Grief Work

There are many misconceptions about grief, one of the most prevalent is the idea that grief is strictly passive. Grief comes upon us and overwhelms us when we experience loss, its outside of our control. There is truth to this, but there is more to it. Grief is also active, it is work that we can and must take into our own hands as we process through the pain of loss.

Dr. William Worden introduced the concept of “grief work” in his book Grief Counseling and Therapy originally published in the 80’s. His model looks at grief work not as emotions or stages to be experienced but rather, as tasks to be worked through. These tasks are:

  1. To accept the reality of the loss
  2. To experience the pain of grief
  3. To adjust to an environment in which the deceased is missing
  4. To withdraw emotional energy and reinvest it in another relationship

Dr. Christina Hibbert, psychologist and grief specialist provides some helpful insights on these four tasks of working through grief.

1) Accept the reality of the loss

Accepting the reality of the loss can come instantaneously for some, but for most, will take time. Telling one’s “story” in a safe environment—letting oneself think, talk about, and process what has happened—can help. Sometimes we have to repeat it over and over to ourselves: “They’re really gone”. But it’s letting ourselves feel the emotions of grief that really solidifies our acceptance of what we have lost.

2) Experience the pain of grief

This is the task people seem to have the hardest time with, and the one most are referring to when they ask me, “How do I grieve?” Many of us fear that if we start feeling the intense mix of emotions inside, we may never get back out of them. Yet, this task is at the core of completing all the others. Letting oneself feel pain is not easy and yet, allowing emotions to arise, to express themselves in healthy ways, is at the core of mourning. As I said before, through is the only way out, “…grief requires us to turn inward, to go deep into the wilderness of our soul…. There is usually no quick way out.”

To encourage this turning inward, and facilitate feeling the emotions of grief, I have created a model I call TEARS. This model shows us how to let ourselves experience grief through 5 different options, each of which is equally helpful in our healing.

 TEARS

  • Talking:  While it is natural to want to isolate oneself during the intense pain of loss, most will find healing in talking or even just being with family, friends or other support people, sharing the burden of grief and knowing they are not alone.
  • Exercise:  Physical activity can be a powerful aid in the release of the difficult emotions that accompany loss. Adults and children will find that exercise “allows for a reduction of aggressive feelings, a release of tension and anxiety and a relief of depression” related to grief.
  • Artistic expression: For many of us, grief is best expressed creatively—through art, music, dance, and so forth. Tapping our creative outlets allows us to process the emotions of grief in a subconscious way that can be powerful and deep. Creativity is particularly valuable for children who are grieving. Encouraging children to express feelings through drawing pictures, creating a collage of photos and written memories, or other creative activities can be a powerful tool for healing.
  • Recording emotions & experiences:  Creative expression and/or recording one’s emotions & experiences through writing or journaling can help release emotions and free the body and soul of them. When we write the things we have seen, heard and feel, we are better able to gain insight and understanding, for it allows us to capture and revisit our experiences, ensuring we do not miss the important lessons being taught.
  • Sobbing: The bible tell us, “Be afflicted and mourn and weep”. There is healing power in allowing our tears to flow for the loss in our lives.  As Washington Irving once said, “There is sacredness in tears. They are not the mark of weakness—but of power. They speak more eloquently than ten thousand tongues. They are messengers of over-whelming grief, of deep contrition, and of unspeakable love.”

3) Adjust to the environment in which the deceased is missing

Using the TEARS method to experience our emotions is key in helping us adjust to the environment in which the deceased is missing. Adjustment takes time and comes as we continually work through the grief emotions that arise. Eventually, we find that we can talk about the deceased and fondly remember them as we engage in new life routines and experiences. Adjusting involves allowing ourselves to adjust, learning to let go, and being willing to move on when we feel ready.

4) Withdraw emotional energy and reinvest it in another relationship

Eventually, we will feel ready to reinvest in other relationships. This doesn’t mean we are “replacing” our loved one; rather, it might mean becoming closer to our living family members, bonding in new ways with old friends or making new friends, or creating new intimate relationships that help us feel healthy and healed. We begin to see that life continues after loss, and hopefully we choose to invest in our new life and relationships even while we carry those we have lost in our hearts.

Types of Grief

Reaction to loss is complex and diverse. Professionals in the field of counseling have identified some helpful categories for grief trends that have been commonly observed. These are helpful when thinking about the various ways loss is handled in our lives. The following summaries are borrowed from the website What’s Your Grief.

Anticipatory Grief

As its name suggests, ‘Anticipatory Grief’ is the reaction to a death you were able to anticipate such as when an individual dies from a long term illness. As soon as you accept and understand someone you love is going to die, you begin grieving.

Complicated Grief

Refers to grief reactions and feelings of loss that are debilitating, long lasting, and/or impair your ability to engage in daily activities. Other types of grief such as ‘Chronic Grief’, ‘Delayed Grief’, and ‘Distorted Grief’ all fall under the blanket of ‘Complicated Grief’.

Chronic Grief

Strong grief reactions that do not subside and last over a long period of time. Continually experiencing extreme distress over the loss with no progress towards feeling better or improving functioning.

Delayed Grief

When grief symptoms and reactions aren’t experienced until long after a persons death or a much later time than is typical. The griever, who consciously or subconsciously avoids the reality and pain of the loss, suppresses these reactions.

Distorted Grief

Extreme, intense, or atypical reactions to a loss – odd changes in behavior and self-destructive actions. Anger and hostility towards oneself or others are common.

Cumulative Grief

When one experiences a second loss while still grieving a first loss.  This is also referred to as “bereavement overload” or “grief overload”.

Prolonged Grief 

(Similar to ‘Chronic Grief’) Grief reactions that are prolonged and intense. The griever is incapacitated by grief and daily function is impaired on a long-term basis. The griever spends much time contemplating the death, longing for reunion, and is unable to adjust to life without the individual.

Exaggerated Grief

An overwhelming intensification of normal grief reactions that may worsen over time. Characterized by extreme and excessive grief reactions possibly to include nightmares, self-destructive behaviors, drug abuse, thoughts of suicide, abnormal fears, and the development or emergence of psychiatric disorders.

Secondary Loss

When a loss impacts many areas of one’s life, creating multiple losses stemming from the “primary loss”.  Though it is easy to think our grief is solely the grief of losing the person who died, our grief is also the pain of the other losses caused as a result of this death.

Masked Grief

Grief reactions that impair normal functioning however the individual is unable to recognize these symptoms and behaviors are related to the loss. Symptoms are often masked as either physical symptoms or other maladaptive behaviors.

Disenfranchised Grief

One’s grief is ‘disenfranchised’ when their culture, society, or support group, make them feel their loss and/or grief is invalidated and insignificant. This can occur when the death is stigmatized (suicide, overdose, HIV/AIDS, drunk driving), the relationship is seen as insignificant (ex-spouse, co-worker, miscarriage, pet), the relationship is stigmatized by society (same-sex partner, gang member, partner from an extramarital affair), the loss is not a death (Dementia, Traumatic Brain Injury, Mental Illness, Substance Abuse).

Traumatic Grief 

Normal grief responses experienced in combination with traumatic distress suffered as a result of a loved one dying in a way perceived to be frightening, horrifying, unexpected, violent and/or traumatic. Distress is extreme enough to impair daily functioning.

Collective Grief

Grief felt by a collective group such as a community, society, village, or nation as a result of an event such as a war, natural disaster, terrorist attack, death of a public figure, or any other event leading to mass casualties or national tragedy.

Ambiguous Loss

Losses that lack clarity and can lead to different views of who or what has been lost. Individuals and those around them may question whether a loss has occurred or if this is a loss that should validate deep emotional responses (such as with disenfranchised deaths).

Inhibited Grief 

Occurs when an individual shows no outward signs of grief for an extended period of time. The individual inhibits their grief, eventually leading to physical manifestations and somatic complaints.

Abbreviated Grief 

A short-lived grief response. The grieving process often seems shorter because the role of the deceased is immediately filled by someone/something else*, because there was little attachment to the deceased, and/or the individual is able to accept and integrate the loss quickly due to ‘Anticipatory Grief’.

Absent Grief

This is when the bereaved shows absolutely no signs of grief and acts as though nothing has happened. Characterized by complete shock or denial, especially in the face of a sudden loss. This becomes concerning when it goes on for an extended period of time. This does not account for differences in how we grieve and it’s important to note that just because you can’t tell someone is grieving doesn’t mean they aren’t.

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Broadening our View of Grief

Grief is tethered to loss, making it inevitable in this life. One definition of grief captures this: “Grief is the normal and natural emotional reaction to loss or change of any kind. Of itself, grief is neither a pathological condition nor a personality disorder.” Grief is normal and natural in this world because loss and change are normal.

Loss and change are broad categories—pushing us away from a narrow understanding of grief. Working within these categories would require us to develop a broad spectrum of change/loss events that may be catalysts for grief.

The Grief Recovery Institute has identified more than forty potential grief events—each of which include some dimension of loss and change. Here is the list they provide.

  • Death of a spouse
  • Divorce
  • Marital separation
  • Imprisonment
  • Death of a close family member
  • Personal injury or illness
  • Marriage
  • Dismissal from work
  • Marital reconciliation
  • Retirement
  • Change in health of family member
  • Pregnancy
  • Sexual difficulties
  • Gain a new family member
  • Business readjustment
  • Change in financial state
  • Death of a close friend
  • Change to different line of work
  • Change in frequency of arguments
  • Major mortgage
  • Foreclosure of mortgage or loan
  • Change in responsibilities at work
  • Child leaving home
  • Trouble with in-laws
  • Outstanding personal achievement
  • Spouse starts or stops work
  • Begin or end school
  • Change in living conditions
  • Revision of personal habits
  • Trouble with boss
  • Change in working hours or conditions
  • Change in residence
  • Change in schools
  • Change in recreation
  • Change in church activities
  • Change in social activities
  • Minor mortgage or loan
  • Change in sleeping habits
  • Change in number of family reunions
  • Change in eating habits
  • Vacation
  • Christmas
  • Minor violation of law
  • Loss of Trust, Loss of Approval, Loss of Safety and Loss of Control of my body

Some of these grief events are counterintuitive. We don’t normally identify exciting new life change with the potential for grief. However, most change includes loss of some kind—there is always a transitioning from something to something. Being aware that grief may be one aspect of change equips us to better face transitions