Most of the support that people receive after a loss comes from friends and family. Doctors and nurses may also be a source of support. For people who experience difficulty in coping with their loss, grief counseling or grief therapy may be necessary.

Grief counseling helps mourners with normal grief reactions work through the tasks of grieving. Grief counseling can be provided by professionally trained people, or in self-help groups where bereaved people help other bereaved people. All of these services may be available in individual or group settings.

The goals of grief counseling include:

• Helping the bereaved to accept the loss by helping him or her to talk about the loss.
• Helping the bereaved to identify and express feelings related to the loss (for example, anger, guilt, anxiety, helplessness, and sadness).
• Helping the bereaved to live without the person who died and to make decisions alone.
• Helping the bereaved to separate emotionally from the person who died and to begin new relationships.
• Providing support and time to focus on grieving at important times such as birthdays and anniversaries.
• Describing normal grieving and the differences in grieving among individuals.
• Providing continuous support.
• Helping the bereaved to understand his or her methods of coping.
• Identifying coping problems the bereaved may have and making recommendations for professional grief therapy.

Grief therapy is used with people who have more serious grief reactions. The goal of grief therapy is to identify and solve problems the mourner may have in separating from the person who died. When separation difficulties occur, they may appear as physical or behavior problems, delayed or extreme mourning, conflicted or extended grief, or unexpected mourning (although this is seldom present with cancer deaths).

Grief therapy may be available as individual or group therapy. A contract is set up with the individual that establishes the time limit of the therapy, the fees, the goals, and the focus of the therapy.

In grief therapy, the mourner talks about the deceased and tries to recognize whether he or she is experiencing an expected amount of emotion about the death. Grief therapy may allow the mourner to see that anger, guilt, or other negative or uncomfortable feelings can exist at the same time as more positive feelings about the person who died.

Human beings tend to make strong bonds of affection or attachment with others. When these bonds are broken, as in death, a strong emotional reaction occurs. After a loss occurs, a person must accomplish certain tasks to complete the process of grief. These basic tasks of mourning include accepting that the loss happened, living with and feeling the physical and emotional pain of grief, adjusting to life without the loved one, and emotionally separating from the loved one and going on with life without him or her. It is important that these tasks are completed before mourning can end.

In grief therapy, 6 tasks may be used to help a mourner work through grief:

1. Develop the ability to experience, express, and adjust to painful grief-related changes.
2. Find effective ways to cope with painful changes.
3. Establish a continuing relationship with the person who died.
4. Stay healthy and keep functioning.
5. Re-establish relationships and understand that others may have difficulty empathizing with the grief they experience.
6. Develop a healthy image of oneself and the world.

Complications in grief may come about due to uncompleted grief from earlier losses. The grief for these earlier losses must be managed in order to handle the current grief. Grief therapy includes dealing with the blockages to the mourning process, identifying unfinished business with the deceased, and identifying other losses that result from the death. The bereaved is helped to see that the loss is final and to picture life after the grief period.

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