Facilitating Grief

Posted on by Wendy E. Smith, MA, LMHC

After losing a loved one, people can feel as if their world has been turned upside down and they will never get out of the dark, disorienting tunnel in which they now live. Nothing seems worth getting up in the morning for. They cry a lot, they are irritable, they desperately want things to be different from the way they are.

In normal grief processing, whether facilitated by a therapist or not, the mourning person gradually, imperceptibly, begins to accept the reality of the loved one’s death and to imagine a life that will not include him (although it frequently–and healthily–does include an ongoing inner conversation with him). Gradually, gradually, the mourner begins to have some happy moments. Around six months after the death, symptoms like insomnia start clearing up. And, then, in my experience, there is often some kind of an existential or spiritual shift that happens. This may manifest itself as a dream, a change in perspective, a new sense of meaning…. However it shows up, the mourner recognizes it as a kind of grace. I usually don’t tell my grieving clients about this shift in advance because I don’t think doing so would be helpful; nobody in such pain would believe me. But they know it when they feel it. A line of Leonard Cohen’s seems to me to describe both sides of the grief experience pretty accurately: “There is a crack, a crack in everything. That’s how the light gets in.”

Some clients show up for grief therapy many years after a death has occurred. These clients have not gone through a normal grieving process. For a variety of reasons, their grief has been complicated and their healing delayed. This might be because, at the time of the loved one’s death, there was unfinished business between her and the mourner, because the mourner could not afford to grieve in the period following the death due to other obligations such as taking care of small children, because the mourner has really mixed feelings about the person who died, because the loved one died by killing himself, or for another reason. Usually the unresolved grief has been adversely affecting the mourner’s life for some time.

In such cases of complicated grief, healing can still occur, but usually not without therapeutic help. In such cases, I help the client finish her unfinished business with the deceased person by using a variety of therapeutic techniques that allow her to communicate with the person she has lost and to feel feelings that have been repressed. I also help the mourner make sense out of the lost one’s death and develop an ongoing internal conversation with her. Paradoxically, having such an ongoing relationship with the dead is what often allows people to feel safe moving past loss and forward in their lives.

Whatever our grief process, losing a loved one is a watershed event; it changes us forever, often in unexpected, life-affirming ways.

Grieving Acquired Disability

Posted on by Wendy E. Smith, MA, LMHC

I originally wrote this article in my capacity as Disability Topic Expert for Goodtherap.org. I now repost it here.

Physical or sensory impairment or the onset of disabling illness often entails multiple concurrent losses which can lead to complicated grief processes, including depression and post traumatic stress disorder. Most obviously, people who acquire a disability or disabling disease lose a part of their bodies and/or the functionality of parts of their bodies. Additionally, they may lose physical comfort, vigor, mobility, spontaneity, the ability to engage in certain activities, aspects of their previous lifestyles, privacy, a sense of dignity, a sense of control, a sense of efficacy/agency, a degree of independence, actual or perceived life roles, friends and other social supports, the ability to work, financial stability, their previous sense of identity and purpose, the ability to pursue previously established dreams, previous assumptions about themselves and the world, their previous body-image, and, all in all, their previous sense of self as a whole. Therapists should be attuned to what a newly disabled person may have lost, or may perceive himself to have lost, beyond the obvious loss of physical or sensory functionality.

How well people adjust to this potentially staggering array of losses is usually much more closely correlated to who they have been prior to the disability, and what social, emotional and financial resources they have available to them, than to how “severe” the impairment itself is. The huge importance of social support after a disabling event cannot be overstated; people with new-onset disabilities may realize how lucky they are to have loving people in their lives as they have never realized it before, or they may feel almost completely socially and emotionally isolated. The most difficult disabilities to deal with with regard to social support seem to be “disenfranchised” disabilities (e.g., those resulting from Fibromyalgia/Chronic Fatigue Syndrome) in which others do not quite believe.

Non-professionals wishing to support a newly disabled person can be most helpful by being available to her as a friend who is willing to listen to her and meet her where she is emotionally. Trying artificially to cheer the person up or suggest that he does not, or will not, have losses is not helpful. Newly disabled people will “cheer up” once they have finished grieving their losses and reorienting themselves to their new situation, often with the assistance of a counselor or therapist.

Another key to successful adaptation to a new disabling condition (and here is where therapists can be particularly helpful) seems to be successful identity reconstruction; this may often entail psychological, existential, and/or spiritual shifts in perspective towards valuing innate qualities (as opposed to physical or comparative ones), authenticity, and taking life slowly and savoring it. Identity reconstruction, it should be noted, is not necessarily a finite process, as some disabling conditions are progressive and require constant readjustment.

Keep in mind also that a large number of the losses with which a person with an acquired disability must learn to cope are not due to the physical impairment itself but, rather, to limitations imposed on the person with the impairment by society. Therefore, therapists should not insist that people with disabilities “accept” their condition of disablement as theirs to adjust to, rather than, say, as an invitation to fight injustice.

Ultimately, it is much more helpful for therapists to view identity reconstruction, rather than “acceptance” of one’s disability, as the end-stage of grieving an acquired disability.