A Grief Therapist Asks about expectations

Dear Dr. Neimeyer,

As a counselor myself, I was interested to read recently that the majority of people who experience a significant loss react with a surprising degree of resilience, to the extent that the grief process can, in the longer term, be a positive experience for them. This tends to counter a prevailing, if rather archaic, view that counseling is routinely a valuable process to help people deal with bereavement. In your opinion, what should grief therapists expect about how people will cope following a recent bereavement?

John S., PhD

Dear John,

Well, to say that the death of one’s child, partner, sibling, parent or friend could in the long run be considered a “positive experience” may be a bit of an overstatement; I’ve met very few grieving people who wouldn’t give back in a heartbeat any degree of personal growth they’ve achieved to have their loved one back physically in their lives. But at the same time, resilience is a clear reality for close to half of the bereaved, who manage to weather the storm of mourning surprisingly quickly, finding their footing in the world once again within a matter of a few months, even if they continue to miss their loved ones keenly. For many others, the loss more profoundly disrupts their mood and functioning for several months, but they too ultimately grieve adaptively, integrate the loss into their lives, and return to their emotional baseline while revising their life routines and goals accordingly.

Another 25%, however, tend to fare worse, experiencing exacerbations of previously problematic patterns (e.g., of chronic depression or substance abuse), family and work related conflicts, or complicated grief, experienced by about 10% of the bereaved. I guess the point I’d like to make is that grieving can lead to surprisingly different outcomes, only a minority of which are likely to benefit from psychotherapy. Most people will adjust to their loss quite well over time, drawing on their own strengths and those of others who care about them, without the aid of a grief therapist.

But allow me to conclude with a few more remarks about your implication about the upside of grief. Beyond resilience per se, which refers essentially to a rapid return to baseline following a significant stressful event, a surprising number of people also report substantial post-traumatic growth (PTG) in the long-term wake of loss. PTG refers to a cluster of developments in the wake of a “seismic” life transition, which include a greater sense of strength and maturity, deepening of relationships and compassion for the suffering of others, keener appreciation for life, greater readiness to embrace possibilities, and often a renewal of spiritual and philosophic frameworks for living. Nothing about this is inevitable, of course, and our own research and that of others suggests that PTG is typically a hard-won outcome of a good deal of painful reflection and meaning-making, which is probably most accessible when the distress of bereavement is sufficiently intense to challenge life-as-usual, but not so overwhelming as to make constructive change impossible. Sometimes on their own, and sometimes with the aid of an understanding counselor, many bereaved people experience this form of loss related growth as well as grief.

Dr. Neimeyer