New Techniques of Grief Therapy

Bereavement and Beyond

Robert A. Neimeyer

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780815352020
• eBook ISBN: 9781351069106
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

New Techniques of Grief Therapy: Bereavement and Beyond expands on the mission of the previous two Techniques books, featuring innovative approaches to address the needs of those whose lives have been shadowed by loss—whether through bereavement, serious illness, the rupture of a relationship, or other complex or intangible losses, such as of an identity-defining career.

The book starts with several framing chapters by prominent theorists that provide a big- picture orientation to grief work and follows with a generous toolkit of creative therapeutic techniques described in concrete detail and anchored in illustrative case studies to convey their use in actual practice. New Techniques of Grief Therapy is an indispensable resource for professionals working in hospice, hospital, palliative care, and elder care settings; clinicians in broader health-care and mental health-care practices; executive coaches; and students in the field of grief therapy.

Part I
Framing the Work

1
Reconstructing the Continuing Bond

A Process Analysis of Grief Therapy¹

Robert A. Neimeyer and An Hooghe

DOI: 10.4324/9781351069120-2

Twenty-five years since publication of the pioneering work on mourners’ continuing bonds to the deceased (Klass, Silverman, & Nickman, 1996), contemporary bereavement theorists and practitioners have clearly embraced its relevance for grief therapy (Neimeyer, 2015b). But just how does attention to the relationship between the client and the deceased help direct the subtle give-and-take of the counseling process as it unfolds in the intimate crucible of therapeutic dialogue? Our intent in the present chapter is to address this question by closely examining an actual session of grief therapy conducted along meaning reconstruction lines (Neimeyer, 2001, 2015a). We will begin by sketching a few of the cardinal themes of this perspective before introducing the detailed case study that will scaffold the chapter.

Loss and the Reconstruction of Meaning

Viewed through a constructivist lens, a central process in grieving is the attempt to reaffirm or reconstruct a world of meaning that has been challenged by loss (Neimeyer, 2006a). This does not imply that all experiences of bereavement entail a search for meaning, however, as we need not search for that which was not lost in the first place. Thus, when an important figure in our lives dies what we deem to be an “appropriate” death, one that fits comfortably enough into the narrative we hold of how life is or should be, it may pose minimal challenges to the practical patterns, relational scaffolding and world assumptions that undergird our existence. But when that death is sudden, horrific, premature or violent, or deprives us of a central figure on whom our sense of identity and security depends, we may be launched into an agonizing search for meaning in the loss and in our lives in its aftermath. The result, when we are unable to find meaning in what has befallen us, can be a grief that is perturbing, preoccupying and prolonged, and perhaps even life-threatening (Prigerson et al., 2009).

To date, a great deal of evidence converges to support the outlines of this meaning reconstruction model (Neimeyer, 2019). For example, inability to make sense of the loss has been associated with intense grief symptomatology in families anticipating the death of a loved one in palliative care (Burke et al., 2015), bereaved young adults (Holland, Currier, & Neimeyer, 2006), parents who have lost children (Keesee, Currier, & Neimeyer, 2008; Lichtenthal, Currier, Neimeyer, & Keesee, 2010) and older widows and widowers, for whom it prospectively predicts difficult adjustment a full 18 to 48 months after the death (R. A. Coleman & Neimeyer, 2010). Moreover, a struggle to find meaning in loss has proven to be a potent mediator of the impact of suicide, homicide and fatal accident, where it accounts for nearly all the difference between these forms of violent death and death from natural causes (Currier, Holland, & Neimeyer, 2006; Rozalski, Holland, & Neimeyer, 2016). Conversely, the ability to find meaning in the loss prospectively predicts well-being and positive emotions over a period of four years (R. A. Coleman & Neimeyer, 2010) and moderates the impact of highly “central” or life-defining death events, substantially nullifying their deleterious impact (Bellet, Neimeyer, & Berman, 2016).

In light of the growing evidence base for the role of meaning making in bereavement, adaptation in its wake has been theorized to entail two forms of narrative activity (Neimeyer, 2019; Neimeyer & Thompson, 2014). The first of these is the need to process the event story of the death itself and its implications for our lives in its aftermath. Making sense of the event story is particularly important when the loss is horrific and tragic, calling for a trauma-informed approach to integrating the narrative of the dying (Perlman, Wortman, Feuer, Farber, & Rando, 2014; Rynearson & Salloum, 2021). The second involves an effort to access the back story of the relationship to the deceased, in order to resolve unfinished business and restore a measure of attachment security. Because this typically requires experientially vivid engagement with memories and images of the deceased, therapeutic work to reorganize the continuing bond requires an attachment-informed approach to grief therapy (Kosminsky & Jordan, 2016; Rubin, Malkinson, & Witztum, 2011). Either or both of these forms of narrative processing may be called for in a given case, giving rise to a great range of creative therapeutic techniques (Neimeyer, 2012b, 2016; Thompson & Neimeyer, 2014).

The Present Case

Inge and Erik were a Flemish couple in their 40s living in Belgium with their two children, ages 4 and 7, when they sought relationship therapy at Context, the Center for Marital and Family Therapy at the University Hospital in Leuven. Both confessed to An Hooghe, their therapist, that they had grown apart over the ten years of their relationship, a pattern linked to Inge’s intense engagement in her work as an international business consultant. Across eight sessions of earnest efforts in couple’s therapy, both spouses stated that they had increased their mutual understanding, felt closer, made behavioral changes in their lives to permit more time together and recommitted to their relationship. But in the course of exploring significant family relationships with each partner, Inge reported to An that she had lost her mother when she was 17 years old, a disclosure that was accompanied by an immense wave of sadness and tears. Of course, Erik knew this, but he had never met her mother, and Inge rarely spoke of her. Over the course of the sessions, all noticed that Inge’s grief for her mother remained a very sad and vulnerable place for her, one that continued to take her breath away tearfully each time the conversation of therapy touched on it. As the marital therapy came to a successful conclusion, Inge approached An with a request for additional individual sessions to work on her prolonged and preoccupying grief, feeling that it would be too difficult to do so with her husband present. Both partners readily consented to the plan, with the intention to then bring them back together and share the story once Inge herself had found words for a grief so deep and pervasive that it seemed to elude expression.

In the ten sessions of grief therapy that followed, Inge remained very “stuck” in her grief, nearly unable to access memories of her childhood or of her time with her mother. Witnessing this striking disconnection from her own history and Inge’s visible suffering with each mention of her mother’s death over 20 years before, An noted that “it was as if everything were put away in a very secure place, which made it possible for her to function in her job and daily life.” Working very slowly and with great caution, the two gradually began to access some memories of Inge’s mother and, as she became better able to “hold” them, invited Erik back in to share the story. It was at this point that Robert Neimeyer (Bob) visited Belgium to offer some days of professional training in grief therapy, opening the prospect of Inge having a single session of therapy with him to supplement An’s efforts, in view of Inge’s near-native proficiency in English. After discussing this possibility as a couple, Inge and Erik accepted the offer, choosing to have Inge meet with Bob individually but on camera, while Erik watched the session alongside An and 15 other therapists in another room, to relieve each of the partners of the immediate impulse to take care of or “rescue” the other. This then was the arrangement as Bob welcomed Inge and Erik, intentionally limiting the background provided him (learning only that she struggled with her grief following the death of her mother) so as to allow Inge to present the problem to him in her own terms, unconstrained by previous case conceptualization. By mutual agreement, Inge, Bob, Erik, An and the reflecting team of other therapists would then meet in a circle immediately afterward to share respectful questions about the therapy process before returning the couple to An’s care for additional processing of its implications. The text that follows represents a verbatim transcription of the filmed interview, interspersed with Bob’s first-person reflections on the work, which centered strongly on re-accessing and reorganizing Inge’s continuing bond with her mother. The chapter then concludes with a summary of the subsequent couple’s session, offering a window on the consultation’s impact.

The Loss of Balance

Therapist (T; speaking initially in Dutch): Inge, dank je wel nog eens [Thank you once again]. I’m eager to learn something of your experience, and I wonder if we might begin with just asking you what kind of hopes or expectations you might have about this hour, about how it might be useful for you?

Inge (I): Uhm, I don’t have a lot of expectations, and I’m not sure what to expect, but one thing that would help me is to find other ways of thinking about, uhm, thinking about [long silence] your place in the world among people, when there’s a change in configuration, like when you lose someone, how you come back into your balance.

T: Yeah, yeah, because the loss of another throws us off balance [gestures with arms and torso like a tightrope walker], and we find ourselves having a hard time finding our footing in the world again, in the sense of a solid place. And the loss that you’ve had, I understand, is the loss of your mother? [Client nods, and immediately struggles with tears.] And just with the mention of her name, the feeling rises in you. [Client begins to cry.] Yeah [gently]. So what is that feeling [gesturing with hand at the level of his torso, like a rising fountain], if you were to describe it in words that were even partially adequate to the experience… . What would we call that, the feeling that comes now?

I: Uhm (sigh) … Being overwhelmed. [T: Overwhelmed, yeah.] [Pause] And in a way reliving it a bit [crying].

T: Reliving it a bit. Reliving the experience of her dying?

I: [Nods yes, tearfully.]

T: So the overwhelming feeling is one of … ?

I: Yeah. Just, uhm, the loss, the loss of balance, loss of the whole way that you thought your universe was functioning. And to have that go, disappear and be changed, and feel that’s out of your control.

In response to my invitation to articulate her expectations about how this hour might be helpful to her—a bid to foster client “agency” in co-constructing the therapy (Coleman & Neimeyer, 2014)—Inge pauses and then, in a slightly self-distancing, second-person voice, seeks a way to make sense of her “place” in the world in the wake of loss, to recover a sense of “balance.” Hearing these vocally emphasized quality terms that begin to shape an implicit metaphor of her existential position (Neimeyer, 2009), I echo the significant phrasing, lightly “performing” the image to give it more embodied presence in the room. A simple mention of her loss evokes strong emotion and tears as we seek a preliminary verbal handle for the feeling and spontaneously elaborate Inge’s position in a universe that loses balance and coherence in light of her mother’s death.

The Center of the Universe

T: Yeah. It’s a deeply, deeply unwelcome change in the structure of the world, and you’re left trying to relearn that world and relearn yourself because both are changed in this experience… . What position did your mother have in this world, in this universe of your childhood and young adulthood?

I: I was 17 when she died. [T: 17.] And she’d been ill on and off for a long time. But when she died, it was still a surprise because we didn’t talk a lot of those things, and she was very much a pillar figure in our house. She was a very dominant person, but not in a bad way. But she was called “M...

Table of contents

• Cover
• Half Title
• Series
• Title
• Copyright
• Contents
• Preface
• How to Use This Book
• Series Foreword
• List of Contributors
• Part I Framing the Work
• Part II Evaluating Grief
• Part III Moving Through Bereavement
• Part IV Articulating Ambiguous Loss
• Part V Practicing Self-Care
• Part VI Fostering Compassion
• Part VII Working With Emotion
• Part VIII Utilizing Imagery
• Part IX Revising Personal Meaning
• Part X Reaffirming Attachment
• Part XI Dialoguing With the Deceased
• Part XII Validating Lives
• Part XIII Re-storying Loss
• Part XIV Facilitating Support
• Name Index
• Subject Index