What Happens In Bereavement Counseling?
The loss of a loved one can be difficult, and some people never get over it. But what is bereavement and what is bereavement counseling? Bereavement counseling is designed specifically to help people who are struggling with their grief after losing a loved one, and there are many bereavement quotes and options like joining a bereavement group to help people navigate their loss. 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. Everyone has their own way of grieving, making it a difficult and complicated process. In fact, there are many ways to spend bereavement time that can help you process your feelings. The challenge for most is that this is a new reality that has never been experienced before, one where their deceased 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 the benefits of 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 and treatment, 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 and treatment 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 that is intended for the treatment of persistent or complex grief. The goal of treatment 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 and treatment 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 guilty 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 treatment. 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 treatment 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.
Commonly Asked Questions About This Topic Include:
What are the 7 tools to process grief?
What is the difference between grief and bereavement?
What is the hardest stage of grief?
What does a bereavement Counsellor do?
What questions do you ask a grieving person?
How long does intense grief last?
Frequently Asked Questions:
What are the 4 stages of bereavement?
The four stages of bereavement are shock and numbness, yearning and searching, disorganization and despair, and reorganization and recovery.
Shock and numbness: This is the immediate period after discovering the death of a loved one. They may not experience any distressing emotions and may, in fact, feel quite numb. This numbness is a self-defense mechanism to protect their mental health that usually wears off within a few days or weeks. Many people may also experience this numbness to cope with their pain and avoid any emotional reactions while taking care of the funeral arrangements or handling their deceased loved one’s affairs.
Yearning and searching: This is the period when the numbness wears off and difficult emotions arise. A person in this phase may feel anxiety, depression, confusion, anger, or any other strong emotion as they begin to accept their loved one’s death. They have a void in their life and yearn for the person to somehow come back and fill it again.
Disorganization and despair: At this point, a bereaved person may withdraw and disengage from others. For example, they may take more sick days from work or not interact with their friends or family as often as they usually do. They are still experiencing the intense emotions from the last stage, but those feelings may not be as intense as they once were.
Reorganization and recovery: During this final stage, the person begins to develop a new normal. They engage with friends and family again and get back to their old lifestyles and hobbies. However, they may still feel a void in their life and continue to grieve, but at this point, they have accepted their loss and are rebuilding. They begin to return to normal functioning, or as normal as they possibly can given the circumstances.
What is the best kind of therapy for grief?
There are many types of therapy that can help with grief. Some of them include cognitive behavioral therapy, acceptance and commitment therapy, complicated grief therapy, and traumatic grief therapy. If the death of a loved one has affected the entire family, then family therapy may be a good option so that all immediate family members can process their grief together. However, most forms of counseling can help when experiencing grief. And in many cases, the therapist or counselor may utilize multiple techniques for better emotional process and healing.
However, one of the best forms of therapy is support groups. A bereavement support group brings people together who are all experiencing loss. Group members can support each other emotionally throughout their grieving process as well as provide coping skills and other tools to keep moving forward.
Furthermore, support groups provide bereaving people the social support they need during this time. While in grief, it is normal for a grieving person to withdraw from family and friends while they process their emotions. Though this is understandable, this can also be quite a lonely time. Support groups offer a support system for a grieving person who is experiencing loneliness but isn’t quite ready to go back to normal functioning yet.
How long should it take to grieve?
There is no amount of time that a person “should” spend time grieving. Grief is a complicated process that everyone experiences differently.
However, the average amount of time that people experience grief is a few months to just under a year. Yet, most people either know someone or have experienced grief themselves for longer than this period. People who experience the difficult emotions of grief for over a year with little improvement or healing are experiencing complicated grief.
Bereaved people who experience complicated grief exhibit all the signs of grief long after their loved one has passed on. They feel intense emotions of anger, fear, depression, or anxiety and may struggle to function normally in life. Though this is normal during the grieving process, the trouble is that people with complicated grief continue to have these experiences a year (or even years) after the death of a loved one. They struggle or simply can’t move on or create a new life for themselves.
There are a few risk factors that affect the chance of developing complicated grief. They include:
- Experiencing trauma in the past
- The death was sudden and unexpected
- The bereaved person is juggling other major life stressors
- The death was of a child or children
It should also be noted that women and people of old age are more susceptible to experiencing complicated grief than other demographics. But that doesn’t mean that people not in these demographics don’t experience complicated grief. Complicated grief can arise in anyone, no matter their gender or age, and no matter what kind of loss they experience (such as the death of a family member, losing someone they were in a relationship with, or pet loss.)
What techniques are used in bereavement counseling?
There are many techniques that therapists and counselors use to help grieving patients. The exact techniques used will depend on who the patient is and the type of counseling they are seeking.
The three most common techniques you will see in grief counseling are:
- Talking about the loved one: Whether experiencing the death of family members or experiencing pet loss, the patient is encouraged to talk about the lost loved one. This will help them process some of the difficult emotions they are experiencing.
- Processing guilt: Grief often brings about guilt. Maybe they believe their actions somehow resulted in the death, or they feel guilty about not sharing feelings with the loved one enough. Counselors allow patients to talk about this guilt and help them process it so they can forgive themselves.
- Distinguish grief from trauma: Grief is mourning the loss of a loved one. Trauma comes from the shock of death and doesn’t heal quickly. Bereaving people who keep having flashbacks of learning about the death or have certain images related to the circumstances of the death in their head may also be experiencing trauma in addition to grief.
In addition to processing the grief, counselors may also help the patients find a path forward toward a new normal and restore their mental health. They may encourage the person to rely on their own strengths and slowly partake in their old hobbies again or new ones. Whatever the case, moving forward is an important part of healing grief, so counselors may give some nudges and help their patients find a new normal or new identity.
However, counselors and therapists may use other techniques and treatment options if they feel are necessary. If a person in grief is experiencing other mental health concerns, the therapist may use other forms of therapy or treatment options to address those concerns. For example, if a patient is experiencing anxiety, they may suggest medication or a similar treatment to help with those anxious feelings. And if they are experiencing trauma in addition to grief, the therapist will conduct treatment designed to help with trauma and PTSD.
Counselors and therapists also may encourage developing mourning rituals to help heal the pain. This can include creating a memory book, cooking the person’s favorite meal, or carrying a remembrance item.
Treatment may also differ for therapists who are helping children grieve instead of adults. Children who are experiencing grief often exhibit symptoms that are different than adults going through grief. They may not be as open as adults to discussing their sadness, so symptoms may manifest in other ways. For example, symptoms of grief in children may include physical health problems such as experiencing stomach or chest pains or not getting enough sleep. Counselors can help children talk about their emotions in a way that is easy for them. For more tips on helping grieving children, you can check out theNational Center For School Crisis & Bereavement.
Finally, if patients are partaking in family therapy with other family members, then the therapist may have slightly different techniques. For example, the counselor may encourage sharing feelings with each other and promoting the development of a support system amongst the family members.
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