grief counseling certification

Grief Counseling: Mood Disorders and the DSM-V-TR

Posted on by Mark Moran

Mood disorders transcend the usual care of pastoral or non-clinical grief counselors.  Most grief counselors deal with the natural phenomena of loss that follows a natural grief trajectory.  Clinical professionals, who may also be grief counseling certified, deal with pathological issues surrounding mood.  Any instability of extremes, whether due to mania or melancholy can disrupt natural life and harm mental health.   Sometimes, moods can be directly affected by an acute grief or loss and this leads down a trajectory of complications due to grief, while in other cases, there is no triggering loss that causes the pathological mood.  Instead it involves an in-depth investigation into the etiology of the disorder reviewing biological, genetic, psychological, social and spiritual issues to explain the condition.

The DSM-V-TR lists numerous mood disorders ranging from Major Depressive Disorder to Bi-Polar Disorders. Please also review AIHCP’s Grief Counseling Certification

The DSM-V-TR groups together a variety of mood disorders which in this blog will highlight Major Depressive Disorder, Persistent Depressive Disorder and its numerous specifiers, as well as Bi-Polar 1 and Bi Polar 2 disorders and finally, Prolonged Grief Disorder.  It is important to remember that for the pastoral or non-clinical grief counselor, one should have a strong understanding of these mood disorders to help refer clients to the appropriate clinical specialists.  A non-clinical grief counselor cannot diagnose or treat mood disorders but they can be trained to spot these disorders and work with clinical professionals in assuring the necessary therapy and medications are received for the client.

Please also review AIHCP’s Grief Counseling Certification, as well as its numerous other Grief Programs.

Etiology of Mood Disorders

Mood disorders find their etiology from numerous factors.  Biologically, whether mania or melancholic, there is a strong connection of genetic inheritance of these pathologies tied to the neurotransmitters (McRay,2016).   When the neurotransmitter, serotonin, is low, depressive states can exist.  Serotonin is the a critically important neurotransmitter for mood stability (Barlow, et. al., 2023).   In regards to mania, the synapses between neurons fire to fast, and a euphoric state overtakes the person.  This is usually due to higher levels of  the neurotransmitter norepinephrine and lower of levels of serotonin, although higher levels of serotonin can also lead to states of mania (McRay, 2016).

Depression can be caused by an internal trigger but also a stressor or external loss.  Hence unipolar mood disorders can be both have a direct external stimuli as well as an internal disruption.   Many times the diathesis or culmination of internal and external events that overcomes a person to the disorder can be attributed to external factors that activate it.  As similar to anxiety disorders, a loss, or lack of social support in that loss, or distorted cognitive thinking can unravel a person’s natural reactions into a pathological state (Barlow, et. al. 2023).

When considering psychological etiology for mood disorders, many aspects involve self image, cognitive distortions, as well as learned helplessness in situations.    When individuals engage in self negative talk and think the worst, then it can affect a person’s overall mental paradigm.  In addition, when a person feels they have no control or power to prevent bad things from continuing, then the person becomes susceptible to pathological mood disorders (McRay, 2016).  In addition to how one thinks, social and cultural and spiritual aspects play a key role.  A person’s support system is key in any mood stabilization because it determines the foundation one has to face multiple problems before succumbing to the issue.  In addition, culturally and spiritually, how one views loss can play a key role in how one reacts to loss.

As one can see, mood disorders are a complications of genetic but also psychological, social, cultural and spiritual aspects of the person.  Sometimes, the mood disorder, such as depression, has a visible trigger, but other times, it is purely at the chemical level of the brain.  Every individual is different and what causes diathesis and activation of a mood disorder, or even anxiety is not a simple equation but a very complex one.

Mood Disorders and the DSM-V-TR

In this blog, we will follow the order of the DSM-V-TR and how it lists and discusses the nature of mood disorders.  We will primarily focus only on the above mentioned disorders.

Bi Polar I & Bi Polar II Disorder

Polarity of symptoms Depression euthymia mania subsyndromal hypomania. Vector illustration

Bi polar disorders are characterized by cycles of depression and euphoria (mania) with symptoms that can greatly affect one’s ability to function in life (McRay, 2016).   The DSM-V-TR states that mania is a period of abnormal and persistent moods of high levels of energy with the possibility of also irritability which lasts at least 1 week (2022).   During this phase of mania, the DSM-V-TR notes these types of characteristics with three needed for diagnosis or four if the mood is only irritability.

  1. inflated self esteem or grandiosity
  2. deceased need for sleep
  3. more talkative or need to talk
  4. flights of ideas or subjective experiences that are racing through the mind
  5. distractibility
  6. increased goal directive activities that can be social, work, academic or sexually
  7. excessive engagement in activities with high potential for bad outcomes.  Such as foolish business investments, spending sprees or sexual activitiy

The DSM-V-TR continues that these states cause severe impairment to social and occupational functioning and has no association with other psychotic, psychological, substance or medicated purposes (2022).  Within itself, these are conditions for mania, which albeit rare, can exist as an issue alone apart from Bi-Polar I or II.

Ironically, Bi-Polar I does not require a depressive cycle although that is very rare for one not to be present in diagnosis.  When we discuss Major Depressive Disorder and a depressive episode we will list its diagnosis as well which would be utilized with any Bi-Polar disorder.

For Bi-Polar I, as well as Bi-Polar II, the DSM-V-TR provides many specifiers since it affects individuals with so many additional subjective aspects.    It can be mild, moderate, severe, possess psychotic features, be in partial remission or full remission, or also include anxious distress, mixed features, rapid cycling, melancholic features, mood congruent psychotic features or mood incongruent psychotic features, catonia, peripartum or seasonal (2022).

Bi-Polar II differs from Bi- Polar I in that there is no state of mania but there always must be a depressive state.  What replaces mania is referred to hypomania.  Hypomanic episodes shares the same characteristics of mania but not as severe or impairing to the individual (only 4 days as opposed to at least a week) but it still manifests a change in functioning that is not characteristic of the individual when not symptomatic (2022).  In addition, the mood shift is observable by others but not enough to cause extreme distress (DSM-V-TR, 2022).

The primary differing diagnosis factor from Bi-Polar I over Bi-polar II is one has not ever been diagnosed with a true mania state ever in life.

It is important to note, some individuals who suffer from Bi-Polar mood disorders cycle more rapidly than others, with 4 mood shifts a year being considered high but there can be less cycles and individuals can move through them quickly (Barlow, et. al, 2023).

Major Depressive Disorder

While depressive episodes are part of bipolar disorders, the same criteria for Major Depressive Disorder that diagnoses an episode of depression for Bi-Polar disorders is also diagnosis Major Depressive Disorder but without any mania or states of euphoria.  Major Depressive Order can find its origins biologically or also be a reaction to a loss or severe stressor.  It is a unipolar mood disorder without a switching from extremes but a state of melachony

Facing Major Depressive Disorder

According to the DSM-V-TR depressed moods or loss of interest in pleasure must persist for periods of 2 weeks or longer (2022).  Diagnostic characteristics include the following and requires five or more symptoms for diagnosis.

 

  1. Depressed mood for most of the day or nearly everyday.  Feelings of sadness, emptiness and hopelessness
  2. Diminished interest in pleasure
  3. significant weight loss
  4. Insomnia or hypersomnia nearly or everyday
  5. psychomotor agitation that is observable by others
  6. fatigue and lack of energy nearly everyday
  7. feelings of guilt or unworthiness
  8. diminished ability to concentrate or think or make decisions
  9. recurrent thoughts about death, recurrent suicidal ideation without a specific plan or with a plan, as well as suicide attempt

These symptoms impair the individual in all aspects of life and are not due to any other psychological, medical or use of substance (2022).

Like bi-polar mood disorders, Major Depressive Disorder also has specifiers that dictate mild, moderate, severe, with psychotic features, partial or full remission, with anxious distress, mixed features, melancholic features, atypical features, mood congruent or mood incongruent psychotic features, catonia, post partem, or seasonal patterns (SAD) (DSM-V-TR, 2022).

Overall, Major Depressive Disorder is one of the most common mental maladies.  It is considered the common cold of mental health (McRay, 2016).  Women are 2 to 1 more likely to develop it, while Bi-Polar Disorder is equal (McRay, 2016).

Mentally, an individual suffering from depression faces the depressive cognitive triad that perceives negative connotations about self, the world and the future (Barlow, et. al., 2023).

Persistent Depressive Disorder

Persistent Depressive Disorder differs from Major Depressive Disorder in that is lasts longer than the normal minimum of 2 weeks but untreated can persist for months to years to decades.  It is not as intense but it leads to numerous health and mental issues.  Diagnosis requires a consistent 2 year period.  It includes poor appetite or overeating, insomnia or hyperinsomnia, low energy, low self-esteem, poor concentration and feelings of hopelessness, (DSM-V-TR, 20220).  Individuals can also suffer from both Persistent and Major Depressive.

Other Mood Disorders

Other mood disorders include Disruptive Mood Dysregulation Disorders that deal with frustration and anger outbursts, as well as Cyclothymic Disorder which does not meet criteria for mania, hypnomania or depressive episodes but still possess similar traits at a less severe level but for a period of 2 years with impaiment.

Ironically, Prolonged Grief Disorder is not associated with mood disorders in the DSM-V-TR but is a stress related disorder to acute grief which resembles depression but is a complex grief reaction.  The trajectory of normal reaction to loss is distorted due to severity of the loss, or various subjective factors involving the person.  AIHCP has numerous blogs on Complicated Grief as well as Prolonged Grief Disorder.

Treatments for Mood Disorders

Treatment for mood disorders should also include a integrated approach that includes medication as well as therapy.  Medication only masks the problem and without life skills and abilities to understand distorted thinking, then long term healing and mental health is not possible.  Also, some medications have complications which involves alternate trials and errors of different medications.  In addition, many individuals feel a mental stigma when diagnosed with depression or bipolar disorders.  This leads to hiding these feelings, or refusing to take the appropriate medications.  This leads to continued chaos, impairment, broken relationships, loss careers, and wasted time.  It is important to face mood disorders as any health condition.

SSRI help stabilize serotonin and mood

Medications

Anti-depressants are utilized to help most individuals with mood disorders, especially melancholy.    There are three types.  First, SSRIs are the most common and most used in modern medicine.  Second, tricyclic and third, monamine oxidase (MAO).  The tricyclics are rarely used with the advent of SSRI’s since tricyclics had more side effects.  SSRI’s stand for Selective Serotonin Reuptake Inhibitor.  They prevent the transfer of serotonin from one neuron to another hence preserving a higher level of serotonin to the body to help maintain mood.  MAO’s help dissolve the break down of Serotonin (Barlow, et. al., 2023).   Barlow notates that 60 to 70  percent of individuals who take medication for depression experience improvement, with half of that meeting full to close recovery to full functioning (2023).  A common SSRI’s include Prozac (fluoxetine).  Others include Celexa, Lexapro, Luvox, Paxil and Zoloft. Sometimes, individuals must go through a regiment of different SSRI until they find the best fit and dosage necessary to manage the depression.  Some need to be on SSRI longer, while others are dosed and gradually let off as needed.

Those who face treatment resistant depression can also turn to other methods to treat depression.   Holistic and natural remedies under the guidance of a primary physician such as St. John’s Wort or hypericum have shown benefits as well (Barlow, et. al., 2023).  Other more direct methods include Transcranial Magnetic Therapy (TMT) as well as Electroconvulsive Therapy (ECT) which directly sends impulses into the brain and neurons (Barlow, et al., 2023).

In regards to bi-polar disorders, a lithium based medication is utilized to help with mania.  Lithium, a common salt in  the natural environment, needs to be carefully dosed but has success with controlling mania states.  It is associated with weight gain which is another reason many individuals with bi-polar disorders wish to avoid their medication (Barlow, et. al., 2023).

Psychotherapy

Psychotherapy when supplemented with medication is the best combo for treating mood disorders.  It is important to fix the chemical issue but one also needs to have a strong understanding of self and ways to think differently.  Cognitive Behavioral Therapy plays a key role in helping individuals reframe and rethink distortions and negative connotations about self.   An individual who is depressed already has negative connotations about self, the world and the future.  AIHCP has blogs about CBT and its importance as a behaviorist therapy stemming from Aaron Beck and Albert Ellis that looks to help individuals think more healthy for better behavior and mental functioning.  In addition, human centered therapies which gravitate towards self esteem and congruence and fulfillment are important.  Karl Rogers and his person-centered therapy looks to support the client in meeting fulfillment through empathy, genuineness and unconditional positive regard.  AIHCP also has a blog to review on human-centered therapies.  Finally, interpersonal skills and support is key.  Individuals suffering from loss need support.  An individual with better support systems can overcome different losses with more success.  Some have stronger internal systems of meaning and spirituality, while others may have more family or friends or financial means to overcome loss.  Basic grief counseling in these ways can help individuals become more resilient when depressed or sad.

Conclusion

Please also review AIHCP’s Grief Counseling Program

Mood disorders can be stable with only one extreme or unstable and shift from mania to melancholy.  They are among, with anxiety, the most common psychopathologies.  Unfortunately, many individuals avoid treatment due to social stigma.  It is important to find the time to take care of one’s mental health if afflicted with a mood disorder.  Mood disorders can be genetic or causal but most all have solutions via medication, psychotherapy and counseling, or an integrated approach.

Please also review AIHCP’s Grief Counseling Certification as well as AIHCP’s multiple other behavioral health certification programs.

Additional Blogs

Anxiety Disorders:  Access here

Grief Video: Grief: The Price of Love.  Access here

Additional Resources

Bipolar Disorder. Mayo Clinic.  Access here

Clinical Depression (Major Depressive Disorder). (2026). Cleveland Clinic.  Access here

Dimaria, L. (2026).  “Types of Mood Disorders”. VeryWellMind.  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

The Unspoken Nursing Skills of End-of-Life Conversations 

Posted on by Joseph Gerard

health care worker comforting a patientWritten by Marchelle Abrahams.

Some conversations are hard to have. And nothing can prepare you. Not a textbook. Not an online tutorial. Not a deep breath before delivering the bad news.

Once you have taken the Nurses’ Pledge of Service, talking to a patient about the end of their life is part of the package. Maybe you were warned how difficult it would be. Maybe you thought you’d cross that bridge when you got there.

The truth is that it doesn’t get easier. Sometimes the opposite. As long as you treat your patient and their family with dignity, the right words will form. Also, there are certain skills nobody has taught you until now.

Words Have Gravity

To you, words are something you speak to share information. An individual who doesn’t have the luxury of time can find comfort or hurt in them.

The journal Federal Practitioner published a paper titled The Meaning of Words and Why They Matter During End-of-Life Conversations several years ago. The advice still holds.

Author Grace Cullen goes into extensive detail on how essential effective communication is in healthcare delivery. However, misinterpretation can influence the quality of the care. 

The former palliative care nurse practitioner (NP) says that discussions must be handled with accuracy and precision. They must be conducted in a timely fashion and require skills that take practice to sharpen.

So, what are those skills?

With her years of experience, Cullen has learned that nurses don’t control how the conversation flows. 

“We approach patients with a blank canvas, open to receive messages that will be shared and reacted to accordingly.” – Grace Cullen, DNP, FNP-BC, ACHPN, AOCNP, RN-BC.

That’s why end-of-life (EOL) talks require compassion, an inherent human trait that isn’t taught in textbooks. Instead, it’s cultivated with training and application, advises Cullen.

Suggested Communication Phrases

Do not use medical terms. Talk in simple language and repeat the information. The truth should be gradually introduced to the patient.

Don’t leave families to their own devices. Offer administrative help, such as suggestions for hospice or palliative care. (Flugelman MY. How to talk with the family of a dying patient. BMJ Supportive & Palliative Care 2021;11:418-421.)

When speaking about advanced planning, Healthier Washington Collaboration Portal suggests the following:

  • What’s your understanding of your current situation?
  • If there ever came a time when you couldn’t make decisions for yourself, who would you trust to do that for you?
  • When you think about dying, have you thought about what the end would be like or how you would like it to be? 

Look to Mentors for Advice

You’ll probably get the best advice from your mentors. And yet, they’ll admit that no matter how many times you have the conversation, it still stings.

That’s why it’s important when finding a preceptor for a nurse practitioner to latch onto someone with years of experience in the EOL field. They can guide you on the best practices and share their wisdom on what works and what doesn’t.

In most cases, a nurse practitioner (NP) preceptor is a proficient clinician. They bridge the gap between classroom theory and real-world practice. In other words, you’re in good company.

ClickClinicals advises using professional NP preceptor matching services to ensure you’re matched with a preceptor aligned with your goals. They’re a sound option for nurse practitioner clinical placement help, and they’ll find you an NP preceptor fast.

Missed Opportunities for EOL Care Discussions

Timing is everything. Having the conversation too late can do more harm than good. A qualitative study published in the JAMA Network revealed a few insights. 

About 140 oncology patients were surveyed. Only 21 (5%) of encounters included EOL discussions. The study found that early EOL care preferences improve clinical outcomes. Unfortunately, most talks occur a month before death, despite most patients wanting information earlier.

Discussions about end-of-life care shouldn’t wait until a patient needs hospice, psychiatrist Natalie Jacobowski tells the Cleveland Clinic. She views it as counterintuitive.

Ask for permission to speak about the “what ifs” when starting treatment to prolong a patient’s life, advises Dr Jacobowski.

Create a Safe Space

Talking about someone’s imminent death is taboo, to say the least. It’s also uncomfortable and morbid.

A patient might not want to broach the topic, as it may appear weak or negative. Dr Jacobowski suggests taking your cue from them. Watch their body language. Acknowledge their fears. 

Take this as a step in the right direction. 

Frame the conversation as: “I imagine there are a lot of thoughts and worries. Is there anything that’s standing out to you that’s worrying you the most?”

That way, the patient will know you’ve created a safe space for them to voice their concerns.

Validate and Respond

Not every conversation goes according to script. Emotions are fraught. Anger. Sadness. Frustration. Grief. Patients are feeling them all at once.

Don’t gloss over their response and carry on like normal. Recognize their emotion and name it. For example: “I can see that this is incredibly difficult and upsetting to hear.”

Always lead the conversation, but also prioritize open-ended questions, because they’ll have many.

Validate their feelings. No judgment needed. Allow for silence. Remember, they’re only just processing the news. It takes time.

 

FAQs: End-of-Life Conversations in Clinical Practice 

  1. Why are end-of-life conversations delayed in healthcare settings?
    Many clinicians hesitate due to discomfort, fear of removing hope, or uncertainty about timing. 
  2. What is the most important communication skill during end-of-life discussions?
    Clarity paired with compassion. Using simple, non-medical language helps patients and families better understand and process the situation.
  3. How can clinicians create a safe space for these conversations?
    By asking open-ended questions, observing body language, and validating emotions without judgment.
  4. How do preceptors help nurse practitioners improve in end-of-life care?
    Experienced preceptors provide real-world exposure, model difficult conversations, and offer feedback that helps refine communication skills.

Key Statistics at a Glance 

Topic Finding Insight
EOL Discussions in Oncology Encounters  5% (21 out of 140 patients)  Very few clinical encounters include EOL discussions.
Timing of EOL Conversations  Often, within one month before death  Conversations are happening too late, limiting patient autonomy and preparedness. 
Patient Preferences  The majority prefer earlier discussions  Patients want transparency sooner, not at critical decline stages. 
Communication Risks  Misinterpretation affects care quality  Poor wording or unclear messaging can negatively influence patient understanding and care decisions. 

 

Parting Words

You chose to become an NP for a reason. And that reason is to care for and help people heal. Keep that in mind whenever sensitive patient discussions arise.

Lectures and textbooks can only teach so much. The rest is up to you. 

Whether you’re at the start or in the middle of this big, bold, beautiful journey called nursing, never forget why you are here.

References:

 

Author bio

Marchelle Abrahams is an award-winning writer (RDMA Awards 2019) who found her voice after carving a niche as a features writer for Independent Media. Currently, she freelances for various print and online publications, while ghost-writing blogs for several clients. 

 

 

Please also review AIHCP’s Grief Counseling Certification, as well as its Child and Adolescent Grief Counseling Program, Pet Loss Grief Counseling Program, Christian Grief Counseling Program, Grief Diversity Counseling Program, Grief Perinatal Program, Grief Practitioner Program and finally its Grief Support Group Leader Program.

Grief Counseling: Death of an Estranged Loved One Video Blog

Posted on by Mark Moran

Unfortunately, when someone dies it does not always occur under the best family conditions.  Some families may be divided, estranged, or not speaking.  In some cases, the estrangement between the deceased and the living family member.  These situations add complications to already a sad and grieving situation.  This video reviews some of the complexities associated with death of a estranged loved one.

Please also review AIHCP’s Grief Counseling Certification Program

The Creative Grief Cycle: Stage 1 – Creation

Posted on by Joseph Gerard

Where Grief First Finds Language

Written by Daniel Stern

A Conceptual Model Emerging from Lived Experience

The Creative Grief Cycle is a conceptual framework that emerged from my own experience of grief and the process of writing through it. In the time following loss, I found that writing did not begin as expression or communication, but as something more immediate—an attempt to give form to experience before it could be fully understood. What I describe here reflects that process. It is not a formal clinical model, but an effort to articulate a pattern that became visible through lived experience, considered alongside existing research in expressive writing, narrative psychology, and grief theory.

In a previous article, I introduced what I call The Creative Grief Cycle—a way of understanding how grief moves through creative expression. In that earlier piece, I described how grief often begins in silence; this stage begins at the point where that silence first breaks into language. This article focuses on that transition: the moment when experience first enters language.

The cycle has three stages:

  • Creation — where grief first takes form in language
  • Communication — where that expression connects with others
  • Rediscovery — where the work can be revisited over time, allowing meaning to evolve

Here, I want to focus on the first stage: Creation.

Research in expressive writing and grief has shown that writing about emotional experience can improve psychological and physical well-being (Pennebaker & Chung, 2011). This aligns with work in expressive and therapeutic writing (Mazza, 2017; Stepakoff, 2009), and with research emphasizing the role of narrative in helping individuals organize and make sense of loss (Neimeyer, 2001; McAdams, 2001). What receives less explicit attention, though, is an earlier phase—the point before writing becomes expressive or communicative, when pre-verbal emotional experience first begins to take form in words. While elements of this transition appear across existing research, they are not typically isolated as a distinct phase in grief writing itself.

 

Writing Begins as Pressure

In my experience, grief did not begin in words. It began as something closer to pressure—diffuse, persistent, and not yet nameable.

This pressure did not feel like a thought or even a clearly defined emotion. It was more constant than that—something ambient, but insistent. It did not organize itself into sentences or ideas. It accumulated.

At times, it felt physical: a weight in the chest, a tightening, a sense of something pressing inward or outward without direction. At other times, it was harder to locate—an internal density, a sense of saturation, as though experience had nowhere to go.

Research in trauma and affective processing suggests that overwhelming emotional experience is often encoded in sensory, bodily, and affective forms before it becomes available to language (van der Kolk, 2014). Putting feelings into words can also change how those experiences are processed (Lieberman et al., 2007). In this sense, what I describe as pressure may reflect a stage where experience is present but not yet organized in language.

What defines this state is not just intensity, but a lack of structure. Something is there—persistently—but it cannot yet be articulated or fully understood.

It is this pressure, rather than intention, that seems to initiate writing.

Writing does not begin here as expression. It begins as a response. Something pushes toward language—not clearly or steadily, but in fragments that appear, recede, and return.

Words surface incompletely: a phrase, an image, a line that will not leave. There is often hesitation, even resistance. The act begins not because there is something clear to say, but because something can no longer remain entirely internal.

In practice, this early movement often appears in small, recurring fragments before anything fully forms. For example:

From “A Picture on the Wall”

A small square of pigment
leaned out of its silence
and took me by the collar.

Or:

From “Between Two Gravities”

Between what demands I shine
and the gravity that pulls me inward…

These lines do not yet explain, resolve, or interpret the experience—they simply hold it in place. What they do is more immediate: they allow something to remain present long enough to be encountered.

At this stage, what appears on the page is not meaning in the usual sense. It is better understood as what I call proto-meaning— the earliest linguistic shape of an experience before it has become explanation, insight, or story.

Experience begins to take shape in language, but it is not yet narrative, explanation, or reflection. What emerges instead are fragments—images, lines, repetitions—that allow experience to exist outside the self for the first time.

This shift is subtle but significant. What was previously diffuse and internal begins, however slightly, to cohere.

Seen this way, fragmented or image-based writing is not a failure of clarity, but the beginning of it.

At this point, writing is not oriented toward communication or interpretation. Its function is more basic. It brings experience into form—giving it just enough structure to be encountered rather than only endured.

This is the first movement of Creation: not clarity, but necessity.

 

When Language Creates Distance

Once experience begins to take form in words, something shifts.

Language introduces structure. Even a single line creates a boundary—this word instead of another, this image held long enough to be seen. What was previously diffuse begins, however slightly, to take shape.

This does not immediately produce understanding. The experience may still feel unclear. But something important changes: distance becomes possible.

Not detachment—but perspective.

The experience is no longer entirely internal. Some part of it now exists outside the self, where it can be returned to. The writer is no longer completely inside the feeling. Something has been set down, even if only partially.

Research on expressive writing shows that, over time, people begin to organize emotional experience into more structured language—connections, causality, and meaning (Pennebaker & Chung, 2011; McAdams, 2001). Before that happens, a more basic shift occurs: experience becomes something that can be held and revisited (Neimeyer, 2001).

Writing begins to do more than respond—it begins to shape.

That shaping is not linear. It circles. It revisits. It approaches the same experience from different angles. But even in fragments, something changes: what was uncontained is now being held, line by line.

 

Why Grief Turns to Metaphor

Even as writing begins to create structure, it rarely does so through direct explanation.

Grief often resists that kind of language. Statements like “I feel empty” or “I am overwhelmed” may be accurate, but they flatten the experience. They fail to capture its movement, its contradictions, and the way it shifts over time.

So the writing moves toward image.

This is not simply stylistic. In early grief writing, metaphor may become necessary because direct language can feel too limited.

In early drafts, grief often appears not as a statement, but as a force. The fragment returns, unchanged:

From “Between Two Gravities”

Between what demands I shine
and the gravity that pulls me inward…

Here, the experience is not named directly. It is approached through something else—gravity, pressure, distance. Not because these are more precise, but because they make the experience possible to hold.

This aligns with work in poetry therapy, which suggests that metaphor provides an accessible structure for experiences that resist direct articulation (Mazza, 2017; Stepakoff, 2009). Cognitive linguistics similarly proposes that metaphor acts as a bridge between emotional and conceptual experience (Lakoff & Johnson, 1980).

In early grief writing, metaphor functions less as ornament and more as a tool.

By mapping internal experience onto something more concrete, metaphor creates a structure capable of holding what would otherwise remain diffuse. It gives shape without requiring full understanding. It allows movement—an image can shift, return, and evolve in ways a direct statement cannot.

Through metaphor, writing does not simply express experience—it begins to uncover it.

 

Writing as Discovery: Aphelion

In my own experience, the first poem I wrote after loss—Aphelion—began without intention. It did not start as an effort to express or explain anything. Instead, it emerged in fragments: isolated lines, images that appeared without context, and a persistent sense of movement that I could not yet name.

The central metaphor developed gradually rather than by design. Aphelion—the point in an orbit where a body is farthest from the center it moves around—became a way of approaching an internal state that resisted direct articulation: a simultaneous sense of distance and attachment, of being pulled away while still held in relation.

An early passage reflects this movement:

Some slip the constellations we hope to trace,
following a hidden geometry,
their own unseen law.

And when they reach aphelion—
that farthest point
where distance feels eternal—
we feel their silence
more sharply than their light.

Early lines did not explain this. They circled it. Images of distance, gravity, and motion appeared before any clear conceptual link was made. The metaphor did not begin as meaning; it functioned first as a container—something stable enough to hold a shifting internal state.

As the poem developed over several weeks, that structure allowed movement. The metaphor could shift, return, and reconfigure in ways that direct language could not. What had been entirely internal began to exist externally—not as a coherent narrative, but as something visible and revisitable.

By the time the poem was complete, the experience itself had not resolved. But it had changed form. What had been diffuse became structured enough to be encountered.

This pattern is not unique to a single piece. Across early grief writing, metaphor often emerges not as stylistic choice, but as necessity—providing the first framework capable of holding experience before it can be interpreted.

At this stage, there is often:

  • no audience
  • no intention to explain
  • no clear endpoint

 

The process itself is the point. Writing is not expressing experience—it is creating the conditions under which experience can be known.

 

The Function of Creation

It is important to be clear about what writing in this stage does—and does not—do.

Writing does not resolve grief.
It does not produce immediate understanding.
It does not yet create stable meaning.

What it does is more foundational.

It transforms experience from something uncontained into something structured enough to be encountered. It brings experience into language—not as explanation, but as form.

What emerges at this stage is not fully developed meaning, but something closer to proto-meaning—the first structures capable of holding experience in language.

This can be understood as a process of linguistic emergence, in which pre-verbal emotional experience begins to take early linguistic form. Through this process, experience becomes something that can be returned to, engaged with, and gradually understood over time.

From this point, the later stages of the Creative Grief Cycle become possible:

  • Communication, where expression becomes relational
  • Rediscovery, where meaning evolves across time

But neither occurs without this first shift.

Before grief can be shared or understood, it must first take form in language.

 

Author’s Bio:

Daniel Stern is a retired engineer turned astronomer and astrophotographer whose poetry explores grief, silence, memory, and renewal. His work lives at the intersection of science and emotion, where observation becomes reflection and language reaches for what cannot be measured. He is the author of Aphelion, his debut book of poetry, and the chapbook The Roar of Silence, a collection born from personal loss and the search for meaning in its wake. In his work as an astronomer, his astrophotography has been recognized numerous times by NASA (APOD). He has discovered deep-sky objects and, in collaboration with others, has been published in peer-reviewed astrophysics journals. Stern lives in Delray Beach, Florida, with his wife, Randie.

Website:           Http://www.theroarofsilence.com

Email:                dstern@mea-obs.com

 

 

 

References

Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338–346.

Lakoff, G., & Johnson, M. (1980). Metaphors we live by. University of Chicago Press.

Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421–428. https://doi.org/10.1111/j.1467-9280.2007.01916.x

Mazza, N. (2017). Poetry therapy: Theory and practice (2nd ed.). Routledge.

McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5(2), 100–122. https://doi.org/10.1037/1089-2680.5.2.100

Neimeyer, R. A. (2001). Meaning reconstruction and the experience of loss. American Psychological Association.

Pennebaker, J. W., & Chung, C. K. (2011). Expressive writing: Connections to physical and mental health. In H. S. Friedman (Ed.), The Oxford handbook of health psychology (pp. 417–437). Oxford University Press.

Stepakoff, S. (2009). From destruction to creation, from silence to speech: Poetry therapy principles and practices for working with suicide grief. The Arts in Psychotherapy, 36(2), 105–113. https://doi.org/10.1016/j.aip.2009.01.007

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

 

 

 

Please also review AIHCP’s Grief Counseling Certification, as well as its Child and Adolescent Grief Counseling Program, Pet Loss Grief Counseling Program, Christian Grief Counseling Program, Grief Diversity Counseling Program, Grief Perinatal Program, Grief Practitioner Program and finally its Grief Support Group Leader Program.

Narrative Therapy and Grief

Posted on by Mark Moran

There are numerous modalities and therapies to help individuals face grief and loss in a healthy way.  Most psychotherapies share equal positive results in helping individuals deal with anxiety, grief, or other mental problems.  In the case of depression, as well as prolonged grief disorders, they also share in efficacy but many counselors prefer integrated approaches sharing from one discipline and incorporated another.  One type of therapy that many grief counselors find effective for grief and loss is Narrative Therapy.  While Narrative Therapy may not be for everyone, nor the sole answer, it can play a part in helping individuals understand their loss in a more constructive and adaptive way.

Narrative Therapy helps the client find new meaning in the loss. Please also review AIHCP’s Grief Counseling Certification

Please also review AIHCP’s Grief Counseling Certification Program and see if it meets your academic and professional goals.

What is Narrative Therapy?

Narrative Therapy is a type of constructivist therapy with postmodern philosophies developed by Michael Kingsley White and David Epston (Tan, 2022).  According to Tan, postmodernism is a world view that truth is not objective or tied to merely observation or within the systems of language in which is described and hence is open to subjective experience (2022). Social Constructionism applies this principle that the client is the expert on what one  experiences and understands one’s own subjective truth best without judgement of others (Tan, 2022).  Narrative Therapy falls under this type of philosophy, albeit, many of its techniques can be applied outside its rigid definitions.

Narrative Therapy is closely tied to meaning making and in that regards in some ways to Existentialist Therapy and the importance of finding subjective meaning to one’s issues.  Meaning is then created through social relationships, especially in one’s use of language in stories or narratives one shares.  Due to this, meaning and subjective reality can be rewritten or reframe or re-understood by the client through Narrative Therapy (Tan, 2022).  Narrative Therapy views human nature as basically positive and able to form new and better constructive directions through formulating healthier meanings about the past and present.  This is especially true regarding grief, trauma and loss.  Narrative Therapy opens the door for others to rewrite the story and replace past narratives that are saturated in negative and oppressive overtones.

Narrative Therapy finds many of its uses in David Neimeyer and his work utilizing meaning making and meaning reconstruction in grief counseling and loss.

Narrative Therapy at Work

A strong therapeutic relationship between client and counselor is required in Narrative Therapy.  It borrows this from many Rogerian concepts that utilize empathy and understanding and a true connection.  This type of connection is key in any type of grief counseling regardless of therapy and should be a fundamental concept for any one hoping to console the bereaved.    Due to the fluid nature of grief, Narrative Therapy does not propose a guide book of handling grief or emphasizing one technique over another.  It instead teaches that there is no true right or wrong way to conduct the therapy again applying to Rogerian person centered theories, as well as its social constructivist ideals (Tan, 2022).

Still, there are tools that are generally applied to individuals to help them move beyond their oppressive past narratives.  The attempt is to better understand the past or loss or whatever narrative, reframe it with new meaning, and incorporate it into the overall life of the person.  Much like any meaning reconstruction, where a person’s life is a likened to a book with various chapters, some good, some bad, but all delivering a theme and message of the wholeness of the person.

Journaling and reconstructing oppressive past narratives is key in Narrative Therapy and critical in Grief Couneling

First, question is key in Narrative Therapy.  The therapist or grief counselor will ask a variety of questions to help assist the person in understanding oneself.  The attempt is to help identify past oppressive narratives and to help the person become unstuck from those perceptions.  The second tool is externalization and deconstruction.  In this, the therapist hopes to help the person realize that he or she is not the problem, but the problem is the problem (Tan, 2022).    The problem or attribute is detached from the individual and seen as an independent and external parasite in itself.  This externalization serves as the starting point in facilitating deconstruction from the oppressive narrative (Tan, 2022).   Narrative Therapy will help the client map the problem and its influence on one’s life and how profoundly or deeply it has negatively altered one’s life.  Many times when  mapping, the counselor will look to label the problem and again externalize it from the person during the deconstruction phase.  A third tool is searching for unique outcomes.  This is more solution based and the therapist helps the client identify times the client dealt successfully with the issue and how this can be incorporated again and at a more efficacious result. Fourth, therapists help clients reauthor their story and find different future outcomes from what they feel by the past oppressive narrative.  They are also aided in reframing that story and taking control of it and finding meaning in that story.  Finally, documenting the evidence of client’s progress is key.  Therapist will include letters that the client later re-read that reinforces and summarizes the therapy when they are feeling less or discouraged.

Highly involved also in healing is writing.  Clients are encouraged to journal, write letters to oneself or unsent letters to others, similar to Gestalt Therapy.  Journaling is key to identifying oppressive feelings and themes, as well as controlling the narrative through the power of the subjective reality of the person writing their story.  This is not to dismiss the event, or even to dismiss facts, but to reinterpret these events and meanings in a more conducive way to healing which sometimes means looking at the loss, event, or problem in a different light.

Ultimately the therapy looks to help clients to control their own narrative through cognitive processes and writing processes to form a new narrative.  The client names the problem, explores how the problem has adversely affected him/her and explores new ways to interpret the the issue or find different meanings.  In addition, the counselor helps the client identify times when he/she successfully dealt with said issues, as well providing the client with encouragement on imagining a sound and healthy future beyond the problem (Tan, 2022).

Conclusion

One can see the useful elements of Narrative Therapy and some of its independent tools in helping individuals, especially with grief.  Individuals suffering from loss, or in some cases, pathological and traumatic loss need a therapeutic relationship that is filled with patience and empathy but they also need ways to face the past loss.  They need to remove the negative narrative that haunts them regarding the loss and find new meaning about the loss and how to incorporate it into one’s life.  This type of Meaning Reconstruction is a key element in Narrative Therapy and helps the person not only understand the past and find new meaning and authority over it, but also how to cope and develop a meaningful future that respects the past loss but also adjusts to it in a healthy and secure way.

New narratives can help individuals move forward from loss in a healthy way. Please also review AIHCP’s Grief Counseling Certification Program

Grief Counselors who are clinically licensed can utilize this therapy for those suffering from prolonged grief disorder, while in some cases, elements of it can be used for those not suffering from pathological or complicated grief reactions.  Journaling is a healthy element of Narrative Therapy for any case in understanding a loss and finding meaning in it.

Please also review AIHCP’s Grief Counseling Certification Program which is applicable for both non-clinical professionals as well as clinical professionals.  Of course, only clinical professionals can utilize Narrative Therapy with those suffering from complicated, traumatic or prolonged grief disorders.

Reference

Tan, S-Y. (2022). Counseling and psychology: A Christian perspective (2nd Edition). Baker Academic.

AIHCP Blogs

Honoring Endings-Access here

Grief Journaling- Access here

Additional Resources

Ackerman, C. (2026). “What Is Narrative Therapy? Techniques & Worksheets”. PositivePsychology.com.  Access here

Clark, J. (2025). “How Narrative Therapy Works”. VeryWellMind.  Access here

Guy-Evans, O. (2025). “Narrative Therapy: Definition, Techniques & Interventions”. Simple Psychology.  Access here

Narrative Therapy. Psychology Today.  Access here

 

 

What Makes Traumatic Grief Different?

Posted on by Joseph Gerard

Grief - human hands holding black silhouette wordWritten by Marko,

The idea of saying goodbye to someone you love forever is heartbreaking. 

But, as hard as it is, it’s a different kind of hurt when you compare it to losing someone out of the blue. It’s sad, but the truth is, being able to say goodbye is a privilege not everyone gets. 

You have time to sit with it, and to hold your loved one’s hand, even if it’s for the last time.

Then there’s the other way, when you’re just living your normal life. And someone knocks on your door and tells you your loved one is just… Gone. Just like that. No last conversations, no warnings. One minute they’re here, the next, they aren’t, and there’s nothing in between that. 

This kind of shock leaves your brain stuck, and that stuck place is called traumatic grief.

In this article, we’ll go over the differences between traumatic grief and what people call normal grief. And if you’re wondering why that difference is important, it’s because you can’t recover unless you know what you’re recovering from.

How Grief Usually Unfolds When Loss Is Expected

Grief always hurts. There’s no way around that. It doesn’t matter if loss is expected; nobody can prepare for it in a way that doesn’t hurt. 

But the hurt usually doesn’t come all at once. Instead, it follows a somewhat steady path. Imagine if a person has a family member who’s terminally ill. They know what’s coming, and the hard moments come little by little. The whole thing feels like this heavy burden they’re carrying around all the time, and when the time comes, and they finally lose their loved one, they already saw it coming.

This all gives the brain some time to prepare.

That doesn’t mean that there’s a way to be actually ready for what’s going to happen, but you can’t help but have a sort of mental rehearsal going on in your head. So, you might cry in your car every few days, or you might imagine what your life is going to look like once that person is no longer here. There’s time, which means there can be closure, and closure is the first step towards healing.

Time also means emotions can adjust. 

By no means does that mean it follows neat little stages that come one after the other. Grief is messy, and some days are better than others. Still, the little things like going to work and making dinner help in keeping you grounded.

And as time heals you, you’ll still have all the memories of the person who’s no longer with you, but it’ll stop hurting (as much, anyway).

If the loss comes without any warning, though, none of this can happen.

What Changes with a Sudden, Traumatic Loss

It’s very frowned upon to say that one kind of grief is harder than another because everyone deals with grief in their own way. 

You can’t know how someone else is feeling, and you can’t be sure that you have it better or worse than they do. With that being said, the grief that accompanies traumatic loss is very different from the grief that happens after an expected loss, and some might say it’s harder. 

And they wouldn’t be wrong.

The hardest part of traumatic grief is that you now have to deal with two things at once. 

Sudden or violent loss measurably increases risk of prolonged grief/trauma (e.g., PTSD-like reactions). – National Institute of Mental Health

You feel the emotional loss, which is heavy enough on its own. But along with that, you’re also in complete and utter shock. And shock and sadness are two different emotions. 

When you’re in shock, it’s basically your brain slamming the brakes even though there was no yield or stop sign in sight.

For the most part, people go numb right after they hear the tragic news. Not in a cold way like they don’t care, but just blank.

Acute stress reactions )e.g., numbness, confusion, dissociation, etc.) are common side-effects of experiencing traumatic events. – Substance Abuse and Mental Health Services Administration

So, they’ll stare at a wall for an hour, or they’ll answer the door and forget they did it a few seconds later. They’ll hire a wrongful death attorney for fatal car crashes in Chicago when they should have hired one in Joliet, where they live. From the outside, this seems absolutely ridiculous, but two things are happening here: one, the brain is trying to protect you. 

And two, that loss made no sense, so it’s pretty much impossible to accept what’s happening. 

The brain keeps searching and searching for a connection between one moment where life was normal, and the next when it fell apart.

On top of all this, there’s also the real-life stuff to handle because there’s no grace period. You have to sign the papers here, make the calls there, decide on funeral arrangements and finances, and yes, hire a lawyer if someone else is to blame for the tragedy. 

It’s not that hard to believe that, because of dealing with all this, a person would forget they opened the door or hired a lawyer in the wrong city, isn’t it?

How Traumatic Grief Feels Different in Daily Life

Normal grief is heavy, but traumatic grief? That’s both heavy and confusing at the same time. 

Here’s what the difference looks like in everyday life.

There’s No Time to Prepare Mentally

If the loss came out of nowhere, the brain didn’t get any of the warning signs. 

No hospital stays, no bad test results, no slow decline, no last conversations… Nothing. As a result of this, the mind will continue acting as if the person is still alive, regardless of the fact that reality is different.

A person who’s grieving could find themselves picking up a phone to call their deceased loved one, or setting an extra plate for dinner. You might say this is pure denial and nothing else, but that’s not the case here. The brain is having a hard time catching up with what’s actually happening because nothing makes sense. 

The worst part is that this can go on for months.

The Body Stays Stressed

Grief consumes both mental and physical health, and with traumatic grief in particular, the body acts as if the danger is still here. You stay in that terrible fight-or-flight mode for a long time. You might notice your heart starts to race at random times, or you’ll jump at small noises.

Your body can stay in a constant state of heightened stress after experiencing trauma; this can negatively affect sleep, heart rate, body regulation, etc. – National Institute of Mental Health

And sleep? Now, that’s a battle every single night. 

You’ll either sleep too much or too little, but either way, you’ll never truly rest.

As crazy as it sounds, all this is normal. This is basically your nervous system doing exactly what it’s designed to do. The problem here is that there’s no ‘real’ threat to handle. Your mind thinks there is a threat, so it reacts accordingly.

Thoughts Keep Going Back to The Dreadful Event

Normal/regular grief revolves around someone’s memories about the person that’s gone (for the most part). These are inside jokes, things you’ll miss (laugh, jokes, routines, etc.) – the good times.

Traumatic grief is different. This type of grief is stuck on death where your mind replays a few moments over and over again. And it’s difficult to get out of that loop.

Core features of trauma-related conditions  are intrusive (negative) memories and repeated mental replay of the trauma. – U.S. Department of Veteran Affairs

The phone call, the news, the moment you found out, rinse and repeat, over and over.

You don’t consciously choose to think this; it simply shows up. The hardest part about this is that the brain is so focused on that tragic event that you can’t hold onto the happy memories.

It’s not that they’ve disappeared, but they’re buried under that replay button that refuses to stop.

It’s Harder to Find Closure

Harder, and even impossible. 

Normal grief gives you an ending. It’s not a happy ending, but it’s an ending nevertheless, where you might even get to hold the person’s hand and tell them you love them. It all makes sense, as painful as it is.

But there’s no ending with traumatic grief, and nothing makes sense anymore. 

Because of the absence of anticipatory coping/closure after experiencing unexpected loss a person can experience prolonged grief. – Harvard Medical School

So, in order to make it all feel sensical, the ‘what ifs’ start to pop up. What if they left 5 minutes earlier? What if someone had been there? 

None of that helps, but it also can’t go away. You know it’s irrational to play those scenarios over and over, but without a proper goodbye, your mind can’t wrap around the fact that this tragedy happened, and it can’t move past it.

Conclusion

None of this has anything to do with how much you loved the person. 

The only thing that matters is how the tragedy happened: was it expected, or was it a shock? And you might say that neither is worse, but truthfully, traumatic grief hits on more levels. Aside from the deep sadness, there’s also shock and pressure, with no soft landing in sight. It’s like your life just attacked you all of a sudden.

Make no mistake; just because you understand the difference doesn’t mean you can fix anything. But it’s useful because it explains why recovery is slower, and why everything feels more unpredictable. 

At the end of the day, if all you can know is that you’re not going insane, that’s still something.

Author Bio 

Marko is an adamant and eager content writer with a decade of experience in various niches,  with healthcare being one of them. With his way of implementing storytelling, comparisons, and examples into hard-to-grasp topics, Marko’s able to make complex things sound interesting and relatable – key ingredients to make something understandable. As a hobby, Marko enjoys offroading, board games, and spending time with his family and his dog Cezar.

 

 

Please also review AIHCP’s Grief Counseling Certification, as well as its Child and Adolescent Grief Counseling Program, Pet Loss Grief Counseling Program, Christian Grief Counseling Program, Grief Diversity Counseling Program, Grief Perinatal Program, Grief Practitioner Program and finally its Grief Support Group Leader Program.

The Creative Grief Cycle

Posted on by Joseph Gerard

The Creative Grief Cycle

Creation, Communication, and Rediscovery in Grief Writing 

Written by Daniel Stern

Grief disrupts the narrative of life. When a profound loss occurs, the future we imagined with that person vanishes, and the past becomes newly charged with memory and absence. 

Yet paradoxically, grief is also one of the most powerful generators of creative expression. Poetry, painting, music, and storytelling have historically emerged from loss, giving shape to emotions that are difficult to express. 

For many writers, including myself, poetry becomes the place where grief first learns to speak. 

I’m not a clinician. What I’m describing comes from my own experience writing poetry about grief. I found that creative expression did more than document loss; it initiated a cycle of emotional processing. My experience aligns with research on expressive writing, poetry therapy, and meaning-making in grief—that creative expression can help people process loss and make sense of it. 

From this intersection of lived experience and research, I began to notice a pattern in how grief can move through creative expression. I refer to this pattern as The Creative Grief Cycle. 

  1. Creation — the act of writing transforms grief into language 
  2. Communication — the work becomes a bridge between the grieving individual and others 
  3. Rediscovery — the creative work can be revisited repeatedly, allowing grief to evolve into reflection 

Together these stages form a self-reinforcing cycle that moves grief from raw emotional experience toward shared understanding and lasting meaning. 

Research on expressive writing, meaning reconstruction, and poetry therapy supports key elements of this cycle.

 

Journaling about loss is a creative and expressive way to cope with grief

Stage One: Creation — Writing as Emotional Processing

The first stage of The Creative Grief Cycle is the act of creation itself. 

When grief is written, it changes form. What was once diffuse emotional pain becomes structured language. Words, metaphors, and images impose order on an experience that initially feels chaotic. 

Psychologist James W. Pennebaker, whose research pioneered the study of expressive writing, demonstrated that writing about emotional experiences improves psychological and physical well-being. His studies showed that expressive writing helps individuals organize traumatic memories into coherent narratives, supporting emotional processing that might otherwise remain unresolved (Pennebaker & Chung, 2011). 

Scholars in poetry therapy also describe writing as a structured way of processing emotional experience (Mazza, 2017). Neimeyer (2012) has similarly emphasized that grief often involves reconstructing meaning after loss, frequently through narrative and creative expression. 

Subsequent studies have found similar benefits. A comprehensive review in Advances in Psychiatric Treatment found that expressive writing can reduce stress, improve mood, and enhance coping with traumatic experiences (Baikie & Wilhelm, 2005). 

In grief specifically, expressive writing has been associated with meaning reconstruction, a central process in bereavement. Neimeyer (2001) describes mourning as rebuilding meaning after a loss disrupts one’s life narrative. 

These findings mirror my own experience writing poetry after the loss of my son. In one poem I wrote: 

“A poem begins in blood. 

My son is gone, yet I write— 

each word a slice of myself.” The Price of a Poem 

Writing did not remove grief. Instead, it transformed grief into something that could be examined and understood. 

Researchers studying poetry therapy describe this process as the movement “from silence to speech.” Stepakoff (2009) explains that poetry allows individuals to represent traumatic grief symbolically, making it possible to approach experiences that initially feel unspeakable. 

In The Creative Grief Cycle, creation is therefore the first step in transforming grief into meaning. 

 

Stage Two: Communication — The Social Function of Grief Poetry 

The second stage of The Creative Grief Cycle occurs when the work is shared with others. 

Grief is inherently isolating. Individuals experiencing loss often feel that their emotions cannot be adequately explained to those who have not lived through similar experiences. 

Poetry can bridge this gap. 

Because poetry communicates through metaphor, rhythm, and imagery, it can convey emotional realities that ordinary explanation cannot. Readers encountering grief poetry can recognize aspects of their own experiences within the work, creating a moment of shared understanding. 

Maybe creative expression can help individuals communicate their complex grief experience when traditional conversation is difficult.

Stroebe (2018) highlights that poetic language can complement scientific models by illustrating the lived experience of grief, bringing emotional depth to processes identified in research. Psychological frameworks describe processes of mourning, but poetry can capture the lived texture of grief—its contradictions, memories, and silences. 

This communicative dimension is visible in many grief poems. In one of my own poems, I describe writing as a way to keep a voice present in the world: 

“I write 

because my voice still walks the earth 

even when his footsteps do not.” Don’t Live Inside That Silence 

The poem becomes more than a personal reflection; it becomes a message others can encounter. 

Communication also allows grief to move across generations. In another poem, written about telling stories to my granddaughter after her father’s death, I wrote: 

“I give her my son 

the only way I still can— 

one story at a time.” Tell Me a Daddy Story 

In this moment, poetry functions as inheritance. Memory travels through language into the future. 

In The Creative Grief Cycle, this is when grief moves from private experience into shared understanding. 

 

Stage Three: Rediscovery — Revisiting the Work 

The third stage of The Creative Grief Cycle emerges and can evolve over time. 

Unlike spoken conversation, creative works endure. A poem written during an intense period of grief can be reisited months or years later. This creates a powerful reflective process. When the writer returns to the poem, they revisit the emotional state that existed when it was written. The poem becomes a preserved record of grief at a particular moment in time. 

Poetry can preserve the emotional complexity of grief in ways that allow both writers and readers to return to the experience with evolving perspectives.

In practical terms, a poem becomes an emotional time capsule. The writer who reads it years later is no longer the same person who wrote it. The grief may have softened, deepened, or transformed. 

In one poem, I tried to capture how silence evolves over time: 

“Silence becomes a cathedral, 

vast and unforgiving, 

its arches built of absence.” The Roar of Silence 

This rediscovery stage allows grief to evolve from raw emotion into reflection. 

In The Creative Grief Cycle, rediscovery completes the cycle by enabling the work to continue generating meaning over time. 

 

The Creative Grief Cycle 

Taken together, the three stages form a continuous cycle: 

Creation → Communication → Rediscovery 

  1. Grief is transformed into language through writing. 
  2. The work communicates the experience to others. 
  3. The work can be revisited repeatedly, generating new insight. 

Each stage reinforces the others. Writing enables communication. Communication deepens meaning. Rediscovery inspires further creative expression. 

This cycle offers an explanation as to  why creative work often continues long after the initial loss. Once grief has been expressed through art, the creative impulse frequently expands into other forms of expression. 

In one poem reflecting on transformation through grief, I wrote: 

“Grief softens us, 

wonder reshapes, 

creation strikes sparks 

across even the softest anvil.” The Furnace Never Cools 

Grief melts what once felt rigid. Creativity reshapes it. 

 

Conclusion 

Grief cannot be eliminated. Loss remains one of the defining experiences of human life. But creative expression changes how grief exists in the world. 

Through The Creative Grief Cycle, grief moves through a process of creative transformation:  

  • Writing transforms emotional experience into language  
  • Communication connects that experience with others  
  • Rediscovery allows the work to continue generating meaning over time 

In this way, poetry does not simply document grief. 

It allows grief to become something else: connection, reflection, and enduring voice. Loss may silence a person’s presence in the world. But through poetry, the conversation continues. 

 

About the Author

Daniel Stern is a retired engineer turned astronomer and astrophotographer whose poetry explores grief, silence, memory, and renewal. His work lives at the intersection of science and emotion, where observation becomes reflection and language reaches for what cannot be measured. He recently published The Roar of Silence, a collection of 15 poems born from personal loss and the search for meaning in its wake. He also authored Aphelion, a book of poetry fused with his deep-sky astrophotography. In his work as an astronomer, his astrophotography has been recognized numerous times by NASA (APOD). He has discovered planetary nebulae and, in collaboration with others, has been published in peer-reviewed astrophysics journals. Stern lives in Delray Beach, Florida, with his wife, Randie. 

 

Website: www.theroarofsilence.com 

Email: dstern@mea-obs.com 

 

References 

 

Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338–346. https://doi.org/10.1192/apt.11.5.338 

Mazza, N. (2017). Poetry therapy: Theory and practice (2nd ed.). Routledge. 

Neimeyer, R. A. (2001). Meaning reconstruction and the experience of loss. American Psychological Association. 

Neimeyer, R. A. (2012). Techniques of grief therapy: Creative practices for counseling the bereaved. Routledge. 

Pennebaker, J. W., & Chung, C. K. (2011). Expressive writing: Connections to physical and mental health. In H. S. Friedman (Ed.), The Oxford handbook of health psychology (pp. 417–437). Oxford University Press. 

Stepakoff, S. (2009). From destruction to creation, from silence to speech: Poetry therapy principles and practices for working with suicide grief. The Arts in Psychotherapy, 36(2), 105–113. https://doi.org/10.1016/j.aip.2009.01.007 

Stroebe, M. (2018). The poetry of grief: Beyond scientific portrayals of mourning. Omega: Journal of Death and Dying, 77(1), 3–16.

 

 

Please also review AIHCP’s Grief Counseling Certification, as well as its Child and Adolescent Grief Counseling Program, Pet Loss Grief Counseling Program, Christian Grief Counseling Program, Grief Diversity Counseling Program, Grief Perinatal Program, Grief Practitioner Program and finally its Grief Support Group Leader Program.

Grief Counseling Certification Video Blog: Fear and Grief

Posted on by Mark Moran

Fear can play a strong role in grieving.  Whether anticipatory and fearful of a future event, or fear that cripples one while grieving to express or reach out, or fear that becomes maladaptive with other types of losses, it needs addressed.  This video looks at how fear can affect grieving. Please also review AIHCP’s Grief Counseling Certification