Loss, Grief, and Bereavement
In most cases, grief is the normal and healthy feeling of anguish experienced in reaction to an emotionally significant loss, often the death of a loved one.
Loss is a natural part of life, but that doesn’t mean that grieving is easy. While each person’s grief is different, it often involves symptoms of common mental health conditions like depression or anxiety. Grief itself is not in itself a mental illness, but when feelings of grief remain intense and last for a long time after a loss, they can keep you from moving forward with a healthy lifestyle.
If you are struggling to cope following a loss, you could benefit from working with a therapist with a specialization in grief. Read on to learn more about grief, treatment options, and guidance for selecting a therapist.
Symptoms of grief
Grief often resembles symptoms of depression, but reactions to loss vary widely from person to person. There is no right or wrong way to feel. That said, some of the most common symptoms include:
- Shock or denial: It’s common to experience shock and disbelief, to begin with. Even if your loss was expected, these feelings can last from days to years, leaving you feeling remote from reality and emotion.
- Feeling lost, sad, confused, or hopeless: You’ll likely experience all of these feelings, sometimes with overwhelming intensity, at some point during the grieving process.
- Anger or irritability: You may feel that the loss you experience was unfair, or be generally angry and short-tempered with those around you.
- Guilt or self-blame: Some people feel as though the loss was their fault or remain preoccupied with things they should or should not have said.
- Numbness or detachment: You may feel emotionally numb or unable to connect with people or experiences.
- Separation anxiety: You might experience apprehension or feel worried about no longer being able to be with the person lost.
- Worry about the future: It’s common to feel concerned about what the future will look like without your beloved one. You might think about experiences in the future that your loved one won’t be there for.
- Difficulty concentrating: You might feel a general sense of mental fogginess, and/or find it harder to focus and think things through.
- Loss of interest in pleasurable activities: If you’re going through the grieving process, the things that usually bring you joy (socializing, hobbies, sex) may seem dull, uninteresting, or even depressing.
- Changes in sleeping or eating habits: Grief can cause you to sleep or eat too much or too little. You might feel tired or exhausted.
- Thoughts of suicide or death: People struggling with complicated grief sometimes become preoccupied with death and may consider suicide.
Although there is no “normal” time period for grief, these symptoms typically do diminish over time.
Types of loss and grief
Grief looks different for everyone. Nonetheless, some of the most common scenarios related to grief include:
- Acute grief: Though it can feel anything but normal, acute grief is the term psychologists use to describe the expected grieving processes that do not develop into complicated grief. This might include milder or less prolonged versions of any of the above symptoms. Simple grief is not a mental health diagnosis, but it is still challenging enough that you may want to seek support while experiencing it.
- Complicated grief: Also known as Persistent Complex Bereavement Disorder, complicated grief is the term for grief that remains intense over a long period of time. It usually involves prolonged, intense experience of some of the above symptoms, broad changes to personal relationships, and a sense of meaningless. People who experience complicated grief could benefit from the help of a therapist.
- Disenfranchised grief: This term is used to describe grief that is, for whatever reason, not deemed socially appropriate. Examples include the grief of parents for a stillborn baby or people who have lost beloved pets. This might also include grief over the loss of someone whose relationship to you is stigmatized (such as a partner in an extramarital affair) or grief over someone who died in a stigmatized way (such as suicide or a drug overdose). If you’re dealing with disenfranchised grief, societal judgment can make an already difficult situation even more challenging.
- Traumatic grief: Grief can be especially difficult if you’re dealing with a death that occurred in a traumatic way. This might include violent or unexpected deaths, as well as those of children or young people who died before living full lives. Research suggests that a traumatic loss is typically associated with chronic grief (3).
- Grief related to a loss other than death of a loved one: Grief can come from different kinds of loss, such as loss of a job, loss of a living situation, falling out with a friend or other loved one, or loss of mobility or independence after becoming disabled. This kind of grief can also overlap with disenfranchised grief if you’re grieving something that society does not see as a worthy cause of grief.
- Grief in relation to cultural norms: Beliefs and practices around grief differ greatly across cultures. Some cultures might encourage a prolonged or openly emotional grieving process, while others might encourage a more stoic reaction. You may find the grieving process to be especially challenging if your own tendencies do not line up with your culture’s expectations.
Prevalence of challenges associated with loss and grief
Most people experience some form of grief after a painful loss. But for some people, acute grief persists long after the loss, for a year or more.
This form of intense, prolonged grief is known as complicated grief, and one study notes that about 7% of people who experience the death of a loved one develop complicated grief (1).
Some studies suggest that women may be more likely than men to develop complicated grief (2).
Stages of grief
Again, it is important to remember that there is no set time or “normal” way to grieve; everyone responds to loss differently. It’s generally accepted that people pass through four stages of grief at some point during the process, as follows:
- Accepting that the loss is real
- Feeling the pain of the loss
- Adjusting to life without your loved one
- Shifting emotional energy away from grieving and into other activities
You might experience more than one stage at once, and it is common to not move smoothly between stages.
Treatment options for loss and grief
One or more of the following options might help you to cope with the emotional strain of loss:
- Therapy: Find a therapist who can help you process your grief, find strategies for managing your pain, and move forward into the next phase of your life. See more tips below on types of therapy and selecting a therapist.
- Support groups: A support group can help you process your emotions and gain solace from individuals who are going through experiences similar to yours. Support groups are often formed around specific forms of grief, such as bereavement after the loss of a child.
- Talk to others: Find someone you trust that you can talk to, such as family and friends. Talking it over can help process the loss, remember the loved one, and help with healing. Furthermore, you’re likely to be helping others processing the loss at the same time.
- Self-care: It’s important to practice self-care during this time, by making sure you eat nutritious foods, get enough sleep, and stay active. Exercise, such as walking or swimming, can help you find purpose in your daily life and may also decrease symptoms of anxiety and depression.
- Relaxation skills: It can be helpful, especially in the immediate aftermath, to teach yourself a relaxation or breathing exercise to help manage grief symptoms. Practice with online self-help resources or download an app to learn meditation, breathing techniques, or relaxation exercises.
- Journaling: Keeping a written record of your thoughts and feelings may help you gain perspective on your grief and provide an outlet for expressing yourself freely.
- Hotlines: If you’re having thoughts of suicide or need immediate support, call the National Suicide Prevention Hotline at 1-800-273-8255. The Substance Abuse and Mental Health Services Administration hotline at 1-800-622-4357 can also help you locate resource and treatment options.
Therapy for loss and grief
Numerous therapy types and techniques are used by therapists to help support people through the grieving process. It is important to consider the available options and decide which one resonates most strongly with you. Examples of commonly-used therapy types include:
- Cognitive Behavioral Therapy (CBT): CBT helps us to become aware of and change loss-related unhelpful thinking patterns and behaviors that can worsen grief, such as self-blaming. CBT helps people to process and understand their loss, and learn coping strategies.
- Interpersonal Psychotherapy (IPT): IPT helps reduce suffering by supporting reconnection with social supports, building positive relationships, and connecting with personal goals.
- Complicated Grief Therapy (CGT): This relatively new model is designed specifically for complicated grief, and draws on attachment theory and elements from other therapy types, including CBT and IPT. It involves exposure to the memory of the loss but focuses also on future goals and relationships.
- Existential therapy: Existential therapy can be helpfully applied to grief through the lens of how one makes meaning in life following a loss. The loss is explored, processed, and better understood, as you move towards building a meaningful life.
- Acceptance and Commitment Therapy (ACT): ACT involves components of both CBT and mindfulness as well as other strategies to help us take an acceptance approach to respond differently to loss.
What to look for in a therapist for loss and grief
There are several factors to keep in mind when selecting a therapist for grief, including:
Specialization: Look for a therapist who has experience and specialized training in grief and the therapy type that resonates with you. They often include this information in their biography on their website or online profile.
Qualifications: With so many different provider types available, it can be difficult to decide which type of mental health professional to see. The most important thing is to look for a currently licensed therapist.
Personal fit: The trusting relationship between you and your therapist, known as the “therapeutic alliance” can have a huge impact on the efficacy of therapy. It’s important to work with someone you trust and feel understood by when talking about the loss of a loved one.
The best way to judge how you might feel about a therapist is to ask for a preliminary phone call. This also allows you to ask about their experience and what therapy with them will be like. Try to speak to a few different therapists before deciding on a provider.
Find therapists specializing in loss and grief
Find therapists who specialize in loss and grief on Zencare. Search by insurance, fees, and location; watch therapist introductory videos; and book free initial calls to find the right therapist for you!
Sources and references
- (1) Shear, K.M., 2012, “Grief and mourning gone awry: pathway and course of complicated grief”. Accessed online March 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384440/
- (2) Cited in Shear, K.M., et al., 2011, “Complicated grief and related bereavement issues for DSM-5”. Accessed online March 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075805/#R49
- (3) American Psychological Association, “A new approach to complex grief”, https://www.apa.org/monitor/nov04/grief
- American Psychological Association, Dictionary of Psychology, https://dictionary.apa.org/grief and https://dictionary.apa.org/disenfranchised-grief
- American Psychological Association, “Grief: Coping with the loss of your loved one”, https://www.apa.org/topics/grief
- National Health Service UK, “Grief after bereavement or loss”, https://www.nhs.uk/conditions/stress-anxiety-depression/coping-with-bereavement/
- Wetherell, J.L., 2012, “Complicated grief therapy as a new treatment approach”, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384444/
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