Grief and Loss

Psychotherapy is necessary when grieving is "intense and protracted, associated with deep unrelieved depression and interfering with normal enjoyments, life tasks or an ability to work." Robert Neimeyer, Ph.D. [1]

People often feel traumatized, disoriented or immobilized after a major loss. I help you cope with the dark territory of bereavement with education, support and problem-solving, so you can:

Get re-oriented after a major loss
Recognize the stages of grief to avoid compounding the pain. These stages go by many names, including shock, denial, anger, bargaining, depression, resolution, and acceptance
Reconcile shame, guilt, remorse, or other difficult feelings
Have a safe place for coping with intense feelings
Get help managing your life while grieving, including relationship or mental health issues made worse by loss

I help the bereaved for a variety of concerns, including:

Are There Stages of Grief?

When Elizabeth Kubler-Ross [2] studied the psychological transitions of dying people, she wrote about stages of grief and loss. Her stages were:

Denial (or disbelief)
Anger (or yearning)
Bargaining
Grieving (or depression)
Acceptance

Other authors describe similar stages, but our current understanding is that these experiences don't unfold in orderly stages. They may occur in a slightly different order and they may overlap. And, not everyone experiences each stage. [1] A recent article by Rick Nauert, Ph.D. [3] summarized findings of the Yale Bereavement Study [4] as follows:

"Disbelief was not the initial, dominant grief indicator. Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from one to 24 months postloss. Disbelief decreased from an initial high at one month postloss, yearning peaked at four months postloss, anger peaked at five months postloss, and depression peaked at six months postloss. Acceptance increased steadily, ... ending at 24 months.”

What are Grief's Course and Resolution?

According to psychologists George Bonanno, Camille Wortman, and colleagues, [1] grief has a different course for different people. Almost half of the bereaved are relatively resilient. They're distressed but not overwhelmed by depression. A smaller group experiences intense depression that mostly resolves after 18 months. But the depression course can vary with others for individual reasons. Some who were in a difficult relationship with the person who died may feel relief after the death.

Psychotherapy for Grief

According to psychologist Robert Neimeyer, psychotherapy is necessary when grieving is "intense and protracted, associated with deep unrelieved depression and interfering with normal enjoyments, life tasks or an ability to work."[1] I would add to this list that some people add immensely to their difficulties by turning to alcohol or drugs to self-medicate their grief.

Does everyone benefit from bereavement therapy? No, for instance, the "resilient" group discussed above. Although some people have said bereavement counseling may actually harm some of the bereaved, especially immediately after their loss, a recent study by psychologists Dale Larson and William Hoyt disagrees with the data underlying that claim of harm. [5] I believe the issue is usually more one of whether they benefit from the process, and I wouldn't ask someone who's overwhelmed to further express their feelings but may instead help them to reduce their symptoms of distress. Also, some people may benefit from bereavement groups, while others may not, depending on the style of the group and whether the person is similar to other participants. [1] In general, experts agree that the best approach is one that meets the needs of the individual, their history and style of thinking, feeling and coping. [1] Finally, some people who appear to be depressed may actually suffer from a recent loss. [6]

Losing a Loved One

Death or other loss of a family member, including estrangement
Becoming a widow or widower after many years of marriage
Heartbreak from losing a romantic relationship
Death of a pet. Some losses are recognized by everyone as overwhelming. Other losses may not bring enough support for the grief-stricken person. A typical loss of that kind is the death of a pet, which some experience with the intensity of losing a family member.

Lost or Disrupted Career

Job loss or career disruption
Financial loss
Damaged reputation

Personal Losses

Changes in physical or mental health or bodily function
Effects of aging on appearance and abilities
Realizing that a cherished dream will never be fulfilled
Losses due to drug abuse or addiction relapse, including loss of the emotional escape provided by addictions (may include referral to residential treatment, 12-step program and/or physician)

Relationship Issues

Loved ones failing to provide needed support
Family members telling you to "get over it" before you're ready or otherwise telling you how you "should" react
Friends leaving you isolated or showing discomfort in conversation

Consequences

Lifestyle changes, such as the need to move out of your home, get help for chores or consider an assisted living facility
Mental health issues triggered by loss, such as depression, suicidal thoughts, anxiety or isolation (may include referral to physician and other resources)
Spiritual or religious consequences, such as anger at God, damaged or lost faith, unanswered questions or prayers, superstitions and fears
Damaged self-esteem
Difficulty meeting job or family responsibilities
Trying to self-medicate your grief with drinking, drugs or other addictions

The list of issues above is by no means complete but is provided to give you a sense of what is often seen by a psychotherapist. One of my goals here is to let you know that you're not alone, even if you're suffering from a loss that seems unusual. There are many resources in the community for coping with grief and loss.

If your issue is one I haven’t covered, I'll be glad to discuss its possible treatment and resolution.

To ask about a free first appointment, please select this link.

Footnotes

1. Brody, J. ( 2004) "Often, time beats therapy for treating grief " In The New York Times, Personal Health, January 27, 2004. Downloaded 2/15/09 from: http://query.nytimes.com/gst/fullpage.html?res=9E01E1DF1438F934A15752C0A9629C8B63&sec=&spon=&pagewanted=all
2. Kubler-Ross, E. (1969). On death and dying: What the dying have to teach doctors, nurses, clergy, and their own families. New York: Touchstone Books.
3. Nauert, R. (2007a). "Normal grief emotions clarified." Downloaded from PsychCentral.com, 2/15/09 from: http://psychcentral.com/news/2007/02/21/normal-grief-emotions-clarified/640.html
4. Maciejewski, P. K., et al., "An empirical examination of the stage theory of grief." In JAMA, 2007; 297: 716-723.
5. Nauert, R. (2007b). "Grief counseling is okay." Downloaded from PsychCentral.com, 2/15/09 from: http://psychcentral.com/news/2007/07/30/grief-counseling-is-okay/1079.html
6. Carey, B. (2007). "Many diagnoses of depression may be misguided, study says" In The New York Times, April 3, 2007. Downloaded 2/15/09 from: http://www.nytimes.com/2007/04/03/health/psychology/03depr.html?_r=1

Gary Seeman, Ph.D.	(415) 271-2350 drgary@drgaryseeman.com