How Caregivers Can Help Someone Stuck in Intense Grief

Grief is a natural response to loss, and it can present itself in many ways. Complicated grief, however, goes beyond the normal grieving process and leaves loved ones in an immovable stage of hopelessness. It is important for loved ones and caregivers to be educated on the signs of complicated grief. The Center for Complicated Grief researches and specializes in treating those who are dealing with a particularly difficult transition out of grieving for a loved one. Professor of Psychiatry Dr. Katherine Shear helps us define grief, treatments, and the healing process.

What are the signs of complicated grief? How is complicated grief different from other forms of grief?

Dr. Katherine Shear, professor of psychiatry, Center for Complicated Grief: The key signs of complicated grief (CG) are strong feelings of yearning and sadness and frequent, insistent thoughts about a person who died that continue over an unusually prolonged period of time. Grief fills the lives of people with CG, robbing them of hope for joy or satisfaction.

To people with CG, the world without their loved one seems permanently empty and meaningless. People with CG may express bitterness over the loss, disbelief or difficulty accepting the painful reality, and sometimes confusion about their sense of self. Very often they try to avoid reminders of their loss, and they second-guess themselves or others, asking over and over, "Why didn't we do something different or do more for the person who died?" They feel estranged from other people and from their own lives. People with CG feel "stuck" and often do not know what is wrong.

Complicated grief is different from other grief because it is not progressing and there are thoughts and behaviors that interfere with healing. The deceased continues to dominate the bereaved person's mind. This is different from usual long-term grief in which we still miss the person who died, we are still sad, we still think about the person, but we have found a way to make peace with the painful reality. Usually, over time we learn that we still have a connection to the deceased person even though they are gone, that we can restore our faith in ourselves and other people, and that there are still possibilities for happiness. People with complicated grief don't learn these things and their intense pain persists.

The Center for Complicated Grief and its affiliated research partners have been studying complicated grief and the grieving process for more than ten years. What new research and treatment information has come out in the past year?

KS: Our mission is to improve the lives of people with complicated grief by helping them recognize this problem and get effective help. We developed a systematic, evidence-based treatment and then confirmed its efficacy in two different studies funded by the National Institute of Mental Health, including one that focused on older adults. The treatment is delivered in 16 weekly sessions and is called Complicated Grief Treatment (CGT).

In the past year we have analyzed new research data demonstrating the efficacy of CGT. We have studied complicated grief after suicide and worked with colleagues to analyze data from a military bereavement study. We are working on further clarifying which symptoms are most commonly experienced and on better understanding different kinds of grief complications. We continue to work on diagnostic criteria to provide a simple way of recognizing CG. We are preparing a short documentary film to help people better understand CG and CGT.

Recently, we have done webinars for several organizations and radio talk shows. We were featured in a Parade magazine story and a story on the Modern Loss website. Links to these stories and events are provided on our website,

A big part of the Center for Complicated Grief is the educating of professionals. What programs are available for professional caregivers?

KS: Caregivers are important in the lives of older people, and we want to help educate and support professional as well as family members who provide care. Caregivers are often in a position to recognize CG even though they are not able to provide needed clinical treatment. Our presentations, webinars, and workshops across the country and around the world are designed to educate professionals about complicated grief and complicated grief treatment. Depending on their background and interest, professional caregivers could potentially participate in some of these educational activities. Additionally, we have started a newsletter, which provides regular updates for bereaved people and their families and professional caregivers, as well for professionals who provide treatment. We are going to be addressing this in more depth over the next year. A book describing how to recognize and treat complicated grief is nearly completed and will be published by Guilford Press.

How does someone who has complicated grief, or knows someone who shows signs of complicated grief, get help?

KS: There are excellent and experienced grief counselors throughout the country and around the world. We have developed a referral list that we continue to grow. It includes therapists who are familiar with CG and some who are skilled in administering CGT. In addition, people who are working with a trusted therapist can put that person in touch with us, and we will help them recognize CG and learn about complicated grief treatment. We are increasing our work to train more mental health professionals from around the country in CGT. Therapists currently trained in the treatment are listed on our website at

The organization called the Association for Death Education and Counseling (ADEC) is an also excellent place to get referrals. To find a therapist in your area, see the Association for Death Education and Counseling's website.

If I know someone with complicated grief, how can I get her or him involved with the research done by the Center for Complicated Grief?

KS: The best way for someone with complicated grief to get involved in our Center is to sign up for the newsletter on our website. They can learn about CG on the website and the newsletter will keep them updated about the latest research and other information. We are going to be soliciting information from people who have been through the treatment, and that information will also be available there.

For people who want to participate in research and who live in the areas of Boston, San Diego, or Pittsburgh, they can contact us at for referral information. We will announce on our website and in social media additional research opportunities as they open up.

Is there anything else you'd like tell us about how the Center for Complicated Grief can help families and caregivers of the elderly?

KS: The older we get, the more likely we are to have experienced the death of a loved one, and some older bereaved people will develop complicated grief. Caregivers and friends can feel helpless and become frustrated with these people. It is important that friends and caregivers recognize the signs of complicated grief and that they provide support and not give up on this person. It is important to recognize that a person with complicated grief is not "wallowing in her or his grief" but is struggling with feelings or thoughts that she or he is not able to control. The Center for Complicated Grief can help educate families and caregivers of the elderly about how to support and talk to someone with complicated grief.


over 4 years, said...

@Dr.R.A.Robinson You can reach Dr. Shear and the Center for Complicated Grief here: @skiing Sorry to hear about the situation you described. I searched online and found these potential resources for you: 1.) GriefShare list of Reno, NV grief support groups: ; 2.) Psychology Today list of grief counselors in the Reno, NV area: ; 3.) a family counseling organization that also covers grief: . Consider also contacting local hospice organizations to ask their recommendation: also offers grief information and support in this area of our website: I hope this helps.

over 4 years, said...


over 4 years, said...

I have my PhD in Human Services and counseling. I am unemployed but looking and interested in your program. If it comes around the Milford, PA area, known locally as near the tri-state area of NY/NJ/PA I would be very interested in certification in bereavement and CG treatment. I am looking to do a post doc to carry on a study about ecotherapy implementation in CBT and with CG how nature may also help heal.

over 4 years, said...

As a complicated grief therapist, I am so happy that we continue to educate Mental Heath Professionals as well as bereaved individuals about the syndrome of complicated and the treatment for this debilitating condition.