Working with Grief in Therapy: Techniques and What to Say
By Kristen McClure, MSW, LCSW | TherapistWorksheet.com
Grief is not a problem to solve. It is a process to accompany. Most of the clinical errors in grief work come from the therapist trying to move the client along — toward acceptance, toward meaning-making, toward resolution — before the client is ready, and sometimes before any of those things are possible.
What We Actually Know About Grief
The Kubler-Ross stages of grief — denial, anger, bargaining, depression, acceptance — were never meant to be a linear roadmap, and the research on grief has moved well beyond them. What we know:
- Grief is non-linear and highly individual
- The “stages” are not stages — they are states that people move in and out of
- Most bereaved people do not require professional intervention — grief is not inherently pathological
- A significant minority experience prolonged grief disorder (formerly complicated grief) — sustained, impairing grief that does not naturally resolve
- The relationship with the deceased continues after death — “continuing bonds” is a legitimate and healthy aspect of grief
- Meaning-making is one of the strongest predictors of grief integration
Types of Loss
Grief is not only about death. Clients grieve:
- Divorce and relationship endings
- Miscarriage and pregnancy loss
- Infertility
- Job loss and career change
- Health changes and diagnoses
- Loss of an identity (the person they were before trauma, illness, diagnosis)
- Ambiguous loss — a loved one with dementia, estrangement, the disappearance of someone
- Disenfranchised grief — losses that are not socially recognized (miscarriage, pet loss, loss of someone with whom the relationship was complicated or private)
Ask about grief broadly. Do not assume that only death warrants the full weight of grief.
What to Do as a Therapist
Bear witness
The most fundamental role in grief work is presence — being with the client in their loss without trying to fix, reframe, or move it along. This requires the therapist’s own capacity to tolerate helplessness and grief. If you rush past grief, examine what the rush is about.
Normalize without minimizing
“What you are describing — the waves, the unexpected moments when it hits you, the not-knowing when you will feel better — that is grief. That is how it works for most people. It does not mean you are doing it wrong.”
Explore the relationship
Understanding who was lost — the full complexity of the relationship, not just the idealized version — is central to grief work. Relationships are complex; grief is shaped by that complexity. “Tell me about them. Not just what they meant to you — tell me who they actually were.”
Hold space for ambivalence
Grief for someone complicated — an abusive parent, a troubled child, an ex-partner — includes relief, anger, and guilt alongside sorrow. These co-exist. Giving permission for the full range: “Sometimes grief includes feelings we are not supposed to have. You can have all of them here.”
Meaning-making over time
Not immediately. Not before the client is ready. But grief tends to integrate through meaning — what the person’s life meant, what the loss means, what continues. “I wonder, as you think about what you’ve lost, whether there are things about what they meant to you that you’re starting to be able to name.”
Prolonged Grief Disorder
When grief is severe, impairing, and shows no trajectory toward integration after more than a year (in adults), consider prolonged grief disorder. Specific therapies — Complicated Grief Treatment (now called Prolonged Grief Disorder Treatment) developed by Shear et al. — have evidence support. Do not assume time alone is the intervention for someone stuck in complicated grief.
Frequently Asked Questions
How long should grief last?
There is no should. Most bereaved people move toward integration (not “getting over it”) within 6-18 months, though grief often resurfaces at anniversaries, milestones, and reminders throughout life. What matters clinically is whether it is impairing functioning and moving in some direction, however slowly.
What is the difference between grief and depression?
Grief and depression overlap symptomatically but differ in key ways: grief is typically triggered by loss, varies in intensity (waves), includes yearning for the specific deceased, and is often accompanied by preserved capacity for pleasure in other areas. Major depression is more pervasive, often involves global negative cognitions, and may persist without the waves. Both can co-occur.
Should I use rituals or structured activities in grief work?
For some clients, yes — writing letters to the deceased, creating memory objects, visiting significant places. For others, these feel forced. Follow the client’s lead. When used well, rituals can deepen connection to the loss in ways that support integration.
What about grief after a death by suicide?
Grief after suicide loss involves additional layers: confusion, guilt, searching for reasons, social stigma, exposure to traumatic material about the manner of death. Specialized resources exist for suicide loss survivors. If you have not worked with this population before, seek consultation.
Kristen McClure, MSW, LCSW is a licensed therapist who creates practical clinical tools to help therapists navigate the hardest moments in their work.