What Happens In Bereavement Counseling?
By Julia Thomas
Updated May 21, 2020
Reviewer Christie LeBeau, LMFT
Losing a loved one can be difficult, and some people never get over it. Bereavement counseling is designed specifically to help people who are struggling with their grief after losing a loved one. It helps by teaching coping mechanisms and giving them a safe space with a knowledgeable professional to talk to. Grief is often associated with extreme sadness, feelings of regret, guilt, and even anger. Emotions can be extremely strong and confusing which is why people who are sometimes grieving have such a hard time talking about it. Behaviors during the grieving process can range from mild crying and anger to smiling and reminiscing.
The Grief Process
Everyone grieves differently; culture, family, personal beliefs all affect how one will grieve. The average person takes between 6-12 months to grieve, and while they may continue to have moments of sadness after this, they will find relief over time. There is no specific "right" way to grieve making it a difficult and complicated process. The challenge for most is that this is a new reality that has never been experienced before, one where their loved one is no longer present. This requires them to forge a new sense of identity and imagine a different future.
In 1969 grief was divided into five stages under the research of Elisabeth Kubler-Ross:
It was expounded upon by Dr. J. W. Worden into the 4 Tasks of Mourning:
- Accepting the loss
- Working through grief
- Adjusting to the new reality
- Maintaining remembrance while moving on.
For those who are looking into grief counseling, it's very likely that they have become stuck in one of these four tasks, likely between working through their grief and adjusting to the new reality. Continuing loss related activities can keep them mired in those rather than attempting restoration activities. Many restoration activities may also trigger more grief such as lifestyle or routine changes. Normally a person will oscillate between restoration and loss, with the balance gradually swinging towards restoration.
Grief is not defined as a mental disorder in the Diagnostic and Statistical Manual but is included in the "conditions for further study"; it can be connected to other mental disorders like PTSD, stress, and depression. It can also trigger relapses if you've already been diagnosed with these disorders. When beginning grief counseling, a therapist will likely ask about things outside of the recent death to try and get a better picture of what may be causing you to become stuck in your grieving process. The first meeting will center around the loss and will involve the therapist asking questions. Try not to censor yourself as it's important to be honest about your grief if you want help. Crying and even anger or yelling is natural during such a time, and you should not be embarrassed or worried that you will offend the counselor.
Bereavement Counseling Vs. Grief Therapy Vs. Trauma Counseling
These two terms are often used interchangeably, but the approach is very different. It helps to know that when you're deciding if you are going to see a therapist for grief help. Bereavement counseling is often offered without clinical help and is for people who are not dealing with complex grief issues. This approach will benefit people who may only be struggling a little and just need a safe environment to vent their grief without judgment and think things through themselves. They will likely not have medications prescribed or previous disorders which may affect their grief. It is best for people who may simply be taking longer than normal to grieve or who feel their response is outside of the "norm" even if that is merely cultural.
On the other hand, grief therapy is clinical psychotherapy which is intended for treating persistent or complex grief. The goal of therapy is to determine conflict, psychosomatic disturbances, behavioral changes, and anything else associated with mourning behaviors. It may be individual or group environments or a combination of two.
Trauma counseling is best for people who are grieving after a violent or sudden loss which may create additional strain on the patient grieving, as well as tragic community events.
After your initial meeting with your counselor when you discuss the actual event of the death, your subsequent sessions will vary depending on the methods of the therapist and the type of counseling you choose. The process will always involve exploring the emotions that a patient is feeling to try and tap into the sadness, anger, guilt, regrets, and other emotions. The length of time spent in counseling often is determined between the patient and therapist since there are no set time lengths.
The Dual Process Model Of Coping
One of the most common methods taught in bereavement counseling is the dual process model. The model is a two-directional approach that involves accepting the grief (loss process) and confronting it through healthy emotional release and changing perspective (restoration process). It works by giving the patient a way to cope when in situations of everyday life that may destabilize them during their grieving process in the post-loss world.
The loss process is about the loss itself and acceptance. This period is used to allow patients to express the way they feel about the loss and the subsequent changes in their life. Demographic changes, location changes, economic changes, friendship, family and routine changes are all part of this too. The process focuses on the pain that these losses have caused rather than allowing the patient to use denial (the first step in the grieving process) which forces them to move on to step 2 or 3. People who feel guilt at this time often struggle with interpersonal relationships, so they are also encouraged to reach out even when it feels overwhelming.
The Restoration Process
This happens after the loss process is complete and the loss has been accepted, and any excessive attachment has been let go. A person is ready to begin the restoration process when they have finished the 5 Stages of Grief and are in step 2 of the Tasks of Mourning. The process focuses on the person creating a new role for themselves in the post-loss world and redefining their responsibilities there. The thought process is adjusted so that when faced with a situation which before would have led back into the grieving process the person can now confront it objectively, accept the feelings, but not be consumed by their feelings.
This model works for everyone because we will all experience some form of grief at some point and life will go on. By being able to choose how you are affected and by consciously allowing or changing with post-loss life, events are the final stage of the grieving process.
Some counselors like to use sense making as part of their bereavement counseling strategy. This includes helping to see benefits that have come from the death, such as an ending of pain for terminal patients or the liberation of a carer to pursue their own goals which may have global benefits. Making sense of the cause of death is also part of the process, but the aim is to help the patient feel a greater appreciation for life and to make it more meaningful without a specific push to move on like the removal of denial using the Loss Process.
There sometimes needs to be specialist counselors if a person looking for bereavement counseling is dealing with mental disorders like intellectual disabilities as they may not have the ability to process grief or understand what is happening. Non-verbal behaviors require a different type of training to determine stress and express grief to continue functioning. This type of bereavement counseling always includes the family and those around the patient so that they can see how others are handling the event and model behaviors based on them. It also can be reassuring in these cases to know that their feelings are normal.
Finding The Right Bereavement Counselor
If you're struggling with grief and you've determined that you're going to need more help than your friends and family can provide you'll want to find a counselor who is supportive and who you can connect with. Because grief counseling is about trusting the therapist to express your grief honestly, it's imperative that you connect well together. Sites like BetterHelp allow you to search therapists based on their location and specialty, so you know who you're dealing with. Don't forget to call and ask about insurance coverage, costs, and what experience they have dealt with situations like yours.