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Counseling Skills for Companioning the Mourner

The Fundamentals of Effective Grief Counseling

Center for Loss and Life Transition

PART ONE: THE STARTING POINT

WHERE DOES EFFECTIVE GRIEF CARE START? IT STARTS WITH YOU, THE CAREGIVER.

It starts with what you believe about grief and mourning.

It starts with your training and understanding of the helping relationship.

It starts with your innate personality.

It starts with your personal experiences with loss and grief.

It starts with how all of this translates into your ways of being when you are in the company of someone who is grieving.

Whenever you enter into a counseling relationship, you are about to embark on a journey through the wilderness of grief with a fellow human being. You might think of the starting point as the trailhead. Before you set off, I urge you to make sure you are as prepared as possible. The wilderness is vast and inhospitable, and the journey is grueling. The mourner is trusting in you to help him survive.

Yes, lives are at stake — usually not literal life-or-death consequences but instead what I consider the even more important life of the soul.

On the journey to come, you will not be the guide, exactly, because (if you agree with me about my companioning philosophy of grief care, which we'll soon talk more about) you will be walking alongside the mourner, not in front of or behind him. As you walk, you will be allowing the mourner to choose the path. After all, this is really his journey — not yours.

But as his trusted and discerning companion, you are tasked with helping him discover paths that lead to healing. You will help him read the compass and look for the signposts that are the six needs of mourning. You will try to ensure adequate shelter (safe places to express thoughts and feelings), food (regular meals of compassion and hope), and water (recognizing what sustains him day to day). You will watch out for the hazards of complicated grief and learn when to refer him to another helper when his needs are beyond your training and experience. While you are not responsible for him, you are responsible to him for all of these things.

Helping people who are grieving — and helping people who help people who are grieving — is my life's work. This book starts at the trailhead of grief and is meant to help you be as prepared for and capable of truly helping mourners as possible.

GRIEF AND MOURNING: FOUNDATIONAL BELIEFS

Like my colleague and friend Rabbi Grollman, I believe that grief is normal and necessary. It is not, as the medical model of grief care implies, an illness that must be cured or a pathology that must be treated. Instead, it is the natural process of integrating losses of all kinds that we as conscious, complex human beings can't help but experience in life.

We grieve whenever something or someone we value and are attached to is taken away from us. And so we grieve during and after divorce. We grieve after significant life transitions, such as going off to college or to live on our own, milestone birthdays, and leaving a job we care about. Perhaps most significantly, we grieve after someone we love dies.

All of these common life experiences (and many others) are, at least in part, losses. And losses naturally engender grief.

Essentially, grief is what we think and feel inside after a loss. Grief isn't just sadness, of course. Often, it is also feelings of shock, denial, disorganization, confusion, anger, fear, and panic. It can include regret and sometimes relief. It may be physical pain and social discomfort. It can be disjointed thinking and spiritual despair. It is physical, cognitive, emotional, social, and spiritual.

Grief is all of that and more.

Mourning, on the other hand, is the expression of those thoughts and feelings outside of ourselves. Mourning is how we heal our grief.

And in the helping relationship, mourning is where you come in.

Your role in helping people who are grieving is to provide a safe place and empathetic presence in which they can honestly, openly, and fully mourn. A sanctuary, if you will. You normalize and affirm.

You bear witness and encourage. And most of all, you listen.

I have written extensively about the fundamentals of grief and mourning in many other resources, so I will not go into more depth or detail about them here. For the purposes of this book — and to help you ready yourself for the trailhead — it is simply enough for you to understand what I mean by grief and mourning ... and by grief companioning.

MY COMPANIONING PHILOSOPHY OF GRIEF CARE

I am a passionate believer in and supporter of grief counseling, both professional counseling and lay support. That's because mourning — which, remember, is the expression of grief outside oneself and is the very key to healing — is mostly not a solo experience.

While some methods of expressing grief can be accomplished alone — such as crying, journaling, and participating in spiritual activities like meditation or prayer — mourning often requires the compassionate, nonjudgmental presence of at least one other human being. And in our mourning-avoidant culture, such a person is rare indeed.

The most fundamental and essential way to mourn is to talk to a good listener about your inner thoughts and feelings. (Whether they realize it or not, all good grief listeners are basically grief counselors.) And so we need effective grief counselors. Lots and lots of them. Trouble is, the medical model of grief care that educates and prepares professional grief counselors (including psychiatrists, psychologists, social workers, and other mental health caregivers) too often does an unsatisfactory job, in my opinion, of preparing them well for the trailhead.

Very early on — in my childhood, actually — I understood that I wanted to be a grief counselor. So after finishing my undergraduate degree, I earned a master's in psychology and then a doctorate. I completed my internship in clinical psychology at the Mayo Clinic. During these years, I also began to counsel grieving families, so that I could learn up close from grievers and those who care for them.

Grieving people taught me a lot about authentic grief and mourning — both then and in the nearly 40 years since I've spent as a grief counselor and educator. What my formal schooling tried to teach me, on the other hand, was often less helpful. You see, according to the medical model of psychological theory, grief can be considered an illness that with proper assessment, diagnosis, and treatment can be cured.

I've always found it intriguing that the word "treat" comes from the Latin root word tractare, which means "to drag." If we combine that with "patient," we can really get in trouble. "Patient" means "passive long-term sufferer," so if we treat patients, we drag passive, long-term sufferers. Simply stated, that's not very empowering.

In my grief counseling philosophy, in lieu of the word "treat," I use "companion." When broken down into its original Latin roots, it means "messmate": com for "with" and pan for "bread." Someone you would share a meal with, a friend, an equal. I have taken liberties with the noun "companion" and made it into the verb "companioning" because it so well captures the type of grief counseling relationship I support and advocate. In fact, that is the very image of companioning — sitting together, being present to one another, sharing, communing, abiding in the fellowship of hospitality.

Companioning people in grief is therefore not about assessing, analyzing, fixing, or resolving another's grief. Instead, it is about being totally present to the mourner — even being a temporary guardian of her soul.

The companioning model is anchored in a "teach-me" perspective. It is about learning and observing. In fact, the meaning of "observance" comes to us from ritual. It means not only to "watch out for" but also "to keep and honor," "to bear witness." The caregiver's awareness of this need to learn is the essence of true companioning.

MY 11 TENETS OF "COMPANIONING" VERSUS TREATING PEOPLE IN GRIEF

1. Companioning is about being present to another person's pain; it is not about taking away the pain.

2. Companioning is about going to the wilderness of the soul with another human being; it is not about thinking you are responsible for finding the way out.

3. Companioning is about honoring the spirit; it is not about focusing on the intellect.

4. Companioning is about listening with the heart; it is not about analyzing with the head.

5. Companioning is about bearing witness to the struggles of others; it is not about judging or directing these struggles.

6. Companioning is about walking alongside; it is not about leading.

7. Companioning is about discovering the gifts of sacred silence; it is not about filling up every moment with words.

8. Companioning is about being still; it is not about frantic movement forward.

9. Companioning is about respecting disorder and confusion; it is not about imposing order and logic.

10. Companioning is about learning from others; it is not about teaching them.

11. Companioning is about compassionate curiosity; it is not about expertise.

If your desire is to support a fellow human in grief, you must create a "safe place" for people to embrace their feelings of profound loss. More than a comfortable office, this safe place is a cleaned-out, compassionate heart. It is the open heart that allows you to be truly present to another human being's intimate pain.

As a caregiver to mourners, I am a companion, not a "guide" — which assumes a knowledge of another's soul I cannot claim. Neither am I an expert. To companion our fellow humans means to watch and learn.

A central role of the companion to mourners involves the art of honoring stories. Honoring stories requires that we slow down, turn inward, and really listen as people acknowledge the reality of loss, embrace pain, review memories, and search for meaning.

The philosophy and practice of companioning also interfaces naturally with the art of hospitality. Hospitality is the essence of knowing how to live in society. Among the ancient Greeks, hospitality was a necessary element of day-to-day life. In a land where borders were permeable, it was important to get to know one's neighbors as potential friends.

One way to do this was to share meals together. First, the guest and host would pour a libation to the gods. Then they would eat ("break bread") together. Then, after the guest had his fill, they would tell each other their stories, with the guest going first. Often, tears were shed because their stories were highly personal: battles, family histories, and life tragedies were recounted. After the evening together, the host and guest were potential allies. Still today, breaking bread and sharing personal stories are key elements of companioning people through death and grief.

The spiritual thinker Henri Nouwen once elegantly described hospitality as the "creation of a free space where the stranger can enter and become a friend instead of an enemy." He observed that hospitality is not about trying to change people, but instead about offering them space where change can take place. He astutely noted, "Hospitality is not a subtle invitation to adopt the lifestyle of the host, but the gift of a chance for the guest to find his own."

And while we're talking about terms, let's consider the word "client," too. Coming from the Latin for "obey" or "incline or bend," it is another power word. I do not treat patients or clients. Rather, I companion my fellow human beings who are experiencing natural, necessary grief.

To reinforce the importance of the companioning philosophy of grief care, throughout the rest of this book, I will use the term "companion" interchangeably with the word "counselor" and I will avoid the use of the terms "patient" and "client."

OTHER MODELS OF CAREGIVING AND THEORIES OF BEREAVEMENT

I believe it is critically important to familiarize yourself with different grief models and theories. The body of knowledge in thanatology is actually very new, and we have more to learn. Beyond the general helping skills literature, there is a unique body of mysterious knowledge that has important application to grief caregiving. While I have attempted to provide leadership and advocacy for a model of "companioning" my fellow human beings in grief, we must also acknowledge that no one model can take into account all the aspects of helping the mourner.

I would encourage you to read and reflect on various models and see what resonates with you in your caregiving efforts. See the Recommended Reading list on page 123. Learn about attachment theory (Bowlby, 1982), the continuing bonds theory (Klass, Silverman, Nickman, 1996), the task-based model of grief (Rando, 1993; Worden, 2008), the two-track model of bereavement (Rubin, 1999), the dual-process model (Stroebe, Schut, Stroebe, 2005), the meaning reconstruction and growth model (Atig, 1996), the disenfranchisement model (Doka, 2002), as well as the companioning model (Wolfelt, 2005).

Being an open learner and knowing you will never arrive at being a "grief expert" will encourage you to keep learning from various researchers, academicians, and clinicians in the area of death education and counseling.

MORE COMPANIONING PREPARATION FOR THE TRAILHEAD

I believe that every grief caregiver must work to develop his or her own theory or point of view about what helps people who are grieving. Challenging yourself to explain what happens in your caregiving relationships with grieving people and families will, in my experience, assist you in understanding and improving the results of the important work you do.

Developing your own grief care precepts facilitates a coherence of ideas about the helping process and also generates new ideas about how to be helpful. Outlined below are 20 principles that undergird my work. My hope is that you will also challenge yourself to write out your philosophy of effective caregiving to people in grief.

1. Bereavement, grief, and mourning are normal and necessary experiences; however, they are often traumatic and transformative. I convey a deep respect for grief and mourning to the mourner, thus enabling her to convert her grief into authentic mourning.

2. The helping process is seen as a collaborative, "companioning" process among people. The traditional medical model of mental health care is inadequate and complicating. As a companion, I try to create conditions that engage people actively in the reconciliation needs of mourning. I provide a "helping alliance" with the mourner that is focused on her needs.

3. True expertise in grief or death lies with (and only with) the unique person who is grieving. Only he can be the expert. The companion is there to learn from the griever and to bear witness to and normalize his journey.

4. The foundation upon which helping grieving people takes place is in the context of an encouraging, hope-filled relationship between the companion and the mourner. The widely acknowledged core conditions of helping (empathy, warmth and caring, genuineness, respect) are seen as essential ingredients in working with grieving people and families.

5. Traditional mental health diagnostic categories are seen as limitations on the helping process. The concept of "gardening" as opposed to "assessing" better describes efforts to understand the meaning of the journey in the grieving person's life. I strive to understand not only the potential complications of the journey, but also individual strengths and levels of wellness.

6. The counseling model is holistic in nature and views grieving people as physical, cognitive, emotional, social, and spiritual beings. Each person is unique and seeks not just to "be" but to become.

7. The underlying theoretical model is systems-oriented and sees the grieving person as being a node in a web of interdependent relationships with society and other people, groups, and institutions.

8. The focus of companioning grieving people is balanced between the past, the present, and the future. Learning about past life experiences (particularly family of origin influences) and the nature of important relationships among the mourner and the important people in her life helps me understand the meaning of the grief and mourning process for this unique person.

9. A grieving person's perception of her reality is her reality. A "here and now" understanding of that reality allows me to be with her where she is instead of trying to push her somewhere she is not. I will be a more effective helper if I remember to enter into a person's feelings without having a need to change her feelings.

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Excerpted from Counseling Skills for Companioning the Mourner by Alan D. Wolfelt. Copyright © 2016 Alan D. Wolfelt, Ph.D.. Excerpted by permission of Center for Loss and Life Transition.
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