Does Continuing Bonds Therapy Really Work?

Dear Dr. Neimeyer,

A good deal of my practice with grieving clients is influenced by your work and that of your colleagues like Dennis Klass on the idea of continuing bonds–the concept that bereaved people really are striving to maintain their attachment to deceased loved ones who have died rather than “let go,” “withdraw energy from the relationship,” and “move on.” The AfterTalk web site, which promotes writing creative and heartfelt letters to the deceased, follows a similar direction.

But my question is this: Does this always work? Mostly I find that people are comforted and even inspired by reconnecting with their loved ones in a way that feels more substantial. But sometimes I work with people who resist the idea of writing to a dead loved one, like a man I am seeing in therapy now who said that doing so “wouldn’t accomplish anything,” and that he “just needed to get on with his life.” Mainly, he said, he was seeing me because of his sleep problems, poor concentration, and uncertainty about if it was “too soon” to start dating again 7 months after the death of his wife of more than 20 years. I guess what I’m saying is that I’m not sure if he is denying his grief or neglecting his bond to his wife, or whether helping him move in the direction he seems to want to go (toward simply rebuilding a life without her) is really what he needs. Can you shed any light on this?

–Melissa

Dear Melissa,

Perhaps the only absolute rule about human behavior is that there are no absolute rules about human behavior. Although I too find that the great majority of bereaved folks I work with (and especially widowed persons and bereaved parents) are greatly relieved by reconstructing in a sustainable way their continuing bond to their loved one, this isn’t universally the case. For one thing, cultures vary greatly in the strength and type of bonds they support, and individuals within cultures vary more greatly still. This means that although many people will welcome opportunities to write about their feelings and appreciation for their loved one in an AfterTalk style letter, or to address similar themes in a guided imaginal conversation in grief therapy, others will not, and in my experience, such preferences should be respected. In this regard I operate on the basis of a simple principle: If you don’t know what people need, ask them; they just might tell you!

Practically speaking, then, I try to listen to the specific struggle my bereaved client describes. Is she inconsolable and preoccupied with the absence of the deceased, feeling desperately alone and hopeless without him or her? Or is she mainly concerned with her inability to function, changed role in the family or the social world, and uncertainty about next steps to take in living? Clearly the former will suggest the relevance of continuing bonds work, whereas the latter could suggest the greater priority of restoring self-regulation, overcoming avoidance of triggering situations, and problem solving about present and future challenges. When the situation remains ambiguous, I might simply ask the client, “Given how you are feeling, do you sense that it would help you in any way if you could feel more connected to _____ as you move forward with your life?” Typically the client’s response of “Oh, yes,” versus “I think that would just make it worse” offers a pretty clear idea of what he or she is needing and is ready for–at least at that moment.

But why do people differ so fundamentally in their openness to cultivating a continuing bond? Possibly for the same reason they differ in how they manage living relationships that become difficult in some way–by holding on more tightly, trying to communicate and work out the problem, or to practice self-reliance, and “move on.” No one of these attachment styles is inherently right or wrong–at least if it isn’t taken to extremes. Mostly, people have learned ways of coping that work for them, and both more connected and more independent styles have their advantages and disadvantages. Discussing with clients how they have handled previous losses–both through death and through breakup or geographic separation–can allow us to ask the genuine question, “How is that working for you?” We can then be open to the possibility that the client’s characteristic style of coping either has been a resource that can be drawn on in dealing with the current loss, or perhaps introduces a further complication that can become a useful focus of therapy.

–Dr. Neimeyer