Section 1: An Introduction to Grief and Loss

Grief is a broad term used to describe reactions to loss. It encompasses thoughts, feelings, behaviours, and physical symptoms that are more or less commonly experienced by people affected by a significant loss. Although there are many common features of grief, it is important to remember that it is a highly individual experience – no two people will experience a loss and grieve in the same way. In other words:

Before we go any further, it is important to define a few key terms. There are many types of losses that people can experience over their lifespan that may result in a grief response (we will be exploring these shortly). The term grief reaction or grief response is often used to refer to grief experiences relating to any type of loss. The term bereavement specifically refers to the experience of having lost a loved one to death, while mourning refers to the different cultural and religious practices through which bereavement is expressed (for example, in Western culture it is common to have a funeral, wear black clothing, and sadly contemplate the deceased).

Grief is complex and multi-faceted. A person’s individual experience and expression of grief is influenced not only by the nature of the loss but also by personal characteristics such as personality and the social and cultural context in which the person is living. You will learn more about these factors and their influence on the grieving process later in this module.

What is Grief?

Julia Samuel explains what grief is.

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Types of Loss

Grief and loss are often associated with people who have been affected by the death of a person close to them (bereavement), and you will meet clients who have experienced such losses. However, clients are more likely to present with many other types of losses. Humphrey and Zimpfer (2008) identify the following categories of loss: relationship loss; loss of some aspect of self; developmental loss; and loss of treasured objects. (Although you may be able to think of other kinds of loss, too!) We will discuss these briefly now and, as you work through this module, try to identify these and other types of loss in the issues and cases we present.

Relationship Loss

This may occur through the death of a loved one (for example, through illness, accidental, or violent death) or the breakdown of a relationship (through, for example, divorce, illness, abuse and distance).

Loss of Some Aspect of Self

This may occur as a result of a relationship loss. For example, a woman may lose her role as a wife through the death of her spouse. However, any situation that involves a significant change to one’s sense of self, such as illness, disability, physical changes, sexual assault, physical assault, domestic and family violence, and more, may result in grief (Humphrey and Zimpfer, 2008).

A loss of dreams or hopes may also be included in this category. For example, parents of children with special needs may have to adjust to a different future than they envisioned for their child and themselves. Consider the various types of losses that the following carer has experienced due to his son’s accident.

Circumstantial or life-changing events, such as those just described, tend to take place over a relatively short period with little or no opportunity for preparation and tend to involve permanent, long-lasting consequences. They also tend to require significant adjustment to a person’s beliefs or assumptions about the world (Parkes, 1993, cited in Machin, 2009). They may be individual or can affect families or even whole communities. For example, at times of war, significant losses, including loss of homes, loved ones, and injury and disability, are experienced across entire communities. Refugees and migrants, in particular, may face significant losses, including their family, home, and identity.

Developmental Losses

Another less visible source of grief includes those losses that arise from developmental change across the lifespan.

Loss of Treasured Objects

Although objects are considered by most as replaceable and unimportant, the symbolic significance or memories that may be attached to them means that their loss can be deeply upsetting. For example, family heirlooms represent an irreplaceable link to the past for many people and, if lost through theft or fire, can result in powerful feelings of loss that may go unacknowledged.

Understanding Different Types of Loss

^{(Adapted from Humphrey & Zimpfer, 2008, p. 12)}

Understanding different types of loss provides a framework that encourages counsellors to assess and consider various losses, both past and present, and to acknowledge the full significance and meaning of these to the client (Humphrey & Zimpfer, 2008). This can be missed when we focus solely on bereavement.

It is also important to understand that losses do not occur in isolation. People typically experience several losses throughout their lives; in some cases, these experiences can build on each other. For example, consider the history of loss of the following client:

Loss	Age
Pet dog died	8
Parents declared bankruptcy – loss of family home	10
Sent to boarding school	12
Miscarriage	22
Divorce	27
Death of grandmother	28
Accident – broken back resulting in chronic pain	34
Hysterectomy – unable to have children	35
Death of mother	41

This client has experienced a number of loss events throughout her life. Some events, such as attending a boarding school, may have been expected transitions for this client. However, even when expected, situational and developmental changes can involve losses and result in grief responses. The client’s experience might also have been impacted by various circumstantial stressors and changes relating to the losses. For example, her parents may have had to work more after declaring bankruptcy.

Usually, people eventually adapt to losses – making sense of them, accommodating and adapting to them and the secondary losses that accompany them – without the need for professional support. This is known as integration of loss. However, multiple losses, particularly those occurring one after the other in a short period, leave little time for this process of integration and can significantly reduce an individual’s ability to cope. In the case of the client just described, the cumulative impact of these losses could result in cumulative loss. You will learn more about cumulative loss in the next section of the module. This also brings us to another important concept: primary and secondary losses.

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The initial focus is most commonly on the distinct events that result in these different categories of loss – the death of a loved one, a relationship breakdown, a natural disaster, an accident, or the diagnosis of an illness. However, every loss is multi-layered, involving the primary event and the less obvious associated losses.

The primary loss is the initial, core loss that forms the foundation of the grief experience. In bereavement, this is generally the loss of a loved one. The initial grief response (which we will explore shortly) is usually attributed to this primary loss.

Secondary losses follow or are associated with a primary loss. For example, in bereavement, secondary losses may include changes in or loss of financial security, social status, social and family roles, identities, family structures, and the sense of safety or certainty in the world and/or a higher power. These secondary losses may initially be overlooked given the dominance of the primary loss, but counsellors should listen carefully for secondary losses and their impacts. Not doing so means we may not fully recognise, or help our clients adjust to, the nature of the losses they have experienced.

It is easy to fall into the trap of considering some losses more significant than others, but counsellors need to recognise the client’s perception of the loss and the meaning it has for them rather than making assumptions about the significance of any particular loss. Understanding and acknowledging the scope of potential client losses encourages counsellors to acknowledge and consider all types of losses, both past and present, and consider how these may be impacting the client’s current situation.

The effects of grief resulting from the types of losses described extend beyond the individual to include family and other relationships and even the wider community, particularly where there has been a large-scale disaster affecting a community or traumatic event such as a suicide, murder, or well-publicised accident. In the following sections, we will focus on the potential impacts of loss across these dimensions on the individual.

The many Kinds of Losses a Person Can Grieve

This video describes the many types of losses a person can grieve. Some of these may be 'secondary losses' and associated with the death of a loved one, but some of them may be unrelated to an end. We are sometimes surprised by the losses we grieve, and quite often, those around us don't see them as being as significant as they are. In general, losses are unique and specific to the person, but they are often tied to the things we cherish and value most.

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People tend to associate particular emotions with the experience of grief, such as sadness, sorrow, loneliness, and yearning. However, grief reactions can encompass many other emotions, behaviours, and cognitions and may impact many aspects of a person’s life.

While there are many common and expected grief reactions, it is important to remember that grief manifests in different ways, with a great deal of variation between individuals (Winokuer & Harris, 2012). The emotional, behavioural, cognitive, and physical features we discuss here are quite common in response to loss, but they are not experienced by everyone. Remember that people have highly individualised responses according to their personalities and situations. Being able to recognise the various common characteristics of grief is important for several reasons, including that it will:

• Help you identify possible grief reactions when clients present with issues unrelated to loss.
• Assist you in normalising grief and grief responses, helping clients understand and learn ways to respond to their grief reactions.
• Assist you in identifying where clients may be experiencing more complex grief reactions that require specialist support.

The symptoms, emotions, and behaviours associated with expected grief reactions generally “represent a process of healthy adaptation and are not inherently pathological” (Pomeroy & Garcia, 2009, p. 49). There are, however, certain problematic symptoms and reactions that may present risks to that individual. You will learn more about these in the following sections of this module. For now, let’s explore some common reactions to loss and grief.

Emotional Features and Impacts

Although most people who have sustained a major loss expect to experience some level of emotional distress, many are taken by surprise by the intensity, fluctuation, and range of emotions that they experience (Pomeroy & Garcia, 2009). These upsurges of emotion may lead people to feel they are on an unpleasant roller coaster ride; just as they start feeling better, they may experience another surge of emotional distress, leaving them feeling overwhelmed and ‘out of control’. According to theorists, these fluctuations are a common feature of the grief experience and play an adaptive function in the grieving process.

There is also a wide range of emotions that may be experienced throughout the grieving process.

• Sadness is a common response to loss and may be expressed or managed in varying ways (often dictated by social expectations).
• Yearning/pining is associated with the early stages after a loss event, generally a bereavement, where intense ‘pangs’ of grief are experienced. Theorists liken this to the feelings of infants when separated from their main caregiver (as described in Bowlby’s attachment theory). There is a feeling of emptiness coupled with a longing for the person lost (Travers, Niloufer, & Kolkiewicz, 2013).
• Anger is commonly experienced in grief, but it can be a distressing and confusing emotion for those who have experienced a loss. It generally results from a sense of frustration and helplessness about being unable to prevent the loss and may be directed at others (Worden, 2009). For instance, in the context of losing a loved one, the grieving person may feel angry at the deceased for dying or at a doctor or God for letting it happen.

Although many people are understanding and supportive of people who are grieving or who have experienced well-recognised losses (for example, bereavement or divorce), they may find certain emotional manifestations such as anger, irritability, or over-sensitivity more challenging to deal with. Although these are common reactions, they may have a significant negative impact on a person’s social and occupational life (Pomeroy & Garcia, 2009).

• Anxiety reactions may range from vague feelings of insecurity to full-blown panic attacks. Upon losing a loved one, there is often a sense of not being able to cope alone, as well as a heightened sense of vulnerability and awareness of one’s own mortality (Worden, 2009). Anxiety is also a common reaction associated with other types of loss (for example, relationship breakdown, loss of job and moving) as people experience a sense of insecurity or lack of control and may find themselves worrying about their future. When anxiety is problematic, counsellors may address this using appropriate approaches (for example, cognitive behavioural techniques); when anxiety is intense or prolonged, a referral to a clinical mental health professional is warranted.
• Loneliness is often experienced, particularly in the case of a close relationship involving day-to-day contact. Stroebe and colleagues (1996) differentiate between the emotional loneliness that arises from losing a major attachment figure and social loneliness, which can be alleviated to a certain extent by social support. For example, people grieving the loss of a loved one or a relationship may often feel lonely, even if friends and family surround them.
• Relief can be the dominant emotion if a loved one experienced a lengthy or painful illness before dying. As one widow described, “The knowing that his suffering, both physical and mental, is over helps me cope” (Worden, 2009, p. 23). It can also occur if the circumstances before loss had been particularly challenging; for example, ending a difficult relationship or leaving an extremely stressful job.
• Numbness. Some people describe a lack of feeling after a loss, usually early in the grieving process. This is not necessarily maladaptive. “We have found no evidence that is an unhealthy reaction. Blocking of sensation as a defence against what would otherwise be overwhelming pain would seem to be extremely ‘normal’” (Parkes & Weiss, 1996, as cited in Worden, 2009, p. 23). However, numbness in the context of other factors, such as trauma, will require specialist assessment, so a referral to a specialist mental health practitioner should be facilitated. You will learn more about identifying referral indicators later in this module.
• Guilt and remorse are commonly expressed – for lost opportunities, things said or done, or actions taken or not taken. For example, there may have been things not done before a loss, which the grieving person thinks could have prevented it. These feelings are often expressed as ‘if onlys’ (Winokuer & Harris, 2012).

Remember, not all clients will experience every emotion identified in the case study; there are vast differences in the intensity and emotional features that clients experience. Due to social expectations about grief (we will explore these further in the next section), clients may feel worried or guilty that they are not grieving ‘enough’ or ‘properly’, particularly if they are not feeling intense emotions or not feeling the same way as others who are grieving. It is important that counsellors normalise and reassure clients that they don’t have to grieve in a certain way. Grief is, after all, an individualised experience. There is no one ‘right’ way to grieve.

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Cognitive Features and Impacts

Grief can disrupt cognitive function, particularly in the days or weeks following a loss. Clients may describe feelings of ‘brain fogginess’ or being ‘brain dead’. For example, Pomeroy and Garcia (2009) describe a client who experienced difficulty finding her counsellor’s office, even though she was familiar with the location. Another client, whose daily routine included reading the newspaper, stated it took “great effort for him to finish reading just one article.” (p. 50). It is not unusual for a client to express worries about ‘going crazy’ or ‘losing my mind’. In fact, experiencing periods where they feel highly distracted and struggle to function is quite common among people who have experienced significant losses. Part of the counsellor’s role is to educate clients about the impacts of loss and grief, including those that people may not anticipate (normalising).

Cognitive features of grief include confusion, difficulties in concentration, and problems with maintaining focus. Decision-making, organisation, and keeping track of things may also be affected. Clients may describe their minds as ‘constantly busy’ but not in a productive way (Winokuer & Harris, 2012). These disruptions in cognitive function can impact the individual’s performance at work or school, particularly if they have only had limited time off work after the loss. Counsellors can discuss these impacts with clients, helping them understand and find strategies for dealing with them.

The Brain Fog of Grief

This video describes the impact grief has on our brain.

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Disbelief can occur in response to various losses, including deaths, and may be particularly common if the death is unexpected. For example, a bereaved person may say, There must be some mistake.” “This can’t be happening. I don’t believe it.” “This must be a dream. I’ll just wake up and everything will be fine.”

Preoccupation with thoughts of the loss are also common. For example, a person who has recently experienced a breakup may repeatedly think of the breakup, the relationship, their former partner, and the events that led to the separation. Similarly, a bereaved person may be preoccupied with the thoughts of the person who has died. At times, this may take the form of intrusive and upsetting thoughts or images (Worden, 2009).

Some bereaved people also describe a sense of the deceased person’s presence, particularly early on, which they may find comforting or frightening (Worden, 2009). In a study of bereaved children, 81% felt watched by their deceased parent four months after the death, with 66% reporting the experience two years after the death (Worden, 1996). Visual and auditory hallucinations are also a frequent experience during this time and do not necessarily indicate problematic grieving; they may even represent a functional role in the grieving process (Parkes, 2005, as cited in Winokuer & Harris, 2012). Dreams in which the person has communication with the deceased are also common.

Physical Features and Impacts

Let's begin by first looking at how emotions affect the body. 

How do emotions influence our body?

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Grief often results in physical symptoms. Some people who are grieving may talk about or seek medical attention for physical symptoms such as those shown in the following diagram (Winokuer & Harris, 2012; Worden, 2009):

What other physical features and impacts may occur in response to loss?

• Sleep disturbances, including difficulty getting to sleep and early waking, are common and tend to dissipate as time passes.

  After Bill lost his wife suddenly, he would wake up at five o’clock each morning filled with intense sadness and review over and over the circumstances surrounding the death and how it might have been prevented, including what he might have done differently. This happened morning after morning and soon caused problems because he could not function well at work. After about 6 weeks, the disorder began to correct itself, and eventually it disappeared.”

  ^{(Worden, 2009, p. 27)}

  Grief is also associated with decreased immune functioning, with evidence suggesting that “the strong link between sleep and the immune system suggests that disrupted sleep following bereavement may affect health directly by suppressing the immune system” (Hall & Irwin, 2001, as cited in Pomeroy & Garcia, 2009, p. 51).
• Appetite disturbances are also common, manifesting as under or over-eating, sometimes resulting in weight changes (Worden, 2009).
• Fatigue, lack of energy, or ‘restless exhaustion’. For example, people may feel continuously busy or agitated in their minds but exhausted physically (Winokuer & Harris, 2012).
• Some bereaved people will talk about having symptoms that mimic those their loved one had before they died. Winokuer and Harris (2012) provide the example of one of their clients attending the hospital three times with shortness of breath and chest pain after her husband died of a heart attack. Pomeroy and Garcia (2009) also point out that focusing on physical symptoms may be a way of attempting to manage or avoid emotional distress.

The discomfort of physical issues such as sleep disturbance and fatigue can significantly reduce a person’s ability to cope and impact their cognitive, emotional, and social functioning (Pomeroy & Garcia, 2009). But while we need to recognise the potential physical effects of loss, counsellors must not assume that any reported physical symptoms are due to grief; we need to refer clients who experience physical symptoms to their doctor for assessment and treatment of potential medical conditions which could be the actual cause.

How Grief Affects the Physical Body

This video describes how the heartbreak of grief can affect us not only emotionally but physically as well.

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Behavioural Features and Impacts

Certain behaviours are common and even expected in those who have suffered a loss. It is important to note that these expectations are influenced by cultural and social context and may or may not be met by any particular individual.

• Crying is a common behavioural feature of grief but is strongly influenced by personality, social, and cultural variables. For example, in some cultures, individuals may be encouraged to adopt a ‘stiff upper lip’ (that is, to not express emotion), while in other cultures, overt behaviours such as sobbing are considered very much a part of the grieving process. Similarly, men and women may be subjected to different expectations.
• Searching behaviours, particularly after a death, may involve literally looking for the person, visiting places that the person frequented, or searching within to try to find a sense of connection with the lost person (Worden, 2009).
• Social withdrawal. It is not unusual for people who have sustained a loss to want to withdraw from other people. Social withdrawal can also include a loss of interest in the outside world, such as not reading newspapers or watching television (Worden, 2009).

  Many bereaved individuals isolate themselves because they have a great deal of difficulty handling social situations where they may be triggered by their grief or where the effort to engage in small talk seems like a great deal of work because their lives have been filled with such deep grief and profound questioning of life and themselves. Many of these individuals have a difficult time fitting neatly in a social context – they may no longer be able to identify with the role that was associated with the deceased person – for example, a widow is no longer a wife, a parent to a deceased child is still a parent, but the child is missing. In addition, many bereaved individuals sense the discomfort of others around them, as people struggle finding the ‘right’ words to speak or avoid them to prevent the discomfort of an awkward social exchange.”

  ^{(Winokuer & Harris, 2012, p. 85)}

7 Signs You're Not Dealing With Your Grief and Loss

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Counsellors need to recognise risk factors and potentially destructive behaviours and address these with the client, applying risk management strategies where appropriate. While you will learn more about this later in this module, one useful distinction is proposed by Pomeroy and Garcia (2009, p. 52), who differentiate between ‘life-enhancing’ and ‘life-depleting’ behaviours:

Life-Enhancing Behaviours	Life-Depleting Behaviours
Crying Talking about the loss Reaching out for support Accepting assistance Taking care of oneself Exercising Getting rest/sleep Seeking out a symbolic connection with the deceased	Substance abuse High risk-taking behaviours Compulsive/excessive behaviours (for example, eating, shopping, working, gambling) Withdrawal and isolation Agitated, aggressive, and demanding behaviours Anxiety-driven behaviours Suicidal gestures or attempts

It is important to note that the behaviours listed here may not apply to all individuals. For example, not all people express their grief through crying or wanting to talk about the loss. Additionally, in some cases, ‘life-depleting behaviours’ may be adaptive. For example, temporarily withdrawing from others may be an adaptive response to a loss, allowing processing and conservation of energy. However, the categorisations described can be useful in helping a counsellor identify potentially destructive behaviours, as shown in the following case study.

Andrew Garfield on losing his mother

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Spiritual Features and Impacts

A person’s sense of meaning and understanding of the world is often very much influenced by their spiritual beliefs. (Spirituality may or may not be manifested in religious or theological beliefs.) A bereavement or other significant loss can challenge a person’s spirituality and may have different impacts depending on the person and the context. For some, spiritual beliefs and religion offer a sense of structure, belonging, and ritual (for example, funeral liturgy and mourning rituals) that can be reassuring in the aftermath of a loss (Winokuer & Harris, 2012). Clients will often share how their faith communities are sources of support, while belief in an afterlife provides hope of reunion with a loved one for many bereaved people (Humphrey & Zimpfer, 2008).

For others, a loss can present a significant challenge to their beliefs. For example, experiencing the death of a loved one, particularly an untimely death, can be difficult to reconcile and make sense of. Losses and challenges can lead to questions, sometimes very painful ones, about one’s beliefs. Bereaved people may query the existence of a God who could let this happen or wonder if they are being punished. Worden (2009) describes how one of his clients told him, “I must be a bad person for this to happen.” This disconnection from one’s faith is often experienced by the mourner as a secondary loss (Pomeroy & Garcia, 2009). Naturally, other types of losses and challenges can also lead to questions, sometimes very painful, about one’s faith.

A lack of spirituality can present different problems. Some people without a belief in something or someone that transcends their personal situation may experience particular challenges when confronted with life-changing events. For example, they may report wishing they had something “to ‘hang on to’ or to ‘fall back on’ during this time of loss… that they envy the strength and comfort that faith and hope provide”. (Humphrey & Zimpfer, 2008, p. 13).

Spiritual beliefs can offer opportunities for meaning and support in times of grief, but counsellors should not assume that this may be the case for all clients. Bereavement and loss can challenge the faith and belief of people resulting in additional issues that may need to be addressed. In addition, changes in belief or the diminution of faith can also be experienced as losses. These may also lead to secondary losses, such as the loss of a faith community, sense of identity, or relationships with others in which a shared faith was central.

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A Note on Circumstances Existing Prior to Loss

When considering the impacts that a loss may have, it is also important to consider the circumstances that are present before it. These factors can impact the person’s grief experience and its effects on them. Let’s look at a few examples:

• Previous experience of loss. The losses a person has experienced before may impact the effects of a more recent loss. For example, multiple losses, and the stressors associated with them, may lead to more challenging grief responses or increased risk of mental health issues. On the other hand, people who have experienced prior significant losses may have developed an understanding of loss and grief responses, as well as skills and resources for dealing with them.
• Health situation. Being physically or mentally unwell, particularly for a long period, can be extremely stressful. Hence, people with serious health problems may be more vulnerable and have fewer resources available to cope with loss. For instance, imagine an individual suffering from a long-term illness and being looked after by a family member. Losing that family member or the relationship with them is likely to have a huge impact on the individual’s life and exacerbate the difficulties they experience.
• Financial hardship. Financial difficulty is a common secondary loss, but it may also precede and exacerbate the effects of a loss. A person with limited financial resources or who experiences significant stress due to financial hardship may have more difficulty coping with a loss than someone who is in a better place financially.
• Social stressors. Social support is important in the aftermath of a loss, so having little social support already in place can cause added difficulties when a person experiences loss and grief. In addition, relationship difficulties that existed before a loss can exacerbate a person’s grief responses. This is particularly the case when unresolved feelings towards or conflicts with a deceased person exist.
• Other stressors. Many other circumstances in a person’s life can influence their reaction to loss. Normal developmental stressors create additional challenges in adapting to losses in life; for instance, an adolescent undergoing physical changes and struggling with peer pressure may have less capacity to cope with parental separation. People from disadvantaged communities might also have fewer resources to cope with a major loss. Imagine the additional difficulties faced by a person who has emigrated to Australia and has limited English language skills; when they lose their job, they will likely have fewer resources and reduced job opportunities, as well as face cultural barriers and potential discrimination, for example. It is impossible to mention all the possible stressors that can impact the experience of loss here, but try to think of other examples. Remember, it is important to keep in mind that all people have some existing stressors in their lives before a loss, and as a counsellor, you will need to carefully assess the nature, severity, and impact of these stressors on the client’s grief experience and the needs they have after a loss.

In the case study, Avanthi’s reactions to her father’s death will need to be considered within the context of relationship difficulties with her father, moving away from her hometown and family (for example, loss of home and identity, having limited family and social support), and relationship breakdown, as well as the financial pressure that restricted her from mourning the way she deemed appropriate. All these circumstantial factors play a part in exacerbating the effects of her father’s death.

It is important to remember that the existence of such circumstances does not necessarily lead to problematic or complex grief reactions. However, considering the impacts of prior circumstances will help you better understand your clients’ grief experiences and respond to their needs.

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Bereavement and other loss experiences do not occur in isolation but have ‘knock-on’ effects on relationships and other social structures. Social networks provide both challenges and support for those who are bereaved. People often feel awkward and uncomfortable around a person who has experienced a loss and may not know what to say or how to help. They may offer clichés such as “he’s in a better place now”, which can be perceived as dismissive and insensitive, or may avoid the person while rationalising that the person “doesn’t need company right now” (Pomeroy & Garcia, 2009, p. 53). Some family members may act in the role of gatekeeper in an attempt to protect the bereaved person, thus inadvertently isolating them from visitors (Lawton & Lawton, 2012). The lack of perceived understanding and support can result in the person feeling increasingly isolated and is often experienced as a secondary loss (Lawton & Lawton).

A strong social support system can help people in the aftermath of a loss by providing emotional and practical help in dealing with the stresses and pressure associated with the loss and the grief responses that follow. As Pomeroy and Garcia explain in relation to bereavement:

Counsellors can help clients ask for and accept help from friends and family or connect the client with community support where necessary. You will learn more about how this is done later in this module.

The Scope of Grief Effects

Although losses are personal, they also occur in social contexts, including family, peer groups, local communities, society, and cultural contexts. The next section will explore the influence of culture and other social forces on grief. For now, we will focus on the impact of grief, bereavement, and trauma on families and local communities. From the effects of personal losses on families to the effects of suicides, murders, publicised accidents, and large-scale disasters on whole communities, the impacts of grief can create a ‘ripple’ effect throughout the social structures shown in this diagram (adapted from Lawton & Lawton, 2012, p. 112):

Families

Families often form the primary source of social support for someone who has experienced significant loss. Some losses bring family members closer together, but the changes that a loss event brings can challenge family structures, highlight dysfunctional family dynamics, and strain or even break relationships. Individual differences among family members in terms of the effects of the loss and grief on them or in their preferred ways of dealing with loss can also lead to misunderstanding, conflict, and further hurt.

Grief is a highly individual experience, and each family member will have their own way of coming to terms with a loss, influenced by the circumstances, their role in the family, their relationship to the deceased family member, and previous experiences. Differences in the experiences of grief between individuals within the same family may be a challenge, especially in terms of emotional expression and coping strategies. Problems can arise when family members have different grieving styles and there is a perceived lack of understanding, support, and communication within the family. Some family members, including children and adolescents, may feel overlooked, excluded, and unheard, leading to feelings of isolation and resentment (Breen, 2011). Depending on the circumstances of the death, family members may also blame other members or be blamed for the loss (Breen, 2011).

A significant loss can have a devastating effect on a family unit, as shown in the following example:

As you can see from the Reynolds case study, various family members will all have their own way of expressing grief and coping with the loss of a close family member. Problems may emerge for both individuals and the family as a whole when communication and relationships within the family become dysfunctional due to these differences.

The economic consequences of loss on individuals and families are easily overlooked but can be of critical importance. Loss of income or financial security is often a secondary loss experienced due to illness, retirement or redundancy, relationship breakdown, loss of home, or the death of a partner or family member. In fact, a significant predictor of poverty for women and children is loss. As Carson and Kerr (2014) have pointed out, mothers whose primary relationships have ended are often at particular risk of financial hardship. In fact, single mothers and their children are the family type facing the highest poverty rates in Australia. In addition, domestic and family violence, which involves a whole range of losses, is a major cause of homelessness for women and children (Mission Australia, 2019).

Being in financial hardship has flow-on effects in many other areas of life. Let’s consider a child affected by parental bereavement (i.e. death of a parent). The family may suffer from financial difficulties – from mild financial strains to poverty and even homelessness (with all the additional losses that entails). The surviving parent may now face having to financially support the family alone. They may be less able to support the child due to their own grief and the responsibilities they face in adjusting to the new circumstances. The family may need to relocate to access affordable housing, job opportunities, or additional support. The child may suffer from a lack of emotional support, reduced opportunities, interference with schooling, health issues, and a wide range of other secondary losses. As such, when supporting a client who has experienced loss, you need to be aware of the impact of loss on the client and their family, including financial considerations, and be prepared to respond to needs arising in different areas.

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Communities

Communities can comprise close friends and neighbours, residents of a particular area, schools, occupational groups, or members of particular ethnicity, culture or religion. In close communities, a loss experienced by an individual is shared and grieved by the whole community, as depicted in the following example.

The involvement of the community in response to loss differs widely according to culture and to the types of losses experienced. This is most commonly discussed in relation to bereavement, so we will focus on that here.

In some cultures, the death of a community member is a community experience. For example:

In Aboriginal culture, a death or loss of a community member may be referred to as ‘sorry business’ and is understood as impacting the whole community.

In many Western cultural groups, there is an increasing trend towards the ‘privatisation’ of grief, with people restricting their mourning to themselves, immediate friends and family, or professionals. There are exceptions to this, including individual and community differences, and some exceptions that relate to particular types of losses. Losses such as war and natural disasters (fires, earthquakes and floods) directly impact entire communities. Natural disasters are usually unexpected, leaving people with little time to prepare. They can have widespread effects, not only on the person experiencing the loss but also on the support networks of friends, family, and community. For example, dealing with the emotional consequences of a natural disaster can be challenging. Those involved may suffer from trauma symptoms such as sleeping and eating problems; headaches and stomach aches; guilt, anxiety and rage; and a preoccupation with the event (Hughes, 1995). Recovery may be further complicated by the loss of friends or loved ones and secondary losses such as the loss of income, jobs, homes, or possessions (Hughes, 1995). In these situations, grief and grieving tend to be shared rather than private.

Other exceptions include well-publicised accidents, murders, or unexpected death of a child or well-known figure. In these cases, the loss often results in large-scale communal funeral rituals such as the placing of flowers, and communities may rally around those who were most directly impacted by the loss, providing emotional, practical, or financial support.

Ethnic and cultural influences

Ethnic and cultural influences, as well as social expectations and how strongly the client associates with their culture or society, can significantly impact an individual's grieving process.

Cultural Influences

Grief Expression: Different cultures have unique norms and expectations regarding how grief should be expressed. Some cultures encourage open displays of emotion, while others may emphasise stoicism. This can affect how an individual copes with and expresses their grief. Stress and tension can be created when a client feels the need to grieve in a way that is different to the cultural norm.

Rituals and Traditions: Cultural practices and rituals associated with death and grieving vary widely. These rituals can provide structure and support during grieving, offering comfort and a connection to one's cultural heritage. Or they can create tension and friction between the client and their loved ones if they do not wish to adhere to traditions.

Belief Systems: Cultural beliefs about the afterlife, reincarnation, or the spiritual significance of death can profoundly influence how an individual perceives and copes with losing a loved one.

Ethnic Influences

Identity and Integration: For individuals from minority ethnic backgrounds, their sense of identity and integration into the larger society may shape the grieving process. Cultural identity and acculturation can impact how grief is experienced and expressed.

Language Barriers: Language can be a barrier to seeking support or expressing grief-related emotions. Individuals from non-English-speaking backgrounds may face challenges accessing appropriate counselling or communicating their feelings.

Social Support Networks: Ethnic communities often provide vital social support networks that play a crucial role in helping individuals cope with grief. The dynamics of these networks and the availability of support can vary among ethnic groups.

Social Expectations

Gender Roles: Societal expectations related to gender can influence how individuals grieve. For example, some societies may expect men to be stoic and not openly express their emotions, hindering their grieving process.

Timeline of Grief: Social norms can dictate how long it is socially acceptable for someone to grieve. Individuals may feel pressure to "move on" or "get over it" prematurely, affecting their ability to process their emotions fully.

Stigma and Shame: Social stigma surrounding disenfranchised deaths (for example, suicides, substance abuse-related, and pet deaths – deaths that are not socially recognised) can impact an individual's willingness to seek help or openly discuss grief.

In conclusion, ethnic and cultural influences and social expectations can profoundly shape an individual's grieving process. Counsellors must be culturally competent and sensitive to these factors to provide effective support and facilitate a more inclusive and understanding approach to grief counselling. Counsellors must ensure they avoid making assumptions based on perceptions around cultural, ethnic or social influences. Instead, they treat every grief case as unique, curiously exploring the client's perceptions of their culture, ethnicity, religion and society.

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What are people's beliefs related to death and dying in different cultures?

Death is a universal experience, but the way we deal with it varies greatly from culture to culture. This video takes a look at death and dying around the world and explore some of the major cultural differences.

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Loss and grief affect many dimensions of a person’s life and often create a ‘ripple effect’ across families and communities. This section of the module was designed to introduce you to these dimensions. It is important to recognise the common manifestations of grief to appropriately identify loss-related needs and help people meet them, and so that we do not “pathologise behaviour that should be recognised as normal” (Worden, 2009, p. 31). Of course, there is a lot more to the grief and loss experience. You will learn more about grief and related issues in the next section of this module. But as in so many other areas relevant to counselling, you must recognise the need to continually add to and update your knowledge of loss, grief, and providing support to those in need.

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