Grief comes in different forms and affects each person differently. Webster’s dictionary describes grief as “deep sadness caused especially by someone’s death, a cause of deep sadness, and trouble or annoyance”. Grief is associated with loss; loss of people, place, or thing. It is a universal experience that happens to all life. In multicultural counseling a counselor should be able to effectively treat and deal with the issues of grief, as they relate to divers groups. The boundaries between normal and complicated grief is a process.
The factors of cultural, social and religious influence, also influences the grief and the level of anxiety that is raised due to that grief. Different people behave differently on the same sort of loss, and this makes it important to understand the impact which the loss has on the person. This diversity warrants further research on the topic of grief counseling and process interventions which have to be chosen in different circumstances with different people.
Grief Counseling and Process Intervention
Grief is a common reality of everyone’s life and almost all have to go through a phase where the loss is too big to handle. Altmaier (2011) states that, the strength of anxiety, stress and grief from a loss depends on the closeness and importance of that lost thing in the life of the person. Many researchers (Ober, et al., 2012; Howarth, 2011; Breen, 2011) have highlighted that death is one of the typical forms of complex loss that most people experienced at least once in their lives. The bereavement of loss of life can be far more devastating to an individual’s behavior and social functioning than any other type of losses.
Such bereavement is common in all cultures and there can seldom be a person who is not disturbed about the loss of a loved one (Howarth, 2011). However, the social detachment and the level of anxiety and depression after the loss can vary from culture to culture, closeness of relation with the deceased one, and the nature of the person. For this reason group counselors have to study and understand the nature and level of grief in order to use the correct strategy and process intervention for grief recovery (Altmaier, 2011).
The term ‘best practices’ has been used in relation with group counseling to analyze the practices that are mostly applicable with people in grief (Kato & Mann, 2009). However, several researchers (Baier & Buechsel, 2012; Ober, 2011) have canceled out this term and claimed that each case would stand different and unique from the other. Because of this, generalizing the grief counseling process and intervention can be unsuccessful. Understanding the varied state of mind and grief symptoms of anger, depression, loneliness, anxiety and other symptoms are necessary for group counseling (Baier & Buechsel, 2012).
The Impact of Loss and Bereavement
The research of Sussman (2011) founds that the grief and bereavement after a loss has different impacts on males, females and children. It has been discovered that men cope with a loss and their state of depression more quickly than women and children. The beginning of this fact can be related to the natural characteristics and the sensitivity of each individual, which is greater in women and children than in men. Stroebe, et al., (2009) separated the impact of loss into three phases and has illustrated that every individual that has experienced a loss will go through these three phases. The first phase is the instant shock where the person is in a mid-state of accepting the loss.
Many people take a long time to accept the fact that a certain loss has occurred (Stroebe, Stroebe, & Hansson, 2009). This has been a common view in the cases of deaths of loved ones, particularly with females and young children. This stage has the first reactions of mourning, yelling, protesting, showing anger and frustration loudly and not welcoming the occurrence of the loss (Howarth, 2011). In the second phase the loss is accepted mentally, but there remains the after effects of the loss, in the form of social impairment and detachment of the person from the social group and/or preferring to be alone (Stroebe, Stroebe, & Hansson, 2009). This is the phase where the counselors needs to get involved and observe the symptoms of the person and the duration of the loss event to know the technique and structure that needs to be used in such a situation Higgins (2009).
The third phase of acceptance, is on in which the person accepts the loss and develops the belief that nothing can change the reality and life has to move on (Stroebe, Stroebe, & Hansson, 1999). Allumbach & Hoyt (2009) focuses the fact that grief counseling should not be stopped early in this phase, as there are chances that the patient could return to the second phase again (Allumbach & Hoyt, 2009). The concept of cognitive therapy is introduced to be sure that the complete transaction of the person in grief takes place from the second phase of emotional distress and pain to the third phase of recovering and moving on with the life by suppressing the memories of the loss person or thing (Altmaier, 2011).
A complex perspective of the grief loss is in the context of young children. Malkinson (2010) underlines the cognitive learning procedure of humans and explains that children from age two- five do not have a solid understanding of loss or death (Malkinson, 2010). They carry likelihood that whatever is gone will return back one day. This is typical in the case of their deceased pets, siblings or parents. As they go into adolescence they develop a better understanding of death and that the departed will not return. A loss of loved one at this stage can be very challenging because the child is already dealing with the questions of self-identity and life-direction. This type of loss can block the mindset, behavior and thinking capability of the child Higgins (2009).
Process, Intervention, and Structure
Several theorists have addressed the fact that after a loss people usually feel lonely and prefer to be alone as they cannot fill the space made by the loss object or person (Watson & West 2006). A person being bankrupted and losing all his life savings in a flash has a high chance of getting isolated from the society and ending up as a depression patient or with physical disorders like brain tumor, high blood pressure or other disorders that happen due to stress and tension (Watson & West 2006). If a therapist is consulted in such a scenario then the first thing to do is to understand beliefs and conjectures which the person is carrying regarding the loss. They may think that people will make fun of them or they will lose their social status. They also may think that they will not be able to take care of their family and children etc.
These are the thoughts that the person develops in the second phase of loss. They can become mentally and emotionally weak, not able to look at the brighter side of the scenario or what is left (Baier & Buechsel, 2012). In the Task-Oriented Approach forwarded by Doel (2006), Eaton & Roberts (2002) shows that the mechanism of motor performance of each individual suffering from losses processed and structured with a technique to make the person believe that the intensity and level of loss is not as big as it is perceived by the person. In his study Doel (2006) defines the practice of using volunteers who can form group with the person to be treated and the volunteers. They will act if they have not had a much greater loss and can share how they have coped with it. This has proved to be a good strategy if conducted in a proper fashion and establishing that the events described by other are similar in nature but unique from one another (Eaton & Roberts, 2002).
The second task is of helping the person to erase the old memories related to that person, business or any other object. The motif here is not to separate the person from the loss, but to lessen the grief and bereavement that is closely associated to the memories of the loss (Eaton & Roberts, 2002). The task oriented intervention for grief counseling shows great limitations when it is implied for the grief therapy of parents who have lost their young children in an accident or been killed. Such cases were abundant after the devastating event of 9/11 and a lot of parents showed little or no recovery by the use of task oriented process and stayed in their state of depression and emotional pain. Brown (2006) has forwarded the Cognitive Behavioral Therapy (CBT) Model for the grief counseling of people in complicated bereavement like those who have experienced sudden death of a loved one, particularly their children.
The ground of this intervention is due to the difference between the rational and the irrational thinking of the distressed people. Irrational thinking makes them perceive their lives to be intolerable without the existence of the deceased one (Brown, 2006). In the CBT process, close bonds are developed with such people and they are given the chance to express the effect of such a loss on their present and future. This presumption, usually based on irrational thinking, is first replicated by other irrational support (Malkinson, 2010). For example, if a mother has lost her child then she is made to believe that her child will be remembered as the one who sacrificed his/her life and he/she would have attained a higher state in the heaven.
The parallel of the irrational thinking with other irrational belief was carried out in the study of Cigno (2006) on ‘Cognitive-behavioral practice’ with 18 mothers and 11 fathers whom children became victim of the street crimes or terrorist activities. Cigno found out that 72.4% of the parents in this research showed signs of improvement and were able to enter the second phase of loss grief to the third phase. At this stage, activities of social engagement and task oriented approach can be available to ensure maximum grief recovery of those people (Cigno, 2006).
The Complicated Grief Intervention Model (CGIM)
To empower the counselors and the social workers in treating complicated grief, there is a need of a model that can define the approach and plan of counselors when they are dealing with a bereaved person (Morris, 2006). The grief of loss of the loved one, a major business downfall or other losses which have a great impact on the outlook of one’s life can be included in complicated grief. The counselor assesses the need and the present condition of the bereaved one in the first step of the model. This is not limited to the emotional state, but also to the practical side; the work and family responsibilities of the bereaved one that are affected by the disposition of the person. These things can be assessed by using the narrative technique and asking the people about their stories related to the lost person or object.
A secondary assessment is also suggested where the friends or family members of the bereaved one are interviewed to know the extent of grief (Altmaier, 2011). When the counselor prescribes activities or medicines to the bereaved person this is the second stage is of intervention. It has been a common observation by many researchers (Watson & West, 2006; Silversides, 2011; Morris (2006) that counselors are not result-oriented in their intervention. Silversides (2011) discusses that many counselors do not plan the outcome of the activity and they do not regularly evaluate the success of the activity. Because of this practice the recovery is temporary. There have been cases reported to have developed the same state of depression and grief after the therapy was over (Silversides, 2011).
For instance, if a hobby is suggested to the bereaved person to exercise, some of the questions that need to be answered are: what will be the duration of the exercise? What end results it will bring or tend to bring? How will it help the bereaved person to replicate the negative irrational thinking with positive irrational thinking? What will be the consequences of the exercise after it is discontinued for more than 6 months? What will be the approach if the person develops the same state of mind again? Answering these questions prior to starting the intervention strategy will raise the probability of achieving desired results over the anticipated time (Drenth, Herbst, & Strydom, 2010).
It is evident that some part of the therapy, like counseling sessions and workshops cannot last forever and they need to be stopped after some period, while few of the routine activities can be carried on for a much longer period as the person wants to. It is necessary for the social worker or counselor to understand the significance of the activities and which are for finite period, and analyze if there would be a need to prolong, modify or substitute it with another activity as per the requirement of the person (Johnsen, Dyregrov, & Dyregrov, 2012). It is both natural and biblical to grieve. The reality is that no matter how happy those who have gone are, and how much they gain by the move, the loss is suffered , and trying to live in denial of this reality is not heroic but caving in to social or religious pressure that is not of God.
There is much evidence that those who confront their inner pain head-on, heal quickest. Inner pain will gradually retreat when we face it, but it will keep haunting us if we run from it. “Surely he hath borne our griefs, and carried our sorrows: yet we did esteem him stricken, smitten of God, and afflicted. But he was wounded for our transgressions, he was bruised for our iniquities: the chastisement of our peace was upon him; and with his stripes we are healed. All we like sheep have gone astray; we have turned everyone to his own way; and the LORD hath laid on him the iniquity of us all (Isaiah 53:4-6, KJV).
Grief is a natural occurring and almost every human goes through this phenomenon at some point of time in his or her life. The extent of grief is dependent on factors of closeness with the lost person or thing and the rational and irrational thinking that the person has developed after the loss. The state of complex grief or bereavement occurs mostly in the case of losing the love ones and entering into the state of loneliness, anger and depression. The degree of these symptoms is more pronounced in teen agers and women. It is for this reason that counselors have to understand the nature and extent of the grief and the irrational thinking that have been developed as a result to prescribe a therapy or activity that best suits the need of the bereaved one.
Allumbach, L., & Hoyt, W. (2009). Effectiveness of grief therapy: A meta-analysis. Journal of Counseling Psychology , 46, 370–380. Altmaier, E. (2011). Best Practices in Counselling Grief and Loss: Finding Benefit From Trauma. Journal of Mental Health Counseling , 33 (1), 33-47. Baier, M., & Buechsel, R. (2012). A model to help bereaved individuals understand the grief process. Mental Health Practice, 16(1), 28-32. Breen, L. (2011). Professionals’ experiences of grief counseling: implications for bridging the gap between research and practice. Omega, 62(3), pp. 285-303. Brown, H.C., 2006, ‘Counseling’, in R. Adams, L. Dominelli & M. Payne (eds.), Social work. Themes, issues and critical debates, pp. 139–148, Palgrave, London. Cigno, K., 2006, ‘Cognitive-behavioral practice’, in R. Adams, L. Dominelli & M. Payne (eds.), Social work. Themes, issues and critical debates, pp. 180–190, Palgrave, London. Doel, M., 2006, ‘Task-Centered work’, in R. Adams, L. Dominelli & M. Payne (eds.), Social work. Themes, issues and critical debates, pp. 191–199, Palgrave, London. Drenth, C., Herbst, A., & Strydom, S. (2010). A complicated grief intervention model. Journal of interdisciplinary Health sciences , 10 (1), 97-109. Eaton, Y.M. & Roberts, A.R., 2002, ‘Frontline crisis intervention: Step-by-step practice guidelines with case applications’, in A.R. Roberts & G.J. Greene (eds.), Social workers’ desk reference, pp. 89–96, University Press, Oxford. Higgins, P. C. (2009). Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner, Fourth Edition. Journal of Palliative Medicine, 12(7), 653-654. doi:10.1089/jpm.2009.9590 Holland, J. M., Neimeyer, R. A., Boelen, P. A., & Prigerson, H. G. (2009). The underlying structure of grief: A taxometric investigation of prolonged and normal reactions to loss. Journal of Psychopathology and Behavioral
Assessment, 31(3), 190-201. doi:http://dx.doi.org/10.1007/s10862-008-9113-1 Howarth, R. A. (2011). Concepts and controversies in grief and loss. Journal of Mental Health Counseling, 33(1), 4-10. Retrieved from Johnsen, I., Dyregrov, A., & Dyregrov, K. (2012). Participants with prolonged grief – how do they benefit from grief group participation. Omega, 65(2), pp. 87-105. Kato, P., & Mann, T. (2009). A sysnthesis of psychological intervention for the bereaved. Clinical Psychology , 16, 275-296. Malkinson, R. (2010). Cognitive-Behavioral Grief Therapy: The ABC Model of Rational-Emotion Behavior Therapy. Psychological Topics , 2, 289-305. Morris, T., 2006, Social work research methods: four alternative paradigms, SAGE Publications, Thousand Oaks. Ober, A. M., Granello, D. H., & Wheaton, J. E. (2012). Grief counseling: An investigation of counselors’ training, experience, and competencies. Journal of Counseling and Development: JCD, 90(2), 150-159. Retrieved from Silversides, A. (2011). When loss leads in new directions. Jane Simington shares hard-won lessons about healing. The Canadian Nurse, 107(6), 34-35. Stroebe, M., Stroebe, W., & Hansson, R. (1999). Handbook of Bereavement: Theory, Research, and Intervention. New York: Press Syndicate .