A Note on Grief Work. . .

The standard matrix can be used to great effect with grieving individuals and families, though particular care should be taken when engaging in grief work as it can pose challenges for many clinicians. For the purposes of this chapter I am referring to a death loss, or bereavement, when I use the term grief. Other forms of grieving will not be covered, though much of the content in this chapter will apply to various forms of loss.

Grief is complex as it is fundamentally a result of a relationship between any two or more individuals. Just as every relationship is different so is the nature of grief. As you do more work with grieving individuals and families you may begin to notice similar patterns and commonalities; take care to not make the mistake of thinking that their grief is all the same. It’s okay for grief to be different! Parents grieving their teenager’s death by suicide is different from a family grieving a death by chronic illness. As much as families value their experience of grief being validated as natural by others there can also be an element of “sacred ownership” over their grief which no other person on earth can understand.

Grief has the potential to establish narrow and rigid patterns of behavior. Of course a change in behavior immediately following a death is to be expected, however some people become stuck for years in a loop of avoidance and disconnection from the present moment, unable to engage in valued action. Much of grief work is naturally ACT consistent as the primary understanding of grief is that while the emotional experience will change over time it will never actually go away. As well, any layperson can tell you that when it comes to grief the goal is acceptance. Strong and flexible contact with the present moment is essential, as well as a flexible sense of self, connection to values, committed action, and defusion to rigid unworkable thought content.

The only hard and fast rule I’ll give you when it comes to ACT work with grieving persons is to absolutely N-E-V-E-R use the more playful forms of defusion such as “silly voices”, singing, etc. to attempt defusion from painful thought content like “It’s my fault they died,” “I’m going to be alone for the rest of my life.” It’s simply too easy to trivialize this kind of thinking.

When it comes to grief I wholeheartedly recommend the work of Dr. Robert Neimeyer, one of the world’s foremost experts on grief. Although Dr. Neimeyer is not an ACT therapist the majority of his work is ACT consistent and can be used with little to no modification.

The Grieftrix

The Grieftrix is a formulation of the standard ACT Matrix which involves a simple tweak in only the lower right hand quadrant of the matrix (Who & what are important to you?). This version of the matrix can be used entirely as a substitute to the standard matrix, or as an additional tool alongside the matrix.

We begin by asking the client to think of all the qualities their deceased loved one embodied in life, probing for answers that involve actions, and instruct the client to write down their responses in the lower right hand quadrant. After they have filled this box we then ask them to circle any of these qualities that they wish to embody in their own life moving forward. It’s not uncommon for clients to circle every quality of their loved one.

From here we move onto the lower left hand quadrant with the same question as the standard matrix. “What inner stuff, like thoughts, feelings, memories, etc., shows up and gets in the way of these qualities you wish to embody?” The top two quadrants remain the same as the standard matrix. The work then becomes one of living a life filled with the qualities that tie both parties together, and of (re)expanding behavioral repertoires narrowed following the death.

The following vignette and grieftrix illustrates this process.

Raul’s brother Mychal died in a motorcycle accident nine months ago at the age of 20. Raul, 17-years-old, just beginning his senior year in high school has been recommended grief counseling by the school counselor.
After working with Raul for several sessions, the therapist invites Raul to complete a grief specific version of the ACT Matrix.

Therapist: I’d like you to take a moment and think about the qualities that your brother embodied. All of those things that he did that made Mychal Mychal. See if you can think of a few and write them in the bottom right hand square.

Raul: He was athletic, always on the varsity teams. He never backed down from anything. He made us all laugh. He was good with girls, but like he also treated them good, you know?

Therapist: Wonderful, I can tell how much you admired him even as you’re speaking. Of all those things you wrote, can you circle which ones you want to embody in your own life? 

*Raul begins circling items.* 

Raul: I ended up circling all of them.

Therapist: Oh really, that’s great. So now let’s move over to the box to the left. What inner stuff like thoughts, feelings, memories, shows up to get in the way of you embodying those qualities on a consistent basis?

Raul: Not wanting to do anything. Sadness. Missing him. Not being good enough. 
Therapist: That’s some heavy stuff.

Raul: Yeah.

Therapist: And when all of that is showing up what do you tend to do on the outside? That’s the question for the top left box.

Raul: I don’t really do anything, just stay in.

Therapist: What are you doing when you stay in?

Raul: Video games, or just listening to music.

Therapist: Is that normal for you?

Raul: The only time I used to go out was with Mychal. We’d go to the basketball court and play pick-up with some other guys. 

Therapist: When’s the last time you did that?

Raul: A couple days before it happened.

Therapist: I see. And other than video games and music, what else do you tend to do when that inner stuff shows up.

Raul: I’ve been pissed off a lot, like there’ll be times when I don’t want to do nothin’. Don’t want to talk to anybody.

Therapist: Yeah, how often is that?

Raul: I don’t know. Just depends on how the day is.

Therapist: Okay. Anything else for this square?

Raul: Nah, that’s it.

Therapist: Alright, now let’s move to the top right. The question for this box is what could you actually do that would move you toward those qualities that your brother embodied?

Raul: I don’t understand.

Therapist: Those qualities that you circled, it seems like you want to add them into your life, how could you do that realistically?

Raul: . . . I’ve been avoiding the park where we used to play basketball. Mychal knew a lot of the guys there and I’m not even sure they know he passed away. 

Therapist: Would going to the park move you toward any of these qualities?

Raul: I think my brother would be pissed if I didn’t ever play again. He’d want me to keep getting better and embarrass some of those fools.

Therapist: *laughs* Interesting. Is that something you think you could actually do?

Raul: I need to. I need to. Mychal was always the one who took me to the park and got me to go. I don’t think I ever said “Hey let’s go play,” it was always him saying it to me. But now that he’s not here I haven’t been getting that motivation.

Therapist: Going on your own would be kind of like honoring him?

Raul: Yeah, most definitely. And it would move me toward being athletic. I might try out for basketball this year. I wasn’t going to but I might now.

Therapist: That sounds very doable to me. Can I also just point out that you’d be willing to go to the park even though it’s for sure going to bring up a lot of memories for you.

Raul: It is, but I have no choice. Like, that was our place. 

Therapist: And you’ve been in your room the past nine months.

Raul: *laughing* Yeah, and if Mychal were here he’d bust my ass.

Therapist: It was obviously important to him, and important to him to spend time with you. We know the grief is going to be with you wherever you go, you might as well have it in you and your brother’s favorite spot.

Raul: That’s right.

Therapist: When do you think you could go?

Raul: Tomorrow after school.

Therapist: I think you should seriously consider going and if you do just notice what it feels like to be back there in that place.

Raul: I will.

In the above vignette the Grieftrix helps Raul move from a rigid grieving style to a more flexible one. If Raul can get to the basketball court he will be re-expanding his behavioral repertoire to include spaces and activities he engaged in and enjoyed before his brother’s death. By pointing out that the grief exists in all places we begin to neutralize the aversive properties of the strong reminders of his brother. We also reduce the appetitive properties of being at home locked onto a video game console in favor of reconnecting with a passion.

Work along these lines would continue with Raul, establishing and promoting psychological flexibility in the aftermath of a world-shattering death. As Raul’s behavioral repertoire expands to include more and more values-guided actions he’s likely to feel more connected to his brother. Death shifts from being viewed as the end of a relationship to simply a change in a relationship.

Raul’s Matrix

Keeping the Relationship in Mind

Understanding the relationship between your client and the person who died is paramount in grief work. This grief specific version of the matrix is designed with the idea that the grieving individual had a positive and overall healthy relationship with the deceased person.

Grief can become complex when the relationship between the deceased and your client was tumultuous, abusive, or otherwise unhealthy. In these situations I would not recommend using this Grieftrix as presented in this chapter. Modifications can be made to the questions in each quadrant that may allow for therapeutic processing of the relationship, though you would have to experiment with unique prompts based on what you know about your client and the deceased.

Other modifications can be made even for situations where there was a limited relationship between your client and the deceased individual. I have used the Grieftrix with families grieving the death of their stillborn child by altering the lower right quadrant’s questions. The following are some examples of the kinds of questions you could ask for the lower right quadrant:

1. What qualities were you hoping your child would get from you?

2. What values were you excited to impart to your child?

3. What qualities of parenthood were you hoping to embody over the rest of your life?

A thorough understanding of your client and their relationship to their grief will allow you to craft workable modifications to the matrix.

The Grieftrix Layout