Grief and Loss Support

Clients who have experienced losses may be very vulnerable, whether due to the nature of the loss, their grief responses, or other circumstances (Harris & Winokuer, 2016). It is therefore critical that counsellors engage empathetically with clients to facilitate a confidential and safe space in which clients can feel safe in expressing intense and often distressing emotions.

While it is important to support a client in resolving or changing a particular issue by applying specific problem-solving or distress-alleviating strategies, supporting people who have experienced losses primarily revolves around providing a safe space where the loss and its effects are recognised and validated. As Pomeroy and Garcia (2009) put it, the job involves ‘holding space’ for the client. It may also involve helping clients by providing information about grief and normalising grief responses; assisting clients in developing and using healthy coping strategies; recognising and helping clients develop continuing bonds or ways of meaning-making; and helping clients access and build on their strengths and resources (Harris & Winokuer, 2016).

A person-centred approach is often appropriate when engaging with and supporting grieving clients. You should acknowledge the client as the expert in their own grief and should focus on the core conditions, including empathy, congruence, and unconditional positive regard:

Various communication skills can also enhance your connection with the client, as well as their sense of safety and support. Some of these skills include:

• Presence and immediacy. Working with people who have experienced losses often talk about the ‘companionship’ aspect and often emphasises how much of their role involves ‘being with’ clients and bearing witness to their pain.
• Communication skills. Attending to the story and emotional needs of the grieving person is crucial. Use verbal (e.g., questioning, a reflection of feeling and content, verbal encouragers) and non-verbal techniques (e.g., appropriate body language, non-verbal encouragers, mirroring). Using these skills will help you to ‘tune in’ to the aspects of a client’s grief experience that are unique to that person (including social and cultural context), and will help you understand how these shape their grieving process and current needs (Winokuer & Harris, 2012).
• Silence. Working with issues of loss and grief must develop the ability to allow a client space to grieve by maintaining a respectful silence. The willingness to sit with clients when there are just no words that can convey what they are experiencing is an important skill.
• Open-ended questions help the client explore their experiences while acknowledging that the client is the ‘expert’ in his or her own grief.

Along with these communication skills, there are general behaviours and values that you should demonstrate when interacting with and supporting clients, particularly clients who have experienced losses. These include:

• Professionalism. This does not mean that you should be detached, clinical, or neutral in your interactions, but that you carefully manage your responses and emotions during sessions; are reliable (e.g., being on time for sessions, following up on the agreements made with clients); maintain healthy professional boundaries; and use support systems such as debriefing and supervision to process the emotions that will inevitably come up for you. Bear in mind that you may be an ‘anchor’ for some clients, and that those who have experienced losses are particularly vulnerable. Therefore, it is crucial that you are reliable and professional in your behaviour and communication.
• Courtesy. This involves being polite and respectful, including in response to the client’s experiences and belief systems, which may differ significantly from your own. It also involves acknowledging the client’s role as an ‘expert’ in their own experience.
• Sensitivity. Clients may present in a highly distressed state and relay personal or distressing information about their loss. Whilst it is important to gather information and carry out assessments, particularly where there is a potential risk, do this in respectful, responsive ways that acknowledge the upsetting nature of the client’s experience. Providing a space that is emotionally safe may involve slowing down story-telling, taking time to focus on other things, and taking more time in assessment, for example.

A Note of Caution About Story-Telling And Focussing On Loss Experiences

Providing space to talk about their experience and express emotions, including painful ones, is an important part of supporting people who have experienced loss. It can be a very validating experience and can provide space for clients to express and discuss things that help them integrate the loss. It can also help clients recognise and come to accept the reality of the loss (Worden, 2009). However, not all clients want or need to talk at length about a loss in order to adapt healthily to it. As always, it is important to be responsive to what the client wants and needs. So, if the client does not want to talk about a loss, do not pressure them to do so. And remember that, in some circumstances, telling and retelling a loss story can be harmful, even if the client wants to.

However, exploration of the loss story should not be the focus if a client presents in a highly distressed or agitated state, particularly if the loss is recent, sudden, or traumatic. In these situations, the counsellor should focus on helping the client reduce their immediate sense of overwhelmedness. Grounding techniques help the client reconnect with their present experience and ‘contain’ distress. You can use these techniques in sessions with clients and also teach them how to use such strategies outside of sessions. Be particularly careful and aware when using such a technique that you are not inadvertently trying to avoid the client’s useful expression of emotions due to your own discomfort, or approaching the situation in such a way that the client feels that their emotions or experience are being invalidated.

Grounding strategies are many and varied. A few that can be useful in and out of session include mental and physical strategies:

Given that no two people grieve in precisely the same way, you will see different grief responses across your clients, and you will see changes in grief responses within individual clients. Being able to recognise grief responses in clients will help you to normalise their reactions and better respond to their needs for further support.

Consider the domains of functioning and potential impacts of loss discussed in the first section of this Study Guide. (It may be useful to review the ‘Effects of loss and grief’ in section one before continuing with this section of the Study Guide.) When working with clients who have experienced loss, gather information about the potential effects from assessment and in the stories they tell, while keeping in mind that what seem to be grief responses may in fact be something else, and that the client may not recognise grief responses as what they are. For example, a client may complain about having trouble concentrating and making decisions; if you know that the client has experienced a significant loss, you might hypothesise that these cognitive features could be related to the loss. Of course, we cannot assume such a relationship, but you can then explore such a possibility with the client if appropriate. You can also provide information about common grief responses, to normalise and help clients understand the range of potential responses to loss.

Exploring Cultural and Spiritual Belief Systems

As you have learned in the previous section, it is important to understand grief responses in the context of that person’s social (including family and other relationships), cultural, and spiritual context. Questions as simple as “What do you think your family’s expectations are of you at this time?” or “How are losses understood within your community?” can help a client explore what may be hidden influences on the grief experience. It can also help to establish the availability of, and the client’s perception of, social support.

It is helpful to ask specifically about any cultural and spiritual beliefs that might be relevant to the way the client is feeling. For example:

• Tell me about your religion/spiritual beliefs/cultural beliefs/traditions.
• How do these influence your funeral and memorial rituals? To what extent do you/your family observe these rituals?
• Is there a particular resource you’d recommend that I could look at to learn more about your traditions to facilitate our work together?

It is also useful to invite clients to “talk about their religious and spiritual involvement and the ways in which they are able to draw on these areas in coping with their loss” (McLeod & McLeod, 2011, p. 291). For example:

• What are your beliefs about death?
• How does this affect the way you maintain a relationship with your loved one?
• Do you have a spiritual or religious community that is supporting you, or which could support you?

Counsellors don’t need to know everything about a client’s culture, social set-up, or spirituality in order to help them. But they do need to listen and be interested, open, and non-judgmental. This is clearly important when the client’s culture or beliefs are clearly different from the counsellor’s, but it remains crucial regardless of the counsellor’s familiarity with any group. Even when you share a client’s religion, spiritual perspective, or cultural background, you need to listen carefully; acknowledge the reality that there will be differences between your experiences and beliefs and those of the client; and possibly pay even more attention to the assumptions and ideas that you hold about the shared perspective or culture. In addition, counsellors who have strong beliefs need to be particularly careful not to impose their own belief systems or assumptions onto their clients. Remember that clients are the greatest source of knowledge about their own social and cultural context, and counsellors must collaborate with clients to develop their understanding of the client’s circumstances and respond to their unique needs.

Some clients may express a strong preference for a particular spiritual or cultural perspective in their counselling, in which case counsellors should respectfully explore the client’s expectations for the counselling process and their intended goals or outcomes. Taking a not-knowing stance, and being open and genuinely interested in clients’ spiritual perspectives are also helpful. Where necessary, counsellors may consider educating themselves about a client’s particular spiritual and/or cultural background to facilitate understanding of the client’s context, and so they can respond more appropriately to the client’s needs.

In some cases, clients may be supported to seek resources and professionals in the community for particular issues relating to their spirituality or culture, while they continue using the counselling process for issues for which counselling is relevant. However, if a client has a strong preference for using a service that shares their culture or belief system, or if the client’s intended outcome fall out of the counsellor’s work role (e.g., to obtain support to mourn using a particular religious or cultural practice), the counsellor can still support the client in identifying appropriate services or professionals, and referring the client in accordance with their professional responsibilities and workplace guidelines.

Due to the variety of ways that grief is expressed among different cultures, the distinction between expected and complex grief responses can only be made when considered within the cultural context of the individual. However, it is important to be able to recognise indicators of complex grief, in part because it is a clear sign that referral to a mental health professional – preferably one with significant grief counselling experience – is required. So, what is complex grief, and how does it differ from ‘uncomplicated’ grief?

Identifying Complex Grief

The majority of people who experience a loss will adapt, integrate their loss, and be able to carry on with their lives, with or without the support of a counsellor. In fact, there is a lack of evidence that grief counselling is helpful in cases of uncomplicated grief (Harris & Winokuer, 2016). However, a small proportion of people get ‘stuck’ in the grieving process or experience overwhelming reactions that can indicate additional support needs. These types of problems in the grieving process are referred to as complex grief (or complicated grief).

As Harris and Winokuer define it, complex grief includes “persistent feelings of intense yearning or preoccupation with the deceased; shock, disbelief, and anger about death; difficulties with trust; and engagement in behaviours and activities try to either avoid reminders of the loss or to feel closer to the deceased” (2016, p. 144). They go on to identify some particular indicators of complex grief, which also indicate the need for referral for more specialised support:

There is currently controversy around the identification of complex grief within the broad spectrum of ‘normal’ grieving, making it challenging to identify when a bereaved individual may benefit from more specialised care (Winokuer & Harris, 2012). Grief in the early weeks, in particular, is often very intense, making it difficult to make a judgement based solely on grief responses. 

Complex grief is associated with higher risks of physical health problems, mental disorders, and suicide (Hall, 2011; Harris & Winokuer, 2016). Thus, it is crucial to identify cases where people exhibit symptoms of or are at risk of developing difficulties related to complex grief.

Identifying Trauma

Trauma is often experienced after a sudden, violent death, particularly if this was witnessed by the individual. However, it may also be experienced in relation to other losses, including non-death losses, and traumatising events often bring losses with them. As such, it is important that anyone working with people who have experienced loss have an understanding of trauma and can identify indications of trauma responses.

Trauma responses include physical, cognitive, behavioural and emotional symptoms, including:

^{(Adapted from Australian Psychological Society, n.d.)}

These can be perfectly normal reactions to distressing or traumatic events and are not necessarily cause for concern, provided that they are not overwhelming and that they fade quickly (Kitchener, Jorm, & Kelly, 2017). However, particularly distressing or ongoing symptoms can prevent an individual from adjusting to a loss and lead to other problems, including serious mental disorders. Trauma symptoms such as these are indicators for referral for more specialised mental health assessment and intervention. And, of course, if someone has experienced something traumatic and wants to access post-trauma support, regardless of whether or not they show such symptoms, they should be helped to do so through referral to a mental health specialist (such as a clinical psychologist).

You are already aware of the legal and ethical considerations involved in your role. However, given the complexities involved in working with clients who have experienced loss, it is important that we revisit a few legal and ethical considerations that are particularly important in the context of loss and grief. These include:

• Duty of care. As you know, workers have a responsibility to protect the well-being of themselves, their clients, and relevant others in the counselling process. This includes providing competent and safe services and assessing and responding to relevant additional issues. Appropriately referring clients experiencing complex grief, trauma, and other mental health issues is part of discharging this duty of care. Workers also need to assess whether clients pose risks to themselves or to others, and respond accordingly. In limited cases, the duty of care requires sharing information with relevant authorities, even without client consent.
• Privacy, confidentiality, and disclosure. As you know, clients who have experienced a loss can be particularly vulnerable. It is your responsibility to provide a safe and private space for your clients to explore their loss experiences, and to protect all information you have about clients. However, in cases where there has been risk of harm to self or others identified, you may be required to disclose client information to another agency or authority. When doing so, you must follow your organisational guidelines and the guidance of your supervisor or manager. On the other hand, if you need to disclose client information for referral purposes, discuss referral options with your clients and obtain their consent for all of the information you provide about them.
• Work role boundaries. Whilst grief and loss issues are not uncommon in general counselling work, specific grief or bereavement counselling is an area that requires specialist knowledge and skills. As a worker, you will need to be mindful of the responsibilities relevant to your work role as well as your limitations in supporting clients with complex grief and loss issues (e.g., trauma, complex grief, mental health problems, suicide risk, or other significant co-occurring issues). You are not expected to work outside of your role, nor is it ethical to do so. Where necessary, support clients to connect with more appropriate professionals or services (e.g., trauma specialists, mental health clinicians).

Client Risk to Self

The grieving process can be an overwhelming and challenging experience, evoking strong feelings of frustration, helplessness, and despair. As such, a grieving person may engage in high-risk behaviours including substance and alcohol misuse, self-neglect, risk-taking and suicidal ideation (Wilson, 2014). In fact, it is not unusual for newly bereaved clients to express that they ‘want to join the deceased’ or to ‘fall asleep and not wake up’. Some will even consider ending their lives. As such, and as always in counselling, it is crucial to be aware of the potential for suicide and other risks to the client, and to assess such risks appropriately. This includes asking clients clearly and directly about suicidal thoughts and other indicators of risk, carrying out an appropriate risk assessment, and referring any client who is at risk of suicide (or another significant risk to self) to appropriate services.

Any organisation that works with clients must have appropriate protocols and processes for managing suicide risk, which workers are required to follow. It is also important that all workers know what is involved in a comprehensive suicide risk assessment, and are able to use this knowledge in identifying and responding to suicide risk. Suicide risk assessments include the following elements (adapted from SuicideLine Victoria, n.d.):

Contrary to what some believe, asking someone about suicide does not ‘give the idea’ to the person. Rather, asking about any thoughts or plans a client has in a calm, matter-of-fact, non-judgemental way is a crucial part of increasing the likelihood that those at risk of suicide will be identified. It can even help people feel understood and supported. You might ask:

• “Sometimes people who have lost someone close to them think about suicide as a way to escape the pain. Have you had any thoughts of suicide?”
• “Are you feeling hopeless?”
• “Have things been so bad lately that you have thoughts that you would rather not be here?”
• “Have you had any thoughts of joining [the deceased person]?”
• “Have you had thoughts about taking your life?”

If the client indicates that they have had thoughts of suicide, this needs to be followed up with specific questions about when the thoughts were happening (including whether they are still happening) and what they involve, such as:

• “When have you had these sorts of thoughts?”
• “Do you have a plan to take your life?” or “Have you thought about a plan to end you’re your life?” and, if they have or have considered a plan, “Would you tell me about the plan?”

It is critical that you ask about suicidal thinking and other risk factors directly, clearly, and sensitively, avoiding any language that could be misconstrued. For instance, it is not appropriate to use a leading or judgmental question such as “You’re not thinking of doing anything stupid, are you?” (Mental Health First Aid Australia, 2016, p.2). Terms involving ‘harm’, ‘risk’, or ‘hurt’ do not directly enquire about suicide; they are ambiguous and could mean anything from drinking alcohol to scratching one’s skin, to suicide. As such, using these terms when assessing suicide risk (e.g., asking “Do you think you might hurt yourself?”) can lead to misunderstanding and generate inaccurate (and therefore dangerous) responses.

Keep in mind, too, that some language relating to suicide that is commonly in use can be problematic (Beaton, Forster, & Maple, 2013). In particular, when discussing suicide we should avoid using terms such as ‘committed’, ‘successful’, ‘unsuccessful’, and ‘completed’. ‘Committed’ links suicide with both crime and sin, so while it has been in regular use for decades, it is now increasingly recognised stigmatising and therefore to be avoided. ‘Successful’, ‘unsuccessful’ (for a suicide attempt), and ‘completed’ risk bringing positive connotations to death by suicide (Beaton et al.). Instead, use terms such as ‘suicide’, ‘died by suicide/death by suicide’, ‘took their own life’, and ‘suicide attempt/attempted suicide’. It can be challenging at first to change the terminology that we are used to using, but it is well worthwhile to make the effort to identify problematic terms and build your familiarity and comfort with appropriate terminology.

In addition to an assessment of risk, responses to suicide risk should also consider identifying and fostering of protective factors (i.e., which help reduce risks). According to SuicideLine Victoria (n.d.), protective factors include:

Actions to address client’s risk to self should be guided by organisational guidelines and protocols, and will typically vary according to the level of risk involved. Responses to low-risk situations may include monitoring the situation, but suicide risk is always an indicator that consultation with your manager or supervisor is required, and that referral to a specialist service should be considered. Moderate-risk situations necessitate the development of a safety plan with the client, organising a referral to an appropriate mental health service or general practitioner, and potentially engaging with the client’s other supports (family, friends, other services, etc.). High-risk situations will typically require you to assist the client in contacting acute mental health services or to alert the police or ambulance, and stay with the client until further support has arrived. In all cases, you must consult your manager or supervisor immediately, as well as documenting all concerns, assessments, and actions taken.

Risk to Others

Where there are serious concerns about risks to others, particularly when the risks are to children or where the client themselves poses a risk to someone else, it is important that you respond appropriately following your organisational protocols and professional responsibilities. This will always involve consulting with your supervisor or manager and may involve informing relevant authorities (police, the child welfare authority in your state or territory, etc.) and taking other appropriate actions.

Although much of the role in supporting grieving clients involves empathetically listening and ‘holding the space’ as the client works through what is happening for them, there are both informal and formal strategies that you can implement to help clients adjust to the losses they have experienced.

Acknowledge, Validate, and Normalise

As you have learned, grief may be expressed in many ways can evoke uncomfortable and distressing feelings. One of the most helpful things a worker can do is to validate the feelings that the client expresses. Clients may present in counselling with grief experiences that have been viewed as ‘wrong’ or ‘pathological’, or which they themselves are concerned are wrong or indicate that they are abnormal. Some will have experienced losses that are not well recognised, and potentially disenfranchised grief. Listen carefully, acknowledge the client’s experience of grief, and help them understand that a wide range of reactions that can be part of responding to loss.

Given the significant and wide-ranging effects of grief, it is not surprising that clients may express worries about ‘going crazy’ or ‘losing my mind’. It is so important for workers to normalise grief reactions by providing information about the range of responses and experiences that can flow from loss. This can be done informally throughout discussions with the client (as shown in the counselling excerpt below) or more formally with printed materials about grief (provided that these are from appropriate sources). Understanding grief in general and identifying particular responses relevant to clients can help them (and their support people) anticipate and cope with the changes and fluctuations in emotions and behaviours that often accompany grief.

Fluctuations in mood, and the absence and recurrence of particular responses, can be likened to a ‘wave’, as described below. Explaining these fluctuations in mood can help clients under-stand and anticipate them, and alleviate concerns about ‘sliding backwards’ or ‘getting worse’.

Working with Emotions

Emotions play a pivotal role in the grieving process and, as we discussed in the beginning section of this Study Guide, it is common for clients to experience a range of emotions, including less expected emotions such as anger, guilt, or relief. It is important to remember that emotions serve an important function and that the role is not to try to talk the grieving person out of any particular feelings, or to try to make them feel better, but to normalise and validate these emotions, allowing the client a safe, non-judgmental space to express them (Winokuer & Harris, 2012). 

It is not unusual for grieving clients to associate intense emotions with negative thoughts or worries (e.g., a client might say, “I think I’m going nuts.”) so it is an important part of the worker's role to help clients recognise the validity and normalcy of their emotions. In some situations, emotional challenges can also be reframed as strengths.

It is also important to consider individual client differences such as personality, grieving styles, and social or cultural preferences when working with emotions. 

While some approaches to counselling demand emotional expression, this can be unhelpful and even harmful. It is important not to force a client to emote and always remind them that they have the choice in how they want to manage their emotions (Winokuer & Harris, 2012). Allow the client to guide what is discussed and when, and help them learn to use grounding strategies or other ways of self-soothing and regulating their emotions.

Remembering

There is often a lot of pressure on bereaved individuals to ‘get over’ a loss and move on with their lives. Counselling offers an opportunity for clients to tell their story of loss by remembering – who the loved person was before the loss, the relationship with the person, the nature of the loss and its meaning, and what life has been like since the loss occurred (Winokuer & Harris, 2012).

Continuing Bonds

As you may remember from the previous section, contemporary approaches to grief and loss include a focus on helping clients ‘relocate’ the deceased loved one, rather than attempting to sever the bonds. The initiation of rituals associated with the loss or establishing legacies to commemorate a loss may be helpful in both attaching meaning to what has occurred and establishing continuing bonds with a loved one. Although there are few prescribed mourning rituals in current Western society, clients may find their own personal rituals that give meaning to their experiences or bring them comfort (Winokuer & Harris, 2012).

Just a few examples of ways to continue the bond after a person has died include:

• Letter writing, such as writing letters to or about the person who has been lost.
• Putting up photos or creating collages of pictures of or relating to the person who has died.
• Visiting places that were important to the deceased or significant in the relationship between the grieving person and the person who has died.
• Celebrating or otherwise recognising the deceased person’s birthday or death anniversary.
• Personal rituals such as reflecting on objects that relate to the person, lighting a candle, singing or playing music that is connected to the deceased person or which expresses the grieving person’s grief, and so on.

Meaning Making

Supporting clients in determining what the loss means in the context of their own life and life story may also be helpful.

Clients should indicate on their own in some way that they are trying to make sense of why the loss happened and what it means to them, and must be in the ‘driver’s seat’ when it comes to choosing ways to try making meaning in the context of loss.

Cognitive Behavioural Strategies

As well as focusing on loss-orientated processes such as grief responses, workers can also help facilitate the management of restoration-orientation activities. Cognitive behavioural techniques can be particularly useful in this area:

Part of a worker's role is to help clients who have experienced losses to access relevant information and support from other sources. This may involve identifying materials and resources (e.g., books, brochures, websites) that might be helpful, as well as facilitating access to support available in the community or specialist services. For example, GriefLine offers telephone and online counselling as well as information resources – a page from its website is shown below:

Before directing a client to any resources or service information, it is important to ensure that the information is current and suitable. For instance, some support organisations have religious affiliations, and some clients will not be comfortable with this. Other resources, such as books and websites, may provide inaccurate or even harmful information or services, so it is crucial that you critically evaluate any resource before suggesting or providing it to a client. Information also needs to be provided in a way that is understandable to the client. For example, the resources and the way you discuss them needs to be developmentally appropriate and responsive to any language, intellectual, or comprehension needs the client has.

Additionally, when sharing information or suggesting resources or services, you should:

• Be aware that grief may impact the client’s mental functioning; explain things clearly and slowly.
• Check in with the client frequently to see whether they have understood the information and/or options presented and whether this is useful to them, and to provide clients with the opportunity to give feedback. For example, you could say:
  • “Is this the sort of thing you had in mind?”
  • “Do you think that could be helpful?”
  • “No one option suits everyone. Should we consider a few other options?”
  • “Do you have any questions or concerns?”
  • “Should we go over that again?”
• Take care not to overload clients with a large amount of information at once.
• Ensure resources are culturally and developmentally appropriate.
• Access translated material in the language of your client where appropriate.

As well as helping clients access community resources and supports, it may also be useful to help clients use and build upon their natural support network (i.e., family, friends, neighbours, and groups they belong to). Some people are reluctant to ask for help or are unable to identify what specific assistance would be helpful. 

Grief Counselling and Other Specialist Support

Grief counselling is a specific type of counselling that focuses on supporting people in relation to significant grief and loss issues: “A counsellor who understands the basic tenets of good counselling practice and who also has expertise in the grieving process can provide a highly specialised form of support to an individual who is struggling with a significant loss” (Harris & Winokuer, 2016, p.8). Such specialist support is particularly important when a client’s focus for counselling is a significant loss or when they are experiencing complex grief.

Generally, a grief and loss counsellor recognises grief as a normal response to loss and focusses on helping the client to acknowledge and integrate their experience. Some of the goals of grief and loss counselling are:

The grief counsellor should also have specialised training in helping clients with intense emotions, contemporary approaches such as meaning making, and responding to complex grief and other significant issues that arise in grief counselling. Grief counsellors may have high level university qualifications in counselling, social work, or psychology, and significant experience counselling clients experiencing a wide range of grief responses. They also need to have a thorough understanding of mental health and risk issues, including assessment and intervention processes. Where mental health issues are a concern, referral to a clinical psychologist or psychiatrist, or working the client’s general practitioner (GP) to arrange this, is important.

Support Groups

In addition to specialised counselling support, clients can also benefit from interacting with others who have also experienced similar losses. Support groups offer many potential benefits to those who have experienced a loss. Grief can potentially be a lonely and isolating experience, and many people find it helpful to talk to others who they feel truly understand what they are going through. Groups offer the opportunity to share support, information, and mutual concerns (Pomeroy & Garcia, 2009). They also offer clients the opportunity to learn healthy behaviours and strategies from others.

In considering which groups may best support client needs, you consider developmental needs and the particular circumstances of the loss. For example, an adolescent may be supported best by organisations such as Headspace, where counsellors have specific expertise in supporting young people, and some people will benefit from participating in groups where people have suffered similar losses, such as stillbirth or suicide bereavement groups. As community resources such as specific services and groups will vary between areas and over time, it is important to research and develop a current list of resources, and keep this updated.

Other Relevant Services

Other than grief-specific services, clients may also benefit from referrals to other specialist services and support. This often aims to facilitate adjustments to both primary and secondary losses, and the various impacts of grief that clients experience (e.g., relationship difficulties, addictions, health issues). If you become aware that a clients may benefit from additional support for needs outside of your expertise, you should always refer clients to services that are more appropriate to meet their particular needs. All counsellors have a responsibility to maintain up-to-date knowledge of available services, so that they can provide effective information and referral services whenever there are indications that clients may benefit from support options in addition or as an alternative to counselling.

We have already talked about the role of specialist grief and bereavement counsellors and clinical mental health professionals. Some other services you may commonly refer clients to include:

• Health and medical services. As loss and grief can significantly impact on a person’s physical and emotional wellbeing, it is not uncommon for clients to experience physical symptoms or life-depleting behaviours (e.g., lack of appetite, not sleeping properly). However, it is important not to assume that physical symptoms are necessarily caused by grief or will reduce with time. So it’s worthwhile to encourage clients to talk with their GP, refer them to a supportive GP if they do not already have one, or provide referral to other relevant medical and health care services.
• Relationship or family counselling. Significant losses experienced in a relationship or a family can put strain on the clients’ relationships with significant others and often cause difficulties more broadly within families than simply impacting one individual. Where appropriate, clients can be referred to family or relationship counselling, or other family-orientated services, for additional support.
• Legal and related services. Some clients need legal advice or support in relation to their circumstances after losses. For instance, clients who have experienced relationship breakdown may be referred to mediation, family dispute resolution services, or family lawyers for support in parenting arrangements and financial settlement; a client who has lost their job and believes they were unfairly dismissed can be referred to Fair Work Commission; Legal Aid Commissions offer legal support to financially disadvantaged individuals; and various services can help with other legal and financial issues.
• Substance abuse and other addiction services. As mentioned before, grieving individuals may react to losses by engaging in life-depleting behaviours including excessive or dangerous use of alcohol or other drugs, or other addictive behaviours. Where there are concerns, clients should be referred to appropriate specialist services or practitioners.
• Financial counselling and emergency relief. Clients facing financial difficulties (e.g., struggling with debts or bills, dealing with significantly reduced income) may benefit from a referral to a financial counsellor who can assist with budgeting, debt management, and dealing with debt collection agencies. Many community services also offer assistance in dealing with financial difficulties, including providing financial relief (such as food assistance and vouchers).

Remember that people who are experiencing grief are particularly vulnerable. When referring clients, ensure that you are following all ethical principles and guidelines set out by your organisation and the counselling profession, including those relating to privacy, confidentiality, getting informed consent for disclosure of client information, and responding appropriately to risks.

Working with clients who have experienced significant losses can be challenging and confronting particularly in regards to empathy and the ability to sit with intense emotions (both the clients’ and the worker's own). Workers need to be able to recognise and respect individual differences in grieving responses and processes, while at the same time remaining alert to possible risks and complications that can arise. Workers and other helping professionals can support clients impacted by loss by adopting a person-centred, empathetic, and professional approach; acknowledging and respecting emotions; paying close attention to the client’s particular circumstances, responses, and needs; and helping clients learn about, normalise, and develop healthy ways to respond to loss and grief reactions. Before we wrap up this unit, reflect on the case study below, and try to identify some of the aspects of loss and grief support that we have discussed in this unit as they are applied in the case study.

• Altmaier, E. M. (2011). Best practices in counseling grief and loss: Finding benefit from trauma. Journal of Mental Health Counseling, 33(1), 33-45.
• Australian Psychological Society (n.d.). Understanding and managing psychological trauma. Retrieved from https://www.psychology.org.au/publications/tip_sheets/trauma/
• Beaton, S., Forster, P., & Maple, M. (2013). Suicide and language: Why we shouldn’t use the ‘C’ word. InPsych, 35(1). Retrieved from https://www.psychology.org.au/publications/inpsych/2013/february/beaton
• Hall, C. (2011). Beyond Kübler-Ross: Recent developments in our understanding of grief and bereavement. InPsych, 33(6). Retrieved from https://www.psychology.org.au/publications/inpsych/2011/december/hall/
• Harris, D. L. & Winokuer, H. R. (2016). Principles and practice of grief counseling. (2nd ed.). New York, NY: Springer Publishing Company
• Humphrey, G. M & Zimpfer, D. G. (2008). Counselling for grief and bereavement. (2nd ed.). London, UK: Sage
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