Monday, September 4, 2017

In Grief: When Counseling Isn’t Helping

[Reviewed and updated December 31, 2023]

If there is no struggle, there is no progress.  ~ Frederick Douglas

A reader writes: Well it seems I am not doing any better now since both my parents have died. And I have no doubt that this is hurting me more than anyone else in the family. My Mom and I lived together and she knew me better than all of them and I knew her better than all of them. The only person in my family that probably knew my Mom as well as I did was my Dad.

But anyway, I just can't make any progress and feel I am in an endless pit of grief, mourning, sorrow, and despair. 
Tonight I asked God to just take me. I don't want to be here anymore. I am sick of it and sick of it ALL!

I think I need to get help. Going to a grief counselor a few times a month is NOT helping much. She is great, but it is not enough for me. I am beginning to think I need to be put in the hospital for awhile. I could never do that though as it is so expensive. But my little heart and baby soul is torn apart and is not healing whatsoever. Nobody seems to get this at all. Everyone is trying to get me to "move on" and "overcome" it. Sorry, that cannot be done. You never "overcome" this. "Keeping busy" does nothing for grief and mourning. In fact, it only delays it. I tried to give one of my older brothers some reading material on "misconceptions about grief" and he said he "doesn't need that". He and my other brother simply want to be "strong" and be "men" about it. Well, I have read and I believe that men who do cry are very strong and are healthy. 

But back to me. I am not in good shape emotionally and every day is a tremendous struggle to get through. I am barely sleeping and not eating like I once did. I am in constant anxiety about the future and have tremendous fear of the future. And tremendous regret of much of the past 27 years of my life. I have never felt so lonely in my life. But a large part of me feels that I can go to all the hospitals and therapists I want to, but nothing will ever change how I feel. Because this whole experience has changed me forever.

My response: My heart goes out to you as I read of the difficulty you're having at this point in your grief journey, and I want to share some thoughts with you.

You say you're not doing any better at all (barely sleeping, no appetite, lonely, anxious, fearful about the future, harboring tremendous regrets about the past); you cannot make any progress, don't want to be here anymore, and feel as if you're "in an endless pit of grief, mourning, sorrow, and despair." While part of that is typical of normal grief, some of what you describe sounds a lot like depression to me ~ and that could be complicating your bereavement.

You say that you're seeing a grief counselor a few times a month but it's not helping much. Is your counselor aware of how you feel about your lack of forward progress, and does she agree with your assessment? You say she's "great," but that doesn't tell me anything about her professional qualifications (education, training, experience, licensure, certification) as a grief counselor.

Have the two of you discussed the possibility that you may have developed a major depressive episode? You might do well to schedule a visit with your primary care physician, who can conduct a complete diagnostic evaluation and rule out any other medical condition that may be causing symptoms of depression.

As I'm sure you know, many of the features of normal grief look and feel like depression, but there are some important distinctions, and they are distinctly different conditions. J. William Worden, highly respected educator, researcher and expert in grief counseling and grief therapy notes, 
One of the functions of the counselor who has contact with people during the time of acute grief is to assess which patients might be undergoing a major depression by using current standard diagnostic criteria. Patients so identified can then be given additional help such as a medical evaluation and possibly the use of antidepressant medications. Once depressions begin to lift through medication, then the focus of treatment changes to the underlying conflicts . . . These conflicts cannot be addressed through medications alone. ~ J. William Worden, PhD, ABPP, Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner, 4th Edition, p. 33 
In his informative article, When And How to Use Medicine for Grief, family physician Dr. Richard Drew draws a distinction between what he calls Situational Depression  and Chemical Depression. Situational Depression (SD) occurs in response to the stresses and losses we experience in life, while Chemical Depression (CD) results from actual chemical changes in the brain. "Most people with SD do very well without medication," he writes. "On the other hand, CD usually requires medication as part of its treatment plan." Although his article is aimed at bereaved parents, it contains useful information for anyone wanting to learn more about what distinguishes grief from depression.

Another alternative is to consider finding another counselor or therapist. An effective grief counselor is knowledgeable about the mourning process, helps you feel understood, offers a witness to your experience, encourages you to move forward, fosters faith that you will survive, and offers hope that you will get through your grief successfully. If you don't sense that your counselor has a good understanding of your grief process or doesn't seem like the person who can help you, you have every right to try another counselor, and I strongly encourage you to do so.

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