A Grounded Theory of the Process of Spiritual Change Among Homicide Survivors

Abstract

Grounded theory was used to generate a mid-range theory of the process of spiritual change in the lives of survivors of homicide victims. Theoretical sampling guided the selection of 30 participants from a larger study of spiritual change after homicide (N = 112). Individual interviews were analyzed using a four-step sequence of line-by-line, focused, axial, and selective coding. Analysis generated a closed theory consisting of three fluids, consecutive but nonlinear stages. Each stage consisted of an overarching process and a state of being in the world: (a) Disintegrating: living in a state of shock; (b) Reckoning: living in a state of stagnation; (c) Recreating and reintegrating the self: living in a state of renewal. Movement through the stages was fueled by processes of spiritual connection that yielded changes that permeated the theory. Findings can be used to help practitioners address the processes that drive spiritual change in the lives of homicide survivors.

Keywords

homicide survivors spiritual change meaning-making complicated grief posttraumatic growth

Approximately 17,000 people die by homicide in the United States each year (Centers for Disease Control and Prevention, 2015). Although homicidal grief is more severe and prolonged than grief due to death by natural causes (Kristensen, Weisæth, & Heir, 2012), the surviving loved ones of homicide victims (i.e., homicide survivors) remain a neglected group. Homicide survivors are at heightened risk of complicated grief, a condition characterized by persistent and disruptive grief that has been observed at higher rates among homicide survivors (23.4%; Rheingold & Williams, 2015) as compared with the bereaved in general (10%; Burke, Neimeyer, McDevitt-Murphy, Ippolito, & Roberts, 2011). Complicated grief has been linked to major depressive disorder and posttraumatic stress disorder (PTSD), which have been observed among homicide survivors at rates of 48.9% and 34.0%, respectively, with comorbidity rates of 87.5% for PTSD and depression and 14.9% for PTSD, depression, and complicated grief (Rheingold & Williams, 2015). Homicide survivors are also at heightened risk of drug use and alcohol abuse (Rheingold, Zinzow, Hawkins, Saunders, & Kilpatrick, 2012).

Homicide survivors often turn to spirituality as they process the murders of their loved ones (Bailey, Akhtar, Clarke, & Starr, 2015; Bailey, Hannays-King, Clarke, Lester, & Velasco, 2013; Burke et al., 2011). Meanwhile, use of spirituality to make sense of the loss has been associated with spiritual change (SC; Wortmann & Park, 2008). SC can consist of spiritual growth or spiritual struggle, which have been associated with enhanced and compromised well-being respectively among bereaved populations (Wortmann & Park, 2008). The important role of spirituality in making meaning of homicide and the implications of SC for survivor well-being highlight SC after homicide as a meaningful area for further exploration.

This study consisted of a grounded theory investigation of the process of SC after homicide among a sample of survivors (N = 30) who reported experiencing changes in their spirituality after a loved one’s murder. The study featured special attention to the role of spiritual meaning-making in SC after homicide. The purpose of the study was to generate a mid-range theory of posthomicide SC that can be used to inform work with the homicide survivor population. Drawing on Pargament (2013), spirituality was defined as an awareness of or faith in a higher power or energy that inspires a person to seek beyond the self for meaning and purpose in life. SC was defined as a change of any magnitude in a person’s spiritual or religious orientation or experience, in any direction (e.g., spiritual growth and spiritual struggle; Balk, 1999). Spirituality and SC were understood as broad constructs that encompass diverse personal experiences, within and outside of different religious contexts. To illustrate, spirituality can include any person’s experience of the sacred, whether in a church or synagogue, nature, or one’s own bedroom. Likewise, SC can include changes that are explicitly religious in nature (e.g., changes in religious beliefs or affiliation), as well as SCs that often occur outside of the context of religion (e.g., change in sense of connectedness to nature).

Conceptual Framework—Existential Theory and the Meaning-Making Model

This study draws its conceptual foundations from the meaning-making model (Carlsen, 1988; Davis, Nolen-Hoeksema, & Larson, 1998), as informed by the existential theory concept of intentionality (Sarte, 1975). The meaning-making model suggests that when a trauma conflicts with a person’s belief system, a discrepancy ensues that compels a process of making meaning of one’s experience (Davis et al., 1998; Park, 2010). Meaning-making is generally completed through sense making (i.e., formulating an explanation for an experience that makes it comprehensible) or benefit finding (i.e., finding a positive outcome derived from an experience; Davis et al., 1998). However, many homicide survivors cannot make sense of or find benefit in their experiences, often for extended periods of time (Murphy, Johnson, Wu, Fan, & Lohan, 2003). Difficulties with meaning-making are problematic, as inability to make meaning of loss has been established as a predictor of grief severity (Keesee, Currier, & Neimeyer, 2008) and is associated with negative outcomes including heightened mental distress, poorer physical outcomes, and decreased marital satisfaction (Murphy et al., 2003).

The homicide of a loved one initiates a disintegration of survivors’ most fundamental beliefs (e.g., beliefs in a benevolent, safe, predictable, and meaningful world; Armour, 2002). For many people, core beliefs are rooted in a religious meaning system (Park, 2005). Perhaps consequently, homicide survivors tend to experience spiritual crisis after a loved one’s murder (Burke et al., 2011). It is within the disintegration of one’s fundamental beliefs that the meaning-making model intersects with existential theory. Existential theorists contend that facing mortality can spark a confrontation with one’s own core beliefs and prompt use of intentionality to offset an impending sense of meaninglessness (Guignon, 2004; Seymour, 2011; Yalom, 1980). In the case of homicide, the murder of a loved one prompts examination of previously unquestioned beliefs and sparks a crisis of meaning that is often combated via an active pursuit of meaning in the aftermath of homicide (Armour, 2002, 2003). Based on the lived experiences of 38 homicide survivors, Armour (2003) characterized meaning-making after homicide as “an intense pursuit of what matters” (p. 519). Action around a higher goal (e.g., truth and justice) transcended the meaninglessness of murder and enabled participants in Armour’s (2003) study to create meaning in the aftermath of murder, despite their inability to make sense of or find benefit in their losses. While Armour (2003) did not consider the role of spirituality in making meaning of homicide, it is important to note that religion has been identified as a primary source of many people’s motivations and sense of life purpose (Emmons, 2003; Park, 2005; Piedmont, 2001). It is likely that spirituality is central to intentionality among spiritually oriented homicide survivors. In accordance with the use of the meaning-making model as a conceptual framework, this study featured particular attention to the role of both cognitive and action-based modes of meaning-making in SC after homicide.

Review of the Literature: SC After Homicide

Spiritual Struggle After Homicide

Previous studies have highlighted a vulnerability to spiritual crisis among homicide survivors. Burke et al. (2011) found that rates of spiritual struggle among a homicide survivor sample were nearly twice of those observed among other distressed samples. Meanwhile, spiritual struggle has been identified as a factor that complicates meaning-making and contributes to complicated grief (Lichtenthal, Burke, & Neimeyer, 2011). Negative religious coping (e.g., anger toward God or a faith community, questioning God's power, and feelings of spiritual abandonment) has been associated with complicated grief, which is a predictor of spiritual crisis (Burke et al., 2011). Both complicated grief and spiritual crisis occur at higher rates among the violently bereaved, as compared with those bereaved by natural causes (Burke & Neimeyer, 2014). Burke, Neimeyer, Young, Bonin, and Davis (2014) contributed qualitative insight into spiritual struggle with a focus-group study (N = 5) in which they described spiritual crisis as an inability to make spiritual sense of loss, changes in spiritual beliefs and behaviors, negative feelings toward God, questioning God’s character, concern about an afterlife, and dissatisfaction with the spiritual support received. Although not derived from a homicide survivor sample, these findings provide unprecedented insight into spiritual struggle in bereavement.

Resilience, Transformational Change, and Spiritual Growth After Homicide

While the risk of spiritual struggle after homicide is clear, studies have also highlighted spirituality as a positive resource for homicide survivors (Bailey et al., 2015, 2013; Sharpe, 2015) and documented spiritual growth among homicide survivor samples (Johnson & Armour, 2016; Parappully, Rosenbaum, van den Daele, & Nzewi, 2002). Bailey et al. (2013) identified spiritual meaning-making as a process that supports meaningful accounts of loss by homicide and promotes the building of resilience. In a subsequent study, Bailey et al. (2015) highlighted spiritual strength as a resource that empowers survivors to pursue meaning after homicide (e.g., by engaging in social action). While these studies did not look at spiritual growth specifically, they highlight spirituality as a positive force in survivors’ lives and serve as a segue to exploration of spiritual growth after homicide.

Parappully et al. (2002) conducted a phenomenological study of the experience of losing a child to homicide among parents who experienced transformational growth after the murder. They assessed transformation using indicators that are understood to suggest spiritual growth (e.g., finding new meaning and purpose, increased optimism and hopefulness, increased compassion, and healthier relationships; Cole, Hopkins, Tisak, Steel, & Carr, 2008). They found that transformational growth was supported by faith in God, religious beliefs, use of prayer and ritual, gratitude, and belief in an afterlife (Parappully et al., 2002). In an examination of the role of spirituality and religion in healing after homicide, Johnson and Armour (2016) documented spiritual growth after homicide more explicitly. Participants in their study relied on spirituality as a source of strength, comfort, and purpose and reported positive changes in their spirituality after homicide, including increased faith and a more personal and intimate relationship with God (Johnson & Armour, 2016). Taken together, findings from these studies highlight a fuller spectrum of SC experiences among homicide survivors that warrants research attention.

The current study utilized constructivist grounded theory (Charmaz, 2006) to generate a mid-range theory of the process of SC after homicide among survivors who had experienced spiritual struggle and spiritual growth in the aftermath of a loved one’s murder (N = 30). Given the grounded theory’s utility in explicating process (Charmaz, 1983), the emerging three-stage theory provides critical insights into the processes that drive different phases of homicidal bereavement. Such insights are lacking in the literature base and can be used to inform services provided to the homicide survivor population.

Methods

This study was conducted as part of a larger investigation that combined grounded theory and survey methodologies in an exploratory sequential mixed methods examination (Creswell, Shope, Clark, & Green, 2006) of the process of SC after homicide. Participants were enrolled in the larger study when they completed its survey (N = 112), which was devised based on a review of factors that impact homicidal bereavement. The grounded theory phase of the study was completed while survey responses accrued, prior to formulation of research questions and hypotheses for survey analysis. The survey phase of the study was completed for the purpose of testing emerging theory. Concurrent data collection enabled use of survey data to guide theoretical sampling.

Grounded theory is an inductive approach involving the development of theory (Charmaz, 2006; Glaser & Strauss, 1970). As a “processual analysis” (Charmaz, 1983, p. 117), grounded theory is a natural match for this study’s purpose of explicating the process of SC after homicide. Constructivist grounded theory adopts symbolic interactionist and social constructionist theoretical lenses that view reality as subjective and meaning as created in one’s interactions with the world (Blumer, 1986, Crotty, 1998). Constructivist grounded theorists recognize data as the joint creation of participant and researcher and emerging theory as an interpretive construction of reality (Charmaz & Belgrave, 2002). Since the researcher enters the participant’s world and is affected by it (Charmaz & Belgrave, 2002), reflexive practice is imperative (Charmaz, 2006).

Given the damaging social milieu that surrounds homicide survivors, the constructivist lens is particularly important in research with this population. Homicide survivors are commonly abandoned or poorly supported by close others and repeatedly revictimized by the criminal justice system (Armour, 2002). They face public and media intrusion (Hertz, Prothrow-Stith, & Chery, 2005) and must contend with society’s stigmatization of homicide victims (Sharpe, Joe, & Taylor, 2013). Stressful experiences serve as constant reminders of loss of safety and control and inevitably influence survivors’ interpretations of their life events and experiences with spirituality. Use of a constructivist lens emphasized the expertise of participants and elevated their role in generating theoretical content pertaining to their own lived experiences.

Participants

Inclusion criteria required that respondents be 18 years of age or older, have lost a loved one to homicide 6 or more months ago, and have experienced SC after homicide. The sample (N = 30) ranged in age from 31 to 81 years (M = 55.7%, SD = 11.2) and the majority was female (86.7%). All participants held a spiritual affiliation, with 66.7% identifying as Christian, 26.6% as spiritual but not religious, and 6.7% with Eastern philosophies. Qualitatively, participants described varying degrees of spiritual centeredness in their lives; for some, spiritually was a centerpiece of life, while for others, it was of minimal importance in day-to-day life. Participants were racially diverse (53.5% Caucasian, 23.3% Latina, 16.7% Black/African American, and 6.7% mixed race) and held a variety of relationships to the deceased (56.8% had lost a child, 13.3% a sibling, 13.3% a parent, 10% an extended family member, 3.3% a spouse, and 3.3% a close friend). While 50% of the sample had lost their loved one more than 20 years ago, less than 3 years had passed for 10% of the sample, between 5 and 10 years for 30%, and between 10 and 20 years for 10%. Domestic violence was the most common mode of homicide (30%). Over one quarter of participants described the murder as a cold case (26.7%).

Recruitment

Participants were recruited through victim service organizations and professionals throughout the United States. A recruitment email was sent by these entities to potential participants describing the mixed methods study and providing a link to its online survey. Recipients were informed that survey respondents may, with their consent, be invited to participate in an individual interview, and that interviewees would receive a $10 gift card. Media recruitment was employed through the posting of flyers and use of a Facebook page. Finally, snowball sampling involved asking respondents to share the study with other homicide survivors.

Sampling

Theoretical sampling guided selection of survey respondents for three iterations of grounded theory. Selection was guided by responses to a modified version of the Posttraumatic Growth Inventory Short Form (PTGI-SF), a measure of growth through adversity that assesses change in five domains (spirituality, interpersonal relationships, sense of personal strength, life direction, and appreciation for the value of one’s own life; Cann et al., 2010; Tedeschi & Calhoun, 1996). Items were reworded and the measure’s Likert-type scale adjusted so that the modified PTGI-SF captured positive and negative change (1: strong negative change; 2: some negative change; 3: no change; 4: some positive change; and 5: strong positive change). The SC subscale of the modified PTGI-SF was the primary selection criterion and consisted of two items that measured SC (numbers 3 and 8; see Appendix 1). Global PTGI-SF scores were a secondary selection criterion. When paired with SC subscale responses that suggested SC, global scores were interpreted as an indicator of the magnitude of that SC, where scores greater than 30 and ranging up to 50 indicated increasing degrees of positive change, and scores less than 30 and ranging down to 10 indicated increasing degrees of negative change. Use of global PTGI-SF scores as an indicator of the strength of SC is justified by a strong correlation between the PTGI and the Spiritual Transformation Scale (Cole et al., 2008), a measure that assesses the changes captured by the PTGI-SF but specifies in each item that spirituality was a factor in the change.

Iteration 1 (N = 11) sought to answer the research question, What is the process of SC in the lives of homicide survivors? by focusing on dramatic SC. Iteration 2 (N = 9) filled in gaps in emerging theory by focusing on moderate and mixed experiences of spiritual growth and spiritual struggle. Iteration 3 (N = 10) was devoted to filling remaining gaps in theory via diversification of the sample. Eligibility criteria for Iterations 1 and 2 are featured in Table 1 and consisted of SC subscale and global modified PTGI-SF score ranges that were devised based on the targeted experience and trends in responses.¹ Demographic and background information was also considered to ensure diversity in participant characteristics (e.g., age, gender, race or ethnicity, relationship to deceased, and time since murder).

Table 1.

Selection Criteria by Target Experience.

Target experience	SC subscale parameters	Global PTGI parameters
Iteration 1
Dramatic spiritual growth	SC ≥ 9	>45
Dramatic spiritual struggle	SC ≤ 3	<25
Iteration 2
Moderate spiritual growth	7 to 8 (with no individual score < 3)	30 to 40
Moderate spiritual struggle	≤5 (with no individual score < 3)	>25 and ≤33
Mixed spiritual growth and spiritual struggle
1) Global growth + spiritual struggle	≤4	>35
2) Global struggle + spiritual growth	≥8	≤33
3) Opposing scores	One SC subscale item > 3; one SC subscale item < 3

Note. SC = spiritual change; PTGI = posttraumatic growth inventory.

Eleven participants were selected for Iteration 1, nine who had reported dramatic spiritual growth and two who had reported dramatic spiritual struggle. This sample was skewed toward dramatic growth due to a shortage of survey respondents reporting dramatic struggle, a limitation that is addressed in the Discussion section. Nine participants were selected for Iteration 2, four had reported moderate spiritual struggle, three had reported moderate spiritual growth, and two had reported a mixture of spiritual growth and spiritual struggle. For Iteration 3, all respondents who had reported change on the SC subscale were considered, and 10 participants were selected who reported underrepresented religious affiliations (i.e., Spiritualism and Buddhism, N = 2) or racial or ethnic backgrounds (African American, N = 2; Latina, N = 5). Change was defined as a score of greater than or less than 3 on either SC subscale item.

Measures

The modified PTGI-SF and a demographic and background questionnaire were used to guide sampling, as described earlier. The modified PTGI-SF was highly reliable, with an alpha of .910 among the full survey sample. Global scores tended to be high, with over half of survey respondents scoring higher than 40 out of 50 possible points (M = 38.64, SD = 9.61). A semistructured interview guide that was designed to elicit descriptions of the process of SC after homicide was used to guide grounded theory interviews.

Procedures

This study was conducted in three iterations of data collection and data analysis. Memo writing was conducted throughout each iteration and was integral to the honing of reflexivity and the identification and reidentification of relationships between emerging categories. Following each iteration of analysis, the researcher identified gaps in emerging theory and adjusted the interview guide for use in the next iteration. For example, questions were added for Iteration 2 to facilitate exploration of four dominant themes in Iteration 1 analysis: (a) increased intensity in survivors’ characters, (b) shifts in survivors’ interpersonal relationships, (c) development of an intense drive to help others, and (d) increased sense of personal strength. Likewise, a question was added for Iteration 3 to facilitate exploration of changes in identity, a dominant Iteration 2 theme. Prompts were also added to elicit description of the interface of cultural identity and sense and use of spirituality.

Data collection

Interviews were conducted individually and privately, in-person, or by telephone or Skype. Participants were given the opportunity to ask questions and asked to verbally verify their consent to participate. They were then asked to describe their experience of SC using whatever spiritual or religious framework best suited their personal belief systems. The interview guide was used flexibly to direct interviews. All interviews were audio recorded and transcribed by the researcher or a professional transcriptionist.

Data analysis

A four-step sequence of coding procedures was used to illuminate the processes and actions taking place in the data and to move the researcher through progressive levels of abstraction toward the generation of theory (Charmaz, 2006; Charmaz & Belgrave, 2002). In Step 1, open coding consisted of line-by-line coding using gerunds that explicated the actions in each line of the data. In Step 2, focused coding was used to organize data units into categories by identifying the most frequent and salient line-by-line codes. Step 3 consisted of axial coding, which involved considering all focused codes at once to identify relationships between categories of analysis. Finally, in Step 4, selective coding was used to map out these relationships and integrate them into a developing theoretical framework.

In Iteration 1, open, focused, and axial coding were conducted using paper and pen. Once a code structure had been established that reflected emerging relationships, transcripts were loaded into R-based Qualitative Data Analysis (Ronggui, 2012) and coded according to that code structure. Quotations were then downloaded and used to guide selective coding and generation of a visual display of emerging theory. Upon completion of Iteration 2 of data collection, transcripts were loaded to R-based Qualitative Data Analysis and coded using the code structure from Iteration 1. Focused coding involved the addition of codes that reflected data units that did not fit the original code structure, while axial coding involved reconsideration of the relationships between emerging categories and revision of the Iteration 1 code structure. Quotations associated with the final Iteration 2 code structure were downloaded and used to guide selective coding and modification of the original visual display of theory. Analysis for Iteration 3 mirrored the process described for Iteration 2 and involved finalization of the code structure and emerging theory.

Ethical considerations

Conducting research with traumatized populations demands attention to ethical considerations. Protocols for this study were approved by the institutional research board at the University of Texas at Austin.The principal investigator (P.I.) advised potential participants of the risk of emotional discomfort and of their right to forgo or terminate participation at any time and also provided all interviewees with the number of a national victim’s support organization; $10 gift cards were provided to offset burden. Privacy and confidentiality were prioritized. Identifying information was never associated with participant data outside of Qualtrics, the HIPPA-compliant survey software that was used. Transcriptions were completed by the researcher or by a professional transcriptionist. Names were not included in transcriptions, and recordings were deleted at the end of the study. A final ethical consideration was the importance of trust among traumatized populations (Alesina & La Ferrara, 2002). The P.I. offset potential challenges by nurturing relationships with service providers who recruited within their respective communities. This is an application of the cultural broker concept, in which an individual who is an insider to a group serves as a cultural broker between a researcher and members of that group (Van Willigen, 2002).

Rigor

Several steps were taken to maximize rigor. Data collection was preceded by pilot interviews with two homicide survivors who were not included in the study sample. These pilot interviews enhanced the researcher’s ability to use the interview guide to direct open-ended interviews. An audit trail was maintained as a method of tracking the analytic process and documenting methodological decisions, as recommended by Rodger and Cowles (1993). In addition, memo writing was employed as a means of maximizing reflexivity (Glaser, 2013). Memoing enabled the P.I. to maximize her self-awareness as a second-generation homicide survivor, managing her reactions to the research and avoiding interpretation of the data through the lens of her own family’s experiences. Finally, member checking (Mays & Pope, 2000) was used to reinforce the credibility of findings. The mean response to a questionnaire item that assessed the fit of the final theory among individual participants was 3.86 on a 4-point scale (N = 7), suggesting that the theory captured participants’ individual experiences to a great degree.

Results

A Three-Stage Theory of SC After Homicide

Figure 1 presents a visual overview of the emerging, three-stage theory of posthomicide SC (Theory of PHSC). Each stage of the theory consists of an overarching process coupled with a state of being in the world: (a) Disintegrating: living in a state of shock; (b) Reckoning: living in a state of stagnation; and (c) Recreating and reintegrating the self: living in a state of renewal. The pairing of the large, forward-pointing arrow that contains the stages with the small bidirectional arrows between each stage which signifies that the process is sequential but nonlinear; while their journeys were riddled with back steps, participants saw forward movement overall. The word, homicide, appears to the left of the process and is connected to it by an arrow to convey that the process was launched by news of the murder. The closed oval that contains the process represents its closed nature; there was no going back to life before the murder, and there was no exiting the lifelong healing process that followed homicide. Connecting with God and connecting with the spiritual realm appear along the inner perimeter of the oval to signify that these processes of connecting spiritually permeated and drove PHSC, to varying degrees and in various manifestations for different participants. The process, changing, appears along the arrows that link these themes, to signify that for most participants, connecting spiritually was the fuel that generated movement through the process and yielded the changes that permeated the emerging theory (e.g., changes in spiritual beliefs and practices, changes in relationships, renewed sense of self and purpose).

Figure 1.

Theory of posthomicide spiritual change.

The emerging theory of PHSC is described later. Italics are used throughout to denote the processes that are featured in Figure 1 and to assist the reader in matching findings to the visual display of the process of PHSC. All names have been replaced with pseudonyms. Male pronouns are used in reference to God in keeping with the language used by most participants. To maximize clarity, pronouns are capitalized when they reference God.

Stage 1: Disintegrating, Living in a State of Shock

Disintegrating

The murder of a loved one launched a process of disintegrating that entailed a progressive unraveling of participants’ lives, senses of identity, and meaning systems. This process began dramatically the moment one learned of the murder and escalated as one had time to process what had happened. Disintegrating was commonly marked by struggling spiritually. One surviving mother recalled feeling intense anger toward God and consciously disengaging from her spiritual practices after her son’s death. As she described it:

I was very angry with God … I used to pray before I got in my car, before I'd eat, before I did anything. And I turned it around. I purposely did not pray. I was so angry with God. I didn't go to church. I felt abandoned. I lost my spirituality along with my son.

A process of intense questioning often exacerbated spiritual struggle. Survivors wondered where God had been at the time of the murder and why He had not intervened. Inadequate answers led to a sense of betrayal and created intense emotional pain. One participant explained:

Suddenly I was also grieving the loss of my faith, because I started questioning, “Why did he get killed? Why did he die? Where was God? Why did He permit this to happen? Why have they not arrested this person? Why has God abandoned me? Why did He forsake me? Why is He permitting me to go through all this grief, through this pain?” And I was literally in agony during that time.

Disintegrating also involved losing one’s sense of identity and purpose. The following quotation from a surviving mother captures this loss succinctly:

When you lose your child it's like, that's your identity. You're not a mother. You're never going to be a grandmother. All those things that I had been for a long time or thought my life would be were gone in an instant.

Living in a state of shock

The process of disintegrating, along with the murder itself, shifted participants’ state of being in the world such that they described living in a state of shock in the early aftermath of the murder. One survivor characterized shock as protective, noting, “It [the brain] doesn't let you connect to what actually happened. In the beginning, I think you would catch fire and die if your brain let you connect.” Living in a state of shock was characterized by numbness and difficulty performing activities of daily living. Symptoms of depression, anxiety, and trauma and addictive behaviors were common. One surviving mother described a depression so severe that it left no room for anything but going through the motions of daily life. She shared, “I cried every single day for two and half years. Literally, two and half years. I was plunged into a deep depression. I had passive suicidal ideation, like, every 30 seconds.” Shock-based symptoms paired with intense questioning diminished participants’ capacity to connect with God or the spiritual realm. Consequently, they described disconnecting spiritually. After her son’s murder, one participant was unable to engage her spirituality as she had previously. She shared, “I couldn't focus properly. I walked into a church and sat there for a while, and then I would leave. A lot of times, I would go to the cemetery and just sit there and talk to my son.”

Stage 2: Reckoning, Living in a State of Stagnation

Reckoning

Stage 1 ended when the initial shock of homicide wore off and participants were compelled to tend in a more clear-headed manner to the crisis of meaning homicide had created in their lives. Reckoning was a cognitive process driven primarily by the subprocess, making spiritual sense of murder, which involved reexamination of one’s beliefs about God or a higher power, evil, suffering, and the nature of the world, and application of these beliefs in one’s attempt to make sense of murder. The questions posed during this stage shifted from those that drove the process of disintegrating (e.g., How could God let this happen?) toward broader existential concerns (e.g., Why does evil exist?). Participants satisfied some of their questions by assigning spiritual meanings to their experiences. For example, some came to terms with evil in the world by turning to their belief in free will. One man shared, “I had a pretty good understanding that God doesn't do bad things. But He allows people to make their own choices. And because of these men's choices, they were the ones to blame.” By assigning responsibility to the killers rather than to God, this participant maintained belief in God’s benevolence.

Making spiritual sense of murder left participants with unanswered questions. Many relied on faith to empower acceptance of these unresolved questions. One survivor explained, “I have been able to accept that the answers may not come how I want them to and that there is a purpose for everything. Even though I may not be able to understand the purpose, there is a purpose.” Others responded to unresolved questions by engaging in a process of reconstructing spiritual beliefs. This process is illustrated by one woman’s objections to Christian teachings about an afterlife. Troubled by the notion that her murdered brother might be in hell, she resolved to look beyond Christianity for spiritual understanding. She shared:

I told him (my therapist), “I'm struggling with this, with the thought of my brother going to hell.” He said really bluntly to me, “Well, where do you think your brother is right now?” And I said, “Well, he's not in hell. I know he's not in hell.” And that was a big moment for me, where I realized maybe there's more out there than I realized. I really should explore.

This participant ultimately rejected Christianity and aligned herself with Eastern philosophies. Her conversion was an example of the reckoning subprocess, changing one’s worldview, which involved pivotal changes in the core belief systems of some participants. Her process also illustrates the manner in which the spiritual meanings participants assigned to their losses in this stage were often socially constructed or formulated in partnership with others (e.g., a counselor, persons in a participant’s church community, and family members).

Living in a state of stagnation

During the reckoning period, intensive questioning consumed participants’ energies and generated a sense of stagnation that was characterized by the inability to move forward in life. One participant described this state of stagnation as follows:

It used to be you had a sense of forward movement. And now it’s kinda just one day at a time. The momentum has slowed down so much. I just feel like I’ve aged like 20 years in just the seven years that it’s been since he was killed. I just feel slammed down and beaten up, and everything is just so much more of a struggle than it used to be.

Stagnation was compounded by conflicts in the posthomicide context that left participants feeling that they no longer fit into the world. Conflict was often interpersonal in nature. One participant lamented, “I kind of lost everything when I lost him [my son], because people didn’t know what to do or what to say. So they thought it was best to just withdraw.” She also recalled her church community’s failure to support her and commented, “It's like in order to fit in, you have to change your story so it doesn't seem so tragic.” She linked the lack of support she received from her church to her ongoing struggles with spiritual disconnection.

Conflict in the posthomicide context was also situated in the criminal justice system. Survivors felt disregarded and harmed by negative experiences (e.g., insensitive victim notification experiences, mistreatment by prosecution attorneys, botched investigations, and inadequate sentencing). A sense of injustice exacerbated spiritual struggle. African American participants were attuned to the racial dimensions of injustice. One mother saw race as integral to the dismissal of her son’s case, stating, “I just felt like it was another black kid murdered, something less that we have to worry about.”

Stagnation sometimes persisted indefinitely. One woman's story illustrates the experience of getting stuck indefinitely. Seven years after the murder, she continued to feel abandoned by her friends and church community and remained preoccupied with the injustice that had permeated criminal justice proceedings in her son’s case. Alienated from her faith, she sought spirituality in gardening, only to find further spiritual struggle. In her words,

If every seed I plant has that potential to grow and become this vegetable or become this flower, and God is nurturing and watching over that … What happened to my son? I can't resolve it. It’s very hard.

Injury to sense of identity and purpose, coupled with the feeling of no longer fitting into the world, foreshadowed participants’ need to transition to Stage 3, which centered around efforts to establish a new, posthomicide self and to fit that new self into the world as now experienced. Participants generally transitioned from Stage 2 once they were able to set aside unresolved questions and focus their energies on taking meaningful action related to the homicide.

Stage 3: Recreating and Reintegrating the Self: Living in a State of Renewal

Recreating and reintegrating the self

Stage 3 consisted of recreating and reintegrating the self, an action-focused process comprising efforts to create meaning after homicide while reestablishing a sense of identity and place in the world. Participants found that reckoning did not provide the sense of meaning they needed and thus set about creating significance by taking action that generated meaning. They commonly did this by helping others. Some entered helping careers. Others approached previous professional helping roles with a new sense of purpose or simply supported fellow survivors. Advocacy was a common mode of helping others. One participant spoke of fighting tirelessly to change the stalking law that had offered her loved ones no protection from the person who killed them. She shared, “I've spent four years with a friend of mine trying to change it. We’ve worked diligently, talking with them to get help for other people so that they don't have to go through what I've been through.”

Survivors also created significance by identifying positive outcomes that had in some cases stemmed directly from the murder (e.g., a loved one’s organs being used to save lives) but were more commonly the product of posthomicide actions for creating significance. By claiming the significance they had created (e.g., prevention of future crime), survivors conquered the meaninglessness of their original stories and authored the end of the story in such a fashion that the murder was no longer in vain. A surviving mother who spoke in prisons to reduce recidivism reflected on the positive outcomes that had come of her son’s death, through her work. She noted, “Due to the loss of one, look how many have been saved, literally saved in life, to make something of it.” Identifying positive outcomes was often infused with spiritual symbolism, with some participants feeling that they had partnered with God and with their loved one who had been killed to achieve victory over evil. The social nature of creating significance highlights the social construction of the meanings created in Stage 3. Actions taken to create meaning after homicide were often taken in partnership with others. Likewise, identifying positive outcomes took place in the context of social interaction.

There were a variety of motivations for creating significance. For instance, participants wished to uphold their loved ones’ legacies. Helping others in their loved ones’ honor enabled participants to make the lives and deaths of their loved ones matter; it also transformed stories of murder and devastation to narratives of transformation and victory. Underlying participants’ motivations for creating significance was a need to offset negativity and meaninglessness. One survivor explained,

I feel this need to try to do something positive, because it was such a negative event. There's absolutely nothing positive that came from losing my son … I feel like I've been desperately searching around, trying to do some good.

Refitting oneself into the world

Refitting oneself into the world involved taking actions to achieve congruence between one’s emerging self and the outside world. By engaging in the subprocesses described later, participants asserted their evolving selves and claimed a place in the world that aligned with their shifting values and higher priorities. In changing relationships, participants eliminated negative and ingenuine relationships from their lives. A surviving mother described being spiritually attuned to the nature of others after her son’s murder, and knowing intuitively who she should avoid being around. She noted,

I always know what I don't want. It's like a discernment, that if I'm involved with people, I just know that's not where you're supposed to be … I didn't know what that was, but now I know it's the Holy Spirit guiding me.

Changing relationships also involved nurturing relationships of substance. One participant explained how the loss of her brother made her conscious of appreciating remaining family. She shared, “I don't take anything for granted … because I didn't get that chance with my brother to grow old with him.” The nurturing of meaningful relationships extended beyond personal relationships to encompass a heightened connection to humankind; in this sense, it overlapped with creating significance. An intensified sense of responsibility for others prompted participants to place high priority on their role as helpers of those in need; this role became central both to their sense of relationships to others and to their sense of purpose after the murder.

Refitting oneself into the world was also facilitated by opposing hypocrisy, a process through which participants called out and rejected the hypocrisy they saw in the world. Opposing hypocrisy commonly manifested in rejection of materialism. Calling out the discrepancy between the purported beliefs and the behavior of churches he had encountered, one participant noted, “Really? You're Jesus loving people? No, what I think you love is the Benjamins, the Jacksons, the Franklins.” Changing relationships and opposing hypocrisy enabled participants to expel from their lives the negativity associated with conflicting with the world in Stage 2, thus protecting the integrity of both their inner worlds and their environment.

For some participants, choosing to forgive facilitated the process refitting oneself into the world by releasing one of the unforgiveness that had fueled stagnation in Stage 2. Forgiveness was often rooted in spiritual convictions and infused with spiritual meaning. Christian participants tended to believe that they were called to offer others the unconditional forgiveness they themselves had received from God. Some understood forgiveness as a doorway to a relationship with Jesus Christ and used offerings of forgiveness as a mode of creating significance. Specifically, by sharing forgiveness with offenders in prison ministries, they felt that they not only helped reduce recidivism but also positioned offenders to receive eternal salvation. One survivor spoke of her work with an inmate, noting, “I got one lady to accept Jesus. It wasn't an act … She's ready to meet Jesus. She believes, and I believe, she's going on to a better place.”

Forgiveness was neither universal nor required before one could move forward. While unforgiveness was often characterized as a sticking point, some participants rejected the notion that they might be expected to forgive. One survivor referred to forgiveness as “the F word” and noted that while her family would never forgive her son’s killer, “We're still gonna go on with our life. It's not gonna stop us from our life.”

Transcending spiritual boundaries involved claiming ownership over one’s own personal spirituality. Some participants complemented their religious faith with nontraditional practices that furthered their personal spirituality. Others distanced themselves from religion and focused on rebuilding their personal spirituality. One survivor noted, “I'm working on my spiritual being, not the sitting and listening to somebody. It's my own personal thing that I have to do right now.” Another participant rejected her church’s suggestion that she had to express her spirituality in a particular way, noting, “No I don't. This is where God helps me right now.” By doing what worked for them and rejecting the obligation to do what was not working, participants claimed their spirituality as their own and enabled it to be a positive force in their healing.

Living in a state of renewal

Stage 3 was characterized by living in a state of renewal. Participants began using their grief productively in this stage and thereby began generating forward momentum in their lives. In so doing, they overcame the sense of stagnation that had dominated Stage 2, and they began feeling better. Actions taken to help others resulted in feeling a heightened sense of interconnectedness and compassion for others that diverted participants’ foci from their own suffering, toward a higher purpose. Development of intentionality around goals of significance was accompanied by becoming emboldened and becoming stronger. Participants became braver, more intense, relentless, and unapologetic in their pursuit of significance. Becoming stronger was described by some as an increase in spiritual strength. Through their own tragedies, participants became unwavering in their spiritual beliefs and commitment. One participant explained,

I am even more convinced that God does love me, and that through that struggle, I exercised strength that I didn't know I had. And still even retaining the belief that there is a God, and that He is omnipotent even though horrible things happen—I can't be moved from that.

Another participant explained that, for her, it was increased spiritual strength that yielded increased personal strength. In her words,

I feel strong, and I strongly believe in God. And I strongly believe that He is looking out for us. And I strongly believe that He is guiding me to what I need to do, everywhere that I go. Every step that I make, He is there. And that makes me feel stronger.

The actions participants took in creating significance became central to their sense of themselves and the world. One survivor described her efforts to open a respite center for homicide survivors and shared, “My path is being shown to me, to work primarily with survivors, to ease their pain, suffering.” Steadfast in her commitment to her spiritual purpose, she asserted, “I just know that I'm going to continue doing what I'm doing. No doubt in my mind.” Creating significance solidified this participant’s emerging identity and facilitated her regaining of footing in the world. Her experience illustrates the process, renewing a sense of identity and place in the world.

It is important to note that while participants experienced a state of renewal in Stage 3, grief was not resolved; rather, it often resurfaced powerfully many years after the murder, as though it had happened yesterday. One participant explained this experience by comparing homicide survivorship to the experience of being shipwrecked. Her words capture the nonlinear, overlapping nature of the stages of the PHSC process:

There are pieces [of shipwreck] floating all around you. You grab on to a piece, and it’s floating, so you’re good and fine. You’re safe. And then a wave comes and bumps you off of it … I never know what’s going to happen. I’ll see her picture and be just fine with it. I’ll go give a speech in front of 5,000 people with no problems. And a song comes on the radio on the way home, and I’ll lose it.

Connecting Spiritually

Each stage of the theory of PHSC was driven by dual processes of connecting spiritually: connecting with God and connecting with the spiritual realm. These processes appear around the inner perimeter of the emerging theory (see Figure 1) and are connected by arrows that signify their overlapping and interactive nature. Connecting with God consisted of activities and experiences of spiritual connectedness that involved a higher being (e.g., prayer, meditation), while connecting with the spiritual realm consisted of activities and experiences that were not specific to a higher being (e.g., seeing signs of a loved one’s presence). While participants often engaged in both forms of spiritual connecting, one was typically dominant. The balance of one’s use of these forms of connecting spiritually varied by individual.

Connecting with God

Participants described connecting with God as a process that required constant recommitment to a relationship with God. The daily choice to pursue God in spite of life’s difficulties was seen as analogous to a lifelong relationship with another person. One participant explained: “I’m angry with my wife, but she’s still my wife … And so for God, yeah, I’m mad at God for this happening. But He’s still God. He still provides. He’s still going to get me through this.” Connecting with God included reaching out to and receiving from God. Practices such as prayer lead to a sense of receiving guidance, protection, comfort, and blessing. One woman described finding strength and comfort in God, noting, “I just felt like God, Mother Mary—everybody swooped down and was just holding me tight, because actually I couldn’t hold myself.” Another participant, who personally investigated her son’s murder in gang territory at night, described how connecting with God fed her intentionality and spiritual purpose and provided her with a sense of protection. In her words,

I never had fear … because I just knew that whatever danger there was, my faith that I had asked God to be my pilot, whatever was supposed to happen was going to happen. And I had His protection.

Connecting with the spiritual realm

Spiritual connectedness was often experienced in ways that did not directly involve a higher power. Participants described sensory experiences of their loved ones who had been killed. A surviving mother described waking up on a Mother’s Day to the feeling of her son kissing her on the cheek. When others said she had been dreaming, she insisted, “I felt my son kiss my cheek on Mother’s Day morning.” Some participants experienced spiritual encounters with angels they believed had been with their loved ones when they died or who appeared to them in a time of dire need. Others experienced spiritual connection by assigning spiritual meaning to symbols in their environments. For example, one woman described being on the water one day with her grandson. She explained that he had been speaking to his father, her son who had been killed, when he suddenly exclaimed, “I love you, Daddy!”, as it began to rain. She reported that since then, “Rain drops are Andrew’s kisses to us.” She described how her family found joy and comfort in the rain. These forms of spiritual connection brought participants comfort. Participants also experienced spirituality in nature and via an enhanced sense of the interconnectedness of humanity that they often experienced through helping other survivors.

Changing

Changing consisted of two subprocesses: (a) Process-oriented changing, which consisted of intentional actions to bring about change within oneself and in the world and (b) Outcome-oriented changing, which consisted of fundamental changes within the survivor. Changing appears along the arrows that link connecting with God and connecting with the spiritual realm to signify its relationship to these processes of connecting spiritually and to the emerging theory as a whole. Namely, processes associated with connecting spiritually drove the changing actions and outcomes in participants’ lives. Changing, in turn, fueled connecting spiritually and ran as a common thread through all stages of the emerging theory.

Outcome-oriented changing and process-oriented changing were interactive, where changes within the survivor (i.e., outcome-oriented changing) created the need for actions directed toward change (i.e., process-oriented changing). For example, losing one’s sense of identity and purpose in Stage 1 was an outcome-oriented changing process that stemmed from the homicide itself. This process was offset in Stage 3 by actions associated with renewing a sense of identity and place in the world. Similarly, conflicting with the world was a Stage 2 outcome-oriented changing process that resulted from stress in participants’ interpersonal environments. This process was offset by refitting oneself into the world (e.g., changing relationships and opposing hypocrisy) in Stage 3.

Process-oriented changing (i.e., actions directed at change) in turn brought about changes within the survivor (i.e., outcome-oriented changing). For instance, questioning intensely was process-oriented changing directed at resolution of unanswered question. This process manifested in struggling spiritually and disconnecting spiritually, examples of outcome-oriented changing that represented changes within the survivor. Similarly, creating significance consisted of actions directed at change (e.g., engaging in advocacy and helping others) that manifested in such changes as feeling better, becoming stronger, and becoming emboldened. These outcome-oriented changing processes in turn facilitated further engagement in creating significance.

While the spiritual dimensions of some of the changes conveyed in this study are obvious (e.g., changes in spiritual beliefs or practices and change in religious affiliation), many changes were broad and may not immediately be perceived as spiritual. However, these changes were deeply spiritual for many participants, who experienced life as inherently and acutely spiritual in the aftermath of their loved ones’ murders. Process-oriented changing was often spiritually motivated and fueled by connecting spiritually. Meanwhile, outcome-oriented changing was often experienced as a result of one’s pursuit of spiritual purpose. In this manner, changes that at first glance may not appear spiritual (e.g., changing relationships, feeling stronger) were indeed manifestations of PHSC in participants’ lives.

Discussion

Several aspects of the emerging theory are key to raising awareness of the needs of the homicide survivor population. For one, findings point to a need to move away from the standard grief assumption (Armour, 2002) that healthy bereavement requires detaching from the deceased and “moving on.” Participants prioritized continued connection with their deceased loved ones and described homicidal grief as lifelong. Practitioners should support survivors in their efforts to move forward on their own terms, with their grief as a permanent but productive aspect of their lives and identity. Second, the process of PHSC was fluid and nonlinear. Survivors moved through the stages sequentially but experienced back-steps along the way and sometimes engaged simultaneously in processes associated with more than one stage. Indeed, each stage was laden with a mixture of growth and struggle, suggesting that SC should be considered as a fluid spectrum of change, rather than a dichotomous construct. Third, the theory of PHSC represents a composite process within which there was individual variation. Participants were diverse in their spiritual beliefs and practices and differed in the degree to which spirituality was important in their daily lives. PHSC should be understood accordingly as a dynamic, intensely personal experience.

Despite variations in participants’ individual experiences, this study’s composite theory lends in-depth insight into a widely applicable process of homicidal bereavement. Indeed, parallels can be drawn between the theory of PHSC and Kuübler-Ross’s (1969) linear, five-stage theory of grief. Stage 1 of the theory of PHSC captures the early aftermath of homicide and is characterized by a state of shock that shares features with Kuübler-Ross’s Stage 1 (denial and isolation). Stage 2 consists of a state of stagnation that sets in once shock has lifted; this state is characterized by intense cognitive processing and negative emotion and shares features with Kuübler-Ross’s Stages 2 to 4 (anger, bargaining, and depression). There are also parallels between Stage 3, which is characterized by forward movement and restoration, and Kuübler-Ross’s Stage 5 (acceptance). The theory of PHSC also differs substantially from Kuübler-Ross’s work (e.g., it is specific to the nuances of homicidal bereavement, it focuses on SC, it features three stages rather than five, and it regard its stages as nonlinear though consecutive). Nonetheless, aforementioned parallels demonstrate that, like Kuübler-Ross’s work, the theory of PHSC captures a staged bereavement process that applies widely to the variable experiences of diverse survivors. Indeed, despite individual variations, all participants navigated the same overall process of PHSC; those for whom spirituality was of little importance, simply did not derive their sense of purpose from spirituality and experienced changes as nonspiritual in nature. Understanding of the stages of the theory of PHSC can not only help practitioners garner insight into SC after homicide but also enhance their understanding of homicidal bereavement broadly.

Findings from each stage of the emerging theory provide insights that can be used to enhance services. Stage 1 findings documented a state of shock and acute distress following the murder of a loved one and therein highlighted the importance of focusing on safety and stabilization in the early aftermath of homicide. Meanwhile, Stage 2 findings demonstrated the difficulty of traditional forms of meaning-making (e.g., sense making and benefit finding) after homicide. Participants found themselves unable to make sense of murder and stuck in a cycle of considering and reconsidering the same questions. This cycle generated a sense of stagnation that was characterized by declines in energy and health along with loss of optimism and the ability to feel joy. It is important that providers understand the risks associated with these reactions, but also accept them as normal responses to severe trauma. Providers must empathically assist survivors in their efforts to break free of the cyclical nature of cognitive sense making so that they may overcome stagnations and generate forward movement in their lives.

Finally, Stage 3 findings reinforce previous depictions of meaning-making after homicide as an active endeavor (Armour, 2003; Bailey et al., 2015) and highlight the centrality of intentionality in the later phases of homicidal bereavement. Participants entered Stage 3 once they were able to transfer their energies from sense making to more active forms of meaning-making. They felt an intense drive to use their loved ones’ legacies to help others and viewed God and their deceased loved ones as partners in their efforts to do so. By creating significance, they transformed narratives of murder into meaningful stories in which they were victors over evil and their deceased loved ones, covictors. These findings provide invaluable insights into the often spiritual, symbolic, and transformative nature of creating significance. Stage 3 also consisted of efforts geared toward refitting oneself into the world. By supporting relevant processes (e.g., changing relationships, choosing to forgive), providers can help survivors reclaim a place for themselves in the world that aligns with their shifting priorities and identity.

The centrality of connecting spirituality throughout the emerging theory points to a need for a better understanding of the spiritual lives of homicide survivors. God was a lifeline for many participants, who felt that He empowered their daily survival. Meanwhile, many were acutely aware of a spiritual realm and were sustained by connection to their deceased loved ones. It is reasonable to suggest that a practitioner’s failure to affirm a survivor’s experiences of the spiritual realm may detract from sensitive, effective services, while dismissing or stigmatizing these experiences may risk exacerbation of trauma and discourage further use of services.

The importance of interpersonal relationships in life after homicide is of particular relevance to practitioners. Whereas lack of support from others was a key aspect of conflicting with the world and contributed to stagnation in Stage 2, positive relationships were central to generation of forward movement in Stage 3. In addition, the finding that spiritual meaning was socially constructed gives new meaning to Joseph and Linley’s (2005) assertion that social support is necessary for proper completion of meaning-making. Indeed, participants who lacked social support and opportunities to partner with others in creating significance were prone to prolonged periods of stagnation. It is likely that prolonged stagnation resulted in part from participants’ unmet needs in their social environment. This finding points to a need for providers to evaluate the degree to which survivors’ social networks and environments support both cognitive and active meaning-making and to focus on developing and strengthening social resources in survivors’ lives.

This study has macro-level implications. A sense of injustice was high among participants in this study, whose tendency toward social action suggests that homicide survivors are ideally positioned to advocate for a more just system. Indeed, survivors are already leading this work. For instance, the Women Survivors of Homicide Movement (2016) is a collaboration of 12 women of color who advocate for homicide survivor interests in inner city communities. Homicide survivors should be regarded as experts and leaders in efforts to expand such community-based efforts and in the advancement of racial equality in the justice system.

Limitations

This study’s sample did not fully reflect the demographics of the homicide survivor population. While nearly half of murder victims are African American (Sharpe et al., 2013), only 16.7% of the sample was Black. Given that all African American and Latinx or Latina participants were female, men of color were absent from the study. Self-selection bias was also a limitation. This study attracted survivors who were many years out from the murder and had experienced spiritual growth; consequently, spiritual struggle was typically shared retrospectively. Moreover, the tendency toward spiritual growth in this study may not reflect the experiences of the full homicide survivor population. Results should be read as a portrayal of PHSC for the current sample of survivors.

Future Directions

The mid-range theory provided here gives a broad overview of the process of PHSC. Each stage as well as the processes of connecting spiritually is rich and would benefit from additional exploration. Forgiveness emerged as a contentious and spiritually charged topic in this study; future research should look more specifically at its role in PHSC. Additional research is also needed to look at the impact of social support and social action on SC after homicide. There is also a need for studies that focuses on nonretrospective accounts of spiritual struggle, particularly among survivors for whom the murder was recent. Finally, the fit of emerging theory should be assessed among people with characteristics that were underrepresented in this study’s sample. There is a need for qualitative attention to PHSC among the African American community and among Black and Latino men. Studies should also focus on religious diversity and representation of youth and young adults. A deeper understanding of the relevance of cultural background, gender, religious affiliation, and life stage in the course of PHSC will help providers provide sensitive, appropriate care for diverse survivors of homicide. A final research direction is to replicate this work with survivors of suicide victims. Pursuit of this direction would enable identification of ways of SC after suicide mirrors or deviates from the process identified in this study and would ultimately be of benefit to the suicide survivor population.

Footnotes

Appendix 1: The Modified Posttraumatic Growth Inventory Short-Form

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by Harry E. and Bernice M. Moore Fellowship.

Note

Author Biographies

Shannon K. Johnson is an assistant professor at the Catholic University of America's National Catholic School of Social Service. She focuses her work on issues of trauma and spirituality among homicide survivors and survivors of other forms of sudden violent death. She teaches a course on death and end of life issues, as well courses on ethics, social work theories, social welfare policy, and social work practice.

Brooks Zitzmann is a doctoral candidate and research assistant at The Catholic University of America's National Catholic School of Social Service. Her work focuses on issues of environmental justice including psycho-social-spiritual pathways toward climate change mitigation. She is a licensed clinical social worker and teaches courses on professional ethics and theories of human behavior in the social environment.

References

Alesina

La Ferrara

(2002) Who trusts others? Journal of Public Economics 85(2): 207–234.

Armour

M. P.

(2002) Journey of family members of homicide victims: A qualitative study of their posthomicide experience. American Journal of Orthopsychiatry 72(3): 372–382.

Armour

M. P.

(2003) Meaning making in the aftermath of trauma. Death Studies 27(6): 519–540.

Bailey, A., Akhtar, M., Clarke, J., & Starr, S. (2015). Intersecting individual, social, and cultural factors in black mothers’ resilience building following loss to gun violence in Canada. In N. Khanlou & B. Pilkington (Eds.), Women's mental health (pp. 311–325). New York, NY: Springer International Publishing.

Bailey

Hannays-King

Clarke

Lester

Velasco

(2013) Black mothers' cognitive process of finding meaning and building resilience after loss of a child to gun violence. British Journal of Social Work 43(2): 336–354.

Balk

D. E.

(1999) Bereavement and spiritual change. Death Studies 23(6): 485–493.

Blumer

(1986) Symbolic interactionism: Perspective and method, Oakland, CA: University of California Press.

Burke

L. A.

Neimeyer

R. A.

(2014) Complicated spiritual grief I: Relation to complicated grief symptomatology following violent death bereavement. Death Studies 38(4): 259–267.

Burke

L. A.

Neimeyer

R. A.

McDevitt-Murphy

M. E.

Ippolito

M. R.

Roberts

J. M.

(2011) Faith in the wake of homicide: Religious coping and bereavement distress in an African American sample. International Journal for the Psychology of Religion 21(4): 289–307.

10.

Burke

L. A.

Neimeyer

R. A.

Young

A. J.

Bonin

E. P.

Davis

N. L.

(2014) Complicated spiritual grief II: A deductive inquiry following the loss of a loved one. Death Studies 38(4): 268–281.

11.

Cann

Calhoun

L. G.

Tedeschi

R. G.

Taku

Vishnevsky

Triplett

K. N.

Danhauer

S. C.

(2010) A short form of the posttraumatic growth inventory. Anxiety, Stress, & Coping 23(2): 127–137.

12.

Carlsen

M. B.

(1988) Meaning-making: Therapeutic processes in adult development, New York, NY: WW Norton & Co.

13.

Centers for Disease Control and Prevention. (2015). National violent death reporting system (NVDRS) fact sheet. Retrieved from http://www.cdc.gov/violenceprevention/nvdrs/.

14.

Charmaz

(1983) The grounded theory method: An explication and interpretation. In: Emerson

R. M.

(ed.) Contemporary field research: A collection of readings, Long Grove, IL: Waveland Press.

15.

Charmaz

(2006) Constructing grounded theory: A practical guide through qualitative analysis, Thousand Oaks, CA: Sage.

16.

Charmaz

Belgrave

(2002) Qualitative interviewing and grounded theory analysis. In: Gubrium

J. F.

Holstein

J. A.

Marvasti

A. B.

McKinney

K. D.

(eds) The SAGE handbook of interview research: The complexity of the craft, 2nd ed. Thousand Oaks, CA: Sage, pp. 347–366.

17.

Cole

B. S.

Hopkins

C. M.

Tisak

Steel

J. L.

Carr

B. I.

(2008) Assessing spiritual growth and spiritual decline following a diagnosis of cancer: Reliability and validity of the spiritual transformation scale. Psychooncology 17(2): 112–121.

18.

Creswell

J. W.

Shope

Clark

V. L. P.

Green

D. O.

(2006) How interpretive qualitative research extends mixed methods research. Research in the Schools 13(1): 1–11. Retrieved from http://www.msera.org/old-site/rits.htm.

19.

Crotty

(1998) The foundations of social research: Meaning and perspective in the research process, Thousand Oaks, CA: Sage.

20.

Davis

C. G.

Nolen-Hoeksema

Larson

(1998) Making sense of loss and benefiting from the experience: Two construals of meaning. Journal of Personality and Social Psychology 75(2): 561–574.

21.

Emmons

R. A.

(2003) The psychology of ultimate concerns: Motivation and spirituality in personality, New York, NY: Guilford Press.

22.

Glaser, B. G. (2013). Introduction: Free style memoing. Grounded Theory Review: An International Journal. Retrieved from http://groundedtheoryreview.com/.

23.

Glaser

B. G.

Strauss

A. L.

(1970) Theoretical sampling. In: Denzin

N. K.

(ed.) Sociological methods: A sourcebook, Piscataway, NJ: Sage, pp. 105–114.

24.

Guignon

C. B.

(2004) The existentialists: Critical essays on Kierkegaard, Nietzsche, Heidegger, and Sartre, Lanham, MD: Rowman & Littlefield Publishers.

25.

Hertz

M. F.

Prothrow-Stith

Chery

(2005) Homicide survivors: Research and practice implications. American Journal of Preventive Medicine 29(5, Suppl. 2): 288–295.

26.

Johnson

S. K.

Armour

M. P.

(2016) Finding strength, comfort, and purpose in spirituality after homicide. Psychology of Religion and Spirituality 8(4): 277–288.

27.

Joseph

Linley

P. A.

(2005) Positive adjustment to threatening events: An organismic valuing theory of growth through adversity. Review of General Psychology 9(3): 262–280.

28.

Keesee

N. J.

Currier

J. M.

Neimeyer

R. A.

(2008) Predictors of grief following the death of one's child: The contribution of finding meaning. Journal of Clinical Psychology 64(10): 1145–1163.

29.

Kristensen

Weisæth

Heir

(2012) Bereavement and mental health after sudden and violent losses: A review. Psychiatry 75(1): 76–97.

30.

Kuübler-Ross

(1969) On death and dying, New York, NY: Macmillan Publishing Company.

31.

Lichtenthal

W. G.

Burke

L. A.

Neimeyer

R. A.

(2011) Religious coping and meaning-making following the loss of a loved one. Counseling and Spirituality 30(2): 113–135. Retrieved from http://www.counsellingandspirituality.com/english/journal.php.

32.

Mays

Pope

(2000) Assessing quality in qualitative research. British Medical Journal 320(7226): 50–52. Retrieved from http://www.bmj.com.

33.

Murphy

S. A.

Johnson

L. C.

Fan

J. J.

Lohan

(2003) Bereaved parents' outcomes 4 to 60 months after their children's deaths by accident, suicide, or homicide: A comparative study demonstrating differences. Death Studies 27(1): 39–61.

34.

Parappully

Rosenbaum

van den Daele

Nzewi

(2002) Thriving after trauma: The experience of parents of murdered children. Journal of Humanistic Psychology 42(1): 33–70.

35.

Pargament

K. I.

(2013) Searching for the sacred: Toward a nonreductionistic theory of spirituality. In: Pargament

Exline

Jones

J. W.

(eds) APA handbook of psychology, religion, and spirituality, Washington, DC: American Psychological Association, pp. 257–273.

36.

Park

C. L.

(2005) Religion as a meaning-making framework in coping with life stress. Journal of Social Issues 61(4): 707–729.

37.

Park

C. L.

(2010) Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin 136(2): 257–301.

38.

Piedmont

R. L.

(2001) Spiritual transcendence and the scientific study of spirituality. Journal of Rehabilitation 67(1): 4–14. Retrieved from https://www.questia.com/library/p5155/the-journal-of-rehabilitation.

39.

Rheingold

A. A.

Williams

J. L.

(2015) Mental health outcomes, social support, and service use among a community-based sample. Violence and Victims 30(5): 870–883.

40.

Rheingold

A. A.

Zinzow

Hawkins

Saunders

B. E.

Kilpatrick

D. G.

(2012) Prevalence and mental health outcomes of homicide survivors in a representative US sample of adolescents: Data from the 2005 national survey of adolescents. Journal of Child Psychology and Psychiatry 53(6): 687–694.

41.

Rodger

Cowles

(1993) The qualitative research audit trail: A complex collection. Research in Nursing and Health 16(3): 219–226.

42.

Ronggui, H. (2012). RQDA: R-based Qualitative Data Analysis. R package version 0.2-3. Retrieved from http://rqda.r-forge.r-project.org/.

43.

Sarte, J. P. (1975). Existentialism is a humanism. In W. A. Kaufman (Ed.), Existentialism from Dostoevsky to Sartre (pp. 345–368). New York, NY: New American Library.

44.

Seymour

C. G.

(2011) Understanding anxiety: The crisis of ethical choice. In: Groom

S. A.

Fritz

J. M. H.

(eds) Communication ethics and crisis: Negotiating differences in public and private spheres, Lanham, MD: Farleigh Dickonson University Press with The Rowan and Littlefield Publishing Group Inc, pp. 45–66.

45.

Sharpe

T. L.

Joe

Taylor

K. C.

(2013) Suicide and homicide bereavement among African Americans: Implications for survivor research and practice. OMEGA Journal of Death and Dying 66(2): 153–172.

46.

Sharpe

T. L.

(2015) Understanding the sociocultural context of coping for African American family members of homicide victims: A conceptual model. Trauma, Violence, & Abuse 16(1): 48–59.

47.

Tedeschi

R. G.

Calhoun

L. G.

(1996) The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress 9(3): 455–471.

48.

Van Willigen

(2002) Applied anthropology: An introduction, Wesport, CT: Greenwood Publishing Group.

49.

Women Survivors of Homicide Movement. (2016). Community. Retrieved from https://www.facebook.com/WSOHMovement/.

50.

Wortmann

J. H.

Park

C. L.

(2008) Religion and spirituality in adjustment following bereavement: An integrative review. Death Studies 32(8): 703–736.

51.

Yalom

I. D.

(1980) Existential psychotherapy, New York, NY: Basic Books.