Pathological Grief Therapy: How to Say "Goodbye"

The loss of a loved one is extremely hard. It’ll happen to all of us at some point, but not all people have the same resources or tools to cope. Sometimes, this process becomes a chronic, serious problem.

Researchers estimate that this type of chronic problem occurs 10-20% of the time when a person goes through mourning. For these cases, there are different techniques, supported by different studies, that can help us break out of it.

Among them, we’re going to talk about directed grief. However, before we begin, we have to distinguish normal grief from pathological grief. This is our question: to what extent is suffering normal?

Normal grief and pathological grief

Mourning, or grief, is a set of reactions that occur at a physical, emotional, and social level. They are triggered by a significant loss; in our case, the death of a loved one.

Symptoms vary in intensity and duration. In some cases they last a lifetime. In any case, remember that at first it is an adaptive (good) reaction.

Grief, sadness, and anxiety are the most common feelings, in that order. Fear of being alone is also common. We may also feel guilty and become disinterested in our surroundings.

These symptoms are normal, but they should disappear within six months to a year.

When the emotional reactions are much more intense, they make it daily life difficult. And if they last over a year, you may be suffering from pathological grief.

Here, unusual grief symptoms appear such as hallucinations or suicidal thoughts. Pathological grief is often complicated, and can give rise to other behaviors. These include social isolation, personal neglect, or substance abuse. This is when we should consider grief therapy and professional help.

Grief therapy: therapeutic strategies

Professionals use both individual and group therapy to treat pathological grief. In some cases, it is effective to use both. Treatment is about giving people tools while also offering social support to end their isolation.

Either way, the main objective of grief therapy is not to forget the deceased, but to transform the process of grieving so the memory of the deceased does not create a blockage. Therefore, the fundamental goals of this therapy are to:

• Facilitate the expression of feelings and experiences in relation to the deceased. Usually the person hasn’t put words to what he feels or thinks. This makes it difficult to get over the loss.
• Discuss the circumstances that led to the death. Depending on the type of death that has occurred (suicide, sudden accident, terrorist attack, etc.) grief can be more painful. Talking about it will facilitate assimilation and acceptance.
• Center the therapy on resolving daily problems and re-adapting to normal daily life. Small, daily steps can have big results.
• Project the patient into the future, gradually incorporating fulfilling activities into their routine. This will make the patient feel that, despite everything, some things are still good.

Directed grief

Psychologists use this kind of therapy with people experiencing pathological grief with avoidance behavior, emotional blockage, and nightmares or invasive thoughts.

In these cases, directed grief can work. It consists of exposing the person to memories associated with the deceased, especially shared experiences.

For example, therapists usually have their patients read old letters or look at photo albums. Regardless of how, the point is to break the disruptive emotional inhibition.

The underlying mechanism that makes this type of therapy work is the weakening of the conditioned emotional response (sadness) through repeated presentation of stimuli that generate that response.

That is, we repeatedly expose the patient to what generates sadness until the emotion lessens.

Repeated exposure can also be done with behaviors that the patient used to like but stopped doing because they bring back memories of the deceased.

For example: going to the movies, traveling, going out to dinner, etc. In these cases, the gratification of the activity will also serve as the underlying mechanism of therapy.

Indicators of recovery after pathological grief

How do we know if grief therapy has worked? What behaviors determine recovery from pathological grief? Here are a series of indicators or signals of recovery:

• The person has regained normal biological aspects, such as appetite and sleep.
• Verbal expression of feelings, such as smiles or hugs, reappears.
• The subject has started doing enjoyable things again, resumes his or her social life, and even participates in volunteer activities to help others.
• The memory of the deceased is already integrated as part of their personal story. It no longer triggers excessive negative emotions. They remember positive experiences they shared with the deceased.
• They enjoy daily life and set goals for the future.

In short, grief is a normal process that requires personal growth and is not always easy to work through. In any case, knowing what pathological grief is and some ways to treat it can help us identify and face the final goodbye. Furthermore, it can help motivate us to seek professional help when we need it.