Case Study 2 — Amara: The Shape of the Grief

What Was Already There

Amara had been grieving since she was fifteen.

She knew this in an intellectual way — she had traced it in family dynamics sessions, in the self-compassion work, in the therapy with Dr. Liang. She knew the grief for Nana Rose, who had been the stable center of her childhood and who had died when Amara was fifteen, leaving her entirely to Grace's unreliable orbit. She knew the grief for the childhood she had never had. She knew the grief for the self she had been before the caretaking role had organized everything else around it.

What she had not fully known, until the grief chapter, was how much of this grief had been carried in the background as infrastructure — a constant low hum that she had metabolized into her personality, her empathy, her clinical attunement. Not depression, not trauma in the acute sense. Just a deep familiarity with loss that had shaped her without her having named it.

The chapter's articulation of the losses we grieve — particularly the lines about ambiguous loss and disenfranchised grief — gave her vocabulary for several things simultaneously.

The Ambiguous Loss of Grace

The concept of ambiguous loss — grief for losses that cannot be named cleanly because the person is still present but something essential has changed — had been written, it seemed to Amara, specifically for the experience of having a parent with active addiction.

Grace during Amara's childhood had been physically present. She was in the apartment. She showed up to parent-teacher conferences. She was, by many external measures, present. And something essential had frequently been absent: her attention, her emotional regulation, her predictable availability. The person who was there had been in a state that made her simultaneously present and not fully there.

Amara had been grieving this without the word for it for fifteen years.

She wrote in her journal: The ambiguous loss concept is useful not because it gives me a new feeling but because it gives me a name for what I've been feeling for a long time. The grief for a mother who was present but not available. The specific loneliness of being the child of someone who loved you and who couldn't, in the fullest sense, reach you.

She brought it to Dr. Liang.

Dr. Liang: "How does it land, having that name?"

Amara: "It makes it more real, somehow. Not more painful — it was already real. More legitimate."

"What was illegitimate about it before?"

"Grace was there. She was alive. She wasn't absent the way a death produces absence. I didn't think I was allowed to grieve something that wasn't a death."

"Disenfranchised grief," Dr. Liang said.

"Yes. I couldn't grieve it the way you grieve a death because no one had a service for it. There was no social acknowledgment. Just — this is how it is, and you manage."

"And?"

"And managing took the place of grieving for a very long time."

The Shift

Something had changed since the phone call with Grace in May.

Grace was more stable than Amara had seen her in years — possibly ever. The Wednesday meetings. Cynthia the sponsor. The job that had lasted longer than any before it. When Amara called now, Grace was present in a different way: asking follow-up questions, remembering things from previous calls, occasionally making a joke.

Amara had expected this shift to produce primarily positive emotion: relief, gratitude, cautious hope.

It produced those things. It also produced grief.

She mentioned this to Dr. Liang in June: "Grace is better. And it's making me sadder, not less sad."

Dr. Liang: "Tell me more."

"Every time I have a call with her that is actually good — where she's present and warm and I hang up feeling something I didn't feel as a child — it reminds me of all the calls that weren't that. All the years they weren't that. There's this grief for something that was missing for a long time and is now, maybe, partially available. But the availability now doesn't undo the absence then."

"It can't."

"No." A pause. "And I notice I'm angry about that sometimes. Not at Grace, exactly. At — the fact of it. That it's too late for parts of it. That I'm 26 and learning to receive what I needed at 8 and 12 and 15."

Dr. Liang: "That anger is grief."

"I know."

"And the grief?"

"Is mine. It belongs to me." A pause. "I've been carrying it as something that belonged to Grace's situation — like it was about her drinking, her illness. The chapter helped me see that it also belongs to me. It's my grief for my childhood. It doesn't depend on what Grace does or doesn't do with her recovery."

The Clinical Application: Grief and Growth

In her practicum, Amara was working with a client — a man in his mid-50s, Bernard, referred for "retirement adjustment difficulties" — who presented what the chapter would recognize as a significant identity loss.

Bernard had been a surgeon for 28 years. He had retired early due to a hand tremor — not severe, not immediately dangerous, but sufficient that he had made the decision himself rather than wait for a review board. He was precise and disciplined and had made the decision he considered right. He had also, six months later, felt largely empty.

"I don't know who I am without the operating room," he told Amara in their second session. "People call me Bernard now. For 28 years they called me Dr. Clarke."

Amara recognized the identity loss immediately. She applied the task-based grief framework internally: this was Task 3 (adjusting to a world in which the defining role no longer exists) with significant Task 1 work still needed (fully accepting the reality of what had changed).

She did not name the framework to Bernard directly. Instead: "What did the operating room give you?"

Bernard: "Purpose. Precision. The sense of being exactly where I was supposed to be."

"What happened in those moments when the work went best?"

He described it: the narrowed focus, the absolute present-moment absorption, the satisfaction that was entirely clear and didn't require interpretation.

Amara, carefully: "I want to offer a frame. Not to explain it away, but to give it a name that might be useful. You're not experiencing a failure of adjustment. You're grieving a loss. The loss of a role that gave you purpose, identity, and a daily context for what you were best at. That grief is entirely appropriate."

Bernard: "I've been telling myself I should be grateful. I had a good career. I retired on my own terms. I know people who —"

Amara: "Those things are all true. And the grief is also true. They're not in contradiction. The 'at leasts' don't cancel the loss."

A long silence.

Bernard: "My wife keeps saying I need a hobby."

"What do you think?"

"I think 'a hobby' is condescending. I performed 3,000 surgeries."

"Your precision and mastery are still yours. The platform is gone. That's a loss. And at some point — not yet, but at some point — what you're building toward is finding new contexts for what made the operating room the operating room for you."

Bernard: "Task 4," he said.

Amara blinked. "You've been reading."

"I have a lot of time now." A slight smile — the first in two sessions.

The Nana Rose Thread

In July, Amara visited her grandmother's grave for the first time since high school.

She had been back to the neighborhood — had stood outside the house, had walked past the kitchen window that she still remembered as having a kind of light that was different from other kitchens. But she had not been to the cemetery since the funeral.

She went alone. Brought flowers her grandmother would have found impractical ("just buy something you'll eat, baby"). Sat for a long time.

She had been in two and a half years of therapy and clinical training, had learned more about grief than most people encounter, and was still not entirely prepared for what sitting at the grave produced. Not dramatic — no collapse, no dramatic release. Just a sustained, quiet grief that was also, somehow, a form of conversation.

She talked.

Not out loud, not performatively. Internally, in the way she had always conducted conversations with Nana Rose since she was fifteen. She told her about the MSW program, about Yusuf, about Grace, about Sasha and Diana and Tomás. About the supervision with Marcus and the clinical work that was starting to feel real. About the girl she had been in the kitchen learning to make rice the right way.

And then, unexpectedly: Thank you for being the person who made the rest of this possible.

She sat with that for a long time.

The continuing bonds model, she thought. Not letting go. Transforming. Carrying.

On the drive back, she called Kemi.

"I went to see Nana Rose today."

Kemi, quiet for a moment. "How was it?"

"Hard. Good. Both." A pause. "I think I've been afraid to go because finishing the grieving felt like losing her again. But the chapter I've been reading — there's this idea that you don't finish. You transform the relationship into something you carry."

Kemi: "That sounds right."

"I've been carrying her the whole time. I just wasn't going to the grave."

"Amara."

"What?"

"She'd be proud of you."

Amara's throat tightened. She let herself feel that without immediately managing it.

"I know," she said.

The Peer Group on Grief

In the peer group's July session, Amara brought the Bridges transition model.

The group was in its tenth month. All four — Sasha, Diana, Tomás, Amara — were entering their second clinical year, which meant increased caseload complexity, higher supervision expectations, and the strange disorientation of being no longer entirely new.

Amara: "I want to try something. I want each of us to name what we're in the neutral zone about right now — something we've ended and haven't yet found the new beginning for."

Sasha: "The identity of being a student rather than a clinician. I'm in between — not fully either."

Diana: "The ending of some of my certainty about what clinical work looks like. I had ideas coming in. I have different, more complicated ideas now. The certainty is gone and the new framework isn't fully formed."

Tomás: "I've been telling myself I should have the answers by now. The neutral zone you're describing — that's what it is. Not a problem. An in-between."

Amara: "Exactly. And the in-between is where the actual formation happens. The neutral zone is uncomfortable because nothing is settled. But it's also where you stop being what you were and start becoming what you're becoming."

Diana: "That's generous to the disorientation."

"It's what the research says. It's also what I've been living."

A pause. Sasha: "Can I ask — what are you in the neutral zone about?"

Amara thought. "The grief work. The Grace work. I've ended the version of the relationship that was organized around Grace's addiction and my management of it. The new version — whatever that is — hasn't fully formed yet. I'm in between."

Tomás: "Is that hard?"

"Yes. But it's the right kind of hard. The kind that's generating something."

Discussion Questions

1. Amara names the ambiguous loss of having a parent who was physically present but emotionally unavailable. The chapter notes that ambiguous loss produces "frozen grief" because the loss hasn't fully occurred. How does having a name for this experience — "ambiguous loss" — change Amara's relationship to the grief, even though the grief itself hasn't changed?

2. Amara experiences grief in response to Grace's recovery — each good call reminding her of the years that weren't like that. The chapter calls this the coexistence of grief and gratitude. Why might improvement in a relationship surface old grief, and what does this suggest about the non-linear nature of grief?

3. Amara applies the tasks-based grief model with Bernard, the retired surgeon. She identifies Task 1 (accepting the reality) and Task 3 (adjusting to the changed world) as the active work. How does framing Bernard's experience as grief — rather than "adjustment difficulties" — change the therapeutic approach?

4. Amara's grave visit represents a form of continuing bonds: an active, ongoing inner relationship with Nana Rose that was being conducted without the visit as a physical marker. What did the visit add to what was already present, and why might physical rituals of grief serve a function even when the inner relationship is already active?

5. The peer group's neutral zone conversation offers a collective framing of what all four are experiencing. How does shared language — a name for the in-between state — change the individual's experience of disorientation? What does this suggest about the role of community and shared vocabulary in psychological development?