Grief Counseling
Bill Flatt, Ed.D.

A member of the church you serve is on the phone. His four-year-old son has just been run over and killed by a truck. A seventy year old woman calls and says that her husband of fifty years has just died. A counselee has told you that she still feels guilty after twenty years because she went to school at age eleven the day her dad died. They all look to you for help. What do you do?

Most of us know all too well that grief is difficult to overcome. The loss of a spouse or the loss of a child or divorce may be the most difficult loss for most people to handle.¹ Other possible losses are too numerous to list. I lost my mother some two years ago and have experienced firsthand how difficult adjustment to one's grief can be. Even though I felt that she would be better off to go to "be with the Lord," I cried when she died and have dreamed about her many times since then. I often catch myself imitating her in speech and in actions. On her birthday and on holidays, I think of her and am both grateful for her life and sad because of her death. Things change and adjustments are hard to make.

During the last eleven years, Jack Redden and I have conducted some 41 grief therapy groups for Memorial Park Funeral Home and Cemetery in Memphis, Tennessee. More than 500 widows and widowers have gone through these groups which meet for two hours a day one day a week for six weeks. The group counseling approach is used.

We have found that treatment in Grief Recovery of Widowed persons' groups significantly aids grief recovery as measured by perception of grief level, number of social relationships, nature of one's actions, perceived level of depression, expression of feelings, ability to live with memories, feelings about the future, and one's perceived level of happiness. Such progress has continued for at least five and one half years following treatment.

We also learned that there are other factors that affect one's grief adjustment positively such as the following: more church activities, beginning "other activities" such as hobbies or work, good health, money, and consideration of remarriage. Losing other relatives by death had a negative effect on grief adjustment. Several factors thus affect the degree of one's grief: the person himself, the nature of the relationship between the griever and the deceased, and the cultural context.² There may be other factors as well.

Grief should not be an embarrassment. Emotional expression should be encouraged. One is helped by facing one's grief and by expressing without interference one's feelings related to the loss.³

I have come to believe that grief counseling can be very helpful to those who are working through their grief. Specifically, the following steps can be effectively utilized with bereaved persons.

Effective grief counseling begins with an attitude of caring, of empathy for people. Good grief counselors are affected by the pain of others. We hurt with them.

When I first began our grief therapy groups, I often dreamed of experiences of our group members. I would see in my dreams coffins and scenes described in our groups. Although this reaction stopped after a few weeks, I still will notice a few tears in my eyes from time to time as a group member describes her sorrow in such words as the following: "I lost my husband to cancer, though he was only forty-five years old. Then recently I found out that I have breast cancer. My children are of no help at all. I don't know how I'm going to make it."

The effective grief counselor must love, must want what is best for those who grieve, must have the ability to feel with them, and must care. She may have healthy personality traits and varied intervention skills, but if she does not care about others she will be ineffective as a grief counselor.

Such a caring person will show interest in the individual. Each person has a different background, character, personality, and spiritual nature. The counselor must understand the person before he or she can even come close to understanding the problem.⁴

Empathy is possible when one cares. The minister "feels with" other persons as they relive their experiences. He feels with them through the expression of anger, guilt feelings, and various memories of the past.

I believe that caring is a necessary first step toward forming a counseling relationship that is therapeutic. If you don't care about others, work on yourself before you try to help them.

It is impossible to learn enough about grief to make it go away or to keep others from hurting. It always hurts when we lose someone we love, and it will hurt no matter how much our helpers know about grief. Yet, certain helpful knowledge is available. Such knowledge helps us not to make some mistakes that will be harmful to those who grieve, and that is very important!

We learn from those who grieve. We learn from experience, and we learn from research.

Study the different stages of grief such as the following ones I have noted: shock, lamentations, withdrawal, frustrations, panic, depression, detachment, adaptation, reinvestment, and growth. Try to get an overall feel for those who hurt. Try to put yourself in their place. Learn and be reluctant to help; that is, do not rush in with easy solutions. When people are hurting, they do not care what books say. Yet, knowing how grievers feel may help you to be of help. You keep your knowledge in the back of your mind while you gently try to assist those who hurt.

Look at examples of those who grieve. Learn from them. Biblical examples teach a great deal about grief. Grief comes to all—even kings, even Jesus. Help is available. Hope is seen at the end of the tunnel.

The counselor who has learned about the process of grief will realize that the griever has different needs at different stages of the grief process. She can then offer the help needed at each critical time. At first, the griever needs to face the fact of the death. Then, there is a need to express the hurt openly and without shame. There is a need at times to verbalize, to talk of the past, the present, and the future. After two sessions of a G.R.O.W. Group recently, one widow said, "I'm a lot better. I think it helped me to talk and cry it through. I can talk without crying now," Even verbalization of guilt, anger, and hostility can be therapeutic. Then, there will be the need to withdraw at times and to make friends at still other times. The counselor learns, listens, initiates, and responds. She does not try to fit anyone into a predetermined straitjacket. Each one grieves differently, and that is all right.

A complication of one's thinking patterns during grief is that the deceased may be idealized by the bereaved. Such thinking keeps one from dealing with the relationship he had with the deceased and delays recovery. The bereaved may also experience a diminishing of self-esteem. He is deprived by the loss, the deceased was perfect, and "my faults are obvious, I was not worthy of her." Both were human; yet they still had a meaningful relationship.

One can never learn everything about grief: people are so different, relationships vary greatly, and death comes in so many different ways. Yet, some things can be learned, and they may make a significant difference in our effectiveness in helping those who mourn. Knowledge about grief may at least help us not to hurt those who mourn, and that is worthwhile; but perhaps we can move beyond not hurting them and actually be of help to them. That is my wish.

Being with someone who is grieving is unpleasant. It causes one to think of his own mortality. It brings sadness. Yet, we will be very limited in our help if we are not there.

I have often heard widows and widowers say that people sometimes say the wrong things to one who is grieving. A few examples are as follows: "You had him for forty years. Mine died after only ten years of our marriage." "Time will heal." "God does not make any mistakes." "You'll find someone else after awhile." "You're not hurting like I am. He was my son. He was just your husband." "If you really had faith, you would not grieve so much." "She is better off." The list could be extended greatly, but by now you get the idea. Those who grieve are usually offended by such statements as these. Sometimes, even at our best, we say the wrong things.

It almost always helps, however, just to be there—to attend, to honor the griever by our presence. A firm handshake, a helping hand with the chores—such help is almost always appreciated. One widow said, "My friend rushed right over when she heard. She said she was sorry and just sat there with me for along time. 1 know she cared, that she hurt with me, that I could lean on her. Finally she got up, made some coffee, and picked up around the house. She helped me get through it all somehow. She knew just what to do and what to say. In fact, she didn't say much."

I have heard many people express similar sentiments. The pattern is the same: it is not so much what you say as long as you do not say the wrong thing; it is being there and helping. Do not just ask if there is anything you can do. Think of specifics and do them: make up the beds, help with funeral arrangements, make telephone calls, take them to the funeral home and stay with them for awhile, take care of the children, and just try to be a good friend.

At this point, bereaved persons need support. You may be able to help when an immediate family member cannot. Be calm, be understanding, be supportive. Do not distort the reality of the situation. Accepting reality is the beginning step in the grief process. The sooner reality is faced by the griever, the less likely the grief will be pathological.⁵

Jesus Christ is thought of by millions as "wonderful counselor" (Is. 9:6). He was concerned. He was empathic. He came to be with his friends who had lost a brother. His mere presence was helpful. He cried (Jn. 11:35). We are also to visit those who suffer (Mt. 25:35-40). The apostle Paul admonishes us to "rejoice with those who rejoice; weep with those who weep" (Rom. 12:15). The Hebrew writer says, "Remember those in prison as if you were their fellow prisoners, and those who are mistreated as if you yourself were suffering" (Heb. 13:3).

One's presence with the griever may be needed for weeks, months, or even years. Be there. Encourage him to express his emotions and to talk about his loss if he wishes to do so. Demonstrate concern by your presence for as long as it is needed.

Claude Lewis was a good friend of mine. He was like a second father to me at one point of my life. He served as an influential elder of the first church I served as minister. We named our third son after him.

When "brother Lewis" died of a sudden heart attack, the family asked me to "hold the funeral," which I was honored to do. Although I felt a lot of pain in my heart, I was able to "preach the funeral" without breaking down. But after the funeral was over, I walked out away from the crowd, broke down, and cried. I had stayed in control "for the sake of others." I did not want to make their grief worse. I wanted to help them by paying just tribute to a good man who had "gone on to be with the Lord." I did not want them to feel sorry for me.

Generally speaking, I do not encourage anyone who is grieving to hold up for the sake of others because it can hamper one's own grief work. Mothers are good examples of this. A friend of mine said that she could not allow herself to break down at the funeral of her husband. She "had to hold up for the sake of their four children." Who knows? It might have helped the children if they had all cried together.

I do not think it is out of line for a minister or a psychologist to cry with people who are grieving. At least they will know that you care. One older church leader said. "People love a compassionate person, a person with a heart. You can't be all bad if you cry with people."

Yet, there are times when one needs to stay in control. The situation is in turmoil. Everyone is coming apart. Somebody needs to be steady, to keep a level head, to be in control, to not "catch the panic."⁶ The more out of control are others, the more in control should be the counselor.

I have noticed that it is helpful in my groups to show some compassion but not too much. I often feel a few tears rolling down my face as someone describes his or her loss of a loved one. It just happens as I feel with them in their sorrow.

I think they appreciate such compassion. They can see that I care, that I am not merely doing my job. I doubt, however, that it would be helpful to them were I to allow myself to break down and cry. They would feel sorry for me and try to help me. Yet, I am there to help them. I want the attention to be on them. So I try to maintain control even when 1 feel like breaking down and crying. I think this is the best professional approach to take: do not be afraid to feel, to care, but stay in control enough to keep the focus upon their grief and not yours. If you care and if you stay in control, you should be able to help.

I am not sure why, but it is very difficult to listen to those who are working through grief. Perhaps they make us think of our own death. We may think that their verbalization of sad feelings makes them worse. We may be threatened as helpers. "After all, they sound so negative, and I'm supposed to help them feel better. If I could just get them to be quiet, then maybe I can still think of myself as an effective helper. What if they talk of suicide? I would not know what to do. Just take your medicine and go to sleep." There may be other reasons why we do not listen well. I do not know. I do know that it is hard to hurt with people. I also know that we cannot help those who grieve if we do not listen and hurt a little with them.

My experiences with several hundred widows and widowers confirm this notion. I have heard many of them say, "My children don't want me to talk. They tell me that its time to put that in the past, but I want to talk about it anyway. Why not talk about it? They act like he never existed, and that hurts. My friends act like that, too. Maybe that's why I like to come to this group so much. You guys will listen." Almost every person in our groups has expressed this sort of feeling at one time or another. They need to work through their grief, but they are encouraged to put it behind them without talking much and without continued crying. Yet, it is hard to do. They are left with a hard task with no means of accomplishing it. One might cry through grief or talk through grief, but it is very difficult to merely "put it behind you" without adequate expression of it.

As a counselor, you may need to listen to details of the same story several times. You will learn over and over again how he died. I do not get bored with this. I see it as their need to work through their feelings toward acceptance of the death.

The word "empathy" should be used in connection with listening. Empathy means to "feel with" the other person. In grief, we listen in such a way so as to "feel with" the bereaved: we relive the experience with them. The counselor feels and accepts the mourner's pain as valid without judgment or evaluation.⁷ One can help if he or she can really listen.

To help those who grieve, one must accept their pain as valid and accept them as persons of value. Otherwise, the one who hurts will not believe that you care or that you understand. Without such belief, he or she will not allow you to help.

Counselors with a strong sense of values or a rigid personality structure often have difficulty with acceptance. They see it as endorsement or agreement, but it is not. It is validation of the other person's experiences as being real. It is acceptance of another person as being of value as a person. It is not judgment of the person or his deceased loved one as being right or wrong, good or bad, lost or saved. Acceptance communicates care and concern for the other person. Jesus accepted the woman caught in the very act of adultery even though he disagreed with her behavior (Jn. 8). We can accept another person even though he or she is of another race, another religion, or even if he or she has no religion at all. We can accept the poor, the uneducated, the uncultured. Their experiences are very real and extremely important to them. Their hearts beat just like ours. We can learn to accept people and to help them work through their grief even though we do not agree with their beliefs or their behavior.

So, I accept each person as being of value. I stay out of the judging business. I concentrate upon the griever, his experiences, and what will help him. If he believes that I accept him, then he can accept me as a helper. Then, perhaps progress can be made.

I do not like to see people suffer. When they cry, I want to say something that will make them stop crying. When they ask hard questions, I want to give sure, helpful answers. It is hard for me to wait, to let them struggle, to see them cry, to go slowly; but it is very necessary to do this in dealing with grief. If I provide a quick fix, the fix does not last. So, I continually tell myself to wait. Let those who grieve take their time. Then, when they work through it at their own pace, the cure will last. There seldom is an easy answer to a hard question.

One tendency in our society is to postpone grief work by means of sedatives. "Let me give you a little sedative," is often the approach to grief by well-intentioned doctors. Many grievers resent this. Many have told me, "I didn't want a sedative. I wanted to be there, I wanted to feel. That is just putting it off. I don't want to rely on those things." I agree with Jackson when he said that in most cases sedatives should be avoided when the purpose is to knock out the anxiety-mediating neural mechanisms.⁸ The main damage done by such medication is to postpone grief work until later when it is actually more difficult to work through it. Give a person time to work through grief but not by drugs. Do not rush in with answers. Learn to tolerate a little pain. Do not expect people to get over the death of a loved one quickly. It may take a year or more to get back to anything near normal. Give the griever time. He or she needs it. Learn to wait.

There are times in counseling when I just listen and perhaps reflect what the person is saying. And there are times when this may be all that is needed. The person is extremely upset and needs to talk. Yet, after a while, even in such cases, counseling usually needs to go beyond mere listening and reflecting. The sharing of one's own thoughts, feelings, and concerns can sometimes be very helpful, too.

I usually begin a grief therapy group by introducing myself, explaining the group process, and sharing a brief profile of my family and some grief experiences of my life. I then invite them, as they feel like doing so, to do the same; and they do. One at a time talks; the others listen and interact. They usually tell about their mate's sickness, long struggles in the hospital and at home, or the shock of a sudden death, the funeral, their children, their life together, and what it has been like since the death. Usually, everyone in the group says something during the first two-hour session. Sometimes one person remains silent, except in telling her name and a few brief remarks about her family. Within two or three sessions, everyone is usually talking, listening, and sharing solutions to struggles. In looking back at films of our sessions, I think my sharing a few personal experiences tells the others that it is all right to talk and to share personal experiences.

By sharing, grievers help one another solve problems. One asks, "What do you do with your husband's clothes?" Another answers, "It was hard for me to even look in his closet, but this is what I did. I got my daughter to come over and help me one day, and we went through everything he had, saved a few things we wanted to keep, and gave the rest away to a charity. I've felt better ever since. I needed to get it out of my sight so that I would not have to see all of his things every time I turned around." This is not a bad idea, right? They have been through similar experiences, and they help each other. One says that she does not know what to do with her wedding ring. Another says, "This is what I did. I wore mine for a few months. Then I decided that I was no longer married. So I quit wearing it but had a jeweler make it into a nice pin that I now wear a lot. I still enjoy it but not as a wedding ring." Again, this is not a bad idea. And they are not telling others that they must do likewise. They are just sharing ideas. One does not know what to call herself. Is she Mrs. John Doe, Mrs. Jane Doe, Ms. Jane Doe, or just Jane Doe? Another shares this idea, "I think it's up to each individual, but here is what I did. For a while, I was Mrs. John Doe. I just did not want anything to change. I was still his wife. Then I ran into some legal problems and began putting everything into my name. Now I'm just Jane Doe. I'm not married anymore. It's not my fault. It's nothing to be ashamed of. It's all right." Again, some good ideas were shared, and I have seen this happen over and over again in our groups. Widows and widowers are there with many different time spans since their mate died. Each is different in many ways, and they have many different perspectives. As they share these, they help each other. They not only learn new ideas, but they get permission to go on with their lives. They learn that it is quite all right to be happy.

In our groups, we have not only shared ideas but also many other things: poems, family pictures, meaningful sympathy cards, helpful scriptures, as well as other items. The pictures help them talk about good times as well as bad times, to learn to deal with memories. They help us to know each other better and to be of more assistance to each other. We often end a group by going out to dinner together.

One thought that I have always shared is my belief that working through grief is not easy. It is very hard. Sometimes I will just admit that I do not know the answers to their questions. I may reply, "It's hard to know, isn't it?" or "I wish I knew."

1 believe it is especially helpful for a counselor to share his thinking about false guilt feelings. Some 85% or more of the grievers I have worked with have had such feelings. "I feel guilty because I was not the wife I should have been." "I did not say goodbye to him before he died." "He died while we were having sex. It was my fault." "I did not get him to the doctor in time. I should have taken him sooner." These and other such feelings arc numerous. A discussion of them may be very helpful. The sharing of your feelings and thoughts may help relieve such feelings. "You did about what I would have done. You did what you knew to do at the time. It is easy to be a Monday morning quarterback." Such shared thoughts may make a great deal of difference in the minds and hearts of grievers. They need reassurance!

What I am saying to you as a helper is that it is all right to share. Be genuine. Let yourself come through. In doing so, you may be of great help to those who mourn.

All of us have learned the value of reinforcement in everyday life. A child brings home a good report card, and we say, "Good job. You did well. I'm proud of you." He goes back to school and works harder. A husband comes home early from work; his wife greets him enthusiastically at the door with a big hug and kiss. He tries to get home early more often.

I often reinforce certain behavior in grief counseling: feeling, thinking, and acting behavior. A widow says that she is now able to talk about her deceased husband without losing control. "Good. That represents progress to me," I reply. Another says, "Well, I finally started getting up in the morning anyway. I ate breakfast several times this past week and cleaned up the house. I think that's pretty good far me." "It is good. I'm glad to hear that," I reply. Another says, "I don't have much money, but I'm not giving up. I'll look for a job." "You know, you're pretty tough. I have a feeling you're going to do all right," I reply. She smiles and says, "I do too." Still another tells of his struggles to take care of himself since his wife died. He can't cook, he makes a mess out of things around the house, he withdraws and clams up a lot. I reply that I think he is doing well under the circumstances and that I'm not sure I could do as well as he is doing. He begins to feel as though he may be doing better than he thought and is encouraged to keep trying. In group counseling, others invariably join in and reinforce healthy actions better than I do. It catches on and can be very effective.

Proper reinforcement helps shape behavior. Used in a healthy way, it can be very powerful. It helps lift a griever up and move her forward during the entire grief process.

When Jack Redden and I first talked about grief counseling, I had never used the group approach to counsel with such people. I had used it with divorced people briefly, and I had counseled with individuals and with families who were grieving, first as a minister and later as a counselor. I had been in several groups during my graduate school training and had read rather extensively about group counseling. I began thinking of how these experiences and ideas could be adapted to help a person work through grief. We could get a rather homogeneous group. They would be able to talk and to freely express their emotions. They would empathize with each other, share helpful ideas, and reinforce each other. They should farm a healthy, cohesive group. And they did over and over again. This happened because we innovated over and over again.

We not only innovated by using the group method, we also applied many tried and proven therapeutic tools to grief counseling. We talked, we listened, we empathized, we accepted clients, we tried to understand, we interpreted, we reinforced, we made assignments: reading, changing actions, talking. We often taught progressive relaxation. We discussed dreams. We read the Bible. I suppose that I have adapted every counseling method I normally utilize and used it in grief counseling. I encourage you to try this. Be creative. Be careful, but use the therapeutic tools you have learned, change whatever you need to change, and use all of these tools to help people work through their grief toward growth. Counseling tools were made for people, not people for counseling tools.

Ministerial counselors should be better prepared than most to deal with certain types of problems. Guilt is an example. Real guilt calls for forgiveness which points toward God. The griever is unable to correct past actions. There may have been infidelity, loss of temper, thoughtlessness, absence at the time of death, as well as many other problems. The griever cannot apologize to the deceased or correct past mistakes; so she punishes herself for all of these, often exaggerating the offenses. But we all make mistakes, we are human, and we need forgiveness. This comes from God; thus, ministers should be able to help. We should encourage the expression and confession of guilt and help the griever feel the forgiveness of God.⁹

The minister has an advantage over other professionals in helping the grievers. He is used in the funeral. He can visit homes, write letters, make phone calls, perhaps preach to them in church, or invite them over for dinner.

The minister can utilize many forces in helping those who mourn. He has the church library, worship, classes, the Bible, others in the church, and countless other possibilities and resources. And there is spiritual support that transcends the counseling relationship. Hiltner lists prayer, the Bible, religious literature, Christian doctrine, the sacraments, and rites as religious resources open to the Christian counselor.¹⁰

There are many other methods that could be adapted and used in grief counseling. Imagery is a good illustration. Even hypnosis could be helpful if used wisely by a well-trained therapist. My suggestion is to utilize the tools that are familiar to you. With a bit of innovation, any counseling method might be adapted and used in grief counseling.

No matter how well-trained and experienced a counselor might be, he or she will need to refer clients to others at times. Others may be better qualified, or clients may not be making much progress, or there may be other reasons far referral. Refer if you need to do so.

You may need help in deciding when grief is so abnormal that a referral should occur. Bachman suggests three indicators of the need for referral: extreme depression or melancholia, psychotic breaks with reality, and suicidal tendencies.¹¹ But how do you tell when one is psychotic? Five signs are impaired intelligence, faulty memory, inappropriate affect, disorientation, and bad judgment. Autton lists ten referral indicators: normal symptoms are severe and prolonged, there is a marked change in behavior pattern, depression is overwhelming and self-esteem is lost, hostility continues at the same level or increases, there are hallucinations, denial persists, there is extreme withdrawal, there are manic-depressive reactions, panic continues, and the person turns to alcohol to solve his or her problems.¹² People who need more help than you can give deserve to be referred to some professional who can give that help. They may suffer for a lifetime without it.

I have used eleven verbs to organize my thoughts on grief counseling. If you do grief counseling, you might do well to engage in some or all of these actions: care, learn, attend, control, listen, accept, wait, share, reinforce, innovate, and perhaps refer. Best wishes as you try to help others.¹³