Use of Bibliotherapy in the Treatment of Grief and Loss: A Guide to Current Counseling Practices

Article excerpt

Grief is a complex and dynamic process influencing individuals of all ages. This article provides an overview of historical and contemporary constructs of grief counseling. Bibliotherapy, a creative counseling tool, is presented as an appropriate intervention when counseling grieving clients. Guidelines for using bibliotherapy with grieving clients are considered.

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Grief and loss related to death and non-death-related incidents often cause significant stress, psychological trauma, and emotional distress including depression or anxiety (Servaty-Seib, 2004). Grief over the loss of a loved one creates some of the most frequent and difficult problems individuals face. In fact, "the death of a spouse ranks first out of 43 stressful events" on the Social Readjustment Rating Scale (Muller & Thompson, 2003, p. 183). Because of the complex and pervasive nature of grief, all counselors will face the challenge of treating grieving clients regardless of the counselor's professional milieu. One valuable intervention that may assist counselors working with grieving clients is bibliotherapy. This intervention is an adjunctive technique in which counselors use self-help or fiction literature to increase client awareness and promote client healing. To date, little has been written about bibliotherapy in conjunction with individual counseling (Floyd, 2003), and even less is found in database searches regarding grief therapy for adult clients. The aim of this article is to present guidelines for using bibliotherapy with grieving clients.

GRIEF COUNSELING

Historical Foundations

Freud first postulated that grief occurs when the libido remains attached to a lost object (person); thus, the goal of the griever was to detach from this object (Freud, 1957). In his opinion, grief, although a natural process, entailed severing the bond to the departed loved one so that the griever could heal and move on with life. Bowlby (1980) suggested that the bereaved might continue with life while maintaining a dynamic connection with the deceased. Although he also advocated detachment from the deceased as one way of effective grieving, Bowlby acknowledged that the griever could maintain some attachment and still proceed with a healthy typical life. Contemporary grief counseling professionals generally support the view that humans are profoundly affected when attachments sever (Rando, 1993). Thus, the findings of Freud and Bowlby remain valuable today, even though contemporary theorists have expanded on their original ideas.

The stages of acceptance model was developed by Kubler-Ross (1969; see also Stroebe, Stroebe, & Hansson, 1993) and emerged from intensive observation and clinical work with dying patients. Individuals diagnosed with terminal illness initially reacted to their diagnoses with anger and denial, eventually moving toward acceptance (Kubler-Ross, 1969). The stages of acceptance model has been widely accepted, and many counselors working with grieving clients continue to use this perspective; nevertheless, the model has been criticized as newer theories have emerged.

Current Trends in Grief Counseling for Adults

Contemporary theorists have criticized the Kubler-Ross (1969) model, in spite of its historic popularity, for representing an oversimplified perspective of a complex process. Some have asserted that this model is unproven as an effective tool for therapy (Neimeyer, 2000). Clients often focus on grieving "correctly" rather than accepting their individual and personal ways of experiencing loss (Servaty-Seib, 2004). Additionally, the Kubler-Ross model has been criticized as being too hierarchical with the resulting risk of disenfranchising or oppressing grieving clients (Massey, 2000; Payne, Jarrett, Wiles, & Field, 2002). According to Massey, the Kubler-Ross model limits healing by denying clients their individual expressions of grief.

The seminal work of Worden (1982) criticized the more traditional grief-related schemas for not meeting client needs of transition through loss and grief. …