Editor’s Note: In part one of this series, which appeared in March 2008, the author discussed grief care and an appropriate pastoral response to those who grieve. In this concluding article, he further elaborates upon that response.
One of the most rewarding parts of grief counseling comes when people choose to evaluate their personal qualities and lay new plans to utilize those qualities. When they show interest in looking ahead, they have covered many miles toward adjustment.
There are times when a grieving parishioner becomes stuck somewhere in the processes of adjustment. Pastors needs to determine whether they can help such a parishioner restart the processes or whether referral to a professional seems advisable.
While in chaplaincy training, a doctor invited me to review patient charts with him. After discussing various methods of diagnosis, he said, “The tests and lab results are indispensable in making a diagnosis, but the most essential tools are the doctor’s ears. Listening gives important clues that enable us to ask the right questions.”
From doctors I have learned three important lessons in assisting grievers: listen, observe, and ask the right questions. A fourth lesson I learned from mental health professionals: when a situation goes beyond your expertise, don’t hesitate to refer. All four lessons are essential for the pastor’s ministry to the grieving.
Listening and observing
The nature of grief can be affected by many personal events and circumstances.
• Multiple, recent losses
• Unwanted divorce
• History of mental illness
• Troubled relationship with the lost person
• Insufficient support system
• Strong dependence on the lost person
• Emotional illiteracy—difficulty in expressing feelings
• Loss considered preventable
• Loss following lengthy illness
• Sudden, unexpected loss
• Breakdown of nuclear family
• Traumatic, violent, mutilating manner of death
• Death of a child—past or recent
• Family legacy of stoicism
• Perceived blame for the loss
Some of these pointers can be red flags indicating that a grieving person may have difficulty adjusting to a recent loss. Meeting regularly with such a person is important. I need to know that movement through the processes of grief continues to happen, no matter how slowly. Regular support sessions prevent persons from allowing grief to take control of their lives.
Feeling out of control and being at the mercy of grief can lead to despair. Allowing grief to take its course without some intentionality causes a person to feel that grief will never end.
Having observed this fear and resignation, I have developed an intentional approach to grieving that has proved helpful for many. This take-charge approach has been instrumental in preventing complicated mourning. The grieving person can be encouraged to adapt the following steps to meet individual differences:
1. Be intentional. Choose a time each day to be alone in a definite place.
2. Take reminders of the relationship to that place and provide a journal. If writing isn’t your strong suit, be sure you choose a private place so that you can talk aloud.
3. Review only one piece of the relationship at each session. Write or talk aloud about what that piece means. Write or talk about how you feel about not experiencing it again.
4. Write or speak a short farewell to what used to be but can’t be now. Repeat the farewell until the strong emotions subside.
5. At each session repeat the farewell you made the day before, then proceed to another piece of the relationship.
6. Continue this process until you sense that the physical relationship will become a relationship of memory.
7. Remember you are not saying farewell to the person or your memories. You are saying farewell to what used to be but can no longer be. This will gradually uncover the memories you tried to avoid. You will cherish the memories.
A man once told the story about a fisherman who lost his wife. His daughter expressed her fear that her father was not grieving well because he didn’t talk and cry. When he was asked about his adjustment, the fisherman said, “Don’t worry about me. I get in my fishing boat, and when I am almost beyond the sight of land, I talk to myself, cry, and yell.” He was being intentional in his own way.
The key is to find that way. Many women find journaling useful, but most men use some other approach to intentional grieving. Everyone grieves differently; therefore, there are many ways of practicing intentional grieving. The bottom line is that people should do something about grief instead of being surprised by every wave of sorrow.
Because retrieving every bit of relationship memory can’t be achieved in a short time, there will be times when something triggers an unvisited part of the relationship. Therese Rando calls these subsequent, temporary, upsurges of grief (STUG).1 It doesn’t mean adjustment hasn’t taken place, but simply means that a tag along piece of the relationship needs to be processed intentionally. Grieving persons need to be told this ahead of time so that they are not taken by surprise.
Two years after Ron’s wife died he accepted an invitation to attend an event at an organization of former military personnel. A friendly woman started talking with him. And then a thought came to him. He met his wife 30 years ago in that same facility. Tears came fl owing down his face. The woman asked him what was wrong. After he told her the reason for his tears she said, “Don’t worry, Ron. Just keep crying.” Ron had adjusted to his wife’s death, but meeting another woman at the same facility triggered a piece of the relationship he had not processed.
While listening to a grieving mother I noticed increased tears when she mentioned her daughter’s drug-related death. I suspected that she felt responsible, so I asked her, “Do you feel your lifestyle played a part in her death?” Her reply told both of us that we had discovered the key issue in her grief.
A woman was grieving the death of her son who was killed in an automobile accident. Her husband was driving when the car slid out of control on an icy road. After listening for 20 minutes, I asked, “Who do you blame for the accident?” She immediately named her husband and said that he always drove too fast. The accident happened six months earlier and she had not shared her anger with her husband. She told me her marriage was sliding out of control. All this information came to light by asking one question.
I often ask, “How is your life different now since your loss?” This always brings out the secondary losses that must be processed along with the primary loss. Failure to identify and grieve for secondary losses can be identified as a major cause of complicated mourning. Asking the right questions comes as an outgrowth of listening and observing— not a process of interrogation.
Some pastors prefer to make a referral when they ascertain that the grief has turned complicated, but making this determination is difficult. Therese Rando remarks, “The demarcation between uncomplicated and complicated mourning is hazy at best and constantly changing. Such change is due not only to advancements in data collection in this area but also to the fact that no determination of abnormality can be made without taking into consideration the various sets of factors known to influence any response to loss. Reactions to loss can only be interpreted within the context of those factors that circumscribe the particular loss for the particular mourner in the particular circumstances in which the loss took place.”2
Looking at grief reactions alone does not reliably determine complicated mourning. The pastor needs to look at mourning as a process of movement from disequilibrium to the restoration of balance and life with purpose. If delay, distortion, or denial halts the movement in this process, complicated mourning could be occurring.
When I suspect that a person is stuck at some point in this process, I discuss it with them. Persons in grief usually sense when they are stuck. Together the pastor and the grieving person can pinpoint the roadblock, and then determine if a referral has become necessary.
Pastors need to tell the grieving person why a referral would be beneficial. Full agreement must precede any referral effort. Pastors should assure the individual that they will continue to provide spiritual support. The grieving person must never feel deserted.
When I make a referral, I tell the grieving person, “Sometimes there isn’t a good person–counselor fit. If, in your first visit, you sense that this referral is not a good fit, I want you to let me know. We can arrange for a different counselor.” To say so is not unethical. Physicians make this request of their patients when making a referral.
Making a good referral requires a referral base that can be built by asking reliable people for recommendations. Among these can be funeral directors, social workers, nurses, hospice directors, and pastoral colleagues.
Make personal contact with the counselors on your list. A good counselor should be happy to answer your questions. Here are some questions you may wish to ask.
• What kinds of clients do you prefer?
• Are you trained to do grief counseling? Complicated grief?
• What is your approach to counseling?
• What length of time do you usually spend with clients?
• What are your credentials?
• What are your fees?
• Describe your views on the relationship between religion and mental health.
• Would you be the only person seeing a referral?
• Are you comfortable with a pastor providing spiritual care during the time you are involved with a client?
With the approval of the grieving person, arrange for an appointment while they are present. Tell the counselor the reason for the referral being made. Ask the counselor to contact you when the person meets the appointment. If the grieving person wants you to accompany them to the first session, do so after notifying the counselor that you will be present.
Early grief support by pastor and congregation facilitates the movement through the processes of grief. This makes the need for referral less likely. Regularly scheduled bereavement support groups held at the church also facilitate smooth movement toward adjustment. Some churches hire a licensed counselor to conduct these support groups.
The work of comforting those who grieve has been the most rewarding part of my ministry. I pray that this will be your experience.
This article is part two of a two-part series:
1 Therese A. Rando, Treatment of Complicated Mourning (Champaign, IL: Research Press, 1993).
2 Ibid., 12.