Every person experiences loss, and almost every person experiences grief at some point during life. It is the natural, human response to loss of any kind, such as death, breakups, moves, and other major life changes. Although we all experience grief, how we experience, process, and cope with grief can be very singular. Counselors must be equipped to identify grief in its various forms and offer compassionate care. This involves guiding clients through the healing process using tailored grief counseling techniques, methods, and therapeutic interventions.
Understanding the distinctions between bereavement, grief, and mourning provides counselors with a better command of the language that they use with and teach their clients. Understanding language and deliberating using the right words provides a mutual context for communication in care that builds a crucial foundation.
Although the two words are often used somewhat interchangeably, bereavement and grief are different.
Bereavement is the fact of loss, and grief is the internal response to bereavement.
When providing therapy for grief and loss, counselors can reference several models and theories that attempt to explain and outline the complex experience of grief and the process that occurs during bereavement.
No one theory or framework for bereavement and grief is universal because every person experiences loss and expresses grief in different ways on different timelines. Plus, loss isn't always straightforward; complex circumstances can lead to complex feelings where grief may be mixed with feelings of relief, happiness, fear, resentment, envy, or anger.
Grief counseling and bereavement therapy begin with a thorough assessment process to gather information and the formulation of a patient case to develop a model of understanding and treatment.
Counselors use a variety of grief assessment tools to gather information, understand the client's loss, document the client's reactions to the loss, identify any precipitating factors or triggers, and understand the origins of the grief. Counselors also use grief assessment tools to evaluate the severity of the client's symptoms and determine if the client meets diagnostic criteria for grief-related disorders, such as prolonged grief disorder (PGD).
Common grief assessment tools include clinical interviews and self-report questionnaires like the Grief Response Scale (GRS), Grief Cognitions Questionnaire (GCQ), Inventory of Complicated Grief (ICG), Prolonged Grief Disorder-13 (PG-13), Grief Impairment Scale (GIS), Grief Experience Inventory (GEI), Bereavement Risk Assessment Tool (BRAT), Beck Depression Inventory (BDI), and the PTSD Checklist for DSM-5 (PCL-5).
To formulate the client's case and treatment goals, counselors then identify the purpose of counseling by conceptualizing the client's struggles and connecting symptoms to underlying factors. The counselor identifies specific problems (such as symptoms or disorders related to the loss), hypothesizes the processes causing the symptoms, and identifies events that trigger these issues. The counselor can then use this information to select evidence-based treatment methods.
Grief counseling often begins with processes of patient education and normalization.
Compassionate bereavement care prioritizes normalization and validation of patients' feelings. Counselors inform patients that their feelings are normal and common. Knowing that one's experience is not unique validates their feelings, reduces shame, and creates a sense of shared experience, which can help mitigate the intensity and severity of negative emotions. Grief support groups can also help with normalization and validation.
Counselors then work with patients to address their most immediate needs. Providing patients with coping strategies to help mitigate the severity of grief symptoms and improve daily functioning. Strategies could involve prioritizing exercise, diet, and self-care. Maintaining a routine, practicing mindfulness for grief, and engaging in breathing exercises are also beneficial. Additionally, seeking social connections, dedicating time to hobbies, participating in a spiritual community, or spending time in nature can be helpful.
Counselors can best support their patients' healing after loss with evidence-based interventions.
Evidence-based approaches to grief counseling aim to help individuals process and adapt to loss through a variety of treatment methods.
Common evidence-based approaches include:
Additionally, counselors often work with groups and families experiencing grief. In these settings, they use many of the same evidence-based modalities for treatment as they do with individuals. Moreover, they might use family-focused grief therapy (FFGT), organize grief support groups, and facilitate peer support services.
As the experience of grief is complex and highly individual, its treatment must be equally individualized to address the specific needs and precipitating factors associated with each patient. For example, a patient's age and the individual circumstances surrounding a loss impact and inform a counselor's approach to therapy.
Grief counseling for children and adolescents must include developmentally-appropriate vocabulary and communication about death and loss that remains open and honest. The process should validate and normalize the child's feelings while also teaching them how to identify their feelings and providing them with the language or other tools (art or play) to communicate their feelings. The process should be collaborative, involving caregivers and teachers in supporting the child in their grief.
Working with adults and older adults, the counselor must consider the context of the person's life. Older adults, for example, are at risk of bereavement overload, as they begin experiencing cumulative losses that can also be isolating.
Considering the specific context around loss or an impending loss is also crucial to the bereavement counseling process. The complexity of case formulation and treatment approaches is exacerbated by various factors, including suicide loss, the loss of a partner, and the loss of a child. Other contributing factors include perinatal loss, disenfranchised grief, ambiguous loss, anticipatory grief counseling, and counseling where abuse or trauma may have been a factor. Additionally, hospice bereavement and caregiver bereavement services also increase this complexity.
Depending on a client's history and the nuances of the specific situation surrounding their grief, they could be at an increased risk for participating in unhealthy or dangerous coping mechanisms or suicide.
During the initial patient assessment and going forward, mental health providers should screen patients for risk factors and signs of risky behaviors, such as unhealthy coping strategies or suicidal ideation.
Counselors should talk with patients about a safety plan that could be used during a moment of crisis. This should include recognizing personal warning signs, using coping strategies, seeking social contact, getting in touch with trusted family or friends, contacting a mental health professional or crisis hotline, and reducing access to lethal means.
Counselors must always be prepared to carry out crisis management and intervention strategies that focus on de-escalating the situation and ensuring safety.
A strong approach to grief counseling is a well-rounded and collaborative approach. Grief counselors should collaborate with general healthcare practitioners and help patients access community resources. These resources can include peer support groups, hospice services, faith-based communities, nonprofit organizations, and support groups tailored to specific types of grief.
As in all types of counseling, maintaining an ethical, professional, and compliant practice is important in grief counseling.
Counselors should strive to practice with cultural humility, recognizing that their cultural knowledge and background are limited and striving to explore and understand a client's background and experiences.
Additionally, counselors must provide clients with thorough explanations of the grief counseling process and the services provided to ensure that the client has been fully informed to decide whether or not (how) they participate in counseling.
Counselors must maintain healthy boundaries with clients. Of course, they should avoid dual relationships with clients, but it is also essential to set boundaries that define the role of the counselor, expectations of treatment, and a structure for the counselor-client relationship.
To foster a professional environment, counselors must prepare and gather all essential forms and documentation. This includes HIPAA privacy notices, informed consent documents, intake assessments, billing and payment records, treatment plans, progress notes, emergency contact procedures, and safety plans.
Online and telehealth grief counseling helps reduce isolation and provides patients with increased access to care and a supportive community. It also effectively reduces grief intensity, stress, and depression.
Counselors can provide grief counseling through online platforms, offering one-on-one sessions via phone calls, video calls, or text messaging. Additionally, they can provide online resources available at any time and more easily facilitate virtual support groups.
When providing online care, however, counselors must be aware of federal and state telehealth rules and regulations for privacy, data security, and treatment. For example, most state licensing boards require that patients be located in the same state as the provider.
Clients can access a variety of counseling and support tools remotely, including video call sessions with counselors, online therapy and chat apps, online support groups, and forums for grief.
Counselors should keep detailed notes regarding their patients' treatments and progress.
To track clinical progress, it must be measured. Most counselors use validated assessment tools such as the grief intensity scale (GIS) to periodically assess their patients. Counselors combine assessment scores with observations and appointment discussions to measure and track client progress while evaluating the effectiveness of treatment approaches.
Ongoing care and relapse prevention are key components to long-term grief counseling success and the prevention of a return to unhealthy coping mechanisms or risky behaviors. Strategies include making plans and strategies for difficult dates on the calendar, building a strong support group, participating in ongoing counseling or group therapy, identifying triggers, avoiding high-risk situations, and creating a relapse prevention plan.
While caring for their clients, grief counselors must also care for themselves.
Grief counselors face a variety of challenges due to the nature of their work, which include a significant emotional toll, compassion fatigue, burnout, and vicarious trauma. Grief counselors navigate challenges by establishing and maintaining professional boundaries, engaging in self-care, and responsibly processing their own grief. This approach ensures that their personal experiences do not negatively impact the client's experience or grieving process.
Grief counselors participate in continuing education to maintain their licenses and certifications while also improving their practices and staying on top of the latest evidence-based approaches to counseling.
