Team Meetings

• Value the importance of mourning
• Pay attention to secondary losses arising from trauma: lost sense of parental protection, loss of childhood, loss of innocence
• Notice when clients are avoiding mourning, as they use:
  • Minimization
  • Precipitous forgiveness
• Invite the client to look at the emotional experience of the loss and its aftermath, focusing on feeling states such as:
  • Rejection
  • Sadness
  • Neediness
  • Disappointment
• Notice when the emotional thread has been lost in the session, and bring the client back to the affect
• Help the individual link feelings to bodily sensations
• Notice discrepancies between expressed emotions and nonverbal physical behaviors
  • Ask the client what he is feeling in the moment
• Look at loss-related emotional themes in the context of specific autobiographical memories
• Get to know the client’s experiences in a more immediate, personal sense:
  • Be on the lookout for detailed images, memories, and specific experiences that can bring stories to life
• Help the individual make emotional connections between more recent losses and earlier ones
• Explore the loss that comes with giving up an idealized view of caregivers.  
• What difficult feelings go along with a shifting view of one’s parents and family?
• Diagnosis & Treatment of Any Associated Mental Disorder

Introduction

Grief and mourning are critical components of life in a sinful, fallen world.  There’s really no way of getting around them.  This fact creates a special level of difficulty for clients with attachment issues.  What we have covered, thus far, is the high level of energy dedicated by such individuals to insulate themselves from their own emotions.  Our job, as therapists, is to work with them to achieve goals which will involve encountering a great deal of their own resistance.

Let’s start by reviewing, what many of us learned in our graduate studies, about the effects of separation.  Bowlby conducted experiments in which he separated young children from their mothers and observed their responses.  He grouped the responses into 3 distinct phases:

1. Protest: refers to acute distress associated with unbearable loss.  In the young children this meant crying, shaking, screaming, throwing themselves around, and searching for signs that the parent had returned.
2. Despair: this phase included a tendency to withdraw, to become inactive, and to make few demands on others, with more intermittent crying.
3. Detachment: the child demonstrates more interest in the immediate environment rather than the absence of the relationship.

Bowlby noted that sometimes adults incorrectly came to believe the child was not less distressed and showing signs of recovery.  In fact, the child had not recovered.  When the mother would visit, these would be a troublesome absence of normal attachment behavior.  The child would seem distant, remote, uninterested in her, detached from attachment-related feelings and behaviors.  In those children for whom the period of separation continued, detachment would become worse still, particularly if there was a succession of institutional caregivers.  Describing the effect on children, Bowlby observed that the child would become interested in material things such as candy and toys and would stop showing feelings when parents would arrive and leave on visiting days; over time, the child would become interpersonally aloof.  That is:

“He will appear cheerful and adapted to his unusual situation and apparently easy and unafraid of anyone.  But this sociability is superficial, he appears not longer to care for anyone.”

What Does Emotional Detachment Look Like in Adults:

Using the term affect phobia to describe the tendency in some individuals to avoid internal affective states, McCullough and colleagues explained that certain experiences and emotions are intolerable because of the conflicted feelings they arouse.  Traumatic experiences are associated with difficult, complicated emotions.  In addition to the expressed and unexpressed anger that client feels towards those who have hurt them, there are a host of affective states of which the individual is often unaware: painful longing for what might have been, distress about having been abandoned by the person trusted most, and the wish to complete the relationship that was somehow derailed too soon.

Adults who are detached from their emotions are at a disadvantage when they meet attachment-related challenges in the interpersonal world.  When relationships become too close, emotional, or complicated, the individual is “afraid to allow himself to become attached to anyone for fear of a further rejection with all the agony, the anxiety and the anger to which that would lead.” (Bowlby).  The tendency toward self-sufficiency provides a sense of comfort and control, keeping relationships safe, but leads to a life that is rather lonely.

Mourning:

To a great extent, trauma is about loss.  In families in which the child has been subjected to physical or sexual abuse or neglect from parents or there is severe parental rejection, abandonment, or harsh criticism, there is a lost sense of caregiver protection, loss of childhood and innocence (Cloitre, Cohen & Koenen).  Additionally, many destructive parents feel moments of regret or shame, leading them to make promises about future changes, causing the child to vacillate between hope and despair.  There can also be significant damage in the event of the loss of a caregiver to death.  In all the above, the therapist is paying attention to aspects of the client’s environment and family such as:

• What were the reactions of the other adults to the destructive behavior/loss?
• Does/did the family talk about it?
• What did they say about it when they talk about it?
• Did the child end up feeling they were to blame?
• Did the child feel secure in the attachment to the other/surviving caregivers?
• Was there another parent/caregiver to attach to?
• Did the destructiveness/loss of one parent mean the emotional loss of the other?

Because strength can be seen as a virtue, especially in attachment deficient or struggling families, when there is loss a sense of pride can develop over behaving as if everything is fine.  The client makes attempts to detach herself from feelings of hurt, sadness, sorrow, or other expressions of dependency, isolating herself from friends, especially when there is a risk that signs of “weakness” will leak out.  Often times, the effort to act as if everything is “fine” backfires.  While the client is working hard to convince themselves, those around them, and perhaps, their therapist everything is all right, they behave in ways which make it obvious they are not.  Another chance to thoughtfully draw attention to an inconsistency.  Remember where pride is involved, and insecure and weak ego is present, so therapist will have to support while pointing this out, even with client who would balk at such support.  After all, they are “better off” & “stronger for it” in regards to what they have been through.

Avoidance – It seems appropriate here to list some of the things to look for in clients who are avoiding mourning.

• Minimizing by:
  • Excessive involvement in intellectual or instrumental activity (work, school, etc)
  • Excessive involvement in leisure activities
• Precipitous Forgiveness
  • Forgiveness as much benefit, at least full and genuine forgiveness.  But there can be no real forgiveness without acknowledgment of the damage done.  Precipitous forgiveness is different.  It appears virtuous and ideal.  It demonstrates maturity and the ability to let go.  It connotes a position of strength, a rejection of the victim role, and a gesture of return to normalcy (Baumeister, Exline & Sommer).  Forgiveness “takes the high road.”  This kind of forgiveness is used in a way that is emotionally dishonest and not terribly helpful, that is, as a way of avoiding the painful experience of mourning.  Herman wrote that some individuals attempt to “bypass their outrage altogether through a fantasy of forgiveness . . . The survivor imagines that she can transcend her rage and erase the impact of the trauma through a willed, defiant act of love.”  The one who grants forgiveness is far more powerful than the one awaiting an apology.  This kind of forgiveness does not allow for the pain of the experience to be incorporated into the client’s reality, preventing any meaningful understanding.

Genuine Mourning – mourning is meaningful, honest & healing.  It comes about through the painful, hard work of acknowledging and experiencing the emotions related to loss, accepting the many complicated, contradictory feelings that accompanied a traumatic history, making sense of the impact such varying emotions have had on the individual’s life and integrating this understanding into the person’s view of himself within his relational word.  Herman wrote:

• True forgiveness cannot be granted until the perpetrator has sought and earned it through confession, repentance and restitution   Genuine contrition in a perpetrator is a rare miracle.  Fortunately, the survivor does not need to wait for it.  Her healing depends on the discovery of restorative love in her own life; it does not require that this love be extended to the perpetrator.  Once the survivor has mourned the traumatic event, she may be surprised to discover how uninteresting the perpetrator has become to her and how little concern she feels for his fate.  She may even feel sorrow and compassion for him, but this disengaged feeling is not the same as forgiveness.

What to Mourn? – Clients mourn the physical or emotional loss of a caregiver due to death, divorce, abandonment during a sensitive period of development or during childhood at large or when clients have experienced the psychological loss of a caregiver due to events surrounding intra-familial abuse, it is important to encourage discussion of such losses in therapy, particularly discussion that is grounded in the emotional experience of the event and its aftermath.

Therapist Strategy – Remember that therapy is not a linear process.  Often times, clients “lose” connections gained weeks or even days earlier, only to find them later along the path.  

The therapist listens for affective themes associated with such losses and invites the individual to clarify, label, and experience different emotions she may have felt both at the time and now, particularly feeling states that the client is not accustomed to considering, such as rejection, sadness, and neediness.  Watch for idealization of the parents and possible struggles for the client as this view point is questioned.

Remember, that these clients “talk around” issues of attachment.  The therapist must be attentive and bring the client back to the affect, not in a pushy or mechanical way, but in a manner that is sensitive to the moment.  As the therapist brings the client back to the affect, notice that emotions related to loss, such as rejection, sadness, and neediness are all difficult to own.  This is because when they arise, they tend to provoke feelings of dependency and a sense of shame for inadequacy.  For example, ” I am sorry for crying, its silly.”

The therapist also does well to notice the client’s tendency to avoid emotions by making observations, giving analytic statements, and talking about feelings instead of experiencing them.  Psychologist Leslie Greenberg and colleagues have emphasized the importance of attending to emotional experience, stating:

• Emotional awareness is not thinking about feeling, it involves feeling the feeling in awareness   Only when emotion is felt does its articulation in language become an important component of its awareness   The therapist thus needs to help clients approach tolerate, and accept their emotions.  Acceptance of emotional experience as opposed to its avoidance is the first step in emotion work.

Along this theme, it is often very useful for the therapist to invite the client to link the emotions they are experiencing with bodily sensations.  McCullough emphasized the importance of the bodily experience of affect, particularly when such emotions have not been often talked about or are difficult to put into words.  She noted that, in treatment, the feeling should create physiological arousal in the body.  “Behavior change does not follow the mere intellectual imaging of affective scenes.  The body must be activated for change to occur.”  Many clients who are avoidant have a strong disconnection between emotional experience felt in the body and conscious awareness.  It is helpful to ask the client:

• What are you experiencing in your body?
• Where are you feeling tension?
• When does your breathing become faster?

It is also helpful to draw out discrepancies between expressed emotions and nonverbal physical behaviors.  Such contrast can be quite pronounced.  For example, a client may talk about not feeling much about a past trauma while she is flushing or her hands are fidgeting.    In as non-shaming language as possible, notice these behaviors and ask the client what she is feeling in the moment.  As greater trust develops in the relationship you will notice such questions are met with less resistance.

Another strategy is to listen for emotional themes and associate these emotions with specific autobiographical memories of the client.  Rather than talking about events in a more intellectualized manner, the therapist fosters emotional connection.  For example, if a highly independent man has themes of isolation, a therapist might ask where else in his life he feels “its all up to me/I’m on my own.”  It may also be helpful to ask for more detailed images and memories of specific affect experiences.  The therapist might ask:

• Can you remember an incident that illustrates that (Ex: the loneliness mentioned above).
• When did you start feeling that way?
• Whereabouts in your body do you experience that feeling?

The therapist can also pull the client away from referring to people in his stories by their title (“my ex”, “my son”, “my doctor”) and use the person’s name.  It makes the story just a bit more personal, keeping the client from maintaining a comfortable distance that comes when referring to people by their roles or titles.

By having the client to address loss-related emotions in the context of specific remembered episodes can help with the process of integrating and making sense of such feelings.  The therapist invites the individual to make meaning of the event or loss and possible effects it may have had on how he views himself and on how she functions within his relational world.

Expect that these conversations will be experience initially by such clients as awkward and difficult.  After all, in many such families of origin, in moments of intense stress in which attachment needs were activated, attachment was withheld.  Such clients now have a tendency to deactivate attachment needs when such emotions are kindled.  

The therapist can also take current situations the client is concerned about which are emotional and draw the client into considering when these emotions have been experience before.  Interpersonal experiences across the life span and connected largely by the emotions they arouse.  This kind of contextualizing loss-focused conversations within the here and now makes it easier for clients who are avoidant of attachment to consider such discussion to be relevant and worthwhile.

Finally, the therapist helps the client develop a more balance view of parents and family.  Coming to realize our family’s imperfections is an important part of development.  In families in which there is adequate security in the parent-child relationship, there is space for the child to develop balance, realistic mental representations of her caregivers, so that parental flaws are seen for what they are.  With an internalized sense of security comes a certain measure of freedom and flexibility.

However, when there is not such security, freedom, and flexibility within the parent-child relationship, it becomes necessary for the child to develop defensive maneuvers to protect her view of one or both parents.  Parent idealization is an important aspect of avoidant attachment and comes about in a defensive effort to keep faith in caregivers.

As such, the therapist helps the client navigate the process of developing a balanced view of family.  The therapist takes seriously the loss of the idealized family/parent for the client, as this loss can be very destabilizing.  It means helping the client examine the painful feelings and the sense of loss that comes with giving up an idealized view and the disorientation that arises when seeing attachment figures through a different lens.  They will need help establishing a new construct in which to view family.

Review Points:

• Value the importance of mourning
• Pay attention to secondary losses arising from trauma: lost sense of parental protection, loss of childhood, loss of innocence
• Notice when clients are avoiding mourning, as they use:
  • Minimization
  • Precipitous forgiveness
• Invite the client to look at the emotional experience of the loss and its aftermath, focusing on feeling states such as:
  • Rejection
  • Sadness
  • Neediness
  • Disappointment
• Notice when the emotional thread has been lost in the session, and bring the client back to the affect
• Help the individual link feelings to bodily sensations
• Notice discrepancies between expressed emotions and nonverbal physical behaviors
  • Ask the client what he is feeling in the moment
• Look at loss-related emotional themes in the context of specific autobiographical memories
• Get to know the client’s experiences in a more immediate, personal sense:
  • Be on the lookout for detailed images, memories, and specific experiences that can bring stories to life
• Help the individual make emotional connections between more recent losses and earlier ones
• Explore the loss that comes with giving up an idealized view of caregivers.  
• What difficult feelings go along with a shifting view of one’s parents and family?

Discussion Video

Topic: MCOTeam Meeting
Date: Mar 14, 2018 10:08 AM Mountain Time (US and Canada)

Gallery View-0 (972 MB)
https://mycounselor.zoom.us/recording/play/J6HP3Qo8ZssLWoHIbQa6YGwkQ4W7bJmdMmaHdAHugnlgMX2WN7ZsHqGFvPchbRl2