When Is Grief Counseling Warranted?

As a psychotherapist, I am sometimes called upon to help someone who is grieving. They may feel overwhelmed with intense emotions that cause them to function poorly. Sometimes their friends recommend they seek grief counseling. Their friends might be concerned about depression, social withdrawal and uncontrollable crying that have gone on too long.

While a student, I was taught not to pathologize a normal grief process. I was also taught that there is not a correct way to grieve. The person who talks openly about their sadness is not more or less healthy than the person who keeps their sadness to themselves. The expression of grief is as much a learned and cultural behavior as it is personal.

There is an assumption that the person who grieves well is facing the loss head on. They are able to talk about the loss, have gained insight into its meaning, and have a sense of resolution. J.William Worden, psychologist, established four tasks of grieving: to accept the reality of the loss, to experience the pain of grief, to adjust to the environment in which the deceased is missing, and to withdraw emotional energy and reinvest it in another relationship. Most people who experience a loss are resilient.

Although psychotherapy (talk therapy) is commonly recommended for grief, not everyone needs to seek counseling or grief groups to find relief. Counseling is not necessarily the right way, or the only way. There are many healthy ways to cope with grief. When a person feels stuck, overwhelmed, or confused they may benefit from journaling or reading. Reading other people’s experiences helps to normalize grief, put it into perspective, and create a sense of universality. Artistic expression such as drawing or painting offers another means of showing how you feel, or the importance of the person you lost. Connecting with your faith, gratitude journaling, volunteering, and advocacy related to your loved one’s death may help.

So when is grief counseling warranted? Grief symptoms are elevated when people lose their loved ones under particularly violent or horrific circumstances. Even then, Bessel Van der Kolk, psychiatrist, believes that one crucial stage in bereavement is to allow the body to calm down. Probing questions to people who have freshly experienced a traumatic loss induces physical stress, which interferes with the natural grieving process. Encouraging people to discuss their pain over and over following a traumatic event can be counterproductive. Let the bereaved person choose if and when they might want counseling. Additionally, George Bonanno, psychologist, says counseling is most helpful for people who had psychological troubles before the loss, and which were exacerbated by their grief. Only about 10 percent of bereaved people have severe grief symptoms of prolonged, dramatic, high-level depression which persists for several years. This figure is higher for people whose loss is extreme or violent. Complicated bereavement might exist for people who had a troubled relationship with the departed before they died.

No amount of counseling will end grief. It is a universal human experience. However, if you need help, your goal is to shore up your psychological resources, whether it is through self-help or counseling.