Counseling Today, Features

Working through grief

Angela Kennedy January 15, 2008

Thanatology is the study of the effects of death and dying on humans, taking into account both psychological and social aspects. Thanatology also involves researching ways to lessen the suffering and address the needs of both the terminally ill and those they will eventually leave behind.

For the past 23 years, Barbara Harris Whitfield, who had her own near-death experience, has been working within the therapeutic specialty of death and dying. The author, workshop presenter and thanatologist maintains a private practice in Atlanta. Having studied with renowned grief expert Elisabeth Kübler-Ross, Whitfield believes grief therapy is still in the early stages of being explored, expanded and defined.

“Elisabeth Kübler-Ross suggests that when we are faced with death, or the death of a loved one, we experience five emotional stages,” Whitfield says. “Her stages were and are a good beginning foundation for learning about our relationship with grieving and our relationship with someone who is dying, including ourselves. My experiences, however, have led me to believe that it takes us a step further. I have learned that the best way to help is to stand back and be a witness — validate the feelings, problems, pain, needs and wants of the dying person.”

Whitfield says neither counselors nor those working through grief should focus on the particular order of the five stages of death and dying: denial, anger, bargaining, depression and acceptance. “The grieving process does us. We don’t do it,” she asserts. “If we can let go of always needing to control and let things come up naturally on their own, half the battle will be over. The most overwhelming lesson I learned in doing my own grieving process is that there are feelings within me that are stronger than my will to control them. I had to give in and let them move and go at their own pace.” Furthermore, Whitfield strongly advocates for grief being considered a normal reaction to loss. She does not believe it should be labeled with a diagnosis or muted with the help of pharmaceuticals. “There’s a big difference between being depressed and being sad,” she says. “When we grieve, sadness overtakes us and rules our life for quite awhile. But there is movement. Eventually we move through sadness and make meaning out of our loss.

“Our society has convinced us that we (individuals who are grieving) are depressed and that drugs will relieve our pain. Prescription drugs only put our grief work on hold, where it will remain until we stop the drugs and let go into feeling the pain. It takes courage to face our loss.”

Whitfield says she frequently sees clients who needed assistance with their grief, but instead of counseling and guidance, they had received only a prescription. “A lot of physicians don’t know how to respect the grieving process,” she says. “We have to wean (our clients) off of these medications that are stopping the grieving process and help them learn how to grieve naturally.”

A changing perspective

Those considering grief counseling as a niche should seek additional educational opportunities related to grief and bereavement rather than relying solely on standard counseling curriculum, Whitfield advises. “Take all the extra classes and workshops you can. Realize that you can’t just sit back and be an expert,” she says. “You have to continually grow in order to help your clients.” She notes that grief and bereavement counseling is fairly new compared with other counseling specialties and is still actively growing and developing.

“I can remember 25 years ago when I had one of my presentations canceled (for the nursing staff of a large hospital in Florida) because they didn’t want me to talk about putting our hands on dying patients,” Whitfield recalls. “They didn’t want me to talk about the word ’spiritual.’ So that whole idea has gone to the wayside.”

Today, she notes, physical comfort, connection and spirituality all play vital roles in working with individuals who are dying. She teaches family members and helping professionals how to ease the suffering of those who are terminally ill by using touch, meditation and visualization. “This helps the dying person to relax,” Whitfield says. “It also helps the round-the-clock caregivers to feel like they are giving some love to the person without hurting them. That’s something I like to teach people, and I’ve been told it’s cutting edge.”

Whitfield also provides support sessions via phone to individuals who are trying to allow a dying loved one to spend their final days at home rather than in a hospital. “I believe this is a trend that is getting more popular,” she says. “Leave them at home if they want to be at home.”

One of Whitfield’s clients, who previously came to Whitfield’s office for counseling sessions, is temporarily living outside the state so she can be with her mother and allow her to die at home. When the client is struggling, she calls Whitfield and has a 30- to 60-minute session over the phone. “It’s just to keep her on track so she doesn’t feel over-responsible and to help her keep her mother at home,” Whitfield explains. “That’s our whole goal — to keep her mother at home so she may die in her own bed.” After the mother has passed, the client will return to Atlanta to begin grief counseling with Whitfield.

Methods for helping people cope with the impending death of a loved one in hospice situations have evolved considerably over the past few decades, Whitfield says. “What I’ve seen change over the years is that, back then, we (caregivers) thought we had to control the situation,” she says. “What I’ve seen happen in my own practice is standing back and allowing the spirit to take over, standing back and letting the dying person run the show. It’s now about just being there as a communicator (in hospice situations) between the dying person and their loved ones.”

Client to counselor

Twenty years ago, Amy Liebman-Rapp was a highly respected designer, sales and marketing professional and management consultant in the Northeast residential construction industry. While she found psychology interesting, she never envisioned becoming a counselor and thanatologist.

Liebman-Rapp was introduced to grief therapy when she sought help coping with her husband’s chronic long-term illness. In 1991, after her husband passed away, she also began looking for ways to help their 8-year-old son cope with the loss. She dove into research, reading as much as she could find on the subject of children’s grief.

“Unfortunately, in the early nineties, there wasn’t very much out there on children’s bereavement (and) certainly not much on how to parent a grieving child,” she says. “So, it became an educational process for myself. I had already been in therapy for the past five years, and I had a great understanding in terms of family systems and chronic illness, but I wanted to know more.”

During this time, school officials and doctors expressed concerns that her son had attention deficit/hyperactivity disorder. But in trying to understand all that her son was going through, Liebman-Rapp discovered that AD/HD and child bereavement share similar features. Eventually, it was determined that her son did not have AD/HD; he was simply a grieving child.

Finding herself at a new stage in life as both a grieving spouse and parent, Liebman-Rapp decided to return to school to pursue a degree in counseling. She attended the graduate counseling program at Fordham University and The Dougy Center/National Center for Grieving Children and Families International Summer Institute in Portland, Ore. With the support of her mentor, Kenneth J. Doka, she collected information both from her research and her own experience and set out to help other parents console and care for grieving children.

“I was trying to make meaning in my own experience and trying to transform my own grief,” she says. “Dr. Doka encouraged me to go out in the world and be a teacher. It’s been an intuitive path for me. It’s never been like work; it is a love and passion.”

Today, Liebman-Rapp, a member of the American Counseling Association, is a private practitioner, speaker and educator. She’s also the founder of The Sanctuary, a New York/New Jersey-area resource center that provides grief counseling, bereavement education and outreach to children, teenagers, adults, families, communities and businesses that have experienced the death of a family member, colleague or friend. Additionally, she helped establish A Little HOPE, a national not-for-profit charitable foundation whose mission is to help provide grief counseling and bereavement support services to children and teens who have lost a parent or loved one, regardless of the circumstances.

“There is a lot of controversy surrounding grief therapy,” she acknowledges. “(The question is) does it work, or should you just do nothing? One of the hot topics in the field is whether narrative therapy works with grieving clients. There is a lot of controversy depending on the type of therapy a client is getting. I think it’s only recently that the telling of the story has been recognized to have therapeutic value in and of itself.”

Liebman-Rapp begins grief counseling with narrative therapy and then moves on to explore the client’s family history. “I come from a family systems perspective,” she says, “so what was going on in the family prior to the death has a lot to do with how the family will cope. It’s all interrelated.”

Another current discussion among grief counselors pertains to human resilience, Liebman-Rapp says, or the factors that make individuals either more or less able to cope and recover from the loss of a loved one. Practical matters, such as financial security, good health and positive social support, affect a person’s grief process as much as their personality traits, coping style and ability to find positive meaning after a traumatic loss, she says.

Much like Whitfield, Liebman-Rapp thinks the Kübler-Ross stages can serve as a starting point in helping clients understand the grieving process. However, she cautions that grief does not follow a linear timeline. “I’m a firm believer that people grieve in their own way. There’s no right or wrong,” she says. “There are misconceptions out there as to how much time it takes to go through the process and the stages, but people go back and forth. It takes years. This isn’t new within the grief (counseling) community, but it’s new in our culture and world. It’s the realization that grief is an ongoing process. Grief never ends. It’s revisited and experienced as secondary losses throughout a person’s life.”

Bernadette Graham, facilitator for ACA’s new Grief and Bereavement Interest Network, believes recent traumatic events, such as the war in Iraq, natural disasters and school shootings, have resulted in a changing worldview of grief and loss. “People are becoming more aware of these traumatic losses and are taking grief more seriously,” she says. “The difficult part to that is, in counseling, grief isn’t a diagnosis. Many counselors steer away from it or try to call it something else like anxiety or PTSD (post-traumatic stress disorder).”

Regardless, grief is something that counselors can’t shy away from, says Graham, a group counselor at Green Door, a Washington, D.C., community program that prepares people with severe and persistent mental illness to work and live independently. “All counselors — school counselors, private practitioners, mental health counselors — you are going to come across situations where people are grieving. Grief touches the entire spectrum of counseling. It’s important for counselors to have at least some knowledge base in this area. Even if they choose not to pursue that type of counseling with their client, they can recognize the issues and refer the client to a grief counselor.”

Graham adds that the counseling profession and society in general are becoming more accepting of the fact that individuals can grieve over any type of loss, be it a loved one, a relationship, a job or even a pet.

Counselors who want to stay connected and current in the field of grief counseling are invited to join the ACA Grief and Bereavement Interest Network. For complete details or to sign up for the Listserv, go to www.counseling.org and click on the box near the bottom of the page that says “About Us.” Scroll down the page until you see “Interest Network Facilitators” and click on the link for more information.