“When someone you love dies, you don’t lose her all at once; you lose her in pieces over a long time…”   

John Irving, A Prayer for Owen Meany (1989)

What is grief?

Grief is the experience of loss. All types of loss can lead to grief: moving, separating from a partner, children leaving home, job loss or change, a permanent life change, and of course, death. Contemporary research in mental health separates grief responses by five dimensions that may affect coping with loss:

  1. Stress reactions, which include changes in physiological functioning and can increase vulnerability to illness or worsen preexisting medical conditions.
  2. Perception and thought, which may increase impulsive and potentially harmful decisions as well as risks of accidents.
  3. Spiritual crisis, which causes questioning related to guiding assumptions and values.
  4. Family and communal response to loss, which is a significant factor in grief recovery (interestingly, this is also an important factor in trauma recovery).
  5. Cultural heritage and current supports, which influence how loss is expressed and coping styles.

What is grief therapy?

According to research by Parkes and Weiss (1983), three tasks must be completed in grief therapy:

  1. The bereaved recognizes and develops an explanation for the loss and the cause of death. Lacking this, the person grieving cannot stop anticipating new loss and will continue to be anxious.
  2. The bereaved emotionally accepts the loss and reminders no longer cause emotional pain. This occurs after constant and ongoing review of thoughts, memories and feelings that change over time in their emphasis and focus. A review of these reminders may be avoided in the early stages of grief to create some distance from the pain and is not actual denial. This only becomes problematic when the review and denial last so long that it is a cause of distress or disability.
  3. The bereaved develops a new identity as they become aware of the change between how the world was before the loss and how it is after.

The job of a grief therapist is to remain present and to “be with” the client. There is no “cure” for grief. According to Alan Wolfelt (1998), grief work is about “companioning” and validating the experience of grief, rather than leading, teaching, analyzing, being an expert or taking away someone’s pain.

Grief does not necessarily require help from therapy. It is a natural event and reaction to loss. Grief therapy is most effective for the most vulnerable, including those with complicated grief, grief-related depression and posttraumatic disorders. Recent research does not support the position that grief can be fully resolved, rather it is a process of understanding and finding meaning over time.

When should I seek counseling for grief?

Grief therapy may be warranted if sadness, depression or anxiety become overwhelming or significantly affects daily functioning. For example, seek therapy if you or someone you know is experiencing at least five of the following symptoms of depression with no sense of relief for at least two weeks:

  • feeling “down” all the time
  • lack of pleasure
  • significant weight loss or gain
  • insomnnia
  • severe agitation or a slow-down in completing daily activities
  • extreme fatigue or loss of energy
  • feeling worthless
  • diminished ability to think or focus
  • thoughts of suicide or death

Unhealthy anxiety produces overwhelming messages of fear that are out of proportion to any actual danger. Anxiety and grief symptoms include:

  • being unable to relax
  • being unable to sleep or having fitful sleep
  • feeling fearful for no reason
  • feeling a sense of panic, losing control or fear of “going crazy”
  • having trouble concentrating
  • having uncontrollable worries or repetitive thoughts that don’t stop
  • being irritable
  • being fearful of embarrassment in front of others

In addition to individual therapy, antidepressants or sleep medications may be helpful, as well as support groups or group therapy.

What is complicated grief?

Most people are able to integrate loss and grief recedes, diminishing the pain. As healing occurs, the loss does not impact daily functioning, unless grief is complicated. In the case of complicated grief, pain from the loss dominates. Disbelief, loss, anguish and bitterness permeate life experience. Complicated grief may be diagnosed if, after six months, the following symptoms are experienced:

  • strong yearning for the person who died
  • intense loneliness even in the presence of others who are supportive
  • strong feelings of anger and bitterness about the death
  • loss of meaning without the person who died
  • obsessive and repetitive thoughts that disrupt daily life
  • disbelief or difficulty accepting the death with the passage of time
  • increasing feelings of shock or emotional numbing
  • losing the ability to care about or trust others
  • physical or emotional agitation when reminded of the loss
  • avoiding people, places and things that are reminders
  • strong urges to see, touch, hear or smell things to feel close to the person who died

Certain conditions increase the chance of complicated grief. These include

  • an unexpected or violent death
  • suicide of a loved one
  • lack of a support system
  • early history of abuse or neglect
  • childhood separation anxiety
  • overly dependent relationship with the deceased
  • lack of preparation for the death
  • poor coping skills, adaptive functioning, low resilience


In addition to professional help, there are many books and other informational resources for helping the bereaved heal after loss. If you are interested in reading more, the source of the above information was the book Life After Loss by Jackson Rainier, PhD, ABPP.


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