Real World Clinical Blog: On Grief and its Permutations

by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way

     There is so much that we get wrong about grief, and it isn’t surprising. Like most things in life, we are desperately trying to keep an unwieldy process orderly and comprehensible. The fact about grief, though, is that it is neither. Grief, by its very nature, defies simple understanding. Despite our efforts to stage grief or to divide types of grief into distinct categories, the unpredictability and idiosyncrasy of each grieving process sustain.

     In our clinical work, a more nuanced understanding of grief can only serve to enhance our efforts with clients. It is first essential to note that grief is neither trauma nor depression. The difference between these words is not mere semantics. Instead, these are highly distinct phenomena. Trauma is the byproduct of an unpredictable and non-sensical attack on our attachment world. We can lose someone to a car accident or something else sudden; this does not automatically mean that we will become traumatized. That is because death is part of life, and despite its unpredictability, our minds are essentially designed to metabolize loss. Further, while grief often looks like depression, the underpinnings of each are quite distinct. Depression is a process by which our minds suspend our ability to motivate and function. Grief, while appearing to lack motivational properties, is us moving through something in a way that is often disruptive, but subtly productive as well.

     There is really nothing unhealthy about grief. Grieving is something that our brains have been wired to do. It can make us feel like we are going crazy, but it is actually our effort to grapple with experiences that feel nearly incomprehensible. We start to run into trouble with grief when thoughts about how grief should be inhibit the nuances of our individual processes. Here are some basic guidelines that might aid you in working with your clients around grief.

There is no timeline, there are no stages

     Grief often does not start immediately after a loss and can actually show up any time. Clients often feel that their grieving process ought to be limited to the societally allotted amount of time given. This is traditionally understood to be about a year. The fact is that grief can last weeks or decades. Also, grief never really ends. We might experience times when we are more in the heightened throws of it than other times, but it rests in us and can become unpredictably re-awakened. For example, if we lost a mother at some point and feel that we have worked through this, the feelings are almost invariably reawakened when we become parents. The grief lies dormant and can reemerge, and this is normal.

We grieve far more than death

     Grief is not limited to losing something to death. While grief is most commonly associated with losing a loved one to death, the fact is that grief insidiously affects many different life processes. In fact, the loss of a home to moving, graduation, or simple life shifts can be one of the most stirring forms of grief. The loss of a job is also quite grief-inducing. Any process that signifies the passage of time, a process that we lack complete control of, can elicit feelings of grief.

Intimacy and depth of grief are not positively correlated

     The level of closeness that we had to someone has no predictable bearing on the level of grief that we experience. There are times when we lose someone we were incredibly close to and the grief feels manageable. There are also times when we lose someone who was quite distant to us, perhaps a childhood teacher or a distant neighbor, and we find the grief difficult to regulate. This is often because society does not have ways in which untraditional grief is recognized and held. We are allowed to cry and miss work over losing a family member, but rarely for a crossing guard or any other figure in our life that represented stability and calm. The fact that society has a narrow tolerance for the types of grief that we are allowed to feel limits our ability to emotionally explore the depths of our own processes.

We talk to the dead

     Many of us talk to the dead. This is not something that we are actually allowed to talk about unless it is cloaked in a religious tradition, but the fact remains that most of us walk around engaging in conversations with both the living and the dead, and this is completely understandable. Conversations don’t just end because life does. Our clinical work is to bring our clients’ relationships with those they have lost into sessions. We need to normalize the process of communicating with the dead and acknowledge the health of the effort to remain connected to those we have loved.

Not all grief has to become goodness

     There is nothing that someone needs to do about the fact that they have lost someone. While there are innumerable ways to honor the dead or the lost, such as 5k races or lighting candles or speaking out, the need to do something “good” to manage feelings that are experienced as “bad” is simply not psychologically necessary. It can be completely healing for some, but the meaning-making process of loss is one that does not need to be demonstrated altruistically or publicly.

Complicated grief

     While grief can become trauma because there is no outlet for it or the loss was so shocking that the brain cannot accommodate it, the more likely scenario is that typical grief has become complicated grief. Complicated grief is actually what occurs when we are not able to tell the whole truth about the person or experience that we lost. For example, let’s say that a client had a largely complicated relationship with their father. Everyone considered their father to be a hero, but privately this is not the client’s experience. Or, someone feels shame around their loss, such as when they lose someone to a drug overdose. When someone needs to perform something inauthentic about their grief, this can manifest itself in a complicated grief. A complicated grief is basically an inability to have a life that exists beyond the grief and to allow one’s identity to become fused with the grief. It can also be related to denial over the loss that persists over time and disallows someone from integrating other aspects of reality.

     Grief is a part of life and a beautiful part, at that. It is not always sadness, but sometimes joy, too. It is unpredictable, but also essential. It is a part of the human existence that ultimately forces us to face our own mortality, giving more life force to our days and our loving, and texture to our psychic landscapes.

Dr. Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. Read more of her clinical perspective and tips on the most burning questions of developing clinicians in her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.