GRIEF THERAPY

When working through any of the 12 steps, there can often be times of sadness and grief. This grief may be for lost or damaged relationships, loss of dreams, loss of material comforts, loss of health, loss of our self-image or a host of other issues. There are numerous grief recovery resources for healthy ways to deal with the grief process. When used along with the 12 steps, the goal of these grief resources is to deal with the grief in a healing way. We can then begin to more fully experience the fulfillment of the 12 step promises.

The majority of grief resources are focused on dealing with the loss of a loved one. If we want to apply the grief process to working the 12 steps, then we will need to adapt those grief resources to the grief that happens during recovery. That is what we try to do in the sections below. We summarize suggestions from several different books below and try to adapt those suggestions for the 12 step program. As with all of the 12 step program, please feel free to take what is useful in your recovery and ignore the rest.

Anxiety, the Missing Stage of Grief

One resource for the grief process is the book Anxiety, the Missing Stage of Grief, by Claire Bidwell Smith. A primary idea is that anxiety can be an additional stage to add to the traditional 5 stages of grief. She notes along with many others that since the original stages of grief by Kubler-Ross were for someone facing their own death, that these stages may not be one after another but might happen at any time during the grief process.

1. Denial - We can see parallels with denial in the first 3 steps of the 12 step program where we finally begin to step out of the denial of our addiction and begin to realize our powerlessness over our addiction and our need for a Higher Power.
2. Anger - Anger could come during many of the 12 steps. We may become angry about our "weakness" in not being able to overcome our addiction by ourself or having to give our recovery over to a Higher Power (steps 1 through 3). We may be angry about having to take an inventory (step 4) or having to confess to someone the exact nature of our wrongs (step 5). We may become angry during steps 4 through 9 when we realize what we have lost. Hopefully at least by steps 10 through 12 we have learned more genuine gratitude and have worked through much of our anger. But most therapists and those in long term recovery have realized that it is important to recognize and accept our anger as being a valid part of the recovery process and not try to deny it. Repressed anger will come out in other ways, usually destructive to ourselves, our relationships or to others.
3. Bargaining - Bargaining might be common in the first steps of the program. Someone may want to just moderate their addictive behavior. But if it is a true addiction, then that will not work and it will become more and more apparent how destructive the addiction is. As the book Twelve Steps and Twelve Traditions (p. 12) puts it "The principle that we will find no enduring strength until we first admit complete defeat is the main taproot from which our whole Society has sprung and flowered.".
4. Anxiety - Claire Smith makes the point that anxiety itself can be addictive. "Worrying about something can make a person feel as though they are doing something proactive about their specific fear, when really they are just perpetuating a heightened state of alert that keeps them in an anxious state." (p. 19). Anxiety is the pathology behind panic attacks. The ways that some drugs work to heighten our fight or flight response also can amplify any sense of anxiety. Claire Smith points out some remedies to our anxiety as making amends, writing about our anxiety and retraining our brain. These of course are covered in steps 8 and 9, steps 4 and 5 and steps 10 through 12 of the 12 step program, respectively.
5. Depression - It is very natural to feel depression during the program, not only from the grief of our losses but perhaps the changes that are happening in our body as well. As Claire Smith points out (p. 115) "Grief is unlike anything we go through during our lifetimes. It is overwhelming and sometimes frightening. Being willing to engage with it and to explore all the ways it shapes us is vital to moving through it.".
6. Acceptance - In order to bring about the Promises of the 12 Steps such as peace and serenity, we will need to get to the stage of acceptance of the reality of our addiction and being willing to work through the steps. It will most likely involve acceptance of the consequences of our addiction as well, but with a comfort, hope and peace from our Higher Power and from the freedom that we have found. Concerning the grief process, Claire Smith puts it this way (p. 120), "remember that this acceptance has a long arc. You will come to many different points of acceptance throughout your grief experience. It is not something that you need to feed daunted by, as some of it does come naturally and in time."

Grief Counseling and Grief Therapy

J. William Worden's four tasks of grieving are covered in his book Grief Counseling and Grief Therapy. He calls these tasks instead of stages since they do not need to be covered in a linear fashion.

1. Accept the Reality of the Loss - This could mean accepting the realities of the losses in my life as I realize the costs of my addictive behavior.
2. Process Your Grief and Pain - Taking appropriate actions to grieve my losses and at the same time honor my new found path of recovery and hope.
3. Adjust to the World in Light of Your Losses - I get used to living in this new world of freedom and yet loss. How do I change my relationships, my finances, my place of living, my professional life?
4. Find a Way to Maintain a Connection to that Part of Your Loss in a Healthy Way - Even though we are giving up the addictive part of our life, those memories will always be a part of our past. Through the process of making amends and then helping other addicts, we stay connected to our past life, but in a way that leads to satisfaction and understanding and deeper healing from any regrets.

How We Grieve: Relearning the World

Dr. Thomas Attig in his book How We Grieve: Relearning the World has the following stages to the grief process. For all of these stages, we can ask the question, "What will need to be grieved in this process?".

1. Changes in the Physical World - How will our recovery affect our physical world. If we are in the stage of giving up our addictive behavior, how will our physical circumstances change? Will we need to move? Will we need to change our surroundings? If we are in the process of making amends, how will our amends affect our finances or our mode of living?
2. Changes in Relationships - If we are in the stage of giving up our addictive behavior, will we need to give up certain relationships? Will we need to work on building new relationships? If we are in the process of making amends, how do we find healing in our relationships? What do we need to grieve that will never be the same or never be at all in our relationships?
3. Changes in Perspective on our Personal Timeline - If we are in the stage of giving up our addictive behavior, how does that change the expected path of our life? If we are in the process of making amends, how should we view this part of our lives that we probably never anticipated having to take part in?
4. Changes in Spiritual Grounding - If we are in the stage of giving up our addictive behavior, this is covered by the first 3 steps and last 3 steps especially. What kind of grieving is associated with changes in our understanding of our Higher Power? If we are in the process of making amends, how does our Higher Power help us in the process of grief?
5. Changes in Relationship with Others and with our Addictive Behavior - If we are in the stage of giving up our addictive behavior, do we want to grieve and/or be angry about the loss of our addictive behaviors and/or the losses that were brought about because of our addictive behaviors? How can we process these feelings in a healthy way? If we are in the process of making amends, how do we grieve the losses that our addictive behavior brought to us?
6. Changes in Identity - If we are in the stage of giving up our addictive behavior, how will our perception and feelings about ourself change? What do we need to grieve about that? If we are in the process of making amends, what do we need to grieve in order to find humility and make the necessary amends?