Permission To Grieve

Jackie’s Story: Keeping Hope Alive While Tending to Invisible Grief

“It’s mind-boggling. That’s what it is…”

Jackie starts unloading her thoughts before she has a chance to settle down and make herself comfy on my couch. Jackie is almost at the “finish line” of medical school - with only two months left to her residency.

She puts her double espresso shot latte down on the coffee table as she throws her sweatshirt over her shoulders. I look at her, trying to make eye contact, but as I glance up, I see that she’s still distracted. She’s stuffing her lab coat into her overfilled backpack.

Ahhh, I take a deep, slow breath. I’m hoping that somehow I can expand my calm energy in the room so the calm aura invites her to settle in.

As a therapist, my job isn’t to change how a client is feeling or to force them to slow down.

Rather, I prefer to meet a client’s energy and gently invite them to get to a centered and connected place, even if for a few moments.

Jackie keeps talking...

“Today has felt like a very long day. She looks at me for a moment, and I wave like “hello, nice to meet your face for a moment”.

She half smiles and then goes on…

“The good news is that I got a few hours of sleep during my shift. I even checked a few things off my to-do list.” She says with a proud grin.

“You’re proud of that, aren't you?” I say, with a mirroring smile. “It's pretty amazing how much you accomplish in a 24 hour day.” I say with a twinkle in my eye.

I want to continue celebrating her productivity, and at the same time, I sense that there is something bubbling beneath the busy energy and noisy chatter. I trust that whatever is there will come up as she settles in.

“Esther”, she says slowly, her voice lowering. She looks up at me slowly.

I look at her, pulling for my focused attention. I notice that she’s looking somewhat childlike in this moment- almost like she borrowed the stance of a little girl, peering up at an adult. I can sense she’s needing some assurance.

“Do you think I’m nuts? I mean there’s no term for that in the DSM but they ought to make one for me… because that's the category I’d fall into...

I try to control my smirk because I find her to be funny…but I do want to answer her properly. But, before I reply, she goes on…

When I was skimming the DSM, the terms ‘Stress and Anxiety’ felt like they described how I’m feeling… do you know those terms?”

She laughs out loud as she finishes her question, and then goes on…

“Of course you do, but do you think I have those? I mean, my mind races and I can’t seem to slow down, even when my body is just so exhausted….”

As she speaks, I notice her level of insight and am glad she’s getting to share.

Then there’s a subtle but significant shift. Her brows seem to slightly soften and her breathing slows down.

Good, I think to myself.

Jackie- the kind of person we all love.

Jackie is the kind of person I’d definitely start a conversation with while waiting on line for my mocha latte. She has a vibrant energy and a confidence that’s compelling and inviting.

Jackie is a brilliant, motivated and kind woman. She has put herself through medical school by saving up throughout high school and undergrad. She’d known that she wanted to be a doctor since she was a child, and was also aware that her parents were not financially capable of footing the bill. By the time she got into Columbia Medical School Jackie had enough money saved to get through all four years without taking out student loans.

To me, that’s more than impressive, it’s almost a bit intimidating, but I am proud of her for the hard work and devotion she’d put into making her dreams a reality

______

As our session continues, I start sensing more of her presence in the room. I let out a slight sigh of relief, I can fully exhale now that she’s beginning to really settle.

I’m relieved to see her shoulders soften as she leans against the fluffy throw on the sofa.

As a somatic therapist, when sitting in session with clients, I don’t just listen to what the client is saying as they speak, but I'm also reading how their body is being held, their muscle tone, their energy and emotions expressed. These are the nonverbal cues that let me know how they are doing, what they may be holding and how comfortable they are (with me, and in their skin).

Somatic Experience Therapy and Offering Emotional Relief

We often incorporate somatic therapies such as somatic experience exercises or sensorimotor psychotherapy to help the mind and body relieve tension and find more inner peace.

Jackie goes on and continues to share about her accomplishments of the week, but instead of the feeling of triumph I’d expect, I sense a wave of exhaustion surface and I get curious about what’s weighing her down.

Esther, stay with what she’s not saying, I hear my internal voice say to me.

Though I don’t move my chair any closer, I pay special attention to her facial details and want to see what’s asking to be read. What’s needing to be sensed, what she isn’t saying, but is desperate for me to understand so I can help her.

I notice an outline of tiredness around her eyes that hadn’t been as visible a few moments before. But now, looking at her eyes, it seems she’s holding something, with a desperation to be shared.

What allows magical moments in therapy.

I trust whatever it is, will come up..as long as I keep staying attuned, kind and open. There is no rush; I’ve learned that trust, space and good clinical skill is what allows the magical therapy moments to happen organically.

Just be here with her, I tell myself. And stay attuned.

I find myself thinking back to our initial meeting.

Jackie had seemed incredibly confident and “together”. She eloquently shared, “On paper, my life has been working out exactly as I planned, but I have this deeply empty feeling inside.” In the last few months we have been peeling away at the layers of her story to try and discover the origins of this empty feeling.

She reports that nothing much has changed since the last time she was here, aside from her placement at the hospital. Her voice gets quieter and her eyes look as though they are glassed over. She is staring at something far off in the distance, lost somewhere.

“Jackie, hey,” I whisper softly. I’m here”. “But I wonder…. how much of YOU is here right at this moment”.

She glances up and smirks slightly.

“I’m here” she says, as a bit of redness blossoms on her high cheekbones.

“Oh, of course you are,” I respond. “But if I were to ask you what percentage of you is fully here and what percentage of you is somewhere else, what would that be?”

She breaths a deep sigh. “Oh. Well, not very much of me would be here, I guess. My attention is pretty divided right now. Sorry about that.”

Zoning out gives me a lot more information than she realizes.

We take a few breaths together. I encourage her to notice what’s happening inside of her, and what may be pulling at her.

“I’ll tell you what I’m noticing. When you asked if anything changed, I said no.

But now that I am more attuned, I realize my answer is totally inaccurate.

I've been working in the obstetrics and gynecology unit for the past two weeks. I am fascinated by that aspect of the human body and the idea of parenthood, I truly am. But at the start of every shift, as I walk into the hospital, I feel a wave of sadness wash over me. My heart seems to drag on the ground, not wanting me to enter. I can’t really pinpoint why.

Anyway, that’s where I went when I was spacing out.”

Her distraction = her anxiety + inhibited grief

I’m impressed that she zeroed in on the origin of her pain so quickly.

I’m not sure that she recognizes the underpinnings of “inhibited grief” just yet, but she is quick. With a bit of prompting, she will come to this understanding on her own. Inhibited grief is a tough concept to grasp for most people, but Jackie has come a long way in the short time we have been working together and already knows that grief is not exclusive to mourning death.

The pieces of her story start to take shape in my mind.

I’m curious about what she had shared a few months ago in one of our sessions. Six months ago, Phil, Jackie’s ex-boyfriend broke up with her. When sharing this with me, Jackie actually laughed. She brushed it off and said that she was thankful.

Obviously she was hurt, but she knew that he was not ready to settle down. She covered the pain well, calling him an idiot, because he is the one who is losing out. Beneath the laughs there was a small tinge of disappointment. She had seemed focused to move on and start her next chapter with someone who would appreciate her for the incredible person she is.

She was right. Anyone who doesn't recognize what a gem she is, doesn’t deserve her. However, Jackie and Phil had really connected, and Jackie had invested many years in this relationship.

Healing from a relationship takes time…

It’s not the sort of thing one can expect to just bounce back from right away. Next to becoming a doctor, Jackie's life dream was to become a mom. Jackie’s mom had been ill for much of Jackie’s childhood, which inspired her commitment to want to give back to the medical community and become a doctor. She also wanted to be able to nurture her own child in a way her mom couldn't.

Her eyes lit up and her soul sparkled when she discussed her dreams of future parenthood with me. It was obvious that those plans invigorated her mind, energized her body and brought vibrance to her spirit.

Now, it seems that her mind, body and spirit are struggling to accept her not yet being at the “goal” of mommyhood by this phase of her life.

Anxiety and Fear are Both Intimately Connected to Grief

Working in the gynecology ward unconsciously stirred up anxiety and fear for Jackie. Fear that her dreams won’t come true, fear that she won’t ever become a mom. She was anxious about her dreams not all aligning as she had planned. Since Jackie lives a fast paced life, her mind has not had the chance to catch up to her body, which has been screaming for her attention for quite a while.

Holding Hope While Allowing Grief To Surface

What her body wants from her though, is a chance to grieve for the life she had hoped to already be in- a reality she has been hungry for. She wanted to be married with a little adorable munchkin…and she wanted it by yesterday.

But it still hadn’t happened. Instead, she was faced with a love she had ended, and an image of her soon-to-be future that was yet present.

Yes, her dreams will still be coming true, but in a different way and at a different timeline than she had planned.

She’s in need of some grieving.

All humans grieve.

Grief is a word often used regarding death or significant loss, but what many people don’t realize is that we all grieve.

As we start unpacking the anxiety that’s related to her grief, Jackie’s energy calms down and her ability to focus comes back online.

“I didn’t realize that working with moms and babies would trigger me like this. I have worked with cadavers and witnessed the most painful deaths you could imagine. The sights and smells that creep other people out don’t phase me in the least. Nothing I went through during med school or residency ever hit me like this.

But watching those happy couples bring new life to the world, full of hope and possibility, feels like a sucker punch in my gut. Literally.

Jackie lets a heavy tear roll down her cheek.

I look at her with a loving and kind embrace, hoping my caring energy could offer some soothing balm to her aching heart.

Esther, It hurts so bad, she says…almost checking if I’m still with her in this pain.

I know, dear, I know how bad this hurts for you. Your tears are telling me some of the pain. I am here with you. And it may be the wrong time to say this, but I truly believe the ache won’t ache this bad

After a few minutes of quiet flowing tears, her tears slow down.

I gently explain that she is finally allowing herself to grieve. She seems a bit more confused than I thought she would be, so I explain that grief is not just about losing someone you love, but the experience of loss of anything impactful.

She seems relieved, by knowing that what she is feeling is “normal”…and that as we tend to all that comes up, we can allow it to move through and out of her system so it doesn’t feel as heavy.

What is Grief?

When you google search the definition of grief, the first line that comes up is “A deep sadness caused [especially] by someone’s death, a cause of deep sadness, a trouble or annoyance.”

My sense is that the world is coming around to the idea that grief is something we ALL experience. Society is beginning to normalize the expansion of our old understanding because physiologically, grief flares in the body regardless of the source of the pain. We’re learning to interpret grief to be more inclusive of each individual’s experience, and recognizing that we each have different coping skills, protective factors and life circumstances that all impact how and why we grieve, as well as the intensity of our felt experience.

Grief - Beyond Death

The process of healing grief is often talked about in the context of death and dying, however, grief encompasses any form of loss, sadness, pain or hurt. A Swiss psychiatrist. Dr. Elisabeth Kubler-Ross is known for her impactful work in grief. She originally describes grief healing in five steps; Denial, Anger, Bargaining, Depression and Acceptance. Since her original description, numerous variations have been suggested, as well as the important notion that grief is not a straight line with step by step instructions. It’s messy and there is no particular order to it.

Grief is individualistic.

There may be some common emotions and experiences between two people, but each individual has a different mix of emotions, triggers, sensations and feelings, as they ride the waves of their losses and changes in life.

You don’t simply walk upward five steps of healing and then tuck grief away in a box with a nice pink ribbon.

Elisabeth Kubler-Ross actually writes about this in her book called “On Grief and Grieving”. She says;

“ The (5) stages (of grief)…were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grief is as individual as our lives. Not everyone goes through all of them or goes in a prescribed order.”

______

As Jackie continued in her healing, we tended to her grief. We helped her hold her feelings as she let go of the pains that had been deeply buried. And as she moved through her pains, and many tissue boxes, she also began feeling better.

A few weeks later she walks into session…

.. and seems a lot more present, a lot more connect-able and a lot more okay. Her grief is not totally gone, but she’s got a nice bit of cheerfulness that had been buried for a while, and my heart skips a beat at seeing it peek through.

Her residency is over and she look a lot more ready to embrace her next phase of life. Over the last few weeks we’d done some really good work and with each session, I noticed a small sliver of pain shake off her, bit by bit.

She left school not just with her diploma, but with something richer;

….a maturity and wisdom acquired by the work she’s done, and her commitment to herself and her dreams.

Grief is hard, but living trapped in unacknowledged grief is worse.

If you’ve been struggling with anxiety or chronic stress you might relate to Jackie and perhaps you are now sensing that it could be related to grief, please be gentle with yourself.

And if you’re ready and able, reach out to get some support to help you release the weighted pebbles on your heart.

Give yourself the space to heal, process and prioritize your healing.

For now, I’m here sending love from my heart to yours,

Xx

Esther