Articles
What is Focusing Oriented Therapy?
by Tina Van Der Worp
Focusing Oriented Therapy is a therapy technique developed by philosopher and psychologist Eugene Gendlin and primarily teaches one to be in a state of deep listening and sensing into what is present within the body. Focusing encourages one to have a welcome and friendly attitude towards one’s own feelings.
The Focusing attitude is a stance of conveying to the inner self that all feelings, thoughts, emotions and felt senses that are present within the mind/body are welcome. There might be a river of sadness, a mountain of tears, a storm of rage, a still lake of peace, or a fountain of joy. The Focusing attitude creates a safe inner holding atmosphere for the Focusing process to unfold. During Gendlin’s development of this technique, he named the sensations that were felt and experienced within the body: the felt sense. The felt sense is a felt experience or a direct knowing of a situation felt within the body.
Focusing encourages people to listen to their felt sense about any given situation of person. It is different from the mental understanding of a person, place or thing. When one accompanies a felt sense with the attitude of warmth, presence and acceptance the felt sense opens and reveals an even deeper level. Often it will open and transform into a new felt sense. Gendlin calls this change a “felt shift”. In his own words, “Such a step feels good; it releases energy. What one finds may feel good or bad, but its emergence always brings relief, like fresh air”. (Gendlin)
Not only is a friendly, warm, non judgemental attitude within the client vital but also without in the therapist’s room itself. The focusing therapist must hold a loving presence which is fundamental in the establishment of safety, trust and a sacred space for the client. Only in a safe, loving environment, not unlike a womb, metamorphosis can happen. This loving presence and the unconditional positive regard not only holds the space for the client as he/she journeys through the storms of his/her inner world but also mirrors the unconditional love within the client, themselves. Like a tuning fork, the vibration of the warmth and presence of the therapist activates that same vibration of warmth and acceptance within the client. “Having entered a state of vulnerability with a genuinely supportive and accepting clinician, clients may internalize a sense of loving response and find it easier to make meaning from their traumatic experience.” (Naff, 2014).
Finding Peace, Building Connection
Healing from the loss of a loved one
by Tina Van Der Worp
“What we have once so enjoyed, we can never lose, for all that we love deeply becomes a part of us.”
-Helen Keller
The death of a loved one and the grief that follows is a universal phenomenon. The grieving process is similar to a journey in which the bereaved travels through their inner emotional terrain with no road map and emerges changed forever. Elisabeth Kubler-Ross states: “You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same again. Nor should you be the same. Nor should you want to” (Kübler-Ross)
While older perspectives viewed grief as a pathological condition with the ultimate goal of helping the client detach themselves from the deceased, newer perspectives show the bereaved no longer have to “find closure” and “move on” as once was believed (Hedtke, 2012). Bereavement therapy now recognizes the importance of the continuing connection as part of the adaptation process (Neimeyer & Harris, 2016).
Symptoms of Grief
Grief is a normal, healthy and adaptive response when a significant person in our life dies. Feelings of sadness, longing, loss of interest in daily activities and frequent thoughts of the deceased are common reactions. The death of a loved one marks a time of intense emotional upheaval, most people are able to navigate through their grief and integrate the loss into their lives.
Accumulated research on ways of coping has discovered that the grieving is a complex process, unique to each individual (Neimeyer & Harris, 2016). Conventional stage models of grief are now viewed to be limited in their assumption that the grief process runs through a fixed emotional course with little room for choice. Grief is in fact, an active phenomenon “rich in choice with many possible paths or options to affirm or sidestep, approach or avoid. Central to this process is the task of “relearning the world,” a world that has been forever changed by the loss” (Neimeyer, 1998, p.40). These understandings have given rise to new paradigms and perspectives of grief (Niemeyer & Harris, 2016; Hedtke, 2012). Bereavement is no longer viewed to be a static phenomenon but rather an ever evolving process of actively integrating and building a connection with the deceased.
Contemporary Perspectives of Grief and Adaptation
Continuing Bonds Theory
In the last 20 years, bereavement studies portray that approximately 60% of the bereaved population experience continuing contact with loved ones after their death (Neimeyer, 1998; Klass, Silverman & Nickman, 1999). Research also shows that 85% of the bereaved find comfort and solace from these experiences whereas only 6% find these experiences upsetting (Neimeyer, 1998; Klass, Silverman & Nickman, 1999). This sense of sustained connection or, “continuing bond” is defined as ‘‘the presence of an ongoing inner relationship with the deceased person by the bereaved individual’’ (Stroebe & Schut, 2005, p. 477). Continuing bonds, or a sense of connection to the deceased, can be experienced in numerous ways such as revisiting memories, sharing stories, honoring qualities of the deceased or by simply retaining a sense of closeness within them. Others may experience the continued bond through engaging in rituals, pursuing their loved one’s life goals, internalizing cherished values which influence their lives and continuing their legacies. In some cases, the bereaved may also physically experience the presence of their loved ones (Currier, Irish, Neimeyer & Foster, 2014; Neimeyer & Harris, 2016).
These numerous ways in which people sense a connection to their loved ones have given rise to conventional perspectives that now recognize the emotional and psychological value of retaining a continued bond (Hedke, 2012; Neimeyer & Harris, 2016; Klass, Silverman and Nickman, 1996).
This research points to the importance of exploring and enhancing the continuing bond as a coping strategy in the treatment grief (Lee, Hou, & Lin, 2017). Deepening the connection through exploring positive feelings for one’s loved one and cherishing their positive attributes has become an invaluable healing tool in the adjustment process (Hedtke, 2012; Neimeyer & Harris, 2016). This active construction and inner representation of one’s loved one allows the bereaved to be continually and positively influenced by their loved one (Klass, Silverman, & Nickman, 1999).
Two Track Model Theory
Another contemporary model of grief is Shimon Rubin’s (1998) Two Track Model or TTM (Rubin, 1999). Rubin suggests that much like a train that moves down two rails, the bereaved move down two simultaneous tracks as part of their adaptation process. While on one hand, the bereaved struggle with the biopsychosocial track or somatically disruptive feelings due to the loss, on the other hand, they also engage in the relational track by retaining and rebuilding their connection to the deceased, through “revisiting memories, sharing stories, preserving a sense of closeness, and partake in shared or private rituals of remembrance” (Neimeyer & Harris, 2016, p.165; Rubin, 1999). Rubin states that oscillating between both tracks is a normal and an adaptive aspect of the grieving process. The TTM model can thus provide grief counselors with a helpful framework in assessing their client’s functioning. Problems in bereavement or feelings of stuckness can indicate to both the counselor and the bereaved where there may be an over or under emphasis, and thus find balance by exploring the other aspects of grief (Neimeyer & Harris, 2016).
Meaning Reconstruction
Another emerging perspective of bereavement is the acknowledgement of finding meaning in the wake of one’s loss. Niemeyer’s Meaning Reconstruction Model (2001) suggests that humans are natural meaning makers and a central process of grief is the attempt to reconstruct a “world of meaning that has been challenged by loss” (Neimeyer & Harris, 2016, p.163). A sense of meaning is found when the bereaved are able to find ways in which the loss has led to growth and positive change (Lister et al., 2008). Neimeyer argues that the bereaved find meaning in two ways: (1) through acknowledging how the loss has positively affected their life (2) reconstructing a relationship with the deceased (Neimeyer & Harris, 2016).
Research points to the positive correlation between high levels of meaning making and the emotional well-being of the bereaved individual (Neimeyer & Harris, 2016). When the bereaved are able to see the psychological, intellectual, spiritual or practical growth and significance in their lives in the wake of their loss, they are more likely to adapt to their change (Neimeyer & Harris, 2016). Alternatively, studies demonstrate the interconnection between the “inability to find meaning in the loss and intense prolonged and complicated grief symptoms” (Neimeyer & Harris, 2016, p.166).
The bereaved find meaning when they re-construct their relationship with the deceased and cultivate a sustained connection. This continuing bond helps “uplift the living” and “generate surprising new meanings, strengthen resilience and restore identities” (Hedtke). Contrary to the conventional perspectives which focused on expressing their loss, research has found that grievers can take an active role in reconstructing their relationship by recounting positive stories of the bereaved. This allows the loved one’s memory to live on in the bereaved and ripple into their lives affecting their worldview, values and faith (Hedtke, 2012).
Essentially, finding meaning within the continued bond requires a shift in perspective from focusing on the negative aspects of one’s loss to reconstructing a sense of continued connection (Neimeyer & Harris, 2016).
Meaning making, however, can only be achieved after the bereaved have undergone a process of honoring and validating their painful feelings surrounding their loss (Neimeyer,1998). Niemeyer states: “Without a willingness to embrace the pain long enough to harvest its lessons, we tend to proceed through the loss blindly, trying to orient to the demands of external reality without an internal compass” (Neimeyer). Cacciatore in her work with bereaved parents, observed that finding meaning in the loss of their child was something that slowly and gradually unfolded after achieving a state of emotional equilibrium. “It is a process of transforming, not abandoning, painful emotional states” (Cacciatore, n.d. p.17).
It is important for bereavement counsellors, when incorporating the concept of finding meaning, to be highly attuned to the client and their readiness to explore this topic. A client’s readiness is directly linked to the client’s grief process. If the client has engaged in both their intrapsychic processes as well as their relational bond to the deceased, then they can be much more emotionally available to exploring meaning in the loss.
Excerpt from "Finding Peace, Building Connection, (2018)"
Ways of healing grief
By Tina van der Worp
There are many ways in which bereavement therapy can be approached and new understanding of grief has led to a rich variety of therapeutic modalities that help the healing process. One modality is narrative therapy- a technique developed in the 1980’s by Epston and White, and is based on the shift from viewing people through their own deficits to focusing on their existing resources. The narrative therapy approach views people as “weavers of narratives” (Neimeyer & Harris) who through sharing their stories, choicefully give significance to certain themes in their lives which create their identity. It is based on the view that people’s understandings of their world can be changed and revised. Focusing on resources and strengths in oneself gives one an opportunity to re-author their story and replace a dominant story focused on deficits to an alternative story that embraces what is already good in one’s life. “Within the new stories, people live out new self images, new possibilities for relationships and new futures” (Morgan).
When applied to bereavement therapy, the narrative approach helps shift the bereaved person’s relationship with the deceased from one that is mostly based on feelings of loss to one that is rooted in connection. This approach “values stories, resilience and love” (Hedke) and cultivates the bond with the deceased. It encourages the “letting go of the stories that no longer serve the living while incorporating other stories to build strength and resilience” (Hedtke, 212, p.37) through inviting people to “recognize, validate, honor, expand and celebrate their relationship to the deceased” (Nell).
Narrative therapist Lorraine Hedtke states that telling stories of the deceased person’s strength enables the bereaved to harvest these qualities and fold them into their lives enabling a resourceful interplay between the deceased and the living. Narrative therapy incorporates techniques such as retelling the death narrative, exploring the continuing bond, writing letters to the deceased, remembering and focusing on the positive values of the deceased (Neimeyer & Harris, 2016). These practices are far more than reminiscing about a loved and “involves the incorporation of the dead person’s voices, stories, love, and membership in the ongoing community of the living” (Granados ). Narrative therapy “allows people to continue to speak about a beloved child, or an older sister who has died, and celebrate what the child's life meant to them and also what their lives continue to mean in the lives of those who love them” (Hedtke, 2014). Ultimately, the re-telling of these stories deepens the ongoing process of the loved one’s voice to thrive within the bereaved. This renewed sense of connection contributes to a new sense of meaning for the bereaved (Neimeyer & Harris, 2016).
The narrative approach is directly aligned with continuing bonds theory and helps the bereaved, through retelling their stories, deepen their connection with the deceased. Although narrative therapy emphasizes the positive aspects of the relationship with the deceased, it is also important to allow the bereaved to express their feelings of pain and despair following their loss. It is important to embrace the whole of grief and allow the client to experience all the aspects aspects of the loss as well as what is not lost.
Bereavement Group Therapy
Group therapy has long been recognized for its positive impact on people. One of the most essential and curative factors of group work is peoples’ recognition that they are not alone in their feelings (Rice, 2015; Yalom, 2015). Bereavement groups in particular, are helpful in normalizing the intense pain and suffering the bereaved experience after the death of a loved one. The concept of universality or the “disconfirmation of the client’s feeling of uniqueness is a powerful source of relief” (Yalom) and an essential healing factor in their grief process. Group participants also reap much benefit and support from openly expressing their grief, talking about their loved one, listening, and being heard by others in a confidential space. Grief expert, Wolfelt referred to support groups as “a healthy, healing workplace of mourning” (as cited by Rogers).
The importance of allocating time for their grief by each week is also facilitates in the healing process. Having a commitment to set aside time to grieve allowed "myself to feel, because is was scheduled into my life” ( Battle et al ). Other benefits of the group process included realizing that their feelings were normal, receiving psychoeducation on the topic of grief and the development of new friendships.
Making Meaning
Another essential element of bereavement group work is the exploration of meaning-making (Rice, 2015). Bereavement groups offer a safe venue in which participants can openly explore the meaning of their loss and listen to others’ perspectives of finding meaning (Rice, 2015). In one study of bereaved spouses, participants reported that the safety of the group allowed them to explore and express aspects of their grief that they normally would not have shared with others (Mackinnon). It is clear that participants in a group become a source of inspiration, hope, compassion and understanding for each other on their grief journeys.
Expressive art therapy
The therapeutic use of art in the treatment of people and their issues, can be a powerful healing process. When applied to bereavement therapy, utilizing the creative process of art making, poetry and journal work can be an effective way to reach unconscious feelings of grief. “Grief often lies beyond words, beyond the simple explanation of our conscious minds. It is in the unconscious, in the mystery of life, that expression of the deep wounds and tragedy of the loss is found” (Rogers). Thus art making provides a way in which the bereaved can engage with intense emotions in a safe way through externalizing and distancing from them through artistic mediums (Finn, 2003). It activates the part of the self that can stand outside the experience and observe it from a distance and “have an embodied knowing of being more than those feelings” (Rappaport). Neimeyer argues that the use of expressive arts engages the body and emotions in ways that go beyond one’s linear thinking and thus enables them to access a vast range of emotions that are beyond verbal expression or mental cognition (Neimeyer & Harris, 2016).
In addition to the access and expression of one’s deeper feelings of loss, art therapy is a powerful way in which the bereaved can explore and enhance their continuing bond with the deceased. The art medium offers the bereaved an opportunity to experience feelings of connection with their loved one viscerally, visually and tactically. The participant reaches into the depths of their feeling bodies and sensations in order to express it creatively which significantly deepens the sense of it. Thus, using art to strengthen the bond with the deceased gives the bereaved a sense of agency in their healing process. Initially grief captures us, but we can capture it back and reshape it. Expressive arts and therapies function beautifully as vehicles to help us reshape grief.
