Those of us who have known grief understand just how all-consuming it is.
Most often the result of loss, grief is capable of coloring your entire worldview, consuming everything from how you relate to others and experience seemingly benign moments in your day to how your body physically feels. It involves sadness, yes, but grief is so much more than that, frequently encompassing feelings of guilt, regret and rage, too. The way grief is processed is highly specific to the individual, making it a nuanced and often murky space to navigate. If you or someone you know is struggling with grief, read on to learn about how grief-specific counseling can help.
Causes and signs of grief
Grief is, reduced to its simplest state, a function of mourning. Causes of grief run the gamut and are specific to an individual’s circumstances, but most frequently, they relate to a significant loss. Some examples include: the death of a family member, partner or close friend; the dissolution of an important relationship; personal injury or illness; or a major change in the health of a loved one.
In grieving, we come to terms with these losses and the new form our lives will take because of them. Arriving at the other side of this incredibly painful process will look like different things for different people. It’s important to note, too, that grief is not linear and is instead often moved through in cycles. Ultimately, though, there is healing to be found, joy to be recaptured and more life to be experienced after grief. And that holds true universally, for anyone.
The work of grieving isn’t easy. For many people, it’s the most difficult experience they’ll undergo in life, and when in the thick of grief, the thought that you’ll ever feel better can seem incomprehensible. This is especially true if depression is a component of your grief experience. Those who are grieving often exhibit some or several of the following symptoms:
- Feelings of deep sadness and/or depression
- Feelings of isolation and being misunderstood
- A lack of energy and motivation
- Irritability and anger — at oneself, the deceased, others, higher powers
- Feelings of guilt, remorse, and/or personal culpability
- Difficulty concentrating
- Trouble sleeping, frequent nightmares
- Changes in appetite
- A constant mental reliving of the event that caused grief
- Dissociation from reality
- Trouble completing normal, daily tasks
- Physical weakness
- Self-destructive behaviors, such as an increase in use of alcohol and drugs
"How lucky I am to have something that makes saying goodbye so hard."
— Winnie the Pooh
Models for understanding grief
While multiple models exist for understanding how grief is processed — and it’s important to note that there’s certainly a cultural component to the way loss is perceived and processed — in much of the Western world, the seven stages of grief model coined by Dr. Elizabeth Kübler-Ross is the accepted model. A Swiss-American psychologist, Kübler-Ross first introduced her model for understanding grief in five stages in 1969, later amending it to include seven. Those stages are:
1. The Shock Stage
The Kübler-Ross model lists an immobilized state of shock or paralysis as the first layer of grief. Those in this stage may appear unnaturally placid at the receipt of bad news. This is especially true if the experienced loss was sudden or unexpected. Numbness, dissociation and disbelief are commonly associated with it, as well as physical reactions like dizziness, shortness of breath and the sensation of being cold.
2. The Denial Stage
After the first round of shock has worn off, those who are grieving often enter into a period of denial, in which they will continue their life as if the loss hadn’t occurred. As a survival mechanism, it is a means of attempting to put off the inevitable and insist on one’s okayness.
3. The Anger Stage
For many, denial is followed by anger, as reality starts to sink in. Emotion that was previously denied bursts forth, and anger is often a more accessible vehicle of beginning to feel again; the full brunt of one’s sadness may still at this point seem too frightening to acknowledge and thereby unleash. During this stage, “why me?” is an oft-repeated thought.
4. The Bargaining Stage
Though it may sound similar, the bargaining stage is distinct from the denial stage in that, although a sense of unreality is also associated with it, in the bargaining stage one is able to acknowledge the grief-causing event took place. It is a last-ditch attempt to find a way out, desperately hoping the bad news is in some way reversible, before succumbing to the next stage.
5. The Depression Stage
The inevitability of reality sinks in. The individual reluctantly accepts that the bad thing happened and they are unable to change it, and they slip into a period of despondency. Whereas when in the anger stage, it is easier to place blame on external factors, during the depression stage, a sense of personal culpability (real or imagined) is often struggled with.
6. The Testing Stage
Having come to terms with reality, the person in question begins to softly, tentatively seek and experiment with true solutions to their situation (i.e. solutions that have a basis in reality, unlike those engineered in prior stages). They begin to crawl away from depression.
7. The Acceptance Stage
Returning to a place of stability, the individual feels at least mostly ready to move forward into the next phase of their life, having achieved a degree of acceptance over the event.
What is described above, it should be noted, is a loose approximation of the average grief cycle. Some individuals may move through these stages at a technically faster rate than others, especially if they’ve experienced other losses before, have belief systems that soften certain elements of their loss or if their culture or family introduced to them a less-Westernized version of what loss means earlier in life.
"What we once enjoyed and deeply loved we can never lose, for all that we love deeply becomes part of us."
— Helen Keller
There’s certainly no timer or stopwatch when it comes to grief, and people will take the time that’s necessary for them to move through its various stages. However, for about 10-15% of people, what seems at first like general grief may actually be something known as complicated grief, also called persistent complex bereavement disorder. It’s characterized as a form of grief that’s become chronic, in which the sufferer’s grief deepens rather than moves toward a stage of acceptance, and it’s ultimately debilitating. Some psychologists believe complicated grief isn’t diagnosable until about six months after a loss, while others put this timeline at closer to a year. Regardless of the amount of time involved, grief is a complicated, nuanced thing.
Process of recovery
It’s important to allow yourself to experience and move through all the stages of grief, so as to avoid getting stuck in any particular one. This is especially true for those of us in death-denying cultures that systematically fail to allow space for grief and healing, and where showing sadness is pathologized. To deny, hide or suppress the emotions associated with grief, though, is to allow them to fester, preventing you from being able to move forward in life. Some actions you can take that may aid you in your grieving process include:
- Seeking grief counseling
- Joining a support group
- Talking to trusted family members and friends
- Starting an exercise routine
- Getting enough sleep
- Naming your feelings
- Writing in a journal
- Volunteering for a cause you care about
- Setting realistic goals
- Honoring the memory of your deceased loved one
In grief counseling, an experienced professional will help you in moving through each of these stages, delivering the support and perspective needed at each one.
Grief counseling and techniques
Anyone who’s experiencing grief has the potential to benefit from professional grief counseling. A trained grief counselor will be able to offer support by:
1. Acting as a companion, free of judgement.
Sometimes, communicating the full depth of our grief to those in our lives can feel difficult, no matter how well-intentioned and loving they are. A grief counselor can help by providing a listening ear that’s free of bias or judgement.
2. Offering perspective that comes with experience.
Your grief counselor may not have personally experienced the type of loss you’re dealing with, but it’s quite possible they’ve professionally encountered it before with other clients. Being able to speak to someone who’s well-acquainted with the various stages of grief can be incredibly reassuring to those currently in the thick of it. It’s evidence that life on the other side of grief continues.
3. Where appropriate, they’ll guide you in completing exercises that are designed to help. For example, they may help you try:
Cognitive restructuring: A grief counselor can help organize the seeming chaos of grief, identifying thought patterns that may be causing blockages in your work toward healing. For example, people who are grappling with loss are often susceptible to playing out a series of internal dialogues that aren’t actually based in reality — “I’m all alone now,” “this is my fault,” or “I’ll never find happiness again,” as a few examples. A grief counselor will help redirect those thoughts in a more reality-based direction, breaking their hold.
Role playing: Sometimes, the burden of unfinished business or the weight of things left unsaid can prove major challenges in one’s road toward healing. To help address this, a grief counselor may have you try a guided role-playing or visualization technique in which some closure can be attained; as an example, they may ask you to pretend the person you’ve lost is sitting in the chair opposite you. What would you say to them?
Coming to terms with reality through language: For someone who’s experienced a loss, certain words can prove exceptionally triggering. A grief counselor may help walk you through hearing or saying those words, such as using the term “dead” in place of “gone.” By working through this language with a grief counselor, you’re doing so in a totally safe space, which will give you better tools to deal with encountering certain topics in the “real” world.
Honoring a loved one’s memory: More than anything, a grief counselor is there to listen and to help you heal. They may be able to help you with ideas for honoring the one you’ve lost and keeping them alive in memory. By ensuring that you’re able to sit with the good memories alongside the difficult ones, a grief counselor can help you come to terms with your new reality — the good and the bad.
"To live in hearts we leave behind is not to die."
— Thomas Campbell
How much does grief counseling cost?
It depends on where you’re located. According to Good Therapy, the average cost of a session can range from $65 per hour to $250 without insurance, with that margin falling within the $100 to $200 range for many parts of the country. Some factors that can impact this include: whether the counselor has received any kind of special training; how experienced overall they are; how long of sessions they offer; if the counselor has a specialization, like trauma.
Is grief counseling right for you?
Not everyone who is experiencing grief will need counseling in order to emerge from it. That said, even if you’re technically able to move through the grief without professional help, a trained counselor can still help by offering a unique insight and tools that may help you cope more deeply. Working with a grief counselor may be of particular use to you if any of the following true:
- Your loss was extremely sudden or unexpected
- You’re at a moment in life where you’re experiencing a low amount of social support
- You’re dealing with a difficult date, like an anniversary or birthday
- The grief is persistent, and may have evolved into complicated (or long-term) grief
- You simply feel like you could use some extra support
If you’re interested in giving grief counseling a try, you could start by looking for therapists in your local area that list special experience in grief and trauma via sites like Maven Clinic or Zocdoc. The Association for Death Education and Counseling offers a database of certified grief counselors, as well, and local hospices and funeral homes can be a resource for information on nearby bereavement services, support groups and counselors. Additionally, your primary care doctor will more than likely be able to refer you to a counselor in your area.