CALIFORNIA STATE UNIVERSITY, NORTHRIDGE Sexual Intimacy After Child Death: An 8 Week Psycho-Educational Group for Grieving Parents A graduate project submitted in partial fulfillment of the requirements For the degree of Master of Science in Counseling, Marriage and Family Therapy By Nelson Mayen August 2019 This graduate project of Nelson Mayen is approved by: _________________________________________ __________________ Alberto F. Restori, Ph.D. Date _________________________________________ __________________ Bruce Burnam, Ph.D. Date _________________________________________ __________________ Diana Losey, MS Date _________________________________________ __________________ Stanley Charnofsky, PhD., Chair Date California State University, Northridge ii DEDICATION This is dedicated to all of us that have lost so much, regardless of the type. iii ACKNOWLEDGEMENTS This acknowledgement goes first and foremost to my mom and dad who probably still do not fully understand what my profession consists of. Thank you for being so understanding of my absence for the past couple of years. To Mayra, you have been a true blessing and a source of strength and love through difficult times in my life. To the rest of my friends that I cherish dearly, I suppose I now have the free time that you have all been asking for. I love you all. This is also for those that have provided the guidance that has helped me in being a better clinician. Clovis, thank you so much for instilling hope and humanity within this work. The dialogue we have shared about therapy and life in general is exactly what my soul was searching for when considering this field. For Janet, thank you for always allowing me the emotional space that I needed. Also, thank you for constantly reminding me that I am where I am supposed to be. I would also like to thank my project committee. For Stan, thank you for all the help. For Bruce, I am so grateful for the time you took to provide constructive feedback on my project. Your excitement for films and the quest for never-ending knowledge is truly admirable. For Diana, I could never make up for all the help you have given me. I know I said this countless times in my emails, but thank you for all the times you put up with me. I would also like to add that your class was among the most impactful courses I took while in graduate school due to the sincerity and necessary tangents about life that you allowed us to be a part of. Lastly, I want to thank all the coffee shops that I frequented while in graduate school. This one is for Cafe Aficionado, Coffee Commissary, and Moby’s Coffee & Tea Company. Thank you for supplying countless gallons of coffee that I consumed throughout this journey. I consistently overstayed my welcome at these locations, so much so that it probably wasn’t worth having me as a customer based off of the electricity bill alone. Nevertheless, thank you so much. iv TABLE OF CONTENTS SIGNATURE PAGE ii DEDICATION iii ACKNOWLEDGEMENTS iv ABSTRACT vii CHAPTER I: INTRODUCTION 1 Introduction 1 Statement of Purpose 2 Statement of Significance 3 Terminology 4 Summary 5 Chapter II: Literature Review 6 Beliefs About Sexual Intimacy After Child Death 6 Gender Differences in Intimacy Response After Child Death 7 Gender and Grief Reactions 7 How and Why Intimacy Varies After Loss 8 Grief Theories and Models 10 Kubler-Ross’ Stages of Grief 11 Worden’s Four Tasks of Mourning 12 Stroeb and Schut’s Dual Process Model 13 Effects of Grief on Bereaved Parents 15 Grief and Attachment 16 The Maternal and Paternal Experience After Child Loss 18 v Adjustment to Loss and the Return to Intimacy 20 Honoring the Loss 21 Focusing on the Grief 22 Adjusting Pace of Therapy 23 Encouraging Storytelling 23 Providing Psycho-Education 23 Dual Control Model of Sexual Function 24 Efficacy of Grief Therapy and Grief Work 25 Conclusion 27 Chapter III: Group Application 29 Target Population 29 Group Format 29 Group Rules 30 Group Outline 30 Chapter IV: Summary and Recommendation 31 REFERENCES 32 APPENDIX A 36 vi ABSTRACT SEXUAL INTIMACY AFTER CHILD DEATH: AN 8 WEEK PSYCHO-EDUCATIONAL GROUP FOR GRIEVING PARENTS By Nelson Mayen Master of Science in Counseling, Marriage and Family Therapy The process of grieving one’s child is an awful experience. To lose a child seems out of order with the general trajectory of life. Whether through illness, violence, or suicide, a child’s death can leave parents’ with an uncertainty regarding their role as people, their role within a relationship, and their role in life. In addition to these uncertainties, the return or failure of return to sexual intimacy and that lack of social acceptability in openly discussing these issues causes additional stressors for grieving parents. This literature review will specify a need and significance for a grief-processing group catered towards parents who which focuses on the theme of sexual intimacy as it is affected by the child’s death. Within a typical relationship, effective communication is already a difficult quality to learn. By creating a support group that focuses on psycho-education, grief models, and strategies to connect with one’s partner, parents are given the potential opportunity to regain purpose, connect with one’s partner, and have space to process grief. In order to assist both parents and facilitators to understand some of the research on the topic of sexual intimacy after child death, the following literature review includes beliefs on sexual intimacy after child death, gender differences in intimacy response after child death, grief theories, the role of attachment after loss, paternal and maternal experience after child death, adjustment after loss, and the efficacy of grief therapy. vii Chapter 1 Introduction The grieving process of losing a child is something that most parents will never experience. Whether the child is lost to miscarriage, stillbirth, or another reason, to endure such a loss is a painful reminder of life’s cruelties. While the topic of childhood death has been extensively researched, information regarding sexual intimacy between grieving parents is not as available. Discussing sexual intimacy after a child’s death might be determined as ill-timed or inappropriate given the circumstances, however it is crucial to remember that even after a child’s death, many parents remain in relationship with a spouse or partner and with the everyday work that is needed for any relationship to thrive. In addition to the complications of navigating the relationship after the loss of the child, grief and bereavement are managed differently both individually and culturally. More specifically, grief is a personal experience and there is simply no right way of processing that grief. It is, however, sometimes these differences in the grieving process that can cause difficulty in the couples’ ability to connect after the loss of the child. Hagemeister and Rosenblatt (1997) state that often men and women respond in different ways to a child’s death. Most importantly, each member of the couple will have different ways needing help to process that grief. Empathic listening, surrounding oneself with family members, avoiding the issue, isolating oneself, or even engaging in sexual intimacy are some of the different ways in which people cope with a child’s death. According to Hagemeister (1997), women most often want to talk about the loss and explore their emotional pain more frequently than men. A study by Johnson (1987) explains that the reason some grieving men prefer sex as a coping mechanism is due to the feeling of comfort that eases grief-related pain. This is not to say that men do not have feelings associated with loss, 1 but rather, some men have different ways of coping with grief. When couples have two divergent grieving processes, many difficult issues may surface in the relationship (Hagemeister & Rosenblatt, 1997). It is important at this point, to add that in this project, that there is no agenda regarding sexual intimacy. The purpose of this project is not to instruct couples how to regain sexual intimacy after a child’s death. Such an idea would be counter to the grieving process and may promote the idea that there is a correct way of grieving, when it is the belief of this author that there is not. The purpose of this project is to discuss the various issues that arise with couples who are dealing with a child’s death and to assist them in approaching common concerns. These issues include effects of grief, grief and attachment, the maternal and paternal experience of losing a child, adjustment after tragedy, honoring the loss, as well as intimacy after loss. Statement of Purpose This project focuses on sexual intimacy for couples following the death of a child. The purpose of the project is to develop a support group for grieving parents who have experienced the loss of a child. Again, the purpose of this project is not to instruct couples how to regain sexual intimacy after a child’s death, but to discuss the various issues that arise with couples who are dealing with a child’s death and to assist them in approaching common concerns. The discussion topics for the support group will consist of the beliefs surrounding the issue of child death, while also providing evidence for what many parents might expect from the death of a child. The discussion will also shed light on how gender differences may affect each member of the couples response to sexual intimacy after the loss of a child. These gender differences include the manner in which both partners grieve, how they interpret the loss, and how they expect their partner or spouse to fulfill their needs after losing the child.