helping the bereaved to accept the loss by helping him or her to talk about the loss
helping the bereaved to identify and express feelings related to the loss (for example, anger, guilt, anxiety, helplessness, and sadness)
helping the bereaved to live without the person who died and to make decisions alone
helping the bereaved to separate emotionally from the person who died and to begin new relationships
providing support and time to focus on grieving at important times such as birthdays and anniversaries
describing normal grieving and the differences in grieving among individuals
providing continuous support
helping the bereaved to understand his or her methods of coping
identifying coping problems the bereaved may have and making recommendations for professional grief therapy
Grief therapy is used with people who have complicated grief reactions. The
goal of grief therapy is to identify and solve problems the mourner may have in
separating from the person who died. When separation difficulties occur, they
may appear as physical or behavior problems, delayed or extreme mourning,
conflicted or extended grief, or unexpected mourning (although this is seldom
present with cancer deaths).
Grief therapy may be available as individual or group therapy. A contract is set up with the individual that establishes the time limit of the therapy, the fees, the goals, and the focus of the therapy.
In grief therapy, the mourner talks about the deceased and tries to recognize whether he or she is experiencing an expected amount of emotion about the death. Grief therapy may allow the mourner to see that anger, guilt, or other negative or uncomfortable feelings can exist at the same time as more positive feelings about the person who died.
Human beings tend to make strong bonds of affection or attachment with others. When these bonds are broken, as in death, a strong emotional reaction occurs. After a loss occurs, a person must accomplish certain tasks to complete the process of grief. These basic tasks of mourning include accepting that the loss happened, living with and feeling the physical and emotional pain of grief, adjusting to life without the loved one, and emotionally separating from the loved one and going on with life without him or her. It is important that these tasks are completed before mourning can end.
In grief therapy, six tasks may be used to help a mourner work through grief:
1) develop the ability to experience, express, and adjust to painful grief- related changes,
2) find effective ways to cope with painful changes,
3) establish a continuing relationship with the person who died,
4) stay healthy and keep functioning,
5) reestablish relationships and understand that others may have difficulty empathizing with the grief they experience, and
6) develop a healthy image of oneself and the world.
Complications in grief may come about due to uncompleted grief from earlier losses. The grief for these earlier losses must be managed in order to handle the current grief. Grief therapy includes dealing with the blockages to the mourning process, identifying unfinished business with the deceased, and identifying other losses that result from the death. The bereaved is helped to see that the loss is final and to picture life after the grief period.
Complicated grief reactions require more complex therapies than uncomplicated grief reactions. Adjustment disorders (especially depressed and anxious mood or disturbed emotions and behavior), major depression, substance abuse, and even post-traumatic stress disorder are some of the common problems of complicated bereavement. Complicated grief is identified by the extended length of time of the symptoms, the interference caused by the symptoms, or by the intensity of the symptoms (for example, intense suicidal thoughts or acts).
Complicated or unresolved grief may appear as a complete absence of grief and mourning, an ongoing inability to experience normal grief reactions, delayed grief, conflicted grief, or chronic grief. Factors that contribute to the chance that one may experience complicated grief include the suddenness of the death, the gender of the person in mourning, and the relationship to the deceased (for example, an intense, extremely close, or very contradictory relationship). Grief reactions that turn into major depression should be treated with both drug and psychological therapy. One who avoids any reminders of the person who died, who constantly thinks or dreams about the person who died, and who gets scared and panics easily at any reminders of the person who died may be suffering from post-traumatic stress disorder. Substance abuse may occur, frequently in an attempt to avoid painful feelings about the loss and symptoms (such as sleeplessness), and can also be treated with drugs and psychological therapy.