Thank you to everyone who responded to our December Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
December Quandary: I’ve heard a lot of grief specialists talking about helping clients finding meaning after loss. But sometimes loss feels meaningless, like all of these COVID deaths, and I’m not sure what to think or feel about it. What’s helped other therapists? And how do I work with my clients around this?
1) Share Your Truth
Our world is awash in grief. So many losses feel unfair, even completely meaningless. Questions feel endless, and answers elusive. As a grief counselor and lecturer, I try to remember that my role isn’t to fix grief, but rather to patiently walk alongside clients wrestling with intense pain. I can help them share their story, wrestle with their many questions, explore continued bonds, and hold the hope that they can once more find their way. Over time, if our therapeutic relationship continues, I can support them as they figure out how to live a meaningful life in the shadow of great loss. This work is tender, sad, and always poignant. It’s an honor to walk alongside those most hurt by COVID and other traumatic losses. I can’t stop senseless deaths, but I can help grievers hold hurt, heal, and grow.
Recently, I’ve become deeply aware of the incredible burden of parallel process. We therapists are tasked with supporting the needs of clients while also weathering our own losses. We too are hurting. Most of us are experiencing a myriad of living losses, like the loss of in-person work connections or traditional holiday celebrations. Others are grieving deaths in the family and the absence of normal grief rituals. Still, others like myself carry a kind of existential grief, or what some call “loss of the assumptive world.” COVID, destructive natural disasters, toxic politics, polarized belief systems, endless shootings, fragile democracy, teenagers who aren’t sure there’s a future to look forward to. What is going on? This often feels shattering to my sensitive soul. How can I help clients make sense of their losses when I too am riddled with so many huge questions?
Recently, I’ve shared my truth with a few of my clients. I admit that their pain resonates deeply with parts of me, that I too struggle, and that some weeks are better than others. Connecting in this way feels authentic. There’s no shame in it. Being this open isn’t something I want to do with every client or very often, but sometimes it feels right. Often, being real with clients reminds me again of the many ways they are a gift to me. This is part of what keeps me working with grief, loss, and trauma. I give and get so much from this work. It’s beautiful to be reminded of that.
We don’t need to be perfect in this work. It’s normal to struggle and feel like you have no good answers. Connection to my own care network and regular breaks are essential to my self-care. So is letting myself be an actual human being in the work. I’m guided toward authenticity by my love of Internal Family Systems and meaning-making models of therapy. I try to get space from parts who long for answers. I try to lean into the power of sustained, caring connection. I believe that lending connection and offering compassion and gently supporting clients as they wrestle with big questions is the work of healing. In my healing space, we talk, we laugh, we sometimes cry, and together, we find each client's unique path forward. This makes sense to me. I choose to trust this is enough. All parts are welcome. No answers are required. For now, it is enough. I am enough. So are you!
Lara Krawchuk, MSW, LCSW, MPH
West Chester, PA
2) The Gift of Allowing
When we lose someone, like so many people have lost loved ones to COVID, the pain that grabs ahold of your insides spreads like a slow, dark fire. Loss is meaningless, until the client finds it. Those feelings of loss are normal, and no two people feel loss the same way. The loved ones we lose hold an important place in our lives. Their laughs, their cries, their faces, the sounds of their voices, are all intertwined in our memories, glued to our emotions—and circumstances beyond our control took them away from us without our permission.
You weren’t ready. It’s not fair. Why them? Why you?
It seems like this pain will never end. But guess what? You're allowed to be impacted, to be sad, and even to be angry. It’s normal to feel like every fond memory with a loved one lost now has pain attached to it. Pleasant memories are now attacked by sorrow, guilt, anger, and the sense that you’ve been betrayed. It’s okay to be overwhelmed.
But you're also allowed to have a finish line for that grief, a finish line only you can establish. After a process—your process—of honoring the place they held in your life, acknowledging the pain of their departure, and allowing yourself to imagine a world without them. You have to believe the love you held for that person wasn’t only for while they were here with you. You also have to believe that this love was held by them for you. And if that's true, you have to give yourself permission to believe that the loved one doesn’t want you to be sad and cry every time you think of them. They want you to remember them fondly, with memories that would make both of you smile. When you’re able to stoke that fire, the pain of your loss will recede as the warmth of their memory grows.
Donn Bradley, AMFT, MA
3) Don’t Rush Healing
Many theories and approaches exist within grief work. The idea of finding meaning is a relatively new one, where the idea is not to jump to the discussion or seeking of meaning, nor to assign or assume the meaning for your client. COVID deaths are senseless, so it’s important to remember that the meaning-making is not in the situation.
Grief work takes time, so take time with the client—to hear their story, to work on acceptance of the reality and processing the feelings, to encourage eventual reconnection with the world around them. Only then might you explore meaning-making. So first, don’t rush it.
Second, remember that it’s not always necessary for you to help your client make meaning from their loss. In fact, you may never know the meaning your client eventually finds; it might happen after therapy has ended. Your work might focus more on sitting in the confusion of the loss with the client and giving them a space to process complicated feelings, which could eventually lead to them finding some meaning down the line.
The work in identifying meaning in grief and loss is personal, subject to the thoughts and actions of the individual. Maybe the client finds the courage to do something they’d always feared doing because the loss helped them realize that life is short. There are ways to live beyond loss that feel meaningful.
Remember that there’s no rush to finding meaning. This could be part of the education you provide to your client. Allow them time and space for processing and feeling, and then assess and explore what comes next.
Christa Orfitelli, LISW
4) The Power of Stories
It’s impossible not to feel devastated by the unprecedented loss during this global pandemic. As therapists, we’re trying to balance the expectation that we hold space for our clients’ pain and help them heal with our own experiences of grief and loss. Here are some things that have helped me cultivate hope and meaning, for myself and my clients.
I use self-compassion as a lifeline for riding the waves of grief together. As clinicians, we know that loss can lead to healing and a deeper awareness of what truly matters, but it also hurts like hell. Helping our clients honor their feelings helps them identify what they need. Moments of great pain are rife with opportunities to connect with the wounded inner child and awaken true authenticity. But we can’t rush our clients to make meaning out of tragedies.
The self-compassion break, created by Kristin Neff and Chris Germer, is a lifeline I use for myself and with clients. It teaches us how to be a compassionate witness to our experience of suffering without drowning in despair or self-blame. Self-soothing touch, too, helps to calm the nervous system and bring us into a state of ventral vagal, which is optimal for connection and creativity. Fierce self-compassion provides fuel for boundary setting and individual and collective transformation.
Second, I’ve learned to focus on what I can control. We can’t take our clients’ pain away. But tending to our own self-care and honoring our capacity matters. By bringing the best of ourselves to our clients, we can help them honor what they need on their grief journey.
I’ve also learned there’s power in other people’s stories. Reading Wave, a chilling story by Sonali Deraniyagala, a woman who lost her parents, husband, and two children in the 2004 Indian Ocean tsunami, left me sobbing 10 years ago when I was a stressed-out mom. Her grief nearly drove her mad until slowly, with time and the incredible support of family and friends and writing her story, she was able to heal and rebuild her life. In doing so, she helped me and so many other readers gain a new sense of appreciation for life and the people in it. Sheryl Sandberg’s Option B is another powerful memoir, and includes resilience-building research. Wild by Cheryl Strayed takes the reader on her journey of mourning her mother, and self-discovery, as she hikes along the Pacific Crest Trail.
Stories of the power of the human spirit can also be found in speeches online on Goalcast, Speaker Slam, and the Power of Positivity, as well as in our friends’, family’s, and clients’ stories.
Last, take in the good and make room for laughter. We must soak up glimmers of peace, beauty, and joy to hold on to hope for our clients and help them slowly open to joy. I recommend you find things that make you laugh, and give thanks for ordinary magic and everyday miracles.
Nicole Schiener, Registered Psychotherapist, RP, CCC, CGE
5) Mutual Witnesses
As a child therapist, attuning to the child’s level of meaningful communication is a constant clinical challenge. This may be in the context of loss, grief, or less obvious life events like shame, relational trauma, or betrayal of trust—any or all of which may induce helplessness and overwhelming stress, well beyond a child’s sense of “meaning.”
To find or to give meaning to disrupting experiences, which still await words of meaning for a child—or the child within the adult—demands sensitivity and creativity. You have to find communication channels beyond words. Research suggests that around 70 percent of communication is nonverbal or preverbal. Facial expressions that mirror mood, prosody that resonates with rhythms of vitality affect, a fleeting gesture such as a sigh—each may communicate a deeper sense understanding than words could ever reach.
In my own clinical work, I’ve often found that in moments where I can find no meaning in the client’s loss or make sense of their suffering, I fall back on my understanding of how extreme stress triggers my own survival systems.
During clinical moments where communication is ruptured by vicarious trauma, I recognize that I do succumb and become numbed. If I witness such moments, I suspend my search for meaning. In other words, I accept that there’s such a gap between the client and I that I can’t bridge it with meaningful contact alone. Instead, I temporarily prioritize the need to regain my own sense of safety. I recall my need to restore my regular breathing as a kind of manual override. I attend to emergency self-care. Only afterward do I lean in to offer some words to the client, to begin to think in terms of meaning. Only after I’ve survived the ruptured moment do I begin the delicate and nuanced process of translating fraught experiences into a narrative.
The final step in this messy, uncharted dance is the challenge of beginning to find the words to chart the ordeal the client and I have both survived. Now, we are each other’s witnesses.
George Halasz MMBS, B Med Sc, MRCPsych, FRANZCP
Next Month’s Quandary: I'm interested in taking my therapy work in a new, exciting direction—making a career pivot, if you will. What creative pivots or career adaptations have other therapists made that's rekindled or transformed their passion for the work? Please tell me your personal stories of reinvention.
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Tags: Challenging Cases & Treatment Populations | challenging clients | Challenging Clients & Treatment Populations | Clinician's Quandary | Depression & Grief | Depression & Grief | grief | grief and loss | grief counselor | grieving | grieving process