On the last track we discussed The Positive Side of Grief. In
my practice I have found three positive sides of grief. They
are the appreciation of life, strengthening of family ties, and finding
meaning in suffering.
On this track we will discuss The Three ‘D’s of Grief. The
Three ‘D’s of Grief refer to forms of emotional and
physical numbing I have found to be common among clients experiencing grief. The
Three ‘D’s of Grief are dissociation, de-realization, and depersonalization. As
I describe The Three ‘D’s of Grief, you may want
to evaluate clients you are treating for susceptibility to these forms of
As you may know, episodes of dissociation, de-realization,
and depersonalization may vary in intensity and duration. I have found
that though some cases last only a few hours, other cases can last several
The Three ‘D’s of Grief
As you are well aware, there are many kinds of dissociation. However,
I have found that, fundamentally, dissociation refers to a
disconnection between experience and emotion, or between mind and body.
if any of these dissociative remarks sound familiar:
Here is grieving client observation
-- Number One:
"It’s like I’m outside of my body looking in."
-- Number Two:
"I have no idea what I’m feeling"
Dave, age 17, made a third dissociative observation when
he stated, "I
knew I should have felt something, but I didn’t feel anything." Dave
was referring to an accidental cut to his hand which happened several days
after his best friend, Jeremy, died from a drug overdose. Dave stated, "It
was a deep cut. The doctor gave me 9 stitches. At first, I just
watched the blood flowing out. I didn’t feel any fear or pain. I
knew what was going on, I just didn’t care. Then my mom saw
it and she freaked. Her scream sort of woke me up, I guess." Later
on this track, I will describe a technique I suggested Dave use to avoid similar
The second D of grief is de-realization. As you may already know, de-realization
refers to another manifestation of mental disconnection. In my experience,
grieving clients who suffer from de-realization don’t feel as
if they are real. I have also found that clients may
feel as if events and circumstances are not real.
Susan, age 32, experienced
residual grief from a childhood trauma of being beaten by an uncle who was
her baby sitter. Susan
experienced periodic moments of de-realization through an
altered perception of time and a general feeling of detachment. Susan
stated, "I feel like I’m in a dream or a play or something when
I think about what he did to me. I don’t even know if the play
is real. Most of the time, I hope it’s not."
In addition to dissociation and de-realization, the third ‘D’ is
depersonalization or the client’s feeling of detaching from
humanity. Have you treated a client who feels less like a person and
more like a robot? I have found that clients who suffer from depersonalization
may have little or no motivation to take care of themselves. Susan
also suffered from depersonalization. Susan
explained her depersonalization experiences when she stated, "Sometimes
life feels mechanical. I’ll take a shower or brush my teeth, but
not because I care about how I look. It’s like I’m just going
through the motions."
To find out more about how depersonalization
and de-realization affected Susan, I asked, "Do you find it very hard to relate
to the other people in your life?" Susan stated, "Yeah. It’s
hard for me to talk to other people because I feel so dead inside. I
try to relate anyway, but I get so confused." Like
other grieving clients I have treated, Susan had to work hard to overcome the
confusion and apathy that can accompany the three ‘D’s
of grief. I asked Susan how she felt when mechanical
feelings affected her ability to think, respond, or even talk. Susan
stated, "I feel determined to concentrate, but it takes a lot of energy. I
get more and more tired when I try to interact with others. It doesn’t
take long before I’m ready to just go home and be alone."
Technique: Partial Involvement
I showed Susan, as well as Dave who was experiencing dissociation, the Partial
Involvement technique. I find that the Partial Involvement technique
is useful for clients when they become overwhelmed in social situations like
Susan often did. As you may already know, the Partial Involvement technique
provides clients with a method for restructuring social interactions. Restructuring
her social interactions to better suit her ability to interact with others
helped Susan to overcome her phases of depersonalization. I
explained to Susan that there are three factors to consider
when implementing the Partial Involvement technique.
3 Factors of the Partial Involvement Technique
--The first factor is Limiting Time. Susan
began to attend social functions in which she could limit the time of her involvement. Susan
stated, "Limiting my time lets me stay only as long as I feel right. As
soon as I start feeling dreamy or mechanical, I can go."
--The second factor is Structuring Activities to Meet
Your Needs. I stated to Susan, "Some social activities
are more demanding than others. For example, it’s easier to go
to a movie or attend a play than to go to a party or have a deep conversation." When
Susan was feeling numb, she began to structure activities that were relatively
--The third factor in the Partial
Involvement technique is Having an Exit. Regardless
of the activity Susan was attending, she had an exit. Susan stated, "It’s
pretty simple to leave without lying to anyone. If I start feeling numb,
I just say ‘I’m sorry, but I’m not feeling well and need
to leave. I’d hoped to stay longer, but I can’t. Thanks
for having me, though.’"
Susan’s experience with two of the three ‘D’s
of grief was minimized through the Partial Involvement technique. After
several sessions of grief-processing work, Susan had fewer and shorter phases
of depersonalization and de-realization. I
encourage you to play this track for your client, if he or she could benefit
from hearing about Susan’s experience with the three ‘D’s
On this track, we discussed The Three ‘D’s of Grief. The
Three ‘D’s of Grief are dissociation, de-realization, and depersonalization.
On the next track we will discuss replacement children. The case study
on the next track represents grieving clients who chose adoption shortly after
beginning their grief-processing work with me.
Peer-Reviewed Journal Article References:
Elmer, T., Geschwind, N., Peeters, F., Wichers, M., & Bringmann, L. (2020). Getting stuck in social isolation: Solitude inertia and depressive symptoms. Journal of Abnormal Psychology. Advance online publication.
Ferrajão, P. C., & Elklit, A. (2020). The contributions of different types of trauma and world assumptions to predicting psychological distress. Traumatology, 26(1), 137–146.
Kramer, U., Pascual-Leone, A., Despland, J.-N., & de Roten, Y. (2015). One minute of grief: Emotional processing in short-term dynamic psychotherapy for adjustment disorder. Journal of Consulting and Clinical Psychology, 83(1), 187–198.
Presseau, C., Contractor, A. A., Reddy, M. K., & Shea, M. T. (2018). Childhood maltreatment and post-deployment psychological distress: The indirect role of emotional numbing. Psychological Trauma: Theory, Research, Practice, and Policy, 10(4), 411–418.
Stappenbeck, C. A., George, W. H., Staples, J. M., Nguyen, H., Davis, K. C., Kaysen, D., Heiman, J. R., Masters, N. T., Norris, J., Danube, C. L., Gilmore, A. K., & Kajumulo, K. F. (2016). In-the-moment dissociation, emotional numbing, and sexual risk: The influence of sexual trauma history, trauma symptoms, and alcohol intoxication. Psychology of Violence, 6(4), 586–595.
Online Continuing Education QUESTION
What are the three ‘D’s of grief?
To select and enter your answer go to .