Normal and Natural Process

Grief is a normal and natural process that takes work to get through. It is not easy to let go of close relationships that have existed in our lives. Dealing with the emotions that occur in the grieving process takes much time and energy, and is usually both physically and emotionally demanding. It is normal for people to grieve in very different ways. Some people grieve openly, while others hide their feelings of distress. Some people grieve quickly, while others take a long time to "finish." There is no "right way" to grieve. Each individual comes up with a method of grieving that fits them and their particular loss.

There are a number of conditions that can make it harder for a person to successfully make it through the grief process. For example, sudden losses are harder to deal with than ones that have been anticipated. With anticipated losses, the knowledge that a loss will occur allows people to prepare, both by feeling grief before the fact of the loss and by planning ways to minimise the negative impact of the loss when it does occur.

The loss of a spouse, lover, child, parent, or best friend is usually more deeply felt than the loss of more distant relations and friends. This is because such central relationships have long and deeply felt histories and an intensity of attachment that does not occur with more distant relationships. Central relationships are more deeply and significantly intertwined into the grieving person's sense of self, and thus leave a bigger hole in the grieving person's sense of self when they are lost.

The amount of support a grieving person can draw upon is critical to how successfully he or she will cope with grief. The more that friends, family and community are present and supportive, and the more that the grieving person is able to accept offered support, the better the outcome tends to be. Isolated people tend to have a harder time.

The "fairness" of the loss is also important. Losses that challenge a grieving person's ability to believe that the world is predictable are harder to manage. It is easier to accept the loss of an aged parent who has lived a full life than it is to accept the loss of a child. Death by disease tends to be easier to accept than death by a random, senseless accident.

Stage Models: Horowitz

Stages and Process of Grief

Even though everyone grieves losses in slightly different ways, there are some regular patterns or stages of grieving that people usually experience. These patterns describe the emotions and mental processes that may be felt at different stages of the grief process.

Horowitz’s Model of Loss/Adaptation

Psychiatrist Mardi Horowitz divides the process of normal grief into the following "stages of loss." These stages are typical, but they do not occur for everyone or always in this exact order.

Outcry. People often get upset when they first realise that they have lost someone important. They may publicly scream and yell; cry and collapse. Alternatively, they may hold their distress inside and not share it with others. Outcry feelings may be suppressed by the person who is feeling them so that the feelings are not felt too strongly, or they may spill out uncontrollably. In any event, initial outcry feelings take a lot of energy to sustain and tend to not last too long.

Denial and Intrusion. As people move past the initial outcry, they will often enter a period characterised by movement between 'denial' and 'intrusion'. This means that people will experience periods where they distract themselves so thoroughly in other activities and thoughts they don't think about the loss, and also periods where the loss is felt very strongly and acutely, perhaps even as intensely as during the initial outcry stage. It is normal for people to bounce between these opposites of engagement and disengagement. People may feel guilty when they realise they are no longer constantly feeling their loss and are able to engage in other activities and emotions, but it is a good thing that this happens. Distraction and disengagement break up the intensity of feeling characteristic of the acute pain of loss so it is more manageable and less overwhelming.

Working Through. As time goes by (days, weeks, months), the movement between denial (not thinking about or feeling the loss) and intrusion (thinking about and feeling the loss very intensely) tends to slow down and becomes less pronounced, with people spending more time not thinking about or feeling the loss, and less time being overwhelmed by it. During the working through stage, people think about and feel their loss, but also start to figure out new ways to manage without the lost relationship. Such new ways of managing might include making preparations to date again (or just starting to think about it), developing new friendships and strengthening existing ones, finding new hobbies, engaging in new projects, etc.

Completion. At some point in time (months, years), the process of grieving is completed or rather, "completed enough", so that life has started to feel normal again. While memories remain of what has been lost, the feeling attached to the loss is less painful and no longer regularly interferes with the person's life. Temporary reactivation of grief feelings may occur on anniversaries important to the lost relationship (marriage and engagement dates, etc.), but such manifestations of hurt feeling tend to be temporary in nature.

Stage Models: Kubler-Ross

Probably the most famous formulation of the stages of grief was developed by Dr. Elizabeth Kubler-Ross in her book "On Death and Dying". Dr. Kubler-Ross actually wrote about the stages that dying people tend to go through as they come to terms with the realisation that they will soon be dead. However, her stages have since been borrowed by the larger grief community as a means of describing the grief process more generally. Coming to terms with dying is certainly a loss experience and an occasion for grief, so there is merit to this borrowing and reason to become familiar with Dr. Kubler-Ross' stages. Again, not everyone will experience all of these stages, or, if all are experienced, they will not necessarily occur in this particular order.

Kubler-Ross' first stage is Denial. In this stage, grieving people are unable or unwilling to accept that the loss has taken (or will shortly take) place. It can feel as though they are experiencing a bad dream, that the loss is unreal, and they are waiting to "wake up" as though from a dream, expecting that things will be normal.

After people have passed through denial and accepted that the loss has occurred (or will shortly occur), they may begin to feel Anger at the loss and the unfairness of it. They may become angry with the person who has been lost (or is dying). Feelings of abandonment may also occur.

Next comes Bargaining. In this stage, people beg their "higher power" to undo the loss, saying things along the lines of, "I'll change if you bring her (or him) back to me". This phase usually involves promises of better behaviour or significant life change, which will be made in exchange for the reversal of the loss.

Once it becomes clear that Anger and Bargaining are not going to reverse the loss, people may then sink into a Depression stage where they confront the inevitability and reality of the loss and their own helplessness to change it. During this period, grieving people may cry, experience sleep or eating habit changes, or withdraw from other relationships and activities while they process the loss they have sustained. People may also blame themselves for having caused or in some way contributed to their loss, whether or not this is justified.

Finally (if all goes according to Dr. Kubler-Ross's plan), people enter a stage of Acceptance where they have processed their initial grief emotions, are able to accept that the loss has occurred and cannot be undone, and are once again able to plan for their futures and re-engage in daily life.

Stage Models: Rando

Therese Rando's Six R's

Researcher and Clinical Psychologist Therese Rando has also contributed a stage model of the grief process that she observed people to experience while adjusting to significant loss. She called her model the "Six R's":

Recognise the loss: First, people must experience their loss and understand that it has happened.

React: People react emotionally to their loss.

Recollect and Re-Experience: People may review memories of their lost relationship (events that occurred, places visited together, or day-to-day moments that were experienced together).

Relinquish: People begin to put their loss behind them, realising and accepting that the world has truly changed and that there is no turning back.

Readjust: People begin the process of returning to daily life and the loss starts to feel less acute and sharp.

Reinvest: Ultimately, people re-enter the world, forming new relationships and commitments. They accept the changes that have occurred and move past them.

Though different in approach and ordering of stages, each of these three models of the grief process share common similarities. They all understand grief to involve an often a painful emotional adjustment which necessarily takes time and cannot be hurried along. This much appears to be universally true, although each person's grief experience will be unique.

Symptoms of Grief

Though each person grieves in unique ways, there are common behavioural, emotional, and physical signs and symptoms that people who are grieving typically experience.

• · Physically, persons affected by grief may experience:
• · Fatigue and exhaustion alternating with periods of high alertness and energy
• · Temporary hearing loss or vision impairment (possibly associated with dissociation)
• · Difficulty sleeping
• · Disturbed appetite (either more appetite or less appetite than normal)
• · Muscle tremors
• · Chills and/or sweating
• · Difficulty breathing or rapid respiration
• · Increased heart rate or blood pressure
• · Stomach and/or intestinal problems
• · Nausea and/or dizziness
• · Mentally, persons affected by grief may experience:
• · Confusion (memory, concentration, judgement and comprehension difficulties)
• · Intrusion (unwanted thoughts, arousal, nightmares)
• · Dissociation (feeling of detachment and unreality, disorientation, denial)
• · Emotionally, persons affected by grief may experience:
• · Shock
• · Fear, anxiety or apprehension
• · Anger, irritability or agitation
• · Guilt
• · Numbness, remoteness, depression

• Coping With Your Own Grief

There are many ways that people can choose to cope with grief and loss in their lives, some constructive and some destructive. Among the more destructive coping methods are people's choice to turn to alcohol or other drugs to dull their pain and/or provide a illusory means of escape from the pressing demands of grieving. Heavy use of either drugs or alcohol may actually extend and prolong the grief period and lead to other serious problems such as substance abuse or dependence (otherwise known as addiction). Additionally, alcohol, and several other drugs and medicines including the benzodiazapines, and the barbiturates have a depressant effect on the brain that can actually lead a person towards serious depression when misused. Magnified feelings of hopelessness and even suicidal thoughts may occur in such circumstances when they otherwise would not. Mixing alcohol with these depressant drugs can be fatal. For these reasons, if alcohol and drugs are to be used at all during a time of grief, their use should be limited, or they should be used as directed by a physician.

Fortunately, there are many constructive and healthy ways to deal with grief. These can include:

Journaling – Many people find comfort in writing out their thoughts and feelings during the grieving period. Some even decide to write letters to the deceased or lost person. This can be a very good way to express feelings that people may not feel comfortable sharing with others and to avoid bottling up of emotions, which can extend the grief process or lead to other physical/emotional problems.

Talking with an Intimate – Others find that talking with a close family member or friend is beneficial and allows them to share memories about the lost relationship or emotions that they are feeling.

Getting Professional Help – Some people decide that they are not comfortable sharing their feelings with close friends and family. Alternatively, they may feel that they do not wish to burden those around them who are also suffering. In these cases, many choose to speak with a professional grief therapist.

In a typical psychotherapy intervention, the therapist will both encourage the person to share feelings and thoughts about the loss and will encourage and challenge them to do things (such as to be a part of social activities, to exercise, etc.) that will help themselves to re-engage life and get better. It can be an empowering process to speak with someone that understands the grief process and can help to normalise the emotions or reactions that are being felt.

Medication - Grief therapists and other doctors that might be consulted during times of grief may suggest that a prescription for anti-depressant or anti-anxiety medications would be helpful. When taken as directed by a doctor, such medicines can be extremely helpful for managing extreme grief symptoms (such as unremitting sadness, anxiety, or confusion, etc.). Since grief is not an illness so much as it is a life process, it is unwise to rely purely on medicines as a way to manage grief related pain. Properly used medicines can take the edge off the worst grief symptoms. They cannot speed the process of recovery and growth that must inevitably occur for grief to resolve.

Support Groups – For those that do not want to speak to an intimate friend or family member or a counsellor one-on-one, a community-based or internet-based support group is an option. Many people find it comforting to speak with others who are experiencing similar types of loss and who are at different stages of the grieving process. As is the case with individual therapy, support group support can help to normalise what grieving people are feeling.

More About Coping With Grief

Good Physical Self-Care – During the grief process, it is important to practice good physical care. This includes getting enough sleep, eating well, and exercising. All of these things will keep grieving people's bodies in good shape while they deal with emotional issues. When such self-care steps are not taken seriously, people may develop conditions (medical and otherwise) which can complicate the grief process.

Keep Active and Social (as tolerated) – Many grieving people feel the need or desire to withdraw from relationships and activities while they are grieving. However, it can actually be helpful for grieving people to stay engaged in other relationships and activities. Such activities provide important opportunities for distraction; allowing grieving people to focus on something other than their grief.

Putting Off Major Decisions – While grieving a loss, it is generally best to put off any major life decisions, as people's ability to think straight and use good judgement can become clouded by their loss. It is best to avoid making any serious decisions such as whether or not to move, change jobs, or to commit to a new relationship until grieving is over.

Be Flexible – Grieving people who are accustomed to a tightly scheduled life should instead allow themselves flexibility with their schedule and daily routine during their grieving process. While many people want to continue to act "normal" during this period and stick to their regular schedule, this is often not practical in the aftermath of a serious loss. Instead, it may be better to allow time for dealing with the loss. For example, completing household chores, such as laundry or washing dishes may be put off and not done as consistently so as to make time for talking with an intimate friend or family member or attending a counselling session. There is no need to feel guilty if things are not done to standard during a time of grief.

Read – People may find comfort in reading books about grieving, self-help, the meaning of life, and inspirational or religious/spiritual matters. Others find comfort in reading something completely unrelated to grief, such as the latest fiction novel, so as to temporarily escape from grief feelings and regain a sense of normalcy, even for a short time.

Pray - People who find comfort in prayer and religious participation should pray and participate in prescribed rituals as a means of helping themselves cope with their loss.

Plan Ahead for Anniversaries – Even after a grieving process has run its course, grief feelings can become renewed in anticipation of anniversary dates that remind people of their losses. It is helpful therefore to figure out what these anniversary dates are likely to be in advance, and to create a plan for managing them. Some people find comfort in making anniversaries into special days that commemorate the lost loved one. Others may decide that they will take the day off work and be alone to process their memories. While there might not be any way to avoid the resurgence of painful memories in the moment, a little time spent planning ahead can make those feelings easier to cope with when they do return.

Understanding When Grief is Complete

It can be difficult for someone who is grieving to know when grieving will be completed. Grief can be an extended process. It has no set timeframe for finishing. Though the passage of time provides little clue as to whether or when grieving will be done, there are several signs that indicate when people are starting to complete the process.

During the deepest stages of grief, people may feel that there is nothing to live for and that all of life is negative. Grieving people also often feel tremendous loyalty for their lost relationship and resist anything that they perceive will take them away from honouring that lost relationship. They are likely to feel very sad and lost. They are likely to be psychologically oriented towards honouring events that occurred in the past rather than events that are presently occurring, or which they might look forward to under other circumstances in the future. Important signs that grief is winding down therefore include the slow return of the ability to feel pleasure and joy again, the return of a present or future-facing orientation (e.g., looking forward to things in the future again), and the return of desire for reaching out to others and re-engaging in life.

The transition from a sad focus on the past to a re-engaged hopeful focus on the present and future does not happen all at once. Rather, it occurs in bits and pieces in a back and forth manner. Grieving people may start to feel guilty when they realise that they are not wanting to remain grieving. They may see their recovery from grief as an abandonment of their past relationship and resist this perceived abandonment. Of course, it is not disloyal or dishonourable to a lost relationship for grieving people to find new ways to feel happy again, but it can feel that way. In time the guilt feelings tend to subside too as life continues.

A final sign that grief is ending occurs when grieving people are able to think about their lost person, place or thing more as a happy past memory and less as a painful present absence. They may still feel pain at the loss, but it is not as acute as it once was.

Helping Other Adults Cope With Grief

In our relationships, we can also be called upon to support others who are grieving a loss. This can be awkward. Many people are unsure what to say or do to be helpful. They worry that they will inadvertently cause additional problems for grieving people by saying or doing the wrong thing. Grief is an individual thing; There really is no set formula for how best to be of service to grieving people. There are, fortunately, principles that can be followed that are most always appropriate.

Reaching Out – Many people are hesitant to reach out to those who are grieving and instead choose to wait for the grieving person to ask for assistance. However, the griever may be dealing with so much that he or she is unable to let others know that help is needed. He or she may be ashamed or embarrassed to not be handling everything well on his or her own. Having a family member or friend offer support or encouragement can be very welcome and much needed.

Help should be offered in the form of specific tasks that the griever might need assistance with, rather than a general "call if you need anything". Grievers are often overwhelmed and not thinking straight, and so may not be able to say what it is they need help with. Would-be helpers can be of greatest service by trying to anticipate what the grieving person needs done, and offering specifically to do those things. Offering to cook, run errands, pick up groceries, clean the house, take care of a pet, etc. are all good examples of specifically helpful things that can be offered.

Do not Minimise the Loss – Often people are unsure what to say to those who are grieving. While wanting to make the grieving person feel better, they may actually accomplish the opposite by minimising the loss, or insinuating that he or she is not behaving as others expect. Avoid using phrases like, "She led a long life and it was her time", "It was God’s plan for him to leave now", "Time heals all wounds", and "She was in such pain, it was probably for the best". These phrases attempt to offer comfort by framing the loss in the context of religion or in terms of the larger perspective. Any attempts of this nature can seem like you are minimising the fresh and overwhelming loss. Such phrases can easily come off the wrong way, leaving the grieving person angry and feeling that you are insensitive or afraid.

The best types of comments to make avoid any attempt to frame the loss, and instead, simply comment on the difficult situation, how sorry you are that the loss had to occur, and whether or not you can be of support or help to the grieving person. A heartfelt and simple, "I'm so sorry for your loss", works quite well.

Listen – Instead of trying to offer "helpful" comments that run the risk of minimising the grieving person's experience, you can offer genuine assistance by simply being present and listening to what the grieving person has to say. Many grievers simply need someone to be there to listen to them and allow them to vent their overwhelming emotions. They are likely to need to be heard and witnessed, rather than to have someone try to make them feel better.

Do not be Afraid to Mention the Lost Person, Place or Thing. Often people may fear that if they use the deceased person's name or refer to the loss, they may make the griever feel worse. However, many grievers feel better if those around them are not acting as though the person or relationship never existed and that nothing has changed. Acknowledging the loss is frequently beneficial to the grieving process. A corollary bit of advice that goes along with not being afraid to mention names, is to not baby the grieving person, but instead treat them normally. The griever needs to see that others are interacting with them as they always have and not treating them with extra-gentle "kid gloves".

Suggest Professional Help – If it becomes clear that a griever is being stuck in their grieving process, experiencing difficulty processing their loss or having troubling physical symptoms, family members or friends should suggest that the grieving person see a therapist or a medical doctor to gain assistance in dealing with their grief.

Helping Children Cope with Grief

Coping with a death or other significant loss can be difficult for the strongest of adults. It can be even more difficult and confusing for children. Here are a few ways to assist a child during grief.

Tell the Child What Has Happened. It is important to communicate openly and honestly with children about what has happened. When a death has occurred, many people try to soften the blow by using euphemistic phrases such as "He's gone to sleep" or "She's gone away". Dodging the issue in this manner, however well intentioned, can result in further confusion. For example, telling a child that a loved one has "gone away" suggests that they had a choice in the matter, and that therefore other people may abandon the child too. Alternatively, the child might think that the loved one can come back again, which can only set them up for further disappointment. Creation of mistaken impressions such as these might create unnecessary fear or confusion for the child, rather than the comfort that was intended.

Showing Some Vulnerability is Okay. It is okay for children to see that adults are suffering as well as they are, and that the loss is difficult for anyone to get through, regardless of age and experience. It is important not feel as though you must have all the answers, or present yourself as invulnerable. At the same time, it is NOT okay for adults to lay the burden of their own grief onto children's shoulders, or to ask children, either explicitly or implicitly, to assist them in coping with their own grief. Making a child into a confidant in this manner is harmful to the child, in that children are not mature enough emotionally to handle that sort of pressure. Adults should be open with children about their own sadness or pain, but not expect or communicate to children that they should do something to make things better for the adults. It can be quite difficult for grieving adults to find the right balance between sharing enough with children to help them understand what has happened, and sharing too much (which can lead to coping problems for the children).

What to Tell Children Depends on Their Age

Children are by definition immature, and have developing understandings of what it means to be dead, to lose something important to you, and how to cope with loss. Though it is important to be open and honest with children about the nature of the loss that has occurred, it is also important that the each child's developmental level be taken into account in deciding how much to say. It is not until about ages 9 to 12 that a child fully comprehends the meaning and reality of death. A very young infant may experience death as a loss but will not be able to verbalise that loss, and in any event will not understand the loss to be irreversible. Children ages 2 to 6 will be unlikely to understand the irreversible nature of death as well. They are likely to ask many questions about what has occurred, and may act out negative behaviours and possibly display fears of abandonment. Children ages 6 to 9 are generally somewhat frightened of death as they begin to understand that it is a permanent condition. However, they also express curiosity about the nature of death.

As young children are naturally self-centred, their questions and thoughts about death tend to revolve around themselves: did they somehow cause the death ("I was naughty so Daddy left".), will it happen to them? ("Will I wake up tomorrow if I go to bed tonight?"), and who is going to take care of them? ("Now that Grandma is gone, who will baby-sit when Mom and Dad are away?"). It is important to answer such questions honestly, when they arise, but also with sensitivity. Children need to know that death is permanent and is not going to change. They also need to know clearly that the death was not caused by anything they did or did not do. Finally, they need to be comforted (to the extent that they become upset by the news of the death).

Children are not always able to verbalise their thoughts about death, or know what the right questions are to ask. They may be frightened of asking questions, or of the answers, they may find out. For this reason, parents may want to step in and provide answers to some common childhood questions about death, even if the child has not asked the questions. Whether or not to offer such information is a judgement call that each parent has to make independently based on their knowledge of their child.

What a parent will have to say about death is often heavily influenced by their religious or spiritual beliefs concerning the nature of death and dying. For example, some parents will believe that heaven and hell are metaphorical or poetical concepts with no underlying reality, while others will believe that these are very literally real places that an immortal soul will take up residence in after death. Some parents will believe in the possibility of reunion with deceased relatives and loved ones in heaven, others will believe in the possibility of reincarnation, and still others will believe that no afterlife exists at all. Whatever the nature of parents' beliefs about death may be, it is important parents remember to be sensitive to their children's developmental needs as they communicate those beliefs to their children.

Explanations concerning death given to children should always be explained in an age-appropriate manner. In general, older children will want, and often can handle more of the truth than younger children. For example, given a situation where a four-year-old's grandmother has died, a parent might simply say:

"Grandma was very sick and died, so you won't get to see her again (in this life), but you know she loved you very much."

Parents may offer more details to an older child. For example, an eight-year-old who has lost his grandmother might be told the following,

"Grandma had a heart problem. She tried some medicine from her doctor, but it did not work. She really wanted to fix the problem, but it was not possible, and she has died. However, she loved all of us very much and will miss us, and though we feel the same about her, we will not get to see her again (in this life). It is very sad".

Cultural and Religious-Spiritual Implications

Different cultural, religious, and spiritual traditions offer participants in those cultures and traditions various rituals that have been developed for helping people to cope with death and the grieving process. For example, the Catholic tradition provides for a "wake", which is a visitation period during which family members and other mourners gather to view the deceased and to share memories and condolences. The Jewish tradition similarly provides for an extended period during which family members may "Sit Shiva" and invite family and friends to celebrate and mourn the deceased. Unlike a wake, however, the deceased person's body is not displayed during the shiva period.

Individual preferences also influence how funeral processions are carried out. While many organised religious practices recommend a formal funeral and burial follow initial mourning ceremonies, some people prefer to be cremated instead of buried. Other people find it helpful to make up their own personal traditions and rituals, so that they honour shared values of the lost person and the survivors. Some mourners find it comforting to go through prescribed rituals, while others may find them to feel hollow. If you find yourself in the later camp and find the idea of a formal ceremony to be less than meaningful, keep in mind that rituals are intended more for the benefit of grieving mourners considered as a group than for the deceased, or the needs of any individual mourner. It is important to think of the mourning family's needs overall needs while planning a funeral.

Grieving the death of someone close commonly raises existential questions about the meaning and nature of life and death. Death reminds all thoughtful adults of their own mortality, and the necessarily limited nature of human ambition. People seek answers for their existential questions in a variety of places depending on their backgrounds. Some find answers in scripture, dogma, or simple faith, others may turn to philosophy and other scholarly pursuits, meditation, or art, and still others will seek answers by deepening their relationships with other people and with their communities. Grief recovery is a good time to deepen existing convictions, religious or otherwise, concerning how to make the most of life. It can also a good time to explore new approaches to existential questions that have not previously been considered. Such engagement can deepen your appreciation of life, but it can also expose you to people who would take advantage of your vulnerability, including con artists, so-called gurus and false or otherwise spiritually corrupt religious leaders. Recall that your judgement tends to not be very trustworthy during times of grief, and do not make binding decisions or agreements while grieving that you cannot reverse later on.

Understanding Pathological Grief

The normal grief process can be considered a mild form of traumatic stress injury. More severe forms of traumatic stress injury are possible, and may occur. Two serious psychiatric disorders that occur in the wake of traumatic stress experiences are Acute Stress Disorder, and Post traumatic Stress Disorder (otherwise known as PTSD). Such disorders may occur after exposure to serious abuse, violent death, combat experience, rape or other life-threatening experiences, and can be disabling.

Though most grief is a mild sort of injury compared to how bad such injuries can get, some griefs are experienced as more traumatic, and can become difficult to resolve. The term "Pathological Grief" is sometimes applied to people who are unable to work through their grief despite the passage of time. It can take most people up to several years to get past a serious loss. A pathological grief reaction may be diagnosed after a long time (one or more years) have passed and the grieving person is not improving. By labelling someone's grief as pathological, a doctor is indicating that the grieving process resolution is delayed for some reason and that professional help is needed. No disrespect is intended toward the patient in using this term.

There is no absolute period within which grief is considered pathological, although there are cultural norms that serve as guidelines. A person might be judged as being "stuck" if they are still actively grieving 18 to 24 months after their loss. An unremitting 'overly intense' grief process of shorter duration might also be labelled as pathological. Keeping these guidelines in mind, know that it is very much appropriate to encourage people who appear to be stuck in their grief process to seek professional grief counselling.