Grief is the other side of love

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Welcome back to Ask Dr.

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Mia podcast.

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Today I have with me David McLaughorn, MSW LCSW.

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He is a counselor within the memory counseling program at Atrium Health, Wake Forest Baptist.

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He specializes in grief and loss with a focus on the aging population.

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David also provides education and support for helping professionals to.

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encourage grief -informed care across diverse service areas.

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David has had additional training with Dr.

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Alan Wilfelt, who is the founder director of the Center for Loss and Life Transition, as well as trainings with David Kessler and Claire Bidwell -Smith, two emerging grief experts.

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So with that intro, I think you know the topic for...

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Our discussion today with David, which really talking about grief, not something that I think most people want to talk about a whole lot.

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But I think my first question for you, David, is kind of how do you how did you get into counseling specifically focusing on grief?

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You know, that's a really interesting question I get asked a lot.

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You know, this is really a second career for me.

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And the one thing that I tell people is that you don't choose grief work, it chooses you.

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And I think most people involved in grief work have been affected by loss in some way or another.

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So for me, there's a bit of a story around it.

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I think, you know, I've been...

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were being groomed for this since an early age.

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So when I was around eight years old, I experienced my first loss, which was a great grandmother.

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But I think more importantly, about six months after that, one of my closest friends was hit by a car and killed.

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So once we got through that, it took a few years of my own grief and mourning process.

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Well, then, my family started to lose individual members over the course of the next 10 to 12 years.

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And so we averaged about one loss every other year during that time.

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And for me, you know, my maternal side of the family was very close.

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I mean, I knew aunts, uncles, great aunts, great uncles, great grandparents.

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You know, I grew up spending the night at my great grandparents house on Friday nights and watching TV.

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So we were very close and so there was a long span there of a lot of loss.

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And so over the years that just kind of stuck with me, I really didn't know what it meant other than the fact that, well, maybe we're unlucky ones and just experiencing a lot of loss.

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And then my dad was diagnosed with cancer and he battled that for about six years.

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And in 2017, he passed.

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My dad was a Methodist minister, and I remember that going into hospice care in the last week of his life, he was counseling one of his church members who had just lost a spouse.

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After his death somewhere along the way, it just hit me one day, I want to go into counseling, and I want to go into grief counseling specifically.

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So I think it was just that culmination of all of those years of loss and just built up.

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And then one day you had the epiphany.

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Yeah, and I think that a lot of us in helping professions have had some personal experience with the people that we want to help.

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It's almost like our work help.

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We're trying to help perhaps younger versions of ourselves go through things that maybe we didn't have access to or had access to growing up.

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But that's quite a lot of loss within quite a long span of time.

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So thank you for sharing that.

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And one question that.

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I feel like I get asked a lot is, you know, how is grief different from say depression?

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When should people see a grief counselor?

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You know, grief has depression in it.

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You know, we think back to Elizabeth Kubler -Ross's stages of grief and depression is one of those.

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But there is a clinical depression as well.

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And, you know, I think that there's a lot of similarities between the two when we look at symptoms.

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And it gets really difficult sometimes to tease the two out.

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I mean, sometimes it feels like splitting hairs a little bit.

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I think the first thing to do is really think about depression and grief and what that is.

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And really it's just, it's pain and they're suffering in that.

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Our society, we're very grief avoidant and we're pain avoidant.

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And so we tend to automatically think anything other than grief is the cause.

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But it's really, it's normal and necessary.

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And it's part of that process of grief and mourning.

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But I will say that sometimes that depression and grief, it can become disabling enough to become a clinical depression.

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That clinical depression can then block our grief healing.

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But I think that there's a few areas to pay attention to when we think about the differences between the two.

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So, In grief, there's guilt over some aspects of the relationship or the circumstances surrounding the loss.

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People often experience sort of a temporary drop in self -esteem, but it's not chronic worthlessness.

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So to simplify that, you know, we're thinking, you know, grief, depression, you may feel guilty and hopeless for a while.

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But with clinical depression, people often experience an ongoing hopelessness and a low sense of self -worth.

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And I think another way to consider it is how long the feelings last and to what extent they affect the daily activities and things.

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So grief will soften over time, whereas clinical depression will not.

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That's a helpful distinction.

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And I feel like when we're talking about how long people grieve, I feel like there's probably no set limit or no set time to grief.

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And I know in my own experience with grief, it seems to have different intensities, but the grief kind of is always there.

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And I appreciate you kind of bringing that up because, I feel like we are a very grief avoidant society and so dealing with paying or the paying of losing someone is difficult to talk about.

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Yeah, well, I appreciate you mentioning the timeframe too, because culturally, I think that there's this idea that once we hit six months, we should be over our grief.

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We hear those messages all around us from family members that are well -meaning.

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We see it on TV.

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Even our doctors, sometimes who aren't so grief -informed, will kind of push us along.

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I have a story that I did.

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tell that is related to one of my clients who, about a year in, went to see his primary care physician.

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And, you know, he was feeling a little sad, obviously still.

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He lost his wife, went in and the doctor said, well, how long has it been since she died?

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He said, well, it's been, it's been over six months, closer to a year now.

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He said, wow, you ought to be over that by now.

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Here, let me prescribe you some medication.

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Luckily, this particular client I had been seeing for a long time and he knew the difference and rejected the medication at the time.

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But he was able to tell the difference.

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But I don't want that to sound like I'm against medication for depression either.

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I think the medication is very helpful in the right circumstance.

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So what does it mean to be grief informed?

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How could a helping profession be grief informed?

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So to be grief informed, it's really just about understanding the need for the pain, right?

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And understanding that there's no timeframe, understanding that people are going to respond to grief in a lot of different ways, you know, as individual as we all are, the way we respond.

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And so it's really just kind of taking the time to step back.

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And if you're someone that's working within a medical model to kind of take a step out of that and think from a more human perspective for a few moments and a less scientific perspective.

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And there's tons of books out there now.

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Dr.

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Alan Wolfelt has lots of information on grief and understanding grief.

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And so I think just taking the time to really tease out.

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you know, what's a human response to a loss versus going clinical immediately can be helpful.

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Gotcha.

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And can you describe to us just kind of in general terms, the different phases of grief and how do we think about this process of grieving over time?

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Sure.

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Well, you know, we think about Dr.

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Kubler -Ross's stages of grief.

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And the one thing about that, that, you know, I'm appreciative of her for the fact that she got people talking about grief.

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However, these stages have really almost become a problem over time because people think of them as linear.

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And so they think, okay, I'm going to go through anger, right?

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And then I'm going to go through denial and I'm just going to be bargaining.

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and reconciliation finally, you know, in the end.

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But that's not really the way grief works.

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If we think of grief like a bowl of spaghetti, right?

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It just intertwines, it weaves in and out.

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That's very much what grief is like, the emotions of grief.

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And there's a lot of different things that come about, a lot of...

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A lot of feelings that come about out of nowhere.

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So we call those grief bursts.

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And those are things that are going to happen for our entire life.

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You know, they come at different times, they come in waves.

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And so we're going to have to kind of experience those for what they are.

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And the importance is taking the time to really sit with those emotions and not brushing them aside.

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Yeah.

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So I think sitting through those emotions is really difficult and it feels incredibly painful in a moment.

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And I also know that people can grieve people before they lost a loved one or that they're grieving the possibility of what it could have, relationships that are not the way you want it to be.

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So I guess my question is, can we talk a little bit about grief and how does that impact grieving of someone who say might have cancer or might have dementia where the person is there, but the relationship has changed or somehow it almost feels, I don't know how you think about it, but I think of it as a little even more complicated than grieving someone who has died in.

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Yeah, that's a great question.

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And so what you're referring to as anticipatory grief.

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And there is a lot of difference between grieving a person who died because there's the event, right?

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And then we're going to grieve that, and we're going to take our time to process that and hopefully actively mourn that loss and that process.

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But with something like anticipatory grief, you're grieving the losses that you've experienced now.

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and you're grieving the losses that you know are going to come.

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And we particularly see that in diseases like cancer or dementia.

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And so the difficulty there is you're kind of grieving two things at once.

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Now, one thing that people tend to, I guess, misunderstand with anticipatory grief, is that it's like, okay, well, I'm grieving now.

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So therefore when the loss actually happens, I won't grieve anymore because I will have grieved all of this time leading up to that death.

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When in actuality with the death, you start grief all over again.

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It's new grief.

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And so that is very difficult for people to wrap their heads around oftentimes because then it's like, oh gosh, how long am I gonna be grieving?

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you're going to literally grieve the rest of your life.

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It's just how you can bring that into your life and how you can incorporate that into your daily existence.

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And then, you know, there's another experience within grief that we look at called ambiguous loss.

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And we specifically see that a lot in dementia, you know, where you've got the person right in front of you.

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They're standing there and you can see them, but it's not the same person.

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that you've known and that you've lived with for years and that you've loved.

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And so that in itself is a loss that we have to grieve as well.

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Yeah, it definitely gets complicated.

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So how does a grief counselor help people who are grieving?

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A big part of what I do and what my colleagues here do at Work in Grief is it's really about what we refer to as sort of a companioning.

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And this kind of goes back to Dr.

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Alan Wolfelt and his Center for Loss and what he teaches in his companioning model.

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And so this companioning model is something that you can use whether you're...

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a trained counselor or just a lay person, you know, trying to support her friend.

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And it's really kind of simple.

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You know, there's not specific skills that you need to learn or anything for that.

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It's just about being human and being present to the mourner.

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Right.

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There's this idea that, you know, we want to be empathetic and good listening here.

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We're going to focus on their grief and not make it about us.

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and what we think.

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And then we're not trying to fix anything because there's nothing to fix in grief.

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You know, there's nothing to treat.

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It's just a human emotion we need to get through.

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So there's lots of different trainings you can take with a mole cell and some of these others that can get you to this idea.

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But the basic ideas of being a companion are again, just walking along beside somebody and not leading them, not being afraid of silence.

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You know, sometimes a person doesn't need you to say a lot.

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They just need to know that you're there, right?

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We're not going to analyze them and we just want to listen compassionately.

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Don't assume that we know what someone is experiencing.

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You know, just because maybe we've had a similar loss, that doesn't mean that we understand exactly what they're feeling.

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And then just remembering that it only takes a minute to be compassionate for someone.

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And that can really change the course of their grieving as well.

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And then there's this idea of knowing what to say and what not to say to people.

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We want to be careful about those things.

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Listening, just saying I'm sorry.

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If you don't know what else to say, say I'm sorry.

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You can't say that enough.

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Things like, I wish I had the words right now, but just know that I care and that I'm here for you.

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Things like that can be really helpful for folks.

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And then things not to say, or like these platitudes that we hear, you know, or, oh, I know how you feel, or, oh, they're in a better place now.

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That can be very difficult.

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And that's not to say, for some people that can be helpful.

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It all depends on your spiritual or religious views.

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And so all of these are generalities, but we just want to keep them in mind as we talk.

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So, you know, things like, oh, it was their time to go, they did what they were here to do.

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Those are all things that can be really invalidating to the person who's experiencing the grief.

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And then I think another one, just there's a reason for everything.

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Again, that's something that can be invalidating.

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So, you know, kind of know who you're talking to.

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And if you're fully aware of what their beliefs are, then some of these may be appropriate.

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We want to be careful not to invalidate someone's feelings.

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Let them know that all of the emotion you're feeling, you know, it's valid.

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are there, but you're not trying to fix the situation.

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And sitting with someone in the pain of grieving is really difficult.

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It's kind of like, don't do anything, just stand there.

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Yeah, it's like, but I want to take this pain away, but-huh.

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Right.

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guess I think of grief is kind of like the other side, the other side of the coin of love, like the stronger the love is, the longer and more painful the grief.

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And so I don't know, I try to think of that as, is kind of like, this is the expression of the loss of love or and of that relationship.

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Yeah, and that's difficult too as a friend or a family member to reach out even though you don't know what to say.

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And I think a lot of people don't reach out because they don't know what to say.

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Right, there's a lot of that, you don't know what to say.

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People tend to not like to be uncomfortable.

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And sitting with someone in pain and in grief is not comfortable at all.

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And so just finding your way to be there and just let them know that you care can make all the difference.

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And again, just sitting in silence, not being afraid of that silence and feeling like you need to feel every space with words.

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handle kind of the being empathetic but not taking on someone's pain?

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If that makes sense.

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Because I think, yeah.

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No, I think this is across a lot of different helping disciplines.

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It's like, we wanna be compassionate and we wanna be empathetic, but there's also a part where...

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If you're totally in the grief and the pain with someone, then I'm not sure how long you can be helpful before it consumes you.

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Right.

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And, you know, it's funny how often I hear that even from my clients.

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They say, well, I don't know how you do this every day.

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And you sit and listen to people all day long and how you do that.

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Honestly, there's a certain part of it that I don't really even understand for myself.

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You know, I think maybe that's part of the being groomed that happened for me over the years.

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I think that there's...

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There's a part of that, just the empathy that I have naturally that allows me to, you know, sit with people and carry that without internalizing it completely.

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Obviously, there's going to be certain losses that hit harder, certain stories that hit harder than others.

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I imagine just like a lot of folks in helping professions, you know, there's a certain amount of compartmentalizing that happens.

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We tend to do that just to get through.

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But the key really beyond just sort of our natural ways of being is to care for ourselves.

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And so we hear the buzzword self -care is everywhere nowadays.

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But there's truth in that.

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And so it's finding, for me, it's finding the things that allow me a physical release.

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It allows me that emotional release as well.

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And part of that for me is allowing myself to feel the emotions that come about and sitting with those too.

00:22:24.955 --> 00:22:32.763
So there's really a lot that goes into that, but I think it's just really being present and mindful of our own needs that can make the difference.

00:22:32.763 --> 00:22:39.832
to read more about grief or how to get through grief, what are some resources that you recommend?

00:22:46.980 --> 00:22:54.440
But I definitely recommend, and I don't want to sound like I'm really pushing Dr.

00:22:54.440 --> 00:23:02.650
Wolfelt's stuff here, but honestly, he's written so many books on every possible topic related to grief and loss.

00:23:02.650 --> 00:23:08.700
So I think that that's a great place to start with the centerforloss .com.

00:23:09.359 --> 00:23:15.440
And you're likely to find all sorts of resources that might be.

00:23:16.324 --> 00:23:18.723
more specific to your needs.

00:23:18.844 --> 00:23:28.663
There's lots of other folks too, you know, Claire Bidwell Smith, you know, she handles a lot with loss of a mother, because she lost her mom when she was a teenager.

00:23:28.663 --> 00:23:32.943
And so she deals with a lot of that and a lot of anxiety related to loss.

00:23:33.044 --> 00:23:35.683
David Kessler has some books as well.

00:23:35.683 --> 00:23:43.076
He wrote along with Elizabeth Kubler-Ross, you know, the book on grief and grieving.

00:23:43.076 --> 00:23:47.435
and sort of applying the stages of loss that she created to grief.

00:23:47.435 --> 00:23:50.675
And so there's some good information in that as well.

00:23:51.496 --> 00:23:58.576
And so I think, and then you have a lot of sort of lesser known folks out there too, writing some really, really great books.

00:23:58.576 --> 00:24:04.675
So I think just kind of go on and searching for what resonates with a person that can be helpful.

00:24:04.675 --> 00:24:11.107
There's lots of books out there that have sort of activities and skills to help a person.

00:24:11.107 --> 00:24:15.508
actively mourn someone who maybe feels stuck and like they're not progressing.

00:24:15.508 --> 00:24:17.988
There's a lot of great books that can help with that.

00:24:17.988 --> 00:24:18.175
So.

00:24:18.175 --> 00:24:25.624
you tell us what are some activities, what are some examples of activities that help people actively grieve?

00:24:32.963 --> 00:24:33.653
Yeah, sure.

00:24:33.653 --> 00:24:42.344
Actually, I have a book here and it's by Megan Devine, D -E -V -I -N -E.

00:24:42.344 --> 00:24:47.084
And she put together a book, How to Carry What Can't Be Fixed.

00:24:47.084 --> 00:24:55.523
And this book is just full of activities and exercises for facilitating mourning.

00:24:55.723 --> 00:24:56.213
Dr.

00:24:56.213 --> 00:25:02.692
Wolfelt has a lot of packets as well on his website related to see, sorry.

00:25:02.692 --> 00:25:08.672
specifically to activities to help facilitate mourning.

00:25:10.031 --> 00:25:28.809
I think this how to carry, I think it's how to carry what can't be fixed is probably one of the better resources I've seen in a while just because it really, I think it touches so many different activities and most people are sure to find something in there that's gonna be helpful for them.

00:25:36.355 --> 00:25:40.155
Yeah, journaling, list making is a big part of it.

00:25:40.155 --> 00:25:43.875
Sometimes it's in this how to carry what can't be fixed.

00:25:43.875 --> 00:25:49.816
There's some drawing that comes so you can bring in art to help facilitate mourning.

00:25:49.816 --> 00:25:55.056
There's really lots of ways that people mourn and it's not always just crying.

00:25:55.516 --> 00:26:00.135
We think about journaling as a big one, but there's other ways to do that.

00:26:00.135 --> 00:26:05.243
And that can be through art, through music, can be through communing with nature.

00:26:05.508 --> 00:26:07.387
and exercise.

00:26:07.607 --> 00:26:13.980
So sort of reframing the way we think about our morning can help us find new activities as well.

00:26:14.983 --> 00:26:16.384
Thank you.

00:26:21.124 --> 00:26:22.905
Well, thanks for having me on.