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Understanding grief therapy: When grieving becomes too much to handle

November 29, 2021 - 13 min read


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What is grief therapy?

Grief counseling vs. grief therapy

Understanding prolonged grief disorder

How can grief therapy help?

Self-care tips for grievers

Know when to ask for help

Suffering the loss of a loved one is something most of us will experience in our lifetime. Yet we don’t typically learn about grief or how to deal with such losses. 

Grief is very personal. Everyone experiences grief, but how you grieve is unique to you. That can make it difficult to know if what you are going through is “normal” or you would benefit from additional support.

What is grief therapy?

Most people experiencing normal or uncomplicated grief have a period of sorrow, sadness, anxiety, or even guilt or anger. Gradually over time, these feelings lessen and the bereaved person learns to live their life in a new way.  The American Psychological Association defines this as grief that lasts 6 months to 2 years following the significant loss. 

For some people, the sense of loss is overwhelming — even debilitating — and does not improve over time. You may have trouble getting out of bed, going back to work, and be unable to find joy anymore in life.  For those experiencing prolonged grief disorder, the most common type of complicated grief, grief therapy may help. 

A licensed therapist, social worker, psychologist, counselor, or psychiatrist are trained clinicians who are equipped to provide grief therapy. Seeing a mental health professional for grief can help you process the feelings you are experiencing, help you develop coping skills, and get unstuck from the prolonged grief you are feeling. Grief therapists can work with you to find healthy ways to grieve, acknowledge and work through the emotions you are feeling, and help you envision a future life.


Grief counseling vs. grief therapy

Grief counseling and grief therapy both involve interaction with a licensed mental health professional. 

The key difference is that grief counseling usually refers to sessions to support normal or uncomplicated grief. Grief counseling may even be offered free of charge by your local hospice. This treatment approach is usually short-term and doesn't require a referral for specialized treatment.

Grief counselors provide a safe space for bereaved family members to process the loss and may even facilitate support groups. This kind of grief work helps people transition back to daily life.

In contrast, grief therapy sessions usually support individuals in the treatment of complicated grief. It also includes resources to treat additional challenges such as anxiety, depression, or addiction. These conditions can be grief reactions, or might be existing diagnoses made more intense by the pain of grief.

Understanding prolonged grief disorder

While most people’s grief resolves over time, a small percentage of grievers may experience deep, persistent, prolonged grief accompanied by an inability to return to normal life.

Some characteristics of prolonged grief disorder include:

    • Persistent and pervasive longing for and preoccupation with the deceased that lasts six months or more after loss

    • Intense emotional pain such as sadness, fear, anxiety, or guilt that impedes normal activities

    • Difficulty accepting the death

    • Emotional numbness

    • Complete lack of joy or ability to experience positive moods

    • Disengagement from social activities

    • Inability to work

    • Depression or suicidal ideation

You can recognize prolonged grief disorder in yourself or others by listening for statements such as:  

    • “I can’t imagine my life without them.”

    • “I am lost and cannot find ways to move forward.”

    • “I feel hopeless about the future.”

    • “I feel stuck and don’t know what to do about it.”

    • “I don’t know who I am anymore.”

    • “I can’t stop thinking about them.”

    • “I can’t get out of bed.”

    • “I have no reason to get up in the morning.”

    • “I rewind the tape of their last day in my head all the time.”

If you or someone you love is experiencing these, it may be time to seek professional help. Complicated or prolonged grief is best treated with a combination of psychotherapy (usually CBT) and psychiatry. A clinician will be able to best determine which course of treatment is the best fit.

How can grief therapy help?

Licensed grief therapists are trained to ensure you receive an accurate diagnosis.  This is important because some of the characteristics of prolonged grief disorder and depression may look the same. Yet they are two separate diagnoses with different treatment protocols. Depression may accompany prolonged grief disorder, or you may experience depression alone, or prolonged grief disorder alone.

In depression, the patient will often express a more global feeling of guilt and sense of worthlessness or being a burden on others. In prolonged grief, the patient may instead have feelings of guilt for things they have said or done or failed to say or do regarding the person who died. Those experiencing traumatic grief will often avoid specific places, things, activities that remind them of the loss. People with depression will often engage in more general avoidance behavior and social withdrawal. 

Sleep disturbances and suicidal thoughts are common to both prolonged grief and depression. To this end, it’s a crucial first step to gain an accurate diagnosis by working with a licensed professional trained in complicated grief therapy.

There are many approaches to grief therapy that your therapist may use. At the foundation, most grief therapy interventions are centered on the four tasks of mourning published by J. William Worden, PhD, ABPP and Fellow of the American Psychological Association:

    • Accept the reality of your loss

    • Process and experience the pain of your loss

    • Adjust to a new reality in which the deceased is no longer present

    • Find an enduring connection or relationship with the deceased in the midst of embarking on a new life

It may feel daunting to consider these tasks of mourning or to envision yourself going through them. It can be scary to talk about death and to think about your life without your loved one. And yet it’s critical to face the reality of the loss and find ways to move through it. 

That’s where a grief therapist comes in. They are trained to create a safe place for you to explore and process your grief, supporting you in defining your future reality.


Self-care tips for grievers

In addition to engaging professional help when you are experiencing complicated grief, there are things you can do now to enhance your well-being.

1. Find a daily routine

Having external factors pulling you out of bed can be helpful to your sense of normalcy. Think about things you would like to achieve (vs. things you “should” do) and start with those. Plan them in your calendar.

2. Get physical activity

It’s proven that moving releases endorphins that lead to a sense of well-being. Try small things first like a walk around the block. You don’t need to run a marathon to see positive benefits. 

3. Eat a healthy diet

The connection between emotional and physical wellness is well-established. Fueling your body with nutritious food supports your emotional sense of well-being and provides nutrients for your body and mind to heal.

4. Restrict or avoid alcohol and other substances

Turn instead to flavored water, teas or juices to add variety to your diet. Self-medication through mind-altering substances or alcohol can lead to addictions and other complications down the road.

5. Get in touch with what you need, and do that

Think about what kind of rest you need. Do you need to spend time alone walking outside, or would you benefit more from being with people? Do you want to read a book, listen to music, curl up under your blanket and stream a show, or go out to a fun new place? Listen to yourself and know that it’s okay to focus on your needs at this time as part of your healing process.

6. Invest in helpful social connections

Friends and family members can be a great support system. At the same time, these close relationships can bring stress as well. Consider who in your life accepts you as you are, lends a supportive ear and advice when you want it. It’s okay to focus on those who make you happy now and provide needed emotional sustenance for your journey.

7. Incorporate things in your day that bring you joy

Try to think of one thing you can do today that brings you joy. It does not have to be a big thing. In fact, sometimes the smallest things are the things that bring us the greatest joy. Think about a food you love, a place you like to go, a person you want to be with, or an activity that makes you feel effortless and free.

Know when to ask for help

Licensed mental health professionals play an important role in supporting grievers experiencing prolonged grief disorder.  If you are experiencing any of the following symptoms, know that help and hope is there for you. It’s okay to seek support that you need to feel better, find joy again, and learn healthy ways to grieve.

    • Inability to get out of bed

    • Deep sense of hopelessness all the time

    • Listlessness that does not go away

    • Suicidal thoughts

    • Depression

    • Inability to work

    • Complete lack of joy, especially in things that used to bring you joy

    • Sleep disruption that does not get better over time

Finally, remember that allowing yourself to move through your grief does not mean you are abandoning your loved one. While your grief may lessen over time, your love for them is as deep and strong as ever. 

That’s why grief therapy is critical to healthy processing of grief. The right therapist can help you move beyond suffering and get back to a healthy baseline and find ways to have an ongoing connection to your loved one even in the face of the loss.

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Published November 29, 2021

Nikki Moberly, PCC, CBC

Better Up Premier Fellow Coach

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