How To Do Grief with Your Clients

Thank you to Jill A. Johnson-Young, LCSW for this great guest post.

Grief, loss of a loved one, and bereavement are some of the most common key words used by potential clients looking for a therapist. They represent a practice specialty that many therapists approach as a generalist area not requiring advanced training. I’m not going to claim everyone needs training, given the right background, but most therapists are not experienced in the business end of death and grief.

Clients seeking help from someone unprepared for the conversations and process after a death can do tremendous damage. It can shut a client down, and make them wary of therapy for years.  I’ve seen the results in my office.

A licensed therapist was one of the speakers for a recent caregiver’s conference. Her topic was coping with grief and loss, and she opened with the “well known and well understood five stages of grief.” Icringed. She assumed there are five known stages of grief. She even attributed them to Elisabeth Kubler-Ross. Why did I cringe?

Elisabeth Kubler-Ross was a genius at getting us talking about death and dying back in the day, but she wasn’t talking about grief. She focused on anticipatory grief, owned by the dying person, not the survivor. Her work was descriptive and unapologetically unscientific, and eventually her goal became talking about death so the dying could prepare and be supported by loved ones who would understand their process. Did you know it wasn’t supposed to apply to survivors grieving after a death?

There are multiple of theories about grief, and even more “stages” that have been created and shared. My personal favorite is this one:

Do you notice what’s missing at the end? Acceptance, closure, peace? An end? A timeline? A neat and clean process? Grief is messy. It has its own clock. And it’s completely personal and intimate, specific to the griever and the loss they had, informed by prior loss experiences. In my approach to grief I frame the goal for grief work to be recovery, not closure. Closure implies leaving something behind, and it shuts down someone searching for a means to work through their loss without fear of losing their loved one forever.

When you are working with clients who have lost a loved one it’s more important than at any other time to start where they are, and to allow them to tell you their story as they experienced it. Most of the time there is no prompting needed. They are in your office to be heard. A griever is looking for a therapist who is realistic, and who doesn’t use platitudes or assumptions they’ve heard from a grief curriculum.

When I first meet with a grieving client, after they tell me their story I ask what things they’ve been told that they know were said with good intentions, but caused anger or hurt. The list will roll off their tongue with emotion, no matter how old the client may be. That list always includes “they’re in a better place”; “you should be glad they are no longer in pain”; “God needed another angel”; “You can meet/give birth/find another (insert here)”; “You need to be strong”; “Aren’t you feeling better by now?.” Even children have lists in their heads of things they’ve been told that have caused them stress because of the expectations they implied or the message that the death was a good thing in some way. The cause of death may have been terrible. They may be exhausted from caregiving. The accident might have been gruesome. The griever’s reality is that they didn’t want another angel, they want their loved one back, and if you want another angel so badly you send one of your loved ones to heaven and get theirs back. They need a therapist who is fully aware of the stuff not to say, and able to hold the space for them to initially talk through the death, the impact, the pain. They need someone who knows that after a loss every morning when you wake up your loved one has died all over again, because in sleep they may be there.

Grievers are usually unaware of the true impact of grief. I do a lot of education about the things they are or will experience. Most don’t attribute their loss of energy, change in appetite (which can cause nutritional issues that impact everything), inattention (car accidents, tickets, stove being left on), irritability, avoidance of loud or crowded places (Costco), difficulty with daily tasks (paying bills), illnesses, change in sleep patterns, and many others to their grief process.

Others will be quick to tell them they are depressed and need meds. What they need, in that moment, is to know this is normal. That’s the moment to timeline their prior losses, and to look at how they coped, who was their support, and how long they grieved- as well as acknowledging that even years after a loss it can still hurt at times.

Doing grief is to help your client identify the “woulda, coulda, shoulda’s”- the stuff left unsaid, undone, the dreams not fulfilled, the apologies needed (on both sides), the thank you’s we all know we should say every day, and then suddenly there are no more days. Writing them down, and then allowing the client to express them. My clients write a letter with them, and close it with “goodbye.” They choose what happens to the letter- the symbolism is theirs. I don’t make suggestions- it’s not my loss.

A therapist skilled in grief work can address losses of all kinds. Your clients experiencing loss need permission to do their grief their way, help and support to use the time in grief to move toward their new normal, whatever that may be, normalization of their experience, an ear open for complications and a history of depression, and absolutely no formulas or rules about what should occur. Being linked to other grievers can be very helpful, but some won’t want to attend a group. Being flexible about what resources you offer is a necessity. For those who may never feel safe in a group there are online programs- many are focused on a belief system, a few are not. I offer “Your Path Through Grief,” a totally online program with a closed online support group accessible around the clock (grievers don’t sleep much),  education including videos, a grief workbook, blogs, a memorial page to build a memorial for their loved one, daily emails for a year, and resources. It can be found atwww.yourpaththroughgrief.com.

Jill Johnson-Young, LCSW is co-founder of Central Counseling Services and the creator of Your Path Through Grief. She’s an experienced hospice social worker, grief counselor, and a Certified Grief Specialist through the Grief Recovery Program. Jill is also a double widow, and is now married to a funeral director. She will be addressing the California State Funeral Directors Association in June, and has presented at national, state and local conferences for several organizations.