Complicated Grief

There was recently an article in the New York Times about complicated grief. Virtually everyone experiences intense suffering after losing someone they are close to, but most don’t have that intense suffering continue on for over a year without lessening at all. That happens with complicated grief, though; indeed, it can persist for many years with no respite. It’s like being buffeted by a hurricane that never passes.

There are other features common to complicated grief. Often, there is intense yearning or longing as well as intense emotional pain. The bereaved person may have ongoing numbness, disbelief, or anger. The person is often preoccupied with the deceased and can’t imagine life without him or her. There is sometimes ongoing rumination about the conditions¬†under which the loss occurred, and the person may get stuck dwelling on something they think they could have done to prevent the death. The bereaved may want to die or think that life is no longer meaningful. The person often isolates her- or himself from others and makes little effort to engage in age-appropriate life tasks.

The Times article notes that a 2009 German study found the prevalence of complicated grief among those who were bereaved to be 7 percent, with a slight increase (to 9%) among those 61 and older. Rates were higher if the person lost was a spouse or child, and also if the cause of death was cancer.

Dr. Katherine Sheer, a psychiatrist who directs the Center for Complicated Grief at Columbia University School of Social Work, has worked with colleagues to develop a treatment for complicated grief. As described in this paper, the treatment is conducted during the course of 16 sessions for research purposes, though clinicians using this approach can vary the length as needed. A key feature of the approach is having the client visualize and tell the story of living through or learning of the person’s death. The focus here is on experiencing the emotions from that time and integrating them with rational knowledge that the person has died. Here are some other components of the treatment:

  • identifying and working towards a personal goal unrelated to the grief or the deceased.
  • bringing a support person to therapy; this person is used to re-establish the client’s often-frayed social connections
  • reviewing photos or mementos of the deceased
  • talking about both positive and negative aspects of the relationship

The clients suffering from complicated grief with whom I’ve worked have mainly been widowed, though I’ve also worked with some adults who have lost a child and a few children who have lost a parent. Sometimes the bereaved spouse had never had complete trust in any human being other than the partner that was lost and feels hopeless about ever establishing such trust with anyone else. Sometimes the person’s main preoccupation is trying to figure out what he or she could have done to prevent the loss. Complicated grief isn’t just experienced by those who had a close and loving relationship with the deceased: I remember one client who believed her late husband had ruined her life and more than anything wanted to reach beyond the grave to let him know what harm he had done to her.

I encourage anyone whose grief has not abated in the course of a year or more and who recognizes themselves in the above description to seek therapy. You can be helped toward resolving feelings of grief and moving out of the darkened, closed-off parlor of your mourning back into light.

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About bobritzema

I am a fourth-generation American of Dutch ancestry and am trained as a clinical psychologist. In 2012, I retired from Methodist University in North Carolina to return to my parents' home and provide them with assistance. I maintain part-time therapy practices in Grand Rapids, Michigan, and Fayetteville, North Carolina. I currently worship at Square Inch Community Church in Grand Rapids. I can be reached at bobritzema@hotmail.com.
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