Treating Death and Loss From COVID – 19
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DIFFERENT APPROACHES TO GRIEF
The Four Tasks of Mourning . Clinical psychologist J . William Worden , PhD , identified four tasks of grief that can help LCM- HCs understand the needs of clients who are grieving . First , the acceptance of the loss typically sets in when the griever realizes that the loved one is not physically present . The second task is difficult and unavoidable : The griever needs to experience the pain of such permanent departure . The third task calls for adjusting to a new reality and environment without the deceased and requires survivors to depend on themselves . The final task for the grieving person is to reinvest their energy into life ahead . The duration of this task varies , and there is no ideal or appropriate time for each task . The healing process depends on multiple factors surrounding the loss and survivor .
Dual-Process Model of Grief . Recently , we have seen a significant shift from the groundbreaking work of Elizabeth Kubler-Ross , MD , and her linear stage model of grief to a dualprocess model of grief developed by Margate Stroebe , PhD , and Henk Schut , PhD . Their model views grief as a dynamic process that oscillates between focusing on the loss ( i . e ., loss orientation ) and focusing on adjustment to the new reality ( i . e ., restoration orientation ). The loss orientation refers to a process associated with confronting the loss and experiencing pain related to it . For example , thinking about the loved one , reviewing pictures of them , and crying about the loss . The restoration orientation typically involves thoughts and behaviors that offer some respite from the loss , and enable grieving people to confront daily struggles and make necessary adjustments to life without the deceased . Oscillating between the two orientations is typical , and clinicians need to normalize and validate such processes .
Meaning-Making Model . Dr . Neimeyer also emphasized paying attention to meaning reconstruction after the loss of a loved one . Meaning-making is essential in post-loss adjustment . The three significant activities delineated by this model are :
• Sense-making : Sense-making focuses on explaining what caused the death , why it happened , and what this means about our life .
• Benefit finding : Benefit finding reflects positive reappraisal or silver lining , and it serves as a means of building new meaning structures .
• Identity reconstruction : Identity change involves reconstructing ourselves . We may change social relationships , relate to people differently , and understand who we are in a different light . Many people find they become more resilient , independent , and confident .
Despite varying models of grief , there is no one correct way to grief . Grief is a highly individualized process , and even though many people accomplish the same grief-adjustment tasks . Some people tend to grieve instrumentally ( e . g ., cognitive processing and dealing with grief through work and activities ). Others will grieve intuitively ( e . g ., expressing their emotions related to loss ), and some embrace both styles of grieving . Acquired knowledge and skills about grief are essential for LCMHCs when working with people who have lost loved ones .
Even though the interviews I conducted reveal the experience of sudden and unexpected loss , the novelty emerging is the impact of the isolation and helplessness that participants felt as they navigated their emotional pain and other grief symptoms while social distancing with no rituals . It ’ s not unreasonable to expect a prolonged and intense grieving process during the pandemic , because surviving family members did not have typical mourning outlets and many grieved individually in isolation .
STRATEGIES AND BEST PRACTICES TO HELP GRIEVING CLIENTS
Our clients ’ cultural backgrounds will play a role in how they experience and express grief . Some cultures might have more somatic complaints , others might express their feelings more , and others will handle grief more cognitively and through actions . Still others will disconnect and not talk about the deceased because of a belief that contact with a dead person is polluting .
Besides racial and cultural influences on how we grieve , many turn to religion and spirituality as a means of coping with loss . It is our responsibility as clinicians to be culturally competent and to approach grieving clients with cultural humility . We don ’ t shy away from asking our clients to explain how their culture views loss and grief . We consider our clients as “ experts ” in their lives , stories , and suffering . Alongside them , we offer a listening ear and empathy through support , reflection , and validation .
Initially , it is imperative to assess clients ’ grieving style and identify with which grieving task they might be struggling . Dr . Worden provides procedures that can help clients work through grieving tasks : continued on page 19
18 The Advocate Magazine Spring 2021 American Mental Health Counselors Association ( AMHCA )
www . amhca . org