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Unspoken Goodbyes: Understanding Grief, Unfinished Business, and the Gestalt Approach

Deon Dsouza

Sophia College, Mumbai

15th May 2025




The whole is greater than the sum of its parts.

- Aristotle


But what happens when one of those parts is lost? Grief is a part of life, intertwined with endings- whether through estrangement, retirement, divorce, immigration, separation or death (Sabar, 2000). It is a feeling of loss, sadness when the end has come. The memories left behind are not always comforting, sometimes echoing with words left unsaid, questions left unanswered or apologies never offered. This emotional residue is also known, in psychological terms, as unfinished business. Apart from sorrow it brings a lingering distress, often in the unresolved space of what was and what could have been (Klingspon et al., 2015). For some, this distress can become prolonged or complicated, leading to difficulties in adjusting and moving on, a phenomenon explored in many grief studies.


This multidimensional nature of grief is emphasized in the Gestalt therapeutic framework, which perceives the human experience as an interplay of the body, mind and environment (Ramu et al., 2025).


The Concept of Grief and Unfinished Business

From a Gestalt perspective, grief transcends mere emotion and influences an individual across domains. The body grieves, manifesting as fatigue, insomnia, restlessness, sometimes even somatic pain. Emotionally, one experiences feelings of sadness, fear, anxiety, guilt or relief among other emotions. Cognitively, there may be denial, dissociation with reality, difficulty concentrating or disorganized thoughts. In the social domain an individual tends to withdraw from company and isolate, while paradoxically there is a need for social support and friendship. Grief can also affect one on a spiritual and religious level with one questioning the universe, the existence of a deity, the concept of justice as well as their own notions of safety (Sabar, 2000).


Amid these dynamic experiences, unfinished business emerges as a critical yet overlooked aspect that can obstruct the grieving process.


Unfinished business (UB) and regret, though often used interchangeably, are distinct emotional experiences. Holland et al. (2018) found that among bereaved individuals, 42.4% experienced UB whereas 37.6% felt regret. There was only a moderately high correlation between the two and participants could report experiencing one without the presence of the other. UB, more so than regret, was a strong predictor of complicated grief, cause of death and the individual’s relation with the deceased, unlike regret which is typically internal and situation-based.


This distinction is essential as UB can shape the trajectory of mourning, increasing the risk of complicated or prolonged grief.


Unfinished business interrupts the grieving process, often complicating the process, preventing individuals from moving on. It is a significant factor in the development of complicated grief, depression and prolonged bereavement (Klingspon et al., 2015). UB can shape how people process loss as well as how they subsequently adjust to life and death in the future.


Unfinished Business in the Context of Grief

Klingspon et al. (2015) categorized unfinished business into three major categories, namely (1) missed opportunities, including untimely goodbyes, absence from future events, cancelled plans, unresolved relational issues;  (2) Statements of admiration and value which subsumes feelings of wanting to express one’s admiration and recognizing the deceased’s worth; (3) Unresolved confessions and disclosures, which encompassed the desire to give or receive forgiveness, share private, untold information.


These themes echo in empirical studies, further highlighting how UB contributes to emotional struggles with grief.


A survey conducted by Yamashita et al. (2017) involving 967 bereaved families of terminal cancer patients found that approximately 26% reported experiencing UB following a loss. More importantly, the participants with UB showed higher scores for depression and grief as compared to those without. The study also found predicting factors for UB included a lack of preparedness for death, conversations about how to go about their daily activities, a positive relationship between the patient and their family and degree of alignment between family and professional caregiving goals.


Although UB is common, its emotional impact can vary greatly. Research indicates that simply having unfinished business and the distress associated with it were linked with poorer grief outcomes and trouble coping. Furthermore, not just the presence of UB but the depth of emotional turmoil mattered more than the type or number of unresolved problems. This implies the importance of therapy that focuses on the underlying emotional processes rather than only addressing specific behaviors or content. (Klingspon et al., 2015).


The Covid-19 pandemic significantly amplified experiences of UB, particularly due to restrictions preventing the traditional mourning processes such as, ‘saying goodbye’ or having funerary rites. A study involving 209 adult grievers found that most participants reported UB in the form of self-blame, guilt or shame or unfinished business with a third endorsing all four. UB was reported to be higher among those who had stronger emotional ties to the deceased. They also indicated more intense and maladaptive grief symptoms. (Lee et al., 2022)


Moreover, unresolved conflict, which is a major dimension of UB accounts for a significant 40% of variance in complicated grief. Also, time since loss did not predict the level of UB or its persistence, which suggests that unresolved emotional conflicts remain, long after the grieving period. (Lee et al., 2022)


Klingspon et al. (2015) found that among 224 participants, 43.3% experienced UB with individuals who lost an immediate relative or suffered from a violent loss were more likely to report UB. The study also found that unfinished business was associated with greater psychological distress, intensified and prolonged grief symptoms, stronger bonds with the late relative and reduced meaning derived from the loss.


Gender and Cultural Differences in Grieving and Unfinished Business

Regarding demographic factors that influence UB, Holland et al. (2018) found women (47.4%) to be more likely to report regret and also felt greater amounts of distress in regards to UB, though other factors such as age, ethnicity and race indicated no significant correlation to levels of distress. This may suggest potential gender-based differences with regards to emotional processing.


Research increasingly indicates that grief is non-uniform and gender may play a role in shaping how individuals experience grief. A longitudinal study by Lundorff et al. (2020) examined Prolonged Grief Disorder among 857 individuals who lost their spouses. The study revealed that although the majority of men and women followed a resilient, low-symptom trajectory, gender-specific differences emerged in those experiencing prolonged grief. Men in the high-symptom group indicated higher baseline symptoms but later indicated a gradual decrease over time, suggestive of an acute grief response. Whereas women in the same group displayed an escalating pattern, reflecting a more delayed grief reaction that accumulated over time.


Complimenting these findings, a meta-analysis of the bereavement fathers, who lost children under the age of 21, excluding stillbirths and miscarriages, concluded that fathers often avoided talking about their grief, re-joined work faster and utilized goal-oriented work as a coping strategy. They also found that intense grief symptoms and post-traumatic psychological consequences decreased over time in mothers whereas in fathers, these symptoms persisted (McNeil et al., 2021).


Alternatively, in regards to adults and how the cause of death of their parents (acute vs. anticipated) influenced their grief responses in 400 young and middle-aged-adults. Gender was found to be a stronger influencing factor with women reporting more intense grief and greater difficulty adjusting to the loss (Hayslip et al., 2015). Additionally being single or separated was linked to more intense grief in young adults.


These studies corroborate the implication of 1st study implying gender-based differences in emotional processing, furthermore suggesting that traditional masculine norms, such as emotional distance and emphasis on productivity, may mask or prolong symptoms in men, particularly in cultural contexts where emotional vulnerability is less culturally accepted.


Challenging this assumption, a cross-cultural study explored how bereaved individuals cope across masculine and feminine societies. Surprisingly, cultural factors along Hofstede’s masculinity-femininity axis did not significantly affect grief responses, although gender differences in grief patterns were found. Men scored higher on restoration-oriented coping while women were oscillating between loss and restoration-orientations, implying a more balanced coping style. The lack of cultural effect may be due to both sampled countries (Netherlands and Ireland) being individualistic cultures. (Severs-Oliva Marcon, 2020)


In contrast, an exploratory study in Delhi contrasted the expressions of grief and coping mechanisms of parents suffering from perinatal grief. They found that fathers tended to suppress outward expressions of grief whereas mothers were more likely to express grief. In regards to coping strategies mothers coped by performing household chores, taking care of other children or engaging in religious activities. Whereas, fathers coped via engaging in work and avoiding talking about the loss. (Das et al., 2021)


These findings reinforce the need for therapeutic approaches that accommodate both culture and gender sensitivity- something that Gestalt therapy is well equipped to do.


Gestalt Therapy as an Intervention for Grief and Unfinished Business

Among the various therapeutic approaches available, Gestalt therapy offers a humanistic approach that addresses the individual on a holistic level and helps them address their unresolved issues through the various techniques developed, most popularly, the empty chair technique which has been adapted in other therapeutic practices as well.


Gestalt therapy is versatile and applicable to a multitude of social contexts, as found in a meta-analysis by Raffagnino (2019). Furthermore, it can be applied with individuals, couples as well as groups - (Raffagnino, 2019).


Corroborating this, another review examined the utility of Gestalt therapy in maternal grief and found that the therapeutic tools offered, helps understand and confront the experience of grief and helps in repairing a relationship with oneself and reconcile with the grief left by their loss. (Enoque De Oliveira & Cézar De Borba Belmino, 2023).


Saadati and Lashani (2013) conducted a study with 34 divorced women, assigning them to a treatment and control group wherein they were subject to traditional gestalt techniques such as the empty seat, assuming responsibility and confronting unfinished business. Post-test results on the General Self-Efficacy Scale indicated that the intervention significantly increased the test group’s self-efficacy.


This therapeutic approach utilizes a variety of methods in order to address grief as well as unfinished business, as discussed below:


Dialogical Self Theory (DTS)

DTS offers a conceptual framework to understand UB as a conflict between multiple internal voices or “I- positions”. The therapeutic process helps clients understand internal parts which were affected by the loss and externalize these parts in order to understand them. Furthermore, it allows for external dialogue between various parts which is useful, especially during conflicts (Neimeyer & Konopka, 2021). This also helps clients reconcile with their grief and develop a new sense of identity by integrating the loss.


Within this strategy, the therapist functions as an ‘external promoter position’. The role of the therapist is to support the emergence of internal voices within the client that helps encourage growth and acceptance. This therapeutic approach emphasizes the importance of internal multiplicity and the therapeutic relationship in helping clients adapt and grow post-loss. (Neimeyer & Konopka, 2021).


This strategy was utilized in grieving mothers wherein, in order to cope with the sense of loss and the void left behind, utilizing this method enabled the grieving mother to formulate a novel meaning of loss as well as provided a larger number of resources to expand upon her new understanding. Furthermore, it allowed for her to incorporate her understanding of her loss in a manner in which she could honor the memory of the lost child. (Enoque De Oliveira & Cézar De Borba Belmino, 2023)


Role-Playing

It is a technique within which clients act out various situations or adopt various roles in order to explore UB, conflicts or view situations from alternate perspectives.  


Within this domain, Playback Theatre, a form of improvised theatre based on the client’s backstories or events from their life can be utilized. Keisari et al. (2023) reported two case studies which utilized playback theatre to cope with the sudden death of a spouse within a 12-week drama therapy group for adults. One of the participants indicated a clinically significant decrease in depressive symptoms and improved psychological well-being post intervention, whereas the second participant reported improved self esteem and relationship satisfaction. The study conducted work in three main domains, namely ‘the event story’ which pertained to what happened during the loss, the ‘back story’ which includes the past the client shared with the deceased, their relationship and conflicts, and lastly, the ‘personal story’ which involves stories of themselves.


Guided fantasy/Imagery

As Erskine (2014) says, “Gestalt Therapy…emphasizes the need for a genuine ‘hello’- full emotional contact and honest communication- before a final ‘goodbye’.”


Within Gestalt therapy, the therapist uses guided imagery to help clients imagine situations related to their unfinished business, for example, imagining a confrontation or a healing conversation. The purpose of this strategy is to increase self-awareness, help process emotions as well as allows clients to try new responses in a safe environment which allows for imagination and creativity.


This strategy was utilized in addressing maternal grief, wherein the therapist created a comfortable environment for the grieving mother to engage in an imaginary dialogue with her child. This allowed for the externalization of emotions such as grief, anger and emptiness. It furthermore decreased the sense of loss as it provided a sense of closure. (Enoque De Oliveira & Cézar De Borba Belmino, 2023).


Dream work

Within Gestalt therapy, dreams are not interpreted, as in psychotherapy, rather they are explored as representations of unfinished business. Clients can reenact or converse with figure from dreams in order to discover or process underlying emotional issues, unprocessed emotions or conflicts.


André (2022) explored her own grief dreams to understand the constituent components of grief dreams related to three distinct losses- relating to deceased individuals, a relationship’s conclusion and losses in the Covid 19 pandemic. Findings displayed that dreams can reflect present conflicts, provide comfort and help in understanding and providing closure. While this study has limitations in regards to its limited sample, it can provide an entry point into further analysis of dream content in order to facilitate acceptance and reduction of conflicts within the client.


A study on nightmares found that Gestalt therapy alone and combined with lucid dreaming techniques reduced the frequency of nightmares as well as improved sleep quality, implying that Gestalt-based dream work can aid in processing distressing unresolved emotional material, which is a feature of UB. (Holzinger et al., 2015)


Although research on Gestalt dreamwork specifically in regards to grief in limited, the principles and techniques are applicable as they enable clients to enact conversations with the deceased, express emotions such as guilt, anger, etc. and integrate the loss thereby reducing the unresolved grief.


Empty Chair Technique

This technique is perhaps the most popular Gestalt therapeutic technique and its utility is far reaching. In this technique, the client faces an empty chair and imagines a person or part of themselves. The counterpart is often someone the client has a conflict or unresolved issues with. The client speaks to the imaginary counterpart, expressing previously unexpressed feelings, thoughts and concerns. This technique allows unexpressed emotions and unmet needs to be brought forward, furthermore allowing for catharsis, novel perspectives, understanding of conflicts and more efficient emotional processing. It also helps shift self-perception from a victim-centric perspective to one where the client is empowered.


The technique serves as a powerful tool for emotional processing, resolution, and personal growth, and the empirical evidence provided underscores its therapeutic value.


Despite differences in research design, sample type and outcome measures, these studies conclude that resolution rather than mere therapeutic alliance or empathy alone is imperative for positive change.


The first study, among a population of 32 individuals, utilized the empty chair dialogue to evaluate components of unfinished business such as blame, need expression and shifts in perception, revealing the clients who reached a resolution (resolvers). Resolvers indicated significantly greater clinical improvement, including reduced distress and improved relationships as compared to non-solvers, this indicates that resolution was more predictive of the therapeutic outcomes than the strength of the therapeutic alliance alone. The study also underscored the effectiveness of the empty chair technique in regards to its facilitation of in-depth cognitive-emotional processing, particularly in regards to expressing one’s unmet needs or shifting one’s perspective. (Greenberg & Malcolm, 2002)


Similarly, King (1988) compared the effectiveness of two therapeutic approaches- empathy combined with the Gestalt empty-chair technique and empathic reflection, which is a more passive Rogerian method, in addressing UB. They found that active engagement via the empty chair technique resulted in greater emotional tolerance and resolution. While both approaches consisted of empathy, the Gestalt technique’s confrontational nature promoted deeper emotional engagement and resolution. This suggests that passive reflection may be insufficient when confronting intense unresolved emotions, whereas the empty chair technique allows for experiential re-enactment, a core mechanism that supports internal integration and resolution.


The application of the empty chair technique in anticipatory grief work highlights its versatility. In situations where literal dialogue with the other party is impossible due to death, comas or unavailability, the empty chair can function as a medium for truth-telling and closure. The case of Jason, who utilized this technique to express supressed love and resentment towards his dying brother indicates how this method can surpass external limitations to enable internal resolution and grief processing. This supports Gestalt therapy’s view that emotional expression, even imagined, can be as healing as real-world communications (Erskine, 2014)


The empty chair method is also applicable to multiple cultural contexts, as indicated in the case study of a 26-year-old Indonesian convict who was burdened by guilt and creative stagnation. He participated in seven sessions of empty-chair work, which helped the client confront guilt related to his father. A decline in his Guilt Sensitivity Scale scores further confirmed therapeutic success. This individualized, practical example demonstrates how this technique can be tailored to address specific emotional barriers such as guilt, which is central to UB. The intervention also enhanced interpersonal engagement, providing relational benefits. (Khairunnisa et al., 2020)


Taken together these studies present a compelling argument for the utility of this technique, especially in the context of unfinished business. However, they must be cautiously interpreted due to their limited sample size and focus on short-term interventions.


Body Sensitivity Training (BST)

Gestalt therapy focuses on the integration of somatic awareness and emotional processing to address grief and UB. Body sensitivity training is a core strategy utilized in this therapy and helps clients understand somatic symptoms of unresolved emotions, further helping address underlying issues and gaining closure and psychological integration.


It posits that unresolved affect manifests as somatic sensations, disrupting the present experience of a client. BST helps client identify these somatic markers which correlate with UB such as grief, anger or guilt (Kaisler et al., 2023).


A 2024 study by Rodríguez and Wooten (2024) found that higher body sensitivity correlated with reduced resistance which in turn enabled them to more easily confront their unresolved grief.


In clinical settings, a 2021 study utilized BST to treat clients with medically unexplained physical symptoms (MUPS), from which many had UB. Clients reported improvements in emotional regulation and sensation integration post BST (Roubal et al., 2021).


BST involves various techniques such as Body scanning and Somatic awareness, in which clients are guided to observe bodily sensations, identifying tense areas or numbness linked to grief. For example, a client might experience a ‘knot’ in their stomach or throat while thinking about the deceased. Kaisler et al. (2023) found that body-awareness exercises helped clients who had low or moderately integrated personality structures recognize how physical symptoms stem from unprocessed grief or anger. Both groups showed positive improvements in regards to well-being, psychosocial health and were more empowered.


Breathwork is another method utilized wherein breathing exercises activate the parasympathetic nervous system which helps clients reduce anxiety and grounds them during overwhelming experiences. It is particularly useful for grief related hyperarousal (Kuhfuß et al., 2021).


Movement and expression is one other method utilized by Gestalt therapists to encourage clients to externalize and embody their emotions. Such actions also help play out internal conflicts and provide a place for catharsis. For example, pounding a pillow to express anger (Kaisler et al., 2023).


BST provides a robust strategy for resolving grief and UB by connecting physical sensations with emotional awareness in order to promote understanding and psychological integration.


Conclusion

In conclusion, grief is a universal human experience, though it is shaped by personal, cultural and relational contexts within which it unfolds. Unfinished business emerges as a vital, yet sometimes overlooked factor that can complicate this process, leaving individuals with unresolved emotions, unspoken words and unanswered questions. The literature reviewed in this article highlights how UB contributes to prolonged grief, psychological distress and may cause issues in emotional adjustment. Though grief is considered a natural response to loss, UB adds a layer of complexity that requires therapeutic intervention. (Bardideh et al., 2022)


Gestalt therapy with its emphasis on the present, emotional processing and integration offers valuable strategies such as the empty chair technique, guided imagery and dialogical work in order to address unresolved grief. These interventions can not only help clients reframe and process their grief but also encourages personal growth, self-efficacy and meaning making. Emerging evidence also suggests that gender and interpersonal dynamics can significantly influence the experience of UB and the coping strategies utilized as well as their effectiveness, implying a need for culturally sensitive and gender-sensitive approaches. (Bardideh et al., 2022; Field & Horowitz, 1998)


However, several limitations to the studies must be noted. First, most studies rely on self-reported data, which may be subject to bias, forgetting or social desirability. Second, many of the findings on UB come from short-term studies, limiting the understanding of how UB evolves over time. Third, there emerges a cultural bias within the literature sources, with a predominance of Western samples. This limits the generalizability of findings to more collectivistic or non-Western contexts such as India, where family systems, rituals and gender norms differ greatly. Additionally, while Gestalt therapy appears promising, there are limited large-scale, controlled studies evaluating its utility in addressing UB in diverse populations.


Future research can focus on longitudinal and cross-cultural investigations of UB. (Bardideh et al., 2022) Expanding this area of study would enhance clinical understanding as well as improve therapeutic outcomes for those struggling with unfinished endings to the chapters of their loss.



References

Deon Dsouza is part of the Global Internship Research Program (GIRP) under IJNGP.

Tags GRIEF | UNFINISHED BUSINESS | BEREAVEMENT | GESTALT | HEALING




 
 
 
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