Helping Bereaved People Deal with Guilt

One would be unlikely to find a reader of this newsletter or anyone who works often with grieving individuals who has not met one—or many—who are struggling with guilt. Evidence points to both cognitive and affective components of guilt, rather than seeing guilt simply as “feeling” (Li, 2014). These thoughts and feelings can be perplexing and even disabling to bereaved persons. An ongoing sense of guilt might be what brings a strong percentage of bereaved people to support groups and individual therapy, and guilt or a sense of regretful failure may be what drives many religious (and non-religious) individuals to a conversation with a faith community leader.

For many reasons, parental bereavement is widely known to include a component of guilt. Likely because of the parent’s natural role to protect and provide for children, they often exhibit significant guilt after a child’s death. Sugrue, McGilloway & Keegan (2014), for example, summarize the findings of other researchers that mothers are especially prone to “excessive guilt” after a child’s death (p. 118). For interest, compare the four domains of guilt described here to the five dimensions of guilt in the research review below.
 
guilt may grow out of a parent’s perceived failure to protect a child or the inability to prevent the accident or illness that caused a spouse’s death. During my career, I have heard descriptions of guilt about the genetics passed on that caused a child’s fatal illness, a grandparent express guilt over giving a teenager the car in which the youngster was killed, and a parent’s guilt about distraction that allowed a young child to wander into a swimming pool. This component of guilt might be the most perplexing for counselors if only because there is often a rational component of “fault” involved. Most of us would think it appropriate for the person who kills a pedestrian to feel intense guilt because he was distracted by texting at the time of the crash.
 
Survivor guilt is the global term we use after any loss where those who survive sense the unfairness that they survived while one or others perished. We have seen this often with parents who experience guilt because they sense the “natural order of things” has been reversed; parents “should” die before their children. This is also common among older adults when a younger sibling dies first. One woman whose sister twelve years her junior died reported: “I just don’t understand how this happens. I am the one with the bad health and the bad habits; I should have been the one to die first. She had so much life left to live.”
 
Relationship guilt is the term I use to describe the “should-haves” and “should-not-haves” that are part of any relationship between two people. Because an unexpected death tends to freeze the relationship with the last communication, many bereaved individuals wrestle with significant degrees of “I shouldn’t have been so hard on him” or “If I had only known she was sick, I would have gotten there to see her.”
 
A fourth kind of guilt I have regularly seen among bereaved persons is what I call transcendent guilt, best described as believing God, the Universe, or Fate is “getting even” for some moral failure or wrongdoing in the bereaved individual’s life. One might expect this guilt would be more prevalent among highly religious people. In fact, I have rarely observed it among this population. Instead, it seems to be part of the quest for meaning in life and the re-evaluation that often accompanies bereavement. In my experience, transcendent guilt seems most prevalent among those who articulate being disconnected from their faith community or their belief system. I have indicated to the authors of the study reviewed below that this would be an interesting theme to explore in that their sample was overwhelmingly non-religious.
 
Understanding the source of guilt is the first step in helping individuals resolve the issue, but it is important to realize that the guilt can be from more than one of these domains. What clearly does not work for the vast majority of bereaved people experiencing guilt is the misguided if well-meaning admonition from friends, family members, and even occasionally professionals to remember they have nothing for which to feel guilty. The fact is that a person who is experiencing guilt will not likely be talked out of it by simply being told their guilt is irrational! Remember that for cognitive guilt, the patient is thinking this through rationally, and that is precisely why she experiences guilt.
 
Instead, several approaches prove practical to help bereaved individuals to work through the guilt they experience. When told by a bereaved person that he or she is struggling with guilt, or in our conversation I suspect they are, I ask them to tell me more about the experience and what they are thinking about when they feel this guilt. On occasion, I have explained the possible sources of guilt outlined above so we can talk about which one(s) may be creating distress for the individual.
 
Secondly, it seems productive to talk through what other times and occasions have elicited experiences of guilt. What this helps us understand is if guilt is a lifetime pattern of emotional and cognitive focus or if it is related to some aspect(s) of the current loss. Because the focus of my practice has been death-related bereavement, I tend to refer folks who struggle with a lifetime of guilt to clinical psychologists, licensed professional counselors, and marriage & family therapists whom I know can address these issues in a more systematic way.
 
Thirdly, I like to inquire about what the bereaved person believes might relieve the guilt. My approach will be different, if for example the patient says she is seeking a dead relative’s forgiveness, he needs absolution from God, or she needs to “do penance” or “make amends” to relieve the guilt. Of course, some bereaved people have no idea—at least in the initial questioning—what might relieve the guilt. Others feel they need to carry it for a while as their “punishment.”
 
Still other bereaved individuals might describe their need to finish the deceased’s project or get involved in a “cause” to work through the guilt. Like most in our profession, my tack is to work with the individual first with what she or he believes will be effective, unless in my professional judgment that behavior would be unhealthy (like the parent who said, only half in jest, “I’m just going to drink myself silly and then I won’t feel this.”) The concept of instrumental grief posited by Doka & Martin (2010) certainly makes space for this “working through” guilt (and other experiences of grief) by taking adaptive action and not just discussing the loss.
 
Fourthly, my tendency is to suggest some activities that have worked for others. Writing a letter to the deceased admitting the perceived wrong and asking forgiveness is one such technique. When this writing is part of a therapeutic process where journal entries are reviewed and discussed in subsequent conversations with a counselor, this often proves incredibly helpful. As experienced therapists know, however, if review of journal entries is intended in a session, it is prudent to get to that early in the conversation. Otherwise, we reach the end of the hour (or 50 minutes) with open “cans” we do not have time to help the patient close.
 
Getting involved in a cause (Mothers Against Drunk Driving, for example) can also help to relieve the guilt, though discussing how and why that process works is very important so the client doesn’t simply mask the feelings with activity. Taking up a “cause” seems especially helpful when individuals feel a need to “make amends.” Such was the case of the dad who became a community/parent educator in his community fire department’s “Children Drown without a Sound” initiative, a couple of years after his toddler died in a backyard swimming pool (another example of Doka & Martin’s “instrumental grief”).
 
Some patients say they need forgiveness from God, and might want direction from the therapist on how to accomplish that. Since my own training is in the pastoral counseling arena, I am probably more at home with this kind of work than some colleagues, but any caregiving professional can ask questions like, “What would it take for you to discover that forgiveness?” or “How would you know if you have received God’s forgiveness?” Referral to the client’s clergy or faith community, if there is one, will also likely be important.
 
Caregiving professionals can also help the bereaved individual set the perceived action or failure to act in the context of the entire relationship. The major difference, of course, between this strategy and the words, “You shouldn’t feel guilty” offered by many friends rests in asking the bereaved person to define exactly what he or she did well in the relationship. Bereaved individuals are well-served when we help them discover that relationships are almost never all good nor all bad, and as we help them recover the good elements in the relationship that might be obscured by the pain of grief-related guilt. However, as Bill Worden (2009) has often stated, this “reality testing” works because the patient is finding her or his own conclusions about the positive contributions to the relationship in context of a lifetime of relating.
 
One of the dominant experiences for bereaved individuals is guilt. The experience can be overwhelming, and most often is not resolved simply with the passage of time. Neither is grief effectively managed by the coaxing of well-meaning family members, friends, or faith community to “not feel guilty;” if anything, such words generally just send guilt “underground.” Our approaches to helping bereaved people experiencing guilt, however, can greatly facilitate their ability to enfold the experiences into living, eventually finding a way to “find renewal,” integrating the experience into the rest of their lives (Hoy, 2016).
           
 
 
References.
 
Doka, K.J. & Martin, T.L. (2010). Grieving beyond gender: Understanding the ways men and women mourn. New York, NY: Routledge.
 
Hoy, W.G. (2016). Bereavement groups and the role of social support: Integrating theory, research, and practice. New York, NY: Routledge.
 
Li, J., Stroebe, M. S., Chan, C. L. W., & Chow, A. Y. M. (2014). Guilt in bereavement: A review and conceptual framework. Death Studies, 38(3), 165–171.
 
Rando, T.A. (Ed.). (1986). Parental loss of a child. Champaign, IL: Research Press. (Though now out of print, there were more than 30 used copies available on Amazon.com for a few dollars each in early July 2017.)
 
Sugrue, J.L., McGilloway, S., Keegan, O. (2014). The experiences of mothers bereaved by suicide: An exploratory study. Death Studies, 38, 118-124.
 
Worden, J.W. (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner (4^th ed.). New York, NY: Springer.

 
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.