“Don’t walk in front of me... I may not follow. Don’t walk behind me... I may not lead. Walk beside me—and just be my friend.” – Cammus

Anticipatory Grief
As a family member or friend of an individual nearing the end of his or her life, you may be experiencing a normal form of grief called anticipatory grief. This type of grief may be characterized by the experience of vacillating between the seemingly competing tasks of being in the present moment with your loved one and yet preparing for the future without them. You may be doing all you can to promote their health today while also physically and emotionally preparing for their death in the near future. Therese Rando explained it well, when she said that anticipating a loved one’s death “...mandates a delicate balance among the mutually conflicting demands of simultaneously holding onto, letting go of, and drawing closer to the dying loved one” (1986).

Though your loved one has not yet died, you may find yourself feeling the pain of loss and experiencing a gamut of grief emotions and responses to loss. You may feel like you are in an emotional limbo, feeling hopeful for their comfort and additional time with them and yet feeling despair as you see the signs and symptoms of death.

You may experience some of the following aspects of anticipatory grief:

• Heightened fear, anxiety, depression and helplessness.
• Changes in your own physical health. Physical exhaustion is commonly reported.
• Feeling overloaded and overwhelmed.
• Feelings of unreality, disbelief and denial.
• Grieving the future you thought you’d have.
• Feelings of anger, hostility and guilt.
• Grieving the change in your relationship.
• Wanting your loved one to die so they (and you) can be at peace, released from this limbo state.

It is important to note that you are not going crazy. Anticipatory grief is a “normal adaptive response to loss and can help us to gradually face and accept the painful reality that our loved one is dying” (Hogan, 2006).

Though anticipatory grief can be a painful process, having time to anticipate the death can allow for:

• Absorbing the reality of the loss over a period of time.
• Saying goodbye and completing any unfinished business with the dying person.
• Reassigning family roles of the dying person.

Some suggestions as you anticipate your loved one’s death:

• Acknowledge you are grieving and allow yourself to express your grief.
• Pay attention to your own needs- recharging all of yourself; physically, mentally, emotionally and spiritually.
• Simplify your life in any way possible; make lists, delegate chores, say no to additional responsibilities. It is okay to take a raincheck or put some social engagements on hold.
• Take advantage of your support system. Reach out for and allow help from others. Connect with a counselor.
• Begin taking a look at what tasks need to be done after your loved one’s death.
• Anticipating a sense of relief after your loved one dies is normal. “Be gentle with yourself. Your desire for them to be released from this life does not diminish your love for them” (Hogan, 2006).
• Share with your dying loved one what it is you cherish about them; allow them the space, if they so wish, to talk about their fears, concerns, hopes and dreams; help them complete unfinished business; and in times of silence, hold their hand.

Resources:
Anticipatory Grief: A Guide to Coping with Impending Loss, booklet by whatsyourgrief.com
Anticipatory Grief: Expecting the Loss, Feeling the Pain, booklet by Marty Hogan, LCSW, MSW Sacred Vigil Press, 2006.
Loss and Anticipatory Grief, by Therese Rando, 1986.

Helping Others Through Grief
Helping Others Through Grief
by Donna O‘Toole

1. Be There
   Grieving people need support and presence more than advice. It is important to offer support over time.
2. Initiate and Anticipate
   Grieving people often don’t know or can’t ask for what they need. Suggest times you’ll be with them. Tell them ways you’d like to help.
3. Listen
   It’s often hard to believe a loss has really happened. Grieving people often need to talk about it a lot and tell stories over and over. Listening without judgment or interruption can be the most important gift you can give.
4. Avoid Clichés and Easy Answers
   “I’m sorry”... “I care”... “You’re in my thoughts” or “I’m with you” may be the best response.
5. Silence is Golden
   Sometimes there are no words for grief and no words that bring enough comfort to take away the pain. Silence can demonstrate your trust and acceptance.
6. Accept and Encourage the Expression of Feelings
   Reassure the person that grief has many feelings... that feelings are like barometers that indicate our internal weather. Expressing feelings can help change the weather. Suggest non-hurtful ways. (cry, punch a punching bag, go running, etc.)
7. Offer Opportunities and Safety for Remembering
   There are many times during grief that remembering helps the healing and growth process. Offer to revisit places and people who can help them get their questions answered or remember and can confirm the importance of the loss.
8. Learn About the Grief Process
   It will help with your fears and feelings of helplessness. When appropriate, share this with your friend as a natural process.
9. Help the Person Find Support and Encouragement
   Help your friend find a variety of supports to deal with different feelings and needs.
10. Allow the Person to Grieve at His or Her Own Pace
    Grief is an individual process. Your ability to not judge the length of time it takes will lighten the pressure to conform to other people’s needs or ways, and will enhance self-trust.
11. Be Patient...
    With yourself and your friend. You may need to give more of yourself than you imagined. Make sure you have your own means of support and self-care to see you through.
12. Provide for Times of Lightheartedness
    Grief can be like swimming upstream... sometimes you need to get out of it and recoup. Laughter and play are wonderful ways to regain some needed energy.
13. Believe in the Person’s Ability to Recover and Grow
    Your hope and faith may be needed when theirs fails. Your trust in the other’s ability to heal is essential. Listen and be with them in emotional pain. DON’T PUSH.

From “Healing and Growing Through Grief”, 1987, by Donna O’Toole, Rainbow Connection

• What to Do When a Loved One Dies: Practical Tasks During an Emotional Time
• Appropriate Expectations You Can Have for Yourself in Grief By Therese Rando, PhD

You Can Expect That:

• Your grief will take longer than most people think.
• Your grief will take more energy than you would have ever imagined.
• Your grief will involve many changes and be continually developing.
• Your grief will show itself in all spheres of your life: psychological, social, physical and spiritual.
• Your grief will depend upon how you perceive the loss.
• You will grieve for many things both symbolic and tangible, not just the loss alone.
• You will grieve for what you have lost already and for what you have lost for the future.
• Your grief will entail mourning not only for the actual person you lost but also for all of the hopes, dreams and unfulfilled expectations you held for and with that person, and for the needs that will go unmet because of the death.
• Your grief will involve a wide variety of feelings and reactions, not solely those that are generally thought of as grief, such as depression and sadness.
• The loss will resurrect old issues, feelings, and unresolved conflicts from the past.
• You will have some identity confusion as a result of this major loss and the fact that you are experiencing reactions that may be quite different.
• You may have a combination of anger and depression, such as irritability, frustration, annoyance, or intolerance.
• You will feel some anger and guilt, or at least some manifestation of these emotions.
• You may have a lack of self-concern.
• You may experience grief spasms, acute upsurges of grief that occur suddenly with no warning.
• You will have trouble thinking (memory, organization and intellectual processing) and making decisions.
• You may feel like you are going crazy.
• You may be obsessed with the loss and preoccupied with the lost love/deceased.
• You may begin a search for meaning and may question your religion and/or philosophy of life.
• You may find yourself acting socially in ways that are different from before.
• You may find yourself having a number of physical reactions.
• You may find that there are certain dates, events, and stimuli that bring upsurges in grief.
• Society will have unrealistic expectations about your mourning and may respond inappropriately to you.
• Certain experiences later in life may resurrect intense grief for you temporarily.

Should I go to a Support Group?

By Kenneth J. Doka, PhD, Hospice Foundation of America

When I counsel bereaved people, they frequently ask if I think they would benefit from a support group. I answer the question with one of my own: “What do you expect to gain?” Support groups are a time-tested method of help for people struggling with all sorts of difficulties. They have evolved from a model that sought to inhibit certain behaviors, such as drinking, to a model that tries to enhance and support individuals as they adapt to life issues.

Groups are not magic. There are no words that can be uttered within a group setting that can make grief disappear. Groups are places to work together to support one another; they are places where one gives as one takes, and this is very important, because sometimes individuals can be so needy in their loss that they have nothing to give. In such cases, individual counseling may be the best approach. Not everyone will find a support group suitable; each individual grieves in his or her own way.

Support groups, though, have much to offer. They can offer, for example, a sense of validation. After all, grief can be so isolating. One is besieged by so many reactions: physical, emotional, and spiritual. One needs a place to sort out all these reactions-to recognize that they are part of the journey of grief. In counseling, I am often asked, “Am I going crazy?” Support groups reaffirm that one is not going crazy; one is simply grieving.

While every loss is unique, through support groups, one can bask in the support of others who have some basis of empathy. They have experienced loss. They understand. They know. Also, groups provide some time away. For many people, their support group can be a break in the loneliness and the boredom that are a daily part of grief. Support groups offer suggestions for coping with the difficulties of grief. There is no one solution to dealing with loss; however, support groups can offer a range of alternatives. By listening to stories of how others coped with a particular problem, one can find solutions that may work best.

Some groups can even be advocates-by working to change laws or challenging social conventions. For example, Mothers Against Drunk Driving (MADD) re-formed the way the law treats driving while intoxicated. Support groups offer two other gifts. They provide hope by providing models that reaffirm that one can survive loss. Also, they reaffirm that in helping others, one helps oneself. One finds, even in the midst of grief, new empathy, new understandings, and renewed strengths.

Kenneth J. Doka, PhD, MDiv, is Senior Consultant to Hospice Foundation of America and a Professor of Gerontology at the College of New Rochelle in New York.

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