Tag Archives: Grief and Loss

Coping with the loss of a supervisee to suicide

By Keith Myers September 11, 2023

two white flowers with black ribbon lying beside a lit tea candle

Marharyta M/Shutterstock.com

Four years ago, I awoke to an email from my supervisee. She thanked me for being a great supervisor, and I thought, “Oh good, she’s going to find another supervisor for a diverse perspective.” But then I quickly realized that this wasn’t a typical exchange. In the next few lines, she said she was ending her life. The tone was resolute and final.

When I read those words, everything stopped. My vision blurred. It felt like I had entered a dark portal that was transporting me into an empty, dark abyss; the portal disappeared behind me, removing any chance I had of getting out. I was stuck, floating almost outside my body. I was in shock.

Moments after the loss

The word supervisee feels so formal and professional, almost sterile. It falls short in describing my connection to this person I had lost. We had spent over 100 hours of supervisory time together during the three years I had been her supervisor. That’s a lot of time. Our relationship was primarily professional, but she had attended my dissertation defense and met my wife, so the professional sometimes merged with the personal.

In the moments after reading the supervisee’s email, my mind started to race with thoughts: Is this real? When did she send the email? Is she alive? Maybe she tried and failed. Is she in pain? How did I miss this? Why would she do this? I have her address; I’m going over there. I should call her.

There is something in our spirit that wants to deny the reality of a deep and sudden loss.
In the email, she thanked me for my supervision, my encouragement and mentoring, and she encouraged me to “fight the good fight.” My first thought was, “Easy for you to say.” But then I realized that it hadn’t been easy for her.

During supervision, she talked about being recently diagnosed with a mental illness and how challenging it was for her and how she didn’t want to keep living like that. I wanted to let her know she wasn’t alone, so I shared that I had witnessed how difficult it could be because I knew someone who had the same mental illness.

I also wanted to tell her that one of my close family members currently struggles with this mental illness, but I didn’t. Sometimes I wonder if disclosing that would have made a difference — not the difference of her dying or living but helped her feel less alone. But maybe that is just the natural feeling we get after loss where we think we could have done something more.

Advice for coping with suicide loss

I have lost several clients to suicide, but I have always been able to differentiate myself from my clients and their decisions and struggles, even ones that result in them ending their lives. I tell my counseling students, “Attach to the person. Detach from their outcomes.”

But the loss of my supervisee was different. It was unfathomable. Because I had been her supervisor, I felt a greater sense of responsibility to her, and this caused me to reflect more on how I could have done things differently. I think it’s natural to evaluate your role when things go wrong. With time and consultation with a mentor, I realized that I had done everything I could. But some of the weight of this loss still remains with me today.

Classes don’t prepare us to cope with client losses, much less the loss of a supervisee. So, I doubt anyone has received training on how to cope with this unless it has been by a mentor who has experienced something similar. Loss by suicide is something we should talk more about — for ourselves as humans and clinicians.

Losing my supervisee to suicide taught me a few things about grief and loss. Although my experience is unique to me, I hope that by sharing what helped during this difficult time, I can help other supervisors and counselors who may experience the loss of a colleague or client at some point in their careers.

Let yourself feel — without judgment. I realized early on that I needed to allow myself space and freedom to feel a host of emotions, such as sadness, hurt, anger, betrayal, guilt and empathy. I never thought this would happen to one of my supervisees, so allowing myself to experience these emotions without judgment helped me process what I was feeling.

We also have to remember that we need to embrace and process these feelings before we act or attempt to find a new purpose. After the memorial service, I sat in my car and thought about what I would do differently because of her death. But my emotional part spoke up and said, “You need to wait. You need to feel your grief before you discover some grand new purpose.” I am grateful I listened to that voice inside me. Allowing yourself to feel before thinking and doing is a healthy response to a shocking loss.

Seek support from others. In my 20-year career as a mental health counselor and 13 years as a counselor educator, I have realized that we do not talk enough about how therapists can cope when a client dies by suicide. So, when it happens, counselors often find there is little professional or peer support. I realize the loss of a supervisee is uncommon; anecdotally, I asked 12 supervisors who had a cumulative 290 years of supervisory experience, and none could recall ever losing a supervisee through suicide. Trust me, you would more than recall if it happened to you. It is forever etched in my heart and soul.

Many counselors receive supervision at the agencies or hospitals where they work. However, since I am an independently licensed counselor in private practice, I was not receiving weekly supervision when my supervisee died. I was just doing monthly consultation. But I knew that I needed more than a monthly check-in during this time, so I asked a colleague who is a trauma-trained supervisor to be my regular, weekly supervisor for the next several months. I knew it was important to have additional and consistent professional support through this season of my life. The supervisor knew about my loss and was always mindful of ways in which I might have been projecting my grief onto my clients or any traumatic countertransference I may have been experiencing. The supervisor was comfortable addressing and exploring these concerns with me if they arose.

I advise colleagues to join a suicide support group. I know that support groups can feel daunting for some, and there may be an issue where the therapist knows the clinician leading the group or has clients in the group. You could also talk to a friend who is a suicide survivor or reach out to your support systems or another mental health professional. Lean on the people who love and support you.

Begin or revisit individual therapy. In addition to supervision, it’s important to be in therapy when coping with suicide loss. I hadn’t seen my therapist in several months, but it helped me find relief and validation for how I was feeling. After I told her what had happened, she looked at me with a blank stare and said, “I never.” Those two simple words resonated with me and affirmed how I felt in that moment. I never thought it would happen either.

Counseling provided me with a safe space to express the unfathomable. It also served as an additional source of support and gave me insight and awareness I would not have had if I were only in supervision. My therapist helped me explore the helper part of myself, which provided perspective around this loss.

Change your perspective. Metaphors, sayings and stories can help us find meaning during difficult or confusing times and help us gain new perspective. For example, the metaphor “Grief is a stone you carry in your pocket” reminds me that grief is always with us, even in times when we don’t realize it is present. It also illustrates how sometimes grief is smooth and contains wonderful memories, but other times, it has sharp edges that can prick you.

After my supervisee died, I resonated with the saying, “What is grief if not love persisting?” This quote allowed me to see how my grief also illustrated how much I cared for this person. If I hadn’t cared, I wouldn’t have felt it so deeply.

Books can also be a great source of comfort. A colleague and friend suggested I read Albert Hsu’s Grieving a Suicide: A Loved One’s Search for Comfort, Answers, and Hope. I’m thankful for this recommendation because it helped me further process my grief and provided helpful examples from a survivor’s faith-based perspective — something that is important to me. Hsu explained that sometimes suicide survivors view their lives through the lens of the death: Everything becomes what happened before or what happened after the loss. On a spiritual level, that is my truth.

An ongoing process

In the months after my supervisee’s death, I found myself obsessively reading her email over and over again. It was like I felt obligated or compelled to memorize it. Maybe I thought that memorizing it would help me not forget her. I wish I could say that I don’t feel compelled to read it now four years later, but I still do. Every year on the anniversary of her death, I find myself reading it again. My therapist recently asked if part of me is still searching for something in her last words. I don’t know the answer to this question yet because I’m still processing through the loss. Grief is an ongoing process after all.

I hope that none of you will ever face a loss like this. But if you do, know that you’re not alone. Give yourself space to grieve and care for the person you lost and rely on the support of others while you try to find comfort and make meaning of the unfathomable.

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Helpful resources

Grieving a Suicide: A Loved One’s Search for Comfort, Answers, and Hope by Albert Hsu, 2017
Myths About Suicide by Thomas Joiner, 2011
“Supporting survivors of suicide loss” by Dana M. Cea, Counseling Today, 2019
Why People Die by Suicide by Thomas Joiner, 2007

Keith Myers has worked in clinical mental health for almost 21 years and is the founding clinic director of Ellie Mental Health in Marietta, Georgia. He received his doctorate in counselor education and supervision from Mercer University. He is a licensed professional counselor, approved clinical supervisor and an adjunct professor with both Mercer University and Richmont Graduate University. Much of his research focuses on traumatic stress and military issues, which resulted in his first book, Counseling Veterans: A Practical Guide. He works with veterans, first responders, couples and trauma therapists who are experiencing secondary traumatic stress.

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Why, when and how to talk with grieving clients about sex

By Kailey Bradley and Victoria Kress March 14, 2023

An older man sits on a couch with his hands on either side of his face and a woman with a pen and notepad sits across from him

SeventyFour/Shutterstock.com

Grief is an experience that everyone navigates at different points in their lives. For the past three years, the COVID-19 pandemic has impacted peoples’ lives in myriad ways and left many experiencing significant grief.

Loss can also deeply affect one’s sexuality, a concept referred to as sexual bereavement. Any form of loss, not just the loss of a sexual partner, can alter one’s sexual desire. As noted in Alice Radosh and Linda Simkin’s 2016 article published in Reproductive Health Matters, both sexuality and grief are stigmatized, which creates a double-barreled taboo. This double stigma can result in someone not feeling comfortable or confident addressing the topic.

When working with clients who have experienced loss, counselors must consider the interplay between grief and sexuality. There are few spaces where clients can address their grief and even fewer safe spaces where they can discuss their sexuality, so it is important that counselors consider how they can approach this subject with clients. This article discusses why this topic is important and when and how counselors can address the intersection of grief and sexuality with clients.

Why is this topic important?

Radosh and Simkin noted that some bereaved clients want to discuss how their sexuality has changed as a result of grief, yet they are often hesitant to do so. Clients may perceive that sexuality and grief cannot coexist. If this is the case, then they may feel shame if they have sexual feelings while grieving. Clients may also believe it is inappropriate to admit that they miss intimacy or that their sexual desire has changed. Other clients may perceive sexuality as distant and remote — something that may never again feel accessible.

The complexities of this topic, combined with counselors’ and clients’ personal discomfort, may cause counselors to avoid addressing it. This discomfort can arise because counselors are uncertain about how to broach the topic, counselors are uncomfortable with the topic of sexuality in general or the client is hesitant to bring the topic up. Although we do not know a lot about how various aspects of sexuality are affected after a loss, it is clear this is an issue that people experience as part of their normal development and growth, so counselors must be prepared to address this topic.

When to address this topic?

Although there is no right time to address this topic, counselors can introduce conversations related to the topic early in the counseling process. They could include questions about how grief has impacted the client’s sexuality on the intake form and then use the information the client provided to gently broach the topic during the first session. Counselors may also need to go slow and consider if it makes sense to bring up the topic during one of the initial sessions. For example, it may not be a good idea to discuss it in the first session if the client has a lot of shame around the topic of sexuality. In this situation, clinicians need to establish therapeutic trust and rapport before mentioning the topic. This approach will help clients feel safe enough to share their experiences.

Counselors can also ask clients to describe the various realms in their lives that have been affected by loss and grief, and they can mention sexuality as one possible area. And throughout the counseling process, clinicians can validate and normalize their clients’ experiences regarding grief and sexuality.

Because clients will move at their own pace and some may want to revisit the topic throughout counseling, regular check-ins with clients can be helpful. Counselors can encourage clients to engage in these difficult conversations by asking them to create “permission slips” to attend to forgotten or challenging dimensions of grief. Clinicians can give clients a scrap piece of paper and ask them to write out an area in their lives that is affected by grief that they find difficult to discuss. Another option is for counselors to write down overlooked topics related to grief and sexuality — such as dating, desire and arousal, physical changes, ways to talk about grief with a partner — on a sheet of paper and then ask clients to choose a topic from the list they want to discuss.

How can counselors help clients?

There is limited research on how to support clients’ sexuality in the context of grief. Formal interventions, however, may not be as important as the compassionate environment and empathic presence a counselor provides. Empathic presence can help clients introduce difficult conversations at their own pace and on their own terms.

Psychoeducation can also play an important role in counseling this population. For example, counselors can share that for some clients, sexual desire and arousal increase after a loss while others have the opposite experience. Providing education around the different reactions people have to grief can validate clients’ experiences and help them connect with the ways they may be experiencing grief. Counselors can also teach clients that grief is not just relegated to the cognitive or emotional domain; our bodies carry and process grief as well, and in this way, our bodies grieve. Providing this education to clients may allow them to feel relief that their somatic reactions surrounding sexuality after a loss are valid.

Another area of psychoeducation that could be valuable to clients is the identification of their grieving styles. The Grief Pattern Inventory is a tool that can help clients gain insight into how they are approaching the grief process. (For more, see Kenneth Doka and Terry Martin’s Men Don’t Cry, Women Do: Transcending Gender Stereotypes of Grief.) Understanding how a person is grieving can help the client and counselor gain valuable insight into the client’s grief process. Intuitive grief is an emotional style of grief in which emotional expression is valued, whereas instrumental grief is a cognitive style of grief in which problem-solving is valued. According to Doka and Martin, a client who identifies as having an intuitive style of grief will prefer a space to emotionally express the wide range of feelings that emerge when considering the intersection of sexuality and grief. In contrast, a client who identifies with an instrumental style of grief may prefer using specific techniques to reengage with their sexuality because they may view the changes in their sexuality after a loss as a problem to be solved. Counselors can introduce this concept to clients and invite them to consider how their grieving style may be affecting how they approach their sexuality after loss.

Finally, creative interventions can be a powerful way to help clients navigate these issues. Counselors can invite clients to write themselves a permission slip to engage with their sexuality in whatever way feels appropriate to them. For example, they might write, “I give myself permission to lean into the feelings that arise when I consider how my sexuality has changed in the following ways.” Clinicians can also encourage clients to create a grief playlist in which they share songs that help describe or capture the feelings surrounding the areas of their life that are affected by grief (including sexuality). Clients could share their grief playlists with their partners and identify how their grief experience is similar or different. Overall, outward expression of loss can help validate the complexity of feelings that arise when navigating this double-barreled taboo.

Addressing personal biases

When working with this population, it is important to be mindful of biases that both the client and counselor may have about grief and sexuality. Some common biases include the assumption that sexual desire disappears after a loss, sexuality is not appropriate to discuss after a loss or having sexual desire after a loss is wrong. To address these biases, counselors can use reflective questions and journaling prompts that ask individuals to reflect on what they have been taught culturally about grief etiquette, sexuality and scripts surrounding what is normal after grief. Again, some might feel judgmental of a griever whose sexual desire and/or arousal has increased after a death. However, addressing our own biases will help create a hospitable environment where a client is met with nonjudgment.

Conclusion

Counselors play an important role in empowering clients who are grieving. Even though we live in a grief-avoidant culture where we shy away from pain, counselors can create a refuge of hospitality where we can openly acknowledge what is uncomfortable. It is in our power and our scope of practice to gently remind clients that it is OK to talk about the intersection of grief and sexuality and to meet our clients with compassionate curiosity and encourage them to grant themselves permission and space to grieve and embrace their sexuality after loss in whatever way makes sense to them.

Kailey Bradley is a licensed professional counselor with supervision designation in Ohio, a national certified counselor and a certified thanatologist. She specializes in the intersections of grief and sexuality as well as issues surrounding chronic and terminal illness. She has a background in hospice work and feels that advocating for grievers is her life’s passion. Contact her at kailey@allrefuge.com.

Victoria Kress is a distinguished professor at Youngstown State University. She is a licensed professional clinical counselor and supervisor in Ohio, a national certified counselor and a certified clinical mental health counselor. She has published extensively on many topics related to counselor practice. Contact her at victoriaEkress@gmail.com.

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Helping youth in foster care cope with grief and abandonment

By Lisa R. Rhodes February 23, 2023

A teenager with a sad face sits on the grass and dreams of a better life in the sunset

Marian Fil/Shutterstock.com

Youth who are aging out of the foster care system frequently wrestle with feelings of grief and abandonment. Counselors who have studied the research literature or have treated this population for many years say the losses experienced by youths during the aging-out process can have a lasting impact on these clients.

“There are relationships that foster youth have with individuals in the system that are discontinued upon aging out. This can be a significant loss that needs to be grieved,” says Brian Russ, a licensed mental health counselor and an assistant professor in the Department of Counseling at Xavier University in Cincinnati. “Along with the loss of their childhood, these older adolescents and young adults can also feel a loss of hope for ever being adopted,” he explains.

Amy Watson, a licensed professional counselor supervisor in Dallas who has more than 20 years’ experience counseling children and youths in foster care, says these clients grieve what their lives might have been like if they never entered the system. However, these youths seldom reveal anything about what they have lost or experienced during their time in foster homes, she adds.

“These clients are definitely traumatized and go into fight, flight, freeze and fawn mode when triggered, which helps [to] temporarily protect them from further losses,” Watson says. “In counseling, we work on ways to manage triggers, process negative feelings and increase coping skills so they can get better at opening themselves up in future relationships.”

Providing unconditional positive regard

Russ, who has worked as a home-based clinician, outpatient coordinator and clinical director at Newaygo County Mental Health in White Cloud, Michigan, suggests that clinicians approach grief with this population by using person-centered therapy techniques.

“There are a lot of complex emotions that need to be processed, and a person-centered counselor can help by offering a safe, therapeutic environment that facilitates the core conditions of unconditional positive regard, empathy and genuineness,” he says. “In this environment, the client can process their emotions without feeling judged, which is necessary for the grieving process.”

Russ offers the following guiding thoughts that can help counselors when working with grief from a person-centered approach:

Detect and reflect. Grief often manifests outside of our awareness; therefore, it is important for counselors to detect the grieving process when it is less explicit. After identifying grief, counselors using the person-centered approach should reflect this to the client to help build awareness and establish an empathic understanding. For example, a counselor could say, “I sense a deep feeling of sadness inside of you. Could this be grief from your loss?”
Offer a safe space and go at the client’s pace. The counseling environment should be rooted in unconditional positive regard. The client should feel safe to express what they are feeling, and because the grieving process can be unique to each individual, the client should move at their own pace. In session, a counselor could tell the client, “I want you to feel like you can work through this grief in whatever manner you feel would be helpful and at whatever pace you feel comfortable. I want this to be a safe space to do this work.”
Help clients make meaning and express their feelings. The counselor’s role is to help clients discover their own meaning about what they are grieving. Clients should have the opportunity to express their feelings in their own way. Clients can have a cathartic experience by expressing their feelings in the therapeutic environment. To facilitate this, counselors could say, “I am curious about what this grief means to you. Do you have any thoughts?” or “Have you found ways of expressing your emotions in the past that have been helpful to you? I am wondering if that would be helpful to you in our session.”
Provide support until the end and don’t be afraid to start the process again. Allowing clients to work toward their own understanding and conclusion regarding their grief is at the heart of the person-centered approach. Clients may want to work toward accepting the loss or saying goodbye. Conversely, they may want to find a way for whatever they have lost to stay with them forever in some form. To help clients work toward their own conclusions, counselors could ask, “How do you feel about where you are at in regard to processing your grief?” or “Is there more work to be done?”

“Our job as counselors is to help the client find this conclusion, and I say ‘conclusion’ with the idea that grief may or may not have an end,” Russ observes. “Some grief lasts forever, and some grief may be cyclical. Either way, we support the client throughout the process.”

Russ says feelings of abandonment often go hand in hand with grief. “There is a loss with both phenomena, but abandonment may connect stronger to feelings of worthlessness,” he says. Allowing clients to “experience unconditional positive regard can help with worthlessness.”

Processing past emotions

Clinicians who work with youth who are aging out of the foster care system can help them to peel away the emotional defenses they have developed to protect themselves from hurtful people and situations. Watson says clinicians can use a cognitive behavioral approach to reframe clients’ thoughts by asking open-ended, empathic questions to start the process. For example, counselors might say:

Tell me about your losses and how you have coped with them.
What would you tell a young person entering foster care about losing siblings and family?
How has loss helped you to develop as a person?

“My clients have a hard time sharing about grief and sadness because they don’t feel safe and have a hard time being vulnerable,” Watson notes. “Once they build trust, they open up more and know I am safe for them. When youth[s] move around a lot, they lack consistency in relationships. Relationships are where youth[s] heal.”

Helping clients work through feelings of abandonment also better prepares them to form positive relationships in their present and future.

“Every person has a right to happy and healthy relationships with boundaries,” says Watson, a board member at WAY Alliance, a North Texas nonprofit dedicated to helping foster care youth transition to independence by providing mentors. “We live in a social world. … If youth do not work through abandonment, they will not have the skills or confidence to be open to relationships and roles throughout life.”

Watson used a trauma-focused cognitive behavioral approach when working with a 17-year-old young woman in foster care whose breakup with a boyfriend triggered feelings of abandonment from her past. The client had been in foster care for about three years, but child protective services had been involved in her life since early childhood when she was removed from her home of origin. She was then placed with an aunt until she was sexually abused by a relative while she was in her aunt’s care.

When Watson began working with the client, she was living in a group home that provided transitional living services. The client, who had also been sex trafficked, had feelings of low self-esteem and was desperate for the approval of men, which Watson describes as a consequence of her trauma.

“The past relationship with her boyfriend was age appropriate (unlike her past encounters with men) and had the boundaries of a normal consensual relationship. The client was especially disappointed because she finally had the experience of dating like the average teenager and felt it was safe,” Watson recalls.

In session, the client expressed negative statements such as “I’ll never have another boyfriend”; “I trusted him. I loved him. I thought he was different”; and “People don’t want me.” To help the client process her feelings of abandonment, Watson asked the young woman several self-reflective questions:

“How does the end of this relationship impact your self-image?”
“Can you see this breakup as part of normal dating rather than the belief that everyone is compatible?”
“How do you feel about the breakup now that some time has passed?”
“What would you tell someone going through a similar dating experience?”
“How does it feel to realize that your family was not there for you and did not protect you?”
“What has helped you cope with being on your own?”

With Watson’s help, the client began to view the breakup as an experience for personal growth rather than one of ruin and rejection.

“We discussed how she could take this time to focus on herself” and move forward, Watson says. The client noted in session that she wanted to grieve only for a week and then “be over it.”

Watson helped the client focus on her schoolwork, which she had been neglecting, and look for a job. They also discussed how she could put her energy into building other relationships — by talking to a staff person she was close to at the group home, for example.

Eventually, the client’s statements began to reflect a new sense of personal power, Watson says. She was now saying, “I know I need to be strong,” “I realize I need to get over this,” “I can’t let it stop me” and “I can’t let it keep me down.”

In a later session, the client “was also able to connect how abusive her trafficker was when she once thought he loved her and protected her and could now see she was a victim,” Watson says.

“This is a big step in healing,” she notes. “That’s all trauma processing. … The goal was for [the client] to find a way to build herself back up.”

Working on self-worth is vital for these youths whether they are recovering from grief, abandonment, or both. “Counselors can help youth with this by assisting them to discover their strengths and giving them opportunities to build self-esteem and self-worth by doing new things, taking risks and gaining confidence,” Watson says.

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Learn more on this topic in the feature article “Counseling youth aging out of foster care” in the February issue of Counseling Today and in the online exclusive “Is Medicaid properly serving youth in foster care?”

Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The impact of cultural resiliency on traumatic loss

By Jessica Meléndez Tyler and Nancy Thacker Darrow January 12, 2023

Alexandra begins her scheduled counseling session with the news that her sister suddenly passed away the day before. The counselor is caught off guard and begins to provide supportive therapy. The counselor learns that while Alexandra’s sister had been sick for some months, her sudden health turn was unexpected and rapid. Alexandra was at the hospital when her sister died and was charged with taking the lead on making funeral arrangements.

Alexandra appears numb and detached in session. The counselor attributes this to the initial shock of the loss and provides warmth and comfort to Alexandra. In the following sessions, the counselor notices that although Alexandra appears to be functioning well following what she endorses as a traumatic loss, she demonstrates a flat affect in sessions, states she has accepted the loss and resumes work immediately although she reports feeling little connection to her current life.

The counselor is concerned that Alexandra is avoiding her grief experience, which may lead to the development of pathological symptoms. However, Alexandra reports that she is functioning just as she was before her sister’s death, only with a lost sense of purpose or spirit. She redirects therapy topics to present stress management and adjustment issues in a new career. After exploration from the counselor, Alexandra acknowledges that without her sister, she finds little point in continuing to pursue her goals as every plan was something she would share with her sister.

Cultural factors

As counselors, working with traumatic loss can be a difficult subject matter. Unfortunately, Eurocentric American society has generally promoted the avoidance of grief in subtle ways, which causes many people to be uncomfortable around people in pain. In addition, we often inadvertently provide the subtle message “it is time to move on” after a loss.

In Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss, Pauline Boss argued that traumatic grief — a grief “so great and unexpected that it cannot be defended against, coped with, or managed” — is significant, complex, and a diverse public and social health concern. The COVID-19 pandemic, along with a rise in social justice issues and a charged election in 2020, created difficult trials and mass grief that continues today. People experienced numerous losses at individual and community levels: loss of personal health, job security, identity, human rights security, mobility, physical safety and loved ones. Typical responses to traumatic loss may be fear, helplessness, illness, instability and even violence. As counselors, we help clients make sense of loss, redefine their lives and find meaning again. But understanding the multitude of factors needed to grieve traumatic loss is an advanced clinical skill, particularly with clients from minoritized backgrounds who have been systematically silenced.

As noted in Robert Neimeyer and colleagues’ Grief and Bereavement in Contemporary Society: Bridging Research and Practice and Darcy Harris and Tashel Bordere’s Handbook of Social Justice in Loss and Grief: Exploring Diversity, Equity, and Inclusion, cultural traditions often affect the way people respond to grief, whether that involves wearing a particular color or garment, crying or praying. Thus, understanding how trauma impacts mental health requires a broader view of identity, community, adaptation and resistance as forms of resilience. Cultural awareness, responsiveness and understanding are essential to increasing access and improving the standard of care for traumatized individuals. However, there are misconceptions about resilience encompassing an individual’s level of grit and fortitude when facing adversity. In reality, particular groups may risk developing traumatic grief because of repeated exposure to pain and suffering (e.g., the Black community, immigrants, members of the LGBTQ+ population). Also, these marginalized populations may not receive adequate treatment or community support for the causes of their grief and trauma because they may only be treated under the medical model, if they are treated at all. Taking a social justice approach, we as counselors can increase individuals’ feelings of meaning, connectedness and support following a traumatic loss. And by exploring the role and impact of cultural resiliency in navigating traumatic loss, we can consider how cultural strength can be utilized in treatment to decrease the vulnerability of disadvantaged communities.

When working with clients going through a traumatic loss, what are the perceptions we hold about the healing process? About resiliency? About treating historically harmed and excluded populations? When people and communities are overwhelmed and unsafe, they experience the world as dangerous. The rest of the world may not know about what our clients have been through, or they may have no appreciation for it. When this happens, traumatized people and communities may feel completely alone, forgotten or ignored. With traumatic loss, focusing on cultural sources for resiliency is paramount to supporting marginalized populations. This construct provides a focused way for counselors to engage with individual stories of suffering, locate causes, charge responsibility, validate the person’s struggle and activate more effective responses.

A cultural resilience approach

Utilizing resiliency soon after a traumatic event can prevent severe mental health concerns. As documented by the literature, resilience has been associated with several positive physical and mental health outcomes. However, as counselors, we must be mindful that most measures of resilience are still skewed toward Western, individualistic practices. Culture can buffer its members from the impact of trauma because it can create meaning systems and provide healing rituals where one can express their pain while remaining connected to a group. A cultural resilience approach to treating clients experiencing traumatic grief can offer a wide range of culturally responsive techniques to decrease client helplessness, hopelessness, self-blame, guilt, shame and worthlessness, especially for those with a poor clinical prognosis. In addition, a social justice approach to integrating cultural resiliency in therapy can be used to evaluate clients’ beliefs about loss, belonging, defeat, marginalization, honor and self-preservation.

Through cultural resiliency, our clients can have a pathway to express their pain in connection to their belonging group. We, as counselors, can increase our clients’ feelings of meaning, connectedness and support following a traumatic loss. We can consider how cultural strength can be utilized in treatment to decrease the vulnerability and oppression of disadvantaged and harmed communities. A social-ecological approach can incorporate cultural variables to activate resilience and acknowledge cultural components of the trauma and a client’s response.

When working with Alexandra, the case example mentioned previously, the counselor could conceptualize Alexandra’s loss from a multicultural and social justice lens, instead of focusing just on stress management. Alexandra is a Black, single, cisgender woman in her 20s who identifies as a Christian. She is in a professional role following her graduate program, and she says that she is close to her two parents and feels supported by them.

First, the counselor considers how Alexandra’s identified cultural and ethnic groups have historically demonstrated resilience. Next, the clinician asks, “How might I effectively integrate a cultural resiliency approach to my work with Alexandra?” The counselor then respectfully asks Alexandra, “What does the healing process look like within your culture as a Black person, a woman and a Christian?”

Alexandra sits and considers the counselor’s question for a minute. She then answers, “That is difficult to answer. As a Black woman, I recognize the expectation to be a strong Black woman. Emotions are a vulnerability that literally makes us less safe so we must push through no matter what. We prevail. As a woman, I also expect to take care of others before myself so my own healing will come with time, but the important thing is that my people are taken care of. As a Christian, healing looks like having faith in God and knowing that this is all a part of God’s master plan. However, I have been angry at God since my sister’s death, so I do not want to discuss faith and his master plan.”

Without identifying a client’s cultural or ethnic affiliation that guides navigating life’s circumstances, counselors may empathize personally with the client but miss the sociopolitical framework that influences the client’s traumatic loss experience. In a 2003 article published in Violence Against Women, Bonnie Burstow discussed how counseling requires both personal and political empathy to understand a client’s social location and how oppression has impacted their well-being. Society and systems are critical in clients’ trauma experiences, and a person’s group identity or identities and the historical trauma with which they are associated often underly their personal trauma history. Trauma occurs in layers, with each layer affecting every other layer.

The counselor considers Alexandra’s reply, and then says, “I hear multiple cultural influences shaping your understanding of healing. I wonder how these cultural components of healing inform your process of grieving the loss of your sister?” Alexandra sits for a moment in silence, with a thoughtful look on her face. “I feel conflicted,” Alexandra says. “I am prevailing, keeping on with my job, taking care of surviving family, and organizing my sister’s things. But I am confused and angry; everything feels unjust. How am I supposed to grieve something that should not have happened?”

The counselor validates Alexandra’s experience of injustice and her conflicted feelings. Alexandra’s question also opens the door for deeper conversations about how her cultural groups have responded to injustice and formed cultural resiliency strategies. But how can the counselor engage in the meaning-making process (the one taught in counseling programs and supervision) with Alexandra through a cultural lens?

Cultural healing and meaning making

For counselors working with clients navigating traumatic grief and loss, exploring historical and cultural healing can deepen the conversation around bereavement and mourning and aligns with our counselor identity of being strengths-based. Some of our clients come from ethnic and cultural groups that have overcome the most traumatic of trials. An intentional counselor can draw upon generations of resilience and attitudes of overcoming impossible odds despite injustices. When counselors focus only on an individual’s lived experiences without considering historical and cultural context, then beliefs about weakness, powerlessness, helplessness and worthlessness may abound because we think that we are entirely responsible for the quality of our life or lack thereof. However, when counselors explore a client’s identity and lived experience in relation to their identified groups, belief systems about belonging, strength and persistence in adversity come to the surface. In this latter scenario, healing can include considerations about how a client’s traumatic loss experience is part of a more significant social injustice that requires institutional and community remedy.

Healing involves a process of forming vulnerable narration about concepts that have been suppressed or silenced. In other words, it is important to narrate the concepts that have only been quietly discussed in the safety of within-group communities or within internal processing and self-talk. Such healing involves a therapeutic relationship of empathic witnessing and a commitment to deepening one’s understanding of the origins of the client’s pain and suffering that has often been pervasive through time and circumstance.

Returning to the example of Alexandra. If the counselor chooses to remain focused only on client functioning and symptom monitoring, they lose an opportunity to deepen the processing and healing of Alexandra’s pain that surrounds her traumatic loss. Prompting deeper reflection on the origins of Alexandra’s pain within her identities (i.e., a sister who was helpless to protect her sister from death, a Black woman who feels that she must make sure everyone else is OK before she allows herself space to grieve, and a religious woman who believes that her higher power wholly abandoned and betrayed her devoted family through this loss) can elicit more meaningful transformations in therapy. Instead of oversimplifying and focusing sessions on the pain of losing a sibling, the counselor can use deliberate Socratic questioning to probe into deeper associations of powerlessness and injustice. This exploration can help Alexandra gain the power to name her generational, historical and personal losses; feel equipped to protect herself through generational resilience; and combat alienation in her traumatic loss through cultural and ethnic identification and belonging.

Counselors can aid in this process by asking clients to tell their story of grief, not only for the immediate loss but throughout their life and previous generations. What has their identified group endured, and how pervasive are those histories in their lived experience? What and who contributes to our client’s grief story? How did they learn their expectations of what it means to suffer? By asking these questions, counselors can help grieving clients label their experiences and examine their beliefs about how their cultures factor into their feelings of traumatic loss.

The counselor decides to guide Alexandra to explore her anger with God gently. The counselor acknowledges that spirituality can be tricky to unpack because it may be perceived as unfaithful or sacrilegious to express doubts about one’s spiritual beliefs outwardly. Alexandra pauses and considers the counselor’s invitation to verbalize how her anger toward God feels. She is hesitant as she begins discussing an almost superstitious belief that if she and her family were faithful and devoted to their religious practices, they would be granted blessings and saved from the suffering others outside her religious faith might experience. She looks down, sheepish in her admission that she genuinely believes that good things happen to good people, and yet her good sister died regardless. Here, the counselor can help Alexandra not only examine her beliefs about being a strong woman of faith but also assess the intersectionality of her being a “good” woman and how that impacted her grief experience. Being a good woman means that Alexandra is outwardly stoic and strong and demonstrates resilience through continuing her responsibilities (e.g., checking in and cooking for her loved ones, managing her sister’s funeral arrangements) and by not becoming emotional around others or needing to be consoled by others.

Over several sessions, the counselor and Alexandra explore reclaiming her personal and community space. They acknowledge the outcomes of Alexandra’s labor to be resilient despite her suffering and implement rituals and ceremonies that express her grief and outrage in a way that is true to her identity as an angry woman, a betrayed woman and a woman who mourns for the generations of Black women who could not express their suffering openly and be met with warmth. The counselor then offers the client warmth and acknowledges the vulnerability it took for Alexandra to name these experiences in therapy and accept support as she not only reconnected with her historical strength and resilience as a Black woman but also rebuilt ties and traditions to being a religious woman who also historically overcame adversity.

The counselor also guides Alexandra to reconnect with nature in her grief processing, as nature has repeatedly demonstrated its resilience through catastrophic impacts. Through this, Alexandra can draw symbolic strengths and models of what resilience looks like. Her grief response changes over time; she no longer feels she must earn her right to be comforted or take up space in processing the traumatic loss. Instead, she resonates with the notion that, like in nature, she can just be and bend and transform as the circumstances require, while remaining rooted in the generations of strength and resiliency that shape her.

Through counseling, Alexandra realized that her grief of suddenly losing her sister would be ongoing and without end. However, she discovered parts of her cultural resiliency that would be beneficial to help her process this grief; using culturally resilient strategies to cope with the loss of her sister allowed Alexandra eventually to readily embrace the injustice and make meaning of the loss experience. Her bond with her sister will always remain, and her meaning-making journey will include how she continues to name and recognize how her sister shows up in her life and informs her cultural resiliency.

Often, to avoid superficial platitudes (e.g., “things happen for a reason”), individuals find themselves at a loss for words to support others going through traumatic loss. Exploring the role and impact of cultural resiliency to help clients grieve traumatic loss can metamorphize their process of bereavement and decrease counselor helplessness in the therapy room. When a horrific event occurs, we, as counselors, do not have words that will heal, and there is no cognitive reframe possible that can make a client’s suffering cease. Nevertheless, we can help clients explore their own histories of resilience and triumph in pain and adversity beyond their lived experience. This empowers a client to continue to fight to survive the unsurvivable and increases their connection and belonging with others in their identified groups and with us as the counselor.

Conclusion

Through a cultural resilience framework, counselors can guide clients through traumatic loss in a way that connects them to the dignity inherent to how their ancestors navigated and overcame suffering. An individual’s cultural groups may also hold generational pain because of oppression and abuse inflicted on the culture. Therefore, it is strongly recommended that counselors explore cultural identities with their clients and highlight helpful aspects of their identified groups that can activate resilience while leaving behind the aspects of the group the client finds unhelpful. The counselor can normalize that culture does not have to be all or nothing, and each person can write the story of how their identified groups activate and empower their group resilience.

Drawing on community connection, resources and rituals that encompass a sense of support and belonging can aid counselors and protect our clients from traumatic grief, which can lead to significant mental health concerns such as mood disorders or posttraumatic stress disorder. Learn about and emphasize the culture-based holistic strategies that clients bring into therapy. This serves to decolonize our counseling practices and enhance our current methods, while also amplifying the voices of generations who have survived and created meaning systems that can contribute to our healing through traumatic loss.

Jessica Meléndez Tyler is an associate professor of practice at Vanderbilt University and a private practitioner. She is a licensed professional counselor, a licensed counseling supervisor, a board-certified telemental health provider and a national board-certified counselor. Her professional interests include working with suicidal clients and crisis counseling, women’s issues, trauma-informed care, cultural resiliency, collegiality, and the intersection of these topics for counselor education. Contact her at jessica.tyler@vanderbilt.edu.

Nancy Thacker Darrow is an assistant professor of counseling at the University of Vermont. She specializes in grief counseling and LGBTQ+ mental health and development. Through research and practice, she aims to dismantle systemic barriers that influence these specialty areas and counselor education broadly. Contact her at nancy.thacker@uvm.edu or through her website at nancythackerdarrow.com.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counseling From a Survivor’s Perspective: The unrecognized grief of IPV survivors

By Leontyne Evans February 3, 2022

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This is the debut article of a monthly online column about working with survivors of intimate partner violence written by a counselor who is also a survivor of domestic violence.

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In August 2021, I wrote an article for Counseling Today challenging counseling professionals to not ask survivors of intimate partner violence (IPV) “Why didn’t you leave?” or to give the perceived notion that leaving would solve the problem. Doing so often causes confusion because most people believe that once someone leaves an abusive relationship, the problem is resolved.

So, let’s go with that for a second. Playing devil’s advocate to my own article, let’s say the protocol for assisting clients who have experienced IPV is to encourage them to leave. If they do leave, then what? What are the next steps? Where do they go from there? Is the problem solved? Will they no longer need the intervention of a professional?

As mental health professionals, we often believe we have all the solutions. We think our degrees, research, theoretical knowledge and certifications give us superpowers to fix people. But we often lack the real-life experience to understand the complicated layers of the situations our clients face.

If a client leaves their abuser, are you prepared to help them along their journey to recovery? Do you understand the journey? Do you understand the new set of problems that will arise after a survivor leaves?

Every counselor should not only be prepared to support their client in deciding how to safely exit an unhealthy situation (if that’s what the client wants to do) but also be adequately equipped to help the survivor prepare for what’s next.

You may be asking, “Well, if someone has removed themselves from an unhealthy environment, shouldn’t that be good enough?” Survivors often receive little to no support once the threat of abuse is gone because so many counseling professionals and organizations believe this very thing. It sounds easy enough: Leave your abuser and get back to living your life. Then all will be well, right? Wrong!

A survivor may experience unexpected issues after they leave their abuser that a clinician can help them to process and understand. As professionals, however, we must understand these issues first.

Each article of my column, “Counseling From a Survivor’s Perspective,” will focus on one specific issue survivors may face post-crisis. In this first column, I explore how counselors can help survivors work through their grief and loss.

Experiencing grief and loss

One of the most overlooked side-effects of leaving an abusive relationship is grief. It may be hard to believe, and maybe even hard for some to understand, but there can be a lot of grief associated with ending an abusive relationship. Even if it was unhealthy, it was still a relationship.

Grief happens after people experience loss. A survivor who leaves an abusive situation may grieve:

Loss of self
Loss of love
Loss of the life they expected to have
Loss of the idea of who they thought their partner was
Loss of friends and family because of isolation

These are just a few examples of the types of loss survivors may experience. These feelings of loss are further complicated by the fact that survivors of IPV may not think sadness is an appropriate response to leaving a toxic relationship. They may find it hard to understand their feelings of loneliness and sadness when others expect them to feel freedom and happiness.

I still remember the day my abuser was taken away in handcuffs. I had looked forward to that day for months. I knew that he would be sentenced to four years in prison and that I would finally have my life back. The irony of watching him being arrested — not for the crimes he committed against me but for something totally unrelated — left me with a sense of bitterness instead of the peace I craved. After seven long years of being on an emotional rollercoaster, the ride was finally over.

However, when the authorities handed me his valuables, placed the handcuffs on his wrist and escorted him away from the courthouse, tears began to roll down my face. My bitterness was replaced with sadness. My anger was replaced with remorse, and my joy was replaced with the fear of loneliness. I cried the entire drive home.

For months, I couldn’t sleep. The sound of the house settling at night caused me to awaken with anxiety. The stairs creaking at 3 a.m. reminded me of the nights when he would come home drunk and take his stress out on me.

I sank into depression, struggling to understand how my mind, heart and body didn’t seem to agree with the verdict. I became angry at myself for missing him, but I also knew I didn’t want him back. This whirlwind of confusing emotions made me feel out of control.

I didn’t understand what was happening then, but now I know this feeling was grief. Grief that I was too embarrassed to explain to anyone else. I was with my abuser for seven years. During that time, we woke up together, went to bed together, ate together, struggled together and celebrated together. It may be hard for some to understand, but I lost my friend. I lost a sense of familiarity. I lost what I thought was love.

Now as an expert in the field, I talk to other survivors every day who have had similar experiences. They are desperately trying to sort through their feelings and understand how they could miss something so toxic. I give my clients space to feel that loss, to grieve it. Similar to those who overcome addiction, survivors of IPV may go through withdrawals or even relapse. For these clients, having a counselor who understands that they are experiencing loss and is invested in helping them explore the journey back to themselves can be life changing.

What counselors must understand

No matter how much abuse was present in the relationship, it was still a relationship. At one point, two individuals loved each other. At one point, the survivor felt safe enough to allow their partner to get close to them to let their guard down. At some point, the survivor let their abuser in — not just into their home but into their heart. Because, let’s be honest, manipulation, gaslighting and the cycle of abuse would not be as effective if the abuser never gained the trust and love of their victim.

Imagine falling in love with someone, feeling a sense of closeness, and then one day waking up next to a stranger, feeling like you don’t know the person you’ve been sleeping with at all. Imagine that the person who once brought you immense joy is also the very person to cause you pain.

If you can’t imagine it, count your blessings to have never experienced something so psychologically damaging. This is indeed a loss. Grief comes in waves, and because the survivor is grieving multiple losses, they may find it hard to communicate or name their feelings.

The client’s mental conflict about ending the abusive relationship can easily be confused (by both the client and the counselor) with missing the abuser when, in reality, it’s often the uncomfortableness of being alone. Counselors can help clients process their feelings and learn to understand the difference between the two. They don’t miss their abuser; they miss themselves — the version of who they were before the abuse happened.

The client may have spent a lot of time and energy attempting to “fix” their partner, and now that they are alone, they may be faced with the idea of “fixing” themselves. Having to examine oneself closely is hard. A good counselor, however, can help clients realize that being in their own company is not necessarily a bad thing.

How to be a supportive ally

You can be a supportive ally by putting a name to what the client is experiencing: disenfranchised grief (i.e., grief that is not or cannot be openly acknowledged, socially validated or publicly supported). And you can remind them that grief is a normal response to any type of loss.

Give the client a sense of normalcy by explaining the cycle of abuse and why they may have these unexpected feelings. Become familiar with the power and control wheel, and help your client to understand it as well. Explain how manipulation and gaslighting play a part in the mixed emotions.

During sessions, you can also talk about various ways the client can rediscover themselves. Help them to sort their feelings and reconnect to the world in this new phase of their lives.

For example, they could join a club, find a new hobby or reconnect with a passion they had put aside because their former partner didn’t like it. As they grieve who they wanted to be, who they once were and the relationships that have been lost, encourage them to enjoy the journey of self-discovery and reconnection. It may be more manageable to help them acknowledge and work through each loss separately.

Now that you have a better understanding of one of the aftereffects survivors may face upon leaving an abusive relationship, you will be better equipped to serve as a professional and an ally.

PopTika/Shutterstock.com

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Leontyne Evans works as the survivor engagement specialist for Survivors Rising, where she helps to empower and uplift survivors by providing education and resources that encourage survivor voice and self-sufficiency. She is a published author of two books, Princeton Pike Road and Relationships, Friendships and Situationships: 90 Days of Inspiration to Keep Your Ships From Sinking, both of which support her mission of ending the cycle of unhealthy relationships. Contact her at leontynesurvivorsrising@gmail.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.