Cap Psych Pod Episode 4: Grief and Loss

Today we’re joined by Selena Ladouceur. Selena is a Registered Psychotherapist (Qualifying) here at Capital Psychological. Selena received her Master of Arts Degree in Counselling & Spirituality from a joint program with the University of Ottawa and Saint Paul University. Her therapeutic intention is to focus on working with individuals and families to help them heal and process emotions in a supportive, non-judgmental, and safe environment. She typically takes an empathetic approach to treatment, concentrating on theoretic lenses best suited to Humanistic, Person-centered, and Emotion-focused therapy.

Today we’ll be chatting about something most everyone has experienced or will experience in their lives, grief and loss. Selena, thanks so much for joining us today.

S: Thank you Kristin for having me and taking the time to share this topic.

Many of us have likely heard of the stages of grief- can you walk us through them and how you would recommend coping with each stage?

S: Sure, so I think first it’s really important to discuss that losing someone or losing a pet, a relative, a loved one- it is never easy to lose someone or experience the grief that’s associated with a loss. So, it’s important to learn how to cope with it and eventually get to a place of being able to accept what has happened.  I’d like to start off by sharing a little bit about grief and what some definitions of grief and loss look like and can include. Grief is very much an emotion generated by an experience of loss and it’s not really stable- it’s not something that once you reach it, it just stays there. It’s something that can change, it’s something that can be felt stronger on specific days. It’s a process, and one that’s never ending. It’s continually manifesting. We can think of grief as a stranger living with us or as something that can be experienced and then accepted but not overcome.

I have a definition of grief and it states “it is the response to loss, particularly to the loss of someone or something that has passed away to which a bond or affection has been formed. Although conventionally focused on the emotional response to the loss, it also has physical, cognitive, behavioural, social, cultural, spiritual, and philosophical dimensions.” I took a grief workshop and that was something that was explained to us in that workshop, so I thought it was important to state that.

Some other definitions explain it as there’s a grief period, a mourning period, a bereavement and then the grief work. Grief Is the natural response to the loss. Mourning is the external or public expression of the loss or of the grief. Bereavement is the stage of having suffered it, and the grief work is the work of dealing with the loss. One thing that I think is really important to talk about is the Kubler-Ross model for grief: it’s the 5 stages of grief. It described 5 primary responses to the loss. These stages are not a linear process, nor do they require completion.  An individual can retreat backwards at any time, and they can also move forwards. It’s back and forth, it’s not kind of that one pathway. For example, a person may feel that they’ve fully moved past something and then the next moment it can jump right back at them. This occurs because grief is insidious and demands to be felt. These stages include denial, anger, bargaining, depression & acceptance.

Denial is the first stage and this stage the reality of the loss is questioned. A person may believe that there was some sort of mistake or mix up or an incorrect diagnosis; especially with cancer victims for example, this is when they’ll try to hold that hope that maybe it’s not as bad as it sounds, maybe there’s a way that with proper treatment we can cure it- kind of that stage.  They may cling to this false reality and prefer to kind of stay there.   

With anger, those who are grieving may begin to cast blame or ask questions like “why me?” They may become angry with the deceased person “they left me” or in the case of a suicide, they can say “it was selfish of them”. They can turn to that kind of resentment.

Bargaining is the next stage and this stage the individual will attempt to bargain away to avoid their cause of the grief. For example, after receiving a terminal diagnosis, they may plead to God “I’ll eat healthier, I’ll quit smoking, I’ll do anything and everything right just so I can get better.”

The fourth stage is depression. During this stage, they’re grieving enters a period of darkness and sadness. They may lose motivation for living, act like themselves and enter the mourning. So sad, why bother with anything.

The next stage would be acceptance. In this stage, they come to accept the loss, although there may still be pain, we like to refer to this as “open wounds” or “raw wounds, raw feelings”. During this stage, there’s a sense of calmness and a resumption of normal activities. It’s okay, going to be okay, things like that.

One thing I also wanted to mention was there’s a lot of myths vs realities around grief and loss. Some myths are things like we only grieve deaths, where in reality, we can grieve every loss. Another myth could be grief is an emotional reaction- grief is not that- it’s actually manifested in many ways. Another myth could be that we should grieve at home- in reality we cannot control where we grieve; it may hit us in a store, triggered by a memory, those kinds of things. It could be physical, spiritual, and emotional and it can occur at various times and places. You can kind of think of it like an ebb and flow.

K: Okay, that makes sense. I’m glad that you mentioned that it doesn’t have to be a death because I know a lot of people think of death when they think of grief and loss, but it could be like a job or anything really. 

How do you recommend helping a friend or family member who may be experiencing a loss?

S: So, mourning a loss like we had previously kind of said is not linear. It’s something that I would try to help them understand. I would share with them what the stages of grief are and how complicated they can be, and when we’re looking at the task associated with mourning, how can we observe that they may be revisited many times over before they’re able complete that mourning stage.  I think I would look at it almost like tasks; I would say the first task would be to accept the reality of the loss or get them to accept the reality of the loss. Often after death, survivors struggle to accept the reality of what’s happened. They also may deny the significance of the loss, accepting that the reality of the death means that coming to terms with the loss both emotionally and intellectually will be necessary.

 Another thing you could do would be to help them process their grief. This task would involve confronting emotions, even the painful ones, encouraging them to express it, recognizing when they are experiencing the pain, naming the emotion, and learning how to cope with [the emotions].

Another task could be to adjust to a world without the deceased. After a loss, many survivors face a world without their loved one and this can be where that wound hits you, you wake up in the morning and your partner’s not there or going into a room where a loved one used to sleep and they’re not there or seeing a dog bed on the floor where your dog used to sleep, anything like that.  This task would involve making internal, external, and sometimes spiritual adjustments to the loss. For internal adjustments, these are going to change one’s identity- survivors must ask themselves “who am I now without this loved one”. External adjustments can include taking on different roles and responsibilities, for example a spouse who was responsible for childcare may now have to seek employment outside of the home. Spiritual adjustments involve changes to a person’s world view, the beliefs, and assumptions. For example, someone who believes that the world is a fair and kind place may no longer feel this way after the loss, and they may start to resent everything around them and have that external blame.

Task four I would say would be to find a way to remember the deceased while still moving forward in life. This means keeping a place in your heart for that person that you lost while being able and willing to move on with your own life. You know how when people always say “carry a piece of me in your heart” it’d be that sentiment- that person is always there with you. This may also mean allowing yourself to be happy and to love again which can be sometimes very difficult, especially after you know, you’ve had the same partner for 40+ years, it’s easier for people to say move on than it is to actually move on. So just holding the space of the person.

K: I know a lot of the time people feel a lot of guilt with that as well.

S: Yeah, so for the four types of loss, to explain too would be the anticipatory grief, delayed grief, disenfranchised or ambiguous grief or loss, and complicated loss. To explain these, the anticipatory grief is a grief that is experienced in advance or impending, so this would be for example a cancer patient finding out it’s inevitable that they’re going to pass or someone who was hit by a car and maybe there’s internal bleeding, etc. or there are complications due to this injury. There may be that anticipation that that could be the outcome. I think that the biggest difference there is knowing it could be coming vs not knowing, vs the sudden. Delayed grief- this emerges if not given time to process an emotion, so it’s expressed at a later time than maybe when the loss was experienced.  Disenfranchised or ambiguous grief can occur when others do not recognize of honor the loss. These terms can be used interchangeably, and it’s surrounding a loss [when] reason of the death is unknown.

Complicated grief can be debilitating, it can be intense, it could be an intense longing for the deceased, parental bereavement, risk factors along with support system not being there anymore. This grief refers to grief that is so severe and long lasting that it significantly impedes the persons ability to actually function. To help support someone through grief too, I think there’s’ a couple planes I could kind of touch on there:

Acknowledging what they’ve been through, so validating what they’ve been through, supporting them. Using terminology- “that sucks, that’s horrible, I can’t imagine how much that hurts”. You want to offer that solace but also that comfort of sitting with them and it’s uncomfortable- it’s hard. Allowing them time to mourn, but giving them space, and letting them mourn without judgement. There’s not a timeline that they have to meet, it’s okay to take 20 steps backwards if they need to, just give them that space to do that.

Creating an environment that facilitates openness. Being there, sitting with them even if it’s just in silence. And acting normal, maintaining a normal because a lot of the time the worse thing someone can do is treat someone differently.

K: right, like tiptoeing around them.

S: Exactly, yeah.  And then, you know check ins too. How are you doing? Do you need anything? Can I bring you food? Things like that. Check-ins that aren’t always considered a “check-in” if that makes sense. And then suggesting professional help I think is really important, you know. Losing someone can be incredibly difficult and there’s so many different types of loss. It can be the loss of a spouse through death, it can be maybe a heart attack or a stroke that can cause changes in the person, there’s so many different ways to lose that connection with someone. I think being able to reach out for help is something that’s really important.

So, obviously grief and loss is a difficult subject for anyone but how would you suggest speaking to a child about a loss?

S: When a loved one dies, children often do not know how to react to the news in the ways that we, as adults do. Their reactions can be very different than ours, and their emotions are not always understandable to them. Emotions are BIG and sometimes the children just don’t have the ability to kind of recognize or understand what it is that they’re feeling. This can often be due to barriers like I said, their age, maturity, understanding of what happened, the understanding of what death is, the fact that they have been sheltered by death possibly and having never experienced a loss before. This can be really difficult too especially if you think of it in the way of spirituality- do they have a belief? Do they believe that the person went to heaven? Can you talk about it in that way? Do they not have that belief? So, religion and spirituality will definitely kind of come into play there as well. 

I think younger children (preschool age) see death as temporary. Sometimes they still believe that it’s reversible, and that that person can come back. Once a child reaches the age of 5-10, then they start to think more like adults do, so they still have the belief that it will not happen to anyone they know, but when it does happen, they’re able to understand the severity of it; they kind of don’t have that belief that they can come back anymore.

Three key things to remember when explaining death to a child are being honest & encouraging questions, listening to them and keeping it age appropriate. I think those are the three key things to remember when you’re explaining this to your child. During your explanation, let the child know that it’s okay to ask questions, anything that comes to mind for them- be open, be supportive, be validating and then sharing it in a way that they can understand it. For example, explaining it to a five-year-old would be very different than explaining it to a twelve-year-old. Making it age appropriate, I think that’s going to be really important.

You can also let the child guide the conversation- how are YOU feeling? What do YOU understand about it? Being curious, asking them what they understand. Children who are having a serious problem with grief can start to show signs and that’s something I think is really important to watch for. If they have an extended period of depression in which they lose interest in daily activities or events or things that they would engage in previously could be concerning. Having a loss of appetite or a change in appetite, change in sleep patterns, a prolonged fear of being alone. They can also become anxiously attached, meaning that they don’t want the parent or loved one that’s left behind to be away from them for long periods of time, or even at times be out of their sight. That can be something that can cause a lot of stress to them. Acting much younger for an extended period can be another one, withdrawal from friends, not wanting to do things, not wanting to act out socially, and believing that they’re talking to someone or seeing he deceased family member for an extended period of time can be something to watch for as well.

One other thing to note is long-term affects of bereavement on children. Children who are bereaved early are more likely to develop psychiatric disorders in later childhood. This was found from a study by The National Library of Medicine in 1998. It found a fivefold increase in children’s psychiatric disorders in bereaved children compared to the general population. Something else to watch for too is denial of the death or avoidance of the grievance. Acting like nothing’s happened- that can be something that can be concerning as well.

You kind of touched on it a little bit but grief and depression can often go hand-in-hand. What are some signs that someone might be falling into a bout of depression and that they may need some professional help?

S: That’s a really good question because they do, they definitely go hand-in-hand and there are definitely some symptomologies that overlaps or cooccur. First, I think it’s going to be important to know some symptoms of depression. If you look at the DSM5, fatigue or loss of energy, feelings of worthlessness are all classed under depression. It diminishes an ability to think or concentrate, it can include indecisiveness, recurrent thoughts of death, suicidal ideation without a specific plan, or possibly even a suicide attempt or plan for committing it. Those are some things to really watch for in depression.

Grief is more the reaction to a loss and it’s more that natural sadness that occurs. When you’re experiencing depression on the other hand, it has a component of negative self focus- guilt, worthlessness, internal self negative talk, I guess you could say.  It tends to be accompanied by feelings of apathy and hopelessness. If a person feels that it’s hard to move, get up, motivate themselves, or they feel that their sadness is persistent or ongoing, never changing, depression is likely the cause. With grief, these moments of moving forward beyond those difficult ones will more ebb and flow so they become less frequent and will offer pleasantries with friends and family afterwards. Unfortunately, with depression, it will take away those pleasantries and this is usually caused because of loss of perspective. That indecisiveness comes up there, or that difficulty concentrating or thinking of anything but the sadness. Depression can sometimes advocate for permanent measures to be taken, as I said before, it talks about it in the DSM5, when there’s significant emotional pain and wanting to just end that pain, suicidation can occur so that’s something where if you’re talking to someone and see the signs and they start talking about “why am I here” or “maybe it would be better if I wasn’t here” that would be a really important time to encourage that person to seek immediate help before engaging in any type of self harm behaviour.

Something that people often talk about is survivor’s guilt.  Can you kind of explain what that is?

S: Yes, survivor’s guilt is huge. I worked with a client who was grieving a loss and it wasn’t until we hit this connection for her that it was like wow, that’s what I’m feeling.  A lot of people don’t know about it. Survivor’s guilt is a particular type of guilt. It may develop in people who survived a life-threatening situation or witnessed a traumatic or catastrophic event.  Even someone who had been the caregiver for a loved one with cancer- watching the disintegration of the person. They can go from being who they are to a very fragile state before impending death. That can be extremely traumatic to witness and to go through. Individuals believe that it’s unfair that they survived when the other person dies, and this can lead them to thinking that they did not do enough to save the life of that person. It’s going to be really important to talk to them about how they’re feeling, what they’re feeling, and explaining to them- especially when we’re talking about an impending death, there is nothing we can do.  The fact that they survived doesn’t make them a bad person. I think it’s important when you’re discussing that with someone to make that very clear to them. It’s okay that they survived, and they don’t have to feel that guilt.  Some symptoms of survivor’s guilt can include nightmares, difficulty sleeping, flashbacks to the traumatic events, and a lot of times too they’ll be almost a suppression of it, so when these triggering moments happen, it’s reliving it all over again because they’ve suppressed it, they’ve tried to forget it.  It can also include loss of motivation, irritability, a sense of numbness and thoughts about the meaning of life. They can start to question “what is the meaning” It’s important to know in times of that to rethink back to Viktor Frankl, what is the meaning of life? What is the purpose for you? What’s meaning making for you? It’s really important to explore what that person’s vision is for themselves moving forward. I think it’s important, kind of like when you’re helping a friend go through losing someone, it’s also important to talk about how to help someone going through survivor’s guilt. They’re much the same- acknowledging what they’ve been through, allowing time to mourn, being kind and patient, creating an environment that facilitates openness, normalization, checking in, and of course suggesting professional help as well.

Some coping strategies for dealing with survivor’s guilt can include things like seeking help, talking to someone, getting that professional perspective, self-care routines are also considered to be a very important part of emotional healing, and that goes for any type of grief or loss- making sure you’re taking care of YOU- you’re taking care of yourself.

Grief can lead to both physical and emotional symptoms, as well as spiritual insights and confusion. While grief is a very natural an inevitable part of life, it’s also one for the most part that can be neglected and misunderstood. Having this experience, it’s really important to allow yourself the time to grieve. Allow yourself to go through that loss, allow yourself to experience the feelings. And then you get to a place of acceptance, and like we said before it’s not linear- it’s going to be something that’s continual, it’s going to be a process. It’s something that you’re going to take 20 steps forward and then 20 steps back and that’s okay. I think it’s important to say that.

Thank you, Kristin, for having me, I hope I was able to shed some light on the grief process, and what affects and impacts it may cause on the individuals who have lost a loved one. I think it’s also important to remember that our job as therapists is to hold space and provide validation and support for our clients as they go through the stages and ultimately just help them get back to what an everyday life can look like for them.

K: Absolutely, thank you for joining. Grief isn’t something that people tend to talk about very openly, so I think it’s important that we open the doors to this conversation and get people talking about it, because it definitely can be very helpful.

S: Absolutely, I have some resources too that I wanted to share.  One of them was the Bereaved Families of Ottawa Group It’s a volunteer-run group and it offers drop-in sessions and also sign-up sessions, so you can do smaller groups if you prefer and it depends on what your needs and preferences are, they kind of cater to that which is good.

Also, there’s another group called Grief Shares it’s a grief recovery support group where you can find help and healing for the hurt after the loss of a loved one.

Thank you so much again to Selena.  If anyone would like to book an appointment with Selena or any of our other therapists, please call the office of visit www.capitalpsychological.com