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CHAPTER 6
Working With Bereaved Individuals
M any people are afraid to approach newly bereaved individuals, feeling concern that they may say the wrong thing or that they may actually
make the bereaved person feel worse by saying something that is inadvert-
ently insensitive or that provokes pain. In this chapter, we will give you some
practical ideas for how to sensitively approach someone who is bereaved
and to offer the best form of support that might be possible to that person.
We have already mentioned in a previous chapter that most bereaved
individuals do not require professional support or therapy to cope with their
losses and their grief. In this chapter, we are not going to focus so much on
what professionals do or do not do, but upon what might be helpful to a
bereaved person, whether you are a friend, colleague, or a counselor. Some
people seek grief counseling not because their grief is complicated or be-
cause deeper unresolved issues in their lives have been triggered by the loss,
but because they need a safe place to explore their grief in a healthy way with
someone who can offer them unconditional support. In this chapter, we will
fi rst explore some of the common expressions of the grief experience, and
then we will discuss some practical suggestions for how to be most helpful
to a bereaved individual.
WHAT IS NORMAL?
This question is perhaps one of the most common queries we receive from
clients and students alike. As there is so much variation in grief from one
person to another, how would you know what is normal? One of our clients
answered this question very well when she said simply, “Normal is a cycle
on the washing machine. If you want normal right now, go to your laundry
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82 Principles and Practice of Grief Counseling
room and look for it to be written on the dial. That’s where you will find
normal when you are grieving.” We laughed at the time when she said this
statement, but we have shared it with many other clients, who will nod in
agreement. When we encounter a significant loss—the “seismic life event”
that we mentioned earlier, our entire world gets turned upside down. There
is often a sense of being off-balance and unable to be the way we have known
ourselves to be in the past, and sometimes there is an accompanying sense of
paralysis or a dizzying need to remain very busy that is not normally part of
who we are. So, let us start with how grief can be experienced by many indi-
viduals and then take a look at some of the more unique aspects of the griev-
ing process as a way of exploring what “normal” grief may look or feel like.
How Is Grief Experienced?
Although grief is often considered primarily an emotional response, it can
be manifested in many different ways with a great deal of variation between
individuals. It is important to note that bereaved individuals will most likely
experience grief in a way that is congruent with their personality and pre-
vious ways of coping with stressful situations. For example, a person who
is not typically emotionally demonstrative with others will most likely not
all of a sudden become highly emotional or seek out places to share his or
her feelings after experiencing a significant loss. Grief can be manifested in
many ways:
• Emotionally —although we expect to see sadness, that is not always the
primary emotion bereaved individuals may feel. It is very common
to feel angry because of what has happened, to feel robbed of the
presence of someone we loved who is now gone, or to feel like we
have lost a part of ourselves that we valued. Sometimes, the anger is
expressed toward medical care providers, clergy, family members, or
oneself. The anger can also be more covert, being expressed through
sarcastic remarks or cynicism about life and people. Many bereaved
individuals report feeling numb—a sense that they are unable to
access their feelings or that they are flooded—that their feelings are
very intense and overwhelming. Guilt and remorse are commonly
expressed, either for lost opportunities, things said or done that they
now wish they had not or that they will never have the opportunity
to clear up, and these feelings are often expressed as “if onlys.” It is
important to remember that emotions do serve a valuable purpose
when they are present, and the listener’s role is not to talk the
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Working With Bereaved Individuals 83
bereaved person out of these emotions, or to try to make him or her
to feel better, but to listen and support the sharing of these emotions
so that the bereaved individual can benefit from the purpose they are
serving. We will talk more about working with strong emotions in a
later chapter.
• Cognitively —it is common for bereaved individuals to complain
that they just cannot focus well or that their minds seem to wander
a lot. Many people describe difficulties remembering, organizing,
and keeping track of things. Time may seem to warp as well; a day
may seem like forever, or it may seem like a brief period. Days and
nights can get switched around as well. Many of our bereaved clients
describe their minds as “constantly busy,” but not productively so.
One client reported that she accidentally forgot to pick up her 2-year-
old son from the day care. She stated that she had a nagging feeling
that something was amiss, and when she got home, she realized
that she had not picked up her son at the usual time of 4 p.m. (and it
was now almost 6 p.m.)! This aspect of grief may be very hard if you
work, as most people have limited time off work after the death of
a loved one, and when they return to work, concentration and focus
can be very difficult.
• Physically —our bodies often “carry” the weight of our grief through
physical symptoms. Many bereaved individuals will share that they
often have symptoms that mimic those of their loved one before she or
he died. One client shared that she had gone to the emergency room
three times with chest pain and shortness of breath that had never been
present before her husband died suddenly of a heart attack. One very
common description from clients is something that we term “restless
exhaustion,” where bereaved individuals may feel continually busy or
agitated in their minds, but exhausted physically. When they try to lie
down or rest, their minds become even busier; however, when they try
to get something done or try to complete a task, they are overwhelmed
by feelings of exhaustion and lethargy. Headaches, bodily aches and
pains, difficulty sleeping, weight loss and weight gain, digestive
problems, and accidents like falling, tripping, and knocking things
over are commonly described as well (Hensley & Clayton, 2008;
Luekin, 2008; Stroebe, Schut, & Stroebe, 2007). It is interesting to note
that there is research linking certain types of bereavement to lowered
immune function and to higher rates of morbidity and mortality
in survivors (Buckley, McKinley, Tofler, & Bartrop, 2010; Goodkin
et al., 2001; Hall & Irwin, 2001; Jones, Bartrop, Forcier, & Penny, 2010;
Schleifer, Keller, Camerino, Thornton, & Stein, 1983).
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84 Principles and Practice of Grief Counseling
• Spiritually —we have already discussed how a significant loss event
can shake up an individual’s assumptive world and the spiritual
effects of a major loss often leave people questioning their beliefs
about God or wondering if there is indeed any higher order or
purpose in life. Over time, many bereaved individuals will often
say that their loss experience deepened their faith or caused them to
reexamine beliefs that they had taken for granted before. On a more
practical level, clients will often share how their faith communities
are sources of support and also, at times, sources of discomfort
or disappointment. Although there are studies that examine the
effects of spiritual beliefs upon bereavement outcome, most do not
conclusively demonstrate either that religion or systems of faith have
a direct impact upon the course of bereavement (Wortmann & Park,
2008). However, it is often thought that many individuals benefit
from the sense of structure and ritual that a faith tradition may
provide for them after a significant loss, such as the funeral liturgy,
mourning rituals, and a sense of belonging to a community at a time
when they may otherwise be isolated (Park & Halifax, 2011).
Balk (1999) stated that three things must be present for a life crisis to
initiate spiritual change in a person: (1) the situation must create a feeling of
destabilization that resists restabilization readily, (2) there must be time to
refl ect upon what has occurred, and (3) the crisis must be something that will
be indelibly etched into the life story of the person who experiences it. Balk
goes further to state,
Bereavement contains all the necessary ingredients needed to trigger spiritual
change. It is a dangerous opportunity, producing extreme psychological imbal-
ance, and possessing suffi cient intensity and duration to allow for serious refl ec-
tion. Its effects color a person’s life forever. (p. 488)
Fowler (1981) mentioned that the times in our lives when we end up
questioning our beliefs and searching for meaning can produce what he calls
a transformed faith consciousness , which allows for greater meaning and un-
derstanding in our lives. Thus, a signifi cant loss event carries the possibility
of spiritual destabilization and the potential for increased depth and per-
sonal meaning in life.
• Socially —there are many effects that grief has upon how bereaved
individuals interact with others socially. If the bereaved individual
has been a long-term caregiver, there is a good likelihood that the
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Working With Bereaved Individuals 85
social network that was in place before so much time was spent
taking care of a dying loved one is no longer in place. Others’ lives
have continued in a very different way from the life of the person
who became a long-term caregiver and with increasing demands
because of the illness of their loved one, there was likely little time
left to socialize and stay in touch with their usual support network
(Burton et al., 2008). Our bereaved clients often describe feeling
socially isolated and aware that they do not “fit” into any identifiable
social group, often feeling acutely aware that they are different
in the way they react to things and to their needs in their close
relationships than before they were bereaved.
Many bereaved individuals isolate themselves because they
have a great deal of difficulty handling social situations where they
may be triggered into their grief or where the effort to engage in
small talk seems like a great deal of work because their lives have
been filled with such deep grief and profound questioning of life and
themselves. Many of these individuals have a difficult time fitting
neatly in a social context—they may no longer be able to identify
with the role that was associated with the deceased person—for
example, a widow is no longer a wife; a parent to a deceased child
is still a parent, but the child is missing. In addition, many bereaved
individuals sense the discomfort of others around them, as people
struggle finding the “right” words to speak or avoid them to prevent
the discomfort of an awkward social exchange.
• Economically —we often do not ask our clients about this particular
issue in bereavement, but it is an area that can be of immense
concern to bereaved individuals. Two of the younger widows whom
I (D.L.H.) saw in my practice had to declare bankruptcy after their
husbands died because there was not enough life insurance to cover
the debts in their husbands’ businesses, and they could not deal with
bill collectors and harassing phone calls and letters on top of their
paralyzing grief.
If the bereaved individual takes time off work to be the
caregiver to a terminally ill loved one, he or she may not only face
lost income, but his or her jobs may have been given to someone
else in his or her absence. In addition, those individuals who take
a leave from their work after the death of a loved one may do so
out of necessity to take care of the estate issues and to take care of
themselves emotionally and physically, but this time may be unpaid
leave from work, with the result being increased financial strain
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86 Principles and Practice of Grief Counseling
in addition to the grief. If the bereaved individual is the executor
of the deceased person’s estate, there are often time-consuming
responsibilities associated with this role and there may be conflict
with surviving relatives about the distribution of the estate, all of
which will land in the lap of the grief-laden executor. Some clients
have difficulties accepting insurance monies and proceeds from an
estate, citing feelings of guilt that the death of the person they loved
has now somehow benefitted them financially.
• Behaviorally— some of the behaviors in which bereaved individuals
may engage can be quite subtle, but they may be very common.
For instance, many bereaved individuals will describe feeling like
they are searching for their lost loved one in a crowd, or they will
automatically scan situations for familiar things that are associated
with their loved one—a car that is similar to the one that your son
drove before he died, and you realize that you are staring at the
driver, looking for your son in the seat. Or, you find yourself going to
places that your loved one would go, even if it is not a place where
you went together beforehand. Some individuals find engaging in
an activity that their loved one used to enjoy to be comforting—
gardening, playing certain music that their loved one would listen
to, feeding birds, collecting stamps, shopping, watching certain
sports events and teams, eating at certain restaurants or certain types
of food that your loved one enjoyed—all are commonly described
by bereaved individuals, and the common thread is often an
identification with the deceased person and an attempt to reconnect
with that person in these activities. Clayton (1990) described
attempts to cope by the increased use of alcohol, tranquilizers,
hypnotics, and cigarettes often reported in bereaved individuals.
Many bereaved individuals describe a sense of “going through the
motions,” or of being on “autopilot” for a long period after they
experience a significant loss. One client described this experience as
“showing up for work, but leaving my brain at home asleep.”
Extraordinary Experiences
Bereaved individuals commonly describe feeling that their loved one has
connected with them through a sign, a dream, a vision, or a hallucination. We
have had clients give descriptions of radios tuned in to the favorite station of
their loved one without them recalling changing the tuner themselves, a bird
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Working With Bereaved Individuals 87
landing on windowsills that they believe represents a visit from the deceased
person, a “sense” of something brushing against their skin, finding a book
open to a page where there is a message for them, flickering lights, butterflies
appearing from nowhere, or hearing the voice of their loved one speaking to
them either silently or audibly. The “visitation dreams” that clients describe
are often very vivid and totally engaging, often with the deceased person
telling them that they are okay, and sometimes the feeling that there was
physical contact with the deceased in the dream.
Many clients share that they have regular “conversations” with their
deceased loved ones, most commonly described as silent discussions that
occur in their thoughts, but sometimes in audible dialog as well. These con-
versations most often happen at the graveside or in a place that was most
frequented by the deceased person, such as his or her offi ce, a favorite rec-
reation spot, or a special place that they shared together. Most bereaved indi-
viduals describe these experiences as comforting and helpful, which is also
supported by Parker’s (2005) research on the topic. What is important to note
about these experiences is that they are common among bereaved individu-
als and they also tend to have a functional role in the grieving process rather
than a pathological or unhealthy infl uence. These experiences are not breaks
in reality that would occur in someone with a psychotic or delusional dis-
order, as the bereaved are aware that the experience is extraordinary when
it occurs, and their interpretation of the event is often kept very private to
avoid social stigma surrounding the experience or their mental state.
Resurgences
It is now known that grief may never be fully “resolved.” It is more common
(and more accurate) to use words such as “integration,” “accommodation,”
and “adaptation” to loss rather than to refer to “recovery from grief,” “reso-
lution of a loss,” or “acceptance.” In fact, it is now recognized that grief may
never really end. Although the intensity of the grieving experience usually
diminishes over time, grief itself may be present in various ways throughout
a person’s lifetime. For example, a girl whose father dies when she is 8 years
old may experience a resurgence of grief later in her life as she experiences
significant life passages and realizes that her father is not there to partic-
ipate in these times with her. There are times when grief that has abated
in its intensity over time can be reactivated in a very real and intense way.
Most commonly, these resurgences occur at significant times, such as anni-
versary dates, the date the loved one died, or at special family times or rites
of passage, such as graduations, weddings, the birth of a baby, or some time
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88 Principles and Practice of Grief Counseling
or event that carries a reminder of a shared time with the deceased (Sofka,
2004). Some people call these “grief triggers” or “grief surges.” Parkes (1975)
used the term grief “pangs” to describe these resurgences of grief. Rosenblatt
(1996) addressed the issue of the ongoing nature of grief, stating that grief
may never really go away completely, and noting that it is probably unreal-
istic to think that a bereaved individual will just stop grieving at some point.
Rather, he stated that grief resulting from major losses will probably recur
at many points over a person’s lifetime. Grief can essentially “sneak up” on
someone when there is a new pang of grief that surfaces in response to a trig-
gering situation or reminder. Rando (1993) described STUG reactions that are
subsequent temporary upsurges of grief that occur in situations where the re-
alization of the loss and its magnitude are brought into the active awareness
of the bereaved individual, sometimes many years later. It is very important
to recognize that there is no specific timeline for grief to end, and the resur-
gence of grief at various points in time after a significant loss is very common
and normal.
Grieving Styles
Doka and Martin (2010) extrapolated on different patterns of the expression
of grief in their descriptions of adaptive grieving styles. These authors de-
scribed three main grieving styles on a continuum, with intuitive grievers
at one end, instrumental grievers at the other, and a more blended grieving
style between them. Intuitive grievers tend to express feelings and wish to
talk about their experience with others. Instrumental grievers tend to grieve
more cognitively and behaviorally and tend to express their grief in terms
of thoughts, analysis, and actions. Individuals who have a blended griev-
ing style may combine elements of both intuitive and instrumental grieving
styles, but they usually have a predominate tendency toward one of the other
style. This exploration of grief emphasizes that there is no “right” way to
grieve; however, bereaved individuals are often expected to grieve in certain
ways based upon gender socialization, and if they do not express grief in a
way that is expected by others, their experience may be labeled as problem-
atic or even pathological.
There have been times when a client or a family member of a be-
reaved individual will assume that a person has not “grieved well” unless
he or she has expressed emotions about the loss. As we stated earlier, not
all bereaved individuals will grieve through their emotions or will need to
share their feelings and talk about their loss. Expressions of grief typically
are congruent with an individual’s existing personality, temperament, and
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EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 4/30/2021 3:46 PM via POST
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AN: 442884 ; Howard R. Winokuer, PhD, Darcy L. Harris, PhD, FT.; Principles and Practice of Grief
Counseling
Account: ns017336
Working With Bereaved Individuals 89
preferences. For example, one of our colleagues recently lost his wife. They
were extremely close, and her illness and subsequent death occurred over
a few short months. He was back to work within a few weeks after the fu-
neral. Many individuals in our work place assumed that he was avoiding
his grief and attempting to bury himself in his work, and they expressed
concern that he was “hiding” from his grief. However, when in speaking
briefl y with him, it was very apparent that he needed the structure of work
to help him through his daily life, and he is by nature a more cognitively ori-
ented individual who tends to process his experiences through his intellect
and analytical thinking. His grief was very real to him, as is his profound
loss, and his choice in returning back to work and focusing on everyday
tasks was very congruent with his personality and previous ways of coping
during times of stress.
For a long time, the goal of grief counseling seemed to be to get the cli-
ent to emote and to “clear” the grief by having emotional catharsis. However,
it seems much more appropriate (and humane) to think of grief counseling
not with this type of goal in mind, but to support the bereaved individual in
working out the process of grief in ways that are aligned with that person’s
values, view of himself or herself, personality, and temperament.
Although emotional expression is now not seen as an imperative in
the way it once was, social support to bereaved individuals can be very
important in assisting the bereaved individual. What is very important
to remember about social support is that individuals will vary widely in
what is seen as supportive and what is not. For instance, if we go back to
the example of my widowed colleague, I doubt he would fi nd it helpful if
one of us showed up to his offi ce, sat down, and asked him to talk about
his feelings. Support to him has come in the form of snippets, which al-
low him to know that his colleagues are thinking of him and care about
him, but not placing an expectation upon him to talk about his feelings
at length. He also seems to greatly appreciate the ability to talk about his
teenage children as they cope with the loss of their mother, and he has of-
ten requested information about specifi c aspects of teen grief and the loss
of a parent.
Mediators of Mourning
The most important aspect of grief counseling is …
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