Crossover   Therapy     
  Sometimes when you lose, you win  
    Introduction

It’s not uncommon for the bereaved to experience vivid visions and to regularly engage in conversations with the deceased. While this need to continue interacting with the deceased usually passes, sometimes it does not: either the bereaved still needs to, but can no longer maintain, the interaction, and resorts to suicide due to a conviction that “this is the only way out”; or the interaction with the deceased intensifies to such an extent as to lead the bereaved to completely withdraw from the world.

Therapies that seek to coerce or persuade those who are bereaved into abandoning the deceased, at best, have little impact, and, at worst, hasten their journeys towards suicide or psychosis.

Crossover therapy is specifically designed to avoid these outcomes: the therapist embraces the world view of the bereaved, facilitating and directing the intense interactions between the bereaved and the deceased. The absence of coercion ensures that the overtures of the therapist are not rejected, and, that by having a foot in both worlds, the therapist can provide the bereaved with a path back to the outside world, one which the bereaved will typically, and voluntarily, choose to follow at some later stage in the grieving process:

If you have any questions, comments, or would like to discuss crossover therapy, then you can do so here.

    Societal Reactions

What happens when someone is discovered to be talking to the dead? How does society react? Well, it will depend on country, on religious and cultural setting, and on the personality traits of those who are close to the bereaved. However, societal reactions usually consist of one or more of the following:

*Rejection

*Demands to Desist

*Ostracization

*Coercive Treatment

Rejection

The conversations between those who are bereaved and the deceased appear extraordinarily realistic: it’s evident to anyone seeing these interactions that the bereaved is not just acting, but really sees – according to philosophical predilection – the deceased or a clear mental representation of the deceased.

Some people believe in the existence of ghosts and spirits. By conversing with the deceased, these individuals may see the bereaved to be unnaturally drawing the deceased back from some spirit world, or to be conversing with an evil spirit that is imitating the deceased. In either case, these individuals will consider it highly likely that misfortune will follow from being in the physical presence of the bereaved.

Some people will see in the behaviour of the bereaved a manifestation of mental illness – whether labelled as madness, insanity, or psychosis. However, even these individuals will almost certainly find the behaviour of the bereaved to be decidedly “creepy” and may experience severe discomfort when in the presence of the bereaved – as with the bukimi no tani (uncanny valley) effect, the human brain seems to be hardwired to avoid people who behave in certain ways, and even psychiatrists and ministers of religion, who more frequently encounter this type of behaviour, may well feel uncomfortable.

Irrespective of the explanations put forward for the bereaved’s behaviour, many people will seek to distance themselves from the bereaved: some friends and family members will cut off all contact with the bereaved, while those who maintain contact will evince feelings that range from anxiety to disgust.

Demands to Desist

Stop doing it! Whether it’s friends, family members, or those acting in a professional capacity, there is usually a strong demand – be it implicit or explicit – made of the bereaved to desist from conversing with the deceased – stop being self-indulgent, don’t bring disgrace on the family, act normally just like everyone else.

However, rather than “rectifying” the bereaved’s behaviour, these demands will typically reinforce it.

Ostracization

Having a family member who is conversing with the dead is often seen to reflect very badly on the family concerned – to be a source of considerable embarrassment, and to damage the standing of family members within the wider community.

The typical reaction in these circumstances is to banish the bereaved, as quickly as possible, to some remote, isolated location, one where others outside the family circle will not see or hear stories about the bereaved’s “unacceptable” behaviour. This ostracization might involve dispatching the bereaved to live with relatives in the country, or incarcerating the bereaved within the confines of a mental hospital or specialist institution.

Coercive Treatment

Many societies will instigate some form of coercive treatment in an attempt to normalize the bereaved’s behaviour. More often than not, the purpose is not to alleviate the bereaved’s distress but to prevent the overt signs of the bereaved’s behaviour from manifesting – the express objective of the treatment being to salve, to reassure, to assuage the discomfort of those who, needs must, remain in contact with the bereaved. For example, a coercive treatment might take the form of:

*A ceremony to banish an evil spirit – a treatment which could make matters either better or worse depending on the bereaved’s prevailing belief system;

*Pharmaceutical medication, such as antidepressive, sedative, or antipsychotic drugs.

Even advocates of pharmaceutical treatments admit that these treatments are only likely to offer marginal benefits. Even in less severe cases of complicated grief, the treatment of depressive symptoms with antidepressants only lowers TRIG (Texas Revised Inventory of Grief) scores by (5-10)% [1].

The use of strong sedatives has the benefit of allowing the bereaved to catch up on lost sleep (with close to 50% of obstetricians prescribing sedatives for mothers of stillborn infants [2]). However, while helping to prevent physiological damage, sedatives do not impact the degree of psychological stress present when their effects wear off.

If the bereaved does not have an undiagnosed mental illness, then the use of antipsychotic drugs, such as dopaminergic agents, that might redress neurochemical imbalances is very unlikely to be effective. A review of pharmaceutical approaches to complicated grief [1] concluded that there is no current indication for the use of antipsychotics, and that given their safety profiles they are unlikely to be used as a first-line treatment in the future.

How to Help!

None of these typical societal reactions is likely to benefit the bereaved, and most of them are likely to do considerable harm. Even if these reactions do not push the bereaved towards suicide or psychosis, and the bereaved’s need to converse with the deceased passes with time, the inevitable consequence of these societal reactions is that the bereaved will become estranged from family and friends: being rejected, being ostracized, being forced to take treatments, and being told to desist from conversing with the most important person in your life will, at best, engender indifference and, at worst, hatred.

So, if you want to help someone in these circumstances, and wish to maintain a good relationship with that person in the future, then you need to eschew these ill-considered, visceral, “knee-jerk” reactions. In order to help, you need first to learn to see the world from the perspective of the bereaved, to understand how it feels to suffer from intense grief.

    Conversing with the Dead

Talking about “the bereaved engaging in conversations with the deceased” is all rather abstract. What does it mean in practice? Would you like to listen in on a real “live” conversation with the dead?

Imagine that a friend, Andie, has become very withdrawn and won’t speak to anybody following the death of her brother, Tim. You hear her engaged in what seems to be a telephone conversation in another room:

*Andie: Thanks.

*Andie: I couldn’t ...

*Andie: Not for long. They’re going to find out about you and then we’re going to have to leave each other ...

*Andie: Promise me? Because I can’t lose you. I don’t have this with anyone else. Nobody listens like you do.

*Andie: I’m so scared ...

A little strange. Sounds like she’s talking to a boyfriend. But it’s good that at last she’s taking to someone.

It’s later that same day when you come downstairs. You can see Andie through the partially open kitchen door talking in an animated fashion – good you think, she’s getting better:

*Andie: You’re late. I thought you’d come earlier.

*Andie: Look, we can’t talk right now, okay? Pacey’s upstairs and I don’t want him to find out about –

*Andie: Look, you know what? It’s just too hard having you both here at the same time, okay! I can’t just tell him. It’s not that easy. There are too many repercussions that I’m not ready to deal with. Besides, why do I have to tell him in the first place? Would you understand if you were him?

*Andie: Then there’s nothing I can do.

*Andie: I won’t do that, Brown.

You enter the kitchen just as Andie finishes one sentence. No one is there. The animated conversation ceases abruptly, and Andie becomes sullen and unresponsive once again.

Then you recall, with a sinking feeling, one part of the conversation: “Brown” was the pet name that Andie used to use to refer to her dead brother when she was a child. All those conversations you’ve overheard have not been with some boyfriend. All the time she’s been talking to Tim.

And what is perhaps even more shocking is the contrast between the happiness and animation in her voice when she is speaking with the “dead” and the apathy and listlessness that accompany the few words she exchanges with family and friends.

She’s slipping away into another world, one that exists entirely within her own mind. You’ve recently attended a funeral for the dead, and now you foresee a funeral of another sort, a funeral for the living.

You’ve only heard one side of these conversations, but how did these conversations go from Andie’s perspective. Well, here is the transcript:

*Tim: I like your hair.

*Andie: Thanks.

*Tim: Did you tell her about me?

*Andie: I couldn’t ...

*Tim: That’s good. What we have is a secret.

*Andie: Not for long. They’re going to find out about you and then we’re going to have to leave each other ...

*Tim: I’m not going anywhere.

*Andie: Promise me? Because I can’t lose you. I don’t have this with anyone else. Nobody listens like you do.

*Tim: I know ...

*Andie: I’m so scared ...

and:

*Andie: You’re late. I thought you’d come earlier.

*Tim: Are you okay?

*Andie: Look, we can’t talk right now, okay? Pacey’s upstairs and I don’t want him to find out about –

*Tim: I don’t care about him. I care about you. And I hate seeing you like this.

*Andie: Look, you know what? It’s just too hard having you both here at the same time, okay! I can’t just tell him. It’s not that easy. There are too many repercussions that I’m not ready to deal with. Besides, why do I have to tell him in the first place? Would you understand if you were him?

*Tim: I guess I wouldn’t.

*Andie: Then there’s nothing I can do.

*Tim: Something ... You can choose.

*Andie: I won’t do that, Brown.

These are fictional conversations taken from an episode of the TV series Dawson’s Creek (Season 2: Reunited) – an episode which you might well find worth watching. However, from the discussions I’ve had with clients, these conversations are quite realistic, particularly in terms of the themes and leitmotifs that reoccur; namely, that the bereaved:

*Has a very strong inclination to maintain contact with the deceased;

*Receives much more understanding from the deceased than from family and friends;

*Is under great pressure to keep the conversations with the deceased a secret – telling family and friends about these conversations would have “too many repercussions” and they wouldn’t understand;

*Knows that a choice will have to be made, one that involves abandoning the deceased or abandoning the external world of family and friends – trying to maintain both sets of relationships and to keep one of them a secret involves too much stress;

*Finds that the deceased is actively encouraging one particular choice, whereas family and friends are typically not even aware that a choice will have to be made, and even if they are aware, they are very ineffective at arguing their corner.

So, if you have a friend or family member who is conversing with the dead, then you need to appreciate that the cards are stacked against you, and that any intervention by you, or by a health-care professional, that forces the bereaved to make a choice is likely to fail – the bereaved is likely to choose the deceased and not you and the world to which you belong.

    A Great Gulf

As someone who is experiencing intense grief, you will have discovered that one of its key, but underappreciated, characteristics is isolation. But the nature of this isolation is not understood by those around you, by family and friends. They mistakenly believe that because you are surrounded by people – people who are sympathetic and ready to help – you could not possibly be isolated. They do not understand that the isolation you feel is a mental isolation, one that arises from the vast disparity between the impact that the death has had on you relative to the impact that it has had on them.

Your interactions with professionals – be they grief counsellors or psychiatrists – confirm your suspicions: it’s very clear that they are just going through the motions, that they don’t understand how deep, how profound, how unbridgeable is the gulf that currently separates you from the rest of humanity.

One of my clients quoted a verse that is particularly apposite (The Rich Man and Lazarus, Luke 16:26):

*And beside all this, between us and you there is a great gulf fixed: so that they which would pass from hence to you cannot; neither can they pass to us, that would come from thence.

You alone can see this great gulf, but those around you are oblivious to its existence.

    Sometimes When You Lose, You Win

If you’re looking towards the future and see either suicide or withdrawal as the least worst option available, then you might find that the portrayal of isolation in the film What Dreams May Come to have a strong resonance.

In this film, Annie and Christy have lost their two children in a car accident. Annie has become withdrawn and suicidal, and has been placed in an institution. She lets her husband know that she wants a divorce. The two meet within the grounds of the institution, where the following conversation takes place:

*Annie: I’m teaching myself to smoke. The doctors call it an affirmation of life.

*Christy: You said “divorce”. You got my attention.

*Annie: I think that we’re too different ... to stay together. I mean .... Well, for one thing, why aren’t you in here? Why didn’t you go crazy? Your children died.

*Christy: I remember. I remember the silence in the house. I thought I was supposed to be strong.

*Annie: For me?

*Christy: For me. For us. Just on general principles. I loved them, Annie. But they’re gone. You’ve got a choice. Life either goes on ... or not.

*Annie: And you choose life. Sometimes, when you win, you lose.

This conversation illustrates admirably the vast gulf that can develop between different individuals who share the same relationship with the deceased. If someone does not react in the same way as you do following a death, they can instantly become a stranger: “We’re too different”, “Why didn’t you go crazy?”

By not following you and succumbing to intense grief, other friends and family members may “win”, after a fashion, but it may be a pyrrhic victory when in doing so they “lose” contact, not just with the deceased, but also with you – with one who remains, at least provisionally, among the living.

There can be a strong sense that you’ve got to choose “life” or “death”, but that “death” is the right choice. That choosing life – the now “illusory world” that corresponds to normality – would, at least for you, not be to win, but to lose. That choosing “death”, whether literally or by way of an existence in an “illusory world” populated by the deceased, is the least worst option. From your perspective this choice is entirely rational: it comes down to the value that you place on the deceased, and for you that value may outweigh all else.

Even if people recognize the vast gulf that exists between you and other people, if they recognize that you have chosen “death”, they mistakenly try to pull you back across that gulf to their side, to an empty normality where you are required to exist without the companionship of the deceased. But their inducements are unlikely to have the desired effect, for “when push comes to shove” you will, most likely, spurn their world rather than forsake the deceased.

Unfortunately, a failure to understand how the bereaved is likely to react is still far too common among those therapists who deal with the more severe cases of complicated grief. What is needed, and what is distinctive about crossover therapy, is the understanding that now is not the time to force the issue, to adopt an adversarial approach, irrespective of how understated this approach may be when couched within the guidelines of a professional protocol – withdrawn you may be, but your isolation makes you exquisitely sensitive to those possessed of a manipulative intent.

In the film, Christy is killed in an accident, and finds himself in an afterlife (one that is a synthesis of various religious paradigms). Shortly after his death, Annie commits suicide. Christy expects to be reunited with Annie, but is disappointed. He learns that in this afterlife everyone creates his or her own world, and that communication between these worlds is based on mutual consent. Annie has built an isolated, crypt-like world around herself, so that the gulf between her and Christy that existed in life has become even greater in death.

At the end of the film, Christy decides to crossover and join Annie in the desolate world that she has created for herself. In doing so, the sense of isolation that led Annie to create this world in the first place is assuaged, and with Christy’s demonstration of solidarity her sequestered, cloistered, enisled world collapses, allowing her to rejoin Christy within his:

*Annie: Sometimes, when you lose ... you win.

And this is precisely the objective of the crossover therapist, to join you on your terms, to deliberately lose, in the hope that in time both of you will win!

    Characteristics of Crossover Therapy

In brief, crossover therapy involves the collaboration between the bereaved and a surrogate for the deceased on a project that involves the construction of a series of written scripts (each of which forms a short play or playlet). These scripts detail interactions – either real or imagined – between the bereaved and the deceased; they are constructed and continuously evolve as the grieving process progresses. The bereaved acts out these playlets, taking in turn the parts of the narrator, the bereaved, and the deceased.

For those individuals who can successfully embrace this paradigm (typically those who are strongly drawn to carry on conversations with the deceased), this therapy provides a powerful mechanism for mitigating the negative experiences of grieving. It gently ushers the bereaved into a new world, one where the deceased is fondly remembered, but also one where the deceased is still readily accessible in a surrogate form:

*“Writing letters is actually a communication with ghosts, and by no means just the ghost of the addressee but also with one’s own ghost, which secretly evolves inside the letter one is writing.” (Franz Kafka, Letters to Milena)

Crossover therapy overcomes the limitations of the talking therapies and addresses the key problems that are associated with a sudden loss:

*Mental Engagement

*Discontinuity of Loss

*Unsaid Goodbyes

*Unresolved Conflicts

Mental Engagement

One key difficulty with any talking therapy is that you may not feel inclined to talk. This may be because it’s just uncomfortable to do so, or simply because your mind is functioning in a slower, more ponderous manner. In the case of the former, being pressed to talk by a counsellor just generates hostility, while in the case of the latter there is nothing to say.

Crossover therapy overcomes these difficulties because it relies on the written word and not the spoken word: you may not wish to talk to someone just now, but you may well be prepared to commit your thoughts to the page or to the screen of a wordprocessor; you can write as and when you feel inclined, adding a few words, deleting them, changing them. The ability to edit what you have written allows you to tentatively follow different lines of thought. It has been my experience when dealing with clients that some of those who have no wish to talk are quite capable of expressing themselves in writing. Yes, at times the text can be fragmentary and somewhat incoherent, but for some individuals this process proves to be very helpful.

A second key difficulty with any talking therapy is its superficial nature. Talk is cheap. It is not considered. It doesn’t engage the subconscious mind. And the subconscious mind, rather than the conscious mind, is the principal protagonist in the grieving process. As neurobiology readily demonstrates, mental processing first occurs subconsciously. And when thoughts or emotions are experienced they only reflect some, but not all, of this underlying subconscious “mentation” – like the shadows cast upon a wall by flickering flames, the contents of the conscious mind are the by-products, the causata of subconscious processes.

The written word (when it extends beyond tweets, text messages, and cursory emails) requires more considered thought: the written word requires subconscious engagement (in contrast to the almost reflex reaction that characterizes the spoken word). The act of writing for non-trivial purposes demands of the subconscious: “What do you think!” Rather than a purposeless and seemingly endless churn, the subconscious mind is encouraged to articulate what it thinks, what it feels, what the options are going forward. And in doing so the grieving process moves forward towards a resolution in a much faster manner than is customarily the case – at least that has been my experience from working with those clients who have engaged in this process.

Discontinuity of Loss

It’s not always appreciated that it is not so much “loss” that occasions grief, but the “suddenness of loss”. Intense grief is driven by the sudden discontinuity in the relationship: yesterday your friend or partner was present; today he or she is gone, gone forever!

For example, consider how much each of these two scenarios concerning a close friend would impact you: in the first, your friend will die within a week; in the second, you will be able to interact with your friend twice a week for the next few months, then once a week for six months, then once a month for a few years. And if at any time a particularly traumatic incident occurs in your life, then your friend can come back to visit for a short period?

The impact of crossover therapy on grief closely mirrors the impact of the second scenario. The surrogate for the deceased interacts with you in the same manner as the deceased would have done via the unfolding series of playlets, with the frequency of interaction decreasing as time progresses. However, if some event in your life warrants it, then a new playlet can be created to help you cope with that event. For example, one client of mine had lost her husband a number of years ago and had been coping quite well until her daughter decided to marry. The absence of her husband to give the bride away reignited her grief, and we created a new playlet involving her husband giving away his daughter and making a speech at the reception to provide some stability around this event.

Unsaid Goodbyes

One of the big problems with an unanticipated death is that there has been no opportunity to say those goodbyes, to express how you feel about the deceased. Even when a terminal illness is present, those goodbyes are often left unsaid, as neither party may be willing to discuss the issue – there is often a feeling that discussing an impending death would be too uncomfortable for the other party, or there may even be an inchoate feeling that discussing a death may hasten its occurrence. Crossover therapy provides an opportunity to say those goodbyes.

Unresolved Conflicts

Another problem with death is that few relationships are perfect: there are often unresolved conflicts that can fester and interfere with the grieving process. Crossover therapy provides a means of resolving outstanding conflicts, with the surrogate saying those things that the bereaved needs to hear in order to resolve the conflict.

    Steps of Crossover Therapy

The Character Synopsis

At the beginning of crossover therapy you need to prepare a character synopsis: a summary that describes the characteristics and interests of the deceased, and that outlines how the deceased is expected to act. This synopsis need not accurately reflect the characteristics of the deceased: instead its purpose is to reflect how you want to remember the deceased. You have a licence to attribute to the deceased any desirable characteristics that you wished the deceased had possessed in life. As many bereaved individuals tend to idealize the deceased, these exaggerations come naturally.

Selecting the Surrogate

You could, of course, write a playlet without a surrogate. I’ve tried this approach with clients on a number of occasions, but they’ve always concluded that the fact that the surrogate is contributing the dialog on behalf of the deceased adds considerably to the sense of reality, and reduces the feelings of isolation and withdrawal. Another reason why introducing a surrogate is very important is that it’s very common for those who are bereaved to be unable to initiate actions by themselves, whereas they can readily participate in those actions that are initiated by others [3].

So, the next step is for you to select a surrogate for the deceased – it could be a friend or it could be a counsellor. Like a scriptwriter working on a new play, the surrogate takes the character synopsis that you have prepared and uses it as the basis for how the deceased should behave within the context of a playlet.

Constructing a Playlet

The next step is for you to select the theme for the first playlet – a brief description of the scene at the beginning of the playlet. Then you start off by creating the first line of dialogue for your part – that is for the part of the bereaved. The surrogate will then respond with a line of dialogue on behalf of the deceased – based on the types of behaviour specified in the character synopsis. You and the surrogate then alternate back and forth with lines of dialogue, together with additional descriptions of the scene, as appropriate, until the playlet is complete.

Together you can revise and adjust the contents as you see fit. The speed at which a playlet is constructed is down to you. You could sit down together, or you could exchange lines of dialogue via texts of email. The latter approach tends to work best, as you are always in a position of expecting a new response and wondering what it might be. With clients, I’ve found it helpful to send lines of dialogue throughout the day and the last thing at night; if the client wakes up in the middle of the night then another line of dialogue will be waiting for a response, or, if not, it will be available first thing in the morning.

The continuous sense of expectation helps to keep you “tethered” to the outside world.

Acting Out the Parts

At various stages during the preparation of a playlet, you read the script out loud using different voices for the narrator and the surrogate (you could get the surrogate to read the part of the deceased, but I’ve usually found that clients find a greater degree of realism when they emulate the voices of the deceased themselves). Once complete, you make an audio recording of the playlet, one which you can play back at any time to remind you of the experiences that you and the deceased “enjoyed together” (some clients even try a video recording and act out their parts in the playlet, but, in general, an audio recording seems to work best).

Sequencing and Run-Down

Playlets can be constructed one after another, or several can be constructed in parallel – as is the case in real life. These playlets can be a source of considerable comfort, and for some people with a strong imagination constructing them can have almost the same impact as interacting with the deceased. Over time as the grieving process progresses, the playlets reduce in number and each takes a longer time to complete.

Re-engagement

When circumstances demand, the device of the playlet can be resurrected as a temporary measure. For example, I had one client whose husband had died early in the year and who had been coping reasonably well until the following Christmas, when she felt a renewed sense of sadness. To work through this difficult period, we created a playlet that centred around the decoration of the Christmas tree – a task that she and he former husband used to perform together. Her character synopsis was enhanced to describe how she and her husband would decorate the tree, and how they would disagree over exactly where to place the lights; she also sent me some photographs of how the tree had looked in previous years. Over several weeks, we exchanged about a dozen brief emails a day adding more and more dialogue to the playlet. By the next Christmas her grief had largely faded away and she found sufficient comfort in replaying the audio of the playlet from the previous year.

Why it Works

Firstly, as far the bereaved is concerned there is no need to keep those conversations with the deceased a secret. Indeed, at the start of the process, the playlets may be written almost entirely by the bereaved, and serve as diary entries of his or her conversations with the deceased.

Secondly, there is no longer the same pressure to visualize and hold conversations with the deceased. The surrogate’s dialog in a playlet offers an alternative (even though at the beginning it may be a less satisfactory alternative). As a result, the frequency with which the bereaved holds conversations with the deceased decreases over time, as the interactions with the surrogate begin to replace those with the deceased.

Thirdly, throughout the process the bereaved is having regular daily contact with the external world. The bereaved comes to realize that there is no need to make a choice between worlds, and that both worlds can continue to exist side by side. In time, memories of the deceased – encouraged through creating, rehearsing, and replaying the playlets – serve as a satisfying alternative to direct visual and conversational interactions.

The overall result is a smooth transition from a life that is centred solely around conversations with the deceased to one in which the deceased becomes the subject of occasional reflection – a transition that proceeds entirely at a speed comfortably to and at the instigation of the bereaved.

    Helping the Bereaved

If you find the bereaved engaged in a conversation with the deceased, then what should you do?

Keep It a Secret

One thing to be very wary about is telling other people about what you’ve seen. If you do, then it’s quite likely that you will precipitate the standard societal reactions – and that, unfortunately, may well be “endgame”. If you feel that the situation is too difficult for you to handle alone, then consider discussing the matter discreetly with a medical professional.

Establishing Solidarity

The single most important thing to do is to show solidarity with the bereaved. But it’s important to do so in a roundabout manner: don’t be blunt, “Andie, I’ve heard you talking to someone who isn't there” – let the bereaved volunteer that information if he or she wishes to do so.

The best way forward initially is to reminisce about the deceased: “I keep thinking a lot about Tim. Do you remember that time when he climbed up on to the roof of the house and then couldn’t get down.”

This type of conversational gambit allows you to discuss the deceased, without requiring the bereaved to respond. Sometimes the bereaved will join in and sometimes not – but the bereaved is likely to be listening intently.

Identifying Points of Continuity

Reminiscing allows you to direct the bereaved’s thought processes towards those aspects of the deceased’s life that are likely to be the most helpful. In particular, try to focus on those things that the deceased cared about and which are still present in the bereaved’s life.

For example, if a mother is ignoring her daughter following the death of her husband, you might reflect on how fond the deceased was of his daughter: “Do you remember how John used to play with Mary on that swing in the garden. Mary seems so sad now.”

Engaging in Shared Activities

Try to get the bereaved to opt into activities that involve the deceased, “I’m going to look for an old album of photographs in the attic. Would you like to come along?” or “I was thinking of making a memorial website for Tim. Could you help me decide what to put on it?”

Creating playlets is just another, and more structured, variant on this theme of shared activities that focus on the deceased. When it comes to crossover therapy, it’s the general principles that matter rather than the specifics.

Talking to the Deceased

Try to move the conversation towards the sensitive issue of the bereaved’s habit of talking with the deceased: “It’s odd but sometimes I almost find myself having a conversation with Tim. But they say that’s quite common after someone close to you has died.” The objective here is twofold: to establish that having such conversations is not uncommon, and to admit that you too find such conversations helpful.

Sometimes the bereaved will know that you know. If so, then indicate that you are not going to tell anyone. For example, if you come in on the bereaved speaking to someone who isn’t there, then don’t act in a surprised manner. Just sit down, and muse to yourself, “Taking to Tim, were you. I find myself doing that at times. Best not to tell anyone. They might not understand.”

Agreeing to keep your knowledge of these conversations a secret is very important in gaining the confidence, not just of the bereaved, but also of the deceased: “Well, Andie, I said that this should just be our secret. But I think we can also trust Pacey.” It’s important to understand that you are dealing with two people and not just with one: the deceased acts as a sounding board for the bereaved, as a protector, as an advisor – a confidant who endorses the trustworthy, and who warns against those who are not.

If the bereaved does confide, then try to determine the role that the visions and conversations play in the grieving process. In most cases, they are welcomed as a source of solace and consolation, and as a means for providing continuity in a time of loss.

    Helping Yourself

If you find yourself engaged in conversations with the deceased, then what should you do?

Do I or Don’t I?

The big question is whether or not you should tell someone – a friend, a family member, a doctor, or a minister of religion – about what you are experiencing. And to be quite honest, it’s a question without an easy answer. If the result:

*Is a sympathetic response and that someone is prepared to keep your secret, then telling that someone might take a great load off your shoulders, and could help considerably in the grieving process;

*Is rejection, ostracization, pressure to abandon your conversations with the deceased, and a referral for treatments that you don’t want to take, then, at best, it will greatly intensify the grieving process, and, at worst, it might push you in the direction of suicide or psychosis.

Only you can judge how the people around you are likely to react and which course of action is likely to be the best.

Testing the Water!

If you suspect that disclosure is likely to result in a negative reaction, then consider “testing the water”: instead of stating that you’re having conversations with the deceased, start off by saying something along the lines of, “I keep thinking an awful lot about Tim,” and see what the reaction is like.

If the reaction is sympathetic, then you can slowly open up a little bit more, along the lines of, “For a few minutes the other day I found myself talking to Tim” or “I once thought I saw Tim in the mirror. I was probably mistaken. The room was dark.” In this way, you can slowly open up to the extent that you feel it is safe to do so.

Getting Medical Treatment

Even if you don’t feel comfortable talking to a friend or family member, you might still consider talking to a medical professional. If you’re worried that a doctor will not treat what you have to say in confidence, then you can still discuss other medical symptoms that you might have and receive treatment for these. For example, if you are having great difficulty sleeping, then taking a sedative for a short period might make it easier for you to cope with daily life.

Discussing Your Experiences Anonymously

Another possibility that is always available to you is to openly discuss what you are experiencing anonymously on one of the websites that deal with grieving.

For example, you can do so here on this website – doing so would be less satisfactory than talking through your experiences with a sympathetic friend or family member, but if that option is not available to you, then I’ll do my best!

    References

[1] Bui E., Nadal-Vicens M., Simon N.M., “Pharmacological approaches to the treatment of complicated grief: rationale and a brief review of the literature”, Dialogues in Clinical Neuroscience, 2012, 14(2), 149-157.

[2] Gold K.J., Schwenk T.L., Johnson T.R., “Brief report: sedatives for mothers of stillborn infants: views from a national survey of obstetricians”, Journal of Women’s Health, 2008, 17(10), 1605-1607.

[3] Lindemann E., “Symptomatology and management of acute grief”, American Journal of Psychiatry, 1944, 101(2), 141-148.

 Crossover   Therapy     
  Sometimes when you lose, you win  
    Introduction

It’s not uncommon for the bereaved to experience vivid visions and to regularly engage in conversations with the deceased. While this need to continue interacting with the deceased usually passes, sometimes it does not: either the bereaved still needs to, but can no longer maintain, the interaction, and resorts to suicide due to a conviction that “this is the only way out”; or the interaction with the deceased intensifies to such an extent as to lead the bereaved to completely withdraw from the world.

Therapies that seek to coerce or persuade those who are bereaved into abandoning the deceased, at best, have little impact, and, at worst, hasten their journeys towards suicide or psychosis.

Crossover therapy is specifically designed to avoid these outcomes: the therapist embraces the world view of the bereaved, facilitating and directing the intense interactions between the bereaved and the deceased. The absence of coercion ensures that the overtures of the therapist are not rejected, and, that by having a foot in both worlds, the therapist can provide the bereaved with a path back to the outside world, one which the bereaved will typically, and voluntarily, choose to follow at some later stage in the grieving process:

If you have any questions, comments, or would like to discuss crossover therapy, then you can do so here.

    Societal Reactions

What happens when someone is discovered to be talking to the dead? How does society react? Well, it will depend on country, on religious and cultural setting, and on the personality traits of those who are close to the bereaved. However, societal reactions usually consist of one or more of the following:

*Rejection

*Demands to Desist

*Ostracization

*Coercive Treatment

Rejection

The conversations between those who are bereaved and the deceased appear extraordinarily realistic: it’s evident to anyone seeing these interactions that the bereaved is not just acting, but really sees – according to philosophical predilection – the deceased or a clear mental representation of the deceased.

Some people believe in the existence of ghosts and spirits. By conversing with the deceased, these individuals may see the bereaved to be unnaturally drawing the deceased back from some spirit world, or to be conversing with an evil spirit that is imitating the deceased. In either case, these individuals will consider it highly likely that misfortune will follow from being in the physical presence of the bereaved.

Some people will see in the behaviour of the bereaved a manifestation of mental illness – whether labelled as madness, insanity, or psychosis. However, even these individuals will almost certainly find the behaviour of the bereaved to be decidedly “creepy” and may experience severe discomfort when in the presence of the bereaved – as with the bukimi no tani (uncanny valley) effect, the human brain seems to be hardwired to avoid people who behave in certain ways, and even psychiatrists and ministers of religion, who more frequently encounter this type of behaviour, may well feel uncomfortable.

Irrespective of the explanations put forward for the bereaved’s behaviour, many people will seek to distance themselves from the bereaved: some friends and family members will cut off all contact with the bereaved, while those who maintain contact will evince feelings that range from anxiety to disgust.

Demands to Desist

Stop doing it! Whether it’s friends, family members, or those acting in a professional capacity, there is usually a strong demand – be it implicit or explicit – made of the bereaved to desist from conversing with the deceased – stop being self-indulgent, don’t bring disgrace on the family, act normally just like everyone else.

However, rather than “rectifying” the bereaved’s behaviour, these demands will typically reinforce it.

Ostracization

Having a family member who is conversing with the dead is often seen to reflect very badly on the family concerned – to be a source of considerable embarrassment, and to damage the standing of family members within the wider community.

The typical reaction in these circumstances is to banish the bereaved, as quickly as possible, to some remote, isolated location, one where others outside the family circle will not see or hear stories about the bereaved’s “unacceptable” behaviour. This ostracization might involve dispatching the bereaved to live with relatives in the country, or incarcerating the bereaved within the confines of a mental hospital or specialist institution.

Coercive Treatment

Many societies will instigate some form of coercive treatment in an attempt to normalize the bereaved’s behaviour. More often than not, the purpose is not to alleviate the bereaved’s distress but to prevent the overt signs of the bereaved’s behaviour from manifesting – the express objective of the treatment being to salve, to reassure, to assuage the discomfort of those who, needs must, remain in contact with the bereaved. For example, a coercive treatment might take the form of:

*A ceremony to banish an evil spirit – a treatment which could make matters either better or worse depending on the bereaved’s prevailing belief system;

*Pharmaceutical medication, such as antidepressive, sedative, or antipsychotic drugs.

Even advocates of pharmaceutical treatments admit that these treatments are only likely to offer marginal benefits. Even in less severe cases of complicated grief, the treatment of depressive symptoms with antidepressants only lowers TRIG (Texas Revised Inventory of Grief) scores by (5-10)% [1].

The use of strong sedatives has the benefit of allowing the bereaved to catch up on lost sleep (with close to 50% of obstetricians prescribing sedatives for mothers of stillborn infants [2]). However, while helping to prevent physiological damage, sedatives do not impact the degree of psychological stress present when their effects wear off.

If the bereaved does not have an undiagnosed mental illness, then the use of antipsychotic drugs, such as dopaminergic agents, that might redress neurochemical imbalances is very unlikely to be effective. A review of pharmaceutical approaches to complicated grief [1] concluded that there is no current indication for the use of antipsychotics, and that given their safety profiles they are unlikely to be used as a first-line treatment in the future.

How to Help!

None of these typical societal reactions is likely to benefit the bereaved, and most of them are likely to do considerable harm. Even if these reactions do not push the bereaved towards suicide or psychosis, and the bereaved’s need to converse with the deceased passes with time, the inevitable consequence of these societal reactions is that the bereaved will become estranged from family and friends: being rejected, being ostracized, being forced to take treatments, and being told to desist from conversing with the most important person in your life will, at best, engender indifference and, at worst, hatred.

So, if you want to help someone in these circumstances, and wish to maintain a good relationship with that person in the future, then you need to eschew these ill-considered, visceral, “knee-jerk” reactions. In order to help, you need first to learn to see the world from the perspective of the bereaved, to understand how it feels to suffer from intense grief.

    Conversing with the Dead

Talking about “the bereaved engaging in conversations with the deceased” is all rather abstract. What does it mean in practice? Would you like to listen in on a real “live” conversation with the dead?

Imagine that a friend, Andie, has become very withdrawn and won’t speak to anybody following the death of her brother, Tim. You hear her engaged in what seems to be a telephone conversation in another room:

*Andie: Thanks.

*Andie: I couldn’t ...

*Andie: Not for long. They’re going to find out about you and then we’re going to have to leave each other ...

*Andie: Promise me? Because I can’t lose you. I don’t have this with anyone else. Nobody listens like you do.

*Andie: I’m so scared ...

A little strange. Sounds like she’s talking to a boyfriend. But it’s good that at last she’s taking to someone.

It’s later that same day when you come downstairs. You can see Andie through the partially open kitchen door talking in an animated fashion – good you think, she’s getting better:

*Andie: You’re late. I thought you’d come earlier.

*Andie: Look, we can’t talk right now, okay? Pacey’s upstairs and I don’t want him to find out about –

*Andie: Look, you know what? It’s just too hard having you both here at the same time, okay! I can’t just tell him. It’s not that easy. There are too many repercussions that I’m not ready to deal with. Besides, why do I have to tell him in the first place? Would you understand if you were him?

*Andie: Then there’s nothing I can do.

*Andie: I won’t do that, Brown.

You enter the kitchen just as Andie finishes one sentence. No one is there. The animated conversation ceases abruptly, and Andie becomes sullen and unresponsive once again.

Then you recall, with a sinking feeling, one part of the conversation: “Brown” was the pet name that Andie used to use to refer to her dead brother when she was a child. All those conversations you’ve overheard have not been with some boyfriend. All the time she’s been talking to Tim.

And what is perhaps even more shocking is the contrast between the happiness and animation in her voice when she is speaking with the “dead” and the apathy and listlessness that accompany the few words she exchanges with family and friends.

She’s slipping away into another world, one that exists entirely within her own mind. You’ve recently attended a funeral for the dead, and now you foresee a funeral of another sort, a funeral for the living.

You’ve only heard one side of these conversations, but how did these conversations go from Andie’s perspective. Well, here is the transcript:

*Tim: I like your hair.

*Andie: Thanks.

*Tim: Did you tell her about me?

*Andie: I couldn’t ...

*Tim: That’s good. What we have is a secret.

*Andie: Not for long. They’re going to find out about you and then we’re going to have to leave each other ...

*Tim: I’m not going anywhere.

*Andie: Promise me? Because I can’t lose you. I don’t have this with anyone else. Nobody listens like you do.

*Tim: I know ...

*Andie: I’m so scared ...

and:

*Andie: You’re late. I thought you’d come earlier.

*Tim: Are you okay?

*Andie: Look, we can’t talk right now, okay? Pacey’s upstairs and I don’t want him to find out about –

*Tim: I don’t care about him. I care about you. And I hate seeing you like this.

*Andie: Look, you know what? It’s just too hard having you both here at the same time, okay! I can’t just tell him. It’s not that easy. There are too many repercussions that I’m not ready to deal with. Besides, why do I have to tell him in the first place? Would you understand if you were him?

*Tim: I guess I wouldn’t.

*Andie: Then there’s nothing I can do.

*Tim: Something ... You can choose.

*Andie: I won’t do that, Brown.

These are fictional conversations taken from an episode of the TV series Dawson’s Creek (Season 2: Reunited) – an episode which you might well find worth watching. However, from the discussions I’ve had with clients, these conversations are quite realistic, particularly in terms of the themes and leitmotifs that reoccur; namely, that the bereaved:

*Has a very strong inclination to maintain contact with the deceased;

*Receives much more understanding from the deceased than from family and friends;

*Is under great pressure to keep the conversations with the deceased a secret – telling family and friends about these conversations would have “too many repercussions” and they wouldn’t understand;

*Knows that a choice will have to be made, one that involves abandoning the deceased or abandoning the external world of family and friends – trying to maintain both sets of relationships and to keep one of them a secret involves too much stress;

*Finds that the deceased is actively encouraging one particular choice, whereas family and friends are typically not even aware that a choice will have to be made, and even if they are aware, they are very ineffective at arguing their corner.

So, if you have a friend or family member who is conversing with the dead, then you need to appreciate that the cards are stacked against you, and that any intervention by you, or by a health-care professional, that forces the bereaved to make a choice is likely to fail – the bereaved is likely to choose the deceased and not you and the world to which you belong.

    A Great Gulf

As someone who is experiencing intense grief, you will have discovered that one of its key, but underappreciated, characteristics is isolation. But the nature of this isolation is not understood by those around you, by family and friends. They mistakenly believe that because you are surrounded by people – people who are sympathetic and ready to help – you could not possibly be isolated. They do not understand that the isolation you feel is a mental isolation, one that arises from the vast disparity between the impact that the death has had on you relative to the impact that it has had on them.

Your interactions with professionals – be they grief counsellors or psychiatrists – confirm your suspicions: it’s very clear that they are just going through the motions, that they don’t understand how deep, how profound, how unbridgeable is the gulf that currently separates you from the rest of humanity.

One of my clients quoted a verse that is particularly apposite (The Rich Man and Lazarus, Luke 16:26):

*And beside all this, between us and you there is a great gulf fixed: so that they which would pass from hence to you cannot; neither can they pass to us, that would come from thence.

You alone can see this great gulf, but those around you are oblivious to its existence.

    Sometimes When You Lose, You Win

If you’re looking towards the future and see either suicide or withdrawal as the least worst option available, then you might find that the portrayal of isolation in the film What Dreams May Come to have a strong resonance.

In this film, Annie and Christy have lost their two children in a car accident. Annie has become withdrawn and suicidal, and has been placed in an institution. She lets her husband know that she wants a divorce. The two meet within the grounds of the institution, where the following conversation takes place:

*Annie: I’m teaching myself to smoke. The doctors call it an affirmation of life.

*Christy: You said “divorce”. You got my attention.

*Annie: I think that we’re too different ... to stay together. I mean .... Well, for one thing, why aren’t you in here? Why didn’t you go crazy? Your children died.

*Christy: I remember. I remember the silence in the house. I thought I was supposed to be strong.

*Annie: For me?

*Christy: For me. For us. Just on general principles. I loved them, Annie. But they’re gone. You’ve got a choice. Life either goes on ... or not.

*Annie: And you choose life. Sometimes, when you win, you lose.

This conversation illustrates admirably the vast gulf that can develop between different individuals who share the same relationship with the deceased. If someone does not react in the same way as you do following a death, they can instantly become a stranger: “We’re too different”, “Why didn’t you go crazy?”

By not following you and succumbing to intense grief, other friends and family members may “win”, after a fashion, but it may be a pyrrhic victory when in doing so they “lose” contact, not just with the deceased, but also with you – with one who remains, at least provisionally, among the living.

There can be a strong sense that you’ve got to choose “life” or “death”, but that “death” is the right choice. That choosing life – the now “illusory world” that corresponds to normality – would, at least for you, not be to win, but to lose. That choosing “death”, whether literally or by way of an existence in an “illusory world” populated by the deceased, is the least worst option. From your perspective this choice is entirely rational: it comes down to the value that you place on the deceased, and for you that value may outweigh all else.

Even if people recognize the vast gulf that exists between you and other people, if they recognize that you have chosen “death”, they mistakenly try to pull you back across that gulf to their side, to an empty normality where you are required to exist without the companionship of the deceased. But their inducements are unlikely to have the desired effect, for “when push comes to shove” you will, most likely, spurn their world rather than forsake the deceased.

Unfortunately, a failure to understand how the bereaved is likely to react is still far too common among those therapists who deal with the more severe cases of complicated grief. What is needed, and what is distinctive about crossover therapy, is the understanding that now is not the time to force the issue, to adopt an adversarial approach, irrespective of how understated this approach may be when couched within the guidelines of a professional protocol – withdrawn you may be, but your isolation makes you exquisitely sensitive to those possessed of a manipulative intent.

In the film, Christy is killed in an accident, and finds himself in an afterlife (one that is a synthesis of various religious paradigms). Shortly after his death, Annie commits suicide. Christy expects to be reunited with Annie, but is disappointed. He learns that in this afterlife everyone creates his or her own world, and that communication between these worlds is based on mutual consent. Annie has built an isolated, crypt-like world around herself, so that the gulf between her and Christy that existed in life has become even greater in death.

At the end of the film, Christy decides to crossover and join Annie in the desolate world that she has created for herself. In doing so, the sense of isolation that led Annie to create this world in the first place is assuaged, and with Christy’s demonstration of solidarity her sequestered, cloistered, enisled world collapses, allowing her to rejoin Christy within his:

*Annie: Sometimes, when you lose ... you win.

And this is precisely the objective of the crossover therapist, to join you on your terms, to deliberately lose, in the hope that in time both of you will win!

    Characteristics of Crossover Therapy

In brief, crossover therapy involves the collaboration between the bereaved and a surrogate for the deceased on a project that involves the construction of a series of written scripts (each of which forms a short play or playlet). These scripts detail interactions – either real or imagined – between the bereaved and the deceased; they are constructed and continuously evolve as the grieving process progresses. The bereaved acts out these playlets, taking in turn the parts of the narrator, the bereaved, and the deceased.

For those individuals who can successfully embrace this paradigm (typically those who are strongly drawn to carry on conversations with the deceased), this therapy provides a powerful mechanism for mitigating the negative experiences of grieving. It gently ushers the bereaved into a new world, one where the deceased is fondly remembered, but also one where the deceased is still readily accessible in a surrogate form:

*“Writing letters is actually a communication with ghosts, and by no means just the ghost of the addressee but also with one’s own ghost, which secretly evolves inside the letter one is writing.” (Franz Kafka, Letters to Milena)

Crossover therapy overcomes the limitations of the talking therapies and addresses the key problems that are associated with a sudden loss:

*Mental Engagement

*Discontinuity of Loss

*Unsaid Goodbyes

*Unresolved Conflicts

Mental Engagement

One key difficulty with any talking therapy is that you may not feel inclined to talk. This may be because it’s just uncomfortable to do so, or simply because your mind is functioning in a slower, more ponderous manner. In the case of the former, being pressed to talk by a counsellor just generates hostility, while in the case of the latter there is nothing to say.

Crossover therapy overcomes these difficulties because it relies on the written word and not the spoken word: you may not wish to talk to someone just now, but you may well be prepared to commit your thoughts to the page or to the screen of a wordprocessor; you can write as and when you feel inclined, adding a few words, deleting them, changing them. The ability to edit what you have written allows you to tentatively follow different lines of thought. It has been my experience when dealing with clients that some of those who have no wish to talk are quite capable of expressing themselves in writing. Yes, at times the text can be fragmentary and somewhat incoherent, but for some individuals this process proves to be very helpful.

A second key difficulty with any talking therapy is its superficial nature. Talk is cheap. It is not considered. It doesn’t engage the subconscious mind. And the subconscious mind, rather than the conscious mind, is the principal protagonist in the grieving process. As neurobiology readily demonstrates, mental processing first occurs subconsciously. And when thoughts or emotions are experienced they only reflect some, but not all, of this underlying subconscious “mentation” – like the shadows cast upon a wall by flickering flames, the contents of the conscious mind are the by-products, the causata of subconscious processes.

The written word (when it extends beyond tweets, text messages, and cursory emails) requires more considered thought: the written word requires subconscious engagement (in contrast to the almost reflex reaction that characterizes the spoken word). The act of writing for non-trivial purposes demands of the subconscious: “What do you think!” Rather than a purposeless and seemingly endless churn, the subconscious mind is encouraged to articulate what it thinks, what it feels, what the options are going forward. And in doing so the grieving process moves forward towards a resolution in a much faster manner than is customarily the case – at least that has been my experience from working with those clients who have engaged in this process.

Discontinuity of Loss

It’s not always appreciated that it is not so much “loss” that occasions grief, but the “suddenness of loss”. Intense grief is driven by the sudden discontinuity in the relationship: yesterday your friend or partner was present; today he or she is gone, gone forever!

For example, consider how much each of these two scenarios concerning a close friend would impact you: in the first, your friend will die within a week; in the second, you will be able to interact with your friend twice a week for the next few months, then once a week for six months, then once a month for a few years. And if at any time a particularly traumatic incident occurs in your life, then your friend can come back to visit for a short period?

The impact of crossover therapy on grief closely mirrors the impact of the second scenario. The surrogate for the deceased interacts with you in the same manner as the deceased would have done via the unfolding series of playlets, with the frequency of interaction decreasing as time progresses. However, if some event in your life warrants it, then a new playlet can be created to help you cope with that event. For example, one client of mine had lost her husband a number of years ago and had been coping quite well until her daughter decided to marry. The absence of her husband to give the bride away reignited her grief, and we created a new playlet involving her husband giving away his daughter and making a speech at the reception to provide some stability around this event.

Unsaid Goodbyes

One of the big problems with an unanticipated death is that there has been no opportunity to say those goodbyes, to express how you feel about the deceased. Even when a terminal illness is present, those goodbyes are often left unsaid, as neither party may be willing to discuss the issue – there is often a feeling that discussing an impending death would be too uncomfortable for the other party, or there may even be an inchoate feeling that discussing a death may hasten its occurrence. Crossover therapy provides an opportunity to say those goodbyes.

Unresolved Conflicts

Another problem with death is that few relationships are perfect: there are often unresolved conflicts that can fester and interfere with the grieving process. Crossover therapy provides a means of resolving outstanding conflicts, with the surrogate saying those things that the bereaved needs to hear in order to resolve the conflict.

    Steps of Crossover Therapy

The Character Synopsis

At the beginning of crossover therapy you need to prepare a character synopsis: a summary that describes the characteristics and interests of the deceased, and that outlines how the deceased is expected to act. This synopsis need not accurately reflect the characteristics of the deceased: instead its purpose is to reflect how you want to remember the deceased. You have a licence to attribute to the deceased any desirable characteristics that you wished the deceased had possessed in life. As many bereaved individuals tend to idealize the deceased, these exaggerations come naturally.

Selecting the Surrogate

You could, of course, write a playlet without a surrogate. I’ve tried this approach with clients on a number of occasions, but they’ve always concluded that the fact that the surrogate is contributing the dialog on behalf of the deceased adds considerably to the sense of reality, and reduces the feelings of isolation and withdrawal. Another reason why introducing a surrogate is very important is that it’s very common for those who are bereaved to be unable to initiate actions by themselves, whereas they can readily participate in those actions that are initiated by others [3].

So, the next step is for you to select a surrogate for the deceased – it could be a friend or it could be a counsellor. Like a scriptwriter working on a new play, the surrogate takes the character synopsis that you have prepared and uses it as the basis for how the deceased should behave within the context of a playlet.

Constructing a Playlet

The next step is for you to select the theme for the first playlet – a brief description of the scene at the beginning of the playlet. Then you start off by creating the first line of dialogue for your part – that is for the part of the bereaved. The surrogate will then respond with a line of dialogue on behalf of the deceased – based on the types of behaviour specified in the character synopsis. You and the surrogate then alternate back and forth with lines of dialogue, together with additional descriptions of the scene, as appropriate, until the playlet is complete.

Together you can revise and adjust the contents as you see fit. The speed at which a playlet is constructed is down to you. You could sit down together, or you could exchange lines of dialogue via texts of email. The latter approach tends to work best, as you are always in a position of expecting a new response and wondering what it might be. With clients, I’ve found it helpful to send lines of dialogue throughout the day and the last thing at night; if the client wakes up in the middle of the night then another line of dialogue will be waiting for a response, or, if not, it will be available first thing in the morning.

The continuous sense of expectation helps to keep you “tethered” to the outside world.

Acting Out the Parts

At various stages during the preparation of a playlet, you read the script out loud using different voices for the narrator and the surrogate (you could get the surrogate to read the part of the deceased, but I’ve usually found that clients find a greater degree of realism when they emulate the voices of the deceased themselves). Once complete, you make an audio recording of the playlet, one which you can play back at any time to remind you of the experiences that you and the deceased “enjoyed together” (some clients even try a video recording and act out their parts in the playlet, but, in general, an audio recording seems to work best).

Sequencing and Run-Down

Playlets can be constructed one after another, or several can be constructed in parallel – as is the case in real life. These playlets can be a source of considerable comfort, and for some people with a strong imagination constructing them can have almost the same impact as interacting with the deceased. Over time as the grieving process progresses, the playlets reduce in number and each takes a longer time to complete.

Re-engagement

When circumstances demand, the device of the playlet can be resurrected as a temporary measure. For example, I had one client whose husband had died early in the year and who had been coping reasonably well until the following Christmas, when she felt a renewed sense of sadness. To work through this difficult period, we created a playlet that centred around the decoration of the Christmas tree – a task that she and he former husband used to perform together. Her character synopsis was enhanced to describe how she and her husband would decorate the tree, and how they would disagree over exactly where to place the lights; she also sent me some photographs of how the tree had looked in previous years. Over several weeks, we exchanged about a dozen brief emails a day adding more and more dialogue to the playlet. By the next Christmas her grief had largely faded away and she found sufficient comfort in replaying the audio of the playlet from the previous year.

Why it Works

Firstly, as far the bereaved is concerned there is no need to keep those conversations with the deceased a secret. Indeed, at the start of the process, the playlets may be written almost entirely by the bereaved, and serve as diary entries of his or her conversations with the deceased.

Secondly, there is no longer the same pressure to visualize and hold conversations with the deceased. The surrogate’s dialog in a playlet offers an alternative (even though at the beginning it may be a less satisfactory alternative). As a result, the frequency with which the bereaved holds conversations with the deceased decreases over time, as the interactions with the surrogate begin to replace those with the deceased.

Thirdly, throughout the process the bereaved is having regular daily contact with the external world. The bereaved comes to realize that there is no need to make a choice between worlds, and that both worlds can continue to exist side by side. In time, memories of the deceased – encouraged through creating, rehearsing, and replaying the playlets – serve as a satisfying alternative to direct visual and conversational interactions.

The overall result is a smooth transition from a life that is centred solely around conversations with the deceased to one in which the deceased becomes the subject of occasional reflection – a transition that proceeds entirely at a speed comfortably to and at the instigation of the bereaved.

    Helping the Bereaved

If you find the bereaved engaged in a conversation with the deceased, then what should you do?

Keep It a Secret

One thing to be very wary about is telling other people about what you’ve seen. If you do, then it’s quite likely that you will precipitate the standard societal reactions – and that, unfortunately, may well be “endgame”. If you feel that the situation is too difficult for you to handle alone, then consider discussing the matter discreetly with a medical professional.

Establishing Solidarity

The single most important thing to do is to show solidarity with the bereaved. But it’s important to do so in a roundabout manner: don’t be blunt, “Andie, I’ve heard you talking to someone who isn't there” – let the bereaved volunteer that information if he or she wishes to do so.

The best way forward initially is to reminisce about the deceased: “I keep thinking a lot about Tim. Do you remember that time when he climbed up on to the roof of the house and then couldn’t get down.”

This type of conversational gambit allows you to discuss the deceased, without requiring the bereaved to respond. Sometimes the bereaved will join in and sometimes not – but the bereaved is likely to be listening intently.

Identifying Points of Continuity

Reminiscing allows you to direct the bereaved’s thought processes towards those aspects of the deceased’s life that are likely to be the most helpful. In particular, try to focus on those things that the deceased cared about and which are still present in the bereaved’s life.

For example, if a mother is ignoring her daughter following the death of her husband, you might reflect on how fond the deceased was of his daughter: “Do you remember how John used to play with Mary on that swing in the garden. Mary seems so sad now.”

Engaging in Shared Activities

Try to get the bereaved to opt into activities that involve the deceased, “I’m going to look for an old album of photographs in the attic. Would you like to come along?” or “I was thinking of making a memorial website for Tim. Could you help me decide what to put on it?”

Creating playlets is just another, and more structured, variant on this theme of shared activities that focus on the deceased. When it comes to crossover therapy, it’s the general principles that matter rather than the specifics.

Talking to the Deceased

Try to move the conversation towards the sensitive issue of the bereaved’s habit of talking with the deceased: “It’s odd but sometimes I almost find myself having a conversation with Tim. But they say that’s quite common after someone close to you has died.” The objective here is twofold: to establish that having such conversations is not uncommon, and to admit that you too find such conversations helpful.

Sometimes the bereaved will know that you know. If so, then indicate that you are not going to tell anyone. For example, if you come in on the bereaved speaking to someone who isn’t there, then don’t act in a surprised manner. Just sit down, and muse to yourself, “Taking to Tim, were you. I find myself doing that at times. Best not to tell anyone. They might not understand.”

Agreeing to keep your knowledge of these conversations a secret is very important in gaining the confidence, not just of the bereaved, but also of the deceased: “Well, Andie, I said that this should just be our secret. But I think we can also trust Pacey.” It’s important to understand that you are dealing with two people and not just with one: the deceased acts as a sounding board for the bereaved, as a protector, as an advisor – a confidant who endorses the trustworthy, and who warns against those who are not.

If the bereaved does confide, then try to determine the role that the visions and conversations play in the grieving process. In most cases, they are welcomed as a source of solace and consolation, and as a means for providing continuity in a time of loss.

    Helping Yourself

If you find yourself engaged in conversations with the deceased, then what should you do?

Do I or Don’t I?

The big question is whether or not you should tell someone – a friend, a family member, a doctor, or a minister of religion – about what you are experiencing. And to be quite honest, it’s a question without an easy answer. If the result:

*Is a sympathetic response and that someone is prepared to keep your secret, then telling that someone might take a great load off your shoulders, and could help considerably in the grieving process;

*Is rejection, ostracization, pressure to abandon your conversations with the deceased, and a referral for treatments that you don’t want to take, then, at best, it will greatly intensify the grieving process, and, at worst, it might push you in the direction of suicide or psychosis.

Only you can judge how the people around you are likely to react and which course of action is likely to be the best.

Testing the Water!

If you suspect that disclosure is likely to result in a negative reaction, then consider “testing the water”: instead of stating that you’re having conversations with the deceased, start off by saying something along the lines of, “I keep thinking an awful lot about Tim,” and see what the reaction is like.

If the reaction is sympathetic, then you can slowly open up a little bit more, along the lines of, “For a few minutes the other day I found myself talking to Tim” or “I once thought I saw Tim in the mirror. I was probably mistaken. The room was dark.” In this way, you can slowly open up to the extent that you feel it is safe to do so.

Getting Medical Treatment

Even if you don’t feel comfortable talking to a friend or family member, you might still consider talking to a medical professional. If you’re worried that a doctor will not treat what you have to say in confidence, then you can still discuss other medical symptoms that you might have and receive treatment for these. For example, if you are having great difficulty sleeping, then taking a sedative for a short period might make it easier for you to cope with daily life.

Discussing Your Experiences Anonymously

Another possibility that is always available to you is to openly discuss what you are experiencing anonymously on one of the websites that deal with grieving.

For example, you can do so here on this website – doing so would be less satisfactory than talking through your experiences with a sympathetic friend or family member, but if that option is not available to you, then I’ll do my best!

    References

[1] Bui E., Nadal-Vicens M., Simon N.M., “Pharmacological approaches to the treatment of complicated grief: rationale and a brief review of the literature”, Dialogues in Clinical Neuroscience, 2012, 14(2), 149-157.

[2] Gold K.J., Schwenk T.L., Johnson T.R., “Brief report: sedatives for mothers of stillborn infants: views from a national survey of obstetricians”, Journal of Women’s Health, 2008, 17(10), 1605-1607.

[3] Lindemann E., “Symptomatology and management of acute grief”, American Journal of Psychiatry, 1944, 101(2), 141-148.