Shibori Healing - Group Therapy for Mothers Pregnant After Loss

I just got back from my second residency at Goddard College, Vermont. I'm doing an MA in Counseling and Psychology (to complement the diploma in psychotherapy I finally completed this summer) and it's pretty much the best thing ever.

My advisor, Wendy Phillips, is an intellectual badass and heartbreaking visual artist. She curates an art show each residency to showcase the work of students throughout the program. Because the program is so very much DIY, there's room for creative work in a way that I haven't found anywhere else in academia. As Wendy says, "I keep thinking they're going to come in and tell me 'You can't do that!' But they haven't yet..."

I exhibited a prototype from a workshop I designed last semester in my course on group therapy. You may have noticed I'm interested in maternal health (ya don't say?), so I wrote my final paper on this idea: designing a hands-on workshop for mothers pregnant after experiencing loss. The product of the workshop would be a baby-carrier, dyed through the traditional Japanese art of Shibori.

Shrouded Shibori by Holly Brackmann

Social support is so important in facilitating the movement through grief. And I feel that the process of working with textiles is something akin to the process of creating a baby: painstaking in one way and yet so comforting as well; following a pre-determined design but also touching an element of the unknown; and in its cultural coding, entirely feminine.

I posted a link to my residency write-up on my Fb page and there was some interest in reading a bit more about this project. So here's the paper I wrote, interspersed with some screenshots for the workshop, which will probably never happen but was really fun to write about.

Shibori Healing: Textile-Based Group Therapy for Mothers

The relationship between parent and child is one of inter-dependence and shared identity; the grief experienced from its loss is almost necessarily 'pathological' in nature (Rando, 1993). Perinatal death (the loss of a child1 at or around the time of childbirth) is experienced by the parents as a profound tragedy with existential ramifications reaching the very core of self-understanding (Taubman-Ben-Ari & Katz-Ben-Ami, 2008). Societal treatment of parents who have lost an infant, however, does not often acknowledge the magnitude of this grief (Rando, 1993). In addition to the pain of loss, mothers report feeling stressed, isolated, and misunderstood.
The situation becomes further complicated when a mother who is suffering from perinatal loss becomes pregnant again. Carrying her 'Rainbow baby' within her, she may experience relief from some of the most severe symptoms of her grief; relief may also bring guilt. Outsiders might congratulate her on 'becoming a mother again' or anxiously refrain from discussing her past pregnancy for fear of causing 'bad luck'. Extra medical attention may feel warranted, or it may increase her anxiety. She may worry that she will not be able to bond with her child.
The intersection of stress and joy at the prospect of a new child, and remaining grief and fear from the loss of a previous one, is an area particularly dense with psychological need. Therapy designed specifically for mothers in this situation, however, is almost nonexistent. The benefits of designing an effective therapy for this population could have long-term positive effects: the anxiety and depression experienced by mothers after perinatal loss can also interfere with their level and style of attachment to the new child (Gaudet, 2010). Mothers who receive counseling and social support undergo shortened bereavement reactions after perinatal death (Forest, Standish, & Baum, 1982). Therapies that address this issue with mothers pregnant again may enhance their abilities to relate with their children.

Issues Associated with Carrying a Rainbow Baby: Terminology
"Rainbow Babies" are the understanding that the beauty of a rainbow does not negate the ravages of the storm. When a rainbow appears, it does not mean that the storm never happened or that the family is not still dealing with its aftermath. What it means is that something beautiful and full of light has appeared in the midst of the darkness and the clouds. Storm clouds may still loom over but the rainbow provides a counterbalance of color, energy, and much needed hope (starwarsmama, 2010).

The terminology used to describe a deceased child is laden with emotion, reflecting the light through which the speaker wishes both the child and their passing to be seen. One comment thread recently posted in the Facebook group, 'Defiling Photos of Dead Babies is NOT ART!' (created by a bereaved mother with the intention of pressuring the creator of the 'Stillborn in th3 USA' series to redact and apologize for her work), discussed the issue of the group's title. A group member took exception to it, stating that, “I am only speaking for myself but the name of this group bothers me in that its name contains the phrase "dead babies" which I find offensive. My child may have died but I would never refer to her as my dead baby” (Leif, 2012).
The term 'rainbow baby' is used to denote a child born after parents' previous experience of the loss of a child to miscarriage, stillbirth, or other fatality. Like 'angel baby' (a deceased child), the term is ambivalent, referring both to joy and grief. Mothers use it to express the healing power of re-engaging in processes of child conception, childbirth, and child-rearing.
The term, however, has not been adopted by medical professionals, who seem more likely to use the rainbow metaphor to market their services as child-friendly (e.g. the University Hospitals 'Rainbow Babies and Children's Hospital' in Cleveland, OH) or in reference to the adopted children of LGBTQ couples. Even within parenting loss support groups, the rainbow metaphor has its detractors. Some Christian mothers find it denies the goodness of God; others find its additional association with LGBTQ causes distressing.
Uses of 'Rainbow baby' must also be seen within the context they occur: the lexicon of parenting groups, many of which use a register that is cutesy and decidedly non-medical. For example, other terms include, 'BFP' (Big Fat Positive, a positive pregnancy test), 'Sticky dust' (wishes or prayers for a healthy pregnancy not leading to miscarriage or loss) and 'DTBD' (Doing the Baby Dance, or having sex). The success of these parenting groups may indicate that American women feel a need to pursue advice and support regarding reproduction outside of the medical field.

Issues Associated with Carrying a Rainbow Baby: Ostracism
I'm sorry you can't see him, but I feel him always, all around me. He's definitely here. I'm not contagious. It doesn't rub off. Why do people freak out when Caleb's name is brought up? Why do certain members of my family completely ignore he ever existed? Why have long time friends just up and block [sic] me from their lives? I don't believe I've been a self pity party. I think I've done quite well. So what's the big deal? Everyone freaked out about death that much? (Evans, 2012)

The social isolation that often accompanies the loss of an infant can have devastating effects (Doka, 1989). Parents experiencing intense grief without knowledgeable support can feel that they are losing their minds (Rando, 1993). The dramatic change in social role that accompanies pregnancy (Taubman-Ben-Ari & Katz-Ben-Ami, 2008) and its subsequent loss in the case of perinatal death can lead to uncertainty as to how to interact with the world (Gaudet, 2010). It has been hypothesized that strangers, friends, and even close family members do not develop the same kind of attachment with a child in-utero as the parents (Rando, 1993). Thus, their need to grieve the loss of their unborn or stillborn child is never fully understood.

Issues Associated with Carrying a Rainbow Baby: Depression and Attachment
It's rough but we're just trying to get by. I think it will be harder on me as it gets closer to February and...[our earlier son's] birth/death date, and when (if) I'm in the 3rd trimester or whatnot - just movement might be hard. I may have a really hard time "bonding" with the pregnancy, for sure. I think i might really hold back (ekandrmkb, 2011).

While it is important and valuable to provide emotional support for grieving parents, efforts to address the emotional complications present in post-loss pregnancies also have a broader significance. Infants of mothers with clinical depression, particularly during the last trimester, are more likely to show disordered capacity for neurorelugation (Goodman, Rouse, Long, Ji, & Brand, 2011; Glover, Bergman, & O’Connor, 2008) marked by infant disorganization and fussiness in general (Hart, Field, & Roitfarb, 1999; Lundy et al., 1999; Zuckerman, Bauchner, Parker, & Cabral, 1990).
This can set a negative stream of interactions in motion, as emotionally withdrawn post-loss mothers face the additional challenge of bonding with a fussy baby (Goodman, Rouse, Long, Ji, & Brand, 2011). Some researchers (ibid.) have recommended that healthcare providers monitor women they perceive to be at greater risk for antenatal depression, assessing their infants for fussiness and helping mothers learn coping and calming mechanisms in caring for their newborns.

Issues Associated with Carrying a Rainbow Baby: Medical Management:
When I labored with my first I was told I was incapable, that my body “couldn’t” do it, that my contractions were inadequate, that I wasn’t dilating fast enough, then that I couldn’t push him out. I was forced to have medicine that almost killed him by putting him into severe distress, then I was forced to have him cut and sucked out of me because of my “inadequacy” (Renee, 2011).

Women with access to healthcare are often monitored more closely in post-loss pregnancies. In many cases, the causes of previous stillbirth or miscarriage remain unknown and the medical management of the subsequent pregnancy is pervasive, conducted as a matter of course. Women have conflicting feelings about this management (e.g. LRusso, 2012; Renee, 2011). Some find that increased management allays some of their fears and validates their efforts to provide a safe environment for foetal growth (LRusso, 2012). Others find it invasive, exacerbating their fears of worst-case scenarios (Renee, 2011). And still others feel that their pregnancy is not being monitored closely enough.
Like patients with medical illness, pregnant women interface with medical procedures and professionals on a regular basis. Their feelings about this involvement must be taken into account in the design of further healthcare therapies, including psychological work.

Issues Associated with Carrying a Rainbow Baby: Pregnancy as a 'Coping Mechanism':
I don't know if since Carys' arrival if I have had much time to remember Jayne, of course I still think about her every day, but Carys keeps me so busy, I'm not sure I'm able to continue to process the grief in the same way. Is this a good thing? Is this the next stage, integrating Jayne into a family that's here with me? Or ought I to make a space for my relationship with Jayne? A time for just me and her? How does anyone else manage mothering rainbows and angels?(JulyBaby, 2010)
Little or no research has been conducted into the reasons behind and factors contributing to the decision to have another child after perinatal loss. While there are mental health contra-indications for becoming pregnant soon after, such as increased risk for anxio-depressive symptoms (Gaudet, 2010; Forest, Standish, & Baum, 1982), an estimated 86% of women become pregnant again within 18 months of suffering perinatal loss (Cuisinier, Janssen, Degraauw, Bakker and Ogduin, 1996). Many women fare better having devoted more time and energy to exclusively grieving a lost infant (Forest et al., 1982); but most do not take this path.
Research literature frames quick re-engagement with the reproductive process as a 'coping mechanism' (Gaudet, 2010; Wolff, Neilson and Schiller, 1970) with a risk of 'replacement baby syndrome' (Gaudet, 2010). Pregnancy after loss may in fact be an added complication in an already labyrinthine grieving process (O'Leary, 2004). It has been found to dampen some aspects of grief, including the loss of self-perception as mother, the loss of social role as mother, and guilt (Lin & Lasker, 1996; Theut, Zaslow, Rabinovich, Bartko & Morihisa, 1990).
Women in online support groups almost universally agree that the decision of when or if to have another child is a complex and personal one. The very concept of 'rainbow baby' indicates that the mother may currently be experiencing intense grief while also welcoming a new child into her life. The belief that the next pregnancy should come only after the first loss has been 'fully grieved' is one that is found more frequently within the medical literature (O'Leary, 2004; Côte-Arsenault, 1995) than the statements or actions of mothers themselves.
And yet, healthcare professionals continue to make that recommendation (Gaudet, 2010; Forest et al., 1982). Such statements about the morality of reproduction (who has a right to bear children, through what means, and with what frequency) are often perceived differently from the perspectives of a healthcare provider and a patient. An assumption that women are persons with agency should lead healthcare providers to facilitate women's choices instead of dictating them. Therapeutic support for the vast majority of women who are pregnant soon after loss is an ethical imperative.

Shibori Healing Group Worksop: Overview
This paper accompanies an eight-session workshop entitled 'Shibori Healing: Textile-based Group Therapy for Mothers'. In this short-term therapy, pregnant women who have previously experienced perinatal loss are encouraged to discuss, learn about, and support others in the various elements of the grieving process. At the same time, they are encouraged to look forward to meeting and raising their new child, to foster an attachment with him/her, and to consider how their experience with loss will both present challenges and provide special meaning to the process of raising a child.
The workshop takes its cues from other support groups (Alcoholics Anonymous, Mothers Against Drunk Driving) but asks questions more often heard in interactional group settings, such as those of an existential nature (Yalom, 2005). 'Shibori Healing' does not rely on the agenda-like structures often used to facilitate support groups; instead, it makes use of the long-standing tradition of communal women's work. Shibori is an ancient Japanese cloth dying technique which is process-intensive and yet easy to learn. With each workshop session, participants are invited to learn and talk about suggested topics while they work on their pieces.
While the technique of Shibori dying does not have special significance to this topic, the assigned textile piece connects intimately with attachment and hope: participants create a baby-carrier for their new infant. 'Babywearing' is both a traditional and contemporary practice which has been shown to increase levels of bonding and attunement between parent and infant (Johnson, 2010; Anisfeld, Casper, Nozyce, & Cunningham, 1990). It is hoped that the act of creating a simple carrier within a safe and supportive female community will foster trust, self-confidence, and a feeling of belonging. The tangible product produced at the end of the workshop may also be experienced as an expression of the participant's growing confidence that the child in-utero will soon be held closely within it.
Reflecting the popularity of online support groups addressing all issues of parenthood, 'Shibori Healing' also takes advantage of the advent of social media. A private online discussion group specifically designed for workshop participants will be made available, lightly moderated on a daily basis by the workshop facilitator. According to statements made online, mothers who participate in online groups designed to support them through perinatal loss often experience them as life-changing, in some ways more intimate than their relationships 'IRL' (In Real Life) (Evans, 2010). It is hoped that the online group will provide another avenue for social support.

Shibori Healing Group Workshop: Technology
People who were once my friends have pushed themselves away because they don’t know what to say, they don’t know how to act. Normal activities like taking a shower, eating and driving to work are no longer the same. But then, God sent me gifts...Friends who really get it. Friends who understand how it feels. And although I would never wish this upon anyone, I am elated to have met some of the incredibly amazing women who have been sent to me...By forming these exceptionally strong bonds with women I have never met, we are honoring our babies. We are celebrating their lives and we are each strengthened by one another (Evans, 2012).

The rise of social media has impacted the normal process of grieving for a lost child. While parents continue to face the challenge of social awkwardness and even ostracism from their friends and family (Rando, 1984), they now have the option of participating in one of hundreds of online parenting and grieving support groups. Many of these groups have secondary affiliations through which parents can further connect and receive support: religious beliefs, the age at which the child died, or the means through which the death occurred. Participants are encouraged to discuss the details of their child's death, the ways they experience and cope with grief, and post pictures of their deceased children.
Almost all of these groups explicitly share the intention of supporting members in their grieving process, helping them to feel that their grief is accepted and validated.2 Stories of miscarriage, stillbirth and infant death are often greeted with long comments of commiseration, transcriptions of prayers made on the initial poster's behalf, and stories of healing from mothers who have experienced the same. These new networks of support offer help in the form of suggestions for burial rituals, trained volunteer guidance, pen-pals and intangible, technologically-mediated human comfort.

Shibori Healing Group Workshop: The Value(s) of Cloth
Cloth, by its very nature and function, occupies the transitional space between the boundary of the self and the other, individual and social, private and public. For the newborn infant, cloth literally becomes a secondary holding environment, and the first experience of feeling mother; of comfort, safety, and warmth… or lack thereof. For this reason, textiles provide what Bion and Winnicott termed a ‘containing environment’. In psychological terms it is this environment, usually created by the parents, where the infant feels held by another (Kalaba, 2011).

The practice of 'babywearing' has been shown to enhance attachment between infants and caregivers (Johnson, 2010; Anisfeld, Casper, Nozyce, & Cunningham, 1990). The carrier produced in this workshop is simply a rectangle of cloth held together by two rings. While participants will be encouraged to become acquainted with and consider using the practice, babywearing itself is optional. The simplicity of this carrier's design allows the cloth to be used for other nurturing purposes: to swaddle the infant (which could help to calm infants perhaps in extra needs of such containment, if their mothers experience pre-natal depression, as discussed above); to keep the infant warm; to reduce distraction during breast feeding if the mother chooses to do so; and so on.
Traditionally, 'women's work' in the Western world has engaged with cloth, producing textile-based objects imbued with psychological meaning. This has been done through the communal and hands-on production of crafts, clothing, and house décor. The modern stereotype of a mother endlessly and endearingly attached to cloth items of special significance, such as an infant's first outfit, may be seen as a continuation of this tradition.
While Winnicott (1957) first touched on the psychological importance of its nurturing, corporeal nature, psychology as a discipline has shied away from studies of cloth. The use of textiles in supporting people through grief has been left to the exploration of community-based projects, most often run by women who have themselves experienced loss. Little Angels Hankies, in which a handkerchief is embroidered with the name of a lost child and then sent to the grieving family free of cost, is one example. Collecting Loss, in which family members contribute clothing worn by a deceased loved one for public exhibition is another.
The use of cloth in 'Shibori Healing' is an effort to continue this small body of work. It is hoped that engagement with textile production will help participants to deeply and tactically engage with the concepts most difficult for mothers who have suffered loss: the felt sense of being a mother; the urge to both create and inhabit safe, womb-like spaces; and the desire to hold a healthy baby in her arms.

Shibori Healing Workshop: The Importance of Group
The group format of this workshop was selected for a number of reasons. The first is simple social validation: participants will be exposed to others experiencing many of the same events (what Yalom (2005) calls the 'principle of universality'). Through this, participants experience a reduction in feelings of isolation and anxiety. The second reason is community.
Historically, Western women engaged in manual labour in close proximity to each other. Time spent with close female kin allowed the transfer of traditional knowledge (Gorer, 1949), especially with regard to parenting techniques and values. Current cultural fragmentation and industrial advances have made this forum all but impossible. The proliferation of online mothers' forums demonstrates that modern women need social advice-giving and support forums (both online and in real life) more than ever. Lastly, the group format has been found to be particularly helpful in addressing existential concerns (Yalom, 2005).
Some theorists have posited that mothering an infant serves not only to transform a woman into a mother, but also as a buffer against her natural death anxiety (Taubman-Ben-Ari & Katz-Ben-Ami, 2008; Deutsch, 1945). The experience of birth itself increases a mother's access to her unconscious ideas about death (Westbrook, 1978). With the loss of a child, the mother is thus forced to confront mortality in a number of ways. Yalom (2005) explains that group therapy has a special ability to deal with such existential issues, helping participants to recognize that, “ is at times unfair and unjust...ultimately there is no escape from some of life's pain or from death” (98). The chance to face these issues not in isolation, but in a supportive group setting, could be helpful for grieving parents.

'Shibori Healing' was initially intended to fit within the framework of therapeutic expressive arts therapeutic, as put forth by Paulo Knill, Ellen Levine and Stephen Levine (2005). But in this workshop, the visual elements of the cloth dyed and sewn are not considered the expression of inner psychological workings. On further reflection, it was understood that 'Shibori Healing' and perhaps therapeutic work in producing textiles in general, speaks to a different understanding.
The production of textiles almost always involves repetition and the fulfillment of a predetermined design. In 'Shibori Healing', the emphasis is put on repetitive, body-based tasks intended to allow space and time for psychological transformations to occur. These transformations can then be expressed and integrated in other areas of the client's life, but are not likely to be evident in the patterns of the shibori cloth itself. The product of this therapy is both functional and relational: loss experienced in the past is carried forward, embedded within an object that can also carry new life.


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1Throughout this paper, the term 'child' is used to refer to foetuses, infants, and small children. This usage is not intended to make a political statement on the beginning of life or the value of reproductive choices; it simply reflects the expression of women participating in online forums through which much of the research for this paper was conducted.

2The willingness to respect the boundaries of group members, however, is not universal. It recently came to light that a visual artist in Louisiana had downloaded and edited pictures of stillborn infants with words such as 'sexy' and 'best friends!' for her piece, 'Stillborn in th3 USA'. Though she had taken images from publicly available sources, as most online images are easily downloadable for the use of anyone who wishes to – the news was reacted to with outrage, calls to news stations, and the eventual hacking of her site such that it could not display her work. The level of rage directed at this artist and her piece corresponds with the level of support offered to women who have suffered loss.

1 comment:

  1. I think this is a fabulous concept for a workshop. I wish there was something like this available when I lost Tristan. I was 3 days from my expected due date when I went to the hospital to discover that he had died inside of me. A later autopsy revealed that he had died from asphyxiation due to a blood clot in the umbilical cord. I had to give birth to him knowing that he had died inside of me without me knowing he was slowly suffering from lack of oxygen. He was 9 pounds 3 ounces. I felt (and still do) completely incompetent, why had there been no warning signs? How could I not have known? He had passed on about 8 hours prior to my ultrasound. I later found out it could have been prevented by taking 1 baby aspirin a day for the duration of my pregnancy.

    I wasn't actually followed by anyone after the fact. I was fortunate enough to have a caring nurse who followed up with me on her own time. After he was "born" I was able to hold him and take pictures with him. I didn't want to take photos with him, I didn't feel like I was worthy. I'm very glad the nurse gently urged me to do so as they offer a very important way for me to remember him. She gave me a box, with his photos, a lock of his hair and his foot and handprints in it. I still have it with his things on a shelf in my room. We decided to have him cremated after the autopsy, a choice made because I couldn't bare the thought of him being in the ground.

    I experienced the same distancing of my friends and family. Everyone poured condolences, but they all seemed to become distant, a result of not knowing how to talk to me anymore I suppose. I decided to become pregnant again with E about 7 months after losing Tristan. E was my "rainbow baby." I was happy and sad all at the same time. I can definitely relate to what you wrote about the conflicting emotional states. I was paranoid, even though I was monitored closely throughout my pregnancy I was terrified something would happen. I couldn't sleep, I counted every single movement and kick and charted them. I showed up at the Dr office just so they could pass the fetal monitor. Even after she was born I stayed awake night after night watching her breath, terrified something would happen if I looked away. She is now 8 years old and that fear still hasn't left me.
    Its hard to find a way to talk about this type of event in present day. When I tell people I have 4 children, I then have to explain that only 3 survive. This causes people often to apologize. I know its a kind and well meant apology, but I wish people didn't feel like they had to apologize or feel awkward. Tristan was no less one of my children than my other 3. At family events I almost feel like family members wish that I didn't bring up Tristan and focused on my living children - almost as if he doesn't count because he's not breathing.

    Every year I write him a birthday card with what happened during that year and put it with his keepsake box. Its my way of connecting with him and keeping his memory alive. This ritual has served to a certain extent as my own therapy. I feel like workshops like this need to be available and in more places. Thank you so much for sharing your work, I hope that it turns into an actual workshop because I feel like many can benefit from these conversations and healing practices - I know I could have.