Growth During Grief
By Scott Janssen, MA, MSW, LCSW
Social Work Today
Vol. 23 No. 3 P. 14

Bereavement can become a time of positive change.

For months after her daughter Millie died from cancer, Cheryl struggled with intense anger and sadness and she had a hard time concentrating and sleeping.

“I was so disoriented,” she recalls, “I had no idea how to be in the world. Nothing made any sense. I thought about her all the time, yearning to see her again and give her one more hug. I blamed myself for not being able to protect her from the suffering she went through. There were even days I thought I was losing my mind.”

One day, after walking in a wooded area, she paused to sit on a bench by a small pond. “I’d been talking to Millie as I walked, crying and telling her how much I missed her. I felt dead inside.”

Suddenly, she noticed how good the warmth of the sun felt. “I became aware of birds singing, dragonflies flying above the water’s surface, squirrels running around in the trees. I could feel all this life around me and was keenly aware of how precious it all was. It was the first time in months I felt a sense of peace, like my heart, which had been so heavy, was starting to open to the world around me in a way it had never done before. As I felt compassion for all this life, I started feeling compassion for myself.”

Looking back, Cheryl came to understand these moments as part of a process of personal growth that slowly emerged within the context of her shattering grief—a process that, as she saw it, eventually altered her sense of what was important and meaningful in life, changed her values, and deepened her empathy for those who are suffering.

Grief and Bereavement Can Lead to Personal Growth
Social workers counseling grieving clients often focus on helping them accept the reality of a loved one’s death; normalize, manage, and process intense emotions; and gain perspective on troubling thoughts and beliefs. As the deeper meaning of a loss is discovered, social workers might help clients optimize existing strengths and supports and learn new strategies, such as mindfulness, cognitive reframing, or somatic awareness.

Typically, goals include helping clients integrate the loss, conceptualize and assimilate ways that enduring bonds with the deceased can be expressed, and reengage in important relationships, roles, and responsibilities.

Though many models of grief counseling recognize that one of the challenges or tasks of bereavement includes establishing a new or altered sense of self in the absence of a deceased loved one, they typically do not focus on the kind of psychological and emotional growth described by Cheryl.

Ting Guan, PhD, an assistant professor at Syracuse University’s School of Social Work in the David B. Falk College of Sport and Human Dynamics, points out that “while grief and bereavement can be associated with negative psychological and emotional states, research has shown that some grieving individuals may also experience personal growth, often referred to as posttraumatic growth, benefit finding, stress-related growth, or adversarial growth.”

She says that “personal growth following grief or other challenging life experiences can occur in various domains, including changes in self-perception, such as feeling stronger or more confident; relationships with others, such as establishing closer bonds with family and friends; and philosophy of life such as accepting new possibilities and finding new meaning and purpose.”

Brian Ballantine, MDiv, BCC, a clinical chaplain with University of North Carolina Hospice, agrees. “People who are grieving need to find new ways of being and engaging with the world. In some cases, this can lead to tremendous personal growth.”

He says such growth “can look like mundane and ordinary things like getting more in touch with your feelings while continuing to be open to other people and relationships. It can also look like taking on new responsibilities within your family structure. There’re lots of opportunities to do hard things as part of the grieving process that can lead to emotional and relational growth.”

Kenneth Doka, PhD, a pioneer in the field of grief counseling, puts it this way:1 “Loss challenges our assumptions about the world. If we are to reconstruct our world—to survive—we need to reexamine both how we look at the world and how we function within that new world. From that reassessment comes growth.”

When such growth occurs, a client might, “emerge with a greater appreciation of life. Realizing how fleeting life can be, we can have an increased appreciation for the relationships we have. Our priorities may change. We realize that no one dying ever regretted the fact that they should have spent more time at work or on the internet.”

Doka has also found that “our spirituality may deepen as we struggle with our faith. We may emerge with a spirituality more complex than we once had. We may recognize that we are stronger than we thought—after all, we survived this loss. We may find we have new skills—talents that had to be honed as we struggle to survive in a new reality.”

Studies have confirmed the potential for personal growth during periods of grief and bereavement.2-5 Research by Tedeschi and Calhoun6 suggests that there are five core areas of potential growth following a loss or psychological trauma: appreciation of life, relationships with others, new possibilities in life, personal strength, and spiritual change.

These dimensions have been corroborated by others. Tan and Andriessen, for example,7 found that many grieving subjects reported positive changes “in caring for others, perspective on life, views of themselves, discovering of new possibilities, and valuing others and relationships.”

For Some, the Idea of Growth During Grief Can Seem Counterintuitive
For social workers attuned to these possibilities, there are strategies and interventions that can help clients identify, explore, and integrate aspects of their grief that may become personally transformative. But it’s important to gauge a client’s level of receptivity to these ideas when inviting growth-related reflections.

For clients who are grieving or who have survived psychologically traumatizing events, the idea of these being potential avenues for growth may seem counterintuitive, given the pain and disequilibrium they are experiencing.

For some, suggesting the possibility that there may be opportunities for positive change within the context of their suffering, or introducing this idea too soon, can feel invalidating or come across as out of sync with their experience.

“Grief is often seen as a bad thing,” Ballantine notes, “and people don’t tend to view bad things as opportunities for personal growth.”

He’s found that any positive changes in a client’s values or perspective usually occur after a protracted period of emotional and psychological struggle. “Initially, grieving clients may retreat into themselves to find new ways of existing and being without a person that was an influential part of their life. It’s a process that takes time and, I would argue, is never fully finished.”

Susannah Kate Matthews, MSW, LCSW, a clinical instructor at the University of North Carolina School of Medicine, notes that “some clients resist the idea that grief can contain seeds for growth because they assume that ‘growth’ necessitates the erasure of the relationship itself. This can seem like an insult to the loved one who has died, as if we must ‘get over’ the loss in order to grow.”

According to Guan, “Some people assume that a negative state cannot coexist with positive thoughts and feelings. Thus, in the context of negative events like the death of a loved one, expressing positive thoughts and feelings may be viewed as an illusionary response, as if the individual is denying the event or its impact.”

Because grief is a highly individualized experience, Guan says, “It is important for clinicians to carefully assess the level of grief and consider the potential for personal growth on a case-by-case basis, and tailor their interventions based on each person’s unique needs.”

This includes keeping in mind that while “most bereaved individuals are expected to adapt to the loss over time, a significant minority may experience prolonged grief and present with abnormally persistent symptoms.” Some may even be at risk for moral injury, prolonged grief disorder, PTSD, or depression.

When areas of growth do emerge, these will likely coincide with ongoing bereavement-related challenges. Just because a client can identify new insights or positive changes in their priorities does not mean they no longer need to cope with the emotional pain of a significant loss.

The dual process model of bereavement8 offers a way of understanding this seeming paradox. It conceptualizes grief and bereavement as an ongoing, dynamic process in which vacillations between loss-oriented and restoration-oriented stressors and challenges occur over time.

Thus, a grieving client might find herself feeling overwhelmed or experiencing distressing, intrusive memories. She may struggle with social anxiety, self-criticism, or fears about the future. At the same time, she may be gaining confidence in her inner strengths and capacity to make decisions under duress or to successfully navigate the stress of being a single parent after the death of a spouse.

Fostering Growth by Facilitating Meaning-Centered Conversations
According to Ballantine, one of the challenges for social workers attuned to the prospect of personal growth in grieving clients is that “people put a lot of pressure on themselves, and get corresponding societal messages, to ‘hurry up’ and get well. But you cannot rush grief.”

He finds Lois Tonkin’s model of bereavement9 helpful. “Tonkin argues that grief is never really finished, so much as a bereaved person grows around their grief; not that the hole the loss created is ever entirely filled, so much as other things take up space around it so the loss is easier to carry.”

Mathews agrees and notes that since grief-related growth can take months or even years to emerge, it can be difficult for social workers practicing “in health care and mental health systems where a focus on profit or cost management, high caseloads, and pathology reign supreme.”

These systems often demand quick results and tie counseling services to a mental health diagnosis. This can leave “little time or room for relational, creative, and holistic care in grief and bereavement work or for fostering healthy change.”

Mathews suggests taking a strengths-based approach focused on a therapeutic relationship, patience with the grieving process, and trust in a client’s capacity to handle adversity and gain wisdom. “As a clinician, I have found inspiration in the work of Alan Wolfelt, PhD.10 This therapeutic approach entails being present with the griever’s pain as opposed to trying to take it away. It is about stepping down from the pedestal of ‘expertise.’ It is about bearing witness to each individual’s capacity to self-heal, with compassion and curiosity.”

Much of the initial work of counseling will necessarily focus on developing a safe, therapeutic connection and helping clients stabilize intense emotions, manage troubling thoughts or beliefs, engage in self-care, and begin to find words for what is happening as they learn to navigate the world in the absence of a deceased loved one.

But it’s never too early to identify and reinforce a client’s existing strengths. Doing so can enhance a sense of self-efficacy and infuse self-narratives with an emphasis on one’s capacity to cope and successfully adapt. Over time, these strengths, or others that develop or emerge, may become spurs or supports for growth.

Psychoeducation is often an important part of grief counseling, giving clients information about the grieving process and normalizing or destigmatizing things that may be normal parts of bereavement. “When initiating grief work with clients,” Matthews says, “it is important to provide education about grief, including dispelling the myth that healing must mean methodically and neatly traveling through the so-called stages of grief. We are here to walk alongside the client as they navigate the stormy seas, the chaos and wilderness of grief and loss, not to push people into conceptual boxes.”

Depending on the client, education might include mentioning that, despite the intense pain and confusion of grief, some people report that, over time, it can “lead to growth, gratitude, and increased awareness of the preciousness and meaningfulness of life and our relationships with others. It can give us insights into what really matters to us.”

For Mathews, a central component of grief counseling is fostering, “conversations that facilitate storytelling and meaning-making.” One model of bereavement that anticipates the importance of these kinds of meaning-centered conversations is Gillies and Niemeyer’s meaning reconstruction model.11

In this approach, bereaved individuals engage over time in three core areas as they adapt to and integrate a loss: making sense of the loss, in which old assumptions about one’s world and social systems are questioned and in which new ones may emerge; finding benefits, which involves a reappraisal of events and the discovery of meaning and lessons learned; and identity change, which refers to new goals and priorities and an altered sense of self.

One way of helping clients find new stories and meaning, or to assimilate painful events into existing narratives or meaning systems, is to ask open-ended questions.

Examples of the kinds of questions Matthews has used to explore for growth (but that might also reveal areas of struggle), include the following:

• What does this loss tell you about what matters most to you?

• What gives you a sense of hope?

• What story would you like to tell about this experience of loss?

• How can you allow these painful emotions enough room to transform into something else?

• How would you characterize your relationship with grief? What relationship would you prefer to have with it?

• What would you say to a friend who is experiencing as much pain as you are now?

As clients reflect on experiences during psychotherapy or grief counseling, social workers may also notice and ask about material that suggests opportunities to shift or expand their perspectives in positive ways. This, in a sense, consciously brings these experiences into a client’s awareness so they can be incorporated into a larger narrative.

When Cheryl mentioned her experience beside the pond to her bereavement counselor, for example, she was able to explore its deeper meaning and begin using these insights as reference points for changes occurring inwardly, such as her deepening compassion for herself and others as well as a growing desire to be of service.

Grief-focused psychotherapy may also be effective in fostering posttraumatic growth. Matthews uses acceptance and commitment therapy, narrative therapy, and expressive arts therapy in her work with bereaved clients. “Both narrative therapy and acceptance and commitment therapy can help support externalizing conversations with clients so that they can begin to identify as individuals experiencing grief, rather than solely or overly identifying as the griever.”

Guan says that “while psychological interventions for grief were not originally designed to specifically target personal growth as the primary outcome, a meta-analysis study has suggested that these interventions can still have a moderately positive effect on posttraumatic growth.12 For instance, cognitive behavioral therapy can help individuals confront and reframe dysfunctional beliefs, engage in self-reflection, and process the event cognitively, leading to a greater openness to new possibilities.”

While being alert for indications of, and opportunities for, growth can enhance a social worker’s practice with grieving clients, it’s important to remember that personal growth does not always ensue from the suffering of grief and bereavement. Not every client will change in ways that are life enhancing. Even those who do may consider it insufficient compensation compared with the enormity of their loss.

Others may change in ways that reinforce or extend their suffering, for example, becoming less trusting, experiencing a loss of self-worth, or becoming entangled in cycles of guilt or shame.

Matthews cautions that, “For clinicians whose work includes using a growth lens, it’s important to meet clients where they are and not put subtle or inferred pressure on them to grow and change.”

But when used appropriately, having a “growth lens” can deepen and expand a social worker’s practice in meaningful ways. “Thinking in terms of metaphors,” Matthews says, “I liken this kind of growth through suffering to the century’s old Japanese art of Kintsugi in which broken pottery is repaired using a cohesive compound dusted with gold. This highlights the cracks, embracing our wounds, not denying them, being transparent about ways we have felt broken while also creating something that is whole again and even more resilient and beautiful.”

— Scott Janssen, MA, MSW, LCSW, is a hospice social worker. He frequently writes about issues related to PTSD and is a member of the National Hospice and Palliative Care Organization’s Trauma-Informed Care Work Group.

References
1. Doka KJ. Can grief be an impetus to personal growth? Psychology Today. May 23, 2016. https://www.psychologytoday.com/us/blog/good-mourning/201605/can-grief-be-impetus-personal-growth

2. Levi-Belz Y. Stress-related growth among suicide survivors: the role of interpersonal and cognitive factors. Arch Suicide Res. 2015;19(3):305-320.

3. Calhoun LG, Tedeschi RG, Cann A, Hanks EA. Positive outcomes following bereavement: paths to posttraumatic growth. Psychologica Belgica. 2010;50(1-2):125-143.

4. Engelkemeyer SM, Marwit SJ. Posttraumatic growth in bereaved parents. J Trauma Stress. 2008;21(3):344-346.

5. Yalom ID, Lieberman MA. Bereavement and heightened existential awareness. Psychiatry. 1991;54(4):334-345.

6. Tedeschi RG, Calhoun LG. The posttraumatic growth inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471.

7. Tan J, Andriessen K. The experiences of grief and personal growth in university students: a qualitative study. Int J Environ Res Public Health. 2021;18(4):1899.

8. Stroebe M, Schut H. The dual process model of coping with bereavement: rationale and description. Death Stud. 1999;23(3):197-224.

9. Tonkin L. Growing around grief – another way of looking at grief and recovery. Bereavement Care. 1996;15:1.

10. Wolfelt A. Companioning the Bereaved: A Soulful Guide for Counselors & Caregivers. Companion Press; 2006.

11. Gillies J, Neimeyer RA. Loss, grief, and the search for significance: toward a model of meaning reconstruction in bereavement. J Constr Psychol. 2006;19(1):31-65.

12. Roepke AM. Psychosocial interventions and posttraumatic growth: a meta-analysis. J Consult Clin Psychol. 2015;83(1):129-142.