The Therapist in Mourning

The Therapist in Mourning: From the Faraway Nearby

ANNE J. ADELMAN
KERRY L. MALAWISTA
Copyright Date: 2013
Pages: 336
https://www.jstor.org/stable/10.7312/adel15698
  • Cite this Item
  • Book Info
    The Therapist in Mourning
    Book Description:

    The unexpected loss of a client can be a lonely and isolating experience for therapists. While family and friends can ritually mourn the deceased, the nature of the therapeutic relationship prohibits therapists from engaging in such activities. Practitioners can only share memories of a client in circumscribed ways, while respecting the patient's confidentiality. Therefore, they may find it difficult to discuss the things that made the therapeutic relationship meaningful. Similarly, when a therapist loses someone in their private lives, they are expected to isolate themselves from grief, since allowing one's personal life to enter the working relationship can interfere with a client's self-discovery and healing.

    For therapists caught between their grief and the empathy they provide for their clients, this collection explores the complexity of bereavement within the practice setting. It also examines the professional and personal ramifications of death and loss for the practicing clinician. Featuring original essays from longstanding practitioners, the collection demonstrates the universal experience of bereavement while outlining a theoretical framework for the position of the bereft therapist. Essays cover the unexpected death of clients and patient suicide, personal loss in a therapist's life, the grief of clients who lose a therapist, disastrous loss within a community, and the grief resulting from professional losses and disruptions. The first of its kind, this volume gives voice to long-suppressed thoughts and emotions, enabling psychologists, psychiatrists, counselors, and other mental health specialists to achieve the connection and healing they bring to their own work.

    eISBN: 978-0-231-53460-4
    Subjects: Psychology, Sociology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. ACKNOWLEDGMENTS
    (pp. ix-x)
  4. List of Contributors
    (pp. xi-xiv)
  5. ANOTHER KIND OF SORROW
    (pp. xv-xvi)
    Jody Bolz
  6. PREFACE
    (pp. xvii-xxii)
    Anne J. Adelman
  7. INTRODUCTION
    (pp. 1-14)

    In the following pages, we reflect on the experience of sadness and grief at various moments throughout the life of a therapist. We specifically address some of the factors that make it difficult for therapists to acknowledge and speak about the strong emotions they encounter over the course of their professional lives. We review some of the ways previous writers have conceptualized the process of grief, and, finally, we introduce the notion of the “middle-distance” as a framework for considering the experience of grief and mourning.

    What are some of the challenges that make it difficult for therapists to address...

  8. PART I. THE THERAPIST’S EXPERIENCE OF LOSS
    • [PART I. Introduction]
      (pp. 15-16)

      In this section, our authors explore grief and loss from three different vantage points. In our first chapter, Kerry Malawista and Linda Kanefield approach the experience of loss through the lens of artistic representation, fictional narrative, and neurological and psychoanalytic understanding. They suggest that rather than moving through “stages” or “phases,” mourning is more like a Möbius strip—a form both simple and elegant that has no beginning or end but rather weaves around itself in a continuous loop. With this perspective, there is no clear endpoint to grief nor any specific goal for mourning. Instead, the mourner finds herself...

    • CHAPTER 1 FROM THE FARAWAY NEARBY: Perspectives on the Integration of Loss
      (pp. 17-31)
      KERRY L. MALAWISTA and LINDA KANEFIELD

      Georgia o’keefe’s 1937 oil painting From the Faraway Nearby depicts the remains of an elk’s skull and antlers above a range of pink and white mountains in the desert. The painting, like its title, captures the dualities of life: the haunting idea that something can be both distant and, at the same time, dangerously close. O’Keefe’s painting is filled with contradictory images—light, representing life, and bones, the marker of death. It denotes the dual experience of something that is simultaneously present and immediate yet absent and elusive. Curiously, the canvas lacks a middle-distance, an artist’s term for the space...

    • CHAPTER 2 EXPERIENCES OF LOSS AT THE END OF ANALYSIS: The Analyst’s Response to Termination
      (pp. 32-48)
      JUDITH VIORST

      A patient is nearing the end of a lengthy analysis. The fantasy is that his analyst, who has a pair of tickets to an Isaac Stern concert, offers him one of the tickets as a gift. At the concert hall, he sits beside the recipient of the analyst’s other ticket, who turns out to be none other than the analyst’s lovely, and unmarried, daughter. They talk, they start to date each other, they fall in love, and soon they are happily married—living, of course, not too far from daddy-analyst.

      A typical patient’s fantasy? Not quite. The fantasy belongs not...

    • CHAPTER 3 MISSING MYSELF
      (pp. 49-68)
      SANDRA BUECHLER

      When I was with Barbara,¹ I almost believed in God. God was one of the few explanations for her radiance that made any sense to me. Her face had its own light. It had, in fact, a whole complement of weather conditions. Brief showers would sometimes magically give way to sunshine. No matter how long clouds prevailed, I always knew the sun would eventually shine through. This continued throughout my three-times-per-week treatment of her, which lasted for more than a decade.

      I couldn’t look at her smiling face without feeling joyful, though not sure why. I firmly asserted what her...

  9. PART II. WHEN A PATIENT DIES
    • [PART II. Introduction]
      (pp. 69-72)

      Every treatment begins with the knowledge, whether conscious or unconscious, that this is a relationship that is bound to end. At the same time, it often begins with the “fantasy of forever” (Robert Winer, personal communication). These interwoven themes form the backdrop and can influence the course of treatment, although one may not know how, until the end. For both patient and therapist, anticipating this future loss becomes part of the process and may be alternately avoided, denied, or minimized. The intersection between how patient and therapist contend with loss lies at the heart of the treatment and ultimately affects...

    • CHAPTER 4 THE HAND OF FATE: On Mourning the Death of a Patient
      (pp. 73-92)
      ANNE J. ADELMAN

      Irina’s¹ ghost has settled into the chair across from mine, in the exact spot that Irina occupied, three times a week, for nearly three years. I glance up and see her deep eyes dance at me; her smile is wry and sad. “You see,” I hear her say, “it’s just as I told you—if there’s only a 1 percent chance that something bad will happen, it will happen to me.” Her thick hair cascades around her. With an intense gaze, she wills me to undo the spell cast by her abrupt death and restore her to life.

      It is...

    • CHAPTER 5 LITTLE BOY LOST
      (pp. 93-106)
      ARLENE KRAMER RICHARDS

      So eurydice welcomes her lover, the great musician Orpheus, to hell. She comforts him with the idea that everything animate must die. But, she adds, even inanimate things change, get used up, get lost, disappear. This death of the inanimate is even more horrible than the death of the musician, even more horrible than the death of the beloved. The death of the inanimate, of the natural, makes it clear that not even nature, not even earth is eternal. Everything gives way to entropy. If entropy is the great law, then death is comforting. In this way she says that...

    • CHAPTER 6 WHEN A PATIENT DIES: Reflections on the Death of Three Patients
      (pp. 107-117)
      SYBIL HOULDING

      Our profession elevates the status of what we—somewhat brutally—designate the “termination phase” of analysis. A terminated case—one in which both parties agree to conclude their relationship at some specified date in the future—is often a requirement for graduation. We recognize the demands on both analysand and analyst during this anticipated ending of a long and intense relationship. The unexpected death of a patient short-circuits this process for the analyst and highlights the special difficulties of mourning this unique relationship.

      Within a five-year period, three patients in three different forms of treatment with me died unexpectedly. The...

    • CHAPTER 7 WHEN WHAT WE HAVE TO OFFER ISN’T ENOUGH: Suicide in Clinical Practice
      (pp. 118-132)
      CATHERINE L. ANDERSON

      Like many psychically powerful pursuits, my struggle to make sense of the ways in which a patient’s suicide affects the therapist stems from my experiences with patient suicide. These painful events propelled me to examine the process by which we work through a patient’s suicide in light of the specific developmental and professional context within which it occurred. In order to give form to this discussion, I provide three clinical examples of suicides that occurred during distinct phases in my career, each of which contributed to a deeper understanding about what had happened and the eventual meaning that each suicide...

  10. PART III. AT THE CROSSROADS OF THE THERAPIST’S PERSONAL AND PROFESSIONAL WORLDS
    • [PART III. Introduction]
      (pp. 133-136)

      In this section, we examine the clinicians’ experience of coping with personal changes and loss, which can profoundly affect one’s sense of self as a therapist. When the frame of our work is shaken—whether by illness, old age, institutional changes, or the everyday losses we encounter in our practice—our identity as therapists is challenged. Such changes can land us in the realm of the middle-distance, where we may lose our perspective. Here, each of our authors examines the consequences of such shifts and highlights the inevitably of the denial and disavowal that we encounter in the middle-distance. These...

    • CHAPTER 8 WHEN THE FRAME SHIFTS: A Multilayered Perspective on Illness in the Therapist
      (pp. 137-157)
      JENIFER NIELDS

      One’s physical experience makes up a “frame” within which psychic action takes place. We don’t notice the power of our bodily experience until it changes. For me, this occurred most dramatically through illness.

      What do we notice then? What happens to us psychologically when our bodily “frame” shifts because of an illness, and we find ourselves functioning under altered conditions, adjusting to new physical sensations, or unable to function at all?

      As therapists, how are we to judge when we can and when we cannot continue to work effectively despite the effects of illness? How are we to discern when...

    • CHAPTER 9 THE LOSS OF AN INSTITUTION: Mourning Chestnut Lodge
      (pp. 158-177)
      RICHARD M. WAUGAMAN

      October 9, 2009—letter from RMW to Harold F. Searles: I got asked last week to contribute a chapter to a book on The Therapist in Mourning. Since then, I’ve told myself I’m probably still grieving leaving the fallopian tube for the uterus and much since then, so I’ll have to condense. The editors loved my idea of writing about leaving the Lodge. I’m hoping that writing about it will help resolve some of the grief.

      Okay, I was exaggerating ever so slightly about mourning the lost fallopian tube I left as an embryo. But I doubt I am alone...

    • CHAPTER 10 THE DEATH OF THE ANALYST, THE DEATH OF THE ANALYTIC COMMUNITY, AND BAD CONDUCT
      (pp. 178-197)
      ROBERT M. GALATZER-LEVY

      When dr. P died suddenly, he disappeared. There was a memorial service, and those patients who could be identified were offered help by other analysts. But after that, not a word. Though Dr. P had been a central figure in his society and institute, his name never came up again, even in relation to projects he had initiated. Study groups to which he belonged became inactive and dissolved for no apparent reason. He disappeared from institutional awareness as if he had never existed.

      Dr. P died from a brain aneurysm that had been diagnosed several years before and for which...

    • CHAPTER 11 THE ANALYST’S DEATH—APPREHENSION YET NOT COMPREHENSION
      (pp. 198-214)
      BARBARA STIMMEL

      Freud was first operated on for jaw cancer in 1923. In 1939, thirty-three operations and sixteen years later, he died. Within the breadth and depth of his powerful theoretical and clinical output during that decade and a half, Freud never makes reference to his illness, his disfigurement, his pain, or his looming death. The political historian Tony Judt transformed some part of his own death into a compelling memoir, one that extols the wonder of looking at the streams of consciousness wandering through his reservoir of memories. Both psychoanalyst and historian kept working while dying. This chapter considers how the...

  11. PART IV. WHEN DISASTER STRIKES A COMMUNITY
    • [PART IV. Introduction]
      (pp. 215-218)

      The first three authors in this section bring us into their experience of working in the midst of tragic events. They each describe their efforts to maintain a therapeutic framework in the face of a global devastation that affects clinician and patient alike. Such large-scale catastrophes underscore the reality that we are limited in our ability truly to provide the protection and stability that we strive for in our ordinary clinical practice. No one is immune to unexpected tragedy—neither patient nor therapist.

      In her chapter on the effects of Hurricane Katrina, Sylvia Schneller invites the reader into the post-Katrina...

    • CHAPTER 12 BROKEN PROMISES, SHATTERED DREAMS, WORDLESS ENDINGS
      (pp. 219-236)
      SYLVIA J. SCHNELLER

      Therapists involved in a long-term dynamic treatment process commit to their patients, either verbally or nonverbally, that the work will continue until completion of the therapy. When something unexpected occurs, such as illness or trauma in either the therapist or the patient’s life, the disruption of that process is frequently experienced as a broken promise. Often, dreams of a fantasized good outcome are shattered. This chapter deals with one such life situation: Hurricane Katrina and the levee rupture that inundated the city of New Orleans in late August 2005. All members of the community, patient and therapist alike, experienced a...

    • CHAPTER 13 WHAT THE LIVING DID: September 11 and Its Aftermath
      (pp. 237-254)
      BILLIE A. PIVNICK

      Ten years after the complex series of events we have collapsed into the phrase “9/11,” many of my patients, especially parents with young children at the time, are still traumatized. Many were so distracted by the aftermath of the attacks that their lives became fragmented, more of a collage of snapshots—memories created as if by flashbulb—than a coherent narrative. With so many separate shards of experience to monitor, some could not recognize their grief. Others did not notice their sadness until many years later. When they did, they were startled to realize that they had somehow lost a...

    • CHAPTER 14 THE LOSS OF NORMAL: Ten Years as a U.S. Navy Physician Since 9/11
      (pp. 255-276)
      RUSSELL B. CARR

      I am not the same person my friends remember. Recently, I received an email from an old medical school classmate who found me on Facebook. At first, pleased to hear from him, I replied. I looked at his family pictures, and he looked at mine. We seemed to be in the same place. Then he asked me during our e-mail conversation, “So I see you are still in the Navy. How do you like it?” When I read those words, I froze. I was transported to a place with mortars, dead young Americans, and triple amputees. I didn’t know how...

    • CHAPTER 15 TIME
      (pp. 277-286)
      ROBERT WINER

      Time’s arrow peers out at me from behind my awareness. It faces me full-frontal; it is aimed at my heart. I began writing about time during the year in which I turned sixty-five.

      Too often, for our patients, and at times for ourselves, time petrifies. There are two reasons for this. One is existential, our anxiety about dying, the other neurotic, our fear of doing things differently. They wrap around each other. We wish for more life.

      I live my life in calendar time, my future disappearing into my past. This is the time of the three-headed Greek god Chronos....

  12. CONCLUSION
    (pp. 287-290)

    Truth be told, we all have disquieting memories that linger in the shadows of our work. As we have seen in the preceding chapters, those who come through the doors of our consulting room inevitably leave their traces on our psyche. We bear witness to their pain, and we cannot remain untouched. We bear witness, too, to those events that shatter the world, whether in a private, interior realm or on a greater, more global scale—events that affect our patients and ourselves equally. After our patients are long gone, we miss the work we had been engaged in with...

  13. THE FIVE STAGES OF GRIEF
    (pp. 291-292)
    Linda Pastan
  14. INDEX
    (pp. 293-308)