In this blog we cover a therapeutic process focused on grief. The hope of these blog posts is to offer those who need therapeutic help, an opportunity to see how a therapeutic process can unfold, and by this allow some level of resonance with the process of healing.
The present case concerns Inge and Erik, a Flemish couple in their 40s living in Belgium with their two children, ages 4 and 7. When Inge and Erik sought couple counseling both confessed to their therapist, that they had grown apart over the ten years of their relationship, a pattern linked to Inge’s intense engagement in her work as an international business consultant. Across eight sessions of earnest efforts in couple’s therapy, both spouses stated that they had increased their mutual understanding, felt closer, made behavioral changes in their lives to permit more time together and recommitted to their relationship.
But in the course of exploring significant family relationships with each partner, Inge reported to An, her therapist, that she had lost her mother when she was 17 years old, a disclosure that was accompanied by an immense wave of sadness and tears. Erik knew this, but he had never met her mother, and Inge rarely spoke of her. Over the course of the sessions, both Erik and An noticed that Inge’s grief for her mother remained a very sad and vulnerable place for her, one that continued to take her breath away each time the conversation of therapy touched on it.
As the marital therapy came to a successful conclusion, Inge approached An with a request for additional individual sessions to work on her prolonged and preoccupying grief, feeling that it would be too difficult to do so with her husband present. Both partners readily consented to the plan, with the intention to then bring them back together and share the story once Inge herself had found words for a grief so deep and pervasive that it seemed to elude expression.
In the ten sessions of grief therapy that followed, Inge remained very “stuck” in her grief, nearly unable to access memories of her childhood or of her time with her mother. Witnessing this striking disconnection from her own history and Inge’s visible suffering with each mention of her mother’s death over 20 years before, An noted that “it was as if everything were put away in a very secure place, which made it possible for her to function in her job and daily life.” Working very slowly and with great caution, the two gradually began to access some memories of Inge’s mother and, as she became better able to “hold” them, invited Erik back in to share the story.
It was at this point that Robert Neimeyer, a grief counseling specialist visiting Belgium to offer some days of professional training in grief therapy, opened the opportunity for Inge to have a single session of therapy with him to supplement An’s efforts. After discussing this possibility as a couple, Inge and Erik accepted the offer, choosing to have Inge meet with Bob individually.
Therapist (T): Inge, dank je wel nog eens [Thank you once again]. I’m eager to learn something of your experience, and I wonder if we might begin with just asking you what kind of hopes or expectations you might have about this hour, about how it might be useful for you?
I: Uhm, I don’t have a lot of expectations, and I’m not sure what to expect, but one thing that would help me is to find other ways of thinking about, uhm, thinking about [long silence] your place in the world among people, when there’s a change in configuration, like when you lose someone, how you come back into your balance.
T: Yeah, yeah, because the loss of another throws us off balance [gestures with arms and torso like a tightrope walker], and we find ourselves having a hard time finding our footing in the world again, in the sense of a solid place. And the loss that you’ve had, I understand, is the loss of your mother? [Inge nods, and immediately struggles with tears.] And just with the mention of her name, the feeling rises in you. [Inge begins to cry.] Yeah [gently]. So what is that feeling [gesturing with hand at the level of his torso, like a rising fountain], if you were to describe it in words that were even partially adequate to the experience... What would we call that, the feeling that comes now?
I: Uhm (sigh) . . . Being overwhelmed. [T: Overwhelmed, yeah.] [Pause] And in a way reliving it a bit [crying].
T: Reliving it a bit. Reliving the experience of her dying?
I: [Nods yes, tearfully.]
T: So the overwhelming feeling is one of . . . ?
I: Yeah. Just, uhm, the loss, the loss of balance, loss of the whole way that you thought your universe was functioning. And to have that go, disappear and be changed, and feel that’s out of your control.
In response to Robert's invitation to articulate her expectations about how this hour might be helpful to her —an approach used to foster client “agency” in the therapeutic process — Inge pauses and in a slightly self-distancing, second-person voice, seeks a way to make sense of her “place” in the world in the wake of loss, to recover a sense of “balance.” Hearing these metaphors of Inge's existential position, Robert echos the significant phrasing, lightly acting out the image to give it more embodied presence in the room. Together they seek a verbal handle for Inge's feeling and spontaneously elaborate on Inge’s position in a universe where balance and coherence has been lost, but a simple mention of Inge's mother loss evokes strong emotion and tears.
T: Yeah. It’s a deeply, deeply unwelcome change in the structure of the world, and you’re left trying to relearn that world and relearn yourself because both are changed in this experience. . . . What position did your mother have in this world, in this universe of your childhood and young adulthood?
I: I was 17 when she died. [T: 17.] And she’d been ill on and off for a long time. But when she died, it was still a surprise because we didn’t talk a lot of those things, and she was very much a pillar figure in our house. She was a very dominant person, but not in a bad way. But she was called “Mrs. Thatcher” in her workplace [T: Ah, Mrs. Thatcher, the Iron . . .] The Iron Lady! [smiling and slightly laughing]. And she was, not in a bad way, but she got her way in everything, had control over everything, she governed everything. In a way, she knew exactly what she wanted, what to do . . . when to do that.
T: The structures were there, and she was the one who kind of helped build them and keep them in good order.
I: Right. And she did that for us children, but she did that for other relatives, for my father. There wasn’t a big balance there, so she was very much a governing person in every sense of the word.
T: So in a way she was almost like a center of gravity or something for this solar system of the family, right? [Inge nods.] And it’s almost like, how does the solar system reorganize when the sun is extinguished, right?
I: Right [long pause, crying silently].
Their exploration of Inge's mother’s “governing” position in the family leads Inge to offer an affectionate characterization of her as “Mrs. Thatcher,” the United Kingdom’s forceful Prime Minister during the 1980s. Then with Robert's suggestion of a modest extension of Inge’s metaphor of her imbalanced universe following her mother’s death, she moves into several moments of wordless weeping, leading ultimately to Robert's gentle intervention.
Continue to part 2 below to find out how Robert and Inge continue their quest for connection.
T: I wonder if you would be comfortable doing something with me just a moment, and that is, I would invite you just to close your eyes with me for just a second [closing eyes as Inge follows]. And allow us to concentrate our breathing . . . just to allow our lungs to fill and empty . . . fill and empty [speaking slowly and opening eyes to follow Inge’s nonverbal behavior], in a natural rhythm. Just feeling maybe with each breath just a little release of the overwhelming feeling, recognizing that it’s always accessible . . . and that that feeling probably has something to tell us . . . and teach us about this woman who was your mother and still is your mother, in an important sense. [Inge opens eyes.] And as we sit here speaking to each other, and as we kind of invite her to join us for that conversation in the ways we can, our goal is mutually to learn something about who you are, what you need, but also about who she is and what she would need, in seeing her daughter now, carrying this grief. [Inge nods, silently.] So I wonder, would you be willing or be able to introduce her a little more, this Iron Lady [Inge laughs] who is the governor and the center of this kind of universe. What was her name?
I: Yvette. [T: Yvette.] Uhm, she worked always very hard, and she herself was an accident. At the time when she was born that was a big deal. [T: Ah.] But she had felt and we felt as children that she felt as an unwanted person for a large part of her life. [T: Wow.] And so that was something. She read a lot of books about it. She never talked to us about it, but we could sense that she had that feeling in respect of her own parents.
T: And a real effort, it seems, across a period of years to make sense of that? Or to say, “Who am I and where do I fit in?”
I: Yes, and to get appreciation from her parents, which never really was to her satisfaction, and that was very frustrating. And I think that’s probably why she worked so hard. [T: Ah.] Because it was something she felt she needed to make up for. And so she was a kind of person who would make all her own vegetables in the garden; she made all of our clothes [T: Wow.] She worked as a teacher; she did a lot of things. Even the evening before she would go to the hospital, she would wash all her clothes, and she made sure all the food was in place, and the laundry was done. She did it by hand, even if she was meant to be in the hospital the next day. So she was this kind of indestructible force [smiling].
In the presence of Inge’s strongly dysregulating and isolating grief, Robert begins with a nearly meditative moment of mindful breathing, matching her respiration and gradually slowing it in synchrony with his own. As her strong emotion softens in response, and she spontaneously re-engages him, Robert invites Inge to “introduce her loved one”, to appreciatively conjure her mother up to re-access a seemingly broken bond. What emerges is a proud but incipient narrative of her mother’s relentless work ethic, rooted, Inge says, in her being an unplanned and unwanted child, and her lifelong effort to compensate for that.
T: Yeah, almost an indestructible force. And how strange that must have been for her as well for you to witness this force having to contend with the force of illness. [Inge: Yeah.] A cancer of some sort?
I: Yes, for years. And there were times, all through my high school period, she was ill on and off. And there were times when I was young and I would go to the hospital to visit her, and I liked those times because she would sit still and not work. And I could talk to her! [laughs with therapist] And she would talk to me, and so we had that special time together. So there were times when her illness was not a threat in that way. . . .
T: Was almost a friend in that way?
I: Yes. It was something that was there.
T: And it opened a space for a special kind of mother-daughter conversation that with all of her busyness would otherwise be hard to find.
I: Right. And there were other times or times when she got really ill, and she asked me to read to her. She had a book that was by Siegel, Bernie Siegel. She read a lot of books about self-healing with thoughts about positive thinking. And she was in a lot of pain; in the end, she was in a lot of pain because the cancer had spread. And we read to her, and it was books in English [laughs]. And she would say, “Is it okay for you to read so long to me in English?” [T: Wow.] And so we would sit with her, sometimes reading. . .
T: So part of your remarkable English language competence was really born in the crucible of that connection with her and reading to her?
I: Probably.
T: Wow, so you were giving that to her as a kind of gift. But she also kind of gave that to you as kind of gift, that you bring forward to me, even.
I: [Smiling tearfully] She was an English teacher [tenderly].
T: Ahh. She was an English teacher [nodding].
I: So that’s why they called her Mrs. Thatcher [smiling]. English teacher with an iron hand! [Both laugh.]
T: How perfect that is! I’m sorry to say I’m not Ronald Reagan. I can’t exactly be the counterpart in the story of relationships across the sea! But it’s a fascinating thing to meet her in this way. If you could picture her to convey what she looked like physically, what would I see in a picture of her?
Echoing but qualifying Inge’s description of her mother as an “almost” indestructible force, and having already begun accessing the back story of her personhood, Robert subtly opens the door to the event story of her dying. What emerges is surprising. The periods of her mother’s illness were more friendly than threatening, slowing her mother’s otherwise intense activity, and permitting a special sort of mother-daughter bond. Significantly, this involved long exchanges in English as Inge read to her mother during her treatment, consolidating Inge’s language competence as well as their relationship. It is a short inferential step to formulate this as a legacy gift from her mother, as well as a reciprocal gift given to an ailing parent by a loving child. Connecting these dots to their exchange in English completes the circle and continues the work of invoking Inge's Mother’s presence as a third participant in the therapeutic triad.
Continue to SHE COULDN'T GET OVER HER MOTHER'S DEATH: WHEN SAFETY WAS LOST to find out how Robert and Inge invite Inge's Mom presence into the room.
Wishing you Well,
Your Shrink in Bansko
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