Grief is a normal, natural, and individualized internal experience of a loss and it changes over the course of the lifetime of a person who is experiencing grief.

Acute Grief

Acute grief, also called early grief, is the intense period of time after a person experiences a loss. During acute grief, a person may experience feelings of being in shock and/or numb. It is common for a person to experience extreme sadness, yearning, and/or searching for their loved one when in acute grief.

Grief can impact a person’s physical, emotional, mental, social, behavioral, and spiritual aspects of their wellbeing. Grief itself is not a psychological disorder but it causes deep emotional distress and suffering. There are no set guidelines to define the timeline or severity of acute grief. It typically has a gradual decrease of the intensity of emotions and a gradual ability to regain typical functioning in the person’s basic daily activities.

Dr. Thomas Attig describes grief as “both experiencing and reacting to loss and actively responding to it. Grieving is about both suffering and resilience, experiencing the devastation and hurt and reaching through them to affirm life” (2004). As the intensity and frequency of grief decrease, the person experiencing grief learns to integrate and carry the pain of missing their loved one as they relearn to lead a meaningful life. “The heart of grieving is making a transition from loving in presence to loving in separation” (Attig, 2004).

Complicated Grief

Complicated grief, also referred to as prolonged grief, and persistent complex grief occurs when acute grief becomes severe in longevity and significantly impairs the ability to function in a person’s daily life. Some of the characteristics of complicated grief are intense yearning, intense sorrow, preoccupation with or avoidance of the deceased, social withdrawal, intense feelings of emptiness or loneliness, feeling life is meaningless or unfulfilling, inability to adjust and interact in new experiences and suicidal ideation. Grief can be complicated if persistent feelings of anger, unhealthy guilt, regret, resentment, bitterness is not worked through. Holding on to these roadblocks could keep a griever from opening up to others and new experiences.

Goals of Therapy for Acute Grief and Complicated Grief

Many people who experience grief will reach the state of integrated grief (incorporating grief into a person’s life without it dominating their being while moving forward to live a fulfilling life) with support and understanding from family and friends. However, the person experiencing acute grief could benefit from either or both individual bereavement therapy and bereavement group counseling to help ease the transition of integrating grief into their life.

Individual bereavement therapy will provide a comforting place to experience catharsis (releasing painful, strong, or repressed emotions to gain emotional relief) by being able to share your grief story. The person grieving will also learn about their physical, emotional mental, social, behavioral, and spiritual grief reactions, and techniques to cope with those grief reactions. Individual bereavement therapy can be done in preparation for taking part in a bereavement group, concurrently while attending a bereavement group or it can be done after a bereavement group to further address the personal grief complications or roadblocks.

In bereavement group counseling a person experiencing grief will also have the opportunity to experience catharsis, learn about the common physical, emotional, mental, social, behavioral, and spiritual grief reactions and techniques to cope with those grief reactions. The grief experience is very isolating even when physically surrounded by loved ones. In a bereavement group, the griever will find support in strangers that will quickly become grief friends.

The purpose of both individual bereavement therapy and bereavement group counseling is helping people confront their loss, regain confidence in themselves, their lives, and their future and to participate in activities that are fulfilling and meaningful (Boelen, 2007).

References:

• Attig, T. (2004). Disenfranchised grief revisited: Discounting hope and love. Omega, Vol 49, p. 197-215
• Boelen, P., de Keijiser, J., van den Hout, M., van den Bout, J. (2007). Treatment of complicated grief: A comparison between cognitive–behavioral therapy and supportive counseling. Journal of Counseling and Clinical Psychology, 227-284.
• Enez, O. (2018). Complicated grief: Epidemiology, clinical features, assessment and diagnosis. Current Approaches in Psychiatry, 269-279.
• Mancini, A., Sinan, B., Bonanno, G. (2015). Predictors of prolonged grief, resilience, and recovery among bereaved spouses. Journal of Clinical Psychology, 1245-1258.
• Complicated grief for professionals. Retrieved from http://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/

– Liz Lassus is a Certified Grief Counseling Specialist