Understanding the Grief Process: A First Step to Helping Bereaved Clients

Article excerpt

Grief is a normal and natural response to any significant loss, especially the death of a loved one or close friend. The grieving process is, however, often misunderstood and/or neglected by both the bereaved and professional helpers. Counselors and family therapists need a framework for understanding the grief process to guide their interventions. The purpose of this article is to describe a framework based on the work of Thresese Rando, a noted grief therapist.

Many of the concerns individuals bring to counseling involve the loss of some thing or some person of value. Tatelbaum (1984) noted that "the majority of clients come. . . for the first time because of an earlier grief that is now affecting their lives" (p. 53). Others who do not seek professional help are also affected (Moriarty, 1983). In his work with elementary children who were acting out in violent ways, Barrett (2000) found that most had experienced early, significant losses that had not been addressed. These children and their grieving had been overlooked. It is important, therefore, that mental health professionals in all work settings understand the grief process. Very few colleges and universities, however, offer a grief course in their preparation programs for counselors or family therapists. Professional helpers who want to learn about grief and mourning must educate themselves by attending workshops or reading books and articles on the subject. This article and the references cited provide information to assist professionals in becoming more effective with clients who have grief issues. (For other resources counselors can search the web for "grief books.")

Dr. Therese Rando, a clinical psychologist, researcher, and grief therapist, well-published with regards to the grief process and therapeutic interventions, developed the framework presented here (1984; 1986a; 1986b; 1988; 1993). This framework includes three phases of mourning - Avoidance, Confrontation, and Accommodation. Within these three phases are six "R" processes of mourning and related tasks (see Figure 1).

Although this framework reflects the view of grieving held today by many mental health professionals in the United States, it should be noted that some researchers (Horacek, 1995; Neimeyer, 2001; Stroebe, Stroebe, & Hansson, 1993) have questioned the validity of the "grief work hypothesis" implicit in the processes and tasks of mourning. Others (Crenshaw, 1990; Kalish & Reynolds, 1981) noted differences in grief responses based on one's cultural, generational, and ethnic background which may vary from those described below. It is beyond the scope of this article to present the many different approaches to grief counseling considered helpful in all circumstances. Readers are encouraged to consult the works cited for a fuller treatment of this subject.

The Phases of Mourning

The Avoidance Phase

The avoidance phase begins when one learns about the death. The human psyche goes into emotional shock, and the mourner may feel confused, disoriented, dazed, or bewildered and wonder if what he is experiencing is normal (Rando, 1988; Wolfelt, 1982). The bereaved often have physical reactions common to bodily shock including weakness, trembling, and exhaustion (Rando, 1993; Tatelbaum, 1984). The emotional shock one feels and the physical manifestations vary from acute to mild. Following an unexpected (Doka, 1996) or violent (Redmond, 1989) death, the mourner's reactions may be acute, especially if the deceased was one's spouse or child (Bernstein, 1997; Horacek, 1995). However, if the death was expected, possibly following a long illness, shock reactions may be mild or nonexistent.

As the reality of what has happened emerges and the shock and numbness wear off, the mourner may move into denial (Fitzgerald, 1992; Kubler-Ross, 1982; Rando, 1993). Denial is both natural and therapeutic and acts as a buffer that allows one to absorb over time the terrible reality of the event. …