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Grief, Loss, and Bereavement


Grieving Thoughts and Behaviors





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The different feelings, thoughts, and behaviors people express during grief can be categorized into two main styles: instrumental and intuitive. Most people display a blend of these two styles of grieving:


There is no right or wrong way to experience grief, though some thoughts and behaviors after a loss can be more helpful or safe than others.

The Process of Recovering from Grief



Silhouette of a person seated on a rock, contemplating a beautiful landscape




Complicated Grief          

The experience of grief is not something a person ever recovers from completely, but time typically tempers its intensity. The term complicated grief refers to a persistent form of bereavement that dominates a person’s life, interfering with daily functioning for an extended period of time.



  • Intense sadness
  • Preoccupation with the deceased or with the circumstances surrounding the death
  • Longing or yearning
  • Feelings of emptiness or meaninglessness
  • Difficulty engaging in happy memories
  • Avoidance of reminders of the deceased
  • Lack of desire in pursuing personal interests or plans
  • Bitterness or anger

The DSM-5 includes diagnostic criteria for “persistent complex bereavement disorder” in the section of conditions requiring further study.

Therapy for Grief

When a person’s grief-related thoughts, behaviors, or feelings are extremely distressing, unrelenting, or incite concern, a qualified mental health professional may be able to help. Therapy is an effective way to learn to cope with the stressors associated with the loss and to manage symptoms with techniques such as relaxation or meditation.


Each experience of grief is unique, complex, and personal, and therapists will tailor treatment to meet the specific needs of each person. For example, a therapist might help the bereaved find different ways to maintain healthy connections with the deceased through memory, reflection, ritual, or dialogue about the deceased and with the deceased.


In addition to individual therapy, group therapy can be helpful for those who find solace in the reciprocal sharing of thoughts and feelings, and recovery results are often rapid in this setting. Similarly, family therapy may be suitable for a family whose members are struggling to adapt to the loss of a family member.

Models of Grief


  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance




  1. To accept the reality of the loss 
  2. To work through the pain of grief 
  3. To adjust to life without the deceased 

As an alternative to the linear stage-based model, Margaret Stroebe and Hank Schut developed a dual process model of bereavement. They identified two tasks associated with bereavement:



Diagnostic and Statistical Manual of Mental Disorders (DSM) and Grief

The Diagnostic and Statistical Manual (DSM) does not define bereavement as a disorder, but preexisting conditions like major depression, or repercussions associated with the trauma of a death, such as acute stress or posttraumatic stress, can complicate bereavement. Normal symptoms of bereavement can mimic those of depression, but these symptoms typically pass within two months of the loss. For those who may be vulnerable to depression, grief has the potential to precipitate a depressive episode, and for those who already experience depression, the bereavement process can be prolonged and worsened by the depression. What distinguishes grief from depression is that the feelings of grief are specifically related to the loss or death, and depression is characterized by a general sense of worthlessness, despair, and lack of joy. 

Case Example 

Mourning multiple losses: Rhonda, 57, had a sudden breakdown, stopped working, became anxious and depressed, and sought therapy after her sister passed away. A full history revealed she had been the sole caretaker for her sister, who had been ill for years and required near full-time assistance. During the time of the illness, Rhonda’s parents had both died of natural causes. Rhonda realized she never had time or emotional energy to mourn her parents’ death, and in fact, resented her sister, and had not mourned her death that had just occurred within the past year, and for which Rhonda felt terribly guilty. She had also been so caught up in her family duties that she had had little time to develop other pursuits. Allowing herself to face the great feelings of sadness and loss slowly dissolved her anxiety, and after a time of rest to fully grieve, Rhonda could return to work. With the support of a therapist and a close friend, she found the strength to begin to build a full life.



  1. Doughty, E. A., Wissel, A., & Glorfield, C. (2011). Current Trends in Grief Counseling. Vistas Online. Retrieved from http://counselingoutfitters.com/vistas/vistas11/Article_94.pdf
  2. Kersting, K. (2004, November). A New Approach to Complicated Grief. Monitor on Psychology 35(10). Retrieved from https://www.apa.org/monitor/nov04/grief.aspx
  3. Major Depressive Disorder and the “Bereavement Exclusion”. American Psychiatric Association. Retrieved from http://www.dsm5.org/Documents/Bereavement%20Exclusion%20Fact%20Sheet.pdf
  4. Wakefield, J. C. (2013). DSM-5 grief scorecard: Assessment and outcomes of proposals to pathologize grief. World Psychiatry. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683270/


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Last updated: 09-30-2014


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