Living With Loss: What Grief Counseling Can Offer

By Amanda LaMela

When someone is grieving, the idea of talking to a therapist often elicits mixed feelings. Some may worry they will be pushed to “move on” before they are ready. Others may fear being forced to revisit the most painful parts of the loss repeatedly. Grief counseling should do neither. Instead, it offers a place to talk honestly about what has changed, stay connected to what the person and relationship meant, and begin finding ways to live in a world that feels forever altered.

Although this article focuses primarily on grief after a death, people can grieve many kinds of loss. We grieve past relationships, infertility, a serious illness or disability, the loss of a job, home, community, identity, or imagined future. Anticipatory grief occurs before the expected loss. This type of grief may occur when supporting a loved one through terminal illness or preparing your child to leave for college. Ambiguous grief is when the loss is not punctuated by a clear ending or resolution. For example, being ghosted by a longtime partner or having a family member go missing. Disenfranchised grief occurs when the loss is not fully recognized or supported by others. Grief may feel disenfranchised after a friendship breakup, the loss of an undisclosed pregnancy, or the death of a secret affair partner. Someone may also experience cumulative grief when several losses occur close together, or traumatic grief when a loss is sudden, violent, or frightening. These forms of grief often overlap, and the labels exist to help people recognize that grief is not limited to death. A loss does not need to be publicly visible or easily explained to have an intense emotional impact. 

Want to explore a poignant media representation of the many faces of grief? Read my prior article, The Many Seasons of Grief & Loss: Anne in Netflix’s The Four Seasons.

There is no “correct” way to grieve.

Grief can affect emotional regulation, attention, memory, sleep, appetite, relationships, identity, and perception of time. It may include sadness and longing, but also anger, guilt, relief, numbness, fear, resentment, and even moments of genuine pleasure. These experiences do not unfold in a universal sequence.

Researchers following people before and after bereavement have identified multiple adjustment trajectories, including resilience, gradual recovery, chronic grief, and preexisting depression that continues after the loss. In other words, there is no “right” way to grieve (Bonanno, Wortman, & Nesse, 2004). This matters when evaluating grief counseling. If researchers offer therapy to everyone who has experienced a loss, including people who are already adapting with the support available to them, treatments may appear to have only a small to moderate effect. On the other hand, researchers found therapy produces strong and measurable benefits when people actively want help or are experiencing substantial distress, impairment, avoidance, or difficulty adapting.

After a loss, some individuals develop prolonged grief disorder (PGD). This is a condition involving persistent yearning or preoccupation with the deceased, related emotional and identity disruptions, and significant impairment beyond what would be expected within the person’s cultural context. Under DSM-5-TR criteria, an adult cannot receive the diagnosis until at least 12 months after the death (Prigerson et al., 2021). While this time requirement is a diagnostic boundary, it does not mean you should postpone seeking treatment. Support can still be valuable without a diagnosis. Still struggling 12 months after a life-altering loss? You aren’t broken or “doing grief wrong.” Therapy isn't meant to pathologize your experience. The right therapist will help you integrate your grief, rediscover meaning, and support regulation and functioning in your day-to-day life.

What happens in grief counseling?

Grief counseling, like any effective therapy, is never one-size-fits-all. The work should reflect the relationship that was lost, the circumstances of the loss, the client’s culture and spirituality, and the problems that are most disruptive now. That being said, several processes appear across most contemporary approaches. Here are the five I find to be most effective:

1. Creating an outlet for grief: After a loss, other people may change the subject, avoid mentioning the deceased, offer premature reassurance, or expect your grief to expire gradually. Well-meaning friends will probably say a lot of dumb things. Therapy provides a relationship where you don't have to protect your trusted counselor from the intensity or complexity of your experience. Your therapist can help you name emotions, notice bodily responses, understand triggers, and tolerate grief in manageable doses. The goal is to gain greater flexibility, increasing your capacity to approach grief when it needs attention and step away when ordinary life is needed.

2. Moving between loss and life: The influential Dual Process Model describes adaptation as movement between two kinds of coping. Loss-oriented coping includes remembering, yearning, crying, and processing what happened. Restoration-oriented coping includes handling new responsibilities, developing routines, reconnecting socially, and imagining a changed future (Stroebe & Schut, 1999). Grief counseling may help restore this movement when someone feels trapped at either pole, either immersed in the loss without respite or staying relentlessly busy to avoid encountering it. 

3. Approaching what has become unbearable: Avoidance can bring understandable short-term relief. Individuals might avoid photographs, conversations, places, belongings, or memories of the death. Over time, however, life can become increasingly organized around not feeling grief. Evidence-based treatments for prolonged grief often use gradual, collaborative revisiting of memories and reminders. This might involve telling parts of the story, visiting a meaningful place, looking at photographs, or having an imagined conversation with the deceased. This helps the mind integrate what happened and discover that painful memories can be approached without permanently losing control.

4. Working with guilt, meaning, and identity: Loss frequently generates thoughts such as “I should have known,” “I failed them,” “I am no longer myself,” or “My life has no meaning without this person.” Brief moments of relief or laughter may trigger a wave of subsequent guilt and sadness. Therapy examines these cognitions without arguing the client out of their feelings. The work may include distinguishing responsibility from hindsight, making room for ambivalence, exploring unfinished business, and reconstructing a sense of identity. When the death was sudden, violent, stigmatized, or medically traumatic, treatment may also need to address trauma symptoms rather than assuming every reaction is grief alone.

5. Transforming rather than eliminating the bond: Contemporary grief work does not require detachment from the person who died. Clients may remain connected through memories, rituals, values, objects, spiritual beliefs, or choices influenced by the relationship. A systematic review found that these “continuing bonds” can contribute to comfort, identity, and meaning, but can also be distressing depending on their form and context (Hewson et al., 2023). Therapy helps the relationship take a form the bereaved person can manage and honor.

How effective is grief counseling?

A 2025 umbrella review examined 33 systematic reviews and meta-analyses of bereavement interventions. Seven offered strong, unconditional support, 24 found benefits under particular conditions, and only two concluded that there was no supporting evidence. The authors concluded that bereavement interventions are generally helpful, while emphasizing some research limitations (Avis et al., 2025). Similarly, a meta-analysis of 31 randomized controlled trials found improvements in grief symptoms both immediately after treatment and at follow-up (Johannsen et al., 2019). Interventions were most effective when they specifically enrolled people showing significant problems adapting to a loss (Currier, Neimeyer, & Berman, 2008).

The evidence becomes stronger when treatments are designed for prolonged grief. A 2024 meta-analysis of 22 randomized trials involving 2,602 adults found that grief-focused cognitive-behavioral therapies produced a medium reduction in prolonged grief symptoms after treatment and a large reduction at follow-up (Komischke-Konnerup et al., 2024). Individual trials reinforce this finding. In an early randomized trial, 51% of participants receiving Complicated Grief Treatment responded, compared with 28% receiving interpersonal psychotherapy (Shear et al., 2005). A larger trial later found that adding the grief-specific treatment to clinical medication management increased response from 54.8% to 82.5%. Adding the antidepressant citalopram did not further improve grief outcomes, although it did help co-occurring depressive symptoms (Shear et al., 2016).

More recently, a trial of 100 adults found that both grief-focused CBT and mindfulness-based cognitive therapy helped, but grief-focused CBT produced greater improvement in prolonged grief symptoms six months later (Bryant et al., 2024). The strongest evidence supports structured, grief-focused therapies for people with persistent and impairing symptoms. Broader supportive counseling may still offer connection, understanding, and help with specific concerns, but its effects are harder to quantify across diverse clients and approaches.

Is grief counseling right for you?

You do not have to prove that your grief is severe enough to deserve attention. Counseling may be worth considering when:

1. You feel unable to speak honestly about the loss elsewhere.

2. Guilt, anger, avoidance, or unanswered questions dominate your days.

3. Grief is significantly affecting sleep, work, relationships, eating, or self-care.

4. The death was traumatic, sudden, stigmatized, or accompanied by other losses.

5. You feel disconnected from your identity, future, or reasons for living.

6. Your world has become increasingly restricted around reminders of the loss.

7. You want support adjusting to life after loss.

A prospective therapist should understand the complexities of grief and explain how they would pace emotionally difficult work. Effective grief therapy should be collaborative. It should make space for culture, spirituality, ambivalence, and the specific relationship that was lost. Good counseling should help grief become less isolating and more integrated into a life that still has room for connection, meaning, and change.

References

Avis, K. A., Missler, M., van Deursen, D., Lenferink, L. I. M., Stroebe, M., & Schut, H. (2025). The efficacy of bereavement interventions: A systematic umbrella review. Harvard Review of Psychiatry, 33(3), 127–148. https://doi.org/10.1097/HRP.0000000000000426

Bonanno, G. A., Wortman, C. B., & Nesse, R. M. (2004). Prospective patterns of resilience and maladjustment during widowhood. Psychology and Aging, 19(2), 260–271. https://doi.org/10.1037/0882-7974.19.2.260

Bryant, R. A., Azevedo, S., Yadav, S., Cahill, C., Kenny, L., Maccallum, F., Tran, J., Choi-Christou, J., Rawson, N., Tockar, J., Garber, B., Keyan, D., & Dawson, K. S. (2024). Cognitive behavioral therapy vs mindfulness in treatment of prolonged grief disorder: A randomized clinical trial. JAMA Psychiatry, 81(7), 646–654. https://doi.org/10.1001/jamapsychiatry.2024.0432

Currier, J. M., Neimeyer, R. A., & Berman, J. S. (2008). The effectiveness of psychotherapeutic interventions for bereaved persons: A comprehensive quantitative review. Psychological Bulletin, 134(5), 648–661. https://doi.org/10.1037/0033-2909.134.5.648

Hewson, H., Galbraith, N., Jones, C., & Heath, G. (2024). The impact of continuing bonds following bereavement: A systematic review. Death Studies, 48(10), 1001–1014. https://doi.org/10.1080/07481187.2023.2223593

Johannsen, M., Damholdt, M. F., Zachariae, R., Lundorff, M., Farver-Vestergaard, I., & O’Connor, M. (2019). Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders, 253, 69–86. https://doi.org/10.1016/j.jad.2019.04.065

Komischke-Konnerup, K. B., Zachariae, R., Boelen, P. A., Marello, M. M., & O’Connor, M. (2024). Grief-focused cognitive behavioral therapies for prolonged grief symptoms: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 92(4), 236–248. https://doi.org/10.1037/ccp0000884

Prigerson, H. G., Boelen, P. A., Xu, J., Smith, K. V., & Maciejewski, P. K. (2021). Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World Psychiatry, 20(1), 96–106. https://doi.org/10.1002/wps.20823

Shear, M. K., Reynolds, C. F., III, Simon, N. M., Zisook, S., Wang, Y., Mauro, C., Duan, N., Lebowitz, B., & Skritskaya, N. (2016). Optimizing treatment of complicated grief: A randomized clinical trial. JAMA Psychiatry, 73(7), 685–694. https://doi.org/10.1001/jamapsychiatry.2016.0892

Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197–224. https://doi.org/10.1080/074811899201046