Roger Solomon on Grief and Mourning
We recently had the privilege of hosting Roger Solomon’s virtual training EMDR with Grief and Mourning in the Era of Covid-19. Roger is a master trainer and clinician who provides excellent lecture materials from years of specialization in grief and mourning. Even more valuable was his use of client videos for teaching. He showed a variety of clients with traumatic grief who were stuck in the process of mourning, some for many years. Roger’s video demonstrations of his clinical work greatly enhanced our understanding of the subject matter. He stopped each video to share what was happening, what was going well, and what was stuck, and his clinical thinking for why he did what he did.
With Roger’s permission, here are some highlights garnered through this two day training. To see clients whose suffering had lasted years finally get significant healing in the first few sessions confirms the importance of this challenging EMDR work we do. It is always energizing and empowering to witness the powerful healing impact of EMDR therapy!
Working with Deep Emotional Pain
This virtual training was an incredible learning experience with value beyond the subject matter. Roger’s workshop is a tutorial in how expert EMDR therapists deal with the need to access profound emotions for the client’s full release. Watching Roger work patiently and with compassion as he conducted powerful EMDR sessions to assist the release of deep,long held traumatic loss provided so much more. Participants noted how emotionally draining successful processing of grief and loss was, even in being witnesses of their emotional pain. Roger was able to move through it, fully present but not taking it on. His supportive presence was verbalized with responses validating the client’s feelings of loss, terror and overwhelm. Asked more than once how he handled this as a therapist, Roger said that he keeps the goal of healing in mind while supporting clients in gut-wrenching release from long held pain. One of his many inspiring comments was “If your client is in hell, you go in hell with them.”
The importance of being courageous EMDR clinicians when working with grief and loss is critical. We all are part of EMDR processing with clients that accesses the agony of human suffering in order to heal. Roger stated, “Many therapists are afraid of the client’s pain but the clients are feeling the pain anyway. They say so.” Years of experience help as client after client has amazing recovery following the most difficult processing. Roger reminds us that we did not cause their pain, but instead have the privilege of honoring it by sitting with them to guide and support them as they release it. He encouraged us as clinicians to ‘face it, get help, it’s a process, focus on personal healing.”
We also do not want to deny our clients the healing they came for because of our own fears when we have the skills to assist. Continuing to do our own therapy reduces therapist barriers to allowing clients to go as deeply as needed for their full recovery to be achieved. This is an effective way to increase clinician window of tolerance, something Francine Shapiro recognized was needed for us. He also commented that she would say ‘the worst part lasts about 20 minutes’, which experience over time confirms.
As clinicians, we also can have our own blocking beliefs that can get in the way of clinical work. Clients are sometimes more resilient than we assume, particularly given what they have coped with to get to this point. Let’s make sure we are willing to go where the client’s brain needs to take them. We have the honor to be present with them in a way that no one else has been willing or able to do. We want to believe in and support our clients as we have prepared them for processing ‘whatever comes,’ including their deepest distress.
Therapist Interventions
Roger repeatedly told clients “I promise you that you will not lose anything you need.” This is especially significant as many fear loss of connection which keeps them from moving on. Such is his faith in EMDR. Many clients with traumatic grief are afraid to let go of their pain because they see it as their connection to those they have lost. More than one client video had the client saying exactly that: “if I heal I am going to lose [the loved one]”. As raw emotion is processed, adaptive memories typically come in, strengthening what the person retains of their memories of the loved one. If this does not happen, he asks “When you think of [loved one] now, what comes up?” to identify where to process.
One client could not let go of the image of her child’s suicide. He said “Let it happen. Don’t force it." The mind finds a way!” Another brief but frequent comment to clients was “trust the brain.” What confidence this gives clients whose own brain truly is the agent of change!
Where to Start
In the assessment phase, the clinician looks for what the brain is ready to process as well as potential blocks like past losses or attachment issues. Regarding where to start with these clients, Roger uses the phrase “what’s on page 1?” That is, what is most predominant in their memory? This accesses the part of the traumatic memory that is most present and stuck.. He asks about when they first learned of the loved one’s death, what was that moment of shock like, searching for that first moment of trauma. If they are numb, having no narrative, the client can't process. With these clients Roger starts with supportive work and psychological first aid such as use of R-TEP or other evidence based interventions for stabilization and support.
Targets in Traumatic Grief Work
All aspects of grief and loss, all stuck points, become targets, including the common feelings of guilt. Grief is a form of PTSD, thus acute (recent) grief can be processed even though it is ‘normal.’ EMDR facilitates ‘nature’s way’ of moving through the mourning process, with very recent events responding to desensitization. Roger commented that ‘guilt is the price you pay for needing to be in control.’ His understanding of trauma underscores the attachment issues that he finds at the base of much traumatic grief and a place where clients often get stuck. He skillfully accesses earlier memories with attachment figures, then processes these targets.
All aspects of the relationship with the deceased need to be explored. As he says, ‘the person is dead and gone but the relationship is not’. Reminders over time allow the death to be accepted. All the aspects of the relationship need to be dealt with (‘the good the bad the ugly)’ as a new relationship eventually is formed with deceased loved one. EMDR therapy acceleratees the client’s ability to adjust to live without their loved one.
When stuck in the midst of processing, he explores their story further. Client: “I can’t let go of the pain, I shouldn’t. I should have helped her more” Roger: ‘Tell me your history with shoulds.’ Client shared being taught to be good by caregivers. She was still unable to process so Roger asked “What is good about the ‘shoulds’?” (crediting Jim Knipe’s work for this intervention). He accessed benefits from the ‘shoulds’ for processing first. This client could then let go of that part of her wife’s death and the irrational belief “I should have taken care of her.”
The client’s memory component causing this stuck place occurred a few minutes before her wife’s dying, when she whispered something to the client that the client did not understrand. Later, she figured out that her wife had said “more morphine.’ Thus” I should have known what she said,’ had linked up with caregiver ‘shoulds’ when she did not do what she was expected to do. This very painful aspect of her wife’s death was not shared (accessed) in session by this client until Roger’s skillful intervention. Roger states that tuck places in processing grief frequently stem from attachment issues that lay the foundation for challenges in the mourning process. These stuck places are potential ‘gaps’ in a client’s adaptive information that trip them up until resolved.
Here are several additional teaching points Roger shared. Grief is the loss, and mourning is the process of dealing with that loss. Trauma is the experience of loss of safety, which is fist established (or not) with caregiveers. We are all going through loss of safety with the trauma of with Covid-19. Complicated mourning is marked by preoccupation with the loss or putting great effort into avoiding the loss, both interfering with daily functioning. Depression is present but in grief there's not the loss of self esteem.
Skillful Use of Parts Language
Roger easily incorporates parts language with many clients, using this framework for clients without moderate to severe dissociation. One example was work with a Marine who had PTSD from his years in combat. Five of his men had survived a serious attack, but in the years since, all of them had completed suicide. This man held so much emotion that Roger needed to proceed slowly. He started by using parts language, asking if the part of him that was in Afghanistan was still there, or does this part know he’s no longer there? He was checking for time and place orientation to learn if the client was dissociative. This client’s combat part knew he was no longer there, so Roger then asked if that part felt separate from him now or a part of him, thus establishing no separation or dissociation was currently being experienced.
Watching this Marine cope with the overwhelming feelings he had been living with and how well he shut them down (as he was trained to do), Roger called this part of him a defense, naming it the Guardian (from Internal Family Systems). The Marine processed giving the Guardian a message that he was ‘doing a good job.’ This reduced his emotional distress as well as made sense to the client. It was an incredibly skillful way to start, honoring the coping needed for the client to get through up to this point.
Honoring defenses as survival coping should be well understood by both clinician and client. We know that avoidance is a necessary survival strategy. Something to remember as EMDR therapists: it’s not resistance, it is coping. We see this in addictions work most clearly. Roger’s way of saying this was “Substance abuse is a substitute action for what cannot be tolerated.” Part of preparation is to develop alternatives so clients have more adaptive solutions.
Grief and Attachment
A person’s attachment history is the ‘bedrock’ of traumatic grief, showing up in the stuck places within the mourning process. This target for processing is worse, as in causes more pain, in his opinion, than the trauma of caregiver abuse. As clients processed, they had ‘waves’ of intense emotion’, which is normal. Roger modeled many supportive words to be with and nurture the client through. “Yes it is awful. How terrible, painful, horrifying. You are doing fine, we will get through this.” With clients, after a layer of grief was released in an emotional wave, then words or a narrative for the event began to come.
Roger’s ‘Therapist as Midwife’ Metaphor
Roger sees our role of EMDR clinicians as like a midwife. We are supportive but the mother [client] is the one giving birth. The mind finds a way, and we are not the change agent, the client is. What a wonderful metaphor for what we do!
More with Roger Solomon
You will also enjoy listening to a Healing Confessionals podcast: Utilization of EMDR Therapy with Grief & Mourning- Roger Solomon, PhD” where Roger discusses key points of this training with Elyse Harper, LMFT, Approved Consultant. Roger’s conversation with Elyse supports and adds to what is written here. We truly appreciate Elyse for doing this interview and her additional podcasts.
Roger presents this 2 day workshop by request around the world. He does not have an active website but you can find future times he is offering this or other EMDR training, including his intensive Art of EMDR workshops on the EMDRIA training site or by googling his name.
Much gratitude to Roger for presenting his masterful work applying his clinical wisdom on working with the critical issues of grief and mourning. We appreciate learning from his years of EMDR therapy and workshops.
Bonnie Mikelson LISW
Director, EMDR & Beyond, LLC