The use of rituals is not restricted to the nadir experience of bereavement.
Goldstein (1998) described the use of a mikveh, a Jewish ceremonial bath, as a
healing tool for a rape survivor. She noted that ‘‘having a Jewish framework in
which this woman could rid herself of the ‘stain’ she felt, was crucial to the
successful completion of therapy and her ability to go back to work,
synagogue, friends and family with a sense of peace’’ (p. 129). Clients surviving
other types of trauma may wish to construct rituals to commemorate, for
instance, the anniversary of the nadir event.
Neimeyer (1999) and Neimeyer, Torres, and Smith (2011) suggested various
writing exercises to help acknowledge the reality and depth of loss. The
therapist can adapt them to fit nadir experiences other than grief, since every
nadir experience is in some sense a loss. One exercise is for a client to compose
a carefully-thought-out epitaph that captures the essence of the person who
died. Another is to journal about the loss, keeping in mind that the material
should be something the client has never adequately discussed with others, and
that involves the client’s deepest thoughts and feelings. Finally, poetry can be
an important reflective exercise, as can the virtual dream, a brief spontaneous
story with a prescribed structure.
Other grief exercises (Neimeyer, 1999) may be used or adapted in therapy. One
is to note the imprint a deceased person made on the client’s life, the way the
person still lives on in the client. Such an imprint may involve mannerisms,
personality, values, or beliefs. Another is for the client to find ways to link
objects associated with the deceased to the client’s everyday life. For example, a
bereaved mother kept her late child’s stuffed toys in a display case. A final
exercise is the use of metaphors to help with the reflection process. An example
of such a metaphor is a client seeing the grief she carries around with her as a
suitcase with treasures hidden away inside it.
The Threshold Phase
The sense of emptiness following the severance phase is a painful yet necessary
one. Clients may wish to numb their pain through drugs or alcohol, or to rush
through this phase (as in the example of a widow who remarries soon after her
husband’s death). For a person who decides to sit with his or her grief,
however, this phase becomes a time of reflection. Yet how can an individual
overcome negative affect enough to make such reflection possible? It is helpful
for therapists to tell clients that while they cannot take away the pain resulting
from a nadir experience, they can help clients cope better with their feelings,
especially when those feelings are most intense. The writing exercises
described in the previous section (Neimeyer, 1999; Neimeyer et al., 2011)
are helpful here, as is expressive writing (Pennebaker, 1997). This latter
exercise involves persons writing about their deepest thoughts and feelings
and tying them to relationships and to ‘‘who you have been, who you would
like to be or who you are now’’ (Pennebaker, 1997, p. 162). Sloan, Marx,
Epstein, and Dodds (2008) found such writing encourages reflection and
discourages rumination.
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Kumar (2005) has recommended mindfulness as another way to deal with the
pain of this stage of acute grief. Mindfulness deals with powerful emotions by
providing a middle road. While some clients obsess about the nadir experience,
others try to avoid difficult feelings through overwork, drugs, or alcohol.
Mindfulness allows clients to stay with difficult feelings as they arise and
dissipate in the present moment. It is neither a ‘‘cure’’ for difficult feelings, nor
a technique that will instantly change clients’ lives. It requires repeated
practice, and Kumar (2005) has recommended that grieving persons engage in
mindfulness meditation three or more times a week, for at least ten to
15 minutes at a time. Mindfulness practice is uncomplicated, but it is hard to
do well and impossible to do perfectly. It is for this reason, Kumar pointed out,
that it is called practice.
The late Chogyam Trungpa introduced Tibetan Buddhism to the West, and
with it the practice of mindfulness meditation, and Berliner (1999a) has relayed
Trungpa’s original instructions. The most crucial ones involve the practitioner
sitting in an upright posture and focusing attention on the outbreath. When a
thought comes up, the practitioner is to experience it, but not to analyze it or
hold onto it. He or she should silent label the thought and return attention to
the outbreath again. Mindfulness practice is not a form of relaxation, and it is
not a way of pushing away painful thoughts and feelings (which only increases
their hold). Rather, it gives space, allowing consciousness to expand to include
all experience—good or bad—and simply letting that experience be (Davis,
1999).
Sometimes the nadir experience is complicated by the presence of posttrau-
matic stress disorder (PTSD), but individuals with PTSD may actually
experience greater posttraumatic growth (Dekel, Ein-Dor, & Solomon, 2012).
Mindfulness meditation is a promising tool for dealing with this condition
(Cuellar, 2008). Niles et al. (2012) have shown that a brief introduction to
mindfulness can significantly decrease symptoms of PTSD among military
veterans. Vujanovic, Niles, Pietrefesa, Schmertz, and Potter (2011) pointed out
several benefits of mindfulness meditation including better distress tolerance
and ability to deal with triggers, better ability to engage in treatment, and
decreased emotional arousal and reactivity.
The treatment of PTSD is beyond the scope of this article, and I refer the
reader to the handbook of the Management of Post-Traumatic Stress Working
Group (2010). A note is in order, however: Clients who dissociate or experience
flashbacks need to ground themselves in ‘‘the sounds of normal life all around’’
(Boon, Steele, & van der Hart, 2011, p. 6). In such cases, focusing on external
sounds is a better strategy than focusing on an internal process such as the
breath.
The Reincorporation Phase
Ultimately, our aim is to help our clients reintegrate with life even though they
may have been profoundly changed by their experience. As one client said to
Nadir Experience
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