This section largely discusses subthemes 2 and 3 from SO2 (‘Sitting with the pain you cannot fix’ and “I would write it in gold” – validating the child’s life’) as well as subtheme 3 from SO3 (‘The power of imagery – the child’s death becomes real’).
The deep empathy derived from mother-therapists’ identification and sharing of the
‘enormity of the loss’ (SO2 subtheme1), also meant that they had to ‘sit with the loss’
they could not fix. This was experienced as difficult and ‘so big … so heavy’, as Marion said (SO2 subtheme2). Moreover, personal grief for the child that died
seemed to add to some therapists’ desires to validate the child. In particular Marion’s quote ‘I would write it with gold’ (SO2 subtheme3) is indicative that she did not just empathise with her client’s grief but that she, too, grieved the child and wanted to validate it.
150 Despite not having met the children who had died, they seemed present and real to mother-therapists (SO3 subtheme3). Images of the children, created through clients’
narratives or/and photographs contributed to this sense. Godel (2007) and Cacciatore et al. (2008) discuss the use of photographs in working with families bereaved from stillbirth as a means of validating the baby and integrating its life into the family narrative. Kaslow and Friedman (1977) furthermore discuss using
photographs in therapy as a means of getting clients to connect to their feelings. The use of photographs can therefore aid therapeutic work.
On the other hand, Yahalom (2013) researched the lived experience of mothers looking at memorable photographs of their children. He concluded that looking at these photographs created ‘an aporia of human relationships’ (p.126). It connected them to emotions, their bonds and verified them. Conversely, it also instilled a recognition that these moments were gone forever.
Mother-therapists in this study were not confronted with a memorable photograph of their own child but of their client’s child. Nevertheless, they could see the
memorable-ness, connection and sense of loss in their client’s eyes, which in turn might have made these photographs memorable, powerful and the children’s lives and deaths real to them. Louisa experienced this as largely positive. She
communicated this power, ‘…she was clearly really, really proud that it was her’s and she really loved this baby,’ (SO3 subtheme3). Thus, for Louisa, similar to Cacciatore et al.’s (2008) and Godel’s (2007) proposition, seeing a photograph and therewith the reality of her client’s baby constituted a useful and therapeutically valuable
151 experience. Whereas for Tessa, the loss aspect seemed to be greater; triggering intense grief, which she experienced as difficult. Nevertheless, for the client, seeing her therapist’s reaction seemed to be healing.
Thus, seeing the ‘realities’ of these dead children, either in a photograph or through their clients’ narratives, may also be what deepened participants’ grief for them.
Having never actually met the children, participants’ profound sorrow over the
children’s deaths relates to the concept of disenfranchised grief (Doka, 1999), which refers to grief that goes unseen and is not recognised by society. At times,
professionals feel that they should not feel like this or are not entitled to engage in rituals or support to mourn the deceased (Christianson & Everall, 2009). This can cause depression and burn out in professionals (Samuel, 2017). O’Brien (2011), Christianson and Everall (2009) and Dwyer et al. (2012) thus advocate that
therapists who confront death in their practice, or work with child-death (Humphreys, 2015) ought to attend to their own feelings of grief in supervision, personal therapy and through rituals.
When a therapist’s personal feelings of loss are attended to, it can provide an opportunity to incorporate the personal into the professional and make therapists comfortable with the notion that they are in constant interaction, as concluded by Palmieri (2018). The lengthy report that Marion wrote ‘…why, I am just writing these two pages,’ (SO2 subtheme3) might therefore have made her feel that firstly she could do something to alleviate the perceived helplessness (Samuel, 2017) (she was using the child’s name, which was something that was important to her client), but
152 also help her process her own grief for the child and mother. Supervision, personal therapy, peer support, self-care and being aware of the impact seemed to help participants come to terms with these deaths, as Tessa stated ‘…the grief and the loss. I could express more in supervision’ (SO3 subtheme5). The findings here therefore highlight the deep impact that working with a mother whose child has died can have on mother-therapists’ personhoods. This ought to be embraced and attended to by therapists as well as their supervisors and managers to help them come to terms with their personal feelings and avoid burnout.
Participants’ experiences of sitting with the unfixable pain, and their desires to validate the children are representative of general bereavement work (Samuel, 2017). Figley (1995) and Rothaupt and Becker (2007) suggest that there are risks in sitting with grief over a prolonged period of time, due to the heaviness of the loss and the inability to fix the reasons for clients’ pain. Even more so, if the bereaved has lost their child (Humphreys, 2015). On the other hand, celebrating the deceased’s life and continuing bonds with them are current ‘trends’ in bereavement care (Rothaupt
& Becker, 2007; Silverman & Nickman, 1996). Research shows that continuing relationships with the dead is healing to the grieving (Rothaupt & Becker, 2007) in particular when the deceased is a child (Klass, 1996; Davis, 2016). Within SO2 subtheme2 and subtheme3 participants thus demonstrate their own embeddedness in current bereavement literature. If the present therapeutic position was that
successful mourning was indicative of decathecting the internal image of the
deceased person, which Freud proposed only a century ago and dominated theories around grief work until the early 1980s (Rothaupt & Becker, 2007), participants’
experiences of their clients and their own experiences might have been interpreted
153 differently by them or by me. Furthermore, the above stated notion of embracing the personal in the professional is more widely accepted in current psychology and psychotherapy practice (Gerson, 1996; Knox, 2014). Hence, coming to terms with and acknowledging their own feelings may have been viewed and experienced differently during a time when therapy was considered to be a more one-directional endeavour where therapists were thought to be doing something to clients rather than attending to the ‘being-with’ aspects of therapy (Strawbridge & Woolfe, 2003).
Or, when countertransference was considered an interference to the work (Maroda, 2004), and/or personal feelings about clients were largely unacknowledged
(Clarkson, 2003).
Furthermore, images of a person (child) who has died may make them equally real to any therapist and therewith create a sense of loss, similar to that outlined by Yahalom (2013), in the knowledge that they are no more. Thus, the grief that mother-therapists’ expressed for these children, though for them related to having children themselves, may have been similarly experienced by non-mother-therapists. As therapists, we often sit with clients who have experiences that are unfamiliar to us.
We refer to related experiences in our lives and use explorations to create insight into and empathy for clients’ unique situations, as Adams (2014) discusses. In fact, Raja (2015) debates the risks of being demographically matched with clients. The findings show that besides the positives that came out of the dyad’s shared
motherhood, there were also challenges. Thus, a greater difference between
therapist and client does not necessarily equate in a lesser quality of the work or less understanding of or empathy for clients. At times it might create the healthy distance to not make something ‘too close to home’.
154 On the other hand, bereaved parents themselves often report that they experience most comfort when talking to other bereaved parents (Davis, 2016; Rothaupt &
Becker, 2007; Schiff, 1977), since they have been there too, and may model
‘posttraumatic hope’ (Romond, 2010). Fellow bereaved parents have experienced this ultimate tragedy, whereas for non-bereaved mother-therapists this ultimate tragedy may constitute their greatest fear, which it did for this sample. Working with this greatest fear is what I discuss in the next section.