Grief Counseling: Stages, Therapy, and Measurement Tools

Introduction to Grief and Grief Counseling

Experiencing loss can have a long-term effect on a person, especially when that loss is deeply personal, such as the loss of a loved one. Grief counseling exists to ease a person through the grief process, which is never the same for anyone. According to Jane V. Bissler, the stages of grief have been "borrowed" from the five stages of dying, yet these are not the same at all, and treating them as equivalent is incorrect. Whereas with dying a person goes through denial, anger, compromise, depression, and acceptance, the stages of grief are not fixed in number, nor do they follow a specific order; they depend on the nature of the loss. For example, some people go through anger, others through depression, and some go through both. Thus, the grief process cannot be generalized.

Grief counseling is a form of therapy focused on helping an individual grieve and address personal loss in a healthy manner. This type of counseling is offered by psychologists, counselors, social workers, and even clergy members or support groups, whether led by a professional or by a community leader. The tasks of grief counseling are to help an individual express emotional loss, accept the loss, adjust to life after loss, and cope with all the accompanying changes.

This therapy also helps with feelings such as sadness, anxiety, anger, loneliness, guilt, relief, isolation, confusion, and numbness—all of which can be experienced after a loss. Behavioral changes such as disorganization, fatigue, inability to concentrate, sleeplessness, changes in appetite, vivid dreams, and daydreaming are also common among the bereaved. Such overwhelming emotional and behavioral changes require guidance, and it is therefore recommended that those affected consider grief counseling.

Grief counseling is a very useful therapeutic tool. It not only helps the individual work through the many feelings associated with the loss of a loved one, but also provides a means for the individual to understand the normal grieving process and to recognize that many of their experiences are, in fact, common. The counseling process varies for everyone. Some individuals express deep physical and psychological pain and need help returning to daily routine, while others experience primarily numbness.

If an individual feels overwhelmed by the loss, it is the psychologist's duty to find specific coping mechanisms to help that person resume normal daily life. If sleep is disrupted, for example, a counselor may involve the individual's physician in the session to assist with improving sleep. As with any counseling, outcomes may be successful or unsuccessful. Those who experience success can return to a normal life, while others continue to experience prolonged grief.

There are many support groups available for those who are grieving. For example, the website GriefNet.org is an internet community of persons dealing with grief, death, and major loss. This community has over 50 email support groups and aims to provide grief support to both children and adults. The website is overseen by a clinical psychologist and traumatologist based in Michigan and operates as a non-profit organization.

Support Resources and Community Networks

Another website aimed at helping people cope with grief is The Compassionate Friends (compassionatefriends.org), which focuses on grief support after the death of a child. The organization's motto is to transform the "pain of grief into the elixir of hope." The website and its 625 chapters across 50 states exist to help those going through the grieving process after the loss of a child by providing friendship and understanding.

The Compassionate Friends also features a letter to the Newly Bereaved on its front page. Even before starting formal therapy, a visitor can read this letter and feel a sense of understanding—and perhaps not feel so alone. The letter acknowledges potential feelings that a parent, grandparent, or sibling might have, such as that "meaning has been drained" from life, that leading a normal life feels impossible, and that things may never feel better again. The website offers compassionate reassurance, noting that all its members have experienced the powerful emotions that come with losing a child. A list of thoughts a parent might be having includes:

"Thoughts of suicide briefly enter your mind. You tell yourself you want to die — and yet you want to live to take care of your family and honor your child's memory,"

and

"You yearn to have five minutes, an hour, a day back with your child so you can tell your child of your love or thoughts left unsaid."

Loss of a Child: Case Study and Family Impact

This section of the letter is important because it helps the bereaved feel understood and part of a community that can support their recovery and help them move forward with life.

As the quotations above illustrate, the loss of a child can be especially traumatic for those close to the child. The case described below also deals with this type of loss, but from the perspective of an elementary school educator. The case involves a principal in Georgia who was mentoring Jodi Clark, an assistant principal, so that Clark might become a new principal. Clark, who had ten years of classroom experience, had just experienced the death of one of her students and was deeply affected by the event, even though the victim was not her biological child.

The principal, Witt, states that she was initially unprepared to console Clark on this matter because she had no formal training, but that she nevertheless spent time allowing Clark to cry over the loss of the child. She came to realize that by crying and talking together, both women took time to grieve and process "the shock of having an event like this occur." The two women then turned their focus to the community and what it could do to help ease the pain of the child's father—a faculty member who had lost his only child. They also wanted to help the students, the other teachers, and the parents grieve. To that end, they decided to call each family personally and inform them of what had happened, so that each family might help console the father in their own way.

The death of a child—whether it affects parents, a school, or an entire community—is devastating. Equally saddening, though different in character, is the death of a parent. For a child, the loss of a parent can be a traumatic event that shapes his or her life for years to come.

Loss of a Parent: The Family Bereavement Program

The Journal of Consulting and Clinical Psychology includes a study on the long-term effects of the Family Bereavement Program (FBP) for parentally bereaved children and adolescents. This randomized trial analyzed the program's effects on grief experienced by children and adolescents over a six-year period. The trial selected 244 participants between the ages of 8 and 16, drawn from 156 families that had experienced the death of a parent. The sample consisted of 53% boys and 47% girls, with 67% non-Hispanic White participants and 33% from ethnic minority backgrounds.

The families were randomly assigned to one of two conditions: FBP (N=135) or a literature control condition (N=109). Two grief measures were utilized: the Texas Revised Inventory of Grief (TRIG) and the Intrusive Grief Thoughts Scale (IGTS). The TRIG uses a 21-item scale to measure the extent of unresolved or pathological grief. It relates to two points in time—past and present—and is comprised of two subscales. The first, an 8-item subscale, measures "feelings and actions at the time of death," and the second, a 13-item subscale, measures present feelings such as "continual emotional distress, lack of acceptance, rumination, and painful memories." The IGTS is a 9-point scale designed to measure grief in a similar manner.

These two measures were administered to participants at four time points over six years, at three distinct junctures: pretest, posttest, and 11-month and 6-year follow-ups. The results showed the following:

"Compared with the control group, the FBP group showed a greater reduction in their level of problematic grief (IGTS) at posttest and 6-year follow-up and in the percentage at clinical levels of problematic grief at the posttest. The FBP also reduced scores on a dimension of the IGTS, Social Detachment/Insecurity, at 6-year follow-up for three subgroups: those who experienced lower levels of grief at program entry, older youths, and boys. Conclusion: These are the first findings from a randomized trial with long-term follow-up of the effects of a program to reduce problematic levels of grief of parentally bereaved youths."

This study is important because it helps draw conclusions about what kinds of treatment are suitable—though grief therapy will always vary from individual to individual.

Conclusion

This paper has discussed a range of topics: a summary of what grief counseling is, social and community resources available to the bereaved, clinical research on bereavement in children and adolescents, the role of family intervention, faith-based approaches, and a systematic review of clinical instruments used to measure complicated grief. One can only hope that the advancements in this field—especially those that have been proven useful and valuable—will continue to improve, for grief is a serious issue and the therapy associated with it is invaluable.