Therapy for Grief & Loss 

I use aspects of relationship theory to support and guide my understandings of many mental health complexities. One theory I reference is relational theory. The relational exchange suggests dysfunction in interpersonal relationships is manifested in unrepaired relationships from the past. The first relationship we have is with our parent(s) and caregivers. The first relationships in life provide experiences that will lay the foundation for future relationships. If a child is born with the experience of unconditional love, feeling safe and engaged in trusting relationships, this supports a positive, healthy relational experience. If a child is born with the experience of fearfulness, anxieties, inconsistency, and abuse, this supports potential struggles in future relationships. The early relationships in life are not all good and not all bad, but they lay a foundation of what needs to be work through in life for the person to move towards happiness.

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Children involved with the foster care systems, in infancy or adolescence, experience grief, and loss. Let me introduce Rick, who was a five-year-old African-American and Mexican male. His biological mother raised him until three years of age. During infancy, he was exposed to his mother’s unresolved attachment concerns. She was not able to securely attach to him. Rick was described as a problematic child. He cried all the time and struggled with cholic. He was physically active and got into many things in the house, which was exhausting to his mother. Then Rick moved to live with his biological father until the age of 5. Rick’s father was stern and rigid with his parenting. Although he had many strengths, he was active in sports, and he was playful. Rick enjoyed memories with his father, but in their short relationship, Rick’s father died. Rick’s mother could not care for him, so he went into the foster care system.

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Rick’s early relationship with his mother left him feeling abandoned and unloved most of the time. His basic needs were not met, and his mom was not emotionally available. Yet this relationship was severed before he understood how this could impact his future relationships. Then there was his dad, who one day was home and the next day was gone. Childhood grief and loss create an unbearable situation. For infants and children, they don’t have the language to put to their experience. They communicate through their play and in their behavior.  When these issues are not addressed, they increase anxieties in a child. The child may learn to avoid and dissociate because, in their minds, there not given other options from adults. 

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Rick entered foster care, and there were no conversations about the unavailability of his mother or the death of his father. Social workers did not provide space for him to explore these feelings. Foster parents and there were a few, did not talk about this with Rick. There were no pictures of his parents and no means of communicating his feelings of grief and loss. Then after some time and a few foster placements, he had little conscious memories of his parents. Most adults assumed he would forget these relationships. Rick did forget conscious memories of his parents. However, not working through the grief and loss of his parents resides in the residue that filters out in his future relationships with others.

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At ten years of age, Rick had behavioral concerns, extreme aggression, enuresis, inattentiveness, and oppositional behaviors. He would physically hit others to include foster parents, at times. There would be moments when Rick would cry hysterically and hit his head against the wall. Most of the foster parents were ill-equipped to manage his behaviors. He felt unsafe, and his emotional pain was intolerable. 

At the onset of treatment, I knew I would be working through the grief and loss of his parent. The early stages of what laid the foundation for him in future relationships. I understood Rick needed repair with an unavailable and unattached mother. I understood I would be used to work through the death of his father. Rick’s mother and father were the two first relationships that left him grieving over their loss.

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In our work together, Rick would come to my office weekly. Rick developed a routine over time, which helped him feel supported, secure, and with consistency, he started to trust. Rick was given the freedom to control this environment (my office) which did not happen in his foster homes or school. There were no rules to follow unless he created the rules. Rick felt empowered. Rick summarized his early experience “I come to see you every week. You are my counselor, we play, you ask questions about my mom and dad, and then I leave.” Rick’s cleverness and intelligence were impressive and a little intimidating at times. He took on the role of parent, and I became the child. He gave me orders, set limits on my behaviors, and was kind towards my emotional reactions. I realized my patience in this process allowed him to work through his losses both consciously and unconsciously. 

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There are typically seven stages of grief and loss. One is shock and denial. This is a state of disbelief and feelings of numbness. Then there is pain and guilt. This is a state of self-blame and a lot of questioning about life and meaning. Then there is anger and bargaining. This is a state of acting out, social isolation, and sometimes having conversations with God. A child can towards or away from their spiritual or religious beliefs and practices. Next is depression. A child feels that all the prior attempts haven’t resolved their pain and suffering. Depression in children is manifested in a few ways. They may express this form of sadness outward or turn inwards. Then a child will attempt to reconstruct a story in their thoughts, feelings, and behaviors. This supports the transition into the later stage of acceptance and hope. Grief and loss are not linear processes, meaning everyone will go through all the stages one step at a time. Some children will cycle through the stages, and some children will get stuck. A child will rarely go from being in shock and denial and moving directly into acceptance and hope. 

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During treatment, I was able to find pictures of Rick’s birth mom and dad. Through the support of his social worker, I was also able to reconnect him with relatives who were also looking for him. Rick recalled some memories of his father. Rick also reported a happy emotion when seeing a picture of his mom. He heard stories about his parents and what he was like as a child. He began to reconnect with family and shared cultural experiences. Rick came into my office one day and said, “I’m ready.” I replied, “Ready for what.” Rick stated, “Ready to write my mom and dad a letter.” This was an indication he was moving through the stages of grief. Rick experienced early losses in his life. Relational theory connects two people, and this is transformative. We were curious about each other. He was able to do some repair in how he experienced the relationship with his mother and father. His behaviors improved significantly, and he got off psychotropic medications. 

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I will end with this; relational theory understands all human behavior is about the interaction between individuals and their interactions with others. The focus is on past and present relationships. This helps us to know how to help our patients best.