Working (as a therapist) Through Grief – by Andrea Hall
As the anniversary of a devastating loss in my life approaches once again, I reflect on the experience of working through grief as a therapist: working through my own grief, and working as a therapist while grieving. I’m no stranger to this process (on either side of the client/therapist seat), though time continuously gleans new discoveries. This year, join me as I take stock of my four most felt “stuck points”: anticipation, avoidance, hierarchy, and authenticity.
(un)Anticipation
As therapists, we often have a sense of our clients’ presenting issues. When we receive new referrals, we may be offered a one-line overview, and when we initially consult, we may hear about the main themes. For existing and returning clients, we are familiar with the pillars of their therapeutic journey. Yet once in a while, a reference to loss can arise unexpectedly; when this reference is particularly illustrative, or in some way parallels my own loss, I have found myself feeling winded, momentarily unable to breathe.** Of course, the fear is that I won’t adequately attune to the client, or that any lapse in how I offer my response will somehow signal to them a need for caution in further disclosure. These are my fears, my sticky moments. My default: aim to show up as a human with human responses, while maintaining the centrality of the client’s experiences and emotions. (Stay tuned for a thought on self-disclosure below.)
**On one occasion, a long-time client (whose work with me was entirely unrelated to grief/loss) unexpectedly shared an anecdote, with the intended themes of love, compassion, and hope. They described two hospice patients in adjacent rooms. One patient, confined to their bed, had a window which faced onto the hospice parking lot. The other patient, still mobile, would visit the other, and would describe the beautiful nature scene that they overlooked from their room, bringing reprieve and delight in the imagery. When the latter patient passed, the former patient requested a change of room, so they could view the scene their friend has described. Upon arrival, they found no such scene, only the realization that it had been imagined and conveyed to them from a place of love, compassion, and hope. Despite every ounce of physiological restraint I could enact, tears involuntarily gathered in my eyes. I hoped I could blink them back before the client saw them. I couldn’t. The client looked up at me, nearly shocked, and asked if I was okay. I concisely assured them that I absolutely was, and shared that my sister’s hospice window had faced a parking lot (ironically, with a view overlooking a beautiful nature reserve on the other side of the building). I thanked them for their observation, and for the anecdote, and proceeded to connect the anecdote back to the theme we had been exploring in their life.
Avoidance
Anyone else ever feel like running away from the wrenching pain of grief? Me too. And I have tried. In addition to being a therapist, I’m also a parent; in or outside of therapy room, my focus, attention, care, priority is often directed toward others’ emotions and experiences. I quite frankly don’t have time for grief much of the time. Many of you will recognize immediately that this mindset can spell trouble. When bereavement, loss, grief (or any other topic that ‘hits home’ for the therapist) arises for clients in session, we turn our gaze away from what comes up for us in the moment, with the promise that we return to explore it at a more appropriate time. But sometimes we may not feel like revisiting it again later, once the initial swell has subsided. So maybe we don’t (this time). And maybe next time, too…. Remember, grief hurts, right? This past year, I did a lot of running from my grief. I packed it in a proverbial box and placed it on a proverbial shelf so that I could be the best therapist and parent that I could be. Unsurprisingly, it started to pop up in places and in ways that I hadn’t expected. Some of the wisest people in my life started to gently suggest that perhaps my arising complaints (often physiological) were connected to something emotional that was unresolved. I ditched my avoidance experiment and tiptoed over to the other side of the seesaw, throwing myself into exposure and releasing myself into the mysterious depths of EMDR. In sum, that which we try to run from will eventually catch up to us.
Hierarchy
For those who have experienced a premature, sudden, or unanticipated loss, thoughts that may arise include: why did this happen, this never should have happened, it feels unfair, it was too soon. The loss can feel incomprehensible. Amidst the painful experience of grappling with this type of loss, feelings of anger – even resentment – can arise. The loss may be compared to others forms of loss; it can feel like there is a hierarchy of understandable losses. Is a child who was unexpectedly struck and killed “worse” than someone who died of natural causes late in their life? Is there a less impactful stage of life to lose a parent, or a partner? Does the age of a person or length of their life when they passed factor into how we validate the impact of a loss on those bereaved? Or, perhaps, the manner in which they passed and how long those bereaved had to prepare for the loss somehow makes it more “manageable”. Until returning to this work, now bereaved, I had never anticipated that grief could somehow be scrutinized, prioritized, judged, or compared. How we may assess grief and its impact is rooted in our beliefs (gone forever, or in a better place?), values (self-determination, or immorality?), biases (did they have a chance to “live their life”, or not?), and so forth. If loss existed on a hierarchy, it is likely that the rankings would be different from one person to the next, and may even change across one’s own life stages. In working to hold the devastation of my own loss, I am grateful that this work has shown me there is often no “good time” to lose someone we love. What we might wish for ourselves and our loved ones (i.e., to live a long life and have a peaceful death), would be contradictory to resent for others.
Authenticity
I remember as if yesterday one of my first encounters as a therapist attempting to support a loss. A couple had entered my office for an initial session. I had no knowledge of their history or presenting issue (a common experience at a publicly funded organization in an underserved community). I only knew that I would need to call an interpreter to have on speakerphone throughout the session. The couple shared that their newborn baby had died in hospital hours after birth. I saw their emotions before I understood their words. They waited eagerly for my responses to come second-hand. I prayed that they heard my tone, and that my words translated exactly how I meant them. Underneath the obvious challenges, my body still literally ached from having just experienced a miscarriage in the days prior. My hormones likely still in overdrive, I thought about my first baby waiting for me to get home from work. At some point during the session, as the couple spoke further about their loss, I could no longer blink back my own silent tears. There seemed not enough words (in my language, at least) to convey my how much I felt for the tragedy and complexity of their experience. Despite my acute awareness of my own shortcomings in this session, I learned that day that my humanity counted more to this couple than anything I might have said to them. They came back to see me a few more times until pregnant once again, and shared the feedback of feeling that their loss had been felt and understood. For the therapist, self disclosure exists across a spectrum between conveying a reaction or thought, to less likely occasions where a more personal experience is shared to help illustrate, normalize, or connect to the client. Regardless of the degree of self disclosure by the therapist, it is expected (professionally, ethically) that the disclosure is offered for the sole purpose of providing therapeutic benefit/value to the client. The absence of some degree of self disclosure as it pertains to bereavement/grief is challenging. Sometimes it is only our tone of voice or facial expression that may reveal our connection to the magnitude of a client’s experience. With that awareness, I continue to reflect on how I bring my own authenticity to my work with clients who are grieving.
Thoughts Continued
As I turn the pages of the calendar, I find both sadness and relief in the inevitable nature of time pressing on. Though I don’t yet know what is to come on my own grief path, I am learning to expect that there will surely be something; I am grateful to my profession and to the clients who open their lives to me for pushing me to places I may not have otherwise ventured.
What are Self-Care and Resilience?
Resilience doesn’t mean a person will not experience challenges or distress – it’s quite the opposite (American Psychological Association, 2020). Resilience refers to the capacity and process of overcoming stress and adversity in an adaptive manner that maintains normal functioning (i.e., physically and psychologically; Wu et al., 2013). 
Already you can see the similarities between self-care and resilience, they both may seem intimidating and difficult to practice. However, just like anything else, these are skills that can be developed over time. You can start small and gradually build up your habits. 
This month, we are celebrating Silm