Losing someone or something we love is very painful. We may experience all kinds of difficult emotions and it may feel like the sadness will never let up. These are normal reactions to a significant loss. But while there is no right or wrong way to grieve —there are healthy ways to cope with the pain. Grief is a natural response to loss. It’s the emotional suffering we feel when something or someone we love is taken away. We may associate grief with the death of a loved one – and this type of loss does often cause the most intense grief. But any loss can cause grief, including: * A relationship breakup * Loss of health * Losing a job * Loss of financial stability * A miscarriage * Death of a pet * Loss of a cherished dream * A loved one’s serious illness * Loss of a friendship * Loss of safety after a trauma The more signifcant the loss, the more intense the grief. However, even subtle losses can lead to grief. For example, we might experience grief after moving away from home, graduating from college, changing jobs, selling our family home, or retiring from a career we loved. Grieving is a personal and highly individual experience.
How we grieve depends on many factors, including personality and coping style, life experience, faith, and the nature of the loss. The grieving process takes time. Healing happens gradually; it can’t be forced or hurried – and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever grief experience, it’s important to be patient and allow the process to naturally unfold. (Bowlby 1977) In 1969, psychiatrist Elisabeth Kübler-Ross introduced what became known as the “five stages of grief.” These stages of grief were based on her studies of the feelings of patients facing terminal illness, but many people have generalized them to other types of negative life changes and losses, such as the death of a loved one or a break-up. The five stages of grief:
* Denial: “This can’t be happening to me.”
* Anger: “Why is this happening? Who is to blame?”
* Bargaining: “Make this not happen, and in return I will ____.”
* Depression: “I’m too sad to do anything.”
* Acceptance: “I’m at peace with what happened.”
If we are experiencing any of these emotions following a loss, it may help to know that our reaction is natural and that we’ll heal in time. However, not everyone who is grieving goes through all of these stages – and that’s okay. In fact, some people resolve their grief without going through any of these stages. And if we do go through these stages of grief, we probably won’t experience them in a neat, sequential order.(Parkes 1972) Kübler-Ross herself never intended for these stages to be a rigid framework that applies to everyone who mourns. In her last book before her death in 2004, she said of the five stages of grief, “They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.” Instead of a series of stages, we might also think of the grieving process as a roller coaster, full of ups and downs, highs and lows. Like many roller coasters, the ride tends to be rougher in the beginning, the lows may be deeper and longer.
The difficult periods should become less intense and shorter as time goes by, but it takes time to work through a loss. Even years after a loss, especially at special events such as a family wedding or the birth of a child, we may still experience a strong sense of grief. While loss affects people in different ways, many people experience the following symptoms when they’re grieving. Important thing to remember that almost anything that we experience in the early stages of grief is normal – including feeling like we’re going crazy, feeling like we’re in a bad dream, or questioning our religious beliefs. * Shock and disbelief – Right after a loss, it can be hard to accept what happened. Feeling numb, have trouble believing that the loss really happened, or even deny the truth. If someone we love has died, we may keep expecting them to show up, even though we know they’re gone. * Sadness – Profound sadness is probably the most universally experienced symptom of grief. We may have feelings of emptiness, despair, yearning, or deep loneliness. We may also cry a lot or feel emotionally unstable.
* Guilt – We may regret or feel guilty about things you did or didn’t say or do. We may also feel guilty about certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, we may even feel guilty for not doing something to prevent the death, even if there was nothing more we could have done. * Anger – Even if the loss was nobody’s fault, we may feel angry and resentful. If we lost a loved one, we may be angry at our self, God, the doctors, or even the person who died for abandoning us. We may feel the need to blame someone for the injustice that was done. * Fear – A significant loss can trigger a host of worries and fears. We may feel anxious, helpless, or insecure. We may even have panic attacks. The death of a loved one can trigger fears about own mortality, of facing life without that person, or the responsibilities we now face alone. * Physical symptoms – We often think of grief as a strictly emotional process, but grief often involves physical problems, including fatigue, nausea, lowered immunity, weight loss or weight gain, aches and pains, and insomnia.
The single most important factor in healing from loss is having the support of other people. People aren’t quite often comfortable talking about their feelings under normal circumstances, it’s important to express them when grieving. Sharing loss makes the load of grief easier to carry. Wherever the support comes from, it is important to accept it and do not grieve alone. It’s normal to feel sad, numb, or angry following a loss. But as time passes, these emotions should become less intense as we accept the loss and start to move forward. If we aren’t feeling better over time, or grief is getting worse, it may be a sign that grief has developed into a more serious problem, such as complicated grief or major depression. The sadness of losing someone we love never goes away completely, but it shouldn’t remain centre stage.
If the pain of the loss is so constant and severe that it keeps us from resuming our life, we may be suffering from a condition known as complicated grief. Complicated grief is like being stuck in an intense state of mourning. We may have trouble accepting the death long after it has occurred or be so preoccupied with the person who died that it disrupting daily routine and undermines other relationships. (Simons 1979) Symptoms of complicated grief include:
* Intense longing and yearning for the deceased
* Intrusive thoughts or images of your loved one
* Denial of the death or sense of disbelief
* Imagining that your loved one is alive
* Searching for the person in familiar places
* Avoiding things that remind you of your loved one
* Extreme anger or bitterness over the loss
* Feeling that life is empty or meaningless
Every person is individual and deal with grieving process differently ,however some people experience high level of distress which brings them to see the counsellor. (Stroebe,Schut & Stroebe,2005)People seeking counselling would quite often come for help with thoughts, behaviours, feelings or ability to coop. Sometimes grieving person realizes that counselling is the way to go sometimes family or friends would recognize the symptoms and recommend counselling to the grieving person. In both cases it’s counsellors responsibility to help the survivor to adapt to the change. There are certain principles and procedures than counsellor should follow to help client work through grieving process and come to a good outcome.
1, Actualize the loss
Talking about loss may be very difficult for client. This can be encouraged by counsellor by asking appropriate questions: when this happened, how this happened, who told you about it, where were you… some clients would need to go over and over it in their minds before they can be fully aware that it has happened. There is not a time scale for this and counsellor will have to follow clients own pace. Counsellor is in this stage clients listener and can facilitate the growing awareness of the loss and its impact by encouraging to verbalize current and past memories of the deceased.
2, Identify and experience feelings
Many clients come to counselling as the are worried about what they are feeling. Some feelings can be very confusing and problematic such as anger ,guilt ,helplessness, loneliness, anxiety. Counsellor’s role is to ensure client that all these feelings are natural and are part of grieving process and help them to acknowledge these sometimes negative feelings. It is important not to leave client with negative feelings but to help them find balance between the negative and positive feelings as focusing on negativity may put client in the risk of complications in the bereavement and make them suitable for medical treatment(Neimeyer 2000)
3, Assist adapt to the loss
To achieve this counsellor may use problem solving approach. What are the problems that client is facing and how can this be solved? Counsellor can help to learn effective coping skills help with self esteem if needed .Good judgement of situation is necessary as during acute grief there is an increased risk of maladaptive response.
4, Help find meaning in the loss
The specific ways in which people find meaning-strategies such as “there’s a spiritual order to the universe”,”she drank too much”,I needed to learn something”-may be less sailent than the process itself .In other words,the ability to reascribe meaning to a change world may be more significant than the specific content by which that need is fulfilled.(Schwartzberg and Halgin 1991,p.245) Finding meaning in loss is one of the goals of counselling. The process can be as important as the meaning.
5, Facilitate emotional relocation
By this counsellor can help client find a new place in their own life which will help them to move forward with life. Some people don’t need any encouragement but there are many who do. Especially with loss of loved ones people are tended to feel that if they will move on it will dishonour the memory of the deceased or no one will ever fill the place of lost one. Counsellor can help client to realize that this is true to certain extend but it is all right to live and enjoy their own life.
6, Provide time to grieve
Grieving requires time and every person deal with loss differently. Client may be going backward and forward in grieving process and counsellor is there to allow as much time as client needs. Sometimes family and friends seem to the grieving person as “they don’t understand” “they keep telling me what to do” etc. Counsellor can help interpret to family members that grieving person needs to accommodate to the loss. There is also a critical time periods which for grieving person is more likely to be difficult to coop with. This would be anniversaries, birthdays ,Christmas and holidays. It is advised to make a note of this dates as grieving person would often need extra support .If these critical dates come after counselling treatment has finished it is advised to make an arrangements to contact client.
7, Allow for individual differences
Grieving process has a wide range of behavioural responses and has strong individual differences in the intensity of reactions, pain ,length of time (Schvartzberg&Halgin,1991) Counsellor can help to explain these differences to the family as sometimes they expect everyone to grieve the same way. Of course client’s ethnicity, religion, upbringing and beliefs play major role in the process and counsellor has to be familiar with these factors.
8, Examine defences and coping styles
When rapport between client and counsellor has developed clients are more willing to discuss their behaviour. Some of the coping styles can be dangerous( alcohol and drug abuse) and not making adjustment to the loss. Counsellor has to be alert and inquire about this as heavy drug or alcohol use can intensify the grief and depression. As a general rule, normal grief does not warrant the use of antidepressants. While medication may relieve some of the symptoms of grief, it cannot treat the cause, which is the loss itself. Furthermore, by numbing the pain that must be worked through eventually, antidepressants delay the mourning process. Counsellor can help with active emotional coping which seems to be most effective way to deal with bereavement. This techniques includes using humour ,reframing and redefining difficult situation.
9, Identify Pathology and refer
In some cases counsellor may recognize a pathological difficulties in client’s behaviour .Some people will not be able to coop and will continue to struggle. This can develop to some type of complicated grief. .In this case counsellor will have to refer client for different type of psychotherapy. Left untreated, complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. To summarize grieving process is natural reaction to the loss It is personal highly individual experience. There is impossible to set a time scale or ask when grieving process is finished.
Bowlby(1980) and Parkes (1972) both say that grieving is finished when a person completes the final phase of restitution. There is a sense in which grieving can be finished when people regain an interest in life, feel more hopeful and adapt to the change. In lots of cases grief counselling is helpful but as a therapists we have to accept that not every grieving person needs counselling and for those who do need it counselling has to be customized as grief is unique to each individual ( Neimeyer,2000)
Bowlby,J.(1980) Attachment and loss ,New York:Basic Books
Kubler-Ross,E.(1969) On death and dying. New York:Macmillan
Neimeyer,R.(Ed).(2001) Meaning reconstruction and experience of loss. Washington D.C :American Psychological Association Parkes,C.M.(1972).Bereavement:Studies of grief in adult life.New York:International University Press. Sanders,C. (1989 ) Grief:the mourning after.New York Wiley
Worden,W.J.(2009) Grief counselling and grief therapy.A handbook for the Mental Health Practitioner New York: Springer Publishing Company