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Grief counseling is a form of psychotherapy that aims to help people cope with the physical, emotional, social, spiritual, and cognitive responses to loss. These experiences are commonly thought to be brought on by a loved person's death, but may more broadly be understood as shaped by any significant life-altering loss (e.g., divorce, home foreclosure, or job loss).
Grief counselors believe that everyone experiences and expresses grief in personally unique ways that are shaped by family background, culture, life experiences, personal values, and intrinsic beliefs. 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 while others experience strong regrets or guilt. Tears or the lack of crying can both be seen as appropriate expressions of grief.
Grief counselors know that one can expect a wide range of emotion and behavior associated with grief. Some counselors believe that in virtually 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 also believe that where the process of grieving is interrupted, for example, by the one who is grieving having to simultaneously deal with practical issues of survival or by their having to be the strong one who is striving to hold their family together, grief can remain unresolved and later resurface as an issue for counseling.
Grief counseling becomes necessary when a person is so disabled by their grief; and, so overwhelmed by their loss that their normal coping processes are disabled or shut down. Grief counseling facilitates expression of emotion and thought about the loss, including their feeling sad, anxious, angry, lonely, guilty, relieved, isolated, confused, or numb.
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 they may experience the 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.
Joanne Jozefowski in 1999 through The Phoenix Phenomenon: Rising from the Ashes of Grief summarizes five stages to rebuild a shattered life.
- Impact: shock, denial, anxiety, fear, and panic.
- Chaos: confusion, disbelief, actions out of control, irrational thoughts and feelings, feeling despair, feeling helpless, desperate searching, losing track of time, difficulty sleeping and eating, obsessive focus on the loved one and their possessions, agony from imagining their physical harm, shattered beliefs.
- Adapting: bringing order back into daily life while you continue to grieve: take care of basic needs (personal grooming, shopping, cooking, cleaning, paying bills), learn to live without the loved one, accept help, focus on helping children cope, connect with other grieving families for mutual support, take control of grieving so that grief does not control you, slowly accept the new reality.
- Equilibrium: attaining stability and routines: reestablish a life that works alright, enjoy pleasant activities with family members and good times with friends, do productive work, choose a positive new direction in life while honoring the past, learn how to handle people who ask questions about what you’ve been through.
- Transformation: rethinking your purpose in life and the basis for your identity; looking for meaning in tragic, senseless loss; allowing yourself to have both painful and positive feelings about your loss and become able to choose which feelings you focus on; allowing yourself to discover that your struggle has led you to develop a stronger, better version of yourself than you expected could exist; learning how to talk with others about your heroic healing journey without exposing them to your pain; becoming supportive of others trying to deal with their losses.
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 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 emotional 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.
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 (iatrogenesis). 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 (i.e, an abnormally prolonged or difficult grieving process) after receiving grief counseling. The APS journal article in turn has been criticized in the British Psychological Society's publication the psychologist as lacking scientific rigour.
Validity of "complicated grief"
Some mental health professionals have questioned whether complicated grief exists. New diagnostic criteria for "complicated grief" have 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 depression, 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 supports 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.
Anticipating the impact of loss or trauma (to the extent than anyone can), and during and after the events of loss or trauma, 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.
The post-trauma self
Because of the interconnectedness of trauma, PTSD, human development, resiliency and the integration of the self, 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.
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.
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