Academic journal article Journal of Mental Health Counseling

Concepts and Controversies in Grief and Loss

Academic journal article Journal of Mental Health Counseling

Concepts and Controversies in Grief and Loss

Article excerpt

Although grief is a universal experience, the ways in which it occurs are not universally agreed upon. In fact, there is considerable controversy about the "normal" duration of grief its expected outcome, and its course. Although most grieving adults will achieve a sense of normalcy at some point, others seem not to do so. Continuing impairment by grief raises a question: Is the experience qualitatively different from normal grief or is it different only in degree? This article discusses grief conceptualizations, including that of complicated grief and approaches to grief counseling.

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Loss is a universal human phenomenon, but people respond to it with varying degrees of grief and mourning. Although the experience is common, its expression varies across individuals. People grieve in different ways, for different durations, and with manifestations that range from depression to rage to avoidance. Working with their clients and within their communities mental health counselors are often faced with issues of grief. Although it has been widely studied, there is still disagreement about the definition of grieving, as is clear from the diagnostic criteria issued by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders ([DSM-IV-TR], APA, 2000).

The loss of a loved one is one of the most distressing emotional experiences people face, yet virtually everyone will deal with grief at some point. Despite the emotional difficulty associated with loss, most people experience a "normal" grieving process in which they endure a period of sorrow, numbness, and even guilt or anger, followed by a gradual fading of these feelings as the griever accepts the loss and moves forward.

In the literature many terms have been used to describe aspects of grief and loss. Bereavement is understood to be the experience of having lost a loved one to death; grief to be various emotional, physiological, cognitive, and behavioral reactions to the loss; and mourning to be the cultural practices through which bereavement and grief are expressed (Brown & Goodman, 2005). Finally, the term complicated (or traumatic) grief (Prigerson & Jacobs, 2001) describes grief that appears to deviate from the norm in duration and symptom intensity. Some defining aspects of both normal and complicated grief presented here provide a context for the articles that follow.

Uncomplicated Bereavement

According to the DSM-IV-TR (APA, 2000), a bereavement v-code can be used when the focus of treatment is a client's reaction to the death of a loved one. The normal grieving process is considered to be characterized by feelings of great sadness and anger, physical symptoms such as weight loss and insomnia, a preoccupation with the death, and difficulty with concentration (Cohen, Mannarino, Greenberg, Padlo, & Shipley, 2002). The clinical presentation of bereavement responds to individual, family, environmental, and cultural variables, although there are common tasks an individual likely goes through to successfully navigate the grieving process (Lin, Sandler, Ayers, Wolchik, & Luecken, 2004).

Uncomplicated bereavement involves reconciliation, which has been defined as "the process that occurs as the bereaved individual works to integrate the new reality of moving forward in life without the physical presence of the person who died" (Cohen et al., 2002, p. 309).

Reconciliation is achieved through specific tasks that take place during bereavement. Cohen, Mannarino, and Knudsen (2004) suggest that these tasks include (1) accepting the reality of the death; (2) fully experiencing the pain associated with the loss; (3) adjusting to life without the loved one; (4) integrating aspects of the loved one into one's own self-identity; (5) converting the relationship from one of ongoing interactions to one of memory; (6) finding meaning in the loved one's death; and (7) recommitting to new relationships with other adults. …

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