Grief Counselling: Understanding Loss, the Stages of Change, and Addressing Resistance

1. Introduction to Grief Counselling

Grief counselling is a therapeutic process designed to help individuals navigate the psychological, emotional, and existential turmoil that follows a significant loss. Rooted in humanistic, psychodynamic, and cognitive-behavioral traditions, grief counselling acknowledges that loss—whether through death, illness, divorce, or injury—is a universal human experience, yet profoundly personal in its manifestation (Worden, 2009). The goal of grief counselling is not to eliminate grief but to facilitate adaptive mourning, helping individuals integrate the loss into their ongoing life narrative and reconstruct meaning.

The field evolved from early psychoanalytic understandings by Freud (1917) in Mourning and Melancholia, which distinguished normal mourning from pathological grief. Later theorists, including Kübler-Ross (1969) and Worden (2009), emphasized the dynamic process of coping rather than rigid stages. Contemporary grief counselling integrates attachment theory (Bowlby, 1980), narrative reconstruction (Neimeyer, 2012), and trauma-informed approaches, emphasizing resilience and post-loss growth.

The counsellor’s role involves creating a safe therapeutic alliance, validating emotions, and assisting clients in identifying coping resources. Counsellors must recognize that grief is not linear; it oscillates between loss-oriented (emotional pain, yearning) and restoration-oriented (adjusting to new roles, responsibilities) processes (Stroebe & Schut, 1999).

2. Effects of Loss, Illness, Divorce, and Injury

Loss manifests in diverse forms, each producing unique emotional and behavioral consequences. Grief is not limited to bereavement but extends to symbolic losses—such as loss of health, relationship, career, or personal identity.

2.1 Loss through Death

Bereavement following death often evokes deep sorrow, yearning, guilt, or anger. Physiologically, it may trigger insomnia, appetite changes, or somatic complaints (Stroebe et al., 2007). Psychologically, it may disrupt identity and worldviews, particularly if the loss challenges one’s sense of meaning or spiritual beliefs.
Case Example – Mrs. L’s Bereavement after Spousal Death:
Mrs. L, a 55-year-old widow, sought counselling six months after her husband’s sudden death. She reported emotional numbness, avoidance of social contact, and self-blame for not detecting his heart issues earlier. Through therapy, she explored guilt as part of adaptive grieving. Using Worden’s tasks of mourning, she gradually accepted the reality of loss, processed her pain, and reconnected with her social identity through volunteer work.

2.2 Illness and Chronic Health Conditions

Chronic illness leads to anticipatory grief, involving mourning before an actual death or irreversible loss. Patients experience anxiety about dependency and future decline, while caregivers grieve the loss of the person’s previous vitality.
Case Example – Anticipatory Grief in Parkinson’s Disease:
A 63-year-old man diagnosed with Parkinson’s experienced despair over losing autonomy. Counselling focused on narrative re-authoring, where he reframed his illness journey as one of courage and teaching resilience to others. This process shifted his emotional stance from helplessness to acceptance.

2.3 Divorce and Relationship Dissolution

Divorce elicits a complex interplay of loss of attachment, identity, security, and shared dreams. The emotional trajectory often mirrors bereavement—denial, anger, bargaining, depression, and acceptance. Children of divorced couples may also exhibit adjustment disorders, requiring family-based interventions.
Case Example – Divorce-Induced Identity Loss:
An executive woman, post-divorce, described herself as “half a person.” Counselling integrated cognitive restructuring and emotional processing, helping her recognize distorted self-blame and reconstruct a personal narrative centered on self-efficacy and autonomy.

2.4 Injury and Disability

Physical injury or sudden disability (e.g., spinal cord injury) can cause grief over bodily integrity, career potential, and future aspirations. This form of loss often produces secondary losses, such as social isolation or loss of intimacy.
Case Example – Coping after Paralysis:
A 28-year-old athlete who suffered paralysis struggled with depression and anger. The counsellor used Acceptance and Commitment Therapy (ACT) to help him detach from self-defeating thoughts and reconnect with values such as mentorship and advocacy, leading to adaptive adjustment.

3. The Stages of Change Model in Grief Counselling

Developed by Prochaska and DiClemente (1983), the Transtheoretical Model of Change (TTM) provides a valuable framework for understanding clients’ readiness to adapt to loss. It conceptualizes behavior change as a cyclical process with six stages:

This model aligns with Worden’s (2009) Four Tasks of Mourning—accepting the reality of loss, processing the pain, adjusting to an environment without the deceased, and finding enduring connection while moving forward. Both emphasize that movement between stages is fluid, not fixed.

4. Addressing Ambivalence and Resistance in Grief Counselling

Resistance and ambivalence are natural components of the grief process. Clients may consciously or unconsciously avoid emotional pain to protect themselves from re-experiencing trauma. Resistance can manifest as intellectualization, minimization, withdrawal, or anger toward the counsellor.

4.1 Understanding Ambivalence

Ambivalence arises when clients simultaneously desire change and fear it. In grief, this may appear as wanting to move on yet feeling guilty about doing so. Counsellors should normalize ambivalence, framing it as an indicator of inner conflict rather than defiance.

Example:
A bereaved father expressed guilt over “forgetting” his deceased son when laughing with friends. The counsellor employed motivational interviewing (MI) to validate both sides of his ambivalence—his loyalty to his son’s memory and his natural need for social reconnection.

4.2 Techniques to Address Resistance

1. Empathic Reflection: Acknowledging client defenses as self-protective, not oppositional.

2. Motivational Interviewing: Using open-ended questions, affirmations, reflective listening, and summaries to evoke intrinsic motivation.

3. Cognitive Reframing: Challenging maladaptive beliefs such as “moving on means betrayal.”

4. Relational Repair: Addressing transference reactions—anger or mistrust toward the counsellor—as part of the therapeutic process.

5. Small-Scale Exposure: Gradual engagement with avoided stimuli (e.g., visiting the deceased’s room) to facilitate emotional desensitization.

6. Narrative Techniques: Encouraging storytelling to externalize pain and reconstruct meaning.

Case Example – Resistance in Grief Therapy:
A middle-aged woman, grieving her mother’s death, resisted counselling by intellectualizing her emotions. The counsellor used gentle self-disclosure, saying, “Sometimes, logic becomes our shield against pain,” leading her to explore her suppressed sadness. Over sessions, she moved from avoidance to cathartic mourning, symbolized by writing a farewell letter to her mother.

5. Integrative Counselling Approaches

Contemporary grief counselling integrates multiple frameworks:

• Cognitive-Behavioral Therapy (CBT): Targets maladaptive cognitions (“I can’t live without them”) and encourages adaptive coping.

• Narrative Therapy: Facilitates re-authoring of life stories after loss.

• Existential Counselling: Explores meaning, mortality, and identity transformation.

• Mindfulness and ACT: Encourages acceptance of painful emotions without judgment.

• Cultural Sensitivity: Recognizes cultural variations in mourning rituals and expressions of grief.

For example, in collectivist cultures such as India, family and community involvement play a central role in coping, and counsellors must respect ritualized mourning practices while addressing individual distress.

6. Conclusion

Grief counselling stands at the intersection of emotional healing, cognitive restructuring, and existential growth. It recognizes that loss is not an event to “get over” but an experience to integrate. Effective counsellors balance empathy with structured intervention, guiding clients through denial, anger, guilt, and acceptance toward meaning reconstruction. The Stages of Change Model and motivational interviewing offer powerful lenses to understand client readiness and address resistance compassionately.

In a rapidly changing world—with increasing loneliness, chronic illness, and digital mourning spaces—grief counselling must evolve into a multicultural, technologically adaptive, and resilience-oriented practice. As counsellors, the ultimate aim is not merely recovery from loss but the reclamation of life, purpose, and human connection.

References

• Bowlby, J. (1980). Attachment and Loss: Vol. III. Loss, Sadness, and Depression. Basic Books.

• Freud, S. (1917). Mourning and Melancholia. The Standard Edition of the Complete Psychological Works of Sigmund Freud.

• Kübler-Ross, E. (1969). On Death and Dying. Macmillan.

• Neimeyer, R. A. (2012). Techniques of Grief Therapy: Creative Practices for Counseling the Bereaved. Routledge.

• Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.

• Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197–224.

• Worden, J. W. (2009). Grief Counseling and Grief Therapy: A Handbook for the Mental Health