Suicide is a significant public health problem, and properly supporting those left behind — the survivors — is a challenging but significant contribution to the wellbeing of the whole community. If a suicide-bereaved person wound up in your therapy room, what counselling tasks would need to be worked through with them? In this post we look at Worden’s general guidelines, which contribute to the effectiveness of grief counselling whatever the circumstances of grief and loss have been.

1. Help the bereaved accept the reality of the loss

Even in healthy, balanced individuals, shock and denial are common reactions following the death of a loved one. Obviously, clients need to identify with the death before they can begin the arduous journey of disidentifying (moving on) from the grief. They must accept on both cognitive and emotional levels that, indeed, a death has occurred. Through use of normal counselling micro-skills, the counsellor listens patiently, encouraging the person to talk about the loss. Recounting past and present memories helps bring clients to a greater awareness of the death. You can ask simple questions such as “How did the funeral go?” or “Where were you when you heard?”

2. Help the bereaved identify and experience feelings

This guideline is no surprise! Recognising feelings is never more intense than when processing a cherished person’s death. There is often much scope for you to help clients appropriately target feelings such as anger, and manage equally strong emotions such as guilt, anxiety, and hopelessness. As with recognition of death (the first guideline), the most effective processes are the twin ones of identification and disidentification. Clients can only resolve, manage, and/or overcome (that is: disidentify from) feelings which they have been able to recognise and experience (that is: identify with). Permission to explore even seemingly “unacceptable” feelings — such as, say, relief that the deceased is gone (and thus, no longer in pain) — is an immense help to clients.

3. Assist living without the deceased

It’s not all about the emotions! In addition to dealing with feelings, you can offer immeasurable assistance to clients on a practical level, encouraging bewildered bereaved individuals to develop the coping and independent decision-making skills that they may not have needed earlier, or may now — in their grief and confusion — be less able to utilise. Even though this “commandment” does not directly deal with emotions, the impact of following it for some clients means that their emotional distress is greatly reduced; life does not look as terrifying when they get help with, say, dealing with estate issues, paying bills (if they were not the main “financial person” in the relationship), or managing domestic issues.

4. Help find meaning in the loss

What was the meaning of this tragedy? Many are the parents who have set up a memorial charity or other foundation to honour the deceased child and to help avoid future deaths occurring in the same way. Examples here include the Daniel Morcombe Foundation, set up by the parents of murdered schoolboy Daniel Morcombe, to ensure child safety, or New Zealand’s McKenzie’s Gift Foundation, offering support to parents of children diagnosed with cancer. In some cases, people lobby for changes in legislation. On one level, these efforts attempt to prevent future deaths, and they are valid for that alone. On a transpersonal level, however, they serve an equally important function: the reassurance to the survivor that the death of the loved one was not in vain. As a counsellor or therapist, you can have a central role in helping facilitate an understanding of the meaning of the deceased’s life and its impact on the client-survivor.

5. Facilitate the transition to forming new relationships

Does your client hang back from forming new relationships (even years after the death), worried about dishonouring the deceased? Alternatively, is there a sense that the survivor is just jumping immediately into a new relationship — as in the case of a lost spouse — in order to “fill the void” and avoid experiencing grief? Neither extreme is conducive to healthy growth, and you, the mental health professional, may be best placed of all roles in the client’s life, to notice what is happening (or not), and to help the client move on at a pace which allows for full expression of the emotions of grieving, and yet — much further down the road — does not see the client stuck in the past (the stuff of many romantic movie plots), pining for a love which can no longer have earthly expression. Your help can encourage the client to experience the grief, intense and unpleasant as it is, in order to come to terms with it and be able to truly move on to forming new attachments.

6. Provide time to grieve

The client may have made it through the funeral, the estate dealings, and the awful first months afterward without the deceased, but now the birthday of the lost loved one is about to roll around, with the special family time of Christmas not far behind. How will the client cope? Naturally, even many months after losing a dear one, the special days such as holidays, anniversaries, and birthdays, are particularly challenging for survivors. They often evoke beautiful memories and sometime painful re-experience of the loss. You can help the client through these times in advance by recognising when they are about to come up and working with the client to prepare in advance for them.

7. Re-interpret normal behaviour

Intense reactions are a normal part of the grief process, but nevertheless fall outside the scope of what many people experience in their everyday lives; thus, to experience such emotions — especially at the level of intensity which grief engenders — is to have the sense of going crazy. You can be of great service to clients simply by normalising such feelings as part of the experience of loss (this is especially true in the case of emotions in the wake of suicide bereavement). Of course, it is incumbent on you as the mental health professional to be clear about what is normal and common and what may require specialist intervention.

8. Allow for individual differences

Many factors affect the experience of grieving: the circumstances of the death, the personality of the survivor, and the relationship between survivor and deceased all cause variation in the grieving reactions. You can be helpful to clients in validating their unique response and expression of grief for the loss

9. Examine defences and coping styles

What strategies is your client using to deal with the loss? Joint exploration of these in session can help to identify those strategies which are adaptive (such as a good self-care regimen or creating a special memorial) and those which are maladaptive, impairing the bereavement process. Included in the latter group are behaviours such as drug and alcohol abuse (or in fact any compulsive behaviour, such as hypersexuality, overspending, or gambling), and the aforementioned relational behaviours of either shutting out relationship permanently or jumping in immediately without experiencing the grief. A list of helpful behaviours, along with a plan for enacting them, can guide clients toward wholeness in their grief journeying.

10. Identify pathology and refer

Using both your training and your own keen observation, you will get a sense of how the client’s grieving is progressing. The goal here is to know when to refer. If you identify pathology triggered by the loss, you may need to make a referral to specialist intervention. Grief counselling is multifaceted and, especially where there is depression, PTSD, or complicated grief involved, appropriate treatment may involve medication and/or other techniques beyond the scope of standard grief counselling — and possibly beyond the scope of your expertise.

References

• Australian Institute of Professional Counsellors (AIPC).  (2010). 10 guidelines for grief counselling.  AIPC Article Library, 2 June, 2010.  Retrieved on 2 April, 2014, from: hyperlink.