Therapist's Overview

Section I

STAGES OF GRIEF

There are two exercises in this section. This section describes grief and the grieving process, as well as the nature of grief work. This section provides a three-stage model for understanding the grieving process, and describes each stage in some detail. The primary goals of this section are to provide information to clients and to help clients figure out where they are in the grieving process.

PURPOSE

The information provided gives clients a means for understanding the grief continuum and assessing their own place along this continuum. The three-stage model was briefly described previously, but is explained to clients in more detail in the Setting Perspective subsection.

TYPES OF SITUATIONS FOR WHICH THIS INFORMATION MAY BE MOST USEFUL

• Helping clients to understand the concept and process of grief work
• Helping clients to think about and explore a framework by which to understand the grief process as a whole
• Helping clients to think about their own emotional condition, with respect to the grief process
• Helping clients to understand the work that may lie ahead, as well as any grief work they've already completed
• Helping clients to think about their own place along the grief continuum

Setting Perspective

STAGES OF GRIEF

The process of working through grief-dealing with the emotions and the situations caused by a death, as well as the impact of the loss on mind, body, and spirit-is frequently referred to as grief work.

But although grief experiences are intensely personal, there are some fairly typical stages of bereavement. These range from initial shock, to anguish and despair once the realization of the loss sinks in, to eventual acceptance. Within each stage are specific emotional and psychological tasks which must be worked through completely before you can move on to successfully complete the tasks of the next stage.

Although these stages are generally a predictable part of the mourning process, grief doesn't always move in a straight line. The stages tend to flow together and fluctuate, so it's not always possible to tell which stage you are in. Emotions seesaw, and overwhelming feelings pass and then return. Moods wash in and out like the tide. Just when you think you are over it, a sound, smell, or image can send you back into emotional turmoil. This back-and-forth movement may occur over a period of months, or even years. Although varying from person to person, it's not unusual for the active stages of grieving to last 1 to 2 full years or more.

Becoming aware of the stages of grief can help you to work through the necessary grief work, which includes the following tasks:

• Facing the reality of your loss
• Working through painful memories
• Experiencing the full range of emotions associated with loss
• Coping with the situational and lifestyle changes resulting from your loss
• Adapting to the loss, and reconfiguring your life

THE THREE STAGES OF GRIEF

The goal of grief work is not to find ways to avoid or bypass the emotional turmoil and upsets brought by your loss. Instead, its goals involve working through the tasks and emotions of each stage of grief.

• Stage 1: Acclimation and adjustment
• Stage 2: Emotional immersion and deconstruction
• Stage 3: Reclamation and reconciliation

Stage 1 is a period of acclimation and adjustment, in which the primary issues you face as someone newly bereaved can be broken down into four tasks:

• Adjusting. Accepting that your loved one is gone, and making sense of the new set of circumstances in your life.
• Functioning. It's a cruel irony that the practicalities of mortgage payments, funeral experiences, insurance claims, hospital bills, disbursement of possessions, or getting back to work hit you at a time when you are least up to facing these issues. But despite your loss, you need to accept that you still have a life to lead, and must continue to deal with your everyday responsibilities.
• Keeping in check. The temptation in the face of a tremendous loss is to emotionally shut down, or, at the other extreme, to let your emotions and behaviors flow unchecked. One of the tasks of Stage 1 is to find a way to manage your thoughts, feelings, and behaviors.
• Accepting support. Often, you don't have to face your loss alone. Learning to accept the kindness, help, encouragement, and support of the friends, family, and others who populate your life is important.

Stage 2 is a time of Emotional Immersion and Deconstruction, and incorporates the most active aspects of grief work. It's not that this stage is any more intense than the first stage-in fact, it's difficult to imagine that anything could be more intense than the period immediately following a loss. But during Stage 2, you're likely to become deeply immersed in your feelings and very internally focused. It's also quite common to undergo a deconstruction of your values and beliefs, as you question why your loved one was taken from you. The tasks associated with Stage 2 include the following:

• Contending with reality. Once the shock of the death has passed, you must begin to more fully resume your normal life, accept that your loved one is gone, and deal with the life changes resulting from your loss.
• Development of insight. Stage 2 is a time for soul searching-the exploration of your place in the world, your current emotional state, and the meaning of your thoughts and feelings.
• Reconstructing personal values and beliefs. In the aftermath of the death and the many changes it may have brought, you need to find meaning in the world and establish what is-and isn't-important in your life.
• Acceptance and letting go. Here the task is to fully accept the death and your feelings about it, find a way to let go of that which has passed, and begin to move toward that which will be.

Stage 3 is a time for reclamation and reconciliation, and is generally thought to be marked by your "recovery" from grief. But the loss of someone close to you leaves a permanent mark on your life, in the sense that things can't be restored to the way they were before the death. However, you can begin to rebuild, creating a new life for yourself and reengaging with the world around you. As this stage ends, you'll become reconciled to the death itself, and the changes it's brought to your life. Perhaps most important, you'll begin to live in the present, rather than the past, reestablish who you are in the world, and plan a future. The primary tasks of this stage are the following:

• Development of social relations. Stage 2 was internally focused, but Stage 3 is externally focused, as you reestablish friendships and renew community connections.
• Decisions about changes in lifestyle. The task here is to make long-term practical choices about how to proceed with your life, including where to live, how to spend your time, what to keep from your old life, and what to change.
• Renewal of self-awareness. This task involves consolidating the things you've learned about yourself and your life through your grief work, and building your daily life around this new self-awareness,
• Acceptance of responsibility. The task here is to both maintain your support network and become increasingly self-reliant, taking responsibility for your own happiness, well-being, and life course.

Therapist's Overview

STAGES OF GRIEF: GETTING LOCATED

GOALS OF THE EXERCISE

This is a simple exercise designed to help clients think about and identity their current grief stage, as well as the grief-work tasks associated with each stage.

TYPES OF SITUATIONS FOR WHICH THIS EXERCISE MAY BE MOST USEFUL

This exercise will help clients think about their current grief-work stage, thus helping them identity the sort of emotional, behavioral, and life-management tasks they may have already completed, are facing at the moment, or are yet to face. This is an especially useful exercise for helping therapists and clients identify current concerns and issues, and for setting the pace for ongoing therapy.

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH CLIENTS

• Does the idea that there are stages to grief fit your own experience with bereavement?
• Are you able to identity and recognize your current grief work stage?
• What are the grief-work tasks you most need to work on right now?
• Are you feeling encouraged, or does the grief work ahead seem overwhelming?
• Are you aware of the difference between thoughts and feelings?
• Which tasks seem most pressing right now?
• Which tasks seem the most overwhelming or difficult to think about?

Exercise I.A

STAGES OF GRIEF: GETTING LOCATED

Based on the descriptions of the grief continuum and the stages of grief, circle the letter that most closely describes where you are right now with each task: A = I'm not ready to deal with this task; B = I'm working on this task; C = I've completed this task.