Loss, Grief and Bereavement

 

It is important to understand that grief cannot be experienced quickly and be done with forever. A hundred years of psychotherapy has shown that people who move too quickly through the grief process are like a rubber band stretching until the elasticity breaks, bringing them right back to where they started.

Although the terms loss, grief and bereavement are often used in place of each other, they have different meanings. Grief is the normal process of reacting to a loss. The circumstance that comes most readily to mind when we speak of grief is the death of a loved one.  Death, and the resultant loss, is almost never a singular event however. In addition to the actual death loss, there is the loss of all the hopes, dreams and expectations about the future.
Grief can occur in response to symbolic or social losses (loss of a job, loss of childhood through trauma or divorce). Grief less commonly understood is the emotions we experience following symbolic losses of anything significant to us; health, future, safety and security, friendships or loss associated with major changes in a familiar pattern of behavior (ability to be energetic or productive for example when diagnosed with an illness). The significant loss of anything we value; good health, security, goals, home, job, our youth etc. will lead us into the grieving process.
Bereavement is the period after a loss during which grief is experienced and mourning occurs. The time spent here depends on the degree of attachment the person has to the person or thing of value that was lost, and how much time was spent anticipating the loss (if there was forewarning).

Grieving is a misunderstood and often neglected growth process. In contemporary society the process of moving through intense emotional pain has become so private and misunderstood that most of us have very little idea of what the process is, or how to deal with it.

Whether grief was caused by death or some other type of loss, incomplete recovery can have a lifelong effect on a person’s capacity for happiness.

For most of the clients who come to see me for grief counseling, the recommendation to do so had come from someone else, a physician, friend or former griever. Most people think that grief happens to everyone and that time heals it. We know however, time in itself, has no healing properties and it is not simply the passage of time that brings about healing.

When I first meet with clients I will explore their sleep, appetite, energy/ productivity, and relationship disturbances that are common in grief. Additionally I explore their available social supports and their participation in exercise. These are important baseline markers that clients can later re-evaluate to determine their progress in healing.

Research shows that people who experience a meaningful loss have a high incidence of depression, sleep interruption, poor concentration and memory, increases in use of alcohol and tobacco, as well as difficulties at work and with personal relationships. It is for some of these troubles that clients seek relief from their grief.
Many clients describe various obstacles in the way that inhibit their grieving such as:

• There is pressure to heal quickly (compassion leave of 3 days is common)
• Others show discomfort with the expressions of grief
• We are taught that showing emotion is unacceptable
• Lacking religious/cultural rituals that help bring strength and perspective in death.
• It is difficult to find someone willing to listen to our grief
• Lacking knowledge and education  because we live in a society that does not educate us on how to grieve
• Inappropriate comments and actions of other people
• Feeling we have to protect others from sadness
• Cultural differences in grieving

“Bury your feelings”, “don’t feel bad”, “time will heal”, “just give it time” “get a hold of yourself”, “keep a stiff upper lip” are common encouragements given to people experiencing loss and grief. These kind of remarks reveal the general misunderstanding people have about grief.  Grieving necessitates the expression and release of feelings in a safe and supportive environment. Grief is considered a lifelong process although the qualitative nature (intensity and duration) of the grief experienced by a person will change over time with steps taken to heal.

Many of the people I see are surprised to discover that even after many years have passed following a loss, they can experience feeling overwhelmed with grief. This is what we call a ‘grief burst’ an expected heightened period of sadness that can overwhelm someone experiencing grief and loss. These grief bursts can seem to come out of nowhere, sometimes long after a loss (month, years even decades) and can be frightening and painful.

Even long after a loss, something as simple as a sound, a smell or a phrase that reminds you of the person you lost, can bring on a grief burst. These can sometimes be predicted for anniversary dates and/or special holidays.

Treatment Approach

I usually start sessions with people by educating them about grief to help them gain understanding and awareness of grief and to help normalize what they are experiencing. Many grievers say they think they are going crazy and are worried about their mental health.

It takes courage to grieve in a society that mistakenly values emotional restraint.
Early sessions with clients involve having them tell their story of loss and grief.
I provide a safe and supportive environment for them to express their thoughts and feelings and specifically help them to explore their feelings of anger and guilt, the two most predominating emotions in grief.

Early sessions are designed to help drain these feelings “off”. I encourage people to start journal writing daily for 10 minutes in order to help them continue expressing their feelings and thoughts, even when not in session. This form of homework helps people take care of unfinished business by expressing the things that they need to say to the deceased (the list of undelivered communications) or the person lost to them.

Processing their pain helps people feel better by modifying the intense feelings that predominate in early grief. Once the intense feelings subside we can shift our focus to specific efforts to care for self. Small goals are set and planned strategies are made for improving sleep, eating, exercise and seeking social supports. The ‘taking action’ stage has an immediate effect of helping people to  feel better because they are doing something and accomplishing small goals towards re-establishing a more ‘normal pattern’ of day-to-day life.

Once self-care efforts are strengthened, I usually have clients complete a loss history to help them become more aware of how their history of losses influence their present loss. Loss is accumulative, so present losses are significantly impacted by unresolved past losses.  A pie of life losses schemata homework assignment helps them to identify the specific impact of each loss they have experienced in their life (using the loss history). This is a useful exercise as many clients discover that the loss that brings them to counseling may not be the loss that impacts them the greatest.  To address the most meaningful and difficult loss, I ask them to prepare a memory box that commemorates their loss or losses and to bring it in to present in a session.

Grief is a natural, healing process even though it can feel very unnatural and confusing.  Grief is a normal and natural response to loss and has common characteristics that help people identify that they are grieving. I typically see these reactions starting immediately after a loss is experienced, but commonly they are reported many months following a loss.

What does it feel like to grieve? You may experience any or all of the following: guilt or anger, denial, disbelief, confusion, shock, sadness, yearning, humiliation, despair, restlessness, a sense of unreality about the loss, difficulty sleeping, eating and concentrating, mood changes, a loss of energy, constant thoughts of the person who died, and a need to talk about him or her.

Most people ask me “how do I “get over” grief? I teach them that Grief is not an illness or disease to conquer. It is the response to loss. There is no timetable for grief. How soon you integrate the loss and learn to live with it depends on your relationship to the person who died and your own adjustment to the empty space he or she left behind. I encourage them to be prepared for the fact that grief changes a person permanently, and that life doesn’t go back to what it was before the loss or losses.

Understanding Grief and Emotions

• All Feelings are OK- no right or wrong
• Express  rather than repress
• Be gentle with self, if needed, be an “emotional wreck”

Frequently people want to know what to expect from the grieving process and although there is no ‘timetable of grief’, it is usually a slower process than most people expect. Grief can take 3-4 years to resolve, but for the majority, intense reactions subside between 6 – 12 months. Some parts of loss will continue with the griever for life and will typically present in the form of grief bursts described earlier.