“Death is nothing”
Death is nothing.
I just went on the other side: it’s like I was hidden in the next room.
I am always me and you are always you.
We are still the first for each other.
Call me with the name you have always given me, that is familiar to you;
Tell me in the same affectionate way you’ve always used.
Do not change tone of voice, do not take a solemn or sad air.
He continues to laugh at what he made us laugh, of those little things that we liked so much when we were together.
Pray, smile, think about me!
My name is always the family word of before:
pronounce it without the slightest trace of shadow or sadness.
Our life retains all the meaning it has always had:
It is the same as before, there is a continuity that does not break.
Because I should be out of your thoughts and your mind,
Just because I’m out of your sight?
I’m not far away, I’m on the other side, just around the corner.
Reassured, everything is fine.
You will find my heart, you will find the purified tenderness.
Dry your tears and don’t cry, if you love me: your smile is my peace.
Henry Scott Holland
Mourning and loss
Mourning and loss are transversal experiences, which affect all people indiscriminately. Usually a mourning of a loved one, the diagnosis of a degenerative disease, the loss of work, mark the life of an individual as if it were a watershed.
Exists a first and after through which the person tends to narrate himself. This is whether it is a physiological or pathological mourning.
The outcome in one or the other condition usually depends on many factors. One of the most incisive concerns attachment, that is, how the first relationships have satisfied the innate need for care, love and protection of the child.
Mourning and attachment
The attachment system (Bowlby, 1980) is in fact a motivational system that guides children to keep proximity to those who take care of them, in case of danger or need.
The quality of these interactions leads to the formation of Internal operating models (Moi) (Wallin, 2009) that contain cognitive-emotional information on how we expect the other to respond to requests for support or protection or to the method with which we will receive care, love and support.
During all development and adulthood, the moi tend to consolidate and become a real attachment style. That is, a stable cognitions and behaviors that are expressed in relationships.
The attachment styles They can therefore be safe or insecure (anxious or avoidance) or disorganized. Usually at the basis of a pathological mourning there is a insecure or disorganized attachment (Onofri and La Rosa, 2015) and the current loss (of a loved one, an animal, etc.), painful reactivation of the past.
A therapeutic approach that helps to process this type of mourning is the Therapy scheme which, through experiential, cognitive, behavioral and therapeutic relationship, allows you to meet the current frustrated needs and the past that prevent the physiological elaboration of mourning, going to work right on the attachment.
The model of the Therapy scheme
In the Therapy scheme (Young et al. 2018), in fact, it is assumed that all of us, as human beings, have since the birth of fundamental needs.
Among these, as already mentioned, there is sure attachment, but we also have the need for autonomy, sense of competence and identity, realistic and self -control limits, freedom to express fundamental emotions and needs, spontaneity and play.
For our well -being it is central that these needs find space to be satisfied in our primary relationships.
However, it often happens that these needs are not adequately satisfied and this generates the formation of Early maladative schemes (SMP). They consist of memories, emotions and behaviors, which develop in childhood and which have reactivated automatically even in adulthood.
The SMP influence our behavior with repercussions on the levels of well -being and personal satisfaction.
The model assumes that what we see of the expression of the schemes are the fashions, which can therefore be considered as parts within the individual who acquire the scene in the here and now expressing internal contents and instances.
Schemes underlying a pathological mourning
In reality, in pathological mourning we can find all the schemes conceptualized in the Therapy scheme, but the most frequent ones relating to the domain, precisely, of the attachment (called detachment/refusal).
Therefore, abandonment/instability (“Everyone will abandon me“), Distrust/abuse (“the other will hurt me or he won’t tell me the truth“), Emotional deprivation (“I’m alone and I will always be“), Inadequacy/shame (“there is something wrong in me and if the others saw it they would judge me“) And social exclusion (“I am different from the others“), Are the most present.
The person following a loss can experience both the physiological pain for loss itselfboth the pain experienced in childhood and the mourning reactivates, acting as a trigger, which he does not know how to take care of it and that he manages with dysfunctional modalities.
Furthermore, in the loss we can detect the presence of all fashions according to this organization: the Vulnerable Child Fash which can be seen from a profound sadness, lack of hope or the angry child when there is the protest for what cannot be obtained (for example the return of the deceased person).
Or the Mode critical/demanding parent that discredits the pain or requires it to be immediately exceeded. Other times the pain is suppressed, hidden, detached from fashions of avoidant coping and cars consolers (for example through the use of substances, alcohol and video games). The healthy adult is often weak and helpless.
In general, in I work with mourning It is therefore essential to bypass the fashions of dysfunctional coping to achieve vulnerable child fashions and satisfy the need below and/or reduce the presence of critical/demanding mode always to achieve and satisfy what is inhibited and limited. All this by activating or “training” the healthy part.
Therapeutic work with the schemes and fashions in mourning
So in therapy there are some steps to follow (not necessarily in this order) to work on pathological mourning or on future loss:
- Observe what is happening in the here and now and in the life of the patient To understand in what mode it is. For example, if it is found in coping fashions, it is good to work by validating this fashions that protects the person from a pain that does not know how to manage and with extreme slowness put it aside, in order to reach the emotional part below.
- Understand the patient’s need for moment. Validation, support, proximity, game etc. They are all needs that can be hidden by coping fashions and critics. It is therefore important to arrive, through specific exercises, to the vulnerable part below to meet his needs.
- To do this it is usually necessary bypass the foding fashions of avoidant copingwhich tend to maintain far emotions and needs in order not to feel the suffering linked to mourning. If the prerequisite for which this part is activated is protective, the long -term consequence is dysfunctional, as the patient does not remove only unpleasant emotions but also pleasant ones and contact with his needs.
- Furthermore, often, there are critical and/or demanding parts that hinder the expression of need or demand certain behaviors. For example. Working on a critical rumination to interrupt it will allow you to get in touch with painful, but fundamental for the satisfaction of the need and the taking care of the same.
- Finally we can find people who manage pain through hypercompensation, that is, in activity (such as work) in order not to get in touch with the most vulnerable part.
Specific work in mourning/future loss
Even in mourning/future loss (whether of a loved one, an animal or health), dysfunctional experiences in childhood that bring with them frustrated needs influence what we expect in the future loss, referring to these memories.
It is therefore likely that we can experience strong disgust, pain, anxiety for what has yet to happen.
In addition to the work previously described with fashions, for losses not yet happened, it is important to create a relationship with them.
To do this it is useful find a sense and a perspective to future loss together with the patient. For example, for a loss of a child who goes away from home, a new sense could be given to the family who remains and build more space in their home.
So it means building a new representation of what will happen and see a new trajectory.
It is also important thank what is lost: This allows you to get out of a feeling of lack of power and bring within us what has left us the loss.
Finally, it is essential not to overlook the investigation into suicidal ideas. Ask the person if there are, what is their content and how detailed it is impact to have a clear picture of the patient and make the implicit emerge.
To conclude
In psychotherapy, mourning work does not involve the use of empathy alone, without proposing a way out.
The identification of the needs below and their satisfaction through the activation of the healthy adult, find a sense that is such for the patient, share a future perspective and thank what has been lost and will all be lost are actions aimed at a proactive work Which can encourage unlocking and the beginning of a process that we are evolutively planned to travel.
Bibliography
- Bowlby, J. (1980). Attachment and loss. Basic Books.
- Dana, D. (2019). Polivagal theory in therapy. Take part in the rhythm of the adjustment. Giovanni Fioriti publisher.
- Young, J., Klosko, J. (2018). Therapy scheme. Erickson.
- Rafaeli E., Bernstein D, Young J. (2010). Therapy scheme: features distinctive. CBT distinctive features.
- Wallin, DJ (2009). Psychotherapy and attachment theory. The mill
- Onofri, A., La Rosa, C. (2015). Mourning. Cognitive-evolutionist psychotherapy and EMDR
- Taken from the workshop: Grief and loss: How To Work With Therapy Scheme – Pain and loss: How to deal with them through the Therapy Scheme approach. Trainer: Katja Molnar
