Counseling

Strategies
for
Loss and
Grief
Keren M. Humphrey

AMERICAN COUNSELING
ASSOCIATION
5999 Stevenson Avenue
Alexandria, VA 22304
www.counseling.org
 Counseling
Strategies
for
Loss and
Grief
Copyright © 2009 by the American Counseling Association. All rights reserved. Printed in the
United States of America. Except as permitted under the United States Copyright Act of 1976,
no part of this publication may be reproduced or distributed in any form or by any means, or
stored in a database or retrieval system, without the written permission of the publisher.

10  9  8  7  6  5  4  3  2  1

American Counseling Association

5999 Stevenson Avenue
Alexandria, VA 22304

Director of Publications
Carolyn C. Baker

Production Manager
Bonny E. Gaston

Editorial Assistant
Catherine A. Brumley

Copy Editor
Elaine Dunn

Cover and Text Design by Bonny E. Gaston.

Library of Congress Cataloging-in-Publication Data

Humphrey, Keren M.
  Counseling strategies for loss and grief/Keren M. Humphrey.
   p.  cm.
  Includes bibliographical references and index.
  ISBN 978-1-55620-246-9 (alk. paper)
1.  Loss (Psychology)  2.  Grief.  3.  Counseling.  I.  Title.
  BF575.D35H86 2009
  158' .3—dc22 2008041860
 Dedication

This book is dedicated to the women who shaped me with their presence:
my mother, Amy Riser Harrington Humphrey,
and my maternal grandmother, Elberta Riser Harrington.
And to the woman who shaped me with her absence,
my paternal grandmother, Lela Marie Beller Humphrey.

iii
 Table of Contents

Preface ix
Acknowledgments xiii
About the Author xv

Part 1  Unique Grief and Unique Grievers

Chapter 1 • Thinking Differently About Loss and Grief
in the 21st Century 3
Loss and Grief Terminology 5
Changing Ideas About Loss and Grief 6
Nine Critical Guidelines for Conceptualizing
  Loss and Grief 7

Chapter 2 • Listening To and Listening For Loss and Grief 19

Types of Loss and Grief 20
Selected Psychosocial Factors 25
Listening for Clues to Loss and Grief
  in Psychotherapy 32
Diagnosing Uncomplicated and Complicated
  Bereavement Grief 33

Chapter 3 • Two Contemporary Models of Loss Adaptation 37

Adaptive Grieving Styles 37
The Dual Process Model 47
Differential Grief in Families 51

Part 2 Counseling Strategies for Loss Adaptation

Chapter 4 • Cognitive–Behavioral and Constructivist Strategies
for Loss Adaptation 57
Cognitive–Behavioral Strategies for Loss Adaptation 57
Constructivist Strategies for Loss Adaptation 62


Table of Contents

Managing Repetitive Thoughts and Ruminative Coping:

Three Strategies 63
Rational Emotive Imagery for Avoidance 64
Telling and Retelling the Story of Obscured Loss 67
Responsibility Pies and Defense Attorneys Meet
Shame and Guilt 71
Loss Experiences Timeline 73
Systemic and Thematic Genograms With Loss and Grief 76
Early Recollections 83
Objects of Connection 85
Therapeutic Grief Rituals 89
Therapeutic Writing for Loss: Giving Sorrow Words 94
Cinematherapy With Loss and Grief 102
Prescription to Grieve 106
Decisional Balance and the Possibility of Change 109
Confronting Secondary Gain 112
Creating a Resilient Image 114
The 2 Questions 116
Breathing Lessons 116
Mindfulness-Based Practices to Manage Distress 118
Using Ecotherapy Strategies for Loss and Grief 124
Client Drawings in Grief Counseling 127
Client-Generated Metaphors 130
Wisdom Chronicles 135
Brief Homework Assignments to Promote Change 138
Shared Reminiscence 140
Loss Characterization to Address Fragmented Identity 141
Using Photographs to Facilitate Meaning Reconstruction 142

Chapter 5 • Emotion-Focused Strategies for Loss Adaptation 147

Respecting Client Differences in Emotional Processing 147
Create a Holding Environment for Difficult Emotions 148
Emotional Processing Challenges in Loss Adaptation 149
General Guidelines for Emotional Processing With
Loss Adaptation 152
Using a Feelings List for Grief Experiences 156
Chair Dialogues 157
Focusing: Moving Deeper With Feelings to Awareness 166
Mapping Loss and Grief: Focus on Feelings 171
How My Dark Emotions Have Made Me Strong 171

Chapter 6 • Narrative Therapy Strategies for Loss Adaptation 175

Narrative Therapy Terminology 176
Basic Assumptions of Narrative Therapy 176
Narrative Style Questioning and Externalizing
Conversation 178
Implementation of Narrative Practices 179

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 Table of Contents

Chapter 7 • Solution-Focused Therapy Strategies for

Loss Adaptation 195
Basic Assumptions of Solution-Focused Therapy 195
Implementation of Solution-Focused Therapy 196

Chapter 8 • Adjunctive Strategies for Loss Adaptation 205

Client Self-Care 205
Therapeutic Massage 206
Labyrinth Walking 206
The Nature Cure 208
Tai Chi and Yoga 208
Creative Activities 209
Mindfulness Meditation 210
Grief Support Groups 210

Chapter 9 • The Counseling Professional Working

With Loss and Grief 213
Three Essential Counselor Roles 213
Practical Suggestions for Counseling Professionals 215
The Person of the Counseling Professional:
Know Thyself 218

References 221
Index 237

vii
 Preface

For years my professional colleagues and I have discussed the need for a book of counseling
interventions to supplement the theoretical literature on loss and grief. The vast majority of this
literature centers on theoretical conceptualizations of bereavement grief and research on distinct
topics (e.g., complicated grief, AIDS-related grief ) or the characteristics of distinct populations
(e.g., bereaved parents, the chronically ill). Although this knowledge base is essential to our
understanding of loss and grief, the literature tends to falls short in consideration of the technical
aspects of intervention. Most often authors suggest a direction for therapy, such as examining
unfinished business or facilitating emotional expression, but the nuts-and-bolts descriptions of
what to actually do with clients in therapy are often disappointingly vague or entirely absent. It
is the old challenge of translating theory into practice, and it is the reason for this book.
The purpose of Counseling Strategies for Loss and Grief is to describe a range of counseling
strategies appropriate to the treatment of loss and grief issues in diverse psychotherapy settings.
It is based on contemporary understandings on the nature of personal and interpersonal loss and
the ways in which people attempt to integrate loss and grief into their lives. The suggested
strategies incorporate constructs and procedures from a wide variety of sources, reflecting both
time-tested counseling strategies and more recent innovations in counseling theory and practice.
Five themes guide this text.

1. Loss and grief are frequently encountered issues in psychotherapy that are inclusive of
both death-related and nondeath-related circumstances. Despite substantial attention
given to bereavement grief, nondeath-related losses just as often present significant
challenges in the lives of clients. “All changes involve loss, just as all losses require
change” (R. A. Neimeyer, 2000a, p. 5).
2. The experience of loss and grief is highly individual and intensely personal, reflecting a
unique interaction of person, loss event, and the multiple contexts in which that loss and
grief occur.
3. The boundary between death-related and nondeath-related loss is permeable so that
knowledge associated with each assists understanding of the other. Differences between
the two have less to do with the fact of death and bereavement and more to do with the
uniqueness of an individual’s response to loss and his or her particular grieving journey.
4. The natural extension of appreciating the uniqueness of each person’s experience of loss
and grief and her or his particular manner of adapting to loss is the importance of tailoring
counseling strategies to client needs. If the experience of loss and grief is unique, then
counseling interventions that address those experiences must prioritize that uniqueness.

ix
Preface

5. It is assumed that counseling professionals regard the strategies described here, like any
therapeutic intervention, as inherently adaptable. Sound theoretical conceptualization
and a solid working relationship precede selection of interventions, which are then
customized to fit the unique needs of clients and the evolving counseling process.

Perhaps it is useful here to point out what this book does not attempt to do. It is not intended
as a comprehensive treatment manual in which a set of prescribed interventions from a
standardized theory are applied invariably to every client, family, or group. There is no laundry
list of goals and objectives from which to pick and choose and no stereotypical list of cultural
characteristics that obscures individuality. Instead, this book describes a broad range of counseling
strategies that are adaptable across various theoretical orientations and includes practical
suggestions for increasing their effectiveness.

Whom This Book Is For

Counseling Strategies for Loss and Grief is intended primarily for counseling professionals and
clinical supervisors working in diverse psychotherapy settings. It also provides a valuable, practical
resource for graduate trainees in counseling and counseling-related professions, where issues of
loss and grief are inadequately addressed (Humphrey, 1993). The counseling strategies outlined
here are most appropriate for adolescents and adults and are primarily aimed at individual
therapy situations. However, suggestions for using these strategies in group and family therapy
settings are provided. Additional resource recommendations specific to certain topics are also
included throughout the text.

Terminology in This Book

Sometimes the terminology associated with professional psychotherapy services can be confusing,
so the following clarifications apply in this text:

• Counseling and therapy refer to psychotherapeutic intervention services provided by

qualified mental health professionals. No distinction is made in this text between
counseling and therapy as long as services are delivered by a qualified mental health
professional.
• A qualified mental health professional possesses at least a master’s degree in counseling or a
counseling-related field (e.g., psychology, social work) and national certification or state
licensure. Counseling professional, therapist, counselor, and psychotherapist are
interchangeable terms describing qualified mental health professionals.
• Grief counseling and grief therapy refer to psychotherapeutic interventions involving both
death-related and nondeath-related grief.
• Strategies is the preferred term for counseling interventions described in this book. The
word techniques implies something done to clients by counselors without input from
clients, whereas strategies suggests a more respectful and collaborative therapeutic activity,
tailored to the uniqueness of clients, that is consistent with effective counseling for loss
and grief.


 Preface

Organization of the Book

Counseling Strategies for Loss and Grief includes two parts. Part 1, Unique Grief and Unique
Grievers, orients readers to current thinking about loss and grief and the implications for
professional counseling practice. Chapter 1 summarizes the shift from traditional to contemporary
grief models in the form of guidelines for conceptualizing loss and grief. Chapter 2 highlights
diverse aspects of loss and grief that merit special attention by counseling professionals. Chapter
3 outlines two contemporary grief models—adaptive grieving styles and the dual process
model—with suggestions for using these models to enhance counseling services with grieving
clients. Part 2, Counseling Strategies for Loss Adaptation, offers detailed descriptions of various
interventions appropriate in counseling for issues of loss and grief, distinguishing them by focus
or theoretical origins. Chapter 4 provides strategies that focus on cognitive and behavioral
interventions, drawing largely from cognitive–behavioral and constructivist therapy models.
Chapter 5 provides strategies that focus primarily on emotional processing. Chapters 6 and 7
offer strategies derived from two contemporary therapies arising from postmodern and
constructivist thinking: narrative therapy and solution-focused therapy. Chapter 8 describes a
number of recommended adjunctive activities that are especially beneficial to grieving clients,
their adaptation to loss, and the counseling process. Finally, Chapter 9 addresses the challenges
of working with loss and grief for the counselor as a person and a professional.

xi
 Acknowledgments

It has been my good fortune to work directly or indirectly with grieving people in a variety of
settings over several careers. I remain in awe of those individuals and families who willingly
shared their dying and their grief with me so many years ago in my first career as a parish minister.
This book began with you.
I am deeply grateful for the clients, supervisees, and students who have taught me so much
about doing and teaching psychotherapy. You convinced me this book was necessary.
I thank my friends and professional colleagues for their contributions and encouragement,
especially Cathie Barrett, Don Combs, Deb Davis, Liz Doughty, Phyllis Erdman, Sue Metzger,
Jan Pattis, and Linda Osborne.
I acknowledge my American Counseling Association editor, Carolyn Baker, whose patience,
good humor, and professionalism are deeply appreciated.
My family is always a reliable source of support, especially my stepchildren Patti and Mike,
who must have wondered if that darn book would ever be done.
I acknowledge my writing partner, Chief the Black Lab, the ultimate practitioner of mindful
attention, who reminds me that long hours at the computer must be balanced with regular
Frisbee and cookie breaks.
Finally, I express my deepest thanks to my husband, Jim, whose sustaining love and unwavering
support for my endeavors so brighten and bless my life. Our life together is a wonderful
adventure.

xiii
 About the Author

Keren M. Humphrey, EdD, NCC, LPC, LCPC, has more than 25 years experience in
the helping professions as a parish minister, probation officer, professional counselor, and
counselor educator. In addition to a private psychotherapy practice, Dr. Humphrey has
provided counseling, supervision, and consultation services in the corrections field and on
college campuses. A popular national and international presenter on grief counseling and
counselor preparation, Dr. Humphrey is also the author of numerous journal articles, coauthor
of Problem Solving Technique in Counseling (CD-ROM), and coauthor with Deborah Davis of
College Counseling: Issues and Strategies for a New Millennium. She has held various leadership
positions in the American College Counseling Association and has been a representative to
the Governing Council of the American Counseling Association. She is the recipient of the
Outstanding Professional Leadership Award and the Award for Dedicated and Outstanding
Service from the American College Counseling Association. Recently retired after nearly 20
years as a counseling professor at Western Illinois University and Texas A&M University–
Commerce, Dr. Humphrey is the CEO of 4 Directions Consulting, Rockwall, Texas.

xv