Reflection on the Bereaved

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CHAPTER 6

Working With Bereaved Individuals

M any people are afraid to approach newly bereaved individuals, feeling concern that they may say the wrong thing or that they may actually make the bereaved person feel worse by saying something that is inadvert-

ently insensitive or that provokes pain. In this chapter, we will give you some

practical ideas for how to sensitively approach someone who is bereaved

and to offer the best form of support that might be possible to that person.

We have already mentioned in a previous chapter that most bereaved

individuals do not require professional support or therapy to cope with their

losses and their grief. In this chapter, we are not going to focus so much on

what professionals do or do not do, but upon what might be helpful to a

bereaved person, whether you are a friend, colleague, or a counselor. Some

people seek grief counseling not because their grief is complicated or be-

cause deeper unresolved issues in their lives have been triggered by the loss,

but because they need a safe place to explore their grief in a healthy way with

someone who can offer them unconditional support. In this chapter, we will

fi rst explore some of the common expressions of the grief experience, and

then we will discuss some practical suggestions for how to be most helpful

to a bereaved individual.

WHAT IS NORMAL?

This question is perhaps one of the most common queries we receive from

clients and students alike. As there is so much variation in grief from one

person to another, how would you know what is normal? One of our clients

answered this question very well when she said simply, “Normal is a cycle

on the washing machine. If you want normal right now, go to your laundry

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un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

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82 Principles and Practice of Grief Counseling

room and look for it to be written on the dial. That’s where you will find

normal when you are grieving.” We laughed at the time when she said this

statement, but we have shared it with many other clients, who will nod in

agreement. When we encounter a significant loss—the “seismic life event”

that we mentioned earlier, our entire world gets turned upside down. There

is often a sense of being off-balance and unable to be the way we have known

ourselves to be in the past, and sometimes there is an accompanying sense of

paralysis or a dizzying need to remain very busy that is not normally part of

who we are. So, let us start with how grief can be experienced by many indi-

viduals and then take a look at some of the more unique aspects of the griev-

ing process as a way of exploring what “normal” grief may look or feel like.

How Is Grief Experienced?

Although grief is often considered primarily an emotional response, it can

be manifested in many different ways with a great deal of variation between

individuals. It is important to note that bereaved individuals will most likely

experience grief in a way that is congruent with their personality and pre-

vious ways of coping with stressful situations. For example, a person who

is not typically emotionally demonstrative with others will most likely not

all of a sudden become highly emotional or seek out places to share his or

her feelings after experiencing a significant loss. Grief can be manifested in

many ways:

• Emotionally —although we expect to see sadness, that is not always the primary emotion bereaved individuals may feel. It is very common

to feel angry because of what has happened, to feel robbed of the

presence of someone we loved who is now gone, or to feel like we

have lost a part of ourselves that we valued. Sometimes, the anger is

expressed toward medical care providers, clergy, family members, or

oneself. The anger can also be more covert, being expressed through

sarcastic remarks or cynicism about life and people. Many bereaved

individuals report feeling numb—a sense that they are unable to

access their feelings or that they are flooded—that their feelings are

very intense and overwhelming. Guilt and remorse are commonly

expressed, either for lost opportunities, things said or done that they

now wish they had not or that they will never have the opportunity

to clear up, and these feelings are often expressed as “if onlys.” It is

important to remember that emotions do serve a valuable purpose

when they are present, and the listener’s role is not to talk the

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un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

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Working With Bereaved Individuals 83

bereaved person out of these emotions, or to try to make him or her

to feel better, but to listen and support the sharing of these emotions

so that the bereaved individual can benefit from the purpose they are

serving. We will talk more about working with strong emotions in a

later chapter.

• Cognitively —it is common for bereaved individuals to complain that they just cannot focus well or that their minds seem to wander

a lot. Many people describe difficulties remembering, organizing,

and keeping track of things. Time may seem to warp as well; a day

may seem like forever, or it may seem like a brief period. Days and

nights can get switched around as well. Many of our bereaved clients

describe their minds as “constantly busy,” but not productively so.

One client reported that she accidentally forgot to pick up her 2-year-

old son from the day care. She stated that she had a nagging feeling

that something was amiss, and when she got home, she realized

that she had not picked up her son at the usual time of 4 p.m. (and it

was now almost 6 p.m.)! This aspect of grief may be very hard if you

work, as most people have limited time off work after the death of

a loved one, and when they return to work, concentration and focus

can be very difficult.

• Physically —our bodies often “carry” the weight of our grief through physical symptoms. Many bereaved individuals will share that they

often have symptoms that mimic those of their loved one before she or

he died. One client shared that she had gone to the emergency room

three times with chest pain and shortness of breath that had never been

present before her husband died suddenly of a heart attack. One very

common description from clients is something that we term “restless

exhaustion,” where bereaved individuals may feel continually busy or

agitated in their minds, but exhausted physically. When they try to lie

down or rest, their minds become even busier; however, when they try

to get something done or try to complete a task, they are overwhelmed

by feelings of exhaustion and lethargy. Headaches, bodily aches and

pains, difficulty sleeping, weight loss and weight gain, digestive

problems, and accidents like falling, tripping, and knocking things

over are commonly described as well (Hensley & Clayton, 2008;

Luekin, 2008; Stroebe, Schut, & Stroebe, 2007). It is interesting to note

that there is research linking certain types of bereavement to lowered

immune function and to higher rates of morbidity and mortality

in survivors (Buckley, McKinley, Tofler, & Bartrop, 2010; Goodkin

et al., 2001; Hall & Irwin, 2001; Jones, Bartrop, Forcier, & Penny, 2010;

Schleifer, Keller, Camerino, Thornton, & Stein, 1983).

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84 Principles and Practice of Grief Counseling

• Spiritually —we have already discussed how a significant loss event can shake up an individual’s assumptive world and the spiritual

effects of a major loss often leave people questioning their beliefs

about God or wondering if there is indeed any higher order or

purpose in life. Over time, many bereaved individuals will often

say that their loss experience deepened their faith or caused them to

reexamine beliefs that they had taken for granted before. On a more

practical level, clients will often share how their faith communities

are sources of support and also, at times, sources of discomfort

or disappointment. Although there are studies that examine the

effects of spiritual beliefs upon bereavement outcome, most do not

conclusively demonstrate either that religion or systems of faith have

a direct impact upon the course of bereavement (Wortmann & Park,

2008). However, it is often thought that many individuals benefit

from the sense of structure and ritual that a faith tradition may

provide for them after a significant loss, such as the funeral liturgy,

mourning rituals, and a sense of belonging to a community at a time

when they may otherwise be isolated (Park & Halifax, 2011).

Balk (1999) stated that three things must be present for a life crisis to

initiate spiritual change in a person: (1) the situation must create a feeling of

destabilization that resists restabilization readily, (2) there must be time to

refl ect upon what has occurred, and (3) the crisis must be something that will

be indelibly etched into the life story of the person who experiences it. Balk

goes further to state,

Bereavement contains all the necessary ingredients needed to trigger spiritual

change. It is a dangerous opportunity, producing extreme psychological imbal-

ance, and possessing suffi cient intensity and duration to allow for serious refl ec-

tion. Its effects color a person’s life forever. (p. 488)

Fowler (1981) mentioned that the times in our lives when we end up

questioning our beliefs and searching for meaning can produce what he calls

a transformed faith consciousness , which allows for greater meaning and un- derstanding in our lives. Thus, a signifi cant loss event carries the possibility

of spiritual destabilization and the potential for increased depth and per-

sonal meaning in life.

• Socially —there are many effects that grief has upon how bereaved individuals interact with others socially. If the bereaved individual

has been a long-term caregiver, there is a good likelihood that the

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Working With Bereaved Individuals 85

social network that was in place before so much time was spent

taking care of a dying loved one is no longer in place. Others’ lives

have continued in a very different way from the life of the person

who became a long-term caregiver and with increasing demands

because of the illness of their loved one, there was likely little time

left to socialize and stay in touch with their usual support network

(Burton et al., 2008). Our bereaved clients often describe feeling

socially isolated and aware that they do not “fit” into any identifiable

social group, often feeling acutely aware that they are different

in the way they react to things and to their needs in their close

relationships than before they were bereaved.

Many bereaved individuals isolate themselves because they

have a great deal of difficulty handling social situations where they

may be triggered into their grief or where the effort to engage in

small talk seems like a great deal of work because their lives have

been filled with such deep grief and profound questioning of life and

themselves. Many of these individuals have a difficult time fitting

neatly in a social context—they may no longer be able to identify

with the role that was associated with the deceased person—for

example, a widow is no longer a wife; a parent to a deceased child

is still a parent, but the child is missing. In addition, many bereaved

individuals sense the discomfort of others around them, as people

struggle finding the “right” words to speak or avoid them to prevent

the discomfort of an awkward social exchange.

• Economically —we often do not ask our clients about this particular issue in bereavement, but it is an area that can be of immense

concern to bereaved individuals. Two of the younger widows whom

I (D.L.H.) saw in my practice had to declare bankruptcy after their

husbands died because there was not enough life insurance to cover

the debts in their husbands’ businesses, and they could not deal with

bill collectors and harassing phone calls and letters on top of their

paralyzing grief.

If the bereaved individual takes time off work to be the

caregiver to a terminally ill loved one, he or she may not only face

lost income, but his or her jobs may have been given to someone

else in his or her absence. In addition, those individuals who take

a leave from their work after the death of a loved one may do so

out of necessity to take care of the estate issues and to take care of

themselves emotionally and physically, but this time may be unpaid

leave from work, with the result being increased financial strain

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86 Principles and Practice of Grief Counseling

in addition to the grief. If the bereaved individual is the executor

of the deceased person’s estate, there are often time-consuming

responsibilities associated with this role and there may be conflict

with surviving relatives about the distribution of the estate, all of

which will land in the lap of the grief-laden executor. Some clients

have difficulties accepting insurance monies and proceeds from an

estate, citing feelings of guilt that the death of the person they loved

has now somehow benefitted them financially.

• Behaviorally— some of the behaviors in which bereaved individuals may engage can be quite subtle, but they may be very common.

For instance, many bereaved individuals will describe feeling like

they are searching for their lost loved one in a crowd, or they will automatically scan situations for familiar things that are associated

with their loved one—a car that is similar to the one that your son

drove before he died, and you realize that you are staring at the

driver, looking for your son in the seat. Or, you find yourself going to

places that your loved one would go, even if it is not a place where

you went together beforehand. Some individuals find engaging in

an activity that their loved one used to enjoy to be comforting—

gardening, playing certain music that their loved one would listen

to, feeding birds, collecting stamps, shopping, watching certain

sports events and teams, eating at certain restaurants or certain types

of food that your loved one enjoyed—all are commonly described

by bereaved individuals, and the common thread is often an

identification with the deceased person and an attempt to reconnect

with that person in these activities. Clayton (1990) described

attempts to cope by the increased use of alcohol, tranquilizers,

hypnotics, and cigarettes often reported in bereaved individuals.

Many bereaved individuals describe a sense of “going through the

motions,” or of being on “autopilot” for a long period after they

experience a significant loss. One client described this experience as

“showing up for work, but leaving my brain at home asleep.”

Extraordinary Experiences

Bereaved individuals commonly describe feeling that their loved one has

connected with them through a sign, a dream, a vision, or a hallucination. We

have had clients give descriptions of radios tuned in to the favorite station of

their loved one without them recalling changing the tuner themselves, a bird

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Working With Bereaved Individuals 87

landing on windowsills that they believe represents a visit from the deceased

person, a “sense” of something brushing against their skin, finding a book

open to a page where there is a message for them, flickering lights, butterflies

appearing from nowhere, or hearing the voice of their loved one speaking to

them either silently or audibly. The “visitation dreams” that clients describe

are often very vivid and totally engaging, often with the deceased person

telling them that they are okay, and sometimes the feeling that there was

physical contact with the deceased in the dream.

Many clients share that they have regular “conversations” with their

deceased loved ones, most commonly described as silent discussions that

occur in their thoughts, but sometimes in audible dialog as well. These con-

versations most often happen at the graveside or in a place that was most

frequented by the deceased person, such as his or her offi ce, a favorite rec-

reation spot, or a special place that they shared together. Most bereaved indi-

viduals describe these experiences as comforting and helpful, which is also

supported by Parker’s (2005) research on the topic. What is important to note

about these experiences is that they are common among bereaved individu-

als and they also tend to have a functional role in the grieving process rather

than a pathological or unhealthy infl uence. These experiences are not breaks

in reality that would occur in someone with a psychotic or delusional dis-

order, as the bereaved are aware that the experience is extraordinary when

it occurs, and their interpretation of the event is often kept very private to

avoid social stigma surrounding the experience or their mental state.

Resurgences

It is now known that grief may never be fully “resolved.” It is more common

(and more accurate) to use words such as “integration,” “accommodation,”

and “adaptation” to loss rather than to refer to “recovery from grief,” “reso-

lution of a loss,” or “acceptance.” In fact, it is now recognized that grief may

never really end. Although the intensity of the grieving experience usually

diminishes over time, grief itself may be present in various ways throughout

a person’s lifetime. For example, a girl whose father dies when she is 8 years

old may experience a resurgence of grief later in her life as she experiences

significant life passages and realizes that her father is not there to partic-

ipate in these times with her. There are times when grief that has abated

in its intensity over time can be reactivated in a very real and intense way.

Most commonly, these resurgences occur at significant times, such as anni-

versary dates, the date the loved one died, or at special family times or rites

of passage, such as graduations, weddings, the birth of a baby, or some time

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88 Principles and Practice of Grief Counseling

or event that carries a reminder of a shared time with the deceased (Sofka,

2004). Some people call these “grief triggers” or “grief surges.” Parkes (1975)

used the term grief “pangs” to describe these resurgences of grief. Rosenblatt

(1996) addressed the issue of the ongoing nature of grief, stating that grief

may never really go away completely, and noting that it is probably unreal-

istic to think that a bereaved individual will just stop grieving at some point.

Rather, he stated that grief resulting from major losses will probably recur

at many points over a person’s lifetime. Grief can essentially “sneak up” on

someone when there is a new pang of grief that surfaces in response to a trig-

gering situation or reminder. Rando (1993) described STUG reactions that are subsequent temporary upsurges of grief that occur in situations where the re-

alization of the loss and its magnitude are brought into the active awareness

of the bereaved individual, sometimes many years later. It is very important

to recognize that there is no specific timeline for grief to end, and the resur-

gence of grief at various points in time after a significant loss is very common

and normal.

Grieving Styles

Doka and Martin (2010) extrapolated on different patterns of the expression

of grief in their descriptions of adaptive grieving styles. These authors de-

scribed three main grieving styles on a continuum, with intuitive grievers

at one end, instrumental grievers at the other, and a more blended grieving

style between them. Intuitive grievers tend to express feelings and wish to talk about their experience with others. Instrumental grievers tend to grieve more cognitively and behaviorally and tend to express their grief in terms

of thoughts, analysis, and actions. Individuals who have a blended griev-

ing style may combine elements of both intuitive and instrumental grieving

styles, but they usually have a predominate tendency toward one of the other

style. This exploration of grief emphasizes that there is no “right” way to

grieve; however, bereaved individuals are often expected to grieve in certain

ways based upon gender socialization, and if they do not express grief in a

way that is expected by others, their experience may be labeled as problem-

atic or even pathological.

There have been times when a client or a family member of a be-

reaved individual will assume that a person has not “grieved well” unless

he or she has expressed emotions about the loss. As we stated earlier, not

all bereaved individuals will grieve through their emotions or will need to

share their feelings and talk about their loss. Expressions of grief typically

are congruent with an individual’s existing personality, temperament, and

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Working With Bereaved Individuals 89

preferences. For example, one of our colleagues recently lost his wife. They

were extremely close, and her illness and subsequent death occurred over

a few short months. He was back to work within a few weeks after the fu-

neral. Many individuals in our work place assumed that he was avoiding

his grief and attempting to bury himself in his work, and they expressed

concern that he was “hiding” from his grief. However, when in speaking

briefl y with him, it was very apparent that he needed the structure of work

to help him through his daily life, and he is by nature a more cognitively ori-

ented individual who tends to process his experiences through his intellect

and analytical thinking. His grief was very real to him, as is his profound

loss, and his choice in returning back to work and focusing on everyday

tasks was very congruent with his personality and previous ways of coping

during times of stress.

For a long time, the goal of grief counseling seemed to be to get the cli-

ent to emote and to “clear” the grief by having emotional catharsis. However,

it seems much more appropriate (and humane) to think of grief counseling

not with this type of goal in mind, but to support the bereaved individual in

working out the process of grief in ways that are aligned with that person’s

values, view of himself or herself, personality, and temperament.

Although emotional expression is now not seen as an imperative in

the way it once was, social support to bereaved individuals can be very

important in assisting the bereaved individual. What is very important

to remember about social support is that individuals will vary widely in

what is seen as supportive and what is not. For instance, if we go back to

the example of my widowed colleague, I doubt he would fi nd it helpful if

one of us showed up to his offi ce, sat down, and asked him to talk about

his feelings. Support to him has come in the form of snippets, which al-

low him to know that his colleagues are thinking of him and care about

him, but not placing an expectation upon him to talk about his feelings

at length. He also seems to greatly appreciate the ability to talk about his

teenage children as they cope with the loss of their mother, and he has of-

ten requested information about specifi c aspects of teen grief and the loss

of a parent.

Mediators of Mourning

The most important aspect of grief counseling is …