Module 6 grief and loss learning resource 30.4.13

Grief and Loss
CHC51712 Diploma of Counselling
Module 6

© Copyright CTA CHC51712 MODULE 6 Grief and Loss Version Date: 30.04.13 P a g e | 2
Contents
Overview...................................................................................................................... 3
Unit Description......................................................................................................... 3
Learning Outcomes (Essential Skills)............................................................................ 3
Content Areas (Essential Knowledge) .......................................................................... 3
Module Duration and Workload................................................................................... 4
Required underpinning knowledge for this module........................................................... 5
What is grief?......................................................................................................... 6
Elisabeth Kubler-Ross (Stages Theory) 1969............................................................. 9
J. William Worden (Task Theory) 1982....................................................................10
Margaret Stroebe and Henk Schut (Dual Process Model) 1999...................................11
Steps in providing support and care relating to loss and grief...........................................21
1. Identify effects and impact of loss and features of grief ...........................................21
2. Engage empathically with people who are living with loss.........................................30
3. Provide support for individuals who are grieving and identify potential for healing and
growth.....................................................................................................................31
4. Identify, inform and refer to appropriate grief and bereavement care services and
resources.................................................................................................................34
5. Identify and recognise risks associated with grief and bereavement support ..............35
6. Access appropriate supervision and debriefing.........................................................36
7. Review and evaluate grief and bereavement support provided..................................36
READINGS & RESEARCH...............................................................................................38
REFERENCES...............................................................................................................38
WEBSITES...................................................................................................................38

MODULE 6 Grief and Loss
The unit of competency in this Module is:
CHCCS426B Provide support and care relating to loss and grief.
Overview
Unit Description
CHCCS426B — This unit describes the knowledge and skills required to provide support for
individuals who are experiencing loss, grief and bereavement.
Learning Outcomes (Essential Skills)
At the end of this module of study you will be able to:
1. Recognise expressions of loss, grief, trauma and bereavement
2. Respond appropriately to a range of approaches and responses to loss, grief and
trauma
3. Engage with individuals experiencing loss, grief trauma and bereavement with
empathy, sensitivity, professionalism and courtesy
4. Refer individuals who show some signs of mental illness to appropriate services
5. Apply verbal and non-verbal approaches to dealing with and responding to grieving
individuals
6. Use effective communication skills, including:
o empathic listening skills
o use appropriate communication techniques to respond to individual needs
o provide information clearly and sensitively
o obtain feedback to confirm understanding
7. Maintain documentation as required, including effective use of relevant information
technology in line with work health and safety (WHS) guidelines
Content Areas (Essential Knowledge)
The following areas are the essential knowledge required for this module. These are
discussed in more detail in the following section. Knowledge areas covered are:
 Potential impact of specific loss(es) and common features of:
o grief and bereavement at the individual, family and community level

o trauma at the individual, family and community level
o complex grief at the individual, family and community level
 Reactions to loss and associated expressions of grief and bereavement
 Awareness of how loss, grief and bereavement can impact on social and emotional
health and well being
 Integration of loss
 Distinctive social, cultural, ethnic and spiritual differences in loss, grief and
bereavement
 Awareness of the context and circumstances prior to loss and their impact on grief
and bereavement
 Understanding of a ‘stress vulnerability model’
 Awareness of the broad spectrum of loss
 Strategies for formal and informal grief and bereavement support
 Available grief and bereavement care services and information resources
Module Duration and Workload
This module is 4 months in duration. Learning and assessment should be completed within
this time frame.

Required underpinning knowledge for this module
The study of grief and loss is an important one for a counsellor. Losses occur for us all every
day in small ways. Fortunately, the larger losses that occur are usually more infrequent, as
to lose someone close to us means a major readjustment in life. The loss of a child, partner
or parent is at the very least incredibly disorientating and at worst can mean that we can
despair to the point that our own life seems meaningless and not worth living. When one
person ends their life others can feel for a time like they too don’t want to go on.
Supporting people to deal with loss is an important skill to learn in counselling. Losses can
range from job loss, moving locations, losing a home, loss of faith, through to separation
and divorce or the loss of friends and family members through death. Fortunately (or
unfortunately) we are all, to some extent, experts for we have all experienced losses. Our
capacity to self-reflect is an important skill in helping others deal with loss as we can identify
the steps and stages that we have gone through on our own grief journeys which are
probably not so different from what others experience as well.
Of course, if someone has a series of losses in their life, it can be extremely hard to find
level ground. Suicides, long drawn-out painful illnesses and other traumatic losses can
require expert attention and the capacity to identify when someone is at risk. It is important
to be able to recognise these risk situations so that we can refer appropriately if someone is
not recovering from a loss.
There is a warning with the study of grief and loss. If you have recently lost someone
precious to you, you could find that this study unit may distress you. It is important to talk
frankly about this with your trainer in order to design strategies to support you through your
study of this vital area.
The following points cover the required knowledge set out in the competencies for this
module.
Potential impact of specific loss(es) and common features of grief
and bereavement at the individual, family and community level
Losing anything is frustrating at the least. You may remember a time when you lost your
wallet or purse. Consider the thoughts, feelings and actions that occurred at the time. If you
found the wallet you would have been relieved and happy as you realised what it would
have meant to have to replace your driver’s licence, credit cards, money etc. If you had lost
that wallet permanently you may have experienced any or all of the following:
Possible thoughts:
 I am so stupid, why didn’t I check it?
 It’s his fault, if he hadn’t distracted me at that moment!
 Where could it be? Maybe I left it in the car.
 Maybe one of the kids took it out of my bag.

 This is dreadful, it will mean I can’t get on this flight, and my colleague will be angry
with me.
Possible feelings of:
 Agitation
 Dread
 Anxiety
 Anger
 Frustration
 Sadness
 Shock
 Disbelief
Possible body sensations:
 Sinking feeling
 Stomach knot
 Palpitations
 Tightness in the chest
 Shoulder tension
 Sweaty palms
 Headache
Possible actions:
 Frantic searching
 Going over and over retracing steps
 Anger outbursts
 Exclamations
 Aggression
 Tears
All this over a wallet or purse!
Loss can be disorientating. There is a period where we try very hard to reverse the loss even
if it makes no sense and it is clear that we will never see that thing or person again, that it
is truly over. We may play with thoughts of ‘if only…’ trying to reverse the damage.
What is grief?
The period of adjustment to a loss is called ‘grief’. It is the experience of getting used to the
loss and it is not easy.
In our counselling work we will encounter many, many people who are in the process of
grieving. Many of them won’t realise what they are experiencing is grief. However, as
counsellors, we need to be fully aware of grief in its various forms.
Loss of loved ones through death and divorce, change in location, change or loss of jobs,
loss of pets, equipment or precious possessions, loss of expectations and faith all take their
toll on us. None of us grieve for a loss in exactly the same way — there are vast individual

differences. There are some commonalities, and we examine three well-known grief theories
below under ‘Reactions to loss and associated expressions of grief and bereavement’.
However, the differences can at times tear families and even whole communities apart as
everyone deals differently with such situations. We can tend to be incredibly judgemental of
others at such times as well. We are not at our best and can consider that others are not
showing appropriate sorrow or sensitivities according to our own standards. This can impact
grieving through lack of support and, even worse, can come at a time when we are quite
vulnerable.
Families need to be reminded that, when we are all grieving in our own way, we may not
have the capacity to help each other terribly well. This may be the time to get outside
support so that one person, or a few people, are not left in the situation of having to be
‘strong’ for everyone else. This naturally would leave this person or persons in a particularly
stressful state and they may ‘go down like a pack of cards’ later when everyone else has
recovered. At that time others may consider that this person is being dramatic or attention
seeking!
Counsellors need to be fully aware of the implications of grieving on family relationships and
in close-knit communities and understand the power of strong painful emotions that come
from a loss.
Potential impact of specific loss(es) and common features of trauma
at the individual, family and community level
Loss can also involve trauma. The shock of a loss from car accidents, murders, rape,
robbery, suicide and even long-term illness can impact the nervous system and produce
long-term damage. When this occurs it is called Post Traumatic Stress Disorder or
PTSD. Clients may find that they have flashbacks to the traumatic event, nightmares that
persist, strong startle responses, lack of control over strong emotion, including see-sawing
of emotions and depression. In these cases it is important to refer the client on for expert
care, which may be to a doctor, psychologist or a psychiatrist in extreme cases.
Traumatised people in a family or community may in turn pass that trauma on to others.
When parents have been traumatised, their capacity to manage children is reduced
considerably as the usual annoyances can be met with extremely strong emotional reactions
and sometimes physical retribution. In addition, traumatised people, particularly those who
have not been treated and don’t realise that they have been traumatised, may turn to drugs
or alcohol and other means to relieve their agitation and body distress. Children and other
vulnerable people may also be deeply affected simply by living with those who are
traumatised.
We can see how incredibly important it is for counsellors and other mental health
professionals to be available and fully trained and skilled in working in the area of loss.

Potential impact of specific loss(es) and common features of
complex grief at the individual, family and community level
Without support, individuals, families and communities may experience complex grief, for
example, with multiple losses through suicide. Complex grief may occur for a number of
reasons. These are discussed below.
No answers
When a loss occurs and we can’t find any reasons that make sense we may not be able to
resolve that loss and it means that we continuously replay the loss trying to find meaning.
Multiple losses
Resolving a loss takes time. If we experience another loss before we have recovered from
the initial loss we are doubly impacted. It takes our psyche some time to believe that the
world is a good place. With multiple losses we can despair of life and conclude that there is
no safe place and no good thing in store for us. We may not recover emotionally.
Denial
At times the meaning of the loss to us is so painful we do not move out of a denial stage
where we suspend our emotional suffering by imagining that the loss has not occurred at
all.
Abuse
When grievers are not supported but attacked in their grief this can add to the wound
making it extremely hard to recover. It seems like an open wound is ripped open further.
Healing takes longer and may never happen, as resentment and bitterness can leave the
person ‘changed’ and untrusting forever.
No education
Many people do not understand the grief process and can be disturbed by what is
happening to them. This can make them wonder if they are losing their mind or if there is
something ‘wrong’ with them. This can extend the grieving period as they feel lost in the
process.
Trauma
Trauma, as we have mentioned above, halts the grieving process through shock. This can
stay in the person’s system. It is important for trauma to be treated so that grief processes
can move forward.
Reactions to loss and associated expressions of grief and
bereavement
There are some common features of grief experiences. Some of these have been noted by
famous grief theorists. It is important for counsellors to be fully versed in these concepts as
they can be used to educate clients and help them recognise what is happening for them
and provide encouragement that the process will not last forever.

Elisabeth Kubler-Ross (Stages Theory) 1969
Elisabeth Kubler-Ross was a Swiss-American psychiatrist and a pioneer in near-death
studies. She is the author of a ground breaking book On Death and Dying. In this work she
first discussed her theory of the Five Stages of Grief outlined below. Kubler-Ross first
applied this theory to those who were dying but later revised this to be applicable to all sorts
of loss experiences. She was an advocate for AIDS victims and set up Hospices for those
who were dying.
1. Denial
"I feel fine."; "This can't be happening, not to me."
Denial is usually only a temporary defence for the individual. This feeling is generally
replaced with heightened awareness of possessions and individuals that will be left behind
after death. Denial can be conscious or unconscious refusal to accept facts, information, or
the reality of the situation. Denial is a defence mechanism and some people can become
locked in this stage.
2. Anger
"Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?"
Once in the second stage, the individual recognises that denial cannot continue. Because of
anger, the person is very difficult to care for due to misplaced feelings of rage and envy.
Anger can manifest itself in different ways. People can be angry with themselves, or with
others, and especially those who are close to them. It is important to remain detached and
non-judgmental when dealing with a person experiencing anger from grief.
3. Bargaining
"I'll do anything for a few more years."; "I will give my life savings if..."
The third stage involves the hope that the individual can somehow postpone or delay death.
Usually, the negotiation for an extended life is made with a higher power in exchange for a
reformed lifestyle. Psychologically, the individual is saying, "I understand I will die, but if I
could just do something to buy more time...". People facing other traumatic situations can
bargain or seek to negotiate a compromise. For example "Can we still be friends?" when
facing a break-up. Bargaining rarely provides a sustainable solution, especially if it’s a matter
of life or death. Bargaining can also include guilt, including survivor’s guilt.
4. Depression
"I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point?"; "I
miss my loved one, why go on?"
During the fourth stage, the dying person begins to understand the certainty of death.
Because of this, the individual may become silent, refuse visitors and spend much of the
time crying and grieving. This process allows the dying person to disconnect from love and
affection. It is not recommended to attempt to cheer up an individual who is in this stage. It
is an important time for grieving that must be processed. Depression could be referred to as

© Copyright CTA CHC51712 MODULE 6 Grief and Loss Version Date: 30.04.13 P a g e | 1 0
the dress rehearsal for the ‘aftermath’. It is a kind of acceptance with emotional attachment.
It’s natural to feel sadness, regret, fear, and uncertainty when going through this stage.
Feeling these emotions shows that the person has begun to accept the situation.
5. Acceptance
"It's going to be okay."; "I can't fight it, I may as well prepare for it."
In this last stage, individuals begin to come to terms with their mortality, or that of a loved
one, or other tragic event. This stage varies according to the person’s situation. People
dying can enter this stage a long time before the people they leave behind, who must pass
through their own individual stages of dealing with the grief.
The Butterfly
An analogy for Elisabeth Kubler-Ross’s ‘stages’ theory is ‘the butterfly’.
The butterfly starts as a caterpillar and grows in size and then turns itself into a pupa or
chrysalis and finally transforms itself into a butterfly. The butterfly then lays eggs and so the
cycle continues. The main feature of this analogy is that, in life, change occurs and at times
in that change we are in a dark place transforming ourselves, but we can emerge as a
butterfly able to move beyond what we were ever able to do before.
This analogy is hopeful and is not unlike Kubler-Ross’s idea that we go through a change
process that takes us through a dark place but that at the end there is light and hope.
J. William Worden (Task Theory) 1982
Worden, an American psychologist known for his work in Gestalt Therapy, developed a new
theory to explain the process of grieving. This was applied first to those who had suffered a
loss through death but then applied to other forms of grieving as well.
Worden’s Task Theory can be viewed as a more ‘masculine’ approach to loss as it is
framed with ‘tasks’ to complete in order to successfully manage a loss.
Task 1: To accept the reality of the loss
Task 2: To process the pain of grief (or to experience it)
Task 3: To adjust to a world without the deceased (or the thing you have lost)
Task 4: To find an enduring connection with the deceased in the midst of embarking on a
new life (to reinvest emotional energy)
The Seasons
This theory has been used by the Seasons for Growth Program and aligns with another
analogy of dealing with grief, using ‘the seasons’ of the year. This follows the pattern:
 Autumn – coming to terms with a loss
 Winter – experiencing the pain of grief

 Spring – adjustment and starting to see some new life
 Summer – renewal and moving forward again
This analogy can be very helpful as it has a time frame of 12 months. Most people who lose
a loved one can identify with the first year as being the hardest time. Into the second year,
while life is still not where they would like it to be, they are generally moving forward.
Margaret Stroebe and Henk Schut (Dual Process Model) 1999
The third theory of grief that has been well established is the Dual Process Model of
Stroebe and Schut. This theory maintains that in a grief process two things happen
simultaneously — grieving work and avoidance of grief.
They recognised that at the beginning of a loss a person is fully involved in grieving and
feeling the sadness of grief but even so they have to get on with life and so avoid their
grieving for periods in order to function. This movement back and forth lessens over time
with people adjusting to their loss. This model lends itself to another analogy of grief and
that is the ‘broken leg’ analogy.
The Broken Leg
While we favour a broken leg, padding it and protecting it, we still need to get up out of bed
and function. We may have artificial supports for a time, including walking sticks and
wheelchairs, but without movement and normal living the leg wouldn’t heal. It needs to
have blood flow and circulation and when a cast comes off the leg needs to move in order
for the muscles to grow again and to file off the bony protrusions that occur in mending
bones. The muscles actually wear down the new overgrown bones to the shape they were in
the first place before the break.
This miracle of nature in healing is also a great one for assisting people to understand both
the need for care and rest and the need to get up and out again in order to feel better and
heal.
Models of grief
The following article is provided as further discussion of models of grief.
Reading: Grief, Loss and Bereavement
Much of what has been written about how people grieve has focused on individual survivors.
The Victorian belief that grief was a sign of a "broken heart" resulting from the loss of a love
was replaced by the psychodynamic view that grief was painful because it involved letting
go of attachment to the deceased. This "letting go" was viewed as essential for "moving on"
with one's life, eventual recovery from depression, and a return to "normal" (Neimeyer
2001). Theories of grieving later included an emphasis on differences between pathological
(complicated) and normal (uncomplicated) grief reactions (e.g., Lindemann 1944), and an
emphasis on phases, stages, or trajectories of the grieving process. The best-known stage
model was presented in Elisabeth Kubler-Ross's (1969) book On Death and Dying. In
discussing anticipatory grief of terminally ill persons she outlines five stages: shock and
denial, anger, bargaining, depression, and acceptance. These stages were viewed by many

lay people and professionals as "the" way successful grief is experienced. Many still gravitate
to this model for its simple linear approach, using it as a prescription to measure how grief is
progressing. Since its publication, this stage model has been applied to other losses
including divorce, chronic illness, and infertility.
Although these models have been prominent in the popular media, many scholars have
been critical of them (Attig 1991). Studies have failed to find any discernible sequence of
emotional phases of adaptation to loss, or any clear endpoint to grieving. Rather than a
passive climb up a linear staircase, characteristics of grieving may more closely resemble
unsteady twisting and turning paths requiring adaptation and change, but with no specific
end. In addition, there is no evidence that someone who deviates from those stages is
experiencing pathological grief, so authors have called for a de-emphasis on universal grief
syndromes and a recognition of varied practices of subcultural groups.
There also have been many challenges to the concept of grief work that underlies these
theories— an assumption that one must do cognitive work to confront the loss and that
failure to undergo or complete grief work results in pathological grief. The idea that one
must "work" at dealing with grief is not a universal concept, and probably is reflective of the
broader emphasis in the United States that anything worth having requires hard work.
Newer models of grief tend to focus on context and circumstances of a loss, variability in
individuals' grief experiences, meaning of the loss to individual survivors and their families,
recognition that rather than a withdrawal of attachment from the deceased (or lost object)
there is a continued symbolic bond, and adjusting to the new world that exists after the loss
(including new interpretations one has of the environment, and new elements in one's
identity). The emphasis appears to have shifted from identifying symptoms to the process of
grieving. For example, the Dual Process Model of Coping developed by Margaret Stroebe
and Henk Schut (1999), suggests that active confrontation with loss may not be necessary
for a positive outcome. There may be times when denial and avoidance of reminders are
essential. Most individuals can expect to experience ongoing oscillation between a loss
orientation (coping with loss through grief work, dealing with denial, and avoiding changes)
and a restoration orientation (adjusting to the many changes triggered by loss, changing
routines, and taking time off from grief). This reflects a movement between coping with loss
and moving forward, but the extent to which one needs either of these dimensions differs
for each individual.
Theories about families have been slower to develop elements that address loss and grief.
Family systems theory (with its emphasis on viewing reactions to loss by the family group as
a disruption in the family system's equilibrium and structure requiring reorganization of roles
and functions; and the impact of reactions of one family member on another) appears well
suited for examining loss. However, its emphasis on the present and current interactions
appears to have slowed development along this line. There are a few notable exceptions,
including Monica McGoldrick's (1991) elaboration of Murray Bowen's work on the legacy of
loss. Bowen (1976) suggested that a family's history and experiences with loss influences

how the family adapts to subsequent losses as well as the legacy of viewing themselves as
either "survivors" or "cursed" (i.e., unable to rise above the losses) that they pass on to
future generations.
Another notable work is that of Ester Shapiro (1994), who integrated individual and family
life-cycle development with systems theory to discuss loss as a crisis of identity and
attachment, in which grief disrupts the family's equilibrium but makes possible development
of new "growth-enhancing stability" … In addressing losses related to chronic illness, John
Rolland (1994) developed the Family Systems-Illness Model to examine the interface of the
individual, family, illness, and health-care team. Rather than focusing on the individual,
Rolland views the family or caregiving system as the central resource affected by and
influencing the course of the illness.
Source: <a href="http://family.jrank.org/pages/750/Grief-Loss-Bereavement-Coping-with-
Loss.html">Loss Grief and Bereavement - Coping With Loss</a>
Awareness of how loss, grief and bereavement can impact on social
and emotional health and wellbeing
Our clients’ bereavement experience can impact on their social and emotional health and
wellbeing. Withdrawal from social connections is very common in grief and this is not always
understood by friends and family. It can at times cause offence. It is important to encourage
clients to express their need for quiet while they sort themselves out and for them to
communicate with friends, colleagues and loved ones about their needs at this time. This
will help others to support them in the way that they need. It seems an obvious point, but
people tend to expect that people should just ‘know’ what is going on inside them.
This withdrawal can mean that people don’t want to move outside their homes. However,
exercise and change of external environment is important and should become a normal part
of daily activity for emotional health and wellbeing. Sights, sounds, smells and sensations all
help to stimulate our senses and can help bring relief to a grieving client. Encouragement to
do this is important and sometimes homework can be given for the client to work on this.
Integration of loss
Integration of loss may include:
 Dual process
 Meaning reconstruction
 Continuing bonds
 Disenfranchised grief
 Grieving styles
To help clients integrate their loss into their lives in a positive way is important. The
following therapeutic model is provided to assist in this process.

STORY The Person’s Story of Loss
The counsellor may want to use a LIFE LINE approach to this to help map the story of the loss over
time. Sequencing the story can assist people who have been traumatised to make sense of the
events. Small children may be encouraged to tell the story in pictures, with what happened first,
what happened next and so forth.
You may also like to ask them, when you lost … what else did you lose? These are the MICROLOSSES.
Other ways are simply to let the person tell you their story with input from you as a counsellor
reflecting back to the person their strengths and how normal they are to be experiencing the
emotions they are under the circumstances.
FEELINGS/BELIEFS/BODY SENSATIONS/ACTIONS? What does it make them feel/believe about
themselves because they have lost this person or situation or thing?
You may need to ask the person directly about their thoughts and feelings when these things were
happening, or what they are currently, as they may not have had an opportunity to express this or
make sense of it.
FEELINGS – Find out what feelings the person is experiencing, list a few if they can’t quite find the
words.
BELIEFS – Ask the person what this loss makes them believe about themselves, others, God, life
because of what has happened.
BODY SENSATIONS – Importantly, ask the person to tell you where they feel the sadness, or hurt or
anger now in their body, i.e. sick feeling in the stomach, heavy feeling in the heart etc. (With children
you can use a body map for them to colour in and indicate their feelings.)
ACTIONS – Ask the client what the loss is making them want to DO. What do they find themselves
doing now that they normally wouldn’t do?
EDUCATE & NORMALISE — Explain to your client that they are normal, explain the seasons or the
butterfly or broken leg analogy to them to help them understand grief. If they have had lots of
losses, explain to them ‘numbing’ and other behaviours people may use to deaden the pain of loss
(alcohol, abuse, stealing, drugs, sex, gambling etc.). Let them know that real healing/adjustment and
feeling better is possible in time. Let them know that particular strategies can lessen the distress
now as well.
LETTING GO — What ideas have they had to help let go of the person/situation/thing? Painting,
talking to the person, writing them a letter, special place/memorial, memorial service, candle
lighting, memory book, planting a tree. Ask the person if they would like to create a ceremony as a
way of letting the loss go. If there has been a death and the funeral is already over let them know
that personal goodbyes can happen at any time to help in adjustment and that just because the
funeral is over doesn’t mean that they have finished saying their goodbyes.

STAYING CONNECTED — What part of the person/situation or thing can they keep close to them?
Ask them about words they would say, memory tokens they can keep with them, new purpose for
life discovered or a feeling of their presence that provides this sense of connection. Ask the person
how they would like to stay connected to the very best part of the person, situation or thing that
they have lost. Even in divorce people may need to have a sense of connection to the best part of
the relationship. It might be that they learned to value themselves and this is what they have taken
from the relationship.
POSITIVE STRATEGIES
Positive thoughts — Help the person find better thoughts to replace bad or negative thoughts, and
get them to practise these new thoughts whenever they can. For example ‘Life will never be the
same’ can be changed to ‘Life has been richer because of this person or situation’.
Making the body feel better — What do they notice makes the bad feeling lessen? Can they use a
body pillow, do more walking, cry, laugh, talk to people, exercise, rock back and forth, engage in a
relaxation strategy.
Making positive plans — What new things will they do in their life they haven’t done before? Join a
club, do some study, start a group, do some craft or gardening, go fishing more, spend more time
with the grandchildren, contact someone they haven’t seen for a long time.
COMMUNITY CONNECTION — Who or what is out there to support them when they feel sad or
lonely? Set them some homework to make a connection with others. Help the person find
organisations or people in the community that they can connect to when they are feeling low or sad.
This is really important to stop suicide or other self-harming behaviours and help create a strong
connection in the community for the person.
Distinctive social, cultural, ethnic and spiritual differences in loss,
grief and bereavement
Understanding other people’s responses to loss and their grief expression can sometimes be
confusing. Some of the different reactions are of course due to the uniqueness of a person’s
own personality, perhaps even partly a hereditary disposition. Other differences are due to
the social situation a person is in, their cultural background, their ethnic group and religion.
Social
Our world is a social world. It is filled with people and the people we relate to on a day-to-
day basis are our ‘social circle’. Social circles have their own rules and values; although very
rarely written or spoken of they are ‘understood’. For example, going to an acquaintance’s
place on 25 December at lunchtime just to ‘pop in’ would be seen as inappropriate in many
social circles. Most people would know the social norm is not to go uninvited to someone’s
house on Christmas day.
Our social circles may dictate certain behaviours around grief and loss. In one group it might
be taboo to talk of a deceased person or the loss of a job, while in another group it may be

considered necessary to talk of such things. In some workplaces to take a day off for
bereavement leave is seen as acceptable; in others it would be seen as reprehensible.
Cultural
In a similar way culture dictates ‘norms’ when it comes to loss as well. Culture is a broad
term of course. Most people see it as an ethnic/racial consideration but it spans social and
religious areas as well as the associated values. Each of us has a personal culture and is part
of larger groups which have ideals and practices around loss.
Ethnic
In Australia we have had a great mix of people from different ethnic backgrounds. However,
when a group from a particular racial background does not mix with others, their cultural
practices are often based on traditional practices that are part of their ethnic background.
The Greek and Italian tradition of wearing black for a whole year when a loved one dies is
one obvious example of this. There are many other less obvious practices that are based on
culture. For example, in some ethnic groups the practice of self-mutilation is regarded as a
demonstration of love when a loved one dies.
Religious/Spiritual
Ethnic groups may also follow religious practices that are part of their traditional culture.
However religion, or spirituality, is more often seen as a choice of world view and beliefs
around the reasons why things happen. ‘God did it’. ‘Satan did it’. ‘He deserved it’. ’It’s fate.’
‘It’s the Secret’ etc. These beliefs will all have an impact on the way in which someone
‘travels’ through their grief journey. For one person a loss can be seen as ‘sabotage from the
devil’, to another the loss is seen as ‘a miracle from God’. The one individual may experience
frustration and hurt and the other jubilation.
As counsellors, our own faith or non-faith position may influence us in viewing the client’s
responses as ‘acceptable’ or ‘strange’. The mind is quite powerful and thoughts have a huge
impact on emotions. We should be happy if we can see that a person is managing their grief
well within their own religious/spiritual background and preferences, and if they have good
support structures in place. It is when we see people twisted in pain in their grief because of
their beliefs that it requires a more complex approach from us as counsellors. We have to
walk a kind and gentle line in these situations.
Ask the person how their faith may be helping them through their loss – this is congruent
with their perspective – we all choose to stay with a faith perspective presumably because it
is helpful to us after all. Then we may gently ask, ‘what are the hardest things about the
loss?’, and then ‘how is your faith or faith community helping with this part of your loss?’. If
the contribution is negative or non-existent we may suggest other resources or thinking
strategies that may help. Be careful to be supportive of the person’s own faith perspective
even so. While we may personally consider the particular faith perspective to be unhelpful
for emotional health, it is not our place to make such judgements. Our kindness and care in
the middle of grief may well assist this person to consider us as a ‘safe place’ in the event
that they choose to leave their non-helpful beliefs behind and to seek us out to help them

move their thinking at a later date. Remember, people lean on their culture, beliefs and
traditions in turbulent times and to challenge these beliefs when they are vulnerable is
unethical and lacks real love and care. It can also be psychologically dangerous.
Awareness of the context and circumstances prior to loss and their
impact on grief and bereavement
The context and circumstances prior to loss may include:
 Socio-economic circumstances
 Age of deceased
 Family relationships
 Presence of mental illness in the deceased
These circumstances naturally have a significant bearing on how people manage a loss and
the extent of their personal suffering. People’s socio-economic circumstances may mean that
they didn’t have access to the very best care to prevent a painful outcome. This might
include medical care, legal care and even food, shelter and travel capacity. This lack of
financial capacity may contribute to the client thinking ‘if only’ thoughts after the loss. They
may compare themselves to others with access to the supports necessary to prevent the
same kind of loss. Loss of innocence at the unfairness of the world and the loss of justice
may be secondary losses in such cases.
Naturally, when someone dies, age is a factor in the impact of this loss. Losing a baby, child
or young person for example can be harder to accept and understand compared to losing an
elderly relative who has lived a long life and died of natural causes, peacefully in their sleep.
However, it is the relationship that we have with someone or something that determines the
grieving that will be experienced. Relationship connections are sometimes unexpected.
Relationships with animals, with jobs, with family members have emotions attached due to
needs inherent in that connection. One person may be more upset about their dog dying
than their husband leaving them. Someone may be more upset about the loss of their job
than their elderly mother dying. The individual connections of meaning in these relationships
determine the emotion experienced and the duration of the grief experience. Counsellors
need to examine these ‘relationship meanings’ with their clients to help them fully
understand the loss experience and to support them in dealing with their grief.
Another important issue is the impact of loss on the mental health of those experiencing the
loss. For example, if a family member had been mentally unwell prior to a suicide, this may
have been a condition that the family and supporters of this individual have coped with for a
long time. The exhaustion and stress levels of family members in this predicament can
precipitate loss of mental health for them as well.
If someone who previously had a mental illness experiences a significant loss this is likely to
increase stress and could increase symptoms of mental illness. Quality professional help will

be required to support this individual through this time. It is a case of adding fuel to the fire
and it will need specialist support.
Understanding of a ‘stress vulnerability model’
The following reading is reproduced to give an understanding of the stress vulnerability
model. This reading is also reproduced on the online student portal as ‘Article for Grief and
Loss’ under Learning Resources.
The stress vulnerability model was proposed by Zubin and Spring (1977). It proposes that
an individual has unique biological, psychological and social elements. These elements
include strengths and vulnerabilities for dealing with stress.
The Stress Vulnerability Model
In the diagram above person "a" has a very low vulnerability and consequently can
withstand a huge amount of stress, however solitary confinement may stress the person so
much that they experience psychotic symptoms. This is seen as a "normal" reaction. Person
"b" in the diagram has a higher vulnerability, due to genetic predisposition for example.
Person "c" also has genetic loading but also suffered the loss of mother before the age of 11
and was traumatically abused. Therefore persons "a" and "b" take more stress to become
"ill".
This model is obviously simplistic. However it does unite different approaches to psychosis.
Vulnerability is not a judgmental term but an attempt to understand the variables involved.
Source: <http://www.hearingvoices.org.uk/info_professionals_stress.htm>

Awareness of the broad spectrum of loss
When one person has a loss, their grief can impact on a great number of people in a
community. Most people can empathise to some extent and imagine what the other person
must be feeling. It can bring up feelings of vulnerability in all of us. We may be particularly
affected if we are similar in some ways to the person who has experienced the loss.
For example, if a young person suicides other families may be fearful for their own child,
particularly if their child has been depressed. If one person is put off in a workplace others
may fear for their security as well. They may feel guilty for still having a job or relieved that
they have been passed by. The effects of a loss ripple out like the widening circles in a pond
when a stone is thrown in.
As well as a broad impact across the community loss itself manifests in many different ways
and covers many situations. People losing friendships, jobs, houses, faith, relationships can
still suffer grief reactions at times as severe as in losing a loved one to death.
Strategies for formal and informal grief and bereavement support
There is a range of strategies to assist people in dealing with their grief. These include more
formal strategies such as counselling and identified grief support groups and extend to other
aspects such as literature or seminars about grief and to the love and care provided by
friends and family.
It is important that people are made aware of the sorts of supports that are out there in the
community. If a person seeks counselling for grief, counsellors should also provide
information on other supports that are available. In the end it may be aspects of all of these
avenues that together assist people to recover well.
Certainly grief groups can help to normalise emotions and experiences as well as provide a
social connection that is meaningful. However, counselling provides a forum for individual
understanding of the grief experience that may not be available elsewhere. Self-awareness
gained through reading material in books, brochures or online and attending seminars can
assist people to take the control of their own wellbeing and that is important in growth.
Friends, colleagues and family can display understanding in accepting an individual’s unique
grief responses without seeking for them to be explained, thus enhancing the grieving
person’s sense of being accepted in the grief experience.
Available grief and bereavement care services and information
resources
Police and coronial procedures
At times police are involved in investigating a death. In suicides this is a routine situation.
This involvement can be traumatic for the family as they are often in shock and disbelief and

they may be asked questions which give them the feeling that they are a suspect in the
death of their loved one.
In these situations, which may intensify the grief experience for people, you may be
required to provide debriefing about this whole situation. Naturally in our communities we
want justice and protection for people. Police provide this for us by taking routine measures
to enquire about the nature of a death to ensure that it was either natural causes or
accidental rather than something deliberate. However as counsellors we should be aware
that this process may be extremely traumatic for the loved ones involved in this sort of
investigation.

Steps in providing support and care relating to
loss and grief
The following steps reflect Elements and Performance Criteria from:
CHCCS426B Provide support and care relating to loss and grief.
These skills apply to work in the industry in both general and in specialist areas of
counselling.
1. Identify effects and impact of loss and features of grief
We have all experienced loss in our life and are familiar with the term. Losses can include
loss of people, things, situations, beliefs, health, careers, animals etc.
Loss may include the following, which are explained in more detail below:
 Primary losses
 Secondary losses:
o losses of the internal world, such as loss of cognitive or sensory capacity
o interaction losses
o losses of the external world, such as material or personal losses
 Cumulative losses
Primary losses
A primary loss is an obvious loss.
For example: ‘My husband died, and I miss my husband.’
‘I lost my ring and I am missing my ring.’
Secondary losses
A secondary loss relates to the other things we may lose as a result of a primary loss.
For example: ‘I lost my job, so I also lost income, I lost the activity each day, I lost my
position in society, AND I lost my self-esteem.’
‘I lost my husband and I lost the person who takes me shopping, who
cleans the windows, and provides the income for me.’
Another way of describing secondary losses is ‘micro-losses’.
Losses of the internal world
Losses can relate to the internal world of the client, such as loss of cognitive or sensory
capacity. This may include loss of ideas, beliefs, attitudes, hopes, faith etc. We all have an
internal world; it is the reason why people will react differently to the same type of loss. We
have different thoughts.

For example: ‘I lost my mother to death – I’m glad it is over, she was in great pain, she
suffered for years, I’m glad she is not suffering anymore, she is with God
now and the angels...it’s OK’.
Or
‘I lost my mother to death – this is dreadful, she had a dreadful end and I
hated to see her suffering, it seems so horrible that such a good person
had such pain. Once you are dead you are dead, there is nothing after
this. The world sucks because there is no justice, some really horrible
people just die in their sleep, why couldn’t my mum!’
Both individuals above have suffered an external loss which is similar, the loss of their
mother, but their internal loss is very different and particular to them. Our internal world can
mean that our loss can be extremely painful or not very, although we may have lost the
same thing and valued the thing we lost in exactly the same way.
When we speak about internal losses we generally consider these losses as the unseen
things that we lose.
For example: ‘I lost my faith when the pastor I respected and looked up to lost his
temper with me when I didn’t agree with him. It made me doubt the
reality of my beliefs. If, after more than 20 years practising his religion, he
is still deep down not a good person what hope is there for me?’
Another type of loss of the internal world is one that cannot be shared publically.
For example: ‘I aborted my baby, I am missing my baby, what have I done? I didn’t
know what else to do and I can’t tell anyone as I am ashamed.’
This is called disenfranchised grief — when people can’t express their grief due to stigma
or shame.
Interaction losses
Interaction losses refer to losses in relationships between people or situations.
Interaction losses also have secondary or internal world losses. You may imagine that the
loss of a partner and the interaction would be the primary loss for a person, yet when
talking to them, they are more concerned about yet another ‘bad’ thing happening for them.
In this case it is the loss of hope for a good world that is the internal world loss, not the
interaction between husband and wife.
Loss presents a complex landscape – but with simple questioning we can hit the mark of the
significant losses for our clients. They will value us if we can ‘get’ them, especially if they
can’t get themselves and why they are acting as they are.

When people get a glimpse of the complex map of primary and secondary losses and
meanings for themselves they are grateful and are on their way to making sense of their
emotions and caring for themselves as they should. This is of course critical to successful
recovery from a loss.
Losses of the external world
Losses of the external world are the obvious losses, which everyone will see and
understand. Loss of job, loss of house, loss of a limb etc. are all examples of an external
loss – they are visible. In some ways primary losses and external losses are related and
secondary losses and losses of the internal world are related, but not in every case.
For example: June and Greg got a new house with a big mortgage. They could afford it
at the time. However the interest rates went up and June lost her job.
They have to sell their dream home. For both of them their external loss is
the house, however their internal losses are quite different.
For Greg, his internal loss is lost pride because his parents always said he
was a ‘nobody’ and only people who could save and buy a house had
‘made it’.
For June, her internal loss was that she had plans for a nursery in that
house as she was desperate for a child. She could see the child care centre
from her front veranda and the primary school was just over the hill. There
was a beach nearby where she imagined herself playing with her child in
the future.
Their primary loss was not actually losing the house, it was the losses of
their internal world that were the most powerful losses for both of them.
The secondary loss for both of them was the actual bricks and mortar of
the new home.
As counsellors it is important not to assume we know what a person is grieving for most. We
have to find out from them what the most difficult thing is in their loss. This will put you in
contact with their internal world of priorities, which is what we need to work with in order to
successfully help someone. Misunderstandings about this can cause people more grief.
For example: Alice’s daughter had a stillborn baby. June her friend is angry at her that
she is grieving and won’t come to bowls and is locking herself away in the
house. She says to their shared friend Marg that she thinks she is trying
for the sympathy vote. She’s never found out that Alice herself fell
pregnant when she was 15 and was shamed terribly by her family. She
finally gave birth at 16 but the baby was stillborn. She felt that God was
punishing her and that her family, who were staunch Catholics, thought so
too. The pain of this news for her daughter had brought her past up
painfully.

Cumulative losses
Losses can build over time. The young woman whose mother died when she was 10 may
experience a build-up of grief over time when she loses her first boyfriend, her girlfriend
moves away and then she loses her children in a custody battle. Cumulative loss is also
multiple losses. However multiple losses may be viewed as a number of losses experienced
in a relatively short time. The sadness of these losses is that in many cases the person has
not been able to integrate or resolve the losses that they have experienced and life itself
becomes the stage of a personal tragedy where pain and grief fill the landscape.
How do we help to identify secondary losses?
Most losses inlcude both primary and secondary losses. As counsellors, it is important to
search out the secondary losses the person may be coping with, as most friends and
relatives will provide acknowledgement of the obvious loss a person may experience. The
individual themselves may or may not have identified the secondary losses, but this is
necessary for a client to understand and validate why they are feeling as they do. It also
helps to work out ways to deal with the loss.
Ask the simple question
How can we identify these secondary losses? The best way is to ask, for example:
 ‘When you lost your job Harold, tell me what other things did you lose as well?’
Or
 ‘Alice it’s been a hard road hasn’t it losing Bert, he was everything to you wasn’t he?
I’m wondering Alice about all the things Bert was to you, the things he did for you
and gave to you and provided for you? I bet it is a long list.’
In asking these questions we acknowledge both the primary and the secondary losses a
person may be coping with.
Discovering secondary (or micro-losses) is a way to help the person build their future and
take some of the pain of the primary loss away. Helping Harold or Alice above, for example,
to find how to deal in other ways with the list of smaller micro-losses can help make life
bearable for them.
For example Alice may have lost the person who helped her sweep the floors or clean the
bath when she lost Bert. As a counsellor you may be able to refer her to home help or a
government agency that will provide this support to her if she is elderly and wants to stay in
her own home.
Harold may have lost his self-esteem in helping others within his workplace. You may find
out that he has been a supporter of cricket with kids for a long time but has never
volunteered to be the coach. Encouraging him in this area may well provide a sense of pride
and involvement that may have been taken away when he lost his job.

It is important that we don’t guess the secondary losses, but actually ask. Sometimes you
may have to prompt the person. This is because it can be incredibly surprising the sorts of
answers people give you. It may be outside of your guess work completely.
For example: Alf is 68 and has had three failed relationships, the last one with a 40-
year-old woman. In checking for Alf’s micro-losses you find out that he is
actually more upset about losing the chance to be a dad. He liked his last
wife, but he was actually hanging out for her to get pregnant for five
years. This secondary loss was actually his primary loss (secretly). Without
asking you may never know.
Features of grief
Grief is the reaction we have to a loss. Features of grief may include:
 Sadness
 Longing
 Somatic complaints
 Integration
In understanding the grief experience it is probably helpful for us to see the grief response
in four domains:
 Emotions/feelings
 Thoughts (cognitions)
 Body sensations/somatic complaints
 Behaviours
Emotions
What are some of the emotions or feelings that people may experience in a loss?
 Anger
 Anxiety
 Depression
 Despair
 Helplessness
 Hopelessness
 Loneliness
 Longing
 Guilt and remorse
 Sadness
 Shock
 Relief
Thoughts
What are some of the thoughts that people may experience in a loss?
 Confusion – ‘I don’t understand’
 Fear of going mad – ‘I must be losing my mind’, ‘I’m going mad’
 Feeling unable to cope – ‘I’m not strong enough for this’, ‘I’m going to break in two’

 Questioning of values and beliefs – ‘Nothing makes sense anymore – how can there
be a God?’, ‘There is no meaning to this’
 Drop in self-esteem – ‘I’m a dreadful person, this is all my fault’, ‘If only I had loved
him more’
 Shock and disbelief –‘ How could this happen?’
 Trauma – ‘I’m destroyed’, ‘I can’t heal from this, it is impossible’
 Blame – ‘They took away my world when they fired me, I hate them’
 Change in worldview –- ‘No more Mr Nice Guy, it doesn’t get you anywhere, I’m
going to be a real bastard, maybe that is the way you keep a woman’
Body sensations
What are some of the body sensations (somatic complaints) people may experience when
grieving?
 Headaches
 Chest tightness
 Stomach pain/knot
 Shoulder tension
 Dizziness
 Dry mouth
 Confused feeling in the head
 Heavy heart
 Heavy legs
 Tingles in the hands and feet
 Dread sensation
 Jumpy/nervy
Behaviour
What are some of the behaviours that people may engage in when suffering grief?
 Withdrawal
 Reckless behaviour
 Nastiness
 Selfishness
 Distraction
 Blame
 Overcompensation – giving
 Talking about the loss repetitively
 Not talking about the loss – avoidance
 Crying
 Sleeplessness
 Over-eating
 Under-eating
 No interest in sex or trying to feel better through sex
 Spending/shopping
 Gambling

 Alcohol
 Drug use
 Suicide
Of course these are not exhaustive lists but it does help us understand some of the
individual differences that occur.
It is mostly the behaviour of grieving people which is obvious as this is externally
demonstrated. Some of the behaviours can be a way to feel better, to have momentary
relief in a sad world, for example withdrawal, over-talking, over-eating, gambling, drugs and
alcohol, shopping etc. Other behaviour can be self-punitive in order to gain some kind of
justice in the world, for example reckless driving, over-giving and even suicide. Other
behaviours can be a form of punishing others including blame, nastiness, resentment and
selfishness etc. Other behaviours are just part and parcel of depression – these would
include under-eating, sleeplessness, crying, loss of interest in sex etc. It may be important
to explore with your client what the behaviours they are engaging in are achieving for them.
It is important to do this in a non-judgemental way so that they can reflect on whether their
behaviour is useful or whether there is another way to act to help them feel better.
1.1 Clarify the impact of specific loss(es) and common features of grief and trauma and
their interplay at the individual, family and community level
Of course grief is not just an individually experienced thing. Even if other members of the
family have not lost something in common they may also grieve on behalf of their family
member. For example a son who fails university experiences this loss personally however
parents may also ‘feel’ for him and grieve this loss as well. Often family members who have
lost a loved one grieve together but of course each person has an internal loss which may
be different and inexplicable. When a child dies a whole community may be caught up in
this loss and imagine the pain of the parents and identify strongly with this loss. Suicide can
have an impact on a whole community and affect a wide range of people associated with
the person who has suicided in powerful ways.
In Indigenous communities the loss of a loved one on top of other losses that may not have
had resolution can have an impact on community members who connect closely at a very
deep level.
1.2 Recognise common but also distinctive expressions of grief and complex grief
We have discussed above some of the more common expressions of grief, and looked at
some of the features of complex grief in the previous section. Complex grief is experienced
when the grief doesn’t follow ‘normal’ patterns.
Complex grief may present as a fixed denial where the client cannot come to terms with
the reality of the loss. For example the elderly gentleman who accidently puts his foot on
the accelerator instead of the brake and kills his wife of 45 years and who persists in
believing that she is coming back from the shops and is just late. Or the mother whose son

went missing and had been previously suicidal who believes that he has just gone off but
will return soon and may just be trying to teach them a lesson. People for whom the reality
is extremely painful may stay fixed in denial.
At times people may feel a numbness in the face of an extreme loss and not have any
emotions around the loss. This may also be a way to prevent strong undesirable painful
emotions from descending. It may be that internally the person believes that they would die
from such a shock.
At times grief may erupt into violence for people that normally wouldn’t be prone to this
type of behaviour. The violence may then be seen as an expression of extreme emotional
self-preservation as the self-destruction, guilt and despair of allowing the pain of the loss
to register may be overwhelming. For example, this might be so for a father who accidently
runs over his toddler when backing out of the driveway.
Suicide as a response to dealing with grief can also be seen as a complex grief reaction.
Inability to recover from grief is also seen as a complex grief reaction. There are
generally subconscious blocks to recovery which may require expert psychological
assistance.
Other examples of extreme complex reactions to grief include: hysterical laughter,
uncontrolled compulsive purchasing, running away by moving or travelling and not returning
home.
1.3 Take into account distinctive social, cultural, ethnic and spiritual differences in loss
and grief
Social, cultural, ethnic and spiritual differences in loss, grief and bereavement may include:
 Reactions to loss
 Individual expressions of grief and bereavement
 Cultural expressions of grief and bereavement
 Spiritual and religious beliefs relating to loss, grief and bereavement
 Coping strategies
Some of the individual experiences that people have in coping with a loss have to do with
their internal world but what contributes to that internal world? We can put this down to
personality and some of the aspects of the person’s world that have shaped their thinking,
values, behaviours and so forth.
For example one family may not talk about loss or feelings but keep these feelings private
and quiet and prefer to act as if all is normal. Another family shaped by cultural expectations
and modelling will have a more overt response to loss and be extremely expressive in
emotions.
Outward symbols of grief may also be displayed in many different ways, for example by
wearing black or attending to certain rituals. Typically, cultural and religious beliefs have

developed over time to ‘help’ in the grieving process. Sometimes however an individual’s
needs and unique thoughts and experiences don’t fit the model and they may feel
unsupported by their religion or culture at the most difficult time in their life. People often
re-evaluate their beliefs and values at times of great loss and redefine who they are and
what they want to believe and how they will behave in future.
All people, regardless of heritage, culture or religious beliefs, have in common the ability to
choose how to express grief. We can choose to think about loss in a positive way and hope
to have adequate support and self-care through the process. As counsellors we need to look
for these features and check that individuals have these supports in place whatever culture,
religion, community or family surrounds them.
1.4 Recognise the elevated risk of developing negative impacts on health and wellbeing
after a loss
There is an elevated risk to health and wellbeing after a loss. Without expression and
resolution and without support for a loss the individual may be traumatised, may not adjust
to the loss and/or may have negative thinking leading to poor mental health. They may also
adopt unhelpful behaviours as discussed above, limiting their healthy integration of the loss.
Grief that is not supported or treated may well provide the start of a more serious mental
illness. Grief is not recognised as a mental illness although depression is very much part of a
normal grief experience and depression is identified as a mental illness. Sometimes it is a
fine line. We have to consider that people need time to recover from loss and that feeling
down is part of that. The fact is that if someone stays depressed for too long, six months or
more, and displays other symptoms such as loss or increase of appetite, weight gain or loss,
lack of desire for sex, lack of desire for socialisation, low self-worth, suicidal thoughts,
heaviness in the chest, legs or body etc. then they would certainly be diagnosed as having a
Major Depressive Episode. The shock of severe losses as well can impact the nervous
system resulting in panic attacks and nervousness. The diagnosis of this may be Generalised
Anxiety Disorder or Panic Disorder if it is persistent. Too much stress for too long can
mean that someone can develop Post Traumatic Stress Disorder.
1.5 Recognise and understand disenfranchised grief
We have looked at the concept of disenfranchised grief above. This is when a loss cannot be
shared publically and the grief is unexpressed because of stigma or shame. It is important
that we recognise how disenfranchised grief works in our counselling practice. To do this we
need to understand typical situations where our society may attribute blame in experiencing
a loss.
For example if someone chooses a path but then grieves as a result of the change that has
occurred the person may feel inclined to hide their pain, believing they may be judged or
judge themselves for the action. To show the grief is to make themselves vulnerable to
others. Examples include abortion, breaking up with a husband or wife, adopting out a child,
quitting a job, moving away from family voluntarily etc.

We need to comfort individuals about the fact that the grief is real despite our sense of a
decision being right or wrong. This is because change requires adjustment and longing for
the familiar, or for something that has worth even symbolically, and it can be a bitter pill to
swallow. Whether the outcome of the change is seen as ‘good’ or ‘bad’ doesn’t negate the
grief experience.
1.6 Identify and demonstrate understanding and respect for specific approaches and
responses of individuals, families and communities to grief
The ways in which people negotiate their losses and go through their grieving will be
extremely different. Our job as counsellors is to show respect and to grow in our
understanding through observation, gentle questioning and testing strategies that bring
relief to individuals, families and communities.
1.7 Demonstrate understanding of integration of loss
Loss is a normal part of life and needs to be integrated into our thinking and our lives. We
need to understand that losses are normal (as is failure) and that none of us, no matter how
clever or avoidant, will be able to live without experiencing a loss. We need to normalise loss
for our clients.
Self-blame for loss is quite common. It is always important to explain to clients that blame
and refusal to forgive yourself or others will not help. Typically the thinking behind this is
that people ‘should be good, and if possible perfect’. We need to observe individuals and
families and support them in positive ways of managing the grief experience and encourage
helpful thought processes.
Dealing with a loss caused by another person can be incredibly hurtful. We can explain to
clients confronting this scenario that the people responsible have had experiences which
have caused them to act in the way they have. To understand this is better than holding
onto a grudge. To forgive themselves as an imperfect human being who is on a learning
curve is also better than to sit in guilt.
2. Engage empathically with people who are living with loss
2.1 Interact with individuals with empathy, sensitivity, professionalism and courtesy
This may include:
 Empathic listening
 Identifying and affirming the grieving person's strengths and opportunities
 Helping manage overwhelming feelings to facilitate coping
 Using questions and concreteness to focus on identifying immediate needs and
concerns
 Facilitating informed choices by the grieving person
 Unconditional positive regard for the grieving person
 Non-judgemental approach

 Genuineness of response
2.2 Identify and respect social, cultural, ethnic and spiritual differences which may affect
grief and bereavement responses
Again, while we may recognise the different ways that people grieve and their various
bereavement responses, to respect these can be incredibly difficult. It is all too easy to
judge, especially around emotionally charged issues and situations. We need to practise
what we preach and this is not always easy.
It may be that you see a woman dressed all in black for a year and you feel that this is not
helping her. It may be that you believe that it is better to speak about the deceased but the
person won’t. You may worry that someone may be repressing their feelings and will suffer
later because their faith expects them to be cheery about the death of their loved one who
is now ‘in heaven’. Respecting other people’s beliefs will assist us to help other people. The
tools to help can be found through understanding the individual’s own culture.
2.3 Apply, within culturally appropriate boundaries, verbal and non-verbal approaches to
dealing with and responding to grieving individuals
Appropriate verbal and non-verbal approaches may include:
 Verbal approaches that support empathy, sensitivity, professionalism and courtesy
 Facial expressions, gestures, eye contact and personal space that support empathy,
sensitivity, professionalism and courtesy
2.4 Apply, within culturally appropriate boundaries, empathic listening skills
Empathic listening skills may include:
 Appropriate brief encouragers which help the grieving person relate their story and
concerns
 Reflection of feelings/thoughts, behaviours and experience (content)
 Hearing the grieving person’s concerns
 Paraphrasing (reflection of content)
 Using open and closed questions to expand or clarify understanding
 Understanding the grieving person's context
 Recognising when higher levels of care may be indicated
 Balancing the frequency of questions
 Summarising and closure
 Application of listening skills within culturally-appropriate boundaries
3. Provide support for individuals who are grieving and identify
potential for healing and growth
3.1 Recognise common reactions to loss and the range of grief responses

As mentioned above our capacity to recognise common reactions to loss and the whole
range of grief responses will be the first step in assisting people. Dealing with young people
facing grief poses additional problems however.
In teenagers grief responses may be more difficult to detect. Even under normal
circumstances adults have difficulty interpreting teenage behaviour. Young people who are
grieving may become involved in drug taking and other risky behaviour. They may oscillate
between withdrawal and excessive socialisation and in extreme situations contemplate
suicide. Being aware of teenagers’ verbal and written expression, their music choices and
unusual behaviours is important, especially after experiencing a loss. It is useful to enlist the
support of peers after a significant loss for a young person to watch them and report any
disturbing behaviours.
Grieving children may oscillate between normal play and distraction behaviours and
feelings of helplessness and sadness. Like adults this movement between grieving and
avoidance of grieving is important for the adjustment process. Assisting younger children to
express their feelings can bring security and relief to the child. This can be done through
drawing and play (for instance with sand tray therapy) and helping them to normalise what
is happening through bibliotherapy (the reading of books for therapeutic purpose). Ensuring
that children do not take on blame for a loss event is also critical. Children are ego-centric
and tend to believe that bad things that happen around them must be linked to their own
behaviour.
3.2 Recognise common reactions to trauma and the range of responses
Trauma responses should also be recognised. Nightmares which don’t stop, flash backs,
hyper vigilance, significant startle responses, inability to manage emotional responses etc.
may indicate that the person has been traumatised by the loss. In these cases it is
important to refer to an experienced psychologist.
The reactions to a traumatic loss can be substantially different to a loss which is anticipated
or expected, for example the sudden loss of a child in a car accident compared to the death
of an elderly parent who has been ill for some time. This does not mean that an anticipated
loss is not traumatic however. Loss experiences are individual and trauma may be
experienced in some seemingly innocuous situations.
3.3 Identify individuals experiencing difficulty in coping with grief and trauma and link
them with options for further help as needed
Difficulty in coping with grief and trauma may include:
 Symptoms of separation distress
 Symptoms of traumatic distress/stress
 Complex grieving
 Suicidal ideation

In dealing with all of these situations the counsellor will need to assess whether these
difficulties mean that the client needs referral to other specialist services for additional
support or treatment.
3.4 Demonstrate understanding of the role of complex grief reactions
We have looked at the features of complex grief in previous sections. When grief doesn’t
end or doesn’t begin or won’t move beyond a certain stage there are reasons for this.
Typically a halting of the grief process has to do with protection of the client’s psyche from
what it fears is ‘worse’ emotional pain. It is important to refer clients experiencing complex
grief for specialist treatment.
3.5 Identify and assess an individual’s suicide risk and where necessary refer to
appropriate services
Suicide risk can be assessed by observation of body language and by listening to the client’s
expression (either in writing or verbally) for signs which indicate loss of connection or
meaning or overwhelming emotional pain. When the client has the means of harm at their
disposal and no one to watch them the potential risk is magnified. If a client has had
thoughts of overdosing, for example, and they have access to tablets and live alone, a
suicide attempt is a very real possibility if they have been thinking about the
meaninglessness of life, the pain of life, or their own worthlessness etc.
Again, referral for appropriate specialist treatment is essential in such cases.
3.6 Use, within culturally appropriate boundaries, communication techniques to respond
to each individual’s needs in relation to their grief and bereavement
As mentioned above the client’s own culture will give us clues in responding to their needs.
If we ask people what they have found helpful or what they need directly this can provide
some useful guidance.
The need to tailor communication techniques to suit the client applies as in any counselling
scenario. The skill of the counsellor is in being able to assess what techniques will be
appropriate for each individual.
3.7 Identify, suggest or use strategies for formal and informal grief and bereavement
support
Grief and bereavement support strategies and grief and bereavement care services may
include:
 Aboriginal health services
 Coronial services
 Emergency services
 Empathic listening
 General practitioners
 Group grief counselling

 Health services
 Individual grief counselling
 Palliative care services and teams
 Practical support
 Psychological services
 Spiritual and faith care services
 Support group
 Telephone counselling services
3.8 Maintain confidentiality in line with organisation practices
Confidentiality provides clients with the sense that they have a space of safety and trust.
However if you sense that a client is suicidal or may do something illegal which will hurt
other people you may need to call the police if you are not able to satisfy yourself that they
are completely safe.
4. Identify, inform and refer to appropriate grief and bereavement
care services and resources
4.1 Identify grief and bereavement care services available in the community
Some general support services were listed above. The type of specific support services
available will depend on the community. In larger cities specialists of all descriptions are
available, including for grief support. Sometimes there can be problems in accessing these
services as they may be at a great distance from the client. Finding these services can also
be a challenge with a number of organisations vying for attention through advertising.
Internet searching can refine this task considerably. We typically think that a smaller
community has limited services for grief support, however on the other hand it may be
easier to review each of the possibilities more quickly.
Lifeline telephone counselling is a nationwide service which is particularly useful for grieving
people as they can access it at all times of the night or day and talk to someone
confidentially who is trained to identify suicidal ideation and can also provide ideas on
further bereavement support within the client’s area.
4.2 Identify referral procedures in accordance with organisation policies and procedures
Referral procedures may include:
 Referral information
 Referral databases
 Referral protocols
4.3 Identify and make accessible general grief and bereavement care information
resources
Grief and bereavement care information resources may include:
 Internet resources

 Fact sheets
 Information packs
 Books
4.4 Fully inform individual about grief and bereavement care service options
In supporting your client it is important to consider what kinds of supports they may prefer.
Some people find reading particularly helpful as they don’t want to go out of their homes
more than necessary. Other people are more inclined to connect with an ‘expert’ to assist
them. Still others may appreciate a help group like ‘Seasons for Growth’ where they can
meet with others who have experienced a loss and form a support network. Find out from
your client what they would prefer.
4.5 Obtain feedback from individual to determine whether options are clearly understood
Don’t forget that a grieving person may have a limited capacity to remember information
and digest it. Ensure you find out that they clearly understand their options by asking for
feedback. You might also provide information on a hand out.
5. Identify and recognise risks associated with grief and
bereavement support
Risks associated with grief and bereavement support may include:
 Compassion fatigue
 Vicarious traumatisation
 Burnout
 Lack of adequate supervision
 Lack of access to external expertise
Grief is a very sad area to work in for the counsellor. Stories of loss can easily trigger our
own fear of losing a loved one or a valued situation. As counsellors we focus on our capacity
to be empathetic but this can also be our own undoing. It is extremely important to have
good supervision and have a place to ‘empty’ our own sadness in hearing a great number of
loss stories. We may be especially vulnerable if the story has some connections to our own
life experience. For example we may have a sick mother and a client’s mother has just died
of cancer. Their painful story may make it difficult for us to adequately support them as our
mind is focused on our own situation. In these cases it may be important to refer the client
to someone else. The way you do this must be gentle and caring and should provide the
client with ‘reasons’ so that they do not feel abandoned.
5.1 Identify and recognise a range of risks associated with grief and bereavement
support
As a mental health professional it will be important that you don’t take this role in
bereavement support lightly. Keep regular supervision in place and reflect regularly on your
own wellbeing and capacity rather than continuing regardless and ignoring your own self-
care.

5.2 Develop and implement appropriate strategies to minimise risks associated with grief
and bereavement support
Strategies to minimise risks associated with grief and bereavement support may include:
 Self-care
 Supervision
 Debriefing
 Back-up support
 External networks and expertise
6. Access appropriate supervision and debriefing
6.1, 6.2 Identify the need to access appropriate supervision and debriefing
This may include:
 Duty of care to clients
 Self-care
As noted above, there are many risks associated with grief and bereavement support work.
Counsellors need to be self-aware in identifying the need for supervision support and
debriefing, as discussed below.
6.3 Develop and implement appropriate strategies to access supervision and debriefing
Various agencies have different rulings around supervision and debriefing and some do not
have anything in place at all. Whatever supervision practices your organisation follows,
when it comes to support you need to initiate this when you need it. New counsellors may
feel awkward about initiating supervision and debriefing outside of ‘regular’ times, however
it is very important that this occurs on a needs basis.
7. Review and evaluate grief and bereavement support provided
7.1 Reflect on outcomes during and after support is provided
It is important to consider how effective your support has been to the client. Ways to do this
include a feedback form, observation of your client’s progress and direct verbal feedback.
One great way to identify value is through use of a ‘scale’, as written or verbal responses
can be hard to evaluate objectively. You might ask the client whether they could rate how
helpful the counselling has been on a scale of 1-10 where 10 has been ‘incredibly helpful’
and 1 ‘not helpful at all’. It is important that you don’t take this feedback personally. Grief is
not an issue which is ‘over’ in one session but takes its own time.
You can also find out from the client what things help them the most and encourage them
to do more of that. We always hope that our help is incredibly useful. However some
grieving clients might find that nothing much can take away the pain and sadness of loss,
especially very early on in the process. If this is the case keep contact with the client as they
will need continued support.

7.2 Identify where further support is required
You may encourage other supports concurrently with your counselling sessions or refer to a
specialist psychologist or grief counsellor or other service provider afterwards if the need still
exists.
7.3 Review practices for continuous improvement
As with any therapeutic intervention it is important to constantly review counselling practices
to see where there is room for improvement. None of us can hope to be immediately
effective in all counselling sessions with clients but we can grow in our capacity. It is usually
our own clients that teach us the most.

READINGS & RESEARCH
Review readings on the online student portal on the following under Learning Resources:
 Stress Vulnerability Model (Article on Grief and Loss)
 Loss, Grief and Bereavement - Coping With Loss
 The Coronial Process
 Grief Recovery Checklist
REFERENCES
Kubler-Ross, E. 1969, On Death and Dying, Simon & Schuster/Touchstone
Marriage and Family Encyclopedia, available at <family.jrank.org>, accessed April 2013
Stroebe M. and Schut H. 1999, ‘The Dual Process Model of Coping with Bereavement:
Rationale and Description’) in Death Studies, Vol 23(3), April-May
Worden, JW. 1982, Grief Counselling and Grief Therapy, Springer Publishing Co., New York
Zubin and Spring. 1977, The Stress Vulnerability Model,
http://www.hearingvoices.org.uk/info_professionals_stress.htm, accessed April 2013
WEBSITES
The following websites provide support material for grief and loss.
National Association for Loss and Grief (NSW)  www.nalag.org.au
Australian Centre for Grief and Bereavement  www.grief.org.au
Australian Child and Adolescent Trauma, Loss
and Grief Network
 www.earlytraumagrief.anu.edu.au
National Association of Loss and Grief
(Victoria)
 www.nalagvic.org.au
Compassionate Friends  www.compassionatefriendsvictoria.
org.au
SIDS and KIDS  www.sidsandkids.org
Lifeline  www.lifeline.org.au
Email to heaven  emailtoheaven.org/

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