When relatives go into therapy or grief counselling together after a bereavement, it can help everybody discover precious pieces of their family’s life and heritage, says psychotherapist Anh Doan.
It’s all about communication. When we’re hurting after a bereavement, we often act like wounded children and forget being adults. People start arguing over petty things and judging each other, asking: ‘Why didn’t they send flowers or a card?’ or ‘Why did they put a happy picture of themselves on Instagram’?
The family dynamic also changes when someone dies. For example, if mum was the one we’d all seek comfort from and rely on, we might want dad to play that role when she dies. And when he can’t, we get angry.
If the person who died wasn’t very emotionally present, we might also realise we didn’t know them very well. That can leave us with a horrific feeling that we’ve lost something precious – important pieces of our family’s puzzle.
When people die we can be left with lots of questions. Family therapists can facilitate important conversations that help relatives learn from each other, open up the photo albums and share precious stories. It’s a bit like digging for old coins and vases – it helps us discover the roots of our lives.
Culture plays a big part, especially for new generations. If your grandad was from Jamaica and now you’re a person of colour in the UK, you might realise you never got to ask him how it was to come here in the 1960s.
If the relationship was terrible or the person who died hurt you, we can ask what you’d like to say to the person who has passed away and explore how to best support you now. This can help close old doors and open new ones.
During this process people start to see life differently and relate better to each other, as well as to the person we’ve lost.
There’s a stigma around mental health, but if you put it into physical injury terms people are often prepared to help. If your brother or daughter broke their ankle you’d be the first to call an ambulance.
With bereavement, sometimes all we can see is a grumpy or angry person, but they are in pain. And grief can trigger depression, post-traumatic stress disorder (PTSD) and complex trauma. So we need to give each other a hand emotionally too.
It’s also about bonding – a chance to connect with your heritage, your inner self, and your family. In this culture we often hide behind closed doors when we feel vulnerable, but we still crave being together.
Family therapy is about everyone working together towards a common goal. People often agree to come when they see that everyone will gain. We always establish firm boundaries to make sure everyone respects and listens to each other.
Systemic or family therapy focuses on how people see themselves within a wider dynamic. Even twins are different in terms of how they perceive their roles.
For family grief counselling or therapy to work, everybody needs to commit to the same goal. It is a massive investment – timewise, emotionally and financially – and a luxury because you usually have to pay privately. It’s much more complex than individual therapy but that doesn’t mean you can’t achieve it.
Sessions last 60-90 minutes with a maximum of four people, usually immediate family. We can be flexible, for example, an individual might prefer to come alone before the rest of the family joins in. You also need a therapist robust enough to hold it together.
Now with Covid, things can feel worse for people who are grieving, isolated and alone. But working on Skype and Zoom is working well, especially for families that are spread out across different countries.
Anh Doan is Head of Counselling at Talking Counselling, an Untangle partner organisation.
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.”
“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.”
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.”
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 Untangle’s counselling and therapy services.
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 deeper and 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.”
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.”
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.”
After experiencing bereavement, grief can feel so overwhelming that it can be hard to know whether your feelings are normal or whether you may be suffering from trauma. Understanding the difference between grief symptoms and trauma can help you recognise a trauma response and know when and how to seek help.
Grief is a painful and complex set of emotions and can involve feelings of numbness, sadness, anger, and distress. It is a natural, human response to loss. There is no set grieving process, but over time, your feelings around your loss ebb and flow, and you find healthy ways to remember your loved one as you settle into a ‘new normal’.
Trauma is an emotional response to a distressing or disturbing event. Sometimes, bereavement can result in trauma, for example, if the death was unexpected, a result of violent crime, or was out of the expected natural order, such as the death of a child or young person. In these cases, you not only have the loss to process, but also the circumstances around the death. A prolonged trauma response is known as Post Traumatic Stress Disorder (PTSD).
A trauma response is your body’s attempt at protecting you from perceived danger. It puts you into a state of hyperarousal, or ‘shock’, linked to the fight/flight/freeze responses. PTSD can present as agitation and aggression (fight), anxiety and hyperactivity (flight), and feelings of disconnection or numbness (freeze). Trauma can also produce physical effects, such as headaches, nausea, digestive problems, sleep disturbances, changes in breathing or swallowing, and panic attacks.
As your brain continues to revisit the trauma, you might experience flashbacks and vivid dreams or nightmares. The impact of these distressing symptoms can be emotionally, psychologically and physically exhausting, and if left untreated, can cause long-lasting impacts on your health, relationships and daily life.
It’s normal to feel a range of emotions as you grieve. As long as you can continue to move forward by working through your thoughts and feelings about your loss and leaning on friends and family if you need to, therapy isn’t usually necessary.
However, if you have any of the psychological or physical signs mentioned above or dealing with grief is stopping you from living your day to day life, you may be experiencing trauma and should seek advice from a professional. Using alcohol or drugs to help you manage your grief can be another sign that you may need to ask for help. Sometimes, people might not spot the signs of trauma in themselves, but the people around them start to pick up on changes in their personality or behaviour and suggest that they seek help.
If you suspect you have trauma, a trained therapist or counsellor can carry out an assessment involving a series of questions designed to identify signs of trauma. They can then work with you to help you manage the symptoms and start to heal.
There are various ways of addressing and treating trauma and PTSD. When considering the available options, look for a service that delivers trauma-informed care, using specific techniques that avoid the risk of causing further trauma.
Trauma therapy or bereavement counselling can provide specialist treatment for PTSD. Two treatment modalities have been shown to be particularly effective in treating trauma: EMDR (Eye Movement Desensitisation and Reprocessing) and trauma-focused CBT (Cognitive Behavioural Therapy). You can find a therapist here.
Medication is not generally used as a first-line treatment option for PTSD but can sometimes be used alongside talking therapies. Your GP can advise you further.
Grief groups can provide additional support while you work through trauma and grief. We arrange various online support groups that can help connect you with other people going through similar experiences.
We asked some of our current members of our community to share their stories about how they come to terms understanding their grief and trauma.
Linn- “I personally liked not being pushed; it was great to know I could come back anytime if I changed my mind. You don’t want to think about things when you’re in that headspace; you want very few options – you want to do the very minimum to get where you want to be, and because of the simple form, I didn’t feel overwhelmed. The therapist I am matched with is great. I never felt like I had to stick with someone I didn’t like.”
Lexie- “I found the whole process so simple – within a week or so, I’d had an initial session with a counsellor, and I’m still having sessions now. It was one of those things that you don’t realise you need until you’ve had it. It was a nice, easy process that made dealing with it at a time of high emotion easier. Without Untangle, I wouldn’t have known who to contact. I didn’t know that grief counselling was a thing.”