Kenneth Doka on Grief Counseling and Psychotherapy

Kenneth Doka on Grief Counseling and Psychotherapy

by Victor Yalom
A leading expert on grief counseling and therapy, discusses how understanding individual grieving styles is essential to grief counselors and all therapists helping clients deal effectively with loss.


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Defining Grief

Victor Yalom: Let’s start with the basic building blocks. What is grief and what is its function?
Kenneth Doka: I think it’s probably important to acknowledge and recognize that grief is a reaction to loss. We often confuse it as a reaction to death. It’s really just a very natural reaction to loss and so we can experience grief obviously when someone we’re attached to dies, but we can also experience it when we lose any significant form of attachment. You can certainly experience grief in divorce, in separation, in losing an object that’s particularly meaningful or significant, in losing a job that has meaning or significance. Whenever we experience an attachment and we experience loss in that attachment, grief becomes the natural way we respond to that. We used to look at the function of grief as kind of allowing a process of detachment and a restoration of life in the absence of that person. Now we no longer really use that old sort of Freudian model. We really emphasize that people really don’t detach. They have a changed and continued bond with the person. It’s the process of adjusting to in many ways what’s going to be a new relationship and a different relationship rather than simply the abolition or detachment from a relationship.

VY: What’s your understanding of how grief helps that? Why is it necessary?
KD: I don’t know—necessary is sort of a strange word in this context. I think it’s just a natural reaction as we respond to a significant loss.
VY: There’s so much being written about evolutionary psychology these days. Is there anyone thinking or hypothesizing about some evolutionary or Darwinian function of grief?
KD: I think Bowlby points out that the initial response to grief arises from an evolutionary desire to reattach. We signal distress as a way of gaining attention and support and maybe rebuilding the bond—think of the child who’s lost in a store and the toddler all of a sudden starts crying and gets help and assistance and maybe even the mother hears the cries. Grief may come from that very basic sense of attachment, but even from an evolutionary standpoint, you can say, even then for an animal who loses a significant attachment, calling attention to oneself is a mixed blessing.
VY: You write that we’ve moved away from universal stages, such as the Kubler-Ross stages to individual pathways of grief.
KD: We used to look for some kind of universal reactions and Kubler-Ross was one such pattern. Actually, Kubler-Ross never really spoke, until later in her work, about applying this to grief; she was talking about a particular aspect of coping with dying, but even there, we move toward more individualized reaction. There are other people who attempted to find—Colin Murray Parkes at one point in his career attempted to find these kind of universal sort of stages that everyone goes through. But now what we recognize is that grief is highly individual and individuals grieve in their own way. Certainly their responses to grief can include a number of dimensions. We can respond to grief physically, on a very visceral physical level with aches and pains and all kinds of physical reactions. We can respond with emotional reactions—sadness, loneliness, yearning, jealousy even, anger, guilt are all relatively common reactions, as well other ones—just a sense of relief sometimes, when a person’s suffering has been very, very long. We can respond cognitively. We may think about the person. We may experience a sense of depersonalization. We may find it hard to focus or concentrate. We can respond behaviorally—again, acting-out behaviors or withdrawal or lashing-out behaviors or even things like avoiding or seeking reminders of the person who died or the thing that was lost. Of course, it can affect us spiritually. Again, everybody’s pattern of grief is highly unique.
VY: You make a point about denial, that people go in and out of denial. It’s not a black or white thing. How do you think about denial?
KD: I think probably most of my writing and talking about denial has probably been in the context of illness. There, what I would say is, again, denial is a basic defense mechanism. Avery Weisman uses a very good term when he talks about life-threatening illness. He talks about middle knowledge.
True denial is very, very difficult to maintain, but people sometimes choose not to focus on their illness, so it is more of a selective inattention than actual denial.
True denial is very, very difficult to maintain, but people sometimes choose not to focus on their illness, so it is more of a selective inattention than actual denial. Again, I think you see that same pattern in grief. It’s hard to really deny a significant loss, but sometimes we choose not to focus on it.

Intuitive vs. Instrumental Grieving

VY: Let’s get back to grieving styles, as that’s been one of your major contributions. You developed these ideas of the intuitive grieving style, which is a more emotional style of processing grief, versus the instrumental style, which is more cognitive and action oriented. Tell us about these and how you came up with these concepts.
KD: That was work I did with Terry Martin from Hood College. Originally, what we were doing was exploring the issue of gender and grief—on differences between the ways men grieve and the ways women grieve. As we moved on into that work and began to do some research, we found that these “male patterns” and “female patterns” were really more widely distributed than we had perceived.
VY: It wasn’t purely male or purely female.
KD: Exactly. We first moved into what we called—kind of with a Jungian perspective—masculine and feminine grief, knowing that men or women could have a more feminine pattern or vice versa. Then we realized that the gender connection was probably unhelpful and inappropriate, so we moved away from gender, although not entirely. We’re saying gender is one of the factors, certainly, that influences one’s grieving style, and certainly we would be comfortable in saying more men may have an instrumental style or lean toward the instrumental style in U.S. culture and probably in many Western cultures. So it’s influenced by gender, but not determined by it. And we look at this as a continuum, so many people are sort of in the middle or maybe an alternate visualization would be two overlapping Venn diagrams with some space separate and lots of space sort of shaped. People who are highly intuitive as grievers will often—when you ask them about their experience of grief, they’ll often talk about waves of affect and waves of emotion. When you ask them how that grief was expressed, it’ll mirror those reactions, “I just kind of felt this. I cried. I screamed. I shouted.” Their expression of grief mirrors their inner experience of grief. When you ask them what helps, how they adapted to grief, they’ll often talk about the fact that it really was helpful for them to find some place, whether in therapy, whether with a confidante, whether in a support group, whether in their own journaling or internal process, to sort of explore their feelings.

On the other end of the continuum are what we call instrumental grievers, and with them the very experience of grief is different. When you ask them how they experience grief, they often will talk about it in very physical or cognitive ways: “I just kept thinking about the person. I kept running over it in my mind. I felt I was kicked in the stomach. I felt somebody punch me.” When you ask them how grief was expressed, sometimes they’ll be curious about that question. They might respond at first “I guess I didn’t express much grief,” but then when you really talk to them about it, they’ll say, “I did talk about the person a lot” or “I was very active in setting up this scholarship fund.” They may not always recognize that as an expression of grief. They may actually be perplexed by their lack of affect. It’s not that they lack affect. Their affect is more muted. When you ask them what helps, it’s often the doing.
VY: You give a great example in your book, Grieving Beyond Gender, of a man whose daughter crashed into a neighbor’s fence and died, and he spent his time after the death rebuilding the neighbor’s fence.
KD: Right, and it’s important to recognize that was the most helpful thing he did. One of the things that sort of helped us think about this was — in my book on disenfranchised grief, Dennis Ryan does a chapter on the death of his stillborn son, which as we were thinking about this, really was a kind of enlightening moment. Dennis is a professor by vocation, but a sculptor by avocation. He talks about after his son was stillborn, this long-awaited child,
his wife would come back from work each day and go upstairs and have a good cry and he would be working, crafting the perfect memorial stone out of a piece of granite. As he’s chipping away at this granite and hearing his wife cry, he’s saying, “Why aren’t I grieving?
his wife would come back from work each day and go upstairs and have a good cry and he would be working, crafting the perfect memorial stone out of a piece of granite. As he’s chipping away at this granite and hearing his wife cry, he’s saying, “Why aren’t I grieving? Where is my grief?” Of course, it’s obvious where his grief was.

Bias in the Mental Health Profession

VY: You said that the mental health profession has had a strong bias toward intuitive or emotional grieving.
KD: Sue and Sue, in their book in Counseling the Culturally Diverse, describe western counseling as swallowed by affect, meaning that the quintessential counseling question is, “how do you feel?” In grief, we’d say a better question would be, “How did you react?” or “how did you respond?” By saying, "How do you feel?" you take one of the dimensions of the ways to respond to grief and make that the primary one.
VY: If this has been the dominant paradigm in counseling and therapy for grief, what kind of problems does that cause for the instrumental griever?
KD: For the instrumental griever, it may simply not validate the honesty of his response. There is one other type of griever we talk about in our book too. We certainly recognize that lots of people are blended. They’re sort of in the middle and they have characteristics of both. We also talk about dissonant grievers. Dissonant grievers are people who really experience grief one way, but find it difficult to express it that way. This might be the male who feels he has to maintain a strong image and though he’s strongly intuitive in his experience, he does in fact repress his emotions.
VY: You also mentioned disenfranchised grief. Can you define that?
KD: Sure. Disenfranchised grief refers to losses that people have that aren’t always acknowledged or validated or recognized by others. You can’t publically mourn those, receive social support or openly acknowledge these losses. This actually started with research I did on ex-spouses — what happens when your ex-spouse dies. A lot of these people really couldn’t get time off from work, because after all, ex-spouse isn’t in the grief rules, the bereavement leave, but whether it’s an ex-spouse or not, you often had a strong relationship and a continued relationship with that person. Then we expanded it. Now when we talk about disenfranchised grief, we talk about a host of relationships that aren’t recognized—teachers, mentors, coach, therapist, patients. Think about that. This would be an interesting dimension. You have a profound relationship with a patient—in some cases, on either end, and when the therapist dies, especially if nobody knows they’ve been seeking therapy, they may have had a significant loss and yet really no opportunity to openly acknowledge or mourn that loss.
VY: When it’s disenfranchised, it’s not noticed or valued or accepted by others that this is really a significant loss.
KD: Or you may just be ashamed to bring it up. In other cases where the loss isn’t always recognized, such as divorce or…we’re better on perinatal loss than we used to be, but for mothers, not necessarily for fathers and siblings and grandparents and others. It’s sometimes when the griever isn’t recognized as being capable of grief—somebody with intellectual disabilities or sometimes the very old or the very young. Sometimes it’s a result of the type of loss that the person experiences—suicide, AIDS, homicide. Then just the ways the person grieves—grieving styles may not be always acknowledged. We do a strange thing with grieving styles. I always say we disenfranchise instrumental grievers early in the process. “What’s wrong with this person? Why isn’t he crying?” We disenfranchise intuitive grievers later in the process. “What’s wrong with that person? He or she is still crying. Why haven’t they gotten over it yet?” Of course, sometimes it can be for cultural reasons. Again, different cultures have different rules about how one is to mourn and especially in bicultural families, others may look askance at different people’s grief.
VY: Once you start throwing in all these factors—different grieving styles, disenfranchised grief, cultural differences—if we move into the area of counseling, how do you help bereaved people? It can get fairly complicated.
KD: It can, which shouldn’t be surprising, because it is always complicated.
VY: Let’s start with the grief styles. Grief is a fairly universal process, but as you pointed out, people grieve differently. How do you even know if grief counseling or a support group or some other type of intervention is necessary to begin with?
KD: I think that’s a very good question, because I think the truth is that most people—and studies vary between 80% to 90%—probably do pretty well without any formal intervention or may just need what we would call grief counseling in the sense of just some validation that says, “No, it’s understandable. No, you’re doing okay.”
VY: So, that would be normal, uncomplicated grieving in?
KD: Yes, that would be a normal, uncomplicated kind of grieving. Bibliotherapy can be so effective with these people, as it provides that basic validation. It provides some good psychoeducation. It may provide some ideas for coping and certainly says that most people get through this. That may be all that’s needed, or they may benefit from psychoeducational seminars, or support groups, or even in short-term counseling. Others may have more significant reactions. One of the things that’s kind of interesting now is there’s some movement to create a category for the next DSM, the DSM-V, called Prolonged Grief Disorder. There are some critics about that, but at this point in time it’s probably an even bet as to whether it’s going to be included or not. Certainly people who are self-destructive, certainly people who are destructive with others, certainly when grief is disabling—where a person really is having a difficult time functioning in a work role or functioning in another role—these are good examples of grief which is more problematic.
VY: Okay, so say you have someone who, for whatever reason, has sought out grief counseling or is already in therapy and then experiences a significant loss. You’ve written that it’s important to first assess what their grieving style is. How do you go about doing that?
KD: First, you ask them about how they’ve tended to experience grief. You ask them about their history about how they’ve dealt with losses before, how they’ve experienced and expressed and adapted to losses before. There are a variety of ways you go about that. And then you ask them about how they have responded to the current loss. An intuitive griever might say, “I just feel sad all the time. I have this overwhelming sense of sadness.” An instrumental griever would probably answer in another domain: “I just can’t concentrate. I just can’t focus since he died. I feel like somebody punched me in the stomach.” So the key to any assessment is asking questions that don’t necessarily prompt one response or another, and then really listening to the language that they use. The book I’d really recommend for people who are starting out in this field or who just need a little bit of a refresher is Worden’s book Grief Counseling and Grief Therapy. Beyond grieving style, there are a lot of things you have to assess.
VY: And as you’ve said, some people are fairly clear-cut, whereas others are blended grievers.
KD: You’ll get a sense for blended grievers as you hear them describe how their grief experience is now versus how they’ve reacted historically to losses. The tip-off would be that if somebody says, “I’ve had a very close relationship with this person and I responded this way,” but you notice that they’ve tended to respond other ways in the past. Maybe they’ve always responded in an intuitive way before and now they’re dealing in a much more instrumental way; that’s when it really becomes kind of intriguing and you really want to ask, “Why the difference now when historically you’ve coped and responded in these other ways?”
VY: I think most counselors or therapists have a pretty good sense of doing therapy with an intuitive or emotionally-based person. That’s the paradigm we’re used to. That’s what we think of. If you have someone who is pretty clearly on the instrumental end of things, what implication does that have? How would you conduct therapy differently?
KD: You start out by respecting and validating that style and helping them draw on their historic strengths. You don’t try to push them to an emotional place that’s going to be very uncomfortable for them. You say, “You’ve mentioned that you’re dealing with a little bit of this guilt. What has helped you before?” Maybe it’s helping them construct some kind of active way to deal with that guilt or to memorialize that person or to do something else. You build on their strengths.
VY: You support them and normalize their reactions.
KD: You support them and normalize. For instance, if I had a Dennis Ryan who said, “I don’t know. I’m not grieving. My wife cries every day and I just hammer away at this stone,” then you might try to help them recognize that that is his expression of grief and it’s a legitimate expression of grief. And you might ask, “Where does that help you? Where are its limits? What else do you need to work with as you deal with this?”
VY: You said there are some more complicated cases. Someone may be an intuitive griever, but for one reason, they’re not accessing their natural response or vice versa. Why might that be?
KD: I think you try to ask what are the inhibiting factors. Maybe the person needs a safe space. For instance, one case I had was a person whose young daughter died of cancer. He tended to be very emotional with other losses, but in this case he removed all the pictures of his daughter—he didn’t want any reminders—and that caused a conflict with his wife. That’s what brought them, really. His wife basically said, I can’t deal with you this way. You need to seek help.
VY: This can create real conflict among couples.
KD: Sure. If they have a different grieving style and they don’t recognize that. This is an extreme case in which it did cause conflict. This guy was an engineer by training, and it was very, very clear that from his past history that he tended to experience things on a very emotional level, but was really repressing emotions in this case. We talked about that and he said, “I’m really fearful if I start letting go of some of these emotions, it’ll be like a dam bursting and I won’t be able to control myself.” And I responded “Don’t dams have an overflow valve?” I’m sort of well known among my friends for not being particularly mechanical or handy. The joke is that my favorite tool is my checkbook. So I was very proud that I figured out that analogy! Then we used that analogy, that he has to find safe places to release some of this emotion and we talked about the strategy of dosing. You can control it. You can dose it.

He found ways to do that. One of the things he used to do was he had a particular song that reminded him of his daughter and he played that on his way home from work and he’d weep. That would reduce some of the energy of his grief, the issue. Then, over time, he was able to begin to talk about his daughter and begin to become confident that he didn’t always have to keep things bottled up. He was able to talk about it and release some of his emotion and at times cry with his wife, and this wasn’t going to leave him fully losing control.

Grief Counseling in Action

VY: Would you say it’s still the case that most therapists don’t get much specific training in grief counseling?
KD: It scares me, yes.
VY: Why does it scare you?
KD: I think that there’s been a real explosion of material about grief in the last 20 years. In my mind, it’s become a specialty. I see clients who have come and say, “I’ve been working with my therapist, but I still can’t accept the loss.”
And you know they’re coming from a kind of Kubler-Rossian kind of model and you’re thinking, “My God, people haven’t been doing that stuff for 15, 20 years in the field.
And you know they’re coming from a kind of Kubler-Rossian kind of model and you’re thinking, “My God, people haven’t been doing that stuff for 15, 20 years in the field.” What we’re saying is that you continue a bond with the person, that it’s very, very normal throughout your life, that you’re going to have surges of grief maybe 30 years later. Your dad died and 30 years later, your granddaughter’s walking down the aisle and you’re thinking, “I wish my father were here to see that.” This is very normal stuff and as I said, there’s a lot of poor information about grief out there, which I think is being filtered into some therapeutic context. I think people who are going to do grief counseling need to really keep abreast of the literature in it.
VY: All therapists have to know how to deal with this. I mean, even if you’re not trained as an addictions counselor, you’re going to have clients who come in for one reason and then you’re going to find out that they have an addiction. Similarly, you’re going to have people that come in to your practice as a general practitioner that are dealing with grief—either as a presenting complaint or in the course of therapy, they’re going to have losses. But I think they really don’t know how they should respond to a grieving client, other than of course being empathic and supportive.
KD: I think there’s some basic information that, therapists ought to be aware of. As I said, we’ve moved away from stages to more universal pathways. We’ve moved away from detachment to a paradigm that emphasizes that we continue a bond with the person. There’s a number of ways that our understanding of grief has changed.
VY: If you had to give some bullet points or a primer to a therapist who does not have specialized training in grief counseling, what are the things you think they need to know or skills that would be good to develop?
KD: I think number one would be to recognize grief in its many manifestations, not just as a response to death, but as a response to any significant loss. I think to understand the fact that we have our own personal pathways, that we do not detach but continue a bond with the person who died, that we recognize the increasing importance of how culture frames our response to grief.
VY: You mentioned culture a couple of times. Can you think of any cases you’ve dealt with or supervised where cultural aspects have been important?
KD: It’s a hard question to answer, because I think culture always has to play a role; every case I supervise has a cultural aspect. I’m half Hispanic and in Hispanic culture, godparents are very, very important. If somebody comes in, they may very well in fact be mourning a godparent and a therapist who’s not familiar with that culture may be trying to figure out why that role is so significant. They’re actually called comadres, compadres—meaning literally co-parents or parenting with.I think understanding how culture affects attachment, how it affects the expression of grief, how different cultures have different rituals—these are all critical pieces to take into mind.
VY: Any case examples jump out as you’re talking about it?
KD: I remember dealing with a client who is Native-American and we used some of the expressive arts. Ultimately he did some wood carving as a way to memorialize the loss, and I think that was very culturally compatible with who he was and what he was and with his culture. It’s kind of a totem-like thing that he ended up carving as a memorial to the person who died.
VY: Was that something he did on his own or did the therapist encourage him to do this?
KD: The therapist encouraged him, by first asking, “What do you normally do?” Again, it’s a sensitivity to what interventions and what strategies work well with what types of people. I just want to go back to make one other comment on those bullet points. The last bullet point I would emphasize is that, I think one of the things we’ve moved away from, as a field, is just asking the question, how do we cope with grief to how has this loss changed us? I think there’s also been a recognition of what some theorists have called post-traumatic growth, that for some, a significant loss is sometimes a spur to significant personal growth.
VY: People that are with their partner or loved ones at the time of death often talk about this being a powerful experience, even a sacred experience, although they might not identify themselves as being religious or spiritually inclined.
KD: They may not be religious, but inevitably it’s a spiritual experience, because it has to do with issues of meaning and transcendence.
As an aftermath of death, people may experience growth in skills, they may have new insights, new priorities in their life, a renewed spirituality
As an aftermath of death, people may experience growth in skills, they may have new insights, new priorities in their life, a renewed spirituality—there’s lots of changes that can occur. Again, sometimes they can go on and use these losses to make very significant changes. I think of John Walsh, host of America’s Most Wanted, whose son Adam was kidnapped and ultimately found decapitated. When he first realized his six-year-old son was missing, the police took a very nonchalant attitude and they said, “If he’s still not here in 24 hours, we’ll go look for him.” He then went on a crusade to change the way we as a society responded to the issue of missing children. The woman who founded Mothers Against Drunk Driving again used her grief to change the way we looked at drinking and driving in the US. It’s very different now than it was 30 years ago. Even teenagers are aware of the fact that there are real complications if you do this. So sometimes grief can be a spur to significant social action as well.
VY: What are some common mistakes or countertransference issues that therapists and grief counselors deal with?
KD: Again, I think failing to recognize the personal pathways, to accept that the client’s ways of grieving, and of not being aware of whatever countertransference issues you have in terms of loss or working through loss. I think using outmoded theories, using outmoded methodologies or even having a single approach.
VY: What about burnout or compassion fatigue?
KD: I think that’s a big issue in grief counseling, because you’re working with people in the midst of suffering. The research on that has really kind of emphasized that self-care is critical in the sense that you validate your own loss, especially if you’re working with people who are dying or ill, and you look toward your own spirituality, however you define it, as to how you deal with suffering and loss and that you find significant ways to find respite.

I think it’s also emphasized that organizations have a responsibility which includes providing support for their staff, providing validation for their staff and maybe even providing opportunities for the staff to engage in their own rituals as a way of validating and supporting their loss. Years ago, I worked with a project where staff dealt with foster parents who were taking on HIV positive kids and this was right at the very beginning of the epidemic, when the standard rule of thumb was that a third of the kids died within six months, another third died within the first year and everybody was dead within three years. They found their social work nursing staff was deeply affected by these losses and so they provided a range of supportive services, including an in-house ritual whenever a child died and a staff support group, as well as and the informal support of administrators recognizing the significance of those relationships and losses and really trying to be supportive to staff in whatever ways they could be.
VY: It seems there’s also a particular problem—you’ve talked about the bias towards intuitive grievers in terms of clients, but it seems there’s also a problem for therapists or counselors who are more instrumental in their grieving style, because working in the mental health field, they can easily be made to feel that they’re not empathic enough or that there’s something defective about them.
KD: I think there’s a paradox there and the paradox is that very often people who get into grief counseling field do it as an instrumental way of coping—so they often can find themselves disenfranchised by the field they selected. I think that was why when I worked on styles of grieving, which we thought was so contrary to the conventional wisdom at the time—that it was so supported by grief counselors, because they acknowledged and recognized what they saw in themselves.
VY: Ron Levant has a different terminology for that, what you’re referring to as instrumental grievers, he talks about as action empathy. Empathy is not just feeling another person, but you can act in ways that are empathic. You give examples of that in your book as well—that someone who takes care of their dying spouse and does a lot of things after the death, but they still feel like they’re not empathic enough because they don’t feel the loss as much as other people do. I think there tends to be a confusion between feeling intensely and empathy, which are in fact two separate concepts. I mean you can feel a lot, but that doesn’t mean you’re actually behaving in a way that’s empathic toward someone.
KD: Right. I would agree with you.
VY: And conversely, you may not feel others so intensely, but you can care deeply about someone and act in a way that is putting their needs first.
KD: Yeah, very definitely.
VY: So, it seems that this can really be troubling to counselors or therapists that are doing good work but have this idea that if they don’t feel a lot—and that idea may be reinforced by their colleagues—that there’s something wrong with them.
KD: Well, a lot of the clinical training is affectively based.
VY: Any thoughts about individual counseling versus group counseling or support groups. How might you make that determination on what would be most appropriate?
KD: For uncomplicated people who are grieving, a support group can be very, very fine. When you look at the research on grief counseling it shows that you need a careful assessment and an individual targeting of intervention. As far as the question of support groups, you need to look at whether the support group is well run, and does it have an emphasis on positive coping and even potentially transformation? You know, how is this experience changing you?
Sometimes the problem with support groups is they can be just places of what we call "shared anguish" where everybody just kind of comes in and says, "Hey, if you think that story’s bad, let me top it off."
Sometimes the problem with support groups is they can be just places of what we call "shared anguish" where everybody just kind of comes in and says, "Hey, if you think that story’s bad, let me top it off." And so you come out of the support group thinking, "Wow, you know, the world’s hostile." So, a good support group leader would say, "Okay, yeah, that was a pretty horrible experience, but how did you cope with that, and how have others of you coped with experiences like that and what have you learned from those?" So there’s got to be this notion of emphasizing not just the sharing of anguish, but also how we kind of deal with that anguish.
VY: I imagine support groups also can be problematic for instrumental grievers if the focus is primarily on expression of affect.
KD: Yeah, it can be. There was the Harvard bereavement study found that, for instance, single dads benefitted more from more problem-oriented support groups like "How to be a good single dad,” rather than groups that really focused on their grief experience.
VY: So, that would be, of course, important to assess that grieving style in making a referral. What are you currently working on now?
KD: Well, we’re doing a book now on spirituality in loss for the Hospice Foundation of America, and so that’s my current project right at the moment. We’re looking now at the issue of spirituality a little bit more deeply.
VY: And just to wrap up, what are some of the most meaningful things you have learned personally and professionally working in this field for several decades?
KD: Well, I’ve very much enjoyed my involvement with two professional associations, The International Work Group on Death, Dying and Bereavement, and The Association of Death, Education, and Counseling. The International Work Group is an invited group—you have to be involved in the field to be invited to join it. But the Association, anybody who’s really interested in grief counseling should join and you’ll benefit tremendously from your experience in that. I very much have found my work with the Hospice Foundation of American to be extraordinarily meaningful, because in many ways—we publish a newsletter for the bereaved called Journeys—and I think what’s really been exciting about that is getting some of the best people in the field to do some writing, really with a self-help emphasis, and really taking some of the best of current theory and practice and really translating it to a lay public. And that newsletter goes out to 60,000 people a year, so that’s a significant segment of people for a bereavement newsletter. And then, of course, I love teaching graduate students at the college in New Rochelle. That’s always a meaningful experience for me.
VY: Well, I think this has been a great—we’ve packed a lot of material into one interview and I think it will be of great interest to our readers. Thank you for taking the time.
KD: Thank you for the thoughtful interview.

Copyright © 2010 All rights reserved. Published July 2010.
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Kenneth Doka Dr. Kenneth J. Doka, PhD, mDiv, is a Professor of Gerontology at the Graduate School of The College of New Rochelle and Senior Consultant to the Hospice Foundation of America. A prolific author, Dr. Doka’s books include Grieving beyond Gender: Understanding the Ways Men and Woman Mourn; Counseling Individuals with Life-Threatening Illness; Disenfranchised Grief: Recognizing Hidden Sorrow; and Disenfranchised Grief: New Directions, Challenges, and Strategies for Practice. In addition to these books, he has published over 100 articles and book chapters. Dr. Doka is editor of Omega: The Journal of Death and Dying and Journeys: A Newsletter to Help in Bereavement. He has served as a consultant to medical, nursing, funeral service and hospice organizations as well as businesses and educational and social service agencies. Dr. Doka is also an ordained Lutheran minister.
Victor Yalom Victor Yalom, PhD is the founder and resident cartoonist of He maintained a busy private practice in San Francisco for over 25 years, but now sees only a few clients, devoting the bulk of his time to creating new training videos for He has produced over 100 videos, conducted workshops in existential-humanistic and group therapy in the US, Mexico, and China, and currently leads consultation groups for therapists.  More info on Victor and his artwork and sculpture at

CE credits: 1.5

Learning Objectives:

  • Describe Doka's orientation to grief therapy
  • List the various styles of grieving
  • Explain the different forms of grief

Articles are not approved by Association of Social Work Boards (ASWB) for CE. See complete list of CE approvals here