Grief is the response to loss of something meaningful

Grief is the natural response to losing a loved one. Most people don’t need grief therapists, even when the loss is sudden and unexpected and very, very sad. People have natural ways of adapting to attachment loss, usually with the support of friends and relatives, and everyone does it in their own way. You can think of healing after loss as analogous to healing after a physical wound. The loss, like the injury, triggers a pain response which can be very strong.  Injuries also activate a healing process. Loss does too. However, a wound complication, like an infection, can interfere with healing. So, too, maladaptive thoughts, dysfunctional behaviors or inadequate emotion regulation can interfere with adaptation to loss.

CG is not less likely after loss of a rewarding relationship

Mental health training does not usually include learning about the syndrome of complicated grief.  However, trainees often are taught that grief is complicated if there was an ambivalent relationship to the person who died. This is a misconception. Adapting to a loss is more difficult if a person can imagine how things could have been different. People might do this because the relationship was conflictual. However, this is uncommon. Most people with complicated grief have had an especially strong and rewarding relationship to the person who died.

Key definitions

Grief is the response to loss that contains thoughts, behaviors, emotions and physiological changed; if the loss is permanent, so too is the grief, but its form evolves and changes as a person adapts to the loss

Acute grief occurs in the early period after a loss and often dominates the life of a bereaved person; strong feelings of yearning, longing and sorrow are typical as are insistent thoughts and memories of the person who died.  Other painful emotions, including anxiety, anger, remorse, guilt or shame are also common. Activities are often focused on doing or not doing things to try to deal with the loss.

Integrated grief is the lasting form of grief in which loss-related thoughts, feelings and behaviors are integrated into a bereaved person’s ongoing functioning; grief has a place in the person’s life without dominating.

Complicated grief is a persistent form of intense grief in which maladaptive thoughts and dysfunctional behaviors are present along with continued yearning, longing and sadness and/or preoccupation with thoughts and memories of the person who died. Grief continues to dominate life and the future seems bleak and empty. Irrational thoughts that the deceased person might reappear are common and the bereaved person feels lost and alone.

Adapting to loss entails accepting the reality of the death, including its finality, consequences and changed relationship to the person who died; adapting means seeing the future as holding possibilities for a life with purpose and meaning, joy and satisfaction.

Examples of Grief “Complications”

Maladaptive thoughts are typically counterfactual, grief-focused or catastrophizing; its natural to second guess a loved one’s death, especially if it was sudden, unexpected or untimely; most people worry about whether they are grieving in “the right way” and many dread the future in a world without their deceased loved one. People with complicated grief ruminate over these kinds of thoughts.

Dysfunctional behaviors are typically related to avoiding reminders of the loss and/or escaping from the painful reality. A bereaved person may try to feel close to the person who died through sensory stimulation and day dreaming about being with them – looking at pictures, listening to their voice, smelling their clothes, trying to recall what it was like to be together. Bereaved people are often inclined to avoid places, people or activities that hold reminders of the person who died. These behaviors are problematic when they become the only way of managing painful emotions.

Inadequate emotion regulation is another common problem for people with complicated grief. Acute grief is typically highly emotional. Most people have a range of ways to regulate these emotions.  They balance the pain with periods of respite, giving themselves permission to set the grief aside for a time. People with complicated grief have trouble doing this; instead, they often focus on things that increase emotional activation. Regular routines including adequate sleep, nourishing meals, adequate exercise and social contacts may be disrupted, making emotions more difficult to manage.