Grief Support for Individuals and Families
Equipping the Laity for Pastoral Care
Grief Support for Individuals and Families
by Anne K. Windus, Ph.D.
The rain continued. The ground was saturated. In the early hours of the morning the earthen dam gave way and a wall of water from a lake plunged down the mountain and over Toccoa Falls and roared through the sleeping college campus of Toccoa Falls College. The raging waters took with it everything in its path...trees, cars, homes, and the lives of thirty-nine students, faculty, staff and children. My father taught at that college and my parents were some of the many that helped those whose homes had been washed away.
Looking back on that disaster of November 1977 I saw that people dealt with their grief in different ways. Some were able to work through the grief more quickly and others took a long time to process the pain and devastation. I also remember my own grief as I walked among the debris left from the flood and visited the funeral homes. As a pastoral care educator what lingers with me now is the question of why there were so few that listened to our stories of grief. I remember one pastor that asked me how I was doing and though I felt numb, I wanted to speak. However, someone caught the attention of the minister and he turned to attend to another need. It was not until a year later that I met Dan Bagby at a missionary orientation and he began to talk about grief and loss in life. He was the first one that listened and heard my grief. He was not afraid to talk about the pain and loneliness of grief. It was OK to question God. This was the beginning of my journey to walk through the losses that I had experienced in my past. Will I ever forget those experiences? No, but the pain has lessened. I was able to finally move on. What does all this mean for us as we learn how to offer care to those in grief. How do we begin to give support?
What Is Grief?
Grief is our response to a loss in our life. Often we are attuned to loss when people die, but there are other significant losses that are painful and create sadness. If that which is lost is of great personal value, the grief will be greater.
Grief can also be cumulative. When you help others that have experienced a loss in life, look at the whole picture of what has happened to them. When an elderly woman moves to a nursing home she may grieve leaving her home and all that is familiar. Those are obvious griefs. Friends may listen to the hurt, for a while, but few go beyond the obvious to learn more about how it impacts other recent losses. Maybe what compounded the pain of the move was losing neighbors that are close friends or the death of other friends or family prior to her move. Maybe it is the fear that she will die alone in the nursing home. It may be the additional loss of not being able to drive and be independent.
Types of Losses
H. Norman Wright (1993) looks at four major categories or types of losses we may experience. They include: persons of significance in our lives, loss of a part of ourselves, loss of external objects, and developmental loss (p. 153).
Persons of significance in our lives: The more important a person is to you the deeper the experience of grief. If you have a relative you are not close to or you do not know well, the grief may not be as deep, even though the person is related (Oates, 1981, p. 16).
Loss of a part of ourselves: These types of losses include physical problems. I remember hobbling in my foot cast down the hall of St. Matthews Baptist Church with Dr. Wayne Oates. He had his foot in a special boot and was using a cane. We were both sharing our struggle of temporarily not being able to drive a car because of problems with our feet. We were both dealing with the loss of our freedom to get around.
I remember the day my mother was told she had diabetes and she had to lose some weight and change her diet. She was in tears. It was a grief for her as well as our family. Her life drastically changed. Our kitchen no longer had the usual cookies and cakes. We all learned to eat more fruits. We were sad that mom could no longer eat all the "good" foods. Yet today we admit that she kept us healthier with the new diet.
We may lose our identity. I live on the mission field and there is often grief and struggle when a missionary returns back to the United States to another kind of job or ministry. It is the loss of identity as a missionary, as well as his or her connection with another culture, especially if the missionary has lived in that culture a long time. Other losses in this category may include those who have lost their innocence (as a result of abuse), loss of a job or loss of a role we fulfill in life.
Loss of external objects: Hurricane Katrina taught us lessons about the grief and pain experienced when there is a loss of property and the loss of things that have been treasured. There is no replacement for the old home place and the family heirlooms. When items that are meaningful are suddenly gone or taken, there is a sense of grief. When items that are important to us are stolen or broken there is a sense of loss.
Developmental loss: As we go through different stages in life there are various kinds of losses such as leaving home for college or retiring from a job. Don't expect every change, however, to bring about feelings of grief. Some changes in life bring excitement and joy. Sometimes excitement and joy are intermingled with grief and loss. One newly retired teacher was glad to be retired so she could then begin a new job that she anticipated enjoying. Others that retire grieve their loss of role and flounder to find new meaning and purpose.
There are parents that say good-bye to their last child with mixed feelings about their "empty nest." Some parents are glad to have the freedom of no children at home and are relieved when a teenager gets out on his or her own. Other parents have a hard time dealing with the empty rooms and the quietness at the dinner table. There is a grief in the changed relationship between the parents and the teenager.
As we have reviewed these categories maybe you recognized losses that you have recently experienced. Perhaps you have supported others that have gone through some of these losses. Is there a particular kind of loss that is most difficult for you to deal with in your own life? Is there a particular kind of loss that is most difficult for you to deal with when helping others?
Symptoms of Grief
What symptoms of grief have you experienced in your own life when you have gone through one of life's losses? Do others you know seem to have the same symptoms or experiences, or are these symptoms uniquely yours?
In his book, Your Particular Grief, Dr. Oates (1981) said "You grieve differently from other people-not so differently that you cannot find fellowship in suffering with them, yet so differently that no one else's grief is exactly like your own" (p. 15).
In Bereavement and Health, Stroebe and Stroebe (1987) compiled a list of symptoms of grief. The first category of symptoms are related to feelings which includes: depression, anxiety, guilt, anger and hostility, loss of enjoyment in doing things, and loneliness (p. 10). The second category of symptoms Stroebe lists is behavioral and includes: agitation, fatigue and crying (p. 10-11). The third category of symptoms is identified as attitudes toward self, the deceased and the environment. This includes: self-reproach, low self-esteem, helplessness, hopelessness, sense of unreality, suspiciousness (doubting the motives of those who offer help or advice), interpersonal problems (ex. withdrawing) and attitudes toward the deceased ("yearning for the deceased," "preoccupation with memory of the deceased," etc.) (p. 11). The fourth category is that of mental/cognitive impairment and includes slowed thinking and poor memory (p. 11). The last category of symptoms of grief is physiological changes and changes in our body. These include: loss of appetite, sleep disturbances, energy loss, bodily complaints such as : headache, nausea, shortness of breath, palpitations, having similar physical symptoms as the deceased had, taking more medications such as alcohol and increased smoking, and susceptibility to illness and disease (p. 11-12).
As you can see, people have a number of responses to loss. No one person has all of these symptoms. Also, some symptoms may come and go or change as the person goes through the grief process. Think back on losses that you have gone through. Which of the above symptoms did you experience? Which symptom was the most difficult to cope with? Did you notice any of these symptoms in others as you supported them?
Stages of Grief
As you work with people who are in grief over the death of someone they have been close to, there are some general stages that most people go through to find healing. Although the names and the number of stages may vary by author, the stages of grief are fairly similar. Though people may not follow the stages exactly, or they may repeat a stage at a later time, the grief may not be as intense the second time. Dr. Oates (1981) used the following stages of grief as a reference point in his own ministry (p. 19):
- Shock, when you first receive news of the death.
- Numbness, as you try to absorb the shock.
- Mixed belief and disbelief, that the news is really true.
- Depression and deep mourning, when you feel like sobbing without control or shame.
- Selective memory, when you get along quite well until a fresh reminder of your loss re-presents the whole issue.
- Commitment, to start "living again" and rebuilding your life.
After hearing about these stages of grief, a young minister came to me and shared his story. His child had died three years earlier and because he was in the pastorate he felt that he had to be strong and not show that he was having a hard time. After all he was a spiritual leader and God must have a reason for what happened. He had tried to get beyond the death of his child, but could not. The young father remarked that he had gone through the first three stages of grief but had then jumped to the final stage and tried to go on and live again. He had not allowed himself to go through the difficult painful process of deep mourning and the sadness so that he could finally move on to "living again." He needed support to do the work of grief and to voice tough questions like"why?" He had gotten stuck in the grief process. Have you ever been stuck in the grief process? What contributed to your inability to move on through the grief process?
After a family member dies, friends and the church community often inquire how the grieving family is dealing with the death of the loved one. This concern may go on for a few months but then the outside support tapers off. The person in grief may begin to wonder why he or she is not "getting over" the death. The grief seems to linger on. What is important to know is that it takes a long time to work through grief. In his book on crisis counseling, Dr. Wright (1993) says, "Everyone varies but the average length of time for grief over the loss of a loved one is approximately two years for a natural death. If it was accidental it is three years, suicide death is four years and homicide is five years" (p. 165). So let those you are helping know that grief takes time.
Remember to ask the families of those that have gone through significant losses how they are doing, not just after the loss, but several months to two, three, or four years after the loss. It can also be helpful to mark your calendar a year from the date a person died so you can remember to check with the family on the anniversary of that important date. The family will be grateful you remembered.
Crisis of Faith
In times of crisis one's faith is challenged. A sudden loss brings about many questions as well as emotions. One of the emotions may be anger with God. Earl Grollman (1995) said:
You may rage at God because of this lingering, crippling anguish. Honest anger could be your form of prayer. You cannot be angry at nothing.....To be furious at God could indicate that there may have been a God-Force in your life that was real and meaningful. Your wrath may be evidence that God was once present in your life and may be again. (p. 185)
It is ok to ask "Why me?" or to ask "Why didn't God prevent this?" Grollman says that "Blaming God is a natural and normal response that helps to vent incensed pent-up emotions" (p. 186).
Dianne Ruby talked about her spiritual journey as she tried to find meaning with her husband's death in the U.S. Army.
Regardless of one's religious orientation, anger toward God is also a very common reaction. In a world that no longer seems just and fair, God is usually ultimately blamed for the injustice; for not intervening and preventing the tragedy, or for seeming not to care. We pray and beg and bargain, but heaven seems not to answer. A crisis of faith, and a reevaluation of beliefs often ensues: If God is good, why did this happen? Although trauma can push some people to the extreme of rejecting their faith, many embrace it even more strongly. Faith not only offers a source of comfort in present sufferings and hope for the future; it also helps survivors as they search for meaning and try to establish some reasoning, and provides a constant in a world that has completely and irrevocably changed. (Dianne Ruby in Living With Grief After Sudden Loss, edited by Doka, p. 82)
When a person in grief asks why something happened, he or she does not want a pat answer, there are no easy answers. They want you to listen and be with them in the depth of their questions.
Another emotion that sometimes arises while supporting someone who has experienced failure or loss, is that of *guilt*. People carry the burden of guilt in a divorce or the fact that they didn't die in an accident, but their roommate did. Norman Wright says:
People experiencing guilt have several choices available to alleviate the guilt: They can rationalize their way out of the guilt; they can project blame onto others; they can attempt to pay penance and work off the guilt; or they can apply the forgiveness available when there has been genuine sin and violation of God's principles. God can and does remove true guilt. But there will be other feelings of guilt that have no basis. People who live by their emotions most of the time will be more guilt-prone than others. Those who have negative patterns of thinking or self-talk will exhibit guilt more than others. Of course, people do not need to seek God's forgiveness for false guilt. What they need is help to change their perspective or their self-talk. But this will take time.... (Wright, "Crisis Intervention and Emergency Practice, Issues and Interventions," in Competent Christian Counseling, p. 604)
Part of your journey as a caregiver may be to help people in pain deal with their anger and/or guilt. If they can work through these feelings it will help them move through the stages of grief in a healthy way.
God's Care and Concern for those in Grief
Grief is a universal experience. How we deal with grief may vary depending on our culture, our faith background, our family, our personality, etc. but we all deal with loss and with death. Jesus was no exception. When he heard his friend Lazarus had died he went to the place where he was buried.
"When Jesus saw her (Mary) weeping, and the Jews who had come along with her also weeping, he was deeply moved in spirit and troubled. Where have you laid him (Lazarus)!" he asked. "Come and see Lord," they replied. Jesus wept. Then the Jews said, "See how he loved him!" (John 11:33-36 NIV).
Jesus knew what it was to see his friends grieving. He understood the grief and felt free to show his emotions. This allowed the Jews to see that he too had great love for Lazarus and the family and that Jesus
understood the pain.
Several verses in the Bible talk about tears and grief. It is healthy to allow people time to weep. If you are not comfortable with tears, this is a good time to listen to your own spirit. What is it that prevents you from being able to be a non-anxious and supportive presence when someone is crying? The book of Ecclesiastes reminds us that there is "a time to weep and a time to laugh, a time to mourn and a time to dance" (Ecclesiastes 3:4 NIV).
Sometimes in the middle of crisis and loss people wonder if God is really listening. They may have doubts because others feel like they are not hearing a response from God. When the Israelites were in slavery in Egypt they went through great pain but the Bible says that God heard them and was concerned, "God heard their groaning and he remembered his covenant with Abraham, with Isaac and with Jacob. So God looked on the Israelites and was concerned about them." (Exodus 2:24-25 NIV)
Psalms has several verses about God's care for and His presence with those who are brokenhearted. "The Lord is close to the brokenhearted and saves those who are crushed in spirit." (Psalms 34:18 NIV) or "He heals the brokenhearted and binds up their wounds. Great is our Lord and mighty in power; his understanding has no limits." (Psalms 147:3,5 NIV)
Another quality we see in God is compassion. This is a great comfort to know God offers compassion when we are in the middle of pain, for instance, "The Lord is gracious and righteous; our God is full of compassion." (Psalms 116:5 NIV)
As we look at the life of Jesus we can see that he was comfortable expressing his feelings of grief. We also see that in the middle of grief and pain God hears us; he cares for and is close to those who are brokenhearted and God has compassion. These are all qualities that are important for us to develop as we minister to those in crisis.
Ways to Express Care and Concern in the Crisis of Loss
I worked as an Emergency Room chaplain during a Clinical Pastoral Education course. I carried a beeper and was on call. I never got used to the beeper going off in the middle of the night and my being awakened to an emergency. Most of the time I was asked to come in to support a family whose relative or family member had just died. The following are some insights I have gained as well as some insights shared by various authors who have worked with people in grief or who have experienced their own crisis:
PRIVACY: As soon as a crisis or death occurs, if possible find a room, corner or a private place where those in grief can be together.
SHOCK AND NUMBNESS: When a person is first told about the death of another they are often in shock and have a hard time processing all the information they are told. You may have to repeat the information to the person at a later time. The grieving person may not be able to make important decisions and may need some help (Wright, “Crisis Intervention and Emergency Practice” in Competent Christian Counseling eds. Clinton and Ohlschlager, p. 603-604).
DENIAL: Occasionally a person has a difficult time believing someone is dead. It may be helpful for this person to see the body of the one who has died so they have time to say good-bye. Most of the time families want to see the body of their loved one at the hospital if the person died there.
LISTEN: When others are dealing with grief the greatest gift you can give is to listen. Let them tell the story of what happened. “Survivors need people who are not afraid of their intense outpourings of emotions and who can provide a shoulder to cry on, whether a week after the loss, or two years later” (Dianne Ruby, “Complicated Grief in the Military,” In Living With Grief After Sudden Loss ed. Doka, p. 83).
SUPPORT RITUALS AND CUSTOMS: If possible, support the customs and rituals of the family who is dealing with the death of a loved one. Be sensitive to different cultures. For example, in the Philippines, the family of the deceased prepares food for those who come to the wake. This goes on day and night for a few days. In the United States visitors often bring food to the home of the family of the person who has died. In South Korea the family has the wake at the place where the person died and they serve food to the visitors.
FAITH CRISIS: Be open to the faith struggles that members of the family may have as they sort through their feelings and ask questions. Be careful not to give pat answers. In time the faith of these family members may grow as they go through the crisis, but in the beginning stages of grief there may be some struggle (Wright, “Crisis Intervention and Emergency Practice” in Competent Christian Counseling eds. Clinton and Ohlschlager, pp. 607).
COMMUNITY OF FAITH: Encourage the community of faith to reach out to the family in grief and be available to journey with them and provide support through the pain.
PRAYER AND SCRIPTURE READING: Be sensitive to the needs of the family. If they are angry with God for what happened this may not be a good time to pray or read scripture. Always ask if they would like you to pray or read a scripture and if so, keep it brief. If appropriate, you may ask the family if they have a specific prayer request. This sometimes gives you insight into what is happening with the family. “Your prayer could reflect the turmoil of the individual’s struggle as well as be a petition for God’s comfort and guidance” (Wright, “Crisis Intervention and Emergency Practice” in Competent Christian Counseling eds. Clinton and Ohlschlager, p. 607).
I hope that these suggestions will give you insight into how to be present with and to support others when they experience a great loss.
Children's Concept of Death and Loss
In the above section I talked about some ways we as laypersons and ministers can help those in grief. The following resource looks at some specific helps that can be useful when talking with children dealing with the death of a loved one. First, it is important to let a child know if someone that he or she loves has died.
Sharing the reality of what is happening allows the child to begin to understand and cope with the experience. Frequently, children are kept ignorant about crisis because of the belief that they should be protected from the suffering that comes with knowledge about a traumatic event. …it is questionable whether such a strategy really eases rather than increases the child’s anxiety, confusion, and pain. (DeSpelder and Strickland, 1983, p. 221)
Dignity Funeral Services puts out a video entitled "Picking up the Pieces," which is about children and how to help them deal with the death of one they have loved. These are some of the suggestions taken from the video produced by the Dignity Funeral Network:
- Let children teach you about their experience with grief. Have the children tell you how they feel rather than you tell them how they need to feel.
- "Don’t assume that children of the same age" have the same experience with grief. For instance, some children are quiet and others may be more verbal in their expression of grief.
- "Don’t lie to children about death." Children are very aware of what is happening around them. If you don’t tell them what is happening they may imagine something far worse than what is actually happening.
- If someone is dying or has died, don’t wait to tell the child everything at one time. Help the child through the journey of life to learn about loss and death.
- Allow children to ask questions about death. The child may repeat a question several times, and that is ok.
- Let children know you really care about them and that you want to listen to their feelings. Look at them and be available to them.
- Understand when children don’t always act sad. Sometimes they need space. They may not be able to handle all the pain at one time.
- Allow children to participate in the funeral if they want to. Let them know what they will see and what will happen.
- Understand that grieving takes a long time.
Most importantly, let children teach you about their experience with grief. Have the children tell you how they feel rather than you tell them how they need to feel. (Taken from: Dignity Funeral Network, Inc. 2003 “Picking Up the Pieces” Video Dignity Memorial.com)
When to Refer
Most of the time people can work through the grief process and begin to “relive” again. They are able to find renewed meaning in life. However, there are some people in mourning that have difficulty and their grief becomes complicated. It is important to know when to refer a person to a trained counselor for help and a complicated grief is one of those times. Gary Collins (1988) lists several signs of complicated grief (p. 352-353):
- Unwillingness to talk about the deceased, accompanied by intense sadness whenever the dead person’s name is mentioned
- A tendency to speak of the deceased person in the present tense (for example “He doesn’t like what I am doing”)
- Open or subtle threats of self-destruction
- Persistent and deep depression, often accompanied by guilt and low self-esteem
- Antisocial behavior
- Excessive hostility, moodiness, or guilt
- Excessive drinking or drug abuse
- Withdrawal and refusal to interact with others
- Refusal to change the deceased person’s room or to dispose of his or her clothing and other possessions
- Resistance to offers of counseling or other help
- Stoic refusal to show emotion or to appear affected by the loss (this usually indicates denial and avoidance of grief)
- A happy, almost euphoric attitude (sometimes explained as “rejoicing in the Lord”)
- Intense busyness and unusual productivity
Learning when to refer someone to a professional is one of the most important skills a lay caregiver can have. It requires knowing and accepting one's limits and it says that you as the lay caregiver take a person's suffering seriously enough to want them to experience healing.
Hopefully this presentation has given you some of the basics of how to help people who have experienced various losses in life. I hope these tools will be helpful as God uses you to offer support and care to many who are dealing with loss in life. May God give you courage, wisdom, compassion and a listening ear as a nonanxious presence for so many that are dealing with the pain of grief. In the midst of the journey with others, God can use you to help change their lives and move them toward wholeness.
Barker, Kenneth ed. The NIV Study Bible. Grand Rapids, MI: Zondervan Publishing House, 1995.
Collins, Gary R. Christian Counseling, A Comprehensive Guide revised ed., Dallas, TX: Word Publishing, 1988.
DeSpelder, Lynne Ann and Albert Lee Strickland. The Last Dance, Encountering Death and Dying. Palo Alto, CA: Mayfield Publishing Company, 1983.
Doka, Kenneth J. ed. Living With Grief After Sudden Loss, Suicide, Homicide, Accident, Heart Attack, Stroke. Washington D.C.: Hospice Foundation of America, 1996. (Bonnie Carroll, Lisa Hudson and Dianne Ruby, “Complicated Grief in the Military,”Chapter 6) (Earl A. Grollman “Spiritual Support After Sudden Loss” Chapter 14)
Elison, Jennifer and Chris McGonigle. Liberating Losses, When Death Brings Relief. Cambridge, MA: Perseus Publishing, 2003.
Grollman, Earl A. ed. Bereaved Children and Teens, A Support Guide for Parents and Professionals. Boston, MA: Beacon Press, 1995.
Kroen, William C. Helping Children Cope with the Loss of a Loved One, Guide for Grownups. Minneapolis, MN: Free Spirit Publishing, 1996.
Kubler-Ross, Elizabeth. Death, the Final Stage of Growth. Englewood Cliffs, NJ: Prentice Hall, 1975.
Kubler-Ross, Elizabeth. On Death and Dying. New York, NY: Macmillan Company, 1969.
Oates, Wayne E. Your Particular Grief. Philadelphia, PA: Westminster Press, 1981.
Stroebe, Wolfgang and Margaret S. Stroebe. Bereavement and Health, The Psychological and Physical Consequences of Partner Loss. New York, NY: Cambridge University Press, 1987.
Wright, H. Norman. Crisis Counseling, What to Do and Say During the First 72 Hours. Ventura, CA: Regal Books, 1993
Wright, H. Norman. Crisis Intervention and Emergency Practice, Issues and Interventions, in Competent Christian Counseling, Foundations and Practice of Compassionate Soul Care vol. I, Clinton, Timothy and George Ohlschlager eds. Colorado Springs, CO: Waterbrook Press, 2002.
Picking Up the Pieces, Dignity Funeral Network, Inc. 2003 (Dignity Memorial.com).
Dr. Anne Windus is an Adjunct Professor of Pastoral Care and Counseling with the Philippines Baptist Theological Seminary extension program and Southern Baptist School of Theology in Manila, Philippines. She uses her background in nursing and her graduate background in pastoral counseling to train Filipino laity and ministers in how to offer pastoral care and counseling. One of her units of Clinical Pastoral Education was as an emergency room chaplain. She has also taught crisis counseling. She has worked as a missionary with the International Mission Board of the SBC in Mexico, South Korea and currently is on furlough from her ministry in the Philippines.