How to Cope with Life After Loss

While we often associate grief with the death of someone significant in our lives, losses come in many forms.

Wendy Lichtenthal, Ph.D., a clinical psychologist and founding director of the Center for the Advancement of Bereavement Care at Sylvester Comprehensive Cancer Center, has been trying to identify the best way to support individuals who are grieving all types of losses for over two decades. She differentiates bereavement from grief, explaining, “Bereavement is the state of having lost someone or something; grief is the response. People experience grief over death and non-death losses.” Grief over non-death losses can emerge for many reasons, including the loss of a relationship, faith, or community. Dr. Lichtenthal has worked with people grieving the loss of their independence, appearance, or body parts due to cancer.

For those who lose someone to cancer, the Center for the Advancement of Bereavement Care plays an important role.

“Caregivers and families of patients can become very connected to the institutions providing care, and so they may feel disconnected after a patient dies. Our Center advocates for a transitional bereavement care model. It promotes the idea that the institution that cared for a patient should support the bereaved while also helping bolster compassionate care that will best support the griever in their community.”

The Center offers individual and group counseling, education, online webinars, and resources. Grief literacy training is available to medical professionals to provide grief-informed care.

What is grief literacy?

Victorian mourners often dressed in black or hung a memorial wreath on their door, a practice that made others aware of their loss. In modern times, knowing whether someone has experienced a significant loss is more challenging.

“Grief literacy involves being aware that there are people around you who are grieving and understanding how to support them in ways that are helpful and, importantly, not harmful,” says Dr. Lichtenthal. It involves demonstrating compassion, which might be as simple as being patient with a grouchy cashier; you don’t know what they’re going through. Perhaps you bring food to a neighbor who lost his partner or lend a listening ear to a friend frustrated by the side effects of chemotherapy.

Compassion can be especially meaningful in the workplace.

“A grief-literate employer recognizes that an employee returning to work after a three-day bereavement leave isn’t done grieving. They understand that grief can impact their employee’s ability to work, and they show compassion and manage their expectations,” Dr. Lichtenthal says.

How to offer support to a person who is grieving

“Letting someone who is grieving know you are there and willing to hold space for their grief, to validate how very hard the experience of loss is, can be invaluable. We also have to be mindful of what we say. Comments that reflect your belief system about loss and grieving may not resonate, and as well-intentioned as they may be, they can leave grievers feeling even more alone,” Dr. Lichtenthal says.

Statements like, “At least she didn’t suffer,” or “He’s in a better place” are potential faux pas, she says. Sometimes, the most appropriate support is less about talking and more about listening. A text or voicemail that says, “I’m thinking of you. I’m here if you need me,” doesn’t demand anything but keeps communication consistent, especially in the months following a loss when many well-wishers return to their own lives. Offering to mow the lawn, pick up kids from school or do laundry are other ways to help.

Part of Dr. Lichtenthal’s mission is educating medical providers on caring for individuals who have experienced loss. Depending on the person, crying or socially isolating might be an appropriate way to process loss. Grief-informed care, Dr. Lichtenthal says, would not automatically label these patients as depressed and prescribe an antidepressant.

Sometimes, the circumstances of the loss make it harder to speak about with others. For example, there may be a stigma related to the cause of the death, or the griever does not feel like they are “entitled” to feel as distressed as they do. “When we don’t feel like we have permission to express our grief to people around us, this can lead to what grief experts call ‘disenfranchised grief.'” When grief becomes disenfranchised, the grieving person can feel more alone in their pain, and since being able to express our grief can be an important part of adapting to loss, this can make the experience of loss more challenging.

This is where workplaces, schools, communities and “grief-informed” health care providers can help. The Center for the Advancement of Bereavement Care is a model for others to follow. “We offer families resources and bolster resources within communities so that they have the capacity, skills and resources to help grieving individuals.”

How to support yourself through grief

“Grief is unique because you can feel so distressed and think something must be wrong with you, but for many people, that distress response is exactly what we would expect in their situation. It is not a pathological reaction. That said, there’s a natural tendency to want to get away from pain, and so people are often trying to figure out what to do to not feel so awful,” Dr. Lichtenthal says. She cautions against statements such as, “I should feel better by now,” which ultimately makes us feel bad about feeling bad.

Caring for yourself means remembering, “We all want a road map to know when we might feel better than we do now, but grief is not linear; it’s more likely to be experienced in waves. It can feel unpredictable and come out in different ways. Some days, it might feel more at the forefront, and other days, less so.”

For some people, professional support may be helpful. Individual or group counseling allows us to process emotions and feel less alone. Accepting help from others is another positive step. Getting enough rest, eating healthy and exercising also contribute to well-being.

What is “coping flexibility”?

Dr. Lichtenthal says coping flexibility, a concept studied by researcher George Bonanno, Ph.D., can be applied in various situations. It points to the idea that there’s no one way to cope in a given situation and that what can help people adapt effectively is to be flexible in choosing a coping strategy based on how well a given approach works.

“You try a coping strategy. If it doesn’t work, you try something different. For example, sharing your grief with others may be helpful in many situations. But let’s say you try it with a friend who says something that doesn’t feel very supportive. Then, in that situation, perhaps you choose not to share further and excuse yourself to go for a walk,” Dr. Lichtenthal says.

Managing expectations improves our ability to cope. To prevent unrealistic expectations, Dr. Lichtenthal personally avoids words like “heal,” “closure,” or “resolution” since they could imply that grief has an “end.” So rather than conceiving of time as healing, she says that “with the passage of time, what happens is there are more chances to digest the reality of the loss and figure out how to adapt, manage and cope.”

Managing special occasions

The holidays can be especially intense with their images of family, friends and celebrations.

“Traditions make the absence of a loved one more glaring,” Dr. Lichtenthal says. Other “markers of time,” such as birthdays, graduations, or weddings, may also cause “profound sadness.”

Feelings of “anticipatory distress” can crop up when the anniversary of a death approaches. We may replay in our mind what was happening the year before the person died; this “redigesting” of memories can be very raw, Dr. Lichtenthal says.

“With social events, there’s an expectation of joy, but nobody knows your internal experience. You’re smiling but may feel like you’re wearing a mask.”

If cheerfulness feels forced, passing on the big, boisterous party is OK. A low-key lunch with one or two friends could also mark the occasion. Consider creating a ritual or new tradition to acknowledge how much you miss the person while honoring your time with them.

“No singular strategy works in each situation,” Dr. Lichtenthal says.

A takeaway that is hopeful

Moving through the myriad of emotions that accompany loss can feel overwhelming. It’s easy to grow impatient with the process.

Fortunately, Dr. Lichtenthal says, “Grief transforms over time. The pain can still be there, but the edges soften, it won’t feel as raw, and your capacity to manage it builds over time. While the circumstances of loss are beyond our control, how we choose to respond is within our control.”

Nancy Moreland is a regular contributor to the UHealth Collective. She has written for several major health care systems and the Centers for Disease Control. Her writing also appears in the Chicago Tribune and U.S. News & World Report.

Tags: Bereavement care, Grief counseling, Grief-informed care, Supporting grieving individuals, Sylvester Comprehensive Cancer Center, Wendy Lichtenthal