Grief and Bereavement

Grief

Grief is normal, and it is a process. Expressing grief is how a person

reacts to the loss of a loved one.

Many people think of grief as a single instance or as a short time of pain

or sadness in response to a loss – like the tears shed at a loved one’s
funeral. But grieving includes the entire emotional process of coping
with a loss, and it can last a long time. The process involves many
different emotions, actions, and expressions, all of which help a person
come to terms with the loss of a loved one.

We may hear the time of grief being described as "normal

grieving," but this simply refers to a process anyone may go
through, and none of us experiences grief the same way. This is
because grief doesn’t look or feel the same for everyone. And
every loss is different.

Mourning

Mourning often goes along with grief. While grief is a personal

experience and process, mourning is how grief and loss are shown in
public. Mourning may involve religious beliefs or rituals, and may be
affected by our ethnic background and cultural customs. The rituals of
mourning seeing friends and family and preparing for the funeral and
burial or final physical separation often give some structure to the
grieving process. Sometimes a sense of numbness lasts through these
activities, leaving the person feeling as though they are just “going
through the motions” of these rituals.

Grief is what’s going on inside of us, while mourning

is what we do on the outside.

Bereavement
 Grief and mourning happen during a period of time called
bereavement. Bereavement refers to the time when a person
experiences sadness after losing a loved one.

Grief Counselling and Grief Therapy

“Grief counselling” may refer to the counseling that any individual might
receive after losing a loved one, while “grief therapy” is more likely to refer to
sessions that a client engages in when they are experiencing issues outside of
the normal range of responses due to their grief.

For example, if a widow is simply struggling to cope with the loss of her
husband, she may seek grief counseling; however, if she has lost her appetite
and has had trouble sleeping for weeks, it may be a more serious problem that
she seeks grief therapy for.

“Each person’s grief is like all other people’s

grief; each person’s grief is like some other
person’s grief; and each person’s grief is
like no other person’s grief.”
It explains that every person’s grief is unique to him or her, and people’s
experiences shouldn’t be saddled with the term abnormal grief. The term
complicated mourning which affirms some kind of difficulty in the mourning
process that brings the person to the attention of mental health worker.
Affirmation of the uniqueness of grief is emphasized in the field of
bereavement. The neural network affecting various parts of brain and its
functions (affect processing, memory retrieval, visual imagery and autonomic
regulation) may account for the unique, subjective quality of grief to understand
the health consequences and neurobiology of attachment.

GOALS OF GRIEF COUNSELING

The overall goal of grief counseling is to help the survivor adapt to the loss of a
loved one and be able to adjust to a new reality without him or her. There are
specific goals that correspond to the four tasks of mourning:

(1) increasing the reality of the loss,

(2) helping the counselee deal with both the emotional and behavioral pain,

(3) helping the counselee overcome various impediments to readjustment after

the loss, and

(4) helping the counselee find a way to maintain a bond with the deceased while
feeling comfortable reinvesting in life.

Wheel Feelings in Grief

Types of Grief
These are the main types of grief that exist. We may experience one or more of
them while dealing with a loss. 
1. Anticipatory grief
This is one of the least well-known types of grief. It’s possible to feel grief
before loss actually happens, for example, if you know someone who has a
terminal disease, the emotion may start to creep in before they pass away. 

Anticipatory grief can be complex, as seeing someone suffer and finally letting

go may bring a feeling of relief, for which people feel guilty. People may also
feel guilty thinking that feeling grief equals giving up on hope. And while some
say that anticipatory grief lessens the impact or loss after the person passes
away, in other cases it doesn’t always work that way.
 
2. Normal or common grief
Some people carry on with their normal routine despite the feelings of grief.
From the outside it may seem as if the person has not been affected by it, but
pain, numbness and other feelings are still present under the ‘normal’ surface.
It’s common for acute feelings of grief to come in bursts, so they may not be
obvious to everyone unless they’re with the griever 24/7. The intensity of
feelings gradually lessens over time until we find ‘the new normal’.
 
3. Complicated grief 
If what's considered to be "normal grieving" does not occur, or if the grieving
goes on for a long time without any progress, it’s called “complicated grief” or
“unresolved grief.” Symptoms of complicated grief might include:

 ●  Continued disbelief in the death of the loved one, or emotional

numbness over the loss
 ●  Inability to accept the death
 ●  Feeling preoccupied with the loved one or how they died
 ●  Intense sorrow and emotional pain, sometimes including bitterness or
anger
 ●  Unable to enjoy good memories about the loved one
 ●  Blaming oneself for the death
 ●  Wishing to die to be with the loved one
 ●  Excessively avoiding reminders of their loss
 ●  Continuous yearning and longing for the deceased
 ●  Feeling alone, detached from others, or distrustful of others since the
death
 ●  Trouble pursuing interests or planning for the future after the death of
the loved one
 ●  Feeling that life is meaningless or empty without the loved one
 ●  Loss of identity or purpose in life, feeling like part of themselves died
with the loved one

4. Disenfranchised grief
Unlike with the other types of grief mentioned above, people experiencing so-
called disenfranchised grief usually get little support or
acceptance. Disenfranchised grief may happen after losing a pet, a non-family
member, or a part of ourselves (such as losing function of a body part after an
accident). The loss isn’t often recognised by society as being ‘worthy of grief’,
which puts even more pressure on grievers, as they feel that no one else
understands them and they may struggle thinking that they must suppress their
emotions.

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.”

Kübler-Ross five stage grief model

A Swiss psychiatrist, Kübler-Ross first introduced her five stage grief model in
her book On Death and Dying.
Kübler-Ross’ model was based off her work with terminally ill patients and has
received much criticism in the years since.
Kübler-Ross now notes that these stages are not linear and some people may not
experience any of them.
The Worden Model: Four Tasks of Grief
William Worden, in his book Grief counselling and grief therapy (1983), laid
out the process of grief as a series of four “tasks” that can be either embraced or
rejected. He lays out no timeline, and allows for the revisiting of tasks over
time. This perspective aligns with our original case that grief is not a linear
progression of stages, and that there is no “perfect” process of grief . From
Worden’s point of view, we flow between tasks, sometimes rejecting them,
sometimes embracing them.
Bereavement Counselling Techniques

1.Gestalt Techniques
Gestalt therapy is in many ways congruent with the counseling needs of
the bereaved. The dialogic relationship between client and therapist,
with its emphasis on a loving authentic presence and communication
that allows expression of each other’s personhood.

The following techniques are implemented:

1.Empty chair technique: Counselors recommend the Gestalt empty chair technique with clients
who are dealing with the loss of a person through death or other events such as divorce. The client can talk
to the person as if he or she is there, sharing feelings, saying goodbye or working out an unresolved issue.

2. Dialogue
3. Discussing Dreams
4. Psychodrama
 2. ART THERAPY AND GRIEF
The process of grief holds many layers of emotions for the people left behind.
They often have to deal with intense emotions under an overwhelming layer of
shock and disbelief. Grief can often result in repressing emotion as well as
experiencing feelings of guilt over thing left unsaid. Art therapy can help clients
by unlocking repressed emotion as well as providing an avenue to externally
express inwardly held emotions.

Art Therapy also provides a valuable outlet for expression for grief. Clients
often describe grief as constantly present and sometimes feel that addressing
that presence through talk therapy can feel exhausting where the same thoughts
and feelings of grief remain pervasive.
The most cited art therapy technique is the use of photos. Clients
are asked to rely on family snapshots as a way of introducing and
describing the deceased loved one’s biography and place in the family.
This technique can be used to aid the client in telling his/her life story
and/or loss story, as well as providing a later visual source for further
reflection.

3. Cognitive Behavioural Therapy (CBT)

The three complex cognitive processes account for the symptoms of
Complicated Grief (CG).
First, the loss experience is not integrated into existing self-knowledge;
individuals suffering from CG tend to have frequent intrusive thoughts about
their lost loved one, yet the loss is experienced as an unreal event .
Second, individuals with CG also experience a disruption in their beliefs
and assumptions about the justness of the world, which causes both
negative global beliefs and the tendency to react with catastrophic
thinking.
Finally, as a result of these cognitive tendencies, individuals with CG tend
to engage in avoidant coping characterized by anxiety and
depressiveness. For example, they react with feeling a loss of control, inactivity,
or withdrawal.
CBT for CG focuses on alleviating symptoms by targeting change in these
cognitive processes.
Specifically, the therapy involves “reversing the processes that maintain
CG” by helping the client to integrate the loss into his or her current
autobiographical knowledge (e.g., using exposure techniques based in
imagery), change their negative beliefs (e.g., via cognitive restructuring
techniques), and reduce the use of avoidant coping strategies (e.g., via
response prevention).

4. Grief support groups

Grief support groups are groups that offer members support and understanding as
they cope with their loss. They can be found in most large cities and towns around
the world, and there are many different kinds of support groups with different areas
of focus. For example, some support groups qualify as group counselling and are
led by a mental health professional, while others may be more informal and led by
a peer.

These are some of the other areas in which support groups can vary:

 Attitude and culture

 Structure
  Attendance
 Consistent group vs. changing group
 Focused on specific loss vs. general loss
 Focused on advocacy and action vs. grief experience  

To reap the benefits of group counselling or support groups which are as under:

 Instillation of hope by seeing those farther along in the grieving process who
are functioning and coping well.
 The universality of grief in a support group reminds you that you are not
alone; there are many others who experience grief as well.
 Information and insight sharing can help you get helpful suggestions, good
advice, and general understanding.
 The opportunity to practice and receive altruism, which is healing in and of
itself.
 The group cohesiveness can help you feel that you belong, that you are
accepted, and that your experience is valid.

However, grief support groups are not for everyone, and there are some pitfalls and
disadvantages as well, including:

 It can be overwhelming, especially when you are feeling vulnerable.

 It can be discouraging to see others in the midst of their grief and leave you
feeling hopeless.
 They will likely not provide you with a therapy experience, especially if a
peer is leading the group.
 You might get bad information or bad advice from others in the group.
 You may experience judgment from others, along with negativity and
insensitivity.
 There may be difficult people in the group who derail healing.
 The culture of the group may be unhealthy or you may feel pressure to adopt
beliefs you don’t necessarily agree with.

Assessment of Grief:

Brief Grief Questionnairea

Each question is rated as: 0 = Not at all, 1 = Somewhat, or 2 = A lot
1. How much are you having trouble accepting the death of _______?
2. How much does your grief still interfere with your life?
3. How much are you having images or thoughts of _______ when she/he died or other
thoughts about the death that really bother you?
4. Are there things you used to do when _______ was alive that you do not feel
comfortable doing anymore, that you avoid? Like going somewhere you went with
him/her, or doing things you used to enjoy together? Or avoiding looking at pictures
or talking about _____? How much are you avoiding these things?
5. How much are you feeling cut off or distant from other people since ______ died,
even people you used to be close to like family or friends?