Article

Illness, Crisis & Loss

Unfolding Meaning 0(0) 1–17

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DOI: 10.1177/1054137316687954
An Integrative Meaning journals.sagepub.com/home/icl

Reconstruction Method
for Counseling the
Bereaved

Alba Payàs Puigarnau1 and

Adrián Chaurand Morales2

Abstract
This conceptual article describes a specific bereavement counseling intervention
method for elaborating relational memories. Based in an integrative meaning recon-
struction process of change, we show in a practical way how by promoting the display
of the continuing bonds with the deceased and favoring the activation of memories
about the lost relationship, the bereaved is able to engage in a process of attributing
meaning, from which a new personal worldview emerges as a therapeutic outcome of
personal posttraumatic growth. Using a case example to explain how the specific set of
procedures of the method are implemented in clinical practice, the article focuses on
the description of the client’s process of change, and how its components reflect the
complementarity and interrelation of these theoretical constructs.

Keywords
bereavement, integrative meaning reconstruction, psychotherapeutic technique,
continuing bonds, posttraumatic growth, unresolved and traumatic memories, grief

1
Instituto IPIR Duelo, pérdidas y trauma, Barcelona, Spain
2
Instituto IPIRMEX Duelo, pérdidas y trauma, Guadalajara, México
Corresponding Author:
Alba Payàs Puigarnau, Instituto IPIR, Passeig de Sant Joan 124 5 -2a, 08037 Barcelona, Spain.
Email: [email protected]
2 Illness, Crisis & Loss 0(0)

During the last several decades, the scope of bereavement research has been
expanded with new theoretical models that emphasize how grief can contrib-
ute to personal, permanent changes, resulting in long-lasting and positive
transformations in identity, worldview, relationships, and values of the griever
(Neimeyer, 2016; Neimeyer & Levitt, 2001). The focus on the role of meaning
reconstruction in mourning has promoted the development of cognitive and
social constructionist models that try to describe how mourners struggle to
make meaning of their loss experiences in order to find benefits (Davis,
Nolen-Hoeksema, & Larson, 1998), to relocate the loss within a narrative
structure that renders the world predictable and coherent (Folkman, 2001;
Janoff-Bulman, 2010), to accommodate the new meanings for changing
one’s identity (Gillies & Neimeyer, 2006), to experience growth and trans-
formation (Calhoun & Tedeschi, 2014), to maintain a sense of purpose in
life, and to assign values to the experience of life after the loss (Hershberger
& Walsh, 1990).
This explosion of models has resulted in an increased theoretical clarity that
offers to the clinician different views of the client’s experience. At the same time,
this profusion of constructs results in an increased challenge as to how they can
be operationalized in specific methods or interventions useful for the clinicians,
who finally have to find ways to relate them as the client’s unfolded experience is
unique and unrepeatable.

Grieving as a Process of Elaborating Memories

Through the process of making meaning of life experiences, we build a coherent
set of schemas, assumptions, and appraisals to explain who we are, our percep-
tion of life, and the world in which we live (Janoff-Bulman, 2010; Park &
Folkman, 1997). After experiencing the death of a loved one, grievers need to
‘‘make sense’’ of the evoked memories of the loss, restructuring new explan-
ations in a way that is coherent with their preexisting self-narratives (Neimeyer,
2000, 2001, 2016; Neimeyer, Klass, & Dennis, 2014; Neimeyer & Sands, 2011;
Stroebe & Schut, 2001).
Relational memoirs are active mental representations of the lost relationship
that allow the bereaved to experience an ongoing bond with the deceased (Klass,
Silverman, & Nickman, 2014; Klass & Walter, 2001). Remembering the life
shared with the loved one is natural way to achieve an adaptive grieving experi-
ence (Boerner & Heckhausen, 2003).These evocations refer to the activities done
together daily in ordinary life; rituals or habits shared on significant days; par-
ticular events that are recalled by specific possessions such as clothes, photos,
letters, memory boxes; or recollection of the positive aspects of the decedent’s
personality and of its impact on the bereaved individual’s life (e.g., ‘‘I miss her
hugs,’’ ‘‘I remember when we went together to that trip,’’ ‘‘She always helped me
with my homework). These memories of the shared life with the deceased include
Puigarnau and Morales 3

difficult moments lived where the relationship was damaged (‘‘We were not
doing very well lately,’’ ‘‘I remember the last fight we had’’).
Relational memories awake more regulated states and less distress than
thoughts related to the death circumstances, which more frequently prompt
traumatic symptoms including emotional numbness, somatic activation, and
intrusive thoughts (Boelen & Huntjens, 2008). These overwhelming death-
related memories must be treated by specific trauma-oriented interventions to
enhance the client self-regulation capacities (Ogden, Minton, & Pain, 2009;
Shear, Boelen, & Neimeyer, 2011). Memories related to the lost relationship
are often associated with emotional states such as sadness, longing, and melan-
cholia. Some relational memories can be understood as unfinished business (e.g.,
the need to express gratitude or forgiveness) that frequently appear associated
with an intense response such as feelings of abandonment, guilt, or even anger
(Jeffreys, 2011).The expression of unfinished experiences maintained over time
may trigger chronic depression and prolonged longing and yearning for the
deceased, manifested by such activity as talking about him or her repetitively,
or rumination (Bonanno et al., 2002).

Why Do Memories Have to Be Elaborated?

An unresolved memory is an uncompleted experience that has been stored by
memory processing as a fragmented experience reflecting unmet interpersonal
issues with the deceased. Because of the lack of some particular elements, the
memory has not been properly processed and therefore is stored in the category
of needs completion. Those lacking elements can be emotional (expressing love,
gratitude, and forgiveness), behavioral (approaching, touching, saying some-
thing, and caretaking), somatic (gestures, postures, and body action), and cog-
nitive (beliefs, conclusions, and meanings). Some of these elements were out of
awareness at the moment the experience took place in the past, and they need to
be expressed, completed, and enacted. If the memory is traumatic (e.g., dealing
with the image of the accident), it needs trauma completion (Ogden et al., 2009),
if relational (e.g., ‘‘I miss her, she was so special,’’ ‘‘I cannot forgive myself for
not taking care of her at that moment’’), it needs a relational completion
(Greenberg & Forester, 1996).
Unresolved memories are often unconsciously reactivated because they point
to areas of significance where the deceased impacted the bereaved individual’s
life in the past. Those areas may have been kept out of awareness and therefore
need to be identified and elaborated in order to be transformed in fruitful
memories. To complete relational memories, the bereaved has to extract their
hidden meaning which often is a reflect of the unmet interpersonal issue.
Characteristic meaning outcomes unfolded from relational memories are: iden-
tifying the gifts received in the relationship, recognition of values, recognition of
personality traits of the deceased that impacted the life of the bereaved,
4 Illness, Crisis & Loss 0(0)

acknowledging and expressing gratitude and love, recognizing possible rela-

tional failures and asking for or granting forgiveness, and integrating the
impact of the loss as a productive source of personal transformation.
Integration and connection coping responses such as memorializing, remembering,
approaching sites associated with the loss, keeping objects and wishing to ver-
balize and share the associated memories, and fantasies may be enacted fre-
quently by the bereaved. It is important for the therapist not to interpret
them as an indication of a problematic clinging to the past, but rather recogniz-
ing that the potential of the past to nourish and impact the present has not yet
been fully unlocked. Thus, active promotion of the disclosure of relational
memories becomes for the skilled therapist an open door to the bereaved person’s
intrapsychic experience and an opportunity to complete and properly elaborate
the hidden specific tasks that must be accomplished (Payàs, 2010).

Integrative Meaning Reconstruction of Memories

Whichever technique the therapist may use to help the client to deal with a grief-
related memoir, healing ultimately comes through the bereaved individual’s cap-
acity to establish and maintain contact with himself or herself and the loss
experience. This contact is gained through increasing awareness of the somatic,
emotional, cognitive, and behavioural levels evoked by the memoir. These levels
are useful open doors of access that facilitate a process of integrative meaning
reconstruction of the loss experience (Payàs, 2010).
These four levels correspond with levels of brain architecture. Cognitive and
behavioral dimensions of the experience constitute the top levels of processing
(controlled by cortical activity), which are regulated by the underlying bottom
level emotional and somatic experience (modulated by the action of the amyg-
dala). LeDoux (1993, 1998) proposed the expression top down for naming the
therapeutic interventions that use cognitive and behavioral doors of access as a
way to process and foster therapeutic changes in the clients, and bottom up to the
approaches that are more focused in the somatic and emotional dimension of the
experience. He asserts that due to how the brain’s neurological traffic is orga-
nized, bottom up processing may have more lasting and steady efficacy than top
down processing.
Integrative meaning reconstruction processing of memories is facilitated by
using interventions that access the bottom levels of the experience. To achieve
this objective, the therapist must use interventions that include careful somatic
and emotional observations and inquiries. This bottom up exploration facilitates
a process of extracting and elaborating meaning where the awareness of the
somatic and affective experience is aligned with its cognitive and behavioral
correlate (Payàs, 2010). Integrative meaning reconstruction model of intervention
for modifying cognitive structures, the self, the world vision, and the narratives
surrounding the loss, may offer new alternatives in cases when other top down
Puigarnau and Morales 5

processing therapies such as cognitive reframing, cognitive behavioral, or dis-

closure approaches have failed. There is evidence that restorying without pro-
moting an integrative processing could strengthen avoidance and dissociation
coping responses in the client (Stroebe, Schut, & Stroebe, 2006).

Unfolding Meanings From Memories

Unfolding meaning from memories (UMM) is a semistructured intervention
designed specifically to elaborate relational memories from life with the loved
one, extracting and consolidating new, positive, and adaptive meanings. The
method is appropriate for bereaved adults and teenagers in an advanced
period of their grieving experience, when they are open to sharing specific mem-
ories of their life with the deceased. Its use is contraindicated in the immediate
aftermath of death while mourners are still experiencing acute grief responses,
with traumatic memories and intrusive imagery associated with the circum-
stances of the death itself. Although it is very beneficial for memoirs related
to unfinished business, UMM is not adequate with very conflictive relationships
or those with neglect or abuse issues.
UMM can be used to settle unresolved emotional issues, restore meaning to
specific painful memories of the lost relationship, reorganize a continuing,
healthy bond with the deceased, transform memories into a continuous source
of love, gratitude, and hope, and foster adaptive changes in sense of identity,
relationships, and perception of life.
UMM represent a particular distillation from other techniques and models,
integrating features and concepts as confronting the event story from construct-
ivist practices (Shear et al., 2011), completing memories and bringing the past in
the here and now from Gestalt therapy and other emotion focused and experi-
ential approaches (Erskine, Moursund, & Trautmann, 1999; Greenberg, 2002;
Perls, Hefferline, & Goodman, 1951), reactivating the original somatic, emo-
tional, and cognitive dimensions of the individual’s memory, and integrating the
somatic dimension of the memoir from Sensorimotor Psychotherapy and other
mindfulness approaches (Ogden & Fisher, 2014; Ogden et al., 2009; Table 1).

Step by Step
A description of the essential components of UMM is provided below.

1. Focusing the Attention to a Specific Memory: Framing a

Memory Scene
The client can be expressing that he or she is having spontaneous recurrent
thoughts about a specific shared event, or actively using mementos such as
key belongings, or using specific activities as stimuli to trigger memories of
6 Illness, Crisis & Loss 0(0)

Table 1. Unfolding Meaning From Relational Memoirs: Components and Integration of

Grief Theories and Therapeutical Approaches.

Grief theory or
Umm component Therapeutic intervention therapeutic approach

1. Focusing in a Select a memoir. Identify a Continuous bonds (Klass

significant memoir. specific scene of the & Walter, 2001)
memoir. Confronting the event
story (Shear et al.,
2011)
2. Activate the state Visualize the scene. Gestalt therapy (Perls
dependent memory. Describe details. et al., 1951)
Phenomenological Sensorimotor psychother-
inquiry of somatic, apy (Ogden et al., 2009)
emotional, cognitive,
behavioral dimensions.
3. Shift from ordinary Explore unmet interper- Experiential therapy,
consciousness to sonal needs. Identify emotion focused
mindfulness. unfinished business. approaches
(Greenberg, 2002)
4. Integrative meaning Inquiry and clarification of Integrative psychotherapy
making. new meanings (Erskine et al., 1999)
unfolded.
5. Completing Promote reparative Resolving unfinished busi-
relational tasks. intrapsychic imaginal ness (Greenberg &
dialogue. Forester, 1996)
6. Fostering trans- Identification and inquiry Sense making (Gillies &
formation and about new changes, Neimeyer, 2006)
growth. outcomes, scripts, Posttraumatic Growth
emotions, meanings. (Tedeschi & Calhoun,
2004)
7. Shift to ordinary Set aside the scene or Benefit Finding (Davis
consciousness. memoir. Appreciation et al., 1998)
of the work done.

the deceased. The therapist invites the client to choose a single specific memory
as the focus of attention. There are several possibilities that the therapist can
encourage. One option is to select a memory that has already been mentioned
repeatedly by the client in previous sessions or invite the client to think about
three to four of the most meaningful memories from life together with the
deceased and choose one of them. Other options are to ask the client to close
his or her eyes, and after a period of silence, let any scene come to mind (if the
trauma dimension has not been yet elaborated, a death-related scene will be
Puigarnau and Morales 7

triggered; these kind of scenes are cannot be processed with this technique). If
the therapist is already working with a meaning expressed in the narrative (e.g.,
‘‘My husband made me feel very special,’’ ‘‘With her, I always felt I was pro-
tected,’’ ‘‘Life with him was always and adventure’’), the therapist may ask the
client to think about a memory in which that significance was being experienced.

2. Activating the State Dependent Memory: Evoking Scene Elements

After selecting a particular scene of the memory, the therapist invites the client
to describe it with details and to see himself or herself and the loved one in it.
The therapist has to see the scene through the client’s description and become
familiar with some of the most relevant elements: where, when, who was there,
and so forth. Those scene elements will be used throughout the rest of the session
to stimulate the client to continue within the scene. Using the present tense and
using specific scene elements as descriptors are useful ways to bring the past to
the present, helping the client to feel as if it is happening now.
The state dependent memory of the scene is activated when the client starts
feeling the emotions and sensations of the past as if they were happening now.
This activation in the here and the now is identified by the therapist by its first
somatic expressions, such as body posture, voice tone, and by the first glimpses
of emotions. At this point, phenomenological inquiry is first directed to identify
and point out the somatic and emotional indications of activation. The therap-
ist’s questions and reflections direct the awareness from the external to the inner
experience in the present moment, enabling a shift from ordinary consciousness
to mindfulness.

3. Shifting From Ordinary Consciousness to Mindfulness:

Phenomenological Inquiry
Once the state-dependent memory is activated, the therapist helps to focus and
deepen the client’s awareness of the cognitive, emotional, behavioral, and som-
atic experience as manifested in the present moment. The therapist maintains an
attitude of interest and respectful curiosity about how the bereaved has orga-
nized the experience of the selected scene, encouraging the client to stay in the
present moment, and noticing and describing the details that come gradually to
awareness. Through indirect and open-ended instructional prompts that are
directed to the different levels of the experience, the bereaved is asked just to
reflect on what is awakening at that present moment.
Attuned open questionings low down the experience of the memory, giving
space to the client to feel and think. There is no need to rush, so what rapidly
happened in that special moment in the past can be now experienced slowly and
gradually. The client can be a fully aware observer of what is going on, noticing
what was previously unnoticed. Tracking and clarifying this new material helps
8 Illness, Crisis & Loss 0(0)

the client to revive the memory in a renewed way, where he or she can extract its
powerful meaning.

4. Integrative Meaning Reconstruction Processing: Grief Task

Identification and Elaboration, and Meaning Clarification Inquiry
The therapist strives to maintain the client’s pace at the natural next step in the
memory processing without pushing, directing awareness to every new piece of
material aroused at the level of the cognitive (a new task or a new meaning),
affective (a new emotion), or somatic (change in position, rate of breathing,
tremor, etc.). As new relational tasks unfold, the therapist may help the client
to stay aware of the new bodily and emotional arousal by making direct inquiry,
thus expanding the boundaries of the client’s integrative capacity, helping to
prevent dissociation, and promoting an organized and complete experience of
the task enclosed in the memory.
Direct questions as ‘‘Why are hugs from your son so important?’’ ‘‘So, he
made you feel safe: what have you learned from this experience?’’ ‘‘What
sense do you make of your life after this experience of feeling special and
unique with your husband?’’ are top down cognitive-reframing interventions
that have to be avoided. Instead, therapist uses a sensitive phenomenological
inquiry with open-ended questions interwoven through all levels of processing,
promoting an integration of the elements that were dissociated at that
moment.
The therapist acknowledges new relational meanings as they emerge and
reflects them back to the client for clarification. Emotional processing may
occur when difficult emotions such as fear, anger, or sadness lead the way to
love and gratitude. The therapist has to be careful that questions that direct the
attention to the cognitive dimensions of the experience are posed in such a way
that the answer has to be found while maintaining open awareness to the emo-
tional and somatic experience. This will ensure that the new significances
unfolded are properly integrated.

5. Completing Relational Tasks: Promoting A Reparative Intrapsychic

Dialogue
With new meanings having been explored, clarified, and expressed, the therapist
encourages the client to start an imaginal conversation with the deceased, in
order to complete the unfinished aspects of the memory that were unacknow-
ledged, missing, or even troubling. To this end, the therapist uses prompts or
incomplete phrases based on previous information that point to the specific task
to be elaborated, such as expressing love, forgiveness, or gratitude for the new
meanings discovered. The mourner is invited to ‘‘share with your loved one’’
what he or she discovers while being within this memory.
Puigarnau and Morales 9

Although this could be done in silence and with eyes closed, the therapist
encourages the bereaved to look forward, to keep a mindful presence, and to
speak aloud. This allows the renewal of the continuing bond to be enacted in an
intense way which will promote a much deeper integration of the material raised.
At the same time, this technique allows the therapist to follow the client and
gently push the dialogue to new meanings and tasks as they naturally unfold. To
help initiate, the clinician offers the client such a prompt as ‘‘What I would like
to tell you (name of the deceased) is . . .’’
It is important that the invitation be stated in the first person, which
encourages intrapsychic contact with the subjective experience. If it is done
in an interpersonal frame (e.g., ‘‘what you would like to tell him about this
memoir is . . .’’), the bereaved may be at risk of losing the contact with the
inner experience, and therefore the state-dependent memory may be
deactivated.
If the client gets stuck in the dialogue process, the therapist may offer prompts
directed to the task to be completed; if the client’s dialogue is fluid and continu-
ous, the therapist can remain silent.
The client may be invited ‘‘to look into (the deceased’s) eyes, and feel what’s
there.’’ The client can then be asked how his or her face reacts and to imagine
what that reaction means as a response.

6. Fostering Growth and Transformation: Integrative Inquiry Directed

to Changes as Outcomes
Once the relational tasks have been repaired and the new meaning disclosed, the
integrative meaning-reconstruction process may progress to a transformation
outcome. The therapist anticipates the transformative potential of the new
meanings unfolded, recognizing its nonverbal signs: new positive emotions
(love and gratitude) and somatic-postural changes (client relaxing posture or
standing straighter, expressing more energy). The final step of UMM is the
exploration of how these new meanings are going to affect the life of the
bereaved. Client awareness is directed toward verbally stating what is going to
be transformed in the present and future as a result of these new meanings.
Growth outcomes such as new life scripts or beliefs (e.g., ‘‘I think life is worth-
while,’’ ‘‘I deserve to be happy again.’’), different behaviors or attitudes (e.g.,
wishing to spend more time in interpersonal relationships, changing priority or
values), among others, are communicated to the deceased in the imaginal dia-
logue. The client is encouraged to relationally elaborate those outcomes within
the frame of the specific relational memory that has triggered them. If possible,
the therapist can suggest an imaginary invocation of assistance from the
deceased in coping with the integration of these growth outcomes in the life of
the client. This reparative dialogue can be directed by the therapı̀st to the reso-
lution of ambivalent feelings about the process of going on with life.
10 Illness, Crisis & Loss 0(0)

Once the transformation is recognized, the therapist directs the client’s mind-
fulness to spend the last few minutes of the process in such positive emotions as
joy, safety, bittersweet-sadness and gratitude, and their somatic correlates, while
connecting them with the new transformation goal. This is the way integrative-
meaning-reconstruction approach brings together all levels of processing, fos-
tering a complete ‘‘bottom-up’’ integration.

7. Shift to Ordinary Consciousness: Closing and Ensuring Safety

The session should be closed by directly asking the client to decide how he or she
would like to finish the dialogue with the loved one. The therapist shifts the
orientation from an intrapsychic experience to an interpersonal one. Some clients
like to say ‘‘farewell’’ or ‘‘goodbye’’ to a part of the relationship, others express
that ‘‘I will always be with you,’’ while others just add ‘‘I love you, thanks.’’
Before closing the session, the therapist must ensure that the client has
returned to ordinary consciousness. Few words, empathic silence, time to shift
to ordinary consciousness, and eye contact constitute the best way to close an
intense memory session. This allows the client and the therapist to appreciate the
positive affect and pleasurable sensations of the transformation as a shared
sacred experience; sacred experiences are felt, not talked.

Case Example
C: I have memories, very loving ones, walking in Barcelona. But the best mem-
ories with him are the ones at the beach. The first time I saw the sea after his
death was so painful!
T: Can you choose a specific scene of a moment at the beach?
C: (moment of silence) Well it would be in the little beach of Xelin, south of
Delta de L’Ebre. We particularly loved that beach, the sand is like little rocks,
that’s why just a few people go there, so we used to go there, each of us with a
book . . . We could be there for hours . . .
T: (slowing the rhythm) Let’s take a moment to enter into that scene,
Monica . . . Can you close your eyes and see it? . . . You’re both there . . . Just let
the image appear . . . and feel it . . . Can you describe it? (using present
tense) . . . Monica . . . you are there now . . ..
C: We are lying under the parasol, with our books, the breeze, the sea, every-
thing is quiet.
T: You are there . . . both . . . look around you Monica . . . What do you see
around you now?
C: (wiping tears with her hands) I feel moved . . . I miss him so much!
T: (giving time): So you are both there Monica . . . please stay there and watch
inside you . . . be aware of your feeling and your body . . . what is that so special
about this moment?
Puigarnau and Morales 11

C: (long silence while she searches): The peace . . .

T: (attuned voice): The peace . . . let yourself feel that peace, Monica . . . Close
your eyes . . . Feel that moment . . . How do you sense the peace inside your body?
Notice it . . ..
C: The breathing . . . I am relaxed, my mind is as if I have nothing to worry
about.
T: So you are there, . . . this relaxed breathing . . . feeling this peace . . . from
what . . . in contrast to what?
C: Well, peace from stress, from ‘‘having to do things.’’ It’s a moment
together, recharging batteries.
T: Okay, let’s pay attention to this . . . You are there lying under the umbrella,
Angel is there beside you, there is peace . . . Go on observing . . . What else do you
feel inside? . . . Be aware of your body sensations while looking for this answer.
C: I feel my chest as opening, a space.
T: Observe this space in your chest. What’s the feeling inside?
C: (searching in silence): I feel safe! (crying . . . uses her hand to touch her
cheek) . . ..
T: (with very soft voice, and slowly) Look around you . . . and inside
you . . . What is it that is so special that makes this moment to feel safe for you?
C: (crying softly . . .): I am with someone that loves me, someone that cares
about . . . I feel so fortunate!
T: Stay there a little bit more . . . with your eyes closed, contemplating every-
thing around you and inside you . . . and be aware of what my questions trigger
in you . . . You feel safe, far from stress, you feel peace . . . your chest is open-
. . . you are there in the beach, the little rocks, him . . ..
C: It’s his presence! . . . that makes me feel safe (tightens her shoulders and
curves her back).
T: Pay attention to your body posture . . . it has changed . . .. . . your shoul-
ders tight . . . your hands on your mouth . . . I am going to ask
you another question . . . What does Angel do to make you feel
safe . . . in peace? Do not think the answer, just look at it in the scene and
inside your body.
C: I can see his loving presence, quiet, serene . . . It’s like I have no doubt that
he loves me (cries softly) . . . it is something solid.
T: Stay there a little more . . . you are watching the scene around you, feeling
peace, safety . . . he loves you . . . What else are you observing?
C: (with her hand still over her mouth and nose, breathes deeply before
answering) It’s like we are both charging ourselves with energy . . . his warmth
is like the warmth of the sun . . . It charges me with vitality . . . In here we do not
need to talk . . . I just feel his loving presence . . . This is the image I want to keep
with me for the rest of my life . . . looking at the sea . . . reading . . . being in silen-
ce . . . bathing . . . eating maybe, if we are hungry . . . We do not have a
schedule . . ..
12 Illness, Crisis & Loss 0(0)

T: (mirroring her pace with body movements, the breathing and the look)
Just stay with all that in the scene . . . feeling all that, sensing his solidity, his
love . . . while you feel safe and in peace . . ..
C: (after a long silence): and we can talk about intimate things . . ..
T: So this memory carries so many important meanings . . . safety, peace,
being intimate, feeling his loving presence . . . Monica be aware of how your
shoulders are tightened, how your hand is closed . . . take a moment to answer
this question . . . And all that is so important in my life . . . because? . . ..
C: . . . Because I never had this feeling of stability in my past life . . . (sighs and
relaxes her shoulders and hands): it was difficult in my past life to have moments
of relaxation. He was my refuge . . ..
T: And I needed a refuge because? . . ..
C: What happened when I was a little girl!
The therapist goes on exploring how the relationship was reparative to a devel-
opmental issue from Monica’s childhood, and how this link gives meaning to their
love history. All this inquiry is done while keeping Monica in the same scene, with
Angel besides her . . ..
T: I am going to ask you to turn to Angel and look at him . . . Tell him, in your
own words, about the discoveries you have made and how grateful you are for
having this memory of him . . ..
C: I want to remember this memory with joy, not overwhelmed by sadness
(crying). I am fortunate to have met you and in how you have transformed my
life.
T: (encouraging): Tell him in your own words. Angel what I want to say to
you is . . .
C: Angel, I need to say to you how grateful I am for what you have given to
me, for what you have made me feel . . .
T: And each time I will recollect this memory of the beach, I will remember
that . . .
C: I have been loved, and that I can feel this connection with you every time
I look at the sea, every time I come here . . . feeling calmed and safe.
T: So Angel, . . . you helped me to repair the loss of my childhood . . .
C: (deeply moved) With your love and strength you’ve helped me to overcome
my insecurities, my feelings of loneliness and my fear that something bad would
happen to me . . . You made me feel safe and loved, as I’d never experienced
before.
The therapist goes on helping the client to complete the relational task of
expressing gratitude.
T: Keep looking at his face while you talk to him . . . you are both . . . there on
the beach . . . You are looking at him . . . and at the same time, you’re aware of
what is happening inside you . . . and Angel, the way I want to keep that moment
in my life is . . . (encouraging the client to complete the phrase)
C: By remembering you and your values.
Puigarnau and Morales 13

T: And these values will impact my life, in a way that . . .

C: (thinking a few moments): In being more social, more intimate with our
friends . . . in taking care of people as you have done to me. (Opening her chest
and moving her hands in front of her) I want those changes in my life!
T: Observe your movement . . . what has changed?
C: I feel more space inside me, the sadness is there but I can feel the energy in
my arms.
T: Keep awareness of those somatic changes, while you tell him in which way
your life is changing now and will change . . .
Therapist does meaning and change inquiry while keeping the client mindfully
present inside the scene and aware of her emotions and somatic responses.
T: Can you see his face Monica? What do you see?
C: He is smiling at me . . .
T: If this smile could talk . . . what would it say? . . .
C: . . . I knew it would be like that, I am so proud of you . . . (crying . . .)

Conclusions
UMM method of intervention is described with its essential components focus-
ing in the description of the clients’ process. The guide can be used by the
therapist as a ground map for the process of elaboration of relational memories.
Using a dialogic intervention focused to the reexperience of specific memories
of the deceased attachment figure, the bereaved can rekindle the relational emo-
tional experience of the past (continuing bond). The therapist’s respectful inquiry
promotes a mindful awareness that gives space for the painful details of the
memoir to emerge, allowing the bereaved to get in touch with the deepest
parts of the intimate relationship that took place. New material that was out
of consciousness at that moment can then be naturally unfolded. The memory
evoked offers fertile ground where different attributes or aspects of the lost
relationship such as values, feelings, unfinished business emerge and are avail-
able for inquiry, clarification, and tracking. Integrative Meaning Reconstruction
may take place in the present reexperienced bond as the bereaved observes,
explores, elaborates, and integrates this new material.
The incorporation of the somatic and emotional levels of information,
aligned with their cognitive and behavioral correlates, provides a greater
depth and a higher level of integration, promoting awareness of specific aspects
of those memories and ways of coping with them that may have been uncon-
scious. As a result, new personal meanings appear as spontaneous outcomes that
reveal a complete, renewed panorama of the experience of remembering. This
renewal leads to a new self, transformed, and expanded (meaning reconstruction,
meanings made, rebuilding shattered assumptions). Acknowledging those changes
that will naturally emerge is the last necessary step of the process of UMM,
where the newly reorganized sense of self, transformed values, and
14 Illness, Crisis & Loss 0(0)

comprehension of the world contributes to a healthier and more fulfilled life

(sense making, benefit finding, and posttraumatic growth).
Once the meanings are unfolded and integrated, the bereaved can go back to
that memory without experiencing pain or avoiding defenses, but rather with
love and gratitude. In some cases, the specific memory will be cherished for the
rest of the client’s life, nourishing the inner representation of the loved one, and
reinforcing a continuous bond as a fruitful presence. In other cases, the bereaved
may spontaneously stop having the need to remember it, and the relational
memoir is gradually forgotten.
It is important to note that UMM is an experiential bottom up method
based in a integrative-meaning-reconstruction process of change, which is
very different than a psychoeducational intervention used to teach the
bereaved how to deal with the painful relational memories or a cognitive
reframing technique used to extract meaning by direct questions (e.g.,
‘‘What is the meaning of these memories?,’’ ‘‘What have you gained through
this experience?,’’ ‘‘How do you think this memories will affect your priorities
in life?’’).
UMM can be useful as a guide to therapist of where the client is in the process
of elaborating memories and extracting their meaning, and how the therapist
might facilitate the next meaning making step. Although not empirically
grounded, several of its components of process of change have proved to be
significantly effective for the elaboration and resolution of painful memories,
and unresolved interpersonal issues. We believe that there is sufficient anecdotal
data to warrant empirical supporting evidence.

Ethical Issues
For presenting the case example in this article, data have been carefully treated.
The consultant freely volunteered to sign informed consent after explaining data
was stored in a secure manner and according to ethical guidelines. The nature
and aims of scientific divulgation were explained, so the consent for using by
anonymization, personal recorded, and written material obtained during clinical
sessions was given and signed.

Acknowledgments
The authors would like to thank Dr. Robert A. Neimeyer and his research team for their
kind review of the document, as for the deft guidance for the appropriate presentation of
our work.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Puigarnau and Morales 15

Funding
The authors received no financial support for the research, authorship, and/or publication
of this article.

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Author Biographies
Alba Payàs Puigarnau, Psychotherapist with 20 years of experience with
bereaved individuals and families. Director of Institute IPIR in Barcelona.
Trained at Metanoia Institute (UK), and Certified member of the
International Integrative Psychotherapy Association (US) Author of Las
Puigarnau and Morales 17

Tareas del duelo (Paidos,2010) an integrative-relational model for bereavement

psychotherapy At present she is the director of the MSC Bereavement and Loss
Counseling program at the University of Barcelona. Spain.

Adrián Chaurand Morales, PhD in Clinical and Health Psychology at University

of Barcelona in 2015. Posgraduate degree as Grief Counsellor by IPIR
Barcelona and the University of Barcelona. At present he is Director of
Institute IPIR in Mexico and of ‘‘Duelo Por México’’, a Programm created to
develop a national network of specialized units that provide support to the
bereaved.