Aileen led a full workshop through an enlightening, experiential journey with grief and its impact on clients and therapists and how each can become stuck. She helpfully based the day around the following five questions asking us to initially work in small groups with various aspects of the themes and then to bring the reflections and insights to the larger group for feedback and discussion:
What does ‘stuckness’ look like?
We discussed what ‘stuckness’ might look, sound or feel like and how we as therapists might recognise it in our clients and, of course, in ourselves. Clients might be experiencing panic attacks/phobias; clinical depression, PTSD, feelings of merely existing not living, delayed grief, exaggerated grief or grief that is somatised or masked within illness or physical issues, thoughts that the deceased is all good or all bad or their grief is experienced as excessive, disabling as though the death had occurred only yesterday. Aileen then highlighted key factors which she felt needed to be borne in mind when working with grief or loss.
- Relational Factors: The client’s quality of relationship with the person who has died, the attachment style of the client and therapist, personality issues such as narcissistic or highly dependent, or historical wounds around abuse or neglect.
- Circumstantial Factors: Where there is death a body to be buried/cremated, violent death; suicide, multiple loss from one family or community, secrets about the deceased emerging after death, abortion or other situations where the client may think/feel they cannot openly grieve due to feelings of shame and/or guilt.
- Historical Factors: Early parental loss, history of depression, previous complicated grief and insecure attachments
- Personality Factors: Those with avoidant attachment patterns may become isolated or feel they are strong enough to ‘get on with things’ and so discount their own need to grieve. Clients might not have been taught as children how to name and process emotions helpfully and so discover that in grief their usual survival patterns feel completely overwhelmed.
Aileen reported that Richard Erskine Ph.D., in his address to the International Integrative Psychotherapy Association Conference in Vichy, France in 2011, had said he felt that the problem was not attachment styles but attachment patterns. ‘An attachment disorder is apparent when someone can only relate to others in the way the attachment was modelled to them and this shows in every aspect of that person’s life’. Often the attachment styles of the therapist and the client will manifest in the therapeutic relationship and in the counselling room either helpfully or unhelpfully.
Who is more likely to become ‘stuck’?
Whilst exploring the second question, Aileen reminded us of the work of John Bowlby and his attachment theory. She said Bowlby had also considered the work of Harry Harlow, an American Psychologist, whose research with monkeys revealed that ‘bonding didn’t just occur to fulfil physiological needs, it serves to fulfil psychological needs’. Bowlby had concluded that ‘grief responses are instinctive and geared towards re-establishing a relationship with the lost love object’. Often those with problematic attachment patterns are more likely to experience complicated grief.
What happens in the brain of those experiencing grief?
Aileen shared with us the work of Mary-Frances O’Connor et all (2008) of the University of California whose study supported the hypothesis that participants whose complicated grief experiences were still activating neural reward activity continued to interfere with their adjustment to a world without their loved one. The research involved a study of 11 women with complicated grief and 12 with normal grief who underwent MRI scanning to observe the neural pathways as their grief was ideographically stimulated. ‘Both groups showed pain related neural activity, however, only the complicated grief group showed the reward-related activity in the Nucleus Accumbens. This correlated with the self-reported feelings of yearning/longing’. (www.ncbi.nim.nih.gov/pmc/articles/PMC25535617).
Aileen explained that this area of science was new to her and that she had found it fascinating as did those in the room saying that ‘all living things have internal systems that are geared towards survival’. This whole aspect of understanding grieving intrigued everyone present.
Aileen referred us to the work of William Worden, Ph.D. and his Four Tasks of Mourning. (Grief Counselling and Grief Therapy, 4th Edition, 2010 Routledge, E. Sussex): Task 1 – To accept the reality of the loss; Task 2 – to work through the pain and grief; Task 3 – to adjust to an environment in which the deceased is missing and Task 4 – to emotionally relocate the deceased and move on with life.
We discussed the Tasks within our groups and felt that the Core Conditions and a sensitive pace were vital to the creation of a place of trust and collaboration. Once the area of ‘stuckness’ within Worden’s Tasks was identified, the therapist and client could explore ways that might help it to begin to move:
- The client might discuss with his/her GP support for physical/illness symptoms.
- Revive the positive memories of the deceased and only move to those negative ones, if necessary, when trust increases within the therapeutic relationship.
- Explore feelings and lack of feelings.
- Reality test feelings of guilt.
- Writing a letter to the deceased or keeping a journal.
- Asking a client to bring in photographs or symbolic objects, if they wish.
- Check out with the client the pay-offs for continuing or stopping grieving.
How might the therapist block the client’s process?
The therapist’s attachment style might mean they are unable to stay with the client in their pain, or be able to co-create the depth of relationship that is needed. They may be unwilling to challenge unhelpful thoughts or behaviours and so collude in keeping the client stuck; be overwhelmed by the client’s or their own feelings of loss or grief; may not have fully appreciated their own process around grief, loss or attachment and perhaps need to make more helpful or timely use of Supervision or their own therapy.
This was a comprehensive workshop and this space cannot do it justice. Thank you, Aileen, for an informative, collaborative and enlightening day which left those attending wanting more.