cultural sensitivity in grief counseling: a cultural application

CULTURAL SENSITIVITY 1

Running Head: CULTURAL SENSITIVITY

Cultural Sensitivity in Grief Counseling: A Cultural Application

Brian Andrew Wong

Marshall University

Author Note

Brian Andrew Wong, Psychology Major and Counseling Minor, Marshall University.

This research was an assignment in the class of Death & Grief Counseling (COUN 456) taught

by Jason Newsome, due Tuesday, November 15, 2011.

Correspondence concerning this article should be addressed to Brian Andrew Wong, email:

[email protected].


Multicultural sensitivity (or at least awareness that there are various culture norms for

dealing with different events in life) is very important for those in the helping professions,

especially therapists. Another very equally important thing to have knowledge of in helping

professions is grief. Grief is a universal experience, yet many are ill prepared to deal with loss.

James & Friedman (2009) point out that it is “strange that we all know what to do if someone

breaks an arm, but very few people are prepared to assist grievers” (p. 23). If a client-therapist

relationship lasts long enough, a particular issue that is bound to arise is grief. Grief, according to

James & Friedman is “the normal and natural reaction to loss…” and “the conflicting feelings

caused by the end of or change in a familiar pattern of behavior” (p. 3). Practically all of us are

more familiar with obtaining things in life than losing; often after experiencing a loss, the griever

“probably became acutely aware of how ill prepared” they were to cope with grief (James &

Friedman, 2009 p. 23); not many are familiar or open about talking about death and loss (James

& Friedman, 2009; Worden, 2009).

“It is only natural and quite healthy for people who are caught in a grieving

situation to seek solace from those around them. However, in rather short order it

becomes abundantly clear to the griever that friends and associates are not of much

help. Even though they are well meaning, they often say things that can seem

inappropriate” (James & Friedman, 2009, p. 39).

This is when grievers usually might turn to therapists or bereavement professionals, who should

be aware of cultural differences. If a therapist comes across as culturally insensitive, the client-

therapist relationship might not last long. There are different cultural norms when it comes to

grieving and mourning the deceased (DeSpelder & Strickland, 2002; Rathus, 2010). In one

culture, what may be viewed as a disorder may be viewed differently in another: “In certain

cultures, one can find combinations of psychiatric and physical symptoms recognized as diseases


only in that culture…Others, however, are quite specific to the individual culture” (Rathus, 2010,

p. 503). As uncomfortable as it may be to discuss death and loss, it is important. It is especially

important for people in the mental health professions – counselors, psychiatrists, psychologists,

and the like – to be aware of cultural differences in order to avoid misperceived signs of

disrespect (Walsh-Burke, 2006).

According to Rosenblatt (2008) there is no knowledge about grief that is culture free.

“Because we are embedded in the realities of the culture we know best, we may

well be oblivious to the cultural saturation of our knowledge and the many ways

that such saturation makes us ill fit to understand, or even pay attention to, the

grieving of people from cultures different from our own” (p. 207).

Being aware and comprehending the intertwining complexities between culture and grief is a

good step to providing support to individuals of diverse cultures in their grief recovery. Different

types of deaths are grieved differently among cultures. Each culture has its expectations when it

comes to the expressions of grief and the mourning rituals, and even who grieves. What is very

important to be aware of in this field is sensitivity and there is an important step in this: “Another

step on the path toward greater cultural sensitivity, but one that falls short of actually getting

there, is…a multicultural perspective” (Rosenblatt, 2008, p. 209).

In this paper I shall apply the culture of Polynesia, a culture that is part of our country,

mostly in Hawaii, but yet is foreign at the same time. For many, when we hear the word

Polynesia we think Hawaii. However, not all are aware that Polynesia is a region in the Pacific

Ocean consisting of several islands. Each island or nation has their own cultural group.

Polynesians have various views on the cycle of life, from birth to death. While all views from

each nation of Polynesia cannot be explored in this paper, we shall focus on a few. Like many,

ancient Polynesians have beliefs in an afterlife, what happens to us after we die, and different


rituals for the demise of a person. There also are some rituals that are still practiced today and

important things for the therapist to keep in mind.

One area of grief to look at is the grief that occurs before death, anticipatory grief.

According to Pomeroy & Garcia (2009) anticipatory grief is “grief over those losses that have

already occurred as a result of the illness and those that are occurring” (p. 28).

In ancient Polynesia when someone became sick, the family received offerings that

consisted of feathers and food. A physician was summoned. The physician would make

medicines in secret. Medicines were produced in secret because it was believed that if not done

in a secretive manner, whatever healing powers the physician possessed would be lost. In caring

for the dying person, ointments were used for massages and invocations were made to the gods.

If these efforts were not working, a pig was presented by a priest. The pig would be used as an

offering to their deity, asking for a cure. During this ritual, the relatives had around their necks

cords; they were atoning for the sins of their sick loved one. At this point, the person either was

cured or died (Williamson, 1937).

Nearly every culture has some belief as to where our souls go when we die; it may be to a

place that is pleasant or a place not quite pleasant. Views of the after-life are diverse among the

different Polynesian groups: the Maori, Pukapukans, Mangaia, Marquesas, the Niue, and the

Mangarevans. In the Maori group, “Po” is the place they call the afterlife. It is here where

societies of aristocrats, commoners, and slaves are divided (Barrow, 1972). Po was believed to

resemble the current “state of social affairs” and here rank or social class was not divided out by

personal fate (Goldman, 1970, p. 561). Traditional societies of Polynesia believed that there

would be punishment for sinners in Po. The Pukapukans felt that adulterers would be thrown into

fire; they also believed that entering souls would entertain the gods with storytelling and


performances of dance and song. Those who were uncircumcised regarded Po as an “unpleasant

purgatory” and that everyone else lived in Tualiku, paradise (Goldman, 1970, p. 561). Other

societies such as the Mangaia, Marquesas, and Niue used social status to be differentiated by the

social status of the deceased. The Mangaia believed that warriors were in a happy upper world to

“defecate upon all others who wandered disconsolately in a miserable lower world” (Goldman,

1970, p. 561). The Marquesas society viewed the after-life as consisting of lower regions in three

levels: chiefs lived in paradise, middle ranks in an average middle, and the defeated and weak in

a miserable upper level. The Niue view two heavens: one heaven inhabited by women who were

accomplished and the other heaven that was not so pleasant; in this unpleasant heaven, rats fed

on the heads of men who did not die on the battlefield. To the Mangarevans, there were five

after-worlds, which had social class subdivided by districts. Good spirits were welcomed to the

best after world. Hapai and Te Piaoi was the most bottom realm for commoners who did not

receive a proper burial upon demise and those who died of starvation. For the Hawaiians, the

poor in the lower world faced a ghostly place, with no flowers, grass, or trees (Goldman, 1970, p.

562). Each Polynesian society believed in an after-life, having different specific beliefs as to who

would go where when they died.

According to Barrow (1972) there is great fear among the Polynesians for the spirits of

their deceased loved ones. The spirits of the dead were believed to “wander about in discontent

before passing on to their dismal underworld” (p. 48). Priests had power and controlled the dead.

Because of this, they were feared and respected. To demonstrate their power, priests in the Cook

Islands used rings of twisted coconut fibre as a means of capturing the soul of the dead and made

it known to the community that the priest had caught the soul of the deceased. In efforts to


release the soul of the deceased, the bereaved family then cajoled the priest with gifts of food or

property.

Williamson (1937) points out that right after death, priests summoned the spirit of the

dead person to return to their body. If there was no sign of return, they would cry “U ate varua e

te atua,” meaning that “the spirit is drawn out by the gods” (p. 274). This was followed by

outbursts of grief from the family; the family dressed and oiled the deceased while omens were

observed by the priests to determine the cause of death.

As is apparent, families are quite involved together in the mourning process and in

expressing their grief. In those days, families lived closer together, perhaps communally, due to

the demographics. Since they did not believe there was such a death as a natural death, I inferred

that they view all deaths as sudden, which likely can bring about acute grief. With acute grief,

families struggle to first reestablish emotional control, equilibrium, and stability of their daily

lives; the greater the stress, the greater will be the need for establishing stability (Shapiro, 1994).

It is very likely that as a way to reestablish equilibrium in the family, these expressions of

mourning and rituals were carried out.

As mentioned before, ancient Polynesians did not believe in natural deaths. All died at

the hand of external causes that could include black magic, drowning at sea, or the eating of

human spirits by gods. Burials were kept secret, because enemies would wait for an opportunity

to slander the deceased and use bones as fish hooks. Common hiding places for the dead

included places such as caves, chasms, and rock ledges (Barrow, 1978).

Like in many cultures, religion and/or spirituality play a part in an individual’s grief to

different extents. In present day Polynesia, religion is still very important and still holds beliefs

about an afterlife. According to an e-mail interview with Polynesian Funerals in Australia, most


in Polynesia have a matter-of-fact attitude/view about death. They view that death is a

progression of life that is natural. The family still takes care of the deceased’s body. After the

embalming, the body is taken back to the home of the family ranging from one night to two

weeks. It is during this time that the community, with friends and the entire extended family,

visits the immediate family. There is a lot of eating of food, praying, and singing. In Australia,

the bodies are buried there or back at the deceased’s home island. The Maori culture cremate

occasionally. However, other cultures such as the Cook Islanders, Samoans, or Tongans never

cremate. In the Pacific Islands, the dead bodies are often buried in the front yard of the family’s

home or even inside the house itself in a place meaningful to the deceased person. Polynesians

still carry on grief rituals, which include grave site visits. A year after the funeral, there is an

unveiling ceremony of the grave stone. Starting from the day of the burial the grave is visited by

family approximately each day for the next two years, with the frequency reducing to weekly

visits after two years. They will continue to visit the grave on anniversaries, birthdays, and

holidays. Food is usually brought to these visits, having a barbecue or picnic at the cemetery.

(Polynesian Funerals, personal communication, Monday, September 19, 2011).

In the Polynesian culture, it is normal to express intense emotions during times of death.

These “violent outbursts of emotions” are often expressed by chanting, dancing, and wailing

(Beaglehole, 1937, p. 319). The way that Polynesians would express their feelings of grief might

be viewed differently in a culture where such expressions of grief would not be appropriate or

normal.

Today, funerals are carried out in a way that has a mix of old customs with new

customers, sometimes with violence. There is some integration of modern times with the ancient


ways of the funeral. A sympathy gift might still not be accepted and might be perceived as not

normal (James, 2002).

In today’s world, with many cultures having been integrated through immigration and

travel, there can be challenges to grievers who maintain overall their culture’s traditional

customs. This is when having a multicultural perspective is important to being culturally

sensitive. Since many today tend to live distances away from family, this may affect how a

Polynesian family can gather together with short notice since the rituals for the dead are carried

out very shortly after the death. Given this, it may pose problems. If there is a delay in the rituals,

there may be fear of the deceased’s soul, especially if the family still adheres to traditional

Polynesian beliefs. On the flip side, the family carried on with taking care of the body

immediately and a grieving family member from afar was not able to attend or come to visit the

family as soon as they would have wished. These two situations could affect a person’s grief.

One thing that can come up is the griever who grew up in Polynesia who now lives in the

continental United States in a mainstream American neighborhood and has become accustomed

to American cultural norms. Since in America it is normal for family to live away from each

other, it is normal for the funeral or memorial service to be held a week or even two weeks or

longer after the death to allow time for people to travel for the services. It is possible that the

griever might have feelings of regret for having moved so far away from Polynesia to America,

for whatever reason. The grief therapist would need to keep in mind the griever’s belief of the

deceased’s soul and their cultural view of the family living close to each other.

Worden (2009) mentions that in cases where the death happened far away, the griever

might have trouble with the reality of the death; there has also been thoughts about whether

home deaths help or make bereavement more stressful. Since the Polynesians are known to show


strong emotions, the magnitude of their expressions of grief might show that the death of a loved

one in their home increased distress in their grief.

Each culture has differing views on what behavior is accepted in different situations and

with grief, how long they carry out grief and mourning rituals. Given the rise in immigration in

America, a therapist might encounter an immigrant family. It is important that the therapist

acquaint herself or himself to some of the modern and traditional beliefs and practices of grief in

Polynesia. The parents will likely still adhere to Polynesian tradition, while the children might

not share the same views since they have been exposed mostly to American culture, a

multicultural upbringing (something that many immigrant parents may not realize). In this

situation, the therapist would need to work with the children and parents to find a way for them

to integrate the two cultures together in their grief. With the traditional Polynesian norms of

grief, it is normal for families to cry and wail loudly but the new generation in America might

not be comfortable with such expressions of grief. It is very important for the therapist to

understand normal grief behavior (Worden, 2009). This is important for an immigrant family,

given that the children will be most likely to be more familiar with American culture. The

therapist should help the family understand their individual differences: “Just as it is important

not to expect everyone who is dying to die in a similar manner, likewise it is important not to

expect all people who are grieving to grieve in the same way” and the therapist should point this

out to those who anticipate that everyone else will grieve in a similar manner (Worden, 2009, p.

102). If a family visits the grave of their loved one very frequently within the first year or so, the

therapist should keep in mind that this is more part of their cultural ways of mourning rather than

an automatic sign of issues relating to the family’s grief.


Grief counseling may not be appropriate for all in helping them with their grief recovery.

There may be many barriers affecting the effectiveness of grief counseling. According to

Worden (2009) one barrier to grief counseling may be cost. Also there is a philosophy that all

who have experienced a death-related loss receive grief counseling. Sometime grief counseling is

helpful when the griever is not happy with their support network. It is not uncommon for after a

month or so after the death caring friends stop checking in on the family. As James & Friedman

mentioned, those around grievers tend to say things that are inappropriate, even harmful.

Grievers then may no longer want to reach out to those people for support. Worden points out

that there is a philosophy that assumes “that some people need help with their bereavement but

wait until they experience difficulty, recognize their need for help, and reach out for assistance”

(p. 86). (I see this is true from personal experience and from observing a grief support group.)

Yet there still remain mixed views on the benefits and the efficacy of grief counseling (Larson &

Hoyt, 2007; Worden, 2009). Just as it is never too early to get help after a broken bone, so too is

it never too early to help someone with a broken heart after loss (James & Friedman, 2009). If

clinical counseling will be detrimental to the grief recovery of someone whose cultural

upbringing where therapy was hardly introduced, then the individual will benefit from another

form of grief support. What is most important for a griever is that they seek a grief recovery

support network that is beneficial to them.

As mentioned before, what some people view as issues in bereavement may be viewed

differently in another culture. So, I stress the importance of being aware overall of cultural

differences and individual differences. In Bosnian and Slovenian adolescent refugees of war in

territories of the former Yugoslavia, researchers were astonished at the low rate of depressive

feelings, even after a follow-up three years later; among the factors considered in this research


were the differences “in national character and prevailing values” (Slodnjak, Kos, & Yule, 2002,

p. 131). In researching bereaved parents and spouses in the United States and China, Bonanno et

al (2005) found some cultural differences in researching deliberate avoidance of and processing

of grief. Grieving and mourning practices in China normally focus on dead adult family

members and that families tend to be larger than the typical nuclear family in the United States.

Multicultural awareness and sensitivity is important in the field of grief and those who

work with grievers of differing cultural orientations. This paper applied the importance of being

aware of a culture that is different from mainstream America. Since the Polynesians care for the

bodies of their deceased loved ones and often have the bodies in their home, it is important to

make sure the therapist does not misinterpret their client having the body still in the home as a

sign of denial (Worden, 2009). (It is important to note that if a person comes to grief counseling

and states that a death or loss occurred, they are not in denial.) With awareness that there are

other cultures and norms for grief, the therapist will be able to assist the griever better. Be aware

that just because a client who comes to grief therapy is from Hawaii and still maintains her

connection to the Polynesian community (in some form, shape, or way), does not mean that she

shares all the same beliefs and practices of Polynesian culture. Just because a client is a second

or third generation African, does not mean they utilize the use of the LoDagaa restraints during a

funeral in Ghana (DeSpelder & Strickland, 2002).

A therapist should ask questions in a manner that does not assume a certain cultural

orientation. Some examples include: Growing up, what were you taught from your family about

death and loss? What are your personal beliefs and views relating to your loved one’s death?

What has your family done to remember your loved one? Have you found comfort in the way

your loved one has been remembered? Are there any rituals that you or your family have been


doing that you find meaningful, and what are they? Are there any conflicts among you and your

family relating to, or as a result of, your loved one’s death? What type of support have you and

your family been receiving since the death occurred? Asking questions in a manner that does not

assume a certain belief or culture will help the therapist to appear more culturally sensitive. If a

client is from a different culture in which the therapist is unfamiliar, it is possible that the client

might find it helpful to them to explain their culture and practices to the therapist. (My race is

Asian, my last name is Chinese, but I do not speak Chinese and do not adhere to the Chinese

culture. I do not add a year to my age each Chinese New Year, I do not believe in the Chinese

superstitions, and I do not identify myself as culturally Asian. Both my parents were born and

raised in America. My father was born in Massachusetts and is the son of Chinese immigrants,

and my mother was born in Minnesota and was Caucasian and of Scandinavian descent. I mostly

grew up in a non-Asian environment. If a therapist asked someone like me those questions, I

would definitely feel that the therapist is not making any assumptions and has a multicultural

perspective and would continue therapy with that person.) It is best to ask culturally-inclusive

and/or culturally-neutral questions. A therapist should ask the griever about the beliefs, practices,

and values that the individual finds important (Walsh-Burke, 2006).

A multicultural perspective is critical in grief therapy, especially for individuals who may

have a different cultural orientation. The individual will have their own views on death, dying,

and grief which are influenced by their cultural upbringing. Being aware of the traditional

practices of grief along with any new integration of those practices will assist the therapist in

helping an individual in their grief recovery.


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cultural sensitivity in grief counseling: a cultural application

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