Prolonged Grief Treatment

What it is and why it works.

Prolonged Grief Treatment (PGT), previously known as Complicated Grief Treatment, is a highly effective talk therapy that has been studied for 30 years. It is the most tested treatment available to help people with prolonged grief. In research studies that included hundreds of people with prolonged grief, an average of two out of three people received significant benefits from PGT.

Adapting to loss: the basis of Prolonged Grief Treatment

When someone we love dies, the grief that we feel is often intense and highly emotional, dominating our minds and disrupting our lives. Just as the loss of a loved one is permanent, so is the grief that we feel after they are gone. However, the quality of grief that we experience tends to change as we spend more time in this unwanted reality. We come to terms with the loss and begin to accept the natural flow of grief. We find ways to restore our own well-being and create meaning in a world without our loved ones. We call this process “adaptation.” 

While adapting to loss is a natural process that most individuals move through at their own pace, prolonged grief occurs when something interferes with adaptation. Prolonged grief is an intense, pervasive, persistent form of grief that continues to dominate an individual’s life. Therefore, the overarching goal of Prolonged Grief Treatment is to “unblock” and facilitate the bereaved person’s natural adaptive process.

3 keys to adapting to loss

• • Accepting the reality, finality, and consequences of the loss 
  • Revising one’s relationship with the deceased person to reflect this new reality 
  • Finding ways to move forward with a sense of purpose, meaning, and possibilities for happiness

Treatment structure

Prolonged Grief Treatment is a short-term talk therapy that aims to resolve impediments and strengthen a bereaved person’s natural adaptive capacity. The treatment is a focused and structured approach that typically takes place over the course of 16 weekly sessions, which is about four months. Although it is a structured intervention, it is also personalized to the individual as each grief experience is unique. The therapist serves as an empathetic guide and companion as the grieving individual adapts to the loss in their own unique way. Together, the therapist and the individual work through a series of experiential activities that focus on the topics listed below.

7 healing milestones of Prolonged Grief Treatment

• • Understanding and accepting grief: Grief is a natural and, in many ways, instinctive human response to loss. 
  • Managing grief-related emotions: As we try to nonjudgmentally observe the flow of grief, we are better able to allow it into our lives and learn to live with it. 
  • Envisioning a promising future: Taking time to think about what is important, meaningful, and interesting to us is an important piece of adapting to a difficult life event. 
  • Strengthening relationships: Allowing others in, sharing stories, and accepting support and comfort are essential for adaptation. 
  • Narrating the story of the death: Being able to think and talk about what happened and share the story of the loss is part of the process of coming to terms with it. 
  • Living with reminders: After the death of a loved one, the multitude of reminders of the loss can be extremely painful. Trying to avoid the pain is natural; however, in the long run, finding a way to live with reminders and recognize the meaning and comfort they contain is more adaptive.
  •  Connecting with memories: Learning and growing from one’s ongoing yet changed relationship with the person who died.

Concluding thoughts

This structured and individualized therapy can be used to help a person with prolonged grief, regardless of who they lost or how the death occurred. Many people who have tried therapy without much success have found that they respond well to the treatment. The treatment works best when a person is willing to try things that may initially seem counterintuitive.

To learn more about Prolonged Grief Treatment or to find a trained therapist in your region, visit The Columbia Center for Prolonged Grief site. 

Sources

Shear, M. K., Skritskaya, N., & Bloom, C. (2022). Prolonged grief disorder therapy. In U. Schnyder & M. Cloitre (Eds.), Evidence-based treatments for trauma-related psychological disorders: A practice guide for clinicians (pp. 329-344). Cham: Springer International Publishing. 

Skritskaya, N. A., Mauro, C., Garcia de la Garza, A., Meichsner, F., Lebowitz, B., Reynolds, C. F., et al. (2020). Changes in typical beliefs in response to complicated grief treatment. Depress Anxiety, 37(1), 81-89. doi: 10.1002/da.22981

Thank you to our contributors

Brooks Perkey & Natalia Skritskaya