In these turbulent times, families have suffered devastating losses of loved ones, from the anguish of COVID-related deaths to gun violence, drug overdose, suicide, environmental disasters, and war. More attention is urgently needed in MFT training and practice to help the bereaved to heal and forge pathways ahead to live and love fully beyond loss.
Attending to death and loss: The shared human experience
Of all life experiences, death and loss pose the most painful and far-reaching challenges for surviving loved ones. Yet, in our American cultural aversion to facing death, the profound impact of loss is minimized. Many are isolated in their grief, lacking vital connection, understanding, and support. Recovery is hindered by workplace demands, lack of paid bereavement leave, financial duress, and barriers to resources that disproportionately affect racial/ethnic minorities and other marginalized communities. In our ethos of “the rugged individual” and faulty notions of resilience, the bereaved are often urged to quickly gain “closure,” “bounce back,” and move on, and are advised to “keep strong” and count their blessings. Caring spouses, family, and friends who are uncomfortable and unsure of what to say or do may withdraw over time. Too often, grief is unacknowledged or minimized, as in pregnancy loss or the death of a cherished pet. Covid-related losses may be suppressed by the understandable wishes to put the pandemic behind us (Walsh, 2020, 2023).
Attending to death and loss is challenging for therapists, as well. We may feel uncomfortable, unsure of what to do, or even helpless: death is not a problem to solve. In meeting with a couple after their baby’s death, the father said: “I don’t know why we’re here—what can you do? You can’t bring back our child!” In our personal lives, we all face painful losses, our own mortality, and family legacies of loss that may constrain our engagement with the bereaved. Yet, by attending to our own losses, our common humanity can enrich our work with those in distress.
Death and loss: A hole in the heart of the family
In the mental health field, most grief treatment models focus narrowly on reducing individual symptoms. The DSM diagnosis of Prolonged Grief Disorder can pathologize diverse experiences. A systemic practice approach is vital to humanize our understanding and expand our attention to influences in family and social contexts in suffering and healing. We address the impact of loss in couple bonds, among siblings, and in the family system, affecting all members, their relationships, and family functioning. Stressful adaptational challenges—as with the loss of a caregiver or breadwinner—compound distress. Rippling through kinship networks, loss touches many lives with immediate and long-term ramifications. Couples and family bonds can be broken, hopes and dreams are shattered. Submerged pain of overwhelming loss can surface years later in problems in life pursuits or other relationships, which may bring people to therapy.
Too often, grief is unacknowledged or minimized, as in pregnancy loss or the death of a cherished pet.
Resilience-oriented, systemic practice with loss and grief
Over my career, from early collaboration with Monica McGoldrick, my specialization in clinical training and practice has been the development of a resilience-oriented systemic approach with complicated loss (Walsh, 2023). At the core is the conviction that distressed couple and family processes can be strengthened to support healing and positive adaptation for all members and their bonds.
Best practices in understanding and helping bereaved clients are informed by early family systems studies and a growing body of grief research:
- Mourning and adaptation are varied and complex processes over time. There is no right way to grieve, no timetable, and no fixed sequence of stages to complete resolution.
- Attention oscillates between grieving and addressing adaptive challenges.
- We heal through our grief, not by getting over it.
- People die; relationships don’t die. Adaptation is facilitated not by detaching but by transforming attachments into continuing bonds through spiritual connections, rituals, memories, stories, and deeds.
A resilience-oriented systemic approach applies core principles and methods of strength-based, collaborative practice (Walsh, 2023). Therapists provide a safe haven and compassionate listening and inquiry to understand both the shared and unique experiences of loss. We depathologize and humanize grief processes and support the inherent human capacity for resilience, helping those who are struggling to cope, to adapt, and to thrive. We facilitate—or repair—vital connections and communication to strengthen kin and social support, mobilize community and larger systemic/institutional supports, and tap cultural, and spiritual resources. In complex and traumatic loss situations, we attend to conflictual or estranged relational dynamics and to deep concerns that complicate grief. When working primarily with individuals, we may employ coaching methods or flexibly combine couple or family sessions, group formats, and community rituals and collaborative action in situations of collective trauma and loss. Applying the research-informed Family Resilience Framework (Walsh, 2016), we strengthen key relational processes–shared beliefs and practices—that facilitate resilience. We highlight the power of connection, meaning-making, hope, and transformation for individuals, families, and their communities to heal from unbearable loss and go forward to thrive.
Froma Walsh, PhD, is a Professional member of AAMFT, Professor Emerita, University of Chicago, and Co-Director, Chicago Center for Family Health.
Walsh, F. (2023) Complex and traumatic loss: Fostering healing and resilience. New York: Guilford Press. www.guilford.com/p/walsh6
Walsh, F. (2020). Loss and resilience in the time of COVID-19: Meaning-making, hope, and transcendence. Family Process, 59(3), 898-911. doi: 10.1111/famp.12588
Walsh, F. (2016). Strengthening family resilience. New York: Guilford Press.
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