Why Am I Sad on My Wedding Day? Identifying Grief in Unexpected Ways (with Jennifer Uhrlass, LMFT)

Grief creeps in for all of us in unexpected ways. From living through a pandemic, our childhood memories, even our wedding day (yes, it’s normal!), feelings of sorrow can be so nuanced that we can’t figure out what’s causing it or how to address it. Crossover Therapist Dr. Jennifer Uhrlass tells us about the many forms that grief takes in our lives, and how identifying it can help us cope with it.

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Transcript

Unknown: 0:00

really allowing yourself to honor your own experience of loss or grief is so powerful and so important that doesn't look in a specific way for everyone. And it really is about honoring your own process and really understanding and tuning in to what that process is teaching you. What it's allowing you to understand about yourself and how you want to move forward in your life.

Crossover Health: 0:25

happiness, success, freedom, energy, fun, balance, strength, peace. It all stems from our physical and emotional well being. You're in the right place for a healthy discussion with experts to show you the way. This is B Well, a podcast from crossover health. Not sick is not enough. Being Well is a movement to get the most we want out of life. In each of our episodes, we pick a health or lifestyle topic, bring in one of our doctors from the frontlines and have a real conversation. Be well do good. Enjoy life.

Danielle: 1:07

What's up everyone, this is Daniel who's about health coach, Program Manager for crossover health and you're in the right place for a healthy discussion. Just a reminder that the following presentation is for informational purposes only and is not intended or implied to be a substitute for professional medical advice. Please do not apply any of the information without first speaking with your doctor. Today we have Jennifer or Alyssa licensed therapist at crossover health, who's here to speak with us about grief. Jennifer is an experienced licensed marriage and family therapist here at crossover. And in her New York City based private practice she's licensed in New Jersey, New York and Connecticut. Jennifer helps individuals to improve the quality of their lives and relationships using her warmth, humor and genuine curiosity for her clients. She combines her commitment to systemic strength based approach with the latest research and evidence based models to help people achieve meaningful and lasting results in therapy. She received her master's degree in marriage and family therapy from Syracuse University and postgraduate training at the Ackerman Institute, Gottman Institute and the New York Center for Emotionally Focused Therapy. In addition to seeing clients, Jennifer is also a mentor to new therapists. Welcome, Jennifer.

Unknown: 2:30

Thank you so much, Danielle. It's great to be here.

Danielle: 2:33

And I can definitely attest to your warmth, humor and genuine curiosity.

Unknown: 2:39

Well, thank you so much. It's always a pleasure to be here with you.

Danielle: 2:42

Yeah. So this is a two part series that looks at the emotion of grief from two different perspectives, one from the traditional Chinese medicine. And today we're going to talk about grief from a mental health standpoint. And let's just dive right in. So where do you see grief pop up in the human condition?

Unknown: 3:05

Well, I think it presents itself in so many different ways across the lifespan. It's something that's, of course, it's universal, it affects all of us. We think about how we've been challenged especially over these last two years with the pandemic, and all the different types of losses that we've experienced there that were really out of the ordinary in so many different ways. And then we think about loss in terms of loss, loss of loved ones, loss of relationships, loss of intimate relationships, we think of loss of experiences, in terms of the pandemic, we were so challenged because it was really so catastrophic of loss and terms of loss of future as we thought of it loss of endings, so people not being able to have certain events as a result of what we were experiencing in terms of loss of friendships, loss of celebrations, loss of employment or income, loss of routine and predictability, a loss of control. And then also this experience of like an overall sense of loss, which we could think about in terms of our assumptive world was completely dismantled. So we think about assumptive world as like the assumptions or beliefs that ground secure or orient people that give a sense of reality, meaning or purpose to life. And so with the pandemic, it was like life is no longer predictable or within our control, and death and loss is no longer outside of our consciousness. So suddenly it was we were confronting it and it was a violent confrontation. It was just right in our faces and we had to we had to deal and adapt and figure things out.

Danielle: 4:49

Yeah, so especially with the past two years, we saw grief pop up a whole lot, because it was like an it was like an exercise and loss and grief and so many different ways. And I've heard you talk about before, like different types of grief, that go maybe beyond the obvious ones like loss of a loved one, can you talk a little bit more about maybe not some of the not so obvious kinds of grief?

Unknown: 5:16

Sure. Well, and when we think about the loss of a loved one, we can also look at that from a few different levels, because for example, it could be the loss of a spouse. So that might be the primary loss. And the secondary loss might be, for example, loss of income. So might you have your own income, but maybe there was a secondary income that was lost along the way. And then there's also a third type of loss like a symbolic loss that you lost partner. And so looking at it, I think, from that complexity can be really helpful to orient people to the different levels of loss in terms of loss of a loved one. But, you know, I think we could feel this to throughout our lives, like in terms of pet loss, or if we go through a breakup, which can be so painful. But in terms of looking at different types of losses, we can think about bereavement, grief, mourning, ambiguous loss, disenfranchised grief, and complicated grief and prolonged grief. So I thought it would be helpful to talk a little bit about some of the differences there, too.

Danielle: 6:20

Yeah, I would love to hear that. And, and just, you know, from that primary, even secondary grief standpoint, you know, I think about losing my grandfather in October, which certainly was a primary loss, I lost a very, very important person in my life. But when I talk about, when I think about that secondary grief, all I could describe, it was like, it's a, it's the end of an era, you know, he was, you know, 95, he was sort of the last of his generation of folks in our community. He was my last grandparent. And it was like, again, it just felt like, I mean, primarily, I'm losing this really important person that I was very close to. But on the secondary level, it feels like, it feels like a much bigger ending, you know, like the end of an era. So what you said about secondary really resonates with me?

Unknown: 7:10

Yeah, thank you for sharing that that's really powerful, and very difficult. So sorry for your loss.

Danielle: 7:17

And like another way that grief just sort of pops up in in weird and interesting ways in our lives, right?

Unknown: 7:24

When it can be helpful to sort of label it or identify it as that because I think so often we're taught or sort of, we're not really that great at sort of acknowledging when we're in pain. In a lot of ways we can be really resistant in some ways to acknowledging like the extent of hurt or pain or loss. And so I think looking at it, or learning about these different types of losses can be so powerful, because you could start to identify and really understand what's going on for me, and what might help me to cope or move through this difficult I

Danielle: 8:02

totally couldn't agree more when you talked about secondary loss. It's like, oh, this thing has a name. So I can identify it. And by doing so, for me, it felt like, oh, there's validity to that, like, that's a real thing that I am feeling. And there's, there's validity to it, which I think also helps in the, in the process of working through grief, which again, can be really complex.

Unknown: 8:29

Yeah, that's really well said, Well, I will go ahead and just jump into a little bit about the types of losses and then if there's anything that we want to focus on in particular, feel free to jump in. So we can start with bereavement. So thinking about bereavement is the state of having suffered the loss of a significant person, we can think of grief as a reaction to the loss of a significant person. It can also be a reaction to the loss of relationships, physical ability, opportunities, or future hopes and dreams. Mourning really refers to the external expression of grief. It includes rituals that marks someone's death, such as funerals, weeks or memorial services. And of course, mourning is strongly influenced by a person's religious spiritual, cultural beliefs and practices. Ambiguous loss is associated with a loss in which there is confusion or uncertainty about the situation. Ambiguous losses are those that lack clarity and can lead to different assessments of exactly who or what has been lost. There may be some question as to whether or not a loss has occurred or if this is a loss that should generate a deep emotional response might be questioning are my grief reactions really valid? There are two different types of ambiguous loss that have been identified. So the first one is when there is a physical absence but a psychological presence. So we can see this situation come up with for example, if we have a loved one in prison, or a loved one who has been deported And then a second type of ambiguous loss is when there is a psychological absence, but a physical presence. So this might look like a person who's struggling with substance abuse, or when there's trauma, and it feels like the person's there but not there.

Danielle: 10:18

Would this also be something like a family member maybe with Alzheimer's or dementia where they're physically present, but there's right that? Yeah, that's so that's so hard.

Unknown: 10:31

Yeah. And then there's something also known as disenfranchised grief, which includes a loss that cannot be socially sanctioned or openly acknowledged or publicly mourned. So, it might be something where the relationship was not recognized or loss is not acknowledged or the Grievers not recognized, or the type of death is stigmatized in some way.

Danielle: 10:55

It is shocking to me how many different types of of grief and loss there really is that I certainly wasn't aware of. Yeah,

Unknown: 11:07

yeah, there's so many different experiences here that can be so helpful to understand and identifying there's also something known as complicated grief. So that can occur when something interferes with our adaptation. So when this happens, acute grief can persist for very long periods of time. A person with complicated grief feels intense emotional pain, they can't stop feeling like their loved ones might somehow reappear, they don't see a pathway forward. A future without their loved one seems forever dismal and unappealing. So that was a definition from the Center for complicated grief. So that's an experience I just wanted to mention, because I think it is something that people can absolutely struggle with, but really feel like, well, why haven't I just moved on by now, I should be in a different place. And really looking at that and recognizing and identifying it as complicated grief might help to give a language and experience to what's going on. There. There's also something known as prolonged grief. And there's some debate about this diagnosis, it was newly added to the DSM, the prolonged grief disorder. So some people believe that pathologizing, a normal and natural response is not helpful. And then there's another side where folks feel, we do see people struggling with this. So providers are seeing people who are struggling with this and identifying this as a diagnosis helps people get the support they need for a very real and debilitating experience. Yeah, I can see where there could be an argument made on either side of that,

Danielle: 12:46

that. Like, who says how long, how much grief is too much relief. But on the other end of that what you're saying is okay, but by putting some parameters around it, it might be helpful for somebody to identify when you might, you might be stuck, this might be prolonged grief, and here is the help that you can get for

Unknown: 13:09

Absolutely, yeah. And that really requires the occurrence. So according to the DSM, we could just kind of identify this briefly, for listeners, requires the occurrence of a persistent and pervasive grief response characterized by persistent longing or yearning, and or preoccupation with the deceased accompanied by at least three to eight additional symptoms that might include disbelief, intense emotional pain, feeling of identity confusion, avoidance of reminders of the loss, feelings of numbness, intense loneliness, meaning less difficulty engaging in ongoing life.

Danielle: 13:50

Yeah, okay. So yeah, there's just, it seems like trying to put some parameters around again, what what that might look like in a prolonged sense, that actually think leads into another great discussion topic is How does grief present in our lives? So, you know, meaning what can when we say grief, what are some of the things that a person can experience?

Unknown: 14:14

Sure. Well, there's there there are several different grief reactions. And so it's important to look at it from a layered perspective or different sort of aspects of how it might present. So there are physical symptoms, there are emotional symptoms, there's behavioral cognitive aspects, and then there's also a spiritual component to so you might be looking at. Some examples of physical might include exhaustion, or headaches or a tightness on the throat or chest or weight gain or loss or feelings of nausea. In terms of emotional symptoms that could look like shock or numbness or anger, fear, sadness, even a sense of relief or lonely in terms of the Gabrielle and cognitive that can include rapid mood changes, restlessness, inability to concentrate, sleep problems, dreams or nightmares, sensing a loved one's presence. And when we think about the spiritual layer, we can think about anger with God or a higher power, turning toward faith or religion, or even questioning our faith or religion search for meaning and purpose. Who

Danielle: 15:26

this complicated what I thought was particularly interesting, I, you know, I think it's, it's, it's important for people to recognize how this can present in your life, but the one that really pulled the call out to me as being particularly conflicting is relief. And people might not understand that that's actually part of their grief process, or they could be feeling that and other things, right. And so it can get really confusing and, and hard for somebody to sort out that, like, emotional grab bag that they're experiencing, to look at it,

Unknown: 16:01

because it's like, it's so you might feel so many conflicting emotions about it. Like, we feel relief. should feel really sad, or you, you're telling yourself we should feel or a certain way?

Danielle: 16:15

Yes. Oh, man, I find that to be particularly important to talk about here. Because there are many expectations on how and and how long that we experience grief. That can be hard for people. Yeah,

Unknown: 16:37

absolutely. And I think it's important to also recognize that there there is this course of grief, right? Grief reactions might be immediate, delayed or absent. Right. So it there's not necessarily a specific kind of, okay, I'm gonna feel this and then I'll feel this or, and then I'm gonna feel like that. And eventually, I'm gonna get to this that often is described as a tangled ball, a spiral, a cycle, a whirlwind. I heard one description recently in a presentation that I attended, where they were describing it as like traffic, like a traffic jam. One day, you're going along, everything seems fine. You're you're moving along, and then suddenly, you're stopped short, right? And you're just you're not moving. Things feel terrible. You don't know how to get unstuck? Yes. So there's really not a specific way that it happens. It's a unique process. And it really depends on so many factors, and how it manifests for each person.

Danielle: 17:38

Yeah, I'm so glad you call that out. Because I think that there is this notion that it does follow that, that I think we've been told the five stages of grief, and then that I'm going to be in this stage. And in that stage of that, eventually, I get to accelerate. But what you're saying is, it's so much more complicated. It is like a tangley ball. And and then I think we have like, oftentimes societal expectations on again, how long we're grieving, and what it's supposed to look like and what you're supposed to feel. And so it can make it so hard for somebody who is experiencing grief, especially if they're measuring it against these expectations. To go, Well, wait, my process isn't looking like that. So now now you're thinking, well, now I'm grieving. But also, is there something wrong with me? Like, you know, that I'm not following this very linear path? Yeah, exactly. Yeah. So anything else to say about the myth of the five stages of grief versus what is actually the case? Yeah,

Unknown: 18:43

well, and it's not to say that they don't have any validity, they certainly can be helpful for a lot of people to think about in terms of acknowledging some of the experience that they might be having, it's just maybe not the full picture or sort of in a way that is there's supposed to be sequential, right? People can experience different layers or different sort of experiences of their grief at different times. But another thing that I think is really interesting to think about is that many positive events can bring about an experience of grief. So we think about shifts in our identity, like getting married or starting a new job, right, that can also create an experience of grief or an experience of grieving. And we might not think about that as something that could bring that on, but it is something that can sort of be very life altering, and can bring

Danielle: 19:36

and we call that you know, oftentimes will say oh, it's it's bittersweet, and I think when you're maybe leaving a job, sometimes it can feel bittersweet, but when you're getting married again, we've got those societal expectations that it it's it's the best day of your life and then you're wondering, but why am I feeling also sad? Why am I feeling trumpeting like why am I feeling these? Oh, There are things that apparently I'm not supposed to feel I'm so glad you brought up the grief that can be associated with positive experiences. Because guess what? They have? Absolutely.

Unknown: 20:11

Absolutely.

Danielle: 20:13

Yeah. So as we think about this very complicated situation with very complicated feelings, what are some of the things that folks can do to cope with grief?

Unknown: 20:28

Well, I think sometimes it's, it can be helpful to work with a therapist or to talk with a professional. But I think in terms of some of the things that are worked on in therapy, if there's someone who is grieving or struggling with this process, we might, we might sort of go through a process of really looking at and accepting the reality of the situation, starting to process the pain of the grief, acknowledge that pain in our lives, and sort of what that loss represents what the meaning is about for us, because it's not something that a therapist or someone else outside of your own life can tell you what it's about, right? It's really something that has to be defined and understood by you. Right, you, you're looking at the meaning of what that represents. And so I think sometimes that process can sort of help people to identify that for themselves. And that starts that, that next sort of level of, of healing of moving forward. But even looking at mindfulness learning strategies, interpersonal effectiveness, emotion regulation, looking at distress tolerance, so learning how to cope with difficult or uncomfortable feelings, adjusting to the world, right, without, for example, without this person, finding an enduring connection with the deceased, if it is a loss of a loved one, while embarking on a new life. There's also, you know, this idea of a dual control model where we look at both loss oriented tasks, but then also restoration orientation tasks. So that might look at honoring and validating the loss in terms of loss oriented, facing the crisis, feeling the feelings, sharing the story, creative outlets, journaling, connecting with others in similar situations. And then on the other side of that, it would be focused on restoration orientation. So sometimes even distraction, like a healthy distraction, sometimes it's not a bad thing, right? Doing something enjoyable, right to keeping your mind off a little bit not to say you're coping in unhealthy or destructive ways, but coping in a way that sort of allows you to have some relief is a good thing.

Danielle: 22:42

Right? Because you do need to feel your feelings and you do need to process your grief, but not 24 hours a day. Right? There are times where you're going to you're going to need some relief and distraction. And that is okay, you know, that's a that is an important part of the process as

Unknown: 22:59

well. And so even kind of looking at physical activity, redefining goals is also part of restoration, finding ways to help others creative outlets, maybe there's something that feels really good to participate in, whether it's making something or doing something that you bring that brings you joy. So looking at it from that sort of honoring the experience, but also honoring the process of moving forward, which can be a real task, which can be very, very challenging.

Danielle: 23:29

Oh, absolutely. None of this is easy. And so maybe we should have said that right away that great. Take home message. Grief is complicated. It's not easy. It looks different for everyone. So yeah, I mean, it isn't easy at all. Can we talk just a little bit about kind of the societal pressure or the culture around us that is pushing us to just move on? How does somebody who is working and processing their grief? What are some things that they may be able to do to? I don't know, combat that culture of, Oh, aren't you over this yet? You should just move on, you know, any thoughts on that?

Unknown: 24:12

Yeah. I mean, I think that's such a great point. I'm so glad you're bringing that into the conversation, because really trying to look at it from the lens of this is my experience. Right? And so I, I have to sort of understand and engage with what this experience is like for me. You know, I think that people can experience a lot of painful aspects of life without really identifying what is it about about it? That's painful, like, I guess one of the examples that comes to mind to me is this idea of where even we might experience this in family of origin, for example, where someone is connected to a family member, but not feeling like they really have any sort of relationship with that person. And how that's incredibly painful but might not be right recognized by maybe like an outside person. That that is well, that is a really painful experience, how does that impact things for this person like in terms of holidays, celebrations, like their sense of family or their sense of identity in their family, but it's something that isn't necessarily readily like seen or that we're open about. But it could be something that sort of a person might be struggling with. And so I think that really allowing yourself to like, honor, your own experience of loss or grief is so powerful and so important that it doesn't look in a specific way for everyone. And it really is about honoring your own process. And really understanding and tuning in to what that process is teaching you, what it's allowing you to understand about yourself, and how you have to how you want to move forward in your life. And I came across this really interesting quote that might be really relevant to share. So it's, everything that happens to you is your teacher. The secret is to sit at the feet of your own life and be taught by it. And so that's by Polly Behrens, but I thought it was very relevant to think about in terms of like, loss or grief as a teacher. Yeah,

Danielle: 26:16

yeah, that's so powerful. And for those of you who will listen to our other episode in this series on grief, that's also how it is viewed from a traditional Chinese medicine standpoint. And what what are you supposed to learn from this? And I know for all of those folks that are listening in, maybe you have, or are dealing with grief, that's a hard pill to swallow. And when you said you sort of have to figure out what it means for you. Again, that's tough. We know it's tough, we know it's hard. Because you do have to figure out what what is the meaningful piece of this for me? Yes. And nobody can tell you what that is, even though we would love it if somebody could, because it would make it a ton easier. But that's just not the way it's just not the way

Unknown: 27:06

it works. There's another interesting quote, from the research that I'd like to share. So goes as human beings, whenever our attachments are threatened, harmed or severed, we grieve. Grief is everything we think and feel inside of us. When this happens. We experience shock and disbelief. We worry which is a form of fear, we become sad and possibly lonely. We get angry, we feel guilty or regretful the sum total of all our feelings is our grief. That's by wolf that really powerful.

Danielle: 27:40

And so true, complicated, giant ball of yarn. That is exactly what is, you know, I mean, it's, it is complicated, and it's individual for everybody.

Unknown: 27:54

Yeah, absolutely.

Danielle: 27:57

Thank you so much, Jennifer, for, for joining me today in this discussion on grief. It was so informative, I hope that our listeners get a better understanding of grief that maybe you know, in your life you can recognize where you're experiencing grief that we've led some validity to what you're feeling and most of all, to give you some tips on how to start or work through the process of of your grief.

Unknown: 28:25

Thank you so much for having me, Danielle. Sure.

Danielle: 28:29

Well as we end, as we do with all of our our folks on on the podcast, would love to get to know you a little bit better by asking you our rapid fire.

Unknown: 28:40

That sounds great. I'm ready.

Danielle: 28:43

Okay, what are you currently watching or listening to?

Unknown: 28:47

Well, I have to admit, I've been diving into some Seinfeld reruns just been, you know, as a show that when it came out, I really was sort of to probably before my real generation, it was a little too young for it, but now sort of watching it from this different perspective. And it's just been nice. I really love laughter I love comedy. And so I'm always interested in in those types of shows.

Danielle: 29:17

Yes, excellent. All right, Seinfeld, what's your go to snack?

Unknown: 29:21

I would say an apple is my go to but I've been lately I've been really loving that Kashi, I think it's like Kashi peanut butter crunch, and I don't know if it's a cereal or like some kind of yogurt topper or something. I don't know what it is. But it is delicious.

Danielle: 29:40

I think technically it's a cereal. But as you said it's it can be used in many ways. Yogurt topper, just delicious on its own with milk without milk, whatever however you want to enjoy it. And what is one thing that you do everyday to stay healthy? So

Unknown: 29:59

I try Hard to always prioritize my sleep. Time passes. It's something that, you know, I'm trying to embrace this notion to that and I think we can we help people work on sleep too. But just this idea of like, it may come right, it might be a struggle to come at times, but it may come and you can create environments to help it come more naturally. So one of the things I got in the habit of doing is I have this really great little like, I put it like a heating pad. Just Oh, I just warm it up. And I just I put it right on my neck. So I'm falling asleep, and it's just been very soothing. So it's been a nice, gentle, soothing nighttime routine that helps me prioritize my sleep.

Danielle: 30:39

I love it. I love it. And sleep is so foundational, and I think it always sort of gets Yeah, I think it gets put on the backburner for a lot of us but sleep. Sleep is foundational to help. So awesome to hear that. That is something you are. Thanks. Well, thanks, everyone for listening. And thank you, Jennifer for thanks again,

Unknown: 31:00

Danielle.

Crossover Health: 31:01

Anyone 18 or over in the United States can be a crossover health member. At crossover. You stay connected to a care team that works together and gets to know you over time. A doctor, a nurse, a mental health expert, a physical therapist, a chiropractor, a health coach, a fitness coach and a care navigator. Go to crossover health.com to join the healthcare revolution. If you like our podcast, please follow or subscribe and leave a review. If you have a topic you want us to explore. Let us know on Facebook or Instagram at crossover health. Until next time, be well