Kayla Bonkowski | Why Anticipatory Grief Deserves Its Own Name

Kayla Bonkowski with a client


Grief has a clinical definition. It is the response to loss. What the standard definition misses is that loss begins before the death does. Kayla Bonkowski, a social work graduate student in Sterling Heights, Michigan, works within a specialty -- hospice and palliative care -- where the grief a family carries before a death is as clinically significant as the grief they carry after.

Anticipatory grief is the term for it. It describes the mourning that begins when a terminal diagnosis is confirmed -- the loss of the future that had been assumed, the loss of the person as they were before illness changed them, and the loss of the role that person played in the family's daily life. None of these losses require a death to be real. They are already happening.

The clinical literature on anticipatory grief distinguishes it from bereavement in several important ways. Bereavement is retrospective -- it is grief for what is gone. Anticipatory grief is prospective and present simultaneously. The person grieving a dying parent is losing them progressively, in real time, while also managing the care relationship, while also anticipating the final loss. The emotional complexity of that situation is not adequately captured by the model most people have for what grief looks like.

Kayla Bonkowski's training at Louisiana State University covers grief theory in depth, drawing on frameworks that have evolved well beyond the Kubler-Ross stage model that most people encounter. Contemporary clinical understanding of grief recognizes it as non-linear, highly individual, and shaped by factors including the nature of the relationship, the circumstances of the illness, and the family system's existing patterns of communication and coping.

In a hospice setting, anticipatory grief shows up in specific and often misread ways. A family member who becomes aggressive or demanding with the medical team may be expressing anticipatory grief through anger. A patient who withdraws from family contact may be experiencing anticipatory grief about burdening the people they love. A caregiver who begins to feel relief at the prospect of the death ending -- even while the person they love is still alive -- is experiencing a normal component of anticipatory grief that is rarely discussed because it carries shame.

Social workers in palliative care are positioned to name these experiences accurately when they arise. Naming matters clinically. A family member who understands that their relief or their anger is a recognized grief response can engage with it differently than one who believes they are simply a bad person for feeling it.

Kayla Bonkowski's psychology background from Rochester College, where she earned a Cum Laude bachelor's degree in 2017, gave her the theoretical foundation in grief psychology that her MSW program builds on. The combination of psychological depth and clinical social work training positions her to assess anticipatory grief and respond to it in the context of the family system, not just in the individual who presents it most visibly.

In Sterling Heights, Michigan, Bonkowski brings this perspective to her broader understanding of what clinical social work in end-of-life care requires. The families who enter hospice are already in the middle of something. They are not waiting for grief to begin. They need a clinician who understands that -- and who knows how to meet them where the grief actually is, rather than where the calendar says it should be.

Anticipatory grief deserves its own name because it is its own experience. It does not resolve with the death. For many families, the grief after a death is shaped significantly by how the anticipatory grief before it was or was not attended to. That shaping is where the clinical social worker's intervention has some of its greatest impact.

In Sterling Heights, Michigan, Kayla Bonkowski holds this as a core clinical commitment. The families she will eventually serve are not waiting for the official start of grief. They are already inside it. Meeting them where they are -- before the death, in the middle of the anticipatory loss, with clinical recognition and skilled support -- is the work that can change what the grief after the death looks like.

The clinical recognition alone -- having a practitioner name what they are experiencing as anticipatory grief, and explain that it is expected and real -- can reduce the shame and confusion that many family members carry. They are not falling apart prematurely. They are responding normally to a situation that has already begun requiring an enormous amount of them.

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