Helping a Grieving Friend - Second Edition more

Helping a Grieving Friend: For the Layperson – Second Edition By Brian Andrew Wong February 2012 INTRODUCTION In school you are taught the importance of fire safety through fire drills. Our parents talk to us about calling 911, about dating, sexual responsibility, and marriage. In college/university you take classes in subjects that help prepare you for your desired career. The American Red Cross offers classes on CPR, First Aid, Babysitting, and becoming a lifeguard to help us be ready for emergencies; they also collect blood donations to prepare for a patient in need of an immediate blood transfusion. Out of all the major life events we are prepared for, death and loss is probably the very few. Death is a universal event, but ironically we are often not taught about how to deal with it prior. On Wednesday, April 7, 2004, my paternal grandfather died in his 90s from injuries sustained in a fall one week earlier. I had a strong attachment with grandpa. Later that year on Monday, December 6, when I was 15 years of age, my mother died of melanoma at the age of 54 after receiving hospice care. She was a retired decorated Sergeant Major in the U.S. Army Band “Pershing’s Own” and is buried at Arlington National Cemetery. People told me things like, “You should be proud of your mother’s service to our country,” “Her death was a blessing, she’s no longer in pain,” and “It is an honor to be buried at Arlington.” I remember people unintentionally saying insensitive things without realizing the impact of their comments. Looking back, I now realize that I had no prior education about grief or any idea about the feelings and thoughts I experienced. I learned that we have been taught myths about dealing with loss. The purpose of this book is to help you to be prepared to support someone you know who is grieving a major loss, who is at least mature enough to understand that death is final, when the time comes. You may not have experienced a major loss, such as a death of a relative – and that is all right. You may be thinking, “But I am not a counselor or therapist.” You do not need to be one in order to help support someone in their grief. You will learn about grief, what to say to a griever, how to help them after the loss, and when professional intervention may be appropriate. I decided to write this book because I have noticed from personal experience that those who are grieving a major loss tend to be isolated or withdraw from those they know. This is due to mostly others not knowing what to say or being afraid that they will bother or upset their friends. Another Page 1 of 18 reason for this isolation is because the griever finds comments said by others to be insensitive to their feelings. John W. James and Russell Friedman from The Grief Recovery Institute point out: “It is only natural and quite healthy for people who are caught in a grieving situation to seek solace from those around them. However, in rather short order it becomes abundantly clear to the griever that friends and associates are not of much help. Even though they are well meaning, they often say things that can seem inappropriate” (James & Friedman, 2009, p. 39). Psychologist J. William Worden (2009) mentions that some people “need help with their bereavement but wait until they experience difficulty, recognize their need for help, and reach out for assistance” (p. 86). A good support network is vital in the wellbeing of people after a major loss. A poor support network can lead to isolation, which can lead to further problems. I have noticed that often those around the griever have been unintentionally poorly-educated on how to deal with grief. At the time I that I am writing this book, I am a junior psychology major with a minor in counseling at Marshall University in Huntington, West Virginia; bereavement and grief is my area of interest in psychology, with a specific interest in complicated grief. In my sophomore year in fall ’10, for one of my counseling classes, I chose a clinical placement at the local hospice. In my junior year in fall ’11, I took Death & Grief Counseling class. To date I have been to 16 funerals/memorial services and 3 weddings. I have no clinical practical experience. From my personal experience, I will share my tips on how to help a friend who is grieving a major loss. I hope that after reading this book, you will be prepared to help someone you know deal with a major loss, should the time come, and that when you face a major loss later in your life, you too will be familiar with grief and prepared. WARNING This book is offering advice to support a friend. Unless you have the credentials to provide counseling or therapy, leave that to the licensed professionals. This book is for the lay person. ****** WHAT IS GRIEF? Before I start talking about how to offer support to a griever, I feel it is necessary to educate you a bit about grief. You may not know what grief is; you may have an idea; you may even have heard mental health practitioners use the word. You may have heard people say, “Good grief.” Wherever you may have heard the word “grief,” there are varying definitions. The definition I like the Page 2 of 18 best for grief is “the normal and natural reaction to loss of any kind” and “the conflicting feelings caused by the end of or change in a familiar pattern of behavior” (James & Friedman, 2009, p. 3). Often, people do not realize that a loss does not always have to involve a death for a person or pet to grieve that loss. For example: Loss of a house (e.g. from moving, fire, or other disaster) Changing schools (e.g. graduation or transfer) Change in relationships (e.g. break-ups, divorces, etc.) Job changes (e.g. layoff, fire, transfer) Loss of a pet (e.g. missing or having to give back to breeder) Fertility There are also some losses that do involve a death that others may not always recognize as a loss. For example: Miscarriage (even husband and friends can be affected) Death of a former significant other (regardless of how long the relationship lasted) Death of a Friend Death of a beloved teacher Death of a classmate or school mate We all experience some level of grief or sadness when a major loss occurs. How we express our grief, often viewed as mourning, will be different. How we mourn may be determined by our culture, religion, socialization of gender norms, and other varying factors. Each of us has a different way of handling our grief. There are no sequences or stages of emotions that a griever has to go through in her or his grief; it is unhealthy for a griever to adhere to a fixed, subjective timeline or sequence of emotions of grief (Wong, 2011a). Keep in mind that in some religions or cultures there are detailed mourning rituals that may seem to be fixed. I am talking about grief, the emotions. WHY DO PEOPLE GRIEVE DIFFERENTLY? People grieve differently and at different paces. Worden (2009) came up with the Mediators of Mourning, or factors, which help with understanding why people may deal with their grief differently. The factors of grief I feel that are relevant to the purpose of this book are: Who the deceased person was. Was the deceased person a friend, a parent, sibling, significant other, etc.? Page 3 of 18 The nature of the attachment to the deceased. What was the strength of the attachment? Was the attachment secure? What was the ambivalence in the relationship like? Was it a dependent relationship? What conflicts were there between the griever and the deceased person? How the person died. Geographically, did the person die close or far away? Was the death expected or unexpected? Did the person die in a traumatic or violent manner? Were there multiple deaths in a single event or short period of time? Did the person die under circumstances in which a body was not able to be recovered? Past Losses. Did the griever experience other major losses in the past? Is the griever voicing any unresolved issues with previous losses? Sometimes, a recent loss can trigger emotions from losses in the past. Personality Variables. Men and women are often socialized differently on grief, on crying, how to deal with expressing feeling, etc. People cope differently: problem-solving coping, or active emotional coping such as using humor. Culture Another important thing to keep in mind as to a griever’s difference is culture as well as religion. People’s cultural, individual, religious, and spiritual beliefs relating to grief and loss are vast. Everyone has their own individual beliefs about death and loss, which are influenced by their culture and whatever religion or deity they believe in (Wong, 2011b). It is important to be aware of other cultural orientations when it comes to grieving a loss. Rosenblatt (2008) points out: “Because we are embedded in the realities of the culture we know best, we may well be oblivious to the cultural saturation of our knowledge and the many ways that such saturation makes us ill fit to understand, or even pay attention to, the grieving of people from cultures different from our own” (p. 207). THE GRIEVER AND GRIEF What does the griever need to do in order to recover from their grief? The most important thing for a griever to do is to acknowledge their feelings, both negative and positive, relating to the loss. I believe that there are two major goals in recovering from grief: review of the relationship to the lost person or pet (e.g. unfinished business, regrets, etc.) and adapting to life without them. Worden has identified certain tasks; his tasks relevant to this book are processing the pain of grief and to “find an enduring connection with the deceased in the midst of embarking on a new life” (p. 50). Page 4 of 18 Suppose you are taking a biology class and you have four tests. You are familiar with the teacher or what the teacher’s tests are like. You goal is to get at least a 90% on all of them. You take the first test and you do not get the score you aimed for; you got a 70%. Your friend Donna is also in that class and you compare scores. She got a 95%. Donna tells you, “It’s okay. It was the first test. There are three more tests. You’ll do better next time.” You study for the next test and you got 80%, not your target minimum score. Now you might be realizing you do not understand the material as well as you thought. You go to your teacher when he is free to go over the test. He points out what you missed, what you got, and what he says in class to give you hints as to what will be tested. So what you did was review what you needed to work on to have a better result on the next test. This is very similar when grieving losses (e.g. break-up, deaths, divorce etc.). Moving in to a new relationship without taking time to work on what is/was unfinished might hinder a griever’s chances of being successful with that next person, of having a meaningful experience with them. “There are three more tests” is true but does very little in helping you with your test scores and comprehension of the material covered in the class and/or textbook(s). The griever should work on both recognizing the problem and preparing for a new endeavor. HELPING SOMEONE IN THEIR GRIEF In this section, I present some loss scenarios using Alex, who is your colleague and friend. I will then talk about helping Alex through his grief in the months and weeks after the loss. Relationship Break-Up Alex has told you that his girlfriend, Jennifer, broke up with him and he is feeling very sad. You have met Jennifer a few times before, when she would make surprise visits to Alex at work, which annoyed him. What would you say? Before thinking about what you might say, think about what you may have heard others say in a similar situation: “She wasn’t your type.” “See, I told you that you wouldn’t last as long as you hoped.” “I can introduce you to some of my single friends. A few of them actually have a crush on you.” “Not all relationships are meant to be.” “There are other fish in the sea.” James & Friedman would point out that the last two comments are intellectually accurate but do nothing to help with the broken heart that Alex might be feeling. What is important is to not tell Alex what to feel and what not to feel. The last two comments indirectly say that he should not be feeling sad about the breakup. If you are unsure of what to say, here is what I would say if I knew Alex Page 5 of 18 well: “I’m sorry to hear Jennifer broke up with you. I know that you enjoyed going to plays at the theater with her.” If you have experienced a similar break-up, you can say something like, “I have experienced the breakup of a wonderful girl. I remember how difficult at first it felt. If you want to talk after work, I’m here.” The comment “there are other fish in the sea” says there is another chance. That comment is quite similar to, “You’ll do better next time.” The fact that there is another chance does not help the griever on an emotional level. The conflicting feelings that Alex might be feeling is loneliness but glad that Jennifer will no longer be making surprise visits to him at work. Since Alex had a very strong relationship with Jennifer, it is likely that he might have sad feelings when he sees other couples out on a date or holding hands when walking on the streets – reminders of the relationship and the times they shared together. When Alex tells you how he feels, openly acknowledge what he said: “That sounds sad,” or, “I can’t imagine how awful that must be.” However, here are three things you should avoid saying: “I know how you feel,” “It takes time,” and “Don’t feel bad.” If you have experienced a hard break-up of a significant other, Alex might find hope of getting through the break-up by hearing about yours. What you can do from this point on is help your friend from coping in an unhealthy manner. It is not uncommon for people when feeling sad to seek unhealthy coping methods: drinking, drugs, shopping, smoking, etc. Death of a Pet Alex tells you that his 8-year-old dog, Sparkles, died after a short illness. She was a major part of Alex’s life. Each day Alex would mention something about her: the nice walks in the park, that she always begged for food when he came home, or the times when he would get a new nice pair of shoes and she would chew them. Remember to acknowledge his feelings, do not tell him how to feel or how not to feel; say something that appeals to his emotion; the fact that the illness is over does not. Avoid saying something that is intellectually accurate. What would you say to Alex? Here is what I would say: “I am very sorry that Sparkles died. Sparkles was a cute dog. I can’t imagine how you must be feeling.” Pets are often viewed as one of the family and develop a strong attachment to their human companions. The death of Sparkles would create a change in a familiar pattern of behavior: Alex would miss coming home to a dog begging for food or treats but will no longer have to worry about a new pair of shoes being chewed. Page 6 of 18 Death of a Grandparent As children, our first death in the family is often a grandparent. Alex tells you that his grandfather died a few days ago at the age of 94 and the funeral is going to be in a week. He died of a spinal injury. In this situation, Alex is a teenager. Grandpa would always take him to the deli to get his favorite sandwich but he would always have to push grandpa up the hill in his manual wheelchair, instead of using the motorized wheelchair. Alex will now miss going to the deli with grandpa, but will not miss having to push grandpa up a hill. Many would start to say that grandpa lived a long life, he is no longer in pain, and be strong for grandma, etc. Now, Alex was very close to grandpa. Given that many experience the death of a grandparent, it is not uncommon to hear, “I know how you feel.” You know Alex well, but have never met his grandfather. Saying this would be inappropriate. Can you think about why it would be inappropriate to say, “I know how you feel”? Earlier I told you about the different factors of grief – the nature of the relationship between the griever and the deceased person. Alex had a different relationship with his grandfather than you had/have with your grandfather. Other things that are not helpful to say, after any death, include but not limited to: “He’s in a better place” “It was his time” “He’s no longer in pain” “He lived a long life” “You should be proud of him. He served in the Army proudly.” In any loss that Alex tells you about that he had a close connection to, you might be able to relate to his loss, but you do not know how he feels. I have learned that for any major loss situation in voicing your condolences, saying, “I can’t imagine how you must be feeling” is helpful. Saying that lets them know that you are all right in listening to them if they want to talk about the loss without you judging their feelings. However, if you were somewhat acquainted with Alex’s grandfather you could say, “I’m sorry to hear your grandfather died. I can’t imagine how difficult this must be for you. I remember when my grandfather died…” Or you could share a happy memory about his grandfather: “I’ll always remember his jokes, his humor.” Death of a Parent The death of a parent can be among the most emotionally difficult losses, especially when the child is a teenager. Alex told you his father died. Alex is a young adult. The age of his father is irrelevant. Alex’s father died in a violent car crash and according to the medical examiner did not Page 7 of 18 suffer any pain. Alex went to his father a lot for advice with his problems. He will now miss the advice his father but glad that he did not have to suffer any pain in that car crash: those are an example of Alex’s many conflicting feelings. Now saying, “He didn’t have to suffer any pain,” does not help Alex emotionally. Think about what you are going to say to him and then write it down. Death of a young child Pretend that your friend Alex and his wife, Nancy, are in their early 30s. Alex does not tell you much about his family, just that he and his wife are having a baby. Two months later the baby is born healthy, after a smooth pregnancy. One year and four months later, their child succumbs to a terminal illness. You go to the funeral and you hear someone say to Alex and his wife, “It will be all right. You’re still young; you can have other children.” That comment is almost the same as saying to Alex when he was dating Jennifer, “there are other fish in the sea.” Both comments imply that there is another opportunity. What Alex and Nancy have not shared was that they had fertility difficulties; so there might not be another opportunity for them to conceive another child. Now, you may be thinking “adoption.” Although adoption is an option for them, one should mention the idea of adoption only if they are close to the couple and when the couple expresses that they are ready to have children again and are willing to explore that option. DISENFRANCHISED GRIEF Disenfranchised grief is grief over losses that are not commonly recognized as a grief issue. Many associate grief with death. For example, a miscarriage can fall under the category of disenfranchised grief because some may not consider the fetus alive until birth. A form of disenfranchised grief that often can receive less attention is ambiguous losses. Ambiguous loss or ambiguous grief is a relatively new concept in grief. There are two types of ambiguous losses: the person is both physically and psychologically absent or the person is physically with you but psychologically absent (Boss, 2010). In the case of a missing person, especially after a week or even a month of searching with no promising leads, it can be especially difficult for the family and those close to the missing person. Such a situation “puts the mourner in an awkward position not knowing whether to hold out hope or to give into grief” (Worden, 2009, p. 62). Many know of the kidnapping and recovery of Elizabeth Smart in Utah. My family has a vacation condominium there, in Little Cottonwood Canyon. Elizabeth Smart was kidnapped from her Salt Lake City home in 2002. I remember that summer when I was hiking the mountains I kept a close eye out for any signs of Elizabeth. There are plenty of places to hide in the Canyon. Every time I saw a blonde girl close to my age, I paused for a moment wondering if it was Elizabeth. I also remember Page 8 of 18 seeing posters with her photo all over the Salt Lake City metro area. This had a small impact on me, since I was not really a permanent resident, but a frequent vacationer in Utah. However, there is an ambiguous loss which has impacted me on a more personal level. When I was living in Bethesda, Maryland (a suburban town outside Washington, District of Columbia) until June 2002, I was on the local community swim team. One of the coaches, Sarah Aronoff (then 20) was lost in a kayaking trip in 2003 on the weekend of Columbus Day. She was kayaking in the Nantucket Sound in Massachusetts, with her friend Mary Jagoda (then 19). When they did not return, their boyfriends called for help. Two days later Mary’s body was found; unfortunately Sarah’s body was not. But since her body was not recovered her family faced two challenges: they could not see the body to help with reality and could not officially sit Shiva (she was Jewish). However, their Rabbi did hold a memorial service at Sarah’s family’s house. I do not remember the emotional state of her parents; but I do remember seeing her two younger brothers: one was sitting in a corner, crying and not speaking to anyone, the other I was told was in his room. I had trouble at that time understanding the loss myself. I knew about Amelia Earhart and her strange disappearance. My mom suggested that I view Sarah’s disappearance similar to Earhart’s. This was my first ambiguous loss and I did not know what to say; my parents did not even know what to say to Sarah’s family. This was my first loss in which there was no body recovered. Sarah helped me a great deal when on the swim team; she helped me improve my butterfly stroke so I could race the 100 meter Individual Medley in the meets. You can read a story of a kayaker who was out kayaking in the same vicinity the same day at http://www.seakayakermag.com/2007/August07/Safety01.htm. The deaths of Sarah and her friend Mary brought upon efforts to enhance kayaking safety measures. The Mary Jagoda / Sarah Aronoff Kayak Safety Amendment received support in the Massachusetts House of Representatives and the State Senate to require that lifejackets always be worn. The other type of ambiguous loss is where the person is physically present but psychologically not present. One example of this loss is Alzheimer’s disease. The person is still alive but forgets who is family is, who he or she is, where he or she is, etc. This can be devastating to the family. One example is former President Ronald Reagan and wife Nancy Reagan. They both had a very strong marriage and Ronnie said that he often felt lonely when Nancy was not with him. However, his Alzheimer’s advanced to the stage where he could not even recognize the woman who he loved so much. Another loss that not many recognize is that in the Lesbian, Gay, Bisexual, Transgender community. The minister who presided over my mother’s funeral, Melinda, is an open lesbian and my Page 9 of 18 dad and I attended her Holy Union. When I came to Marshall University, I joined the LGBT student activist group, Lambda Society, out of support for Melinda and my LGBT support comes out of the connection Melinda has with my mom. During my active times in Lambda in my freshman year and first semester as a sophomore, I have met a couple of transgender or gender nonconforming people and noticed that this population does not receive much support or understanding as the other groups in what I call the “GBLT sandwich.” Being that I like to advocate for what is least paid attention to, I began to help with transgender advocacy on campus. I found out that not many know the differences among sexual orientation, gender expression, and gender identity. Now, let’s bring your friend Alex back into the picture: Alex comes over to your house and he says things are not going well for him. His younger sister, born Jennifer, has been consistently identifying as Thomas. Alex has no other siblings and his parents always wanted a daughter. It is rough for Alex and his family. They always knew Jennifer was a tomboy (mostly wearing a dress and makeup to church) but had no idea that she would start identifying as a man. Thomas is not only a female-to-male transgender, but is also gay. Alex is somewhat religious but not as religious as his parents. Alex’s sibling’s change is a huge conflict with their religious beliefs (Deuteronomy 22:5 regarding cross-gender behavior and Leviticus 18:22 regarding homosexuality). Thomas is no longer welcome at the parents’ house, so Alex has let him stay with him until the situation settles. The parents have acknowledged the ambiguous loss; they have gone to their parish for support. They have not adapted to the loss to the point where they can refer to their other child by his preferred name and pronouns. It is a major change for the family. Alex is making a more visible effort to come to getting used to having a brother. Now, what you might say to Alex may not come as easy, depending on your knowledge of the LGBT community. Let’s assume that the only knowledge of the transgender community you have is of drag kings and drag queens. (I like to view a transgender person as one whose gender expression may not always align to their sex assigned at birth and who may not always conform to society’s gender norms, and whose gender identity may not match up with their sex at birth.) So what would you say? Well, I would start off by asking Alex how he has been dealing with it. Before the next time you see him, do some research on the issue and on some of the common challenges families face. And even invite the two over for dinner to show your support. For this situation, Alex most likely will be needing your support more than ever before because of the unique challenges. Your personal beliefs and views on the issue and issues relating to this loss are not important and should be kept to yourself. If you have any personal issues with the loss, do your best to remain neutral in expressing your views about Page 10 of 18 the LGBT community and work on supporting Alex through his conflicting feelings. Again grief does not have to involve a death; grief is the “conflicting feelings caused by the end of or change in a familiar pattern of behavior” (James & Friedman, 2009, p. 3). Thomas is somewhat happier to start living as who he always knew who he is. Alex is feeling conflicted. He may be happy that his brother no longer has to hide who he really is but will miss having a sister. My basics in expressing condolences:      Acknowledge the type of loss (e.g. I am sorry to hear of the death of….the divorce…etc.) Share a happy memory if you knew the deceased (e.g. “Your father told great jokes; I will miss his jokes.”) Be sensitive to their feelings (e.g. I can’t imagine how you must be feeling.) Avoid saying things that are intellectually accurate (e.g. in a better place, no longer in pain, other fish in the sea, etc.) Avoid expressing your views of the death (e.g. his death was a blessing, she’s home with God). Suggested activity for practicing giving condolences: Look at different Death Notices or Obituaries at www.Legacy.com and select people who died at different ages, of different causes. Pick a few of their family members and write a condolence letter to them, keeping in mind what you have learned so far. Include how you would offer to help them after the funeral. (If you are going to sign their guestbook on www.Legacy.com do not offer to help them after the funeral unless you personally know the family). My advice for written condolences is to handwrite it (if possible). Make sure all that is written on the card is by you. If you do not know what to say, just mention that you are not sure of what to say and that you were saddened to hear of the death or loss. For further advice on writing condolences, please consult the suggested sources at the end of the book. HELPING A GRIEVING FRIEND AFTER THE LOSS Upon death, we usually know what to do: notifying people of the death, burial and funeral arrangements, and placement of obituaries. But what about after the funeral/memorial services, when those who may have traveled in for the funeral have returned home? After a major loss, people will have a certain degree of difficulty in adapting to life without the lost person (including pets), because they are no longer in their lives as they were before. It is not uncommon that after a funeral, friends of the grieving family stop checking in on the family. This is the time most important to help your grieving friend. Before, I mentioned the isolation and withdrawal. If your friend wants to be left alone, Page 11 of 18 give them their space; but do not leave them totally alone. Even when among people and their close friends, it is normal for them to feel lonely. Typical responses to loss include, but not limited to:      Changes in eating patterns Sense of time and direction Changes in sleep patterns Reduced attention and concentration Feeling numb (Just because one is feeling numb, does not mean they are not aware of what happened. Sometimes numbness is mistaken for denial. If you are having a tooth pulled and are awake, receiving local Novocain, are you in denial that your tooth is being pulled even though you cannot feel something being pulled?) Let’s assume that you know the grieving family well enough that you keep in contact on a frequent basis. You go to the funeral. Often at the funeral friends of the family who live nearby say something like, “If you need help at all, please let me know.” That is kind but it would help by telling specifically how you are willing to help. Grievers are overwhelmed and might not know what they might need help with and might forget that you offered to help. Here are some ideas as to how you can specifically offer help to them: Assist in cooking meals Assist with grocery shopping Giving the children a ride from/to school on your way from/to work Take the children out somewhere to give occasional breaks from the adult(s) Help in walking the dog(s) Offer to spend time with the family and be a willing listener If you know the family well, you can give them a phone call a few weeks later and check up on them, because sometimes the family may forgot you offered to help. Remind them that you are willing to help out, but do not force it on them. Let them know you are willing to listen to them talk about the loss, or anything else, but do not force them to. After that, let them reach out to you. Those Special Days There will be days and times after the loss that the griever will find emotionally difficult, such as anniversaries, birthdays, holidays, and other times important to them. Holidays are times when grievers will tend to feel most lonely, especially the first holidays after the death. If the deceased loved Page 12 of 18 one had an annual tradition, offer to help your friend continue that tradition. If you are spending the holidays in town and they are alone, offer to reach out to them. Invite them in your celebration; celebrate together. They may not want to talk about how they are feeling during this time of year, but you including them in your holiday activities can make them feel less alone. If you are out of town during the holidays, call your friend and let them know you are thinking of them. If your friend shared an annual tradition with the deceased loved one, call them around that time to let them know you care. If your friend’s loved one died of a terminal illness, the anniversary of the diagnosis may be an important date. For your friend, there will be important dates in her or his life that he or she will miss their loved ones: graduations, birthdays, sharing of good news at school or work, and other times when they would usually share with that loved one. Talking with your grieving friend Do not be afraid to mention the words like death or demise or say, “no longer alive” or to mention how the person died; depending on the culture/religion of the family and the circumstances of the death, it may be best to not mention how the person died if asked. (For example, in some cultures, mentioning death by suicide would bring dishonor to the deceased and the family. Respect the family’s wishes concerning mentioning the cause of death.) Talk in the past tense; this can assist the griever with reality. Often, during the first month or so after the death of their loved one, reality does not seem to feel real even though they know their loved one has died. If there was no body recovered or they did not view the body, it can take longer for reality to sink in. The griever may still be used to the old routine but might have trouble adapting. For example, Alex might forget that Sparkles is no longer alive and might come home and put food in her bowl but then reality will come back. It is normal for grieving people to voice their regrets: “I should have…”, “I wish I had…”, “If only I…” These feelings are often mislabeled as guilt. James & Friedman (2009) interpret these expressions of regret as what could have been “different, better, or more” (p. 20). Unless the griever is found guilty in a court of law, “guilt” is not an appropriate word to use. Did your friend truly intend for the person’s death? For example, a mother, whose daughter died of leukemia, may feel regret for not being more insistent on the doctors giving her daughter further treatment and might feel responsible. In this type of situation, it is best to validate her sadness but assure the mother that she did all she could to care for her daughter: “I can’t imagine how you are feeling. I know how much you loved her and that you did everything you could to help her get better. You did what any loving parent would do.” It is also important to keep the griever’s cultural orientation in consideration when discussing regret. Page 13 of 18 DOES YOUR FRIEND NEED GRIEF COUNSELING OR THERAPY? From personal experience, it is never too early to work on the grief recovery process or to address one’s grief. The same concept applies to a cut, a cut that needs a bandage but might not need an emergency room visit. Would you say, “Give it time,” and let your friend bleed? There has been debate over whether grief counseling is effective. I believe that grief counseling is not effective for all grievers; each person should find a grief support network that is beneficial to them. Two days after my mother’s death, I started seeing one of my school’s full-time clinical psychologists. I met with him once a week during the academic school years until I graduated. I felt that early intervention helped me avoid further problems, such as complicated grief. The concept applies to diagnosing an illness early: the earlier that an illness is detected and treated, the chances of the illness getting worse will reduce. A good grief support network can reduce a griever’s chances of experiencing complicated grief. Going into the details of what complicated grief is, the specific types of complicated grief, and the treatment of complicated grief is beyond the scope of this book. Assuming you still see your friend after one yar after the death, it is helpful to know some symptoms of complicated grief. If your friend is showing signs of complicated grief, it may be time that they start seeing a grief counselor or therapist. If they are bringing up issues that you are not comfortable with or feel beyond your knowledge, let them know this and suggest they seek a grief counselor or therapist. If you know of a grief counseling resource, let them know about it. Or you can reach out to one that you already know for advice. Here are some signs of complicated grief from the griever, especially one year after the death: Sign 1: griever cannot speak of the deceased without experiencing fresh and intense grief Sign 2: small events trigger an intense grief reaction Sign 3: griever has fear they will die the same way their loved one died Sign 4: will only talk negatively or only positively of deceased Sign 5: unwilling to move any material items that belonged to the deceased especially if someone is suggesting they do so. (Sometimes, grievers just do not feel the need to move the possessions of the deceased. One must consider cultural and religious differences for this one.) Sign 6: if after a long period of time after the death, they are experiencing the loss as if the death just occurred Sign 7: if after a long period of time after the death, the griever is having the same difficulties they had just shortly after the death. Page 14 of 18 If the griever is having difficulty and is showing some distress after a long stretch of time after the death (e.g. a year or later) that is not part of their cultural and/or religious tradition(s) in grief/mourning, then it would be wise to suggest an appropriate form of grief counseling. Here are some ways to help your friend at this point:  If your friend goes to a religious congregation weekly, contact their religious leader and express to them your concerns and let them take it from there. Ministers, Rabbis, and other religious leaders very often deal with grieving families, and for one who still holds strong to their religion, this would be the best avenue.   If you go to school together talk to the dean, principal, counselor, or social worker about your concerns for your grieving friend. If your friend likes to read, you can give them a book to read on grief. These books can often be found in the self-help section of bookstores. I personally recommend The Grief Recovery Handbook: The Action Program for Moving Beyond Death, Divorce, and Other Losses by John W. James and Russell Friedman. This is a great book for one who is action-oriented and a logical thinker. You can read their articles at www.griefrecoverymethod.com and on their blog “Broken Hearts” at http://www.psychologytoday.com/blog/broken-hearts.  If there is a hospice nearby, that would be also a great place to start. Hospice is a form of care for terminally ill patients whose condition is no longer treatable, offering palliative care to the patient so they will not have to die in pain as well as support to the families. Many hospice programs offer support groups for people who lost a loved one to different types of death. One does not have to lose a loved one who received hospice care to receive grief support from a hospice.  Discourage your friend from making any unnecessary drastic lifestyle changes (e.g. moving) or sudden changes in relationships (e.g. dating too soon or too often). If they do, suggest counseling. Also, discourage unhealthy coping habits (e.g. eating, smoking, drinking, drugs, sex, etc.).  The Dignity Memorial Compassion Helpline offers free grief counseling over the phone from licensed counselors who hold doctorate or master’s degrees. Available 24 hours a day, 365 days a year, the Helpline is helpful for when family or friends are unavailable for support. The Helpline can also refer you to local grief counseling resources. Their toll-free number is 1-800480-1234. Page 15 of 18 If your friend is thinking about suicide, do not leave them alone. Immediately call 911 or the National Suicide Prevention Hotline at 1-800-273-TALK (8255) and follow their instructions. If you are not physically with them, for example, talking over the internet on instant messaging, keep them talking, contact the police department closest to them or the Suicide Prevention Hotline, and do what you can over the internet to keep the responses coming until help arrives. A Note on Grief Support Groups About a month after my mother died, I went to two grief support groups. Support groups are often grouped by age and by type of loss. Support groups are helpful to those who feel that their support network is poor or who feel they are the only ones experiencing their loss. When I attended the support groups, I met other teenagers who lost a parent and I felt no longer alone. I found the groups helpful. Grievers often experience similar feelings, but that is just the tip of the ice berg. I feel that support groups are helpful in the early days of grief and to those who feel that they are the only who has experienced their type of loss. However, as I mentioned, there are differences in each persons’ relationship to their deceased loved one or pet. James & Friedman (2009) point out that grievers tend to already be isolated in their grief and that support groups by type of loss would only add to that isolation: “Since we believe that grievers are already isolated in our society, we also believe that segregating grieves by type of loss adds to that isolation” (p. 21). FINAL NOTE I hope you learned the basics of helping a friend who is grieving a major loss. Being educated some on grief is the first step to helping a friend. The griever’s relationship to the deceased, their culture, their religion, and other factors will affect how they might grieve. And if you feel that they are having trouble with their grief, and your support does not seem to be helping, suggest they seek grief counseling or therapy as soon as possible. Page 16 of 18 References Boss, P. (2010). The trauma and complicated grief of ambiguous loss. Pastoral Psychology 59(2), 137-145. DOI: 10.1007/s11089-009-0264-0. James, J.W. & Friedman, R. (2009). The grief recovery handbook: the action program for moving beyond death, divorce, and other losses. New York, NY: HarperCollins. Rosenblatt, P.C. (2008). Grief across cultures: a review and research agenda. In M.S. Stroebe, R.O. Hansson, H. Schut, & W. Stroebe (Eds.) Handbook of bereavement research and practice: advances in theory and intervention (pp. 207-222). Washington, DC: American Psychological Association. Wong, B.A. (2011a). The impact of the so-called stages of grief. Available online at www.slideshare.net/brianw8. Wong, B.A. (2011b). Cultural sensitivity in grief counseling: a cultural application. Available online at www.slideshare.net/brianw8. Worden, J.W. (2009). Grief counseling and grief therapy: a handbook for the mental health practitioner. (Fourth edition). New York, NY: Springer Publishing. Suggested readings for further grief education: Bloomfield, H.H., Colgrove, M., & McWilliams, P. (2000). How to survive the loss of a love. Allen Park, MI: Mary Book / Prelude Press. Brehony, K.A. (2000). After the darkest hour: how suffering begins the journey to wisdom. (First edition). New York, NY: Henry Holt and Company. Dower, L. (2001). I will remember you: a guidebook through grief for teens. New York, NY: Scholastic Inc. Fitzgerald, H. (2000). The grieving teen: a guide for teenagers and their friends. New York, NY: Simon & Schuster. Friedman, R. & James, J.W. (2006). Moving on: dump your relationship baggage and make room for the love of your life. New York, NY: M. Evans & Company. Gillette, B. (2003). Condolences and eulogies: finding the perfect words. New York, NY: Sterling Publishing. Grollman, E.A. (1993). Straight talk about death for teenagers: how to cope with losing someone you love. Boston, MA: Beacon Press. Page 17 of 18 James, J.W., Friedman, R. & Matthews, L.L. (2002). When children grieve: for adults to help children deal with death, divorce, pet loss, moving, and other losses. New York, NY: HarperCollins. James, J.W. & Friedman, R. (2009). The grief recovery handbook: the action program for moving beyond death, divorce, and other losses. New York, NY: HarperCollins. Correspondence concerning this book may be addressed to the author at brian.wong@live.marshall.edu or wong_brianandrew1989@yahoo.com. Page 18 of 18