Patrick O'Malley is a grief counselor with more than 35 years of experience. He has written many well-regarded articles on grieving, including the namesake New York Times article that inspired his new Sounds True book Getting Grief Right: Finding Your Story of Love in the Sorrow of Loss. In this episode of Insights at the Edge, Tami Simon and Patrick discuss his unique approach to grief and how it diverts from the popularly accepted five-stage model created by Elizabeth Kübler-Ross. Patrick asserts that the Kübler-Ross model, while helpful as a foundation, can actually create an emotional cage for people as they struggle to find the acceptance and closure that they expect to end their grieving. Tami and Patrick also talk about the odd way in which the concept "closure" became entwined with grief therapy and why sharing our stories of loss can be the most important step in the process. Finally, Patrick shares his own story of loss and explains that the simple act of being compassionately heard can be the most important step toward healing.

Tami Simon: You're listening to Insights at the Edge. Today my guest is Patrick O'Malley. Patrick O'Malley has been providing grief counseling and education to clients, volunteers, and colleagues for over 35 years. He's also served as a consultant to physicians, attorneys, and businesses, and has written numerous articles on grief and other mental health topics for many popular and professional publications. With Sounds True, Patrick O'Malley is the author of the new book Getting Grief Right: Finding Your Story of Love in the Sorrow of Loss.

In this episode of Insights at the Edge, Patrick and I spoke about how there's no one path to grief and how Elizabeth Kübler-Ross's five-step model leading to a mythic type of closure and completion has actually created a cage for many people in which they feel ashamed about how they're grieving and how long it's taking. We talked about the myth of closure, our culture's imbalanced emphasis on positivity, and also a new framework for grieving that's based on telling and listening to our shared stories of loss. We talked about how to respond skillfully when someone's grieving—what works and what doesn't—and how listening with deep attention and compassion literally changes something in the brain of the person being heard. Finally, we talked about the shift that happens when we realize how our grief is actually a function of how deeply we love. Here's my conversation with Patrick O'Malley:

Patrick, to begin with, could you tell our listeners a little bit about how you came to write your new book, Getting Grief Right?

Patrick O'Malley: I was a beginning therapist in 1979, fresh out of graduate school, and was working for a local family service agency. Just absolutely full of life—I'd finished school, it was a really an amazing time in the therapy world. Therapy was really sorting of beginning to take off and had not completely lost the stigma, but there was certainly more openness to it. So, I was well trained and training as I went, and taking on all sorts of interesting cases of families and adolescents and couples—and really quite young for a therapist. I was I think 26 when I began, and looking back on it that just seems frighteningly young, but I was.

In 1980 my wife and I had our first pregnancy. She was pregnant and delivered our son three months premature. So, he weighed about 2.2 pounds and lived his first six months in the neo-natal ICU. He was a preemie that we really were very unsure for many, many weeks whether or not he would survive.

But he began to grow and he began finally to breathe on his own. So, then we were able to bring him home at age six months and he was home with us for a little bit under three months—and was certainly struggling. Some developmental delays. We had a few trips back to the hospital. But mostly, we thought we were out of the woods and on the way.

And on May 17, 1981, he suddenly died. [He] was at our home and we did everything right. We did CPR. His physician was there immediately.

We were, of course, just without words for the devastation—as were just dozens and maybe hundreds of people who'd sort of followed his miraculous life.

Then, I returned to work, and it was in the spring of 1981 and I took a week off and went back to work and just was trying to sort—understand myself in terms of what had happened and process this just unspeakable loss.

Time went on and I was struggling with myself. I had really been not trained at all in anything to with grief, amazingly, in graduate school. Now, I talked to students in grad—obviously colleagues—all the time and I always ask them that question, "Did you get any training?" specifically in grief and loss. And the answers invariably [were] no—that it might have been embedded in another course like family life cycle development, that kind of thing.

So, I really didn't know much about it and I began to look and study and did what I could to understand. And at that point in time, the sort of bible of how we grieve was the text written by Elizabeth Kübler-Ross on the stages of grief. And so I latched onto that as many had, and kept trying to understand my own grief in the context of a belief that I would go through stages and come to some conclusion.

It was also a time in therapy where there was a lot of various therapies going on with catharsis and gestalt therapy and this notion of trying to reach resolution, reach closure. The word "closure" became a very key point for me in trying to understand what was going wrong with me.

Well, this went on for several years and I also began to get a lot of clients who had loss because I was the guy in town who had had a loss. So, understandably folks wanted to come work with me, and I was pretty much preaching to them as I preached to myself—that we're on a course here; this is going to go in a sequence, and that sequence is going to lead us through denial and anger and bargaining and depression and acceptance, and we might call it closure and just bear with me and we'll get there.

But, it wasn't happening. It wasn't happening for them and it certainly wasn't happening for me. I began to doubt the road map I was using and, over time, then began to really sort of set that aside and do what I might have been doing all along—and that is just listen to folks who were coming to see me and listen to myself, and understand that this was not a human experience that really lent itself to something as neat and tidy as I had believed it should. Consequently, there [were] some turning points in the mid-'80s where I really started to hear what I came to understand—and that is what people really wish to do when they came to see me was to tell me the story of their loss—to help me help them understand that story. And although some folks that I worked with before sort of liked the five stages and I'd have them read it and we'd kind of figure out where they were, it really was not ultimately very useful and very fulfilling for them or for me.

The book is really the story of my story and this parallel journey with really, probably—I don't think it's overstating it now after 38 years to say—thousands of folks I've sat with who have experienced loss and helping them connect with their story, which is very simple and organic in a way. I mean, it takes us back probably to where grief was before psychology sort of got a hold of it and tried to make it into a model and tried to make it something more analytical.

So, that's kind of the basic way I got into this. This book is sort of the outcome of these years and years of my own transition and transformation as a grieving parent and as a therapist. There's the rich, deep understanding that happens even today with folks who just desire to have acknowledgement for their loss and understand that they're not getting it wrong—that their loss is based on their attachment to their loved one that is a unique attachment and something to be honored. So, all the feelings that come with loss are really, in essence, an expression of that love and that sacred story that connects them with the one who has died.

TS: At the very beginning of Getting Grief Right you wrote the following: "I want to make clear at the outset that this book offers no promise that grief will end. This book will not help you get over your grief, but it will help you experience your sorrow in its purest form." And, I thought that was a very strong position—"this book offers no promise that grief will end." I think that having grief end—having as you say "closure"—that's what most people think they're looking for. That's what's supposed to happen, right? At a certain point I'm going to get over this, right? Go back about my life.

PO: Yes, [I think] that is I think the kind of common way folks think about it and that's fed pretty strongly I think through a lot of different sources in our culture. Then what happens is, "Well what's wrong with me because I'm not—I must be being deficient in my grief."

As the years unfolded and more and more people came to understand that the notion of the stages of grief, it really in my opinion is a psychological model that became embedded in our culture to a degree that I'm not sure any other model has. And you can hear people—they may get it wrong, but they know there's stages and they know there's something at the end. They may not have it all exactly right, but it's been popularized. I note it in the book. You can see it in sitcoms. We found a Homer Simpson—that Homer's being described that he's got an illness and he goes through the five stages of grief in about 30 seconds. So, it's just deeply embedded in our culture.

Over time, I began to notice more people were coming to see me not just to describe their grief, but to describe or ask the question of, "What's wrong with me? why am I still feeling this? I should be done by now. It's been three weeks, six months, two years"—fill in the blank. They're, "I must be defective in some way because I read an article in a magazine or I heard a newscaster say that we've got to get closure." Or, there's been some influence there that sets up some reference point that really takes people then out of their story and into this self-analytical mode of feeling like they're getting it wrong—or even worse, sometimes feeling shame for the intensity and the length of the experience that they're having with loss.

TS: Are you saying, Patrick, that there's no timeline for grief?

PO: What I would say is that it is not certainly that the experience of grief doesn't change over time, but there really isn't a timeline to say that then you come to some conclusion and then it's over. It may be less intense over time, but I tell folks all the time it may change—you may have less intensity and less frequency. But, if you have just an absolute moment of despair and sadness 10 years from today, that doesn't mean you didn't grieve correctly. And that again I think is folks just continually sort of monitoring their self about how they're doing.

The language I use is that your loss is a part of your life story, and that story will be with you for your life. I often say this and it's just amazing—even this week it's happened—where I will say, "The intensity of your loss is directly connected to the amount of your love, and if you are able to see that, then the self-judgment falls away, the self-criticism dissipates." There's an understanding that our basic design to be attached to those we love is what has happened here—that attachment is now broken in this lifetime.

And, when it's restated—which I believe strongly that it is—as you know your every tear is about your love, then the shame can go away and we can be present to our story in whatever form that takes for however it shapes and forms over years to come.

TS: Now, I just want to make sure that I have a clear understanding of your view of Elizabeth Kübler-Ross's five-step model that, as you say, has been so embedded in our culture. You write a chapter in Getting Grief Right and you call it "the cage of the stages." So, obviously you don't think we should get stuck inside a cage of these five, linear progressive stages. So, do you think there is some applicability, but it's just not universally applicable? Or do you think it's just doing more harm than good and we should throw that model out?

PO: Well, that's a very important question, and there's certainly a lot of conversation [and] discussion about that. We need to back up a step and remember that the original population for whom she was researching—that she wrote her five stages—were not grieving people, they were dying people. These were terminal patients that she was interviewing, and in that interviewing she began to see these patterns of the five stages. Denial, anger, bargaining, depression, acceptance.

It's a little bit debatable. Some folks are pretty firm on how this happened, but I've read a lot about it. And it seems that—I don't think she—and you'll hear people who have interviewed and talked to her—she did not mean for this to become so rigid even if you look at it in its original population of dying people—terminal patients rather than grieving people. But I was guilty—if you want to call it that—as much as any that it was just so simple and sequential and we're looking for some sort of a foothold in this chaos of loss that if we could just march through in a sequence, wouldn't we all feel better?

Now, all that being said, she did not stop the next thing that happened, which was its applicability to grief. In fact, she coauthored a book on that as well. So, you hear her go back and forth about this when she was alive—that she didn't mean to be taken so lock-step—but at the same time she did see its applicability almost anywhere.

To her credit, we would not be where we are today without her because she opened the conversation. She—and you look at her early work and the resistance she was getting to this idea of interviewing terminal patients—she was absolutely a pioneer. You can see her connection to the hospice movement and see her connection to more of an open conversation about it.

So, how I would answer that question is rather than say, "These stages always happen and in this order," or say, "There is nothing valuable about these stages," I would say certainly any of these can happen to anybody, but if they don't happen you didn't grieve incorrectly. And if they do happen, it's another way of describing your experience.

But, where it went was just so—it got so confined. That's the metaphor of the cage, that it really limited people's ability to own their story and embrace their story if it wasn't lining up.

I went through that myself. I went into therapy a couple times after my son died and I was trying to look to figure out where I'd missed it and what I'd done wrong, and why [I wasn't] at some higher level of acceptance at that time. I experienced that same kind of internal pressure and, again, I still see people do it. Again, they might not be able to articulate the theory even now—because it's now many years old—from where it came, but they do believe there's such a thing as closure.

To talk about that for a second: The best I can figure the notion of closure sort of worked its way into grief literacy or grief talk coming out of the gestalt therapy movement. You know—a lot of the gestalt was to do various exercises to help you manage your unfinished business so that you could come to closure. "Closure" loosely being defined—I think—as that you've come to some resolution in which whatever was bothering you didn't bother you anymore.

You kind of look over time [and] you can see how it sort of replaced the word "acceptance" in Kübler-Ross's language. If there's an event—an international event—in the next week, you will hear folks still talk about closure as if that's a defined thing that's going to happen and we've got to make sure that people get that. And that's a lot of what triggers people to come see me, is to say, "I haven't reached closure."

TS: I can also imagine people being confused about the difference between, "Am I grieving or am I depressed?" And how do I which one? And if it's going on and on and there's no endpoint, maybe this is depression. How do you know the difference?

PO: Well, that is a very important question, and they look the same. You can have—if you look down the depression list—low energy, overeating, under-eating, oversleeping, under-sleeping, loss of interest in pleasure. I think what happens is that they parallel—it looks like a parallel process for awhile. And I would say certainly that some folks who aren't depressed when they start grieving may end up with clinical depression. I do think that's a place to seek consultation—to be sure that it is not moving into clinical depression.

Oftentimes one of the distinctive factors with depression is the sense of self-loathing—isolation, a lot of self criticism. Now, that can happen in grief too, but it's I think more dominant with just straight-out depression. That I think is certainly a time to maybe double-check and be sure. My experience is people tend to call grief depression way too early, and that's where it sort of becomes clinical. Now we've got to treat it as an illness. And for many people, I will make that judgment call and I'll say, "I think your chemistry's just worn out." It may have been before the loss that you came into this with already some factors, and some folks have wrestled with depression before their loss. So, they need to really keep an eye on it.

But with many folks, I'll say, "I think you're ready for a consult. Let's look at trying to manage that." And for other folks it's more clear that really what they are is sad, not depressed.

TS: Now, in talking—once again—I want to just circle back for a moment about this idea of closure. It sounds like you're saying there is no closure to grief actually. It could spring up 20, 30, 40, 50 years later. Is that what you're saying—there is no such thing as closure, really?

PO: Well, if closure's being defined as, "I've achieved a level in which I will no longer an experience that I would call grief,"—that would be the most rigid definition of closure—I could go this far and say you know there may be some closures along the way—if we're going to look at that. That there are things that go along the way that feel like I've moved into a different place.

But, I think the way closure was typically discussed is that you're done. And so—yes, if we're using the "I'm done" definition of closure, then there's no room for anything to pop up later.

We can get into this in a second, but I talk in the book a bit about how in the world can we reach that when we have so many triggers in our environment, so many reminders in our environment that may create a surge of emotion that's going on.

To get back to your question, I think closure's been rigidly defined and, in that regard, my hope is we just take it out of the vocabulary—just not make it a thing that we have to wonder if we've got or we don't got. That if we just stay with our story. And that means if you have three years and you don't think about your loss and then you do, it didn't mean you didn't have closure. It didn't mean you did. I think it's a word we just need to eliminate.

TS: I'm going to have closure on closure.

PO: Closure: we just closed it.

TS: Exactly. It's over. I'm moving on.

PO: Yes.

TS: OK, so let's move into the framework if you will that you're offering that is I think radically different than stages that lead to some endpoint—which is this idea of storytelling. Help me understand how either voicing or writing—sharing—my story of grief is really going to help? How does that change me?

PO: Sharing—and we talk about embracing your story, knowing your story. Well, of course most of us know our story. But, the story may have gotten lost again in this process of trying to make sure we get grief right or that we're doing it right.

So, what I'm really encouraging folks to do is to step into that story. And we have processes in the book that help you connect even at a deeper level.

I tell a story in the book about a fellow I was seeing that just—I couldn't get him on my steps and stages program. I was working everywhere I could to kind of make that make sense to him. He just wanted to talk. I began to realize that when we'd look at primarily what folks need, it's acknowledgment. We'll talk a little bit more about that in a bit about what we need to do as a community.

But, the idea of connecting to your story is to know that you had a unique relationship with the one you lost. It can't be anything else because it starts with your unique attachment to the one who died. And so, my encouragement is rather than trying to figure out if I'm getting it right or wrong, to really deepen into the story—to see how it has been part of your life. And then [the depth of feeling that you have about the absence of that person] starts to make sense.

We kind of go through a three-chapter way of thinking about that—life before the loss, the death itself, and then life after the loss. Those are sort of the loosely described three chapters of our story. Of course, the third chapter is still going on.

So, there are ways in the book to try and just prompt questions. For instance, I ask a question many times with folks: "Tell me about who it was that you lost. Also tell me about who you got to be with that person that you don't get to be with anybody else." That's a loss. There are ways in which we connect to those we love that—they are unique to us, but it's unique to ourselves to be with them.

I think about a friend that died and he thought I was the funniest guy in town. Nobody has laughed as hard at my material as he did. I miss getting to be funny in the way that he thought I was funny. So, I miss him and I miss that part of me I got to be with him. That's an example of how we can deepen our story if we step into it and really try and understand it at all sorts of levels.

TS: Now, you mentioned that what people are seeking is acknowledgement. So, I write my story down—isn't it important that I share it with someone, that there's some acknowledgment of this story of grief?

PO: That's the completed circle—that if we have our story and we don't have a place for it to go, it feels incomplete. And many folks don't and I understand that and we make room for that as we write about it. And some folks are just introverted and don't want to—or not necessarily introverted, but just so private they don't necessarily want to take that step when possible. That's where we'll talk about maybe how we can be better as a community. The story is in its fullness if we have a place for it to be received, and that's why a lot of people end up in my office, is that they don't have anywhere else for their story to be received.

They may not be having any real clinical symptoms I need to deal with. There are some folks here that are here because the death was traumatic and we have to work through some of the PTSD—the post-traumatic stress aspects of their loss. But, there's a group of folks that come just because they're isolated and don't have a place to share their story. I think the fullness and the richness of the sacredness of the story is at its best when there is the right kind of place for it to be received.

TS: I want to talk about that in quite some depth if that's OK, and I think this comes from a place of knowing somebody very well who went through a series of losses, and even though this person was friends with many therapists and other people, she had a really deep sense that nobody really wanted to hear her story in all of the detail that she wanted to describe it—that that it wasn't considered part of our sort of friendship circle or function to provide that for each other. I wonder if you can talk more about a vision, if you will, that you would have of a community that knows how to be there for each others' grief?

PO: I do, and we address that in some detail in the book when we talk about help for the helper. The idea is again more organic and simple than we might make it out to be.

Part of it is presence and attuned listening and an open heart to receive the story. It is our own anxiety—and as many years as I've done this, it happens to me. If I'm in the role of driving to the house where a loved one has died, I say that same thing to myself that probably most of us say, and that is, "What in the world am I going to say to this dear person?" That's the wrong question. The right question is, "How can I be present for this dear person?"

My role there is not to guide or to coach or to minimize or make it better or spin it or find the positive; it is truly to be with and to—what I call sitting with—just being present. I think our anxiety sort of gets in our way because it's almost contrary to our instincts to not try and change the suffering that someone may be experiencing. The work of this is not to find new things to say as much as it is to learn how to listen, learn what that attunement looks like, learn how to be present, and then consistency over time.

So many folks say, "It was all kind of over when the last casserole dish was picked up." The community really fades away. And so we give ideas—call on the second anniversary, always make sure you call on special days, write a note just because you're thinking. When we looked at some of the research that—a couple of authors did a survey, and I think they got 8,000 surveys back. [It said,] "What do you need in the time of your loss?" and the number one thing was "acknowledgment."

So, that's got more science to it than just art that there really is a desire to just know. So, in description of what you're looking at in that friendship circle, these sounded like all folks who certainly had kind of a human understanding, but it just didn't click. They didn't, the friend didn't get what they needed, which is again I think that very tender, gentle being-with that's so important—and being with past the days of the death, being with weeks and months later.

In some way it's sort of like we're talking about with the organic nature of grief, the organic nature of being the helper is to take the pressure off yourself by not figuring out what to say and being present. Now, in that, we write about the discouragement of things like saying, of giving clichés, trying to make somebody feel better.

There's a difference between consolation, which is to make you feel better, and condolence, which is to be with you in your sadness. It's very tempting to sort of wrap this all up sometimes with clichés. Often times with folks I work with we spend a little time with me asking this question: "Tell me about some things that were said to you that you're struggling with by those who were trying to help." And, almost always somebody's got something—and not bad-intended folks. Well intended, well motivated, desire to be helpful. But, they just said something that didn't match, didn't attune, that was minimizing, all the way to something that was hard to hear.

How we change as a community is just I think so crucial to being able to create an environment where we don't have to have not only not have shame about our loss, but not feel like we have to protect others from who we are because we're still in a state of mourning.

TS: Now, I want to dig in a little bit deeper here because you're saying, "I don't know what to say. Well, that's not the right way to go about it; it's your presence that matters." But, I don't know what to write in the card. I don't know what to say when I get on the phone. It's one thing if it's a close friend and I can just sit next to them, but for people who are not in that immediate circle I just don't know how to reach out in a way that makes sense. I'm so overwhelmed with sadness and I don't have the kind of connection. I don't know what to do. What would be your advice for those situations, which I think a lot of people find themselves in a lot of the time?

PO: Yes, well, I think again simple is good and that is it can start with an authentic, "I am sorry that you are going through this difficult time." And, that I think is the shortest version of connection. Beyond that is—if you want to—I want to hear more about your life with him or her, about what this has meant to you. I want to be able to listen, but I think the really initial response is to just—and it may feel overstated, but there's not many other ways of saying this—is, "I am very sorry. My loving condolences to you about this." Then, [do] not go further; [do] not say, "And, I know exactly how you feel." Or, "I know it's going to get better." Just, stop with the acknowledgment of your sorrow for their sorrow.

TS: OK, I'm going to be a little challenging here Patrick. You're the expert, but I went through an experience of loss and I got many cards that said, "I'm sorry for your loss." And, I noticed at a certain none of them touched me or penetrated. It was like, "Oh." I was like, "Everybody knows to say now, 'I'm sorry for your loss.'" So, I have 50 cards that say, "I'm sorry for your loss." And, none of them really touched me.

PO: Right.

TS: Those cards didn't touch me.

PO: Yes, well, if you look at that and I agree that can be—that's kind of the most simplistic and short thing to say. But if you look at that from what you wished you had heard, let me try and take that back to you: What do you wish you would have heard?

TS: Something more personal, "I know how much blah, blah, blah meant to you." That might have helped if there was something like that, yes. It's almost like Hallmark got a hold of, "I'm sorry for your loss."

PO: Right, right. I agree. And I mean I see that again as a starting place, but I think something more personal is that I know how much you loved him or her—or again, not "I know," but, "I imagine your life without him or her will be very hard or different." Something that does have more personal touch to them.

Or if they knew the person to say, "I knew who he or she was as best I could in your life and what an absence or what a hole that may be for you." Those kind of things take it up a step again without trying to overprescribe anything that needs to happen. And then I think the next level is indeed the more personal and that is, "Tell me more. Tell me how you are."

TS: Now, having sat in the counselor's chair and heard people share with you the damaging things that they heard in the grieving process, can you just summarize for our listeners some of the things that were really—these are the things that reported historically have just been so painful. Don't do these things.

PO: Yes—the don't—some of the things I've heard—I mean, the most consistent thing is that it feels minimized. What the response is, is to say, "This is not that big a loss." I mean, that's the implied—is that you know we know you and you're going to get fine and you're a fighter—things that again just change the acknowledgment.

Now sometimes—and I think I tell a story in the book about a woman who came to see me whose baby had died and one of the relatives says to her, "You know, God must've really wanted that baby more than you." Well, that's damaging. The poor woman had to really work through the question of [whether she was] being punished.

You can get things that are an edge like that. Again, I'm not able to judge whether that woman had bad intent—I doubt if she did—but it was the kind of thing that ends up with somebody having to now think through their own character. "Is something wrong with me, did I do something wrong?"

I would say the majority are not hurtful like that. The majority are just in some form minimizing or, again, a cliché that tends to simplify it. And all the clichés usually have a spin towards something that's better—that it's more positive. "He or she's in a better place," or, "At least they got to live a full life." Those are not necessarily—depending on your beliefs—untrue things, but they're not where I am right now. Where I am right now is in the deep missing and pain of this relationship of my life that's lost.

TS: Now, and another comment you make is that often people say something like, "Please let me know if I can help." But, that can sometimes not be the most effective thing because you're not really offering any actual help—you're just kind of throwing that out without any follow-through. I thought that was interesting because I know sometimes when there's a loss I either say something like that or I think to say something like that, because I want to help but I also feel just kind of ineffectual, and I'm probably not going to do anything. What's your suggestion around that?

PO: Well, actually do something, you know to say—

TS: Oh, that!

PO: Yes, that. It's like, "I'm going to bring you dinner next Thursday and if you want to visit, we can visit. If not I'll just drop it off." Or, "It looks to me like your grass needs to be cut and I can get that done for you." Or, "Do the kids needs to be picked up?" Look [and] kind of use your radar to see if there isn't something to do rather than that kind of open-ended offer—because, again, I think [it's] well-meaning. But, very few folks are going to follow through with that. So, I think if your intuition is working for you, you should be able to see something that might be done and then actually do it. And then do it again.

So, the bereaved I think don't want to have to solicit the help they need. They can and they may, but it's just good to have it offered. If you get turned down, don't personalize that. Better to have offered and you may learn a little bit more about what they do need. I do think that's an often-stated, often-made statement that isn't necessarily over time become sort of meaningless.

TS: I think one of the traps that a lot of people fall into—I know fall into it—is just avoidance. I just sort of avoid that person somehow, because I don't really—I just avoid. And it seems like that's actually the opposite of the acknowledgment that they really want.

PO: Yes, and the avoidance can come in a couple of ways. One is, "I don't want to make them feel worse by asking them how they're doing." Well, let them tell you that they don't want to talk. I really would encourage folks to err on the side of being told, "You're giving me more than I need," than for somebody to be as isolated as they can get.

Yes, I think it's important to approach and make yourself a note if you have to, to say, "It's the anniversary of the death. I need to make a call." Or, just an email, "I was thinking about you today." Or, "You know, let me take you to coffee. I didn't know your dad very well. I'd like to hear some stories about him." Just reaching out I think is offering such the kind of support we ought to be giving each other when we're going through this.

TS: Now, there's one sentence I took out of the book that I want to hear you comment on it—it has to do with the kind of listening that you mentioned bereaved people really crave and need. And here's the quote: you said, "Listening with deep attention and compassion literally changes something in the brain of the person being heard." I thought that was so interesting. What happens in the brain of the person being heard?

PO: Well, you know we in the therapy business have been doing what we've been doing for a long time without really much scientific evidence that it's useful. So, aren't we lucky that now we have all this brain science that's coming out? We can actually take pictures of the brain and see that maybe something's actually happening.

So, I think what is happening in the brain is that deep acknowledgment and recognition opens up the mind and what we would say is it sort of creates new neural pathways—where I can just get said what I need to say, have it acknowledged and supported, not have to defend or self-criticize, and it really has a powerful effect on just the state of mind that we're in because it's that loving, caring, holding attunement. Those of us who've done the parenting thing you know we learned that 50 years ago in terms of how do we listen to kids.

You get a whole lot further if you're able to listen and reflect than sometimes guiding and coaching. Something happens where just my humanness and your humanness connect. Really, what's probably happening more than anything is just the sense of safety—that I can feel safe with this person as I tell them what's inside me, and thus we're in a relaxed, not un-painful state of mind, but we're not in an anxious state of mind that feels unsafe because we feel like we're going to get judged or criticized or abandoned in what we're doing.

So, I do think if we summed up, "What does that kind of listening do?" it creates safety. How does our mind respond with safety? It opens up. We're able to hear ourselves and understand and really create our own self compassion because we understand that what we're experiencing is what happens when we love someone.

TS: There's a chapter, Patrick, in Getting Grief Right that you call "The Culture of Positivity," and you're looking at our contemporary Western culture and how it handles grief and mourning with this emphasis on, "Get on through it! You're strong!" I'm curious how grief and mourning have been approached in other times and other cultures, and what you think our contemporary culture needs to learn from these other times and cultures.

PO: Well, we looked probably at in our culture pre-industrial time when life was more in the community, and those who were bereaved were honored for a period of time. You remember the wearing of the black or the black arm band.

So, those who were grieving were noted in the community as going through a special time. The theory would be that when industrialization started and communities sort of collapsed and everybody sort of crowded in, there wasn't any time or acknowledgment of that. So, I think we did probably have good acknowledgment and rituals in the community at a certain point in our own culture that have changed with modernization.

You can certainly still read some of the anthropology of other cultures that really do take time out and create rituals for the ones who are grieving and help them process that over time.

The culture of positivity—we write a little bit in the book about the history of that and it's deep, deep, deep in our culture. I'm not making a statement that there's something inherently wrong with positivity. But, when you begin to label emotions as either negative or positive, then we would likely label the emotions of grief as negative. And that's dangerous. That's again suggesting I'm doing it wrong.

The label of negative or positive emotion really should not be applied to many of our human experiences. It just is what we are experiencing. In this culture, we have to fight—and I'm one of many, many voices who are trying to say we need to have a different way of treating people who grieve and not see that they are wallowing or stuck in negative emotions, or they're not being positive enough. The other thing I think we inadvertently do is reward people who look like they're not grieving and we'll call them positive. Well, I can promise you many of them are just presenting like they're not grieving because it doesn't feel safe, and when the day's over and the door is closed, they've got to be with their sadness over their loss.

You can kind of hear that in language. "How is he or she doing?" "Oh my gosh, they're doing horrible. They're just a mess." You know: "They can't really get up and function." Speaking of their grief, "How is he or she doing?" "Oh they're great, they're back at work in a few days." "Really? So it's a positive person."

I think our language—not necessarily by intent to harm—it sort of reinforces that if you're doing well, then you're a positive person. But, that doing well may mean that that person is just having to shut down everything they're going through.

For listeners: be conscious of knowing that you don't know how somebody is doing and how they're presenting may be what they've got to do in a certain circumstance to get through the day. By all means be careful to not label their grief and their grief process as something that's either positive or negative. It just doesn't led itself to that.

TS: At this point in your life, Patrick, how do you honor your grief if you will? What do you do in relationship to your baby son Ryan that you talked to us about, or any grief in your life?

PO: Well, we were just at—every day on the anniversary of his death, I don't work. I haven't done that every day since he died, and that was May 17. So, May 17 my wife and I were, spend our time at the cemetery and we have two or three family members—my mom and my dad are both buried near my son. So, we make that trip to do that.

This book has really been that. It's been a way of honoring him and there's a deep desire I have is for folks to see that here I am all these years later. And in the process of writing this book, I just had so many days where a surge of sadness would come and this sense of, "Gosh, today he would be 36 years old. What would all that look like?"

I'm very conscious of when you lose someone as young as he was there's a "who he was" and then a "who he was supposed to be," and so I'm very conscious of that.

My lovely new Japanese daughter in-law at Christmas—this was just kind of caught us off guard—she said, "Let's do something today that's in my culture. Can we take food to the cemetery?" "Well, yes, we can do that." She'd never been to the cemetery to see where our loved ones are buried. So, we packed up the family and the grandkids and off we went to the cemetery on Christmas day, and we put a cookie on every grave. It was just the sweetest thing.

In her culture they—several times a year—go to the cemetery and honor their ancestors and do so in very defined ways. And one of the ways they do that is to take food to leave for them. So, she brought to us a real gift. We'll do that every year. We'll load up on a holiday and go to the cemetery and leave some food.

TS: Now, one of the things you emphasize in Getting Grief Right is that we each have a unique way of grieving—that there's no one path to grief. Why is that so important for people to understand that—that each of us has a unique way of grieving?

PO: I think that's all still in the idea of making sure we are careful to not be self-critical about how we grieve. We talk about the idea that we—several things happen. One is we have a unique relationship. We have a unique attachment. So, that's part of our uniqueness.

The other is we have our own personality type. How we are wired in our basic cells is going to have a lot to do with that. So, that uniqueness is to not be competitive or comparative with how you think you ought to grieve or how you see other people grieve, but again to own that for yourself as, "This is who I am. This is my story." And although there are certainly within a family many overlapping stories, there still is a sense of uniqueness to it.

We really emphasize that uniqueness to bring out the point of attachment—that attachment is what is at the basis. We cannot again grieve who we're not attached to and we attach because we love and because we're bound to attach. We look at that uniqueness both in terms of how we are, who we are, the circumstances of the death, the life stage where we are. All of those are part of our story. So, when we talk about that what we're really trying to do again is help folks deepen their story. It's not stuff they don't know—our desire for the book is to bring that out in some ways that may have not been evident.

TS: I want to ask you Patrick kind of a reaching question, if you will in a certain sense—I noticed being with the book Getting Grief Right, as I was reading it I reflected on various losses in my life. But I also tuned into a feeling of grief about species loss and the environment, and other collective issues for the whole planet. And I thought to myself, "I wonder what Patrick O'Malley has to say about getting grief right when it comes to the grief we feel about the environment and our collective."

PO: We were specific in our approach to deal with death loss, but there is really such importance in understanding living loss in the same way. That living loss is things like you've just described—what's going on in the world that saddens us; what's going on around the world that saddens us; what happens to the environment; fractured friendships; divorce. There's just so many living losses.

What I would say is that's again going to be unique in terms of who you are and what you find you're attached to. So, if you notice those feeling of grief related to sort of a sense of the environment or the species or the culture or whatever it is, I think go back backwards a bit and say, "If I am feeling this sadness, then it is describing to me an attachment that I have to certain parts of the world, to certain parts of my world, that are either in jeopardy or are dying, and thus I am going to be sad about that." There is nothing again unhealthy or diagnosable about that. It speaks to the fact that your heart takes in what it takes in and attaches to it, and in that you've created a bond. And when that bond is threatened by extinction or death or whatever it is that's our natural response—is [to] again have that sense of loss and sadness.

TS: What do you see—having worked with so many people—is the shift that happens when we connect to the idea that our grief is a function of our attachment or our love? How does that change the griever?

PO: Well, what it does I think is take the pressure off. And it's [harder] to argue with, "Now that I'm sad, it's about my love," than, "What's wrong with me?" I think it's important—I'm going to steer off on this for just a second to talk about complicated attachment.

I mention that in the book. I see many folks who wonder why they're not grieving, or why they may even be feeling—and this is a very hard thing for folks to say—a sense of relief. Well, it's the same principle, and that is that that attachment was complicated. That attachment—if you want to even call it that—may have been dangerous.

I get a lot of folks who come in and say, you know, "Somebody in my life has died and I ought to be feeling more than I'm feeling." I get the opposite rather than, "Why am I feeling so much?"

Well, when we walk into that story, typically what we're looking at—or what ends up happening—is that the attachment itself was in peril because it wasn't safe. It's the same sort of relief I see with people who realized their sadness is about love. I see a lot of relief in folks who understand that the fact that they're not grieving is not a character flaw—not grieving like they thought they would, but is really based on an attachment that was complex, and maybe an attachment that was even painful and damaging.

So mostly—to answer the question—what I see is relief that, either direction—either, "Why I'm not feeling more than I do?" or, "Why I'm feeling as much as I do?"

TS: Well, don't a lot of people feel relief when someone who's been ill for a long time or an elderly person dies and there's a sense of "They're out of their suffering"?

PO: Right.

TS: How does that fit in with what you're saying?

PO: Well, that's a sort of relief usually based on a loving attachment and that is compassion for someone's suffering. For somebody's soul to be released from their body is a relief. Now, I still hear some folks saying, "That doesn't feel right. I feel guilty for even thinking that."

But again, if you look at it from the point of their love for them it was their deep pain for their pain and their suffering. So, to again attach that back to love and to understand that your loved one was in pain makes that sense of relief not feel like you're feeling something wrong.

TS: There's one thing I want to highlight here before we conclude our conversation. You were talking about recently going to the gravesite and offering a cookie—Japanese ritual to the beings that have been deceased in your family. And here's something you write about in the book that we can think of grief in a different way as quote, "An ongoing relationship between the living and the deceased." That really got my attention—this idea that when grief comes up in our life, it's part of a relationship between us and the deceased. That really touched me, and I wonder if you can comment on that.

PO: Yes, the sort of clinical way of describing that—or at least a model—is the idea of enduring bonds—that our bonds don't stop after death. When you look at the steps and stages in closure model it almost, if not does, that it seems to imply that the bond is broken because of death—that there is no more ongoing relationship. And so, I'm clearly in the camp of enduring bonds and that honoring of the relationship—that remembering, that thinking, writing, rituals, whatever those are continues that relationship in this lifetime.

Other cultures probably do that differently and maybe more than we do. And I do think in other even subcultures in this culture, that's a very acceptable way of thinking about it. But, I believe those two words are a really lovely way to put it—and that is it's an enduring bond. It's not a bond that ends because of death. And yes, to stay in that process of honoring that in whatever way feels like its honoring is a very healthy place to be.

TS: Finally, Patrick, you wrote Getting Grief Right with a good friend of yours and coauthor Tim Madigan. As I was reading the book, one of the things that touched me was how when we feel our grief in a deep and pure way, it can connect us with friendship, and how much we love certain people. I wonder if you can comment on that—the connection between feeling our grief, honoring it, and friendship.

PO: You know there are—we didn't say this specifically, but let me—I think it's a good time to talk about the power of support groups as an example of that. I will hear some folks who connect with others who have gone through loss who were strangers to them at the time of the death create a lovely intimacy. And they will say, "This feels to me closer than some of my friends and family members, because we share our loss together."

That is so important as a part of a community, and when you hear somebody talk about their loss and you have had your loss, and there is intimacy, it's just a lovely, sacred, deep intimacy. That's certainly the experience Tim and I have had with each other. We've had our losses and we had friendship for many, many years. We just kind of kept working at this and it's been a wonderful, bonding time for Tim and me through this to have shared our losses with each other and to take this message to the world.

I think it's as deep a community that you can have when you have that kind of connection of love and support and compassion and reality-sharing, and telling your story with each other. That's what we hope to happen out of this is—that folks will open up and tell their story and receive story and create that really—as you described it—just wonderful, deep, loving, intimate connection with each other.

TS: I've been speaking with Patrick O'Malley. Along with Tim Madigan, he's the author of the new book Getting Grief Right: Finding Your Story of Love in the Sorrow of Loss. Patrick, thank you so much for your true heart and for all of the energy you put into writing this beautiful and hopeful book. Thank you so much.

PO: Well, thank you Tami. I appreciate this time very much.

TS: SoundsTrue.com. Thanks everyone for listening. Many voices, one journey.

You can listen to the audio recording of this interview here.