Grief counselling and its Importance for healing

Grief can be defined as a response to the loss of a person or object to whom we are attached. Grief is commonly linked with the loss of a loved one, however, other types of losses include those which are termed disenfranchised or socially negated (including miscarriages, abortions, and stillbirths). Vicarious losses are stimulated by another’s loss (including September 11, the Indonesian Tsunami and the death of Princess Diana). Whilst anticipatory or pre-empted losses include for example the feared loss of one's life via a chronic disease, the loss of a job, a home, a teenage child, or one's looks via the ageing process. All losses can have a significant impact on individuals.

The responses to loss are highly personal and based upon “each person's unique perception of the experience” (Shapiro, 1993, p.10). However, although grief reactions are indeed highly unique, theorists indicate that there are a range of common factors experienced as a result of being ‘a subject’ of loss. These include:

• Feelings: sadness, anger, guilt, anxiety, loneliness, fatigue, helplessness, shock, yearning, emancipation, relief, and numbness.
• Physical sensations: tightness in the chest and throat, hollowness in the stomach, and breathlessness.
• Thought patterns (cognitions): disbelief, confusion, preoccupation, hallucinations, and a sense of the presence of the lost person or object.
• Behaviours: lack of sleep, appetite disturbances, absentmindedness, social withdrawal, dreams of the deceased, avoiding reminders of the deceased, searching, calling out, sighing, restless overactivity, crying, visiting places or carrying objects that remind the survivor of the deceased, and treasured objects that belonged to the deceased (Worden, 2005; Geldard & Geldard, 2001; Bowlby, 1980).

Figures indicate that anywhere between 20-33% of individuals experience more complicated grief reactions (Doka, 2006) which are marked by an excessive degree of intensity after a lengthy passage of time, a lack of movement towards psychical assimilation or accommodation of the loss, and the presence of maladaptive behaviours (Freud, 1917).

It is important to understand in depth the distinctions between normal and abnormal grief (or mourning and melancholia/pathological grief) given that these presentations must necessarily have a bearing on the clinical work engaged in. Worden (2005) argues that grief counselling is required to assist people to transition or subjectively ‘move’ through their uncomplicated grief reactions and reach an internal sense of having healed from the psychological pain, burden or wound inflicted by the loss; whilst grief therapy is deemed to envelop the employment of a range of therapeutic interventions which assist in the resolution of conflicts which render healing and re-contextualization of the loss difficult.

Notwithstanding the distinctions between normal and abnormal grief, and grief counselling and grief therapy, arguably the key goal of any form of grief work is to assist the client to psychically heal in all aspects of their experience (cognitions, affects, behaviours and systems of meaning) so that they can experience a less psychologically painful existence without ‘the other’, and to assist the client to have within ‘the self’ an inner awareness of movement through their grief and towards a more adaptive relationship with the deceased or lost object.

Mediating factors such as who the person was, the nature of the attachment, the mode of death, historical antecedents, personality variables, social variables and concurrent stresses may create enhanced complexity in the grief response.

The literature indicates a societal shift towards professional support for assistance with grief (Wolfe, 2006). However, the restorative process takes time given that effectively part of the self is lost when a significant death or loss is experienced. In essence, the heart and the head conflict because it is so difficult to relinquish the bonds, connections and ties that are a part of our most intimate relationships (Shuchter, 1986).

In therapeutic work, it is essential that individuals are located in their own experience of grief and that practitioners are explicitly and implicitly aware that ‘one size’ does not fit all. The healing nature of the therapeutic relationship and its role in clients' psychological renewal can never be considered a sidebar. This relationship can never be anything less than healing and significant if the grief counsellor acts as a fellow traveller rather than a consultant, shares the uncertainties of the journey, and walks alongside (rather than leading) the grieving individual as they treck the unpredictable road towards adaptation (Neimeyer, 1998).

Many clients have significantly benefited from being engaged in a therapeutic process which helps them with their grief and a number of studies, including quantitative statistical and qualitative case study approaches indicate the psychological healing and subjective psychical movement experienced by clients and its significant benefit to their lives (Range, 2006; Stroebe et al, 2006; Freud, 1917; Bowlby, 1980; Luepnitz, 2002; Yalom, 1991, 2008).

REFERENCES

Bowlby, J. (1980). Loss, Sadness and Depression: Vol III of Bowlby’s Attachment and Loss Trilogy. New York: Basic Books

Doka, K.J. (2006). Acute Grief. Retrieved 13 August 2008, from http://www.death reference.com/Gi-Ho/Grief.html

Freud, S. (1917). Mourning and Melancholia. Standard Edition of the Complete Works of Sigmund Freud, edited and translated by Strachey, J. Vol.14. (1957). London: Hogarth Press.

Geldard, D. & Geldard, K. (2005). Basic Personal Counselling: A Training Manual For Counsellors. NSW, Australia: Pearson Education.

Leupnitz, D.A. (2002). Schopenhauer’s Porcupines: Intimacy and Its Dilemmas. New York: Perseus Books.

Neimeyer, R. (1998). Lessons of Loss: A Guide To Coping. New York: McGraw-Hill.

Range, L.M. (2006). Traumatic Grief. Retrieved 13 August 2008, from http://www.death reference.com/Gi-Ho/Grief.html

Shapiro, C.H. (1993). When Part of the Self Is Lost. San Francisco, CA: Jossey-Bass Inc.

Shuchter, S.R. (1986). Dimensions of Grief. San Francisco, CA: Jossey-Bass Inc.

Stroebe, M., Stroebe, W. & Schut, H. (2006). Theories of Grief. Retrieved 13 August 2008, from http://www.death reference.com/Gi-Ho/Grief.html

Wolfe, B. (2006). What Is Grief Counselling & Grief Therapy? Retrieved 13 August, 2008, from http://www.death reference.com/Gi-Ho/Grief.html

Worden, W.J. (2005). Grief Counselling and Grief Therapy (3rd ed.). East Sussex, England: Routledge.

Yalom, I.D. (1991). Love’s Executioner and Other Tales of Psychotherapy. London: Penguin Books.

Yalom, I.D. (2008). Staring At The Sun: Overcoming The Dread of Death. Victoria, Australia: Scribe Publications.