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Complex Grief

Complex Grief

Do we ever “Get Over” our losses?

By Cara Crisson, PsyD

complex grief - new directions counselingOn a typical day in December, Janey’s mom called her out of school to tell her that her grandmother had passed away in the hospital. Although her grandmother was always active and healthy, she suddenly got sick during Janey’s senior year of high school. Janey was inconsolable.

How long is too long to grieve?

Grief is a universal experience; however, everyone experiences it differently. Janey is a 19-year-old young woman who has had a lot of trouble “getting over” the death of her grandmother. Although it is normal to move back and forth through the stages of grief nonlinearly, most people do come through, accepting despite the pain. But not everyone passes through the stages at the same pace. Unfortunately for some, the experience of a loss is overwhelming, and they struggle to function well.

What does complex grief look like?

Complex bereavement shares a hybrid of symptoms of depression, anxiety, and PTSD. Which symptoms the person experiences are based on their own coping responses and can be inconsistent. Some people may suffer feelings of self-blame, sadness, and difficulty accepting the death. In our story, Janey started having problems concentrating at school, sleeping at night, and passing her classes. When her mom tried to help, Janey would get really angry and yell that she didn’t know what she was going through.

Three Things to Consider When Grieving:

  1. Connect with those Who Get It! – Your feelings can be overwhelming, and it is often helpful to work through them with someone who understands that grief is not the same for everyone.
  2. You are not alone, yet your experience is unique – It’s important to remember while in grief you are not alone, but others may not understand the reasons you are experiencing a death so acutely.
  3. Your future exists – By moving the focus away from what you’ve lost, and creating a version of the future where they both honor the past and recognize the future, people can start to heal despite complex bereavement feelings. Finding ways to honor the memory of your loved one while investing in your own future is likely be helpful.

The experience of agitation, anger, and difficulty spending time with other loved ones can vary. What is consistent, is these difficulties do not remit after a reasonable amount of time, lasting at least six months to a year. A year later, Janey’s parents have been encouraging her to get out of the house and spend time with her friends, but all she can think about is how much she misses her grandmother and she says nothing is fun when she tries to live her life.

Who experiences complex bereavement?

Up to 10-20% of individuals who have a substantial loss experience complex bereavement. This is even more likely when the loss was sudden, violent, or involved a child. The more complicated a person’s emotions regarding the person’s death, the more likely they are to experience complex grief responses. For these reasons, those who have lost loved ones to a novel disease, such as Covid-19, may be more likely to experience complex grief. Children can also experience complex bereavement, especially if they lost a primary caretaker, such as a parent.

How can we manage feelings of complex bereavement?

A therapist is likely to assess the specific areas that are difficult for the individual to experience and tailor a plan to help them through the task of grieving. A therapist will help to identify the thoughts that have been impeding them from moving forward, identify maladaptive coping patterns, and help them to explore new ways of moving forward.

The interventions used to achieve these goals will differ significantly based on what is comfortable for the client and therapist. It may be helpful to do role plays, face painful memories, and target negative beliefs that may have developed as a result of the loss.



“Complicated Grief.” They Mayo Clinic. Retrieved from the world wide web.

Duffy, M., & Wild, J. A cognitive approach to persistent complex bereavement disorder (PCBD). The cognitive behaviour therapist. 2017, 10, 1-19.

Khosravi, M. Worden’s task-based model for treating persistent complex bereavement disorder during the coronavirus disease-19 pandemic: A narrative review. Macedonian journal of medical sciences, 2020, 8, 553-560.

Robinaugh, D.J., LeBlanc, N.J., Vuletich, H.A., & McNally, R.J., Network analysis of persistent complex bereavement disorder in conjugally bereaved adults. Journal of abnormal psychology, 2014, 123 (3), 510-522.