Many people have an idea about what constitutes “acceptable” and “normal” ways to grieve. In the public safety and medical professions, we experience our own grief and sometimes we experience the grief of others. We are sometimes wired to care for others often at the expense of ourselves. Our own grief reactions are influenced by a number of factors that can include years of exposure to the trauma (misery) we witness in our jobs as well as an overall negative perception of seeking help from behavioral health resources. A discussion about grief is a way that we can begin to prepare ourselves and help others.
People often believe that the experience of sadness is the standard of all people who grieve. While this is the case for many, there are exceptions. What does the research data tell us about “normal versus complicated” grief? It should be noted that many researchers and clinicians approach this topic in different ways. For example, one researcher suggests three types of distinctions of grief (Strobe et al, 2001). These include; trauma without bereavement, bereavement without trauma, and traumatic bereavement. Many of us have heard about the stages of grief by Elizabeth Kubler Ross of denial, anger, bargaining, depression, and acceptance. Many can relate to these stages. One of the limitations of these categories is the failure to recognize the “uniqueness” of the grief experience (Worden, 1997).
What is normal grief and complicated grief? Grief counseling involves helping people facilitate normal grief and adapt to the loss. This can be done by chaplains or peer support specialists who have been trained by clinical professionals. Grief therapy involves specialized techniques to treat complicated grief. Grief therapy treatment must be done by a licensed clinician.
One clinician/researcher has identified specific goals that correspond to the four tasks of mourning (Worden, 2018). Worden suggests the first task is increasing the reality of the loss. This first task involves helping the grieving person with the denial of the loss. It can be helpful to normalize the idea that the loss seems unreal and that some form of denial is a common experience.
Task two is to process the pain of grief. It is believed that failure to process these feelings can lead to complicated grief. This second task involves helping the person express healthy feelings about the loss. Again, normalizing these feelings as a common response is often helpful.
Task number three is assisting the person in the process of adjusting to life without the deceased. In this task, we support the person in this adjustment. It is important to note that we should not force or pressure the person to move on. We simply want to encourage and support behaviors and attitudes that are healthy such as self-care and other resiliency-oriented behaviors.
The fourth and final task is finding a way to remember the person while moving through the rest of life. In this task, we can pay attention to and encourage ways that the grieving person can move on to life without the loved one. For example, helping to memorialize the person with a token or expression of tribute. Examples such as planting a tree, placing a plaque, or starting a scholarship for the person lost help to accomplish this task. It is important to understand that we should not pressure the grieving person to move through the tasks. In contrast, we should enable the normal processes of grief. In other words, we encourage waiting for the person to be ready for each task. If the grieving person is stuck, we should consider a referral to a professional licensed clinician.
Everyone does not need grief therapy during a loss. However, we should attempt to understand some signs of complicated grief. These include; lowered self-esteem, prolonged depression (after a loss), and a general decrease in functioning. This can include isolation, no longer participating in pleasurable activities, and tardiness/absence from work. Other symptoms include; a history of depression or anxiety and maladaptive coping such as excessive alcohol or drug use. A useful way to begin looking at grief reactions is to look at the big picture of feelings, physical sensations thoughts, and behaviors. (Worden, 1997).
There is no standard for the way we express grief or the amount of time we spend in mourning. The focus should distinguish between healthy and maladaptive behaviors and attitudes. Also, we should consider what is baseline or normal functioning for the person who is grieving. Are they back to doing the things that they enjoy? Are their actions and attitudes reflecting continuing life without the loved one? We should look at behaviors and symptoms that may indicate the presence of complicated grief.
The bottom line is that grief is unique to the individual and is influenced by a number of variables. Please seek professional advice if you or a loved one is confronting potentially unhealthy expressions of grief. Make an appointment with an Employee Assistance Program (EAP) if your employer provides one. Another option is to schedule time with a licensed mental health clinician.
References Kübler-Ross, E. (1969). On Death and Dying. New York, NY: Macmillan Worden, J.W., Forms of Complicated Grief. (pp. 17-29) Washington, DC: Hospice Foundation of America. Stroebe, M. Coping with Bereavement. OMEGA-Journal of Death and Dying 26. 19-42. Stroebe, W., Stroebe, M., Abakoum G & Shut, H. (1996). The Role of Loneliness and Social Support and Adjustment to Loss. Journal of Personality and Social Psychology 70. 1241-
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