Counseling a broken heart

By Bethany Bray

August 2022

Romantic breakups can be a painful process that often involves feelings of loss on many levels.

According to Jessica Rizk, a licensed professional counselor and supervisor who owns a private practice in Northern Virginia, initial feelings of loss after a breakup can occur in two phases, the first of which is the loss of routine. A person may acutely feel the loss of activities that brought them comfort and connection such as phone calls and texts from their partner, watching their favorite TV shows together or their usual morning coffee time.

As the breakup begins to sink in, the person may feel loss over what could have been, Rizk continues. This second phase may bring painful feelings about unmet expectations and the absence of a future with their partner — either one they imagined or one they discussed and planned as a couple.

These multifaceted feelings of loss can intertwine with anger, disappointment, vulnerability, regret, shame, betrayal, self-doubt, loneliness or even relief. In short, there can be a lot to unpack in counseling.

Rizk, a member of the American Counseling Association whose practice focuses on helping clients with relationship issues, recommends counselors start by offering empathic listening, which, she says, these clients need first and foremost. There is healing in being truly and completely heard, she notes.

“Clients may not feel they have the opportunity to get it all out to friends and family without judgment,” she explains. “Having an opportunity for the client to speak completely unfiltered is my main goal. Counseling is about talking about pain without judgment — even if they need to talk about something over and over.”

Although post-relationship heartbreak is not uncommon, Rizk aims to treat each client who seeks counseling after a breakup as if they are going through a new and unique experience. This includes prompting them to share how they met their ex, what drew them together and other details of the relationship, including its end. It’s important for clients to talk through the breakup — when they are ready — so they don’t get “stuck” in feeling angry and relying on unhealthy coping mechanisms, she says.

As clients share, Rizk says she tries to stay as neutral as possible and reassures the client that they will not feel the sadness, anger or any other feelings they are experiencing forever. She often needs to gently explain to clients that they may never know what caused a breakup.

“Depending on how vulnerable and open the client is, some of them are coming to counseling to figure out the why. Others are unhappy with being single or are looking to figure out why it [painful breakups] keeps happening and they jump from relationship to relationship,” Rizk says. “I try and listen to their stories and pull out threads to bring into sessions and gently process together. … Each client will cope in a different way, and my desire is to walk alongside the client as if I’ve never heard this pain before.”

Wondering why

Clients sometimes come to counseling after a relationship ends to seek closure, says Kelly Weber, a licensed professional counselor (LPC) who sees individual clients at her private practice in Phoenix, Arizona. They are often looking for help to move through a painful period that is full of difficult emotions and unresolved feelings about the relationship and its end. It can be a confusing and hurtful experience, she notes.

This can especially be the case, Weber says, if the breakup was unexpected, such as the discovery of infidelity, or the other person ended the relationship without much explanation. Inadequate closure — that feeling of having the rug pulled out from underneath you — can cause a person to replay scenarios over and over in their mind, wonder what happened, and question if it was their fault, she says.

For clients with a preexisting mental illness, a breakup can exacerbate their symptoms, especially rumination, self-doubt, intrusive thoughts and overthinking the “what-ifs,” Weber says. For some clients, this can lead to depressive episodes, trouble sleeping, weight loss or gain, isolation/withdrawal and distress to the point where it interferes with daily life. She has seen clients get to the point where their thoughts about the relationship and breakup are all-consuming and they are unable to get out of bed or meet their work responsibilities.

As with any client who is experiencing intense distress, Weber says that it’s important to ask clients who are experiencing a breakup about suicidal thoughts, including hopelessness or feeling like they can’t go on without their partner. In her experience, it’s not common for clients to answer in the affirmative, but “it’s important to ask the question,” she says.

Marquita Johnson, an LPC with a solo private practice in the greater Atlanta area, also notes that many of her clients are seeking closure when they come to counseling after a breakup. She reminds them that closure doesn’t have to be about getting answers from their ex; closure is for them, she says. 

To keep this focus, she often suggests that clients who are looking for answers about why a relationship ended write out their thoughts and feelings in a journal or compose a letter or email to their ex that does not have to be sent. She prompts them to reflect on what did and didn’t work for them in the relationship.

Johnson also provides psychoeducation on how clients may regress when they are triggered by contact with an ex or by something that reminds the client of the relationship and the time they spent together.

“They need to understand that it can be a roller coaster,” Johnson explains.

Johnson adds that clients may also need psychoeducation on how social media can trigger and worsen negative thoughts if a client continues to follow or look at an ex’s posts. She often spends time explaining that although it’s tempting to keep tabs on their ex’s life through social media, seeing their ex’s posts can prolong post-breakup pain and cause them to compare themselves or jump to conclusions on whether their former partner is happy or remorseful.

Working through loss

Kristyn Macala, a licensed professional clinical counselor at a trauma therapy practice that offers online counseling to clients in Ohio, stresses that these clients need a supportive and gentle approach. If a counselor tries to put a positive spin on the breakup, prompting the client to identify good things that came out of a relationship before they are ready, they are likely to stop coming, she says.

Instead, Macala tries to create an environment for these clients to “feel however they need to feel” after a breakup.

“For me, the most important thing is creating the space, the rapport and the connection [with a client], so they feel comfortable and know that we can take our time, and that’s OK,” says Macala, who specializes in sex and couples counseling.

Macala uses psychiatrist Elisabeth Kübler-Ross’ five stages of grief model with clients experiencing heartbreak. When describing this concept to clients, she refers to these five stages as “tasks of mourning” because even though their ex is alive, they are still mourning the loss of a person they loved. Kübler-Ross’ model can help them accept the reality of the loss and the pain that comes with it as well as come to terms with a world where they are no longer a partner to that person, Macala explains.

“If the relationship was a ‘first’ in some way (e.g., first relationship, first relationship with a partner with a certain identity or characteristics, first sexual partner or committed partnership), the loss may be particularly painful because they likely had expectations and dreams that were unfulfilled and made personal sacrifices to invest in the relationship,” says Naomi J. Wheeler, an assistant professor and director of the Family and Relational Stress and Health (FReSH) Lab at Virginia Commonwealth University.

It can be tempting for a counselor to try to make a client feel better after a breakup, but the best support is the kind that honors all feelings as valid in the process of healing and taps into the client’s own internal wisdom, says Wheeler, an LPC in Virginia and a licensed mental health counselor in Florida. This includes the ups and downs of vacillating between hating a former partner and loving them, feeling lost and lonely, or feeling free and empowered.

Rizk often prompts clients to describe and explore their feelings of loss by asking them to tell her the story of their relationship, from beginning to end. This gives counselors an opportunity to listen for “sticking points” that may need further attention later in therapy, she explains. In fact, the language they use to describe their situation often provides a lot of context, Rizk says. For example, she listens for phrases such as:

• “I don’t know what’s next.”
• “I don’t know what to do with myself.”
• “I feel like I’m never going to find anyone else.”
• “I’m going to throw in the towel and stop dating.”
• “I have never not been with someone.”
• “I don’t know how I’m going to bounce back from this.”
• “I don’t know how I’m going to tell my family.”
• “Without my partner, I’m not strong enough.”

Clients who use this type of language often need to focus on their identity and self-worth in addition to grief work in counseling, Rizk notes. It may also indicate that they struggle with a fear of loneliness or have previously relied on a partner to find happiness or fulfillment. These feelings may be further complicated if a client comes from a culture or family system that places value and importance on marriage or couplehood over singleness, she adds.

“There can be a sense of confusion on ‘what now’ or ‘what’s next.’ They invested so much in the relationship that they forgot to invest in themselves,” Rizk says. “There is a lot of grieving, but how they grieve can be very telling of how they view love, [including a reliance on] external love instead of self-love.”

Quelling negative thoughts

It’s easy for clients to fall into negative thought pattens and ruminate on the what-ifs after a painful breakup. So helping clients become aware of this inner “script” is a vital first step in counseling, Macala says, as well as equipping them with tools to stop and reroute intrusive thoughts. When left unchecked, unhealthy thoughts can intensify other mental health challenges such as depression and anxiety.

“When those [negative] thoughts are swirling in our brain we can really get down on ourselves,” agrees Kasie Morgan, a licensed clinical mental health counselor and supervisor at a practice in Mount Holly, North Carolina. She’s noticed that clients often respond by questioning themselves and asking, “What did I do? What doesn’t this person like about me? Why does this always happen to me?” The first thing she helps clients do is redirect the focus by telling them, “This is not about what is wrong with you; it’s about what happened to you.’”

Morgan also finds that helping clients to forgive themselves can be an essential part of healing. A person’s self-talk often defaults to “should” statements, such as “I should have known the other person was going to hurt me or treat me poorly.” These clients often need to hear (sometimes repeatedly) from a counselor, she says, that nothing they can do will control or change the behavior of another person — all they can do is focus on their own actions and thoughts. 

“That is a hard concept to work through,” Morgan admits. “A lot of times when we talk about a breakup or dismantling a relationship, there’s a lot of talk about forgiving the other person. But we forget to talk about forgiving ourselves for our shortcomings and our patterns. Part of the process is letting go of the things within yourself that have driven you to a place of not liking yourself. Being kind to yourself is vital.”

Morgan uses acceptance and commitment therapy techniques with her clients to help them build resiliency and learn to separate fact from fiction in their thought patterns and emotions. She asks clients to identify the residual feelings they have from a past relationship (e.g., despair, sadness, relief). Then she helps clients put those feelings in context by pointing out a positive fact or aspect that came out of the relationship. For example, she may note that the client devoted a lot of time, energy and emotion to this person and relationship and prompt them to explore it further by asking themselves, “What are the facts about me that have come out of this relationship?” 

Rizk also says that cognitive reframing techniques are her go-to for clients who are spiraling into negative thought patterns after a breakup, including feeling that they have somehow failed or are “not enough.” She supplements this work by prompting clients to make a list of things that they are good at or have been successful at outside of their love life. Clients can also ask supportive friends and family to help them identify some positive qualities and accomplishments that they can add to the list, she says.

When Rizk discusses the client’s list with them in session, she emphasizes that they are worthy of love and have a lot of be proud of. Positive aspects of a client’s life, such as work accomplishments or valued friendships, can often be forgotten or put aside when a client is in a romantic relationship, especially one that is falling apart, she notes.

The language that clients use when describing their negative thought patterns can also uncover core beliefs that need to be explored and challenged in counseling, Macala says. This includes catastrophizing or making generalizations such as “bad things always happen to me,” she adds.

Macala says she gently broaches these conversations about core beliefs, and she doesn’t delve deeper into the issue with the client until after they have moved past their initial emotional response to the breakup, are stabilized and indicate they are ready to discuss these beliefs further. She begins by talking about what core beliefs are, giving examples such as “I am unworthy” or “I am helpless,” and explaining that some of them can come from negative things we’ve heard in our formative years. She then asks clients, “Does any of this sound familiar? Does it resonate with you?” And she says they often respond “yes.” 

“I don’t challenge them right away,” says Macala, who estimates that one-third of her caseload is struggling with some kind of relationship loss or grief. “This person has believed that two plus two equals five their whole life and I’m telling them that two plus two equals four, and it’s upsetting. … Sometimes it takes a lot of work to exchange them [core beliefs] for something more helpful.”

Macala says that the cognitive behavior therapy technique of reframing, which is strengths-based, can be particularly helpful for clients who disclose catastrophizing thought patterns and beliefs such as “I can’t do anything right.” 

Exploration of core beliefs and reframing helped a male client that Macala once worked with who came to counseling after the end of a long-term relationship. His partner had cheated on him, and the client was navigating a lot of pain, denial and a need to mourn the loss of the relationship and the long-term plans he had imagined with his partner.

His presenting concern was depression, she recalls, but as they began to work together it became apparent that the breakup was exacerbating not only his depression but also his substance use.

Initially, Macala worked on thought stopping techniques with this client to quiet his rumination and equipped him with healthy coping mechanisms, such as positive affirmations and gratitude journaling, to turn to instead of substance use. Once he was stabilized, they began to focus on his values, and it became clear that undergoing childhood abuse and abandonment by his mother had caused him to believe that he was unlovable, Macala says.

She challenged this belief by asking the client to write out a list of his values. For each value that had a negative connotation, she asked him to think of a positive one to match it. From there, she suggested the client put the positive values on a vision board to look at and remember each day.

“Negative beliefs focus on what isn’t there,” Macala says, “and reframing flips it to focus on what is there.” 

Rediscovering self

“We often invest a lot of our time and resources in our relationships, and as a result, we can wrap much of our identity and sense of self into a significant relationship or partner,” says Wheeler, an ACA member who specializes in family and relational stress. “So, when the relationship ends, a person may grieve the loss of the partner, the loss of the life built together, as well as the future they had imagined, and begin a process of rediscovering themselves outside of the partnership.”

Wheeler and the other counselors interviewed for this article emphasized that clients can benefit from counseling work that guides them to explore and reconnect to their identity after a painful breakup. A first step can be to ask the client to identify hobbies, interests and social supports — including those which they had abandoned during their relationship — that they want to connect or reconnect with.

For Weber, this focus on reconnection to self often comes after she’s done grief work with a client and they have moved forward from an initial state of vulnerability and sadness where, in some cases, they’re crying all the time. She often explains this concept by describing it as “working on version 2.0 of themselves.”

Weber finds that dialectical behavioral therapy techniques can be helpful to give clients a new perspective after a breakup and boost confidence. In particular, she uses role-play to build communication skills and to help clients better express their needs.

Morgan also recommends counselors help clients who are going through a breakup identify and explore their core values and beliefs, including values that come from their family of origin. There are numerous values worksheets available at therapistaid.com that are helpful in this realm, she notes.

She advises counselors to help clients identify what values they want to closely examine and how those values affect their ability to be a romantic partner. “It’s important to identify not only [clients’] current values but also what they want them to be,” she says. “For example, I might want to have creativity in my life but right now I’m working at a job that isn’t creative.” 

“A lot of values are generational, so it can be helpful to see how they impact your life and play out in your own values,” she adds.

Johnson specializes in counseling the millennial population, especially with dating and relationships, and often spends a lot of time helping clients to identify and strengthen their identity and values after a breakup. She created two sets of cards related to relationships that she often uses in session with clients recovering from a breakup. The first set of cards prompts conversation on what a client wants for themselves in a relationship, with questions such as:

• What did your mother or father teach you about relationships?
• If your relationship was a traffic light, would the signal be green, yellow or red, and why?
• How do you know you feel safe in a relationship?
• If you had the relationship of your reality, what would that look like? (Johnson says she purposely uses the word “reality” here instead of “dreams” to keep clients from imagining or dwelling on a false reality.)

The second deck of cards contains a series of relationship affirmations for counselor and client to repeat together and talk through. Some of the affirmations include: 

• The success of a relationship is a shared responsibility, based on trust and vulnerability.
• Healthy control is having both self-control and the remote control. (This affirmation interjects a little humor and usually sparks a laugh before diving into the heavy topic of self-control, Johnson notes.)
• When I’m in conflict with my partner, I am actually looking to connect with them.

In addition to the card prompts, Johnson also has clients identify and write lists of negotiable and non-negotiable aspects that they value in relationships and areas they are working on (e.g., self-confidence) to track and discuss in counseling. 

Having clients focus on themselves during this phase of therapy, Johnson says, often reveals the need to work on skills such as communication and assertiveness, as well as the need for psychoeducation on the different types of attachment styles and how that can influence a person’s romantic relationships.

Johnson notes that these conversations can also prompt wider discussions about what the client views as a healthy relationship, when and how they feel safe to become vulnerable with a partner, and what they’ve learned and internalized from their own relationships as well as others’. And it shifts their focus to realize that they have the power to set boundaries for the choices they make with romantic partners in the future, she adds.

Making meaning

With their relationship in the rearview mirror, an important part of the healing process is for clients to reflect and create meaning from the experience. However, “there’s no easy way to do that,” Macala admits. “We have to approach it from the perspective of putting ourselves in the driver’s seat. We get to decide what we are going to take from it [the relationship].”

Although this is an essential part of counseling after a breakup, it should come after a client has processed the loss and is ready to reflect on the entire relationship, including its painful end, Macala says.

The ultimate goal should be to guide the client as they identify what was good and healthy in the relationship. “Then, we discard whatever was unhealthy and what we don’t need anymore,” Macala says. Take, for example, a client who experiences a bad breakup with someone they have a child with; rather than thinking about the negative parts of the breakup, the client could choose to focus on the fact that this relationship also gave them something positive: their child.

One approach that Macala uses to prompt these discussions is to have the client make a list of things that were red and green flags in the relationship. Clients are often familiar with the idea of red flags in a relationship, such as jealousy or controlling behavior. Conversely, green flags can include things such as finding a partner who enforces healthy boundaries in their life or has good social supports. Macala suggests clients make meaning from their past relationship by expanding their thinking to include both the red flags they want to avoid repeating in their next relationship and the green flags they’d like to seek out.

Weber agrees that a counselor can help clients make meaning from the good and the not-so-good aspects of an ended relationship. She finds it helpful to spur these conversations by having the client draw a line down the middle of a blank piece of paper. On one side, they list all the things they will miss about the relationship, and on the other side, they include all the things they won’t miss.

“Through the grieving process, we are able to recognize both sides of that piece of paper,” Weber says. “We do not want to romanticize it [the relationship] or put it on a pedestal but have a realistic view of what happened.”

 

The need for self-love

Clients who are healing from a painful breakup often ask their counselor when they should start dating again. There is no “right” answer to this question, and a professional counselor shouldn’t advise a client on what they should or shouldn’t do, but it’s an important topic to talk about, notes Kelly Weber, a licensed professional counselor (LPC) with a private practice in Phoenix, Arizona. Weber uses the question as an opportunity to explore why — or why not — a client feels they are ready to date again. 

Jessica Rizk, an LPC who owns a private practice in Northern Virginia, says that clients’ questions about when to start dating again often have some underlying reasons. If it’s because they are uncomfortable with being single, they may benefit from unpacking those feelings in therapy.

Rizk has worked with clients who dove back into dating and relationships soon after breakups because they were unable to tolerate feelings of loneliness and vulnerability and struggled with self-love. These feelings can stem from abandonment or negative experiences in their past, including childhood, she explains.

“They are attracted to feeling loved by someone,” Rizk says. “The reality is that they’re trying to fill a bucket with a hole in it. It’s not their partner’s responsibility to fix their bucket.”

Rizk helps clients work through these issues, explaining that a relationship is doomed if one of the partners is seeking connection to meet a need, such as self-love, that only they can meet themselves.

Clients may avoid talking about a breakup or blame others for relationship problems because they fear loneliness or feel they are unworthy of love — all of which can be processed in counseling, adds Marquita Johnson, an LPC with a counseling practice in the greater Atlanta area.

“Their identity is often enmeshed with being a part of a couple,” Johnson says. “I tell clients, ‘A single dollar bill still has value even though it’s alone. It is not valueless if it’s not with other bills.’”

She sometimes assigns these clients “homework” by asking them to do an activity by themselves (e.g., eat in a restaurant or attend a social gathering alone) and then write in a journal to process the experience. She prompts them to think about how they felt during the activity and, in turn, what value can be found in being single and doing things on their own.

Kasie Morgan, a licensed clinical mental health counselor and supervisor at a practice in Mount Holly, North Carolina, agrees that a counselor’s role can include helping a client explore their thoughts and feelings related to relationships after a breakup as well as whether they are ready to begin dating again and take on the “heavy work” of being in a partnership.

Entering another relationship “is a heavy thing and they need to work through their connection to self before” they’re ready to date again, Morgan says. “Until they are happy with where they are in life, it’s going to be increasingly difficult to find a relationship and be fully committed to that person.”

  ***** Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org. **** Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.