Grief and bereavement
Most grief doesn't need treatment. Distinguish what does — and treat it without rushing the work.
Who this is
Bereaved clients across the spectrum — uncomplicated grief, prolonged grief disorder, bereavement complicated by trauma, sudden or violent loss, child loss, loss to suicide.
Developmental and contextual frame
Acute grief is universal and not a disorder. Prolonged grief disorder (DSM-5-TR) is a new formal diagnosis requiring 12+ months of intense yearning and identity disruption. Distinguishing the two is the first task — and the easiest mistake is pathologizing normal grief.
What to assess
- Type of loss (sudden, expected, violent, suicide, child)
- Time since loss
- ICG-19 or PG-13-R if prolonged grief is suspected
- Suicidality (elevated after losses, especially loss to suicide)
- Depression and PTSD separately
- Social supports and bereavement community
- Cultural and spiritual frameworks for grief
- Continuing-bonds expression
Modality fit
Watchful waiting + support
For uncomplicated acute grief — most clients heal without intervention.
CGT / PGT (Complicated Grief / Prolonged Grief Treatment)
Evidence-based for prolonged grief disorder; combines imaginal and situational revisiting with goals work.
Meaning-centered approaches
Helpful when loss has disrupted identity and worldview.
CBT or trauma-focused approaches
When PTSD is comorbid with grief, especially after violent or sudden loss.
Common pitfalls
- Pathologizing normal grief — most acute grief doesn't need treatment
- Rushing the client toward 'resolution' or 'acceptance'
- Misreading depression as grief (or vice versa)
- Avoiding the deceased person — clients usually want to talk about them
- Skipping memory and continuing-bonds work
- Treating all losses as equivalent
What therapists often miss
- Loss to suicide carries unique features — guilt, search for meaning, stigma
- Anticipatory grief in caregiving contexts
- Disenfranchised grief — losses society doesn't fully acknowledge (miscarriage, ex-partner, pet, estranged family member)
- Children's grief presents very differently
- The deceased's birthdays, holidays, and anniversaries can trigger episodic grief years later — this is normal
Resources to share
Bereavement support groups
Local hospice and community resources; specialized groups for specific losses.
Modern Loss / What's Your Grief
Written resources that don't sanitize grief.
Survivors of Suicide Loss groups
AFSP and local equivalents.
More primers
Working with adolescents
Developmental brain, family system, and a still-forming identity — modalities and stance both need adjusting.
Working with couples
The relationship is the client. Your job is to track the pattern, not to be the umpire.
Working with LGBTQ+ clients
Affirmative care isn't a modality — it's a stance that runs through everything else.
Working with neurodivergent adults
Late-diagnosed ADHD and autism in adults need affirmative, skills-forward work — not pathologizing.