Do I need therapy?

If you are considering counselling or therapy to deal with grief and bereavement, here are some pointers from two experts to help you think it through. Like unwelcome visitors, loss, bereavement and grief will inevitably turn up and insist on becoming part of our lives at some point. When they do, there’s no right or wrong way to feel or act – we are all different…

But if life feels like too much to cope with, talking to a professional can really help. “A lot of people find it difficult to express themselves with family or friends,” says Adetoun Adams, an NHS psychotherapist and a counsellor for the charity Mind in East London. “ Talking to a stranger allows people to open up and can make things feel lighter.”

Talking therapies

“Grief counselling is often the go-to approach rather than therapy,” says Dr Iain Jordan, a consultant in psychological medicine at Oxford University Hospitals. “Just talking through your problems and experiences in counselling, especially very painful ones, is very valuable.” However, some types of loss are more complex and traumatic than others, and there are many other types of ‘talking therapies’ that you can explore or request to be referred for, including clinical behavioural therapy (CBT), mindfulness-based cognitive therapy, and dynamic or interpersonal psychotherapy.

Exploring your new identity in therapy after a loss can be vital, for example – such as figuring out who you are once you are no longer someone’s wife, daughter, or sister. Iain recommends therapy after a traumatic event as “you can recover by telling a different story, learning strategies for behaving differently, or changing unhelpful beliefs and assumptions.”

How to choose a therapist

If you’ve decided to try therapy, Iain recommends doing a little research and having a brief phone call with a few different therapists to see if there’s chemistry: “A mutually trusting relationship is fundamental – without it nothing will happen.”

“It is OK to ask for someone who matches your life experience,” says Adetoun. “A black person might feel more comfortable seeing a black therapist, for example. Or you can ask to see a woman because you have issues with men.” However, Iain suggests thinking through the reasons behind your preference. “Are you avoiding something that you should be experiencing? Or is it because only this person can understand my experiences? “For example, if I am a man with a toxic attitude towards women, it might be a good idea for me to see a female therapist to focus on that.”

Accessing therapy

In the UK, your GP can refer you for free NHS support, or you can self-refer through the Improving Access to Psychological Therapies (IAPT) programme which will assess you before assigning you to a therapist. You can also go through your local Mind branch. In some areas, there is often a long NHS waiting list, but it depends on the severity of your needs as to how long it will take to get seen by someone. For a recent loss, you can get three sessions of early bereavement support and then go back on the list to a wait for a therapist in the longer term.

If you want to go private and pay, Adetoun and Iain recommend looking for a therapist or counsellor on trusted websites including psychologytoday.com and the British Association of Counsellors, or considering Untangle’s Group Therapy Programme.

Virtual support

Counselling and therapy are increasingly available online and becoming more popular in this time of social distancing. But does online grief counselling work? “The evidence so far suggests that online works as well as face-to-face therapy,” says Iain. However, he feels that more intense types of therapy might be more difficult online. “Some things happen in a room that would be harder to create at a distance, and it feels like a richer encounter when you are together.” Adetoun thinks that taking part in therapy online or over the phone is better than going without, as “at least you are talking to someone.”

Medication – or exercise?

Some of us might consider drugs to tackle issues like depression, but Iain isn’t a big fan of prescribing medication for people who are grieving, sad or anxious. “There should be a clear indication for it,” he explains. “Even if you have clinical-level disorder the effect is only slightly better than with a placebo”. Instead, he suggests putting an emphasis on exercise and eating well, keeping up connections with your loved ones, and making time to enjoy small day-to-day activities are probably more effective when combined together. “But if you are suffering terribly, talk to your doctor about medication to help you through a difficult period,” he continues. “You can then go on to get better in other ways, including therapy.”

So does grief counselling work?

Telling a complete stranger your innermost thoughts can feel scary, but Adetoun’s advice is to try it before making your mind up: “Therapists have to provide a safe environment,” she explains. “You will be listened to, not judged, and everything is confidential.” Iain agrees: “Be curious. If you are suffering, want to behave differently or understand yourself better, any kind of therapy is useful. And you should grieve. You are supposed to stop and reflect. You’ll miss out if you don’t. It allows for a new period of transition.”

“There’s an old joke that goes ‘how many therapists does it take to change a lightbulb’? The answer is: ‘Only one – if the lightbulb wants to change’. If you are willing to open yourself up to a different way of seeing yourself, it is almost always the right thing.” Often you won’t need long-term therapy: “after a bereavement some people just need one or two good sessions,” says Adetoun.

And your courage to take the plunge will pay off: “If people are brave enough to try, it can help them work through the different phases of their grief, or just come out feeling lighter,” she continues. “And they’ll know that although they are no longer thinking about the person they’ve lost every minute of the day, they still carry that person around in their heart.”

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