Psychotherapy and the Widowed Patient

E Mark Stern

• Publisher: Psychology Press
• Year: 2014
• Topic: Psychology
• eBook ISBN:
  9781317765790
• Subtopic: History & Theory in Psychology
• Index: Psychology

Coming at a time of renewed interest in the developmental changes of the life cycle, Psychotherapy and the Widowed Patient is a rich resource that examines the impact of a spouse's death on an individual's mental health. Psychiatrists and psychoanalysts address a wide range of issues concerning loss, grief, and bereavement, and provide practical and creative approaches for both widowed persons and the helping professionals charged with treating their grief. Chapters in this compassionate volume discuss the characteristics of individuals who are more likely to seek professional help in coping with grief, widowhood as a time of growth and development, the value of openness instead of denial in dealing with death, the grieving process in young widowed spouses, the similarities of widowhood to separation and divorce, the role of dependency in how well widowed patients develop emotionally, and the role of loyalty in the process of grief. The more clinical chapters examine strategies for carrying out experiential psychotherapy with widowed patients, rational-emotive therapy, grief therapy, the effects of new perspectives on spousal bereavement on clinical practice, and aspects of bereavement response to loss, with a timeframe for viewing psychotherapeutic intervention. A review of the psychological literature regarding widowhood completes this comprehensive new book.

When the Spouse Is Dead: The Alternative Approach of Experiential Psychotherapy

Alvin R. Mahrer
Terry M. Howard
Patricia A. Gervaize
Donald M. Boulet

Alvin R. Mahrer, PhD, is Professor of Psychology with the School of Psychology at the University of Ottawa. Terry M. Howard is in the doctoral program of the School of Psychology. Donald M. Boulet, PhD, is Director for the Centre for Psychological Services, University of Ottawa. Patricia A. Gervaize, PhD, is Associate Professor with the Department of Obstetrics and Gynecology of Ottawa Civic Hospital and the School of Medicine of the University of Ottawa. Address correspondence concerning this article to Alvin R. Mahrer, PhD, School of Psychology, University of Ottawa, Ottawa, Canada K1N 6N5.

SUMMARY. The purpose is (a) to show practitioners how to carry out experiential psychotherapy with patients whose spouses are dead, and (b) to defend the thesis that experiential psychotherapy is a viable alternative to approaches that comprise the field of bereavement counselling, grief therapy, mourning, death and dying.

There is a more or less established field of bereavement counseling, grief therapy, death and dying therapies. These therapies share a set of accepted truths, clinical axioms, assumptions and presumptions about (a) what their patients are like, the central features of these patients and the focus of therapeutic work; (b) the goals and optimal directions of change with these patients; and (c) the appropriate therapeutic methods and procedures, including the roles of the therapist and the helpful relationships with the patient. If you are going to work with someone whose spouse is dead, here is an established approach.

Experiential psychotherapy offers a distinctive alternative. We decline virtually all of the accepted truths, clinical axioms, assumptions and presumptions in the field of bereavement counseling, grief therapy, death and dying. Accordingly, our aim is to show practitioners how to carry out experiential psychotherapy with these patients, to invite practitioners to choose the experiential alternative, and to join us in declining the accepted truths and practices of the traditional approaches in this field.

THE FOUR STEPS IN EACH EXPERIENTIAL SESSION WITH PATIENTS WHOSE SPOUSES ARE DEAD

Experiential psychotherapy is based upon its own existential-humanistic theory of psychology and psychiatry (Mahrer, 1989a), and is a comprehensive, intense, powerful approach that offers the ready and willing patient an opportunity to undergo radical and profound personality and behavior change in each session (Mahrer, 1978, 1985, 1986, 1989b, 1989c, 1989d; Mahrer & Gervaize, 1986). It is also distinguished from such other experiential therapies as the experiential family therapy of Carl Whitaker based on the work of the early “Atlanta group” (Malone, Whitaker, Warkentin, & Felder, 1969; Whitaker & Malone, 1969), from the updated and revised experiential therapy of the current Atlanta group (Malone, Malone, Kuckleburg, Cox, Barnett, & Barstow, 1982a, 1982b, 1982c), from Gendlin’s experiential focusing therapy (1973, 1978) within a client-centered framework, the experiential family therapy of Kempler (1970) within a Gestalt framework, Kutzin’s (1970) experiential therapy integrating structured fantasy and communications theory, Friedman’s (1982) experiential therapy based upon Angyal, Rogers, and Gendlin, and from the other experiential psychotherapies.

The fundamental principle in our experiential psychotherapy is that each session offers the patient an opportunity to go through the same four steps. Patients whose spouses are dead go through the same four steps as all other patients. There are no special steps for patients that other approaches may label as bereavement or grief patients. We proceed through these four steps whether this is the initial session, the final session, or any intervening session whatsoever. There is no special intake or evaluation session (cf. Schwartz-Borden, 1986).

The office is relatively soundproofed. Chairs are large and comfortable, situated alongside each other a few feet apart. There is no smoking or drinking. Therapist’s and patient’s eyes are closed throughout the entire session which ends when both agree that the work is completed for this session, generally after an hour and a half to two hours or so.

What follows are the four steps in each session. These will then be further elaborated and contrasted with bereavement and grief therapies.

1. Attaining the Level of Strong Feeling and Accessing the Inner Experiencing

The purpose of the first step is to access an inner experiencing, to lift it closer to the surface so that it is sensed and felt. It does not matter whether this inner experiencing has anything to do with the spouse’s death. It can be any nature and content whatsoever. What is uppermost is the accessing of an inner experiencing, typically one that is rarely felt by the patient for it is generally alien, deeper, and essentially inaccessible.

The way to access an inner deeper experiencing is through the crucible of strong feeling. Accordingly, the overall direction of the first step is toward attaining a level of strong feeling, whether the route is direct or circuitous, whether it takes a short time or a long time.

Each session begins by showing the ready and willing patient how to express any feeling whatsoever that is immediately present, or how to focus attention on whatever feelinged attentional center may be uppermost right now. From these natural beginning places, we move in the general direction of strong feeling, whether we work with the same continuing feeling or feelinged attentional center, or whether we proceed through a series of subsequent feelings and feelinged attentional centers. The process is wholly open and flexible, and is determined fully by the patient’s readiness and willingness, as well as by whatever feelings and feelinged attentional centers occur next. Once we attain the level of strong feeling, an inner experiencing accesses, and the first step is completed.

2. Appreciating the Inner Experiencing

Whatever the nature and content of the accessed inner experiencing, the goal of the second step is “appreciate” this experiencing by (a) welcoming, receiving, and accepting it; and (b) lifting it out a bit, raising and opening it up, giving it some form and shape. The inner experiencing is thereby enabled to be a little closer and more present within the patient. Whatever its nature and content, whether it has anything to do with the spouse’s death, the inner experiencing is now appreciated, more welcomed and present.

3. Being the Inner Experiencing in Earlier Scenes

The goal of the third step is for the patient to undergo a radical and transformative disengagement from the ordinary personality and into the wholesale being of the inner experiencing. The opportunity and the challenge is to leave go of the very person the patient is, and to transform into the radically different person who is the inner experiencing, with its own distinctive thoughts and feelings, perceptions and outlook, personality and character, actions and behaviors.

The method is for the patient to be the inner experiencing within defined and explicit scenes from the past. These scenes and situations may have taken place at any time in the patient’s life, from a few months ago to many years ago, from adolescence or childhood or infancy. Now the patient is truly being the inner experiencing in earlier scenes, and this opens the way for the final step.

4. Being-Behavior Change in the Prospective Extratherapy World

The final step offers the patient the opportunity to be and behave as this new inner experiencing in the imminently future extratherapy world. The ultimate opportunity and challenge is for the patient to be and to behave as this new experiencing from now on, permanently, as a new personality. In any case, the final step provides the patient with a taste and sample of what it is like to be and to behave as this new experiencing in prospective scenes and situations in the imminent external world.

Patients whose spouses are dead are given the opportunity to go through these four steps in each experiential session, whether or not any of the content bears upon the spouse’s death directly or indirectly, or not at all.

SOME FUNDAMENTAL DIFFERENCES

The balance of the article shows practitioners how and why to undertake these four steps with patients whose spouses are dead, and essentially to illuminate some fundamental differences between the experiential approach and the field of bereavement counseling, grief therapy, mourning, death and dying. Our thesis is that the experiential approach is a distinctly viable and preferred alternative. The traditional field includes a body of accepted truths, “facts,” clinical axioms, assumptions and presumptions. The whole package is uniformly declined by the experiential approach. Accordingly, the experiential approach will be presented and contrasted with the traditional field in regard to (a) the central features of the patient and the focus of therapeutic work; (b) the goals and optimal directions of change; and (c) the therapeutic methods, and procedures, including the role of the therapist and desired relationships with the patient.

The Experiential Approach to the Central Features of the Patient and the Focus of Therapeutic Work

How do we arrive at some way of understanding this person in this session? How do we arrive at whatever is to be seen as the central features of this person, and the focus of therapeutic work in this session?

We begin each session with any feeling or feelinged attentional center that is present. It does not matter whether this is the initial session or any other session whatsoever. We begin with whatever feeling is right here in the patient, present right now, or we begin with whatever feelinged attentional center is front and center on the patient’s mind right now. It may be any feeling whatsoever. It may be any feelinged attentional center whatsoever. It may have some direct or indirect connection with the spouse’s death. It may have nothing to do with the spouse’s death. The patient is absolutely free to start with any feeling or feelinged attentional center at all.

Wherever we begin, there is complete freedom for the feeling to change to some other, and there is complete freedom for the attentional center to change to some other. The only important guideline is that the feeling gradually move in the direction of strong feeling.

The central feature and focus of work in this session is the inner experiencing that emerges when the patient attains the level of strong feeling. Once we arrive at a level of strong feeling, the therapist listens for the nature of the inner deeper experiencing that is accessed, that is present at this strong level of feeling. This inner deeper experiencing is the central feature of the patient and is the focus of all the work in this session.

Nothing else serves as the central feature of the patient. Nothing else serves as the focus of therapeutic work. All we can do is to grasp the nature of this precious inner deeper experiencing as faithfully as we can. We may grasp this inner deeper experiencing with words such as standing up for oneself, being tough and certain, being strong and defiant. Or we may grasp it as the experiencing of closeness and oneness, intimacy and bonding, being one with. These words point toward the nature of the inner deeper experiencing, and this experiencing constitutes the central feature of this patient as well as the focus of the therapeutic work in the balance of the session.

The inner deeper experiencing may or may not have any connection with the spouse’s death. When the patient reaches the level of strong feeling, the patient may be feeling or attending to some aspect connected to the spouse’s death, or the patient may be feeling and attending to something entirely unrelated. Likewise, the nature of the inner deeper experiencing may be connected with the spouse’s death, or it may have no connection whatsoever. We simply accept and use whatever inner, deeper experiencing is present when the feeling level is strong.

Even if the patient is attending to some aspect connected with the spouse’s death, all we prize is the nature of the accessed inner deeper experiencing. Accordingly, we have no list of experiencings that “these patients” are expected to have, no “theory” of “their psychodynamics” or inner personality processes. We do not hold that the spouse’s death is uppermost and that such patients have predefined kinds of feelings or symptoms or reactions or anything at all.

Within and across each session, there is wholesale flexibility for any experiencing, feeling, or feelinged attentional center. In each session, we begin with any feeling or feelinged attentional center. As we move toward the level of strong feeling, the initial feeling may continue or it may give way to some other feeling. Similarly, an initial attentional center may remain or it may be replaced with a progression of other feelinged attentional centers. In the same way, we accept and use whatever inner experiencing occurs at the level of strong feeling. Within each session there is wholesale flexibility until we arrive at whatever inner experiencing occurs at the level of strong feeling.

This same wholesale flexibility pertains to the next session, and to all subsequent sessions. Regardless of where we began or what was achieved in the prior session, the present one opens with any feeling or feelinged attentional center that is present, and we accept any progression of any feeling or feelinged attentional center on our way toward strong feeling. Once we attain the level of strong feeling, we accept any inner experiencing that occurs.

Declined Approaches to the Central Features of the Patient and the Focus of Therapeutic Work

The experiential approach declines a body of accepted truths, “facts,” clinical axioms, assumptions and presuppositions with regard to the central features of the patient and the focus of therapeutic work.

The patient is classified as falling in a given category with predefined characteristics of what patients in that category are like. The central features and focus of therapeutic work are already predefined and predetermined by the category into which the patient is placed. The patient is classified as a bereavement case, a widow, undergoing grief, coping with loss. Such a classification predefines the central features of the patient and the focus of therapeutic work. Once the patient is labeled as a widow or coping with grief, the therapist has a good idea of what the patient is like. The category includes a predefined description of the patient’s personality characteristics, symptoms, psychodynamics, the kinds of stresses, prognosis of treatment, present and future feelings and thoughts and problems. The category is powerful. Classify the patient as falling in the category and you have predefined what “these patients” are like. We decline the use of such classifications and categories.

Death of the spouse places high levels of “stress” on the patient. We decline the general truth that the death of the spouse is automatically a central feature in the patient’s world, and that it is automatically a high-stress life event. Most approaches, on the other hand, presume that the death of the spouse is something that releases a great deal of ‘stress’ on the patient (Barrett, 1979; Dohrenwend & Dohrenwend, 1974; Maddison & Viola, 1968; Parkes, 1972), and that this stress...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• The Widowed and the Widowed Patient: A Preface
• The Widow as Survivor and “Killer”
• On Inspiration
• Widowhood: Integrating Loss and Love
• When the Spouse Is Dead: The Alternative Approach of Experiential Psychotherapy
• Psychotherapist and Widower
• Separation, Widowhood, and Divorce
• The Loss Unit: Reflections on Widowhood
• Treating the Widowed Client with Rational-Emotive Therapy (RET)
• An Agenda for Treating Widowed Parents
• Widowhood: The Labor of Grief
• The Ties That Bind: Loyalty and Widowhood
• Widowhood as a Time for Growth and Development
• Whom God Has Joined
• My Granddaughters Cope with the Death of Their Father
• Therapists Raised by Widowed Fathers
• Treating the Bereaved Spouse: A Focus on the Loss Process, the Self and the Other
• The Construing Widow: Dislocation and Adaptation in Bereavement
• Object Loss and Pathological Consequence: A Study in the Psychological Treatment of Loss and Self-Injury
• The Fullness of Emptiness