GRIEF THERAPY

JASMEEN KAUR
CLINICAL PSYCHOLOGIST
 Definitions

 The Old English term reave or bereafian has become our modern word
‘bereavement’. The archaic definition included ‘to be robbed’ or ‘deprived of
something valuable’ (Chambers Dictionary, 1995).

 In contemporary society bereavement most commonly refers to the death of a

significant person. Bereavement can be expressed in culturally various acts of
mourning, for example; funeral ceremonies, or ritualized withdrawal from public
activities.

 ‘Grieving’ refers to the psychological component of bereavement, the feelings

evoked by a significant loss, especially the suffering entailed when a loved person
dies.
 Beareavement: refers to loss.
 Grief: Emotional, cognitive, functional and behavioural responses to death.
 Mourning: Behavioural manifestations of grief.

 Attachment Theory

 Attachment comes from a need for safety and security.

 When the attachment figure disappears or is threatened, response is intense anxiety and emotional
protest.
 Bowlby concludes that there are good biological reasons for every separation to be responded to an
automatic, instinctive way with aggressive behaviour.

 https://www.verywellmind.com/what-is-attachment-theory-2795337
 Manifestations of normal grief

 Feelings
 Physical sensation
 Cognitions
 Behaviour

 Feelings
 Sadness: it is the most common feeling in the bereaved people. Often manifested by crying.
 Anger: it is frequently experienced after a loss. It comes from two sources:

1) from a sense of frustration that there was nothing one could do to prevent death.
2) From a kind of regressive experience after a loss of close one.
 Guilt and self reproach: usually the guilt is manifested over something that happened or something
that was neglected at the time of death. Most of the time it is irrational.
 Anxiety: survivors fear they will not be able to take care of themselves on their own. Second,
heightened sense of personal death awareness.
 Loneliness: feeling frequently expressed by those who have lost spouse or who were used to a
close day by day relationship.
 Helplessness: feeling that is frequently experienced. The person feels powerless in the situation.
Feels that it is something out of his hands and could not do anything for the deceased loved one

 Physical Sensation
 Commonly reported sensations experienced by people in grief;

1) tightness of chest and throat, dry mouth.

2) Oversensitivity to noise
3) Sense of depersonalisation.
4) breathlessness.
5) Weakness in muscles, lack of energy.
 Cognitions

 Disbelief: it it often the first thought that comes to mind especially if the death was sudden.

 Confusion: many newly bereaved people say that there thinking is very confused, they have
difficulty in concentrating.

 Preoccupation: this is an obsession with the thoughts of deceased. Sometimes preoccupation takes
form of intrusive thoughts or images of deceased person.

 Sense of presence: in this the grieving person may think the deceased is somehow still in the
current area of time and space.

 Hallucinations: they are usually transient illusory experiences occurring within weeks of loss. They
can visual or auditory type.
 Behaviours

 Sleep disturbances: difficulty going to sleep, early morning awakening. Sometimes require
medications but in normal grief they usually correct themselves.
 Appetite disturbances: can manifest in both overeating and undereating. Undereating is more
frequently seen.
 Social withdrawal: its common to withdraw from other people after a loss.
 Absent mindedness: newly bereaved people may find themselves acting in absent minded way or
doing things that may ultimately harm them.
 Visiting places or carrying things that reminds them of the deceased.
 Some people avoid the places or things that trigger painful feelings of grief.
 Dreams of the deceased: it can be a normal kind of dream or a distressing one or even a
nightmare.
MODELS OF GRIEF
 Grief is universal. At some point in everyone’s life, there will be at least one encounter with grief. It may
be from the death of a loved one, the loss of a job, the end of a relationship, or any other change that
alters life as you know it.

 Grief is also very personal. It’s not very neat or linear. It doesn’t follow any timelines or schedules. You
may cry, become angry, withdraw, feel empty. None of these things are unusual or wrong. Everyone
grieves differently, but there are some commonalities in the stages and the order of feelings experienced
during grief.

 One model of grief: Elisabeth Kübler-Ross’ popular “Five Stages of Grief” model. Although not much
evidence has been found to support this model, it has stuck around in popular culture.

 In 1969, a Swiss-American psychiatrist named Elizabeth Kübler-Ross wrote in her book “On Death and
Dying” that grief could be divided into five stages. Her observations came from years of working with
terminally ill individuals.

 Her theory of grief became known as the Kübler-Ross model. While it was originally devised for people
who were ill, these stages of grief have been adapted for other experiences with loss, too.
 The five stages of grief are:
 denial
 anger
 bargaining
 depression
 acceptance

 Not everyone will experience all five stages, and you may not go through them in this order.

 Grief is different for every person, so you may begin coping with loss in the bargaining stage and
find yourself in anger or denial next. You may remain for months in one of the five stages but skip
others entirely.
 Stage 1: Denial

 Grief is an overwhelming emotion. It’s not unusual to respond to the intense and often sudden
feelings by pretending the loss or change isn’t happening. Denying it gives you time to more
gradually absorb the news and begin to process it. This is a common defense mechanism and helps
numb you to the intensity of the situation.
 As you move out of the denial stage, however, the emotions you’ve been hiding will begin to rise.
You’ll be confronted with a lot of sorrow you’ve denied. That is also part of the journey of grief, but it
can be difficult.

 Examples of the denial stage

 Breakup or divorce: “They’re just upset. This will be over tomorrow.”

 Job loss: “They were mistaken. They’ll call tomorrow to say they need me.”
 Death of a loved one: “She’s not gone. She’ll come around the corner any second.”
 Terminal illness diagnosis: “This isn’t happening to me. The results are wrong.”
 Stage 2: Anger

 Where denial may be considered a coping mechanism, anger is a masking effect. Anger is hiding
many of the emotions and pain that you carry. This anger may be redirected at other people, such as
the person who died, your ex, or your old boss. You may even aim your anger at inanimate objects.
 While your rational brain knows the object of your anger isn’t to blame, your feelings in that moment
are too intense to feel that.
 Anger may mask itself in feelings like bitterness or resentment. It may not be clear-cut fury or rage. Not
everyone will experience this stage, and some may linger here. As the anger subsides, however, you
may begin to think more rationally about what’s happening and feel the emotions you’ve been pushing
aside.

 Examples of the anger stage

 Breakup or divorce: “I hate him! He’ll regret leaving me!”

 Job loss: “They’re terrible bosses. I hope they fail.”
 Death of a loved one: “If she cared for herself more, this wouldn’t have happened.”
 Terminal illness diagnosis: “Where is God in this? How dare God let this happen!”
 Stage 3: Bargaining

 During grief, you may feel vulnerable and helpless. In those moments of intense emotions, it’s not
uncommon to look for ways to regain control or to want to feel like you can affect the outcome of an
event. In the bargaining stage of grief, you may find yourself creating a lot of “what if” and “if only”
statements.
 It’s also not uncommon for religious individuals to try to make a deal or promise to God or a higher power
in return for healing or relief from the grief and pain. Bargaining is a line of defense against the emotions
of grief. It helps you postpone the sadness, confusion, or hurt.

 Examples of the bargaining stage

 Breakup or divorce: “If only I had spent more time with her, she would have stayed.”
 Job loss: “If only I worked more weekends, they would have seen how valuable I am.”
 Death of a loved one: “If only I had called her that night, she wouldn’t be gone.”
 Terminal illness diagnosis: “If only we had gone to the doctor sooner, we could have stopped this.”
 Stage 4: Depression

 Whereas anger and bargaining can feel very “active,” depression may feel like a “quiet” stage of grief.
 In the early stages of loss, you may be running from the emotions, trying to stay a step ahead of them. By
this point, however, you may be able to embrace and work through them in a more healthful manner. You
may also choose to isolate yourself from others in order to fully cope with the loss.
 That doesn’t mean, however, that depression is easy or well defined. Like the other stages of grief,
depression can be difficult and messy. It can feel overwhelming. You may feel foggy, heavy, and
confused.
 Depression may feel like the inevitable landing point of any loss. However, if you feel stuck here or can’t
seem to move past this stage of grief, talk with a mental health expert. A therapist can help you work
through this period of coping.

 Examples of the depression stage

 Breakup or divorce: “Why go on at all?”

 Job loss: “I don’t know how to go forward from here.”
 Death of a loved one: “What am I without her?”
 Terminal illness diagnosis: “My whole life comes to this terrible end.”
 Stage 5: Acceptance

 Acceptance is not necessarily a happy or uplifting stage of grief. It doesn’t mean you’ve moved past
the grief or loss. It does, however, mean that you’ve accepted it and have come to understand what
it means in your life now.
 You may feel very different in this stage. That’s entirely expected. You’ve had a major change in
your life, and that upends the way you feel about many things. Look to acceptance as a way to see
that there may be more good days than bad, but there may still be bad — and that’s OK.

 Examples of the acceptance stage

 Breakup or divorce: “Ultimately, this was a healthy choice for me.”

 Job loss: “I’ll be able to find a way forward from here and can start a new path.”
 Death of a loved one: “I am so fortunate to have had so many wonderful years with him, and he will
always be in my memories.”
 Terminal illness diagnosis: “I have the opportunity to tie things up and make sure I get to do what I
want in these final weeks and months.”
The 7 stages of grief

 The seven stages of grief are another popular model for explaining the many complicated
experiences of loss. These seven stages include:
 Shock and denial. This is a state of disbelief and numbed feelings.
 Pain and guilt. You may feel that the loss is unbearable and that you’re making other people’s
lives harder because of your feelings and needs.
 Anger and bargaining. You may lash out, telling God or a higher power that you’ll do anything
they ask if they’ll only grant you relief from these feelings.
 Depression. This may be a period of isolation and loneliness during which you process and reflect
on the loss.
 The upward turn. At this point, the stages of grief like anger and pain have died down, and you’re
left in a more calm and relaxed state.
 Reconstruction and working through. You can begin to put pieces of your life back together and
carry forward.
 Acceptance and hope. This is a very gradual acceptance of the new way of life and a feeling of
possibility in the future.
 As an example, this may be the presentation of stages from a breakup or divorce:
 Shock and denial: “She absolutely wouldn’t do this to me. She’ll realize she’s wrong and be back
here tomorrow.”
 Pain and guilt: “How could she do this to me? How selfish is she? How did I mess this up?”
 Anger and bargaining: “If she’ll give me another chance, I’ll be a better boyfriend. I’ll dote on her
and give her everything she asks.”
 Depression: “I’ll never have another relationship. I’m doomed to fail everyone.”
 The upward turn: “The end was hard, but there could be a place in the future where I could see
myself in another relationship.”
 Reconstruction and working through: “I need to evaluate that relationship and learn from my
mistakes.”
 Acceptance and hope: “I have a lot to offer another person. I just have to meet them.”
Differences between grief and depression

You can expect to grieve and feel sad after a loss, but prolonged feelings of sadness and
hopelessness could mean that you have depression.
Everyone grieves differently. Some people may have symptoms that are very similar to depression,
such as withdrawal from social settings and intense feelings of sadness. However, there are very
important differences between depression and grief.
 Symptom duration. People with depression feel depressed almost all the time. Grieving people
often have symptoms that fluctuate, or come in waves.
 Acceptance of support. People with depression often begin to isolate themselves and may even
shun others. People who are grieving may avoid vibrant social settings, but they often accept
some support from loved ones.
 Ability to function. Someone who is grieving may still be able to go to work or school. They may
even feel that participating in these activities will help occupy their mind. However, if you’re
clinically depressed, you may experience symptoms so severe that you’re unable to go to work or
do other important tasks.
 Grief can be a trigger for depression, but not everyone who grieves will experience depression.
MOURNING PROCESS
 British psychiatrist Colin Murray Parkes developed a model of grief based on
Bowlby's theory of attachment, suggesting there are four phases of mourning when
experiencing the loss of a loved one.

 Shock and numbness: Loss in this phase feels impossible to accept. Most closely
related to Kübler-Ross's stage of denial, we are overwhelmed when trying to cope
with our emotions. Parkes suggests that there is physical distress experienced in
this phase as well, which can lead to somatic (physical) symptoms.

 Yearning and searching: As we process loss in this phase, we may begin to look
for comfort to fill the void our loved one has left. We may try to do so by reliving
memories through pictures and by looking for signs from the person to feel
connected to them. In this phase, we become very preoccupied with the person we
have lost.
 Despair and disorganization: We may find ourselves questioning and feeling angry
in this phase. The realization that our loved one is not returning feels real, and we
can have a difficult time understanding or finding hope in our future. We may feel a
bit aimless in this phase and find that we retreat from others as we process our pain.

 Reorganization and recovery: In this phase, we feel more hopeful that our hearts
and minds can be restored. As with Kübler-Ross's acceptance stage, sadness or
longing for our loved one doesn't disappear. However, we move towards healing and
reconnecting with others for support, finding small ways to reestablish some
normalcy in our daily lives.
TASKS OF MOURNING

Psychologist J. William Worden provides a framework of four tasks that help us

understand how people journey through grief. Healing happens gradually as grievers
address these tasks, in no specific order, going back and forth from one to another over
time.

Worden doesn't believe grief is a passive progression of stages that a person is carried
through. Rather, Worden empowers mourners to actively engage with four tasks.

Worden's four tasks of grieving are:

 1. Accept the Reality of the Loss

 Some denial can serve a purpose in that it allows you to slowly absorb the full
weight of the loss. However, remaining or idling in denial is the antithesis of
acceptance. You must confront your own denial and accept that the loss has
occurred.

 Acceptance is the surrendering to reality as it is. Therefore, you must acknowledge

the loss and not pretend that it didn't happen. Your loved one died. Your company
passed on you for that position. Your partner said no to your marriage proposal.
You cannot make loss disappear through denial. Acceptance is the first step
towards adapting and moving forward.
 2. Experience the Pain of Grief

 For whatever reason, we are afraid to feel in our culture. We take pills, distract
ourselves with entertainment, and generally avoid discomfort, but this isn't helping
us. Avoidance compounds our pain.

 You must experience the pain of what you have lost. Allow the emotion into your
consciousness and take proper steps to process the feelings. You can process with a
trusted friend, mentor, or family member.

 Yet, there are many ways to process emotion outside of words. If writing a song,
painting a picture, or making a video is your thing, then by all means, do what works.
Feelings of grief and pain are natural. What isn't natural is suppressing those
emotions.
 3. Adjust to an Environment With the "Deceased" Missing

 Life is not the same now that your marriage has ended, your friend has moved
away, your work has laid you off, or your loved one has died. You may feel like
adjusting to life without your loved one is a betrayal of your loved one, that
pursuing another goal is a betrayal of your dream, or that getting closer with a
new friend is a betrayal of your friend who moved away.

 This kind of reasoning can leave people stuck. You have to adjust and adapt to
the new normal, which entails reorienting and restructuring what you do
without your loved one in the picture.
 4. Find an Enduring Connection with the "Deceased" While Embarking on a New
Life

 Even though that part of you is gone and irretrievable as a result of the loss, what
was is still part of who you are. The joy and warmth you experienced from your
deceased loved one will always be with you. Try to think of the time you had with
them as a gift. Rather than focus on what you lost, put your attention on what you
received from your loved one.

 When dreams die, there can be blessings and curses. With the passing of your
dream comes realizations of other passions. So, start out on a new life, but keep
with you those cherished moments and memories as a source of joy and strength.
You are stronger for having known your loved one. You are better for having
shared those years together.
"Cheap" Grief

 Engaging with the four tasks empowers you to adjust to a new normal and
continue with the stuff of life. But too many want the moving-forward part without
the hard work. A kind of "cheap" grief process isn't really moving forward at all.
It's ignoring and avoiding, which actually accomplishes the opposite. It keeps you
stuck.

 "Cheap" moving forward cements you where you are. Physically, you are getting
older, your kids are growing up, and the place you live is changing; but inside,
you are still in that same place.
COMPLICATED GRIEF
• While the intensity of grief usually fades with time for most people, these feelings
don't improve for people with complicated grief. They might be so intense that
they disrupt their day to day lives.

• A person with complicated grief might also display certain dysfunctional behaviors
and might experience irrational thoughts, such as thoughts that the person who
has died might come back to life. It’s a chronic form of grief that could impair one’s
life. When grief lingers, complicated grief occurs. About 7% of bereaved people
might experience complicated grief.

• Complicated grief, also known as complicated bereavement disorder

Symptoms
• The signs and symptoms of complicated grief are similar to normal grief. However,
whereas symptoms fade with time with normal grief, people with complicated grief
experience them more intensely and persistently.

• Some signs to look out for include:

• Excessively avoiding reminders of their loss
• Obsessively thinking about their loss
• Intense longing for a person who has died
• Feeling a sense of loss of purpose in life
• Excessively seeking proximity to reminders of things that remind them of the person
they’ve lost
• Suicidal thoughts
• Being unable to accept that the loss has occurred
• Experiencing persistent and intrusive thoughts about the person you’ve lost
• Symptoms of complicated grief might also manifest physically.

• People with the condition might experience:

• Loss of appetite
• Insomnia
• Stress
• Weakened immune function
How to Identify Complicated Grief

• Grief is a normal reaction to losing a loved one. When it is persistent and

accompanied by dysfunctional behaviors and nonadaptive thoughts, it becomes
complicated.
• In a 1997 study, a team of mental health experts came up with a diagnostic standard
for complicated grief. They proposed the following diagnostic criteria to help
determine whether a person has complicated grief or not. These include:
• The loss occurred at least 6 months ago
• Symptoms of persistent and acute grief, which might include a yearning for the
person who has died, feelings of loneliness, preoccupying thoughts about the person
who has died
• At least two of any symptoms of shock, anger, difficulty trusting other people, inability
to accept death.
• Symptoms persist for more than a month
• Symptoms cause significant impairment in a person’s life
Other features of complicated grief might include:

• Having trouble continuing with their regular routines

• Avoiding places or activities that remind them of the person they lost
• Sleeping problems
• Lack of interest in one’s self-care
• Reckless, impulsive, and potentially self-destructive behavior

• Some people believe that if you are still experiencing feelings of acute grief six
months to a year after a loss occurs, then you might have complicated grief. But this
isn’t a hard and fast rule.
Complications

• Many symptoms of complicated grief might look like symptoms of depression. In

certain cases, complicated grief might even evolve into depression. Depression
can occur alongside complicated grief and worsen the symptoms of the
condition.

• In cases where death is violent and sudden, a person might also

experience PTSD. When complicated grief goes untreated some complications
might develop including:
• Suicide and suicidal thoughts
• Anxiety
• Substance abuse
• Depression
Causes

• There is no identifiable cause of complicated grief, but some people might be more
at risk of developing the condition than others. Certain risk factors might make a
person more susceptible to experiencing the condition, including:

• People who experience an unexpected or shocking death of a loved one

• People with a history of mental disorders
• People with a history of substance abuse
• People who experience more than one death within a short period
• Not being present when the loss occurred
• Witnessing the loss in real-time
COMPLICATED GRIEF VS. DEPRESSION
Depression Complicated Grief

• depression cannot be caused by an emotional • complicated grief is typically sparked by a

state, but rather a chemical influence in the traumatic event, such as loss of a loved one.
brain. • complicated grief is specific and can be
• Depression is a constant feeling of sadness. pinpointed to loss of a loved one

• For depressed individuals, there is nothing that • This severe form of grief is often characterized
can change their feelings of extreme sadness, by a long period of sadness.
distantness, or hopelessness, and it does not • person suffering from complicated grief may feel
come or go in waves, rather existing as a waves of happiness or normalcy when around
consistent flatness. certain support systems or in certain situations,
and then triggering reminders of the loved ones
• People suffering from major depressive
can snap them back into bereavement.
disorder can also display feelings of guilt,
might feel guilty all the time. • A person with complicated grief may feel guilty
they did not die along with their loved one
GRIEF COUNSELLING
• Grief counseling, also known as bereavement therapy, is a form of therapy
intended to help you cope with loss, like the death of a partner, family member,
friend, colleague, or pet.

• Grief counseling can help you navigate the aftermath of a loss and make
practical decisions, like funeral arrangements.

• In the long run, it can help you accept the loss of your loved one and adapt to life
without them.
• The goals of grief or bereavement counseling can include four main stages such
as:
• To accept the reality of the loss
• To work through the pain of grief
• To adjust to life without the deceased
• To maintain a connection with a loved one you’ve lost while finding ways to move
on with life.

• The main goal of most grief counseling is to help the client integrate the reality of
their loss into their life going forward, and helping them to maintain a healthy bond
to the loved one they lost (Neimeyer, 2013).
• According to Dr. Robert A. Neimeyer, there are two important first steps for working with a
new client reeling from their loss:

Processing the Event Story of the Death

• Clinicians working with a bereaved client will first encourage the client to engage in a
healing re-telling of the loss. The clinician must create a safe space for the client to open
up and build trust, so when the time comes to help the client rewrite the story of their loss,
they are able to communicate effectively with the clinician.

Accessing the Back Story of the Relationship

• In addition to hearing about the loss event itself, the clinician will also learn about the
client’s relationship with the loved one they lost. As Neimeyer says, “Death may end a life,
but not necessarily a relationship.” The clinician will guide the client through learning how
to reconstruct their bond with their loved one rather than relinquishing it (Neimeyer, 2013).
3 Techniques used in Grief Counseling

• Three of the biggest things a good grief counselor can do for their client are to:

• Let them talk about the deceased; ask them about the person, and allow them to speak about their lost
loved one in a safe space.

• Distinguish grief from trauma; if the client is struggling to get an image out of their head or experiencing
flashbacks to the moment they learned of their loved one’s death, they are experiencing trauma, which
can keep them from working through their grief.

• Deal with any guilt they are feeling and help them organize the grief; the client may feel guilty about what
they did or didn’t do while their loved one was alive, or they may feel guilty about not feeling “sad enough”
or moving on while their loved one is dead. Encourage them to let go of the guilt and commit to living a life
that will honor the deceased, even if that means forgetting about them for a little while
• Dr. Kenneth Doka recommends encouraging clients to use rituals to connect with their
loved one and carry on despite their grief. These four types of rituals can help:

• Rituals of Continuity – These rituals establish that the lost loved one is still a part of the
client’s life, that the bond is still there.

• Rituals of Transition – This type of ritual marks a significant change that has occurred in
the grief response, such as cleaning out the room of the deceased or donating their
belongings.

• Rituals of Affirmation – In this ritual, the client can discharge any built-up regret by writing
a letter or a poem to the deceased thanking them for their love and support.
• Rituals of Intensification – These rituals connect group members and reinforce their
common identity; a military unit may gather periodically to remember their fallen
comrades or the survivors of an act of violence may revisit the site and place flowers or
erect a memorial to those they lost (Wheeler-Roy & Amyot, 2004).

• Smaller, everyday rituals can also be helpful for those grieving a loss; these are called
Rituals to Commemorate, and include things like lighting a candle and thinking of the
loved one, watching home videos or going through old pictures of the loved one, traveling
to a place the loved one always wanted to visit, or visiting the burial site and leaving a
tribute or symbolic item, like flowers or a balloon.

• The mental health professional will not always encourage or apply the same
techniques equally; there are a million different ways to grieve, and every healthy
method of grieving is valid.
• There are two poles in grieving, with people falling anywhere on the spectrum
between. The poles are “Intuitive Griever” and “Instrumental Griever.”

• The Intuitive Griever experiences feelings associated with their grief intensely
and is open with expressions of their grief (e.g., crying, lamenting their loss). For
them, successful strategies to cope with their grief involve facilitating their
experience and expressing their feelings.

• They may experience prolonged periods of confusion, inability to concentrate,

disorganization, and disorientation, and they might also suffer from physical
exhaustion and/or anxiety.
• The Instrumental Griever is more prone to thoughts of grief than feelings of grief and is often
reluctant to talk about their feelings. They prioritize mastery of themselves and their environment
and find success in problem-solving strategies. They may experience brief periods of cognitive
dysfunction, like confusion, forgetfulness, and obsessiveness, and they may have increased
energy levels (Wheeler-Roy & Amyot, 2004).

These are some of the techniques that grief counselors or therapists may use:

• Acceptance and Commitment Therapy (ACT): ACT is a form of psychotherapy that

encourages you to accept negative feelings and circumstances so you can begin to focus on
healthier patterns that can help you reach your goals.

• Cognitive Behavior Therapy (CBT): CBT is also a form of psychotherapy. It involves

identifying and changing thought patterns that can negatively influence your behavior.
• Group Therapy: This form of therapy is carried out in a group setting. It can be comforting to
share your feelings with other people who are going through the same thing you are and work
toward recovery together.

• Art Therapy: Art therapy uses creative forms to express your emotions and promotes healing. It
can be helpful to people of all ages, including children, who may struggle to communicate their
feelings.

• Play Therapy: Play therapy is often used to help gain insights into a child’s thoughts and feelings
in order to help them process unresolved emotions and build constructive behavior patterns.

• Thus, Grief counseling involves talking about the person you lost, your relationship with them,
how they died, how their death has impacted you, and how you’re coping with it.
• What Grief Counseling Can Help With

• Grief counseling can help you identify and express your emotions. If you have lost someone who was an
integral part of your life, grief counseling can also help you rebuild your routine and your identity.

Expressing Your Emotions

• In the aftermath of a loss, you may experience a range of emotions that can include:
• Shock, Numbness, Sorrow, Yearning
• Anger, Denial, Helplessness, Regret, Guilt, Anxiety
• For instance, you may not just feel saddened by losing a loved one, you may also feel
angry at them for leaving you. Maybe you regret something you said to them before they
passed.

• It can sometimes be difficult to admit these feelings to others, or even yourself. However,
harboring unresolved issues can take a toll on your mental and physical health and
make it difficult for you to move on.

• Grief counseling can offer a safe space for you to express your emotions and process
them so that you can start healing. You may find that you experience these emotions in
different stages; grief counseling can help you navigate each stage and reach
acceptance.
Rebuilding Your Routine

• If you lived with the person you lost, or if they were a part of your daily routine in some
way, it can be difficult to approach certain spaces or activities without them.

• Additionally, it can also be stressful to figure out how to take on certain tasks yourself. For
example, if your partner managed your finances or certain household tasks, you may
have to take on those roles yourself.

• A grief counselor can help you address your anxiety around these issues, work with you
on a plan to tackle them at a pace you’re comfortable with, and gradually rebuild your
routine.
Redefining Your Identity

• When you lose someone very close to you, like a partner or family member, for instance,
you may feel like you have lost a certain part of your own identity as well.

• Grief counseling can help you redefine your identity by encouraging you to focus on
your other interests or relationships. It can also equip you with the skills and confidence
you need to try new hobbies, reach out to other people, and build a support system for
yourself.

• You may also find that you gain a new identity, like “widow” or “single parent” if you
have lost a spouse, for instance. Grief counseling can help you explore what this means
to you and how you can deal with adopting these new identities.
Benefits of Grief Counseling

• Grief counseling can offer you several benefits, which can include:

• Fewer physical and emotional symptoms

• Development of coping skills that can help you adapt to life without your loved one

• Improved self-awareness, as you start to understand what you are feeling and why

• Acceptance of your loss, which involves integrating it into your reality and maintaining a healthy
bond with the person you lost, as you move forward with your life
GOALS
• Resolve the conflicts of separation

• Better adapt to the death

• Resolution of these conflicts- patient to experience thoughts & feelings that he or

she has been avoiding.

• Therapist provides the social support necessary & gives the patient permission to
grieve
Procedures

1. Rule Out Physical Disease

• Grief may present with somatic symptoms • Important to rule out actual disease

2. Set Up the Contract and Establish an Alliance -Patient agrees to explore his or her relationship
with deceased -Past relationships-explored only if they directly affect response to the immediate
bereavement.

3. Revive Memories of the Deceased

• Talk about the person • Build groundwork of positive memories- help the patient if he or she is
resisting experiencing negative feelings • If the patient comes to treatment aware of only negative
feelings-positive memories and affects need to be retrieved • In case of multiple losses-explore the
least complicating first
• 4. Assess Which of the Four Mourning Tasks the Patient Is Struggling With
• I- Nature of the attachment to the deceased
• II- Ok to have mixed feelings. Redefine the relationship
• III - a: Problem solving/role playing
-b: Helped to explore how the loss has affected sense of self
• IV- Permission to stop grieving -Sanctioning new relationships -Moving on with life is not an
affront to the memory of the lost loved one.

• 5. Deal With Affect or Lack of Affect Stimulated by Memories

• -Explore ambivalent feelings which are undersurface -In case of a violent death-patient may
focus on only the disturbing aspects
• -Help remember the deceased in a positive and comforting way
• -Guilt- reality testing is important
• 6. Explore and Defuse Linking Objects Symbolic objects (belongings/ reminders)
• Represent the conflicting wish to annihilate the deceased & at the same time keep him or her alive
• Both of these wishes are condensed in the linking object
• Different from keepsakes/token of remembrance which don’t create so much anxiety when lost •
Useful to bring for therapy- towards the end, if patients themselves stop bringing it -therapy was
effective.

7. Help the Patient Acknowledge the Finality of the Loss • “Chronic hope for reunion.” • Important to
assess-may reflect hope for decision making/inability to lead an independent life

8. Design a New Life Without the Deceased • Envision what they would want for themselves •
Articulate new life goals
• 9. Assess and Help the Patient Improve Social Relationships • Friends may avoid due to
uncomfortable situations(mourning) • Often feel stigmatized in social settings-avoid the same.

• 10 Help the Patient Deal With the Fantasy of Ending Grieving • What would they lose in giving up
the grief-some feel they will forget the person • Some feel relinquishing grief-make others think
they didn’t care.
Techniques

• A)Gestalt therapy technique of the empty chair(Barbato & Irwin, 1992) • Talking to the deceased
has a greater impact than talking about the deceased • Useful for completing unfinished
business, handling guilt and regrets • Alterations-having the patient switch chairs and talk for the
deceased as well as to the deceased.

• Grief Resolution Therapy Modification of Gestalt therapy technique 3 phases

• 1) Cognitive restructuring for decision to re-grieve
• 2) Using guided imagery -Relive -Revise -Revisit -Final scene
• 3) Future oriented identity reconstruction
• Cognitive behavioral therapy (CBT)
• Cognitive behavioral therapy is a form of therapy that involves learning to identify negative
thought patterns so you can work to change them. This treatment is based on the fundamental
premise that by learning to cope with your negative thoughts and behaviors, you can relieve
symptoms and live a healthier, more productive life day to day. If you are looking for a more
action oriented, you can search for therapists specifically trained in CBT. CBT has been proven
in study after study to be one form of therapy that results in substantial improvement in quality of
life. It’s actually even as, if not more, effective than several other types of therapy.

• Cognitive behavioral therapy (CBT) for grief works by helping you become aware of your
negative thought patterns. These patterns can lead to behaviors that make it difficult to process
grief. During CBT sessions, a therapist might ask you to discuss what you’re thinking about or
feeling in terms of your grief. Identifying these negative thought patterns can help you
understand how they’re affecting your behavior. CBT grief therapy tools that are used to promote
healing often include:
• Cognitive Reframing or Restructuring: Cognitive reframing or restructuring helps you become
aware of negative thought patterns or distortions. You work through sessions to first identify
negative thought patterns, so you can begin to take healthy steps to change them.

• Targeting Behaviors: Targeting behaviors involves addressing unhelpful or harmful behaviors or

habits and replacing them with helpful ones.

• Developing a New Narrative: This technique helps you come up with a new narrative about your
loss. It eases negative thoughts and feelings, rather than dwelling on them.
Acceptance and commitment therapy (ACT)

• Acceptance and commitment therapy helps you learn to accept negative emotions and situations
and then develop healthy patterns. It hones in on your ability to enhance psychological flexibility,
so you can accept your feelings instead of trying to run away from them, feeling guilty about
them, or avoiding them altogether. Psychological flexibility is the ability to be very present and in
the moment in your life.

• Acceptance and commitment therapy (ACT) uses mindfulness to help you process grief and
accept loss. This type of therapy can be used for prolonged or complicated grief that lasts for a
year or more after a loss occurs. ACT helps you reprocess a loss emotionally. It also helps you
begin to process any emotions you might have been avoiding dealing with. ACT uses several
grief therapy techniques to achieve acceptance and healing. These can include:
• Accepting negative feelings and emotions
• Distancing from negative feelings and emotions in order to understand them
better
• Focusing on the present
• Observing yourself experiencing different situations and circumstances
• Identifying your values
• Overcoming difficulties through the use of the previous techniques
Traumatic grief therapy

• Traumatic grief therapy allows you to process a sudden trauma-related grief – for example, losing
a loved one unexpectedly. This form of therapy looks at trauma response and the grief that’s
associated with a traumatic (usually unexpected) death.

Complicated grief therapy (CGT)

• CGT involves learning to address the symptoms of complicated grief. This form of grief may result
in feelings of hopelessness and prolonged, intense sadness. Those experiencing complicated
grief may fixate on the person they lost, or on the circumstances surrounding the death. CGT
often includes acceptance and commitment therapy.
Group Therapy

• Group therapy for grief is when small groups of individuals gather to share thoughts and feelings
with others who are also grieving. Often, groups are made up of people who’re recovering from
similar experiences. Support groups can offer a brave and safe space for you to share and heal
in a confidential, supportive, loving environment.
Art therapy

• Art therapy uses creativity to promote healing and help you process your grief. It can support,
improve, and restore functioning and a sense of well-being. The idea behind art therapy is the
belief that artistic and creative self-expression can have a healing effect on us. Painting, drawing,
coloring, making collages, and even sculpting are all common activities during art therapy
sessions.
• Role-playing psychodrama • Play the role of both themselves and the deceased person • Talking
back and forth until a particular conflict is resolved.

• Homework • Monitoring of affect and paying attention to the cognitions that stimulate the affect •
Letters to the deceased can be written & shared with the therapist • Makes the therapy shorter
and more effective
• Counsellor’s Own Greif • Bereavement in others also touches the counselor personally in three
ways
• 1) Aware of our own losses
• 2) Counselor’s own feared losses
• 3) One’s own personal death awareness
• Thus explore one’s own history(s) of loss(s)

Stress & Burnout

• Professional burnout-progressive professional ineffectiveness- under too much stress that is badly
managed • 3 guidelines:-
1) Know your own personal limitations.
2) Can avoid burnout by practicing active grieving
3) Know how to reach out for help and know where his or her own support comes from
Tips for Coping with Grief
• In addition to the techniques and strategies listed above, counselors will likely also offer the following three
tips for those who are grieving.

Do not grieve alone

• It’s vital that you stay connected with others during this time. Your support system may include your
family, friends, leaders in your faith, a bereavement support group, and/or a licensed mental health
professional to help you cope.
• Your support system can help you:
• Make the funeral arrangements or help you with new responsibilities.
• Find peace and comfort through your faith’s mourning rituals.
• Share your grief with others who can relate.
• Work through your difficult emotions in a safe setting.
Take good care of yourself

• It can be easy to forget about our own needs when we are reeling from loss, but neglecting
yourself won’t help you effectively deal with your grief.
• Remember to:
• Do something creative to express your feelings (e.g., write something, paint, put together a
scrapbook, or play a musical instrument).
• Eat, sleep, and exercise to avoid adding physical fatigue to your emotional fatigue.
• Be patient with yourself and allow yourself to feel whatever you feel.
• Understand what triggers your grief and prepare for those triggers (e.g., plan to take a day or two
off of work, let your friends and family know you’ll need extra support, etc.).
Seek professional grief counseling

• Not everyone will need the services of a counselor or therapist during their grieving period, but it
can be very helpful for those who are really struggling. A qualified professional can help you
understand the grief process and give you the tools you need to cope with your emotions.

• While everyone grieves differently, these three tips are essential for anyone who must cope with
a profound loss.