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INTRODUCTIONRESEARCH THATMATTERS: BRIDGINGTHE GAP BETWEENRESEARCH ANDPRACTICE INTHANATOLOGYJohn R. Jordana The Family Loss Project, Sherborn,Massachusetts, USAPublished online: 29 Oct 2010.

To cite this article: John R. Jordan (2000) INTRODUCTION RESEARCHTHAT MATTERS: BRIDGING THE GAP BETWEEN RESEARCH AND PRACTICEIN THANATOLOGY, Death Studies, 24:6, 457-467

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Death Studies, 24: 457–467, 2000

Copyright 2000 Taylor & FrancisÓ0748-1187/00 $12.00 1 .00

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INTRODUCTIONRESEARCH THAT MATTERS: BRIDGING THE GAP

BETWEEN RESEARCH AND PRACTICE INTHANATOLOGY

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JOHN R. JORDAN

The Family Loss Project, Sherborn, Massachusetts, USA

This article serves as an Introduction to this two-issue special series of DeathStudies on the integration of research and practice in thanatology. Af ter discussingthe lack of dialogue between researchers and practitioners in the �eld, the authoridenti� es some common elements of the research and clinical processes in thana-tolog y. These include the central role of pragmatic theory building and the universalhuman encounter with loss. The author then o¡ers sug gestions for enhancing theexchange between researchers and clinicians, including improvements in theory,methodology, and the dissemination of research �nding s. Lastly, the individual arti-cles in the series are introduced to the reader.

This special series of Death Studies grew out of a recurring experi-ence of mine at the annual conferences of the largest and best-known association of thanatology professionals, the Association forDeath Education and Counseling ( ADEC ). While attending one

Address correspondence to John R. Jordan, Ph.D., The Family Loss Project, 26 Curve

Street, Sherborn, MA 01770-1051. E-mail : jjordan50@aol.com

I would like to thank the colleagues who generously provided independent peer review

of these articles. They included David Browning, LICSW, Phillip Carverhill, Ph.D., Louis

Gamino, Ph.D., Dennis Klass, Ph.D., Illene Noppe, Ph.D., Simon Rubin, Ph.D., Gordon

Thornton, Ph.D., and Robert Zucker, M.A. In addition, each of the authors in this series

also served as a peer-reviewer for the manuscript of another author. I extend my thanks to

each and every one of you who helped to make this special series possible. In particular, I

would like to thank Dr. Robert Neimeyer for his advice, encouragement, and numerous

consultations throughout the process of putting together this series, my ® rst editorial e� ort.

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type of concurrent session ( e.g., an experiential workshop on theuse of a new technique in grief counseling ), I would notice that thegroup consisted primarily of counselors or therapists. The tonewould be friendly, and the discussion would be oriented aroundfeelings and personal experiences. Participants would be enthusias-tic about the technique, and everyone seemed to take for grantedthat the method would work for bereaved persons. The presenterand the audience would rarely discuss the ideas, research, or eventhe theory behind the technique.

In contrast, if I attended a di¡erent type of session ( e.g., a reportof research on a new bereavement measure ), the audience wouldconsist almost exclusively of researchers, and the tone would bevery di¡erent. Discussion would be just as lively but more competi-tive and challenging. People would question the thinking and databehind the measure and compare it to other research in the � eld,but almost no one would talk about how this measure would relateto their own personal experiences of loss or their professional workwith bereaved persons. I also realized that although I tended torun into the same people at similar types of presentations, therewas very little crossover between the two groups.

In thinking about these di¡erences, I began to recognize thatmost of us in the thanatology � eld probably mirror the larger ‘‘cul-tural’’ split between researchers and clinicians in all of the medicaland social sciences. Perhaps more importantly, I noticed thatrarely did conferences or professional journals provide venueswhere colleagues from these two worlds could actually talk withand listen to one another. These observations led me to organizetwo symposia at ADEC conferences. The � rst was titled ‘‘Thera-pists are from Venus, Researchers are from Mars : Opening theDialogue ( or Let’s Do Lunch Together on Earth )’’, and thesecond, ‘‘Research That Matters : A Report to Grief Counselorsfrom Mars and Venus’’. These two lively meetings were wellreceived by people from both ‘‘planets,’’ and at the initiative ofEditor Robert Neimeyer, subsequently led to this special series ofDeath Studies. I hope that the articles that follow will help to stimu-late more of the ‘‘interplanetary’’ dialogue that has been missing inthanatology. To get us started, I have included below some of myown observations about the nature of the split, and the changesthat might help us to close it.

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Research That Matters 459

The Problem

As Silverman ( 2000 ) and others have pointed out, the dilemma ofthe researcher–practitioner split is hardly unique to thanatology.Researchers and clinicians in perhaps every profession really dolive in di¡erent domains ( Beutler, Williams, Wake� eld, & Entwis-tle, 1995; Goldfried & Wolfe, 1996 ). They have di¡erent demandson their time, di¡erent criteria by which their success and pro-fessional competence are judged and rewarded, and di¡erent audi-ences that do the judging. Moreover, researchers and practitionersoften operate from di¡erent knowledge bases, and they use di¡er-ent ways of acquiring and verifying that knowledge. All of thesesocial, psychological, economic, and epistemological factors play arole in creating the divide that exists between the two worlds.

Yet there are also common elements that have the potential tobring members of the two communities together. The commonfoundation of social science research and therapy ( in this case,illness and grief counseling ) is a human encounter in which twopeople work together to better understand the experience of one( in this case, the dying or the mourner ). Whereas therapy goesbeyond this foundation, attempting to change the individual’sexperience in some positive way, researchers and therapists bothstart with the creation of a context in which the person facingdeath or loss can teach us about their encounter with these existen-tial life events. Although the methods of science may place morerestrictions on the way that information is communicated ( e.g., viaa paper-and-pencil questionnaire ), research methods are really justanother way for the dying or the bereaved to communicate theirexperience to the receiver of the information.

Second, both clinical practice and good research are ( or at leastought to be ) grounded in dynamically evolving theory. Everycounselor operates from a general, though sometimes implicit,model of how people face death and loss, and what can be done tofacilitate this process. Most grief counselors can articulate themodels of mourning and recovery that guide their caregiving,although for many clinicians their working theory has developedalmost exclusively out of personal and professional experience withloss, rather than the � ndings of relevant empirical research. Like-wise, many researchers attempt to ground their studies in a larger

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theoretical framework. Unfortunately, many others do not, or elsethey fail to do so in ways that speak to the pragmatic questionsthat matter to ‘‘front-line’’ caregivers ( see Wolfe & Jordan, inpress ). Yet theory, as it builds on clinical and personal experienceand is re� ned through social science research, is the commonground that caregivers and researchers should be able to share.Theory integrates and guides the decision-making process in bothdomains. In a very real sense, both clinical and research activitiesare essentially meaning-making activities in which the weaving ofthe ‘‘data’’ at hand into a coherent explanation is central tomaking progress. 1

Finally, as Silverman ( 2000 ) so obviously yet astutely points out,loss is a universal human experience that applies to everyone,including clinicians and researchers. The death of my father whenI was in my mid-twenties was a painful yet ultimately quite posi-tive life-changing experience for me, one that has shaped my pro-fessional and personal life in a myriad of ways since then. Mostgrief counselors would acknowledge that they are drawn to thework in part because they seek to deal with loss in their own life,including their own mortality. This tradition of understanding theintersection of one’s own life experience with that of one’s clientmakes discussion of this issue a relatively normalized activity inclinical training and literature.2 No such tradition exists in thana-tology research, however. Yet as a grief counselor who is alsopursing research activities, I know that my personal encounterswith loss, and my clinical practice with hundreds of bereavedpersons, shapes the research process, from the formulation ofhypotheses to the interpretation of results. It would be enriching tosee researchers in thanatology describe their own loss experiences,and the impact they have had on the research activity and theory-building they pursue.

1 For recent valuable discussions of thanatological theory, see Bonanno and Kaltman

(1999) and Corr, Doka, and Kastenbaum (1999).2 The emphasis in psychodynamically oriented training is on keeping one’s own trans-

ference or ‘‘pathology’’ out of the therapy process, a caution that has merit given the poten-

tial for any therapist to project their own issues on to a client. However, in the training that

my colleagues and I o� er, we have come to understand the grief counselor’s loss experiences

as primarily a resource to be skillfully used in the therapeutic encounter, rather than anti-

septically guarded against by the clinician.

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Research That Matters 461

Building Bridges : Suggestions for Change

I suggest three areas of change in the � eld of thanatology whereclinicians and researchers can potentially span some of their di¡er-ences. The � rst is in the realm of theory. I believe that research inthanatology should have as its ultimate aim an increase in ourability to help people who are facing loss experiences, whether it betheir own mortality, or the loss of a loved one. Theory is the bridgeover which empirical � ndings can cross into the world of the practi-tioner.3 Accordingly, researchers must ask themselves whethertheir studies pass what Lund and Caserta ( 1997–1998 ), in theirexcellent review of adult bereavement research, call the ‘‘SoWhat ?’’ test. That is, researchers must carefully consider not justwhat they want to learn and how they want to learn about it( traditionally referred to as internal validity ). They must also askhow their results will be used, and whether they can meaningfullycontribute to the professionals, family, and friends who providecaregiving to the dying and bereaved ( external validity ). Theymust anchor their choice of topics and research methods in theo-retical advances that help the caregiver perform their mission moree¡ectively (Newman & Tejeda, 1996 ).

Likewise, clinicians must make the e¡ort to understand therationale and methods of research, so that they can intelligentlyinterpret what the research has to teach, and assess the implica-tions of the data for practical theory making. They must also beopen to critically examining their own ‘‘assumptive world’’ aboutthe nature of bereavement and the nature of help for the bereaved.Mental health professionals in general, and grief counselors in par-ticular, have shown a penchant for adopting theory on convictionalone, mostly because it ‘‘feels right.’’ Yet there is convincing evi-dence that many of the clinical constructs that have guidedbereavement interventions over the years may be not much morethan collectively shared assumptions ( Bonanno & Kaltman, 1999;Lund & Caserta, 1998; Stroebe & Stroebe, 1991; Stroebe, van denBout, & Schut, 1994; Wortman & Silver, 1989 ). In my experience,

3 This does not mean that all research needs to be intervention research. Studies that

increase our knowledge of the basic processes of coping with life-threatening illness, grief,

and adaptation after loss also contribute greatly to this goal.

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it is rare for therapists to wonder about the potential harm done toclients when caregivers operate on the beliefs that ‘‘everyoneknows’’ to be true. For example, operating on a largely psychoana-lytic model of grief resolution, for many years clinicians haveencouraged bereaved clients to decathect from the deceased, andsometimes pathologized them when they resisted doing so. Yet newtheoretical developments and empirical evidence suggest that thisapproach may not only be wrong, it may be harmful for manymourners, particularly bereaved parents ( Klass, Silverman, &Nickman, 1996 ). Similarly, Bonnano and his colleagues haveauthored a series of studies that bring into serious question thewidely held assumption that outward expression of grief is alwayshelpful to people ( Bonnano & Kaltman, 1999 ). Perhaps we can saythat clinicians must be willing to pass the ‘‘How Do You KnowThat For Sure?’’ test, allowing solid empirical research to modifyand disprove even the most passionately held clinical notions.

The second area of change involves the methods that we use tostudy the encounter with death and loss. In my experience, clini-cians often dismiss research as unable to capture the ‘‘heart’’ of thematter in these most intimate human encounters with loss. It istrue that most studies in this � eld have primarily used stan-dardized, paper-and-pencil measures of mental health functioningor global measures of bereavement to assess how ‘‘well’’ the personis doing. While relevant, these measures often miss importantaspects of the loss experience ( Neimeyer & Hogan, 2001 ), includ-ing those issues that may be most relevant to the counselingprocess. To take one example from an area of particular interest tome, recent reviews of suicide survivors have suggested that theremay be few, if any, di¡erences between suicide bereavement andother types of loss. I have argued in a recent literature review( Jordan, in press ), however, that it is precisely in certain thematicaspects of suicide bereavement ( such as the heightened sense ofresponsibility for the death, or the feelings of abandonment by thedeceased ) that many survivors have their greatest difficulty. Theseare factors that do not show up in commonly used mental healthmeasures, but that do emerge in more qualitative studies of sur-vivors or with measures that are designed to assess these speci� caspects of grief ( Bailey, Kral, & Dunham, 1999 ). The emergence ofwell-conceived qualitative methods for studying the profoundlysubjective aspects of dying and mourning promises to greatly

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Research That Matters 463

enrich our theoretical understanding of grief and loss and are to beencouraged ( Neimeyer & Hogan, 2001 ). This includes the need forqualitative studies of the processes by which hospice services,bereavement support groups, and formal therapeutic interventionshave their impact. In the same vein, studies of interventionsdesigned to assist the dying or the bereaved need not be limited tothe so-called ‘‘gold standard’’ of treatment efficacy studies. Efficacystudies in psychotherapy research use randomized, controlled trialsof precisely speci� ed treatment protocols for highly circumscribedproblems ( e.g., people meeting only criteria for a depressive butnot an anxiety disorder ). In contrast, so-called e¡ectivenessresearch seeks to assess the potency of interventions in the actualcaregiving setting. One example is the well-known Consumer Reportsstudy of the e¡ectiveness of a wide range of psychotherapies con-ducted by many types of providers for many types of problems( Seligman, 1995 ). Applied to the thanatology � eld, e¡ectivenessintervention research could add much to our knowledge aboutwhat will actually work in the ‘‘real’’ and uncontrolled settingswhere most caregivers operate. Both qualitative studies and e¡ec-tiveness research are also more likely to be perceived as relevant bycaregivers, because their methodologies more closely approximatewhat actually transpires in caregiving settings such as hospices andbereavement aftercare programs.

Lastly, there are tremendous changes that need to be made toimprove the dissemination of research � ndings to caregivers inservice-oriented settings ( Neimeyer, in press ; Wolfe and Jordan, inpress ). I f my experiences at ADEC are representative, then withthe exception of the relatively small number of professionals whoengage in both activities, researchers and clinicians really do nottalk much to one another. There are many reasons for this, butsome simple changes might greatly facilitate dialogue. First, ifresearch must ultimately serve the agenda of improved service,then it is incumbent on researchers to include clinicians in everyphase of the research process, from design to implementation tointerpretation. Editors and publishers should encourage ( perhapsrequire ) researchers to explain with more clarity and depth whattheir � ndings could mean for clinical practice. Regular consulta-tion with clinicians about the interpretation of � ndings before theyare published would facilitate this process. Second, forums thatpromote dialogue between researchers and caregivers need to be a

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regular part of professional meetings and journals in thanatology.Research updates for clinicians, symposia on the integration ofresearch and practice, and perhaps regular research reviewcolumns in thanatology newsletters and journals would greatlyhelp the process. Third, education to become an ‘‘intelligent con-sumer’’ of research needs to be a part of the training experience ofgrief counselors in all settings. One way to do this would be torequire such training as a prerequisite for certi� cation as a griefcounselor/therapist. Lastly, there is much that researchers can doto make research more ‘‘user friendly.’’ Above all, this meansdesigning and disseminating research that addresses the pragmaticquestions that clinicians need to have answered ( Newman &Tejeda, 1996; Wolfe and Jordan, in press ). It also means includingsimple, nontechnical explanations of what measures are measuringand what statistical tests are analyzing. Expanded consideration ofwhat a study’s � ndings could mean for training and practice( along with appropriate caveats about not overgeneralizing ) wouldalso be a welcome improvement to most journal publications.

Cutting Edge Issues

The � eld of thanatology is alive with new theoretical developmentsand research � ndings that have tremendous implications for thepractice of caregiving with the dying and the bereaved. I amdelighted to say that this Special Series o¡ers an inviting survey ofmany of these topics. Because of the length of the articles and theimportance of the topic, the Editor has generously agreed topublish the papers across two sequential issues of Death Studies.

Phyllis Silverman leads o¡ the � rst issue by concisely raisingmany of the problems and concerns of the two cultures/planets,putting the split in the larger context of all scienti� c disciplines.She also reminds us of the common ‘‘third culture’’ of personal lossand mortality that binds all of us together into one community.Next, Selby Jacobs and Holly Prigerson introduce the Death Studiesreadership to a potentially new diagnostic category called traumaticgrief . Because their work has been primarily published in psychi-atric journals, many readers may be unfamiliar with the large bodyof scienti� c work that has led to this new development ( Prigersonet al., 1999 ). Whether one favors or disapproves of the e¡orts to

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Research That Matters 465

create a medical diagnosis related to grief, I personally believe thatcaregivers in thanatology should carefully inform themselves aboutthis important new development, because it is likely to have enor-mous theoretical, clinical, and even economic rami� cations fortheir work. Jacobs and Prigerson also provide a cogent review ofcontrolled intervention studies related to traumatic grief, and o¡erspeculation about the direction that future studies will lead us.

Wortman and Silver ( 1989 ) and their colleagues shook up thethanatology � eld in 1989 with their controversial article on the‘‘myths’’ of bereavement. In this issue, Christopher Davis, CamilleWortman, Darrin Lehman, and Roxane Silver once again ask usto stretch our clinical assumptive worlds with another provocativeset of � ndings from their research. They cite data that suggests that� nding meaning after a traumatic death may not be a necessaryelement of recovery for all mourners. They also note, however, thatmourners who feel the need to � nd meaning, but are unable to doso, are another high-risk group for problems in their mourningprocess. This is another valuable illustration of a potential ‘‘red� ag’’ of immediate importance to clinicians that has emerged fromempirical research. Finally, Robert Neimeyer presents us with twosigni� cant matters for consideration. The � rst is an extremelyimportant report of a meta-analysis of bereavement-related inter-ventions that concludes that not only is grief counseling of littledemonstrable help for many grievers, but a sizeable portion ofmourners may actually be better o¡ not pursuing counseling. Thisis a � nding that should give pause to every dedicated grief thera-pist who simply assumes that counseling is good for every bereavedindividual, or at least carries little or no downside risk. Coupledwith this disquieting � nding, however, is the additional conclusionthat for high-risk mourners, counseling may be much more helpful.Again, this reinforces the point that identi� cation of elevated riskin mourning should become a central focus of our research e¡orts.Neimeyer also responds to the Davis et al. ( 2000 ) � ndings in lightof his own strong interest in meaning reconstruction as a centralprocess in the mourning experience.

By way of introduction to the second issue in this series, BenWolfe is the Director of one of the oldest and most respectedbereavement support programs in the United States, St. Mary’sGrief Support Center. Together, the two of us make a plea from

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the clinical ‘‘trenches’’ for research that matters ( i.e., that helpsclinicians like ourselves as we address the complexities of support-ing people through crucially difficult periods in their lives ). ShirleyMurphy then provides us with an excellent example of just suchresearch. Her ongoing longitudinal studies of a carefully designedgroup intervention for parents who have lost a child throughsudden, violent death are exactly the kind of clinically focusedresearch to which grief counselors should pay attention. Many ofthe speci� c � ndings have been reported elsewhere, so here Dr.Murphy o¡ers us a brief summary of the � ndings, and then anexpanded discussion of the clinical implications of the research. Forexample, one of the most clinically signi� cant � ndings is that, byand large, only the high-risk group of mothers bene� ted from theintervention. This replicates � ndings from several other studies(Murray, 1998; Raphael, 1977 ) and once again suggests thatimproving our skill at identifying and designing interventions formourners at high risk for bereavement complications will greatlyimprove the e¡ectiveness and efficiency of our limited resources.This is just one compelling example of the way that replicatedempirical research can guide caregivers toward real improvementsin direct service. Finally, Robert Neimeyer closes out this two-partspecial series of Death Studies with some cogent thoughts on how thegap between research and practice in thanatology can be nar-rowed. He makes the case for a dynamic ‘‘essential tension’’between researchers and practitioners that can bene� t both camps.

I am very pleased with the direction this special series has taken.I hope that it will serve as a catalyst for further development of thecommunication that will enrich the entire community of thana-tology professionals who, all things considered, prefer Earth astheir home planet.

References

Bailey, S. E., Kral, M. J., & Dunham, K. ( 1999 ). Survivors of suicide do grievedi¡erently : Empirical support for a common sense proposition. Suicide and LifeThreatening Behavior, 29, 256– 271.

Beutler, L. E., Williams, R. E., Wake� eld, P. J., & Entwistle, S. R. ( 1995). Bridg-ing scientist and practitioner perspectives in clinical psychology. American Psy-cholog ist, 50, 984–994.

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Bonanno, G. A., & Kaltman, S. ( 1999 ). Toward an integrative perspective onbereavement. Psycholog ical Bulletin, 125, 760–776.

Corr, C. A., Doka, K. J ., & Kastenbaum, R. ( 1999). Dying and its interpreters :A review of selected literature and some comments on the state of the � eld.Omega, 39, 239–260.

Davis, C. G., Wortman, C. B., Lehman, D. R., & Silver, R. C. ( 2000 ). Searchingfor meaning in loss: Are clinical assumptions correct ? Death Studies, 24, 497–540.

Goldfried, M. R., & Wolfe, B. E. ( 1996). Psychotherapy practice and research :Repairing a strained alliance. American Psycholog ist, 51, 1007–1016.

Jordan, J. R. ( 2000 ). Is suicide bereavement di¡erent : A re-assessment of theliterature. Suicide and Lif e-Threatening Behaviour.

Klass, D., Silverman, P. R., & Nickman, S. L. ( 1996 ). Continuing bonds : N ew under-standings of grief . Washington, DC: Taylor & Francis.

Lund, D. A., & Caserta, M. S. ( 1997–98 ). Future directions in adult bereave-ment. research. Omega, 36, 287–304.

Murray, J. A. ( 1998 ). Caring for families a¡ected by infant death : Evaluating anintervention. Grief Matters : The Australian J ournal of Grief and Bereavement, 1( 3 ),6–11.

Neimeyer, R. ( 2000 ). Grief therapy and research as essential tensions : Prescrip-tions for a progressive partnership. Death Studies, in press.

Neimeyer, R., & Hogan, N. ( 2001 ). Quantitative or qualitative: Measurementissues in the study of grief. In M. S. Stroebe, R. O. Hansson, W. Stroebe, & H.Schut ( Eds. ) Handbook of Bereavement Research : Consequences, Coping , and Care.Washington, D.C. : American Psychological Association Press.

Newman, F. L., & Tejeda, M. J. ( 1996 ). The need for research that is designed tosupport decisions in the delivery of mental health services. American Psycholog ist,51, 1040–1049.

Prigerson, H. G., Shear, S. C., Jacobs, S. C., Reynolds, C. F., Maciejewski, P. K.,Davidson, J . R. T., Rosenheck, P. A., Pilkonis, P. A., Wortman, C. B., Wil-liams, J. B. W., Widiger, T. A., Frank, E., Kupfer, D. J ., & Zisook, S. ( 1999).Consensus criteria for traumatic grief : A preliminary empirical test. BritishJ ournal of Psychiatry, 174, 67–73.

Raphael, B. ( 1977). Preventive intervention with the recently bereaved. Archives ofGeneral Psychiatry, 34, 1450–1454.

Seligman, M. E. ( 1995). The e¡ectiveness of psychotherapy : The Consumer Reportsstudy. American Psycholog ist, 50, 965–974.

Silverman, P. ( 2000 ). Research, clinical practice, and the human experience :putting the pieces together. Death Studies, 24, 469–478.

Stroebe, M., & Stroebe, W. ( 1991). Does ‘‘grief work’’ work ? J ournal of Consulting& Clinical Psycholog y, 59, 479–482.

Stroebe, M., van den Bout, J., & Schut, H. ( 1994 ). Myths and misconceptionsabout bereavement : The opening of a debate. Omega, 29( 3 ), 187–203.

Wolfe, B., & Jordan, J. R. ( 2000 ). Ramblings from the trenches : A clinical per-spective on thanatological research. Death Studies, in press.

Wortman, C. B., & Silver, R. O. ( 1989 ). The myths of coping with loss. J ournal ofConsulting and Clinical Psycholog y, 57, 349–357.

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