Grief and loss strike an imbalance in life. During the adjustment process, numerous complications can occur that can veer a person off course in adjustment. Sometimes Grief Counseling and simple talk can help but other times more powerful forms of counseling are required via licensed counselors with an expertise in grief counseling. In some cases, therapy involves looking solely at the past and the emotional aspect via Psychodynamic Approach, sometimes professionals utilize a more rational approach through Cognitive Behavioral Therapy, and in some cases, professionals utilize a combination.
Cognitive Behavioral Therapy or CBT has a high success rate in helping complicated and dysfunctional grievers find understanding and meaning in life through examination of the loss and recognition of unhealthy feelings, irrational thoughts and imbalanced behaviors. It involves intense reflection, grief work and homework, and application to help the person reframe distorted views due to complicated grief or even cases of depression. Originally utilized by Aaron Beck (1967), it looked to challenge distorted feelings and help the person find healing through rational re-direction. In essence, CBT recognizes the Cognitive Triangle of thought, behavior and emotion. Each aspect of human existence affects the other. Thoughts can positively or negatively affect behavior, behavior can affect emotion and emotion can affect thought. If any of these are imbalanced, it can create a distortion itself.
Albert Ellis, (1957) was a core contributor to Beck’s thought. Ellis was discouraged by the limitations of psychoanalysis and limitations of only becoming aware of an emotion but wanted tools to cognitively help the person move forward. Ellis drafted the ABC Model which identified a triggering or Activating event with a belief that in turn caused a consequence. An activating event could be labeled as any traumatic event or loss that in turn was interpreted by the person. In complications of grieving, the interpretation or belief regarding the event many times caused negative consequences, instead of the event itself. The purpose of the therapy was to revisit the event, understand it and correlate proper consequences from the objective nature of the event instead of subjective beliefs or faulty conclusions. Hence irrational, unhealthy, and counter productive thinking and new distorted behaviors from an event are key elements within complications of grieving. CBT looks to challenge those ways of thinking and behaviors with an indepth cognitive, intellectual and rational discussion to help correct the emotions and behaviors via better thinking or reframing.
Cognitive Distortions
Individuals who suffer from depression or complications in grieving generally have a faulty cognitive view of reality. Due to the event, loss, or trauma, there is a type of worldview that haunts them and adversely affects their emotional and behavioral response to life. For those suffering from depression or complicated loss, many have a variety of distorted views which include:
- All-or-nothing thinking: Viewing situations in binary terms, without considering nuance.
- Catastrophizing: Anticipating the most adverse outcomes without empirical justification.
- Mind Reading: Presuming to understand others’ thoughts without direct evidence.
- Emotional reasoning: Basing conclusions on emotions rather than objective data.
- Labeling: Characterizing oneself or others based on a singular trait or event.
- Personalization: Attributing external events to oneself without a clear causal line
McCleod. S. (2023). Cognitive Behavioral Therapy (CBT): Types, Techniques, Uses. Simple Psychology. Access here
As McCleod points out, many of these distortions are assumptions that usually are tied to lower self image or negative self schemas. These negative self schemas play a key role in the illogical thinking and ideals of a depressed person
Cognitive Triad and Cognitive Distortions
Beck used the example of the Cognitive Triad that illustrated three ideals of self, the world, and the future. In all cases of depressed individuals, the self image of the person was negative, the ideal that the world hated them was present and that the future possessed no future blessings. Beck theorized that this triad stemmed from a negative schema in life that originated from a negative life event that was never processed properly. This in turn led to a complication in grieving or adjusting. From these events, a series of even more cognitive distortions emerged within the depressed person in how they viewed life itself.
Among the many included magnification of bad events or minimization of good events, over personalization of others emotions as if they are correlated with oneself, and improper correlation of negative causal events with oneself (select abstraction). As one can imagine, a depressed person is trapped not only with emotional imbalance but is also haunted daily with these negative cognitive sequences
CBT Process
CBT challenges these thoughts. It looks for one to reframe them and see things in different lights. It looks to gain a better understanding of these thoughts and behaviors and incorporate better problem solving ways to deal with them. This reframing involves first a serious discussion and revisiting of the activating event and understanding it more objectively. Sometimes the therapist will utilize exposure therapy with the patient, asking them to discuss and think about the past incident. For more traumatic or painful memories, this takes time and over sessions, longer exposure occurs. Sometimes, this is through direct memory or pretending to be a bystander watching the past. This challenges the person to face one’s past, fears and trauma and move forward.
Following analysis, one is asked to discuss thoughts and emotions associated with the event. This is where illogical and damaging thoughts and behaviors can identified and weeded out. The patient is given alternative ways of thinking and reframing thoughts about the event, as well as ways to better cope with daily issues. This is key in helping the individual. The therapist not only unroots the cognitive distortion but also gives the patient the psychological and mental tools necessary to alter negative thoughts and behaviors in association with the event. Sometimes, the therapist and patient can role play a future event to help the patient better prepare for interaction. Other tools include meditation and ways to calm oneself when a potential social trigger presents itself that can challenge the new reframing.
CBT gives the patient the opportunity to also be their own therapist. To work through issues, apply skills and complete homework assignments.
It is essential in CBT to identify and recognize the distorted thought or maladaptive coping in response to the event and give the person the tools necessary to properly understand the issue and reframe it for healing purposes. CBT usually takes 20 sessions or so to finally uproot the issue and help reframe and correct distorted thinking.
Limits of CBT
While CBT is successfully, it can have limitations. It is based primarily upon the cognitive thought process and looks to correct maladaptive coping and distorted thoughts to help the person find balance, but other therapies, such as the Psychodynamic Approach Looks at the emotional response stemming from the past event and how that event negatively affects present day emotions. The Freudian Psychodynamic Approach finds the repressed feelings and how to cope with those feelings. If utilized in combination with cognitive, I feel both approaches integrated can help the person have a more holistic and complete person healing process. The other limitation of CBT is if solely utilized as talk, it does not address the chemical imbalance within the brain and neurotransmitters. Sometimes, serotonin balance is necessary and depression medications are necessary to help a person find new balance and alter thought process.
Hence, a multi faceted approach is sometimes necessary in treating a person, not merely an intellectual approach. This does not mean CBT is not highly effective. It is extremely useful tool in helping individuals reframe negative thoughts and behaviors due to an incident and helping them correct those issues.
Conclusion
CBT and other therapies combined are excellent ways to help correct complications in grieving stemming from distorted thinking and helping the individual from an intellectual standpoint reframe and understand the loss in a logical way void of false images. It is a heavy talk based therapy that asks one to revisit the past, rethink and reframe it, and correct distorted thoughts and behaviors. It sometimes requires additional therapies with it to help others overcome depression or complications in the grieving process but overall is very successful. This type of therapy or any grief therapy is reserved for licensed therapists. Pastoral grief counselors who are not licensed need to refer more serious cases of grief and loss to these types of licensed counselors.
Please also review AIHCP’s Grief Counseling Certification. The program is open to both licensed and unlicensed Human Service professionals and offers an online and independent program that leads to a four year certification.
Additional Resources
“Cognitive Behavioral Therapy (CBT)”. Cleveland Clinic. Access here
“What is Cognitive Behavioral Therapy?”. (2017). Post Traumatic Stress Disorder. APA. Access here
Raypole, C. & Marcin, A. (2023). “Cognitive Behavioral Therapy: What Is It and How Does It Work?”. Healthline. Access here
“Cognitive Behavioral Therapy” Psychology Today. Access here