Death Studies, 24: 541–558, 2000

Copyright Ó 2000 Taylor & Francis

0748-1187/ 00 $12.00 1 .00

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SEARCHING FOR THE MEANING OF MEANING :

GRIEF THERA PY A ND THE PROCESS OF
RECONSTRUCTION
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ROBERT A. NEIMEYER
University of Memphis, Memphis, Tennessee, USA

A comprehensive quantitative review of published randomized controlled outcome

studies of grief counseling and therapy suggests that such interventions are typically
ine¡ective, and perhaps even deleterious, at least for persons experiencing a normal
bereavement. On the other hand, there is some evidence that grief therapy is more
beneŽcial and safer f or those who have been traumatically bereaved. Beginning with
this sobering appraisal, this article considers the Žndings of C. G. D avis, C. B.
Wortman, D . R. Lehman, and R. C. Silver ( this issue ) and their implications f or a
meaning reconstructi on approach to grief therapy, arguing that an expanded concep-
tion of meaning is necessary to provide a strong er basis for clinical intervention.

What role does the ‘‘search for meaning’’ play in the struggle of
bereaved persons to adapt to loss, and how might professional
therapy assist with this e¡ort when indigenous sources of support
fail ? In taking up these thorny questions, Davis, Wortman,
Lehman, and Silver ( this issue ) posed a provocative challenge to
the sometimes glib assumptions of grief counselors and researchers,
o¡ering data that undermine the presumed necessity of meaning
making and extrapolating from suggestive research Ž ndings to
frame recommendations for practice. My intention in this article is
in a sense to reverse this emphasis, by o¡ering Ž rst some data
regarding the efficacy of psychotherapy for bereaved persons and
then pondering the prospects for a meaning reconstruction

Received 4 November 1999 : accepted 6 March 2000

Address correspondence to Robert A. Neimeyer, Ph.D., Department of Psychology, Uni-
versity of Memphis, Memphis TN 38152. E-mail : [email protected]

541
54 2 R. A . N eimeyer

approach to grief counseling in light of these results. As we shall

see, these somewhat di¡erent peregrinations lead to a surprisingly
similar destination—namely, a more discriminating endorsement of
grief therapy for some, but by no means all bereaved individuals,
and a cautious optimism about the value of ‘‘intervening in
meaning’’ for this subset of mourners.

Is Grief Therapy J ustiŽ ed ?

A great deal has been written about grief counseling in the last 25
years, giving rise to a burgeoning popular and professional liter-
ature pro¡ering assistance to the bereaved, as well as to persons
su¡ering a wide range of additional losses through means other
than the death of a loved one. In the face of this proliferating
attention, one might assume that grief counseling is a Ž rmly estab-
lished, demonstrably e¡ective service, which, like psychotherapy in
general, seems to have found a secure niche in the health care Ž eld,
at least in North America.
Ironically, perhaps, this assumption represents at best a half-
truth. Grief counseling has indeed proliferated, both in the formal
venues of professional conferences, workshops, and publications,
and in the countless institutional or community-based programs
run by grief therapists, or operated on a mutual support basis by
lay leaders. Moreover, scores of uncontrolled descriptive studies
indicate that bereaved persons in these programs typically report
reduced depressive, anxious, or general psychiatric symptom-
atology following their participation, reinforcing the impression
that grief counseling is indeed e¡ective in assisting with ‘‘recovery’’
from acute grieving.
However, only controlled studies in which bereaved individuals
are randomly assigned to treatment and control conditions can
yield a clear verdict on the e¡ectiveness of grief therapy. Uncon-
trolled studies are at best suggestive, as acute grief could simply
remit with the passage of time, as a function of ‘‘curative factors’’
( e.g., social support ) in the natural environment or as a result of
the bereaved person’s own coping e¡orts. Indeed, when controlled
Meaning of M eaning 543

studies of professional interventions are analyzed ( as in Rose and

Bisson’s, 1998, review of debrieŽ ng interventions cited by Davis et
al., in press ), results are often equivocal, with di¡erent studies sug-
gesting positive, negative, and ‘‘no di¡erence’’ conclusions. Such
results make it essential to conduct a comprehensive review of all
controlled outcome studies of grief counseling to reach conŽ dent
conclusions about whether grief therapy is indeed e¡ective, and if
so, for whom.
My colleagues—Barry Fortner, Adam Anderson, Je¡ Berman—
and I have just completed such a review ( Fortner & Neimeyer,
1999 ). 1 In undertaking this project, we were struck by the extent
to which recent reviewers of this literature ( e.g., Kato & Mann,
1999 ) analyzed only a small subset of the available studies, and
even then, relied primarily on impressionistic evaluations of
outcome, supplemented by relatively global application of quanti-
tative review methods. Others ( Allumbaugh & Hoyt, 1999 ) o¡ered
more detailed quantitative reviews of the published and unpub-
lished literature but included numerous uncontrolled one-group
studies that could have in ated estimates of the e¡ectiveness of the
therapies studied. The result was signiŽ cant discrepancy from one
review to the next regarding the efficacy of psychosocial interven-
tions for the bereaved. To remedy these and other shortcomings of
previous reviews, my colleagues and I located all scientiŽ cally ade-
quate outcome investigations of grief therapy published between
1975 ( when the Ž rst such research appeared ) and 1998, a total of
23 separate studies reported in 28 di¡erent papers. As criteria for
inclusion, all had to focus on bereaved persons mourning the death
of a loved one, who received some form of psychosocial interven-
tion ( psychotherapy, counseling, or facilitated group support ), and
who were randomly assigned to a treatment or control condition.
The over 1,600 participants in these studies had experienced a
wide range of losses—of spouses, children, and other family
members—who had died from a broad spectrum of causes, both
sudden and protracted. Professional therapists provided therapy in
19 of these studies, and nonprofessionals conducted the remainder.
Finally, it was notable that the majority of studies assessed

1
A full report of the study appears in Fortner’s dissertation of the same title, July,
1999, University of Memphis, which is now being readied for publication.
544 R. A . N eimeyer

outcome on generic measures of health, depression, anxiety, or psy-

chiatric distress, while only a few attempted to measure grief per
se, and then typically using idiosyncratic or unvalidated measures.
We assessed the efficacy of grief therapy using two statistics, one
of which has been widely used in meta-analyses conducted over the
last 20 years and one of which represents a recent innovation in
quantitative review procedures. The Ž rst of these was Cohen’s d,
which re ects the posttest di¡erence between treated and untreated
groups across a range of outcome measures—a straightforward
measure of the degree of beneŽ t associated with participation in
therapy ( Cohen, 1997 ). The second, more novel procedure allowed
us to estimate treatment-induced deterioration, which represents the pro-
portion of participants who are worse o¡ after treatment than they
would have been if they had been assigned to the control group.2
It is important to emphasize that this latter measure did not re ect
absolute deterioration—the case of an individual functioning more
poorly after therapy than before—because the therapy could still
be deemed helpful in this case if the same person would have been
even more symptomatic with no treatment. Likewise, therapy
clients could actually make some gains but still fall short of where
they would be if the treatment held them back relative to where
they would be if untreated. Thus, we were interested in treatment-
induced deterioration, deŽ ned as all instances in which therapy
recipients theoretically would have fared better if left alone, irre-
spective of the absolute direction of change they showed over the
course of the study.
Analyzing the 23 randomized controlled studies using these
metrics produced some interesting results. To begin with, we found
that the mean e¡ect size of .13 was positive, and reliably di¡erent
than zero, re ecting the superiority of outcomes for treated relative
to untreated persons. However, the e¡ect size was also quite small
in absolute terms, when compared with the much more substantial
e¡ects associated with psychotherapy for depression and for
2
This method assumes that individuals would maintain their relative positions within
groups whether assigned to the treatment or control condition, and that outcome scores in
both conditions are normally distributed. Given these assumptions, it is possible to estimate
the percentage of the treatment group falling below where they would otherwise fall on the
control distribution, taking into account the variance and mean of each condition. Formulas
for this z statistic and Cohen’s d, as well as other methodological details of the review, can be
found in the original report.
Meaning of M eaning 545

psychological disorders more generally. Stated in other terms, the

average participant in grief therapy was better o¡ than only 55%
of bereaved persons who received no treatment at all—hardly an
impressive demonstration of the efficacy of grief counseling.
The analysis for treatment-induced deterioration was perhaps
more sobering still. When we computed this statistic, we discovered
that nearly 38% of recipients of grief counseling theoretically
would have fared better if assigned to the no-treatment condition ;
in strong contrast, only 5% of clients in a broad range of psycho-
therapies for other problems showed such deterioration ( Anderson,
1999 ). Thus, not only is the tangible beneŽ t of grief therapy small,
but its risk of producing iatrogenic worsening of problems is unac-
ceptably high—a troubling pattern that is unique among typically
e¡ective and safe psychosocial interventions.
What could account for these disconcerting Ž ndings ? Unfor-
tunately, simple explanations focusing on the intractability of loss,
or the necessity to engage in distressing ‘‘grief work’’ prior to rees-
tablishing an emotional equilibrium, however valid, fail to account
for the di¡erential deterioration of treated versus untreated clients.
Moreover, spontaneous improvement of treated and untreated sub-
jects alike seems implausible, given the Ž ndings of Allumbaugh and
Hoyt ( 1999 ) suggesting essentially no improvement in the latter
category over the brief periods associated with the average treat-
ment study. The brevity of the therapies provided ( whose mean
number of sessions was 7 ) might also be argued to mitigate the
e¡ectiveness of these interventions, as substantial grief can persist
for a period of years. However, such an argument is weakened by
the variable length of therapy represented by these two dozen
studies, and our Ž nding that e¡ect size was uncorrelated with
length of treatment. Nor did categorical distinctions associated
with the therapies or therapists account for the poor showing of
these therapies, as outcome was also unrelated to type of treatment
( individual vs. family vs. group ), therapeutic approach, or level of
training of therapists ( professional vs. nonprofessional ). What,
then, could explain the limited use and high risk of grief coun-
seling ?
In pursuing answers to these questions, we found some prom-
ising leads in the di¡erential responses of di¡erent clients to the
interventions o¡ered. For example, clients varied considerably in
546 R. A . N eimeyer

the length of time between their loss and enrollment in bereave-

ment programs ( M 5 6 mos. ), with some being o¡ered services
immediately after the death had occurred, and others being
approached many years later. Interestingly, better outcomes were
obtained for clients who were more distant from the death ( r 5 .5
between treatment e¡ect and weeks of bereavement ). Likewise, the
deterioration e¡ect was strongly correlated with client age
( r 5 2 .7 ), suggesting that younger clients fared better than older
ones in such therapies. Perhaps most interesting, however, was the
result of a follow-up analysis in which we discriminated between
outcomes in those 5 studies o¡ering treatment for persons who were
traumatically bereaved ( e.g., through violent, sudden, or untimely
death, or whose grief was more chronic ) and those that focused on
‘‘normal’’ bereavement reactions. Here, the results were especially
clear : Counseling for normal grievers had essentially no measur-
able positive e¡ect on any variable ( d 5 .06 ), whereas the subset of
studies o¡ering therapy for traumatic grief showed a reliable posi-
tive e¡ect ( d 5 .38 ). Equally heartening was the Ž nding that dete-
rioration e¡ects were substantially lower for traumatized clients
( 17% ) than for normal or unselected samples, for whom nearly one
in two clients su¡ered as a result of treatment. Together, these Ž nd-
ings point toward an intriguing and consistent conclusion: That
grief therapy is appropriately o¡ered to mourners experiencing
protracted, traumatic, or complicated grief reactions. Conversely,
existing evidence from scientiŽ cally credible controlled outcome
trials suggests that grief therapy for normal bereavement is difficult
to justify.

Grief Therapy as Meaning Reconstruction

Although the evidence reviewed above provides some encour-

agement for grief therapy as a legitimate treatment for chronic or
traumatic bereavement, it remains the case that the e¡ect sizes
associated with such therapies are only half as robust as those
associated with psychosocial interventions for other problems. It
therefore seems critical to pursue the question, ‘‘Why are the
results of grief therapy so modest, even for potentially traumatic
grief reactions ?’’
Meaning of M eaning 547

Answers could be sought in a variety of factors. At a method-

ological level, it could simply be that medically oriented
researchers are assessing an inappropriate domain of outcome,
focusing on psychiatric and physical problems, rather than features
distinctive to grief per se ( Neimeyer & Hogan, 2000 ). For example,
Rubin ( 1999 ) has argued that adaptation to loss progresses
along two clearly distinguishable tracks, one of which concerns
symptomatology ( e.g., anxiety and depression ) and the other of
which centers on the relationship to the deceased. In support of
this conceptualization, independent researchers ( Byrne & Raphael,
1997 ) have provided evidence that core features of grieving focus-
ing on disruptions in the attachment relationship to the lost loved
one ( such as yearning for the deceased ) are relatively independent
of general depression ( see also Jacobs & Prigerson, this issue ). Sig-
niŽ cantly, persistent relational distress also predicts poorer long-
term outcome deŽ ned in terms of both mental and physical health
status ( Prigerson et al., 1997 ). This raises the possibility that
unique goals of grief therapy—such as helping the bereaved trans-
form the concrete relationship to the deceased to a symbolic one—
have yet to be assessed by existing outcome studies, despite the
existence of validated scales that might reveal such distinctive pat-
terns ( Neimeyer & Hogan, 2000 ).
A more substantive explanation for the generally unimpressive
beneŽ ts of grief therapy might focus on the nature of the treatment
itself. To a remarkable degree, controlled studies of grief counseling
fail to describe the conceptual models that underpin their
approach to therapy, in sharp contrast to the general psycho-
therapy outcome literature, which tends to test well-delineated
models of treatment. When grief therapy is described in such
studies, it tends to be based on suspiciously simplistic models, such
as stage theories of grieving that have been largely repudiated by
contemporary theorists and researchers ( Corr, 1993; Neimeyer,
1998 ). Thus, a second possible reason for the weak showing of grief
counseling is that it rarely draws on the best available theories
regarding the nature of bereavement and its facilitation.
If investigators were interested in designing and testing more
promising approaches to grief therapy, on what principles and pro-
cedures might they draw ? One answer that is suggested by the
results of Davis et al. ( this issue ) would be those deriving from a
548 R. A . N eimeyer

focus on meaning making processes in the aftermath of bereavement.

Such a perspective would argue for a signiŽ cant shift in the
implicit paradigm under which grief therapy is practiced, away
from a medical model emphasizing the control of disruptive symp-
tomatology, and beyond the well-intended but vague assumption
that a sharing of feelings in a supportive environment will promote
‘‘recovery.’’ Instead, intervention, when indicated, might be
informed by the proposition that ‘‘meaning reconstruction in
response to a loss is the central process in grieving’’ ( Neimeyer,
1998, p. 110 ). My goal in the present section is to consider what
guidance the results of Davis et al. might give in developing such
an alternative treatment approach, and how related scholarship
might further the synergy of research and practice in this area.
Davis et al. ( this issue ) discussed two illuminating studies of
persons bereaved by sudden infant death syndrome ( SIDS ) and
motor vehicle accidents ( MVAs ), reporting data on the percentage
of those who undertake a ‘‘search for meaning’’ in their loss, and
the relation of this search to psychological well-being. In so doing,
the authors provocatively focus attention on the important minor-
ity of bereaved who do not seek the meaning of the death, and the
evidence that they fare as well as—or better than—their counter-
parts who engage in a protracted search for signiŽ cance. Their
Ž ndings therefore serve as a useful corrective to the glib assumption
that meaning must be sought in the death and must be found if the
loss is to be resolved. However, taken out of the broader context of
their Ž ndings, this conclusion presents a distorted picture of the
relationship of meaning making to a favorable outcome to bereave-
ment. For this reason, it is worthwhile to reiterate and clarify the
Ž ndings they report in their article. In brief, the data of the SIDS
study document the following :

d 86% of parents who lost a child to SIDS undertook a search for

the meaning of the death, whereas 14% did not.
d Of the 14% who did not seek existential answers for why the
death occurred, 3% seem to have foreclosed on pre-existing
meanings for the death ( e.g., as God’s will ), whereas 11%
reported having no such meaning.
d 18% of the parents had discontinued their search for meaning in
the Ž rst month following loss, over half of them without Ž nding
Meaning of M eaning 549

satisfactory answers.
d Those parents who neither sought nor found meaning in the
death fared as well psychologically as those parents who had
successfully struggled for meaning, and both groups ultimately
did better than those who searched for meaning in the death,
but found none.
d The search for meaning was ongoing for many parents, even
when some sense was made of the loss early in bereavement ; in
other words, sense making in the early weeks of loss was pro-
visional rather than permanent.

Many of these patterns are reinforced by the results of the MVA

study, in which 70–80% of respondents reported having been con-
cerned with the issue of the meaning of their loved one’s death,
whereas 20–30% did not. Again, those persons who sought answers
to no avail fared worse in their adjustment to the loss than did
those who never sought answers in the Ž rst place, although the
large number of persons who sought and found workable meanings
were intermediate in their adjustment on a number of measures.
Taken together, these studies document that the ‘‘search for
meaning’’ plays a compelling role in the grief of the great majority
( 70–85% ) of persons experiencing sudden, potentially traumatizing
bereavement, although a signiŽ cant minority apparently copes
straightforwardly with their loss, without engaging in deep-going
re ection about its signiŽ cance ( Attig, 1996 ). For those who seek
meaning and Ž nd none, the loss can be excruciating, and data
suggest that they report intense su¡ering on a variety of outcome
measures. Conversely, bereaved persons who Ž nd a measure of
meaning in the loss fare better, rivaling the adjustment of those
who never feel the need to undertake existential questioning in the
Ž rst place. Even these ‘‘Ž nders’’ are not necessarily ‘‘keepers,’’
however, insofar as many of those who felt they had found answers
to why the loss had occurred revisited these answers in the months
that followed.
These Ž ndings carry important implications for the practice of
grief therapy. First, and most obviously, they highlight the fact
that a quest for meaning plays a prominent role in grieving, at
least for those who are bereaved by the sudden death of a loved
one. When a client is struggling for signiŽ cance in the loss, the
550 R. A . N eimeyer

counselor would be well advised to facilitate this process, perhaps

by drawing on some of the speciŽ c meaning-making strategies that
have been formulated for this purpose ( Neimeyer, 1998 ). Second,
grief counselors should be cautious about instigating a search for
meaning in the minority of cases in which clients do not sponta-
neously undertake such a search, insofar as these individuals might
well be coping adaptively using pragmatic, rather than philo-
sophic, strategies. 3 Finally, counselors would do well to remember
that meaning-making is more an activity than an achievement, as
early, provisional meanings of the death tend to be revisited as the
reality of living with loss raises new questions and undermines old
answers.

The Meaning of Meaning

Although Davis et al. ( this issue ) appropriately sensitized prac-

ticing therapists to the importance of a search for meaning for
most, but not all, bereaved persons, their data are ultimately too
global to specify how such a search might be undertaken in the
context of therapy. However, Ž ndings from another study by
Davis, Nolen-Hoeksema, and Larson ( 1998 ) extend this work in
practically helpful directions.
Unlike the participants in the SIDS and MVA studies, the 205
participants in the 1998 research were bereaved by the slower pro-
gressive death of loved ones in home-based hospice settings, chie y
by cancer. Because death was anticipated, the researchers were
able to assess pre-loss functioning ( an average of 3 months prior to
the death ), as well as post-loss adjustment across the Ž rst 18
months of bereavement. More important, they posed more reŽ ned

3
This contrast between the majority of grievers who seek meaning in the death and
the minority who apparently do not might re¯ ect their di€ erential emphasis on what
Stroebe and Schut (1999) have referred to as ‘‘loss-oriented’’ and ‘‘restoration-oriented’’
processes in adjustment to bereavement. Brie¯ y stated, the former involves a high degree of
re¯ ective grief work, whereas the latter involves primarily adapting to the demands of a
changed external world. One of the advantages of this ‘‘dual-process’’ model is that it resists
privileging one of these orientations over the other, although it speci® es that most grievers
will ‘‘oscillate’’ between the two spheres of readjustment over time.
Meaning of M eaning 551

questions about the e¡ort after meaning at each of the post-loss

interviews, asking not only whether the survivor had been able to
‘‘make sense of the death,’’ but also whether she or he had ‘‘found
anything positive in the experience.’’ In this way the researchers
were able to examine two component processes of meaning-
making, sense-making and beneŽ t-Ž nding, and to demonstrate that
these were largely unrelated and had di¡erent antecedents and
consequences. For example, those persons who were able to make
sense of the death 6 months later tended to be those who lost an
older relative, who had a pre-existing spiritual or religious frame-
work, and who had displayed less distress in the months preceding
the death. Conversely, the ability to Ž nd a ‘‘silver lining’’ in the
loss was associated only with the personality characteristic of ( pre-
loss ) optimism–pessimism. Furthermore, while being able to
explain the loss was associated with less distress 6 months following
the death, only Ž nding beneŽ t in the experience was consistently
associated with better adjustment at the 13- and 18-month post-
loss interviews. More interesting, analysis of participants’ responses
indicated that it was not the content of the sense made ( e.g., that
death was part of the life cycle ; that it was the will of God ) or the
beneŽ t found ( e.g., an enhanced perspective, bringing the family
together ) but simply whether meaning was made of the loss, that
predicted adaptation to bereavement.
For grief therapists, these Ž ndings suggest that the meaning-
making processes that are most relevant to facilitate tend to shift
over time, from an early emphasis on Ž nding an answer to the
question of ‘‘why’’ the death occurred, to a later focus on the posi-
tive ( albeit unsought ) beneŽ ts of the loss for survivors. Moreover,
the directional change in meaning reconstruction clearly is impor-
tant to trace, insofar as those persons who gained in sense-making
from 6 to 13 months post-loss showed the greatest improvement in
psychological well-being, whereas those who lost ground in the
quest for meaning showed the greatest deterioration in functioning.
Meaning reconstruction therefore appears to be a dynamic process
with multiple aspects, whose provisional outcomes predict key fea-
tures of adaptation to bereavement.
Extending the work of Davis and his collaborators, how might
we elaborate the notion of meaning reconstruction to make it still
more adequate to the subtleties of this process in the lives of
55 2 R. A . N eimeyer

bereaved persons? What seems essential is transcending a simple

‘‘cognitive’’ reading of the concept of meaning, which interprets it
as a conscious, intellectual acquisition of individuals, rather than a
predominantly tacit, passionate process that unfolds in a social
Ž eld. Drawing inspiration from recent qualitative research in
bereavement ( Neimeyer & Hogan, 2000 ) and broader construc-
tivist theories of psychotherapy ( Neimeyer & Mahoney, 1995 ),
meaning reconstruction might be deŽ ned more broadly to include
the following.

1. T he attempt to Žnd or create new meaning in the life of the survivor, as

well as in the death of the loved one. Because our relationships with
intimate others provide a repository of shared memories and a
validating context for our most cherished beliefs ( LandŽ eld,
1988 ), the loss of these relationships undermines our self-
narrative, and with it, our identity ( Neimeyer, 2000b ). Culti-
vating this insight, contemporary grief theorists such as Attig
( 1996 ) have construed grieving as a process of ‘‘relearning’’ the
world and the self, Ž nding a new existential grounding for one’s
self-concept and life direction. Frantz, Farrell, and Trolley
( 2000 ) have documented the pervasiveness of this personal
reconstruction in the lives of nearly 400 bereaved adults, who
reported a year following the loss that they viewed themselves as
more mature and independent ( 3 2% ), living more fully in the
present ( 17% ), and more compassionate and expressive with
others ( 14% ). SigniŽ cantly, a minority also acknowledged
regressive shifts in their sense of self, noting that a part of them
had died ( 10% ), that they were more fearful of death ( 5% ), or
were hardened by the experience ( 5% ).
2. T he integ ration of meaning , as well as its construction. A more ade-
quate theory of personal knowledge would view any given con-
struction of signiŽ cance as situated within a unique ecology of
meaning ( Neimeyer & Harter, 1988 ), a system of personal con-
structs that vary in their hierarchical organization ( Kelly, 1955/
1991 ; Mahoney, 1991 ). Thus, the ‘‘same’’ meaning might for
one person represent a relatively peripheral construction,
whereas for another person ( or at a later point in bereavement )
it might function as a central, organizing frame for living.
Something of this kind has been demonstrated in the sophisti-
Meaning of M eaning 553

cated qualitative research of Richards and Folkman ( Richards,

Acree, & Folkman, 1999; Richards & Folkman, 1997 ), who
have traced the way in which spiritual constructions of the
meaning of a death evolved across the course of bereavement for
caregivers of gay men who died of AIDS. Initially, spiritual
interpretations seemed to provide ad hoc explanations for the
death itself, serving as coping resources for the surviving
partner. With time, however, spiritual frames of meaning came
to pervade the existence of the majority of these men, resulting
in a substantially deepened sense of purpose and signiŽ cance in
their lives with others.
3. T he construction of meaning as an interpersonal, as well as personal,
process. Although the meanings we assign to loss are highly idio-
syncratic, they are nonetheless negotiated in a social context
( Neimeyer, 1998 ). Nadeau ( 1997 ) has studied this highly inter-
active process in families contending with the death of a
member, developing a taxonomy of the strategies by which they
collectively seek signiŽ cance in the event ( through the interpre-
tation of meaningful coincidences, ‘‘mind reading’’ the desires of
the deceased, and so on ). Similarly, Hagemeister and
Rosenblatt ( 1997 ) have investigated the shared meanings of the
sexual relationship between spouses who have lost a child,
meanings that promote joint healing ( e.g., ‘‘this is a way of
affirming our love for each other’’ ) or create emotional impasses
( e.g., ‘‘sex is too painful, because it is how we made this child’’ ).
Thus, the social Ž eld is vital in the construction of meaning,
providing an audience for those accounts by which we attempt
to render unwelcome life transitions intelligible ( Harvey, 1996 ).
4. T he anchoring of meaning making in cultural, as well as intimate, discur-
sive contexts. A fuller appreciation of reconstructive processes fol-
lowing loss must surely take into account frameworks of
meaning that are too large to be conŽ ned to a single local
network of relationships and too enduring to be accumulated in
a single generation. Indeed, the very terms in which we con-
strue death and grief are cultural artifacts, as are the social roles
we assign to survivors ( Neimeyer, 1998 ). As Klass ( 1999 ) has
demonstrated in his elegant ethnographic study of bereaved
parents, grieving individuals routinely draw on the discourses
and rituals of the cultural traditions in which they are situated,
554 R. A . N eimeyer

and reinterpret these at personal and interpersonal levels. A

more extensive appreciation of the uniqueness of grieving
among groups that are often con ated in the minds of would-be
helpers is beginning to emerge from qualitative studies, such as
the focus groups with representatives of various Asian American
subcultures conducted by Braun and Nichols ( 1997 ).
5. T acit and preverbal, as well as explicit and articulate meaning s. A
common shortcoming of cognitive accounts of meaning-making
is their simplistic assumption that the construction of signiŽ -
cance is ( or should be ) a logical, verbalizable process
( Neimeyer, 1995 ). But more philosophically sophisticated
( Polanyi, 1958 ) and clinically compelling ( Guidano & Liotti,
1983 ) accounts of personal knowledge and its development
argue that the ‘‘deep structure’’ of our constructions of reality is
in principle tacit, inexpressible in any complete sense in public
speech. Stated di¡erently, there are some meanings that are too
embedded in our lives, too embodied in our actions, to be
amenable to formulation in a set of ‘‘beliefs’’ or ‘‘self-
statements.’’ In the context of grief therapy, this implies that the
counselor needs to attend to nuances of client meanings that
might be hinted at by vocal tones, gestures, and emphases, as
much as communicated in straightforward propositions
( Neimeyer, 2000a ). The possibility that the most important
meanings of loss might elude simple verbal formulation also
prompts a variety of more metaphoric, poetic, and narrative
strategies for exploring the multiple meanings of a loved one’s
life and death, and its relevance to a client’s own ( Neimeyer,
1998 ).
6. T he processes of meaning reconstruction, as well as its products. A corol-
lary of the predominantly cognitive interpretation of meaning in
our Ž eld is that it is often regarded as a product, as something
that is ‘‘searched for’’ and ‘‘found,’’ rather than created by the
persons or groups who seek it. Although it is important to
acknowledge that some meanings of loss are indeed discovered
as well as invented ( Attig, 2000 ), an emphasis on pre-existing
truths obscures the delicate processes by which fresh meanings
are typically constructed. For example, one key process entailed
in rebuilding an assumptive world decimated by loss might be
the ability to tack back and forth among di¡erent styles of nar-
Meaning of M eaning 555

rating our experience, between objective, external accounts,

subjective, involved narratives, and re exive self-examination
( Goncalves, Korman, & Angus, 2000 ). Principles and pro-
cedures for developing life narratives that can accommodate
traumatic experiences have been o¡ered by a number of con-
temporary constructivist therapists ( Neimeyer & Stewart, 1998;
Sewell, 1997; Stewart, 1995 ).

In summary, the perspective I am advocating here argues for

our selective engagement in grief therapy with those bereaved
persons whose grief is traumatic or prolonged, as well as respectful
witnessing of the self-help e¡orts of those who do not require our
well-meaning involvement—and might even be harmed by it.
When grief therapy is o¡ered, I believe it must attend to the pro-
found challenges to clients’ ( inter )personal systems of meanings
brought about by tragic loss and facilitate the survivors’ own strug-
gle to Ž nd signiŽ cance both in the death and in their ongoing lives.
Finally, I would advocate a more reŽ ned and clinically rich con-
ception of the process of meaning reconstruction, one that accredits
its complexity, its social character, and the conditions that facili-
tate or impede it. The work of Davis and his colleagues, as well as
the other contributors to this special series in D eath Studies, o¡er us
some useful direction in this e¡ort.

Conclusion

A close review of the most authoritative and reliable research cur-

rently available leaves us with sobering conclusions about the
general e¡ectiveness ( or even advisability ) of grief counseling and
therapy, as well as a few clues as to when professional intervention
might be more clearly indicated. These same Ž ndings, in com-
bination with the work of researchers like Davis et al. ( in press ),
also suggest possibilities for the reŽ nement of grief therapy and
research in a way that can ultimately strengthen both. I hope that
some of the results and re ections o¡ered here contribute to this
development, and prompt us toward a more adequate theory of
556 R. A . N eimeyer

the reconstructive processes that permit adaptation to profound

loss.

References

Allumbaugh, D. L., & Hoyt, W. T. ( 1999 ). E¡ectiveness of grief therapy : A meta-

analysis. J ournal of Counseling Psycholog y, 46, 370–380.
Anderson, A. ( 1999 ). T reatment induced deterioration in psychotherapy. Unpublished
masters thesis, University of Memphis, Memphis, TN.
Attig, T. ( 1996 ). How we grieve : Relearning the world. New York : Oxford University
Press.
Attig, T. ( 2000 ). Relearning the world : Making and Ž nding meanings. I n R. A.
Neimeyer ( Ed. ), M eaning reconstruction and the experience of loss. Washington, DC.
American Psychological Association.
Braun, K. L., & Nichols, R. ( 1997 ). Death and dying in four Asian American
cultures. D eath Studies, 21, 3 27–359.
Byrne, G., & Raphael, B. ( 1997 ). The psychological symptoms of conjugal
bereavement in elderly men over the Ž rst 13 months. International J ournal of
Geriatric Psychiatry, 12, 241– 251.
Cohen, J. ( 1997 ). Statistical power analysis for the behavioral sciences ( rev. ed. ). New
York : Academic.
Corr, C. A. ( 1993 ). Coping with dying : Lessons we should and should not learn
from the work of Elisabeth KuÈ bler-Ross. D eath Studies, 17, 69–83.
Davis, C. G., Nolen-Hoeksema, S., & Larson, J. ( 1998 ). Making sense of loss and
beneŽ ting from the experience : Two construals of meaning. J ournal of Person-
ality and Social Psycholog y, 75, 561–574.
Davis, C. G., Wortman, C. B., Lehman, D. R., & Silver, R. C. ( this issue ).
Searching for meaning in loss : Are clinical assumptions correct ? D eath Studies,
24, 497–540.
Fortner, B., & Neimeyer, R. A. ( 1999 ). T he e¡ectiveness of grief counseling and
therapy: A quantitative review. San Antonio, TX : Annual Meeting of the Associ-
ation for Death Education and Counseling.
Frantz, T. T., Farrell, M. M., & Trolley, B. C. ( 2000 ). Positive outcomes of losing
a loved one. In R. A. Neimeyer ( Ed. ), M eaning reconstruction and the experience of
loss. Washington, DC : American Psychological Association.
Goncalves, O. F., Korman, Y., & Angus, L. ( 2000 ). Constructing psychopath-
ology from a cognitive narrative perspective. In R. A. Neimeyer & J. Raskin
( Eds. ), Constructions of disorder ( pp. 265– 284 ). Washington, DC : American
Psychological Association.
Guidano, V. F., & Liotti, G. ( 1983 ). Cog nitive processes and emotional disorders. New
York : Guilford.
Hagemeister, A. K., & Rosenblatt, P. C. ( 1997 ). Grief and the sexual relationship
of couples who have experienced a child’s death. Death Studies, 21, 231– 251.
Meaning of M eaning 557

Harvey, J . H. ( 1996 ). Embracing their memory. Needham Heights, MA : Allyn &

Bacon.
Kato, P. M., & Mann, T. ( 1999 ). A synthesis of psychological interventions for
the bereaved. Clinical Psycholog y Review, 19, 275– 296.
Kelly, G. A. ( 1955/ 1991 ). T he psycholog y of personal constructs. New York : Rout-
ledge.
Klass, D. ( 1999 ). T he spiritual lives of bereaved parents. Philadelphia, PA : Brunner
Mazel.
LandŽ eld, A. W. ( 1988 ). Personal science and the concept of validation. Interna-
tional J ournal of Personal Construct Psycholog y, 1, 237– 250.
Mahoney, M. J. ( 1991 ). Human change processes. New York : Basic.
Nadeau, J. W. ( 1997 ). Families making sense of death. Newbury Park, CA : Sage.
Neimeyer, R. A. ( 1995 ). Constructivist psychotherapies : Features, foundations,
and future directions. In R. A. Neimeyer & M. J . Mahoney ( Eds. ), Construc-
tivism in psychotherapy ( pp. 11–38 ). Washington, DC : American Psychological
Association.
Neimeyer, R. A. ( 1998 ). Lessons of loss : A guide of coping . New York : McGraw-Hill.
Neimeyer, R. A. ( 2000a ). The language of loss. I n R. A. Neimeyer ( Ed. ), M eaning
reconstruction and the experience of loss. Washington, DC : American Psychological
Association.
Neimeyer, R. A. ( 2000b ). Narrative disruptions in the construction of self. In
R. A. Neimeyer & J. Raskin ( Eds. ), Constructions of disorder : M eaning making
frameworks f or psychotherapy ( pp. 207– 241 ). Washington, DC : American Psycho-
logical Association.
Neimeyer, R. A. & Harter, S. ( 1988 ). Facilitating individual change in personal
construct psychotherapy. In G. Dunnett ( Ed. ), Working with people ( pp. 174–
185 ). London : Routledge.
Neimeyer, R. A., & Hogan, N. ( 2000 ). Quantitative or qualitative ? Measurement
issues in the study of grief. In M. Stroebe, H. Schut, & R. Hansson ( Eds. ),
Handbook of bereavement. Washington, DC : American Psychological Association.
Neimeyer, R. A., & Mahoney, M. J. ( Eds. ). ( 1995 ). Constructivism in psychotherapy.
Washington, DC : American Psychological Association.
Neimeyer, R. A., & Stewart, A. E. ( 1998 ). Trauma, healing, and the narrative
emplotment of loss. In C. Franklin & P. S. Nurius ( Eds. ), Constructivism in
practice ( pp. 165–184 ). Milwaukee, WI : Families International.
Polanyi, M. ( 1958 ). Personal knowledg e. New York : Harper.
Prigerson, H. G., Beirhals, A. J., Kasl, S. V., Reynolds, C. F., et al. ( 1997 ).
Traumatic grief as a risk factor for mental and physical morbidity. American
J ournal of Psychiatry, 154, 616–6 23.
Richards, A. T., Acree, M., & Folkman, S. ( 1999 ). Spiritual aspects of loss among
partners of men with AIDS : Postbereavement follow-up. D eath Studies, 23, 105–
1 27.
Richards, T. A., & Folkman, S. ( 1997 ). Spiritual aspects of loss at the time of a
partner’s death from AIDS. D eath Studies, 21, 515–540.
Rose, S., & Bisson, J. ( 1998 ). Brief early psychological interventions following
trauma : A review of the literature. J ournal of T raumatic Stress, 11, 697–710.
558 R. A . N eimeyer

Rubin, S. ( 1999 ). The Two-Track Model of Bereavement : Overview, retrospect

and prospect. D eath Studies, 23, 681–714.
Sewell, K. W. ( 1997 ). Posttraumatic stress : Towards a constructivist model of
psychotherapy. I n G. J . Neimeyer & R. A. Neimeyer ( Eds. ), Advances in person-
al construct psycholog y, Vol. 4 ( pp. 207– 235 ). Greenwich, CT : JAI Press.
Stewart, J . ( 1995 ). Reconstruction of the self : Life-span oriented group psycho-
therapy. J ournal of Constructivist Psycholog y, 8, 1 29–148.
Stroebe, M., & Schut, H. ( 1999 ). The Dual Process Model of coping with
bereavement : Rationale and description. D eath Studies, 23, 197– 224.