Video 019 Complex Grief (Phase 1 – Avoidance)
Use this solution
When a client’s grief has become complicated or complex i.e. it deviates from the norm in: either the time or intensity of specific or general symptoms of grief and/or the level of impairment in social, occupational, or other important areas of functioning.
Originator:
Solomon & Rando (2007)
Solomon & Rando (2012)
Lazrove S. (1996 June)
Video production
Matthew Davies Media Ltd, Llanidloes, Powys. www.matthewmedia.com
Take-Away Section
What this covers
The sudden, accidental death of a grandson when out cycling with his grandfather. This case highlights the difference between trauma and complex grief. Feeling the pain of loss and separation is a healthy and necessary process and EMDR doesn’t take away that pain. What it does is release the complex nature of stuck or distorted grief by processing the trauma.
How long
10.53 minutes
Related videos
See Videos 020 & 021 to be released in November and December 2021.
Go to ‘Take-away’?
Wrap up: for understanding of our approach to grief work and various ‘theories’ of how to work with grief.
Aide mémoire: step by step description for using the standard EMDR protocol for this phase of grief work.
+ Wrap up
“Change the story and you change the future”
EMDR and Narrative therapy in a case of complex grief
Two of the founders of EMDR Gateway, Richard and Sally Worthing-Davies were systemic and family therapists prior to training in EMDR. Another, Dr Marilyn Tew, has also studied systemic theory and practice since becoming an EMDR Consultant. With this systemic perspective on our work, we are very interested in using Narrative Therapy as a framework in our EMDR work.
Systemic therapy seeks to address people not only on the individual level, as had been the focus of earlier forms of therapy, but also as people in relationships, such as in couples, families, work groups, etc. to effect change and development. Narrative therapy, sharing many of the assumptions underlying systemic therapy, offers one way of effecting change. It seeks in particular to help people identify their values and skills through the stories they tell, and with knowledge of their ability to live these values, to live out a different story that will influence how to go on with life in a more health-promoting way. The use of the word “story” in no way implies that people are living in a “make-believe” world. Rather it means that we construct stories to make sense of our experience, and that the meanings we give to these stories can strongly influence how we go on with our lives.
So how does this idea fit with EMDR? It’s already there implicitly when we ask for a negative cognition (NC) in addressing past traumas. This is the current meaning a client is giving to a story they are bringing to therapy. In the Standard EMDR Protocol we then go on to identify, and eventually install a strong positive cognition (PC) and so create the basis for a preferred story that will influence how to go on with life in a more health-promoting way. Then, when we address current internal and environmental triggers that stimulate maladaptive behaviour, as in the second prong of the overall EMDR process, we further strengthen the basis for the preferred story; and with the third prong, where we directly seek to install a desirable cognitive/behavioural response, we consolidate a new pattern and the preferred story.
Theories of death and bereavement
There are many different psychological theories of death and bereavement, each one suggesting ways of helping clients navigate through the process. It’s one of these theories that we use in this series of three videos on complicated grief corresponding to Lazrove’s complicated grief protocol. This in turn is based on Rando and Solomon’s six R’s of complicated grief. You can read more about it below.
We do not hold that Lazrove’s protocol has the status of “truth” but as one of several theories and protocols that sit alongside each other as potentially useful frameworks for helping create with the bereaved preferred stories about death and dying that best fit their contexts (Appendix A provides a brief list of theories of death and dying).
The principles guiding our work in this area are informed by systemic thinking and in particular Narrative therapy. In creating a non-evaluative atmosphere, we work to ensure preferred stories, rituals and ceremonies are co-constructed with the bereaved to make sense of their loss in a way that is coherent with significant relationships and stories in their lives.
Putting this into practice
The 6 tasks of mourning are:
- Recognize the loss, acknowledge the death, understand the death .
- React to the separation, experience the pain, feel, identify, accept, and give some form of expression to all the psychological reactions to the loss, identify and mourn secondary losses.
- Recollect and re-experience the deceased and the relationship, review and remember realistically, revive and re-experience the feelings.
- Relinquish the old attachments to the deceased and the old assumptive world.
- Readjust to move adaptively into the new world without forgetting the old, revise the assumptive world, develop a new relationship with the deceased, adopt new ways of being in the world, form a new identity.
- Reinvest in life without the deceased.
How to apply the Standard EMDR protocol
Solomon and Rando then placed these 6 tasks into 3 phases of working with complicated or complex grief. They call these 3 phases:
- Avoidance
- Confrontation
- Acceptance
These three phases roughly relate to the three prongs of EMDR processing – i.e. the past memories underlying the current painful circumstances, the present triggers and the future without the loved one.
We have created three videos that demonstrate the application of the Standard EMDR protocol to working with complicated grief. Each video is about 10 minutes long and is accompanied by a step by step description of the process that can be copied and printed for use by therapists.
Video 019 Phase 1
In the avoidance phase, the client has one or several of the following problems: difficulties in expressing grief; absence of mourning; considerable delay in the onset of mourning; or an inhibited ability to mourn. These difficulties could relate to the actual events surrounding the death, hospital or funeral memories, or painful past memories involving the deceased. If there are dysfunctionally stored memories that underlie the current negative response to the loss, these need to be identified and processed.
Video 020 Phase 2
In the confrontation phase, therapists are dealing with skewed aspects of the mourning process. Mourning can be: distorted; conflicted; or unanticipated i.e. taking the client by storm. These are usually present triggers that continue to stimulate pain and maladaptive coping. In the confrontation phase, therapist and client address current situations where ‘stuck points’ and/or particularly painful moments are experienced. Catastrophic anticipatory anxiety about the future may also be present, which can be addressed with the ‘Flash forward’ protocol (see Video 007)
In the acceptance phase of complex grief, the therapist is dealing with difficulties in finding a sense of closure i.e. mourning has become chronic. Work in this phase is about laying down a positive future template. This involves facilitating adaptive coping in present and anticipated future stressful situations. Clients may need to learn new coping skills that can then be actualized by the future template.
The three videos provide a concise, clear and comprehensive description for using EMDR with complex grief. It is our dearest hope that therapists will find these useful in their work and also that they will be the springboard for exploring other theories of death and bereavement that can illuminate the use of EMDR in this field.
Appendix A (From Death Talk; Conversations with Children and Families; Glenda Fredman, 1979)
- Phase theories: in addition to the Lazrove model above, we have:
Colin Parkes (1972) who describes grief as a process or set of symptoms that start after loss then fades away. Numbness is the first phase, giving way to pining and yearning. The third phase is despair, and it’s only after this that recovery and re-organised behaviour occurs.
Bowlby (1989) identifies protest, despair and detachment as a characteristic series of responses to all forms of mourning. He also suggested that the mourner needs to pass through the phases of numbing, yearning and searching for the lost figure and disorganisation and despair before mourning is resolved and re-organisation is possible.
Stage theory: Elizabeth Kubler-Ross (1970) described five stages of dying: denial and isolation; anger; bargaining; depression; and acceptance. The last stage is when the dying person needs to let go of life with acceptance.
Task theory: Worden (1991) links “task” of mourning with Freud’s concept of grief work. Four tasks need to be accomplished for the process of mourning to be complete. Freud argued that “tasks” is to be preferred to “stages” or “phases” because “tasks” imply something can be done and that there is an end-point, which is an antidote to the helplessness affecting mourners. Worden identifies four goals of grief counselling to help the bereaved complete the four tasks of mourning: to increase the reality of the loss; to help deal with expressed and latent affect; to help overcome impediments to readjustment after the loss; to encourage saying an appropriate goodbye and feeling comfortable reinvesting back in life.
[1] White, M. and Epston, D. (1990) Narrative Means to Therapeutic Ends. W. W. Norton, New York.
[2] Shapiro, F. (1989) Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 20, 211-217.
[3] Lazrove, S. (1996, June). In Work with victim advocates: EMDR and MADD, an evolving story. From grief to mourning: an EMDR protocol for complicated bereavement. Presentation at the 1st EMDR International Association Conference, Denver, CO
[4] Solomon, R. M. & Rando, T. (2012) Treatment of grief and mourning through EMDR: Conceptual considerations and clinical guidelines. Revue européenne de psychologie appliquée 62 pp 231-239
[5] Solomon, R. M. & Rando, T. (2007) Utilization of EMDR in the Treatment of Grief and Mourning. Journal of EMDR Practice and Research 1(2):109-117 DOI:10.1891/1933-3196.1.2.109
[6] Rando identifies 6 tasks of mourning in cases of complex grief. He then groups these 6 tasks into 3 phases of working with complex grief.
+ Aide-mémoire
This is the first part of the protocol for complex grief and it addresses the initial shock, disbelief and avoidance of the sudden death. Its aim is to release the trauma surrounding the sudden and shocking nature of the death in order to release the client to be able to engage with feelings of grief and loss. This uses the standard EMDR protocol:
- Take time to allow the client to tell their story and, when s/he is ready, ask the client to identify the worst moment of the death. This is the trauma target. If there is more than one target, process the first, worst, and last.
- Identify the negative cognition associated with the target.
- Identify the positive cognition or the preferred belief about the death.
- Ascertain the VOC from 1–7 to ensure there is enough hope in the system to be able to work with the trauma.
- Go back to the target and ask the client about the feelings.
- Get a SUDs level from 0-10.
- Identify the body location where the disturbance is held.
- Use bilateral stimulation and standard protocol processing to reduce the SUDs and until you hear more adaptive information emerging from the processing.
- Proceed to stage 2 of the complicated grief protocol Video 020.