The most well-meaning person may still occasionally find themselves saying “time heals all wounds” or “it was meant to be.” As mental health counselors, we need to hold ourselves to a higher standard. We must recognize the grief that accompanies life, and hold space as clients experience the various dimensions of grief, allowing them to find their way through.
A platitude is a trite statement meant to assuage emotional discomfort. You might be surprised at the number of clients I have heard whose counselors offer platitudes when a client is grief stricken about a significant. “Things will look better tomorrow.” “He’s in a better place.” In our culture, we may be trained to offer these cliches to alleviate another person's discomfort, but as counselors, we must make space for difficult feelings. People need time and space to enter into the process of grief, and we need to learn to manage our own discomfort so we do not interfere with the client process.
Grieving can be triggered by numerous life events. In my work with people managing persistent pain, I find people wrestling with thoughts like “if only I hadn’t moved that shelf” or “If I could go back, I would have stopped for one more second at the stop sign.” As counselors, we may notice these as thoughts of the past, and challenge people to utilize the skills of mindfulness or CBT to bring their awareness into the present. While this is an important and noble goal, we must not rush too quickly past the grieving. We can help people get into their lived experience of this bargaining. “Where do you feel it in your body when you think about not moving the shelf? What happens to your breath? What do you notice in your hands, shoulders, back?” Often people will talk about loss of time at work or being unable to play with children. These losses must be mourned.
I sometimes meet with people who are incredibly angry. They are angry at their family, their job, their insurance, their doctor, the medical system, and, inevitably, me. An angry person may be grieving a significant loss that they are not yet ready to accept. As counselors, our job is to help people get in touch with their anger, validate the emotion, examine the behaviors, and figure out how to let this emotion move through them. There can be a temptation to focus on the behavior instead of the feeling of anger, because we were not all equipped to deal with anger in the therapy office. There are obvious limits; threats or self harm are clear boundaries. But how validating can it be for a client to yell, shake their fist at the sky, and let out the anger that everyone has been scared to sit with? Slowly, if we can validate and build rapport, we can learn what role the anger serves, and help clients discover skills for recognizing, using, and releasing anger that no longer serves its original purpose.
More than anger, deep sadness and guilt often permeate the life of a person managing persistent pain. When they discuss this with their doctor, the diagnosis is often depression and medication is prescribed. People whisper “the medication doesn’t work.” Too often, it is not a chemical depression but a reexamination of life that is triggering this sadness and guilt.
Sometimes medication can help lift spirits enough to re engage people, and sometimes no amount of chemicals can touch the hopelessness. In this situation, we follow our clients down the proverbial rabbit hole. Resisting the temptation to tell them we understand how they feel, that we have had pain too, or that life is about making lemonade out of lemons, we must hold the space for them to cry, to feel deep guilt about the changes that may happen due to this medical condition, and to face the hopeless future. As we stare into the bleak darkness with our clients, the light of connection is born. On their own, they will find their deepest values, and realize that this sadness has served its role. Together we will discover ways clients can pursue a meaningful life, perhaps completely different than the one they had planned, but a life that honors their goals and values.
If, as counselors, we recognize and sit with the discomfort of grief, we are also role modeling how our clients can manage when the waves of grief return unexpectedly. Our clients will have learned that fighting means getting stuck, and feeling allows moving forward. And for goodness sake, please don’t tell them that “God never gives us more than we can handle.” Let their loved ones share cliches, while you lead them on the true path to acceptance.
Kris Fant, LPC, LMHCis a mental health counselor at Progressive Rehabilitation Associates, working with peoplewho are managing persistent pain or traumatic brain injuries. When she is out of the office, she dual sports her way into the woods on two wheels to reconnect with nature and herself.