Peer Perspectives

A Grief Trajectory

By Lisa S. Zoll, LCSW

According to Fredrik Backman in A Man Called Ove, death is a strange thing. It is also perplexing, puzzling, and mysterious. It is a unique and unpredictable process for each person, and responses are highly personal. There have been scholarly attempts to put the process into stages, states, and tasks. While these efforts provide a roadmap for clinicians who treat individuals experiencing grief, there is little that can be done to harness the grieving process into a straight path that can easily be followed by those who grieve.

There are multiple definitions of grief that range from simplistic to complex. In Treatment of Complicated Mourning, Therese A. Rando defines grief as “the process of experiencing the psychological, behavioral, social and physical reactions to the perception of loss.” A more complex definition suggests that grief is a multifaceted response to loss, particularly to the loss of someone or something that has died, where a bond or affection was involved. Although conventionally focused on the emotional response to loss, grief also, according to Vuurden Psychology, has physical, cognitive, behavioral, social, spiritual, and philosophical dimensions.

The definition of grief that will be used in this article is that grief is a response to the loss of someone, something, or somewhere where a significant and emotional bond has been formed. This may include a tragic death, a divorce, a loss of a job, or a move from a beloved home.

Regardless of the definition, common reactions to grief include, but are not limited to, sadness; longing; missing the deceased; nonacceptance of the death; feeling the death was unfair; anger; feeling stunned, dazed, or shocked; emptiness; preoccupation with thoughts and images of the deceased; loss of enjoyment; difficulties in trusting others; social impairments; and guilt concerning the circumstances of the death.

Many scholars of thanatology have proposed that grief can be put into linear stages, that there are specific tasks that one must complete, or that there is a predetermined process to grieving. More recently, the transtheoretical model of change—encompassing emotions, attitudes, intentions, behavioral processes, regression, and maintenance—has been applied to the process of grief. While these approaches attempt to define the experience and process of grief, there are shortcomings to any model that tries to make grief an orderly and definitive process or experience. Therefore, a new model, comprising event grief, working grief, and forever grief, will be explored as a possible trajectory of grief. No timeframe is imposed on achieving these stages.

Case Illustration: A Woman’s Experience Through the Trajectory

Lynn Shiner experienced a tragic and traumatic loss when her ex-husband murdered her two children, Jen and Dave, on Christmas Eve 1994. In her book, Stabbed in the Heart: Three Murdered Children, Two Resilient Mothers, she tells the story of her grief event that began 23 years ago, the work of grief that she has done, and her forever grief, which she continues to live with today and will continue to live with in the future. She found it difficult to place herself in any stage of grief, to find any form of closure as it related to the loss of her children, or to fit her experience into any model that was presented to her in her grief counseling. She believed that she was not meeting the expectations of the parameters set by clinical models, resulting in additional feelings of anxiety and inadequacy. Shiner believed that her experience could best be expressed in a trajectory: the event, the work, and the never-ending process of grieving the loss, thus removing stages, expectations, order, and timeframes.

The event grief. Their father stabbed Jen, 10, and Dave, 8, to death. Shiner’s response to this discovery resulted in an initial physiological reaction that included numbness, vomiting, wailing, racing heart, chest pains, and uncontrollable shaking. In the days that followed, she experienced suicidal thoughts along with an intense yearning to be with her children. She existed in a “zombielike” state where she experienced panic attacks, anxiety, confusion, fear, and a complete loss of control of daily life. Grief stripped away her independence, beliefs, confidence, self-esteem, and hope, leaving her vulnerable, exposed, and dependent on others. She felt incapable of decision making. The visions of the event and memories of her children were overwhelming; the “what-ifs” were endless.

The work of grief. In the beginning, grief controls the griever; over time the griever begins to have some control over the grief by doing the hard work of grieving. It is an engaging process in which the griever must actively participate. After the initial event, Shiner was stripped of her life as she knew it. She began to move forward slowly with the support of her boyfriend, who listened to her telling and retelling the story daily in all its painful aspects and who helped to keep her from ending her life. She returned to her job after three weeks to provide some routine and structure to her life, even though her ability to fulfill her role was compromised. She began seeing a psychologist twice a week. She surrounded herself with a small support system of people whom she knew that she could trust, assessing each person based on whether she felt safe with them. Additional work involved coming to terms with her spirituality, asking, “Why would God allow something like this to occur?”

The work of grief in Shiner’s case involved keeping the deceased in her life, talking about them, talking to them, sensing their presence, and deciding how her relationship with them would continue. In searching for meaning in her loss, she became an advocate for children and crime victims, spending most of her career strengthening legislation, technology, and policies that would support victim services, including the passage of the Jen and Dave Law. Initially, her motivation for her work was her own survival, not realizing the impact that her efforts would have on others. The work that she was doing would ultimately rebuild what was stripped away from her by tragic loss.

The forever grief. Shiner’s grief work continues into this aspect of the trajectory. While she has periodically experienced upsurges of her grief (e.g., Christmas, Mother’s Day, birthdays, graduations, and weddings) the intensity and duration of the feelings are diminished and the grief no longer consumes or controls her life as it did in the previous stages of grief.

With Nancy Chavez, she coauthored Stabbed in the Heart, a book that describes her experience from the event grief to the forever grief. The book became a way for her to, not only memorialize her children and describe the important role of community, but to share her journey of resilience, endurance, and life beyond the loss of Jen and Dave. Her memories of her children have become fond and comforting rather than painful and have given her a sense of joy and hope. Shiner has discovered that grief is the scholar of life, its teachings are immeasurable, and it is a powerful reminder of how fragile life can be.

Approaches to Grief

The trajectory of grief seeks to explore the experience of grief in a less structured way as identified in the stages or tasks often associated with grief. It is meant to be fluid in nature with work being done throughout the trajectory. The first aspect of the trajectory is the event grief itself. This includes the event that causes an individual to have an emotional reaction to a loss. It is loss that held significance and to which an attachment was formed. In Shiner’s case, it was the murder of her two children.

The work of grief comes in many forms. In Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner, J. William Worden illustrates the following tasks that the grieving individual should complete to accommodate the loss:

• accept the reality of the loss;
• experience the pain of the loss;
• adjust to the environment without the person, place or thing; and
• reinvest in a new reality.

Robert A. Neimeyer, PhD, approaches grieving from a constructivist approach. In Lessons of Loss: A Guide to Coping, he suggests that “Meaning reconstruction in response to a loss is the central process of grieving.”

The constructivist approach uses cognitive processes to emphasize sense-making and benefit-finding within the grieving process.

Cognitive behavioral therapy has been utilized to help alleviate symptoms of grief by helping the bereaved to work on changing irrational beliefs and thoughts into rational beliefs and thoughts. According to Ruth Malkinson, PhD, the hard work of grief is multifaceted and can involve any combination of these and other evidenced-based approaches since no two individuals grieve in the same way.

Part of the ongoing work of grief is finding ways to cope with what Rando described as a sudden temporary upsurge of grief (STUG). These events produce a reaction with periods of intense grief that occur when a catalyst reminds one of the absence of the loved one or resurrects memories of the death, the loved one, or feelings about the loss. These reactions can be expected and can happen in response to anniversaries, birthdays, and family celebrations. Or, they can be unexpected in the form of a song on the radio, a smell, or something that is read or seen that brings up the memory of a loss. They tend to catch the individual off guard and, according to the Open to Hope website, “come like a bolt out of the blue. Those intense upsurges of grief that take you totally by surprise. They ambush you, triggering an up bubble of grief emotions.”

The approach taken depends upon the individual’s experience of loss and how that individual finds ways to accommodate or assimilate the loss into their lives, either on their own or with the assistance of a therapist, counselor, clergy, support group, family, and/or friends. The assumption is that, regardless of the approach, grieving is an ongoing process that leads to some level of adaptation at some point in the process, and the individual moves from doing the hard work of grief to forever grief in the trajectory. The transition is most likely to occur when the event no longer controls or consumes the griever’s life. Shiner made this realization 10 to 13 years after the event and this indicated to her that she was moving forward in the trajectory. She believes that without the work it would be difficult for grievers to move forward.

Forever grief is the grief that will linger in various forms long after the loss and involves coping with reminders that bring stored memories to consciousness. Residual forms of grief such as STUGs remain in the forever grief, with the duration and intensity diminished. According to the Mayo Clinic, when you lose someone close, your grief doesn’t just magically end in time; reminders often bring back the pain of the loss. Additionally, as time goes on, fond memories surface and can become a source of comfort, peace, and joy to the griever. Individuals learn how to cope and find ways to weave their loss into a new life that has been forged through their grief work. In this way, grief becomes an opportunity for growth rather than an obstacle to living. For Shiner, living with grief has become the trajectory of her life. Her work will go on in ways that help her to make meaning and find benefit in her loss.

While the trajectory of grief does not offer exact stages for individuals to pass through or tasks for individuals to accomplish, it demonstrates a trajectory that individuals can be expected to experience following a grief event. It postulates that grieving a loss may never come to a definitive end and that closure is a myth. It does not mean that an individual cannot and will not return to a meaningful life by finding ways to accept the reality of the loss as suggested by the tasks of grief suggested by Worden, by constructing meaning in the meaning reconstruction approach of Neimeyer, or by working to alter irrational thought patterns as suggested by Malkinson. This trajectory can serve as a path that begins at the grief event and moves through the twists and turns of the grief experience.

Lynn Shiner, former director of Pennsylvania’s Office of Victims’ Services, coauthored this article.

— Lisa S. Zoll, LCSW, is an instructor at Temple University College of Public Health, School of Social Work.