Tag Archives: Grief and Loss

The impact of cultural resiliency on traumatic loss

By Jessica Meléndez Tyler and Nancy Thacker Darrow January 12, 2023

A profile shot of a woman looking out a window.

Alexandra begins her scheduled counseling session with the news that her sister suddenly passed away the day before. The counselor is caught off guard and begins to provide supportive therapy. The counselor learns that while Alexandra’s sister had been sick for some months, her sudden health turn was unexpected and rapid. Alexandra was at the hospital when her sister died and was charged with taking the lead on making funeral arrangements.

Alexandra appears numb and detached in session. The counselor attributes this to the initial shock of the loss and provides warmth and comfort to Alexandra. In the following sessions, the counselor notices that although Alexandra appears to be functioning well following what she endorses as a traumatic loss, she demonstrates a flat affect in sessions, states she has accepted the loss and resumes work immediately although she reports feeling little connection to her current life.

The counselor is concerned that Alexandra is avoiding her grief experience, which may lead to the development of pathological symptoms. However, Alexandra reports that she is functioning just as she was before her sister’s death, only with a lost sense of purpose or spirit. She redirects therapy topics to present stress management and adjustment issues in a new career. After exploration from the counselor, Alexandra acknowledges that without her sister, she finds little point in continuing to pursue her goals as every plan was something she would share with her sister.

Cultural factors

As counselors, working with traumatic loss can be a difficult subject matter. Unfortunately, Eurocentric American society has generally promoted the avoidance of grief in subtle ways, which causes many people to be uncomfortable around people in pain. In addition, we often inadvertently provide the subtle message “it is time to move on” after a loss.

In Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss, Pauline Boss argued that traumatic grief — a grief “so great and unexpected that it cannot be defended against, coped with, or managed” — is significant, complex, and a diverse public and social health concern. The COVID-19 pandemic, along with a rise in social justice issues and a charged election in 2020, created difficult trials and mass grief that continues today. People experienced numerous losses at individual and community levels: loss of personal health, job security, identity, human rights security, mobility, physical safety and loved ones. Typical responses to traumatic loss may be fear, helplessness, illness, instability and even violence. As counselors, we help clients make sense of loss, redefine their lives and find meaning again. But understanding the multitude of factors needed to grieve traumatic loss is an advanced clinical skill, particularly with clients from minoritized backgrounds who have been systematically silenced.

As noted in Robert Neimeyer and colleagues’ Grief and Bereavement in Contemporary Society: Bridging Research and Practice and Darcy Harris and Tashel Bordere’s Handbook of Social Justice in Loss and Grief: Exploring Diversity, Equity, and Inclusion, cultural traditions often affect the way people respond to grief, whether that involves wearing a particular color or garment, crying or praying. Thus, understanding how trauma impacts mental health requires a broader view of identity, community, adaptation and resistance as forms of resilience. Cultural awareness, responsiveness and understanding are essential to increasing access and improving the standard of care for traumatized individuals. However, there are misconceptions about resilience encompassing an individual’s level of grit and fortitude when facing adversity. In reality, particular groups may risk developing traumatic grief because of repeated exposure to pain and suffering (e.g., the Black community, immigrants, members of the LGBTQ+ population). Also, these marginalized populations may not receive adequate treatment or community support for the causes of their grief and trauma because they may only be treated under the medical model, if they are treated at all. Taking a social justice approach, we as counselors can increase individuals’ feelings of meaning, connectedness and support following a traumatic loss. And by exploring the role and impact of cultural resiliency in navigating traumatic loss, we can consider how cultural strength can be utilized in treatment to decrease the vulnerability of disadvantaged communities.

When working with clients going through a traumatic loss, what are the perceptions we hold about the healing process? About resiliency? About treating historically harmed and excluded populations? When people and communities are overwhelmed and unsafe, they experience the world as dangerous. The rest of the world may not know about what our clients have been through, or they may have no appreciation for it. When this happens, traumatized people and communities may feel completely alone, forgotten or ignored. With traumatic loss, focusing on cultural sources for resiliency is paramount to supporting marginalized populations. This construct provides a focused way for counselors to engage with individual stories of suffering, locate causes, charge responsibility, validate the person’s struggle and activate more effective responses.

A cultural resilience approach

Utilizing resiliency soon after a traumatic event can prevent severe mental health concerns. As documented by the literature, resilience has been associated with several positive physical and mental health outcomes. However, as counselors, we must be mindful that most measures of resilience are still skewed toward Western, individualistic practices. Culture can buffer its members from the impact of trauma because it can create meaning systems and provide healing rituals where one can express their pain while remaining connected to a group. A cultural resilience approach to treating clients experiencing traumatic grief can offer a wide range of culturally responsive techniques to decrease client helplessness, hopelessness, self-blame, guilt, shame and worthlessness, especially for those with a poor clinical prognosis. In addition, a social justice approach to integrating cultural resiliency in therapy can be used to evaluate clients’ beliefs about loss, belonging, defeat, marginalization, honor and self-preservation.

Through cultural resiliency, our clients can have a pathway to express their pain in connection to their belonging group. We, as counselors, can increase our clients’ feelings of meaning, connectedness and support following a traumatic loss. We can consider how cultural strength can be utilized in treatment to decrease the vulnerability and oppression of disadvantaged and harmed communities. A social-ecological approach can incorporate cultural variables to activate resilience and acknowledge cultural components of the trauma and a client’s response.

When working with Alexandra, the case example mentioned previously, the counselor could conceptualize Alexandra’s loss from a multicultural and social justice lens, instead of focusing just on stress management. Alexandra is a Black, single, cisgender woman in her 20s who identifies as a Christian. She is in a professional role following her graduate program, and she says that she is close to her two parents and feels supported by them.

First, the counselor considers how Alexandra’s identified cultural and ethnic groups have historically demonstrated resilience. Next, the clinician asks, “How might I effectively integrate a cultural resiliency approach to my work with Alexandra?” The counselor then respectfully asks Alexandra, “What does the healing process look like within your culture as a Black person, a woman and a Christian?”

Alexandra sits and considers the counselor’s question for a minute. She then answers, “That is difficult to answer. As a Black woman, I recognize the expectation to be a strong Black woman. Emotions are a vulnerability that literally makes us less safe so we must push through no matter what. We prevail. As a woman, I also expect to take care of others before myself so my own healing will come with time, but the important thing is that my people are taken care of. As a Christian, healing looks like having faith in God and knowing that this is all a part of God’s master plan. However, I have been angry at God since my sister’s death, so I do not want to discuss faith and his master plan.”

Without identifying a client’s cultural or ethnic affiliation that guides navigating life’s circumstances, counselors may empathize personally with the client but miss the sociopolitical framework that influences the client’s traumatic loss experience. In a 2003 article published in Violence Against Women, Bonnie Burstow discussed how counseling requires both personal and political empathy to understand a client’s social location and how oppression has impacted their well-being. Society and systems are critical in clients’ trauma experiences, and a person’s group identity or identities and the historical trauma with which they are associated often underly their personal trauma history. Trauma occurs in layers, with each layer affecting every other layer.

The counselor considers Alexandra’s reply, and then says, “I hear multiple cultural influences shaping your understanding of healing. I wonder how these cultural components of healing inform your process of grieving the loss of your sister?” Alexandra sits for a moment in silence, with a thoughtful look on her face. “I feel conflicted,” Alexandra says. “I am prevailing, keeping on with my job, taking care of surviving family, and organizing my sister’s things. But I am confused and angry; everything feels unjust. How am I supposed to grieve something that should not have happened?”

The counselor validates Alexandra’s experience of injustice and her conflicted feelings. Alexandra’s question also opens the door for deeper conversations about how her cultural groups have responded to injustice and formed cultural resiliency strategies. But how can the counselor engage in the meaning-making process (the one taught in counseling programs and supervision) with Alexandra through a cultural lens?

Cultural healing and meaning making

For counselors working with clients navigating traumatic grief and loss, exploring historical and cultural healing can deepen the conversation around bereavement and mourning and aligns with our counselor identity of being strengths-based. Some of our clients come from ethnic and cultural groups that have overcome the most traumatic of trials. An intentional counselor can draw upon generations of resilience and attitudes of overcoming impossible odds despite injustices. When counselors focus only on an individual’s lived experiences without considering historical and cultural context, then beliefs about weakness, powerlessness, helplessness and worthlessness may abound because we think that we are entirely responsible for the quality of our life or lack thereof. However, when counselors explore a client’s identity and lived experience in relation to their identified groups, belief systems about belonging, strength and persistence in adversity come to the surface. In this latter scenario, healing can include considerations about how a client’s traumatic loss experience is part of a more significant social injustice that requires institutional and community remedy.

Healing involves a process of forming vulnerable narration about concepts that have been suppressed or silenced. In other words, it is important to narrate the concepts that have only been quietly discussed in the safety of within-group communities or within internal processing and self-talk. Such healing involves a therapeutic relationship of empathic witnessing and a commitment to deepening one’s understanding of the origins of the client’s pain and suffering that has often been pervasive through time and circumstance.

Returning to the example of Alexandra. If the counselor chooses to remain focused only on client functioning and symptom monitoring, they lose an opportunity to deepen the processing and healing of Alexandra’s pain that surrounds her traumatic loss. Prompting deeper reflection on the origins of Alexandra’s pain within her identities (i.e., a sister who was helpless to protect her sister from death, a Black woman who feels that she must make sure everyone else is OK before she allows herself space to grieve, and a religious woman who believes that her higher power wholly abandoned and betrayed her devoted family through this loss) can elicit more meaningful transformations in therapy. Instead of oversimplifying and focusing sessions on the pain of losing a sibling, the counselor can use deliberate Socratic questioning to probe into deeper associations of powerlessness and injustice. This exploration can help Alexandra gain the power to name her generational, historical and personal losses; feel equipped to protect herself through generational resilience; and combat alienation in her traumatic loss through cultural and ethnic identification and belonging.

Counselors can aid in this process by asking clients to tell their story of grief, not only for the immediate loss but throughout their life and previous generations. What has their identified group endured, and how pervasive are those histories in their lived experience? What and who contributes to our client’s grief story? How did they learn their expectations of what it means to suffer? By asking these questions, counselors can help grieving clients label their experiences and examine their beliefs about how their cultures factor into their feelings of traumatic loss.

The counselor decides to guide Alexandra to explore her anger with God gently. The counselor acknowledges that spirituality can be tricky to unpack because it may be perceived as unfaithful or sacrilegious to express doubts about one’s spiritual beliefs outwardly. Alexandra pauses and considers the counselor’s invitation to verbalize how her anger toward God feels. She is hesitant as she begins discussing an almost superstitious belief that if she and her family were faithful and devoted to their religious practices, they would be granted blessings and saved from the suffering others outside her religious faith might experience. She looks down, sheepish in her admission that she genuinely believes that good things happen to good people, and yet her good sister died regardless. Here, the counselor can help Alexandra not only examine her beliefs about being a strong woman of faith but also assess the intersectionality of her being a “good” woman and how that impacted her grief experience. Being a good woman means that Alexandra is outwardly stoic and strong and demonstrates resilience through continuing her responsibilities (e.g., checking in and cooking for her loved ones, managing her sister’s funeral arrangements) and by not becoming emotional around others or needing to be consoled by others.

Over several sessions, the counselor and Alexandra explore reclaiming her personal and community space. They acknowledge the outcomes of Alexandra’s labor to be resilient despite her suffering and implement rituals and ceremonies that express her grief and outrage in a way that is true to her identity as an angry woman, a betrayed woman and a woman who mourns for the generations of Black women who could not express their suffering openly and be met with warmth. The counselor then offers the client warmth and acknowledges the vulnerability it took for Alexandra to name these experiences in therapy and accept support as she not only reconnected with her historical strength and resilience as a Black woman but also rebuilt ties and traditions to being a religious woman who also historically overcame adversity.

The counselor also guides Alexandra to reconnect with nature in her grief processing, as nature has repeatedly demonstrated its resilience through catastrophic impacts. Through this, Alexandra can draw symbolic strengths and models of what resilience looks like. Her grief response changes over time; she no longer feels she must earn her right to be comforted or take up space in processing the traumatic loss. Instead, she resonates with the notion that, like in nature, she can just be and bend and transform as the circumstances require, while remaining rooted in the generations of strength and resiliency that shape her.

Through counseling, Alexandra realized that her grief of suddenly losing her sister would be ongoing and without end. However, she discovered parts of her cultural resiliency that would be beneficial to help her process this grief; using culturally resilient strategies to cope with the loss of her sister allowed Alexandra eventually to readily embrace the injustice and make meaning of the loss experience. Her bond with her sister will always remain, and her meaning-making journey will include how she continues to name and recognize how her sister shows up in her life and informs her cultural resiliency.

Often, to avoid superficial platitudes (e.g., “things happen for a reason”), individuals find themselves at a loss for words to support others going through traumatic loss. Exploring the role and impact of cultural resiliency to help clients grieve traumatic loss can metamorphize their process of bereavement and decrease counselor helplessness in the therapy room. When a horrific event occurs, we, as counselors, do not have words that will heal, and there is no cognitive reframe possible that can make a client’s suffering cease. Nevertheless, we can help clients explore their own histories of resilience and triumph in pain and adversity beyond their lived experience. This empowers a client to continue to fight to survive the unsurvivable and increases their connection and belonging with others in their identified groups and with us as the counselor.


Through a cultural resilience framework, counselors can guide clients through traumatic loss in a way that connects them to the dignity inherent to how their ancestors navigated and overcame suffering. An individual’s cultural groups may also hold generational pain because of oppression and abuse inflicted on the culture. Therefore, it is strongly recommended that counselors explore cultural identities with their clients and highlight helpful aspects of their identified groups that can activate resilience while leaving behind the aspects of the group the client finds unhelpful. The counselor can normalize that culture does not have to be all or nothing, and each person can write the story of how their identified groups activate and empower their group resilience.

Drawing on community connection, resources and rituals that encompass a sense of support and belonging can aid counselors and protect our clients from traumatic grief, which can lead to significant mental health concerns such as mood disorders or posttraumatic stress disorder. Learn about and emphasize the culture-based holistic strategies that clients bring into therapy. This serves to decolonize our counseling practices and enhance our current methods, while also amplifying the voices of generations who have survived and created meaning systems that can contribute to our healing through traumatic loss.

Jessica Meléndez Tyler is an associate professor of practice at Vanderbilt University and a private practitioner. She is a licensed professional counselor, a licensed counseling supervisor, a board-certified telemental health provider and a national board-certified counselor. Her professional interests include working with suicidal clients and crisis counseling, women’s issues, trauma-informed care, cultural resiliency, collegiality, and the intersection of these topics for counselor education. Contact her at jessica.tyler@vanderbilt.edu.

Nancy Thacker Darrow is an assistant professor of counseling at the University of Vermont. She specializes in grief counseling and LGBTQ+ mental health and development. Through research and practice, she aims to dismantle systemic barriers that influence these specialty areas and counselor education broadly. Contact her at nancy.thacker@uvm.edu or through her website at nancythackerdarrow.com.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counseling From a Survivor’s Perspective: The unrecognized grief of IPV survivors

By Leontyne Evans February 3, 2022


This is the debut article of a monthly online column about working with survivors of intimate partner violence written by a counselor who is also a survivor of domestic violence.


In August 2021, I wrote an article for Counseling Today challenging counseling professionals to not ask survivors of intimate partner violence (IPV) “Why didn’t you leave?” or to give the perceived notion that leaving would solve the problem. Doing so often causes confusion because most people believe that once someone leaves an abusive relationship, the problem is resolved.

So, let’s go with that for a second. Playing devil’s advocate to my own article, let’s say the protocol for assisting clients who have experienced IPV is to encourage them to leave. If they do leave, then what? What are the next steps? Where do they go from there? Is the problem solved? Will they no longer need the intervention of a professional?

As mental health professionals, we often believe we have all the solutions. We think our degrees, research, theoretical knowledge and certifications give us superpowers to fix people. But we often lack the real-life experience to understand the complicated layers of the situations our clients face.

If a client leaves their abuser, are you prepared to help them along their journey to recovery? Do you understand the journey? Do you understand the new set of problems that will arise after a survivor leaves?

Every counselor should not only be prepared to support their client in deciding how to safely exit an unhealthy situation (if that’s what the client wants to do) but also be adequately equipped to help the survivor prepare for what’s next.

You may be asking, “Well, if someone has removed themselves from an unhealthy environment, shouldn’t that be good enough?” Survivors often receive little to no support once the threat of abuse is gone because so many counseling professionals and organizations believe this very thing. It sounds easy enough: Leave your abuser and get back to living your life. Then all will be well, right? Wrong!

A survivor may experience unexpected issues after they leave their abuser that a clinician can help them to process and understand. As professionals, however, we must understand these issues first.

Each article of my column, “Counseling From a Survivor’s Perspective,” will focus on one specific issue survivors may face post-crisis. In this first column, I explore how counselors can help survivors work through their grief and loss.

Experiencing grief and loss

One of the most overlooked side-effects of leaving an abusive relationship is grief. It may be hard to believe, and maybe even hard for some to understand, but there can be a lot of grief associated with ending an abusive relationship. Even if it was unhealthy, it was still a relationship.

Grief happens after people experience loss. A survivor who leaves an abusive situation may grieve:

  • Loss of self
  • Loss of love
  • Loss of the life they expected to have
  • Loss of the idea of who they thought their partner was
  • Loss of friends and family because of isolation

These are just a few examples of the types of loss survivors may experience. These feelings of loss are further complicated by the fact that survivors of IPV may not think sadness is an appropriate response to leaving a toxic relationship. They may find it hard to understand their feelings of loneliness and sadness when others expect them to feel freedom and happiness.

I still remember the day my abuser was taken away in handcuffs. I had looked forward to that day for months. I knew that he would be sentenced to four years in prison and that I would finally have my life back. The irony of watching him being arrested — not for the crimes he committed against me but for something totally unrelated — left me with a sense of bitterness instead of the peace I craved. After seven long years of being on an emotional rollercoaster, the ride was finally over.

However, when the authorities handed me his valuables, placed the handcuffs on his wrist and escorted him away from the courthouse, tears began to roll down my face. My bitterness was replaced with sadness. My anger was replaced with remorse, and my joy was replaced with the fear of loneliness. I cried the entire drive home.

For months, I couldn’t sleep. The sound of the house settling at night caused me to awaken with anxiety. The stairs creaking at 3 a.m. reminded me of the nights when he would come home drunk and take his stress out on me.

I sank into depression, struggling to understand how my mind, heart and body didn’t seem to agree with the verdict. I became angry at myself for missing him, but I also knew I didn’t want him back. This whirlwind of confusing emotions made me feel out of control.

I didn’t understand what was happening then, but now I know this feeling was grief. Grief that I was too embarrassed to explain to anyone else. I was with my abuser for seven years. During that time, we woke up together, went to bed together, ate together, struggled together and celebrated together. It may be hard for some to understand, but I lost my friend. I lost a sense of familiarity. I lost what I thought was love.

Now as an expert in the field, I talk to other survivors every day who have had similar experiences. They are desperately trying to sort through their feelings and understand how they could miss something so toxic. I give my clients space to feel that loss, to grieve it. Similar to those who overcome addiction, survivors of IPV may go through withdrawals or even relapse. For these clients, having a counselor who understands that they are experiencing loss and is invested in helping them explore the journey back to themselves can be life changing.

What counselors must understand

No matter how much abuse was present in the relationship, it was still a relationship. At one point, two individuals loved each other. At one point, the survivor felt safe enough to allow their partner to get close to them to let their guard down. At some point, the survivor let their abuser in — not just into their home but into their heart. Because, let’s be honest, manipulation, gaslighting and the cycle of abuse would not be as effective if the abuser never gained the trust and love of their victim.

Imagine falling in love with someone, feeling a sense of closeness, and then one day waking up next to a stranger, feeling like you don’t know the person you’ve been sleeping with at all. Imagine that the person who once brought you immense joy is also the very person to cause you pain.

If you can’t imagine it, count your blessings to have never experienced something so psychologically damaging. This is indeed a loss. Grief comes in waves, and because the survivor is grieving multiple losses, they may find it hard to communicate or name their feelings.

The client’s mental conflict about ending the abusive relationship can easily be confused (by both the client and the counselor) with missing the abuser when, in reality, it’s often the uncomfortableness of being alone. Counselors can help clients process their feelings and learn to understand the difference between the two. They don’t miss their abuser; they miss themselves — the version of who they were before the abuse happened.

The client may have spent a lot of time and energy attempting to “fix” their partner, and now that they are alone, they may be faced with the idea of “fixing” themselves. Having to examine oneself closely is hard. A good counselor, however, can help clients realize that being in their own company is not necessarily a bad thing. 

How to be a supportive ally

You can be a supportive ally by putting a name to what the client is experiencing: disenfranchised grief (i.e., grief that is not or cannot be openly acknowledged, socially validated or publicly supported). And you can remind them that grief is a normal response to any type of loss.

Give the client a sense of normalcy by explaining the cycle of abuse and why they may have these unexpected feelings. Become familiar with the power and control wheel, and help your client to understand it as well. Explain how manipulation and gaslighting play a part in the mixed emotions.

During sessions, you can also talk about various ways the client can rediscover themselves. Help them to sort their feelings and reconnect to the world in this new phase of their lives.

For example, they could join a club, find a new hobby or reconnect with a passion they had put aside because their former partner didn’t like it. As they grieve who they wanted to be, who they once were and the relationships that have been lost, encourage them to enjoy the journey of self-discovery and reconnection. It may be more manageable to help them acknowledge and work through each loss separately.

Now that you have a better understanding of one of the aftereffects survivors may face upon leaving an abusive relationship, you will be better equipped to serve as a professional and an ally.



Leontyne Evans works as the survivor engagement specialist for Survivors Rising, where she helps to empower and uplift survivors by providing education and resources that encourage survivor voice and self-sufficiency. She is a published author of two books, Princeton Pike Road and Relationships, Friendships and Situationships: 90 Days of Inspiration to Keep Your Ships From Sinking, both of which support her mission of ending the cycle of unhealthy relationships. Contact her at leontynesurvivorsrising@gmail.com.



Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Perspectives on grief and loss

Compiled by Jonathan Rollins October 26, 2021

If you go to the books page on Amazon and enter the word “grief” in the search box, you’ll receive a message saying there are “over 60,000 results” available.

To winnow the choices, you might decide to view only those titles released over the past 90 days. This narrows it down to “over 10,000 results for ‘grief.’’’

Titles published in the past 30 days? “Over 5,000 results for ‘grief.’”

Finally, if you click on books “Coming Soon,” you receive a somewhat manageable “541 results for ‘grief’” (at least that was the case as September drew to a close).

This prodigious output would seem to support the statement that grief is a universal and yet very individualized experience — one that continues to captivate and challenge us as humans. The ever-increasing numbers of books, journal articles and other reports on grief and loss also hint that our thinking about this experience continues to evolve.

Counseling Today recently invited several American Counseling Association members with in-depth knowledge in the area of grief and loss to share their insights on specific aspects of grief that they believe to be largely overlooked or misunderstood. 


Maintaining continuing bonds with the deceased

By Kenneth J. Doka

In recent years, there have been significant challenges and changes to the understanding of grief. These changes include such aspects as:

  • Extending the understanding of grief from reaction to a death of a family member to a more inclusive understanding of loss
  • Acknowledging that there are no universal stages in grief and recognizing the very personal pathways that individuals take when experiencing loss
  • Recognizing the multiple and multifaceted reactions that people have toward loss (rather than seeing grief as primarily affect) and the ways that responses to grief are influenced by culture, gender and spirituality
  • Seeing the possibilities of transformation and growth in mourning rather than coping passively with loss
  • Moving from understanding grief simply as a normal transitional issue to recognizing its more complicated variants and the necessity for careful assessment
  • Acknowledging that certain individuals show great resilience as they cope with loss and grief
  • Maintaining a continuing bond with the deceased rather than pushing to relinquish ties to the deceased 

It is this last area of continuing bonds where I wish to focus. Sigmund Freud, over a century ago in Mourning and Melancholia, argued that bereaved individuals must detach from the deceased by withdrawing emotional energy from the person who has died and reinvesting it in others to go forward with a healthy life. 

This notion has been deeply challenged in recent years. In their groundbreaking 1996 book Continuing Bonds: New Understandings of Grief, Dennis Klass, Phyllis Silverman and Steven Nickman drew on research with bereaved children, spouses and parents, as well as teachings of Eastern religions, to both emphasize and demonstrate the importance for many bereaved persons and groups to maintain an ongoing connection to the individual who has died. They stressed that connections of this type were comforting and eased the grief of those who were bereaved.  

Bonds are maintained in several different ways. First, we always retain memories of the deceased. This is critical. Many bereaved individuals fear that as they cope with loss, those memories will fade. This exacerbates their sense of loss and impedes the grief process. Counselors should affirm to clients near the beginning of grief therapy that the goal is not to diminish memories of the deceased but rather to help them find comfort in such memories as the pain of loss lessens. The amelioration of grief means that over time, the intensity of the grief experience lessens, and individuals function in ways comparable to (or perhaps even better than) the way they did prior to the loss.  

The fact that these memories are always retained is also a reason for subsequent surges of grief that may occur years after the loss. For example, think of a young woman whose father died when she was a little girl. Two decades later, as she walks down the aisle to be married, she has deep pangs of grief that her dad is missing this event. In fact, at the termination of a counseling relationship, it is helpful to suggest, and even to identify, the significant life events or major transitions that might generate such surges of grief in clients.

Second, important attachments become part of one’s own biography. We are influenced by so many factors. The ways that one interacts with others who are important in one’s life frame an individual’s personality. In addition, significant attachments in one’s life leave their legacies, and sometimes their liabilities, on the identity of the bereaved individual. Those legacies (and sometimes liabilities) can include everything from personal gestures to beliefs to the ways that one views self and relates to others and the world. 

Third, survivors retain spiritual ties such as the belief that the deceased is interceding for them (or will intercede) and that they will be reunited in an afterlife. Many spiritual systems have beliefs and practices that strive to retain a connection with the deceased, such as Roman Catholic Anniversary Masses or the Jewish Mourner’s Kaddish — a prayer said at the memorial service as well as for 11 months following the person’s death. In fact, Klass’ interest in Eastern religions was one influence on the development of his theory. Klass pointed out that in traditional Chinese worship, the veneration of one’s ancestors was a common practice that served to reinforce a continuing family bond across generations.

Furthermore, many bereaved persons report extraordinary experiences in which they have sensed the continued presence of the deceased in their lives, whether it is dreaming about the deceased or other ways in which they believe they have encountered the deceased. Such experiences are, in fact, quite common in bereavement.

Finally, increasing numbers of bereaved persons are using the internet and social media, particularly Facebook, to provide death notifications and to continue ongoing relationships with the deceased. For example, they may visit the Facebook page of the person who died, comment there on pictures, post memories and even leave messages to the deceased. It is not unusual for mourners to “keep alive” the digital identity or Facebook page of a person who is deceased. 

Continuing bonds can be applied to groups, communities and even nations. Communities may name parks, streets or buildings after individuals or erect memorials to the person. Nations may honor ties with deceased leaders by naming cities after them and building monuments or establishing holidays to celebrate them.

While continuing bonds are generally healthy, they can at times be problematic when we fail to acknowledge the death or are burdened by promises made to the deceased prior to death. For example, one client, a young widow, promised her spouse prior to his death that she would never remarry. Now she feels torn between her promise to her dead husband and her desire to engage in a new romantic relationship. 

Continuing bonds are natural and normal responses in bereavement. Yet we need to guide clients so that these bonds do not become chains that inhibit their adaptations to loss and perhaps even their personal growth.

Kenneth J. Doka is professor emeritus of counseling at the College of New Rochelle and senior vice president for grief programs at the Hospice Foundation of America. Contact him at kndok@aol.com.



School counseling: Grieving children and adolescents

By Jillian M. Blueford

We often see grief as a common reaction to loss, but at times we try to separate it from who we are and who we want to be. We treat grief the way we treat many life stressors, tending to what is most immediate in hopes that one day, that stressor will be a thing of the past — something we have “overcome” or “persevered” through. However, grief involves a lifelong shift that does not work on a timeline or according to expectations. 

This experience is especially true for children and adolescents, who are not immune to grief and who could have a longer time to navigate their grief while anticipating additional losses in the future. Grief can permeate every aspect of life, and it affects children and adolescents in ways that are as unique as they are during these fast-moving developmental stages. Reflecting on my professional experiences counseling grieving children and adolescents, I have yet to encounter two young people with the same grieving response.

Although we have established that a child’s or adolescent’s response to loss will vary and can appear at any time, we can expect for their grief to influence their presence at school. School is a significant part of many children’s and adolescents’ upbringing. So, naturally, their grief might make an appearance in the classroom, in the cafeteria, on the playground, at sporting events, during choir performances, at club meetings and elsewhere. 

This also means that school counselors may be called on to provide services. These services are often introduced after a school staff member is made aware that a student has endured a death-related loss. According to Judi’s House/JAG Institute, 1 in 14 children in the U.S. will experience the death of a parent or sibling by age 18. This statistic does not account for the deaths of other family members, friends or community leaders, nor does it cover the nondeath losses that children and adolescents endure (e.g., moving, separation of caregivers, pandemics, changes in health, financial instability). COVID-19 has shone a light on some of these losses, but the truth is that many of these losses happen so frequently that we do not recognize these changes as they happen, nor do we seek to understand how children and adolescents grieve these losses long term.

In my experience providing counseling services in schools and outpatient settings, I have often been asked, “What does grief look like for children and adolescents?” I perceive this question to mean “what behaviors stand out for grieving children and adolescents?” But I tend to shift the focus to time and circumstances. 

When we first encounter a loss, it can throw many of us for a whirl. Our appetite, sleep patterns and engagement level with our relationships may be affected. It is typical and expected to be bombarded with an influx of thoughts and emotions. This is no different for children and adolescents who experience a loss.

Furthermore, I expect the academic performance of children and adolescents who are grieving to change. I expect them to become more distracted in class, to potentially distance themselves from others, and to ask more questions about death and the safety of their world. I particularly try to understand how recently the loss occurred and the relationship or attachment the child or adolescent had with what they lost (e.g., a person, experience, material item, health). Those markers give me a better idea of how the child or adolescent has been responding and areas within their grieving process that negatively affect their daily activities over time.

If we tend to focus only on the losses that children and adolescents endure during an academic year, then we may forget to ask about their history of losses. Having this information can help us conceptualize current grieving responses that may otherwise feel sudden and unusual. Understanding the timing also helps illuminate “re-grief,” or the understanding that as children and adolescents mature, their recognition of their losses will change. This can lead to a resurgence of grief, especially as children and adolescents reach developmental milestones, many of which happen while in grades pre-K-12. 

On top of the other responsibilities that school counselors have, fully addressing a child’s or adolescent’s grief can be overwhelming. Given that grief does not have an end date, engaging with grieving students is an ongoing responsibility and requires different care and attention levels. School counselors may believe they have already put in intense effort to support a grieving child or adolescent, but in fact this effort requires a lot of ongoing listening, empathy, validation and education.

Any adult can benefit from a refresher on how children and adolescents respond to a loss. I have seen these educational conversations make all the difference when students are mislabeled as “problematic” but are really just having a difficult time with their grief. Caregivers and families, who are often grieving themselves, can especially benefit from understanding the unique aspects of child and adolescent grief. School counselors should identify resources and strategies that adults in other environments can use as well. 

The organizations listed below provide curricula, podcasts, interactive activities and strategies supported by data. Share these resources with families and any adult who interacts with children and adolescents.

  • Coalition to Support Grieving Students
  • Judi’s House/JAG Institute for Grieving Children and Families
  • The Dougy Center
  • National Alliance for Children’s Grief
  • National Center for School Crisis and Bereavement
  • Grief-Sensitive Schools Initiative

In addition, connect with local counseling professionals, particularly in bereavement settings. Often, these organizations will host grief camps and services for children, adolescents and their families at little to no cost. They can also serve as consultants to supplement your understanding of grief and loss and perhaps provide in-person individual and group services.

My first experience providing counseling was through my time as an intern for a hospice bereavement center. In visiting schools and facilitating grief groups, a passion was sparked in me for addressing grief and loss. It was the school counselors who often advocated for our services, referred families and empowered grieving children and adolescents to believe that they were cared for and not alone in their grief. 

Jillian M. Blueford is a licensed professional counselor, national certified counselor and clinical assistant professor in the Department of Counseling Psychology at the University of Denver. Her primary research expertise falls under grief counseling training and preparation and counseling grieving children and adolescents. Contact her at jillian.blueford@du.edu.



Working with military grief of noncombat deaths

By Joanne Steen

In the United States, there seems to be a widely held belief that military personnel die only in war. However, total military deaths since 9/11 paint a much different picture of how and where U.S. service members have died. In the first seventeen years after 9/11, a total of 22,365 U.S. military personnel died on active duty, according to the Department of Defense (DOD). Of this number, 31% died in Iraq or Afghanistan, while the remaining 69% died in the line of duty, but not in armed combat or war. 

These statistics are surprising to many, and they emphasize a sobering reality of military service: Military personnel regularly die in the line of duty, both in peacetime and in war. 

I learned this lesson the hard way. I married a Navy pilot several years before 9/11 and never worried when he flew. He loved to fly, was well-trained, and the U.S. was not at war. Life was better than good — until the day the helicopter he was flying exploded in midair as he and his six-person crew were returning to Naval Station Norfolk in Virginia. There were no survivors.

War deaths embody the ultimate sacrifice made by military personnel in the defense and protection of our rights, freedom and homeland. But apart from armed combat and war, service members also lose their lives in other military operations worldwide; in terrorist attacks at home and abroad; in training to maintain their operational readiness levels; because of accidents, equipment failure or human error; by suicide or homicide; and because of illness and disease. 

Counselors who work with surviving families or veterans benefit from knowing these common causes of death in the military, because how a service member died is very important within the military culture. The cause of death can deprive survivors of validation of their loved one’s service and unfavorably affect the support they receive.

Prior to 9/11, there was little in the way of literature and military-focused grief resources for family members or professional service providers. Survivors such as myself struggled to cope with this life-changing loss and a grief that few others seemed to fully grasp. The grief constructs of prolonged grief disorder or complicated grief didn’t easily adapt to military grief. As a survivor, I sometimes felt like a fish out of water, isolated in military grief and unable to chart a path forward on my own. 

In hindsight, here are three things I wish my therapist and I had known when my late husband was killed. 

1) Military grief has a long shelf life. Military grief can be complex, complicated and messy. Contrary to another popular belief, military families are not prepared for the loss of their loved ones.

Like a perfect storm, military grief is the result of the intersection of three powerful circumstances: the death of a loved one who died much too early in life (the average age of death is 28, according to the DOD); the high likelihood that death was sudden, unexpected and potentially violent in nature; and the unique factors that military service brings to death. A few of these factors include a sudden death far from home; a traumatic notification and casualty assistance process; limited details or classified information; unrecoverable, unviewable or partial remains; the soul-searing traditions of a military funeral; and the realization that common symbols of our country, such as the American flag, have become personal symbols of loss.

Some military families live on base or post, and when their service member dies, they are given a limited time to relocate off the military installation. When Laura Monk asked for a few more weeks to move off post after her husband, U.S. Army Specialist Austin Monk, died of leukemia at age 22, her request was denied. “All the grief books I had read said not to make any major decisions the first year,” Laura recalled, “but before I was ready, I had to leave the home Austin and I shared, plus my support network on post.” 

2) Noncombat deaths can be marginalized and the associated grief disenfranchised. In many areas of our country, knowing a military family is the exception rather than the norm. As a result, the challenges faced by these families and veterans are often unrecognized or misunderstood. 

Couple this limited awareness with the pervasive belief that military personnel die only in war, and the families who experience noncombat losses often find their service member’s death marginalized. U.S. Air Force Master Sgt. Steven Monnin battled posttraumatic stress disorder before ending his life in 2004. His surviving spouse, Elizabeth Monnin, recalled going to an event in support of surviving families and seeing an object that was akin to a traveling memorial. When she inquired if her husband’s name could be added, she was asked how he died. After Elizabeth explained, she was told, “No, this is for real heroes.” While not all replies are this extreme, many conversations send a not-so-subtle message that combat deaths garner more appreciation and greater respect than do noncombat deaths. 

3) Finding meaning in noncombat deaths can be challenging. Families of military personnel who were killed in armed combat or war usually find meaning in their loved one’s direct actions to protect or defend the nation from those who want to do great harm to America. They find purpose in their loved one’s ultimate sacrifice for the greater good.

But what happens when the death seems senseless? Finding meaning in a live-fire training accident or an exploding helicopter can be difficult. Families sometimes turn to making meaning out of their loved one’s life rather than their death.

My search for meaning in my late husband’s death was long and painful. Eventually I concluded there was no great meaning in his death, but I found renewed meaning in his short life. He loved his family, loved his country and loved to fly. He was simply one of the good guys and was memorialized by his commanding officer as “the man every father secretly hopes his daughter will bring home.” What more did I need to search for? 

Joanne Steen has more than 20 years’ experience as a national certified counselor, author, and educator on grief, loss and resilience, with a specialty in traumatic and line-of-duty losses. She is the co-author of Military Widow: A Survival Guide and the author of We Regret to Inform You: A Survival Guide for Gold Star Parents and Those Who Support Them. She is the founder and principal consultant of Grief Solutions, which offers customized training and resources on grief. Contact her at joanne@griefsolutions.net.



‘You aren’t grieving correctly’

By Claudia Sadler-Gerhardt

“Why are you still wearing your wedding ring?”

“You shouldn’t be dating yet. It’s too soon.”

“Why aren’t you dating yet? It’s been long enough.”

“Your kids need a dad. Find another husband.”

“Are you really still sleeping in your marital bed? Still living in the same house?”

“Plenty of divorced people are single parents, so this isn’t any different.”

Losing an intimate partner is profoundly life-altering at any time, but for a young adult (those ages 20 to 40), the loss is atypical and unexpected. There also appear to be societal expectations regarding what such off-time widows or widowers should do or should not do during this time of grief. Research supports that partner death increases the risk of physical and mental health concerns, including depression and anxiety, financial insecurity, loss of identity and loss of social connections. For the young widow or widower with children at home, becoming a sudden and unexpected single parent and the only income earner can be overwhelming. 

There is a paucity of research and literature about off-time widowhood. There is also a lack of role models for the young widow or widower because cohort members are unlikely to have lost partners. Additionally, there is ambiguity about what behavior is socially acceptable for this age group. Support programs are often geared toward widows or widowers in later stages of life who have different needs and concerns than the younger widow or widower does. In addition, young parents who are simultaneously working and raising children have a lack of discretionary time for obtaining grief support.

Given the current COVID-19 pandemic, the continuing opioid crisis and high rates of motor vehicle accidents, it is likely that rates of young spousal death may increase. A colleague and I recently conducted a qualitative research investigation (unpublished) with six young widows and one young widower (all 20 to 40 years of age) whose partners had died within the past 10 years. We hoped to learn about their lived experience of widowhood, including relational, financial, parental and personal changes resulting from the death of a spouse or partner. 

The first blatant phenomenon was that all of these widows and widowers had been told by someone that they were not grieving or acting correctly. Most of the issues revolved around when to date again (or not), when to remove wedding rings, when to change beds and whether to allow children to join the parent in the bed, and how to relate with their in-laws. Comments ranged from “children need a dad/mom” to opinions that it was way too early for the widow or widower to be dating. Another concern was the awkwardness of possibly dating someone who had known the spouse before their death. In-laws often disapproved of the surviving spouse returning to dating because that could essentially result in their adult child being “replaced” in the family. Additionally, it can be challenging for the surviving spouse to interact with or to maintain a relationship with their in-laws after the death of their spouse.

Another big change involved social and friendship relations. The participants reported losing friends who were uncomfortable having someone who was now single in a group of couples. In addition, friends were often uncomfortable asking or talking about the spouse or partner who had died, under the guise of not upsetting the griever. Widows reported feeling as if they didn’t fit in. Many were encouraged to “move on,” to remember that they were still young and needed to find someone to be with. Others were told that being widowed was similar to being divorced. Although in death, unlike with divorce, there is no other parent to help out.

Another big area of struggle related to identity. Who is this person now that they have been widowed? Are they still married or suddenly single? Stereotypical widows are not 40 years old. The young widow or widower often deals with being the only wage earner, a solo parent and the primary housekeeper and has little time to work on self-identity. 

Most of the participants in our study were parents who expressed a need to stay healthy for their children. Children often were scared that the surviving parent might die. Work, parenting and other tasks left little time for the surviving parent to engage in self-care or grief support. Finding some semblance of balance was challenging. Social media was a convenient resource for helping these individuals learn about grief and obtain supportive networks. There are online groups for young widows, and there are also hospice services for their families. Making time to exercise was another challenge that was noted, although most of the study participants acknowledged its importance. 

I have worked with many grievers for several years, taught undergraduate and graduate grief counseling courses, and presented numerous grief workshops. So, what have I learned about young off-time widows and widowers from a clinical counseling perspective? 

Assessment is absolutely critical. Do not make assumptions. Assess from a biopsychosocial-spiritual perspective. Obtain referrals if appropriate. Assess family and in-law relationships.

Recognize the unique needs of the widow’s or widower’s developmental stage.

Give consideration to the utility of telehealth appointments if appropriate.

After ensuring that basic needs are being met, work with the widow or widower on areas such as identity and roles, social support, self-care and grief support. 

Be aware that widows and widowers will likely experience others telling them how to grieve in the right way. Foster their ego strength in making their own decisions. 

Above all, be a safe companion for these grievers while allowing time for their stories to be shared. 

Claudia Sadler-Gerhardt is a licensed professional clinical counselor with supervision designation in Ohio. She is a past president of the Association for Spiritual, Ethical and Religious Values in Counseling, a division of ACA. Contact her at drclaudiasadlergerhardt@gmail.com.



Behavioral manifestations of grief in young clients 

By Rebekah Byrd

I had been working with Kai in play therapy for about six months because he was at risk of being kicked out of his third preschool due to problematic behaviors. He had been working hard and making progress but seemed to regress and was also experiencing a recent and intense overdependence on his mom. 

Jordan, an adolescent, was referred to me because he was having explosive emotions. His temper tantrums had become so aggressive that his grandmother no longer felt safe around him.  

As counselors, we are often working with children and adolescents because of an identified behavioral issue. We know that the presenting issue is rarely the problem. Rather, it is often a behavioral manifestation of the real underlying concern. Similarly, other reasons for seeking counseling services, such as anxiety or depression, are frequently manifestations of unrecognized grief and loss that have been unidentified, untreated or, often, misdiagnosed.

It is imperative that we remember and help other important figures in a child’s and adolescent’s life understand that what adults may understand as grief and loss might look very different for children and adolescents. Many of the concerns raised in Kai’s and Jordan’s cases are behavioral manifestation of grief. Regression, volatile emotions, acting-out behavior, temper tantrums, overdependence, a constant demand for attention, and aberrant activity are all common manifestations of grief among children and adolescents. The question is, how often do we miss these? 

In the third edition of his book Play Therapy: The Art of the Relationship, Garry Landreth noted that when we focus on the problem, we miss the child. In my experience, children and adolescents are always communicating. Kai told his parents that his teacher had died. He was struggling to understand this. His parents assumed he was regressing into his old ways of lying. They were in disbelief that we had come so far in six months only to be right back where we started. Kai’s behavior had amped up to a level that seemed worse than when his preschool teachers were stating that he was at risk of losing his spot in the school’s program.  

Full of frustration, worry and fear, Kai’s parents were asking me what to do. I understood that Kai was dealing with some very real themes of death and dying in the playroom. He was doing difficult work and trying to process these concepts through play in a very real way. I encouraged the parents to see these behavioral concerns as symptoms of grief and loss instead of assuming that Kai was reverting to old behaviors. We turned our focus to the child rather than on the problem.  

Almost immediately, Mom started sobbing. She kept saying, “The assistant T-ball coach!” Dad then realized what was happening. They both remembered that Kai’s assistant T-ball coach had recently passed away. When Kai reported that his teacher had died, his parents had dismissed it as a lie, never considering the impact that an assistant T-ball coach could have on their 4-year-old and not thinking about how many 4-year-olds call any adult who works with them their “teacher.” 

The parents felt awful that they had dismissed Kai’s real feelings of grief and loss and had also missed the opportunity to comfort him when he reached out to them using his words. (This was a major accomplishment for Kai, as it would be for most 4-year-olds who don’t understand grief and loss, much less why they are feeling such strong emotions.) The parents felt ridiculous for not putting this together sooner, and we were able to process that.  

As counselors, we don’t always have this information, and as school counselors, we might not meet with parents or other important adults as much as we would like in order to put these pieces together. So, it is imperative that we recognize the many facets of grief and loss and the impact on children and adolescents so that we can assist in the healing process.

Jordan had suddenly lost his mom, and his grandmother was now his guardian. His loss was front and center for him and for those around him daily. However, his family had thought that Jordan had already worked through the loss of his mother. These “new” behaviors he was exhibiting (explosive emotions, temper tantrums, aggression) were treated as somehow being separate. It can be easy to assume that caregivers will make the connection between an adolescent’s acting out and their experience of grief, but what happens when the family/caregiver doesn’t see it that way or is too mired in their own grief and loss and is triggered by what this is bringing up for them?  

When parents or caregivers are also grieving, adolescents may keep their sorrow to themselves. They may feel pressure to be “OK,” or they may feel responsible for not causing their grieving parents or caregivers further distress. 

In addition, adults may recognize the issue of “primary loss” with children and adolescents — the substantial loss that often refers to the death of a loved one (in this case, Jordan losing his mother) — but overlook or lack awareness of the many secondary losses. “Secondary loss” refers to all the subsequent losses associated with the primary loss. In Jordan’s case, the secondary losses included losing his sense of safety and attachment to the world, his main source of support, his family role, his carefree attitude and happiness, his home (his mother’s death meant he needed to move in with his grandmother), his regular bus route and bus ride with familiar faces, and the list goes on and on.  

Counselors must also understand how culture plays a role in child and adolescent processing and displays of grief and loss. Many types of grief and loss exist (e.g., ambiguous loss, anticipatory grief, complicated grief, delayed grief, disenfranchised grief, traumatic grief), along with different models for engaging in this process. Counselors must be able to recognize, acknowledge and affirm needs associated with grief and loss issues to assist clients in their healing journey. Because children and adolescents are not always able to verbally process feelings, the use of play therapy and expressive arts may be essential to the process of helping them cope and heal.

Rebekah Byrd is a licensed professional counselor in Tennessee, a licensed clinical mental health counselor and licensed school counselor in North Carolina, a national certified counselor and a registered play therapist supervisor. She is an associate professor and director of the Institute for Play Therapy and Expressive Arts Education and Research at Sacred Heart University and co-author, with Chad Luke, of Counseling Children and Adolescents: Cultivating Empathic Connection. Contact her at byrdr@sacredheart.edu.



Helping professionals and the experience of personal loss

By Barb Kamlet

Two significant worlds collided in my life on Aug. 28, 2006. On that date, I started graduate school to earn my master’s degree in counseling and, earlier that day, my father and my family learned of his terminal diagnosis. In my first journal entry for my first class, Cultural Issues and Social Justice, I wrote the following: “Today I learned about two new cultures — those who believe they are living and those who know they are dying.” 

It was a poignant and challenging time to be the grieving daughter of my dying father as I was going to graduate school to become a grief counselor. During the next 21 months, until my father’s death, I discovered yet another culture — that of helping professionals experiencing personal loss. It was a time filled with painful support gaps and myriad self- and other-imposed expectations that, as a therapist-to-be, I “should” already possess whatever coping skills I would need to navigate through the experience of my dad’s illness and death.  

I rose to the occasion by confusing my roles. I became the counseling professional in interactions with my family — interpreting what I thought they needed to know and screening out what I thought they didn’t — and the grieving daughter with my colleagues — people who couldn’t remotely understand the relationship I had with my dad or the grief I was experiencing. Clearly, this was my way of avoiding what was really going on inside me.  

Perhaps it was because I was working as a hospice grief counselor where my dad died that those expectations were so prevalent and that my questions eventually became twofold: Was I the only therapist who felt like this and, whether I was or not, could I go someplace for support where I wouldn’t be known, where I wouldn’t be using my “therapist brain” and where I wouldn’t run into my own clients if I chose to attend a grief support group?  

Sadly, when I tried to research grief support for hospice professionals for my group’s class project, there wasn’t much, if any, to be found. So, real-time research became my invaluable go-to. In the course of that research, I learned there were other counselors and helping professionals who were experiencing similar challenges around their own personal losses. 

Many spoke about a logistical challenge: In trying to find their own grief counselor, they faced a very real possibility of creating a dual relationship, particularly if they lived in a small community. Another common theme that echoed my own experience was the self- or other-imposed pressure to stay in role as a counselor, particularly with other grieving family members and counselor colleagues. Yet another widely expressed concern centered on the issue of transference, countertransference and possibly crossing professional boundaries when sitting with their own grieving clients. One interviewee expanded on that challenge, stating, “As a provider of grief support myself, this also led to my delayed reaction, as when I felt something, I intellectualized it.”

As Marion Conti-O’Hare wrote in The Nurse as Wounded Healer: From Trauma to Transcendence, “All too often … health professionals are reluctant to reveal themselves because of the potential for vulnerability, created largely by an orientation toward perfection and flawless performance.” For counselors and other helping professionals, hiding behind their professional role can serve as a protection or mask that allows them to compartmentalize or intellectualize their own grief. This is a means of avoiding potential vulnerability and the painful feelings of grief that we encourage our clients to journey through. 

As a result of my research, I have had the opportunity to present at several national conferences, and the question I am asked most frequently is this: “We have a colleague whose loved one died recently, and we’re wondering how to help.” Knowing the challenges that we, as grief counselors, experience around finding our own support when we are grieving, I think the answer is a simple one. We should do just what we do for our clients and other grieving people in our lives — meet them where they are and ask them to share their story. Pervasively during my research, grieving colleagues, much like our grief clients, wanted the opportunity to share their story and have it heard without judgment.  

A grief counselor captured the essence of that need when she wrote: “This time has been utterly transformative as I have experienced it through many lenses of the heart and mind and soul — and with both personal and professional perspectives. It would help me to be able to share this with someone interested in the many facets and [to be] able to ask questions that might assist me in organizing, integrating and reconciling my experience.”  

Another colleague wrote more succinctly, “Not sure if you’ll find any added themes from my story, but I felt like sharing it anyway as a way to deal with my own grief.”

To paraphrase something ACA President S. Kent Butler wrote recently in his column for Counseling Today, when it’s us as counselors who are the bereaved, can we allow ourselves to be our human self rather than our counselor self? I challenge every counselor working with grieving clients to be the role model for your clients and for our grief-denying society at large by giving yourself the grace to be your human self when you find yourself in that sacred space of grief.

Barb Kamlet is a licensed professional counselor and national certified counselor. Her private practice, GriefJourney Counseling PLLC, is in Aurora, Colorado. In addition, she is the co-founder and executive director of Shimmering Wings, a nonprofit dedicated to providing support and resources to individuals who have experienced a childhood death loss. She continues to do hospice grief counseling. Contact her at griefjourneycounseling@gmail.com.



Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

A firsthand experience of grieving pet loss

By Corban Smith August 10, 2021

Dallas came into my life at eight weeks old when I was only 19. The small brown bundle of rolls and wrinkles that clumsily paraded around my house with oversized paws never had any chance of developing into what most would consider a classically “good dog.” As he grew into his oversized appendages as a 115-pound lap dog, I was also developing through the tumultuous stage of emerging adulthood. As my social, occupational and personal identities solidified, Dallas remained a constant denominator across each dimension of my self-identity. I was a “dog owner,” and most who knew me were unable to picture me without my enormous and drooly companion at my side.  

As life progressed, Dallas effortlessly provided the unconditional positive regard that so many counselors strive to exude to clients. He was present during graduations, new jobs, loss of family members and personally devastating health diagnoses. Whether I was joyous or tormented, Dallas was there to share in my experience and offer the validation I needed through his droopy brown eyes.  

Eventually our family was complete when I met my now fiancée, a veterinary student at the time in the university where I was receiving my master’s in counseling. She promptly told me that Dallas was overweight and kindly pointed out other ways I could best serve Dallas. As we reached relationship milestones and eventually added another companion animal, Willett, Dallas seemed to become even more joyful and content.

Dallas (Photo courtesy of Corban Smith)

Dallas gets diagnosed

In the 11 years leading up to August 2019, Dallas had survived dozens of mischievous acts that threatened his well-being. So much so that although I knew his life eventually would come to an end, I couldn’t envision a world where anything could cause his demise. One morning that began as any other, I took Dallas outside to produce his abnormally large morning “business” deposits. I heard him emit a strange noise and looked down to see him convulsing on the grass. As he continued to seize, I held him as I never had before. Covered in morning dew, grass and dirt, I had never felt so helpless. I screamed for my partner, and once Dallas emerged from his postictal phase, we took him to his veterinarian.  

The news was grim. Given my financial status, the veterinarian advised against costly diagnostic techniques, reasoning that I likely would be unable to afford the likewise costly treatments for whatever was discovered. He concluded that Dallas likely had a sinister brain tumor lurking in his furry brown head and said we should focus on making his remaining time with us as comfortable as possible. As the first pains of grief and guilt set in, I began experiencing shame that I could not afford to give Dallas the care that might prolong our time together just a little longer.

Armed with anti-seizure medication and the terrifying knowledge that Dallas would, in fact, no longer be with me one day, I began one of the most stressful years of my life. A pattern soon developed in Dallas’ symptom management. He would have an extended period of time with no symptoms, then a breakthrough seizure would emerge in the middle of the night like an evil intruder. My partner, now Dallas’ primary veterinarian, would reassess his medication, and the cycle would continue. Slowly, the periods of well-being shortened, and the breakthrough seizures increased in intensity. 

This slow end-of-life process was excruciatingly unpredictable and painful as I began to experience a feeling of learned helplessness. Each evening, I crawled into bed terrified that at some point in the night, I would hear the initial gag that signaled an episode. During the day, I walked around the house dreading the discovery of puddles from postictal incontinence. I lamented this emotional roller coaster immensely. Periods of health were bright spots in my life, while breakthrough seizures were increasingly darker reminders of reality. I knew eventually, I would have to say the words: “This is it.” 

The event

The gagging and thrashing noise signaling a seizure came, as it always did, in the middle of the night, just when I imagined that things were OK. This one felt different though. Not only did it last longer and cause more confusion afterward, but the unsettling truth that Dallas was at his maximum dosage for medication signified that this was, in fact, “it.” We waited apprehensively with a semblance of hope to see if another seizure came. Previous recurrent seizures had presented eight hours after the first; this next round came in just four.

Making the decision that this particular day would be Dallas’ final day was shamefully easy. A combination of emotional exhaustion, stress surrounding the impending doom, and the reality of treatment limitations all likely contributed. My partner was forced to go and work at the practice where we would remind Dallas that he was a “good boy” for the last time, while I got the privilege of spending Dallas’ last day with him. I was disassociated from what was coming later that day and treated it as simply any other day for Dallas. In between additional seizures that day, Dallas got to play his favorite game, “What Won’t Dallas Eat?” We lay on the couch and watched The Fifth Element (the movie in which Dallas’ namesake, Korben Dallas, is the protagonist) while his sister, Willett, licked his ears, attempting to rid his head of any hint of ill will. Eventually, the time came to load up, and I experienced the first sense of loss that snapped me back to reality. Leaving Willett behind, I told her, “We’ll be back,” then quickly amended that statement to “I’ll be back,” tears forming in my eyes.  

I had experienced euthanasia of a pet only once before, when I was a little boy. I was transported back to my younger self on that day, attempting to organize thoughts of death and meaning of life in an intellectual way instead of experiencing the present pain. What had made this unavoidable outcome cognitively distant was Dallas’ presentation when he was not seizing. Even in the euthanasia room, Dallas presented in his usual demeanor. He happily ate Cheez Whiz sprayed on the floor for him, selflessly sharing the remnants on the clothes and faces of my partner’s co-workers as they came in one by one to say goodbye. Eventually, we were left alone with him.

My partner and I sat there, attempting to say our final goodbyes while Dallas tried to reassure us that everything would be OK. My partner was forced to take on the role of veterinarian in telling me what to expect. She kindly outlined the euthanasia process, as I am sure she had previously with countless other mourning owners, but her voice was shaky, and tears were forming in her eyes. Another veterinarian timidly knocked on the door and asked if we were ready. I shakily answered “yes” but truly was not. She knelt next to Dallas and began administering the chemical as I tried to remember every detail of my beloved companion lying on the floor. In true Dallas fashion — being the dog that could handle anything and survive — it took an extra dose of the lethal concoction for him to pass into the next world. Once my fiancée’s co-worker told us Dallas was gone, I embraced him wholly, one last time, and then truly broke down in a way that only a deep loss can provoke. 

The Grief Process

Grief truly is a unique and unavoidable part of the human experience. We are all forced into grief through loss at some point in our lives. I had experienced loss before in the form of relationships, failed endeavors and hobbies deemed too dangerous for someone of my growing age. But these things were nothing compared to the way Dallas had deeply embedded himself within my self-identity. The pain of this loss permeated through my core.  

As a counselor, I have been trained on grief, bereavement and the strategies we use to empower our clients. All of that knowledge and experience seemed to dissipate as soon as Dallas was diagnosed. Suddenly, grief and loss were not topics discussed in a classroom; they had become deeply personal.  

Soon after Dallas was diagnosed, I had begun preparing for his loss as best I could through that classroom knowledge. I dusted off my crisis intervention textbook and attempted to remember the works of Elisabeth Kübler-Ross and William Worden. I quickly landed on Worden’s tasks of mourning model as I tried to intellectualize my now inevitable loss of Dallas. As a counselor, I try to promote resilience and empowerment in my clients. As I embarked on the dangerous endeavor of becoming my own counselor, I told myself to focus on the tasks I could accomplish to help myself emerge from this process more resilient than I had been going in.  

Tasks of mourning

Worden’s tasks of mourning are not intended to be completed in any particular order and may be revisited throughout the mourning process. As soon as Dallas was diagnosed — and before I sought out knowledge of grief — I had begun to complete the tasks, and I continue to do so after the loss of Dallas. Sometimes I feel content in my accomplishment of tasks, whereas other times I am caught off guard by signs suggesting a lack of progress. My understanding of the grief process so far is that it ebbs and flows in a nonlinear, somewhat unpredictable manner throughout.

Task: Accept the reality of the loss. I began to accept the loss of Dallas conceptually as soon as he was diagnosed with the potential brain tumor. During the year of symptom management, I was able to work through this task on a surface level so that I thought I would be ready for my new reality when Dallas was gone.

Once Dallas had passed, I struggled with this task on a much deeper core level. I naively believed that the previous work on the task prior to Dallas’ departure would help insulate me from not accepting this new lonely reality. Returning home from the veterinary clinic on the day he was euthanized, I was most struck by the sense of numbness. The rest of that week’s activities and responsibilities seemed to pass me by because this new reality I was living in was foreign from the one I had known.  

Technology was both a curse and a blessing as I attempted to gain footing on this task. I found myself clinging to Dallas’ presence through endless scrolling of the camera roll on my iPhone. As I scrolled upward, Dallas became younger and more the companion I idealized. Photos of him jumping as high as houseguests offered a stark comparison with the old man that had required assistance to get on the bed. The Live Photo feature was particularly unsettling. By holding my finger on a photo, Dallas all of a sudden sprang back to life, my phone emitting the daily sounds and visuals that I desperately longed for again in our home.

Social media did, however, provide one of the best mediums for memorializing Dallas as I continued through this task. My favorite photos discovered while scrolling were shared with friends and family in a memorial post. As others expressed sadness and condolences, I was astonished to learn how many other lives Dallas had touched. Friends and contacts long forgotten reemerged to share stories and memories of Dallas. Many of them validated my new reality without Dallas as being both painful and uncomfortable. Their support helped me better accept this different world and motivated me to move closer to it instead of resisting and staying in the one that was comfortable.

Task: Process the pain of grief. I am very fortunate in that any inhibition to process the pain of my grief was self-inflicted rather than being promoted by those around me. I have heard stories of those who lost pets whose grief was disenfranchised by those around them. Expectations to continue working while compartmentalizing grief plague many people after the loss of a companion animal. I was extremely fortunate that no one in my life placed such expectations on me. I was supported and understood as having just lost a family member that was deeply integrated in my self-identity.  

My work on this task was predominantly inhibited by self-imposed restrictions. I falsely believed that the processing of loss completed since Dallas’ diagnosis would be sufficient for the actual event to be a mild speed bump on my road of productivity. The counselor in me said, “It is OK for you to experience this pain and have difficulty functioning,” but my cultural background stated simply, “Get over it.” 

Toxic masculinity is prevalent in our world, and I am also guilty of propagating it. People who do not know me well would consider me a classic stereotype of masculinity by most metrics. I am genetically broad-shouldered and proudly wear a full beard. My previous hobbies have included skydiving, riding motorcycles and owning German sports cars. I drive an SUV to my Olympic weightlifting club, and my bias toward men who are similar to me says that the loss of a dog should not break such men down to tears or inhibit their ability to participate in life roles. As I viewed myself through this lens, I repressed the pain and the experiencing of it longer than I should have. Eventually, I could no longer be the stable and stoic presence in my home and work; I had to succumb to the pain.  

As I began to reconcile my views on masculinity with what I knew as a counselor, I realized the feeling of pain and the expression of my emotions were among the manliest endeavors I could partake in. I shared my feelings and experience more freely with those around me and continued to be validated and supported as I tried to meet life’s demands while experiencing such pain.

Task: Adjust to a world with the deceased missing. Articles I read in advance of Dallas’ loss described the new home environment as having a “deafening silence.” As I attempted to mentally prepare for Dallas’ departure, I became attuned to the noises he emitted on a day-to-day basis. I tried to steel myself for what an absence of those noises might be like, but the void upon returning home after his passing was still debilitating.

My partner and I did our best to make this task as quick as possible. We removed all the reminders we could think of shortly after Dallas’ passing. Toys that were Dallas-sized and unattractive to Willett were donated to my partner’s practice for other dogs to enjoy. The tumbleweeds of short brown fur were sucked up from the various surfaces where they always clung. Dallas’ medications and food were removed. These physical reminders were easy to erase; classic conditioning ingrained over the span of 12 years was much more difficult to ignore.

Given the enormity of Dallas, there was little he could do that did not resonate throughout our small home. The clicking of his nails as he walked, the thud of furniture as he forcibly followed his intended path, even the heavy panting echoing through the house from his mere existence were all instantly gone. There was no longer a giant brown speed bump in the kitchen to navigate while we were cooking or a face of pure joy at the bottom of the steps when we returned home. Even watching TV at night without the occasional burst of flatulence from the corner of the sectional seemed a foreign experience.  

Countless other experiences have become isolating and lonely affairs since Dallas passed. Thankfully, as time passes, this task becomes easier as the frequency of unexpected reminders diminishes. Eventually, I know the relationship between daily activities and Dallas’ presence will erode and disappear, shifting this void from absence to a new normal.

Task: Find an enduring connection with the deceased while embarking on a new life. Worden’s previous iterations of this task involved the phrases “emotional reallocation” and “emotional reinvestment.” This task is characterized by a sense of moving on while accepting and appreciating the impact of the loss on the griever’s life and self-identity. As I move forward in my life, it is impossible not to consider the impression my relationship with Dallas has left and the residual effects it will have in the future. 

I think of all the lessons I learned from Dallas and how they will present in the future. I wonder how my capacity for caring for those around me would have changed without first caring for Dallas. I wonder how differently I would experience frustration without first building patience through Dallas’ destructive behaviors. Lastly, without experiencing the loss of Dallas, I wonder how much less prepared I would be for loss in the future. I feel that my experience of being a caregiver to Dallas has greatly elevated my ability to show compassion and kindness in other roles. Thanks to Dallas, I am able to be a bit better in my many life roles as a counselor, partner, son and friend. 


As I continue to bounce between and progress within these tasks, I sometimes find myself wondering, “Am I doing this right?” Questions about whether I removed reminders too soon, carried on with life too soon or even made the decision to euthanize too soon have dominated my grieving process. 

This experience has provided me better insight into a process that I had conceptualized only in a classroom previously. Being forced to confront this inevitable human experience has taught me to give clients who are grieving a lot of room and compassion and to hold minimal expectations about how they grieve. Grief is an individualized experience. While there are models, none perfectly encapsulates what it means, feels and looks like to grieve.  

Our grieving process culminated last year as we traveled home for Christmas. Dallas lived his life, with the exception of his final five months, in my small home in Alabama. Before we moved into a proper home in Virginia with a fenced-in backyard, his outside time was spent on a picturesque patch of land next to a lake. Closing my eyes, I can still picture my happy and healthy Dallas splashing around and chasing geese, frequently looking back at me for encouragement. This location, where Dallas seemed his happiest, is where we spread his ashes on a cold Alabama day with tears in our eyes but a sense of resolve in our hearts. I hope that one day I do find him there again, splashing and galloping, just over the Rainbow Bridge.




Corban Smith is a doctoral student in the counseling and supervision program at James Madison University (JMU) with a specific interest in substance use and offender counseling. He currently works as both an adjunct faculty at JMU and as a jail/emergency services clinician at Valley Community Services Board. He and his wife reside in Harrisonburg, Virginia, where they enjoy being of service to any being they come across. Contact Corban at smitcor@icloud.com.

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Untangling trauma and grief after loss

By Lindsey Phillips May 4, 2021

Death, loss and grief are natural parts of life. But when death arrives suddenly and unexpectedly, such as with suicide or a car accident, the overlap of the traumatic experience and the grief of the loss can overwhelm us. 

Glenda Dickonson, a licensed clinical professional counselor in private practice in Maryland, describes traumatic grief as “a sense-losing event — a free fall into a chasm of despair.” As she explains, the experience of having their everyday lives ripped apart by a sudden and unexpected death can cause people to go into a steep decline. “They are down there swirling,” she says, “experiencing all the issues that are part of grief — shock, disbelief, bewilderment.” 

In some cases, people get stuck in their grief and can’t seem to find a way forward. And in certain instances — such as when someone loses their child — individuals may not even want to get out of that state because, for them, it creates a sense of leaving their loved one behind and moving on, adds Dickonson, a member of the American Counseling Association. 

Elyssa Rookey, a licensed professional counselor (LPC) at New Moon Counseling in Charleston, South Carolina, worked with a client who had experienced two traumatic losses. When the client was 15, his stepfather died from suicide, and when the client was 20, his mother died on impact in a car accident. After the death of his mother, the client started having nightmares and became anxious about the possibility of losing other loved ones in his life. 

Rookey noticed that the client used “I” statements frequently in sessions: “I should have done more to help them. I shouldn’t have said that before she left.” The client blamed himself for their deaths and thought that he was cursed, says Rookey, who specializes in treating trauma, grief and traumatic grief. 

His mother’s death also triggered the client’s feelings of abandonment in connection with his biological father, who had left him when he was a child. At times, the client wanted to avoid others and be alone, but that subsequently increased his feelings of isolation and fear of additional loss. He also hosted feelings of anger about having to “grow up” and assume adult responsibilities, such as paying a mortgage and keeping a piece of property maintained, before he was ready. In many ways, Rookey says, he was “stuck” in the trauma and avoiding the feelings of grief and loss. 

Identifying traumatic grief 

Not every sudden or catastrophic loss results in traumatic grief. Some people experience uncomplicated bereavement. But others may show signs of both trauma and grief. They might avoid talking about the person they lost altogether, or they might become fixated on the way their loved one died.  

Because of the trauma embedded within the grief, it can be challenging to differentiate between posttraumatic stress disorder (PTSD), grief and traumatic grief. “PTSD is about fear, and grief is about loss. Traumatic grief will have both, and it includes a sense of powerlessness,” Dickonson explains. “A person who is experiencing traumatic grief becomes a victim — a victim of the trauma in addition to the loss. … They will assume those qualities of experiencing trauma even while grieving the loss.” She finds that people who have traumatic grief tend to talk about experiencing physical pains, have trouble sleeping and are anxious.

People experiencing traumatic grief could have distressing thoughts or dreams, hyperarousal or anhedonia/numbness, says Nichole Oliver, an LPC in private practice at Integrative NeuroCounseling in Chesterfield, Missouri. She notes that some of the symptoms can be confused with other mental health issues. For example, a person going through traumatic grief may have a loss of appetite and trouble sleeping (which can resemble signs of depression) or have great difficulty focusing (which can look like a sign of attention-deficit disorder). 

On its website, the Trauma Survivors Network lists common symptoms of traumatic grief, which include: 

  • Being preoccupied with the deceased
  • Experiencing pain in the same area as the deceased
  • Having upsetting memories
  • Feeling that life is empty
  • Longing for the person
  • Hearing the voice of the person who died or “seeing” the person
  • Being drawn to places and things associated with the deceased
  • Experiencing disbelief or anger about the death
  • Thinking it is unfair to live when this person died
  • Feeling stunned or dazed
  • Being envious of others
  • Feeling lonely most of the time
  • Having difficulty caring about or trusting others 

Rookey, who also works for the South Carolina Department of Mental Health in partnership with the Charleston County Sheriff’s Office, always screens for trauma because clients may have underlying issues that affect or complicate their grief. When working as a counselor in Miami, she noticed that some adolescents who were court referred for their substance use had also experienced traumatic loss (having a friend who was shot and killed, for example). In these cases, counseling sessions focused on grief, PTSD and anxiety in addition to the issue of substance use, she notes. 

Rookey first meets with clients to get a better sense of their story. These conversations often lead her to ask questions such as “Have you ever felt this sense of loss or fear in the past?” The questioning helps uncover underlying issues that may be affecting the person’s ability to grieve in a healthy way, she explains. For example, a client might reveal that the way they’re currently feeling reminds them of how lost they felt after their parents’ divorce. This may lead to the discovery that the client never fully dealt with that loss at the time, and that is now affecting how they are processing this new loss.

A new layer of loss

“COVID-19 brought a brand-new dynamic to grief,” says Dickonson, who specializes in treating trauma, bereavement, traumatic grief and mood disorders. “People have lost jobs, relationships, businesses and homes. … There is an endless sense of loss that keeps coming on.”  

The pandemic has also added a layer of trauma to expected grief because it has restricted the ways that people are able to mourn death. Rookey, who is also an LPC in Florida, had a client whose husband died not long before the COVID-19 virus reached the United States. After the husband’s death, the client moved from Florida to South Carolina, where her husband was from, because he had always wanted their children to live there. A few months later, the client’s aunt in Puerto Rico died from natural causes, but because of quarantine restrictions, she was unable to travel to attend the funeral. All of these circumstances left the client feeling helpless, frustrated and isolated, Rookey says.  

The COVID-19 pandemic has severely curtailed people being able to grieve communally, which can make even anticipated deaths more traumatic, Rookey notes. 

“Losing a loved one to COVID-19 could definitely complicate the grieving process when people are unable to say goodbye or to be with their loved one when they pass,” says Tamra Hughes, an LPC in Centennial, Colorado. “Those experiences can torment a person who is trying to come to terms with the loss.” 

“And COVID-19 is front and center in all we see and do right now. So, there is a constant reminder of the circumstances of the loved one’s death,” she continues. “These cues can all act as triggers for the client, eliciting negative emotions, physiological reactions and trauma responses.”

Grief is personal

Everyone grieves differently, so identifying traumatic grief in clients is not always a straightforward matter. Hughes, an ACA member who specializes in grief, traumatic grief, trauma, complex trauma and anxiety, says no two cases are the same in grief work. She approaches her work through the lens of the adaptive information processing model of eye-movement desensitization and reprocessing (EMDR) therapy. Among the areas she considers are the client’s level of stability in their life, their attachment style and their mental model of the world. These factors affect the way they manage adversity and trauma, Hughes explains. 

Working as a counselor at a funeral home helped Oliver, an ACA member who specializes in PTSD and grief, understand and appreciate how people’s social and cultural factors (such as personality, spirituality and race/ethnicity) affect how they approach loss and mourning. For example, under some religious beliefs, shame is attached to suicide, whereas others may celebrate it as a brave act. And while some people consider crying a weakness, certain cultures incorporate wailing into their funeral ceremonies. 

Hughes, the owner and therapist at Greenwood Counseling Center, knows that some clinicians are afraid to ask clients about their spiritual beliefs regarding death. She encourages counselors to ask difficult questions such as “What do you think happens to people after they die?” Otherwise, “it becomes the elephant in the room,” she says. “It’s not about putting your own religious or spiritual beliefs on the client. It’s about understanding the [client’s] context … because then you can work within that framework to help them through the grief.” 

Legal proceedings connected to homicides can further complicate a person’s experience with grief. Sometimes people assume that the best way to process their grief and heal is through seeking legal justice, Rookey says. But often, their grieving doesn’t really begin until after they separate the legal aspect from their own grief and trauma, she observes. 

Oliver uses individual clients’ unique life experiences to tailor her psychoeducation efforts and counseling techniques. For example, she may explain trauma symptoms to someone who works in information technology by comparing their body to a web browser that has too many open tabs. This visualization helps the client understand why their body and emotions are overloaded. Then she’ll ask the client to pick which two or three tabs they want to prioritize and work on that session. 

Oliver also has clients put together a playlist of songs that express their current mood and their feelings of mourning, which may be difficult for them to convey verbally. In session, clients can use these songs to explain the way they are processing their grief in that moment. That helps regulate the limbic system, which is the part of the brain involved in behavioral and emotional responses, she says. Oliver also keeps a three-ring binder of images — such as a person bent over in shame or a person torn in half between their heart and brain — in her office. Sometimes she asks clients to select an image that resonates with them as a way to jump-start their conversation. 

Unspoken words 

People may come in for counseling immediately after a sudden loss, or they may wait weeks or even months before seeking help. If the counselor does begin working with the client soon after the loss, their main goal during those first two or three weeks of therapy should be to “hear” the client’s loss and validate their feelings, Hughes says. Counselors could offer some guidance for coping and self-care, but she cautions against making suggestions about how to “heal” because that can sound dismissive. 

Dickonson finds “sacred silence” — silently sitting and being present with a client — a useful tool when working with traumatic grief. “We have to develop the capacity to sit with our client’s anguish, to stay fully present but not be intrusive, and to speak but also know how to be quiet and fully connect. We don’t have to break the silence. … Sometimes that’s what they need. They just need us to be there with them and show them that we care,” she says. 

Dickonson also keeps a tissue box within reach of clients in case they want it, but she does not offer them a tissue if they start crying. “Tears are very cathartic, and if I give you a tissue, it can [insinuate] that it’s time to stop crying,” she explains.

Hughes eventually provides clients with a space to voice unspoken words — what they would have liked to say to their loved one and what they think their loved one would have said to them. “There’s something about articulating it and speaking those words [out loud] … that contributes to helping the brain reconcile some aspects of [the grief],” she says. It also provides clients with an opportunity to get closure on something that feels so abrupt and unfinished, she adds. 

One technique that Dickonson uses with some of her clients as they begin emerging from their grief and have started their journey to posttraumatic growth is to assume the voice of the deceased and then write or record how they believe their loved one would comfort them. As a prompt, she asks clients, “What would your beloved say to you if they were here right now?” 

As clients share their interpretation of their loved ones’ words, Dickonson watches the way their face changes at certain parts and then asks, “How did you feel when you heard what your loved one might have said to you?” She finds this exercise often leads to productive discussions and helps clients give voice to things they might feel guilty for saying themselves. 

Processing the trauma 

When Hughes helps clients process life challenges, including traumatic grief, she addresses their trauma through EMDR. Hughes is an EMDR therapy trainer, the owner of EMDR Center of the Rockies, a member of the board of directors for the EMDR International Association (EMDRIA) and an EMDRIA-approved consultant. “EMDR helps the brain to organize information in a way that is more adaptive. In the case of traumatic grief, it can help foster healing and closure in the grief process,” she explains.

If conflict existed in the relationship with the person who died, clients may need to work through challenges that they had or feelings of guilt or shame that can be present following the loss, Hughes adds. 

A traumatic loss can also trigger a past trauma, which might be the underlying reason for the client’s current complicated grief response, Oliver says. She once worked with a man whose mother had just died. Although their relationship had been strong at the time of her death, the client’s mother had been abusive when he was a child. Her death triggered this past childhood trauma, causing the client to feel not only grief over her loss but also anger for the past abuse and guilt about the relief he felt for no longer having to care for her. The client was afraid to admit these complex feelings to Oliver because he was ashamed for feeling resentment, anger and relief when he thought he should be feeling only grief. The client’s cognitive dissonance disrupted his ability to grieve in a healthy way and further anchored him in a complicated grief response, Oliver notes. She validated his feelings and reminded him that expressing the full range of his emotions didn’t mean that he was attacking his mother’s memory. 

Rookey has used exposure therapy to help clients process unresolved trauma around losses that they experienced firsthand. But she cautions clinicians not to use the approach if they think it could be triggering for a client, especially if the client doesn’t have a good support system. 

Rookey used the approach with a woman who became triggered by the sound of sirens after she watched her partner die from a traumatic accident. While the woman was sleeping, her partner went outside to smoke, and he was shot after being caught in the middle of a botched burglary. By the time the woman woke up and realized what was happening, her partner had crawled inside the kitchen and was slowly dying. She called 911 and held him while she waited for the ambulance. 

It wasn’t just the grief of loss that was traumatic for the client, Rookey explains. It was the trauma of repeatedly asking herself, “Why didn’t I do something to help him?” 

The client began to operate in survival mode and avoided thinking about her loss. But sirens became a trigger for her. When she heard them, she would run to a bathroom and cry. So, Rookey decided to use in vivo exposure to help the client retrain her body and mind to get to a healthy state again. 

First, Rookey asked the client, who worked near a hospital, to step outside whenever she heard an ambulance and listen to the sirens while engaging in calming activities such as deep breathing. After the ambulance passed, the client would repeat positive affirmations (e.g., “It wasn’t that bad”). This slowly exposed the client to the trigger in a safe way. After the client was comfortable hearing the sirens outside her work, Rookey had the client record herself recounting the traumatic incident as if she were reliving it, and she replayed this recording every day. “It’s a way to show your body you can get distressed, can get triggered, can be fearful, but you will be OK,” Rookey says.  

In session, Rookey asked the client what parts of the story affected her most. This questioning helped Rookey discover that the client’s guilt over not preventing her partner’s death was what was holding her back from fully grieving and moving forward. They worked together to reframe the event to help the client realize she was not responsible for the death: Her partner always stayed up late and smoked a cigarette before bed. She had called for help. There was nothing else she could have done. 

Creating new meanings 

What makes a loss traumatic is not only the way the person died but also the meaning attached to the death, Oliver says. She worked with a woman who had developed an irrational thought attached to her son’s traumatic death. The son had been struggling with a drug addiction for a decade, but the night before he died from suicide, they had had a fight and the mother had said some unkind things. She blamed herself for his death. 

“Her core belief [that she was responsible for her son’s death] kept her anchored to the pain of the grief, so we couldn’t process the grief until we relinquished that belief,” Oliver says. 

To begin the process of untangling the client’s negative belief from her grief, Oliver presented another contributing factor to the son’s death. She told the client, “Numerous research studies reveal complex neurobiological changes in the brains of individuals who have completed suicide. Postmortem autopsies reveal that these individuals have 1,000 times the cortisol in the brain, and other systems such as the HPA [hypothalamic-pituitary-adrenal] axis, receptors and neurotransmitters are not functioning normally. That means they do not have access to the prefrontal cortex, the reasoning part of the mind.” 

That information comforted the client. When addressing traumatic grief, it’s often about planting seeds of hope and disentangling the fragmented pieces in people’s minds, Oliver says.  

Oliver continued to help the client find and connect the fragmented pieces through memory reconsolidation, which is the brain’s innate process for transforming short-term memories into more stable, long-lasting ones. Oliver had the client recall the memory of her son’s death, and then they created mismatched experiences in the brain by pairing the client’s belief that she was responsible for her son’s death with the contradictory information that she had supported him through rehab and that he had attempted suicide previously. 

Recalling this information caused a clash with the client’s cognitive distortion that the son’s death was all her fault, Oliver explains. The process helped the client integrate more pieces of the puzzle until she had a clearer picture of the event and was able to get “unstuck” from the negative thought. As a result, the emotionally charged memory (the client’s self-blame) moved from the amygdala to the hippocampus, reducing the trauma response by creating new learning (the realization that her son’s death was not her fault), Oliver adds.

Finding a way forward 

After mitigating the trauma of their loss, clients are ready to take a step forward. “With traumatic grief, it’s about making meaning of the death and who they are now,” Rookey says. “They were on one course … and it got skewed, and now they’re on a parallel path.” After processing through the trauma and grief of the loss, she has clients visualize themselves moving forward on the different path. The exercise encourages them to think about their future and gives them some meaning as they start down this new path, she says. 

Hughes believes the goal is “to get to a place where the grief is replaced by increases in the positive memories of the person and the essence of who they were.” People will still feel sadness about the loss, but this feeling should be more manageable and is coupled with gratitude for the time shared with the loved one, she explains. 

With counseling and support, clients can emerge from the “chasm of despair” — the steep decline they fall into after the traumatic loss — and begin to transform their pain into something positive and potentially powerful, Dickonson says. That might include being more involved with their families, developing a greater appreciation for life or even embracing new opportunities that emanate directly from the traumatic event. “They still feel the sadness,” Dickonson says, “but they are ready to move forward.”

This is when counselors could encourage — but not push — clients to continue their transformation process from the sense-losing free fall to a sense-remaking journey, Dickonson advises. Counselors should also be mindful that when clients come out of the grief abyss, they may replace their grief with another unhealthy coping behavior, she cautions. So, counselors have to continue to support clients as they start this journey forward. 

Rookey and her client who lost his stepfather and mother all before he turned 21 had to address his negative beliefs about his responsibility in their deaths before he could find a way to move forward and grieve in a healthy way. By the end, the young man’s guilt and anger had lessened. He sold his mother’s home, bought a truck and set up autopay for his bills. These were small steps toward him carving out his new identity and moving forward on his parallel path.



Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@counseling.org.


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.