The Companioning Philosophy of Grief Care: Being Present to Pain

While I was trained in the classical medical model of bereavement care, I have come to advocate for, instead, a caregiving model I call “companioning.” I’ve always found it intriguing that the word “treat” comes from the Latin root word “tractare,” which means “to drag.” If we combine that with “patient,” we can really get in trouble. “Patient” means “passive long-term sufferer,” so if we treat patients, we drag passive, long-term sufferers. Simply stated, that’s not very empowering.

On the other hand, the word “companion,” when broken down into its original Latin roots, means “messmate”: com for “with” and pan for “bread.” Someone you would share a meal with, a friend, an equal. I have taken liberties with the noun “companion” and made it into the verb “companioning” because it so well captures the type of counseling relationship I support and advocate.

That is the image of companioning – sitting at a table together, being present to one another, sharing, communing, abiding in the fellowship of hospitality.

Companioning the bereaved is not about assessing, analyzing, fixing or resolving another’s grief. Instead, it is about being totally present to the mourner, even being a temporary guardian of her soul. The companioning model is anchored in the “teach me” perspective. It is about learning and observing. In fact, the meaning of “observance” comes to us from ritual. It means not only to “watch out for” but also “to keep and honor,” “to bear witness.” The caregiver’s awareness of this need to learn is the essence of true companioning.

As a bereavement caregiver, I am a companion, not a “guide”– which assumes a knowledge of another’s soul I cannot claim. To companion our fellow humans means to watch and learn. Our awareness of the need to learn (as opposed to our tendency to play the expert) is the essence of true companioning. My companioning philosophy of bereavement care includes eleven main tenets. The remainder of this article explores the first tenet, which is about the role of pain in grief.

Tenet One: Companioning is about being present to another person’s pain; it is not about taking away the pain. 

To be bereaved literally means to be "torn apart." When someone is torn apart, there is a natural need to embrace the heartfelt pain of the loss. There is no pill we can take to relieve the pain and suffering and no surgery that can reassemble the pieces of a broken heart. The way in which we care for fellow humans who are suffering the pain of loss has much to do with the ways in which we will be able to supportively companion others.

Sadly, current North American culture often makes the person in grief feel intense shame and embarrassment about feelings of pain and suffering. People who are perceived as "doing well" with their grief are considered "strong" and "under control." Society erroneously implies that if grieving people openly express feelings of pain and suffering, they are immature or overly emotional.

In contemporary North American culture, pain and feelings of loss are experiences most people try to avoid. Why? Because the role of suffering is misunderstood. Normal thoughts and feelings that result from loss are typically seen as unnecessary and inappropriate. Yet, only in gathering courage to move toward this hurt is anyone able to ultimately heal.

Grief Is Not Shameful

As the bereaved experience grief, they are often greeted with what I call "buck-up therapy" – messages like "carry on," "keep your chin up," or "just keep busy." And combined with these messages is often another unstated but strong belief: "You have a right not to hurt – so do whatever is necessary to avoid it." In sum, the person in grief is often encouraged to deny, avoid, or numb themselves to the pain of the experience.

When personal feelings of grief are met with shame-based messages or silent indifference, discovering how to integrate the loss becomes all but impossible. If the bereaved person internalizes stated and unstated messages that encourage the repression, avoidance or numbing of grief, they often become powerless to help themselves. I often say that finding the way into and through grief is often more difficult than finding a way beyond it. In fact, internalizing the belief that mourning is wrong or bad tempts many people to act as if they feel better than they really do. Ultimately, denying the grief denies one the essence of life and puts one at risk of for living in the "shadow of the ghosts of grief."

When we as caregivers experience the pain and suffering of a fellow human being, we instinctively want to take the pain away.

Yet, to truly companion another human being requires that we sit with the pain as we overcome the instinct to want to "fix." We may discover that we want to fix another's pain because it is hurting us too much.

Suffering doesn't mean something is wrong. It isn't happening because we made the wrong move or said the wrong thing. As Thomas Moore wisely noted, "The basic intention of any caring – -physical or psychological – -is to alleviate suffering. But in relation to the symptom itself, observance means first of all listening and looking carefully at what is being revealed in the suffering. An intent to heal can get in the way of seeing. By doing less, more is accomplished."

Ultimately, if we rush in to take away a person's grief pain, we also take away the opportunity for her to integrate the loss into her life. To be truly a healing presence, we must be able to share another person's pain while realizing there is nothing we can do to instantly relieve it and knowing that we are not responsible for it – -all the while seeking to empathetically understand what the pain feels like. The paradox of entering into the pain lies in the truth that as you affirm someone's feelings of suffering, you are also affirming his eventual capacity to move beyond those feelings. As Helen Keller taught us years ago, "The only way to the other side is through."

The Wisdom of the Soul

Yes, sometimes it may seem as if you are "doing" very little as you open your heart to a fellow struggler. And yet this is an example of how companioning inspires an attribute of the soul: wisdom. Wisdom is the sense of recognizing that in your helplessness you ultimately become helpful. A wise caregiver will have the wisdom to know what she can do, accept what she can't do, and have the spirit of the heart engaged in ways that can and do make a difference.

In providing a soulful response to another person's pain, we must discover and nurture two qualities that are within us: humility and "unknowing." We must first be present with an open mind and an open heart. To be open in this way of being is not an absence of thought, however. In fact, it is a clear, focused attentiveness to the moment. It is about immediacy – -being present in the here and now.

When we as caregivers focus the power of our attention on the suffering of another human being, the full measure of our soul becomes available to her. Releasing any preconceptions of the need to take away pain allows our hearts to open wide and be infinitely more present, loving and compassionate. Presence in the fullness of the moment is where the soul resides.

And being present to people in the pain of their grief is about being present to them in their "soul work." There is a lovely Jungian distinction between "soul work" and "spirit work."

• Soul work: a downward movement in the psyche; a willingness to connect with what is dark, deep, and not necessarily pleasant.

• Spirit work: a quality of moving toward the light; upward, ascending.

In part, being present to another person's pain of grief is about being willing to descend with them into their soul work, -which precedes their spirit work. A large part of being present to someone in soul work is to bear witness to the pain and suffering and not to think of it as a door to someplace else. This can help keep you in the moment. Dark, deep and unpleasant emotions need to be held in the same way happiness and joy need to be held – -with respect and humility.

Acknowledging Our Own Suffering

As our hearts begin to open to the presence of suffering, challenging thoughts may creep in. Can I really help this person? Is the pain of his loss touching my own losses? If I reach out to support, what will happen to me? In the push-pull this experience triggers, there is little wonder that being present to the suffering of others seems so difficult.

The capacity to acknowledge our own discomfort when confronted with suffering is usually less overwhelming when it is no longer minimized or denied. To give attention to our helplessness can free us to open more fully to another as well as to our own pain and suffering. We no longer find ourselves wanting to run away. We can slow down, be still and open to the presence of the pain. We can witness what is without feeling the need to fix it!

When we become conscious that any part of us wants to run away from the pain, we can gently embrace it; an entire new level of receptiveness becomes possible. As we become the companion, we begin to see what is being asked of us that is not so much about "doing" but instead about "being." We discover what anxieties and fears might be inhibiting our helping hearts, and come to trust the healing power of presence.

Finally, we can begin to listen –- truly listen – and give honor to the pain. Instead of pushing away suffering or merely releasing the need to "fix" it, we are able to enter into it. We are not indifferent or passive; we are fully available and open. We are truly being hospitable to the pain of another person.

In opening to our own suffering from life losses, we enhance our desire to be of service to those around us. We become truly available at deeper levels of our souls. We do not deny pain but open to it and learn what it is trying to teach us. In becoming more sensitive and responsive to one's own pain as well as the pain of others, we continue to see ourselves as students always learning to become more heartfelt companions to our fellow strugglers. What an honor!

By Dr. Alan Wolfelt