Grief Education

GOAL: To identify how adults and children experience grief as a process of recovery and to have an outline of our agency bereavement services.

OBJECTIVES: Upon completion of this session, the participant should be able to:

  • Discuss the various theories of the grief process.
  • Discuss anticipatory grief and some indicators of abnormal grief reactions in dying persons and their families.
  • Discuss the meaning of terminal illness and death upon a family, at different ages and stages of its development.
  • Better understand Bereavement services offered by HHHC which includes the Good Grief Program for grieving children.
  • Discuss the pattern of grief that may be experienced by professional caregivers – nurses, Hospice workers, etc.
  • Understand ways for professional caregivers to separate from patient or family at the appropriate time and feel okay about closure.

Important Grief Definitions

Grief - The process of experiencing the psychological, social and physical reactions to a loss.

Mourning – The outward expression of grief which is influenced by cultures and follows prescribed social customs.

Bereavement – The state caused by loss such as death.

Anticipatory Grieving – That which is experienced before a loss actually occurs, as in the case of terminal illness or long-term caregiving.

Grief Work or Tasks of Mourning – The process of feeling emotions, thinking through the loss, facing the reality of the loss and fashioning a life without the person in your life.

Adapted from Death and Grief, A Guide for Clergy, Dr. Alan Wolfelt, PhD., Accelerated Development Inc., Muncie, IN, 1988.

Factors That Influence Grief

  1. The Relationship with the Person Who Died
  2. The Coping Mechanisms of the Bereaved
  3. Past Experience with Bereavement
  4. The Unique Character of the Person Who Died
  5. The Nature of the Death
  6. The Bereaved’s Religious and Cultural History
  7. The Ritual or Funeral Process
  8. The Support System of the Bereaved

Other factors which are surfacing in society today are:

  • Emotionally unhealthy family systems
  • Fragmented and blended families
  • A mobile society where family members are not readily available

To better understand some of the emotions that accompany grief, view an article on The 10 Most Common Grief Expressions.

Myths About Grief

  • Grief and mourning are the same experience.
  • There is a predictable and orderly progression to mourning.
  • One should move away from grief, rather than toward it.
  • The goal is to “get over your grief”.
  • Tears are a sign of weakness.

For more Grief myths and realities, view this information from the Hospice Foundation of America.

List of factors and Myths About Grief adapted with permission from Bereavement Skills Training Outline, Dr. Alan Wolfelt, PhD. For a catalog of Dr. Wolfelt’s publications, write or phone: Companion Press, 3735 Broken Bow Road, Ft. Collins, CO 80526 (970)226-6050.

The Experience of Grief

Four Phases of Mourning

  1. Shock/Numbness
  • Lacks rationality
  • Healthy avoidance
  • Delusions/Hallucinations
  • Searching/Yearning
    • Desire to get loved one back
    • Painful repetition of loss
    • Denial of permanence of loss
    • Anger and Guilt
  • Disorganization/Despair
    • Life falling apart
    • No meaning/purpose
    • Helpless hopelessness
    • Fatigue, apathy, depression
    • Lack of self-esteem
  • Reorganization/Recovery
    • Putting life back together
    • Reinvestment in new activities/relationships

    Four Tasks of Mourning

    1. To Accept Reality of the Loss
    • Reunion impossible
    • Benefit of viewing dead body
    • Opposite – Denial
  • To Experience Pain of Grief
    • Need for assurance that pain is okay
    • Opposite – Not Feeling
  • To Adjust to Environment in which the deceased is missing
    • To make sense of loss
    • To modify one’s assumptions
    • Opposite – Not adapting
  • To Withdraw Emotional Energy and Reinvest it in other Relationships
    • Not loving deceased any less, but beginning to love others too
    • Opposite – not loving

    Manifestations of Normal Grief

    Feelings: Sadness, anger, guilt/self-reproach, anxiety, loneliness, fatigue, helplessness, shock, yearning, emancipation, relief and numbness.

    Physical Sensations: Stomach hollowness, throat tightness, chest tightness, over-sensitivity, depersonalization, breathlessness, muscle weakness, lack of energy and dry mouth.

    Cognition: Disbelief, confusion, preoccupation, sense of presence, hallucinations.

    Behaviors: Sleep disturbances, appetite problems, absent-mindedness, social withdrawal, dreams of deceased, avoiding reminders of deceased, sighing, restless over-activity, crying, visiting places or carrying objects that remind of deceased, treasuring obejects that belong to the deceased.

    Adapted from Grief Counseling and Grief Therapy, Second Edition (Springer, 1991), J. William Worden, PhD.

    View Techniques Used to Assist the Bereaved

    Children’s Grief

    Children experience three developmental stages associated with death:

    1. No Concept of Death (until age 5)
    • Loss as a departure (asleep, gone away)
    • Death gradual or temporary
  • Personification of Death (between ages 5-9)
    • Death fantasized as a separate person (invisible), accepts fact of death, seeks ways to avoid it, i.e., “See you in the morning.”
    • Death is identified with the dead.
  • Death Universal Experience occurs at different times and circumstances (age 9 or later)
    • Final cessation of all bodily functions
    Excerpted from Behavioral Concepts and Nursing Throughout the Span, S.L. Roberts, (Englewood Cliffs, NJ: Prentice-Hall, Inc.), 1978, pp. 151-154

    View the presentation on children’s grief that was shared in the volunteer training session.

    Additional Links

    Recommended Library Resources

    • Video: Beyond Death’s Door