Dear Dr. Neimeyer,
In my practice I have encountered some clients who have experienced a significant loss in the past (e.g., loss of a parent when they were teenagers), which obviously altered their world views. They made sense of their losses by coming to the conclusion that bad things can happen randomly in this world, while at the same time believing that they were punished by God for reasons that they cannot explain.
As a result of this world view, they have been leading a very cautious life and they are not enjoying their lives because they are just waiting for the next bad thing to happen or they are trying to avoid God’s punishment again.
I would greatly appreciate your thoughts and feedback about the ways that these clients can be helped.
Dear Dr. A–
Like you, I have often worked alongside clients whose tragic or early losses of intimate loved ones brought with them important secondary losses of their “assumptive world,” that framework of implicit faith that life is more or less predictable, that the universe is just, and that we have a modicum of control over our lives and those of people we care about. The traumatic or premature death of those very people can cruelly shatter these assumptions, leaving us with the difficult choice between discarding all such beliefs as fragile illusions, or preserving them, but at the cost of believing that we did something to deserve these very outcomes. The clients you describe seem to be vacillating between these two untenable positions, between fearful vulnerability and guilt.
Also in my practice, I commonly witness related spiritual struggles in bereavement, as about 25% of religiously-inclined mourners question God’s intent, love or power after having sustained devastating losses. Our research further suggests a link between such crises in the relationship between the mourner on the one hand and God and/or the faith community on the other, and prolonged, complicated grief, as if an anguishing separation from the loved one through death triggers a further sense of separation from God and fellow believers. This sense of distance and despair can be particularly acute for bereaved people who believe in a caring God who is powerful and personally involved in our lives, as it can be difficult to reconcile this with the feeling that such a deity has caused or permitted the death of our child, partner, sibling or parent, sometimes following great suffering, and sometimes in sudden or horrific ways. As a result, the mourner is left with two problems for the price of one: the death of the loved one, and the death of a simple and trusting relationship to the divine. Addressing both in therapy calls for blending psychological and spiritual interventions.
In addition to focusing on “unfinished business” with earlier losses (e.g., revisiting the relationship with parents at the time of their death, perhaps through writing an AfterTalk letter), it is important to make room for the deep existential questions entailed in the spiritual struggle such clients might face. Perhaps this would take the form of a dialogue with a wisdom figure in the person’s religious tradition–a trusted imam, rabbi, priest, minister or devout practitioner of the same faith, such as a grandparent–in which the client could pour out his or her pain and doubt, and seek counsel and perspective. Of course, this need not be a literal dialogue, as it could involve a an imaginal conversation with an historical figure from the relevant religious tradition who has personal meaning to the client, or even the “wise elder” the client may one day become, as the client is guided with eyes closed to envision this figure in detail, and then begin to voice his or her concerns before taking the perspective of the imagined person and responding. The Techniques of Grief Therapy books cited elsewhere on this site provide concrete instructions and examples of such interventions.
A further possibility is to consider the “healing power of guilt,” as my colleagues Celeste Miller and Paula Loring describe it. This would entail taking seriously the client’s sense of culpability, and then drawing on the resources in the client’s own faith tradition, exploring the practices (e.g., doing a suitable penance or atonement), and rituals (e.g., of forgiveness or absolution) by which one can move from a state of weakness or error to a position of redemption or moral betterment. Such an approach is often more deeply respectful of the client’s sense of wrongdoing than is simple (and usually ineffective) reassurance or logical counterargument that his or her feelings of culpability are misplaced.
Finally, you could consider exploring together spiritual traditions that offer guidance in how one might live consciously, intentionally and compassionately in a world in which much is outside our control, in which all people and things are understood to be impermanent, and in which we as human beings exert far less control than we might prefer. Buddhism, for one, offers a good deal of wisdom and related practices to cultivate less attachment to suffering in such circumstances, and contemporary writers within this perspective (such as Pema Chodron) can be read and discussed profitably by clients contending with life’s randomness.