Grief Treatment Plans
Grief is a normal, inevitable part of life. At some point, nearly every person in the world will experience a significant loss that leaves them feeling mournful and sorrowful. Despite this, many people who experience intense, ongoing grief do not seek professional mental health services. While grief is a natural response to loss, and its symptoms often decrease over time, everyone deals with it differently. Some people may cry for weeks on end and lose their appetite, while others manage their pain with humor and distraction.
As a therapist or counselor, your job is to help people come to terms with the loss in their lives. Still, grief can become a problem if it's prolonged, brings up old trauma, triggers a mental illness, or prevents a person from taking care of themselves and living a healthy life. This guide will examine the different types of grief and how you can develop a customized treatment plan for each client's unique needs.
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What is Grief?
Grief is a term used to describe the feelings, behaviors, and thoughts someone experiences due to the loss of something or someone close to their heart. People can experience grief after losing many things, such as a job, a sentimental object, a relationship, or anything else they may have loved.
When you hear the term “grief,” you likely think of losing a loved one. The type of grief usually contains a period of mourning, sadness, and loneliness a person feels after a loved one's death, also known as bereavement. It's impossible to measure human emotions, but everyone experiences the types and stages of grief differently.
Here are the different types of grief your clients may be going through.
This type of grief tends to occur within the first several months of losing a loved one and consists of intense symptoms, such as:
- Sadness and guilt
- Sleep problems
- Feelings of numbness or shock
- Distress that leads to physical discomforts, such as shortness of breath
- Poor concentration
These symptoms are a typical part of the grieving process and tend to resolve with time and patience. Eventually, the symptoms will become less frequent and the grief will lose its intensity. With acute grief, clients should still experience moments of happiness, such as laughter or enjoyment. However, if a person becomes depressed while grieving, they may benefit from clinical treatment.
As someone begins to heal from their initial, acute grief, they may transition into integrated grief. At this stage, they may resume their daily routines and activities as the intense pain of grief begins to subside. While the sadness of losing a loved one does not disappear, the bereaved person gradually learns how to integrate the loss into their daily life. Sometimes, your client may learn they can still feel connected to their loved one.
While experiencing integrated grief, they may fall back into acute grief and briefly feel intense symptoms again. This regression is a normal part of the process and tends to happen around significant events, such as the loved one's birthday, anniversary, or holidays. Integrated grief represents feeling loss but accepting the reality to a point where the symptoms are no longer debilitating.
When transitioning from acute grief to integrated grief, a client may develop a form of complicated grief. This type of grief brings on symptoms of acute grief for extended periods after losing a loved one. Often, they will experience frequent, debilitating memories of the deceased loved one and become ashamed that they cannot overcome their grief. Other times, they may feel that enjoying their life and returning to their usual activities is a betrayal. Complicated grief tends to occur if:
- The deceased was very young, such as a child.
- The loss was violent, unexpected, or provided no closure.
- The client has little social support.
- The client has experienced child abuse, neglect, or unhealthy relationships.
- The client has a history of anxiety or mood disorders.
Other common signs of grief include physical and emotional symptoms, such as:
- Anger and resentment
- Anxiety, insecurity, and helplessness
- Feelings of emptiness
- Shock, disbelief, and denial
- Significant weight loss or gain
- Frequent and excessive crying
- Nausea or loss of appetite
- Difficulty concentrating
While experiencing several or many of these symptoms is a sign of healthy grieving, if a client experiences them excessively or intensely, they may benefit from grief therapy or counseling techniques.
Diagnosing grief and bereavement disorders poses a unique challenge because it's so typical for people experiencing grief and loss to feel pain, sadness, and many other symptoms listed above. As a result, it can be challenging to know when your client's symptoms have reached a level that requires clinical intervention.
When assessing someone in mourning, look beyond their current symptoms. For example, do they have a history of mental illness? Have they experienced grief before? Do they have family and friends to support them through this difficulty? These are some factors to highlight during the diagnosis stage.
The DSM-5-TR recognizes that normal grief is similar to experiencing depression, but it does not always require a diagnosis. The manual also states that grief can sometimes even kick-start depressive episodes. Here are some identifying characteristics of grief that differentiate it from clinical depression:
- Someone who is grieving can still experience moments of positivity and happiness. If they are living with depression, these positive emotions are nearly fully inaccessible.
- Negative emotions of grief usually relate to the loss of the deceased, triggered by reminders or memories. During depression, negative emotions are often much more constant and caused by an inability to experience happiness.
- People living with depression tend to have poor self-esteem or self-loathing. With grief, these feelings usually relate to guilt about the deceased, such as having regrets about their last conversation.
- Sadness and loneliness related to grief tend to subside steadily over time. With depression, these feelings are often constant and unwavering.
- If a grieving person has frequent thoughts of death, it could be out of a desire to join their deceased loved one. During depression, suicidal ideation more often relates to escaping the pain of depression and feelings of worthlessness.
When treating a client for bereavement and grief, consider their cultural or religious norms and history of mental illness. A client who has experienced depression or depressive episodes can be at significant risk of their mental health declining due to grief. Assessing for depression may be helpful in some cases.
10 Types of Grief Therapy and Techniques for Helping Clients
Just as people experience different types and symptoms of grief, they also process grief in many ways. Grief therapy techniques help mental health professionals provide various approaches to dealing with the loss of a loved one, relationship, or any other significant loss in someone's life. The therapy technique that will work best for your client depends on several factors. Sometimes, combining grief therapy tools and techniques may offer a more effective outcome. Let's look at some methods you can use in grief counseling.
1. Cognitive Behavioral Therapy
Cognitive behavioral therapy is a method used in many circumstances to help clients identify negative thought patterns and learn how to change their behavior. The learning outcome of CBT is to help people process grief, understand how their thoughts affect their behavior, and guide them to live healthier lives. With CBT, you and other mental health professionals can:
- Identify and address unhelpful behaviors or harmful habits
- Introduce healthier, positive ways to cope
- Develop a new narrative surrounding the loss of a loved one
- Establish cognitive restructuring to change negative thought patterns
2. Acceptance and Commitment Therapy
As a therapist or counselor, you can use acceptance and commitment therapy to help your clients accept the negative emotions they feel instead of avoiding or feeling guilty about them. This technique can help people embrace their psychological flexibility, making it easier for them to be present in their lives and develop healthier patterns. The ACT method involves using mindfulness to process grief and achieve acceptance and healing by:
- Identifying personal values
- Overcoming difficulties
- Accepting negative feelings
- Focusing on the present
- Embracing confusion, happiness, and pain without looking to control or change these feelings
- Observing yourself experiencing negative emotions and situations to better understand them
3. Traumatic Grief Therapy
Some cases of grief also involve trauma, which can result from an unexpected or violent death or even being present and witnessing the loved one as they passed. Trauma can often mask grief and make it difficult to accept the feelings or go through the normal grieving process. Traumatic grief therapy focuses on the trauma response alongside the grief itself, disentangling the two emotions to help the client heal.
As a therapist, you may have worked with clients who needed someone to listen to them and validate their feelings. Companioning is a form of grief therapy treatment focused on that. Rather than trying to analyze or “fix”’ the client's situation, a companioning therapist is present and provides a safe space for people to express their thoughts and emotions and feel supported.
5. Complicated Grief Therapy
As mentioned above, complicated grief can often bring back intense symptoms associated with acute grief and cause someone to feel that they've regressed in their grieving process. Complicated grief therapy helps clients address these symptoms of severe, prolonged sadness or hopelessness and accept that these emotions are a natural part of losing a loved one. Complicated grief treatment often combines with ACT methods to help clients who may fixate on the loss or the circumstances surrounding the death.
6. Group Therapy
Group therapy is a technique for people who can benefit from sharing their thoughts and feelings with others who are in a similar situation. Group therapy can be effective for grieving clients who lack a support system. They can listen to others in various stages of their grieving process and learn how to recover from a similar experience. This therapy may also help clients consider others' perspectives and understand that the guilt or sadness they feel is normal.
As with group therapy, some people may benefit from reading about shared experiences of grief from another person's point of view. With bibliotherapy, you can encourage your clients to read about stories of loss, bereavement, or even trauma-related grief to learn how others have worked through these emotions and life experiences. Bibliotherapy can help clients feel validated in their fluctuating symptoms and supported as they start their healing journey.
8. Art Therapy
Bereaved people need to find purpose in their day and continue to embrace new activities. Using art therapy, you can promote creativity and healing in your clients as they process grief. Many people use various forms of art to express and regulate their emotions, and art therapy is no different. Artistic and creative self-expression, such as through coloring, drawing, painting, or making collages, may heal your client and inspire them to see the beauty in life again.
9. Play Therapy
Like art therapy, play therapy generally focuses on helping children process grief. If you are treating a child who has recently lost a parent or close loved one, play therapy can help them use their imagination to express their feelings and learn to self-regulate their emotions. Play therapy may involve storytelling, playing with puppets, or similar games involving toys. After a significant loss, teaching children to express themselves and have an outlet can make it easier for them to begin healing.
10. Interpersonal Therapy
This therapy technique aims to clarify a client's relationships with others in their life. One of the goals of interpersonal therapy is to release repressed emotions to learn how to stop avoiding them altogether. As a counselor or therapist, you can encourage your client to talk about their relationship with their deceased loved one, including the circumstances leading up to and following their passing.
You can also ask your client to speak honestly about their memories of their loved ones and how the event has affected their relationships with others. For instance, some grieving people may pull away from their significant other, friends, or family and self-isolate.
Goals of Grief Treatment
As with any other treatment plan you develop for your client, grief treatment plans should include specific, measurable objectives you and your client wish to accomplish throughout your sessions together. Here are some examples of goals you can focus on setting during grief treatment.
- Increased understanding of loss: Your client will learn how to describe their feelings, identify issues, gain awareness, and establish steps to manage grief.
- Validate the past: Your client will accept that there is no right or wrong way to grieve and that the process is ever-changing. They will validate their past with their loved ones by creating new life experiences, gaining emotional support, and forging healthy relationships.
- Accept responsibility for change: Address underlying feelings of grief and learn to resolve or let go by accepting the change.
- Decrease extreme grief: Reduce the potential for harmful behaviors relating to grief and loss, such as substance abuse or disordered eating, and learn healthy coping techniques to address feelings.
- Correct irrational thinking: Challenge irrational or unreasonable thoughts with reality and identify specific areas of distortion relating to past grief and loss.
- Deal with uncomfortable feelings: Deal with sadness, “what-ifs” and survivor guilt resulting from grief and loss.
Keep Your Grief Treatment Notes and Plans Organized with ICANotes
As a mental health professional, thoroughly understanding grief can prevent you from overtreating healthy symptoms while identifying warning signs. Grief comes in many shapes and sizes, so it's vital to keep all sessions with your clients well-documented so you can monitor their progression and determine if they need clinical intervention or treatment adjustments.
With ICANotes, you can equip yourself with the behavioral health tools and templates you need to keep your session notes and treatment plans legible, well-organized, and ready for sharing with other professionals if needed. Our clinically robust and intuitive EHR software can reduce the time you spend on documentation, help you maintain compliance, and empower you to deliver more comprehensive care. Contact us today for more information or request a free trial online.