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Preparing Grieving People for the Holidays
by William G. Hoy
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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 Year’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 “move on,” 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, “Most grieving people dread some part of the approaching holidays; what concerns you the most?” Fruitful conversations in groups and with individuals also grow out of questions like, “How do you think the holidays will be most different for you this year?”
 Encourage plans that include both self and others.
Early in my career, I counseled grieving people to “Do as much celebrating as you like…and no more.” 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 patients/clients are part of families where some level of holiday observance is both 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, “I’m not coming to the family Christmas Eve dinner this year,” many bereaved individuals will find it more useful to say to the hostess, “You know, my energy level just hasn’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?” This acknowledges the tradition and the family expectations while setting appropriate boundaries around the bereaved person’s own needs.
 Talk about expected pitfalls.
Ask the bereaved folks with whom you work, “What do you expect to be the hardest part of the holidays this year?” 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 person’s experience.
The widow of one minister seemed particularly troubled by the approaching holidays even five years after her husband’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 “sharing” 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 loss—and especially during holidays—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 body’s simple response to lack of time for cognitive and emotional processing during the waking hours. The bereaved person who tries to “stay busy so I don’t think about it” 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 “most changed” 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 client’s own healthcare provider is also important.
When possible, I think it is necessary to counsel individuals about normal bereavement “symptoms” before they visit the doctor. I explain the apparent preference some professionals 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 for major depressive disorder.
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 (O’Connor, Whitlock, Bell & Gavnes, 2009, p. 801).
 Holidays in bereavement can be a lonely, perplexing time for the individuals and families to whom we provide care. Anticipating the pitfalls and helping individuals prepare for the inevitable difficulties of the holiday season is a gift that keeps giving all year long.
Reference.
O’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, 793-803.
The Author: For more than three decades, William G. Hoy has been counseling with the bereaved, supporting the dying and their families, and teaching colleagues how to provide effective care. After a career in congregation, hospice, and educational resource practice, he now holds a full-time teaching appointment as Clinical Professor of Medical Humanities at Baylor University in Waco, Texas.
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Here are two resources of interest in preparing bereaved individuals for the holidays.
 The National Center for School Crisis and Bereavement at University of Southern California has produced a colorful one-page flyer in a printable PDF version entitled Halloween and Grieving Students: A Check-in Can Help; it is available free right here.
What’s Your Grief is an online portal of resources for individuals dealing with bereavement as well as the professionals and volunteers who provide care to them. Their website includes an amazing posting entitled Sixty-Four Tips for Coping with Grief at the Holidays and can be accessed here.
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Your Professional Library
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Smith, H.I. (1999). A Decembered Grief: Living with loss while others are celebrating. Kansas City, MO: Beacon Hill Press.
 Though certainly not new, A Decembered Grief continues to be a perennial favorite for people walking through their first holidays in bereavement. Harold Ivan Smith helps grieving people develop a practical plan for altering traditions rather than abandoning them and opens the dialogue for what he calls “befriending grief” rather than attempting to escape it.
A highlight of this book is its arrangement into short and readable chapters of a few pages. Each one presents an important idea for negotiating grief during the holidays, including: Minimize the seasonal stressors; Nap; Observe a quiet holy day; Let others in on your grief; Use some of your seasonal decorations; “Zesticize” this season and nearly 50 other practical ideas.
For both bereaved people facing the holidays and for those of us who care for them, this volume is a keeper.
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Gillies, J. & Neimeyer, R.A. (2006). Loss, grief, and the search for significance: Toward a model of meaning reconstruction in bereavement. Journal of Constructivist Psychology, 19, 31-65.
 Though there have been many articles and books published in the last dozen years related to the meaning-making process in grief, it would be hard to find one that improved on the theoretical underpinnings of the process first introduced in a systematic form here. Following a thorough review of the existing literature on meaning making in bereavement, Gillies and Neimeyer propose a model of how meaning is reconstructed (or reaffirmed) after the death of a loved one. Essentially, the authors conclude, one of two possibilities exists for bereaved people. Either the loss is consistent with the bereaved person’s pre-loss meanings (beliefs, priorities, self-perceptions, etc.) permitting the beliefs to remain intact in one’s bereavement. Or, the loss is seen as inconsistent with these meanings, creating a need to reconstruct that system of beliefs. As an example, a 50-year old bereaved person may see the death of an elderly parent as consistent with their beliefs because the parent died with a minimal amount of suffering at the end of a well-lived life. On the other hand, this same bereaved person may see the death of her 22-year old son in a car crash as completely inconsistent with her beliefs (i.e. young people shouldn’t die with so much life ahead of them, etc.)
The “search for meaning” proceeds in light of what Gillies and Neimeyer define as six “domains” of meaning: 1) daily activities and priorities; 2) self-perceptions; 3) interpersonal relationships; 4) view of the future; 5) view of the world; and 6) faith/spirituality. One’s loss of meaning can be experienced in one or several of these domains. In the example above, the challenged meaning domains likely include personal priorities, view of the future, view of the world and faith/spirituality.
 When meanings must be reshaped, Gillies and Neimeyer posit that this meaning reconstruction occurs through one (or more) of three meaning making activities: sense making, benefit finding or identity change. These processes lead to a “reconstructed meaning.” If the reconstructed meaning leads to decreased distress, then those meanings form the framework of the new post-loss meaning structures. If distress is not reduced adequately, the bereaved enters into one or more of these three activities again in an attempt to reshape the meanings and beliefs so as to eventually reduce distress. Since a bereaved person may find meaning in one “domain” (i.e. faith/spirituality, view of the world, self-perception, view of the future, etc.) and not others, he or she may experience continued distress and continue his/her “search for meaning” until the new meanings address all domains of meaning.
Readers who have attended one of Dr. Hoy’s workshops on bereavement have undoubtedly noticed the connections between his notion of “Reaffirming” (seeking the spiritual and philosophical anchors that support in the loss) and the perspective of Gillies and Neimeyer. The connection is clear and Hoy often says his own thinking and practice has been deeply shaped by the research first articulated in this paper.
Sense-making is the bereaved person’s attempt to find some philosophical or existential explanation for the loss in response to the oft-heard phrase, “This is just so senseless.” Benefit-finding is the bereaved person’s attempt to discover the “silver lining” in the cloud of loss, discovering some enduring “good” to come from the experience. People who report “identity change” frequently describe themselves as more resilient, independent and confident as a result of their changing sense of self in the loss.
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