Ginger Schenck raises some very important questions and comments which I will attempt to address in order: 1) During the course of the treatment, Kathy did explore alternative responses she might have made to her brother had she realized she was saying good-bye forever. She frequently talked about how much she missed having him in her life. She wished she could talk to him about her parents and their lives together. She wished she could feel less alone, in terms of family. She would fantasize what life would be like if he were alive - how they would share family, life, children as cousins. She missed the fun she imagined they would share. Sometimes she missed what she said might be the "protective aspects" of having a big brother. Exploration of this "protective aspect," however, lead to a more complex picture of her relationship with her brother. Earlier in treatment Kathy spoke only of her adoring feelings of her adoring brother. As time went on, though, she began remembering the times when he tormented her with teasing and made fun of her in front of his friends. (After all, his father was behaving this way with him, so one way he probably coped with that was to behave that way toward his little sister.) So, in working with Kathy, we came to develop a more complex picture of her relationship with her brother. As we did this, we explored how understandable were her feelings at that last good-bye. He had been taunting and teasing her. She was getting no other attention from anyone else and it seemed so natural that she should hope to get more attention as the "only child." BUT SHE NEVER WANTED HIM DEAD. During our work together, we focused on how, as a young child, she linked her wish for more attention for herself to almost killing her brother. Although this sounds crazy to an adult mind, and even Kathy at age 7 told herself, "No, things don't happen that way," Kathy had lived her life as if she believed (at least unconsciously) that she had killed her brother. So I focused on demonstrating to her how she forever after linked "getting attention" with "hurting others." She began to see this omnipotent idea operating at multiple levels in her life. For example, she remembered how as a very young child, before her brother's death, Kathy felt her closeness to father (and attention from father) HURT mother. She used to think how she was "robbing" mother - but it was OK because "mother had Dan." There was this balanced system in Kathy's developing moral code: "I get father which is hurting mother, but it's OK because mother loves Dan and he is her favorite." Had Kathy not experienced this earlier dynamic, perhaps she would not have developed the "pathogenic belief" that she hurt others by getting attention. Certainly the death of her brother at the same time that she is wishing for attention would deeply confirm for a young mind her "pathogenic belief." Add onto that the fact that NO ONE EVER TALKED TO HER ABOUT HER BROTHER's DEATH and you have a context just ripe with the ingredients for potent, powerful, "pathogenic beliefs." So, in answer to your question about whether I worked with Kathy to "rewrite" her history, I guess I would say that I mainly worked with Kathy to accept the feelings she had, realize they were only part of a very complex picture, and to understand all the factors involved in her "pathogenic belief" that she hurt people by wanting and getting attention.
2) Yes, I agree with you that Kathy's fear of hurting others and her deep feelings of unworthiness blocked her ability to attach closely to others. In addition to those dynamics, I would say that her guilt toward her mother played a major role. Kathy's "pathogenic belief" that she hurt others by getting attention was deeply linked to her relationship with her mother. Kathy felt very angry with her mother for not loving her the way Kathy needed, but Kathy also felt very sorry for her mother. Right from Kathy's birth, Kathy was close to father. Father enjoyed using Kathy against her mother (although Kathy couldn't know that early on). Father would praise Kathy's intelligence and looks and soon after disparage the mother into tears of humiliation. As I said, Kathy was allowed (in her own moral code) to have father's attention, because mother had Dan. But when Dan died and he died because in Kathy's mind she had killed him by wishing he would disappear, Kathy's balanced "moral code" feel apart! Her deep sense of guilt and shame resulted in that awful "drowning" incident shortly after her brother died. Kathy felt she was BAD AND SHOULD DIE. For 7 years following the death of her brother, Kathy hid and was barely alive. Then she came to life in High School for 2 brief years at a time when her mother was finally doing a little better (mingling with people, working some). That "sunshine" period came to a total halt when Kathy fell in love for the first time. Kathy was basking in the "sunshine" of popularity, awards, and a powerful first love when her father basically "flipped out" and abruptly ripped her out of her school and community to send her off to a boarding school in another state. She was not allowed to come home even for holidays. He refused to buy her a ticket! Father was jealous and infuriated at Kathy's new love. Once again, she could see she had hurt someone (this time father) by being in the limelight. So she stays hidden at boarding school which felt like a huge punishment for hurting father with her "sunshine." Then she goes to college and is "allowed" another short stint in the limelight. She loves her studies, is active in student politics and sports, and suddenly she marries a man very much like her father - jealous and competitive with her. She hides behind him for years and is able to do this because she has her 3 children whom she loves more than anything in the world. Then when the marriage ends and she's free, she becomes involved with several men who prize and cherish her. What does she do? She get pregnant, punishes herself with abortions she doesn't believe in, and then gets pregnant again needing another abortion. She leaves the men who are permissive about the abortions. She wants punishment. She feels undeserving of attention from men for many reasons and one is that she sees her mother as very unloved and maybe even unloveable. So, there are complex reasons for Kathy's inability to let good people close to her.
3) In terms of slowing Kathy down, I never thought of that. After the difficult "refusal to recover" stage, Kathy's creativity seemed to be unleashed. It flowed so coherently and so beautifully that I just followed it. I think in retrospect I wish I had invited her in for an extra session during the time when she had the painful memories of the "drowning incident." I thought of that at the time. Unfortunately, I think I was influenced negatively by the idea of the research and staying to the protocol. I would do so differently if I could do it over again.
4) Briefly, in terms of the stages of grief, Kathy did not fully complete her grief work in the treatment. She knew it and chose not to complete it. Yes, I think all those stages are important, but I think they are very case specific by which I mean Kathy did much of her work in a unique way and I imagine she will do more of it at other times in her life. She has returned to me several times since termination to work on other aspects of it. In terms of the impact of the "delayed" grief, I think the most important part for Kathy is that she was SEVEN-YEARS-OLD when she suffered this loss. Because of her young mind and the lack of parenting, the "pathogenic beliefs" she developed were extreme. She was in the "searching" stage of grief for many years looking for her brother in China. The Tianeman Square reaction was fascinating from that point of view.
Thanks so much for your insightful comments.