Grief: New Perspectives in Treatment

There is a common misconception that mourning is inextricably linked to death. While death is the most accepted experience of grief, many different kinds of loss can elicit strong feelings of grief and pain and have a significant mental health impact. Heightening our awareness of the myriad ways our clients are impacted by loss can help us recognize their symptoms, validate their experience, and assist them with coping effectively.

Here are a few types of loss that can feel equal to the loss felt by death

• Loss of self-image/concept loss

This is often found in individuals whose work life has changed. Due to job loss or a role change, they no longer feel the same sense of identity they once held for themselves.

• Loss of abilities

This includes any physical or mental deficit or physical injury that prevents a person from doing something previously held meaning for them.

• Loss of future goals and dreams

Losing something to which a person has dedicated time, effort, hope, and expectation can be extremely difficult to accept.

• Loss resulting from a shift in the concept of the world

Erik Erikson notes that individuals must build a sense of self as they grow, move out of their parent's home and family identity and into the larger world to develop their own.

If people cannot absorb or cope with this shift, they may experience self-doubt and a loss of who they believed they were.

Many of today’s young adults have lost their expected trajectory because of the pandemic, and many are grieving while simultaneously figuring out their place in the world.

• Loss of a relationship or friendship

Losing primary relationships in our lives is painful and requires dedicated time to reflect and grieve.

Six ways to help our clients cope

Everyone copes with various kinds of grief in different ways. Some wish to stay silent and need time alone to process what has happened. Others need to talk about it, express their emotions, and have the support of people they trust.

As a therapist, what’s most important is to identify how your client processes grief, respect that, and provide support in the unique way they need it.

Six techniques that help you do this effectively

• Invite clients to share at their own pace

One of the biggest challenges for grieving clients is expressing the pain of their loss. As we do with all clients, it’s important to invite grieving people to share at their own pace, emphasizing that therapy is safe and nonjudgmental.

This can be especially important if the loss isn’t universally accepted or what has been traditionally identified as something to grieve. This disenfranchised grief can take time to identify.

• Create plenty of space for venting

During the first few therapy sessions, your client may need you just to listen. Healing requires the person to feel heard, and quick solutions or goal-setting can be dismissive.

Allow time for venting and exploring. This will often lead to a greater understanding of how the loss is felt. It can also help you gain a more in-depth understanding of the full impact of this loss on your client.

Especially now, grief is so layered. Prioritizing time to explore sets you up to provide better insights later on.

• Permit yourself to follow the client’s path

Clients can come in with displaced grief, focusing on ‘fixing’ symptoms that may seem unrelated. Displacement is a protective measure that serves a purpose.

Have faith that through the therapist's alliance, patience, and encouragement, they will eventually be able to accept insights into how grief has played a role in their current distress.

Avoid putting pressure on them or moving too fast. Let the client recognize the loss and process it through their discovery.

• Recognize cultural differences

Loss is perceived differently across the globe. It’s in our client’s best interest for us to take the time to understand and respect cultural uniqueness.

Make it a priority to educate yourself on cultural norms. Ask questions that assist in exploration while avoiding assumptions through your cultural lens.

• Be aware of gender-based biases and differences

Even today, men often feel as if they’ll be judged if they are open about how they’re feeling. They may not have been socialized to express their feelings and struggle to articulate verbally what they’re going through.

I try to make a special effort to recognize this. We’re evolving, but we still have a long way to go.

• Educate and set expectations

Grief is complex and, by its very nature, ebbs and flows in waves over the course of time. Providing psychoeducation for clients on what grief looks like can help orient them and set realistic expectations.

Validate their feelings of loss, even if the loss isn’t traditionally recognized as a cause for grief. Let them know there will be moments of relief, joy, and pain that don’t necessarily have an order—and that’s ok.

And when in doubt, consult. Even the most seasoned therapists can benefit from a trusted colleague's perspective.