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RH: How practical! But I’m wondering why she was angry.

Kessler: She’d said when it was her time, she wanted to get hit by a Mack truck or have aggressive cancer. She said her worst fear was that she’d die slowly. She had her stroke in 1995 but lived until 2004.

RH: So much of death and dying intersects with religion and theology. Do people who have a belief in God cope better than people who don’t?

Kessler: We all have a personalized belief system shaped by our family, our life experience, whatever our religious upbringing has been. I’d say people do better when they have a sense of meaning in life, and early on, I learned a lesson from an atheist who said sometimes people make the mistake of thinking an atheist doesn’t find meaning in life. “We have meaning,” he said. “We just don’t have God.” People who find any kind of meaning in their life, religious or otherwise, find a comfort in facing death that others usually don’t.

RH: I’ve known a few people who’ve lost loved ones and had others try to console them by saying, “She’s in a better place.” Isn’t leapfrogging the painful parts of the grieving process where many of us get into trouble?

Kessler: The most visited page on my website covers the worst things to say to people in grief. One of them is “she’s in a better place.” Of course, none of those things we say are malicious. No one wakes up and says they’re going to be mean to someone grieving today. But context and timing are everything. If you say to someone at a funeral, “she’s in a better place,” it probably isn’t going to go over well. If in six months, however, the griever seeks out advice from his clergy and is looking for understanding, that statement can often be helpful. It’s all about context and timing.

RH: How can therapists best prepare themselves to work with grieving clients?

Kessler: Kübler-Ross believed that how you approach a loved one’s death shapes how you grieve. Before and after is a continuum. Therapists should be aware of anything we can do to help clients be proactive and involved when a loved one is dying. We have to normalize that experience to let people know there’s no right thing to say. It’s about being present. Our life must be witnessed, our death must be witnessed, and our grief must be witnessed. It’s a primal experience.

RH: Being present is more important than knowing what to do or say?

Kessler: Right. Often, our job is to just help that family member, or even the dying person, step up to the plate. Freud said grieving is a natural process that shouldn’t be tampered with. One hundred years ago, in Freud’s time, we’d all be part of a loved one’s dying in our home. Now illness has moved into hospitals and death into funeral homes, so we don’t know how to show up.

RH: What are the practical issues of death and dying that therapists should address?

Kessler: I know therapists who make a plan when they’re working with someone who’s dying. They ask, “So what’s going to happen when you can no longer come into the office? Will I visit you in the hospital? Will I go to your home?” I think that’s such a powerful thing. I’ve seen therapists do wonderful life reviews with someone at the end of their life as well—whether they’re reviewing their whole life, or reviewing their therapeutic relationship. I love when therapists dive into that fearlessly.

RH: Why do most of us avoid talking about grief?

Kessler: We often think we’re running from grief, but what we’re really running from is the pain of loss. Actually, grief is the gift that’s been given to us to help heal.

RH: That’s a powerful reframe.

Kessler: Grief always works if you allow it. It’s not an illness. I try to help people do what I call “translations.” If you see an angry family member of a deceased loved one in the hospital, don’t call security, translate that feeling into “I’m not seeing someone in anger. I’m really seeing someone in pain. If they’re really yelling, it’s because they’re really in deep pain.” We should help people use the word “sad” instead of “depressed.” If I said to you, “My sister died and I’m so depressed,” you might say, “I know a good psychiatrist who can prescribe something.” But if I said, “My sister died and I’m so sad,” you’d say, “Of course you are! That’s your sister. You should be sad for a while.” So it’s best not to run from that sadness, but invite it to pull up a chair. That sadness is going to be there for a while.

Ryan Howes, PhD, is a psychologist, writer, musician, and clinical professor at Fuller Graduate School of Psychology in Pasadena, California. He blogs “In Therapy” for Psychology Today. Contact: rhowes@mindspring.com; website: www.ryanhowes.net.

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