13 Types of Grief + How to Treat Loss in Therapy

Every day, millions of people are affected by the loss of a loved one.

They remember the precise time, location, and what they were doing when they heard the news and its devastating impact.

While commonplace, we may feel ill equipped to manage our grief and not ready to accept its impact on our lives. Dealing with pain requires work at multiple levels, both psychological and physical, and often requires support (Samuel, 2019).

Grief therapy offers psychological help for the grieving process and those whose ability to function has been harmed by losing someone close.

This article explores grief and loss, the different types, and the approaches used in grief therapy to provide treatment.

Before you continue reading, we thought you might like to download our three Grief Exercises [PDF] for free. These science-based tools will help you move yourself or others through grief in a compassionate way.

What Are Grief and Loss?

“Grief is the emotional reaction to a loss, in this case, to death” (Samuel, 2019, p. xvii), and mourning is the process of adjustment to a world without that person.

Grieving is about finding a way to live with a reality that we don’t want, breaking our sense of control over life and forcing us to confront our mortality.

The intensity of our feeling of loss following the death of a loved one can be tied to our degree of attachment and experienced as physical sensations or difficult emotions.

The following physical sensations and perceptual experiences often accompany the grieving process (modified from Worden, 2009):

• Hollowness in the stomach
• Tightness in the throat and chest
• Being oversensitive to noise
• Feelings of unreality
• Shortness of breath
• Muscle weakness and lack of energy
• Dry mouth

Strong emotions typically occur during grief, including (modified from Worden, 2009):

• Sadness
  Failure to acknowledge and embrace sadness can cause more complicated and prolonged grief.
• Anger
  A common reaction to loss that leads to many issues during the grieving process.
• Guilt and self-reproach
  Often regarding something that happened or was neglected at the time of death.
• Anxiety
  Ranging from feelings of insecurity to panic attacks, sometimes associated with fears of being unable to take care of yourself in the absence of the other person.
• Loneliness
  The loss of a day-to-day relationship can leave someone feeling all alone. Social support can help but does not remove the sense of a broken attachment.
• Fatigue
  Feelings of apathy and listlessness are not uncommon following the death of a loved one and may limit behavior and activity.
• Helplessness
  Survivors can be left feeling vulnerable and helpless, especially when they have young children to look after.
• Shock
  Sudden death, by its very nature, can cause the survivor to experience shock.
• Yearning
  Yearning or pining for the loved one is a typical reaction to death, and as it reduces, may indicate the mourning process is coming to an end.
• Emancipation and relief
  It is not uncommon for a survivor to experience a sense of relief, especially where the deceased was oppressive or was suffering a prolonged illness. While a normal response, it may be accompanied by feelings of guilt.
• Numbness
  While the previous feelings are common, so too is an absence of emotions, at least initially. With so many feelings to experience and manage, the early stages of grief may be overwhelming and result in a protective numbness.

It is important to note that each person’s experience of grief is different, and while the emotions above are typical of loss, they are not exhaustive.

13 Types of Grief According to Psychology

While grief is frequently viewed in terms of our emotional response to the loss of a loved one, it can be expressed in other ways, including physical, behavioral, social, and cognitive (Worden, 2009).

Types of grief can take various forms, including (Elizz by SE Health, 2019; CaringInfo, n.d.; WebMD, n.d.):

• Abbreviated grief
  A short-lived response to a death, possibly following the experience of prolonged anticipatory grief or something immediately filling the space left by the loss.
• Absent grief
  The bereaved may not acknowledge or may remain in denial of what has happened. If prolonged, the lack of response can be concerning and require specialist support.
• Anticipatory grief
  For a caregiver, grief can begin before the person being cared for dies. It may be associated with a sense of losing what they expected life to be like. Such feelings can start with a terminal diagnosis or a worsening state of health.
• Chronic grief
  A sub-type of complicated grief (see below), left untreated, chronic grief can involve extreme feelings of hopelessness, a sense of disbelief, and a loss of meaning, leading to severe clinical depression or thoughts of self-harm and even suicide.
• Collective grief
  A shared experience of grief that affects a family, group, or community, often preceded by an event (natural disaster or attack).
• Complicated grief
  Where grief seems to deviate from what’s expected, complicated grief interferes with the ability to function. Complicated grief may include chronic (see above), delayed, or absent grief (American Psychological Association, n.d.).
• Cumulative grief
  Multiple deaths over a period of time can leave the bereaved without the opportunity or capacity to process each loss.
• Delayed grief
  Grief may not occur immediately after losing a loved one but may be postponed until another significant event occurs, resulting in what may seem an excessive response to the present situation.
• Distorted grief
  An extreme form of complicated grief exhibited as self-destructive behavior, anger, guilt, or hostility toward others.
• Disenfranchised grief
  When others do not recognize the importance of the loss, such as the death of an ex-partner, pet, or colleague. Society may consider the loss as minor or not legitimate.
• Inhibited grief
  Grief may not always be outwardly visible; it may result from a conscious effort to maintain privacy or keep emotions hidden from close friends or family.
• Masked grief
  Atypical physical symptoms and behaviors can be a response to grief without being attributed to the loss.
• Normal grief
  While there may not be a ‘typical’ grief shared by everyone, normal grief is considered to be when emotional intensity surrounding the death gradually decreases or basic daily activities begin to return to normal.

As professionals, but also as a society, “we need to learn to support a healthy grieving, and to help people to understand that each person goes at their own pace” (Samuel, 2019, p. XX).

3 Real-Life Examples of Grief and Loss

The following examples of grief and loss introduce some of the factors specific to each type of grief, bringing their own challenges and potentially requiring focused attention.

Death of a parent

The death of a parent has the potential to shake up how we feel (at any age) about our own mortality and our place in relation to earlier generations. Our parents are typically part of our first relationships (Dawson, 2018).

Telling the truth regarding an ongoing illness or funeral arrangements is essential. Young children can be left not knowing what is happening, shielded from what is going on, and passed from one family member to another. Instead, the news must be given simply and directly in a quiet, safe, and supportive environment. Maintaining familiar boundaries and structures can help the child feel more safe and secure (Samuel, 2019).

Here are more strategies for helping children cope with grief.

Death of a partner

When partners are committed to one another, they typically hope and expect to build long and meaningful lives together. Cut short by death, their future becomes unimagined.

The emotional effect of losing a partner is considerable and, perhaps, unsurprising; after all, we often define ourselves according to our relationship. “Social connection and emotional support are beneficial to the wellbeing of both men and women” and can help the bereaved find meaning and adapt to their new lives (Samuel, 2019, p. 47).

Death of a child

For most parents, the loss of a child is unimaginable, “leaving a fathomless hole” that “takes a long time to rebuild their lives afterwards” (Samuel, 2019, p. 185).

The parent is left in the tragic situation of having to rethink and realign their ideas of their present and future lives. Feelings of guilt can be all consuming, regardless of the cause of death, and may require focus during therapy. Hope and post-traumatic growth do not suggest in any way that death was a good thing or reduce its severity, but can lead to building new and meaningful futures (Samuel, 2019).

How to Perform Grief Therapy: 10 Types of Approaches

The treatment given to those attempting to process grief must be specific to the individual and their experience.

The following 10 approaches overlap and complement one another in supporting the bereaved (modified from Worden, 2009).

1. Helping the survivor actualize loss

Losing someone can give a sense of unreality; it can feel like it isn’t really happening. One of the best ways to actualize the loss is to talk about what has happened.

When and where did the death occur?
What happened?
How were you told and where were you?

Visiting the grave can also make the loss more concrete.

2. Helping the survivor identify and experience feelings

Many feelings may not be recognized or felt to their full degree during intense grief. It is essential to help survivors experience the following:

Anger – arising from feelings of frustration and helplessness.
Guilt – for what the bereaved did and did not do to affect the outcome (usually irrational).
Anxiety and helplessness – feelings of helplessness can leave the bereaved unsure if they can survive alone and concerned about their own mortality.
Sadness – it can be challenging for many to show their upset in front of others. Crying can be helpful if associated with an awareness of what was lost.

3. Assisting living without the deceased

Ultimately, those left behind must learn to live and make decisions without the deceased. The counselor may focus on problem-solving, asking:

What problems are you facing, and how can they be resolved?

It is important to neither rush the bereaved to make decisions nor encourage a sense of helplessness, but instead communicate that they will be able to make decisions when they are ready.

4. Helping find meaning in the loss

Counselors can support the bereaved as they attempt to find meaning in their loss; the process may be as vital as the answers they identify.

Questions may include:

Why did this happen?
Why did this happen to me?
How has this loss changed me?

5. Facilitating emotional relocation of the deceased

An essential part of the grieving process is for the bereaved to move forward by finding a new place in their life for the loved one. Some may find this challenging, as they feel they are dishonoring their loved ones.

6. Providing time to grieve

Adapting and adjusting to a world without a loved one takes time. The process is a gradual one. The counselor must recognize that interventions and support are often longer term, with strong emotions resurfacing during anniversaries and other occasions.

7. Interpreting ‘normal’ behavior

Grieving people may feel they are going crazy or acting abnormally. The counselor can help by normalizing grief behaviors, such as heightened distractibility or a preoccupation with the deceased.

8. Allowing for individual differences

No two people grieve in the same way; the process and feelings associated with loss are unique. There is tremendous variability in the following:

• Intensity of affective reactions
• Degree of impairment
• Length of time it is experienced

Families may need help to understand that each member differs in the time and the way they grieve.

9. Examining defenses and coping styles

The bereaved are likely to experience heightened defenses and maladaptive coping styles. Unhelpful behavior, such as excessive alcohol use, may indicate failure to adjust to the loss, and the counselor may need to intervene.

10. Identifying pathology and referring

The counselor must identify those in trouble, recognize their own limits, and know when to refer. Some pathologies will require specific help from a dedicated professional, including prolonged or complicated grief.

9 Tips for Your Grief Counseling Sessions

There are many and varied techniques and tips for use in grief counseling and therapy (Worden, 2009).

• Evocative language
  Speaking of the loved one in the past tense or using words such as “died” rather than “lost” is essential when dealing with reality issues or encouraging painful feelings to surface.
• Use of symbols and objects
  It may help to ask the bereaved to bring photos, letters, videos, and belongings to sessions to provide focus and a sense of immediacy.
• Writing a letter
  A farewell letter written to the deceased can lead to a sense of resolution and reduced negative feelings.
• Drawing
  Both the act and outcome of drawing can help reflect feelings. It is particularly valuable in children or those lacking the words to explain their emotions fully.
• Role-play
  Using role-play to practice new skills or feared forthcoming situations can rebuild confidence.
• Cognitive restructuring
  Negative self-talk and covert thoughts can be unhelpful. Testing their validity or accuracy can help lessen their effect.
• Memory books
  Creating a memory book for the deceased can be a powerful exercise for the whole family. Collecting photographs, certificates, writing, and drawings can help the group reminisce and mourn a realistic, less contrived image of the person.
• Directed imagery
  Imagining the deceased and talking to them as they sit in an empty chair can encourage talking to rather than about the person.
• Metaphors
  When directly confronting feelings is difficult, metaphors can be helpful. Images can conjure up an open dialogue about the pain of loss.

Grief Resources From PositivePsychology.com

Grief is not one but many emotions and may require support from well-trained therapists and counselors (Brown, 2021). We have many resources that can help, including:

Handy worksheets

• Grief Sentence Completion Task
  This exercise can help clients to consider feelings in the moment and understand the sense of loss.
• If I Could Talk to You One Last Time
  This exercise encourages the bereaved person to consider their feelings and emotions by finishing a series of prompts.
• My Grief Plan
  Learn practical strategies for coping with grief and find a way to move forward with life using this worksheet.
• Challenging Unhelpful Thoughts Arising From Grief
  Use this worksheet based on a cognitive-behavioral approach to replace negative thoughts.

Recommended articles

• 9 Grief Books, Worksheets, & Journal Prompts to Help Clients
  Our grief books article is a recommended read, with additional resources to help clients deal with grief.
• Maranasati Meditation: How to Practice Mindfulness of Death
  When we are forced to confront our own mortality or struggling to make peace with a loved one facing a terminal diagnosis, maranasati meditation can be a helpful way to lessen the anxiety of death. It is based on early Buddhist practices focused on mindfulness of death.
• Grief Meditation and Yoga: Healing Through Awareness
  Dealing with the stress of bereavement can be mediated with the application of specific yoga exercises. This Grief Meditation and Yoga article can be a valuable instrument in the healing process.

Professional tools

The 17 Grief and Bereavement Exercises can be purchased directly or are available with a subscription to the Positive Psychology Toolkit©, but some exercises are described briefly below:

• Journaling Through Grief in 40 days

Journaling creates a lasting record for the bereaved to revisit and reflect upon their journey in a safe, nonjudgmental way.

Step one – Find a safe place and relax while encouraging self-compassion.
Step two – Use the prompts included to help the process of writing about loss.
Step three – Reflect on the feelings that arise while writing and how the process affects their intensity.

• People Supporting You As You Grieve

Creating an accurate representation of the relationships and resources available to the bereaved person can support them as they process loss.

Step one – Begin by creating a support network map.
Step two – Identify and reflect on the strength of each connection.
Step three – Evaluating the completed diagram, consider whether there are sufficient connections and if they should be strengthened.

A Take-Home Message

Whether expected or out of the blue, the death of a loved one results in multiple feelings of loss, impacting our emotions, thinking, behavior, identity, and sense of meaning we find in our lives (Brown, 2021; Samuel, 2019).

Grief can take many forms and may leave the bereaved feeling out of control and hopeless. Support from family, friends, and a trained therapist or counselor can help them come to terms with what has happened.

Treatment may need to focus on understanding what the loss means to the individual and helping them experience feelings hidden from those closest and even themselves. Anger, guilt, and sadness are common and should be recognized as normal responses to a challenging event.

Focusing on helping the bereaved learn to live, make decisions, and find meaning in their lives encourages them to move forward and live again with hope. The journey may not be straightforward and can often be protracted, but moving forward is possible with the proper support.

This article introduces some of the essential concepts regarding grief. It provides insights and supporting resources for those wishing to perform grief therapy or coming into contact with the life-changing impact of loss.

We hope you found value in reading this article. Don’t forget to download our three Grief Exercises [PDF] for free.

[Reviewer’s Update]

While this article focuses on death specifically, it’s important to note that there are a wide variety of events and experiences that can constitute “loss” and trigger “grief.”