Many of us volunteered or were otherwise called into service to provide help to the vast number of victims left in the wake of the attacks. Within weeks, various support groups were formed to assist those who needed a community of others with whom to share their grief and obtain the necessary help in managing their loss and adjusting to a very new and different life. Support groups for family and friends of the deceased led by clinicians from all disciplines were common and geographically diverse. Several groups were designed to meet the needs of any family member or friend needing support, while others were specifically designed for parents, siblings, spouses, or friends. There were groups for fiancé/es, pregnant women, and children, both young and old, as well. Many of these groups were time-limited, usually eight to ten sessions, while others had undetermined endings. Some, by design or not, became self-help groups after termination, while others disbanded following the departure of the group’s leader(s).
Like many of my colleagues in the mental health disciplines, I volunteered my time at the Red Cross where I provided a variety of services. One of these assignments led to my involvement with Cantor Fitzgerald, a financial services firm, and the subsequent co-leading of a time-limited (eight session) heterogeneous support group consisting of nine people whose relatives, all Cantor employees, were murdered on September 11th. This group, which began in November of last year and ended in January of this year, became autonomous and was still meeting more than six months later.
The Widows Support Group
In January, I was asked to take over the leadership of a support group of widows, all in their thirties, that had been meeting since November led by a therapist who was ending her work as the group’s leader. The request came from a member of my first group, a woman whose son-in-law perished in the attack and whose daughter was one of the members of the widows’ group. The initial session with the group members, an unacknowledged mutual trial session, was a positive one, with group members expressing feeling “safe” and thus able to complete their grief work. The issues related to their previous group experience, as well as an exploration of their feelings about a new group leader, especially the change from a female to a male leader, were handled to the apparent satisfaction of all concerned.
One of the challenges of conducting bereavement support groups, especially under such unique and unfamiliar circumstances as these, is the role of the professional charged with successfully helping those who have entrusted themselves to his care. I functioned in several different, but related roles. Mindful of the fact that this was not designed as a psychotherapy group and also aware that every group member was already seeing another individual therapist, I functioned as a facilitator and guide, counselor and mental health resource. As a respectful host I further developed the necessary skill of knowing how and when to stay out of the way of an increasingly cohesive group. I was able, I believe, to create an atmosphere of comfort, safety, and open communication that helped group members have opportunities to express their pain and anger and to help them understand that their emotions were appropriate.
I helped them to understand that grief was not an illness, but a natural response to loss and that they had the resources to learn and to mature from the experience; that a central purpose of the group was to facilitate this process of healing and growth. I was mindful of the possibility that some might suffer from abnormal or pathological grief reactions, better thought of as “complicated grief reactions” or “complicated bereavement” (Worden, 1991). These include such reactions as chronic grief, delayed grief, exaggerated grief, and masked grief reactions. This last category describes so many of the clients therapists see in their practices who present symptoms and behaviors which cause them difficulty but are not recognized by the clients as related to current or earlier losses in their lives.
Though minimal, there was some establishment of ground rules and shaping expectations in order to insure that the group would provide a safe environment, that each person would have enough time to share as much or as little as they chose, and that they would not be told what they should or should not be feeling or given unwanted advice.
Bereavement groups have a multiplicity of goals and purposes and they may change as the individuals involved proceed through the various phases of their grief work. The literature (Lehman, Ellard, and Wortman, 1985; Lieberman and Videka-Sherman, 1986; Schwartz-Borden, 1986; Thompson, 1996) suggests that these groups can provide a sense of belonging, help develop feelings of fellowship and solidarity, help participants gain hope, receive new ideas on how to problem solve, receive information regarding other sources of help, improve skills related to social relationships, and become less lonely and isolated. Worden (1991) describes mourning – the adaptation to loss – as involving four basic tasks that must be completed in order for mourning to proceed to some sort of satisfactory completion. These are (1) to accept the reality of loss; something notoriously difficult when the loss is sudden, unexpected, and especially tragic like the deaths these widows’ sustained; (2) to work through to the pain of grief, as opposed to denying the need to grieve; (3) to adjust to an environment in which the deceased is missing, and (4) to emotionally relocate the deceased and move on with life.
Worden’s four tasks provided a useful framework throughout my stewardship of the widows support group. While conventional practice wisdom in the area of bereavement work has generally relied upon a stage or phase schema, along the lines of Elisabeth Kubler-Ross’s (1969) stages of dying or Bowlby’s (1980) phases of mourning, the concept of tasks suggested an action orientation. This focus encouraged activity on the part of these bereaved women, as well as implied an active role for the participating clinician.
Phases imply certain passivity, something that the mourner must pass through. Tasks on the other hand are much more consonant with Freud’s concept of grief work and imply that the mourner needs to take action and can do something. Also, this approach implies that mourning can be influenced by intervention from the outside. This can be a powerful antidote to the feelings of helplessness that most mourners experience. (p.35).
Feelings of helplessness are an especially pronounced feature of sudden or traumatic death. Barrett (1978) wrote about the necessity of enduring and working through one’s grief as one of the ways in which widows are able to maintain and enhance their self-esteem. As a result, she cautioned against treatment modalities for widowed persons that focused primarily on the reduction of feelings of sorrow, anger, depression, guilt, and so on.
Support groups for bereaved individuals, like all intervention strategies, have a potential for both positive and negative consequences. Iatrogenic effects are a particular concern with individuals who have been traumatized and are therefore especially psychologically vulnerable following tragic loss. Hiltz (1975) reported a “backfire” phenomenon in her early work at the Widows Consultation Center in New York, where many participants became more depressed and less able to cope as a result of their involvement in a bereavement group. These women tended to become overwhelmed by listening to the experiences and feelings of others as opposed to feeling supportive and supported and gaining important perspective about their own ordeal. It is generally assumed that these individuals terminate their participation on their own after recognizing the consequences, rather than the benefits, of their group experience.
The Need to Know Just How They Died
One of the most significant issues raised at every session of my group was the need to know exactly how their husbands perished in the terrorist attack on the World Trade Center and whether to what extent they suffered. Suppositions, inferences and conjectures about the minutes following the actual attack and the minutes prior to the collapse of both towers were among the most animated and painful moments of each group session. Some women had telephone contact with their spouses immediately after the attack; others relied on hearsay to piece together the actual events, always mindful that no one could know because no one on the upper floors, where their husbands worked, survived.
My initial handling of these moments in the group primarily consisted of containment and protective interventions in order to minimize the risk of retraumatization. A widow who believed that her husband had died painlessly of smoke inhalation was not helped to subsequently believe that he may have been incinerated or that he died as a direct result of the actual building collapse when the medical examiner listed the cause of death as “blunt trauma to the head.” Some in the group accepted my recommendation that they develop and emotionally lock in a plausible scenario that they could accept as the likely way their husbands died. While quite helpful, this device was complicated by the continuous flow of additional information received by the widows, which generated new theories and images of how their husbands actually perished. In addition, active speculation and theorizing concerning the actual manner in which their husbands died continued as DNA-identified body parts and personal effects were returned throughout the life of the group.
There is a common assumption that the bereavement process progresses in some sort of sequential manner marked by a gradual and identifiable reduction in grief and other indications of a return to normalcy. While in many instances this may be true, friends and family worry when observable indicators are not reassuringly evident or, worse, when a bereaved individual appears to be doing less well eight months after her traumatic loss than was true earlier in the process. The widows in my group came to recognize and accept that feeling “worse,” instead of “better” is not necessarily a worrisome sign, but an indication that the painful work of grieving is proceeding as it unavoidably must. As one member stated:
“I am far more upset now than I was in the beginning because I am no longer in shock and have lost the emotional protection of my early numbness… but that’s okay.”
The bereavement process is not completed in weeks or months, but may extend over a period of years (Osterweis, Solomon, & Green, 1984). Further, widows are not attempting to “recover” insofar as that means returning to pre-bereavement baselines as much as they are recognizing that a successful outcome to their grief work is the ability to change; to adapt and alter their images and roles to fit their new status.
The widows experienced stresses and interpersonal difficulties with well-meaning family and friends who wished them to have “a quick recovery,” or told them that it was time to “get on with your life;” to remember that “you still have a lot to live for,” or advised them that they “must try to stop feeling this way.” Often, they reported either becoming enraged at the inconsideration or the thoughtlessness of well-intentioned others who managed to say things and give advice that only aggravated their pain and grief. Several of the widows expressed their resentment at feeling it necessary to reassure family members and friends that they were doing okay, when they were feeling not okay at all. They felt guilty when their depressed demeanor was perceived by others as “clouding up the atmosphere” at family celebrations; events they attended with considerable difficulty or simply avoided altogether.
Some of the work in the group involved strengthening their coping repertoires, helping them to express their needs and feelings during awkward and uncomfortable interactions and to help others know how better to assist them at this most difficult time in their lives. They also wanted help tolerating those moments in their interactions with others when they felt their bereavement was being inappropriately ignored or trivialized or that people in their lives were treating them as though “everything was back to normal when nothing will ever be normal again.” Some examples:
“I was with a group of my married girlfriends and all they did was complain about their lousy husbands while I’m sitting there, newly widowed, and no one seemed to know or care that I didn’t have a husband to complain about even if I wanted to!”
“One of my really close girlfriends said to me, “boy you’re so lucky. I wish I was single like you!”
“Not only was I feeling like the fifth wheel with these two couples, but I had to listen to them plan their summer vacation without me and my dead husband at a place the six of us used to go to together”
Their understanding, acceptance, and forgiveness of the friends and family responsible for upsetting moments like these occurred gradually and were especially helped by their increasing ability to advocate for themselves more satisfactorily and thus enlighten the unaware.
The members of the group appreciated the extent to which they were involved in a role transition from wife to widow (Silverman, 1972). This concept was later elaborated by Golan (1975) in her description of the experiences of war widows in Israel (a strikingly analogous population to the ‘war’ widows of September 11, 2001) whom she described as making the transition from wife to widow to woman. This transition, both implicitly and explicitly, was the major underlying theme throughout the life of the group.
The transition and its milestones took many forms and aroused many conflicts and dilemmas for the women in the group. Many decisions, e.g. when, whether, and how to dispose of a husband’s clothing and personal possessions; whether or not to replace a husband’s voice message on the telephone answering machine; whether to use the present or the past tense when referring to the deceased spouse, were difficult to process and resolve. One woman, anxiously contemplating relocating to a new house in her neighborhood told me “I thought that maybe I had to move out in order to move on.”
While in some ways this appealed to her, she worried that she was robbing herself and her children of the vestiges of her deceased spouse; that his ‘presence’ or his aura would only remain if the house they shared together as a family was retained.
The transition from “we” to “I” (Yalom and Vinogradov, 1988) involved the contemplation of complex questions of growth, identity, and responsibility for the future that made it feel like an emotional minefield. The increased use of the first person singular was usually upsetting, but gradually accepted as part of the “new normal.” It forced repeated confrontations with the reality of their husbands’ permanent absence and reinforced the recognition that they were now alone, needed to find a meaningful social and emotional life in addition to being the head of the household, breadwinner, and, for some, combined father and mother.
The tension between the wish and need to make changes in their lives and their sense of devotion and love for their husbands was palpable. They worried, like the individual who struggled with whether or not to move to a new home, that any changes they made might represent a betrayal of the marital relationship. Large and small decisions confronting them were often characterized by the recognition that their husbands were not there to help them choose. Some participants shared inner conversations with their spouses as though they were still present to help in decision-making. One group member, reflecting on life without her husband, said:
“I was having trouble deciding whether to buy a new car and what kind to buy so I asked my husband in my head what he thought I should do and I didn’t like his answer so I said to him, “hey, you’re dead! You don’t have a say anymore. I’m gonna get the car I want!”
The bittersweet laughter that followed provided a much needed and memorable moment.
Occasionally, the idea of new relationships with men came up in the group, usually when one of the women sensed the apparent interest of a male friend or a new male acquaintance. Their responses ranged from flattered and intrigued to offended and exploited and often led to a reassertion of their intention to maintain their loyalty to their deceased spouses and to maintain the celibacy that fate had cruelly imposed. My careful forays into the future, including their ideas and feelings about new relationships with men, the possibility of eventual remarriage, and one day, perhaps, bearing children with other men were acknowledged as necessary and important topics, for some timely, while for others, premature.
One woman, just returned from a vacation with her two young children and two other families, told us of a chance encounter with a man she met while skiing. Her description of her positive experience, which included sexual intimacy, sent shock waves throughout the group. Everyone was impressed that she was able to enjoy herself, felt entitled to the pleasure, and suffered no guilt as a result. Stunned, admiring, and envious, every woman agreed that her experience gave them hope that perhaps one day, they, too, might be capable of enjoying the company, as well as the arms, of another man. It was a moment in the group like no other. As a support group leader, I was grateful that this had been shared for it seemed to have advanced their grief work and the dynamic role transition in which they were all involved.
As a mental health professional for the past thirty-three years, this group, and the one before it, has been two of the most challenging and meaningful professional experiences of my career.
Richard B. Joelson, DSW
110 East 87th Street
New York, NY 10128
Barrett, C.J. (1978). Effectiveness of Widows’ Groups in Facilitating Change.
Journal of Consulting and Clinical Psychology, 46, 20-31.
Golan, N. (1975). Wife to widow to woman. Social Work, 20, 369-374.
Hiltz, S.R. (1975). Helping Widows: Group Discussions as a Therapeutic
Technique. The Family Coordinator, 24, 331-336.
Hopmeyer, E. & Werk, A. (1993). A Comparative Study of Four Family
Bereavement Groups. Groupwork, 6, 107-121
Lehman, D.R., Ellard, J.H., & Wortman, C.B. (1986). Social Support for the
Bereaved: Recipients’ and Providers’ Perspectives on What is Helpful.
Journal of Consulting and Clinical Psychology, 54, 438-446.
Lindemann, E. (1944). Symptomatology and Management of Acute Grief.
American Journal of Psychiatry, 101, 141-148.
Miles, H. & Hays, D. (1975). Widowhood. American Journal of Nursing, 7,
Osterweis, M., Solomon, F., Green, M. (Eds.). (1984). Bereavement:
Reactions, Consequences, and Care. Washington, D.C.: National Academy
Schwartz-Borden, G. (1986). Grief Work: Prevention and Intervention.
Social Casework: The Journal of Contemporary Social Work, 65 , 499-505.
Silverman, P. (1972). Widowhood and Preventive Intervention. The Family
Coordinator, 21, 95-102.
Thompson, S. (1996). Living with Loss: A Bereavement Support Group.
Groupwork, 9, 5-14.
Worden, J.W. (1991). Grief Counseling & Grief Therapy. New York:
Springer Publishing Company.
Yalom, I. & Vinogradov, S. (1988). Bereavement Groups: Techniques and
Themes. International Journal of Group Psychotherapy, 38, 419-446.