Grief counseling refers to a specific form of therapy, or a focus in general counseling with the goal of helping the individual grieve and address personal loss in a healthy manner. Grief counseling is offered individually by psychologists, clergy, counselors or social workers , in groups led by professionals, as well as informal support groups offered by churches, community groups, or organizations devoted to helping individuals grieve specific losses.
Specific tasks of grief counseling include emotional expression about the loss (which can include a wide range of feelings), accepting the loss, adjusting to life after the loss, and coping with the changes within oneself and the world after the loss. Typical feelings experienced by individuals, and addressed in grief counseling, include sadness, anxiety, anger, loneliness, guilt, relief, isolation, confusion, or numbness. Behavioral changes may also be noticed, such as being disorganized, feeling tired, having trouble concentrating, sleep problems, appetite changes, vivid dreams, or daydreaming about the deceased.
The purpose of grief counseling is to help individuals work through the feelings, thoughts, and memories associated with the loss of a loved one. Although grieving can occur for other types of loss as well (such as loss of goals, ideals, and relationships), grief counseling is generally directed toward positive adjustment following loss after the death of a loved one.
Grief counseling helps the individual recognize normal aspects of the grieving or mourning process, cope with the pain associated with the loss, feel supported through the anxiety surrounding life changes that may follow the loss, and develop strategies for seeking support and self-care.
Grieving is a normal life process—an adjustment reaction to a loss. Grief counseling is meant to facilitate that normal process. No specific precautions are warranted. However, there are certain circumstances in which complications to the normal grieving process may occur. These circumstances may involve the loss of a child, or the loss of a loved one due to an accident or homicide, for example.
In these cases of complicated grieving, more extreme responses to the loss may be observed, depending on the individual's capacity for coping, personal resiliency, and support system. For example, if the individual feels isolated, he may be at greater risk for severe depressive symptoms or a suicide attempt. Alternatively, if the survivors feel rage or anger over the loss, there may be a risk of harm to others.
Grief counseling helps the individual work through the feelings associated with the loss of another, accept that loss, determine how life can go on without that person, and consolidate memories in order to be able to move forward. Grief counseling also provides information about the normal grieving process, to help individuals understand that many of the symptoms and changes they are experiencing are a normal, temporary reaction to loss. For some individuals, the primary focus of grief counseling is to help identify ways to express feelings about the loss that the person has been unable to expresson his or her own. Individuals who seek grief counseling may be experiencing an emotional numbness, or a residual shock in reaction to the loss, and need assistance to return to a normal life. In those cases, grief counseling will focus on helping the individual get in touch with those feelings and become more active in the daily routine. This often requires accepting the loss as a reality.
For some people, grieving may initially be so extreme that physical and psychological symptoms may be experienced, while other people appear to experience no symptoms whatsoever, similar to the numbness described above. Activities of daily living may feel overwhelming to an individual who has experienced a loss. In these cases, grief counseling may focus on specific coping skills to help the individual resume some normalcy in his or her daily routine. For example, if sleep patterns are disrupted, grief counseling may include consultation with the individual's physician to assist with temporary strategies to increase sleep. If the individual is having trouble getting to work on time, behavioral strategies may be used as an interim measure to help the person return to aspects of normal daily life.
Additional work in grief counseling may involve identifying ways to let go or say good-bye if the individual has not been able to do so successfully. Therapeutic letters may be a helpful mechanism to express thoughts that were not conveyed prior to the death. Dreams are frequently experienced by survivors, and these can be a focus in grief counseling as well. The dreams can often be a way of consolidating the memories about the deceased.
No specific preparation is required by the participant; however, a need for grief counseling is indicated by prolonged symptoms (such as crying spells, preoccupation with the deceased, lack of motivation, or suicidal thoughts), and the severity of personal distress over the loss. A patient seeking grief counseling would most likely undergo a clinical evaluation by a therapist, before the grief counseling began, so that the therapist could understand the patient's personal history and goals for treatment.
Aftercare is usually provided through informal support systems, which may include family and friends, as well as support groups.
A slight risk exists regarding treatment of complicated grief. Such circumstances include chronic, prolonged grieving or unexpected loss (particularly due to a violent accident, suicide, homicide, or the death of a child). These factors complicate the grieving process due to the unexpected, sometimes violent nature of the loss, that feels inconsistent with expectations and desires for loved ones. In these cases, an initial adverse effect may be seen from participation in treatment, due to the increased focus on the loss. This reaction improves over time, as adjustment is facilitated. Two other factors impacting individual adjustment include the type of relationship the individual had with the deceased, and the resiliency of the individual.
Normal results from grief counseling include being able to move on with one's life, recognizing and accepting the physical loss of the individual, and being able to bridge that loss with positive memories of the deceased. Successful coping will be characterized by a return to normal routines, although some symptoms may be experienced periodically throughout the year or so following the loss.
Abnormal results would include an unsuccessful outcome of prolonged grief, exhibited by continued preoccupation with the loss of the individual, crying spells, and depressive symptoms being the most likely complications. Some disruption of the daily routine would persist, and there may be extreme emotional responses, that could include no apparent reaction to difficulty containing feelings. Other complications include "unfinished business," or feelings of unresolved issues with the deceased. Sometimes the feelings of unresolved issues can be as simple as wishing they had communicated their love and affection for the person the last time they saw them, or may be as complicated as unresolved feelings about a history of abuse by the deceased.
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The Compassionate Friends. P. O. Box 3696, Oak Brook, IL 60522. (630) 990-0010. <http://www.compassionatefriends.org> .
SHARE Pregnancy and Infant Loss Support. St. Joseph Health Center, 300 First Capital Drive, St. Charles, MO 63301. (800) 821-6819.
SIDS Alliance. 1314 Bedford Ave., Suite 230, Baltimore, MD 21208. (800-221-SIDS). <http://www.sidsalliance.org> .
Widowed Persons Service, AARP. 601 E. Street, NW, Washington, DC 20049. (202) 434-2260.
Deanna Pledge, Ph.D.