When you have experienced loss, it is natural to feel a wide range of emotions, and you might feel overwhelmed by grief. Grief is a powerful emotional and physical reaction to the loss of someone or something. It is characterized by deep feelings of sadness and sorrow, and often by a powerful yearning or longing to be with that person again. Other effects of grief include feeling numb and empty, as if there is no meaning to anything, or being annoyed at yourself for how you are feeling compared to how you ‘should’ be dealing with things. You might feel angry that your loved one has gone and left you behind. Perhaps others are expecting you to be moving on and this is making you feel worse. You may also be worried that you will never feel better, or that you will not be able to cope. Show
Grief is also felt physically: you might be struggling to eat or sleep, or might feel sick in your stomach. These feelings may come in waves, and you may be tossed from one to another. All of these feelings are a normal part of grieving. Despite the pain, the process of grieving is an important part of how we come to terms with loss. Powerful feelings of grief and loss are so normal and natural that they are typically not given a ‘diagnosis’ like other conditions such as anxiety or depression. There is no right way to grieve, and unfortunately, no quick fix. Although there are no short-cuts, there are things you can do to help yourself along the way. Judging and comparing yourself to how you ‘should’ be feeling can add to your suffering and pain. Start by learning to be patient, kind and understanding with yourself, like you would with a dear friend. This is a difficult journey, and treating yourself kindly can support you along the way. What is it like to grieve?Gloria and Mario
Aspects of counseling that Gloria found helpful
What is loss?When we talk about loss we often mean the death of someone that we love. It is important to acknowledge that people can also experience grief when confronted with other losses such as: the breakup of a relationship, the loss of an important role such as a job, or the diagnosis of a life-changing illness. For much of this guide we will refer to bereavement, but most of it is relevant other losses too. Losses within the lossWhen someone dies you might experience many losses. Part of grieving is about recognizing what you have lost, and loss comes with many changes that are not always immediately visible. There is the physical loss of the person and their presence, and other less tangible losses such as:
Characteristics of the lossNot all losses are the same and not all losses affect us in the same way. The circumstances of the loss can affect how you grieve. Some of the characteristics of the loss that can affect how you grieve include:
What is grief?Grief is more than just sadness and you might be overwhelmed by a variety of different emotions and feelings in your body as your grief changes over time. Grief is different for everyone: everyone deals with it in their own unique way. We can separate the effects of grief into thoughts, feelings, and behaviors. You might experience some, all, or none of these.
Grief often feels like it comes in waves that can initially feel intense and overwhelming. These waves of grief can feel like they come out of nowhere, or can be triggered when you are reminded of the person you lost. When you first lose someone, it can feel as though you are constantly being hit by enormous waves of grief – sometimes so close together that it feels as though you hardly come up for air between them. With time, the size of the waves tends to lessen, with larger gaps in between waves. As the weeks, months, and years pass by you will experience many ‘firsts’ as you navigate life without your loved one – your first dinner out, your first supermarket trip, your first birthday without them. In each of these moments it will be natural to feel their absence, and for waves of grief to be triggered again. Figure: Grief often feels like it comes in ‘waves’. To begin with, the waves feel intense and frequent, but over time they tend to be spaced further apart and feel more manageable. The difference between normal and complicated griefThere’s no ‘right way’ to grieve, and no ‘right amount’ of time to grieve for. However, some people’s grief seems to last for longer than others, follows a different course, and doesn’t seem to get better with time as we would expect. Psychiatrists sometimes call this ‘Prolonged Grief’ or ‘Persistent Complex Bereavement Disorder’. The main difference from ‘normal’ grief is that the strong grief reactions continue at an unbearable intensity for much longer than would be expected, and impact the bereaved person’s life in powerful ways. Figure: An illustration of different ‘trajectories’ of grief. The most common type is ‘resilient grief’. ‘Prolonged grief’ typically follows the rough trajectory of ‘chronic grief’. [1] If you are struggling with a prolonged grief reaction you can feel as if you are in the depths of grief all the time, and can feel overwhelmed by an intense longing for the person you have lost. It can be a real struggle to carry on with your daily life and you might find you can’t get on with the things you used to do before, such as working, socializing and seeing friends and family. A prolonged grief reaction is more likely when the loss was particularly traumatic, for example after losing a child, or losing a loved one in sudden, violent or traumatic circumstances. How other people might respond to your loss and your griefIt is natural for your friends and loved ones to want to be supportive. Sometimes though, you might find that the way that other people respond to you can be unhelpful. For instance, other people might:
Remember that it’s OK to let people know what you need and what you don’t. Grief can be like a rollercoaster: there will be times when you want to talk and other times when you don’t. Sometimes you might want a distraction and to not think about it, at other times all you might want to do is talk about how you feel. You may not know what you need from others and this can be confusing for you and them. Remember that there are no rules – whatever you’re feeling is OK. Metaphors and models of griefPsychologists have many different ways of thinking about grief. It used to be commonplace to think of grief as a process that goes through various stages. Some of these older models of grief were based on the idea that people ‘move on’ and ‘let go’ of their loved one. However, some people find this notion uncomfortable. More recent models of grief present alternative perspectives that you may find more helpful. As you read the theories and models below, there may be some that resonate with your experience and others that don’t. That’s absolutely fine! Remember there is no right way to grieve – the theories are just some ways of understanding the process of grieving. Loss is like a woundWhen someone you love dies, it can feel as though you have been injured by their loss. Loss is often described as an open painful wound that needs healing. Just like a physical injury, the pain of loss is very raw to begin with. The wound is all that you can think about – it is all consuming – and any movement reminds you that it is there. In this early stage you may be so consumed by your injury that friends and family need to take extra care to look after you and be there for you. Grief is often described as the process of healing from the wound. If the conditions are right then wounds will heal naturally in time. Sometimes, though, it is too painful to acknowledge or tend to a wound – and so time does not always heal in the way we would hope. If a wound is left unattended then it can become infected, and the pain of grief worsens. An infected wound needs to be cared for in order it for it to heal. Talking about what happened, and how you feel is a way of tending to your grief and helping it to heal. It does not make the injury go away – a serious injury leaves a scar. However, as time and life goes on, it becomes a part of you, and no longer hurts in the same way. Continuing bondsSome ways of thinking about grief describe ‘stages’ that grieving people go through, often ending with ‘acceptance’ or ‘investment in a new life’. Grief researchers Denis Klass, Phyllis Silverman & Steven Nickman questioned these stage models, and proposed a different way of thinking about grief[2]. They argue that when a loved one dies you go through a process of adjustment and redefine your relationship with that person – your bond with them continues and endures. They say a relationship never ends – grief is not something that you go ‘through’ to ‘let go’ or ‘move on from’ your loved one. Instead, grieving is the process that helps you to form a different relationship with them. Although your loved one has gone physically, you can learn to remember them, and they can continue to live on in your memories and heart. This will mean different things for each person, for example it could mean you continue to say goodnight to them and tell them about your day, you might carry on some of the routines and things that you did together, or you go to their favourite place on their birthday. “they are remembered, not forgotten” Life grows around griefAnother helpful metaphor for grief was developed by Dr Lois Tonkin. The idea is that we don’t ‘get over’ grief – it doesn’t ‘go away’. Instead as times goes on, you learn to grow around your grief. Imagine drawing a circle on a piece of paper. The first one represents you and your life. Shade a section within that circle to represent your grief – soon after your loss it might almost be filling the entire circle of your life. Many people’s intuition is that with time the shaded section of the circle becomes smaller as the grief passes. Tonkin’s theory proposes the opposite – rather than the shaded area growing smaller, the outside circle (you and your life) grows bigger – your life grows around the grief. You will have many ‘firsts’, new experiences, and ups and downs in your life. You might start to reconnect with your family and friends, you may meet new people, start to socialize again and even start to have moments when you feel joyful and happy. As these experiences accumulate, the outer circle grows bigger. As this happens your grief remains but it no longer dominates and so becomes more bearable. In this way your life ‘grows around’ your grief, and you continue to carry your grief with you. Tasks of griefWilliam Worden’s model of grief uses an acronym ‘TEAR’ to describe his four ‘tasks’ of grief [3].There is no order to Worden’s tasks, and grieving involves cycling between tasks over and over as you learn to come to terms with your loss.
Kubler-Ross’s five stages of griefMany people have heard of Elizabeth Kubler-Ross’s stage model of grief. This theory was popular in the 1960s and – for good or bad – has become a part of Western popular culture. What many people don’t realize is that Kubler-Ross originally developed her model while conducting therapy groups with terminally ill people: it was developed as a way to understand the stages of her patient’s own grief as they were dying. The model proposes that people go through five stages of grief which include denial, anger, bargaining, depression and acceptance.
An unfortunate aspect of the stage model is that it can set up an expectation that there is a ‘right’ way to grieve: a correct way to move through the stages. Actually, what we know is that grief affects people differently. A better way of thinking about the Kubler-Ross model is to understand that the stages are not linear: people don’t necessarily go through all the stages or in any particular order, and it is natural to move back and forth between stages over and over. Treatments for griefPsychological treatments for griefIf you feel that you are struggling to come to terms with your loss you may find it helpful to speak to someone about how you are feeling. Many people find bereavement counseling helpful, and you may be able to find a specialist bereavement counselor near you. If you are struggling with symptoms of prolonged grief or traumatic bereavement, specific psychological interventions are recommended for these conditions. Medical treatments for griefGrief is a normal human experience for which there are no recommended medical treatments. Some medical professionals argue that symptoms of depression (which may perhaps predate or ‘sit alongside’ experiences of grief) can be distinguished from symptoms of grief and propose that medical treatments such as antidepressant medication can be helpful in these cases. This view is not without controversy.[4] How can I help myself to grieve?There are many things that you can do for yourself that will help you to work through your grief. We describe a selection of tasks and activities below that you might like to try. Some of the suggestions might make more sense at particular points of your grief journey, so don’t feel that you have to try all (or any!) of them right away. Some might be appropriate when your grief is raw, and others might be more helpful when you have had a little time to come to terms with what has happened. Rituals & customsRituals help us to come to terms with loss and are a way to honor and respect our lost loved ones. They are so important that all cultures have their own rituals that are part of the grieving process, for example:
From a psychological point of view, these rituals are imbued with meaning and fulfil two essential functions – they help us to make sense of what has happened, and confront the reality of the loss. You can make your own rituals to remember and celebrate the life of your loved one. For example, some people choose to plant a tree or hold a memorial service at their favourite place. You could think about what would be meaningful for you: how do you want to honor the life of your loved one? What would you like to do on anniversaries to remember your loved one?
Express your griefTalking about your feelings of grief can help you to begin to come to terms with your loss. Could you find some close friends or family with whom you would feel comfortable talking about how you feel? Another helpful way of expressing your grief is to keep a journal and write about how you are feeling. Some people find it helpful to speak to a professional grief counselor to express how they feel. Remember that sometimes other people (understandably) want to make you feel better. Although this is well-intended, it could also mean that they try to cheer you up when actually you need to talk. If you want to talk, don’t be afraid to let others know that you don’t need them to make it better, you just need the space to be heard. Make a memory boxAfter a loved one dies, some people find it important to keep their memories alive. One suggestion is to put together a ‘memory box’ of items and photos that remind you of your loved one. For example, you might include photos, some of their favourite belongings, their favourite music, a treasured item of clothing, letters, their favourite book, or sentimental items they gave you. You could place the box in a special place, and perhaps set a regular time when you visit your memory box like on their anniversary. Telling your grief storyTalking about your loss and telling the story of your loss and grief can help to process what has happened. Whether you lost your loved one suddenly or after a long illness, there is often much to process and come to terms with. As your mind tries to make sense of your loss, you may feel a need and even an urgency to tell your story and make sense of what has happened. This can be an important way of processing all the emotions that you are feeling. If you don’t feel that you’ve had a proper chance to speak about what happened then you might find it helpful to write your story from your perspective, as if you are telling someone about what happened. If you decide that this is something you would like to try, here are some tips to get you started:
Tackling avoidanceIn the early days, the loss may be raw and it can be too painful to do things that remind you of your loved one. As time goes on, it is important to begin to face the places and situations that you have been avoiding. Here are some tips:
Telling the story of your loved one’s life and your life togetherYour loved one’s life wasn’t just about their death. It can help to remember your loved one’s life and the life you shared together. Writing from your perspective, imagine telling someone else about your loved one. Use the prompts below to get you started:
Write a letter to your loved oneSometimes the feelings we have about our loved ones are not straightforward – while they were alive either of you may have said or done things that were hurtful, or which you regret. Writing to your loved one can be a helpful way of working through your feelings. Try to express how you feel, and say all the things you wish you had said. Here are some tips to get started:
Once you’re done, think about what you want to do with your letter. You could keep it somewhere safe, or get rid of it if you prefer. There is no right or wrong answer, just be kind to yourself and do whatever feels right for you. Get in touch with the parts of your griefIt is normal to struggle with different emotions when you are grieving: one minute you might feel angry and outraged, and the next minute ridden with guilt and regret. Psychologists encourage people to find ways to feel and ‘process’ their emotions: to acknowledge and work through your thoughts and feelings. Many of us are used to avoiding or suppressing how we feel, so it might feel quite strange and unfamiliar to face your emotions at first. One way of working with your emotions is to imagine each emotion as one part of yourself. For example, there is one part of you that feels angry that your loved one has gone, another part that is sad, and perhaps another part of you that is scared. Sometimes our emotions conflict with each other. For example, your angry part might be angry with the part of you that feels scared. Or the part of you that feels guilty might get in the way of the part of you that accepts what has happened. Here is an exercise to help you to work with these conflicts. In your own time, work through the steps below:
Dealing with regret and guiltWhen someone whom we love dies it is common to feel some regret and guilt. You may recall things you did or said, or that you failed to do or say. Events that might ordinarily have seemed trivial may take on a new meaning in the light what has happened. Over time most people find ways of resolving these emotions. However sometimes guilt and regret can get stuck: as though it keeps looping on a circuit. This can be very distressing, and can get in the way of grieving in a healthy way. If you are feeling guilt or regret, here are some things that you might try:
Confronting difficult decisionsThe death of a loved one may mean that you are faced with some challenging decisions. If you lived together you may have to confront financial decisions, or even have to move home. Even the smallest of decisions can feel overwhelming in the early days. If your circumstances allow, it is often advisable to postpone any big decisions until six to twelve months have passed. If big decisions are unavoidable, you may need help to try to think through your options clearly. Consider enlisting the help of a trusted friend or family member to help you work out a plan. A classic problem-solving strategy is to:
References[1] Bonanno, G.A., Malgaroli, M. (2020). Trajectories of grief: Comparing symptoms from the DSM-5 and ICD-11 diagnoses. Depression and anxiety, 37(1), 17–25. https://doi.org/10.1002/da.22902 [2] Klass, D., Nickman, L.N., Silverman, P.R. (1996). Continuing Bonds: New Understandings of Grief (Death Education, Aging and Health Care). New York: Routledge. [3] Worden, J. W. (1991). Grief counselling and grief therapy: A handbook for the mental health practitioner (2nd edition). London: Springer. [4] Friedman, R. A. (2012). Grief, depression, and the DSM-5. The New England Journal of Medicine. About this articleThis article was written by Dr Matthew Whalley and Dr Hardeep Kaur, both clinical psychologists. It was reviewed by Dr Hardeep Kaur and Dr Matthew Whalley on 2020-08-04. What are the psychological effects of death?Throughout the lifespan, unexpected death of a loved one is associated with the development of depression and anxiety symptoms, substance use, as well as other psychiatric disorders (3, 13, 14) and heightened risk for prolonged grief reactions (15), Despite this evidence that death of a loved one is associated with ...
What are the psychological responses to grief?Emotional responses may include sadness, anger, guilt, anxiety, loneliness, helplessness, hopelessness, shock, yearning, relief, and numbness. Behavioral responses may include social withdrawal, changes in activity level, avoidance of places or reminders of the deceased, focus on reminders of the deceased.
What are the 3 factors that affect the grieving process?Factors Influencing Grief Responses. Current health situation.. Relationship with person who has died/thing which has been lost.. Age of person grieving.. Previous experience of grief.. Cultural background.. Belief system.. Financial situation.. Knowledge around cause of loss/death.. How does death of a loved one cause stress?The death of someone you love can shake the foundation of your existence and affect both mind and body. During a period of grief, you can become preoccupied with thoughts, memories, and images of your friend or loved one, have difficulty accepting the finality of the loss, and experience waves of sadness and yearning.
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