You may be wondering when does ‘normal’ grief become a problem that could benefit from professional help.
Losses can be very disorienting and painful, making it difficult to envision how to go on living. Other times people do not feel like they are having an especially strong reaction, but wonder if they should. It is not uncommon for people to think that they are “going crazy” after severe loss, making it hard enough to comprehend the present let alone consider the future. Despite how impossible it may seem in the midst of grieving, given enough time and gentle attention, grieving can eventually lead to deep reflection and growth.
As you may be experiencing, the pain of loss can more fully connect you to a sense of what really matters in life. Rather than taking what matters for granted or shying away from the pain that comes with caring, you can learn to deepen your commitment to the things that matter, when you are ready. Until then, it is enough to simply acknowledge your hurt and longing without holding too tightly to any expectations about what you should or shouldn’t be experiencing or doing.
When to Seek Grief Counseling
Under most circumstances, people are able to navigate their grief with the support of family, friends, and community. In fact, when it comes to treating bereavement-related grief alone, research shows that the majority of people are resilient and do not benefit from the addition of counseling or therapy. However, as a general rule of thumb, it is worth considering counseling or therapy if you find that you develop enduring impairments in functioning (e.g., relationship problems, problems at work, difficulty fulfilling important roles). A grief counselor can help if you are experiencing any of the following:
Sleep disturbances. Persistent sleep disturbances (e.g., trouble falling asleep, waking in the night, oversleeping, etc.) can disrupt your energy, mood, and focus, making it difficult to tend to the responsibilities and relationships that matter to you. A counselor can help you develop habits that will promote a full and restful night’s sleep.
Lack of social support. While family and friends can be of great comfort during times of loss, you may find yourself in a period of life where there are few people who you can turn to for support. A counselor is a member of your community who can provide additional support, offering genuine compassion and companionship during a difficult time. They may also be able to help connect you with other individuals experiencing grief by recommending bereavement groups.
Role transitions/stress. Loss can result in changes to your life that may press you to change or take on new roles. For example, you may find yourself having to take greater responsibility for paying bills, maintaining a household, or parenting children. It can also be difficult to maintain or develop new relationships following a loss. Counseling can be useful in helping you find practical solutions to the problems posed by role transitions, manage stress, and help identify areas of life where you can meaningfully invest.
When to Seek Grief Therapy
Sometimes additional factors can compound the difficulties of grieving, in which case it makes sense to seek professional guidance. Please consider contacting a licensed therapist who practices evidence-based psychotherapy if you are experiencing any of the following factors in addition to your grief:
History of addiction. Experiencing strong emotions can be a trigger for people to have abused drugs or alcohol. A therapist can help develop healthier ways of coping with emotions so that you can stay present to your experience and choose a path forward that is more in line with your values.
Anxiety. Losing a loved one can be very anxiety provoking. Life without the deceased can seem foreign, strange, and worrisome. The sense of security we gain from our relationships is often disrupted when those relationships change, increasing our awareness of our own mortality and vulnerability. While this is a very understandable and natural reaction to loss, people often get stuck struggling with anxiety. It can be helpful to work with a therapist to develop new coping skills and gain a broader perspective.
Depression. There is a good deal of overlap between the symptoms of depression and the symptoms of grief, and both can be caused by bereavement and loss. While similar on the surface, depression and grief are actually distinct reactions that can be treated differently. Unlike grief alone, depression is a psychological disorder that can be treated with psychotherapy. You may be experiencing both grief and depression simultaneously, in which case therapy may be of benefit to you. Depression can be distinguished from bereavement-related grief in that individuals struggling with depression may exhibit the following symptoms:
Guilt about things other than actions taken or not taken by the survivors at the time of death.
Thoughts of death other than the survivor feeling that he or she would be better off dead, should have died with the deceased person, or wishing to join the deceased.
Feelings of worthlessness or self-loathing; feeling undeserving of life.
Prolonged and marked functional impairment.
Hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person.
Traumatic death. Exposure to sudden, unexpected, or violent deaths can be very upsetting, whether or not you had a relationship with the deceased. Deaths resulting from accidents, suicide, crime, combat, or sudden illness can lead to intense feelings of fear, helplessness, or horror, in some cases resulting in the development of Post Traumatic Stress Disorder (PTSD). PTSD is a type of anxiety disorder involving struggling with re-experiencing a traumatic event, trying to avoid reminders of a traumatic event, and being hypervigilant (“keyed up” or “on edge”) about possible threats to safety. You may benefit from therapy if you have been experiencing several of the following symptoms of PTSD for at least one month:
- Re-experiencing the traumatic event:
- Intrusive and distressing images, thoughts, or perceptions
- Recurrent distressing dreams
- Acting or feeling as if the event were happening again (“flashbacks”)
- Distress when exposed to reminders of the event
- Re-experiencing the traumatic event:
- Avoidance of reminders of the traumatic event:
- Efforts to avoid thoughts, feelings, or conversations about the trauma
- Efforts to avoid activities, places, or people associated with the trauma
- Inability to recall important aspects of the trauma
- Diminished interest or participation in significant activites
- Feeling detached or estranged from others
- Flattening of feelings (e.g., unable to have loving feelings)
- Sense of foreshortened future
- Increased arousal
- Difficulty falling or staying asleeo
- Irritability or outbursts of anger
- Difficulty concentrating
- Exaggerated startle response
Complicated/Prolonged Grief. Given sufficient time and care, it is generally the case that bereaved individuals’ functioning returns, even without therapy. However, research suggests that about 10% of bereaved individuals do end up having substantial and enduring impairments in their functioning (e.g., for more than one year), in which case therapy can be useful. Consider seeking the assistance of a licensed therapist if you are experiencing several of the following symptoms on a daily basis (from the DSM-5):
- Persistent yearning for the deceased.
- Intense sorrow and emotional pain in response to the death.
- Preoccupation with the deceased or the circumstances of the death.
- Difficulty accepting the death; experiencing disbelief or emotional numbness over the loss.
- Difficulty with positive reminiscing.
- Bitterness or anger related to the loss.
- Blaming yourself for the loss.
- Avoiding reminders of the loss.
- Desiring to die to be with the deceased.
- Difficulty trusting others since the death.
- Feeling alone or detached from others since the death.
- Feeling that life is empty or meaningless without the deceased.
- Feeling you can’t function without the deceased, or feeling confused about your identity without the deceased.
- Difficulty or reluctance to pursue interests since the loss or to plan for the future (e.g., friendships, activities).
People experiencing one or more of the above factors are more likely to benefit from evidence-based psychotherapy, though there are also other distressing situations not listed above for which therapy can be helpful. It may be useful to have an initial consultation with a professional to see if therapy can address your needs.
Most importantly, while therapy is a responsible way to care for yourself during times of pain and suffering, it is also about focusing your energy in directions that promote growth and enrich your quality of life. Therapy is an investment in learning new ways to deepen your relationships, find more fulfillment in your experiences, and get more involved in the things that matter to you.
Please feel free to contact me if you or someone you care for is struggling with grief. I am a licensed psychotherapist who offers grief counseling and therapy services. I would be happy to talk more with you about your situation, discuss treatment options, or schedule an initial consultation.