Bette G. Furn- Adjustment and the Near-Death Experience: A Conceptual and Therapeutic Model

8/3/2019 Bette G. Furn- Adjustment and the Near-Death Experience: A Conceptual and Therapeutic Model

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A d j u s t m e n t a n d t h e N e a r - D e a t hE x p e r i e n c e : A C o n c e p t u a l a n dT h e r a p e u t i c M o d e lB e t t e G . F u r n , P h . D .Counseling Services, University o f H artford

ABSTRACT"Most mental health practitioners, and counseling psychologistsin particular, possess skills for helping near-death experiencers. What is neededis a conceptual framework tha t is both familiar to practit ioners and highly rele-vant to that client group. Cross-cultural counseling in general, and the consid-eration of world views more specifically, are suggested. Using tha t framework,the world view assimilated during the near-death experience (NDE) is viewedas being in contrast to that of the ~'old self," significant others, and the majorityculture. The difficulties reported by NDErs are considered analogous to thoseassociated with culture shock. The world views of the practitioner, NDEr, andrelevant others should be taken into account in the formulation of psychoeduca-tional and therapeutic interventions.

The specific questi on being considered in this essay is: in wha t wayscan counseling psychologists aid near-de ath experiencers (NDErs) in ad-justi ng to the experience and its aftereffects? While the focus is on thepart icul ar skills and orientat ions of counseling psychologists, it is hopedthat the model to be presented will prove useful to a wide variety ofpractitioners working in medical and other health-care settings. Eachaspect of the question will be considered separately, with all relev antterms defined. The final section will suggest a paradigm from whichto view the partic ular adjustme nt problems of the NDEr, and from whichto draw appropriate intervention strategies.

A major premise of this paper is tha t most mental health practitioners,and counseling psychologists in particular, should alrea dy posses the

Requests for reprints should be sent to Dr. Furn at the Counseling Services,Universityof Hartford, West Hartford CT 06117.Journa l of Near-Death Studies, 6(1) Fall 1987

4 9 1987 Hum an Sciences Press


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r e q u i s i t e s k i l ls f o r a i d i n g t h i s p o p u l a t i o n ; w h a t i s n e e d e d is a co n c ep -t u a l f r a m e w o r k t h a t is , o r s h o u ld b e , b o t h f a m i l i a r to t h e p r a c t i t io n e ra n d h i g h l y r e l e v a n t to t h e c l i e n t g r o u p. S u c h a p a r a d i g m c a n b e p ro v i d e db y t h e l i t e r a t u r e o n c r o s s - c u l t u r a l c o u n s e l i n g .

C o u n s e l i n g P s y c h o l o g y a s a n A p p l i e d D i s c i p l i n eT h e h i s t o r ic a l r o o t s o f c o u n s e l i n g p s y c h o lo g y c a n b e t r a c e d , i n p a r t ,

t h r o u g h t h e m e n t a l h y g i e n e m o v e m e n t o f t h e e a r l y t w e n t i e t h c e n t u r y .W h i l e t h i s , i n a n d o f i ts e lf , is n o t a p a r t i c u l a r l y e x c l u s i v e d i s t i n c t io n ,i t h a s b e e n c o u n s e li n g , m o r e t h a n o t h e r b r a n c h e s o f p s y ch o lo g y , t h a td e r i v e d it s h e r i t a g e f r o m n o n m e d i c a l a n d n o n p s y c h o a n a l y t i c t r a d i t io n s( W h i te l e y , 1984). I n i t i a l l y t h r o u g h t h e v o c a t i o n a l g u i d a n c e m o v e m e n t ,a n d l a t e r v i a t h e c l i e n t - c e n t e r e d a p p r o a c h o f C a r l R o g e r s , c o u n s e l i n gp s y c h o l o g y d e v e l o p e d a s a d i s c i p li n e c o n c e r n e d w i t h l i fe - s t a g e i s s u e s o fs u b j e c t i v e i m p o r t t o i ts c l i e n t p o p u l a t i o n . H i s t o r i c a l l y , i ts f o c u s h a s b e e nd e v e l o p m e n t a l , a n d r e m e d i a t i o n h a s b e e n a p p r o a c h e d l a r g e l y t h r o u g ha p s y c h o e d u c a t i o n a l m o d e l . T h e A m e r i c a n P s y c h o l o g i c a l A s s o c i a t i o n(1 98 1) r e f e r s t o s e r v i ce s b y co u n se l i n g p sy ch o l o g i s t s a s t h o se f o r 'T ac i li ta t -i n g e f fe c ti v e f u n c t i o n i n g d u r i n g t h e l if e s p a n d e v e l o p m e n t a l p r o c e s s . . .w i t h a s i g n i f i c a n t e m p h a s i s o n p o s it iv e a s p e c t s o f g r o w t h a n d a d ju s t-m e n t a n d w i t h a d e v e l o p m e n t a l o r i e n t a t i o n " ( p . 6 5 4 ) .

W i t h s o m e s ig n i f i c a n t o m i s si o n s, t h e a b o v e d e s c ri p t io n c a p t u r e s t h ee s s e n t i a l s p i r it o f c o u n s e l i n g p s y c h o l o g y a s a n a p p l i e d d i s ci p li n e . W h i l ei t m a y s e e m t h a t w h a t h a s b e e n p r e s e n t e d i s a t h i n l y v e i l e d e x a m p l eo f p r o f e s s io n a l c h a u v i n i s m , i t is i m p o r t a n t t o r e c al l , fi rs t , t h a t m a n yo f t h e s p ec if ic s o f o r i e n t a t i o n a n d t e c h n i q u e a r e n o t u n i q u e t o c o u n se l-i n g p s y c h o lo g i s ts , a n d , s ec o n d , t h a t t h e c o n c e p t u a l f r a m e w o r k a s i t h a sb e e n o u t l i n e d t h u s f a r a l l o w s fo r a n e a s y i n c l u s i o n o f t h e n e a r - d e a t he x p e r i e n c e r a s a n a p p r o p r i a t e c l ie n t , i f o n e is w i l l in g t o c o n s i d e r a n e n -c o u n t e r w i t h d e a t h a s a l i f e s t a g e .

F o r r e a s o n s t h a t s h o u l d b e c o m e c l e a r e r in t h e f o l lo w i n g s ec t io n s , iti s p a r t ic u l a r l y i m p o r t a n t t h a t i n t e r v e n t i o n s d e s ig n e d f o r t h e N D E r b eg e n e r a t e d f r o m a p a r a d i g m p r i m a r i l y c o n c e r n e d w i t h a d j u s t m e n t i ss u e so f p e o p le i n g e n e r a l , a s o p p o s e d t o th o s e p r i m a r i l y c o n c e r n e d w i t h a t y p -i ca l re s p o n s e p a t te r n s . A f r a m e w o r k d e r i v e d f r o m n o n m e d i c a l a n d n o n -p s y c h o a n a l y t i c t r a d i t i o n s s h o u l d n o t o n l y b e m o r e a p p r o p r i a t e t o t h i sc l i e n t g ro u p , b u t c o u ld a ls o f r e e t h e p r a c t i t i o n e r f r o m m a n y o f t h e in -h e r e n t b i a s e s o f o r i e n t a t i o n s m o r e a c c u s t o m e d to t h e d i a g n o s i s o f d is -e a s e a n d p s y c h o l o g ic a l p a t h o l o g y .

T h e h i s t o r ic a l l e g a c y o f c o u n s e l i n g p s y c h o l o g y h a s c a l le d f o r t h e p ro -


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v i s i o n o f p s y c h o e d u c a t i o n a l s e r v i c e s f o r a b r o a d r a n g e o f d e v e l o p m e n -t a l a n d a d j u s t m e n t i s su e s . T h e m a n d a t e f o r t h e f u t u r e i s t o a n ti c i p a t en e w c l i e n t p o p u l a t i o n s a n d t o a d d r e s s t h e i r s p e c i a l n e e d s ( W h i t e l e y ,1 9 8 4 ) . T h e n e a r - d e a t h e x p e r i e n c e r r e p r e s e n t s s u c h a c l i e n t g r o u p .

T h e N e a r - D e a t h E x p e r i e n c eI n t e r e s t i n t h e n e a r - d e a t h e x p e r i e n c e ( N D E ) , a s s u c h , is a r e l a t i v e l y

n e w p h e n o m e n o n , b e g i n n i n g i n t h is c o u n t r y s o m e f if t ee n y e a r s a g o w i t ht h e w o r k o f R a y m o n d M o o d y (1 9 75 , 1 9 7 7) a n d E l i s a b e t h K i i b le r -R o s s .S i n c e t h e i r p i o n e e r i n g e f f o r ts , a n u m b e r o f i n v e s t i g a t o r s ( G a l l u p , 1 9 8 2 ;G r e y s o n , 1 9 8 2 ; G r e y s o n & F l y n n , 1 9 8 4 ; R i n g , 1 9 8 0 , 1 98 4 ; S a b o m , 1 9 8 1)h a v e s i g n i f i c an t l y e l a b o r a t e d u p o n t h e i n i t i a l d e s c r ip t i v e w o r k , em p l o y -i n g m o r e s c i e n ti f ic a ll y r ig o r o u s m e t h o d o l o g y . B o t h t y p e s o f i n q u i r y h a v ey i e l d e d h i g h l y c o n s i s t e n t f i n d in g s .

I n g e n e r a l , t h e N D E m a y b e t h o u g h t o f a s a p r o c e ss t h a t o c c u rs f o rs o m e i n d i v i d u a l s a s a r e s u l t o f c o m i n g c l o se t o d e a t h , o r , p e r h a p s , o fb e i n g c l i n ic a l ly " d e a d " f o r a p e r i o d o f t i m e . K e n n e t h R i n g ( 1 9 8 0) r e l a t e da t h o r o u g h c o m p o s i t e d e sc r i p ti o n o f w h a t m i g h t b e c o n s i d er e d a " ty p i-c al" N D E , b a s e d o n m o r e t h a n o n e h u n d r e d i n t e rv i e w s w i t h n e a r - d e a ths u r v i v o r s . W h i l e t h e r e a d e r i s e n c o u r a g e d t o c o n s u l t t h a t s o u r c e, a b r i e fo u t l i n e o f t h e e x p e r i e n c e i s a p p r o p r i a t e h e r e .

C o m m o n l y , t h e e a r l y s t a g e o f t h e e x p e r i e n ce i s ac c o m p a n i e d b y f ee l-i n g s o f p e a c e a n d q u i e t , p e r h a p s a l so i n v o l v i n g t h e v i e w i n g o f o n e 's o w nb o d y a n d t h e s u r r o u n d i n g a r e a f ro m a v a n t a g e p o i n t s o m e w h e r e a b o ve .T h e i n d i v i d u a l m a y t h e n h e a r a b u z z i n g o r o t h e r s i m i l a r s o u n d , a n db e a w a r e o f m o v i n g o r b e i n g d r a w n t h r o u g h a d a r k t u n n e l o r s o m e o t h er" p a s s a g e w a y . " I n th e d e e p e r s t a g e s o f t h e e x p e r i e n c e , th e i n d i v i d u a l m a ye n c o u n t e r a n e x c e p t i o n a l l y b r i l l i a n t l ig h t , w h i c h o f t e n i s p e r c e i v e d ase n c o m p a s s i n g , o r a c t u a l l y b e i n g , s o m e s o r t o f a p r e s e n c e . T h e " l i g h t "m a y a f fo r d t h e e x p e r i e n c e r t h e o p p o r t u n i t y t o r e v i e w h i s o r h e r l i fe , a si f i n a r e p l a y t h a t i s v i v i d l y c l e a r d e s p it e a n i n s t a n t a n e o u s q u a l i ty . T h er e v i e w a l l o w s f o r a c r i ti c a l a t t i t u d e t o w a r d t h e d e t a i l s o f o n e ' s o w n li fe ,w h i l e , n o n e t h e l e s s , o c c u r r i n g i n a n a t m o s p h e r e o f t o t a l l o v e a n d a c ce p -t a n c e. A t t h a t p o i n t, i n g e n e r a l, t h e e x p e r i e n c e r b e c o m e s a w a r e t h a ta d e c is i o n w i l l b e m a d e a s to w h e t h e r h e o r s h e w i l l s ta y o r r e t u r n . I ns o m e i n s t a n c e s t h e e x p e r i e n c e r c h o o s e s, w h i l e i n o t h e r s t h e r e i s n o op -t io n . T h e '~ re tu rn " to t h e p h y s i c a l b o d y i s a b r u p t , u s u a l l y w i t h o u t a w a r e -n e s s o f h o w o n e w a s r e t u r n e d .W h a t h a p p e n s l a t e r w i l l b e c o v e re d i n g r e a t e r d e p t h i n t h e s e c ti o no n a f t e re f f e c ts ; a t t h i s p o i n t , h o w e v e r , i t i s a p p r o p r i a t e t o s a y t h a t t h e


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e x p e r i e n c e r , i f p r o n e t o d i s c u s s t h e m a t t e r a t a l l, f i n d s g r e a t d i f f i c u l t yi n a d e q u a t e l y c o m m u n i c a t i n g t h e n a t u r e a n d q u a l i t y o f t h e e x p e ri e n ce .T h e r e i s a p r o f o u n d s u b j e c t iv e s e n s e o f i t s in e f f ab i l it y , b u t w i t h n o d o u b ta s t o i t s r e a l i t y .

T h e a b o v e d e s c r i p ti o n n o t w i t h s t a n d i n g , t h e r e a d e r i s u r g e d t o re c a llt h a t a l l h u m a n e x p e r i e n c e i n v o l v e s v a r i a b i l i t y ; t h e n e a r - d e a t h e x-p e r i e n c e i s n o e x c e p t io n . N o t a l l N D E s f o ll o w t h e p a t t e r n p r e c i s e ly , a n dp e r h a p s m o r e s ig n i f i c a n t ly t o t h e m e n t a l h e a l t h p r a c t i t i o n e r , n o t a llN D E r s r e s p o n d t o i t i n a u n i f o r m f a s h i o n .

I t is e s t i m a t e d t h a t s o m e w h e r e b e t w e e n 3 5 % a n d 4 0 % o f p e o p le w h oh a v e b e e n c l o se t o d e a t h c o u l d r e p o r t N D E s ( R i n g, 1 98 4). U s i n g G e o r g eG a l l u p ' s ( 19 8 2) e s t i m a t e s , t h a t c o u l d i n v o l v e ro u g h l y 8 m i l li o n a d u l tA m e r i c a n s . G i v e n t h e e v e r - i n c r e a s in g s o p h i s t i c a t io n o f m e d i c a l t e c h n o l-o g y , i t i s r e a s o n a b l e t o a s s u m e t h a t t h e n u m b e r h a s i n c r e a s e d , a n d i sl i k e l y t o c o n t i n u e t o d o s o. I t is a ls o q u i t e l i k e l y t h a t a w i d e v a r i e t y o fi n d i v i d u a ls , w h o m a y c o m e c lo s e t o d e a t h t h r o u g h a n y n u m b e r o f c ir -c u m s t a n c e s , c o u l d p o t e n t i a l l y u n d e r g o t h e e x p e ri e n ce . T h e r e s e a r c h l it er -a t u r e t h u s f a r h a s s h o w n t h a t n o n e o f t h e c o m m o n l y c o n s id e r ed d e m o -g r a p h i c v a r i a b l e s ( ag e , s e x , r a c e , so c i o ec o n o m i c s t a t u s , e d u c a t i o n a l l e v e l ,m a r i t a l s t a t u s , r e l i g i o u s a f f i l i a t i o n , g e o g r a p h i c v a r i a b l e s ) a r e s i g n i f i -c a n t l y r e l a t e d t o t h e o c c u r r en c e o r c o n t e n t o f t h e N D E . N e i t h e r d o e st h e m a n n e r i n w h i c h o n e c o m e s c lo s e t o d e a t h s e e m t o a f fe c t t h e e x -p e r ie n c e . L i t t l e r e s e a r c h i s av a i l a b l e , h o w e v e r , o n p o p u l a t i o n s s i gn i fLc a n t l y d i f f er e n t f ro m t h o s e o f t h e W e s t e r n w o r ld . T h a t n o t o n l y le a v e sa q u e s t i o n a s t o t h e u n i v e r s a l i t y o f t h e e x p e r i e n c e , b u t a ls o , f o r t h e p r a c -t i t io n e r , w a r r a n t s a ca v e a t a s t o w h a t a s s u m p t i o n s o n e m i g h t m a k ew h e n w o r k i n g w i t h s o m e o n e fr o m a n o n - W e s t e r n h e r i t a g e .

T h e A f t e r e f f e c t sA s o n e m i g h t e x p e c t , b e i n g s u b j e c t t o s u c h a p r o f o u n d a n d ( ~u n u su a l"

h a p p e n i n g m a y p r e s e n t p r o b l e m s . A l t h o u g h m u c h o f t h e r e s e a rc h l it er -a t u r e t o d a t e h a s c a t a l o g u e d , f a i r l y e x t e n s i v e l y , w h a t t h e a f t e r e f f e c t sa r e, t h e r e i s s o m e d i s a g r e e m e n t a s t o w h e t h e r t h e l i s t is c o m p l e t e, a n dt o w h a t e x t e n t i t is b i a s e d i n e m p h a s i z i n g t h e p o s i t iv e . A n y ~ t ra n sf o r-m a t i o n " t h a t o c c u rs i n t h e l if e o f t h e N D E r m a y b e a p r o c e s s i n v o l v i n gy e a r s .

W h i le i t m a y s e e m p r e m a t u r e t o e x p r e ss s u ch s t r o n g re s e r v a t io n s p r i o rt o o u t l i n i n g j u s t w h a t t h e a f t e r e f f e c t s a r e , i t is cr u c i a l , I b e l i e v e , i n a id -i n g t h i s p o p u l a t i o n , t h a t t h e i n t e r v e n t i o n i s t b e c a u t i o n e d a g a i n s t c o l-l u d i n g i n a k i n d o f '~ p ed e st al ef fe c t. " F o r r e a s o n s t h a t s h o u l d b e c o m ec l e a r e r l a t e r i n t h i s s e c t io n , t h a t m a y b e d i f f ic u l t t o do .


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T h e r e s e a r c h l i t e r a t u r e p r e v i o u s l y c i t e d i n t h e t e x t w i l l s e r v e a s t h ep r i m a r y s o u r ce s fo r s u m m a r i z i n g t h e a f te r e ff e c ts o f t h e N D E . I n o r d e rt o p r e s e n t t h e m a t e r i a l i n a f a s h i o n m o r e m e a n i n g f u l t o t h e p r a c t i t io n e r ,i t w i l l b e o r g a n i z e d a c c o r d i n g t o t h e f o l l o w i n g c a t e g o r i e s : p e r s o n a l , i n-t e r p e r s o n a l , a n d c u l t u r a l a f te r e ff e c ts . W h i l e s o m e o f t h e s e m i g h t r e a-s o n a b l y b e in c l u d e d i n m o r e t h a n o n e c a te g o r y , t h e d i s t in c t i o n s h o u l dp r o v e p r a g m a t i c a l l y u s e f u l.

Persona l A f tere ffec tsM o s t s o u rc e s c o n s u l t e d a g r e e t h a t t h e N D E r i s l i k e ly to fe e l a s e n s e

o f l os s a t h a v i n g t o r e l i n q u i s h t h e i n c r e d i b le b e a u t y a n d p e a c e e n c o u n -t e r e d i n t h e " o t h e r w o r ld . " H e o r sh e i s r e l e g a t e d t o a n e x i s t e n c e t h a tn o w s e e m s t e r r i b l y m u n d a n e b y c om p a r i so n . S o r ro w , a n g u i sh , a n d t h ei n a b i l i t y , f o r m a n y , t o b e a b l e t o s u c c e s s f u l l y c o m m u n i c a t e t o o t h e r s t h ep r o f u n d i ty o f w h a t h a s o c c u rr e d , o f te n m a y s i g n a l t h e b e g i n n i n g o f am a j o r , c li n i c a l d e p r e s s i o n . ( I t i s i m p o r t a n t t o n o t e t h a t t h e d e p r e s s i o n ,a s e x p e r i e n c e d b y t h e N D E r , w i l l d if fe r in s o m e s i g n i fi c a n t w a y s f ro mt h e m o r e t y p i c a l ca s e, i n t e r m s o f d i a g n o s t i c c r i t e r i a [ A m e r i c a n P s y c h i -a t r i c A s s o c i a t i o n , 1 9 80 ]; f o r e x a m p l e , f e e l i n g s o f w o r t h l e s s n e s s , e x c e s-s i v e g u i l t , a n d s u i c i d e i d e a t i o n a r e h i g h l y u n l i k e l y . T h e a f f e c t i v e p a i n ,h o w e v e r , i s a s i n t e n s e . )

A c o r o l l a ry p r o b l e m i s p r e s e n t e d b y v i r t u e o f n o t b e i n g a b l e t o c om -m u n i c a t e t h e n a t u r e o f t h e e x p e r ie n c e . I f t h e N D E r d o es m a k e a n a t -t e m p t t o sh a r e w h a t h a s j u s t t r a n s p i r e d , i t i s l i k e ly t h a t t h e r e s p o n s ew i l l b e o n e o f d i s b e l ie f , o f g r e a t e r o r l e s s e r i n t e n s i t y . T h i s n o t o n l y s e r v e st o f u r t h e r i s o la t e t h e N D E r e m o t i o n a l l y , c o n t r i b u t in g t o t h e d e p r e s s io n ,b u t a l s o fu e l s th e f e a r o f b e i n g t h o u g h t c r az y . T h i s i s a s ig n i f i c a n t a n dp e r s i s t e n t r i sk . I n a d d i t io n , s o m e N D E r s r e p o r t g e n e r a l d i f f i c u lt y i n co p-i n g w i t h t h e r u d i m e n t s o f l a n g u a g e ( A t w a t e r , 1 98 3), a s o p p o s e d t o t h ei n s t a n t a n e o u s a n d t o ta l c o m p r e h e n s i o n t h a t w a s p r e se n t d u r i n g t h eN D E . T a k e n a l l t o g e t h e r , t h e s e " s y m p t o m s , " w h i c h f o ll o w f r o m t h e c o n-t e x t o f t h e i n d i v i d u a l ' s c l o se e n c o u n t e r w i t h d e a t h , m a k e h i m o r h e rs e e m a l i k e l y c a n d i d a t e f o r a p s y c h i a t r i c r e f e r ra l . D e p e n d i n g u p o n t h ef r a m e o f r e f e r e n c e o f t h e c o n s u l t i n g p r o f e s s i o n a l , i f i n d e e d o n e i s co n-t a c t e d , t h a t c o u l d sp e l l d i s a s t e r o r r e l i e f f o r t h e e x p e r i e n c e r .

T h e a f t e r e ff e c t s d e s c r i b e d t h u s f a r g e n e r a l l y b e g i n t o s u r fa c e i n t h ep e r io d i m m e d i a t e l y f o ll o w in g t h e N D E ; o t h e r s b e c o m e a p p a r e n t o v e rv a r y i n g l e n g t h s o f t im e . N o t th e l e a s t o f t h e s e i s a c h a n g e d a t t i t u d e to -w a r d d e a t h . P e o p l e w h o h a v e r e p o r t e d a n e a r - d e a t h e x p e r i e n c e s h o wa m a r k e d a n d l a s t i n g d e c l i n e i n t h e i r f e a r o f d e a t h . I t w o u l d n o t b e o v er -


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B. G. FUR N 9

s t a t i n g t h e c a s e t o s a y t h a t , f o r m o s t , a l l f e a r o f d e a t h i s g o n e . T h i s i sn o t to s a y t h a t t h e p r o c e s s o f d y i n g i s v i e w e d t o t a l l y w i t h o u t d r e a d , b u tt h a t a c t u a l l y b e i n g d e a d e v o k e s n o f e a r. C o n c o m i t a n t l y , t h e r e i s am a r k e d i n c r e a s e i n a b e l i e f i n li fe a ft e r d e a t h , w h i c h m a y b e m o r e r ig h t l yd e s c r i b e d a s a c e r t a i n t y t h a t t h e r e i s a l i fe a f te r d e a t h .

A s o n e m i g h t e x p e c t , t h e N D E r i s a l so li k e l y t o u n d e r g o r e l ig i o u s o rp h i l o s o p h ic a l c h a n g e s . T h e s e m a y i n c l u d e c o n s i d e r in g o n e s e l f a s m o r es p i r i t u a l t h a n r e l ig i o u s , w i t h a r e p o r t e d d e c r e a s e d e m p h a s i s o n f o r m a la s p e c t s o f r e li g io n . A n i n c r e a s e d a w a r e n e s s o f t h e p r e s e n c e o f G o d a n da t e n d e n c y t o w a r d e m p h a s i z i n g t h e u n i v e r s a l s o f r e l ig i o n a r e a l so ci te d .F o r m a n y , t h a t t r a n s l a t e s b e h a v i o r a l l y i n t o a m o r e s e re n e o r p e a c e f uld e m e a n o r , l e s s i n t e r e s t i n m a t e r i a l t h i n g s , a g r e a t e r a p p r e c i a t i o n o f a n dn e e d f o r s o li t u d e , a n d a f o c u s o n t h e v a l u e s o f l o v e , c o m p a s s i o n , a n dg i v i n g .

P r o b a b l y m u c h m o r e d i f fi c u lt f o r m o s t p r a c t i t io n e r s t o a c c e p t a r e t h ed a t a r e p o r t i n g h e i g h t e n e d p s y c h i c a b i l i t i e s , in c l u d i n g c l a i r v o y a n c e ,t e l e p a t h y , p r e c o g n i t i o n , s y n c h r o n i c i t y , a n d t h e ~ ' w it n es s in g " o f f u t u r ep e r s o n a l e v e n t s . M o r e r a re l y , a n d c e r t a i n ly m o r e d i s tu r b i n g l y , N D E r sr e p o r t v i s io n s o f o u r p l a n e t a r y f u t u r e ( R in g , 1 98 4). W h e t h e r o r n o t o n ea c c e p t s t h e c r e d i b i l i t y o f t h e s e r e p o r ts , i t is fa i r l y e a s y t o s e e t h a t t h eN D E r w i l l b e d e a l i n g w i t h s u b s t a n t i a l s k e p ti c is m .

O v e r w h a t s e e m t o b e f a i r l y e x t e n d e d p e r i o d s o f t im e , t h e N D E r isa l s o a p t t o f e e l a s t r o n g e r s e n s e o f s e l f - e s t e e m a n d a s s e r t i v e n e s s . F o rs o m e , i t s e e m s t o d e r i v e f ro m t h e i r d i r e c t e x p e r i e n c e w i t h ~ t h e li g h t "a n d i ts a m b i e n c e o f t o t a l l o v e a n d a c c e p t a n c e ; f o r o t h e r s , i t m a y c o m ef r o m t h e l i f e r e v i e w a n d a f r e s h p e r s p e c t i v e o n p s y c h o l o g i c a l e n c u m -b r a n c e s .

A l t h o u g h t h e l i t e r a t u r e t o d a t e t e n d s t o f o cu s o n t h e m o r e i n t r ig u i n gr e v e l a t o r y a n d g r o w t h - i n d u c i n g a s p e c t s of t h e N D E , i t s h o u l d b e a p p a r -e n t t o t h e p r a c t i t i o n e r t h a t m u c h o f w h a t h a s b e e n d e s c r i be d a l so fa l lsw i t h i n t h e r e a l m o f p r o f o u n d p s y c h o lo g i c a l d i s tr e s s. S u c h c l i ni c al t e r m sa s d e p r e s s i o n , a n x i e t y , a n d a d j u s t m e n t r e a c t i o n c o u l d a l l b e a p p r o p r i -a t e l y a p p l i e d , w h i l e a h o s t o f o t h e r m o r e p a t h o l o g i c a l d e s c r i p t o r s w o u l dp r o b a b l y c o m e to m i n d . O n a p h il o s o p h ic a l , a s w e l l a s a d e e p l y p e r s o n a ll e v e l, t h e N D E r h a s u n d e r g o n e a n e x i s t e n t i a l c r i s is o f t h e f i r s t o rd e r.A d i f f ic u l t y i n a d j u s t m e n t , o f t e n e n d u r i n g f o r y e a r s , i s to b e e x p e c te d .

Interpersonal AftereffectsC o m m o n l y c it e d, a l t h o u g h n o t th o r o u g h l y e x p l or e d , i s t h e s t r a i n u p o n

t h e p r i m a r y r e l a t io n s h i p s o f t h e N D E r . B o u t s o f c r y in g , s e e m i n g l y i n-


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10 JOURN AL OF NEAR-DEATH STUDIES

a p p r o p r i a te a n g e r, w i t h d r a w a l , a n d o t h e r b e h a v i o r s d e e m e d a t y p ic a lo f t h e N D E r m a y s u r f a c e s h o r tl y a f t e r t h e e x p e r i en c e , w i t h l o n g e r - t e rmv a l u e a n d l if e -s ty l e c h a n g e s g e n e r a l l y e v o l v i n g m o r e s l o w l y . A l l o f t h e s em a y b e p r o b l e m a t i c n o t o n l y f o r t h e N D E r b u t a l s o f o r f a m i l y a n d f r ie n d s ,w o r k c o l le a g u e s , s u p e ri o rs , a n d a n y o n e e l se r e g u l a r l y i n v o l v e d w i t h t h ee x p e r i e n c e r . R e c o n s i d e r th e p e r s o n a l a f t e re f f e c t s o u t l i n e d a b o v e , a n dr e c a ll t h a t t h e N D E i s n o t s i g n i f ic a n t l y c o r r e l a t e d w i t h a n y o f t h e c o m -m o n d e m o g r a p h ic v a r i ab l e s. W h a t t h a t m e a n s is t h a t a n y n o r m a l , a v e r-a g e in d i v i d u a l , h a v i n g h a d a c lo s e e n c o u n t e r w i t h d e a t h , m a y s u d d e n l ys o u n d l i ke , a c t li k e, a n d t h i n k l ik e a n e n t i r e l y d i f fe r e n t, a n d p r o b a b l yu n f a t h o m a b l e p e r so n . U n f o r t u n a t e l y , t h a t s e e m s to be t h e r u l e , r a t h e rt h a n t h e e x c e p t i o n .

F r o m t h e p e r s p e c t i v e o f t h e N D E r , h e o r s h e h a s b e e n p r i v y to a n e x -t r a o r d i n a r y " r ea l m " o f e x p e r ie n c e t h a t h a s e n l i g h t e n e d h i m o r h e r t oa w h o l e n e w c o n c e p t u a l i z a t i o n o f s e l f a n d o t h e rs , t o w h a t i s i m p o r t a n ta n d w h a t i s n o t, a n d s o o n. P r o b a b l y i n p a r t b e c a u s e o f t h e N D E ' s i n-e f f a b i l it y , t h e e x p e r i e n c e r a l s o m a y f e e l a s e n s e o f e x c l u s i v i t y ; e v e ns h o u l d o n e t r y t o e x p l a in t h e n e w f r a m e o f r e f e re n c e , n o w o r d s a r e a d e -q u a t e , a n d n o o n e w h o h a s n o t e x p e r i e n c e d t h e s t a t e c o u l d e v e r r e a l l yu n d e r s t a n d . T h a t k i n d o f a t t i t u d i n a l s e t t r a n s l a t e s i n t o s i g n i fi c a n t in -t e r p e r s o n a l b e h a v i o r p r o b l e m s .

I n v a r y i n g d e g r e e s o f i n t e n s i t y a c r o ss t h e e n t i r e p o s t - N D E p e r io d , t h eN D E r i s q u i t e l i k e ly to h a v e g r e a t d i f fi c u l ty i n i n t e g r a t i n g h i s o r h e ra t t i tu d i n a l a n d b e h a v i o r c h a n g e s w i t h e x p e c t a n c i e s p r e v i o u s l y m e t b yt h e % l d s el f. " W h a t u s e d t o b e r o u t i n e r o le f u n c ti o n i n g , m a y s e e m s u-p e r f l u o u s o r i n s i g n if i c a n t i n l i g h t o f n e w v a l u e s a n d p r io r i t ie s .

F r o m t h e p e r s p e c t i v e o f s i g n i fi c a n t o t h e r s, a l l o f t h a t m a y b e p e r c e i v e da s t a n t a m o u n t t o i n t e r p e r s o n a l b r e a c h o f c o n t r a c t. I m a g i n e f o r a m o -m e n t a ty p i c a l m i d d l e -c l as s f a m i l y w h o s e p r i m a r y w a g e e a r n e r n o l o n g e rp a r t i c u l a r l y v a l u e s t h e A m e r i c a n w o r k e th ic , w i t h i t s e m p h a s i s o nc a p i t a l i s m a n d e c o n o m i c g r o w t h ; w h o n o l o n g e r c o n s id e r s c o m m u n i t ys t a n d i n g a s w o r t h y o f b e i n g b o t h e r e d a b o u t ; a n d w h o h a s m o v e d m a t e-r i a l a c c o u t r e m e n t s t o t h e b o t t o m o f t h e p r i o r i t y l is t. S h o c k , a n g e r , a n do t h e r s i m i l a r r e a c t i o n s a r e p r o b a b l e to w a r d s u c h a u n i l a t e r a l n e e d t oa l t e r t h e f a m i l i a r , i n a d d i t i o n t o a m b i v a l e n c e a n d p e r h a p s g u i l t a t fe el -i n g s u c h t h i n g s t o w a r d s o m e o n e w h o h a s n e a r l y d i e d.

A l m o s t p a r a d o x i c a l l y , t h e i n t e r p e r s o n a l s t r a i n i s r o o t e d i n t h e N D E r ' sc o n v i c ti o n t h a t l o v e a n d u n c o n d i t i o n a l a c c e p t a n c e o f o t h e r s a r e p a r a -m o u n t v a l u e s; t h e i r t r a n s la t i o n i n to t h e m i n u t e s t d e t a il s o f e v e r y d a yl if e b e c o m e s a n i m p e r a t i v e . T h e c o r o l la r y l i fe - s t y le s c h a n g e s r e q u i r e da r e p e r c e iv e d a s e n o r m o u s a n d u n r e a s o n a b l e t o t h o s e m o r e f i rm l y r o o t edi n t h e t r a p p i n g s o f t h i s w o r l d .


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B. G. FUR N 11

C u l t u r a l A f t e r e ff e c tsI n t h e b r o a d e s t s e n s e , m u c h o f t h e a b o v e r e f le c t s a m a j o r s h i f t in t h e

f r a m e o f r e f e re n c e o f t h e N D E r f r o m t h e p r e - N D E v a l u e s y s t e m t o t h eo r i e n t a t io n e x p e r i e n c e d d u r i n g t h e p r o ce s s o f t h e N D E . T o t h e e x t e n tt h a t a w i d e l y s h a r e d v a l u e s y s t e m i s s y n o n y m o u s w i t h ~ c u lt u re ," it m a yb e s a i d t h a t N D E r s h a v e p h i l o s o p h i c a l l y a n d b e h a v i o r a l l y a d o p t e d an e w c u l t u r e . C u l t u r a l a f t e re f f e c ts , t h e n , r e f e r n o t j u s t t o tr a n s a c t i o n sb e t w e e n t h e e x p e r i e n c e r a n d s o c ie t y , b u t a l s o t o a s i g n i f ic a n t s h i f t i nh i s o r h e r w o r l d v i e w . T h e N D E r ' s c o n c e p t i o n o f s e lf , o f o t h e r s , o f n a -t u r e , o f t h e n a t u r e o f l i fe , a n d o f t i m e m a y b e s i g n i f i c a n t l y a l t e r e d d u r -i n g a g e n e r a l l y e x t e n d e d p e r i o d f o l lo w i n g t h e N D E .

T h e l i t e r a t u r e d e s c r ib e s w h a t m i g h t b e c o n s id e r e d a m o r e s p i r i t u a lo r i e n t a t i o n t o l if e; t h a t is , t h e N D E r , p a r t i c u l a r l y i f h e o r s h e h a s h a da d e e p e x p e r i e n c e , t e n d s t o e x p r e s s a h e i g h t e n e d a p p r e c i a t i o n o f o r r e v e r-e n c e fo r li fe , a n d s t r e s s e s l o v e a s b e i n g o f t h e u t m o s t i m p o r t a n c e . F r e -q u e n t l y i t a ls o in v o l v e s a d e e p l y fe l t n e e d t o d e t e r m i n e t h e r e a s o n f o ro n e 's b e i n g h e r e a n d t o a c c o m p l i s h w h a t e v e r o n e ' s p u r p o s e i s. T h e N D Ea n d i ts e v o l v in g r a m i f i c a t i o n s b e c o m e c e n t ra l t o t h e w a y i n w h i c h t h eN D E r p e r c e iv e s a n d r e l a t e s t o t h e w o r l d.A g a i n , i t i s i m p o r t a n t f o r t h e p r a c t i t i o n e r t o r e c a l l t h a t n o n e o f t h ea f t e r e ff e c t s d e s c r i b e d n e c e s s a r i l y p e r t a i n t o a n y g i v e n i n d i v i d u a l w h oh a s h a d a c l os e e n c o u n t e r w i t h d e a t h . T h e i n f o rm a t i o n p r e s e n t e d h e r ei s a c o m p i l a t io n o f d a t a t h a t t e n d s t o d i s t i n g u i s h N D E r s a s a g r o u p ;v a r i a t io n w i t h i n t h e g r o up m a y b e c on s id e ra b le . G i v e n th e u n u s u a l a n di n t r ig u i n g n a t u r e o f t h e p h e n o m e n o n , i t m a y b e e x t r e m e l y t e m p t i n gto m a k e u n w a r r a n t e d a s s u m p t i o n s a b o u t t h e N D E c l ie n t. T h e t a s k o ft h e i n t e r v e n t i o n i s t s h o u l d b e t o e d u c a t e t h e e x p e r i e n c e r a n d s i g n i f ic a n to t h e r s t o w h a t a r e , o r m a y b e , t h e i s s u e s w i t h w h i c h t h e y h a v e t o c o pe ,a n d t o p ro v i d e a f r a m e w o r k t h r o u g h w h i c h t o f a c i li ta t e a d j u s t m e n t .

W h a t C o n s t i t u t e s A d j u s t m e n t ?I t o f te n s e e m s t h a t a n u n d e r s t a n d i n g o f w h a t ~ a d j u s t m e n t " i s c o m e s

m o s t e a s i l y b y d e t e r m i n i n g w h a t i t is n o t. I n a s e n s e , i t is c o n s p ic u o u sb y i ts a b s en c e . N o n e t h e l e s s , t h e t e r m c l e a r l y i m p l i e s a n i n t e r f a c e w i t hs o m e ~'o th er ," g e n e r a l l y u n d e r s t o o d t o b e a t t h e s y s t e m l e v e l. T o v a r y -i n g d e g r e e s , th e n , i t r e f l e c ts th e c o n g r u e n c e o f p e r s o n - e n v i r o n m e n t f it .

A s a c o n s t r u c t d e f i n i n g a n a s p e c t o f p s y c h o l o g ic a l h e a l t h , i t g e n e r a l l yr e f e r s t o a s u c c e s s f u l b a l a n c i n g o f p e r s o n a l n e e d s , i n t e r p e r s o n a l o b l ig a -t io n s , a n d c u l t u r a l e t h ic s . D i f f e r i n g fo r m a l d e f i n i t io n s s e e m t o f o c u s v a r -


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12 JOURNAL OF NEAR-DEATH STUDIES

iously, and subtly, on one or anothe r of the t hre e components. RobertGoldenson (1984) defined adjustment, in part, as ~'the modification ofattitud es or behavior to mee t t he demand s of life effectively, such ascarr ying on constructive interperson al relations, dealing with stressfulor problematic situations, handli ng responsibilities, or fulfilling personalneeds and a i m s . . . " (p. 16). The focus of th at definitio n is on the cul-tu ra l level, here r efe rre d to as ~'the dema nds of life." Ben jam in W olma n(1973) shifted the emphasis slightly to the personal level, and definedadjustment, in part, as ~'an harmon ious rel ation with the env iro nme ntinvolving the ability to satisfy most of one's needs and meet most of thedemands, both physical and social, th at are put upon o n e. . . " (p. 9). Asomewhat more equivocal and probably more realistic definition wasprovided by Hans Eysenck (1972):

1. A state in which the needs of the individual on the one hand andthe claims of the environment on the other are fully satisfied. Harmonybetween the individual and the objective or social environment. 2. Theprocess by which this harmonious relationship can be attained. Thestate is of course expressible only in theoretical terms, since in prac-tice no more than a relative adjustment is reached in the sense of op-timal satisfaction of individual needs and untroubled relation to theenvironment . . . (p. 25)

The relativistic and nonjud gmental pos ture reflected in that definitionshould appeal to the practi t ioner interested in devising interventionstrategies within a cross-cultural framework. It presupposes no abso-lute values and acknowledges that adjustment is as much an ongoingprocess as it is an end state.

As a construct defining psychological disorder, or '~maladjustment,"it refers to an incongruence in perso n-env ironme nt fit, gen erally recog-nized as being of signif icant propor tions an d o ften as being of a tem-pora ry nature. The Diagnostic and Statistical Man ual of Mental Dis-orders (DSM-III) (American Psych iatr ic Association, 1980) disti nguishedan adjustment disorder as meeting the following criteria:

A. A malada pti ve reac tion to an iden tifiabl e psychological stres-sor, th at occurs withi n t hre e month s of the onset of the stressor.

B. The maladapti ve na tur e of the reacti on is indicated by eith erof the following: (1) im pa ir me nt in social or occupa tional func-tion ing (2) sympto ms th at are in excess of a no rmal and expect-able reaction to the stressor.

C. The distu rbance is not merely one instance of a patt er n of over-reaction to stress . . . .


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D . I t i s a s s u m e d t h a t t h e d i s t u r b a n c e w i l l e v e n t u a l l y r e m i t a f t e rt h e s t r e s s o r c e a s e s o r . . . w h e n a n e w l e v e l of a d a p t a t i o n i sa c h i e v e d . ( p p . 3 0 0 - 3 0 1 )

A f i n a l c a v e a t n o t e d t h a t t h e d i s t u r b a n c e s h o u ld n o t m e e t t h e c r i t e r i af o r a n y o t h e r m o r e a p p r o p r i a t e d i a g n o s t i c c a t e g o r y .

W h e t h e r o n e v ie w s t h e r e s p o n s e o f t h e N D E r a s n o r m a l o r m a l a d a p -t i v e i n q u a l i t y a n d d e g r e e , it is a p p a r e n t t h a t a p r o c e s s o f a d j u s t m e n to f g e n e r a l l y s i g n i f i c a n t p r o p o rt io n s m u s t b e u n d e r t a k e n . R e g a r d l e s s o ft h e n a t u r e a n d e x t e n t o f t h e a d a p t a t i o n t o b e a c h ie v e d , t h e t h e r a p e u t i cg o a l s h o u l d b e to e a s e a n d e n h a n c e r e o r i e n t a t io n t o t h e d e m a n d s o f t h ee n v i r o n m e n t , g i v e n t h e f r a m e o f r e f e r e n c e o f t h e e x p e r i e n c e .

C r o s s - C u l tu r a l C o u n s e l i n g a n d W o r ld V i e w sT h e c o m m o n d e n o m i n a t o r o f t h e r e s e a r c h l i t e r a t u r e o n N D E s i s i t s

r e c u r r i n g r e p o r t s o f a b a s i c c h a n g e i n t h e w o r l d v i e w o f e x p e r i e n c e r s.A s a r e s u l t o f h a v i n g u n d e r g o n e t h a t p r o c e ss , as o u t l i n e d a b o v e , t h e in -d i v i d u a l c o m e s t o i d e n t i f y w i t h a f r a m e o f r e f e r e n c e t h a t i s s i g n i f i c a n t l yd i f f e r en t f ro m t h a t o f t h e p r e d o m i n a n t c u l tu r e . V i e w e d i n t h a t f a sh i o n ,t h e N D E r is a m e m b e r o f a c u l t u r a l m i n o r i ty , w h o s e b e l ie f s, v a l u e s , a n da t t i t u d e s c o n fl ic t w i t h t h o s e o f t h e m a j o r i t y c u l t u r e . ( R e c a l l t h a t m o s ts t u d ie s h a v e r e l ie d o n sa m p l e s t a k e n f r o m t h e a d u l t A m e r i c a n p o p u l a-t io n ; th e m a j o r i t y c u l t u r e r e f e r r e d t o , t h e n , i s t h a t o f t h e W e s t e r n w o r l da n d i t s J u d e o - C h r i s t i a n h e r i t a g e . V e r y d i f f e re n t f i n d in g s , i n t e r m s o fa f t er e f fe c t s a n d a d j u s t m e n t , m a y e m e r g e f r o m n o n - W e s t e rn c u l tu r e s. )

A p p r o p r i a t e i n t e r v e n t i o n s t r a t e g i e s , th e r e f o r e , w o u l d b e s t b e g e n e r -a t e d f r o m a c r o s s - c u l t u r a l p a r a d i g m . V e r y o f t e n t h e t e r m ~ 'c ro s s- c ul tu r al "i s w r o n g f u l l y e q u a t e d w i t h g e o g r a p h y o r e t h n i c g r o u p ; w h i l e t h o s e a r ec o m p o n e n t s o f t h e p a r a d i g m , h e r e i t i s u s e d i n i ts b r o a d e r c o n n o t a t i o na s a n a r e a c o n c e r n e d w i t h i n v e s t i g a t i n g d i f fe r e n c e s i n w o r l d v i e w s a n di n d e v e lo p i n g i n t e r v e n t i o n s t r a te g i e s t h a t t a k e i n to a c c o u n t t h e v a l u es y s t e m o f t h e c l ie n t .

D e s p i t e t h e u n u s u a l c i r c u m s t a n c e s t h r o u g h w h i c h t h e re o r i e n t a t i o no c c u rs , t h e p r o c e s s N D E r s u n d e r g o i s n o t u n i q u e t o th a t , o r a n y o t h e r ,s p e ci fi c g r o u p a t t e m p t i n g c u l t u r a l a d a p t a t i o n . T h e d i f f ic u l t i e s r e p o r t e db y N D E r s b e a r a s t r i k i n g r e s e m b l a n c e t o th o s e a s s o c ia t e d w i t h c u l t u r es h o c k , i.e ., a n x i e t y , d e p r e s s i o n , d i f f i c u l t y i n d i s c e r n i n g a p p r o p r i a t e r e-s p o n s es , a n d b a r r i e r s t o c o m m u n i c a t i o n . I f o n e c o n s id e r s t h e w o r l d v i e we x p e r i e n c e d d u r i n g t h e p r o c e s s of t h e N D E a s t h e '~ ho m e c u l t u r e , " a n d


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the world view of this rea lm as the ~'host culture ," then Pau l Pedersen's(1981) description could easily apply to the NDEr:

The specific symptoms of culture shock focus on either dissatisfactionwith the host culture or idealization of the home culture. The host cul-ture is criticized as being peculiar, irrational, inefficient, and unfriendly.The visitor is likely to fear being taken advantage of, being laughedat or talked about, not being accepted, and wanting to spend more timearound persons from the visitor's home culture . . . Minor annoyancesin the host culture become exaggerated, and the few remaining linkswith the home culture become extraordinarily important . . . Cultureshock is likely to extend over a long period of time, reappear in a vari-ety of forms, and not be limited to an init ial adjustment . . . The vis-itor experiences a genuine identity crisis, requiring either that the for-mer identity be disowned or that the visitor create and maintainmultiple identities . . . In either case, the visitor is required to reinte-grate, confront, and challenge the basic underlying assumptions of hisor her personality. (p. 319)

While th e impe tus for change is, for NDErs, group-specific, the prob-lems are not.

Using a cross-cultural paradigm, it is clear that the process of adjust-men t following the NDE is a normal response, d emonstr ably similarto tha t of culture shock, and, as such, tends to follow a predictable pat-ter n (Adler, 1975). The first stage involves the initi al contact with wh atabove was referred to as the host culture; for the NDEr th at is the periodimmedia tely following the awareness of ret urn ing to the physical body.According to Peter Adler, the stage "is mar ked by the excitemen t andeuphoria of the new experience," and in which "the individual is stillfunctionally integrated with his or her own culture" (p. 16), i.e., thatof the NDE. The second stage is characte rized by confusion and disorien-tation, as the individua l becomes increasingly aware t ha t his or her at-titudes and values conflict with those of the major ity culture. Inappropri-ate behaviors and interpersonal mi sund erst andi ngs contribute to one'ssense of being different, and of feeling isolated. Ali enation, depression,and wit hdraw al are common reactions. During th e th ird stage, the in-dividual may actively cultivate relationships with only those who sharehis or her culture, i.e., other NDErs. A strong rejection of the host cul-tur e is likely. However, "rejection of the culture th at causes negativefeelings is more than a reactive behavior an d becomes the basis for new,intu itive, emotional, and cognitive experiences" (p. 17). The four th s tageinvolves a gradual increase in coping skills and personal flexibility,along with a degree of comfort in one's status as both ins ider and out-sider. The fifth, and final, transitional stage is marked by an acceptance


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o f c u l t u r a l s i m i l a r i t i e s a n d d i f fe r e n c e s. T h e i n d i v i d u a l i s a b l e t o g i v e ,a s w e l l a s t o in s p i r e , a d e m e a n o r o f s e n s i t i v i t y a n d t r u s t . E x p r e s s i v e -n e s s , h u m o r , a n d c r e a t i v i t y r e - e m e r g e i n a h e i g h t e n e d f a s h i o n , i n a p -p r e c i a t i o n o f d i f fe r e n c e a n d d i v e r s i t y . A l t h o u g h t h e s t a g e s a r e l i s t e d s e-q u e n t i a l l y , t h e p r o c e s s i s n o t a l i n e a r o n e . T h e c l i e n t m a y b e f u n c t i o n a l l yi n m o r e t h a n o n e s t a g e , w i t h ~ 'p r og re ss io n " i n s o m e a r e a s a n d ~ r eg r es -s i o n " i n o t h e r s o c c u r r i n g s i m u l t a n e o u s l y .

W h i l e t h e a d j u s t m e n t p r o c e s s t e n d s t o f o ll o w t h i s p a t t e r n , t h e r e i s c on -s i d e r a b l e v a r i a t i o n f r o m i n d i v i d u a l t o i n d i v i d u a l i n t h e q u a l i t y a n d d e -g r e e t o w h i c h t h e t r a n s i t i o n a l b e h a v i o r s a r e m a n i f e s t e d . P e r s o n a l i t y ,c o p i n g s k il ls , a n d e n v i r o n m e n t a l v a r i a b l e s , a m o n g o t h e r f a ct o rs , c a na ll c o n t r i b u t e t o t h e e a s e o r d i s -e a s e w i t h w h i c h t h e t r a n s i t i o n i sn e g o t i a t e d . O n e i m p o r t a n t f a ct o r s e e m s t o b e t h e m a g n i t u d e o f t h e d if fe r-e n c e b e t w e e n t h e h o m e a n d h o s t cu l tu r e s . I t m a y b e , t h e n , t h a t N D E r sw h o h a v e h a d a p a r t i c u l a r l y d e e p o r p r o l o n g e d e x p e r i e n c e w o u l d h a v eg r e a t e r d i f f i c u l t y a d j u s t i n g .

G i v e n t h i s g e n e r i c f r a m e o f r e f e r e n c e f ro m w h i c h t o v i e w th e a d ju s t-m e n t p r o b l e m s o f N D E r s , t h e i s su e t h e n b e c o m e s h o w b e s t to f a c il i t a tet h e a d j u s t m e n t p r oc e ss ; i n th e l a n g u a g e o f t h e p s y c h o l o g is t , t h a t m e a n sd e v e l o p i n g a t r e a t m e n t p l a n . A s n o t e d e a rl i e r, i n t e r v e n t i o n s d e s i g n e df or t h e N D E r a r e m o r e a p p r o p r i a t e ly d r a w n f ro m n o n m e d i c a l a n d n on -p s y c h o a n a l y t i c t ra d i t i o n s , g i v e n t h a t t h e N D E i s n o t a p a t h o l o g i c a lp r o ce s s. I n a c t u a l i t y , t h e n , t h e p r a c t i t i o n e r i s n o t s o m u c h d e v e l o p i n ga ~ t re a t m e n t " p l a n , a s h e o r sh e is e s t a b l i s h i n g a w o r k i n g m o d e l t h r o u g hw h i c h t o e n l is t t h e a i d o f t h e c l i e n t i n d e t e r m i n i n g h o w b e s t t o n e g o ti -a t e t h i s s t a g e o f d e v e l o p m e n t . T h i s s h i f t i n s e m a n t i c s a n d c o g n i t io n i sn o t a t r i v i a l o n e , i f t h e p r a c t i t i o n e r i s g e n u i n e l y t o c o n s id e r th e N D E ra c l i e n t , a n d n o t a p a t i e n t . C o n c e p t u a l l y , t h e n , t h e p a r a d i g m i s c r o s s -c u l t u r a l , a n d t h e e x e m p l a r , t h e p s y c h o e d u c a t i o n a l m o d e l; s p ec if ic in -t e r v e n t i o n s t r a te g i e s m u s t f lo w f r o m b o th .

Therapis t VariablesT o o o f t e n a c o n s i d e r a t i o n o f t h e r a p i s t v a r i a b l e s i s n e g l e c te d , e v e n

t h o u g h i t i s , i m p l i c i t l y , t h e f i r s t s t e p i n f o r m u l a t i n g a n i n t e r v e n t i o ns t r a t e g y . W h e n e m p l o y i n g a c r o s s - c u l t u r a l f r a m e w o r k , a t l e a s t t h r e ei s s u e s m u s t b e c o n s i d e r e d : 1 . t h e w o r l d v i e w o f t h e t h e r a p i s t , 2 . t h e w o r l dv i e w o f t h e c l i e n t, a n d 3 . t h e w o r l d v i e w o f t h e t h e r a p i s t v i s -a - v is t h ew o r l d v i e w o f t h e c l ie n t. P r i o r t o e n g a g i n g i n a n y f o r m o f t h e r a p y , i ti s i m p o r t a n t t h a t t h e t h e r a p i s t b e o v e r t ly a w a r e o f h i s or h e r v a l u e s ys -t e m . I n th e c r o s s - c u l tu r a l e n c o u n t e r , t h a t i s a n i m p e r a t i v e ( I b r a h im ,


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16 JOUR NA L OF NEAR-DEATH STUDIES

1 9 85 ). W o r k i n g w i t h s o m e o n e o f a s i g n i f i c a n t l y d i f f e r e n t c u l t u r e i s~ 'lik ely t o h i g h l i g h t o t h e r w i s e h i d d e n c o n f l ic t s i n o u r o w n b e h a v i o r a ta r a t e m a n y t i m e s f a s t e r t h a n w h e n w o r k i n g w i t h i n o u r o w n fa m i l i a rc u l t u r e " ( P e d e r s e n , 1 9 8 1 , p . 32 1 ). F o r t h e b e n e f i t o f t h e c l i en t , t h e s e is -s u e s m u s t b e re s o l v e d to t h e g r e a t e s t e x t e n t p o s s i b l e p r i o r t o e n t e r i n gi n t o t h e t h e r a p e u t i c r e l a t i o n s h i p . I n a d o p t i n g a c ro s s - cu l t u ra l p a r a d i g m ,t h e p r a c t i t io n e r is e t h ic a l l y b o u n d t o b e k n o w l e d g e a b l e o f t h e c l ie n t 'sc u l t u r a l r e f e r e n c e g r o u p , a n d to r e l a t e w i t h s e n s i t i v i t y ( S u n d b e r g , 1 9 81 ).F i n a l l y , a s a r u l e , i t i s c o n s i d e r e d b e s t t h a t t h e t h e r a p i s t a n d c l i e n t ina c r o s s - c u l t u r a l e n c o u n t e r s h a r e t h e s a m e w o r l d v i e w (S u e , 19 8 1) .

T h e p r a c t i t i o n e r w h o c h o o se s t o w o r k w i t h N D E r s m a y b e p a r t i c u l ar l ys u s c e p t i b l e t o c o n f li ct , b o t h i n t e r n a l l y a n d i n t h e d y a d i c r e l a t i o n s h i p( B u sh , p e r s o n a l c o m m u n i c a t i o n , N o v e m b e r 5 , 1 98 4). T h i s i n v o l v e s n o to n l y t h e i n c l in a t io n o n t h e p a r t o f m a n y t o e q u a t e t h e N D E w i t h s o m ef o r m o f m e d i c a l o r p s y c h o l o g i c a l d i s t u r b a n c e , b u t i t a l s o in c l u d e s a te n -d e n c y o n t h e p a r t o f o t h e r s t o b e a t i f y it . A p r o f e s s i o n a l s t a n c e n e c e ss i -t a t e s t h e o f t e n d e l i ca t e b a l a n c i n g o f e m p a t h i c i n v o l v e m e n t w i t h o b je c-t i v e d i s ta n c e . I t s e e m s l ik e l y t h a t g i v e n t h e a t t i t u d e s e t o f a ~rN D E r t h a t s u c c e s s fu l l y t r e a d i n g t h a t f in e l in e i s a p r e c a r i o u s p r o c es s .

O n e m i g h t r e a s o n a b l y a r g u e , t h e re f o r e , t h a t t h e b e s t t h e r a p i s t f o r t h eN D E r i s a n o t h e r N D E r . H o p e f u l l y t h a t i s n o t n e c e s s a r i ly t h e c a se . N o to n l y m a y h e o r s h e b e to o in v o l v e d i n a p e r s o n a l s t r u g g l e t o a d j u s t tob e o f h e l p , b u t t h a t m i g h t a l s o r e i n f o r c e t h e e x i s t i n g t e n d e n c y t o a ss o ci -a t e p r i m a r i l y o r e x c lu s i v e l y w i t h o t h e r N D E r s a n d t h u s i m p e d e t h e a d -j u s t m e n t p r o c e s s .

W h a t i s p r o p o s e d h e r e i s t h a t t h e t h e r a p i s t 1. b e t h o r o u g h l y a c q u a i n t e dw i t h t h e N D E a n d i t s a f t e r e f f e c t s , 2 . a s s u m e a c r o s s - c u l t u r a l p e r s p e c -t iv e , a n d 3 . b e s y m p a t h e t i c t o n o n - W e s t e r n p h i l o so p h i e s , p a r t i c u l a r l yt h o s e o f t h e F a r E a s t , a n d t o m y s t i c a l t r ad i t i o n s .

Assessment TechniquesO n c e th e r a p i s t v a r i a b l e s a r e a c c o u n t e d fo r, t h e i s s u e t h e n b e c o m e s

h o w t o a s se s s th e c l i en t , t h a t is , h o w t o ex p l o r e t h e n a t u r e a n d q u a l i t yo f t h e N D E , a n d h o w t o d e t e r m i n e t o w h a t e x t e n t t h e c l i en t 's e x p e r i en c ec o n f o rm s to g r o u p n o r m s . I n a d d i t i o n t o p r o v i d i n g t h e t h e r a p i s t w i t hn e c e s s a r y " d i a g n o st ic " in f o r m a t i o n , a s s e s s m e n t t e c h n i q u e s s h o u l d a l sob e t ie d t o t h e d e s i re d o u t c o m e o f t h e t h e r a p y p r o g r a m ( G o t t m a n & M a r k -m a n , 1 97 8). T h e i n f o r m a t i o n g a t h e r e d e a r l y i n t h e t h e r a p e u t i c r e l a ti o n -s h i p s h o u l d a s s e s s t h e i s s u e s , a s w e l l a s p r o v i d e a b a s e l i n e f r o m w h i c ht o e v a l u a t e t h e s u c c es s o f t h e i n t e r v e n ti o n .


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Depending upon when during the post-NDE period the practitionerbecomes involved, some assessment techniques may be more appropri-ate than others. Reconsideration of the adjustment stages and their ac-companying behaviors suggests that during the earliest stages of ad-justment the more passive, empathic listening modes would leastalienate the client, combined perhaps with basic forms of real ity test-ing, i.e., orienting the client to time, place, and person. During laterstages, basic in terviewing techniques tha t employ empathic, facilita-tive styles should suffice.These techniques should be familiar to experienced therapists, par-ticularly those t rained in counseling psychology and re lated disciplines.What is needed is for the therapis t to use the initial contacts to 1. dis-cern the na ture of the client's experience (NDE vs. non-NDE), 2. ascer-tain the stage of adjustment the client may be in, 3. enlist from the cli-ent what type of help might be useful, and 4. establish a baseline, viainterview and behavioral observation techniques, from which to evalu-ate change.

Intervent ion StrategiesA major premise of this paper has been tha t most practitioners alreadypossess the requis ite skills for aiding this part icular population. Whathas been needed is a framework from which to proceed. If the interven-tionist accepts the cross-cultural perspective, and is willing to employthe psychoeducational model, then virtually any of the commonly usedtherapeut ic techniques should also be effective for the NDEr. This wouldinclude, but not be limited to, individual, group, and family therapy and

crisis intervention. Thus, the specifics of what s trategy to use and whenwould be best left to the discretion and expertise of the therapist.Often neglected, however, is a consideration of the uniqueness of theindividual, apart from the group with which he or she has been identi-fied. As has been stressed throughout, there may be considerable in-dividual varia tion in the nature and quality of the NDE, and in theprocess of adjustment. The lat ter depends, in part, on the degree of differ-ence between the pre- and post-NDE world views, and on the degree ofdifference between the post-NDE world view of the experiencer, and thatof the culture and significant others.In order to individualize the intervention strategy to the needs of theNDEr and significant others, it is proposed that the Scale to AssessWorld Views Across Cultures (SAWVAC) (Ibrahim & Kahn, 1984) beconsidered as an educational tool for use dur ing the therapeut ic process.


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The scale is grounded in exi stenti al theory, and uses "a set of univer salconstructs of value emphases and value orientations to under stan d ourown and others' world views. Specifically, it e xamines one's views of hu-man nature, hu ma n relationships, nature, time, and activity. As Ibra-him (1984) noted:

Starting with an analysis of the client's world view as the first sourceof information, we are freed from perpetuating stereotypes and biasesthat exist regarding the client's specific group.The client-specific information gained through SAWVAC can beplaced in the context of the client's primary group information and inthe larger context of the majority culture . . . i.e., is the individualalienated from him or herself, alienated from own primary culture oralienated from the larger majority culture. (pp. 8-9)

In the absence of group data for NDErs, using this scale, it can nonethe-less prove extre mely useful in hi ghli ght ing pre- and post-NDE valuechanges, an d for exa mini ng differences between the world view of theNDEr and the world views of rele vant others. (Should a data base us-ing the SAWVAC accumulate, the scale could the n be bette r consideredas a part of the assessment process, as well as a potent ial research tool.)

B e n e f i t s a n d L i m i t a t i o n sThe primar y streng th of the position of this paper is the functional

integrat ion of two heretofore distinct areas of research and practice. Theconceptual lin king of cross-cultural counseling with the near-death ex-perience should provide a broad range of practition ers wit h the basisfrom which to successfully intervene in the adjus tmen t process of NDErs.However, until the model is field tested and criti cally researched, it re-mains at the level of theoretical speculation.

R e f e r e n c e s

Adler, P. (1975). The translation experience: An altbrnative view of cultu re shock. J o u r -na l o f H u m a ni s t i c P sychology , 15(4), 13-23.American Psychiatric Association. (1980). D i a g n o s t ic a n d S t a t i s ti c a l M a n u a l o f M e n t a lD i sorders (3rd ed . ). Washington, DC: American Psychiatric Association.American Psychological Association Committee on Standards for Providers of PsychologicalServices. (1981). Specialty guidelines for the delivery of services by counseling psychol-ogists. Am er ica n Psychologist , 36 , 652-663.Atwater, P. M. H. (1983). Coming back: The aftereffects of survival. V i t a l S i g n s , 3(2), 16.Eysenck, H. J. (Ed.). (1972). Encyclop edia o f Psychology. New York, NY: Herder & Herder.


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G al lu p , G. , J r . (1982) . A d v e n tu re s in Im m o r ta l i t y : A L o o k B e y o n d th e T h re sh o ld o f D e ath.N e w Y o r k , N Y : M c G r a w - H i l l .G o t t m a n , J . , & M a r k m a n , H . ( 19 78 ). E x p e r i m e n t a l d e s i g n s i n p s y c h o t h e r a p y re s e a r c h .I n S . G a r f i e ld & A. B e r g in ( Ed s. ), H a n d b o o k o f P sy c h o th e ra p y a n d B e h a v io r C h a n g e(2nd ed . ) . N e w Y o r k , N Y : J o h n W i l e y & S o n s .Go ldenson , R. M. (1984). L o n g m a n D ic t io n a ry o f P sy c h o log y a n d P sy c h ia try . N e w Y o r k ,N Y : L o n g m a n , I n c .Gr e y s o n , B . (1 98 2) . N e a r - d e a th s tu d ie s , 1 9 8 1 - 1 9 8 2 : A r e v ie w. Anabios is , 2 , 1 5 0 - 1 5 8 .Gre yson , B. , & F lyn n , C. (Eds .) . (1984). The Near-D eath Experience: Prob lems, Prospects,Perspectives. Sp r in g f ie ld , I L : Ch a r le s C . Th o ma s .Ibrah im , F . (1985). Ef fec t ive c ross -cu l tu ra l ly counse l ing and p sycho therapy: A f ramew ork .Co uns eling Psychologist , 13, 6 2 5 - 6 3 8 .Ibra h im , F . (1984) . Cross-cu l tura l counse l ing and psycho therapy: In i t ia l c l ien t assessment .U n p u b l i s h e d m a n u s c r i p t , U n i v e r s i t y o f C o n n e c t i c u t, S t o r r s .I b r a h im , F . , & Ka h n , H . ( 19 84 ). S c a le to A ss e ss W o r ld V ie w s A c ro ss C u l tu re s (S A W V A C ).U n p u b l i s h e d m a n u s c r i p t , U n i v e r s i t y o f C o n n e c t i c u t , S to r r s.Moody, R., J r . (1975) . L i f e A f t e r L if e. Co v in g to n , GA: Mo c k in g b i r d Bo o k s .Moody, R., J r . (1977) . Ref lec t ions on L i fe A f te r L i fe . N e w Y o r k , N Y : B a n t a m .Pe d e r s e n , P . (1 98 1) . A l te r n a t iv e f u tu r e s f o r c r o s s - c u l tu r a l c o u n s e l in g a n d p s y c h o th e r a p y .I n A . J . M a r s e l l a & P . B . Pe d e r s o n ( Eds .) , C ro ss -C u l tu ra l C o u n se l in g a n d P sy c h o th e r -apy (2nd ed.) . N e w Y o r k , N Y : P e r g a m o n P r e s s .Ring, K. (1980) . Li fe a t Dea th . N e w Y o r k , N Y : C o w a r d , M c C a n n & G e o g h e g a n .Ring, K. (1984) . H e a d in g T o w a rd O m e g a . N e w Y o r k , N Y : W i l l i a m M o r ro w .Sabo m, M . (1981) . Recollections o f Death: A M edica l Investigation . N e w Y o r k , N Y : H a r p e r& Ro w.Sue , D. (1981). C o u n se l in g th e C u l tu ra l l y D i f f ere n t. N e w Y o r k , N Y : J o h n W i l e y & S o ns .Su n d b e r g , N . ( 19 81 ). Cr o s s - c u l tu r a l c o u n s e l in g a n d p s y c h o th e r a p y : A r e s e a r c h o v e r v ie w.I n A . J . M a r s e l l a & P . B . Pe d e r s e n ( Eds .), Cross-Cul tura l Counse l ing and Psycho ther-apy (2nd ed . ) . N e w Y o r k , N Y : P e r g a m o n P r e s s .W hite ley , J . (Ed.). (1984) . Co unse l ing psychology: A h is to r ica l pe r spec t ive . Counse l ing Psy -chologist, 12, 1.Wolman, B. B. (Ed.) . (1973) . Dic t ion ary o f Beha v iora l Sc ience . N e w Y o r k , N Y : V a n N o s -t r a n d R e i n h o l d .

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Bette G. Furn- Adjustment and the Near-Death Experience: A Conceptual and Therapeutic Model