When the death is tragic and untimely, as when a significant person dies by suicide, overdose or fatal accident, grief can be particularly complicated by a gamut of challenging emotions, ranging from horror and helplessness to anger and incomprehension.  In such cases, grief therapy needs to adopt a carefully tailored approach that recognizes the role of trauma in impeding the mourner’s integration of the loss.  In this 2-day workshop, we will begin by considering how we can quickly assess our clients’ needs in terms of the Tripartite Model of Meaning Reconstruction in bereavement, featuring obstacles to processing the event story of the death, accessing the back story of the relationship with the deceased, and revising the personal story of the mourner’s own sense of identity in the shadow of loss.  We will then consider flexible techniques that 1) help mourners not only make sense of the loss in the context of the changed story of their lives but also make sense of themselves as survivors in light of it, and 2) access and reconstruct the terms of attachment to the deceased so as to reaffirm constructive bonds in a sustainable, non-physical form, and to resolve unfinished business in bonds that are more problematic or ambivalent.

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LEARNING OBJECTIVES

Day 1:

• Distinguish between therapeutic “presence” and “absence” in the process of therapy;

• Implement Restorative Retelling procedures for mastering the event story of the loss;

• Identify markers for the use of narrative retelling of an event story of loss, and guidelines for avoiding re-traumatization;

• Summarize guidelines for Analogical Listening as a form of embodied dialogue to help clients make greater sense of their emotions and themselves;

• Describe how a non-literal, figurative form of inquiry into the felt sense of loss can help clients symbolize their implicit embodied meanings; and

• Experiment with visual arts to externalize the inner landscape of loss, permitting further dialogue with it to discover unanticipated steps toward healing.

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Day 2:

• Recognize process markers of when imaginal dialogue is called for in a therapeutic session with a bereaved client;

• Summarize the procedures involved in introducing, facilitating and processing of symbolic interactions with the deceased;

• Describe techniques for prompting client “witnessing” of the interaction and tailoring it to use safely in cases when the deceased has profoundly abused, neglected or abandoned the client;

• Adapt imaginal dialogues for use in both in-office and telehealth settings; and

• Distinguish between different forms of therapeutic prompts for imaginal correspondence with the deceased to serve goals of bereavement support, as well as to advance several distinctive goals in grief therapy.

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GRIEF COUNSELLING CONTENT COVERED

Day 1: Integrating the Narrative of the Death

We will first discuss the power of presence as a fundamental dimension of the therapeutic “holding environment” that makes deep work possible with highly vulnerable and traumatized survivors.  This will provide a context for studying how to facilitate a healing “re-telling” of the loss experience under conditions of emotional regulation, deliberation and sense-making regarding the dying narrative.  Drawing on clinical videos of clients contending with losses through both sudden natural death and suicide, we will learn to listen between the lines of the stories clients tell themselves and others about the death and how we can help them integrate the narrative of the loss into their lives with less reactivity and greater meaning.  Subsequently, we will introduce techniques for helping mourners discern the deeper significance of their experience and identify the important needs and life lessons implicit in them by listening to the unvoiced meaning of their grief, which often resides at the level of their embodied emotion.  Drawing on a telehealth demonstration of Analogical Listening, we will explore the role of metaphor in helping clients reach beyond literal language to symbolize how they carry their grief somatically, and what it can tell them and us about how they now might move toward healing.  We then consider arts-assisted methods that build on this somatic exploration and prompt clients to visually symbolize the living impact of their losses.  Externalizing them in this way can help survivors to step back, make greater sense of what they have been through and discern a way forward.  Alternating between visualizing and voicing the felt sense of their grief can help clients find the self-compassion, insight and action required to reconstruct life out of their loss.

 

Day 2: Resolving Unfinished Business in Bereavement

Facilitating symbolic dialogues with the dead using the related techniques of imaginal dialogue in spoken or written form or chair work in face-to-face work with grieving clients can promote reconstructing attachment and resolving unfinished business.  We will introduce principles of imaginal dialogue and illustrates them through clinical videos of a full session of online therapy with a young man contending with preoccupying guilt and grief after the sudden death of his father, punctuated by active discussion to highlight important processes and procedures in the intervention.  Special attention will be given to the role of such dialogues with the deceased when the pre-loss relationship with the client was characterized by complication and conflict, as commonly precedes suicide, overdose, and other forms of violent death. The utility of chair work will be illustrated in the case of parents mourning a young adult daughter’s suicide, and specialized prompts for imaginal correspondence with the deceased to address several specific therapeutic goals will be offered.  In combination, the engagement with these techniques extends emotion-focused procedures to promote not only activation and resolution of the continuing bond, but also its realignment through an alternation between self-immersive and self-distancing perspectives.