Unfortunately, grief is an inevitable and inescapable part of life. My name is Dr. Samantha Brustad, licensed psychologist and owner of Teletherapy-Solutions.com. In today’s blog post I will discuss grief counseling / grief therapy, describe types of grief and make recommendations for healing and recovery.

Grief is a reaction to any form of loss. Bereavement is a type of grief involving the death of a loved one.  Bereavement and grief encompass a range of feelings from deep sadness to anger. The process of adapting to a significant loss can vary greatly from one person to person. It often depends on a person’s background, beliefs, and relationship to what was lost.

Grieving Thoughts & Behaviors

Grief does not just include feelings of sadness. It can also involve guilt, yearning, anger, and regret.  These emotions can often be surprising in their strength or mildness. They can also be confusing. For example, a person may mourn a loved one who died from cancer and yet feel relief that the person is no longer suffering.

Grief can cause a person to vaciliate between different thoughts as they make sense of their loss. Thoughts can range from soothing (“She is at peace now.”) to distressing (“She didn’t deserve this!”). People may assign themselves varying levels of responsibility, from “There was nothing I could have done,” to “It’s all my fault.”

Some people find comfort in grieving behaviors such as sharing their feelings among company. Other people may prefer to be alone with their feelings, engaging in silent activities like exercising or writing.

The different feelings, thoughts, and behaviors people express during grief can be categorized into two general styles: instrumental and intuitive. Most people display a blend of these two styles of grieving:

·       Instrumental grieving has a focus primarily on problem-solving tasks. This style involves controlling or minimizing emotional expression.
·       Intuitive grieving is based on a heightened emotional experience. This style involves sharing feelings, exploring the lost relationship, and considering mortality.

No one way of grieving is better than any other. Some people are more emotional and dive into their feelings. Others are stoic and may seek distraction from dwelling on an unchangeable fact of living. Every individual has unique needs when coping with loss.

Models of Grief

Grief can vary between individuals. However, there are still global trends in how people cope with loss. Psychologists have outlined various models of grief outlined below:

Five Stages of Grief

In 1969, Elisabeth Kubler-Ross identified five linear stages of grief:
·       Denial
·       Anger
·       Bargaining
·       Depression
·       Acceptance
Kubler-Ross noted that everyone experiences at least two of the five stages of grief. She acknowledged that some people may revisit certain stages over many years or throughout life. The process of grief is not linear.

Four Tasks of Mourning

Psychologist J. W. Worden also created a stage-based model for coping with the death of a loved one. He divided the bereavement process into four tasks:
·       To accept the reality of the loss
·       To work through the pain of grief
·       To adjust to life without the lost person
·       To maintain a connection to the deceased while moving on with life

Dual Process Model

As an alternative to the linear stage-based model, Margaret Stroebe and Hank Schut developed a dual process model of bereavement. They identified two processes associated with bereavement:
Loss-oriented activities and stressors are those directly related to the death. These include:
·       Crying
·       Yearning
·       Experiencing sadness, denial, or anger
·       Dwelling on the circumstances of the death
·       Avoiding restoration activities

Restoration-oriented activities and stressors are associated with secondary losses. They may involve lifestyle, routine, and relationships. Restoration-oriented processes include:
·       Adapting to a new role
·       Managing changes in routine
·       Developing new ways of connecting with family and friends
·       Cultivating a new way of life.
Stroebe and Schut suggest most people will move back and forth between loss-oriented and restoration-oriented activities.

Healing from Grief

Everyone grieves in their own way and in their own time. Some people recover from grief and resume normal activities within months, though they continue to feel moments of sadness.

Sometimes people grieve for years without seeming to find even temporary relief. Grief can be complicated by other conditions, most notably depression.
The grieving process often involves many difficult and complicated emotions. Yet joy, contentment, and humor do not have to be absent during this difficult time. Self-care and social support can be vital to the recovery. Feeling occasional happiness does not mean a person is done mourning.

Grieving the loss of a loved one be a difficult process, whether the loss is due to death, a breakup, or other circumstance. One of the hardest challenges is adjusting to the new reality  of living in the absence of the loved one. Adjusting may require a person to develop a new daily routine or to rethink their plans for the future.

Complicated Grief

The experience of grief is not something a person ever recovers from completely. However, time typically tempers its intensity. Yet an estimated 15% of people who have lost a loved one will experience “complicated grief.” This term refers to a persistent form of bereavement, lasting for one year or more. In addition, the symptoms of complicated grief to be more severe. Complicated grief often dominates a person’s life, interfering with their daily functioning.

Prolonged symptoms may include:
·       Intense sadness and emotional pain
·       Feelings of emptiness and hopelessness
·       Yearning to be reunited with the deceased
·       Preoccupation with the deceased or with the circumstances of the death
·       Difficulty engaging in happy memories of the lost person
·       Avoidance of reminders of the deceased
·       A reduced sense of identity
·       Detachment and isolation from surviving friends and family
·       Lack of desire to pursue personal interests or plans

Depression and Grief

The DSM-5 does not define bereavement as a disorder. Yet typical signs of grief, such as social withdrawal, can mimic those of depression.
So how can one tell the difference between grief and depression?
·       Grief is typically preceded by loss. Depression can develop at any time.
·       The sadness present in grief is typically related to the loss or death. Depression is characterized by a general sense of worthlessness, despair, and lack of joy.
·       Symptoms of grief may improve on their own with time. Someone with depression often needs treatment to recover
Despite their differences, depression and grief are not mutually exclusive. If someone is vulnerable to depression, grief has the potential to trigger a depressive episode. If someone already has depression, their condition may prolong or worsen the grieving process. A therapist can help a person in mourning recognize and manage any depressive symptoms.

Disenfranchised Grief

Disenfranchised grief occurs when a person’s mourning is restricted in some way. Society may stigmatize a person’s mourning process or refuse to acknowledge their loss. Grief may be disenfranchised for several reasons:
·       Society devalues the loss. The loss of a pet often garners less sympathy than the loss of a human relative. Others may say “it was just an animal” and accuse the person of being too emotional. Yet research shows the mourning period for a pet is about the same length as for a human family member.
·       The loss is ambiguous.  An adopted child may grieve the loss of their birth parents, even if said adults are alive. If a loved one has late-stage dementia, family members may feel as if the person they knew is gone.
·       Society stigmatizes the circumstances of the loss. Pregnancy-related loss is often considered taboo. Women who undergo a miscarriage may feel guilt and shame. They may avoid telling others about the loss to avoid being blamed.
·       Society doesn’t recognize the person’s relationship to the deceased. A co-worker or friend may mourn a person, but they will likely receive less support than a family member. The same is true for ex-spouses, even though they used to be family. In societies with systemic homophobia,  same-sex partners may also have disenfranchised grief.
·       Others do not consider the person capable of grief. When young children experience loss, adults may misinterpret signs of bereavement. They may believe the child is not capable of understanding the loss or have prolonged feelings about it. People who have cognitive impairments or intellectual disabilities may also have disenfranchised grief.

All in all, if you have lost someone or something precious, you may wish to connect with a licensed therapist. Therapy can help with any sort of loss, whether society validates the grief or not. Therapy is an opportunity to explore your feelings and memories without judgment. No loss is too big or too small to warrant support.

Remember, you do not have to endure your grief alone.


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