grieving

July 23, 2009

How to Choose a Therapist

Most of us are not at our best under pressure. Similarly, when depressed, anxious, or otherwise stressed and in crisis, the patience and clarity of thinking needed to choose a therapist might well be in short supply. So here are a few pointers, things to consider, when you decide to consult someone for psychological assistance:

1. Ask a friend if he or she can recommend a therapist with enthusiasm. Also, be sure to request that your acquaintance explain “how” the therapist was helpful. Not all counselors are equally adept at treating every problem, so your friend’s recommendation should be carefully considered in light of whether your issues are different from your friend’s. You might also ask your physician for a recommendation. A good way to phrase the question is, “If you needed to get a therapist for someone you loved, who would you choose?”

2. Internet searches of various kinds can help find a good person. Various organizations list therapists who perform a certain type of therapy or work with certain types of problems. An example would be the Association For Behavioral and Cognitive Therapies: www. abct.org/ The National Register of Health Care Providers in Psychology is another such group: http://www.nationalregister.org

3. Some information about the therapist is usually available on web sites such as those mentioned above. If the therapist has a web site of his own, you will usually find out a good deal more.

4. What kind of therapist are you looking for? There are many choices. Clinical Psychologists are doctoral-level professionals (Ph.D. or Psy.D) who typically have completed four years of training beyond their college Bachelors degree and had additional instruction and supervision in the form of a year-long internship, often within hospitals or clinics. In most states psychologists cannot prescribe medication, but have received more graduate training in psychological evaluation (testing) and therapy than is typical of any of the other disciplines who perform therapy.  Psychiatrists are physicians trained in medicine, who also receive specialized training during a psychiatric residency. They can and do prescribe medication and a number of them also do therapy. Clinical Social Workers generally have a Masters Degree obtained in the course of two years of post-college study, in addition to practical experience and a history of supervision. Marriage and Family Therapists usually also have a Masters Degree and may have a similar amount of training as do the social workers, although their education is not identical to that group. All of these disciplines encourage and sometimes require therapists to continue their study via post graduate course work, supervision, and reading.

4. What kind of therapy do you want? In part, that might depend on what kind of problem or problems you have. Psychodynamic psychotherapists will tend to pay much attention to early life issues including unresolved feelings toward one’s parents, and the potential impact of additional events that occur during the growing-up years in an attempt to free you from repetitive patterns of behavior that might have started at that time. Cognitive behavioral therapists use CBT to focus more on present day concerns, attempting to help you take steps to alter the automatic and self-defeating thoughts that influence your mood and fuel your depression and anxiety, as well as assisting you in changing your behavior. They spend much less time on early life events as a rule, and do not usually consider “insight” into the causes of your troubles to be crucial to assuaging your emotional pain. Marriage and family therapy aims to treat couples and family systems, usually meeting with the marital pair or family group rather than with one person at a time.

5. Try to determine how much experience your potential therapist has with a given kind of problem. Some therapists specialize, for example, in treating alcohol and drug abuse and are certified in this field (CADC or certified alcohol and drug counselor). If you have anxiety issues, on the other hand, ask your therapist how many people he has treated with this condition. Similar questions might be asked of someone who you wish to consult for the treatment of depression or schizophrenia. Don’t be afraid to ask. Any reasonable professional in the health care field will welcome your making an informed decision.

6. Other factors might be considered. How active do you want the therapist to be? Some tend to direct the therapy, while others are more comfortable listening to you and responding to just those issues that you believe are important. Some people choose therapists based on gender, believing that they will feel more comfortable with one or the other sex. Age of the therapist is important, since it tends to be correlated both with professional experience and life experience. If you believe that not everything in life is learned in a classroom, you will probably want to see someone who has a few gray hairs and who has been married with children.

7. Financial considerations often enter into the choice of a therapist. MDs are usually the most expensive people to see and Masters level professionals are the most economical. Ask your therapist about what he charges for his services and what portion, if any, of his fee is covered by insurance. Some communities have public mental health agencies that offer therapy at a heavily discounted price, although they often have long waiting-lists. A portion of therapists will discount their fees if you can make a good case for such a discount.

If you go through your insurance company, it is likely that they will steer you toward a practitioner who has a contract with them and has agreed to discount his fee to you. Understand, however, that the discount also typically benefits the insurance company, since they will have to pay less money in benefits if you choose a provider who is in their network. Therefore, their recommendation comes with a degree of self-interest.

Be aware that (as the old saying goes), sometimes “you get what you pay for.”

8. Some people choose not to use their medical insurance to pay for counseling. They make this decision because they have concerns about the impact of a mental health diagnosis on their future ability to get life or disability insurance, and the possibility that having a “pre-existing (mental health) condition” will complicate their medical coverage should they ever change jobs or go for a period without insurance and then attempt to obtain it again.

9. Remember that the most important element in obtaining a therapist is getting a person who is accomplished, talented, experienced, and a good fit for your therapeutic needs. You should also have a sense that he really cares and wants to help. While some of the other considerations mentioned previously might be important, if the therapist can’t help you, nothing else really matters. When you meet the therapist (see my blog post “What to Expect in Your First Therapy Session“) he should be able to convey expertise, compassion, and competence, as well as giving you a sense of hope. Don’t settle for less.

July 16, 2009

Infidelity and Its Treatment

http://upload.wikimedia.org/wikipedia/commons/1/11/Lana_Turner_in_The_Postman_Always_Rings_Twice_trailer_2.jpg

The names don’t really matter. Today they are Tiger Woods; Mark Sanford, Governor of South Carolina; and John Ensign, U.S. Senator from Nevada. Tomorrow they will be someone else. Every day, there are other names, little known, but causing no less pain.

How does it happen? How does it happen that people who claim to live by well established moral norms, who have taken a public oath to remain faithful to their spouse, violate that promise? There are several reasons:

1. Power and celebrity = opportunity. People in positions of power and celebrity have more opportunity than most to be unfaithful. They are surrounded, sometimes literally, with admiring and attractive younger people. As Oscar Wilde said, “I can resist anything, except temptation!” The famous and powerful have plenty of that.

2. Contiguity. You might think that the separation of sexes in some religious fundamentalist societies is unfortunate or wrong, but it does keep opportunity at a minimum. In modern Western secular civilization, men and women work together, eat together, and travel together on business. Repeated contact with a sympathetic business associate, pulling together with that person as a team on a business project, creates not just the opportunity for sexual contact, but the chance to get to know and like one another. Perfectly moral and decent folk can find themselves stirred by the presence of a person to whom they are not married, even though they weren’t looking for anything outside of the marriage.

3. Disinhibition. Alcohol and drugs. If you are around sexually attractive people in a party atmosphere or when you are “under the influence,” your judgment and hesitation are more likely to be set aside.

4. The “Great Man” rationale. More than once, I’ve heard men justifying the concept of infidelity in the case of those who are accomplished and powerful. Often, the rationale includes reference to the role that “the great man” plays in benefiting society. According to this line of reasoning, the “heroic” figure is thought to have earned the right to live by a different set of rules than the common man, and should be given the chance to be compensated for his contribution to society by being allowed multiple sexual partners.

5. The “It won’t hurt anyone” rationale. The faithless sometimes persuade themselves that there is nothing wrong with their behavior so long as anyone who might be injured (spouse/children) never knows about it. This is akin to the old philosophical question, “If a tree falls in the forest, but no one is present to hear it, does it really make a sound?” What the argument ignores is that the transgressor is changed by his act of betrayal, that he must tell a continuing set of lies in order to maintain the fiction of his character, that he risks his partner’s physical health in the event that he has become a carrier of a sexually transmitted disease, and that it is impossible to guarantee that the secret will never be revealed.

6. Mid-life crisis. Poor humanity. Poor man. We age, we lose our youthful good looks, sometimes our hair, our virility, our energy, our strength, our stamina. The antidote? A youthful or new sexual partner who, for a time, can help us shut out the dreaded and self diminishing passage of time.

7. Solace. The ups and downs of life are inevitable, even in the luckiest of lives. The best marriages are not immune to the daily stress that  takes a toll on a spouse’s ability to be compassionate, encouraging, and supportive. Financial worries, business reverses, family illness, house keeping, and child rearing soon diminish the “date night” and honeymoon atmosphere of the early days of the relationship. A fresh and sympathetic set of ears, all understanding and acceptance, often develops into something more, and something sexual.

8. “It’s not natural.” Some people, mostly men, justify infidelity with the notion that man was not meant to be a monogamous creature and the flowers of the field (i.e. the opposite sex) were meant to be enjoyed.

9. Longevity. At the turn of the last century in America, that is, about 1900, the average life expectancy was about 50 years. By that standard it was usual for marriages to be relatively short, 25 to 35 years at the most, many much shorter. No longer. Many now last 50 years and more. What happens in that time? People get older, their bodies change, and their personalities alter as well. When I do marital therapy, I usually ask couples what initially drew them together. The most frequent answer I get is something like, “He was hot and we had a lot of fun.” Thirty years on, it goes without saying, he isn’t so “hot” and they sure aren’t having fun.

In order for marriages to thrive into mid-life and beyond, the couple has to work very hard at the relationship, to keep the sexual spark alive despite physical changes and familiarity, and to see to it that personality alterations are compatible or synchronous. Too often one partner wants the marriage to be exactly as it was at the beginning and believes that both the personality and physical changes in the other person amount to a breach of contract. Meanwhile, the other might feel held to a contract that is no longer appropriate to the current state of the couple’s life together and to their age, personality, and experience. One or the other very well may see infidelity as tempting under such circumstances.

10. The scoundrel factor. Although an injured spouse sometimes believes that “evil”  is the most likely explanation for her spouse’s betrayal, in most cases it really isn’t. Most people don’t set out to behave badly and many feel guilty when they do. That said, there are certainly more than a few cads among us, and they do with impunity what others only do with hesitation, a troubled conscience, or not at all.

11. Boredom. Boredom doesn’t cause anyone to stray, but it does set the stage for the temptation. Routine can kill even the things that we love. The pattern is well-known: wake up, go to work, come home, play with the kids, do the bills, and collapse from exhaustion. Or, the stay-at-home parent’s version: wake up, make food, shop, make food, take care of the kids, do the housekeeping, make food, clean, and collapse from exhaustion. Either way, the routine is deadening and there is little room for excitement.

12. A lack of sex. Again, this doesn’t cause infidelity, but can set the stage for it. A warning here: cease sexual contact at your own risk and at the risk of your marriage. But, this is not to suggest that you should have sex only because your partner wants to.

13. Cruelty, sarcasm, and a lack of appreciation. If the marriage has turned into a battle ground, with gratitude replaced by indifference or hostility, infidelity is more likely on either side.

—

When the infidelity is exposed, the result is devastating to the victimized spouse. Rage, sadness, a loss of self-regard, and feelings of inadequacy are common. What did I do? What didn’t I do? Why did he do that? If he felt that way, why didn’t he leave first before he took on another partner? The devastation occurs whether the infidelity is fresh, or the betrayed person discovers it years after it occurred. The emotional clock of devastation only begins to run from the point that one becomes aware of what happened.

If a couple comes to therapy in the wake of such news, several factors go into the therapist’s evaluation of the situation. First, is the infidelity over or is it still going on? If the marriage is to have any chance, the “other” relationship has to end. Moreover, it has to end because the spouse having the affair wants it to end and believes that the marriage is worth saving, not because his marital partner is threatening to leave or because of the fear of financial devastation in the course of a divorce.

The therapist will try to gauge what still binds the marital couple together, if anything. Do they still have positive memories of their courtship? Do they have children and are they concerned about the effects of a divorce on their offspring? Are they still in love? If there is no love on the part of even one partner, therapy is almost certain to fail to recreate it.

If the both parties want to save the marriage, have positive memories of the start of their relationship, and if loving feelings still exist between them, treatment often can help to repair things. One of the first items in need of attention will be allowing the injured spouse to grieve. This will require both tears and anger, but will need to be time limited. That is, however great the injury, the victimized spouse must understand that he cannot forever bring up the infidelity to be used as a weapon when he feels unhappy or aggrieved in the future. As the old farm expression goes, “Don’t burn down the barn to kill the rats.”

Of course, apology by the roving partner will be necessary and it will take time to rebuild trust. Once the immediate crisis is over, the couple needs to look at what contributed to their estrangement and what changes need to be made in their relationship. They have to reaffirm a set of values by which to live and goals for their relationship and for the family. Changes in patterns of communication will likely be necessary, as will time and attention to each other. Serious self-reflection and responsibility-taking will be particularly important for the unfaithful member of the relationship, but the partner too must be willing to look at the possibility that he contributed to his spouse’s feelings of disaffection.

Such situations aren’t easy, but they can come out well. Good will, sincere contrition on the part of the person who strayed, and emotional generosity on the part of the victim are all key. The betrayal is never forgotten, of course. But time does its work on the scar of infidelity, just as bodily scars tend to soften and fade over time, even if they never fully disappear. Happiness and love may yet flourish.

—

The image above is a cropped screenshot of Lana Turner from the film The Postman Always Rings Twice, sourced from Wikimedia Commons.

July 9, 2009

What to Expect in Your First Therapy Session

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Going to therapy for the first time takes some courage. You are about to talk about some very personal things to someone who is a complete stranger. What can you expect?

1. First of all, expect to be at least a little bit nervous at the beginning. But even before you get inside the therapist’s office, you will have to fill out some paper work. You will also receive a written description of the therapist’s practice, including such details as whether the therapist accepts your medical insurance and how he handles that. Additionally, he will give you information about how your medical records are safe-guarded and the extent to which those records are confidential.

2. The therapist should greet you, bring you into his consulting room, and sit face-to-face with you. Therapists generally want to convey “openness.” It is therefore rare for a therapist sit behind a desk, with you on the other side.

3. After a few “ice breaking” words, the counselor will ask you why you have sought treatment. If you already told him some of this on the telephone, he will want you to fill in the details.

4. Don’t feel that there is a particular “correct” order in which to tell your story. Simply tell it. Initial sessions should generally allow enough time for you not to be rushed. The therapist has probably scheduled at least 75 to 90 minutes to spend with you.

5. If it makes you feel better, it is entirely appropriate to bring an outline of the topics about which you wish to talk, and to consult this outline or read directly from it whenever you need to.

6. The counselor is likely to have some questions for you. He should want to know about your background, not only about the concerns that exist in your life at the moment. Unless he knows that history, he won’t be able to fully understand how you came to have the current difficulties and whether they represent a repetitive pattern in your life.

7. Among the topics you might be asked about are such things as a description of your parents and their approach to rearing you, relationships with siblings, the educational and social history of your school years, whether you changed residences with any frequency as a child, past and current health concerns for you and your family, the presence of any traumatic events in your life, your dating experience, the type of friendships you have or have lost, work background, alcohol or drug use, current medications, present family relationships (spouse/children), financial concerns, and past or current depression or anxiety issues.

Additionally, expect to be questioned regarding any evidence of mood fluctuations, sleep, digestive problems, headaches, caffeine use, suicidal or homicidal thoughts or actions, difficulties in maintaining attention, hyperactivity, hallucinations, delusions, hobbies, religion, how you feel about yourself, whether you can be assertive in your life (say “no” or ask for things), diet and eating/weight problems, obsessive thoughts, compulsive actions, and what you hope to get out of therapy.

Of course, the first session won’t have time to touch on all these areas in the initial session. A counselor will proceed gently.

8. You should not feel that you must discuss topics that are too uncomfortable for you. A sensitive therapist will give you permission to cover only the ground you wish to and a sense of control over the session’s progress so that you don’t become overwhelmed.

9. The therapist might well ask you what challenges you’ve had in life and how you have managed to overcome them. This kind of question helps you to know what strengths you have and to help you remember that you have surmounted past difficulties and therefore can rely on those strengths to help you surmount the current problems.

10. By the end of the session, the therapist should provide feedback about what you have said. This is, in part, to help you and the therapist know if he has heard and understood you and whether his initial impression of you seems appropriate.

11. The counselor, to the extent that he offers interpretations of the material you have presented, should let you know that this is a first impression and therefore not necessarily perfectly accurate. An expert therapist needs to hear your concerns about him personally, his ideas, the therapy approach he is recommending, and his effect on you. Such a person will not be offended by your concerns and wants to hear from you what feels right and what doesn’t feel right about the therapy process.

12. The counselor will normally allow a good deal of time to answer any questions that you have about him and his approach. Although most people usually do, it is not essential that you make another appointment at that time. If you already believe that this therapist is not the right one for you, it is perfectly appropriate to say so and ask him for a referral to another professional.

13. By the end of the session you ought to have a sense of direction and at least an initial treatment plan as articulated by the counselor. The therapist is likely to remind you of the importance of regular attendance and that your dedication to your own healing is essential to obtaining the results you want. Therapy, unlike medical intervention such as brain surgery, requires effort and activity on your part. It is also essential that you have the courage to look at yourself honestly, recognizing that in order for your life to be better you will have to be willing to change some things about yourself.

14. At the end of the first session you might feel exhausted, in part because talking about big emotions is hard work! You are likely to be less anxious than you were when you came into the session. You may feel some amount of relief at having talked about things that you have rarely if ever discussed before. If the therapist has done his job, you should have a sense of hope.

15. In the days following the first psychotherapy encounter, you might well find yourself still processing the material you discussed. This can be unsettling, but it is quite normal. Additionally, a person new to therapy can feel that he has said too much and made himself too vulnerable to the therapist, especially if he (the patient) is a private person. Some people will therefore not return to therapy after the first session. If you have this hesitation, however, remember that it is in your interest to persist despite your discomfort if you sincerely wish to change your life. Good luck!

—

The above image is the entry to Sigmund Freud’s office at Berggasse 19 in Vienna, Austria. It originally was posted to Flickr by James Grimmelmann and was sourced through Wikimedia Commons.

May 22, 2009

Father’s Day

Father’s Day can be complicated.

Like any day of honor, some tributes are deserved more than others, or not at all.

Some obligations are carried out with joy, while others are a matter of dutiful routine.

And sometimes there is pain, where once there was (or should have been) pleasure.

But, for myself, Father’s Day is pretty simple.

While I miss my dad (who died 11 years ago), the sense of loss is no longer great. He was 88 when he stroked-out in July 2000, soon to be followed by my mother in February 2001, and our family dog in November 2001: a tough 16 months.

The experience taught me what Hamlet’s uncle Claudius knew when he said to his wife (Hamlet’s mother), “O Gertrude, Gertrude, when sorrows come, they come not single spies, but in battalions.”

“When will dad be OK again?” my children asked my own wife. It took a little while, but eventually time and the loving support of family and friends did the job of healing.

But being healed isn’t the same as being indifferent and, as I said earlier, I still miss my father.

If you saw the movie “Peggy Sue Got Married” with Kathleen Turner and Nicholas Cage, think back to the scene of her time-travel from middle age to age 16; specifically, to the moment when she talked to her deceased grandmother on the phone, now suddenly back to life.

I’d give a lot to have a moment like that with my dad.


My father was a good story-teller. One of his favorites was about his time as a star Chicago Cubs pitcher.

He wasn’t, of course.

Somehow, all the records of his “career” in the major leagues had been “lost,” or so he told us. He also informed me and my brothers that he’d been able to pitch nearly every day, and was so reliable and dependable that his teammates called him “Rain or Shine” Milt Stein (able to pitch, “rain or shine”). We all came to value this funny tale and, in fact, had my wife and I had a male child, the boy’s middle name would have been “Rainer,” as in “rain or shine,” in honor of the newborn’s grandfather.

Another story he told frequently was based in fact rather than imagination.

Twenty year old Milt Stein had a tough time in 1932, the depth of the Great Depression. He could find little steady work, though he had enough to eat thanks to living with his parents. Finally, he landed a full-time job at the opening of the 1933 Chicago World’s Fair. His boss told him that he could work every day if he wished (although he didn’t have to), but work and money were so dear that he did — 170 consecutive days from May 27th into November.

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It was a few years after my dad died when I first realized that these two stories were actually different ways of telling the same morality tale: my dad was “Rain or Shine” Milt Stein, reliable and hard-working, both on the imaginary playing field of his “major league” career and at the World’s Fair performing a real job.

I don’t even know if my father was aware of the connection between these stories.

Dad was an intelligent, but uncomplicated man. If he had lived in a more prosperous time he’d certainly have graduated college. But, as things turned out he worked as a postal supervisor, raised three boys, and was married to the same woman for almost 60 years.

When I was very little, my father played a game of make-believe with me. In those days before everyone had some sort of recording device, he used our floor model vacuum cleaner extension as a pretend microphone for a radio show he fashioned out of his imagination. We would take turns speaking into the nozzle as he interviewed me.

I guess my career in interviewing people goes pretty far back.

http://upload.wikimedia.org/wikipedia/commons/thumb/2/2f/Blue_vacuum_cleaner.svg/200px-Blue_vacuum_cleaner.svg.png

I owe my love of baseball, a sense of fair play, and a strong work ethic to my father; and the fact that years later, each night at bedtime, I would reach into my own imagination as he did with me during our “radio show,” to tell my young daughters a story; a different one nearly every night, especially with my first-born.

Dad was not a perfect man or a perfect father. His three sons all saw too little of him because of his dedication to work and the shadow of the Great Depression on his view of matters financial. He deferred to my mother too much for our well-being.

But it is Father’s Day, not the day to get into his shortcomings.

In 1985 Milton Stein’s youngest brother, my Uncle Harry, died suddenly. I’d not been very close to my uncle, so that loss didn’t much affect me except for the fact that it made my dad’s mortality palpable to me: if Harry, my father’s youngest brother could die, then surely my father would, possibly soon. The family history of heart disease had killed Harry, and my dad had narrowly escaped alive from his own heart attack at age 47, over 25 years before.

In the wake of Harry’s death, I asked my “old man” (now genuinely old) if he’d be open to doing a videotaped history of his life, with me as the interviewer — the “radio show” with the roles reversed. He complied readily.

I still have the four hours of video that my father and I created together. Much of it is filled with the detail of his life, but at a few points my normally controlled dad let down his guard.

Most moving of all was his recollection of returning to the USA from WWII service in Europe. He hadn’t seen my mom for about two years. He called her as soon as he was situated on American soil.

As I’ve detailed elsewhere (Love Letters), the catch in Milton Stein’s voice and the tears in his eyes as he recalled hearing the woman he ached for — the love of his life — would have been unforgettable even without the video evidence.

I’m sure that you can tell I have a soft spot for my dad.

And, lucky me, I have two wonderful daughters who will make me feel like the most important person in the world on Father’s Day.

But, I’m even luckier than that.

They make me feel like it is Father’s Day every day.

—

The photos above are all of my father, with the obvious exception of the vacuum cleaner, made available from the Open Clip Art Library; and the poster from the 1933 Chicago World’s Fair, created by Weimer Pursell, silkscreen print by Neely Printing Co., Chicago; both sourced from Wikimedia Commons.

The first picture of my dad is probably from some time in the early to mid-1930s. The second photo looks as though he was a teenager when it was taken.

The night time snap-shot probably took my dad by surprise while he was on a date, before he met his wife-to-be (my mother). It was likely shot by a street photographer, who would have handed my father a numbered envelope that identified the negative. Dad would have had to mail the envelope to the company with payment in order to get developed copies of the picture.

I recall seeing such photographers in downtown Chicago at least as late as the 1960s. Now, of course, just about everyone carries his own camera/phone.

The final image is of the young Stein family in late 1959: my mom and dad and, left to right, Jack, myself, and Eddie.

March 15, 2009

“I Know How You Feel”

Correct answer? I don’t. How could I?

But I may still be able to be helpful to you without absolutely knowing “how you feel.”

Why don’t I know exactly how you feel? I am not you. I am not your age or perhaps your gender. Maybe I’m not your religion. I wasn’t born in the same place under the same circumstances. My parents made more money or maybe less. They survived the Great Depression well, or badly, or not at all. And so on.

The point is, I’m not in your skin, so I can’t know precisely what it feels like to be there. It’s true, I might well have some idea, perhaps even a very good one. What might that idea be based on?

First of all, we are both human and have a certain set of broadly shared, although not identical life experiences. Secondly, as a therapist, I’ve talked to thousands of people who have told me what they think about certain things and how some events effected them. So I know the range of what is possible in reaction to an enormous number of events. I’ve also read much in the way of text books, been told much by my teachers, and have shared in the richness of emotion, perception, and experience found in great memoirs and novels.

And yet, despite all of this, I am open to surprise. My father died in the year 2000 at the age of 88. Rather suddenly. I’d known he was mortal at least since the time of his heart attack when I was 11. Prior to his death I’d counseled numerous people who were suffering from losses. I listened to their stories. Still, despite dad’s advanced age, I was shocked at the abruptness of his death, the “here today, gone tomorrow” reality of it. And surprised, too, by how tired I was for months afterward. As if some of the life force taken from him had been taken from me too. And even with this experience now well under my belt, even with having “lived” a loss like this (rather than just read about it or heard about it), I can’t say for sure that “I know how you feel” if you tell me about the death of your father. Your relationship with your dad might have been different enough, and his life circumstance different enough to explain some of this lack of identity.

You might ask me: “How then can you help me in grieving my own loss?” In several ways. I can listen to you and bear witness to your pain. I can be sympathetic. I can accept the emotions and stories you share: the varied combination of sadness, anger, exhaustion, and sense of separation from the world that comes with the death of a loved one. I can abide with you, acknowledge your pain, and let you knowI will “be there” until it passes. And, if you will accept the comfort, our relationship will help to reattach you to life, even while you are grieving something that tends to detached you from it.

You will never be exactly the same as you were before your loss, of course. But, you will very likely heal if you share your grief. If you hold it in or try to “move on” too quickly or shed your tears only privately — then your sadness might well pass more slowly or not at all. Human contact in the aftermath of a loss is crucial. A supportive spouse, friend or therapist can help. Time usually does the rest.