Bereavement counseling

Definition

Bereavement counseling—sometimes called grief counseling—refers to counseling offered to individuals who have suffered a loss, typically the death of a loved one, in order to help the bereaved through the process of mourning and recovery. It may also be offered before death to help survivors cope with terminal illness and to healthcare staff after the death of a senior for whom they have worked.

Bereavement or grief counseling should not be confused with grief therapy, which is a specialized form of mental health care given to people who are having trouble with the mourning process. Grief counseling is intended for those who are having a normal or uncomplicated grief reaction; it may be offered by clergy, social workers, nurses, or marriage and family counselors who have received advanced training in helping people with grief.

Description

There is no single model or pattern of bereavement counseling. It may take the form of one-on-one conversations between the client and the counselor in the senior's home or in the counselor's office or in a hospice.

Bereavement counseling may also take the form of group meetings of recently bereaved people; these may be sponsored by a church or synagogue, senior center, local hospital, or other community group.

Bereavement counseling is not intended to guide individuals to grieve in a supposedly correct or appropriate way, but to offer companionship during the process of healing from a loss. Although at one time thanatologists (people with expertise in issues related to death and dying ) tried to identify stages or patterns to the grief process, most counselors in the early 2000s focused on attentive listening to bereaved individuals and allowing them to grieve in their own way. It is generally accepted that people vary widely in their responses to death or loss, depending on their age, general health, level of education, size of extended family and other social support, financial situation, ethnic and cultural background, gender, religious or spiritual convictions, and the circumstances of the death or loss. Some people deal with grief primarily through the emotions whereas others prefer to think, pray, or meditate, and still others get involved in taking care of the dead person's affairs or other activities that keep them busy. Many seniors are helped by mourning rituals from their particular culture or religion.

Bereavement counseling is intended to help in several ways:

• Validate the mourner's individual reactions to the loss. This approach means that the counselor accepts the person's way of grieving rather than challenging or criticizing it. It is not unusual, incidentally, for different family members to react differently to the loss of the same relationship; for example, three siblings may react in different ways to the loss of a parent.
• Explain or discuss the physical, emotional, and mental reactions that often accompany grieving so that the bereaved person is not further distressed by unanticipated feelings or thoughts. It is not unusual for mourners to wonder whether they are going crazy or have a serious illness in addition to grieving their loved one.
• Help mourners organize day-to-day tasks so that they are not stressed further by unpaid bills, household disorder, delayed legal paperwork, or other problems that may arise when everyday chores are neglected.
• Assist mourners with recognizing their own strengths and developing new or stronger coping mechanisms.
• Refer mourners to a mental health professional if they seem to be developing complicated grief (described below).

Seniors have special needs in bereavement counseling for a number of reasons:

• The death of a loved one often comes after a series of other losses, such as retirement (loss of one's occupation); moving into a smaller apartment or assisted living facility (loss of a home); reduction of income; and the physical limitations that come with old age. In some cases, seniors do not have time to cope with one loss before the next one occurs.
• The physical effects of grief on the immune system and general energy level are harder on seniors than on younger persons.
• Seniors find their social support system shrinking with each death of a family member or friend, in contrast to younger adults who find it easier to remarry or make new friends.
• Seniors are at greater risk than younger adults of committing suicide if they develop complicated grief.
• Elderly men have increased mortality rates after the death of a spouse whereas elderly women do not appear to be affected this way.

Normal bereavement

Normal bereavement is characterized by a range of physical and emotional symptoms that vary from person to person. Anxiety , depression , a sense of numbness or unreality, anger or guilt, wide mood swings, difficulty paying attention or concentrating, and jumpiness or an intensified startle reaction are common emotional accompaniments of normal bereavement. Some grieving people experience hallucinations of seeing the dead person or hearing the person's voice; these experiences do not mean that the bereaved person is mentally ill. Loss of appetite, insomnia , nausea or vomiting, headaches , chest pains, shortness of breath, and feeling easily fatigued are common physical reactions to grief. In addition, the human immune system is weakened by grief, so that mourners are more likely to get colds, flu, or other contagious diseases during bereavement.

Medications or other forms of therapy are not usually necessary for people in a normal bereavement process; however, seniors who are having trouble with insomnia may be given a medication for a brief period of time to help them sleep. In general, doctors do not routinely treat seniors with antidepressants simply because they are grieving; they look for signs of a major depression or complicated grief before prescribing antidepressants. The best way to care for bereaved seniors is to make sure that they eat properly, get enough sleep, avoid exposure to contagious illnesses, avoid self-medicating with alcohol or drugs, and follow the doctor's other healthcare recommendations.

Complicated grief

Complicated grief refers to a type of intensified mourning that goes on for months or even years after the death or loss and does not seem to be resolving or lifting. Although a precise definition of complicated grief had not been developed as of 2008, researchers think that it affects between 6 and 20 percent of bereaved people. Most counselors use 6 months after the death as a rough timeline in assessing whether a bereaved person has complicated grief. Complicated grief is characterized by symptoms or behaviors that are so severe that they interfere with normal functioning, such as a high level of jumpiness or agitation; difficulty trusting others or moving forward with life; intense pining or excessive bitterness and anger about the death; talking about joining the loved one or saying that life has lost all meaning; and blaming oneself for the death or insisting it could have been prevented. There are a number of factors that increase seniors' risk of complicated grief:

• The death was sudden, so that there was no opportunity to say good-bye to the loved one or settle unresolved problems.
• The loved one was murdered or committed suicide.
• The loved one died in a mass disaster (earthquake, hurricane, fire, terrorist attack, transportation disaster).
• The seniors lack friends, have no other family, or have no spiritual community.
• The relationship with the dead person was difficult or conflicted.
• The seniors were abused as children or suffered other traumatic experiences in childhood.
• The seniors have a history of being inflexible or having difficulty adapting to change.

Seniors who appear to be suffering from complicated grief should be referred to a psychiatrist or other experienced mental health professional, particularly if they are at risk of suicide . Grief therapy, which is more structured and more directive than bereavement counseling, usually consists of a combination of medications and psychotherapy intended to help seniors deal with emotions and improve coping skills.

Family and healthcare givers

Many hospice organizations offer bereavement counseling to family members or healthcare professionals who cared for seniors before death and became close to them.

Pet loss

Since the 1990s many counselors have recognized that the loss of a pet can be as painful to seniors as the death of a friend or family member. For many seniors, their pets are their only household companions. In addition, advances in veterinary medicine have extended pets' life spans just as humans' life spans have been increasing. It is no longer unusual for a dog to live to be 10 to 15 years old, depending on breed, while cats may live into their early twenties or even thirties. Some breeds of large parrots may live to be 80 or 90 years old. This increased longevity means that senior may have had their pet for many years and miss the animal acutely. The loss may be particularly painful if the animal had to be euthanized, as the decision to put a pet to sleep is a reminder of seniors' own end-of-life issues.

Several schools of veterinary medicine have pet grief hotlines. In addition, most veterinarians with small-animal practices have had some training in pet loss issues and can help seniors struggling with this type of bereavement.

Viewpoints

There has been some debate among healthcare professionals regarding the health benefits—physical as well as mental—of bereavement counseling. Beginning in 2002, some psychologists began to report that their clients had been harmed by grief counseling. These findings made their way into the popular press in 2007, when an article published in Newsweek cited a researcher to the effect that “four in ten who entered grief therapy … would have been better off without treatment.” A Swedish study published in early 2008 reported that bereavement counseling did not appear to affect the rate of illness or death in 50 elderly men and women after they had been widowed. While many thanatologists question the notion that bereavement counseling is either harmful or ineffective, they agree that further research is warranted for the sake of the wellbeing of bereaved people.

Another debate concerns the need to standardize a working definition of complicated grief so that persons who are having difficulty in bereavement can be identified and offered help. Some psychiatrists have proposed defining complicated grief as a mental disorder and adding it to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), anticipated to be published in 2010 or 2011.

KEY TERMS

Bereavement —The period after the death of a loved one during which grief and mourning take place.

Complicated grief —A chronic state of intense mourning that lasts for months or years after the loss.

Grief —A collections of reactions to death or other losses. Grief involves thought processes and spiritual considerations as well as emotional reactions.

Mourning —The process of adjusting to a death or other loss. Mourning is often shaped or affected by the bereaved person's religious or cultural background.

Thanatology —The study of death and dying and of human reactions to these events.

Validation —In counseling, the support for or corroboration of the client's feelings or thoughts.

Resources

BOOKS

Beers, Mark H., and Thomas V. Jones. Merck Manual of Geriatrics, 3rd ed., Chapter 15, “Social Issues.” Whitehouse Station, NJ: Merck, 2005.

PERIODICALS

Begley, Sharon. “Get Shrunk at Your Own Risk.”Newsweek (June 18, 2007): 49.

Grimby, A., and A. K. Johansson. “Does Early Bereavement Counseling Prevent Ill Health and Untimely Death?” American Journal of Hospice and Palliative Care 24 (December 2007/January 2008): 475–478.

Shear, Katherine, Ellen Frank, Patricia Houck, and Charles Reynolds III. “Treatment of Complicated Grief: A Randomized Controlled Trial.” Journal of the American Medical Association 293 (June 1, 2005): 2601–2608.

OTHER

Carmack, Betty J. “Coping with Animal Companion Loss across the Age Continuum.” ADEC Forum April 2007 [cited March 5, 2008]. http://www.adec.org/coping/PDF/Coping%20with%20Animal%20Companion%20Loss.pdf

“Normal Reactions to Loss.” AARP [cited March 4, 2008]. http://www.aarp.org/families/grief_loss/a2004-11-15-reactions.html

“Statement on Studies of Grief Counseling.” Association for Death Education and Counseling (ADEC) [cited March 4, 2008]. http://www.adec.org/documents/Grief_Coun-seling_Helpful_or_Harmful_Revision.pdf

ORGANIZATIONS

American Academy of Grief Counseling, 2400 Niles-Cortland Rd. SE, Suite # 3, Warren, OH, 44484, (330) 652-7776, (330) 652-7575, http://www.aihcp.org/aagc.htm.

American Association of Pastoral Counselors (AAPC), 9504-A Lee Highway, Fairfax, VA, 22031, (703) 385–6967, (703) 352-7725, info@aapc.org, http://www.aapc.org/index.cfm.

Association for Death Education and Counseling (ADEC), 111 Deer Lake Road, Suite 100, Deerfield, IL, 60015, (847) 509-0403, (847) 480-9282, http://www.adec.org/.

Michigan State University College of Veterinary Medicine Pet Loss Support Hotline, (517) 432-2696, http://cvm.msu.edu/alumni-friends/information-for-animal-owners/pet-loss-support/plsh_brochure.pdf.

National Center for Death Education (NCDE), Mount Ida College, 777 Dedham Street, Newton, MA, 02459, (617) 928-4500, http://www.mountida.edu/sp.cfm?pageid=307.

Rebecca J. Frey Ph.D.