Home | Examination

Unique Tools in Grief Care

Thomas Bilney College of Psychology and Philosophy

This course is approved by the State Board of Embalmers & Funeral Directors of Ohio for 2 (two) hours of self-study continuing education credits.

Styles of Grieving

In our society we all lean toward a strong urge to stereotype various categories of people and situations. Most grief caregivers tend to "lump" those experiencing grief into two primary categories.

The first group we will call the "Good Grievers". Those are the ones who seem to be making a marked progress towards healing and restoration to a somewhat of a normal lifestyle. This person tends to be either conservative or timely in their display of emotion. Even though they may feel the pain and the stress of grief in reality they are working their way through the process.

The second group we will call the "Lousy Grievers" Those are the ones who keep fighting the idea of accepting the loss and getting on with their lives. This type of person usually displays a higher level of emotional output with a more spontaneity. They require much more attention and care and sometimes they show very little response or progress.

That particular stereotype of "Good" and "Lousy" should probably not be used. Grief is neither is good or bad. It is really a sensation of the emotions and feelings layered around that sensation. Bereavement is the actual expression of that sensation we call grief. The level of bereavement is often figured by the complexity of the grief on is experiencing.

Many grief counselors now speak of grief in "phases" rather than stages. These phases may be experienced in no specific order and are not limited to a certain number of instances during the grieving process. Examples may be the "yearning" phase, where the persons entire focus is on resolution or returning to some format of normalcy. This may develop into panic in the griever. There will many times be verbal expressions indicating a need for balance and a return to a normal pattern in life. Sentences like "I wish I could just enjoy a night out with my friends again" or "I can seem to concentrate on a good book anymore" are pleas for life to return or adjust to a place where normalcy is once again experienced.

The "numb" phase is where the griever has moved into a "self-protection" mode so as to feel nothing from the pain of the grief. Many times someone in the numb phase is unresponsive or seemingly oblivious to the circumstances. This may often ignore the circumstances around them as a form of denial of the loss. This is especially true of children and adolescents. Adults experiencing a numb phase are usually willing to honestly admit to the loss they have experienced, but simply dont want to express or experience the results or consequences of that loss.

The "disorganization" phase or the "despair" phase where everything is "up for grabs" and no certain outcome is determinable by the griever. When this phase is in its strongest mode the griever may feel out of control and even worthless. Lifes definitions may not hold any value anymore. Many times the person experiencing this phase in a strong intensity will act out of character and spend money on things they normally wouldnt or involve themselves in relationships that will not benefit them at all.

Some of the latter phases may include "reorganized behavior" or the "recognized hope" phase where the griever may begin to see light at the end of the tunnel. Hope is beginning to be seen on the horizon of life. Normal patterns in their life are starting to reestablish. New and/or adjusted relationships are beginning to be beneficial once again.

Irregardless of what phase or phases they are experiencing simultaneously, the process of grief is still one that is necessary, natural and completely normal. Remember that people in grief are not required to experience grief in any specific order or in any specific time frame. They may experience these "phases" more than once and in various combinations and sequence.

People who are in what is referred to as fresh or intense grief are not usually pressed into a predictable mold of interpretation. Examples of fresh or intense grief would include ; parents in an emergency room finding out for the first time that their son was just killed in an accident; a husband who has just read the divorce papers filed against him by his wife; the mother of two young children who has just been told she has a terminal illness that will end her life in a few short months. These fresh and intense situations will produce an array of initial reactions which tend to diminish after a short period of time. Depending on the severity and circumstances surrounding these situations, this time frame may be anywhere from a few minutes to a few days.

In Martin & Dokas book "Men Dont Cry / Women Do Transcending Gender Stereotypes of Grief" (Published by Brunner/Mazel) people experiencing grief are referred to as instrumental grievers or intuitive grievers.

Instrumental grievers tend to progress with the process of loss. Some may move slower or faster than others, but at least there seems to be progression. Many instrumental grievers find applicable tools in their life that will help them deal with the loss in an effective manor. The danger in identifying these tools is that they may lean strongly into what is commonly called "self-medication". These grievers might repeat an action that seemed to help until it becomes habitial or harming.

There are four very popular ways in our society that people "self-medicate". They are; 1). Food, Alcohol and or Drugs. This is where the griever becomes dependent on the comfort or feeling that comes from over or constant indulgence in such a substance. 2). Obsessive businesses or the extreme pursuit of career endeavors. This is when the griever attempts to eliminate the pain of grief by keeping busy or becoming a "work-aholic". The constant grind of working covers or drowns out the pain of grief that they might normally have to deal with. These self-medicating grivers are usually excellent at suppressing any expression of their grief. 3). Entertainment. This may include obsessive television or movie viewing, addiction to the internet, gambling, physical risk taking or other extreme challenges that give a momentary high that appears to cover hours, days, and weeks of the pain felt in the loss that is being grieved. 4). Obsessive or inappropriate sexual activity. This has many implications of the grievers need for personal acceptance and to be valued by those around them or even by strangers. In the act of inappropriate sexual behavior, the griever may actually be trying to fill the mental or spiritual void felt by the loss with a physical relationship. Some intense grievers may only be interested in satisfying a partner so as to gain their approval or acceptance. These misdirected activities never assist the griever in coping with the big picture involved in their grief, but usually complicates the problem and may result in a more complex grief because of those problems.

Some Instrumental grievers may grow to become a stronger person as an end result of the grief process that they experience. They may also develop a compassionate attitude through acceptance of their loss. This may include a more helpful attitude towards others who may be experiencing grief similar to theirs. Some instrumental griever may even progress into caregivers themselves.

Intuitive grievers tend to be moved or disturbed by the processes of grief. They are regularly thrown about emotionally and mentally by the waves of pain and feelings that they feel. They rely strongly on others for support and care. They can become very dependent, easily led astray by wrong influences in their lives. This may also lead them into the processes of "self-medication". They may never see a complete resolution in their grief. Their noticeable or outward grief process may take years or even decades. Typically, intuitive grievers experience very slow or hardly noticeable changes in their attitude toward life in general during their grief. It takes a very patient caregiver to work with an intuitive griever

There are positives characteristics to both types of grievers. There are very evident weaknesses in both types of grievers. The intuitive griever is more likely to accept care and help along the path of grief, whereas the instrumental griever may be more cognitive and self directed. The instrumental griever may be able to fit back into a normal pattern of life quicker than an intuitive griever. However, when the intuitive griever does eventually fit back into lifes normal patterns, they can many times feel very secure and permanent. All people suffer the threatening of their personal peace in their lives whenever there is any form of substantial loss felt. The intuitive griever regains that sense of peace when they sense the expression of love, care and compassion from those around them. The instrumental griever finds their peace when they sense that they are beginning to return to the normal patterns in their life. It should be noted that these lines blend together very closely regarding how peace is re-established in their lives.

There are blended versions of both instrumental and intuitive grievers. It is very rare that they make an equal blend. It is also rare that an individual is completely one type of griever or the other. Blended grievers are those where the mix is not as obviously polarized. There is almost always more of one style or another found in the blended griever. Under scrutiny it becomes blatantly obvious.

One blended group we will call the "Appearance Managers" This group is more intuitive than instrumental. They have a unique ability to screen their behavior for content as to what they believe is appropriate for the circumstance they are involved in at any given time. They can temporarily bottle up their expressions if they sense that there is no help available for them or that they would be looked down upon for such an emotional or verbal display of their grief. They can be explosive and very dynamic when trapped in high pressure circumstances.

The other blended group we will call the "Wishful Grievers" While they are mainly instrumental in nature, they tend to have an unusual desire to appear or become more intuitive in their grieving processes. They may often come down on themselves because they dont have the stronger emotions or feelings typically associated with people suffering loss. Wishful grievers can be easily overcome with a temporary depression. Some may even go to the extreme of mimicking more severe emotional responses in their grief simply to appear more sensitive or more connected with other grievers in the same loss experience that they respect.

Positive Approaches to Grief Caregiving

As we move towards helping and caring for those in fresh or intense grief, we must continue to build our caregiving principals on positive values. Many times we think we need to respond to an invitation that has not been issued. The best help is given to those who desire it. This can most effectively be accomplished by allowing your role to be defined by the person experiencing grief. There a couple of good ways to approach this. It can be done verbally, however most caregivers find that a printed questionnaire works fine if the person in grief is willing to acknowledge their need for a caring relationship and take the few brief moments to express their true needs in the grieving process. A simple questionnaire like the one below may help direct your efforts and eliminate many frustrating moments during the caregiving experience.

Grievers Needs Questionnaire

I need my emotional concerns addressed (anger, sadness, despair)

I need my family issues addressed (disunity, conflict, communication)

I need my financial issues addressed (debts, wills, investments, future expenses)

I need my spiritual issues addressed (God, faith, community, belief systems and values)

I need my social issues addressed (spending time where and with whom)

I need help in setting goals (focusing on the future, jobs, residency, new relationships)

Once these questions are answered by the griever, the caregiver should be able to formulate a plan of care that will be most effective to help the griever walk through the grief process. This is accomplished by being able to see what areas the person seeking help is truly desiring or needing it in.

Most people experiencing fresh or intense grief just need a listener. Listening is easy. You dont have to be their "superman" and you dont need to be a fancy linguist. Most of the time it will only cost you a little time. Remember, that those in grief seem to have a keen sense of who is really listening and who is simply patronizing them.

Most people are not looking for a precise list of instructions to help them in their grief process. Instead, they may respond better to a story or example that you share with them. I f you are going to share an example of someone or something that there is any chance that they may know or have come in contact with personally, be sure to disguise names, places and dates well enough so as to protect the privacy of the person or situation you are describing in your example or story. Sometimes you may want to rehearse a story or personal example more than one in the process of your caregiving.

Most people that seek out a caregiver or counselor in their grief are primarily looking for acceptance. Since they are full of emotions and feelings and the simple need to expel them verbally for the most part. A non-condemning quiet listener in some circumstances may do them more good than the best psychotherapist. We as caregivers often thing we must have all the answers to everyones problems. If someone asks a difficult question that we have no response or insight on, it is always better to say "I dont know" than to try a generate a weak or useless response for the sake of looking helpful or intellectual.

Tom Attigs book "How We Grieve: Relearning the World" (Published by Oxford University Press) conveys the message that most grievers need to "relearn their world" after they have experienced a loss. This relearning process affects them in three primary ways.

The normal physical surroundings of the griever have changed because of the absence of the person or thing that they have been separated from. Typical appearances and responses in rooms or other areas may no longer be the same. The loss creates noticeable vacancies in certain environments. These empty areas in the grievers physical surroundings need to be addressed. Rapid replacement of these losses in the physical surroundings of a griever can do more harm than good. Many instrumental grievers see a replacement such as a new spouse or a new employee as simply part of the cure for the grieving process. The decision is made quickly because of the perceived need to fill a physical vacancy.

The relearning process means that we must relearn relationships. Relationships must be repositioned and reevaluated because of the absence the loss has created. This may also produce new relationships or the need for relationships that were never before required. This may make the griever very uncomfortable and awkward. Many times former relationships cannot continue in the same manner because the dynamics and the former catalysts that were produced by what or who it is that has been lost, are no longer there. With the proper support and care they will process through these necessary changes.

Finally the griever must personally re-learn themselves. They have been changed personally by the loss they have experienced. Their emotional balance is affected. Their spiritual and religious values may be threatened or challenged. They may even be feeling differently physically from the stress that has come on them because of the loss.

One way to help those experiencing grief is through strength assessments. Strength assessments can help us see loss through more of a positive light. Many times when we experience a loss, we naturally see it as a negative experience. Many losses we suffer in life do have a negative affect on us initially.

But is loss always a negative experience? Obviously not. Lets look at an example where and experienced loss is good but still causes us to grieve. For example kicking the habit of smoking. The loss created the absence of cigarettes in our life. We no longer have them in our pocket or purse. We no longer hold them in our hand on a regular basis. We no longer smell them burning or taste the smoke in our mouths. We no longer have to step outside to "take a smoke". We no longer have to keep a ready supply of chewing gum or breath mints so others wont smell the aftermath of our habit.

Would we still grieve? Obviously, yes. We have to relearn ways to deal with the time we stepped outside to smoke. What should fill the space in our pockets or purse? Even in dealing with the relearning processes, this "positive" loss can still have negative effects. This is when we have to concentrate on what our strengths are in order to deal with the effect of the grief we experience.

A strength assessment is a tool that may help us and those who are grieving find a positive way to cope with the negative pain and discomfort of the loss. Discovering our strengths may help us find ways of processing our expressions of grief.

Here is a very basic set of questions you can use as a caregiver that may help identify the strengths of the person you are working with. When you ask these questions, listen closely and help them refine their answers so that both you and they have a foundation to work off of.

Personal Strength Assessment

  1. What is your greatest strength?
  2. What are some compliments you have received about that strength?
  3. What have you done that you are proud of?
  4. What is one of the best times you have experienced in your life?

If you are working with a family in their loss through death, here are some questions that might stir the conversation in positive ways to help them as a family unit cope with their loss.

Family Strength Assessments

  1. What are two of the greatest strengths of your family?
  2. How do your family members compliment or balance each other?
  3. What are your best memories of family activities?
  4. If your family were to break apart, who would be missed the most?

If these questions are answered accurately by the person or persons being interviewed , more than likely a very noticeable strength (or strengths) will become obvious. Then this strength(s) can be discussed and utilized to the benefit of the griever in his or her grief process.

There are three key principals or processes that will utilize strength assessments to their highest capability. First, encourage the person or family to use of the strength to bring about positive effects. Example; If the family enjoys singing together, encourage them to sing a song that brings a smile to their faces or joy to their hearts. If an individual has a hobby or strength of working with plants, gardens or landscaping, encourage them to plant a tree or a special or unique plant in their yard or garden in memory of the one that has died. Secondly, utilize the passions that compliment or motivate those strengths to help cancel potential further losses. Example: if that person is an artist, go to their favorite gallery with them. Or, buy a painting for them to evaluate for you. In these ways you are having them express the passion that motivates the strength that they have identified.

Finally, create activities that use the strength to memorialize the loss or give the loss new meaning. Here is an example on the personal level. Deborah was a professional pianist. She played concert piano in the symphony of the metropolitan city she lived in. She had an adopted daughter named Cynthia. Cynthia was killed at age thirteen in an automobile accident. Deborah was having a hard time performing concerts and slowly resigned form the symphony. Deborahs counselor encouraged her to write a short song on the piano that she could use as a warm up before her practices and performances. This song would be a memorial song and would dedicate each practice or performance to the adopted daughter she loved and had lost. Within a week Deborah was back to work with the symphony. Before every practice or performance she played her new song in memory of her daughter.

One way a family might utilize their strengths would be like this. Every year the Johnsons gathered together at Dad and Moms house on new years eve to bring in the new year. They had done it for nearly ten years since the youngest of the three children got married. Dad died this last spring, so this will be the first new year that the family will not have everyone there. The biggest event of the new years eve celebration was a big meal of ham and pumpkin pie. It was always a very joyful time and very delicious. Moms caregiver suggest that the family all gather together and each person sign the tablecloth used with this years meal with a permanent marker, allowing them space to make a comment about their love for Dad on the tablecloth. At the end of the meal the tablecloth is neatly folded and placed in the China cabinet where it can be observed in the following years to come. This brings closure by memorialization to and event where the loss is obvious. Now that the loss has been memorialized, the family can go on with the same celebration with a fresh start. The tablecloth is still there to be observed when needed, but it is no longer in use. There is a new one on the table next new years eve.

Systematic Tools to Relieve the Grief

It is always good to develop a process tailored to the grievers needs that you are caring for. The following is a broad spectrum basic systematic approach to helping someone who is experiencing fresh or intense grief receive some relief to the sensation of their grief.

1). Encourage the griever accept the reality of the loss, not necessarily the loss itself.

Gently remind the griever that life has and is changed because of the loss that has occurred. Life is not over or eliminated. Things will be different, but not destroyed. We may not be able to know or accept why, but we will be better off to accept the reality that the loss or point of separation has occurred.

This approach is meant to help the griever who tends to have a periodic or continuous phase which includes a denial that the loss has ever occurred. As long as there is an acknowledgement that the loss or separation is indeed a reality in the grievers life this approach may not need a lot of emphasis.

In cases of traumatic or sudden losses, the person immersed in fresh or intense grief may verbally deny the loss simply to allow themselves time to accept the reality of it. If this period of verbal denial continues and is endorsed by their lifestyle, it is important to start helping them develop a mentality that begins to accept the loss as a reality in their lives.

2). Help the griever work through or process the pain involved with grief

Grief can be emotionally and mentally draining. If the griever can be educated and informed about the facts surrounding grief and loss, they may be able to see hope in the fact that they are not being singled out in their emotions or feelings. Grief is natural, normal and necessary for all people to experience when a loss occurs.

Spiritual guidance is an important part in the function of relieving ones grief. Inspirational books, CDs and other material may uplift the depressed feelings. You may want to help the griever connect or reconnect with their faith and their belief systems. This may be done with their minister, rabbi or priest. It may just mean to take them to a worship service or a chapel to pray.

When someone wants to pray or desires prayers to be said on their behalf, it is an indicator that they have been spiritual active or have spiritual influences in their lives. It also indicates a belief system that endorses God or some format of a higher power than themselves.

When talking with someone about spiritual matters you may find that learning their spiritual ideals will help you be more effective as an aftercare provider in their life. In regards to their spiritual life you may want to ask them three key questions:

    1. What is your source of strength?"

    2. "What is true peace to you?"

    3. "Where do you find security?"

The answers to these three questions will tell you a lot about that particular persons faith and/or spiritual life. Are their answers based on the faith they practice or are they represented by tangible items around them? There are no wrong answers just informative answers. Use these answers to formulate a persons religious posture and spiritual position. You will notice that we have not questioned them about their religious preferences or denominational affiliation.

There are several practical procedures to help the griever cope with the immediate symptoms of grief and the related emotions. Pausing to take a deep breath will often help to lower the momentary anxiety. A period of quietness which may include visualizing a very serene or peaceful location may help to quiet the hurt of the pain of loss. Sometimes the griever needs to separate himself or herself from the catalyst that may be stimulating the pain from the loss. As a caregiver we should always be sure that the griever is not alone during such short periods of separation.

3). Help the griever adjust their environment to the loss

Caregivers can help by helping the griever develop a management plan for handling new or unexpected situations in the home (with other family members), the workplace (with relationships and fellow co-workers), and social functions (church, community events, dates etc.) Such plans may include a network of support contacts and even some of the practical procedures previously mentioned.

Sometimes this may even include such practical and fundamental things like re-arranging furniture or the removal of health care equipment used by the dying patient. It may include the process of taking down the wedding picture from the wall since the divorce has been finalized for several months.

Many times when a parent looses an child in death or even when a child gets married or moves to another state to take a permanent job, the parents leave their bedroom completely set up as though they will be coming back to re-inhabit it ant any time. There comes a time when the room must be changed in use and style; when the furniture must be removed or relocated to a more useful place in the house.

The family recreational vehicle is no longer being used because Mom was the primary motivator for its use when the family went on vacation.

These are all ways that the environment has and must change in the event of a loss. The effective caregiver must be aware of the necessary changes in the grievers environment and be willing to help process them through it.

4). Help the griever to emotionally reposition them selves to the loss.

It is at this stage we as caregivers start the processes in grief that help the griever separate from the loss and move ahead into new future. This can be assisted in a number of ways. One way is to encourage them to write a "good-bye" letter to the person or circumstance that has been lost. A follow up would be to write a "hello" letter to the new life they will be living after experiencing the grief from the loss. If the griever has a more religious or spiritual mentality this might be accomplished in the form of a prayer (written or spoken). Some grievers never need to accomplish this task in the grieving process because they have already come into the realization of the permanence of the loss.

Some grievers reposition themselves to the loss with one climatic event. It is usually a self initiated event that has an intense healing effect on their outlook of the future and their grief. Take the example of Dan, the auto mechanic. Dan and his son Mark used to work on cars in their garage on the weekends. They had a very good relationship and enjoyed working together. They would always dream together that someday they were going to build the best stock car in the county and take it out to a local track and race it. They never got to live out their dream before Dan died suddenly of a massive heart attack at age 48.

Mark was emotionally devastated. He tried to work through his grief and even sought out professional care. It seemed as though his loss and his personal regrets kept overwhelming him. He could no longer work on cars on the weekend. He was haunted by not only the failure to fulcill the dream he and his father had, but also all of the good memories working together on the weekends.

Finally, Mark decided to do one last thing. He went out and purchased a car that could be rebuilt into a stock car racer. He worked every weekend for three months rebuilding and preparing the car. Then one weekend he took the car to the track and entered it in competition, himself as the driver. One the rear quarter panel of each side of the car appeared the word "Dad".

It didnt matter if he won, it mattered that the dream had finally become a reality.

This was a literal event that was left undone in Marks grief processing. Now it had been fulfilled and Marks life could return to some format of normalcy.

Mark and his "Dad" realized their dream of going to the races with their own car. From that point on Mark started to heal from his grief more progressively and was even able to resume working on cars again.

It is usually at this point of repositioning that we start to enable the griever to experience life with less support and care then we have previously extended to them. They will never completely heal from their grieving experience. There will always be memories, and they will occasionally be "ambushed" by those memories. Though they may not willingly acknowledge it, it will be to their benefit that the grieving process does not come to an ultimate end. This is how they learn to deal with their next grief experience in a more effective manor. Life will now begin to assume a more normal pace as they step back into the circle of life.


There are many positive tools that can help the progressive caregiver give assistance and relief to those experiencing grief. We as caregivers must be willing to keep a positive attitude and utilize the necessary tools that will help both the instrumental and intuitive griever find the care and help they need to process through their grief. We must remember to listen and express our personal care and concern, helping to guide their lives away from pitfalls of self-medication and isolation. Caring for those in the grieving process can be very rewarding because we learn about our own grief and how we process it ourselves.

Click here to return to Thomas Bilney College home page

Thomas Bilney College
P.O. Box 750491
Dayton, Ohio    45475