Background
What is Grief?
The Emotions of Grief
Healing Strategies for Helping Families Grieve
Caring for Self
When to be Concerned
Summary
References
Resources

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Background

The experience of grief wears many faces for families whose lives are challenged by change, turmoil, illness, death and/or the loss of hopes and dreams. Grief is a process not easily acknowledged in our society, particularly the grief of experiences other than death. Yet grief is often an integral part of most life changes and experiences. Families who can acknowledge their grief and learn healthy ways to express their pain can then free their emotional energies to focus on life and the challenges ahead. Grief that is not allowed a healthy release frequently finds expression in anger, abuse and/or neglect of a loved one, substance abuse, illness and sometimes by the sabotaging of another's efforts to help.

It is a commonplace in the bereavement literature that unresolved grief can lead to difficulties coping with any losses throughout life. Families in need of planned or crisis respite all struggle with feelings of loss. For example, a mother who seeks out crisis nursery services may also be in the process of divorce which brings its own unique grief to the situation. The family of a child considered medically fragile who is in need of respite care may experience a sense of loss over not having a "healthy" or "perfect" child. The spouse of a family member with Alzheimer’s may grieve the loss of the life they have planned together.

Knowledge of the process of grief and how to help individuals and families cope with their loss experiences can be an invaluable asset to planned and crisis respite programs and their service providers. By offering individuals and families opportunities to grieve their losses and acknowledging the hurt that accompanies those losses, we offer them tools and strategies to cope with the ongoing losses that are a part of everyone's life.

What is Grief?

Grief is one's own personal experience of loss. Mourning, on the other hand is "grief gone public." It is the outward sharing and expression of the pain. Sometimes it is helpful to make a distinction between the two in order to understand that there are some individuals in our society who have "permission" to grieve but cannot mourn. Society does not easily acknowledge the grief of a parent whose child is born with a disability, parents who experience a miscarriage, families where a loved one is diagnosed with a life-threatening illness, families affected by AIDS, or dementia, such as Alzheimer’s, etc. Caregivers can be helpful to such families by labeling their experience as one of grief and normalizing their pain and emotions. It is important to remember that all losses need to be grieved in some way.

The Emotions of Grief

People experience the pain of grief with a variety of emotional responses which include shock ("it can't be true"), denial ("the tests were wrong"), anger ("why did she get AIDS and not someone else?"), guilt ("why did I smoke [or drink alcohol] during my pregnancy"), fear (“how will I manage to care for him?”), exhaustion, depression, confusion, and bargaining ("if only we could have a miracle"). These are just a few of the myriad of emotions people in grief experience. It is also important to understand that people experience these emotions in a roller-coaster fashion: sometimes feeling up and hopeful, other days feeling deeply depressed, other days coasting along and feeling virtually no emotion. All of these emotions are a normal part of the grief and mourning process.

Healing Strategies for Helping Families Grieve

• Become aware of your own personal issues around grief. This means becoming aware of your own fears, attitudes and beliefs about grief. For example, if an individual were raised to believe that "We don't air our dirty laundry in public," then that individual may have difficulty helping a family who needs to vent and share their pain openly and/or with great emotion.
• Acknowledge the family's grief. Label their experience as one of grief. Let them know they have a right to have their feelings.
• Be there. One's presence can be the greatest gift given to a grieving individual. Sometimes holding someone's hand, offering a hug, or just acknowledging, "This must be so hard for you," can be enough to support someone in their grief process.
• Listen. Grieving people need to share their pain with another person who will not judge them or give them advice and suggestions. Listening to someone tell their story over and over can often be an invaluable gift to them in helping them sort through their feelings and release their pain.
• Offer "permission to grieve." Teach grieving families that it is important to express the emotions of grief, but that there are ways to express pain that are more healing than others. For example, an angry parent can learn to express their anger through physical activity such as yard work, tearing up old phone books, writing letters, or screaming in a pillow. The key is to help grieving people find constructive ways to release their feelings of grief rather than to take it out on others or themselves.
• Help families create a memory book. This might include photos, drawings, funny things someone said or did, etc. This is especially helpful to families who have experienced a death.
• Develop and encourage support groups. Support groups give families a chance to share their pain with others experiencing loss.
• Children love, therefore they grieve. Encourage children to participate in all of the above suggestions. By teaching children how to deal with the pain of loss early in life, we can teach them how to grieve the losses that are an inevitable part of their future lives, losses such as moving, divorce, the break-up of a relationship, or the death of a friend, loved one, or pet. Children can draw pictures or write letters to an ill sibling or grandparent as a way to express their love and concern.
• Encourage families to write letters to someone who has died or is ill. Frequently they can express many unresolved emotions in letters that need never be sent. Writing a letter or note to a family member who is in crisis respite may offer a caregiver a healing release of feelings of frustration and despair.

Every grieving individual or family can teach us about what they need from us at this painful time in their lives. Grieving individuals can also remind us about what truly is important and meaningful in our own lives.

Caring for Self

It is very important when working with individuals who are in pain to take good care of oneself, physically and emotionally. There are times when care providers can become too involved or attached to trying to "fix" the problems their families face. This can deplete the psychological energy needed to work effectively with families who are experiencing grief. It is helpful to realize that each of us have gifts to share with others, such as the gifts of one's presence, understanding, love, and concern. Becoming overly attached to how others receive these gifts, sets us up for pain and disappointment. It is also important to nurture oneself on a regular basis by setting limits, treating oneself in special ways, and taking moments each day to renew, relax and appreciate life.

When to Be Concerned

There are times when the grief experience can be overwhelming and individuals and/or families may need more extensive counseling and support. Clues to more complicated grief and mourning include:

• lack of basic self-care
• unusual and alarming behavior patterns
• suicidal threats or attempts
• multiple losses that can be overwhelming
• severe withdrawal and/or depression
• substance abuse
• radical lifestyle changes

Summary

All losses need to be grieved for, obvious losses as well as symbolic losses, such as the loss of hopes and dreams, or the loss of what never will be. Since families who seek out planned and crisis respite services are also families experiencing some kind of loss, knowledge of the grief process, and how to assist someone in the process, can enhance one's effectiveness and sensitivity to families in need.

References

Cole, Diane. After Great Pain: A New Life Emerges. New York: Summit Books, 1992.
Kushner, Harold. When Bad Things Happen to Good People. New York: Schocken Books, 1981.
Rando, Therese. How To Go On Living When Someone You Love Dies. Massachusetts: Lexington Books, 1988.
Register, Chert. Living with Chronic Illness. New York: MacMillan, 1987.
Simons, Robin. After the Tears: Parents Talk About Raising a Child with a Disability. New York: Harcourt Brace Jovanovich, 1987.
Veninga, Robert. A Gift of Hope: How We Survive Our Tragedies. New York: Little, Brown and Co., 1985.
Wholey,Dennis. When the Worst That Can Happen Already Has: Conquering Life's Most Difficult Times. New York: Hyperion, 1992.

Resources

Kathleen Braza, M.A., Bereavement Consultant, Healing Resources, P.O. Box 9478, Salt Lake City, Utah, 84109. 1-800-473-HEAL.

Center for Loss and Life Transition, 3735 Broken Bow Road, Fort Collins, Colorado, 80526. (303)-226-6050

Association for Death Education and Counseling. 638 Prospect Ave., Hartford, Connecticut 06105-4298. (202)-232-4825.

The Dougy Center for Grieving Children. 3909 S.E. 52nd Ave., Portland, Oregon 97206. (503) 775-5683.

About the author: Kathleen Braza, M.A., is a bereavement consultant and national speaker on issues of grief and loss in adults and children. She is Adjunct Clinical Faculty at the University of Utah teaching courses in death, dying and bereavement. Reviewed and Updated by Nancy Olson and Terri Whirrett, Technical Assistance Coordinators with ARCH National Respite Network and Resource Center.

ARCH Factsheet Number 21, March, 1993; revised January, 2002