Grief and Loss

What is grief?
Grief is a broad term used to describe reactions to loss. It encompasses thoughts, feelings, behaviours, and physical symptoms that are more or less commonly experienced by people affected by a significant loss. Although there are many common features of grief, it is important to remember that it is a highly individual experience – no two people will experience a loss and grieve in the same way.

“Each person’s grief is like all people’s grief; each person’s grief is like some other person’s grief; and each person’s grief is like no other person’s grief.”

(Worden, 2009, p. 8)

The term grief reaction or grief response is often used to refer to grief experiences relating to any type of loss. The term bereavement specifically refers to the experience of having lost a loved one to death, while mourning refers to the different cultural and religious practices through which bereavement is expressed.

Loss of some aspect of self
This may occur as a result of a relationship loss. For example, a woman may lose her role as a wife through the death of her spouse. However, any situation that involves a significant to
change to one’s sense of self, such as illness, disability, physical changes, sexual assault, physical assault, domestic and family violence, and more may result in grief (Humphrey and Zimpfer, 2008). A loss of dreams or hopes may also be included in this category. For example, parents of children with special needs may have to adjust to a different future than the one that they had envisioned for their child and themselves.

Circumstantial or life-changing events, such as those described above, tend to take place over a relatively short period of time with little or no opportunity for preparation and tend to involve permanent, long lasting consequences. They also tend to require significant adjustment to a person’s beliefs or assumptions about the world (Parkes, 1993, cited in Machin, 2009). They may be individual or can affect families or even whole communities. For example, at times of war, significant losses including loss of homes, loved ones, and injury and disability are experienced across entire communities. Refugees and migrants, in particular, may face significant losses including their family, home, and identity.

Developmental losses
Another less visible and obvious source of grief includes those losses that arise from
developmental change across the life span.
“Equating grief with death and bereavement often obscures the reality that multiple losses
are experienced across the life cycle. Those most readily overlooked are the losses that come with developmental changes – starting school, leaving school, moving house, retirement etc. which may be absorbed into the fabric of day-to-day life that the impact may hardly be noticed (Sugarman, 2001).”

(Machin, 2009, p. 3)

Relationship loss
This may occur through the death of a loved one (e.g., through illness, accidental, or violent
death) or the breakdown of a relationship (through divorce, illness, abuse, distance, etc.).

Loss of treasured objects
Although objects are considered by most as replaceable and unimportant, the symbolic significance or memories that may be attached to them means that their loss can be deeply upsetting. For example, family heirlooms represent an irreplaceable link to the past for many people and, if lost through theft or fire, can result in powerful feelings of loss that may go unacknowledged.

Primary and secondary losses
The initial focus is most commonly on the distinct events that result in these different categories of loss – the death of a loved one, a relationship breakdown, a natural disaster, accident, or the diagnosis of an illness. However, every loss is multi-layered, involving the primary event and the less obvious associated losses.

The primary loss is the initial, core loss that forms the foundation of the grief experience. In bereavement, this is generally the loss of a loved one. The initial grief response (which we will be exploring in more detail shortly) is usually attributed to this primary loss.

Secondary losses follow or are associated with a primary loss. For example, in bereavement, secondary losses may include changes in or loss of financial security, social status, social and family roles, identities, family structures, and the sense of safety or certainty in the world and/or a higher power. These secondary losses may initially be overlooked given the dominance of the primary loss, but counsellors should listen carefully for secondary losses and their impacts. Not doing so means we may not fully recognise, or help our clients adjust to, the nature of the losses they have experienced.

There is also a wide range of emotions that may be experienced throughout the grieving process.

  • Sadness is a common response to loss and may be expressed or managed in varying
    ways (often dictated by social expectations).
  • Yearning/pining is associated with the early stages after a loss event, generally a
    bereavement, where intense ‘pangs’ of grief are experienced. Theorists liken this to the

feelings of infants when separated from their main caregiver (as described in Bowlby’s
attachment theory). There is a feeling of emptiness coupled with a longing for the person
lost (Travers, Niloufer, & Kolkiewicz, 2013).

  • Anger is commonly experienced in grief, but it can be a distressing and confusing emotion for those who have experienced a loss. It generally results from a sense of frustration and helplessness about not being able to prevent the loss and may be directed at others (Worden, 2009). For instance, in the context of losing a loved one, the grieving person may feel angry at the deceased for dying, or at a doctor or god for letting it happen. Although many people are understanding and supportive of people who are grieving or who have experienced well-recognised losses (e.g., bereavement, divorce), they may find certain emotional manifestations such as anger, irritability, or over-sensitivity more challenging to deal with. Although these are common reactions, they may have a significant negative impact on a person’s social and occupational life (Pomeroy & Garcia, 2009).

  • Anxiety reactions may range from vague feelings of insecurity to full blown panic attacks. Upon losing a loved one, there is often a sense of not being able to cope alone, as well as a heightened sense of vulnerability and awareness of one’s own mortality (Worden, 2009). Anxiety is also a common reaction associated with other types of loss (e.g., relationship breakdown, loss of job, moving) as people experience a sense of insecurity or lack of control, and may find themselves worrying about their future. Where anxiety is problematic, counsellors may address this using appropriate approaches (e.g., cognitive behavioural techniques); where anxiety it is intense or prolonged, a referral to see a clinical mental health professional is warranted.

  • Loneliness is often experienced, particularly in the case of a close relationship involving day-to-day contact. Stroebe and colleagues (1996) differentiate between the emotional loneliness that arises from the loss of a major attachment figure and social loneliness which can be alleviated to a certain extent by social support. For example, people who are grieving the loss of a loved one or a relationship may often feel lonely, even if they are surrounded by friends and family.

  • Relief can be the dominant emotion if a loved one experienced a lengthy or painful illness before dying. As one widow described, “the knowing that his suffering, both physical and mental, is over helps me cope” (Worden, 2009, p. 23). It can also occur if the circumstances prior to loss had been particularly challenging; for example, ending a difficult relationship or leaving an extremely stressful job.
    
  • Numbness. Some people describe a lack of feeling after a loss, usually early on in the grieving process. This is not necessarily maladaptive. “We have found no evidence that is an unhealthy reaction. Blocking of sensation as a defence against what would otherwise be overwhelming pain would seem to be extremely ‘normal’” (Parkes & Weiss, 1996, as cited in Worden, 2009, p. 23). However, numbness in the context of other factors such as trauma will require specialist assessment, so a referral to a specialist mental health practitioner should be facilitated. You will learn more about identifying referral indicators in the later in this Study Guide.
    
  • Guilt and remorse are commonly expressed – for lost opportunities, things said or done, or actions taken or not taken. For example, there may have been things not done before a loss, which the person grieving thinks could have prevented it. These feelings are often expressed as ‘if onlys’ (Winokuer & Harris, 2012).