In the throes of grief, the pain, longing, sadness, and emptiness we feel can become so unbearable that it may seem they will overwhelm us forever. And yet, while grief may be with us always, we also have a remarkable ability to adapt to the disorienting and unwelcome changes brought on by the loss of someone we love. With compassionate support, self-care, and opportunities for pleasurable and meaningful activities, most bereaved people can look forward to a fulfilling, meaningful life, comforted by warm memories, keeping their loved one close in their heart.
For some people, though, adapting to the unwanted reality of a life without the person they lost can seem impossible, and the bereaved person can become “stuck” in the acute, intense pain or adapt in ways that can restrict their capacity for living a fulfilling life. When grief interferes with the bereaved person’s life and becomes increasingly debilitating, evidence-based psychotherapy can be helpful.
Is grief an illness?
Grief is not an illness; it is our natural way of learning to live with the injury that a loved one’s death inflicts upon us. Just as following any other major injury, it is unsurprising when bereaved people don’t look well in the weeks or months after suffering a loss. Disrupted sleep, changes in appetite, irritability, tearfulness, lack of energy, withdrawing from others and usual activities, trouble concentrating, longing for and preoccupation with the deceased are all to be expected. This is why we lower expectations for bereaved people and provide additional care and support. And while it is natural for upsurges in grief intensity to continue throughout the rest of a bereaved person’s life, over time, grief generally become less disruptive, painful emotions become more manageable, and interest in life gradually returns. When a person does not begin to feel or look “well”, or at least better, over time, we begin to worry.
Is prolonged grief actually depression?
One common worry is that the bereaved person has become depressed. In fact, depression can sometimes follow a loss, and it’s important to address depression regardless of what triggered it. What is far less often recognized, though—even by professionals—is that prolonged or complicated grief and depression are two different psychological conditions, and that treatments that are effective for depression may leave the symptoms of prolonged grief untouched.
Grief and depression do share some similarities. Sadness, tearfulness, social withdrawal, disturbances of sleep or appetite are common in both conditions. However, anguished and unrelenting longing for the deceased, painful ruminations about the death, excessive avoidance of reminders, and a sense that time is moving on but they are not, are all unique to the syndrome of prolonged or complicated grief.
People who experience both depression and grief can usually distinguish between the two. Researchers have also identified important differences in both the experience of these conditions and their effective treatment. In one major study, Dr. Katherine Shear of the Center for Complicated Grief at Columbia University and colleagues showed that antidepressant medication was effective for reducing symptoms of depression but had little effect on the symptoms of prolonged grief. Two other research studies found that psychotherapy for depression was far less effective than a therapy developed specifically for prolonged grief in relieving the suffering and symptoms associated with that condition.
How can psychotherapy help someone who is grieving?
Though rarely easy, when grief is progressing in a way that a bereaved person finds manageable, psychotherapy is not necessary, though some bereaved people may benefit from compassionate support, psychoeducation for understanding the impact of loss, the expected course of grief, and tools for adaptation. However, when the natural process is not “working” and grief has become unmanageable, specialized grief-focused therapy with someone who is knowledgeable about interventions for grief adaptation can be especially helpful.
Left untreated, prolonged or complicated grief has been associated with chronic high levels of distress, reduced self-care, self-injurious thoughts, and increased risk for serious illnesses, including heart disease and cancer. It can interfere with a person’s day-to-day functioning, disrupt relationships, and sap joy from life. For people who might have complicated grief, there is a specialized, time-limited, evidence-based treatment, proven efficacious in three clinical trials funded by the National Institute of Mental Health. Dr. Gorscak served as a therapist and supervisor on these clinical trials, and has trained hundreds of clinicians to provide this specialized therapy. The treatment is a structured, time-limited approach, which focuses on obstacles that interfere with successful adaptation to the loss, regulation of painful emotions, and facilitation of self-care and meaningful life goals. For those with prolonged or complicated grief, this specialized therapy can be the key to living a full life once again.
Bonnie Gorscak, PhD