Grief and Loss Presentation

by Catherine O’Mahoney

In this article I am going to discuss the Grief and Loss that is associated with the death of a loved one.

Grief is a multi-faceted response to loss. Although conventionally focused on the emotional response to loss, there are  physical, cognitive, behavioural, social and spiritual responses.

John Bowlby proposes that we grieve because we are biologically willed to attach. The attachment theory suggests it is a human instinct to form strong, persistent affectional bonds. A natural response to the loss of an attachment bond is separation anxiety, which generates intense but predictable behaviours; this is geared to revive the lost relationship. Grief work generally allows the bereaved to redefine their relationship to the deceased and to form new ties. It is important to recognise that grief is a normal experience and that the process of mourning does require experiencing the pain of the loss. No other human being can travel all the way with the bereaved, but most would long for someone to draw alongside, to journey as far as it is possible. Since mourning is a process, it has been viewed in various ways, primarily as stages, phases, and tasks. William Worden suggests that there are four tasks of mourning;

1. Accepting the reality of the loss.

2. Working through to the pain of grief.

3. Adjusting to an environment in which the deceased is missing.

4. Emotionally relocating the deceased and moving on with life.

He saw that the bereaved may go back and forth between two or three of the tasks while going through the process of mourning, before they can finally work through the fourth task.

Elizabeth Kubler-Ross proposed that there are five stages to grief. The five stages are

1.  Denial.

2. Anger.

3. Bargaining.

4. Depression

5. Acceptance.

The stages or tasks are not linear. Some people go through the stages quickly or even skip some entirely. Other people seem to linger or return to certain stages after a period of feeling better.

The mourning process may last for months or years. Intense symptoms of emotional distress generally last between six and twelve months, with less intense grieving continuing for one to three years and even longer for some people. However, if mourning is not complete, growth and development cannot take place and lifetime complications could develop.

I believe that there is no completion date to grieving.  If the bereaved allows themself to work through both the stages and tasks with support, they can achieve closure, emotionally relocate the deceased and move on with their life. In other words accepting the reality that their loved one is physically gone and recognising that this new reality is the permanent reality. While the bereaved ultimately learns to accept the reality of the death, they also find psychological and symbolic ways of keeping the memory of the deceased person very much alive.

There are many feelings, physical sensations and cognitions that are associated with the process of mourning, some of these responses are present in the initial stage. Disbelief, numbness and shock are some of these responses. The loss comes as such a shock, it seems impossible to accept what has happened. This gives the person moments away from the pain of the loss. It helps them to survive the loss. It also helps them cope to make survival possible. It is nature’s way of letting in only what an individual can handle at that particular time. As the shock starts to wear off, the horror of reality steps in. The future that the bereaved envisioned is gone, along with the personal expectations for the life that was planned. The person who is dead is often the very person that is relied on, the one that the person turns to for comfort and support.

Anger is a necessary stage of the healing process. Anger can be one of the most confusing feelings for the bereaved. Anger has no boundary, it could be directed at the deceased person for dying, at the doctor or the hospital for not saving the loved one or at oneself (retroflection). Anger at God for allowing this to happen is not uncommon. It is important to feel the anger, as the more it is felt and expressed without hurting anyone in the process, the more healing can take place. Family and friends can get quite frightened at the amount of anger that is being displayed by the bereaved. They are always more comfortable when the bereaved does not give off the sense that she is falling apart. They urge the bereaved to be strong because they have touched their own pain. It is very difficult being around a grieving person without being touched by their pain. The thinking behind this is if they can put a lid on the grieving person’s emotions, they will not need to look at their own. The awkward feeling of not knowing what to say or do prevents people from providing support to a person in grief. The most important thing to remember is nothing needs to be said; just by sitting down and being there support is being shown.

When the bereaved experience the physical sensations that are associated with grief this can be quite overwhelming and distressing. Tightness in the chest, panic attack like symptoms and lack of energy are only some of those symptoms. It takes a lot of energy to go through grieving for a loved one so therefore, the bereaved ought to take as much rest as possible in the initial weeks after the death. Grieving is such hard work. It is a time when support is at its peak so allow friends and family to take over the day to day chores. To levitate the panic attacks and the tightness in the chest certain skills are required, to be able to take deep breaths and the ability to say ‘I will be ok in a while, this sensation will pass.’ Another task is to call up a ‘safe place’ in times of distress this is very therapeutic as it enables the bereaved to visit a place of tranquillity within their minds eye so that, it  assist them in calming down. This is called self-soothing and can be very helpful in these stressful situations.

Telling the story is part of the healing process. In trying to comprehend the loss and make sense of it this can be extremely difficult. There is a huge void created by the loss of a loved one. As one woman verbalised ‘this is the bleeding stage of grief.’  The body is feeling the sensations but the mind is lagging behind, it is trying to integrate something new into the psyche. The death is something that happened too fast for the mind to understand. Telling and retelling the story often in detail is so important to the grieving process. The story has to be verbalised. Grief has to be witnessed in order to heal.

Grief has several symptoms in common with depression including sadness, insomnia, poor appetite and weight loss. Where they differ is that grief tends to be trigger related. In other words, the person who is grieving may feel relatively better while in certain situations, such as when friends and family are around to support them. But triggers, like the deceased loved one’s birthday or their wedding anniversary, could cause the feelings to resurface more strongly. Generally, after the event has passed these acute feelings will subside. Depression on the other hand, tends to be more persistent, with the bereaved rarely getting any relief from their symptoms. This occurs when the symptoms become chronic, disabling and more intense. Depressed people tend to focus on themselves and their role in the loss, while grieving people tend to focus more on what was lost. Another name for this is complicated grief.

Freud believed that in grief, the world looks poor and empty while in depression, the person feels poor and empty (Worden 1983)

I think it is crucial to understand that ample feelings will occur, it is necessary for the bereaved to keep them in perspective, and to try to understand why they feel a certain way. If there are any unresolved issues that cause particular emotional pain, counselling is a very beneficial process to undertake. Counselling can bring about a more valuable adjustment to the loss. This will enable the bereaved to complete any unfinished business with the deceased and they will be able to put closure on the life as they knew it. With this in place it allows the bereaved to live with a fresher perspective on life. In doing this the bereaved do not give up their relationship with the deceased, but they do find an appropriate place for the dead loved one in their emotional life. With this in place the bereaved is able to remember the deceased with ease, while also reinvesting in life for the future.

Bereavement groups are also very important, not only because they allow the individual to be with others who have experienced loss, but because they provide a forum for talking and being witnessed in the depth of each individual’s unique loss. This allows the bereaved to communicate with other individuals who are also grieving.  Every member of the group is assisted in their own process. This practice allows the bereaved to explore with safety the uniqueness of their loss in order to heal. This group facilitation can be very beneficial for the process of the grieving individual. As I mention previously ‘grief work’ has to be witnessed.

Each bereavement group is facilitated by trained bereavement counsellors. The bereavement course normally runs for seven weeks. Each week has a different theme as shown below.

Upon reflection the loss of someone that is both loved and cherished through death points to our own mortality, and teaches us to live life more fully in the present. Death teaches us about loss. We experience loss in order to see more clearly what we value, where our values come from and what in our lives is of greatest value. This also, enables us to be more aware of the relationships that are extremely important in our lives right here and right now. This allows us to be grateful for those relationships and experiences and to cherish them as best we can. The learning from this is to appreciate, communicate, validate and be grateful for those particular people in our lives today, as this is what ultimately matters and it can never be lost.

Loss through experience of death reminds us that pain and limitation are opportunities to learn lessons, reflect and awaken potentials within ourselves. On a conscious level, or deeper level, we understand the soul never suffers injury and our deeper self, our soul, provides support, strength, courage and understanding, these qualities support us when we know our body cannot do everything we want. Loss is always a time of renewal. Renewal must take place within our thoughts. We must re-think our lives and make decisions that will better serve our purpose. Loss provides an opportunity to begin creating a new future in which we may create new ways of looking at relating to our self, and to others. The cycle of life exists and continues all around us.

There is no grief like the grief that does not speak’ – Henry Wordsworth Longfellow

Book List on Grief.

  • On Grief and Grieving Elizabeth Kubler-Ross and David Kessler 2005
  • Grief Counselling and Grief Therapy J. William Worden 1983
  • Life Lessons Elizabeth Kubler-Ross and David Kessler 2000
  • Grieving a Beginner’s Guide Jerusha Hull McCormack 2005
  • On Death and Dying Elizabeth Kubler-Ross 1970
  • The Year of Magical Thinking Joan Didion 2006
  • Bereavement Courses
  • Family Ministry, Paul Street, Cork.  021 4275136

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