Leave-taking rituals in mourning therapy.

Therapeutic leave-taking rituals are a short-term strategic form of mourning therapy. These rituals consist of three phases: a) preparatory-in which the therapist explains how performing a ritual might help in taking leave of the deceased; b) reorganization-in which the client carries out certain tasks, such as writing daily entries in a 'continuous letter' to the deceased; and c) finalization-which is divided into a leave-taking ceremony, a cleansing rite, and a reunion ritual which symbolically expresses the client's most important relationships in his or her new stage of life. This directive approach is especially relevant in treating clients with a conflicted grief syndrome. One of the various factors that may lead to complications in the mourning process is the absence of well-developed traditional burial and mourning rituals. Traditionally, mourning rituals to a certain extent help survivors to fulfill their mourning tasks, providing them with a socially accepted framework in which they can, even must, temporarily direct all their attention to the person who is no longer there, thereby affirming the person's death and accepting its consequences. Mourning rituals are of limited duration and are a substantiation of the phases of recovery (1, 2). This is perhaps most clearly expressed in traditional Jewish mourning rituals, in which the year of mourning is divided into four parts: up to three days of grief, seven days of mourning, thirty days of gradual readjustment, and eleven months of remembrance and recovery, during which the survivor gradually emerges from his or her temporary isolation, taking on increasing personal and social responsibilities until once again the survivor can take his or her place in the community (3-5). Where there are no such well-developed rituals, many survivors, left to their own devices in mourning and in adapting themselves to their altered circumstances, do not succeed in bringing their mourning processes to a satisfactory resolution (1, 2, 6-8). When traditional Onno van der Hart, Frits A. Goossens Isr J Psychiatry Relat Sci Vol. 24 Nos 1-2 (1987) 87-98 2 mourning rituals are either absent or inadequate for a satisfactory process of working through, therapeutic leave-taking rituals can give a client an opportunity to resolve his or her grief. This is primarily true for a conflicted grief syndrome, but also for an unexpected grief syndrome, as distinguished by Parkes and Weiss (8). Therapeutic Leave-taking Rituals The example that motivated us to work with therapeutic leavetaking rituals is described by Palazzoli et al (9). A 2 1⁄2-year-old girl had not been told by her parents that a seriously handicapped baby brother had been born, or that he had died six months later. She, however, showed some reactions to this, one of which was to stop eating. The therapists instructed her parents to tell the girl about her brother and his death, and, together, to bury some of his clothes in the garden and plant a tree on the grave. This therapeutic ritual turned out to be a moving experience, not only for the girl but for the parents as well, and as a result her symptoms ceased immediately. With the idea that this method may very well work with adults, too, we started systematically applying rituals in mourning therapies for the clients of a community psychiatric service unit; usually for those clients who suffered from diverse psychiatric complaints that turned out to be related to unresolved chronic grief (10, 11). In this approach, mourning is seen as a form of leave-taking. The leave-taking rituals are formalized symbolic acts by means of which the survivor can take leave of the person no longer there. Most forms of grief therapy are necessarily intensive treatments, often consisting of several sessions per week (12, 13). In contrast, therapy involving leave-taking rituals starts out with at least one session per week with the therapist, but subsequently, the emphasis is placed on homework to be done by the client and the therapeutic sessions can thus serve more as evaluations of progress and consultations. Therapeutic leave-taking rituals consist of three phases: 1) preparation, 2) reorganization, and 3) finalization. A memorial ceremony may follow later. As in other therapeutic approaches, thorough assessment and diagnosis must precede grief therapy or therapeutic leave-taking rituals as the treatment of choice. A preliminary contract for treatment must be agreed upon.