EGOLESSNESS AS A TOOL FOR GROWTH IN BUDDHIST PSYCHOLOGY

Remember all those times when someone, in breaking up with you, said “it’s not about you; it’s me”?  That might seem like a trite cliche, but it is likely true. So little in life is really “about you.”

Buddhism teaches that the cause of all of our suffering is our clinging to what we believe to be our “self.”  Understanding egolessness or selflessness is the key to healing our personal wounds as well as our relationships, and is an important concept in Buddhist psychology.

We tend to cling to our belief in a solid “I” out of a fear of groundlessness, in a false attempt to create some ground under us.  However, in clinging to a solid sense of self, we close down our world, believing that we are in the middle of it all.  In other words, we become self-centered.  The experience of selflessness opens us from the claustrophobia of self-centeredness into the spaciousness of possibility and connection.

Analytical and mindfulness meditation are effective methods for directly experiencing and understanding that no true “self” exists.  Here’s an exercise that can help you get this important concept:

  • Sit in a comfortable position, and bring your attention to your breath.
  • Once you are relaxed and undistracted, examine your notion of a solid self, and ask questions that challenge that notion.  Some questions that can aid this exploration are: “Am I my head?  My hands? My gut?  My profession?  My hobbies?  My thoughts? Where is ‘I’ anyway?”
  • As you go through this exercise, notice your emotions and body sensations.  You might feel fear, and with accompanying tightness in a particular place in your body.  That’s normal – we all fear groundlessness until we realize that groundlessness, or selflessness, is actually an opening into spaciousness and possibility.
  • Be patient when you slip into a state of self-clinging.  We all have this habitual tendency, and it’s a tough habit to break.  Realizing the universality of self-clinging, we can develop compassion for ourselves and all others.  This in itself can be incredibly transformative and healing.

Because of our human tendency to cling to a sense of self to maintain what we believe to be stability and ground, you will need to return to this exercise over and over. As you become familiar with the body sensations that accompany your fear of selflessness, you can breathe into those sensations to loosen the grasp of self-clinging when it arises.  In doing so, you will have a better understanding of your everyday experiences, reactions and communications with others.

Have you ever noticed that the people in your life have different opinions and viewpoints about you?  If the “self” were solid, how would that be possible?  People’s views are merely their own projections, and no two people see things in exactly the same way.  This concept is extremely helpful in human relationships.  When we are able to get our ego out of the way, we can actually hear what another person is saying or requesting.

A useful way to put this into practice is in your personal and professional relationships, which always offer the opportunity for growth.  For example, when someone criticizes something we did, our habitual tendency is to immediately defend our actions – and ourselves.  At these moments, our egos tend to rear their ugly heads and we really don’t hear the request underlying the criticism.  It takes discipline to let go of the knee-jerk reaction to protect the ego.

One of the best tools for letting go of this tendency to defend our egos is to slow down, and feel where we feel the emotions connected with the criticism.  For me, it is a clenching in the stomach and jaw, and fluttering in my heart.  When I am able to slow down without immediately reacting, I take a breath and ask myself what those body sensations are telling me.  Often, it is feeling hurt and misunderstood.  I can then discern what the most effective response would be.  When I am able to leave my ego at the door, I breathe into my hurt feelings with self-compassion, and let it go.  I can then determine what the underlying communication truly is, and respond accordingly. This is the opening into true compassion, connection and openness.

Using the Buddhist Practice of Tonglen to Transform and Heal the Aloneness of Grief

The funeral has been planned and taken place. The cards and casseroles have stopped coming. Friends have gone back to their daily routines. It has been a month or so since your loved one’s death. Nothing feels the same. You feel alone. You feel like no one can possibly understand the depths of your sadness and despair.

Opening ourselves to our grief, rather than hiding from it, offers the possibility of true growth and transformation. It can be exquisitely painful to lean into one’s grief. Running from it, isolating ourselves, numbing our pain in alcohol, drugs or sleep can be so tempting. How, then, to allow ourselves to feel the pain of grief, and at the same time, let go of self-pity and feelings of aloneness and begin to heal?

A Buddhist meditation practice called tonglen, or “sending and receiving” can be very healing at this time. It is a practice all can do, Buddhist or not. Sogyal Rinpoche, in The Tibetan Book of Living and Dying (1994, p. 193), describes tonglen as one of the most “useful and powerful” practices in the Tibetan Buddhist tradition:

When you feel yourself locked in upon yourself, Tonglen
opens you to the truth of the suffering of others; when
your heart is blocked, it destroys those forces that are
obstructing it….[I]t helps you to find within yourself
and then to reveal the loving, expansive radiance of your
own true nature.

The practice of tonglen involves breathing in suffering and breathing out love and compassion for all beings, including yourself. As Sogyal Rinpoche states (p. 195),
“Before you can truly practice Tonglen, you have to be able to evoke compassion in yourself.” You breathe in your own pain and suffering, and breathe out peace, love and compassion for yourself. One way to do this is to imagine breathing in a dark cloud of smoke, and breathing out light. Once you are able to evoke a sense of self-compassion, you can then imagine breathing in the pain and suffering of loved ones, and sending them love and compassion on the outbreath. A natural outgrowth is to extend this sending and receiving to all beings.

The practice of tonglen allows the bereaved to know they are not alone: We all experience loss and grief. It helps us drop the “why me?” of self-pity, which can leave grief stuck in place. Instead of that self-centeredness, a sense of unity and compassion for all can develop.

Leaning into one’s grief through the practice of tonglen can be extremely healing and spiritually transformative. The Tibetan Book of Living and Dying and other works, such as the writings of Pema Chodron, go into further detail about the practice. In addition, trained meditation instructors in Buddhist centers throughout the world can work with you to deepen your understanding and experience of the practice.

THE MYTH OF PERFECTION: A BUDDHIST PERSPECTIVE

Many of the clients in my psychotherapy practice come to see me for depression and anxiety caused by self-criticism and negative self-talk. I have discovered that these clients are caught in the trap of perfectionism. Perfectionism has been defined in psychology (Stoeber & Childs 2010) as “a personality disposition characterized by an individual striving for flawlessness and setting excessively high performance standards, accompanied by overly critical self-evaluations and concerns regarding others’ evaluations.”

From a Buddhist perspective, perfectionism is kept in place by an attachment to the “self” as a separate, unique and real entity. In addition, forgetting that we are human beings living in samsara (the endless cycle of birth, old age, sickness and death and its attendant suffering) further solidifies perfectionism.

Human beings in the “human realm” of samsara all experience anger or aversion, jealousy, grasping, ignorance or lack of understanding and pride – known in Buddhism as the “five poisons.” Those with perfectionistic tendencies forget this, and believe that they are uniquely deficient when they experience these afflictions. Some feel so much shame, or have such a strong need for others’ approval that they try to hide behind a mask of perfectionism – covering up mistakes rather than owning up to and learning from them, overindulging in food, drugs or sex to numb the pain, giving in to others’ needs rather than expressing their own.

Instead of trying to deny or hide imperfections, acknowledging them mindfully can lessen perfectionism’s control. The first step is to mindfully notice your thoughts of self-judgment. The goal is to acknowledge those thoughts as soon as they arise and then let them go, dispassionately and without judgment. It takes a lot of practice not to get caught in the web of those thoughts.

One important tool in overcoming perfectionism or other dysfunctional tendencies is to recognize where you feel the associated feelings in your body. For example, if you experience jealousy, you might feel a hot, tight sensation in your chest. Exploring the sensation further, you discover that it would be red if it had a color, oval if it had a shape, and about two inches long if it had a size. Precisely describing the bodily feeling, as in the above example, is very effective in recognizing and letting go of self-critical thoughts as soon as they arise.

Then, breathe into that physical place with compassion, instead of immediately trying to avoid the feeling. You can’t turn it off like turning off the radio, and the more you try, the more intense it becomes. In the vernacular of the ‘70s human potential movement, “what you resist persists.” As you breathe out, breathe out light and space.

Continuing to breathe in and out in this way leads naturally to the Buddhist practice of tonglen, or sending and receiving – taking in the heavy, dark negative feelings, and sending out light, spacious healing feelings. This practice is first done for oneself, and then extended to all beings who suffer from perfectionism’s grip.

The benefits of this practice to counteract perfectionism are many and powerful. First is the engendering of compassion for oneself and one’s human foibles. Extending this compassion out to all who are suffering from perfectionism leads naturally to knowing that you are not alone, separate and distinct from all others.

We are perfect in our imperfection. Acknowledging and leaning into our imperfections with compassion and without judgment leads to tenderness and openness. As Leonard Cohen sang, “There’s a crack in everything. That’s where the light gets in.”

Psychotherapy and the Middle Way

When I hear the clients in my psychotherapy and grief counseling practice talk in black and white terms, or view their options in terms of extremes, I am reminded of the Buddhist concept of the Middle Way. When the Buddha was asked how one should meditate, he responded “not too tight, not too loose.” He analogized this to a string instrument, like a lute: If the strings of the lute are too tight, they will break, and if the strings of the lute are too loose, they won’t play.

So it is as we live our lives and navigate its changes. Ideally, we strive to find a middle way where the “strings” of our life can resonate. However, due to anxiety, we may get wound up to the breaking point, where there is no give and take, no spaciousness to allow things to be. On the other hand, we may be so downtrodden with depression that our “strings” are too loose — we just don’t have the emotional energy to tighten them enough to play.

The Middle Way can be likened to living in the space of ambiguity — which is truly the condition of life. Because of our emotional histories, living in ambiguity can be fraught with difficulties. In our anxiety, we frantically fill the spaces in our lives with doing, rather than being. Yet, possibilities for growth and renewal can only arise if we are able to rest in that unknown space. If we can take a breath and rest in that space, called “the gap” in Buddhism, we see that it truly is spacious, vibrant, alive and full of possibility.

Similarly, our emotional wounds sometimes prevent us from seeing the complex nature of the people in our lives, including ourselves. At its extreme, we see them as all good or all bad, known as “splitting.” In fact, sometimes the same person is seen as all good one minute, all bad the next. A goal for people in therapy with this type of issue is to be able to see the shades of gray — people, including the client, are neither all good nor all bad. Many people with this tendency are perfectionists, with resultant depression, eating disorders, self-injury and other issues. For these clients, having a safe experience that it is OK not to be perfect (and that perfection is in fact impossible for human beings) leads to self-compassion, and compassion for others. Their emotional “strings” can then be loosened enough to let themselves — and others — be, allowing for the possibility of joy, satisfaction and intimacy in their lives.

The Middle Way approach is also helpful in my work as a grief counselor. People who are struggling with their grief sometimes ask me “when will I feel better, and when will I ‘get over it’”? Some go the “too loose” extreme, numbing the pain of grief with drugs or alcohol, or jumping into a new relationship. Others go to the “too tight” extreme, idealizing and idolizing their deceased loved ones, or holding on tightly to their pain for fear that letting go will mean forgetting their loved ones. Finding that Middle Way, where the bereaved can safely feel and express their pain and go through their own personal journey of grief, without having a map, but the compass of the grief counselor, is a key component to growing and healing in grief.

Caring for Tibetan Buddhists at the End of Life

Many people in the baby boomer generation, who were raised in the Jewish and Christian faiths, have turned to Tibetan Buddhism and other Eastern religions.  As this generation ages and enters hospice care, it will be important for health care providers to understand their unique needs at this sacred time in their lives.

Broadly speaking, Buddhist practice emphasizes a deep understanding of the mind, the importance of karma (cause and effect) and preparing for death.  For Buddhist practitioners, the moment of death is considered the most important moment of life.  Developing a calm and aware mind, acting virtuously for the benefit of other beings and abandoning harmful actions are the most important practices for preparing for death.  If the Buddhist practitioner is able to stay relatively aware at the time of death, he or she can be reborn in what is called a “Pure Land” and continue on the path toward enlightenment.

The most important practice for Tibetan Buddhists and those supporting them at the end of their lives is called “Phowa”, or transference of consciousness.  Phowa is aimed at assisting practitioners to be reborn in a Pure Land, where the cycle of suffering, or samsara, ceases.

An important concept in Tibetan Buddhism is the concept of the “bardo”, which means “in-between.”  Every moment can be considered a bardo, or a transition to the next moment.  In fact, our present life is a bardo between what came before and what will happen next.  The bardo between this life and the next is called the “bardo of becoming” and is traditionally considered to be forty-nine days. It is a time of self-review and purification of negative acts, in order to be reborn if not in a Pure Land, then at least as a human being who has the potential of attaining enlightenment. It is said to be a very vivid and at times intense and frightening experience, and the practitioner’s spiritual community, or sangha, traditionally practices at the end of each week to assist the deceased’s journey through the bardo. The dying process is seen as a separation of the mind from the body, and it is the mind that continues into the bardo between this life and the next.  Therefore it is important for the mind to be clear and calm at the time of death.  It is said that whatever thought one dies with is the one that will return most powerfully when one reawakens in the bardo. Traditionally, it is said that it takes 72 hours for the mind to completely separate from the body and begin the journey into the bardo between this life and the next.

As death nears, clinicians and others should refrain from touching the body, especially the feet, because doing so may direct the patient’s consciousness downward to rebirth in a lower realm, where he or she cannot benefit others and have the potential for enlightenment.  The patient may wish to be in the traditional posture of dying, lying on the right side in the posture of the “sleeping lion”, which is the posture in which Buddha died.

In developing a plan of care for Tibetan Buddhist practitioners, the hospice team and other caregivers need to consider the patient’s views on suffering, alertness and karma.  The following are some considerations in developing a plan of care for dying Tibetan Buddhist practitioners:

1.  Determine if the patient has a spiritual teacher (or guru) and the patient’s wishes for contact with the guru, and how to contact him or her.

2.  Determine if the patient has a community of fellow practitioners (the sangha), and if so, how to contact them.

3.  Provide a quiet space for sangha members to come and sit with the patient to meditate or do Phowa practice.

4.  Help the patient arrange an altar with pictures of the guru and other pictures that are important to the patient for his/her practice, as well as any meditation tapes, prayer beads, etc.

5.  Clarify issues and wishes regarding the use of pain medications.  Many practitioners may believe that the use of pain medications may unduly cloud their minds, but unrelieved physical pain may do the same.  As with all patients, this is a balancing act.

6.  For the social worker and bereavement coordinator, understand any family dynamics issues — there may be unfinished business or at least conflicting feelings if the patient was raised in a different faith.  The chaplain, in doing his/her spiritual assessment may want to do a “spiritual ecomap”, which is like a genogram, which is useful for families who practice multiple faiths.  This will be more and more important as the baby boomer generation continues to age.

7.   It is also important to facilitate discussions with family members about the patient’s wishes for end of life and at the time of death.  Educate family members on the need for a calm and peaceful environment, and let them know that if they are too outwardly emotional, they may be asked to leave the room.

8.  Clarify after-death wishes.  Does the patient want the body to stay untouched for 72 hours in order for the mind to separate and enter the bardo?   Sangha members and others may come to be with the body during that time to recite prayers and read from the Tibetan Book of the Dead. If on the other hand, the patient wants to donate his or her organs, that is totally acceptable, and most Buddhist teachers say it is a great way to generate good Karma. Cremation is traditional, but confirm wishes, and if they want to be cremated, and determine if they want a ceremony or viewing.

9.  Bereavement support may also need to be modified — grieving sangha members may not want bereavement support in the first 49 days after the death, so that they can turn inward to help their fellow sangha member’s journey in the bardo.  With respect to non-Buddhist family members, listen for and validate any feelings they may have in regard to their loved one’s Buddhist practice.

References

Smith-Stoner, M. (2006).  Phowa:  End of Life Ritual Prayers for Tibetan Buddhists. Journal of Hospice and Palliative Nursing, Vol. 8, No. 6.

Sogyal Rinpoche (1994). The Tibetan Book of Living and Dying. San Francisco:  Harper San Francisco.

A Buddhist Approach to Grief Counseling

Grief theorists, in keeping with Western culture’s emphasis on autonomy and individuation as signposts of psychological health, have long held that disengaging from the deceased is necessary for the successful resolution of grief (Marwit & Klass, 1995).   For example, according to the psychoanalytic view of Freud (1917), grief work entails decathecting, or detaching libidinal energy from the deceased.  Furthermore, the attachment theory of Bowlby (1969) posits that the bereaved individual attempts to maintain a bond to the deceased until he or she realizes the impossibility of doing so, and eventually “lets go” of his or her relationship to the deceased.

The predominant beliefs in the importance of disengaging and letting go in resolving grief have been gradually giving way to the concept that continued attachment to the deceased loved one is a healthy and necessary task of the grief process (Silverman & Klass, 1996).  The work of Worden (1981, 1992, 2002) can be seen as a bridge between the majority view of theorists beginning with Freud and the more contemporary view of the importance of continuing bonds. Worden originally described one of the major tasks of mourning as “withdrawing emotional energy from the deceased and reinvesting it in another relationship” (1981, p. 13), in keeping with the goal of decathexis described by Freud.  Significantly, in subsequent editions of his work (1992, 2002), Worden acknowledged that the bereaved do not in actuality decathect from the deceased.  Accordingly, Worden now describes this task as “emotionally relocating the deceased and moving on with life” and suggests that finding a place for the deceased in the life of the bereaved “will enable the mourner to be connected with the deceased but in a way that will not preclude him or her from going on with life” (2002, p. 35).

My approach to grief counseling is strength-based and solution focused.  Narrative therapy, a relatively new model of cognitive therapy (Carr, 1998), is in accord with this focus.  Narrative therapy has been found to be useful for helping clients access continued attachment and spiritual beliefs about death as a means of making meaning and finding the strength to emotionally relocate the deceased and move on with life.

Grief as a Holistic and Spiritual Process

Worden (2002) has identified four tasks of grief: (1) to accept the reality of the loss; (2) to work through the pain of grief; (3) to adjust to an environment without the deceased; and (4) to emotionally relocate the deceased and move on with life.   Worden’s formulation recognizes that grief impacts the bereaved in the physical, behavioral, cognitive, emotional and spiritual domains (Worden, 2002; Attig 1996).  Similarly, Marrone (1995) has identified the following phases in the grief process:  (1) cognitive restructuring, in which the bereaved reorganizes and restructures his or her thoughts and concepts to assimilate a loss; (2) emotional expression of the experience of the loss; (3) psychological reintegration of new coping behaviors and cognitive strategies for adjusting to life without the deceased; and (4) psychospiritual transformation, “which involves a profound, growth-oriented spiritual/existential transformation that fundamentally changes our central assumptions, beliefs and attitudes about life, death, love, compassion or God” (p. 498).

The fourth phase or task identified by both Worden (2002) and Marrone (1995) as described above provides the ground for working to transform and maintain the bereaved’s relationship with the deceased loved one.  As observed by Silverman and Klass (1996), “we need to consider bereavement as a cognitive as well as emotional process that takes place in a social context of which the deceased is a part….People are changed by the experience; they do not get over it, and part of the change is a transformed but continuing relationship with the deceased” (p. 19).  Cognitive interventions are useful for accessing and working with this transformative process, and as discussed below, narrative therapy provides a powerful cognitive container for the transformative work of grief.

Spiritual belief in continued attachment as a source of strength.

Whereas Freud and his followers may have seen continued attachment to the deceased as a form of pathological grief, the experience of continued bonds to the deceased is now viewed as a strength, resource and form of resiliency in the normal grief process (Benore & Park, 2004; Angell, Dennis & Dumain,1998).    Coping with loss has been called “a spiritual process that includes locating our {loved ones] in time and place, and transporting our recreated ‘experiences’ to the here-and-now” (Angell, Dennis & Dumain, 1998, p. 618).  Benore and Park (2004) have found that religious and spiritual beliefs in an afterlife and continued attachment to the deceased enable one to adapt more easily to the death of a loved one:

“The bereaved who strongly believe in [continued attachment] do not need to reconcile a loss of the person, but rather a change in the relationship.  Beliefs that the deceased person and the resulting relationship continue may eliminate the        most distressing aspects of death, whereas those who do not believe in [continued  attachment] must deal with the difficult issues of permanent loss, the void in their life and relationship network, and the sense of isolation (p. 12).

Grief and Spiritual Transformation

As one gets in touch on a deep level with his or her own suffering and resiliency in the face of that suffering, he or she can begin to get a panoramic view of the human condition and tap into his or her spiritual strength. Religious and spiritual beliefs have been observed to be one way in which individuals create meaning and a sense of order and purpose to the human condition, life and death, as well as creating an ongoing relationship with the deceased (Golsworthy & Coyne, 1999; Calhoun & Tedeschi 2000). “Because religious beliefs are central to many people’s global meaning systems, and because death is a central arena for the enactment of religious beliefs, these beliefs are likely to be a central part of the process of coping and adjustment following bereavement for many people” including beliefs in continued attachment to the deceased (Benore & Park, 2004, p.4).

The strength-based approach I use with my grieving clients, through the use of techniques of narrative and solution-focused therapy, is informed by my Buddhist practice.  In particular, I come to each session with my clients with the ground that each human being possesses inherent wisdom, or Buddha Nature, and that this wisdom can be called upon to access the individual’s strengths and resilience in times of suffering.  As Levine (1982) notes, grief fully experienced allows us to “plumb the depths” of our souls and to “touch something essential in [our] being….[W]hat is often called tragedy holds the seeds of grace” (pp. 85-86). Those “seeds of grace” are the basic goodness or Buddha Nature possessed by all, and it is my job as collaborator or partner in the journey of grief to support my clients in getting in touch with the strengths that they possess but which may be obscured by the intensity of their feelings of helplessness and loss.  Through narrative therapy, including the use of literary and other creative forms of expression, clients are able to create some space around that intensity, which in turn gives them some perspective and hope for change and transformation.

The broader perspective that can be reached through narrative therapy techniques can put the client in touch with both the uniqueness and universality of grief and suffering.  Paradoxically, contemplating the universal truth of suffering can open us to acceptance and peace.  As His Holiness the Dalai Lama (1998) observes, “if we can transform our attitude towards suffering, adopt an attitude that allows us greater tolerance of it, then this can do much to help counteract feelings of mental unhappiness, dissatisfaction, and discontent” (p. 140).  The Dalai Lama (1998) suggests that the most effective practice to help one tolerate suffering is to contemplate and understand that “suffering is the underlying nature” of existence as human beings:  “If your basic outlook accepts that suffering is a natural part of your existence, this will undoubtedly make you more tolerant towards the adversities of life” (pp. 141-142). Through allowing ourselves to experience and express our suffering, we can see that there is a way out of that suffering, through working with it as a fact of life, and finding a meaningful way to grow, transforming hopelessness into hope and possibility.  Narrative and solution-focused therapy can foster the realization that grief is not necessarily pathological, but an integral component of the human condition.  Through experiencing our own unique grief, we can tap into its universality, lessening our hopelessness and isolation, and deepening our connection with others and the human condition.  This is the transpersonal and transformative work of healing grief.

References

Angell, G.B., Dennis, B.G. & Dumain, L.E. (1998). Spirituality, resilience and narrative:  Coping with parental death.  Families in Society:  The Journal of Contemporary Human Services, 615-629.

Attig, T.  (1996).  How we grieve: Relearning the world. New York:  Oxford University Press.

Benore, E.R. and Park, C. L. (2004).  Death specific religious beliefs and bereavement:  Belief in an afterlife and continued attachment.  The International Journal for the Psychology of Religion 14(1), 1-22.

Bowlby, J. (1969). Attachment and loss: Attachment (vol. 1). New York:  Basic Books.

Calhoun, L.G. & Tedeschi, R.G. (2000). Posttraumatic growth: The positive lessons of loss. In Neimeyer, R.A. (Ed.), Meaning reconstruction and the experience of loss (pp. 157-172). Washington, D.C.: American Psychological Association.

Carr, A. (1998). Michael White’s narrative therapy.  Contemporary Family Therapy, 20(4), 485-503.

Dalai Lama, H.H. & Cutler, H. (1998). The art of happiness:  A handbook for living.

New York:  Riverhead Books.

Freud, S. (1917). Mourning and melancholia. Standard edition of the complete works of Sigmund Freud (vol. 14). London:  Hogarth Press.

Golsworthy, R. & Coyle, A. (1999). Spiritual beliefs and the search for meaning among older adults following partner loss.  Mortality, 4(1), 21-39.]

Klass, D. (1993). The inner representation of the dead child and the worldviews of bereaved parents. Omega, 26(4), 255-272.

Levine, S.  (1982). Who dies? An investigation of conscious living and conscious dying. Garden City, NY:  Anchor Press.

Marrone, R. (1999). Dying, mourning, and spirituality: A psychological perspective. Death Studies, 23, 495-519.

Marwit, S. & Klass, D. (1995).  Grief and the role of the inner representation of the deceased. Omega, 30(4), 283-296.

Silverman, P.R. & Klass, D. (1996).  What’s the problem? In Klass, D., Silverman, P.R. & Nickman, S.L. (Eds.), Continuing bonds:  New understandings of grief (pp. 3-27). Philadelphia: Taylor & Francis.

Worden, J.W. (2002, 1992, 1981). Grief counseling and grief therapy:  A handbook for the mental health practitioner. New York:  Springer Publishing Company, Inc.