Getting Through Grief with Yourself: Relearning Self-pleasure After the Loss of a Partner

Anna H.
For Sallie Foley, 5/3/09
SSW 700- Treatment of Sexual Dysfunction


Despite the copious amounts written in books and journals addressing the theories of, and approaches to, understanding and treating depression, grief and loss, and sexual (dys)functioning as isolated topics, very little can easily be found that looks at the intersection between these very common aspect of life. The loss of a romantic partner-- be it due to a breakup, separation and divorce, or death-- is a near-universally experienced part of human relationships. Stroebe, Schut & Stroebe report that particularly among older populations, as many as 45% of women and 15 % of men older than 65 become widowed (Stroebe, Schut & Stroebe 2007). Sadly, losses of this nature, though relatively common, are most often accompanied by a significant period of grief or bereavement, encompassing a multitude of emotions ranging from severe loneliness, to anger, relief, confusion or depression. Included among these are the very real, but not often acknowledged, needs for physical comfort and expression of one’s sexuality; despite this reality, however, modern healthcare and culture does little to acknowledge that sexuality remains a part of those people struggling with depression due to grief and loss, particularly if they are widows, widowers, or the elderly. Although self-pleasuring may or may not have been part of a client’s sexual routine before or during their time with their partner, learning-- or relearning-- ways to derive feelings of pleasure in both sensual and sexual experiences, safely, in the privacy of one’s own home, with the help of a sex therapist, can empower grieving clients to provide themselves with another means of solace.

In this paper I will discuss the ways in which therapists can help bereaved clients begin to reintegrate sexuality into their lives on their own, after the loss of a their partner, by affirming their need for comfort and pleasure and teaching them sensuality-focused means of self-pleasuring, even in the midst of grief. I will begin first with an overview of what Worden calls the “mourning process”, looking at how people proceed through what occurs after loss (Worden, 2009). I will continue on from there to discuss the integration of sexuality into grief, bearing in mind that the assumption of this paper is that clients are not dealing with a low sexual desire disorder per say, only sexual desire mitigated by grief. Due to the dearth of study on specific treatment for learning to use self-pleasuring as an outlet for sexuality and a source of comfort during the mourning process, I will finish with a discussion of sex therapy approaches used in treating low sexual desire, low arousal, and overcoming orgasm difficulty. Through these, I hope to suggest a course of sex therapy tasks meant, in conjunction with continued therapy for bereavement and support, to make one comfortable with masturbation and more attuned to their body’s sexual response.

This paper focuses specifically on self-pleasure and masturbation practices as a safe and non-threatening sexual activity that can continue to be enjoyed even after becoming single, though there are many others which can be explored to whatever extent the client has interest. All that must be emphasized with a cautionary note is that a client’s emotional and physical safety stay of paramount importance in whatever sexual expression is chosen. Clients dealing with grief and loss are likely suffering through some degree of depression, and clinicians must be particularly aware of their clients’ moods, affect, and engagement in high risk behavior as a result.

Sexuality is not often talked about as an aspect of bereavement that deserves to be addressed and promoted as an aspect of life which does not simply end after the loss of a partner or spouse. Sex therapists have for years promoted the idea that adult sexuality continues for as long as we live, and even major life changes such as losing a partner do not have to spell the end of one’s sexual life or the enjoyment of sensual activities. “Divorce may impact your sexuality by depriving you of a partner… and widowhood… has a unique impact on your opportunities, desire for, and capacity to be sexual, but neither need derail your sexuality or sexual identity,” (Foley, Kope, & Sugrue, 34, 2002). In the context of grief and mourning, however, in order to get the stage of a therapeutic relationship where clients are ready and want to address their sexual needs, it is important that clinicians in all fields of therapy first understand better what the experience of loss does to a person, physically, emotionally, and psychologically.

Stroebe, Schut & Stroebe outline in their review of health outcomes related to bereavement that there are extensive implications for physical as well as mental health when one has lost a loved one, including strong support for the idea that the “quality or nature of the lost relationship has much effect on outcome [for the survivor’s experience of loss]” (Stroebe, Schut & Stroebe, 1967, 2007). Therefore, the impact on surviving spouses of deceased partners, or individuals who have just been through divorce, separation, or breakup, is that one can expect to go through much during his or her time of grief over both the loss of relationship and partner. Physically, loss frequently manifests itself in a variety of behavioral and psycho-somatic changes which make up, in part, the experience of grief. These can include changes in a number of activities and aspects of daily living which are also hallmarks of depression, such as fatigue, agitation, weeping, social withdrawal, loss of appetite, sleep disturbances, and physical complaints (Stroebe, Schut & Stroebe, 2007). Further, depression as a normal result of grief can directly negatively affect how one responds to things that once gave them pleasure, sensually and sexually. Changes in general mood, attitudes towards sexuality, and physical wellbeing can be as mild as losing interest temporarily in one’s favorite past times, or can be as severe as to cause anhedonia, or the inability to take pleasure, physically or mentally, from normally pleasing events and activities. Seidman and Roose describe reduction in sexual interest as one of the most common changes in sexual response during depression, which can express itself physically as well as emotionally; for example, roughly “one third of depressed men develop loss of nocturnal penile tumescence (NPT), suggesting that depression can impair the neurophysiology of arousal or genital vasocongestion,” (Seidman and Roose, 2001). For the purposes of therapy, what this translates to is that clinicians can reassure their clients confidently with normalizing statements that, if they experience symptoms of marked decrease in arousal or sexual interest, these are common grief reactions influenced by both the loss itself, that they will likely dissipate or lessen over time, and if the client wishes to work on them clinically, they are completely welcome to do so, as sexuality is a normal and healthy part of life, even during major loss.

Emotionally and psychologically, Worden explains that there are “tasks” involved with processing and moving through the “phases” of mourning which, though a client may not follow a linear progression of milestones, are nonetheless essential to understand if clinicians want to provide support and help through loss (Worden, 2009). The first of these is “to accept the reality of the loss…that the person is gone and will not return” (Worden, 2009). This becomes a more complicated matter if the client’s partner is not deceased, but rather they are divorces, separated, or otherwise no longer in a relationship. As the literature I found devoted to the process of grieving spends little time addressing losses of these natures, I will for the purposes of this paper apply the tasks of grieving a dead partner also to the tasks of grieving a now-ended relationship. Regardless of the type of loss, many newly-single or widowed people go through a period of denial, during which they struggle against the concept that their relationship has ended and will not be the same again; it may take a person a very long time to come to terms with this. The second task, according to Worden, is to “process both the emotional and behavioral pain of grief,” (Worden 2009). While the degree of pain over a loss may vary from person to person, and certainly is can be effected by the circumstances of the relationship’s end, all people feel some level of sadness and pain when a deep and once-profound romantic bond has been broken. The third task Worden describes is for clients to begin to adjust to the world without their loved one by their sides; this includes making “external adjustments” in their new roles as single people, and possibly single parents, while continuing to live their lives, and “internal adjustments” to how they now must think of themselves (Worden 2009). Finally, the fourth task Worden discusses is that the bereaved person must find an enduring connection with their former partner “in the midst of embarking on a new life”. At the core of this task is integrating the ended relationship into their lives, as something which shaped and was of great value to them, perhaps for many years, while at the same time acknowledging and beginning to move towards a new phase of life where that relationship is no longer a dominant feature.

A note on differences among grief experiences with regards to stigma in society and gender. Greenblatt noted in 1978 that the experience of widowhood is far more common, and implies that such loss is potentially more difficult to bear, for women than for men:
Spousal mourning is a problem that mainly affects women because they have greater longevity, are usually younger than their husbands, and their marriage rate after bereavement is lower than that of widowers. Loss of spouse is, of course, a tragedy of major proportions. A widow is not only faced with loneliness, loss of companionship, and unmet sex needs, but also lacks the comfort, information, and support of a partner of many years. If her income is reduced, which is often the case, the widow may find herself poorer…. The widow’s place in society may become complicated; many widows, as well as their friends and relatives, view widowhood as something of a stigma.
(Greenblatt, 1978)
While it is easy to dismiss these observations as antiquated and outdated because of their age, there remains a significant amount of truth to them, although I would argue that the stigma and hardships described above apply equally to both men and women. A person accustomed to living with their partner and sharing a household does need to suddenly cope with the practical loss of supportive income, as well as the emotional support and companionship of their former mate, as Worden notes in his third task of making the internal and external adjustments necessary to continue living with this new and major life change. Further, it does seem to be the case that those who go through grief at the loss of a partner, particularly those who are already marginalized such as the LGBTQ and aging populations, end up denied recognition as continuing to be sexual beings. Bent and Magilvy are some of the few who explicitly acknowledge that grief in lesbian women who have lost life partners is further complicated not only by their marginalized status in society generally, but in regards to significant legal disadvantages such as visitation rights for partners in hospitals, being allowed to be beneficiaries of wills, and in some cases custody battles for children (Bent and Magilvy, 2006). Feelings of intense hurt, anger, and confusion with regards to the legal issues surrounding partner loss for this population can make the mourning process all the more painful. Foley, Kope and Sugrue note that “unlike a woman’s young adulthood, later in life her single “sexual self” may not be highly valued by the culture. Women often remark that they have to encourage themselves to stay sexually vibrant,” (Foley, Kope and Sugrue, 2002). Very little research can be found which specifically studies the sexual health or wellbeing, or even the role that sex continues to play, in the lives of those who are mourning partner loss. As Greenblatt seems to be suggesting, the general population, despite the high likelihood that most of its members will experience just this type of loss at least once in their lives, seems unwilling to acknowledge that those with grief still wish to experience sexual pleasure. In part, gender differences may be considered to try an account for this bias when looking at the way men and women view sex and it role or function in their lives, despite our modern views about female sexual liberation, it continues to be at least more acceptable for a man to have sexual needs than a woman. Regardless of this gendered division, it is important to affirm clients in their sense of loss and loneliness in missing sex and sexual expression or intimacy with their former partner, and to encourage them in their wish to remain sexual even now that they are single.
With the understanding that clients can process these multiple tasks of mourning simultaneously as life and emotion dictate, I suggest that a counselor or sex therapist’s role begins to shift from just grief work to also exploring and reclaiming the client’s sense of sexuality in the context of loss is when the client has begun to take on Worden’s third task. Recognizing that those feeling emotional pain and grief over the loss of a partner may include clients who were seeing someone for 6 months or coupled to for 56 years, it is important for clinicians to let clients who come to them with grief process it and progress through their own phases of mourning without an expected timeline for “getting better”, or even getting to the point of wanting to incorporate their sexuality into their healing. Clients may not initially feel the desire to feel or act sexually, and a client’s sexuality may be dormant for quite some time; some clients may never want to be sexual with another partner again. Foley, Kope and Sugrue remind clients that there is hope, after one becomes single again, of remaining sexual, even without their former partner:
Some single women who were previously partnered can honestly predict that there is little likelihood that they will find a new sexual partner. Their sexual response to this status is as varied as their circumstances. Some choose not to be sexual at all, others continue to masturbate and explore sensuality, and some even choose to have occasional sexual experiences.
(Foley, Kope, Sugrue, 2002).
Though addressed to women, these considerations apply to all people reintegrating sex after partner loss, since, after a time, many people do find their sexuality reemerging, whether or not they feel they are done grieving. It is at this point that sex therapists may best add their input in regards to sexual expression and health, to reassure them that their sexuality, as an integral part of their humanity, is not at all inappropriate or wrong, and in fact can be a wonderful way to self-sooth and satisfy their desire for pleasure.

The tasks of working on low sexual desire hinge on a client wanting to feel sexual, or experience sexual pleasure- so too with expressions of sexuality after loss. If the client has reached a place in their mourning process where they wish to have the means to fulfill themselves sexually, then clinicians should be ready to provide them with ways that they may get reacquainted with their sensuality and sexuality, and back in the groove. Providing permission for a client to discuss their desire to have sexuality back in their lives and offering the therapeutic context as a safe place in which to redevelop a sense of sexual self after their partner is an ideal first step, as it reaffirms trust in the therapeutic relationship, and shows the clinician’s willingness to address all needs presented by their client as they cope with loss. As a warm up for therapists to begin work on sexual exploration, it is a good idea to ask the client for a background on their self-care regimen. Understanding what they are, or are not doing, to take care of and enjoy their bodies gives you a good jumping off point for addressing the physical need for human contact, and eventually sexual needs, and leads directly into the first exercises aimed at getting clients back in touch with their sexual and sensual selves. Ask if they ever go to a salon, or get massages, or if they have in the past, how comfortable they were with that experience. Such activities are a good way to provide for the need we all have for human contact, which may not otherwise be satisfied if the client does not have children or close friends nearby. Worden points out that “being able to discuss emerging sexual feelings, including the need to be touched and to be held, is important. The counselor can suggest ways to meet these needs that are commensurate with the client’s personality and value system,” (Worden, 2009). Engaging such activities, if they do not already, is also a non-sexual way of easing clients into a reawakening of their sensuality, and getting them to begin enjoying the sensations of their body again.

Sensate focus exercises are an excellent place to begin the therapeutic work of reintegrating sensuality and sexuality into a client’s life, regardless of whether they masturbated before or during their previous relationship, because they allow for a slow and non-threatening progression from imagination to action. Hertlien, Weeks, and Gambescia, emphasize the use of sensate focus exercises in the context of systemic sex therapy as part of treatment for several different sexual dysfunctions (Hertlien, Weeks, and Gambescia, 2009). In the context of reincorporating masturbation and self-pleasuring into the lives of bereaved clients seeking comfort and an outlet for their sexuality, sensate focus techniques can be a particularly useful tools to “practice skills they have learned in the office” for getting reacquainted with their bodies’ enjoyment after much emotional suffering and to
[e]xperience sensual and sexual touch within a familiar, relaxed, comfortable environment. The therapist prescribes detailed cognitive and sensual behavioral homework that incorporates sensual and eventually sexual touch. Each assignment involves small incremental steps that help to build confidence, competence, and an increased sense of efficacy in overcoming the sexual problem.
(Hertlien, Weeks, and Gambescia, 2009).

In the case of bereaved clients, the assignments taught also help to slowly restore their comfort and enjoyment of their sexuality without their partner’s involvement. Worden cautions that “there are those whose only sexual experiences have been with their deceased partner, so the counselor may need to address any anxiety concerning new sexual experiences,” (Worden, 2009). In reality, whether or not a client had had sexual experiences with someone other than their former partner, if they were in a long-term, committed relationship with that person and, for one reason or another, are no longer with them, then it makes sense that a client might feel nervous, uncomfortable, or perhaps even guilty at wanting to still be sexual without them. It is therefore an important task in therapy, in conjunction with the actual practice of sensate focus, to allow time for sadness or a renewed grief that the client now must practice their sexuality on their own, even if they are ready and want to begin moving forward.

Sensate focus is usually taught as a partnered activity, and it is therefore necessary to adapt the exercises to be done individually, and for at least some of the non-erotic focus exercises, such as receiving massage, to be done by a professional. Originally, the purpose of sensate focus was to systematically desensitize an anxious or disengaged partner to the anxieties and distractions which were preventing them from enjoying fulfilling sexual relations with their partner. However since “the blueprint of the exercise must carefully fit the situation”, clients can feel reassured that sensate focus can work for them as well, and that the plan they and their therapist come up with to gently and unhurriedly bring sexual experiences back into their lives will be only built to do what they want it to, and not push them too far or too fast (Hertlien, Weeks, and Gambescia, 2009). To achieve this, progression through the exercises must be made in very small steps, to avoid feelings of frustration or failure, be it to respond without grief or to respond at all.

Hertlien, Weeks, and Gambescia put forth nine functions of sensate focus which can be reconsidered and drawn on as they relate to grieving clients without partners. Of those that apply to clients wishing to resume their sexuality by themselves, the first is for the client to “become more aware of his or her own sensations”, meaning to pay attention, during the exercise, purely to the physical senses they experience when they, for example, run their hand over their arm, or rub lotion into their feet (Hertlien, Weeks, and Gambescia, 2009). This may be particularly difficult to do when starting out with a client who is in the process of mourning, as they have been working so hard already in managing their emotions, maintaining their daily lives, and trying to move on after their partner is no longer with them. The grieving process described above from Worden is a challenging and highly strenuous emotional and mental task, and to tell a client to focus on setting all that aside for a while may be met with relief, or anger, or utter bewilderment. Eventually, however, the hope is that in training their mind to let itself rest for these few minutes or hours, and just experience sensations that are pleasurable and comforting, the client will find the ability to both enjoy their sexuality for itself and use it as a healthy, temporary relief from all the other feelings they have. The second function which can be utilized by the single client is to “focus on one’s own needs for pleasure” (Hertlien, Weeks, and Gambescia, 2009). In this context, this translates to the client training him or herself to pay attention to what their body tells them it wants, and not feeling guilty or conflicted about satisfying those needs and wants without the help, participation, or support of their former partner.

The third and possibly most vital function that such clients can make use of in their own plan is to “expand the repertoire of intimate, sensual behaviors” that they currently have (Hertlien, Weeks, and Gambescia, 2009). This can mean anything that the client is comfortable and has interest in exploring: if they enjoy the feel of satin, perhaps they can see what it is like to sleep on satin sheets; if they never learned how to masturbate, now is the time to learn. It is important to use positive language when offering or hearing out options for clients to consider when expanding their sexual repertoire, and to encourage anything safe that might promote arousal and sexual feelings to get a client in a sexual frame of mind. Clients may wish to incorporate erotic novels, videos, or pictures into their practice, and this may be particularly useful if they wish to try and develop new sexual fantasies that do not involve their former partner. Alternatively, if for example remembering erotic moments with their deceased spouse is not too painful, and they can incorporate them in a healthy way which allows them to experience sexuality without their partner, but still keep the memory of them close at heart, clients should not be discouraged from using what feels good to them.

Foley, Kope, and Sugrue include masturbation in their chapter on overcoming low arousal as an exemplary means of finding out what one enjoys and one of the safest ways to experiment with sexuality on one’s own. “A number of writers have suggested that masturbation serves as the ideal learning opportunity for people to explore hour their bodies respond to stimulation,” (Foley, Kope, and Sugrue, 2002). Unfortunately, masturbation remains a largely taboo subject, which the client may take some coaxing to talk about, be it to admit to doing it, in which case they should be applauded for knowing and enjoying their bodies, or to admit they don’t know how, to which a therapist would do well to reply that their client is not alone, and if they want to try learning, there are a number of fun and non-threatening ways to go about it.

In a society where sexuality can focus more on giving pleasure to a partner than giving pleasure to yourself, masturbation has developed an unsavory reputation as being selfish, dirty, and practiced by those who aren’t getting any ‘real’ sex…. The fact is, masturbation is a great way to get in touch with your own sexual responses, rhythms, and desires, and can be part of anyone’s sex life, whether or not he or she has a partner. Masturbation is a natural, healthy part of sexuality and sexual practices worthy of recognition in its own right, whether or now you ever use a vibrator.
(Blank and Whitten, 2000.)

To help with masturbation practices in both men and women, many counselors recommend the use of sex toys, including vibrators, massagers, dildos, and anal plugs, both to increase stimulation for those people who have had trouble orgasming with manual stimulation, for those who simply want a change of pace, or for those miss the feeling of fullness being with a male partner can provide. Blank and Whidden have reassuring words for those of more conservative backgrounds who might be uncertain about introducing anything man-made into their sexual activities: “The only real difference between using the vibrator and using your hand(s) to masturbate [or a penis for penetrative sex] is that the vibrator moves faster and has more endurance. It won’t change the ways and places you like to be stimulated,” (Blank and Whidden, 2000). Clients should never feel ashamed or embarrassed if they are unsure or don’t know how to masturbate, with or without the help of a toy, and again it is the job of the therapist to reassure their client that their exploration of their sexuality on their own is healthy and positive.

Using these techniques, therapists and counselors can work with bereaved clients who have lost partners to replenish their sense of a sexual self and to reassure them of the importance of their continued sexuality, if and when they are ready to return to it. Recognition of their struggles and pain, acknowledgement of their loss, and support and constructive help in creating exercises to aide them in their return to life as a sexual being, as well as a bereaved person, are the first important steps that a therapist can offer in to met their client’s needs. Always keeping in mind the process of mourning in which clients are actively engages to one extent or another, and the need for clients to have time to grieve over the immense changes they have had to go through-- both in their everyday lives and in their expression of sexuality-- therapists can help facilitate clients’ learning of the use of self-pleasure as a means of self-soothing, an outlet for sexual feelings, and a tool to sustain them as healthy individuals for the rest of their lives.

 
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