Understanding Grief
This blog follows the launch of a new online course on ‘Understanding Grief and Cognitive Behaviour Therapy: Guide to Grief Focussed CBT. I enjoyed researching and writing it and the first participant, a GP, has just enrolled. The blog includes information from my book ‘The Flourishing Woman.’
About grief:
As we move through life, we experience various losses and grief, and these may feel very distressing.
- Loss involves separation from something that has meaning to us and to which we feel connected. This may be associated with death of a loved one or pet, or other losses such as a job or relationship.
- Grief is the response to loss, and affects many aspects of us (physical, psychological, social, spiritual).
We may experience grief in a number of ways, via feelings, physical sensations, thoughts and behaviours. Feelings occur in no particular order, and you may feel like you are on a rollercoaster. The emotions may include shock, sadness, anger, guilt, anxiety, loneliness or helplessness. Physical reactions include tiredness, breathing difficulties or muscle weakness. Behaviours can include crying or restlessness, and we may withdraw from others, or have problems sleeping or eating. A whole range of thoughts can occur, from catastrophic thinking to more hopeful thoughts.
Processing loss and grief takes time, sometimes a very long time. This may be because we have a strong attachment to the lost person. Some experts talk about there being ‘tasks’ or work in grieving, including accepting the reality of the loss, working through the pain of grief, adjusting to an environment without the lost person or item (such as a house) and rebuilding your own life and identity. Loss and grief may also challenge our beliefs about the world and we need to process these too.
In the past we talked about ‘closure’ or ‘moving on’, but we now know that it is vital to create continuing bonds or connections with the person or item that has been lost. To do this we focus on the meaning of the connection. For example, if we lose a parent, we might continue to contemplate what they would say or do in a particular situation to help guide us (Howell, 2016). An extension of this idea is reconstructing meaning. An example might be doing something to honour the person, such as a memorial or raising funds for a cause.
Strategies for dealing with grief:
It is important to pause a while to work through the emotions. During this process it is vital that we maintain self-care, including such as eating regularly and keeping to routines as much as possible. Avoiding alcohol or other substances is advised.
Grounding exercises may assist when feeling disoriented and doing simple things that are normally enjoyed, such as taking a walk in nature, listening to a podcast or looking at a magazine. Reflecting on and using our strengths and resources to manage the loss and grief can assist. We may want to connect with others or have quiet times.
The concept of ‘grief time’ can be helpful, particularly once the acute grief has settled a little. This means allowing some grieving time each day, such as half an hour or an hour, to focus on the grief and have a cry, look at photos, or write in the journal. Outside this time it is okay to have less focus on the grief.
It can also help to create a folder or box about the loss and grief, with mementos and pictures that can be looked at whenever we choose to. Considering how to manage celebrations or anniversaries is important, and choosing the best way to manage them. Whether wanting to be alone or with others, it is important to be kind to ourselves, choosing what we want to do and reducing expectations on ourselves at those times.
Author and clinical psychologist Julie Smith refers to the ‘pillars of strength’ that we need to work on to stabilize and rebuild our lives as we grieve. These are based on the work of the work of grief psychotherapist Julia Samuel who speaks about the importance of:
- The relationship with the person who has died or finding new ways to feel close to the loved one, such as visiting the grave.
- Our relationship with self or self-awareness, using our coping skills and gaining support.
- Expressing grief.
- Time, and at the start taking it one hour or one day at a time.
- Mind and body self-care.
- Listening to our own needs and possibly setting limits or boundaries inrelation to work or with others.
- Structure or routine.
- Focusing on our feelings and internal world (Smith, 2022).
We all grieve in different ways, so drop any comparisons with others, and remember, there is no timeline for grief. If loss and grief is very distressing or the emotions are not easing over time, seeing a therapist may be helpful. Sometimes grief can be complicated because it remains intense over time, especially when the loss involves uncertainty or trauma. Occasionally depression can result or there may be issues related to the trauma. In these instances, seeing a doctor and a therapist is vital. They will listen and provide empathy, support and information.
Therapists use various grief counselling approaches. Grief is challenging because many losses are beyond our control, and because attachments are lost. There may be related losses, such as loss of financial security or a shared future. A therapist can
guide us through these issues and also monitor how we are progressing, including checking for any risk of self-harm (as we are more vulnerable when grieving).
A therapist will also encourage reconnection with other people and ways to rebuild our identity. One particular tool from narrative therapy is particularly helpful in maintaining connection with a lost loved one. It encourages you to say ‘hello again’ to the person we are grieving, and means that we can have an ongoing connection with them while still learning to live a life without them being physically present.
To do this, we ask ourselves questions such as these:
- ‘If you were seeing yourself through [deceased’s name] eyes now, what would you be noticing about yourself that you could appreciate?
- What difference would it make to how you feel if you were appreciating this in yourself right now?
- What would (they) have said or done in certain situations?’
Hopefully these ideas have been helpful. You can read more in the books listed below, or you may be interested in the new online course!
Take care.
References:
- Lerner, D. (2022). ‘Attachment grief living with the loss of a child,’ Psychotherapy Networker, 46(4), pp. 25-29.
- Howell, C. (2016). Listening, learning, caring & counselling, Exisle Publishing, Wollombi, pp. 190-191.
- Howell, C. (2023). The Flourishing Woman. A guide to mental health and wellbeing. Exisle Publishing, New Zealand, pp. 162-168.
- Smith, J. (2022). Why has nobody told me this before?, Penguin Random House, London, p. 146.
