Grief and Loss

In her 2005 memoir “The Year of Magical Thinking,” recounting both joyful and painful memories of love and loss in her family, the writer and author Joan Didion counsels readers that “grief when it comes, is nothing we expect it to be.”

We ask ourselves what is “normal” for us to feel when faced with grief and loss. How long will we feel empty, depressed, sad and/or angry? As individual and couples therapists, we are frequently asked these challenging questions by those who have lost a loved one, as well as by people who face the mourning process of losing a relationship due to divorce or break-up. This journey of grief involves traveling through emotional pain, adjustment and transition, and understanding and acceptance. Eventually, most people will experience the transition of grief as it transforms over time to some state of acceptance and integration. For many years, Dr. Elisabeth Kubler-Ross wrote about the fluid yet identifiable five stages that people go through after the diagnosis of a terminal illness: denial, anger, bargaining, depression and finally acceptance of inevitable death. Dr. Kubler-Ross’s theory of stages also applies to the experience of survivors and loved ones.

I reflect on my own grief process after both of my dear, elderly in-laws passed away within three months of each other in the past year. During my thirty years as their family member, they were solid and steadfast sources of support and caring. I draw from my own memories and experiences in what I offer through my empathic presence to clients struggling with similar traumas. The words are often few, but I repeat the reminder that time helps us makes sense of the reality. The range of negative emotions and reactions by survivors ranges from the beginning period of the first, acute stages of grief (three to six months) to the following twelve months (or longer) of shock and disbelief, anger, depression, sadness, and acceptance.

A recent study in the Journal of American Medical Association by the Dana-Farber Center for Psycho-Oncology and Palliative Care Research revealed that the particular emotion of yearning exists in the common experience of grief. This three-year-long Yale Bereavement study reported interviews with 233 persons who had suffered a loss from death. The research confirmed that the most characteristic feature or emotion felt after a loved one’s death is not depression and sadness but “yearning” or the pining and missing the person; a strong desire for having them come back. This yearning is further described as hopes and wishes to see them again. We wish for things unsaid or for the ability to again share stories or acknowledge the end of the existing relationship, and the pain and sorrow of loss that comes with saying goodbye to expectations and the changes that material reality brings.

A striking result of the study was a related finding that “preparation and advance knowledge about a person’s prognosis and pending death brings beneficial effects, specifically that a six-month or longer period helps survivors better prepare for the death and facilitates more acceptance and less disbelief afterwards.” The study indicates that over the course of the three-year study period, disbelief was an important coping response at first, but yearning for the deceased peaked at about four months after the loss, anger at five months, depression at six months, and acceptance of the loved one’s death was significantly higher and increased at the two-year mark.

Both clinicians in the field and the general public know that what helps the grieving process are questions and open, honest conversations that invite survivors to reflect on special memories and stories that recount the deceased person’s positive experiences as well as the historical events that are full of attachment-rich emotions. Isolation and loss are inherently traumatizing and the experience of separation is predictable in its significant impact on distress. It is helpful to remember deceased individuals as whole people, understanding them in the context of their life. Remember their values and preferences, how they influenced others, and how they lived their lives rather than how they died. Michael White, the distinguished narrative therapist, would encourage this approach by incorporating the lost relationship in the resolution of grief by the process of “saying goodbye to and saying hello.” As clinicians we hope to develop an attachment via the therapeutic bond that offers a safe haven and a secure base to others by offering accessibility and an empathic responsiveness during these difficult times that we all must face.

Lucy S. Raizman, MSW, LCSW, LMFT is a Senior Therapist and Director of Council for Relationships’ Doylestown office. She can be reached at 215-345-8454 ext. 2.