The use of somatic treatments to address grief is both the unique factor and the integral part of the success of the Degriefing process. Treating the physical body is what differentiates Degriefing from other therapies that rely solely on talk to affect the healing of grief after loss. Grief is the body’s innate reaction to loss and the symptomology is complex, multi-faceted and case-specific. As we approach the body filled with grief, we must recognize the work is like delicately peeling back the petals on a lotus flower. It takes time, care and introspection on the part of the practitioner and must be handled with only the client’s needs in mind. In this final installment, we will focus on the use of treatments for Somatic Degriefing used during actual client process work. There are infinite combinations of approaches to address the grief held by the body. With the use of a comprehensive intake form and proficient listening, a practitioner can assess the way to begin the Degriefing work by combining the forces of various integrative therapeutic systems, thereby serving each person’s uniquely individual needs. I find as the work progresses the opportunity to integrate new approaches keeps appearing.

Grief Builds

Daily losses often feel like minor irritants. For example, being stuck in traffic and losing time can cause shoulder tension, a headache or bad humor. But, losing one’s spouse, home, job or pet can feel like a “blow to the gut.” Unresolved grief can live, hide or be held in the body for decades. Each subsequent loss will usually aggravate the old holdings. The cumulative effect can produce a grief reaction that at times seems disproportionately dramatic. This is because the effect of “one plus one” in grief is not two; it is, in reality, an exponential result we feel.

I have often heard my clients deny their grief. “The dent on my new car door is not such a big deal. Other people have it worse.” They want to deny the fact they waited and saved before buying the car of their dreams; their first new vehicle ever. They can’t understand why they feel so bad about a car. In reality, each person’s loss is painful and needs reckoning with, no matter how petty their mind wants to make it. In Buddhism, this is referred to as “the comparing mind.”

Several months after my husband died, I was visiting a friend in San Francisco. I decided to wash some clothing at a nearby laundromat. When I took my clothes out of the washer and put them into the dryer, I realized my favorite khaki pants were missing. My breathing got short and rapid, I felt frantic. I anxiously looked in every washer and dryer, but they were nowhere to be found. Knowing they were gone, I burst into tears. I just couldn’t stand to lose anything more at that time. I felt out of control and gripped with despair. I cried for hours.

For an individual who has not fully grieved the loss of their parent, who has just been dealt a broken romance or who has been victim to sexual abuse during childhood, one more grievous moment can cause an outrageous response. When a favorite article of clothing is damaged or something spills on the rug, the reaction of rage might be shocking. At first glance it seems to be about the article of clothing, or the rug, whereas in reality one more loss was just enough for the metaphoric dam to burst. The reaction of hysterical tears is really about the combination of losses. The damaged garment represents the straw that broke the camel’s back and released the emotional floodgates of a condition called “bereavement overload.” The grief process is non-linear, so we may find a new loss activates the memory of painful, unresolved events from our past. This is one process we cannot mentally outsmart, rationalize away or control.

With Degriefing, clients are able to use a variety of tools to recognize the onset of a grief reaction. The intention is then to transform the discomfort into cognitive information, identify the stimulus, the responding thought, the somatic effect and then use this new sense for deepening awareness and compassion toward self.

Dealing with each challenging loss, rather than postponing, avoiding, accumulating and then waiting for, the next loss to occur is a more pragmatic approach to staying centered and empowered in our lives. Unfortunately, most people don’t realize this and wait until they cannot stand the pain before acknowledging they might need some help to normalize their grief and release the sensations of physical, emotional and mental sufferings.

When grief remains unaddressed, it becomes altered and complicated by the influence and compilation of subsequent losses. In grief terminology this is called “complicated unresolved grief.” It is much easier to address each issue at the time of loss, rather than waiting to handle a whole lifetime’s worth of grief experiences. Recognizing the feelings carried in our bodies, before they build up into armored emotional walls of muscular holdings and postures, we are then able to convert the grief as “raw material.” The body is the barometer for our feelings and grief is the body’s response to loss — any loss. The degrees of grief will correspond to the impact of the loss. Grief fuels the journey of our deepening personal awareness, preventing the backlog of difficult emotions.

Know Your Own

Stephen Levine, noted author and teacher, has told me, “We can be present for another’s grief only to the extent that we know our own.” A bodyworker not familiar with their own personal grief can have a difficult time holding space for their clients. Grief is as universal as the smile. When I smile you might also, and when I cry, your eyes too, might mist. A client’s cathartic release of emotions can definitely activate the practitioner’s grief holdings, an event known as “somatic resonance” or “genetic compassion.”

In order for a practitioner to serve a client (and loved ones) well, it is imperative they attain an overview of the “grief tapestry” of the individual. When they recognize what previous issues or body/mind memories have been reactivated, they can skillfully formulate an intentional plan to holistically accommodate their client’s physical and emotional needs.

A practitioner familiar with her own emotions regarding grief is much less likely to have a profound reaction herself during process work. To stay appropriately focused on serving the client, a skilled Degriefer must recognize the essential difference between the expressed somatic experience of the client, while monitoring her own personal feelings of grief. If a practitioner cannot cope with the cathartic release of the client’s grief, the client will sense this and intentionally not allow deep expression of emotion.

Developing a Somatic Treatment Program for Grief

In addition to employing talk therapies, the Degriefing process employs a range of somatic treatments intended to provide an immediate physical comfort, as well as instigate long-term, positive changes.

Once legal and ethical treatment boundaries are clearly established, it is important to determine a client’s personal boundaries. A practitioner can best accomplish this by employing a detailed, comprehensive intake form. The form should include questions about the client’s preferences regarding somatic treatments (previous experiences with body treatments or grief relief techniques); physical condition and medical history; relationship to and feelings about their body (somatic awareness map drawing); level of safety they feel (sometimes secondary losses become primary grief issues needing immediate attention before we can get to the most recent loss); educational, cultural, regional influences (in relation to their physical behavior and functioning); and finally, what does the client want from treatment?

After filling out an intake form with the client, the practitioner should listen to what the client has to say. It is the practitioner’s responsibility to hold space for the individual to hear himself as well. Many times when a the client formulates a question, and before he completely verbalizes the whole sentence, he starts receiving answers from his own source of wisdom. I call this the art of “non-interruption” on the part of the practitioner to allow a client to ask and process at the same time. Pragmatically, tissues then have safe space to put form to their feelings.

After talking to the client about the array of treatments employed in the Degriefing process, the therapist should be able to determine which somatic treatments to employ first. Obviously, understanding personal boundaries is paramount. For example, it would probably be counterproductive to initially recommend touch therapies for a person who has experienced rape, to recommend acupuncture for a person who fears needles or to recommend aromatherapy for a person with severe allergies. To be most effective in implementing a plan, a therapist will have to use intuition and a trained eye to interpret more subtle messages, including body language.

Somatic treatments are usually not employed in the initial Degriefing sessions when interviews and verbal counseling might be more appropriate.

Since the client should be actively involved in his rehabilitation, it is important that the practitioner formulate a plan with a client, rather than for a client. Of course it is the therapist’s role to suggest and guide an appropriate course of treatment, but Degriefing requires the client be included in the planning process. A therapist should also consult with any attending medical or health care staff and (if appropriate) arrange discussions with the client’s family, primary caregiver or associated support network. The better educated the grief counselor, the better able he or she is to ascertain a client’s physical condition.

In some cases, it is recommended a client’s personal physician review the chosen treatment regimen beforehand in order to screen for any potentially adverse effects. For instance, a doctor might remind the patient of existing allergies, skin conditions, physical disorders, etc. Undergoing a complete physical exam is usually not a priority with many grieving individuals; however, having one can establish a physical “baseline” that can help direct a course of treatment. Before starting, the practitioner should explain every treatment in detail to the client beforehand.

The tools I use during those initial sessions with clients include not only the intake from, but also a list of grief relief techniques, a grief timeline, a list of myths regarding grief and personal pictures that the client brings to portray the loss. The frequency of somatic treatments varies according to individual circumstances. Experience, however, dictates that somatic treatments take place an average of once a week. Sessions are most effective if they are held at least 72 hours apart. Every client meeting is different. A complete private counseling session typically lasts 90–120 minutes. In clinical settings (such as a bedside hospital visit), an hour-long session is more realistic. The time allocated to somatic treatments varies depending on the client’s physical and emotional condition. My personal preference is a two-hour session for Degriefing. Depending on the availability, stamina, finances and intention of the client, at times an hour to an hour and a half will suffice. Conversely, out-of-town clients often book three-hour sessions. Typically, at the start of a series of treatments, one-third of the session is devoted to somatic treatments. Verbal counseling usually precedes physical encounters. This allows the counselor time to access and address the acute needs of the client for each session. In the case of acute physical pain, the Degriefing bodyworker may choose to employ somatic treatments immediately without a verbal warm-up.

Assessing The Grief

To assess whether a particular symptom is grief-related or a longstanding problem being exaggerated by the loss, one significant question must be asked and answered: “How long has this been an issue for the person?” For example, if a woman has always been prone to headaches and finds that after her husband died, the symptoms became more severe, then we realize this is probably an exaggerated reaction to, not primarily caused by, the event of loss. If these pains had begun at the time of the death, I would suspect they are grief-related. Another consideration comes in the form of sympathy pain, such as in the case of the mother who loses a child to a liver ailment, then speaks of her own pain in the same area. The mind has a body and the body has a mind. The body is the barometer of our feelings. Any description of bodily sensations can be valuable in recognizing the way our body reacts to grief. A body that has held a lot of grief memory in the organs, muscles and tissues can enter a state of depression or despair when confronted with more loss. The individual might fear their physical discomfort is medically based, rather than an accumulation of unresolved grief held by the body.

Degriefing issues to observe and assess during this process include:
· What actually is the individual’s state of numbness? Level of shock? Are they able to begin to normalize it (tell their story of loss)?
· Are they able to locate their bodily discomfort by using language to describe sensations or placing their hands to identify the areas of distress? Can they identify where the grief is felt?
· When should you begin physical, hands-on work to enable the client to “be with” the discomfort, rather than rescuing them from the pain?
· Are the clients aware of their inner voice or thoughts that are structuring their actions and influencing their beliefs? Ask how and where their body reacts to the thoughts going through their mind?
· Does the person use sounds to express their grief?
· What language are they choosing to use to express themselves? Once identified, the therapist should model that active listening feedback.
· What is the emotional connection, as well as their familial relationship to the story of loss?
· What are the primary and secondary losses the individual is experiencing? What other unresolved losses have been restimulated? Which is the most acute and/or available to start with?
· How can the client identify their present state of being? What emotion, sensation, color or sound can represent them most accurately?

Since Degriefing is not a substitute for medical attention, always advise the client to have a physical examination with their doctor.

The following are examples of case studies using the Degriefing process.

Maureen

Maureen is a 41-year-old single mom with three children, the youngest of which was living with her at the time. She had been in two marriages that drained her energy and, according to her description, were unsatisfying and unsuccessful. When she was diagnosed with breast cancer, she had been involved in a difficult and stressful relationship with a man for six years.

Her father, an alcoholic military officer, and her mother, a chain smoker, both died of cancer when Maureen was in her 20s. She described both parents as mean and abusive; she had not spoken to her only sister for 10 years.

Maureen was referred to me while undergoing chemotherapy and radiation, and she felt emotionally lost and unhappy. She was looking for the strength to end the relationship with her boyfriend in the midst of so much other loss. She had been sent home from the hospital the same night as her breast was removed in surgery. She walked into the bathroom and unbuttoned her pajamas, looked at her body in the mirror and realized that she had never felt more like a woman.

She said she never spoke up for herself, and now knew this was the beginning of her new life; she was going to use this as an opportunity to learn to meet her needs. At the time of our first meeting I asked her to bring pictures of her children and her mom, dad and sister.

We started with the grief timeline, pictures of her family and then her pictures of whom she was before chemotherapy and radiation stripped her of her familiar image. She had lost all her hair and had gained 12 pounds from the chemo, putting her directly into early menopause. She was innocent and trusting of our work and the process of becoming self-aware and empowered.

When people undergo chemotherapy their sense of smell is often altered, along with developing extreme nausea. Before I used any oil with her, I had her smell it. Roman chamomile, lavender, rosemary, bay laurel, clary sage, lemongrass, basil and peppermint didn’t aggravate her nausea. Willing to partake in regular bodywork, we started by massaging her whole body, using ginger on her feet for purposes of grounding. We did lymphatic drainage in the breast area and stretched the mastectomy scar that occupied the right side of her chest. She loved the sensation of a tuning fork on her sacrum and sternum, and the sound of Tibetan bowls.

Her most underdeveloped sense was her self-esteem and confidence. Her greatest fear was the belief she did not deserve and could never achieve self-respect and adult compassion and support. We identified her primary beliefs, how they affected her sense of self, and who instilled these beliefs. We identified how much they influenced her private moments with herself.

Maureen was agreeable to doing some therapeutic art for self-expression. She agreed to make a collage of her immune system with markers and magazine pictures every other week to monitor what she was experiencing internally. She did expressive drawings of her immune system, her body image before surgery, after surgery and what her ideal image is regarding her physical body after reconstruction.

We met once a week for four months, two hours at a time, then once every other week for 10 months. She filled in the grief timeline with colors, as well as with pictures pasted on the graph. I’d asked her to journal after every session and to read it to me at the beginning of the next. She started writing letters and poems and remembered that she loved to express herself that way. She practiced psychosomatic semantics with me to become more proficient in communication with her children and her friends. She returned back to work after radiation, which occurred between the seventh and ninth months of our work. I did rejuvenating massage to increase her energy depleted by the cumulative effects of the radiation and applied lavender oil to her radiated skin.

James

James, 38, came to see me as the result of a personal recommendation from a former client. James had undergone a heart and liver transplant and was suffering terribly from the effect of the immuno-suppressant drugs. He regretted the decision he’d made when the hospital called and gave him 20 minutes to decide if he was going to accept the organs. He had been on a list for two years and had almost given up any hope of being chosen. James’ father was a missionary, and as a child James had suffered a terrible sickness in Asia that damaged his organs. He had been preparing all his life to die young and now he was confused. He did not get any solace from the transplant support groups because he never met anyone who had undergone what he did. He had a girlfriend and she pushed him into saying yes to the transplants, and now he was also angry with her.

He had many side effects, including the new and strange sound in his chest of a healthy heart. It kept him up at night. He had learned to play the piano and now his hands were shaking so much from the drugs that he couldn’t play, and he was grieving that as well. The resentment he felt toward his partner was laced with guilt, because she loved him and just wanted him to live and be well.

We did the timeline; he brought pictures of himself before the illness and before the transplant. He felt he wanted to learn to relax with his new situation and identify his emotional distress. He said he had felt much more in control of his life when he was ready to die. He did not feel ready to live.

At the first session I told him I had never met anyone in his position and that I wasn’t exactly sure what to say. He was thrilled to hear that, because everyone else had been preaching to him about what they would do if they were in his shoes, and he was so relieved to hear a genuine response. I believe that was when he decided to trust me.

We talked and I gave him a lot of written materials regarding the grieving process. I normalized his grief explaining this ambivalent loss. His grief was specific to undergoing a change that was intended to be positive, much like accepting an upwardly mobile job transfer and then grieving the old house, the old friends and the old neighborhood. I explained we sometimes surprisingly grieve the absence of the familiar. This calmed him down because he was afraid he had really made a mistake.

We did a guided meditation so he could meet the “adopted organs” in his body and name them. We did bodywork on his chest and abdomen so he could feel me stretch his scars. I used massage cream without essential oils since he was very sensitive to fragrances after taking so many new medications. I placed a small Tibetan bowl on his abdomen and chest and rang them, sending the vibrations to his core. He loved that.

At the next session he raged, he cried, he laughed and he made fun of himself respectfully as the bionic man. He wondered if he had ever forgiven his girlfriend and that by telling his girlfriend he loved her with “all of his heart” would he theoretically be lying? He did some growling and crawling on the floor of my office, while I beat a little drum. This was for him to release his rage. He prayed to feel gratitude for the gifts of life. He wrote a letter to the donor families and chose not to send them until he made more peace with his ambivalence.

The third session he asked for some bodywork on his neck and shoulders and I did so accordingly. We also talked about him writing about his experience and he said he was not ready to do that, but had been thinking about it. We talked about classical music he could relax to and the need to take trips to the ocean to put his feet into the familiar Pacific for grounding. He decided to make a tape of his experience and play it for his friends so they could better understand how he was coping.

He thanked me, said I had helped him tremendously by “hearing” him and that he would call if he needed more assistance. We had only three sessions, but he felt that was all he needed.

Theresa

Theresa. 28, was referred to me by a colleague. She had been the driver in a car accident where her fiancé was killed. They had been broadsided by a truck that ran a red light. She saw him die. Theresa had been in bed, depressed for six weeks and her parents were petrified for her.

Theresa came into my office with her head hanging and couldn’t make eye contact with me. The tears kept rolling down her face. She said she felt responsible for her fiancé’s death no matter what anyone said, and did not know if she wanted to live. While driving, they’d had an argument about the wedding plans and were fighting at the time of the accident. She felt so much guilt that she had been driving, even though he was not wearing his seatbelt, and she felt she had so many things that she’d wanted to say to him. Her shock was awesome; she had no appetite, couldn’t sleep and was showing signs of dissociation. She kept forgetting what she was talking about in mid-sentence, forgetting where she was, and not remembering what she had just been doing or saying at any given moment. I asked her to make an agreement with me that if she felt suicidal she would call me no matter what time, day or night, and she agreed. It is now 31⁄2 years later and I am still working with her.

For the first six months, I saw her weekly. She kept having flashbacks, reliving the moment of the crash — the glass shattering and all the sounds. Because her fiancé had refused to put on his seatbelt, she was also angry with him. She was suffering from PTSD (post-traumatic stress disorder), which, in grief language is often referred to as a STUG (sudden temporary upsurge of grief), as well as complicated grief due to all the other losses in her life she had not yet dealt with.

Although she brought pictures, she was hesitant to show them. Instead I had her do the timeline in the office with me there. Her young life showed so much loss. She had been molested in church as a child, her best friend had died of leukemia in junior high school, she had been stalked and mugged when she was living in the city, her cat recently ran away, she had not been able to find a job in her field and now her favorite grandmother was very ill. Her sibling, two years older, had two children and Theresa felt like a failure, weird and disconnected from her family, her friends and her life. She had not yet gone through her fiancé’s things and was afraid of the emotion she would feel doing that.

We started slowly and she chose to talk only about certain losses to begin the process. She cried incessantly, gagged and shook. Her body temperature was erratic; hot and then cold, shivering or sweating. At times she had no voice to express words or sounds; just a whimper would escape. I brought out the paper and the markers and she did self-expression with both her dominant and non-dominant hands. She dated all her artwork and still continues to do it.

After meeting for two months, we began some very basic body and energy work. She was vulnerable and kept her clothes on and so I did reiki to start. We progressed to foot massage and neck massage, which she responded to since she had suffered whiplash from the car accident. Sometimes she would release deep moaning sounds and tell me what was going on. Sometimes she could not reveal anything, so we had a hand signal agreed upon, called a responder, that would let me know to stop immediately. My agreement with her was to absolutely honor her pace and to know that her pace could shift at any given moment during our two hours together.

Most often I used lavender oil with her, sometimes with a drop of roman chamomile, or rose and neroli. She enjoyed the sound of the Tibetan bowls, especially the big resonant ones, but took exception to the use of the tuning fork anywhere other than on her feet.

I had a session with her parents to explain the nature of the Degriefing work and to support them in understanding the journey involved in healing the grief of a lifetime. At times, she exhibited young and immature behavior, and at other times, she was absolutely rational, coherent and eloquent. The key for her was to use nostril breathing when she felt a memory begin to overtake her. She bathed regularly in lavender before approaching sleep. Sometimes the nights were sleepless and painfully long. That was when the art served as an outlet for her grief.

Focusing on writing was initially excruciating for her and concentrating on reading was difficult; movies were able to capture her attention on occasion. This has all eased somewhat. She is now more aware of how her coping mechanisms function and she now feels more intellectually aware of her grief process. She talks about returning to school at some point, and she is pleased she has taken up ballet as a way to reestablish a new relationship with her body. Slowly she has begun to date. She still feels she is not ready to get involved, yet enjoys going out like “normal” people. We dialoged regarding how and when to tell people that her intended had died; she’s learned to wait until she feels comfortable, or doesn’t mention it at all.

She visits her fiancé’s grave regularly and “talks” to him. She says she knows he is not there, yet she is able to feel peace and connection to him at the spot he is buried. I support that because it serves as an outlet for her to continue to release her grief; gently making peace with her life as her path unfolds.

Lyn Prashant, founder of the Degriefing™ Process, completed JFK University’s Graduate Psychology Grief Certification Program. She has a private therapeutic bodywork, yoga and grief counseling practice in Marin County, Calif. She teaches at UC Berkeley Extension, at Alive & Well! School of Conscious Bodywork, and presents nationally and for the University of Arizona. Her forthcoming manual is titled The New Art of Degriefing: Transforming Grief Using Body/Mind Therapies for Health Care Professionals, Counselors, Clergy and Caregivers. She is presently in a Ph.D. program in Degriefing with the University of Integrative Learning. In 2003, the University of Arizona is offering a five-day national certification training in Degriefing. For information, call 415/457-2272, visit www.degriefing.com, or e-mail lyn@degriefing.com.

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“Grief Relief” Techniques, Defined
Breath: Nostril breathing, yogic breathing, mouth breathing, “ahh” breath, pranayama.

Movement: Tai chi, yoga, qigong, hiking, skipping, walking, aerobic classes, swimming, dancing, crawling, bike riding, camping.

Nature: Walking or hiking, filling the home or office with flowers, visiting a farmer’s market, planting a memory garden, walking the beach or resting on a beach.

Self-expression: Grief work (individual or group), journaling, spiritual search or meditation, list-making, reading, watching movies, prayer, creating an alter, art therapy or crafts, drama therapy, educational study, hobbies and sports, creating a photo album, story-telling, dream exploration, napping, letter writing, private devotional chanting, talking to clergy, attending services or attending an organized retreat.

Smell: Use of essential oils (applied directly to the body, in bath water or diffused in the air).

Sound: Internal — crying/sobbing, singing, making animal sounds, voice
dialogues, mantra repetition, laughing/sighing, devotional chanting, wailing/screaming, talking gibberish. External — soothing music, nature sounds, ethnic rhythms, heartbeat sounds, drumming, listening to opera/classical/jazz.

Trauma Touch Therapy: Self-massage, Swedish, shiatsu, reiki, compassionate touch, rocking, acupuncture, reflexology, mudras.

Water: Taking hot baths, cold soaking for feet and hands, visiting bodies of water, taking hot showers, using cold compresses, enjoying hot thermal springs.