OVERCOMING GRIEF AND BEREAVEMENT
CONTENTS:
Grief is due to some significant loss (e.g. the death of a loved one, divorce, moving home, child abuse, losing a body part to surgery, or retirement). It is not an illness but a normal reaction to the pain of loss.
You need to know that the reaction of grief shows the loss to be significant and can symbolize the depth of your relationship to the deceased.
Your grief is unique and it can be helpful to write out your own story:
Consider who died and how they died; whether the loss was expected or sudden; how the loss affects you. Note who can be relied on for support as you grieve and the way you and your loved one would want your life to progress now.
It is likely that you will want to talk about your loss but may not have anyone ready to listen to you - a support group can be invaluable as you work through your grief. Grieving can give you time to adjust to life without your loved one; you may never ‘get over’ your loss but you can learn to continue a meaningful life.
You need to work through your grief and come out the other end better prepared for any future loss. It is unrealistic to think you can overcome your grief in a few weeks or months; two to three years of mourning before returning to normal life is not abnormal.
In the early days of your loss you will feel physical reactions (e.g. numbness, headaches, nausea) and emotional reactions (e.g. shock, anguish, anger). How long you grieve is different for everyone and even three years of grief is not unusual; eventually your pain will ease.
When you learn of the loss of a loved one your ‘fight, flight, freeze or faint’ response of the body to perceived threat is activated and subsequently adrenaline is released to help the body deal with the danger. Other chemicals may be released which numb the pain and you can feel worse at about six weeks when these chemicals are returning to normal levels. At this point family and friends are likely to become less available as they expect you to have come to terms with your loss. As a result you may feel isolated and notice the absence of your loved one even more.
Upon suffering a loss you can feel out of control - consider how you can regain some control over your life. In the first few months after a loss you may have disturbed sleep and not take adequate care of yourself.
See Program 1: Coping Strategies Counselling Advice – Nutrition, Exercise, Managing Your Time and Sleep Management.
You may feel depressed, anxious, angry or other troublesome emotions. Contact your doctor and let them know you are grieving – your GP may prescribe some sleeping medication for the short-term. If you are grieving it is likely you need to forgive someone. Think of someone you have felt distanced from since your loss.
See Program 1: Coping Strategies Counselling Advice –Troublesome Emotions, Forgiveness, Program 6: Overcoming Anger, Program 8: Overcoming Anxiety and Program 12: Overcoming Depression.
To heal the wound caused by loss of innocence or loss of body parts (e.g. removal of a breast due to cancer) you need to talk about it with others.
See Program 10: Overcoming Childhood Abuse.
Parents do not expect to outlive their children and we all hope to die peacefully in our sleep; so sudden infant death, suicide, homicide, accidents, undiagnosed or terminal illness such as cancer can be a shock and impact on our views about life and death.
Your grief can be described as having a wave-like pattern representing the ups and downs of grief. Usually the waves can be triggered by (e.g. a favourite song, a significant date or changes in the season). By identifying these triggers you can be better prepared next time.
In a journal draw your wave-like pattern of grief noting the triggers for the ups and downs you have encountered so far since your loss. Are there any triggers that set off an increase in the intensity/frequency of your grief? How could you prepare yourself for the next such trigger? Can you identify times when you found it easier to cope?
Healing occurs from what you do in the passage of time. You cannot rush grief and need to be patient with yourself; to properly grieve it is necessary to allow yourself to feel the pain. Yearning for a loved one can be extremely painful initially but gradually you will get used to your loss.
Write in your journal any unhelpful beliefs about bereavement expressed by others or which you hold and reflect on them, for example: ‘You’ve got to be strong for the children’ and ‘I’ve got to move on’.
See Program 1: Coping Strategies Counselling Advice – Modifying Maladaptive Thinking.
It is normal to feel sad and cry for your loss; crying can de-tox your body and leave you feeling better.
List in your journal any helpful beliefs about grief you can think of, for example: ‘It is normal to feel sad for a loss’ - and compare to your list of unhelpful beliefs.
Allow yourself to grieve and realize that this does not mean you are forgetting your loved one.
It is necessary you accept the finality of your loss (e.g. ----- is DEAD).
Explore the things you have lost along with your loved one (e.g. partner, friend, financial security, independence, caring role, future dreams).
It is healthy to express your grief rather than let it build up and compromise your well-being; keeping a diary, crying, talking to someone or a support group can release your grief. If your grief is overwhelming you can gain control by scheduling uninterrupted ‘grief time’ each day to allow yourself to think about your loss. This will allow you to express and come to terms with your grief. You could write to your loved one; listen to music that reminds you of them; look at photographs of your time together etc.
If you are grieving as a couple (e.g. the loss of your child), you need to share your thoughts and feelings; give each other space as necessary; do not compare how you are grieving and bear in mind that people express their emotions differently depending on their personality type. It can be helpful to keep a dated diary in which you write to your loved one. In this way you can make sense of what is troubling you and keep track of your progress.
Keep a list of emergency numbers close at hand - your doctor; nearest hospital; the most understanding person you know.
Write positive coping statements on a flashcard (e.g. ‘I am coping with my grief’ and ‘I will recover from my grief in time’) - keep copies on you and in places where you can see them.
3. Improve Your Sense of Control
To deal with worry, list your worries then put them into groups (e.g. financial, home, work, children). Mark each group in order of priority starting with the issues you want to address first. When you think of other issues, add them to these groups.
To deal with sympathy cards, decide whether you want to send a thank you card, a personal note of thanks, ask a relative to respond on your behalf or thank them in person by phone.
Try making a daily ‘To do’ list – do not list too many tasks and break large tasks into small manageable steps; this will improve your sense of control.
Initially, it is better not to think too far ahead – focus on today and put aside thoughts of next year or after.
You may think that ‘life should be fair’ and that it is ‘unfair’ your loved one died unexpectedly. It is necessary that you accept yourself and others as fallible human beings and that while you would prefer life to be good to you it can be a mixture of good, bad and neutral.
Guilt and anger are barriers you need to overcome – identify your barriers by writing down if and how you relate these troublesome emotions to the death of your loved one.
Learn to deal effectively with relationship problems.
See Program 1: Coping Strategies Counselling Advice – Troublesome Emotions, Making Your Love Last and Program 13: Overcoming Destructive Relationships.
4. Dealing with Unhelpful Thoughts
The way we think affects the way we feel and behave – grief may distort your thinking more than usual. You must be motivated to identify and challenge unhelpful thoughts; then strengthen conviction in helpful alternative beliefs.
See Program 1: Coping Strategies Counselling Advice – Modifying Maladaptive Thinking.
Use a thought diary for problem situations causing strong distress – list:
Situation/trigger.
Dysfunctionsl thoughts.
Dysfunctional feelings, physiology and behaviour.
New functional alternative thoughts.
New functional feelings, physiology and behaviour.
Note (before and after challenging your unhelpful thoughts): the intensity of dysfunctional and functional, feelings, physiology and behviour (0-100%); also the credibility/level of belief in dysfunctional and functional thoughts (0-100%).
If you wish to express anger or hurt to someone via letter or email, do not post it until after 48 hours. Re-read the message and decide whether this is what you want to say and consider the consequences of sending the letter/email.
To move on from the death of your loved one try writing in your journal:
Any circumstances of difficulty between you and the deceased.
What you would have liked to have said to the deceased about these problems.
How you would have liked your relationship to be different.
The qualities you valued about your loved one.
What the deceased could have said to make you feel better.
Perhaps you have questions about the death of a loved one. Write down any unanswered questions you have about the death of your loved one. Consider who could help you answer these questions. You could contact the health professional and/or the police involved, and research any literature about the situation or illness leading to the death of your loved one.
If a loved one committed suicide you need to understand why they felt they had no other choice. Joining a support group for suicide survivors can help you come to terms with your loss. If you feel suicidal seek medical help immediately.
Be self-reliant and develop a positive body image.
See Program 1: Coping Strategies Counselling Advice – Criticism, Countering Self-Criticism, Coping with the Need for Approval and Improving Your Self-Image and Combating Self-Harm.
When your grief is new you may feel like doing ‘nothing’ which is a normal response but after a while you will manage better if you distract yourself from your grief – do things you enjoy; spend time with family and friends. Rather than waiting until you feel like doing something – ‘just do it’. After the death of your loved one you need to consider the activities you used to do before your loss and which you can resume now starting with the easiest.
A daily routine can be helpful.
See Program 1: Coping Strategies Counselling Advice – Planning an Activity Schedule and Distraction Techniques.
Keep as well as possible.
See Program 1: Coping Strategies Counselling Advice – Nutrition, Exercise, Managing Your Time and Sleep Management.
To deal with stress and when making difficult decisions:
See Program 1: Coping Strategies Counselling Advice – Problem-Solving, Controlled Breathing and Relaxation Techniques, Program 22: Overcoming Stress and Program 23: Overcoming Stress At Work.
If you are misusing alcohol or other addictive substances:
See Program 4: Overcoming Addiction.
It is usually best to return to work as soon as possible – this will distract you from your loss and provide social support. If you require extended leave, or to discuss other options, contact your Human Resources department.
When you are alone in the house it can help to distract yourself by turning on the radio or television. Avoid a silent house unless you can cope with your feelings.
Build a good support network.
See Program 1: Coping Strategies Counselling Advice – Social Skills Training, Communication Training and Negotiation Training.
If there is a particular day, time or date that you used to enjoy with the deceased before your loss and now dread, try planning activities you find possible and pleasurable to occupy this gap.
You may be avoiding activities, places or people for fear of losing control of your emotions – this will only make your grief worse. Identify what you are avoiding; your thoughts about it; what you fear would happen if you did not avoid it. Deal with your distress in situations you fear by exposure FEAR (face everything and recover).
See Program 1: Coping Strategies Counselling Advice – Controlled Breathing and Relaxation Techniques, Eye Movement Technique (EMT), Mood Induction Procedure, Rational Emotive Imagery (REI), Imago Graded Exposure and In Vivo Graded Exposure.
Make a list of things you think would support you through your grief (e.g. joining a support group, reading self-help material, going on holiday). Select the easiest item first, break it down into small steps if necessary and take immediate action.
To explain the death to children, use simple terms appropriate for the age of the child/children. Allow children to see your emotion so they can learn that it is normal to be sad when a loved one dies. Answer their questions clearly and honestly, and encourage them to say ‘goodbye’ to the deceased by: viewing the body; writing a poem, letter or card to go in the coffin; drawing a picture; or placing a special flower on the coffin.
Children need to learn that death is a normal part of life. Let them know they are not to blame for the death and keep them involved in the funeral arrangements.
Try to create a ‘family time’ when you and your children can discuss and honour the deceased. Teenagers can feel awkward talking about the death and a bereavement support group could help them to open up.
It can help if a family member of the same sex as the deceased parent tries to form a close relationship to the child/children – this can fill the gap of the missing parent and facilitate discussions about puberty, dating and choosing a career.
You may have to explain the events of the death many times. Planning what you want to say and writing it down can help you feel more in control. You could send an email if you need to tell a number of people – such as work colleagues.
When someone upsets you, be assertive and speak up to let them know you are hurt, offended or disappointed, and what you expect from them. Sleeping on the matter before taking action is a good idea.
You may lack self-confidence.
See Program 1: Coping Strategies Counselling Advice – Assertiveness Training, Neuro-Linguistic Programming (NLP), Building Confidence I, Building Confidence II, Building Confidence III, Building Confidence IV and Program 16: Overcoming Low Self-Esteem.
Perhaps you fear forgetting your loved one – it is better to think about how you can remember them rather than what you might forget. As you adjust to life without your loved one, making changes (e.g. getting rid of the belongings of the deceased) will become easier. Only do things you are comfortable about and feel are beneficial to you. It is your decision whether or not you take off your wedding ring – do not let others pressurize you one way or the other.
Visit the grave of the deceased if you are comfortable to do so and if you feel guilty when you do not, then deal with this negative emotion.
See Program 1: Coping Strategies Counselling Advice – Troublesome Emotions.
Waiting at least twelve months before making any important decisions such as selling your home, is advised by most health professionals.
Write in a journal:
What roles did the deceased play in your life?
What values did you learn from them?
What are the memories you and your loved one shared?
How would they want you to remember them?
If they were here now, what would they say?
You may find it helpful to tell others the life story of the deceased, especially if the death is tragic. Making a book of memories about their life story and distributing copies can be therapeutic. Children can be assisted to make their own memory book. When remembering your loved one try to focus on your happy times together.
Make a list and try some activities which enable you to maintain a connection to your loved one (e.g. support a significant charity or cause; listen to their favourite music; make an album of your favourite photographs).
It is necessary that you let people know your needs as otherwise they will not know how to comfort you. With time you will learn to accept life without your loved one and look to the future.
Consider your past losses and the things you have to relinquish to move on:
Are there any past losses you can make up for?
How did you cope with these losses? List any helpful and unhelpful strategies.
Did you mark the loss with a memorial ritual?
What was your most difficult loss and why was it so hard for you?
How have these losses affected your life?
Looking back, how could you deal with similar losses in future?
It can help to write a Goodbye letter to ‘Grief’ and then a reply from ‘Grief’ to you. In this way you can question and confront your loss, to try and come to terms with grief. By re-writing these letters after two years you will be able to see your progress.
Write in your journal:
How will your life be different after your loss?
Can you accept your changed life after loss?
What one thing would you like to change at the moment?
Is it feasible? If so what is holding you back?
Make two columns on a sheet of paper. In one column write the heading ‘Best Friend’ and in the other write ‘Worst Enemy’. List in the two columns ways in which you are your own best friend or worst enemy.
New events (e.g. the anniversary of the death, going out with friends, shopping without the deceased, family gatherings) can increase your grief unless you prepare for them in advance. Write in your journal any new events you have already experienced since the death of your loved one. How did you deal with these events?
Tackle new events by:
Making plans for dealing with predictable new events – how would you like to recognize the date? Who do you want to be with on this day? Is there anything particular you would like to do? Do you want to be alone or with family? What action do you need to take in advance?
Set realistic targets – do not demand things of yourself and remember it is normal to feel sad.
Spend time remembering fond memories of your loved one, both alone and with others – this will maintain a connection with your loved one.
If you are prepared for these new events you will feel more in control. A few new events that need special consideration are:
The first anniversary of the death – challenge any negative thoughts (e.g. ‘I’ll never get better’); expect the event to be difficult.
The first religious holiday – discuss the occasion with family; change your usual plans if necessary; allow yourself to feel sad and to cry; do not feel guilty about enjoying yourself and take care of you. Modify any maladaptive thinking.
Your loved one’s birthday – do something special on the day to reminisce and maintain a connection.
Your wedding or relationship anniversary – watch your wedding video; write an anniversary card to the deceased; visit their grave; plan whether to spend the day alone or with others.
The death of a baby – this brings many events that will never happen (e.g. weddings, grandchildren). Doing something like lighting a candle for them on a significant date can help you acknowledge your loved one. For experiences you will never have with your partner – these include retirement and travelling – find ways to recognize these losses. Becoming an orphan or an adult orphan will change your outlook and it is necessary that you allow yourself to adjust to the change.
Deal with unexpected new events by examining your thinking.
See Dealing with Unhelpful Thoughts.
It is possible to come out the other side of grief and be happy without forgetting your loved one. You may find hope in that others have overcome grief and found happiness and a sense of purpose again. Tell yourself that creating a new life will be hard work but you can do it, and your loved one would want you to move on and have a good future.
Write in your diary what you hope the future will be like when you have overcome your grief. You need to choose to work through your grief for a brighter future which integrates your memories of the deceased without forgetting them.
If negative thoughts are preventing you from moving forward, for example, ‘It’s not fair – my life is over’.
See Dealing with Unhelpful Thoughts.
In your journal identify and challenge unhelpful thoughts which hinder you from moving forward on a new path. Form new beliefs and consolidate these helpful alternative thoughts.
Expect to have ups and downs as you travel along your new path and for progress to be slow; eventually you will adjust to this new path. Create a good support system – mix with people you feel comfortable with and who understand your loss (e.g. family, friends, bereavement support group, grief counsellor). Seek opportunities to try new things, enjoy yourself and the company of others who have your best interests at heart.
Write in your journal activities you enjoyed in the past. Which do you want to continue? Note any activities you have always wanted to do but have never had the chance. Which of these could you pursue now?
Consider how your loved one would advise you about moving forward without them. What would they want for you now? Also, you could reverse roles and consider the advice you would offer them. If you had plans with the deceased, could you do these things now, alone or with others?
At some point it is likely you will glimpse your old ‘happy’ self. This is a significant moment that can give you hope that it is possible to find purpose in life again.
As you find your way along the new path, set yourself manageable goals – specify the goal and the action you need to take to achieve the goal. Do it and once you have achieved one goal continue and set new ones.
You may eventually form a new relationship – do not rush into one as this can be an emotional decision rather than based on facts. If you feel guilty you need to realize that you have done nothing wrong by starting a new relationship.
See Dealing with Unhelpful Thoughts.
If your loss was the death of a child you may decide to have more children. Whatever your loss it is possible to love again but still keep a special place in your heart for your loss. Perhaps you feel guilty about moving on after the death of a loved one, disillusioned by a divorce or sentimentally attached to a place in the past. It is crucial that you let go of the past so you can have a full life. Eventually the day will come when you feel you have let go of the past and live for the present and future.
For further coping strategies:
See Program 1: Coping Strategies Counselling Advice – Competitiveness and Perfectionism, Frustration, Procrastination and Persistence.
10. Supporting Someone’s Grieving
When someone you care about is grieving you need to do your best to support them through this difficult time. Grief is the anguish experienced after a significant loss (e.g. death of a loved one, divorce or retirement).
Consider:
Do you have any personal experiences of loss?
What things helped you through your grief?
Did people do or not do things that upset you?
You cannot know another person’s pain; each person’s grief is different so curb any impulse to tell someone what to do. It is best to listen to the bereaved person and help them to regain a sense of control in their life; encourage them to talk about their loss. If you are unsure about what support to offer ask the bereaved person how you can help them.
Keep in mind that grief follows a wave-like pattern with ups and downs and sometimes a bad day can come out of the blue triggered by (e.g. hearing a special song on the radio).
Try to learn about grief, be a good listener, do not judge or make comparisons, and remember significant dates. Offer practical help such as baby sitting, encourage them to resume things they used to enjoy, call when you say you will, help them to re-establish their routine and spend some regular time with them (e.g. going for a walk together).
If someone you care for is finding it hard to accept their changed life, suggest that they try attending a support group specific to their loss or see a grief counsellor. Seek immediate medical help if you think the bereaved person is at risk of harm or suicide.
Prepare for death and grief by organizing your will and affairs, telling your loved ones now how much you care for them, and your hopes for their future. Appoint a guardian for your children and choose a person to make decisions for you in the event that you cannot yourself. Make clear your wishes for the funeral, burial/cremation, organ donation etc.
It can be therapeutic to keep a journal – you could write to your deceased loved one or to yourself. Explore your thoughts, feelings, old and new memories, and address any questions you may have for your loved one. Do this regularly and with time you are likely to write less as you move on.
It is possible to prepare for loss. Firstly, you need to be able to talk about these inevitable losses in life. This will not lessen the pain of loss nor make your journey any easier. However, you will feel stronger and more in control when working through your grief by preparing for the loss.
Try to think about what your response would be to the loss of a loved one, end of a relationship or relocation. Be realistic about your ability to cope with a major loss.
A nutritious diet and regular exercise are necessary both before and after a loss. Your physical health is as important as your mental health when working through grief.
You need to be prepared for a major loss before it occurs. Preparing for loss will improve the quality of your life. You will not live fearing unavoidable losses and will feel confident that you can deal with any major loss in future.
See Program 1: Coping Strategies Counselling Advice – Relapse Prevention.
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