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A grief ther­a­pist shares the strate­gies she has learnt in help­ing clients cope with be­reave­ment

Be­reave­ment is one of the few things in life that is guar­an­teed – and yet it is also one of the least un­der­stood. Grief psy­chother­a­pist Ju­lia Sa­muel ex­plains how build­ing ‘pil­lars of strength’ – strate­gies that sup­port us and, cru­cially, en­able us to keep go­ing – will help us live with and learn from los­ing a loved one

Ev­ery day thou­sands of peo­ple die, ex­pect­edly and un­ex­pect­edly; around 500,000 deaths a year oc­cur in Eng­land and Wales. On av­er­age ev­ery death af­fects at least five peo­ple, which means that mil­lions of peo­ple will be hit by the shock of the news. They will for­ever re­mem­ber where they were when they heard that their par­ent, si­b­ling or child was dy­ing or had died. It will im­pact ev­ery as­pect of their world for the rest of their lives and ul­ti­mately al­ter their re­la­tion­ships with them­selves.

Death is the great ex­poser: it forces hid­den fault lines and sub­merged se­crets into the open, and re­veals to us how cru­cial those clos­est to us have been. Love from oth­ers is key to help­ing us to sur­vive the love we have lost. With their sup­port, we can en­deav­our to find a way to bear the pain of go­ing on without the per­son who has died – dar­ing to trust in life again.

In my pro­fes­sion there is a wealth of well-re­searched prac­ti­cal strate­gies as well as psy­cho­log­i­cal un­der­stand­ing, which are es­sen­tial for any­one who is griev­ing. I want peo­ple to un­der­stand that grief is a process that has to be worked through – and ex­pe­ri­ence has taught me that grief is work. Hard work. But if we do the work, it can en­able us to heal.

Grief doesn’t hit us in tidy phases and stages, nor is it some­thing we for­get and move on from. The work in­volves find­ing ways of cop­ing with our fear and pain, and ad­just­ing to the ‘new nor­mal’. That most peo­ple can some­how find a way to bear the un­bear­able says much about our ex­tra­or­di­nary ca­pac­ity to evolve as we work to­wards re­build­ing our lives. THE PARA­DOX OF GRIEF is that find­ing a way to live with the pain is what en­ables us to heal. Cop­ing with grief means en­dur­ing the pain as it hits (this of­ten feels like a storm crash­ing over us) and then hav­ing a break from it through dis­trac­tion, busy­ness and do­ing things that com­fort and soothe us. Ev­ery time we al­ter­nate be­tween these two poles, we ad­just in­cre­men­tally to the re­al­ity that we don’t want to face: that the per­son we love has died. It is of­ten the be­hav­iours we use to avoid pain that harm us the most. Talk­ing to a friend when some­thing trou­bles us is a (con­tin­ues p76)

Death steals the fu­ture we hoped for, but it can’t take away the re­la­tion­ship we had

pos­i­tive be­hav­iour; numb­ing our pain with al­co­hol a neg­a­tive one. The task of the be­reaved is to dif­fer­en­ti­ate be­tween them while at the same time learning new be­hav­iours that sup­port our ca­pac­ity to heal and ex­press pain.

The per­son who has died feels alive to us,

even though we know that they are dead. We en­vis­age their body as if they were alive. We won­der if they are lonely, cold or fright­ened. We speak to them in our minds and ask them to guide us in the big and lit­tle de­ci­sions in our lives. We look for them in the street, con­nect to them through lis­ten­ing to the mu­sic they loved or by smelling their clothes. We may have a sense of an on­go­ing re­la­tion­ship, while know­ing that noth­ing will move for­ward again. When this is un­ac­knowl­edged or even de­nied, our minds may be­come dis­or­dered or un­bal­anced; but when this is un­der­stood, our over­whelm­ing feel­ing will be one of re­lief.

Al­ter­nat­ing ‘let­ting go’ with ‘hold­ing on’ is some­thing we need to learn to live with. Rit­u­als such as the funeral or visit­ing the grave give a shape to the let­ting go; the ac­knowl­edg­ment that this per­son has died and is no longer phys­i­cally present. Peo­ple then as­sume they must en­tirely for­get their loved one and sub­se­quently suf­fer guilt for aban­don­ing them, but the re­la­tion­ship does con­tinue, although in a rad­i­cally dif­fer­ent form.

Death steals the fu­ture we an­tic­i­pated and hoped for, but it can’t take away the

re­la­tion­ship we had. The con­nec­tion to the dead is main­tained through our me­mories, which are prob­a­bly the most pre­cious gift we will ever pos­sess. They be­come part of us, our guides as we carry on with our lives.

We may want to be happy again, know­ing it is right and fair, but feel guilty be­cause

some­how it feels wrong. There is of­ten conflict be­tween our head and our heart: our head knows it was, for ex­am­ple, a ter­ri­ble ac­ci­dent, but in our heart we feel as if we have done some­thing wrong. These po­lar op­po­sites need to find a place where they can sit side by side. Un­der­stand­ing that we need to hold both con­cepts in­side us can be lib­er­at­ing.

So­ci­ety ap­proves if the be­reaved is brave and get­ting on with things. Para­dox­i­cally, the grief that should cause con­cern is one that has been cut short, for ex­am­ple by self-med­i­cat­ing. As a so­ci­ety we need to learn to sup­port a healthy griev­ing and to help peo­ple un­der­stand that each per­son goes at their own pace.

Our cul­ture is im­bued with the be­lief that we can fix just about any­thing and make it bet­ter. Or, if we can’t, that it’s pos­si­ble to trash what you have and start all over again. Grief is the op­po­site of this be­lief: it re­quires en­durance, not avoid­ance, and forces us to ac­cept that there are some things in this world that can­not be fixed.

There is of­ten conflict be­tween our head and our heart: these op­po­sites need to find a place where they can sit side by side

WHEN A PART­NER DIES Few events are as painful, for it is the death of the dream of an imag­ined fu­ture, as well as the cou­ple’s cur­rent life to­gether. It is the end of a mu­tual set of cir­cum­stances: com­pan­ion­ship, sta­tus and of­ten fi­nan­cial se­cu­rity may all be af­fected by un­wanted change. It is an un­com­fort­able fact that one study found the re­cently be­reaved are six times more likely to suf­fer heart dis­ease than the na­tional av­er­age, which gives cre­dence to the con­cept of be­ing ‘bro­ken-hearted’. An­other re­vealed that sur­viv­ing part­ners are 66 per cent more likely to die within the first three months af­ter their part­ner’s death. WHEN A PAR­ENT DIES Usu­ally the first faces our eyes lock on to when we’re born are those of our par­ents; the first hands to hold are theirs. Ev­ery re­la­tion­ship we have is, in some way, re­lated to the foun­da­tions that be­gan with our par­ents.

When a par­ent dies, the in­ten­sity of what we feel will de­pend on the re­la­tion­ship we had. We may feel that the per­son who loved us most in the world has died, leav­ing us ut­terly dev­as­tated. Or we may be re­lieved that it is the end of a re­la­tion­ship that has al­ways been dis­ap­point­ing or hurt­ful. We may have com­plex feel­ings of love and hate, re­lief and guilt. Un­doubt­edly it puts us in touch with our own mor­tal­ity be­cause we are of­ten the next in line to die. WHEN A SI­B­LING DIES The ideal si­b­ling re­la­tion­ship gives you your ‘team’, the peo­ple who are on your side through thick and thin for the rest of your life. The power of the si­b­ling bond can over­come years of non-com­mu­ni­ca­tion. Brothers and sis­ters are for­ever con­nected through shared ge­net­ics, his­tory, se­crets, me­mories and lan­guage.

While few adult sib­lings are com­pletely es­tranged, around one third de­scribe their re­la­tion­ship as dis­tant or ri­val­rous. This does not make the death of a si­b­ling less dif­fi­cult, it sim­ply adds a layer of com­plex­ity: the loss of an op­por­tu­nity to re­pair what has been bro­ken and re­gret for the ac­tions of the past tend to bring with them their own at­ten­dant pain.

WHEN A CHILD DIES There is al­most noth­ing more trau­matic than the death of a child. It tears up the rule book of life: our chil­dren should bury us, not the other way round. The death of a child leaves a fath­om­less hole and, of all the losses, it takes par­ents who have lost a child the longest to re­build their lives.

I urge cou­ples, if they feel the need to see a ther­a­pist, to do so to­gether. It is a loss that shakes the re­la­tion­ship and family sys­tem to the core, and it is hard to re­cover from without the par­tic­i­pa­tion of both par­ents in counselling. As many par­ents have said to me, hav­ing a child die makes you a mem­ber of a club that no one wants to be a mem­ber of and leaves many fam­i­lies with a sense that they are now out­siders. In ad­di­tion, many feel that they have been sin­gled out to have this ter­ri­ble thing hap­pen to them.

If cou­ples can find ways of com­mu­ni­cat­ing with each other, they can be­come closer through their loss, as they are the only two peo­ple in the world who un­der­stand how the other feels. How­ever, re­search shows that cou­ples who al­ready have dif­fi­cul­ties in their re­la­tion­ship and who don’t seek sup­port are more likely to sep­a­rate fol­low­ing the death of a child. FAC­ING YOUR OWN DEATH When the even­tu­al­ity of death has been ac­cepted and the fo­cus is no longer on fight­ing for life but on find­ing a way to ac­cept the lim­ited fu­ture we may have, there can be a good death. If we choose to be­lieve some­thing that gives us com­fort in life and in the face of death, we are likely to suf­fer less. If we have cho­sen to talk to the peo­ple around us about our dy­ing, they will suf­fer less, too. No­body can ever know what the dy­ing per­son’s ex­pe­ri­ence is like, but we do know that be­ing present or ab­sent at the death of some­one we love stays with the peo­ple who love them for ever. A death where ev­ery­one is aligned in their feel­ings and think­ing is eas­ier.

We all want to die pain­lessly, peace­fully and with dig­nity, and we want to be with the peo­ple who love us, in a place where we feel safe. We can’t con­trol the out­come, but we can en­sure we use all the means of sup­port to make it as tol­er­a­ble as pos­si­ble.

Be­ing present or ab­sent at the death of some­one we love stays with us for ever

JU­LIA SA­MUEL, 57, MBE, is a grief psy­chother­a­pist who has spent 25 years work­ing with the be­reaved both in pri­vate prac­tice and the NHS at St Mary’s, Padding­ton.

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