What is Grief Therapy, Stages of Grieving, and How Can Grief Therapy Help?

Many people often get surprised to hear about therapy for grief. Therapy for grief, also known as grief counseling, is designed to help you process and cope with your loss. This loss may be of a friend, a pet, or a family member. Loss can also be associated with other life circumstances. Grief affects each one of us differently. It also impacts different people at different times. During the grieving process, it is normal to experience anger, sadness, confusion, or sometimes even relief. It is also common to experience guilt, regret, and even symptoms of depression.^{(1, 2, 3, 4, 5)}

Grief therapy is done by a psychologist, a licensed therapist, a grief counselor, or a psychiatrist. Consulting a mental health expert for dealing with grief and loss can help you process and cope with the feelings you are experiencing and also learn new strategies to cope within a safe space.

A person tends to grieve in stages or periods, with each stage involved with different feelings and experiences. In order to help make sense of the grieving process, many experts follow the stages of grief.^{(6, 7)}

The typical stages of grief are described by the Kubler-Ross stages of grief model, which was created by Elisabeth Kubler-Ross. While these stages of the grief model were originally designed about people dying and not about the grieving process, but later the same grief model was rewritten by Kubler-Ross to apply the principles to the grieving process following a loss.^{(8, 9)}

As per the Kubler-Ross model of grief, there are five stages of grief that a person goes through following a loss. These include:

• Stage 1: Denial – The first stage after the death of a loved one is to be in denial about what has happened. This denial helps temporarily protect you from the overwhelming wave of emotions that are associated with grieving.
• Stage 2: Anger – You will find yourself getting angrier than usual and direct your emotions at other people, especially the person who died. It is also possible to feel angry at yourself.
• Stage 3: Bargaining – Once you move away from the stages of denial and anger, you will find yourself going through a period where you come up with a lot of ‘what if’ and ‘if only’ sentiments.
• Stage 4: Depression – This is usually the quiet stage of grieving. During this stage, you are likely to experience an overwhelming feeling of confusion and sadness. It is common for a person to feel like they are unable to take the weight of their emotions any longer during this depression stage, and you may want to stay alone, away from others.
• Stage 5: Acceptance – The last stage of grief is acceptance of what happened and understanding what your life now looks like without the loved one you have lost.

While these five stages of grief are widely accepted, but in recent years, many experts have further expanded this five-stage model to include seven stages.

These seven stages of grief include:

1. Denial and shock
2. Guilt and pain
3. Anger and bargaining
4. Depression
5. Making an upward turn
6. Reconstruction and working through the grief
7. Acceptance and hope

It is essential to keep in mind that there is no evidence to support the stages of grief. According to a review done in 2017, several experts believed that following a grief model might not be the best when dealing with people who are going through grief. ⁽¹⁰⁾

The Kubler-Ross model of grief was written to help understand the stages that people who are dying and what their families go through, and not for people to use after experiencing a loss. One positive outcome of these stages of grief models is that they emphasize that grief is not one-dimensional. There are many dimensions to grief, and it is absolutely normal to experience grief through many emotions and feelings.^{(11, 12, 13)}

Grieving can be a long-lasting process, and in overwhelming cases, it may start to interfere with your daily life. This may develop into a condition known as prolonged grief disorder.^{(14, 15)}

According to the American Psychological Association, here are some of the symptoms that are associated with prolonged grief disorder:⁽¹⁶⁾

• Difficulty accepting the loss
• Intense emotional pain
• Pervasive longing for the deceased
• Emotional numbness
• Persistent feelings of depression
• Feeling like you have lost a part of yourself
• Withdrawal from social activities that you used to enjoy at one point in time

Typically, this type of prolonged grief tends to involve the loss of a partner or child. It can also be due to sudden or violent death. According to a meta-analysis carried out in 2017, prolonged grief disorder may impact approximately ten percent of people who have lost their loved ones.⁽¹⁷⁾

Seeking therapy after experiencing a loss in your life can help you overcome feelings of depression and anxiety. Grief therapy enables you to process the experience of loss at your own pace. Every mental health professional will use a different approach to help patients deal with grief. Two of the standard methods used during grief therapy are cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

1. Cognitive Behavioral Therapy (CBT)

   Cognitive-behavioral therapy is a commonly used therapy approach for dealing with mental health conditions like anxiety, depression, and post-traumatic stress disorder (PTSD). During a session of cognitive-behavioral therapy, your therapist will help you identify the negative thought pattern that is impacting your behavior following the loss in your life.

   They are going to ask you to explore the thoughts you have related to loss and grief and any other negative thoughts. This will help you address how such thoughts are affecting your behavior and mood. Your therapist can help you reduce the impact of these negative thoughts with strategies that involve reinterpreting, targeting, and reframing behaviors.^{(18, 19, 20)}

2. Acceptance and Commitment Therapy (ACT)

   Acceptance and commitment therapy is another common technique used to help people process grief and loss. According to a research paper sponsored by the American Counselling Association in 2016, acceptance and commitment therapy may be helpful in dealing with prolonged, complicated grief as it encourages patients to use mindfulness to come to terms with and accept their experience.^{(21, 22, 23)}

   There are six main processes used under acceptance and commitment therapy during grief counseling. These include:

1. Acceptance of the negative emotions: This step focuses on developing a willingness to experience and accept the negative thoughts and feelings.
2. Cognitive defusion: The process of cognitive defusion involves distancing yourself from your emotions to make it easier to examine and understand them from afar.
3. Developing contact with the present moment: By teaching the technique of mindfulness, acceptance, and commitment therapy encourages people to focus on the present moment. This will help you accept change and also experience life in the present moment.
4. Observing yourself as context: This step of the process involves observing yourself as having the experience of being an outside observer of the experiences in your life.
5. Values: Values are the principles that you hold that will help give direction to your life.
6. Taking committed action: The final step of ACT involves taking firm action and overcoming various obstacles by working through the above steps.

Grief therapy for children takes into account many of the same things that grief counseling for adults deals with, but the therapist has to work in ways that are age-appropriate for children. According to the American Academy of Child and Adolescent Psychiatry, children, especially those who are younger, tend to react differently to death than adults.⁽²⁴⁾ In general, children who are in pre-school view death as a temporary phenomenon and something that is reversible. However, children aged five to nine years are known to think slightly similar to most adults. Some of the common ways in which grief counselors treat children through a period of loss include:

• Narrative Therapy: Many children’s books directly address the concept of death but in a child-centric manner. During narrative therapy, a therapist uses books to help develop an understanding of death and dying in a child. They also explain what can happen as the child moves forward in life without their loved one.^{(25, 26)}
• Play Therapy: This form of grief counseling uses a child’s most instinctive nature of interacting with the world through play. A therapist may use puppets, dolls, stuffed animals, a dollhouse, and other toys to encourage the child to speak up and communicate their feelings, thoughts, concerns, and any questions they may have about death.^{(27, 28)}
• Art Therapy: This form of grief counseling allows a child to express themselves and communicate creatively and without the need for words. A therapist typically asks a child to draw or paint a picture of the person they are grieving. This is used as a way to explore the child’s feelings and emotions.⁽²⁹⁾

It can be very difficult to continue living your life after the loss of a loved one. Every person manages and deals with grief in their own way, so it is challenging to predict the outlook of people battling grief. It is also, therefore, difficult to tell which treatment would work the best.

Healing and coping with grief is a unique and individualized process, and grief therapy can play a supporting role in this healing process by counseling you on how best to cope with the situation. Remember that grief does not follow one path, and there is no right way or wrong way to heal and get over your grief. Counseling with a trained therapist can help you deal with your grief in a better way than dealing with it alone.

References: