06 Dec CANBERRA GRIEF CENTRE FEATURES IN CANBERRA DOCTOR EDITION OCTOBER 2017
Grief and Bereavement: To support or treat?
To be human is to experience loss; of home, country, identity, resources, employment, relationship, health, opportunity, future. And in response to this, we grieve. Grief is necessary and appropriate. Grieving is the process of adjusting to ‘new’ in the wake of what has been taken from us through loss or death.
Bereavement (the experience of loss following a death) is a loss accompanied with finality like no other. In these circumstances, the work of grief requires us to accept the reality and finality of the death, to process the layers of loss that sit around the death, to confront and attend to the multidimensional aspects of the pain (physical, emotional, cognitive, spiritual pains) and embark on the process of change, adaption and re-defining ‘self’ in the absence of the person.
There is no magic nor prescribed timeline for this process. It can’t be hurried, nor should it be. Good bereavement outcomes rely on a number of factors but none so important as permission and support to ‘grieve’ in the midst of re-shaping a new sense of living.
Humans have an innate capacity to grieve well with minimal or no intervention from professional services (Raphael, Minkov, & Dobson, 2001) when permitted to do so. The bereaved instinctively know what it is they need, or at least DON’T need, in order to attend to this experience. The bereaved are not broken, they are grieving. There is nothing to fix. Instead, in the absence of a key attachment which has been disrupted by death, grief seeks other supportive attachments without judgement or expectation.
All too frequently, grief is misdiagnosed, mislabelled or missed completely. We seek ways to ‘treat’ it, to move it along, to create a more socially acceptable illusion of ‘happiness’ to fit with a paradigm of ‘wellness’. In many cases we pre-emptively label it depression and support it with a pharmacological response. Grief is not depression. It is sadness.
However, where MDD presents in bereavement (more commonly presents where there is a history of depression rather than a single episode), evidence suggests, pharmacological treatment in collaboration with grief therapy can reduce the risk of more complex and complicated presentations in grief (Shear, 2009; American Psychiatric Association, 2013).
As health practitioners, we must be cautious about imposing our own fears (of client deterioration in health or other factors) on the bereaved. Tolerance to hold the space of grief chaos is challenging but essential. A premature pharmacological response or inappropriate therapeutic intervention can inhibit and disrupt innate resilience and capacity, increasing the risk of complicated and pathological grief. In the midst of the most tragic of deaths and losses, most people have a capacity to endure, survive and thrive, but only where a grief sympathetic environment exists; one which is permissive, empowering and focused on what the bereaved are managing rather than what they are not managing (strengths based).
There is more to grief than Kubler-Ross. Research, studies and client experiences have provided significant insight and advancements in our understanding of when grief is being derailed. In order to promote good bereavement outcomes, it is imperative that health professionals upskill in understanding the difference between healthy grief and more complex, complicated, pathological presentations. An experienced and trained grief therapist will assist the bereaved to cope and manage the whole grief response, eliminating the need to avoid, deny and medicate that which must be adapted to and lived with.
‘Grief is a human, not medical, condition, and while there are pills to help us to forget it – there are no pills to cure it. The things is, nature is so exact, it hurts exactly as much as it is worth, so in a way one relishes the pain, I think’
Julian Barnes, Levels of Life (2013)
Our experience with many variants of loss, indicates that for most clients an average of 4-5 visits with a counsellor (where the therapist is specifically trained in and experienced with grief) is sufficient to promote a new and healthy relationship with their grief. Following this time, clients might choose to return in anticipation of certain dates, occasions or where the presenting loss has been aggravated by another life stressor/event.
Canberra Grief Centre is a private practice managed and owned by Sonia Fenwick and Mandy Cox, both qualified and professionally registered counsellors with over 14 years’ experience supporting death, dying and loss. Clients can self-refer or consent to another person facilitating contact with the Centre.
Sonia and Mandy are able to consult with GPs about client cases involving general or more complex presentations of grief as a means of designing a healthy bereavement pathway for the client.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing, Washington DC.
Raphael, B., Minkov, C., & Dobson, M. (2001) Psychotherapeutic and pharmacological intervention for bereaved persons. In M.S. Stroebe, R.O. Hansson, W. Stroebe,& H. Schut (Eds.) Handbook of Bereavement Research (pp. 587-612). Washington, D.C.: American Psychological Association
Shear, K. M. (2009). Grief and Depression: Treatment decisions for bereaved children and adults, The American Journal of Psychiatry, 166(7), 747-748.