How to Do Bereavement Counseling

As the funeral car pulled away, all was quiet except for the sound of the tires on the snow.

I wanted the world to stay silent for a long time – it didn’t. Everything moved on, with a small part of me left behind.

Psychology defines grief as the pain and anguish experienced after losing a loved one. And understanding and coming to terms with that sense of loss may require repeatedly retelling your story (Morris, 2018).

A counselor, especially one focusing on bereavement, will encounter individuals whose grief is overwhelming and who are struggling, emotionally and physically, to move forward after the death of a loved one.

This article introduces the bereavement process and offers support and intervention techniques for clients experiencing grief.

What Is the Bereavement Process? 28+ Symptoms

“Death is the last great taboo,” writes Julia Samuel (2019, p. xii). While there are very few subjects that are no longer spoken about, we often remain silent surrounding the topics of death and bereavement, leaving us unsure how to respond to our own or others’ grief (Samuel, 2019).

Someone who has not lost anyone close to them or is confronted with their first experience of death may be unclear about what to expect from grief, and this not knowing may even intensify the process (Morris, 2018).

Sue Morris (2018) identified four recurring themes that shed light on grief, its symptoms, and where to begin to focus resources and attention:

• Grief is unique.
  While we are all confronted by grief in our lives, the experience remains unique to each one of us. Indeed, “it is impossible to truly know another’s pain or sense of loss” (Morris, 2018, p. 12).
• Grieving is about finding the space and time to live without the person we have lost.
  As soon as we hear about the death of a loved one, our life changes. Yet, it is possible to find a way to live without them physically and with meaning, but it takes time to adjust.
• Our grief will not always own us.
  While our life may initially feel hopeless, helpless, and out of control, in time, we can learn to gain control of our thoughts about death and our behavior (Samuel, 2019).
• No one else can do it for us.
  We may feel isolated and alone and wonder if we are normal, but grieving is a process that we must go through. “The best advice is to take things slowly and pay attention to your inner voice” (Morris, 2018, p. 14).

Morris (2018) outlines a list of physical and emotional reactions or symptoms that typify the grieving process. We may experience more than one at once, or they may come and go with time. All are common responses to grief.

Emotional reactions/symptoms	Physical reactions/symptoms
Extreme sadness	Numbness
Disbelief	Headaches
Despair	Nausea
Shock	Racing heart
Worry	Muscular tension
Anguish	Aches and pains
Anger	Difficulty sleeping
Guilt	Loss of appetite
Regret	Agitation
Peace	Restlessness
Emptiness	Fear
Pining	Panic
Confusion	Crying and sobbing
Relief	Gastrointestinal problems

There is no definitive list of symptoms of bereavement, and they are unique to the individual and the situation. It is also impossible to know how long each will last. Much experiencing loss report that grief arrives in waves that are often unpredictable yet typically lessen with time (Morris, 2018).

A Look at Bereavement Counseling

The American Academy of Grief Counseling (AAGC) offers comprehensive grief training for qualified professionals, such as physicians, counselors, and social workers (American Institute of Health Care Professions, n.d.).

AAGC objectives include the provision of certification, recertification, and fellowship status for those in the practice of grief and bereavement counseling.

Training in bereavement counseling

Grief counseling certification is offered by AAGC and includes the following four modules:

• Death, dying and mourning
  Students learn the major theories, process models, and cultural issues surrounding death.
• Grief counseling for helping professions
  Case studies help students enhance theoretical knowledge with practical skills.
• Grief therapy
  Includes group bereavement counseling, grief as a social phenomenon, and knowledge of the skills required to help clients through the grieving process.
• Working with grieving children
  Helping children mourn the loss of a loved one fully express their feelings of loss.

Courses are available online, and certification requires an ongoing commitment to study.

How to Support Your Clients in Therapy

Support during the grieving process can take many forms and must remain specific to the client and the situation they are facing.

The following steps are a sample of some of the assistance professionals can offer clients to support them through bereavement counseling.

Managing a client’s expectations

Sometimes a client’s expectations can be unrealistic regarding how they should overcome grief. Therefore, it’s helpful to spend time discussing practical beliefs.

Realistic beliefs include (modified from Morris, 2018):

• You cannot hurry grief.
• There is no quick fix.
• Grief is not an illness. There is no medicine to fix it.
• Grieving is a healthy process, giving us the time and space to adjust to our loss.
• If we love deeply, we cannot expect to grieve shallowly.
• Crying is a natural and helpful way to express how we are feeling.
• Sadness after such a loss is entirely normal.
• Grief does not always start and finish; it may come in waves.
• There is no single or right way to get through grief. The process is our own.
• Until we have been through a full year, there are many unknown triggers.

Exploring the client’s relationship with themselves

Death may change our relationship with the world, others, and even ourselves. Counseling a client during bereavement involves making them consciously aware that during such a time of change, they need to show themselves compassion (Samuel, 2019).

The client may find it helpful to write down their conflicting feelings and messages in a journal to clarify their thinking.

Time during grief

It is vital to understand that our perception and experience of time can be very different during grief. Clients can become more self-accepting and less anxious through understanding the following:

• They should allow more time than usual to make decisions.
• Grieving often takes longer than expected or wanted, but its intensity does lessen over time.
• The future can appear daunting and the past more appealing. It can be helpful, at least initially, not to look too far into the distance.

Permission to grieve

Clients should be encouraged to permit themselves to grieve. The process, thoughts, and feelings will often feel awful, but by grieving openly without limitations, it is possible to learn to move forward without a loved one (Morris, 2018)

Morris (2018, p.43) suggests that we should remember, that “healthy grieving means becoming an active participant instead of a passive recipient.”

Helping clients with depression & anxiety

When grieving, it is perfectly normal to feel depressed and anxious, but such feelings are not the same as clinical depression. Extreme feelings of sadness, panic, anxiety, apathy and lack of motivation are common reactions to loss (Morris, 2018).

However, if accompanied by a history of clinical depression or expressions of suicide, referral to a psychiatrist or prescribed medication may be necessary.

For more ideas on what to discuss with clients, we share this article suggesting 40 counseling interview questions.

7 Bereavement Interventions to Try

The following four interventions are valuable techniques for understanding the experience and process of grief.

Keeping a journal

Writing in a journal can be highly therapeutic when faced with grief. While it’s a practical way to express feelings about a loved one, it can also maintain a connection with them.

You can write about any thoughts or feelings you experience. Morris (2018) offers the following helpful writing prompts:

• Thoughts about the death of your loved one
• Their absence
• How you feel
• How life continues to change without them
• Memories of them
• Things you wish you had said to them

There doesn’t need to be a particular structure. Whatever comes naturally is best.

Finding structure

During grief, it can feel like life is in chaos. Samuel (2019) suggests adopting a flexible structure of good habits to regain the feeling of control. As the days pass, encourage your client to:

• Start or continue exercising
• Return to work (even if only part-time) and begin chores
• Set aside time to remember the person who has died
• Engage in self-care: cook healthy food, buy nice flowers, listen to music, or have a massage
• Create a regular sleep routine

Create a worry box

Death can be a time of worry. To manage feeling overwhelmed by all the things that need to be done, it is important to find ways to regain a sense of control (Morris, 2018):

Morris (2018) suggests creating a worry box:

• Find time and space to write down all the issues that are causing you to worry.
• Group them; for example, finances, funeral, house, and children.
• Now, sort each group into priority order. What needs to be attended to now, what can wait, and what do you have control over?
• This may seem like a simple and obvious task, yet it can help the person feel like they are bringing their worries back under control. By revisiting the list at the start of each day, they can set goals for completing each task and recognize the progress they have made.

4 Tips & interventions for children

“Children benefit from knowing that grief is a normal reaction to loss” (Morris, 2018, p. 38).

While parents want to protect their children, it is important to tell them the truth, for example, if someone is dying. Otherwise, children can feel excluded and, years later, harbor resentment.

Consider the following:

• Breaking the news
  It can be helpful to have a friend or another family member present when telling the child what has happened. Explain clearly and simply, answering the child’s questions about what has happened truthfully. Words such as “passed on” may not be familiar to children, so it is important to use the word “died.”
• Seeing the body
  While upsetting, “seeing the dead body can be a way to help a child face that reality” (Morris, 2018, p. 95). But remember, a child should not be made to do anything they don’t want to, and they will require a great deal of support and comfort.
• Regular routines
  Despite the high degree of upset, it is vital to return to normal routines and discipline as soon as possible.
• Children protecting adults
  Children often take on the task of protecting adults, concealing their grief, and appearing to deal with upset. Take time to check what is going on and talk about how they feel.

5 Helpful Worksheets and Workbooks

The following worksheets and workbooks help use with the client inside or outside of a bereavement counseling session.

Unhelpful Beliefs About Grieving People

Many unrealistic and unhelpful beliefs are held about people who have lost a loved one (Morris, 2018).

The Unhelpful Beliefs About Grieving People worksheet captures some of these thoughts and recognizes them as unhelpful.

Challenging Unhelpful Thoughts Arising From Grief

The grieving process can lead to unhelpful thoughts that cause powerful negative emotions, destructive behavior, and harm other relationships.

Remember, especially early in the grieving process, to be kind to yourself and recognize difficult thoughts and emotions as they arrive. However, when ready or if they are causing harmful behavior, the Challenging Unhelpful Thoughts Arising From Grief worksheet provides a Cognitive-Behavioral Therapy-based approach for replacing negative thoughts with more positive ones (Morris, 2018).

What Firsts Have You Experienced?

Inevitably, after someone dies, there will be many ‘firsts’ that occur without them, especially over the next 12 months.

The What Firsts Have You Experienced? the worksheet helps you consider the ‘firsts’ you have been through without your loved one and prepare for others yet to happen.

Moving Forward From Grief

While your life is forever changed following the death of a loved one, it is possible to move forward (Samuel, 2019).

Use the Moving Forward From Grief worksheet to consider what you would like your life to look like on the other side of grief.

Seeking New Opportunities

Once you can accept that life has changed following the death of a loved one, it can be time to plan a new life path (Morris, 2018).

While you may never regain the life you had, it is possible to create a new one. Use the Seeking New Opportunities worksheet to consider what opportunities you have to try new things and how life may look.

3 Activities & Exercises for Your Sessions

No experience of loss or bereavement is the same.

Therefore, the therapist or counselor must understand the situation specific to the client, remaining open to how they feel without any bias (Worden, 2018; Morris, 2018).

Understanding the Mediators of Mourning

The counselor should spend time with the client, building a picture of the mourning process and its mediators.

Use the Understanding the Mediators of Mourning worksheet to fully appreciate the impact of the situation and the potential effect of the client’s loss early on in counseling to ensure that the correct degree and type of support is given.

Memory book

Creating a memory book for a lost family member can provide comfort to a client. In the session, describe to the client how they can put snapshots, poems, drawings, certificates, and other memories in a book or folder. Creating and reflecting on the collection can be especially helpful for children to reconnect or maintain a connection with the deceased (Worden, 2018).

Directed imagery

Visualizing the deceased sitting in an empty chair and addressing them with feelings and anything that needs to be said can be a powerful and positive technique.

The power comes not only from imagining the person but also from being present and talking to them (Worden, 2018).

Top 3 Bereavement Books for Children & Adults

We have included three of our best-recommended grief books on helping adults and children deal with bereavement below.

1. Overcoming Grief: A Self-Help Guide Using Cognitive Behavioural Techniques – Sue Morris

This is a practical guide to help anyone facing grief regain a sense of control over their life.

Along with detailing coping techniques, it tackles avoidance, making decisions, and returning to ‘normality.’

Find the book on Amazon.

2. Grief Works: Stories of Life, Death, and Surviving – Julia Samuel

Julia Samuel takes the reader through a series of stories from those who have experienced both love and loss and found ways to come to terms with the unwanted changes in their lives.

This fascinating and compassionate book will help anyone experiencing grief.

Find the book on Amazon.

3. The Memory Book: A Grief Journal for Children and Families – Joanna Rowland

Grief is painful for anyone yet can be incredibly impactful for children.

This beautiful and impactful journal has space for photos and drawings to remember the person who has died.

The journal is a companion to the bestselling book The Memory Box by the same author.

Find the book on Amazon.

A Take-Home Message

The pain and upset experienced after the death of a loved one can be all-consuming and hard to express.

Unlike education in school, where we are taught and then tested, in life and grief, we are tested first, and if we’re lucky, learning follows.

Support from family, friends, partners and professionals such as bereavement counselors can help us navigate the process of grieving.

Most importantly, we must learn that grief is unique to the person and the situation. The experience can be shared but never judged. Ultimately, compassion from others and toward ourselves is essential to move forward and find a new path in life.

Bereavement counseling can help by managing clients’ expectations and encouraging them to explore their relationship with themselves, their loved ones, and the future.

Why not try some techniques, worksheets, and tools with clients to help guide them through the difficult grieving process?