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How Does Grief Lead to Change? Understanding the Process of Change in Three Contemporary Psychotherapies

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Abstract

There is an increased interest in emotions across the psychotherapy field, but a lack of theoretical work on how emotions are understood in different affect-oriented psychotherapies. In this article, we investigate the role of grief and grieving in three contemporary affect-oriented psychotherapies, that emphasize emotional processing as a pathway to change. Within Emotion-Focused Therapy (EFT), grieving is related to the development of acceptance and agency. Intensive Short-Term Dynamic Psychotherapy (ISTDP) postulates that grieving without defenses enables recognition and acceptance of painful losses. In Compassion-Focused Therapy (CFT), tolerating the pain of loss is viewed as a pathway to self-compassion. We argue that comparing theoretical and clinical perspectives on grief and grieving may help us to understand commonalities in how contemporary psychotherapies understand and work towards change. We suggest that grief and grieving represent a central process of change in contemporary psychotherapies and explore the theoretical and clinical implications of this assumption in therapies with patients who have lost someone or something important.

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References

  • Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Kansas City: Seven Leaves Press.

    Google Scholar 

  • Abbass, A. (2016). The emergence of psychodynamic psychotherapy for treatment resistant patients: Intensive short-term dynamic psychotherapy. Psychodynamic Psychiatry, 44(2), 245–280. https://doi.org/10.1521/pdps.2016.44.2.245.

    Article  PubMed  Google Scholar 

  • Abbass, A., Town, J., Ogrodniczuk, J., Joffres, M., & Lilliengren, P. (2017). Intensive short-term dynamic psychotherapy trial therapy: Effectiveness and role of “unlocking the unconscious”. The Journal of Nervous and Mental Disease, 205(6), 453–457. https://doi.org/10.1097/nmd.0000000000000684.

    Article  PubMed  Google Scholar 

  • Angus, L., Boritz, T., Mendes, I., & Gonçalves, M. M. (2019). Narrative change processes and client treatment outcomes in emotion-focused therapy. In L. S. Greenberg & R. N. Goldman (Eds.), Clinical handbook of emotion-focused therapy (pp. 243–260). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Bowlby, J. (2005). A secure base: Clinical applications of attachment theory. London: Routledge Classics.

    Google Scholar 

  • Calhoun, L., Tedeschi, R., Cann, A., & Hanks, E. (2010). Positive outcomes following bereavement: Paths to posttraumatic growth. Psychologica Belgica, 50(1–2), 125–143. https://doi.org/10.5334/pb-50-1-2-125.

    Article  Google Scholar 

  • Coughlin, P. (2017). Maximizing effectiveness in dynamic psychotherapy. New York: Routledge.

    Google Scholar 

  • Fosha, D., Thoma, N., & Yeung, D. (2019). Transforming emotional suffering into flourishing: Metatherapeutic processing of positive affect as a trans-theoretical vehicle for change. Counselling Psychology Quarterly, 32(3–4), 563–593. https://doi.org/10.1080/09515070.2019.1642852.

    Article  Google Scholar 

  • Frederickson, J. (2013). Co-creating change: Effective dynamic therapy techniques. Kansas City: Seven Leaves Press.

    Google Scholar 

  • Frederickson, J., Messina, I., & Grecucci, A. (2018). Dysregulated anxiety and dysregulating defenses: Toward an emotion regulation informed dynamic psychotherapy. Frontiers in Psychology, 9(2054). https://doi.org/10.3389/fpsyg.2018.02054.

  • Gilbert, P. (2010). Compassion focused therapy: Distinctive features. London: Routledge.

    Book  Google Scholar 

  • Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043.

    Article  Google Scholar 

  • Gilbert, P. (2017). Compassion as a social mentality: An evolutionary approach. In P. Gilbert (Ed.), Compassion: Concepts, research and applications (pp. 31–68). London: Routledge.

    Chapter  Google Scholar 

  • Gilbert, P., & Irons, C. (2005). Focused therapies and compassionate mind training for shame and self-attacking. In P. Gilbert (Ed.), Compassion: Conceptualisations, research and use in psychotherapy (pp. 263–325). London: Routledge.

    Chapter  Google Scholar 

  • Greenberg, L. S. (2014). The therapeutic relationship in emotion-focused therapy. Psychotherapy, 51(3), 350–357. https://doi.org/10.1037/a0037336.

    Article  PubMed  Google Scholar 

  • Greenberg, L. S. (2019). Theory of functioning in emotion-focused therapy. In L. S. Greenberg & R. N. Goldman (Eds.), Clinical handbook of emotion-focused therapy (pp. 37–59). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Greenberg, L. S., & Goldman, R. N. (2019). Theory of practice of emotion-focused therapy. In L. S. Greenberg & R. N. Goldman (Eds.), Clinical handbook of emotion-focused therapy (pp. 61–89). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Greenberg, L. S., & Paivio, S. C. (2003). Working with emotions in psychotherapy. New York: Guilford Press.

    Google Scholar 

  • Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry, 16(3), 245–246. https://doi.org/10.1002/wps.20442.

    Article  PubMed  PubMed Central  Google Scholar 

  • Have-de Labije, J. T., & Neborsky, R. J. (2018). Mastering intensive short-term dynamic psychotherapy: Roadmap to the unconscious. London: Routledge.

    Book  Google Scholar 

  • Kirby, J. N., Day, J., & Sagar, V. (2019). The ‘Flow’ of compassion: A meta-analysis of the fears of compassion scales and psychological functioning. Clinical Psychology Review, 70, 26–39. https://doi.org/10.1016/j.cpr.2019.03.001.

    Article  PubMed  Google Scholar 

  • Kirby, J. N., & Gilbert, P. (2017). The emergence of the compassion focused therapies. In P. Gilbert (Ed.), Compassion: Concepts, research and applications (pp. 258–285). London: Routledge.

    Chapter  Google Scholar 

  • Kramer, U., Pascual-Leone, A., Despland, J.-N., De Roten, Y., & Nezu, A. M. (2015). One minute of grief: Emotional processing in short-term dynamic psychotherapy for adjustment disorder. Journal of Consulting and Clinical Psychology, 83(1), 187–198. https://doi.org/10.1037/a0037979.

    Article  PubMed  Google Scholar 

  • Lane, R. D., Ryan, L., Nadel, L., & Greenberg, L. S. (2015). Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science. Behavioral and Brain Sciences, 38, E1. https://doi.org/10.1017/S0140525X14000041.

    Article  Google Scholar 

  • Leaviss, J., & Uttley, L. (2015). Psychotherapeutic benefits of compassion-focused therapy: An early systematic review. Psychological Medicine, 45(5), 927–945. https://doi.org/10.1017/S0033291714002141.

    Article  CAS  PubMed  Google Scholar 

  • Leichsenring, F., Leweke, F., Klein, S., & Steinert, C. (2015). The empirical status of psychodynamic psychotherapy - an update: Bambi’s alive and kicking. Psychotherapy and Psychosomatics, 84(3), 129–148. https://doi.org/10.1159/000376584.

    Article  PubMed  Google Scholar 

  • Lilgendahl, J. P., & McAdams, D. P. (2011). Constructing stories of self-growth: How individual differences in patterns of autobiographical reasoning relate to well-being in midlife. Journal of Personality, 79(2), 391–428. https://doi.org/10.1111/j.1467-6494.2010.00688.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lundorff, M., Holmgren, H., Zachariae, R., Farver-Vestergaard, I., & O’Connor, M. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders, 212, 138–149. https://doi.org/10.1016/j.jad.2017.01.030.

    Article  PubMed  Google Scholar 

  • Neimeyer, R. A. (2016). Meaning reconstruction in the wake of loss: Evolution of a research program. Behaviour Change, 33(2), 65–79. https://doi.org/10.1017/bec.2016.4.

    Article  Google Scholar 

  • Pascual-Leone, A. (2018). How clients “change emotion with emotion”: A programme of research on emotional processing. Psychotherapy Research, 28(2), 165–182. https://doi.org/10.1080/10503307.2017.1349350.

    Article  PubMed  Google Scholar 

  • Pascual-Leone, A., & Greenberg, L. S. (2007). Emotional processing in experiential therapy: Why “the only way out is through.” Journal of Consulting and Clinical Psychology, 75(6), 875–887. https://doi.org/10.1037/0022-006X.75.6.875.

    Article  PubMed  Google Scholar 

  • Pascual-Leone, A., & Kramer, U. (2019). How clients “change emotion with emotion”: Sequences in emotional processing and their clinical implications. In L. S. Greenberg & R. N. Goldman (Eds.), Clinical handbook of emotion-focused therapy (pp. 147–170). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Sheppes, G., Suri, G., & Gross, J. J. (2015). Emotion regulation and psychopathology. Annual Review of Clinical Psychology, 11, 379–405. https://doi.org/10.1146/annurev-clinpsy-032814-112739.

    Article  PubMed  Google Scholar 

  • Stiegler, J. R., Molde, H., & Schanche, E. (2018). Does the two-chair dialogue intervention facilitate processing of emotions more efficiently than basic Rogerian conditions? European Journal of Psychotherapy & Counselling, 20(3), 337–355. https://doi.org/10.1080/13642537.2018.1495245.

    Article  Google Scholar 

  • Vara, H., & Thimm, J. C. (2020). Associations between self-compassion and complicated grief symptoms in bereaved individuals: An exploratory study. Nordic Psychology, 72(3), 235–247. https://doi.org/10.1080/19012276.2019.1684347.

    Article  Google Scholar 

  • Wampold, B. E., & Budge, S. L. (2012). The 2011 Leona Tyler award address: The relationship—and its relationship to the common and specific factors of psychotherapy. The Counseling Psychologist, 40(4), 601–623. https://doi.org/10.1177/0011000011432709.

    Article  Google Scholar 

  • Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). New York: Routledge.

    Book  Google Scholar 

  • Wong, P. T. P. (2008). Transformation of grief through meaning: Meaning-centered counseling for bereavement. In A. Tomer, G. T. Eliason, & P. T. Wong (Eds.), Existential and spiritual issues in death attitudes (pp. 375–396). New York: Taylor & Francis.

    Google Scholar 

  • Wong, P. T. P. (2010). Meaning therapy: An integrative and positive existential psychotherapy. Journal of Contemporary Psychotherapy, 40(2), 85–93. https://doi.org/10.1007/s10879-009-9132-6.

    Article  Google Scholar 

  • Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner (5th ed.). New York: Springer.

    Book  Google Scholar 

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Correspondence to Hanna Sayar.

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Sayar, H., Hjeltnes, A. How Does Grief Lead to Change? Understanding the Process of Change in Three Contemporary Psychotherapies. J Contemp Psychother 51, 135–143 (2021). https://doi.org/10.1007/s10879-020-09482-4

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