Normal Versus Complicated Grieving

This post covers what grief is like both in situations where the bereaved is grieving effectively and when this is not the case.  While this post refers to grief as a response to the death of a loved one, there are many reasons that a person may experience grief.  For example, grief in the present can result from something that happened in the past such as childhood neglect or abuse.  I will cover this in depth in a subsequent post.

Counsellors distinguish between so-called normal (or uncomplicated) grief and abnormal (complicated) grief.  Uncomplicated grief looks like depression in many ways and in fact grief can sometimes precipitate an actual depression.  Much like a depressed person, a bereaved person often experiences disturbances in sleep and/or appetite and may become absent minded.  It is also common for a bereaved person to cry and/or to sigh a lot.  The bereaved often withdraw socially and lose interest the outside world for a period of time.

Those experiencing normal grief reactions also often dream of the deceased.  These may be regular dreams in which the deceased simply appears or they may be distressing dreams or nightmares.  Some bereaved people avoid reminders (such as places or objects) of the deceased, while others intentionally go to and seek out places or things that remind them of the deceased.  Relatedly, some may treasure certain objects that belonged to the deceased and may carry these objects around with them.  Another experience associated with normal grief is for the bereaved to find themselves searching for or even calling out for the deceased.

Grieving takes time and some move through it more readily than others.  Although there is no standard amount of time that it takes to recover from a significant loss, as noted in the previous post there are standard phases which involve particular tasks that the bereaved tend to pass through.  How long it takes a person to pass through these phases varies.

Although grieving is a completely natural and normal response to loss, counselling can facilitate the grief process.  It can help a person to more readily and more thoroughly move through the phases and accomplish the tasks associated with the grieving process.  Talking about a significant loss can help a person to accept it and to work through the feelings associated with it.

When a person does not grieve effectively it is refer to as a complicated or abnormal grief reaction.  This is when the normal phases and tasks associated with grieving are not experienced or accomplished.  Complicated grief can take several forms.  Grief can become chronic, it can be delayed, it can be exaggerated or it can be masked.  Each of these types of complicated grief reaction is described below.

As the name implies, a chronic grief reaction is one that does not come to a satisfactory conclusion.  This can be for a myriad of reasons, but it requires an assessment as to which of the tasks of grieving is not being accomplished and why.  A delayed grief reaction is one in which the grief process is suppressed entirely or in which it is experienced but in a minimal way which is not sufficient to the loss.  An exaggerated grief reaction is one in which a person becomes emotionally overwhelmed by grief and may resort to maladaptive coping strategies such as the use of alcohol or drugs or some type of compulsive behavior.  Masked grief is when a person does not allow himself to experience grief such that the feelings get subverted into physical (psycho-somatic) symptoms or some type of maladaptive behavior.

Counselling can help with all of these types of complicated grieving.  The goal of counselling in complicated grieving is to identify and resolve the reasons that the grieving process is absent, delayed, excessive, or prolonged.  In prolonged and excessive grief the bereaved person is usually conscious of the fact that they are experiencing difficulty grieving, whereas in absent and delayed grief reactions the person is not.  In either case, the therapy generally involves assisting the bereaved to experience thoughts and feelings that s/he has been avoiding.  The counsellor seeks to become part of a social support system that would give the client the permission, compassion and the strength needed to grieve effectively.

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