Bereavement is a normal process that occurs in response to significant loss, commonly the loss of a loved person. Occasionally this normal process can become ‘stuck’ and a psychological therapy can be helpful to resolve the difficulty and allow the bereaved person to resume and complete the normal mourning process.
Common stages of psychological reactions to loss include:-
– at first shock that the loss has occurred. This can include various degrees of psychological denial, commonly in the form of repetitive thoughts of “I can’t believe it” or “it cannot be true”.
– then the reality of the loss begins to dawn and intense sorrow and pain is often felt.
– the wish to see or hear the lost person can be intense too, and fleeting hallucinations are common and normal in the early stages of bereavement, for example, catching a fleeting glimpse of the person out of the corner of one’s eye at home when there is no-one there, or hearing the person call you.
– the next phase can last a long time, usually some months, and consists of gradually learning in many, many, small everyday ways that the person is gone and will not be returning, and that life (and sometimes oneself) will change as a result. This often takes the form of coming across many small reminders of the person in everyday life – waking up to silence instead of the sound of someone else breathing; automatically laying a place at table for the lost person; smelling their favourite scent when out on the street, etc, etc. At first there are many of these instances, but as each one is come across they tend not to be so surprising or so painful when come across again, and so gradually, bit by bit, the pain of the loss reduces. A lot of emotional energy is taken up dealing with these numerous painful reminders and so at first the bereaved person’s emotional life seems to be entirely taken up with the bereavement. As the reminders and the pain associated with them decreases however, the bereaved person usually finds that more of their emotional energy is gradually freed, and becomes available to re-invest in both past pleasures and, often, new ones. Most people begin to feel better within about six months, and feel considerably better by a year after the loss.
When the process of bereavement becomes ‘stuck’, it is sometimes because the bereaved person finds it too painful to face the loss and prolongs the denial stage, refusing to believe that the loss has occurred. Sometimes it is because the person avoids reminders of the loss, and thus avoids opportunities to accept and work through the loss; both of these latter examples may be because the loss seems just too painful to feel. Sometimes it is because the person continually revisits or recreates reminders of the person, unable to ‘let those reminders go’, and in effect continually re-traumatises themselves; this example may be due to an underlying belief that to do anything else would be somehow disloyal or would be the same as forgetting the lost person. These examples of why the mourning process sometimes gets stuck are not exhaustive, but may be the sort of thing that come to light during a psychological therapy.
CBT is not particularly indicated for people who have experienced a recent bereavement – for this I would advise finding a bereavement counsellor. However, there is a good evidence base for CBT in helping people with what is called Prolonged Grief, or what we might think of as ‘stuck’ grief.