Bereavement often takes our sense of self – but it can be regained

The experience of grief following the death of a loved one is commonplace. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders added a diagnosis of long term grief disorder. Even though the grief associated with death and dying is generally normal, it does not diminish how distressing it can be, and sometimes the experience of grief can make other psychological issues worse.

It is painful because of the inescapable reality and limits to our control. The model of grief proposed by Kbler-Ross was five stages. The idea of stages has been challenged by the non- linear nature of the experience of loss, but her work shows the common employment of defences such as denial and bargaining.

In denial, we don't believe that the loss has happened, whereas in bargaining, we try to make up for it. Joan Didion shows a type of thinking that can accompany grief. We both know that the loss is real but we don't believe it. Didion didn't throw out his shoes as she thought he might still need them.

Without them, the reality of the loss would be too overwhelming. We absorb this reality in small amounts to make sure we don't end up unraveling it. We generally accept that the loss has happened and confront the feelings that come from it.

Identity rupturing is a common feeling. Our sense of ourselves is closely related to our sense of others. Our self-identity is affected when we lose someone. When I'm not the daughter who tries to impress her father or the husband who cares for her wife, who am I? I don't know how to see myself as a single person. Or as a child? When we grieve our losses, we also grieve for better or for worse ourselves. We were. We are no longer

Ivan saw me because of the struggle with identity. Ivan's father died of a heart attack when he was three years old and he was raised by his mother. Ivan's mother died of breast cancer six months before he sought my assistance. Ivan had lived with her for most of his life, except for a short time in a university share house, and he had been her primary care giver through her illness. Ivan experienced his mother's death as a profound shock and struggled to believe she wouldn't come back.

While he was missing his mother, he felt like a stranger to himself in an alien world, he told me. His world was tilted on its axis and he couldn't find a way to get it back to normal. Ivan felt lost and alone even though he was a capable person with good friends. He said that he can't get a grip on who he is anymore, despite trying very hard. He didn't want to burden other people with his feelings so he withdrew from them.

Ivan wanted me to help him get over his mother's death and feel better about himself. When it comes to grief, there is only one way to go, and that's through. I was hoping that we could integrate his mother's death into his life trajectory and form a more robust sense of self. I knew that Ivan had lost many of his identity roles. Ivan resented his mother's reliance on him even though he loved her. He was free of the latter but still felt guilty.

I was no stranger to the anguish of grief and I empathised with Ivan. We pay a price for loving. To help Ivan, I had to go beyond my comfort zone. We needed to find a way for him to maintain a meaningful relationship with the memory of his mother while also reorganising his self- identity to incorporate her absence and continue to find meaningful connections to people and experiences in the present.

It was more difficult than ever. Ivan felt relieved to hear that his identity was a response to loss. He realized that his relationship with her was able to keep her alive. He continued to be influenced by her memories and experiences. He began to speak more openly to his friends after I encouraged him.

The process of grief is very individualized. We don't get over the death of a loved one, but we do reorganize around it. We are able to reintegrate despite being altered. This can happen naturally over time. Ivan might benefit from a little extra help in his process.

The Talking Cure was co-authored by Gill and Dr. Winship. Gill is a guest on Three Associating, a show in which therapists look at their blind spots.

Ivan is a fake amalgam to show similar cases. Both authors wrote The Therapist.