If you’re interested in this topic and want to find out more, you might like to see the on-demand CPD videos we have on this same subject. You can see our video library on this topic over on our sister site Therapy Education Online (ThEO).

In this short article we take a look at four areas that therapists might want to consider when working with someone experiencing complex grief.

Complex grief, sometimes called complicated grief or prolonged grief, is where the natural grieving process becomes significantly debilitating and long-lasting. Unlike “typical” grief, which tends to gradually diminish in intensity over time, complex grief persists, intensifies, and disrupts a person’s daily life and functioning. 

To understand complex grief, we need to explore its symptoms, causes, risk factors, and the ways in which we might work effectively with someone who is experiencing complex grief.

Learn more about working with bereavement in our online CPD workshop:  Working with Complexity in Grief  with Dr Erin Hope Thompson on Friday 18th October, 10am – 4pm. 

Symptoms of Complex Grief

The symptoms of complex grief extend beyond those of normal grieving. They include:

1. Intense sorrow and emotional pain: A person with complex grief may feel overwhelming sadness and anguish, making it difficult to manage daily activities.
2. Persistent yearning or longing for the deceased: This intense longing can dominate the individual’s thoughts and emotions.
3. Difficulty accepting the death: The person may struggle to come to terms with the loss, often feeling unrelenting disbelief or shock.
4. Preoccupation with the deceased: Continuous thoughts about the person they have lost can be all consuming, affecting the person’s ability to concentrate on anything else.
5. Avoidance of reminders: The individual may go out of their way to avoid places, people, or activities that remind them of the person who has died.
6. Detachment from others: They might withdraw from social activities and relationships, feeling disconnected or numb.
7. Intense emotional reactions: Feelings of anger, bitterness, or blame regarding the death can be overwhelming.
8. Depression and despair: A deep sense of hopelessness and sadness is common, often accompanied by thoughts of self-harm or suicide.

Causes of Complex Grief

Several factors can contribute to the development of complex grief. These include:

1. Nature of the relationship: The depth and complexity of the relationship with the deceased can influence the grieving process. The loss of a spouse, child, or close friend may trigger complex grief.
2. Circumstances of the death: Sudden, unexpected, or violent deaths are more likely to result in complex grief compared to anticipated or natural deaths.
3. Individual psychological factors: Pre-existing mental health conditions such as depression, anxiety, or PTSD can exacerbate the grieving process.
4. Lack of social support: A strong network of supportive friends and family can help mitigate the intensity of grief. Lack of support can lead to feelings of isolation and prolonged grief.
5. Previous experiences with loss: Individuals who have experienced multiple losses or have unresolved grief from past losses may be more vulnerable to complex grief.

Risk Factors

Certain risk factors can increase the likelihood of someone developing complex grief. These include:

1. Personal history of trauma or abuse: Those with a history of traumatic experiences may have a more difficult time with their loss.
2. High dependency on the deceased: Individuals who were highly dependent on the deceased for emotional or financial support may be more at risk of complex grief.
3. Limited coping mechanisms: People with fewer coping strategies or resilience may find it harder to navigate the grieving process.
4. Ambiguous loss: Situations where the fate of the deceased is unknown, such as missing persons cases, can complicate the grieving process. This can also be the case with unresolved or explained causes of death, and when the death is unexpected and/or very sudden.
5. Cultural or societal factors: Cultural norms and societal attitudes toward death and grieving can impact how individuals process loss.

Working with Complex Grief in the Consulting Room

Working effectively with someone experiencing complex grief could involve a range of ways of working and interventions. These may include:

1. Working directly with complicated grief: With the agreement of the bereaved person therapy can be used to focus on helping individuals adapt to the loss and rebuild their lives. This might involve revisiting the story of the death, addressing negative thoughts, and fostering re-engagement in daily life by developing interests that could bring pleasure, and to maintaining or re-establishing connections with those still present in the bereaved person’s life.
2. Honouring the person who has died and maintaining meaningful bonds with them: This is known as ‘Continuing Bonds Theory’ (Klass, Silverman & Nickman, 1996) which supports the idea that bereaved people are likely to find it helpful to create a meaningful bond with the person they’ve lost, but one that is new and potentially different from the bond that exist when the person was alive.
3. Planning Ahead: Having a mindful and thought-through plan in place for difficult moments ahead, such as anniversaries, or family gatherings.
4. Cognitive Behavioural Therapy (CBT): CBT can be helpful if the predominant issue for the bereaved person is intrusive thoughts or behaviours that are harmful. 
5. Medication: There is debate about the interface between complex grief and depression, but some people do find antidepressants or anti-anxiety medications helpful alongside therapy to alleviate some of the symptoms associated with complex grief.
6. Support groups: Participation in support groups can be helpful for some people. They can provide a sense of community and understanding, allowing individuals to share their experiences and gain support from others who are going through similar struggles. It’s worth noting that groups can be very difficult for some people, despite the huge benefits they can bring.
7. Mindfulness and stress-reduction techniques: Practices such as meditation, yoga, and deep breathing exercises can help manage the emotional and physical symptoms of grief.
8. Self-care and allowing others to care: Learning about compassion and self-care, allowing time for sadness, and allowing others to be of help.

Conclusion

Complex grief is a debilitating condition that can severely impact an individual’s life.

Recognising the symptoms and understanding the underlying causes and risk factors are crucial for effective intervention.

With appropriate therapeutic support it is possible for people to arrive at a relationship with their grief that means they can regain a sense of normalcy and find a way to live meaningfully despite their loss. 

Upcoming Workshop with Dr Erin Hope Thompson

Want to explore more? Join us for our upcoming workshop – *Working with Complexity in Grief* with Dr Erin Hope Thompson on Friday 18th October, 10am – 4pm. 

In this presentation Dr Erin Hope Thompson, a Clinical Psychologist specialising in working with grief, will talk through what complexities can look like in grief and how we can work with them therapeutically.

Resources

You can read more about Models of Grief in a previous blog here on the Brighton Therapy Partnership website: “Models of Grief” blog, 2021

“Continuing Bonds: New Understandings of Grief” (1996) – Dennis Klass

“When Grief Is Complicated: A Model for Therapists to Understand, Identify, and Companion Grievers Lost in the Wilderness of Complicated Grief” (2018) – Dr Alan Wolfelt

“Complicated Grief: How to Understand, Express, and Reconcile Your Especially Difficult Grief” (2022) – Dr Alan Wolfelt (book for bereaved people)

“Supporting People through Loss and Grief: An Introduction for Counsellors and Other Caring Practitioners” (2013) – Dr John Wilson

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