Grief is an existential given – we will all have to go through bereavement of a friend, relative or pet at some point in our own life. Whilst grieving is a painful process for most of us, for others there can be mixed feelings of guilt, regrets, denial, shame and even relief, that make it more complex to resolve. 

Most emotional support services that focus on bereavement have two strands, one is called “grief facilitation” and the other “grief therapy”. In facilitation, the process of grieving is normalised and a supportive space is created to encourage talk about the deceased and create memorials. This may involve one to one or group work, and some homework to collect resources such as photographs and write down recollections of the loved one between sessions. The emphasis here is on creating a calm and safe space where the onus is on the client to self-soothe and direct their own process.

Grief therapy is used for more complex cases where the person’s grief may have arisen after a long delay, or where there are elements of trauma that prevent the person from undertaking the tasks associated with grief such as acceptance. Complicated grief is believed to impact between 10 – 20% of grievers.1 For many people, the most difficult time is the first several days or weeks. After about six weeks, individuals usually are able to gradually return to their daily routine and normal activity. Social isolation is both a risk factor and a maintaining factor in complicated grief, so it is very important that a network is created around a person who is known to be experiencing complicated grief.

For an adult with complicated grief, emotions become overwhelming and their difficulty with daily functioning goes on for much longer. Factors which make complicated grief more likely include the proximity of the relationship with the loved one, for example a first degree relative, a child, or a best friend. The experience of loss through sudden, unexpected, traumatic and multiple concurrent or consecutive deaths, and loss through suicide, all carry a higher risk of those left behind, subsequently struggling to process the grief.

The cost of complicated grief in workplaces is often underestimated. Any employee going through the grieving process needs support and flexibility, but many employers do not address these needs openly or thoroughly. Employees experiencing grief processes are known to experience higher levels of daily stress than normal. This can lead to poor decision making, substance misuse and increased risk of injury. Because of these issues, employers are potentially losing billions annually, according to a study by the Grief Recovery Institute.2 

In order to help those with complicated grief we first need to identify them. Look out for symptoms such as intense sorrow, pain and rumination over the loss of their loved one, difficulties concentrating, intrusive thoughts such as triggered reminders of the loved one and attempts at avoidance of these, prolonged pining, numbness, detachment and bitterness with an inability to enjoy life. At its most extreme, individuals may start to fail to carry out self-care and normal functioning, and say things like “life isn’t worth living” or “I wish I had died with them.” If you recognise these symptoms in someone you know or in yourself, it is important to seek help.

Once a person understands that they have a complicated grief process, we can signpost them to the appropriate level of support to suit their needs. They may require a range of support mechanisms, from accessing compassionate leave, undertaking grief facilitation, and accessing medications to assist with sleep, low mood and depression where deemed necessary by the individual’s doctor.3 There are many fantastic types of grief therapies available, which include Narrative and Creative Therapies, Trauma-Focused CBT, Interpersonal Psychotherapy, Gestalt Therapy, and EMDR, all of which can be accessed via the InsideOut App. All of our therapies focus on helping the person to grow in spite of and around their grief, rather than trying to propagate the myth that we can ever ‘get over’ such a substantial loss.  

Author: Dr Rebecca Lunson Southall, Chief Therapist & Content Contributor at InsideOut