The second situation is if the grief reactions from one loss are delayed and then appear with a vengeance after another loss. A client I had is a prime example of someone experiencing delayed grief. The death of a co-worker was “the straw that broke the camel’s back” that caused her to be inundated with the grief of her previous losses. Delayed grief reactions can arise several months or even years after the loss. I have a client now whose father committed suicide 15 years ago when she was in her early 20’s. While she did grieve some then, she harbored a deep-seated anger toward him that she never addressed. She came to see me when she lost one of her twins (a daughter) while still in the womb. She felt that something was adversely affecting her relationship with the surviving twin (a boy) and she wanted to focus on that “something” before it caused a long-term problem with him. We addressed the death of her daughter, but a large amount of our counseling time was dedicated to her delayed grief relating to her father’s death. She is now fully grieving his death and is noticing a favorable change in her attitude toward her son.
The third mourning situation that may require professional help is when grief reactions are exaggerated. In his book Lessons of Loss, Robert Neimeyer lists some examples of exaggerated grief. These include substantial guilt, thoughts of suicide, extreme hopelessness, prolonged depression or anxiety, uncontrolled rage, substance abuse, and persistent difficulties that radically disturb your ability to function at work or to accomplish routine daily tasks.
The fourth problematic mourning situation is when the grief is masked. In this case, the bereaved experience physical and/or psychological symptoms or behaviors that do not seem to be associated with grief. Physical symptoms can vary greatly ranging from a stabbing chest pain to an unexplained weight loss. In masked grief, there is no medical basis for the physical symptoms and they go away after the associated loss is dealt with in therapy. I want to stress that not all physical problems are the result of grief. However, if there is no pathological basis for the problem, it can be worthwhile to investigate if it may be a physical manifestation of grief.
Similarly, some behavioral problems may be masked grief reactions. For example, it is common for children to “act out” their grief through bad or even delinquent behavior.
How can you know if you could use help? The most common way is to have an innate feeling that you are “stuck,” that you’re not getting anywhere in your mourning, or that something is not right and you’re not sure what it is. I have never had a client be wrong when he/she came to me with a problem he/she thought was the result of a loss. However, I have had clients come to me specifically because another therapist refused to listen to them when they felt their problems were grief related.
The other way to find out you could use some help is if you go to an astute doctor who recognizes that grief could be the reason for, or a contributing factor in, your physical or behavioral ailment.
In conclusion, when can professional help benefit a bereaved person? The answer is when you, a friend, or a family member feels that you are “stuck” in your mourning; are strongly grieving over a death that occurred in the distant past; are experiencing exaggerated grief reactions; or are having physical, psychological, or behavioral problems that have no other explanation.
