Signs of Unresolved Grief

I include questions about close family members in my Client Information Form, that can indicate unfinished grieving: If deaths or divorces occurred, in what year they happened, and the causes of these endings. I notice any affect that is displayed as they tell me about these events. If the client looks uncomfortable or seems to be retroflecting (bottling up) emotion, I comment that they seem unresolved about the loss, ask them if that’s true and if they have any sense that it is interfering with their current life.

I of course do not work with them on their unresolved grief in this first session.  There are obviously good reasons they haven’t worked through the event on their own, and we need to establish a good therapeutic alliance before undertaking this intensely emotional work.   But I know that, for the  therapy to be complete, we will probably have to address the unresolved grief at some point.  

In the first post on this topic, I talked about the woman who had been in therapy with me for about 5 years and wanted to terminate in one session.  When I explored why she was so hasty, her negative history about grief emerged and she began to realize how and why she avoided grieving.  Her resistance was connected to the death of her grandmother, who had died  about 40 years before, when she was about 8.   She was with her grandmother when she died, but her family had not fully addressed her reactions to this traumatic experience. Her parents also prevented her and her younger siblings from going to the funeral, apparently thinking a child shouldn’t experience such sad events.   And afterwards, they spoke very little of the grandmother and didn’t show much emotion when they did. 

As we talked during this session that she had initially wanted to be her last,  she began to remember important, emotionally rewarding contacts with the grandmother. She recalled how she had taught her to cook, read to her, provided milk and cookies when she came home from school.  (Her grandmother lived in an apartment upstairs from her family)    She accessed a sense-memory of the smell of her grandmother’s apartment and the feel of her body when they hugged.  She was even able to hear the sound of her voice as she recalled her sitting on her lap while her grandmother read to her.   She felt a mixture of grief, sadness, and love for the grandmother. With many tears, she expressed her gratitude for what she had gotten from her.  Over a period of a few sessions, we dealt more with her feelings toward her grandmother and she was eventually able to say goodbye to her while, at the same time, feeling more completely that her grandmother’s essence was part of her.  We realized that her incomplete mourning of her grandmother’s death had partially  prevented her from feeling a loving, appreciative connection to her.  

Empty Chair Work on Grief

I frequently work with clients who have unresolved grief using the Gestalt Therapy empty chair approach.   I have them imagine the lost person in the chair opposite them and ask them if they can visualize them there.  If so, I ask them to describe what they see, how the person looks, what the affect seems to be and whether the latter is looking at them or away.  I then ask them what they are feeling, emotionally and physically and if they would like to say that to them.  Many therapists I have supervised through the years are reluctant to use this method because they think the client would not be able to imagine the lost person in the chair. I have found, however, very few clients refusing to do this.  If they can’t form a visual image, I tell them that’s not necessary, just to get some sense of the person there.  It can be a feeling, a sound, even an odor.  

I notice whether or not they are fully expressing what they are feeling and, if not, point that out and ask them to feel the effects on them of the holding back, especially physically. Notice I do not push them to express their emotions but explore their reasons for suppressing them and the effects on them. Frequently, they are clamping down on their bodies because they are feeling a complex set of conflicting emotions, and I suggest this might bethe case. For example, they are angry at having felt abandoned by the dead person , but know logically that the person didn’t choose to die. (The exception would be where the death is through suicide in which case the anger is obviously somewhat justified and needs to be expressed) I then suggest they express the whole complex of emotions. For example, “I feel sad and miss you, but also am resentful towards you because. . . . .”

The next step is suggesting that the client switch seats, assuming the role of the person who is gone. Clients will sometimes protest that they don’t know what that person would say and I suggest that they just imagine it. Or I may suggest, after they have switched chairs, they just say spontaneously what comes to mind. In the last analysis, it is what the client imagines the dead person thinking and feeling toward the client is what’s important.

For example, an ex-client had had a very difficult relationship with a demanding, critical mother and a father who became very distant when he returned traumatized from Army service in WW II. After her mother had died while she was still in therapy with me, she imagined her up in Heaven, looking down on her and feeling guilt and sadness that she hadn’t been more loving towards her daughter. Whether or not her mother would actually have felt and said these things to her daughter is unknowable and therefore irrelevant; what is important, is that the imagined positive interchange was healing to my client.

A very moving piece of work I did with a shy, single, isolated young man in a Gestalt Therapy workshop many years ago was on his pent-up, debilitating grief about the death of his cat.   He had no close friends, dearly loved his cat and was devastated by its death. He didn’t feel free to tell other people about his grief because he expected them to ridicule him for having this such intense emotions about an animal. After I and the group members let him know that his feelings toward the cat were safe with us, he was able to pour out his grief, sadness and love toward the cat in the empty chair. It was a very intense, moving experience for all of us. When he switched chairs and assumed the role of his cat, the latter expressed love for providing a great life with him. Interestingly the cat also gave him permission to not only get another cat, but also suggested that he expand his affectional population to include humans!