First Interview with Kenneth J. Doka
Kenneth J. Doka, Ph.D., mDiv
Dr. Doka is an ordained Lutheran minister and Professor of Gerontology at the Graduate School of the College of New Rochelle. He is Bereavement Consultant to Hospice Foundation of America. He is editor of Omega, a professional journal, and Journeys, the monthly bereavement newsletter of Hospice Foundation of America. Dr. Doka was elected President of the Association for Death Education and Counseling (ADEC) in 1993, and is a former chairperson of the International Workgroup on Death, Dying and Bereavement. Dr. Doka's books include Disenfranchised Grief: New Directions, Challenges and Strategies for Practice, Death and Spirituality (with John Morgan), and the Living With Grief Teleconference Companion Series.
Q: How did you originally get involved in the field of grief and bereavement?
A: Very much by accident. As a seminarian, I was scheduled to do my Clinical Pastoral Education work with juvenile delinquents, but at the last minute was switched into working with dying children. This was in 1971, when there was very little written about this particular grief experience. I ended up writing two master's theses on the subject and joined the "second generation" of grief and bereavement researchers and writers.
Q: What was the prevalent thinking about grief then, and what did you learn that helped shape how grief is now viewed?
A: The major problem in earlier thinking about grief was that it was assumed that there was only one way to grieve-the griever needed to express his or her grief in a purely affective way in order to "get over" the loss. Yet through my work with dying children and their families, I witnessed many people grieving in a more instrumental way--that is, people expressing their grief more by talking or doing than by emoting. On a personal note, it also took me a long time to realize that I was experiencing my own grief through the work, and that my own grieving process is more instrumental.
I also learned that you can't go in with an agenda when working with grieving people; you need to listen for what it is that they need, even if they can't always articulate that for you.
Q: What other developments have you seen in the field?
A: There has been an amazing growth in the field over the last 30 years. In a sense, two tiers have developed. Through the work of professionals active in the field, a deeper understanding of the complexities of the grieving process has developed. Yet there is another tier that I see as still being stuck in old models or old theories about grief. In many ways it's easier to rely on these old models--they are very easy to learn and teach. The older models are very prescriptive; they tell you how people should feel, and that the ultimate goal is to have the griever move in the direction of "acceptance." I realized how some of these models have invaded our thinking when I saw an episode of "The Simpsons" built around Kubler-Ross' Stage model! But as professionals have learned over the years, people's reactions to grief vary in so many ways; people do not move in a straight line from one stage to the next in such a linear fashion.
During the 1970s and 1980s, the older models began to be challenged and newer thinking developed. Both ADEC (The Association for Death Education and Counseling) and the IWG (International Work Group on Death, Dying, and Bereavement) came about at this time. These organizations translated individual growth and ideas into a more collective way of thinking and provided rich opportunities for dialogue, and they both continue to do so today.
Q: What is some of the "first-line" thinking about grief and bereavement that you are seeing today?
A: I can identify six trends in the field that are continuing to gain interest and attention. A number of new applications and models have been suggested, yet what I believe to be a healthy lack of consensus exists around these models. The definition of grief also continues to be extended-it's clearly not just a reaction to death, but to the many types of losses that individuals face. We are moving beyond looking at grief as a purely affective process to its cognitive and behavioral ramifications. We also continue to move beyond the concept of simply "coping" with loss to a broader perspective of the transformative nature of loss. The concept that people do not detach from a loved one after death, but develop what some researchers have called "continuing bonds" is an ongoing discussion. And, in general, the field has become much more sensitive to how the diversity of culture, gender, and ethnicity may affect grief reactions. While all of these trends continue to generate informative research and discussion, I believe that at the same time we must be clearer in our need to continually evaluate interventions and to develop clinical, empirical models.
Another interesting development is that the DSM-V (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which is considered the Bible of Psychiatric Diagnosis) which is close to print, will most likely include a category of "complicated grief." While this is a somewhat controversial inclusion, it does take the important step in the recognition that there is problematic grief. On the other hand, there is a real concern that once the category exists, diagnoses will happen that may not fit a particular situation. The danger is always in finding the correct balance.
Q: In the past few years, some negative connotations of the term "grief counselor" have been promulgated through newspaper and magazine articles. Why do you think that is, and what harm if any does it do to the field?
A: Unfortunately, the media does not understand the nuances of the field, so many of these articles were based on a misunderstanding of what grief counseling is, as well as a misunderstanding about critical incident stress debriefing. Basically, the response to those types of perceptions is that all good professionals know that there should never be a "one size fits all" approach to grief counseling; one must be intentional in one's work, and always remain sensitive to the environment.
Q: One of your major roles in grief and bereavement has been through your involvement in HFA's National Bereavement Teleconference, which you have participated with since the beginning. Why are programs like the teleconference important?
A: The HFA teleconference was developed by Jack Gordon in answer to the question of how to move first-line information and knowledge about grief into the larger professional population. In the eleven years that we've presented the program we've certainly done that-the teleconference is the largest event of its kind in the field annually. And the word "event" encompasses one of the most exciting by-products of the program for me. As I travel throughout the country, I continually meet people who tell me about the coalitions and networks that have been created in their communities around a particular teleconference broadcast; connections that might not have been made without the impetus of a program like ours.
While the teleconference is perhaps its best-known program, HFA also has a number of other endeavors that also meet its mission of getting this information to a broader audience. The recent Clergy End-of-Life Education program, which has a new online component, is an example of a program developed to speak to a specific professional audience. And HFA's mission includes consumer education as well. Journeys [for which Doka serves as Editor] is the single largest bereavement newsletter, and is unique in that it features monthly columns by some of the most cutting-edge writers in the field, in a publication geared specifically for bereaved individuals, not academics.
Q: The 2005 Teleconference will focus on "Ethical Dilemmas at the End of Life." Why is the topic an important one for HFA to examine?
A: The most important reason is that our core audience of hospice professionals face these critical situations every day. In addition, medical decisions have become more complex and more costly. And the ethical decisions that families face really can complicate or facilitate the grieving process.
The key issue in helping families is that we must be very careful to allow them time to process the information that they are being given. Families are often pushed into making decisions quickly, which creates an atmosphere of crisis where one may not always really exist. A more collaborative process, which allows families time to ask questions and talk through their options, will aid them later in their grieving.
Of course, the more that families can have conversations about what loved ones would want at the end of life, which are then articulated in advance directives documents, the more at ease they will be later when faced with difficult decisions. These decisions are never easy ones-but with a recognition of what is needed, families can feel supported during these times. We hope to discuss some of these complexities during the teleconference.
Q: What do you see yourself doing in ten years?
One thing about this field is that it makes you very aware of your mortality--to not assume you will be here indefinitely. Yet, I expect to be here in ten years, doing what I hope is the same variety of things that I'm doing now.
