Dealing With Grief and Bereavement: A Help Guide
The British Association for Counselling and Psychotherapy
The British Association for Counselling and Psychotherapy (BACP) is an association for UK-based counselling professionals. It supports practitioners, enabling them to provide a better service.
Loss and bereavement are a universal experience. And yet they are still something that many of us tend to live in fear of, or avoid thinking about entirely, until they are upon us. We are left struggling our way through, wondering if what we are experiencing is 'normal', and if what we are doing is the ‘right’ thing.
This guide aims to support you in preparing for bereavement and navigating grief, as well as to dispel the many myths surrounding the topic.
The most famous model of grief is ‘the Five Stages’, made popular as far back as the late 1960s, when psychiatrist Elisabeth Kübler-Ross published her book On Death and Dying.
Kübler-Ross worked with terminally ill patients, and she noticed that there were commonalities in the ways that people process a terminal prognosis. She felt that, in general, people went through stages, which she identified as:
Denial - you refuse to believe a diagnosis or impending death is possible.
Anger - realising it is possible, you feel frustrated and enraged, and that the world is unfair.
Bargaining - negotiating with God or yourself for more time, trying to change habits and your lifestyle.
Depression -despairing your lot, regretting your life, perhaps cutting yourself off from others.
Acceptance -emotions finally stabilise as the impending future is prepared for and embraced.
It’s best to see the model as a loose guide to help you understand grief, over a process you must follow with grief. Kübler-Ross herself actually never meant for her book to lead to a prescriptive and linear road map for grief, when she was actually writing about the process of dying. Later in her life she commented that she felt her model was misunderstood.
Many psychologists have since challenged her ideas, and pointed out that there isn't any research to support the theory of stages. And yet the model remains extremely popular.
In summary, if you hit some stages in a different order, redo several stages, and others not at all? That does not mean there is anything ‘wrong’ with you. Grief is largely personal, and we all find our unique way through it.
There are many myths about grief out there, and buying into them can see you beating yourself up, or stopping yourself from processing your loss. Here are some to watch for.
1. There is a 'right' way to grieve.
Again, there are indeed ‘models’, but they are best seen as guides to help you understand how you are thinking and feeling during a loss. Grief is an individual experience.
2. Grief is about emotions.
Grief certainly can feel a tsunami of emotions. And emotions are at its crux. But grief is also made up of thoughts, and of physical symptoms. We can be caught up in cycles of nostalgia, negative thinking, and worry about our own future and mortality. Physical responses can include exhaustion, headaches, sleep problems, or changes in appetite.
3. You can control grief.
You can certainly try. But it’s unlikely to be overly successful, and more likely to lead to anger or rage. Grief is often described as waves. Much like we can’t control what days waves are big or small, slow or fast, calm or wild? Grief seems to have its own agenda. It’s best to surf our way through it as best we can, going with the waves over resisting.
4. You can’t plan bereavement.
While you can't control grief, you can plan how to handle a bereavement, if you know that someone you love will be passing away from something like terminal illness. There has even been a rise in ‘death cafes’, getting together with others to talk about concerns about death and navigating loss, and ‘death doulas’, people who help you and your family navigate death and loss together. Planning can be especially helpful if you have children, who can benefit from talking about what will happen, and from being given a say in creating rituals that help them make sense of loss.
5. If you don’t grieve, there is something wrong with you.
Some people take their time to feel grief. Others don’t seem to have deep feelings of loss, but are soon back to normal. This said, if you are telling yourself you don’t need to grieve, and are instead resisting, this is not a helpful approach. Look for signs of emotional avoidance, such as foggy-headedness, fatigue, loss of interest in your usual activities, or snapping at others.
6. Grief is the same as profound sadness.
You can be grieving and not feel sad. In fact you can feel annoyed, angry, and guilty. Or you might sometimes feel oddly peaceful or even have moments you randomly, for no reason, feel deliriously happy. Grief is a process of letting go and adjusting to life without someone or something, not just sadness.
7. Grief is for grownups.
Children grieve just as much as anyone and should not be left out or avoided during a loss, but rather should have their voice and needs heard.
8. Grief only pertains to losing a person we know.
The stages of grief can come before death, if someone, or even ourselves, has been diagnosed with a terminal illness. Other people experience debilitating grief over things like losing a loved pet, or a country to war or natural disaster, losing a way of life, or even losing a very precious object, such as a musician having their rare instrument stolen.
9. Real grief, if you love someone, lasts forever.
This is a dangerous romanticisation of grief that novels and movies unfortunately encourage. Grief is a processing, not a state of being. Like all processes, it does tend to fizzle out and then end. If we choose to stay in a state of grief it is more likely we have let grief mutate into depression or even obsession, and it’s time to seek professional support.
Do you feel blank, or numb? Or do you actually feel normal, as if the loss that is affecting others around you simply isn’t having the same sort of result for you personally?
Again, grief is not prescriptive. There is no recipe, no right and wrong.
Some people go through a period of numbness, as if their brain needs time to even begin to process the loss. Grief can come after a few weeks, or even months.
And other people are very resilient. Perhaps you’ve navigated loss before and have an understanding of death, so are less affected. Or perhaps you are naturally low on emotions. After a bit of sadness, you are okay.
The trick here is not to convince yourself you are just resilient, and that’s why you ‘feel nothing’, if actually you are just numb and repressing your grief.
Note that even people who are resilient and bounce back from loss faster than others do feel sadness, and perhaps nostalgia. If you truly feel nothing, it’s more likely you are just blocking your emotions.
Signs you are repressing grief can include:
- avoiding people and places related to the loss
- refusing to talk about the loss
- a change in social habits, such as hiding out at home, or going out more than usual
- using addictive habits more than usual, like drinking, overeating, recreational drugs, or bingewatching TV.
Losing a loved one to suicide can be a different sort of grieving experience. There can be more anger and guilt, or even shame and embarrassment, despite everyone telling you not to feel such things.
And you might also experience feelings of rejection and abandonment. How could they have done this to you? What were they thinking leaving you behind?
It’s also still possible to face stigma, even in this day and age where mental health is a popular topic. Not everyone is comfortable talking about suicide, and some religions take strong views on it.
Furthermore, you might feel unable to connect in regular grief groups where others have lost loved ones to accidents, age, or illness. Do try to find support groups, either in-person or online, where you can connect to others who have gone through similar, and know what you are going through. You might want to see if there is a “Facing the Future” group near you, an incentive headed up by the Good Samaritans.
It can also be helpful to educate yourself about suicide. Read accounts of suicide survivors as well as the science and research.
If a loved one has received a terminal diagnosis it can be tempting to pretend that everything is fine. But this approach inevitably leads to stress and worry.
Facing what is ahead and making plans now for how to deal with your loss, on the other hand, can help unite family members and ease anxiety. It means less stress and unecessary conflict when the time comes. This can involve things like:
- talking as a family about what is ahead
- spending time with your loved one and saying what you need to say
- making practical preparations like the funeral, personal rituals, celebrations, the will, etc
- talking with your workplace about what leave will be available if required
- exploring topics of death and the after life
- speaking to a spiritual advisor
- hiring a death doula to help your family
- having counselling sessions.
Preparing for loss is especially important if you have children. Children are often far more cognisant of what is going on around them then adults give them credit for. Pretending a family member isn’t sick when they evidently are is usually unhelpful. Instead, consider things like reading books together about death and dying (there are many written just for children), having disucsssions, and letting children come up with their own ideas about rituals they would like to do when their loved one dies to mark his or her passing.
Loss and bereavement can trigger pre-existing mental health issues, such as:
- anxiety disorder
- eating disorders
- post-traumatic stress disorder (PTSD)
- sleeping problems.
Even if you have not experienced depression before, grief, if not dealt with, can turn into major depression. Low moods along with symptoms such as obsessive thinking about the person you have lost can also mean you've developed what is referred to as 'complicated grief disorder', or 'prolonged grief disorder' (see the next section).
If several months after a loss you find you are feeling worse and not better, it's advisable to talk to your GP. Or book a session privately with a counsellor. (You can find a UK-wide registered grief counsellor or an online therapist you can talk to from anywhere on our booking site. )
Have you been grieving for over six months now? And you are feeling worse, not better?
'Complicated grief' refers to bereavement that lasts over six months without showing signs of improvement. Your symptoms are not just those of depression. Instead your day-to-life rotates around your grieving, you have obsessive or even illogic thoughts about the person you lost, your life is very compromised compared to before your loss, and you can't imagine anything changing.
While it's status as an 'official' mental health diagnosis is pending, complicated grief is seen as a valid concern and is a term you can use with a therapist. The American diagnostic manual, the DSM, has marked the condition for more research, calling it "persistent complex bereavement disorder" and accepting that it is different than, say, major depressive disorder. The World Health Organisation's manual, the ICD, has announced that "prolonged grief disorder (PGD)" will be included for the first time in their 11th edition that is published in 2022*.
Symptoms of complicated grief can include:
- persistent low moods and sadness
- constantly thinking about and longing for the deceased
- illogical thoughts about the deceased and their death
- unable to feel yourself
- not functioning well in areas such as work, home, and education
- not interested in the life you were leading before
- isolating yourself socially from friends and family
- a desire to be reunited with the loved one you lost
- possiby having suicidal thoughts.
Some groups of people are more likely to develop complicated grief disorder than others. These include women, women who suffered a miscarriage, people who did not benefit from healthy attachment with a caregiver as a child, anyone who was dependent on the deceased, and those who were already diagnosed with mood disorders or going through high stress before their bereavement happened.
*Killikelly, C., & Maercker, A. (2018). Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability. European journal of psychotraumatology, 8(Suppl 6), 1476441. doi:10.1080/20008198.2018.1476441
Bereavement counselling helps you come to terms with a loss and navigate your way back to coping.
Online grief counselling can be a godsend if you are feeling too low to leave the house but need support.
Family counselling can be incredibly useful in the face of the loss of a child, or a sudden loss that has left your family unit dysfunctional.
A grief support group can be a great resource if you are feeling alienated by loss, and would like to be in the company of others who understand and are going through the same thing.
Acceptance and commitment therapy (ACT) holds the perspective that pain and suffering are a normal and unavoidable part of human experience. It helps you stop the endless cycle of emotional suffering caused by trying to control and avoid things, and can help with feelings or rage, helplessness, and disbelief.
Cognitive behavioural therapy (CBT) focuses on helping you not be at the mercy of your thoughts. You'll learn to recognise when your thinking is distorted, and how to reach for the more balanced thoughts and behaviours that will stop you spiralling into depression.
Mindfulness based cognitive therapy (MBCT) helps you be in control of negative thinking and unhelpful behaviours by learning to more in the present moment.
Existential therapy is helpful if a loss or bereavement has made you question the point of your life. It helps you identify what gives you a sense of meaning, and then supports you to create a life that feels worth living.
Bonanno, George A. The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After Loss.
Collick, Elizabeth. Through Grief.
Didion, Joan. The Year of Magical Thinking.
Devine, Megan. It's Okay That You Are Not Okay.
Kushner, Harold S. When Bad Things Happen to Good People.
Rando, Dr. Therese. How to Go On Living When Someone You Love Dies.
Tatelbaum, Judy. The Courage to Grieve.
Ward, Barbara. Healing Grief.
Child Bereavement UK - helping families who have lost a child as well as helping children grieve.
Cruse Bereavement Care - support, advice and information for children, young people and adults, including a national hotline.
Grief Encounter - helping bereaving children and young people, including a national hotline and text/email services.
The Good Grief Trust - a charity run by the bereaved, for the bereaved.
NHS pages about grief an bereavement - general information, including when to see your GP about grief.
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Harley Therapy Ltd. “Dealing With Grief • Bereavement Support”. Harley Therapy, 10 Dec. 2019, https://www.harleytherapy.co.uk/deaing-with-grief.htm. Accessed 18 Sep. 2021.
Harley Therapy Ltd. (2019, December 10). Dealing With Grief • Bereavement Support. Retrieved from https://www.harleytherapy.co.uk/deaing-with-grief.htm
Harley Therapy Ltd. "Dealing With Grief • Bereavement Support." Last modified December 10, 2019. Accessed September 18, 2021. https://www.harleytherapy.co.uk/deaing-with-grief.htm.