06 May 2003

Useful techniques in bereavement counselling

Counselling the loved ones of someone that has died from Aids or any terminal illness for that matter is a very difficult thing. Here are some useful techniques in bereavement counselling.


Evocative language: The counsellor can use tough words to evoke language, e.g. “your son is dead” versus “you lost your son”. This language will assist the client in perceiving the reality of the loss and can stimulate some of the painful feelings that need to be felt. Also speaking of the deceased in the past tense can be helpful.

The use of symbols: The counsellor can ask clients to bring photo’s of the deceased to counselling sessions. This creates a sense of immediacy of the deceased and a concrete focus for talking to the deceased rather than talking about him/her. Letters written by the deceased can also be useful as well as audio/videotapes of the deceased. Articles of clothing and jewellery can also be used. The counsellor needs to be sensitive to the client’s culture of doing things and deal with what the client is comfortable with.

Writing: The counsellor can ask the client to write a letter(s) to the deceased expressing thoughts and feelings. This can help take care of unfinished business by expressing things that need to be said to the deceased. Keeping a journal of one’s grief experience or writing poetry can also facilitate the expression of feelings and lend personal meaning to the experience of loss.

Drawing: The counsellor can also ask the client to draw pictures that reflect his or her feelings as well as experiences held with the deceased. This works well with children, but can also be used with adults.

Role playing: The counsellor can assist the bereaved to role play various situations that they fear or feel awkward about, as one way to build coping skills. The counsellor can enter into the role play, either as a facilitator or to model possible new behaviours for the client.

Cognitive restructuring: The underlying assumption of the cognitive restructuring technique is that our thoughts influence our feelings, particularly covert thoughts and self-talk that constantly go on in our minds. By helping the client to identify these thoughts and reality test them for accuracy or overgeneralisations, the counsellor can help to lessen the dysphoric feelings triggered by certain irrational thoughts such as “no one will ever love me again”.

Memory book: One activity a bereaved family can do together is to make a memory book of the lost family member. This book can include stories about family events and snapshots, poems and drawings made by various family members, including children. This activity can help the family to reminisce and eventually to mourn a more realistic image of the dead person. In addition, children can go back to revisit this memory book in order to reintegrate the loss into their growing and changing lives.

Directed imagery: Helping the person to imagine the deceased, either with their eyes closed or visualising their presence in an empty chair and then encouraging them to say what they need to say to the deceased can be very powerful techniques. The power comes not from the imagery, but from being in the present and again, talking to the person, rather than talking about the person.

The purpose of all these techniques is to encourage the fullest expression of thoughts and feelings regarding the loss, including regrets and disappointment.


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HIV/Aids expert

Dr Sindisiwe van Zyl qualified at the University of Pretoria before working for an HIV/AIDS NPO in Soweto for many years. She was named one of the Mail & Guardian's Top 200 Young South Africans in 2012.

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