When experiences of presence go awry: A survey on psychotherapy practice with the ambivalent‐to‐distressing ‘hallucination’ of the deceased

Abstract

Objectives. Experiences of presence, involving the sensory perception or felt presence of the deceased, are common amongst the bereaved (30-60%). Despite them being predominantly comforting and reassuring, a minority (approximately 25%) report ambivalent or distressing experiences. The study's aim was to explore how psychotherapy is practised with this subset.Method. A mixed-method approach, involving both quantitative analysis and thematic analysis, was used to analyse data from an online survey, conducted in English and Spanish, amongst mental health therapists (i.e., psychologists, psychotherapists, and counsellors). Seventy responded to the survey and four of them were further interviewed.Results. The participants primarily framed interventions for ambivalent-to-distressing experiences of presence as grief therapy, with the severity of the presentation as the main factor influencing their clinical decision-making, but several perspectives co-existed regarding how to intervene. These discourses were categorized into two themes: 'A normalising and exploratory psychotherapy' and 'A grief stages psychotherapy'. The main sources of patient's distress, as understood by the sample, were located in the bereaveddeparted relationship, in pre-existing mental health issues, and in a societal taboo or stigma. Conclusion.After comparing and contrasting the participants' working hypotheses with existing knowledge on experiences of presence, and contemporary theories in the research area, guidelines are presented on how to intervene with people disturbed by their experiences of presence.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Sensory experiences of one’s deceased spouse in older adults: An analysis of predisposing factors

“…Notably, as we found no association with registered neurodegenerative or psychiatric diseases, our results support the literature cautioning against assuming SED to be a sign of mental health issues (Hayes & Leudar, 2016;Kamp et al, 2020;Keen et al, 2013a;Sabucedo, Evans, Gaitanidis, & Hayes, 2020). It is important to normalize SED to avoid unnecessary distress due to concerns about one's mental health, which becomes even more apparent in the wake of the worldwide COVID-19 pandemic, which have left many to grieve under unfamiliar and restricted circumstances (Carr, Boerner, & Moorman, 2020;Wallace, Wladkowski, Gibson, & White, 2020).…”

“…A history of trauma is one pathway to SED A strong connection between previous interpersonal trauma and SED was identified, which points to trauma as one potential pathway to SED, similar to research on hallucinations (Luhrmann et al, 2019), where trauma (and related dissociation) is a strong predictor of hallucinations in both clinical and non-clinical populations (Longden, Moskowitz, Dorahy, & Perona-Garcel an, 2019;Morrison & Petersen, 2003;Read, van Os, Morrison, & Ross, 2005). This is particularly relevant from a clinical perspective, as psychological suffering from previous trauma may be carried over into experiences of SED among a minority of the small group of people with distressing SED according to the clinical experience of psychotherapists (Sabucedo, Evans, Gaitanidis, & Hayes, 2020). However, the individual experience of SED must be viewed in light of their personal and cultural context (Hayes & Leudar, 2016).…”

“…Lastly, auditory hallucinations have been associated with hearing impairment (Badcock et al, 2017;Linszen, Brouwer, Heringa, & Sommer, 2016), but it is unclear if such sensory deprivations are similarly associated with auditory SED. Exploring potential connections to mental and physical health is important, particularly because SED are associated with stigma in many cultures (Grimby, 1998;Rees, 1971;Sabucedo, Evans, Gaitanidis, & Hayes, 2020). As a consequence, these experiences may often be perceived as positive in themselves, but worry about others people's reactions may cause distress and be detrimental to the individual (Kamp et al, 2020).…”

Sensory and Quasi-Sensory Experiences of the Deceased in Bereavement: An Interdisciplinary and Integrative Review

“… 6 , 62 Some SED may be distressing in themselves (eg, seeing the deceased cry or hearing a hostile voice), perceived as intrusive or disturbing in their timing, and/or continuing a difficult (or abusive) relationship. 3 , 16 However, distress can also be mediated by how an experiencer responds to SED. Hence, it does not simply reflect the content of the experience, a point that applies equally to certain distressing phenomena in psychosis, such as hostile voices.…”

“… 3 , 70 , 89 , 90 Stigma can be a cause of feelings of ambivalence and distress, highlighted by a reluctance to disclose SED among bereaved people in some Western countries. 2 , 4 , 16 , 60 As such, the experiences may be initially welcome, but worriedness over one’s mental health (due to the perceived association in general society between hallucination and psychosis) as well as other people’s reaction, or the anticipation of it (eg, family and doctors), may cause distress to the individual. 2 , 16 , 60 , 62…”