THE INSIDIOUS FORCE OF MISOGYNY

 

Misogyny is an insidious and often subtle force that brings many women to therapy. The demeaning of women in the workplace, gender inequality at home, rape, sexual harassment, domestic violence, and other emotional and physical abuses against women result in symptoms ranging from depression and anxiety to PTSD.

Many of the women in my psychotherapy practice have experienced a significant increase in their symptoms due to the misogyny pervading our society since the election of Donald Trump.   Indeed, it has been widely reported that there has been a significant increase in existing, new and returning clients seeking help with post-election anxiety. As the Seattle Times recently reported (3/25/17) ,as many as 80 percent of potential new therapy clients are seeking help for post-election distress.

What makes misogyny so insidious is the unconscious acceptance — by women as well as men — of behaviors that demean women. For example, if a woman is attending a business meeting with male coworkers, she is more likely to be asked to take notes or fetch the coffee than one of her male colleagues. Even if the woman feels this is wrong, she may feel powerless to do anything but acquiesce. She may even offer to offer these “traditionally female” services out of her own unconscious conditioning. Compounding matters, women simply are not used to saying no or being assertive with male peers.

Women who are ambitious and successful are often seen as unlikeable “bitches.” Hillary Clinton recently said, in her interview with journalist Nicholas Kristof at the Women of the World Summit, “Certainly, misogyny played a role [in my loss of the presidency]. That just has to be admitted.” In his summary of the interview, Kristof wrote:

“[Clinton] noted the abundant social science research that when men are   ambitious and successful, they may be perceived as more likable. In contrast, for women in traditionally male fields, it’s a trade-off: The more successful or ambitious a woman is, the less likable she becomes (that’s also true of how women perceive women). It’s not so much that people consciously oppose powerful women; it’s an unconscious bias.” (New York Times, 4/9/17).

The constant barrage of bad news about the mistreatment of women in our society has caused significant re-traumatization in clients with a history of sexual abuse.   Events like the surfacing of the video of Trump with Billy Bush bragging about grabbing women’s genitals and the disclosures of Trump’s history as a sexual predator are triggers for anxiety and trauma. News of the culture of sexism at Fox News and elsewhere has re-triggered women who, like Hillary Clinton, have faced painful challenges in traditionally male fields.

One of the most disturbing aspects of misogyny is its unconscious acceptance by women, as Hillary Clinton noted. In fact, when I worked as a corporate attorney and executive, women were more apt to call me a “bitch” than men were (although sexism by my male peers certainly existed).

Women’s unconscious bias also spills over into heterosexual marriages. As a broad generalization, women tend to look to their husbands as the decision makers and tend to take on traditional roles of homemaking. In addition, women are generally expected to make less money than men (which is borne out by statistics of income inequality). This expected income inequality may also lead to marital conflicts, including resentment by women who earn more than their husbands, and self-esteem issues by men whose wives are the chief breadwinners in the family. While these gender-based norms and attitudes are changing, my clients report that they still pose significant challenges in their marriages.

The good news is that the recent presidential election and upsurge of reports of misogyny and sexual harassment by men in powerful positions has raised awareness of sexual oppression. As a child of the anti-war and feminist movements of the ‘60s and ‘70s, I am optimistic that the resistance and consciousness raising that have begun will continue and will reap positive results, as it did in ending the Viet Nam War, Nixon’s resignation and more equality for women in the ‘70s. The Women’s Marches the day after the inauguration in January augured a renewed sense of solidarity and confidence that we can all make a difference.

This renewed awareness of misogyny, sexism and inequality has already reaped positive results. Male clients have reported more understanding of and sensitivity regarding the challenges their female partners and colleagues face, and are willing to be more open and vulnerable with them. Women are less willing to ignore sexist behaviors and are speaking up more and more.

In addition, the onslaught of news in the media of sexual inequality and assaults provides an opportunity for women to look at their own assumptions and prejudices regarding men. As James Gordon, a psychiatrist and founder of the Center for Mind Body Medicine, wrote in The Guardian (2/9/17), Donald Trump represents the archetypal fool or trickster, who holds a mirror up to our own foibles and failings. Gordon aptly states:

“[The fool] performs a vital social function, forcing us to examine our own preconceptions, especially our inflated ideas about our own virtue. Trump was telling all of us – women and minorities, progressives, pillars of the establishment, as well as his supporters – that we were just like him.”

Ultimately, the fool is not there to taunt us, but to teach us to look at our conscious and unconscious preconceptions and prejudices. As Gordon concludes:

“The joker who is now our president has served an important function, waking us up to what we’ve not yet admitted in ourselves or accomplished in our country. He is, without realizing it, challenging us to grow in self-awareness, to act in ways that respect and fulfill what is best in ourselves and our democracy.”

The time is ripe for awakening and the dawn of an enlightened society. Instead of shunning and demonizing the Trumps in our lives, it is time to look at them with compassion for their ignorance and self-destructive aggression and arrogance. And, it is time to look at ourselves and work to promote understanding, healing and equality for all.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

© 2017 Beth S. Patterson. All rights reserved

STAYING SANE IN AN INSANE WORLD

The world around us may seem chaotic and downright insane these days. Here are some tips for remaining sane amidst the world’s seeming insanity:

Impose news and media “blackouts.” It is so easy to get caught up in the frenzy of the ever-changing news these days. Imposing limits on watching television and looking at and interacting with social media is of critical importance.

Limit news watching to one hour a day. The 24/7 news media like CNN work by sucking you in. Resist the temptation to be glued to your television or digital news media, and limit watching to one hour a day.

Be aware of triggers and trauma. The insanity of the world around us can make us feel unsafe and distrustful. In fact, many of my clients have been reporting an increase in anxiety and reactivation of old traumas, due to the pervasive news of sexual assaults, deceptive practices, gun violence, racism, war…and the list goes on. It is important to understand these triggers and develop self-compassion around them. Professional support can help us heal and develop a sense of safety and trust.

Spend time with friends and family. When we are feeling stressed out, anxious or depressed, it is so easy to isolate ourselves. Be sure to make time for the people in your life who nurture and support you.

Be mindful of negative thoughts. Negative thoughts of anger, fear, hopelessness and despair can proliferate automatically when the world around us seems chaotic. If we are not mindful about our thoughts, they can become epic novels! If you have a mindfulness meditation practice, make sure to practice and stay vigilant about discursive thoughts. If you do not have a mindfulness practice, there are many apps, such as HeadSpace that can be helpful.

Practice self-care. Stress is exhausting, both emotionally and physically. Get a massage, take a walk in nature, cuddle with your pets and loved ones. This is particularly important for those of us in the caring professions. Do all you can to not take on the traumas and stress of clients or patients. Maintain healthy boundaries. Be mindful not to take on others’ stress or trauma by maintaining healthy boundaries. Get support from others if you are experiencing secondary trauma or overwhelm.

Practice staying in the present moment, moment to moment. Being in the present moment is like an oasis in the desert. Mindfulness isn’t limited to sitting on a cushion. Our time “on the cushion”, so to speak, prepares us for out daily lives “off the cushion.” For example, if you are washing the dishes, be present with that: Notice how your hands feel in the soapy water. Feel the sensations of your sponge wiping the plates. When thoughts arise, simply return your attention to washing the dishes. This can be done with any daily activity, such as driving.

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.

 

 

USING MINDFULNESS-BASED PSYCHOTHERAPY AND MINDFULNESS MEDITATION TO OVERCOME TRAUMA

As a psychotherapist specializing in trauma and grief, the tenth anniversary of 9/11 gave me the opportunity to contemplate anew working with trauma — including my own. I was an eyewitness in New York City to the horrors of the terrorist attacks on the World Trade Center that beautiful September day. All of the media attention about the 9/11 anniversary could have reactivated serious traumatic reactions if I were not mindful of my thoughts and body sensations. I was aware that seeing footage of the collapse of the towers and revisiting other events of that day made my heart race and my hands tingle. I was also aware that my thoughts were careening back to the events of that tragic day and my feelings of helplessness and hopelessness. Staying mindful of the present moment helped me work with my thoughts and feelings. Focusing on my breath rather than my thoughts, I was able to breathe into my body sensations and emotions of fear and anxiety, and breathe out calm, healing and compassion for myself and all others experiencing those feelings.

Unresolved trauma — whether from abuse, witnessing or being a victim of violence, grieving a sudden or painful death, being in a car accident, or a myriad of other difficult events — can affect every aspect of a person’s life: physically, socially, emotionally, cognitively and spiritually. For example, intrusive thoughts and images can impact a person’s sleep, eating and overall health. The body’s flight, fight or freeze response to unresolved trauma can impact a person’s social and emotional life. Trauma is usually accompanied by negative beliefs such as “I am not safe”, I do not deserve love”, “The world is a terrifying place”, “God cannot help me”, “I deserved to be hurt.,” which affect the traumatized person’s sense of self, world view and spirituality.

Mindfulness meditation and mindfulness-based psychotherapy can be powerful tools in healing trauma. Mindfulness meditation helps free people from the seeming power and “truth” of their thoughts, helping them stay in the present, rather than dwelling on the past or worrying about the future. In addition, many people dealing with depression, anxiety or trauma are not connected to their bodies. They literally live in their heads. This is a coping mechanism to escape the pain of their feelings — it may have served them in the past, but is no longer serving them. Mindfulness meditation helps a person focus on the present moment and notice where thoughts and emotions are felt in the body. This experience can help the traumatized person feel grounded. The simple act of feeling one’s feet on the floor, feeling the support of the floor and Mother Earth, is especially effective in letting go of racing thoughts about the past and future and being grounded in the present. This grounding helps clients feel safe in the present,

Mindfulness practices keep us in contact with things as they really are, helping us let go of the seeming power and solidity of our thoughts. Dealing with the past in the present moment creates spaciousness and workability around swirling and claustrophobic thoughts and feelings. Thus, mindfulness based psychotherapy allows traumatized clients to re-experience the traumas of the past while being in touch with their present thoughts, feelings and body sensations. The experience of the present moment actually provides a sense of safety and distance from past horrors. We are able to experience as a witness the thoughts, feelings and emotions associated with the past without being stuck in them, simply letting the experiences come and go. This witnessing ability is extremely powerful, allowing us to see that we are not our thoughts or our past experiences.

Physiologically speaking, working with the present body sensations, emotions and feelings associated with the past actually releases traumatic material that is literally stuck in the amygdala, or “reptile brain.” This stuckness affects our adrenal system and other body systems as well as our brains, resulting in the automatic flight, fight or freeze response Mindfulness practices facilitate the release of traumatic images from the brain, making them less intrusive. In turn, the individual can choose more healthy responses than fight, flight or freeze, let go of negative thoughts about him or herself, and actually replace those thoughts with positive thoughts.

As one client grieving the traumatic death of her husband noted, “I still miss him, and still have images of him being in the ICU on life support, but those images no longer intrusive and disturbing. They are now just memories, and the negative beliefs about myself and the world are gone. I know that my husband’s death was not my fault and I am OK.”

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.

Children and Grief: A Story of Trauma, Abuse and Healing

In my therapy work with grieving children and adolescents, it is important for me to keep in mind that the child’s age and stage of development at the time of the loved one’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 will enable me 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 with appropriate interventions.

For example, I successfully worked with a grieving twelve-year old girl, who I will call “Abby.” I worked with Abby both individually and in a small group with other grieving pre-teens at a hospice-based children’s grief support group. Abby’s maternal grandfather died suddenly and violently two years ago while cleaning his gun.  There is some uncertainty as to whether the death was accidental or a suicide.    Abby is an only child, who lives with her mother.   Although Abby did not speak with me about it, her mother has reported that Abby’s father physically abused Abby when she was four or five years old and he has been court ordered to not have contact with her. Abby has not seen her father (who is divorced from her mother) since she was six years old.  She had a very close relationship with her grandfather, and spent every Saturday with him, doing special things together.  Abby reports that since her grandfather’s death, she spends her Saturdays alone, mostly sleeping.

The Interdependence of Grief and Development

Childhood grief and development are interdependent:  The early death of a parent or other loved one 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.  Furthermore, children re-experience their grief as they reach each milestone in their development.  .

Capacity to Grieve and Understand Death’s Finality

A child’s ability to understand the meaning and finality of death corresponds to his or her cognitive development.  For example, a three to five year old 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  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

In working with Abby’s grief over her grandfather’s death, I always kept in mind that she was dealing with her loss both from her current cognitive developmental stage, and from the earlier stages she was in when her father abused and then left her.  Thus, she was likely relating to her grandfather’s death emotionally from that earlier stage, and may believe that she is somehow be responsible for his death. The child at this stage needs someone who can clarify what the child is thinking and feeling, and can reassure and build self-esteem by praising the child’s accomplishments.   This is something that I tried to do each time I met with Abby.

Although Abby is able to grasp and verbalize abstract concepts about death, her grief process was still informed by early developmental issues of safety and trust, as well as the magical thinking of the child in latency.  Abby’s grandfather’s sudden and violent death, coupled with her father’s abuse and abandonment, seems to have made it unsafe for Abby to trust and truly connect with her peers at a life stage when peers and feeling accepted are so important to social and emotional development.

Developmentally, even in more “normal” circumstances, 12-year olds yearn to belong, but may feel different and isolated, as the brain and body go through a dramatic growth spurt instigated by a surge of hormones. Physically, a 12 year old girl is starting to become a woman, and may experience self-consciousness and awkwardness that may lead to withdrawal.  Emotionally, she may experience a strange and seemingly uncontrollable roller coaster of highs and lows exacerbated by pubertal hormonal changes, as well as grief over the impending loss of her childhood.  Cognitively, in moving from concrete to abstract thought, an introspective and intelligent 12-year old like Abby is increasingly aware that others may not share her feelings, thoughts and values.  A grieving pre-teen, like Abby, may also feel different because so few of her peers have experienced the loss of a loved one.  This recognition can lead to the first taste of existential alienation, causing further withdrawal.  Those who are more firmly in the formal operational stage of abstract reasoning can have a more panoramic view about these differences, and develop true compassion and empathy for others.  The child not quite out of concrete operational thought, especially one dealing with profound grief like Abby, may have a difficult time getting to that stage, and may regress to more egocentric behaviors, like those I have witnessed in Abby’s case.

Tasks of Children’s Mourning

Worden (1996) 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 loved one when he or she understands, through the achievement of formal 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 loved one 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 was clearly the case for Abby.  Abby has an understanding of the abstraction of death’s finality.  She has been grappling in our sessions with giving spiritual meaning to the finality of death.  My job was to empower Abby’s cognitive work by normalizing and validating her process and the private thoughts she has chosen to share with me, while at the same time providing a safe space for her emotional process.  Furthermore, as Abby was then a pre-teen on the cusp of profound developmental challenges, I needed to stay aware that as she comes to terms with the meaning of her grandfather’s death, her new cognitive abilities also opens her to a new level of understanding – and pain – about the loss of her father.

Experiencing the Pain and Emotional Aspects of the Loss

The pain and emotions of grief can be frightening for a child to experience. Awareness of the child’s capacity based on his or her stage of emotional development to cope with strong emotions is important. It is also important to assess the child’s coping and defense mechanisms, and their effect on how the child experiences the pain of the loss.

In Abby’s case, the abuse and abandonment by her father early in her life has left deep developmental holes and she has split off from her emotions, which has complicated her grieving process over the death of her grandfather.  Journaling in a group setting proved to be an effective means for Abby and the other group members to deal with their feelings, as well as allowing them to connect with the others and feel less isolated, empowered by the realization that they have all experienced a loss, and they are not so different, after all.

Adjusting to an Environment without the Deceased

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 loved one, who is not there to nurture and support the child’s growth and achievements. An intervention I used with Abby was the creation of a memory box for her grandfather, in which she has placed pictorial depictions of their relationship.  We also did an art therapy project together when Abby returned from summer vacation.  This was primarily a non-verbal exercise in which Abby was able to “tell” her grandfather through the medium of collage about her summer activities and experience her emotions of loss and sadness on a somatic level.  My job in this process was to simply sit beside her and be an empathetic witness.  In joining with Abby in this way, we established a good degree of contact and trust.

Relocating the Deceased in One’s Life

As the child grows and changes, his or her relationship with the deceased parent or other loved one also changes (Christ, 2000).  Thus, according to Worden (1996), another ongoing task is to find new ways to memorialize the deceased loved one with the attainment of each developmental milestone:  Children need to “find a new and appropriate place for the dead in their emotional lives – one that enables them to go on living effectively in the world.”  The above-described art therapy projects have been helpful with Abby in this regard.  The narrative therapy intervention of letter writing was also helpful at this stage, having Abby write a letter to her grandfather.  This process helped Abby clarify her feelings and create a safe container for them, allowing her to relocate her grandfather and live an effective life.