Using Anger Mindfully

Many of us, especially those on the spiritual path, tend to look at anger as an entirely negative emotion.  However, anger used mindfully can be extremely positive, powerful and ultimately healing.  Anger is simply energy, and we always have a choice as to what to do with it. Dzogchen Ponlop, in his recent book Rebel Buddha (2010) aptly states:

We usually think of anger … as negative.  Ordinarily, our impulse would be either to cut through it and get rid of it or to transform its intense energy into good qualities like clarity and patience….[T]he  direct experience of our unprocessed, raw emotions can generate a direct experience of wakefulness. These emotions are powerful agents in bringing about our freedom, if we can work with them properly (p. 144).

So, what do we do that that energy?  We are often afraid to feel its raw power, and fear that expressing it will make us seem less than the kind compassionate people we are.  However, using anger mindfully will actually awaken our compassion, starting with compassionate lovingkindness toward ourselves.

In fact, many people who are compassionate toward others do not treat themselves with the same degree of compassion, and are self-critical and often depressed.  It has been said that depression is “anger turned inward.”  One of the major goals in treating depression in psychotherapy and in grief counseling is to help clients feel safe to express their anger, and turn the energy of anger outward.  “Ex-pressing” anger literally means pushing it out, so that it becomes workable and is not a toxic agent against oneself.

Anger in its pure form, without the “additives” of concept and labeling it as a bad thing, is simply energy.  The key is to harness that energy through the use of mindfulness.  Mindfulness enables us to recognize the anger without simply reacting — either spitting it out against another or turning it against ourselves.  By looking at it without reacting, we have the ability to choose to use our anger productively.

The following are some suggestions for using anger mindfully:

  • Notice how anger manifests in your body — is it a burning sensation in your heart?  A cold tight clenching in the pit of your stomach?  A flush of heat in your face or hands?  Become as familiar as you can with your own unique physical “early warning signs” of anger so you can catch its energy without reacting.
  • As soon as you notice the physical sensation of anger, stop and breathe.  Allow the energy of anger to wake you up to what is actually happening at that moment.
  • Give yourself permission to feel hurt, abandoned, scared, frustrated or sad with a sense of compassion for yourself.  Breathe in light, peace and compassion, and breathe out the dark, heavy sensations of anger without judgment, accepting it just as it is.
  • If you notice the anger turning inward against yourself, continue to breathe it out more forcefully.  Use your body to keep the energy of the anger outward — shake it off your hands into the air, stomp it into the ground with your feet  — whatever it takes not to turn that energy against yourself.
  • Be curious.  Ask yourself:  “What is this feeling?  What is it telling me?”
  • Trust your body to tell you the appropriate course of action.  Is there something you need to say to someone who has hurt you, in a way that will forward your own healing and contribute to the growth of the other person and your relationship with him or her?  Is it something you can simply let be, making sure not to turn the anger inward?

As Stephen Levine (1987) eloquently says, “the investigation of anger…leads us directly to the love beneath, to our underlying nature. When we bring anger into the area where we can respond to it, where we can investigate it, where we can embrace it, it emerges into the light of our wholeness….Then anger is no longer a hindrance, but a profound teacher.”

References

Dzogchen Ponlop (2010).   Rebel Buddha: On the Road to Freedom.  Boston:     Shambhala Publications, Inc.

Stephen Levine (1987).  Healing into Life and Death.  New York:  Doubleday, a division of Bantam Doubleday Dell Publishing Group, Inc.

© 2011.  Beth S. Patterson, MA, LPC.  All rights reserved.

A GRIEF THERAPIST’S VIEW OF THE FILM “RABBIT HOLE”

Despite a few flaws, “Rabbit Hole”, starring Nicole Kidman and Aaron Eckhart, provides an excellent portrayal of grief.  The stars’ characters, Leah and Howie, play a married couple who lost their 4-year old son to a car accident eight months prior.  All of the emotions of grief — shock, sadness, anger, guilt/blame, regret — are enacted by the main characters, as well as by Leah’s mother (Dianne Wiest), and the teenage boy who caused the accident, swerving to avoid the family’s dog, and killing Leah and Howie’s son, who ran into the road after the dog.

Leah and Howie assiduously try not to blame each other for the accident.  Instead, and as a result, they each blame themselves.  At the same time, they both know realistically that they are not to blame –but heart and head are simply not the same.  Themes of life’s constant moment-by-moment changes run through the movie, and a scene of Leah planting flowers, and a neighbor accidentally stepping on one, breaking it in two poignantly shows how fragile and ephemeral life is.  Yet, we hold on to the hope that nothing dies.  Certainly a four-year old boy should not die.

Change is part of the grief process too.  Grief changes us.  We are never the same after a major loss.  In fact, part of the process of grief is to find one’s “new normal.”  Conversely, as we change, our grief changes. As Leah’s mother eloquently describes it, grief is like a brick in one’s pocket — we always feel it, but over time it feels less heavy.  After some time, we can actually forget that it’s there sometimes, but memories come back, and we feel the brick again.

Leah and Howie struggle to make sense of their loss.  Sense-making is one of the paramount parts of the grief process.  They join a support group of grieving parents, who all strive to make sense of their tragic losses. Some turn to God in trying to make sense of the process, saying “it must have been God’s will.”  This statement infuriates Leah.  It is too bad (one of the movie’s flaws) that there was not an experienced grief counselor facilitating the group to validate both responses and work with Leah’s rage at God.              Howie thinks of starting an intimate relationship with another grieving parent as a way to cope with his loss.  This demonstrates how grief changes a marriage.  A family is a system, and the couple in a marriage is a system within that system.  A system is like a mobile, always trying to create equilibrium.  When an integral piece of the mobile/system is removed — here, Howie and Leah’s beloved son — the mobile/system sways wildly, trying to create a new equilibrium.  “Rabbit Hole” is about the process of finding a new equilibrium, a new normal, in the marriage of Leah and Howie.   The work of a grief therapist entails helping members of a family to create their own unique and healthy equilibrium, make sense of their loss, and find a new way of being in the world, transforming loss into healing and growth.

Journaling: A Powerful Tool for Grief and Difficult Life Changes

I often suggest journal writing to my clients who are grieving the death of a loved one or dealing with a difficult life change as a useful way to deal with and befriend the intense emotions that often accompany these experiences.  Some say, “oh, I’m not a good writer.”  To that I reply that what is important is the act of expression, not how pretty or correct it is.  In fact, the word “express” literally means “push out”, that is, pushing out all of those churning, claustrophobic and chaotic feelings in a way that gives them “breathing room” and makes them workable.  The following are some tips for the use of journaling as a healing tool in grief and other difficult life transitions:

1.  Write in longhand, rather than typing. The act of putting pen to paper is a physical act of expression and “pushing out” whatever is churning inside you, and in my experience it is more effective than typing.  Don’t worry about your penmanship — just get it out.  The appearance of your written words on the page may hold some truths you have not yet realized.

2.  Don’t worry about spelling, grammar or correctness. This is a right-brained (emotional) experience, not a left-brained (rational) one.  Again, just get it out in stream-of-consciousness fashion.  You may be surprised at what you push out.

3.  Breathe. Let your body be part of the process.  Notice what you feel and where you feel it in your body.  Our bodies hold more truth than our thoughts do.  Feel what you are feeling and go with that.  If you need to cry, do so, and keep on writing.  You can let your tears fall on your paper as part of your expression.

4.  Write mindfully. Stay in the present as your write.  Feel your pen on the paper.  Notice the textures and movement of your hand, eyes and the rest of your body.  Feel your breath.  Notice your thoughts, and when they wander, take a breath and come back to the pen, paper and act of writing.

5.  Use letter-writing as part of your journal. Are there things you are yearning to say to a loved one who has died?  It can be helpful sometimes to write those things in your journal in the form of a letter to your loved one.

6.  Write down your dreams. Dreams can be a powerful source of healing in grief and life transitions, and writing them down is a great way to remember and learn from them.  Keep your journal by your bed, and when you go to sleep, tell yourself that you will remember your dreams.  When you start to awaken from a dream, stay in a semi-sleeping state and write down a few key words that will help you remember the dream when you wake up, and then write as much as you remember from the dream.  Be aware of your emotions and body sensations as you recall your dream through writing.

7.  Draw pictures. Sometimes our emotions can seem to overpower our ability to write.  Just draw what you are feeling, again in a stream-of-consciousness fashion, not worrying about what it looks like.  It can even be lines and shapes. This can be another powerful way to get our feelings out in a way that makes them workable.

8.  Connect with a power higher than yourself. I truly believe that the more we allow ourselves to feel our pain, the more compassion we develop for ourselves and all others who are in pain.  This in turn helps us connect with a sense of transcendence, whether one calls it God, Buddha Nature, Christ Nature, or the Ultimate.  Allowing ourselves to feel and express our intense pain in the safe space of journal writing  is an opportunity for real healing, transformation and growth.

Winter, Grief and the Dark Night of the Soul

Winter, nature’s dark night of the soul, has been viewed in many faith traditions as a time of spiritual questioning and aridity, a time of turning inward in a search for what is personally important, a quest for spiritual union.   This journey can be a difficult one, full of sadness and loneliness.  Our losses can be felt most poignantly at this time.  It can be excruciatingly painful as the holidays remind us of times when our loved ones were with us.  The pain of our losses, coupled with the darkness and holidays, can seem too much to bear at times, and we try to cover our pain with liquor or other escapes.

Rather than resulting in permanent devastation, the dark night of the soul is viewed by mystics and others as an opportunity for profound personal and spiritual growth.  Growth comes from touching into our pain, not turning away from it.  The dark winter months can actually aid us in this process if we allow the darkness to envelop us like a sweet blanket of warmth, protecting our hearts as we feel our pain.  As expressed by psychiatrist Gerald May (2004) in his book The Dark Night of the Soul: A Psychiatrist Explores the Connection Between Darkness and Spiritual Growth:

“The dark night is a profoundly good thing. It is an ongoing spiritual process in which we are liberated from attachments and compulsions and empowered to live and love more freely. Sometimes this letting go of old ways is painful, occasionally even devastating. But this is not why the night is called ‘dark.’ The darkness of the night implies nothing sinister, only that the liberation takes place in hidden ways, beneath our knowledge and understanding. It happens mysteriously, in secret, and beyond our conscious control. For that reason it can be disturbing or even scary, but in the end it always works to our benefit.”

 

The following are some suggestions for turning in to our pain and finding growth and spiritual union:

  • Journal – This act of expression can be powerfully helpful in pushing out the swirling confusion of emotions so that they become workable.
  • Engage in meaningful ritual – Light a candle in honor of your loved one, set an extra place at the holiday table, go to your loved one’s resting place, make a donation in your loved one’s name or any other activity that helps guide you toward peace.
  • Take care of your health – This time of year, with the added burden of grief, can be extremely stressful, and it is important to attend to our physical health.  Make sure to drink lots of water and eat healthy food.
  • Move your body – Take a walk in the fresh crisp air, do yoga or any other physical activity that engages your body and mind.
  • Practice mindful walking – notice each step and connect to Mother Earth.  Notice your breath, breathing in peace and nourishment, breathing out stress and pain.  Feel that sense of peace and nourishment and letting go of stress and pain first for yourself, and then for all others (which is everyone!) who are experiencing pain and suffering.
  • Give yourself a gift that your loved one wanted for you, whether a material gift or a gift of relaxation, such as a massage.
  • Spend time in nature, with compassionate friends, and schedule “dates” with yourself, treating yourself kindly as a friend.

The Lonely Grief of Losing a Loved One to Dementia

The grief involved in seeing a loved one lose his or her capacities to Alzheimer’s disease and other dementias is among the most difficult we can experience.   One experiences the ongoing day-to-day horror of witnessing a loved one slip further and further away.  There are myriad other losses faced by a spouse or partner as their loved one slips into dementia:  the loss of couple activities, the loss of friends who are uncomfortable with the situation or don’t know how to respond, the loss of one’s hopes and dreams for the future and growing old together.   You just don’t know where you fit in any more.  The day your beloved stops recognizing you is among the most painful on this journey.

All of the experiences of grief identified by Elizabeth Kubler-Ross confront a couple after a diagnosis of dementia.  Shock and denial are common — many people faced with this terrible diagnosis hope against hope for a quick cure or hope that the diagnosis was wrong.  Anger is a major component of the process, and can either tear the couple apart or bring them together at the beginning stages of the disease process as they forge a new relationship in uncharted territory.  Depression is certainly a risk in going through the inexorable, seemingly never-ending grief of living with a person with dementia, as well as for the person with dementia as he or she loses their independence and daily functioning.  Guilt is also common — often a loved one feels guilty going on with and enjoying his or her life.

The following are some suggestions for self-care for those living with a loved one with dementia:

  • Allow yourself to feel your anger and use it productively.  This can be a time of deep questioning of one’s religious and spiritual beliefs.  Talk about those questions with friends and clergy.  This “dark night of the soul” can ripen into a deeper spiritual strength, which is an invaluable inner resource in the grief process.
  • Express yourself — journal, write poetry, draw or paint, dance or move to yoga.  Getting those churning feelings out, i.e., “ex-pressing” them, is vital in preventing depression and burnout.
  • Speaking of burnout, take time for yourself.  At first you may feel guilty.  However, nourishing alone time — walking in nature, in a yoga class, having a massage — and time with supportive friends and family is vital in preventing burnout.  If you burn out, you won’t be able to be there for yourself or your loved one.  As they say in the safety announcements on an airplane, you need to put your own oxygen mask on before you can help the person sitting next to you.
  • Join a support group with others who are losing a partner to dementia.  The Alzheimer’s Association has a tremendous wealth of resources to support family caregivers.
  • Speak to a therapist or counselor who understands the process of grief you are going through. Use that time as your own special, sacred time to deal with all of the feelings you are going through, including feelings about other losses and hurts in your life that may be surfacing.

In sum, self-care and being with others is critical as you go through this process.  May you learn and grow as you journey on this road of loneliness and grief.

Grief After Suicide: A Personal and Professional Perspective

Despite the suicide of my best friend many years ago,  I sometimes still reel from the loss and experience profound grief. This is especially so on anniversaries, birthdays, and when suicide is in the news.

My initial reaction to my friend’s sudden death was shock. I was unprepared for her death. In the months following her suicide, I experienced a myriad of intense emotions: Of course, I was sad to lose my best friend. I had a bit of guilt, but primarily feelings of helplessness that there was nothing I could have done to prevent her self-destruction. I also felt a sense of shame, and was afraid people would condemn me somehow for allowing a friend to take her own life, despite the fact that I knew I had no control over her death. Perhaps the most intense feeling I experienced was anger. My feelings of anger would hit unpredictably, often when I was driving. I would smash my hand against the steering wheel and wail in anger and anguish — How dare she leave me without saying goodbye? I hope no one saw me – they would surely have tried to have me committed!!

And yet, despite the seeming insanity of my profound grief, I knew, as a grief counselor, that my reactions were normal and that in fact my anger was healthy — better to extend my feelings of anger outward rather than turn my negative energy inward in a way that can fester in negative self-thoughts and depression.

All these years later, my grief can hit unpredictably — while listening to a piece of music that I associate with my friend, when I have accomplished a goal she would have been happy to share in with me or other times. I have learned, both personally and through my professional work, to prepare for the more predictable moments of grief, such as my friend’s birthday or the anniversary of her death. I have always told my bereavement clients that those anniversaries and important days stay in our bodies — sometimes our bodies know it before we do. In fact, I found myself walking around feeling particularly irritable and out of sorts about two years after my friend’s death, only to realize later that it was in fact her birthday! My body knew it before my mind did. So, I practice what I preach and prepare for those important days and create rituals around those days. For example, I light a candle on the anniversary of my friend’s death each year.  Nonetheless, my grief is still unpredictable, and can be triggered by events in the news, especially other suicides.

As I discussed in another blog post, suicide can be a form of “disenfranchised grief”, i.e., a grief that is not accepted by society, in this case, because of the nature of the death — Thus my feelings of shame. It was difficult for me to share my grief, other than with those who knew my friend or had experienced a similar loss, out of fear of judgment or invalidation. As a result, I was often left feeling isolated and alone in my grief.

As a grief counselor, I tell my clients that we do not “get over” the death of someone close to us. Rather, we need to go through the pain of our grief. That process can be profoundly healing and transformative. We can find a place for our loved one in our life and in our heart. I know that my friend is still there for me as a guardian angel, and I still ask her for guidance and support.

Suicide grief is understandably difficult, and it is important for those left behind to get support — whether through friends, family, spiritual community or a professional grief counselor, psychotherapist or grief/suicide support group. It is important to take care of ourselves — eat well, get exercise, sleep — because grief is exhausting and stressful. Journaling and other forms of expression can be immensely helpful for getting out the myriad of swirling emotions and thoughts. As someone who not only “talks the talk” but has “walked the walk,” I know how important it is to allow ourselves to go through the pain of our sudden loss and get support in the process in order to heal and grow.

Helping the Person with Dementia Grieve After the Death of a Loved One

Caregivers and family members often ask whether they should tell a loved one with Alzheimer’s Disease or other dementia about a death in the family, and how they can help them grieve.  Although much has been written about the profound grief of caregivers and other family members throughout the course of the successive losses associated with dementia, surprisingly little has been written about bereavement in the dementia patient.

The loss in cognition of a person with dementia does not mean that the person does not feel the loss somatically or emotionally.  Although the individual might not be aware cognitively of the loss, he or she may have a vague sense that something isn’t right.  Just like a child knows when a loved one is not around, the person with dementia may sense a loss of contact with a loved one in his or her body. The concept of “death” may lack meaning for them, but they know — or rather feel — that something is amiss. People with dementia thus have the capacity to grieve.  Learning their language and sense of reality is important in helping them grieve a loss.

The following are some suggestions for communicating the death of a loved one to a person with dementia, and helping him or her grieve:

  • Tell the person with dementia once that a loved one has died and assure him or her that both he or she and the deceased are fine. It is respectful to tell the truth, and do so as simply and caringly as possible.
  • When telling him or her for the first time about the death, make sure there is enough time for the person to process this information to the best of his or her ability, and to cry or otherwise react.  Being in a comfortable, quiet and familiar setting can be helpful for the dementia patient to process the information and feel safe to express his or her feelings.
  • If he or she continues to ask “Where’s Mary?”, saying that Mary is dead will likely be incomprehensible and may actually re-traumatize him or her.  Telling him or her each time that their loved one has died can be like hearing it for the first time over and over. It is best to simply say that Mary is not here now, and then ask questions to check the patient’s current reality and where he or she is in the memory process.  Asking the individual where he or she thinks Mary is can be helpful in eliciting feelings.
  • Explore what age the person believes he or she is in order to gauge what memories of the deceased he or she may have, and explore those memories as a way to bring the person who died to life as a source of comfort.
  • Redirect the person from thinking to feeling. Language that elicits feelings instead of thoughts can be very helpful, since the person with dementia lives in the feeling rather than the thinking world.  If the person with dementia asks “Is Mary dead?”, a helpful response might be “Yes, and she’s OK — what does it feel like to you that Mary’s not here?”
  • Show him or her old pictures of the person who died that are contemporaneous with the state of their memory, and elicit memories and feelings in that way.
  • Artwork can be a powerful way for the individual to express feelings of loss.
  • Likewise, playing a favorite song can elicit feelings and memories, and can be a source of comfort.
  • Perhaps most importantly, remember that the person with dementia has not “disappeared” — the core essence of who he or she is as a feeling, spiritual person  is still there.  As the title of Lisa Genova’s beautiful novel about a woman with dementia states, she is “Still Alice.”  It is our job as professional and family caregivers to reach and communicate with that spiritual essence, whether through touch, life review, music, art, nature or whatever vehicle best reminds the person that it is safe for them to feel their loss and that they are okay.

The Death of a Parent: Working With Grieving Children and Teens

The death of a parent is the most elemental loss that a child can experience.  Many in our culture believe that children cannot understand death and lack the capacity to grieve.  Because of this misconception, coupled with confusion and anxiety in communicating with children about death, children are often told that the dead parent has simply “gone away.”  Shielding children from death deprives them of the ability to grieve and ultimately heal.

The age and stage of development of a child at the time of his or her parent’s death will strongly influence the ways in which the child reacts and adapts to the loss.   An understanding of the child’s emotional and cognitive development can enable caregivers and professionals to determine how best to communicate about death with the particular child, to understand and empathize with the child’s experience and guide the child through the grieving and healing process.

The Interdependence of Grief and Development

Childhood grief and development are interdependent:  the early death of a parent affects a child’s development, and the child’s development affects how he or she will grieve and reconstruct his or her relationship with the deceased parent.  Furthermore, children re-experience their grief as they reach each milestone in their development.  The deceased parent is a “missing piece” (quoting the poem by Shel Silverstein) that the child needs to reconstruct in order to provide himself with a “history of his past that he could then build on, alter and modify with changing developmental concerns….During each succeeding developmental stage, he may need to step back and…reconstitute the missing piece” (Garber, 1988, p. 272).

Capacity to Grieve and Understand Death’s Finality

There has been much controversy concerning when children develop the capacity to grieve and understand the finality of death.   Some believe that a child cannot truly grieve until adolescence, when he or she has become “fully differentiated” and has achieved the cognitive level of formal operational thinking.  In contrast John Bowlby, in his studies of attachment, believed that infants as young as six months experience grief reactions similar to those of adults.  Some theorists believe that the capacity to grieve begins at the cognitive stage of object permanence, around the age of one and one-half to two, while others believe that this capacity begins at approximately three years old, when the child has reached the psychological stage of object constancy, i.e., “a coherent mental representation of important attachment figures.” (Worden, 1996, pp. 9-10, citing Bowlby (1963, 1980) and R. Furman (1964)).

A child’s ability to understand the meaning and finality of death corresponds to his or her cognitive development.  A three to five year old, in the preoperational stage, believes that the deceased person has gone away and will return at some point.  Thus, it is common for a child of this age to constantly ask questions such as “Where’s Daddy?”  and “When is Mommy coming home?” A child of five to approximately nine years of age, in the concrete operational stage of cognitive development believes that death can be avoided.  Furthermore, a child in this egocentric phase also believes that his or her parent died because either the parent was bad or the child was bad, and that if the child is good, the parent can return.  This is thus seen as one of the most vulnerable and difficult developmental stages for adjusting to a parent’s death. The child at this stage needs someone who can clarify what the child is thinking and feeling, can reframe events to make them more understandable, can reassure and build self-esteem by praising the child’s accomplishments and by emphasizing the child’s importance.  Research has found that children over the age of nine generally have a realistic understanding of the inevitability and finality of death.  However,  although children over nine years of age understand death’s finality, their reactions to a parent’s death is determined by their cognitive and emotional level of development and other factors such as gender and the relationship with the surviving parent.

Tasks of Children’s Mourning

The noted grief counselor and expert J. William Worden has identified four tasks of mourning:  (1) accepting the reality of the loss, (2) experiencing the pain and emotional aspects of the loss, (3) adjusting to an environment without the deceased, and (4) relocating the dead person in one’s life.  The satisfactory completion of these tasks depends on both the child’s stage of development at the time of the death and his or her adaptability and ability to attend to any unfinished tasks at later stages of development.

Accepting the Reality of the Loss

A child can accept the reality of losing a parent when he or she understands, through the achievement of operational thinking, “the nature of abstractions such as finality and irreversibility” (Worden, 1996, p 13, citing Piaget, 1954).  Some grasp of such abstractions is possible during the concrete operational stage of cognitive development, and is only fully understood at the formal operational stage.  Thus, if a parent dies before formal operational cognition has been achieved, the child will experience a deeper level of grief when he or she attains that cognitive stage and fully and deeply comprehends the finality and irreversibility of the loss.  This usually occurs in early adolescence, another  particularly vulnerable time in the process of adjusting to a parent’s death and in overall development.  Christ (2000, pp. 190-91) calls the adolescent’s profound experience of his or her loss due to the attainment of formal operational thinking, coupled with adolescent developmental tasks such as separating from family, negotiating a more adult relationship with the surviving parent, finding one’s identity and true values and deepening relationships with peers “daunting challenges for adolescents that often exacerbate pre-existing vulnerabilities.”

Experiencing the Pain and Emotional Aspects of the Loss

The pain and emotion involved with death, generally called the mourning process, can be frightening for a child both to experience and to witness in others.  Awareness of the child’s capacity based on his or her stage of emotional development to cope with strong emotions is important.  For example, as noted above, children of approximately five to seven years of age are very vulnerable.  They can understand death’s permanence on some level, but lack the ego strength and socialization to deal with the intensity of the loss.  It is therefore important for the surviving parent and others in the child’s life to model and express their grief without overwhelm, so that the child can be less afraid of his or her own feelings.  The egocentric magical thinking of children at this age compounds that vulnerability when they believe that they were somehow the cause of the death and that they can do something about it.  It is therefore important for grief therapists and the child’s caregivers to assure children at this vulnerable stage that they were not the cause of their loved one’s death.

Adjusting to an Environment without the Deceased Parent

This task is an ongoing process through progressive stages of development as well as important transitions throughout one’s lifetime.  The child– as well as the adult he or she will become –  re-experiences his or her grief at each stage of development as a result of his or her growing cognitive abilities, and also as he or she comprehends the vacuum left by the dead parent, who is not there to nurture and support the child’s growth and achievements.  In addition, the child’s grief will be experienced, and the loss of the parent acutely felt, at times of life transitions such as birthdays, graduation, leaving home, marrying and having a child of one’s own.   It is thus important that parents, caregivers and therapists not minimize the reoccurrence of grief, but to support the child or adult through this new stage of adjusting to life without the parent.

Relocating the Dead Parent in One’s Life

As the child grows and changes, his or her relationship with the deceased parent also changes. Thus, according to Worden (1996), another ongoing task is to find new ways to memorialize the parent with the attainment of each developmental milestone:  The loss of a parent in a child’s infancy, especially if that parent was the primary caregiver, will inevitably lead to difficulties in attachment and trust, and consequent feelings of anger or  depression as the child grows and is unable to attach or become intimate with others.  In order for such an individual to successfully relocate and internalize the deceased parent, as well as complete Worden’s other tasks, he or she will need to transfer the process to other figures, such as a trusted teacher or therapist, in order to reconstruct his or her parental loss and the deceased parent’s place in his or her life, and it is the job of the grief therapist and others in the child’s life to support and facilitate that process.

The Many Faces of A Child’s Grief

Grief is not a “one size fits all” proposition.  Many factors affect a child’s grief process and adjustment to life without the dead parent.  Factors affecting the child’s grief and bereavement process include the gender of the child and deceased parent, the child’s relationship with the surviving parent, the effect of the death on the surviving parent, the preparation and information regarding the death accorded to the child and the family’s strengths and resources.  An understanding of these factors and of the child’s emotional and cognitive development is crucial for a therapist or caregiver to support the child’s completion of the tasks of mourning and enable him or her to internalize the “missing piece” through grieving and healing.

References

Baker, J.E. & Sedney, M.A. (1966). How Bereaved Children Cope with Loss:  An Overview.  In Corr & Corr (Eds.) , Handbook of Childhood Death and Bereavement. New York:  Springer Publishing Company.

Christ, G.H. (2000). Healing Children’s Grief:  Surviving a Parent’s Death from Cancer. New York: Oxford University Press.

Fogarty, J. (2000).  The Magical Thoughts of Grieving Children:  Treating Children with Complicated Mourning and Advice for Parents. Amityville, New York:  Baywood Publishing Company.

Garber, B. (1966).  Construction and Reconstruction in a Case of Parent Loss.  In Altschul, S. (Ed.) Childhood Bereavement and its Aftermath. Madison, Ct.:  International Universities Press.

Worden, W. (1996).  Children and Grief:  When a Parent Dies. New York:  Guildford Press.

Teens and Grief: A Guide for Parents

Adolescence is one of the most difficult and chaotic stages in life, and is widely recognized as a particularly difficult time for dealing with the death of a parent or other loved one. According to renowned developmental psychiatrist Erik Erikson, the task of adolescence is to begin to find one’s unique identity, and if this task is not accomplished, it can result in what Erikson calls “role confusion” or the “identity crisis.” Other important developmental tasks in the teen years are finding a sense of belonging and peer acceptance, withdrawing emotionally from parents and achieving emotional independence.

It is no wonder then that intense emotions of anger, guilt, confusion and isolation, and even depression can accompany teen grief. Other symptoms that are considered typical of distress before and after a parent’s death include a decline in academic performance, sleep problems and withdrawal from family discussions. Acting out behaviors and abuse of drugs or alcohol can also accompany the intense grief of the adolescent.

It is important for psychotherapists, grief counselors and parents to honor the grief of adolescents and support the entire family in the grief process as well. A family is a system, and a system is like a mobile, always working to maintain equilibrium. When an important part of that mobile is removed due to the death of a parent, the family system/mobile loses its balance, swaying wildly to find a new equilibrium. It is important that the surviving parent get professional grief support, by a grief counselor and/or in a grief support group, so that he or she can maintain open communication with grieving teens, while simultaneously experiencing the intense grief resulting from the death of a partner. Allowing the teen to witness the parent’s expression of grief can be a powerful healing tool. This “mirroring” can be a way of showing the teen that it is safe to express one’s grief, and is a sign of strength, not weakness.

As noted previously, in the transitional stage from childhood to adulthood, peers become increasingly important as the teen seeks to achieve autonomy from his or her parents. Because grief is not something that teens typically experience, the grieving teen may feel isolated and may then withdraw from interpersonal support. Compounding this difficulty is the fact that facing the reality of mortality is often avoided in the teen years from a developmental viewpoint. Adolescents may thus greatly benefit from a grief support group with other grieving teens. The healing power of knowing that one is not alone is so important in the work of grief at any age, and is crucial at this critical developmental juncture. In addition, the providing of mutual support can help the teen develop compassion and a greater sense of perspective — powerful healing tools in the work of grief and growth.

The following are some suggestions for parents to facilitate the grief process of the grieving adolescent:

• Allow the teen to participate in the planning of funeral and memorial rituals and to attend those rituals

• Encourage the teen to express feelings of anger, sadness and guilt without judgment

• Encourage communication about the circumstances of the death and the teen’s feeling about it

• Encourage communication about the deceased parent’s life and the impact that parent had in the life of the teen, and encourage conversation about the deceased with family members and friends

• Keep memories of the deceased parent alive through collecting mementos, journaling and other forms of self-expression

• Freely express your own feelings of sorrow

• Keep pictures of the deceased parent on display in the home, and look at photo albums and videos together

• Talk about times that might be difficult, such as birthdays, graduation, Mother’s Day/Father’s Day, Superbowl Sunday and other significant times, and discuss creating rituals around those times.

• Talk about how to prepare and get support during the year at those significant times

• If the teen is exhibiting signs of depression, such as consistently expressing negative beliefs about him or herself, extended disruptions in sleeping or eating patterns, extended poor academic performance, acting out or self-destructive behaviors, seek the guidance of an experienced grief therapist

• Be gentle with yourself and continue to get the support you need for your own grief

The Pain of Unaccepted Grief

Some forms of grief are unaccepted in our society.  This has come to be known as “disenfranchised grief.”

For example, Carl’s partner Bob died. Bob’s parents would not allow Carl to play a role in Bob’s funeral plans.  Peggy’s beloved dog Lolly died three months ago, and her friends don’t understand the depth of her grief. Janet’s ex-husband died in a car accident, and her friends think she should be glad he is finally out of her life instead of being sad and grieving. Barbara’s best friend committed suicide, and she feels more judgment than compassion from her peers regarding the death.  Laurie’s son has been diagnosed with a debilitating mental illness, and her family and friends don’t understand her grief.

These are all examples of what has been called (Doka, 1989) “disenfranchised grief.” Disenfranchised grief has been described as “a grief that persons experience when they sustain a loss that is not or cannot be openly acknowledged, publicly mourned or socially supported” (Doka, 1989, p. 6). Disenfranchised grievers may feel that they don’t have the right to grieve, and may feel abandoned or isolated in their pain. Validation, acknowledgement and support are vital to the healing of grief, and when these elements are missing, the grief process can become complicated and difficult, requiring professional grief counseling.

Disenfranchised grief can occur when (1) the relationship is not recognized, (2) the loss is not recognized, or (3) the griever is not recognized. Examples of unrecognized relationships include those between gay partners, ex-spouses, neighbors, colleagues, counselors and others. In the example of Carl and Bob described above, Carl sought grief counseling to work out his feelings of anger toward Bob’s parents and toward the medical establishment. My nonjudgmental validation of Carl’s feelings and acceptance of his grief assisted him on the road to healing.

Pet loss is an important example of a loss that is not recognized. Peggy came to see me because her grief about the loss of her beloved Lolly had become depression: she blamed herself for Lolly’s death, and was judging herself and feeling shame for having such strong feelings of grief. Peggy’s harsh self-judgments were reinforced by the responses of her friends that it was “only a dog” and that she should “get over it.” In validating the depth of Peggy’s grief, I assured her of the strength of the human-animal bond and the unconditional love we receive from our pets, and that her grief was not only acceptable, but right.

Other examples of losses that are not universally recognized or accepted include abortion, divorce, infertility, job loss, disability, suicide and witnessing another’s decline due to dementia. Some of these losses, such as suicide or abortion, are not always socially validated, and cannot always be publicly expressed. A deep sense of loss may be felt after losing a job, losing one’s independence due to disability or illness or having a loved one with dementia. However, because there is no literal, physical death in these situations, the grief that these types of losses can cause is not always recognized or accepted. Group support, in addition to counseling, for these types of losses can be very helpful and validating.

Disenfranchised grief can also occur when the griever is not recognized, because it is incorrectly assumed that he or she is not capable of grief. Examples include children, people with dementia, roommates in nursing homes, and people with developmental disabilities. Everyone experiences loss and grief, and a person’s level of cognitive development or dysfunction must be taken into account in providing support and counseling.

Those experiencing disenfranchised grief may lack the social (or societal) support necessary to face the pain of grief and accommodate it, and if the relationship has been severed or not openly acknowledged, there are often no bereavement rituals or outlets for expression to help the disenfranchised griever cope with the loss (Rando, 1988). Indeed, the “very nature of disenfranchised grief creates additional problems for grief, while removing or minimizing sources of support” (Doka, 1989, p. 7). The support of a grief counselor or group can be of great help for those experiencing the complications of disenfranchised grief, so that the loss can be validated and the grief transformed into healing and growth.

References

Doka, K., ed. (1989). Disenfranchised Grief: Recognizing Hidden Sorrow. New York: Lexington Books.

Rando, T. (1988). How to Go on Living When Someone You Love Dies. New York: Bantam Books.