Interview with Laura Palomares: grief as seen by a psychologist

Grief is a complex process, but Laura Palomares explains it for everyone to understand.

The kind of sadness, longing and even despair we feel when we lose something or someone to whom we felt attached has a name in the field of psychology: bereavement.

In fact, bereavement is one of the most painful psychological processes there is.and can sometimes make us unable to enjoy life. However, psychological assistance through therapy with psychologists can help us to overcome this discomfort and to accept that there are certain moments that will not return and that this is natural.

It is precisely this experience gained in psychotherapy that gives psychologists a unique perspective on what grief is and how we can manage it emotionally. For this reason, on this occasion we interviewed a specialist in the field: Laura Palomares, from Avance Psicólogos, who works in bereavement therapy.

Laura Palomares: the point of view of a bereavement expert

We talked to Laura Palomares Pérez, a psychologist expert in bereavement and emotional bonds and Director of the psychology center Avance Psicólogos in Madrid, to talk to us about bereavement, both in terms of the pain it causes and how to work in psychotherapy to overcome it.

It is usually understood that grief is something that arises from losing a loved one, through a breakup or death. However, there are other causes, right? What defines grief?

Grief is a state of recovery and readjustment after a loss. For this reason we should not consider grief a disease, but a normal process of rebalancing with different phases, which will help us to gradually regain normality.

The loss can be due to the breakup of a relationship or the death of a loved one, but it can also be due to the loss of a job, a house, a drastic change of life, the loss of a pet, the amputation of a limb, etc.

The grieving process will be different depending on how important the loss is to us, whether it is a loved one or a life-changing event.

Grief is to some extent a normal psychological phenomenon when it appears after losing someone or something that was important to us. At what point is it considered a reason to attend psychotherapy?

The grieving process involves a series of phases that it is important to respect. We say that a grief is pathological or unresolved, when there is a blockage in any of them.

If we have settled in sadness or anger, we do not find meaning in our lives, we do not believe what happened or we recreate the loss with the same emotional intensity as when it happened, if we notice that since then new fears have appeared, such as fears of death or illness, phobias, anxiety or panic crises, etc., this is a reason to attend psychotherapy.

Alterations of the sleep or of the feeding, obsessive or catastrophic thoughts or compulsive conducts, are other signs that have to be taken care of.

Also denoting unresolved grief are behaviors such as keeping all personal items as the loved one left them, talking about the loved one in the present tense or not talking about the loved one at all.

What are the fundamentals of psychological therapy applied to bereavement?

Psychological therapy is based on the knowledge that expressing emotions of anguish and pain without fear of judgment is crucial for overcoming grief.

In Avance Psicólogos we work from different currents of psychology, taking advantage of each of its techniques. In this way, humanistic psychology manages to deepen the emotional and make it emerge, with different techniques such as role playing, the empty chair, the evocation of memories through photographs and objects, etc..

It is a matter of delving into feelings and favoring the resolution of ambivalent emotions, guilt, anger, unresolved situations, etc., with the aim of preparing for the farewell, which does not mean forgetting the loved one or object of mourning, but finding a new place for him or her in our emotional imaginary.

On the other hand, cognitive-behavioral psychology helps to restructure at the level of thought and behavior the new situation before the loss, favoring the application of resources to assume and face the new reality before the loss.

The application of Third Generation Therapies, especially Acceptance and Commitment Therapy, focuses on the acceptance of the loss without forgetting the context and values of the person, fundamental for the grief to flow naturally and according to the individual differences and specific needs of each person.

From your experience at Avance Psicólogos, what are the strategies that a therapist should follow to adapt to this reason for consultation by a patient?

The deep respect for the pain of the person who comes to consultation, from an attitude of absolute and unconditional accompaniment, is fundamental in the therapist's way of being and feeling the relationship with the patient. Without this there is no therapy. The therapeutic relationship must be felt as an extremely safe space, in which there is no room for judgment or rushing.

From there, the therapist focuses his attention on supporting and accompanying to facilitate the acceptance and recognition of the loss, to express the emotions and feelings that come from it, to face in a practical way the new life situation and reality before the loss and finally, to accompany in the farewell with a new sense of life.

How does the recovery and the return to normality take place? How long does it usually take to overcome grief?

Recovery occurs with the closure and overcoming of each of its phases, respecting the time of each person and making sure that they are being resolved.

The phases of grief are denial, that is, not accepting or assuming the absence of the loved one, which usually occurs at the beginning, at the moment of shock; the anger phase, which consists of feelings of rage and anger often against the world, with the need to look for someone to blame, sometimes also anger against oneself, and even the hidden anger with the person who has been lost, feeling "abandoned" by him or her; the phase of sadness, which is accompanied by feelings of loss of the meaning of life, but which begins to be a preparation for saying goodbye and for reaching the last phase of acceptance, which finally leads to peace of mind.

These phases do not always occur in order and are often mixed up, and are naturally followed through to resolution if they are respected and worked on adequately during therapy. The acceptance phase comes from allowing the previous ones, especially pain and sadness, although very often the person who is grieving feels forced to recover by those around him or her. Expressions such as "you have to be strong", "you should be better by now", only hinder the grieving process and increase distress.

As for the time of the mourning process, it usually depends mainly on the level of depth and intensity of the bond, individual personality traits, the support of the person's environment, etc. It is not easy to establish an approximate time frame. It is also important to bear in mind that, if the loss is sudden, grief takes longer and is more likely to become chronic.

Finally... could you tell us about a case of a bereavement patient whose recovery makes you feel especially satisfied?

I can think of several, of which I have fond memories and a special affection, but I will tell you about two.

Once, R., a 28 year old woman, fun and vital, came to me for consultation, but she complained that she had been suffering for months from anxiety and severe back pain that did not respond to any physical cause. As we delved deeper during the first evaluation sessions, R. and I recognized the deep pain she still felt because of the death of her father, which had occurred 8 years ago, suddenly due to a Heart attack. Her emotion when talking about it was as if it had just happened, and her crying was desperate.

As soon as we started to work on his grief, also taking into account the avoidances that he had been giving in his environment since then, his physical symptoms disappeared, he stopped suffering from back pain, his anxiety subsided and the best thing is that his relationship with his mother and his partner improved significantly.

I remember a recent case, that of A., a 36-year-old man who is practically discharged and only attends follow-up sessions every two months at the present time. It came to A.'s and my attention that he was again feeling intense anxiety, with serious difficulty sleeping and deep sadness. He told me of the tremendous frustration he felt at having to sell his beach house.

That house was for him a refuge, it meant much more than material property; to A. that house symbolized a safe place, which provided him with rest and the possibility of recovering from the fatigue he was subjected to throughout the rest of the year, due to the intensity of his work.

Once we understood that he was in mourning, we were able to work on it and even formalize a farewell to the place, the house, the neighborhood, etc., with the purpose of finding an alternative way to spend the vacations and disconnect, in the same city where he liked to enjoy his vacations so much.

The moments of grief, especially when they are due to the loss of a loved one, are the hardest and most difficult in a person's life. But we also know that if they are channeled in a natural way towards overcoming them, they are moments of profound transformation that entail many positive aspects. The person becomes more aware of enjoying the present, develops resilience, learns to relativize and even loses fears.