Clinical Application of the Perspective Shift Technique in Persistent Grief: From Grief Care to Grief Therapy

Abstract

Grief has long been understood primarily as a domain of care rather than therapy: a naturalresponse to loss that unfolds over time, with the supporter’s role being to accompany theprocess rather than to intervene in it. The Continuing Bonds framework (Klass, Silverman,& Nickman, 1996) significantly advanced grief theory by reconceptualizing adaptation asan ongoing internal relationship rather than simple detachment. It provides a broadconceptual account of how bonds may continue and change after death, while notprescribing a single standardized experiential procedure for facilitating thattransformation.This paper distinguishes between grief care, appropriate for the broad range ofbereavement responses that change over time, and grief therapy, which may be warrantedwhen grief remains persistently fixed and continues to produce substantial suffering orimpairment. The paper uses the clinical term frozen grief to describe cases in which therelational meaning of the loss remains organized around unspoken words, unresolved guilt,or a fixed representation of the deceased that shows little movement despite time andsupportive care.The Perspective Shift Technique (PST; 人格移動, Murai, 2026a) is proposed as onestructured grief-therapy method for selected cases of persistent or frozen grief. Within theauthor’s Three-Layer Rational Consciousness Zone Theory (Murai, 2026b), PST isconceptualized as being conducted in a rational optimal zone in which experientialengagement and reflective continuity coexist. This is a clinical model rather than anestablished neuroscientific state. PST guides the bereaved client to engage with aninternally experienced perspective attributed to the deceased. When unexpected materialarises that does not fit the frozen relational narrative, it may function as a predictionmismatch and may contribute to changes in relational memory and meaning. The presentauthor calls the embodied moment of felt conviction that sometimes accompanies suchchange tokushin (得心). Tokushin is treated as a clinical indicator of experiential change,not as proof that memory reconsolidation has occurred.The therapist’s role in PST is that of a facilitator, not an interpreter — avoiding theintroduction of predetermined content and allowing the client’s own experience to lead.This non-directive stance is a core procedural principle of PST because therapist-suppliedcontent can shape what emerges and increase the risk of suggestion, demandcharacteristics, or confabulation.Three clinical cases are presented — frozen grief without tears, grief with unspokencommunication, and grief-associated depression with somatic symptoms — illustratinghow PST may loosen fixed relational understanding and allow the continuing bond with thedeceased to be experienced in a new form. The paper argues that grief care remains thefundamental framework for bereavement, while targeted grief therapy may be appropriatewhen grief remains persistently frozen and clinically burdensome.