Grief Counseling

by

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.

 

 

           

 

 

           

 

 

 

by

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.

by

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.

 

 

by

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.

by

Psychotherapy and the Middle Way

When I hear the clients in my psychotherapy and grief counseling practice talk in black and white terms, or view their options in terms of extremes, I am reminded of the Buddhist concept of the Middle Way. When the Buddha was asked how one should meditate, he responded “not too tight, not too loose.” He analogized this to a string instrument, like a lute: If the strings of the lute are too tight, they will break, and if the strings of the lute are too loose, they won’t play.

So it is as we live our lives and navigate its changes. Ideally, we strive to find a middle way where the “strings” of our life can resonate. However, due to anxiety, we may get wound up to the breaking point, where there is no give and take, no spaciousness to allow things to be. On the other hand, we may be so downtrodden with depression that our “strings” are too loose — we just don’t have the emotional energy to tighten them enough to play.

The Middle Way can be likened to living in the space of ambiguity — which is truly the condition of life. Because of our emotional histories, living in ambiguity can be fraught with difficulties. In our anxiety, we frantically fill the spaces in our lives with doing, rather than being. Yet, possibilities for growth and renewal can only arise if we are able to rest in that unknown space. If we can take a breath and rest in that space, called “the gap” in Buddhism, we see that it truly is spacious, vibrant, alive and full of possibility.

Similarly, our emotional wounds sometimes prevent us from seeing the complex nature of the people in our lives, including ourselves. At its extreme, we see them as all good or all bad, known as “splitting.” In fact, sometimes the same person is seen as all good one minute, all bad the next. A goal for people in therapy with this type of issue is to be able to see the shades of gray — people, including the client, are neither all good nor all bad. Many people with this tendency are perfectionists, with resultant depression, eating disorders, self-injury and other issues. For these clients, having a safe experience that it is OK not to be perfect (and that perfection is in fact impossible for human beings) leads to self-compassion, and compassion for others. Their emotional “strings” can then be loosened enough to let themselves — and others — be, allowing for the possibility of joy, satisfaction and intimacy in their lives.

The Middle Way approach is also helpful in my work as a grief counselor. People who are struggling with their grief sometimes ask me “when will I feel better, and when will I ‘get over it’”? Some go the “too loose” extreme, numbing the pain of grief with drugs or alcohol, or jumping into a new relationship. Others go to the “too tight” extreme, idealizing and idolizing their deceased loved ones, or holding on tightly to their pain for fear that letting go will mean forgetting their loved ones. Finding that Middle Way, where the bereaved can safely feel and express their pain and go through their own personal journey of grief, without having a map, but the compass of the grief counselor, is a key component to growing and healing in grief.

by

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.

by

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.

by

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.

by

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.

by

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.