reviewing
the
multifaceted contributions of personal construct theory to
conceptualizing the
suicidal choice, which provides an empirically informed and novel
approach to
the multiple paths that can eventuate in self-harm (Neimeyer &
Winter,
2004).
GRIEF AND LOSS
Several years ago, our research program
in
thanatology took a new and integrative turn, shifting toward the study
of grief
and loss from our previous concentration on death attitudes and suicide
intervention. In part, this represented a natural extension of the
previous two
foci, in combination with the impact of my clinical practice, which had
long
included significant numbers of clients dealing with losses of all
kinds,
through bereavement, assault, illness, job loss, relationship
deterioration, and
geographic displacement. But this move also embodied a more personal
motivation
to span my two largely separate identities as a thanatological
researcher on
the one hand, and constructivist psychotherapy theorist, on the other,
as well
as to respond to personal experiences of loss of my mother,
father-in-law, and
best friend in short succession. The result was a new hybrid program of
scholarship on meaning reconstruction in the wake of loss, a program
that is
quickly moving to center stage as an orienting frame for my own
thinking and
that of my current students.
The overarching proposition animating
our
work to date is that grieving is a process of reconstructing a world of
meaning
that has been challenged by loss (Neimeyer, 1997). Issues of
meaning-making in
the wake of loss had of course received some attention in earlier work
on
bereavement (Marris, 1974; Parkes,
2001),
but for the most part this had been a side note to a
much more central concern with emotional stages of adjustment in
response to
loss or a psychiatric preoccupation with acute symptomatology of
grieving
construed in largely pathological terms. In contrast, a new breed of
grief
researchers was beginning to attend to the ruptured assumptive world of
the
bereaved person (Janoff-Bulman,
1989),
the cognitive processes by which the bereaved cope
with loss (Bonanno & Kaltman,
1999),
and the post-traumatic growth displayed by many of
those who suffer adversity (Tedeschi,
Park, & Calhoun, 1998).
Likewise, it was apparent that the field of grief
theory was in ferment, as scholars took a second look at timeworn
assumptions
about the need to "withdraw emotional energy" from the one who had
died, in order to "reinvest" it elsewhere (Hagman, 1995).
Instead, thinkers were beginning to focus on the
potentially sustaining continuing bonds the bereaved construct to the
deceased (Klass, Silverman, & Nickman, 1996),
and the active processes by which they strive to
"relearn the world" in the wake of loss (Attig, 1996).
My own entry into these discussions in various
professional settings [3] was enthusiastic, as I saw the immediate
applicability of
constructivist
concepts and methods in advancing an alternative, and more constructive
understanding of the human response to loss.
Our initial constructivist contribution
to
this conceptual reorientation took place at the juncture of thanatology
and
traumatology, as my post-doctoral colleague, Alan Stewart, and I
endeavored to
conceptualize loss in terms of the traumatic assault on the survivor’s
world of
meaning (Neimeyer & Stewart,
1996).
Our guiding metaphor in this work was the
self-narrative, defined as the life story one both enacts and expresses
that
gives a sense of coherence to one’s identity over time. In our view,
traumatic
loss disrupts the continuity of the narrative construction of self,
dislodging
the individual from a sense of who he or she is (Neimeyer,
2000c).
Complicated grief can result, especially in
vulnerable individuals whose senses of self and relationships are
tenuous as a
function of an insecure attachment history (Neimeyer, Prigerson &
Davies,
2002). For example, the struggle to "emplot" traumatic events within
one’s self-narrative can leave one with a fragmented sense of
autobiographical
continuity through time, much as a previously naïve conscript into
the Vietnam
war might survive horrific experiences of combat that his fellow
infantrymen did
not, only to find it impossible to build a conceptual bridge between
the person
he once was and the person he had become. Traumatic losses of many
kinds, we
theorized, would introduce sharp experiential discrepancies into the
survivor’s
self-narrative, while at the same time challenging the individual’s
capacity to
subsume the traumatic events into the pre-existing construct system.
Gradually
I elaborated this model to include other forms of disruption of the
self-narrative occasioned by loss, contributing not only to
disorganized
narratives as described above, but also to dominant narratives in which
a
single constructed view of the traumatic self comes to "colonize" a
person’s identity, and dissociated narratives in which secret stories
of loss
(e.g., through disguised suicide or unspoken histories of marital
infidelity)
precluded the fuller integration of the experience into one’s personal
of
relational reality (Neimeyer, 2004; Neimeyer & Arvay, 2004).
To assess construct systems that had
been
compromised in these ways, we experimented with the use of biographical
construct repertory grids, a variation of repertory grid technique that
I had
previously explored in the early 1980’s (Neimeyer,
1985c).
The method consisted of a structured interview in
which interviewees were presented with triads of life events anchored
by
iconically rich scenes depicting important "chapters" in the person’s
life narrative (e.g., when I rode my tricycle to the community swimming
pool at
age 5, playing baseball at age 12, serving in Vietnam, when my first
child was
born). Comparing and contrasting these "plot elements" in their own
life stories, respondents formulated thematic constructs that compared
and
contrasted the different events (e.g., powerful vs. helpless; filled
with rage
vs. filled with love). Case studies using this technique accompanied by
a
visual printout of self identity plots proved illuminating both to us
as
investigators and therapists, and to the bereaved or traumatized
persons with
whom we shared the results (Neimeyer,
Keesee, & Fortner, 2000; Neimeyer & Stewart, 1996).
Roughly contemporaneous research by Kenneth Sewell
and his colleagues (Sewell, 1996;
Sewell, 1997; Sewell et al., 1996)
extended this "life event grid" paradigm,
and lent valuable empirical support to the emerging constructivist
model.
Although I remain fascinated with the
potential power of grid technique to aid in the articulation of meaning
systems
disrupted by loss, I also find myself shifting in other methodological
directions. In particular, I have been drawn to broader narrative
models and
methods, prompted in part by misgivings I share with Yorke (1989)
and others about the degradation of more
comprehensive meanings entailed by the segmentation of accounts of loss
into
the adjectival antonyms elicited by repertory grid technique. Not only
does the
relatively unconstrained report of oral or written narratives of loss
provide a
valuable source of qualitative data that is subject to various forms of
disciplined analysis [4] (Neimeyer
& Hogan, 2001),
but it also began to suggest a vast array of
narrative means to therapeutic ends in the context of grief counseling.
As an
example of the former, my students Adam Anderson, James Gillies and I
began
experimenting with the coding of brief responses to probing
questions—which we
put to over 1,000 bereaved persons to date—regarding (a) the sense they
have
made of their loss experience, (b) any form of unexpected benefit or
life
lesson the experience has brought them, and (c) and progressive or
regressive
shifts they have noticed in their sense of personal identity in the
wake of the
loss. Like Davis and his colleagues (Davis,
Nolen-Hoeksema, & Larson, 1998),
we are finding that the inability to make sense of
the loss, in particular, is emerging as the single best predictor of
intensified grieving, outweighing the contribution of "objective"
factors such as the relationship that was lost (e.g., of a parent,
child,
friend), the cause of death (e.g., from natural or unnatural/violent
causes),
or the passage of time. More tentatively, we are also glimpsing a
relationship
between the inability to find existential benefit in the loss or
regressive
identity change on the one hand, and more traumatic or complicated
forms of
grieving on the other.
Aside from these indices of
meaning-making,
my colleague Heidi Levitt and I have also been drawn to examine the
various
narrative processes by which people formulate accounts of loss, and the
implications these carry for their integration of death into their life
story (Neimeyer & Levitt, 2000; Neimeyer
& Levitt, 2001).
For example, some people narrate their losses in an
"external" voice, focusing on objective events in a way that might be
reported by an outside observer ("My mother died of emphysema in the
fall.
All of her children were there at her bedside, sitting in vigil. Nurses
came
and went, sometimes gesturing one or more family members into the hall
for a
medical update."). Others engage in a more "internal" and
emotional narrative process ("When my mother lay dying, I felt a
cascade
of emotions, from hope, to despair and loneliness, to deep sadness. But
above
all, I had a sense of awe and privilege to be there."). Still others
present a more "reflexive," significance-seeking account ("My
mother’s death made me aware of the fragile order of life, and the
critical
importance of sharing these life transitions as a family."). In
subsequent
research spearheaded by my student Adam Anderson, we investigated the
role of
these various narrative processes in promoting integration of loss, and
facilitating adaptation to bereavement. Although it is too early to say
what we
will find in our longitudinal research, we suspect that an alternation
among
narrative processes in ongoing personal grief journals will prove most
helpful
in embroidering meaning of the loss, and facilitating a vital continued
engagement in life (Neimeyer &
Anderson, 2001).
Not surprisingly, the elasticity of the
narrative metaphor has prompted a good deal of creative theorizing on
the part
of not only our own research group, but also that of like-minded
clinicians and
scholars (Attig, 2000; Nadeau,
1997; Romanoff & Terenzio, 1998).
In my own writing in this emerging genre, I have
tried to harvest the lessons of cutting-edge constructivist research to
formulate some working propositions that scaffold a new theory of
grieving, one
that better accounts for the individuality of grief, our active
personal
processes of adaptation, and familial and cultural factors that shape
our
efforts after meaning (Neimeyer,
1997; Neimeyer & Jordan, 2001; Neimeyer & Keesee, 1998).
Equally, I have tried to use this nascent theory in
a generative way, to envision new constructivist
practices—biographical,
interview-based, reflective, metaphoric, poetic, and narrative—that
help
bereaved people take perspective on their losses and weave them into
the fabric
of their lives (Neimeyer, 2001a;
Neimeyer, 2001b; Neimeyer et al., 2000).
One unanticipated offshoot of this work is the not
uncommon discovery by other clinicians and helping professionals that a
constructivist and narrative approach provides a more coherent and
useful
framework for their best practices (e.g., the creation of meaningful
rituals;
transformative procedures for restoring a sense of community in the
wake of
violation or loss) than did traditional theories (Neimeyer
& Tschudi, 2003).
I have consistently found such reports to be highly
affirming, as, in the words of an insightful participant in one of my
grief
therapy workshops, "we as bereavement professionals finally have a
chance
to put our practice into theory." Thus, I am hopeful that a
constructivist
and narrative perspective on bereavement and its complications can help
foster
a more effective approach to grief therapy, whose uncertain outcomes in
available research studies call for deep-going analysis and reflection
(Jordan
& Neimeyer, 2003).
CLOSING CODA
In this brief chapter I have tried to
reflect on my long involvement in the field of death studies, an
involvement
that has drawn impetus and occasional new direction from my parallel
work as a
constructivist theorist and clinician, as well as simply a maturing
person.
This has afforded me a rare opportunity to reflect on the many
interconnected
networks of enterprise that constitute an evolving research program,
glancing
back in time to its undergraduate origins in an early fascination with
the
measurement of death threat, and sometimes glimpsing the outline of
findings
that are still taking shape. No brief account can convey all the
peregrinations
of a lengthy and multifaceted program of study [5],but I have tried to
suggest something of the braiding together of
different
strands of theory, research, and practice on death attitudes, suicide
intervention, and grief that has animated, and perhaps constrained, my
work in
this area. I hope that the resulting account is a reasonably honest
one—at
least as written from my present position in mid-career—and that the
decision
to focus reflexively on that work in which I have been most directly
involved
does not obscure the critical contribution made to this program by many
others,
and which is beginning to suggests clear roles that psychologists might
play in
research and practice in the broad end-of-life arena (Haley et al.,
2003). No
doubt each of my students and colleagues could provide his or her own
unique
account of some of these same developments, and see rather different
significance in them!
Aside from any literal utility of this
review in acquainting interested readers with the broad purview of
research
programs that they might explore, extend or critique, I also hope that
the
frequent citation of the work and role of others suggests something of
the
social nature of science, and the importance of collegiality and
community in
supporting our individual and joint initiatives. Just as the
identifiable
strands of our personal networks of enterprise are complexly
inter-braided, so
too are they bound up with those of many others. Ultimately, I hope
that this
summary of my own collaborative work continues this process, suggesting
points
of useful contact and contrast with the work of others who share my
long-term
fascination with the role of death in human life.
[1] Readers interested in some personal
reflections on the development
of these other core branches might consult Neimeyer (1996) and Neimeyer
(2000a).
[2]
Actually, despite the utility of the SIRI in our own
research
programs and those of other investigators, one significant constraint
of the
original version become clear in these studies—the instrument’s ceiling
effect
with more highly trained respondents (e.g., counselors with
postgraduate
training in psychology). This stimulated our work on a revision of the
instrument—the SIRI-2—that removed this ceiling effect, while at the
same time
meeting or exceeding other indices of the original scale’s validity and
reliability. For a report on the revised measure, see Neimeyer and
Bonnelle (1997).
[3] Chief among these
was the Association
for Death Education and Counseling, in which I had been active for
many
years, eventually serving as its President in 1996 and 1997, and the International Work Group for Death, Dying
& Bereavement, which I chaired 2002 to 2004. The latter in
particular
provided a place for generative dialogues with several scholars on the
forefront of bereavement research and practice, pushing all of us
toward a more
central recognition of the role of meaning making in adaptation to loss.
[4] Actually, my
students and I had already started
experimenting with
the coding of free-response narratives some years before in our
research on
death attitudes (Holcomb,
Neimeyer, & Moore, 1993).
But it took a conceptual as well as methodological
reorientation for me to shift to the elicitation and analysis of
various forms
of narrative in connection with loss.
[5] For other attempts
to synthesize aspects
of this research program
and situate it in the broader context of death and loss studies see
Neimeyer
and Van Brunt (1995),
Wass and Neimeyer (1995)
and Neimeyer (1998).
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REFERENCES
Attig, T. (1996). How we grieve:
Relearning the world. New York:
Oxford University Press.
Attig, T. (2000). The heart of grief.
New
York: Oxford.
Bivens, A. J., Neimeyer, R. A.,
Kirchberg,
T. M., & Moore, M. K. (1994). Death concern and religious belief
among gays
and bisexuals of variable proximity to AIDS. Omega, 30, 105-120.
Bonanno, G., & Kaltman, S. (1999).
Toward an integrative perspective on bereavement. Psychological
Bulletin, 125,
760-776.
Bright, J. I., Baker, K. D., &
Neimeyer, R. A. (1999). Professional and paraprofessional group
treatments for
depression: A comparison of cognitive-behavioral and mutual support
interventions. Journal of Consulting
and Clinical Psychology, 67, 491-501.
Dattel, A. R., & Neimeyer, R. A.
(1990). Sex differences in death anxiety: Testing the emotional
expressiveness
hypothesis. Death Studies, 14,
1-11.
Davis, C. G., Nolen-Hoeksema, S., &
Larson, J. (1998). Making sense of loss and benefiting from the
experience: Two
construals of meaning. Journal of
Personality and Social Psychology,
75,
561-574.
DePaola, S. J., Neimeyer, R. A.,
Griffin,
M. & Young, J. (2003). Death anxiety and attitudes toward the
elderly among
older adults: The role of gender and ethnicity. Death Studies, 27,
335-354.
DePaola, S. J., Neimeyer, R. A., Lupfer,
M.
B., & Fiedler, J. (1992). Death concern and attitudes toward the
elderly in
nursing home personnel. Death
Studies, 16, 537-555.
DePaola, S. J., Neimeyer, R. A., &
Ross, S. K. (1994). Death concern and attitudes toward the elderly in
nursing
home personnel as a function of training. Omega, 29, 231-248.
Fortner, B. V., & Neimeyer, R. A.
(1999). Death anxiety in older adults: A quantitative review. Death
Studies,
23, 387-412.
Fortner, B. V., Neimeyer, R. A., &
Rybarczeck, B. (2000). Correlates of death anxiety in older adults: A
comprehensive review. In A. Tomer (Ed.), Death attitudes and the older
adult (pp. 95-108). Philadelphia: Brunner Routledge.
Gruber, H. E. (1989). Networks of
enterprise in creative scientific work. In B. Gholson, W. Shadish, R.A.
Neimeyer & A. Houts (Eds.).
Psychology of science (pp. 246-265).
New York: Cambridge.
Hagman, G. (1995). Mourning: A review
and
reconsideration. International
Journal of Psycho-Analysis, 76, 909-925.
Haley, W. E., Larson, D. G.,
Kasl-Godley,
J., Neimeyer, R. A. & Kwilosz, D. (2003). Roles for psychologists
in
end-of-life care. Emerging models of practice. Professional Psychology,
34, 626-633.
Holcomb, L. E., Neimeyer, R. A., &
Moore, M. K. (1993). Personal meanings of death: A content analysis of
free-response narratives. Death
Studies, 17, 299-318.
Hughes, S. L., & Neimeyer, R. A.
(1990). A cognitive model of suicidal behavior. In D. Lester (Ed.), Current
concepts of suicide (pp. 1-28). Philadelphia: Charles Press.
Hughes, S. L., & Neimeyer, R. A.
(1993). Cognitive predictors of suicide among hospitalized psychiatric
patients. Death Studies, 17,
103-124.
Janoff-Bulman, R. (1989). Assumptive
worlds
and the stress of traumatic events. Social
Cognition, 7, 113-116.
Jordan, J. R. & Neimeyer, R. A.
(2003).
Does grief counseling work? Death
Studies, 27, 765-786.
Kelly, G. A. (1955). The psychology of
personal constructs. New York: Norton.
Kirchberg, T. M., & Neimeyer, R. A.
(1991). Reactions of beginning counselors to situations involving death
and
dying. Death Studies, 15,
603-610.
Kirchberg, T. M., Neimeyer, R. A., &
James, R. K. (1998). Beginning counselors' death concerns and empathic
responses
to client situations involving death and grief. Death Studies, 22,
99-120.
Klass, D., Silverman, P. R., &
Nickman,
S. (1996). Continuing bonds: New
understandings of grief. Washington:
Taylor
& Francis.
Krieger, S. R., Epting, F. R., &
Leitner, L. M. (1974). Personal constructs, threat, and attitudes
toward death. Omega, 5,
299-310.
Kübler-Ross, E. (1969). On death
and dying.
New York: Macmillan.
Marris, P. (1974). Loss and change.
London:
Routledge.
Moore, M. K., & Neimeyer, R. A.
(1991).
A confirmatory factor analysis of the Threat Index. Journal of
Personality and
Social Psychology, 60, 122-129.
Nadeau, J. W. (1997). Families making
sense
of death. Newbury Park, CA: Sage.
Neimeyer, R. A. (1985a). Actualization,
integration and fear of death: A test of the additive model. Death
Studies, 9, 235-250.
Neimeyer, R. A. (1985b). The development
of
personal construct psychology. Lincoln: Nebraska Press.
Neimeyer, R. A. (1985c). Personal
constructs in clinical practice. In P. Kendall (Ed.), Advances in
cognitive-behavioral
research and therapy, Vol. 4, (pp. 275-335).
Neimeyer, R. A. (1986). The threat
hypothesis: a conceptual and empirical defense. Death Studies, 10, 177-190.
Neimeyer, R. A. (Ed.). (1994a). Death
anxiety handbook: Research, instrumentation, and application. New
York:
Taylor
& Francis.
Neimeyer, R. A. (1994b). The Threat
Index
and related methods. In R. A. Neimeyer (Ed.), Death anxiety handbook
(pp.
61-101). New York: Taylor & Francis.
Neimeyer, R. A. (1995). Constructivist
psychotherapies: Features, foundations, and future directions. In R. A.
Neimeyer & M. J. Mahoney (Eds.), Constructivism
in psychotherapy. (pp.
11-38). Washington: American Psychological Association.
Neimeyer, R. A. (1996). Process
interventions for the constructivist psychotherapist. In H. Rosen &
K. T.
Kuehlwein (Eds.), Constructing
realities. (pp. 373-411). San Francisco:
Jossey-Bass.
Neimeyer, R. A. (1997). Meaning
reconstruction and the experience of chronic loss. In K. J. Doka (Ed.),
Living
with grief (pp. 159-176). Washington, D. C.: Taylor &
Francis.
Neimeyer, R. A. (1998). Can there be a
psychology of loss? In J. H. Harvey (Ed.), Perspectives on loss: A
sourcebook
(pp. 331-341). Philadelphia, PA: Brunner Mazel.
Neimeyer, R. A. (2000a). Research and
practice as essential tensions: A constructivist confession. In S.
Soldz &
L. McCullough Vaillant (Eds.), Reconciling
empirical knowledge and
clinical
experience (pp. 123-150). Washington: American Psychological
Association.
Neimeyer, R. A. (2000b). Suicide and
hastened death: Toward a training agenda for counseling psychology. The
Counseling Psychologist, 28, 551-560.
Neimeyer, R. A. (2000c). Narrative
disruptions in the construction of self. In R. A. Neimeyer & J.
Raskin
(Eds.), Constructions of disorder:
Meaning making frameworks for
psychotherapy
(pp. 207-241). Washington, D. C.: American Psychological Association.
Neimeyer, R. A. (2001a). The language of
loss. In R. A. Neimeyer (Ed.),
Meaning
reconstruction
and the experience of
loss .
Washington, D. C.: American Psychological Association.
Neimeyer, R. A. (2001b). Lessons of
loss: A
guide to coping. Philadelphia & London: Brunner Routledge.
Neimeyer, R. A. (2003). Fostering
posttraumatic growth: A narrative contribution. Psychological Inquiry,
in
press.
Neimeyer, R. A., & Anderson, A. S.
(2001). Loss, transition and the search for significance. In N.
Thompson (Ed.),
Loss and grief: A guide for human services professionals .
Basingstoke,
UK
& New York: Palgrave.
Neimeyer, R. A. & Arvay, M. J.
(2004).
Performing the self: Therapeutic enactment and the narrative
integration of
traumatic loss. In H. Hermans & G. Dimaggio (Eds.), The dialogical
self in
psychotherapy. New York: Brunner Routledge.
Neimeyer, R. A., & Bonnelle, K.
(1997).
The Suicide Intervention Response Inventory: A revision and validation.
Death
Studies, 21, 59-81.
Neimeyer, R. A., & Chapman, K. M.
(1980). Self/ideal discrepancy and fear of death: the test of an
existential
hypothesis. Omega, 11, 233-240.
Neimeyer, R. A., & Dingemans, P.
(1980). Death orientation in the suicide intervention worker. Omega,
11, 15-23.
Neimeyer, R. A., Dingemans, P., &
Epting, F. R. (1977). Convergent validity, situational stability and
meaningfulness of the Threat Index. Omega,
8, 251-265.
Neimeyer, R. A., Fiedler, J. M., Harter,
S., & Alexander, P. C. (1993). Der Gruppenprozeß bei der
Behandlung von
Inzestopfern. In J. W. Scheer & A. Catina (Eds.), Einführung in die
Repertory
Grid-Technik, Vol. 2 (pp. 128-137). Bern, Switzerland: Huber.
Neimeyer, R. A., & Fortner, B.
(1995).
Death anxiety in the elderly. In G. Maddox (Ed.), The Encyclopedia of
Aging
(pp. 252-253). New York: Springer.
Neimeyer, R. A., & Fortner, B.
(1997).
Death attitudes in contemporary perspective. In S. Strack (Ed.), Death
and the
quest for meaning (pp. 3-29). Northvale, N.J.: Jason Aronson.
Neimeyer, R. A., & Fortner, B.
(2000).
Death anxiety in older adults. In G. L. Maddox (Ed.), Encyclopedia of
aging (3
ed., ). New York: Springer.
Neimeyer, R. A., Fortner, B., &
Melby,
D. (1999). Intervening in suicide: Do personal or professional factors
make a
difference? Australian Journal of
Grief and Bereavement, 2, 43-46.
Neimeyer, R. A., Fortner, B., &
Melby,
D. (2001). Personal and professional factors and suicide intervention
skills. Suicide and
Life-Threatening Behavior, 31, 71-82.
Neimeyer, R. A., & Gillies, J.
(2001).
Multidimensional Fear of Death Scale. In J. Hoyer & J. Margraf
(Eds.), Angstdiagnostik -
Grundlagen und Testverfahren. Berlin: Springer Verlag.
Neimeyer, R. A., & Hogan, N. (2001).
Quantitative or qualitative? Measurement issues in the study of grief.
In M.
Stroebe, R. Hansson, W. Stoebe, & H. Schut (Eds.), Handbook of
bereavement
research (pp. 89-118). Washington, DC: American Psychological
Association.
Neimeyer, R. A., & Jordan, J. R.
(2001). Disenfranchisement as empathic failure. In K. Doka (Ed.), Disenfranchised grief.
San Francisco: Jossey Bass.
Neimeyer, R. A., & Keesee, N. J.
(1998). Dimensions of diversity in the reconstruction of meaning. In K.
J. Doka
& J. D. Davidson (Eds.), Living
with grief: Who we are, how we
grieve (pp.
223-237). Washington: Hospice Foundation of America.
Neimeyer, R. A., Keesee, N. J., &
Fortner, B. V. (2000). Loss and meaning reconstruction: Propositions
and
procedures. In R. Malkinson, Rubin, S. & Wiztum, E. (Ed.), Traumatic and
non-traumatic loss and bereavement (pp. 197-230). Madison, CT:
Psychosocial
Press.
Neimeyer, R. A., & Levitt, H.
(2000).
What's narrative got to do with it? Construction and coherence in
accounts of
loss. In J. Harvey (Ed.), Loss and
trauma (pp. 401-412). Philadelphia:
Brunner
Routledge.
Neimeyer, R. A., & Levitt, H.
(2001).
Coping and coherence: A narrative perspective on resilience. In R.
Snyder
(Ed.), Coping with stress
(pp. 47-67). New York: Oxford.
Neimeyer, R. A., & MacInnes, W. D.
(1981). Assessing paraprofessional competence with the Suicide
Intervention
Response Inventory. Journal of
Counseling Psychology, 28, 176-179.
Neimeyer, R. A., & Mahoney, M. J.
(1995). Constructivism in
psychotherapy. Washington, DC: American
Psychological
Association.
Neimeyer, R. A., & Moore, M. K.
(1994).
Validity and reliability of the Multidimensional Fear of Death Scale.
In R. A.
Neimeyer (Ed.), Death anxiety
handbook (pp. 103-119). New York: Taylor
&
Francis.
Neimeyer, R. A., Moser, R. &
Wittkowski, J. (2003). Assessing attitudes toward death: Psychometric
considerations. Omega, 47,
45-76.
Neimeyer, R. A., & Neimeyer, G. J.
(1984). Death anxiety and counseling skill in the suicide
interventionist. Suicide and
Life-Threatening Behavior, 14, 126-131.
Neimeyer, R. A., & Pfeiffer, A. M.
(1994a). Evaluation of suicide intervention effectiveness. Death
Studies, 18,
127-162.
Neimeyer, R. A., & Pfeiffer, A. M.
(1994b). The ten most common errors of suicide interventionists. In A.
Leenaars, J. T. Maltsberger, & R. A. Neimeyer (Eds.), Treatment of
suicidal
people (pp. 207-233). Philadelphia: Taylor & Francis.
Neimeyer, R. A., Prigerson, H. &
Davies, B. (2002). Mourning and meaning. American Behavioral
Scientist, 46,
235-251.
Neimeyer, R. A., & Raskin, J.
(Eds.).
(2000). Constructions of disorder:
Meaning-making frameworks for
psychotherapy. Washington, D.C.: American Psychological
Association.
Neimeyer, R. A., Shadish, W., Freedman,
E.,
Gholson, B. & Houts, A. (1989). A preliminary agenda for the
psychology of
science. In B. Gholson, W. Shadish, R.A. Neimeyer & A. Houts
(Eds.). Psychology
of science (pp. 429-448). New York: Cambridge.
Neimeyer, R. A., & Stewart, A. E.
(1996). Trauma, healing, and the narrative emplotment of loss. Families
in
Society, 77, 360-375.
Neimeyer, R. A., & Stewart, A. E.
(1998). AIDS-related death anxiety: A review of the literature. In H.
E.
Gendelman, S. Lipton, L. Epstein, & S. Swindells (Eds.), Neurological and
neuropsychiatric manifestations of HIV-1 infection (pp.
582-595). New
York:
Chapman & Hall.
Neimeyer, R. A., Stewart, A. E. &
Anderson, J. (2004). AIDS-related death anxiety: A research review and
clinical
recommendations. In H. E. Gendelman, S. Swindells, I. Grant, S. Lipton,
I.
Everall, & (Eds.), The neurology
of AIDS (2nd Ed.). New York:
Chapman &
Hall.
Neimeyer, R. A., & Tschudi, F.
(2003).
Community and coherence: Narrative contributions to a psychology of
conflict
and loss. In G. Fireman, T. McVay, & O. Flanagan (Eds.), Narrative
and
consciousness: Literature, psychology, and the brain. New York:
Oxford.
Neimeyer, R. A., & Van Brunt, D.
(1995). Death anxiety. In H. Wass & R. A. Neimeyer (Eds.), Dying:
Facing
the facts (3 ed., pp. 49-88). Washington and London: Taylor
&
Francis.
Neimeyer, R. A. & Winter, D. (2004).
To
be or not to be: Personal construct perspectives on the suicidal
choice. In T.
Ellis (Ed.). Cognition and suicide:
The science of suicidal thinking.
Washington, DC: American Psychological Association.
Neimeyer, R. A., Wittkowski, J. &
Moser, R. (2004). Psychological research on death attitudes: An
overview and
evaluation. Death Studies, in
press.
Parkes, C. M. (2001). Bereavement. (3
ed.).
London & New York: Brunner Routledge.
Rigdon, M. A., Epting, F. R., Neimeyer,
R.
A., & Krieger, S. R. (1979). The Threat Index: a research report. Death Education,
3, 245-270.
Romanoff, B. D., & Terenzio, M.
(1998).
Rituals and the grieving process. Death
Studies, 22, 697-711.
Scheer, J. W. (Ed.). (2000). The person
in
society. Giessen, Germany: Psychosozial Verlag.
Scheer, J. W., & Catina, A. (Eds.).
(1993). Einführung in die
Repertory Grid-Technik. Bern, Switzerland:
Huber.
Scheer, J. W., & Catina, A. (Eds.).
(1996). Empirical constructivism in
Europe. Giessen, Germany:
Psychosozial
Verlag.
Sewell, K. (1996). Constructional risk
factors for a post-traumatic stress response following a mass murder. Journal
of Constructivist Psychology, 9, 97-108.
Sewell, K. W. (1997). Posttraumatic
stress:
Towards a constructivist model of psychotherapy. In G. J. Neimeyer
& R. A.
Neimeyer (Eds.), Advances in
personal construct psychology, Vol. 4, (pp.
207-235). Greenwich, CN: JAI Press.
Sewell, K. W., Cromwell, R. L.,
Farrell-Higgins, J., Palmer, R., Ohlde, C., & Patterson, T. W.
(1996).
Hierarchical elaboration in the conceptual structure of Vietnam combat
veterans. Journal of Constructivist
Psychology, 9, 79-96.
Tedeschi, R., Park, C., & Calhoun,
L.
(Eds.). (1998). Posttraumatic
growth: Positive changes in the aftermath
of
crisis. Mahwah, N. J.: Lawrence Erlbaum.
Terry, M. L., Bivens, A. J., &
Neimeyer, R. A. (1995). Comfort and empathy of experienced counselors
in client
situations involving death and loss. Omega,
32, 269-285.
Wass, H., & Neimeyer, R. A. (1995).
Closing reflections. In H. N. Wass, R. A. (Ed.), Dying: Facing the
Facts. Vol.
3, (pp. 435-446). Washington, D.C.: Taylor & Francis.
Yorke, M. (1989). The intolerable
wrestle: Words,
numbers, and meanings. International
Journal of Personal Construct
Psychology,
2, 65-76.
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ABOUT THE
AUTHOR
Robert A. Neimeyer, Ph.D., is a
Professor
of Psychology at the University of Memphis, Memphis, TN, USA, where he directs the Psychotherapy Area.
Neimeyer has published 18 books and over 200
book chapters and journal articles on constructivism and its
application to
psychotherapy, death, and grief, and edits the peer-reviewed journals
Death
Studies and the Journal of Constructivist Psychology. He
can be contacted at neimeyer@memphis.edu.
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REFERENCE
Neimeyer. R. A.
(2004). Constructions of death and loss: Evolution of a research
program. Personal
Construct Theory & Practice,
1, 8-22
(Retrieved from http://www.pcp-net.org/journal/pctp04/neimeyer04.html)
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Received: 31 Dec 2003 - Accepted: 12 Jan 2004 -
Published: 31 Jan 2004 |
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