Grief and Mental Health: A Clinician’s Guide to Supporting Patients in Grief

Grief impacts all of us each day. However, with so many life stressors to address, grief often falls by the wayside when someone enters behavioral health care unless it is explicitly flagged as the reason they are seeking treatment. By redefining grief, we can better understand the role it plays in one’s mental health and support our patients in whichever season of grief they are experiencing.

What is grief?

The standard definition of grief: deep sorrow, especially that caused by someone's death.

Culturally, in the United States, grief is seen as an emotional reaction to the death of someone. While this is certainly one element to the grief experience, it fails to encompass how truly universal and constant grief’s presence is in our everyday lives.

Let’s redefine grief: a normal, natural reaction to something being taken from us.

While the primary experiences people often associate with grief are illness and the death of a loved one, grief can be evoked during any major life event -- good, bad or neutral -- when significant change has occurred that is out of someone’s control. These major life events can include divorce, job loss, financial insecurity, physical abuse, empty nesting and even the onset of a global pandemic.

The importance of mourning

Pulling back the layers of the grief experience, we can further organize grief into two buckets:

• Internal feelings of grief
• External expression of that grief, which is “mourning”

Any time an individual experiences a major life change that evokes feelings of loss, they experience grief. While many individuals will attempt to disregard or silver-line those feelings in order to “feel better,” the grief can remain for those who haven’t actively mourned their loss.

Participating in the practice of mourning is essential to processing grief. This can look vastly different from person to person and situation to situation. Ways in which one mourns loss may include:

• Crying
• Talking about the loss with a trusted friend
• Writing about the loss in a journal
• Looking through photographs or letters
• Returning to physical spaces that evoke memories and emotions

This process can often be overlooked by grievers for many reasons, including lack of time or patience with the process, or the belief that their grief is not valid enough for mourning.

Working grief into assessments

For clinicians, assessing for grief when building new client relationships can create a space of deeper understanding about a client’s lived experience, weaving together two deeply related concepts of grief and mental health. This intermixing allows providers to first consider a client’s experience from the grief perspective of “what has been lost” and, in essence, what needs to be grieved.

One helpful tool is a Grief Recovery Timeline, which allows an individual to review their life through a timeline of meaningful gains and losses, showing a visual representation of loss and impact. This practice expands the individual’s understanding of what losses they have experienced, as well as the quantity of losses experienced, which can provide some insight into their journey thus far.

Supporting your patients in grief

Supporting a client in grief requires simple yet essential skills: compassionate curiosity and sitting with grief.

Compassionate curiosity is the practice of asking questions related to the client’s story in a way that allows them to process their experience, rather than actually describing the experience to the clinician for answers and perspective. When compassionate curiosity is working in tandem with reflective listening and appropriate use of silence, a client pulls themselves deeper and deeper into their story, often coming to new realizations throughout the conversation.

As we break down major life events, we see a clear line to loss: loss of security, safety or plans for the future. Like all grief experiences, these losses require that attention be paid in order to process and integrate the loss into the individual’s story.

Individuals experiencing grief, whether they realize it or not, want to be validated in their feelings and understood deeply by someone else. Through this lens, rather than guiding the work, a clinician transitions to a companion along their grief journey, allowing the client to lead where they need to go. The practice of companioning in grief can be equated to walking alongside, engaging in compassionate curiosity as the client answers your questions and processes through their story.

Sitting with grief can feel uncomfortable for many. Basic nature bids us to rush to a solution or silver lining, and further, as mental health professionals, we are also compelled by training to create goals and pillars to determine progress. However, rushing to solutions and action can create feelings of inadequacy in patients when the solution presented doesn’t feel as simple to them. When we sit with grief, we allow for feelings to be validated and deeper processing to occur.

By broadening our definition of grief and loss, we can better understand how both impact us each day and support our patients who are navigating grief and loss along their mental health journey.

Here are some helpful resources for you and your patients.

For clinicians:

• Death & Grief Studies Certification - Center for Loss & Life Transition
• Grief Counseling Certification - American Academy Grief Counseling
• Grief Counseling and Grief Therapy, Fifth Edition: A Handbook for the Mental Health Practitioner

For grievers: 

• Mental Note: Healing Through Grief and Loss (podcast)
• It's OK That You're Not OK: Meeting Grief and Loss in a Culture That Doesn't Understand (book)
• Writing Your Grief: The 30 Day E-Course
• What’s Your Grief: A Grief Website for the Rest of Us