H. Norman Wright
Here are some losses that we begin to
encounter as children that have a
counterpart in adult life:
 Loss of a favorite toy
 Dropping an ice cream cone in the
dirt
 Not receiving an anticipated gift
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A friend starts playing with
someone else
Parents decide to move away from
the familiar neighborhood
A pet gets lost or dies
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Divorce—Mom or Dad remarries
Being promoted to an advanced
class and leaving your friends
behind
Having your friends promoted to an
advanced class and being left behind
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A teacher leaving in the middle of
the school year
A class mate dies
A grandparent dies
Gaining weight
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Discovering you were adopted
Loss of innocence
Losing a library book
Catching the “tooth fairy” in the act
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Not making the Little League or
soccer team
Not getting invited to a birthday
party
Not getting a favorite teacher of
your sibling
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Loss of a job
Retirement
Aging
Job change that is not anticipated
Abortion
Miscarriage
Stillbirth
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Giving a child up for adoption
Separation/divorce
Children leaving home
Move to another city
Physical illness/injury/disability
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Terminal illness of a child, friend,
lover
Death of a child, friend, parent,
partner, pet
These can move us into crisis or
trauma
Crisis throws us off balance and into a
state of disequilibrium and panic.
1. The capacity to cope is diminished as
the shock overwhelms the person at
the same time additional stressors are
added.
2. The loss doesn’t make sense, and can’t
be understood or absorbed.
3. Sudden loss or sudden death usually
leaves the survivor with a sense of
unreality that may last a long time.
4. Symptoms of acute grief and of
physical and emotional shock persist
for a prolonged period of time.
5. Sudden loss or death fosters a
stronger-than-normal sense of guilt
expressed in “if only…” statements.
6. In sudden loss or death, the need to
blame someone for what happened
is extremely strong.
7. There’s a profound loss of security
and confidence in the world which
affects all areas of life and increases
many kinds of anxiety.
8. Sudden loss or death often involves
medical and legal authorities.
9. Sudden loss or death often elicits a
sense of helplessness on the part of
the survivor.
10. The loss cuts across experience in
the relationship and ends to
highlight what was happening at the
time of death, often causing these
last-minute situations to be out of
proportion with the rest of the
relationship and predisposing of
problems with realistic recollection
and guilt.
11. Sudden loss or death leaves the
survivors with many regrets a sense
of unfinished business.
12. In the event of sudden loss or
death there is the need to
understand why it happened. Along
with this is the need to ascribe not
only the cause but the blame.
Sometimes God is the only available
target and it is not uncommon to
hear someone say, “I hate God.”
13. The death tends to be followed by a
number of major secondary losses
because of the consequences of lack
of anticipation.
14. The death can provoke
posttraumatic stress responses.
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Multiple Deaths: One death is
sufficiently devastating; dealing
with a set of losses overloads your
emotional circuits.
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Violent Death from Accident, Suicide,
or Murder: These events are
additionally weighted with overriding
concerns about the possibility of the
persons suffering, guilt over your
inability to prevent the death, and
shame about the way it occurred. You
may also have to deal with distractions
from law enforcement and other official
agencies.
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Questionable Deaths: Not knowing
or being sure about the
circumstances can lead to intense
anger and frustration.
Discovering the Body: Finding the
body is shocking enough; having to
break the news adds additional
trauma.
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Witnessing the Death: While seeing
a peaceful, tranquil death may be of
some comfort, watching a person die
leaves a permanent imprint. The last
impression may be all the more
horrific if the death were under
difficult or unusual circumstances.
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Hearing the News: Learning of the
person’s death in a callous manner
or getting confusing or dishonest
information primes us for
problematic mourning.
Notoriety: Having a loved one die in
a way that generates news coverage
means putting a public face on
private grief.
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A Body That’s Not Presentable or
No Body: Dealing with a badly
damaged body may be particularly
traumatic for a child or teen. Not
being able to view or positively
identify the remains can also
produce lingering doubts.
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Secrets Discovered After the Death:
Discovering that the person
mourned as mother was actually
grandmother.
Phase I - Impact
 Time: Few hours to a few days
 Response: Should I stay and face it or
withdraw?
 Thoughts: Numb, disoriented. Insight
ability limited. Feelings overwhelmed.
 Directions you take to regain control:
You search for what you lost.
 Searching behavior: Often reminscing.
Phase II – Withdrawal/Confusion
Time: Days to Weeks
Response: Intense emotions. You feel drained,
anger, sadness, fear, anxiety, depression,
rage, guilt.
Thoughts: Thinking ability limited.
Uncertainty and ambiguity.
Directions you take to gain control:
Bargaining, wishful-thinking. Detachment.
Searching Behavior: Puzzled, unclear.
5. Trauma is a wounding.
I am frightened inside; the terror of death has
attacked me. I am scared and shaking, and
terror grips me. I said, “I wish I had wings like
a dove. Then I would fly away and rest. I
would wander far away and stay in the desert,
I would hurry to my place of escape, far away
from the wind and storm.”
Psalm 55:4-8, New Century Version
Commitment
to Family
Selfless Devotion to
Loved Ones
Love of the Putrid
Rolling
In it
Sniffing
Eating
It
Humping
Licking gross
things
Frisbee
Gland
Chasing
Balls
Bikes
Cars
Cats
Anticipation is “to feel or realize
beforehand: foresee. To look forward
to or to foresee and fulfill in advance.”
Trepidation—”trepidatory grief” would
be a closer fit for the kind of grief
people with a life-threatening illness
and their loved ones go through up
until the point where bad days out
number the good ones.
Five Stages
Stage 1: Denial and Isolation
Stage 2: Anger
Stage 3: Bargaining
Stage 4: Depression
Stage 5: Acceptance
Anticipatory grief is not just focused upon
a future loss.
For anticipatory grief to be healthy it’s a
process of starting to now the loss of a
loved one in the future without
separating prematurely from them.
Involvement is still important while
recognizing what will occur in the
future.
As one person said, “It’s possible to
mourn the future without
relinquishing the present.”
Questions to Ask
1. “What is going on in your mind as
you watch what is occurring?”
2. “What’s the most difficult part of
this for you each day?”
3. “How could others be more
supportive of you at this time?”
4. “Let’s look at some of the losses
you’ve already experienced and how
they’re affecting your life.”
With anticipatory grief, there are three
factors which occur: (1) what occurs
within the person; (2) what occurs
between the person and the dying
loved one; and (3) what occurs
between the person and the family
and friends.
There are four sets of psychological
processes and they overlap. The first
one is a growing awareness and
acceptance and gradual accommodation
to the loved one’s dying.
Questions to Ask
1. “When did you begin to grasp that
could be
dying?”
2. “To what extent have you been
rehearsing
death
and what it will mean?”
3.
“Can you describe for me some of
the impact or consequences
of
dying?”
The second set of psychological
process is processing the death
emotionally.
1. “How would you describe your
emotional response at this time?”
2. “Which has been the most difficult
for you?”
3. “When did you come to the
realization that
would die while you go on living
and how did that affect you?”
What would you suggest?
The “crazy” feelings of grief are
actually a sane response to grief. The
following examples are all
symptoms of normal grief:
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distorted thinking patterns, “crazy”
and/or irrational thoughts, fearful
thoughts
feelings of despair and hopelessness
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out of control or numbed emotions
changes in sensory perceptions
(sight, taste, smell, etc.).
increased irritability
may want to talk a lot or not at all
memory lags and mental “shortcircuits”
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inability to concentrate
obsessive focus on the loved one
losing track of time
increase or decrease of appetite
and/or sexual desire
difficulty falling or staying asleep
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dreams in which the deceased seems
to visit the griever
nightmares in which death themes
are repeated
physical illness like the flu,
headaches or other maladies
shattered beliefs about life, the
world, and even God
Third are processes or thoughts that go on in the
person’s mind as they await the death.
1. “At a time like this, our mind often goes
into overload with so many thoughts.
What’s been going through your mind?”
2. “What steps have you taken as you
prepare for your life without
?”
3. “What have you been saying to God
at this time?”
4. “Often we think about our own
death at a time like this—perhaps
how and when, and do I want to die
like this. Tell me about your mental
journey.”
The fourth set in this process is
planning for the future.
In planning for the future there are
three steps that are important. A first
step is giving attention and energy to
the dying person.
A second step is resolving your personal
relationship with the person.
1. “Can you think of any unresolved
business between the two of you or
something which needs to be said by
either party?”
2. Mention that at this may be a time to
share with them the twenty
significant words which are: “I was
wrong; You were right; I am sorry; I
forgive you: Please forgive me; I love
you; and Thank you.” Then ask,
“Which of these would you like to
express?”
A third and final step is simply helping the
dying person and responding to their
last washes.
How Do Families cope with Expected
Losses
First show Ball of Grief.
A terminal illness creates a multitude
of problems that many family
members never consider. Some of
the special problems include the
following:
Numerous remissions and relapses, so
loved ones are on an emotional
merry-go-round.
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Lengthy periods of anticipatory
grief.
Increased financial, social, physical
and emotional pressures.
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Family disruption that goes on and
on.
The varying emotional responses of
each family member to the
progressive decline of the loved one.
Rarely is every family member on
the same page when it comes to
grieving.
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Uncertainty, which continues more
than anyone wants.
Various treatments, which are
accompanied by their side effects
and are sometimes futile.
Dilemmas over decisions such as
hospital costs, treatment plans and
so on.
How do families cope?
Avoid abandonment
1. Giving brief and formal monologues.
2. Treating the person as though the
disease or accident has turned him or
her into a nobody.
3. Ignoring or rejecting the cues that the
person attempts to give.
4. Literally abandoning the person.
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I am not sure exactly how it works,
but this is amazingly accurate. Read
the full description before looking at
the picture.
The picture below has 2 identical
dolphins in it. It was used in a case
study on stress levels at St. Mary’s
Hospital.
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Look at both dolphins jumping out of
the water. The dolphins are identical. A
closely monitored scientific study
revealed that, in spite of the fact that the
dolphins are identical, a person under
stress would find differences in the two
dolphins. The more differences a person
finds between the dolphins, the more
stress that person is experiencing.
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Look at the photograph and if you
find more than one or two
differences you may want to take a
vacation.
The Family Unit
When a family member dies, the family
balance or unit dies as well. There’s a
hole in the fabric of the family, and
not everyone will realize this. If
something affects one family
member, it affects the others.
Some of the unique problems to
consider in the family system are:
1. How close was each family member
to the dying person? What was the
quality of their relationship or their
level of attachment?
2. What is the grieving pattern of each
person and what does each know
about grief?
3. To what extent does each person
want to be involved with the dying
person at this time?
4. How does the expression of grief
affect the grief of other family
members?
5. How will the family handle “after
death” issues if there are differences
such as what type of funeral,
disposal of remains, type of service,
disposal and disbursement of
clothing and personal affects,
photographs shown or not shown,
holidays, anniversaries, etc.?
6. What are the specific reasons for the
grief of each family member?
Grieving Differences
“It doesn’t help to talk about it.”
“You can talk about it, but not with
me.”
“We’re doing fine, but thanks for
asking.”
“Let’s just move on.”
“If you’re not sharing feelings, you’re
not grieving.”
“Let’s let others help us grieve.”
2. Phases of Family Adaptation
These four emotional responses of the
family to the crisis of prospective
loss—disorganization, anxiety,
emotional liability, and turning
inward—will be dramatically
different at various phases in the
family’s adjustment to the illness.
Just as a terminally ill person
progresses from a state of health to
disability to dying, a family’s
progress in response to a fatal illness
can be roughly divided into three
phases:
(1) The preparatory phase, beginning
when symptoms first appear and
continuing through the initial
diagnosis;
(2) the middle phase, which can be
quite lengthy, when the family lives
with the reality and caretaking tasks
of the fatal illness; and
(3) the final stage, when the family
accepts the imminent death and
concludes the process of saying
farewell.
Four Tasks of the Grieving Family
In his 1982 book Grief Counseling and
Grief Therapy, William Worden first
suggested the notion of specific tasks
that grieving persons need to
perform to heal the wounds caused
by death.
The Four Tasks Are:
1. Shared acknowledgment of the
reality of death.
2. Shared experience of the pain of
grief
3. Reorganization of the family system
4. Redirection of the family’s
relationships and goals
Steps to help the family member move
forward
1. Embrace the fact that life will be
different; it is a new life. This means
realizing you have to give up some
of the old routines.
2. Realize your social circle and/or
support network may be drastically
altered.
3. Work on reducing the amount of time
you give to negative thoughts. Negative
thinking involves thoughts about your
supposed inability to cope with all your
new responsibilities, roles and
challenges. Negative thoughts will
never create the courage needed to deal
with change. They are the number one
force in prolonging grief.
4. Look for support from
knowledgeable sources. Seeking
knowledge and support from
credible resources is very wise.
5. All mourners need a companion, an
ally, someone who will walk with
you through the painful journey.
 How
do you help?