grief counselling: necessary or optional? counselling.pdf · grief counselling: necessary or...

2
Grief Counselling: Necessary or Optional? By Dr Bill Webster With the current growing emphasis on grief counselling and therapy, it is valuable to discuss the criteria by which grief may be considered pathological or complicated. For the purposes of this article, I am distinguishing between grief support, which every bereaved person requires in one form or another, and grief counselling, which every individual may not require. If grief is not a disease but a natural human reaction to any loss, why should we seek to treat it according to a sickness model? Yet it is often difficult to decide when counselling is appropriate, and when, in fact, the manifestations of grief displayed by the person are part of the normal process. Even normal reactions are sometimes so intense, unusual and uncharacteristic that the bereaved may feel they are losing control or “going crazy”. Often, however, support and encouragement by friends, family, or in a group, enables them to address and overcome these concerns. The question becomes: “How do I recognize the grief reactions that may benefit from, or even require the help of a professional counsellor?” There is no doubt that certain criteria and specific situations expose an individual to a higher risk for complicated grief reaction. These may include a background of mental instability, or a history of serious and chronic medical problems. Additional life stresses such as divorce or the loss of a job, just to name a few, may contribute to complicating the process. Where the relationship was either highly dependent, or, perhaps surprisingly, highly ambivalent or troubled, people often have trouble in their adjustment. Traumatic situations such as accidents, suicide, violent death, and where the survivor was at risk themselves can predispose the situation to a complicated reaction. I emphasize again, these factors can predispose, but do not always necessitate the situation becoming pathological. It is far too simplistic to label all individuals who have these risk factors as candidates for “abnormal” grief responses. Also, even those without these risk factors are not immune to troubled processes of grief. Pathological grief is not a separate set of grief responses, but an intensification, a prolongation, or an inhibition of normal grief. The person often is “stuck” for one reason or another. So what could alert you to potential situations that may require counselling. If the following changes in behavior are sustained with lasting intensity for 6 weeks to 4 months, they deserve careful scrutiny:

Upload: trinhthuy

Post on 05-Jun-2018

212 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Grief Counselling: Necessary or Optional? Counselling.pdf · Grief Counselling: Necessary or Optional? ... I am distinguishing between grief support, ... these risk factors as candidates

Grief Counselling: Necessary or Optional? By Dr Bill Webster

With the current growing emphasis on grief counselling and therapy, it is valuable to discuss the criteria by which grief may be considered pathological or complicated. For the purposes of this article, I am distinguishing between grief support, which every bereaved person requires in one form or another, and grief counselling, which every individual may not require. If grief is not a disease but a natural human reaction to any loss, why should we seek to treat it according to a sickness model? Yet it is often difficult to decide when counselling is appropriate, and when, in fact, the manifestations of grief displayed by the person are part of the normal process. Even normal reactions are sometimes so intense, unusual and uncharacteristic that the bereaved may feel they are losing control or “going crazy”. Often, however, support and encouragement by friends, family, or in a group, enables them to address and overcome these concerns. The question becomes: “How do I recognize the grief reactions that may benefit from, or even require the help of a professional counsellor?” There is no doubt that certain criteria and specific situations expose an individual to a higher risk for complicated grief reaction. These may include a background of mental instability, or a history of serious and chronic medical problems. Additional life stresses such as divorce or the loss of a job, just to name a few, may contribute to complicating the process. Where the relationship was either highly dependent, or, perhaps surprisingly, highly ambivalent or troubled, people often have trouble in their adjustment. Traumatic situations such as accidents, suicide, violent death, and where the survivor was at risk themselves can predispose the situation to a complicated reaction. I emphasize again, these factors can predispose, but do not always necessitate the situation becoming pathological. It is far too simplistic to label all individuals who have these risk factors as candidates for “abnormal” grief responses. Also, even those without these risk factors are not immune to troubled processes of grief. Pathological grief is not a separate set of grief responses, but an intensification, a prolongation, or an inhibition of normal grief. The person often is “stuck” for one reason or another. So what could alert you to potential situations that may require counselling. If the following changes in behavior are sustained with lasting intensity for 6 weeks to 4 months, they deserve careful scrutiny:

Page 2: Grief Counselling: Necessary or Optional? Counselling.pdf · Grief Counselling: Necessary or Optional? ... I am distinguishing between grief support, ... these risk factors as candidates

• major deterioration in personal hygiene habits

• difficulty in simple decision making

• expressions and manifestations of fear, anger or guilt

• hyperactivity or compulsive talking

• sustained memory problems and confusion

• hallucinations ( seeing or hearing things that are not actually present)

• major disturbance of self esteem, preoccupation with worthlessness, and self-

condemnation

• depression and withdrawal

• significant impairment in social functioning

• initiating or increasing alcohol or drug abuse

• Physical symptoms: failure to eat, continued weight loss, extreme sleeping

problems

While you and I may recognize the need for therapy, the decision and commitment to begin can only be made by the person themselves, and sometimes we can only suggest that help might be appropriate. If, however, there are threats of suicide, homicide or self mutilation, and the person refuses to seek help, your decision to act should be different. Your responsibility should be to take definitive steps to immediately inform an appropriate party. This may be a parent, spouse, physician, member of the clergy, or the police. You may be afraid that your intervention is betraying a confidence, but such actions grow out of your respect and concern for the individual and the community, and have an integrity all their own. A caring friend is always willing to take that chance. Dr. Bill Webster is Executive Director for the Centre for the Grief Journey. For a brochure on Dr. Webster’s work, including the many books, tapes and videos specifically designed for grieving people, offered through the Centre, please write: Dr. Bill Webster, 3243 Grassfire Crescent, MISSISSAUGA, Ont.L4Y 3J8 or contact Bill through his website at www.griefjourney..com