On grief and loss.

Shortly after graduating with my master's degree in the 1980s, I procured a clinical social work position at a nonprofit, United Way agency in a small town in North Carolina. My job involved counseling children, adults, and families. It was my ideal job and exactly what I wanted to do with my career. One of the first clients I interviewed was a 52-year-old, walk-in client, Jan (a pseudonym), who was a teacher at the local elementary school. She was the mother of two adopted children, ages 9 and 11, and had recently lost her husband to cancer. During the first visit, she was overwrought with grief over the death of her husband, who had been the principal of the school where she taught. She told me that she had married in her late thirties and that, after several years of marriage, she and her husband decided to adopt a brother and sister, ages 1 and 3 at the time. She never imagined that she would be parenting these children alone. Jan had spent the majority of the last two years, when she was not working, caring for her husband at a large medical center 45 minutes away. He had fought the cancer valiantly but, after undergoing multiple treatment regimens, had succumbed to the illness. She described her husband as "the love of her life" and, without him by her side, did not know how she was going to have the strength to raise her children. She spent the hour tearfully relating her struggles during the time that she attempted to care for her husband and children, while holding onto her job teaching 30 fifth-graders. She alluded to the fact that her children had often been "on their own" while she traveled back and forth to the hospital. Although she expressed some guilt about this situation. she also felt she had no choice, given the lack of reliable babysitters, the enormous medical expenses, and the unpredictability of her schedule. Following further expressions of sadness and despair, she ended by saying that she walked into the agency feeling lost, lonely, and more anxious than she ever had in her life and needed my help. As a 25-year-old, novice social worker, I had very little personal experience with death and had received no formal educational training in grief and loss. I remember feeling totally overwhelmed, myself, and quite inadequately prepared to assist this woman who was experiencing so much anguish and despair. I took my anxiety along with my notes from the session to my supervisor, who calmed me down and carefully guided me through my first experience with a grieving client. She handed me Kubler-Ross's (1969) book On Death and Dying and mentored me weekly on how to help this bereaved wife and mother through her grief. Little did I know that this was the beginning of a career in which issues of grief and loss would play a central role in my practice and, later, my research and teaching. As social workers, we will all deal with issues of grief and loss in both our personal and professional lives. The death of a family member or friend can be simultaneously an opportunity for growth and a challenge to a client's mental health. Unattended or complex grief can lead to other emotional problems that may appear to be far removed from the actual source of the discomfort. Regardless of the vulnerable client population with whom we work, social workers will be confronted with a myriad of issues in which grief and loss are at the core. Having the knowledge and skills to assist individuals, families, and groups with their losses is an essential component to being a competent practitioner. Understanding and assisting our clients with grief and loss issues is particularly relevant in today's uncertain environment. Loss, and the grief it produces, occurs in various forms, in a variety of situations, and is not immune to any age group or population. Grief may be defined as a multidimensional experience that results from a significant loss of person or object. It can involve the emotional, cognitive, physical, social, behavioral, and spiritual components of a person's life. …