June 28, 2007: Dealing With Grief and Loss - Dr. Kenneth J. Doka

Dr. Ken Doka:  I think sometimes it’s important to recognize that probably in the first couple of months, it’s very hard to typify what is normal grief.  This is a horrendous loss.  It’s a terrible loss and it affects us in lots of different ways.  I think some things we can say about us is it affects us on all kinds of levels.  It affects us physically.  It affects us emotionally.  It affects the ways we think, the ways we behave.  It affects us spiritually and I think for a lot of people, as I’ve experienced grief in my life and I’ve talked with many of the people who’ve experienced their own losses, they often use a metaphor like a roller coaster to describe it.  Ups and downs and highs and lows and times that you think you’re doing better and times that you really feel much worse.

Dr. Ken Doka:  If you think of grief as sort of this straight line where you’re going to go from feeling bad to feeling better, that’s not going to happen.  You’re going to have this kind of uneven journey.

Dr. Ken Doka:  You experience grief in all kinds of ways and all of us do that very differently.  Most people today choose not to typify the process of grief in stages.  It’s just for most people not a kind of helpful way of looking at the grieving process.  If you think about it, here we are.  We’re very individual people.  Even the three of us.  We have different spiritualities.  We come from different generations.  To think we’re going to experience a loss and react to it in the same predictable set of ways is probably when you think about it not particularly likely.

Dr. Ken Doka:  So I think it’s important to really kind of realize there is not going to be this set series of predictable stages.  We moved away from this notion of universal stages to really individual pathways of grief.

Dr. Ken Doka:  I like to use the term amelioration and what I mean by that is that for most people who are grieving, over time they say it’s less painful now than it was over time.  They usually are able to function as well as they function before the loss.  But there’s still moments and there’s still periods in which one still experiences, even years later, these sort of surges of grief, you know.  It may be that your child dies at four years old and then this June you realize that some of his classmates or some of her classmates are graduating from high school.  And that was 13 years ago.

Dr. Ken Doka:  We’ve done some work, Terry Morton and I, on gender differences, but what we really like to emphasize are grieving styles that are influenced by gender but not determined by it so we really look at them as a continuum.  And so we say some people who grieve really experience grief on a very feeling level and then other people who experience grief experience their much more cognitive level and they find doing things, building a memorial, running a scholarship for their child is very very helpful.  And again, all of these are normal and natural ways of handling grief. 

Dr. Ken Doka:  Each of us deal with grief in our own very very individual way and certainly that’s true for couples.  And sometimes what happens is couples impose their way of grieving on the other person.  All the factors that affect how we grieve differently have little to do with love.  It’s different attachment styles, different relationships, different expectations, just because somebody grieves differently doesn’t mean they had less love for the person who died or anything of that nature.  It just means that they grieve differently. 

Dr. Ken Doka:  We recognize sometimes that even what’s helpful to one person is not helpful to the other.  It’s just recognizing and supporting each other and recognizing that in this period of time, it’s important to keep the lines of communication between people open and to keep the lines of respect open.

Dr. Ken Doka:  Often people who are very feeling will talk about expressing their feelings and maybe shouting and crying.  And often they’ll find that ways to help them explore and develop their feelings, like a support group in some cases, or maybe like something else can be very very useful and very important.  Talking to a confidante.  Talking to a counselor.  Writing in a journal. 

Dr. Ken Doka:  We also have to understand that siblings are going to grieve differently.  They’re going to grieve differently because of their own grieving styles, where they are in development, too, and so sometimes we can do the same thing to siblings that we do to couples.  We expect everyone to grieve in the same way.

Dr. Ken Doka:  I think one of the valuable things about hospice is that hospice has always had as part of its philosophy that the unit of care was always the family and therefore the death of the patient doesn’t end the need for care so I think hospice has been a pioneer in providing services for the family whether the patient is a child or an adult that extend way beyond the patient’s death.

Dr. Ken Doka:  I think, recognize that often for lots of reasons, it’s probably a complaint that many parents make about their teenagers generally.  I think the thing I would try to say is do you see any indication of problems?  Is there acting out behavior?  Is there substance abuse?  Is there difficulty beyond the kind of normal teenage trauma.  And then I think to help teenagers identify sources that they can do both within and outside of the family.  But as I said, adolescence is a tough area and adolescents don’t want to appear different than their peers.  They don’t want to be identified very often as the kid who’s lost his brother.  They want to be accepted on their own.  So I think it’s important to again keep lines of communication open.  To respect where they are at development.  And just look for danger signs and help them find.  Well, I think, for instance, if there’s radical changes in grades or behavior.  I think if there’s certainly delinquent behavior.  If there’s acting out behavior including maybe sexual acting out.  If there’s substance abuse.  All of these would be signs that I would.  Suicidal self-destructive behavior.  Behavior destructive of others.  All of those would be important, you know, just not functioning.

Dr. Ken Doka:  I think grieving families need a couple of things.  I think they need a good sense of understanding how to use the resources around them.  A good sense of what resources are available, including their own personal resources.  When I work with families, I often have them make a list of their friends and support network, and then I have them label who’s good for doing things and who’s good for listening and who’s good just to have a good time with, and that’s important, too.  Just to have time off from your grief because it is such hard work.