Grief Counseling

Types of Grief and Grief Counseling

Grief Counseling


1. Loss of loved one through death, separation, divorce, incarceration.

2. Loss of an emotionally charged object or circumstance, e.g. loss of a prized possession or a valued job or position.

3. Loss of a fantasized love object, e.g. death of a intrauterine fetus, birth of a malformed infant.

4. Loss resulting from narcissistic injury, e.g. amputation, mastectomy


1. Shock and denial. Patient's initial reaction is shock, followed by denial that anything is wrong. Some patients never pass beyond this stage and may go doctor shopping until they find one who supports their position.

2. Anger. Patients become frustrated irritable, and angry that they are ill; they ask, "Why me?" Patients in this stage are difficult to manage because their anger is displaced on doctors, hospital staff, church/God, and family. Sometimes anger is directed at themselves in the belief that illness has occurred as a punishment for wrongdoing.

3. Bargaining. Patient may attempt to negotiate with physicians, friends, or even god, that in return for a cure, he/she will fulfil one or many promises, e.g. give to charity or attend church regularly.

4. Depression. Patient shows clinical signs of depression: withdrawal, hopelessness, psychomotor retardation, sleep disturbances, and possibly suicidal thoughts. the depression may be a reaction to the effects of the illness on his/her life, e.g. loss of job, economic hardship, isolation from friends and family, or it may be in anticipation of the actual loss of life that will occur shortly. 5. Acceptance. Person realizes that death is inevitable and accepts its universality.


1. Alarm - a stressful state characterized by physiological changes,e.g. rise in blood pressure and heart rate

2. Numbness - Person appears superficially affected by loss, but is actually protecting himself/herself from acute distress.

3. Pining (searching) - Person looks for or is reminded of the lost person.

4. Depression - Person feels hopeless about future, cannot go on living, and withdraws from family and friends.

5. Recovery and reorganization - Person realizes that his/her life will continue with new adjustments and different goals.

Four Tasks of Mourning In Grief Counseling

1. to accept the reality of the loss

2. to work through the pain of grief

3. to adjust to an environment in which the deceased is missing Economic as much as emotional!

4. to emotionally relocate the deceased and move on with life. Anything the counselor can do that helps family members stay connected to each other and to extended families and extrafamilial resources will have a profound impact on the long-term postdeath adjustment of the family. NORMAL GRIEF




guilt and self-reproach






yearning ("pining")




Physical sensations

hollowness in the stomach

tightness in the chest

tightness in the throat

oversensitivity to noise

depersonalization ("I walk down the street and nothing seems real, including myself.")

feeling short of breath

weakness in the muscles

lack of energy

dry mouth





sense of presence of the deceased



sleep disturbances

appetite disturbances

absent-minded behavior

social withdrawal dreams of the deceased

avoiding reminders of the deceased

searching and calling out


restless overactivity


visiting places or carrying objects that remind the survivor of the deceased

treasuring objects that belonged to the deceased


1) Help the survivor actualize the loss talk about the loss

visit the gravesite

2) Help the survivor to identify (focus) and express feelings: anger


anxiety and helplessness


3) Assist living without the deceased decision-making


4) Facilitate emotional relocation of the deceased"

find a new place for the lost loved one that allows the survivor to move on


5) Provide the time to grieve

3 months

1 year

6) Interpret "normal" behavior 7) Allow for individual differences

8) Provide continuing support (groups?)

9) Examine defenses and coping styles



10) Identify pathology and refer


1) Evocative language

2) Use of symbols

3) Writing

letters to deceased


4) Drawing (esp. with children)

5) Role playing

6) Cognitive restructuring

Identify damaging self-talk, e.g. "No one will ever love me again."

7) Memory book

8) Directed imagery

imagine deceased as present and address him/her

Abnormal Reactions in Grief Counseling


1) The person cannot speak of the deceased without experiencing intense and fresh grief.

2) Some relatively minor event triggers and intense grief reaction.

3) Themes of loss come up in the person's talk.

4) The person who has sustained loss is unwilling to move materials possessions belonging to the deceased.

5) The person is developing physical symptoms like those the deceased experienced before death.

6) The person makes radical changes in lifestyle following a death or excludes from their life friends, family members, and/or activities associated with the deceased.

7) The person seems chronically depressed (together with persistent guilt and low self-esteem) or experiences false euphoria following a death.

8) Person shows a compulsion to imitate the deceased.

9) Self-destructive impulses

10) Unaccountable sadness occurring .at a certain time each year

11) A phobia about illness or death.

12) Facts about how they acted at the time of the death (e.g. avoiding visiting the grave or participating in funeral, etc.) SPECIAL TYPES OF DEATHS

• Suicide

• Sudden death • Sudden Infant Death Syndrome

• Miscarriages

• Still Births

• Abortion




1. social and ethnic context

2. history of previous losses

3. timing of death in the life cycle

4. nature of death

5. family position of the dead or dying family member

6. openness of the family system (Differentiation / level of family stress)

The lower the level of differentiation (and the higher the level of stress!), the less able to express directly to each other divergent or anxiety-provoking thoughts and feelings without either becoming angry or upset.


1. View the family in context (three-generations).

2. Talk openly, directly, factually (unanxiously).

3. Help family members (at least two of them) to talk openly, directly, factually with each other.

4. Respect the family's hope for life and living, when a member is dying.

5. Remain human but emotionally nonreactive (at peace) to the family's pain (Not that the pastor should not experience emotions, but that his or her actions should not be guided by emotions.)

6. Deal with the symptoms of stress ("sideshows").

a) Help family to use its own style, customs, and rituals to deal with death.

b) Funeral should be personalized as much as possible, and include the wishes of the dying.

c) Family members should see the dead member.

d) Children need to be told, given opportunity to see dead member, attend funeral, say good-bye.

e) Family should talk frequently of the dead member.

Help family get a balanced view of the person who died.


Death creates a vacuum, and emotional systems will rush to fill it (cutoffs, freedom, shifts in responsibility, replacement).

Six opportunities during this rite of passage:

1. Chance to take or shift responsibility.

2. Chance to reestablish contact with distant relatives (or close relatives who live at a distance).

3. Opportunity to learn family history.

4. Chance to learn how to deal with the most anxious forces that formed one's emotional being.

5. Chance to shift energy directions in the family triangles, all of which seem to resurrect themselves at such moments.

6. Chance to reduce the debilitating effects of grief.

Grief is the residue of the unworked-out part of the relationship.

It is not so much an individual who is dying as it is a member of the family--part of the organism is dying.

As long as the dying person is above ground, he or she is a live part of the organism.

Funerals as Rites of Passage


In rites of passage it is really the family that is making the transition to a new stage of life rather than the identified member focussed on during the occasion.

The months before and after rites of passage are "nodal" periods that function as "hinges of time." Family relationship systems seem to unlock, so that doors between family members can be opened or closed with less effort than at other times.

This is because these events occur, not at random, but at critical times in the family life cycle.

Myths that inhibit forming a family process view:

1. The family is breaking down (because of physical distance). But a major issue is the development of alternative types of families, with major ramifications for rites of passage.

2. Culture determines family process in fundamental ways. (Rather it appears that individuals and families adhere to those societal values that most coincide with their own lifestyle.)

When someone reacts fanatically to a value issue in family life, the roots of the fanaticism lie in the family member's unworked-out relationships with the family of origin.

3. The rite of passage is the same as the ceremony that celebrates it. (Corollary: The family members who are the focus of the ceremony are the only ones going through the passage.)

Some individuals are married long before the ceremony, and some never do leave home. Some family members are buried long before they expire and some remain around to haunt for years, if not generations.

The ceremony can be useful for:

• meeting people

• putting people together

• reestablishing relationships

• learning about the family

• creating transitions

But the more important time is the months before and after. Use the event as an excuse for reentry.

• e.g. bring brother and sister into communication again while the loved one is dying, rather than depending on the funeral to do it.

• When clergy facilitate the meaningful involvement of family members at life cycle ceremonies, they are in fact allowing natural healing processes to flow.

In fact, rites of passage always indicate significant movement in a family system.

• Look for extremes in handling the transitions as symptoms of lack of flexibility in the system. (no one or everyone invited; cremation, no funeral or major extravanganza)

I find it interesting that the authors speak to Rites of Passage in their article.

I have been a student of Stan Grof's work over the years, including his book, "The Ultimate Journey" from which the following is excerpted from a review of the book by Renn Butler;

"Grof writes that our modern industrial civilization typically gives more attention to the wardrobe, makeup, and even plastic surgery for the corpse than to counseling dying individuals and their families. This is in marked contrast to preindustrial societies for whom death and dying were paramount in their worldviews and important inspiration for much of their art and architecture. For example, the shamans of many cultures—going back at least thirty thousand years—began their careers with a spontaneous or induced experience of death and rebirth. They explored, firsthand, territories of the psyche that transcend the boundaries of individual consciousness. Similarly, in the rites of passage, initiates were guided into non-ordinary or holotropic (“moving toward wholeness”) states of consciousness and had a personal experience of numinous realities that transcend biological death. In the ancient mysteries, neophytes participated in various mind-expanding processes or “technologies of the sacred” to move beyond individual consciousness and experience directly the higher transpersonal dimensions of existence. The Goddess Mysteries of Eleusis, for example, held near Athens for almost two thousand years—and which it is now virtually certain used ergot, a naturally occurring form of LSD—had as their participants many of the creative and intellectual giants of Western culture. Pythagoras, Plato, Aristotle, Epictetus, Euripedes, Sophocles, Plutarch, Pindar, Marcus Aurelius, and Cicero all attest to the life-changing power of their holotropic experiences at Eleusis or the other mystery sites.

Grof also reviews the themes of the Egyptian, Tibetan, Mayan, and medieval European Books of the Dead. These sacred texts had a dual purpose: to prepare the dying for the adventures in consciousness that follow biological demise and to guide initiates through experiences of psychospiritual death and rebirth in healing rituals. Preparation for death in these cultures was recognized as identical to spiritual practice for living. In the central theme of the book, Grof writes that the preindustrial societies recognized a basic fact of human nature that we have forgotten—that facing death in supported holotropic states opens connections with transpersonal dimensions of reality beyond death, resulting in a transcendence of the fear of dying, as well as healing of emotional and psychosomatic problems, increased vitality, and higher functioning in everyday life.

The benefits of undergoing these inner transformative experiences have now been rediscovered in modern times through powerful experiential processes such as LSD psychotherapy and Holotropic Breathwork. Grof and his colleagues conducting sessions in these modalities for the past fifty years found that individuals working through unfinished aspects of their biological birth also confront and consume their fear of death in the process. These perinatal sequences then automatically open out into experiences of spiritual rebirth, archetypal and mythological domains, and unitive ecstasy. Rather than the ultimate biological disaster and personal defeat, death represents a gateway to a fantastic cosmic panorama, a vastly freer mode of consciousness which the individual experiences as his or her own rediscovered higher nature.

People who experience death and rebirth sequences of whatever provenance automatically develop an interest in spirituality of a non-sectarian, universal and all-encompassing nature, feelings of planetary citizenship, and a high value placed on warm human relationships. They also discover what the mystics have understood, that the representations of death in the psyche, including its substantial bardo states and hells, are, like all forms, actually empty and ultimately products of our own consciousness—a consciousness that is now recognized as essentially commensurate with the Absolute Consciousness and All There Is."

And I am reminded of how we in the United States did wakes and funerals before WWII, when we were still a much more agricultural and village country.

Wakes were at the deceased's home, the members of the village and community came to pay their respects, food and help were proferred, and the survivors wore black to signify their grieving, I think to say metaphorically, "I will not be involved in the day to day activities of the village for awhile, but I will be back."

In a sense, the grieving process is pathologized today, with professionals guiding it when perhaps the village shaman should be in charge of the next non-ordinary states workshop for everyone.

Renn Butler

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