When tears are not enough: if called upon to help those walking the anguished path of grief, will we know what to do to help ease their pain and alienation?

• Author: Jeffreys, J. Shep
• Position: Medicine & Health - Psychological management of critically ill persons

WE ARE CARE providers all. Whether you are a professional care provider or someone who wants to comfort a loved one in pain, you can learn how to accompany and support an anguished person on his or her "grief journey" when tears are not enough.

What can I do to help a person who is grieving? It is a question most of us have asked, or will ask, at some point in our lives. Many never find a satisfactory answer, as grief tends to alienate, isolate, and paralyze. Even the most capable, confident people find themselves wordless--helpless--in the face of anguished tears, angry outbursts, and deepening depressions. However, most of us eventually find ourselves called on to "help" someone who is walking this lonely path. What we can do is serve as an exquisite witness for that person.

An exquisite witness might be a friend, someone from the faith community who comes to visit the family, or the surgeon who stops by the recovery room "after removing a tumor and then proceeds to reassure the waiting loved ones. What distinguishes an exquisite witness is not one's level of training, but the willingness to approach another human being with compassion and deep respect for that person's needs, fear, and grief.

In listing the characteristics of an exquisite witness, the professional's role should be seen in a context that is far more "human" than clinical. It is not simply a matter of "This is what I do because this is what I have been trained to do," but rather, "This is what I do because this is part of the meaning of who I am and how I choose to live."

Drawing on many years of learning as a member of the training staff of On Death and Dying author Elisabeth Kubler-Ross, I believe it is vital to take a comprehensive approach to grief, addressing three critical dimensions: heart (the process whereby old loss material may rise to the surface and interfere with the ability of a care provider to be available to a grieving person); head (knowledge of the phenomenon we know as grief); and hands (what the care provider says and does to help the grieving person engage in the process of mourning in the healthiest way possible).

Here are a few insights:

* Be aware of your "cowbells," which refer to the personal loss issues that may surface in a caregiver when he or she is working with a grieving person. The word has its origins in my childhood. When I was four years old and attending a preschool program, during outdoor recess I would cling to the chain-link fence and look longingly toward home, missing my mother and wanting to be with her. At the same time every day, a junkman would come by ringing a cowbell roped to the handlebar of his pushcart. The sound of that cowbell and my yearning, grieving feelings became connected.

We all have our cowbells. They accompany us to the bedside of patients and loved ones, our interactions with counseling or pastoral clients, and every human contact we engage in. As care providers...