Grief Counseling Techniques and Interventions in Social Work

Life, unavoidably, involves loss. The death of a loved one. The decline of one’s health. Being laid off from work. Loss leaves indelible marks on each of us.

Most people experience grief at some point in their lives. Mental health experts note that the losses of human life, jobs, homes and connections resulting from the COVID-19 pandemic have left many people with grief. Addressing this emotion can be a complex process that varies from person to person, but social work practitioners can employ a range of grief counseling techniques and interventions to help people navigate it.

Grief and Grieving

The shock and pain of loss can involve waves of feelings and sensations that seem outside of our control. Beyond sadness, grief may manifest in many ways.

Common Signs of Grief

Most theories and models of grieving agree on its common symptoms and manifestations:

• Shock, disbelief and denial that the loss has occurred or will occur
• Sadness, despair and loneliness
• Anger and resentment
• Regret, guilt and shame
• Anxiety, helplessness, insecurity and fear
• Depression, numbness and feelings of emptiness

Grief may also manifest physically as:

• Fatigue
• Nausea or loss of appetite
• Pains and aches
• Heart palpitations
• Headaches
• Insomnia
• Difficulty concentrating
• Frequent episodes of crying
• Feeling faint or lightheaded
• Significant weight loss or gain

Mental health experts emphasize that experiencing some or many of these symptoms while grieving is healthy. If someone experiences them intensely, or for a long period of time, grief counseling techniques or grief therapy may be helpful.

The Nonlinearity of Grief

According to the popular Five Stages of Grief theorized by Elisabeth Kübler-Ross, grief manifests in a plurality of ways, in the following stages:

• Denial: Disbelieving or ignoring the loss
• Anger: Expressing aggression or a sense of injustice or unfairness at the situation, which can be expressed against others or self-directed
• Bargaining: Making wishes, promises or prayers about what a person will do to avoid suffering the loss
• Depression: Experiencing a lack of interest in previous activities, as well as numbness, lethargy and difficulty concentrating and participating in activities
• Acceptance: Coming to terms with the loss and moving forward with living

Kübler-Ross later theorized that a person may go through only some of these stages, and they may experience them in any order.

“People experience, and express, grief and loss in many different ways,” says Virginia Commonwealth University instructor Carrie A. Hartwell, Ph.D., LCSW. “Often, it’s a combination of these, and the process of healing from grief isn’t linear. People tend to cycle forward and backward through ‘stages’ of grief.”

The Commonality of Grief

Social workers know that loss happens to almost everyone. Grief often accompanies major life changes, such as:

• Death
• Divorce
• Declines in health or capabilities
• Estrangement from family or friends
• Separation from loved ones as a result of immigration
• Lengthy military deployments
• Financial losses
• Job loss
• Loss of possessions due to natural catastrophes or political upheaval

As a person ages, they are likely to have more losses to grieve. Some losses have a direct, significant impact on daily life, requiring ongoing adjustment and adaptation.

The Individuality of Grief

Although almost everyone experiences grief at some point in their life, each person grieves in their own way, in their own time. As writer Joan Didion reflects, “Grief turns out to be a place none of us know until we reach it.”

For some people, grief may last six months or a year — or longer. For some, grieving is a lifelong process. The particularity of grief is important to highlight; the experience is different for everyone, and there are many healthy ways to grieve.

Grief Amid a Pandemic

Many people are experiencing grief as a result of the pandemic.

As Dr. Hartwell notes, “The pandemic has resulted in multiple, sustained losses for many of us — through unprecedented deaths and illness in our families and communities, as well as through disruption and disconnection from aspects of our lives that brought us joy and purpose.”

Self-care and self-soothing techniques may be challenging to adopt during a time of isolation and disorder.

“It’s vitally important for us to recognize that as our lives have changed, so, too, have our needs and our capacities, and therefore we all need to give ourselves (and others) the space and grace to not be as ‘productive’ as we are when we aren’t living through a crisis.”

Grief Counseling Techniques

Grief does not just “dissipate” on its own. Resolving grief is an active process — purposeful activities by which the grieving person expresses and processes their grief.

Grieving as a Verb

Two siblings may respond in divergent ways to a pandemic-related loss. One sibling may avoid talking about the loss and instead dive into a new hobby and move forward with seemingly little interest in talking about their loss for many months. The other sibling may feel overwhelmed by the loss and need to reminisce with friends and family about what life was like before the pandemic.

According to the Dual Process Model of Grief, both modes (“restoration-oriented” activities and “loss-oriented” activities”) are healthy. People often move back and forth between them during the grieving process.

Restoration-Oriented Activities

Suffering a loss often means losing a sense of normalcy. Restoration-oriented activities seek to renew routine and order in a person’s life.

Restoration-orientation activities enable a person to create new habits and senses of meaning. During the pandemic, a person may have picked up a new hobby while in quarantine, for example.

Even distracting oneself from the loss by watching movies or diving into a project can be a healthy and necessary restorative activity that helps a person cope with grief.

Loss-Oriented Activities

While restoration-oriented activities foster a sense of “moving forward” with life after grief, loss-oriented activities center the absence — the person or thing we are missing.

Common loss-oriented ways of grieving include:

• Processing the loss with other people
• Reminiscing about the loss
• Considering mortality
• Reflecting on the meaning of the loss
• Making art in response to grief
• Creating or participating in rituals

Riding the Waves of Grief

The main insight of the Dual Process Model of Grief is that grief does not follow a linear process; sometimes a person needs to do things to affirm their ability to create a “new normal” after a loss. Other times, a person needs to sit with their grief, to feel it, to respond to it with others or through other meaningful activities.

Social workers with training in grief counseling techniques can help clients navigate the confusing grief process.

Many potential benefits await people who seek grief counseling. Those with chronic grief that interferes with daily functioning may find relief through one or more counseling techniques, including talk therapy, companioning and rituals.

Talk Therapy

Many people in the throes of grief need to talk with another person. Speaking with a social worker, counselor or therapist can offer healing and consolation to the person grieving.

In talk therapy, clients can explore the nuances of their grieving process. Clients can discuss contradictory feelings (“I wish I could have done more” and “I did all I could”), share memories and reminisce, and learn skills to cope with and honor the loss even while moving forward in life.

While many social workers, therapists and counselors adapted their grief counseling techniques to phone or virtual meetings during the pandemic, talk therapy still helps grieving people cope.

Companioning

Social workers, counselors and therapists can act as companions for grieving clients. Companioning involves actively, supportively listening to a client’s concerns and validating the grieving person’s emotional reactions as natural.

Companioning also involves helping grieving clients organize and prioritize day-to-day tasks and establish new routines.

During the pandemic, in-person companioning may not be safe or possible, yet social workers and clinicians have adapted companioning models for video chat and teleconferencing.

Rituals

A common response to loss is a feeling that the world is out of our control. Rituals can be crucial for facilitating the grief process and for recovering and establishing a renewed life after loss.

When people think of grief rituals, they may think of public displays, such as funerals and vigils. As Emily Esfahani Smith of The Atlantic writes, “Though the substance of these rituals may vary — Catholic Latinos view crying as a sign of respect at funerals while Tibetan Buddhists see it as a disruption — public mourning rituals occur across nearly all cultures.”

Participating in public rituals can combat feelings of isolation, but guidelines in place to slow the spread of COVID-19 limited public rituals, making it especially difficult for people with unprocessed grief to cope. Social distancing and quarantine measures have made people lonelier and more anxious.

Grief rituals need not be public, however. Rituals can be small, everyday activities, such as lighting a candle, singing or playing music, traveling to a meaningful location, writing a letter, or visiting a grave or other site associated with the loved one and leaving flowers or a symbolic item as a tribute. These private, personal actions can help a grieving person in their dark moments.

Rituals can help those going through grief a sense of order and purpose, which can combat feelings of being “helpless” or “powerless.” They can be used to soothe oneself or give oneself space and time to feel and remember who or what they have lost.

Social Work Interventions to Support Those in Grief

Sadness, sorrow, loss and questioning the meaning of one’s life are common experiences that nearly everyone must face, but the pandemic has complicated them. Social workers with skills in grief counseling techniques and interventions can support people from all walks of life through their grief.

Learn more about how VCU’s online Master of Social Work program prepares social workers to support individuals through the grieving process.