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Death in the Family: Adapting
a Family Systems Framework
to the Grief Process
a
b
Joseph McBride & Steven Simms
a
The Bereavement Center , Lawrenceville, New
Jersey, USA
b
Division of Oncology , The Children's Hospital of
Philadelphia , Philadelphia, Pennsylvania, USA
Published online: 30 Nov 2010.
To cite this article: Joseph McBride & Steven Simms (2001) Death in the Family:
Adapting a Family Systems Framework to the Grief Process, The American Journal
of Family Therapy, 29:1, 59-73, DOI: 10.1080/01926180126032
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The American Journal of Family Therapy, 29:59–73, 2001
Copyright ©2001 Brunner-Routledge
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Death in the Family: Adapting a Family Systems
Framework to the Grief Process
JOSEPH MCBRIDE
The Bereavement Center, Lawrenceville, New Jersey, USA
STEVEN SIMMS
Division of Oncology, The Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania, USA
This paper presents a framework for adapting a family systems ap-
proach to the grief process. The framework places the bereaved and
therapist in the larger context. The therapist builds a relationship
around each family member’s unique experience with death, and
uses the grief timeline to facilitate timely systemic interventions.
This perspective helps the therapist navigate pitfalls and remain stra-
tegically positioned to address grief sensitively and effectively in
psychotherapy.
Laugh and the world laughs with you, weep and you weep alone.
Ella Wheeler Wilcox
This article describes an approach organized as a primer for therapists seek-
ing to build a clinical framework that addresses death and the grief process
within a brief family systems model. The framework orients the therapist to
attend to three fundamental activities. The first is to develop an awareness of
the larger context of death in which families grieve. Second, it emphasizes
building relationships with families around their unique experience of death.
The third is to facilitate timely systemic interventions. Using the grief timeline
to strategically time interventions has not been emphasized in the family
therapy literature.
Death is a natural and expected life event. Western civilization has cul-
tivated a context, however, which often veils the grief process and sustains
Address correspondence to Joseph McBride, MSW, The Bereavement Center, 2999
Princeton Pike, Suite 5, Lawrenceville, NJ 08648.
5
9

60
J. McBride and S. Simms
barriers for the bereaved (Walsh, 1983). Systematic attention to death as a
developmental and family process in psychotherapy (Walsh, 1983; Walsh &
McGoldrich, 1991; Shapiro, 1994; Ventura, 1996) is gaining more clinical and
research attention (Fristad, Jedel, Weller, & Weller, 1993; Videka-Sherman &
Lieberman, 1985). When grief is the presenting “symptom” or a death of a
loved one occurs during psychotherapy, therapists-in-training (Munichin &
Nichols, 1993, pp. 263–287) and some experienced psychotherapists (Worden,
1
991, pp. 133–140) may find themselves grappling uncharacteristically for a
foothold in the unfamiliar terrain of death.
The context of death may organize the therapist to avoid the topic and
unwittingly direct the process away from death to other less stressful but
familiar therapeutic issues. The therapist must attend to the context and
timing issues in order to avoid this interpersonal process (Munichin, 1974,
p. 106). By failing to recognize this influence on the therapy process from
the larger context of denial, the therapist can inadvertently miss the bereave-
ment issues as the essential focus.
DEATH IN CONTEXT
We live in a death denying and death-defying society (DeSpelder & Strickland,
1
987). We drive our cars fast, drink and eat to excess at fast food restaurants,
smoke, overwork, all with the unspoken idea that death happens to the
other person. Death is constantly in our view, through the instant media
exposure of tragedies or by the deaths in our families and daily lives. We
spend precious little time discussing it with our family and friends. For ex-
ample, how often is it that the preferred manner of dealing with a bereaved
person is to not talk to them about the dead lest we upset that person or
ourselves?
It is in this larger context that one must suffer through the bereavement
process (Walsh & McGoldrich, 1991). The context often does not provide for
awareness of recovery or support. This is a form of institutionalized denial,
fostered by a declining influence of religion and its rituals, the lack of educa-
tion about bereavement on all levels, and a media- induced positive charac-
terization of people who push on despite loss.
THE THERAPIST IN CONTEXT
This framework begins with the focus on the therapist. The first fundamental
activity is to tune into the context of death. Every discussion about death and
related issues, including therapeutic bereavement encounters, is colored by
the denying and defying perspective. The therapist establishes and then sus-
tains a focus on the death experience in context. It is this experience of grief
with uncertain and ambivalent support that drives the bereaved to therapy.

Death in the Family
61
A therapist who appreciates the experience of the bereaved and under-
stands his or her own place in this context of denial becomes a more pow-
erful “helper.” This means that the therapist is aware of the pressure that the
context places on the bereaved to not express their intense feelings. Also,
the therapist needs to tune into his or her own understanding of this context
and its influence on setting a therapeutic tone that provides a safe environ-
ment for the bereaved. Shapiro states this clearly when she says, “Our self
awareness when facing the challenging work of grief therapy constitutes the
only deterrent against our almost inevitable attempts, both personal and
professional, to bring quick resolution to the slow, complex process of heal-
ing” (Shapiro, 1994, p. 5).
The therapist must also be sensitive to how lifestyle, family life, ethnic,
cultural heritage, and community identity perspectives influence the context
of denial (McGoldrich, Almeida, Hines, Garcia-Preto, Rosen, & Lee, 1991). In
an attempt to cultivate an appreciation for the many facets of diversity, the
therapist must assess these influences. These may include the individual’s
race, gender, sexual orientation, or national origin and also what the client
feels are the important influences on their experience (Lifton, 1968, 1973).
TIMING AS AN INTERVENTION
AND THERAPEUTIC RELATIONSHIPS
A focused intervention schema that is sensitive to timing and relationship
issues in the bereavement process is crucial. The facilitation of timely sys-
temic interventions requires seeing grief as normal, timing the interventions
with the grief process and constant attention to the relationship. A sharp
focus on the grief time line (Tames, 1977) helps the therapist effectively time
each session and to allow the bereaved opportunities to accomplish the four
tasks of grief: accept the reality of the loss, experience the pain, adapt to the
new environment, and reinvest emotional energy (Worden, 1991). This frame-
work also helps therapists challenged by a cost-conscious health care reim-
bursement system to maximize treatment outcomes.
Timing of Sessions
The importance of strategically timing sessions is not emphasized in the
bereavement therapy literature. Asking how and when the death occurred is
the first key step. The answer indicates which paths families take into the
treatment process and helps determine the timing of interventions. Families
can typically take three different paths to therapy. The primary path is where
the death of a loved one is the reason for the referral. The secondary path is
where a client or family is referred to therapy with a presenting behavioral,
psychiatric, or family problem, but during treatment the issue of grief sur-
faces as a central issue. The delayed path is one in which the client or family

62
J. McBride and S. Simms
TABLE 1. Initiation and frequency of sessions
Death to Therapy - Months Number of Sessions
Murder/suicide
Sudden death
Natural causes
Total
4.30
6.02
7.58
6.28
12.52
8.67
6.72
8.71
enters treatment many years after a death. The presenting complaint is linked
to unresolved issues surrounding the death. This paper will focus on the
primary path.
In cases that follow the primary path, the first step in deciding the tim-
ing of sessions for the therapist is to assess the family’s pace of grieving
within their cultural and ethnic context. Since treatment is by its nature time-
limited, it is important to maximize the use of sessions that are available. The
therapist does this by matching the intervention with the critical phases of
the grief process.
In 106 families referred to the first author’s practice with the primary
presenting problem of the death of a family member, the average time of
entry into treatment from the death was 6.6 months (Table 1). The average
number of sessions was eight (Table 1). Looking closer at these families
where a family member died of a murder/suicide, entry into treatment was
earlier than the other categories at 4.3 months from the time of death. The
average number of sessions was 12.5. Sudden death survivors (unexpected
death from accident, heart attack, or other medical reasons) were the next
group to enter therapy at an average of 6 months and 8.7 sessions. Families
in which natural causes (chronic or terminal illness) resulted in the death
entered therapy at 7.6 months and averaged 6.7 sessions. The race of the
families included 71 Caucasian, 33 African-American, 1 Latino, and 1 Asian-
American family (Table 2).
This practice-based pattern points to the relevance of this model, in
particular, the importance of the timing of sessions to mirror the grief pro-
cess relevant to the type of death. As an example, in families where the
death was from natural causes, the entry into treatment was at 7.6 months.
This is the time when the bereaved are emerging from the shock phase of
the bereavement process and starting to experience the emotional rollercoaster
of the disorganization phase. The therapeutic process, which begins at this
TABLE 2. Type of death and race
Caucasian African-American Other
Total
Murder/suicide
Sudden death
Natural causes
Total
11
32
28
71
11
8
14
33
1
23
40
43
1
2
106

Death in the Family
63
point, includes attending to the larger framework of entry and timing of the
sessions to the grief timeline.
Therapeutic Relationships
It is important for the therapist to create a safe environment for the bereaved
to talk about the deceased. Open and factual terminology is essential. This
includes assessing the level of anger, blame and responsibility concerning
the situation, events, and the person who died. This careful tracking of the
events before, during, and after the death provide needed insight. It is help-
ful to acquire the details of the funeral. This is often overlooked and can
provide valuable information for the therapist. It is these events, surrounding
the death and the funeral, which can provide the therapist a first look at the
level of functioning of a family and an opportunity to create a working
relationship. The old Irish expression, “where there is a funeral, there is a
fight,” lends some folk wisdom to this concept.
At this point, the therapist begins to gain an understanding of how the
death has impacted the survivors and to understand how the death has
changed the structure of the family. Who disciplines since the father who
took most of this responsibility is no longer there? Are the parents capable of
caring for each other or their other children after the death of their child? The
variations of this are as extensive as the number of families that experience
a death. The therapist needs to appreciate that the changes in the context
created by the loss will have a powerful impact on the behavior of the
survivors and will influence their personal grief processes.
FAMILY SYSTEMS FRAMEWORK
Grief Timeline
The grief timeline is a useful way to describe the process of grief. It offers a
picture of the experience for the bereaved. While there are different versions
of this concept (Bowlby, 1980; Gilliland & James, 1988; Clayton, 1990), an
awareness of following a timeline facilitates the application of this concept
in the therapy process. This grief timeline comprises three distinct but over-
lapping phases called shock, disorganization, and reorganization (see Figure
1
; Tames, 1977).
The therapist utilizes the timeline to highlight the bereaved individual’s
position and important transitions in the grief process to both design and
implement interventions. When clients and families present from the pri-
mary and delayed paths, the therapist uses the grief timeline to plan the start
of therapy. From the secondary path, the therapist uses the grief timeline to
address grief within the therapy process.
It is important for the therapist to adapt the timing of the sessions with
the place of the bereaved in the grief timeline. Initially, the client may re-

64
J. McBride and S. Simms
FIGURE 1. Grief timeline.
quire more frequent contact with the therapist. It is essential for the therapist
to remain flexible including availability for phone contact and more frequent
sessions. This is because the bereaved are feeling overwhelmed, isolated,
and at a time when they are usually emerging from the shock phase. Weekly
sessions are typical although more contact may be needed. As the client
progresses through the disorganization phase, the frequency of sessions is
decreased. First, the sessions are decreased to every other week, then monthly
as the client progresses, based on his or her ability to cope with the varying
intensity of the grief process. It is important to arrange to be with the client
through the first year of the process. The pacing of sessions to cover this
period allows the therapist to work with the client through the most impor-
tant and potentially difficult transitions of the process. This includes difficult
waves of grief that occur when clients feel that they are finally seeing progress.
Anniversaries, birthdays and other significant events in the family life are
almost always challenging for the bereaved. The timing of sessions in syn-
chronization with the grief timeline is the therapeutic intervention. Phone
contact is maintained throughout the therapeutic process as needed.
Shock Phase
In the shock phase, the bereaved may show a familiar set of indicators of
grief. Shock, numbness, and crying are often evident and may persist for
weeks to months. Daily activities may be done in mechanistic fashion. Al-
though this aspect of grief may be described as a negative experience, its
adaptive function serves to insulate the bereaved from an overwhelming

Death in the Family
65
emotional experience. The immediate response from others is to increase
closeness after the death. However, the bereaved often require emotional
distance (Tames, 1977). It is ironic that many of our Western traditions find
people interested in the bereaved at the time when they are least likely to be
able to benefit from the emotional support and personal closeness. The
therapist needs to avoid being seduced by the bereaved wanting to push
away from the task at hand, since it can be counterproductive to this phase
of the grief process. The therapist and bereaved need to acknowledge the
expression of the symptoms as part of the grief process.
Disorganization Phase
This phase can last many months to years. It presents the most difficult
challenges for both the bereaved (Tames, 1977) and the therapist. It is here
that the bereaved experiences the strongest feelings of grief. In contrast to
the shock phase, the bereaved now seek an intimate connection with others
to talk about the deceased and their feeling that they may be “going crazy.”
The intimacy of interpersonal relationships allows for the strong ventilation
of feelings. It is here that barriers emerge and others distance themselves
from the bereaved. The therapist must understand that the overwhelming
indicators of grief in this phase can present in a variety of emotional expres-
sion such as sadness, anger, anxiety, and guilt (Worden, 1991). This contrib-
utes to the difficult and intense nature of this phase of the therapy process.
The context of the denial of death becomes more evident. The bereaved are
cautioned not to talk about the deceased at a time when it is most important.
The therapist needs to be aware that the emotional intensity can increase to
seemingly “unmanageable” for the bereaved
The structure and functioning of the family are impacted. Grief affects
the ability of family members to perform their roles (Hare-Mustin, 1979). The
therapist attends to how death and grief change the day-to-day roles and
activities of each family member. As an example, parents may find it difficult
to discipline their surviving children. The disrupted hierarchy and discipline
may affect the development of the child and the family. The consequences
for each family are based in their premorbid level of functioning, the role of
the deceased, support system, and the family members’ flexibility to adapt to
the changes.
Reorganization Phase
In this phase, the bereaved may still have deep feelings toward their loved
one, but they are more successful in negotiating the world in the face of their
loss. During this phase, the indicators of grief are less evident. Grief reac-
tions are present but the duration and intensity of expression is reduced.
When the bereaved establishes a new and balanced relationship with the
deceased, they can negotiate reentering the mainstream of life in a meaning-

66
J. McBride and S. Simms
ful manner. As a result, the bereaved expands their participation in their
social network. They start functioning on a level comparable to before the
loss.
FOUR TASKS OF MOURNING
Worden offers a task-oriented framework of mourning at the individual and
family level (Worden, 1991). The combination of the timeline with the four
basic tasks provides a more comprehensive picture of the grief process. This
enables the therapist to design therapeutic interventions that are in sync with
the experience of the bereaved. Figure 2 illustrates the fit of the timeline and
task orientation.
The tasks are the challenges facing the bereaved during each phase. As
an example, accepting the reality of the loss is the challenge during the
shock phase. The second task of experiencing the pain is the work of the
disorganization phase. The adaptation to a new environment is the transition
between the disorganization and reorganization phases. Finally, the reinvest-
ing of emotional energy and the reorganization phase meld nicely.
The following information helps the therapist organize the approach of
using the timeline and task orientation to have an integrated view of the
process.
FIGURE 2. Four tasks of mourning.

Death in the Family
67
First Task of Mourning
The first task of mourning is accepting the death and the loss (Worden,
991). This is a subtle process that is difficult to assess. The individual may
1
first talk about the deceased in first person. As the acceptance of the loss
begins, the past tense may be more frequently used. The family also devel-
ops a shared acceptance of the reality of the loss. Family members slowly
incorporate the deceased in conversations. The deceased’s possessions are a
helpful barometer. The individual may first link the loss to an object, then
use the object as a symbol of the loss or transitional object, and finally place
the object in a safe place as a treasured keepsake (Worden, 1991). For ex-
ample, immediately after a death the bereaved person may hold onto a
possession of the deceased. At first, he or she constantly carries this with
them and is upset if it is misplaced. As the grief progresses, the bereaved
person is able to separate from the object but knows where it is and how to
gain access to it quickly. Finally, the object is put away in a place for safe-
keeping.
It is important to understand that the acceptance of the death is an
ongoing process, not an end point. The bereaved will experience the loss on
some level throughout his or her entire lifetime. Survivors of expected deaths
may accept the loss sooner than survivors of unexpected and sudden deaths
(Parkes & Weiss, 1983).
Systemic Interventions
Maintaining a focus on the context of death helps the therapist to join and
form a supportive relationship with the bereaved that reduces their isolation.
While individuals and organizations in their context either minimize or deny
the death and grief, the therapist adopts a position of acceptance and close-
ness. Sophisticated interventions are not required. It requires that the thera-
pist be comfortable with the expression of denial and subsequent intense
pain by the bereaved. This relationship with the therapist needs to offer a
safe place to express this pain.
Bereavement therapy is demanding. The therapist must tolerate intense
emotional expression of family members’ feelings of powerlessness when
faced with unspeakable tragedy and loss. The therapist can also experience
this feeling of loss of control. When this occurs, many therapeutic approaches
direct the therapist to reduce the intensity. While this familiar approach helps
the therapist maintain his or her own safety net, it can hinder the therapeutic
encounter.
During these initial sessions, the therapist also supports and educates
the bereaved. The therapist educates the bereaved about the context of death
and the grief process. This is done because the bereaved person has most
likely had little education on the extent of the grief process. The key points
are to normalize the indicators of grief and give permission to grieve.

68
J. McBride and S. Simms
The picture session is an important systemic intervention (Hunsberger,
1
984; Lawrence, 1992). The deceased needs to be included in therapy. After
allowance of time for joining, each individual is requested to bring four to
five pictures to the session. Every picture tells a story and it is the therapist’s
task to use these photographs as a tool to acquire information about the
family. It is a powerful event for a family member to bring personal photo-
graphs of the deceased to a therapist. They often do not appreciate that they
have completed this assignment successfully. They have shared photographs
of their loved ones requested by a virtual stranger. A few weeks before they
may not have been able to talk about the deceased. This process is the first
step to help the bereaved gain a sense of mastery over death.
Clinical Case Examples
Ms. S is a 47-year-old office manager. Her husband of 8 years died while the
couple ate lunch in a restaurant. He was recovering from recent heart sur-
gery for a congenital heart condition. Three months into the grief process,
Ms. S came into therapy with their adopted seven-year-old daughter. Her
daughter had a history of behavior problems that they were working on in a
previous therapy. She presented with concerns regarding the grief process
and how she was feeling overwhelmed functioning as a single parent with
this demanding child.
Identifying Ms. S’s early position on the grief timeline, the framework
guided the therapist to develop the following interventions:
1
. Provide a safe environment to talk about the depth of her feelings. She
felt pressure from relationships in her context to remain silent and there
was limited recognition of her grief.
2
3
. Provide an outline of normal grief for her to compare her experience.
. Give permission to grieve and acceptance of the range of feelings, and to
ask others to listen.
4
. Reinforce the need for continued firm and consistent limits for her daugh-
ter.
Second Task of Mourning
The second and most difficult task of mourning is to experience the pain
(Worden, 1991). The individual has progressed through the shock phase and
they start to accept that their loved one is not going to return. The bereaved
is most likely faced with expectations from others that they should be over it
by now. The fact is that they are now face-to-face with the most intense
emotions in the grief process. It is no coincidence that this task and phase
occur at the time when most people enter bereavement therapy.
It is crucial that the family share in the expression of pain to accomplish
this task. A family member may not participate in the shared expression of

Death in the Family
69
pain through disallowing feelings and/or dysfunctional or unhealthy behav-
ior. This can disrupt the family process of experiencing the pain. Helping
family members accommodate to the differences in expression and timing of
grief reactions is key to the successful negotiation of this task.
Systemic Interventions
In the disorganization phase, experiencing the pain is paramount. The thera-
pist attends to the individual and family levels. Continued contact through-
out the difficult and emotionally demanding disorganization phase is crucial.
The basic framework for guiding the contact is:
(
(
(
a) reduce the isolation,
b) provide an environment that allows expression of all emotions,
c) promote the transition to the next stage of individual and family devel-
opment,
(d) restore order in the family with developmentally appropriate, firm and
consistent limits with children.
At the individual level, the task of the therapist is to foster an environ-
ment in which the bereaved can feel comfortable to express unspeakable
feelings. This requires a safe place and permission to express all of their
feelings. It is imperative to continue to discuss details of the death, funeral,
and relationship with the deceased. When working at the individual level,
patience is required because the bereaved may repeatedly review difficult
aspects of the death and/or their relationship.
Each person’s grief happens in a family context. It is important for the
therapist to take an active leadership role in helping the parent(s) to pro-
mote shifts in hierarchy and flexible boundaries. This unremitting attention
to grief in context creates room for the individual grief while attending to the
survival of the family. The importance of roles is highlighted. Extended fam-
ily or community relationships play an important role in supporting the grief
process.
As the individual and family progress, the therapist needs to support
and validate their looking toward the future. Family members may often feel
uncomfortable with feeling better. The therapist helps place this transition in
context as a normal phase of the grief process.
A person experiencing a tragic, unexpected death including suicide or
violent death, may take a longer time to enter this phase. When this occurs,
the bereaved receives pressure from their context and themselves to get over
the death. This can create a high level of anxiety at a time when the be-
reaved expects and is expected to move on with their lives. The bereaved
should have the opportunity to work as long as they need to progress through
the grief process.

70
J. McBride and S. Simms
Clinical Examples
Ms. D is a 67-year-old grandmother whose 40-year-old daughter died of a
heart attack during her second ER visit in one evening. She was sent home
after the first visit with the diagnosis of GI distress. She returned later in
cardiac arrest and died within 1 hour after being admitted. Ms. D entered
treatment 8 months after the death due to her own unstable emotional state
and her concern about her two grandchildren, Kelsy 15, and Kevin, 12.
Kelsy exhibited several concerning symptoms, including withdrawal, and
isolating herself in her room and refusal to wear any clothes that were not at
least two sizes too large. The latter was later connected to the fact that her
mother was a buxom woman who often wore tight fitting clothes.
Ms. D herself was angry, scared, and she felt overwhelmed by the pros-
pect of having to raise the children of her divorced daughter by herself. Ms.
D was seen alone to process her grief experience and to plan strategies to
support the granddaughter in her difficult grief reaction. Fortunately, her
daughter was a very effective parent and she had few behavior problems
with the children. However, due to Ms. D’s emotional state she felt unable to
provide the structure and to set limits for the children. The disorganization of
the family was the first area for intervention. The therapist supported her in
setting clear limits and to provide the opportunity to include the death in
their daily conversations. The children were assured that Ms. D could handle
their input about their mother and to share their grief, a process that oc-
curred slowly over a period of several months.
Third Task of Mourning
The third task of mourning is adapting to the environment where the de-
ceased is missing (Worden, 1991). The adaptation to the loss starts at the
time of death. This task serves as the transition from the disorganization
phase to the reorganization phase. The progression from shock to confusion
now emerges into a realization of what changes the death has created for the
individual and family. The loss is highlighted by the changes in the practical,
everyday routines. This adaptation process requires new individual and in-
terpersonal patterns to be established. This means new responsibilities and
changes in lifestyle while grieving the loss. The family must be able to cope
with disorganization while working to realign relationships and delegate
new family roles.
Systemic Interventions
The therapist now shifts to actively challenging the bereaved to organize
new behavioral patterns. This is accomplished by helping the bereaved as-
sume responsibilities, take risks into new areas and activities, and to become

Death in the Family
71
aware of how the practical aspect of day-to-day living mirrors their grief
process. The family simultaneously experiences the grief and begins to more
effectively adapt to the changes. The family defines the new roles and re-
sponsibilities and a shift in boundaries helps begin to promote adaptation.
Clinical Examples
During a support group for survivors of recent deaths, Ms. V, whose hus-
band died over a year ago, spoke about a recent night out with her friends.
This was her first venture out of the house since her husband’s death. She
returned home late in the evening and was struck with the fact that the
house was dark. Her husband would have been driving her and he also
always left the lights on for their return. This new and unfamiliar event
provided her with the realization that the loss of her spouse of 35 years
meant she had to adapt her environment in a practical manner.
Fourth Task of Mourning
The final task of mourning is the reinvestment of emotional energy in rela-
tionships with the living (Worden, 1991). The individual turns their attention
to reestablishing intimate relationships. The bereaved still has room for the
deceased in their everyday experience but their focus is now expanding the
other facets of their life.
At the family level, the deceased is included in family life. This process
is particular to each family based on the role of the deceased and type of
death. The family assigns the deceased a place in their world. The loss has
less of an impact on the daily functioning of the family.
Systemic Interventions
The therapist’s work centers on continued coping with the loss and promoting
an expanded social network. The direction is to help the bereaved to rees-
tablish the relationship with the decreased in a form that allows new relation-
ships to be established. The therapist also focuses on the guilt feelings of the
bereaved for moving on without the deceased. The bereaved finds a unique
way to include the deceased in their daily life while building other relation-
ships.
Clinical Examples
Mr. R’s 31-year-old wife, while driving home after leaving their 4-year-old
son at daycare was hit broadside by a teenager drag racing. Her 5-month-old
son was uninjured, but she died instantly. The family entered treatment 9
months after the accident. At 18 months after the death, the father was utiliz-

72
J. McBride and S. Simms
ing occasional sessions for support. The last sessions revolved around the
father’s new relationship. He met a divorced woman with two children and
it quickly became a serious relationship.
The therapist punctuated the father’s shift from his relationship with his
deceased wife to his new partner. This included dealing with the feelings of
disloyalty contrasting with the need for a new relationship for himself and a
mother figure for his three children. This complex process included the
blending of the families leaving a respected position for the surviving children’s
mother while creating a new family structure.
THE THERAPIST’S PERSONAL CONTEXT
Therapists involved in working with the bereaved face the difficult task of
being with clients that are struggling with loss and grief. It can be said that all
mental health work includes being with clients experiencing pain but grief
work is unique in the permanency and depth of the loss. It is important for
the therapist’s own context to include a professional and personal support
system. The professional support network can include targeted supervision,
connection with colleagues who do similar type of work, and membership
in professional societies specializing in working with death and dying issues.
The personal network starts with the therapist having faced the issues of
grief and loss in their own lives. A therapist providing grief therapy does not
need personal experience with loss. What can be helpful is for the therapist
to have an awareness of his or her own struggles with death. This is to
suggest that the therapist be aware of how these personal feelings and struggles
inform the therapy process. A personal network can be helpful to provide
support to the therapist. It is the times when the therapist starts to look over
their shoulder thinking that something is to happen to them (e.g., excessive
worrying about themselves and family members) that the support system
can add some important perspective. The compassion and energy required
for this work dictates that the therapist develop a supportive network.
CONCLUSION
A framework was presented for adapting a family systems approach to the
grief process. This framework places the bereaved and therapist in the larger
context. Tuning into the context that surrounds each death and using the
grief timeline to facilitate timely systemic interventions are fundamental ac-
tivities. This person-in-context focus helps the therapist navigate pitfalls and
remain strategically positioned to sensitively and effectively address grief in
psychotherapy.

Death in the Family
73
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