“My mother says I’m still grieving over the loss of my father,” my new patient, a 42 year old father of one, an electrician lost in a loveless marriage of twelve years, told me. “He died six years ago.” Now, twenty years ago, back in my early days as a newly minted psychologist who was eager and anxious to help, I would have focused on the grief, the death of his father and used a contemporary “Empirically Supported Treatment (EST) to “treat” my new patient’s reported bereavement. I would be already honing in on a diagnosis, likely an adjustment disorder, chronic with depressed mood and trying to tease out just how “complicated” his grief was, reducing his emotional distress to a DSM code for billing purposes. I needed the insurance company to pay for his sessions.
I’d be instantly designing a treatment plan: build a rapport for one or two sessions, assess for unhealthful behavior, e.g. substance use, introduce some homework to track thought and moods (an ABC chart) and have the patient rate his symptoms of grief on a scale from one to ten. I might “prescribe” some light reading and a movie or two over our expected six to eight sessions, and assign some more homework, e.g. journaling, a letter to father, before I concluded treatment was done. After all, I was a new psychologist, I needed patients to get well for my own self-esteem and potential referral, and since I was a member of health insurance managed care panels who routinely conducted their “utilization review”, I needed to conduct an action oriented cognitive behavioral plan of symptom management. After all, it was “where my field”, psychotherapy, “was going.”
However, at the end of session six, having tidily summarized “our” progress (after all, who was it, exactly, who I was treating?), I slipped. I made the mistake of questioning just what it was about his grief that upset his mother so much. Why it was that she felt he was still grieving over the loss of his father. In the ensuing six sessions (after I requested an extension from the insurance company), my patient began to explain his mother’s relationship with father (it was a horribly controlling and abusive relationship), his mother’s own history as a child of alcoholic parents and the tragic untimely death of her brother. I inquired about her relationship with this two younger sisters, both younger than my patient, who were very close emotionally to their mother, unlike my patient, whose “complicated grief” had led to his “estrangement” from his sisters and his mother after his father (a deeply troubled and psychologically impaired man) died.
Over the next six sessions, I shifted with my patient from a tidy checking off a symptom list, recording ABC’s and scaling moods, to actually trying to empathize and understand his whole family, even intergenerationally, e.g. his mother’s parents, his father’s. I learned there was alcoholism on both sides of the family. I also learned about the relationships of my patient’s mother, not only the one she had with her dead husband, but her difficult relationship with men: her own alcoholic father (who died of cirrhosis), her brother who she loved dearly and was tragically killed in a car accident. I asked my patient to start to think about whether his mother’s feelings about his complicated bereavement might also be affected by her own broken relationships with men who were centrally important to her life: her husband, father and brother. He might even want to write about it. I prescribed a movie, “A River Runs Through It.”
Over the next weekly sessions (my patient never missed) a larger discussion opened about how after his father’s death, his two younger sisters (each also torn apart by their abusive father) healed themselves by creating a new sisterly alliance and a renewed harmonious triadic family subsystem with their mother, just the three of them. (I was thinking back to my old family systems work in graduate school, revisiting psychodynamic theory and feminist thinking in addition to measuring “symptom relief”). It turns out that after his father died, he – being the only male and the oldest of the three children – took it the hardest. His mother and two sisters (his family, despite their myths, was never very close) formed an alliance in the wake of his father’s death. They all were freed from his tyranny, oppression and abuse. My patient, however, being the oldest, married and with a family of his own, had been “triangled out” by his mother and sisters. In their rejoicing after his father died, my patient was, inadvertently, left out. He had lost not only his father, but his whole family. By our sixteenth week, my patient realized it was not a complicated grief over his father’s death he was feeling, but a loss of his family of origin.
Over the next several sessions, my patient, whose insurance had run out, agreed to continue to see me for another eight sessions. We focused on aspects of his relationship with his father that he missed, some which he never had, and how he, himself, had grown compassionate toward the man his father was, despite the trauma and abuse visited upon him. I worked with him to sense how this experience might be affecting his own marriage and relationship with his son. We had come full circle to appreciate patterns in his relationship with his wife and son that echoed choices and beliefs that came from his childhood and created new alternative beliefs. His mood had lifted considerably. He had rejoined the gym. His marriage was rocky, but he had become more interested and involved in his son’s cub scouts and little league. At the end of our twentieth session, my patient said he felt like he could “take it from here.”
Six years later, he called on me. My former patient was 48 and his wife had just filed for divorce having learned he had been having an affair. He told me that the affair had been going on for a couple of years and that he met a woman at a high school reunion who he once dated. She was divorced and had two daughters. He wondered whether he could come to see me to just “run a couple of things past me.” After, of course, I acknowledged I would enjoy reconnecting with him, I sat back in my office. I thought through my own life experience as a psychologist and a twenty year career. I was grateful I had never thrown out the “baby with the bath water.” I was not seduced by old wine in new bottles (psychotherapy is continually rediscovering itself). I watched as I grew into a greater trust and confidence in myself rediscovering the eclectic schools of theory and practice that made me not only who I was as a psychologist, but as a human being. I smiled, put a book back on the shelf and awaited my next session.
Dr. George Geysen is a clinical and forensic psychologist in private practice in Glastonbury, Connecticut. Learn more about his practice and his work at www.drgeysen.com.