SUPPORTING someone with long-term grief is exhausting, yet ultimately so rewarding. But what do you do if your friend doesn’t seem to be getting better?

We need to see their grief journey like a mosaic. A piece of mosaic is formed from a combination of multiple small broken pieces or fragments of material called tesserae. Each mosaic is unique, with what is present and what is not there, playing an equal role in making up the image. We need to recognise that our friend’s situation is unique. Vincent Van Gogh said: ‘‘There is nothing more truly artistic than to love people." Here the carer is helping their friend to produce a mosaic of their grief, putting together very painful broken pieces of their lives resulting in peace and hope. There is no fixed time for how long this takes.

Successful grieving occurs when a survivor gradually integrates the ‘event story’ of the death into their narrative, while gaining some comfort from the ‘back story’ of a loving relationship with the deceased.

Here, bouts of anguish alternate with times of normality, giving time out from grieving. This leaves the bereaved with ‘bittersweet’ emotions, a peaceful understanding of the deceased and redefined hopes.

As a helper our role is to enable the deceased to handle their emotions; to journey with them on their pilgrimage of change and support them in their search for meaning.

This might initially involve helping in a practical way. It is common for people to feel discouraged and fall away from supporting a bereaved person. But they require friends with stickability. A good friend allows the bereaved to talk about their loss and reflect with them about how life has changed. This means being able at times to sit in silence with your friend, not feeling you have to offer any answers.

We know that it is more difficult for the bereaved if they have had insecure attachments in life, are highly anxious and feel emotional lonely. Financial loss only worsens the situation. Those with intrusive thoughts about the deceased with a fragmented sense of their own security fair less well. Complicated losses from sudden death such as suicide, and murder, also muddle the journey of grief. We know that enduring grief is unhealthy, which can lead to functional impairment and lower quality of life.

If grief persists, it can cause cardiac disorders, immunological dysfunction, increased alcohol and smoking, increased hypertension and for some suicide ideation and attempts. As one parent put it: ‘‘I am like a frozen computer that is busy dealing with an internal virus, unable to engage with other people or activities.’

Positive factors aiding recovery include a positive spirituality, social support, financial security, a securely attached experience, and an ability to find some meaning in the loss.

There is usually a good reason why a bereaved person reacts the way they do.

When the person is in denial, we have to find out why the grief is delayed and help them begin the mourning journey. When there is fear of loss of control, we teach them how to handle their emotions, allowing feelings to come and go. The bereaved can spend a lot of time visiting a doctor with real somatic issues. This somatic grief shows how the emotional impact of loss manifests itself in the body. Therapists educate the client to find ways of releasing this pain that they have held within. People often ask: "how do I know when I’ve ended bereavement?". Ending mourning doesn’t take the pain away but it does mean you are stronger to carry the pain.

In the end, the bereaved has to be enabled to be the architect of their own solution, which respects their dignity. Supporting the bereaved requires open questions to invite the story of loss to be shared. We use questions such as, "what does the loss mean to you now, what is the hardest part of the journey and how has it changed over time?". This allows the bereaved to share more fully their loss experience and enable them to begin to gain a new perspective on the situation. We need to convey interest in the hardest part of the narrative, the parts of their narrative that people least hear.

It’s a long process, but people do come through it, learning to integrate their loss and carry it more lightly.

Bill Merrington is a therapist, bereavement specialist and book writer on loss issues (yorkbereavement.com).