I see clients for counselling in a place in Fulham, in West London. Like all of us they have experienced or will experience loss in their lives. We will all lose loved ones at some point in our lives. Even if so far you have not lost someone close to you there will probably have been some important loss to you that you will have grieved over. Very often people come into therapy to deal with change in the form of an undesired loss of something such as a relationship. Perhaps the most famous book on grief is that by Elisabeth Kübler-Ross entitled ‘On Death and Dying’ published in 1969. In it she proposed five stages to grief: Denial, Anger, bargaining, Depression, and Acceptance. Her view seemed to be that they roughly occurred in that order with Denial coming first until ideally we came to acceptance of the loss. In my experience grief does not always follow this progression and sometimes we go back and forth between stages. I want to talk about each stage.
The first reaction of many to learn of the loss of someone close is to deny the possibility that it could have occurred. This is of course a defence against emotional pain that is feared to be overwhelming. In my experience some people never fully accept the loss of a loved one and always cling to the hope that one day they might appear and the whole experience was a misunderstanding of some kind.
This is usually experienced after learning of a great loss. This is another defence mechanism. The intense pain that starts to be felt gets deflected onto others, including the person who died, or onto oneself. Often a lot of anger is directed against those who cared for the person who died including the medical staff or family members. Old resentments among family and friends can emerge with new intensity.
This is a way of trying to gain control over a situation over which we can never have had control. For those who have blamed themselves over the loss they think of ways they think they could have prevented the loss. Others think of ‘if only’ scenarios that might have prevented it. It is a way of starting to come to terms with the loss. For some people this stays with them, always believing that an ‘if only’ scenario would have prevented the loss.
After we have gone through the defences the significance of the loss starts to be felt. We can go through a depression caused by the immense sadness of the loss. This depression can last a long time but there are no short cuts and there is no ideal length for this or any of the stages of grief. We need to let it run its course.
According to Elisabeth Kübler-Ross this is the final stage of grief that we need to reach. It is the point where we have finally come to terms with our loss and can move on with our lives. We no longer harbour anger or resentment. We no longer cling to ‘if only’ scenarios. We have let our feelings of sadness run their course. We are now able to live with the gap in our lives that can never be filled again. Not everyone is able to reach this stage and I believe we can go back to different stages of grief when it becomes too much for us. I believe that therapists can only help their clients grieve by enabling them to undertake the process that is natural to them.
For clients who are stuck in grief therapists can help them look at the obstacles to their mourning and bring back the flow of the grieving process. There are some grieving processes that are particularly difficult, for example when parents lose their children or where there is evidence that negligence of medical staff did contribute to someone’s death. Grieving for someone close with whom we had a difficult relationship is also more difficult than grieving for someone who was very good to us. We have to learn to carry the legacies that are left behind by those who are gone. Sometimes there is anger and bargaining apart from that normally expected in the stages of grief outlined above that needs to be processed. We cannot bring back the people who have died but therapists can be with the feelings of those who are left behind so that they can be borne and not make the experience of the loss worse than it needs to be.