Drive is a borderline concept between the spiritual and the somatic, as a psychic representative of stimuli that come from the body and reach the soul (psyche), as a measure of the necessary work imposed on the psyche as a result of its connection with the bodily. “Drive” means “to set in motion, to push”. This is activity, a dynamic force. The two most effective forces in a person are hunger and love. The two strongest drives in a person are Thanatos (the drive for death, destruction, hatred) and Eros (the drive for life and love).
The prominent Argentine psychoanalyst Etchegoyen R. Horacio wrote in his work “The Fundamentals of Psychoanalytic Technique”: “The action of the life drive in perception is aimed at finding connection and contact with an object, primarily with the mother’s breast, while the death drive manifests itself in avoiding or destroying contact, connection with the object. Therefore, it is the life drive that directs the subject to the object that generates perception” (Etchegoyen R. Horacio, 2020, p.507). Pathological sadness, where the death drive begins to dominate.
The purpose of life is death. All that lives must die for internal reasons. Lifelessness was before life. The pleasure principle is the task of libido. The reality principle is the task of external reality. Life is a compromise between these drives. To what extent we can accept reality is the immense inner work of the Adult Ego-state.
When we face the death of a loved one, we lose a part of ourselves. We touch the fear of our own death. Our life now changes. Without that person our life changes and routine becomes different. If we lose a child, we don’t have to prepare special meals for them, think about what to wear, plan their wardrobe as they grow. When we lose a spouse, a partner, we have to take on some of their obligations: paying bills, loans, cooking, household duties that this person used to do. When elderly parents pass away, they teach us to die. We are overwhelmed by immense regret for unsaid words, for wrong actions…
Healthy attachment is a kind of bonding. It occurs through the mediation of an object, that is, through relationships with a significant Other. The drive for life seeks development, seeks renewal, seeks to complicate life, sets goals and life tasks for itself, allows you to dream and love. The drive for life preserves life. The drive for death seeks to reduce tension to zero. This is a regressive movement. At its core is an unconscious sense of guilt. The goal of the drive for death is dissociation, regression, division.
When grief overwhelms us, we feel confusion, fear, horror, and despair. In the case of loss, depending on the circumstances, we may feel hatred. We may have a desire for revenge, and sometimes we freeze and feel helplessness, powerlessness, sadness, longing, despair.
Sometimes these feelings are mixed, and we cannot name them. We regress to primitive anxieties, archaic, total. All anxieties are activated.
Psycho-oncology of grief
Psychoanalyst and psycho-oncologist Jane Goldberg has spent much time trying to understand why we get sick. She says, “Cancer patients are prone to intense fears, anxieties, and anxieties… The fear of separation and loss — and can be of relationships, including death and divorce, or of something inanimate, such as a job — is persistent, and the actual experience of it is extremely traumatic. A diagnosis of cancer is usually made several years after this type of trauma” (p. 177, Goldberg, 2021). We recognize a grieving person by their appearance. They wear mourning clothes. Their gaze is directed at the floor, into the distance, into themselves. Their gaze is sad… We feel cold and detached when we meet someone who is grieving. Their bodies speak of pain: drooping shoulders, sagging chest, powerless arms, weak hands.
There can be several types of pathological grief
1. Blocking grief. A person does not experience grief, time freezes. The body may react by abusing alcohol, smoking, or using drugs.
Transactional analyst Tony White has researched this topic extensively. He found that this is a way for people to get rid of pain. Depressants reduce alertness by slowing down the activity of the central nervous system. They are called depressants because they slow down the heart rate and breathing, and can also cause a decrease in attention span (White, 2013, pp. 23-24).
This is sometimes called “self-medication.” People take drugs to avoid unpleasant experiences or memories or to avoid dealing with problems and responsibilities in the here and now. The drugs are used to numb the person or allow them to put off thinking about something, and thus the symptoms “go away.” In the short term, this is a good solution because it stops the pain, works quickly and effectively, which makes it very attractive to the Child Ego State, but it is clearly a bad long-term solution because the pain returns when the drug wears off (White, 2013, pp. 81-82).
Knowing that a person uses one or another drug that belongs to depressants, we can assume that the person has deep depression that requires treatment.
2. Or there may be severe anxiety, accompanied by obsessive-compulsive disorder.
3. Sometimes identification with the deceased occurs. The body may have symptoms similar to those of the deceased.
4. A person can react to grief with physical illnesses. Especially when they have a prohibition: “Don’t feel!” and a driver: “Be strong!” and/or “Please Others!” and the Adaptive Child dominates. Jane Goldberg claims that in psychosomatic cancer patients, sensory states and signals of anxiety, fear, pain, guilt, shame, and anger are blunted (Goldberg, 2021, p. 249). At the same time, Jane Goldberg draws attention to the physiological state of submission; the functioning of biological systems is suppressed and ineffective (p. 177, Goldberg, 2021). A person with a strong grief reaction may lose hair or teeth, develop tumors, or develop lung diseases. The body may react with panic attacks.
The role of loss in the family system
When a psychologist works with grief, it is important for the specialist to process all layers. It is important to remember that the statute of limitations is related to the intensity of emotions. What do we need to pay attention to:
1. Who did the person lose?
2. What part of himself has the one who grieves lost?
3. How to realize this part of yourself?
4. Who has the family system lost?
5. How to restore balance?
It is necessary to work separately with the sensations in the body and feelings. It is important for the psychotherapist to keep in focus those feelings that arise in therapy: longing, pain, sadness, guilt, anger, rage, joy, relief. The therapist needs to be persistent on this topic in order to be able to support these feelings.
Working with the image on the chair
Empty Chair Dialogue (in which the client engages in an imaginative dialogue with a [significant] Other to identify emotional traumas in relation to that Other and to transform the inadequate emotional schemas that underlie and are rooted in such traumas (p. 387, eds. Hanley & Winter, 2023).
This is one of the most effective techniques for working with grief. It is important to note that time is important for such work. Must pass at least six months after the loss. Working with the image of the deceased on a chair helps to accept and value the experience that was in the relationship. The following questions can be helpful for the psychotherapist in such work:
- What kind of person he was?
- How do you remember about the person?
- What have you heard about the person?
- What did the person say about himself?
- What did those around the person know him as?
- What did the person's loved ones know him as?
- What did only you know the person as?
- How are you similar?
- What makes you different?
- What was the person like with you?
- Where and with whom can you be like that?
- What gift would you like to receive from this person?
- What do you want to give the person?
Tony White has modified the Gouldings' farewell work. He emphasizes the following:
1. Facts. It is necessary to gather facts and remember not only the good, but also the bad.
2. Unfinished relationships. It is important to symbolically either complete them or let them go. What the deceased promised, and
will never fulfill. What the one who lost promised, and also will never fulfill. It is important to talk about it out loud and forgive.
3. Express feelings of resentment. It is important to express any negative feelings toward the deceased or yourself.
4. Remember what you valued about the person you lost. What was valuable in your relationship.
5. Say “Goodbye” to this person.
6. Open the door to new experiences, say “Welcome!” to your own life.
Stuck in grief and its causes
There are several reasons for getting stuck in grief. These can lead to pathological grieving or complicated grief. Among them, the following stand out:
• Old, unresolved losses. Trigger in grief.
• “Echelon of Deaths,” when losses follow one another. This may be several deaths of loved ones within a short period of time, or a tragedy may occur to several family members at the same time.
• Family grief. Transgenerational unlived losses.
• Trauma of abandonment in childhood at the body level. Often accompanied by serious psychosomatics.
As a psychotherapist, you will understand that the grieving process is normal, not pathological. A number of signs indicate this. Progress is made in the therapy process:
• adaptation to reality improves,
• pain decreases,
• new events occur in the life of the person who has lost,
• relationships with the deceased become symbolic. The person accepts the given and moves on with their life. They give meaning to what they have experienced.
Grief counselor William Worden points out the following, “Depression is a pathological form of grief and in many ways resembles grief (normal grief), except for one exceptional characteristic: the impulses of anger directed at the object of ambivalent love are turned inward” (p. 52, 2020). It is extremely important for us as specialists to understand where the normal work of grief takes place and where the pathological experience of loss begins. Worden also points to the factor of self-esteem and self-respect. In the normal reaction to grief, there is no drop in self-esteem and self-deprecating statements. And if loved ones feel guilt, then this guilt is for specific actions, not total, existential. That is, if a major depressive episode develops during the experience of loss, it should be considered as complicated, hypertrophied grief (p. 52, Worden, 2020).
Working with grief in TA
Given that grief and depression are similar, we work with grief as with depression. We confront very gently, give the Child place and space to express their feelings, untangle feelings and experiences, work with the decontamination of the Adult Ego-state. We remember that people perceive personal loss as a catastrophe and believe that they are largely to blame, increasing feelings of hopelessness and scolding themselves very much.
The therapist’s task is to carefully develop the Adult Position. It is important that compassion for oneself and one’s loss emerge from the Adult Ego State, and to work on ensuring that the person takes care of themselves during the grieving process and of their living loved ones (p. 367, eds. Cornell, Graaf, Newton & Thunnissen, 2016).
Conclusion
When a person grieves, he or she falls into an emotional pit. At the foot of the mountain, which is worth climbing, is death. At the top is immortality. A person’s immortality is the memory of him, which is preserved by other people and passed on from generation to generation. Falling into an existential pit, a person feels the fear of his own death, loneliness, isolation and meaninglessness. When he comes out of the crisis, he finds freedom, will and takes responsibility.
Death is absurd. It is extremely important for a person to find meaning in the events that have occurred. Irvin Yalom wrote that the feeling of meaning gives rise to values. Values, at the same time, enhance meaning.
The therapist's task is to capture the overall pattern, to help find meaning and significance in what appears to be a random tragic event in life (pp. 519, 522, Yalom, 2015).
Understanding that my care is not always needed by everyone is already a certain level of spirituality. If a person finds and sees his purpose. If, looking back, he sees and appreciates what has been done. Then a person moves to the level of cosmic identity. Here the value system lies beyond life and death. There is something that was before me and will be after me. A person begins to think in large categories, not tied to everyday life. This gives wisdom, gives a greater understanding of life, confidence in life and awareness, Man is a part of the Universe. He is a part of something eternal. Understanding that life was before me and will remain after me makes life meaningful.
What we can do for the deceased is to preserve their memory. And to fulfill ourselves in such a way that the people who know us remember us with love. To do something important and meaningful for the one we lost.
The role of the therapist in the grieving process is extremely important. The experience of therapeutic presence involves both a) being grounded and in touch with one's whole and healthy self;
b) be open, receptive, and immersed in what is relevant at the moment; and
c) to provide a greater sense of credibility and broadens awareness and perception.
This grounded, immersed, and expanded awareness also arises from (d) the intention to be with and for the client, serving the client's healing process.
Literature
- Etchegoyen R. H. The Fundamentals of Psychoanalytic Technique. – London: Karnac Books, 1991. – 600 p.
- Cornell W. F., de Graaf A., Newton T., Thunnissen M. (ред.). Into TA: A Comprehensive Textbook on Transactional Analysis. – London: Karnac Books, 2016. – 444 p.
- «The Sage Handbook of Counselling & Psychotherapy» edited by Terry Hanley & Linda Anne Winter, London, SAGE Publications Ltd, 2023, — 650p
- Tony White «Working with Drugs and Alcohol users», London and Philadelphia, Jessica Kingsley Publisher, 2013, — 222 p.
- «Handbook of Thanatology» edited by Heather L. Servaty-Seib & Helen Stanton Chapple, USA, Association for Death Education and Counseling, 2021, — 623 p.
- Jane Goldberg, “Psychotherapeutic Treatment of Cancer Patients”, Tailor & Francis, 2018, - 398 p.
- Worden J. W. Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner. – New York: Springer Publishing Company, 2018. – 352 p.
- Yalom, Irvin D. Existential Psychotherapy. Basic Books, 1980., - 544 р.
- Webinar "Existential transitions (crises)".Karikash Vladymir Ukrainian Institute of Positive Psychotherapy, Kyiv, 2021.