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, stillbirths).
Vicarious losses are those which 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 ones life via a chronic disease, the loss of a job, a home, a teenage child, or ones looks via the ageing process. All losses can have a significant impact on individuals.
The responses to loss which become manifest in an individuals experience are highly personal and based upon “each persons 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 of sadness, anger, guilt, anxiety, loneliness, fatigue, helplessness, shock, yearning, emancipation, relief and numbness; the experience of a range of physical sensations such as tightness in the chest and throat, hollowness in the stomach and breathlessness; the experience of a range of thought patterns, or cognitions, such as disbelief, confusion, preoccupation, hallucinations and a sense of the presence of the lost person or object; and the enactment of a range of behaviours such as lack of sleeping, 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 treasuring objects that belonged to the deceased (Worden, 2005; Geldard & Geldard, 2001; Bowlby 1980).
Figures indicate that anywhere between twenty and thirty three percent 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 goals 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) in order 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 (especially children and spouses), the nature of the attachment (especially ambivalent or dysfunctional), the mode of death (especially suicide, sudden or ambiguous), historical antecedents (especially a prior history of mental health issues), personality variables (especially ego strength and attachment style), social variables (especially where there is a lack of, or no support network) and concurrent stresses (especially other recent deaths or serious economic impacts) may create enhanced complexity in the grief response.
The literature indicates that there is 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 are in 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 the therapeutic work it is essential that individuals are located in their own personal 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 as a side-bar. This relationship can never be considered as 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).
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.