A Body-Mind Experiential Psychotherapy Approach to Bereavement
Bereavement refers to feelings of sadness and depression after the loss of something significant or the death of a loved one. There are many representations of loss, including a breakdown of a relationship, losing a pet, a limb or lifestyle. The death of a loved one often results in the most intense grief because of the significance of the relationship and the finality of death. A person can develop a range of emotional and physical issues associated with their loss, for example, grief, anxiety and physical symptoms such as insomnia and anorexia.
Individuals are more likely to misuse alcohol and be vulnerable to physical illness during the grieving period. Intense emotional reactions are common in the first weeks after suffering from a loss, including crying, irritability, worry, anger and guilt. This can be accompanied by the loss of interest in usual activities, and body sensations and symptoms that are a result of feeling anxious and depressed. Some people recover from their loss after a month, while others may need four or five years to adjust to living with their loss. A prolonged response to grief can continue for six months after the loss when a person protests against the loss, has a reluctance to adapt to not having what they have lost, and feels an intense yearning for it. This is called a prolonged grief disorder (PGD) (Management of Mental Disorders, Treatment Protocol Project 2004). Traumatic grief is another form of bereavement. It is more complex as it contains issues stemming from both the trauma of witnessing the event, and grieving for the loss; for example, people who have lost a family member and were present at the time of the incident often struggle with anxiety. The anxiety is a result of trauma and grief symptoms. These include having intrusive flashbacks of the incident, separation anxiety without the relationship, avoidance of the scene of the incident, hyper vigilance and startle responses in daily living, difficulty with concentration, and being unable to sleep.
When a person commences therapy it is necessary to provide them with psycho-education about how trauma impacts their body and mind. This involves normalizing how the client developed traumatic grief in response to the dangerous event and significant loss. It helps to begin with explaining how our brain is intimately connected with our body and how they communicate with each other about how they feel. This communication can become stuck in the body and mind at the time of experiencing the trauma. With this stuck communication the trauma of the loss cycles repetitively between the brain and the body. This causes the person to struggle with living with ongoing trauma symptoms that can become, and look like a generalized anxiety disorder.
The anxiety is caused by dysregulated emotions. These emotions stem from the fear response to the trauma and emotions of grief connected to the loss. The body may shake, tremble or feel hot or cold. A therapist can help the person process the dysregulated emotions by recalibrating the central nervous system so the body-mind can feel calm again. In summary, trauma treatment involves providing psycho-education, helping the client make meaning of the event, understand and transform what happened, and revise the person’s assumptions that the world is a dangerous and frightening place, and that they are to blame for the incident occurring. An example of a person experiencing dysregulated emotions was observed when a client was grieving her mother’s death. The client blamed herself for her mother’s death at the beginning of therapy and as therapy progressed this self-blame decreased. The mother was elderly, and at the time of her death she had been living in a hospital. The mother suffered from breathing difficulties and the client observed the hospital staff neglecting her health. The mother died without medical staff discovering her until the following day. For many months after her mother’s death, the client blamed herself for not spending more time at the hospital to ensure medical staff took good care of her. The client’s healing occurred as she made meaning from her mother’s death and remembered the special times spent with her mother prior to her death. She released her grief by allowing herself to take all the time she needed to cry and to form a more realistic picture of her mother’s passing. It helped her to know that everyone grieves in their own way according to their personality, culture and available support.
Some people can express their emotions, while others are more stoic and seek a distraction from dwelling on an unchangeable fact. The client was able to rebuild her life by socializing more and changing her work life to better suit her stage in life. She accepted that she had been suffering from depression in connection to her grief about her mother. She also realized that she had other unresolved issues with her mother and felt sad that they were unable to work through them together although, she felt an inner calm with knowing that they loved each other. She did experience moments of anxiety when people handled her roughly emotionally and without tenderness and understood this was part of her grieving.
Being with bereavement or loss
A person can develop a generalized anxiety disorder in response to a loss. Common signs and symptoms are both psychological and physical, such as worrying excessively, feeling ‘keyed up’, having difficulty concentrating and experiencing periods of insomnia. Physical symptoms include muscle tension and aches, headaches, fatigue, rapid breathing, dizzy spells, trembling, twitching, fast or irregular heartbeats, nausea or diarrhea, dry mouth and clammy hands. I worked with an adolescent person who suffered from anxiety in response to his parents separating which resulted in the breakdown of his family unit (Australian Centre for Grief and Bereavement). He found it difficult to get on with his school work and required assistance with getting extra time to complete assignments and sit for high school exams. His mother, who also came for therapy, tried to postpone separating from her husband because she knew her son would become very upset. When the separation occurred he almost immediately became anxious, afraid, tearful, angry, and his limbs ached. At the core of his anxiety were feelings of abandonment from his parents, loneliness as a family member, and anger towards his mother. He experienced a sudden change from being the eldest son of a whole family unit to finding himself in a fractured family. There were added complications after the separation as both parents rapidly commenced new partnerships. As a result of losing his family structure his view of the world and human nature deteriorated. He spent many therapy sessions talking about his feelings of hopelessness and disenchantment with human beings, such as their mistreatment of one another and lack of commitment and loyalty. The loneliness he felt was connected to his parents being preoccupied with their own issues and new partnerships. He felt lonely because he felt they showed a lack of interest and attention towards him.
There are four stages involved in grieving. There is shock and denial as an initial reaction to loss which can last up to three months. Then there is an intense concern about the loss where the person cannot think about anything except the loss. For example my client constantly thought about the past when his family as a whole went to sports events and shared close family occasions. He thought about what he previously had and the painfulness of losing that and having to live in a divided home. The sadness about the loss of family unity and the chaos of moving between two houses occupied most of his thoughts during day-to-day activities. This stage can last from six months to a year. He stayed locked in this stage for several months. It was a struggle for him partly because his parents and grandparents wanted him to ‘get over it’ and ‘move on’. There were indicators from his parents that he ‘ought to be more of a man’ and not feel the pain of the separation so intensely. This made him feel more angry and lonely because nobody seemed to really understand him. He was experiencing more physical pain with headaches, muscle aches and the inability to sleep. Having these symptoms made him feel more anxious. We worked from a sensorimotor perspective working with his body and allowing and feeling the presence of the tightness and coolness in his arms and hands. He began to feel his rage which resided underneath his body sensations. As Pat Ogden says, sensorimotor psychotherapy is a real delight because you do not need the content that comes from words because the necessary information to heal what is present is all in the body (nicabm.com).
The third stage of grieving is the most painful part for the griever. Here the person gradually accepts the reality of the loss. This stage is referred to as despair and depression. The person’s behavior can become irrational as they feel a mixture of anger, sadness, anxiety and guilt. My client felt guilty for disrupting the emotional atmosphere at home when he had bouts of uncontrollable tears and anger in the form of shouting (Australian Centre for Grief and Bereavement).
Jungian psychotherapist and writer Miriam Greenspan’s approach to grief encourages what she calls “emotional alchemy, a process by which fear can be transformed into joy, grief into gratitude, and despair into a resilient faith in life” (Platek, B). She believes in the process of transformation rather than following our popular culture which wants us to appear normal and successful. Greenspan’s willingness to be able to ‘be present with what is’ beautifully reflects how Hakomi and sensorimotor body-mind psychotherapy invites the client to be with their present moment experience. For example, as my client felt his rage, his right hand subconsciously made a fist. I directed him to become aware of how he felt when he observed his body tighten and how he felt when his mother asked his father to leave. Founder of Hakomi psychotherapy Ron Kurtz said it well: “We are asking for a verbal report on what the client is experiencing” (Kurtz, R.) The client explores their experience with the use of an experiment. For instance, the therapist directs the client by saying, ‘as you feel the right hand make a fist, and you notice your feelings of anger, I ask you to put words to your anger and sadness.’ The client may say the anger is more like rage, and the sadness like despair, and the words that come are “how can you do this to us”. With increased meaning the client begins to sob, and as these held in tears are expressed the nervous system naturally calms. With the sadness being expressed greater clarity is gained and further insight and words come, such as “I’m alone and there’s nobody here for me.” Together, my warm therapeutic presence and my repeated and ongoing availability for the client as he needed to see me, helped him transform and know that he was not alone and that there was someone there for him. My therapeutic presence was able to match where he was at psychologically and what he needed emotionally.
Greenspan said “the Buddha taught that we increase our suffering through our attempts to avoid it. If we try to escape from hard grief, we may develop a serious anxiety disorder or depression, or we may experience a general numbness. It is difficult to live a full life if we haven’t grieved our losses. Addictions have to do with our inability to tolerate grief and despair. Unrecognized despair can turn into acts of aggression such as homicide or suicide. When we don’t have ways to befriend and work with our grief, fear can turn violent” (Platek. B.). It is important to remember that everyone has their own way of grieving. We need to give it our attention, allow it to unfold and to bring us on a journey of self-discovery where we can know ourselves. As Greenspan continues, “if we can hang in there with grief, it changes from a feeling of being ‘hemmed in’ by life to a feeling of expansion and opening … where we can reach a new state of normal” (Platek, B). This is a deeper normal where we become authentic with who we are in the world.
The final stage of grieving is recovery. The goal of grieving is not the elimination of all of the pain or memories of the loss. Instead, recovery is about reorganizing one’s life so the loss is still important, but is not the center of one’s life. My client was able to excel in the Higher School Certificate, was accepted into university and studied law. He still had moments of distress and anxiety, but the symptoms diminished and his confidence as a young man blossomed.
References:
1. Australian Centre for Grief and Bereavement 2010, grief.org.au.
2. bpd.about.com.
3. Johanson, G., Hakomi in the Trenches.
4. Management of Mental Disorders Treatment Protocol Project (2004); World Health Organization Collaborating Centre for Evidence in Mental Health Policy 2010.
5. Ogden, P., Body-Mind-Spirit Integration: Sensorimotor Psychotherapy for Treating Trauma, www.nicabm.
6. Ogden, P., Integrating the Body in Trauma Treatment: A Sensorimotor Approach, www.nicabm.
7. Platek, B., An Interview with Miriam Greenspan on Moving from Grief to Gratitude, Hakomi Forum – Issue 19-20-21 Summer 2008.
8. Psychologytoday.com.
9. Kurtz, R., The Organization of Experience in Hakomi Therapy.