Notes for Therapists


If you are a therapist

working with a parent

or anyone bereaved

by suicide or other traumatic

death, it can be hard to see

the light in the darkness.


I offer you these

observations and tips

based on my own

reading and training, as well

as my professional

and personal experience.

Keep going; we need you!



Please...


Consider your own emotional state before agreeing to work with us. This is tough work, and the hardest thing any parent will face.


If you doubt your capacity to be fully present, or suspect that you may become emotionally avoidant, then be honest with yourself about this and say no. I had two therapists whom I sensed were unable to tolerate the level of my pain, and I withdrew, then dropped out of treatment. I found the experience quite damaging.


Hold onto hope; survival is possible and pain does soften over time.


Please take time to listen, rather than rushing into treatment. Being heard and having our pain validated is immensely valuable and therapeutic in its own right. We need a safe space and enough time to tell you what has happened to us, to explore emotions and cognitions, to develop our own narrative, to absorb the shock, to process the trauma and eventually to integrate the loss.


Please be human in your response, and acknowledge explicitly just how hard this is. At a first session with one therapist she asked me to tell her my story. I did so, which took a lot of courage and ended in my being an emotional wreck. She did not react in any way. She said absolutely nothing, just continued to look at me. I felt as though she had not heard anything I had said or understood anything of my pain, even that she thought I had no right to these intense feelings. I found it hugely invalidating and I withdrew from therapy after two sessions.


Be honest about your own experience/lack of experience in dealing with traumatic grief; firstly with yourself, but also with your client. Lack of experience does not necessarily mean lack of skill.


Be open to learning from us and ask what we need from you – but be aware that we may not easily be able to put this into words.


Stay curious, ask questions, be interested. When I spoke about Anton or my feelings about Anton and my therapist didn’t ask me to elaborate, or ask any questions to further the discussion it felt as though she a) wasn’t interested and/or b) wasn’t able to withstand my pain.


Keep believing in our capacity to endure the pain, in time, and at our own pace – this cannot be rushed. Know that people can and do integrate the loss and the pain of traumatic grief, and some will experience Post-Traumatic Growth. If you don't believe we will survive, how are we to believe it?


Do not make the mistake of even thinking that your client could/should “move on” from losing a child. No parent “moves on” from this kind of grief; but they can learn to live alongside it, often using Continuing Bonds with their child to navigate the future.


We need to know that you are able to tolerate the huge emotional pain we are experiencing, and we're highly sensitive to cues that you may not be capable of this. Please try to be fully present and congruent with us at all times.


Help your client to find meaning in their life:He who has a why to live can bear almost any how” Nietzsche.


Ensure you have effective supervision and self-care.


--------------------------------


Be aware that...


The trauma needs to be processed before we can conceptualise our loss. It will act as a block to our ability to process the knowledge that our loved one is dead, and prevent us from integrating the loss into autobiographical memory. Narrative work can be helpful for this; though appraisals will need to be tested (2).


There is no ‘fix’, let alone a quick fix, for bereaved parents; there aren’t going to be any happy endings, but we can learn to accommodate the loss.


There's no linear path. We may oscillate between dark periods of Loss Orientation (Dual Process Model) that may include fear and even terror, and times when we feel numb and disconnected, or even apparently OK. Stroebe & Schut talk of the "...dosage of grief. It is arduous and exhausting to grieve, respite at times is recuperative" (7).


We may be incapable of accepting the death. We will be experiencing very intense emotions and are often preoccupied with our loved one. We may be unable to see beyond the death, and have many images of the death itself, whether or not we witnessed it. We might believe our life is meaningless and fear the future (2,3).


Our triggers are everywhere and omnipresent, unlike in PTSD. Violent loss can be far more difficult to incorporate into existing autobiographical knowledge, and particularly for bereaved mothers (2). Almost 3 years after losing Anton, I still have occasional panic and fear responses.


Yearning is the defining emotional response to GRIEF; unlike DEPRESSION which is defined by hopelessness. Its immensely hard for us to absorb the reality that we will never see our child again. And grief may morph into depression (2,3).


We may be cognitively or emotionally avoidant, or just not ready. Your collusion with what may be unconscious avoidance will not help. If you are anxious about it, just imagine how terrified we may be. Proceed with sensitivity and challenge gently.


Feelings of guilt may be hiding a sense of our own helplessness (4), but will need to be explored with the deepest sensitivity you can muster.


Help us to give ourselves a fair trial before committing ourselves to a life of self-blame and criticism; skilful use of Socratic dialogue to gently challenge our negative cognitions and facilitate restructuring is particularly important for bereaved parents who have lost their children to suicide. We'll often have a skewed focus towards the negative and be unable to recall all the positive things about the relationship with our child. This is where CBT can really help.


See also: My post about my own experience of finding therapy

My post about Traumatic Loss Dual Process Model Continuing Bonds Accommodation Theory



References:

  1. Class, D, Silverman, R and Nickman, SL (1996) Continuing Bonds: New Understandings of Grief Taylor & Francis US

  2. Dr Michael Duffy, Queen's University Belfast. One Day Workshop (February 2022). New approaches to trauma and traumatic grief. Responding to unexpected and traumatic grief: A cognitive approach to traumatic and complex grief.

  3. Duffy, M & Wild, J (2017). A cognitive approach to persistent complex bereavement disorder (PCBD) The Cognitive Behaviour Therapist vol. 10, 1-19

  4. Dr Phyllis Kosminsky and Jan McGregor-Hepburn Nscience Therapy Masterclass Series: Working with the pain of loss, March 2022

  5. Murray Parkes, C & Prigerson, H.G. (2010). Bereavement: Studies of grief in Adult Life 4th Edition.

  6. Margaret Stroebe, Henk Schut , and Kathrin Boerner (2017) Cautioning Health-Care Professionals: Bereaved Persons Are Misguided Through the Stages of Grief OMEGA—Journal of Death and Dying 2017, Vol. 74(4) 455–473

  7. Stroebe, M & Schut, H, Utrecht University, The Netherlands. The Dual Process Model of Coping with Bereavement: A Decade on OMEGA - Journal of Death and Dying Vol. 61(4) 273-289, 2010

  8. Lois Tonkin TTC, Cert Counselling (NZ) (1996) Growing around grief—another way of looking at grief and recovery, Bereavement Care,15:1,10,DOI: 10.1080/02682629608657376




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