Preparing Grieving People
for the Holidays
William G. Hoy
As the air turns crisp in autumn, we inevitably begin to think toward the holidays coming at the end of the year. In my experience with bereaved people, the weeks between Thanksgiving and New Yearâ€™s Day pose the most challenging period for most people during the first year or two of bereavement. Wise counselors and group leaders look for ways to get bereaved clients ready for the almost certain difficulty that accompanies Christmas and the other end-of-year holidays.
Here are some ways I have found helpful as the year ends.
Inquire about holiday plans early.
Simply asking about holiday plans in the early fall helps signal bereaved people that it is okay to feel a sense of sadness or dread as the season approaches. Remember that many bereaved individuals are receiving clear messages from family members to â€œmove on,â€ and your questions create a climate where grief is acceptable, even during the time of year when social expectations are to be happy. Early in the fall, I try to ask groups and individuals with whom I am working, â€œMost grieving people dread some part of the approaching holidays; what concerns you the most?â€
Fruitful conversations in groups and with individuals also grow out of questions like, â€œHow do you think the holidays will be most different for you this year?â€
Encourage plans that include both self and others.
Early in my career, I counseled grieving people to â€œDo as much celebrating as you likeâ€¦and no more.â€ Through the years, I have adapted that approach, realizing it creates more stress for some grieving people than it alleviates. Following that advice may actually damage relationships. Many of our clients are part of families where some level of holiday observance is expected and necessary. I have never found the practice of total withdrawal to be adaptive. Instead, we must coach group members and individual clients to anticipate the events of which they are expected to be a part. Some of these may be obligatory family gatherings where absence causes more stress than presence, and many clients are better off at least participating minimally.
Instead of saying to the extended family, â€œIâ€™m not coming to the family Christmas Eve dinner this year,â€ many clients will find it more useful to say to the hostess, â€œYou know, my energy level just hasnâ€™t returned to the level it was before Bob died and the experts all say that is normal. Will it hurt your feelings if I come but feel the need to leave before the evening is over?â€
This acknowledges the tradition and the family expectations while setting appropriate boundaries around the bereaved personâ€™s own needs.
Talk about expected pitfalls.
Ask clients and group members, â€œWhat do you expect to be the hardest part of the holidays this year?â€
Especially in support groups, talking about a few of these and devising plans together for managing the pitfalls actually helps everyone adapt better. In both individual and group work, you will want to do some grief education in the period leading up to the holidays.
Talk about trigger points and the unexpected waves of sadness some people feel at hearing a favorite song, seeing the shopping mall transformed into a holiday wonderland, and smelling a favorite holiday food cooking. I try to remind bereaved people that we are sensory beings and our senses are bombarded during the holidays, contributing to the difficulty of this period. The sights, sounds and smells that used to bring such joy now harbor incredible sadness, but talking about those possibilities in advance and making a plan to address them can be a huge help in handling the holidays.
Assess spiritual support as holidays approach.
The winter holidays of Hanukkah and Christmas are rooted in religious belief and practice, so it makes sense to address the role faith and spiritual support might play in the holiday season. Reflecting together on the ways the client makes spiritual meaning of the holidays is important. Sometimes, this discussion leads to new discoveries of support afforded by beliefs and community; sometimes, the discussion exhumes old spiritual hurts that create roadblocks in the grieving personâ€™s experience.
The widow of one minister seemed particularly troubled by the approaching holidays even five years after her husbandâ€™s death; she sought counsel because the ongoing difficulty with the holidays perplexed her. As she and her counselor talked, she shared the difficulty she had with â€œsharingâ€ her husband with the congregation all of those years. She had grown up in a family where extended family was always together from Christmas Eve afternoon until the evening of Christmas Day. Because their congregation held several church services on Christmas Eve and another on Christmas morning, her husband was only home to sleep from early Christmas Eve morning until nearly noon on Christmas Day. He had died at an early age with school-aged children and his widow felt the church had robbed her and them of those experiences she had so treasured from her own childhood.
Affirm the importance of physical fitness
. Few things are more important for bereaved people in the early months of lossâ€”and especially during holidaysâ€”than getting adequate rest, exercise, and nutrition. The stresses of bereavement make these both vitally important and easily overlooked. In both groups and individual counseling, I inquire of clients early and often about how they are eating and sleeping. While insomnia can be indicative of clinical depression, bereavement-related insomnia is often the bodyâ€™s simple response to lack of time for cognitive and emotional processing during the waking hours. The bereaved person who tries to â€œstay busy so I donâ€™t think about itâ€ seems especially prone to this night waking. The heart and mind are not so easily fooled.
I ask about how sleeping and eating habits have â€œmost changedâ€ since the loss and I watch for signs of weight changes (tight- or loose-fitting clothing is a possible indicator). Of course, clients will usually point these changes out anyway. Nutritional suggestions such as increasing fresh vegetable intake, reducing salt and paying close attention to sugar, alcohol and caffeine intake may help clients begin paying closer attention to these factors but a consultation with the clientâ€™s own healthcare provider is also important.
When possible, I think it is necessary to counsel clients about normal bereavement â€œsymptomsâ€ before they visit the doctor. I explain the apparent preference some providers have for dispensing antidepressant and sleeping medication with little provocation and no clinical evidence of true depression. These are rarely warranted and generally carry significant and often distressing side effects. We have a rather elaborate clinical decision-making matrix to diagnose clinical depression and while many of these symptoms are mimicked in bereavement, it is rare to find a bereaved person who truly meets the criteria
Of course the good news is that bereaved people who do receive antidepressant therapy from their primary care provider have better overall outcomes when they also receive good psychosocial support including counseling and mental health follow-up (Oâ€™Connor, Whitlock, Bell & Gavnes, 2009, p. 801).
Oâ€™Connor, E.A., Whitlock, E.P., Bell, T.L., & Gavnes, B.N. (2009). Screening for Depression in Adult Patients in Primary Care Settings: A Systematic Evidence Review. Annals of Internal Medicine, 151
William G. (Bill) Hoy
is an educator, counselor and author who has specialized in end-of-life and bereavement care for more than 25 years. Dr. Hoyâ€™s passion is equipping the next generation of physicians and other healthcare professionals through his research, writing and teaching responsibilities on the Medical Humanities at Baylor University. His newest book is Do Funerals Matter? The Purposes and Practices of Death Rituals in Global Perspective