Abstract

The experience of loss and its consequent grief are integral and unavoidable aspects of life. Loss is also implicit in nearly all adverse life experiences; however, it is not often specifically recognised within psychological formulations except in situations of bereavement. This universal nature of the suffering of grief means that loss can provide a key integrating concept of care for adverse life events. As such, an understanding of loss and grief is essential knowledge for every counsellor. This chapter is an overview of loss and grief theory and research and discusses the process of grieving and when grieving becomes problematic. It will show how this knowledge can guide an integrative approach to care.

Introduction

In counselling and other mental health disciplines, loss and grief have often failed to be a focus of care compared to the search for empirically supported interventions for more ‘serious’ diagnosed disorders. Loss has largely only been considered when dealing with death and bereavement. As with many other conditions we have sought the most appropriate means of ‘fixing’ grief. But grief has not been a ‘condition’ that fitted the mould of clear definable symptoms, single definitive theories and targeted session specific interventions.

So why would we argue that grief and loss is fundamental to our work in counselling? There are many reasons why knowledge of loss and grief is vital for counsellors.

• Grief is universal and inevitable irrespective of age, culture, socio-economic status (SES), gender, or context; independent of all ways of categorising people. As such loss and grief offer a shared language and a shared experience among us all, including counsellor and client. Loss and grief are not confined to situations of death and includes whenever someone is separated from something of importance to him or her.
• Grief is commonly comorbid with, or integral to understanding other disorders.
• Grief and loss as a universal experience offers a key integrating concept that can underpin prevention and early intervention when dealing with adverse life events.

Besides these above reasons for knowing about loss and grief, there is ample evidence that failure to deal with issues of loss and grief can lead to long term problems of diagnosable disorders. These include Prolonged Grief Disorder as defined in the ICD11 (WHO, 2019; Killikelly & Maercker, 2018). This diagnosis is also proposed for the DSM-V-TR version (Prigerson et al., 2021) but is currently termed Persistent Complex Bereavement-Related Disorder within the current DSM-V section on Conditions for Further Study (APA, 2013). Other disorders such as mood disorders (Hensley, 2006) and Post Traumatic Stress Disorder ([PTSD] Horowitz, 2011) have been associated with grieving. In particular there has existed a blurring between the symptoms of depression and the sadness of grief leading to misdiagnosis of grieving as a disorder or confusion as to a differentiation of the conditions (Zisook & Kendler, 2007).

Topic Description

Before we go any further, let us gain some consensus around some of the concepts we will use in this chapter.

Change: Besides death and taxes, change is about the only other thing that can be guaranteed in this life. Sometimes change alters our world in ways that we do not wish to occur. We ache to return to the world as it used to be. Such a change involves loss.

Loss: Loss is not a particular event but a lived experience, a sense of ‘being kicked in the guts’, a desire to want the hands of time to turn back to a time where our world hadn’t come crashing down around us. Miller and Omarzu (1998) offer a useful definition of this experience as: “Loss is produced by an event which is perceived to be negative by the individuals involved and results in long term changes to one’s social situations, relationships or cognitions” (p. 12). This definition recognises that loss is a) experienced, b) perceived and defined by the person experiencing it, c) involves many adverse life events; and d) has far reaching effects.

Grief: Put most simply, grief is the reaction to loss; whatever that reaction happens to be. The reported symptoms of grief can be manifest across all domains of the biopsychosocial-spiritual model (Engel, 1977; Sulmasy, 2002). Biological effects may include crying, headaches, tremors, appetite changes, sexual problems and a compromised immune system. Psychologically, people may report anxiety, sadness, anger, confusion, concentration difficulties, suicide ideation, among other symptoms, while socially, those in grief can report loneliness, estrangement from others, role confusion, and social network changes. When we speak of spiritual and existential effects, these often move beyond religious crises of faith to more general effects such as loss of purpose and meaning, and questions about life and death. The symptoms across all the domains also interact leading to an even greater sense of confusion and feeling overwhelmed. Grief affects the whole person and may manifest itself very differently in people even if they are facing the same type of loss or situation of loss.

Mourning/Grieving: Grief is the manifestation of an internal process as people try to deal with varying levels of disarray and struggle to find some stability in this altered world. This internal process is what we call grieving. Mourning then is this process in situations of bereavement. Consistent with the theorists such as Raphael (1984) and Rando (1993), I prefer to use the terms grieving and mourning to reflect this internal process of adjusting to loss. Some prefer to define mourning in terms of the public expressions of grief, including culturally relevant rituals (Stroebe et al., 2001).

Grieving is a natural healing process experienced in all cultures and societal groups. It is a process that has been part of the human experience ever since people became attached to things or people of importance in their lives and lost those things. It is reflected in the art, music, stories and rituals of all peoples around the world. In considering grieving from a medical model viewpoint that sees grief as a condition to be treated, it may be more useful to see grieving as being a natural healing process rather than a disease in need of treatment.

Complicated Grief/Prolonged Grief (ICD11; DSM-V-TR)

For most people, the process of grieving proceeds to the point where people are able to re-establish themselves in their lives; although in many ways, changed. For a significant minority of grieving people, this natural process of healing does not proceed toward restoration but rather leads to some form of perceived deterioration. Common patterns of symptoms are associated with problems in grieving a death. Few areas of adversity besides death have been defined in terms of grieving a loss and hence attempts to categorise problematic patterns in adjustment have been confined to the area of bereavement. In the area of bereavement, these patterns of symptoms have been defined by terms such as Complicated Grief, Prolonged Grief Disorder or Persistent Complex Bereavement-Related Disorder.

While intense distress after a death is normal and anticipated, symptoms that persist at least six months after the death become concerning. The patterns of symptoms indicating problems in grieving a bereavement include:

• a searching or yearning for the deceased that preoccupies the person to a disabling degree
• severe distress when reminded of the deceased or circumstances of the death
• avoidance of reminders
• a loss of the sense of self and role in life
• ongoing impaired functioning in life domains
• patterns of distress that are outside what is expected from usual cultural, social or religious norms.

(Killikelly & Maercker, 2018; Shear, 2015).

The prevalence of such problems in grieving following a death is difficult to determine. Unlike other mental disorders where only those diagnosed with the condition meet the full diagnostic criteria for the range of symptoms, all those grieving a death display intense symptoms in the early days following the bereavement. Hence determining when normal grieving becomes problem grieving can be difficult to ascertain clearly. Shear (2015) and Aoun et al. (2015) estimate between 2-3% and 6-7% display these patterns of symptoms, and this appears consistent across a number of different national studies (Fujisawa et al., 2010; Kersting et al. 2011; Williams et al., 2017).

Problems associated with non-death losses have been less likely studied in terms of grief responses. In such cases grieving people may be diagnosed with other disorders such as depression, anxiety, adjustment disorder, PTSD or substance use disorder (Kendler et al., 2008). Problems associated with grieving losses may be underestimated, with their impact spread across many disorders.

Risks for Problems in Grieving

If we accept that some people will struggle to heal through grieving, being able to ascertain who may be at risk for problems in grieving is valuable to counsellors. Many explanations for problems in grieving will be offered through the theories of grieving that we shall discuss later in this chapter. Some studies though have determined various risk factors through statistical means in exploring outcomes among grieving people.

Many studies have considered risks associated with problem grieving. We see risk associated with three broad categories: the person of the griever him or herself, circumstances surrounding the loss; and the context of the loss. In reviewing empirical studies of complicated grief, Lobb et al. (2010) found risks within the person included previous loss, previous mental health, attachment style as well as cognitive appraisals and high distress at the time of the death. Factors associated with the loss itself included death involving violence and other trauma, the quality of the caregiving or dying experience, close kinship relationship to the deceased, marital closeness and dependency, and lack of preparation for the death. In terms of the context of the loss, perceived social support played a key role.

It is difficult to easily separate these risk factors as their interactions may be more important than their singular effects. The risk factors may also influence grieving in discrepant ways in different populations. For example, there is risk of being a young widow; yet there is also noted risk in losing a lifelong partner in older people. Hence rather than simply assuming risk based on noted characteristics, we need to hear the story of the client in depth for possible risks, and the priority of those risks or their interaction in terms of disruption to the normal process of healing through grieving.

Understanding how risks work against healing occurring through grieving is through recognition of the loss and grief theories that suggest how the grieving process progresses and how it may be compromised for some people. So let us consider very briefly the major theories concerning this process of grieving.

Major Theories

Counsellors have often become wedded to a single theory or school of thought and view all people experiencing a condition only through the lens of this favoured theory. With such a limited view, we risk missing the true story a person tells in all its complexity. We hear only the part of the story that ‘fits’ our theoretical view of the world. Loss and grief is one of the best examples of a concept or condition that refuses to be boxed into a single theory. There is no ‘one size fits all’ definitive theory of grief. Rather what we have is an amazing picture of a deeply complex human experience for which each theory offers us part of the picture. Just like the story of a person’s grief, the story of the theories of grief is complex and much more interesting than a singular view of grief offered by only one theory.

Theories around grief and loss are largely considered WHY models (why grief occurs) and/or HOW models (how the process of grieving proceeds). To suggest that theories of grieving began in the 20th century is naïve. Philosophy, religions and stories from every culture have sought to understand grief, loss and suffering and comfort it. We should never discount the innate and cultural understandings of grief that a person brings. They form an integral part of the story they will tell and so form the basis of understanding how we best care for grief.

From a more formal psychological perspective, we can follow a story of the theories of grief and loss. However, we need to recognise that the theories mainly discuss loss through death. Moving to non-death losses will require us to go even beyond this theoretical story.

Early theories came from the psychodynamic work of Sigmund Freud in Mourning and Melancholia (1917). He largely argued that as people became attached to love objects, they attached psychic energy (libidinal bonds) to these things, a process known as cathexis. While these love objects remained, the internal energy remained in equilibrium and the mind remained stable. Any disequilibrium, and hence mental instability caused by loss of these love objects was seen in the intense grief reactions. The key to successful grieving was the removal of this psychic energy from the lost love object, a process of decathexis, and its placement in new available objects. This required an exchange process whereby the griever undertook ‘grief work’. By repeatedly re-examining aspects of the relationship with the lost object, the griever can relinquish the libidinal bonds that bound him or her to the lost object. A failure in this exchange process through unresolved ambivalence would then result in problems in grieving.

While also a psychodynamist, John Bowlby (1970, 1973) in his attachment theory, enhanced the understandings of grieving. Bowlby argued the need to consider the interpersonal perspective of grief with emphasis on the early experiences and attachment patterns developed between the griever and the deceased. He argued that yearning and searching for the lost loved one was normal. Therefore, the intense feelings and behaviours of grief were not indicative of pathology but were aimed to try to restore the lost love object to the griever. It was Bowlby who suggested that problematic attachment patterns may lead to problems in grieving. These theories were later expanded (Fraley and Shaver, 1999; Stroebe, 2002). This idea of an ongoing relationship with the deceased was expanded to the concept of continuing bonds by Klass, Silverman and Nickman (1996).

Bowlby (1980) was also the first to suggest that the process of grieving seemed to follow a pattern of stages and/or phases: Shock and numbness, Searching and yearning, Disorganisation, Reorganisation. These Stages/Phasic theories were also advocated by others (Parkes, 1972; Raphael, 1984; Hardt, 1978-79). The most popularised stages model was offered by Kübler Ross in her book On death and dying (1969). However, her stages were concerned with the process of dying and not on the situation of bereavement itself. Stages theories often spoke of the symptoms most noted in each stage rather than the part of the grieving process that was occurring that underpinned these symptoms. A number of theorists (Worden, 1991, 2009; Rando, 1993) tried to bring together the idea of grief work and stages in the Task Based models, which described the work the griever may be doing in each stage. Worden spoke of four tasks, being: to accept the reality of the loss; processing the pain of grief; to adjust to a world (both external and internal) where the deceased is no longer; and finding an enduring connection with the deceased within a new life. Anything that prevents a person moving through the stages of healing by successfully undertaking the tasks required of that stage can lead to problems in grieving.

As social beings our grief is more socially than individually constructed. The Social Learning/Social Constructionist theories increase our understanding of grief by helping us understand: a) what our social context considers a loss, and so determines the ‘right’ to be grieved or not, b) the rituals around the grief, c) the adjustments that will be needed to deal with the loss, and d) the language and attitudes around grief itself (Glick et al., 1974). At times the loss is not given legitimacy by the surrounding social environment and the grief is disenfranchised by others leading to its lack of recognition by others and a ‘loneliness’ for the griever (Doka, 1989).

The Cognitive-Behavioural school of thought argues that rather than grieving being a process over which a person had little control, cognitions and behaviours could alter the experience. The cognitions that people hold concerning the lost object, the process of grieving itself, as well as understanding the use of problem-solving and planning to rebuild the world are all important aspects of grieving. Irrational thought patterns, problematic core beliefs and depressive/avoidant coping patterns are often viewed as at the root of problems in grieving (Boelen et al., 2006).

Personal Construct Theory (Kelly, 1955) is a humanistic theoretical approach that argued that each of us constructs our individual reality based on patterns or ‘templates’ that we create. The theory recognises that an important question we then need to consider in loss is: What is the meaning of the loss to the person? From a constructivist perspective, problems in grieving occur when the person is unable to construct or re-construct a meaningful personal reality following the loss (Neimeyer et al., 2002).

These theories noted above are the main schools of thought that guide our thinking about loss and grief, and collectively offer a much better representation of the lived experience of grieving. A number of theoretical models have been developed that bring together aspects from several theories of grief. Bonanno and Kaltmann (1999) offered a Four Component model, while Rubin (1999) offered a Two Track model of bereavement. Maccallum & Bryant (2013) offered a cognitive attachment model that distinguishes both adaptive and prolonged grief by integrating aspects of attachment, memory, and identity. The most influential integrative model is the Dual Process model (Stroebe and Schut, 1999). It argues there are two forms of stressors related to grieving: loss oriented stressors and restoration oriented stressors. Throughout grieving people oscillate between reacting to these two stressors. Initially people spend more time with loss oriented stressors and as healing occurs, move to spend more time working with restoration oriented stressors. However, it is the oscillation between the two forms of stressors that assists with grieving.

Neurobiology offers us new insights. However, rather than a new theory, neurobiology offers us a greater understanding of the mechanisms of grieving and explanations as to why good theory has persisted and been validated within people’s experiences of grief. When we look at the grieving brain we see areas in the brain that are associated with processing of emotions, understanding the mental states of others, retrieval of emotion-laden episodic memories, processing of familiar faces, visual images, unconscious automatic motor responses, autonomic regulation and modulation, and coordination of a combination of functions (Freed et al., 2009; O’Connor, 2005). Neurobiology shows us how important it is for a grieving person to deal with the oscillation between approaching and avoiding the memories and finding a sense of accommodation of both (Freed & Mann, 2007). Hence a counsellor needs to have comfort in sitting with the person’s often changing state of ‘moving toward’ and ‘running from’ their confusion and pain by ‘sitting in the rubble’ with people. Neurobiology also points to potential mechanisms of problem grieving finding the nucleus accumbens, the centre of the brain that determines if something is worth doing over and over again, working hard in those reporting complicated grief (O’Connor et al.,2008).

Non-Death Loss

These many theories offer us a fuller understanding of grieving associated with death rather than any other loss. If we look at the definition of loss more broadly, we see that loss and resultant grief occurs following many non-death situations. Grief symptoms have been found among people experiencing situations as diverse as brain injury (Carroll & Coetzer, 2015), parenting children with mental disorders (Schofield et al. 2010), migration (Gitterman & Knight, 2019), unemployment (Archer & Rhodes, 1987), foster care (Mitchell, 2018), and nursing home placement (Van Humbeeck et al., 2016). However, often these symptoms of distress have not been interpreted as grief reactions but designated as adjustment disorders or their sadness interpreted as depression or anxiety. In trying to categorise the many non-death losses, Sofka (1999) suggests: a) obvious losses such as relationship breakdown, b) not so obvious losses such as loss of a dream, c) developmental losses across the life span, d) temporary losses and mini-losses such as small changes in life and; e) limbo losses associated with an uncertainty or a tenuous situation.

Boss (1999) offered the term ambiguous loss to describe a situation of loss in which a person is unsure if a loss really has occurred or not. For example, the loss surrounding the situation of a missing person or a threatened miscarriage or the diagnosis of a life-threatening but potentially curable condition may all involve ambiguous loss. This contrasts with what are termed non-finite losses that occur over a long period of time where an endpoint may not be clear (Bruce & Schultz, 2001). These non-finite losses are associated with a different grieving to that of the grieving of a death. This grieving is often termed chronic sorrow (Teel, 1991). Chronic sorrow is long-term sadness that accompanies ongoing loss and that sometimes comes to the fore, and sometimes sits uncomfortably on the periphery of the consciousness (Olshansky, 1962). The grief associated with death tends to display an intensity of distress that, while it may fluctuate to some extent short term, generally lessens over time. Chronic sorrow may be episodic in nature, but the intensity of distress in difficult times remains consistent over the long-term.

Counselling with Grief and Loss

Assessment

Rather than conjuring a picture of the ‘expert’ counsellor deciding what part of a person’s grief will be heard and explained and evaluated, I prefer to consider assessment as hearing the most complete story that may help the counsellor to generate in collaboration with the grieving person some hypotheses as to what may be causing their pain. A vitally important aspect of counselling with grief is the undertaking of a holistic assessment of the person’s experience. The primary aim in caring for the grieving person and being able to gain a useful and focussed assessment is ensuring the person feels safe within the therapeutic relationship.

It is important to hear about the circumstances of the loss and its repercussions in the life of the person and also to understand the world ‘that was’, the one lost to the person. We need to understand how the world they now inhabit (the world ‘that is’) most differs from the one they knew before the loss and in which they felt some sense of safety. In understanding the often complex story of grief there are key questions we can consider. These questions should not simply be asked as in a structured clinical interview. Rather the questions allow us to sort the story we are able to bring out using our interpersonal skills according to what we know about grief and loss. Murray (2016) offers ten questions of loss based on the various theories and studies of grief. These offer a means of ensuring a fuller assessment of a person’s grief.

1. What has been lost? Identify the many death and non-death losses that can be involved in a loss experience as well as seek those causing the most distress, the primary losses.
2. What was the position/role/ importance of that loss in the life of the person? Consider the centrality and the meaning of the loss to the person and hence the likely disruption to other areas of the person’s life.
3. What are the major symptoms of grief that this person is experiencing? Are there any causing particular distress? Consider the physical, emotional and social manifestations of grief and potentially problematic symptoms such as suicide ideation or trauma responses.
4. How far along the journey of mourning has the person progressed? Consistent with phasic and task models, this allows us to consider the progress of grieving.
5. What is the world of the person like? Consider how different is the world of the person now ( the world ‘that is’) and hence what makes their current situation feel safe or unsafe.
6. How is the person trying to deal with the transition from the world ‘that was’ to the world ‘that is’? Consider the current coping mechanisms being used and so recognise both adaptive and maladaptive forms of coping.
7. What strengths does the person bring to his or her loss? This forms the basis of a strengths-based approach encouraging us to identify the resources both within and around people to stabilise their world.
8. What hindrances are there to the progress of mourning? Consider the risk factors present that may compromise the healing process.
9. Is there any indication that mourning has become complicated? Signs of problems in grieving suggest a need for more targeted interventions to occur that can ‘unblock’ the normal healing process of grieving.
10. Are there particular characteristics of the person that are going to challenge my care of him or her? Consider issues that may challenge care, such as culture, sensory or cognitive impairment or existing disorders.

Grief Counselling and Grief Therapy

Grief following a loss is normal. Distress in itself is not indicative of pathology and hence does not necessarily require therapy. What is required is support for the healing process of grieving. Basic supportive counselling is a vital area of prevention and early intervention. Loss threatens a person’s sense of safety, mastery and control. The basic aim of all grief counselling for normal grief is the stabilisation of the griever and the returning of some sense of safety. It will be the grieving person who determines how best to return to a sense of safety as they will tell you what aspects of the loss are making them feel most ‘unsafe’. They will also tell you what makes them feel ‘safe’ as paradoxically loss can increase safety in some areas. For example, a relationship breakdown may cause grief, but if that relationship was emotionally taxing or harmful to the person, there may be a sense of increased safety in some aspects of this loss. Safety will always be defined by the griever and needs to be respected and understood by the counsellor.

Safety can be felt internally, interactionally or organisationally. Internal safety comprises the thoughts, memories, feelings or sensations, making the person feel most safe or unsafe. Interactional safety may be enhanced through helping the person to improve communication with health professionals, or partners or family and friends. It may also be enhanced through community education to reduce stigma or ignorance about grief. Supporting organisational safety requires interaction with systems that may cause concern, such as hospitals or coroners or mental health services.

General Principles of Grief Counselling

Several writers (Humphrey & Zimpfer, 1996; Worden, 1991) have offered general principles of care. In situations of loss, basic processes of support and symptom modulation will be needed initially to build trust, stabilize the person and allow the experience to be put into words. Once this personal sense of greater equilibrium has been supported in the griever, other important issues can be dealt with utilising the most appropriate therapeutic approaches.

Currier, Holland & Neimeyer (2008) surveyed 119 practitioners concerning their approaches to grief counselling and found three overarching categories. The first category is the importance of the presence of the helping professional. The study found the need for cultivating a safe and supportive environment, providing deep and empathic listening, and assuming a respectful and non-judgemental stance. The second category concerned the elements of the process of therapy and included: storytelling; facilitating integration or finding meaning; expressing and processing emotions; facilitation of continuing bonds; psychoeducation; focussing on the good, and exploring of spirituality and existential concerns; drawing and expanding upon existing resources and re-orienting toward future and hope. In terms of facilitating these processes, all psychological techniques may be potentially valuable for caring for someone affected by the loss. More than one approach is required over time to assist a person in grief. A continual process of ‘assessment’ and ‘intervention’ and ‘reassessment’ is needed.

Counselling to Therapy

As we discussed, it is often difficult to determine when normal grief that simply requires support for the natural healing process becomes problematic and in need of more in-depth support or therapy. Bonanno (2004) found that resilience, characterised as a pattern of high initial distress for a few weeks, followed by quite low levels of distress, is common among between 30%-60% of grieving people. Resilience is different from recovery, and chronic or delayed grief and can still be exhibited in traumatic losses and alongside PTSD.

Even for those who display symptoms of problematic grieving that fits a diagnosable category, there is no one definitive evidence-based method of intervention that fits all grieving people. As much as we would like to have an easy definitive ‘treatment’ for problem grieving, this is not the reality. Rather, a holistic thorough assessment for what may be causing problems in healing for one griever may not be applicable for another. For example, for one person, the problem may be due to an inability to process grief because of the avoidance of the memories due to trauma; while for another, the grieving difficulties occur due to a problematic attachment pattern that existed between the griever and the deceased.

Different theories and the techniques of care associated with such theories may then be required to assist the grieving person. For the first person, trauma techniques such as prolonged exposure or EMDR may be a first step necessary, while for the second person, attachment or psychodynamic work or Interpersonal Therapy (IPT) may be the most valuable approach. As such, an integrative, person-centred approach is vital in caring for problems in grieving.

A Counselling Model Example Built from Theory

According to the Dual Process Model (DPM) of grief, problem grieving occurs when a person becomes ‘stuck’ in dealing with one category of stressors, most commonly the loss oriented stressors. According to the DPM, the healing of grieving requires an ability to accommodate the oscillations between loss-oriented and restoration-oriented stressors. As they are restored, grieving people find the ability to live with their experiences of the loss within their new world where the lost object is no longer present. When oscillation is reduced, and the griever remains ‘stuck’ in one group of stressors, healing does not occur. Such problems may be manifested in the symptoms of Prolonged Grief Disorder.

According to the model then, intervention needs to restore this oscillation between the stressors, so the normal process of grieving is then restored. Complicated Grief Treatment (Shear,2010) is a manualised bereavement-focused individual therapy. It is grounded in the DPM, Attachment Theory and with techniques modelled from both Interpersonal Therapy and Cognitive Behavioral Therapy. It also includes elements of Compassion-focused Therapy (Gilbert,2014) and self-determination theory (Ryan & Deci, 2000).

Conclusion

Loss, and grief that may result from it, is universal to us all and so integral to the work of counsellors. This chapter has considered the many theories that, when taken together, offer us a clearer picture of this complex human experience. It has also highlighted that loss and grief may be implicit in many of the presenting problems we see with clients that are not specifically labelled as grief. We have seen how theory can also guide our assessment and care of people who are grieving in such a way that we can offer respectful person-centred care across the many diverse loss experiences we may encounter among clients.

Recommended Resources

Books

Harris, D. L. & Gorman, E. (Eds.) (2011). Counting our losses: Reflecting on change, loss and transition in everyday life. Routledge.

Murray, J. A. (2016) Understanding loss: a guide for caring for those facing adversity. Routledge.

Neimeyer, R.A. (Ed.) (2012). Techniques of grief therapy: creative practices for counseling the bereaved. Routledge.

Stroebe M. S., Hansson, R. O., Stroebe, W., & Schut. H. (Eds.). (2001). Handbook of bereavement research: Consequences, coping and care. American Psychological Association.

Websites

Australian Centre for Grief and Bereavement
Australian Child and Adolescent Trauma Loss and Grief Network
Good Grief (Includes Seasons for Growth Program):

Glossary of terms

Ambiguous loss: Loss associated with a situation of loss in which a person is unsure if a loss really has occurred or not.

Chronic sorrow: Long-term sadness that accompanies ongoing loss and that sometimes comes to the fore, and sometimes sits uncomfortably on the periphery of the consciousness (Olshansky, 1962).

Complicated grief: A pattern of symptoms associated with problems in adjustment to the loss and so is noted in grief that does not heal or is delayed in healing. Has been termed Prolonged Grief Disorder and Persistent Complex Bereavement-Related Disorder in classificatory systems.

Grief: The reaction to loss, whatever that reaction may be.

Loss: Loss is produced by an event which is perceived to be negative by the individuals involved and results in long term changes to one’s social situations, relationships or cognitions (Miller and Omarzu, 1998, p. 12).

Mourning/grieving: The process that occurs internally as people try to deal with loss.

Non-finite loss: Loss that occur over a long period of time where an endpoint may not be clear and chronic sorrow occurs.

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Author information

Judith Murray is a qualified counselling psychologist, registered nurse and secondary school teacher and has worked in all these areas. Most recently, to July 2021, Judith worked as an Associate Professor in Counselling and Counselling Psychology at The University of Queensland (UQ), Australia, She was the director of both the Master of Counselling Program and the Master of Psychology Program at UQ. She has also worked part-time in Haematology and Oncology nursing at The Princess Alexandra Hospital, Brisbane. Previously she was responsible for the establishment of a Loss and Grief Unit in the Centre for Primary Health Care in the School of Population Health at UQ. She is currently working part-time in private practice in the area of loss and grief.