Licensed Psychologist, #PSY6906
Individual Psychotherapy
Cognitive / behavioral and Jungian approaches

Serving San Francisco and the Bay Area for the past 30 years

Death, Loss, Dying and Bereavement

⦁ HIV and AIDS
⦁ Bereavement for Past Losses
⦁ Bereavement for Present Losses

Psychotherapy with Gay and Bisexual Men
Dr. Karr has over twenty years of experience working with clients who are dealing with their death and dying process.


Since 1980, Dr. Karr has been dealing professionally as well as personally with clients and close friends who have died from AIDS. He has been present at the deaths of numerous clients. He is comfortable and at peace with being present through a client’s death and dying experience. His comfort with death and dying has enabled many clients to look at, talk about and face their death. He has helped facilitate many clients’ deaths to be “good deaths” rather then “bad deaths”. Some of the characteristics of a good death are:

  • A death that is conscious and talked about.
  • A death that is honored as a transformation process similar to birth.
  • One in which the client has been able to communicate and involve the important people in the clients life throughout the death process. In these situations, the client has been able to communicate unsaid feelings, such as angers, hurts, or loves to important people in their life. A person is able to have a better death if they have completed as much of their old baggage as possible with others in their life.
  • One where prior to death, they have dealt with issues affecting the people to be left behind after death including wills, good-byes, taking care of dependents and pets, insurance, property, burial/cremation and funereal issues.
  • Spiritual Issues. Many clients have found greater peace and harmony through reconnection to previous spiritual traditions or finding new ones that help them make sense and find purpose in death and dying.
  • Coming to Terms with Loss. Many clients must come to a place of peace and acceptance concerning their life ending and various hopes, dreams and desires having not been manifested or completed. A good death requires letting go of one’s feelings of failure for the achievements not met. This includes letting go of the expectations that have not been met as related to families, friends and lovers.
  • Releasing One’s Body and Physical, Sensual life.
  • Releasing one’s attachments including relationships, property, and desires.
  • Developing a good relationship with one’s health care providers and emotional care providers, so that one’s death is as comfortable as possible and that there is the least amount of emotional and physical pain as possible (requiring the necessary amount of medications to alleviate pain and yet stay conscious). This includes learning to communicate pain honestly and accurately.
  • Being able to die despite friends, family or lovers being attached to one’s continued living, being able to do one’s best to help those around one’s self to come to terms with one’s death. This, however, is not done out of co-dependent tendencies of being trapped into attachments in order to continue living for others.
Bad deaths Dr. Karr has observed include numerous painful deaths of clients and friends which have been destructive both for the person dying and the people around them. Some examples of bad deaths are:
  • A client reported that a friend of his had died without telling any of his friends or family that he was even sick. The client’s mother found out that her son had died of AIDS after she called his office and was told by the secretary that he had died the day before. The mother did not even know her son had AIDS and was sick.
  • A client’s partner, upon whom he was dependent, refused to deal with his dying process and died without a will. The result of this was that the client’s lover’s family came and took all of their property including joint property and left him with a vacant apartment.
  • A client’s lover refused to set up a living will to deal with his dying process. He went into a coma, and his Pentecostal Christian family came and physically took him back to Kansas , refusing to allow the client see him. His lover had Pentecostal preachers preach at him while he was dying.
  • A client’s friend who was dying was in great pain. Being a recovering addict, clean and sober for over 14 years, she refused to take any morphine to reduce her pain out of her conviction that she would never take any addictive substance again. Even though she was dying and addiction was entirely irrelevant, she continued to suffer much longer than necessary before finally accepting the doctor’s recommended pain reliever.
  • Many clients have suffered intense trauma, often entering therapy over and around the issue of finding a dead friend or loved one. Without being prepared for their death this kind of death is very damaging. This is particularly the case wherein a person has committed suicide, sometimes as an alternative to a long slow death from cancer or AIDS, but has not arranged for someone to find them. A characteristic of what we are calling bad deaths is that they not only create a good deal of suffering, but they increase the destructiveness for others surrounding them.
  • A person uses their death as a way to punish, manipulate and hurt others. Such people harbor old wounds or present wounds towards the people they wish to harm through their own death. For example, a client’s father was very angry that he and his wife and children moved out of town. His father called two weeks after they moved and told him that their moving destroyed his life. He went downstairs in the basement, put a gun in his mouth and killed himself. This made extreme trauma for the client and his extended family. Many people in their process are very angry and may dump anger, guilt and blame upon their friends and family as they die. This rage and anger does need to be expressed and dealt with. But it is better dealt with within the context of therapy than being acted out upon others through their own suicide.

These are just a few of the numerous horror stories that Dr. Karr has been told concerning the destructive potential of death and dying. We are talking about, in many cases, a situation where people have ample time to prepare for and experience their death, where people have the time to facilitate other people in their life in their dealing with the death, taking care of practical concerns, and so on. A person has choice in how they deal with their death where it occurs over a period of time and they experience it consciously. This is a very different situation in sudden death where a person has no time to deal with their death, and the people around them have no opportunity to prepare for their death. It is Dr. Karr’s philosophy that the death and dying process is a primary human experience and a great opportunity for growth, transformation, for both the dying the person and their important others.

Three Redwood trees in the National AIDS Memorial Grove, where the ashes of the dead are spread

Bereavement for Past Losses                                                                   Bereavement is the process of dealing with the loss of a loved one through death. This process may be a very long-term process in therapy. It can take the form of a person dealing with a death that may have occurred long ago, including parents, siblings, or friends, partners and lovers. American culture is extremely poor in helping people to complete their mourning process. American culture tends to expect people to complete their mourning process in a short period of time; months, weeks, and sometimes just days. This is particularly unreasonable when the person lost is a parent, sibling or significant other. American culture is extremely bad when a person experiences the death is of a pet or animal friend.

Downieville cemetery, Sierra County, CA









Often children have not been included in the mourning/loss process and when they become adults they still need to deal with the death of a parent. It is Dr. Karr’s clinical experience that a good deal of depression in adult clients is the result of uncompleted mourning and loss issues. In regards to gay men who survived the AIDS epidemic in the seventies, eighties, and nineties, there were so many deaths that people were unable to process them contemporaneously. Many gay men or the friends and families of persons who died of AIDS have unresolved issues with death, which needs to be dealt with in a therapeutic manner. One of Dr. Karr’s clients is a woman who needed to process the death of her gay uncle with whom she was very close to.

Pre-Restored AIDS Grove Fern Carving















Bereavement for Present Losses
Dr. Karr deals with many clients who are going through a current bereavement process. He has a good deal of experience of helping clients who have a friend, partner or family member who is going through a dying process. He may work individual therapy with such persons, or as a couples or families with the dying person. The bereavement, like the death and dying process, has within it the opportunity and potential for transformation and growth for the bereaved person as well as the dying person. It also has a great potential for facilitating greater intimacy and love between the bereaved person(s) and the dying person. A good death for the dying person becomes a good death for the bereaved person(s). A bad death for the dying person becomes a bad death for the bereaved person. It is Dr. Karr’s philosophy that a healthy bereavement process is necessary for those important others around the dying person. Such a process is needed in order to decrease the pain and the potential destructiveness of all involved.