Dear Dr. Neimeyer,
My colleagues and I are currently recruiting clients for a traumatic loss group in our clinic, one that draws on your approach to grief therapy as meaning reconstruction, which has strong relevance when losses are sudden and often violent. The group is designed to run 12 weeks, and is closed, meaning that the same 8-10 members should be in the group from the beginning to the end. In terms of referrals received, I have already been in touch, through a bereavement support organization in our area, with a mother who lost her daughter to suicide, and she is still thinking about whether she wants to attend or not. Another bereavement service also mentioned two people, one of them also bereaved by suicide, who they might want to refer, and I have been contacted by someone who lost her father recently to cancer and had support for this from another organization, but this recent bereavement has triggered unresolved issues around her mother’s suicide 30 years ago, which she believed was connected to her father leaving her mother, and she is wondering if she could attend the group. I do not know anything else yet. The question would be whether this would be too complex for the group to address or, if we ask her to focus on the suicide mainly, whether this would be possible or, indeed, desirable, as it seems her feelings in connection with the one are so closely connected with her feelings in connection with the other.
What do you think? Our eligibility criteria do not stipulate a maximum period since the bereavement, and it would be fine to include her from a criteria perspective, but before arranging to meet her, I was wondering if you have any other thoughts on this and whether I have missed anything.
Edith S., PhD
I appreciate your recognition that those who have lost loved ones to traumatic death, such as suicide, homicide and fatal accident, have special needs that are often poorly accommodated in a group whose members have often had more normative losses to anticipated natural causes. But I do have questions about the long-term maternal suicide/recent paternal death case in the context of the group. Understandably, these two losses will be conjoined for the client, and can’t truly be separated. I would be concerned that one dynamic of most group members would be to find a villain responsible for the suicide—and that they could join with the client in blaming the father in this respect, potentially complicating her fresh grief for her father’s death by arousing anger at his possible role in motivating her mother’s tragic action. On the other hand, her long-term perspective on a traumatic loss could make a valuable contribution to the group, just as their fresh perspective could help her revisit her mother’s loss in a helpful way—especially with the meaning-making tools offered throughout the treatment, which could help her revisit an old loss in a new way.
Perhaps the ideal response to questions of this sort would be to ask the true expert—the client herself—about the her readiness for the group, in an initial interview to consider its appropriateness for her. So I would screen her for the group, and discuss the issue of her tandem loss directly, but slowly, one small piece at a time—not in a big clinical conjunction like I’ve provided above. How do you imagine the group might help you with your old grief for mum? Your fresh grief for dad? How do you think the other group members might handle your own mixed/troubling feelings about why your mother ended her life? If they responded with anger at your father, how might this be helpful to you? Harmful to you in your grieving? You get the idea: These kinds of questions would be salted through a half hour of conversation. Then you could make a more make a more informed decision together: Would this be better handled in the group, which could provide some specifically helpful advise and member perspectives, even from other suicide loss survivors, or in an individual therapy, which could focus more time on what is uniquely important to you? I’d tend to trust her thoughtful conclusion.