What Is Grief Counseling? Techniques and How It Helps

We’ve gotten emails before when we mention Kubler-Ross. This article begins with it, but quickly expands and moves beyond it.  The Editor

 

Tables of Contents

  1. What Is Grief Counseling?
  2. Benefits of Grief Counseling
  3. Different Grief Counseling Techniques and Interventions
  4. Grief Counseling for Children
  5. Grief Counseling for Teens
  6. Grief Counseling for Adults
  7. Family Grief Counseling
  8. Grief Counseling Resources
  9. The Importance of Grief Counseling

Grief is the emotional response to a loss, typically that of a loved one. Grief can encompass many different emotions — sadness, anger, guilt — as well as have significant mental and physical impacts on those suffering from it. Many people are familiar with the five stages of grief that Swiss psychiatrist Elisabeth Kübler-Ross coined in her book On Death and Dying more than 50 years ago. Kübler-Ross conceived the model to describe the emotional journey of the dying. She theorized that people working through grief follow a particular pattern:

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

While this provides a basic framework for understanding grief, researchers have since expanded on the Kübler-Ross model to account for the highly individualized nature of grief. Many people experience these stages in a different order, or they may not experience all of them, and feelings of grief can recur throughout a person’s life.

Most people naturally resolve or figure out how to manage their grief over time. For many others, these emotions persist and can have severe negative impacts on their lives. The purpose of grief counseling is to help people navigate this complex process and learn how to grieve in a healthy way.

 

The original five stages of grief have been adapted to seven.

According to Grief.com and PsychCentral, the Kübler-Ross model has evolved over time to meet the new understanding of grief. Original Model: 1. Denial. 2. Anger 3. Bargaining. 4. Depression. 5. Acceptance. Kübler-Ross Change Curve: 1. Shock. 2. Denial. 3. Anger and frustration. 4. Depression. 5. Testing. 6. Decision. 7. Integration.

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What Is Grief Counseling?

Accepting loss and dealing with the emotions that come with it can be a painful process. While many people are able to work through grief on their own, others struggle to cope and may need professional assistance in the form of counseling. What is grief counseling? It’s a form of therapy designed to help people work through the various stages and emotions of grief following a loss. Counseling can help individuals avoid some of the more acute manifestations of grief and process their emotions in a healthy manner. According to famed psychologist William Worden, the following are the primary objectives of grief counseling:

Accept the Loss

One of the first and most critical steps in working through grief is coming to terms with the reality of a loss. Denial is a natural response, allowing individuals to pace their grief and the pain that comes with it. However, to truly cope with grief and heal, individuals must learn to acknowledge their loss.

Work Through the Pain

Many people respond to a loss and the ensuing grief by trying to avoid it and suppress their emotions. This only compounds their suffering. An essential part of managing grief is experiencing the pain that comes from it and persevering.

Adjust to Life

When people experience grief, it’s generally because they lost someone or something that was a huge part of their lives. Adapting to a loss can be extremely challenging and can even feel like a betrayal. This reasoning can leave people feeling stuck. Grief counseling can help individuals reorient and restructure their lives after a loss.

Maintain a Connection

While accepting a loss and adjusting to life after it are essential steps in the grief process, it’s also important to maintain a connection to what was lost. When a loved one dies, for example, it can be helpful for the bereaved to remember the happiness that person brought instead of focusing only on the pain of the person’s absence.

Types of Grief

While it’s generally associated with the death of a loved one, grief can also stem from other traumatic experiences, such as the loss of a job or the end of a relationship, and these can be felt just as acutely. Additionally, grief can take many different forms, including the following:

  • Complicated grief is a type of grief in which the symptoms are persistent (lasting up to a year or longer) and intense, making it hard for sufferers to function normally. People experiencing complicated grief may feel hopeless or detached and are preoccupied with thoughts of who or what they’ve lost. Estimates vary, but according to WebMD, between 5% and 10% of bereaved people experience complicated grief.
  • Maladaptive grief is a type of grief in which individuals are consumed by their loss and attempt to cope in ways that are harmful. They may try to avoid reminders of what they’ve lost or engage in self-destructive behaviors.
  • Broken heart syndrome is a type of grief in which the stress caused by grief takes a physical toll. With intense grief, the body may release stress hormones that cause part of a person’s heart to swell and beat irregularly, causing chest pain similar to a heart attack.
  • Depression is one of the stages of grief. Certain symptoms of grief, such as anxiety or hopelessness, can look like depression, but they’re different. Grief-stricken people may experience depression, which can make the grieving process worse. Signs of depression include trouble sleeping, fatigue, and poor appetite, along with feelings of self-pity or loneliness.

 

Benefits of Grief Counseling

Grief counseling isn’t some miracle cure for dealing with loss. It won’t help the bereaved forget about a deceased loved one or avoid the pain of loss. Instead, it can help the bereaved understand, accept, and manage emotions to live a full life — but there’s no guarantee that everyone will experience the same benefits.

The numerous benefits of grief counseling include the following:

Reduces Anxiety, Guilt, and Depression

Grief counseling can help individuals manage anxiety and avoid depression by providing them with strategies to work through their emotions constructively. Feelings of guilt are also common for the grief stricken. They may feel guilty about things they did or didn’t do when their loved one was alive, or for not mourning enough. Counseling can help patients overcome these feelings.

Helps People Understand the Grieving Process

Understanding the stages of grief and loss allows individuals to more fully tap into their thoughts and emotions, opening a path to healing. Grief counselors can help patients understand this process.

Reminds People There’s More Than One Way to Grieve

People dealing with grief may feel like they’re doing it wrong — that they’re not sad enough or that they’ve been grieving too long — but there’s no “right” way to grieve. Counseling reminds patients of this and helps them recognize that every person’s experience is unique.

Helps People Honor the Deceased Without Trauma

Allowing people to express their thoughts and feelings about a deceased loved one is a vital part of the grieving process, and it’s important they be able to do this without experiencing further trauma. Counseling can provide patients with a safe space to talk about the deceased and honor the deceased’s memory, which can be a tremendous source of comfort and relief.

Helps People Understand That Grief Can Be Caused by Different Kinds of Loss

Though grief is traditionally associated with the death of someone close, people may grieve for many different reasons: losing a pet, going through a divorce, moving away from family and friends, or being diagnosed with a terminal illness. Counseling can help people give themselves permission to grieve over such things without feeling weak or selfish.

Guides Patients Back to Self-Care

Grief can exact a heavy toll, leaving sufferers feeling drained physically, mentally, and emotionally. Counseling can guide patients toward self-care strategies to help them cope and recover, including mindfulness practices and simple tips like exercising and getting enough sleep.

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Different Grief Counseling Techniques and Interventions

Many different methods can help individuals work through loss. Medications such antidepressants or sedatives can help people manage some symptoms of grief, but these are generally best used as a temporary solution. Grief counseling is considered a more effective and sustainable approach. Each person’s grief journey is unique, and thus a wide variety of grief counseling techniques and interventions are available to help guide them.

 

Seven methods of grief counseling.

According to Healthline, Frontiers in Psychiatry, and Psychiatry Advisor, these are the primary techniques used in grief counseling: Talk Therapy: Talking about the loss. Cognitive Behavioral Therapy (CBT): Reframing negative thought patterns. Mindfulness: Incorporating breathing exercises, journaling, and mantras. Complicated Grief Treatment (CGT): Using targeted psychotherapy and antidepressants. Acceptance and Commitment Therapy (ACT): Incorporating acceptance, mindfulness, and action. Ritual: Remembering and mourning through activities and objects.

 

Talk Therapy

One of the more common counseling tactics, talk therapy involves people talking through their emotions and discussing their loss. A grief counselor can provide a safe space for patients to talk about their deceased loved one, helping them maintain a connection to the person they’ve lost. Talk therapy can be done individually or in a group. Many people find bereavement group counseling helpful in dealing with the symptoms of grief.

Cognitive Behavioral Therapy

In cognitive behavioral therapy (CBT), individuals attempt to identify and alter thought patterns that negatively influence their behavior. A grief counselor can help patients recognize and explore these thoughts and develop strategies to lessen the impact they have on their lives.

Mindfulness

Individuals engaged in mindfulness — whether through meditation or some other practice — focus on the present moment to become more aware of their thoughts and emotions. Practicing mindfulness can help people ground themselves and work through the complex and overwhelming emotions of grief. A recent study in Frontiers in Human Neuroscience revealed that mindfulness practices can help reduce symptoms of grief and improve emotional resilience following a loss.

Complicated Grief Treatment

Between 5% and 10% of bereaved people experience complicated grief, wherein feelings of grief persist and become overwhelming. Complicated grief treatment (CGT) can help patients work through these emotions and adjust to life after a loss. CGT revolves around seven core themes:

  • Understanding and accepting grief
  • Managing emotional pain
  • Planning for the future
  • Strengthening existing relationships
  • Telling the story of the loss
  • Learning to live with reminders
  • Creating a connection to memories of the deceased

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) helps individuals accept negative emotions and the reality of their loss so they can move forward. Using ACT, counselors help patients distance themselves from their emotions and experiences to better examine and understand them. By focusing on their own values and goals for the future, patients can then convert that understanding into action to work through their grief.

Ritual

Ritual is a form of grief counseling that incorporates ritualistic elements — such as farewell ceremonies, writing assignments, or conversations with the deceased person — as a way of dealing with loss. By employing symbolic objects or acts, these rituals provide individuals with an opportunity to act out and express painful emotions, while also preserving a connection to the deceased.

 

Grief Counseling for Children

While grief is a universal experience — everyone has or will suffer a loss — it affects everyone differently. Young children experience and process grief in a very different way than adults. Age and stage of development have a significant impact on a child’s understanding of death and grief.

  • Birth to 6 months: Children at this age have no concept of death, though they may experience feelings of separation and abandonment, which can cause anxiety or distress. These feelings and experiences may lay a foundation for a future understanding of death.
  • 6 months to 2 years: Children at this age may begin to grasp the idea of death, but don’t fully understand it. If someone close to them dies, they may react with anger or experience severe rejection. They may believe the deceased is lost and try to actively seek the person out.
  • 2 to 5 years: Children at this age don’t comprehend that death is irreversible, or final. Because of their still limited understanding, they may appear to have a subdued reaction and return to normal behavior sooner than a more mature child.
  • 5 to 10 years: Children at this age begin to understand that death is final and that the person who’s died isn’t going to return. As they get older, they may accept that death is not only final but also inevitable and that all people eventually die, including themselves. This may lead to them worrying about their loved ones and attempting to contextualize their own death by asking questions like “Who will feed my pets?” They may be afraid of death and invent stories or jokes to protect themselves.

Helping Children Understand Grief and Loss

An understanding of death is a key component of grief counseling for children. This understanding revolves around four key conceptsuniversality (everyone dies), permanence (death is irreversible), nonfunctionality (the body stops working when someone dies, so they’re not suffering), and cause of death (there are physical reasons why someone dies). Dealing with a loss can be especially challenging for children, who often struggle to manage their emotions even in the best of times. Multiple methods can help children understand and work through grief and a loss.

Use Concrete Language

As is often the case with children, honesty is the best policy, particularly when helping them understand death and grief. To avoid confusing them, it’s best to use concrete words like “died” or “killed” rather than figurative language like “lost” or “went to sleep.”

Family Cultural Background

Culture can greatly influence a child’s understanding of and response to grief and loss. A normal grief reaction in one culture may be considered abnormal in another. This is an important consideration when providing grief counseling to a child. Counselors can create a safe space for youth to express themselves free of judgment.

Integration of Faith and Belief Systems

Children may also find comfort in their family’s religious or cultural beliefs. These concepts can help them better understand and make sense of death and loss, as well as offer hope against the finality of death.

Develop Rituals to Remember Loved Ones

Rituals can provide a measure of comfort for children by allowing them to remember and honor the memory of the deceased. A memorial service or other forms of ritual can help them see how important the deceased was to other people and understand that it’s OK to grieve.

Provide Information on the Grief Process

Feelings of grief may be confusing to children who’ve never experienced them before. Guiding them through the grief process — helping them understand that it’s a normal feeling and that their feelings aren’t wrong — is vital.

Let the Child Take the Lead

Perhaps most important, children should take the lead in their grief process without being told how to think or feel. They should be encouraged to work through grief in whatever way works best for them.

 

Grief Counseling for Teens

Teenagers have a more sophisticated understanding of grief and loss than younger children, but may lack some of the healthy coping mechanisms that adults possess. This can make working through grief particularly challenging for them. Grief is often overwhelming, and it can be difficult for young people to control their emotions, thoughts, or how they feel physically. That lack of control may frighten some teens, and they may attempt to suppress their emotions to avoid feeling like an outcast and to fit in with their friends. It’s also natural for teens to test the boundaries of their independence, and they may lean into this inclination when experiencing a loss. They may pull away from adults and others who can help them, causing them to become socially isolated. Without an outlet or support from those around them, teens may try to escape their pain by engaging in self-destructive behaviors like alcohol and substance abuse or risky sexual activity. When providing grief counseling for teens, numerous tips and techniques can be effective in overcoming these hurdles:

  • Teens may retreat inward in the wake of a loss and struggle to express their thoughts and emotions. Simply starting the conversation and providing teens with a safe space to talk about what they’re feeling can help them start the process of working through their grief.
  • Similar to younger children, teens should take the lead in their grief process. Getting teens to open up is an important first step, but counselors and adults can best help them by acting as listeners and learners and allowing them to be their guide.
  • Each teen’s grief experience is highly personal. Some may respond with extreme sadness and crying, while others may use humor and laughter as a coping mechanism. Grief counseling should help them understand that what they’re going through is normal and that there’s no correct way to grieve. Effective counseling validates their emotions and allows them to process grief on their own timeline.
  • Teens’ social environment — the relationships they have with family, friends, and community — has a major impact on how they respond to and cope with loss. Understanding the importance of social connections and how they influence grief is essential. Counseling for bereaved teens should look beyond individual coping and factor these relationships into treatment, such as through family programs or group therapy.

 

Grief Counseling for Adults

Grief manifests in adults in many of the same ways as teens and children. They may experience anger, shock, sadness, or guilt, or all of these emotions.

The techniques for helping grief-stricken adults are varied and depend on the individual, the nature of the loss, and several other factors. Grief counseling for adults, particularly those dealing with the loss of a loved one, often follows certain guidelines:

  • Talk about the deceased. People often want or need to talk about the person they’ve lost. Sharing memories of their loved one — including the deceased’s likes and dislikes, habits, and even faults — can help people work through grief. It may be the first time they’ve had an opportunity to properly express their thoughts and feelings about the deceased in a truly safe space. Counselors may ask bereaved people what advice their loved one might give them if the loved one could speak to them or how the loved one would want them to live their lives.
  • Distinguish grief from trauma. Counseling can help the bereaved separate their grief from the shock and pain that the memory of their loved one’s death causes. Some people become fixated on these memories — images of the deceased lying in a hospital bed or the phone call informing them of the death — and can’t move past them to begin to grieve in a healthy way. Counseling can help grief sufferers minimize the trauma associated with these memories and recontextualize them to begin the grief process.
  • Deal with guilt. Guilt can be a serious issue obstructing the grieving process, particularly for adults. Spouses may feel guilty over things they did or didn’t do or say when their significant other was alive, or that they’re not grieving as much as they should be. Counselors can support bereaved adults by helping them understand how these thoughts are unproductive and suggesting that the best way to honor their loved one’s memory is to live a full life. They may encourage patients to take breaks from grieving and incorporate rituals that pay tribute to the deceased, possibly helping the bereaved overcome guilt.

 

Family Grief Counseling

Loss can sometimes bring families closer together. Other times, it can disrupt the balance within a family and cause tension. Many factors come into play when a family suffers a loss, beyond simply the pain of losing a loved one: Past grievances, the stress of funeral arrangements, and concerns over the estate can all impact the grief process in a negative way.  Family grief counseling differs slightly from other forms of grief counseling in that it often attempts to address issues that go beyond individual grief and emotions. The dynamics of family grief are complex and challenging, yet mutual healing can be achieved if certain considerations are made.

 

Statistics about grief in America.

The death of a loved one has ripple effects. According to the Centers for Disease Control and Prevention, Judi’s House, Scientific American, and the New York Life Foundation, 2.7 million to 2.9 million people die annually in the U.S., and each deceased person leaves behind an average of nine close relatives. Meanwhile, 5% to 10% of grievers suffer complicated grief, and 7.3% of children suffer the loss of a parent or sibling by age 18. Additionally, 54% of adults who lost a parent before age 20 struggled to find grief resources.

 

Different Ways of Grieving

People grieve in their own way, even if they’re grieving the same loss. Within a family, this could mean one person wants to talk about the deceased while another tries to avoid the subject. Each person’s relationship with the deceased or the person’s role within the family may influence how the person responds to the death. These differing responses can create friction. Effective counseling accounts for these differences and respects each person’s unique grief experience, while encouraging family members to respect each other.

Unresolved Issues

Often, discord following a death in a family stems from past grievances or disagreements. There could be resentment between siblings over the care of a deceased parent before their death, for example, with one feeling that the other didn’t do enough to help or wasn’t around. Helping families work through loss and grief often entails addressing and resolving these underlying issues.

Making Arrangements

The stress of making funeral arrangements and figuring out who’ll pay can cause anger, confusion, and resentment. It’s important for families to take the time to discuss plans and discuss how to cover the expenses. This can help avoid future disagreements and relieve unnecessary stress that can exacerbate the grief process.

Kind Communication

The death of a loved one naturally creates stress and heightens emotions, potentially leading to family members behaving out of character and blowing up at one another. Counseling can help families communicate civilly through various methods, such as refraining from using “you” statements — which can sound accusatory — and instead using “I” statements.

 

Grief Counseling Resources

Numerous grief counseling resources are available to help people better understand the nature of grief and work through the pain of loss. Individuals looking for more information should explore the following resources:

 

The Importance of Grief Counseling

Grief is a universal experience, yet people grieve in their own way. The pain of a loss — whether the death of a loved one or another traumatic event — can be overwhelming, exacting an emotional, mental, and even physical toll on the bereaved. Grief counseling is crucial for many people, helping them navigate their feelings and come to terms with loss in a healthy way. Many different approaches to counseling exist, with techniques that vary based on age and other factors. Ultimately, counseling can help those left behind remember and maintain a connection to what they’ve lost, while also helping them move forward and live full lives.

 

Infographic Sources

Centers for Disease Control, “FastStats: Death and Mortality”

Frontiers in Psychology, Ritual in Therapy for Prolonged Grief: A Scoping Review of Ritual Elements in Evidence-Informed Grief Interventions

Grief.com, Five Stages of Grief by Elisabeth Kubler Ross & David Kessler

Healthline, Therapy for Grief: What You Need to Know

Judi’s House, Childhood Bereavement Estimation Model

New York Life Foundation, Bereavement Survey Key Findings

PsychCentral, 5 Stages of Grief After Facing A Loss

Psychiatry Advisor, When Mourning Does Not End: Identifying and Treating Complicated Grief

Scientific American, “COVID Has Put the World at Risk of Prolonged Grief Disorder”

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AfterTalk Grief Support

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