Understanding migratory grief: How therapy can help

According to the IOM's World Migration Report, there are approximately 281 million international migrants worldwide. Furthermore, the UK Parliament's report revealed that around 1.2 million new immigrants arrive in the UK annually. Despite the high numbers, there is limited research on the emotional and psychological impact of migration grief, specifically its impact on counselling. This suggests a need for more research, which would help address the challenges immigrants, refugees, or asylum seekers face.

What is migratory grief?

Many migrants struggle with loneliness and cultural isolation. Some of them show signs of depression, anxiety and often express difficulty with the loss of social network and familiar environment. They might find that they are unable to engage in work and social activities due to the difficulty of adapting to a different language and environment.

Migratory grief is a complex experience that requires greater understanding and the need for tailored support and interventions during counselling.

Various risk factors of migrants’ mental health have been researched, including gender, income, language skills, social support, social isolation, and discrimination. However, grief is a risk factor for mental disorders, raising the question of why this area remains under-researched on this subject. Migratory grief is a spectrum, which may vary from homesickness and nostalgia, to Ulysses syndrome – a stress disorder that is specific to immigrants. This highlights the diverse responses migrants may experience and underscores the importance of recognising and addressing migration grief in counselling.

How grief manifests

The wide range of responses to loss and bereavement can be categorised into behavioural, cognitive, and emotional. However, they are deeply personal and vary significantly among individuals and groups. Behavioural reactions to grief could be changes to an individual’s daily routines and habits, such as withdrawal from social activities, neglect of personal hygiene, and changes in sleep and eating habits. They may engage in risky behaviours such as substance abuse.

Cognitive responses to grief can include changes in thought processes and mental functions. This may include difficulty concentrating, confusion, or even short-term memory loss and obsessive thoughts about the loss. They may experience disbelief and anxiety regarding the circumstances of the loss, so they often question the facts surrounding the loss.

The somatic reactions to grief could be decreased muscle power, a tight chest, shortness of breath, or even choking. However, not all individuals express grief in these ways, and some people may show resilience or even experience post-traumatic growth.

Cultural considerations in grieving

Different cultures have different ways of grieving. In Western cultures, what is considered a normal or healthy way to cope may not be the same in any other cultures. Migratory grief is complex, including the loss of family, language, culture, social status, and group belonging. Migrants may experience profound loneliness, frustration, and a longing for their homeland, as well as identity loss. The stress of migration can lead to more severe behavioural and cognitive issues.

Grief is a deeply personal experience and a natural response to loss, and there is no right or wrong way to feel. The Five Stages of Grief model proposed by Kübler-Ross emphasises the emotional distress that individuals may experience after a loss. However, it is important to remember that not everyone goes through these stages.

The Dual Process Model by Stroebe and Schut outlines that people go through their lives with both an ongoing feeling of loss and efforts to escape grief. This model is particularly important for migratory grief, as migrants need to balance their past and adapt to their unfamiliar environment.

While the five stages of grief model stresses clients facing the loss and pain that they are experiencing, the dual process model states that both denying and avoiding are essential elements of a healthy grieving process. Then again, the Continuing Bonds Theory questions the traditional grief models, highlighting that maintaining the connection that has been lost can be beneficial for healing. For migrants, this could include maintaining cultural traditions, language, or relationships from their homeland, helping them integrate their past into their present.

Migratory grief is linked to attachment theory, as individuals may struggle to establish new secure attachments while grieving what they left behind. In the event of loss, this secure foundation is disrupted, resulting in anxiety, confusion, and emotional distress as the individual loses their emotional stability. Emotions are biochemically linked with the individual’s nervous, hormonal, digestive, and immune systems, which helps explain why emotional distress can have physical symptoms.

Social expectations can shape grief responses by anticipating certain behaviours, allowing the individual to move on. In some cultures, there may be an expectation to return to work shortly after a funeral, which can lead individuals to suppress their grief to meet these societal expectations. It is a tradition that Black Americans often engage in communal gatherings to celebrate the deceased’s life while they are grieving. However, the social pressure to participate in these activities can influence how an individual may express or cope with their grief.

If an individual is dealing with multiple losses, their grief may be delayed until they feel emotionally safe to process it. With migration, the feeling of being different may grow, and they may feel that no matter how much they try to integrate into their new country, they will always be different. At the same time, their original community may begin to see them as altered, who have been influenced by others, and they feel less connected to their roots. The sense of not belonging to either community can lead to identity confusion and emotional distress.

Counselling approaches for migratory grief

Counsellors should be aware of their limitations and unconscious biases when they are working with migratory grief. A therapist’s awareness of their own beliefs, values, and biases, through reflective practice and supervision, helps them prevent damaging the therapeutic relationship and hindering the client's journey.

Migratory grief should be considered as an influencing factor when working with depression. To effectively support the client, the therapist must consider sociocultural factors while being mindful of avoiding stereotyping. Additionally, the therapist must be aware that the client may experience frustration, insecurity, and cultural shock due to language barriers as they struggle to express themselves fully. Prolonged grief disorder (PGD) can occur when grief reactions persist for a significant length of time, and it affects the individual's ability to function effectively. Therefore, therapists should be able to recognise signs of PGD and provide appropriate support for the client.

If the therapist was unable to collaborate with the client due to the complexity of their issues or if the client’s needs exceeded their ability to work with them, they should consider referring the client with their consent. Additionally, connecting the client with a community of their own ethnicity may be beneficial, as limited access to cultural and religious institutions can impact their coping ability.

Given the complexity of migratory grief, it is essential to address grief reactions effectively by normalising the client’s thoughts and feelings. Reframing the client’s experience with affirmative statements will help the client to start the process of grief. To avoid retraumatising the client, it is important to be aware of the possible meaning of endings to them. Therefore, the therapist should maintain transparency with clients regarding the end of the therapy throughout the process.

Therapists should be able to recognise the difficulties associated with leaving home, culture, and social identity behind. It is essential to identify these issues so that therapists can employ effective therapeutic interventions that are appropriate for the client's needs.

Migration-related grief requires a culturally sensitive approach in counselling. Therapists need to recognise the complexity of grief so they can validate clients' experiences and enable them to navigate their therapeutic journey.

Migration can bring profound emotional challenges. If you're finding it hard to cope with the changes, talking to a counsellor can provide a safe, understanding space to explore these emotions and begin healing.