Grief and Loss

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COPING WITH GRIEF AFTER LOSING YOUR JOB

 

Many of us think that grief should be reserved for the death of a loved one. However, grief can be experienced after any life transition, and one of the biggest life changes is the loss of a job. Here are some tips for coping with job loss.

  1. Remember to have compassion for yourself.

Feelings of shame often arise after losing a job. Shame is one of the most poisonous emotions humans experience. It can lead to self-punishment, which can come in the form of berating yourself for not doing a better job or for making a mistake that led to the job loss. Self-punishment may also play out in negative behaviors like substance abuse or promiscuity. Take time to understand that we all make mistakes, and that no one is perfect – including you. Self-compassion is so important in all aspects of your life. Be gentle and kind with yourself. Take the time to nurture yourself in body and mind. Do things that bring you peace and comfort, such as reading a good novel, getting a massage or taking a warm bath. Do them with the intention of caring for yourself with kindness and compassion, and breathe that into your heart.

  1. Develop skills to banish negative thoughts.

Thoughts of shame, blame, regret and doubt are inevitable after losing a job. The key is to not let those thoughts develop a life of their own. Mindfulness meditation techniques can be particularly helpful at this time. Learn to notice those negative thoughts as soon as they arise. Instead of following a thought, breathe into the feelings in your body that accompany the thought. It might be tightness in your chest or stomach, a clenching of your jaw or some other body sensation. Allow your breath to loosen those physical sensations. When the thoughts come up again, simply breathe into the accompanying body sensations. You may want to enlist the aid of a mindfulness meditation instructor or friend who practices mindfulness if this is a new technique for you.

  1. Take some healthy alone time.

The shame and other negative emotions that accompany losing a job may lead you to want to isolate yourself and avoid social interactions. It is fine to take some time to recover from the shock of losing your job. At the same time, it is important to use that time in a healthy way. Avoid the urge to overindulge in food or alcohol. Exercise can be extremely beneficial to help you combat depression, and the best form of exercise I have found is walking. Feel each footstep as it hits the ground, and when you notice yourself getting lost in negative thoughts, return to feeling your feet hit the ground. Treat yourself to a massage or other activities that help you feel better.

  1. Take some time each day to do something positive.

When we lose a job, we may feel hopeless or even worthless. Do something each day that reminds you of your worth. It may be something as simple as helping an elderly person cross the street, saying hello and smiling to people on the street or giving someone directions. You can offer to help your neighbors walk their dog, or volunteer your time for a cause you believe in. Being of service to others, even in the simplest of ways, will remind you that you are worthy and have something to offer.

  1. Express yourself.

It is so important to get the swirling emotions of grief out of your body in a way that is beneficial. Keeping all that stuff inside will only lead to depression and dis-ease. Keeping a journal is a great way to express yourself, and can help you not only get out all those messy emotions, but also may help you clarify what is now important to you and your next steps on your career path, or if applicable, your path to retirement.   If writing is not easy for you, there are other forms of expression that can also be beneficial, such as drawing or painting, dancing, singing or playing music or simply moving. The important thing is to move that energy outward.

  1. Evaluate and call on your support systems.

One of the most difficult things for me after losing my job many years ago as an attorney in the entertainment business was the loss of people I always believed would be there to support me, especially my colleagues in my corporation. It felt like they were staying away from me because they believed that the loss of my job might be contagious! This is what we in the grief field call a “secondary loss.” That is, the loss of my colleagues, and the lack of support from them was an offshoot of the loss of my job. I was given the opportunity to evaluate who was really there for me and, and to develop a greater appreciation for those who stepped forward to support me on my new path, and to actually allow myself to be vulnerable enough to let them to be of support to me. In retrospect, I now know that this process helped me develop as a compassionate human being in my personal and spiritual life, as well as in my professional life.

  1. Use this time to reflect on what is important to you.

Undoubtedly, people trying to be supportive have told you that losing your job can be a “blessing in disguise.” When you first lose your job, it feels like a blow and not a blessing. While you may not see your job loss as a blessing, it is nonetheless a great opportunity to take the time to reflect on, and perhaps re-evaluate, your passions, priorities and values. For example, when I was laid off from my corporate job as an entertainment lawyer, it felt like a death blow. I no longer knew who I was, because I had so strongly identified myself as my job. When I got over the shock of losing my job, it became apparent to me that I was being given the opportunity to find a new career path that more suited my spiritual path and my personal development. The loss of my corporate job and following the steps described above allowed me to fulfill my dream to become a psychotherapist and grief counselor and to express who I really am.

 

 

           

 

 

           

 

 

 

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HOW UNDERSTANDING IMPERMANENCE CAN HEAL DEPRESSION AND GRIEF

 

One of the most important tenets in Buddhism is that all phenomena are impermanent. All things and all beings are constantly changing. Nothing stays the same, and ultimately everything dies. We tend to consider this bad news. However, accepting impermanence can also be considered good news. If everything stayed the same, there would be no possibility for growth. Also, understanding that nothing stays the same can alleviate feelings of hopelessness, helplessness and overwhelm.

We all struggle to hold on to others and to things, and resist impermanence. This leads to tremendous suffering. The incorrect belief that things are “stuck” and will never change also results in great suffering.   I have observed in my years as a psychotherapist that the struggle to resist impermanence and the belief that things don’t change are universal. It is only through letting go of the resistance to change and impermanence that true healing and growth is possible.

For example, many of my clients with depression feel mired in difficult situations that they believe are permanent. It can take a lot of work for them to give up the beliefs that keep them stuck. I too am prone to depression. My Buddhist practice and study have been invaluable in helping me let go of my negative beliefs. I now know that those beliefs are just insubstantial thoughts that I no longer need to hold on to. Of course, I get thrown back into feelings of hopelessness on occasion. When that happens, I call on a friend to remind me that whatever situation is getting me down is impermanent and will change. My friend’s reminders are just what the doctor ordered at those times, and I feel a tremendous weight lifting and the restoration of hope just from hearing the words “remember that it’s impermanent.”

A big part of my psychotherapy practice is working with grief and loss. I have found that clients who have difficulty acknowledging that everyone dies have a very difficult time processing their grief. Of course, the death of a loved one or beloved pet is never easy. Although death is never easy for those left behind, always remembering impermanence helps ease the way, and despite profound sadness and grief, those who “grieve well” know that death is a natural part of life.

One of the most significant moments in my meditation practice occurred about fifteen years ago. My wonderful cat Andy was “meditating” with me at the time. I recall having a clear realization that Andy would not be with me forever. My emotions went from sadness to acceptance. I was left with a profound sense of the preciousness of life, knowing that the fact that nothing lasts is what makes life so precious. Andy, who died last summer, has ever since been my reminder of both impermanence and the preciousness of life. As the great Buddhist master Dilgo Khyentse Rinpoche said:

                                     Life is fragile, like the dew hanging delicately on the grass,  crystal drops that will be carried away on the first morning breeze.                                

                                                                            

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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.

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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.

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Caring for Tibetan Buddhists at the End of Life

Many people in the baby boomer generation, who were raised in the Jewish and Christian faiths, have turned to Tibetan Buddhism and other Eastern religions.  As this generation ages and enters hospice care, it will be important for health care providers to understand their unique needs at this sacred time in their lives.

Broadly speaking, Buddhist practice emphasizes a deep understanding of the mind, the importance of karma (cause and effect) and preparing for death.  For Buddhist practitioners, the moment of death is considered the most important moment of life.  Developing a calm and aware mind, acting virtuously for the benefit of other beings and abandoning harmful actions are the most important practices for preparing for death.  If the Buddhist practitioner is able to stay relatively aware at the time of death, he or she can be reborn in what is called a “Pure Land” and continue on the path toward enlightenment.

The most important practice for Tibetan Buddhists and those supporting them at the end of their lives is called “Phowa”, or transference of consciousness.  Phowa is aimed at assisting practitioners to be reborn in a Pure Land, where the cycle of suffering, or samsara, ceases.

An important concept in Tibetan Buddhism is the concept of the “bardo”, which means “in-between.”  Every moment can be considered a bardo, or a transition to the next moment.  In fact, our present life is a bardo between what came before and what will happen next.  The bardo between this life and the next is called the “bardo of becoming” and is traditionally considered to be forty-nine days. It is a time of self-review and purification of negative acts, in order to be reborn if not in a Pure Land, then at least as a human being who has the potential of attaining enlightenment. It is said to be a very vivid and at times intense and frightening experience, and the practitioner’s spiritual community, or sangha, traditionally practices at the end of each week to assist the deceased’s journey through the bardo. The dying process is seen as a separation of the mind from the body, and it is the mind that continues into the bardo between this life and the next.  Therefore it is important for the mind to be clear and calm at the time of death.  It is said that whatever thought one dies with is the one that will return most powerfully when one reawakens in the bardo. Traditionally, it is said that it takes 72 hours for the mind to completely separate from the body and begin the journey into the bardo between this life and the next.

As death nears, clinicians and others should refrain from touching the body, especially the feet, because doing so may direct the patient’s consciousness downward to rebirth in a lower realm, where he or she cannot benefit others and have the potential for enlightenment.  The patient may wish to be in the traditional posture of dying, lying on the right side in the posture of the “sleeping lion”, which is the posture in which Buddha died.

In developing a plan of care for Tibetan Buddhist practitioners, the hospice team and other caregivers need to consider the patient’s views on suffering, alertness and karma.  The following are some considerations in developing a plan of care for dying Tibetan Buddhist practitioners:

1.  Determine if the patient has a spiritual teacher (or guru) and the patient’s wishes for contact with the guru, and how to contact him or her.

2.  Determine if the patient has a community of fellow practitioners (the sangha), and if so, how to contact them.

3.  Provide a quiet space for sangha members to come and sit with the patient to meditate or do Phowa practice.

4.  Help the patient arrange an altar with pictures of the guru and other pictures that are important to the patient for his/her practice, as well as any meditation tapes, prayer beads, etc.

5.  Clarify issues and wishes regarding the use of pain medications.  Many practitioners may believe that the use of pain medications may unduly cloud their minds, but unrelieved physical pain may do the same.  As with all patients, this is a balancing act.

6.  For the social worker and bereavement coordinator, understand any family dynamics issues — there may be unfinished business or at least conflicting feelings if the patient was raised in a different faith.  The chaplain, in doing his/her spiritual assessment may want to do a “spiritual ecomap”, which is like a genogram, which is useful for families who practice multiple faiths.  This will be more and more important as the baby boomer generation continues to age.

7.   It is also important to facilitate discussions with family members about the patient’s wishes for end of life and at the time of death.  Educate family members on the need for a calm and peaceful environment, and let them know that if they are too outwardly emotional, they may be asked to leave the room.

8.  Clarify after-death wishes.  Does the patient want the body to stay untouched for 72 hours in order for the mind to separate and enter the bardo?   Sangha members and others may come to be with the body during that time to recite prayers and read from the Tibetan Book of the Dead. If on the other hand, the patient wants to donate his or her organs, that is totally acceptable, and most Buddhist teachers say it is a great way to generate good Karma. Cremation is traditional, but confirm wishes, and if they want to be cremated, and determine if they want a ceremony or viewing.

9.  Bereavement support may also need to be modified — grieving sangha members may not want bereavement support in the first 49 days after the death, so that they can turn inward to help their fellow sangha member’s journey in the bardo.  With respect to non-Buddhist family members, listen for and validate any feelings they may have in regard to their loved one’s Buddhist practice.

References

Smith-Stoner, M. (2006).  Phowa:  End of Life Ritual Prayers for Tibetan Buddhists. Journal of Hospice and Palliative Nursing, Vol. 8, No. 6.

Sogyal Rinpoche (1994). The Tibetan Book of Living and Dying. San Francisco:  Harper San Francisco.

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Do Our Pets Grieve After Loss?

Lucy and Andy, my two cats, have been best buddies ever since we brought Andy home fourteen years ago, when Lucy was one year old.  As I write, they are nestled next to each other.  Lucy, who has always been very healthy, is starting to show the signs of age:  recurrent urinary tract infections, and the beginnings of kidney failure.   As a hospice bereavement counselor, I support family members through their anticipatory grief, and their grief after the death of their loved one.  Is Andy starting to prepare for Lucy’s demise? How will she react after Lucy dies? How can I support her in the process?  I know plenty about supporting humans through their journey of grief — how do I do that with my animal partners?

Many have observed behavioral changes in their pets after their animal and human companions die.  They may search for their friend, stare out the window, seemingly in hopes that their friend will come back, stop eating, cry or seem depressed, clingy or withdrawn.

Some researchers believe that a cat or dog’s concept of death is similar to that of a young child.  Young children do not have the cognitive development to understand the finality of death, and grief counselors urge parents to talk honestly about death, in as much detail as a child can understand and tolerate — we cannot do that with our pets.  Pets can experience absence of what they became used to with their animal companions — their warmth when cuddling, their heartbeat, eating side by side.  Some behaviorists believe it is helpful to show surviving pets the bodies of their deceased buddies.  Indeed, it has been observed that a cat may stop searching for his or her playmate once shown the corpse of his dead friend.  If that is not possible, searching behaviors may continue until the surviving cat realizes in some way that his or her friend is not coming back.

So, how do we support our grieving animal friends? As a grief counselor, I always keep in mind Maslow’s hierarchy of needs, and it is therefore important to start with the physical.  With humans, I always ask if they are eating and sleeping well and getting exercise, using psychoeducation to explain that grief is stressful in all domains — physical, emotional, social and spiritual — and that if the bereaved does not take care of the physical component, he or she will not be able to move forward in a healthy way on the journey of grief.  Obviously, we cannot explain this to our animal companions.  Instead, look for eating and sleeping changes.  Not eating can be very dangerous in animals, and can lead to liver failure and death.  Hand feeding may be necessary in this case, and the physical closeness involved in hand feeding can be soothing and aid in healing.  It is also important to observe if the animal is urinating normally, as urinary tract infections can occur in times of stress.

Emotional support is also important in the healing of grief.  I have observed time and time again how important touch is in working therapeutically with those who are dealing with loss.  When I comfort a grieving spouse, a hospice patient who is scared and confused in dementia, and others who are experiencing the pain of loss, the touch of a hand or a hug is often  far more healing than words.  It is the same with our pets — massage them and talk to them in comforting tones. Continue to observe their behavior, and if they seem fearful, depressed or anxious, spend as much time as you can with them, talking to them in a soothing way and petting them so that they learn that they are safe.

Our pets are very sensitive to changes in their human companions’ emotions, and may become anxious.  Therefore, it is important for us to take care of ourselves, and get the support we need, whether from friends, a grief counselor or a support group, so that we can best support our pets.

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Mind the Gap: Living in the Space Between Loss and Healing

One of the most difficult phases in any life transition is the space of the unknown between a loss or change, and healing or new beginning.  All life changes, even positive ones, entail a sense of loss or grief.  For example, there is a sense of loss in giving up addictive behaviors like cigarette smoking, despite the fact that the change is a positive one.  Even the change of getting a better job or promotion entails loss — you might be giving up security, relationships and the comfort of the known in making such a change.  The most difficult changes involve the death of a loved one or death of a relationship.

Our lives are always in transition.  Every breath we take involves a transition, from inhaling to exhaling, to the gap or space before the next inhalation.     After the end of a phase in our lives, we have a tendency to jump into something (or someone) new, because that space of the unknown can be so uncomfortable.  William Bridges (1980) calls this space the “neutral zone.” As Bridges explains (p. 112), “one of the difficulties of being in transition in the modern world is that we have lost our appreciation for this gap in the continuity of existence.  For us, emptiness represents only the absence of something.  So, when the something is as important as relatedness and purpose and reality, we try to find ways of replacing those missing elements as quickly as possible.”

Resting in the space of the neutral zone — feeling the pain of our loss, exploring our options, getting to know ourselves on a deeper level — is the key to transformation and growth.   How can we sit in that space of the unknown that feels anything but neutral, without giving in to the impulse to do something?  The first step is to be rather than do, which sounds much easier than it is, until we develop some friendliness toward ourselves and our anxiety.  Notice the impulse, and instead of acting on it, explore it with curiosity:  Where do you feel it in your body?  What is it telling you?  Breathe into it and let it be without having to change it in any way.

Mindfulness meditation, especially mindful breathing, is very helpful in learning how to be in the gap or neutral zone:  Feel the cool air entering your nostrils on the in-breath.  Pause and then feel the warm air leaving your nostrils on the out-breath.  Notice in particular how the out-breath dissolves and experience the space before your next in-breath.

Journaling can also be helpful in navigating the neutral zone.  Journaling helps us get those swirling emotions out of our bodies and head in a way that is workable and spacious.  We can gain some perspective on the stages of our journey — a major function of the neutral zone, and get to appreciate that time as a time for renewal.

Finding a regular time and place to be alone is also helpful in the neutral zone.  The period after a loss is a natural time to turn inward. This time of year, the barren stillness of winter, is also a natural time to turn inward.  Experience the loss of summer’s richness and the loss of the autumn leaves.  Know the gap before spring comes again as a time for renewal.  Without death, there can be no rebirth.

The Christian mystics call this gap and time of turning inward the “dark night of the soul.” It is a time to allow ourselves to feel the pain and despair that is a universal part of the human condition in the face of loss and change.  We may feel bereft and spiritually arid, and it is necessary to feel those feelings in order to transform them.  Despair can be seen as the manure from which spiritual growth and personal transformation arise.  As Michael Washburn so beautifully says in the aptly titled article The Paradox of Finding One’s Way by Losing It (1996), “It is only in the depths of despair that genuine spiritual life is found.  It is a paradox that we sometimes have to lose our way in order to find our true self.  We sometimes have to die to the world and to our worldly self before we can discover that our deepest and truest self was within us all the time.”

REFERENCES

Bridges, W. (1980). Transitions:  Making Sense of Life’s Changes. Cambridge, MA:  Perseus Books.

Washburn, M. (1996).  The Paradox of Finding One’s Way by Losing It:  The Dark Night of the Soul and the Emergence of Faith.  In Sacred Sorrows, Nelson, J.E and Nelson, A., eds. New York:  G. Putnam’s Sons.

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Coping with Grief During the Holidays

The holiday season is upon us.  This time of year can be particularly difficult for those who are grieving the death of a loved one, and can revive or intensify one’s grief even after many years have passed.  Here are my top ten tips for coping with grief during the holiday season:

1.  Spend time with family and friends.

2.  Spend some “alone time” to reflect.

3.  Light a candle in your loved one’s honor.

4.  Volunteer your time to help others, with the intention that your are giving in honor of

your loved one.

5.  Tell stories about the life of your loved one.

6.  Write a letter to your loved one.

7.  Express your feelings through journaling or art.

8.  Make a donation to your loved one’s favorite charity or group.

9.  Have a party for the deceased with people who loved him or her, play his or her

favorite music and prepare his or her favorite foods.

10. Take care of yourself — buy yourself flowers, take a trip out of town, get a massage,

read a book, take a walk, and have a date with yourself.

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EMDR as a Healing Tool in Transforming Traumatic Grief

The intense and painful experiences of grief are generally considered “normal.”  However, when those experiences are extremely distressing, unduly interfere with day-to-day functioning or do not subside to a manageable level over time, the bereaved may be experiencing complicated or traumatic grief.  Complicated grief has been proposed as a new diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and suggested components of the diagnosis include (1) that sufferers experience bereavement by death; (2) that their reactions include intrusive and distressing symptoms, including yearning, longing and searching for the deceased; and (3) that the bereaved exhibit at least four marked and persistent trauma reactions, which may include:  “avoidance of reminders of the deceased,  purposelessness, feelings of futility, difficulty imagining a life without the deceased, numbness, detachment, feeling stunned, dazed or shocked, feeling that life is empty or meaningless, feeling a part of oneself has died, disbelief, excessive anger or bitterness related to the death, and identification symptoms or harmful behaviors resembling those suffered by the deceased” (Mitchell et al, 2004, p. 13).

Even in cases that do not fit the criteria for complicated grief as described above, the events surrounding the death may be sufficiently traumatic to interfere with daily functioning or result in unrelenting distress.  As a psychotherapist specializing in grief and loss, I have found EMDR (Eye Movement Desensitization and Reprocessing) to be an effective tool for alleviating trauma in grief.  As in grief, trauma affects the whole person — body, mind and spirit, and on a hierarchy of needs, trauma must be dealt with in order for the healing process of grief to proceed in a healthy, and healing, fashion.

What is EMDR?

In brief, EMDR was developed by psychologist Francine Shapiro after making a chance discovery that the lateral movement of her eyes reduced the intensity of disturbing material she was dealing with in her life (Shapiro, 1995, p. 2).  Dr. Shapiro spent several years scientifically studying this phenomenon, and found that bilateral stimulation, i.e., stimulation on both sides of the body — whether in the form of eye movements, tapping, sound or other forms — released traumatic material from the brain in a way that made the material workable. Trauma that is locked in the brain leads to the “fight, flight or freeze” response, and EMDR helps transform traumatic images into memories that no longer have a deleterious hold on the individual.

In addition to this physiological response to trauma, the traumatized individual often develops negative beliefs about him or herself (such as “I do not deserve love, “I was at fault” etc).  The beauty of EMDR is that it works on a cognitive level as well as the physiological level, not only facilitating the transformation of traumatic images in the brain, but also allowing the individual to replace negative cognitions about him or herself with positive ones (such as “I deserve love”, “I did the best I could”, etc.).  EMDR also works on a somatic level, with the therapist guiding the client to feel the traumatic images and negative beliefs in the body, thus further facilitating the transformation of the images into non-intrusive memories, and also transforming the negative beliefs into positive, useful ones. Therapists need to be trained to practice EMDR, and follow a standardized protocol in EMDR work with clients.

Case Studies

Two cases in my practice are illustrative of the effectiveness of EMDR in resolving traumatic grief.  “Carol”, the mother of two small children, came to see me complaining of ongoing distress after the death of her husband nine months before.  “Bill” was in a motorcycle accident, sustaining a broken leg. After being admitted to the hospital, Bill suffered a stroke and brain swelling, and died after being taken off life support two days later.  Carol was concerned about her irritability, particularly toward her children, and her anger toward Bill for dying and leaving her with two small children to raise alone. She also expressed guilt regarding her anger toward Bill, which I spent time validating and normalizing, since anger is often exhibited as a normal grief response.   Carol spent much time telling her story — a useful healing tool for making meaning of a seemingly senseless situation (White, 1995).  She did not exhibit signs of trauma for the first few months that we worked together.  However, as the anniversary of Bill’s death approached, Carol found it difficult to sleep, being awakened by intrusive images of Bill lying in the hospital bed and her shock when she learned of his condition.  We explored Carol’s negative cognitions around these images and Bill’s sudden death. The negative belief that that most impacted Carol was her belief that Bill’s death was her fault because she had a premonition that he would be in an accident, and she did nothing to prevent it.   In describing the images of Bill lying in the ICU and her belief that it was her fault, Carol felt tightness in her chest and had difficulty breathing. After two 90-minute EMDR sessions, Carol was able to replace her negative belief “I was at fault” with the positive belief “I did the best I could.”  She reported that she still, of course, experienced memories of Bill’s death, and reported she was very pleased that that she could feel sadness without guilt.  Carol was thus finally able to process her grief and loss in a healthy way.

My work with “Mary” was deeply profound and moving.  Mary’s husband “Don” suffered with Lou Gehrig’s disease (ALS) for three years, and Mary witnessed the horrible, inexorable ravaging of Don’s body while his mind stayed strong.  Mary’s expressed purpose for coming to see me was that she was unable to feel Don’s presence in her life.  Mary described Don as her soul mate, and I assured her that because of the strength of their bond, she would find a place for Don in her heart and feel his presence as a support in order to move forward. However, it was clear that she would first have to deal with the traumatic images that prevented her from fulfilling this step in her grief process.  The most disturbing image, and target for our EMDR work, was finding Don lying in a pool of blood on the bathroom floor after falling out of his wheelchair.  I taught Mary the “butterfly” technique, in which the client crosses his or her arms across the chest in a hug and taps alternately below each shoulder, simulating the bilateral stimulation used in formal EMDR sessions. I instructed Mary to use this technique at home as a resource when traumatic images arose.  After two sessions, with Mary working at home with the butterfly hug when disturbing images and emotions arose, Mary reported that those images had receded as mere memories that were no longer unduly disturbing.

Mary came into our next session glowing, and reported that she had felt a tug at the back of her shirt while sitting quietly one day and “knew it was Don, back in my life.”  She reported that she subsequently felt Don’s presence coming to her every night before she fell asleep.  Our trauma work was done, and Mary was well on the way to healing her grief.

Conclusion

My work with both Carol and Mary, as well as many others, has enhanced my confidence in my therapeutic skills in identifying and working with traumatic grief, and has increased my trust and faith in the effectiveness of EMDR as a healing tool in grief.

References

A. Mitchell, Y. Kim, H.G. Prigerson, M.K. Mortimer-Stephens. (2004). Complicated Grief in Survivors of Suicide. Crisis 25(1), 12-18.

F. Shapiro. (1995). Eye Movement Desensitization and Reprocessing:  Basic Principles, Protocols and Procedures. New York:  Guilford Press.

M. White. (1995). Re-authoring lives. Adelaide:  Dulwich Center Publications.

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The Use of Narrative Therapy in the Transformative Work of Healing Painful Life Transitions

Helen Keller has said that “the only way to get to the other side is to go through the door.”  This is certainly true in the work of transforming painful emotions, such as those we experience after a divorce, into healing and growth. This process involves allowing ourselves to feel the intense emotions of grief – sadness, anger, despair and other difficult emotions, as well as tapping into our internal strengths and external sources of support.

Narrative therapy and has been used with a wide variety of difficulties and issues, including reactions to a major life transition.  The role of the narrative therapist is as collaborator or co-author with the client.  As such, the narrative therapist partners with the client to explore the stories that give meaning to the client’s life (White, 1995). The The

Narrative therapy is thus an empowering vehicle for “re-authoring lives” (Carr, 1998, p. 468; White, 1995), in which the therapist takes the role of a partner or collaborator with the client, rather than an authority figure (Angell, Dennis & Dumain, 1999).. The narrative therapist partners with the client to create a safe place to feel the emotions of loss and change, and to explore the stories that give meaning to the client’s life. The use of narrative or story is a useful vehicle for making meaning and sense of difficult experiences in our lives, by allowing us to access alternative cognitions and gain self-knowledge.

A narrative therapy tool that is often used in this work is the use of written expression, such as journaling and letter writing.  This can be a powerful vehicle for expressing the emotions of loss and change and accessing the individual’s unique internal strengths and resources.

The collaborative approach of the narrative therapist can be useful for accessing the client’s spiritual strengths by respectful inquiry into the client’s worldviews, including his or her beliefs before the loss, and how they may have changed since the loss, and discussing spiritual and existential issues that arise in this context. (Calhoun & Tedeschi, 2000, p. 167).

As one gets in touch on a deep level with his or her own suffering and resiliency in the face of that suffering, he or she can begin to get a panoramic view of the human condition and tap into his or her spiritual strength. Religious and spiritual beliefs have been observed to be one way in which individuals create meaning and a sense of order and purpose to the human condition and its difficult transitions (Golsworthy & Coyne, 1999; Calhoun & Tedeschi 2000).

Narrative therapy can be an effective tool for working painful emotions and finding new meaning in one’s life.  The process of expression literally takes deep feelings out of the body, externalizing them so that they become workable. Through this process, my clients are able to see that they have some control over their lives, and can tap into their strengths and their inherent wisdom.  With my guidance as a partner on the path of healing painful life transitions, my clients can discover their unique strengths, resources and resiliency, deepen their spiritual beliefs, and enhance the meaning of their lives in the context of the human condition.