Grief as a Family Process: A Developmental Approach to Clinical Practice

Grief as a Family Process: A Developmental Approach to Clinical Practice. By Ester R. Shapiro. New York: Guilford Press, 1994. 308 pp. $30.00.

In Grief as a Family Process, Shapiro argues for a new perspective in working with individuals and families who are dealing with grief. This comprehensive, well-organized treatment of a complex subject is written for clinicians, who should find it very satisfying for its attention to current research and liberal use of case examples. Shapiro presents the material in straightforward language, thereby making it accessible to a wide range of practitioners. Each chapter is divided into topics, which makes it easier to use as a reference and guide.

Shapiro calls her approach to family bereavement a "systemic developmental" approach, which she defines in chapter two. The systemic development approach emphasizes the developmental stage of the grieving person or family at the time of the death and the way in which the death affects the system in which the person or family lives and functions. In using this approach, Shapiro presents a broad-based discussion, examining issues that other approaches might inadvertently ignore.

In part one Shapiro presents an overview of the developmental approach. Then in part two she discusses the experience and effects of grief from an individual perspective for both adults and children. The chapters review current perspectives, relating them to the developmental approach. Chapter three reviews three major theoretical approaches: psychoanalytic theories, psychosocial theories, and attachment theory, emphasizing the work of Freud, Lindemann, and Bowlby, respectively. Chapter four presents the story of a young family confronting grief issues after the sudden unexpected death of the father. Shapiro's recounting of the family's experience and the ensuing therapy is detailed, sensitive, and revealing, illustrating how the systemic developmental approach is put into action.

In chapter five, Shapiro addresses bereavement in childhood, reviewing and tying theory to the systemic developmental approach. This review is followed by a discussion of the influence grieving parents have on grieving children. Chapter six opens with an interesting discussion of bereavement in infancy, reviewing some of the current research in this area and referring to one of the children in a case example introduced in chapter four. The remainder of the chapter presents a useful discussion of bereavement in the preschool, schoolage, and adolescent stages of development.

Part three chapters seven through ten) shifts the focus to families. Chapter seven opens with a discussion of family systems theory and its relationship to family bereavement. After briefly reviewing the basic concepts of family systems theory, Shapiro focuses on bereavement as it appears in the family systems literature, then offers a brief discussion of how other family systems concepts relate to the issue of bereavement. Chapter eight presents a complex treatment of the relationship between family development and grief on the family unit.

Chapter nine discusses strategies for establishing emotional equilibrium in the family, offering discussions of the role of emotional avoidance and family triangles in the stabilization process and an interesting discussion of what can happen to family members as they work toward emotional equilibrium. Short but useful case examples are sprinkled liberally throughout the chapter. Chapter 10 addresses the ways in which the death of a child affects the development of the family, interweaving case examples to illustrate points. This chapter presents a particularly valuable discussion of the challenges these families encounter as other children in the family begin to move into adolescence. Again the discussion is enhanced by the use of case examples skillfully interwoven into the text.

Part four (chapters 11 through 13) deals with the cultural and social factors of family bereavement, beginning with an excellent chapter on the sociocultural context of grief. Shapiro clearly recognizes the impact of cultural background on how individuals and families handle the grief process. Interesting discussions include how cultures somatize their stress, the differing views of hallucinations among cultural groups, and how cultural views of helping professionals affect the helping process. Chapter 12 builds on this discussion by illustrating the concepts of sociocultural background and family developmental history in a case example. In her discussion of the Ruiz family, Shapiro clearly shows how awareness of a family's cultural traditions and beliefs facilitates the therapeutic process.

The last chapter in this section, chapter 13, deals with the circumstances surrounding death and their impact on the grief process. Shapiro notes the stressors that are particular to the circumstances of death, describing through examples how the grief process for the child whose father was shot to death in a robbery attempt differs from the grief process for the child whose father died of sudden heart attack. Shapiro also reviews some of the current literature on the role of stressors in bereavement, including the role of anticipation, death by accident, and death by murder. The chapter concludes with a discussion of trauma and its relationship to bereavement, a discussion of post-traumatic stress disorder, the impact of trauma, and recover.

In the concluding chapter, Shapiro sets forth her view regarding the ramifications of the systemic developmental perspective on work with families and individuals who are working through the grief process. She argues that we must recognize the role our cultural assumptions and personal biases play in this process as well as question the mental health profession's traditional emphasis on the need for the family to somehow "detach" itself from the deceased family member. Shapiro argues instead that the family needs to transform the way in which it is attached to the deceased member. By so doing, we can help the family survive and grow.

Shapiro presents a sound, well-researched, and well-structured treatment of a difficult topic. Her generous use of case examples enlivens and clarifies her presentation, and the topic headings used throughout the book make it a valuable resource. In my practice, have seen many families dealing with grief. I now feel that I can do a better job helping these families by using the ideas Shapiro explores.

Jim Stafford Social work Department University of Mississippi University, Mississippi

Copyright Family Service America Sep 1996
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