https://doi.org/10.52456/WACJO325

An empirical research study into the faith journeys of bereaved Christian mothers in the UK.

Abstract

This article is the second of two articles originating from MA research into influences on the faith journeys of bereaved Christian mothers in the UK.

The first article (also in this issue) offered a tentative conceptual model that integrated Neimeyer’s meaning reconstruction model (Neimeyer & Sands, 2022) with Pargament’s theory of religious coping (1997).

This second article presents the findings of a small research project that explored the potential influences on bereaved mothers’ faith journeys that were identified in the first article . The research used an interpretive phenomenological approach to explore influences that may be relevant to, and could be influenced by, Christian ministry.

The research findings confirm that faith re-appraisal often occurs after the death of a child and suggest that potential influences on the mother’s faith journey include her pre-loss core faith beliefs, the nature of her relationship with God and the availability of appropriate spiritual support. It highlights the need for churches in the UK to increase their understanding of the muti-faceted impact of child death in order to substantively improve both the scope and the appositeness of the spiritual and emotional support they offer bereaved mothers.

Keywords: child death, faith reappraisal, meaning construction, religious coping, maternal grief, pastoral care, theodicy, spiritual growth.

Research aims

Lived experience aligns with limited research on the spirituality of bereaved parents in suggesting that bereaved mothers may re-appraise aspects of their faith in the light of their child’s death. However, there appears to be no such research in a UK Christian context.

The conceptual model presented in the previous review article (see Neve [2023], this issue) suggests that a bereaved mother’s faith journey may be influenced by her pre-loss core faith beliefs, her relationship with God and her relationship with her faith community.

This research therefore utilises these pre-identified themes to explore the lengthy and often hidden faith journeys of Christian bereaved mothers in the UK, with the hope of informing and shaping UK Christian ministry.

Methodology

This research is an ethnographic study[1] (Swinton & Mowat, 2016:156) of three bereaved mothers, who professed a Christian faith at the time of their child’s death from natural causes, as research suggests death by accident, murder or suicide are associated with different outcomes (Lichtenthal et al., 2013:327-330). The research focused on mothers whose child died ten to twelve years ago, as studies show that after this length of time outcomes such as post-traumatic growth and prolonged grief disorder have settled (Meisenhelder, 2021:104; Harper, O’Connor & O’Carroll, 2015:907; Lannen, Wolfe, Prigerson, Kreicbergs & Onelov, 2008:5870). The research falls within the qualitative research paradigm as it focuses on the ‘deep’ investigation of the subjective experiences of the three bereaved mothers (Bottery & Wright, 2019:113; Swinton & Mowat, 2016:60).

Semi-structured interviews were utilised to explore the participants’ experiences within the pre-identified themes proposed in the first article. An adapted interpretive phenomenological approach (Brinkmann & Kvale, 2015:30; Thomas, 2013:53) utilising thematic content analysis was employed to analyse the data (Smith, 2008:67-76), with the issues revealed in the interviews initially clustered into the pre-identified themes of faith reappraisal, relationship with God and relationship with their faith community. The participants’ views of what helped them through their grief, and the changes they retrospectively noticed in their faith since their child died, were also included as they are pertinent to the research.

Critical reflection upon these results identified of a number of connected sub-themes, which were then used to compare the three mothers’ faith journeys (Swinton & Mowat, 2016:272; Smith, 2008:70).

These connected sub-themes were also used to inform private conversations with three other individuals with noteworthy personal experience of child death, subsequently referred to as ‘expert sources’, in order to triangulate the participant data (Smith, 2008:239). (As all three of these individuals have previously spoken publicly and written about their personal experiences of child death, they were not considered suitable as research participants.) These individuals included the Bereaved Parents’ Co-ordinator (Park, 2022) from the organisation ‘Care for the Family’ (Care For The Family, 2021). This individual has both personal experience of the death of a child along with extensive experience of supporting many other bereaved parents, and thus provides a rich picture of the experience of child death. The researcher also gathered informal data through private conversations with two bereaved mothers who have both written and spoken extensively about their personal experiences of child death within the context of a UK Christian faith community (Gantlett, 2022, 2021; Williams, 2022, 2019, 2018). It is acknowledged that, with their extensive capacity to theologically reflect upon their experiences, these two bereaved mothers are not typical. However, it is this ability to reflect and explore their experiences in the context of their Christian faith that makes their contribution to this field of study so valuable.

Evaluation of the presence or absence of these sub-themes, within both the research participants experiences and the triangulation data from the expert sources, identified some potential interconnected influences on the mothers’ faith journeys. These potential influences were then compared to the proposed integrated model presented in the first article (Denscombe, 2011:204).

Results

Participant variables

To aid the understanding and interpretation of results, it is appropriate to mention some key participant variables that may exert influence on the mothers’ faith journeys.

All participants in this research have been given pseudonyms.

Catherine’s daughter Hannah was diagnosed with a brain tumour at 4 years old and subsequently died aged 13. Catherine attends an Anglican church. Ruth’s daughter Olivia was diagnosed in utero with a condition incompatible with life and died shortly after birth. Ruth attends an independent evangelical charismatic church. Jane’s son Ben was stillborn after being diagnosed in utero with a life-limiting genetic disorder. Jane attended a Pentecostal church for many years before moving to a new church.

Initial analysis of participant data

Table 1 summarises the raw data.

Table 1: Total number of comments per issue.

This data suggests these participants found their faith and relationship with God provided them with more comfort and strength (total comments for 2 (a) = 51) than challenges (total comments for 1(b) + 2(b) = 11+12 = 23).

Relationships with their faith community appear to have caused the bereaved mothers more pain and distress (total comments for 3(a), 3(b), 3(c) and 3(d) = 54+49+25+19 = 147) than afforded support (totals comments for 3(e) = 15).

The participants felt that what helped them the most was being able to be real, being understood and talking about their child (total for 49(a) = 35).

Initial thematic analysis

Faith reappraisal

After the death of their children, both Catherine and Jane struggled to align their core faith beliefs about the nature of God and suffering with their reality. They both experienced intense and persistent questioning around the issues of divine healing and God’s plans and purposes, with Catherine stating she still asked God, ‘Why didn’t you heal her?’ Additionally, while Catherine’s belief that Hannah was safe in God’s care ‘eased a lot of the upset’, she also described how she had asked herself, ‘Is this punishment for something that we’ve done?’ Jane similarly declared, ‘I still don’t have all the answers I want’ and wondered whether sin or a lack of faith was in any way responsible for Ben’s death. However, Ruth stated she did not question why her daughter died because she knew ‘we live in a fallen world’.

Relationship with God

All participants expressed the view that their relationship with God was important and gave them strength and comfort, both before and after their child’s death. For Ruth, her relationship with God was key, as she said, ‘I just felt so completely held by God and so sure of what he was doing.’ However, all participants experienced some negative feelings towards God after their child died. Ruth said she ‘got very, very angry with God’, Catherine stated she ‘really felt quite sore with God’ and ‘disappointed’, while Jane described how she felt ‘so let down’. All participants also expressed a disconnect from God around the time of their child’s death, with Catherine saying God was ‘surprisingly distant’. All the participants similarly found prayer a significant comfort while their child was ill, but after their child died, they all found personal prayer difficult.

Relationships with church and faith communities

All participants felt misunderstood and judged by other people in both their church and wider faith communities since their child died. This was a significant issue for Ruth and Jane, with Ruth saying, ‘I felt there was a lot of judgement there and criticism and that was very, very difficult.’ Jane similarly declared, ‘people telling you how you should be feeling… is really unhelpful’.

All participants experienced some support from their churches before their child died and around the time of death, but they all felt this support reduced after the initial months. Jane particularly appeared to lack support and stated, ‘everyone wanted to pray for me before, and then afterwards I felt a bit abandoned, you almost feel like you failed’.

Ruth and Jane found their church services difficult after their child died. Ruth described them as ‘alienating’ and ‘absolutely irrelevant’, adding church ‘doesn’t provide you with a means with which to access God in your reality’.

Participants’ perception of what helped them

Ruth and Jane expressed the view that they needed a safe person to be real with, and to be understood. Jane stated, ‘I think you just want people there who you can be real with’ and Ruth felt, ‘There definitely wasn’t room to be real, to question to begin with, so that made things harder.’ All the participants felt it was helpful for them to be able to talk about their dead child, with Jane saying it was ‘one of the biggest things that would help’ and Ruth saying it was her ‘greatest need’, but that she felt people wanted her ‘to shut up and go away’.

All participants spoke about needing Christian support that also had good knowledge of maternal grief. Ruth stated, ‘I think the absolute best thing [to have] is a Christian who’s walked through it. The second-best thing is really a Christian with an awful lot of experience of child bereavement… because then they’re not going to say stupid things.’

Changes in the participants’ faith over time

All participants had experienced changes in their faith since their child died. Table 2 shows an interpretation of the participants’ individual faith journeys as described by them in their interviews.

Table 2: Interpretation of the participants’ faith journeys

It appears all participants struggled with their relationship with God around the time of their child’s death, while later on their faith journeys were more diverse and, at the time of this research, had seemingly different outcomes.

Results interpreted through meaning reconstruction process

To determine whether the participants were able to reconstruct meaning through their faith reappraisal, the presence of any sense-making and benefit finding was assessed and is listed in table 3.

Table 3: Meaning reconstruction components

This approach to interpreting the participants’ faith journeys tentatively suggests that, currently, Ruth has been able to reconstruction meaning in her life while Jane has not. It is unclear if Catherine has been able to reconstruct meaning, but it appears she has become more comfortable with holding the tension of her reality with her questions, which may in time influence her ability to reconstruct meaning through any ongoing faith reappraisal.

Emergent main themes and sub-themes

Reviewing the data indicates the presence of two main themes: relationship with God and relationship with faith community. Within these themes various sub-themes emerged as potentially important factors that may influence a bereaved mother’s faith journeys.

The two main themes would appear to be the mother’s relationship with God and her relationship with her faith community (including but not exclusively her church community). Sub-themes to the theme of her relationship with God are the mother’s pre-loss core faith beliefs, the questioning of these beliefs and the ability to hold any tension between reality and these beliefs. Sub-themes connected to the theme of the mother’s relationship with her faith community include disenfranchisement, misunderstanding and disconnection from her church community and the provision of knowledgeable one-to-one spiritual support from her wider faith community.

Within these sub-themes it appears there are notable similarities and differences in the participants’ experiences. These are summarised in table 4. This table indicates that, compared to Jane and Catherine, Ruth appears to have experienced a different faith journey after the death of her child.

Table 4: Summary of the experiences of participants by the emergent themes and sub-themes

Additional data for triangulation purposes

The emergent sub-themes were used to inform and frame the expert source conversations for data triangulation purposes.

All three expert sources expressed the opinion that pre-loss Christian faith is commonly reappraised by the mother after the death of her child. Furthermore, all argued the nature of the mothers’ pre-loss theodicy and beliefs about the nature of God have a fundamental influence on this process. Indeed, Williams described theodicy as a ‘skeletal structure when life is in chaos’. Park stated, ‘if a bereaved parent’s concept of God is flawed, their faith is more likely to be blown apart’. All expert sources felt churches today are often failing to help people gain sound theodicy and theology, arguing that teaching around suffering needs to be explored and lived, not merely taught or imposed. Gantlett, however, said for her there was ‘no theodicy that helps or satisfies’, but being comfortable with the ‘mystery of not-knowing had proved to be enough’. Indeed, all three concurred that being comfortable with the mystery of God could be a helpful approach for bereaved parents unable to find any acceptable answers to their questions.

Lament was also highlighted as an important part of processing grief with God, with Williams stating emphatically ‘lament is the key to spiritual growth’. All three sources felt evangelical churches were particularly poor at offering opportunities for lament, or providing any communal worship that acknowledges the reality of suffering.

All the expert sources stressed appropriate spiritual support is vital for bereaved mothers, with Williams stating this provides ‘the safe container for exploring and finding a theodicy that makes sense’. Gantlett said, ‘there are not enough safe people in the church’, and Park emphasised the need for ‘people to be there for the long haul and without judgement’. Gantlett and Park independently stated that the greatest need of bereaved parents is for people to ‘turn up and shut up’. All three expert sources also called for more training for ministers and pastoral carers and a greater understanding of parental grief within the Church.

Table 5 summarises the major themes discussed in these conversations and whether each source was in agreement with each premise. It is notable there appears to be no difference in these views, except for Gantlett’s somewhat differing view on the role of theodicy.

Table 5: Views of expert sources from their interviews

Summary of results

The data from the participants’ interviews triangulated with the views of the expert sources suggests bereaved mothers often reappraise aspects of their faith as part of the process of meaning reconstruction after the death of their child.

Analysis of the results indicates some of the sub-themes identified in the participant interviews may influence this process and hence the faith journeys and outcomes of bereaved mothers. These influences may include the mother’s pre-loss core beliefs and her ability to hold them in tension with reality, the nature of her relationship with God and the provision of appropriate one-to-one spiritual support. These results also infer, while church communities can and do support bereaved mothers, they also have the potential to cause significant distress.

Discussion

Exploration of potential influences

Core beliefs

The traumatic nature of child death appears to illuminate a bereaved mother’s core beliefs, exposing any inconsistencies in her faith that were previously hidden. As the starting point of a bereaved mother’s faith journey, her pre-loss core beliefs would appear to be particularly influential. These beliefs may be incorporated into her worldview through her church’s theological approach and teaching and, in this small study, core beliefs concerning suffering and divine healing were found to be particularly important to the bereaved mothers.

Prior to their child’s death both Catherine and Jane believed God could heal their child and had prayed accordingly with their faith communities. When their child died, this core belief was shattered. Jane’s comment, ‘everybody was praying for him, and he still didn’t get healed’, reveals her frustration and disappointment in God. Catherine’s comment, ‘you know that it is possible for healing, complete healing, to happen, and it’s difficult when it’s not forthcoming’, demonstrates the tension that exists for both her and Jane between their beliefs and their reality. This tension may be due in part to the way their churches preach and pray for healing (Clifton, 2014:213).

For example, Jane’s continuing struggles with the fact her son was not healed in utero may be due to aspects of her Pentecostal church background, as at the heart of the Pentecostal worldview is the idea that ‘healing is God’s will’ and ‘faith should be manifest in the supernatural’ (Castelo, 2014:216). The tension between her reality and her belief that divine healing happens if there is ‘enough faith’, appears difficult for her to hold, and she seems unable to embrace the mystery of God. This ongoing struggle may begin to explain her persistent spiritual and emotional distress twelve years after the death of her son (Kelley, 2010:88).

Conversely, while she still has many unanswered questions, Catherine declared, ‘I just have to trust that there is a purpose to her not having been healed’, indicating that over time she has become more able to hold the tension between her beliefs and reality. This ability to accept there are no answers to some questions appears to have, over time, ameliorated her spiritual distress.

At the time of Olivia’s death, Ruth seemed to trust God’s plans and purposes, saying she ‘had been chosen by God to carry Olivia’. As such, her faith seems to have provided her with less challenge and more comfort than the other participants. While Ruth deemed her theodicy congruent with her reality, stating her ‘faith made sense’, it would appear that over time she has consciously or subconsciously ‘chosen’ not to question some aspects of her faith because she felt, like Gantlett (2022) and Swinton (2018:3), there were no answers, no theodicy, that would satisfy.

It may be that those who do not question their core faith beliefs, or are comfortable with the tension of not knowing, have better faith and grief outcomes than those who continue to question. This is possibly because any persistent spiritual questioning that is unexplored and unsupported may be destructive to an individual’s spiritual core, subsequently damaging all areas of their functioning (Park, 2020:273; Roepke, Jayawickreme & Riffle, 2014:1059; Hughes, 2011:50).

Relationship with God

This research suggests the ability of a bereaved mother to either accommodate her core beliefs, or hold the tension of not knowing, may facilitate her relationship with God. Conversely, if persistent questioning and a negative opinion of God continues for a significant length of time this would appear to disrupt this relationship. Park (2022) believes disappointment in God is a common experience for bereaved parents and indeed both Catherine and Jane acknowledged feeling this way. This may have contributed to the disruption they both experienced with their relationship with God. Indeed, Catherine described how ‘it didn’t stop me from trusting Him, but I didn’t seek Him out at all’. This disconnect may hinder any meaningful religious practices such as prayer, lament and spiritual contemplation that could be employed as coping activities (Swinton, 2018:14; Jueckstock, 2018:48; Hastings, 2016:86). It is conceivable the disrupted relationship both Catherine and Jane had with God reduced their capacity to utilise any religious coping practices, and particularly to be real with God and lament in God’s presence. At the time of this research, even though her faith had become ‘more intense’ when Hannah was ill, Catherine feels her relationship with God has returned to much the same as it was before Hannah became ill. However, Jane’s persistent questioning, and ‘less secure’ and seemingly more fragile faith, suggest she may be experiencing complicated spiritual grief (Burke & Neimeyer, 2014:1095).

By contrast, Ruth demonstrated a secure relationship with God in the first few years post loss, declaring her ‘relationship with God has been fundamental’ to her experience. After Olivia died, Ruth’s stated need was ‘to find God in it’, and this appears to have driven her desire to connect with God. She described her relationship with God as having ‘a raw realness’ and she was able to use religious practices such as contemplation and lament to bring her pain to God to help her cope with her suffering. Indeed, Ruth stated that since Olivia’s death her faith ‘really, really grew’. As such it appears she is the only participant experiencing some spiritual post-traumatic growth (Waugh, Kiemle & Slade, 2018:8).

Furthermore, Ruth appears to have had a significant spiritual encounter with God that sustained her through her grief as she explained, ‘His presence and His power… was such a tangible thing… that kind of intellectually held me.’ It is notable bereaved mothers Gantlett (2021:77,86) and Williams (2018:159) also had spiritual encounters with God that appeared to sustain them through their grief. It could be argued that these transformational changes only occurred because these three mothers were able to maintain their connection with God. These encounters may explain one of the ways a secure relationship with God can influence a bereaved mother’s faith journey.

Provision of support by church and faith community

Bereaved mothers need people who will listen to their stories and acknowledge their pain, as narrating is an important method of restructuring meaning (Shear, Boelen & Neimeyer, 2022:154; Seigal, 2017:50). Catherine’s comment that talking about Hannah would help ‘if there was anyone to listen’ demonstrates it was, and indeed remains, hard for all the participants to find people who are comfortable with listening to their experiences. Ruth’s comment, ‘my absolute greatest need was to be able to talk about Olivia, but people really just could not handle it’” further highlights this difficulty. This may explain why bereaved mothers often seek support from other bereaved mothers, who ‘understand both their need to tell their stories and the depth of their pain’ (Park, 2022).

Additionally, if a bereaved mother’s core beliefs are not congruent with her reality, she may also need a safe place to explore and potentially deconstruct and reconstruct these beliefs (Miner, 2008:228; Wolterstorff, 2002:56; Fowler, 1995:296). However, all participants gave examples of how, at times, their church failed to provide them with any safe place to explore their doubts. Ruth was told ‘it was wrong to feel angry with God’ and stated she felt her grief was ‘misunderstood and interpreted as a faith crisis’. When Catherine felt she needed to ‘forgive God in order to move on’, she was told by her vicar’s wife this was ‘blasphemous’, an approach to the ‘forgiveness of God’ that Kendall amongst others would not agree with (2012:6-8). This response not only left her distressed and alienated but potentially impeded the prospect of any spiritual growth (Zàhorcovà, Halama & Enright, 2020:199; Martinčeková & Klatt, 2017:248).

However, despite this negative experience, Catherine reported less judgement and disenfranchisement of her grief than either Ruth or Jane. Indeed, both Ruth and Jane repeatedly spoke about such difficulties with their church communities. This disparity could be in part because both Ruth and Jane’s children died around birth, which can result in a more disenfranchised and misunderstood grief compared to the death of an older child (Lang, Fleiszer, Duhamel, Sword et al., 2011). Indeed, Jane was asked by one church member, ‘You didn’t know him, so how can you grieve?’

Both Jane and Ruth’s interviews also revealed the depth of their disillusionment and frustration with the church services they attended after their child’s death. Both these churches are evangelical charismatic churches who generally offer less opportunity for liturgy and lament in their services (Emerson, 2018:28,57; Percey, 2013:45; Stackhouse, 2013:156-7). This difference may further explain some of the difficulties Ruth and Jane experienced, as Wortman and Park believe Christian denomination affects the process of grief (2008:703). Catherine did not express any concerns about her church services, possibly because she attends an Anglican church, which may have provided her with a more liturgical, and potentially more relevant, experience during her intense early grief. It is likely members of Ruth and Jane’s evangelical church communities were also challenged to appraise their own core beliefs around suffering and divine healing in the light of the trauma in their midst. As such, it is difficult to know whether bereaved mothers disconnect from their church community because they feel misunderstood and judged, or whether this disconnect is precipitated by some in the church community themselves withdrawing, unable to cope with the mothers’ spiritual distress and questioning. It is likely that there is in fact a reciprocal dynamic occuring that contributes to the disconnect experienced by both parties in the aftermath of this incomprehensable tragedy.

Indeed, within the evangelical tradition (Foster, 2017:229) reconstructing faith in the light of loss appears to be challenging. This may be due to a more rigid theology, where holding mystery may be viewed as contrary to biblical truth (Emerson, 2018:xxiii), and where there is an expectation God will intervene (Greig, 2020:70). Furthermore, the process of going through a process of faith reappraisal can cause individuals to become uncomfortable with their church community, either because their faith has transitioned or because they seek more support and understanding (McLaren, 2021:284; Wortmann & Park, 2009:27; Jamieson, 2007:33; Hagberg & Guelich, 2005:296; Fowler, 1995:275). It thus appears not unusual that Ruth and eventually Jane sought out new church communities after the death of their child.

While this research has shown that both church and wider faith communities can cause bereaved mothers much pain and distress, they can also provide the context for appropriate one-to-one supportive and nurturing spiritual relationships. Indeed, when exploring Ruth’s faith journey, it is possible to see how a negative experience with a church community can be mitigated by the availability of some appropriate and sustained one-to-one spiritual support. Indeed, Ruth intentionally sought out and received significant spiritual support from a number of individuals within her faith community. This may have facilitated her spiritual formation, as she stated her faith, her gifting and her desire for God all grew in the years after Olivia died (Benner, 2012:179; Jamieson, 2007:63). It is noteworthy both Williams and Gantlett also had some form of spiritual accompaniment, with Gantlett stating she ‘had wise people who could theologically pull me through, but most people don’t have that’.

Interconnection of influences

The above discussion suggests that, while it is difficult from this limited research to confirm the nature of any causal relationships, the three proposed influences would appear to be interconnected and interdependent. A proposed model illustrating how these potential influences may impact the faith journeys and outcomes of bereaved mothers is shown in figure 1.

This model suggests good preaching engenders the bereaved mother with sound theology and theodicy, while apposite worship facilitates her connection to God. The further provision of competent pastoral ministry, as the presence of one with another, provides a safe place for the bereaved mother to explore her doubts and questions, reconstruct her beliefs and be heard, understood and accompanied in her grief. This model would appear congruent with the concept that preaching and worship are key components of good pastoral ministry (Lyall, 2001:135; Peterson, 1992:19; Willimon, 1979:47).

Implications for Christian ministry

Although it is difficult to measure the effectiveness of any Christian ministry (Swinton & Mowat, 2016:162), it would appear there is a significant gap between what some churches perceive as the needs of bereaved mothers and the expectations of the mothers themselves. While it was anticipated the participants would have experienced a degree of disconnect from their church and faith communities after the death of their child, the amount of misunderstanding and judgement Ruth and Jane in particular experienced raises concerns about the support some UK churches offer bereaved mothers. However, it must be noted churches are not the only context where support for bereaved parents is lacking, as several studies have found support is inadequate in many professional contexts due to the ‘absence of comprehensive understanding’ of parental grief (Vig et al., 2021:1).

Nevertheless, this potential lack of understanding of the magnitude and nature of parental grief by both church ministers and laity may go some way to explain why bereaved parents might experience inadequate pastoral care and seemingly irrelevant or inappropriate church services. It has also been noted some churches may lack a coherent and honest engagement with suffering (Swinton, 2018:121), with many creating cultures in which people feel compelled to ‘have it all together… or pretend’ (Emerson, 2018:98).

Lived experience suggests some bereaved mothers seek professional grief therapy because they cannot find anyone else who will listen and sit with the overwhelming reality of their pain. Meisenhelder states the aim of any such therapy is to normalise grief and encourage self-care through non-judgemental listening (2021:102). I would strongly suggest this undertaking should not be beyond that of authentic Christian ministry, responding as it should to the call to hold, support and love the marginalised and broken (Hastings, 2016:116; Kelley, 2010:126; Crabb, 2005:xi; Isaiah 61:1; Matthew 25:40). Indeed, the ability to listen, acknowledge and hold another’s pain without judgement is the ‘principal element in providing any effective pastoral support’ (Lyall, 2001:55). One positive outcome of the recent Covid pandemic is that it appears some churches are starting to realise all grief and trauma need better support and understanding, and that they must endeavour to equip the body of Christ for this crucial role (Loss & Hope, 2022).

Additionally, if a bereaved mother in time ceases to ask, ‘why God?’, she may well begin to ask, ‘where are you God?’, or ‘what do I do now, God?’. It is at this point in her faith journey that a knowledgeable spiritual accompanier can encourage an awareness of God, as the mother chooses to lean into her pain and hold the tension of all her questions in the presence of God (Emerson, 2018:33; Swinton, 2018:113; Hastings, 2016:116). Indeed, as Wyatt argues, ‘ultimately suffering is not a question that demands an answer, it is not a problem that requires a solution, it is a mystery which demands a presence’ (2009:220).

However, it is important to note this ‘presence’ should come from one who has explored and tested their theodicy, so they are able to help others do the same (Nash, 2011:39; Oden, 1984:223). As such, Sollereder asserts the Church needs to practice a ‘compassionate theodicy’ that provides ‘pathways of possible meaning that the person suffering can choose’ (2021).

It is also important to note that spiritual support in the context of trauma or bereavement, should not become fixated on spiritual growth. While spiritual growth and indeed redemption are possible in these circumstances (Benner, 2012:71), it is a process that is neither inevitable nor easy (Hastings, 2016:16). As this research has shown, suffering does not always lead to growth (Swinton, 2018:20). Suffering can lead to ‘chaos, confusion and immaturity’, and rather than building faith it can lead to disbelief (Oord, 2019:134). Spiritual growth, if it happens, is a gift from God in the darkness (Isaiah 45:3) that needs to be held in tension alongside the pain of loss (Kelley, 2010:135).

While all three participants in this research sought to access spiritual support after their child’s death that was both Christian and knowledgeable about maternal grief, only Ruth was ultimately able to do this. Ruth affirmed that such support is vital for bereaved parents, stating ‘I think it’s really important, really important, to be able to process your grief with God with others… and it’s the most difficult thing to find.’ I would respectfully encourage the Church to start asking why this desperately needed spiritual support is so hard for bereaved mothers to find.

Comparison with other research

The premise that successful meaning reconstruction predicts better grief outcomes (Jueckstock, 2018:48) appears to be supported by this research, as each participant’s ability to reconstruct meaning seems to have impacted both their faith and grief outcomes. As such, the proposed model presented in article one (Neve, 2023) integrating meaning reconstruction with religious coping activities could potentially provide one framework for understanding how this process may occur in bereaved Christian mothers. However, this research has highlighted that the holding of beliefs and reality in tension, or being comfortable with the mystery of God, can also be an approach to meaning reconstruction for some mothers. Thus, the proposed model could be amended to more explicitly include this alternative approach to meaning reconstruction. An amended model is shown in figure 2.

Figure 2: Possible use of religious coping by bereaved parents within the meaning reconstruction model (adapted to include the role of mystery of God & holding tension of beliefs)

Additionally, the finding that bereaved Christian mothers in the UK may reappraise aspects of their faith and can experience complicated spiritual grief in the form of a disconnect from God or their faith community, aligns with the results from Burke and Neimeyer’s studies in the USA (2014:1103). However, this research raises the question as to whether it is possible for a bereaved mother to experience spiritual growth, as an aspect of post-traumatic growth, while also suffering from complicated spiritual grief. I would reason that, as spiritual formation is predicated upon the grace of God, it seems unlikely any significant spiritual growth could occur alongside a complete disconnect from God. Conversely, if the bereaved mother’s disconnect is solely from her church community, then these results imply there is still the potential for spiritual growth to occur, especially if there is still some connection to the wider faith community. While Stelzer, Palitsky, Hernandez, Ramirez and O’Connor claim the absence of communal religiosity is ‘strongly predictive of vulnerability to poor bereavement outcomes’ (2020:64), I would tentatively suggest the limited results of this research indicate a bereaved mother’s relationship with God appears to have a greater influence on her post-loss faith journey than her relationship with her church community. However, this research reminds us that the connections between personal faith and connection to God and church community are complex and easily fractured.

Limitations and further research

Despite their spiritual struggles, all participants had kept their Christian faith and stayed within a church community and thus these results will be skewed towards such experiences. It is acknowledged the support provided by the researcher to each participant is part of their faith and grief journey, and thus it is inherently part of the research. It is possible the researcher could have introduced bias into the data via any prejudgments or assumptions (Shenton, 2004:72), but it is hoped this possibility is reduced by the substantial triangulation of the data from other experienced sources (Denscombe, 2011:160). Furthermore, although use of the integrated model aided the study design and analysis, its use may too have influenced these results.

This research is also limited by the small number of participants, and thus its transferability is constrained. Research with larger numbers of participants over a greater range of Christian denominations is recommended. However, transferability of findings should not be discounted as, although each case is unique, it is as Shenton argues, ‘an example within a broader group’ (2004:69) and can provide indicators of what is helpful or unhelpful in these circumstances.

While researching just one category of child death may have produced greater clarity, this research could be mined for far more information. As acknowledged by other researchers (Pohlkamp et al., 2021:2; Harper, O’Connor & O’Carroll, 2015:913; Ungureanu & Sandberg, 2010:315), there is need for much more research with bereaved parents across the entire spectrum of experiences. Research on the perceptions and expectations of ministers concerning the support they provide might inform conversation in this area, as would research on the faith journeys of mothers, and indeed fathers, who had lost their faith and left the Church. While it is accepted that generally maternal and paternal grief differ in nature (Alam, Barrera, D’Agnostino, Nicholas & Schneiderman, 2012), there is little research solely on the grief of bereaved fathers (Proulx, Martinez, Carnevale & Legault, 2016:308).

Bereaved parents need much longer support than is currently recognised and more research on this is key as, in the absense of a grief model that accomodates parental grief, many parents continue to be given the inappropriate diagnosis of prolonged grief disorder (Neimeyer & Harris, 2022:409).

Conclusion

This research confirms the view of Campbell that ‘ministering to the bereaved is challenging because questions about grief are so closely intertwined with questions about faith’ (2020:524). Furthermore, there seems to be a two-way disconnect between grief theory and Christian ministry (Kelley, 2010:2,28), with many ministers knowing little about traumatic grief, particularly the isolating and devastating grief of bereaved parents (Harrill, 2021:67; Kelley, 2021:207; Daniel, 2019:199,202). It is likely this disconnect contributes to the misunderstanding around grief that often thwarts the provision of compassionate and substantive care for the bereaved. However, if we are to participate in God’s redemptive work in the world, I would agree with Hastings (2016:18) in arguing this needs to change.

To increase our knowledge and awareness of the multi-faceted impact of child death on a mother it is necessary to observe and seek to understand the varied lived experiences of bereaved mothers. However, to examine their complex experiences clearly, their journeys need to be viewed through more than one lens. Therefore, this research has sought to briefly observe a small part of the faith journeys of bereaved mothers by looking through the lenses of trauma, grief, spiritual formation and suffering. Accordingly, the lens of trauma reveals that the death of a child shatters the bereaved mother’s world, and so we need to recognise her brokenness. The lens of grief reveals that she will have an overwhelming need to talk about her child, and so we need to give her a safe place to be heard. The lens of spiritual formation reveals that her faith will be challenged and may evolve, and we need to support this precarious and precious process. And the lens of suffering helps us understand that the bereaved mother is hurting and lost, and, if we do nothing else, we need to be there.

As this study and wider research suggests, the practice of ‘being there’ for bereaved parents is a challenging endeavour. With the Church appearing to struggle to provide the spiritual support bereaved mothers need, church leaderships must purposefully increase both their understanding of maternal grief and their provision of care for the bereaved. It is vital Christian ministry can support those marginalised by the tragedy of child death in informed, sensitive and compassionate ways, not just at the point of crisis, but by continuing to accompany the bereaved through the dark months and years ahead. Furthermore, attention must also be given to supporting those who provide the bereaved with this care, as it is often long-term and personally demanding.

As such, it is also time for the UK Christian Church to recognise the roles other Christian ministries can play in the spiritual formation of those suffering from traumatic bereavement, including the death of a child. Indeed, lived experience suggests other intentional one-to-one relationships such as Christian coaching, mentoring and spiritual direction have much to offer the bereaved mother. The forward focus of coaching and mentoring, with their inherent emphasis on reviewing internal and external resources and exploring limiting beliefs, can be especially helpful to a bereaved mother in exploring questions such as ‘what now?’ when she becomes stuck in her grief (Shear, Boelen & Neimeyer, 2022:158; Collins, 2002:241). Similarly, the use of a spiritual director can provide the bereaved mother with a secure place for spiritual questioning and exploring nascent faith transitions that may not be available within her local church community (Jamieson, 2007:65; Guenther, 1993:98).

Swinton and Mowat argue the aim of practical theology is to inform and shape the life of faith by feeding back into the practice of the Church, not just to increase our understanding of its practices but to change them (2016:25-26). Therefore, it is hoped this research may help inform and shape Christian ministry, in whatever form or context, for the challenging but privileged work of supporting bereaved mothers after the death of their child, and thus facilitating the survival of their faith.

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About the author

Elizabeth Neve BSc (Hons), MA

Elizabeth completed her MA in Spiritual formation at Waverley Abbey College in 2022. She currently works as a grief therapist, an EMCC senior accredited coach/mentor specialising in loss and transition, and a pastoral supervisor. She also develops and delivers pastoral care training courses for ACC, and can be contacted at liz@elizabethneve.co.uk.

Copyright

Copyright 2023 Elizabeth Neve

[1] Ethical approval for this research was granted by the Waverley Abbey College Research Ethics Committee.

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https://doi.org/10.52456/WACJO324

The proposed construct of a model integrating the use of religious coping with the process of meaning reconstruction after the death of a child

Abstract

This is the first of two articles originating from MA research designed to explore possible influences on the faith journeys of bereaved Christian mothers in the UK, with the hope of informing and shaping UK Christian ministry.

Lived experience aligns with research in suggesting that the death of a child often triggers a faith reappraisal in the bereaved mother. Research further suggests that there may be a number of factors that can influence this process. However, while there has been research on maternal grief in other countries and cultures, there appears to be none in a UK Christian context.

This first article presents a literature review relevant to this field of study and proposes a tentative conceptual model that may help illuminate how factors relevant to Christian ministry can influence faith reappraisal after the death of a child. This conceptual model integrates the contemporary meaning reconstruction model (Neimeyer & Sands, 2022) with Pargament’s theory of religious coping (1997).

This integrated model was subsequently used to inform a small empirical research project undertaken with bereaved Christian mothers, the findings of which are presented in part two (also in this issue).

Keywords: child death, faith reappraisal, meaning construction, religious coping, Christian, complicated grief, maternal grief, spiritual growth.

• maternal grief
• spiritual growth

Introduction and rationale for the research

‘I don’t understand! Why would God let her die?’ In the hours after her daughter died, this mother’s anguished cries could be heard throughout the hospice. Her bewilderment, and disappointment in the God she said she loved, were evident as her questions tumbled out into the space between us.

As a volunteer chaplain in a children’s hospice, I heard many such questions as I sat with bereaved parents in the terrible emptiness and disorientation that occurs after the death of a child. As a bereavement counsellor I have journeyed with bereaved parents as they try to work through the emotional and spiritual challenges of this complex and very personal crisis. As a pastoral carer, I have witnessed how a church community, its people and its practices can hinder or facilitate the precarious faith journeys of bereaved parents. As a mother suffering perinatal loss, I, too, have been compelled to question my previously untested beliefs about God, whilst disenfranchised and misunderstood by a church community ill equipped to recognise my spiritual and emotional needs. Yet, I have also witnessed how long-term Christian mentoring can support the spiritual formation of a bereaved mother, and even facilitate her spiritual growth.

This lived experience supporting Christian parents after the death of their child suggests their faith brings comfort at one level whilst also bringing internal tension, as the parents seek to align their beliefs with their suffering. For some parents these struggles may produce spiritual growth, as they discover a deeper, more commited faith that does not negate their pain or deny their reality (Chandler, 2014:17; Kallmier, 2011:106; Fowler, 2000:40). However, for others their spiritual distress can trigger a loss of faith and a detachment from their faith community, causing upsetting secondary losses at a time of maximum disorientation in their lives. These faith struggles occur alongside the crushing sadness, guilt and fear experienced by bereaved parents and, as such, grief and faith are locked together in a long bewildering journey, with an often-uncertain faith outcome.

Witnessing these varied faith journeys and outcomes, I wondered what influences bereaved parents’ faith journeys. Is there anything Christian ministry can do to support the parents who make, as one parent described it, “the long journey back to faith”?

This article, therefore, discusses the literature relevant to the faith journeys of Christian parents after the death of their child and offers a tentative conceptual model that may help illuminate how factors relevant to Christian ministry can influence faith reappraisal after the death of a child.

This proposed model was used to inform a small empirical research project undertaken with bereaved Christian mothers, the findings of which are presented in a part two.

Background: The impact of child death

The grief of bereaved parents is known to impact all areas of their life (Hawthorne, Joyner, Gaucher & Liehr, 2021:229; Meisenhelder, 2021:102; Vig, Lim, Lee, Huang et al., 2021:9), and even increases their risk of mortality (Parkes & Prigerson, 2010:143). The longing for the child and the feeling of emptiness can last a lifetime and bereaved parents struggle with cognitive, affective and physical symptoms for many years after their child’s death. As a result, bereaved parents – in particular bereaved mothers – are sometimes diagnosed, some may say controversially, with prolonged grief disorder (Pohlkamp, Kreicbergs & Sveen, 2019:1533; Burke & Neimeyer, 2014:1089; Lichenthal, Currier, Neimeyer & Keesee, 2010:794).

While research on the relationship between bereaved parents and their faith or church communities is limited, secular studies frequently note bereaved parents need their grief recognised, understood and supported by those around them (Hawthorne, Joyner, Gaucher & Liehr, 2021:229; Meisenhelder, 2021:102; Pohlkamp et al., 2021:526; Vig et al., 2021:6). Indeed, disenfranchisement of grief by those close to bereaved parents has been found to increase their risk of prolonged grief disorder (Shannon & Wilkinson, 2020:145). This need to be heard and accompanied in grief is recognised by Wolterstorff, a bereaved Christian parent, when he says, ‘what I need to hear from you is that you recognise my pain, you are here for me’ (2002:35). However, while bereaved parents may receive spiritual and emotional support in the short term from healthcare chaplains or community faith ministers (Wells, 2018:14, Nolan, 2012:129, Nash, 2011:43), many parents report their long-term grief, and any concomitant spiritual distress, is often hidden, disenfranchised and misunderstood (Gantlett, 2021:229; Petro, 2015:14; Price & Jones, 2015:222; Hurcombe, 2004:52).

Literature review

This review focuses on literature that attempts to illuminate the faith journeys of Christian parents after the death of their child. To date most published research has been undertaken on bereaved mothers, with bereaved fathers grief being less well understood (Proulx, Martinez, Carnevale & Legault, 2016:308). However, while it is accepted maternal and paternal grief differ in nature (Alam, Barrera, D’Agnostino, Nicholas & Schneiderman, 2012), many studies do not distinguish between the grief of fathers and mothers. Thus, by necessity, this review includes research undertaken on both parents as well as that undertaken solely on bereaved mothers.

This review will now explore some of the factors and processes that research and lived experience suggest could influence the interaction between faith and grief, and that may be responsible for the range of both faith (Jueckstock, 2018:48) and grief (Keesee, Currier & Neimeyer, 2008:1146) outcomes observed in bereaved parents. While grief is acknowledged to affect all areas of functioning (Parkes & Prigerson, 2010:21), this review focuses on the spiritual aspects of grief and particularly on the spiritual core beliefs (Pargament & Exline, 2020; Kallmier, 2011:78) that may be shattered by the death of a child.

Grief theory and Christian ministry

Despite mainstream grief theory evolving significantly over the last fifteen years, Hindmarch argues conventional grief theories are ‘often perceived as inadequate’ when it comes to understanding the devastating death of a child, particularly when those theories focus on the resolution of grief (2009:35). Furthermore, while spirituality is known to both facilitate and complicate bereavement (Park & Halifax, 2022:358; Christian, Aoun & Breen, 2019:321; Gubi, 2015:121; Machin, 2009:51; Doka, 2002a:3), much grief theory does not specifically incorporate aspects of spirituality (Park & Halifax, 2022:356; Harvey, 2018; Hastings, 2016:17; Klass, 2014:3). Indeed, a recent complilation of contemporary grief research (Neimeyer, Harris, Winokuer & Thornton, 2022), whichaims to bridge the gap between researchers and practitioners, contains minimal reference to spirituality generally and even less to Christianity (Park & Halifax, 2022:359). This observation strengthens the view of Kelley that there is ‘a significant disconnect between the world of grief theory and the world of Christian ministry’ (2010:2).

Nevertheless, some contemporary grief studies do acknowledge spirituality can be a coping strategy for bereaved parents across a range of different faiths and cultures (Frei-Landau, Hasson-Ohayon & Tuval-Mashiach, 2020; Parente & Ramos, 2020; Baykal, 2018; Hussin, Guàrdis-Olmos & Aho, 2018; Rouzati, 2018). However, research into how Christianity and grief interact in bereaved parents is limited, and there appears to be none within a UK context. As such, much of the research quoted in this review is from the USA, where a ‘deeply entrenched form of Christendom’ still exists in many areas (Murray, 2004:17). This contributes to a cultural framework which has the potential to influence the worldviews of many Americans, including beliefs around the role of God in their suffering. Vig et al. acknowledge, in their systematic scoping review of research into child death (2021), that most studies they reviewed were carried out in the USA. They argue that in the USA Christianity is seen as a significant source of support to bereaved parents, whereas other studies carried out across mainland Europe appear to show religion plays a less significant role in these parents’ grief (2021:12). However, in post-Christendom Britain, where Christianity and churches are more marginalised (Murray, 2004:20), it is unclear how and to what extent Christian faith impacts the grief and faith journeys of bereaved parents in a UK Christian context.

With no specific grief model to illuminate the grief of Christian parents, this review will consider just two models that research indicates could provide insight into this area and that are most relevant to Christian ministry. The first is the contemporary meaning reconstruction model (Neimeyer & Sands, 2022), which can be viewed through the lens of spirituality and religion (Hall & Hill, 2019:467). The second is Pargament’s theory of religious coping (1997).

Meaning reconstruction

Frankl famously argued, ‘to live is to suffer, to survive is to find meaning in the suffering’ (2004:9), and indeed Kessler contends that meaning reconstruction is the ‘sixth stage of grief’ (2019:2). However, as grief theory moves away from the ‘stages model’ of grief (Stroebe, Schut & Boerner, 2017), much contemporary grief research emphasises the role of meaning reconstruction throughout the entire grieving process. Despite this theory appearing to be a paradoxical way to understand the grief that occurs as a result of the seemingly senseless death of a child, this relatively new approach is proving to be insightful in understanding this traumatic loss.

‘Meaning’ can be a confusing concept but, according to Kelley, is concerned with how individuals make sense of a life event, how they integrate this into their system of core beliefs, and how this then brings coherence to their life narrative (2010:41). Indeed, one important method of reconstructing meaning is through the process of narrative reconstruction, or telling stories (Shear, Boelen & Neimeyer, 2022:184). Kelley argues traumatic loss can potentially disrupt or even decimate our life story, our meaning system and our sense of self (2010:83). As such, for bereaved mothers, the process of telling the story of their loss finds a place for the death of their child within their self-narrative.

However, when spiritual beliefs form part of an individual’s core beliefs, any conflict between these and the individual’s reality can trigger spiritual struggles, which over time can result in a range of outcomes, from loss of faith through to spiritual growth (Wortmann & Park, 2009:18). Lichenthal et al. argue that the ‘loss of a child can be especially disruptive to a parent’s meaning structures as the death is often perceived as meaningless’ (2010:792). Indeed, multiple research studies have shown the reconstruction of meaning is central to predicting the grief outcomes of bereaved parents (Neimeyer, 2019:79; Bogensperger & Lueger-Schuster, 2014; Keesee, Currier & Neimeyer, 2008). Conversely, research by Davis, Wortman, Lehman and Silver suggests some parents do not need to reconstruct meaning (2000:497) and yet adjust well to their loss. Doka reasons that when meaning reconstruction is not required, it is likely the bereaved parent’s core beliefs can absorb their loss without being completely disrupted (2002b:51). However, the different research approaches to the actual content of meaning reconstruction make comparisons between these findings difficult. As Neimeyer’s meaning reconstruction model is the most widely accepted within grief theory (Kelley, 2010:71), this review utilises his approach, and thus will now explore the roles of sense-making and the ability to find unsought benefit as a consequence of the experience.

Sense-making

One component of meaning reconstruction, according to Neimeyer, is the capacity to make sense of the experience. Studies by Keesee, Currier and Neimeyer in the USA found that, regardless of the passage of time, the parent’s gender or the cause of death, the degree of sense-making as a component of meaning reconstruction was a potent predictor of current grief symptoms. In their research it accounted for fifteen times more distress than any other factor, with the inability to make-sense a positive predictor for prolonged grief disorder (2008:1145,1157). Further research, also carried out in the USA, found around 45% of parents were unable to make any sense at all from their child’s death but, where sense-making did occur, themes involving spirituality and religious beliefs were the most common (Lichenthal, et al., 2010:791,807). This suggests religious beliefs can be employed to make sense of loss, particularly by considering what may follow death, or whether God is absent or present in suffering (Park & Halifax, 2022:357). For Christian bereaved parents, this can involve attempts to grasp some reason for their child’s death, such as illness as a consequence of a ‘fallen world’, or perhaps embracing the belief that their child’s suffering has ceased and they are now ‘safe’ in heaven.

Kelley argues that, for Christians, how they make sense of loss depends on how they conceive the relationship between God and suffering (2010:87), suggesting a bereaved parent’s core beliefs about the nature and character of God are reappraised in light of their child’s death. However, Swinton believes ‘a crisis of theodicy after tragedy should not be framed as a crisis of faith, but rather as a crisis of understanding’ (2018:111). Furthermore, Daniel asserts a ‘toxic theology’ hinders the process of faith reappraisal and exacerbates the stress and anxiety associated with grief (2019:199,200). She describes this theology as consisting of rigid beliefs where God is seen as an authoritarian figure rewarding faithfulness, and where tragedy is a punishment from God. Daniel argues this impacts the ability to live with unanswered questions and is a significant factor in any prolonged grief disorder. Swinton concurs stating, ‘raw pain inspires hard questions and that problems arise when we try to answer them’ (2018:12). Indeed, for bereaved parents who ask ‘why did God let my child die?’ (Nash, 2011:22), there is frequently no answer (McIntyre, 2015; Finkbeiner, 1996:170) and no theodicy that satisfies (Scott, 2020:325; Swinton, 2018:13). As such, while much research suggests the process of sense-making is important for bereaved parents, it would also appear to have the potential to trigger spiritual distress and bewilderment for some Christian bereaved parents.

Benefit finding

The other component of meaning reconstruction according to Neimeyer is finding unsought benefit in the experience of the loss (Lichenthal et al., 2010:801). Multiple studies have found that, while parental grief is complex and prolonged, many parents respond in adaptive ways and can experience unsought benefits, including all aspects of post-traumatic growth (Albuquerque, Narciso & Pereira, 2018:199; Waugh, Kiemle & Slade, 2018:5-8; Thomadaki, 2017; Engelkemeyer & Marwit, 2008:344; Gerrish, Neimeyer & Bailey, 2014:151). While this process takes ‘many years of effort’ (Lichenthal, Neimeyer, Currier, Roberts & Jordan, 2013:337), post-traumatic growth can include an increase in compassion, a greater appreciation for life, changed priorities and often an enhanced spirituality (Tedeschi & Calhoun, 2017:11; Lichenthal et al., 2010:802). In fact, Gantlett, writing after the death of her daughter, testifies she has ‘a more tender heart’, and experiences joy in a ‘deeper way’ (2021:264). However, Lichenthal et al. found, while bereaved parents were more able to find benefits than make sense within the meaning reconstruction process, at least 20% of bereaved parents were unable to find any unsought benefits five years post loss (2010:807). Interestingly, as well as experiencing more prolonged grief disorder, bereaved mothers also experience more post-traumatic growth compared to bereaved fathers (Waugh, Kiemle & Slade, 2018:5-9).

The finding that bereaved parents can experience spiritual growth after the death of their child aligns with the concept that Christians are formed into the likeness of Christ through suffering and life’s experiences (Mayseless & Russo-Netzer, 2017:179; Chandler, 2014:75-79; Kallmier, 2011:110; Hagberg & Guelich, 2005:172-3; Fowler, 2000:49; Romans 5:1–4), especially when those experiences create dissonance and challenge personal faith (Pargament, Murray-Swank, Magyar & Ano, 2005:246). Hagberg & Guelich state questions about meaning often ‘provide the energy for movement on our spiritual journey’ (2005:13) and Bridges also believes faith transitions start with ‘letting go of what no longer fits’ (2004:128-129). In agreement with this view, Gantlett states that, after her daughter’s death, her faith was ‘stripped back by pain and suffering’ and she ‘reconstructed a faith relationship with God that was more beautiful than what she started with’ (2021:77,86). Similarly, Wolterstorff, writing after his son’s death, declares his reconstructed faith revealed ‘a different kind of God, more mysterious’ (2019). As such, it appears that, for the experience of loss to trigger spiritual growth, the expectations of faith and God must be clarified (Shelby, 2005:135). Klass however cautions us that, although bereaved parents may find new growth and spirituality after their child’s death, all parents say they ‘would trade all the growth and gains if only they could have their child back’ (1999:6).

Religious coping

Pargament, Smith, Koenig and Perez describe people turning to religion when faced with stressful life events as ‘religious coping’, and argue people are more likely to engage in religious coping if religion has been a consistent and compelling part of their lives (1998:711). Religious coping strategies can be central to personal resilience (Park & Halifax, 2022:358; Dolcos, Hohl & Hu, 2021; Wortman & Park, 2008:703), but the way in which the bereaved utilise religious coping would appear to depend upon their concept of God (Kelley, 2010:114).

In their research with bereaved parents, Ungureanu & Sandberg found religious coping was of particular importance to bereaved parents (2010:313), while Anderson, Marwit & Vandenberg found that bereaved mothers who utilised religious coping had better grief outcomes (2005:823).

Pargament, Bockrath and Burdzy describe religious coping as both negative and positive, and operating in three dimensions: religious beliefs, religious practices and religious community. They state positive religious coping includes seeking God’s presence and care, and seeking to grow one’s relationship with God and other Christians, whereas negative religious coping includes faith questioning and struggles (2011:57). Notably, Balk argues spiritual change can happen during grief because an individual spends time in both negative and positive religious coping (1999:491), echoing the oscillation of loss and restoration activities in the dual process model of grief (Stroebe & Schut, 2010). As such, bereaved parents may spend time seeking God for comfort while also questioning God’s purposes.

Religious coping in grief as connections with God and faith community

Kelley believes religious coping that reflects a secure connection to God and a sense of connectedness to others is the most helpful to the bereaved. She argues that the belief that God is present in their suffering, while also being spiritually connected to others, leads to increased wellbeing physically, mentally and spiritually (2010:112).

Research by Jueckstock, carried out on bereaved parents in the USA, found that when the connection with God was deemed ‘secure’, the bereaved parent was able to ‘self-soothe’ and engage in positive religious meaning-making practices, such as prayer and lament, with their grief experiences characterised by recovery and resilience. Conversely, parents who continued having negative feelings towards God also displayed a lack of trust in God, and subsequently disconnected from God (2018:40,47).

Research by Burke & Neimeyer has explored a form of grief they describe as ‘complicated spiritual grief’, where grief triggers a disconnect from God or the faith community and a subsequent disruption in religious coping practices (2016; 2014). Significantly, their most recent research has shown that bereaved parents have a heightened risk of complicated spiritual grief, with 30% of bereaved parents being found to experience this form of grief (Burke, Crunk, Neimeyer & Bai, 2021:249). In such cases, the most common findings were resentment and doubt towards God, dissatisfaction with spiritual support and substantial changes in spiritual beliefs and behaviours (2014:1100). Their research found that bereaved individuals suffering with complicated spiritual grief indicated they frequently ‘felt robbed or lied to about God’s character’. Additionally, these individuals often felt misunderstood or abandoned by their churches who often sought to fix them with platitudes, with many seeking a fresh start in the safety and anonymity of other churches (2014:1103). Bridges’ statement that communities of faith often ‘offer only silence and abandonment when beliefs shatter’ as a result of suffering (2015:87), suggests that connection to a faith community can be difficult to maintain in such circumstances. As such, any disconnect from the bereaved individual’s church, or even their wider faith community, has the potential to hinder the bereaved mothers’ access to important religious coping resources, thus contributing to her spiritual and emotional distress.

The integration of meaning reconstruction and religious coping

Burke and Neimeyer (2014:1090), Lichtenthal et al. (2011:117) and Hall and Hill (2019:470) all argue that religious coping can provide the avenue for meaning reconstruction in bereaved parents. Indeed, Kelley believes that when faith is a significant component of a bereaved parent’s core beliefs, the capacity to reconstruct meaning and the nature of the bereaved parent’s relationship with God, would appear to be strongly connected (2010:89). Jueckstock concurs and goes even further in stating that the way in which Christian parents engage in meaning reconstruction is ‘directly related to their relationship with God’ (2018:48).

However, bereaved individuals also need safe and supportive places to lament and explore the religious issues that may mediate meaning (Doehring, 2019:241; Swinton, 2018:114-118; Wyatt, 2018; Bray, 2013:900; Pargament et al., 2005:264; Doka, 2002b:52). The church community can be viewed as being the ‘container’ that offers opportunities for religious coping activites such as lament and worship while also providing a safe place to facilitate spiritual questioning and supportive relationships.

It thus appears that the ability of a bereaved Christian parent to reconstruct meaning after the death of their child may occur through the use of religious coping practices, which in turn are influnced by the parent’s connection to God and connection to their faith community. The relationships between personal faith, connection to God and connection to church community are complex and almost certainly reciprocal, and therefore it is difficult to identify the causal process. However, its does appear that, just as ‘meaning reconstruction activities act on pre-loss meaning structures to construct new meaning structures’ (Gillies & Neimeyer, 2006:55), religious coping can potentially act on pre-loss faith beliefs to construct new faith beliefs in the aftermath of traumatic bereavement.

From the ideas presented in this literature review, a tenative conceptual model integrating meaning reconstruction theory with religious coping, in the context of child death, has been constructed and is illustrated in figure 1. The model includes references to the individual research articles that underpin the proposed integration of the two separate theories.

This proposed model takes the premise that a Christian bereaved parent’s core faith beliefs are illuminated by the death of their child, resulting in a reappraisal of their faith. If these core faith beliefs are found to be incongruent with their traumatic reality, then these Christian beliefs may be shattered.

The model proposes that, if reconstruction of meaning is subsequently required due to the shattering of these beliefs, the process may be influenced by both the bereaved parent’s relationship with God and their faith community facilitating any religious coping. When the process of meaning reconstruction is successful as a result of religious coping, the parent may experience some post-traumatic spiritual growth. Where it is unsuccessful, there is the possibility of developing prolonged grief disorder or complicated spiritual grief.

Correspondingly, if the bereaved parent’s core faith beliefs are deemed congruent with their reality, meaning reconstruction is deemed unnecessary. However, it is assumed that religious coping may still be utilised in order to gain comfort and connect with God in their suffering, which may or may not result in spiritual growth.

Conclusion

This literature review appears to suggest that the faith journey of a bereaved mother may be influenced, to some extent, by her religious coping activities acting upon her pre-loss faith beliefs, to facilitate the reconstruction of meaning in her life after the death of her child. These religious coping activities occur as a consequence of her connection to God and her faith community. Any resultant reconstruction of meaning appears to contribute to a reduction in emotional and spiritual distress, thereby influencing both the mother’s faith and grief journeys and outcomes. A tentative conceptual model is proposed that outlines this process.

The research on bereaved Christian mothers in the UK that is presented in article two utilises this conceptual model to provide an interpretive framework that assists in both the design of the research interviews and the approach to the data analysis. The research presented in article two thus focuses on exploring the pre-identified themes of faith reappraisal, relationship with God and relationship with faith community (see Neve, 2023; also in this issue).

Figure 1 Possible use of religious coping by bereaved parents within the meaning reconstruction model

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About the author

Elizabeth Neve BSc (Hons), MA

Elizabeth completed her MA in Spiritual formation at Waverley Abbey College in 2022. She currently works as a grief therapist, an EMCC senior accredited coach/mentor specialising in loss and transition, and a pastoral supervisor. She also develops and delivers pastoral care training courses for ACC, and can be contacted at liz@elizabethneve.co.uk.

Copyright

Copyright 2023 Elizabeth Neve

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https://doi.org/10.52456/WACJO322

Introduction 

‘No therapist will deliberately harm their client, but all therapists who ignore the challenge of racism contribute to the perpetuation of racism and inadvertently contribute to the client’s pain about oppression’ (Mckenzie-Mavinga, 2016:212). The challenge of this statement and the desire to do no harm (BACP, 2018:9) was the driver for researching this topic.

The aim of this critical literature review is to look at how White privilege and the experience of being other can impact the dynamic in the counselling room, and how an awareness of difference and an ability to work with it can help clients manage their experience of race-based trauma.

Firstly, it will give a brief history of Blackness in the UK and some statistics around mental health issues for those of a non-White British background. It will then look at the client’s experience of racism as trauma. It will explore a Christian anthropological view and examine how the Bible has viewed slavery before turning to racism in the context of the Church. It will consider the issues facing therapists when working with someone from a different race or ethnicity. Lastly, it will offer some therapeutic responses for working with clients who have experienced racism as trauma.

Rationale 

The subject of ‘Black Lives Matter’ has been much in the news in the last few years, especially following the death of George Floyd in the United States (BBC, 2020b). Over this period, I have been counselling a Black[1] client of African-Caribbean descent who has identified trauma and identity issues in the wake of these events. Research has shown this is not uncommon, with 23% of the Black community experiencing common mental health problems in a given week compared with 17% of White British people (Burrell, 2021:200; gov.uk, 2020). Eight per cent of Black or Black British adults have experienced post-traumatic stress disorder (PTSD). This is twice as many as those from White British backgrounds (Mind, 2021).

Alongside this, I have been working through my personal response to White privilege (Eddo-Lodge, 2018:86-87) and the Church’s role in, at times, disenfranchising the other (Lindsay, 2019:38). Through my client’s challenge, the intersectionality of race and ethnicity not only entered the counselling room but also my consciousness (Turner, 2021:21). For the first time, I had to recognise my own feeling of shame and guilt at my perceived powerlessness and inadequacy in the face of my client’s experience of racism (Mckenzie-Mavinga, 2016:26).

Intersectionality is a huge topic which can relate to any areas where the majority use difference to marginalise the other (Turner, 2021:18-22). The focus of this essay is race and ethnicity and what happens when this is brought into the counselling room.

Race: Black history and mental health 

A brief overview of Black history in Britain 

An overview of the history of Black people in Britain is marked by the fact that, as Maharaj notes, people of colour have been ‘pawns in the [economic/ political] game’ (2021:122), used when labour was needed, either as slaves, indentured servants or, in more recent times, low-paid workers in the making of modern Britain (2021:123).

While there is evidence of Black people in Britain as early as the first century (Olusoga, 2021:30), significant numbers of Black people are not recorded until the late 17^th and early 18^th century (Olusoga, 2021:76). Their presence, mainly around ports, was linked to commerce, marked by the shipping of goods and people from Africa and the Caribbean by plantation owners and slave traders (Olusoga, 2021:86). Some people of colour arrived as free citizens, others as slaves, but whatever their status the majority found themselves living in poverty (Olusoga, 2021:97).

The expansion of the British Empire into Africa and the rise of social Darwinism in the late 1800s led to a growth in white supremacy, viewing Black people as racially inferior, their dark skin and distinctive facial features marking them out as different (Olusoga, 2021:405-406).

The history of the Black community in the UK often overlooks the fact that many Africans were sent to Britain to study at university. They often stayed on as professionals, leading to the creation of a Black British middle class in the early 20^th century (Olusoga, 2021:420). This runs counter to the earlier view of Black people as less mentally capable (Lago, 2006:27).

The First and Second World Wars brought a further influx of people of colour from the colonies who came to fight for the ‘Mother Country’ (Burrell, 2021:201). Following the Second World War, with high labour shortages, people from the Commonwealth were invited to come and work. Another wave of immigration began with the Windrush generation from 1948 onwards (Maharaj, 2021:121).

The 1948 British Nationality Act gave people born in commonwealth countries the ability to claim British citizenship. The Race Relations Act (1964, 1968 and 1976) and the Equality Act 2010 sought to give greater equality to people of colour (BBC Bitesize, 2021). However, the 1905 Aliens Act and the 1962 Commonwealth Immigration Act sought to restrict the types and numbers of Black people able to enter Britain each year (Olusoga, 2021:512). The 1980s use of sus law and subsequent race riots continued to highlight inequalities in the administration of law and order (Olusoga, 2021:516).

Black people’s mental health and access to services 

This section identifies the impact of being Black on people’s mental health and their ability to access services[2].

The 2016Equality and Human Rights Commission’s, Healing a Divided Britain report, highlighted the higher prevalence of poverty (EHCR, 2016:65), overcrowded housing (EHCR, 2016:60) and reported significant growth in long-term unemployment among the BAME population (Olusoga, 2021:525). These factors have been shown to have a negative impact on mental health outcomes (Bignall, Jeraj, Helsby & Butt, 2019:14).

Maharaj argues that equality of access is not possible when institutional structures still carry their colonial legacy (2021:122) and do not seek to address the culture and history of those with non-White backgrounds in the services they provide (Maharaj, 2021:123). Coupled with the perceived stigma attached to mental ill-health, this has led to people of colour not accessing services early (Rethink Mental Illness, 2021). The cultural need for silence around issues of mental health also play into this (Venson, 2020:28; George, 2018:34).

Statistics have shown that when Black people do access mental health services, they are more likely to be medicated than referred to talking therapy (Bignall et al., 2019:16). There is also evidence that Black people are more likely to drop out of therapy if their culture is not included in the counselling process (UEA, 2021). The Equality and Human Rights Commission have shown that White people have better chances of recovery having engaged with mental health services (2018:113).

Public Health England (2019) has highlighted the need for a change in the Eurocentric approach to therapies to reduce barriers to access for those of different ethnicities. Cosford and Toleikyte (2018) see creating a level playing field for access as a ‘contentious and complex’ issue among some public health and healthcare commissioners, leading to reduced action in this area at a local level.

Experiencing racism as trauma 

 What is trauma? 

Before examining the effects of living with racism as trauma, it is important to be clear about what trauma is. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines traumatic stress as occurring in response to exposure to a traumatic or stressful event(s) where there is a risk of serious harm or death (American Psychiatric Association [APA], 2013:265).

Ellis defines trauma as ‘any stressful event that is prolonged, overwhelming or unpredictable’ (Ellis, 2021:36). Lee argues that, just as the experience of trauma is unpredictable, it can leave a sense of lack of control, a lessened sense of trust in others and a diminished sense of safety (2012:5). It can also lead to a distrust of self and one’s cognitions (Lee, 2012:5). This lack of safety and trust can lead to a state of hyper-vigilance (Welsh, 2018:4) and the use of safety behaviours to avoid perceived threats (Scott and Stradling, 2006:13) or hypo-vigilance and potential dissociation (Sanderson, 2013:38).

While much race-based trauma would not fit the DSM-5 definition of traumatic stress as the causal criteria is not met, there is a growing view that racial trauma should be included as a category of traumatic stress (Olson, 2021). In the absence of a formal entry in the DSM-5, Carter, Mazzula, Rodolfo, Vazquez, Hall, Smith, Sant-Barket, Forsyth, Bazelais and Williams developed the Race-Based Traumatic Stress Symptom Scale to provide a criterion which would allow a correlation between event and symptoms, identifying ‘race-based traumatic stress occurs [sic] from events that are sudden, out of one’s control, and emotionally painful (negative)’ (2013:2).

‘Living while Black’

The title of Kinouani’s book, Living While Black, was chosen to reflect the ‘challenges of existing, resisting and thriving within white supremacy’ (Kinouani, 2021:5-6). The designation, Black, has come from a hierarchical distinction developed in the years of the slave trade and colonialisation (Coates, 2015:7). White colonialists used blackness as a ‘physiological sign’ to highlight a ‘psychological inferiority’ (Ellis, 2021:61). It is important to note that race is a social construct (Winters, 2020:33) which has no grounds in biology (Ellis, 2021:66).

If unchallenged racism can infiltrate systems the effects of this ripple wide. Over time, unequal treatment becomes institutionalised, leading to a failure to ‘provide an appropriate or professional service’ (Macpherson, 1999). Research shows that while young Black people are more likely to access higher education, they are less likely to attend ‘prestigious’ universities or exit with high grades (Eddo-Lodge, 2018:67). They are also less likely to obtain a ‘highly skilled’ job (Roberts and Bolton, 2020:1). This is borne out by a recent survey of FTSE 100 companies that revealed only 2% of CEO roles are held by people from an ethnic minority background (Powell, 2021).

The nature of race-based trauma is widespread, being felt not only at an institutional and systemic level, but also at an individual level (Winters, 2020:6). The individual can supress the feelings and effects of racism causing a trauma response. At an interpersonal level, racism can be experienced by the individual in community (Winters, 2020:6).

For individuals and communities’ race-based trauma can also be experienced intergenerationally. In this instance, the fear generated by trauma experienced in one generation is passed on to the next (Ellis, 2021:116). Mckenzie-Mavinga refers to ‘ancestral baggage’ (2009:78), the emotional response of one generation impacting subsequent generations. Unlike other forms of ongoing relational trauma, when racism is experienced as trauma, it carries with it the weight of history as well. Mckenzie-Mavinga’s ‘baggage’ feels like an apt description for this heavy load.

Conceptualising of racism as trauma using the Waverley integrative framework

Having examined what race-based trauma is, and the lived experience of Black people, the Waverley integrative framework is now used to conceptualise its impact on the individual. It uses the six areas of functioning to examine some of the characteristics that are likely to be encountered (Ashley, 2015:152).

Physical 

Coates highlights that racism is a ‘visceral experience’ (2015:10); it is felt in the body. Kinouani notes that ‘physicality’ has been used to ‘racialise’ Black people (2021:9). A difference in physical appearance has been used to create boundaries. Shadism, hair texture and the white definitions of beauty can all play into the ‘negative gaze’ (Mckenzie-Mavinga, 2016:93). Kinouani highlights the dehumanising crossing of boundaries when, for example, White people want to touch Black people’s hair (2021:19). She also comments that having a Black body marks you out in White spaces and can mean it is harder to be accepted (2021:125).

Black people report a low-level, ongoing fatigue (Winters, 2020:70; Houshmand, Spanierman and De Stefano, 2017: 205). This is related to continued secretion of stress hormones, which in turn can lead to other mental and physical illnesses (Sanderson, 2013:30). The fatigue is a deeply held traumatic stress which can pass generationally and take ‘inordinate amounts of energy to overcome’ (Winters, 2020:33).

Emotional 

Having highlighted how Blackness has been used as an indication of inferiority (Kinouani, 2021:9), this has led to some Black people feeling shame in who they are (Kinouani, 2021:163). The felt need to assimilate whiteness and deny parts of self can be equally as abhorrent as the feeling of shame (Kinouani, 2021:163).

Another emotion common in the experience of Black people is living with fear. Recent statistics on the use of stop and search legislation by police in England and Wales have shown that Black people are nine times more likely to be stopped than White people (gov.uk, 2021). A client of the author has reported that ‘nowhere feels safe, not even home’.  He reports living in fear; a phenomenon which Winters also notes in her description of ‘place-based fear’ (2020:77).

Another emotion which is common in the context of racial trauma is what Mckenzie-Mavinga refers to as ‘Black rage’ (2016:51). Anger at unfair systems and unequal treatment can simmer below the surface. It is often suppressed due to a fear of the repercussions. The ‘brutal, unforgiving’ White response to civil unrest is an example of this (Ellis, 2021:208). The fear of being labelled with a mental health problem can also lead to internalising anger (Mckenzie-Mavinga, 2016:72). Keeping rage hidden because it feels dangerous can lead to depression. One key role of therapy is to provide a safe place for exploring emotions (Mckenzie-Mavinga, 2016:73).

Rational 

In the rational area of functioning one can see mental fatigue. There is a need to shut down feelings, and thoughts of injustice are not given voice, which can lead to silencing (Mckenzie-Mavinga, 2016:33).

Kinouani comments that in her work as a psychologist, she does not feel she has ever worked with a client of colour who has not been experiencing injustice of some type (2021:59). This can lead to a sense of lack of safety and disconnection with the world, an ‘ontological insecurity’ (Kinouani, 2021:58). These thoughts are not just for the individual, but also extend to the family. There is often concern for the safety of children as they venture out into the world (Ellis, 2021:121). The fact that there is a need for ‘the Talk’ to ready children for the experience of racism in the outside world, with particular reference to authority figures and the need to stay safe, can be alarming (Kinouani, 2021:192). There is a recognition that this step away from the ‘normalcy’ of the general parenting experience needs to be grieved (Kinouani, 2021:111).

Volitional 

Thinking leads to behaviour and the need to assimilate can be found in the way Black people can often feel the need to adopt two personas. In the world of work there is a different way of dressing, a different style of language so that the Black person can be accepted in the White space (Kinouani, 2021:122).

The concept of ‘Black excellence’ (Kinouani, 2021:103) and the need to be doubly good to succeed is prevalent in behaviour (Kinouani, 2021:123). The need to work twice as hard can lead to long-term stress. Failure or mediocrity can confirm racial bias, and this can play into the emotion of shame for self, family and community (Kinouani, 2021:162; Turner, 2021:51).

Ellis notes the delicate balancing act between action and speaking out against racism and the desire to stay quiet and be safe. This is part of the daily dilemma of living for those who are Black (Ellis, 2021:5).

Mckenzie-Mavinga highlights the destructive behaviours that can result in internalised oppression. The fact that one stays silent can cause the individual to act against themselves and can lead ‘to low self-concept and feelings of powerlessness’ (2016:16).

Spiritual 

This leads into the spiritual area, which Kallmier describes as the place where we discover within ourselves ‘security… self-worth and… significance’ (2011:78).

As we have examined the other areas of functioning, there has been a felt lack of security (Kinouani, 2021:58); self-worth, with the ‘low self-concept’ described by Mckenzie-Mavinga (2016:16) and significance, the need to try harder and conform to fit in (Kinouani, 2021:122). This could indicate challenges owing to racism in the spiritual area of functioning.

There is also the dichotomy of holding the Christian faith, a religion with links to a colonial past, which has in itself ‘created barriers to faith’ for some (Lindsay, 2019:xxvi) and the expression of culturally relevant faith, which was frowned upon (Burrell, 2021:202). This has led to the setting up of Black majority churches (BMCs) outside the mainstream denominations (McLean, 2020:36). It is interesting to note that BMCs are now the fastest-growing denominations in the UK (Maiden & Daley, 2021).

Winters states that faith has been one of the main ways Black people have endured racism (2020:91). While Winters is writing about US culture, there is likely to be some correlation with UK experience. For example, in the 2011 UK census African-Caribbean and Black Africans who described themselves as Christians ‘ranked religion as the third most important factor in their lives’. This compares with White Christians who seldom valued ‘religion as central to their identity’ (Thompson, 2018).

Relational 

In the relational aspect of the model, the attention turns from the internal aspects of self to ‘‘the self’ in… dialogue with the ‘outside world’ (Ashley, 2015:152).

Kinouani describes connection as being fundamental to human relationships, but racism creates the opposite of this – the breakdown of relationship (2021:21). Siegel (2011) describes the need to feel positivity about ourselves as being based in a sense of connection with others. There can be a sense of cultural homelessness for second-generation immigrants. They are neither part of their parents’ culture nor are they accepted by their native culture. This can lead to a sense of disconnection (Kinouani, 2021:64).

A Christian perspective on racism 

Christian anthropology 

From a Christian anthropological perspective, the foundational premise of creation is one of equality. Scripture views all of humanity as being created in the image of God (Genesis 1:27). This is carried through in the Abrahamic promise that all nations will be blessed through Abraham’s children (Genesis 22:15-18). This promise is fulfilled in Christ ‘the seed’ of Abraham (Galatians 3:16). Moreover, the New Testament places an emphasis on the equality of all people, ‘neither Jew nor Gentile, neither slave nor free’ (Galatians 3:28). This is radical inclusivism (Wallis, 2016:8). Lindsay argues Jesus’ message is essentially one of ‘equality and reconciliation’ (2019:xxvi; John 3:16).

However, this is not homogeneity, as there are diverse groups (Mckenzie-Mavinga, 2016:92) who make up the picture of heaven where ‘every nation, tribe, people and language’ (Revelation 7:9) will worship God together. Each person is unique, with distinct characteristics, and all are equally welcome in God’s kingdom (Lindsay, 2019:21). McLean comments that undermining or devaluing this concept ‘is an offence to God’ (2020:39).

The Bible and slavery 

Against the view of the equality of all people outlined in the previous section, historically, the Bible has been used to condone slavery.

The pro-slavery ideology of the late 18^th century had its roots in the Eurocentric interpretation of Genesis 9:24-27, where Noah, on waking from a drunken slumber, condemns the actions of his youngest son, Ham, and curses his descendants to a life of servitude to his brothers (Lindsay, 2019:40). Those who uphold this view see the descendants of Ham being identified as Black Africans (Olusoga, 2021:55).

The New Testament writings of Paul encourage ‘slaves, [to] obey your earthly masters’ (Ephesians 6:5; Colossians 3:20) even when they are harsh, which is used by those who condone slavery to argue that the New Testament is not speaking against slavery. Masters are equally encouraged to ‘provide for your slaves’ (Colossians 4:1). This interpretation has upheld the practice of slavery as biblical and, with it, the treatment of Black people as other. On the other hand, the use of Scripture explored in the earlier section on Christian anthropology has been used to counter this view, condemning slavery by painting a different picture of the uniqueness and equality of all people from God’s perspective.

The Church and racism 

As much of theology has grown out of European schools of thoughts, the Church could be accused of whitewashing the Gospel (Lindsay, 2019:55). The historical context for the biblical story was the Middle East and Africa and yet pictorially it has been represented by White people, ‘the blonde-haired, blue-eyed Jesus’ being the antithesis of reality (Lindsay, 2019:55). Kinouani argues that a white version of Christianity was used to advance ‘imperial and colonial agendas’, justifying enslavement and the supremacy of the White master (2021:166).

Dalal’s 2002 research into the usage of the words ‘black’ and ‘white’ in the Bible demonstrate that white was associated with purity and goodness. Through time this symbolism became associated with people’s skin colour; by default, the opposite becomes true and black is linked with evil and sinfulness (Ryde, 2009:48).

Some would argue that racism has become institutionalised, not only in society, but also within the Church (BBC News, 2020a). The emergence of the Black Church in the 1950s in the UK was a direct development out of a lack of acceptance by the established Church of immigrants, whose spirituality was expressed in more ‘vibrant’ and ‘expressive’ ways (Burrell, 2021:202).

Part of arriving at a Christian worldview around race involves the disentangling of Scripture from the socio and political agendas that it became tied to in the rise of colonialism. Kwon argues that sadly the Church provided the ‘moral cement for the structure of racism in our nation’ (Lindsay, 2019:47). Isaac (2020) is reported as saying that in the face of the Black Lives Matter movement, many church leaders ‘are staying quiet or withdrawing’ (Fung, 2020:43), potentially an avoidance strategy in light of not knowing how to respond. Turner argues avoidance can come from ignorance, or through a ‘wilful unwillingness to admit to [its] existence out of… shame’ (2021:37).

Lindsay talks about ‘the white supremacy iceberg’ (See Figure 1) where the tip of overt racism is viewed as unacceptable within the Church context. However, what is below the surface: racial bias, acceptance of White privilege, colourism, etc can be held as socially acceptable. He maintains that when these behaviours go unchallenged, they reinforce systemic racism (2019:11). Something, which on balance, if challenged, the Church would not want to be aligned with.

Figure 1: White supremacy iceberg (Lindsay, 2019:12)

Just as Lindsay talks about the Church having a ‘colour-blind mentality’, seeing everything as ‘race neutral’ (2019:21), this could be equally true of Christian counsellors. This is a key area for self-inquiry when working with people of a different ethnicity to ensure complacency on the part of the counsellor does not make the discussion of race-based trauma a no-go area for the client (BACP, 2018:15).

For clients who have experienced barriers to integration within the Church because of their colour, finding a Christian counsellor who can recognise racism for what it is can be a helpful part of the reconciliation process within themselves and then with the wider Church (Lindsay, 2019:30).

As Winters says, the ‘Black church is a place of refuge where you know your Blackness is unconditionally accepted’ (2020:116). The Church can be a place of spiritual and socio-economic support (Winters, 2020:91). Faith often plays an important part in helping clients facing difficult or traumatic events, providing support and resilience (Alleyne, 2011:127; Watson, 2011:26). Kinouani cites The Royal College of Psychiatrists’ report that those patients with a spiritual practice have better outcomes (2021:166). ‘The sense of hope and peace of mind’ engendered through spiritual practice can help with integration and the ability to live with the issue while working for change (Kinouani, 2021:166-167). Lago recommends that transcultural therapists understand and appreciate the importance of faith and spirituality in their client’s lives (2011:177).

Intersectionality: Privilege and otherness 

Intersections are many layered. Ablack describes intersectionality as ‘what happens when our multiple, identifying processes overlap’ (2021:150). This section will examine the challenge of working with white privilege and otherness in the counselling room. It is important to note that the ethical framework within which counsellors work emphasises the need for equality, inclusion and the valuing of diversity (UKCP, 2019:4; BACP, 2018:15; ACC, 2004:5).

Power dynamics 

Privilege is neutral. It is how privilege is used that determines whether it is oppressive. It can be used to create a power advantage over the other or exercised with humility to build relationship with the other (Turner, 2021:31).

Tuckwell highlights that historically ‘whiteness’ has become the measure against which other things and people are judged (2002, cited in Ryde, 2009:46). It is viewed as neutral (Ryde, 2009:39) and consequently, Blackness is regarded as a deviation from the norm (2009:38). The writer agrees with Hook, Davis, Owen and DeBlaere (2017:47) that the normality of whiteness can mean that for the White person it feels invisible, a taken-for-granted aspect of privilege. As such it can create an ‘unintentional and unconscious’ bias (Sue, Capodilupo, Torino, Bucceri, Holder, Nadal & Esquilin, 2007:280) and be used for the oppression of the other (Turner, 2021:30).

It has been recognised that the psychotherapy relationship can be unequal, with the therapist having role, societal and historical power (Proctor, 2017). Drawing on Lago and Thompson (1989, cited in Lago, 2006:38) one of the challenges for the White therapist is being aware of the ‘myriad of disadvantaging mechanisms that exist… [for] black people’. They caution against the re-enacting of the White supremacist power dynamic in the counselling room; the White counsellor taking on a superior role to that of the Black client. Williams also raises the need for White people to be willing to give up power and for Black people being given the opportunity to take on their own agency (Jackson, 2020:23).

Microaggression 

Sue et al. (2007:273) highlight the use of microaggressions as, ‘brief everyday exchanges that send denigrating messages to people of color because they belong to a racial minority group’.  The impact of microaggression is reinforced by Kinouani’s research experience from several social media polls conducted in 2017. While the sample size was small, 563 participants, over 85% of participants found covert racism more challenging than overt and 36% of responders described the impact of subtle racism was akin to ‘losing one’s mind’ (2021:61). Disbelief and gaslighting by White people were a common experience when Black people tried to share their concerns (2021:60).

Turner agrees with this finding, highlighting the fact that microaggressions are often unrecognised by the privileged whereas they form ‘a sea of daily hatred through which the other swims’ (2021:48). The lack of understanding around the effort needed for survival in this milieu can impact negatively on the therapeutic relationship, with the effect that the client is not seen.

One form of microaggression is ‘colour blindness’ [sic] (Williams, 2021:175). All people are seen as equal, colour is not important. While this might seem an admirable approach, Winters (2020:192) gives a convincing challenge that by not seeing Blackness, the person of colour is made invisible, and as such racism is ignored. For her this is a ‘sublime… ignorance’ (2020:30).

Research by Houshmand, Spanierman and De Stefano demonstrated that the lack of recognition of microaggressions experienced by the client can lead to a breakdown in the therapeutic relationship (2017:204). They also found that where counsellors exhibited microaggressions towards their clients it not only influenced the client’s view of the counsellor’s competence, but, according to Constantine, the impact was perceived to be more harmful than those perpetrated by people outside the helping professions (2007, cited in Houshmand, Spanierman and De Stefano, 2017:205).

For the White counsellor being willing to sit with the discomfort of difference and articulating it in the room can form the basis for successful transcultural therapy (Jackson, 2018:10). On the other hand, Ziffo maintains that by attending to the political ideology which shapes the racism debate, the counsellor can be in danger of viewing the client ‘through the prism of my ”white fragility”’, leading to an inability to meet the client as a unique individual (2020:12-13).

Can a White counsellor work effectively with a Black client? 

Bearing in mind the subtle undertones of power and microaggression, the question of whether a White counsellor can work effectively with a Black client needs to be addressed. 

A variety of studies have been conducted over the years into the benefits or otherwise of ethnic matching in the process and outcome of therapy. Karlsson’s 2005 study considered analogue, archival, direct measure and outcome, and qualitative studies that were available. He surmised that the evidence for benefits in ethnic matching were inconclusive as there was not enough empirical evidence to support this conclusion (2005:124). From the perspective of his study there were too many variables and lack of common definitions around words like ethnicity and culture, which made the comparison of studies difficult (2005:125). Karlsson saw shared values, language, level of acculturation and ethnic identification as having greater impact on the effectiveness of therapy than solely outward ethnic matching (2005:122-123).

Farsimadan, Khan and Draghi-Lorenz argue that what Karlsson sees as insurmountable variables are the elements that make up ethnicity; without them there is only a comparison of physical features. The separating out of aspects of ethnicity to compare studies was unhelpful (2011:19). Farsimadan et al. responded to Karlsson’s work with their own study in which they also considered analogue, archival, direct measure and outcome, and qualitative studies from the 1980s onwards. Their conclusions contradicted Karlsson’s findings, as they found evidence that matching ethnic dyads had beneficial impact in terms of higher uptake of therapy, lower dropout rates during therapy, longer duration of working and greater post-therapy effectiveness (2011:18-19).

They went on to argue that the facets most likely to affect the therapeutic process were the preconceived assumptions of either party and a lack of understanding of the others’ culture, values and experiences (Farsimadan et al., 2011:20). They also argue that the level of acculturation of the client can in some respects offset the ‘cultural incompetence’ of the therapist (2011:19).

McLeod argues that client and counsellor matching at a cultural or ethnic level can never be a complete solution. While the dyad may share common aspects of ethnic origin, there will be other layers where their experiences do not intersect (2018:40). For example, this creates a dilemma for people who want to choose a counsellor who shares their faith and their cultural background and experience. Statistically Black counsellors are in the minority (York, 2020:4) and within that number those that are, for example, Christian, will form an even smaller cohort, meaning that the client could be left with the choice between someone who shares their ethnicity or someone who shares their faith.

Turner talks about how Black people feel the need ‘to kill off, a part of ourselves’, in effect wearing a mask to be accepted in society (2021:79). This raises a question for the therapeutic process: if a Black client is working with a White therapist are they able to bring their full self to the therapeutic process or is there a need to hide parts of self? (Dos Santos and Dallos, 2012:62). If there is an element of titrating self, then therapy may not be as effective.

Self-awareness 

Turner suggests that whiteness is not the problem, but the intersection of privilege and supremacy that can be attributed to it (2021:41). As such the White counsellor working with the Black client needs to be acutely aware of their own potential prejudice, for this will come into the therapeutic space (Turner 2021:49). The development of self-awareness then becomes critical for the counsellor in relation to working with Black clients.

The need for the counsellor to be aware of themselves as a racial and cultural being, recognising the stereotypes and assumptions that influence their worldview is key (Sue et al., 2007:280). Ryde notes that ‘every individual is embedded in their culture’ (2009:192) and as such the White therapist needs a clear understanding of their own culture to understand areas of difference when working with a client of colour.

Figure 2: The cycle of White awareness (Ryde, 2009:50)

Ryde has developed a helpful model, ‘the cycle of white awareness’ (Figure 2). Working through this model enables the White counsellor to face their own ‘complicity in racism’ but also to relate in a ‘less defensive way’ (2009:52). She challenges the necessity of staying open to ‘painful and confusing feelings’ so that a process of integration is possible (Ryde, 2009:141). Another useful tool for the counsellor in identifying ‘normalised’ racism is Lindsay’s ‘white supremacy iceberg’ (2019:12, Figure 1 above). The application of this model can help grow self-awareness and aid recognition of when covert racism is in effect.

Sue et al. identify willingness to discuss colour as one of the keys to creating a therapeutic alliance (2007:281). Zhang and Burkard’s research has shown that counsellors who are willing to discuss colour difference are seen as ‘more credible’ and able to create ‘stronger working alliances’ with their clients than those who are avoidant of this subject (2008:77). McLeod cites Dos Santos and Dallos’ research into cross-cultural therapy between White therapists and clients of African-Caribbean descent, drawing attention to the ‘awkward conversations’ that evolve when the subject of race or colour is avoided (2018:40).

Jackson notes that transcultural therapy is most successful where the ‘white therapist is comfortable with difference’ (2018:10). Tuckwell (2006:207) suggests that developing a ‘secure sense of white identity’ that is not identified with power from its colonial history needs a willingness for deep introspection and internal work on the part of the counsellor, something which must be acknowledged as essential for those working in this area.

Training 

Most counselling theories were developed in the West with a subsequently Eurocentric bias (Lago, 2006:82). They were developed in the era of the industrial revolution with its emphasis on autonomy and individuation. Consequently, theories focused on an ‘I’ culture (Lago, 2006:84). This is often out of step with Black cultures with their emphasis on the importance of the collective and ‘we’ culture (Sue et al., 2007:281). As a result, training courses that have been developed historically reflect the Western roots of the founding fathers of psychotherapy. Watson argues that training should reflect the multicultural society in which we live. She emphasises the need for transcultural issues to be integrated within the course rather than addressed as a ‘one-off’ teaching (2011:19).

Mckenzie-Mavinga (2011:31) highlights the importance of trainers grappling with their own cultural awareness to deliver courses that meet the needs of working in a multicultural society. When the tutor is confident and competent, students feel supported to explore cultural diversity and develop their self-awareness (Jackson, 2021:21). This ensures they are qualified to practice competently with clients of different ethnicity and backgrounds. An ability to address this as a primary aspect of teaching, with practical examples, gives space for students to learn how to address this issue and be confident in broaching it with clients (Mckenzie-Mavinga, 2011:33).

Lago (2006:126-130) outlines three aims for training. Firstly, to examine ‘beliefs, attitudes and awareness’ so that students can understand their own stereotypes, value others’ ‘psychological and cultural frameworks’, and learn to use their observing self to check their attitudes while working with clients and recognise when they are trying to impose ‘their own frame of reference’. Secondly, he recommends gaining knowledge so that students are transculturally literate. Lastly, developing skills which include the ability to ‘tolerate ambiguity’ and ‘manage anxiety’ when working with difference.

From the perspective of Black trainees, there is often a sense of participating in the course to pass but having to titrate oneself to not overwhelm White students (Cousins, 2020:21; Venson, 2020:19). Watson’s research reports that Black students experienced their training as an ‘unsafe place… to explore issues of ‘race’’ (2004:190).

The future development of training needs to ensure that participants can learn from each other’s experiences in a safe way (Jackson, 2021:22). Cousins talks about the ability to ‘hold boundaries while staying curious’ (2020:21). This feels like an important skill to learn.

With the discussion around Black Lives Matter there has been an increase in focus on training and ensuring that diversity and inclusion is woven through the whole of learning, not just an add-on module. The creation of the Diversity and Inclusion Coalition, drawn from eleven professional bodies and associations, is to help training institutions develop the tools to tackle this area more effectively in their teaching (Jackson, 2021:24). This feels like a significant step forward in countering a piecemeal approach to training in cultural relevance.

Lastly, it is important to recognise that the challenges around training also apply to supervision (Ryde, 2011:142). Just as the trainer needs to be competent to work with issues of difference in the training room, the supervisor needs to be robust and courageous to bring it into the supervision space (Ablack, 2021:149). Mckenzie-Mavinga has begun a transcultural supervision group to give a space to express and normalise the powerful feelings evoked by racism (George, 2020:29). The group is open to all in recognising that skirting around racism as an issue does a disservice to counsellors and their clients alike.  

Towards a therapeutic response 

In this section suggestions for a therapeutic response for the client who is facing race-based trauma are explored. Moodley, Lago and Talahite highlight how Carl Rogers’ 1977 counselling videos of working with a Black client in the Right to be Desperate and On Anger and Hurt are still used as a starting point for teaching when working with race in the counselling room (2004:viii-ix). Their ground-breaking book sought to address the deficits and benefits of Rogers’ work, offering alternative responses based on the research and experience gathered in the 25 years that had passed since the videos had been produced. While acknowledging their valuable contribution to this discourse, Turner draws attention to the ongoing progress that has been made in working therapeutically in this area (2020:35). Learning from the experience of those that have been ‘othered’ can be an important part of understanding how to work effectively with Black clients. Entering their world feels like an appropriate place to start when working from a stance of cultural humility (Hook, Davis, Owen and DeBlaere, 2017:9).

Multicultural orientation framework 

While recognising the value that multicultural counselling competencies (awareness, knowledge, and skills) explored in Lago’s work (2006:138-141) have brought to the therapeutic world, Hook et al. point to deficits in the research in measuring their effectiveness. They highlight difficulties with accuracy of measurement strategies and question whether in fact competencies are the best measure of success in clinical practice (2017:22). Working with intersections further complicates matters and, in light of this, they have developed a multicultural orientation framework (2017:21). This moves the focus from the ‘ways of doing’ to the ‘ways of being’ with the client (2017:9).

They recommend three ways of practising in a multicultural context: working from a stance of cultural humility, making use of the opportunities presented by the client and the importance of practising from a place of comfort.

Davis, DeBlaere, Brubaker, Owen, Jordan, Hook and Van Tongeren’s research, involving 128 participants, demonstrated that humility on the part of the therapist can give better therapeutic outcomes and be effective in healing ruptures (2016:483). With a knowledge of one’s own cultural values it is possible to be open to a different perspective, working with ‘respect, lack of superiority and attunement… [to the others’] cultural beliefs and values’ (Hook et al., 2017:29). Mckenzie-Mavinga asserts that a lack of awareness of oneself as a ‘racial and cultural being’ can impair working with those from a different background (2016:20).

When opportunities to explore the client’s cultural identity, values and beliefs are presented, these should be examined (Hook et al., 2017:32). Zahid (2021:113) encourages the ‘broaching’ of difference when it is presented as it can be validating for the client. It can create a safe space to examine the hurt caused by racism. Ignoring the opportunity and maintaining silence on this issue can speak of collusion, widening the gap of difference rather than drawing closer to understand (Wright, 2021:41).

Having a high level of cultural comfort means that the therapist can manage conversations around areas of difference while maintaining a sense of ease and calmness (Hook et al., 2017:37). The client, sensing this, is then able to share their experience without fear of judgment or rejection. This is backed up by research that shows lower dropout rates for therapists able to express cultural comfort with their clients (Hook et al., 2017:37).

Having recognised the benefits of working from a multicultural orientation framework, it is important for the counsellor to be humble enough to learn from the Black person’s lived experience, but knowledgeable enough that the person of colour is not expected to educate the counsellor. This is a tightrope which needs to be navigated with empathy and a willingness to learn (Jackson, 2020:21).

Body, mind and heart 

According to Ellis, racism impacts three areas: body, mind and heart (2021:160). As such, a therapeutic response to race-based trauma needs to work in these areas with the client. 

Body 

Coates describes racism as being primarily visited on the body. It is the visible identity which marks one out as Other (2015:10). Van der Kolk and McFarlane raise the need for trauma treatment to, amongst other things, re-establish ‘a sense of safety’ in the body (1996:17).  Fisher highlights research that has shown the link between PTSD and ‘autonomic dysregulation and unresolved physical responses’. She argues that a somatic focus is needed alongside established therapeutic practice when working with trauma (2019:2).

Merleau-Ponty sees ‘the body as a conduit to the unconscious’ (1962, cited in Turner, 2021:12). Talking therapies can help manage secondary symptoms (Fisher, 2019:7) but working with the body provides a way of connecting with the internalised trauma experience that has become ‘stuck in the body’ (Menakem, 2021:178; Caldwell & Leighton, 2018:21). Ellis, drawing on Caldwell, highlights the point that if the body has been the cause of discrimination, the body can be objectified as the source of harm and thus no longer listened to (Ellis, 2021:176).

When working with race-based trauma, Shraboni offers the useful question: ‘how do you carry your racial and ethnic identity?’ (Ellis, 2021:253). Noticing the somatic response to this can begin to unravel where trauma has been held.  Allowing the client to experiment with different ways of moving and being can start the creation of a different narrative (253).

Menakem’s five anchors for working through pain are a helpful tool, especially for grounding when exploring areas of discomfort and distress (2021:167). The anchors are somatically based and involve (1) quieting self, (2) noticing what is happening within the body, (3) recognising discomfort and staying with it, (4) allowing self to move through the experience and (5) releasing the remaining energy through physical activity (2021:168-172). His assertion that ‘healing does not happen in your head. It happens in your body’ (2021:175) is a powerful reminder when working with trauma. His body and breath practices are useful in both calming and activating the body, depending on whether trauma has left an impact of hyper- or hypo-arousal (2021:141-146).

Cornell maintains that in the West people no longer listen to their bodies (1996:8). He argues the body contains the wisdom for healing if the client allows themselves the time and compassion to stop and listen (1996:8). Gendlin suggests using the ‘felt sense’ to explore how the sensations held in the body can elucidate the feelings that are held below the surface (Nada Lou, 2003). Gently questioning the ‘felt sense’ with curiosity and openness can begin to ‘shift’ the ‘stuck’ feeling and enable a different relationship with the experience (focusing.org, 2022). Menakem’s body scan (2021:157) would be a good access point for this.

There are benefits of integrating traditional healing practices with African and Caribbean clients (Kinouani, 2021:157) in which movement and body focus play a significant role. Zahid recommends using body-based techniques in therapy as ‘a bridge’ between the two cultures in the room (2021:108).

One note of caution when working in this area is to ensure that the client remains within their ‘window of tolerance’ (Siegel, 1999, cited in Ogden & Fisher, 2015:48). Being within this space with a little discomfort, the challenge of feeling ‘safe, but not too safe’ (Ogden & Fisher, 2015:48) can allow the client to ‘remain reflective and compassionate’ while also feeling secure enough to work (Ellis, 2021:7).

Mind 

Traumatic events are often repeated over and over in the mind. They are frequently accompanied by thoughts and feelings of shame and low self-worth, perpetuating themselves in a negative spiral from which there appears to be no escape (Welsh, 2018:44). Ellis recommends the use of mindfulness to connect what is happening in the body with the cognitive aspects of processing trauma. Mindfulness allows the processing of thoughts in a non-judgemental way. Working with the present experience in the ‘here and now’ can help bypass the tendency to get stuck in the negative cognitions of the past or thoughts for the future (Ellis, 2021:160). Ellis claims that allowing the focus on the present can be ‘enough to bring a different perspective to our experience’ (2021:161).

However, he also cautions that mindfulness can be seen as a Western concept, so framing it in the right way can be an important part of presenting it to Black clients. The focus is on being with oneself, which he acknowledges is not necessarily easy (Ellis, 2021:165). Menakem recommends grounding techniques when dealing with issues that are discomforting so that they do not become overwhelming (2021:146).

Magee (2019) encourages the use of mindfulness to help in the understanding of both what is going on in the mind and emotions, which in turn can enable the client to become more self-compassionate and emotionally resilient.

Heart 

According to Mckenzie-Mavinga, ‘Self-esteem can only be raised if we increase self-love and love who we really are’ (2016:154). These challenging words speak to the essence of working with the heart in race-based trauma. Working at this level means learning self-compassion. For the therapist this involves ‘witnessing and acknowledging’ but without the need to respond. It moves beyond empathy, moving from feeling ‘with’ the individual to feeling ‘for’ the individual, experiencing ‘warmth, concern and care’ with the desire to enhance the client’s wellbeing (Ellis, 2021:186-187).

Ellis recommends a compassion practice alongside mindfulness in working with race-based trauma (2021:187). This allows the recognition of suffering and aids the client in extending compassion to themselves in the same way they would to other people (Neff, 2011:10). Mckenzie-Mavinga talks about ‘feeling it in our bones’ (2009:39). The sheer depth of feeling expressed in this statement needs to be witnessed and validated in the processing of trauma.

Kinouani describes self-care by the client as essential to cushion the effects of race-based trauma (2021:196). She has developed the Blackness-centred compassion therapy model, which seeks to address the lack of focus on the felt unsafeness of those who have experienced racism, examining the interrelatedness of the ‘here and now’ and the ‘there and then’ exposure to racism (2021:221-225).

The affect regulation system model may also be also helpful in this context (Gilbert, 2013:24). For people who have experienced trauma their ‘threat and self-protection system’ is of necessity highly activated. Helping clients to bring their ‘soothing and contentment system’ online can help counter this. As this system becomes effective, feelings of safety and connectivity become possible (Gilbert:2013:25-27).

‘We’, not ‘I’ 

Kinouani acknowledges the importance of the African concept of Ubuntu, the interdependence of community in which self is discovered that has often been lost in the face of acculturation (2021:205). Also, Lago comments that the individuation of Western therapeutic approaches can be at odds with the ‘we’ culture of Black clients, who place emphasis on kinship systems and the importance of family and community (2006:126). It is vital that therapists working with Black clients can respect and understand non-Western culture (Ryde, 2009:128).

In the therapeutic context, sharing with others and the involvement in support groups can be beneficial for the client (Winters, 2020:93). Just as racism is experienced individually and collectively, there is also a sense in which healing needs to come at both an individual and community level. Winters’ example of Safe Black Space Community Healing Circles is a powerful model of how the mix of African cultural practice, mindfulness and self-care have been integrated into a space where trauma can be explored at a group level within the Black community (2020:93).  

In summary, working from a position of cultural humility with those who have experienced race-based trauma can open the door to efficacious work in this area. This ensures that the therapist is not guilty of ‘perform[ing]’ whiteness on the client (Ryde, 2009:128). 

Concluding reflections

Turner asks the question, ‘can, or even should, [therapy] divorce itself from the cultural construct it is always operating within?’ (2020:36). I believe the answer to this is no. Racism is still an issue within our culture and addressing the counselling needs that arise from this are an essential part of the therapist’s tool kit.

Through the process of writing, I have learnt about my own lack of awareness of the lived experience of the Black community and how creating a culture of acceptance, equality and awareness in the therapeutic space is essential. Recognising difference from the outset can be helpful in establishing and developing therapeutic relationship.

My personal experience as a White therapist working with a Black client firstly challenged my ignorance in this area. It then taught me that this is a place for humility and continuous self-examination. It has helped me to develop my own sense of self regarding my culture and values. And lastly, I recognise that while this article has given me the opportunity to learn and grow in this area, it will continue to be a subject for ongoing professional development.

In conclusion, I have wrestled with the knowledge that my White heritage gives me a privilege that others do not have. As Turner rightly observes, ‘Difference is difficult. It is complicated. It is nuanced. That is why it is so important’ (Turner, 2021:21).

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About the author

Liz Doré BA (Hons) Counselling

Liz is an integrative counsellor who trained at Waverley Abbey College and runs an online and in-person private practice from Shaftesbury in North Dorset. She has a background in HR having worked mainly in the Christian charity sector. In addition to her counselling, Liz is a leader at her local church.

Contact: counsellingwithliz@protonmail.com Website: www.counsellingwithliz.com

Copyright

Copyright 2023 Liz Doré

[1] I have chosen to use the term Black in my essay to refer to the mainly African Caribbean community experience being explored. I have chosen to capitalise the words Black and White when referring to people and race. This gives equal treatment to both groups, which feels important in the discussion of privilege and otherness. I have used BAME (Black Asian Minority Ethnic) only when it has been referenced for statistical purposes, as whilst an often-used acronym, it carries the danger of putting ‘everyone who is not white into a singular category’ (McLean, 2020:38) when there are clear distinctions of culture, language and experience for those of different ethnic groups.

[2] In some instances, statistics relate to the BAME community, as published statistics do not always separate out Black, Asian and Minority Ethnic groupings.

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https://doi.org/10.52456/WACJO323

Introduction

Background and rationale

The exponential increase in suicide worldwide, with one death every 45 seconds, and more than 800,000 people taking their own lives every year (World Health Organisation, 2021), has resulted in a concerted effort in suicide prevention by many governments (Manchester University, 2020). In the UK (2020) and Northern Ireland (statistics for 2019), 6,057 people took their own life (Office of National Statistics, 2020; Public Health Scotland, 2020). The ripple effect of these suicides is far-reaching. American psychologist, Julie Cerel, estimates that 135 people will be affected by one suicide (2018, cited in O’Connor, 2021:15), with children, parents, partners, friends, colleagues, schools and communities stunned by each death (Jordan & McIntosh, 2014).

Despite the focus on suicide prevention, until now, support for those who have lost a loved one to suicide has been primarily neglected. UK governments have launched action plans explicitly focused on supporting the bereaved by suicide in the hope of preventing further self-harm, distress and suicides (Manchester University, 2020; National Suicide Prevention Leadership Group Scotland, 2018).

Those bereaved by suicide are 65% more likely to attempt to take their own lives than those bereaved by other causes (Scottish Government, 2020) and are more likely to be engaged in high-risk behaviours such as drug and alcohol misuse, financial recklessness, sexual promiscuity and reckless driving (Manchester University, 2020). They are also more likely to use tranquillisers and anti-depressants, have more stomach ulcers and suffer from insomnia, heart disease and autophobia (fear of being alone) (Lukas & Seiden, 2007). These government initiatives are much needed as the impact of a suicide on a loved one can profoundly affect every aspect of their person– the physical, emotional, behavioural, cognitive, social and spiritual, (Kallmier, 2011:65) – as well as their sense of ‘security, self-worth and significance’ (Ashley, 2015:84).

Suicide is one of the last remaining ‘taboos’, plagued by stigma, myth and misunderstanding (O’Connor, 2021:11). It is not caused by a single factor, but is the ‘end product of a complex set of biological, psychological, social and cultural determinants that come together in the perfect storm’ (O’Connor, 2021:13). This ‘perfect storm’, culminating in the suicide of a loved one, leaves the bereaved with complex issues. The American Psychiatric Association ranks the level of stress from the suicide of a loved one as ‘catastrophic’, stating it is equivalent to a concentration camp experience (Hsu, 2017).

Acknowledging and addressing the impact of this type of bereavement on mental health seems very much to the fore of research. However, the role of spirituality for people bereaved by suicide does not seem well-researched or understood (Cepuliene & Pucinskaite, 2021; Burke & Neimeyer, 2014).

Why the local church?

There are many support groups nowadays for those bereaved by suicide, offering help and a listening ear through group meetings. However, they do not necessarily address the spiritual needs that are central to the Christian faith. After a loved one’s suicide, the bereaved’s spiritual core can be profoundly affected, either positively, encouraging spiritual depth and growth, or negatively due to stigmatisation and other influencing factors (Cepuliene & Pucinskaite, 2021), resulting in a faith crisis or loss of faith.

As a survivor of suicide, someone bereaved by suicide and deeply impacted by it, , I believe the local church could be helped to confidently and effectively support those in their congregation in this situation, encouraging positive spiritual formation. This could be achieved by highlighting the spiritual challenges and the traumatic effects suicide has on the bereaved (Zylla, 2012), as well as indicating what support is life-giving. The church is the ideal community to accompany Christians who may be struggling with debilitating grief and facing a faith crisis. It already offers a ‘broad-based approach to helping people’ and provides holistic support for individuals, which includes the ‘spiritual and personal growth of those in our church communities’ (Kallmier, 2011:13).

Literature review

Introduction

An examination of the literature on suicide demonstrates an emphasis on suicide prevention. Historically, within suicide research, little attention has been paid to suicide survivors, but recent analyses have identified a clear gap (Rivart, 2021; O’Connor, 2021; Jordan & McIntosh, 2014).

It also highlights a growing recognition that suicide bereavement differs in many ways from other tragic bereavements due to the complexity of the grief process and the social, practical, emotional, psychological and spiritual challenges the bereaved face (Ross, 2021; Griffin, 2019; Jordan & McIntosh, 2014). The complexities of suicide bereavement can lead to further suicides; supporting the suicide bereaved is now recognised as a means of suicide prevention, so-called ‘suicide postvention’ (Shneidman, 1975, cited in Ehrlich, 2027:2).

Research consistently validates the intensity of suicide bereavement (Cepuliene & Pucinskaite, 2021; Pitman et al., 2018; Ali, 2015; Jordan & McIntosh, 2014), the loss of hope, anguish, despair, guilt and shame complicating the grief process. There is an acknowledgement that this type of incomprehensible violent death can lead to the bereaved questioning their beliefs about ‘self, people, the world, and God’ and can result in ‘disenfranchised grief’ when loss is not recognised or understood by society (Weaver & Stone, 2005:42).

Despite recent research by Manchester University (2020), in a study entitled ‘From Grief to Hope’, which addresses many of these areas of challenge, there is no mention of the spiritual aspects of suicide bereavement, which can torment many Christians and non-Christians alike (Hsu, 2017; Vandecreek & Mottram, 2009).

Jordan and McIntosh’s Grief after Suicide covers many aspects of suicide grief in great detail but only affords one page to ‘religion’. It recognises that ‘religious convictions about suicide may complicate the grieving process’ (Jordan & McIntosh, 2014:317), and gives general advice for therapists to include a ‘clergy member such as a pastor, rabbi, or imam’ in the therapeutic context. It does, however, acknowledge that ‘spiritually meaningful interventions can be powerful tools for healing’ (Jordan & McIntosh, 2014:317).

From a Christian theological perspective, it has been difficult to find research that explicitly addresses how suicide bereavement affects spiritual formation (Campbell, 2020). The spiritual aspect of grief often appears neglected in research, and spiritual support seems limited or non-existent. In their attempt to somehow find meaning in loss, faith arguably plays a significant role in recovery for Christians (Campbell, 2020; Vandecreek & Mottram, 2009). Zylla states in The Roots of Sorrow that ‘faith itself is tested at the root by the ongoing situation that seems to indicate God’s absence,’ which becomes ‘inextricably linked to a challenge of faith’ for the suicide bereaved (2012:4).

Cepuliene & Pucinskaite (2021) highlight the challenges faced in suicide bereavement that were detrimental to faith and what helped spiritual growth in these extreme circumstances influencing the trajectory of the bereavement process. These included the need to be helped by their religious community without being judged, and the recognition of spirituality and religion as an important resource in bereavement.

Christian theology and suicide

There have been many points throughout history where societies have gone to extremes ‘to castigate those who have taken their own lives, from dismembering bodies, dragging bodies through the streets, cutting out hearts, hanging in the centre of cities, persecuting families of the deceased and incarcerating the person whose suicide attempts were non-fatal, only to hang them later’ (Wilkens, 2003:387). Sadly, much of this resulted from the position of the Christian Church in the fifth century following Augustine of Hippo’s strong stance against suicide: ‘Certainly, anyone who kills himself is a murderer’ (Vandecreek & Mottram, 2009:747; Wilkens, 2003:387). His interpretation of the sixth commandment was that ‘thou shalt not kill’ also applied to oneself. Aquinas adopted this view (c.1265), supporting Augustine’s attribution ‘that God denied heaven’ to those who died by suicide (Vandecreek & Mottram, 2009:747). This view became deeply embedded throughout the centuries and remains even today in some traditions, where suicide is still regarded as a mortal sin with no hope of forgiveness (Hsu, 2017; Vandecreek & Mottram, 2011).

This Augustinian view has impacted survivors significantly and is compounded by the social shame following a suicide, marital problems, alcoholism and depression, which add to the bereaved individual’s overwhelming grief (Ross, 2021; Wilkens, 2003).

Every faith community is likely to differ in its theology and approach to suicide, which will impact the bereaved’s spiritual formation and grief journey to their benefit or detriment.

Suicide contagion

There is much debate about whether suicide is ‘contagious’ or not. Some state that there is no research evidence and that it is unlikely (Kleinman, 2014). However, there is agreement that ‘prolonged exposure can increase the likelihood of suicide contagion’ (Ferguson, 2018; Joiner, 1999).

If the suicide bereaved in our congregations who are vulnerable to suicide are to be helped, consideration of this question could be invaluable. Statistics verify that those bereaved by suicide are 65% more likely to take their own lives (Scottish Government, 2020).

Professor Niederkrotenthaler, head of suicide research at Vienna University, states there is a correlation between high-profile suicides reported in the media and increased population suicides. When the method is mentioned, suicides increase even more. His research suggests that suicide by hanging among men aged 45–64 years increased after the suicide of Robin Williams by the same method (Niederkrotenthaler, 2020).

Professor Rory O’Connor, an international expert in suicide prevention and a researcher who has devoted his life to suicide, often grapples with the question of whether he will die by suicide (O’Connor, 2021). He recognised it was inevitable that one day it would affect him, and that he would have suicidal thoughts. It is a question latent in many survivors bereaved by suicide. For others, it is something they tackle daily, even to the point of taking their own lives. It is an area worthy of careful consideration for pastoral carers when supporting the bereaved by suicide.

Pastoral care of the bereaved

Zylla’s The Roots of Sorrow: A Pastoral Theology of Suffering, offers advice and insight for churches and those involved in the pastoral care of the tragically bereaved and suffering. It considers how the church might help others ‘live hopefully in a broken world’ (Zyla, 2012:1). Zylla suggests the need for a spiritual vision ‘for the suffering and oppression of the most broken persons and communities in the world’ (2012:1). This spiritual vision requires churches to embrace a theology that boldly recognises the presence and often the absence of God in tragic circumstances, and is prepared to search deeply with the afflicted, to help them find peace even when they cannot find answers to their suffering. For those pastorally caring for the afflicted, it takes courage and a willingness to accept that sometimes there are no answers and that their words can be impotent in the face of ‘unspeakable anguish’ (Zylla, 2012:3).

There is also a growing recognition in the psychology of trauma that sacred texts can be an effective way of coping with the medium and long-term effects of trauma (Brown, 2022). Brown argues that this is not a new phenomenon and can be found in many of the Psalms if read through the lens of coping theory, a way of adapting to stressful situations. Kallmier (2011:30) states how the Bible provides us with an understanding of human existence and purpose that can support a person through ‘the most troubled and testing times in life’. Hughes has a high view of scripture and gives great significance to the authority and sufficiency of Scripture in the Waverley Model of Counselling, considering it central to helping people (Ashley, 2015). Brueggemann, however, disputes this and asserts that the dialogue in the Psalms is ‘essentially theological, not psychological’ (2007, cited in Brown, 2022:277).

Finding meaning in suicide bereavement

Psychiatrist Viktor Frankl, who endured years in a Nazi concentration camp, said that a sense of meaning is necessary to endure suffering. He developed a psychotherapeutic model called logotherapy. Its central focus is man’s [sic] desire to find meaning (Hemphill, 2015).

Kessler (2019:1,2) argues that beyond the familiar five stages of grief, ‘denial, anger, bargaining, depression and acceptance ’, as identified by Kübler-Ross in 1968, is another stage called ‘finding meaning’. Lichtenthal (2011) refers to this as meaning-making. Finding meaning in loss ‘empowers us to find a path forward’ (Kessler, 2019:2). As the suicide bereaved struggle so intensely to find any meaning from their loss, effective pastoral care (Cepuliene & Pucinskaite, 2021) could help them and prevent them from getting stuck in one of the other five stages of grief.

The challenge for the suicide bereaved is to attempt to make sense of a self-inflicted, intentional and deliberate death that violates the bereaved individual’s ‘fundamental norms of self-preservation’ (Jordan, 2001:92; Sands, 2008). Current bereavement theory suggests that the most difficult aspects of bereavement and grief are intensified and particularly problematic when the mode of death is suicide. Someone killing themselves deeply inhibits a ‘person’s ability to make meaning, and the griever’s relational world with the self, others, and ongoing relationship with the deceased’ (Bell et al., 2012:50). Brown (2022) asserts that narrative is an important process in coping with trauma.

Spirituality in meaning-making

‘Spiritual meaning-making,’ viewing life through the lens of faith, can generally help Christians to make sense of the death of a loved one (Cepuliene & Pucinskaite, 2021:4; Lichtenthal et al., 2011:5; Doehring, 2018:1). However, making sense of a suicide is particularly difficult due to trauma, the ‘not knowing why’ and the endless questions around a loved one’s death.

Research suggests that Positive Religious Coping (PRC), a faith framework for making sense of tragic bereavements, can help transpose tragedy psychologically into something more positive with time and distance (Levi-Belz, 2017; Lichtenthal et al., 2011). For some, however, the loss of a loved one to suicide ‘can trigger a spiritual crisis’ (Cepuliene & Pucinskaite, 2021; Dransart, 2018), putting their spiritual resources under too much strain to cope with this approach.

However, an emphasis on religious coping and trauma and meaning-making neglects the role of spiritual practices in that process (Doehring, 2018). Combining research on Porges’ polyvagal theory (Doehring, 2018:241), Doehring demonstrates the central role that body-centred spiritual practices can have on those experiencing suicide bereavement or other traumatic bereavements. She suggests that spiritual practices like listening to music, meditating on scripture, proclaiming scripture aloud and liturgy can connect the bereaved with grief and compassion and the goodness of God, enabling them to reach wholeness.

Summary

Research into the spiritual aspects of suicide bereavement seems limited but is considered essential for the positive growth of a suicide-bereaved Christian. Faith issues, understanding the theological complexities and having defined long-term pastoral guidelines could help churches support the bereaved effectively. If dealt with patiently and sensitively, faith can help individuals find meaning in their tragic circumstances.

Effective postvention support for the bereaved can help to empower them and help them find meaning again in their lives (Jordan and McIntosh, 2014). However, research also suggests that the spiritual/faith dimension in the context of suicide bereavement can be a ‘valuable resource or an obstacle’ (Cepuliene & Pucinskaite, 2021:22; Lichtenhal, 2011:5).

Methodology

This research used autoethnography as a research method, as well as narrative qualitative research (Swinton, 2006) in the form of semi-structured interviews to examine the lived experiences of three Christian participants who had lost a loved one to suicide. Autoethnography is a research method suited to sensitive issues that explores the lived experiences of the researcher. It is distinctive from other research methods in three ways: it is qualitative, self-focused and context-conscious (Fahie, 2014). It also ‘intends to connect self with others, self with social, and self with the context’ (Ngunjiri, Hernandez & Chang, 2010:2). The hope is that ‘the telling may be of benefit to others’ (Campbell, 2020:521).

My story 

In autobiographical research it is important to give context through narrative, without which there would be no motivation for this research.

On 31 December 2003, Hogmanay, a day of great celebration, fireworks and parties in Scotland, my husband – a generous, gregarious, kind considerate man – unable to face another year of uncertainty, took his own life while the family were shopping for gifts for his 48^th birthday.

Returning home with his birthday gift, I found an open letter on the console table – a bill for my father’s funeral two weeks before, which my husband was paying for as my step mum could not. A fatal mistake had been made. It referred to the cost for the funeral of my husband rather than my father, no doubt confirming in my husband’s mind that he was meant to die. I searched everywhere for him and realised the key to the garage was on the inside of the locked door. Battering the reinforced garage door window with a boulder, the horror and trauma started. Each moment is as vivid now, eighteen years later, seemingly etched forever on my mind with a power to propel me back to the pain and anguish of that moment, which shattered my life and the lives of my three sons and family forever. There was only one name I screamed over and over. Jesus. Once inside, I irrationally checked for a pulse, and leaned my head on his chest, listening and hoping beyond hope for a heartbeat. I dialled 999 and was told to calm down or they would not help me.

The coroner’s report said his death would have been instant, and he would not have suffered. The suffering for us was only just beginning, and would take at least fifteen years for me to be able to revisit and process it deeply. My young teenage sons would struggle over the years with depression, anxiety and broken hearts at losing their father, carrying a deep sadness that he would never know their wives and children.

From the start, despite suicide being an ‘unmentionable’ subject at the time, I did not lie about the cause of my husband’s death. The ripples of his death were shocking and far-reaching.

My teaching colleagues, friends, family, my children’s friends and their parents and my husband’s colleagues in Edinburgh, London and Manchester were deeply shocked by his unexpected death. They flew to Edinburgh for his funeral, arriving in chauffeur-driven limousines contrasting starkly with the poverty and desolation surrounding the church where we worshipped. My husband had impacted many lives. A book of memories was compiled by his colleagues and I am struck by the love and care he showed his staff and how he touched their lives.

Autoethnographic research is challenging for the researcher and has deeply impacted me, ‘generating emotional pain’ (Ellis, 2000:738) as I reflected on my situation. However, it is considered invaluable in researching sensitive topics like suicide bereavement (Ali, 2015) and has resulted in a deeper understanding of myself and my experiences (Ellis, 2000:738). Previously denied feelings and unrecognised fears and insecurities have been acknowledged as I looked to answer questions, collect evidence and produce findings that were not determined in advance.

Ethical considerations

Ethical approval for the research was granted by Waverley Abbey Research Ethics Committee before approaching participants for interviews.

Participants

To protect identity and confidentiality, I have referred to the participants by the pseudonyms of Eve, Leah and Holly.

Eve, in her sixties, discovered that her grandmother, whom she adored as a little girl, had taken her own life. A family secret for 50 years, it came as a great shock to her. Still, it gave her a retrospective understanding of why her mother suffered such extreme anxiety and fear throughout her lifetime, crippling her ability to lead a normal life. This family secret evoked powerful emotions, including anger, and highlighted the shame of suicide. Eve’s initial reaction was to perpetuate this secret.

Leah lost her aunt, who was ‘like a mother’ to her. She was someone who was admired and significantly respected in her family and community. This bereavement caused a complete mental breakdown for Leah, who attempted to take her own life on several occasions.

Holly lost her son unexpectedly and, due to the intensity of her pain, she found communication with her husband difficult.

Practical theology and qualitative research

In recent research, autoethnography has proved to be a ‘significantly useful tool’ in exploring complex issues of lived experience, attracting attention within practical theology (Campbell, 2020:521). Practical theology as a discipline reflects on and gives a perspective to our practices and human experience (Swinton, 2006) while critical reflection and analysis seek to determine what is going on in the light of scripture and tradition. By examining the Church’s stance on suicide historically and pastoral practices in a contemporary context, I hoped to reveal prevailing attitudes to suicide through qualitative research methods using theological reflection (Swinton, 2006). It is an important place for reflection when accompanying the bereaved by suicide with the many questions related to their loved one’s suicide and to a good God who has allowed such a terrible event in their lives.

Practical theology recognises God’s redemptive purposes in human experiences, and considers how a situation as devastating as suicide can be redeemed and how the Church can help that process.

Findings

The data was analysed in a three-phase process: preliminary exploratory analysis, open coding and development of themes (Ngunjiri, Hernandez & Chang, 2010). My personal journals were reviewed from the time of my bereavement to now and extracts were taken that were relevant to the themes and subthemes identified. I also relied on memories of my lived experience.

Five significant themes developed from the data, namely: the uniqueness of each bereavement situation; the importance of presence; mental health issues; the stigma and isolation of suicide including the fear of judgement and negative emotions such as shame, guilt and anger (see Table 1).

Identification of themes                                        Number of mentions

Table 1: Summary findings of themes                

The uniqueness of every bereavement

The three participants interviewed had unique grieving processes and circumstances. Eve lost her grandmother but had to cope with her mother’s extreme behaviours, unaware of the cause. Holly lost her son, which impacted her mental health profoundly and the communication between her and her husband. Leah lost her aunt who was ‘like a mother’ to her and attempted suicide due to this loss.

Holly, who was a new Christian at the time of her son’s suicide, did not feel the need to question God. As a person, she said she was ‘accepting’ of whatever came her way.

Negative emotions 

Grief, guilt, abandonment, anger, shame, rejection and the fear of judgement are the most common feelings experienced by suicide survivors, who differ from other bereaved individuals by the intensity of these feelings (Berardelli et al., 2020), which results in isolation and restraint about sharing with others how their loved one had died.

From a charismatic background, Eve discovered a family secret buried for fifty years and never spoken of because of shame and the fear of judgement from friends and family and, more specifically, from the church community her father pastored. She said, ‘the charismatic movement did not consider suicide as an option and was unempathetic and judgemental at the time’.

Leah, a non-Christian in her thirties at the time of her bereavement, felt suicide was outside her frame of reference. She did not know anyone who had experienced a suicide and was unsure whether she was allowed to talk about it or not. Her family were judgemental of her aunt’s death and avoided speaking about it. This caused a tremendous internal struggle for Leah, who later attempted suicide herself on several occasions.

Holly, also in her sixties at the time of her bereavement, from a Pentecostal church, stayed away from her church community as she felt she would be judged as a bad mother following the suicide of her son and that people would not understand. Holly’s son’s suicide affected her profoundly and traumatically. Initially, she could not leave the house and would close the curtains on the world. She survived through medication prescribed by the doctor in the first month following her bereavement. It allowed her ‘a peace in her head’ that kept her alive. Even today, eight years later, she still has times when she closes the curtains and stays in bed for a day or two, or however long it takes, before she can face the world again.

Guilt and shame are challenging emotions faced by the suicide bereaved that perpetuate and differentiate it from other tragic deaths. Jordan and McIntosh’s research showed that the public held the belief that the spouse bereaved by suicide had the opportunity to prevent their spouse’s suicide (Jordan & McIntosh, 2014). I continually wonder if I could have prevented my husband from taking his own life and feel a weight of responsibility that has not diminished with time.

In my journal, for the first time in fifteen years, I was able to acknowledge my feelings.

January 2018

I feel bewildered and totally confused. Shocked that my gentle husband would choose such an act of violence against himself. Shame for myself and my three sons that we have to endure the pain forever of such a horrible death of someone so loved and lovely, constantly sensing the judgment of others. Guilt that I did not prevent him from taking his own life.

Anxiety

Eve spoke of the life-changing effect suicide had on her mother who was 37 at the time of her mother’s suicide. Shame compelled her to keep it a secret resulting in extreme anxiety, where she could never be left alone.

Holly spoke of the physical ache, ‘an absolute ache in the pit of my stomach that just would not go’ and wondered ‘how can I live with this?’

Silence

Eve’s ‘family secret’ was kept for fifty years. Her sorrow, compounded with shame, led to Eve’s mother holding a secret that became unbearable and manifested in a complete breakdown in her mental health and ability to live a ‘normal’ life.

‘Unspeakable suffering leads to ‘mute suffering’ (Zylla, 2012:11). Suicide silences the bereaved. Zylla suggests this calls for a ‘theology of lament’ (2012:11), helping the bereaved to identify with the suffering in the Psalms and Lamentations and allowing them to acknowledge how painful their suffering is, which helps release the bereaved from that constricting silence caused by so many negative emotions.

Silent grief is not about inevitable sadness but about ‘unnecessarily painful, prolonged and unyielding grief that makes other joys in life impossible’ (Lukas, 2007:13).

Mental health

Another dominant theme was the effect the loved one’s suicide had on the participants’ mental health, resulting from the extreme emotions experienced. For the bereaved by suicide, the most basic of tasks can sometimes seem like an impossibility due to pathological grief, which is a grief that goes on without end (Weaver & Stone, 2005:10), leaving them unable to function at the most basic of levels. This was highlighted in the participants’ interviews. Eve’s mother ‘could not function even in the most basic of tasks’, Holly ‘buried herself away from the world’ under her duvet for days at a time and Leah became suicidal.

Eve’s mother’s mental health deteriorated so much that she could not function properly in the basics of life and lived with extreme anxiety until her death fifty years later. She moved in with Eve and her young family. Eve often wondered and prayed for her mother, never understanding the cause of her behaviour and extreme anxiety until the family secret was revealed fifty years later. Eve also suffered. She was 10 at the time of her grandmother’s suicide and had been close to her. She has no recollection of the time of her suicide, yet her younger brother remembers every detail. As a grandmother, Eve now recognises an inexplicable unconscious compulsion to make sure her own grandchildren would always remember her and is constantly concerned that they will forget her. Trauma prevented her from remembering details about her grandmother, whom she loved dearly. It made sense when she discovered how her grandmother had died and realised the effect on that 10-year-old child.

Leah felt close to her aunt who was ‘like a mother’ to her and was devastated by her death. She struggled with daily life and work, eventually having to take a long sabbatical. How the workplace deals with the bereaved by suicide is a subject worthy of research. Even more extreme, she went to the Forth Road Bridge, a popular place where the suicidal jump to their death, to take her own life. She was prevented from jumping by the bridge patrol. She repeatedly returned to the bridge, confused and distressed, and needed medication for many years to stabilise her.

The importance of presence

Wells argues that our way of embodying our faith is to look for ways to be ‘with God’ and ‘with one another’. He maintains that the word ‘with’ is the most important word in theology (Wells, 2015:9).

According to studies, suicide survivors value the help given by their religious communities (Vandecreek & Mottram 2009; Dransart, 2018; Cepuliene & Pucinskaite, 2021). The importance of the presence of pastors, Christians, friends and family to the suicide bereaved cannot be overemphasised. ‘Being with’ and practical help were instrumental in bringing hope and love to the participants. Holly and her husband were visited daily by Christian friends who listened without judgement and supported them with prayer and practical support in the initial months following the bereavement. They came every evening to ensure their safety and supervised their sleep medication.

‘I will never forget this as long as I live’, said Holly. ‘They were a lifesaver’ and ‘sent by God’. Being allowed to talk and explore her emotions and questions without judgement ‘saved her life’.

Pastors also played a significant role in allowing both Holly and Leah to explore their questions about suicide and the feelings they had. After her aunt’s suicide, Leah was anxious to find out whether God was ‘angry with someone for taking their own life’. She explored many theological questions over the months, slowly reaching conclusions about ‘who God was and how he viewed suicide’.

The presence of God

Tragedy can also be an invitation to live more deeply and experience God’s presence more profoundly. As well as the presence of pastors, Christian friends and family, God played a central part in each bereavement situation. God’s perceived presence experienced as ‘being with them’ and God’s thoughts about the actions of their loved ones were vital.

Leah, a non-Christian at the time of bereavement, felt a compulsion to find out what God thought about someone who took their own life. Unexpectedly, an Alpha course appeared on her Facebook page, so she attended and then went to a second course. She became a Christian and was baptised. She discovered that ‘God does not judge my aunt for taking her life the way people do’ and felt comforted by God.

Holly was a new Christian when her son died, and the support of Christians led her to want to go to church. She, too, did an Alpha course, and the pastor and his wife supported her ‘with great love and kindness’ that she will never forget. Her pastor, a friend of mine, connected us. She said contacting me ‘helped so much. Knowing someone else had gone through this terrible experience and was a big part of the healing process.’ Holly has a strong, deeply intimate relationship with God and says, she ‘learned so much about God through losing my boy’.

Eve, a mature Christian of many years, was shocked by the discovery that her grandmother had taken her own life, despite it being over fifty years ago. She felt the ‘presence of God and his compassion and love for my grandmother’ and has no doubt that God is ‘a God of mercy and love who knew every detail of my grandmother’s suffering, understands and has compassion for her’. She felt deeply angered at the church’s attitude and approach to suicide.

Stigmatisation

Though any sudden, unexpected, tragic death can be shocking, Pitman states that suicide has always been considered the most stigmatising, thought to arise from ‘social distaste and disapproval, blame and shame’ (Pitman et al., 2018:121).

Potter (2021:1) states that ‘The stigma of suicide can be lethal if not properly addressed.’ Increased social stigmatisation and isolation not found in the aftermath of accidental deaths or natural deaths is the reality for the bereaved and can manifest in encountering social avoidance, negative attitudes, gossip or even overt blame for the death (Wilkens, 2003).

All three participants avoided situations where they had to explain and give details, leading to further isolation. Many survivors lie about the cause of death of their loved one.

Ten years after her son’s suicide, Holly still buries herself away on days when she ‘can’t face the world’. She chooses to isolate herself because of the pain caused by a lack of understanding and people speaking carelessly.

Journal extracts

In autoethnographic research, in a sense, I am the fourth participant. Below are some extracts from my journals highlighting some of the tensions and questions resulting from my husband’s suicide that reinforce some of the research findings, including faith challenges, extreme pain and emotions, suicide contagion, meaning-making and the importance of the presence and will of God.

22 Jan 2004

It is now 22 days since we were torn apart. It feels like my heart and organs have all been ripped out. It feels like I have a head and body and no limbs. The pain is physical. It is so painful I feel I will stop breathing. My heart aches even more for the pain K must have experienced over the last few months. His secret agony. I was robbed of such a beautiful companion. Why Lord?

Isaiah 57: The righteous pass away, the godly often die before their time and no one seems to care or wonder. No one seems to know that God is protecting them from the evil to come. For the godly who die will rest in peace.

5 March 2004

Psalm 6:6 I am worn out from sobbing. My pillow is wet from weeping. My vision is blurred by grief.

How many more tears can fall, Lord? For eight weeks, I have wept myself to sleep and wake up weeping. I am standing on God’s word. This is the day the Lord has made. I will rejoice and be glad in it. I am looking for things to rejoice in, sunshine, birds, the sky. Creation is a comfort.

Making sense of a senseless suicide is extremely challenging. Five months after my husband’s suicide, I had many ‘why questions’ that tormented me, and I realised only God could change the direction of my thinking.

5 May 2004

Why did you allow it, Lord? Why do my sons have to suffer so much? Why did I go out that morning? Why K? Am I being punished? Lord, show me my sin. You intervene and stop so many suicides. Why suicide? Was there not another way? Lord, please save me from self-pity and unhealthy thinking. Please turn my sorrow into compassion for the lost, the sick and the broken-hearted.

31 Oct 2004

All my earthly dreams and ambitions have died with ‘K’. My only purpose and desire now is to live for God.

4 December 2005

It’s almost two years now and it’s only by God’s grace and mercy that my sons and I have come this far. The pain is still overwhelming. It consumes and chokes me and weighs heavily on my heart.

The wonderful thing is that you (K) loved so much and were loved so much that we don’t feel angry with you. I just feel the pain of the agony you went through.

24 August 2010

Lord, I dreamt last night that K rejected me. I guess he did by ‘choosing’ to take his own life. I can’t believe after seven years, the depth of my grief, that I can still be wracked with grief and pain even now. He was stolen from me. How I miss him. Thank you that the dream made me realise how I truly feel and that I do feel rejection but didn’t want to admit it.

Thank you, Lord, for bringing me this far. Please don’t let his death be pointless. Use my experiences to help others.

1 January 2011

A new year. 7 years on. Thank you that Hogmanay is over. I can breathe again. A great sigh of relief. It breaks my heart, again and again, to think of the pain my sons have and what K endured secretly. What a waste of a beautiful life with devastating consequences.

18 February 2012

Lord, I come to you. I don’t know why this pain and sorrow remain and keep rising to the surface again and again. Please give me beauty for ashes. I give you my sorrow, my tears, the flashbacks, the pain of feeling K’s pain. He will now know why he was suffering so much. ‘The righteous die young to save them from further sorrow’. There is consolation somewhere in that.

31 December 2013

Lord, I only want your vision for my life.

It does me no good to focus on those traumatic moments again. Trauma has such power, but the Lord has strengthened me, comforted me, and kept me moving forward. He is teaching me about trauma and how I don’t have to keep slipping back into it.

8 November 2016

Why am I still mourning my husband? It is so painful to keep weeping like this. Do I have some sort of prolonged grief? No one would understand after such a long time. I don’t, either.

31 December 2016 – 13^th anniversary of K’s death

I can’t go there today. It’s still too painful. There must be something wrong with me. Too much pain in looking back. I just want to move on. Lord, please show me how to do that.

During this research, while immersed in my studies, I wrote in my journal:

17 March 2022

I woke suddenly at 4am with the powerful compelling thought in my mind that I should take my own life.

This was disconcerting and frightening, as in the years since my husband’s death, I have never had suicidal thoughts. I did have an indifference to living, which is quite different.

As well as participant care and support, self-care in this research project was critical. It is known that personal emotions, judgements and experiences can affect the researcher through autoethnographic research and can trigger the researcher’s trauma (Raab, 2013). Initially, I was naive about how intensely the research would affect me. I soon realised the importance of organising my study in a way that allowed time for other distractions and regular meetings with my prayer support team and fortnightly with a friend who is an experienced counsellor of twenty years and a counselling supervisor. I also met monthly with my spiritual director.

Discussion and analysis

Returning to my original research question on how the local church can effectively support and help the spiritual formation of those bereaved by suicide in their congregation, the consensual view that suicide bereavement results in complex grief and psychological, emotional, social and spiritual challenges seemed reinforced through the three interviews. The results indicated the devastating and life-changing effects following the loss of a loved one to suicide. The resulting intense negative emotions, life-long reflections of guilt and shame, and negative behaviours were also highlighted.

Pastoral

Pastorally supporting those bereaved by suicide is complex and requires insight into the psychological pain they experience. The experience of all three participants was such that they felt helped and comforted by the presence of Christian friends who were prepared to listen and not offer any solutions or platitudes, praying with them and caring for them holistically without trying to fix anything. The data showed that clergy played a major role in supporting the suicide bereaved. Feeling understood and not judged, blamed or criticised was highly important.

Spiritual

The spiritual aspect of bereavement was crucial in each case and discovering God’s perspective on their loved one’s way of dying was critical to their ‘recovery’. Having a safe space to explore their grief and the implications for their faith without judgement resulted in spiritual growth rather than decline.

Each participant discovered for themself that God is a God of compassion who does not judge those who take their own lives in this way. Leah sought God as a non-Christian and discovered ‘a God of kindness and compassion’ who cared about her aunt and her state of mind and ‘was not angry and judgemental’. Holly took great comfort in the presence of ‘the God of all comfort’ who loved her son even more than she did. Eve also found comfort and reassurance, knowing ‘God did not judge my her grandmother as the church did’.

The question ‘why?’

One of the most significant challenges and struggles for those bereaved by suicide is the question, ‘why?’. The participants interviewed were shocked by the lack of signs before their loved one’s death and saw no signs of any mental health issues or inner struggle in their loved ones before they took their own lives. Holly had a happy family meal with laughter and fun the night before her son’s suicide, with no indication of his private suffering. Leah’s aunt, a successful local journalist who was well-liked and respected in her community, had been grieving the loss of her husband a few months earlier but showed no signs of the depths of her grief. Eve remembers her grandmother’s home as happy, a place where she loved to spend time as a child. The hidden pain a loved one is experiencing adds to the shock and trauma of their suicide and the ongoing agony that they suffered so much without it being known.

Is suicide bereavement different?

Understanding this question is critical if we are to support the bereaved effectively. Jordan suggests that suicide survivors are differentiated by self-perceived intentionality and self-perceived responsibility (Jordan, 2020).

The intensity of emotions is another differentiating factor. The bereaved often experience anxiety, depression and ‘complicated grief’ (CG), struggle with guilt, self-blame, hopelessness, post-traumatic stress disorder (PTSD), and are at greater risk of suicide (Jordan & McIntosh, 2014; Tal et al., 2012).

The ‘not knowing why’ adds to the deep emotional pain and is one of the elements that arguably separates it from other tragic bereavements, and the question compounds guilt. It causes continual reflection about what else you could have done and whether you missed crucial signs or whether it was your fault.

Helping churches understand the many issues the bereaved deal with, the ongoing internal struggles and the journey of exploring difficult theological questions can often determine whether someone flourishes in their spiritual formation or flounders.

Beyond surviving: Post-traumatic growth

Post-traumatic growth is defined as ‘positive psychological change experienced as the direct result of the struggle with highly challenging circumstances’ (Hone, 2017:205). One of the profound psychological results of traumatic events like suicide can be post-traumatic growth which includes a deeper appreciation of life and spiritual change resulting from a highly challenging, high-stress situation (Levi-Belz, 2017).

Spiritual growth and transformation are possible even in devastating circumstances (Payne & Field, 2004). The biblical idea of ‘persistence of hope in the face of unspeakable suffering’ and the movement from ‘mutism to lament’, from ‘loneliness to community’ and from ‘indifference to compassion’ (Zylla, 2012:11,14), could be lifegiving to those bereaved by suicide.

Conclusion

Despite millions bereaved by suicide each year, there remains a lack of research evidence regarding the most effective way to support those facing such bereavement. There is no vaccine against suicide and it can affect your life at any moment. It is indiscriminate of social class, race and background and can strike in the most unexpected of families. No one is immune (O’Connor, 2021:37).

Benore and Park (2004) observed that most bereavement research ignores the role of religious belief, including the roles attributed to God (Vandecreek & Mottram, 2011). For the participants involved, exploring difficult theological questions without judgement and seeking God’s presence were critical. For the local church to support the suicide bereaved, reflecting on the theology of suicide is vital to combatting stigma and providing care (Potter, 2021).

Coming to terms with a traumatic event like the suicide of a loved one is highly challenging physically, emotionally and intellectually, demanding a new narrative to make sense of life. Religion appears to facilitate positive outcomes as it relates to ‘meaning-making’ (Brown, 2022).

O’Connor (2021:44) states that ‘suicides are an awful indictment on society’. We live in a world where we are deemed failures if we do not conform to the standard set by society. As a result, many individuals do not think they are valued or valuable. It appears to be ‘a societal disorder in a toxic world’ that makes it difficult for sensitive, caring people to remain here (O’Connor,2021).

Ministers and pastoral caregivers have ‘the sacred task of entering into the suffering of others’. This is demanding, especially in tragic bereavement situations like suicide, but possible with an understanding of the challenges faced by the suicide bereaved and a ‘more fully developed framework of pastoral theology and the theology of suffering’ (Zylla, 2012:167).

As we navigate life post-pandemic and face the challenges of the high cost of living, there is a potential for an increase in suicides; the local church has an opportunity to provide pastoral and spiritual support to those in their congregation bereaved by suicide.

Through deep reflection on the issues surrounding suicide, and education and training (Zylla, 2012; Cepuliene & Pucinskaite, 2021), the local church could positively impact the spiritual formation of those suicide bereaved in their congregation. Through presence and sensitivity, active listening and practical support, the church could restore the fragile hope of those afflicted by suicide, encouraging spiritual growth and offering postvention support to those who might otherwise lose faith or, more significantly, take their own life.

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About the author

Angela Thomson MA Spiritual Formation, EMCC Practitioner, BA Stirling University, PGCE (Secondary) Moray House

Angela lives near Edinburgh and has worked as a community pastor in an urban priority area for the last fifteen years. She supports and supervises others in leadership roles, is involved in spiritual direction, coaching and mentoring and supports those bereaved by suicide through different charities. She has just completed her MA in Spiritual Formation at Waverley Abbey College. This article is drawn from her final research project dissertation.

She can be contacted at athomson2012@hotmail.co.uk

Copyright

Copyright 2023 Angela Thomson

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https://doi.org/10.52456/WACJO326

Context

The following transcript is an edit of a dialogue[1] about race that took place between Ellen Yun (EY), a Chinese British psychotherapist, and Janet Penny (JP), a White[2] British counselling psychologist. It grew out of their conversations about race over a period of more than three years, particularly in the context of Christian counselling. It represents a snapshot of their current reflections on the past and aspirations for the future concerning race. Undoubtedly, the conversation will continue to develop.

Interview

EY: How do you feel about making some space to talk about race? What do you notice about yourself?

JP: There’s a curiosity for learning something about myself, about race and expanding awareness. Because we know each other, it feels like a safe space to gently explore the issue of race and have quite an open conversation. What about you?

EY: Over time, I’ve had other conversations around this. There’s been a shift in me because historically I haven’t had safe spaces to just be myself. I’m increasingly recognising it wasn’t always safe to be me in very typically British evangelical White spaces. I hid anything that would make me stand out, but that was equally so within Chinese spaces, because the two cultures can appear to be similar, but for very different reasons; both have ‘stiff upper lip’, ‘hide yourself’, ‘hide any kind of vulnerability’ within their cultures.

I’ve been on an ongoing healing journey from the various traumas I’ve experienced and safety within relationships is one of the areas I have explored as part of that. This conversation with you feels safe enough for me because we have spent enough time together over the years. I feel safe enough to go towards the conversation, knowing that you won’t minimise or gaslight my experience. It is really important that you’re willing to stay with any discomfort, and stay with humility. There’s never been the general space to broach this topic in my academic career, so it’s meant that I’ve never really been able to name the oppression that I’ve felt, let alone articulate it. But today I’m excited. I feel like there’s a shift because you’re willing to engage and make space for this dialogue.

JP: That feels encouraging. I wonder too if it’s no accident that at the start of a conversation on race, the word ‘safety’ feels important. And hearing what you’ve said about difficult experiences and those experiences of oppression, to start having conversations like this feels like quite a big risk.

EY: It is. Safety is very different for the both of us, and I know that the risks for me speaking out means potential ostracism and being cut off in terms of opportunities in White British spaces. But also, as a Chinese person, if I speak out, it could mean ostracism from my culture as well. The two cultures, British and Chinese, are very similar in terms of emotion suppression and I’ve witnessed this in some pockets of the UK’s responses to uncomfortable topics. It feels like it’s part of the identity of British values and society to not talk about things so they will ‘go away’, which has been very similar for me within my lived experience of Chinese culture. For me it’s like a double dose of silencing because I’m really aware I have a Chinese identity and a British identity, but both of them include high levels of emotional suppression and censorship. And both are rooted in trauma for very different reasons.

For example, British culture has a lot of colonial baggage, and the reverberating damage this has caused. I can imagine the stiff upper lip being one response to that: ‘We’ve got to keep calm and carry on because if we face what we’ve done to the world; it would be awful.’

For the Chinese, we’ve had the history of opulence, survival and of land being colonised. There’s been domination of different lands, and all the different wars between lands. But also, Chinese people have often had to flee for refuge, and it’s still happening – some Hong Kongers are fleeing for survival. It might not be perceived that way, but I’m offering an intergenerational lens of how my people have a history of needing to flee and of displacement. In survival you can’t feel because if you feel you’ll die.

JP: There’s some resonance there between the two cultures, but behind each are very different stories. And I think you’re quite right that as we’re talking about race, we’re sometimes talking about trauma. Your phrase really hit me, ‘if I feel I die’, and I think, for you, that’s been much more experiential.

EY: In the last few years I’ve had the opportunity to remove myself from the predominantly White and predominantly Chinese spaces that I was involved in. I’ve had the time and space to process some of the various traumas I’ve experienced in both spaces and have increased space to breathe and feel. It’s been a whole season of deconstruction and reconstruction of who I am.

I remember talking to you after I’d left a predominantly Chinese diaspora church, and you commented that that I’m going to be in a liminal space. That stayed with me because just to have someone name it was really important.

Deconstruction has been deeply excruciating at times, and yet, it’s been the most life-changing, transformational process. I’ve needed this process of deconstruction because I’ve been suffocated by people and systems. It has been so unconsciously oppressive that I did not have the space to question, ‘What do I believe?’

Stepping away from a predominantly Chinese church and also from my teaching role at Waverley gave me breathing space to consider, ‘Who am I? What is “this” that I have been involved with? Who am I without both areas in my life? What am I doing? Had I unconsciously been living out a part of me that had internalised racism and also perpetuated the cycle of tokenism? What dynamics had been occurring unconsciously within and between both systems and communities that I had been a part of so long?’ It’s been a deep questioning of my whole identity and it’s been a change to now be naming things. There has been a cost to ‘deconstructing’, but the liberation and continued healing has been life changing. The fact that I’m able to have this conversation with you is testament to that – I definitely wouldn’t have done it five years ago, or even a year ago.

JP: I think I’m really struck by the risk that this is for you, and that it is a different kind of risk for me.

EY: And that’s really important to name.

Equity is one of my core values because I have not experienced much equity in my life. For example, for someone like yourself with your intersectional identities, you have the privilege to pick and choose whether you engage with issues around race. I don’t have the same privilege with the marginalised identities I have. These issues of injustice, inequity and oppression are what I have to contend with daily. I’m using a lot of my energy just to survive in the inequitable and unjust systems that we live in.

JP: I’m aware that other people’s lives can be so saturated with experiences of racism –big and small – that I have not had to face. There’s a level of emotional, physical and spiritual labour that I just don’t have to do. It’s important to articulate that we’re starting the conversation from different places.

EY: Understanding intersectionality has been transformational. I have a lot more marginalised identities than you have, so, from the start, I face more oppression than you and exert labour in ways you don’t have to.

In the UK we have a class system, and it’s important to name that. We can hold privilege with class, status, wealth, education, gender, etc, but if people don’t see where they hold privilege compared to others, and if you’ve never experienced being marginalised, you won’t know what that experience is like.

I know the personal cost of what it is to speak out against oppressive systems. In my experience with the marginalised identities I hold, the Christian counselling world has been oppressive with its Eurocentric focus, as has the White British evangelical world in this country. If I speak out, at best I would be ignored and invalidated, or, at worst, I would lose opportunities, be shunned or exiled for having the audacity to speak up about the oppression I’ve experienced in these spaces. We have to look at history to see how and where this oppression has occurred and how it still continues to impact our marginalised communities today. The fact is, Jesus was not White. But how many of us in this country are consciously aware that Jesus was not White?

JP: Yes.

EY: Some of my formation as a Christian has been through the lens of individualistic Christianity, through books and resources that have been available, which for me have mainly been White and Western-centric. But the Bible includes a collectivist culture; we see this through how they were living, through their actions. If you really loved your neighbours as yourself, what does it mean to love and look after others in community?

The collectivism that I have experienced through my Chinese heritage gives me a glimpse of the beauty of what loving our neighbour could be like in community, but my personal experience has also shown me how, for example, nefarious nepotism can operate when communities have experienced collective trauma that remains burdened and unhealed. Both individualism and collectivism that have been impacted by trauma can have challenges. But when healed from the impact of trauma we can welcome our individual identities; we can be ourselves and we can also love the collective as ourselves. But that seems to be lost in the polarity of choosing one emphasis of culture over the other.

JP: Yes, we do inescapably perceive faith, Scripture and theology through the lens of our own embeddedness within a particular culture and point in history. For me, on the one hand, I want to say that there is an inevitability to that; we are creaturely, we ‘come in skin’; we dwell in one time and space. But on the other hand, I can be committed to reflecting on how that embeddedness is shaping my experience and my faith; how I relate to other people and how I relate to people that come from different contexts.

We hold the Christian theological idea of what ‘one in Christ’ is, that is, ‘neither Jew nor Gentile… nor is there male or female, for you are all one in Christ Jesus’ (Galatians 3:28: NIVUK), while recognising there are social realities. The apostle Paul talked about the social realities of being a husband, a wife, a slave, a master, a child, a parent. Those social realities were not ignored and there were relational ethics that addressed those.

EY: That’s true. I wonder how much of the deeper internal exploratory work have we done as Christians or as therapists? What does it really mean to see you as ‘one in Christ’, and where are the areas where I don’t treat you as one in Christ?

If you’ve never shared ongoing relational space with a Muslim person for example, how would you know how you would interact with them or love them? You never get a chance to be challenged on how you are in relation to someone else.

One of the narratives I’ve experienced in British culture has been, ‘We don’t talk about race or racism because it would make everyone feel uncomfortable; it’s not “nice.”’

JP: Yes, it can become avoidance. I think one of your questions [in preparation for the interview] was about the discomfort or otherwise of talking about race, and I think avoidance keeps the comfort levels manageable. But the massive cost is that one doesn’t actually explore the issues nor do the work of asking: ‘What does it mean to me to be White?’, for example.

From a Christian perspective, how am I really valuing another person as an equal in Christ? Have I ever reflected on my own racial identity so that I can feel a degree of security that allows me to then be open to other people? Or that enables me to have basic empathy and curiosity about somebody else’s experience?

EY: Yes! That’s why it’s important to have this conversation, especially as professional counsellors because we’re working with so many different people – and not just about race, but any other identity that is different to ours.

Whoever comes in [the counselling room], even a Christian, you can’t assume that you’ve got a similar experience. But in looking at yourself in relation to that person and knowing what your story and identities are, you can acknowledge and name those within the therapeutic relationship. Being aware that someone who is Black, or a person of colour, will experience racism, means it can be acknowledged that it is a specific oppression that not everyone has experienced, rather than gaslight or minimise that person’s experience. And it can be helpful to know that you as a White person also represent something for them.

But if the counsellor hasn’t done their own internal work of reflecting on what their identities and privilege are, then they might perpetuate something oppressive. They might be tempted to simply reframe the client’s experience as something else, e.g., as intra-psychic, but those experiences of racism cannot be reframed, and harm could be done again by trying to reframe racial experiences.

JP: Yes, and there is the potential for re-enactment of trauma. I think trauma is the right word here. The minimising of racial trauma or reframing it as something else perpetuates a cycle of trauma.

Going back to what you said about counselling being oppressive, I am aware that I am struggling to say counselling is racist.

EY: What comes up for you?

JP: I think I’m reluctant to make those kinds of blanket statements because there is nuance. However, there is definitely something built into the history of counselling that is biased. It is quite Eurocentric, and, historically, it has been developed from a Western, White, male perspective. One of the sticking points that has really challenged me is the intrapsychic focus in counselling and how that relates to issue of race. For example, it’s not ethical to label experiences of racism as a purely intrapsychic issue in need of reframing, or concerned with their inner defences. There are social realities, and it can be hard to grasp that if you have not experienced racism yourself.

To respond to a client who has experienced racism by saying they need to think more positively feels – I want to say – abusive, actually. It is racism in itself and racism is abuse.

EY: Take time to sit with that, ‘racism is abuse’.

JP: Yes absolutely.

EY: It is abusive. Slavery was highly abusive; people were stripped of their names, their identities, their families. They took on their slave masters’ names. This racism still exists now, and people are still being abused now. In the last week or so a Black school girl was being physically beaten. White people stood back. How can we not say this is abusive? What does that actually say? Black lives don’t matter? If you think about it, it’s like saying White people are more important.

Let’s switch it the other way and say one White person with a gang of Black people –- well, not gang… even my language there… I’ve just caught myself with my language of – ‘a gang of Black people’. That’s how I’ve been subconsciously conditioned about Black people by the media and other anti-Black narratives. So, I’ve got to own that. But imagine it was a group of people of colour doing that to a White child. Can you imagine? It wouldn’t be dealt with in the same way; it would be demonised.

JP: it is abusive, and issues of power are involved.

EY: I understand that there’s nuance in saying that counselling is racist and you don’t want a blanket statement. Parts of me feel reluctant to say that too, but then other parts are also saying, actually, it is institutionally racist because of the material that has historically been taught. What has been taught is very Eurocentric. The counselling literature we’re reading is all mainly by White males. How many resources do we cite by people of colour?

This impacts students from other cultures. Does the literature really resonate with them or not? Do they see themselves in the literature or not? We’re presenting a very Westernised family dynamic that doesn’t represent how their culture is and it doesn’t honour a different perspective. There’s no humility towards another culture.

As a Chinese person, from a collectivist culture, the focus is more about other people with an intrinsic hierarchical structure within relationships, with implicit expectations about social norms about how one sees themselves and how one sees oneself in relation to others. The collective is often always elevated above the needs of the individual. That will always enter into the counselling room but it is not seen or acknowledged within the Eurocentric framework of counselling. With collectivist cultures the focus is definitely more on other people so more time may be needed to help the person separate which are their thoughts and which are the thoughts of others within their community.

JP: Yes. And you made the point about naming it for yourself, doing that internal work – that feels important.

EY: Yes, I think so.

In the last few years, I have intentionally trained in the Internal Family Systems (IFS) model of therapy (e.g., Schwartz & Sweezy, 2019) as it is the approach that has most resonated with me. It is a model that has reconciled all these different parts of me; my Chinese, British and Christian identity, and everything in between. I think that model in itself helps us to welcome all parts of ourselves, even the ones that we want to exile off – including the uncomfortable ones.

Perhaps some of those parts have been affected by trauma, or we could say sin. Those parts have good intentions, but they’ve been burdened with a role of carrying trauma that doesn’t belong to them. Once they’re unburdened, they can fully flourish in what God has always had for them once they’ve been redeemed and restored.

What if the internal part that adopts stoicism and having a ‘stiff upper lip’ is in fact a trauma response and what if it could be redeemed and transformed? What would it want to do instead with all that energy it uses to keep such a stiff upper lip? It really depends on the own individual person’s personality, but if collective stoicism could be redeemed, what would It look like? Maybe it would release compassion, feeling for oneself and for others.

However, until we really do that deeper work, sitting with that discomfort, we won’t get to know our parts and offer them transformation.

The more trauma you’ve had, the harder it is to feel safe. We could think of stoicism as a protective part with trauma underneath. But, in IFS terms, the more we gently move towards the stoicism and get to know it, the more it might relax and in time give space for the trauma it is protecting underneath to be heard. Ultimately it is about that redemption of the trauma, redemption of sin. But that takes a lot of time, and it takes safety, compassion and grace.

Maybe you’ve experienced this increased space and relaxing between us as we’ve been meeting?

JP: Yes, it takes time. Timing in and of itself won’t necessarily do the healing, but things like listening, empathy, being open to ourselves, being open to others does take time. I love the IFS approach because of its empathy of understanding, and the idea that most people are just trying to do their best; we can understand people’s protective impulses in that light. This kind of approach allows me to look in and to lift the lid on dark corners where my thinking can be biased, where I make assumptions or say something that could hurt another person. It allows me to sit with that and work that through.

I think for me what’s important is that commitment to staying on the reflexive journey. Some of the IFS principles allow me to mindfully and compassionately explore and understand what is going on for me as I talk about this topic of racism.

EY: Yes, IFS allows you that refreshing perspective of saying these things that you’re thinking or exploring the racism that you have experienced in different parts of self.

Also, IFS looks through the lens of intergenerational trauma and legacy, looking at how much of that belongs to you and how much of that belongs to your family system. It provides a way to say, for example, ‘Actually 50% of it belongs to the British culture that I’ve absorbed. And 50% of it belongs to my direct experience.’ Before, I would have felt very guilty about having unconscious racist beliefs. But now I can update my parts and say 50% of my racist beliefs belong to what I have absorbed externally. When that 50% has been released, through the way that IFS does by unburdening and bringing healing and redemption, then I’m left with the other 50% of things I need to work through – the way that I might still be racist in my thoughts, words or actions and bring conscious intentionality to unlearn, update, heal and transform my relationship with myself and with others. This approach offers a very different way of healing that I’ve not experienced with any other model.

JP: It is interesting to hear you talk about IFS in relation to race and cultural identity.

For me, it’s a lovely antidote to what can potentially happen as we talk about race. That is, there is the potential to get drawn into the drama triangle (Karpman, 1968), into those psychic or emotional positions of victim, rescuer and perpetrator. But even as we talk about the drama triangle, we have to make the distinction between the psychic/inner positions of victim etc. and the actual experience of being a victim because, of course, within people’s experience, they have literally been a victim.

But when talking about race, rather than getting defensively drawn into the drama triangle positions I can pause and ask: ‘What is my experience? How am I perceiving the world? How am I relating to others? What am I highlighting, augmenting and what am I silencing and not being attentive to?’ These questions help me step out of the unhelpful positions in the drama triangle; to step out of the potential of trying to rescue someone or play the victim myself as any racism in me is challenged. But also, to step out of polarisation and the potential re-enactment of abuse. I think globally we’re seeing the polarisation of views increasingly. Globally we’ve been under stress and under stress cognitive narrowing occurs, which is where you lose the nuanced viewpoints. Thinking then reduces to fight, flight or freeze, literally and metaphorically.

EY: It is polarised, and everyone is essentially trying to protect themselves because they do not want to get hurt or feel shame. Shame is such a powerful emotion – no one wants to feel shame. But when shame is felt, then protective strategies are activated.

The challenge is to step back from hurt and defensiveness to offer love and compassion. We have become so disconnected from each other; how do we start coming back together again? If people were able to really listen and create enough safe space to talk, clarity and healing could come.

JP: Shame is so potent, yes. That’s the knee-jerk response sometimes. Responding to what you’ve said, allowing myself as a White person to ask, ‘How can I be reflective about any of my own tendency towards racism?’, keeps commitment to that reflexivity. It can help to give room to that without then feeling a kind of false sense of personal shame.

But again, it brings us back to the issue of safety. Safety enables people with different experiences to say what was wrong, what is trauma and allow that to be heard. We can start by getting out of what in game theory is called a zero-sum game (e.g., Colman, 2008), that is, the idea that if I’m winning, you can’t win and if you win, I can’t win. I just don’t think God is like that. We can hear each other without feeling threatened that we will lose.

EY: What is important is being able to listen to one another and for people to be able to say, ‘This has been hard for me.’

It might activate other people’s guilt or shame, but if someone is able to make space for that shame knowing that they do not have to respond from it, while they can acknowledge the shame if it is there, it doesn’t need to overtake them.

It takes a lot of internal work first. You’ve got to welcome your own shame and guilt and then step back, really hear the story and be with that person and acknowledge what they have experienced. Reparations and restitutions will come later, but it is important to acknowledge and give space to what people have experienced, listen, have your own spaces to process what is evoked and not burden the person of colour.

JP: Yes.

Part of me is wondering if there is anything that we have not yet found the courage to say at this point in our dialogue, and wondering how it is landing with us?

EY: It is a big risk to dialogue about race for someone like me with marginalised identities, whether the risk is real or not – I can see one of my parts wants to help by minimising the risk – but I know there is a massive risk for me in speaking out. I don’t know if you feel like that in any way, but for me, the risk of speaking out is I could lose opportunities. I won’t be seen in the same way anymore.

Historically, labels of ‘troublemaker’ have been used for people speaking out. And in my experience, Chinese people often get missed; we’re not seen as in need as others, but we do have needs. We’ve been an invisible community in the UK. If we look at the Afghans, Ukrainians and Hong Kong people who in the past few years have been seeking refuge in the UK for different reasons, they’ve all experienced different traumas. But because the Hong Kong people are perceived to be ‘fine’ and have financial privilege, they get overlooked. They’re not eligible for most benefits, but they’re experiencing trauma. They will also need the help of the mental health system. The British system is limited because they are oversubscribed, but also the cultural sensitivity is lacking to work with this community as not enough attention has been given to them to understand their needs, let alone the Chinese communities that have been here for a few generations that have been overlooked.

JP: It feels like what you’re saying is that there’s a way of perceiving that is a kind of pecking order for who’s suffering the most, which can result in genuine suffering, trauma, racism or abuses or issues, whether it be physically or otherwise, not being attended to.

EY: Yes. And in my lived experience, there are massive issues within the counselling field and I realise I’m a part of that too, but for different reasons.

I would love to see an overhaul of how we train people, so that counselling can train people in a way that is inclusive. It needs to be equitable because my current reflection is that it hasn’t been. It hasn’t been intentional, but a lot of my identities were not welcome so there was no freedom to express and integrate my whole self.

Certain parts of my identity and culture that were obviously different were not explicitly acknowledged to me or others; it was as if talking about differences was a no-go area. In my time at Waverley, I do not recall any literature that mentioned Chinese people, let alone centred them. And being at Waverley as a college, the first thing I used to do when I entered the space was always check who was in the room – it so unconscious. Am I the only person of colour in the room, are there any other East Asians in the room? I then do the mental gymnastics of how I think I need to be in that space in order to fit in. All that is going on and I realise I have unconsciously expended a lot of energy navigating the environment to survive and keep myself as safe as I can because I didn’t know how safe it would be.

JP: That’s another kind of concrete outworking that tells me about the emotional labour you have to do on so many levels that I do not as White person and that’s probably repeated in many, many ways throughout the days and weeks and months.

EY: Exactly. It is exhausting. I now realise why I’ve had periods of anxiety and overwhelm, because it has been too much. My baseline for operating in this world is very different to someone like yourself.

JP: There is so much that I have not had to process. It can leave me with a sense of ‘What can I do?’ ‘How can I help?’ Some of that might tip into rescue mode, but also a part of that brings me back to the value of really hearing people’s lived experience and simply allowing space for that.

EY: What we are saying now is similar to what I’ve written before in an article, but racism is a ‘we’ issue. For so long from what I’ve heard in organisations, whenever the topic of racism comes out, it is always the people of colour that talk about it and the White people have nothing to say; they feel as if it doesn’t affect them so they sit back. But racism is a ‘we’ issue. And none of us are exempt from it. We are all part of the issue and so we will need to do our part.

You cannot choose to be not racist; you have got to be anti-racist. We are in a racist system; we cannot escape it. You can be in denial about it, but then that is being complicit. And if you don’t think racism is real or relevant then is there an unethical element to your [counselling] work, because you’re negating the experience of the clients in front of you?

That goes back to how we need to train our counsellors differently. In my experience IFS has really helped to facilitate that compassionate space to really look at one’s shadow sides. We need to do the internal work as counsellors because there is the risk of perpetuating harm and trauma.

A part of me says, ‘Who do you think you are trying to do this in academic contexts?’ Being Chinese, I’m such a minority within the Christian counselling field. There’s definitely not many that look like me in Christian counselling spaces and there’s not many that are like me in the Chinese Christian spaces. So, I’m not going to be heard. But I’m at a point where if I have space to talk, then I’ll talk.

I would like East Asian counsellors and anyone that identifies with a shame honour culture for them to know that you [JP] were my lecturer way back in 2004 when I started at Waverley and then you were my supervisor for my dissertation during my MA. The fact that we can now speak as peers, inhabiting a space that is more equitable, it is very strange. This would not be heard of within a Chinese context. People would ask, ‘How dare you question your elder? Who do you think you are?’ ‘Who do I think I am to do this? Who do I think I am to take up space with someone who used to teach me, the audacity.’ The cultural narratives are strong. Equity with someone ‘superior’ is not heard of. But here I am… because we are both committed to doing our own internal work about these issues.

JP: That is so powerful to hear. I am aware that my own impulse, because of my own history, is to resist perceiving myself as that elder figure image. And from a Christian perspective I am not that figure. But if I did that, that would negate your experience and your culture. I can hear for you this is important. There is the social reality of our history and our cultural realities. My temptation would be to psychologise it or pathologise it, and minimise it, rather than actually understand that is the process that you have gone through.

EY: It is huge. There is the shame, the backlash of ‘I’m a rebel, I’m insubordinate, I don’t know my place’ would come. In Chinese culture, it is unheard of that you would think you could have equality and equity with a ‘superior’. So, this is a weird experience but also liberating and a free place. But there will be parts of me that will be thinking, ‘What does she think of me?’, because there is always that constant inner dialogue. But it is not as loud as it used to be.

JP: The danger is I could slip into an intrapsychic perspective on this experience. But to pause to really receive that that has been your experience, that this is a big deal in a way for you that it is not the same for me, is important.

EY: Thank you for acknowledging and validating the differences between us.

For me, what is important, is the acknowledgement of the impact of racism between us, and the fact that you have been my ‘superior’ and now I’m experiencing a different relationship that is more open, genuine and authentic with someone who used to teach me. And now to know that I have my own expertise that you don’t have is strange, but also beautiful. It is a redeeming relational experience for me.

JP: As I reflect on what the conversation has been like today, it does feel like such a gift that you have given me – to be open to talk about this. And I’m hoping this will be a gift beyond us.

EY: Thank you. It highlights the importance of our ongoing conversations. It takes both of us because racism is a ‘we’ issue. There needs to be enough space of safety for both of us to enter into the dialogue. And you are not doing it for a performative reason; you are doing it to see genuine change. I am not interested in tick box exercises or performative action. I am interested in genuine transformation. This is where the IFS really comes into its own. What conditions do we need to foster and allow for so that we would both enter and transform each other, to have transforming and redemptive conversations? From my experience, I can say in the years we’ve been doing this, I feel like there have been unhurried, genuine, consistent, redeeming, ongoing, sanctifying conversations. These conversations could continue for our whole lifetime; it’s not a one-time only quick fix and we can bring about awareness to the counselling profession.

I have seen you experience these thoughts and feelings and have courage and confidence to move towards them for the both of us and for the greater good. In turn, my parts that have been on survival mode have been able to increasingly relax at finally being seen, heard by you and also experiencing your commitment to make a difference, together. So, it has been a journey and a joy to embody this experience together, thank you.

Personal reflections

Ellen Yun

Being able to have this conversation at this point in time highlights for me that I have navigated enough of my personal history with regards to keeping silent and not speaking up to have the courage and confidence to use my voice and state my opinion. At the same time, when Janet and I initially started dialoguing after George Floyd was murdered, I experienced her willingness and curiosity towards exploring racism and its impact personally and on Christian counselling. This gave me space to practice using my voice. As we’ve continued to dialogue, I have witnessed and experienced Janet genuinely desiring to be anti-racist and do her own internal work. Experiencing this within relationship with Janet created enough safety needed between us to continue to move towards uncomfortable conversations and into the unknown for ongoing transformation.

The words in this conversation are not enough to show the depth of internal work that is involved, because that comes through experiencing the ongoing journey of it. But my hope is that readers would accept the invitation to having curious, uncomfortable conversations about racism for authentic and genuine personal and collective healing, redemption, liberation and transformation.

Janet Penny

What drew me into the conversation about race arose from at least two experiences. Firstly, my relationship with Ellen, over many years now, has moved through a number of changes, initially from student and tutor to eventually colleagues and peers. Over that time, we have dipped into conversations about race. As is evident in our dialogue, I have not always appreciated the impact of this shift in relationship for Ellen, owing to my negation of her cultural context in this respect. But our conversation on race has remained alive and impacted us both.

Also, in parallel, some of my own doctoral research on power dynamics in Christian counselling forced me to reflect on what it meant for me to be White, and Christian. As Ryde points out, ‘White people tend not to consider themselves as having a race’ (2009; p. 33). My own experience resonates with this; being White has been wrongly thought of as neutral, which is a position that impedes any genuine dialogue about race. Also, with a focus on power dynamics within Christian contexts, I have questioned how we can know and experience the theological truth of being one in Christ, while also being wise and redemptive about our social realities that shape our relating. Undoubtedly, these are some of the questions and issues I will continue to reflect on.

References

Colman, A. M. (2008) Dictionary of Psychology, (3^rd edn) Oxford: Oxford University Press.

Karpman, S. (1968) Fairy tales and script drama analysis, Transactional Analysis Bulletin, 7 (26), pp. 39-43.

Schwartz ,R. C. & Sweezy, M. (2019) Internal Family System., (2^nd edn) New York: Guilford Press.

Holy Bible: New International Version. (2012) London: Hodder & Stoughton.

Resources

Acho, E. (2021) Uncomfortable Conversations with a Black Man. London: Pan

Boakye J. (2023) I Heard What You Said: A Black Teacher, A White System. London: Picador

Gutierrez, N. (2022) The Pain We Carry: Healing from Complex PSTD for People of Color. Oakland, CA: New Harbinger

Kim, M. (2023) The Wake Up: Closing the Gap Between Good Intentions and Real Change. New York: Hachette Go.

Kleinrock, L. (2021) Start Here, Start Now: A Guide to Antibias and Antiracist Work in Your School Community. London: Heinemann Educational Books

Menakem, R. (2021) My Grandmother’s Hands. London: Penguin

Reid, N. (2022) The Good Ally. London: HQ

Shukla, N. (2017) The Good Immigrant: 21 Writers Reflect on Race in Contemporary Britain. London: Unbound

Tang, S. (2023) Asian American Psychology and Psychotherapy: Intergenerational Trauma, Betrayal, and Liberation. Lanham: Rowman & Littlefield Publishers

Yun, E. (2021) Breaking Intergenerational Pain and Burdens: A Reflection of Shangi-Chi, SOLA Network. [online] Available at: https://sola.network/article/breaking-intergenerational-pain-and-burdens-reflection-shang-chi/ [Accessed 23/8/2023]

About the authors

Ellen Yun 甄婌婗 (Yun Shuk Yee)

MA in Integrative Psychotherapy, BA (Hons), Internal Family Systems Level 3 Trained, Dip Supervision, MBACP (Reg), ACC (Reg)

Ellen is Chinese British and works as a psychotherapist, supervisor and speaker. She has also worked as a tutor at Waverley. She has contributed a number of articles to the Association of Christian Counsellors Accord journal and the SOLA Network. She is committed to a journey of personal and collective healing, liberation and transformation, one encounter at a time. In recent years the Internal Family Systems model of therapy has been an integral part of this personally and in her current approach to therapy.

Ellen has sixteen years’ experience of offering therapy to children, young people and adults.  She has a particular interest in attachment and intergenerational experiences that impact who we are, and also of the intersection of identity, faith, culture and ethnicity. She seeks to offer a safe and welcoming space to those with diverse and often marginalised experiences.

Ellen is committed to a lifelong journey of being and working in an anti-oppressive and anti-racist manner and advocates for this in psychotherapeutic and Christian spaces.

www.ellenyuncounselling.com

Dr Janet E. Penny, BA (Hons), MSc, PGPDip, C. Psychol., AFBPsS; HCPC Registered Psychologist, Chartered Psychologist, Associate Fellow of the British Psychological Society

Janet is the Head of Post-Graduate Counselling and Research  at Waverley Abbey College. As well as having a private clinical practice, Janet is a research supervisor for doctoral candidates at the Metanoia Institute. Her own doctoral research was on power dynamics and the development of intra-cultural competence within Christian counselling. She has many years’ experience teaching in higher education, focusing on the integration of faith and psychology in Christian counselling, and research methodology.

Copyright 

Copyright 2023 Ellen Yun and Dr Janet E. Penny

[1] Given the relational and conversational context of the topic, the article has kept that conversational style.

[2] While there are other views on this question, the choice has been made to capitalise the word ‘white’ when referring to identity as to not do so could imply that White is the norm or neutral compared to other identities.

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https://doi.org/10.52456/WACJO321

Abstract

This paper proposes a support model for individuals who might be experiencing moral injury. There is no agreed definition for moral injury (Hodgson et al., 2021). For the purposes of this paper, we suggest moral injury is the ongoing negative experience of being exposed to one or more events that are beyond an individual’s moral boundaries. The paper begins with a brief exploration of this definition. Moral injury is not a mental illness (Williamson et al., 2021) and therefore it is inappropriate to speak of ‘treatments’. Instead, moral injury tends to be classified as a syndrome (Koenig & Al Zaben, 2021). In this sense it sits somewhere between a symptom and a formal disease or disorder. As a result, we speak of supporting (not treating) an individual experiencing moral injury. By extension, this support does not require the expertise of a mental health clinician. In fact, the support model suggested in the article should extend beyond mental health professionals to include chaplains, peer support officers and even appropriately trained workplace managers and colleagues.

The support model is made up of six elements, described using the acronym ‘SAF T LOCK R’ (Story, Assess/Analyse, Forgiveness, Test/Try, LOCK in the changes, Review/Refer). These six elements are presented in a somewhat logical sequence although, in practice, the experienced moral injury supporter will adjust the length and sequence of each element to suit the individual. There may even be times where some elements can be omitted altogether. This flexibility and its adaptability to numerous contexts is an advantage over other approaches to support moral injury such as pastoral narrative disclosure (Hodgson & Carey, 2022), which is a rigorous eight-step process designed exclusively for chaplains in a defence context.

Keywords: moral injury, spirituality, forgiveness

The SAF T LOCK R model for supporting individuals experiencing moral injury

Moral injury could be defined as the ongoing negative experience of being exposed to one or more events that are beyond an individual’s moral boundaries. There are some key components of this definition that warrant exploration. One individual’s moral boundaries will differ from the next person and they may change over time. What a person deems morally acceptable when they are 15 years old may be different to when they are 50. The journey of life will expose us to countless events. Some of these we will witness, some will be done to us and some we will do ourselves. Hopefully many of these events are pleasant and enjoyable. However, there will be occasions where these events fall outside of our moral boundaries (what we believe to be right and wrong). In these cases, we may experience some level of temporary discomfort – noting that we may also be completely unaffected by exposure to such events (they will be ‘water off a duck’s back’ so to speak). On some occasions the discomfort will be long lasting. It is in this case that we might find ourselves ‘morally injured’. Simply speaking, there are two ways of resolving this. The first is to choose to shift our moral boundaries. This may sound extreme but is the experience of the authors that in practice it is very common. For example, the seasoned emergency services first responder or long-serving soldier is likely to conclude that somethings they considered unacceptable at the start of their career have somehow become OK and no longer trouble them. They have moved their moral boundaries. The second process of resolution is more complex. The event/s cannot be changed and if the boundaries cannot be moved then our attention is drawn to reducing the ongoing negative impact to an extent that the individual can live a flourishing life in spite of their exposure. To that end, the ‘SAF T LOCK R’ model – a six-element process for working with people who have experienced moral injury – has been developed by the current authors and is  outlined below.

Story

There is healing to be found in simply telling one’s story (Gu, 2018; Rosenthal, 2003). If the story is traumatic, then this can be a form of helpful exposure therapy (Held et al., 2018). Telling and recasting our stories is at the core of narrative therapy (Bryant, 2021). At best, the experience of storytelling can be deeply cathartic, at worst it can be iatrogenic. With respect to moral injury, it is helpful to consider the idea that the person has two stories to tell. The first story relates to the event/s itself, the second story is their personal journey since the event/s transpired. Exploring both stories can be helpful.

Simply allowing space for the person to recount the event/s may cause the person to see the event/s in a new light. Some gentle questioning such as ‘what do you think might have motivated X to do that?’ might cause the individual to think differently about the perpetrator. Carefully timed and crafted questions that actively seek growth such as ‘in the midst of the pain you have described do you feel you have grown in any way?’ might help the person see the event/s in a fuller perspective. When the individual has been the perpetrator of the moral wrongdoing it is very possible their shame has prevented them from telling anyone else the details of the story. Individuals often describe a great sense of relief and release when they can tell their story, which may have been bottled up for many years. Sometimes, simply having a chance to air the story is enough to remove its sting.

The second story relates to how the person has coped since the event/s. What changes in mood and behaviour have they (or their loved ones) noticed? How are they different as a result of the event/s? This second story is important as the details of the event/s may not be able to be changed but one/s reactions as a result may have some room to move as we will explore in the next element.

Assess/analyse

This element of the support process involves assessing the type and extent of the moral injury as well as helping the individual ‘pull-it-apart’ so they understand it better. The assessment can be formal or informal. Formal assessments may involve a validated tool such as the Moral Injury Exposure and Symptom Scale – Civilian (MIESS-C) (Thomas et al., 2023) or the Moral Injury Scale – Youth[1] (MISY) (Chaplo et al., 2019). These formal tools will not only assist in quantifying the extent of moral injury but will also be helpful in defining the type of injury involved. Of course, they will be also invaluable in asking the primary question of whether this person’s experience is in fact moral injury at all.

The three types of moral injury stem from the role the individual played in the event. They may be the perpetrator of the moral injury. In this case, it was something they did (or failed to do) that is causing the moral injury and the symptoms are likely to be described using words such as guilt or shame. Alternatively, the individual may be the victim of a moral injury – something that has been done to them, in which case they are likely to describe their symptoms as betrayal or abuse. The third type of moral injury occurs when an individual is a witness to one or more events, usually resulting in symptoms such as disbelief, shock or disappointment. The assessment/analysis element is designed to assist the individual in better understanding what is happening for them by giving some language and categories to describe their situation.

The more advanced moral injury supporter may use their analysis of the story to incorporate some basic cognitive behavioural therapy (CBT) techniques where appropriate. A common example that emerges when working with moral injury is an individual’s experience of false guilt. False guilt (sometimes known as toxic guilt or harmful guilt) is experienced when an individual is ‘quick to accept that everything is their fault even though it isn’t’ (Cikanavicius, 2018, para. 8). Basic CBT techniques can be very helpful in helping the individual adjust their thoughts or behaviours following the event and as a result diminish the level of negative experience.

Forgiveness

There are times in life when humans conduct themselves in immoral ways toward one another. No amount of storytelling nor cognitive reframing can escape the fact that someone has exposed another individual to a moral offense that causes ongoing negative impact. In these cases, the only constructive option is forgiveness. Of course, forgiveness is a two-sided affair and supporting an individual through forgiveness varies according to which side of the offense they find themselves.

When the individual is the victim of the offense

Let us first consider the situation where the individual has been offended against. According to Tripp et al. (2007) there are four possible pathways toward justice: revenge, reconciliation, forgiveness and avoidance. These show surprising alignment with Augsburger’s Offender-Offended grid, which suggests four possible outcomes: revenge, authentic reconciliation, forgiveness and denial (1996:93) especially when one considers Enright’s view that denial is one type of avoidance – along with suppression, repression, displacement, regression and identification (2001:95–101). Enright later asserts: ‘One may forgive and not reconcile, but one never truly reconciles without some form of forgiveness taking place’ (2001:31). We, along with Watson et al. (2016), would therefore suggest that in the short term, the person who has been offended against has three immediate options: revenge, avoidance or forgiveness, with reconciliation being a medium-term possibility after some level of forgiveness has occurred.

In practice, the person seeking support following a moral injury may well have explored revenge and experimented with a variety of avoidance strategies, yet continues to live with negative experience often characterised by a sense of betrayal or abuse. The supporter has at their disposal countless tools to assist in the process of forgiveness, and the SAF T LOCK R model recommends a collaborative approach in selecting the forgiveness tool that will best suit the individual. While many forgiveness tools take a psychological approach (Elliott, 2011; Enright, 2001; Worthington et al., 2010), SAF T LOCK R encourages the supporter to consider applying a tool that aligns with the individual’s spirituality. While The discipline of psychology is less than 200 years old, but the major world religions have been engaging in practices of forgiveness for thousands of years.

The ten-day period known as the ‘Days of Awe’ – Rosh Hashana, Yom Kippur and the days between – is a popular time for forgiveness. Observant Jews reach out to friends and family they have wronged over the past year so that they can enter Yom Kippur services with a clean conscience and hope they have done all they can to mitigate God’s judgment. (Cohen, 2022, para. 7).

For the Muslim, the Qur’an promises: ‘If any one does evil or wrongs his own soul but afterwards seeks God’s forgiveness, he will find God Oft-forgiving, Most Merciful’ (Surah 4, v. 110). Encouraging forgiveness, the Buddha said: ‘Hate never yet dispelled hate. Only love dispels hate’ (Dhammapada 1:5). Those following the Buddhist faith are exhorted to forgive as a way of reducing suffering.

Perhaps the Christian faith places the greatest emphasis on forgiveness, with Jesus exhorting: ‘For if you forgive other people when they sin against you, your heavenly Father will also forgive you” (Matt. 6:14), teaching echoed by St Paul in his letter to the church in Colossae: ‘Bear with each other and forgive one another if any of you has a grievance against someone. Forgive as the Lord forgave you’ (Col. 3:13).

Forgiving is never easy. While some psychological approaches may be helpful, many individuals find forgiveness impossible by sheer force of will, yet are able to extend forgiveness in ways they might describe as supernatural when their spirituality is involved.

When the individual is the perpetrator of the offense

When the individual has offended another by something they have done or something they failed to do, they may be left with emotions of shame and guilt. While psychological models (Elliott, 2011; Enright, 2001; Worthington et al., 2010) should not be discounted and may be the only alternative for the individual who claims no spirituality or does not want their spirituality included in the support process, SAF T LOCK R again advocates for the inclusion of a perpetrator’s spirituality when seeking forgiveness. This will take the form of apology, confession or repentance.

In Islam, sincere repentance is known as taubah. This requires the follower to:

• recognise and admit they have made a mistake;
• ask forgiveness from Allah and if the sin was against a person, they have to ask forgiveness from that person also;
• try to atone for the sin if possible by, for example, returning money if it was stolen;
• make the intention never to do the sin again (Matthews, 2023, para. 6).

Ken Sande (2004) approaches forgiveness from a Christian worldview and advocates for a similar list of what he describes as ‘The seven As of confession’:

1. Address everyone involved;
2. Avoid ifs, buts and maybes;
3. Admit specifically;
4. Acknowledge the hurt;
5. Accept the consequences;
6. Alter your behaviour;
7. Ask for forgiveness;

The forgiveness element of SAF T LOCK R can vary radically from individual to individual. Some may want to include some form of facilitated ritual, some may prefer to engage in a practice of solitude. Some may wish to include the people involved, others may seek a rite of private confession and absolution. Some may prefer the services of a mental health professional and many may prefer the involvement of a chaplain or faith leader.

Additionally, forgiveness is a process (Enright, 2001; Sande, 2004). Worthington et al. helpfully distinguish between decisional forgiveness and emotional forgiveness, observing: ‘A person could make a decision to forgive an offender yet still not feel a sense of emotional peace toward the offender’ (2011:172). For the individual experiencing moral injury there can be a lag between the choice to forgive and the alleviation of the negative experience. There is no ‘one-size-fits-all’.

Test/try

Acceptance and commitment therapy (ACT) has been shown to be effective in supporting people with moral injury (Borges et al., 2022; Evans et al., 2020). According to Corey (2016), when applying ACT:

[clients] learn to identify with thoughts and feeling they have been trying to deny…. Client and therapist work together to identify personal values in areas such as … spirituality…Therapy involves assisting clients to choose values they want to live by, designing specific goals and taking specific steps achieve those goals :256).

Thus, ACT underpins the ‘F T LOCK’ elements of the SAF T LOCK R model.

Discussions of forgiveness will involve identifying and embracing the sense of anger, abuse, betrayal, guilt or shame rather than engaging in practices of avoidance or denial. Where possible, the client’s spiritual understanding and value of forgiveness is identified and explored. The next element will give the client the opportunity to commit to (or LOCK in) a new set of behaviours but for now SAF T LOCK R presents the individual with an opportunity to test (or try on for size) a change they wish to make. This is not an essential element. The enthusiastic individual may have a clear sense of their desired change and commit immediately to LOCK in a change. However, experience suggests many individuals will prefer to adopt a reversable ‘baby step’ (or conduct an ‘experiment’) that they can subsequently discuss with the support person. Test/try can also take the form of ‘homework’ in the more traditional ACT models.

LOCK in the change

Aspects of all four preceding elements (Story, Assessment/analysis, Forgiveness and Test/Try) come together at the LOCK stage. Until this point the individual may have been toying with new perspectives on their story or they may have been considering the adoption of new cognitive beliefs in light of the analysis of their story. Or they may have come to a sense of the need to confess a wrongdoing or possibly extend the gift of forgiveness to an individual or an institution. They may even have undertaken a baby-step in one of these directions. Now is the time to take the plunge; LOCK in a new mindset, LOCK in a date to meet and apologise, LOCK in a time and location for a rite of forgiveness, LOCK in a daily self-care practice. As Corey notes when discussing ACT ‘a commitment to action is essential, and clients are asked to make mindful decisions about what they are willing to do to live a valued and meaningful life’ (2016:256).

Review/refer

For the simplicity of the model, Review/refer is listed as the final element but, in practice, this is a constant throughout the process. Informal review is an intentional activity of checking the process continues to be helpful for the individual. However, it is recommended where possible that a review meeting be organised for some time after the individual has resolved to LOCK in a change to see how it went. This can involve celebrating any identifiable improvements and processing outcomes that didn’t go to plan. Referral may occur at any stage in the SAF T LOCK R process. For example, if the initial telling of the story suggests significant unprocessed trauma, the support person may choose to refer immediately to specialist mental health support. Another example might be the mental health professional who refers to a faith-based chaplain for the forgiveness element.

Summary

First identified amongst veterans by Shay (1994), moral injury came to prominence through the seminal work of Litz et al. (2009). Moral injury has now been seen amongst healthcare workers (Phoenix Australia & Canadian Centre of Excellence, 2020) and emergency services workers (Lentz et al., 2021).

SAF T LOCK R is grounded in the principles of acceptance and commitment therapy, exposure therapy, cognitive behavioural therapy, forgiveness and religious CBT, all of which

have been shown to be effective in the alleviation of moral injury symptoms (Jones et al., 2022; Koenig & Al Zaben, 2021). Future refinements to the SAF T LOCK R model will be possible with ongoing application and further research.

References

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Author note

Shannon Hood https://orcid.org/0000-0002-1387-8600

Correspondence concerning this article should be addressed to Shannon Hood, Dean of Counselling and Chaplaincy, Asia Pacific School of Pastoral Care and Counselling, 1 College Ct, Karrinyup WA 6018. Email: shood@pbc.wa.edu.au

Copyright

Copyright 2023 Dr Shannon Hood and Rev Michael George

[1] Although this 24 questions scale is designed for youth it is equally applicable for use by adults and is slightly more comprehensive than the MIESSC.

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