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C 9HAPTER
B C : B , DEREAVEMENT AREGIVING EFORE URING, AND
A LFTER OSSES
Rejoice with those who rejoice, [and] weep with those who weep.
—Romans 12:15
Blessed are those who mourn, for they will be comforted.
—Matthew 5:4
Bereavement is a universal human crisis that strikes everyone sooner or later. In terms of human wholeness
there is no aspect of pastoral care ministry in which the stakes are higher. The fact that clergy have
automatic entrée to the agonizing world of most sorrowing people gives them unparalleled opportunity as
well as responsibility. They are the only professional persons with substantial training in grief caregiving.
They are called to be effective guides and companions of the bereaved as they walk through the shadowed
valleys of life’s multiple losses. Obviously it behooves pastors to develop a high degree of competence in
bereavement care and counseling.
Insightful Studies of Grief and Crisis Healing
Contemporary approaches to both crisis intervention and grief caregiving have their roots in the
pioneering research of a young Boston area psychiatrist named Erich Lindemann. In 1942 there was a
tragic fire in which several hundred people died at the Cocoanut Grove nightclub in Boston. Lindemann
decided to study the varied responses among survivors and close relatives of those who died, focusing on
the consequences for their health or illness of how they handled their profound individual and family grief.
His most significant finding was that those who did what he called their “grief work” well recovered1
much faster than those who repressed their sorrow. He later summarized his findings, which have been
confirmed by other research:
Studies show that many people become sick following the death of a loved person. A great many more hospital
patients have had recent bereavement than people in the general population. And in psychiatric hospitals, about
six times as many are recently bereaved than in the general population. . . . Furthermore, in a great many
conditions, both physical and psychological, the mechanics of grieving play a significant role.2
Lindemann and countless other grief researchers have shed light on the dynamics of the healing process.
These dynamics have many similarities with those of any severe crisis. But the loss of someone or
something that has been a significant part of a person’s world of meanings and satisfactions is a
psychological and spiritual amputation. How traumatic it is depends on the nature and importance in their
lives of what they lose, and also on the development of their coping skills. The responses employed in
C o p y r i g h t 2 0 1 1 . A b i n g d o n P r e s s .
A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .
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coping with new losses are the same ones they have learned in coping with previous deprivations,
frustrations, and losses, large or small. These coping skills, learned from their culture, are filtered through
their parents’ responses to losses. If individuals have learned constructive, reality-oriented coping skills,
they will follow a somewhat predictable process of working through the mixture of powerful feelings
resulting from the bereavement and making the adjustments required to live without what has been lost.
This work (called “grief work”) must be done by grieving persons themselves, hopefully with strong
support from family, close friends, caregivers, and their faith community.
In the decades since Lindemann’s pioneering research, crisis intervention and grief-healing methods
have been studied extensively, refined, and greatly improved. Caregivers today have more understanding
and better methods available for making this vital healing ministry effective than ever before in the
century-spanning history of care with persons suffering from life’s many-faceted problems.
Grief: A Strand in Life’s Multicolored Fabric
As we have seen, some feelings of grief result from all significant crises, losses, life transitions, and
changes, not just in the deaths of loved persons. Every life event on the Holmes-Rahe stress scale involves
some losses and therefore grieving. The price people pay in health problems for unresolved grief is
extremely high, and there is evidence that many psychosomatic illnesses are related to unhealed grief. The
same is often true of alcoholism and other drug and behavioral addictive illnesses, including compulsive
sexuality, gambling, and religiosity.3
Some years ago, the staff of the pastoral counseling and growth center with which I was associated4
decided to ask all of the people who came for help if they had experienced major changes or losses within
the preceding two years. More than one-third of our clients could identify a painful loss or a cluster of
several losses, often correlated with the onset or dramatic worsening of the pain that had brought them for
help. These counselees suffered from a wide range of presenting problems, including marriage and family
crises, sexual dysfunction, depression, job difficulties, substance abuse, psychophysiological illnesses, and
religious and ethical problems. Many reported general psychological-spiritual malaise and depression.5
Caregivers should know that grief experiences triggered by different types of crises typically have
distinctive differences as well as similarities. They all bring some degree of sadness and longing for what
was lost. The grief in involves sadness and longing for the lost satisfactions of earlierdevelopmental crises
life stages. Grief in , as the husband of a woman with Alzheimer’s put it, “hangs over me likechronic crises
a dark cloud that keeps blocking the sunlight and refuses to go away!” Grief feelings in collective or
are shared by most members of the large or small affected group in varying degrees andcommunity crises
expressions. Grief feelings in have special poignancy resulting from the terrible sense of beingacute crises
hit out of the blue without any time to prepare to cope with the trauma. For this reason, the grief impact
may cut deeper and be more devastating initially. Grief in long-term or chronic crises includes many
opportunities to do what is described as “anticipatory grief work.” If survivors have done this before their
loved ones die, they still feel some pangs of loss, but the grief usually is much less protracted than in acute
crises triggered by unexpected losses.
Factors that Complicate Crisis and Grief Recovery
The way people respond to losses varies tremendously depending on their culture; their resources; the
quality and length of relationships; the timeliness of the loss; and, in cases of death, whether it was
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expected and its nature. The more dependent, conflicted, or ambivalent relationships were, the longer and
more complicated the recovery process tends to be. Grieving following the deaths of children or
adolescents probably produces the most agonizing and protracted recovery process. Sudden, unexpected, or
violent deaths usually are followed by more extended and difficult grief work with more shock and anger
than slow, expected deaths. There are more unfinished aspects of the relationship, which produces greater
guilt. The vacant social roles such as companion in attending church or in recreational travel that had been
filled by the deceased have not been gradually refilled.
When the bodies are not found or are terribly mutilated (so that the casket is left closed) or when the
body is cremated immediately after death, recovery may be protracted because the grieving persons are not
able to accept the reality of the loss by dealing with the image of the dead person’s body. Since our own
identity and that of others are integrally related to body image, having an opportunity to deal with feelings
about the body is often necessary for the grief wound to heal as fully as possible. The traditional wake or
visitation time before the funeral, when the body is visible, can be a grief-enabling experience for many
mourners.
Caregivers also need to be aware of numerous societal factors today that often cause recovery from
crises and grief to be very difficult, protracted, or blocked. They include the following:
1. The weakening, or rejection by many people, of traditional religious beliefs that were
comforting, and the failure to develop more viable beliefs to replace them.
2. The fact that most pastoral caregiving of bereaved persons extends only a week or so beyond
the funeral or memorial service, whereas the journey of recovery often extends over two years
or more.
3. The fact that much, if not most, of the caring for terminally ill persons is done by impersonal
medical and nursing home staff members rather than the family.
4. Our death-denying culture that programs us to deny feelings about our mortality and dying or
escape from them in a variety of ways.
5. Geographical distances and interpersonal alienations deprive many friends and family members
of opportunities to say “Good-bye,” or “I love you!” or “Please forgive me,” or simply “Thank
you!” to dying people.
6. Not having opportunities to view and perhaps touch the body so that friends and family can say
good-bye to the dead person’s physical presence.
7. The ways that interpersonal conflicts are stirred up in broken and blended families when death
occurs and wills are implemented.
8. Social stigmas that unfortunately are often attached to certain deaths, including those from
suicide and AIDS.
9. The many ways that people suffering from poverty and discrimination carry a multiple
load—their economic problems and one-down social esteem added to their painful losses.
10. The fact that women raised in traditional families often derive their feelings of self-worth
mainly from their caretaking roles makes the deaths of persons for whom they were primary
caretakers deeply disruptive to their sense of meaning and value.
To the extent that one or more of these individual or social complications apply to care receivers or
caregivers, it is important to treat them and to encourage them to treat themselves with extra caring and
compassion over what is usually a longer time.
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Dying Persons Can Be Our Teachers
Sooner or later, crises and losses teach everyone agonizing lessons. These lessons come as unwelcome
intruders and as rude confrontations with painful truths that understandably are resisted tenaciously. But as
suggested earlier, they can offer unexpected opportunities to learn valuable lessons that can contribute to
personal growth that enhances overall well-being and preparation for coping constructively with future
crises and losses.
Let me illustrate this personally. In recent decades life has taught me much more than I wanted to learn
about the process of dying. In this respect my experiences are comparable to those of many people in the
last third of life expectancy. In addition to awareness brought by several near-death experiences, my main
teachers have been several terminally ill persons. They include both of my parents, my spouse’s parents,
and two valued mentors. Also included have been a number of friends around my age and several former
students whose deaths were particularly shocking because they were much younger than I. I remember
each person with gentle sadness, mixed with gratitude for the precious gifts I received from many of them.
Some of my most valuable learnings came from Lois, a nurse and close friend of my spouse and me.
She died in her late forties after a protracted and debilitating struggle with cancer. Shortly before her death,
I asked her if she would talk with me about her experience of dying so that I could learn from her and share
her insights with others (as I am doing here). In her usual generous spirit, she replied that she was glad to
do so. In what for me was a deeply moving conversation, she shared her intense feelings and needs. One6
particularly strong need was to have people listen to her swirling, changing, and conflicted feelingsreally
as her malignancy gradually spread. She described how terribly let down she felt when some of her friends
and one of her several physicians changed the subject or tried to give her superficial reassurances.
Although she knew that they did this because of their own discomfort with the grim facts and her intense
feelings, it hurt anyway. Having read Elisabeth Kübler-Ross’s book , she said that theOn Death and Dying 7
many feelings she had experienced included the five described in that book (denial, anger, bargaining,
depression, and acceptance). But she added that her feelings would come and go, never following a
particular sequence.8
Lois told of experiencing waves of fresh anger at each new stage of her progressive illness. One of her
many friends was especially helpful when Lois told her that the oncologist had just informed her that the
malignancy had spread to her vital organs. The friend hugged her warmly and shared her intense
disappointment and anger.
After Lois shared the details of her struggles with fear and grief, I expressed my warm affirmation of
the ways in recent months she had become even more vital and alive than she had been before. She
responded, “When you know your future here probably will be short, it makes the present more
important.” As we concluded our conversation, I was pleased when she said that it had been very
meaningful and helpful to talk about her experiences so fully. I expressed my deep appreciation and told
her how profoundly I had been touched by all that she had shared. Lois helped me see more clearly that the
process of dying can be an important stage of continuing spiritual growth for some people, even as they
struggle to cope with the multiple losses of dying.
Using Losses as Growth Opportunities
Insightful novelist Alice Miller once declared, “The human soul is virtually indestructible, and its
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ability to rise from the ashes remains as long as the body draws breath.” Eleanor Roosevelt was such a9
person. Throughout her life, she used a series of severe crises and losses as opportunities to learn and
grow, and heighten awareness and empathy for other suffering people. Eleanor’s mother rejected her for
“not being a beautiful child” and then died when Eleanor was only eight. One bright spot in her young life
was her adoration of her father (Theodore Roosevelt’s brother), who adored her in return. But his chronic
alcoholism interfered with his ability to give the dependable, loving attention she desperately desired. He
died from his addiction when Eleanor was only ten, just two years after Eleanor’s mother died. As a young
adult, she married FDR, who went on to become a four-term president during the Great Depression and the
first years of World War II. During her years as First Lady, her deep empathy for the pain of the countless
victims of social, economic, and civil rights oppression had a profound influence on the development of
FDR’s policies. Behind the scenes she helped shape the national safety net that helped millions of
impoverished people (including my childhood family) during the shattering economic tragedy and
collective grief of the devastating depression. After FDR’s death, her courageous, prophetic outreach
became overt. Her influence continued to expand through her caring service to the oppressed in her own
country and the wider world.
For caregivers, it is crucial to know that wounded people usually only in retrospect make the discovery
that growth has occurred through their crises or losses, after they have coped with the worst of their
traumas. At that point it is appropriate to ask a door-opening question such as: “As you look back now on
your terrible loss, are you aware of anything useful that you have learned as you struggled to cope?” To
raise the possibility of growth before this point ignores people’s intense pain, causing them to feel
misunderstood and resentful. It also sets them up to feel they are failures if they do not experience some
growth. It is well to remember that huge losses like the deaths of children are so utterly devastating to most
parents, siblings, and grandparents that deriving any sense of having grown usually is impossible except
perhaps in very long retrospect.
Opportunities for spiritual and ethical growth occur frequently in crises and grief because they often
shatter false gods, such as achieving power and wealth, that many people worship in our society. Crises
and losses often confront people with the need to rethink and possibly revise their spiritual beliefs and
guiding values. The hope is that they will do this in directions that bring more spiritual vitality and deeper
meaning to their lives.
Making Grief and Crisis Caregiving Holistic
As a caregiver, keeping the seven dimensions of wholeness in the back of your mind as you offer crisis
and grief care can help you see and respond to opportunities to make your healing ministry more holistic.
Severe traumas often create wounding that needs healing in many dimensions of sufferers’ lives. To
illustrate, basic physical self-care is usually diminished in the days and weeks following a major grief, at
precisely the time when stress overload makes self-care even more important than usual.
Pastor Marjorie was on target when she paid a pastoral visit to Larry, a man in his mid-fifties. She had
conducted the funeral for Larry’s wife, Betty, who had died three weeks earlier. After a brief exchange of
relatively superficial comments, the pastor intentionally invited Larry to move their pastoral conversation
to a deeper level by asking him: “How are you doing, Larry, in handling your loss just a short time after
Betty’s funeral?” “OK, I guess” was his response. Marjorie then pressed him directly, “Are you taking care
of your health, Larry? I mean by getting enough rest, good food, and some fast walking or other exercise
on most days?” Larry said, “The trouble is I really don’t have time or energy to do such things for myself
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right now. It makes me forget what I’m feeling when I start digging myself out from under the pile of work
that I’m way behind on.” The pastor responded, “I understand that you don’t feel like it or have enough
time given those heavy demands. But as you probably are aware, your body is under extra heavy pressures
these days. To handle this load of stress and keep from getting sick, you need adequate self-care now even
more than usual. So I wonder, doesn’t it make sense to make time to do these things for a while, even
though you don’t feel like it?” Larry agreed and said he would try to talk better care of himself. Pastor
Marjorie affirmed this intention and then helped him decide on a realistic plan for improving his self-care.
Pastor Marjorie focused holistically on Larry’s physical and mental self-care and the wellness of his
vocational life as she helped him do his unfinished grief work.
Six Tasks of Coping and Growing through Grief
A transformational approach to caregiving with those suffering many types of normal grief involves
going beyond the first essential goal of helping them survive, cope, and recover from their losses as fully
as possible. The goal that transcends this is to help them learn how to use their grief as an opportunity to
grow at least a little as whole persons by the ways they handle their grief. When grieving persons
accomplish this goal, they discover a hidden possibility expressed symbolically by Albert Camus: “In the
midst of winter, I finally learned that there was in me an invincible spring.”10
The movement from the initial shock of new loss to the ultimate experience of new life involves six
tasks with which the companionship of a pastoral caregiver can be very helpful.
Task One: Dealing with Numbness and Shock
When death or other severe losses strike, the usual response is feelings of psychological numbness and
shock mixed with a sense of unreality. The mind cannot yet accept the overwhelming pain of facing the
reality that someone or something that was loved is really gone. But gradual acceptance of the grim reality
of the loss must eventually occur or the healing process will be blocked and incomplete. Full acceptance
usually occurs over a period of several months or even years.
In the first hours and days after severe losses people often feel that their agony and depression will
never diminish. Only as their grief work progresses with the passage of time will they discover that they
can walk through the dark valley of death and eventually emerge to a brighter day. The psalmist clearly
expressed this awareness: “Weeping may linger for the night, but joy comes with the morning” (Ps. 30:5).
The role of caregivers in facilitating normal grief is to cooperate with the psyche’s inner process of
recovery. During this shock phase, effective caring includes using supportive care methods as previously
discussed in this book. These often include gratifying dependency needs. Severe losses activate grievers’
“inner child,” often bringing painful feelings of anxiety, deprivation, and abandonment. The need to be
comforted is intense.
On a personal level, I remember nothing the pastor said at my mother’s funeral, but I recall how much I
appreciated his comforting touch on my shoulder as he left the funeral parlor after the service. Acts of
spiritual ministry during task one, such as familiar scripture, prayers, hymns, and rituals, can bring comfort
and hope to bereaved individuals and families who are religious. Taking gifts of food and offering help
with practical needs, such as providing transportation, are symbolic, nonverbal ways of communicating
nurturing care. A congregation’s lay caring or grief recovery team should surround the grieving individual
and family with the supportive care they need. Providing a meal after a funeral or memorial service is a
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way of providing physical nurture and affirming the ongoingness of life despite the loss. It also is a way of
saying, “We can, must, and will walk on into the new, unknown future—together!”
Task Two: Expressing and Talking through Feelings as They Are Gradually Released
After the 1942 Cocoanut Grove nightclub fire, Lindemann made a most illuminating discovery. He
learned that .experiencing and expressing agonizing grief feelings are indispensable to the healing process
In fact, blocked feelings result in the healing process being delayed or blocked long term, whereas facing
the painful feelings is the path to eventual healing.
To help grieving people do their grief work, caregivers must go against the cultural tendency to avoid
painful feelings. This is why grieving persons often need help in expressing fully and talking through the
variety of powerful emotions the loss has triggered in them. This is encouraged by responsive, dialogical
counseling with occasional focused questions aimed at enabling the persons to get in touch with their
feelings and express them fully. Often these feelings are ambivalent and conflicted. They range from total
despair to relief and joy (about which most people feel some guilt). Task two begins and continues
intermittently as persons’ denial gradually diminishes and they allow the stark reality of the loss to enter
their awareness. By experiencing and verbalizing the feelings repeatedly, they gradually transform the raw
agony of loss into gentle sadness and a renewed gratitude and love for the lost person. But grief feelings
often return unexpectedly for a long time after a major loss. Grieving is unpredictable.
One primary goal of grief work following deaths is to make the relationship that has been lost in
external reality strongly and vividly internal in survivors’ minds and hearts. Repetitive reminiscing and
storytelling help them accomplish this. Thus the relationship is not completely lost because memories and
images of the deceased become more vivid and alive. Those who have internalized the lost relationship
often say something like, “I feel that she is still alive, supporting and giving me strength.” This can enable
grief-stricken people to find comfort and solace, especially if relationships have been relatively healthy.
But in toxic or dependent relationships, the negative side of this internalizing process is seen. It may be
expressed in statements of feeling controlled, such as, “I feel that he is still here watching to make sure I
shape up like he wanted.” People who continue to feel oppression and/or protracted depression after family
members die need to be helped to exorcise these mental ghosts. Doing this will help free them from being
trapped in the past and enable them to get on with living in the new present and emerging future that the
death has made potentially available to them. The cognitive-behavioral methods described earlier provide
effective approaches to enabling this self-liberation.
The key feelings that most often infect grief wounds are unresolved (with remorse and oftenguilt
shame), (with resentment and rage), and (of death and punishment among some persons withanger fear
traditional religious beliefs). To encourage awareness and expression of these feelings, counselors may ask
one or two opening-up questions such as: “Are you having feelings that are really disturbing? If you had
your relationship to live over, what would you do differently? Have you been able to express these feelings
or talk about them?” Such questions should be asked only when caregivers have the time and skills to help
the person express, talk through, and begin to release and resolve the intense feelings he or she may elicit.
It’s also wise to balance such questions with one like, “What kind of warm, positive feelings have been
occupying your mind?” or “What about the person and your relationship do you most enjoy
remembering?”
Some persons can be helped on their grief work journey by being encouraged to jot down notes to
themselves about their feelings and thoughts day by day. Keeping an informal grief healing journal can be
of special help to many men and some women who have difficulty getting in touch with and expressing
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their feelings. Writing a personal letter to the loved person, expressing what they wish they had said before
that person died, can also awaken suppressed feelings. Writing or verbalizing answers to self-queries such
as the following often enable grieving persons to become aware of more of their feelings:11
• What things will I miss receiving from the lost person?
• What are the things I am sorry I did or didn’t do before the loss?
• What are the things for which I am most thankful about the lost person?
In major losses, or those around which there are conflicted feelings, the working through of feelings
occurs on many levels and usually takes two years or longer. Feelings of gentle sadness often linger as an
ongoing legacy of the loss. Severe grief such as that triggered by the death of a passionately cherished
dream, a loved spouse or child, or a parent on whom grieving persons are still dependent usually takes
several years to be resolved. After many major losses, flashbacks of sad feelings may be triggered
unexpectedly for many years when something associated with whomever or whatever was lost awakens
forgotten memories.12
Tasks Three and Four: Coping and Then Rebuilding
The grief recovery work of coping with the difficult changes following losses immediately (task three)
and the rebuilding of one’s life without whatever one has lost (task four) is a continuing process. Coping is
often highly stressful and filled with demanding challenges, especially following severe, multiple, or
unexpected crises and grief. For traumatized persons to stay as fit as possible it is essential for them to
increase their self-care and their receptivity to the care of others. Therefore, caregivers should encourage
persons weathering crises and grief to be very kind and gentle with themselves and also to let those in their
circle of mutual care know that they need extra support and loving.
The process of coping and rebuilding involves unlearning countless habitual responses and learning new
behavior to meet personal needs formerly met by whomever or whatever is no longer available to them. It
also involves making countless decisions about how to cope with the many new problems the loss has
brought. Caring persons in their faith community, including lay caring team members, should be guided in
functioning as a substitute extended family for those who lack such a family-and-friends support system.
They can do this by offering whatever practical help and emotional support are needed. This support can
take many forms. For example, a widow who has never handled her finances, or a widower who has never
cooked for himself, needs help in learning these skills. Emotional support as well as reality testing may be
needed as bereaved persons make decisions and begin to venture out into new relationships and
experiences, such as going to social gatherings without the deceased and reinvesting some of that energy in
other relationships.
Emotional and spiritual wounds caused by grief cannot heal fully until bereaved persons have moved
ahead to accept the reality of their losses, surrendered their emotional ties to what is no longer available,
and formed other relationships to provide new sources of interpersonal need-satisfaction. Psychiatrist
Gerald Caplan described insightfully the importance of letting go of what is gone:
In the crisis of bereavement the sufferer must actively resign himself to the impossibility of ever again
satisfying his needs through interaction with the deceased. He must psychologically “bury the dead”; only after
this has been done will he be free to seek gratification of these needs from alternative persons. Those who cope
maladaptively with bereavement may pretend that the loved one is not dead, or they may magically introject his
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image by taking his characteristics into their own personality, and they will thus evade the painful act of
resignation. This is likely to result in their energies remaining bound up with the deceased, so that they are not
free to love others.13
The unhealthy consequence of attempting to hold on to whatever or whomever is no longer here is
clear. Persons are unable to move ahead by learning new ways to help create a new future with new
possibilities and gains, as well as new problems and pain.
Caregivers can encourage progress in doing tasks three and four by encouraging care receivers to
respond to door-opening queries such as these:
• What will I do to improve my self-care so as to sustain my health during this time when heavy stress
increases my vulnerability to illness? How will I go about developing and implementing the self-care
action plans I need to do now? How will I motivate myself to take good care of my physical, mental,
and spiritual wholeness even when I don’t feel like doing it?
• From whom do I need and want to seek temporary help? What kinds of help do I need from them,
and how will I request this help?
• What do I need to do to help fill the aching void I feel so that I can get on with living my life? When
and how will I begin taking these actions?
• When will I take steps to develop a grief-healing action plan for myself?
• What cherished plans or dreams must I let go of now in order to move ahead on this new phase of my
life journey?
Task Five: Enhancing Spiritual and Ethical Wholeness
Religious resources have much more than supportive and comforting functions in bereavement. The
death of another person confronts us with our own mortality. Existential anxiety can be handled
constructively only within the context of a vital, living faith. The symbols and affirmations of one’s
religious tradition can touch deep levels of the psyche, gradually renewing the feelings of basic trust in life
and the universe that alone can enable persons to handle existential anxiety creatively. Therefore, the
pastor’s teaching and priestly roles are important in helping the bereaved put their loss in the context of
faith. A pastor’s skills in facilitating spiritual growth may help grieving people enlarge their faith and
revitalize their relationship with God.
In crisis and bereavement counseling, the original root of the word (to bindreligion—religio
together)—has dynamic significance. When shattering loss fragments one’s life, vital religion may help
bind it together, restoring some sense of coherence and meaning. The crisis of death confronts some people
with the poverty, obsolescence, or irrelevance of their beliefs and values. This awareness can open them to
the growth process of revising and renewing their spiritual lives and their priorities. A renewed faith
usually develops only after people have finished much of the most painful phases of grief work and are
able to reflect on and learn from their losses.
Progress in spiritual and ethical growth can be aided by encouraging care receivers to list their answers
to questions such as these:
• What beliefs and values of my loved one do I want to honor by the ways I now choose to respond to
my grief and live my life?
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• Do I need to seek guidance from a trained counselor, spiritual guide, or mentor, and if so, from
whom?
• Which of my religious beliefs and values can be sources of spiritual recovery and renewal now?
Which of my beliefs do I need to drop because they are obsolete?
Task Six: Reaching Out for Mutual Support and Care
A story about a family I know well illustrates the healing that can occur when grief-wounded people
reach out to others who are also walking through shadowed valleys. The infant daughter of a midwestern
couple was desperately ill. She was called “Little Ruth” by her devoted parents, Clem Lucille and Doc, and
her older siblings, Miriam and Junior. In spite of treatments by the physicians with the best medicines then
available, she was growing steadily worse. She cried almost nonstop as her frantic parents took turns
holding her tenderly and rocking her gently as they walked the floor day and night. All their efforts to
comfort her pain proved futile. Finally, after several awful days, Ruth died on her first birthday.14
As usually is true in such family-shattering tragedies, Ruth’s family and their relatives were devastated.
Her totally exhausted parents were in shock, as were Ruth’s six-year-old sister and her almost
four-year-old brother. The family’s pastor conducted the funeral in the family’s rented home with Ruth’s
tiny body on the couch surrounded by flowers from their own and some neighbors’ gardens. The little
group of relatives and close friends present was submerged in what felt like bottomless grief. For the first
time ever Miriam and Junior saw their stoic father weep. At the end of the brief service, Junior kissed Ruth
good-bye on her cold forehead. Her body was buried in a tiny coffin under a large oak tree in the local
cemetery just a short way from Abraham Lincoln’s memorial and grave.
In dismal days and weeks of family depression after Ruth’s death, Clem Lucille struggled to avoid
being crushed by the enormous loss of her dear daughter. Her deep faith helped some. But she sensed
intuitively that she must more to help keep her sanity, cope with the tragedy, and go on with her life.do
Eventually she decided on the action she would take. Every morning she read the local newspaper, looking
for reports about the deaths of children in that community. When she found such sad stories, she looked in
the phone directory to try to find the parents’ addresses. If she located their addresses, she penned them a
brief note simply saying that she was very sorry about their huge loss and that she had them in her thoughts
and prayers. She added that she knew something about the dark valley through which they were walking
because she, too, had lost a dear child.
Clem Lucille continued to do this for several years, feeling that she was responding to God’s intention
for her life during the years of gradually softening pain in her slow recovery. She never talked about the
responses she must have received from some of the grieving parents who were helped by her little notes.
But one thing was clear to her husband Doc. He could tell that she was finding important help by reaching
out to other grieving parents. On a personal level I am profoundly grateful for what Junior learned from
Clem Lucille Clinebell, my mother, when I was a very young Howard Jr. By reaching out with healing
love during our family’s darkest time, she taught me a precious lesson about the key role of such outreach
in self-healing and resolving grief.
Outreach by grief-suffering persons for mutual healing is an important aspect of the New Testament’s
understanding of grief healing. The Apostle Paul wrote in his second letter to the Christians in Corinth:
“He comforts us in all our troubles, so that we in turn may be able to comfort others in any trouble of
theirs” (2 Cor. 1:4 NEB). To the Christians in Rome, he enjoined: “Rejoice with those who rejoice, [and]
weep with those who weep” (Rom. 12:15).
How can caregivers plant the seeds of mutual healing in the minds and hearts of those in crises and
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grief? One approach to encourage this outreach is to ask questions such as these when the timing is right in
caregiving relationships, hoping that suffering persons will move toward action answers to self-queries:
• How can I best reach out to others and perhaps move beyond the awful loneliness of my personal
grief?
• What are the mutual support and sharing groups in which I might be able to get but also give others
some help?
• In which group or groups will I try for a while to discover whether they are helpful to me?
Caregiving with Those Whose Grief Wounds Do Not Heal
Grief is not per se an illness. Rather, it is a universal human crisis that wounds people in their minds,
hearts, and spirits. This wounding makes them more vulnerable to developing physical, psychological, and
spiritual problems. Fortunately the vast majority of grievers have adequate personal, social, and spiritual
resources to heal their grief wounds without professional assistance. However, as pointed out earlier,
numerous factors in our culture make healing more difficult and cause the grief wounds of many people to
become infected. When grief wounds are deeply infected, they necessitate longer-term counseling or
psychotherapy.
If grief-burdened people are recovering from crises and losses in normal, healthy ways, they accomplish
the six tasks described above gradually over time. In contrast, some people continue overidealizing the
deceased to defend themselves against facing the threatening negative side of their ambivalence. They use
two ego defenses—denial and repression—that diminish their overall well-being. These defenses enable
them to avoid experiencing the agonizing depth of their grief feelings and thereby prevent the healing of
their grief wounds. Their wounds are infected and cannot heal until they face and deal with the
out-of-awareness, threatening feelings.
Blocked or frozen grief takes a heavy toll on the well-being of sufferers, robbing them of creativity and
aliveness so that they live with little or no zest for life. The longer grief work is delayed, the more costly it
becomes to people’s mental, physical, spiritual, and interpersonal health, and the more psychotherapeutic
help is usually required for healing to occur. Another look at the death of my baby sister, described earlier,
will illustrate the high cost of blocked grief. That tragedy cast the dark shadow of death over our whole
family system. On a personal level, the shadow of death had a deep impact on my development in my
troubled childhood and adolescence. More than thirty years of reduced aliveness, chronic “drivenness,”
and periodic depression even stretched into my adult life. In my midyears, a skilled psychotherapist
effectively enabled me to uncover and lance my long-buried wound. This drained off the emotional
infection so that very belated healing finally could occur.
My passionate convictions about the importance of clergy’s learning basic skills in grief counseling
come from asking myself some searching “what if” questions: What if our pastor had known how to help
our whole family express and work through our devastating feelings of loss and guilt during the months or
longer following Ruth’s death? What if he had known enough about children’s grief to help my parents
learn how to help Miriam and me? What if he had been able to recognize the symptoms of infected grief
wounds in children and had recommended that we be given help by a play therapy therapist? I know that
basic training in pastoral caregiving, including grief counseling, was not available many years ago when
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that pastor received his training. In any case, the answer to my questions is crystal clear: if our pastor had
had these basic insights and skills, all of my childhood family could have been spared years of needless
suffering and diminished wholeness.15
Here are some danger signs that point to complicated grief, if they persist undiminished in intensity long
:after a trauma
• continuing withdrawal from normal relationships and activities;
• undiminished mourning or the inappropriate absence of mourning;
• acute depression that does not lift and may be suicidal in intensity;
• severe and often multiple psychosomatic illnesses;
• disorientation or severe personality changes;
• severe, undiminishing guilt, shame, anger, fears, or loss of interest in life;
• continuing escape via prescribed or street drugs or alcohol;
• severe depression marked by feelings of inner deadness.
Caregivers usually encounter persons with infected grief wounds that cannot heal after suicides,
homicides, conflicted divorces, and the deaths of children and youth. When they encounter what appear to
be complicated grief responses, they should encourage the persons to express the full spectrum of their
feelings about whom or what they have lost. By responding acceptingly to tentative expressions of mixed,
conflicted, or negative feelings, further catharsis of feelings is encouraged. This process should be
continued until these feelings are faced and talked through so that grieving people make some peace with
themselves and their losses. Along with resentment (and/or anger toward the deceased, relatives,
physicians, God, and so on), there often is a load of guilt about those feelings that must also be talked
through until it is resolved.
Grief wounds must heal from the inside and in ways that reflect the uniqueness of each person. Healing
cannot be forced, but the caregiving relationship can encourage and expedite the process. If inappropriate
grief symptoms persist after several months in spite of caregiving efforts, it is crucial that grieving people
be referred to a competent pastoral psychotherapist who is skilled in helping people with blocked grief
work.
Needed: Innovative Congregational Crisis and Grief Programs
Over the years, I have asked participants in many lay and professional workshops in a variety of
cultures, “How many of you have had painful changes or losses within the last few years?” Depending on
the ages of those involved, 35 to 60 percent raise their hands. Because the frequency of losses accelerates
with the passing years and more things are lost that cannot be replaced, learning to handle losses without
being disabled or embittered becomes increasingly essential for creative aging.
In every congregation, as in our general society, there are numerous people of all ages who are the
“walking wounded.” They appear to be normal in their surface behavior, but at deeper, hidden levels of
their lives they suffer from unhealed grief wounds. These diminish drastically their aliveness, spiritual
vitality, creativity, and joy in living. Obviously, new strategies and programs are needed to help these and
countless other grieving people find healing. Congregations and their leaders must have central role inthe
devising and implementing such innovative approaches. One of the most effective things faith
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communities can do to enhance the overall wholeness of those whose lives they touch is to create such
programs to minister effectively with wounded people before, during, and after significant losses and other
painful crises. The most effective existing programs are multifaceted with the following six parts:
Part One: Education to Help People Prepare to Deal Constructively with Crises, Losses,
and Painful Transitions
The goal of such preventive education is to enable members of faith communities to learn about the
importance and process of grief work and how they can cultivate this healing in themselves, their families,
and their friendship circles. Knowledge of the six basic tasks of grief work can provide cognitive maps that
learners can use to guide themselves when crises and losses strike. Sermons, one-on-one caregiving
conversations, and educational programs on all age levels can be effective channels for congregation-wide
learning.
End-of-life caring education, using an educative counseling or coaching approach, is an essential part of
constructive grieving programs in congregations and hospitals. In spite of greater openness than in the past
to talk openly about dying, our culture unfortunately is still largely death denying. In this social context,
the goal of death education is to help congregants face and learn how to deal constructively with their
mortality. A vital resource for use in such a program is Bill Moyers’s PBS series On Our Own Terms: Bill
. (This four-part video can be ordered from 800-PLAY-PBS.) Many other resources areMoyers on Dying
available from the end-of-life care movement that has been growing in recent years. It received a major
boost when former First Lady Rosalynn Carter experienced the pain of caring for her terminally ill mother.
This motivated her to join with others in forming the Last Acts Coalition, which works to improve
end-of-life care (their website is ).lastacts.org
Crisis and grief education should include coaching people to take two essential actions that help them
prepare to die well. The first is preparing a living will (also known as an advanced directive to physicians).
This gives instructions to one’s primary care physician about what one wants done or not done after one is
no longer able to express one’s desires. (Usually this includes “no heroic measures after all hope for
recovery evaporates.”) A second action is signing a legal document giving what is called “durable power
of attorney” to a trusted, responsible family member or other such person. This empowers the person to
make crucial decisions for you if and when you are no longer able to make these for yourself. Different
states in the United States have somewhat varying requirements for these documents, so it is important to
check with your primary care physician or the state medical association to discover what is required.
Another important objective of holistic death and grief education is to help participants increase death
awareness and learn how to make some peace with this reality. Confronting death and one’s feelings about
it can be life enhancing if done in the contexts of a supportive, caring community with a growing,
reality-based faith. Issues about death should be raised gently in the context of living life in all its fullness.
When this is done effectively, many people spontaneously consider revising their short-sighted or
misguided values or life plans and priorities in light of their awareness of their mortality.
It is fortunate in recent years that issues related to death and dying have been brought out of the closet
to be discussed openly in many circles. But most people in Western cultures still ignore, deny, repress, or
run from their feelings about their eventual death. There is abundant evidence that it may be spiritually
helpful for some people in the prime of life to develop an ongoing awareness of these anxieties. Letting
themselves experience, express, and talk through these feelings, individually or in a group, with an
empathetic listener can produce diminished fear of death and other life-enriching benefits. These may
include a greater sense of aliveness and the preciousness of life, enhanced creativity, openness to greater
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intimacy, and increased empathy and compassion. Even decreased vulnerability to addictions and
increased caring for and about future generations and the biosphere may result from confronting and
accepting the reality of death long before it becomes imminent.
In grief caregiving, it is crucial to wait to raise issues with the bereaved about their dying until they
have experienced significant healing of their initial pain and loss. This means after they are well along in
doing whichever of the six tasks of the grief recovery and healing they need to do and seem open to a
question such as, “What have you learned from this painful loss?”
Here are some guidelines that have proved useful in leading life-enhancing death awareness
conversations and learning events:
• Raise issues of confronting death in the context of a caring relationship or caregiving community or
group.
• Limit such queries to people who are mentally and emotionally stable.
• Confront feelings about death in the context of a growing, reality-based faith that includes dealing
with death.
• Encourage reflection on the hidden possibilities for valuable learning and growth in learning from
their painful losses.
• Help people learn to celebrate the now rather than live in the past or future.
• Raise questions about death feelings gently so that people will feel little pressure to deal with them
until they are ready.
• Encourage people to revise their values, plans, and priorities in light of their awareness of their
shrinking futures, and reinforce life-enhancing revisions by affirming them.
Part Two: Caregiving with Dying Persons and Their Families
Each person’s dying is as unique as his or her living. We all tend to die much as we have lived, but
dying always is an interpersonal event. In our lonely society, the relative richness of people’s interpersonal
caring networks makes a tremendous difference in the quality of their dying. The terminality and eventual
death of one member usually brings grief to the whole family system. On the positive side, deaths can
awaken awareness in friends and family of how precious their relationships with one another really are. In
a moving story of his grief, Mitch Albom reminds readers of an easily forgotten truth about grief and
relationships: “Love is how you stay alive even after you are gone.”16
For many church families the presence of a trusted pastor during all or even part of what is often a long,
lonely watch is a precious supportive and caring gift. This is primarily a ministry of presence highlighted
by brief prayers, scripture, and religious rites that bring comfort and communicate personal messages, such
as “Thank you,” “I am very sorry,” “I love you!” and “May God be with you on your journey.” When
dying persons or their families want their pastor to be present, their wishes should be honored if possible.
Pastoral experiences with terminally ill persons suggest that several resources that caregivers and family
members can help provide often help dying persons. The resources include the following: (1) Being
of one person—or, better, a few persons—who will listen withnurtured by a small caring community
empathy and give loving support and gentle physical and spiritual care until persons die. (2) Completing as
. Tying up loose ends in their lives, especially issuesmany of the unfinished things in their lives as possible
in close relationships such as expressing love or thanks, or asking for forgiveness or giving it. (3) Doing
the challenging anticipatory grief work that often is needed as people try to cope with the multiple losses of
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. Knowledge of Elisabeth Kübler-Ross’s five stages of dying is useful in facilitating this process, asdying 17
is knowledge of the six tasks of growing through grief discussed above. (4) Having meaningful religious or
spiritual beliefs, or a personal philosophy of life that provides some sense of trust and at-homeness in the
, as well as some meanings that transcend the huge losses of one’s own dying. (5) universe Having a setting
. Substantialwhere one can die with dignity without terrible pain, surrounded by caring family and friends
evidence suggests that people are much more afraid of the pain and indignity that often accompany dying
than they are of death itself. Fortunately, medical and pharmacological science continues to make major
advances in pain management. Caregivers can play significant roles in collaboration with patients, their
families, hospice workers, and primary care physicians to ensure that health-care professionals with current
knowledge and clinical skills do everything possible to reduce suffering to a minimum. (6) Reviewing the
. (7) good things and significant people that give their lives meaning, joy, and purpose Knowing that their
. Dying is a very private and an intensely interpersonalloved ones are also receiving much-needed care
experience. Pastoral caregivers, like hospice workers, often spend more time serving burdened family
members than they do serving the terminally ill persons. In any case, caregiving with family members
gives indirect but important care to the ill persons.
When visiting terminally ill persons, it is wise to follow the insightful approach of a hospice social
worker with two decades of experiences in this vital service. She states,18
When I am serving the dying, I remember that I’m there to serve the living. The dying will take care of itself.
Dying folks are very resilient! Until the moment of death they have strengths. When you ask them, “How are
you doing?” they usually answer, “I’m doing fine.” This usually isn’t denial but an indication of their
continuing strength in spite of the decline of their physical body.
Her approach to dialoguing with these patients is especially insightful and worth emulating:
I dialogue with them, not about their death, but about their life. I ask a series of gentle, socially acceptable
questions, like, “How long have you lived in this community? How long have you been married? How many
children do you have? What was your work? How did you stay married so long? How did you make it through
those difficult years?” I listen carefully for patterns in their responses because these begin to paint a picture. It’s
a picture of their priorities, of what gives their life meaning and purpose, who and what they value, and what
they have learned about life. As I listen I mirror back to them all the things that were strong and good about
their lives and all the things I admire about them and their life stories. This helps them die with meaning at
peace with themselves and their lives.
The affirming dialogical process she describes is called “therapeutic reminiscences.” This dialogical
interaction can be very therapeutic with many healthy older people as well as terminally ill people.
Dying persons frequently ask nonmedical caregivers about the prognosis of their illness. The
appropriate response is to say in effect, “I suggest that you ask your doctor, who has the knowledge to
answer you accurately.” On the issue of family members withholding the truth from patients, be aware that
many dying persons really know the truth on some level of their minds. Furthermore, if they are not
consciously aware of their terminality or are surrounded by a conspiracy of silence, they may be deprived
of opportunities to complete unfinished issues in their lives as well as enjoy recalling the things that have
given their lives meaning and perhaps zest.
Our identity as humans is shaped in and by our early and continuing close interpersonal relationships,
primarily in our families. We incorporate those persons in our sense of identity, thus making them a
significant aspect of who we are. Facilitating grief healing in family systems of dying persons, therefore,
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requires some understanding of how it feels to have a part of oneself and one’s world torn away. This
makes family grief experiences so profoundly disturbing, whatever the quality of those relationships. The
more crucial to one’s identity a dead person was, the deeper the sense of agonizing amputation and
emptiness that follow the death. And the more painful or conflicted the relationship was, the more infected
the grief wound and the longer healing will probably take. Because they were a major part of parents’
identity as well as the collective identity of the family system, the process of adjusting to irreparably
changed identity is particularly difficult and protracted when children die. The death of a sibling is also
difficult because this robs brothers and sisters, as well as parents and others in the family system, of
essential parts of their identity. The deaths of parents rob children of any age of relationships around which
the family identity was formed.
Survivors of family deaths respond in a wide variety of ways. A dear friend was the full-time caretaker
for his wife through a long, debilitating illness ending in her painful release in death. He reports that as he
looks back, the wedding vow “in sickness and in health” took on added significance for him. He added that
the words of 1 John came alive in a new way: “Beloved, let us love one another, for love is from God:
everyone who loves is born of God and knows God.” He then quoted Martin Luther’s observation: “We are
to love our neighbor just as we love ourselves, and our wife is our closest neighbor.”19
The responses of primary family caregivers, in contrast to this friend’s response, are usually ambivalent.
Feelings of love, genuine caring, and longing for the dead person are in conflict with anger and often
resentment toward the care receivers, who often become unreasonable and demanding as their health
deteriorates. The negative emotions usually result in self-punishing guilt as caregivers say to themselves, I
. Helping family members experience, expressshouldn’t feel like this with a person in this sad condition
repeatedly, and talk through these negative feelings is often crucial to their healing.
Part Three: Healing Funerals, Memorial Services, Family and Congregational Rituals
During the first twenty-four hours after a death, unless preplanning has been done by the deceased,
more than fifty decisions must be made, usually by family members. It can be difficult, if not impossible,
for them to make rational decisions about funeral arrangements in the midst of their sorrow. Decisions
made under such extreme emotional stress can be costly and later regretted. Funerals are often very
expensive. Preplanning can reduce this cost substantially, and membership in a low-cost funeral20
cooperative can result in even greater savings. A valuable resource for preplanning is Let the Choice Be
by Barbara Hilton. When pastorsMine: A Personal Guide and Workbook for Planning Your Own Funeral
sense that certain families seem particularly vulnerable to making decisions they will later regret, it is
appropriate to ask them if they would like a member of the lay caregiving team to accompany and support
then when they are making decisions about how much to spend on the funeral.
During the pastoral visit soon after a death, as the funeral or memorial service is being planned, the
pastor should encourage the bereaved family to talk together about the circumstances of the death, how
they found out about it, and their feelings. They should also be asked about the memories they cherish and
the things they most valued in the person who has died. (With the family’s permission, it is often
meaningful to incorporate some of these valued memories and attributes in the meditation and memorial
message during the funeral.)
An important purpose of funeral and memorial services is to facilitate the emotional release of grief
feelings so that healing may occur. What is said during the service should be straight and clear about the
painful reality of the loss and the appropriateness of mourning. Healing can be blocked in survivors if
anything is said implying that stoicism in the face of grief is a sign of real strength or Christian virtue, or
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that one whose faith is strong and vital will not experience agonizing grief. The funeral should include
familiar hymns, prayers, and scripture that bring comfort and that also help release dammedup feelings.
The funeral is also a service of thanksgiving for the deceased person, a service of mutual support of the
bereaved by the Christian community, and an affirmation of the beliefs of this community that helps the
bereaved put the loss in the larger context of a life-affirming faith. A pastor can help the family and friends
mourn by expressing her or his feelings of grief and loss and by creating appropriate rituals of
participation, such as inviting everyone to put a flower on the casket before leaving the gravesite.
Caring support of survivors needs to continue during the weeks and months following the funeral.
Pouring out and eventual resolution of often mixed feelings can be encouraged by asking questions such as
these during postfuneral visits with the family: “Would you tell me more about the way he [or she] died?
What has your grieving experience been like since the funeral? What sorts of things seem to occupy your
thoughts or feelings or dreams? What do you miss most? What seems to help you most?” After asking only
one or two questions, it’s wise to stay out of the griever’s way by keeping quiet and simply being a
listening presence.
A pastor should encourage and coach families in devising ways to celebrate the lives of family members
who have died. One way of doing this that many find meaningful is to collaborate in creating loving family
rituals or memorials. These can highlight the things about the person that they remember with gratitude.
Some families find it helpful to designate “remembrance places” in their homes. What they decide to have
there often include favorite photos of the dead person with other family members and items belonging to
the person that symbolize what they wish to remember. When children die, parents often place their
favorite toys on such a memorial. Informal family rituals of remembrance on important dates associated
with the missing person—for example, birthdays, anniversaries, and favorite holidays—can help them
transform the heightened sadness they feel on those days. Families who are members in congregations can
be encouraged to find or help create healing opportunities such as grief-healing groups there.
Ritual meals can bring many people comfort and healing. An insightful writer on food describes the
emotional nurturing that eating can bring: “It seems to me that our three basic needs, for food and security
and love, are so entwined that we cannot think of one without the other.” When the underpinnings of
people’s psychological world are shattered and their comfortable assumptions about the permanence of
their lives are undermined by painful trauma, they often crave comforting foods. Often they crave foods
that have body-mind association with their childhoods. The custom in many cultures of having meals21
after funerals, either at churches or in homes, can be a valuable healing ritual.
Part Four: Setting Up and Leading Crisis-Coping / Grief-Healing Groups
Another essential part of a strategy for helping the bereaved is for the pastor to set up and lead or,
better, to colead a crisis or grief-healing group. Such groups are efficient ways of deepening the grief
ministry of a congregation and a means of beginning the training of a lay crisis and grief team.
Participating in such a group can help people finish their own grief work and learn how to help other
grieving persons. Using crises and losses in this way requires three things: being in mutual caring
relationships, finding spiritual meaning, and generating reality-based hope during the recovery journey.
Crisis and grief-healing groups offer small interpersonal communities within which these three
transformational experiences often occur. Such groups are relatively easy to set up and lead. How to do so
will be described in on group caregiving.chapter 15
Part Five: Collaborating with Hospice Programs
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In responding in therapeutic ways to the needs of terminally ill persons, the hospice movement is the
most humanizing development in modern times. A Christian physician, Cicely Sanders, who started the
first modern hospice at Saint Christopher’s Hospice in a suburb of London in 1967, states, “A modern
hospice, whether it is a separate unit or a ward, or home care or hospital team, aims to enable a patient to
live to the limit of his potential in physical strength, mental and emotional capacity and social
relationships.” Hospice programs enable many terminally ill people to have the blessing of dying in their22
homes surrounded by family members rather than in the impersonal atmosphere typical of many hospitals
or nursing homes. The hospice does this by attending carefully to the control of pain and by arranging
frequent visits by a trained volunteer to give the dying and their family support and care. Hospice
residential facilities enable persons in the final phase of terminal illnesses to die in a humanizing
environment where alternative therapies such as massage and harp music are often available. The volunteer
continues to stay in touch with the family as they do their grief work after the death.
Pastoral caregivers should learn from and cooperate fully with hospice programs in their communities.
If none exists, they can work with community health-care services to launch such a program locally.
Clergy should encourage members of their congregation to take hospice training and volunteer in its
program. Remember that the people close to dying persons are simultaneously struggling with severe
anticipatory grief and with carrying the enormous load of caring for very sick family members or friends.
They need the caring expertise of their pastor but also regular support from a lay caring team and/or from a
community hospice program.
Part Six: Training and Coaching a Team of Lay Caregivers
Another essential part of a congregational grief-healing program is to train a carefully selected lay
caring team to help carry the considerable load of supportive care of persons with normal grief feelings in
congregations. Two factors make this essential. There are too many hurting persons experiencing
disturbing crises, losses, perplexing decisions, and life transitions in even small congregations for a pastor
working alone to respond effectively to these multiple pastoral care needs. Furthermore, the process of
recovery usually is too extended—at least a year and often much more—for any one person to provide the
needed ongoing care. Caregiving is ultimately the responsibility of the whole faith community, with
selected members of that community leading by receiving special training for this shared ministry of
healing and wholeness.
Dealing with Perplexing Theodicy Questions
A World War II tombstone at the site of the Normandy beach invasion expresses the painful hope of
countless grief-shattered human beings: “Maybe someday God will tell us why he broke our hearts.” When
tragedy strikes good people who believe that God is both loving and just, their religious faith is often
deeply shaken or shattered. The father of a six-year-old girl who had just died from cancer expressed his
agonizing grief, asking his pastor, “How can a loving heavenly Father take the life of an innocent child like
my dear daughter?” Caregivers must deal with the fact that the theodicy question is the jagged rock on
which the ship of many people’s faith crashes in their storms of crises and grief.
When religious people ask this question or express the anger toward God that often accompanies the
question, pastoral caregivers should welcome their openness in expressing this anger. Such questions may
open a door of opportunity for listening and accepting the person’s doubts and suffering. It is usually a
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mistake to attempt to answer theodicy questions because there are no easy or fully satisfying answers, and
most people do not expect an answer. What they most need is an empathetic listener who does not try to
defend God, but supports them with caring understanding of their theological struggles. After the process
of grief healing has moved far beyond the first awful agony, some bereaved people may be helped by
mentioning the classical theological answers. Depending on people’s beliefs, these may include pointing to
the unfinishedness and imperfection of the universe, and God’s respect for human freedom. Or they may
be helped by looking at their suffering in the context of the mystery of Jesus’ suffering and death.
Drawing on the Grief-healing Energy of Nature
In no area of caregiving is the healing energy of God’s living creation more useful than in ministering
with bereaved people. A major reason people find nature healing was expressed well by Henry David
Thoreau. While he lived in a small self-constructed hut near Walden Pond, he wrote, “I went to the woods
because I wished to live deliberately, to front only the essential facts of life, and see if I could not learn
what it had to teach, and not, when I came to die, discover that I had not lived.” When people come alive23
in their awareness of the wonder and mystery of the miracle of being alive, they can transcend their
haunting awareness of their mortality.
Finding Healing Resources in the Arts
Because of the universality, existential anxiety, and profound mystery most people experience during
crises, disasters, and severe losses, such tragedies call out for many expressive voices. Through the
centuries, music, poetry, prose, drama, and visual arts have had a place in enabling people to cope with
life’s many painful traumas. These media provide the symbols and images that articulate to some extent the
dual mystery of living and dying in which we are involved.
Because of the multifaceted nature of grief and the great variations in ways that grief healing occurs in
different people and cultures, facilitating the healing process often involves flexibility and imagination in
the responses of caregivers and counselors. Music therapy has been used widely and effectively to help
patients in various types of institutions, including mental hospitals. The insights and methods from that
therapeutic specialty can be adapted and used by clergy in facilitating grief healing. The approach involves
a complementary partnership between music and verbal interaction. The music is chosen because it has
some association with a lost relationship or with painful or positive feelings associated with whomever or
whatever has been lost. It may include familiar songs, loved hymns, or improvised or composed music by
the counselor and/or the bereaved person. The music can be associated with a relationship that “never
was.” For example, an Australian music therapist describes working with a woman suffering from
protracted grief following a stillbirth. The therapist asked what music she would have liked to have sung to
the dead baby if it had lived. When they sang that lullaby together, the grieving woman poured out her
sadness, remorse, and anger. Her feelings thus became accessible for healing dialogue and resolution.
Some grieving people, including those with no musical training, find it helpful to accept the suggestion
that they create their own words and melodies to express their feelings about their loss. What they create is
then played or sung, perhaps to the lost person or activity. Following a stroke, an older man found it helped
heal his grief to hear a tape recording of some of his favorite music to which he had enjoyed dancing with
his wife before his stroke. Therapists who do palliative care with patients in the final stages of their lives
have found that music can be a healing resource for them and their relatives during these trying times. If24
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people want to plan their funeral or memorial services, choosing the music is a major feature of this
process.25
Music has the power to awaken suppressed grief feelings that need to be experienced, expressed, and
gradually worked through. This makes the process of choosing the hymns or other music for funerals or
memorial services a caregiving opportunity. Active involvement of close family members in this choosing
is a part of a collaborative, partnering approach to grief caregiving.
Learning from Your Own Crises and Losses—Don’t Waste Your Pain
The crises, grief, sins, mistakes, and failures in your life probably have taught you some unexpected but
valuable insights about handling such problems. By looking back on your life, you may be surprised by26
the growth you have experienced during painful crises and losses. If so, it’s important not to waste these
fragments of pain-derived wisdom. Such difficult and costly learnings are new assets that you can use in
helping other wounded people find healing. In fact, your brokenness will be either a bridge or a barrier to
others who have been broken by crises and grief. If you attempt to hide your brokenness and pretend that
everything in your life is healthy and whole, suffering people will sense that something in you is not
authentic. But if you own your brokenness and learn from it, it becomes a bridge of empathy and
acceptance, as well as a spring of healing for the brokenness of others. You can continue your healing by
being a wounded healer to others. Here is an awareness exercise aimed at enabling you to reexperience
how you have grown in your crises and grief. Remember that slash marks [/] mean pause, and close your
eyes while you do what has been described.
Learning Exercise. To prepare yourself to be receptive to the learnings that are available in this
exercise, do what is needed to let your body-mind-spirit organism become keenly alert but also very
relaxed. / Go back in memory and recall a painful personal loss of someone or something you felt you
couldn’t live without. (Or as an alternative, recall a disturbing crisis when you felt as if the rug had been
pulled out from under your life.) / Now, take a few minutes to relive that painful experience in detail,
letting yourself experience again the full range of thoughts and feelings you had when it first happened. Be
particularly alert for feelings of weakness and vulnerability, of desperately needing and being dependent on
others for help. / As you let yourself relive that trauma, try to discover if the pain and struggle taught you
anything that has proved to be useful in your caregiving or your personal life. Perhaps they brought you
some new insights and skills that you have found useful in coping more effectively with later crises. Or
perhaps they made you a little stronger, more empathic and caring, or changed your spirituality and ethical
priorities for the better. / If you just discovered that you did grow, even a little, think about who or what
enabled you to transform painful negative circumstances into a positive learning experience. / Now, with
your eyes closed to focus your thoughts, reflect on what you have just relived, becoming aware of any
unfinished feeling associated with that experience. / Recall what or who you found helpful in coping and
how it was helpful. / Become aware of what that experience taught you about yourself and about how to
cope with future crises or losses in your life. / Now, reflect on how that crisis or loss influenced your
relationship with God and your real faith—meaning what you really believe. / Think about how learnings
during one of the many unwelcome detours on your life journey have influenced your caregiving. And
think about how you can use what you learned to help recipients of your caring skills to experience some
growth during their crises and grief. / Jot down notes about what you want to remember and use in helping
those who seek your care. If you have learned and grown through any of your crises and losses, Henri
Nouwen’s apt phrase “the wounded healer” will acquire fresh meaning for you.
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In this spirit, here is a prayer-poem that came to my mind and heart unexpectedly as I struggled to make
peace with two huge personal losses—the death of my father and, before that grief was fully resolved, the
death of my mother:
For my pain, O God—which I did not choose, and do not like, and would let go of if I could—
Give me the wisdom to treat it as a bridge,
A crossing to another’s pain—to that person’s private hell.
Grant me the courage not to live alone
Behind my shell of hiding,
My make-believe side which tries to always seem “on top,”
in control, adequate for any crunch, not really needing others.
Let me own my hidden pain so that it will open me
To those I meet,
To their pain and caring—
That in our shared humanity,
We may know that we are one—in You.
Making Music with Whatever You Have Left
On November 18, 1995, Itzhak Perlman, widely recognized as one of the world’s greatest violinists,
gave a concert at Lincoln Center in New York City. Having been stricken with polio as a child, he walks
with great difficulty, aided by braces on both legs and two crutches. When he reached his chair, he sat
down slowly, put his crutches on the floor, and released the braces. Then he picked up his violin, tucked it
under his chin, nodded to the orchestra conductor, and began to play.
As he finished the first few bars of the music, there was a loud snap, letting everyone in the hall know
that one of the violin’s strings had broken. Everyone expected that he would struggle off the stage to find a
string or another violin. They knew that it is impossible to play a symphonic work with only three strings.
But to everyone’s surprise, he refused to believe this. He paused a few moments, closed his eyes, and then
signaled to the conductor to begin again. His music was filled with more power, passion, and purity than
people had heard from him before as he changed and recomposed the piece in his head. When he finished,
there was awesome silence before the audience stood as they clapped, cheered, and shouted their
appreciation. He smiled, wiped sweat from his forehead, and raised his bow to quiet the crowd. Then he
said, in a quiet, pensive tone, “You know, sometimes it is the artist’s task to find out how much music you
can still make with what you have left.”
Isn’t this the challenge facing us when painful losses or disabilities hit us? We grow through our crises
and grief when, in spite of them, we decide to make whatever music we can with what we have left. That
music often is amazingly powerful!
Reality Practice Skill Development Session
Parishioner’s role: If you have had a painful loss in your life that you would like to discuss—perhaps
the one you relived above—go to the pastor seeking help. Or as an alternative, role-play Jane Carey, a
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woman in her midforties whose husband, Dick, died unexpectedly two months ago from a heart attack.
You feel the loss intensely and find it almost impossible to go into social situations, especially to the
church where you were active as a couple. You feel very depressed and would like to hide from people.
Pastor’s role: Use what you have learned from this chapter about facilitating grief work as you counsel
with one of these parishioners. Be aware of the person’s need for help with particular grief work tasks as
these are discussed above.
Observer-coach’s role: Be aware of the interaction between the parishioner and the pastor. Interrupt
periodically to ask how the parishioner is feeling and to give the pastor feedback on her or his effectiveness
in facilitating the grief work process, especially task two—the pouring out of unfinished feelings.
Recommended Reading
Albom, Mitch. . New York: Doubleday, 1997.Tuesdays with Morrie
DeSpelder, Lynne Ann, and Albert Lee Strickland. . 5thThe Last Dance: Encountering Death and Dying
ed. Mountain View, Calif.: Mayfield Publishing, 1996.
Doka, Kenneth J., and Terry L. Martin. Men Don’t Cry . . . Women Do: Transcending Gender Stereotypes
. Philadelphia: Taylor & Francis, 2000.of Grief
Dotterweich, Kass. . St. Meinrad, Ind.: AbbeyGrieving as a Woman: Moving through Life’s Many Losses
Press, 1998.
Gilbert Richard. . South Bend, Ind.:Finding Your Way after Your Parent Dies: Hope for Grieving Adults
Ave Maria Press, 1999.
———, ed. . Amityville, N.Y.: Baywood, 2000.Healthcare and Spirituality: Listening, Assessing, Caring
James, John W., and Russell Friedman. The Grief Recovery Handbook: The Action Program for Moving
. Rev. ed. New York: Harper Perennial, 1998.Beyond Death, Divorce, and Other Losses
Lund, Dale A., ed. . Amityville, N.Y.: Baywood, 2000.Men Coping with Grief
Meyer, Charles. . Mystic, Conn.:Surviving Death: A Practical Guide to Caring for the Dying and Bereaved
Twenty-Third Publications, 1997.
Rando, Therese A. . Champaign, Ill.: Research Press, 1993.Treatment of Complicated Mourning
Reed, Kenneth. . Indianapolis: Grief Healing, 2002.Healing through Grieving: Learning to Live Again
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