What My Grief Has Taught Me About Psychotherapy

by Margie Nichols, Ph.D.

In 2004 I lost my daughter Jesse four days before her tenth birthday.   For reasons of sheer survival, I went back into counseling right after Jesse died, after a hiatus of a number of years, with New York -based therapist Bruce Wood.  Among his many skills, Bruce has a great deal of experience with post-traumatic stress, which I guarantee you ensues upon the loss of a child. My own process of stumbling back to semi-normalcy (one forever has a piece of themselves missing after a loss like this) has helped my practice and informed my beliefs about psychological theory in ways I’m just beginning to understand.

More than anything it has confirmed, or re-confirmed, the value of psychotherapy. I can’t imagine getting through this without Bruce.  I have renewed appreciation for how important it is to have someone in your life who listens to you talk about yourself and your experience without wanting reciprocal attention; who is not affected by your decisions or behavior and therefore has no stake in your direction other than to help you attain your own goals; who does not judge you, but will also tell you the truth about yourself, in a compassionate way; who doesn’t nag you but doesn’t let you run away from reality, either; who is smart enough and competent enough for you to trust their guidance; and who above all makes you feel they care about you and that they will always be in your corner.

A lot of times, that’s all you need to heal – a supportive environment within which you can process your own experience and recover from your wounds.  But it also helps to have a therapist skilled in specific techniques and knowledge – sex therapy, for example, is heavily dependent on certain behavioral interventions and upon medical knowledge, some conditions, like OCD, really do require specific CBT protocols.  All therapists, in my opinion, need to have at their disposal some methods for changing thoughts and behaviors, some for helping process people trauma and emotionally charged issues, and some that help with affect, mood, and behavior regulation.  I suspect the wave of the future also includes body oriented work, as we learn more about physical ways of healing emotional disorder.  In my case Bruce is an experienced EMDR practicioner and this really helped the PTSD  I experienced from  witnessing my daughter endure three months’ hospitalization and a rather horrible death.

But the other thing I’ve learned through my own grief healing is the immense power of the unconscious mind, of stored memories, associations, and processes that have a primitive, symbolic logic rather than a rational one. We don’t understand much about the operations of this mind, although psychologists since Sigmund Freud have been speculating  Certain sounds, smells, even colors were connected to memories of my daughter, and as I untangled the web of my grief I found threads that led from her and her death back to earlier losses, childhood fears, little and big traumas suffered throughout my life.  I have gained a profound respect for grieving rituals because I understand that they allow the brain to engage in a primal undoing and re-doing that seems to heal pain and allow a future-orientation in the person who has experienced loss.  For example,  I have yet to meet a mother who does not  feel blame for the loss of her child, no matter how illogical. As the mother of someone who died in the 9/11 attacks said, “I’m his mother.  I’m supposed to keep him safe. I failed.”  And I know that no amount of rational thought dispels that feeling – but sometimes acts that can only be construed as making reparation, doing penance, or symbolically undoing and redoing the past can heal some of the self-blame.  Often the ‘reparation’ involved a certain period of mourning under circumstances of self-deprivation.   Not long ago I was working with a client who was overcome with grief over the loss of a beloved dog about eighteen months prior.  When I asked her why she hadn’t gotten a new dog, something I knew she wanted, she replied, “Cassie wants two years.”  My client’s unconscious mind told her she needed to grieve two years for her dog before she could ‘move on’ enough to enjoy another puppy, that respecting the bond she had with Cassie meant ‘depriving’ herself for a certain amount of time.

My own process has also taught me that there is an inner wisdom most of us have that guides us, and the best therapists respect that wisdom and try not to have preconceived judgments about the ‘right’ ways to heal.   I’ve found no theories of psychotherapy or prescriptions for mental health that can adequately explain some of the things that were most helpful to my recovery, and some of these things seemed doubtful at the time.  For example, within four months of Jesse’s death I knew I needed to adopt another child and that it should be an older child from Guatemala (I eventually adopted two). Although many people warned me about a ‘replacement child,’ my therapist supported me – and it turned out to be the best thing I could have done for myself and my family.  For a long time after my daughter’s death it was extremely helpful for me to keep a public internet journal, through which I exposed my grief in excruciating detail. My LiveJournal was very important – until eventually it wasn’t, and I have no idea why I needed to start it and why it was okay to stop. Periodically I need to play Billie Holiday’s  ‘Good Morning Heartache’ and sob my heart out.  Why do I need this? And why not every day?  I have a little garden that is a tribute to Jesse, and tending the garden feels like a way of maintaining a connection to my child. These things are not ‘rational’ but they are critically important.

We know so little about healing.  We know it requires love, trust and safety, but we’re pretty clueless about everything else.  Current psychotherapy research is very much focused upon comparing different theories and techniques, eg. CBT vs. antidepressant medication, exposure protocols versus insight techniques. Yet the only therapy outcome findings that are consistently replicated over time highlight the importance of therapist characteristics like empathy and active listening skills and the quality of the therapist-client bind.  In part from my own healing I’ve learned to hold all theories lightly and focus on their common underpinnings instead of their differences.   The longer I practice therapy and the more I contemplate my own growth, not only through my grief but over a lifetime, I realize I need to cultivate what the Buddhists call ‘don’t- know mind’ – ‘beginners mind’, one free of preconceptions and assumptions, one that can recognize and follow the lead of the mysterious healing process of my client’s unconscious.

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