Counseling the Broken Hearted - Memories of Grief
Grief is painful. When we talk about grief we are referring to the extreme emotional reaction of an individual to loss, which often includes shock, sadness, fear, anger, confusion, somatic disorders, and loss of identity. If the grief is not resolved, complicated grief will be the outcome; that is, grief that is prolonged past what society considers normal (Curran, 2007). Some people grieve for years and never do resolve it (Paffenroth, 2006), especially the parents of a child who has died. Commonly, we associate grief with bereavement or the loss of a loved one to death; however, other losses cause grief also, losses such as sensory loss (hearing or vision), loss of memory (as in Alzheimer's, for example), loss of employment, mobility, or independence. Crawford-Faucher (2007) discusses the professionally induced grief that nurses inevitably suffer when all the deaths they witness add up and become somehow "personal." Likewise, Macpherson (2008) describes a program of storytelling that helps pediatric nurses in the cancer ward to recover from the pain of seeing children die. An article in the Practitioner (June 29, 2006) argues that simply realizing the end of life is approaching can cause a loss of "expectancy" in elderly people, which brings grief and may precipitate a crisis in the individual.
Of course, grief is nothing new. To experience it is part of the human condition. "Griefe," or "dying of a broken heart" was only two hundred years ago an official cause of death. Everyone knows at least one example of a marriage in which the surviving spouse died within hours, days, weeks or months of a long-time partner. Moreover, in the 1960s a study showed that loss of a spouse increases the survivor's likelihood of death by seven times! (the Practitioner, 2006). The stress and emotional upheaval that grief causes is significant. The death of a spouse, for instance, "ranks first out of 43 stressful events' on the Social Readjustment Rating Scale" (Muller & Thompson cited in Briggs & Pehrrson, 2008).
Professionals have long believed that grief has a potentially negative effect on an individual's health. Anderson (2006) reports that the immunity of two groups was tested in the laboratory in a study of the effects of grief on physical health. One group had suffered the death of a spouse; the other group, used as a control, had not experienced a death. The test results showed, "Response to mitogenic challenge, a measure of the immune system's ability to respond to assault by infectious and toxic agents, was significantly compromised at eight weeks following the death of a spouse" (p. 128). Thus, the negative impact of grief on health and the quality of an individual's life can hardly be overstated.
"truism" we often hear is that "Time heals," but really, it isn't so. Although healing may indeed take time, the mere passage of time is not enough to be a healing agent. Dependence on time to heal grief is not a wise course. Moreover, if depression occurs as a result of unresolved grief, the person may not take proper care of self. Accidents, self neglect, and self-harm may be the result of the attendant despair that sometimes overwhelms the person with a "broken heart."
The presence of anger that the grief-stricken must deal with at some point can further complicate grief if not dealt with constructively. "I doubt anything is more fundamental to dying and grief than the simple human reaction of anger; it is surely on a par with fear as the predominant feeling in the process" (Paffenroth, 2006, p. 57)
Unpleasant feelings must be confronted, embraced, and resolved for healing to take place. Some people are able to do this with no outside assistance; others, however, can benefit greatly from counseling and be spared the development of complicated grief. Church going people more often than not turn to their pastor for counseling, and this is natural since the pastor is often seen as an "expert," and the suffering individual may hope to find answers to questions about painful loss and other spiritual dilemmas connected with death and grief.
This paper will explore ways pastoral counselors can manage grief when members of the congregation come for help. In an older congregation grief may actually be the most common reason for seeking pastoral care because old age itself presents a series of losses and death occurs more frequently in the elderly.
Grief is common; yet, like the cold, it is not easy to effectively treat. Smith (2008) likened the experience of losing her mother to Robinson Crusoe when he was cast adrift a mile from shore, "an indistinct image of a stranded, barefoot man, pant legs tipped at midcalf -- straining, poling a raft back to his wrecked ship to gather provisions" (p. 77). Reassembling the pieces of one's life after bereavement is the difficult task of grief. Treatment requires first and foremost that the counselor possess that quality we call empathy; that is, the ability to feel what the other person is feeling. Willingness to do this, to experience another's pain and suffering, comes with Christian compassion and is part of loving one another as the New Testament demands. Sympathy or pity is not what is needed. As Keim (2007) points out, "The other's loss is also our loss. It should hurt like hell. If it doesn't, then something inside of us has died" (p. 18). Assuming that the pastor's empathy is well developed, we will look at some ways Christian counselors might deal with grief.
Ego Integrity, Life Review, and Narrative Reconstruction
Whiting & Bradley (2007) state, "Contemporary research suggests that the most influential factor in predicting well-being after loss is the ability to make sense out of what has occurred" (p. 123). According to these authors, if the grieving person can derive or construct meaning from what has happened, ego integrity will result. This involves finding answers to questions of how and why events leading up to the loss took place and reasons for decisions that had to be made. Sense making is what heals the pain and makes the person stronger.
The disruption of a devastating loss inevitably triggers a loss of identity and questioning the meaning of one's life. Many widows, for example, have been caregivers for most of their lives. When the husband dies and they are left with no one to take care of, the structure and fabric of their lives is disturbed and/or destroyed. Suddenly, there are no responsibilities and no reason to get out of bed in the morning. An older woman that lost her husband recently told me, "It's like a great, malicious gray wolf leaped and in one bite tore a throbbing chunk of flesh out of my heart. And afterwards, the chards of my whole life lying around my feet, bloody and unrecognizable" (Dunlap, 2008).
Part of the process of healing from grief requires that the person re-author his or her own life story so that it comes out differently and makes sense -- so that there is a new reason to get out of bed in the morning. Identity reconstruction with renewal of ego integrity is a goal in the process; that is, the development of the ability to see oneself and one's new role or mission in life as worthwhile and meaningful. The essential sense making questions that emerge during the crisis of grief are, "What led to this? What action was taken? How does this outcome fit with my philosophical and spiritual understanding of life?" (p. 123). Ego integrity as Erikson conceptualized it, develops when an older adult is able to see his or her life and the choices made as "productive, satisfactory, and valuable" (Whiting & Bradley, 2007, p. 119).
Just as important as sense making is the ability to find something beneficial in the circumstances before and after the loss. Whiting & Bradley (2007) reported Neimeyer's research in 2002. He interviewed "hundreds of bereaved adults who in the 2 years after a significant death found themselves more interpersonally close and connected, deeper in their spiritual belief, healthier in their personal habits and lifestyle, and existentially more aware than at a younger age" (p. 123). Finding benefits such as these can be difficult -- they emerge gradually over a period of time during which the individual is adapting to the loss. Something else that helps healing is to review the relationship with the deceased person and find "positive themes" (p. 123). "Positive reminiscing is one way of benefit finding that reaffirms the worth of the relationship to the individual's life story" (p. 123). The counselor might ask, "How did the relationship [with the deceased] make your life different than it would have been had that person not come into your life? What impact did the person make on your growth and development?"
The goal of narrative reconstruction is to recreate identity after the loss. This means fitting the loss into one's life story so that both the…