Moving Through Grief : An Emotionally Focused Approach

July/August 2022

Originally Published by Psychotherapy Networker

In our first session, my client Sarah appeared on the screen in stylish, dark-rimmed glasses and nicely coiffed blonde hair. With a tone of impatience, she began by telling me that her friends and family had encouraged her to call a therapist.

“It’s been more than two years since I lost Steve,” she said. “We were married for almost four decades. They think I should’ve moved on by now.” The creases at the bridge of her nose deepened. “Moved on. What does that even mean?”

We sat in silence for a moment together. Good question!

I work from an attachment and Emotionally Focused Individual Therapy (EFIT) perspective, in which the key to returning to healthy living after a loss like Sarah’s entails moving through challenging emotions—a natural and organic process of alternating protest and despair. To facilitate this, I’ll begin by tuning into my client and her experience of loss and grief, and pay particular attention to the nature of the relationship with the deceased. For instance, were there indications of attachment insecurity in the form of a lack of trust, or perhaps unresolved issues between Sarah and Steve?

In the process of discovery with Sarah, other questions abounded. Had she had a personal history of loss or trauma that might deepen the impact of losing her husband? How did she usually deal with emotion? Did she have a tendency to turn the volume on her feelings up or down, thereby reactively intensifying or suppressing emotion? Or did she have a history of regulating emotion effectively, moving with and through her feelings in a manner that allowed her to face and navigate these pivotal moments in her life?

Had she and her family engaged in any kind of ritual surrounding Steve’s death? Had she cried? Were her friends and family just losing patience with the organic grief process that inevitably follows a major loss?

All this was information that would guide the process in EFIT, in which we’re looking for the rationality of the client’s feelings and behavior, rather than trying to identify some pathology.

I did wonder if Sarah was stuck. Was something blocking her grief process, such as an unresolved betrayal or some other pivotal moment in her relationship history for which she couldn’t move through the associated emotions? Or perhaps she was up against a block in her own developmental history? If so, my intent would be to remove it by allowing her to feel what might have been intolerable or unacceptable to feel in that earlier, pivotal moment. This time, she wouldn’t be alone, and as I accompanied her, I might be able to identify other relational and imaginal resources that we could rely upon.

But in the absence of signs of a block, Sarah would likely benefit simply from a companion in her grief, not an intervention per se. It was possible she just needed me to normalize it all, and walk alongside her.

Grieving with Feeling

“Steve wasn’t supposed to go first,” Sarah said when I asked about his death. “He was always so spritely and spirited. I guess I just assumed he’d take care of me in my old age.”

She explained that while they were a couple, they’d enjoyed fulfilling careers and hobbies. Sarah had been a teacher with an artistic bent, and when she retired, she’d built herself a stained-glass studio. Steve, after he’d retired from investment real estate, had spent a lot of his time in an adjoining workshop, where he worked on his car and occasionally built furniture.

“He was the love of my life,” she said simply. “I miss his company.”

Sarah no longer took pleasure in her studio. She often found herself angry and anxious. Even in the presence of her children and grandchildren, she was finding it hard to experience joy. At times, it was difficult for her to get out of bed. “I feel like I’ve lost all sense of purpose,” she told me.

Positioning myself as a safe person she could turn to during this time of need—a temporary attachment figure, in EFIT lingo—I invited her to share more of her story of love and loss. She painted a moving picture of herself and Steve as a young couple, how they’d created a family—two daughters—and had bought a cabin in the woods when the girls were young. It had become a home away from home, and it remained, for her, a mansion of memories.

Sarah’s smile faded as her focus returned to her husband’s death. There’d been many visits to the emergency room as his health mysteriously plummeted. “Then, we got our diagnosis,” she told me.

I took notice of the word our, a powerful symbol that they’d lived as a securely attached couple. If there’s a block, I told myself, it likely wasn’t connected to the security of their relationship.

"Tell him now, Sarah," I said. "'It's okay to leave us.' Say that now. Look him in the eyes and allow yourself to feel whatever you feel."

She explained that Steve had already been struggling with pain when the doctors had told them they weren’t sure where the cancer had originated, nor whether treatment would have any impact. The prognosis wasn’t good, they’d warned. The pain would only increase.

“I can’t go through this,” he’d declared one night at the kitchen table. Instead of treatment, he’d opted for medical assistance in dying, which is legal in Canada and allows terminal patients to put an end to pain and agony on their own terms and timelines. In Steve’s case, the intervention was a doctor-administered, assisted death by injection.

As her words about Steve’s choice reverberated within my body, I slowed my speech, lowered my voice, and looked into her eyes. To move her more deeply into her experience, I asked, “What happens inside of you, Sarah, at the moment you hear those words, ‘I can’t go through this?’”

“Nothing,” she said, quickly shaking her head. “I was in survival mode. I was focused on our daughters. He’d made his peace. I supported him.”

Here was a possible clue to a potential block. Perhaps Sarah had shut down and turned off her own emotional experience in those moments. To support her husband’s decision and be there for her daughters, her attention had gone toward them and away from herself. Perhaps this was where she was stuck.

From an attachment perspective, isolation is inherently traumatizing. The EFIT therapist assumes that nobody encounters vulnerability alone. Another key premise is that once identified, blocks to the organic grief process can be removed, and corrective emotional experiences choreographed. We make this possible by accompanying our clients as they move with and through the emotional experience they might not have had permission to feel, or felt safe enough to feel, during pivotal moments. In EFIT, we talk about making the frightening manageable, the alien familiar, and the unacceptable tolerable. Reframing these defining emotional moments can then help to shape a new narrative.

To start, I validated Sarah’s strategy of getting through those tough times. I explained that it made good sense that her energy and resources were diverted to her daughters. Then I told her that therapy with me could give her the chance to make emotional contact with herself and her feelings if she hadn’t been in “survival mode” in those moments. Transparency provides agency.

“We were at peace,” she insisted. “We were grateful he didn’t have to go through all the pain of treatment.”

Okay, I thought to myself, either she’s not ready for this, or his decisive declaration to shape his own destiny wasn’t a key moment in producing a block to the organic grief process. Staying curious and open, I inquired more about their life together and listened as Sarah shared more memories. One was of a hike she and Steve had enjoyed near their cabin. As his health had deteriorated, so had his ability to walk long distances. All Sarah had wanted for him on what became their final Christmas together was for him to make it to the top of the mountain. Remarkably, he did.

A Never-Ending Bond

Now that we had a well-established alliance and hints of a potential block were more visible in her survival-mode statement, I homed in on the present.

How did Steve exist now to her? Did she still rely on him in some ways? Did she call upon what attachment theorists refer to as a “mental representation” of him, which could be an image or just a felt experience of his presence? Could he be there for her as a secure, albeit imaginal, attachment figure during times of need?

In essence, I wanted to know if Sarah was maintaining a “continuing bond” with Steve. This is a term used in grief literature to capture what playwright Robert Anderson wrote more than a decade after the death of his first wife: “I have a new life. Death ends a life, but it does not end a relationship, which struggles on in the survivor’s mind toward some final resolution, some clear meaning, which it perhaps never finds.”

Indeed, from the perspective of many mourners, and from an attachment point of view, grief lasts a lifetime. Following the loss of a loved one, individuals negotiate and renegotiate their relationship with the deceased and begin to incorporate and integrate that relationship into their lives, allowing for continued growth.

In the sessions that followed, Sarah continued to talk about Steve. As she did, I endeavoured to keep her in the here and now, so she could move more deeply into her felt experience of him.

Had she had a personal history of loss or trauma that might deepen the impact of losing her husband? How did she usually deal with emotion? Did she have a tendency to turn the volume on her feelings up or down?

“Help me see what you see when you look back on your life together,” I said. “Help me to get to know Steve a little more.”

She described a young Steve, stoic and strong. The details she provided gave me snapshots of him through most of their life together. There was the day young Cali caught her first fish off the dock at the cabin. Other vivid memories included their 10th wedding anniversary celebration and summer vacations abroad. I noticed that none of these details came from his final days, when he was unwell and struggling, which remained a missing chapter in their life story.

“I Don’t Want to Let You Go”

I began to narrow our focus on this later period. Almost reluctantly, Sarah told me about some of the meals they savored before his death. Many friends and family visited or wrote letters to Steve, which he answered. But she and Steve didn’t write letters to one another. “I couldn’t have written one, even if I’d wanted to,” she explained. “There were no words to describe how we felt about each other.”

When I asked about their final hour and moments together, Sarah described the palliative care room, with its stark, colorless walls. Steve’s body was fading. The staff had helped them carefully plan his death for 2 p.m.

“The girls are there,” she said, staying in the present. “We’re all there together. They’re at the end of his bed. I’m beside him, his big hand wrapped in mine.” They’d shared a lovely meal and a bottle of wine the night before, and in the morning, they’d eaten a full breakfast. He was in and out of sleep for most of the day. As the girls read to him, Sarah dozed on and off as well.

Just before 2 p.m., the doctor arrived. With his family hovering over him, Steve’s green eyes, open and alert, slowly filled with tears. “I don’t know if I can do this,” he’d said.

The doctor offered to give him more time. Sarah remembered the girls hugging him and saying, “It’s okay, Daddy, you won’t have pain anymore.” She’d echoed, “Yes, it’s okay.”

Feeling the power of these last minutes, and the emotional significance of these key phrases, I probed further.

“Sarah, what does it mean, ‘It’s okay’? That it’s okay to leave us?”

“Yeah, it’s okay to leave us,” she said. Her eyes veered off into the distance.

Setting up what we call in EFIT a corrective emotional experience, I reinvoked the trancelike state we’d occupied in the palliative care room just moments earlier. Describing Steve’s physical features in detail, and using my voice and emotional presence, I let Sarah know I was there with her as I focused and amplified the picture by asking her to dim surrounding details, including her daughters, and focus instead on herself, her inner experience and her husband. With continued magnification, Sarah was drawn further into herself and her inner, deeper experience.

As I painted the picture of the room and Steve, I reminded Sarah that I was there too, and encouraged her to say what she said in those final moments, but in an emotionally connected way, rather than in the survival mode she was in at the time. “Tell him now, Sarah,” I said. “‘It’s okay to leave us.’ Say that now. Look him in the eyes and allow yourself to feel whatever you feel.” As Sarah did this and the magnitude of these final moments engulfed her, barriers to her inner emotional world began to dissolve. Without them, rather than either shutting down or remaining in “survival mode,” she tuned into and expressed her inner experience. She cried softly at first, and then sobbed.

Catching her breath, she looked squarely at me and said, “I’m not one for being vulnerable in front of people.”

“We aren’t wired to do this alone,” I reassured her. Again, I told her that it made sense that she put herself aside to honor her partner’s wishes and be there for their family. I repeated that this was now the opportunity to make space for herself and her experience.

Sarah paused for a moment, reflecting. Then she resolutely stated, “It was okay to leave us, but I don’t want to let you go.”

Holding on and Letting Go

In the sessions that followed, we revisited that room and those pivotal moments. As we dimmed the backdrop and muted the images of others in the room, Sarah gained greater access to her inner emotional world. Her numbness shifted to vulnerability. At one point, angry and exasperated, she said, “I’m facing the biggest loss of my life, and I don’t have the person I count on most to hold me.”

A cascade of emotions followed: sadness, anger, more anger, and finally, profound sadness and deep longing.

Struggling with the back-and-forth of letting him go but not wanting to do so, Sarah was finally able to say to Steve, “I don’t want you to go.” Then, suddenly tearful, she begged, “Don’t leave me. I don’t want you to go. I want you back.”

As many experiential therapists have explained, once the felt experience takes hold, felt shifts occur, and transformation becomes possible. As Sarah found and made space for more of herself, and as the details of Steve’s face, his hands, and his emotional presence became clearer and more vivid, she began to access her husband in new ways as a reliably—albeit imaginally—secure attachment figure.

With the process in full motion, I followed rather than led Sarah, simply encouraging her to let herself sob while Steve held her with his big hands and warm embrace. I stayed out of the way so that she might have a powerful, corrective emotional experience.

Finding “Me” in the Strength of “Us”

Secure in his decision to utilize medically assisted death, Steve had been able to move with and through the emotions associated with saying goodbye to family and friends. But all the while, as Sarah stood beside him, she’d been holding her breath and suppressing her own needs and emotions. Now she could breathe again.

Sarah continued to move through the grief process and into growth and resilience. “I definitely feel different,” she told me a few weeks later.

“What helps you to know this?” I asked.

“I’m learning to live with the grief,” she said. “I’m learning to accept the pain, rather than avoiding it. Now I allow myself to cry. On Christmas day, I just wanted to have a moment to myself to let it out, so I left the girls and their families and went for a walk. I cried and was sad, and I talked to Steve. I had that time with him.

“I can look at things I couldn’t look at before,” she continued. “Like his apple tree. When he first died, I couldn’t look at it. Now I see it and feel some joy. I can also look back and know we had a normal marriage: we’d fought and had some rough times.” She started to smile. “When he first died, no, everything had been golden between us.”

We grinned together at this.

“I’m no longer a we, I’m a me,” she said. “He’s not here, and I am. I know that the colors will come back in my life, but it’ll never be the same. I’m more able to accept that. And if I need to be sad, then others need to let me be sad. This is the new me.”

As we continued to meet, she spoke less about her longing for Steve and conveyed that she was sharing more of her daily life with him. She told him about a new puppy and the birth of a grandbaby, as well as some fear and anxiety surrounding her own health concerns. While describing their new connection to me, she paused at one point and confidently announced, “I can be with him and without him.”

A few weeks later, Steve’s apple tree began to show signs of spring, and Sarah shared how she’d told him that the cedar box that held his ashes—its top engraved with an eagle—would have a companion box that would hold her ashes one day. That box, too, would bear the crest of an eagle on its lid. Side by side, the eagles would face each other.

“Eagles,” she told me, “mate for life.”