Counseling the Broken Hearted -

Counseling the Broken Hearted - Memories of Grief

Grief is painful. When we talk about grief we are referring to the extreme emotional reaction of an individual to loss, which often includes shock, sadness, fear, anger, confusion, somatic disorders, and loss of identity. If the grief is not resolved, complicated grief will be the outcome; that is, grief that is prolonged past what society considers normal (Curran, 2007). Some people grieve for years and never do resolve it (Paffenroth, 2006), especially the parents of a child who has died. Commonly, we associate grief with bereavement or the loss of a loved one to death; however, other losses cause grief also, losses such as sensory loss (hearing or vision), loss of memory (as in Alzheimer's, for example), loss of employment, mobility, or independence. Crawford-Faucher (2007) discusses the professionally induced grief that nurses inevitably suffer when all the deaths they witness add up and become somehow "personal." Likewise, Macpherson (2008) describes a program of storytelling that helps pediatric nurses in the cancer ward to recover from the pain of seeing children die. An article in the Practitioner (June 29, 2006) argues that simply realizing the end of life is approaching can cause a loss of "expectancy" in elderly people, which brings grief and may precipitate a crisis in the individual.

Of course, grief is nothing new. To experience it is part of the human condition. "Griefe," or "dying of a broken heart" was only two hundred years ago an official cause of death. Everyone knows at least one example of a marriage in which the surviving spouse died within hours, days, weeks or months of a long-time partner. Moreover, in the 1960s a study showed that loss of a spouse increases the survivor's likelihood of death by seven times! (the Practitioner, 2006). The stress and emotional upheaval that grief causes is significant. The death of a spouse, for instance, "ranks first out of 43 stressful events' on the Social Readjustment Rating Scale" (Muller & Thompson cited in Briggs & Pehrrson, 2008).

Professionals have long believed that grief has a potentially negative effect on an individual's health. Anderson (2006) reports that the immunity of two groups was tested in the laboratory in a study of the effects of grief on physical health. One group had suffered the death of a spouse; the other group, used as a control, had not experienced a death. The test results showed, "Response to mitogenic challenge, a measure of the immune system's ability to respond to assault by infectious and toxic agents, was significantly compromised at eight weeks following the death of a spouse" (p. 128). Thus, the negative impact of grief on health and the quality of an individual's life can hardly be overstated.

"truism" we often hear is that "Time heals," but really, it isn't so. Although healing may indeed take time, the mere passage of time is not enough to be a healing agent. Dependence on time to heal grief is not a wise course. Moreover, if depression occurs as a result of unresolved grief, the person may not take proper care of self. Accidents, self neglect, and self-harm may be the result of the attendant despair that sometimes overwhelms the person with a "broken heart."

The presence of anger that the grief-stricken must deal with at some point can further complicate grief if not dealt with constructively. "I doubt anything is more fundamental to dying and grief than the simple human reaction of anger; it is surely on a par with fear as the predominant feeling in the process" (Paffenroth, 2006, p. 57)

Unpleasant feelings must be confronted, embraced, and resolved for healing to take place. Some people are able to do this with no outside assistance; others, however, can benefit greatly from counseling and be spared the development of complicated grief. Church going people more often than not turn to their pastor for counseling, and this is natural since the pastor is often seen as an "expert," and the suffering individual may hope to find answers to questions about painful loss and other spiritual dilemmas connected with death and grief.

This paper will explore ways pastoral counselors can manage grief when members of the congregation come for help. In an older congregation grief may actually be the most common reason for seeking pastoral care because old age itself presents a series of losses and death occurs more frequently in the elderly.

Grief is common; yet, like the cold, it is not easy to effectively treat. Smith (2008) likened the experience of losing her mother to Robinson Crusoe when he was cast adrift a mile from shore, "an indistinct image of a stranded, barefoot man, pant legs tipped at midcalf -- straining, poling a raft back to his wrecked ship to gather provisions" (p. 77). Reassembling the pieces of one's life after bereavement is the difficult task of grief. Treatment requires first and foremost that the counselor possess that quality we call empathy; that is, the ability to feel what the other person is feeling. Willingness to do this, to experience another's pain and suffering, comes with Christian compassion and is part of loving one another as the New Testament demands. Sympathy or pity is not what is needed. As Keim (2007) points out, "The other's loss is also our loss. It should hurt like hell. If it doesn't, then something inside of us has died" (p. 18). Assuming that the pastor's empathy is well developed, we will look at some ways Christian counselors might deal with grief.

Ego Integrity, Life Review, and Narrative Reconstruction

Whiting & Bradley (2007) state, "Contemporary research suggests that the most influential factor in predicting well-being after loss is the ability to make sense out of what has occurred" (p. 123). According to these authors, if the grieving person can derive or construct meaning from what has happened, ego integrity will result. This involves finding answers to questions of how and why events leading up to the loss took place and reasons for decisions that had to be made. Sense making is what heals the pain and makes the person stronger.

The disruption of a devastating loss inevitably triggers a loss of identity and questioning the meaning of one's life. Many widows, for example, have been caregivers for most of their lives. When the husband dies and they are left with no one to take care of, the structure and fabric of their lives is disturbed and/or destroyed. Suddenly, there are no responsibilities and no reason to get out of bed in the morning. An older woman that lost her husband recently told me, "It's like a great, malicious gray wolf leaped and in one bite tore a throbbing chunk of flesh out of my heart. And afterwards, the chards of my whole life lying around my feet, bloody and unrecognizable" (Dunlap, 2008).

Part of the process of healing from grief requires that the person re-author his or her own life story so that it comes out differently and makes sense -- so that there is a new reason to get out of bed in the morning. Identity reconstruction with renewal of ego integrity is a goal in the process; that is, the development of the ability to see oneself and one's new role or mission in life as worthwhile and meaningful. The essential sense making questions that emerge during the crisis of grief are, "What led to this? What action was taken? How does this outcome fit with my philosophical and spiritual understanding of life?" (p. 123). Ego integrity as Erikson conceptualized it, develops when an older adult is able to see his or her life and the choices made as "productive, satisfactory, and valuable" (Whiting & Bradley, 2007, p. 119).

Just as important as sense making is the ability to find something beneficial in the circumstances before and after the loss. Whiting & Bradley (2007) reported Neimeyer's research in 2002. He interviewed "hundreds of bereaved adults who in the 2 years after a significant death found themselves more interpersonally close and connected, deeper in their spiritual belief, healthier in their personal habits and lifestyle, and existentially more aware than at a younger age" (p. 123). Finding benefits such as these can be difficult -- they emerge gradually over a period of time during which the individual is adapting to the loss. Something else that helps healing is to review the relationship with the deceased person and find "positive themes" (p. 123). "Positive reminiscing is one way of benefit finding that reaffirms the worth of the relationship to the individual's life story" (p. 123). The counselor might ask, "How did the relationship [with the deceased] make your life different than it would have been had that person not come into your life? What impact did the person make on your growth and development?"

The goal of narrative reconstruction is to recreate identity after the loss. This means fitting the loss into one's life story so that both the loss and life itself are given "significance and meaning." In the process, one learns to see oneself as strong and resilient, courageous, and empowered. Whether the individual can get up and go on and have a happy life after the loss depends on how the person views self

Is he or she a victim or a survivor? A strong person making spiritual progress or weak and debilitated? Whiting & Bradley (2007) argue that there must be an outcome for every loss. Whether the outcome is "reconciliation" or "vulnerability" or "victimization" depends on successful and positive identity reconstruction.

It used to be believed that the grieving individual had to achieve detachment from the person who had died. This was Freud's theory, that "grieving people need to break free from the deceased, let go of the past and reassert their individualism by charting a new course for life.

A healthy grief experience, according to Freud [was] one in which the deaths of loved ones [did] not leave 'traces of any gross change' in the bereaved" (Bush, 2007, p. 37). It is sad to note that Freud himself was never able to recover from the grief of losing his daughter and later his grandson. His theory of healthy detachment, which failed to help him, has also fallen into disrepute among therapists in recent years.

The focus of counseling now is directed toward "transformation of self as individuals experience continuing bonds, not detachment, with those lost by death" (Whiting & Bradley, 2007, p. 124). Healing power is located in continuing attachment and bonds of love. True, the relationship is changed by separation. "What is mourned when someone dies is both the relationship and the self as reflected in that relationship" (Silverman cited in Whiting & Bradley, 2007, p. 125). During identity reconstruction, a newly adapted relationship forms with the deceased person.

Perhaps the worst and longest-lasting grief is that of parents who have lost a child. Bush (2007) lost his son and describes his reaction to subsequent deaths of children, reported on television. "We think to ourselves, 'Those poor parents have no idea how hellish their lives are probably going to become in the next few years" (p. 36). He researched parental grief because he found that time did not heal him as promised; in fact, he felt worse two years later after the death of his son and states, "I undertook this research mostly as an attempt to figure out if I was losing my mind and if I would ever start feeling better about life" (p. 36). He learned that his responses, some of which were shortness of breath, numbness, emotional anesthesia, incoherent thoughts, expecting to see his child run in at any moment, and seriously "questioning the nature of God" were common for bereaved parents (p. 37). Research also shows that the pain continues much longer for parents (and thus should probably not be considered "complicated grief" or pathological grief).

The need to nurture and reinforce bonds with the deceased child is as real and pressing as it is in spousal bereavement, maybe more so. "For decades, counselors for the bereaved urged them to let go of the dead and get on with their lives, an approach that has been called the 'breaking bonds' method" (Bush, 2008, p. 38). Clinical evidence, Bush points out, shows this to be a misguided approach to healing grief.

The same crisis of meaning that occurs with the loss of a spouse occurs when a child dies. Despair and hopelessness overtakes the parents, intensified by the fact that the future the child represented evaporates, and the child as an extension of the self is lost. Hope seems to die when the child dies. Days and weeks come and go, but nothing really matters. Some parents turn away from God and the church completely and forever. Others turn to God for comfort and their faith is strengthened. Bush (2007) states some grieving parents experience both increased doubts and renewed faith at the same time. He sums up by saying, "The trauma of parental grief is horrific and long-lasting" (p. 39).

It follows (and makes sense) that if we believe in eternal life as promised by God, then the love experienced in a human relationship while the person was with us does not die with the physical body. The departed person still loves the partner or parent who remains behind. To be able to say, "My husband still loves me even though he is not here," affirms the truth that love never dies because "...love is of God; and everyone that loveth is born of God, and knoweth God...for God is love" (I John 5:7,8). (This particular passage in Scripture could also provide comfort to the bereaved Christian whose spouse or child was an unbeliever.) to nurture and sustain an adapted relationship to the deceased person helps to bring healing from grief and mitigates the pain.

Narrative Reconstruction

What is the role of the pastoral counselor as the bereaved person reconstructs the story of his/her life, integrates the loss of a loved one into the story in a meaningful manner, and emerges from the process a stronger person healed of grief?

What Whiting & Bradley (2007) call "a therapeutic alliance" is forged between counselor and bereaved. The counselor's role is to bear witness to the transforming effect of the narrative reconstruction in which the meaning of the person's life changes.

The counselor helps by noticing and acknowledging "nuances of meaning, characters, emotional patterns, consistency; and uncharted courses" (p. 126).

Whiting & Bradley (2007) quote Metzger's statement, "Stories heal us because we become whole through them. As in the word 'remember,' we re-member, re-store, re-claim, re-new" (p. 126). Older adults in particular are often isolated from social contact and lack opportunities to engage in meaningful conversations about their relationship with a loved one who has died; thus, the need for pastoral counseling is heightened.

The counselor is not a diagnostician or an expert, but rather a companion that listens and empathizes, a healing presence to witness "ambiguity, confusion, contradiction, and nuance of the evolving story" (p. 127). Grief is not a sickness. Rather it can be seen as is an opportunity to grow. "The counselor has the privilege to engage in the artful practice of collaborating as a partner in the re-authoring process of a life story" (p. 127). Telling the story allows the teller to sort out the experience of loss and to find the meaning of his or her own life, to reconnect with self, God, and others.

As the grief-stricken tell their stories they become aware that the events in their lives are not random but patterned. Telling the story allows them to externalize their feelings, beliefs, values, and attitudes. The counselor aids mainly by facilitation.

Counselors might open and sustain the conversation with powerful questions that elicit the story and its implied meaning. We suggest the use of open-ended prompts to assist counselors in exploring the narrative with aging adults. The narrative conversation can begin and expand with clients when they are asked, "Tell me more about the impact of this upon your life." Questions such as "What did you learn about yourself and your life?" Or "What do you need for your own healing... what is unfinished?" begin to address the idea of finding benefit and adjusting the narrative toward reconciliation (p. 127-28).

In a companioning relationship, both counselor and bereaved are benefited. Just the act of paying attention to grief and addressing it is beneficial. An article in the Christian Century tells about novelist Mary Gordon. When her father died, her mother sent her to camp. Her aunt was a nurse at the camp and her grandmother was cook. Her aunt taped a picture of Alfred E. Neuman (Mad Magazine's "What, me worry?" kid) to the end of her bed. This was intended to cheer her up as though the advice "Keep smiling" could substitute for confronting and talking about her feelings. The need is not for platitudes but "To acknowledge that the work of mourning is an honorable job, to insist that its wages be paid, that it be given its due" (Gordon cited in "Mourning Vocation," 2007, p. 6). The counselor provides direction in this work and acts as a guide.

If the bereaved person provides a story that is dis-empowering, the counselor's duty is then to provide a different perspective and thus help the person to see the benefits of the situation. Counselors need to listen with an ear for discerning how the story coincides with the client's philosophical and religious assumptions. Patience is called for as the storyteller searches for benefits and struggles to fit the pieces together in a new way that leads to healing.

Much evidence... shows how survivors often become more compassionate and merciful..." (Bush, 2007, p. 37). If there is any benefit to grief, it is that it forces the broken-hearted to relearn the world.

Psychologically, we renew our self-confidence, self-esteem, and self-identity.... Behaviorally, we transform our habits, motivations, dispositions, and ways of doing things.... Socially, we reconfigure our interactions with others.... Intellectually, we question and seek answers and meanings. We change our understandings and interpretations. Spiritually, we seek peace and consolation (Attig, cited in Whiting & Bradley, 2007, p. 128).