Coping With Anticipatory Grief

The grief you experience while coping with a dying parent or other loved one is different than what you experience after someone has died. Anticipatory grief is felt before the death occurs, and it can affect both the loved ones of someone who is nearing death and the person who is actually dying.

You may have mixed feelings while a loved one is dying. You may hold on to hope while also beginning to let go. These emotions can be deeply painful. To make matters worse, people are less likely to get support for their grief at this time.

Sometimes, other people who have not been through this experience may react poorly. They may think you are giving up on the dying person. Fortunately, there are things you can do to help cope with the grief you feel for someone who is still here.

This article describes anticipatory grief and some of the strategies that may help both the dying and their loved ones during this time.

Understand Your Grief

Anticipatory grief is deep sadness felt during the last days of life. It can be experienced by both the dying person and the dying person's loved ones.

Grief before death gives you a chance to say goodbye that you don't have when a loved one dies suddenly. Still, grief before death doesn't replace or even shorten the period of grieving that follows death.

People sometimes use words like "battle" and "fight" to describe terminal illness. These metaphors incorrectly suggest that patients can "beat" their illness with enough effort. This can make it hard for the dying person and their loved ones to express grief before death.

Not everyone feels anticipatory grief, but it is common.

Feeling grief while your loved one is still alive does not mean you are abandoning your loved one or giving up. Instead, anticipatory grief may give you a chance to gain meaning and closure you might not have had otherwise.

You may feel like you are somewhere between holding on and letting go. Some people find this very painful. They may feel they are betraying their loved one if they lean at all towards letting go.

The truth is that it is possible to live with both holding on and letting go at the same time. You don't have to choose.

Let Yourself Feel and Grieve

Everyone grieves and responds differently to news about a terminal diagnosis. Anticipatory grief can begin as soon as you’re told a loved one may die soon. You could also experience a delay as you process the information about your loved one's diagnosis.

Let yourself feel the pain in your heart. This helps you be honest and true with yourself.

Anticipatory grief is not just grief for the coming death of a loved one. It is also grief for the other losses that go along with death, such as:

• The loss of a companion
• The loss of shared memories
• The loss of dreams for the future

Sometimes, grief from the past may resurface during this time.

Denying the pain you feel now can prolong grief later on. Grief serves a purpose, whether it occurs before death or after death.

Researchers have identified four phases and tasks of grief. The tasks include:

• Accepting the coming loss
• Working through the pain
• Adjusting to a new reality where your loved one is absent
  
• Connecting to your loved one in a different way as you move forward

This doesn’t mean you should give up on your loved one or forget them. Instead, these tasks will help you hold onto the joy and love you once shared. They can also help temper the deep sadness that may make remembering painful.

Don’t Go It Alone: Express Your Pain

Staying strong when a parent or other loved one is dying can be challenging. Always give yourself permission to feel sad or ask for support from other people in your life.

It’s important to let yourself feel your pain. Still, many people find it hard to express grief before death. They may feel they are being unsupportive of their dying loved one. Talking to a trusted friend is a good way to cope with these feelings.

One large difference between anticipatory grief and the grief you feel after someone dies is that there is often more anger in anticipatory grief. You may also find it harder to control your emotions.

People who don't have a loved one facing death might have no way of understanding how you feel. And even someone who has been through the death of a loved one will likely have experienced it differently.

It can be upsetting when someone tries to tell you what to do or how to feel. Some people react to this unsolicited advice with anger; others simply shut down. However, neither will help you cope.

Find a friend who doesn't judge and will let you express anger. This person should be a good listener and should not try to "fix things" or tell you how you should feel.

If your friend tries to share unwanted advice, speak up. Let your friend know you want someone who will listen and not try to fix things.

There is no easy fix for your emotions. Still, a good listener can help you feel less alone. Online support groups can also be helpful. Groups like CancerCare provide support for caregivers of people with terminal illnesses.

Spend Time With Your Dying Loved One

People sometimes talk about how hard it is to spend time with a dying loved one. They may not want to remember their loved one as they were dying. Instead, they may want to remember how the person was before their illness.

Spending time with a dying loved one is important for many people. This is true not just for the person who is dying but also for close loved ones. If you decide not to visit your dying loved one, it's possible you may regret your choice later on.

Find meaningful ways to spend time together. Try sharing old photographs or memorabilia. Ask your loved one to share stories about family heirlooms and other possessions like jewelry. You may find that reminiscing can be healing.

Consider making videos of your loved one sharing stories. These recordings can be shared with children, friends, and other family members.

You can also try giving your loved one a hand or foot massage. This can help reduce the pain and stiffness of arthritis. It can also provide needed touch. Reading your loved one's favorite novels out loud is another meaningful way to spend time together.

Everyone finds meaning in different things. Ultimately, the activities you choose are not important. What's important is the time you spend with the person, even if it's in silence. Don't feel like you need to fill all of your time together with chatter.

You may feel nervous about visiting your loved one. Many people fear they will break down and make their loved one's grief even worse. This is why it can be helpful to learn how to talk to a dying loved one. 

Keep in mind that your loved one almost certainly prefers to see you, even if there are tears.

You may be afraid your loved one will want to talk about their death. If you feel anxious, take some time to think about and face your own fears. It's possible that you will upset your loved one more by avoiding the subject than by talking about it.

Let Children Express Their Grief

Children also experience anticipatory grief and need to be included in the grieving process. It is just as important for kids to work through their grief. Like adults, children need a safe place to express themselves.

There are several grief myths about children and teens. For example, it is a myth that children don't feel an impending loss as deeply.

One study found that parents with advanced cancer were not aware of how deeply distressed their children were. On the other hand, this study also found that these children learned to value other family relationships much more than children who did not have a parent with cancer.

Talking about death with children who have a seriously ill parent has been shown to be helpful. It can help decrease anxiety, depression, and behavioral problems. Children need to know they will be cared for after the death. They need to understand they won’t be abandoned.

There are many good books to help children cope with death and dying. You can also ask your loved one's hospice centers if they offer camps or support groups for children who are facing the loss of a loved one.

Some of the tips below, like art therapy, may also be helpful for children.

Consider a Retreat

The organization Inheritance of Hope offers Legacy Retreats for young families facing the death of a parent. These retreats are all-expense-paid trips for qualified families with children under 18.

Legacy Retreats help families form lifelong memories. These families also get help learning to cope with a parent's terminal diagnosis.

Try Journaling

Keeping a journal can be healing. It can help you express things you wouldn’t feel comfortable sharing with a friend. A journal can also be a place to record thoughts you had around the time of your loved one’s death.

Some people prefer a private journal. Others may want to use a site like CaringBridge. This type of forum can help you share thoughts and feelings with friends and family. It also lets you share updates and requests for help.

You may also want to try writing letters. For example, a letter to your dying loved one might help you say all the things you've been wanting to say.

If you are the person who is dying, consider writing letters to your children or other family members. Some people write letters to be opened on future occasions like birthdays or graduations. Letters are a helpful way to express emotions and can be a gift to those left behind.

Take Advantage of Holistic Methods of Coping

A holistic approach may be helpful both for the dying person and their loved ones. "Holistic" means treating the whole person, including mental and emotional health. Some of these therapies have been found to help with emotions like anxiety.

A few small studies found that a holistic approach can help bring hope and healing to people who are grieving.

Some examples include:

• Guided imagery
• Meditation
• Art therapy, the practice of creating and/or viewing art to promote well-being
• Massage therapy
• Qigong, a Chinese practice of meditation and breathing
• Music therapy, using music to promote well-being

Nurture Your Spirituality

Spirituality is important for those who are dying and for their caregivers. Spirituality takes many forms, including:

• Organized religion and prayer
• Meditation
• Communing with nature
• Listening to music that is meaningful to you

Studies have shown that people have better quality of life in their last days if they have an active spiritual life. Caregivers may also experience less depression if their dying loved one has an active spiritual life.

What is good for the dying person may also be good for their loved ones. One review found that spirituality can be helpful for the family and friends of the dying. Spirituality is associated with a better quality of life and a lower risk of disease and death.

Maintain a Sense of Humor

There’s not much room for humor when someone is dying. Still, in the right setting, humor can sometimes be healing. In fact, one review found a strong benefit of humor in the end-of-life setting. Humor can benefit the patient and loved ones alike.

Humor is helpful in many ways, but it's important not to trivialize your loved one's situation. Don't make jokes about pain, for example. Avoid too much laughter if the dying person has sore ribs or belly pain.

It may take some thought to bring humor to your loved one's bedside. One person might enjoy funny emails and memes. Others may enjoy silly movies or television. Some people may even appreciate jokes about death.

Some cancer centers even offer laughter therapy for people with advanced cancer. While laughter isn't always helpful, sometimes, it can lighten a heavy mood.

Practice Forgiveness

Forgiveness can be healing. Learning to forgive yourself is just as important as forgiving others.

The time before death is very emotional. There may be anger and resentment among family members. Still, this is also a time to resolve differences.

Listening is an important first step toward forgiveness. Two people can sometimes say the same things, just in different ways. At other times, you may continue to disagree with what your loved one is saying even after talking it through. When this happens, ask yourself this question: "Is it more important to love or to be right?"

Someone once said resentment is a poison you prepare for another and drink yourself. Letting go of resentment and pain from the past can be freeing. Give yourself the gift of forgiveness.​

Give Your Loved One Permission to Die

Sometimes, a dying person may remain until a specific moment. For example, they may wait for a graduation, a birthday, or a visit from a loved one.

Some people seem to wait to die until after a loved one says goodbye. The goodbye can act as permission to die.

This can be helpful for the dying person and for loved ones. A goodbye can be a beautiful gift.

Summary

Anticipatory grief is the grief you feel before a person has died. It is a common experience. There are many ways to cope with anticipatory grief, but everyone grieves in individual ways. 

It is important to let yourself grieve. It may also be helpful to find someone to talk to who won't judge you or offer unwanted advice.

Try to spend time with your dying loved one, even if it's difficult. Talk to children about death and grief and let them express themselves. Children with terminally ill parents may also benefit from a family retreat.

Other coping strategies can include journaling, writing letters, and holistic approaches like meditation and art therapy. Spirituality can also be helpful for both the dying and their loved ones.

A sense of humor can help both you and your loved one. It can also be important to practice forgiveness and to give your loved one permission to die.

A Word From Verywell

As much as we try to impose order on emotional and turbulent situations, grief does not fit into neat categories or stages and isn’t time-limited. Give yourself permission to feel however you feel leading up to a loved one’s death, and then days, weeks, months, or years after.

— KATHLEEN DALY, MD, MEDICAL EXPERT BOARD