Monday, October 15, 2012

Seeing a Specialist in Grief Counseling: Does It Matter?

A reader writes: I’ve been suffering from depression for a long time and am under the care of a psychiatrist. I went to see my doctor for the first time since my father died and was a complete wreck since I had to re-tell what happened. I was crying because it's hard to talk about Dad's sudden downfall and last day, but my psychiatrist seemed to think that I was being overly emotional. I tried to tell him that I'm not upset every day and that I didn't think that my sadness less than five months after Dad's death was abnormal. I did confess to doing some stupid things immediately after he passed and how hard some things have been, but I walked out of his office feeling like I should be over it. 

He didn't come out and say it but disregarded my comments about five months not being that long, how I've tried to be social, do yoga, etc. All I got in return was the sense that there is something wrong with me. I don't know how he expected me to behave since while I can talk about Dad, going over his last days is much different. I know people tell us we should be "over it," but I was let down that my doctor couldn't recognize that I'm trying and that I'm early into the grief process (he didn't seem to think that whatever my grief books have to say meant very much). I feel like everything I've been proud of doing meant nothing. In my mind a psychiatrist or counselor should congratulate you on what you have overcome and suggest actions that can help with what you haven't. I guess I just thought I was doing better by following an exercise plan and trying to re-connect with friends, but since I'm admittedly emotionally fragile, to hear only negatives hurt. I suppose that because I was trying to fill that void and a doctor ignored my efforts it stung harder. 

My doctor asked whether I'd rather “experience the grief and be miserable for a year or more” or take something to ease the pain. He even told me that to come to your online grief forum and vent was the wrong thing to do because none of the members are counselors! I responded that this place has been more than helpful but he brushed that off as well. Right now I'm torn - I personally believe that my emotions are natural since Dad passed recently, but it seems that I'm in the minority with that belief. I left my doctor's office more upset and angry than I have been in a long time. 

My response: I am disturbed by a number of things you’ve said about your psychiatrist’s reaction to the grief you’re experiencing following the death of your father. If this is representative of your doctor’s understanding of normal grief, I think it’s safe to say that he is woefully misinformed. Not all psychiatrists, therapists and counselors are experienced in, educated in, and trained in thanatology (the study of death, dying, grief and loss). Like everything else in health care today, grief counseling and grief therapy are specialties with their own body of knowledge, research, and recommended best clinical practices, and just because you're seeing a psychiatrist, it doesn't necessarily follow that he is knowledgeable about the normal grief process.

I am reminded of a passage in one of those grief books your doctor is so quick to dismiss, written by Dr. Alan D. Wolfelt. (Since you’ve already read some books on grief, you probably recognize Dr. Wolfelt as an author of some of the best. He is an internationally known and respected teacher and grief counselor who acts as educational consultant to hospices, hospitals, schools, universities, funeral homes and a variety of other community agencies across North America. He serves as Director of the Center for Loss and Transition in Fort Collins, and is on the faculty at the University of Colorado Medical School’s Department of Family Medicine.) In his book, Companioning the Bereaved: A Soulful Guide for Counselors and Caregivers, here is what Alan has to say about the traditional medical model of mental health care, particularly with regard to understanding grief:
Our modern understanding of grief all too often lacks any appreciation for and attention to the spiritual, soul-based nature of the grief journey . . . academic psychology has been too interfaced with the natural sciences and laboratory methods of weighing, counting and objective reporting . . . [this book] presents an alternative based on “companioning” versus “treating” one’s fellow human beings in grief. Critical self-observation would suggest that perhaps we rely too much on psychosocial, biological and psychodynamic constructs that we have been taught to “treat away,” such as depression, anxiety, and loss of control . . . Without doubt, the grief journey requires contemplation and turning inward. In other words, it requires depression, anxiety and loss of control. It requires going into the wilderness. Quietness and emptiness invite the heart to observe signs of sacredness, to regain purpose, to rediscover love, to renew life! Searching for meaning, reasons to get one’s feet out of bed, and understanding the pain of loss are not the domain of the medical model of bereavement care (pp. 8-9). 
Alan goes on to express his hope that his philosophical model of companioning will eventually replace the more traditional medical model:
The companioning model
• empathizes with the human need to mourn authentically without any sense of shame
• encourages every one of us to discover how loss has forever changed us

• understands the normalcy of drowning in your grief before you tread water, and that only after treading water do you go on to swim

• helps the caregiver acknowledge the responsibility for creating conditions that allow the grieving person to embrace the wilderness of grief (p. 19).
In another passage, he offers what I believe to be a perfect description of what we provide in our online Grief Healing Discussion Groups ~ creating Divine Momentum:
In grief, Divine Momentum is the notion that the process of mourning will, all by itself, lead to healing and reconciliation. In embracing and expressing their grief, mourners will, over time and with the support of others, move forward. To trust in Divine Momentum is to believe that healing can and will unfold . . . you help create Divine Momentum for healing by offering a safe starting place for the journey. You offer a free and open space for mourners to give attention to that which they need to give attention to (p. 40).
What about controlling and confronting the pain of grief? You say your doctor “asked whether I'd rather ‘experience the grief and be miserable for a year or more’ or take something to ease the pain.”
For many people in a mourning-avoidant culture, it is easier to avoid, repress or deny the pain of grief than it is to confront it. Yet, it is in confronting one’s pain and realizing it doesn’t mean something is wrong that we ultimately integrate loss into our lives ... Trying to avoid, repress or deny the pain of grief makes the mourner an opponent of the journey and creates more chronic states of anxiety and depression (p. 168).
You say your doctor told you “that to come here and vent was the wrong thing to do because none of the members are counselors!” What your doctor fails to realize is that the real “experts” in grief are the people who come together to share in and grow through their common experience of loss, and for many grieving people, support groups are one of the best helping resources. Furthermore, what makes this particular site different from many other message boards “out there” is that this one is closely monitored and moderated by a professional grief counselor who is certified as a Fellow in Thanatology (Death, Dying and Bereavement) by the Association for Death Education and Counseling. (For your doctor’s information, ADEC is a multidisciplinary professional organization dedicated to promoting excellence in death education, bereavement counseling and care of the dying, and the people it certifies are required to meet its rigorous educational standards, demonstrate excellence in counseling and pass a comprehensive national board examination.)

I understand that you’ve been in treatment with this psychiatrist because you’ve been “suffering from depression for a long time.” Clinical depression is now recognized as a true medical disorder, and certainly if you’ve been given this diagnosis, you should continue with a physician who is giving you appropriate treatment for it. Nevertheless, you are right in your observation that there is a difference between clinical depression and the sorrow that normally accompanies grief. Clinical depression is an illness that can be treated – but grief is a normal, natural and healthy process that requires an entirely different approach.

As you’ve already discovered, not every psychiatrist or psychotherapist is educated, trained and experienced in death, dying and bereavement, and you deserve far better information, comfort and support for your grief than what you’ve obtained from your psychiatrist. Good for you for recognizing that, and I hope that in addition to the medical treatment you’re receiving for depression, you will look elsewhere to find someone who specializes in grief and loss. You are worth it, and you certainly do deserve it.

Your feedback is welcome! Please feel free to leave a comment or a question, or share a tip, a related article or a resource of your own in the Comments section below. If you’d like Grief Healing Blog updates delivered right to your inbox, you’re cordially invited to subscribe to our weekly Grief Healing NewsletterSign up here.


  1. Marty,

    what an excellent reply to your reader. It is fortunate that your reader was connected to your community and has the opportunity to be educated on the grief process and share from other walking this journey.
    Good work as always, I so appreciate and admire your good advice.

  2. I'm glad that your reader came by to share their pain at your blog about missing their father. This is a tender place for all of us to fall, Marty.

    When we love someone we never stop missing them. The psychiatrist was wrong and insensitive to the grief your reader poured out. The doc's vessel was cracked. He inflicted harm. It really was a form of bullying.

    Once a therapist told my husband that he needed to get over the loss of our precious Katie. I was incensed, wrote a letter and told the therapist so and also said I thought she was outrageous to charge for that session.

    The grieving world is unique. I think the therapist chosen has to have had losses in his or her own life to possess the empathy to understand and feel the mercy in their own loss to be able to extend it to the suffering world.

    We all hurt somewhere. We all need kindness and understanding but especially when we are grieving.
    Warmly,Marty, and thank you.
    Mary Jane

    October 17, 2012 9:09 AM

    1. My dear Mary Jane, I followed your link and read your excellent article, "How to Choose a Good Therapist." (Obviously we were on the same wavelength this past weekend!) I agree completely with your statement, "I also think the best therapists are 'Wounded Healers.' As long as they have worked on their own places of sorrow, betrayal, fear and loss these therapists are sensitive to your pain." From one Wounded Healer to another, thank you ♥

  3. I'm glad that your reader came by to share their pain at your blog about missing their father. This is a tender place for all of us to fall.

    I am working on grief counseling.

    1. Thank you, Joey ~ and I deeply appreciate your description of this as "a tender place for all of us to fall." I am wishing you peace and healing in your own grief journey.♥

  4. Marty--thank you for this compassionate, supportive, true and helpful response to your reader's query. I wish she'd change doctors! Psychiatrists like hers are a danger to mental health and any kind of moving forward and through--grief as well as depression! As a therapist and a bereaved mother, I know what you are saying is absolutely true. How her doctor can not know that support groups are one of the most helpful and healing places for people in grief is incredible to me. So glad she wrote to you and that she has connections on your forum.
    --Love to you,

    1. Thank you, Karla ~ and I agree with you completely about the healing power of support groups. ♥

  5. awesome post!! thanks for sharing this wonderful story i love reading it, i learned a lot from this and it gives me a different perspective on the topic!

    US Patent No: 8,287,534

  6. Alicia, my dear, you are so welcome, and it warms my heart to learn that this was helpful to you! ♥


Your comments are welcome!