Article excerpts from Howard Clinebell’s book:
Basic Types of Pastoral Care and Counseling: Resources
for the Ministry of Healing and Growth (1)
by David Tillman, December 2013
United Theological Seminary, New Brighton, MN 55112
Class: Pastoral Care in Grief and Loss, taught by Dr. Trina Armstrong
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Key issues: “Ministers are the only professional persons with training in counseling who have automatic entree to the world of most sorrowing people. This gives clergy an unparalleled opportunity and responsibility to be effective guides and companions of the bereaved as they walk through their shadowed valley of loss.” (1)
“Studies show that many people become sick following the death of a loved person. A great many more hospital patients have had a 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.” (1)
Blocked, unfinished grief takes a heavy toll, sapping one’s creative juices. The longer the healing is delayed, the more costly the protracted grief is to the person’s wholeness. The death of my younger sister, Ruth, on her first birthday when I was four and a half, cast a dark shadow over our family. We all paid a high price for not knowing how to experience healing of our grief.” (1)
There is a virtual epidemic of unhealed and largely unrecognized grief wounds in most congregations and communities, particularly those with a sizable group of older persons. Life is a continuing series of separations and losses, small and large. Handling bereavement is an indispensable part of human growth. Many losses are potential opportunities for personal and spiritual growth. The frequency of losses accelerates with the passing years. For this reason, learning to handle losses without being crippled by them is an essential skill of creative aging.” (2)
Grief Work Task and Help Needed: (2)
“Experiencing shock, numbness, denial and gradually accepting the reality of the loss.
Help needed: A ministry of caring and presence, practical help, and spiritual comfort.
Experiencing, expressing and working through painful feelings—e. g., guilt, remorse, empathy, anger, resentment, yearning, despair, anxiety, emptiness, depression, loneliness, panic, disorientation, loss of clear identity, physical symptoms, etc.
Help needed: A ministry of caring, and responsive listening to encourage full catharsis.
Gradual acceptance of the loss and putting one’s life back together minus what was lost, making decisions and coping with the new reality; unlearning old ways of satisfying one’s needs and learning new ways to satisfy these needs. Saying “goodbye” and reinvesting one’s life energy in other relationships.
Help needed: A ministry of crisis care and counseling, facilitating reality testing, and support in the difficult tasks of rebuilding one’s life (the ABCD approach).
Putting one’s loss in a wider context of meaning and faith; learning from the loss.
Help needed: A ministry of facilitating spiritual growth.
Reaching out to others experiencing similar losses for mutual help.
Help needed: A ministry of enabling outreach to others.” (2)
Note: “Except for the first two, these grief work tasks do not necessarily occur in lineal sequence. For example, coping with the new reality brought by the loss (task 3) begins almost immediately after the loss and continues throughout the other tasks.”(2)
“During the visit immediately after the death, as the funeral is being planned, the minister should encourage the bereaved family to talk together about their loved one—the circumstances of the death, and the memories and attributes they most cherish about that person.” (3) One purpose of the funeral is to facilitate the emotional release of grief feelings. What is said during the service should be straight and clear about the painful reality of the loss, so far as this life is concerned, and the appropriateness of mourning. Nothing should be said implying that stoicism in the face of grief is a sign of real strength or Christian virtue, or that one whose faith is genuine will not experience agonizing grief. The funeral should include familiar hymns, prayers, and scripture that bring enspirited comfort and also help release dammed-up feelings. A grief-enabling meditation on a text such as “Jesus wept” (John 11: 35) or “Blessed are those who mourn” (Matt. 5: 4) can help to give permission to grieve to those who need this.” (3)
“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.” (3)
“It is crucial that caring support of the family continue during the weeks and months following the funeral. Many people are unaware that the bereaved continue to need special support during the extended process of working through the loss.” (3)
“The two feelings that most often infect the grief wound are unresolved guilt (remorse, shame) and anger (resentment, rage). It is important therefore to ask questions such as, “If you had your relationship to live over, what would you do differently?, ” “Do you feel much anger or resentment?, ” and “Have you been able to express these feelings?” These questions should only be asked when the pastor is willing to help the person express, talk through, and begin to release and resolve the intense feelings they may elicit.” (3)
“The way people respond to losses varies greatly depending on their own resources, the quality and length of the relationship, the timeliness of the loss, whether the death was expected, and the nature of the death. The more dependent and ambivalent the relationship, the longer and more complicated the recovery process.” (3)
“The difficult grief task of rebuilding one’s life without the lost person involves unlearning countless habitual responses, learning new behavior to meet needs formerly met by the deceased, and making countless decisions about how to cope with the new problems the loss brings. Church members in general and the lay caring team in particular should be guided in functioning as a substitute extended family for those who lack a support system, offering whatever practical help and emotional support is needed.” (4)
“Two signs that persons are moving toward the completion of the recovery process are “saying good-bye” (emotionally) to the lost person and reinvesting some of that energy in other relationships. The grief wound cannot heal fully until one has accepted the reality of the loss, surrendered one’s emotional tie to the lost person, and begun to form other relationships to provide new sources of interpersonal satisfaction.” (4)
“Religious resources have much more than a supportive comforting function in bereavement. The death of another confronts us with our own mortality. Existential anxiety (about nonbeing) can be handled constructively only within the context of a vital faith. The symbols and affirmations of one’s religious tradition can touch deep levels of the psyche, gradually renewing the feelings of basic trust that alone can enable persons to handle existential anxiety creatively. Therefore, the minister’s teaching and priestly roles are important in helping the bereaved put their loss in the context of faith.” (4)
The Grief Wound that Does Not Heal
In normal recovery from grief, persons gradually deal with those ambivalent feelings that are present in all close relationships. If, instead, persons continue to over-idealize the deceased, they are utilizing the defenses of denial and repression. These defenses enable them to avoid the agony of the loss, but they also prevent the grief wound from healing. The wound is infected and cannot heal until the person deals with the repressed feelings.” (4)
Here are some danger signs that may indicate pathological grief if they persist over several months or longer: increased withdrawal from relationships and normal activities; the absence of mourning; undiminished mourning; severe depression that does not lift; severe psychosomatic problems; disorientation; personality changes; severe, undiminishing guilt, anger, phobias, or loss of interest in life; continuing escape by means of drugs or alcohol; feelings of inner deadness.”
“It is important to emphasize that grief per se is not an illness. It is a normal human healing process for which most people have adequate resources—resources that they can be helped to mobilize by pastoral caring. Only when a grief wound is infected does it become a pathological process requiring counseling or psychotherapy.” (5)
Setting Up and Leading a Grief Healing Group
“The new strategy needed to enable a congregation to minister more effectively to the bereaved, has three parts. The first is to inform members of the congregation, through sermons and adult education programs, about the nature and importance of grief work, and how they can enable this healing in themselves, their families, and friends.” (5)
“The second part of a strategy is to train a carefully selected lay-caring team to carry much of the load of supportive caring of persons with normal grief in the congregation (see chapter 16). There are too many persons going through a variety of crises, losses and transitions in a typical congregation, and the process of full recovery is too extended (at least a year and often much more) for a pastor working alone to respond fully to these multiple pastoral care needs.” (5)
“The third part of a strategy for helping the bereaved is for the pastor to set up and lead (or co-lead) a grief healing group periodically. Such a group is both an efficient way 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 one both finish one’s own grief work and learn to help other grieving persons. I cannot think of any one thing that a pastor or congregation could do that would have greater healing impact than providing regular opportunities for grieving people to participate in such a grief group. (6)
“Several grief group formats have been used effectively in churches. The most common model is a series of weekly one and a half or two hour meetings, for four to eight weeks. Such groups often recontract at the end of the agreed-upon time to extend the length of the group to deal with unfinished issues. A second format is to meet for a longer time on a single day or a weekend retreat. Bob Kemper, pastor of a church near Chicago, reports that a three-hour grief sharing session in his church was remarkably effective. Twenty-six people attended the session.” (6)
Pastoral Care of the Dying and Their Families
“Ministering to the terminally ill and their families is a vitally important pastoral care opportunity.” (7)
“Each person’s dying is as unique as his or her living. But five things seem to help some people use their dying to gain wider perspectives, mobilize new strengths, and thus die well:
Having a small caring community of persons who will listen and give warm support. Dying is both a very private and an intensely interpersonal experience. In our lonely society, the richness of one’s interpersonal network makes a tremendous difference in the quality of one’s dying.
Completing as many of the unfinished issues as possible in their lives, especially in their close relationships (e. g., expressing love or asking and receiving another’s forgiveness). Ted Rosenthal points out, “I don’t think people are afraid of death. What they are afraid of is the incompleteness of their life. “14
Doing the complex grief work of dying so that they can reach the experience of acceptance (Kubler-Ross).
Having a faith system, a sense of trust and at-homeness in the universe gives some meaning that transcends the multiple losses of dying.
Having a setting where one can die with dignity. The hospice movement is the most humanizing development in recent years so far as dying is concerned. A Christian physician, Cicely Sanders, who started the first modern hospice St. 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.” (7)
“Hospice programs enable some terminally ill people to die in their homes surrounded by family members rather than in the impersonal atmosphere typical of many hospitals.” (8)
The Crisis of Grief and Divorce
“Divorce is one of the most widespread grief experiences in Western societies. In the United States, for example, over one million couples terminate their marriages each year.” (8)
“Divorce is usually an ego insult, an experience that diminishes self-esteem. Women are programmed to feel especially responsible for the success of interpersonal relationships including marriage. Thus their sense of failure and guilt is often intense. Both men and women feel the painful wound of being rejected by their ex-spouse, particularly if they did not initiate or want the divorce. Feelings of failure and rejection are reinforced by the judgmental attitudes of some church people. Unresolved anger, bitterness, resentment, loneliness, self-doubt, and depression swirl together producing the infected grief wounds that frequently result from divorce. Even if the individual wanted and needed to be freed from a miserable, mutually destructive relationship, there is usually pain and grief intermingled with the sense of relief and release.” (8)
“The first is to help them work through and resolve the grief and the pain. If people remarry before their grief work from an earlier marriage is completed, the new relationship is almost certain to be complicated by unresolved feelings and conflicts from the earlier relationship. Some people are not open to pastoral divorce counseling because they fear that they will be judged or at least not understood by ministers. When a couple in marriage counseling decides to divorce, it is important to encourage them each to continue in individual counseling aimed at helping reduce the emotional damage of splitting a family.”
“The second closely related objective is to help divorcing people learn and grow from the experience. To do this is the best preparation for either remarriage (which five out of six divorced men and three out of four divorced women in the U. S. do) or creative singlehood. Helping persons identify and change whatever they contributed to the death of their marriage and coaching them as they learn new communication and conflict resolution skills are two essential parts of this learning-growth process. The scores of new decisions a divorcing person must make are likely to be more constructive if she or he has an opportunity for reality-oriented crisis counseling around these complicated issues. Participating in a creative divorce retreat or group, or in a grief growth group can be a valuable experience for those going through separation and divorce.” (8)
“The third objective of divorce counseling—to reduce emotional damage to children to a minimum—will be discussed in chapter 13. The decision to end a destructive marriage is often a first and essential step toward a new, more constructive life. The possibilities that it will be so can be increased with the aid of a skilled pastoral counselor and/or an effective growth group.” (8)
Suicidal Crises and Grief
“Suicidal persons are more likely to turn to clergy than any other profession except physicians. Yet, many ministers are less able to recognize suicidal lethality than are those in other helping professions. It is crucial for ministers to know how to respond in suicidal crises. The pastor’s role in such crises has four facets:
(1) recognizing suicidal persons.
(2) providing emergency help until a referral to an appropriate mental health professional or suicide prevention center can be made.
(3) continuing pastoral care and counseling of the person and the family to help them deal with the underlying causes of the suicidal behavior within the individual and in the family system.
(4) helping the family deal with the destructive consequences of an incomplete or a completed suicide.”
“Suicide is seldom a sudden, unpremeditated act. Before attempting suicide, most people send out cries for help. These distress signals include: Obvious suicidal threats—The old belief that “People who talk about suicide don’t kill themselves” dies much more slowly than the countless people who demonstrate its falsity. The only safe axiom to follow is this: All suicidal threats must be taken very seriously! Even if persons are only trying to manipulate others, with no intention of self-destruction, the fact that they use such a deadly threat indicates that they and their relationships are profoundly disturbed. Covert suicidal threats— Those who articulate feelings that life is empty and meaningless, who believe they are no longer valued or needed by others.” (9)
“The higher the lethality probability, the greater the need for the pastor to use whatever approach is necessary to prevent suicidal action. In a caring and accepting but a very firm manner, the minister should use persuasion, theological arguments, staying with the person, driving her or him to a physician or hospital emergency room, or— if nothing else works—phoning the police and using physical restraint. An appeal to at least postpone suicide is sometimes effective.” (10)
“During the first conversation with suicidal persons, obtain the names and phone numbers of close relatives, friends, and physicians, and explain why it is necessary to let them know that he or she needs extra emotional support during this crisis. The family should be told not to leave persons alone during their acutely suicidal phase. Involving the family physician as soon as possible is also important, in case antidepressant medication or temporary hospitalization is needed. An evaluation by a psychiatrist of persons making a suicide threat can be helpful in deciding whether hospitalization and psychiatric treatment are needed. The methods of crisis counseling described earlier are relevant in working with suicidal people.” (10)
“Most suicidal persons need three forms of help once they are beyond the acute suicidal crisis.
First, they need ongoing, supportive pastoral care.
Second, psychotherapy and/or family counseling to resolve the underlying intrapsychic problems (e. g., pathological guilt) and the interpersonal pathology that fed the suicidal behavior; and
Third, help with the spiritual and value problems at the root of their sense of meaninglessness and despair.” (10)
“At its deepest level, the suicidal person’s problem is a theological problem. As one with some expertise in spiritual growth, the minister has a unique and indispensable contribution to make to the longer-term healing of suicidal persons and their families.
In working with suicidal persons, it is helpful to remember that only a small portion of those who threaten suicide actually attempt it, and that of those, only a fraction actually kill themselves. It is also important to remember that the ultimate decision and responsibility for suicide remains with the person. If they have decided unequivocally to end their lives, (which 5 percent or less of suicidal persons actually have), they will probably do so, no matter how competent the persons who attempt to prevent it.
Suicide is often the tip of the iceberg of deep problems in a family system. The whole family needs pastoral care and often conjoint family therapy. Following an incompleted suicide attempt, it is important for the whole family to receive help in opening up their communication and resolving destructive interactions that probably contributed to the suicidal behavior. The family of a completed suicide almost always needs extended pastoral care and counseling to deal with the swirling feelings of unhealed shame, guilt, and rage toward the dead person. Their grief wounds are almost always infected.” (10)
“Counseling with suicidal persons often is threatening and demanding. It confronts us with the ultimate issues of life and death, and with our own suicidal tendencies (including protracted suicide such as killing ourselves by chronic overwork and self-stressing). Our effectiveness in dealing with the existential issues with which the suicidal person is struggling will depend on how we deal with these issues ourselves and whether we have found meanings in our own lives that enable us to transcend and transform, to some degree, the pain and tragedies of our existence.” (11)
The Pastor’s Own Losses and Crises
“Go back in memory, now, and recall a painful personal failure, rejection, defeat, or loss of someone (or something) you felt you couldn’t live without—or some awful crisis where you felt as if the rug had been pulled out from under your life. Take a few minutes to relive that awful experience, letting yourself experience again the agonizing feelings you felt when it happened. / Now, reflect on what you have just relived; become aware of what is still unfinished about that experience; what you learned from it; and how it altered your faith, your real beliefs, and your relation to God, what was and was not helpful to you. You may have just gotten in touch with your most valuable potential asset in pastoral care and counseling with people in severe crises and grief. Whatever your crisis counseling and bereavement skills, their ultimate usefulness will depend on how you cope with your own crises and losses, and what you learn about yourself, life, people, and God from those unwelcome intruders.”(11)
Questions for class discussion: In class practice in pairs a suicide conversation. Switch off being the person talking about suicide and the person providing pastoral care.
How has the reading affected your understanding of grief and loss? I can feel the tug in my heart and the concern in my mind about providing care to people dealing with loss and grief. I have a better understanding and resources to refer back to, around providing care to people in bereavement, loss, and grief. I see the value of training, experience, and reflection as steps to becoming a compassionate, empathic, and supportive care provider.
How will you apply what you have learned in your ministry setting? In my volunteer hospice chaplaincy and upcoming CPE residency, this will be very helpful in providing care around the loss and grief that I witness. At the church I attend, I see the transformative value of setting up a grief healing group, which Clinebell outlines in his paper. I will talk to the senior minister about her thoughts about setting up and leading, or co-leading with me, a grief healing group.
(1) Author unknown, writes about Howard Clinebell’s book: Basic Types of Pastoral Care and Counseling: Resources for the Ministry of Healing and Growth, 3rd Edition/13 (Abington Press, Nashville, 3rd edition, – 2013).
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