Someone you love dies. You are broken-hearted and very, very sad. You can’t concentrate, eat or even get a good night’s sleep. Co-workers and family members have been supportive, but even they can see how this is impacting you. Feeling overwhelmed and a bit lost about how to “get over” your grief, you look up mental health professionals in your area who take your insurance.
It can take a lot to reach out for help when grieving. You might think that you do not need help or that you “should” not need help. Plus, find the “right” therapist for you can be difficult. Each has their own style and personality. After you go through all of that and get an appointment, then what?
Health Insurance and Grief
Once you meet, explain your situation, and decide to work together, your therapist has a decision to make. If they want to use your health insurance, they have to determine your diagnosis. Insurance companies require a diagnosis for payment purposes. Often, if you have enough symptoms to meet criteria for clinical depression or post traumatic stress disorder or an adjustment disorder, that is your diagnosis. If you do not want to be diagnosed, you have the option to pay out-of-pocket which can be a financial obstacle.
So here is the million dollar question: should there be a diagnosis for grief? This would mean that the symptoms of grief are not a normal reaction to losing a loved one. Society does not permit much of a reaction to loss. We rarely talk about it and are generally at a loss of what to do to help people in bereavement. Should we, then, shuffle you off to professionals when you are no longer behaving normal? One could argue that what is disordered is society’s response to grief.
Treatment of Clients in Grief
Whether or not you are diagnosed with a disorder related to their grief, the therapist often engages in some form of grief therapy. But what are they treating? As a clinician, I am reminded of the importance of diagnostic criteria (symptoms), the amount of client distress and the impact on functioning. Helping someone who has repetitive negative thoughts, lack of basic hygiene, and consistent thoughts of death makes sense. What if you are trying to handle other people dealing with grief? Sometimes friends and family have their own grief challenges, beliefs and ways of coping. There can be a clash between different grief styles, expectations and family dynamics. Might that not warrant some professional support and assistance?
What Do Those in Grief Want?
Some find grief therapy to be very helpful in navigating grief. Others do not, unfortunately. Why the difference? What are you hoping to achieve when seeking grief therapy? For most, feelings of grief are not the usual, day-to-day emotional reality. The world has changed; family and friends come and go; thoughts seem out of control; appetite has changed, etc. Do you want to stop feeling the negative emotions related to grief? Do you want someone to change your reaction to reality? Generally, it is important for those in grief to feel “seen” and validated in the pain. For some, the only person capable of providing that may be a therapist.
In the most recent edition of The Diagnostic and Statistical Manual, the resource mental health practitioners use to diagnose disorders, there is a section for future research which includes Persistent Complex Bereavement Disorder. This work may help shed light on ways we can de-stigmatize some diagnoses and provide treatment for the extreme symptoms of grief while also allowing therapy for supportive (and preventative) purposes. Only time will tell. Meanwhile, we try to balance the need to support with not pathologizing grief. It is not easy, but then neither is losing a loved one.