Loss and Bereavement (Emotional therapy views)

This is another from the reports I write for my course, it’s also a topic that was very hard for me to write about at the time so it’s a little bit awkward in points. Regardless, I hope whoever reads it finds it interesting!

large (1)Loss is something that will unavoidably affect us throughout our lives, for it comes in many different ways. Death is of course the first thing we think of when it comes to loss and bereavement but loss does not have to refer solely to the loss of a loved one; whether it be the loss of a job, a limb, health, innocence, home, or happiness (or many of the other things that can be lost throughout our lives), each loss—no matter how small—can be difficult and require a period of adjustment, or ‘mourning’ if you will.

Loss is not exclusive to death, whereas bereavement only deals with loss through a death, and both words are not interchangeable but do share a core meaning which is that the person suffering from loss or who is bereaved has lost something that was, in any capacity, important to them. Both do elicit a wide variety of feelings that might depend on the person lost, the person suffering from the loss, or the situation surrounding the occurrence of the loss. Where a sudden, unexpected loss has as higher chance of leaving someone feeling angry or numb, a loss that takes place over a long period of time, that someone can see coming is just as likely to give way to exhaustion and hopelessness. But even those examples are vast generalisation and it is impossible to predict what losses and bereavement will leave people feeling. Far more often than not, it is the tangle of numerous emotions that form the process of mourning, if one can only traverse it to the other side.

Grieving people will often be afraid of ‘being left behind’, not just by the deceased but by those around them, because grief may make them less social then they were. With this loneliness and fear of isolation they might start to fear how they will be able to cope with the intensity of their feelings, as well as the day to day life that still requires their attention. Having to look after others if they too were affected by the death might be extremely difficult and make some people put their own emotions on the back burner whilst they try to help others. This may cause them to turn to drinking/drugs to help coping with the situation. Some may lose themselves to religion or work as an attempt to keep themselves busy (more of this when I talk about denial). The over-empathic reaction of friends and families, as well as overwhelming subjective advice and the social pressures surrounding the bereaved are all things that can add up to make grief an even more complicated process than it already is.

The framework for some of the effects of loss reflects the general categories of emotions that come into play and I shall be using it as a guide to go through some of the stages of loss and large (3)bereavement in more detail. Grief itself is often preceded by shock. Any loss, even those we might have expected, comes with a measure of shock. Grief and the sadness/tears that represent it more commonly tend to show themselves only once the shock has receded and allowed for the reality of the situation to register. Below grief and in the centre of the framework sits denial: the refusal to believe that the loss is real, maybe accompanied with the belief that ‘things will sort themselves out’ (if we’re not talking about someone’s death). Denial can manifest in many ways, from people acting as though the other person is still around (talking about them in present tense, not mentioning their death at all), to small actions that reveal that our mind has not yet registered the loss fully (turning around to address someone we used to live with, picking up a phone to call someone who is deceased). Similarly, some people can go in denial over the loss of a relationship, stubbornly believing that they can get back with the other person even if that isn’t going to happen.

From there the framework goes in three different directions. Now not all people will go through all of those paths, and the order might be different for everyone, but they do offer a clear image of grouped reactions. On the right sits the concepts of ‘minimising’ and ‘idealising’. The first word refers to the process of trying to make the loss seem lesser than it is. This might be mostly seen in losses of jobs, home, health, or similar situations where it would be easier for the person to pretend that the loss and changes did not affect them a lot, even if they do. Idealising for its part, is when a person might put on a pedestal the one that has died, or looks back upon what has been lost through rose-tinted glasses. It is a fact that people ‘do not speak ill of the dead’, which is one of the primary causes of idealisation as only the ‘good’ sides of that person are ever talked about and whatever else they were is lost to memory. Similarly people might look back on a job or relationship, remembering how wonderful it all was before whilst completely disregarding all the issues/stress that it came with.

On the opposite side of the framework we see another three concepts: avoidance, depression, and withdrawal. Avoidance is self-explanatory and occurs when the person suffering the loss tries to avoid anything that is related to it, including but not limited to thinking about it and facing up to the consequences of it. Depression is to an extent a separate problem all together, although it can be triggered by the occurrence of the loss of bereavement.  Finally, withdrawal is used here to mean the departure of the person who has suffered the loss from their usual circles of society, with a possible nuance that they are pushing people away. This can be done for different reasons, whether it is that the person is private in their mourning process, or that they are distancing themselves from others as a way to avoid further pain, protect others from their own pain, or something entirely different.

Finally, the last segment of the framework goes down from guilt to anger. Anger is a totally normal feeling when facing loss. Anger at the situation, its possible unfairness, anger at our helplessness or the injustice of the world: it is rare that loss does not at some point elicit some form of anger. Anger in turn can give way to guilt. Be it guilt over being angry in the first place, or over events that happened prior to the loss that the anger may have been masking before it dissipated. That anger and guilt cannot be felt at the same time does not prevent one from masking the other, and it is often the case that we may be angry at something as a way to disguise how we may feel guilty about it (whether there is an actual reason for guilt and not just a perceived one). After this comes bargaining, although as discussed during the study day, this is almost a stage that could happen before the actual loss. This can be seen in people who pray and may bargain with their god(s), promising to do certain things if the loss is avoided, if the person is saved. Also outside of that, people do it in their daily lives ‘if this doesn’t/does happen, I will/won’t do this’ is a very common thing.

large (2)After that, one starts to move in the stages where one can learn to deal with the loss and grief more effectively. First comes the adjustment period, often particularly relevant for people who have had a particularly strong phase of denial or have carried through habits that are no longer relevant/healthy now that the loss has occurred. Adjustment can take many shapes, depending what the loss was. In the case of career, it could be finding a new path to walk down, when it comes to health or an ability to be self-dependent, it would be taking the correct steps to ensure that all needs are met. In the case of bereavement, it could mean moving house, putting away the belongings of a partner that are no longer needed, or anything else that would allow the person to start moving on with their lives. At last, the final step of acceptance can happen. This does not necessarily means being ‘over’ the loss, but being capable of acknowledging it and the effects it has had on our lives, as well as being capable to handle the emotions still attached to it.

Talking about grief and loss is one of the most difficult things for people to do: we live in a culture where the ‘get over it’ mentality is unfortunately dominant and forces people to bury how they truly feel about what is happening in their lives. Alongside this there is the awkwardness that comes with talking about loss: it is an uncomfortable, often difficult topic, and those that are going through it might be afraid of hurting others by bringing up their own issues. Similarly, they might be afraid of other people’s reactions: will the people around them try to appropriate the grief onto themselves (even if they were not as close to the deceased), might they only respond by bringing up their own experiences in loss? People will also be afraid of their own reactions when talking about this: they might not be wanting to show their more vulnerable side for fear of being judged (especially true for men who are told from a very young age that ‘boys don’t cry’ and other such fabricated societal ideas).

This is where the job of the counsellor is particularly important as we offer a safe place for people to work through the stages of loss and bereavement. As with every other client it is important that we respect the boundaries of what they can and cannot handle, which means we must never rush, patronise, pity or make promises. What we can offer however is an attentive ear, someone who is capable of empathising with them. It is important to allow the person to cry if tears come during the session, although it is perfectly okay to give physical and verbal expressions of concern and understanding. We are here to guide the person through what is a process that everyone who suffers loss goes through (and even those that bury it all away will eventually need to go through it or it will come back to them after the fact), we are here as someone who offers a safe, supportive environment that they may not have access to anywhere else, especially as we are totally separate from the situation. With the counsellor that person can safely start to actualise the loss and allow themselves to feel the pain of grief, and the time we give the client who is grieving is entirely theirs: there are no children, friends or family who require their attention during that time. It is also important to remember to have non-emotional (and obviously non-judgemental) reactions to whatever it is that our client is telling us. Where empathy and validation are important, if the client see that the counsellor themselves are upset by the topic they might close off and not speak as openly.

As counsellor we must, however, also be aware of our limitations. It might be that a particular client is in a situation that hits too close to home for ourselves, or that we have just largeundergone a loss of our own and cannot take on the task to help someone else through grief. When such situations arise it is good to know how, and when, to refer someone to a colleague, or doctor, or anyone who will be able to offer better care to them.

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