Research Article

Qualitative Health Research

2023, Vol. 0(0) 1–15
Experiences of Fathers in Norway © The Author(s) 2023

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Therapeutic Writing After the DOI: 10.1177/10497323231216099
journals.sagepub.com/home/qhr
Death of a Child

Olga V. Lehmann1 , Trine Giving Kalstad2,3, and Robert A. Neimeyer4,5

Abstract
After the unexpected death of a child, bereaved parents require prompt access to helpful support systems. Online
therapeutic writing courses can make such support accessible. Because few studies have included bereaved fathers as
participants, we explored the experiences of fathers whose children died unexpectedly and who were part of an online
course of therapeutic writing in Norway. We piloted two courses (group 1, six weeks, n = 9; group 2, 5 weeks, n = 5).
We describe our methodological considerations for using poetic representations in qualitative health research and
present four poetic representations based on fieldwork notes written by the principal investigator. Then, we triangulate
and narratively analyze them together with two collective poems written by participants from each group; excerpts of
the writings from two fathers, one per group; evaluation surveys (n = 4; n = 3); and, anonymous check-out journaling
from the second group (n = 3). Resistance was a salient feature of our participants’ grief, and writing enabled them to both
be in contact with their emotional world and process difficult emotions as they looked for meaning despite the death of
their children. Those who attended the most classes perceived the course as transformative, being part of an ongoing
self-exploration, and a possibility to continue and strengthen the bond with their children. Our findings mirror the
complexities of the grief experiences of fathers, giving account of their need to find a rhythm to dive into their emotional
world, the importance of peer support, and the value of diversifying intervention techniques to meet individual needs and
preferences.

Keywords
therapeutic writing, grief, bereaved fathers, resistance, emotions, meaning-making, poetic representations, journaling,
online groups

There are too few empirically based treatments that ac- healthcare professionals mind how factors such as gender,
knowledge individual differences in grief, and many of the developmental stage of parents, and the relational
those available treatments are not as helpful for bereaved nuances with their deceased child can lead to unique
parents as for other bereaved people (Pelacho-Rios & journeys of grief integration (Pedraza et al., 2023).
Bernabe-Valero, 2022). Bereaved parents can be at a
heightened risk of developing disorders such as prolonged
1
grief, posttraumatic stress, anxiety, and/or depression Department of Social Sciences, University of Stavanger, Stavanger,
(Aoun et al., 2015; Bottomley et al., 2022). Still, about Norway
2
The Norwegian SIDS and Stillbirth Association, Oslo, Norway
two-thirds perceive that they are not receiving sufficient 3
Department of Crisis Psychology, University of Bergen, Bergen,
support as they grieve (Aoun et al., 2015). When the death Norway
of a child is unexpected, such as in the case of perinatal 4
Department of Psychology, University of Memphis, Memphis, TN, USA
5
loss or SIDS, there are not enough support systems to Portland Institute for Loss and Transition, Portland, USA
follow up parents in an often traumatic and challenging
Corresponding Author:
process of grief (Corno et al., 2020). Person-centered and Olga V. Lehmann, Department of Social Sciences, University of
individualized support has shown positive effects in Stavanger, Kjell Arholms hus, Stavanger 4021, Norway.
helping bereaved parents (Dyregrov et al., 2000), and Email: [email protected]
2 Qualitative Health Research 0(0)

Parents who either feel overwhelmed or feel the Research findings about men’s experiences of grief can
need to avoid any expression of grief and mourning be contradictory. Some reports indicate that fathers re-
tend to struggle the most adapting to life after the death spond to grief according to masculine gender roles and
of their children (Barrera, 2007). In terms of couple social norms, coping with their feelings privately and
dynamics, both bereaved parents are said to have avoiding or silencing their grief while being rational,
shared spaces for affective processing such as pro- instrumentally oriented, and emotionally detached (Mota
viding each other consolation, as well as remembering et al., 2023; Williams et al., 2020; Zylla, 2017). Fearing a
and maintaining the bonds with the child over time breakdown, men can also keep busy as a coping strategy,
(Bergstraesser, 2015). Some important themes to help and this motivation competes with wanting or having the
parents process and integrate their grief could be ac- need to hold space to relate with their dead child in their
knowledging emotions, resolving unfinished business, daily life (Proulx et al., 2016).
and building a form of legacy for the child (Moriconi & Bereaved parents feel grateful for receiving person-
Cantero-Garcı́a, 2022). centered psychosocial support where their feelings of
Writing is one among many tools that can support sadness or anger are met and validated (Cacciatore
individuals and families to attend to their emotional ex- et al., 2013). Other feelings, such as shame and guilt,
periences as well as finding motivation and meaning as appear to be relevant as well and require attention when
they nurture the bond with their deceased sons or providing support (Barr, 2012). Selected findings
daughters. Writing can help people embrace the emotional suggest that bereaved fathers would benefit more from
tonalities in their memories and imagination in a way that emotionally oriented interventions (Schut et al., 1997),
restores and helps them shape identity with a sense of that is, from that which is in opposition to the social
dignity as they adapt to life course’s challenges (Lehmann representations of their gender. Other perspectives
& Synnes, 2023). Therapeutic writing promotes affective imply that people who cope with grief in more in-
processing and meaning-making about what makes us strumental forms—a more cognitive, action-oriented
suffer—grief, in the case of this article, and thriving in life style often associated with men’s experiences—will
despite such suffering. Scholars have described the seldom participate in individual or group forms of
structure and the intend of therapeutic writing techniques support, especially if such support forms prioritize
in different ways, some of them more focused on exposure emotional ventilation over other tools (Doka et al.,
to the traumatic experiences (Pennebaker, 1997), and 2010). In general, men are less likely to seek psy-
some others, more focused on the creative and dialogical chotherapy, and when they do, their dropout rate could
aspects that writing itself can evoke (Neimeyer, 1999, be 45% or higher (Seidler et al., 2021).
2012). Either used by the own initiative of the bereaved, as When it comes to bereavement support groups, some
part of low-threshold and/or specialized interventions, research even suggests that male participants experi-
writing has proven to have therapeutic effects. The lit- ence an increase in depression symptoms and a decrease
erature in psychology and the humanities provides solid in energy and vigorous mood (Maruyama & Atencio,
support for the therapeutic effects writing can have when 2008). The way emotions are approached in these in-
it enhances affective processing and meaning-making of terventions, whether these mood changes are temporary
grief, trauma, life transitions, and many other circum- or not, and whether they are a part of affective pro-
stances (Den Elzen et al., 2023; Den Elzen & Lengelle, cessing of difficult emotions remain to be studied.
2023; Neimeyer, 1999; Pennebaker & Smyth, 2016; Innovating in mental health support for men requires a
Steffen et al., 2022). profound understanding of men’s motivations and ex-
In the present study, we target writing among bereaved pectations to develop helpful interventions for them.
fathers because very little research on bereavement after Whatever the reasons for men to grieve the way they do,
the unexpected death of a child includes men as partic- researchers and practitioners need to map their needs
ipants (Kersting et al., 2013; Mota et al., 2023). The and wants while integrating perspectives of gender,
literature available on the topic centers mostly on parents personality, and culture. Therefore, research and de-
whose children die due to chronic illnesses such as cancer velopment efforts targeting the exploration of the lived
(Aho, 2009). Meta-analyses emphasize how grief expe- experiences of bereaved parents are crucial to map their
riences differ between women and men, which leads them needs and preferences and include these in low-
to respond differently to interventions (Shut et al., 2001). threshold and/or specialized support systems. In the
Among other factors, men can experience a lack of ac- present article, we aim at portraying narratives about
knowledgment for their needs in grieving, receive less the emotional world of men in relation to their grief and
attention from healthcare providers, and experience answer the following questions: what are the lived
pressure to support their female partners (Mota et al., experiences after the unexpected death of a child that
2023; Obst et al., 2020). men speak about in an online course on therapeutic
Lehmann et al. 3

writing? How do fathers whose children have died letters to other course participants, to oneself, and to the
unexpectedly experience being part of such a course on deceased (Hedtke, 2012; Neff & Germer, 2018; Neimeyer,
therapeutic writing? 2012). Other activities featured more implicit forms of
dialogue within the self, using creative and imaginative
tasks, such as sketching the table of contents of one’s
Methodology biography (Neimeyer, 2011) or writing about grief using
Study Participants poems or songs as prompts (Metcalf & Simon, 2002).
Independent of these different practices, writing served as
Nine participants enrolled in the first course; five attended a platform for dialogue between the participants with
all six sessions, while the other four attended some of the diverse aspects of their identity, their partners, healthcare
sessions. Five fathers enrolled in the second course, three professionals, other peers, and their children.
of them attended all the sessions, one attended some of the
group sessions and the individual guidance sessions, and Implementing the Writing Courses. We facilitated the first of
one withdrew from the course, asking if he could instead our writing courses for bereaved fathers in the autumn of
receive only the emotional first aid from a psychologist. 2022 for 6 weeks with 3-hour weekly encounters and a 30-
All of them resided in Norway, living in six different cities minute session of individual feedback about a chosen text.
of the country. The average age of the participants was Given the positive response to the individual sessions, we
35 years. The main causes of death of their children were reorganized the structure of the second course, running it
sudden infant death syndrome (SIDS) or stillbirth (n = 9), for 5 weeks in the spring of 2023 with 2.5-hour weekly
illness, accident, or not reported (n = 5). Aside from two encounters, along with three 30-minute sessions of in-
participants who enrolled in courses 14 and 18 years after dividual feedback on the chosen text. All participants
the death of their children, the average length of the grief were offered two free emotional “first aid” sessions with a
of the participants was 15 months. The average age of the psychologist to process the difficult emotions that would
children who died by illness and accident was 2.8 years, arise in the course. Both the emotional first aid and in-
while for the rest of the participants, the children were dividual feedback sessions were popular, even among the
born dead or died within a few days after birth. participants who dropped out or did not attend all the
sessions of the course.
The principal investigator met the study participants
Our Writing Courses
via Zoom. Each evening session started with a practice of
For our study, we integrated techniques from diverse mindful transition into writing and check-in journaling
theoretical backgrounds in psychotherapy and the hu- with incomplete sentences about their feelings at the
manities, following the premises of pluralistic psycho- moment. Psychoeducation about the week’s topic (hope,
therapy. Pluralistic psychotherapy emphasizes that human dialogue, compassion toward shame and anger, self-
beings have different needs and wants and that providing a compassion loving-kindness, and meaning of life, re-
diversity of techniques and models will make it more spectively) in relation to grief, emotions, and existential
probable to meet these differences of individuals (Cooper meaning was provided. The writing practices consisted of
& McLeod, 2007). Pluralistic approaches to grief and individual tasks and reflective questions in small groups
bereavement have proven to have significant and long- and in plenary sessions, to foster emotional awareness,
lasting positive effects among their users (Steffen et al., affective processing, and meaning-making. Participants
2022). In Table 1, we present a detailed outline of the were encouraged to decide for themselves how little or
course, with a brief description of the psychoeducation how much to write, as well as how little or how much to
and writing practices that we used in both groups. Most of share with one another. To promote a sense of safety and
the sessions were alike for both groups. However, as this rhythm for the group dynamics, participants were also
was a research and development (R&D) project, small reminded that they could speak about their inner processes
modifications were introduced in group 2 in order to while writing without reading the exact words they wrote.
attend to some of the feedback from participants in group At the end of each session, the participants journaled
1. The general aspects of the course structure and contents based on check-out reflective prompts and received at-
are based on a previous study on online writing courses home practice.
among mothers in Norway (Lehmann et al., 2022).
Independently of the theoretical premises of the diverse
techniques that we used, one of the intentions of these
Data Collection and Data Analysis
techniques was to promote genuine dialogues between Poetic Representations. We crafted four poetic represen-
participants and others and parts of themselves. Some of tations based on fieldnotes from the principal investigator
the practices implied explicit dialogue in the form of while facilitating the two writing courses. These fieldnotes
4 Qualitative Health Research 0(0)

Table 1. Structure and Contents of the Writing Courses for Bereaved Fathers.

Practices repeated every session Week Writing practices and psychoeducation sessions per week

Mindful transition. Guided meditation in 1 Adapted version of proprioceptive writing (Metcalf & Simon, 2002): Listening to a
group 1. Written practice of piece of music and reconstructing experiences about it. Includes reflective
awareness where participants questions
describe what they notice in their Psychoeducation about therapeutic writing (Neimeyer, 1999, 2012; Pennebaker &
surroundings and within for group 2 Smyth, 2016)
Check-in: Incomplete sentences about Chapters of our lives: Writing the table of contents of one’s autobiography followed
what participants feel and do not feel by reflective questions (Neimeyer, 2011)
in regard to grief and the course as 2 Psychoeducation about the dual process model of grief (Stroebe & Schut, 2010)
they start the session Acrostic with the letters in the name of the child who has died
Check-out: What have I learnt today 3 Shared reading of Rumi’s poem “The guest house” (Jalal al-Din & Barks, 1996)
about grief/writing/myself? Psychoeducation on the dialogical self theory (Hermans, 2001)
The guests of the inner house: Bringing the wisdom of silent aspects of one’s identity
forward through reflective questions (Lehmann et al., 2022)

Group 1: Autumn 2022 Group 2: Winter 2023

4 Psychoeducation about anger and Psychoeducation about anger, guilt,

meaning (Frankl, 1990; Pascual Leone shame, and meaning (Frankl, 1990;
& Paivio, 2013). Greenberg & Iwakabe, 2011; Lengelle
et al., 2016; Pascual Leone & Paivio,
2013)
Adaptation of the practice “How would Participants write a dialogue between
you treat a friend” (Neff & Germer, parts of themselves that are stuck with
2018) shame and parts of themselves that
bring in compassion
Practices that remained the same in both groups
Psychoeducation about compassion and self-compassion (Lehmann, 2018; Lehmann
et al., 2022; Neff & Germer, 2018; Shulz & Monin, 2018)
Writing about the unfairness beneath anger and what one can possibly learn about it

Group 1: Autumn 2022 Group 2: Winter 2023

5 Psychoeducation about shame and Modified version of “Introducing a loved

meaning (Greenberg & Iwakabe, 2011; one” (Hedke, 2012) where parents
Lengelle et al., 2016) introduce their grief in a third person
narrative
Participants write a dialogue between
parts of themselves that are stuck with
shame and parts of themselves that
bring in compassion
Modified version of “Introducing a loved Same practices as in week 6 for group 1
one” (Hedke, 2012) where parents
introduce their grief in a third person
narrative
6 Second version of chapters of our lives: N/A
Writing the table of contents of one’s
autobiography followed by reflective
questions (Neimeyer, 2011).
Reflective questions about it and
comparison with draft from week 1
Modified version of “correspondence
with the deceased” (Neimeyer, 2012).
Participants write a letter to their child
Writing a collective poem with the
prompt “a door is opened”
Lehmann et al. 5

mainly contained summaries of what participants said attention to the key events and the stories these events
in the discussions in the plenary group, session by form, how characters are positioned in the script of the
session (11 weeks total). Poetic representations are narrative, and the emotional nuances in the narratives
emotionally compelling syntheses, here in the form of (Silver, 2018).
free verse poems written based on data from study The first two pieces consisted of short poems
participants (Faulkner, 2005, 2009). In qualitative written collectively in the chat during the last session
health research, poetic representations are relevant of each course. The other pieces were two poems
because they can provide insights into the bodily ex- written by a participant from each of the two courses
periences of the suffering of participants (Ohlen, 2003), and a summary table of the check-in and check-out
evoking the multi-voicedness of experiences within a journaling week by week shared by one of these fa-
participant and/or across participants. Such syntheses thers. In addition, we included the data from anony-
of data also invite a dialogue among participants, the mous evaluation surveys from both groups, check-out
researchers, and audience of the article (Lehmann & journaling practices from the second group, and an
Brinkmann, 2021). e-mail follow-up with a participant. When possible, we
One can think about these poetic representations as used pseudonyms to refer to the participants and their
spoken word poems rather than a classic poetic form. children. For the data filled out anonymously, we
The process of crafting the poetic representations in- numbered the participants and used the abbreviations
volved the following steps: (a) transcription of the “ES1” or “ES2” to specify if the evaluation survey
fieldnotes, separating the paragraphs into rows; (b) was from the first or second group and then numbered
adding an extra column with codes that summarize the the participants, and we used “CHO” for check-out
contents of each paragraph; (c) adding an additional journaling specifying the session.
column for analytical remarks and themes; (d) refining
the codes and finding overarching themes for them; (e) Reflexivity of the Principal Investigator. The practice of
sketching poems to reflect key themes; (f) reading the writing fieldnotes when facilitating online groups grounds
poems several times and reorganizing the wording and me. Attending to different emotional rhythms, life stories,
polishing the themes; (g) sending the poems to the and perspectives is humbling; it asks for my listening and
coauthors of the article for feedback; (h) sending the of my remembrance. A participant read once a line from
poems to the study participants for feedback; (i) in- an unfinished poem, reiterating the struggle to find words
corporating feedback and synthesizing the poems that were faithful to his suffering and to the urge for
to reduce their length; and (j) refining the aesthetics of finding a way back to a life rhythm. The heartbeat of his
the stanzas while keeping faithful to the fieldnote desire to cherish words continued to resonate in me; he
transcriptions. reminded me of the power and responsibility of my own
The final product corresponded to four poetic repre- words. As researchers, we often write about the experi-
sentations with the following themes: (a) grief and time ences of our participants in rather complicated ways;
about their experiences of temporality in grief, for some as creative methods in qualitative inquiry are powerful tools
nuanced by the pandemic; (b) owning one’s emotions, to come closer to our participants: they enable us to speak
regarding the participants’ experience of emotions and from and to our human condition.
emotional processing; (c) parallel fatherhoods, about the There is much that happens in the context of writing
ambiguous experiences of being fathers of a dead child groups that transcends writing itself. It is about the
while opening themselves for new pregnancies; and (d) sense of reciprocity being nurtured in these meetings
grieving as a process, highlighting the participants’ ex- (Lehmann & Brinkmann, 2019). What a participant
periences of grief and meaning-making from a dialogical shares can echo or provide perspective to the experi-
perspective. ences of another. They might share the struggle to find
words to the ineffable and, while crafting a sense of
Narrative Analysis of the Poetic Representations and the togetherness, sow the fabric of grief with soft and
Participant’s Writings. In order to ensure the qualitative rough edges. The blanket of their words is a companion
validity of our poetic representations, we contrasted them as each of them transits the storm of difficult emotions
with other forms of data and analyzed all these materials and traumatic memories at their own rhythm. I wrote
narratively. We followed the premises of narrative psy- the four poetic representations as an attempt to inter-
chology, where stories are central to human experience weave the threads of unique life stories of my par-
and existence, and researchers are to collect data that ticipants, mirroring the complexities of masculine
resembles how the psychological life of participants is like grief.
through the meaning-making processes that give account Given how tragic it is to be given and withdrawn
of it (Josselson & Hammack, 2021). In specific, we paid from a child too quickly, I wanted to voice for these
6 Qualitative Health Research 0(0)

bereaved fathers what I felt to be true in the 11 weeks I I try moving on with life. It works.
attended to their longings. Aware of the interpretative Yet, there are reminders,
aspect of my recollection of the fieldnotes, I knew my almost daily, that something isn’t
poems would not be sufficient unless their content as it should be.
would be contrasted with actual narratives from the I struggle when times are good:
participants themselves because my first and foremost Am I not going deep into grief?
audience is them: I wanted these poems to portray what Will the balloon burst?
is to grief from their perspective, not mine. It is I don’t know if I am including my child
therefore that each of the four poetic representations is enough in my current life.
accompanied by data from surveys, or writings that our When, and how to grieve?
participants shared with us, altogether with reflections Now, writing: a way of grieving.
nourished by academic literature. It’s scary. Perhaps not for me?
Echoes of the future, reminiscences.
Echoes of the past, my own childhood
Ethical Considerations
mirroring current parenthood.
We received the approval number 885234 from the Surprised to travel in time,
Norwegian Agency for Shared Services in Education through emotion. I find lessons,
and Research (SIKT) to carry out this project, given that things I thought I had processed.
our research protocol fulfilled their criteria for data I work on them, once again,
protection. Our project was exempt of approval from I have other resources now.
the Regional Committee for Medicine and Health
On grief and time is a poem that invites us to re-
Research Ethics (REK) because they considered that
consider temporality on the light of suffering and love.
our research protocol did not involve major risks for the
There are phenomenological aspects of mourning that do
participants. Our participants also gave us permission to
not follow a chronological order; they are rather forms of
use excerpts of their own writings in this research
disruptions (Shardlow, 2022). Enabling bereaved fathers
article.
to consider nonlinear approaches to temporality seems to
allow them to reconstruct their identity narratives more
Results and Reflections freely (Barak, 2014). During the course, we briefly
mentioned that both love and grief were to be measured
in terms of the intensity of our feelings, not chrono-
Men’s Grief for a Child in Four Stanzas logical time. What we did not expect was that this theme
would be so recurrent in the descriptions and sharing of
First Stanza: On Grief and Time
our participants, even before the topic was explicitly
Three, eleven months, introduced.
five years, fourteen? Some perceived that the lock-down during the
Time isn’t clear. COVID-19 pandemic affected their perceptions of
Rushing back to work, time, leaving them with several constrains to enroll in
new pregnancies, conventional activities and/or too much time to grieve.
one’s partners’ suffering, It can be overwhelming for parents to deal with the
a pandemic shutting it all down. loss-oriented aspects of grief, and during the COVID-
No travel, no football, no pub, 19 pandemic, the disruption of roles, routines, and
how unjust, “doing” grief relationships imposed further challenges for the be-
in this unnatural manner. reaved to find a time that felt appropriate to grieve
Even for those who had a chance (Hooghe et al., 2021). Yet, the topic of the pandemic
for recreating—trips, drinks, or sports— was not as recurrent as it was the case for the over-
there was not as much room arching emotional tonalities related to grieving. A
to speak about men’s grief, as a norm. sense of ambiguity in terms of how long their grief
Melancholia: feeling like I am missing would last, independent of the number of months or
body parts. Grief is physical for us. years after the death of their children, was a common
Isolated, because of this and that— experience for all participants. The emotional inten-
partly because I resist. sity and the challenges to label and/or process difficult
I have no words, or few words. emotions seemed to rule such ambiguity of time, as we
I let grief freeze, explore in the next section.
Lehmann et al. 7

Second Stanza: How to Own Emotions (Doka et al., 2010; Huang et al., 2023; Schut et al., 1997;
Zylla, 2017). Resisting grief might also reflect the pressure
Paved with resistance, that implicit or explicit social norms about gender impose on
my readiness to grieve, men (Mota et al., 2023; Zylla, 2017). In addition, our par-
to writing. ticipants, as we will exemplify in the next paragraphs, also
The hard parts: needed to develop emotional literacy about difficult emotions
removing the masks such as anger, guilt, and shame (Barr, 2012; Moriconi &
used when telling a grief story. Cantero-Garcı́a, 2022).
An urge to avoid.
Finding words for feelings, Integrating Perspectives: The Participants’ Narratives on
letting feelings be. Emotions. After writing and editing the four poetic rep-
This grief of instances. resentations, we sent them to the course attendants, asking
Grief asks me to say what I mean, for feedback about whether they felt seen and felt the
truly. Not the headlines, words conveyed the experiences of the group. One of
what lies behind. them replied with the following:
An unexplored forest of emotions.
Tension, willingness to be in control. I’m in a period just before the anniversary of the death of my
Disbelief for some memories. daughter, so I struggle to have enough cognitive capacity
Then, there is regret. while reading these poems. In general, I can say that I liked
An autopsy that leads nowhere: them and felt seen in a lot of what you wrote. The challenges
it was no one’s fault. to express ourselves and find words for feelings was the part
Why do I keep wanting to find a cause? that best answered your question about the process in the
What if I could have saved us from this tragedy? course, together with the raw emotions that make it difficult
Unfairness, that’s what I think the most. to share something. (Steinar, father of Lia)
The despair of wanting
to rescue them into life numbs me. Steinar’s words suggest what other parents said in the
I can’t change it. Anger, so much anger. evaluation surveys: that working with emotions and meaning
I fear the anger I feel. during the online course mattered to our participants, even if
Anger is a lonely place, to begin with. they proved difficult. This might indicate, similar to other
Then, I notice the unfinished: research findings, that addressing emotions is relevant in
conversations that didn’t happen, grief interventions for bereaved fathers (Schut et al., 1997).
or didn’t go the way they should, Even if the context of our intervention is different, research
with healthcare, family, or friends. on parenting courses suggest that working with emotions as
Unfinished dialogues with myself, parents is painful and confrontative yet meaningful (Ansar
with my partner, with my child. et al., 2021). For instance, a participant emphasized that
Going into feelings, in a giving way. working with emotions involves resistance and tension:
Now I can see it,
how hindered these emotions I need a bit of time to connect with my feelings. I need to put a
have remained. lid on and keep them at a distance to function at work during
There is also the mundane, the day, and this takes a lot of energy, and I need to “warm up
Honoring other states of mind, a little” or let things in gradually so that I don’t become
the days I want to stay “busier,” overwhelmed. (Participant 2, CHO, day 2)
the days I need to be more practical.
Difficult periods lead to ambivalence. Another participant highlighted in the evaluation survey of
being in contact with their core feelings and that he appre-
How to own emotions is a poetic representation that ciated “being able to write with feelings as a direct departure
evocates the practice of being in contact with one’s own point, without rationalizing them” (Participant 1, ES1).
emotions and the practice of remembrance among our par- However, it can also well be that resistance to it might result in
ticipants. As they grieve, these men attuned with their own feeling overwhelmed and demotivated for some, which also
emotional rhythm, something that can be challenging and is mirrors other perspectives in the literature (Doka et al., 2010).
often experienced in diverse forms of resistance. Such re- There are at least two important aspects to consider in
sistance is not only negative: it belongs to grief, and it can these possible explanations: the cultural nuances of
give account of instrumental aspects of grief that can po- emotional literacy and understanding of fatherhood.
tentially lead to constructive patterns of grief integration Studies on emotional literacy indicate that men who
8 Qualitative Health Research 0(0)

express conformity to masculine norms and expectations can Parallel Fatherhoods is a poetic representation set to
have higher symptoms of depression in general compared convey the ambiguity of affirming our participants’ sense
with other men (Milner et al., 2019). This does not neces- of still being fathers of a child who died too soon, while
sarily mean that men feel at a lower intensity but that, when for some of them this fatherhood merged with the ex-
living in accordance with classic views of masculinity, they perience of having children again. Writing and reflecting
might strive to deal with difficult emotions covertly, which is about their grief, these parents were also authoring their
something that can both give them a sense of mastery and identity. The renewal of identity is an important part of
isolate them or help them avoid emotional processing (Cook, the process of integrating grief into everyday life (Den
1988). Even if there are few studies about the ways in which Elzen, 2021; Gillies et al., 2013; Lengelle, 2021). This
culture affects emotional literacy, regulation, and expression theme appeared to be as relevant for the fathers as it was
in Norway, preliminary findings have suggested that Nor- for the women who attended online writing courses
wegian students are less likely to perceive themselves as (Lehmann et al., 2022). As part of this process, parents
aware and sensitive to emotional expression and control often imagine the possible lives their children could have
when compared with American students (Hystad et al., lived, feeling confronted with how difficult it can be to
2010). At the same time, Norway, like other Nordic continue a bond while having lost them at such an early
countries, has promoted a change in the social representa- age (Milman & Rheingold, 2023). The life trajectories of
tions of fatherhood, aspiring to gender equality. This means people who undergo transitions such as the death of a
that, nowadays, Norwegian fathers are expected to engage beloved one are unique, giving expression to diverse
actively in the care of the child without this threatening their pathways to find existential meaning (Lehmann &
sense of masculinity (Magnunsson et al., 2008). This adds to Brinkmann, 2021).
the complex landscape of the possible experiences of our
participants, showing why a focus on culture in further Integrating Perspectives: The Participants’ Narratives on
studies would be crucial to gain a better understanding of the Fatherhood. In the evaluation survey, some participants
needs and wants of bereaved parents. shared that loneliness, the challenges of being a father,
death, and long-term illness were the most difficult
Third Stanza: Parallel Fatherhoods topics to write about. At the same time, there was also a
All we should have lived, sense of appreciation for being in the course and
together. writing, even if it was difficult. One participant said, “It
The dreams of a playful childhood, was nice to see that there were many others in the same
interrupted unknown territory as me” (ES1), and another added that
by illness, accidents, the unknown. he learned “that I can withstand my grief—the painful
A pregnancy, a birth, a funeral. and the good about it” (ES2). In recognizing this, some
Duality: being in a maternity ward, of our participants affirmed that if writing becomes an
families welcoming a new member, opportunity for both meaning-making and affective
and we, saying goodbye. processing, it is likely to have therapeutic effects (Den
To be a father once more. Elzen et al., 2023; Lehmann et al., 2022; Neimeyer,
No one understands … they say, 1999; Pennebaker & Smyth, 2016). The following two
“you must be stronger.” cases bring forward the theme of identity and father-
Stronger? hood, along with how challenging it can be to integrate
It’s difficult as hell to remain enthusiastic a parallel fatherhood.
as new pregnancies arrive.
How to prepare for an upcoming birth? Artur’s Case. Artur’s poetic prose, Grieving Nora,
My role as a father of other children, consists of 74 lines and is a philosophical questioning that
Celebrating a death anniversary helped him honor the absurd. Some of his existential
just days before a new child is born. inquiries appear once in the text, such as “Suffering?
Life in its raw nuances. Uneasiness? Insomnia? Longing for closeness?” (line 1)
Some find their way or “Is one one’s own source? With voice, thoughts,
to new pregnancies, new children, meanings, and feelings?” (lines 8–9). Other questions are
some don’t. repeated, evoking the piercing willingness to affirm his
A question sneaks in: daughter’s ephemeral presence, “How are you?” (lines 14,
will we survive this as a couple? 21, and 30), “who could you have become” (lines 14 and
While proud to have become a father, 16), or “were you?” (lines 14, 31, and 44). This is the story
some days are easier than others. of a father who makes a promise: “I will never forget you
Lehmann et al. 9

… even if our time together was so short” (lines 62–64); This stanza gives an account of the father–child re-
and the story of a father who asks for a promise: “Never lationship that emerges during pregnancy, along with the
stop visiting me” (line 70), followed by the grand finale “I wish of many fathers for connecting emotionally with
love you/Nora’s dad, and ‘Noravind’ [Nora’s wind] we their child during pregnancy (Bonnette & Broom, 2012).
follow” (Lines 73 and 74). Fred also reflected the importance of continuing the bond
In addition, Artur shared (see Table 2) a summary of with the deceased as part of grief integration (Klass, 2006)
his check-in and check-out journaling week by week, because it seems that his daughter, Sol, catalyzed a
giving an account of an evolving process of meaning- process several years long of reevaluation and transfor-
making. For instance, in the first weeks, there was more mation of his life purpose involving, among others, en-
self-criticism and caution, while in the last 3 weeks, gaging himself in volunteer activities to support bereaved
there was an awareness and processing of emotions, as parents and changing careers.
well as a focus on the continuation of the bond with his Now, it is fair to say that not all of our participants
daughter. wrote and shared the way Artur, Fred, or others did. It is
difficult to define what dropout is about in our study
Fred’s Case. Fred’s poem, My Story of Grief, consists of because some of those who withdrew from the course
924 lines and is rich in images and memories that invite attended the individual guidance sessions and/or the
the reader to travel in time and touch upon different parts emotional first aid sessions with the therapists we col-
of the silver lining of suffering, love, and wisdom. Writing laborated with. What we can say is that, in similar writing
about the death of his daughter, Sol, he noticed all that courses for mothers, there was larger recruitment and
grief amplifies: the awareness of previous miscarriages retention of participants (Lehmann et al., 2022). One
and his attitudes toward them, the longing for the second father wrote in the evaluation survey, I personally feel that
pregnancy to be alright, and coping with the tragedy of it was ok to attend to the course but that I did not get so
perinatal death. Fred’s journey of self-discovery not only much help on my way forward with my grief process or
unveils what fatherhood is about but also what the human how to be more aware and safer with my own feelings.
condition through and beyond manhood can represent. He (Participant 4, ES1) His feedback is important, and al-
writes about a miscarriage that preceded Sol’s death years though his child had died because of a long-term illness
later: and he could not attend all the sessions because of his job,
She was just under 12 weeks pregnant. it might be the case that therapeutic writing does not work
I say “she was pregnant” (…) because obviously the for all men and/or that it is to be set as part of other
baby grows in the woman’s body. interventions.
It is not like the father can say “I’m pregnant,” or even However, all three participants who responded to the
“we’re pregnant.” evaluation survey in the second group affirmed that they
“We’re having a baby” or “my wife is expecting,” are would have liked to have extra sessions. We asked this
more acceptable. group explicitly for feedback about what they thought
I feel that language is inadequate at times. would motivate more men to enroll in these kinds of
Doesn’t the pregnancy also belong to the father? courses. What some of them said was that “responsibilities
Somehow? at home” (Participant 3, ES2) could be a constraint and
It feels undefined. that “it takes time for men (generally speaking) to feel
Abstract. themselves safe enough to share in front of others”
A part of my soul was invested. (Fred’s poem, lines 99– (Participant 1, ES2), to which another added the
109) following:

Table 2. Artur’s Check-In and Check-Out Journaling Practices.

Check-in journaling about

Day feelings Check-out journaling about learning

1 N/A N/A
2 Neutral, introvert I have problems sharing with others whom I think have it worse than me.
3 Glad, thoughtful I am afraid that my daughter’s death is not bad enough to be spoken about.
4 Ready, excited I had more feelings of shame and guilt than I had assumed. I try to find joy in the moments that I
had with her.
5 Vulnerable, tired I have learned that I am more ready and conscious to take Nora with me onwards.
6 Known, relieved I want to continue writing about Nora. I feel that I have a deeper contact with her this way.
10 Qualitative Health Research 0(0)

I had been waiting for a course like this to be offered (...). I Compassion for others can be stronger
thrived best in the sessions with three participants, but this than compassion for self.
can be the introvert in me speaking. I liked a lot how the set- Interesting noticing that.
up was made so we could share as much or as little about Gratitude.
what we wrote, but we could anyway speak about what we Finding meaning is a practice,
had written. (Participant 2, ES2) being of support to others helps.
It’s a way to have peace.
This highlights that there were individual preferences It feels good, to shape grief with language,
about what makes low-threshold interventions helpful. and accept what can’t be said.
The book of grief
already has a cover sketch.
Fourth Stanza: Grieving as Process
Holding the book close to my heart,
How to formulate my grief? Resistance. I walk onwards…
Confusion: What’s grief, what’s me?
Difficult to write a reflection, Grieving as Process is a poetic representation that
to be in contact with feelings. renders the experiences of participants with a sense of
It turns out a little cliché, a little standard. humanity that belongs to grief as an existential condition;
Writing another draft, it connects grief with important attitudes to be integrated
Wanting it to be a good one. into life through attention, compassion, and flexibility.
Reading out loud what’s on paper? The bereaved parents that participated in our courses
Hearing the critic’s voice within, found use in exploring the mind as a dialogical scene
The perfectionist, the vulnerable within. (Hermans, 2001) as they identified and elaborated upon
Difficult to get started and find words, different positionings of the self that were active as they
and difficult to stop writing afterwards. grieved and aimed at restoring their lives after the loss.
How unique is grief! Giving room to different parts of the self as one writes
In this writing group we built respect about the experiences of grief has proven to be helpful in
for what happened to all of us. finding meaning and integrating grief to a renewed sense
It’s touching to listen to one another, of identity (Den Elzen, 2021; Lengelle, 2021). Bringing
despite the overwhelm. the diverse positionings of the self into awareness also
There are so many men who grieve in me: reflects, similarly to the dual process of grief, how life and
The irritable, the impatient, grief are intertwined process to be balanced (Stroebe &
the enthusiastic, the egoistic, Schut, 2010). The poem then illustrates the nuances of
The ashamed, he who struggles men’s experiences of resistance, along with how impor-
with uncertainty. tant it is for men to focus on aspects other than grief in
There’s also a man within who steps back: their daily lives (Huang et al., 2023; Mota et al., 2023;
the one who finds energy, the one who takes Proulx et al., 2016; Zylla, 2017). Recent research findings
perspective, have even suggested that an adaptive recovery in be-
the one who holds an overview of life, reavement can be also achieved by focusing on more
the one who keeps going, resolving, instrumental aspects, such as having a focus on living
the one who loves… toward the future while reducing the focus on loss-
What can these teach me? oriented aspects of bereavement (Huang et al., 2023).
Looking at the bright side, In addition, the poem also exemplifies that a dialogical
a provoking statement. perspective isn’t limited to internal positionings of the self
Choosing how to take things but is directed to a sense of otherness (Hermans, 2001;
pushes our boundaries. Lehmann & Brinkmann, 2019), highlighting the impor-
Finding a sense of inner worth, tance of peer support, the strong effect of understanding,
Learning to stand for ourselves, and compassion from other bereaved.
because it is difficult, to grieve.
It feels easy to say it. It’s not. Integrating Perspectives: The Participants’ Narratives on
Listening to others is humbling, Grieving as Process. During the last session of each group,
We mirror each other, the unexpected the participants wrote a collective poem starting with the
shape that our family gained. prompt “A door is opened.” Each participant was asked to
Meeting at diverse phases of life, write at least one line. Once all the participants shared
it gives perspective. their suggestions in the chat, we reread them together and
Lehmann et al. 11

reorganized the lines until we had agreed that the creation attitude (Steffen et al., 2022) in the development of
was ready. courses in therapeutic writing.

Group 1, Autumn 2022

A door is opened Conclusion and Implications
darkness, on the inside. Our exploratory study of the experiences of fathers at-
A future that never came into being. tending an online course of therapeutic writing after the
Grief is here. unexpected death of a child, here set in the context of
I was looking forward to getting to know you Norway, sheds light on the emotional tonalities of men’s
You will always be in our memories, grief. The use of poetic representation as a form for
you will, always, be there. qualitative inquiry facilitated the understanding of such
Group 2, Winter 2023 tonalities; these evocative syntheses put into words layers
A door is opened of our participants’ experiences that they struggled to
What will meet me once I go in today? verbalize. For instance, grief nuanced the perception of
Fear, Shame, Guilt, Love? temporality for most of our participants giving account of
See you there, you see me. the uniqueness of emotional rhythms to process difficult
I am here, emotions and memories. Only for some of them the
you are here. perception of temporality was explicitly affected by the
COVID-19 pandemic. In addition, resistance appeared to
These two poems head in a similar direction with the be a salient feature in the experiences of our participants.
poetic representation about grief as a process, suggesting An advantage of such resistance could be a more explicit
that the integration of grief is an ongoing practice and that focus on restoration of life after the death of their children,
the online course on therapeutic writing provides tools to the downside of this being avoided, and/or a limited
help them working with emotions and strengthening the literacy of emotions. Emotional awareness, writing skills,
bond with their children. Some studies suggest that the and communication skills are deepened and developed
less the parents are able to come to terms with the death of during the context of courses alike ours, but for fathers
their children, the more likely they are to report severe whose emotional avoidance or illiteracy is strong for
intensity of symptoms in their grief (Keesee et al., 2008). many reasons, therapeutic writing might be difficult.
At the same time, making sense of a child’s death is one of For many of our participants, writing became a helpful
the most challenging aspects of the emotional processing tool for meaning-making, affective processing, peer
and integration of grief, given the meaninglessness of this support, and a dialogical platform to continue a bond with
tragedy itself (Lehmann et al., 2022). their children. Given that fathers have unique experiences
Online courses in therapeutic writing are only one of of grief and that the death of their children happens during
the multiple resources that bereaved parents can access, specific periods of their life course, it is important to
and even if writing proves to be helpful, grief and diversify the offers available for bereaved parents. Online
emotional awareness are an ongoing process, so the or onsite groups of therapeutic writing might not work for
purpose of writing is not necessarily fulfilled by the end of all men, and within the setting of a group of therapeutic
the course but can be incorporated as a habit moving writing, it is crucial to have a pluralistic set of techniques
forward. As one participant added, “This course started a and tools that can meet their individual needs and desires.
process, so that I now feel that I can continue doing it To the best of our knowledge, this is the first study of its
myself at home, using time for writing, for myself, and for kind in Norway, and there are various aspects that can be
her [daughter]” (Participant 3, ES1). considered in further studies. First, for those men for
In Norway, at times, it is difficult to find grief support, whom the course worked, it appeared to be transforma-
so low-threshold interventions and contact with peer- tive, as documented in the current article. The emotional
support organizations are essential. The varied tech- awareness and willingness to work with emotions, as well
niques and approaches in the courses were also experi- as having the time to write and the motivation and/or
enced as positive because many participants shared that “I experience to do it, are not to be underestimated. Second,
have gained insight about new techniques and aspects of the role of personality, culture, and developmental tra-
previous modalities of writing that I will bring with me jectories should be further addressed in the data collection
onward” (Participant 2, ES2) or that “I liked it that I could of similar studies in the future. Further research could
challenge myself, and since there were many different target these features more explicitly to map the needs and
practices, I found some that I was more interested in, some wants of mourning fathers, as much as those of mourning
that met my needs” (Participant 3, ES1). Excerpts such as mothers. Although it is important to simplify data col-
this confirm the importance of holding a pluralistic lection for participants, it could also be ideal to have more
12 Qualitative Health Research 0(0)

longitudinal data from men. Having access to more of the of writing coaching, the crafting of the poetic representations, as
diary excerpts of participants or recording the course well as the leading role in the analysis of the data, and writing the
sessions could serve this goal. Third, the number of article.
participants in courses for fathers was lower than in T.G.K. supported the recruitment of participants via the orga-
similar courses offered to mothers (Lehmann et al., 2022). nization she works for and the collection of the evaluation
Whether it is the social representations of gender or an- surveys. She provided general feedback on earlier drafts of the
other factor, it is important to break the stigma around article, as well as adding literature references to support the
men’s grief, both to motivate men to search for and accept arguments.
support and to make support more available and effective R.A.N. supervised O.L. in the planning and facilitation of the
for them. Developing campaigns targeting these topics courses. He also provided general feedback on earlier drafts of
could motivate more men to enroll in studies, hence this article, providing literature references to support the article,
lowering the accessibility barriers for support. as well as suggestions about the article’s structure.
Fourth, further considerations about the course content,
schedule, and pedagogical style could be considered. For Declaration of Conflicting Interests
instance, addressing the effects of these courses online and The author(s) declared no potential conflicts of interest with re-
onsite could provide insights about settings that promote spect to the research, authorship, and/or publication of this article.
or disrupt working with emotions. For most of our par-
ticipants, taking the course online came in handy for Funding
practical reasons. We did not address nor evaluate how the
The author(s) disclosed receipt of the following financial support
participation in an online course might have or not en-
for the research, authorship, and/or publication of this article:
hanced awareness and/or disclosure of emotions. Ex-
The project is funded by EkstraStiftelsen Helse og Rehabilitering
tending user involvement and the pilots of such courses
(Foundation Dam) (grant number: 2022ST-0000000064).
could provide wider learning experiences to improve the
course structure and contents. Fifth, given the popularity
that the individual writing sessions had among our study Ethical Statement
participants, further studies could contrast the use of We received the approval number 885234 from the Norwegian
techniques in therapeutic writing in different online or Agency for Shared Services in Education and Research (SIKT)
onsite settings both on a one-to-one or group basis. Sixth, to carry out this project, given that our research protocol fulfilled
there are many other writings of the study participants that all of their criteria for data protection. Our project was exempt of
we did not include because of limits in the length of the approval from the Regional Committee for Medicine and Health
present article or because of the privacy of our participants. Research Ethics (REK) because they considered that our re-
Seeking permission to draw on these in further qualitative search protocol did not involve major risks for the participants.
studies could enrich our understanding of therapeutic All of our participants received and freely signed a consent form
processes prompted by such writing assignments. following the guidelines from SIKT and REK.

Acknowledgments ORCID iD
We want to thank each of our study participants for the courage it Olga V. Lehmann  https://orcid.org/0000-0002-0111-307X
took for them to enroll in this course and be in touch with their
emotions as they aspired to find a meaning in their lives after References
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