6 x Therapy Today: The Magazine for Counselling and Psychotherapy Professionals (Volume 22)

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Menzies RE, Neimeyer RA, Menzies RG. Death anxiety, loss, and grief in the time of COVID-19. Behaviour Change 2020; 37(3): 111–115.

Neimeyer R, Milman E, Lee SA. Apocalypse now. In: Pentaris, P (ed). Death, grief and loss in the context of COVID. Abingdon: Routledge; 2021 (pp.40–59). Fausto-Sterling A. Sexing the body: gender politics and the construction of sexuality. New York: Basic Books; 2000.

Plagiarism

I am also delighted to bring you a heartfelt account of finding meaning after loss, written by David Kessler, the US grief specialist who worked with Elisabeth Kübler-Ross on her famous books about grief. He describes how no amount of knowledge prepared him for the impact of the sudden death of his 21-year-old son. But through his experience of surviving more pain than he ever thought imaginable, he offers valuable insights both for practitioners and for anyone personally dealing with loss. US family therapist, academic and writer Dr Pauline Boss is taking a different approach. Originator of the concept of ‘ambiguous loss’, after years of writing, teaching and training practitioners, she has written her latest book, The Myth of Closure, 9 for the general public (reviewed in this issue). ‘Ambiguous loss’ may be physical or psychological. Physical ambiguous loss refers to deaths where there is no verification of the death itself – no body, no death certificate, for example. It can also apply to other losses, such as a job, money, and even the ability to mourn together, as happened in the time of COVID. ‘Psychological losses are amorphous and much harder to identify and quantify,’ Boss says. ‘For example, they could be loss of trust in the world as a safe place, loss in trust that your friends are safe enough to be physically near you, loss of feeling secure about going to buy groceries, of being able to go about your daily routine, go out of your house and feel safe. It is a really long list. It wasn’t just brought on by the pressures of the job. My issues had been building and manifesting in complex ways from as early as I can remember. But no partner could or should take on that burden; nothing could shake the feelings of worthlessness, and gradually the looking for relationships evolved into compulsively looking for connection through sex. I started to lose control and yet no one – friends, family, therapist, gay or straight – seemed to have any answers. Nor did gay culture, which didn’t allow any discussion of how the relentless pursuit of hedonism might contribute. Other gay people were doing great, it said. If that was the case, then why wasn’t I?

We are living in a time of grief – we are grieving not just the millions of deaths from COVID-19, but the loss of much that we previously thought we could take for granted. Despite all our medical breakthroughs and technologies, we have discovered we are not in control, and that a tiny virus can evade all our protective barriers and overwhelm us. We are grieving the loss of our assumptive worlds 1 – that is, the beliefs and values that grounded and secured us, that gave us confidence that we could keep ourselves and those we love safe. His research with a UK sample of 183 people found similar results – most reported PTSD symptoms (83.1%), psychological distress (64%) and functional impairment (56.8%), and 39.3% reported clinically significant symptoms of dysfunctional grief. Disrupted meaning was a key factor across all four findings, he found. Further analysis of these data showed that particular circumstances of pandemic loss – such as the inability to be with the loved one at the end of life because of hospital safety protocols or Government restrictions, and dissatisfaction with funeral arrangements – accounted for 59% of the variance in functional impairment and 71% of the variance in dysfunctional grief. 3 Of course, it is likely some of the healthcare providers mentioned in this survey were therapists. We can’t be naive or complacent – there will be incidences when therapists get it wrong, either intentionally or inadvertently. And, through legislation, education and awareness, we have to ensure that anyone who is LGBTQ+ (or wondering if they may be) can access therapy without fear of judgment or that they will be pressured to change a fundamental aspect of who they are. Often, the focus on understanding dementia, providing treatment and engaging in communication can emphasise verbal interaction, and the value of non-verbal communication can be ignored. As Julia states, continued connection is important, and, as such, attention to kinaesthetic engagement is key – not only when people’s cognitive faculties are impaired but more so within/in dementia relationships where meaning making through language as we ‘know it’ is changed and challenged. If the author disagrees, but we are satisfied that the work has been published elsewhere, is in the public domain and the complainant can fully prove it is their work, we will publish a clarification in the next available issue or as soon as possible. If the complainant can't provide this evidence, we will take no further action. The final decision will rest with BACP. Online posting by authors after publicationShe says coaching is frequently misunderstood as highly directive and technique based. ‘Yes, coaches often have a toolbag of frameworks to use, but we also need to have the discipline to be focused on the person in the room and give them space to think – not reach for this or that tool and think this will fix them. That’s not our job. The tools are a way of helping them to explore things further for themselves. And you are always listening for their strengths and for the resources within them as well as the pain and suffering.’ Breen LJ et al. Risk factors for dysfunctional grief and functional impairment for all causes of death during the COVID-19 pandemic: The mediating role of meaning. Death Studies 2022; 46(1): 43-52.