Understanding loss: A guide for caring for those facing adversity by Judith Murray

Reviewed by: Carolyn A. Walter, University of Pennsylvania, Philadelphia, PA, USA.

Judith Murray’s Understanding Loss: A Guide for Caring for Those Facing Adversity is a thoughtful, comprehensive text for all practitioners caring for those who are facing loss and grief from many life-changing events including death, acute or chronic health disorders, divorce or separation, dislocation, and trauma. Her major thesis is

Loss is an integral part of life. It is not something that happens to us as we live; rather, it is life itself … In our view, any event that involves change is a loss that necessitates the process of grief and transition. (p. 4)

These ideas are validated by McCoyd and Walter’s (2015) thesis in their text Grief and loss throughout the lifespan as well by other researchers and authors (Stroebe, Hansson, Stroebe, & Shut, 2001; Hooyman & Kramer, 2006). Murray devotes one full chapter (Chapter 7, “The Individuality of Loss”) to the ways in which the reactions to loss or grieving or mourning are perceived differently by each individual. It is the interpretation of change by the person experiencing it that constitutes loss. Thus, a similar loss can be viewed by one person as a threat and for another, a challenge or opportunity. She recognizes in this chapter both internal influences (i.e., age, gender, culture, spiritual beliefs, and vulnerability or resilience) and external influences (i.e., social context of the loss or stigma, family context, and social support) on grieving. Again, she takes a postmodern perspective by emphasizing the individuality of loss—there is no “right” or “usual” way to grieve. She cautions practitioners to avoid placing their interpretation of loss upon a client.

The author does a fascinating job presenting her perception of how adults integrate loss into their lives rather than resolve their loss. In keeping with the postmodern framework, we do not “get over” a loss, rather it becomes a part of us. Similar to the Dual Process Model (Stroebe & Schutt, 1999) which Murray references in Chapter 3, “Grief and Grieving,” the paradox of both “personal deterioration and personal growth can co-exist within the same experience of loss” (p. 96). In Chapter 6, “The Integration of Loss,” Murray offers the view that the grief literature in general has overemphasized the deficit model of grief (depression, anxiety, and other negative emotions) without acknowledging the possibility of the positive aspects of loss as a growth and adaptive experience.

However, I would argue that the contributions on growth through meaning-making (Neimeyer, 2001, 2012; Neimeyer, Harris, Winokuer, & Thornton, 2011) as well as Rubin’s (1999) “Two-Track Model of Bereavement” have provided substantial counterpoint to the deficit model in the grief literature. Rubin has found that the dimensions of Track 1 (biopsychosocial functioning, anxiety, depression, work, and meaning-structure) and Track 2 (continuing relationship with the deceased and memorialization of the deceased) both need to be assessed and considered. Murray’s chapter on integration would have been strengthened by acknowledging these theories as contributing to the grief literature, allowing for a more positive examination of a holistic approach to understanding grief. Although Murray mentions the contributions of Neimeyer and Rubin in other chapters (albeit briefly), it is unclear to me how Murray views how these researchers have changed the landscape of understanding grief and loss.

In the last four chapters of this text, Murray presents her approach to the application of theory to practice, including a detailed examination of how practitioners might intervene with those who have suffered loss. Her approach to intervention begins with the important concept of enabling, which she defines as assisting the person to find his or her particular strengths to cope with a loss that will help her or him “live more fully in the world as it is experienced” (p. 162). The core issues of safety and respect are carefully examined as little therapeutic work can be done if the person does not feel safe in the alliance.

I think she does an excellent job of describing how various theories of intervention such as mindfulness, regrief therapy, Gestalt therapy, task or process models such as those offered by Rando and Worden, narrative therapy or meaning-making, cognitive behavioral theory (including dialectical behavior therapy), and brain-based theory can be applied differentially throughout the treatment process. The use of rituals and creative pursuits is also explored as appropriate techniques for those suffering from a loss. She provides some excellent case examples that illustrate how the practitioner might use these theories during the intervention process.

Murray posits that what we are learning from biology supports the importance of helping people to experience the “deeply sensory and emotional aspects of grief but also assisting them to use the logical higher-cortical functions in order to regulate the emotions” (p. 216). By helping people to integrate their story of loss into their lives, Murray believes that we are “helping to integrate the brain to process the experience as a whole” (p. 217). From my perspective, this integration is critical and has been well-defined by Murray in this book.