By Jacob S. Sawyer, Ph.D., Assistant Professor of Psychology at Penn State Mont Alto

Many wonder if they are grieving the “right” way. This can be especially true for those who believe in a linear, stage model of grief. The most well known example of this is likely the Kübler-Ross model, which begins with denial and ends with acceptance of the loss. Along the way, one could be expected to experience anger, bargaining, and depression. But what if you never accept that the loss occurred? What if you skip some of the feelings in the middle? What if you actually feel a sense of relief after the death of a loved one?

Thankfully, researchers have studied the experiences of the bereaved, and have not found any empirical support for a stage model of grief. In fact, most participants in recent bereavement studies experienced little change in symptoms of depression postloss, or experienced an increase in symptoms of depression shortly after the loss with an eventual return to baseline levels at 18 months postloss.¹ However, about 10 to15% of individuals experience chronic distress and depression after the death of a loved one.² Even participants who experienced little change in levels of depression postloss would occasionally experience yearning for the deceased and intrusive thoughts related to the loss.¹

Since everyone experiences loss in a different way, how do you know when it might be beneficial to seek professional help? It would be reasonable to assume that anyone could benefit from therapy related to the loss of a loved one, or to engage in what is commonly called “grief work.” Research in this area paints a more nuanced picture. An analysis of grief-focused therapy found that most individuals experienced little to no improvement. Furthermore, one study found that 38% of individuals receiving treatment for grief would have been better off in the control group that did not receive treatment!³

However, those who experienced more “complicated grief” (i.e., persistent and intense grief) found the most benefit from treatment.⁴ Complicated grief reactions last longer than what is typically experienced by most during bereavement (at least 6 months),⁵ and can impair daily functioning. Some examples of reactions that are related to higher levels of complicated grief include feeling:

• It is unfair that the person died
• Anger about the death
• Disbelief, stunned, and/or dazed
• Life is empty without the person who died
• Envy of others who have not lost someone close ⁶

Not everyone needs to talk through their reactions to the loss of a loved one, but some can certainly benefit from therapy that is specifically focused on grief, loss, and bereavement. Research has found that there is not one right way to grieve (and grief can even include the absence of depressive symptoms), but there can be factors that make grief more intense and prolonged. These instances are when grief-focused therapy seems to be the most helpful.

1. Bonanno, G. A., Wortman, C. B., & Nesse, R. M. (2004). Prospective patterns of resilience and maladjustment during widowhood. Psychology and Aging, 19(2), 260-271.
2. Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events?. American Psychologist, 59(1),          20-28.
3. Jordan, J. R., & Neimeyer, R. A. (2003). Does grief counseling work?. Death Studies, 27(9), 765-786.
4. Schut, H., Stroebe, M. S., van den Bout, J., & Terheggen, M. (2001). The efficacy of bereavement interventions: Determining who benefits. In M. S. Stroebe, R. O. Hansson, W. Stroebe, & H. Schut (Eds.), Handbook of bereavement research: Consequences, coping, and care (pp. 705-737). Washington, DC, US: American         Psychological Association.
5. Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., Reynolds, C., Lebowitz, B., Sung, S., Ghesquiere, A., Gorscak, B., Clayton, P., Ito, M., Nakajima, S., Konishi, T., Melhelm, N., Meert, K., Schiff, M., O’Connor, M., First, M., Sareen, J., Bolton, J., Skritskaya, N., Mancini, A. D., & Keshaviah, A. (2011). Complicated grief   and related bereavement issues for DSM?5. Depression and Anxiety, 28(2), 103-117.
6. Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., Frank, E., Doman, J., & Miller, M. (1995). Inventory of Complicated Grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research, 59(1), 65-79.

For more information, see:

https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/

https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374

**All information and link content is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or psychological or medical treatment of a qualified psychologist, physician, or other healthcare provider.