In Your Head: An Interview with Dr. Sara Corse, Ph.D., Clinical Psychologist
Seeking help from a therapist in the aftermath of babyloss often raises conflicting emotions within the bereaved based on their preconception of grief, and of the psych-profession in general. "I'm not depressed, I'm grieving!" babyloss parents scream from their blogs, in defense of their decision to not seek outside help.
Maybe.
Do we really know the difference between the two sets of emotions? And why are we all worked up about seeing a therapist anyway? Does it signal that we're weak? Can't handle it? Need to take our ugly emotions inside, out of public, into an office with a shut door? Or (gulp) maybe we're even a wee bit crazy?
What about those of you who sought help and were confronted with professionals who told you to buck up? Who didn't understand what infertility and babyloss had to do with each other? Who glossed over the loss and focused on something else -- or vice versa, assumed the loss was the be-all-and-end-all to your problems? And you were left wondering: was it them, or me?
In order to try and clarify some of these issues I went directly to the source. Dr. Sara Corse is a psychologist who specializes in grief counseling and the author of Cradled all the While, a memoir of her experience in dealing with her mother's terminal illness. Dr. Corse sees individuals, couples and families at Council for Relationships in Philadelphia. (Disclosure: I, Tash, interviewer, saw a grief therapist regularly, until recently. I consider it on the whole, a positive experience.)
Tash: Thank you so much for agreeing to this interview. How does one become "a psychologist who specializes in Grief Counseling?" That is, are there special courses or training that you do?
Dr. Corse: There are several professional pathways to working with people who are grieving. A grief counselor may have training as a psychologist, social worker, couple and family therapist or nurse. Grief is a normal life process, and as such is covered in courses on lifespan development. Therapists learn to work with both normal and complicated grieving in courses and supervised experience in counseling. Some programs offer semester-long courses in grief and there are many opportunities to specialize through self-guided readings, advanced supervision, workshops and conferences.
Why did you decide to go into this particular avenue of psychology?
I developed an expertise in grief counseling several years into my career, motivated by my own experience of loss. When I was 36, I cared for my mother as she was dying of cancer. I’d lost my father to a heart attack when I was 18, and I was struck by how different the two losses were for me emotionally. I have always been one to read everything I can get my hands on when I’m trying to process something distressing, so I read widely on death and grief. I also began writing what became “Cradled all the while” a few months after my mother’s death, and found the process of writing to be helpful, both in terms of my own grief and in terms of opening my interest in grief counseling. It is more than a decade since my mother’s death, and I now have a wide and varied clinical practice. About 20% of my clients come specifically for grief counseling and many others have had losses in their life that they have not fully grieved, and this becomes part of their therapeutic work.
I know I felt this early on (I no longer do) and I've seen it expressed by others: how do you answer the grieving parent who responds, "Well what do you know! Have you ever been through this?" What is it exactly that you can offer someone regardless of whether you've been through that particular situation or not?
It is common for people who are grieving to feel very alone with their experience. There is often a deep desire for connection with others who’ve been through the same thing, and at the same time, a wish for acknowledgement or appreciation that their loss is unique. I openly share with clients whether or not I have experienced a loss like theirs personally. In fact it is sometimes more difficult to work with someone who is grieving a loss similar to my own, because I have more of my own experiences to filter out in order to be responsive to the client’s emotions. What I try to offer all clients, however, is an open-minded curiosity and interest in their unique story of loss and a commitment to accompany them in their grieving process.
I know you don't want to start analyzing people who you don't even know, but are there any ground rules for how someone would know perhaps it's time to seek out this particular kind of help? I know a common refrain around here is, "Of course I'm depressed! My baby died!" and some people are just reluctant to seek out this kind of help due to monetary constraints, preconceptions regarding psychotherapy that were in place before their loss, or just not understanding the profession and what it can offer.
To understand when it’s time to seek grief counseling, it might be helpful to first have an idea of what normal grieving looks like. I like Theresa Rando’s model of mourning (grief refers to emotional, behavioral, physical and social reactions to loss; mourning refers to the work of processing and integrating the experience of loss).
She calls the first phase of mourning the Avoidance Phase, during which time the person in grief comes to recognize the loss. This includes acknowledging the death and working to understand the death.
The second phase is the Confrontation Phase, in which the grieving individual experiences the deep emotional pain of the loss. The work of mourning during this phase is reacting to the separation from the loved one through feeling, identifying, accepting, and expressing one’s emotions. It also involves identifying and mourning secondary losses that coincide with or develop as a consequence of the initial loss, such as the loss of the role relationship one had or would have had with that individual. During this phase, mourners recollect and reexperience the deceased and the relationship—reviewing and remembering their life, and reviving and reexperiencing the feelings engendered by that relationship. The person in mourning relinquishes old attachments to the deceased and to previous beliefs about how the world works.
The final phase of mourning is the Accommodation Phase. A new relationship is developed with the deceased, new ways of being in the world are adopted and a new identity is formed…one that incorporates the experience of grief and loss but is not wholly defined by it. And finally there is a reinvestment in life. The process of mourning a specific death can take place over many months and years, and may be revisited and reworked at different points throughout life.
This model of “normal” mourning serves as a backdrop for addressing complicated mourning. (I use quotes because the word normal seems to trivialize the pain of grief. I know that when I have been in mourning, nothing felt normal about it, and I wouldn’t have wanted anyone to suggest that it was). Complicated mourning is associated with several risk factors. These include specific circumstances of the death, such as a sudden, unexpected loss, death from an overly lengthy illness, the loss of a child, or the perception that the death was preventable. Other risk factors are related to the griever’s prior or concurrent condition, such as previous losses that were not fully mourned, high levels of life stress, depression and anxiety or a perceived lack of social support.
Grief counseling can help with both types of mourning, but is particularly useful in complicated mourning (or during complicated periods of normal mourning). So how does one know if it’s time to seek counseling?
One indicator that counseling might be helpful is feeling stuck—as with struggling to move from the Avoidance Phase of mourning into the Confrontation Phase. Denial is sometimes a cause of that feeling of stuckness. It is often a feature of the Avoidance Phase, manifesting either as not acknowledging the reality of the death or not acknowledging the feelings associated with it. Denial is not something we do, but something that happens—a natural psychological reaction which provides us with a time-out—a temporary delay of grief until we can gather the psychological resources necessary for experiencing the devastating pain associated with the loss. Although initially adaptive, if denial continues for too long, it becomes maladaptive and delays us coming to terms with the loss. Counseling can offer support in coming to acknowledge and confront the grief.
Another indicator is a persistence of depression or anxiety. Grief and depression share common symptoms, such as sadness, difficulty sleeping, loss of appetite and loss of energy. But in grief, our moods, such as sadness, anger, despair, or hopelessness, are triggered by sights, sounds, memories and thoughts about the loss. In depression, the symptoms are more persistent and pervasive. In grief, moods and symptoms change over time—from acute grief, which may be debilitating and immobilizing, to later stages of mourning when feelings can be bracketed—at least enough to function at work or at home. The feelings may not be any less strong and may still hit powerfully and unexpectedly, but they can be felt and expressed without interfering with overall functioning. In depression, bracketing is far more difficult. Mood and energy are more consistently down.
In terms of how long is too long for feeling depressed during normal grieving, some professionals use two months as a marker. On the one hand, I think 2 months is too short a time to diagnose depression in someone who is grieving the death of a child. On the other hand, if someone is struggling with feeling depressed, and having trouble resuming normal activities two months after the death, therapy can be such a helpful tool that I encourage it even if it is a part of grieving and not depression.
We've all been told at least from within this community that grief is a normal life process, and there is no wrong way to grieve. What benefits are there then to seeing a therapist as opposed to, say, duking it out on your own?
Here are some things clients have shared with me about how therapy has been helpful for them:
* feeling validated, feeling heard, feeling listened to
* feeling not alone: being able to reflect on and express their feelings with another person rather than keeping them inside
* not feeling blamed or judged
* appreciating that they don't have to reciprocate with the therapist--they don't have to take care of or listen to the therapist's feelings. They don't have to prove to the therapist that they will be okay. They don't have to take any responsibility for making the therapist feel like he or she is being helpful.
* being able to talk about the experience as many times in as many ways as they want or need without worrying about being a burden.
* being able to ask questions and get feedback and learn a framework for understanding their experiences that can support them through the phases of mourning.
* being encouraged to explore feelings that they may shy away from with the support of the therapist, and thus learning how to tolerate these emotions as they come and go during mourning.
* having a space to grieve that feels safe and where time and expectations don't (or shouldn't) matter.
* being able to talk about their feelings about or worries about other family members confidentially, and explore in therapy ways to address them.
* with couples, helping partners understand and appreciate the different ways people have of mourning, and learn to support each other and stay connect through the grieving process.
* having a place to explore other issues that are kicked up by the loss and may be important to address at this point in life.
Do you have any suggestions on "finding a good fit?" I feel as though I rather lucked out, although I did look for someone who specialized in "grief." Others in these parts have not been very fortunate in finding doctors that they feel are helpful (some sound downright oblivious to the basic issues surrounding infant death). What should we look for when we go in the first time (or few times)?
* someone who makes you feel comfortable telling your story and sharing your feelings.
* someone who has some experience with working with grief.
* someone who communicates an interest and curiosity in you.
* someone who will answer your questions, even if they come across as challenging, without being defensive or dismissive.
* someone who will engage with you around questions of fit, and doesn't suggest that he or she is the only person who can help you.
* someone you respect.
* someone who respects your boundaries—not imposing their beliefs or experiences on you and not pushing you before you have developed trust.
Along the lines of "there is no wrong way to grieve": It seems to me that, sadly, for some members of society at large there are indeed "right ways." It's not uncommon for us to occasionally get comments to the effect of "hurry it up already," or, strangely, "You need Grief Counseling!" One of our contributors (Bon) recently wrote a hospital to ask them to change the language on their fund-raising literature as she found it offensive to someone who had lost a family member at this institution. The campaign went public, a newspaper picked a line out of Bon's argument, built a story around it, gave it a controversial title, and then posted it on the internet -- and opened the comments. The public comments were stunningly offensive in my mind, one of them though told Bon to "Get Grief Counseling."
I thought that was a rather strange insult; it seemed to be indicating that the commenter was uncomfortable with Bon's emotions and that Bon was better off dealing with these feelings privately (preferably in an office with a doctor present, apparently) -- not publicly. But it also really tiptoes the line as to how the public at large views therapy, and it's worth.
Our society does communicate a strong message of intolerance for the wide range of feelings that grief entails. Tears and sadness, maybe. Anger and advocacy, not so much. And our society follows up the intolerance for the full range of emotions with intolerance for any of those emotions that last longer than a few days or weeks. Bon handled the whole situation, from beginning to end, with grace and balance. She was attuned to the impact the hospital’s fundraising letter had, not just on her but on any parent who’s baby did not survive, and took action to raise the level of awareness and sensitivity of the fund-raising world to this point of view. The public comments suggesting that Bon get grief counseling miss the mark. In fact, a healthy processing of grief often leads to an action such as Bon's. When we have done (or are doing) the work of mourning, we are able to speak out regarding the universal truths of grieving and loss and can advocate for societal change. When we embrace the full range of feelings that loss brings to our lives, and integrate our most painful experiences into a new way of being in the world, we find energy for transforming our experience of loss into something positive for others.
What do you see as the biggest hindrance to grieving?
I don’t think there is one big single hindrance, but there are several roadblocks, some internal to the person who is grieving and some external. Earlier I mentioned denial. It is the persistence of denial, not its early existence, which proves problematic. If we cannot sustain knowledge of the fact of the death and the irreversibility of the death, we cannot mourn. Another hindrance to grieving is the inability to gain necessary information to answer questions about how and why the death occurred. We often hold off on feelings of loss until there is greater understanding.
External hindrances include the impact of commonly held myths about mourning, such as the notion that grief follows a set path or sequence of stages, resolves in a matter of months or comes to complete resolution. Another external hindrance for parents grieving the loss of a baby is society’s tendency to minimize the loss. In fact, grieving the death of a child means not only experiencing the loss of the brief relationship, but also the loss of potential, about which they are continually reminded. The perpetuation of societal attitudes about grief makes it hard for people in mourning to acknowledge their feelings, both to themselves and to others, to be patient with themselves and to seek and gain support from others.
What then do you see as the most helpful thing (or things!) one can do to process grief?
In terms of denial, there are various experiences early on that can help grievers acknowledge the death and begin to experience and express their feelings. These include having the opportunity to hold or touch or view the body of the deceased, and to participate in rituals that acknowledge the death, such as a funeral.
As the process of grieving continues, it helps to talk about the death and any feelings, and to find people who are willing to listen and ask questions.
Participating in a support group with people who are experiencing or have experienced a similar loss can be helpful for exploring and validating feelings. This includes on-line support groups.
It helps to create rituals or memorials that are meaningful. Some people plant a tree or garden, donate to a cause, or launch an initiative in their loved one’s memory, enacting love and the pain of loss in a way that benefits others.
And as we’ve discussed, grief counseling is helpful, particularly when we feel stuck or alone, when we are experiencing a complicated period of grieving or when we have an inner sense that in processing this loss, we are provided an opportunity for making other important life changes in therapy.
How do you feel about online support -- like this site -- or blogging as a means of self-help?
I think it is a fantastic medium for several important processes of grieving: The work that people do in writing about their experiences, whether blogging or commenting on other people’s posts, is transformative. The writer must engage her or his emotions in the crafting of a post, which then offers both an expressive outlet and a mode of working through the experience that deepens personal understanding and connection to the experience. In posting on the internet, writers have an immediate outlet for sharing their experiences with others. Because there is an intended audience, the emotional, intellectual and creative work of blogging is different from personal journal writing—in considering what one wants to share publicly, the writer’s perspective is lifted to the universal (or at least in that direction). This process of moving from the personal to the universal is something that gradually happens during the process of mourning, and writing for an audience facilitates it.
Blogging also offers a wonderful way to network with others who have experienced something similar. Particularly for those who are new to grief, being able to read and comment on posts by people who are further along in their mourning can be very validating. For parents grieving the loss of an infant, being part of a blogging community is a way to create a set of loving relationships around oneself and one’s lost baby. Sharing grief this way brings meaning to the baby’s short life, and when others in the blogging community respond to or even anticipate one’s own grief reaction, the grieving parent feels far less lonely.
The one caveat I would mention about on-line communication is that it is different from face to face communication in terms of how people filter emotions, opinions and reactions. On the one hand, people may hide certain reactions and reveal other reactions in order to gain social acceptance or approval. On the other hand, sometimes people are inappropriately unfiltered in their reactions, such that they say things and say them in certain ways that they never would if they were face to face (internet bullying, perpetuating conflict and misunderstanding, etc.). So I would encourage people to continue to nurture supportive face-to-face relationships for grieving as well.
Have you sought out therapy in the aftermath of your babyloss? Why or why not? Did you find it useful/helpful?
20 Comments
Reader Comments (20)
Well don't I feel screwed given I (obviously) lost my child, it was sudden and unexpected and it was preventable. This is why I wish people would cut me more slack and give me more space and time, but 11 months on, the overwhelming urge out there seems to me that I need to "move on already". Especially as I'm one of the lucky ones, and I'm pregnant again. That should really make me over it.
I started seeing a counsellor who specialises in post-natal depression about a month after I lost my daughter - my first child. She was good, and yeah, I guess you could say I had post-natal depression in the purest sense of the term, but I felt that she was equipped to deal with a loss like mine. She always seemed at a loss for words, and I wonder if she'd ever dealt with a girl in my shoes. To me, it seemed like I was totally beyond her capabilities, so we did not continue the sessions for long. She made me feel more broken and damaged.
Now I see a family counsellor who I like and who likes me. We get along, she makes me think and she also says she's learning a lot from me. I find I look forward to our fortnightly sessions and I do feel better when I walk out of them. And this to me is worth the $150 a fortnight and it shuts people up from asking all the time "so are you getting grief counselling????"
Thanks to Tash and Dr Corse for this post.
Of course, there's also the fact that I have lots of unresolved issues with my mother, who's a psychiatrist, and the fact that every therapist I've ever talked to uses almost exactly the same turns of phrase as my mom. I'm sure that doesn't help either.
I now am seeing a therapist who has also experienced the loss of her son and infertility. So far, I find it incredibly helpful to talk to a member of my own tribe every week, and just check my anxiety and sadness in.
When we were doing infertility treatment, we sought counselling twice along the way -- once when we were wrangling with the question of just how far we wanted to pursue this, and again when we'd reached the end of our agreed-upon number of IUIs & I was suffering from anxiety attacks. I chose a woman I had heard speaking at an IVF seminar; she seemed friendly & approachable & as it turned out, she was from the same area of the country I was & we had mutual friends! She had used donor gametes to build her family & specialized in infertility, grief & loss issues. She was great -- we only saw her twice, but each time, we walked away feeling we had been understood, that we weren't as far apart in our thinking on the issues at hand as we had thought, & that we had received some good suggestions for next steps we could take.
A year or two after we last saw her, I started having anxiety attacks again. I told a friend, who is a high-powered corporate lawyer, & she suggested I speak to a woman who had done stress management seminars for her law firm. I thought I was going to talk about stress management -- guess what, most of our conversations revolved around grief, pregancy loss & infertility, even though she had no personal experience with the subject. I saw her again during another stressful time in my life a few years later.
About a year ago, dh & I had a few sessions with a counsellor we were referred to through our workplace employee assistance program, & I saw her myself again recently to help me with some anxiety issues that I've been having (again). Once again, we lucked out -- we both really liked her. And once again, grief, pregnancy loss & infertility popped upin our discussions, even though I was supposedly there to talk about other things.
We saw a psychologist recommended by our rabbi, once, about a month after A died. He was expensive, and turned out to not be covered by our insurance. But that one session was very good, and he helped by pinpointing what was going on in one small corner of my life-- fixed that one thing right up, and was worth the money we paid for the session out of pocket.
After that, I saw a researcher at a local university, who was working on a counseling protocol for mothers of dead babies. I was a bit too self-aware for her protocol to help much, but it was good to have a place to go and talk. It only lasted ten weeks, and was over before the fifth monthaversary. Which was more than two years ago now.
My sister's been on my case to see someone since shortly after that, but I only recently went, and only because she was the one to do the heavy lifting of finding someone covered by my insurance who looked like a good fit for me. And in that, I SOOOO hear Catherine-- I got exhausted just thinking about needing to be the one shopping for a therapist. Had the first one been covered by my insurance, I think I would've continued to go. The second kinda fell into my lap (I got a call from someone in my OB practice-- they thought this study might be good for me). But thinking about having to tell my story as a downpayment on a potential relationship with a therapist, who may or may not turn out to be a person I would voluntarily trust with that story? That seemed unfair to both me and my child. I mean, if the shrink turns out to be an ass, it's not like I can get that story back, you know?
Anyway, so my sister did good-- the psychologist I am seeing now is a good fit. She spent some weeks getting to know me, sort of free-flowing kind of "what happened this week" sessions, but just this past week she's given me my first hard homework. A writing assignment, whatdayaknow. A blog post, likely.
While pregnant, we visited him several times, once right before the loss when I was 8 months pregnant. A month later, when we showed up at his office without a baby, me obviously not pregnant, he knew and he just started crying. He has lost three young children of his own- one to cancer and two in a tragic accident. He knows loss. And more than anything, he has been incredibly validating.
She is one of those people you just warm to. I don't think she's told us anything we couldn't have worked out for ourselves but it is so freeing to have an hour once a fortnight or three weeks that is our "Emma" hour. We were just starting to extend the length of time between sessions when we told her we were pregnant again. Now we're considering what we want from her: do we still want grief counselling? (I think yes. I think it's even more important now I'm pregnant again. I need Emma to stay very full and real in my mind) or do we need her to provide pregnancy after loss support? Based on my current emotional state, I'd say yes to that too!
Both my husband and I said that we were prepared to grab anything that was offered to us to help us deal with this enormous, horrible, tragic event. We also attend a bereaved parents group once a month, which is beneficial in a different way. I suppose I'm a "do-er" and just "doing" therapy makes me feel like I'm being proactive about dealing with my grief - and that in itself is valuable.
also...on the hospital advocacy debacle, thanks so much for the validation. i needed it - the promise of inclusion by the hospital on a decision-making board has thus far gone nowhere and i've been feeling really exposed and intimidated by the prospect of once again approaching them to ask what happened to our planned meeting. will keep the community posted if i can once again gird my loins to pipe up.
I really feel the counselor I found was a gift - she turned up right when I needed her. She is a MA in social work and a DBM. After she lost her daughter she took some years off of counseling to grieve and do her homework, and then she came back to the field specializing in pregnancy loss and maternal and reproductive mental health. Really a perfect fit for me. She totally gets it, totally validates me, never rushes me.
More than anything she just holds space of 'It WILL get better." Which I so need to hear. And I can cry there without feeling responsible for her reactions, without needing to be strong for anyone. (By the way, she is located north of Boston and if anyone here is local to me and would like her information, I'd be happy to share her. You can drop me a line on my blog.)
I also wanted to add: I know traditional therapy isn't for everyone. But I do think it's wonderful to have someone take care of us during this time without our having to reciprocate. I think massage and energy work are another route for feeling nurtured, for helping the body process the loss, to begin healing. Sadly not covered by insurance but some practitioners have affordable 30 minute sessions. That's what I'm doing, and I find it is worth it.
Thank you so much for posting this interview. Very validating and useful.
something about losing a baby is, it sucks up all of your energy. there's nothing left to hold back all the other stuff that you'd been doing along the way up until your baby dies. crap i had no idea i was "handling" with crashed down upon me, and that's what i had to deal with.
thanks, debra.
To my knowledge, she didn't specialize in grief counseling, but she hit all the bullet points Dr. Corse mentions above. I don't remember how long I saw her -- six weeks or six months. It just helped to have that space to grieve without feeling like I had to also comfort someone else. That was probably the biggest thing for me.
Before the birth of my older daughter (the year after Gabriel died) my husband and I also saw a private therapist through our midwife office. We specifically went (just one session) for her help with previous traumatic birth. I really needed to talk about what had happened with Gabriel, and find a way through to birthing my next baby. It was cathartic, and it helped me leave my horrible experience laboring with Gabriel behind when I was laboring with her.
Thanks, again, for a great post and great comments.
ciao,
rpm
In the beginning, it was really one of the only things I could physically "do" to grieve. That was one of the main reasons we went. Now, it's becoming more of a chore, we've talked the same issues a hundred times and there's not much left to say.
All in all, I do find it's a valuable resource. I don't think there's anyone IRL that knows we go- dead babies come up so rarely in conversation that it's just never been mentioned.
I haven't sought out counseling, partly because my husband did, and was met with a particularly awful experience with a counselor who was defensive and condescending (I've written about it before - she saw his expression when he saw the wall full of baby photos in her office and said, "Well, you're going to see them everywhere"). That session actually caused damage; my husband, who had been ready to open up and start talking about his grief, shut down for a couple months afterward. One of the saddest things about this experience is, while we both know there are helpful, qualified, compassionate counselors out there, neither one of us is likely to risk another hurtful encounter, at least for some time.
But this interview is extremely helpful in that it gives me some things to look for and consider if I ever do scrape up the energy and bravery to seek out counseling.
I also get shiatsu massages as a type of emotional therapy too. I go to my psychologist when I need to figure something out or need a witness to a stage of grief, I go to the shiatsu therapist when i feel stuck emotionally, feel depression (the pervasive mood) descending, or when I can't stop perseverative angry thoughts. I find it much easier and more effective then CBT in getting me unstuck, or releasing me from perseveration. It makes me wonder a lot about the way we carry emotion in our bodies (e.g. anxiety and irritable bowels, grief and heartache) and wonder if emotions become a physical habit.