290 Grief and Loss Across the Lifespan
Accompanying the Bereaved in Their Grief
Many students feel hesitant about their ability to work with bereaved people
and somehow believe they must remove a client’s sadness or, in some other
way, work magic. In truth, sadness is a normal part of human existence and
a customary response to loss. Losses related to attachment, to status and
resources, and to meaning or valued goals inspire pain and likely contribute
to the high rate of diagnosed depression in the Western world (Horowitz &
Wakefield, 2007). Yet, these losses and concomitant feelings are common across
all cultures and throughout human history. We trust that most bereaved peo-
ple will be helped by the practitioner, friend, or family member who has the
courage and compassion to sit with them calmly and truly listen to their sto-
ries and feelings. A brief word about “calmly”: a listener’s rising anxiety (due
to pressure to make magic happen or a belief they must do something) compro-
mises calm listening. Listening calmly means gently probing the bereaved’s
thoughts, feelings and actions and listening with intentness and quiet.
It is very important that supporters actively help the bereaved tell the
stories of their losses and what they mean to them. This is the opposite of say-
ing “I’m here if you want to talk”—an offer grievers seldom mobilize to avail
themselves of. Good support entails asking questions about what led up to the
death, what happened during the death (and how that affected the bereaved),
how the bereaved was thinking and feeling immediately after the death, how
that differs from current feelings, and what fears the person has about moving
through life without the loved one. Although these questions are geared to a
death loss, they are easily adapted to other types of loss. Most important, these
questions should be posed gently and one must respond with interest, empa-
thy, and patience. Asking the bereaved person specific questions, rather than
offering a vague invitation “to talk,” provides both guidance and permission
to begin to talk. There is no magic here, but over time, the bereaved usually are
able to make meaning of the loss and create a story with a narrative line that
allows them to feel that the experience is understood and contained.
Of course, losses can threaten long-term well-being and may evoke intense
sadness. The DSM-5 is clear that if grieving people begin to have extreme
symptoms that meet the criteria for major depressive disorder, they should
be referred for psychiatric evaluation. Yet, the removal of the “bereavement
exclusion” and the decision not to include prolonged or complicated grief as
diagnoses in the DSM-5 have left clinicians with more questions than answers
about when loss responses and grief require psychiatric treatment rather than
supportive counseling. Wakefield (2013) has neatly explained the history and
rationale of DSM-5’s removal of the bereavement exclusion and the great dif-
ficulty it creates for grievers and their caregivers. Although the bereavement
exclusion had long been criticized as too narrow (divorce and job loss can pro-
voke depressive symptoms, too) and also too short (the 2-month bereavement
exclusion of DSM-III and DSM-IV does not recognize that most grievers expe-
rience such symptoms for at least 6–12 months), the removal of the exclusion
has led to even greater concerns. These can be summed up in Allen Frances’
words (Frances is the editor of DSM–IV TR): “Many millions of people with
normal grief, gluttony, distractibility, worries, reactions to stress, the temper
tantrums of childhood, the forgetting of old age, and ‘behavioral addictions’