The Clinical Layers of Grief: Moving Beyond the Five Stages to Heal Trauma and Loss

This article was updated on October 12, 2026.

There is no right or wrong way to grieve. Every individual processes loss in their own time and in their own unique way. While standard cultural narratives often treat mourning as a predictable, linear path, modern neurobiology and trauma-informed psychotherapy reveal that deep healing is an evolving, multi-layered process.

The Anatomy of the Five Stages of Grief

The foundational concept of the stages of bereavement was developed by Swiss-American psychiatrist Dr. Elisabeth Kübler-Ross in the late 1960s. Originally formulated to describe the psychological defense mechanisms of terminally ill patients, these stages are now widely applied to general trauma and loss:

• Denial: A protective shock response where the unconscious mind buffers the immediate impact of catastrophic news.
• Anger: A surge of mobilizing survival energy directed outward or inward as the harsh reality of the loss begins to surface.
• Bargaining: A cognitive attempt to regain control through "what-if" scenarios and internal negotiations to postpone the emotional pain.
• Depression: A deep somatic retreat characterized by profound sadness, emptiness, and the heavy realization of the permanent change.
• Acceptance: A state of stabilization where the reality of the loss is integrated into the individual's baseline narrative.

Although popular culture frequently misinterprets these stages as a linear checklist, clinical experience proves they are highly cyclical. A person may navigate from anger to a brief baseline of acceptance, only to be pulled back into deep depression or denial on significant anniversaries, birthdays, or holidays.

Furthermore, acceptance itself is not a static destination. There is an initial, structural acceptance that a physical death has occurred, but over time, this state must continually deepen as the profound existential meaning of the loss evolves within the nervous system.

Processing Grief from Surface to Depth

Beyond the traditional five stages, psychological mourning moves in distinct waves and vertical layers. Anyone who has survived a profound loss understands that emotional waves can hit months or years later, often triggered by subtle interoceptive or environmental cues out of conscious awareness.

However, the concept of vertical layers of grief remains largely unrecognized. Rather than simply looping through the same five stages horizontally, individuals process loss from surface to depth. Each time a grief wave returns, an advanced trauma therapist guides the client to meet the stages in a more profound, psychologically integrated way.

This layered complexity explains why people are frequently blindsided by intense mourning for estranged family members or even relatives they never personally met. The breaking of an attachment bond—even a fractured or unfulfilled one—triggers deep developmental longings that must be carefully processed.

Clinical Vignette: Thawing the Frozen Layers of Estranged Loss

The following clinical composite case study illustrates how unexamined grief can unfold in complex layers over time following the death of an estranged family member.

Sara’s Story

Sara felt a sudden wave of shock when local authorities notified her that her older sister, June, had died from a heroin overdose hundreds of miles away. The sisters had been completely estranged for over twenty years. Growing up, their relationship lacked a secure attachment; by the time Sara was five years old, June had left high school and severed ties with the family to live with a volatile partner.

As extended family and friends reached out to express their condolences, Sara consistently dismissed her own underlying somatic response. She flatly informed others that she felt no genuine sense of personal loss because they were never close. She maintained she was simply relieved that June’s chronic suffering had ended.

After coordinating the burial arrangements with her husband, Sara returned to her daily professional and personal routines in Manhattan, acting as though the event had left no internal footprint. However, as the initial shock dissolved, her internal body state began to shift.

While sorting through the sparse personal belongings returned from June’s apartment, Sara was hit by intense waves of sadness for the sister she had never truly known. The pivotal turning point occurred when she uncovered an old photo album and discovered that June had meticulously preserved childhood photographs of Sara as a baby.

This unexpected discovery shattered Sara’s defensive emotional numbing. Realizing she had been deeply important to her sister sparked a profound desire to understand June’s history. Sara contacted individuals in the community where June spent her final years. She learned that before her severe downward spiral, June was an incredibly creative portrait artist who frequently sketched drawings of baby Sara. Neighbors recalled June as a generous woman who loved to cook and routinely opened her home to provide hot meals for the less fortunate.

Learning about June’s hidden warmth, her isolation following a toxic relationship, and her eventual surrender to addiction forced Sara to confront a depth of grief she had completely suppressed. Recognizing that her intellectual insight was not enough to manage the painful emotional waves, she sought specialized trauma therapy to process her complicated loss.

Retraining the Nervous System After a Major Loss

Human beings are biologically hardwired for secure attachment to ensure survival from infancy. We are not inherently hardwired to navigate the pain of detachment and grief. Because processing loss induces profound discomfort, society frequently encourages emotional avoidance.

Grieving individuals are often met with well-meaning but insensitive cultural pressures to "move on" or accelerate their healing timeline. Yet, because there is no single right path, true resolution requires making spacious room for all internal emotional states.

While structured cultural rituals offer a vital holding environment for collective support immediately after a loss, the deepest therapeutic work begins after the funeral ends and the social circle returns to normal life. 

Grief fundamentally shifts your internal world. By committing to an experiential mind-body healing process, you allow the pain of loss to gradually transform into a profound, integrated appreciation for love, boundaries, and life itself.

Specialized Grief and Trauma Recovery in NYC

When the pain of a loss feels stuck, complicated, or entirely overwhelming, standard talk therapy or cognitive advice is rarely sufficient. 

True integration requires working alongside an experienced mental health professional who specializes in bottom-up, mind-body oriented trauma psychotherapies.

From my private practice in Greenwich Village, Manhattan, I utilize advanced experiential modalities to help individual adults and couples safely unpack the complex layers of bereavement, unburden historical shame, and gently restore nervous system regulation.

👤 Josephine Ferraro, LCSW - NYC Psychotherapist and Trauma Specialist

I am a licensed New York City psychotherapist and Trauma Specialist with over 25 years of clinical experience. 

I am an advanced practitioner of mind-body therapies including:

• Attachment-Focused EMDR
• AEDP
• IFS Parts Work Therapy
• Somatic Experiencing
• Clinical Hypnosis (Hypnotherapy)

I am also an Emotionally Focused Therapist For Couples and a Certified Sex Therapist. 

I provide a free 15-minute phone call before setting the initial appointment. 

I see clients in person in my office in Greenwich Village, Manhattan, NYC (10011).

I also see clients online throughout New York State.

To learn more about my therapy services or to schedule an initial consultation:

🌐 Website: Josephine Ferraro, LCSW - Manhattan Psychotherapist - NYC

✉️ Email: josephineferraro@iCloud.com

📞 Call: (917) 742-2624 during standard business hours

Parallel Losses For the Psychotherapist and the Client

This article was updated as of September 13, 2026.

Loss and grief are painful, inevitable parts of the human experience, and they are among the most common reasons people seek therapy. 

Yet, healing isn't always a one-way street; there are times in psychotherapy when the therapist and the client navigate parallel losses simultaneously. 

This shared vulnerability occurs far more often than most people realize, transforming the therapeutic session into a uniquely shared, deeply human experience. (To explore these themes further, see my articles on the emotional impact of losing parents and the intersubjective nature of therapy at the end of this post.)

Parallel Losses For the Psychotherapist and the Client

This parallel process between the psychotherapist and client often benefits the therapeutic work because, through her empathy, the therapist has more to give to the client because she is going through a similar process.

In order for this process to be healing for the client, the therapist must be trained and skilled at being able to experience the client's suffering while, at the same time, dipping into her own experience briefly without getting lost in her experience.  

The psychotherapist's focus must be mainly on the client and, while their experiences might be similar in some ways, the therapist can't assume that the client's experience is exactly the same as the therapist's experience.

From my own experience as a psychotherapist and from what colleagues have told me about their experiences, it's often the case that a client comes to therapy at the same time that a therapist is having a similar experience.

Depending upon the psychotherapist's theoretical orientation, the therapist probably won't share her loss with the client, especially if it will impinge on their work, because the therapy is focused on the client and not the therapist.

There might be times when it is therapeutic for the therapist to share a similar personal experience with the client, but only if it is in the service of furthering their work together.

Let's take a look at how this parallel process between therapist and client shows up in therapy in the following fictional vignette:

Fictional Vignette: Parallel Losses For the Psychotherapist and the Client

Lois

Lois began therapy because her mother, who had advanced Alzheimer's, was rapidly decompensating both physically and mentally.  

Parallel Losses For the Psychotherapist and the Client

Her mother began showing signs of dementia about 10 years before.

Until recently, the decline had been slow and her mother still knew Lois and Lois' siblings.  But a month prior to Lois starting therapy, her mother was becoming increasingly confused and no longer recognized Lois and other family members.

The doctor at the skilled nursing facility where Lois' mother lived told Lois and her siblings that her mother's condition was worsening, and they discussed the treatment plan, including advanced directives.

Lois and her mother were close, and it was excruciating for Lois to see her mother deteriorate over time.  Prior to the dementia, her mother had been very sharp and active, so it was especially difficult for Lois to watch the mother she knew slowly disappear.

She found support at an Alzheimer's support group, but she found her visits to see her mother increasingly difficult.

Knowing that her mother's life would soon be coming to an end, Lois knew that she would need more than her support group.  She needed the one-on-one support of a psychotherapist.

From the first therapy session, Lois felt understood and cared about by her therapist (see my article: The Creation of the "Holding Environment" in Therapy).

In addition to helping Lois cope with emotional pain of watching her mother decompensate due to Alzheimer's disease, the therapist also provided Lois with practical information. 

Lois felt fortunate that she found a psychotherapist who was so knowledgeable about loss, grief and the practical issues involved with having a family member who has dementia.

Little did Lois know that her psychotherapist also had a mother who was suffering with advanced Alzheimer's disease, and they were both going through a parallel process.

Lois' therapist wondered if it would be therapeutically beneficial for her to disclose to Lois that she was also going through a similar situation.  But she sensed, based on things that Lois told her, that Lois needed something different from her at this point in time--she needed to feel that her therapist was outside the world of Alzheimer's disease, nursing homes and hospitals.

As a result, her therapist decided that there would be no therapeutic benefit to disclosing her personal situation to Lois, so she kept it to herself.  She didn't want to impinge on Lois' experience.

Even though her therapist didn't disclose her personal situation to Lois, Lois felt that her therapist was present with her in a way that she had never felt before with her other therapists--as if her therapist really understood what Lois was going through--and this was healing for Lois.

Two months before Lois' mother died, her therapist called her to let her know that she would have to cancel their next two appointments because she had a loss in her family.  

When they resumed work together, Lois expressed her condolences to her therapist.  She didn't ask if the person who died was close to her therapist because she already felt overwhelmed by her own emotions.  Sensing that Lois didn't want to know, her therapist didn't divulge that her mother had just died from complications of Alzheimer's.

When Lois got the call from the nursing home that her mother died the night before, she was grief stricken.  All along she was grieving for the changes in her mother.  Somehow, she thought that, since she anticipated her mother's death.  She knew she would be upset, but she didn't think she would be so upset.

After their father died a few years earlier, Lois' siblings looked to her for advice because she was the oldest, and now it was no different with their mother's death.  They looked to her for guidance and emotional support, so Lois was glad to have her weekly therapy sessions so she could get her own emotional support from her therapist.

Lois resumed her therapy sessions a week after her mother died, and she was relieved to feel enveloped in the caring and empathetic environment that her therapist created for her (see my articles: Why is Empathy Important in Psychotherapy? and The Psychotherapist's Empathic Attunement to Unconscious Communication in the Therapy Session).  

Parallel Losses For the Psychotherapist and the Client

She could feel her therapist's attunement to her, and there were times in her sessions when she felt she didn't even need to talk.  It was enough to be there and feel her therapist's empathy.  

Aside from her advanced clinical training and experience, her therapist also had her own therapy that she relied on for her support through the grief process.  

Her therapist had many years of experience helping clients to cope with grief.  As she listened to Lois talk about her feelings, she recognized the parallel experiences between them.  She sensed the similarities as well as the differences in their relationships with their mothers and their experiences of grief.

Just as Lois found these therapy sessions to be healing, her therapist also had an internal experience of how healing these sessions were for herself.

Conclusion

It's not unusual for a psychotherapist and client who are working together in therapy to be having a parallel experience--whether it's about loss, happy experiences, personal relationships or any other experiences.

Most of the time, if the psychotherapist is skilled, experienced and can contain her own experiences with appropriate boundaries, the client can benefit from going through this parallel experience with the therapist--whether the client knows about the parallel experience or not.

There are times when even the most skilled psychotherapists must be aware of their own limitations and not take on certain clients because they are aware that they have a particular emotional vulnerability to whatever the client is going through and the therapy wouldn't be beneficial for the client.  Usually these instances are more the exception than the rule.

The therapist usually makes a decision on a case-by-case basis, depending upon the client's needs and the therapist's comfort level with disclosure, whether or not to disclose her own experience.  For instance, in substance abuse treatment, therapists often reveal their own history with substance abuse because this is an accepted practice in substance abuse treatment.

Psychotherapists' disclosure is a topic where there are many different views.  While the therapist is expected to be genuine and no longer expected to be a "blank screen" with her client, the decision to disclose personal information or not must be viewed in light of whether it would be of therapeutic benefit to the client and not solely for the therapist's benefit.

Getting Help in Therapy

Whether or not to start therapy can be a challenging decision (see my articles: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent and Psychotherapy and Beginner's Mind).

Finding a licensed mental health professional who is right for you is a process (see my articles: How to Choose a Psychotherapist).

When you and your psychotherapist are a good match, you can benefit from your work together in ways that might exceed your expectations (see my article: The Benefits of Psychotherapy).

The healing process in therapy can lead to emotional breakthroughs and a more fulfilling life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, IFS, AEDP, Somatic Experiencing therapist and a Certified Sex Therapist.

who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

I offer a free 15 minute phone call before setting up an appointment.

I see clients in my office in Greenwich Village, New York City or online.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

See my articles:

Who Are You After Your Parents Die?,  

Grief: The Emotional Impact of Losing Both of Your Parents and Coping With Grief).  

The Psychotherapy Session: A Unique Intersubjective Experience).

Grief: The Emotional Impact of Losing Both of Your Parents

Even if you think you're prepared for the deaths of your parents, the actual experience can be emotionally challenging and change how you feel about yourself (see my other articles about death and grief: 

Coping with the Loss of a Loved One: Common Reactions

Coping with the Loss of a Loved One: Taking Care of Yourself, Allowing Room For Grief 

Holding Onto Grief as a Way to Stay Emotionally Connected to a Deceased Loved One).

Grief: The Emotional Impact of Losing Both of Your Parents

Most people, who have lost their last parent, say that they never anticipated feeling like an "orphan."

You might think that once you're an adult and you begin seeing your parents' health deteriorate, something you anticipated for a long time, that you would be prepared yourself for it emotionally, but the actual experience is different from what most people expect.

A Fictional Vignette: The Emotional Impact of Losing Both Parents

Ted
Ted's father died when Ted was in his late 40s.

Ted and his father were close, and it was difficult to see his father struggling with dementia during the  last several years of his father's life.

During his father's early struggle with dementia, Ted moved closer to his parents, and he and his younger sister took turns helping their parents with basic daily activities of life.

All the time that he was spending with his family put a strain on his marriage, which was already falling apart.  This eventually led to his wife asking him for a divorce.  Even though Ted would have liked to salvage his marriage, his wife had already made up her mind.

Ted understood that they both had been unhappy in their marriage for a long time, but he felt it was especially thoughtless for his wife to leave at that point when he was already struggling emotionally.

When the end came, Ted grieved for the loss of his father, and he was flooded with many early memories of their good times together.

He also spent more time with his mother, whose health also began to deteriorate.

Ted noticed that, after his father died, his mother was having serious memory lapses, and her doctor confirmed that, similar to his father, his mother was suffering with dementia.

There were times when his mother thought that Ted was his father.  There were also other times when she seemed to be completely lucid, and Ted cherished those times.

The emotional burden of ending a 20-year marriage, taking care of his mother, who was gradually slipping away into advanced dementia, and maintaining a stressful full time job weighed heavily on Ted.

He knew he could talk to his sister and to friends, but Ted realized that he needed more than that--he needed help from a psychotherapist.

Grief: The Emotional Impact of Losing Both of Your Parents

By the time he began therapy, Ted had already lost 20 pounds and he was looking gaunt (see my article: Self Care For Caregivers).

He knew he wasn't taking care of himself, and he needed emotional support.

He told his therapist that he always anticipated and feared this stage of his life, but going through it now was much worse than he anticipated.

Before his father's health deteriorated, Ted looked up to him as a strong, wise, vibrant man.  He admired his father's wisdom, and he often sought his father's advice.

He told his therapist that if his father was still alive, they would have discussed his mother's condition and come up with a plan, but his father was gone and, even with his sister's help, Ted felt alone, especially after his wife left him.

Watching his mother deteriorate almost seemed unreal to him.  When she was in good health, she was very sharp, and she had always been an active and admired member of their community.  Now, he could hardly believe this was the same woman.

Having the emotional support of his psychotherapist helped Ted to get through this difficult time.  He also began taking better care of himself.

A year later, Ted could no longer maintain his mother at home, and he and his sister placed her in a skilled nursing facility.  By that time, his mother no longer recognized either of them, but they both went to visit her every week.

Two years later, Ted got the call from the nursing facility that his mother died.  He went through the motions with his sister of arranging for her funeral.

A week after the funeral, Ted felt lost.  He had never experienced anything like this before.  Not only did he miss his parents, but he also felt like a young, vulnerable child again who was unprotected in a potentially dangerous world.

The reality was that Ted was functioning much better on a day-to-day level compared to how he was doing before he went to therapy.  But his inner emotional experience was that he felt so young, lonely and vulnerable--as if he wouldn't survive without his parents.

His therapist helped Ted to understand that he was going through a normal stage of grieving that most people experience after their second parent dies.

Ted spent many sessions talking to his therapist about feeling lost and dreams that he had about being young and being with his parents.

He suddenly realized that now that both of his parents were dead, they had taken a part of him with them.

With his parents and aunts and uncles gone, there was now no one who knew him as a young child.

His sister, who was 10 years younger than Ted, remembered certain aspects of his adolescence and they could talk about their parents, but Ted felt the loss of those early childhood experiences with his parents.

Ted also began thinking more about his own mortality, which he used to avoid doing in the past.  He kept thinking, "Now that my parents are gone, I'm next."

He realized how precious time is, and he felt like he was wasting time in a job that he hated.

More than ever, he felt the need to be doing something that he really liked, so he went for training to become a graphic artist, something that he had always wanted to do (see my article: Reclaiming a Lost Part of Yourself and Finding Personal Meaning in Your Life).

To deal with his grief, Ted went to the cemetery once a week to visit his parents' grave.  At first, he felt awkward about what to do.  But as time went on, as he stood by the grave, he had conversations with his parents.

Ted wasn't sure if he believed in an afterlife or not or if he was really communicating with his parents, but he felt soothed by these conversations.

As he continued to talk to his therapist about his experiences with grief, Ted began to realize that his relationships with his parents didn't end after their death.  By remembering them, talking about them and having these conversations at the grave site, he was continuing to develop his inner experience of his relationship with his parents.

As time went on, Ted developed a different perspective about each of his parents.  He could now understand how they felt about the deaths of their parents and the sacrifices they made to maintain a good life for him and his sister even when they were grieving.

He knew that his friends meant well, but some of them weren't very tactful--telling him things like he shouldn't feel as bad because his parents were both in their 90s when they died (see my article: Expressing Condolences in a Caring and Tactful Manner).

Ted knew that they didn't understand because they hadn't experienced the loss of both of their parents yet.

Other friends, who hadn't lost either parent yet, seemed to be avoiding Ted, as if they were trying to avoid thinking about the eventual deaths of their own parents and their own death.

So, having a time and place in therapy was very helpful to Ted, especially his  friends and family members stopped calling him as much to find out how he was doing.

Ted also found it very helpful to write about his feelings in a journal (see my article: Writing to Cope With Grief) and The Benefits of Writing Between Therapy Sessions).

Grief: The Emotional Impact of Losing Both of Your Parents

A year later, Ted was working at a job that he really loved.  He was also dating a new woman and their relationship was getting serious.

Although the emotional pain wasn't as acute as it had been after his parents died, Ted still thought about them every day and wondered what they would think as he was making changes in his life.

His weekly ritual of visiting his parents grave site and seeing his therapist continued to soothe him, as he went through his grieving process.

Conclusion
Many people experience the loss of their last parent as a loss of a part of themselves.

It often comes as a surprise that they feel as if they have been orphaned and a younger part of themselves feels more vulnerable.

They develop a different perspective of their lives, realizing that life is finite.  This can lead to making major changes in life to live a happier life.

People who haven't experienced the loss of the last parent often don't understand what it's like.  Although they might be well-meaning, their lack of understanding often causes them to say tactless things or to avoid contact.

It's also not unusual for marriages that are already struggling to fall apart during this time as the emotional impact of grieving puts extra stress on a marriage.

Having a place where you can talk about your loss and the internal changes you're going through can be soothing.

Getting Help in Therapy
If you're going through a difficult time grieving the loss of your parents, you could benefit from seeing a skilled psychotherapist who can help you through the stages of mourning (see my article: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Everyone goes through the mourning process in his or her own way.  There is no "right way" to do it.

An experienced psychotherapist knows that mourning is a unique experience and can help you through the process so you don't get stuck in complicated grief (see my article: Unresolved Grief and Complicated Mourning).

Family members and friends, who are uncomfortable with the thoughts of their parents' and their own mortality, might tell you to get "get over it" or to "move on" with your life.  Even though they might be well-meaning, this can cause you to feel ashamed of your feelings.

Rather than suffering alone, you could benefit from working with a skilled psychotherapist, who has experience helping clients through the mourning process.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

I have helped many clients to work through the mourning process.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also, see my other articles about grief: Articles About Grief - by Josephine Ferraro, LCSW.

Understanding the Difference Between Guilt and Shame

Guilt and shame are two emotions that are often confused, but there are basic differences between them. In earlier articles about shame, including Overcoming Shame, I discussed shame, what it is, what causes shame, and what can be done to overcome shame.  In this article, I will describe the differences between guilt and shame and give examples to clarify those differences.

Shame vs Guilt

Let's take a look at the differences between guilt and shame:

Differences Between Guilt and Shame:

• Shame is a Pervasive Feeling About Oneself vs Guilt Which is Usually About Behavior: Whereas shame is often a pervasive, negative feeling that people have about themselves that can be emotionally crippling in severe cases ("I'm a bad person"), guilt isn't a feeling about oneself--it's a feeling about a particular behavior ("I did something bad").

• Shame Has No Redeeming Qualities Whereas Guilt Can Lead to Taking Responsibility and to Change: There are no redeeming qualities to being ashamed of oneself.  When people feel ashamed, they feel badly about themselves and it often makes them want to isolate or avoid whatever makes them feel ashamed.   Shame about oneself can actually cause someone to avoid looking at whatever s/he feels ashamed about.  But feeling guilty can force someone to look at himself or herself and take responsibility for negative behavior.  Feeling guilty can have redeeming aspects to it if it leads to people making amends for things they feel badly about doing.  Feeling guilty can lead to making an effort to reconcile with others and to making other changes.  Guilt can help people to avoid making similar mistakes in the future.

• Shame Can Be Longstanding Whereas Guilt is Often Transitory: Whereas feeling guilty about a particular behavior is often temporary, feeling ashamed often goes to the core of how a person feels about him or herself.

• Shame Can Contribute to Depression and Anxiety:  Feeling ashamed can contribute to mental health problems, like depression and anxiety, because it's an overall pervasive feeling about oneself.  It usually goes to the core of how people feel about themselves, whereas guilt usually does not affect people in this way.

Examples of the Difference Between Shame and Guilt

Shame:
Joe felt ashamed because he felt so socially inept that he avoided attending gatherings, including the funeral service for his friend's mother.

Feeling Ashamed and Avoiding People and Situations

His shame had a snowballing effect because not only did he avoid the funeral, but he felt so ashamed of himself that he avoided calling his friend or going to places where he knew his friend would be.  After a while, Joe and his friend became estranged, which made Joe feel even more ashamed.

Guilt:
Sharon felt guilty that she didn't go to her friend's mother's funeral service because the timing was too close to her own mother's death and it was too hard for her.

Feeling Guilty and Apologizing

But she called her friend in advance to express her condolences and offered to see her one-on-one when she knew her friend would be alone and feeling lonely after everyone else had gone.  Her friend accepted her apology and they remained close friends.

Shame:
Betty suffered with a lot of shame because she gained 20 lbs over the last year due to overeating.  Her doctor recommended that Betty see a nutritionist to change her eating habits, seek help in therapy to overcome the underlying issues to her overeating, and go to the gym to exercise.  But Betty felt that her weight gain made her "ugly."

Feeling Ashamed, Isolated and Immobilized

Instead of taking steps to lose weight, she isolated herself at home and continued to berate herself for gaining the weight.   This, in turn, made her feel more ashamed and she continued to overeat to deal with her pervasive feelings of shame.  It became a vicious cycle.

Guilt:
Cindy felt guilty about overeating for the last year and gaining 20 lbs.  Her doctor advised her that Cindy needed to take steps to lose the weight for health reasons.  Cindy knew that she was successful at losing weight in the past and that she could do it again.

Feeling Guilty But Taking Steps to Get Healthy

Rather than dwelling on the fact that she had been overeating, she made a commitment to her doctor and to herself to make important lifestyle changes to get healthy.  Then, she made an appointment with a nutritionist to develop better eating habits.  She contacted a therapist to deal with the underlying issues involved with her overeating.  She also began going to the gym three times a week.  Whenever she was tempted to overeat, she remembered how guilty she felt in the past, and she used that feeling to motivate herself to change.  As she lost weight and got healthier, she felt more motivated to continue getting healthier.

Shame and Guilt Can Be Difficult to Handle on Your Own
While it might be easier to overcome feelings of guilt, as compared to feelings of shame, they can both be difficult to overcome on your own.

Getting Help in Therapy
People who tend to suffer with shame often have a hard time asking for help because they feel they don't deserve it (see my article:  Overcoming the Shame that Keeps You From Going to Therapy).

Getting Help in Therapy

But everybody needs help at some point, especially when it comes to overcoming guilt or shame.

When you work with a licensed psychotherapist who has experience helping clients to overcome guilt or shame, you're usually able to work out these feelings in a way you can't on your own.

Letting go of difficult feelings that are holding you back in your life can free you to lead a happier and more fulfilling life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

I have helped many clients to overcome feelings of guilt and shame.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Inconsolable Grief for a Mother's Death

This article was updated on September 12, 2026.

This article is about inconsolable grief for a mother's death in an enmeshed mother-daughter relationship. 

Inconsolable Grief for a Mother's Death

Enmeshed Mother-Child Relationships
Enmeshed mother-child relationships often hinder emotional development for the children in those relationships.  

It's not unusual for these adult children to have difficulty forming adult relationships outside of the family because the relationship with the mother has become all consuming to them and leaves little room for other adult relationships.

In this type of enmeshed relationship, when the mother dies, the adult child often feels inconsolable grief because she is so emotionally dependent upon the mother.

Clinical Vignette
The following fictionalized vignette is a composite of many cases to protect confidentiality:

Ina:
Ina was an only child.  Her father had abandoned the family when Ina was an  infant, so she had no memories of him.  Her mother often said to her, "It's you and me against the world."

When it was time for Ina to start school, both she and her mother experienced tremendous separation anxiety.  Every weekday morning was an ordeal.  They would both cry when the school bus came.  Ina's mother would come everyday to bring Ina her lunch and sit with her in the school cafeteria.

Ina's teacher tried to talk to the mother about allowing Ina more time and space to form friendships in the classroom.  She tried to tell her that Ina wasn't forming friendships during recess and the lunch hour because she was so focused on the mother.  But the mother got annoyed and complained to the principal that the teacher was trying to interfere with her relationship with her daughter.  After that, the teacher backed off.

Ina made a few friends in junior high and high school, but she still preferred to spend her free time with her mother.  She had very good grades, but she didn't participate in any social activities in school.

When it was time to apply for college, Ina only wanted to apply to local colleges so she could remain at home.  Her guidance counselor advised her that her grades were so good that she would probably get scholarships to colleges outside their town, but Ina wasn't interested.  Her mother also thought it was best for Ina to stay close to home.

Ina had crushes on boys, but she had no interest in dating. When her friends talked about meeting someone and getting married, Ina cringed.  She never wanted to get married.  Her mother had spoken to her about how miserable she felt when Ina's father abandoned them, and Ina couldn't see why her friends would want to risk getting hurt like this.

After college, Ina worked as a customer service representative at a local bank.  After work, some of the employees would go out to dinner or to a movie and they would invite Ina to come along.  But Ina preferred to go straight home to have dinner and watch TV with her mother.

As the years past, Ina's manager encouraged her to apply for other jobs at the executive headquarters, but Ina wanted to remain close to home.  She was a good worker and customers liked her.  She received two promotions at the local branch, but her manager told her that she was limiting her career by only considering jobs at the local branch.  Ina explained to him that she was happy doing what she was doing, and she didn't feel the need to apply for jobs outside of their branch.

Over the years, employees that were trainees under Ina excelled beyond her because they sought opportunities at the executive branch.  Ina remained in her job as a senior customer service representative, but this didn't bother her.

When Ina was in her mid-40s, her mother was diagnosed with Stage 4 cancer.  Ina took time off from work to take care of her.  Despite what the oncologist said, Ina had no doubt that her mother would recover.  Even as her mother's health continued to deteriorate, Ina held onto this belief.

When the doctor recommended hospice care, Ina became furious.  She felt he was giving up on her mother, and she told him so.  She held onto her belief that her mother would survive up to the day she died.  Then, she went into shock.

For several weeks, Ina was unable to even get out of bed.  Her aunts took turns taking care of her.  All she wanted to do was sleep.  She felt that living life without her mother was unbearable.  When she was awake, all she did was cry.  She was inconsolable.

After three months, Ina returned to work.  She felt like she was in a daze.  She had lost more than 20 lbs. and she looked pale.  Fortunately, she knew her job so well, after all those years, that she could perform her duties, even though she felt like she was living in a dream.  Whenever anyone tried to express their condolences, she would stop them. She didn't want to talk about it.

When she got home, she didn't know what to do with herself.  Everywhere she looked, she saw reminders of her mother.  She was unable to give away her mother's clothes.  Instead, she would often go into her mother's closet, hold her mother's garments to her face and smell her mother's perfume which was still embedded in the clothes.  Then, she would cry.  Her aunts offered to help Ina give away the clothes, but Ina wouldn't even hear of it.

On the fifth year of the anniversary of her mother's death, Ina's manager found Ina crying at her desk.   He closed the door and talked to Ina about going to therapy.  He confided in Ina that he had attended therapy several years ago when he and his wife ended their marriage, and he found it helpful.

By this time, Ina's grief had grown worse, not better.  She knew she couldn't go on like this, so she decided to start therapy, even though she didn't feel that anyone could ever help her to feel better about her mother's death.  Even the thought of feeling better made Ina feel that she would be disloyal to her mother.

Initially, Ina was defensive in therapy.  She only wanted to talk about her mother and the times they spent together.  She never wanted to talk about any plans for the future.  She couldn't even envision herself making plans for the future that didn't include her mother.  Although she would never hurt herself, there were many times she wished she could just go to sleep and not wake up.

At first, she resisted all recommendations about things she could do to take care of herself so she could feel better.  She didn't want to exercise or go to a yoga class or join a book club.  She didn't want to reach out to the few friends who remained in her life.  She just wanted to keep doing what she was doing, even though she was feeling miserable.

Then, her therapist recommended that they do inner child work using hypnosis.  Ina had never experienced hypnosis before, but she decided to give it a try.  She felt it was better than her therapist's other recommendations.

Much to her surprise, Ina was able to sense the younger part of herself that felt so vulnerable and afraid.  Using hypnosis, she was able to nurture that younger self, and she began to feel some relief from her grief about her mother's death.

After a few months, Ina still felt sad, but it wasn't an inconsolable sadness.  She still missed her mother, but having the ability now to nurture herself emotionally, she felt the sadness was more manageable.  She still visited her mother's grave every week and "talked" to her mother, but she wasn't crying as much as she was before.

After several months, Ina felt like she might be ready, with help, to give away her mother's clothes.  So, her aunts came to help her clean out the mother's closet.  Ina held onto a particular dress that she knew her mother really loved, and she allowed her aunts to give away the other clothes to a charity organization.

At her therapist's recommendation, Ina did her own private ritual to commemorate her mother's life.  She set up a place on her dresser with a picture of her mother, a candle, and her mother's favorite broach.  Then, she said a tearful goodbye to her mother, acknowledging that her mother was gone, but she would always have a place in Ina's heart.

After that, Ina felt somewhat better.  She realized that she would always have her memories of her mother, and she believed her mother was "in a better place."

Gradually, over time, Ina became more social.  She had some regrets that she had remained "stuck" for so long and she would never get that time back.  But she began to take her first tentative steps to make friends and, for the first time in her life, to date men.

Enmeshed Mother-Child Relationships:  Overcoming Inconsolable Grief 
In the vignette above, Ina eventually attends therapy to deal with her inconsolable grief.  But there are many people, who have similar experiences of grief, who never even consider going to therapy. 

They remain stuck emotionally in their grief for the rest of their lives.  In their senior years, they often have regrets for everything they never experienced in life (see my article: The Many Layers of Grief).

For people going through this experience who are open to therapy, they're often surprised that they can feel better.

Often, what happens is that they experience how they can internalize their mother emotionally in a new way, even though the mother is no longer alive.

Although the mother is no longer alive in the here-and-now, the adult child can feel the mother as alive in his or her own internal world.

This type of work, for people who have been entangled with a parent, isn't quick.  Often, the person who feels grief has mixed feelings about letting go of the sad feelings.  There is an illusion that by holding onto the sadness, they're holding on to their dead parent in some way.

Clients are often surprised that letting go of the sadness allows them to make room for a different experience, the internalization of the parent in a healthier way.

Getting Help in Therapy
If you've someone close to you and time has passed, but you're not feeling any better, you owe it to yourself to get help from a licensed mental health professional who has experience helping clients with this issue.

In most cases, people find a new way to overcome their grief that still honors the relationship with the person who died.  But it also allows the person who is still alive to transition to having a more meaningful life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, IFS, EFT for couples, AEDP and Somatic Experiencing therapist.  

I have helped many individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

I offer a free 15 minute phone call before setting up an appointment.

I see clients in person in my Greenwich Village office or online.

You can call me at (917) 742-2624 during business hours or email me.

Also see my articles:

The Many Layers of Grief

Overcoming Shame in Enmeshed Families