When we talk about grief, the first thing we think of is an irreparable loss. Therefore, one of the factors that can bring complications in this process is the absence of traditional burial and well-developed grief rituals.
What is the purpose of a grief ritual?
Traditionally, grief rituals helped people to grieve, providing them with a socially accepted structure in which they could and should temporarily direct all their attention towards the deceased, thus declaring their death and accepting its consequences.
What is a therapeutic farewell ritual?
When traditional grief rituals do not exist or are inadequate, therapeutic ‘farewell’ rituals provide the person with an opportunity to resolve their grief. They are used both in conflicted grief syndrome (the person uses grief as an excuse not to live the life that corresponds to them), and in unexpected grief syndrome (the person dies unexpectedly due to an accident, natural disaster, etc.) (Parkes and Weiss, 1983, cp. Van der Hart and Frits, 1991).
Palazzoli et al. (1974, cp. Van der Hart and Frits, 1991) describe the example of a two-and-a-half-year-old girl whose parents had not explained to her that her brother had been born with serious difficulties, nor that he had died six months later. However, their daughter seemed to react to this by refusing to eat. The therapists instructed her parents to talk to her about her brother and his death and, together, to bury some of his clothes in the garden and plant a tree on the grave. This therapeutic ritual was a moving experience, not only for the girl but also for the parents, resulting in the immediate disappearance of the symptoms.
Grief therapies in adults
Thinking that this method could also be used in adults, Van de Hart (1987) began to systematically apply rituals in grief therapies in a community psychiatry unit; generally in people with psychiatric demands related to unresolved chronic grief. This grief technique is conceived as a form of farewell. These types of rituals are formalized in symbolic acts through which the client can say goodbye to the deceased person.
Most grief therapy modalities are intensive treatments, often with several weekly sessions (Ramsay, 1977 and Volkan, 1981). In contrast, therapy that includes farewell rituals begins with at least one session per week with the therapist, but subsequently, the emphasis is placed on the work the patient has to do at home and therapeutic sessions are dedicated to consultations and evaluating progress.
Phases of the therapeutic farewell ritual
Therapeutic farewell rituals consist of three phases: 1) preparation, 2) reorganization, and 3) completion. Afterwards, a commemorative ceremony can be held.
As in other therapeutic methods, assessment and diagnosis must precede grief therapy or therapeutic farewell rituals. There must be a preliminary treatment contract to which everyone agrees. In therapy, the choice of ritual must be based on an adequate assessment of both the patient’s complaints and their environment (partner, family, friends, etc.). It is important to establish whether the patient is the only family member with grief problems or if the entire family is suffering from unresolved grief. In the latter case, family therapy is more appropriate, in which rituals are also used (Gelcer, 1983, cp. Van der Hart and Frits, 1991). If there are other tensions in the family, related or not to the loss, as a rule we should first focus on “the past”, that is, unresolved grief, and ask the spouse and/or family to support and cooperate in this remembrance. Clinical and health psychology training is essential for you as a psychotherapist to apply the three phases of therapeutic farewell rituals in therapy.
Preparatory farewell phase
In this phase, the patient presents their loss in an unstructured way. The therapist explains how performing a farewell ritual could help them resolve their grief. It is important to ensure that the patient is well motivated for the ritual, as it will be an arduous emotional task and will require great effort. Not only can it trigger intense emotions towards the deceased, but the person may struggle between hope and discouragement. The family, whose support and collaboration have been requested, must be informed of these issues. During this phase, family members can be encouraged to talk to each other about the loss, perhaps with the therapist’s guidance. The preparatory phase ends with a definitive contract, which specifies the agreements between therapist and patient regarding the farewell ritual and the nature of their joint work. Once this task is completed, the person will have at least one session per week with the therapist.
Reorganization farewell phase
During this phase, most of the work on grief and other traumatic experiences is carried out. When this process begins, most people report an increase in dreams about the deceased and the past. Normally, the process reaches its lowest point in terms of the client’s mental state. They experience a state of deep despair and depression when they realize that the meaning of their existence can no longer come from the deceased and that they will have to detach from the bonds that keep them united, or at least grant the deceased person a less central place in their life. As they lack a new perspective or object from which to derive meaning, on some occasions, they may wish to end their own life. In certain cases, for the patient to overcome this impasse without harm, extra support from the therapist is needed in the form of more frequent contact, explanations of the process, and sometimes medication.
During this phase, the patient follows certain rules that separate the grief period from ‘normal’ life. These rules, whose origin is found in Jewish tradition (Lamm, 1969, Herman et al, 1987, cp. Van der Hart and Frits, 1991), can also benefit non-Jews. For example, the person can light a candle every day or every night, abstain from drinking alcohol and eating meat, participating in parties or celebrations, and giving up various luxuries or pleasures, having sexual relations, going to the hairdresser, etc.
To initiate or encourage the grief process, the therapist asks the patient to choose an object that symbolizes their relationship with the deceased. The patient gives one or more of these to the therapist to keep. Afterwards, they are asked to relate to the objects differently; for example, by placing them in a more important place, literally and metaphorically. They could frame a photograph from an album and put it on a living room table. Treating these symbols differently implies a change in conscious experience regarding the deceased. The person can create drawings, paintings, sculptures, poems, or stories that serve as key symbols, or find them in nature (piece of wood, shells, fruits, etc.), being able to work on them or alter them to increase their resemblance or connection with the deceased. The search for symbolic acts and objects is not a matter of naivety on the part of the therapist, but a way of discovering what the client feels is appropriate and meaningful.
In fact, “The Continuous Farewell Letter” is the most common way to create a symbol of the relationship with the deceased. This task is extremely appropriate for patients with a conflicted grief syndrome, who thus have an opportunity to express and integrate their ambivalent feelings towards the deceased. If the farewell encompasses more than one person, the patient writes a different continuous letter for each person in a different notebook. After writing for a while to one of them, they often discover that they still have something to say to the other. The recent grief has reactivated the grief of a previous loss. In this way, different grief processes can be carried out simultaneously. The use of separate notebooks is a way to differentiate them. In this way, the patient can realize towards whom certain feelings are directed (sadness or anger, for example).
Once the entire or almost entire letter is completed, the therapist discusses with the patient what will be done with the respective topics and/or notebooks. The patient will write every day, or three times a week, at a fixed time and place, for forty-five minutes to an hour; less if the tension becomes too painful. Fixing a time and place gives the letter a ritual character, providing a framework in which the client expresses and elaborates their emotions. The patient may require special assistance, and the therapist, to help them, may need to read relevant passages in the letter. It is preferable to consult the therapist about the completion of the letter; if the person makes this decision on their own, they risk finishing too soon, thus avoiding the experience of pain. Signs that the process is ending are: less preoccupation with the past, dreams involving saying goodbye to the deceased, and greater interest in people and things in the present. At this stage, a ceremony is prepared to say goodbye to the letter(s).
Completion farewell phase
This phase includes a farewell ceremony, a purification rite, and a reunion rite. The patient solemnly says goodbye to the created and collected symbols through a farewell ceremony, which often takes the form of a funeral, or the objects are first burned and then buried. Sometimes, it is an appropriate occasion to clean and remove the deceased’s clothes and other belongings from closets. Certain objects can be given away and, in this way, reduce or lose contact with these symbols. The purpose is to reduce preoccupation with the deceased and it is often evident that the completion of the ritual “puts something in its place” with respect to the person(s) they are saying goodbye to. Sometimes it is necessary to “put different things in their place” with different family members. This can be best done if the farewell ceremony is performed for each person separately. It is also important to keep certain key symbols, to relate to them differently. For example, a widow can move her husband’s photograph from the bedroom to the living room. The goal is not to make all existing symbols disappear, nor to erase the memory of the deceased from the client’s consciousness.
Once the farewell ceremony is completed, the patient performs a purification ritual such as bathing or showering. This marks the success of the transition phase. Afterwards, they will celebrate their entry into “normal life” with a ritual reunion, which often consists of a special meal with the spouse, family members, or friends. The ritual reunion is of great importance, as it symbolically expresses the most significant relationships in the new phase of their life.
Once the farewell ritual is completed, it will be convenient to have some follow-up sessions. During these sessions, a commemorative ceremony is proposed, since even after all the grief work of the farewell ritual, certain dates will resurface the pain (the date of death or the deceased’s birthday, for example).
As a psychologist, having training like ISEP’s Master in Clinical and Health Psychology will provide you with the confidence to face these types of cases.