Journal of LGBT Issues in Counseling

ISSN: 1553-8605 (Print) 1553-8338 (Online) Journal homepage: https://www.tandfonline.com/loi/wlco20

LGBTQ+ Loss Experiences and the Use of Meaning

Reconstruction with Clients

Laura S. Wheat & Nancy E. Thacker

To cite this article: Laura S. Wheat & Nancy E. Thacker (2019) LGBTQ+ Loss Experiences and
the Use of Meaning Reconstruction with Clients, Journal of LGBT Issues in Counseling, 13:3,
232-251, DOI: 10.1080/15538605.2019.1627973

To link to this article: https://doi.org/10.1080/15538605.2019.1627973

Published online: 29 Jul 2019.

Submit your article to this journal

Article views: 42

View Crossmark data

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=wlco20
JOURNAL OF LGBT ISSUES IN COUNSELING
2019, VOL. 13, NO. 3, 232–251
https://doi.org/10.1080/15538605.2019.1627973

LGBTQþ Loss Experiences and the Use of Meaning

Reconstruction with Clients
Laura S. Wheata and Nancy E. Thackerb
a
Department of Educational Psychology and Counseling, The University of Tennessee, Knoxville,
TN, USA; bDepartment of Special Education, Rehabilitation, and Counseling, Auburn University,
Auburn, AL, USA

ABSTRACT KEYWORDS
Common losses, such as the death of a loved one, losses Disenfranchised grief; grief;
related to aging, or the breakup of a relationship, often pos- death loss; grief
sess unique features for LGBTQ þ people. Disenfranchised grief reconciliation; LGBTQ;
meaning reconstruction;
may result from fewer supports and increased feelings of non-death loss
vulnerability. Additionally, some losses are unique to
LGBTQþ people, such as those associated with coming out.
Meaning reconstruction is a current model for integrating and
reconciling grief for LGBTQ þ clients. This model privileges indi-
vidual context and social construction, supports client agency,
and includes a growing research base within the field of
thanatology. A clinical example provides context and practical
applications for counselors.

Although loss is a common and ubiquitous aspect of the human experi-

ence, it is not always recognized or supported, leading to disenfranchised
grief (Doka, 2002). Disenfranchised grief describes the complex mourning
experience individuals face sometimes as a result of social stigmatization
surrounding a death or loss (Doka, 2002). Some types of disenfranchised
losses may contain elements regarded as unacceptable or unworthy of
mourning within the griever’s wider society (Shear, Boelen, & Neimeyer,
2011). Other losses may simply not be viewed with the same weight and
respect as others (Shear et al., 2011). The death of an immediate family
member, romantic partner, and sometimes friend or pet, often results in
temporary expressions of sympathy and offerings of help from others. Such
offerings can depend on the relationship to the deceased and those left
behind. However, people dealing with nondeath losses in general tend to
find fewer available resources, because it may be hard for others to see
these as losses or to understand their reactions are related to grief
(Collings, 2007; Day & Higgins, 2016; Harris, 2013).
People identifying as lesbian, gay, bisexual, transgender, or queer/ques-
tioning (LGBTQþ) experience a variety of losses, death and nondeath

CONTACT Laura S. Wheat lwheat@utk.edu Department of Educational Psychology and Counseling, The
University of Tennessee, 1126 Volunteer Boulevard, Knoxville, TN 37996-3452, USA.
ß 2019 Taylor & Francis Group, LLC
 JOURNAL OF LGBT ISSUES IN COUNSELING 233

related, finite and nonfinite, throughout their lives. LGBTQ þ individuals

face common types of losses most people experience at some point in their
lives (e.g., death of family and friends, job transitions, children leaving
home), but these experiences may include features distinct to the
LGBTQþ population. LGBTQ þ people also uniquely experience losses dir-
ectly related to their sexual/affectional orientations and gender expressions
and identities. Typical and unique loss experiences exist within the context
of a particular developmental stage and cultural milieu and interact with
intersectional forces (Bordere, 2016; Salazar, 2006). LGBTQ þ individuals
can subsequently experience distinguishable features of grief unlike other
populations.
When grief is disenfranchised, it is frequently more difficult to mourn
and to make sense of (Doka, 2002). Unfortunately, many of the losses
LGBTQ þ people experience may go unrecognized by the professional
counseling community, despite best efforts at sensitivity to cultural compe-
tence and individual context (McNutt & Yakushko, 2013). Lack of know-
ledge about current research and paradigms for understanding grief, and
specifically grief experienced by LGBTQ þ people, may unintentionally dis-
enfranchise LGBTQ þ clients or lead to ineffective or potentially harmful
treatment (McNutt & Yakushko, 2013). Therefore, in this article, we
describe common losses with unique features for LGBTQ þ people as well
as losses typically specific to the LGBTQ þ community. Then we introduce
readers to Neimeyer’s (Neimeyer, Klass, & Dennis, 2014) model of meaning
reconstruction and its applications to working with grieving individuals in
the LGBTQ þ community. Finally, we discuss limitations of this approach
with this population as well as directions for future research.

Common losses with unique features for LGBTQ 1 people

Loss may be considered a universal human experience, as all people eventu-
ally experience the death of a loved one as well as a myriad of significant
nondeath losses throughout a lifetime. LGBTQ þ individuals experience the
same losses; however, these losses often possess characteristics that color
the experience somewhat differently. In this section, we will examine the
unique features of bereavement of a partner or spouse, a child, and a friend
or community member in addition to losses associated with aging and the
end of a relationship.

Partner/spousal bereavement
Losing a parent, sibling, peer, or child to death can have a profound and
long-lasting impact on those left behind to mourn. For people in the
234 L. S. WHEAT AND N. E. THACKER

LGBTQ þ community, however, there are unique features to the experience

of bereavement depending on the type of loss experienced. The death of a
partner or spouse may create difficulties for the bereaved due to differing
degrees of “outness” between partners (Green & Grant, 2008). For many
reasons, partners or spouses may have different levels of self-disclosure
about their LGBTQ þ identity with the people in their lives, which can
complicate the survivor’s bereavement. If the survivor was more out than
the person who died, the survivor may not be included in the family’s
plans for memorial rituals or disposal of remains, thereby left to mourn
alone and without access to the social support and recognition afforded by
public rituals (Broderick, Birbilis, & Steger, 2008). If the deceased was
more out than the survivor, their relationship may have been kept secret
out of respect for the survivor’s needs. The survivor may feel regret regard-
ing the lost opportunity to celebrate their coupleship together or guilt over
“forcing” the deceased to keep a part of their lives secret. In either case, the
survivor experiences lowered support opportunities, greater isolation, and
greater disenfranchised grief as a result (Jenkins, Edmundson, Averett, &
Yoon, 2014).
LGBTQ þ people bereaved of a partner or spouse may also experience
differences in support from friends, family, and community regardless of
the couple’s degrees of outness (McNutt & Yakushko, 2013). For instance,
the bereaved may be impacted by heteronormative social structures within
their surrounding context. People in the surrounding area may be accepting
and even welcoming of LGBTQ þ couples and families; however, if public,
mental health, or religious and spiritual resources are not set up to under-
stand and value the needs of this population, they may not be able to
access the types of support that would be helpful for them (Bristowe et al.,
2018). There is often a dearth of mainstream grief support groups tailored
to this population, decreasing the likelihood that a griever would find the
kind of support they need from a group (Whipple, 2005). Whipple (2005)
found that in contrast to married, presumably heterosexual women, lesbian
widows tended to seek and find comfort from friends, representing a family
of choice (FOC), rather than members of their family of origin (FOO).
Participants in her study often described feeling rejected and disregarded
by their own families as well as the families of their partners.
Lack of support in grief may also arise from a sense of disconnection
from other LGBTQ þ people in general, regardless of support from other
cisgender or heterosexual people (McNutt & Yakushko, 2013; Nadal et al.,
2011). Across the country, cities and neighborhoods vary widely with
respect to whether there is an identifiable, accessible, and close-knit
LGBTQ þ community or even whether individual LGBTQ þ people know
others within their communities (Burnes & Singh, 2016). Within the
 JOURNAL OF LGBT ISSUES IN COUNSELING 235

LGBTQ þ community, there may be varying degrees of support available

for the bereaved, as bisexual, transgender, and queer identifying (BTQ)
people in particular tend to be less visible and accepted within the commu-
nity in the first place (Green & Grant, 2008). This may lead to a feeling of
double disenfranchisement (Cacciatore & Raffo, 2011), as BTQ people sense
a lack of understanding of their identities and the unique aspects of their
life experiences including loss, amongst not only the cisgender, heterosexual
community, but also from within the very community created to support
people of differing sexual orientations and gender identities and presenta-
tions. For instance, not only may an individual identifying as a woman in a
relationship with another woman go unrecognized as bisexual, should she
lose her partner and begin dating a man, she may lose connections among
the LGBTQ þ community if she is seen as abandoning it and becoming
“straight.” She may lose the benefit of support from the exact people who
would understand the unique aspects of loss of a same-sex partner. This
disenfranchisement may be experienced to an even greater extent by BTQ
people of color, who may face compounded discrimination based on racial
or ethnic factors (Kum, 2017).
Several other considerations may impact LGBTQ þ people’s bereavement
when a partner or spouse dies. Gay males, for instance, may struggle with
gender-based expectations from those around them regarding the appropri-
ate “male” way to mourn and experience grief (Wester, 2008). These gen-
der-based expectations may also intersect with cultural expectations as well
as internal and external constructions of what it means to be a gay male in
general. Bereaved gay males may also continue to be subjected to stigma
surrounding HIV and AIDS, even if the death had nothing to do with the
disease and neither partner was HIV positive (Hornjatkevyc & Alderson,
2011). LGBTQ þ people whose partners or spouses are dying in a hospital
or other medical facility may fear discrimination in the health care system
and, in some cases, actually experience it (Jenkins et al., 2014). This may
be particularly true for unmarried couples or for those interfacing with reli-
gious institutions. Finally, bereaved individuals may face a host of legal
issues such as contested wills and custody battles, depending on the rela-
tionship the survivor has with the deceased’s FOO as well as the state laws
where the couple resided (Jenkins et al., 2014).

Death of a child
Many of the same characteristics coloring the experience of partner
bereavement may also apply to the loss of a child. LGBTQ þ people raising
families do not always feel supported by other members of the community
or by the mainstream (Cacciatore & Raffo, 2011). When a child dies, they
236 L. S. WHEAT AND N. E. THACKER

may not find many avenues for recognition and assistance from inside or
outside the LGBTQ þ community.
Changing legal statutes may also impact LGBTQ þ parents’ ability to take
ownership of their child’s remains and make burial/cremation decisions
(Chauveron, Alvarez, & van Eeden-Moorefield, 2017). Although the U.S.
Supreme Court’s ruling in Obergefell v. Hodges (2015) made it legal for
same-sex couples to marry and therefore possess the right to be recognized
as parents of children born to them by being listed on the birth certificate,
LGBTQ þ couples still face obstacles related to recognition of their status as
parents (Chauveron et al., 2017). If a couple is unmarried and raising chil-
dren, the law in the state in which they live may designate only the bio-
logical parent as the legal parent, thereby leaving the other parent with
fewer legal rights regarding the child should they separate. Additionally,
state laws currently vary widely with respect to second parent adoption,
custody, or coparenting agreements (Chauveron et al., 2017). This may cre-
ate a situation in which a separated or divorced parent of a child is unable
to participate in final disposition decisions, thereby disenfranchising one of
the child’s two parents in their grief.

Death of a friend or community member

The death of a friend is one of the least recognized forms of bereavement
in current literature (Genevro, Marshall, & Miller, 2004), though for many
LGBTQ þ people, this loss may have more impact and engender deeper
grief than the death of a family member. As mentioned previously, many
LGBTQ þ people consider themselves closer to FOCs rather than FOOs
(Whipple, 2005). FOCs often consist of close-knit networks of friends with
bonds similar to those of nuclear and extended families. Individuals
included in this network have often been through difficult experiences and
traumas and provide support that can be counted on in a world that
frequently seems hostile towards LGBTQ þ people.
Older LGBTQ þ individuals in the U.S. may be particularly reliant on
their close networks for support and affirmation (Jenkins et al., 2014; Kum,
2017). Adults in this cohort survived decades of oppression, violence, dis-
ease, and rejection, but also experienced great gains in freedom, acceptance,
and pride. Those in their FOCs may represent the strongest, most intimate
bonds in their lives. Indeed, as they age, adults identifying as
LGBTQ þ tend to become more invisible in mainstream American society
(Jenkins et al., 2014), making their support networks even more vital as
sources of recognition and validation, but also as potential sources of care
as they age and become less independent.
 JOURNAL OF LGBT ISSUES IN COUNSELING 237

Nondeath losses: aging and relationship loss

In addition to the aforementioned death-related losses, nondeath losses
such as aging or the breakup of a relationship also impact
LGBTQ þ individuals in unique ways. Many aspects of aging entail losses
for the average person – loss of free and painless movement, loss of good
health, and loss of independence. These same losses take on a slightly dif-
ferent character for many LGBTQ þ people, however. Those living with
life-limiting illness, for instance, may experience additional barriers to
access for healthcare, such as the difficult choice between taking hormones
and improving their disease conditions; dealing with heteronormativity or
homo/bi/transphobia from providers; struggling with past experiences of
trauma or discrimination by healthcare providers, leading to expectations
of future trauma or discrimination; wanting providers to know LGBT-
friendly community services; and continually judging whether to come out
to providers (Bristowe et al., 2018).
Older LGBTQ þ people may face additional, secondary losses attendant
on the aging process (Jenkins et al., 2014; Kum, 2017). They may experi-
ence a loss of independence as they transition to living in retirement com-
munities or long-term care. They may be separated from partners
inadvertently through heteronormative assumptions and potentially lose
their ability to access their FOCs. Older LGBTQ þ adults tend to undergo
the loss of visibility in mainstream society, and this may be even more true
for those no longer living independently, as they may not feel comfortable
identifying their sexual orientation or gender identity (Arthur, 2015). Older
transgender individuals as well as LGBTQ þ people of color often face com-
pounded disenfranchisement and isolation (Kum, 2017). In addition, as
many hospices and palliative care organizations are run by or affiliated
with religious organizations, LGBTQ þ older adults may experience micro-
aggressions related to their status from well-meaning hospice workers
(Arthur, 2015). Finally, as LGBTQ þ elders reminisce as part of the devel-
opmental process of life review, they may revisit past losses and experience
a mixture of emotions (Bristowe, Marshall, & Harding, 2016). This process
can bring up a shadow of old grief and necessitate additional processing to
help reconcile it.

Losses common to LGBTQ 1 individuals

All of the losses discussed in the previous section are nearly universal
losses. Most human beings can relate to the grief of loving someone who
has died or has otherwise severed ties, and the natural losses related to
growing older are common. LGBTQ þ people often experience particular
losses purely as a result of their gender identity/expression or sexual
238 L. S. WHEAT AND N. E. THACKER

orientation, however. These include losses related to coming out, marginal-

ization, and religious or spiritual identity.
Coming out is a continual, complex process that often starts with coming
out to the self (Mosher, 2001). The acknowledgement that one may in fact
have an identity that fits something other than cisgender and/or heterosex-
ual frequently results in a temporary loss of identity as one’s understanding
of self has changed (Matthews & Salazar, 2012). They may begin to ques-
tion many aspects of their identity. As an LGBTQ þ person begins to rec-
oncile and own their identity and begin to live it out, they will come out to
others (Mosher, 2001). This is a continual process throughout a person’s
life; each time is different and entails greater and lesser degrees of vulner-
ability as it is often difficult to anticipate reactions, even among those the
person knows best. As they come out to friends and family, they may
experience ambiguous loss, where there is psychological loss but one is still
physically present, creating ambiguity and challenging the reconciliation of
grief (Boss, 2006). For example, perhaps a person comes out to a sibling
they expect to be supportive. If that sibling has an unexpected negative
response, however, but not to the point of severing the relationship, the
individual may experience ambiguous loss, which is itself difficult to define.
Perhaps their relationship with their sibling is forever changed from that
moment and can no longer be what it was because the LGBTQ þ person
cannot share an aspect of their lives or who they are with them. They may
also feel an internal sense of greater distance and less intimacy with their
sibling than they had before. Even if life appears to continue as usual and
the siblings interact with each other as they always have, the
LGBTQ þ person may mourn the relationship they had before coming out.
An individual coming out to others as LGBTQ þ may also experience the
loss of societal value and significance in some areas of the country
(Mosher, 2001). This can happen especially in two arenas, the religious or
spiritual community (Wood & Conley, 2014) and the racial, ethnic, or cul-
tural group (Kum, 2017). Those in one’s religious or spiritual community
may view LGBTQ þ identity as a sinful choice, an abomination, or evidence
that one has strayed and should be encouraged to return to the truth
(Wood & Conley, 2014). As self-acceptance grows, attendance at religious
services may diminish, though LGBTQ þ adolescents in particular may very
much desire family support (Roe, 2017). If an LGBTQ þ person’s identity
within their spiritual or religious group is especially salient for them, this
apparent juxtaposition could contribute to a crisis of faith as they attempt
to reconcile who they are with what they believe.
The loss may not always be one sided, however. Those in the
LGBTQ þ community, perhaps due to feeling rejected and abused by main-
stream religious groups, are commonly less religious or accepting of
 JOURNAL OF LGBT ISSUES IN COUNSELING 239

religion than non-LGBTQ þ individuals (Newport, 2014). Therefore, an

LGBTQ þ person may feel as though they must choose between their belief
system and their sexual orientation or gender identity – or between a reli-
gious community and the LGBTQ þ community (Sumerau, Cragun, &
Mathers, 2016). Either choice entails a loss that may represent a significant
part of one’s identity. Cultural groups and communities often possess as
many, if not more, within-group differences as between-group differences
(Sue & Sue, 2016), however, and there are certainly many spiritually cen-
tered LGBTQ þ affiliated organizations. Professional clinical literature has
also begun to recognize the importance of addressing the intersection of
spirituality and sexual/gender minority identity development (Beagan &
Hattie, 2015; Chan, 2017). Clinicians should attend to all aspects of a cli-
ent’s experience, as undoubtedly some aspects will fit the dominant narra-
tive and some will not.
Loss of faith or loss of outright or tacit membership in a religious or
spiritual community may represent one facet of perceived marginalization
for LGBTQ þ individuals. Although marginalization is experienced by all
kinds of minorities, the complexity is increased for people holding multiple
minority statuses. For LGBTQ þ people of color, there may be additional
challenges and losses associated with racism and sexism in addition to
rejection or loss of standing within the racial or ethnic community, if the
prevailing culture is disapproving or outwardly hostile to
LGBTQ þ identities (Kum, 2017). LGBTQ þ elders of color often live at the
intersection of any and all of these exclusions as well as invisibility due to
age (Kum, 2017).
The losses discussed in the previous two sections may also intersect in
unique ways. For instance, though an individual identifying as transgender
may experience the death of a parent in many of the same ways anyone
else would, they might experience unique features related to the level of
acceptance of their identity their parent possessed, particularly if the parent
was not accepting or had rejected them. This may also cause losses associ-
ated with coming out to resurface as the bereaved child grieves the finality
of now losing the ability to reconcile the relationship. Any simmering con-
flicts in the family associated with the individual’s coming out may also
flare, potentially igniting new losses.
Despite the many possible losses recounted thus far, burgeoning research
focused on the needs, experiences, and characteristics of LGBTQ þ people
offers hope in the resilience of people to overcome their challenges. Across
developmental levels, when LGBTQ þ people are able to reconcile and inte-
grate their multiple identities, they are just as resilient as their cisgender/
heterosexual counterparts (Beagan & Hattie, 2015). Indeed, thanatological
research suggests that positive reconciliation of grief includes processes of
240 L. S. WHEAT AND N. E. THACKER

sense making and to a lesser extent benefit finding (Holland, Currier, &
Neimeyer, 2006). This process of reconciliation and integration represents
one way to view working with LGBTQ þ clients who struggle in dealing
with losses and will be explained in greater detail in the following section.

Meaning reconstruction as a process of reconciliation in grief

Research in the field of thanatology, or the “study of death, dying, grief,
and loss” (Chapple et al., 2017, p. 118), has largely refuted the long-popular
idea that most people in grief proceed through predictable and orderly
stages to reach a level of acceptance that effectively means grief is at an
end (Holland & Neimeyer, 2010). Instead, healing in grief may be under-
stood as a process of reconciliation, of rebuilding a new narrative and a
new understanding of who one is now that the losses have occurred. One
of the more recent developments in thanatological research focused on grief
reconciliation is the emphasis on meaning reconstruction as a model, or
metatheory, of understanding and working with people in grief (Neimeyer,
2001, 2016). This approach differs from prior methods of facilitating heal-
ing as it represents a shift from focusing on categorizing grief into stages
or phases and into an emphasis on how an individual mourner experiences
loss and transforms the relationship with what or whom is lost. “Letting
go” and “moving on” are no longer the goal; rather, the mourner works to
understand themselves differently in response to loss. This model combines
some of the basic tenets of constructivism and narrative therapy in a man-
ner that accentuates the individual nature of grief but grounds it firmly in
a social context (Neimeyer et al., 2014). Key elements of working from a
meaning reconstruction lens include sense making, benefit finding, and
identity reconstruction (Gillies, Neimeyer, & Milman, 2015). Essentially,
loss disrupts one’s self-narrative, which provides coherence to one’s past,
present, and future. In other words, people live their lives and construct
their identities according to the stories they tell about themselves, others,
and the world around them. When loss enters the story, whether unexpect-
edly or due to an anticipated event, it disrupts an individual’s ability to
make sense of what has happened in the narrative. The work of mourning,
then, is to recreate a “world of meaning” (Neimeyer, 2006, p. 83), to con-
struct a new narrative that makes sense of the loss event in the context of
personal identity and accounts for the ripples of effect both backwards and
forwards in the story. This backwards and forwards movement encom-
passes the event story of the loss itself and the aftermath, as well as the
back story of the relationships impacted by the loss (Neimeyer & Sands,
2011). This reconstruction also involves finding or creating some hope and
 JOURNAL OF LGBT ISSUES IN COUNSELING 241

resilience in the narrative, positive or growth elements that resulted from

the loss.
Neimeyer and Jordan (2013) pointed out that just as constructivists
believe that individuals make meaning through interaction with others, the
model of meaning reconstruction in grief also focuses on the social creation
of meaning in grief, and this represents another key element of this model.
An individual making sense out of a loss incorporates meanings given by
kinship, community, and/or cultural constructs, which then influence the
mourner’s behavior and identity. This social creation of meaning in grief
extends to families as well, as each family member possesses their own
individual narrative that is mutually influenced by the family narrative. For
example, digital storytelling can be an effective intervention for families
bereaved of a child (Rolbiecki, Washington, & Bitsicas, 2017). Storytelling
increases connection among family members while helping them to recon-
struct a shared narrative which includes new meanings. It also encourages
family members to better communicate their feelings amongst each other
and thus lower postloss distress (Rolbiecki et al., 2017).
Another common element of meaning reconstruction, narrative-based
therapeutic practices provide structured opportunities for grieving clients to
tell and retell their stories, as the counselor bears witness to, and partici-
pates in, the continuous process of meaning making (Neimeyer, 2006;
Neimeyer & Thompson, 2014). Methods of eliciting and exploring the story
are as diverse as counselors and clients themselves, and can be as expres-
sive and creative as needed. Neimeyer and Thompson (2014), emphasizing
the utility of expressive techniques to help clients make meaning and
expand clinicians’ repertoire, suggested various techniques in music, cre-
ative writing, theater and performance, dance and movement, and visual
arts, in addition to several multimodal techniques. These expressive meth-
ods of helping clients make sense of their losses through narrative means
may be adapted according to the needs of individual clients and are amen-
able to blending with spiritual approaches. For instance, findings from a
weekend group intervention blending secular Buddhist, meaning recon-
struction, and expressive narrative methods for adults grieving death and
non-death losses suggested a correlation between the ability to make sense
of and integrate a loss and a reduction in painful symptoms of grief
(Neimeyer & Young-Eisendrath, 2015). Overall, narrative methods of
meaning reconstruction offer flexibility in individual approaches to recon-
ciling grief within one’s intrapersonal and social contexts. This flexible
framework is appropriate for working with grieving LGBTQ þ individuals
as it aligns with the Competencies for Counseling with LGBTQQIA
Individuals and Competencies for Counseling Transgender Clients
(ALGBTIC LGBQQIA Competencies Taskforce, 2013; American
242 L. S. WHEAT AND N. E. THACKER

Counseling Association, 2010). Just as these competencies emphasize

respecting clients’ capacity and potential for healing within cultural con-
texts, the meaning reconstruction model similarly offers a foundation to
co-construct diverse cultural meanings through empathic thera-
peutic connection.
Research focused on meaning reconstruction in grief has progressed at a
steady rate, moving from the characteristics of meaning making to the
development of instruments such as the Grief and Meaning Reconstruction
Inventory (GMRI; Gillies et al., 2015) to methods of systematic application
and measures of effectiveness (Neimeyer, 2016). Although no studies to
date have examined the use of this specific model with
LGBTQ þ populations, one group of researchers in the United Kingdom
used narrative therapeutic principles to conduct a series of workshops with
people with learning disabilities who identified as lesbian, gay, bisexual, or
transgender (Elderton, Clarke, Jones, & Stacey, 2014). They found the par-
ticipants enjoyed telling their stories and were able to create more positive
self-identities as a result. Several authors have suggested other narrative
therapeutic counseling interventions to effectively meet the needs of this
population (Cohn, 2014; McLean & Marini, 2008; Steelman, 2016). Overall,
narrative therapy itself shows promise as a frame for working with this
population. Although meaning reconstruction is not completely aligned
with this approach, it does share a worldview seeking empowerment of cli-
ents to decide how they will restory their self-narratives in response to loss.

Clinical applications: a case example

To more fully conceptualize working with grieving LGBTQ þ clients
through a meaning reconstruction framework, it is helpful to have an
example from clinical practice. In this example, the client is a fictional
composite representing an ideal case so that interventions are clear; in real-
ity, both clients and therapeutic relationships are complex and
multifaceted.

Working with Tan

Tan, a 24-year-old multiracial graduate student who preferred they/them
pronouns, came to counseling because they were experiencing difficulty
processing the death of a past lover. After an initial intake assessment that
confirmed Tan’s immediate safety and readiness for counseling, we began
the first session. In this session, I (first author) spent time listening to
them and asking questions to elicit and deepen the story, hoping in the
process to communicate empathy and safety within the therapeutic
 JOURNAL OF LGBT ISSUES IN COUNSELING 243

relationship. As Tan opened up, they shared that they identified as gender-
queer and chose not to label their sexual orientation. They had been in a
relationship with a White cisgender female, Hannah, for 11 months until
about a year and a half ago. The relationship began with strong mutual
attractions, but Tan’s academic demands put a strain on their free time to
spend with Hannah, which left her feeling unappreciated. The two began
fighting more regularly, and one night a bad fight resulted in Tan kicking
Hannah out of their shared apartment. Hannah only returned once to col-
lect her belongings, and the pair lost touch. Tan was only able to talk about
it with a few friends.
It took several months for Tan to really accept that the relationship was
over, and during that time, they leaned on their friends quite heavily. It
was not easy to admit they had not expressed their love well or that they
had lost their love. Following several months of slowly healing heartache,
Tan heard that Hannah had been driving home late one night and been
struck by a drunk driver in a head-on collision. She was killed instantly.
Tan described feeling “numbness and horror at the same time,” a mixture
that continued for a day or two after hearing the news. They were unable
to attend the funeral because Hannah had not disclosed their relationship
to her parents; she had simply told them she was living with a roommate,
and they did not even know Tan. Tan chose not to go because, they said,
“it would be harder to go to the funeral as her friend and former room-
mate than to stay home and wallow but not have to be a different person.”
No one seemed to recognize Tan’s grief or understand it and they were left
alone. Since then, though things were better on a daily basis, they still
wrestled quite a bit with guilt, sorrow, and longing. Tan stated that the
hardest times, especially at first, were when they were quiet and alone, so
they tried to be anything but that. This strategy had worn thin by now,
however, and they finally decided to reach out for professional help.
In the early sessions with Tan, they often got stuck and could not find
the words to express what they were thinking or feeling. Once, as I could
see them struggling, I pulled out a sheet of paper with several questions
listed, such as “If you were a color, which one would you be?” and “If you
were an animal, which would you be?” I told them to write down answers
as quickly as possible, listing the first thing that came to mind. Next, I
asked them to pick one of their answers and write a little more about it on
the other side of the paper. I gave them 10 minutes so there was plenty of
space for thought. Finally, Tan spoke about what they had written. Tan
answered the question, “If you were an article of clothing, which would
you be?” They said they were a scarf. Sometimes the scarf hung there
limply on a coat hanger, waiting to be seen; but sometimes it was tightly
wrapped around something solid. This activity seemed to “unstick” Tan
244 L. S. WHEAT AND N. E. THACKER

and elicit more of their self-narrative. They stated most of the time they
felt like the limp scarf, just hanging around and feeling sad, in addition to
waiting for someone to notice. When they were not feeling limp and sad,
they often felt very anxious and “tightly wound”, as with the scarf in use.
By continuing to use this metaphor, Tan was able to express the over-
whelming guilt they felt about Hannah’s death and the harsh last words
they had said to her. I continued helping Tan describe the event story. It
became apparent that there were two event stories to flesh out, the end of
the relationship and the day of Hannah’s death, so we explored each of
these in turn.
Toward the middle of our sessions, as we moved in and out of the event
and back stories, discussing themes as they arose, Tan spontaneously cre-
ated a playlist of songs about Hannah and their relationship. They reflected
on our discussion the previous week regarding the sharp juxtaposition
between Hannah’s significance and how few people really understood their
feelings. Hannah had been Tan’s first stable adult relationship, and they
had felt proud of how well they were “adulting” through this accomplish-
ment. When they grew apart because of Tan’s dearth of free time, culmi-
nating in their terrible breakup, Tan felt as though they had failed; and
upon Hannah’s death, they felt regret over lost opportunities and love.
They also felt as though they had to “toughen up,” as their friends’ toler-
ance for mourning seemed time limited and their parents offered little
sympathy. Tan had experienced few opportunities to really explore and
express their feelings and thoughts in order to make sense of them.
The songs on the playlist were organized chronologically, starting with a
song that reminded them of the first time they saw Hannah, moved
through memories of their time together, and progressed to the present
day. The last song, “It Must Have Been Love” by Roxette, evoked the real-
ization that Tan had been in love with Hannah and the excruciating pain
they felt then and now. We spent three sessions on this playlist, and my
main objective was to listen for changes in meanings as Tan told stories or
reflected. This would indicate sense making, and as I reflected the changes
I heard, they had the opportunity to become more aware of and continue
their own process of retelling. Gradually, Tan realized that underneath the
overt grief about the lost relationship and death of their partner was a
deeper grief about not being fully seen and accepted. They sensed the gen-
eral community’s willful ignorance of issues affecting LGBTQ þ people and
admitted how deeply it hurt to feel invisible. Their relationship with
Hannah was about more than “adulting,” it was also about owning and lov-
ing the self. Because the outside world and even those closest to them
viewed Tan as female despite frequent correction, being in what outsiders
considered a same-sex relationship would have been even more alienating.
 JOURNAL OF LGBT ISSUES IN COUNSELING 245

Meeting Hannah, feeling her unquestioning acceptance of Tan as they

were, and realizing there was a connection was extremely powerful and
empowering for Tan.
For the last few sessions, Tan wrote chapter titles for their autobiog-
raphy. The purpose was for them to group the epochs of their life into
units of meaning, making sense of the losses they grieved within their over-
all life context – and thereby integrating those losses more fully and recon-
structing identity. We discussed their process of creating chapter titles as
well as how Tan would sequence them. As termination approached, Tan
wrote a chapter title for the next chapter in their life: “Walking in Pride
and Sunlight”. They knew their grief was not “fixed” or over, and they
knew there were plenty of challenges still to come, but they felt more ten-
derness than guilt or regret in remembering Hannah. The tenderness was
an expression of affection for Hannah, of course, but it was also directed
toward the self in forgiveness for mistakes made. They would continue to
grieve periodically, but as Tan reflected, “it will be cleaner now.”

Discussion
As mentioned above, this case was a fictional composite, designed to high-
light the intentional use of meaning reconstruction as a framework for work-
ing with a grieving LGBTQ þ client. A primary and continuing focus for
counselors should be bearing witness to the stories clients tell and remaining
curious about nuances; counselors must understand the “whole story” will
never be revealed because it is endlessly nuanced (Neimeyer, 2001).
Additionally, not every client will need focus on every element of this model;
rather, counselors should listen carefully to the self-narrative, particularly the
pieces touching on loss, to assess possibly problematic and hurtful aspects of
the event story or back story which may need attention. In Tan’s case, they
possessed a lot of guilt regarding the way their relationship with Hannah
ended and regret over unfinished business. They also internalized perceived
messages about their identity from their family and presumably wider society
around them. All of these pieces disempowered Tan and kept them “stuck”
in a holding pattern of sorts. I (first author) used our therapeutic relation-
ship to underscore the beginnings of their meaning making and subtly
reframe some of their assumptions. I allowed them to move back and forth
from event stories to back stories and throughout their self-narrative as they
needed. We both utilized expressive narrative-based interventions to help
elicit sense making and identity reconstruction.
A key theme in this case was the egalitarian approach I took to our rela-
tionship. Tan was just as free to suggest their own strategies for meaning
making as I was, and in fact, they did assert their autonomy in later
246 L. S. WHEAT AND N. E. THACKER

sessions by spontaneously creating the musical playlist to represent their

relationship with Hannah. When they presented it to me, I viewed it as an
invitation to collaborate and operated from that perspective. In addition,
though my reframes sometimes dominated the meaning making occurring
in early sessions, Tan was always free to reject or clarify my understanding
of what they said. This empowering approach is well suited to clients
whose losses and identities are disenfranchised or misunderstood by others.
As stated above, not every element of the meaning reconstruction frame-
work was included in my work with Tan. Toward the end of our time
together, I did sense an uplift in them, more hopefulness and optimism
about the world and their place in it, as well as a reconciliation of their rela-
tionship with Hannah. If we had worked together longer, I may have
encouraged Tan to focus on the strengths they had developed as a result of
thriving through this tumultuous and painful time in their life. This would
have constituted a focus on benefit finding. If we had been able to include
Tan’s family in this process at some point, we may have addressed their
views of Tan’s relationship and their identity as well as their response to
Tan’s grief; and in their turn, Tan would have been able to express their
story and how it felt to be essentially rejected and ignored by them. This
might have resulted in a social creation of meaning that was integrated into
Tan’s new self-narrative as they negotiated that process. As it was, however,
these were not prioritized for Tan’s work in the time we spent together.
Several clinical concerns should remain in the forefront of counselors’
minds in working with clients like Tan. Similar to clients experiencing
depression, anxiety, trauma, or other clinical concerns, grieving clients
should be monitored for development or recurrence of suicidal ideation.
They should also be assessed to determine whether their symptoms align
better with complicated grief than with “typical” acute grief or the process
of adapting to loss (Shear, 2015). As complicated grief may be comorbid
with depression and other medical concerns, clinicians should attend to
whether psychiatric or medical treatment may be necessary (Robbins-Welty
et al., 2018). In addition, a thorough clinical history should include explor-
ation of past losses, both death and non-death related, how clients have
processed and integrated those losses, and whether elements of those losses
still feel unfinished or incomplete. Finally, as with any other clinical focus,
counselors should ensure their competence to work with grieving clients by
engaging in continuing education and supervision.

Limitations and implications

As with any counseling perspective, meaning reconstruction as a frame for
helping grieving LGBTQ þ clients has its limitations. Clients with cognitive
 JOURNAL OF LGBT ISSUES IN COUNSELING 247

processing disorders or who possess some intellectual or developmental dis-

orders may not be good candidates for interventions centered on meaning
making. Clients who identify with more collectivistic cultures may benefit
from the use of a modified version of this model, such as working within a
group or family rather than individual counseling.
Counselors should also assess clients’ developmental levels to deter-
mine whether and in what ways a meaning reconstruction perspective
might be helpful, perhaps in conjunction with other counseling
approaches. The Family Bereavement Program, for instance, incorporates
concurrent child and caregiver sessions focused on parenting, expression
and coping, resilience, and communication skills (Ayers et al., 2014).
Although building a coherent narrative is an aspect of the program,
developers emphasize that it is more important for young clients to tell
their stories, thus strengthening connections with others, and to be
allowed to express what they wish to express without being inhibited
(Sandler & Ayers, 2002). Similarly, an LGBTQ þ adolescent who is
struggling with the developmentally typical feeling that “everyone is
watching and judging me” and who is also grieving a loss may need
help first working through self-inhibiting behaviors before integrating
the meaning of the loss into their narrative.
A final consideration concerns counselors’ role as witness and cocon-
structor when utilizing meaning reconstruction with clients. Counselors
hold power in the therapeutic relationship and carry identities of varying
degrees of privilege or marginalization. Because of the strongly relational
nature of working from a meaning reconstruction lens, counselors should
take great care to continually assess how their identities “come into the
room” and enter the work (Ratts, Singh, Nassar-McMillan, Butler, &
McCullough, 2016). They may do this through seeking supervision, moni-
toring relational dynamics and attending to potential shifts in tone, and
refreshing their knowledge and skills related to working with
LGBTQ þ clients.
Although the research base for this model has been growing apace, none
has focused specifically on its use with LGBTQ þ clients grieving a loss.
However, because of its versatility and emphasis on developing and sup-
porting client agency, meaning reconstruction as an approach to help this
population shows considerable promise. Future research studies could pro-
vide valuable insight into how it may be most applicable and efficacious,
particularly with respect to disenfranchised grief related to non-death
losses. Further research may also highlight how LGBTQ þ clients create
meaning in unique ways across various types of loss experiences, which
may inform how scholars and practitioners can adapt current practices
used with the general population.
248 L. S. WHEAT AND N. E. THACKER

ORCID
Laura S. Wheat http://orcid.org/0000-0002-4747-150X

References
ALGBTIC LGBQQIA Competencies Taskforce. (2013). Association for Lesbian, Gay,
Bisexual, Transgender Issues in Counseling competencies for counseling with lesbian,
gay, bisexual, queer, questioning, intersex, and ally individuals. Journal of LGBT Issues in
Counseling, 7, 2–43. doi:10.1080/15538605.2013.755444
American Counseling Association. (2010). Competencies for counseling transgender clients.
Journal of LGBT Issues in Counseling, 4, 135–159. doi:10.1080/15538605.2010.524389
Arthur, D. P. (2015). Social work practice with LGBT elders at end of life: Developing prac-
tice evaluation and clinical skills through a cultural perspective. Journal of Social Work
in End-of-Life and Palliative Care, 11(2), 178–201. doi:10.1080/15524256.2015.1074141
Ayers, T. S., Wolchik, S. A., Sandler, I. N., Twohey, J. L., Weyer, J. L., Padgett-Jones, S.,
… Kriege, G. (2014). The Family Bereavement Program: Description of a theory-based
prevention program for parentally-bereaved children and adolescents. Omega - Journal of
Death and Dying, 68(4), 293–314. doi:10.2190/OM.68.4.a
Beagan, B. L., & Hattie, B. (2015). Religion, spirituality, and LGBTQ identity integration.
Journal of LGBT Issues in Counseling, 9(2), 92–117. doi:10.1080/15538605.2015.1029204
Bordere, T. C. (2016). Social justice conceptualizations in grief and loss. In D. L. Harris, &
T. C. Bordere (Eds.), Handbook of social justice in loss and grief: Exploring diversity,
equity, and inclusion (pp. 9–20). New York, NY: Routledge.
Boss, P. (2006). Loss, trauma, and resilience: Therapeutic work with ambiguous loss. New
York, NY. W. W. Norton.
Bristowe, K., Hodson, M., Wee, B., Almack, K., Johnson, K., Daveson, B. A., … Harding,
R. (2018). Recommendations to reduce inequalities for LGBT people facing advanced ill-
ness: ACCESSCare national qualitative interview study. Palliative Medicine, 32(1), 23–35.
doi:10.1177/0269216317705102
Bristowe, K., Marshall, S., & Harding, R. (2016). The bereavement experiences of lesbian,
gay, and/or trans people who have lost a partner: A systematic review, thematic synthe-
sis and modelling of the literature. Palliative Medicine, 30(8), 730–744. doi:10.1177/
0269216316634601
Broderick, D. J., Birbilis, J. M., & Steger, M. F. (2008). Lesbians grieving the death of a
partner: Recommendations for practice. Journal of Lesbian Studies, 12(2–3), 225–235.
doi:10.1080/10894160802161380
Burnes, T. R., & Singh, A. A. (2016). “Gay in the Bank, Queer in the Streets”: The intersec-
tion of LGBTQQ and social class identities. Journal of LGBT Issues in Counseling, 10(1),
55–71. doi:10.1080/15538605.2015.1138096
Cacciatore, J., & Raffo, Z. (2011). An exploration of lesbian maternal bereavement. Social
Work, 56(2), 169–177. doi:10.1093/sw/56.2.169
Chan, C. D. (2017). A critical analysis of systemic influences on spiritual development for
LGBTQ þ youth. Journal of Child and Adolescent Counseling, 3, 146–163. doi:10.1080/
23727810.2017.1341795
Chapple, H. S., Bouton, B. L., Chow, A. Y. M., Gilbert, K. R., Kosminsky, P., Moore, J., &
Whiting, P. P. (2017). The body of knowledge in thanatology: An outline. Death Studies,
41(2), 118–125. doi:10.1080/07481187.2016.1231000
 JOURNAL OF LGBT ISSUES IN COUNSELING 249

Chauveron, L. M., Alvarez, A., & van Eeden-Moorefield, B. (2017). The co-evolution of
marriage and parental rights of gays and lesbians. Journal of GLBT Family Studies, 13(2),
114–136. doi:10.1080/1550428X.2016.1187105
Cohn, A. S. (2014). Romeo and Julius: A narrative therapy intervention for sexual-minority
couples. Journal of Family Psychotherapy, 25(1), 73–77. doi:10.1080/08975353.2014.881696
Collings, C. (2007). That’s not my child anymore! Parental grief after Acquired Brain
Injury (ABI): Incidence, nature and longevity. British Journal of Social Work, 38(8),
1499–1517. doi:10.1093/bjsw/bcm055
Day, J., & Higgins, I. (2016). Mum’s absence(s): Conceptual insights into absence as loss
during a loved one’s delirium. Journal of Clinical Nursing, 25(13–14), 2066–2073.
doi:10.1111/jocn.13268
Doka, K. (Ed.). (2002). Disenfranchised grief: New directions, challenges, and strategies for
practice. Champaign, IL. Research Press.
Elderton, A., Clarke, S., Jones, C., & Stacey, J. (2014). Telling our story: A narrative therapy
approach to helping lesbian, gay, bisexual and transgender people with a learning disabil-
ity identify and strengthen positive self-identity stories. British Journal of Learning
Disabilities, 42(4), 301–307. doi:10.1111/bld.12075
Genevro, J. L., Marshall, T., & Miller, T. (2004). Report on bereavement and grief research.
Death Studies, 28(6), 491–575. doi:10.1080/07481180490461188
Gillies, J., Neimeyer, R. A., & Milman, E. (2015). The Grief and Meaning Reconstruction
Inventory: Initial validation of a new measure. Death Studies, 39(2), 61–74. doi:10.1080/
07481187.2014.907089
Green, L., & Grant, V. (2008). “Gagged grief and beleaguered bereavements?” An analysis
of multidisciplinary theory and research relating to same sex partnership bereavement.
Sexualities, 11(3), 275–300. doi:10.1177/1363460708089421
Harris, D. L. (2013). Infertility and intimacy: Life’s layered losses. In B. DeFord, & R. B.
Gilbert (Eds.), Living, loving and loss: The interplay of intimacy, sexuality and grief
(pp. 101–118). New York, NY. Routledge.
Holland, J. M., Currier, J. M., & Neimeyer, R. A. (2006). Meaning reconstruction in the
first two years of bereavement: The role of sense-making and benefit-finding. Omega -
Journal of Death and Dying, 53(3), 175–191. doi:10.2190/FKM2-YJTY-F9VV-9XWY
Holland, J. M., & Neimeyer, R. A. (2010). An examination of stage theory of grief among
individuals bereaved by natural and violent causes: A meaning-oriented contribution.
Omega - Journal of Death and Dying, 61(2), 103–120. doi:10.2190/OM.61.2.b
Hornjatkevyc, L., & Alderson, K. G. (2011). With and without: The bereavement experien-
ces of gay men who have lost a partner to non-AIDS-related causes. Death Studies,
35(9), 801–823. doi:10.1080/07481187.2011.553502
Jenkins, C. L., Edmundson, A., Averett, P., & Yoon, I. (2014). Older lesbians and bereave-
ment: Experiencing the loss of a partner. Journal of Gerontological Social Work, 57(2–4),
273–287. doi:10.1080/01634372.2013.850583
Kum, S. (2017). Gay, gray, black, and blue: An examination of some of the challenges faced
by older LGBTQ people of color. Journal of Gay and Lesbian Mental Health, 21(3),
228–239. doi:10.1080/19359705.2017.1320742
Matthews, C. H., & Salazar, C. F. (2012). An integrative, empowerment model for helping
Lesbian, Gay, and Bisexual youth negotiate the coming-out process. Journal of LGBT
Issues in Counseling, 6(2), 96–117. doi:10.1080/15538605.2012.678176
McLean, R., & Marini, I. (2008). Working with gay men from a narrative counseling per-
spective: A case study. Journal of LGBT Issues in Counseling, 2(3), 243–257. doi:10.1080/
15538600802120085
250 L. S. WHEAT AND N. E. THACKER

McNutt, B., & Yakushko, O. (2013). Disenfranchised grief among lesbian and gay bereaved
individuals. Journal of LGBT Issues in Counseling, 7(1), 87–116. doi:10.1080/15538605.
2013.758345
Mosher, C. M. (2001). The social implications of sexual identity formation and the com-
ing-out process: A review of the theoretical and empirical literature. The Family Journal,
9(2), 164–173. doi:10.1177/1066480701092011
Nadal, K. L., Wong, Y., Issa, M.-A., Meterko, V., Leon, J., & Wideman, M. (2011). Sexual
orientation microaggressions: Processes and coping mechanisms for lesbian, gay, and
bisexual individuals. Journal of LGBT Issues in Counseling, 5(1), 21–46. doi:10.1080/
15538605.2011.554606
Neimeyer, R. A. & Thompson, B. E. (Eds.). (2014). Grief and the expressive arts: Practices
for creating meaning. New York, NY: Routledge.
Neimeyer, R. A. (2006). Lessons of loss: A guide to coping. Memphis, TN. Center for the
Study of Loss and Transition.
Neimeyer, R. A. (2016). Meaning reconstruction in the wake of loss: Evolution of a
research program. Behaviour Change, 33(2), 65–79. doi:10.1017/bec.2016.4
Neimeyer, R. A. (Ed.). (2001). Meaning reconstruction and the experience of loss.
Washington, DC. American Psychological Association.
Neimeyer, R. A., & Jordan, J. R. (2013). Historical and contemporary perspectives on
assessment and intervention. In D. K. Meagher., & D. E. Balk (Eds.), Handbook of thana-
tology (2nd ed., pp. 219–238). New York, NY. Routledge.
Neimeyer, R. A., Klass, D., & Dennis, M. R. (2014). A social constructionist account of
grief: Loss and the narration of meaning. Death Studies, 38(8), 485–498. doi:10.1080/
07481187.2014.913454
Neimeyer, R. A., & Sands, D. C. (2011). Meaning reconstruction in bereavement: From
principles to practice. In R. A. Neimeyer, H. Winokuer, D. Harris., & G. Thornton
(Eds.), Grief and bereavement in contemporary society: Bridging research and practice
(pp. 9–22). New York, NY. Routledge.
Neimeyer, R. A., & Young-Eisendrath, P. (2015). Assessing a Buddhist treatment for
bereavement and loss: The Mustard Seed Project. Death Studies, 39(5), 263–273.
doi:10.1080/07481187.2014.937973
Newport, F. (2014). LGBT population in U.S. significantly less religious. Retrieved from
http://www.gallup.com/poll/174788/lgbtpopulation-significantly-less-religious.aspx
Obergefell v. Hodges, (2015). 556 S. Ct. 3204. Retrieved from https://www.supremecourt.
gov/opinions/14pdf/14-556_3204.pdf
Ratts, M. J., Singh, A. A., Nassar-McMillan, S., Butler, S. K., & McCullough, J. R. (2016).
Multicultural and social justice counseling competencies: Guidelines for the counseling
profession. Journal of Multicultural Counseling and Development, 44, 28–48. doi:10.1002/
jmcd.12035
Robbins-Welty, G., Stahl, S., Zhang, J., Anderson, S., Schenker, Y., Shear, M. K., …
Reynolds, C. F. (2018). Medical comorbidity in complicated grief: Results from the
HEAL collaborative trial. Journal of Psychiatric Research, 96, 94–99. doi:10.1016/j.jpsy-
chires.2017.09.017
Roe, S. (2017). “Family support would have been like amazing”: LGBTQ youth experiences
with parental and family support. The Family Journal, 25(1), 55–62. doi:10.1177/
1066480716679651
Rolbiecki, A. J., Washington, K., & Bitsicas, K. (2017). Digital storytelling: Families’ search
for meaning after child death. Journal of Social Work in End-of-Life and Palliative Care,
13, 239–250. doi:10.1080/15524256.2017.1387216
 JOURNAL OF LGBT ISSUES IN COUNSELING 251

Salazar, C. F. (2006). Conceptualizing multiple identities and multiple oppressions in cli-

ents’ lives. Counseling and Human Development, 39, 1–18. Retrieved from https://www.
highbeam.com/publications/counseling-and-human-development-p104229
Sandler, I. N., & Ayers, T. S. (2002). Response. Journal of Palliative Medicine, 5(6),
942–943. Retrieved from https://home.liebertpub.com/publications/journal-of-palliative-
medicine/41
Shear, M. K. (2015). Complicated grief. New England Journal of Medicine, 372(2), 153–160.
doi:10.1056/NEJMcp1315618
Shear, M. K., Boelen, P. A., & Neimeyer, R. A. (2011). Treating complicated grief:
Converging approaches. In R. A. Neimeyer, D. L. Harris, H. R. Winokuer., & G. F.
Thornton (Eds.), Grief and bereavement in contemporary society: Bridging research and
practice (pp. 139–162). New York, NY: Routledge.
Steelman, S. M. (2016). Externalizing identities: An integration of narrative therapy and
queer theory. Journal of Family Psychotherapy, 27(1), 79–84. doi:10.1080/08975353.2016.
1136549
Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice 7th ed,
Hoboken, NJ: Wiley.
Sumerau, J. E., Cragun, R. T., & Mathers, L. A. B. (2016). “I found God in the glory hole”:
The moral career of a gay Christian. Sociological Inquiry, 86(4), 618–640. doi:10.1111/
soin.12134
Wester, S. R. (2008). Male gender role conflict and multiculturalism: Implications for coun-
seling psychology. The Counseling Psychologist, 36(2), 294–324. doi:10.1177/
0011000006286341
Wood, A. W., & Conley, A. H. (2014). Loss of religious or spiritual identities among the
LGBT population. Counseling and Values, 59(1), 95–111. doi:10.1002/j.2161-007X.2014.
00044.x