The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 16: Grief and BereavementTable 16-4a: Supporting the Bereaved during the Grief ProcessWhat NOT to Say26 picas“I know just how you feel.”“You’ll get over this in time.”“Don’t cry.”“It was God’s will.” Or “God knows best.”“You can have another child.” Or “You’ll findsomeone else.”“If you need anything, call me.”“You should be glad s/he didn’t suffer more.”BecauseEven if others experienced a similar loss, everyrelationship is unique. No one knows exactlyhow the bereaved feel.People do not “get over” their grief. They canlearn to manage it and learn to adjust to life.Many bereaved equate “getting over it” withforgetting their loved one.Though meant as reassuring, this is oftenperceived by the bereaved as an attempt to“shut down” their grief.This can offend nonreligious people and evenreligious people may not be comforted by this.Avoid clichés.The idea of replacing the loved one is abhorrentto the bereaved.This puts the effort on the bereaved. Since mostpeople experience decreased energy duringbereavement, they are unlikely to call.The length of time a person suffers is irrelevantto the bereaved; their focus is on the death ofthat loved one.(See next page for Table 16-4b.)XVIAt various points along the grief journey, it may be appropriate to encourage use of ritual. Van deHart states that rituals can provide therapeutic expressions that symbolize transition, continuity,and healing. 34 Therapeutic bereavement rituals are usually rituals of transition or continuity.2 Rituals of transition may relate to the separation of the loss or the transition to adjusting tolife without the loved one. These symbolic actions may include writing letters to the deceasedand then perhaps burning them, taking off a ring or melting it into another piece of jewelry, andputting away photographs of the deceased. Transition rituals may be most appropriate duringWorden’s Tasks I and II. Rituals of continuity may be related to the transformed relationshipwith the deceased as a new type of connection is established. 2 These rituals may include visitsto the grave, mentioning the deceased’s name during a prayer, or creating a square for the AIDSquilt, and may be most effective during Tasks III and IV.The elements of a ritual include the people involved, the symbols to be used, the ritual actionand the characteristics of the ritual. The ritual, like the grief process, is a personal experienceand must be created for the individual. It will arise from the circumstances, the personality, andthe beliefs of the bereaved. 2U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 343