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August 31, 2017

Grief is More than Just Being Really Sad

Of the many challenging topics I deal with as a therapist, grief and trauma are up there. I was recently asked how the two overlap in my world. To answer that, let’s start with a story:

It was a normal, quiet evening at the office. A client and I had already been sitting together for 30 minutes that evening. There was no lack of conversation happening. On this night it wasn’t our exchange of words that caught my attention as being special. Rather it was his decided, momentary pause and deep sigh mid-sentence, atypical for him. He sat there for a second having a deep personal realization:

“You know”, he said. “Sometimes the grief process feels more traumatic than actually losing her”.

It was a profound statement from a man who likes to keep things close to the chest. Fighting off tears, he talked about the occasional anguish that he still felt over the loss of his wife; how it caught him off-guard at times. It was intense and sudden. It wasn’t that her passing wasn’t distressing but he had worked through the initial impact of that. Now came the hard part — learning how to rebuild a life without the original pieces.

There was more conversation that followed about the transition through her death and back into life. I couldn’t help but notice the overlap between Trauma and Grief throughout. It made me wonder why we don’t talk about them in the same sentence more often. Thinking back over the years of working with clients who had either experienced a traumatic event or had grieved a loss, there definitely seemed to be a shared link in their processes of healing.

To start understanding their similarities, we can begin with a definition. The definition of psychological trauma comes in many ways: when an overwhelming amount of stress affects an individual causing them to exceed their emotional resources; a “stuck” process in which an individual has difficulty accommodating or assimilating significant sudden information into their normal world view. Grief often can be described in a similar way — as the deep and conflicting feelings that come as the result of the end of or the change of normal patterns of being.

Much like my client hinted at above, the process of grieving the loss of someone you love can be intense in itself. Most people are familiar with Elizabeth Kubler-Ross’ “Stages of Grief”: Denial, Anger, Bargaining, Depression and Acceptance. But when it comes time to grieve they often look to this information to inform what their process “should” look like. What most fail to be aware of is how varied the grieving process actually is and how unique it can be day to day. In fact, one of my first questions to clients is “How do you think you are SUPPOSED to do this?”. The answer often has an impact on how they would have grieved alone had they not come to see me, or how we start our work.

Akin to working through trauma, grief is no short process and it looks very different on an individual level. With so much variability, how can any therapist genuinely help either group of people? Well, fear not. There are great approaches to help people work through both. I use a model called Acceptance and Commitment Therapy to help my grief clients. Here’s a basic view of the model and a little bit about how the steps apply to grief.

Acceptance is the first principle of Acceptance and Commitment Therapy. The raw process itself is about learning to not avoid feelings and thoughts we judge as “bad” or “negative”. When it comes to grieving, this step can be tough. It means making room in your emotional world for the thoughts and feelings you’re having to exist. We learn to breathe into those feelings and allow them to be what they’re going to be. Often, I see clients fight this step because they are afraid they’re going to drown under the emotions. They try many things to hide from their thoughts and feelings (which only makes them worse in the long run). Acceptance for grief also means forgetting any “rules” about how to grieve properly; “I SHOULD be doing this” or “I SHOULD be feeling that”. Holding on to those rules will only slow down the process. In many ways, this is akin to the Exposure piece of EMDR.

This acceptance is somewhat predicated on engaging with two other main areas in ACT; Mindfulness and Defusion.

Mindfulness is being aware of and in-contact with your present moment. To deal with all the thoughts and feelings we’re having, we need to know what they are. For many people this means stopping to be present and, in grief work, to anchor ourselves. When we let our brain latch on to its stream of consciousness it can carry us away like we are being swept out to sea. Stopping to turn our attention toward our general state of being in the present tense can help us feel grounded.

Defusion is a secondary process of Mindfulness in that it also helps us feel grounded. Defusion is the active process of putting some space between ourselves and our thoughts. Normally, we live a very “first person” life with our thoughts: we “are” the thought: we call that “Self-as-Content”. But by defusing, we can become an observer of our thoughts — i.e. I notice that my thoughts are racing, I notice that I’m having feelings of being overwhelmed. This nonjudgmental process allows us to recognize that we aren’t actually our thoughts but they happen in a larger context of life. We call this “Self-as-Context”. It serves to help us recognize that our thoughts and feelings are manageable.

Values is another key step and living in agreement with our values is the important part. As you’re working through your grief process are you honoring what’s actually important to you? If family togetherness is important to you, are you leaning into that or are you pushing away from them? Doing so will create more psychological friction.

The Committed Action step is all about moving forward. One of the things I see that keep people stuck in grief (possibly turning it into complicated grief) is a “standing still” or a “moving backwards”. There is much to be learned about ourselves from the grieving process: our true nature, our capacity to love, our range of emotions. Using that information to move forward is extraordinarily helpful. When people shut down and don’t engage in these processes or, worse, sabotage themselves it fuels the grief process more. Not only does it not help the grieving process but it means that you’re having to overcome even more during the later parts of the process.

Much like dealing with trauma, grief work and the secondary trauma that can come requires self-compassion. It works best when we reduce our amount of unhelpful self-judgement and can maximize our psychological flexibility. The overlap, at this point, seems obvious between the two challenges and I hope that by reading this, you now know a little bit more about how they fit together and how I approach the healing process.

If you’re engaged in this process now or know someone that is, I would be happy to answer any questions you have. I am blessed to have been a part of so many grief journeys and would love to be a part of yours, even in some small way. Feel free to reach out to me on Facebook if you want to connect or via email at alex@riverpathcolorado.com

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