Kevin M. Kozin, MTS, LICSW
By Kevin M. Kozin, MTS, LICSW
When experiencing a loss, it can seem that everyone has some sage (and often misguided) advice they are ready to give you. For example, you may hear remarkably unhelpful things like: Get over it, Move on already, Time heals all wounds. While possibly well intentioned, these words imply that a loss is something that a person “gets over.” For many losses, we do not “get over” the loss. Instead, we need to find a way adapt to the loss. We cannot “get over” things like the loss of a child or a partner, but we can find new ways of relating to that experience and adapting to the new situation.
Speaking about a loss can be difficult. Sometimes, “I’m sorry for your loss” is the best statement you can provide. When you are asked difficult questions about a serious loss, it’s OK to say, “I don’t know.” You may be joining with them in the “not knowing” of what is going on for them, and it can help to feel connected. It is often more helpful to use words like “died” or “death” instead of “passed on.” Especially with younger people, it helps them to understand what really happened.
Dr. J. William Worden describes four “Tasks of Mourning” that one must go through to facilitate a healthy adaptation, and Elisabeth Kübler-Ross describes the “Five Stages of Grief” which help to conceptualize some of the key emotions that people experience.
Dr. Worden is clear that these are active tasks, not things that happen to us, but things that we must do, to facilitate a healthy adaptation to loss. I’ve adapted Dr. Worden’s tasks to include all losses, by using “lost attachment.”
1. To accept the reality of the loss
2. To process the pain of grief
3. To adjust to a world without the lost attachment
4. To find an enduring connection with the lost attachment while embarking on a new life.
These tasks look nice and tidy with a simple four point plan of action. However, they can be remarkably difficult. Dr. Kübler-Ross describes the “Five Stages of Grief” as:
• Denial
• Anger
• Bargaining
• Depression
• Acceptance
In grieving, it is useful to experience all of these stages of grief as we process a loss. Unlike Dr. Worden’s tasks, you may notice that these aren’t numbered, but in bullet points. Worden’s tasks are more linear. You accomplish one task and then move on to the next. Dr. Kübler-Ross’s stages of grief are more fluid emotional states, and we may experience any one of them, and then move to a different stage at any time. There isn’t any one stage that is most useful or even necessary. A useful guiding principle is that in moving through the stages, the main concern is getting “stuck” anywhere but acceptance (that’s the eventual goal). So, one can experience denial, then depression, then acceptance, and move back to denial. It’s useful to notice when we are in these stages, but not to judge ourselves for being in any one of them.
There isn’t a timeframe for when things should change or healing should occur. In fact, some people never work thorough their losses. That’s why it is important to address the tasks in a deliberate and meaningful way. Healing isn’t about the amount of time that it has been since the loss.
Various age groups tend to process grief and loss differently. Infants and toddlers may sense a change in routine and caregivers, and can experience separation anxiety and regression. Having consistent caregivers is very useful at this age. Children of three to six years often struggle with the concept of the body not-functioning and finality of a death or loss. They can be prone to magical thinking and also regression. Consistent limit setting, patience, and simple (concrete) explanations are most effective. For example, a burial can be frightening if not better understood, since they may not understand the finality of death and become concerned that their loved one can’t breathe underground.
Between ages six to nine years, they begin to understand finality of death and may want details as to how someone died. They often have difficulty concentrating and worry about themselves and others, such as a caregiver or parent dying. It would be helpful to provide a space for talking about how the death/loss affects them personally. For ages ten to thirteen years, they may be able to understand that death is inevitable and happens to everyone. At this age, they may identify more with adults of their own gender and experience an array of feelings. They are often thinking about how death/loss affects relationships. For this age, it is helpful to encourage expression of feelings and foster open communication about death/loss.
Teens will often have the ability to confront and prepare for an impending loss. For teens and adults, they may not just be grieving for a current loss, but what might have been. They will often desire time with their peers. Some concerns is that the teen will be “parentified” and attempt to take on the role of the parent a parent during a major loss. Another possibility is that they may turn to risky behaviors. During this time, it is important to have open communication with the teen about their experience and to allow them the space to process their feelings, while offering support for when they are ready.
For all ages, be on the lookout for complicated bereavement, such as a grief response that is extended, amplified, delayed, distorted, absent, conflicted, chronic, or unresolved. This is when the grief response is interfering with psychological functioning, which can co-occur with adjustment disorders, depression, anxiety, substance abuse, PTSD, and suicidality. Some common indicators are sudden loss, conflicted relationships, pre-existing mental health issues, limited successful coping skills, financial or employment distress, or multiple stressors.
Never Worry Alone. In grief, one should not be alone in the process. Connectivity is a healing and protective factor. If you have concerns for another person, family, or yourself, you may benefit from working with a grief counselor. Below is a list of resources that may be useful in getting help or learning more about grief and loss. The way through grief and loss is together, not alone.
RESOURCES
The Children’s Room in Arlington – www.childrensroom.org
Offering a full array of bereavement services for families who have experienced early loss. Their website is full of helpful bereavement information.
Compassionate Friends – www.compassionatefriends.org
A national organization that helps families who experience the death of a child.
NASW Social Work Therapy Referral Service
www.therapymatcher.org or (800) 242-9794.
This is a free and confidential service from the National Association of Social Workers that connects people to psychotherapists on a range of issues – not just grief and loss.
Kevin M. Kozin, MTS, LICSW is a local psychotherapist and grief counselor in Lexington, MA and works with adolescents, adult, families, and couples. Mr. Kozin is highly active in the community in his work on the Board and Executive Committee of the National Association of Social Workers, Massachusetts (NASW-MA) and serving as the Co-Chair the Mental Health and Substance Abuse Committee of NASW-MA. He holds master’s degrees in Social Work and Theology from Boston University and completed post-graduate training at the Massachusetts Institute for Psychoanalysis. Information on Mr. Kozin’s practice can be found at www.kozincounseling.com or by contacting him at (781) 325-1858.
