Section XXXVII: Survivor's Guilt

Corresponding with Fallen Friends

Goals of the Exercise

1. Accept that loss is part of life.

2. View self as a fortunate survivor.

3. Reflect on the meaning of life.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Corresponding with Fallen Friends” activity addresses survivor's guilt by testing distorted cognitions and asking whether the standard the veteran/service member is using in self-judgment is reasonable. This is a three-step exercise. In step one, the veteran/service member writes a letter to a fallen friend, expressing thoughts and emotions about the death and his/her own survival. Step two is a written version of the “empty-chair” technique; the veteran/service member writes a reply he/she believes the friend would make to his/her letter. The third step asks the veteran/service member what he/she would want for the friend if he/she had died while the friend survived. Note: It is important to allow the veteran/service member freedom to write what he/she feels and thinks, but equally important to ensure key questions are addressed. The veteran/service member should consider why he/she feels guilty and think about what he/she could have been expected to do differently, given the circumstances. If appro- priate, the veteran/service member may be guided to apologize or ask forgiveness if he/she feels he/she made a mistake that contributed to the death, while considering whether he/she would forgive the friend if the roles were reversed. Follow-up can include asking the veteran/service member to decide how he/she can honor the friend's memory and bibliotherapy with books listed in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner.

EXERCISE XXXVII.A Corresponding with Fallen Friends

Many people who suffer from survivor's guilt wish they could tell the person who died how they feel and what they are thinking. In this exercise, you will have the chance to let your friend, family member, or comrade know how you feel about his or her death. First, we ask that you write a letter to the person who died and tell him/her whatever you wish you could say if you could talk with him/her again.

1. Please compose a short letter to the person who died, expressing your thoughts and emotions about what happened. Along with anything else you want to say, be sure you explain why you feel this death was your fault and what you believe you should have done differently, under the conditions and with the information you had at the time. If you believe you were at fault and wish to ask for his or her forgiveness for your role in the death, please do so.

Dear_____

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Sincerely,

When you've written your letter, please read it aloud and visualize the person to whom you're writing listening as you read it. When you've finished this reading, briefly describe your thoughts and emotions in reaction to the experience:

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2. Now we're going to ask you to move on to a step you may not have considered. Again, we'll ask that you picture the person you lost facing you, having heard you read the letter you just wrote to him or her. Now, do your best to look at yourself through his or her eyes. Please write another short letter, this time the one you believe your friend or loved one would be most likely to write to you in reply to the letter you just wrote. What would he or she think and feel—would your friend or loved one blame you?

Dear_____

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Sincerely,

3. Finally, we'll ask you to imagine a different outcome in which you had died while your friend or loved one had lived, and in which he or she was feeling guilty and responsible for your death. If that had happened, what would you have wanted for the other person? Imagine him or her writing a letter like the one you wrote in the first part of this exercise. What would you want to say in reply to that letter? Would you be angry at your friend or loved one for living, or would you be happy that they had survived even if you had been less fortunate?

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4. Many people, when they think about this, decide that they would want their friends who had survived them to mourn and then let go, to move on with life and be happy, perhaps to do some good things in their names. Does this sound like a wish you might have for someone close to you who had survived when you died? If so, what are some things you can do to make the world a better and more joyous place, in the name of the person you lost?

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Be sure to bring this handout back to your next session with your therapist, and be prepared to discuss your thoughts and feelings about the exercise.

Carrying the Legacy

Goals of the Exercise

1. Accept that loss is part of life.

2. View self as a fortunate survivor.

3. Reflect on the meaning of life.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Carrying the Legacy” activity addresses survivor's guilt by probing the veteran's/ service member's cognitions regarding the death of a friend or loved one, asking him or her to consider whether the thoughts contributing to guilt and depression are rea- sonable. It presents the idea of cognitive distortion, asking the veteran/service member to weigh whether the guilt-producing thoughts seem valid or distorted and to supply a balanced and realistic alternative if the original cognition is distorted. The activity's second part asks the veteran/service member how he/she thinks the deceased friend or loved one would want his/her memory to be carried forward—with guilt and unending sadness, or with a period of mourning followed by a lifetime of gratitude for having shared time with him/her and with positive memories. It concludes by asking the veteran/service member to think of a way to make the world a better place as a living memorial. Follow-up can include bibliotherapy with books listed in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner and/or video- therapy using films on “Death and Dying” and/or “Grief and Loss” recommended in Rent Two Films and Let's Talk in the Morning, 2nd ed., by John W. Hesley and Jan G. Hesley, published by John Wiley & Sons.

EXERCISE XXXVII.B Carrying the Legacy

Survivor's guilt occurs when a person believes he or she has done wrong by surviving a situation in which a friend or loved one has died, especially if the person feels he or she caused the death or should have prevented it but failed to do so. Survivors of combat, natural disasters, and accidents and friends and family of people who die by suicide sometimes feel this way. The problem is that the belief that causes the guilty feelings is often not accurate and people blame themselves for things over which they had little or no control, sometimes living under a cloud of grief and regret for the rest of their lives as a result. This exercise asks you to look at whatever beliefs underlie guilty feelings about a situation in which you lost someone close to you, and see whether those beliefs are reasonable. A loss is a loss no matter what, and no one has any business telling you how long or how short your period of grief over a loss should be. Your heart is your own. However, if you are punishing yourself for something of which you aren't really guilty, you're also taking something from all the other people, still living, who care about you. The goal here is to make sure that your understanding of what happened and your role in it is accurate.

1. To begin with, please rate the strength of your belief that you are at fault somehow in the situation in which your friend or loved one died and you lived, on a scale of 1 (least) to 10 (most) intense:_____ Now rate the strength of your negative emotions about yourself related to the same situation on the same 1 to10 scale:_____

2. Read through each of the self-blaming negative thoughts below. For each, circle it if it's a thought you've been having; then think about evidence for and against it, and identify a positive alternative thought that might be more realistic. Use 2.g. through 2.j. for any self-blaming thoughts you may experience that are different from those in 2.a. through 2.f. After you finish this exercise, practice doing this when you catch yourself thinking these kinds of thoughts.

a. Self-blaming thought: “It is my fault he/she is dead.”

Alternative thought:

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b. Self-blaming thought: “I should have done more to prevent it.”

Alternative thought:

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c. Self-blaming thought: “Everyone blames me.”

Alternative thought:

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d. Self-blaming thought: “My life can never be happy again. It would be disloyal of me to let go of this grief.”

Alternative thought:

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e. Self-blaming thought: “I don't deserve to be alive since he/she is dead.”

Alternative thought:

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f. Self-blaming thought: “He/she would blame me if he/she was still here.”

Alternative thought:

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g. Self-blaming thought: “_____ .”

Alternative thought:

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h. Self-blaming thought: “_____ .”

Alternative thought:

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i. Self-blaming thought: “_____ .”

Alternative thought:

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j. Self-blaming thought: “_____ .”

Alternative thought:

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3. Please read the self-blaming thoughts and your alternate thoughts over again. Now we'll ask you to go back to question 1 and re-rate the strength of your belief thatyou are at fault and your negative emotions about yourself on that 1 to 10 scale. Have your ratings changed, and if so, how?

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4. Finally, we'd like to ask you to think about the person you lost, what he or she was like, and what would be the most fitting way to remember that person. It's common in our society for events to be held as memorials for people who have died. Think of those memorials, and whether it's more suitable for them to keep the focus on grieving the loss, or on celebrating what the person being remembered brought to the world. Once you had time to go through your own process of grief, which way would you want to be remembered, and what do you believe the person you've lost would want—more grief from now on, or healing and pleasure at their memory?

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5. We would like to ask you to conclude by taking some time and thinking about what would be the best way to carry on the legacy of your friend or loved one in your life; perhaps there's a cause you could volunteer for in his or her name, or it might just be a matter of sharing that person's best qualities with the world by working to make them as strong in your own dealings with people as you can. Please think about this, and write the idea you choose here:

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Be sure to bring this handout back to your next session with your therapist, and be prepared to discuss your thoughts and feelings about the exercise.