Intro to Counseling & Pastoral Care
Anna Zhang 23/09/1998

(Student at Morling College, Sydney).

Grief and loss are the two most intertwined experiences. As we live in this sin-marred world, loss is inevitable thus grief occur in many different ways. This essay will be studying the subject of Counseling for Grief and Loss, by giving not only their definitions but also exploring related issues, such as the responses towards grief and loss, counseling and pastoral care techniques, and lastly the subject of children and grief.

1. Definition of Grief & Loss Commonly, grief has been often associated with death and dying. However, in recent years, the association of grief is being recognized beyond simply the human death and dying. It can happen with any loss, being the deprivation of a meaningful relationship. It could be in the case of a pet, a friend, a family member or even marriage, job, health, role and identity. Accordingly, it is the most universal experience, as in one way or another we would have had loss, therefore grief.

Despite its universality, it is however difficult to define grief. Common loss experiences tend to be buried in a conspiracy of silence. As not many people want to talk about loss. Although loss may be buried in silence, grief, "being the response of emotional pain to the loss" cannot be ignored. It manifests itself in anger, fear, disappointment, vengeance or punishment, guilt and deep sorrow. It is difficult to single out "grief" as one particular emotion, there are just so many facets of this intense and lingering emotion.

Technically speaking, bereavement is not the same as grief, but is the actual state of the loss. Thus we may say "Mr. Jones is in bereavement, grieving over the recent loss of his beloved wife". Ideally, grief is the emotion that is "involved in the work of mourning, whereby a person seeks to disengage himself from the demanding relationship that has existed and to reinvest his emotional capital in new and productive directions for the health and welfare of his future life in society".

2. What Happens When Grief & Loss Occur ?

Two types of reactions usually occur, being one the healthy response, the other the unhealthy response.

2.1 the Healthy Response According to Dr. Elizabeth Kubler-Ross, who has studied countless numbers of people both young and old, who were dying, it is noted that people tend to pass through the following stages:

1. Denial & isolation
2. Rage and anger
3. Bargaining
4. Depression
5. Acceptance
6. Hope

However, we need to realize that these stages do not follow one by another in a lineal way, rather, cyclically, with one or two stages recurring from time to time. Eventually, one will come to acceptance of the loss, and a new hope for the future. Growth is marked as a result of a positive grief work.

Observations are also made by Edgar Jackson, that those who respond healthily towards grief tend to have a healthy and stable personality, who is prepared before the loss, and encouraged to work actively through the feelings, and is more accepting towards his/her emotional expressions.

2.2 the Unhealthy Response Contrary to the healthy responses, there is the unhealthy response. Clinebell calls it "the grief wound that does not heal". Instead of going through the stages of grief, and arriving eventually at hope and re-growth, the bereaved gets stuck in one of those stages. He/she may continue to over-idealize the deceased, deny the loss ever happened, thus to avoid the agony of the loss. This kind of grief in turn impairs a normal life of the bereaved to such an extend that professional counseling is often needed.

Lindemann lists nine abnormal reactions to grief as follows:

1. Overactivity, with a sense of well-being rather than a feeling of loss.
2. Acquisition of the symptoms of the last illness of the deceased.
3. A medical disease, psychogenic in nature, such as ulcerative colitis.
4. Marked alteration in relationship to friends and relatives.
5. Furious hostility against specific persons.
6. Loss of feelings as if acting out life, not living it.
7. Lasting loss of patterns of social relations, with general listlessness.
8. Behavior detrimental to one's own social and economic existence, such as unreasonable generosity.
9. Agitated moods of depression.

Although grief may be delayed sometimes, it is never to be denied. In fact, the longer it is delayed, the more difficult it is to do it effectively. Therefore, it is not wise to have the doctor immediately prescribe sedatives for the grief-stricken. As it masks the pain of the immediate situation which the bereaved needs to face. Similarly, those "sedative words" said often by pastors would do much harm than help, as they try to shied away the pain for the bereaved and at times as an attempt to "defend for the Almighty". The following story told by Deits is an example of such case.

An outstanding teenage girl at Deit's daughter's school, much loved by family, friends and teachers, yet died one day while she was on a ride with her boyfriend. Out of one moment of carelessness, she was thrown out of the car and her boyfriend, the driver run the car over and crushed her to death. This caused such a shock wave in the community that by the time of the funeral, both parents and school mates were just longing for comfort and sense in this senseless tragedy. "Praise God" was the exhorts given by the preacher, as the preacher branded the young girl as the most beautiful flower in God's garden, one day as God was taking a walk in the garden, picked as a special treasure.

People walked out the chapel bewildered , angered and unconsoled. As well as teenagers feared to be good in their own lives, as they might end up being the next on God's flower list.

In this case, religion has become a hindrance rather than help in people's grief work. Especially for those who meant well, yet failed to apply effectively the component of faith, to think through the whole issue with sensitivity and maturity, harms are often done without even realizing so.

3. What can one do in terms of Counseling & Pastoral Care ?

It is crucial for the bereaved to do his/her grief work properly, thus to allow a healthy future living. When rushed through the grief work, or sometimes deny the process of grief, the bereaved will carry baggage into the new relationship. This can be seen evidently in the case of a divorce. If partners remarry too soon after a divorce, and without working through problems in the previous relationship, then issues like unresolved anger, resentment, depression, anxiety, etc will be present in the new relationship, even sometimes seems to appear without a reason.

In this case, the bereaved will have to face the complication of a double grief in life, being the past and the present as a result of undealt issues in the past. Then the bereaved will have to grieve over the past loss before the present relationship problems can be worked through. Therefore, the place of counseling and pastoral care is absolutely essential.

3.1 Counseling Grief counseling could be used as an aid to the healthy grief, thus "to cooperate with the psyche's inner process of recovery", or in particular, when "the grief wound that does not heal", professional counseling is needed rather than merely pastoral care. This could be done either with individuals, or in a group situation which is homogeneous in nature - a widow/widower group, or a divorcee group or even a group of people who all have lost their loved ones in a natural or moral disaster - e.g. earthquake, bush fire, plane crash, Granville bridge, war, etc.

Several components are needed in grief counseling as tasks for both the counselor and the bereaved to accomplish for effective loss resolving.

     Table 3.1
Counselor                  Bereaved
Remain open to the loss
   Perceive the openness
Be empathic                Express one's feelings
Encourage reminiscing      Reminisce
Insist on the loss         Acknowledge the loss

Similar but more comprehensive to the above model, Flatt has suggested the following eleven verbs as important steps in grief counseling : care, learn, attend, control, listen, accept, share, reinforce, innovate, and finally refer if you need to do so. Some of these could be seen evidently in the example of Jesus Christ, who is called the "Wonderful Counselor" (Is.9:6), and "a man of sorrows, and acquainted with grief" (Is.53:3b)

In spite of his personal danger of being stoned by the Jews, he cared for Lazarus enough to go back to Judea, that he may attend to the bereaved. He acknowledged death. While others misunderstood the expression "sleeping" as real sleep, he said plainly to his followers that "Lazarus is dead" (Jn.11:14). When arrived, he listened to what they have to say which involved not just grief but even somewhat a complaint directed to him. All these he listened first, before moving into action of his own. He shared in the sorrow of Martha and Mary and all those who were at the tomb and wept with them. Though he is the Lord of life and knew that Lazarus could be raised from the dead shortly, he still accepted Mary and Martha just as they are.

While most of these steps can be easily understood, there are three verbs seem to require some explanations. They are control, reinforce and innovate .

Control : this means that the counselor is not to break down while ministering to others who are grieving. At the first thought, this may seem to contradict with the example of Jesus, who wept with the crowd. Yet here, "control" means to keep a level head, to not "catch the panic". In fact, the more out of control are others, the more in control should be the counselor. This principle also applies to group therapy as when the counselor break down, group members would feel sorry for him/her, and try to help and comfort the counselor. Thus control needs to be operated in order to keep the focus upon their grief not yours.

Reinforce : this means to encourage people and help them towards positive feeling, thinking and acting behavior. In particular when the bereaved is making progress, the counselor encourages with "Good job. You did well! I have a feeling that you will get through". This reinforcement will then helps lift the bereaved up and move him/her forward during the entire grief process. Proper reinforcement helps shape positive behavior. Innovate : this means to be creative in the methods used in grief counseling. On top of the conventional methods used in therapy, try use other tools the counselor have learned. For example, teaching progressive relaxation, discussing dreams, reading the Bible, even hypnosis could be helpful if used wisely by a well-trained therapist. With a bit of innovation, any counseling method might be adapted and used in grief counseling to help people work through their grief toward growth.

3.2 Pastoral Care Pastors are among the most privileged to have first-hand contacts with people who grieve. There are chances pastors could extend their care, such as hospital visitations, home visits to members in the congregation, messages from the pulpit or at home groups, phone calls or cards or letters, church libraries, and even invite them over for dinner, but most of all, funerals.

Oates has listed five modes of caring which pastors could use in the ritual of the funeral alone. They are :

1. Planning the funeral is itself an opportunity to enable the whole family (include the children) to begin assimilating the reality of the death of their family member. The objective is to enable them to put into words their ideas, feelings and memories of the deceased.

Basically, to do this is to let the pain sink in and sting.

2. The funeral itself is a time of mourning and a time of celebration of the life of the deceased. More than that, a funeral is a time to worship God in Jesus Christ as thanks-giving for the ever-present help of God in the valley of the shadow of death. Although the primary purpose is designed for the comfort of the family and to show the support of the community, it is not a time for admonitions about the need of persons to "straighten up and fly right" or to convert them with the threat of death.

3. Eliciting the family story of the death. At the time of the planning of the funeral, set a time a month ahead for another family gathering to give more comfort and guidance after "the crowd has thinned out". Encourage them to talk freely about what people have said to them and how they felt.

In some way, this is like a "debrief" session after the funeral. 4. Developing "the Story" of a Death. Here the pastor is to be an active listener to enable family member to share about how the person died, details about the circumstances of the death, the survivors' experience at the death and when and how each member learned of the death.

This is particularly important for those who were absent at the event of death and funeral, as they need to know "the death story" in order to give an account for their grief. This is also important for children as when they grow up they would naturally want to ask and know about the story so to find the missing puzzle in the family picture. Even when the deceased is abusive and violent, "death story" still needs to be constructed to be constructed for proper acknowledgment and forgiveness for the deceased. As denial of their opportunity to grief would only hinder their growth in future relationships.

5. Follow-up: the most neglected ritual in the care of the bereaved is the follow-up over the ensuing months after the loss. The first Christmas, Easter, birthday of the deceased are all focal times for follow-up, especially important is the first anniversary of the deceased. A visit, a phone call or a letter would mean much to the survivors in their work of grief.

Furthermore, we need to take note of the difference between ministering to the believing family and the non-believers. To the former, the hope of resurrection is at the core of Christian faith, which we can draw upon for peace and comfort (I Thes. 4:13-14). To the latter, communication become more challenging as the framework of understanding is more limited. Although there must be a concern for salvation of the bereaved, sympathy or concern for the immediate grief should also apply. In doing so, the relationship with the bereaved would be built, thus the groundwork for an encounter with God is laid.

4. Children and Grief

The miracle of life starts at the time of conception, proceeds onto childhood, adolescence and gradually as a full-grown adult. Being at the beginning stage of life, childhood is often seen as so far away from any painful losses, especially death - the very loss of life itself. However, in many cases, death is not all that strange to children. Some children do die and some experience death through the loss of a parent, a sibling, a friend or a pet. It is only in the last decade or so that people start to have an increased awareness in the area of children and grief. Some issues will be studied as below.

4.1 Do Children Really Grief ? Yes. According to Jackson, although a young child is incapable of having a concept of death as adults, because neither time and space nor language facility ideas have been developed yet, all the more the child focuses himself on the feelings. This feelings of need and relationship is the center of his life. When this central needs are dislocated, there can be very strong feelings. This is why a child can have a tremendous sense of grief without having any "idea" of death.

How they respond to grief, would vary from person to person. It depends on their concepts of death at the appropriate developmental level, their relationship with the person who died, the circumstances surrounding the death, and the ability of caregivers to communicate with and emotionally support them.

There is a variety of emotions manifest in the grief of children. For example, denial, guilt, anger, depression, sadness and even panic. In most cases, the feeling of guilt is quite prevalent. As children are more likely to feel guilt than adults. For them, bad things happen when they are naughty. The "desertion" of a loved one is often seen as a retribution for wrongdoing. Hence many children feel responsible for "causing" the death of their loved one. "It is my fault. I should have been nicer, then my sister/grandma/daddy/Pussy will not die". This feeling of guilt can leave scares for years if not handled properly.

4.2 To Tell or Not To Tell In the past, people have chosen not to tell the children regarding their lost ones, believing this act is to be protective, to shield them from pain and harm. "They are still so young, they won't understand. If I don't tell, then they will not know". Or simply, people choose to tell half-truth as if this would blunt the sharpness of that painful loss. "Mummy has gone away to a long trip.", or "Papa has fallen asleep" or "Pussy got lost in the mall this morning". Because of this choice of not telling the truth, children are also denied the opportunity of attending funerals.

But are these things really shielding children away from the pain of loss ? It is often recognized by adults that the unknown is the most difficult to deal with. The unknown frightens us as we have no idea of what it is, thus what to do with it. Yet when it comes to children, we assume that truth is bad for them, and they prefer half-truths or even white lies. Although it is possible to confuse children with this kind of misinformation, but "children have built-in lie detectors and can sense when they are being deceived. They will quickly lose confidence in those dishonest persons to whom they must nevertheless turn for guidance and understanding".

They question the statements made up for them. "If mummy has gone away, why didn't she even say good-bye ? How could she just leave like that?" Or "if Papa has fallen asleep, then when is he going to wake up?" The deception is further compounded as children see others mourn: "Why is everyone so said just because she has gone onto a trip/Papa is sleeping ?" If not handled with care, even theological explanations could cause children harm. Told that "God took Mummy because he needed her in heaven", a child could develop anger and a deep resentment against God who seems so "selfish" that He robbed the child of his loved one. God then becomes "an enemy".

With all these half-truths and white lies, children are denied the opportunity to grieve and to attend the funeral (in a simplistic way, a ritual of saying good-bye). Since they could not deal with the loss honestly, can't express their grief verbally , they often do so through actions. Numerous studies revealed behavioral problems in children and youth who had experienced the death of a parent when they were younger.

It is in the light of all these potential harms and dangers, that "to tell the truth" is very important to children. Use simple but clear words, always accompanied by sympathy and support. With openness and honesty, children no longer need to fear death as a "mystery", but start to see a wholesome picture of death as part of life. Try to understand their developmental level thus to establish an effective communication. Allow them the opportunity to re-visit the subject as they grow up as they will need to come to terms with the loss in their own way and at their own pace. This is a process of learning and it may take weeks, months even years to do.

Children should also be allowed to attend the funeral and no age is too young to go. Jackson comments that if a child refuses to go, it means that already the child has picked up anxiety about death. Equally important it is to tell without delay, preferably by a parent or someone close to them. Otherwise there may be the possibility that children will be told by the wrong person, at the wrong time, and in the wrong way.

Grief work is not easy. As it is said, "it(grief) is so high that you can't get over it, so low that you can't get under it, so wide that you can't get around it. The only way to do it is to go through it". Not only does it apply to adults, but also children whom are often denied of grief under the guise of protection. Counselors and pastors can be vital facilitators in the process of the grief. Rather being impaired by all sorts of unhealthy responses towards grief, the bereaved can be helped to have new growth by acknowledging the loss, then to choose to live again by seeing the hope of new doors open in one's life. Our God is the Lord of hope, who leads us out of darkness into light, and brings life out of death.