For this assignment you are to prepare and submit a Design Mock Counseling Workshop? chapter (ATTACHED). The length is determined by the amount of information you feel is nee

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C 9HAPTER

B C : B , DEREAVEMENT AREGIVING EFORE URING, AND

A LFTER OSSES

Rejoice with those who rejoice, [and] weep with those who weep.

—Romans 12:15

Blessed are those who mourn, for they will be comforted.

—Matthew 5:4

Bereavement is a universal human crisis that strikes everyone sooner or later. In terms of human wholeness

there is no aspect of pastoral care ministry in which the stakes are higher. The fact that clergy have

automatic entrée to the agonizing world of most sorrowing people gives them unparalleled opportunity as

well as responsibility. They are the only professional persons with substantial training in grief caregiving.

They are called to be effective guides and companions of the bereaved as they walk through the shadowed

valleys of life’s multiple losses. Obviously it behooves pastors to develop a high degree of competence in

bereavement care and counseling.

Insightful Studies of Grief and Crisis Healing

Contemporary approaches to both crisis intervention and grief caregiving have their roots in the

pioneering research of a young Boston area psychiatrist named Erich Lindemann. In 1942 there was a

tragic fire in which several hundred people died at the Cocoanut Grove nightclub in Boston. Lindemann

decided to study the varied responses among survivors and close relatives of those who died, focusing on

the consequences for their health or illness of how they handled their profound individual and family grief.

His most significant finding was that those who did what he called their “grief work” well recovered1

much faster than those who repressed their sorrow. He later summarized his findings, which have been

confirmed by other research:

Studies show that many people become sick following the death of a loved person. A great many more hospital

patients have had recent bereavement than people in the general population. And in psychiatric hospitals, about

six times as many are recently bereaved than in the general population. . . . Furthermore, in a great many

conditions, both physical and psychological, the mechanics of grieving play a significant role.2

Lindemann and countless other grief researchers have shed light on the dynamics of the healing process.

These dynamics have many similarities with those of any severe crisis. But the loss of someone or

something that has been a significant part of a person’s world of meanings and satisfactions is a

psychological and spiritual amputation. How traumatic it is depends on the nature and importance in their

lives of what they lose, and also on the development of their coping skills. The responses employed in

C o p y r i g h t 2 0 1 1 . A b i n g d o n P r e s s .

A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .

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coping with new losses are the same ones they have learned in coping with previous deprivations,

frustrations, and losses, large or small. These coping skills, learned from their culture, are filtered through

their parents’ responses to losses. If individuals have learned constructive, reality-oriented coping skills,

they will follow a somewhat predictable process of working through the mixture of powerful feelings

resulting from the bereavement and making the adjustments required to live without what has been lost.

This work (called “grief work”) must be done by grieving persons themselves, hopefully with strong

support from family, close friends, caregivers, and their faith community.

In the decades since Lindemann’s pioneering research, crisis intervention and grief-healing methods

have been studied extensively, refined, and greatly improved. Caregivers today have more understanding

and better methods available for making this vital healing ministry effective than ever before in the

century-spanning history of care with persons suffering from life’s many-faceted problems.

Grief: A Strand in Life’s Multicolored Fabric

As we have seen, some feelings of grief result from all significant crises, losses, life transitions, and

changes, not just in the deaths of loved persons. Every life event on the Holmes-Rahe stress scale involves

some losses and therefore grieving. The price people pay in health problems for unresolved grief is

extremely high, and there is evidence that many psychosomatic illnesses are related to unhealed grief. The

same is often true of alcoholism and other drug and behavioral addictive illnesses, including compulsive

sexuality, gambling, and religiosity.3

Some years ago, the staff of the pastoral counseling and growth center with which I was associated4

decided to ask all of the people who came for help if they had experienced major changes or losses within

the preceding two years. More than one-third of our clients could identify a painful loss or a cluster of

several losses, often correlated with the onset or dramatic worsening of the pain that had brought them for

help. These counselees suffered from a wide range of presenting problems, including marriage and family

crises, sexual dysfunction, depression, job difficulties, substance abuse, psychophysiological illnesses, and

religious and ethical problems. Many reported general psychological-spiritual malaise and depression.5

Caregivers should know that grief experiences triggered by different types of crises typically have

distinctive differences as well as similarities. They all bring some degree of sadness and longing for what

was lost. The grief in involves sadness and longing for the lost satisfactions of earlierdevelopmental crises

life stages. Grief in , as the husband of a woman with Alzheimer’s put it, “hangs over me likechronic crises

a dark cloud that keeps blocking the sunlight and refuses to go away!” Grief feelings in collective or

are shared by most members of the large or small affected group in varying degrees andcommunity crises

expressions. Grief feelings in have special poignancy resulting from the terrible sense of beingacute crises

hit out of the blue without any time to prepare to cope with the trauma. For this reason, the grief impact

may cut deeper and be more devastating initially. Grief in long-term or chronic crises includes many

opportunities to do what is described as “anticipatory grief work.” If survivors have done this before their

loved ones die, they still feel some pangs of loss, but the grief usually is much less protracted than in acute

crises triggered by unexpected losses.

Factors that Complicate Crisis and Grief Recovery

The way people respond to losses varies tremendously depending on their culture; their resources; the

quality and length of relationships; the timeliness of the loss; and, in cases of death, whether it was

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expected and its nature. The more dependent, conflicted, or ambivalent relationships were, the longer and

more complicated the recovery process tends to be. Grieving following the deaths of children or

adolescents probably produces the most agonizing and protracted recovery process. Sudden, unexpected, or

violent deaths usually are followed by more extended and difficult grief work with more shock and anger

than slow, expected deaths. There are more unfinished aspects of the relationship, which produces greater

guilt. The vacant social roles such as companion in attending church or in recreational travel that had been

filled by the deceased have not been gradually refilled.

When the bodies are not found or are terribly mutilated (so that the casket is left closed) or when the

body is cremated immediately after death, recovery may be protracted because the grieving persons are not

able to accept the reality of the loss by dealing with the image of the dead person’s body. Since our own

identity and that of others are integrally related to body image, having an opportunity to deal with feelings

about the body is often necessary for the grief wound to heal as fully as possible. The traditional wake or

visitation time before the funeral, when the body is visible, can be a grief-enabling experience for many

mourners.

Caregivers also need to be aware of numerous societal factors today that often cause recovery from

crises and grief to be very difficult, protracted, or blocked. They include the following:

1. The weakening, or rejection by many people, of traditional religious beliefs that were

comforting, and the failure to develop more viable beliefs to replace them.

2. The fact that most pastoral caregiving of bereaved persons extends only a week or so beyond

the funeral or memorial service, whereas the journey of recovery often extends over two years

or more.

3. The fact that much, if not most, of the caring for terminally ill persons is done by impersonal

medical and nursing home staff members rather than the family.

4. Our death-denying culture that programs us to deny feelings about our mortality and dying or

escape from them in a variety of ways.

5. Geographical distances and interpersonal alienations deprive many friends and family members

of opportunities to say “Good-bye,” or “I love you!” or “Please forgive me,” or simply “Thank

you!” to dying people.

6. Not having opportunities to view and perhaps touch the body so that friends and family can say

good-bye to the dead person’s physical presence.

7. The ways that interpersonal conflicts are stirred up in broken and blended families when death

occurs and wills are implemented.

8. Social stigmas that unfortunately are often attached to certain deaths, including those from

suicide and AIDS.

9. The many ways that people suffering from poverty and discrimination carry a multiple

load—their economic problems and one-down social esteem added to their painful losses.

10. The fact that women raised in traditional families often derive their feelings of self-worth

mainly from their caretaking roles makes the deaths of persons for whom they were primary

caretakers deeply disruptive to their sense of meaning and value.

To the extent that one or more of these individual or social complications apply to care receivers or

caregivers, it is important to treat them and to encourage them to treat themselves with extra caring and

compassion over what is usually a longer time.

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Dying Persons Can Be Our Teachers

Sooner or later, crises and losses teach everyone agonizing lessons. These lessons come as unwelcome

intruders and as rude confrontations with painful truths that understandably are resisted tenaciously. But as

suggested earlier, they can offer unexpected opportunities to learn valuable lessons that can contribute to

personal growth that enhances overall well-being and preparation for coping constructively with future

crises and losses.

Let me illustrate this personally. In recent decades life has taught me much more than I wanted to learn

about the process of dying. In this respect my experiences are comparable to those of many people in the

last third of life expectancy. In addition to awareness brought by several near-death experiences, my main

teachers have been several terminally ill persons. They include both of my parents, my spouse’s parents,

and two valued mentors. Also included have been a number of friends around my age and several former

students whose deaths were particularly shocking because they were much younger than I. I remember

each person with gentle sadness, mixed with gratitude for the precious gifts I received from many of them.

Some of my most valuable learnings came from Lois, a nurse and close friend of my spouse and me.

She died in her late forties after a protracted and debilitating struggle with cancer. Shortly before her death,

I asked her if she would talk with me about her experience of dying so that I could learn from her and share

her insights with others (as I am doing here). In her usual generous spirit, she replied that she was glad to

do so. In what for me was a deeply moving conversation, she shared her intense feelings and needs. One6

particularly strong need was to have people listen to her swirling, changing, and conflicted feelingsreally

as her malignancy gradually spread. She described how terribly let down she felt when some of her friends

and one of her several physicians changed the subject or tried to give her superficial reassurances.

Although she knew that they did this because of their own discomfort with the grim facts and her intense

feelings, it hurt anyway. Having read Elisabeth Kübler-Ross’s book , she said that theOn Death and Dying 7

many feelings she had experienced included the five described in that book (denial, anger, bargaining,

depression, and acceptance). But she added that her feelings would come and go, never following a

particular sequence.8

Lois told of experiencing waves of fresh anger at each new stage of her progressive illness. One of her

many friends was especially helpful when Lois told her that the oncologist had just informed her that the

malignancy had spread to her vital organs. The friend hugged her warmly and shared her intense

disappointment and anger.

After Lois shared the details of her struggles with fear and grief, I expressed my warm affirmation of

the ways in recent months she had become even more vital and alive than she had been before. She

responded, “When you know your future here probably will be short, it makes the present more

important.” As we concluded our conversation, I was pleased when she said that it had been very

meaningful and helpful to talk about her experiences so fully. I expressed my deep appreciation and told

her how profoundly I had been touched by all that she had shared. Lois helped me see more clearly that the

process of dying can be an important stage of continuing spiritual growth for some people, even as they

struggle to cope with the multiple losses of dying.

Using Losses as Growth Opportunities

Insightful novelist Alice Miller once declared, “The human soul is virtually indestructible, and its

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ability to rise from the ashes remains as long as the body draws breath.” Eleanor Roosevelt was such a9

person. Throughout her life, she used a series of severe crises and losses as opportunities to learn and

grow, and heighten awareness and empathy for other suffering people. Eleanor’s mother rejected her for

“not being a beautiful child” and then died when Eleanor was only eight. One bright spot in her young life

was her adoration of her father (Theodore Roosevelt’s brother), who adored her in return. But his chronic

alcoholism interfered with his ability to give the dependable, loving attention she desperately desired. He

died from his addiction when Eleanor was only ten, just two years after Eleanor’s mother died. As a young

adult, she married FDR, who went on to become a four-term president during the Great Depression and the

first years of World War II. During her years as First Lady, her deep empathy for the pain of the countless

victims of social, economic, and civil rights oppression had a profound influence on the development of

FDR’s policies. Behind the scenes she helped shape the national safety net that helped millions of

impoverished people (including my childhood family) during the shattering economic tragedy and

collective grief of the devastating depression. After FDR’s death, her courageous, prophetic outreach

became overt. Her influence continued to expand through her caring service to the oppressed in her own

country and the wider world.

For caregivers, it is crucial to know that wounded people usually only in retrospect make the discovery

that growth has occurred through their crises or losses, after they have coped with the worst of their

traumas. At that point it is appropriate to ask a door-opening question such as: “As you look back now on

your terrible loss, are you aware of anything useful that you have learned as you struggled to cope?” To

raise the possibility of growth before this point ignores people’s intense pain, causing them to feel

misunderstood and resentful. It also sets them up to feel they are failures if they do not experience some

growth. It is well to remember that huge losses like the deaths of children are so utterly devastating to most

parents, siblings, and grandparents that deriving any sense of having grown usually is impossible except

perhaps in very long retrospect.

Opportunities for spiritual and ethical growth occur frequently in crises and grief because they often

shatter false gods, such as achieving power and wealth, that many people worship in our society. Crises

and losses often confront people with the need to rethink and possibly revise their spiritual beliefs and

guiding values. The hope is that they will do this in directions that bring more spiritual vitality and deeper

meaning to their lives.

Making Grief and Crisis Caregiving Holistic

As a caregiver, keeping the seven dimensions of wholeness in the back of your mind as you offer crisis

and grief care can help you see and respond to opportunities to make your healing ministry more holistic.

Severe traumas often create wounding that needs healing in many dimensions of sufferers’ lives. To

illustrate, basic physical self-care is usually diminished in the days and weeks following a major grief, at

precisely the time when stress overload makes self-care even more important than usual.

Pastor Marjorie was on target when she paid a pastoral visit to Larry, a man in his mid-fifties. She had

conducted the funeral for Larry’s wife, Betty, who had died three weeks earlier. After a brief exchange of

relatively superficial comments, the pastor intentionally invited Larry to move their pastoral conversation

to a deeper level by asking him: “How are you doing, Larry, in handling your loss just a short time after

Betty’s funeral?” “OK, I guess” was his response. Marjorie then pressed him directly, “Are you taking care

of your health, Larry? I mean by getting enough rest, good food, and some fast walking or other exercise

on most days?” Larry said, “The trouble is I really don’t have time or energy to do such things for myself

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right now. It makes me forget what I’m feeling when I start digging myself out from under the pile of work

that I’m way behind on.” The pastor responded, “I understand that you don’t feel like it or have enough

time given those heavy demands. But as you probably are aware, your body is under extra heavy pressures

these days. To handle this load of stress and keep from getting sick, you need adequate self-care now even

more than usual. So I wonder, doesn’t it make sense to make time to do these things for a while, even

though you don’t feel like it?” Larry agreed and said he would try to talk better care of himself. Pastor

Marjorie affirmed this intention and then helped him decide on a realistic plan for improving his self-care.

Pastor Marjorie focused holistically on Larry’s physical and mental self-care and the wellness of his

vocational life as she helped him do his unfinished grief work.

Six Tasks of Coping and Growing through Grief

A transformational approach to caregiving with those suffering many types of normal grief involves

going beyond the first essential goal of helping them survive, cope, and recover from their losses as fully

as possible. The goal that transcends this is to help them learn how to use their grief as an opportunity to

grow at least a little as whole persons by the ways they handle their grief. When grieving persons

accomplish this goal, they discover a hidden possibility expressed symbolically by Albert Camus: “In the

midst of winter, I finally learned that there was in me an invincible spring.”10

The movement from the initial shock of new loss to the ultimate experience of new life involves six

tasks with which the companionship of a pastoral caregiver can be very helpful.

Task One: Dealing with Numbness and Shock

When death or other severe losses strike, the usual response is feelings of psychological numbness and

shock mixed with a sense of unreality. The mind cannot yet accept the overwhelming pain of facing the

reality that someone or something that was loved is really gone. But gradual acceptance of the grim reality

of the loss must eventually occur or the healing process will be blocked and incomplete. Full acceptance

usually occurs over a period of several months or even years.

In the first hours and days after severe losses people often feel that their agony and depression will

never diminish. Only as their grief work progresses with the passage of time will they discover that they

can walk through the dark valley of death and eventually emerge to a brighter day. The psalmist clearly

expressed this awareness: “Weeping may linger for the night, but joy comes with the morning” (Ps. 30:5).

The role of caregivers in facilitating normal grief is to cooperate with the psyche’s inner process of

recovery. During this shock phase, effective caring includes using supportive care methods as previously

discussed in this book. These often include gratifying dependency needs. Severe losses activate grievers’

“inner child,” often bringing painful feelings of anxiety, deprivation, and abandonment. The need to be

comforted is intense.

On a personal level, I remember nothing the pastor said at my mother’s funeral, but I recall how much I

appreciated his comforting touch on my shoulder as he left the funeral parlor after the service. Acts of

spiritual ministry during task one, such as familiar scripture, prayers, hymns, and rituals, can bring comfort

and hope to bereaved individuals and families who are religious. Taking gifts of food and offering help

with practical needs, such as providing transportation, are symbolic, nonverbal ways of communicating

nurturing care. A congregation’s lay caring or grief recovery team should surround the grieving individual

and family with the supportive care they need. Providing a meal after a funeral or memorial service is a

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way of providing physical nurture and affirming the ongoingness of life despite the loss. It also is a way of

saying, “We can, must, and will walk on into the new, unknown future—together!”

Task Two: Expressing and Talking through Feelings as They Are Gradually Released

After the 1942 Cocoanut Grove nightclub fire, Lindemann made a most illuminating discovery. He

learned that .experiencing and expressing agonizing grief feelings are indispensable to the healing process

In fact, blocked feelings result in the healing process being delayed or blocked long term, whereas facing

the painful feelings is the path to eventual healing.

To help grieving people do their grief work, caregivers must go against the cultural tendency to avoid

painful feelings. This is why grieving persons often need help in expressing fully and talking through the

variety of powerful emotions the loss has triggered in them. This is encouraged by responsive, dialogical

counseling with occasional focused questions aimed at enabling the persons to get in touch with their

feelings and express them fully. Often these feelings are ambivalent and conflicted. They range from total

despair to relief and joy (about which most people feel some guilt). Task two begins and continues

intermittently as persons’ denial gradually diminishes and they allow the stark reality of the loss to enter

their awareness. By experiencing and verbalizing the feelings repeatedly, they gradually transform the raw

agony of loss into gentle sadness and a renewed gratitude and love for the lost person. But grief feelings

often return unexpectedly for a long time after a major loss. Grieving is unpredictable.

One primary goal of grief work following deaths is to make the relationship that has been lost in

external reality strongly and vividly internal in survivors’ minds and hearts. Repetitive reminiscing and

storytelling help them accomplish this. Thus the relationship is not completely lost because memories and

images of the deceased become more vivid and alive. Those who have internalized the lost relationship

often say something like, “I feel that she is still alive, supporting and giving me strength.” This can enable

grief-stricken people to find comfort and solace, especially if relationships have been relatively healthy.

But in toxic or dependent relationships, the negative side of this internalizing process is seen. It may be

expressed in statements of feeling controlled, such as, “I feel that he is still here watching to make sure I

shape up like he wanted.” People who continue to feel oppression and/or protracted depression after family

members die need to be helped to exorcise these mental ghosts. Doing this will help free them from being

trapped in the past and enable them to get on with living in the new present and emerging future that the

death has made

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