Dr. Marie Dezelic

MEANING-CENTERED GRIEF MODEL:

An Existential Approach for Addressing the Lifelong Phase in Grief

© 2014

 

MARIE S. DEZELIC, PH.D.

GABRIEL GHANOUM, PSY.D.

 

 

(ABSTRACT)  The Meaning-Centered Grief Model, based on Viktor Frankl’s theory of Logotherapy & Existential Analysis, “Processing Through Loss, Grief, Transitions and Transformation: A Meaning-Centered Existential Approach,” is depicted in a “Conceptual Pictograph” to offer clinicians and grievers a guide and an education of the ongoing process of grief.  This model incorporates previous grief models, stresses important considerations that impact grief, and proposes a “Continual Phase” of grief—a lifelong journey of recovery and meaning-making.  The Continual Phase encompasses key concepts from Viktor Frankl’s Logotherapy & Existential Analysis, specifically, healing and recovery through meaning.

 

KEY WORDS:  Meaning-Centered Grief Model, Grief, Grieving, Logotherapy & Existential Analysis, Viktor Frankl, Meaning, Conceptual Pictograph

 

Introduction

 

            The Meaning-Centered Grief Model, offered by Marie Dezelic and Gabriel Ghanoum, is an existential approach for understanding the ongoing changes during the grief process based on the underpinnings of Viktor Frankl’s Logotherapy & Existential Analysis, a meaning-oriented theory and existential therapy (Dezelic, 2014; Frankl, 2006; Frankl, 2004; Frankl, 2000; Frankl, 1988; Frankl, 1986; Frankl, 1978; Ghanoum, 2013; Graber, 2004; Lukas, 2000; Marshall & Marshall, 2012). This new model combines the well-known stages and model conceptualizations of grief theories from J. Bowlby, E. Kubler-Ross, T. Rando, R. Neimeyer, and A. Davis Bush (Bowlby, 1980; Davis Bush, 1997; Kubler-Ross, 1969; Kubler-Ross & Kessler, 2005; Neimeyer, 2006; Rando, 1993), in a flexible manner utilizing the approaches of these various theories as building blocks to an ongoing lifelong grief phase. Grief, the process a bereaved individual goes through to assimilate loss after the death of someone, is a very unique and individualized process, where no two grief displays are exactly the same.  As the theories and models have been designed as conceptual constructs, and do not fit every person exactly, the more knowledge, understanding, language, and tools clinicians have, the greater the benefit that can be provided for patients who have entered into the unchartered territory of grief.  Having various models to draw information from, offers the clinician a more comprehensive map and guide when walking with the patient in this new unknown world—life after the loss. This model builds upon the pre-existing stages and models toward an ongoing “lifetime phase” from an existential perspective. The Meaning-Centered Model of Grief, “Processing Through Loss, Grief, Transitions and Transformation: A Meaning-Centered Existential Approach, is depicted in a “Conceptual Pictograph,” a term coined by Marie Dezelic (Dezelic, 2014; Ghanoum, 2013) as a concrete tool and handout for clinicians and patients to apply in the grief therapy process.  The “Tangled Ball of Emotions” is utilized as a visual to help clinicians and patients understand how the many emotions, and layers of these emotions are experienced through the various models designed by pioneers in the field of Grief Work, Death and Dying.  Additionally, Viktor Frankl spoke of two particular triads in Logotherapy & Existential Analysis, the Tragic Triad and the Neurotic Triad (Dezelic, 2014; Frankl, 2006; Frankl, 2004; Frankl, 2000; Frankl, 1988; Frankl, 1986; Frankl, 1978; Ghanoum, 2013; Graber, 2004; Lukas, 2000; Marshall & Marshall, 2012), where three concepts combine to make each triad.  These two triads, and their components, are often preceptors to existential crises in the form of despair and an existential vacuum, and are contained within the area of the “Tangled Ball of Emotions.” The Tragic Triad—Unavoidable Suffering, Guilt, and Death, and the Neurotic Triad—Aggression, Depression, and Addiction, have been incorporated to help clinicians examine how these triads are experienced during the initial stages of grief, as well as with the varying emotions. 

            In The Tragic Triad—people in despondency experience Unavoidable Suffering: Pain experienced from suffering which is unavoidable, such as in the case of a death of a loved one or a trauma;  Guilt: Responsibility, fault, or blame one experiences from a situation one has been a part of, caused, or has been afflicted by; and Death: The deep sadness, awareness or questioning one experiences when one realizes the transitoriness of life after the death of someone.  In The Neurotic Triad—people in despair experience Depression: The feelings one experiences in their inner world where they have lost their will to live; Aggression:  An outward expression of violence through the anger and rage experienced internally by means of controlling others; or Aggression turned inward—the attempt to harm oneself through means of self-mutilation or, at the extreme level, with a suicide attempt—to extinguish one’s existence from this world completely; and Addiction:  The attempt to numb or dull one’s pain and despair through substance abuse or a particular behavior; or exhibited as thrill-seeking behavior in order to experience invincibility and appear larger-than-life, without regard to consequences (Dezelic, 2014).

            The initial stages of grief, and the inner experiences and outer expressions of pain, through Frankl’s Triads, can often lead to Existential Frustration, Despair and Loss of Hope, possibly leading to an Existential Vacuum—“in internal pulling force, of inner void, emptiness, boredom, apathy, struggle, and meaningless existence” (Dezelic, 2014)—for a period of time. The clinician’s work with the patient is to be present, validate, support, and navigate through their internal emotional landscape and meaning constructions often expressed and experienced through the Tragic and Neurotic Triads (Lukas, 2000; Neimeyer, 2012; Neimeyer, 2006; Rainer, 2013; Rando, 1993; Winokuer & Harris, 2012).

 

Important Considerations that Impact Grief

 

            Every individual experiences grief in a very unique way.  Although we can see some similarities, hence having models that offer a guide to the vast set of emotions, behaviors, cognitions and displays of them, no one person grieves in exactly the same way.  There are several impacts that can cause grief to be more or less difficult, more or less chronic, and more or less complicated.  Clinicians should assess for these considerations, which will assist them in understanding the particular context in which the grieving person is now living, what he/she carries into the grieving process, and what might prevent his/her progress, leaving him/her effectively “stuck” in a particular area.  Important considerations to assess: Nature of the Death, Amount of Suffering, Attachment and Nature of Relationship with Deceased, Former Losses and Traumatic Exposure, Current Support Network, Age of Griever, Gender, Culture, Faith Beliefs, Additional Stressors in One’s Life.

            The Nature of the Death. Whether the death was sudden, as in the case of a tragic accident, suicide or homicide; or prolonged and expected, as in the case of a terminal illness diagnosis, it will have an effect on both the griever and the grief process.  The specific type of death creates an impact as well, such as a terminal diagnosis, tragic accident, suicide, homicide, or substance overdose, depending on the meaning constructions previously developed for each type of death.  Several issues that may present themselves include whether the griever was provided the opportunity to “say goodbye,” what information was known about the condition or situation, what was seen, and how any of these issues were integrated (Kubler-Ross & Kessler, 2005; Neimeyer, 2001; Rando, 1993).   

            The Amount of Suffering.  Whether the griever witnessed their loved one suffering for an extended period of time, or whether the nature of the death included suffering, effects the grief process.  Prolonged suffering may provide relief for the griever once their loved one has died, because now the suffering is no longer present.  Sudden deaths can also have an effect of relief, because the griever takes solace that there was not prolonged suffering (Ghanoum, 2013; Kubler-Ross & Kessler, 2005; Rando, 1993). 

            Attachment, Nature of Relationship with Deceased.  The griever’s attachment style—secure, anxious-ambivalent, avoidant, or disorganized, will play a major role in how grief is experienced.  The griever will possibly use the same style in addressing their grief, or many times, the style will no longer feel comfortable or offer safety, as the loved one is no longer present to interact and engage with; this can produce a traumatic response for the griever. The nature of every relationship is different, and depending on whether this is a couple/partnership, a parent-child, sibling, relative, friend or other type of relationship, the closeness or lack thereof, impacts the intensity of the grief process (Bowlby, 1961; Bowlby, 1980; Rando, 1993). 

            Former Losses, Traumatic Exposure.  Former losses, or previous exposure to traumatic events can impact the current grief process.  If the griever has had several losses, this can compound the traumatic response for the current grief, or lessen the impact (provided that they have developed coping strategies or become comfortable with death).  Likewise, if the griever has been exposed to traumatic events in their life, this can increase the effect of the current grief, or it can lessen the impact.  Multiple deaths at the same time, such as an accident where several family members or friends are killed, or terminal illness where several people are diagnosed with the same illness, such as HIV/AIDS or Cancer, can have a greater impact on the griever as they will need to process several losses at the same time or within a close timeframe of each other. Loss of pets can be equally as traumatic as with human beings, especially if the pet is part of the griever’s support system, viewed as a family member, and the griever has a strong attachment bond to the pet (Kubler-Ross & Kessler, 2005; Neimeyer, 2001; Rando, 1993). 

            Current Support Network.  If the griever currently has a support network of family, friends and co-workers, this can assist the griever in the grief process. The grief experience can be very lonely for the griever, as he/she might feel that no one understands his/her loss; having outside support can offer some reprieve from the inner state of loneliness, despair and loss.  If the griever does not have a support network established, this can exacerbate the feelings of loneliness and despair. Efforts should be taken to help the griever enter into a support group and begin to expand his/her social network. Additionally, it is important to recognize that the first few weeks after the death are often characterized by extra support; however, this often diminishes precisely when the griever needs the support most, while going through some of the more difficult stages of grief; specifically, when the griever is starting to recognize that life will no longer be the same, and the deceased is no longer returning (Kubler-Ross & Kessler, 2005; Neimeyer, 2006; Neimeyer 2001; Rando, 1993).

            Age of Griever, Gender, Culture, Faith Beliefs.  The age of the griever and their cognitive development impacts the way the griever grieves, understands and integrates the death into their current experience; a child losing their parent or sibling has a different impact than a parent losing their child, spouse, or parent. Likewise, men and women not only grieve differently, but approach the process from a different set of acceptable aspects of the gender roles they each take part in. Additionally, there is a need for culturally sensitive grief clinicians. Cultural and religious practices impact the grief process by increasing certain expectations on the griever, but can also bring peace and comfort through rituals, ceremonies and support (Clements et al., 2003; Ghanoum, 2013; Kubler-Ross & Kessler, 2005; Sunoo, 2002).

            Additional Stressors in One’s Life.  Additional stressors in the griever’s life can add to feelings of helplessness, hopelessness, and/or despair. During the initial stages of grief, the griever often feels overwhelmed by his/her own feelings, emotions, cognitions, and even behaviors. Having additional stressors such as financial constraints, work-related problems, family relationship issues, additional losses, and personal medical  complications/disabilities will only add to the experience of being overwhelmed, and can often exacerbate the grief response, leading to a chronic or traumatic response (Ghanoum, 2013).

 

“The Meaning-Centered Grief Model”

 

I. Processing Through Stages

            This section pertains to the process of going through the many stages and constructs of the models depicted in the “Conceptual Pictograph,” by Bowlby, Davis Bush, Kubler-Ross, Neimeyer, and Rando, of the feelings, emotions, cognitions, and behaviors—the inner and outer experiences of grief (Bowlby, 1980; Davis Bush, 1997; Kubler-Ross, 1969; Kubler-ross & Kessler, 2005; Neimeyer, 2006; Rando, 1993). The “Tangled Ball of Emotions” depicts the emotions, which are then translated to thoughts and behaviors by the griever.  There are several grief theories, which have not been included that can be added in this section for further understanding of common responses and movement through the grief process.

 

Spiraling Through the Stages

            First and foremost, it is important to recognize that grief is a NON-LINEAR PROCESS.  The models presented in the “Conceptual Pictograph” do not claim a linear quality, rather, they propose an understanding to the entire grief construct and possibilities within. Clinicians will see patients spiraling through the various stages and models presented, sometimes in a forward moving direction, sometimes in a backward moving direction, and often times, jumping and skipping stages and then jumping back into previous stages. Depending on the “Important Considerations which Impact Grief,” (previously detailed) clinicians will observe more or less of this typical spiraling action.  The experiences will have a tri-part impact on the Body—Somatic pain, on the Mind—Psychic distress, and on the Spirit—Spiritual uncertainty and questioning, throughout the various stages of grief. 

           

Validating and Being Present with the Griever

            The clinician’s role in addition to offering techniques, which will help alleviate distressing symptoms and move toward coping and healing, is to Validate and be present with the griever’s inner and outer experiences, and the multi-dimensional levels (somatic, psychic, and spiritual) of pain and distress. A non-anxious, supporting, validating presence with unconditional positive regard, is many times all that the griever needs when seeking support from a therapist. Having one’s experience validated can be healing in itself, and the opportunity to make sense of the overwhelming changes the loss and grief is having in one’s life, makes navigating the “newness” less stressful. The unknown territory of grief can produce a stress/traumatic response, therefore, psychoeducation on the various stages is oftentimes helpful for the griever, to simply have an idea that others go through the grief process, and what the griever might or might not go through himself/herself. The clinician can offer guidance and support, as well as various exercises and techniques, while movement is taking place between the stages and models. Grievers often feel comforted in experiencing their varying levels of pain and distress, knowing that there is guidance, (someone with a “flashlight” in this dark and unknown place) and that there is the possibility of hope; hope not only for recovery from pain, but hope for a future with meaning and the possibility of staying connected with their loved one while recovering from the loss.

 

II. The Continual Phase of Grief:

            The Continual Phase of Grief—proposed by Dezelic and Ghanoum (Ghanoum, 2013)—is not a finite stage; rather it is an ongoing phase that continues throughout the bereaved person’s lifetime, where the griever continues to work on assimilating the loss, and reconnecting to life and meaning-making possibilities. Essentially, this phase spans across the lifetime in an ongoing journey of recovery, post the prior grief stages and models. It is in this “overall, ongoing life phase” where the griever can (1) Recover Meaning, accesses (2) Resources of the Spirit—the unique essence of the individual, and works on (3) Healing through Meaning, Memory, Restoration and Re-activation (Dezelic, 2014; Frankl, 2006; Frankl, 2004; Frankl, 2000; Frankl, 1988; Frankl, 1986; Frankl, 1978; Ghanoum, 2013; Graber, 2004; Lukas, 2000; Marshall & Marshall, 2012; Rice et al., 2004; Welter, 2005).

 

(1) Recovering Meaning

            The griever is assisted by the clinician through meaning-oriented Logotherapy & Existential Analysis techniques to become aware that his/her Will to Meaning still exists, which may have been covered by the debris of grief; and that Meaning in Life has not ceased to exist even though a tremendous loss has occurred.  The griever learns to hold their grief present in their life, in the one hand, while accessing Meaning and Recovery, in the other hand simultaneously.  

 

(2) Resources of the Spirit

            The clinician helps the griever by accessing the many ongoing Resources of the Spirit of Frankl’s Nöetic (Spiritual) Dimension to assist in reactivating in his/her life and meaning possibilities. Resources of the spirit include: Spirit as the Healthy Core of the Individual, Self-Awareness and Discovery, Responsibility and Response-ability, Freedom To Act with Choice (Not Freedom From Something), Will To Find Meaning, Goals and Purposes in Life, Creativity and Imagination, Conscience (Beyond the Superego), Ideas and Ideals, Love (Beyond the Physical), Awareness of Mortality, Commitment to Tasks, Compassion and Forgiveness, and Sense of Humor (Dezelic, 2014; Graber, 2004; Rice et al., 2004).

 

(3) Healing through Meaning, Memory, Restoration, and Re-activation

            The griever is assisted and accompanied by the clinician toward Healing and Recovery of the varying levels of multi-dimensional pain through the four areas of Meaning, Memory, Restoration, and Re-activation:

            (A) Meaning: Creating new Meaning in the Moment, which can be found and fulfilled, where the griever can act with purposeful living, and be aware of the meaning possibilities of each moment; finding one’s new Meaning in Life, where the loved one is no longer physically present to experience life with the griever, and recognizing that the Will to Meaning exists even after the loss. New meanings can be created through the V. Frankl’s Meaning Triangle—Creativity, Experiences, and Attitudes.   Frankl’s Meaning Triangle consists of “Creativity: The creative gifts one offers through his[/her] innate gifts and talents in his[/her] work, deeds done, and goals achieved which held/hold meaning for him[/her];  Experiences: The experiences one has received from encountering others in relationships of all kinds, and from nature, culture or religion, that were deeply meaningful;  Attitudes: The attitudinal values one has realized by taking a stance toward a situation or circumstance, that was courageous or self-transcending” (Dezelic, 2013, p.46).  The griever can also engage in their Ultimate Meaning, an overarching meaning in life, where he/she can now incorporate the deceased person’s life as part of their journey toward their personal Ultimate Meaning.

            (B) Memory: Allowing the griever the safety to stay connected to the deceased by holding onto memories, revisiting memories, keeping their loved one’s memories alive in their present life through rituals, dreams, and spiritual presence; and even creating new memories with the deceased in the griever’s present life, such as sharing a new/memorable event with the deceased through their spiritual presence or memory of them, and including them somehow in the event.

            (C) Restoration: Feeling that one has been restored to a place that he/she can now continue to move through life, not “move on” from the deceased; there is a space for experiencing joy and happiness while maintaining the memory and connection with the deceased, and even the sadness. This joy and happiness does not replace the loved one, it can happen simultaneously, while holding the loved one close and present in one’s life.

            (D) Re-Activation: A feeling that life has regained a spark, excitement and possibly passion. New Meaning is often created through becoming mindfully present and connected to life. This is experienced as moving from Dis-Connection, while in throws of the painful grief, to Re-Connection with an acceptance that the loved one is no longer present, yet can still be a major part of the griever’s ongoing life. Here the griever possibly takes up and carries out a cause or project on behalf or in memory of the loved one, or even begins something new that the griever did not have the opportunity to before. The “Transitoriness of Life,” a recognition that death marks an end to a temporal existence (Dezelic, 2014; Frankl, 2006; Graber, 2004) has opened the griever’s eyes to following through with old, unrealized dreams, and old or new goals one wishes to accomplish before their own death. It is important to recognize that “Acceptance” does not mean accepting the death and moving on from the loved one; it is the ability to recognize that the death has occurred, it was difficult to go through the loss and change, and that the griever can maintain a connection with the deceased, even though the context of the connection has changed.  Acceptance here is the ability to continue to move forward in life, with a sense of re-activation after the loss has occurred.

 

Overview of the Continual Phase of Grief—Recovering Meaning, a Lifetime Journey of Recovery: Staying connected with the loved one; Continuing to create meaning with the loved one and self; Creativity, new Experiences, and Attitude; Meaning in the Moment; Ultimate Meaning; Ongoing Process; Surviving through the loss; Acceptance that the loved one is no longer present, yet can continue to have a presence in the griever’s life; The possibility of growth and thriving; Resilience; Transcendence; Defiant Power of the Spirit; New relationship with the deceased; Self-Transcendence.

 

Conclusion

 

            The Meaning-Centered Grief Model, “Processing Through Loss, Grief, Transitions and Transformation: A Meaning-Centered Existential Approach, is depicted in a “Conceptual Pictograph” to offer clinician’s and grievers a format, a guide, a navigation tool, and an awareness for the ongoing process of “Keeping your loved one sacred and present, while recovering Meaning in your life.”  The Continual Phase of Grief’s essence focuses on creating new meaning and significance after the loss, and learning how to continue to carry on a healthy relationship with one’s grief and the deceased.  This new Grief Model incorporates previous well-known and researched grief theories and models as building blocks to the Continual Phase of Grief, and continues the grief process throughout the griever’s lifetime, as the griever’s life is forever changed by the relationship with the deceased and the loss.  The Meaning-Centered Grief Model is based on the theory and therapeutic approach of V. Frankl’s Logotherapy & Existential Analysis, and is proposed as a new Grief Construct for clinicians and grievers.

 

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