Approaching Grief Work
What is grief?
Grief is an emotional, neurological and physiological response to loss
Most commonly we think about grief as a response to death, however other losses can also trigger grief such as divorce, relocation, loss of home, the loss of physical or cognitive ability, and the loss of freedom & rights.
Presentations of Grief
All grief is unique, and no grief presentation is identical to another. A number of factors can influence how grief shows up for someone, including (but not limited to):
- The kind of grief being experienced
- The attachment quality to any lost person/ people / relationship
- The bereaved’s trauma template
- Cultural or religious beliefs
- Access to resources
The “Stages” of Grief
Dr. Elisabeth Kübler-Ross is known for identifying 5 main stages of grief: Denial, anger, depression, bargaining and acceptance. Her model is helpful for understanding the various emotional experiences layered inside of a grief response, but it is often misapplied as a linear process, progressing towards acceptance. The 5 stages she identified were not meant to map out a guideline for healing, rather to communicate naturally occurring (sometimes co-occurring) emotional processes involved in grieving.
“There are really only two stages of grief: who you were before and who you are after” – Ted Rynearson, MD
I think that we gravitate to the idea of healing grief as a linear process in order to provide ourselves with some hope that we will eventually recover. Grief is all-consuming, disorienting and completely life altering. We want a rubric or roadmap to try and make sense of the gut-wrenching transformation we are undergoing and to confirm there will be an end to the process.
With grief there’s no end, there’s just new.
Sometimes grief subsides. Sometimes it lingers. It usually shape-shifts along the way, and we shift forms with it. The work is not about getting to the end of the process, it’s about supporting ourselves within it.
When grief is prolonged
Prolonged grief disorder (PGD) is included as a diagnosis in the latest revision of the Diagnostic and Statistical Manual of Mental Disorders. A few criteria distinguish it from “typical” grief, one being that “the duration and severity of the bereavement reaction clearly exceed expected social, cultural, or religious norms for the individual’s culture and context” – DSM-V TR
Cultural expectations and practices around grief and specifically bereavement differ vastly. In the United States, our expectations revolve heavily around our work culture. It is customary for US employers to offer 1-5 days paid leave for grief/ bereavement after the loss of a direct family member, but this is solely up to the employer’s discretion. No federal law in the US mandates paid time off for grief.
What are we then left to conclude when our grief process isn’t “wrapped up” by the time we are expected to get back to work? That our grief experience is wrong, belaboured or disordered.
It’s OKAY if your grief experience isn’t succinct, and doesn’t line up with the business calendar. It’s also okay to get support, at any point in the process. The goal doesn’t have to be to “get over it” or “get through it”… it can simply be to connect and resource yourself as you continue to grieve.
The quote continues: “The only cure for grief is to grieve” – Earl Grollman, author & bereavement counselor
The mental health industry doesn’t have room to honor natural, spiritual experiences without the stigmatization of a disorder. Take a moment to consider how ridiculous it is that we classify our emotional responses to the ultimate existential crisis as a mental health diagnosis.
Of course, the medical model that we use serves to provide some people with access to care. In doing so, however, it pathologizes appropriate experiences and promotes the idea that there’s some version of wellness we need to strive for, glorifying those that present without visible symptoms.
In case you needed to hear it, it is natural to grieve. There is no timeline or linear path through grief, but there are ways to work with it, honor it and grow within it.
Grief Therapy
There are a variety of therapeutic approaches to coping with and healing through grief. Some grief-focused modalities are structured and short-term in length, others are ongoing such as process and support groups. Most people would benefit from some form of therapeutic support along the way, but the ideal format and approach will differ from person to person.
There’s no straightforward map as to when to enter therapy or which modality to try, but consider the idea that time may be needed to feel and survive the initial impact before cognitive unpacking can happen. In the beginning, grief work must be aimed at stabilizing. Grief specialist Ted Rynearson, MD suggests that in the first six months following a loss the therapeutic task ought to be providing basic support, rather than engaging in processing or integration. Later on, a different level of processing can begin.
Some specific grief therapy modalities to check out include:
- The Grief Recovery Method
- Complicated Grief Therapy (CGT)
- Restorative Retelling
- Cognitive Behavioral Therapy (CBT)
- Acceptance and Commitment Therapy (ACT)
- Critical Incident Stress Management (CISM)
- Eye-Movement Desensitization and Reprocessing (EMDR)
Co-occurring experiences/ diagnoses need to be a consideration when establishing a care plan. Grief can exacerbate pre-existing conditions, so therapeutic interventions need to account for that. Depression, PTSD, OCD and other disorders can flare up in response to grief, and should be addressed concurrently.
#grief #bereavement #griefwork
