Grief counseling refers to supportive and/or therapeutic counseling that is focused on dealing with an issue of loss. The loss might be the actual death of a loved one, or it might be a different type of significant loss experienced as a result of a major change in one’s life (e.g., debilitating injury, job loss, natural disaster).
What Is Grief Counseling?
In the narrowest sense, grief counseling is another term for bereavement counseling, and focuses on helping people to deal with the pain and upheaval that can accompany the death of a loved one. In a broader sense, grief counseling refers to providing support to those who are dealing with significant distress as a result of other types of significant endings or losses brought about by a major change in their lives (e.g., divorce, job loss, disability, immigration).
Core Concepts of Grief Counseling
The core concepts of grief counseling include normal grief, complicated grief, Persistent Complex Bereavement Disorder, formal grief counseling, and informal grief counseling.
Normal (Uncomplicated) Grief
Grief is a natural and normal response to loss, which can be experienced emotionally, physically, and in one’s thoughts. It might negatively impact a person’s abilities to function for a time.1 Despite some popular theories, it has been clearly demonstrated that there is no one way to grieve, nor are there clear stages that one must go through to grieve.2,3
In the case of a death-related loss, normal grief is usually characterized by a feeling of acceptance of the loss accompanied by a yearning for the person who has died. In normal grief, distress typically peaks, and then starts to decrease, at around 6 months following the loss.2
Grief often comes in waves. Soon after the loss those waves might be very high, and quite frequent. Over time, however, these waves will begin to decrease in height and frequency, only increasing again when triggered by significant reminders such as anniversaries, holidays, or new losses.
It is really important to recognize that each person experiences grief in their own unique way, and it is also normal that some individuals might not experience significant distress reactions at all following loss.4
Complicated Grief
Complicated grief (which might also be referred to as “prolonged grief”) is a term used by mental health professionals to refer to grief that has continued to cause significant distress and disruption in a person’s life, without showing signs of decreasing over time (i.e., usually more than 6 months). It is estimated that up to 20% of individuals who are grieving, either a death-related or non-death-related loss, will experience complicated grief.5
In addition to long-standing intense distress and disruption, complicated grief related to a death is further characterized by:
- Persistent yearning for the loved one who has died
- Frequent images or thoughts of the loved one
- Feelings of emptiness and lack of meaning in life without the loved one
- Withdrawal
- Difficulty managing distressing emotions and thoughts
- Behaviors that focus on either actively avoiding reminders of the loved one who has died, or trying to hold onto reminders of the deceased in an attempt to feel closer to them.6,7
Persistent Complex Bereavement Disorder
Persistent Complex Bereavement Disorder is a diagnosis that might be made if a person is suffering from ongoing grief that has become debilitating.
It is characterized by the following criteria:
- At least 12 months have passed since the death of the loved one (for children it would be 6 months)
- Persistent longing for, and preoccupation with, the deceased loved one
- Possible distressing preoccupation with the way in which the loved one died
- Difficulty accepting and believing that the loved one has died
- Bitterness or anger related to the loss
- Active avoidance of memories of the loss
- Distressing memories of the loved one
- Feelings of self-blame, guilt, shame, etc. related to the deceased and/or their death
- Wanting to die to be with the loved one
- Feeling alone and that life has no meaning or purpose without the loved one8
Formal Grief Counseling
Formal grief counseling refers to therapeutic counseling which is provided by trained and licensed mental health professionals, who work from a psychological framework.9
Informal Grief Counseling
Informal grief counseling refers to supportive (non-therapeutic) counseling provided by clergy, peer support groups, or volunteer-based organizations.9
What is the Goal of Grief Counseling?
The goal of grief counseling is determined by the client.
Some examples of the types of goals that clients might bring to grief counseling include:
- Relief from persistent pain and distress (e.g., emotional, physical, spiritual)
- Finding a way to experience joy again (without feeling guilty)
- Adjusting to the direct and indirect changes that have occurred in their life as a result of the loss
- Resolving sleep issues
- Figuring out how they feel about the loss, ways to cope, and how to move forward
- Integrating the loss into their beliefs about life and death
- Replacing unhealthy thoughts and/or behaviors that they might have been using to cope with the loss
What Can Grief Counseling Help With?
Counseling for normal or uncomplicated grief is not necessarily beneficial, and in some cases can cause harm,10 since grief is a normal response to loss and will typically resolve on its own without the need for counseling assistance.11
For individuals, however, who have a history of mental illness, a lack of social support, and/or who have experienced a number of significant losses within a short time—if it is their own decision to seek counseling (i.e., not pressured or forced)—they might find grief counseling to be beneficial.9
Professional counseling that focuses specifically on addressing complicated grief, has been found to be helpful in the following areas:10,12,13
- Accepting the loss —including traumatic losses (e.g., unexpected death due to suicide/violence/accident/terrorism, death of a spouse or child)
- Identifying and increasing the use of healthy coping responses and behaviors
- Reducing and/or resolving prolonged, intense distress, as well as functioning difficulties (e.g., at work, socially, with family)
- Improving sleep quality
- Identifying ways in which the person can continue to feel connected to a loved one who has passed away
- Rebuilding their understanding of the world and their purpose in it (as this is sometimes shattered in the face of significant loss)10
Grief Counseling vs Psychotherapy
Grief counseling that is not intended to be therapeutic, but rather is focused on providing education and/or emotional support, is not psychotherapy. This type of grief support might be offered through a peer group (of people who have experienced a similar loss), or by a pastoral counselor who hasn’t completed a professional designation in a mental health field.
Grief counseling can be a form of psychotherapy if offered by a qualified mental health professional. State licensed mental health professionals such as psychologists, professional counselors, social workers, or psychotherapists, and some pastoral counselors, will provide grief counseling that is based in psychological theory and utilizes evidence-based therapeutic interventions.
Common Types of Grief Counseling
Grief counseling might be offered individually, in groups, or in families. It might be offered more informally through non-professional peer support (by someone who has experienced a similar loss), or pastoral counseling. It might also be offered more formally in a therapeutic way by a licensed counselor or psychologist.
Formal grief counseling can be beneficial to individuals who are suffering from complicated grief.
Examples of therapeutic interventions that might be used to address complicated grief include:12
- Imaginal revisiting: The counselor asks the client to talk about the death of their loved one and they work together to identify and explore the parts of this event that the client is finding hard to accept. They then work toward resolving these areas.
- Situational revisiting: The counselor and client identify how the client has begun to avoid people, places, things, and/or situations that they used to enjoy, that now trigger reminders of their loss. The client is challenged to re-engage in these areas of their life.
- Imaginal conversation: the counselor works with the client to experience an imagined conversation between the client and the loved one who has died, to resolve outstanding concerns or issues that continue to cause the client distress.
- Cognitive restructuring: the counselor and client identify thoughts or beliefs related to the loss that are continuing to cause significant distress to the client. They then work to shift these beliefs to be more compassionate and adaptive, in order to reduce distress.
Grief Counseling Examples
Due to the fact that grief counseling is most appropriate and beneficial for those who are experiencing complicated grief, the examples provided will be related to these types of situations.
Case Example 1
Taylor’s mom died of cancer after a 2-year excruciating battle with the illness. She died at home. During the last nine months of her life, the family was not able to afford the expensive chemotherapy and radiation treatments she needed. They had already lost their home due to the costs of treatment. Taylor, who is 28 years-old, moved back with her family a year into her mom’s illness to help with expenses, and to take care of her younger sisters who were aged 12 years and 7 years.
Eighteen months after her mom’s death, Taylor is still struggling. She feels her grief is still as strong today as it was in the days after her mom passed away. She doesn’t understand why she can’t get past this. Her friends have told her she needs to “let go” and get on with her life.
Taylor meets with a social worker, through a local community agency. She tells the social worker that she doesn’t know what is wrong with her, and she is feeling guilty that she hasn’t been able to move on. The social worker explains what complicated grief is, and Taylor that they can work together on helping her to move through it.
Taylor is relieved to hear that she isn’t doing anything wrong and it isn’t her fault. She and the therapist work together to begin to identify the multiple areas of loss that Taylor has recently suffered. By acknowledging and validating her many losses, the weight of her grief begins to make sense to her, and Taylor begins to experience a sense of relief.
Case Example 2
Anna, who is 18 years old, is dealing with complicated grief related to the death by suicide of her 15 year-old brother. He passed away 7 months ago. Anna has been unable to attend her college classes. She is having trouble sleeping. She finds she doesn’t want to be around friends because she feels like they are talking about things that don’t really matter.
All she can think about is losing her brother and how devastated her parents are. She is constantly fearful that the people she loves are going to suddenly die. Her family had no idea her brother was so distressed. They had a birthday party for her brother a week before he took his own life, and Anna thought he seemed really happy. She is convinced she must have missed some sign, and believes if she had been paying better attention, she would have been able to stop this from happening.
Anna meets with a psychologist who asks her about how her brother’s death has impacted her. They identify how she has been affected physically, emotionally, socially, and how it has affected her thinking and behaviors. They explore her fears as well as her coping strategies. They also explore the areas she is feeling stuck in regarding her brother’s death, recognizing that her guilt is one of these areas. The therapist also provides information to her about a peer support group for the siblings of individuals who have died by suicide.
Case Example 3
Lamar’s younger brother Jordan, who was an 40 year old African American man, died during a traffic stop in which he was beaten to death by the attending officers. The assault was videotaped by a by-stander, and went viral on the internet. Lamar is haunted by the images. He can’t get them out of his mind and heart. There were protests around the country as a result of the death. The attending officers were not charged.
For months Lamar was able to channel his anger and pain into protests, and taking care of his brother’s wife and children. Lately, however, he is having trouble functioning. His anger has been overwhelming and is coming out in his close relationships. He doesn’t like the person he is becoming.
Lamar meets with a professional counselor. His counselor listens to Lamar’s story and his concerns. They work together on developing goals for therapy. The counselor explains to Lamar that he seems to be experiencing both trauma and grief, and provides education on how these can lead to complicated grief.
They work to identify the ways in which Lamar has been impacted, both directly and indirectly, by the loss of his brother. They take note of the symptoms he has been experiencing, as well as of the supports and coping strategies he has been using.
The counselor reflects back the tremendous strength and courage that Lamar has demonstrated in surviving this tragedy and supporting others, while at the same time acknowledging his exhaustion and pain. Lamar feels like he is being seen and heard. He feels hope for the first time in a long time, that he will be able to get through this.
Cost of Grief Counseling
The cost of grief counseling will depend on the credentials of the grief counselor or support person, the setting in which the service is offered, and whether the client has access to health benefits.
Informal Grief Counseling
Informal grief counseling offered by a non-licensed faith-based counselor (e.g., a clergy member in a religious setting) might be offered free of charge if the person is a member of the community. Similarly, grief support might also be offered free of charge if it is provided by non-professionals who have had a similar experience, or if it is offered in a peer support group.
Formal Grief Counseling
Health insurance might cover all or part of the cost of visits to specific licensed mental health practitioners (e.g., professional counselors, psychotherapists, social workers, psychologists). Typically, with health insurance coverage, the cost to the client will be $20-$50 per session.14
Some larger employers offer Employee Assistance Plans which provide confidential counseling services to their employees and their dependents. This type of plan would allow access to specified mental health professionals, usually for a limited number of sessions, with no charge to the client.
Cost of Therapy with Mental Health Professionals15,16
| Possible Grief Counseling/Therapy Providers | Range (per one-hour session) | Average cost (per one-hour session) |
|
Licenced Pastoral Counselors, Professional Counselors, Psychotherapists, and Social Workers These mental health professionals have completed a master’s degree (typically a M.A., M.Ed., or M.S.W. in a mental health-related field such as psychology, counseling, social work, or marriage and family therapy) |
$0-300 | $100< |
|
Psychologists A licensed psychologist has completed a doctoral degree, typically in clinical counseling or educational psychology. |
$70-$250 | $70-150 |
How to Find a Grief Counselor
American Institute of Health Care Professionals provides directories of certified grief counselors:
Who Is Able to Offer Grief Counseling?
Informal grief counseling, focused on support, is sometimes offered by volunteers, or faith-based counselors, such as pastoral counselors, most of which are not required to be state licensed to practice.
Formal grief counseling or therapy is offered by state-licensed mental health professionals such as professional counselors, social workers, pastoral counselors (in a few states), and psychologists. These therapists can complete additional training to become certified grief counselors. When seeking grief counseling, it is a good idea to ask if grief counseling is an area that the practitioner specializes in.
Key questions to ask a Grief Counselor when considering who to work with:
- Are you a licensed mental health professional? (If that is important to you).
- Do you have specialized education and experience in dealing with complicated grief?
- Do you offer services to individuals, groups, or both?
- What are your fees? Do you accept health insurance? Do you offer a sliding scale for fees? (Note: A sliding scale for fees refers to reduced fees that are linked to one’s income level)
What to Expect at Your First Appointment
If you are attending a grief counseling appointment with a mental health professional, at the first appointment you might expect that your counselor will:
- Introduce themselves and briefly explain their approach to counseling
- Provide information on administrative processes such as session duration and frequency, fee payment, how they deal with missed appointments, etc.
- Answer any questions you might have
- Go over any intake information, if provided prior to the session<
- Ask about your loss(es) and how you have been impacted
- Ask about your goals and begin to suggest a treatment plan that can guide your work together to help to achieve those goals
Is Grief Counseling Effective?
The effectiveness of grief counseling depends on the type of grief being experienced. Results will differ depending on whether the person is experiencing normal/uncomplicated grief, or complicated grief.
Normal or Uncomplicated Grief
Research has indicated that counseling for normal or uncomplicated grief is not beneficial since normal grief is natural and not a disorder that requires treatment.12 In fact, participating in grief counseling for normal grief has been found to lead to deterioration for some individuals.11
In extenuating circumstances, however, where an individual has a history of mental illness, is lacking social support, and/or has experienced a number of significant losses within a short time, grief counseling might offer some benefits.9
Complicated Grief
Grief counseling is most beneficial for individuals who are suffering from complicated grief, which is a prolonged (more than six months), intense, debilitating, and sometimes life-threatening response to loss. Therapeutic approaches that target the areas in which an individual is feeling “stuck” can help to resolve grief symptoms and allow the client to begin to move forward in a healthier and more adaptive way.5,10,11,13
