Making Sense of Grief and Loss

Grief is something most of us will encounter, yet it remains rarely talked about. It can follow the death of someone we love, but also the loss of health, identity or relationships. When grief arrives, it often brings a complex mix of emotions that feel overwhelming or unexpected.

In this episode, Dr Lee David speaks with Professor Lucy Selman – a leading researcher in palliative and end-of-life care at the University of Bristol and founder of the Good Grief Festival – about what grief really is and how we can better understand and support it.

They explore grief as a natural human response rather than a mental health problem, looking at why it can involve emotions far beyond sadness, including anger, guilt, shame and relief. Lucy explains how grief is shaped by relationships, culture and identity, and why naming grief can bring relief and permission to respond with compassion rather than self-judgement.

 The conversation also challenges common myths about grief – including the idea that it follows a neat timeline – and introduces the dual process model to explain how people move between mourning and everyday life. Together, they reflect on the importance of connection, self-care and practical support, as well as when additional help may be needed.

This is a discussion about making space for grief, understanding its many forms and finding ways to live alongside loss with kindness and flexibility.

Key moments

00:00 Why we struggle to talk openly about grief
02:13 What grief is and the many forms loss can take
04:50 Naming grief and why it brings relief
09:46 Understanding grief with the dual process model
13:25 Guilt, self-blame and compassion in bereavement
16:49 How we start making sense of loss
20:19 Why grief isn’t linear
23:52 Noticing loss with compassion
26:12 When grief becomes more complex and support is needed
30:17 Day-to-day self-care during grief
34:23 How to support someone who is grieving
40:12 Presence, compassion and practical support

About the guest

Lucy Selman is professor of palliative and end of life care at the University of Bristol. She has spent over 20 years researching psychosocial and spiritual aspects of serious illness, communication and decision-making, family caregiving and bereavement. Her work focuses on grief and how people are supported through illness and loss. Lucy is on LinkedIn and X.

The Good Grief Festival (Website, Instagram, LinkedIn) offers courses for bereaved people and professionals, including a new course for GPs and primary care clinicians.

About the host

Dr Lee David is a GP, CBT therapist and author specialising in mental health and wellbeing. Lee has written many books on CBT, mindfulness and teen wellbeing, and speaks regularly at conferences and in the media. Away from work she enjoys running, hiking, singing in a choir and spending time outdoors with her family. You can find Lee through her website and on Instagram, TikTok (@dr.lee.david), Facebook and LinkedIn.  You can find more about her books, wellbeing courses and therapy here:  https://linktr.ee/dr.lee.david 

Transcript

Lucy Selman (00:00)
I think as a society, we don't really talk openly about grief and what it is and what it feels like. So sometimes when people are bereaved, or they have that serious diagnosis, or something else happens in their life, they can be really taken by surprise and almost shocked at their emotional reaction. Because grief isn't the same as sadness or depression, You can feel anger, despair, regret, guilt, shame, all of these very complex emotions. Because each grief is as unique as your relationship with that person that you've lost or that situation that you've lost or found yourself in. I do think that we need to have much more open conversation about what grief is.

Lee (00:48)
Welcome to the Choice Space podcast. I'm Dr. Lee David, GP, CBT therapist and author.

Today we're talking about something that touches almost all of us at some stage in life, grief. It isn't a mental health problem, but a very human response to losing someone or something that matters deeply.

Yet many of us can feel unsure how to talk about grief or how to support others who are living with loss.

Feeling more able to talk about grief is often the first step. When we understand it better, conversations can feel less daunting, whether that's in our personal lives or in healthcare settings.  It can help us listen with care.  Stay present with someone who's grieving and recognise what we might need ourselves when loss affects us.

Today I'm delighted to be joined by Professor Lucy Selman, a leading researcher in palliative and end-of-life care at the University of Bristol. She spent more than 20 years exploring how people are supported serious illness and bereavement.  
and she founded the Good Grief Festival to help bring these conversations into the open in a more accessible and compassionate way.

Lucy, welcome. Could you introduce and share what first drew you into your work around grief?

Lucy Selman (02:07)
Hi, Lee, thank you. My name's Lucy Selman. I'm professor of palliative and end of life care at the University of Bristol. I'm a social scientist. And I've been doing research into serious illness and caregiving and bereavement for the last 20ish years. I became particularly interested in grief, the time of the pandemic, it was a coming together of both my professional interests and also my own personal experiences of bereavement. pre-pandemic we applied for funding for the Good Grief Festival from the Wellcome Trust and then during the pandemic I had to pause my main research projects

So I sort of pivoted my research to focus more on grief and loss. And together with Emily Harrop at Cardiff University, I led a national study looking at experiences of bereavement during the pandemic.

Lee (02:55)
Wow, okay, so lots of experience Let's start with some of the basics. Could you explain what grief is and what kind of situations might lead to somebody experiencing it?

Lucy Selman (03:08)
so grief, as you said in your introduction, is often understood as the emotional process that we go through when we lose someone or something that's important to us. That feeling that we get around grief is natural, it's universal, and I think is also unavoidable as we face the losses of everyday life.

we can feel grief both around the death of somebody, so a bereavement, but also through other forms of loss, separation, divorce, estrangement, which can also be associated with similar painful feelings of separation. I think, you know, in the West, we have a certain way of thinking about loss and grief in terms of our own individual experiences.

but it's also very social and cultural phenomenon as well. So throughout different cultures, throughout history, as a society, we've reacted grief and loss in different ways.

Lee (04:03)
I think it's so and what I've noticed is that people are sometimes more able to recognise grief when it comes around a bereavement perhaps because it's more expected when we've lost somebody important, then we would expect to have grief. We don't always, how we respond is very variable.

But it has often seemed to very powerful to name grief when it's come up in other parts of life as well. So when people have had a major change, sometimes it can be a loss of something we expected, an expected future that just doesn't happen. And it could be something that really meant a lot to us.

and it can to the health of our children, for example, or other experiences where something is really challenging our vision of how life was supposed to be There's just this fundamental shift away from that.

Lucy Selman (04:51)
Yeah. Yeah, I think that's true. And I think sometimes we can be taken by surprise because of that. I think in particular of infertility, for example, so that idea of, know, I thought my life was going to pan out a certain way. And now this has happened to me and it's changed everything. Or diagnosis with ⁓ a chronic condition or a serious illness. It can also lead us to think that, you know, I, I thought I was a certain kind of person. I thought I was to have a certain kind of life and it can really I think shatter people's sense of themselves and their own identity as well as what's going to come next.

Lee (05:28)
Yeah, and what I found is that the naming of it as grief is really powerful. It has such a big impact and it's almost like a palpable relief that people have that says, yes, this actually really names my experience really clearly when perhaps they were struggling to understand why is this affecting me? Why am I having these big waves of emotion? Why does this feel so strong? And when you can name it as grief, it perhaps give some kind of permission that this is a significant event and there may not be a quick way because you can't just switch off grief. We're not supposed to. It's something that we navigate in some way. Has that been your experience?

Lucy Selman (06:07)
Yeah, definitely. And one of the reasons we started Good Grief Festival, and we also run educational courses alongside our events and festivals, is that I think as a society, we don't really talk openly about grief and what it is and what it feels like. So sometimes when people are bereaved, or they have that serious diagnosis, or something else happens in their life, they can be really taken by surprise and almost shocked at their emotional reaction. Because grief isn't the same as
sadness or depression, got lots of different elements to it. You can feel anger, you can feel despair, regret, guilt, shame, you can feel all of these very complex emotions. each grief is as unique as your relationship with that person that you've lost or that situation that you've lost or found yourself in. I do think that we need to have much more open conversation about what grief is.

Lee (07:01)
So there are lots of different ways to understand the experiences of grief and there's a huge list of different emotions. I think they can be very intense. They can come out of the blue and be quite unexpected at times. remember not long after having lost my dad, I had a consultation with a patient who just looked a bit like him and I just had this overwhelming moment that just hit me it was very unexpected. just wasn't expecting it at all. I hadn't been thinking about him, it my consciousness and so sometimes these reminders can come in very unexpected ways, can't they?

Lucy Selman (07:36)
Yeah, that's right. And I think as professionals, sometimes we can think that those feelings and those personal reactions don't belong at work and we try to push them down perhaps. But actually, in my view, those insights and our own personal experiences can really bring something to how we respond to people in their bereavement, because it is such a human experience. And it's one of those, I think, very uniting experiences that if we can find a way of integrating them it can really bring a depth and an authenticity in our ability to relate to people. I think you're right, you sometimes we're very surprised by what grief can bring. I remember second daughter Ada was stillborn in 2018. And I remember being very by how anxious I felt  I went out shopping with my mum and she went off to do something and we were going to meet 20 minutes later and she didn't come at the exact time that she said she would be there and I was really overcome by this anxiety and I'd never really experienced anxiety before. So it's funny how these experiences of loss can really shape our experience of everyday life, at least for a time, most people, of course, do then integrate the loss in their lives and they do find a new normal they carry on primarily through support of friends and family. But obviously, we also know that people do need support and it is important that they feel connected to others and that there is different types of support available to them.

Lee (09:10)
Yeah, I don't think we get over grief, I think we make room for it. And it does change us in some way. Over time, we find ways to make that our new normal, as you say, we find ways. to find meaning, even through loss, I think that sometimes can be very powerful.

a layer of adaptation, of adjustment re-understanding how we view ourselves in the world that I think comes through a very significant change. Are there any models around how we understand grief that you find particularly helpful when you're talking to people to try and its impact?

Lucy Selman (09:46)
So a model that I really like is Struber and Schut's dual process model. And the reason I like this is that describes grief as a process of oscillation between two different states or ways of coping with grief and loss. So on the one hand, there's more loss oriented coping and behaviours. So this is around really confronting and experiencing and being with the pain of loss. But then on the other side, there's restoration  oriented behaviours which are more around the practical and social changes and your changes in role and relationship that might follow a bereavement. And I like this model because it really captures the fact that within grief, you can feel many different things at the same time. So you can be sad and really the pain of loss. But then in the next moment, also be going out with friends and talking about new things and perhaps even laughter and connection with people. So it's I think, a really nice way of capturing how grief involves both accommodating and realizing and coming to terms with the loss and at the same time also feeling the pain of loss and perhaps reflecting on past memories and relationships.

Lee (11:02)
really glad you said that one actually, Lucy, because that's probably the one I use the most when I'm talking to people as well, because it's really practical. I talk about a pendulum where we swing between time where we're feeling very sad and we're mourning and we're really experiencing whatever those emotions may be,

And then at other times we're able to engage in life. We get stuff done we might have lots of things that we need to do that are important, both related to the loss and also related to our general lives.

And I feel like that model gives us permission to be able to do both. it's helpful not to get stuck. I think if you spend all your time mourning and you're not doing any of the practical stuff or you're just always practical and perhaps never giving yourself that space to notice the emotions, that's possibly a bit less helpful.

Lucy Selman (11:48)
I think it is possible for people to become more stuck in one sort of mode of coping or one type of response to another. somebody I know lost a they 
became very involved in activity and doing things and found it harder to stay with the pain of their loss or even really think about the loss of the child. in that situation, they actually found it helpful to kind of almost go physically to the memory box and make themselves remember and feel the feelings every now and again, because if they didn't, they could feel this sense of stress building up and a sense of from their own emotions. So I think, there is bit of art of recognizing what you need as a bereaved person at certain time and giving yourself permission, of course, to kind of be natural not be sort of castigating yourself for the way that mourning, the way that you're feeling. But at the same time, perhaps recognize, okay, that there does need to be a bit of an oscillation. There does need to be a bit of attending to both their loss and also the new life.

Lee (12:52)
So it's just recognizing that both of those modes are really important and I think that can also be very problematic if we get caught up in mourning and are not actually doing things that move life forward, worked with people where it's almost a permission to be able to, I'm allowed to carry on living, even if perhaps I've lost something significant. And so rebuilding that willingness to engage in stuff that matters to them personally, also can be quite challenging if there's a sense of guilt perhaps around the loss in some way.

Lucy Selman (13:25)
And it's interesting that you mentioned guilt because I think in bereavement, as in many aspects of our lives, we have a sort of an idea of what we should be doing and we should be feeling sometimes. So I think having compassion yourself and really recognizing this is how I feel now and that is okay, but also allowing that to change over time important. for example, when you're in the more loss oriented, you know, mode and ways of behaving, it can make you feel very socially isolated because you feel very different from everyone else. there's like a carousel and everyone's going around the carousel kind of living their lives. And when you're bereaved, suddenly you see yourself off the carousel and you're watching life continue for other people, but you're in a very different mode of existence.

if you become very stuck in the loss oriented, ⁓ behaviours and ways of thinking, it can be quite difficult to reconnect with people. So I do think something helpful that you can encourage people to do is to look around them and think about who is out there that I can talk to, who is there, who I can connect with. And sometimes connecting is just being with somebody. So it's not necessarily, talking in depth about what you're feeling or about the person who's died even, but just making sure that you are still able to connect with people in an

Lee (14:49)
I think the power of connection is so important. And there's a few things I'd love to pick up on there. One of them is about guilt. And I say this probably in most episodes, I think, because guilt is a very emotion. I think we have a lot of it in the Western world.

I would always say that guilt is a sign that we care about something or somebody, that it's a sign that something is really important. What it doesn't necessarily mean is that we've done something wrong, that we should be blamed, or that we need to give ourselves a hard time about the fact that that thing has happened. And so sometimes it's not about trying to eliminate guilt as much as just make room for it and recognize this is just an element of caring. of being  engage in something that's meaningful to me personally, rather than a sign blame or shame lacking in some way. it's often mentioned as an emotion that comes up around So it might not be something we can just say, I'm not going to feel that anymore as much as I can recognise it, acknowledge it. I can be self compassionate. I can give myself kindness.

around the fact that this really difficult emotion has shown up and I'm having lots of negative thoughts maybe there's self-blame there's lots of regret sometimes there's all these should I could I I didn't all of those type of thoughts can come and it's not necessarily trying to get rid of them as much as to recognize these are all a sign that this matters deeply to me and can I be kind to myself and make some space for them, but not necessarily buy into them as absolute facts that I am to blame, that I did do something wrong, that that isn't necessarily true, it's just a sign of care. And so one of the tenets of self-compassion that comes up again and again and again is this shared common humanity. It's about connecting with others. And as you say, the connection could be through the loss, but it might I think often it is these smaller connections just going out for the walk, 
the dog walk with somebody, making eye the delivery driver who's bringing the parcel we've ordered. These small connections can be so powerful, can't they?

Lucy Selman (16:49)
Yeah, definitely. think when someone has died in particular, quite natural to start thinking, you know, what if, like, what if we'd gone to the GP earlier or the diagnosis had come earlier? What if I'd done something different during the pregnancy and I didn't have a miscarriage? I think that that is a very natural to a loss and I think that part of the process of accommodating the loss is also telling yourself and potentially others as well the story of the loss of what happened and I think some of the what-ifs that we go through are because of that because of the need to create a story and find meaning and a sense of completion in what happened. And sometimes I think the complexities and difficulties that people have in grief is where it's hard to find a narrative that makes sense. It's to create that story of the loss you're able to really accept and make sense of. Julia Samuel has this wonderful expression of the shitty committee that she talks about. She's a well known bereavement expert and psychotherapist and author. And she talks about how, we do have this ability to internalize negative voices negative accounts of our own behaviour, that's where the guilt and the blame and the shame comes in. I think if we can find a way of thinking about those voices as, here's the voice again, here's that shitty committee telling me that I'm not good enough or trying to take me down the sort of self-blame route then that can help introduce a bit of distance between our thoughts and who we actually are. those are just thoughts. 

Lee (18:32)
Yeah, I love that idea. maybe we could hold that committee with a bit of kindness, because it sounds like what they really want is to try and make sure that we don't do something wrong. They're wanting in many ways for us to make choices that and positive. but coming about it in a way that's quite negative and critical. That's not really helpful at that point. And it's part of our brain trying to get power, I think, around a situation where we really are quite powerless when there's been a loss that may well be outside our sphere of influence, And so sometimes I think our brain wants to try and take ownership of something where we weren't really to blame, but it does feel then, could I keep myself safer in future? it might be a safety mechanism that the brain goes into. So if we can think of that committee as we don't have to believe them, they're kind of doing their best to help us, but probably they're not really doing it in a way that's really thoughtful and they're not really seeing the bigger picture. We can maybe let them do their thing, but we don't have to agree that the words that they're using are correct.

Lucy Selman (19:30)
there are situations where you need to get to a point where you can say, I did the best that I could at that time.

I had no idea my actions were going to lead to this. And so, there's a sense in which the story that you're telling yourself can have that wider perspective and that more compassionate perspective. But perhaps to get there, you need to go through something which is a bit more arduous.

Lee (19:56)
Yeah, so there's something about coming to terms the fact that life - there are things that happen that are so hard and so painful. And sometimes there's no real easy way to make sense of that. And so sitting with that as a very difficult idea can take time, I think, for it to really make sense again, in how we can move forward through it.

Lucy Selman (20:19)
Yeah, I think that's right. And I think that's one reason why THE idea of grief as a finite period that you move through and then you come out the other side is so unhelpful. Because actually, I think some of the process coming to terms with the loss is more like a spiral, that working your way through things and coming back to them again in a different way. And different emotions will come up ALONG journey that you're on.

And often, you know, you might have a bereavement later on in life, which then reawakens, memories and experiences that you had previous losses as well. So that's sort of part of the journey of bereavement throughout your life, I think.

Lee (20:55)
worked with people where they would say, feel like I should have got over this by now. I should have moved through this by now. There does sometimes seem to be an expectation that we should be able to just process grief quite quickly then get on with life. Is that something you've come across?

Lucy Selman (21:12)
we've got lots of very unhelpful ideas in how we talk as a society about grief, like, well, it's been six months, you should really be moving on now or, is that really healthy that you're still going to visit your partner's grave every week? I think, a lot of those theories and concepts can really affect people in a negative way and make them think, I'm doing this wrong as well, on top of everything else. So it becomes again, part of that shitty committee that you're blaming yourself for not even grieving properly.

Lee (21:45)
So it's about that compassion and maybe a recognition that we're very individual and how we experience the spiral of grief, which feels much more complex than just a line where you go through and then you come out the other end and it's all done, it is much more complicated and there might not even be an end point. I think that's life in general, isn't it? We're kind of muddling through and I don't know if there is that clarity about what we're supposed to be doing for anything.

Lucy Selman (22:12)
I think that's exactly right. And sometimes, you know, you might start blaming yourself because you feel like you're not feeling sad enough. You might think, well, I feel kind of relieved, it was a complicated relationship. And actually, THERE'S part of me that is glad I don't need to engage in that anymore. But that is also part of grief and loss, that you can have all of those different types of emotions around somebody dying, for example.

Lee (22:36)
Yes, I've worked with a number of people where someone has a long term illness that has required a lot of care and they love the person but it's also taken a big toll to be a carer and so there's that complexity around self care and caring for another and then a loss which has perhaps been quite protracted and there's been a lot of moments where possibly someone became unwell and then they recover. And is quite fatiguing navigating that, isn't it?

Lucy Selman (23:03)
Yeah, yeah, certainly. it's almost one of the hardest parts caring for somebody in some ways the kind of uncertainty around when that moment is going to come. And the emotional toll it can take where you think, somebody is declining, they get readmitted to hospital, it looks like they're going to die and then they rally, the emotions around that obviously, a lot of the time, glad that they're still with you, but at the same time, like when is this going to happen again? And when will it actually end in the death? It's a huge amount to handle. And I think the sense of relief, for the person, especially if they're suffering, that's no longer the case, but also for your own life and what it can do when you're in that role is completely normal.

Lee (23:52)
This is the choice pause, a short two to three minute tool you'll hear in every episode.

each time with something different to help you pause, notice and choose your next step.

Today's pause is noticing loss with compassion.

Take a slow breath in and a longer breath out.

Let your shoulders settle and release any tension in your face or jaw.

gently notice if there's any part of you carrying a sense of loss today.

This might be the loss of a person, but it could also be a change in health, a relationship that's altered or a part of life that no longer feels the same.

Notice how it shows up in your body. perhaps a sense of heaviness or tightness. 
or a mind that feels a little cluttered or unfocused.

Allow whatever you find to be there without judging it or trying to make it different.

If it helps, place a hand on your chest or offer yourself a gentle hug.

a quiet way of saying. This is hard. I'm here with you. I care about you.

Take another slow breath. Let the breath create little more space and a little more kindness around whatever you're feeling.

Now ask yourself, what would a small act of care look like today?  Maybe it's taking a moment to rest. Reaching out to someone, stepping outside some fresh air. or simply allowing your emotions to be as they are without pressure or judgement.
carry that warmth with you as you move into the rest of your day.

Lee (25:38)
So what I'm really hearing is that no emotions really are wrong around grief and that it's just really complex and our version of grief is okay. i know that also sometimes there are times that people can develop more significant problems,
where actually seeking support is really important. Can you give us some pointers about when people might start to notice that perhaps seeking medical support or more wider support. we've talked about friends and family and connection, but sometimes people do need more than that, don't they?

Lucy Selman (26:12)
Yeah, that's right. I mean, you can think about of bereavement support needs as a sort of triangle. So along the bottom, you've got like the biggest group of people, maybe around 60%, who will get through their grief through support of friends and family and community. And then you've got this middle strata, maybe around % of people who could do with some extra support. So they might want to go
to bereavement support groups.
they might benefit from contacting one of the amazing bereavement charities that we have in the UK or going to to one support through those charities. And then at the very top, we've got around 10 % of people who experience more complicated bereavement. So for example, prolonged grief disorder, which is now recognized as a mental health condition. There's different ways of defining prolonged grief disorder.

But in general, some of the features that people talk about are persistent longing for or preoccupation with the person who's died, intense emotional distress. So thinking about those emotions we've been talking about, more acute and debilitating degree. So sadness and guilt and anger and blame But also kind of avoiding reminders of the loss and having real difficulty in reengaging with life, sometimes a loss of identity or sense of self, and all of those things together causing ⁓ a significant distress or functional impairment. So all of those things, are indicators that somebody might be experiencing prolonged grief disorder. And in that situation, specialist psychotherapeutic support is recommended. And so sometimes I think clinicians might, see those things and think, oh, know, antidepressants are needed here. But actually, the evidence suggests that it's not antidepressants that are needed as a people need that more specialist, sometimes specialist CBT, which I know that you're a CBT practitioner yourself. that can also really help people to kind of shift. And find some way of moving through and beyond that phase that they're stuck in.

Lee (28:20)
Yeah, and so it sounds like it's very much the intense emotions we might see through grief anyway, but The dial is really quite high to the point that they're affecting how people live their daily lives.

So they might be avoiding, the daily activities and doing stuff. cutting down on things that matter. I'm just not living my life the I like to at this point. It would also be after a period of time, roughly when would it normally be Because I think early, probably that would be much more normal, wouldn't it, after a significant loss?

Lucy Selman (28:45)
Yeah there's different views of the point at which you might be able to identify a prolonged grief disorder. So in the ⁓ International Classification of Diseases, ICD 11, it's from six months bereavement. And in the DSM five, it's from 12 months
And there's also your sort of cultural background or your social norms of grieving, where you are, where you live, should also be taken into account. Because in some cultural contexts, to be ⁓ still very engaged in mourning and showing emotional signs of bereavement is quite normal, nine or 12 months, whereas in other cultural contexts, it's not seen as so normal. So that should also be taken into account.

Lee (29:37)
And that really highlights there that six to 12 months of having quite a big impact of still very much within the territory of normal grief. And I think that also gives permission for people not to feel like I should just be able to have got over this by now. It's five months down the line, but actually that may just be how they're responding. it doesn't automatically mean that we need to view this as a mental health condition that might need treatment as much as support. Can we look at some of the ways, I mean, you've mentioned there some of the really important things we can do to support ourselves when we're experiencing grief. Can we talk a little bit more about some of the day-to-day things people can choose that might be supportive?

Lucy Selman (30:17)
I think one of the things that we can do when we're bereaved is think about the basics. So think with others, going for the walk, having a cup of tea, picking up the phone or answering the phone if someone calls you answering a text. what you're eating and sleeping, relaxing properly, those are all important. I think about my own experiences of bereavement, it's almost like treating yourself like a child.

and helping yourself and ⁓ nurturing yourself as much as you can. And giving yourself a break. So if you know you've got to do something that's difficult, if you know you've got to go and engage in the world, potentially bump into people you know, and that that's going to be hard, do it for a short period of time, come home, build in some time to relax afterwards and nurture yourself and do something nice for yourself.

Lee (31:03)
So it's knowing you personally, and being able to say, these are the things that matter to me and I need to make sure that these things are in place. So it's the self care basics, it's the nutrition. we may have a big impact on sleep and we're experiencing grief. And so we might need to have rest periods through the day.

we want to try and keep routines that feel healthy and are supportive, even when we might not have much of an appetite. But I still think it's important that we're leaning towards healthy choices, that we're, thinking about what would support me, that would just be a move in the direction of self care, even when this is a really difficult period. So it's not being too stringent, but it is also recognising
that there are structures we can put in place that do look after us a bit more. but thinking about if this happened to somebody I cared about, what would I want for them? And then starting to make some of those choices for ourselves as well.

Lucy Selman (31:56)
we know that bereavement can have major physical and mental impact. So yes, it's very normal for your become disturbed. it's this point of vulnerability. So you might be more fall ill yourself So I think the more you can do to nurture and support yourself, the better really.

Lee (32:16)
there's also something about thinking about what we need to be leaning away from in terms of coping strategies. And some things that can be less helpful in my experience would be trying to numb difficult feelings with choices like alcohol, for example, because I think that really gets in the way of us being able to gently process or make sense of our experiences.

it just reduces that capacity for the brain to start to order the memories and slowly get them back into a place where life starts to make sense again. And I think alcohol just stops that process from taking place. You've and I think if we're really needing to avoid things or to avoid people in particular, we're cutting ourselves off, that also feels like a very isolating choice, which...is not so supportive. Are there any other things you we will be trying to not do when we're working through grief?

Lucy Selman (33:11)
I think you've picked up the main ones there, of isolating yourself trying to numb the feelings. Ultimately, you can't get over grief, you can only go through it. So obviously, grief can be incredibly painful. And it might be that, in the first few months after a loss, it's very difficult for you to be with the feelings that you have. But ultimately, longer term, it is going to be important that you are able in some sense to find some way of being with the more difficult emotions.

Lee (33:42)
Lucy, for friends and family who might want to support someone who's grieving, I know people can sometimes feel a bit of a loss and it's sometimes because perhaps there's a sense that they just don't know what can help grief can...
often indicate something really significant that's happened that we feel quite powerless. We can't change that. And I think often want to make things better for people. And with grief, it's not as straightforward as I can make this better, And so sometimes people feel at a bit of a loss and they may pull back or they may feel overwhelmed themselves.

I just wondered what your thoughts were about what can we do as friends, as family, as a supporter of someone who's experiencing grief?

Lucy Selman (34:23)
Yeah, I think you're right. Sometimes we feel very uncomfortable when we can't fix things. So I would say one of the major things we can do is to think about how we're talking to somebody. Are we kind of jumping in there trying to fix something which is unfixable? Are we able to be with them in their pain? I think sometimes just being alongside somebody and being a compassionate presence can be the most important

So it might be that, your friend or your family member doesn't want to talk to you about what they're feeling at that moment, but actually just going around and sitting with them and watching TV and maybe making cups of tea is really helpful just to show that you're not afraid and you are there. And then when the time is right, they will open up and they will talk to you in the way that they need to. So I think, yeah, being able to be with your own discomfort and your own inability to
fix a really important thing you can do.

And then I would say, on the more practical side, can be really helpful to just offer to do certain things, if you know that someone is struggling. take their kids to school. The classic obviously is to cook food and take it round or to just think about, could I take the load off in some way? Can I offer to do their shopping or offer to tidy their house? do some cleaning for them. it's not always that you need
to be able to have those in-depth emotional conversations. Sometimes the practical things can be really helpful as well.

So I being able to be with your discomfort and be with somebody without trying to fix them and accepting their own experiences of grief and how they're behaving is really important. And then also, you know, in conjunction with that, thinking about practical ways of supporting people is also really important.

Lee (36:10)
I think that's such a nice way to think about it. So the practical things and maybe noticing what we can do that would make their life, like you say, take the kids to school or pick them up or have them around for a play date or just something that gives the person a little bit of space and time to process their experiences. And I love that idea of sitting next to someone and maybe saying to them, I'm fine if you don't want to talk about it. If you do,

you can trust me, but otherwise let's just sit and watch a movie or let's go for a walk. Let's do something that feels positive. And I'm just here to support you in whatever way that you need right now. And it feels like that would be really, really powerful for people rather than us pulling away because we feel a bit uncomfortable And actually that recognition that there isn't a quick fix. I know there's nothing I can do that will make this easier, but I can be here alongside you.
feels really powerful in its own right, I think.

So I know that there's a fantastic course that you're launching in the very near future for primary learning about grief. Can you share a bit more about that?

Lucy Selman (37:14)
Yeah, so primary care staff, GPs and others, they play such an important role in supporting bereaved people, not least because people will come to primary care with physical and issues, which when you dig a little bit deeper, you discover, you know, there's been a bereavement or another type of loss. So we at Good Grief Festival, we've developed a course which is all about grief and bereavement for primary care. And we've worked with GPs and GP trainers to develop the course content. And it consists of seven webinars. We are bringing in some grief experts like Professor Mary Frances O'Connor, who's a working on grief and bereavement. Julia Samuel, Andy Langford...

We think it covers all of the physical mental health impacts of bereavement, the role of primary care, also taking care of yourself as a clinician and it launches on the 28th of January, so registration is already open. and it's the first time we're running it. So we're really excited about it.

Lee (38:21)
we'll share some links about how people can access that in the show notes, because it sounds like such a useful course.

I think as clinicians, we're supporting others through their losses. We're also experiencing our own losses and the two can sometimes impact upon one another. as you mentioned earlier, it can help create empathy around the care that we give and lived experience in recognizing how impactful it can be to live with loss.

How can we support ourselves as clinicians when we're working with others with their losses?

Lucy Selman (38:54)
I think there's two sides to that. So one is what can you do as a team? So what can you do as a practice recognize that bereavement is part of your experiences as clinicians? So can you get together as a team? Can you build in ways of recognizing and remembering losses that you've as a team? And then on an individual level, it's really about finding out what works for you. So what enables you to take the space and the time that you reset? how can you make sure that you look after yourself and protect yourself, in your work, but at the same time, without really repressing your own experiences of grief and loss, because as you said, I think it can actually bring a lot to your relationships with your patients, if you're able to be honest, and sometimes even share maybe common experiences you've had reflect on your own experiences of grief and loss.

Lee (39:48)
Yeah, so it's working within the teams and acknowledging that impact on ourselves and putting in enabling us to offer that effective care to others. So just to finish, we always end with a choice space takeaway. So it's just one or two small So from your perspective, what one or two small things could somebody try in how they talk about grief, support somebody grieving or look after themselves after a loss that might make that moment just feel a little bit more open or more manageable in day-to-day life?

Lucy Selman (40:18)
when you're supporting somebody else who's bereaved, whether it's a family member or a friend or maybe a patient, really bearing in mind that you can't predict and you shouldn't judge people's experiences of grief. grief is very If you can reach out to them and show that you're there so that if they do want to talk, you're available, but also if they don't want to talk and they just want someone to come around and sit and watch TV with them, that's also

And again, to think about the practical aspects and that they might be struggling with in everyday life and whether you can lend a helping hand there as well.

Lee (40:51)
I love that. And I would add that if you are the person who's experienced the loss, that if people are offering to support you, do lean into accepting it, don't pull away or say, no, I'm okay. But actually allow people to offer that practical support it's trying not to allow perhaps our sense of guilt to cut us off from others 
even if we don't feel able to be as engaged, don't want to be completely isolated. And I would just add, going back to all the positive things we can do around self-care, getting outside in the outdoors, moving our bodies gently, thinking about nutrition.  
about gentle ways that we can look after ourselves and just putting those things in place and supporting others to do the experiencing loss.

Thank you so much. Such a lovely conversation. So important, so powerful.

Lucy Selman (41:39)
thank you so much for having me. It's been a really enjoyable conversation.

Lee (41:42)
Thanks for listening to the Choice Space podcast. I hope this conversation has offered a little more room to pause, breathe and find your own way forward. You can find all the ways to connect with Lucy in the show notes, including information about the Good Grief Festival and the new Primary Care Grief Course. If today's episode has been helpful, please download, follow and share with someone who might value the space as well. I'd love to have you with me for the next episode.

Until then, take care and keep making space for what matters most. 

This episode was edited by Elle Dixon.