Complicated Grief, Attachment, and Art Therapy

Theory, Treatment, and 14 Ready-to-Use Protocols

Briana MacWilliam

• Publisher: Jessica Kingsley Publishers
• Year: 2017
• Print ISBN: 9781785927386
• eBook ISBN: 9781784504588
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

This wide-ranging book on art therapy and grief provides everything an art therapist needs to feel confident in creating an effective treatment plan. It features fourteen clear-cut protocols, outlining 4-8 week curriculums for working with Complicated Grief, and explains the theory which informs the practice, including popular and evolving models such as Attachment Theory, Mindfulness, Dialectical Behavioral Therapy (DBT) and Art Therapy Relational Neuroscience (ATR-N).

Suitable for a variety of settings and clinical populations, the book breaks through the analytical jargon of the field and provides first-person narratives of art therapists exploring their own experiences of grief and client case studies.

PART I

Theory

1

The Language of Grief

When There Are No Words

Briana MacWilliam

What you never get over

Many times, I have heard the expression, “Some things you never get over, you just learn to carry them.” It’s a phrase that rings both true and false for me. Yes, old patterns of relating affect the ways we interact with new people. And yes, some wounds cut so deep we are left with scarring. But there is a difference between climbing over something and/or dragging it behind you, and stopping to cut it up into itty-bitty pieces, cook it over a campfire and then eat it, so you can keep going, unencumbered. Sitting down to write this book, I found myself banging my head against the wall, trying to take a definitive position on whether or not there are some losses you just can’t get over. Ultimately, the stand I decided to take is this: I don’t know.

I don’t know if grief is something a person will ever be rid of, or if it is something he or she will simply learn to carry. Or if it is something you think you’ve gotten over, and then it shows up again at your back door. The truth is, no one else can tell you either. Only you can answer that question for yourself. I can tell you from my own experience and the experiences of others, loss is something that will never go away.

And in that vein, here’s another quote for you, “Attachment is the root of all suffering.” I saw this as I was happily researching articles on attachment theory, looking for clinical support for this book. It stopped me in my tracks. There I was, with the aim of offering hope to grievers and clinicians alike, and Buddha had to throw a wrench in the works. At first, I took the meme as a personal criticism; “You’re steering people towards suffering,” it told me. But then I realized it was a thumbs up that I was headed in the right direction. After all, how can we overcome suffering—or learn to carry it, or cut it up into itty-bitty pieces—if we are unwilling to address it?

As an art therapist, I have been largely trained in the psychoanalytic tradition, which, in its modern configuration, is a humanistic clustering of theories aimed at examining the machinations of our biological drives, the ego and its relationship to early attachment “objects,” and the development of a self-identity. While analysis has been criticized for being a horse of a different color, with no unifying vernacular or streamlined modus operandi (unlike behavioral sciences, which are often based on a single and uniformed model), I would argue its strength lies in this varied approach. Examining psychic phenomena—such as the experience of grief—from within numerous frameworks allows us to see alternate patterns and transfer our point of view, according to the needs of the individual (Pine, 1990).

But one need not accrue the student loan debt that I have to grasp the common thread throughout all of these theories, which is this: relationships are important. Chances are, you already knew that (because everybody knows that) but how they are important, and in what way for each and every individual, slips into a gray area that has kept many an analyst well fed and living on the Upper West Side (at least, in New York City). It is not my intention with this book to paint a black and white picture, or to suggest formulaic solutions, but to illuminate just how foggy it all is, and offer a small but steady nightlight.

The title of this chapter, “When there are no words,” alludes to an experience of loss that shakes us to our very core. From our earliest beginnings, we form a sense of self through what are called “identifications,” which is a fancy word for saying, “in relationship to others” (or more specifically, our perception of others). As infants, we are prompted to respond to a collection of sounds, and eventually learn that these sounds are called “words.” The first word a child is encouraged to learn is his or her name, and hot on its heels, the use of a first person pronoun: “I,” “me,” “mine,” “myself,” etc. A mastery of these words allows us to think abstractly and thus identify with this concept of “self” in relationship to others (both animate and inanimate objects). Thus, we think we know who we are based on our affiliations and the things we own (literally and figuratively). This is when the ego—our thinking self—assumes its throne.

My last name, MacWilliam, is Scottish and it means, “son of William.” The name, which has lasted for generation upon generation, exemplifies this defining of one’s self in relation to (or in belonging to) another person. But what happens if we lose that person? What happens if I assume someone else’s last name? What meaning does a name have then? What meaning does the “I” have, if I no longer have an identification to tell me? Who am “I” now?

Perhaps, I am without words. Without a name. But I still am. And I have experienced a shift in self-consciousness: I am not my thoughts, but my awareness of them. Albert Einstein referred to the “illusory sense of self” as an “optical illusion of consciousness.” Spiritualist Eckhart Tolle assures us, however, “The recognition of illusion is also its ending. In seeing who you are not, the reality of who you are emerges by itself” (2005, p.28). I am not suggesting the only way to be your authentic self is to leave all your loved ones behind and live in isolation for the rest of your life. I am suggesting that the illusion grief creates—a feeling as if you cannot go on, or your life is irreparably damaged—is one that prevents you from inhabiting a more whole sense of self. It’s true, you may never be the same; you might find ways to grow! You might also crash around butting up against whatever external people, places, and things help you recreate that illusion—until it dissolves again. And it will. Because, as I said before, loss is here to stay.

Six myths about grief

At a national conference for writers, I attended a workshop in which a presenter posed the question, “What is it about love that we can’t get enough of?”

A woman in the audience raised her hand and said, “Love heals.”

Immediately, I thought, “Why isn’t that a bumper sticker?” Then my thoughts circled around the experience of grief—of love lost; a void that is not always felt in the physical sense, but in the absence of spirit. Sometimes loneliest of all when the lost love object is standing right next to you, a living reminder of what once was. “Love heals” is not a bumper sticker because when we think about love we cannot help but think about the pain the loss of it causes, and who wants to be reminded of that at every red light?

As a society, we do not know how to talk about or handle our grief. And this affects all aspects of life, even the most trivial. To cope, we develop myths about the appropriate ways to handle grief. There are many myths out there; some may be specific to an individual’s family dynamic, while others might be reflective of cultural values, or some combination of the two. John W. James and Russell Friedman, founders of The Grief Recovery Institute, identify six most commonly held myths about grief in the Western world, and the negative impact they have on the bereavement process. In their book, The Grief Recovery Handbook, James and Friedman (2009) explore several scenarios to illustrate this point. Here are a few common phrases associated with each myth.

1.Don’t feel bad. “Pull yourself together.”

2.Replace the loss. “Let’s go to the pet store tomorrow. I’ll buy you a new puppy.”

3.Grieve alone. “She just needs her space. She’ll get over it.”

4.Just give it time. “Time heals all wounds.”

5.Be strong for others. “Gotta keep a stiff upper lip for your mother and your sister.”

6.Keep busy. “If you wallow in here, you’ll never get over it. Get back out there. Find something to do.”

The problem with each of these myths is that they involve a form of repression and disregard of painful feelings that otherwise become stuck in the body, which can lead to significant diagnoses, such as anxiety and depression. This might also leave us feeling deeply disconnected from our inner life and vitality, resulting in a feeling of numbness, emptiness, and purposelessness. While it may be contrary to popular belief, I suggest the following instead:

1.Feel as bad as you do.

2.Don’t replace the loss.

3.Find someone who shares your pain.

4.Take all the time you need to acknowledge the loss and take stock of its meaning.

5.Let others take care of themselves and/or know your limits.

6.Don’t burn out on distractions.

Grief is the normal and natural reaction to loss of any kind, though we have been socialized to believe that these feelings are unattractive and disruptive to others. More than that, to be willing to grieve properly is to be willing to feel pain. The irony is that in an avoidance of pain, we only compound it. So why do we do it?

Somewhere along the line, these patterns of avoidance served a protective function. Through various interactions with his parents, a child learns certain thoughts and feelings are unacceptable and should be eliminated. Through the upheavals of grief, those repressed creative parts of the self are unearthed, offering an opportunity to finally express their contents, in order to become a whole person. An understanding of the relationship between creativity and paradox helps illuminate this process. This is explored in more depth in the body of this text.

The nature of unfinished business: A bio–psycho–social–spiritual perspective

Life is full of losses. Some might be “little losses,” as Kübler-Ross (1969) described them, while others make your whole life feel like the Titanic. And loss can take on many forms, such as the death of a loved one, a major transition, a romantic heartbreak, divorce, loss of a job, estrangement from a family member, loss of a friend, death of a pet, and so on. One might assume the nature of the loss defines the depth of your grief, and recent studies regarding violent death would support that assumption (see Chapter 3). But why might a mourner suffering the loss of a long-anticipated death of a family member caused by a slow-moving cancer display complicated grief symptoms, while the mourner of a violent and deadly attack on her spouse is able to pick herself up and move on after a “normal” period of grief?

It is the thesis of this text that the underlying mechanisms of grief are uniquely related to our earliest attachment models. Thus, often it is the nature of your unfinished business that defines the despair, qualifying each individual’s grief as a distinctive experience, one that cannot be neatly tucked into specific stages or lumped into a population of mourners with a special type of loss.

James and Friedman (2009) describe grief as “the conflicting feelings caused by the end of or change in a familiar pattern of behavior” (p.3). Unfinished business can be thought of as “unfinished emotions attached to a living person with whom you have a less than fulfilling relationship” (p.9). If grief is like reaching out for someone who has always been there, and they are no longer there, then unfinished business is like reaching out for someone who has never been there for you, and still isn’t—be he dead or alive.

To begin, let us examine four dimensions of experience including the physical, mental and emotional, social, and spiritual realms. Please keep in mind, these dimensions are inextricably intertwined, but sometimes it helps to consider the color of each woven thread in its own right when examining the larger tapestry.

What happens to us biologically when we grieve?

In its earliest forms, loss was sensed before it was articulated, defined by those awful moments of unbearable hunger, before your mother was able to feed and soothe you. It was also inevitably quelled by her smiling, cooing and caressing embrace, which assured you all was well with the world. In the present, loss rips open those pangs of our initial blissful fantasies and violent deprivations, shining a light on the nuances of those original attachment and bonding dynamics. It is a cell memory—as is the lost object of our affections—a part of our very bodily existence.

For example, according to neuro-psychiatrist Dr. Amen (2007), there are four phases of romantic attachment—attraction, infatuation, commitment, and detachment—each phase with its own chemical trigger. When we love someone, eventually, he will become imbedded in the limbic part of our brains (his smell, the touch of his skin, the sound of his voice, the beat of his heart, etc.). When we cannot interact with our love object as we are used to, that part of the brain becomes inflamed, looking for him. This inflammation is associated with...

Table of contents

• Cover
• Title Page
• Contents
• Introduction
• Part I. Theory
• Part II. Self-Studies
• Part III. Applications
• Contributors
• Subject Index
• Author Index
• Plates
• Join our mailing list
• Copyright
• Of Related Interest