Georgia Family Crisis Solutions

How individuals and families cope with dying, death, grief, loss, and bereavement is as unique as a
fingerprint. The response to the death of a family member, relative, or close friend places one in the
category of "bereaved." Those who are bereaved experience grief, a person's response or reaction to
loss, which encompasses physical, psychological, social, and spiritual components. How one copes with
other life events and adapts to one's present and future is also part of the grieving process.

In the broadest context losses can be thought of as the loss of one's possessions, one's self, one's
developmental losses, or one's significant others. Historically, many grief counselors and grief
therapists have chosen to follow the popular "grief counseling theory of the time." However, in the
twenty-first century there are constantly changing theories regarding grief and loss, and new
challenges and questions raised by researchers, clinicians, and the bereaved themselves regarding
what is or is not helpful during the bereavement process. In addition to counselors and therapists as
defined in the more traditional sense, "grief and bereavement specialists" have emerged to help
people deal with their grief, both before and after death.

What Is Grief Counseling and Grief Therapy?
In Grief Counseling and Grief Therapy (1991), the clinician and researcher William J. Worden, Ph.D.,
makes a distinction between grief counseling and grief therapy. He believes counseling involves helping
people facilitate uncomplicated, or normal, grief to a healthy completion of the tasks of grieving within
a reasonable time frame. Grief therapy, on the other hand, utilizes specialized techniques that help
people with abnormal or complicated grief reactions and helps them resolve the conflicts of separation.
He believes grief therapy is most appropriate in situations that fall into three categories: (1) The
complicated grief reaction is manifested as prolonged grief; (2) the grief reaction manifests itself
through some masked somatic or behavioral symptom; or (3) the reaction is manifested by an
exaggerated grief response.

Does a person need "specialized" grief counseling or grief therapy when grief, as a normal reaction to
loss, takes place? Are people not able to cope with loss as they have in the past or are individuals not
being provided the same type of support they received in previous generations? Individual and family
geographic living arrangements are different in the twenty-first century than in past years. People have
moved from rural to urban centers, technology has altered the lifespan, and the health care decisions
are becoming not only more prevalent but often more difficult. Cost and legal issues become factors in
some cases.

Today, ethics committees in hospitals and long-term care facilities are available to help families and
health care providers arrive at common ground. Traumatic and violent deaths have also changed the
bereavement landscape. What had helped individuals and families in the past in many situations has
eroded and the grief and bereavement specialist, or the persons, agencies, and organizations
providing those services, is doing so in many cases out of default. Grief counseling is used not only by
individuals and families, but in many situations by schools, agencies, and organizations, and in some
cases by entire communities affected by death.

Goals of Grief Counseling and Therapy
Professionals believe that there are diverse frameworks and approaches to goals and outcomes of the
grief counseling and therapy process. Robert Neimeyer believes, "The grief counselor acts as a fellow
traveler [with the bereaved] rather than consultant, sharing the uncertainties of the journey, and
walking alongside, rather than leading the grieving individual along the unpredictable road toward a
new adaptation" (Neimeyer 1998, p. 200). Janice Winchester Nadeau clearly reminds grief counselors
and grief therapists that it is not only individuals who are grieving, but entire family systems. A person
is not only grieving independently within the family system, but the interdependence within the family
also affects one's actions and reactions. According to Worden there are three types of changes that
help one to evaluate the results of grief therapy. These are changes in: (1) subjective experience, (2)
behavior, and (3) symptom relief.

Where Is Counseling Done and In What Format?
Grief counseling and grief therapy are both generally done in a private area (generally an office
setting). These private areas may be within hospitals (for both inpatients and their families and for
outpatients), mental health clinics, churches, synagogues, chemical dependency inpatient and
out-patient programs, schools, universities, funeral home aftercare programs, employee assistance
programs, and programs that serve chronically ill or terminally ill persons. Additional sites might
include adult or juvenile service locations for criminal offenders. Private practice (when a counselor or
therapist works for herself) is another opportunity to provide direct client services.

Treatment options include individual, couple, and family grief counseling or grief therapy, and/or group
counseling. Sessions are approximately one hour in length, or longer for individual sessions. Groups
are either closed (for a set period of time with the same small group of individuals attending each
session) or open (offered once, twice, or several times a month and open to whoever attends without
previous registration or intake). Grief support groups are generally not therapy groups, but supportive
therapeutic environments for the bereaved. Group sessions are generally ninety minutes long.
Treatment plans are used by grief counselors in most individual and family counseling situations and in
all grief therapy situations.

In some cases a grief counselor may be meeting with a person one time to help "normalize" what the
person is feeling, while grief therapy requires multiple sessions. In most cases a fee is paid by the
person utilizing the grief counseling or grief therapy service and is either paid on a sliding scale or by
self-pay, third-party insurance, victim assistance programs, community charitable care programs, or
some other type of financial arrangement. Some hospice/palliative care programs offer grief
counseling and grief therapy services at no charge for a limited number of sessions.

Crisis intervention hotlines emphasize assessment and referral, and residential settings for children,
adolescents, and adults are also locations where grief counseling or grief therapy is utilized. A number
of grief therapists do consulting work with other grief therapists or grief counselors, or with agencies
or organizations.

Approaches Used
There is not one method or approach. Each counselor or therapist has his or her own techniques that
he or she utilizes because they are effective, although counselors often defer to other techniques that
suit a particular person much better based on the individual's circumstances. Counseling and therapy
techniques include art and music therapy, meditation, creation of personalized rituals, bibliotherapy,
journaling, communication with the deceased (through writing, conversations, etc.), bringing in photos
or possessions that belonged to the person who has died, role playing, bearing witness to the story of
the loved one, confiding in intimates, and participating in support groups.

The "empty chair" or Gestalt therapy technique is also an approach widely used by grief counselors
and grief therapists. This technique involves having an individual talk to the deceased in an empty chair
as if the deceased person were actually sitting there; afterward, the same individual sits in the
deceased person's chair and speaks from that person's perspective. The dialogue is in first person,
and a counselor or therapist is always present. The Internet also provides a number of sites that
address the topic of grief and provide links to counseling services and organizations.

How Effective Is Counseling?
Various factors will determine the effectiveness of grief counseling or grief therapy. Some counselors
and therapists utilize instruments to measure the effectiveness of the helping sessions. Others rely
upon subjective comments from the client, his or her family, behavior observations, cognitive
responses, symptom relief, and spiritual discussions. Because grief is a process and not an event, what
takes place along the grief journey may alter how one continues to cope and adapt to loss. One loss or
multiple losses do not make a person immune to future hardships.

Qualifications of Counselors and Therapists
Most grief counselors and grief therapists have advanced degrees in either social work, nursing,
psychology, marriage and family therapy, medicine, theology, or a related field. Many have terminal
degrees. In the United States and Canada, there is no state or provincial grief counseling or grief
therapy certification requirements as of 2001. However, to practice in the United States in fields such
as social work, psychology, or marriage and family therapy, a state license is required.

Georgia Family Crisis Solutions Counseling Center offers advanced Grief Counseling and we invite you
to make your appointment today.