Second Interview with Kenneth J. Doka

Dr. Doka is a professor of gerontology at the graduate school of The College of New Rochelle. Dr. Doka has written or edited 18 books, including HFA’s Living with Grief series, and has published 60 articles and book chapters. He is editor of Omega, a professional journal on death and dying, and Journeys, HFA’s monthly and special issue bereavement newsletter. Dr. Doka was elected president of the Association for Death Education and Counseling (ADEC) in 1993. He was elected to the Board of the International Work Group on Dying, Death and Bereavement in 1995, and served as its chairman from 1997 to 1999. He is an ordained Lutheran minister.

Q: Hospice Foundation of America’s 14th annual National Bereavement Teleconference will focus on “Living With Grief: During and After the Death.” Why has HFA chosen to focus again on grief and bereavement?

A: What has happened over the years is that the “old ways” that we’ve looked at grief have changed. Yet we have realized that these newer ways of thinking have not always translated into practice. We explored a similar phenomenon in HFA’s most recent teleconference on pain management--why is there a body of professional knowledge that has not been fully translated in popular practice?

The teleconference has always provided an extraordinary vehicle to reach a great range of professionals, who may not always have other opportunities for the best education in grief and bereavement brought to them. The experts that have been invited to participate in the program and the book are known nationally and internationally for their cutting-edge work in the field. One strength of the program will be our ability to look comprehensively both at the work done around grief during life-limiting illness, as well as the grief issues that follow death. We’re enthusiastic about this “return” to the topic of grief, in part as a way to reassure our core audience that education around grief and bereavement will always remain a priority to the work of Hospice Foundation of America.

Q: What changes are you seeing in the field of grief and bereavement, both in the academic literature and in professional practice?

A: The popular notion of grief was that it was purely an emotional experience, one in which it was necessary to detach from the person who had died and then “move on.” In professional circles, this understanding has been more nuanced, and some significant trends have emerged:

• We’re gaining a broader understanding of loss and its impact on all involved, both during an illness and after death.
• We’ve moved beyond looking at grief purely as affect, to the idea that grief is a comprehensive reaction, which can include cognitive and behavioral ramifications.
• Rather than simply “coping” with grief, we now look more at how loss and reaction to loss can change, and at times even transform, a person. For most people, grief changes lives. While many feel diminished by a loss, others learn new skills, new abilities, even a new sense of spirituality, as a result of the grieving process. The life and work of Catherine Sanders is an excellent example. Following the death of her son in the 1970s, she became focused on grief work, partly due to what she perceived as a lack of information and support. She became one of the foremost writers in the field of grief and bereavement.
• There is a greater emphasis on the concept of continuing bonds. It is natural and, in most cases healthy, to want to stay connected to the person who has died, not to detach. Much of our understanding of this concept is based on a closer examination of grief in other cultures
• Both here and in the work being done internationally, the impact of cultural issues on grief has been significant. Many of the early studies in grief were done on white English or American widows; we’re learning more all the time about the social constructs of grief, and how responses from other cultures can hold a mirror up to our own.
• Over the last decade, more evidence-based practice in grief has emerged, to support ideas of what works and what doesn’t. It’s important to be able to examine the work that we do with grieving people to understand, for instance, what makes a support group effective, and what doesn’t? Good intentions are not enough; professionals must be able to examine outcomes and justify what we do and why we do it.
• Newer models have been developed, emphasizing the individuality of the grieving process, which have allowed us to replace older models, such as the “stage” model of grief that had become pervasive in popular understanding. Some of these models include Worden’s Task Model, Stroebe and Schut’s Dual Process Model, and Rando’s Six “R” Processes. All of these newer models emphasize the common issues associated with grief, and how persons approach these issues, rather than assuming a set of common responses.

Q: What implications do the trends discussed above have on actual practice, in a hospice bereavement group or other setting?

A: They can help reframe the way that we approach bereavement. It may be as simple as asking, “how did you react to the loss”, or “how has your life changed,” as opposed to “how do you feel about the loss?” Based on newer understandings, professionals can examine if their grief work is focused strictly on emotional responses, or if it is more task-oriented. It may simply mean looking at the structure of support groups, to ensure that they are based on newer models and understandings. In both the teleconference program and the companion book, we’ll be able to explore some of the issues above in greater detail, and to discuss the implications of these new models on professional practice.