Grief from the (Flexible) Therapist’s Chair

I’ve had the opportunity to spend the last several days at he Evolution of Psychotherapy Conference in Anaheim, California. We are surrounded by upwards of 6,000 fellow therapists of all kinds- psychiatrists, psychologists, social workers (go my team!), clinical counselors, marriage and family therapists, and students and interns of all sorts. I think I have even spotted some of our illustrious speakers walking past our booth (I’m still hoping to spot Yalom strolling by).

I’ve also had the chance to hear some of the stories from those who have stopped to chat after seeing Your Path Through Grief on our backdrop. (Maybe they also read my t-shirt that says “Let’s talk about death.”) They’ve shared some of their losses and the impact those losses had, and some have shared how difficult it is to know what to say to a grieving client without causing more pain or creating a barrier rather than a therapeutic bond in the initial session.

I can’t say I am surprised to hear just how intuitive they are about the impact those experiences were, and their concern about being cautious with clients. We are all aware that our experience is not the client’s. So how do we go about meeting the client where they are, and being flexible in our technique to do the work that grief requires?

Wait- what did I just say? Yes, I meant that. Grief work is all about not being in a box of skills that work for our everyday clients. Grief requires that we:

  • Acknowledge where they are starting from. Hat may mean they need time to even speak the name of the loss. It might also mean that they really need you to use their loved one’s name repeatedly in session, so they know you get who they were, and they have the comfort of hearing that name spoken.
  • Expect to hear and support their experience of having their deceased loved one’s coming back to visit in some way. That is a perfectly common and normal event, and it is usually comforting to grievers. It may also make them more comfortable with you if you find a way to bring it up and normalize it, because you are, by default, the one who is going to tell them they are not “crazy”- they are simply experiencing the abnormal time following a death.
  • Allow them to revisit any services they attended or were part of- and to ventilate the parts that they found distressing or uncomfortable, or simply wrong for their loss.
  • Hear and absorb their memories of the death, or the aftermath. That can be hard if you are not someone who can listen to a parent describing visiting the tow yard to see the car their child died in, or the accident scene. It may seem more traumatic to you to incur that experience on oneself, but to someone who lost a loved one in a traumatic event where they were not allowed to see the body, those visits are really a means of making the death more real, and to feel like they were there with them in some way. Many grievers are told not to do the very things they needed to, and hold onto that in a way that complicates their grief process. It’s not for “closure” or “acceptance,” but it does help them to not feel that their loved one died without them much of the time.
  • Support the client as they talk through the dying process as they watched it if they were bedside. That also means knowing the language of death, and the dying process. That allows you to reframe terms like “death rattle” into Cheynes-Stokes respirations, the variable breath pattern and sound of the dying person no longer having an active swallow, so fluid that sits on the vocal chords makes a sometimes very loud noise. It can cause nightmares if the client is not aware that it in fact did not mean the dying person was gasping for air and “drowning.” It also means knowing enough about the subject to help the client understand that the medications being used were for comfort, and did not hasten the dying process. I can’t tell you how many times I have heard even the most knowledgeable people tell me that they caused their loved on to die prematurely because they allowed the use of morphine or some other medication. That frequently comes from too many Google searches, or upset friends and family saying less than helpful stuff after not having been there to understand what was really occurring.
  • Make space for the client to seek additional support in non-traditional places. Mediums, various readings from a variety of practitioners, traditions from their own culture or one they found that feels right for them. A holistic, flexible acceptance for the client seeking other means to connect with their deceased loved one, or to allow their spirit to leave or rest will create a much better therapeutic bond.

Not so very long ago we had only a few leaders in our field, and the early practitioners of psychotherapy tended to follow the same rigid dogma. Today, I am sitting amongst drums, energy mats, residential care featuring horses and ocean trips, and “integrated healing.” We are breaking out bit by bit. To do effective grief work the box you offer should include all of that and more. It will welcome your client and prepare you for where they may need you to go.