Humanistic Therapy for Traumatic Grief

Humanistic Therapy for Traumatic Grief

Humanistic Therapy for Traumatic Grief

Humanistic traditions (H-T) “naturally lend themselves to meaning-making interventions” (Piazza-Bonin et al., 2016b). The alliance is considered foundational to H-T as a catalyst for change (Piazza-Bonin et al., 2016a). H-T include person-centered therapy,constructivist therapy, and humanistic-existential (H-E) therapy. The person-centered therapy’s primary tenet is that clients have the necessary inner resources to make their decision with an empathetic therapist’s support (Piazza-Bonin et al., 2016a). Constructivist therapy focuses on a narrative to develop meaning-making in an otherwise chaotic world (Piazza-Bonin et al., 2016a).

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treating traumatic grief with Humanistic Therapy

Humanistic Existential therapy is a philosophical approach that faces existential questions focused on purpose, freedom, and responsibility to promote growth (Piazza-Bonin et al., 2016a).

David Cain, Ph.D., Kirk Schneider, Ph.D., and Robert A. Neimeyer, Ph.D. each took a different bereaved client through person-centered, H-E, and constructivist approaches, respectively (Piazza-Bonin et al., 2016a). To analyze the clients’ moment-by-moment development, they used the Innovative Moments Coding System (Piazza-Bonin et al., 2016a). Innovative Moments (IMs) in the session tracked changes that move away from the problematic narrative, including Protest IMs (P) that tracked the client’s new thoughts, Reflection IMs (R) that tracked the client’s ability to reflect and reconsider the problem, Action IMs (A) that tracked new coping strategies or solutions, and Reconceptualization (RC) that combine the last three elements to create change and ultimately promote a new self-narrative (Piazza-Bonin et al., 2016a). The researchers found that the constructivist approach had clinically significant R IMs and RC IMs, reflecting the client’s improvement in creating new life meaning after bereavement (Piazza-Bonin et al., 2016b). Across the three nuanced approaches, there was a “linkage between particular therapy procedures (e.g., chair work, narrative exercises, embodied meditation) and the production of change” (Piazza-Bonin et al., 2016b, p. 300). The researchers also objectively measured alliance in 5-minute spans and consistently found high alliance on all three accounts (Piazza-Bonin et al., 2016b). Participants completed a Global Assessment of Functioning (GAF) before and after the six sessions, and each of the three clients had significantly improved on the measurement (Piazza-Bonin et al., 2016b). Overall, the case studies demonstrated a connection between the alliance, humanistic therapy techniques, the self-report measurement, and the clients’ movement from grief to growth (Piazza-Bonin et al., 2016b).

 REFERENCES

Piazza-Bonin, E., Neimeyer, R. A., Alves, D., Smigelsky, M., & Crunk, E. (2016a). Innovative moments in humanistic therapy I: Process and outcome of eminent psychotherapists working with bereaved clients. Journal of Constructivist Psychology, 29(3), 269-297. https://doi-org.lib.pepperdine.edu/10.1080/10720537.2015.1118712

Piazza-Bonin, E., Neimeyer, R. A., Alves, D., & Smigelsky, M. (2016b). Innovative moments in humanistic therapy II: Analysis of change processes across the course of three cases of grief therapy. Journal of Constructivist Psychology, 29(3), 298–317. https://doi-org.lib.pepperdine.edu/10.1080/10720537.2015.1118713

 

 

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Grief to Growth

Overall, the case studies demonstrated a connection between the alliance, humanistic therapy techniques, the self-report measurement, and the clients’ movement from grief to growth (Piazza-Bonin et al., 2016b).

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Limitations

These case studies created preliminary data on the effectiveness of utilizing H-T for complex grief; however, the results cannot be generalized due to only observing three case studies.

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IMPLICATIONS

It is promising that grief symptoms may significantly reduce after only six sessions utilizing humanistic aproaches. (Huang et al., 2021).

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Next Step

I am here to support you through you traumatic grief by utilizing humanistic techniques for you to heal, move into greater acceptance, and reconnect with your life. 

Treating Traumatic Grief with MBCT

Treating Traumatic Grief with MBCT

Treating Traumatic Grief with MBCT

Mindfulness-Based Cognitive Therapy (MBCT) is a Mindfulness and Acceptance third-wave behavioral tradition that recognizes thoughts, feelings, and somatic experiences with acceptance and free of judgment. It is an evidence-based practice that improves symptoms of depression (Huang et al., 2019). 
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treating traumatic grief with MBCT

MBCT may also be an effective treatment for traumatic grief, which includes depressive symptoms such as rumination, wherein clients “attempt to avoid being engulfed by the catastrophic stories of what these cognitions associated with them.”

Huang et al. (2019; 2021) researched 8-week group MBCT programs with 19-23 bereaved individuals in Taiwan who had lost a significant relationship within 6-months to 4 years utilizing fMRI scans alongside emotional regulation self-report measurements. Pre-treatment fMRI scans of participants from Huang et al. (2019) showed activity in the thalamus, creating heightened emotionality that inhibited cognitive functioning. The fMRI scans coincided with the indications of rumination in the grief self-report measures. Post-treatment fMRI results indicated a clinically significant increase in emotion regulation and executive function in participants (Huang et al., 2019). Pre-treatment fMRI scans of participants from Huang et al. (2021) indicated heightened activity in the brain during a resting state, which manifested as rumination and a distracted mind. Post-treatment fMRI scans of participants showed decreased activity during resting state, indicating decreased rumination, distractibility, anxiety, unregulated emotions, and an increased calm and mindful resting state (Huang et al., 2021).

 

 

REFERENCES

Huang, F., Hsu, A., Chao, Y., Shang, C. M., Tsai, J., & Wu, C. W. (2021). Mindfulnessbased cognitive therapy on bereavement grief: Alterations of restingstate network connectivity associate with changes of anxiety and mindfulness. Human Brain Mapping, 42(2), 510–520. https://doi-org.lib.pepperdine.edu/10.1002/hbm.25240

Huang, F.-Y., Hsu, A.-L., Hsu, L.-M., Tsai, J.-S., Huang, C.-M., Chao, Y.-P., Hwang, T.-J., & Wu, C. W. (2019). Mindfulness improves emotion regulation and executive control on bereaved individuals: An fMRI study. Frontiers in Human Neuroscience, 12. https://doi-org.lib.pepperdine.edu/10.3389/fnhum.2018.00541

 

 

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Emotional regulation

The fMRI also showed continued raised activity during emotionally arousing situations, demonstrating that the brain began activating at appropriate moments of arousal rather than remaining in hyper-arousal (Huang et al., 2021). 
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Limitations

Some limitations in the MBCT research by Huang et al. (2019; 2021) are that there were small sample sizes, no waitlist control groups, losses occurred up to 4-years prior, and the relationship to the deceased varied. 
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IMPLICATIONs

Despite these limitations, it is promising that grief symptoms and emotional regulation, including rumination and sadness, may significantly reduce within a couple of months utilizing MBCT techniques (Huang et al., 2021).

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Next Step

I am here to support you through you traumatic grief by utilizing mindfulness and cognitive therapy techniques for you to feel calmer and more like yourself again. 

Are you in Suspended Traumatic Grief?

Are you in Suspended Traumatic Grief?

Jasper National Park Waterfall

Are you in Suspended Traumatic Grief? 

 

A few years ago, new buzzwords became prominent including: pandemic, quarantine, face masks, isolation, social distancing, ICU unit, COVID testing, death toll, virtual learning, and telehealth. The pandemic set the stage for increased demand of teletherapy sessions due in part to people grieving unprecedented losses and facing the associated anxiety and depression. In the last couple of years and months, horrific war and acts of terrorism have broken out and globally people are facing devastating and traumatic losses. As Vázquez Bandín (2020), a psychotherapist based in Spain, described at the height of the pandemic, “Living a loss is painful and difficult. In these times of pandemic disease, it is even more distressing.” The author spoke to the unique trauma of being “powerless with an unfinished history, with an unfulfilled human task: to be able to see their dying off, to be able to bury their dead, to be able to say goodbye to them, to be able to have a proper grief. It is difficult for the mind to close what is left unfinished in the experience. It becomes an obsessive thought, a permanent shock, or even worse, it turns into some form of physical or mental illness; in short, a trauma and a suspended grief” (p. 358). In this suspended grief, mourners have been left with the “impossibility of the living to be comforted in close proximity to others – without hugs, touch, and bodily affection…no way to say goodbye or have a memorial or ceremony to honor and gather with friends and family” (Vázquez Bandín, 2020, p. 358). The collective pandemic isolation combined with grieving loved ones created a storm for complex traumatic grief. Vázquez Bandín (2020) urges that “….the help of professionals is recommended in the case of coronavirus 2019 crisis, not only because living a loss is a painful personal process to endure but also because these losses have occurred in catastrophic and devastating social conditions” (p. 357). 

Traumatic grief, also known as complex grief, goes beyond the normal bereavement process and a traditional trauma lens because it brings with it unique psychosocial and neuropsychological elements (Hagl et al., 2015; O’Connor, 2013; Alonso, 2020). It is not unusual for psychopathology to follow after a traumatic loss. Estimates range from 10-15% of people who lose a loved one experience heightened depressive symptoms and posttraumatic symptoms that extend beyond the typical bereavement passage of time, which may be in part due to pre-occurring individual biological, psychological, or environmental stressors or due to the nature or type of loss such as unprecedented losses due to a pandemic, war, or a loss incongruent with the natural developmental timeline such as losing a child or an adolescent or a young child losing a parent (Alonso, 2020; O’Connor, 2013). Not only are grievers left to process the traumatic and sometimes unfinished business of the loss, but they have also lost emotional and practical support and possibly financial security (Hagl et al., 2015).

Traumatic grief symptoms may include but are not limited to depression, intense yearning, emptiness, numbing, activity avoidance, anxiety, ruminating thoughts and may precipitate psychosomatic occurrences, substance use, and increased risk of death by suicide or death due to accidents or health issues within the first year after the traumatic loss (Alonso, 2020; Hagl et al., 2015).

Persistent Complex Bereavement Disorder, includes a 12-month minimum for adults of either or multiple expressions of “persistent yearning…intense sorrow…preoccupation with the deceased” or “with the circumstances of the death.” In addition, at least six symptoms related to “reactive distress to the death” including but not limited to “marked difficulty accepting the death” or “social identity disruption” such as, “a desire to die in order to be with the deceased” (p. 789-790). A specifier of “traumatic bereavement” is proposed that includes the death of a loved one due to homicide or suicide. 

Some people have yet to process the grief of those lost by covid and many more will need support from other global traumatic wars and acts of terrorism that have taken place in the last couple of years and months.

If you suspect you may be suffering from traumatic grief or persistent complex bereavement for any reason, you do not need to go through it alone. I am here to support you during this difficult time. You can go to my contact page to reach out.  

References

Alonso-Llácer, L., Barreto Martin, P., Ramos-Camos, M., Mesa-Gresa, P., Lacomba-Trejo, L., & Pérez-Marín, M., (2020). Mindfulness and grief: The MADED program mindfulness for the acceptance of pam and emotions in grief. Psicooncologia, 17(1), 105-116. https://doi-org.lib.pepperdine.edu/10.5209/psic.68244

Hagl, M., Powell, S., Rosner, R., & Butollo, W. (2015). Dialogical exposure with traumatically bereaved Bosnian women: Findings from a controlled trial. Clinical Psychology & Psychotherapy, 22(6), 604-618. https://doi-org.lib.pepperdine.edu/10.1002/cpp.1921

O’Connor, M., Piet, J., & Hougaard, E. (2014). The effects of mindfulness-based cognitive therapy on depressive symptoms in elderly bereaved people with loss-related distress: A controlled pilot study. Mindfulness, 5(4), 400–409. https://doi-org.lib.pepperdine.edu/10.1007/s12671-013-0194-x

Vázquez Bandín, C. (2020). Only the living can witness the passing of death: Mourning in times of pandemic. The Humanistic Psychologist, 48(4), 357–362. https://doi-org.lib.pepperdine.edu/10.1037/hum0000225

 

 

Structured Premarital Therapy

Structured Premarital Therapy

Structured Premarital Therapy

 

Sometimes people assume couple therapy is predominately for married couples or couples in crisis, however, couples also commonly come to therapy when they are engaged. Premarital therapy can support you on the preventive side and set you up for a happier marriage. In sessions, I hear couples share how grateful they are for going to premarital therapy because there are so many facets of their relationship that they didn’t think to address until they started. In 10 sessions, we touch on the following 7 premarital topics. Depending on your needs as a couple, we may spend further sessions addressing particular topics or practice using helpful tools. 

Effective Communication

I start sessions with education around communication because no matter how normal your way of communicating seems to you, you may have a different communication style than your partner. Beyond the differing styles, you both could likely benefit from some coaching. We address listening actively, showing empathy, conveying respect, and demonstrating trust. Listening and showing empathy are skills that many people think they already do, yet often only partially do. Both skills are a must for a happy relationship. Since mutual respect and trust are key components of relationships, they need to be implemented in words and actions by both people in a partnership to come to fruition. 

Intimacy

Intimacy is a lovely topic to address next since communication is foundational for intimacy. When your partner feels heard, they will feel safer to be more vulnerable with you. In romantic partnerships, many people share that they desire their partner to be their best friend. If that is the goal, then emotional, intellectual, active, and physical intimacy is a prerequisite. You do not need to have the same profession to find intellectual intimacy, and active intimacy can be developed through introducing each other to activities you start to enjoy together. Often physical intimacy takes up the most time during discussions of intimacy. Since long-term physical intimacy is connected to engaged communication and intimacy on other fronts, I usually start the topic by exploring different types of intimacy before talking about physical intimacy. When we start talking about physical intimacy, it feels like a natural flow from other conversations around intimacy, and it can feel more comfortable to discuss the topic. 

Managing Conflict 

With the tools to manage conflict, maintaining healthy communication and developing intimacy is more accessible. Unless shown otherwise, we tend to model much of our conflict resolution, or lack thereof, from our early relationships. Many people never receive the tools to safely express their negative feelings, to disagree without yelling, apologize beyond the typical “I’m sorry but…” or resolve real-world problems as a team. We spend time focused on learning new ways to face conflict safely so that you are able to reconcile and feel close again. 

Financial Matters

Finances can create friction in marriages if couples do not discuss essential nuances of financial issues before getting married. Each individual brings their own money story and assumptions about how finances are handled in marriage. In therapy, we discuss your relationship to money, tendencies around saving or spending, future joint spending plan, and strengths with managing finances. I also like to have a little fun here and imagine how you would allocate money as a couple as you earn more or if you were to win a sizable amount of money. 

Family & Friends 

While you know you both had relationships before each other, you might forget this undeniable factor in the sweep of romance. You and your partner may have different ideas and expectations about the time you will spend together versus time with family or friends. You may be comfortable seeing your family for significant holidays only, while your partner likes to have weekly dinners and wants you to join once you are married. You may enjoy going out with friends every weekend, while your partner would prefer if you spent most of the weekend with them. Premarital therapy helps develop a shared understanding of how you will maintain and merge certain relationships once you are married.

Values

We explore values and morals based on upbringing, spirituality, religion, and culture. We will take time to explore your shared and differing values and morals. Even if you grew up practicing the same faith or are from the same culture, you cannot assume your partner’s cultural or immigration story is your story. I have worked with couples born in the same country who have different relationships with their home country and assimilation to the US. It can be a beautiful process to unpack each other’s cultural and spiritual stories with curiosity and reverence. Even if you have different values or morals, this can be an opportunity to appreciate your shared values and expand your mind to consider others! 

Love Languages

Have you taken the love languages quiz? I like to touch on love languages to see that each person is showing their partner love in the way their partner prefers to receive love rather than how they want to receive love. I have heard many times in couple therapy that someone will, for instance, explain that they are giving their partner all of these gifts and that their partner does not appreciate the gifts, and then the partner shares in session that they would much rather have their partner give them a neck massage or play pickleball with them than be given a scarf. Then it clicked for the giving partner that they needed to speak their partners’ love language.

Solving Relationship Issues

Solving Relationship Issues

Solving Relationship Issues

One key to resolving relationship issues is accepting innate personality differences between partners. No two people are exactly alike, and differences in personality, interests, and goals are natural and normal. Instead of trying to change your partner, choose to appreciate and accept their unique qualities. You may find that there are strengths in what you each contribute to the relationship due to your differences. For example, if one partner is keener on organizing and scheduling, and the other partner thrives on being in the moment and adventuring, then you can lean on each other’s strengths when it comes to planning a vacation. One partner can organize the logistics to get to your destination, and the other partner can discover the spontaneous experiences on the trip that make it memorable. 

Another way to solve relationship issues is by changing the triggering action or inaction that led to the cycle of conflict. If something one partner does or fails to do triggers negative emotions or reactions in the other partner, it can be helpful to work on changing the behavior if possible. For example, if one partner constantly forgets to do something around the house that they agreed to do like washing the sheets every week, they can set a phone notification on the same day every week to take initiative before their partner ends up reminding them. 

It is also essential to accept that spending enough time with someone will inevitably lead to some annoyances and behaviors that cannot easily be changed. However, how you respond to these annoyances is critical. Emotional acceptance of the triggering action from the responding partner can be a helpful tool. By accepting the behavior and reframing your emotional response to it, partners can avoid a negative relationship cycle of blaming and defensiveness. For example, if one partner chews loudly at dinner, the other partner can accept the behavior as a minor annoyance, and proactively put on some jaunty dinner music or a fun podcast to be played on the dining room speakers to drown out the loud chewing. 

Recognizing and calling out unhealthy communication patterns is another key step in solving relationship issues. Instead of falling into these unhealthful patterns, a couple can see each other on the same team working against unhealthy ways of relating. Instead of me vs. you, it becomes couple vs. problem.

Developing healthy communication is vital. As a speaker, utilize “I” or “my” statements (i.e. I feel, from my perspective), make brief statements about what you want, and then give your partner space to respond. As a listener, it is crucial to be focused on what your partner shares, demonstrate empathy, and respond to your partners’ needs. 

Exploring each other’s challenges and trauma from childhood and earlier relationships can help you to be aware of each other’s current sensitivities and triggers to avoid unintentionally causing pain or misunderstanding. 

Additionally, when you break a relationship agreement, the way forward is to take full responsibility for your breach of trust and empathize with your partners’ pain. These steps pave the way toward forgiveness and creating a new narrative as a couple.

How does Therapy help Relationship Issues? 

Sometimes, despite best efforts, relationship issues can persist. In these cases, therapy can be an invaluable resource. In therapy, we help couples address unique relationship problems and develop deeper, healthier connections.

Having a therapist present can help you bring up your unique relationship problems safely, explore the root causes, and provide the support you need to implement tools for resolving some of your relationship problems. The therapist acts as a mediator, an educator, and a facilitator for deep-rooted change in your relationship. Therapy makes facing your relationship problems more manageable, as you can explore and learn healthier ways to relate, communicate, and love.