There’s a subtle stigma associated with those who don’t love the holiday season. Look no further than “A Christmas Carol” and “The Grinch Who Stole Christmas.” “How can anyone resent this, the most wonderful time of the year?” some wonder. “Their heart must be two sizes too small!”
Heart size notwithstanding, the holiday season is far from the most joyous time of year for many. For those navigating grief during the holidays, the contrast between public merriment and private feelings of grief, loneliness, and loss can feel especially sharp.
Recommended course: Loss, Grief and Bereavement, 5th Edition
The journey of grief
Everyone grieves differently. Whether due to the death of a loved one, a terminal diagnosis, or the loss of a relationship, grief is a natural part of the human experience. Grief is as complex and varied as those it affects.
Understanding the grieving process is a critical aspect of patient care and something with which all clinicians should be familiar. Grief is a total-person emotion, blending physical, emotional, cognitive, behavioral, and spiritual reactions into a multifaceted experience of loss.
When the cause of grief is death, four primary factors influence the grieving process, including:
- The circumstances related to the person’s death (sudden vs. expected, violent vs. peaceful, suicide vs. homicide vs. natural causes, etc.)
- The bereaved person’s relationship with the deceased (close vs. estranged, etc.)
- Social and economic stressors (isolation due to quarantine, inability to be with their loved one before passing, secondary loss, financial hardship, etc.)
- Mental health issues
Theories of grief
Elizabeth Kübler-Ross’ famous Five Stages of Grief (denial, anger, bargaining, depression, and acceptance) tracks a general, if not universal, emotional pattern for grief. Each stage may be uniquely affected by factors related to the loss.
However, this approach assumes a linear progression through each stage, while in reality, grief — like every other human emotion — rarely sticks to a schedule. Psychologist J.W. Worden later proposed a cognitive-behavioral approach to grief that focuses instead on “tasks” each bereaved person must complete, including:
- Accepting the reality of the loss
- Processing the pain of grief
- Adjusting to a world without the deceased
- Finding an enduring connection with the deceased while embarking on a new life
Alternately, clinical psychologist and thanatologist Therese Rando has proposed a process model, which groups six “R” tasks of grieving within three larger phases:
- Avoidance phase: Recognize the loss and experience the pain of that loss.
- Confrontation phase: First, react to the separation. Second, recollect and re-experience the relationship with the deceased. Third, relinquish old attachments to the deceased.
- Accommodation phase: Readjust to a world without the deceased and reinvest in new relationships while accepting the changes caused by the loss.
Handling grief during the holidays
Theories of grief and models of grief processing patterns are useful for clinicians, but remember: They are descriptive, not prescriptive. Several steps, stages, or processes may occur simultaneously, and patients may see recurrences at significant times throughout the year — especially during the holiday season.
Those who’ve suffered loss may feel the grief more keenly during the holidays, as their loved ones are no longer there to celebrate with them. Long distances may keep families separate for the holidays, even when there hasn’t been a death. The loss of that time together, while it may seem small in comparison to the loss caused by death, can trigger similar feelings of grief.
As someone entrusted with the care of a bereaved patient, what’s the best way to help a patient cope with grief during the holidays? As in any relationship, communication is key. For clinicians and patients, therapeutic communication is vital. This includes any communication practice that promotes the patient’s comfort, safety, trust, or health and well-being.
Bereaved individuals may be struggling to make meaning of their loss, especially when they feel belittled, invalidated, or unsupported in their grief. For some grieving patients, simply having someone present is a comfort. For others, hearing a clinician ask meaningful questions about their loved one may help process their grief.
Additionally, a patient’s personal, religious, and cultural beliefs about life and death are important to keep in mind, as these will likely inform their entire grieving process. Leave judgment at the door, listen attentively, and above all, support them with compassion.
