Prof. Joseph Levine

Conversation 78: The Meaning of Human Presence After the Death of a Dear Person in the Lives of His Relatives

By Prof. Levine & Dr. Salganik

Hello to our readers

Recently, one of us [Y.L.] saw Professor Asa's book "The Book of Presence" in a bookstore. From the caption on it, it seems that the book discusses what presence is and the meaning of human presence [Asa Kasher, "The Book of Presence", Keter, January 2025].

Asa Kasher (born 1940) is an emeritus professor of philosophy at Tel Aviv University, specializing in the pragmatics of language and professional ethics.

About the book, it is written that "A dear person who has passed away sometimes leaves an unbearable gaping wound in the hearts of his or her loved ones… The understanding that it is possible to continue to give a rich existence to the human presence of the deceased, even after his or her physical existence has passed from this world…

On his journey [after the death of his son Eliraz], Kasher gradually began to understand that all the memories, people and experiences that a person holds close to his heart have a presence, even if it is not physical…

The presence of a deceased person in the lives of his loved ones does not have to be based solely on facts… A person can create imaginary situations in which he is together with the dear person who has passed away. He can tell him about events in his life, receive reactions and ask for advice."

So much for the book.

The classical approach to mourning, defined by Freud in his article “Mourning and Melancholia” (1917), saw mourning as a process of gradual separation from the deceased in favor of emotional rehabilitation and reintegration into life.

Sigmund Freud

Freud (1917) argued that “normal” grief is characterized by complete emotional detachment and renewed investment of emotional resources after a period of mourning. Worden (2009) published four central tasks: acceptance, coping with pain, reacclimatization, and distancing from the deceased.

William Worden

Klass and his colleagues advocated the “continuing connections” approach and emphasized that creating an internal connection with the deceased contributes to the preservation of identity, emotional regulation, and spiritual meaning [the deceased as an internal object].

Dennis Klass, Professor Emeritus, Webster University, St. Louis, Missouri, USA.

Stroebe & Schut (1999) described a Dual Process Model, in which the bereaved person “oscillates” between focusing on the depth of the pain (loss-oriented) and focusing on restoring life (restoration-oriented). The model allows for a combination of internal connection with the deceased and learning coping skills.

Prof. Dr. M.S. Margaret Stroebe

A systematic meta-analysis (Hewson et al., 2023) of 79 studies in the field showed that the continuing connections are diverse (memories, objects, sensory sensations) and influence processes of meaning and identity.

Whereas a prospective study (Field et al., 2006) with 56 mourners that examined the continuing connections after 7–12 months, found that the types of internal and external connections are differently related to symptoms of grief and depression later on.

Silverman (2000) found that group therapy that supported the maintenance of internal connection resulted in significant positive changes in depression and anxiety measures compared to the approach of detachment from the deceased.

Clinical applications in therapy include:

Guided writing: Writing letters to the deceased and receiving an imaginary “response” encourages emotional regulation and meaning (Neimeyer, 2001). [See also the interesting article in Hebrew by Prof. Eli Witzum on this topic in the newspaper Sichot, 2020].

Professor Emeritus Eli Witztum – Ben Gurion University

Support groups: A “common space” for sharing memories and objects maintains a sense of belonging and security (Silverman, 2000).

Symbolic environment: Meaningful images, music, or objects that provide a supportive presence (Worden, 2009).

The “continuing connections” approach therefore presents a holistic view of grief, which allows for the integration of internal connection with the deceased and ongoing life. Recent evidence supports the therapeutic efficacy of maintaining internal connection, while differentiating between different forms of connection and adapting clinical intervention.

It can therefore be said that “in contrast to a complete rejection of the depth of connection, the integration of planned internal presence can contribute to optimal adaptation after loss.”

References:

Freud, S. (1917). Mourning and melancholia. In J. Strachey (Ed.), The Standard Edition of the Complete Psychological Works of Sigmund Freud (Vol. 14, pp. 237–258). Hogarth Press. Psychoanalytic Electronic Publishing

Klass, D., Silverman, P. R., & Nickman, S. L. (1996). Continuing bonds: New understandings of grief. Taylor & Francis. Routledge

Neimeyer, R. A. (2001). Meaning reconstruction & the experience of loss. American Psychological Association. JSTOR

Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197–224. PubMed

Silverman, P. R. (2000). Enhancing bereavement care through support groups. Death Studies, 24(3), 271–282. https://doi.org/10.1080/07481180050121469 Cambridge University Press & Assessment

Worden, J. W. (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner (4th ed.). Springer Publishing Company. SCIRP

Hewson, H., Galbraith, N., Jones, C., & Heath, G. (2023). The impact of continuing bonds following bereavement: A systematic review. Death Studies. Advance online publication. Taylor & Francis Online

Field, N. P., Gal-Oz, E., & Bonanno, G. A. (2006). Continuing bonds and adaptive bereavement: The contribution of different forms of loss-related memories. Omega – Journal of Death and Dying, 53(2), 105–121. PubMed

Aguila, E., & Cohen, S. (2021). Validation of the Continuing Bonds Scale in bereaved adults. Journal of Death and Dying, 83(4), 378–395. SAGE Journals

Milberg, A., Liljeroos, M., & Krevers, B. (2022). Family members’ long‑term grief management: A prospective study of factors during palliative care and bereavement. Palliative & Supportive Care, 20(1), 45–53. Cambridge University Press & Assessment

Our integrative model of the "Self"

Our model of the self includes the components of the human psyche. The model first assumes the existence of the "primary self", which is in fact the basic biological nucleus consisting of a number of innate structures and subject to increasing development throughout life. This self includes the instinctive, emotional and cognitive parts of the person. The primary self uses the reservoirs and mechanisms of emotion, memory and cognitive abilities and contains initial nuclei for the future development of other psyche structures.

Within the primary self there is the potential for instrumental abilities that are innate, but can also be promoted, or conversely, suppressed, through the influence of reference groups. The primary self also has cognitive abilities that are partly innate and partly dependent on interactions with the environment during the first years of life.

In addition, it includes temperament and emotional intelligence, which are partly innate and partly dependent on interactions with the environment in the first years of life. Finally, it includes an energy charge that is mainly innate but can be suppressed through the influence of reference groups, as well as through various situational factors.

The primary self also includes the seven channels of personal sensitivity. From the primary self, innate nuclei develop that constitute a premordial basis for the development of several superstructures during the interaction of the infant and later the person throughout his life with the figures in his environment:

a] The emotional coordination mechanism.

b] Three structures that together make up the secondary self or social self, these include:

1] The group of internalized figures, which we will metaphorically call the board of internalized figures,

2] The group of enemies,

3] The group of self-representations.

Illustration of the model we develop for the Self

The group of internalized figures that we will metaphorically call the board of internalized figures consists of the internalization of influential figures in one's life, arranged in a hierarchical order.

These figures have an ongoing dialogue between them and sometimes even conflicts, with one or more introverted figures having the greatest influence on the individual's attitudes, feelings and behavior, which we have called the "leading self".

The attitudes of the internal leader play a central role in making decisions about the internalization of information and figures. He decides whether to reject the internalization or, if accepted, in what form it will be internalized. In other words, in a sense, we assume that this influential figure is also a kind of internal censorship.

This board consists of "secondary figures" that include the following types:

1] Representations of internalized figures that originate from the significant figures that the person was exposed to during their life, but as mentioned, there may also be imaginary figures represented in books, films, etc. that have greatly influenced the person.

2] Internalized representations of "subculture" [subculture refers to social influences in the environment in which a person lives and are not necessarily related to a specific person].

We note that the individual is generally unaware that his actions, feelings, and attitudes are caused by the dynamic relationships between these structured figures.

We will add that internalized key figures on the board [usually human], usually refer to significant people in a person's life who have played key roles in shaping their beliefs, values, and self-perception. These figures may include family members, friends, mentors, teachers, or any other influential person who has left a lasting impression on the person's psyche.

Sometimes, these will also include historical, literary, and other figures who have left a significant mark on the individual and have been internalized by him.

The term "internalized" implies that the influence of these key figures has been absorbed and integrated into the individual's thoughts, attitudes, and behaviors. This internalization occurs through the process of observing, interacting, and learning from these important people.

As a result, the individual may adopt certain values, perspectives, and approaches to life that reflect those of the influential figures. These internalized figures can serve as guiding forces in decision-making, moral reasoning, and emotional regulation.

Now we will also note that from the primary self arises and builds from a potential nucleus at birth a structure that we will call the enemies’ group.

Thus, in addition to the board of characters, the social self also contains the "enemies’ group" and more precisely the "internalized enemies’ group." This is the place where the characters who threaten the person in a significant way are internalized and which the dominant characters in the board of characters prevent from entering and being internalized in the board of characters [we hypothesized the existence of this group last year in light of the evolutionary need for higher animals, including humans, to create such a group for their survival].

The characters in the "enemies’ group" are characters with negative emotional values and are represented schematically relative to the characters in the board of internalized characters.

We note that the transition between the board of directors and the enemies’ group is usually not common or even rare and usually occurs following a traumatic or threatening event for the person.

The RGFT Treatment Approach

We will now move on to and discuss the Reference Group Focused Therapy (RGFT).

In addition, from the primary self, as mentioned, a supergroup of self-representations develops at different periods of life [for example, self-representation as a child, teenager, adult, etc.] including the body representation.

Self-representation in a certain sense is also a kind of container for the flow of information of attitudes, emotions, and behaviors from the dynamics in the board of directors of the characters.

This is a psychotherapeutic technique that emphasizes understanding and addressing the influence of internalized reference groups on people's psychological state. These reference groups usually consist of significant figures from the person's past, such as family members, teachers, or friends, whose attitudes, behavior, and expectations have been internalized and continue to unconsciously influence the person's feelings, thoughts, and behavior.

Unlike other therapeutic approaches that may focus on a unified “self” (such as Gestalt therapy), RGFT operates on the idea that people have multiple “selves,” each of which is shaped by different reference groups.

These selves may represent various roles that the person has internalized from their social environment, especially those rooted in early life or significant experiences. RGFT treatment often involves identifying these internalized figures and examining their impact on the person's current behavior and mental state.

By bringing these influences into conscious awareness, people can begin to separate themselves from unhelpful or negative aspects of these internalized figures, allowing for more conscious and healthy choices in their thoughts and behavior.

Our approach differs from other approaches, such as Jungian therapy, which focuses on universal archetypes, or Gestalt therapy, which emphasizes the present moment and the integration of different parts of the self.

RGFT focuses more on the historical and social contexts that shape a person's identity and behavior [see previous blogs and video conversation #36 on YouTube titled "LEVINE & SALGANIK" regarding RGFT therapy.

Finally, RGFT therapy also assesses and attempts to address the person's sensitive channels.

The place of the deceased in the mourner's psyche based on our self-model

Based on our self-model that includes the “primary self,” the internalized figure groups (the board of figures and enemies’ group, and self-representations) and the experience coordinating agency, it is possible to understand how the deceased (“the dead person”) continues to appear in the life of his relative.

In Reference Group Focused Therapy, the therapist helps to raise awareness of the influence of this internalized figure, diagnose when it supports or, alternatively, limits action and emotion, and helps to develop tools for a healthy integration of the relationship – whether through intentional internal dialogue, writing exercises or group work with the “memory space”.

The presence of the deceased within the primary self and the channels of sensitivity

We assume that the relative internalizes the figure of the deceased into the internal figure system, both as part of the board of internalized leaders – which give him influence over attitudes, feelings, and behaviors – and in the collection of self-representations throughout the stages of life.

The presence of the deceased within the primary self and the channels of sensitivity

In the primary self model, the biological and instinctive core creates the foundation for the initial emotional and cognitive responses. After the death of a loved one, some of the responses (such as despair, sadness, and pain) are activated in the threat channel and the energy channel – an internal “warning” and mental exhaustion are activated.

At the same time, in the attachment channel, intense feelings of longing for the deceased arise. The sensitivity mechanism associated with attachment to the loved one will determine how intense the feeling of the deceased’s absence will be and how the internal connection with him will be expressed.

The Board of Internalized Figures and the Internalized Figure of the Deceased

If the deceased is very significant to the mourner in his or her board of figures, the figure of the deceased can be an “internal leader” entity or a high-influence figure.

This figure influences:

Attitudes: for example, how family processes should be “managed” in his or her absence.

Emotions: frustration or comfort resulting from internal representation of the deceased.

Behavior: decision-making (continuing to uphold one’s values, accepting imagined advice).

Over time, the character can change its place in the hierarchy of the character board, usually moving down the hierarchy, but not necessarily. In cases where the deceased is relatively less significant, his place in the hierarchy of the character board is likely to be relatively lower.

Dynamic relationship with the experience coordinating agency

The experience coordinating agency monitors the interaction between the external world and the internalized figure. When a difficult situation arises (for example: the anniversary of the deceased's death), the mechanism "activates" the "conversation" with the deceased figure: the deceased's relative may find himself "consulting" with him in his mind, and from there emotional-cognitive feedback is created that guides coping.

The roles of additional groups in the dynamics with the deceased

The Enemies’ Group

It is possible that sometimes, probably not often, the deceased's internalized image may move to the enemies’ group – for example, following a feeling of betrayal on his part, whether real or subjective, leaving a mourning person unprotected, etc.

It is also possible that this image had its origins in the enemies’ group during the deceased's life. These situations can lead to negative feelings of threat, anxiety, and more.

Subgroup of Self Representations

Throughout life, different representations of the self (child, teenager, adult) develop. The figure of the deceased in the board of directors will sometimes influence one of these representations, especially the current representation.

Applying RGFT to understand the presence of the deceased in one’s life

RGFT therapy focuses on identifying and locating internalized reference figures and understanding their influence. Here are three main steps:

Figure mapping

Creating an internal board of directors “map”: The patient indicates which figures (including the deceased) are internalized and how each one influences a person.

Identifying the role of the figure of the deceased: discovering the way in which he is present – as a leading figure, a guide, as a threat, as an accuser, etc.

Guided dialogue

Internal dialogue sessions: The therapist guides the patient to invite the deceased into a deliberate “dialogue”, ask him questions and write down his answers as they arise in the patient’s mind.

Creating an AI-assisted avatar of the deceased based on the available documentary (videos, photos, voice records) and on the character of the deceased expressed during the RGFT sessions and using it in working through the mourning associated issues.

The therapist contributes to clarifying the differences between emotional dialogue and guilty or aggressive reactions.

Integration and conscious choice

Addressing the deceased's healthy contribution (supportive memories, values he represented).

Release from harmful internal roles (guilt, unresolved anger).

Combining the deceased's image with self-representations with feelings of empowerment, filling an emotional gap, and identity continuity.

This is in the hope that this will contribute to:

Improved emotional regulation: Reduction of anxiety attacks and internal anguish as the deceased image becomes a source of resilience rather than a threat.

Identity continuity: A feeling that the relationship with the deceased continues stably as part of the personal identity.

Reduction of guilt and anger: Through the transition of the deceased figure to a pluralistic board of directors that mitigates conflicts.

We note that in therapy, the figure of the therapist is also internalized, contributing to a pluralistic board of directors that mitigates conflicts.

In conclusion, looking at the self-model and its composition – the primary self, the interplay of internalized figures and the experience coordinating agency, the presence of the deceased in the life of his relative is understood as the formation of a continuum of internalized death that affects attitudes, emotions and behaviors.

RGFT therapy allows for a bridge between pain and an opportunity for mental growth and identity integration, by consciously mapping, managing and regulating the internal connection with the deceased.

That's it for now,

Yours,

Dr. Igor Salganik and Prof. Joseph Levine