Complicated Grief

Grief over the loss of a person due to death or the end of a relationship can take many forms.  Intrusive, recurring thoughts centering around or dominated by the loss often cause the grieving person to experience poor concentration, sudden or prolonged tearful spells, and confusion about the future. In a sense, the individual’s future is temporarily “lost” after the experience of a significant loss. Eventually, if the severe grief does not resolve itself into a painful but bearable acceptance of the loss within a few weeks, or at most four to six months (depending on the severity of the loss), the grief becomes more problematic (Complicated Grief) and requires more intensive professional help.

What is complicated grief?

Individuals who must live through significant losses at any moment in their life (i.e., deaths, major illness, debilitating accidents, divorces, jobs) almost invariably experience severe depression and discouragement, and exhibit strong, uncharacteristic emotional responses that can be cause of concern. Among these strong emotional or psycho-somatic responses there can be a diminished appetite, weight loss, insomnia, despair, loss of self-esteem and moments of suicidal ideation.  In many cases, the feelings of guilt that not enough was done to prevent the loss from occurring, or an unreasonable belief of having contributed to the loss can become quite overwhelming. Among the most frequent coping strategies that may be instinctively adopted are the avoidance of talking on anything more than a superficial level about the loss, or refusing to talk about it at all. This is a rather primitive defense mechanism and can serve a useful purpose, at least briefly. 

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How is it treated?

In general, Complicated Grief can be successfully treated with Cognitive Behavioral Therapy techniques that target the loss-related processes and focus on symptoms of painful intrusive memories and seek to integrate the behavioral avoidance. Additionally, the treatment focuses on the restoration of normal functioning by helping the grieving person re-establish relationships and connection with valued life goals.
CBT can be flexibly applied to all types of grief, however in the treatment of Complicated Grief the most effective protocol shown in research studies to produce the best results consists of 16 sessions, each approximately 45-50 minutes in length. Each session is structured, with an agenda that includes reviewing the previous week’s activities, doing work in session, and assigning tasks for the following session.

The treatment is typically divided into three phases:

In phase one, i.e. during the first three sessions, the primary goals are to establish a strong therapeutic alliance, obtain a history of the client’s interpersonal relationships, provide psychoeducation about the model of complicated grief, and describe the elements of treatment. A supportive person (family member, close friend) is invited to attend the third session.

In phase two, i.e. sessions 4 to 9, the client is asked to complete a number of exercises inside and outside of the session that help with the loss and address restoration of the capacity for joy and satisfaction in life.

In phase three, i.e. sessions 10 to 16, the therapist and the client review progress and collaboratively decide how to use the remaining sessions to complete the work and consolidate treatment gains.