Introduction. What is grief?
Grieving is a subjective experience. It refers to the feelings, thoughts, and behaviours related to the loss of something really meaningful. It could be the loss of a loved one, relationship, social position, or anything else significant to a person. However, we usually mention grief in the context of bereavement. Bereavement is a particular period of mourning after the decease of a loved one. It is the composite set of responses: the emotions of grief with sadness, protesting and longing, the cognitive processes of consideration, comprehension and making sense of the inevitability and nature of death. Grief can activate dormant psychological or mental disorders, trigger old traumas, or might persevere far lengthier than it should.
Bereavement integrates religious, spiritual, cultural and social aspects of adaptation. People respond to grief in a variety of ways. Some cry for weeks, hardly finding a minute to look after themselves. Others might nervously laugh or try to handle their pain with humour. Others are shocked and neither laugh nor cry. All these responses are normal—there is no proper way to grieve. The loss of a loved one is such a difficult human experience that the bereaved often reach out to a therapist for grief counselling.
Missions of mourning in grief counselling
Mourning is the process of embracing loss. It is the process of adjusting to loss by accomplishing several tasks. The symptoms of morning are similar to those of depression. Be mindful that adjusting doesn’t mean forgetting—it means establishing a way to cherish the recollections of a loved one while moving forward in life. Above all, embracing loss means adapting to life without the loved one while holding a space for them in your heart.
1. Admit that the loss is real
After losing a loved one, a grieving person often minimises or rejects the reality of the loss. To complete this task and move on, the bereaved must fully accept the fact of the loss.
2. Work through the pain of grief
Grief encompasses distressing emotions such as guilt, self-blame, anger and sadness. One might feel more comfortable avoiding these feelings, suppressing them rather than experiencing them. However, processing the hurt of grief means facing, identifying and making sense of these feelings.
3. Attune to a world without the deceased loved one
The loss of a loved one will typically generate some life changes. These can range from slight alterations in day-to-day routines to embracing a completely new worldview.
4. Find a way to cherish the memories of a deceased loved one while moving forward in life
Moving forward does not mean erasing the recollections of the passed loved one from your mind. It means making a place for the deceased one in your thoughts. The place that is significant but still leaves space for others.
The process of grieving
Before considering the” normal” course of grieving, we should be aware of the variation of” normal” between situations, individuals and cultures. The information presented below serves as just a tiny window into what one should anticipate.
The grieving process usually involves
- Feelings of guilt related to the deceased
- Reduced concentration
- Intense feelings of sadness
Acute Grief
For several months after the loss of a loved one, a person may feel symptoms of acute grief:
- Feelings of numbness and shock
- Heavy distress up in waves of 10 to 60 minutes that often comprise tension in the throat, shortness of breath and emotional and physical discomfort
- Disturbed sleep
- Decreased appetite
- Restlessness
Grief counselling can help identify these signs to help alleviate their severity. They typically do not qualify for a diagnosis by themselves, as, according to psychiatrists and psychologists, they are a regular fragment of the grieving process. Usually, those who are grieving will still be able to feel sometimes happy. It distinguishes between depression and grief.
The symptoms of acute grief will usually begin to improve naturally. Over a period of several months, the sadness related to grief will lose some of its intensity, and other signs will become less recurrent.
Integrated grief
As the fresh injury of acute grief heals, integrated grief starts. During this phase, a person recommences normal activities as the agony of grief gradually declines. That does not mean that the grieving person misses their loved one any less or that the pain and discomfort fully evaporate. Instead, the bereaved have realised how to fit the loss into their life. Above all, they have established a way to stay related to the deceased within a new reality. The reality without the loved one.
Sometimes, the bereaved will regress to acute grief (particularly around significant events, such as anniversaries and holidays). This regression is typical and does not imply a failure. It is simply a part of the process. For many people, integrated grief will be a normal, enduring phase. The grieving person will continue to feel sorrow for the rest of their lives and never stop missing their loved ones. However, the symptoms of grief are no longer disabling. The bereaved has embraced the loss and acknowledged its reality.
Complicated grief
When an individual fails to shift from acute to integrated grief, they may advance to complicated grief. During complicated grief, the bereaved may feel symptoms of acute grief for many years after the loss. Consequently, recollections of the loved one continue to be highly upsetting and devastating. In addition, people suffering from complicated grief may become ashamed of their sorrow and wonder why they could not recuperate. Other times, they may think that enjoying their life or overcoming grief is a betrayal of the lost loved one.
Risk factors for complicated grief:
- The loss was violent or unanticipated
- The bereaved person suffers anxiety or mood disorders
- The deceased was a baby, child or a very young person
- The bereaved person has no social support
- The bereaved person has experienced childhood trauma or abuse
A grief process metaphor
Acute grief: think of it as a fresh deep wound. You feel penetrating pain, but that is part of the healing process.
Integrated grief: as time passes, the wound gradually heals and becomes a scar. The deep wound has healed, but the mark will always be present, raw to the touch.
Complicated grief: occasionally, our wounds turn out to be infected or inflamed and do not heal. The injury persists for an extended period, causes enormous pain and only seems to deteriorate. At this point, professional help is recommended.
Treatment of grief in grief counselling
Grief counselling, Eye Movement Desensitization and Reprocessing (EMDR), cognitive behaviour therapy (CBT) and appropriate rehabilitation may be highly effective in managing complicated or prolonged grief. However, individuals, who are both bereaved and traumatised, may need to address their trauma first.
There may be an increased risk for some grieving individuals for aggravations of pre-existing psychological conditions or the commencement of new disorders, such as post-traumatic stress disorder (PTSD) following a violent loss. Moreover, bereavement may induce other psychiatric conditions, including anxiety disorders, bipolar disorder, major depression or substance use.
If an assessment reveals existing psychiatric conditions, such as substance use disorder, depression, PTSD or other anxiety disorders, we have to deal with them in parallel with bereavement counselling. Consequently, antidepressants or other medications may be beneficial for psychiatric complications.
Grief counselling requires compassionate, hopeful psychotherapeutic interventions which acknowledge the human suffering involved, validate the strengths of the bereaved and consider their spiritual needs.
Loss is a focal concern for all of us, both its reality and our fears of it.