Treating Trauma and Grief: A Hierarchy of Needs
John was referred to me for counseling after his wife was killed by a drunk driver in a head-on collision witnessed by John. Mary came to see me for grief counseling after her husband died a painful and horrific death from cancer. Louise is seeing me to deal with intrusive memories of her brothers’ emotional abuse when she was caring for her dying father.
These three situations are different in many ways – different relationships, different coping mechanisms, different types of deaths. However, each of these individuals is experiencing traumatic grief. It might be more accurate to say that they are experiencing the effects of trauma that are preventing them from processing their grief in a healthy way.
Through my work with many clients experiencing traumatic grief, I have come to understand that trauma must be processed before the loss of a loved one can be processed in a healthy way. This truth brings to mind “Maslow’s Hierarchy of Needs.”
Abraham Maslow was a psychologist who posited that basic physiological needs, such as food and shelter, and then safety and security, must be attended to before one can accomplish “higher” needs, such as a sense of belonging, and ultimately, self-actualization and the achievement of one’s potential. The classic diagram for Maslow’s Hierarchy of Needs is a pyramid, with fundamental physical needs at the broad base of the pyramid, and self-actualization at its pinnacle.
In describing self-actualization, Maslow (1943) said: “[S]elf-actualization… refers to the desire for self-fulfillment. This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming.”
The prioritization of needs to be attended to in the work of healing trauma and grief strikingly parallels Maslow’s hierarchy of needs. This hierarchy is reflected in trauma therapies like EMDR, which works first on the physical realm, then the behavioral, cognitive, emotional and ultimately the spiritual realm of existence.
The physical effects of trauma can be tremendous. Many traumatized individuals have difficulty sleeping due to intrusive images and thoughts. They are often hyper-vigilant, leading to imbalances in the adrenal and other bodily systems. These physical effects can lead to other dire effects, such as deep depression and suicidality. It is thus critical to treat these physical effects of trauma as the first priority. Moreover, if one is experiencing the physical effects of trauma, it is virtually impossible to process the loss of a loved one in a healthy way.
Moving up the pyramid, once physical symptoms are managed, it is necessary to deal with the behavioral dysfunctions that often result from trauma. For example, a person trying to cope with trauma may turn to drugs or alcohol in a vain attempt to ease the pain. He or she may also self-isolate and cut off sources of social support. Finding healthy ways to cope and and cultivating support are important in healing trauma and grief.
Cognitive work can be seen as the next priority in processing trauma. Negative self-beliefs go hand-in-hand with trauma. For example, the surviving partner of a sudden or violent death may believe “it’s all my fault.” An individual dealing with an abusive relationship may believe “I don’t deserve love.” Cognitive therapeutic work is thus necessary to let go of the power of such erroneous thoughts.
Once the grip of erroneous negative self-beliefs is loosened, and those beliefs are replaced with positive and healthy beliefs, one can then go about the work of healing grief. The intense emotions and unpredictability of grief can be navigated successfully on the broad base of physical well-being, healthy ways of coping, and positive beliefs.
The healing of grief, like working to achieve the stages of Maslow’s Hierarchy of Needs, is a process of transformation and spiritual growth, i.e., self-actualization. The fruition of this process includes a sense of acceptance and realism, self-compassion and compassion for others, independence and interdependence, and an appreciation of life in all of its impermanence and imperfection.
Maslow, A. H. (1943). A Theory of Human Motivation, Psychological Review 50, 370-96.
Maslow, A.H. (1943). Motivation and personality. New York: Harper.