A client, Abby, comes to counseling to deal with feelings of loneliness and stress following an abrupt breakup with a long-term boyfriend. She had thought they would get married and now is questioning everything: her ability to be in a relationship, the meaning of the past few years and her value as a person. She reports ongoing sadness, moments of strong anger and fear at the prospect of wading back into the dating pool.

Abby says her friends are “sick of hearing about the breakup” and are encouraging her to “get back out there” and find someone new. Each of these conversations makes Abby feel worthless, embarrassed and even more alone.

Counselors could use a variety of treatment plans to help Abby get a handle on her symptoms. But what if the boyfriend had died in a tragic accident instead of simply ending their relationship? Would that change the diagnosis or shift the choice of intervention? Grief has its own category of treatment plans and possible interventions, yet those struggling with everyday losses often manifest grieflike symptoms. Being laid off, losing a scholarship opportunity, aging — the list of grief-inducing experiences is infinite, and experts agree that these losses can launch us into the same grief process that accompanies the death of a loved one. The problem is that clients, and the communities they live in, often have different expectations for how we should respond in such moments.

“I think the public sometimes attributes grief reactions solely to losses due to the death of a loved one,” explains David Capuzzi, a grief expert and past president of the American Counseling Association. “In reality, people experience the same grief reactions to a variety of other transitions and losses that are not death-related.

“In addition, Westerners are not taught how to help those around them cope with the role of grief in daily life. We celebrate births, anniversaries, job promotions, being the recipient of an honor or award, and most of us have no trouble commenting positively on the good fortunes of those around us. By contrast, few know what to say to someone after a relationship ends, a job is lost or an anticipated ‘life marker’ is not realized.”

Mark Stauffer, a counselor in Portland, Ore., who has co-authored several books with Capuzzi, suggests that we imagine a continuum of loss based on our reactions to it. “On one side are more significant losses, [including the] death of a loved one, major illness or trauma, that generally spark greater grief processes and are often accompanied by social and cultural recognition and ritual,” he explains. “On the other side, everyday loss may attract little attention and may reflect a more idiosyncratic response to life and identity.”

Stauffer, a member of ACA, notes that the same type of event can trigger grief in one person but register as neutral for another. He offers the examples of a child moving between grade levels in school, watching the election of a political candidate who does not reflect one’s own culture or having a child join the military. These experiences may ignite a grief response in some individuals and no response in others.

A counselor might be the first person to explain to a client how life transitions can cause feelings of grief, and counselors should be open to recognizing everyday losses for what they are. “Many losses could fall into [the everyday losses category] as we progress through life’s journey, since change and transitions are two of life’s constants,” Capuzzi says.

He adds that grief reactions can follow different patterns and durations. “Some individuals become lethargic and depressed, [while] some turn to food, drugs or alcohol to numb their feelings or avoid experiencing their feelings. Some fill their time with activities or responsibilities that prevent them from facing the reality of a loss. Still others need to talk about their loss to such an extent that the people around them prefer to keep their distance.”

How to help

Let’s return to our client, Abby, who is grieving the loss of her relationship. Helping her view her experience as part of a grieving process might offer a context that allows her to be gentler to herself. Although her conscious mind might reflect the larger culture’s often limited patience for grief (“I need to get over this already”), the empathic experience of counseling can help Abby feel subconsciously safe enough to tell her story, perhaps again and again, which most counselors agree is a necessary part of treatment.

“I think the first step in assisting a client to deal with any transition or change that he or she interprets as a loss is to allow the client to ventilate freely for the purpose of helping the client get in touch with the reality of the loss and the void that has been created,” Capuzzi says. “I believe it is a mistake for a counselor to ‘push the river’ or attempt to circumvent this aspect of the grieving process [because] clients need to fully assimilate and come to terms with what has happened before they can move on. They need to be allowed to feel their pain before they can initiate the process of moving on.”

Stauffer recommends helping clients develop awareness, connection, acceptance and dignity in dealing with everyday losses. “I prefer mindfulness-based therapies for everyday losses [because] they can help increase acceptance and awareness of the loss events [and] also of the natural qualities of grief,” he says. “As self-awareness increases around the topic of grief and loss for clients, the connection between death and everyday loss may come to light.”

Capuzzi suggests that counselors think about the four “basic tasks” of mourning: accepting the reality of the loss, experiencing the pain of grief, adjusting to a new reality, and letting go and reinvesting emotional energy.

Part of the counseling process might involve helping clients to accept their new reality, such as living life without the job they once held or absent the community of friends or colleagues they had hoped was permanent. “They also need to be taught that it is OK to grieve in whatever way is natural for them and that it takes effort to overcome a loss. Only then can a client let go of ‘what was’ and begin to reinvest in ‘what is and could be,’” Capuzzi says. “Losses can be painful, but every loss opens up spaces in our lives that can be filled with something different and fresh. Most clients will not see this at first, but those who do their grief work later report that their lives are richer than they could ever have imagined.”

A role for resilience

Once Abby has recognized her breakup as a grief-worthy experience and truly vented her sadness and comprehended it for what it is, the counselor might wish to help her move through to a place of self-assessment and appreciation. Some mental health experts suggest that the difference between just getting through a loss and becoming stronger because of it comes down to resilience, or the ability to bounce back from a life challenge. Certain people may naturally find this easier than others, but counselors would do well to consider resilience development as part of the long-term treatment plan for those experiencing any kind of grief.

“Resilience is about developing and maintaining the strength to overcome adversity,” explains Marymount University professor Tamara E. Davis, a member of ACA and the counselor educator vice president for the American School Counselor Association, a division of ACA. “In children, resilience can be developed by helping them develop the internal and external assets that will sustain them when life is difficult or when hard times occur. For adults, resilience typically comes through a sense of hopefulness and optimism about the present and future and the belief that one can overcome difficulties, either through prior experience in overcoming [difficulties] or through optimism that one can.”

Davis explains that strengths-based counseling techniques, which identify a client’s strengths, talents and abilities, can help a grieving client recognize that he or she already possesses the skills to get through a loss. “More than anything, strengths-based counseling is related to self-efficacy,” she says. “If the counselor can help the client recognize and identify the strengths that have helped them in difficult times before, they are much more likely to believe that they can work through the difficulties they are currently facing. The belief that ‘I have what it takes to overcome’ goes a long way in terms of actually overcoming.”

Davis adds that counselors can assist clients in recognizing both their internal and external assets in order to foster resilience. Internal assets include personal strengths, while external assets include support systems and people on whom the client can rely. “Literally identifying and writing down the external support systems in our lives reinforces that we are not alone,” she advises. “The feeling of having others in your corner is a reminder that we have people in our lives to help us. Being able to pull from this list when crisis occurs is a critical way to develop resilience.”

Steve K.D. Eichel, an ACA member who is a resilience expert in Newark, Del., says resilience often can mean the willingness or ability to find help when needed. “Resilience is the single most important client factor in being able to face, cope and even triumph over all adversities,” he says. “I define resilience as the ability to navigate one’s way to the resources that will help the individual withstand and learn from adversity.”

Eichel warns counselors that resilience won’t always appear in the form they might expect. “Our society approaches loss and grieving in a manner that is destructive and even offensive,” he says. “On average, workers are allowed two or three days to deal with the death of a spouse. Ridiculous! Traditional religions like Judaism and Catholicism have a much healthier approach. Active mourning is expected to last a week to a month, and the mourner is accorded unique status — for a full year. I would say that the person who deeply grieves, cries and mourns is often exhibiting resilient behavior.”

Although acknowledging that it would be ideal for a person to have developed resilience prior to experiencing an everyday loss such as an illness or a layoff, Davis contends that resilience can grow in the midst of crisis. “Consider someone diagnosed with cancer. The person really has two ways of responding,” she says. “They can either give in to it, say ‘I have no control over this, so I’m going to give up,’ and then isolate themselves as they go through treatment. Or they can say, ‘I can’t control that I have cancer, but I can control my attitude about it and the support systems I choose to help me get through it.’ Research supports that those who are more hopeful and optimistic about their recovery stand a better chance of a healthier and happier recovery.”

Eichel has found it beneficial to point out the resilience he sees in his clients. “The ability to tolerate difficult feelings, to verbalize experience, to increase awareness and be open to feedback, to remain focused and to build a relationship are all examples,” he says. “I also try to build an awareness of the strengths manifested in behaviors outside the office, even if those behaviors are ultimately ineffective.

“I believe counselors can help build client resilience by challenging them, and to challenge them means being open to being challenged [ourselves as counselors]. In my experience, participation in some kind of ongoing group — led by a highly experienced and trained group therapist or facilitator — is one way to be open to such challenges. Ongoing participation in peer supervision and consultation is another way.”

Eichel also advises counselors to build their own resilience. “I strongly believe the single most important thing a counselor can do to promote her client’s resilience is [for the counselor] to engage in ongoing, consistent personal growth. That may mean ongoing, depth-oriented therapy, or it may mean becoming involved in a personally challenging ongoing growth activity. Or it may mean training for a marathon. It does not mean quickie, weekend seminars once or twice a year. Treating one’s own growth in a superficial manner will usually lead to great difficulty with truly and sincerely promoting deeper growth in our clients. And, generally, deeper growth is necessary for increased resilience.”

Reimagining recovery

So what can Abby expect in the future as she recovers from her grief and reframes her experience as something that might help her build her own strengths? “Recovery for one of my clients is when the client begins to re-experience a zest for life — not as it once was, but as it is in the present,” Capuzzi reflects. “When I see the focus of counseling sessions transition from describing the many facets of the grief that was earlier experienced to animated discussions about new relationships, goals, experiences, etc., then I know that recovery is well under way and that the counseling process may be coming to an end.”

Stauffer notes that blessings are often connected to our grief experiences, and making room to see all sides of the loss can be part of recovery. As an example, he points out “the higher-paying job requiring more time away from family or the birth of a first child [that] marks the loss of singlehood.” Deeper grief work may lead to recognizing the unexpected feelings of relief and closure that come through the loss experience, Stauffer says.

Davis agrees that resilience-building techniques, or those emphasizing assets and resources, can allow clients to see their losses in this deeper, more three-dimensional manner. She adds that this understanding is part of the natural evolution of the wider counseling field. “It is my belief that the focus on resilience, strengths and positivity in counseling will be the wave of the future,” she says.

David Capuzzi and Mark Stauffer will be presenting a Learning Institute on “The Many Facets of Grief” on March 21 from 9 a.m.-4:30 p.m. prior to the main ACA 2012 Annual Conference & Expo in San Francisco. A separate registration fee applies, and participants can earn six CE hours for the session. For more information, visit counseling.org/conference or call 800.347.6647 ext. 222.

Stacy Notaras Murphy is a licensed professional counselor and certified Imago relationship therapist practicing in Washington, D.C. To contact her, visit stacymurphylpc.com.

 

Letters to the editor: ct@counseling.org