After orienting clients to the practical issues of confidentiality and structure of the therapy protocol, the therapist honors the narrative nature of attachment [35], by encouraging them to introduce their loved ones, describing not only their death but also the relevant aspects of their lives. Philosophically, this invitation to flesh out and appreciate the relational story of the life of the deceased constitutes an act of resistance to the dominant cultural narrative of death as loss, expunging the existence of the person and requiring detachment or “letting go” as the only approved form of resolution of bereavement. Practically, this opening move also begins to access the broader account of a shared life as well as a synoptic story of the death, as both will provide orientation for subsequent phases of therapy. Thus, clients are invited to describe who their loved ones were as persons, as members of the family, and especially in relation to them, in a way that accentuates their unique qualities, strengths, and life experiences. Some questions that may be used to prompt this discussion include Who was ___ to you? What did having ___ in your life mean to you? Are there particular stories that ___ would want us to know about her life? and What might ___ say he appreciated about you, and how you might deal with the challenges you are facing now? Moving from surface to depth, the therapist encourages clients to share particularly meaningful words and scenarios reminiscent of the deceased to call forward relational connections that could mitigate the pain of the loss, a theme considerably developed in later therapy modules.

As a way of scaffolding the clients’ overall life trajectories and tracing their personal loss histories, the therapist coaches them to construct a loss timeline [36] that includes significant turning points and life episodes, noting their emotional and practical response to each, and segmenting these into chapters of their lives with distinct titles [37]. Acknowledging previous losses that punctuate the clients’ life stories and placing them in chronological order allow therapist and client to recognize their role in giving shape to the latter’s self-narrative, revealing previous means of coping and biographical and relational sources of resilience. Significantly, this often prompts greater awareness of the role of ambiguous losses that are unnamed and unmourned, such as miscarriages, relational breakups, job loss, and illness, all of which can otherwise be disenfranchised and unsupported [38]. Combing through the timeline helps both members of the therapeutic dyad—therapist and client—to recognize recurrent themes (e.g., of challenge and survival, abandonment or the resurgence of hope) and to connect the clients’ experiences across time to relevant family, cultural, or spiritual beliefs and resources. When clients are preoccupied with the event story of the death (especially when it was sudden or violent, as in cases of suicide or fatal accident), the therapist may implement special procedures for retelling the narrative of the death to promote greater emotion regulation and sense-making in the face of a traumatic experience [16]. Drawing on protocols developed by Rynearson and his colleagues, these involve slow-motion exposure to the most difficult details of the dying narrative, as the therapist supports the client in achieving greater mastery over the experience without relying on avoidance coping [39].

Having sketched the landscape of loss(es) in the clients’ lives in the previous session, the therapist is now in a position to delve into the story of the death more fully, drawing on the general structure of the meaning reconstruction interview [40]. This flexible framework suggests a sequence of Entry, Experiencing, Explanation, and Elaboration questions, with several examples of each that the therapist can adapt to the client’s needs. For example, the therapist might enter the story by encouraging clients to recall details of the loss and how they responded at that time, and how this feeling has evolved since (Entry), deepen into visualization of critical scenes and their associated embodied emotions (Exploration), progress to inquiries into the sense they made about the loss when it occurred and any philosophic or spiritual beliefs that helped them do so (Explanation), and conclude with questions about the longer-term import or lessons the loss carried for their lives or sense of self (Elaboration). Experiencing and Explanation questions are prioritized when the event story of the death is particularly preoccupying or traumatic, in keeping with a restorative retelling approach. The session concludes with directed journaling homework, which encourages further reflective writing around specific prompts to help the client consolidate sense-making and benefit finding regarding the experience [30].

Having drawn forth a significant amount of emotionally significant material in the previous two sessions and the journaling that followed, this fifth session provides an opportunity for therapists and clients to sift through the memories, emotions, and themes that have emerged, and to gain further perspective on them considering various contemporary models of grief. To facilitate this, the therapist briefly describes the Dual Process Model of coping with its depiction of oscillating attention to the loss and restored living [41], the Two-Track Model of bereavement with its emphasis on both biopsychosocial symptoms of grief and the pre- and postmortem relationship with the deceased [42], and the Shattered Assumptions model with its description of the fracturing of implicit beliefs in justice, predictability, and control resulting from a tragic loss [43]. In each case, the therapist joins with the client in considering the applicability of the concepts to their own experience of loss to give them greater intelligibility, and to consider what most requires therapeutic attention: mindful regulation of turbulent emotion, reflective processing the implications of the death for their belief system, active engagement with avoided experiences, reaching out to relevant others, etc. The session concludes with assigning the task of writing a “Hello Again Letter,” as discussed below, taking care to collaborate with the client to ensure conditions of safety and usually privacy in engaging this emotionally evocative assignment.

Phase 4 marks a shift from focusing predominantly on the event story of the death to concentrating on the back story of the relationship to the deceased, not only in life, but also beyond the loved one’s death. In keeping with a contemporary continuing bonds model of bereavement [44], the goal of this phase is to provide resources for helping the bereaved reconstruct, rather than relinquish their attachment to the deceased, in a form that is sustainable in the person’s physical absence. Session 6 builds on the preliminary work in session 2 involving introducing the loved one, by reviewing clients’ writing of an unsent letter to the bereaved whose goal is to say “hello again” rather than to say a final “goodbye” [45].

Many clients need no further encouragement than to write as if to the deceased to speak to the heart of their relationship, how it is for them now, and what they hope or plan for going forward, sometimes spontaneously addressing lingering concerns or regrets as well as affirming love. However, when they are uncertain how to begin, the therapist can offer any of several “conversation starters” in the form of incomplete sentences, such as My most treasured memory of you is…, The one question I have wanted to ask you is…, or I want to keep you in my life by… [31]. Having completed this letter between sessions 5 and 6, clients can choose to email the letter to the therapist or simply share all or part of it in session. In either case, clients read the letter aloud in session (unless they request that their therapist, or in the case of group therapy, another trusted group member do so), to witness, validate, and explore the passionate feelings and meanings it conveys. After discussing both the content and process of this writing, the therapist suggests that clients write letters back to themselves on behalf of the loved ones, in a way that addresses the feelings, questions, and needs that their own letters implicitly or explicitly contain.

Having drafted a letter as if from the loved one as a between-session assignment, clients speak about the usually vividly emotional experience of doing so, and read the letter to their therapist in session 7. Alternatively, or additionally, the therapist may also read the letter to the client with expressiveness, which can deepen the sense of the letter speaking to them with a voice outside the self. For many clients, this restoration of a symbolic dialogue with the deceased introduces further correspondence to and from their significant persons, helping install their voices as a kind of “portable secure base” that remains accessible despite their physical absence. To further consolidate this experience, clients are assigned the life imprint exercise as homework prior to the next session.

In keeping with a postmodern conception of self, the meaning reconstruction approach presumes that our personalities are constructed as a pastiche or residue of innumerable relationships with others, and especially those who play intimate roles in our lives. Accordingly, the life imprint encourages bereaved clients to trace the impact of the deceased on their personal identities, at levels ranging from their gestures and mannerisms, through their choice of vocations and avocations, to their most abiding characteristics and values [32]. Reviewing these multiple imprints with their therapists, who encourage elaboration on the embodied or enacted legacies in the form of memories and stories, conveys the deep sense in which the deceased have a continued existence in and through the clients’ own lives. Although this is typically deeply affirming of cherished bonds, occasionally imprints are ambivalent or even negative, in which case therapists collaborate with the client in discovering ways to relinquish or release them. The session can end with a plan to perform an activity that honors the imprint of the loved one, often by engaging in meaningful actions (visiting a special, but previously avoided, location), or performing a dedicated act of kindness that extends the loved one’s concerns [46].

In this session, clients report back on their self-observations following the work on the back story of their relationship to the deceased over the last few weeks. The therapist engages clients in discussion of additional possible expressions of connection to their loved ones, as in dreams, experiences of their tangible or intangible presence in clients’ daily lives, and for many of the bereaved, a sense of spiritual connection that implies the prospect of reconnection in an afterlife. Leading from one step behind, the therapist follows clients’ cues in such discussions, taking care to respect their personal and cultural beliefs and practices. This session also serves as a kind of “expansion joint,” permitting further attention to the correspondence with the deceased or life imprint methods for clients who choose to explore them further.

To promote integration of the work of therapy by fostering an imaginative, self-distancing perspective [47], session 10 engages clients in writing a brief “make believe” story about themes of loss for 8 min during the session, as the therapist circulates through the room in the case of group therapy, or steps out of the room in individual therapy, or away from the camera in online videoconferencing to give clients privacy without distraction. Termed a virtual dream story because of its draw toward a fairy tale or magical realist fictional style, the method involves priming clients with two elements each of setting (e.g., a traumatic loss, an empty house), figures with voice (e.g., a crying child, a talking animal), and potentially symbolic objects or features (e.g., a mountain, a sunrise), which they are encouraged to include in any form they like into the narrative [48]. The short time available for the writing tends to circumvent the interruption of a self-critical or editorial voice, and the resulting story is typically emotionally powerful, and at this point in therapy, hopeful, whether the plot of the story literally or figuratively recapitulates the plots or themes of clients’ personal loss stories. After reading aloud and discussing the resulting narrative, client and therapist can use any of several additional techniques to extend the method in healing directions (e.g., facilitating imaginal dialogues between pairs of elements, or retelling the story from the perspective of one of the elements to decenter the narration and discover in it new possible meanings). Other alternatives prompt clients to consider what the story reveals about themselves, about what they need, so that they can plan practical steps to meet these needs in the coming week [49].

As therapy moves toward termination, the therapist coaches clients to plan a ritual of remembrance that honors their loved ones, or a ritual of renewal that symbolizes the new possibilities they wish to embrace in the future [38]. For example, clients may pursue a legacy project such as launching or contributing to a charitable cause that reflects the core values of the deceased, or plan a holiday ceremony as a family that acknowledges the deceased but also recommits the family members as a unit to their shared future in their new form. Some symbolic steps in these directions can be taken immediately, whereas others inherently represent longer-term projects to be nurtured over time.

In what may be the final session of the planned series, clients report on their success and next steps with their rituals of remembrance and renewal, and review turning points in their therapeutic journey toward greater hope and meaning. In individual therapy, the therapist might give the client a small symbolic gift (e.g., a stone engraved with the word “peace” or “remembrance”) that captures an important theme of the therapy, whereas in group therapy the group itself might practice a ritual to recognize their joint efforts across the past few months, as through writing a collaborative poem to which each group member contributes a single line [50]. In both cases, the action serves as a simple but memorable means of recognizing the solemnity of the life transition, commemorating the work of therapy, and anchoring shared hopes for a fulfilling future.