Each year, in California alone, a quarter of a million people die.  In the US as a whole, three million do. As these statistics suggest, many of us will, at some point in our lives, lose a loved one and experience grief.

From normal to prolonged grief

Grief refers to intense sorrow and other reactions experienced in response to the death of a loved one.

Though most people eventually adapt to the loss, sometimes grief does not abate.  Instead, it becomes chronic.  This is known as complicated or prolonged grief disorder.

What are the symptoms of this condition?

Grieving individuals may…

  • Feel depressed and emotionally numb.
  • Experience intense loneliness.
  • Avoid any reminders of the loss (e.g., activities, places, people).
  • Experience severe emotional pain and suicidal thoughts.
  • Feel either unable or unwilling to accept the loss and move on with their life.

How is prolonged grief disorder treated?

To give you a better idea of what therapy may entail, the rest of the article will discuss a treatment known as prolonged grief disorder therapy.

Prolonged grief disorder therapy (PGDT)

PGDT integrates elements from different forms of psychotherapy, including cognitive behavioral therapy, motivational interviewing, and interpersonal therapy.  PGDT has four phases, each lasting multiple sessions.

Phase I consists of history taking, providing information on how people react to loss and how adaptation occurs, and giving information on the goals and processes of the treatment.  At this stage, patients may also be asked to fill out a grief monitoring diary (to rate their grief intensity throughout the day).

A friend or family member is asked to accompany the patient in one session, not only to provide support but also to offer an outside perspective.

Phase II includes the core “revisiting sequence” (e.g., imaginal revisiting, situational revisiting, memory work), as described below.

During this phase, the patient is asked to engage in visualization and tell the story of what happened when they learned of the death.  Then, they are instructed to reflect on the story.  The story is recorded and replayed several times during therapy course.

In addition, various activities, locations, or individuals previously avoided (due to their association with the deceased) are identified, and the grieving person is encouraged to slowly expose themselves to these triggers.

Last, positive and negative memories of the loved one are discussed—for instance, while looking at old pictures.

As can be seen, many of the exercises of this stage resemble exposure therapy exercises because both require confronting situations and activities that have been avoided (though avoided for different reasons).

Next is Phase III, or the midcourse review.  This is followed by Phase IV, the closing sequence.  At this point, a technique called imaginal conversation may be used.

Specifically, the grieving person is instructed to imagine that the deceased is physically present in the room and then to speak alternately to and as the deceased.  They can ask questions and provide answers they believe they would have received had the loved one been alive.

This exercise is followed by time for reflection.

Finally, toward the end of the treatment, the patient’s feelings about therapy termination are explored.

Getting help for your grief

If you are experiencing prolonged or complicated grief, therapy may be beneficial.  Prolonged grief disorder therapy (and other similar treatments) can make it easier to gain clarity about your relationship with the deceased and to make sense of the loss.

Treatment can help you integrate the loss into your life in a way that allows you to live a meaningful life linked to the past and open to the future.