By Elizabeth J. Clark, PhD, ACSW, MPH

Loss is being deprived of something one has had, or hoped to have. Loss is a recurrent theme in life, and many professionals, including social workers, have received training in helping people learn how to adjust to loss and how to cope with accompanying grief.

About Loss and Grief 

• Every loss has an accompanying grief.
• Grief is a process, not an event.
• Loss, like stress, can accumulate.
• Grief cannot be postponed forever.
• Everyone grieves differently.

Continuous Losses at Work

Some occupations require us to deal with death on a regular or continuous basis. These numerous losses create a stressful work environment. We experience what I’ll refer to as professional grief.

Whether you are a social worker, nurse, physician, clergy person, office assistant, or professional caregiver, if you confront multiple and continuous losses at work, you will experience a grief response.

So how do you deal with our own grief response, for example, when a client dies? To function adequately during a loss or crisis situation, professionals are trained to set aside their personal emotions — yet all experience is personal.

Professional grief is often internalized and not openly expressed. There is no easy outlet for it, and the demands of work continue. This can result in cumulative grief, or bereavement overload. This can further lead to burnout or post-traumatic stress disorder.

Bereavement Overload

There is an expectation that professionals who work in high loss settings get used to dying and death. But familiarity with death does not make it easier.

Most people in the helping professions do not enter their fields prepared to cope with death, and they often spend years trying to develop the right blend of compassion and involvement while protecting themselves as much as possible from personal hurt.

How It Differs from Personal Grief

Professional grief is different from that experienced when you lose a loved one to death:

• Professional caregivers are distant mourners.
• The effects of professional grief are often hidden and subtle.
• Professional losses accumulate.
• Professional grief may be transformed into other emotions such as anger, anxiety, blame, helplessness, and guilt.
• Professional grief may take the form of a chronic or delayed grief response — one that never seems to come to a satisfactory conclusion.
• Professional grief is a significant cause of burnout.

Maintaining Balance

Working in a high loss environment requires a balance between engagement and detachment, and the balance requires ongoing self-monitoring. If balance is lost, the detachment or engagement can become dysfunctional. This may result in the inability to meet your own needs or the inability to care for others.

Several things may happen if you are unable to maintain a healthy balance in a high-loss work environment. These include the following:

• There may be a decrease in your tolerance or sensitivity, and you will be unable to adequately meet the demands of your work.
• You may become overly cynical, and your sense of the world may become jaded. Cynicism is one of the best clues to burnout.
• You may experience a post-traumatic stress reaction which could include sensory imprints or flashbacks — sights, sounds, or smells that bring back a certain situation.
• You may find it difficult to maintain hope at work or in your personal life.

Working in high loss environments is stressful, but it also is rewarding. There is much to learn about the human spirit and human experience, how people maintain hope, and how people find strength and meaning through adversity. Professionals who spend years working in such settings often mention their feeling of making a positive difference in the lives of others. These individuals have found ways to maintain balance in their lives. They monitor their reaction to loss, recognize professional grief, and express it in appropriate ways. Instead of feeling overwhelmed or diminished by the multiple loss environments, they find their lives are enriched by working there.

As bereavement expert C. Murray Parkes noted:

With proper training and support, we shall find that repeated griefs, far from undermining our humanity and care, enable us to cope more confidently and more sensitively with each succeeding loss. (“Orienteering the caregiver’s grief,” Journal of Palliative Care)