Supporting clients experiencing grief and loss (with Richard Sedgman)

[00:00:05] Bronwyn: Hey, mental workers. You're listening to the Mental Work podcast, the podcast about working in mental health for early career mental health workers. As always, I'm your host, Bronwyn Milkins, and today we are talking about working with clients who have experienced grief and loss.

Supporting clients through grief can be really daunting, especially when the emotional weight of their loss feels overwhelming or outside your lived experience. In this episode, we'll unpack evidence-based approaches, practical tips, and common mistakes to avoid so you can feel more confident in navigating these deeply human and often challenging conversations. Here to help us out with this topic is our guest today, Richard Sedgman. Hi, Richard.

[00:00:41] Richard: Yeah. Hi Bronwyn, thanks for having me.

[00:00:43] Bronwyn: It's such a pleasure to have you on. Could you please start off by telling listeners who you are?

[00:00:48] Richard: Yeah, absolutely. So I'm a social worker, therapist. I live in Melbourne. I've got my mental health accreditation as a social worker. Degrees in counselling, family therapy as well. And I run my own business called Live Well HQ, so that's a private practise.

I work for Federation University in Melbourne as well, where I support social work, um, students on their placements. And I've also done community radio as well where I'm talking about mental health issues as well. So yeah, that's a bit of a summary.

[00:01:18] Bronwyn: Yeah, so a bit of an all rounder. You know, interestingly, we haven't had somebody on the podcast explain the mental health accreditation for social work. Could you just tell us how long that takes to get that accreditation and just what's involved?

[00:01:33] Richard: Yeah, absolutely. Look, I can't lie, it's a bit of a nightmare, there's a lot of paperwork. You have to have experience working in the mental health field. So I was, I was working in a hospital in Melbourne, an inpatient unit for mental health and also addiction. So that certainly helped to go towards those hours. There's a lot of paperwork, but I'm so glad that I've done it and I use, yeah, I use it every day and, you know, for clients to be able to claim on Medicare as well is really super important.

[00:02:02] Bronwyn: So it was getting the hours in mental health, and is there a few case studies or requirements that you have to do as well?

[00:02:09] Richard: Yeah, you do, so at the end you have to do an exam, which I think went for about three hours. And so you've gotta do, I think there was two, yeah, two case studies, which are really, really thorough, just going through the whole process and you know, what, what sort of strategies that you use with them and yeah, it was very challenging.

[00:02:27] Bronwyn: Yeah, totally. I can hear it and see it as I'm talking to you that you're like, oh my gosh, I'm so glad that's over!

[00:02:33] Richard: I am very relieved it's over!

[00:02:35] Bronwyn: Yeah, and it's good that you've got it. So thanks for explaining that. So we're talking about grief and loss today, and how did you come to be interested in working with clients have experienced grief and loss.

[00:02:46] Richard: Yeah. So in, in private practise, and I guess all of my social work roles, I was exposed to grief and loss with different client situations. But I think my passion for it kind of really grew after I, I went into palliative care for three years. That was probably the most challenging role I've ever had, but also the most satisfying one as well. I think I really learned a huge amount about grief and loss and working with people at end of life and, you know, families afterwards was really an extraordinary experience for me. And I learned a lot about the right and wrong ways to help clients, yeah, with grief and loss.

[00:03:30] Bronwyn: I'm interested whether working in palliative care... was that towards the start of your career or did you have a bit of experience behind you?

[00:03:37] Richard: Yeah, so I definitely had a bit of experience behind me before I did that job which I'm really, really glad that I did because I think if someone was just coming, you know, straight out of uni into palliative care, I think they would struggle. I think having life experience is incredibly important in that area.

[00:03:54] Bronwyn: I've never worked in palliative care before. Like, how would you describe it overall? Is it extremely rewarding or is it just like overwhelmingly challenging? I just imagine it's, yeah, full of lots of emotions.

[00:04:07] Richard: As I said, it was definitely the most challenging area that I've ever worked in. But, but also the, the most impactful on me. I think, you know, it, it really made me question my own mortality as well. And when you're seeing people at end of life, there's, there's kind of really no BS anymore, you know, when they're talking about how they're feeling and, yeah, look, I loved it. I think, three, three years was enough for me. I think I was ready to, you know, move to another area after that. But I, I just learned so much about it.

And just kind of sharing in those, those incredible moments, when someone's looking back on their life and, you know, good, good and bad. But it's, it's a really interesting area for a therapist as well. And I was reflecting on this the other day that you're not sort of working towards a positive outcome, and I think that that does make it quite tricky as a, as a therapist, you know, because in palliative care all of your clients are gonna, are gonna die. And you can't really put a positive spin on it for families. As a therapist, you really gotta look at it in a bit of a different way than maybe what you normally would.

[00:05:18] Bronwyn: Yeah, absolutely, that's a really interesting insight that you've just described. I was thinking as you were saying that, that sometimes as therapists, we feel discomfort talking with clients about their problems, and so we wanna put a positive spin on it. But you cannot do that with palliative, like you said, so it's like you just have to sit with your own emotions in that.

[00:05:39] Richard: Absolutely. And I think it's, I think it's one of the mistakes that, that therapists can make in this area that we're so quick to find solutions and put a positive spin on it. But when you're sitting with someone who's, who's got Motor Neurons Disease and they're going through hell and their family's going through hell, you don't wanna be sitting there trying to put a positive spin on it at all. It's actually, it's actually quite offensive to them to, to even, attempt to do that. So yeah, it's really about just sitting in the space with them, which I think some therapists would actually really struggle to do.

[00:06:16] Bronwyn: Totally. So let's just talk about how you see grief, bereavement, loss... could you tell us a bit about those and potentially the differences?

[00:06:24] Richard: Yeah, absolutely. So there's differences and there's, and there's overlaps, with all, all three of those things. So griefs about the response, you know, physical, emotional, cognitive, you know, response to loss. It could be losing someone through death, but it, it can also be other things as well, loss in someone's life, um, loss of relationship, you know, that's, that's a huge one, forced redundancies for people and that's, that's really tough, you know, when they're, when they're not ready for retirement age, grief, you know, when someone gets sick, just trying to sort of make sense of that.

So grief is, subjective and, I guess, you can have two clients in the same, similar situation, but be feeling it in a different way.

[00:07:09] Bronwyn: What stands out for me there is that grief doesn't have to involve the death of somebody or, or a pet, for instance. It can be like you are grieving over the loss of something that you had, like work, and then you no longer have that.

[00:07:23] Richard: Yeah, absolutely. So it's, it's, it's a loss of something that that's really important in your life and that, and that means a lot to you. And yeah, as I said, that could be a few different things. Bereavement obviously is the death of a loved one, and that kind of needs a, a bit of a specific approach.

[00:07:39] Bronwyn: I'd love to talk about some approaches. Maybe I'll start by sharing a little bit about how grief was for me when I first encountered it professionally. I had trained exclusively in cognitive behavioural therapy before I started working with clients, and when I was faced with my first client who had experienced grief, I quickly realised that cognitive behavioural therapy was not gonna cut it here, and I didn't know what to do.

So I looked at some stuff and I found some stuff, but a lot of it for me, what I realised was sitting with the client and being in that space with them and I didn't really have a name for it, but I was like, this is what I'm gonna do for now as an early career psych. So I'm keen and curious to hear what some approaches you use or that you know about for working with clients who have experienced grief and loss.

[00:08:22] Richard: So I use a few different approaches, but one, one of the best ones, or one of the first ones I use is the acceptance and commitment therapy. And that's, that's really good for people that are maybe a little bit stuck, you know, having the complicated grief. And the basics with that one is just sitting, as hard as this is for clients, you know, just sitting in, sitting in that painful emotion... I think as a society we're so quick to, I'm feeling slightly uncomfortable about something and so I just want to, I just wanna wipe that I don't wanna feel it or, but I think especially in grief, people do need to sit in it . And as a therapist you can, you can definitely help them with that. Promoting acceptance of painful emotions instead of control or avoidance, that's a really important thing. Using value-based actions, um, reconnecting with life. Just really, really labelling how you're feeling, as I said, just kind of sitting in that emotion.

[00:09:22] Bronwyn: I really like ACT for that as well because, with grief, one understanding that I have with grief is that the feelings come in waves. So you might be good one second. And then you see a loved one shirt that they used to love wearing. And then the grief is overwhelming in that moment. But ACT can teach you to ride the waves and be like, oh, this is really painful, okay, yeah. Is that what you've found?

[00:09:44] Richard: Absolutely. And that's literally the example that I use for a lot of people is at the start of grief, it's like you're out in the ocean and, and you're getting hit by waves and they're really strong and they're coming all the time. And, you're barely able to get to the surface, you know, to take a breath before you hit it again by the wave.

But over time, as I say to people, the waves don't ever stop, but the waves do get more gentle, and there's, there's a little bit more distance between the two waves, you know, before they hit you. So I, I think people kinda like that analogy, and I think, I think it sums up grief, like incredibly well, actually.

[00:10:26] Bronwyn: Yeah, I agree. I like the wave analogy, how you explained that was really nice. Are there any other aspects of Acceptance and Commitment that you wanted to talk about, or are there any other approaches?

[00:10:36] Richard: Probably the one that I use the most from the ACT is the, is the narrative therapy. So that's helping clients to re-author their story after loss. This is a really, really, huge one in grief and loss. It's not saying this is a good thing that you've lost that person... But, I guess it's kinda re reshaping their grief narrative,

That it's okay to feel what you're feeling, but this doesn't have to be the end of your life. You can evolve into something else after losing that loved one, or the loss of whatever in your life.

[00:11:10] Bronwyn: Do you find that narrative therapy or reshaping your story is good for people who are dying as well?

[00:11:17] Richard: Yeah, absolutely. Some of the most distressing ones that I, that I saw were, you know, the ones like the Motor Neuron Disease, and the approach that I tried to use with them was that... I mean, there's, there was a grief that, that they were not going to be able to experience anymore in their life. And, you know, their hopes and dreams that they had were obviously not gonna happen, but it was really about looking back on their life and finding a sense of purpose and meaning, 'cause for someone to feel like their life has actually been of value, is incredibly powerful for someone who's dying.

[00:11:54] Bronwyn: Yeah, absolutely, because it must be awful what they're experiencing and they would be in a lot of pain and experiencing a lot of loss of their bodily functions as well, and their livelihood. So being able to reclaim some sense of value and meaning in their life.

[00:12:08] Richard: Yeah, and also it's about them... which is really hard for things like Motor Neurons Disease is, helping that person to accept that they're still offering something to the world or their family because it's very hard when people are losing, you know, their function, to feel like anyone actually really wants 'em around and they, they're just kind of getting in the way. So yeah, it's, it's really important to go, well, your family loves you and just having you around them, even, even though you are struggling is still a blessing for them.

[00:12:39] Bronwyn: Yeah, that's really nice. What I'm hearing with these approaches from your perspective is that there's a huge dose of curiosity, empathy, non-judgment, making space for emotions, sitting in those emotions, not making it, like not putting a silver lining on it if somebody's dying, does that sum well?

[00:12:55] Richard: Uh, yeah, absolutely. Absolutely. I heard this really great quote, and it was from Brene Brown who I, I love her work so much, and it was saying, um, empathy's not about fixing someone's pain or pulling them out of a dark hole, but it's about climbing down into the hole with them and saying, I know what it's like down here, and you are not alone. I love that quote so much. And yeah, I, I actually think about it a lot in sessions, you know?

[00:13:22] Bronwyn: I love that quote too. It like gives me shivers when, like I heard you say that it's so powerful and yeah, I feel like it perfectly encapsulates everything we're trying to do.

[00:13:30] Richard: Absolutely. Yeah, it actually completely changed me in my approach as a therapist when I heard that.

[00:13:35] Bronwyn: So, I wanna turn to some early career applications here. I think many early career therapists worry about saying the wrong thing in grief work, and I feel like this is really understandable, it's like, I think the image that maybe early career psychs might have in their head is, say, a client comes to you and their partner has died, and then you say, "oh, I'm so sorry to hear that", and then they snippet you and they're like, "what are you sorry about", or something like that. So I think they're, they're afraid of saying the wrong thing. What would you say to other career folks who are scared of saying air quote the wrong thing?

[00:14:09] Richard: I really sum up grief work in this way that it kind of requires a balance of humility, presence, and patience. The humility is what I was talking about before, you know, just having a sense of curiosity. Presence, just literally being able to stay with that person in that moment. And patience as well, it's not a... grief is not a quick process.

I think one of the things that therapists can do is that they can rush in, try to find solutions and they kind of put pressure on themselves that they have to come up with answers or solutions. But as I said before, grief is not about that. And I think what I found with clients as well in this area is that they're not looking for answers, they're not looking for solutions, 'cause they know, they know that whatever loss they've had, they can't, you know, replace someone that they've lost, so it's really about just sitting in that moment with them, don't rush it, don't look to silver lining sort of statements. Things like if you've lost someone, you know, they're in a better place, at least you've had all these years together and time heals or wounds, those sort of things... they're really not helpful to say those things at all.

[00:15:22] Bronwyn: Is that something like, I hope not through your own experience, but it's like, what effect do you think those platitudes really have on clients? Like when you say like, well, at least you've had a, a great life with them and, yeah, time heals all... What do you think the effect is on clients when they hear that?

[00:15:39] Richard: I think it's actually pretty devastating to be honest, and I think most of the clients I've worked with. In this area would not say anything in response back. But yeah, I think inside, I think they actually feel really alone and those comments are just not helpful at all, they make it worse.

[00:15:56] Bronwyn: I really like how you said alone... when we say these comments to clients, even though they're well-meaning from us, it leaves them feeling isolated and not seen and not heard.

[00:16:05] Richard: Totally, absolutely. And that quote that I mentioned before, it's about, sitting with 'em in that, in that place. What- whatever they need to feel in that moment is okay.

[00:16:15] Bronwyn: Are there any other common mistakes you reckon therapists make when supporting grieving clients?

[00:16:21] Richard: I think one of the things that we can do as a therapist which doesn't always help is... cause we're uncomfortable with sitting with someone with that grief... I remember at the start I was like, wow, this is really, really hard to be around this. You know, like, what do I say? But avoiding, avoiding the painful emotions is actually not great. It's not great for the client. So just giving them a safe space to feel or express their feelings. You know, whether it's a man who's never cried in his life before, just to say, that's okay, that's all right. You know, don't, don't avoid these, these painful emotions.

[00:16:58] Bronwyn: Mm. Do you ever have this thought, or have you ever had it when working with grief and loss that, like, maybe if I don't put a positive spin on it, like if we just keep on crying ever, every session, is this helpful? Or like, do you ever doubt that sitting in that space are too long, is unhelpful?

[00:17:14] Richard: It is a bit of a tricky one actually, and it kind of changes with the clients, but, I think it's completely okay for them to be in that sad space. But I guess if they're in that sad space for too long and they're not progressing, then that, that sort of turns into complicated grief. Grief, grief is... it changes the, the emotions can change all the time and, you know, you can, you can feel like you're doing okay six months later and then, and then be triggered by something again and, and be crying and upset, and, that's okay as well.

[00:17:48] Bronwyn: You saying that reminded me of something that, like, sometimes I say to clients as well, which is like, grief doesn't have a timeline. There's no, like, you're supposed to be feeling better right now, and I think a lot of people who experience grief, sometimes they can cop that from like other family members or other people in their life. And it's like, you know, they died two years ago. Why are you still upset?

[00:18:07] Richard: Yeah, the amount of times I've heard that from family members or friends, oh, you know, what's going on? Like, why, why are you still upset? And part of the grief process that people wanna hold onto is, is that memory of that person. They don't want to forget that person, so if you stop feeling that grief, then it's almost like you're forgetting that person.

There's kind of a comfort in a weird way of someone still feeling some sense of grief that they're still remembering that person. And, and I say to people all the time, the level of grief is gonna be based on how much you loved and cared for that person. So if you really cared for them a lot, that grief is gonna be huge and it's gonna be with you forever.

[00:18:49] Bronwyn: Yeah. Absolutely. It just reminded me potentially of another mistake. And that's trying to, for therapists, try and rush the process. Which I guess is what you were talking about as well. But I remember again, having an early CBT background for myself, it's like if you're doing strict CBT, you give people homework assignments and it's like, you know, so you'll do the thing and if a client comes to you and they're like, you know, I'm going to, for example, clean out the wardrobe of my loved one as a CBT therapist, you'd be like, great, let's make that an assignment together, and I think that it could be a significant mistake.

And I'm curious to hear your perspective if you try and be like, okay, so this week you said you're going to clean out the wardrobe, did you do it? It's like, they may have said it, but you can't rush that timeline. What do you think?

[00:19:32] Richard: Yeah, absolutely. And it really comes back to the, the point that there is no timeline for grief. It's good to set homework for a client, encourage them to do some positive things. And one example obviously is, you know, if, if you've lost someone and-, a partner and you know, their clothes are still in the cupboard and they, they have to be ready to get rid of those clothes and, and some people actually never are. And, and that's okay.

If they say to you "it was too much, I couldn't do it" to go "Okay, that, that's, that's okay. That's fine, i, I completely understand that". You really don't wanna put timelines on grief at all.

[00:20:09] Bronwyn: I just wanted to ask you about cultural considerations. And even as I'm thinking about this, I'm like, you know, culture, it's like how long is a piece of string? It's so different for every culture and which culture you're talking about. But are there any broad considerations that we should keep in mind when working with clients from diverse backgrounds experiencing grief?

[00:20:26] Richard: Yeah, absolutely. So it really comes back to that, that sense of curiosity and I use the term with this, practise curiosity over assumption. I've worked with lots of different cultures that have got very, very different views and behaviours on grief, and it's really interesting for me to hear about that, and I definitely go outta my way to say, like, I'd love to learn more about that, that, that sounds really interesting. And, just sort of coming to that in a place of respect. Um, and it's like, it's okay to go, " I don't know anything about that, please tell me what that is." like, what what does that mean for you?

[00:21:06] Bronwyn: So it really comes back to the humility and the curiosity and yeah, that the humbleness of being like, yeah, I don't know. So don't pretend, you know, when you don't.

[00:21:14] Richard: Oh, look, that's absolutely the worst thing that a therapist can do... that's act like, you know about a particular thing and you don't because, yeah, especially in this area, you're gonna, you're gonna get found out pretty quick!

[00:21:26] Bronwyn: Yeah, yeah, definitely, yeah. Richard, this has been a really enlightening conversation, I've really gained a lot from listening to you and your experiences and your knowledge here. What do you hope that listeners will take away from our conversation today?

[00:21:40] Richard: it's really important not to feel worried about seeing clients with grief and loss. They are really emotionally challenging sessions, but as, as I said before, for me, I've found it a real privilege to talk to people at end of life, and people that have lost a lot.

It's complicated, but it's kind of not complicated as a therapist. Empathy is feeling with people. When someone's in a deep hole and they shed out from below, "I'm stuck. It's dark", empathy says, I'm gonna climb down and, and, and sit beside you in that. And to me that's even more powerful than you reaching down to support someone. You're actually getting down on the ground with them to be in that moment with them. And that's really, really powerful.

Therapists don't need to be scared about working with grief and loss clients as long as you're coming in with respect and empathy and sense of curiosity. And you don't have to have had that life experience exactly the same as, as that person to be able to show those things.

[00:22:42] Bronwyn: Awesome. Yeah, there's a lot of good stuff in there. Thank you so much, Richard, it's been a real pleasure. If listeners wanna learn more about you or get in touch, where can they find you?

[00:22:51] Richard: I've got my business, uh, Live Well, HQ so it's, uh, livewellhq.com.au. I'm on Instagram as well if people want to contact me. More than happy to offer support that I can.

[00:23:05] Bronwyn: Awesome, thank you so much, and I'll make sure I pop those links in the show notes. Thanks again.

[00:23:09] Richard: Thanks for having me, appreciate it.

[00:23:11] Bronwyn: No worries. Listeners, if you enjoyed this episode, please follow Mental Work Podcast, rate and review on your podcast app, and share it with a friend or a colleague who might enjoy the conversation too.

Thanks for listening to Mental Work. I'm Bronwyn Milkins, have a good one, and catch you next time, bye.