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When you have experienced a loss, grief can be overwhelming. It can be difficult to know where to turn. I interviewed Lara Krawchuck MSW LCSW MPH, a grief expert, about how to best cope when things feel out of control after a loss.
Lara is the founder and CEO of Healing Concepts, LLC a counseling, continuing education and consulting practice in West Chester, PA. Her clinical specialties include supporting families facing illness, living losses, life transitions, and bereavement. She facilitates several support groups for patients facing cancer and healing retreats for helping professionals. Lara is a long time adjunct professor at the University of Pennsylvania School of Social Policy & Pratcice and West Chester University’s MSW program. She regularly teaches advanced clinical social work practice, supporting families at the end of life, and loss and grief related classes. She lectures nationally on ambiguous loss, caregiving, coping with cancer & illness, creative healing, grief, and professional stress management.
What are the different stages of grief? Does everyone go through these stages?
Research has shown that the stages of grief do not accurately depict how people actually grieve. There are no set emotions or neat stages for grievers. People can experience virtually any emotion when they are grieving and though healing is always possible; it does not always look like what has been defined as "acceptance" by Elisabeth Kugler-Ross MD. Instead, people who are grieving engage in a process by which they explore the unique meaning of their loss and what the loss means to them in terms of who they are and where they are going. What just happened eventually leads to who am I now without this person and who am I going to be? This process of Meaning-Making can look like questioning or exploring the fine details of the loss. It can also involve asking what this loss says about them or the state of the world or God. Finally, people can explore how to rebuild their lives and once again lead lives that make sense to them, even in the shadow of great loss. The tricky thing is that there are no clear answers to the questions. Even members of the same family come to very different conclusions about what occurred and what the loss means for their present and future selves.
How is grief from a job loss or divorce different than grief from a death? Or is it the same?
In some ways these kinds of losses are very different. Grief from a divorce or job loss are often called "living losses" or "ambiguous losses" because they involve the living, and are sometimes lacking "closure" or full endings. For example, you may be divorced from someone, but still see them regularly when navigating co-parenting. You may be forced to leave a job, but are still friends with others who work there. These grievers often need to learn to honor the pain of the loss while still engaging in the old relationship in new ways. This can be very difficult. Also it can be hard to give yourself permission to grieve someone who is still alive or a place that still exists, so people often feel pressure to "move on" instead of honor the depth of the losses. Usually there are no rituals to mark the death of a relationship, so people can feel a lack of the ability to say goodbye in a way that feels healing. They too often lack community support around their grief. For example, many cancer patients I work with are told to be grateful for surgeries that take off parts of their bodies because "it got rid of the cancer" or to stop being so sad about hair loss or job loss because they "need to see the big treatment picture and be grateful". This seriously undermines their ability to grieve living losses and can complicate emotional healing from often devastating cancer treatments.
On the other hand these living losses can be similar to a death in that they are extremely painful, and each individual will grieve in a way that reflects the unique quality of the relationship to that which was lost. These grievers also ask questions about what happened, and why and who they are now. Exploring the loss and making sense of what has changed is the key to healing, even if this process is not done “neatly".
What advice would you give parents that feel they shouldn't cry or be upset in front of their kids?
It is important for children to hear hard truths from the people they love and trust the most. They should not hear things by accident at school. They can be taught that it is ok to be sad, or cry when sad, and that it it is also okay to play and have fun, even when grieving. Showing, by example, can be very powerful because kids will not feel as much pressure to protect other grieving loved ones or hide or bury their true emotions. Buried grief can bubble to the surface in troublesome ways later on in a person's life. We can teach kids not to fear grief, but to find safe ways to express it.
What does the current research say about the effectiveness of psychotherapy for grief? Is there a type of psychotherapy that has been found to be more effective than others?
The limited research on the effectiveness of psychotherapy is a bit mixed, but I am told every day by grieving individuals and families that having a safe and knowledgable therapist (or support group or clergy) to guide them through grief helps immensely when the life they knew was shattered. Individual, family and group support are all good options. People should select helpers who are well versed in the new ways of thinking about grief and how to heal. Do not work with anyone locked into old ways of thinking or who tries to solve grief through medication alone. Healthy grieving usually requires receiving support from someone safe as you wrestle with the hard questions, and find your way to rebuilding a meaningful life. You can't really medicate away the pain of grief, though sometimes this is a part of the path towards healing.
What are the benefits and differences of individual therapy and group therapy for grief?
Some people prefer to explore their pain privately with someone safe. Others prefer being in the company of others who "get it". Bereavement specialists at local hospices can be a good place to seek group support or names of local therapists trained in offering grief support.
When a person is grieving, what are some ways they can cope with the additional stress of working, being a parent, and being a spouse?
I have lots of ideas here! It is really important to let others know what you are struggling with so that they support you in your grieving. Tell them what you need from them because they just do not know. I told my spouse when my beloved father died that I wanted him to stop trying to "fix" my grief and instead start hugging me tightly when I came apart at the seams. I told my children not to worry when "mommy was having a moment" but instead to come in for a huge bear hug. To this day they still heed this request and I love it! Tell your friends and family exactly what you need from them, update them when your needs change (as they undoubtedly will), and never expect them to read your mind because they will surely fail at that.
Seek out and accept help. Tell your story to those who will listen. If you have to find a professional to listen then do it! Seeing a counselor in times of grief is a strength. Try not to see it as a weakness and you will reap the benefits!
Give yourself a break - grief is hard! It takes a lot of mental energy and sometimes other things will get dropped or forgotten. Mistakes will be made. Try not to judge. Instead be really kind to yourself and to others who are grieving.
Give yourself time - LOTS of it! Grief does not end after 6 months, or a year, or even longer. For many, grief takes along time and it is hard. Do not listen to anyone who tries to tell you how or how long to grieve. Great love often requires great grief. You can grieve deeply and also learn how to thrive again at the same time. Take time to honor the pain and also take time to seek beauty and joy. Over time the pain will lessen. If it does not then have the wisdom to seek support.
How does grief appear differently when the death was expected (i.e. long-term illness) versus sudden and unexpected?
Deaths that were sudden, considered preventable, or traumatic can be especially challenging to heal from because they can be particularly difficult to make sense of. Do not hesitate to seek professional support or a group if the death of your loved one was traumatic in any way. It can also be challenging for loved ones and friends to know what to say in these circumstances, so professional help can really make a difference to these grievers. Guidance is often necessary to help these grievers heal.
A death that was expected can also be challenging because of the trauma of witnessing suffering or decline in someone you love deeply. Also, just because we know someone is sick does not always translate into knowing they are going to die - so people often wrestle with feeling blindsided even after a long illness. Again - no one can tell you how to heal so take your time and seek support of someone who is willing and able to deeply listen without rushing your pain.
For more information on therapists that can help you, see the Association for Death Education and Counseling's Resources page or contact your local Hospice organization for more information.
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