When experiences of presence go awry: A survey of psychotherapy practice with the ambivalent-to-distressing 'hallucination' of the deceased

OBJECTIVES Experiences of presence, involving the sensory perception or felt presence of the deceased, are common amongst the bereaved (30-60%). Despite them being predominantly comforting and reassuring, a minority (approximately 25%) report ambivalent or distressing experiences. The study's aim was to explore how psychotherapy is practised with this subset. METHOD A mixed-method approach, involving both quantitative analysis and thematic analysis, was used to analyse data from an online survey, conducted in English and Spanish, amongst mental health therapists (i.e., psychologists, psychotherapists, and counsellors). Seventy responded to the survey and four of them were further interviewed. RESULTS The participants primarily framed interventions for ambivalent-to-distressing experiences of presence as grief therapy, with the severity of the presentation as the main factor influencing their clinical decision-making, but several perspectives co-existed regarding how to intervene. These discourses were categorized into two themes: 'A normalising and exploratory psychotherapy' and 'A grief stages psychotherapy'. The main sources of patient's distress, as understood by the sample, were located in the bereaved-departed relationship, in pre-existing mental health issues, and in a societal taboo or stigma. CONCLUSION After comparing and contrasting the participants' working hypotheses with existing knowledge on experiences of presence, and contemporary theories in the research area, guidelines are presented on how to intervene with people disturbed by their experiences of presence. PRACTITIONER POINTS Perceiving the deceased person, or feeling their presence, is common and normal amongst bereaved people. When these experiences are distressing or ambivalent, therapists' share that psychological suffering may originate from the departed-bereaved relationship, pre-existing mental health issues, or the effect of societal taboo or stigma. Psychotherapy is frequently aimed at normalizing, accepting, supporting, and exploring patient's experience.