The Importance of Processing Your Own Reactions and Fears Related to Death We all know that someday we will die. We hear about death every day in the news. We walk by cemeteries in our communities and we read obituaries. Most of us have lost someone we love. As counselors, we are often asked to help patients process their emotional responses to the death of a loved one, identify their fears about death or work through their own close encounters with death stemming from their behaviors. Regardless of any differences between ourselves and our patients, we all share the common knowledge that one day we will die. The question is, are we at peace with death in our own lives to the extent that we are prepared for the conversation when a patient identifies death as a clinical issue? Or are we more likely to say, "It's important to talk about this," while hoping someone else will do so? Grief Competency as a Clinical Skill Counselor training addresses a vast array of clinical skills, attitudes and knowledge. We are challenged to identify elements of countertransference and transference in our exchanges with patients. We are frequently reminded of the critical importance of protecting our patients' rights and confidentiality. We are encouraged to maintain a detailed focus on the value and quality of the therapeutic bond. In preparation for conducting meaningful group therapy, we are taught to identify the differences between content and process, and to work toward the development of group cohesion. We are held to high standards in providing unconditional positive regard as well as upholding belief in the ability of people to change. Despite these lofty goals, we are not taught how to process our own reactions, worries, fears and anxieties related to death. Grief competency does not seem to be a valued clinical skill. Over the course of 32 years working in the addiction field—whether in prevention, treatment or education—it has become increasingly clear to me that grief can be a barrier to recovery engagement and/or a factor in the relapse process. My own experiences serve to illustrate this point. Unaware and Unprepared My father served as chair of the drama department at the high school I attended. I started going with him to work on scenery construction when I was eight years old. At age 14, I made my first appearance on stage in a play. The intensity of my relationship with my dad was similar to when a parent serves as their child's coach. We worked together every day. When I was cast in a play, he knew just the perfect memory to help me focus my feelings. Students often told me that they stayed in school because of his influence. I placed my dad on a towering pedestal. As a teenager, I didn't foresee how my curiosity and experimentation with drugs would eventually create an enormous gap in our relationship. At age 21, I was completely unprepared when Dad was diagnosed with lung cancer and died just a few months later. By that time I was using drugs nearly every day, had disconnected from most members of my family, had become stagnant in an unproductive life and had given up on my earlier dreams of college and a career in theater. Stunned by my dad's death, my use escalated and my ability to understand my own emotional life went up in smoke and down the drain. One year later, I was at a party with my girlfriend, Nancy, along with many others in my superficial circle of friends. Everyone was drunk. We stepped out onto the back porch to get some fresh air. Nancy's coat got snagged on the door; she lost her balance retrieving it, and stumbled through a railing to fall three stories. She died a few hours later in the hospital. My drug use and its consequences escalated once again. Nancy's death brought my anxiety and depression from losing my dad back with full force. I couldn't see any options available to me other than using and drinking more heavily in an attempt to bury both deaths. Again, I was unaware and unprepared. The influence of drinking and drug use had pushed away my self-awareness. Access to my full range of emotions was cut off. My ability to express myself clearly had become unavailable and irrelevant. I knew I was very sad and deeply lonely. I also knew that any desire to change how I was feeling could be immediately—although temporarily—solved by any number of substances. I preferred to be numb. I did not need to go from feeling miserable to feeling euphoric. It was enough to be moved to apathy. This was to be my daily life for many years. It was in therapy, roughly 10 years later, that I was finally able to begin sorting through the grief. A significant first step was to remove my dad from the pedestal I'd placed him on and see him as a fallible human being. Moving blame from myself to the substances I used allowed me to find perspective on the person I had become, as well as how to accept the potential of whom I could be. I had to find a way to create different connections with Dad and Nancy, honoring those relationships while replacing mourning with healing. The pathway was much clearer, although not less painful, when I experienced the deaths of my second wife, Colleen, and my mother . . .this time living free from the restrictions and illusions delivered by drink and drugs. Welcoming the Conversation In a 2015 study examining losses identified by persons in addiction treatment, Furr, Johnson and Goodall found that 72 percent of their participants had experienced the death of someone prior to the onset of their substance use disorder; 77.6 percent had this experience during active abuse; and 62 percent described escaping their feelings through using. These findings suggest how important it is to address the process of loss through death, as well as to develop new coping strategies as the full extent of the loss is felt. It is very clear that the losses of my dad and Nancy contributed to the escalation of my use, and that the work I eventually did allowed me to process the grief after the deaths of Colleen and my mother without returning to using. People become ready to talk about death for a variety of reasons in their own time. Resistance can be fueled by active addiction, fear or by simply lacking the emotional vocabulary needed to engage in the conversation. When clinicians have not had their own conversations about death or have not found a way to make peace with their own losses, resistance to engaging their clients around death may be a matter of lacking grief competency. The window of opportunity to engage in this discussion may only be open for a brief moment, as we guard against experiencing painful memories or acknowledging that we have no power over death. Clinicians need to stand at that open window with a welcome invitation and not a quick referral. Whether it is to clarify the role grief played in ongoing use or to identify its risk as a potential relapse factor, clinicians have a responsibility to be prepared when the moment presents itself. David Chastain, PhD, CSAC, serves as an assistant professor and clinical placement coordinator for the Hazelden Betty Ford Graduate School of Addiction Studies. He presents on this topic nationally, most recently at the Association for Recovery in Higher Education annual conference in Washington, D.C., and at the Addiction Studies Institute in Columbus, Ohio.