Grief counseling
Encyclopedia
Grief counseling is a form of psychotherapy
that aims to help people cope with grief
and mourning
following the death of loved ones, or with major life changes that trigger feelings of grief (e.g., divorce
).
Grief counselors feel that everyone experiences and expresses grief in their own way, often shaped by culture. They believe that it is not uncommon for a person to withdraw from their friends and family and feel helpless; some might be angry and want to take action. Some may laugh.
Grief counselors hold that one can expect a wide range of emotion and behavior associated with grief. Some counselors believe that in all places and cultures, the grieving person benefits from the support of others. Further, grief counselors believe that where such support is lacking, counseling may provide an avenue for healthy resolution. Grief counselors believe that grief is a process the goal of which is "resolution." The field further believes that where the process of grieving is interrupted, for example, by simultaneously having to deal with practical issues of survival or by being the strong one and holding a family together, grief can remain unresolved and later resurface as an issue for counseling.
and thought about the loss, including sadness, anxiety, anger, loneliness, guilt, relief, isolation, confusion, or numbness.
It includes thinking creatively about the challenges that follow loss and coping with concurrent changes in their lives. Often people feel disorganized, tired, have trouble concentrating, sleep poorly and have vivid dreams, and experience change in appetite. These too are addressed in counseling.
Grief counseling facilitates the process of resolution in the natural reactions to loss. It is appropriate for reaction to losses that have overwhelmed a person's coping ability. There are considerable resources online covering grief or loss counseling such as the Grief Counseling Resource Guide from the New York State Office of Mental Health.
Grief counseling may be called upon when a person suffers anticipatory grief
, for example an intrusive and frequent worry about a loved one whose death is neither imminent nor likely. Anticipatory mourning also occurs when a loved one has a terminal illness
. This can handicap that person's ability to stay present whilst simultaneously holding onto, letting go of, and drawing closer to the dying relative.
In March 2007, grief counseling and grief therapy were placed on a list of treatments that have the potential to cause harm in clients in the APS
journal, Perspectives on Psychological Science. In particular, individuals experiencing "relatively normal bereavement reactions" may experience worse outcomes after receiving grief counseling.
Grief therapy is a kind of psychotherapy
used to treat severe or complicated traumatic grief
reactions, which are usually brought on by the loss of a close person (by separation or death
) or by community disaster. The goal of grief therapy is to identify and solve the psychological and emotion
al problems which appeared as a consequence.
They may appear as behavioral or physical changes, psychosomatic disturbances, delayed or extreme mourning
, conflictual problems or sudden and unexpected mourning). Grief therapy may be available as individual or group therapy
. A common area where grief therapy has been extensively applied is with the parents of cancer
patients.
). Researchers have suggested that people may resort to receiving grief therapy in the absence of complicated (or abnormal) grief reactions and that, in such cases, grief therapy may cause a normal bereavement response to turn pathological. Others have argued that grief therapy is highly effective for people who suffer from unusually prolonged and complicated responses to bereavement.
In March 2007, an article in the APS
journal, Perspectives on Psychological Science, included grief counseling and grief therapy on a list of treatments with the potential to cause harm to clients. In particular, individuals experiencing "relatively normal bereavement reactions" were said to be at risk of a worse outcome after receiving grief counselling. The APS journal article in turn has been criticized in the British Psychological Society
's publication the psychologist as lacking scientific rigour.
, posttraumatic stress disorder, and personality disorders.
Empirical studies have been attempting to convincingly establish the incremental validity
of complicated grief. In 2007, George Bonanno
and colleagues published a paper describing a study that demonstrates the incremental validity of complicated grief. The paper cautions, "the question of how complicated grief symptoms might be organized diagnostically is still very much open to debate."
As this is a current debate in the field, new research on this topic is likely to appear in the scientific literature.
, each person has unique emotional experiences and ways of coping, of grieving and of reacting or not. Sudden, violent or unexpected loss or trauma imposes additional strains on coping. When a community is affected such as by disaster
both the cost and sometimes the supports are greater.
Weeping, painful feelings of sadness, anger, shock, guilt, helplessness and outrage are not uncommon. These are particularly challenging times for children who may have had little experience managing strong affects within themselves or in their family. These feelings are all part of a natural healing process that draws on the resilience of the person, family and community.
Time and the comfort and support of understanding loved ones and once strangers who come to their aid, supports people healing in their own time and their own way. Research shows that resilience is ordinary rather than extraordinary. The majority of people who survive loss and trauma do not go on to develop PTSD. Some remain overwhelmed.
This article addresses counseling with complex grief and trauma, not only complex post-traumatic stress disorder
but those conditions of traumatic loss and psychological trauma
that for a number of reasons are enduring or disabling. For example, where an adult is periodically immobilised by unwelcome and intrusive recall of the sudden and violent death of a parent in their childhood.
One that they were unable to grieve because they were the strong one who held the family together, or whose feelings of outrage and anger were unacceptable or unmanageable at the time or because the loss of the breadwinner catapulted the family into a precipitous fall losing home, community and means of support.
, counseling of the complex traumatic aftermath of a violent death in the family, for example, require an integrative approach, using a variety of skills and techniques
to best fit the presentation of the problem.
Disruption in the previously supportive bonds of attachment
and of the person's ability to manage their own affects challenges traditional, so called 'non-directive' client centered counseling approaches. One example of this paradigm shift in approaches is the Multitheoretical Psychotherapy
of Jeff Brooks-Harris.
The post-traumatic self may not be the same person as before. This can be the source of shame, secondary shocks after the event and of grief for the lost unaltered self, which impacts on family and work. Counseling in these circumstances is designed to maximize safety, trauma processing, and reintegration regardless of the specific treatment approach.
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
that aims to help people cope with grief
Grief
Grief is a multi-faceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions...
and mourning
Mourning
Mourning is, in the simplest sense, synonymous with grief over the death of someone. The word is also used to describe a cultural complex of behaviours in which the bereaved participate or are expected to participate...
following the death of loved ones, or with major life changes that trigger feelings of grief (e.g., divorce
Divorce
Divorce is the final termination of a marital union, canceling the legal duties and responsibilities of marriage and dissolving the bonds of matrimony between the parties...
).
Grief counselors feel that everyone experiences and expresses grief in their own way, often shaped by culture. They believe that it is not uncommon for a person to withdraw from their friends and family and feel helpless; some might be angry and want to take action. Some may laugh.
Grief counselors hold that one can expect a wide range of emotion and behavior associated with grief. Some counselors believe that in all places and cultures, the grieving person benefits from the support of others. Further, grief counselors believe that where such support is lacking, counseling may provide an avenue for healthy resolution. Grief counselors believe that grief is a process the goal of which is "resolution." The field further believes that where the process of grieving is interrupted, for example, by simultaneously having to deal with practical issues of survival or by being the strong one and holding a family together, grief can remain unresolved and later resurface as an issue for counseling.
Counseling
Grief counseling becomes necessary when a person is so disabled by their grief, overwhelmed by loss to the extent that their normal coping processes are disabled or shut down. Grief counseling facilitates expression of emotionEmotion
Emotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...
and thought about the loss, including sadness, anxiety, anger, loneliness, guilt, relief, isolation, confusion, or numbness.
It includes thinking creatively about the challenges that follow loss and coping with concurrent changes in their lives. Often people feel disorganized, tired, have trouble concentrating, sleep poorly and have vivid dreams, and experience change in appetite. These too are addressed in counseling.
Grief counseling facilitates the process of resolution in the natural reactions to loss. It is appropriate for reaction to losses that have overwhelmed a person's coping ability. There are considerable resources online covering grief or loss counseling such as the Grief Counseling Resource Guide from the New York State Office of Mental Health.
Grief counseling may be called upon when a person suffers anticipatory grief
Anticipatory grief
Anticipatory grief refers to a grief reaction that occurs before an impending loss. Typically, the impending loss is a death of someone close due to illness but it can also be experienced by dying individuals themselves...
, for example an intrusive and frequent worry about a loved one whose death is neither imminent nor likely. Anticipatory mourning also occurs when a loved one has a terminal illness
Terminal illness
Terminal illness is a medical term popularized in the 20th century to describe a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a short period of time. This term is more commonly used for progressive diseases such as...
. This can handicap that person's ability to stay present whilst simultaneously holding onto, letting go of, and drawing closer to the dying relative.
In March 2007, grief counseling and grief therapy were placed on a list of treatments that have the potential to cause harm in clients in the APS
Association for Psychological Science
The Association for Psychological Science , previously the American Psychological Society, is a non-profit international organization whose mission is to promote, protect, and advance the interests of scientifically oriented psychology in research, application, teaching, and the improvement of...
journal, Perspectives on Psychological Science. In particular, individuals experiencing "relatively normal bereavement reactions" may experience worse outcomes after receiving grief counseling.
Grief therapy
There is a distinction between grief counseling and grief therapy. Counseling involves helping people move through uncomplicated, or normal, grief to health and resolution. Grief therapy involves the use of clinical tools for traumatic or complicated grief reactions. This could occur where the grief reaction is prolonged or manifests itself through some bodily or behavioral symptom, or by a grief response outside the range of cultural or psychiatrically defined normality.Grief therapy is a kind of psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
used to treat severe or complicated traumatic grief
Grief
Grief is a multi-faceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions...
reactions, which are usually brought on by the loss of a close person (by separation or death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
) or by community disaster. The goal of grief therapy is to identify and solve the psychological and emotion
Emotion
Emotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...
al problems which appeared as a consequence.
They may appear as behavioral or physical changes, psychosomatic disturbances, delayed or extreme mourning
Mourning
Mourning is, in the simplest sense, synonymous with grief over the death of someone. The word is also used to describe a cultural complex of behaviours in which the bereaved participate or are expected to participate...
, conflictual problems or sudden and unexpected mourning). Grief therapy may be available as individual or group therapy
Group therapy
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group...
. A common area where grief therapy has been extensively applied is with the parents of cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
patients.
Efficacy and Iatrogenesis
At present (as of 2008), a controversy exists in the scholarly literature regarding grief therapy's relative efficacy and the possible harm from it (iatrogenesisIatrogenesis
Iatrogenesis, or an iatrogenic artifact is an inadvertent adverse effect or complication resulting from medical treatment or advice, including that of psychologists, therapists, pharmacists, nurses, physicians and dentists...
). Researchers have suggested that people may resort to receiving grief therapy in the absence of complicated (or abnormal) grief reactions and that, in such cases, grief therapy may cause a normal bereavement response to turn pathological. Others have argued that grief therapy is highly effective for people who suffer from unusually prolonged and complicated responses to bereavement.
In March 2007, an article in the APS
Association for Psychological Science
The Association for Psychological Science , previously the American Psychological Society, is a non-profit international organization whose mission is to promote, protect, and advance the interests of scientifically oriented psychology in research, application, teaching, and the improvement of...
journal, Perspectives on Psychological Science, included grief counseling and grief therapy on a list of treatments with the potential to cause harm to clients. In particular, individuals experiencing "relatively normal bereavement reactions" were said to be at risk of a worse outcome after receiving grief counselling. The APS journal article in turn has been criticized in the British Psychological Society
British Psychological Society
The British Psychological Society is a representative body for psychologists and psychology in the United Kingdom. The BPS is also a Registered Charity and, along with advantages, this also imposes certain constraints on what the society can and cannot do...
's publication the psychologist as lacking scientific rigour.
Validity of "Complicated Grief"
Mental health professionals have questioned whether complicated grief exists. A new diagnostic criteria for "complicated grief" has been proposed for the new DSM, the DSM-V. One argument against creating a classification for "complicated grief" holds that it is not a unique mental disorder. Rather it is a combination of other mental disorders, such as depressionClinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
, posttraumatic stress disorder, and personality disorders.
Empirical studies have been attempting to convincingly establish the incremental validity
Incremental validity
Incremental validity is a term used in the field of psychology to describe the gain in validity resulting from adding new predictors to an existing selection system. Incremental validity shows that a new measure improves upon existing measures. For example, an existing measure for depression might...
of complicated grief. In 2007, George Bonanno
George Bonanno
George A. Bonanno is a professor of clinical psychology at Columbia University, Teachers College. He is known as a pioneering researcher in the field of bereavement and trauma. The New York Times on February 15, 2011, stated that the current science of bereavement has been "driven primarily" by...
and colleagues published a paper describing a study that demonstrates the incremental validity of complicated grief. The paper cautions, "the question of how complicated grief symptoms might be organized diagnostically is still very much open to debate."
As this is a current debate in the field, new research on this topic is likely to appear in the scientific literature.
Grief and trauma counseling
Anticipating the impact of loss or trauma (to the extent than any one can), and during and after the events of loss or traumaPsychological trauma
Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...
, each person has unique emotional experiences and ways of coping, of grieving and of reacting or not. Sudden, violent or unexpected loss or trauma imposes additional strains on coping. When a community is affected such as by disaster
Disaster
A disaster is a natural or man-made hazard that has come to fruition, resulting in an event of substantial extent causing significant physical damage or destruction, loss of life, or drastic change to the environment...
both the cost and sometimes the supports are greater.
Weeping, painful feelings of sadness, anger, shock, guilt, helplessness and outrage are not uncommon. These are particularly challenging times for children who may have had little experience managing strong affects within themselves or in their family. These feelings are all part of a natural healing process that draws on the resilience of the person, family and community.
Time and the comfort and support of understanding loved ones and once strangers who come to their aid, supports people healing in their own time and their own way. Research shows that resilience is ordinary rather than extraordinary. The majority of people who survive loss and trauma do not go on to develop PTSD. Some remain overwhelmed.
This article addresses counseling with complex grief and trauma, not only complex post-traumatic stress disorder
Complex post-traumatic stress disorder
Complex post-traumatic stress disorder is a psychological injury that results from protracted exposure to prolonged social and/or interpersonal trauma with lack or loss of control, disempowerment, and in the context of either captivity or entrapment, i.e. the lack of a viable escape route for the...
but those conditions of traumatic loss and psychological trauma
Psychological trauma
Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...
that for a number of reasons are enduring or disabling. For example, where an adult is periodically immobilised by unwelcome and intrusive recall of the sudden and violent death of a parent in their childhood.
One that they were unable to grieve because they were the strong one who held the family together, or whose feelings of outrage and anger were unacceptable or unmanageable at the time or because the loss of the breadwinner catapulted the family into a precipitous fall losing home, community and means of support.
The post-trauma self
Because of the interconnectedness of trauma, PTSD, human development, resiliency and the integration of the selfSelf (psychology)
The psychology of self is the study of either the cognitive and affective representation of one's identity or the subject of experience. The earliest formulation of the self in modern psychology derived from the distinction between the self as I, the subjective knower, and the self as Me, the...
, counseling of the complex traumatic aftermath of a violent death in the family, for example, require an integrative approach, using a variety of skills and techniques
Integrative Psychotherapy
Integrative psychotherapy may involve the fusion of different schools of psychotherapy. The word 'integrative' in Integrative psychotherapy may also refer to integrating the personality and making it cohesive, and to the bringing together of the "affective, cognitive, behavioral, and physiological...
to best fit the presentation of the problem.
Disruption in the previously supportive bonds of attachment
Attachment theory
Attachment theory describes the dynamics of long-term relationships between humans. Its most important tenet is that an infant needs to develop a relationship with at least one primary caregiver for social and emotional development to occur normally. Attachment theory is an interdisciplinary study...
and of the person's ability to manage their own affects challenges traditional, so called 'non-directive' client centered counseling approaches. One example of this paradigm shift in approaches is the Multitheoretical Psychotherapy
Multitheoretical Psychotherapy
Multitheoretical psychotherapy is a new approach to integrative psychotherapy developed by Jeff E. Brooks-Harris and his colleagues at the University of Hawaii at Manoa...
of Jeff Brooks-Harris.
The post-traumatic self may not be the same person as before. This can be the source of shame, secondary shocks after the event and of grief for the lost unaltered self, which impacts on family and work. Counseling in these circumstances is designed to maximize safety, trauma processing, and reintegration regardless of the specific treatment approach.
See also
- Death educationDeath educationDeath education is education about death that focuses on the human and emotional aspects of death. Though it may include teaching on the biological aspects of death, teaching about coping with grief is a primary focus. A specialist in this field is referred to as a thanatologist.-References:**...
- GriefGriefGrief is a multi-faceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions...
- Grief therapy dog
- List of counseling topics
- Postponement of affectPostponement of affectPostponement of affect is a defence mechanism which may be used against a variety of feelings or emotions. Such a 'temporal displacement, resulting simply in a later appearance of the affect reaction and in thus preventing the recognition of the motivating connection, is...most frequently used...
Sources
- Hammerschlag, Carl A. The Dancing Healers. San Francisco: Harper San Francisco, 1988.
- Hogan, Nancy S., Daryl B. Greenfield, and Lee A. Schmidt. "Development and Validation of the Hogan Grief Reaction Checklist." Death Studies 25 (2000):1–32.
- Rubin, Simon Shimshon. "The Two-Track Model of Bereavement: Overview, Retrospect, and Prospect." Death Studies 23 (1999):681–714.
- Sofka, Carla J. "Social Support 'Internetworks,' Caskets for Sale, and More: Thanatology and the Information Superhighway." Death Studies 21 (1997):553–574.
- Staudacher, Carol. A Time to Grieve: Mediations for Healing after the Death of a Loved One. San Francisco: Harper San Francisco, 1994.
- Stroebe, Margaret, and Henk Schut. "The Dual Process Model of Coping with Bereavement: Rationale and Description." Death Studies 23 (1999):197–224.
- Wolfe, Ben, and John R. Jordan. "Ramblings from the Trenches: A Clinical Perspective on Thanatological Research." Death Studies 24 (2000):569–584.