Loss and the grieving process.

Loss and grief are topics that are rarely addressed in the training of recreation professionals, and yet they are an inevitable facet in our lives and the lives of our consumers. Recreation therapists working in high-crime areas, hospitals, hospice, and nursing homes and those advocating for battered women, abused children, and the homeless consistently face loss, death, and grief on a daily basis with their clientele. However, there is little, if any, formal training in the area of grief counseling for most recreation professionals. But the need to understand and assist with the grieving process is both reasonable and necessary.

The Grief Workshop is an interactive training which has been presented with significant success and gratitude to recreation therapists and allied professionals at state, regional and district levels, as well as to university students. Before assisting someone with their loss, it is advisable that the professional fully examines his/her own loss(es), reads related literature, and contacts bereavement organizations. The key concepts for an introductory exploration are presented in the following overview.

Your Previous Experience with Loss

The role of a professional is to assist grieving individuals into a period of adjustment. Grief work is very difficult, but before we begin to help others, we need to examine our own losses. And often, the deeper we look at ourselves, the more effective we can be with others. When a friend or relative suffers from a stroke or loses a parent or child, we are reminded of our vulnerability and may become frightened that we could easily be in the same situation.

There are many forms of loss, some more devastating than others. Obvious forms of loss include the death of a loved one, loss of a job, divorce, retirement, or financial impoverishment. Other losses which are not so obvious may include moving, illness, separation, graduation, or a wedding. Even numerous "mini losses" such es haying an argument with a co-worker, receiving a traffic ticket, or failing an exam may accumulate and cause fatigue, depression, emptiness, and despair. In addition, with significant loss, we may experience a decrease in concentration, and changes in appetite, sleep patterns or sex drive. The effect of loss is ultimately an individual perception and may be temporary, or in some cases, permanent.

Mourning a Loved One

Have you experienced the loss of a loved one? Although everyone experiences loss of some type in their lives, losing a loved one can be a painful and traumatic experience. We may feel that we have lost a significant part of our life, and if only for a moment, we may feel an immense loss of our identity.

The grief we feel is caused by our loss, and mourning is the process of adapting to the losses in our life. Through the complex and personal process of mourning, we acknowledge the pain of loss, feel the pain, and then live past it. How we each mourn depends upon our state of readiness and our perception of loss.

Kubler-Ross (1969), a pioneer researcher on death and dying, categorizes the coping mechanism of death as a series of five distinct stages: denial and isolation; anger, bargaining; depression; and finally acceptance. Although it has been argued that each grieving individual may pass through these stages in different sequences and spend a different amount of time in each stage, psychologists agree that there are several stages which most individuals encounter.

Whether the loss is sudden or predictable, the first reaction to death is shock and denial. At the onset, we may weep silently or out loud, and the shock may be mild or beyond comprehension. Some people feel a severe gut-wrenching pain deep inside their stomach, while others may feel stunned or look bewildered, not believing that the loss has occurred. Although these reactions in the first phase are very different, they are all nonetheless very normal and last for a relatively short time.

The next and much longer phase is intense psychic pain. We may feel hopelessness, anxiety, fright, and helplessness which may be exhibited in lethargy, hyperactivity, aggression or regression. We are angry at the doctors, at care providers, a tour friends, et the deceased, at God. We may also feel guilt, shame, regret, or ambivalence. We may have not had a chance to say our good-byes, to express our love, or to take care of unfinished business. In our despair, we may deplore, "I should have called more often," or "I should have visited last week." And in denying our loss and searching for the deceased, we may have disruptive dreams, fantasies or nightmares.

After the initial shock has worn off, and the fear, anger and depression have diminished, the bereaved enters into an adjustment phase. Usually with the absence of the deceased comes a change of routine. It may seem that death is an ending, but for the survivor, it must also be a beginning. And finally, as we begin to accept these changes and understand our loss, the necessity of moving ahead is realized.

RELATED ARTICLE: Easing the Pain Through Intervention

Finding comfort in the death of a loved one can seem an impossible task, but those who experience the support of a social network or the intervention of a professional may find the trauma less overwhelming. Assisting with the dying and bereaved is a difficult task because it reminds us of our personal losses, as well as heightens our awareness of our own future losses.

We may begin to question our belief system and re-evaluate our lives. The most commonly asked questions about loss and grief are:

Q: What do I say?

A: Hearing about a loss can be both awkward and terrifying. But despite your own personal feelings, the bereaved foremost needs genuine empathy, reassurance and support. In a caring manner you state that you are very sorry about the loss, and acknowledge that the loved one will be missed very much. Do not attempts to minimize the loss with cliches or simplistic, pat answers. In addition, refrain from relating personal examples of loss.

Q: Is it okay to show emotion?

A: Although you may feel like crying as the bereaved begins talking about the loss, do not feel ashamed or less than professional. The emotional pain that you are feeling is real, and will be only temporarily disabling. As the caretaker, however, it is your primary responsibility to consider the needs of the bereaved first, and act with dignity and assurance.

Q: What can I do to help?

A: Most grief-stricken individuals don't know what they want or need. They may feel confused and have difficulty making decisions. In the interim, reassure the bereaved that he or she is not alone and offer specific and direct assistance which you know can relieve some of the burden of everyday life. As a professional, you are somewhat limited in the amount of personalized assistance you can give. If it is possible, offer to bring a meal to the home or attend the funeral service. There are numerous organizations and specific support groups which can provide assistance during this time, and you can refer the bereaved to one of these community and/or national associations. Later on, make yourself available as a good listener when the bereaved wants to talk about the loss.

Q: How long does the grieving process last?

A: The grieving process is different for each individual. It is both a natural and personal process which takes time. To ignore it, will only magnify the reaction at a later date, and the greater the loss, the more time it will take to heal. The process of healing is not a smooth and steady progression from sorrow to happiness. It is more like a jagged staircase, full to ups and downs, leaps forward and slides downward. A full range of emotions may be exhibited and knowing this helps in the grieving process. Typically, the process takes about a year, but it is not uncommon to extend beyond this time.

Q: What happens if the bereaved is still depressed after a year?

A: Unlike mental illness, the feelings suffered during grief both gradually and permanently disappear. However, when grieving is incomplete, delayed or unresolved, it can become the source of additional problems, including substance abuse, clinical depression, panic disorder, or illness. Although the bereaved is well within the normal range for grieving, it may be necessary to aggressively intervene. Strongly suggest that attending a support group or receiving counseling is in order, and supply the needed information for a smooth transition.

These reflective exercises can be used for personal exploration or by facilitator to assist with the loss and grieving process.

Reflection Exercise #1: Your Loss History

Directions: Memories are very important, but they cannot inhibit you from living in the present. By reflecting on your own losses, you can become more effective in assisting others with their grief. Respond to the following questions, and then discuss your answers with a partner or facilitator.

1. The first death I can remember was the death of: , and I was year old. I had these feelings at the time:

2. The first funeral/ritual service I attended was for: ,and I was year old. What I remember most about that experience was:

3. My most recent loss by death was: . This is what happened and how I felt:

I coped with this loss by: I knew I had resolved my grief when:

Reflection Exercise #2: Looking Ahead: Your Most Difficult Loss

Directions: Looking into the future, explore the feelings you may experience when facing the loss of loved one. Discuss your answer with a partner or facilitator.

1. Of all the people in my life, the most difficult death for me would be:

It would be most difficult because:

2. On a sheet of paper, write down the things you admire, respect or like most about your loved one. Draw a line and write down those things you do not admire, do not respect, dislike, or irritate you about your loved one. Reflect on what you have written.

3. Divide a sheet of paper into three columns. On the left side write down the activities you did or are doing with your loved one. In the middle column list the activities you will continue to do after you have lost your loved one. On the right side list those new activities you may/will begin after your loss. Reflect on the lists.

Reflection Exercises #3: Describing Your Grief

Directions: This exercises may be used when reflecting on a past loss or in anticipation of a future loss. On a sheet of paper describe your grief using pictures, symbols and words. Share this exercise with a partner or facilitator.

Reflection Exercises #4: A Letter to Your Loved One

Direction: Use this exercise when reflecting on a past or in anticipation of a future loss. Select a particular loved one (parent, spouse, sibling, child, relative, friend) and on a sheet of paper write a letter to that individual, responding to the statement "When I think about you..." Let yourself experience any emotions you have while writing to your loved one. Now, take the letter, fold it up, place it in an envelope. Refer to your letter whenever the feeling of loss surfaces, or share it with a friend or facilitator.

Reflection Exercise #5: Helping Yourself

Direction: Drawing on the suggestions listed below or your own experiences that have given you comfort, make a list of those things which you can do to help yourself cope with a loss. Discuss these activities with a friend or facilitator.

1. Exercise 6. Get a massage

2. Keep a journal 7. Call a friend

3. Listen to music 8. Volunteer

4. Read inspirational books 9. Pray, Visualize or Meditate 

5. Go to a place of worship  10. Talk with a therapist

Individuals facing tragedies and loss often look to the recreation professional for help. Exploring the grief process with the bereaved is a means of bringing balance, harmony and acceptance into the lives of those who need it the most. By reading extensively and attending workshops on grief and loss, the recreation professional will be prepared to contribute in this process. Assisting patrons with their loss may be one of the most meaningful and substantive services that can be informally provided by a recreation professional.

RELATED ARTICLE: Coping with Your Own Grief

1. Accept your emotions

2. Express your feelings

3. Don't expect your grief to disappear overnight

4. Bring your children/family members into the grieving process

5. AVoid long periods of isolation

6. Help yourself and others through support groups

7. Rest and eat nutritionally

8. Regain your routine/schedule as soon as possible

9. Allow your friends to help you

10. Consider professional counseling

References are available from the authors upon request.