Grief and Loss
by Anita M. Knight
â€œThe LORD is close to the brokenhearted and saves those who are crushed in spiritâ€ (Ps. 34:18).
Loss is an inevitable part of the human experience, and grief is a natural response to loss (Shear et al., 2011; Humphrey, 2009). Grief is a transformational, multidimensional, and unique experience; no two people experience grief in exactly the same way. Although grief is often conceptualized as a response to death or dying, persons may also struggle with grief in the wake of divorce, termination from work, lost expectations, and lost dreams.
The symptoms of acute grief are natural responses to significant loss and should not be pathologized. However, grief can become pathological. Bereavement may progress to a condition known as complicated grief (Shear et al., 2011), which is distinguished from acute grief by intensity and duration. Although complicated grief was not included in the fourth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV-TR), Shear and colleagues (2011) proposed that complicated grief should be added to the DSM-V. In cases where acute grief is experienced, symptoms tend to diminish in intensity across time. However, the grieving period varies based on the magnitude of the loss. Complicated grief occurs in approximately ten percent of bereaved individuals (Shear et al., 2011) and is more likely to occur in women. Risk factors for developing complicated grief include losing a child, suffering a loss due to natural disaster, or suffering a loss due to violence. It is also important to note that children grieve differently than adults and do not have the ego strength to endure grief in the same intensity and duration. Grief counselors need to look for opportunities when children are open to expressing grief and capitalize on those opportunities by inviting expression of loss.
Counselors should assess the severity of grief and distinguish between those who have acute grief and those who have complicated grief. The primary feature of complicated grief is a sadness and yearning, which is severe and prolonged. Complicated grief is often misdiagnosed, partially due to omission from the DSM-IV-TR and lack of awareness (Shear et al., 2011). Shear and colleagues (2011) performed a factor analysis and identified six different criteria that they are proposing for complicated grief in the DSM-V:
yearning and preoccupation with the deceased
shock and disbelief
anger and bitterness
estrangement from others
hallucinations of the deceased
behavior change, including avoidance and proximity seeking
Often, the bereaved are resilient and have developed life skills that help them integrate the loss in a meaningful way. For this reason they may not need treatment (Humphrey, 2009). However, through the therapeutic interview counselors can assess severity and duration of symptoms and the presence of risk factors that may predispose individuals to complicated grief. Care should be taken to prevent complications and address risk factors. Counselor characteristics including caring and empathic listening are important in facilitating the grief process (KÃ¼bler-Ross, 1969). More recent approaches to grief and loss include art therapy and eye movement desensitization and reprocessing (EMDR) for cases of traumatic loss, such as in the case of sexual trauma (Underwood, Stewart, & Castellanos, 2007). Complicated grief treatment includes in vivo and imagined exposure that emphasizes processing traumatic symptoms and establishing a sense of connection with the lost loved one (Shear et al., 2005), cognitive-stress theory (Folkman, 2001), and family-focused grief therapy.
The Wonderful Counselor (Is. 9:6) provides guidance for Christians on how to grieveâ€”with hope and in the awareness of life after death. Paul wrote, â€œAnd now, dear brothers and sisters, we want you to know what will happen to the believers who have died so you will not grieve like people who have no hopeâ€ (1 Th. 4:13 NLT). The passage discusses the reunion between the deceased and the Lord. This vision of resurrection and reunion provides hope to those grieving a lost loved one.
Romans 12:15 provides guidance for pastoral counselors: â€œRejoice with those who rejoice; mourn with those who mourn.â€ A Swedish proverb captures the same sentiment and states, â€œShared joy is double joy and shared sorrow is half-sorrow.â€ There is comfort and relief in the process of sharing grief with others. Christian counselors can extend this comfort to those who need their care, wisdom, and support.
Bowlby, J. (1980). Loss: Sadness and Depression. New York, NY: Basic Books.
Crenshaw, D. (1990). Bereavement: Counseling the Grieving Throughout the Life Cycle. New York, NY: Continuum.
Engel, G. L. (1961). Is grief a disease? A challenge for medical research. Psychosomatic Medicine, 23,18-22.
Folkman, S. (2001). Revised coping theory and the process of bereavement. In M. S. Stroebe, R. O. Hansson, & H. A. W. Schut (Eds.), Handbook of Bereavement Research: Consequences, Coping and Care (pp. 563-84). Washington, DC: American Psychological Association Press.
Humphrey, K. M. (2009). Counseling Strategies for Grief and Loss. Alexandria, VA: American Counseling Association.
Kissane, D. W., & Bloch, S. (1994). Family grief. British Journal of Psychiatry, 164(6), 720-740.
KÃ¼bler-Ross, E. (1969). On Death and Dying. Scribner: New York, NY.
Love, A. (2007). Progress in understanding grief, complicated grief, and caring for the bereaved. Contemporary Nurse: A Journal for the Australian Nursing Profession, 27(1), 73-83.
Parkes, C. M. (1998). Bereavement in adult life. BMJ, 316, 856-859.
Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F. (2005). Treatment of complicated grief: A randomized controlled trial. Journal of the American Medical Association, 293(21), 2601-2608.
Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N.,â€¦Keshaviah, A. (2011). Complicated grief and related bereavement issues for DSM-V. Depression & Anxiety, 28, 103-117.
Underwood, L., Stewart, S., & Castellanos, A. (2007). Effective practices for sexually traumatized girls: Implications for counseling and education. International Journal of Behavioral Consultation and Therapy, 3???(3).
Worden, L. (1982). Grief Counseling and Grief Therapy (p. 41). New York, NY: Springer.