The Whole Thing Counts (Thoughts on Loss)


In the therapy room recently, a client shared her experience of the loss of a close family member. She reported that her grief, raw and tender, felt especially intense because the relationship had not been optimum when the person had passed. Because of this, she also carries guilt, remorse, and regret, along with the heaviness of her grief.

As she spoke, I was reminded of the loss of my Nana several years ago. When it became apparent that Nana was falling ill and close to passing, I drove from New Hampshire to Pennsylvania to visit her. While we were out for lunch, my Nana – always keen, snarky, and sharp as a tack – persistently called me by someone else’s name. For the bulk of the visit, she didn’t know who I was or why we were eating together. She was confused, and even seemed nervous. I left the visit feeling profoundly sad and did not see my Nana alive again – she passed a month later.

I loved and respected my Nana deeply, and harbored no small amount of anger that my last memory of her felt so counter to my experience of her as a human. For a while, I regretted venturing down to Pennsylvania that last time, wishing to have the whole trip exorcised from my memory so my remembrance of my Nana wouldn’t be tainted. At her funeral, I didn’t go in to see her in her casket. I didn’t want to see her dead; I didn’t want to add that picture to my memory book.

I’ve thought a lot about my Nana’s passing, and that last visit, over the past few years, and I have concluded that it matters very little, if at all, what transpired in that last visit with my Nana. It is an infinitesimally tiny, and highly unrepresentative, fragment of a long and loving relationship. The ending to the story bears no resemblance to the whole, and it makes sense to me to believe that it is the whole thing that counts.

And the whole thing is this: Nana smiling and holding babies. The gentleness of her patience. Warm oatmeal with whole milk, butter, and sugar. Sharp wit and sarcasm. Shuffling Nana in and out of the pounding rain in Mexico, me on one arm and my best friend on the other. The smell of baking potato bread. Nana crying while watching my father sing. Hugging Nana after my grandfather’s passing. Laughter in the kitchen. Ropy, strong, agile hands the exact size of my own. Storytelling. Nana at my smallish makeshift wedding, in her purple sweater. Seeing everything, and calling it “bee-yooo-tee-full.”  Shaping potato balls. Love large enough to create a family the size of a small army, in which Nana, at age100, knew everyone’s name.

And so…

My client and I concluded that, to honor her grief, it would be lovely for her to do something that recognizes the relationship she had, in its entirety, with her lost love one. She has the opportunity to celebrate the relationship, with all of its tenderness and difficulty and complexity, many years long, a lifetime of human connection. In stitching together the moments that make up something like love, she can touch on the pulse of the relationship – the whole thing – and hopefully give herself the grace and compassion to heal.

Originally posted on my blog, Common Humanity, at Psych To read more, visit


Useful Information

Some frequently asked questions and useful answers.

Online therapy works in the same way as in-office therapy, but is done online, similar to a Skype or FaceTime conversation. Clients are able to have sessions from home, work, or any other convenient location. We meet with clients using a HIPAA-compliant secure platform.

Online therapy allows you to work with us from the comfort of home, or any private location of your choosing. For some, the screen provides an added layer of comfort that makes the challenging work of being vulnerable in therapy a little easier.

Online therapy also creates the unique opportunity for you to work with us without the constraints of proximity! The practice was born in Keene, New Hampshire, but has since grown to service clients anywhere in Massachusetts, Pennsylvania, Connecticut, Vermont, New Jersey, Florida, and New Hampshire.

Online therapy is a great option for clients that travel for work, for college students that go home during the summertime and do not want a break in their sessions, and for anyone with a challenging or inconsistent day-to-day schedule. It is an excellent choice for clients seeking a therapist with a particular specialty that they are unable to find support for locally. Some of our clients report that online therapy makes the vulnerability element of therapy a bit less intimidating.

No. For some clients with more complex symptoms or safety concerns, having a local therapist that is readily available is important in case of crisis or the need for a higher level of care. Online therapy is also a challenge for clients that do not have access to a private, quiet space to be “in session” for the hour, or for those that do not have adequate internet connectivity.

There are several reasons why we don’t accept insurance. The most important are:

Confidentiality. Insurance companies require that your information be shared with them in order to pay for services. We prefer that clients’ information is kept as confidential as possible.

The pressure to diagnose. Insurance companies require that clients are given a mental health diagnosis in order to pay for therapy. We have found that many clients benefit from therapy, but do not meet criteria for a diagnosis. Not using insurance allows clients to access therapy without being given a mental health diagnosis.

Flexibility and freedom. Insurance companies dictate the length and number of sessions they will authorize, as well as when a client is no longer eligible for the benefits of therapy. Because we do not work with insurance panels, you and we can collaborate to determine your individual needs regarding session length, frequency of sessions, and when to terminate therapy.

While we do not accept insurance, many clients choose to submit receipts to their insurance companies to receive reimbursement via out-of-network benefits. We are happy to provide these receipts for you! Please check with your insurance company for details on your benefits.



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