A Comprehensive Guide to Grief Counseling in Seattle

Symptoms of Grief

Grief is a deep sorrow, usually caused by a loss of some kind. Grief isn’t always initiated by a death; it can be due to any kind of loss. In therapy, I often see loss related to expectations, dreams, identity, abilities, and family. Symptoms of grief include misery, sadness, anguish, pain, distress, agony, torment, and despair. People may feel anger, confusion, denial, avoidance, isolation, and physical manifestations. Initially after a loss, such feelings can be all consuming and the idea of living any sort of normalcy is far from the imagination. This guide is meant to help you navigate common questions around grief, grief counseling, and give you a starting point to asking other questions. If you or a loved one are suffering, know you don’t have to face this sorrow alone.

A handprint on a wet window. — Photo from Unsplash

Grief v. Depression

Practically speaking, grief and depression can feel very similar but there are important differences. Grief is an emotional that all humans can relate to at some point in their lives. It often comes in waves with small moments of contentment or happiness mixed in. Grief looks different for different people depending on the cultural context and type of loss.

During grief, self-esteem typically remains stable and there isn’t a self-loathing component. Grief can turn in to depression if not dealt with and accessed. It’s not uncommon to experience other emotions during grief such as anger, anxiety, confusion, loneliness and more.

Depression is considered a mental illness, where grief is not. To receive a Major Depression diagnosis, a person would have to have experienced at least one major depressive episode which lasts at least two weeks. Another major differentiation between grief and depression is the self-esteem piece. People experiencing depression tend to feel a sense of worthlessness or excessive inappropriate guilt. They may even feel suicidal. These symptoms aren’t typically present with grief alone. If you’re unsure what may be happening with you, please feel free to reach out and discuss your concerns. Schedule a free consultation by clicking here.

Best Kind of Therapy for Grief

There are many modalities of therapy that work well with grief. I primarily utilize the evidence-based practices of Acceptance and Commitment Therapy and Narrative Therapy. Acceptance and Commitment Therapy (ACT) accepts that suffering is part of life and instead of rejecting or denying that fact works to become more psychologically flexible and resilient. Narrative Therapy works to incorporate the new reality of the loss into the greater story of the person’s life.

How a Therapist Can Help with Grief

Firstly, a therapist can hold a safe place for you to express your thoughts and emotions without judgement or making it about themselves. That’s something you rarely get in everyday life. Holding space is a powerful tool. Therapists can also help teach practical skills to cope with intense emotions, build helpful communication strategies, and relate to pain in a more manageable way. Therapy isn’t about ‘fixing’ you or ‘getting past’ the loss but rather moving forward as an integrated whole.

Grief Coping Skills

Reaching out to support systems (friends, family, community, spiritual leaders)

Movement (if too much, start with envisioning movement in your mind)

Getting into nature

Mindfulness Practices

Spiritual Practices

Rituals

Journaling

Art

Individual Therapy

Family Therapy

Support Groups to specific kind of loss

Engage in physically comforting activities (focus on your five senses—touch, taste, smell, sight, hearing)

Kinds of Grief

· Integrated grief: This kind of grief describes when a loss has been accepted and integrated into regular living. It doesn’t mean you’ve forgotten the pain but rather it’s become part of your story.

· Disenfranchised grief: This kind of grief isn’t socially acknowledged which often leads people to suffer in silence. There aren’t typically social prescribed ways of coping with this kind of loss. Check out my blog on disenfranchised grief and chronic illness.

· Ambiguous grief: This kind of grief relates to a loss that isn’t apparently concrete. An example may be early pregnancy loss, death without a body, or a loss of a dream.

· Anticipatory grief: This kind of grief typically occurs when there’s knowledge of a loss that’s going to happen but it hasn’t happened yet. Someone might feel this if they’ve been given a terminal diagnosis or if they know they’re going to end a relationship.

· Complicated grief: This type of grief occurs when grief doesn’t lessen over time and the impacts of the loss compound to lead to other challenges impacting quality of life.

Grief v. Mourning

Grief describes the emotions we feel after a loss, while mourning is the outward expression or acting out of those feelings. Mourning is often associated with rituals and traditions depending on a person’s beliefs and culture.

Grief v. Bereavement

The word bereavement refers to the experience of loss or of deprivation. Grief is the emotional, psychological, and behavioral response to loss. Bereavement can be thought of as a state of being whereas grief is the personal response to that loss.

How Long Does Grief Last?

There is no set timeline for grief. Many people explain that grief never fully goes away but that they relate to the loss differently, grow around the loss, or have a different relationship to the person or object that was lost. Many people say that the emotions change but that grief doesn’t end full stop. Of course, if grief is interrupting your daily functioning for an extended period, it may be time to seek out professional help.

What Does Grief Do to The Body?

Grief can trigger a fight or flight response in the body because your nervous system detects the pain of the loss as a threat. When our bodies stay in a fight or flight response for a long time, it strains our body’s ability to take care of itself. Sustained stress on the body can negatively impact our immune systems. This can lead to a variety of physical impacts including trouble with the heart, chronic illness, and disease. Prolonged mental suffering can impact physical health. Even though culturally our minds and bodies are often split and seen as two distinct entities, in reality they are intrinsically connected and form recursive loops with one another. Our physical health can impact our mental health and vice versa.

Common Theories of Grief

Dual process model: Stroebe & Schut:

· This theory focuses on the oscillate between loss and restoration orientations. This essentially means people oscillate between working to accept and face a loss and avoiding it.

Meaning Reconstruction Theory:

· This model focuses on meaning making related to the loss and incorporating that significant event into ones life.

Kubler-Ross Five Stages of Grief:

· One of the more well-known theories of grief. It describes five stages: Denial, Anger, Bargaining, Depression, Acceptance.

Bowlby: Attachment Theory:

· Also describes phases. Four phases of mourning—numbing, yearning and searching, disorganization, re-organization.

Some areas of Grief I Specialize in Working With

· Chronic Illness: When working with people facing chronic illness, injury or a significant life altering diagnosis grief is often a common emotion that arises. Grief can be felt as a response to a changing of abilities, the loss of dreams, expectations, hopes, plans, identity. These changes can be more on display which can lead to unhelpful or unwanted comments. They can also be inviable and often go unaddressed and unvalidated. Able ism is rampant in our culture and can intensify ambiguous and disenfranchised grief. Illness, injury, or diagnosis can also greatly impact relationships, including romantic, friendship and familial relationships. Part of learning how to move forward can be working on establishing new patterns of relating, different ways of connecting and communicating. There can be an additional layers of complexity added when a person has different marginalized identities. We know women, people of color, poor people, fat people all get different treatment within the American medical system.

Grief can also be experienced by loved ones, friends and family members as their lives are also impacted. It can be grief felt by loved ones even though they aren’t the ones experiencing the health issue. This can be felt as ambiguous grief or anticipatory as they look towards a future where more loss may occur. There aren’t solid social safety nets for people experiencing physical health issues (or mental health) in our country, thus people are left to fend for themselves in processing the mental, emotional and real world impacts of dealing with health issues.

· Infertility: Dealing with fertility and pregnancy loss carries a load of messy emotions and complicated feelings. People often share describing the feeling of whiplash, oscillating between excitement, anxiety, and dread. Even when couples are dealing with infertility, there is often an undue amount of pressure put on the person with the uterus because we live in a patriarchal society that assumes that person is the problem. Neither sex is disproportionately responsible for fertility issues. Such sexism and other areas of marginalization such as able ism, fat phobia, transphobia, racism and more can add other layers of grief as it reminds people of their inferior status in society.

People can experience deep grief around changing relationships with their bodies, their relationships and identifies.

· Perinatal Mental Health: Pregnancy and parenthood can be exciting times during a person’s life. This time can also bring times of grief and loss. The complicated nature of humans is that we can experience multiple realities at the same time. Postpartum is a time of significant change and it’s normal for people to feel grief around the loss of their old life, relationships, body, and daily engagements. Grief can be compounded if there are health issues with the baby, feeding challenges, delivery complications, or family of origin concerns. This is a common time when old boundary issues and family or origin patterns come to the surface and demand attention. People often need to grieve the relationship they wish they had with their family to fully commit to being the kind of parent they want to be for their new baby.

· Divorce: Whatever the circumstances surrounding divorce, it’s normal to feel grief during this time of significant life change. The loss and change of family structure, identity, and financial status are some ways grief can happen during and after a divorce. Privilege and marginalization impact peoples’ experiences during this time. For example, women tend to be more negatively impacted financially from divorce and if there are children involved tend to have the bulk of parenting responsibilities. It can be normal to not only feel grief, but relief, excitement, fear, uncertainty and more. It can be helpful to surround yourself with loved ones and focus on rebuilding a life you love.

Other Examples of Loss

Loss of a pet—either due to rehoming or death

Moving

Loss of a job

Retirement

Loss of a parent, child, grandparent or other family member

Grieving the family you wanted versus the one you have

Suicide

Loss/Change of faith

Betrayal

Financial Loss

Miscarriage

Loss of community

Loss of a friendship

Collective or cultural grief (such as covid)

Generational grief

In Conclusion

I hope you can utilize this guide as a resource as you move along your grief journey. Know that each person’s experience is unique and what’s been discussed here is by no means prescriptive of how your experience will go. If you’ve been feeling stuck after a loss or life change, know that you don’t have to face it alone. There are great resources out there both from lay people, peers, and professionals. If you’d like to hear how I can help or where might be a good first step, reach out and schedule a free consultation today.