What Happens In Bereavement Counseling?
Are you experiencing the death of a loved one? This type of grief can be difficult to overcome, especially on your own. However, understanding the options available to you in this time of need can help you to experience a higher quality of life.
In this article, we'll discuss bereavement and the role that bereavement counseling can play in the grief process. We'll also explore supportive strategies that may be helpful as you walk through the process of restoration.
What are bereavement and bereavement counseling?
Bereavement is defined as the process of losing a close friend or family through death. Bereavement counseling is designed specifically to help people who are experiencing grief after losing a loved one.
Supplementary bereavement support can vary and may include tools, such as joining a bereavement group to help people navigate their loss. These tools can help those experiencing grief by teaching them about coping mechanisms and giving them a safe space with a knowledgeable professional to talk to.
As grief can be associated with extreme sadness, feelings of regret, guilt, and even anger, bereavement support options can be helpful. Understanding the range of the grief process and the options available for your support can help you to navigate the next steps more confidently.
The grief process
Everyone grieves differently. Culture, family, and personal beliefs can all affect how one will experience grief.
The average person takes between six and 12 months to grieve, and while they may continue to have moments of sadness after this, they may be able to find relief over time.
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 may never have been experienced before, requiring some to forge a new sense of identity and imagine a different future without the presence of their loved ones.
In 1969, grief was divided into five stages under the research of Elisabeth Kubler-Ross. These include:
Denial
Anger
Bargaining
Depression
Acceptance
Dr. J. W. Worden expounded upon it in the Four Tasks of Mourning, which include:
Accepting the loss
Working through grief
Adjusting to the new reality
Maintaining remembrance while moving on.
Those who are looking into the benefits of grief counseling have likely become stuck in one of these four tasks, such as between the stages of working through their grief and adjusting to the new reality after their loved one dies. Working with a grief therapist or specialist can help many to progress more effectively through and between these stages, making progress toward a more fulfilling experience.
Prolonged grief disorder or complicated grief
Prolonged grief disorder, also known as complicated grief, was officially recognized in the DSM-V in March 2022 as a distinct condition. This condition highlights that while experiencing bereavement is a universal part of losing a family member, the intensity and duration of grief can vary significantly among individuals. Unlike the common process of bereavement, prolonged grief disorder is characterized by extreme longing and preoccupation with the deceased, which can hinder a person’s ability to carry out daily activities for an extended period.
There is no right or wrong way to experience grief, but prolonged grief disorder indicates a profound struggle to move forward after a loss. It's not uncommon for this form of grief to coexist with other mental health challenges, such as PTSD, stress, and depression, indicating the complex nature of bereavement and its impact on mental health.
What to expect in grief counseling
For those grappling with difficult feelings surrounding grief, bereavement counseling, including grief counseling and bereavement therapy, may offer emotional support. Connecting with these services may help individuals process their loss, providing further information and strategies to navigate their sorrow.
It may be key for family members to recognize when a loved one may need this additional support to heal. Through the assistance of qualified professionals, those experiencing prolonged grief can find a path to gradually rebuild their lives, acknowledging their loss while beginning to embrace the future.
When beginning grief counseling and treatment, a therapist may ask about things outside of the recent death to try and get a better picture of what may be causing you to remain in your grieving process. The first meeting may center around the loss and involve the therapist asking questions.
You may lean into the experience and refrain from censoring yourself, as it's important to be honest about your grief to truly heal. Crying, anger, or yelling is natural for many during such a time, and your counselor can offer strategies and support that may elevate you to a higher quality of life.
Counseling types: Grief therapy vs. trauma counseling
These terms may often be used interchangeably, but the approach can differ. Knowing the differences between modalities can help when deciding whether to seek formal support for the first time.
Bereavement counseling and treatment can be offered without clinical help and may be more appropriate for people who are not dealing with complex grief issues. This approach can benefit people who may only be struggling and just need a safe environment to vent their grief without judgment or learn about additional resources. They may not have medications prescribed or previous disorders, which may affect their grief.
Grief therapy is generally designated as clinical psychotherapy that is intended for the treatment of persistent or complex grief. The goal of treatment for some is to determine the sources of conflict, psychosomatic disturbances, behavioral or emotional changes, and anything else associated with mourning behaviors. It may be in individual or group environments (such as support groups or family therapy) or a combination of the two therapeutic types.
Trauma counseling and treatment can support many who are grieving after a violent or sudden loss, which may create additional strain on the patient grieving.
If you are experiencing trauma, support is available. For more resources, please see our Get Help Now page.
After your initial visit with your counselor, in which you will likely discuss the actual event of the death, your subsequent sessions may vary depending on the methods of the therapist and the type of counseling you choose. The process will generally involve exploring the emotions that a patient is feeling to try and tap into the sadness, anger, guilt, regrets, or other buried emotions. The length of time spent in counseling may often be determined between the patient and therapist since there are no set time lengths. While therapy may not always feel enjoyable, treatment can help you develop healthy coping strategies that prevent you from turning to unhealthy behaviors, such as extreme risk-taking or using illicit drugs.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
Coping strategy: The dual process model of coping
One of the most common methods taught in bereavement counseling is the dual process model of coping. The model is a two-directional approach that generally involves accepting the grief (loss process) and confronting it through healthy emotional release and changing perspective (restoration process). It can work by giving the patient a way to cope with triggers or events in everyday life that may destabilize them during their grieving process.
Coping strategy: Intentionality in the loss process
The loss process is generally about the loss itself and acceptance. This period can allow patients to express how they feel about the loss and the subsequent changes in their lives. Demographic changes, location changes, economic changes, friendship, family, and routine changes can all be a part of this, too.
This specific 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 can support them in moving on to their next healthy step. For example, when families experience the loss of a child, each may need to work through how this death impacted them in different types of ways. Children in the family may mourn the loss of a sibling while parents acknowledge how the death has changed their overall family dynamic. It may even be that one spouse handles the loss differently.
Coping strategy: Embracing the restoration process
The process of restoration can often begin after the loss process is accepted and any excessive attachment has been let go of. A person may be ready to begin the restoration process when they have finished the stages of grief or at any point in their own individual healing process.
The process generally focuses on the person creating a new role for themselves in the post-loss world and redefining their responsibilities there. The thought process is usually adjusted so that when faced with a situation that would have led back into the grieving process, the person can now confront it objectively, accept the feelings, and not be consumed by their feelings.
Coping strategy: Sense-making
Some counselors like to use sense-making as part of their bereavement counseling treatment. This can include helping survivors to see the benefits that have come from the death, such as an ending of pain for terminal patients or the liberation of a career to pursue their own goals.
Generally, sense-making aims to help the patient feel a greater appreciation for life and make it more meaningful without a specific push to move on until they feel completely resolved and ready to do so.
Bereavement support for those living with grief
There may need to be specialist support provided by trained counselors if a person looking for bereavement counseling is dealing with mental disorders or intellectual disabilities.
Non-verbal behaviors may require a different type of treatment to determine stress and express grief to continue functioning. Additionally, this type of bereavement counseling can include the family and those around the patient to potentially encourage them to see how others are handling the event and model behaviors based on them.
How can online therapy help those in bereavement?
Bereavement can be a complex emotional process that can have both emotional and physical effects. In-person therapeutic models may not feel feasible or available to those who may have difficulty leaving the bed or the home due to the weight of their sadness. Online therapy can provide support to someone from the comfort of their own home or safe space and can be used through in-app text messaging for a more direct or immediate response than many would find with traditional in-person models.
Is online therapy effective for those living in bereavement?
Current literature suggests that virtual intervention models can support those experiencing grief or prolonged grief. Studies referenced in a recent meta-analysis found that individuals in the test group experienced increased user satisfaction rates after virtual intervention and lessened symptomatic intensity after the intervention and support were received.
Takeaway
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 defend 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 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. Suppose the death of a loved one has affected the entire family. In that case, family therapy may be a good option so that all immediate families 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 participants 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 with 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, losing someone they were in a relationship with or a 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 families 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 imparting feelings to 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 the National Center For School Crisis & Bereavement.
Finally, if patients are partaking in family therapy with other families, then the therapist may have slightly different techniques. For example, the counselor may encourage imparting feelings with each other and promoting the development of a support system among the families.
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What is the difference between grief and bereavement?
What is the hardest stage of grief?
What does a bereavement counselor do?
What questions do you ask a grieving person?
How long does intense grief last?
What is involved in bereavement counseling?
How soon should you have bereavement counseling?
Is grief counseling a good idea?
What a grieving person should not do?
Is bereavement classed as mental health?
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