10 Guidelines for Grief Counselling

Whatever the circumstances of loss and grief, there are certain principles and procedures that contribute to the effectiveness of grief counselling. Some of the guidelines adapted from Worden (2005) are listed below.

1. Help the bereaved actualize the loss

The goal is to help the bereaved come to a place of complete awareness that the death has occurred. The mourner must accept reality before they can deal with the emotional impact of the loss. The best way to actualize the loss is to talk about the loss.  The counsellor’s role is to be a patient listener and encourage the person to talk about the loss including past and present memories of the deceased.  Bringing the client to a greater sense of clear awareness that the death has occurred can be achieved through such questions as “how did the funeral go?” “Where were you when you heard?”

2. Help the bereaved identify and experience feelings

Numerous feelings may not be recognised or may even be intentionally avoided by the bereaved because of the overwhelming pain associated with the loss of a loved one. Such feelings as anger, guilt, anxiety, helplessness and loneliness are problematic for bereaved individuals because in times of significant loss the level of intensity with these emotions is strong. Anger needs to be properly and effectively targeted, guilt needs to be evaluated and resolved and anxiety needs to be identified and managed. The role of the therapist is to assist the bereaved explore these and other feelings in order to resolve, manage and overcome them. Identification and experience of feelings enables the bereaved client to feel a sense of relief and encourages them to start exploring options.

3. Assist living without the deceased

This involves helping people accommodate the loss by facilitating their ability to live without the deceased and make independent decisions. To assist with this, the counsellor may use a problem solving approach. The counsellor will need to help the bereaved identify the problems that arose since the loss occurred.  Decision making techniques are also valuable as in many relationships, one spouse is a primary decision maker and when that person dies, the survivor often experiences the decision making problems. The counsellor can help the bereaved develop coping skills and decision making skills to enable them to take over the role of decision maker and minimise emotional distress.

4. Help find meaning in the loss

The goal of the counsellor is to help the bereaved find the meaning in the death of a loved one. For example, some people who have experienced a loss will set up a memorial charity in honour of the deceased, lobby for change in legislation as an attempt to prevent future deaths. This helps create a feeling that the death of the loved one was not in vain. The counsellor can help facilitate this. Meaning may also be found in reassessing perceptions about the death and also assessments on the deceased loved one’s impact on the life of the client.

5. Facilitate emotional relocation of the deceased

Some people are hesitant to form new relationships after the death of a loved one, where as others are quick to jump into new relationships. This is especially true for individuals who have lost a spouse. Those that are hesitant may have strong beliefs that the new relationship will dishonour the deceased. The counsellor’s focus regarding this is to help the survivor realize that the lost person can never be replaced and that it is alright to form new relationships as a part of the process in moving on.  For those who are quick to form new relationships, they may be attempting to replace the lost spouse and fill in the void. In this instance the focus will be on helping the client realise the need to experience intense grief, rather than avoiding it by finding a token replacement for the loss, and for them to start coming to terms with and accepting the loss prior to forming new attachments.

6. Provide time to Grieve

Grief is a process and it requires time. Certain points in time are particularly difficult for the survivor. For example, birthdays, holidays and anniversaries all have the potential to evoke the painful experience of the loss. It is the counsellor’s role to recognize these critical times and assist the client to prepare in advance for them.

7. Interpret normal behaviour

After a significant loss, many people have the sense that they are going crazy.  The role of the counsellor is to reassure the client that their behaviour is normal and common in grieving individuals. As such, it is critical for the counsellor to have a clear understanding of normal grief behaviours in order to offer reassurance to the bereaved about the normality of the new experiences that they are facing in their loss.

8. Allow for individual differences

People experience loss in different ways and as such grief is experienced differently too. It is important to note that there are different behaviours that a grieving person can exhibit. The intensity of the grieving reactions, the length of time that the person takes to resolve painful emotions and how a person displays their grief will vary from person to person. The role of the counsellor is to help interpret the variability of the behaviours to each individual.

9. Examine defenses and coping styles

The focus here is for the counsellor to help the client examine their coping styles. This helps identify both functional and dysfunctional coping strategies in dealing with the loss. For example, one common ineffective coping strategy in grief is substance abuse. The counsellor will have to look out for this ineffective coping mechanism in the sense that substance abuse, particularly alcohol, can intensify the experience of grief and depression and impair the bereavement process. The counsellor can help highlight the various coping strategies employed and encourage the client to evaluate their effectiveness and together (the counsellor and the client) can explore other more effective coping mechanisms that the client can employ.

10. Identify pathology and refer

The goal here is to know when to refer. If the counsellor identifies the existence of pathology that has been triggered by the loss, it may be suitable for the grief counsellor to make a professional referral. Grief counselling is a multifaceted practice and some cases may be more difficult, especially where there is complicated grief involved. Such cases may require specialist intervention in some other form that may be beyond the scope of more standard forms of grief counselling. At this point, a referral for specialized intervention may be more appropriate depending on the boundaries of your own training and expertise.

Source: www.mentalhealthacademy.com.au