The Upside of Loss: Helping Grieving Clients in Therapy By Richard B. Joelson, DSW on 2/28/23 - 2:39 PM

The funny thing about grief, aside from the fact that it lasts forever, is that it has a life of its own.

My wife died in September of 2021 after a three-year-long battle with cancer. She and I considered ourselves extremely fortunate that this happened in her eighth decade of life and not sooner, that she was minimally symptomatic and pain-free until the very end, and that the original six-month prognosis turned out to be three quality years. The love and support from family and friends throughout this period was, and still is, a major component of our, and later my, well-being. I believe the nature and quality of my own grief experience had a great deal to do with the quality of care that my loved ones and I were able to provide for my wife. My satisfaction with that care sustains me. That I have no regrets about her care means everything.

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I need no help in continually realizing how much I have lost after a glorious thirty-five-year love story. When I hear family, friends, and countless others describe how much my wife meant to them and their feelings about losing her, my own loss feels that much greater. Not surprisingly, those moments are emotionally mixed. When the sadness and sense of loss is intensified, it provides an opportunity to savor the gift of her presence in my life for all those wonderful years together. For me, that is grief at its best.

Of Magical Thinking

Joan Didion, in her book, The Year of Magical Thinking, spoke of her experience after the sudden death of her husband after 40 years of marriage. One of her reported observations is something that I have experienced countless times. The frequent wish to share information with a departed loved one is ongoing and serves as another reminder of the loss. Didion writes, “I could not count the times during the average day when something would come up that I needed to tell him. This impulse did not end with his death. What ended was the possibility of response.” For me, this form of verbal intimacy is one of the greatest losses of all. Most recently, this was manifested by the birth of our grandson, born four months after my wife died. He is the first child for our son and the first male grandchild after four granddaughters. Fortunately, my wife knew about the pregnancy, but not the gender. The impulse to discuss this great event with her occurs frequently, and probably always will.

A common fear among the bereaved — me included — is what I call “memory fading,” as well as other “fades,” like the sound of her voice and her laugh, and the way she looked and sounded upon hearing stunning news of any kind. Of course, pictures are wonderful, and videos are even better, but the details of the interactions of everyday life for over thirty-five years are sometimes difficult to retain.

J.W. Worden, in his excellent 1991 book, Grief Counseling & Grief Therapy, described mourning — the adaptation to loss — as involving four basic tasks:

  • To accept the reality of loss, which can be extremely difficult when it is sudden, unexpected, and tragic, like the deaths on 9/11
  • To work through the pain of grief, as opposed to denying the need to grieve
  • To adjust to an environment in which the deceased is missing
  • To emotionally relocate the deceased and move on with life

Worden’s four tasks suggest an action orientation that I have always found to be useful when working with grieving clients in my psychotherapy practice, as opposed to the more well-known stage or phase schema for bereavement which tend to imply passivity and a lack of action as the mourner passes along a continuum. Worden’s approach, which is more consistent with Freud’s concept of grief work, encourages activity and implies that the process can be influenced by outside intervention, such as a participating clinician.

Following the attacks on the World Trade Center on September 11, 2001, I conducted a bereavement group for eight widows. The group was scheduled to last 16 weeks, but they remained together for over three years. That is when they felt their grief work had advanced to the point where the group was no longer necessary, while recognizing that their grief was not over — because it never would be.

Clearly, bereavement is not a process that progresses in a sequential manner marked by a gradual and identifiable reduction in grief and other indications of a return to normalcy. In many cases, indicators of “progress” are not reassuringly evident. The mourner may appear to be getting worse as months go by, causing needless worry among friends and family. In fact, feeling “worse” is not necessarily a bad sign. It may be an indication that the painful work of grieving is proceeding as it unavoidably must, in fits and starts. The bereavement process may take weeks, months, or years. It is not a path to “recovery,” insofar as that means a return to pre-bereavement baselines. Instead, the process leads to the mourner’s increased ability to change, adapt, and alter his or her self-image and role to fit a new status.

Grief is Not a Disorder

Grief is sometimes seen as a disorder — like depression — and treated by some clinicians with medication only. This tends to cause grievers to believe that there is something the matter with them, something they must get over as quickly as possible. The potential self-esteem consequences of this belief are worrisome, especially when well-meaning others encourage “recovery” or “moving on” as essential.

When Emily, a 32-year-old mother of three whose husband was killed in the World Trade Center attacks came to see me three weeks later, she was already on anti-depressant medication and claimed to be feeling sick. The advice she was given by friends, family, and, unfortunately, her psychopharmacologist, was that she had to “wait for this to pass” and to “protect” her children, ages 10, 7, and 5, by minimizing the loss and acting “normal.” “You must try to stop feeling so sad” was the comment she recalled being most upsetting.

Worden’s tasks described earlier provided an excellent road map for the grief work ahead. She was receptive to the idea that grief was something you do, not something you have. She could influence the process rather than remain feeling passive, helpless, and anxious, and her grief was normal and necessary, not an illness from which she had to recover. My assessment of Emily’s mental status suggested that she was someone who was not likely to be retraumatized by interventive strategies designed to help her acknowledge and “handle” her feelings, as sometimes occurs with those suffering a loss, especially one so sudden and tragic. I also assessed the quality of her marital relationship to see if it was positive, ambivalent, or troubled, and to determine if specific interventions to address related issues might be in order. We normalized her grief and understood together that as an organic process, it needed to “breathe” and not be inhibited or minimized. We role-played instances where well-wishers offering unhelpful or hurtful advice needed a response from Emily. A self-described introvert, conflict-avoider, and people pleaser, Emily needed self-advocacy skills and “finding my voice” to help others help her.

My work with grieving clients like Emily has, not surprisingly, often triggered my own grief responses. It requires effort to stay fully with them and not be distracted by my own sense of sadness and loss. Work with Emily preceded the loss of my wife but working with her and many others certainly activated old memory networks regarding earlier losses in my life, like the death of my father when I was eight years old. My ability to be empathically attuned, I believe, has been significantly enhanced by my own past and ongoing grief journeys.

Looking Back, Moving Forward

Months before she died, my wife urged me to consider the possibility of a new romantic relationship after she was gone. She knew of my unwillingness to even consider such an idea based on two things: one, my high tolerance for independent living, and two, my belief that I had the love of my life for 35 years and could not imagine a second experience with a new “leading lady.” Thanks to a recent serendipitous encounter, I came to realize that perhaps another romantic adventure at this stage of my life was not entirely out of the question. I had conflicting feelings about the fact that this chance meeting — where the mutual attraction was immediately clear — occurred only two months after the death of my wife. Initially, I considered not acting on my desire for more contact. However, I also appreciated that I could not ask someone to wait until I achieved the arbitrary one-year milestone that widows and widowers are “supposed to” allow before it is socially acceptable to consider a new partner.

Like grief, the heart does not operate in accordance with the calendar. Thirteen months later, I am glad I seized the opportunity to explore a new relationship however earlier than expected —especially since this was never expected at all! The important insight for me is that mourning a lost love and embracing a new love were not at all incompatible. The new relationship has served to ease the transition from a memorable 35-year marriage to a new partnership that is similarly meaningful, valuable, and life-enhancing.

Questions for Thought and Discussion

What about this article resonated with you personally? Professionally?

How have you incorporated your own personal grief work into your practice with grieving clients?

What are some of the inner challenges you have when working with clients who have experienced loss?      

File under: The Art of Psychotherapy, Musings and Reflections