Member Contributor — Anita Wallace, LMFT

Covid and Traumatic Grief

As I write this, more than one million Americans have died from Covid. That number is staggering. Staggering and hard to comprehend. Like many Americans, my clients have also been affected. Sixteen percent of my clients have lost a family member to Covid. We hear the number of one million, but we can’t process it. And we can’t process it because it is by its very nature traumatic. Just as my clients who have lost a loved one to Covid struggle to grieve because their loss wasn’t a timely death, but a traumatic one.

Here I’d like to mention that I am pleased to see Prolonged Grief Disorder in the DSM-V-TR. But please note that Prolonged Grief Disorder is not traumatic grief. Nowhere does the DSM mention the cause of death. Someone may experience what would be considered a timely death, such as the death of nonagenarian parent who died peacefully, and still experience Prolonged Grief Disorder.

Years ago, I had the wonderful opportunity to do a training with Bill Worden and Therese Rando, two of the giants in the field of thanatology. One of my most important take-aways from that training was that the nature of a death can make bereavement more difficult to process. My interpretation of that was that if every time the bereaved person tries to remember their person who died, which is an important part of the grieving process, they are retraumatized by the memories of how their person died, they can get stuck. They need help processing the trauma to move forward with the grief. This idea has influenced the way I do grief work ever since.

Here are the factors that can make a death traumatic: when it is sudden, when it is preventable, when it is the result of violence such as homicide or suicide, when the person who died suffered great bodily injury, when there are multiple deaths, when the bereaved person was present when their loved one died and thought they would die as well and when a child dies. To therapists this list makes sense. We can easily see how any of these factors are traumatic by their nature. It is also easy to see how there could be multiple factors that make a death traumatic. For example, if members of the same family are killed in a homicide/suicide. There are multiple deaths, the deaths are sudden, the deaths are the result of violence and there could be great bodily injury.

From here it makes sense to me that so many of us are having a difficult time grieving or even acknowledging deaths from Covid. For my clients their trauma is connected to the seeming preventability of the death (for example, if their loved one died after vaccines became available) and in some cases to the fact that they too had Covid and thought they were going to die. Their grief is complicated by the trauma we are all facing; that their loss was one of hundreds of thousands, now more than a million. Maybe they weren’t able to have a funeral. Or the funeral was only on Zoom. Or they have family members or friends who think Covid isn’t real or can’t kill you and insist their loved one died from something else. In these ways their already traumatic grief becomes disenfranchised and isn’t acknowledged.

Before I begin any work around grief, I check in with all of my clients regarding trauma associated with the loss. This starts with the basic question of how their person died. Was it a death they had time to prepare for; a death that makes sense in the order of things; did they get to say goodbye? Or was it a traumatic and sudden loss? If it was traumatic, I ask follow-up questions including how they are sleeping, if they are having nightmares, if they are having intrusive thoughts about either finding their loved one or their loved ones final moments, if they are having trouble concentrating; if they are avoiding thinking about their loved one, how has their view of the world changed since their person died? How is their support structure; are they talking to anyone about their feelings or are they trying to avoid feeling all together? Are they feeling guilty about anything? I know theoretically that someone can experience a traumatic loss and not experience symptoms of being traumatized, but in my clinical practice I have yet to meet that person.

We then begin to process the trauma surrounding the grief. I might refer them to therapist who knows EMDR. I provide psychoeducation around trauma and the body. I might ask them to tell part of the story to me very slowly while we focus on what is happening in their body while they are talking. We practice different breathing techniques and ways to self-soothe so that they can learn to better control the flight/fight/freeze/fawn responses they may be experiencing. If it doesn’t overwhelm them, I strongly encourage my clients to practice simple meditation where they learn to focus on their breath. If that is too difficult and they like the idea of meditation I refer them to guided meditations as appropriate.

Only when a client is able to remember their person who died without experiencing symptoms of trauma do we move more deeply in the process of both mourning and grieving. Mourning is considered to be more of the behavioral component of adjusting to the death while grief is more centered on the emotional side. For my clients who lost a loved one to Covid, this might be their ability to no-longer be triggered by their own memories of being hospitalized and fearing their own deaths. It might be coming to terms with having to say good-bye over FaceTime and the fact that they had to drop their loved one off at the Emergency Room Entrance and weren’t allowed to go inside with them. When that is fully processed, then they are fully able to engage with the memories of their loved one and that healing can begin. 

Anita Wallace, LMFT, is in private practice in Glendale. She specializes in working with issues related to trauma, grief, death and dying and post-partum depression. She especially enjoys working with couples and is currently completing her core skills training in Emotionally Focused Therapy. She can be reached at info@anitawallacelmft.com.