Category: Grief/Loss

A Therapist Uses Her Grief as a Resource for Working with Trauma

Posted on by Psychotherapy.net Team

A Place of Emotional Safety

My Mom recently posted photos on a social media site of birthday flowers that my and my sister’s family sent this year, along with others from years past. One of the photos showed flowers sitting in my grandparent’s kitchen.

Seeing the yellow cabinets and green tiles again brought back memories of cooking and baking with my grandmother in that kitchen. I can no longer smell the warm, sweet, and all-encompassing aromas that wafted effortlessly through their home but, as I remember them fondly, a sense of calm washes over me. My grandparents’ home was a safe place for me, where my creativity reined. When I was a young adult, my grandfather reminded me that I called their house “the happy place” when I was little. That description still fits for me today, though I can never revisit that place and time again like it was in my mom’s photo. After my last grandparent’s death, their house was sold to another family.

In the wee hours of this morning, I revisited that kitchen in the small interstice between sleeping and waking, simultaneously sensing the welcomed echo from my Mom’s flowers post and an invading sadness, tinged by a dull ache of homesickness from living so far from my family of origin and missing those who have died (several anniversaries of which have just recently passed). When the alarm on my smartphone sounded, I hit the snooze button to remain in the tenderness of the memory of that time where everyone still lived and gathered in that happy place, if only for a few more minutes.

The tinge of sadness, grief, and disenfranchised grief that grew as my consciousness expanded through the end of my intentionally prolonged dream reminds me that that place, as it was, and that time, when I was carefree and loved ones lived on, can no longer exist in my current reality.

The Privilege of a Happy Childhood

As I write this, I am aware of the privilege I carry to having had loving family members and safe places to rest my head, with food on the table every day and dessert in the oven on some of those days. That is not the case for many of my therapy clients, the majority of whom have experienced multiple forms of abuse embedded within precarious living situations that stagger fine lines between poverty and unintended negligence. Their grief, embedded within traumatic life events, is permeated by a kind of disenfranchisement that holds an invisible but unyielding grasp on their wellbeing and potential to positively evolve.

If grief could be described as ice cream, I would say it is quite like vanilla, a standard flavor, the most standard flavor. Everyone will eventually be served a scoop alongside some other more desirable option, whether they ask for it or not. Disenfranchised traumatic grief, then, would be like ribbons of lemon sorbet being folded into the mix with filaments of tart lemon zest that are neither easily seen (recognized) nor able to be dissociated from the rest of the scoop. The sting of the tartness sharpens the senses as one eats the part of the dessert, they neither ordered nor wanted in the first place but couldn’t push away once it was in front of them, either.

Several of my past and present child clients live in care situations outside of the homes occupied by their families of origin. They did not choose to be born; they did not choose to be neglected or abused; and they also did not choose to be removed from their families of origin, which represents another form of grief for them, though their circumstances did not promote healthy wellbeing or allow for a normal course of development. Often, their ambivalence oscillates between longing for the happy days they lived with their loved ones, which may have been few and far between, and wishing for something that never existed for them, in a mother that held them, made them feel wanted and loved or in a father that fixed boo-boos rather than creating them.

However, holding on to that place in my memory serves as a resource when I’m feeling down, discouraged, or otherwise off balance.

Memory as Resource

As Easter is nigh, revisiting my grandparents’ kitchen reminds me of dying eggs, baking cookies, and blending homemade orange slushies at the countertop with my grandmother. The sliding glass door from the kitchen opened to a small wooden porch at the back of the house. On that porch, I remember rubbing “motion” (my word for “lotion,” which was sunscreen) generously and gingerly on my grandfather’s head before he took me on the riding mower to cut the grass around the yard and over the hills behind their house.

At every turn past a small pompom tree that grew in the front yard, I would pull off a budding white flower or a leaf and squeal in delight as I put it on the hood of the riding mower and watched it shake off to the side with the vibration of the motor. I would usually finish the ride asleep on my grandfather’s lap, soaking in the sun from a warm summer’s day, not feeling a care in the world.

My grandmother’s death preceded my grandfather’s by 11 years. After my grandfather died, a young couple bought their house and land and made changes and new additions. Some changes were voluntary, like repainting the kitchen and rebuilding a bigger, sturdier deck onto the back of the house as an outdoor extension to the kitchen in summer months. Some changes were involuntary, but necessary, like removing the vestiges of trees that had died, which opened the landscape to reveal different views of the house and land.

My family has remained in contact with the new family in the house, and my mom has been on a walk-through tour of the updates and renovations they have made to the over-100-year-old house that she grew up in. I, however, do not believe I will ever be able to walk through it again, not because I wouldn’t be invited, but because I am afraid that it will change my capacity to continue to hold my happy place in my mind and heart.

As an expat living thousands of miles away, I count on my happy memories as resources to wash away the vanilla- and lemon-tinged grief that shows up on the dessert plate of my current existence, unwanted and unexpected, across the oceans and continents that divide me from my family back home. These memories, and the soul-nurturing feelings I can still feel upon revisiting this place and these people in my dreams, provide palate-cleansing relief to the sharp contrast of my therapeutic work with traumatized individuals and families.

So, in that short interstice between the still-sort-of-sleeping and not-quite-waking early hours of the morning, when a visit to my grandparents’ kitchen is ever-so-real and still possible, hitting the snooze button becomes a worthwhile endeavor, if only to hang on to a place and a time that does not exist anymore, except in my mind.

Addressing Countertransference in Grief Counseling

Posted on by Psychotherapy.net Team

Jordan’s Angry Grief

Jordan walked into my office, smiled, and sat down in the chair across from me. Then she burst into tears. She sobbed uncontrollably for about two minutes, but it felt like hours. Ripping tissues from the box on the small table in front of her, she seemed intent, perhaps aggressively so, on showing me just how much she was suffering. When she finally looked at me, her face was blotchy, her nose was still running, and she hiccuped with the last of her sobs. “I’ve been waiting for days to be able to do this,” she said.

I asked her if she could tell me what she was so upset about. “You know!” she said, “we’ve talked about it so much. I’m still mourning my dad’s passing.”

Jordan was right. We had talked about her father’s illness and death many times in the course of our work together. But I found myself wondering if our talking was doing any good. Jordan’s father had died when she was in her mid-twenties. She was now in her early thirties. There was no question that his death had been painful and perhaps even traumatic for Jordan, but it seemed to me that it sometimes became more significant when Jordan needed to avoid dealing with a present-day difficulty. Further, I found myself thinking — with some guilt for even having the thought — that Jordan became particularly distressed about having lost her father when she felt criticized, whether at work or by someone with whom she was in a relationship, for instance, her mother, sister, or girlfriend.

As these thoughts passed through my mind, I asked myself, not for the first time since I’d begun working with Jordan, what was the matter with me? What kind of therapist was I that I couldn’t feel sympathy for a client who was so clearly suffering? I’m not normally so hard-hearted, so as I listened to her sobs and murmured sympathetic words, I wondered how to explain what was making it so hard to empathize.

As a psychotherapist, I recognize that my reactions to clients are based on a complex combination of factors, including their personalities, psychodynamics, personal styles, and histories — both mine and theirs. The interaction between who I am and who they are, what I have experienced and what they have experienced, and what we both expect from and see in our relationships can create a fascinating, complicated, and often confusing experience for both me and the client. The image I find most helpful when I’m thinking about this co-created experience is Winnicott’s concept of “the squiggle.”1

Winnicott worked for a time with young children, and during that time he devised a game that he called “the squiggle.” He used it to explain to therapists how we and our clients co-create an experience that has part of each of us in it but is not created or owned by either of us. In this game the therapist and the child each have a pen or a pencil, and they have a piece of paper between them. The child makes a mark on the paper, and the therapist makes a mark connecting to the child’s mark. Taking turns, they gradually make a design over the entire paper. It’s a design that they create together. Winnicott suggested that this is what happens in therapy.

In the room and in our work, Jordan and I were not yet able to talk about — or even formulate for ourselves — the ways that we were co-creating an experience that in some ways replicated old experiences, and in some ways represented new possibilities for us both. My job was to step back enough from what we were creating to be able to be curious about it. That curiosity, as the relational psychoanalyst Stephen Mitchell suggested in much of his writing, is a huge part of what makes therapy therapeutic.2

Changing the metaphor, Mitchell likened therapy to a dance. He suggests that a therapist’s job is to stop every so often, and ask “Why are we dancing to this music? And why this step?”

Instead of asking myself what the matter with me was — or, as I might also have done, what was the matter with Jordan — my job was to ask why Jordan and I were engaged in this particular relational interaction; this particular dance step, so to speak. But when you have a visceral reaction to someone, as I was having to Jordan’s pain, it’s hard to take that step back. It’s hard to ask those questions, and harder to get a reasonable response from yourself.

Magda’s Quiet Pain

As I was struggling to understand my powerful reaction to Jordan, Magda, a client of mine in her fifties, was grieving and trying to put her life back together after her husband died of a massive heart attack. I remember how she had walked into my office and started to cry. Unlike Jordan, Magda was embarrassed about crying and quickly got her tears under control. She smiled and said, “I don’t cry anywhere else but here. You keep encouraging me to let myself cry, so I do, with you. But I’m not sure what the point is.”

My reaction to Magda was very different from my reaction to Jordan. It wasn’t simply that I felt more sympathy toward Magda than Jordan. I felt something angry or aggressive in Jordan’s pain, almost as if she was trying to push it onto or into me, and I wanted to ward it off. Magda, on the other hand, was careful with what she brought into my office and gave to me to hold. With her, I had more of an impulse to let her know that I could handle her sadness, and that I thought she would find it helpful to share it rather than keep it inside her.

In other words, I wanted to stop Jordan’s outburst and I wanted to encourage Magda to allow her emotions into the room.

Among my psychodynamically-oriented colleagues, there is a recognition that our responses to our clients contain helpful information about them as well as about us. What did my reactions have to tell me that could help me work differently with each of them?

Many clinicians suggest the use of diagnoses to help clarify what techniques are most useful with what clients. While I agree that an assessment of a client’s personality structure and psychodynamics can help pinpoint important factors that will influence their ability to respond to one sort of intervention over another, I also think it’s important to remember that assessments of clients can — and should — change over time. As a relationship with a client deepens as we get to know them and, conversely, they get to know us, some of the dynamics that may initially seem paramount turn out to be part of a temporary self-protection or façade that kept other things out of our awareness.

Further, diagnosis may capture our own hostility or negativity about a client. For instance, I found myself diagnosing Jordan as having a personality disorder, but when I questioned myself about this diagnosis, I realized it was a way of giving myself permission to keep my distance from her. The most obvious truth was that because of my own personality structure and dynamics, I was more comfortable with Magda’s sadness than with Jordan’s angry grief.

Dueling Countertransference

But there was, of course, more going on. Interestingly, I identified with the losses both women were facing. Like Jordan, I was mourning my father, who had died sometime before her father died. Our relationships with our fathers were quite different, but the sense of loss had many parallels. On the other hand, Jordan told me that she had always been “daddy’s little girl,” and that she didn’t think she could live without his constant praise and reinforcement that she was special. My relationship with my own father had been different, and I asked myself if I was envious of the special connection Jordan kept talking about.

As I opened myself up to the possibility that some of my reaction to Jordan was related to envy, I began to hear some of her words and view her actions differently. I began to wonder if Jordan unconsciously wanted me — or someone I represented — to feel envious of her relationship with her father. And if so, why? Was she angry at, or hurt by that other person? Did she need that reaction to get revenge on them? Or did she need to see their (my) envy to feel special? Was there something she had not internalized about the special relationship? Or was the relationship really not so special after all?

For quite a while I didn’t say anything about any of my thoughts to Jordan. As I was letting these ideas begin to gel, I was also working with Magda and exploring some of my countertransference reactions to her. While it’s easy to coast with positive feelings about a client, it can also be useful to try to understand what makes that person so much easier for us than someone else. I asked myself why I was so much more empathic to Magda’s quiet grieving than to Jordan’s loud, almost aggressive pain. There was the fact that it fit better with my own personality structure, but was there more to it?

I tried to put into words for myself what I admired about Magda’s way of expressing her feelings, and the words that immediately came to my mind were “elegant, self-contained, quiet dignity.” I realized that there were several personal connections in my life to those words, and that my countertransference to Magda also had something to do with my relationship with my own father. But as I was thinking more about some of these issues, I was also reading more about grief, and I realized that perhaps even more than the most obvious relational dynamics that were emerging in the work with each woman was the question of each of our relationship to grief itself.

I have always found the idea of stages of grief simultaneously useful and disturbing. On the one hand, it can be useful to know that some of the difficult emotions that emerge after a loss are a normal part of a process, and that many of them will gradually diminish as the process moves forward. On the other hand, I have never known anyone who goes through a neatly organized process of grieving that follows a particular outline. Of course, many of the current experts on grieving point this out as well. But once I began to add the idea of grieving to the “squiggles” that were emerging in my work with each client, our discussions took on more shape.

Making Space in Therapy for Pain

I began to gently explore with both Magda and Jordan some of the complexities not only of their relationships with the people they were mourning, but also with their respective feelings of loss. Not surprisingly, Jordan reacted angrily, telling me that I was trying to push her through the stages of grief, not letting her manage them on her own time. She was surprised when I replied that she might be right. “I’m not really sure what stage you’re in right now,” I said. “Can you tell me?”

Jordan turned out to be well-read in grief literature. “I think I’m in denial,” she said more quietly than usual. “I don’t want it to be true.” It turned out that Jordan had been angrily fighting the feeling of sadness, despite all the tears and sobbing.

Magda, too, had been fighting her feelings of grief. “If I don’t cry,” she said, “I think I won’t feel it. But when I come into your office, I get hit with all those feelings.”

“Is that a good or bad thing?” I asked.

“Probably good,” she said. “I think I need to let myself feel them.”

Listening to both women talk in very different ways about their styles of mourning made me realize that an important part of my countertransference had been about my own ways of dealing with grief. According to some grief specialists, the hardest thing for most of us is to make emotional space for grief, and yet, making space for it is the only way to let ourselves move forward. As many of these specialists tell us, making space for grief allows us to make room to grow and to live, even with loss. Paying attention to my countertransference reactions to each of these very different clients’ grieving styles allowed all of us to find a new way to make space for this painful but unavoidable emotion. And making space allowed for growth. Jordan and I continued to struggle with many distinct aspects of our relationship, while Magda and I felt like a much more comfortable fit. But as we made space for the pain in our different ways, Jordan and I found moments of connection, while Magda and I found moments of difference. And all of us grew in a variety of interesting and often different ways.

References

1 Winnicott, D.W. (1989) “The Squiggle Game.” In Psychoanalytic Explorations, Routledge.

2 Mitchell, S. (1995). Hope and Dread in Psychoanalysis. Basic Books, Inc.

Psychotherapy and Multiple Sclerosis: Behind The Mask of Joy

Posted on by Psychotherapy.net Team

Marion was the last of seven children in her family who grew up in a rural part of Maine. Family and schoolmates formed her social world, and she delighted in the freedom, adventure, and playfulness of her childhood. She loved boating, fishing, bike riding, star gazing, and silent walks in the woods. Marion spoke lovingly of her family, their home, and the natural beauty and peace where they lived. As a secure and robust and cheerful child, Marion had earned the nickname “Joy.”

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Marion completed high school and briefly worked different jobs until receiving a diagnosis of Multiple Sclerosis and experiencing a gradual diminishment of her physical capabilities. She grieved over the loss of her dreams of marriage and a family of her own through which she might show and teach her children the many things she had learned and loved. The dreadful progressive disease had eroded many of her hopes and dreams and abilities, as she became increasingly dependent on others for all daily care and mobility.

The Burden of Multiple Sclerosis on Joy

When I began meeting with her for supportive psychotherapy at the nursing facility where she lived, Marion was limited to moving her neck and one arm. While she could speak, Marion experienced mild cognitive deficits, which to a degree further increased her dependence. Over time she lost contact with her siblings, who were older, and who had either died or had health problems of their own.

As in childhood, Marion continued to be known to family, friends, and both the residents and staff of the nursing facility by her childhood nickname due to her usually cheery outlook. Sustaining a public image of cheerfulness allowed her to retain a central component of her personality, and to preserve a partial degree of control in her life.

As the burden of life’s troubles weighed more heavily on “Joy,” which began as an appropriate nickname, it gradually came to reflect a mask over her sorrow more than an expression of her native temperament.

Everyone at the nursing facility knew her simply as Joy. They believed her to be genuinely joyful because she would always greet others with an almost exaggerated cheerfulness and claims of feeling happy. “Hi Joy, how are you doing today?” would be cheerfully met with “I’m great, super, I’m good.” Some staff persons would marvel at her upbeat demeanor, despite her debilitating disease.

The nursing aides would use a mechanical lift to move her from bed to a wheeled recliner, and then I would wheel her to the facility library where we would meet for psychotherapy. On the way to the library, passing staff would smile and greet Joy and ask how she was doing, and she would respond by stating, “I’m fantastic, terrific!”

But when the library door closed behind us, Marion would cry or rage as she shared her feelings about her predicament and her losses. “I need you to know how I feel inside, but I don’t want the others to know,” she desperately explained.

Finding Grace in Grieving Through Psychotherapy

Marion felt so little control over her life circumstances, over her body, and over her privacy. It offered her a bit of control, though, to publicly maintain her lifelong persona as someone happily delighting in life. At the end of therapy sessions, she would ask to pause so it might not look like she’d been weeping, and so she might regain her composure. Then, during the ride back to her room, she would again sing out her cheerful assurances to others that she felt “wonderful.”

Marion got along nicely with some of the nursing aides who cared for her, yet she would squabble with some of the others. One day the aide with whom she sometimes quarreled asked me, “Why does she like the others, and not us?” In our next session, I offered Marion feedback about the observations and concerns of her caregivers, and she was willing to explore the matter.

“What do you do differently with the aides that you get along with?” I asked. “Well, I give them compliments,” she answered. Maybe you could experiment, I suggested, and try giving compliments rather than criticisms to the other aides. Within a few days, Marion and all her aides were pleasantly working together. “I guess they’re like me; you like someone more when they’re nice to you,” she said.

In retrospect, that particular session, and our psychotherapy in general, provided Marion with the opportunity to verbalize and learn from her emotional reactions to the situation. Adjustment to a disability condition is always a complicated and painful process.

For Marion, her M.S. had been slowly progressing over decades. She felt some resentment towards others who could walk, whom she thought might take their good luck for granted. At moments, she felt cheated by her illness.

Generally, the process of adaptation includes grieving the losses that result from an illness or injury. During therapy with Marion, we focused on her personal strengths: her resilience, her humor, her motivation to keep trying without giving up. We also repeatedly talked through her feelings of loss and grief, while highlighting the truly exciting and delightful experiences she had enjoyed as a child. We focused on the meaningful ways that she strove to be herself, even under such difficult circumstances.

Marion felt she had a supportive alliance through psychotherapy, a relationship that helped her to cope in her own ways, and that allowed room for the full range of her emotions.

Final Questions for Thought and Discussion

What was your reaction to the author’s work with Marion?

How might you have worked similarly or differently with her?

What challenges have you experienced working with physically challenged clients?

The Upside of Loss: Helping Grieving Clients in Therapy

Posted on by Psychotherapy.net Team

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. 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?

The Gift of Presence in Grief Counseling: A Path Forward

Posted on by Psychotherapy.net Team

Grief is an inevitable part of life, one that I personally believe to be among the greatest sufferings of humankind. Yet, while often a source of deep pain, grief can also be a source of great love. That reluctance to let go of someone we cherished is the last act of affection we give to those who have passed.

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Grief is a process of many intertwining emotions. Shock, anger, depression, and confusion may surface, to name just a few. While Elisabeth Kübler-Ross created a helpful formula addressing the stages of grief, it is important to remember there is no right or wrong way to grieve. Contrary to what people may say, each person grieves differently.

Grief is Like an Ocean

Grief is like the ocean; enormous, ever-changing. It comes in waves, ebbing and flowing. Sometimes it is calm, gentle, almost peaceful. Other times it is overwhelming, strong and aggressive. These are the times it can knock us off our feet, taking the wind from our sails. The enormity of loss often weighs heavily. When that heavy feeling right in the pit of the stomach forms, we can feel like we are sinking into it.

On other days, it is almost manageable. Life continues. We get caught up in everyday routines, our pain almost fleeting. A gentle wave comes to the surface when we are hit with a memory or a reminder of our loved ones. We slowly learn to tread water, working to keep our heads above the tide. It can be challenging at first, but we get through. The day passes. Much like the waves in the ocean, our pain is fluctuating.

Can we ever really learn to live well in our grief and move on from the pain of our loss? I feel we never truly part from those we love, and many people don’t wish to. We can, however, move forward and learn to live with our loss, gradually easing the pain. We can adapt, move around our grief, and eventually rebuild a life without our loved ones. Counselling can help reach this goal.

Working with grief in a therapeutic setting has been one of the most beautiful yet difficult presentations for me and the clients I have had the privilege to work with. I have found it important to honour the strength it takes for a client in their suffering to show up each week to face their pain.

Grief counselling is intended to help the client process their thoughts and feelings around the loss. Of course, talking through grief does not take it away, nor minimise the impact the loss has on the client’s life. It can, however, soften the experience, allowing the client to healthily process their thoughts and feelings, holding space entirely for the client’s experience, anguish, and grief, enabling a level of gentle healing to occur.

When beginning to work with grief in the therapeutic setting, I value the importance of firstly holding space for the clients. I emphasize the value of the client’s emotional experience, allowing the raw feelings to surface in a gentle, safe environment. It is important to sit with these feelings, holding the client fully in the presence of their pain.

When Anger Gives Way to Pain

Recently whilst working with a new client in session, they seemed reluctant to visit their grief, presenting each week with anger and deflecting on the initial reason they had begun therapy. Each week they presented irritated and angry, often projecting these emotions at small minor inconveniences that happened within the week, sometimes exploding and intensely reacting as they told their stories. Sessions became governed by anger, with the client unwilling to take it anywhere else. For a few weeks, I allowed space for this anger, and we worked in the moment to afford the client full autonomy in the sessions.

A few weeks on, the client presented another angry story, like the previous week and the week before that, and again over a small inconvenience. As usual, I held space for the high emotions, and once the client had finished their story, silence filled the room. They looked at me for empathy and understanding, but I did not respond to the story on this occasion.

“Would you not be angry at this?” they asked. After some silent pondering, I shared that in my experience of working as a therapeutic counsellor, at times anger can be a secondary emotion, explaining that sometimes if you are hurt in some way you might express this negative emotion instead of emotional pain — that for some, it might be easier to express anger rather than hurt. A pause.

I felt now was the opportunity to move into the next phase of our work, compassionately inquiring about the feeling of anger further. “Tell me, what is underneath your anger?” I noticed the shock at being challenged on their aggression as the client processed this question.

Softly encouraging the client, I invited them to “Stay with the thoughts and feelings that are surfacing,” and in response, they had a deeply emotional reaction to the question. Answering quietly, they said, “grief, my anger is grief.”

Relief washed over them as they identified and acknowledged the emotion. “Ok,” I said as I let out a breath, “let us together hold space for your grief. I know this is hard, I know this is painful, but let us together sit with this pain until it passes, soothes, or settles. I promise you are safe. If we sit with it right here, right now, exactly as we are, it will soften for the time being.”

On Reflection

On reflection, I realise the importance of sitting with these feelings, fully leaning into the experience, holding the client present in their pain and softly working through the emotions. Reassurance and gentle guidance are paramount when working with grief.

Within my therapeutic work, compassion and empathy are a salve to emotional injury. Sitting with a client in their pain is a powerful thing to do. It does not come naturally to a lot of people, as often they will want to repress, suppress, or avoid that pain and those experiences, much like my client did. However, the healing is in feeling them.

Now that my client had accepted their feelings, we began to do the work. Sometimes we would sit in total silence, acknowledging the energy in the room while my client worked through the feelings they experienced, and once the energy shifted, we began to regulate each emotion.

To move into this level of awareness and regulation I often encourage clients to acknowledge where in the body they feel sensations, softly inviting them to explore the feeling with me. “How does that feel? Does it feel hard or soft? Describe the sensation your body is experiencing right now?” This keeps the client grounded, and usually I find the feelings soften.

It may feel beneficial to lead the client into some gentle breathwork, staying present and engaged, co-regulating alongside the client. I may invite them to put their hand on their heart, to keep eye contact with me as we inhale through our noses and exhale through our mouths. This encourages the body to regulate and settle. Once I feel regulation has occurred, we may move into sharing memories of their loved ones, often discussing loving moments or times of laughter.

My clients’ laughs and their glistening smiles as they recount their memories are beautiful moments to witness, and moments I will always be very humbled to be part of.

Questions for Thought and Discussion

What is your reaction to the author’s approach to addressing grief therapeutically?

Is her approach similar to or different from your own way of addressing grief?

Are there particular grief-related issues that you struggle with in counseling?

What personal life experiences have influenced your approach to grief counseling?   

Grief, The Dismissed Yet Common Experience

Posted on by Psychotherapy.net Team

When I mention grief and loss to my clients, I see their eyes widen with concern. Some will quickly offer, “Oh but wait, no one close to me has died.”

One day it hit me, everyday grief is not normalized nor validated in society. We are so quick to acknowledge the death of someone but not quick enough to acknowledge ended relationships, loss of a job, divorces, loss of finances, loss of friendships, miscarriages, loss of identity, expectations, aging, or retirement.

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As I continue to advance my knowledge and practice in grief, I realize it’s not that grief is not acknowledged, but that instead many—clinicians likely included—don’t fully appreciate its innumerable forms, both great and “seemingly” small, especially, perhaps, if they have not directly experienced it. Recently, this awareness hit me when a client in my grief group expressed with sadness, “I don’t think I belong here.” This person had joined the group after losing their eyesight, while others were in attendance due to losing someone from either suicide or homicide.

I remember feeling the urge to tear up, hearing someone who was experiencing a huge loss invalidate their own pain. In that moment I realized just how dismissed the common experience of grief and loss truly is.

I then offered the client a list of commonly experienced feelings including sadness, anger, confusion, heaviness, pain, disbelief, fear, numbness. They answered, “Yes, I've felt every single one of those.” I then explained to the client that grief is not a “one size fits all” type of experience. It is unique to every individual, not linear. Nor are there rules to grieving, which often make it seem complicated. Some clients simply don’t have a vocabulary that extends to emotions, so providing a list such as this one has been helpful in my work with grieving clients.

It was my goal to help this client understand that grief is a reaction to loss, which explains why they not only belong here in the group, but they also belong in their grief. The truth is, grief does not have to be recognized by others to be validated.

As time went on and the group members became closer, the “who/what” of their grief no longer mattered because they eventually started to bond over the “why.” They began to realize that their pain was the same. Sure, they were all there for different reasons, but their tears looked the same, and their voids felt similar. Eventually, they found comfort and healing within each other’s experiences and words.

After realizing that grief has no face, just different cases, my client no longer felt as if they didn’t belong. Their differences are what made the group feel full. They provided support and balance for each other. The group became a safe space to feel their grief that was either dismissed by themselves, society, or by those around them. Dismissed not because it did not matter, but because it was simply not understood or spoken about.

This client felt that they didn’t belong because the discussion of grief had been shoved under the table for far too long. Discussions around or about grief can be easily dismissed because they are heavy and can be scary. Yet it is something that can’t or at least shouldn’t be avoided. All will someday experience loss, and grief will inevitably follow. Working with grieving clients has taught me that opening a space in clinical conversations can and has helped my clients feel normal, something that loss takes from them. I always say, “Awareness can lead to understanding, and understanding can lead to healing.”

I then ask the next question, “Do clients dismiss grief out of fear that if they talk about it, the pain attached to it becomes real or too much of a burden to bear?” No one likes feeling sadness, pain, anger, and irritation, but ignoring these feelings doesn’t make them go away. If anything, dismissing them will only make them come back harder. The sadness they feel isn’t there for no reason. It’s there because what they are experiencing is part of being human.

If I were to have dismissed my client’s pain and referred them to a colleague, who knows what their grief would have morphed into—it would have likely expanded to include loss-of-clinician. Dismissing the client’s grief would not have made their eyesight come back, nor would it have made the emotional pain they felt lessened or disappear. Yes, this client’s loss differed from others in the group, but if we crossed out “loss of eyesight” and had that same client explain the feelings of loss they were experiencing, we would see that the “who/what” attached to our losses doesn't make them more or less painful. Yet the “who/what” attached to our support system can increase chances of healing and acceptance.

***

It is my hope that one day no one will say, “My loss does not belong here,” but until that day, I will welcome all losses and forms of grief into my therapy group and in conversations with my clients. I will open similar doors to these experiences in my own life.

That Tipsy Session: The Power of Self-Disclosure

Posted on by Psychotherapy.net Team

“This is the first time in years that I am feeling proud of myself,” Chris announces with a timid smile. His eyes are unusually bright, his pale face beaming with a new energy.
He has not been drinking for a month, his longest stretch without alcohol in almost a decade. His words trigger the memory of a year-old incident that still sends waves of shame through my body.

A Sudden Loss

That day, Paris was just opening after its very strict first lockdown, and I had lunch with a friend. We sat at the newly-created terrace of a restaurant just behind the Palais Royal. My beautiful friend had already ordered drinks. “Just one glass,” I thought to myself. We sipped the crisp white wine, a well-deserved celebration under the shining sun of that spring as she recited her lockdown poems.

Two hours later, I was back to my office, covered with sweat and dreading the session to come. With a bitter taste in my mouth, I was appreciating the particular irony of the situation: getting tipsy just before the session with Chris, my alcoholic client. As his familiar face appeared on my screen, a fleeting thought popped into my mind about one advantage of online therapy—at least he could not smell the alcohol on my breath.

“I hate being stuck in this place,” he offered immediately, skipping the usual icebreaker about the weather with which my British clients often begin their sessions.

His company had switched to remote work, and Chris had fled London for his parents’ home in Spain. They had acquired the house a couple of years earlier. Their move to Spain had been hastily decided without consulting their son; seemingly out of the blue, they had swiftly sold their home in England, along with almost every belonging that had been part of Chris’s childhood.

“Why did they have to go?” Chris had wondered many times, struggling with this sudden loss. His parents’ decision had seemed senseless at the time, inexplicable. Chris’s previously unremarkable drinking then spiralled out of control. Freshly graduated from college, unemployed, and lonely, Chris had simultaneously lost his home and his family following the crazy self-exile of his parents. At that point, his life seemed to come to a halt; his drinking slowly but surely replaced everything that he was missing—friends, career, and any challenge that could have given him an opportunity to feel good about himself.

Locked-down in Spain, Chris complained: “It is so weird to be here, locked down in this dreadful villa… it feels surreal.” Every time he spoke about his parents, he looked confused, his grey eyes wandering, slipping away from my gaze. Chris was spending all of his time with his parents, something that had not happened since he had left home for college. Outside and all around the otherwise beautiful Spanish villa-turned-prison, there was a foreign town, blindingly bright under the scolding sun, a town in which he knew no one.

“In the evening they just sit in front of the television, staring at some random Spanish talk show… I feel like an idiot. I have no clue what it is about,” he grumbled, more puzzled than ever.

“Do your parents speak Spanish?”

“No, they don’t, apart from a few basic words. This freaks me out… I simply feel like I am playing a part in a bad movie,” he shared, his eyes filled with loss.

“Is this feeling something you have experienced being around your parents before?”

“I am not sure… I don’t have much recollection of my childhood… at least not about my feelings… my parents were working a lot. I was spending most of the time at school, or at my friends’ places.”

In our previous sessions we had tried to make some sense of his confusion, but something seemed to be missing, a piece of information without which we could not move forward. We stumbled, and Chris was drinking in his usual solitary and well-controlled manner.

“I think I am fine,” he reassured me (or himself) every time I inquired about the approximate amount of alcohol he had drunk during the week.

“Fine? What do you mean by ‘fine’?” I would stubbornly ask, reminding him that at the age of thirty-two he had no close friends, no experience of romantic relationships, and no exciting career, despite his reasonably successful studies.

After a year of weekly conversations, we were stuck in a dynamic that had left us both steaming with frustration. This is when that dreadful “tipsy session” happened.

That Tipsy Session

I was sitting in front of my screen, fighting the dizziness from my drink at the Palais Royal, when Chris delivered the piece of information we had been missing: “My father spilled everything out,” he announced without noticing my discomfort.

The previous evening, his mother had been down with a migraine, and his father had brought him to a nearby recently-reopened eatery. He had ordered a bottle of wine and emptied his glass immediately. Then he explained: back in the UK, Chris’s mother had had an affair with the local pub landlord. This was the only reason for their sudden decision to expatriate. This had been his ultimatum, and the only way they felt they could keep their relationship together.

As I was doing my very best to focus on Chris’s words, his face magnified by my screen, I was painfully aware of failing him. I knew that his father’s telling this difficult truth might open a window for Chris to share his own. But could he use it? After all, shame had been keeping him silent. The window of possibility was closing quickly, as Chris’s return to London was planned for a few days later.

“How do you feel about what your father has disclosed to you?”

“I didn’t know what to say… I couldn’t imagine anything like this was going on… they are too old for that!”

“This must have been difficult for your father to open up about…”

“So awkward… We sat there, drinking and trying to avoid each other’s eyes… He never told me anything this private before,” Chris admitted, fidgeting uneasily in his chair.

“So, you were not the only one withholding something important from your family?” My own allusion to his drinking resonated with an obvious irony.

“What do you mean?” he hissed, pretending that he had no idea about what I was speaking about.

“Maybe this was an opportunity for you to talk to your father openly about your struggles with alcohol?” I made another desperate push.

Chris shook his head with resolve. He had been keeping his drinking problem for himself for years, and the shame he had accumulated in the process was an obstacle he could not overcome. Not yet.

I sighed and let him go with a certain relief. Even if I made it through the session without a major blow, by the end of it I was exhausted and, for the first time, wished to be elsewhere, not in front of my screen with Chris.

For the full week following that session, Chris stayed on my mind. To tell or not to tell? I was not sure whether a self-disclosure would break the brittle trust we had both worked hard to establish. The next time Chris appeared on my screen, I plunged in first.

“Before we start, I have to share something with you,” I announced, and his face dropped in response, preparing for bad news. “During our last session… you may have noticed that I was not fully present,” I stumbled forward, and he nodded. “I thought you were distracted for some reason… but it was ok,” he added generously.

“No, it wasn’t ok,” I sighed and stumbled further. “Just before our session, at lunch, I had a glass of wine. It was a mistake, and I have to apologize.”

“So, you were drunk?” he giggled, and I could not figure out whether there was more confusion or relief in his voice.

“Well, a little tipsy, I guess,” I nodded, trying not to avoid his eyes.
We stayed silent for a minute before he asked, perplexed, “Why are you telling me this today? You didn’t have to…”

“No, I didn’t… but I value our relationship, and owe it to you to be honest… but I was too ashamed to tell you last time,” I shared, hoping that we could capitalize on this example of self-disclosure.

“I know what you mean…” he sighed and looked sideways.
From that point on, Chris finally started opening up. Instead of endlessly complaining about his mother’s misstep and other misfortunes, he now talked honestly about himself.

“I actually know exactly when this whole ridiculous affair started… I got really drunk one evening at the pub, and the landlord had to call my parents to fetch me. My mother came, and this is when they took it off…”

Chris’s discovery that his drinking was somehow at the root of what he saw as his family’s downfall added a new dimension to the shame he was constantly feeling about his unfulfilled life. It took us much longer, of course, to realize that his mother had other reasons to cheat on her husband which had nothing to do with her son but rather with her husband’s very quiet but steady drinking, which had been going on unnoticed for years.

“This was probably his one and only way to relax…” Chris had always seen his father returning from work and pouring himself a large glass of whisky, calling it his “medicine.”

***

Through our increasingly honest conversations, Chris was slowly learning the power of vulnerability. After several months he became strong enough to tell his parents about his own struggle with alcohol. Initially, his father met his honesty with defiance. Chris’s admission put him in an uncomfortable place where he had to face his own addiction. In the weeks that followed that confrontation, from a distance I witnessed their family stumbling through an uneasy change of dynamics. They talked more openly about the drinking issue that had run in the family for a few generations, and Chris eventually opened up about his therapy work. The change was slow, but with each passing week, he felt stronger about his decision to quit alcohol and soon started experimenting with sober days, then weeks… Today he has not had a drink in a month.

“I am really proud of you today, what a journey,” I say, and then I finally ask the burning question that has been on my mind since that dreadful session: “Did my telling you about that drink I had before our session play any role in your recovery?”

“I was first shocked that you would tell me… then I felt angry about it… but somehow this helped me feel less ashamed about my own drinking… I remember thinking that if you didn’t die from shame when you told me, then I wouldn’t die either if I told my parents,” he admitted.

Through his further conversations with his mother, we have now learned that her affair had been a desperate attempt to recover the intimacy she had lost with her husband. My turning up tipsy for the session was probably a similar kind of act. That incident, or rather what we were able to make out of it, strengthened our therapeutic bond. On a more immediate level, by self-disclosing, I demonstrated to Chris in the here-and-now of the session that shame does not kill you.

Thinking back, I am still bewildered by that shameful drink, which fortunately became a step on Chris’s path towards pride.

Unlocked: Online Therapy Stories

Posted on by Psychotherapy.net Team

Laila

Riyadh, Saudi Arabia

Laila is very good at hiding. This is the first time we meet, and as her unveiled face appears on my screen, I can barely distinguish her features hidden by the thick darkness of the room.

From her initial email, I know that Laila is in her late 30s, unmarried and, as a result of these circumstances, is living in her parents’ house in a very conservative Middle Eastern country. She warns me straightaway that it has been a difficult and risky decision for her to engage in therapy, especially online and with a Western therapist. It is also her only option if she wants to keep it away from her family and confidential.

Privacy is an issue. Her parents’ house is vast and has many rooms, but her nine siblings come and go as they wish, following the rhythms of their prayers, meals and social obligations. Some of them are married, and their young children are constantly running around the house, untamed and loud.

Connecting with Laila for our first session, I automatically become an accomplice in her rule-breaking behaviour. Starting as partners-in-crime results in an immediate intimacy and a strange sense of kinship that usually takes time to create in therapy.

“Where are you now? Is this your room?”

“Yes, it is my room, and fortunately the door is locked.”

I overhear children’s voices and some music resonating from the bowels of the house. By contrast, her room is very quiet, and from the little I can see of it, rather spartan.

“I told them I was having a migraine and had to lie down.”

“Do you have migraines often?” She smiles sadly: “Yes, I do.”

As we would realise later, this was the only excuse she had found as a child to isolate herself and get some personal space. Nevertheless, Laila’s migraines’ ‘purpose’ does not make them any less real or painful. They can last for days, and self-isolating in a dark room has become a habit that her family accepts as another bothersome part of her character, alongside the irritating stubbornness that she displays on certain occasions. The recently installed lock on her door, which has caused many heated conversations with her father, is also the welcome consequence of her ‘condition’.

“I am not sure therapy can help me. Something terrible is about to happen …”

Before she can finish, we are interrupted by a strong knock on the door. Shaken by its invasive forcefulness and Laila’s abrupt backing away, I do not have time to fully realise what is happening, and she is gone. My screen suddenly goes blank.

For several days, I can’t stop thinking about this aborted session, worrying for Laila and wondering whether she will ever make it back to my virtual therapy room. In the meantime, Paris empties as a result of the lockdown. Bewildered Parisians watch its deserted streets from their windows or balconies. Their screens become the only way of maintaining a connection with others. The fleeting conversation with Laila is nearly forgotten when an email from her arrives. This time she is resolved to start working with me, as soon as I am free. We arranged to reconnect the following evening.

As Laila joins the video call, her face instantly fills my screen in an unexpected close-up. She is wearing a dark purple hijab neatly framing the beautifully defined features of her face. A fierce energy emanates from her. No distance or screen dampens that down.

Laila tells me that she has been postponing therapy for years, unsure of how to proceed. It started with her parents insisting that she consult a local psychiatrist, perplexed as they were by her moodiness and unwillingness to engage in any discussions about marriage plans. Laila hated it. One of her older brothers, chosen to drive her to the appointment (as she was obviously not allowed to drive), would wait for her in the corridor. She could feel his presence behind the door and his annoyance at what was just another time-consuming task for him.

***

The psychiatrist did not unveil anything (nor did Laila unveil her face in his presence). He did not seem very interested in her concerns and promptly prescribed antidepressants and a break from work. It convinced Laila not to come back to this or any other local doctor. Taking a pill would not make her problems go away. The risk of being forced to leave her job scared her.

She works as a nurse in the maternity ward of a large hospital and, strangely enough, her work has become her most cherished space in finding some privacy. There, she is valued for her skills, away from her father’s constant scrutiny.

“How do you feel about talking with me, a Western woman living thousands of miles away?”

“I do not know if I can trust you. But I have no choice.”

I tell her that confidentiality is the very basis of therapy, but I don’t know if my words are enough to reassure her.

So here we are – two women sitting in front of their computers in two opposite parts of the world – talking with each other through a screen, in a language that is neither one’s mother tongue. Having grown up in an autocratic state, I know too well that a foreign language can turn into a space of freedom, a boundary and a safety blanket, unavailable in one’s mother tongue.

Laila has to talk in a hushed voice. Her family members are constantly passing by her room, and sometimes I clearly distinguish their voices resonating in the tiled corridors of her parents’ vast house, approaching and vanishing again.

Do they speak English? Yes, a bit, but not as well as her. Laila has been passionate about learning English since her teens. She has always felt that this language offered her a space for free thinking and privacy, which she considers unattainable to her in Arabic. Her father has always scolded her for spending too much time reading in English or watching American films, but since she has had to study English for her nursing degree and, later on, to work at the international hospital, he has grudgingly conceded her this ‘frivolousness’.

Since her late teens, Laila has been avidly using social media, where she now has the majority of her meaningful social connections, her ‘online friends,’ as she calls these virtual bonds. In this parallel world, women are able to befriend men; friends can exchange unveiled pictures of each other, discuss intimate topics and even share their religious doubts.

“Last time we spoke, you said that something terrible was about to happen. What did you mean?”

Laila shoots a quick look towards the door as if to check that nobody is there to intrude her space, but the house is silent.

“My parents received another marriage proposal for me … they know that this is maybe the last chance to get rid of me.”

“Do you know this man?”

“No, but his mother is coming tomorrow to look at me.”

Laila lowers her head and slips away from the camera, so that only a part of her forehead, covered by the hijab, stays visible.

The marriage hunt started when she was eighteen, and her parents’ attempts to find her a suitable husband have become ever more determined and desperate. First Laila could highlight the flaws in the aspiring grooms that would make good deal-breakers: lack of a respectable career, a physical defect or, even more convincing for her parents, lack of religious fervour. As time went by, the suitors grew older, their flaws became more obvious, but her parents’ desire to finally settle their insubordinate daughter also became more urgent.

This time, it is an older cousin who is already married and is now considering taking a second wife.
“I am getting too old to be a first wife … but not old enough to be left in peace.” Laila’s voice cracks and she is close to tears.

That evening I find it hard to join in the conversation over the now-traditional online aperitif with friends. The mundane topics around COVID symptoms, current government strategy and facemasks feel far removed from what I am still struggling with: the prospect of a forced marriage on Laila.

This is one of those times when I almost physically stumble on the limits of what I am able to offer to a client; therapy can be an empowering force, but certain brute realities of existence can have a stronger adverse effect. I desperately want Laila to be free, and the intensity of my yearning is only a distant pale echo of what she is probably feeling, trying to get to sleep in her lonely room. The laughter of my friends and the jazz in the background are making Laila’s isolation even more blatant in my mind.

I grew up as an only child and, at bedtime, my desolate condition would usually feel cruel. I would lie in bed for hours, fantasising about potential siblings, little doll-like brothers and sisters to dress and feed. Laila, on the contrary, has many siblings but this did not make her any less lonely; none of them understood her stubborn rebellion against the family rules or arranged marriage. I imagine her sitting on her lonely bed, scrolling through on her laptop her online friends’ intimate messages. Would she be able to act on what we had plotted, maybe foolishly, together?

That night I dream that I am lost in a strange place – maybe an abandoned hotel or a school – unable to get out of its intricate staircases, endless corridors, and vast empty rooms. I am pacing through the rooms as a lonely ghost, unable to find an exit or someone to ask for directions. Rescued by the morning alarm, I have to lie down for a few seconds, trying to distinguish the harrowing dream from the nightmarish reality of another lockdown day.

During the day I find myself checking emails between sessions, hoping to hear from Laila, but she keeps silent. Or is she kept silent? In my current monotonous reality, Laila’s story starts to resemble a television drama with weekly episodes on my computer screen. I do not need Netflix, as my clients’ real-life stories are filling the void left by the lockdown which has robbed me of many of my daily joys. Laila’s distress washes me away in a powerful emotional wave that I am unable or unwilling to control; I find myself washed out on the shore of my balcony, covered with the debris of my own frustration, hurt and with a deep feeling of loss. I stand there contemplating the grey field of Parisian rooftops with hundreds of red chimneys erected in a frozen dance; birds are swirling in the still air, oblivious to the lockdown. For the first time I regret not smoking, as a cigarette would probably have been a good kick right now. My tea has become cold and tasteless. I go to the kitchen and pour myself a large glass of crisp white Burgundy.

By the time I go to bed – later with every passing day – Laila’s email is waiting for me in my inbox: “I barricaded myself in the room as planned. Did not come out when the man’s mother came. I don’t know what happened there. Have to go now, as my father wants to talk. Will write later.”

My heart starts racing; I know I should not be checking my emails at this time, but the lockdown seems to have altered many rules. I know that I have to do something. I go to the bathroom and wash my face with cold water. I look in the mirror and dislike what I see – an ageing woman with unkempt hair and puffy eyes. Since hairdressers shut down, my usually dark curls are showing more and more grey. I open the drawer, fetch the scissors and start cutting, methodically, until the sink is filled with hair. As I cut, I think about my husband telling me that he really prefers women with long hair; all the things I could not say no to come over me like a big wave. My own anger takes me by surprise; how can I have all this inside, after all these years of therapy, trying to heal? Then I realise that this is not just about me, but also about Laila. I am outraged and rebelling on her behalf.

***

Next time we meet online, the connection takes a while to settle, like the surface of a lake disturbed by the stone thrown by a child, and her bright face appears. She looks at me in bewilderment and I start thinking that something has gone wrong. But before I can utter a word, Laila takes her hijab off in a resolute gesture. This is the first time I see her head uncovered – she looks like a little girl, and her hair is even shorter than mine, she is almost bald. We stare at each other in amazement and the mirroring effect of our screen encounter becomes even more striking. She is the first to talk.

“I cut my hair. You did too?”

“Yes, I did.”

“If my father finds out, he will be really mad.”

“Do you want him to see it?”

She keeps silent for a moment, playing with her hijab, which is lying on her lap like a little dead animal.

“In a way I do, even if I am scared he may kill me.”

“Kill you?”

“I mean … I don’t know. I never did anything like this before.”

She looks directly into the camera; in her wide-open eyes I see a mixture of excitement and defiance.

Now it is my turn to feel scared.

“But does he really need to know?”

“No, maybe not yet.”

With her naked head she looks so young and vulnerable that I want to protect her, to make sure she is safe. But I have to remind myself that she came to me in search of empowerment. Trusting me, she took a risk, and it is now my turn to trust her. I feel like the parent of a toddler who is climbing a jungle gym for the first time, realising that the child could fall and hurt themselves, but also has to learn this new skill in order to eventually master it.

“My father called me yesterday after he learnt I did not show up in the guest room. He was very upset.”

“Is this over now or will she return?”

“Anyway, not before the lockdown is over.”

“Oh, good. This gives us a few weeks to figure something out.”

“Yes. I do not want to marry, ever.”

She stares at me with her intense dark eyes and I desperately look for words to reassure her, but I stumble as I am not certain that we can fight against her father’s will, the omnipotent power over his daughter given to him by his country’s tradition and law.

“Can you talk about it with your mother?”

“I tried. She keeps repeating that I have to marry and have children, otherwise I will never be happy. She does not know any other way.”

“What about your older sisters?”

“They all wanted to get married. Now they think I should too.”

“What about your online friends?”

“Yes, they understand. We talked about the ways out. They advise me to get ill or to lose a lot of weight. Just to gain some time.”

Laila shows me her room. It looks like a prison cell, although the bare necessities for a reasonably comfortable life are there. The only objects Laila cherishes are a few books on a shelf and a television. But even those tend to attract the unwanted attention from her family – why doesn’t she watch television in the common room? Why does she need all these American books?

The electric light is always on, even though the bright Middle East sun shines outside nearly all year around.

“We are strong on privacy here,” Laila explains.

The shutters are closed all the time, to prevent neighbours getting a glimpse of the women of the house. As a result, Laila has no access to the outside world. Before the lockdown, almost her only outings consisted in commuting to her workplace in her brother’s car, with tinted windows for the same reasons of privacy, making everything outside look bleak and slightly unreal. Laila recognises that often she feels like a ghost, as the familiar world turns into an uncanny copy of what reality is supposed to be. The days go by in a sort of depleted way, a succession of small familiar tasks, starting with making coffee for her father, ending with the evening prayer. Only then, as she finally locks her door behind her, taking off her hijab, does Laila feel that she is still alive.

After our session I gasp for fresh air. The balcony is not enough; I also feel a terrible itch to be moving. I put my running shoes on and venture outside after signing the compulsory ‘attestation de déplacement dérogatoire’ (‘self-declaration form for travel’). I feel rebellious again and, as I start running, I take my mask off my face and shove it into my pocket. The prospect of a police patrol stopping me only heightens my resolve.

The riverbanks are closed, but I ignore the warning sign as I sprint down to calm and vast Seine. As I follow the river, very close to the edge, I can smell its slightly rotten water, finally free of pollution. The water carries a sense of calm power, vague possibility and quiet hope. But Laila lives in a desert. I have not run properly for weeks and the air soon starts hurting my lungs. I ignore the pain and keep pushing towards the Eiffel Tower, looking ghostly and slightly out of place in the middle of the empty city.

***

The next time I connect for the session with Laila, it is with a palpable sense of dread in my stomach. I realise that Laila is late, which is unusual. I open Telegram, our prearranged back-up option, only to find a message from her asking to chat here instead. Of course, we can. This is not the time for worrying about strict boundaries.

“My father found out that I’d cut my hair and confiscated my computer. He thinks that it is all because of the American films.”

“How did he find out?”

“I think my mother told him. She tells him everything.”

“How are you doing?”

“It does not make such a difference to me. It is just that my door is locked on the other side.”

Using a chat room adds the option of staying hidden. Laila seems comfortable with this new set up; I am less used to sudden restrictions. She is so accustomed to things being taken away from her that it does not seem to throw her out of balance.

“For how long will you be punished?”

“I don’t know. It depends on his mood.”

“Has it happened before?”

“Yes. When I was a teenager I spent a lot of time in here, but I actually liked it. It gave me some peace … this is when I studied English.”

The language that she learnt whilst imprisoned has eventually become her space of freedom. Ironically, we use English for a therapy session, both being in breach of her country’s expectations. As we are chatting with our respective doors locked, it feels like two teenagers secretly communicating behind their parents’ backs.

“As a teen, did you have friends to talk with?”

“No. Not really. I did not have social media back then.”

Laila is sounding distant. Is she typing something to her friends simultaneously?

“Can I ask you about something?”

I am glad that she asks, whatever the question may be.

“Do you think about me sometimes?”

If she only knew how much I have, she would probably feel uncomfortable.

“I do. I worry for you. And sometimes I wonder how much I am really helping you.”

“You don’t know how much you have been helping me.”

I am regretting that this conversation is taking place by chat, but again, we have to settle for what we have. I would prefer to see her eyes, even if the screen turns eye contact into a weird imagination game. Doing with less, turning things around: these are lockdown lessons that Laila has had to master well before many of us.

***

It is the sixth week of lockdown and I am lying in bed at midnight, unable to calm down the frenetic flow of my thoughts. All the little things that my life ‘before’ was made of are spinning in my mind – a coffee with a friend in the nearby café, a chat with the friendly waiter at the bistro where I stop by for lunch, a stroll to an art museum, a quick drive to the seaside for a lunch of oysters, outside under the pale Normandy sun – all things made impossible by the need to keep away from others. In the end, life’s pleasures are a lot about being with or at least near others.

As I am quietly mourning all things lost, my phone buzzes, announcing a Telegram call. Before picking up, I notice that the screen displays an international number with a prefix I cannot place.

“It’s Laila.”

Her now familiar voice is filled with a mixture of dread and excitement; I suddenly feel completely awake, with a jolt of adrenalin rushing into my blood.

“Where are you, are you ok?”

“I am in Bangkok … at the airport. I ran away.”
“Are you alone? Does your family know where you are?”

“I don’t know. I am so scared … if they find me, they will kill me.”

Her voice is that of a little girl; the kind of voice my daughter would have when waking up from a horrible nightmare in the middle of the night.

“How can I help you?”

“You cannot. It is too dangerous. My online friends are helping.”

She keeps silent for a moment; I am waiting for her to reassure me that everything is ok, that she will be fine somehow. My heart is pounding heavily in my chest.

“Laila …? Are you there?”

“I have to go now! I just wanted to say goodbye and … thank you.”

Before I am able to respond, she is gone, her voice abruptly replaced by the long beep of a dead line. As I put down the phone, I suddenly understand all that I have been missing. Everything clicks into place. Laila had been preparing her escape all along. I feel betrayed, like an object that fulfilled its purpose and can now be discarded. After a few moments the hurt gives way to anxiety: what will happen to Laila now? I pick up my phone again and start scrolling the international news. No mention of a Saudi girl on the run. Not yet.

The next time the phone comes alive in my hands, it is past midnight. Laila sounds different, she talks with a new urgency that makes me sit up in bed, alert.

“Why didn’t you tell me about your plan?”

“I couldn’t. It was too dangerous.”

I can now hear some muffled male voices and a noise as if somebody is banging on a door.

“Where are you now? What is happening there?”

“I am in a hotel room, still at the airport. Look at the news.”

Laila disconnects or maybe the call drops out.

I return to the live news page still open on my phone screen: this time Laila is there. I recognise her frail silhouette in the slightly blurred images. A short video shows her walking through a dark corridor flanked by several men in uniform – Thai police most probably. They escort her somewhere. With her black t-shirt, a red backpack and an uncovered head, Laila could easily pass for a normal teenager were it not for the policemen with watchful looks surrounding her in a tight circle. She looks vulnerable but proud.

This time I call her back; she responds in a second.

“What is your plan?”

“To ask for asylum. I am not leaving this room until I see somebody from the United Nations.”

As we talk, I can hear the banging on the door and the voices getting closer again; something smashes loudly on the floor.

“They are trying to get me to unlock the door.”

“Are you sure they cannot break in and harm you?”

“I don’t know. I barricaded it with all the furniture that I had in here.” Her voice is trembling; I can sense her terror almost physically.

“Do you want us to stay on the phone? Is this helpful?”

She keeps silent for a second; I can hear her heavy breathing.

“Yes, please.”

I grab my dressing gown and, headphones in my ears, I go to the kitchen and make some coffee. I have to keep my hands busy to keep the anxiety at bay. The futile routine of making coffee contrasts with the mayhem in a Bangkok hotel room on the other end of the line; it is surreal. But Laila’s voice confirms that this is not just a bad dream of mine.

As we sit and talk, her online friends are rushing to attract as much attention as possible to her case. After just a few hours, social media is buzzing with her story, but it is still not enough to reach a high-ranking UN official. She keeps silent for a long moment and I can hear her tapping on her phone, fast and furious. I just stay there, listening to the noises from yet one more room where she has had to lock herself in. I hope this is the last time she has to do that.

Then Laila starts talking. She tells me all about how she has planned for this since the very first day of the lockdown. Her family was scheduled to have a holiday in Turkey and when it was cancelled, she managed to keep the travel authorisation signed by her father. The household was shaken by the lockdown, and the usually steady routine was disrupted as all family members had more time on their hands. With Ramadan starting a few days before, Laila knew that this was the right time for her to attempt the escape. The impending marriage, which now seemed inescapable, had left her with no other option than to act before the end of the quarantine.

“You have helped me to feel stronger, I have had hope again.”

***

That night, those who know Laila are not sleeping. After a few hours of social media frenzy, she finally receives a message from a French journalist.

“He wants me to record a video and post it on social media. To attract more attention.”

I see his point. The only images of Laila that are circulating online are blurred and vague; her scream for help has no face yet. But I also know what showing her uncovered face to the whole world would mean for her. Her family would never get over the shame; they would be unforgiving.

“Are you prepared to do this?”

She stays silent for a long moment. I listen to her accelerated breathing; she is hyperventilating.

“Laila, let’s try to breathe more slowly, breathe with me.”

For a few minutes we are inhaling and exhaling together, finding a shared rhythm.

“I am so scared,” she whispers.

“I know you are. I am scared for you too.”

“They will kill me.”

“Let’s make sure they cannot. Do you remember the first time you showed me your face?”

“Yes …”

“You did it then, even though it was risky.”

“I did.”

A few seconds pass and I finally hear her voice, trembling but clear. Laila tells the world about who she is and why she has barricaded herself in this room. She asks for asylum. As soon as she is done, the video of her talking to the camera appears in my Twitter feed. Then we both observe how her video makes a storm; it is also taken by this storm and propelled further and further around the virtual world. To watch this happening is fascinating. There is no way back for Laila after this, we both know it.

I suddenly feel exhausted; outside the sun is coming out from behind the sleepy buildings. Paris is waking up, oblivious to what has been happening to Laila that night. I make myself another coffee and take it to the balcony. As I watch the sunrise, Laila is crying, at the other end of the world.

I use my phone again, this time to photograph the sky and the rooftops, bathing in the pink light of pale morning sunshine. As she receives my picture, both of us already know that she will make it.

“I have to go and unlock the door … There is somebody from the United Nations here. Thank you for staying with me.”

“Yes, the world is waiting for you outside.”

We hang up, and back on my computer screen I watch her march out of the room under the glare of the waiting cameras, towards a future in which she will probably still have to hide for a while. As I contemplate my city slowly returning from a deep and troubled sleep, I hope that the days of locked rooms are over for Laila.

***

Unlocked: Online Therapy Stories was published by Confer Books on 20th January 2022 and can be found online at Amazon UK, Amazon US, and Karnac Bookshop.
 

A Matter of Death and Life

Posted on by Psychotherapy.net Team

Excerpted from A Matter of Death and Life by Irvin D. Yalom and Marilyn Yalom, published by Stanford University Press, ©2021 by Irvin D. Yalom and Marilyn Yalom. All Rights Reserved.

Numbness, 50 Days After

Numbness persists. My children visit. We take walks in the neighborhood, cook together, play chess, and watch movies on TV. Yet I remain numb. I feel uninvolved in the chess games with my sons. Winning or losing has lost significance.

Yesterday evening there was a neighborhood poker game, and my son Reid and I both played. It was the first time I’ve ever played together with one of my sons in a game of adults. I’ve always loved poker but at this game, at this time, I could not shuck the numbness. Sounds like depression, I know, but still I took pleasure in seeing Reid’s happiness about winning thirty dollars. As I walked back to my home, I imagined how good it would have felt to arrive home, be greeted by Marilyn, and tell her about our son’s winning night at poker.

The following night I try an experiment and place the portrait of Marilyn in plain view in the room while my son, his wife, and I watch a movie on TV. But, after a few minutes, I feel so much tightness in my chest that I again put Marilyn’s portrait out of sight. The numbness persists as the film proceeds. After about a half hour, I realize that Marilyn and I had seen this movie several months before. I lose interest in seeing it again but remembering that Marilyn had enjoyed it a great deal, I honor the bizarre notion that I owe it to her to watch the entire film.

“I notice that the numbness recedes the first few hours of the day when I am immersed in writing this book and also when I work as a therapist”. Today, a woman in her late twenties enters my office for a consultation. She presents her dilemma. “I’m in love with two men, my husband and another man I’ve been involved with for the last year. I don’t know which is the real love. When I’m with one of them, I feel that he’s my real love. And then the next day or so I feel the same way about the other man. It’s as though I want someone to tell me which one is the real love.”

She discusses her dilemma at length. Midway through the session, she notes the time and mentions that she had seen my wife’s obituary. She thanks me for being willing to see her at this difficult time. “I worry” she says, “about burdening you with my issues when you’re suffering such a huge loss.”

“Thank you for those words,” I reply, “but some time has gone by, and I find that it helps me if I’m engaged in helping others. And also, there are times when issues arising from my grief enable me to help others.”

“How does that work?” she asks. “Are you thinking of something that may be helpful to me?”

“I’m not clear about that. Let me just ramble for a minute. Let’s see . . . I know that getting involved in your life in this session temporarily diverts me from my own. I’m thinking, too, of your comment that you don’t know your real self and that you cannot know which of these two men the real you really wants. I keep thinking about your use of real. I feel this may be tangential, but I’ll just trust my instincts and tell you what our discussion stirs up in me.

“For a very long time I’ve felt that an event often felt ‘real’ only after I shared it with my wife. But now, weeks after my wife’s death, I have this very strange experience of something happening and my feeling I must tell my wife about this. It’s as though things don’t become ‘real’ until my wife knows about them. And, of course, that is entirely irrational because my wife no longer exists. I don’t know how to put this in a way that will be helpful but here it is: I, and only I, have to take full responsibility for determining reality. Tell me, does this have any meaning for you?”

She seems deep in thought and then looks up and says, “That does speak to me. You’re right if you’re implying that I cannot trust my sense of reality and that I want others—perhaps one of my two men, perhaps you—to identify reality. My husband is weak and always defers to my observations, to my sense of reality. And the other man is stronger, very successful in business, very sure of himself, and I feel safer and more protected and trust his sense of reality. Yet I also know that he’s a long-term addict who is now in AA and has now been sober for only a few weeks. I think the truth is that I mustn’t trust either of them to define reality for me. Your words make me realize that it’s my job to define reality—my job and my responsibility.”

Toward the end of our hour together, I suggest that she is not ready to make a decision and should tackle this in depth in continued therapy. I give her the names of two excellent therapists and ask that she email me a few weeks from now to let me know how she is doing. She is deeply touched by my sharing so much with her and says that this hour has been so meaningful that she didn’t want to leave.

I’m So Glad My Parents Are Dead

Posted on by Psychotherapy.net Team

“I’m so glad my parents are dead,” he casually offered, as if telling me the day’s weather forecast or some similarly innocuous and inconsequential news. Raising more than a little bit of concern in my mind that was already reeling with possibilities, all of them quite dark, I decided to sit back, breathe, and let him lead the conversation. This, despite bursting with questions, centering mostly on the possible ill fate of this new patient’s deceased parents. “All things considered,” he said, without discernible affect, “I’m glad it’s over… I’m glad they’re dead, and I’m not afraid or ashamed to say it.” This is the kind of stuff that patients save for the doorknob experience; you know, that profound, therapy-altering utterance the otherwise reticent, resistant, or un-ready patient leaves you with on their way out of session, leaving you wondering if they will return to complete the story. However, this was clearly not one of those mysterious or seductive therapeutic mic drops designed to keep me wondering what would come next, nor was it a planned device strategically designed to keep me at therapeutic bay. This was an opening to, or perhaps an invitation from this 60-something man, who seemed to have his act together—except, of course, for this most disturbing utterance. So I wondered silently, at least for now, “How and when did his parents die, why was he glad they were dead, what role if any, did he play in their deaths, and why did he so quickly and emphatically share that relief over their deaths with me, a stranger?” Murder, suicide, murder-suicide, euthanasia? Was he the culprit, the victim? The greatest challenge for me in the moment was trying to quiet my mind and let him share his story, which I was sure was going to be a whopper. Surprisingly, he went on to talk not about his parents, but about the pandemic, which he said initially “hadn’t really hit me in any significant way.“ He was a late-career professional with a few stable income streams that allowed him to work remotely. He said he and his family were healthy, and that he had not taken any hit in income or status. He seemed content in the telling, but considering the opening salvo about his parents, I felt the need to dig a little further. Anxiety, perhaps, or maybe a masked depression because, after all, this pandemic infects everyone at one point or another, in one way or another; perhaps not physically, but emotionally. As his story unfolded, and however much I tried to ferret out this man’s hidden symptomatology, I was left with a nagging question of “Why is he here?” As the session ended, I was left with more questions than answers, which is probably a good thing because it left me in a state of curiosity, looking forward to the next visit when more would hopefully be revealed about this man who clearly was carrying a great burden with him. But in what form and to what extent was he burdened? That was the $64,000 question. The next session came, and as it began, I broke with my own personal and professional protocol by deciding to lead the session with a question. I asked him what he meant when he said that he was relieved that both his parents were dead. He seemed to look past me, fell into his chair as if a great weight were pulling him backwards, and then released what seemed to be a years-long held breath. His parents, as it turned out, had died of natural causes four and eight years ago; first his father and then his mother. He spoke with neither sadness nor regret, spending little time relaying the details of their passings. As much as I wanted to ask him, I refrained. It seemed that his relief came from the fact that his parents, who lived to 97 and 98 respectively, had passed well before the COVID pandemic, not only freeing him of the burden of their care during its clutches, but also without concern of having to do so during this period of quarantine and forced isolation. He recalled how important it was for him to be at their sides during their final descents, and how grateful he was to have been there with and for them to usher them out of their lives with the same constant and gentle compassion with which they had ushered him into his. He had become painfully aware of how families had not only been ravaged by the deaths of loved ones during the COVID pandemic, but tortured by their inability to visit family members in hospitals, convalescent homes, and hospices. Unlike his own parents, these people were dying in the care of strangers. While these events deepened the relief he expressed when we first met, his life had recently been upended when he and his wife took over the care of her 91-year-old parents, who now resided at two different extended-care facilities; neither of which allowed visitors. Unlike his own parents for whom he and his wife had cared up to their deaths, his in-laws might very well spend their last months or years in the care of strangers—isolated from family. The relief he felt at the passing of his parents, and the gratitude he harbored over being able to care directly for them, was slowly being eclipsed by profound sadness, anger, impotence and fear. That is why he came to see me, and it now made perfect sense. He hadn’t come to share his relief, but to express a deep guilt over abandoning his in-laws, even though that abandonment was compelled by circumstances beyond his control. When possible, phone calls, the occasional Skype, and window visits dulled the pain, but could not replace the care and comfort that comes with holding hands, hugging, caressing, bedsides visits, and vigils. His forced inability to attend directly to his in-laws had also rekindled the fears of mortality that he thought he had buried along with his parents. His personal narrative around dying while he was caring for them was one of hope, because he envisioned that like them, he would pass in the arms of loved ones. Now, that narrative had shifted, and death seemed to be a dark and lonely place, and the path towards it frightening. And that was where our therapeutic journey would begin.