Mourning and grief as healing processes in psychotherapy.

The argument developed in this paper can be outlined as follows: relationships are vital for growth, for adults and especially for children; to ensure that we work to maintain relationships, evolution provided for pain on separation, which stimulates behaviours designed to restore the relationship. If the separation is permanent, it is necessary to form other relationships. This requires modifying the attachment to the lost object, a process which involves unlearning of emotional bonds and then learning new bonds to new objects. The process of mourning and the affective state of grief, I believe, assist in this unlearning and new learning. The stages of mourning involve cognitive learning of the reality of the loss; behaviours associated with mourning, such as searching, embody unlearning by extinction; finally, physiological concomitants of grief may influence unlearning by direct effects on neurotransmitters or neurohormones, such as cortisol, ACTH, or norepinephrine. Besides losses occasioned by bereavement, life and normal development include many other kinds of losses. Mourning for these losses is as necessary as mourning after a death. Failure to adequately mourn can result in psychopathology or psychosomatic illness. In comparison, appropriate mourning is adaptive, and parallels can be drawn between it and healing in psychotherapy. The psychoanalytic and psychotherapeutic literature supports the notion that mourning and grief in therapy act to heal. Given that there may be a biological basis for this healing through the effects of mourning on learning, psychotherapists might actively seek to encourage identification of losses and their adequate mourning in therapy. Various approaches are discussed. Two case reports of mourning occurring in psychotherapy are given, followed by suggestions for research.