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.

 

 

           

 

 

           

 

 

 

GRIEF CAN BE MESSY

 

A common complaint of my grief therapy clients is that they don ‘t think they are “grieving right.” I assure them that’s there’s no “right” way to grieve, and that, in fact, grief can be downright messy.

Just from a superficial point of view, the face of a grieving person can be pretty darn messy – bloodshot eyes, runny, red nose, puffy eyelids, red nose and other outward appearances that we might want to hide. Grief can also throw other physical aspects out of whack. Individuals who are grieving may either not sleep well or get too much sleep. Eating patterns can get interrupted as well, and it’s not uncommon for a bereaved person to either lose or gain too much weight.

The emotional side of grief is equally messy and can also be unpredictable. Emotional outbursts can seemingly come out of nowhere. I remember many times after a significant loss sitting in my car at a red light and screaming or pounding on my steering wheel. At times like those, I’m tempted to say to the driver next to me: “Don’t worry. I’m not crazy. I’m just grieving.”

People who pride themselves as being patient and calm can find themselves being angry, irritable, intolerant and impatient in their grief. I reassure clients who are concerned about this that these are normal grief reactions. At the same time, however, I am vigilant as a clinician to make sure these clients are not depressed. There is a major difference between normal grief and depression. Whereas grief, though difficult is usually “normal”, depression is not, and needs additional care.

A pitfall for some grieving clients is that they believe grief should follow an orderly fashion, and may point to the five stages of grief described by Dr. Elizabeth Kubler-Ross, i.e., denial, anger, bargaining, depression and acceptance. Dr. Kubler-Ross never intended for these stages to be linear and predictable, but rather, touchstones in the grief process. We cycle in and out of these stages in a sequence that is neither predictable nor orderly, but rather, can be downright messy. However, if a griever believes these stages to be linear, after experiencing some initial denial, he or she may think “OK, I’m done with that stage. I’ll check it off my list and go on to the anger stage.” They may point to Kubler-Ross’s model as proof that they aren’t grieving “correctly.”

There are many ways to work in a healthy and healing way with the mess that is grief. Because grief’s myriad expressions and emotions are unpredictable, grief can be stressful and exhausting. Therefore, the first step in healing grief is to take care of your physical being, making sure to get enough sleep, eat healthily and get exercise.

Telling the story of your loss can also be immensely helpful, as a way to make meaning of the loss. This will help with the feelings of confusion, helplessness, hopelessness and despair that can accompany grief. In addition, telling the story can help the bereaved maintain an emotional connection to his or her deceased loved one. Telling the story can be done by talking to others, journaling, writing a letter to your loved one, painting, or by any other form of expression. Expression helps to literally push out all of the swirling, messy feelings in a way that makes them workable.

Reaching out for support is also extremely important in working with the mess of grief. Calling on friends, family or one’s spiritual community and calling on one’s inner strengths and resources are all very beneficial in preventing isolation and depression.

Working with the messiness of grief can be like tending an unruly garden. Gently pulling the weeds, giving the dirt nutrients and carefully tending to the growing plants allows them to bloom. Similarly, giving our grief tender loving care can allow the mess of grief to transform into healing and growth.

TREATING TRAUMA AND GRIEF: A HIERARCHY OF NEEDS

John was referred to me for counseling after his wife was killed by a drunk driver in a head-on collision witnessed by John.  Mary came to see me for grief counseling after her husband died a painful and horrific death from cancer.  Louise is seeing me to deal with intrusive memories of her brothers’ emotional abuse when she was caring for her dying father.

These three situations are different in many ways – different relationships, different coping mechanisms, different types of deaths.  However, each of these individuals is experiencing traumatic grief.  It might be more accurate to say that they are experiencing the effects of trauma that are preventing them from processing their grief in a healthy way.

Through my work with many clients experiencing traumatic grief, I have come to understand that trauma must be processed before the loss of a loved one can be processed in a healthy way.  This truth brings to mind “Maslow’s Hierarchy of Needs.”

Abraham Maslow was a psychologist who posited that basic physiological needs, such as food and shelter, and then safety and security, must be attended to before one can accomplish “higher” needs, such as a sense of belonging, and ultimately, self-actualization and the achievement of one’s potential.  The classic diagram for Maslow’s Hierarchy of Needs is a pyramid, with fundamental physical needs at the broad base of the pyramid, and self-actualization at its pinnacle.

In describing self-actualization, Maslow (1943) said:

“[S]elf-actualization… refers to the desire for self-fulfillment.  This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming.”

The prioritization of needs to be attended to in the work of healing trauma and grief strikingly parallels Maslow’s hierarchy of needs.  This hierarchy is reflected in trauma therapies like EMDR, which works first on the physical realm, then the behavioral, cognitive, emotional and ultimately the spiritual realm of existence.

The physical effects of trauma can be tremendous.  Many traumatized individuals have difficulty sleeping due to intrusive images and thoughts.  They are often hyper-vigilant, leading to imbalances in the adrenal and other bodily systems. These physical effects can lead to other dire effects, such as deep depression and suicidality. It is thus critical to treat these physical effects of trauma as the first priority.  Moreover, if one is experiencing the physical effects of trauma, it is virtually impossible to process the loss of a loved one in a healthy way.

Moving up the pyramid, once physical symptoms are managed, it is necessary to deal with the behavioral dysfunctions that often result from trauma.  For example, a person trying to cope with trauma may turn to drugs or alcohol in a vain attempt to ease the pain.  He or she may also self-isolate and cut off sources of social support.  Finding healthy ways to cope and and cultivating support are important in healing trauma and grief.

Cognitive work can be seen as the next priority in processing trauma.  Negative self-beliefs go hand-in-hand with trauma.  For example, the surviving partner of a sudden or violent death may believe “it’s all my fault.” An individual dealing with an abusive relationship may believe “I don’t deserve love.”  Cognitive therapeutic work is thus necessary to let go of the power of such erroneous thoughts.

Once the grip of erroneous negative self-beliefs is loosened, and those beliefs are replaced with positive and healthy beliefs, one can then go about the work of healing grief.  The intense emotions and unpredictability of grief can be navigated successfully on the broad base of physical well-being, healthy ways of coping, and positive beliefs.

The healing of grief, like working to achieve the stages of Maslow’s Hierarchy of Needs, is a process of transformation and spiritual growth, i.e., self-actualization. The fruition of this process includes a sense of acceptance and realism, self-compassion and compassion for others, independence and interdependence, and an appreciation of life in all of its impermanence and imperfection.

References:

Maslow, A. H. (1943). A Theory of Human Motivation, Psychological Review 50, 370-96.

Maslow, A.H. (1943). Motivation and personality. New York: Harper.

 

 

The Healing Power of Love in Grief

The way we grieve is a result of what we learned about love and relationships as a baby. We all learned certain “rules” growing up about love, such as “don’t give your heart away” or “don’t love too fully or you’ll get hurt.”

Through my work as a grief counselor, I have come to believe that the grief process is akin to the process a young child goes through in separating from his or her primary caregiver (PCG). For the first few months of life, the infant experiences no separation from the PCG – they are one and the same. Little by little, the developing child comes to understand that he or she and the PCG are in fact separate beings. The child starts to experiment by crawling or walking away from the PCG, coming back as necessary for “emotional refueling.” Playing peek-a-boo games teaches the toddler that even though something may be physically hidden from view, it still exists. Around the age of three, the child is able to understand the more abstract notion that he or she can keep a representation of the PCG, in his or her heart, and with that emotional presence and support, can venture out further into the world without the PCG. The development of this capacity is called 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)).

The inability to retain a sense of object constancy, and to remember that the PCG is a resource even when she or he is not physically present leads to many difficulties in forming healthy relationships and good boundaries. For example, those with borderline personality disorder or other attachment disorders were unable to achieve the capacity for object constancy because the mother or other primary caregiver was neglectful or abusive, physically and/or emotionally and did not therefore create a sense of safety and trust in the growing child.

Grief theorist J. William Worden (2002) describes certain tasks a bereaved individual to complete in order to navigate the grief process in a healthy way. The first task is to accept the finality of one’s loss; the second task involves feeling, and not avoiding, the pain of one’s grief; the third task is to adjust to an environment without the deceased; and the fourth task is to “emotionally relocate” the deceased and move forward in life. This process of “emotionally relocating” the deceased loved one is akin to the development of object constancy.

This process of grief and love was illustrated in a poignant way with one of my grief therapy clients, who I will call “Joe” for the sake of confidentiality. Joe came to see me for therapy after the death of his young wife, “Jody” as it became clear that his suffering in his grief was unrelenting. A common theme in Joe’s lamentations was that his wife was quite mean to him, especially as her cancer progressed and affected her brain. Joe was unable to talk about Jody without crying, and he developed some unhealthy coping tools to assuage his pain. As the first anniversary of Jody’s death drew closer, Joe’s suffering increased.

I recently asked Joe if he loved Jody, and with tears streaming down his face, Joe for the first time in our sessions said that he loved his wife. It felt as if a dam Joe had built around his heart had burst, and he was able to open his heart to his love for Jody. This was truly a breakthrough in Joe’s path to healing his grief.

It was clear that Joe needed to find a place for the Jody he loved in his heart in order to move forward in life. For so many of us, like Joe, this is a process of having the courage to love wholeheartedly. Many of us hold back pieces of our love out of fear that doing so will make us too vulnerable. However, vulnerability is not a weakness and does not put us at risk of harm. Rather, the word “vulnerable” simply means the ability to be open. Being open allows us to see things more panoramically and makes us stronger, not weaker. More importantly, being open to loving fully allows us to keep our loved ones with us as a source of strength and support when they are not there in person.

Loving and living fully after loss often entails completing “unfinished business” with our loved one in some way, whether through therapy, journaling or other expressive means. We may need to forgive our loved ones for their human weaknesses, and also forgive ourselves for difficulties in the relationship. No relationship is perfect, and letting go of resentments, guilt or fear is an important piece of the process of finding an open place in our hearts for our loved ones who have passed. Only then can we relocate the deceased emotionally in our hearts, heal our grief and move forward in life.

Life, Love and Work: How to Navigate Life in the Workplace After A Loss

Life cannot be compartmentalized. Life and loss happen at the same time that you are expected to fulfill obligations at work. Here are some tips for dealing with challenging life events and remaining productive.

The challenge of maintaining emotional stability at work while going through a divorce, death or other major loss is called a “dual process” – on the one hand, you are navigating your loss, and on the other hand, you are getting back into your life and its obligations.

It is important to attend to your loss.  If you try to push your loss under the rug and not deal with it, this can lead to delayed grief, a form of complicated grief.  In order to prevent this, it is important to have support – reach out to others who have gone through a similar loss.  Join a support group. Get emotional sustenance from your spiritual community.  Get professional support from a counselor specializing in grief and loss.  Express your feelings to a trusted friend or co-worker.

Grief and loss can make us question things we always believed in, and journaling or other forms of expression can help us create meaning.  Take care of your physical health.  Grief is extremely stressful in all areas, including the physical.  Make sure you’re getting enough sleep and eating healthily.  See your doctor to support you in maintaining your physical health.

If you attend to your physical, emotional and spiritual health, you will be more successful in re-entering the workplace and maintaining emotional stability on the job.  Don’t forget, though, that you aren’t perfect and that “grief spasms” can come without warning.  If you get sad or angry and start to cry or snap at a co-worker, excuse yourself.  Take a two-minute break.  Breathe in cool, nourishing air, and breathe out stress and tension.  Roll your shoulders and neck as you breathe in this way.  Feel your feet grounded firmly on the earth. It may be helpful to confide in a trusted co-worker, and ask him or her to remind you to take those mini-breaks.

It is important, though, to maintain a balance regarding how much you share about your personal situation at work.  If you feel that your feelings around your divorce or other loss are interfering with your job performance or if your situation requires you to take time off from work, you may want to explain to your boss — in professional and non-emotional terms — what is going on and that you are going through a difficult situation and you are confident that you will get back to peak performance shortly.

It is also good not to confide in too many work colleagues about your personal life – keeping a boundary between your personal and professional life is important in all circumstances.   Additionally, work can be an “oasis” where you can just do your job and put your feelings aside for a while.  We all have our own balance point, and it is important to be mindful when you are tipping to the side of expressing too much about your personal life.

If you are unable to get the emotional stability to do your job, whether you are feeling overwhelmed by your loss, are finding that the pain of your loss remains fresh with little relief, are having intrusive thoughts that are preventing you from sleeping, having negative beliefs about yourself or other difficulties, a therapist who specializes in grief and loss can be extremely helpful.

How to Be with Someone who is Grieiving

Your best friend’s beloved cat just died.   Your favorite co-worker was just laid off.  Your elderly aunt, who suffered from cancer for many years, just died and your cousin is bereft.  In any one of these situations, you might likely be uncomfortable, and don’t know what to do.  You are certainly not alone with this dilemma.

The first thing to remember in being with someone who is grieving a loss is the word “be” – notice that the title of this article starts with “how to be”, not “what to do.”  You may be tempted in the case of the death of your best friend’s cat to offer to take him to get a new pet.  In the case of your laid off co-worker, you might be tempted to give her resume- writing or job-hunting tips.  In the case of the death of your aunt, you may be tempted to tell your cousin that the death was a blessing and at least she lived a long life.

Although these possible reactions sound like they might be helpful, they actually can do more harm than good at the beginning of someone’s grief process. Here are some “doing” things to avoid:

  • Avoid the temptation to fix it.  People don’t like to feel that something is wrong with them that needs to be fixed.
  • Avoid giving advice, unless it is asked for.
  • Avoid the use of clichés, such as “maybe it’s a blessing” or “I know just how you feel” or “God works in mysterious ways.”

The key to being with a grieving person is listening.  Sounds easy, doesn’t it?  However, listening is really not that easy for most of us.  We find it much easier to do than to be.  So, we give advice, or offer to fix it or do something else to fill the space.  It is difficult for us to sit in silence with another, being a caring presence.  We tend to be uncomfortable witnessing another’s suffering and sitting in that empty, groundless space.  So, we do things to fill that silent space that are well-intended but not helpful to the grieving person.

The following are some keys to effective listening and being a caring presence for someone who is grieving:

  • Center yourself before entering the room.  Have the intention of being present for your friend. Slow down. Breathe mindfully, inhaling nourishment and ease for yourself and your friend, and exhaling stress and tension.  Feel your feet on the floor in order to get grounded.
  • Leave all distractions aside.  Turn off your cellphone, iPad and computer.  Don’t worry – your messages will still be there and can wait.  Forget about your plans for the rest of the day — they too can wait.
  • As you sit with your friend, check in with yourself periodically, putting about seventy-five percent of your attention on your friend, and about twenty-five percent on yourself.  Check to see if you are staying present – Is your mind wandering? Are you jumping ahead and figuring out the next thing to say?  Are you getting anxious hearing about your friend’s loss?
  • Leave your agenda at the door – simply be with your friend as he or she is at that moment, as much as your might wish to make it better or different – remember that it’s their process, not yours.
  • In staying present, be aware of your own triggers.  Perhaps you lost a beloved pet, just as your friend just did, and being with your friend is triggering your own pain.  Breathe into that pain for yourself, and breathe out from that tender place for your friend.  Your own pain is truly an opportunity to be authentically and open-heartedly present with your friend, and an opportunity for healing for both of you.

 

There is nothing more healing than feeling truly heard and understood.  This is the essence of active listening and “companioning”:  being with another in life’s journey as equals on the path.  Listening to and being a mirror for another’s pain is the essence of companioning.  As the eminent humanistic psychologist Carl Rogers noted:

I find that when I am close to my inner, intuitive self, when I am somehow in touch with the unknown in me…whatever I do seems to be full of healing. Then, simply my presence is releasing and helpful to the other. There is nothing I can do to force this experience, but when I can relax and be close to the transcendental core of me…it seems that my inner spirit has reached out and touched the inner spirit of the other. Our relationship transcends itself and becomes a part of something larger. Profound growth and healing and energy are present (Rogers, A Way of Being, 1980).

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.

The Pain of Unaccepted Grief

Carl’s partner Bob died. Bob’s parents would not allow Carl to play a role in Bob’s funeral plans and Bob’s healthcare providers did not recognize Carl’s decision- making authority. 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.

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.

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.

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.