A woman who lost her adult son to sudden death

Dear Dr. Neimeyer,

I am currently working with a woman who lost her adult son to sudden death when he was residing in a foreign country 5 years ago. Since then she has been absorbed in a deep and isolating grief, though she has two other adult children and a husband who remain quite concerned about her. I have seen her with her husband in therapy for 12 sessions, but her grief remains intense and unremitting, to a point that she seems to have cut off from all other relationships with friends and family, and although not actively suicidal, clearly wants to die. Her psychiatrist has been unable to alleviate her anguish with several adjustments in antidepressants, and my best efforts to empathize with her suffering only seem to reinforce it. She presents with a deep feeling of being all alone, and she even looks this way, leaning away from her husband on opposite ends of the sofa in my office and sending few signals of feeling connected to me as well. I feel very stuck in this therapy, but am reluctant to “abandon” her by suggesting that she consult another therapist, as this client describes vividly the pain caused by a childhood experience of being “unwanted,” and even felt abandoned by her son when he left to live in another country. What could I do to help restore momentum to the therapy, and help this woman find the hope and meaning that seems to have died with her son?

Dear Beverly,

As central as empathy and compassion are in attending to those in deep grief, there are times when they are not enough, and this appears to be one of them. We ourselves can ultimately be drawn into their hopelessness, as the therapeutic options seem to narrow to the point of trying “more of the same,” only harder! In the service of opening up some options, let me therefore brainstorm a few alternatives, each with a brief explanation. I’ll start with a few easy-to-implement suggestions, and then work up to more complex interventions.

  • Shift the proxemics:  If part of your client’s problem is a sense of isolation from others, move your chairs closer together by one foot when part way through a session.  Then continue as before, and after a few minutes, process with the client whether she noticed a difference, and if so, which felt more comfortable and why. Likewise, invite her to sit closer to her husband, or him to her, in a separate experiment with physical closeness.  If the closeness is welcome, ask in what other ways she would like to invite more of it in her life.  If it is uncomfortable, ask to talk with that part of her that prefers distance about what makes that necessary, despite her loneliness.
  • Take a walk:  If the problem is “no movement,” literally mobilize her by conducting your session as you stroll together through the neighborhood of a nearby park, speaking therapeutically about how it feels to be in motion, as you literally walk alongside her going forward.  In addition to helping promote psychological movement, the exercise can itself be a form of behavioral activation, self-esteem, and self-care.  It can also set the stage for walking with friends or family as homework.
  • Investigate motherhood:  Interview her about the best part of being a mother, during those special years she had with all three of her kids.  Ask “What did Stephen represent to you?”  Consider how she can still be a good mother to her living (and grieving) children, and what Stephen–and his death–meant to each of them.
  • Open the photo album:  Stimulate the stories of her family and their interrelationships over time, considering what endures in each even following this hard mutual loss.
  • Talk to Stephen, not just about him:  Use chair work to encourage her to express to her son symbolically in an empty chair where she is in her grief, what she feels and what she needs.  Then change chairs, loan Stephen her voice, and have him “respond” to mom, offering advice, counsel, and–almost surely–love and appreciation.
  • Go to the source:  In this variation, consider chair work with her mom about the abandonment your client felt as a child, and what she needs and is seeking as a result.
  • Family meeting:  Invite the other adult children into therapy with mom and dad to talk with them about their perception of who is hurting most, next most, and least, and what each needs from the others to feel or adapt better.  Help them plan a shared ritual that honors Stephen to reduce their individual isolation.
  • Ground the client:  When she is overwhelmed by emotion, move her back into head by discussing problem solving strategies or coaching in diaphragmatic breathing to modulate and tolerate the affect.

Note that most of these approaches can be used in tandem rather than as stand-alone interventions, but beware of overloading her by implementing too many at one time.

–Bob Neimeyer

One comment on “A woman who lost her adult son to sudden death

  1. Dear Dr. Neimeyer,

    These are such clear and wonderful guidelines to offer Beverly who is also struggling. Every therapist knows that place of questioning our helpfulness and it is awful and yet humbling. And yet, it prompts a therapist to both stay present in session and in one’s notes (suggestion of Dr. Irvin Yalom). i.e. “I felt helpless with so-and-so and when I was a teen I felt this same way when….” I thought your suggestion of moving one’s chairs closer such an interesting way to test, for the client, the immediacy of her feelings in her “body self.” Boundaries are key in all relationships in and out of the counseling room. I also wonder if she sees the husband ever by himself and the wife alone. What are their individual intimacy needs outside of the absence of their child. Losing a child brings out every painful realty that was present before the death of a child. I think it is important to see the couple off and on alone with the understanding that it can be shared when they come back together again. Walking with the clients is a beautiful example you have given to change the space that might not be lending itself to true openness.

    Also, as we bereavement therapists know, grief counseling is difficult work. The feelings of loss are huge in the room and our souls do not measure pain the way our ego does. I also think Beverly might want to ask her client straight out, “What is helping you in this therapy do you think? and is there something else you wish for that I may be able to do to help your healing this most tragic and painful loss of your child? (And use the name of her child which is so important.)

    As a therapist who has lost a child I would also offer that Beverly might consider another bereaved mother therapist in conversation with her client to refer to. Tell her client that she “can only imagine the pain” for unless she is a mother herself I do not believe she can understand nor imagine that agony. Ask the sad mother what she thinks. I like “I-Thou” communication in session because it brings one to be in an intimate space, a trusting space. Of course, the therapist might want to be certain of the ego structure within her client.

    Lastly, it’s not news to those who know of my thoughts or have read my book that I believe in the power of a group experience. I love the healing energy of groups and facilitate bereavement groups as well as attend them. (I like being on both sides of the equation. We as therapists need to fill up our little wells.)

    I hope my input helps a little and I always respectfully offer it, Dr. Neimeyer. When I stop by it is my way of doing what I can when I can but your assistance is consistently beneficial to your readers and very much so, to me.

    Mary Jane

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