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A Review of: “UnderstandingGrief as the Process of LossEvolves”Published online: 15 Aug 2006.

To cite this article: (2006) A Review of: “Understanding Grief as the Process of LossEvolves”, Death Studies, 30:2, 193-197, DOI: 10.1080/07481180500455673

To link to this article: http://dx.doi.org/10.1080/07481180500455673

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Jacobs, S., Mazure, C., & Prigerson, H. (2000). Diagnostic criteria for traumaticgrief. Death Studies, 24, 185–199.

Jordan, J. R. & Neimeyer, R. A. (2003). Does grief counseling work? Death Studies,27, 765–786.

Prigerson, H., Ahmed, I., Silverman, G. K., Saxena, A. T., Maciejewski, P. K.,Jacobs, S. C., & Kasal, S. V. (2002). Rates and risks of complicated grief amongpsychiatric clinic patients in Karachi, Pakistan. Death Studies, 26, 781–792.

Rando, T. A. (1993). Treatment of complicated mourning. Champaign, 1: ResearchPress.

Sanders, C. M. (1997). Risk factors in bereavement outcome. In M. S. Stroebe,W. Stroebe, & R. O. Hansson (Eds.), Handbook of bereavement: Theory, research,and intervention (pp. 255–267). New York: Cambridge University Press.

Schut, H., Stroebe, M., van den Bout, J., & Terheggen, M. (2001). The efficacy ofbereavement interventions: Determining who benefits. In M. S. Stroebe, R.O. Hansson, W. Stroebe, & H. Schut (Eds.), Handbook of bereavement research:Consequences, coping, and care (pp. 705–737). Washington, D.C.: AmericanPsychological Association.

Understanding Grief as the Process of Loss Evolves

A review of Nonfinite Loss and Grief: A Psychoeducational Approachby Elizabeth J. Bruce and Cynthia L. Schultz. Baltimore: Paul H.Brookes, 2001. 258 pp. (ISBN 1-55766-517-6). $19.77. Reviewedby Whitney A. Brosi.

Elizabeth J. Bruce, a counseling psychologist in private practice in Victoria,Australia, specializes in loss, grief, and trauma. Her dissertation, completedin 1994 at LaTrobe University, is titled A Longitudinal Investigation of Lossand Grief for Mothers and Fathers of Children with Intellectual Disability.

Cynthia L. Schultz has a doctorate in psychology from the Universityof Queensland, with special focus on counseling, community, and healthpsychology. Along with Elizabeth J. Bruce, she co-authored ‘‘ComplicatedLoss: Considerations in Counselling the Parents of a Child with an Intellec-tual Disability,’’ which appeared in The Australian Counseling Psychologist,1992, 8, 8–20; and ‘‘A Cross-Sectional Study of Parenting Perceptions: Car-ing for Children with Intellectual Disability,’’ which appeared in AustralianJournal of Marriage & Family, 1994, 15, 56–65.

Whitney A. Brosi, an Assistant Professor in the Department ofHuman Development and Family Science at Oklahoma State University,is trained as a marriage and family therapist, having worked extensively withpatients, their families, and physicians in the primary care context. The titleof her dissertation, completed in 2004 at Michigan State University, wasExperiences of Elderly Recipients of Care: A Feminist, Case Study Analysis ofMother-Daughter Dyads. In addition to her research on recipients of familycare, Dr. Brosi recently co-authored a paper titled ‘‘I’m Just Glad My Three

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Jobs Could Be During the Day’’: Women andWork in a Rural Community,which will be published in Family Relations.

The purpose of this book is to introduce the concept of non-finite loss and offer a psychoeducational framework to work withthose experiencing such losses. Nonfinite loss ‘‘refers to losses thatare contingent on development; the passage of time; and on a lackof synchrony with hopes, wishes, ideals, and expectations.’’ (p. 7).The authors present the reader with the difficult question, howdoes a person experience and process grief when loss is progres-sive or evolving? When loss does not happen in a moment, forexample with a death, but when it progresses in the form of anillness or disability, how do we manage?

The book is organized in a way that guides the reader throughthe process of socialization, development, and loss. The first half ofthe book describes normal learning processes of children and howsuch processes direct our loss experiences across the lifespan. Thelatter half of the book introduces the reader to intimate portraits ofnonfinite loss. Through vignettes, case studies, and clinical applica-tions, we are led through the journey of nonfinite loss. The readeris challenged to consider how the dichotomy of ‘‘who I should be’’and ‘‘who will I become’’ combines to create an alternate reality(see p. 144).

The Importance of Social Constructs & Expectations

This book is grounded in the assumption that we developand become attached to expectations about our lives. Bruce andSchultz state ‘‘the meaning of life is tied up with expectations thatare just as much about the future as they are about the present’’(p. 12). Beginning in childhood, humans begin the reciprocalprocess of receiving and constructing stories about their lives.Such narratives define one’s past as well as the future. As thereader learns about the concept of nonfinite loss, it is importantto understand the power of such expectations and correspondingnarratives. Nonfinite loss disrupts the bereaved’s concept of whatis=was to be. Consequently, a lifetime of expectations shapedby family values, societal expectations, and personal decisions ischanged. Nonfinite loss changes a person’s social construction oflife and future both in a moment and many times from that point

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forward. As a result of nonfinite loss, we are required to adapt,accept biases and judgments, and are faced with creating a newnarrative.

Foundational Concepts

In their discussion leading up to nonfinite loss and grief, the authorsaddress key therapeutic issues such as anxiety and homeostasis.Although relevant across the lifespan, Bruce and Schultz empha-size the foundations of such concepts in childhood. As individuals,we learn what is ‘normal,’ developing a series of expectations asdescribed above. The process of becoming attached to this patterncreates homeostasis, and when disrupted, causes anxiety or stress.The process of addressing anxiety, homeostasis, and attachment toan ideal self are central to all therapy, not just to those workingwith individuals experiencing nonfinite loss.

It is important to note that the authors spend much of the firstpart of this book explaining how these processes are created ininfancy and childhood. Bruce and Schultz offer a comprehensivereview of cognitive and emotional processes in childhood, includ-ing conceptions of self, personality development, fears, creation oflabels, and identity formation. The authors ground their discussionin development in two ways: (a) emphasizing that a child’s stage ofdevelopment shapes his=her concepts of self and the world; and (b)noting that developmental stage has a profound effect on a per-son’s experience with loss. By addressing the complex issues ofdevelopment, the authors create a solid framework for the secondhalf of the book. Specifically, understanding the processes of devel-opment allows the reader to appreciate the therapeutic tasksoutlined in the latter portion of the book.

Clinical Applications

The authors describe a well-organized therapeutic approach that iscollaborative, educational, and sensitive to unique loss responsesand personality types. Through describing the psychoeducationalfoundations and 14 guiding principles to addressing non-finite loss,the authors give individual therapists enough information to beginintegrating this approach into their own work. The final chapter

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includes case studies that demonstrate the applications of thisapproach, for those who wish to review examples.

As a medical family therapist and one who has worked exten-sively with loss and grief, I can attest to the relevance and validityof the approach described in this book. Individuals experiencingloss, in particular an evolving loss such as nonfinite grief, benefitfrom therapy that is collaborative and includes appropriate realitytesting. Although the term reality testing can elicit negative reac-tions, when done correctly and with the specific client in mind, itcan be very effective. In fact, such work is critical to the processof forming an alternate reality or as it was once described to me,‘‘a new normal.’’ If clients continue to be attached to the idea of‘‘who I should be’’ when this ideal is not possible, the loss perpe-tuates itself. Therapists must be prepared to sit with clients as theydo this work. It is a long and difficult process.

It is important to note that the process described in this bookis complex and requires two key things: (a) clients capable ofinsight and (b) a long-term therapeutic commitment. In order forclients to appreciate the inherent nature of their fading reality, theymust first accept their idealized reality and the value they haveplaced on it. Take for instance the case of infertile women whowant to give birth. It may be after the loss process begins beforethey say, ‘‘I guess I always thought I’d be a mother. In truth,I now realize that my infertility has ruined the life I had planned.’’Keep in mind that this acknowledgement may not come for sometime and that it is a necessary component for reality testing.I believe that the process described by Bruce and Schultz requiresa long-term therapeutic relationship. Given the roots of childhoodschemas and the amount of time humans spend creating their‘‘ideal’’ lives, the process of reforming this ideal will take morethan six sessions. This constraint is important to consider given thatmanaged care systems often dictate limits on the number of ses-sions for which a client can receive reimbursement. Of course,each therapeutic relationship is unique. However, I believe thatthis work requires a long-term partnership.

Nonfinite Loss and Related Work

Nonfinite loss parallels ambiguous loss as described by Boss (1999).Boss addressed two types of ambiguous loss: first, where one is

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physically gone but psychologically present (e.g., a MIA soldier, amissing child) and second, a condition in which one is present inbody but not mind (e.g., Alzheimer’s disease, addiction); nonfiniteloss is similar to the latter. Boss’s work is rooted in family therapyand has significant relevance for caregivers. Consequently, theBruce and Shultz model is almost one of a kind in that it is indi-vidually targeted for a person experiencing an illness, rather thanone caring for that person. Clearly there are linkages betweenthe work of Bruce and Schultz and that of Boss. Therefore, thera-pists interested in exploring valuable ways of addressing suchlosses would benefit from finding the parallels between Boss’s workand that described in this book.

Ways to Use this Book

As I reviewed this book, I challenged myself to think of ways itcould be useful to colleagues. I determined that this resource, inits entirety, would be particularly valuable for practicing cliniciansand those in graduate courses in the areas of grief and loss, familiesin crisis, non-normative development, and special populations.I also deemed that the chapters on clinical applications and work-ing directly with clients would be valuable supplemental readingsin counseling and therapy courses. Despite how each individualreader wishes to integrate the information, Bruce and Schultz havedone a nice job outlining and describing a challenging process on adifficult topic.

Reference

Boss, P. (1999). Ambiguous loss: Learning to live with unresolved grief. Cambridge,MA: Harvard University Press.

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