Working With The Themes of Grief

During my Master’s program, I came across a research project completed by Susan Carter (1989), entitled “The Themes of Grief.”  Utilizing content and thematic analysis, Carter identified nine (9) core themes inherent in the narratives of her study population of grievers: Being Stopped, Hurting, Missing, Holding, Seeking, Change, Expectations, Inexpressible and Content.

Clients presenting with the phenomena of grief seek support and a way to come to terms, work through – process and reconcile oneself with the traumatic lifetime events/losses they have endured.  In 1993, I revisited Carter’s study and theory of ‘The Themes of Grief’ and created a grief assessment instrument utilizing the core themes and their content referred to as TOG (MOT – 1995).  I also prepared a poem as a handout for use with grievers to introduce them to Carter’s concept of the themes of grief. 

The goal was twofold: to generate an objective measurement of the client’s presenting bereavement response according to the depth of content noted within each theme.  This tool and the scores represent my meager attempt to reflect the depth of a grievers experience concerning the vast phenomena of grief endured at a particular moment in time.  Subjectively, clients state that working with the themes of grief is beneficial towards facilitating, understanding and reconciling themselves with the loss at hand.

I continue to use TOG as a research grief assessment tool (MOT, 1995) in my practice and would like to share the poem, Healing + Recovery (1993) utilized with grievers to introduce Carter’s nine themes of grief as identified below in italic, bold print:

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Trauma Counselling – Depth Levels of Conversation

In my last article, I provided brief descriptors of the first 3 levels of conversation – formal operations, contact maintenance and standard conversations.  In this article, I present brief descriptors of the last two, and what I consider are, the ultimate goal and true depth levels of therapeutic conversations:  Level 4 – Critical Occasions and Level 5 – Intimacy essential to achieve with survivors of traumatic lifetime events (TLE) towards healing and wholeness.

Level 4 – Critical Occasions – are essential conditions to meet for significant life-change and growth and implies that the client is both accessible to work and seeks to truly express the impact and depth of their inner experiencing.  The therapist genuinely and willingly joins the client in this degree of depth conversation.  Critical attention is provided to the revisiting of particular and significant times, relationships and conversations that made a difference, sometimes referred to as a crisis turning point or that moment in time when the stage was set within a sequence of events where one’s future outcomes were influenced [duly or unduly] in a significant way.  Conversation at this depth level results in genuine changes in words, thoughts, feelings and acts of both participants. 

This depth of client and therapist conversation is a highly desirable state of emotional investment where the client revisits the impact and a difference in one’s sense of being follows.  Emotionality is in the moment and there are candid descriptors of past and present, inner experience with self-questioning.  The client’s focus and concern is upon expression of their inner experience and the talk varies in form, tempo and emotional toning.  Typically, this depth of talk is prompt where fluid clusters of percepts emerge with slight hesitancy noted with the new material coming into consciousness.  At this point, the therapist is not forgotten, but part of the background, while the client accesses deep states of inner awareness.  The client’s use of adjectives and adverbs expressed at this time conveys the texture and colors of their inner experiencing which may be enhanced by the use of exclamations, slang, profane or obscene remarks.  Typically, body posture is relaxed and open, and one’s body language changes in keeping with the emerging emotions. 

However, intense immersion and overt behaviors ranging from rigidity to utter limpness or physical contortions visible in one’s face or body may also occur.  The client is on the expressive side of their presence, their accessible and attention is somewhat reduced for they are strongly focused on inner flow.  This is the place of change potential or cross-roads talk where participants emerge with a difference in perspective, attitude, or emotion.  This is a powerful plane where repeated returns to a word, topic, feeling or phase occur without conscious awareness. 

In these moments, the client may be unable to recall something particular, there can be abrupt switches of topics or feelings, a loss of one’s train of thought with a felt sense presents of either physical restless or unusual immobility.

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“I don’t want to focus on the past. I just want to get on with finding another job. Something more fulfilling.”

This was the message I received after seeing a client who I’ll call Bill for the first time. He was calling me to cancel our second appointment. In his early 40’s, Bill had recently been laid off. He was shocked, he said, because although he had changed jobs many times, this was the first time he was let go. He also revealed during our initial session that he was unhappy at work, had been thinking about a career change for a year or so, and if anything good was to come from this experience, it was that he would use the time and severance pay to really identify what he wanted. “I don’t even feel like I’ve made a real career decision before. “ he said, adding that he had a feeling that he was trapped in some kind of work pattern that wasn’t serving him anymore, and he wanted to find out more about that so that he could change it. This story is one I hear often within the group of mid-career shifters I see in my counselling practice. “I’ve been pretty good at getting jobs, and some I really liked, but I feel like I’ve been surviving.”

As someone who made a major career change myself at about age forty, I can empathize with the mid-life search for meaning and a yearning to feel passionate about my work. There is a certain tension to these experiences when you are over forty, which sometimes reveals itself in a familiar dance between feelings of desire and panic. “What if I make the change, give up my pension plan, and blow it? What if I don’t change and I never get to find out if it could be better?” Making a “real career decision” at mid-life has its particular risks and tradeoffs.

One way I work with mid-career shifters is through story, and in particular, through a method called Guided Autobiography. Career construction theory, narrative methods and storytelling are not new to career counselling. These approaches highlight key concepts such as re-evaluating purpose, clarifying values, the creation of a career identity, managing change, and the importance of meaning-making. If telling stories is a natural way to make sense of our world and ourselves in it, then using narrative approaches within career counselling (a meaning-making process in itself!) can really support clients seeking hope and new perspectives as they prepare to make their next career move.

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Reflections of a Trauma Nurse/Counsellor’s Academic, Research & Clinical Experiences: Trauma Memories [TM]

Experts assert that traumatic memory [TM], unlike ordinary memory, may not be altered by the passage of time.  Some argue that traumatic memory is ‘frozen in time or timeless, inflexible, invariable, and immutable or not capable or susceptible to change’ [1].

TM’s are believed to be unique memories that resist integration or are dissociated from ordinary verbal, autobiographical memory (AM).  The theory of state-dependent memory, learning and behavior and model of ideodynamic healing [2] is devoted to understanding and treating TM.  The lack of proper integration of intensely emotional arousing experiences noted in traumatic events into the memory system (AM), results in dissociation and the formation of TM protected by amnesic barriers.

The consequence of dissociation of TM, especially clients with complex, posttraumatic stress and dissociative symptomology or disorders, is that the various components are also dissociated from one another (fragmented).  These dissociated verbal memory fragments, in turn, are dissociated from affect (feelings), beliefs, and the somatosensory (body, 5 senses) dimensions of being plus one’s behaviours associated with the traumatic experiences.  Each dimension is in turn dissociated from one another or the sense of self is unaware of the other.  In Jungian psychology this is referred to as the unconscious or shadow. 

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