Section 2: Understanding the Grieving Process

Grief theories provide a conceptual base for understanding grief and loss as a process involving many common characteristics and phases. Although you are not required to know the models and theories associated with the field of grief and loss in great depth at this stage of your studies in counselling, a general understanding of these will help you understand and anticipate the process that people may go through. This will help you to identify and normalise reactions to loss and to identify where further help may be needed.

Before we commence on this part of the journey, it is worth noting that some earlier counselling approaches to grief often see grief as a pathology, as if it were an illness or a problem to be solved. These approaches generally focus on bereavement, although some recognise other types of relationship loss, and under such assumptions, there was much emphasis on ‘letting go of’ or ‘severing the bond with’ the person who had been lost. These assumptions are evident in the popular idea of getting ‘closure’, suggesting that grief should end just like recovering from an illness. This idea, however, is falling out of favour and can even be seen as harmful to people who experience loss (Harris and Winokuer, 2016). In contrast, the contemporary approaches see grief as a normal, adaptive response to loss, as described in the following:

With that in mind, we will begin by looking at a few stage or phase-based theories that are influential and remain commonly cited in the area of grief and loss work; we will also consider some of the arguments against their use.

Stage and Phase-Based Models

Many theories of grief, and particularly bereavement, suggest that people go through stages or phases in their grieving process. Whilst the stages and phases are slightly different in each theoretical model, they are similar in proposing that people need to move through these stages or phases in order to reach some kind of recovery. These models are prone to create problems when an individual’s experience does not match with the suggested stages or phases of a given theory, and there is limited evidence that the models describe what most, let alone all, bereaved people will go through.

Attachment Theory and Grief

As you may remember learning previously in your diploma, attachment theory explores the nature of the connection or attachment between humans, particularly between primary caregivers and infants, and the consequences of separation. Bowlby hypothesised that the grief process reflects the disruption of attachment bonds – resulting in similar distress behaviours displayed by infants when separated from their primary caregiver, such as crying, clinging, and anger designed to regain the connection (Pomeroy & Garcia, 2009). Bowlby’s observations of mourning were then expanded by others into phases in grieving: numbness; yearning and searching; disorganisation and despair; and reorganisation (Harris & Winokuer, 2016). The idea that attachment has a significant influence on grief has also been adopted by many others (for example, Worden, 2009), but there is a lack of empirical evidence to support the attachment-based stage model of grief (Machin, 2014). Some research has also questioned the tenet that attachment style predicts adult adjustment more broadly (Lewis, Feiring, & Rosenthal, 2000).

John Bowlby Attachment and Loss

Dr. John Bowlby, founder of Attachment Theory, explains how the mother/father/child relationship forms the foundation for all intimate, complex relationships in our lives.

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Kübler-Ross’ Five Stages Model

One of the most widely known models when talking about grief is the ‘five stages’ model developed by Elizabeth Kübler-Ross, the five stages being denial and isolation, anger, bargaining, depression, and acceptance (1969). Despite its wide application to grieving, Kübler-Ross’s model was not developed in relation to grief. It was based on her observations of patients as they died of terminal illnesses; while they might have been grieving, the focus of the model was not grief. So, contrary to popular belief, Kübler-Ross’s model isn’t a model of grief at all!

In addition, Kübler-Ross’s observations were not systematic or supported by research, even among the population she was observing (people with terminal illnesses), let alone among people experiencing loss and grief (Harris & Winokuer, 2016). Nonetheless, the stages were adopted by many, including counsellors, and applied to work with grieving people. It is also concerning that the stages are often considered discrete and sequential – to be moved through one after another – despite Kübler-Ross herself stating that movement back and forwards between stages occurs and that stages can overlap.

Given its popularity, it is very likely that you will come across this model at some point in your counselling practice (some clients may even cite it). So it is important to be mindful that the model is not supported by evidence and does not necessarily provide helpful guidance regarding the experiences of grieving people. This also applies to other stage and phase models (such as Rando’s model, which we consider next). It is also important to remember that believing that they ‘should’ progress through certain stages or ‘should’ feel something included in the model can cause additional difficulties for clients. Remember that clients may not experience the stages described in this model or progress through the described phases at all, so it can be useful to help clients come to understand that such models are not necessarily accurate.

Task-Oriented Models of Grief

Some more recent models of grief suggest that rather than fixed stages, the grieving process presents people who experience loss with a series of tasks associated with ‘processing’ or ‘progressing through’ grief (McLeod & McLeod, 2011). Those who promote task models claim a distinction between them and stage models: namely that stage models describe grieving while task models describe processes in which bereaved people can actively engage. However, they share many of the characteristics (and criticisms) of stage models.

Rando’s ‘Six Rs’

Rando’s model of bereavement, also known as the ‘six Rs’, proposes that bereaved people’s processing of grief involves six tasks: recognising the loss; reacting to the separation; recollecting and re-experiencing the deceased and the relationship; relinquishing old attachments to the deceased and assumptive world; readjusting with adaptive movement into the new world; and reinvesting (McCoyd & Walter, 2016). As with stage theories, there are significant criticisms of task theories, including this one. These criticisms are very similar to those of stage models and include: that Rando claims her processes are universal (experienced by everyone who experiences loss and grief, regardless of individual and cultural circumstances); that Rando claims that bereaved people must move through these processes in order to heal; and that task models, in general, suffer from a lack of empirical support (they are not supported by research) (McCoyd & Walter, 2016; Ober, Granello, & Wheaton, 2012).

Beyond Mourning and Care of Self with Therese A. Rando

This segment is from the final 3 minutes of a two-day seminar titled, Core Strategies for Treating Traumatic Bereavement with Dr. Rando.

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Worden’s Model

Worden (2009) identified four key tasks he believes to be required for a healthy grieving process:

A strength of Worden’s approach is that it is an active model which encourages responding to each client’s individual presentation and can assist clients in identifying their own needs and goals, which is critical to providing support in the context of grief (Harris & Winokuer, 2016). Despite the tasks being numbered, Worden (2009) has stated that they should not be viewed as fixed or prescriptive but that “tasks can be revisited and worked through again and again over time. Various tasks can also be worked on at the same time” (Worden, 2009, p. 53).

Nonetheless, it is problematic and potentially harmful to insist that a task must be undertaken; you may have noticed in the Worden extract that the tasks specify things Worden believes ‘need’ to be done. It is also perfectly understandable that people would assume that a numbered series of tasks, such as Worden’s, indicates that the tasks are discrete and sequential (with all the problems this entails). It is also problematic to assume that aspects of grieving are universal and, as mentioned regarding Rando’s model, there is a general lack of research evidence to suggest that task models are accurate in their ideas about grief and how it should be addressed.

Four Phases and Four Tasks of Grieving

This video describes Wordels four tasks of grieving. 

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Contemporary Approaches to Loss and Grief

More recent approaches to loss and grief focus more on adjustment to and integrating loss rather than on ‘recovery’ or ‘resolution’. There is the acknowledgement that, while grief may diminish over time, it may continue to have a presence in a person’s life, with the potential for reactivation at certain times (for example, anniversaries and milestones) (Winokuer & Harris, 2012). For example, a girl whose mother dies when she is 8 years old may experience a resurgence of grief later in her life as she experiences her mother’s absence at significant life events such as marriage and having children herself. There is also an increasing acknowledgement that patterns of grieving vary widely according to individual, social, and cultural factors.

The Dual Process Model

Developed from a cognitive stress perspective, the dual process model of grief describes the grief experience as a process of oscillation (movement) between two modes of functioning: loss orientation and restoration orientation.

In the loss-orientation, people may be immersed in the pain of separation, missing what has been lost, and coming to terms with the loss. At other times, in the restoration-orientation mode, the person engages in day-to-day activities, general life tasks, the things that need to be done in the aftermath of the loss, problem-solving, making appropriate adjustments, and focusing on other aspects of life (Hall, 2011). This process is depicted by Machin (2009, p. 44):

The adaptive, regulatory function of oscillation in the model is important to note. The ‘break’ from the distressing, sometimes overwhelming nature of loss orientation is important for mental and physical health and necessary for “optimal adjustment over time” (Stroebe & Schut, 1999, p. 216). Worden (2009) uses the notion of ‘dosing’ to describe how bereaved people may expose themselves to the amount of pain they can cope with before switching to restoration-orientation coping strategies.

The model suggests that the focus of coping with grief may “differ from one moment to another, from one individual to another, and from one cultural group to another” (Hall, 2001). The dual process model uses these differences in coping to account for the diversity in the grief experience across individuals.

The Dual Process Model of Coping with Bereavement

Professor Margaret Stroebe discusses the Dual Process Model of Coping with Bereavement.

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Continuing Bonds

While classical grief theory based on psychodynamic principles suggested that ‘recovery’ from bereavement involved disengaging from or ‘letting go’ of a deceased individual, more recent theories and practices focus on maintaining a sense of continuity. This may be through memory and a “revised inner representation of the deceased (or person or thing which has been lost)” (Machin, 2009, p. 5). Pomeroy and Garcia provide an example of one way in which a widower continued the bond with his dead wife:

Many non-Western cultures show the significance of continued bonds through religious beliefs and rituals. For example, in Japanese culture, the maintenance of ties with the deceased is accepted and sustained by religious rituals.

This has implications for counsellors, who are encouraged to shift their focus from promoting ‘closure’ and sharing ideas about continuing bonds with clients when appropriate. For example, counsellors may support bereaved clients to explore the idea of continuing bonds and find healthy ways to maintain bonds with the deceased if that is what the client wants.

CONTINUING BONDS THROUGH GRIEF THERAPY

Grief therapist, Dr. Dawn Joosten-Hagye, PhD, LCSW, MSW, GC-C, explains the need for Continuing Bonds after the loss of a loved one.

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Meaning Making

Significant loss, particularly bereavement, can challenge our assumptions and beliefs about the world. Through loss, we may learn that not everyone is trustworthy – that some people harm others; that the world is not always a safe or predictable place; and that we have little ability to prevent many ‘bad things’ from happening to us (Winokuer & Harris, 2012). The reconstruction of one’s assumptive world, therefore, can be a central task for those who experience bereavement and other significant losses. It involves ‘relearning’ aspects of the self and the world (Attig, 1996). Such adjustments can include attempts to integrate the loss into the griever’s ‘personal narrative’, where the loss fits into “a meaningful plot structure” (Neimeyer, Prigerson & Davis, 2002, p.239). This, in turn, can involve the use of narratives and life stories or other activities such as the following:

Meaning-making can involve talking or not talking – it doesn’t have to be about story-telling, although that can be how it appears. People might make meaning out of creating artworks, committing to a particular practice or enacting a particular value, or working to support a particular cause, to take just a few examples of the many ways that meaning-making can be done.

As you can see, approaches to grief have started to move away from stage, phase, and task-based models to focus on helping people integrate their memories and the importance of what has been lost into their present and future lives.

Various factors help account for this diversity in how people grieve, from individual differences to the type of loss, to the family and cultural environment the person is in. Having an appreciation and understanding of the impact and influence of these factors will help you to respond to specific client needs based on their individual situation. So, let’s explore some of these factors further, particularly in relation to bereavement.

making meaning after the death of a loved one

David Kessler is an expert on grief, and discusses in this video, beyond the classic five stages of grief to discover a sixth stage: meaning. Many people look for 'closure' after a loss. David argues that it’s finding meaning beyond the stages of grief that most of us are familiar with — denial, anger, bargaining, depression, and acceptance — that can transform grief into a more peaceful and hopeful experience.

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Worden (2009) identifies seven factors that may be particularly important in understanding a particular person’s grief experience after a death. He refers to these as the ‘mediators of mourning’. Let’s explore each of these seven factors in turn.

1. Relationship with the Deceased

Relationships, including their meanings and consequences on an individual’s perception of themselves, strongly influence the nature of the grief response (Machin, 2009). How the person was related or connected to the deceased person will influence how they might grieve. Generally, the closer the person was to the deceased, the more intense the bereavement. For example, the loss of a grandparent who lived in a different country will be mourned differently from the loss of a parent or sibling with whom a person is close. However, it is important to acknowledge that even if the relationship bond is similar (children losing a parent), each person will experience this loss differently (Worden, 2009).

2. Nature of the Attachment

As you have already learned, some theorists have likened grief to the distress experienced by individuals separated from their attachment object (for example, a person). Worden (2009) considered attachment to be critical in grief and suggests that counsellors attend to:

• The strength of attachment (he suggests that the grief response often increases in intensity in proportion to the intensity of the relationship with the deceased).
• The security of the attachment.
• The ambivalence in the relationship and/or conflict with the deceased. These factors may result in feelings of guilt or unresolved anger.
• Dependent relationships: Worden suggests that relationships that were ‘enmeshed’ characterised by high dependency can affect an individual’s ability to adjust to a life without the deceased, particularly where that person carried out many of the day-to-day tasks such as paying bills, driving, and organising social activities.

Worden provides an example of how some of these factors may impact a person’s grief response:

3. How the Person Died

Factors such as physical proximity, levels of violence or trauma, suddenness, multiple losses, whether the death was preventable, or if there is any social stigma associated with it can all pose significant challenges for the bereaved (Worden, 2009). Walsh explores some particular aspects of death that may create particular challenges or distress in its aftermath:

There is also evidence that deaths resulting from suicide pose significant additional challenges for those bereaved (Worden, 2009). Later in this module, we will discuss factors that can lead to complex grief responses and other referral needs.

4. Historical Antecedents

Individuals come to counselling with varied histories and experiences, all influencing their current situation. This is no different when it comes to grief and loss. A person’s experience of loss may be shaped by the previous losses they have experienced, how they have grieved these losses, and their mental health history, for example (Worden, 2009). As you should recall from section one, cumulative grief results when a person suffers several losses over a period of time. This can mean that adjusting to additional losses may be more challenging. Cumulative losses can also result in an accumulation of stress, increasing vulnerability to further mental health issues.

Some types of loss and trauma can also have impacts across generations. This is particularly relevant for Indigenous communities who have experienced historical loss and trauma through colonisation and displacement. Many Indigenous people have suffered the loss of their lands, cultures, languages, and families – as well as experiencing other traumas – which have impacted them personally and as a community (Calvary Health Care). For example:

5. Personality Variables

We started exploring the highly variable and diverse nature of grief responses in the previous section of this module. While a large part of this variation can be explained by individual circumstances combined with cultural and social context (which you will learn about shortly), psychological variables such as personality, coping methods, attachment style, beliefs, and values also influence the grief experience.

A person’s personality and habits may influence their grief responses. For example, an introverted person who is not typically emotionally demonstrative is unlikely to suddenly become highly expressive after experiencing a significant loss (Winokuer & Harris, 2012). Their learned and habitual ways of coping and other personal factors can also have an influence. This is one of the reasons why theories of grief that propose particular experiences and processes as part of the grief response are so problematic: they do not consider how people vary in their experiences, expressions, and ways of coping.

Coping Styles

Coping refers to our efforts to adjust to the demands of a situation and includes both behaviour and cognition (ways of thinking) (Humphrey & Zimpfer, 2008). Significant loss events such as bereavement represent situations that place demands on people and to which they must adjust, so coping strategies are an important consideration in situations of loss and grief. Bereaved people’s typical ways of coping with stressful situations will likely influence how they respond to loss (Winokuer & Harris, 2012).

According to Worden (2009), coping strategies include:

• Problem-solving coping. An instrumental coping mechanism that aims to locate the source of the problem and determine solutions. People vary in their problem-solving ability (and some situations are more or less amenable to problem-solving).
• Active emotional coping. This type of coping involves strategies such as humour, reframing, the ability to identify something positive in a situation, expression of emotion, and the ability to accept support.
• Avoidant emotional coping. These strategies include blame (of self or others) and other strategies such as distraction, denial, and social withdrawal; as you might imagine, this type of coping can become unhelpful if maintained for long periods. Using substances such as drugs, alcohol, or food to manage intense distress also falls into this category.

The following example shows a person with a problem-solving coping style adopting an avoidant emotional coping style when faced with the loss of his wife.

Worden (2009) suggests that avoidant emotional coping may be the least effective coping strategy in the context of grief and loss. However, what appears to be avoidant coping can be useful at times, at least temporarily, and in some cases is not actually avoidant at all. For example, Worden also discusses the case of a bereaved man who spent significant amounts of time alone; while others were worried that this meant he was withdrawing and not ‘dealing’ with the loss, this was actually a healthy and helpful strategy for him. He was “doing his grieving … in his own way” (p. 102).

FACTORS AFFECTING GRIEF

In this video, Christine Lister, presents various factors that affect how someone moves through their grief process.

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The Stress-Vulnerability Model

The stress-vulnerability model theorises that the effects of challenging events are determined by the interaction between a person’s vulnerability (the things about their genetic make-up and prior experience that mean they are more or less vulnerable to the effects of stressors); the stressors that they are exposed to; and their resources, including protective factors against the effects of stress, such as supports and coping strategies. According to the model, this interaction determines whether a breakdown of normal functioning and various risks (such as mental health risks) may occur. This model can be explored using the ‘water tank metaphor’:

Grief and loss present significant stressors, and interacting with the person's vulnerability and the resources available (for example, helpful coping strategies, social supports and financial resources), may lead to well-being issues. The stress-vulnerability model can help understand the range of factors that may impact an individual, consider their multiple stressors, and identify what strategies may be helpful (including specialist referrals).

As you can see, when considering grief experiences, counsellors must consider the various stressors and protective factors that apply to clients. Interventions may be suggested to reduce some stressors and enhance coping and protective factors. Social support is a key protective factor we will discuss in more depth in the next section of this module.

The Stress Vulnerability Model

Heather Brundrett and Mark Ellis demonstrate using the Stress and Vulnerability Model with a patient.

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Grieving Styles

Although there are many commonalities in the grief experience, people also grieve in very different ways. Doka and Martin describe three main patterns of grieving or ‘grieving styles’, which Winokuer and Harris (2012) place on a continuum, as depicted in the following graphic:

Intuitive grievers	Blended grievers	Instrumental grievers
Express feelings Wish to talk about their experience with others	Combine both but usually with a tendency toward one or the other style	Grieve more cognitively and behaviourally Express their grief in terms of thoughts, analysis and action

People are often expected to grieve differently according to gender, with women associated with intuitive grieving and men with instrumental grieving styles. Winokuer and Harris (2012) point out that “if people do not express grief in a way that is expected by others, their experience may be labelled ‘problematic’ or even ‘pathological’” (p. 88). Counsellors need to identify and respect an individual’s unique grieving style and develop interventions that meet that person’s particular need, putting aside their own assumptions about how people or particular groups of people ‘should’ or ‘usually’ grieve.

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Attachment Style

You should recall the concepts of secure and insecure attachment styles from earlier in your studies. Parkes investigated the association between attachment style and bereavement outcomes and believed that individuals who had experienced secure attachment with their parents as children experienced less distress as a result of bereavement than those who had experienced insecure relationships, while those who learned to avoid attachments had difficulty expressing their feelings during bereavement (Worden, 2009). According to this model, people with secure attachment styles tend to be able to process the pain of separation and move on to develop healthy continuing bonds with the deceased loved one. Although these individuals do experience separation distress and consequent searching and pining behaviours, they are not overwhelmed by the loss. Conversely, insecure attachment styles (particularly anxious/preoccupied and anxious/ambivalent styles) are associated with difficulties in adjusting to the loss of an attachment figure, resulting in some cases in the development of complex grief (Worden, 2009).

Grieving Styles 

This video looks closer at grieving styles and the benefits and disadvantages of them.

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Spirituality

As we have already discussed, spiritual practices and religious rituals are an important part of part of how many people make sense of and respond to loss. Spiritual questioning and quests for meaning are common components of bereavement reactions. When clients are experiencing a spiritual crisis or challenge due to loss, they may find it more difficult to cope with the loss and grief they are experiencing (Worden, 2009). On the other hand, clients may also draw on mental resources from their spiritual perspective or belief system to help them cope with the loss. In general, counsellors have a professional responsibility to respect and help clients work through things within the context of the client’s spiritual framework (or lack thereof).

6. Social Mediators

So far, we have explored the influence of relationship factors, the circumstances surrounding the loss, and individual characteristics that influence the grieving process. However, people exist within a sociocultural context. As such, understanding the cultural and social factors at play is crucial in supporting people who are grieving.

Cultural Influences

We all belong to various cultural and social groups, which are made up of smaller subcultures. These cultural groups play a large part in what we consider a loss and how we grieve them. These give us particular rituals and behavioural guidelines for some losses while often failing to recognise others. Every culture has norms, values, and beliefs that are considered acceptable, but what is considered an acceptable reaction or emotional response to death varies widely between cultures. For example, some cultures frown upon public displays of emotion, especially negative emotions such as sadness and anger, and behaviours such as crying and sobbing. Others consider public displays of grief important and necessary. In some countries, funerals are loud and expressive affairs, while in others, funerals are quieter. And, as we have already discussed, people who grieve in ways that are not expected or considered ‘normal’ or acceptable within a given culture may experience judgement, social avoidance, or worry that they are not behaving properly.

After our previous discussions, it won’t surprise you to learn that culture can have a significant effect on the recognition of and reactions to loss, affecting:

As such, in considering a person’s grief experience, counsellors must consider the current family and family of origin influences, ethnicity, cultural practices, socio-economic factors, gender, sexuality, spirituality or religion, and other cultural variables. A lack of cultural awareness can result in serious misunderstandings between the counsellor and client, resulting in incorrect ‘labelling’ of grief experiences, and is likely to impact on the counselling process negatively. Klass (2003) describes examples of culturally appropriate mourning that could be misconstrued as ‘pathological’ depending on the observer’s own cultural and individual beliefs and assumptions, including an Egyptian mother who mourns her child’s death intensely for seven years, a Balinese man who seemingly laughs and makes light of the death of a loved one and followers of some belief systems who feel possessed by the deceased person’s spirit.

While counsellors need to identify and respect cultural differences, it is equally important not to make assumptions based on obvious cultural characteristics such as ethnicity. A person’s apparent cultural affiliations and other aspects of identity may not wield the strongest influence on their grief experience (Murray, 2016). For example, an Aboriginal client may take more of their values and beliefs around death from their Christian faith than from the traditional beliefs of their ethnic group. So while it is important to understand the common cultural practices that may influence a person’s grief experience, counsellors should also consider individual differences and avoid assumptions and stereotyping. Building your understanding of diverse groups and cultures is important and helpful, but understanding also comes from exploring the individual’s own experience:

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Social Expectations

The expectations on people from their families, friendship and peer groups, ethnic and faith communities, and broader societies also impact the experience and expression of loss and grief. Pomeroy and Garcia discuss some of the ways that social expectations within western culture can impact experiences of bereavement:

Such social rules can cause great difficulty for people who do not grieve in the socially expected or sanctioned way. Rather than risk isolation or rejection at this particularly vulnerable time, grieving individuals may try to conform to expectations by putting on a ‘public façade’ which does not reflect their inner experience.

This case study was taken from Reading E to demonstrate the effect that societal expectations can have on people who experience losses. It also shows how the right kind of social support and adoption of positive social roles (in Jerry’s case, helping with the foundation's work) can support the grieving process. This case study also highlights how valuable the recognition of continuing bonds (talking about his memories with Peggy’s friends) and meaning-making (setting up a foundation in Peggy’s name) can be.

This highlights a few other social factors we must consider: social support and social roles. Worden (2009) cites research showing that high levels of perceived emotional and social support, both within the family and in the community, are associated with reduced stress in the context of bereavement; conversely, those who experience complications in grieving often have inadequate or problematic support systems. It is important to note that the availability of social support has not been shown to accelerate the grieving process but may “soften the blow” (Worden, 2009, p. 74). In addition, involvement in a wide range of social roles (for example, family member; friend; employee; volunteer; member of community, religious, political, or activity group) has been found to enhance adjustment to loss (Worden, 2009).

Disenfranchised Grief

A key consequence of social and cultural factors is that particular loss experiences may not be recognised or validated. Disenfranchised grief refers to grief that people experience when they incur a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported. According to Doka (2009), there are several different ways by which grief may be disenfranchised and thus excluded from social support. Examples include where:

• The lost relationship was not considered valid, socially acceptable, or important within a family, community, or broader society (for example, partner loss in same sex couples, miscarriage).
• The loss itself is not recognised or viewed as significant (for example, pet loss).
• The grieving person is exempted from rituals that might give meaning to the loss or is not seen as capable of grieving (for example, children, or individuals with intellectual disabilities).
• Some aspects of the death or loss are stigmatising, embarrassing, or socially unacceptable (for example, deaths from AIDS and suicide).
• The grief response or behaviour of the individual falls outside of social norms (for example, highly expressive grief responses, few outward responses, and talking to the deceased loved one).

The implications for disenfranchised grief can include a lack of social acknowledgement of the loss, a social stigma applied to the bereaved person, and avoidance or lack of support.

Disenfranchised Grief When My Grief Does Not Matter

This video looks to correct that mentality and assert that everyone's grief matters.

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Implications for Counsellors

As you can see, counsellors need to recognise and identify the social and cultural forces influencing responses to loss. Where social pressures discourage people from grieving in the way that feels right to them, counsellors can also help clients to “grieve in ways that are congruent with their needs, free from the dictates of social rules that may deny or invalidate the deeply human experience of grief” (Harris & Winokuer, 2016, p. 54).

7. Concurrent Stressors

Other factors that affect the grieving process include the changes, challenges, and crises that arise before, at the same time as, and following the loss (Worden, 2009). Changes and challenges occur for everyone, but multiple concurrent changes and stressors can be associated with greater difficulties after loss (consider the impacts of loss discussed in section one, including personal, social, and financial effects).

The stress vulnerability model (which we discussed earlier) can help counsellors identify the multiple stressors that clients may be experiencing as well as the stress incurred by a loss itself. This, combined with the person’s coping ability, vulnerabilities, and resources, can help counsellors assess which clients are likely to be at higher risk of complex grief reactions and mental health issues (which you learn more about in the next section of this module).

Grief Counselling: 3 Techniques Therapists Can Use

In this video, Counselling expert Mark Tyrell shares three techniques for good grief counselling that can be used to help clients stop grief from becoming an on-going burden in their lives.

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In this section of the module, you have learned about the theories and models developed to understand and describe the grieving process and ways of supporting people after loss. While there are many common elements across various models, relying on a particular model or explanation can mean that counsellors use inappropriate frameworks for responding to loss or miss individual and cultural variations. As such, it is important to recognise and understand the factors that influence a particular person’s grief experience, particularly the individual factors and the sociocultural context in which the loss occurs. All of these factors will influence the support process and whether or not support is helpful. We turn our attention to providing loss and grief support next.

Attig, T. (1996). How we grieve: Relearning the world. New York, NY: Oxford University Press.

Calvary Health Care. (n.d.) Bereavement across cultures: A resource for health professionals. Retrieved from https://www.caresearch.com.au/caresearch/Portals/0/Documents/PROFESSIONAL-GROUPS/Calvary_A5_real.pdf

Doka, K. (2009). Disenfranchised grief. In Encyclopedia of death and the human experience (pp.379-381). Thousand Oaks, CA: SAGE Publications.

Hall, C. (2011). Beyond Kübler-Ross: Recent developments in our understanding of grief and bereavement. InPsych, 33(6). Retrieved from https://www.psychology.org.au/publications/inpsych/2011/december/hall/

Harris, D. L. & Winokuer, H. R. (2016). Principles and practice of grief counseling. (2nd ed.). New York, NY: Springer Publishing Company.

Humphrey, G. M & Zimpfer, D. G. (2008). Counselling for grief and bereavement. (2nd ed.). London, UK: Sage

Klass, D. (2003). Grief and mourning in cross-cultural perspective. In The Macmillan encyclopedia of death and dying (pp. 382–389). New York, NY: Thompson.

Korff, J. (2019). Mourning an Aboriginal death. Retrieved from https://www.creativespirits.info/aboriginalculture/people/mourning-an-aboriginal-death

Kübler-Ross, E. (1969). On death and dying: What the dying have to teach doctors, nurses, clergy and their own families. New York, NY: Scribner.

Lawton, S., & Lawton, K. (2012). Bereavement and primary care. In P. Wimpenny (Ed.), Grief, loss and bereavement (pp111-120). Oxon, UK: Routledge.

Lewis, M., Feiring, C., & Rosenthal, S. (2000). Attachment over time. Child Development, 71(3), 707-720.

Machin, L. (2009). Working with loss and grief: A new model for practitioners. London, UK: Sage

Machin, L. (2014). Working with loss and grief: A theoretical and practical approach (2nd ed.). London, UK: Sage.

McCoyd, J. M. L., & Walter, C. A. (2016). Grief and loss across the lifespan: A biopsychosocial perspective (2nd ed.). New York, NY: Springer.

McLeod, K. & McLeod, J. (2011). Counselling skills: A practical guide for counsellors and helping professionals. (2nd ed.) New York, NY: Open University Press.

MHPOD (n.d). The stress vulnerability model. Retrieved from http://www.mhpod.gov.au/assets/sample_topics/combined/Risk_and_protective_factors/risk_objective_2/index.html

Murray, J. (2016). Understanding loss: A guide for caring for those facing adversity. New York, NY: Routledge.

Neimeyer, R. A., Prigerson, H., & Davies, B. (2002). Mourning and meaning. American Behavioral Scientist, 46, 235–251.

Neimeyer, R. A., Burke, L. A., Mackay, M. M., & van Dyke Stringer, J. G. (2010). Grief therapy and the reconstruction of meaning: From principles to practice. Journal of Contemporary Psychotherapy, 40, 73-83.

Ober, A. M., Granello, D. H., & Wheaton, J. E. (2012). Grief counseling: An investigation of counselors’ training, experience, and competencies. Journal of Counseling & Development, 90(2), 150-159. https://doi.org/10.1111/j.1556-6676.2012.00020.x

Pomeroy, E., & Garcia, R. (2009). The grief assessment and intervention workbook: A strengths perspective. Belmont, CA: Brooks/Cole Cengage Learning.

Stroebe, M., Gergen, M., Gergen, K., & Stroebe, W. (1996). Broken hearts of broken bonds? In D. Klass, P. R. Silverman & S. Nickman, S. (eds.). Continuing bonds: New understandings of grief. (pp. 31-43). New York, NY: Routledge.

Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197-224.

Walsh, F. (2007). Traumatic loss and major disasters: Strengthening family and community resilience. Family Process, 46, 207-227.

Winokuer, H. R. & Harris, D. L. (2012). Principles and practice of grief counseling. New York, NY: Springer.

Worden, J. W. (2009). Grief counseling and grief therapy. A handbook for the mental health practitioner. New York, NY: Springer Publication Company.