Understanding Grief Therapy and How It Can Help

by Sara Lindberg

We’ve surpassed 600,000 COVID-related deaths in the United States, and many people are grieving a loss related to this pandemic.

Whether you’re dealing with a pandemic-related loss or grieving a loss related to something else, finding a way to cope is critical.

Grief counseling may help people of all ages process and cope with their feelings after experiencing a loss.

In this article, we look at how grief can affect you, the stages of grief, and how therapy for grief can help.

Therapy for grief, or grief counseling as it is often called, is designed to help you process and cope with a loss — whether that loss is a friend, family member, pet, or other life circumstance.

Grief affects everyone differently. It also affects people at different times. During the grieving process, you may experience sadness, anger, confusion, or even relief. It’s also common to feel regret, guilt, and show signs of depression.

A licensed therapist, psychologist, counselor, or psychiatrist can provide therapy for grief. Seeing a mental health expert for grief and loss can help you process the feelings you’re experiencing and learn new ways to cope — all in a safe space.

Grief generally follows stages or periods that involve different feelings and experiences. To help make sense of this process, some experts use the stages of grief.

The Kübler-Ross stages of grief model, created by Elisabeth Kübler-Ross, was originally written about people dying, not about people grieving, but later, she wrote on applying the principles to the grieving process after a loss.

There are five stages of grief under the Kübler-Ross model. These include:

  • Denial. After the death of a loved one, it’s not uncommon to be in denial about what happened. This can help temporarily protect you from the overwhelming emotions that come with grieving.
  • Anger. You may find that you are angrier than normal and direct your emotions at other people, including the person who died. It’s also possible to direct the anger toward yourself.
  • Bargaining. When you move out of denial and anger, you may find a period where you create a lot of “if only” and “what if” statements.
  • Depression. This is often called the “quiet” stage of the grieving process. You may experience overwhelming feelings of sadness or confusion. It’s common for your emotions to feel heavy during the depression stage, and you may want to isolate yourself from others.
  • Acceptance. When you get to a point where you accept what happened and understand what it means in your life, you’ve reached the acceptance stage.

Over the years, some experts expanded this model to include seven stages:

  1. shock and denial
  2. pain and guilt
  3. anger and bargaining
  4. depression
  5. the upward turn
  6. reconstruction and working through
  7. acceptance and hope

It’s important to note that the empirical evidence to support the stages of grief as a model is lacking, and, according to a 2017 review, some experts believe it may not be best when helping people going through bereavement.

Kübler-Ross’s model was, after all, written to explore the stages that people who are dying and their families go through, not for people to use after death.

One positive outcome of this model is that it emphasizes that grief has many dimensions, and it’s perfectly normal to experience grief through many feelings and emotions.

When grief is long lasting and interferes with daily life, it may be a condition known as prolonged grief disorder. According to the American Psychological Association, prolonged grief is marked by the following symptoms:

  • pervasive yearning for the deceased
  • difficulty accepting the death
  • intense emotional pain
  • emotional numbness
  • feeling like you’ve lost a part of yourself
  • persistent depression
  • withdrawal from typical social activities

In general, this type of grief often involves the loss of a child or partner. It can also be the result of a sudden or violent death.

According to a 2017 meta-analysis, prolonged grief disorder may affect as many as 10 percent of people who have lost a loved one.

Finding help for grief

Seeking therapy after a loss can help you overcome anxiety and depression by processing your experience at your own pace.

Each mental health expert may utilize a different approach to help patients tackle grief, and cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) are two methods often used for bereavement.

Cognitive behavioral therapy

CBT is a common treatment approach for mental health conditions like depression, anxiety, and post-traumatic stress disorder (PTSD).

During a CBT session, the therapist will help you identify negative thought patterns that can affect your behaviors.

They may ask you to explore thoughts related to grief and loss or other unhelpful thoughts to address how these thoughts affect your mood and behavior. They can help you lessen the impact with strategies such as reframing, reinterpreting, and targeting behaviors.

Acceptance and commitment therapy

ACT is another method that may help with grief and loss.

According to a 2016 research paper sponsored by the American Counseling Association, ACT may also be helpful with prolonged, complicated grief by encouraging clients to use mindfulness to accept their experience.

ACT uses the following six core processes for grief counseling:

  1. Acceptance of negative emotions. This step involves a willingness to experience and accept negative emotions and thoughts.
  2. Cognitive defusion. This process involves distancing from emotions so that it’s easier to examine and understand them.
  3. Contact with the present moment. By teaching mindfulness, ACT encourages people to focus on the present as that is when change is possible and when you experience life.
  4. Self as context. This step involves observing yourself having your experiences or becoming an observer of the experiences in your life.
  5. Values. These are the principles you hold that help direct your life.
  6. Committed action. The culmination of ACT, this step involves taking action and overcoming obstacles by working through the previous steps.

Grief counseling for children incorporates many of the same elements as counseling for adults, but the therapist works in ways that are appropriate for children.

According to the American Academy of Child and Adolescent Psychiatry, children, especially younger ones, react differently to death than adults.

In general, preschool-age children see death as temporary and reversible, but kids ages 5 through 9 think slightly more like adults. Some common ways grief counselors treat children include through:

  • Play therapy. Play therapy uses a child’s most instinctive behavior of interacting with the world around them by playing. A therapist may use dolls, puppets, stuffed animals, a dollhouse, or other toys to encourage the child to communicate thoughts, feelings, questions, and concerns they may otherwise struggle to express in talk therapy.
  • Art therapy. Art therapy allows a child to express themselves creatively and without words. A therapist may ask a child to draw or paint a picture of the person they are grieving and then use it as a way to explore their feelings.
  • Narrative therapy. Several children’s books deal directly with death but in a child-centric way. A therapist may use books to help a child understand death and dying and what can happen moving forward.

Things you can do to feel better if you’re grieving

Self-care is a critical component of the grieving process. In addition to participating in therapy, consider things you can do to take care of yourself. Here are some ideas to get you started:

  • Stick to a daily routine.
  • Get physical activity daily.
  • Eat a healthy diet.
  • Restrict or avoid alcohol.
  • Practice mindfulness meditation.
  • Spend time with friends and family.
  • Incorporate at least one thing in your day that brings you joy.

It can be difficult to quantify or predict the outlook for people dealing with grief, especially since each person manages it in their own way. It’s also challenging to predict if any one treatment may work the best.

Grief does not follow one particular path. Healing is unique to each individual, and the outlook for people dealing with grief looks different for each person.

A therapist can play a key role in supporting the healing process by facilitating counseling sessions based on your situation.

Complete Article HERE!

Deprived of the rituals of death, we are left to invent ways to contain our grief

When I lost my brother David, I did not know how to grieve. Not because I lacked experience, but because suicide obliterates the rituals we have built around death.

By Adam Mansbach

We have just lived through a year that burned ritual to the ground — both the rituals of life and the rituals of death. All of us who have lost someone have had to contend with the partial or total suspension of the comforts to which we might have looked. We are not able to cry together, nor crowd a house with food and bodies. Perhaps we have been denied even the chance to bear witness to the jolting finality of burial. And so we may find that our grief cannot run its course — that it is unable to find its way back to the ocean, absent the normal waterways.

Ten years ago, when I lost my brother David, I did not know how to grieve. Not because I lacked experience, but because suicide obliterates the rituals we have built around death. How do you celebrate a life when the person who lived it contends, as David did in the note he left behind, that he had always wanted to be dead? How do you mourn when the death has been fought for — sought, with the same fervor that most of us seek to continue living?

When I try to talk about it, suicide defies me. I have learned that it cannot be grafted onto other conversations. Even discussions of death, of depression, provide not a means of ingress but a reminder that there are no bridges to this island. You must swim. The few times I have done so, I have been a little drunk, and hours into a first conversation with someone I know I want to keep. A sense that I am being dishonest takes hold of me — that everything is false until I bare this wound. I grow impatient to find a way, bore open a point of entry, my heart throwing off sparks as if I were working up the courage to declare my love.

But once I speak it, I must contend with what it feels like to recite a narrative I have whittled down from something incomprehensible to a set of talking points. It feels obscurely disrespectful, to speak as if I understand. My brother bought an expensive skateboard that did not arrive on his doorstep until after he was gone; he was planning to live and planning to die at the same time. It was not an either/or but a both at once — no more a paradox than a train station with two sets of tracks running in opposite directions. I can write these words, shape this idea into a metaphor, but I don’t truly understand it at all.

I wish I could say that I learned to be gentle with myself when I lost David and realized that I had no means of finding peace. But I was not. I tried to force myself, at every turn — to cry when I couldn’t but felt I should, to let go of what I didn’t actually want to relinquish, to hold onto things that burned. I tried to write about him almost immediately, and castigated myself when no words came.

It took me nine years to find the language I was looking for — not a language that alleviated my grief, but one that contained it. It came suddenly, the way they say grace does. The week David would have turned 40, I began to write very fast, with an intuition about what came next and how disparate ideas connected that I trusted entirely — even or perhaps especially when it meant I was putting forth a notion only to question or disavow or undercut it.

I knew it was a ritual, even if I did not know whether a ritual was meant to fill the hole left by the loss, or deepen it until I could crawl out the other side. I would not say I found closure, as some people have asked. That word is loaded and mysterious to me. But I did find something, or perhaps something found me.

It was David’s story; it was my own. I could not tell it until his death had receded enough for me to see the whole thing at once, and until I realized that it was OK, was necessary, for the particles of my loss to float in solution, unreconciled, suspended like judgment. That if all I did was stare at them the way I might the tank of undulating jellyfish at the aquarium — which I also cannot understand, but do not seek to — that would be enough.

I think about this now, at a time when so many of the rituals that have guided and succored us are trapped on the other side of the glass. What can we do, when what we need cannot be accessed, or simply does not exist? Perhaps we can trust ourselves to intuit and then invent the things we need — to become the rituals that will sustain us.

Complete Article HERE!

The 5 Types of Grief

— What They Are and What They Feel Like, According to Experts

Grief doesn’t just happen after bereavement.

By Madeleine Burry

The loss of a loved one isn’t the only life event that leads to grief, and grieving isn’t just about hard crying, deep sadness, and other ovewhelming emotions. “We grieve and experience loss at every life transition,” Emily Stone, PhD, owner and senior clinician at Unstuck Group, a consulting organization for churches. That grief can be spurred on by sad or tragic events (a house fire, an infertility diagnosis, the loss of a job) and even by more joyous moments, like a child graduating kindergarten or going off to college, she says, because of what’s lost due to the change.

Opening up to the possibility that there are various types of grief is important for healing. “When we can recognize and name what’s going on emotionally inside of us, we can be kinder to ourselves during the process,” California-based therapist Skylar Ibarra, MSW, LCSW, tells Health. “Once they were able to see their grief for what it was, they were able to start healing,” she says.

Here, are some of the lesser known varieties of grief a person may experience, what they feel like, and what can cause them.

Anticipatory grief

Expecting loss or change can lead to anticipatory grief. With it, “we end up essentially experiencing the loss before it even happens,” Robin Hornstein, PhD, a licensed psychologist and co-owner of the Philadelphia-based mental health practice Hornstein Platt & Associates, tells Health.

That can have a destructive element. Hornstein recalls a person diagnosed with a disease in childhood who anticipated dying young. Now, the individual is in their 80s. “Approaching their actual death, as they are not well, has made them understand how much time they have spent worrying,” Hornstein says.

But there’s a reason people engage in this behavior: It provides a sense of control. “Anticipatory grief is our mind and body’s way of preparing for the loss. We do this to make the ‘after’ of the loss a bit less intense-and it works,” Ibarra says.

Delayed grief

Grief doesn’t always happen immediately: Sometimes people aren’t in a place to process loss, Stone says. That can be because of cognitive or emotional reasons, she notes, such as a young age or trauma. “I often see delayed grief in clients when they hit points of transitions in their life: at their wedding, at graduation, at the birth of a child,” Stone says.

This type of grief “can feel overwhelming, confusing, and unwarranted at first, since we don’t immediately recognize that we are grieving a long-ago loss,” Ibarra explains.

Absent grief

With this type, it may seem to people around you-and yourself-as if you’re not grieving something you feel you should be grieving, or your grief doesn’t look like the grief of people around you. But there can be a lot of reasons for not having a typical response, Ibarra says.

Shock, a feeling of relief that someone’s free from pain, or lack of understanding how to grieve-these can all lead to absent grief, Hornstein says. “Sometimes it could be linked to already processing the loss, such as an abusive parent or someone who has been ill for a long time,” she notes.

A person might even grieve without realizing it. “Many people think of grief as uncontrollable tears, ripping clothing, not being able to get out of bed, etc.,” Ibarra says. But it can also manifest as anger, difficulty concentrating, or intense worry, she says. “These aren’t the typical grief reactions we see in popular media, but they are what I see in my office,” she notes.

Inhibited grief

“Inhibited grief is usually classified as grief that someone is consciously attempting to quash,” Ibarra says. This can look like overworking or being excessively busy, Hornstein says. “Sadly, this does not stop the grief, just twists it into a different form that is harder to work through,” she says.

Ibarra compares it to ignoring a pebble in your shoe: Leave it in place instead of removing it, and a blister will form. “So not only do you now have to deal with the pebble, but the blister, too,” she says.

Disenfranchised grief

This type of grief isn’t recognized by our culture, Stone notes. That can be because people don’t think the event is worthy of mourning or due to your circumstances. For example, you may not be fully and openly mourn the loss of a lover in an extramarital affair, she points out.

It can also be a kind of grief that feels hard to explain, Hornstein says. “I once literally cried over a death on a long-running TV show and felt an acute sense of sadness,” she says. But taking off of work due to Poussey dying on Orange Is the New Black might not make much sense to others, she says.

“There are so many situations where a loss is not recognized or just glazed over by society.” Stone says. “This can be a very dark and lonely journey for the person experiencing the loss.”

There are other types of grief, too

People may experience environmental grief tied to the worsening climate, Ibarra says. “Another one that many people experience is perpetual grief after the diagnosis and living with a long-term disability,” Ibarra says. Or, people may grieve over the loss of an imagined future (this can occur due to an infertility diagnosis, the loss of a job, and so on).

There can also be unexpressed grief that’s intergenerational, Hornstein notes. She gives the example of survivors of genocide victims, who will never know their predecessors. “They might harbor a sense of fear/doom that this could happen again or is still happening in a different way and have grief symptoms that are expressed in familial patterns,” Hornstein says. It’s something that’s seen in BIPOC people in the United States, she notes.

“This type of grief is hard and needs unpacking so that feelings can be expressed, and actions taken to be more present and find ways to feel safe,” Hornstein adds.

Coping strategies for different types of grief

Coping strategies may differ based on the type of grief a person experiences. “If someone is experiencing a delayed grief reaction because they are in crisis, then the crisis needs to be addressed first,” Ibarra says.

But there are some general strategies that apply to all types of grief, Hornstein says. These include:

Be kind to yourself

“If you notice you are grieving, be compassionate, allow for time, drop the need to be perfect at it or anything else, do not judge the quality or length of time you grieve, and honor the feelings,” Hornstein says.

Practice memorializing

It can be cathartic and healing to create a memorial for the person or thing you’ve lost, Ibarra says. “This may be a letter you burn or an altar you maintain for years. It allows us to accept the reality of the loss, create a space to feel our feelings, and to build a new life moving forward-all critical parts of the grieving process,” she says.

Look out for displaced grief

That can take the form of crying over flowers instead of missing someone who has died, Hornstein says. “Allow the grief to lead you where you need to be,” Hornstein says.

Signs you should seek help

“No one escapes grief,” Hornstein says.But the process-though normal and necessary for long-term health-can be challenging and painful, Ibarra says. And the kind of grief you feel over one thing or event may be very different than that of another, so your response may feel unfamiliar and worrisome. “You deserve support as you navigate this experience,” Ibarra says. That’s true for anyone experiencing grief, she says. Still, there are a few indicators that you should reach out for help.

You think you want it

“You do not need to be broken and nothing needs to be wrong with you to seek the help of a professional,” Ibarra says-that is, if you think you’d benefit from support, seek it out.

Your day-to-day routine is suffering

If you are not able to go through the ordinary routine of life-taking regular showers, showing up to work on time, and so on-it’s a good idea to seek help, Hornstein says. Difficulty sleeping or an inability to eat are also cues to reach out for support, she says.

You feel a prolonged sense of hopelessness

Certain feelings-such as intense, out-of-control anger or prolonged hopelessness-can be a sign that you should seek professional help, Ibarra says.

You’re dealing with survivor’s guilt

Reach out to professionals if you experience guilt over being alive or a desire to self-harm, Hornstein says. But keep this in mind: “You do not need to wait until things get really bad to seek help,” Ibarra adds.

Complete Article HERE!

There Are 5 Stages of Grief

— Here’s What to Expect From Each One

Everyone who grieves experiences them, but we do it in our own way on our own timetable.

By Madeleine Burry

Whether it’s the death of a loved one, the loss of a job, the end of a relationship, or any of life’s small and large tragedies, we all grieve at some point. While you shouldn’t anticipate that your grief will resemble another person’s, there are certain common stages of grief we all experience.

Where the stages of grief originated

These stages of grief have typically been classified as denial, bargaining, anger, depression, and acceptance. The five stages originate from a 1969 book, On Death and Dying, written by psychiatrist Elizabeth Kübler-Ross. Though there’s some dissent about these five stages and not everyone goes through them at the same time or the same way, they’ve been accepted by psychology experts for decades and remain the model that is applied to all forms of loss.

“Coping with a loss is a very singular and unique experience to each person,” Holly Schiff, PsyD, a licensed clinical psychologist in Connecticut with Jewish Family Services of Greenwich, tells Health. Nor is the grieving process accompanied by a timetable, although often the worst symptoms peak at the six-month mark, she notes.

The grieving process is a “messy jumble of highs and lows, ebbs and flows, steps forward and backwards,” Schiff says.

Here, a look at what happens during each of these five stages, along with coping strategies for grieving.

Grief stage 1: denial

This initial stage of grief helps us to cope and survive a loss, Schiff says. “You are living in a ‘preferable’ reality, rather than actual reality,” she says. You might refuse to acknowledge the loss by keeping it to yourself and going about your life. When emotions start to overwhelm you and urge to to face the loss, you fight back and focus your mind elsewhere.

You may experience shock or disbelief while navigating denial, Arianna Galligher, LISW-S, associate director of the STAR Trauma Recovery Center at Ohio State University’s Wexner Medical Center, tells Health. “Many people describe feeling numb,” Galligher says, or struggle to connect with their emotions.

Grief stage 2: anger

Grief-related anger may lead you to ask “Why me?” or wonder why life is unfair, Schiff says.

“This response may be directed outward, inward, or both,” Galligher says. That is, it’s not unusual to blame yourself or to feel anger toward friends, family members, and others. In the case of a bad medical diagnosis, for instance, the target might be a doctor who didn’t catch the disease early on-or, someone who is fired may feel fury at their boss.

If it’s a loved one’s death you’re grieving, you could also be angry at the person-furious that they didn’t seek help sooner for a health symptom or mental anguish. If you’re grieving the end of a relationship or job, you might feel anger toward your ex or boss, blaming them for things ending.

Anger may feel unfamiliar, or maybe immature. But don’t avoid this necessary stage of grief, Schiff says. “The more you allow yourself to feel it, the more quickly it will dissipate.”

Grief stage 3: bargaining

During the bargaining phase of grief, people seek to resume their pre-loss life. Essentially, it becomes an attempt to negotiate out of the grief, Schiff says.

Many people experience guilt during this phase, too. “This response is often punctuated by ‘what if’ or ‘if only’ thoughts that seek to regain some sense of control when a person is feeling helpless or powerless over the outcome of a situation,” Galligher notes.

These thoughts may circle around and around: What if we’d skipped that errand-then we would have avoided the car accident. Or if only I’d made time for weekly date nights, we’d still be together.

Grief stage 4: depression

Facing the new, post-loss reality can lead to sadness and despair, Schiff says. “This is a natural and appropriate response to grief,” she explains.

During this phase, you may feel lonely, cry frequently, or feel disengaged from your regular activities and relationships. Depression can affect your sleep and appetite. People in this stage might find themselves losing or gaining weight, or they could feeling fatigued during the day because they’re waking up throughout the night.

Depression isn’t always displayed with a lot of emotion, however; sometimes it mean simply feel uninterested in day-to-day life and not feeling strongly about anything. If you don’t cry, it’s doesn’t mean you aren’t in the depression stage of grief. Think of “depression” as more of a stage where your emotions are muted, with grief preventing you from finding pleasure or contentment in things.

Grief stage 5: acceptance

Reaching the acceptance stage of loss doesn’t imply that you feel happiness-it simply indicates that you’ve acclimated to the loss and your new reality, Galligher says.

That means that while your emotions may stabilize, during the acceptance stage you may still feel sorrowful. During this phase, you’re learning to live with your loss, Schiff says.

While your emotions may stabilize, and you may no longer have the extremes of other stages, sadness may still occur.

Other ways of looking at grief

The Kübler-Ross theory can make grieving seem like an orderly, step-by-step process.

But in reality, mourning a loss isn’t a math equation: You may find yourself going from one stage to another and then again, Schiff says. Or, you may “even feel like you are in multiple stages at once as you cycle through a variety of emotions,” she says.

This rigidity is one of a few reasons for critiques of the Kübler-Ross model, Galligher says. This approach also assumes that all cultures conceptualize-and therefore, cope-with grief in the same way, she notes, which is not necessarily accurate. Other modern theories of grief focus less on stages and more on grief-related tasks (think: accepting the loss), Galligher says.

When to seek help

The grieving process can feel isolating and overwhelming. “It is important for people to seek help when they are grieving, and lean on family and friends for support,” Schiff says.

Grief can understandably affect your mental health, so consider reaching out for professional help if grieving-and feelings associated with the process-are making it hard for you to handle day-to-day functions or maintain relationships, Galligher says. Attending support groups or seeing a therapist can help you navigate life after loss, she says.

“If you feel like grief is taking over your life, speak to someone,” Schiff says.

Grief coping tactics

Navigating grief is innately challenging, but here are some therapist-recommended strategies to potentially ease the process:

Let your support system go work

While your grief is personal, there’s no need for it to be a solo operation. Seek support from friends, family, therapists, and support groups, Schiff recommends. She also recommends informing people in your workplace as needed. That way, “your job doesn’t expect the same ‘you’ to show up every day.”

Feel your feelings

“Give yourself permission to feel a range of emotions without judgement,” Galligher recommends. Expect challenging days and weeks to occur. It can be helpful to allocate a certain amount of time each day to grieving, Schiff says. But give yourself the grace of grieving without a deadline-again, there’s no set end-date for the process.

Prioritize self-care

Make sure you’re taking care of your physical and emotional needs: Don’t neglect sleep, exercise, and eating, Galligher says. And, avoid self-medicating with alcohol or drugs, she adds.

Plan ahead

Anniversaries, holidays, and other milestones can trigger feelings of grief, Galligher notes. “Engage in intentional self-care in anticipation” of these moments, she recommends. That might mean, for instance, deleting social media in the lead-up, taking time off of work, or reaching out to loved ones for support.

Complete Article HERE!

What Is Anticipatory Grief And How Does It Work?

By Judy Ho, PH.D., A.B.P.P., A.B.P.d.N.

Anticipatory grief, also referred to as anticipatory loss or preparatory grief, is the distress a person may feel in the days, months or even years before the death of a loved one or other impending loss. “It’s the experience of knowing that a change is coming, and starting to experience bereavement in the face of that,” says Allison Werner-Lin, Ph.D., a licensed clinical social worker and associate professor at the University of Pennsylvania’s School of Social Policy and Practice in Philadelphia. Many of us have experienced anticipatory grief without realizing there’s a name for it, she adds.

Some experts say anticipatory grief, when managed with coping techniques, can lessen the pain of post-loss grief. Others argue grief before loss has no effect on grief after loss.

Who Has Anticipatory Grief, and When?

Patients with a terminal illness, as well as their family members, friends and caregivers, often experience anticipatory grief. However, any kind of looming change can bring on anticipatory grief. This is true “even if the change is exciting and anticipated and chosen,” says Werner-Lin. For example, a person who puts in notice at her job may grieve the loss of friendship she expects will happen when she no longer sees her current co-workers every day.

Scenarios that may provoke anticipatory grief include, but are not limited to:

  • Diagnosis or progression of a degenerative disease, such as Alzheimer’s disease, other forms of dementia or Parkinson’s disease
    In one study conducted in Cork, Ireland, 29 people caring for a family member with Parkinson’s filled out questionnaires to assess their levels of anticipatory grief. Caregivers “were preoccupied with thoughts about…what life could have been if they were never diagnosed,” researchers found.
  • End-of-life care
    Anticipatory grief may affect the caregiver, the patient or both. In one study of family caregivers in Japan, a woman taking care of her husband, a cancer patient who was expected to die within six months, said, “I become anxious thinking about the future even when I am asleep. What should I do? My husband is the firstborn son. His 92-year-old mother is still doing well. He is genuinely firstborn. Everyone in the household relies on the firstborn son, and everything important is left to him. If he dies, everyone will be troubled.”

    • Caring for children with chronic disease
    • Hereditary cancer risk
      Anticipatory grief often surfaces in people who have genetic conditions that elevate their cancer risk, says Werner-Lin, who is also a senior advisor to the National Cancer Institute’s Clinical Genetics Branch and studies patients who have Li-Fraumeni Syndrome and BRCA mutations. In these cases, the patient imagines when a cancer diagnosis may come and how it will change their quality of life.
    • Awaiting an organ transplant
      Besides grieving the possible scenarios of their own death, patients on a heart transplant list “were also grieving in this way for their potential heart donor and the death that would have to happen to extend their own lives,” according to a study published in the Journal of Heart and Lung Transplantation.
    • Amputation
      A review of 134 studies of the social and psychological challenges that face amputees found that the time before the operation can be the most upsetting. Patients express grief over the unknowns surrounding their future, including “pain, financial difficulties, general health and future functional capabilities at home or on the job.”
    • Impending loss of a pet
    • A new job, a new relationship, a geographic move or a teen leaving home for college
      Even planned, desired life changes can prompt anticipatory grief related to the prospective loss of identity, friends or routine.

    Anticipatory grief can also surface around pregnancy and childbirth, including:

    • In-utero complications
      Parents who learn that their unborn baby may not survive can experience anticipatory grief around the potential loss.
    • Premature birth
      “Anticipatory grief may set in as parents mourn the loss of their ‘imagined’ or ‘wished for baby,’ as they struggle to develop a bond with their ‘real baby,’” write researchers in Primary Care of the Premature Infant. In some mothers, these feelings “may be rooted in her belief that her inability to bring her baby to term is a personal failure.”

    Anticipatory Grief and Age

    The younger a person is, the more severely they may experience anticipatory grief, particularly as it relates to death. In a review of 15 studies exploring anticipatory grief and illness, doctors at the University of Illinois at Chicago found that “younger caregivers and younger patients tended to report higher ratings of anticipatory grief.” In one study of adults with terminal cancer, patients under age 25 experienced more anticipatory grief than patients age 26 to 55. The younger group “viewed death as extinction,” influencing their grief, researchers found.

    Anticipatory Grief vs. Conventional Grief: What’s the Difference?

    Think of conventional grief as “grieving backward,” says Werner-Lin—mourning a loss that has already happened. Anticipatory grief is forward-looking. We’re grieving “what we still believe we might lose,” she says.

    This leaves space for hope, however unrealistic, that the loss may not occur. Anticipatory grievers might find themselves “hanging on to possibilities” in ways that may not be helpful, Werner-Lin says. Conversely, in a situation like a pandemic, it can be helpful to step back and remember that the worst might not happen.

    What You Might Feel When Experiencing Anticipatory Grief

    People undergoing anticipatory grief report a range of feelings that may include:

    • Anger or irritability
    • Anxiety
    • Denial
    • The desire to withdraw from social situations
    • Desperation
    • Dread
    • Guilt
    • An intense preoccupation with the dying person
    • Lethargy or lack of motivation
    • Loneliness
    • Loss of control over one’s emotions
    • Sadness
    • Tearfulness

    The Stages of Anticipatory Grief

    There’s no set order to what you might feel as you undergo anticipatory grief, and there’s no “finishing” one feeling before you move to the next. You may experience many emotions one day and none the next. You may think you’re done feeling certain emotions only for them to return days or weeks later.

    With that in mind, here are four phases a person with anticipatory grief may experience, separately or simultaneously, in any order, according to the University of Rochester Medical Center, a nonprofit research university in Rochester, New York:

    • Accepting that death is inevitable. This phase often co-occurs with feelings of sadness and depression.
    • Feeling concern for the dying person. For family and friends, this phase may express itself in regret—for example, feeling regret over past arguments or disagreements with the person they are about to lose. For the dying person, this concern may translate to fear of what it’s like to die.
    • Rehearsing the death. A person may become focused on funeral arrangements, saying goodbyes and other concerns related directly to what will happen in the time immediately surrounding the impending death.
    • Imagining the future. Family and friends may envision what life will be like without their loved one. This phase may include visualizing holidays and other special occasions without the person or thinking about objects that will be left behind. The person dying may think about similar scenarios, wondering what it will be like for their loved ones to experience life without them. The dying person may also imagine what their own experience may be like after death—what, if anything, comes next.

    Potential Benefits of Anticipatory Grief

    Anticipatory grief doesn’t necessarily reduce pain after loss. Any potential benefits have largely been studied in the context of anticipatory grief before death.

    Some early research suggested the preemptive processing of a loss could help a person better cope once the loss occurred. “Within this paradigm, the bereaved are able to deal with any unfinished business, say their good-byes, clarify any misunderstandings, and prepare for social adjustments to come, thereby having a less distressful and disabling period of bereavement when the death does occur,” according to a research review published in the journal Counselling, Psychotherapy, and Health.

    However, some more recent studies argue that anticipatory grief has no effect on post-death bereavement. Others find that pre-loss anticipatory grief may be a factor in predicting prolonged grief disorder.

    At best, research is contradictory. However, keep in mind that one doesn’t choose to feel anticipatory grief. More important than considering its benefits is making sure you get the proper help to work through it.

    How to Deal With Anticipatory Grief

    If you’re experiencing anticipatory grief, it’s important to talk about it with someone. “Grief is a universal human experience,” says Dr. Werner-Lin, and discussing it with others is how you begin to work through it.

    She gives the example of a group of rare disease patients and caregivers her research team worked with. Prior to talking about their anticipatory grief, “they all really independently felt like they were just plain struggling and not holding up their end of the bargain of humanity,” she says. “When really what was happening is something we could explain and work through. Talk about the dimensions of it. Talk about where it moved into their lives and filled in cracks and crevices, or was taking over their day-to-day lives and their relationships.”

    Dr. Werner-Lin recommends using the American Psychological Association’s Psychologist Locator Program to find a mental health provider who specializes in grief, whether that be a psychologist, psychiatrist, psychiatric nurse practitioner, social worker or counselor.

    Common counseling interventions include narrative therapy, which can help the grieving person reframe loss, and active listening, which allows the grieving person ample time and space to talk out their feelings, prompted by insightful questions from the counselor. This type of out-loud musing can help a person process their grief.

    Another form of evidence-based intervention is cognitive behavioral therapy. In this type of therapy, grief-related thoughts are identified and processed, and the grieving person is taught to reframe their evaluations about themselves, the world and their future. It focuses on managing distressing emotions and encouraging actions to help a person experience pleasure, joy, and a sense of community.

    If you don’t have the financial resources to hire a counselor, it’s still beneficial to talk to family and friends, who can engage in active listening and offer other support that’s important for processing grief, such as empathy and validation.

    For an end-of-life patient, anticipatory grief therapy may improve quality of life before death and may alleviate depression.

    Many insurance plans cover a percentage of therapy costs retroactively via claims forms. Call the number on your insurance card to ask about policies.

    Complete Article HERE!

What the Pandemic Taught Us About the End of Life and Grief

Hospice workers, ethicists and therapists say grief is a pathway toward healing

By Vicky Diaz-Camacho

Grief felt “closer” this year for Meagan Howard. It’s the only way she could describe it.

On May 16, her good friend died in a car accident. There was something different about this death. As a Black woman in the mental health field, Howard said she has personally felt the compounding trauma of the pandemic with racial tensions.

That’s why it hit harder.

But as she sat in silence and cried with another friend to mourn their loss, she felt the release.

“That was more healing than someone saying, ‘It’s going to be OK’,” she said.

Meagan Howard
Meagan Howard is transparent about her own difficulty to grapple with grief and now encourages others to find ways to navigate sometimes complex emotions.

Years ago, Howard personally struggled to acknowledge the grieving process when her grandmother died. Now, she works against that to help her own clients who are navigating complex feelings of anger, avoidance and sadness — symptoms of grief — and in her personal life.

She specifically counsels folks with substance use disorders at Midwest Recovery Centers, which can often stem from unresolved trauma and loss.

The pandemic sparked a new kind of uncertainty, ranging from housing and job security to health security. This is why it’s more important now than ever to take a moment to pause and feel, she added.

A paper for the National Institutes of Health (NIH) on preparing palliative care providers explained that “anticipatory grief is the normal mourning that occurs for a patient/family when death is expected.”

That anticipation evaporated in the wake of the public health crisis. Back in March 2020, the number of people infected and dying from complications skyrocketed. This, mental health experts say, caused a mental health whiplash.

“As a society, we’re just kind of told lock it down, keep it moving,” she said.

However, she witnessed a shift this year that ranges between communal trauma to communal grief.

Howard said grieving as a society has been an essential step toward collective healing.

“One of the most powerful things that I saw from the pandemic is this sense of community,” she said. “There is power in being able to share your grief in a community setting with someone else. (It) gives us power when we feel like we don’t have any.”

From a mental health perspective, grief is healthy.

“It’s needed, it’s necessary, it’s essential,” Howard said.

“If we’re not allowing ourselves that grieving process, then almost in a sense we almost start to die internally. And I know that sounds kind of morbid, but that’s what it feels like is happening if we’re not allowing that to come out.”

Researchers at the NIH outlined what they call “context of grief” during the pandemic, which underscored how the public health crisis complicated an already sensitive process.

The study identified three specific changes during COVID-19: spread of the disease; social distancing and the increase of deaths; and hospitalizations and overburdened hospital systems. It outlined the financial, emotional, social and mental toll this would take on society at large.

Among the recommendations was to address grief head-on:

“Approach difficult conversations directly and do not shy away from discussing emotions, grief, and overall patient and family distress during advance care planning conversations.”

Trauma and loss experts have long advised families to begin conversations early about advance care planning. The idea is to ease ourselves into more comfortable conversations about what to do when someone we love dies. More importantly, these conversations serve as an emotional buffer.

Caring Conversations

Life unexpectedly changed, leaving communities unsure how to grapple with uncertainty and at the same time inciting communal trauma of seeing folks die from COVID-19.

This brought to the surface ethical considerations that impact the grieving process. How do families broach the subject of advance care planning or Do Not Resuscitate (DNR) orders?

That’s where Terry Rosell comes in. Rosell is an ethics consultant at the Center for Practical Bioethics — one of the only three centers of its kind in the United States.

(Disclosure: the author’s spouse recently accepted a job at the center. The interview was arranged and conducted without their involvement.)

Rosell, who is also a faith leader, works closely with medical professionals and has seen firsthand how COVID-19 changed the way in which families and their doctors approach life and death discussions.

Terry Rosell
Terry Rosell is an ethics consultant and educator for the Kansas City University of Medicine and Biosciences and the University of Kansas Medical Center. He also was a theology professor.

“It’s hard enough to die. It’s hard enough to deal with our loved ones dying. So we ought to make it better,” he said.

End-of-life care is also known as hospice and palliative care, which emphasizes keeping the person comfortable while they’re dying. This is part of what Rosell teaches when he presents to physicians and hospital staff.

“The first ethics matter around end-of-life care is taking care of these patients. Just because they’re no longer curative, just because they’re no longer receiving aggressive care, we still have a duty to care for them,” he said. “We ought not to abandon dying patients, right?”

Another part of his job is educating on advance care planning, which ensures a person’s wishes are fulfilled. To some extent, this practice can curb the anxieties that come with anticipating loss.

But not everyone may know what hospice care or advanced care planning entails, which brings to the forefront the lack of visibility of end-of-life services. What the pandemic revealed was the need to address these conversations earlier on.

This helps with the processing part of loss, Rosell explained. Death is a part of life and grief follows suit.

“Any kind of significant loss has a grief response. It’s just part of being human,” he said.

Part of being human is finding comfort in some sort of routine, whether that be spiritual or a ritual. To that end, Rosell added: “Don’t give up on the grief rituals during COVID times. It helps us”

‘I don’t know who I am anymore’

For Oscar Orozco, being vulnerable is part of his job.

Orozco was a former medical social worker for Children’s Mercy, where he helped at-risk children. Today, he works as a grief counselor at Kansas City Hospice and Palliative Care. He echoes Rosell’s points on advance care directives to reduce the added stressors of planning while someone is on the decline.

Oscar Orozco
Oscar Orozco, a grief counselor at Kansas City Hospice and Palliative Care, sees grief as an unpredictable wave.

Even though he’s been in his new role for a short few months, the need for counseling folks through the process has never been more clear.

This year hardly anyone has been able to catch their breath. Orozco said he has talked to health care workers who are friends or clients and they said: “I can’t do this. It’s too much.”


“(There’s) death and traumatic death, and it’s different. This is not death that people could see coming,” Orozco explained.

Another piece of complex trauma is identity and how folks have struggled to come to terms with the absence of their loved ones.

“In our grief work, what I hear almost often is, ‘I don’t know who I am anymore’,” he said. “People don’t realize that it’s much more than just the death of that person, but it’s the death of … routines, of day-to-day activities and memories and parts of our lives really that died with that person.”

He sees grief like an ocean. It’s unpredictable but sooner or later it’s easy to know when the waves are coming. Managing grief is like swimming, he explained, and sooner or later, we learn how to stay afloat.

Oscar Orozco with his grandparents
Oscar Orozco (middle) lost his grandfather a few months ago. He’s since learned how to process the loss by channeling his grandfather’s love of food into his own life.

That’s how he feels about the recent death of his grandfather. He channels his emotions into cooking, which is how his grandfather expressed his love for the family. This physical act helps him emotionally recover and process.

Processing is key, he said, but that’s been on the back burner for so many during the pandemic. So he advises folks who have experienced loss to be active and deliberate in the grief journey. That could mean going to their burial site for a visit, or it could be to buy their favorite meal from their favorite restaurant.

Grief is an individual process. Orozco advises people to embrace the emotion whether it be by crying, journaling, hiking or traveling.

“You know, whatever it is that comes out naturally to express, but never cast it aside because we’re afraid of where it might lead,” he added.

“We need to talk about this. We need to have those conversations because as uncomfortable as they might be, they could be lifesavers for (us) to continue to live our lives in a meaningful way.”

5 Tips on Navigating Grief

  1. Grief can be complicated and hard to pinpoint. That’s OK. Acknowledge the feeling or sensation (it could be a stomach ache, fatigue, lack of focus or emotions such as profound sadness or anger) as a first step. Experts say there are several kinds of grief:
    1. Complicated grief: When loved ones ruminate about the cause of death, worry about the consequences, feel guilty and display avoidant behaviors, such as denial. Around 7% of bereaved people will experience this kind of grief.
    2. Disenfranchised grief: When a loved one loses a person or child. It “can occur when families are unable to grieve with normal practices of social support and rituals in burial and funeral services,” according to the NIH.
  2. Asking for help to begin the grieving process is OK. “Grief counseling can help,” said Terry Rosell at the Center for Practical Bioethics. “Ministers, clergy, rabbis, priests, there are a lot of people who can help with grief counseling (for free).” You can find grief counselors at your local hospice organizations and mental health professionals who specialize in loss — for good reason. One example is the Solace House Center for Grief and Healing.
  3. Communication is powerful. Talk openly with family members, chosen family or biological relatives, or friends about their wishes before death — sick or not. Studies on the psychological impact of meaningful conversations — or saying “goodbye” — among family members of cancer patients show it helps with depression and complicated grief.
  4. Engage in activities that remind you of your loved one. This can also be characterized as play therapy if your loved one was an artist, which eases the transition from grief to acceptance. “I very much believe that spiritual practices or just rituals is how we get in tune with what our body is telling us about the loss we experienced,” said therapist Meagan Howard.
  5. Cry. Therapists advise sitting in a safe, quiet place or with a support network to embrace the feeling and release. This is good both physically and psychologically. Crying is the body’s “release valve,” according to Dr. Judith Orloff, who wrote: “After crying, our breathing, and heart rate decrease, and we enter into a calmer biological and emotional state.”

Complete Article HERE!

How The Pandemic Has Exposed The Gap In Bereavement Support

By Katie Lynch

Workplace well-being and employer benefit packages have been expanded and highlighted in recent months in light of current events and as companies look to attract talent and build loyalty within their organizations. While vacation time, remote and flexible working, paid parental leave and other wellness perks are often touted as part of a progressive company culture, bereavement leave and grief support still remain a gaping hole in the employee value proposition, leaving people scared to share or ask for help during difficult life events at work.

Even in the wake of Covid-19, I find the conversation around grief and loss in the workplace lacking. Few companies have truly publicly acknowledged the devastating loss of this past year and its impact on employees. As of this writing, the death rate from Covid-19 in the U.S. has surpassed 580,000 Americans, leaving an estimated5.2 million Americans grieving (according to a recent calculation that for every person lost to Covid-19, nine close family members are left to grieve). It is undeniable that this pandemic has affected each one of us, so suffice it to say that all Americans have experienced grief and loss this past year. Why then are companies not talking about its impact on their employees and offering more support?

Companies that strive for empathetic and inclusive cultures need to acknowledge these issues and remove the stigma associated with grief and death in the workplace. According to the Society of Human Resource Management’s (SHRM) 2019 survey, 89% of employers were providing some form of bereavement leave to their employees. However, traditional bereavement leave lasts just one to four days, depending on the employee’s relationship to the deceased. Not only are some companies still not providing leave, but those that do provide it often fail to provide an adequate amount of time away and lack ongoing support for employees dealing with a grief event. When a company only provides employees with one day off following the loss of a loved one, it signals a lack of empathy and support from leadership.

Something that may be contributing to the lack of discussion about grief in the workplace is the lack of any federal or state legislation requiring companies to provide paid leave to their employees. Currently, there is no federal requirement to provide paid leave even for a funeral, let alone time to grieve one’s loss. The fact that the U.S. Department of Labor calls this “funeral leave” and not even bereavement leave shows how antiquated our view of bereavement remains. In an encouraging turn of events, President Biden recently announced the American Families Plan, which would immediately guarantee three days of paid bereavement leave if passed. As of today, though, Oregon is the only state to sanction the overarching need to support grieving employees with a law requiring bereavement leave for employees, with California hoping to follow suit as legislators consider a similar bill.

While some companies are investing in programs to help employees in need, there is room for further support. Having spent years working with people through challenging life transitions, I know firsthand that dealing with grief and loss is not just a single moment in time, and it almost always requires ongoing guidance, education and specialized support.

In 2017, two years after the tragic death of her husband, Facebook COO Sheryl Sandberg famously placed the company at the forefront of the bereavement discussion by championing the need for expanded bereavement leave policies for employees and recognizing that employers need to support their people throughout these situations. Yet, little has changed outside of a select few companies, including Facebook and SurveyMonkey, both supplying bereavement leave of 20 days for immediate family members and 10 days for extended family members. Mastercard, Zillow and New York Life Insurance Company have all in recent years adopted bereavement leave policies of 10 to 20 paid days, depending on who passed away.

While there were great hopes that 2020 would usher in a new era of discussing grief and loss in the workplace and providing employees with adequate leave and support, either internally or with the help of a third party, many companies have failed to take this crucial step. What is so shocking is that even before Covid-19 wreaked havoc on our world, it was reported that grief costs employers an estimated $75 billion each year in lost productivity alone. This number has most certainly skyrocketed in the past 14 months. What we are experiencing now is not new, but it has been worsened. If the risks and costs to businesses are so severe, why do companies not invest more heavily in supporting these employees?

Moving Forward

We need to use the momentum from Covid-19 to do better for our employees. With this mission helping to drive my company and me, we are having these difficult conversations with clients and are providing their employees with proper support in this area. We are hopeful that moving forward, more companies will recognize their responsibility to promote conversations in the workplace on dealing with grief and loss as well as training managers and employees on how to support colleagues following a grief event.

Companies that want to lead with empathy and be at the forefront of this movement will need to model their programs after progressive examples and invest in programs offering robust and ongoing support to employees following a loss. They will also need to create policies that are more inclusive, ensuring that bereavement leave is not just given for the death of a parent, spouse or child, but any family member to whom the person was close. This should also include miscarriage. In addition to leave, companies should also provide employees with ongoing and more robust emotional, administrative and logistical support.

Lastly, the topics of death and grief must become part of the conversation in the office, and managers and leaders need to get comfortable with the uncomfortable. The results will be seen in both better business outcomes and profits as well as a happier and healthier workforce overall.

Complete Article HERE!