Issues Treated in Therapy:
Grief is a reaction to loss that can encompass a range of feelings, thoughts, and behaviors, and is experienced differently by each person according to his or her culture, background, gender, beliefs, personality, and relationship to the deceased or loss. Feelings common to grief are sadness and yearning. Guilt, regret, anger, and a sense of meaninglessness can also be present. Some may also a feel a sense of relief and liberation. Emotions can be surprising in their strength or mildness, contrary to the expectations of the griever; they can also be confusing, such as missing a painful relationship.
Thoughts during grief can vary from “there’s nothing I can do about it” to “it’s my fault, I could have done more” to “he had a good life” or “it wasn’t her time.” They can be troubling or soothing, and people in grief can bounce between different thoughts as they make sense of their loss. Grieving behaviors run from crying to laughter, sharing feelings to engaging silently in activities like cleaning, fixing, or exercising. They can involve being with others or by oneself.
The different feelings, thoughts, and behaviors people express during grief can be categorized into two main styles: instrumental and intuitive.
It is helpful to know that grief is natural and time limited. It can continue anywhere from two weeks to almost two years, and is usually different for each relationship or event. It is also quite normal to be able to experience joy, contentment, and humor even amidst the worst loss. Factors contributing to soothing grief include strong social support, optimism, and physical exercise. Most people recover from grief and can continue with their usual activities, while still feeling moments of sadness, within six months. Some people feel better after about a year to a year and a half. For others, their grief may be longer lasting, continuing for years without seeming to improve or with any break, and this may be due to factors before the loss such as pre-existing depression or high dependency on the departed.
Everyone grieves in their own way and in their own time. Some people are more emotional and dive into their feelings while others are stoic and may seek distraction from dwelling on an unchangeable fact of living. Neither is better than the other, but if at any point one is concerned about whether one’s grief-related feelings, thoughts, and behaviors are “normal” and “healthy,” a consultation with a qualified mental health professional may be advised.
Although people may be familiar with the five stages of grief described by Elizabeth Kubler-Ross in 1969 (denial, anger, bargaining, depression, and acceptance), research has shown that we cope with grief not in linear or cyclical stages, but in a dual process described by Stroebe and Schut that goes back and forth between the experience of loss (sadness, anger, yearning, crying) and the experience of restoration (feeling “normal,” joy, contentment, laughing), which gives the bereaved respite from attending to their grief.
Another model that helps people get a handle on their grief was developed by psychologist J. W. Worden, who noted four Tasks of Grief:
The Diagnostic and Statistical Manual (DSM) does not define bereavement as a disorder, but pre-existing conditions such as major depressive disorder, or trauma surrounding a death which can cause acute stress or posttraumatic stress, can complicate bereavement. What distinguishes grief from depression is that grief is specifically related to the loss or death, and depression is characterized by a general sense of worthlessness, guilt, and lack of joy.
Most people accept that someone has died, but accepting the reality of the loss involves waiting for the numbness, shock, and sense of unreality to subside. To work through the pain of grief is to think one’s thoughts, feel one’s emotions, and to do what our bodies need to do about the grief we experience. This may be memories of the deceased, pangs of guilt or longing, and crying or being with other people.
Adjusting to an environment where the deceased is missing is a further step in acceptance, where the bereaved begin to rebuild their world, picture of the future, and sense of meaning in the absence of the deceased. People can establish new routines or adapt previous ones. To emotionally relocate the deceased acknowledges that our relationships are not severed by death. The physical presence of the departed may be missing, but we can continue to relate to them through our memories, feelings, and rituals.
Rhonda, 57, had a sudden breakdown, stopped working, became anxious and depressed, and sought therapy. A full history revealed she had been the sole caretaker for her sister, who had been ill for years and required near fulltime assistance. During the time of the illness, Rhonda’s parents had both died of natural causes. Rhonda realized she never had time or emotional energy to mourn her parents’ death, and in fact resented her sister, who had died a year previously, and not mourned her death either, for which Rhonda felt terribly guilty. She had also been so caught up in her family duties, she had had little time to develop other pursuits. Allowing herself to face the great feelings of sadness and loss slowly dissolved her anxiety, and after a time of rest to fully grieve, Rhonda could return to work and, with the support of a therapist and a close friend, begin to build a full life.
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Last updated: 05-14-2013
Grief, Loss, and Bereavement Articles