EMDR and Narrative therapy in a case of complex grief. (October 2021)
“Change the story and you change the future”
Two of the founders of EMDR Gateway, Richard and Sally Worthing-Davies were systemic and family therapists prior to training in EMDR. Another, Dr. Marilyn Tew, has also studied systemic theory and practice since becoming an EMDR Consultant. With this systemic perspective on our work, we are very interested in using Narrative Therapy as a framework in our EMDR work (1). This is because it provides a unique, clear, and easy way to remember a ‘birds-eye-view of the entire EMDR process. It can help you navigate through and keep track of where you are even in the most complex cases.
Because the entire Complex Grief process is split into three short videos, you don’t have to master the entire ‘jigsaw’ of complex grief before beginning work with your client - start with Video 019 which focuses on the trauma, move to 020 when you are ready to work on present triggers and loses, and then onto 021 when looking to the future.
Systemic therapy seeks to address people not only on the individual level, as had been the focus of earlier forms of therapy, but also as people in relationships, such as in couples, families, workgroups, etc.
Systemic therapy seeks to address people not only on the individual level, as had been the focus of earlier forms of therapy, but also as people in relationships, such as in couples, families, workgroups, etc.
to effect change and development. Narrative therapy, sharing many of the assumptions underlying systemic therapy, offers one way of effecting change. It seeks in particular to help people identify their values and skills through the stories they tell, and with knowledge of their ability to live these values, to live out a different story that will influence how to go on with life in a more health-promoting way. The use of the word “story” in no way implies that people are living in a “make-believe” world. Rather it means that we construct stories to make sense of our experience and that the meanings we give to these stories can strongly influence how we go on with our lives.
So how does this idea fit with EMDR? It’s already there implicitly when we ask for a negative cognition (NC) in addressing past traumas. This is the current meaning a client is giving to a story they are bringing to therapy. In the Standard EMDR Protocol we then go on to identify, and eventually install a strong positive cognition (PC) and so create the basis for a preferred story that will influence how to go on with life in a more health-promoting way (2). Then, when we address current internal and environmental triggers that stimulate maladaptive behaviour, as in the second prong of the overall EMDR process, we further strengthen the basis for the preferred story; and with the third prong, where we directly seek to install a desirable cognitive/behavioural response, we consolidate a new pattern and the preferred story.
Theories of death and bereavement
There are many different psychological theories of death and bereavement, each one suggesting ways of helping clients navigate through the process. It’s one of these theories that we use in our series of three videos on complicated grief corresponding to Lazrove’s complicated grief protocol (3). This in turn is based on Rando and Solomon’s six R’s of complicated grief. You can read more about this below (4,5).
We do not hold that Lazrove’s protocol has the status of “truth” but see it as one of several theories and protocols that sit alongside each other as potentially useful frameworks for working with a bereaved client to create preferred stories about death and dying that best fit their contexts (Appendix A provides a brief list of theories of death and dying).
The principles guiding our work in this area are informed by systemic thinking and in particular Narrative therapy. In creating a non-evaluative atmosphere, we work to ensure preferred stories, rituals and ceremonies are co-constructed with the bereaved to make sense of their loss in a way that is coherent with significant relationships and stories in their lives.
“In the Standard EMDR Protocol we then go on to identify, and eventually install a strong positive cognition (PC) and so create the basis for a preferred story that will influence how to go on with life in a more health-promoting way.”
Putting this into practice
Rando identifies 6 tasks of mourning in cases of complex grief. He then groups these 6 tasks into 3 phases of working with complex grief (6).
The 6 tasks of mourning are:
Recognize the loss, acknowledge the death, understand the death .
React to the separation, experience the pain, feel, identify, accept, and give some form of expression to all the psychological reactions to the loss, identify and mourn secondary losses.
Recollect and re-experience the deceased and the relationship, review and remember realistically, revive and re-experience the feelings.
Relinquish the old attachments to the deceased and the old assumptive world.
Readjust to move adaptively into the new world without forgetting the old, revise the assumptive world, develop a new relationship with the deceased, adopt new ways of being in the world, form a new identity.
Reinvest in life without the deceased.
How to apply the Standard EMDR protocol
Solomon and Rando then placed these 6 tasks into 3 phases of working with complicated or complex grief. They call these 3 phases:
Avoidance
Confrontation
Acceptance (or accommodation)
These three phases roughly relate to the three prongs of EMDR processing – i.e. the past memories underlying the current painful circumstances, the present triggers, and the future without the loved one.
We have created three videos that demonstrate the application of the Standard EMDR protocol to working with complicated grief. Each video is about 10 minutes long and is accompanied by a step by step description of the process that can be copied and printed for use by therapists.
In the avoidance phase, the client has one or several of the following problems: difficulties in expressing grief; absence of mourning; considerable delay in the onset of mourning; or an inhibited ability to mourn. These difficulties could relate to the actual events surrounding the death, hospital or funeral memories, or painful past memories involving the deceased. If there are dysfunctionally stored memories that underlie the current negative response to the loss, these need to be identified and processed.
Video 020 - Phase 2
In the confrontation phase, therapists are dealing with skewed aspects of the mourning process. Mourning can be: distorted; conflicted; or unanticipated i.e. taking the client by storm. These are usually present triggers that continue to stimulate pain and maladaptive coping. In the confrontation phase, therapist and client address current situations where ‘stuck points’ and/or particularly painful moments are experienced. Catastrophic anticipatory anxiety about the future may also be present, which can be addressed with the ‘Flash forward’ protocol (see Video 007).
Video 021 - Phase 3
In the acceptance phase of complex grief, the therapist is dealing with difficulties in finding a sense of closure i.e. mourning has become chronic. Work in this phase is about laying down a positive future template. This involves facilitating adaptive coping in present and anticipated future stressful situations. Clients may need to learn new coping skills that can then be actualized by the future template.
The three videos provide a concise, clear and comprehensive description for using EMDR with complex grief. It is our dearest hope that therapists will find these useful in their work and also that they will be the springboard for exploring other theories of death and bereavement that can illuminate the use of EMDR in this field.
Appendix A (From Death Talk; Conversations with Children and Families; Glenda Fredman, 1979)
1.Phase theories: in addition to the Lazrove model above, we have:
Colin Parkes (1972) who describes grief as a process or set of symptoms that start after loss then fades away. Numbness is the first phase, giving way to pining and yearning. The third phase is despair, and it’s only after this that recovery and re-organised behaviour occurs.
Bowlby (1989) identifies protest, despair and detachment as a characteristic series of responses to all forms of mourning. He also suggested that the mourner needs to pass through the phases of numbing, yearning and searching for the lost figure and disorganisation and despair before mourning is resolved and re-organisation is possible.
2. Stage theory: Elizabeth Kubler-Ross (1970) described five stages of dying: denial and isolation; anger; bargaining; depression; and acceptance. The last stage is when the dying person needs to let go of life with acceptance.
3. Task theory: Worden (1991) links “task” of mourning with Freud’s concept of grief work. Four tasks need to be accomplished for the process of mourning to be complete. Freud argued that “tasks” is to be preferred to “stages” or “phases” because “tasks” imply something can be done and that there is an end-point, which is an antidote to the helplessness affecting mourners. Worden identifies four goals of grief counselling to help the bereaved complete the four tasks of mourning: to increase the reality of the loss; to help deal with expressed and latent affect; to help overcome impediments to readjustment after the loss; to encourage saying an appropriate goodbye and feeling comfortable reinvesting back in life.
White, M. and Epston, D. (1990) Narrative Means to Therapeutic Ends. W. W. Norton, New York.
Shapiro, F. (1989) Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 20, 211-217.
Lazrove, S. (1996, June). In Work with victim advocates: EMDR and MADD, an evolving story. From grief to mourning: an EMDR protocol for complicated bereavement. Presentation at the 1st EMDR International Association Conference, Denver, CO
Solomon, R. M. & Rando, T. (2012) Treatment of grief and mourning through EMDR: Conceptual considerations and clinical guidelines. Revue européenne de psychologie appliquée 62 pp 231-239
Solomon, R. M. & Rando, T. (2007) Utilization of EMDR in the Treatment of Grief and Mourning. Journal of EMDR Practice and Research 1(2):109-117 DOI:10.1891/1933-3196.1.2.109
Rando, T. A. (1993). Treatment of complicated mourning. Champaign, IL: Research Press.
