Grief and loss are part of life and is experienced by most of us at some point in life. People deal with grief in many different ways, and not necessarily going through a predictable group of ‘stages,’ although some do. How people grieve can depend on the circumstances of the loss (e.g., sudden death, long illness, death of a young person) as well as past experiences of loss. There is no time limit on grief – some people get back to their usual routine fairly quickly, others take longer. Some people prefer time alone to grieve, others crave the support and company of others.
CBT for Bereavement
In the first session clients are given a psychological assessment to measure the symptoms of anxiety, depression, attitudes, and core beliefs as well as a semi-structured interview to gain an understanding of the client’s history and presenting problems.
A problem list is collaboratively drawn up to target those areas the client wants to change as a result of the therapy. An individualised programme is collaboratively drawn up with the client and forms the blueprint for the CBT sessions.
The conceptual framework of the therapist goes through six stages:-
- Coming to terms with reality of the loss.
- Working with the emotional pain, anger, guilt and suffering attributed to the loss.
- A readjustment of life without the significant person, in the present tense.
- Taking the emotional investment that the client had placed in their significant ‘other’ and rebuilding connections and relationship with others.
- Building ‘living memories’ which recognise the quality, importance and irreplaceable impact of the person in their loss, and building awareness of the impact and meaning this has for the person now.
- Spiritual Implications.
CBT works effectively by taking the client through the various stages inherent in the grieving process, and uses both cognitive (thinking) and behavioural techniques (doing) to cope more effectively with both the clinical symptoms of depression/anxiety as well as acting as an aid in the healing process.
More complicated grief reactions
Not every relationship is that smooth or free of conflict. Many people have mixed feelings about the person that they lost. Many children have been repeatedly disappointed by their parents or caregivers in more ways than they can count.
It is human to feel ambivalent. The people that we lose often had very human problems – addictions, poor parenting, gambling, or infidelity. These problems are real and are prevalent, yet the unwritten rule of grief is “You don’t speak ill of the dead.”
However, if you can’t speak about it, where does it go? The body remembers everything. Consequently, any unfinished anger or unresolved issues remain with the living, which often impede the natural healing. Excessive amounts of time and energy are spent trying to redo conversations once had, create the statements that were never voiced, or imagine reactions never received. These are heavy bricks to carry for endless days, months, or even years.
Adults have extreme difficulty with guilt for even having the “ambivalent” feelings. Children have an even tougher time with them as it is confusing to have two directly opposing feelings towards a person that was significant in their lives.
None of us do very well with incongruence. So our inclination is to swallow it, hide it away, and hope that it will one day disappear on its own.
Allow yourself the opportunity to name and label these differing emotions. Take inventory of the entire relationship. Help children have a chance to talk. Ask what they miss about the person, also ask what they don’t miss. Permission to have these mixed feelings is crucial. There are no perfect relationships.