Working with Grief
Helping counsellors, therapists and mental health professionals support grief with confidence, compassion and clinical understanding.
A Guide to Working Therapeutically with Grief, by Dr Erin Hope Thompson MBE
This page explores key psychological frameworks and therapeutic approaches used in grief work, including CBT, ACT, and CFT, alongside broader grief models such as the Dual Process Model, Continuing Bonds, and Attachment Theory.
Written by Dr Erin Hope Thompson MBE (BSc, ClinPsyD), it brings together evidence-based perspectives to help practitioners deepen their understanding of grief and integrate it meaningfully into clinical practice.
Working with grief requires more than offering comfort. It involves supporting clients as they navigate the emotional, relational and identity-based impact of loss – while holding space for pain, uncertainty, and the process of adapting to life after someone has died.
This guide explores key grief models, therapeutic approaches, trauma-informed practice, and practical tools to help therapists work safely and effectively with bereavement.
Build a foundation for understanding grief, bereavement, and the therapeutic role in supporting clients after loss.
Explore key theories that explain how people experience and adapt to loss, including the Dual Process Model and Tasks of Mourning.
Discover practical ways to support grief processing, emotional expression, memory work, and meaning-making.
Understand when grief becomes more complex and how trauma-informed approaches can support processing.
Introduction
Working with grief requires more than offering comfort.
For therapists and mental health professionals, working with grief involves understanding how loss affects not only emotion, but also identity, meaning, relationships, and a person’s sense of safety in the world.
In clinical practice, grief rarely presents in a linear or predictable way. Clients may move between deep distress and relative stability, or experience conflicting emotions that feel difficult to hold. Contemporary research has consistently shown that grief is best understood as a dynamic and oscillating process rather than a fixed sequence of stages (Stroebe & Schut, 1999).
To support this understanding, the flowchart here illustrates how we conceptualise the distinction between integrated grief responses and more complex or complicated grief presentations. Rather than viewing grief as “normal versus abnormal,” this framework helps clinicians think in terms of adaptation, risk, and the degree to which grief is becoming integrated into a person’s ongoing life.
This kind of formulation can be particularly helpful in guiding clinical decision-making – especially when considering pacing, stabilisation, and the most appropriate therapeutic approach. As Neimeyer (2015) highlights, bereaved individuals are often not only seeking relief from distress, but also trying to make sense of a world that no longer feels coherent or familiar.
Across this guide, we explore key grief models and therapeutic approaches, including CBT, ACT, and Compassion Focused Therapy (CFT).
We also consider broader frameworks such as Continuing Bonds, Meaning Reconstruction, and the Dual Process Model.
Our aim is to support clinicians in developing a more responsive way of working with grief – one that can –
✔ Recognise the breadth and individuality of grief experiences
✔ Tolerate uncertainty in the therapeutic process
✔ Support meaning-making alongside emotional pain
✔ Respond flexibly to individual differences in grief experience
Our approach at The Loss Foundation
At The Loss Foundation, our approach is integrative, evidence-informed, and grounded in real-world clinical and group experience with bereaved people.
We move away from rigid stage-based interpretations of grief and instead focus on understanding the ongoing, adaptive processes that shape how people respond to loss over time. This includes recognising when grief is naturally evolving, and when additional support may be needed where symptoms become more prolonged, complex, or distressing.
Importantly, we also acknowledge how widely misunderstood traditional models such as the “five stages of grief” can be in both clinical and public discourse. Many service users tell us they feel these models do not reflect their lived experience and can sometimes create unnecessary pressure or self-judgement.
Formulating Grief – Psychological Models – 2 hour course
✔️ Explore key grief theories and psychological models
✔️ Understand anticipatory grief and its impact
✔️ Analyse real-world case studies in grief support
✔️ Learn how to help clients maintain continuing bonds
✔️ Discover evidence-based support recommendations
Grief models
Grief is not a single, uniform experience, and over time several psychological models have been developed to help describe the different ways people respond to loss.
Early frameworks, such as the well-known Kübler-Ross model, suggested that grief could unfold through a series of emotional stages, including denial, anger, bargaining, depression, and acceptance. While this model has been widely recognised and is often helpful as a way of naming common reactions, it is now understood that grief is rarely linear. People do not move neatly from one stage to another, and many may revisit emotions or experience several at once.
Other models, such as continuing bonds theory and meaning reconstruction approaches, emphasise that maintaining an ongoing inner connection with the person who has died can be a healthy and natural part of adapting to bereavement.
This ongoing connection might take many forms, including:
- Speaking to the person internally or feeling their presence in everyday life
- Preserving rituals or habits that were meaningful within the relationship
- Keeping or using personal items that evoke a sense of closeness
- Drawing on memories as a source of comfort, guidance, or strength
- Continuing to celebrate important dates or milestones in ways that feel meaningful
- Sharing stories or memories of the person with others to keep their legacy alive
They also suggest that finding new meaning in the loss is an important aspect of adjustment, helping individuals integrate the experience into their ongoing life. Together, these perspectives highlight that grief is highly individual, dynamic, and shaped by personal, cultural, and situational factors, for example:
- The availability of social support and wider life context
- Personal relationships and the nature of the attachment to the deceased
- Cultural and religious beliefs that shape mourning practices and expression of grief
- The circumstances of the death (e.g., sudden versus expected loss)
Deepen your knowledge
Our grief models course for mental health professionals helps you support clients with confidence and compassion.
While no single model can fully explain the experience of grief, psychological frameworks can offer valuable insight into the many ways people respond to loss. Below are examples from our Grief Journey Workbook, introducing several of the most widely recognised approaches to understanding bereavement. These resources help illustrate the diverse ways grief can be experienced and understood.
More reading on grief models
👉 The Five Stages of Grief: a useful map, or an outdated story? (LinkedIn)
👉 The Evolution of Grief: From Letting Go to Staying Connected (LinkedIn)
👉 Continuing Bonds Theory in Grief Counselling
👉 Understanding Grief Through Psychological Models
Therapeutic approaches – CFT, ACT + CBT
Grief therapy often benefits from drawing on a range of therapeutic approaches, allowing clinicians to respond to the unique needs of each bereaved client. Different approaches offer valuable perspectives on emotions, thoughts, behaviours, meaning-making, and self-compassion, helping therapists support clients in navigating grief in a flexible and individualised way.
Explore further how Compassion Focused Therapy (CFT), Acceptance & Commitment Therapy (ACT), and Cognitive Behavioural Therapy (CBT) may benefit your grief work:
| Approach | Core focus | How it can support grief work | Key therapeutic tools |
| Compassion Focused Therapy (CFT) | Developing compassion, reducing shame and self-criticism | Helps clients respond to their grief with kindness, especially where loss brings guilt, anger, shame, or harsh self-judgement | Compassionate imagery, soothing systems, self-compassion practices, emotional regulation |
| Acceptance & Commitment Therapy (ACT) | Making space for difficult experiences while moving towards values | Supports clients to hold painful grief emotions without becoming overwhelmed, while reconnecting with meaning and valued living | Acceptance, mindfulness, cognitive defusion, values work, committed action |
| Cognitive Behavioural Therapy (CBT) | Understanding the relationship between thoughts, feelings, and behaviours | Helps clients explore grief-related thoughts, coping patterns, avoidance, and behaviours that may be maintaining distress | Cognitive restructuring, behavioural strategies, coping skills, thought monitoring |
More reading…
👉 Meaning-Making After Loss – Rebuilding Narrative, Identity, and Continuing Bonds
👉 Working with Traumatic Memories in Grief – Clinical Considerations for Therapists
👉 Why Compassion Focused Therapy is a Powerful Tool in Grief Work
👉 Grief and Identity: Who Am I Now? (LinkedIn)
👉 Compassion Focused Therapy in Grief Work: Understanding the Inner World of the Bereaved Person (LinkedIn)
Therapist grief aid library
Access practical grief therapy resources, training, worksheets and guided meditations designed for professionals supporting bereaved clients.
Trauma + complicated grief
Trauma and complicated grief can significantly shape how a person experiences and processes loss, and it is important for therapists to recognise when grief has become more complex or is intertwined with traumatic responses. While grief itself is a natural response to loss, complicated grief may involve prolonged, intense, or disabling symptoms that interfere with daily functioning. When trauma is also present – such as sudden, violent, or unexpected death – clients may experience intrusive memories, hyperarousal, avoidance, or feelings of shock that overlap with grief reactions.
In clinical work, supporting trauma and complicated grief often requires a more paced, stabilising approach before deeper grief processing can take place. This may include grounding techniques, emotional regulation strategies, and careful attention to safety and window of tolerance. An integrative, trauma-informed approach helps therapists hold both the grief and the trauma responses together, recognising that healing is not linear and may involve oscillating between processing loss, managing distress, and rebuilding a sense of stability and meaning.
Clinical comparison of integrated (acute) grief and complicated or trauma-related grief presentations
Grief reactions exist on a spectrum and may evolve over time depending on the circumstances of the loss, prior trauma history, and available supports. While many individuals experience acute grief that fluctuates and gradually becomes more integrated, others develop patterns of persistent, dysregulated, or trauma-linked grief responses. The table below outlines key clinical features that may help differentiate these presentations and guide therapeutic focus.
| Adaptive Grief | Complicated / Traumatic Grief | |
| Emotional experience | Emotions fluctuate and gradually become more manageable | Emotions remain persistently intense or difficult to regulate, with little movement over time |
| Trauma features | If trauma is present, it can usually be processed without dominating the grief experience | Trauma responses (e.g. intrusive memories, hyperarousal or avoidance) dominate or repeatedly interrupt grief processing |
| Narrative of loss | Gradually able to acknowledge and make sense of the reality of the loss | Difficulty integrating the reality of the death |
| Functioning | Functioning may reduce initially but generally improves over time | Marked disruption to daily functioning and roles |
| Processing style | Oscillates between loss-focused and restoration-focused coping | Dominance of loss-related distress or avoidance of processing |
| Clinical focus | Supporting adaptation, emotional expression, continuing bonds and meaning-making | Stabilisation, pacing, trauma-informed grounding before deeper grief work |
| Therapeutic stance | Curious, exploratory and meaning-oriented | Containment, safety-first, regulation, gradual processing |
What you might notice in grief and trauma presentations
While these categories can help orient clinical thinking, in practice presentations are often fluid and overlapping. The following table outlines what therapists may notice in the room, and how this can inform support.
| What you might notice | What this may suggest | Therapeutic Response |
| Intense intrusive images or memories of the death | Trauma may be interfering with grief processing and reducing the person’s ability to engage with the loss | Prioritise grounding, stabilisation and reducing overwhelm before deeper grief work |
| Avoidance of reminders of the loss | Avoidance may be reducing opportunities to process both grief and trauma | Work gradually with exposure, pacing and safety-building rather than pushing emotional processing too quickly |
| Persistent disbelief or inability to accept the death | The reality of the loss has not yet been integrated and may remain psychologically “unreal” | Support gradual reality integration, meaning-making and gentle exploration of the loss |
| Emotional flooding in sessions | The person’s window of tolerance has narrowed, making grief processing difficult | Slow the pace and prioritise regulation and containment before further exploration |
| Difficulty engaging in narrative processing | The threat system may be dominating, making reflective processing difficult | processing difficult. Use stabilisation, co-regulation and gradual narrative work as tolerance increases |
| Oscillation between numbness and overwhelm | The person may be moving outside their window of tolerance, making it difficult to stay engaged with grief | Help build emotional regulation and support safe oscillation between loss-focused and restoration-focused coping |
Where next?
Our grief courses + resources…
Our practical grief courses and resources help therapists and mental health professionals work with grief with greater confidence, compassion, and clarity – combining psychological understanding with tools you can use directly in your clinical practice.
💛 Practicing Compassion Focused Therapy (CFT) in Grief Work
Learn how to apply compassion-focused techniques and evidence-based practices to help individuals navigate grief with kindness and resilience.
🧠 Formulating Grief –Psychological Models
Explore key grief theories, anticipatory grief, and real-world case studies to strengthen your therapeutic approach and support practice.
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Working with grief FAQs
Grief models are best used as formulation tools rather than rigid frameworks. Approaches such as the Dual Process Model, Continuing Bonds, and Attachment Theory can be integrated to support clinical understanding, guide case formulation, and inform flexible intervention planning.
Modern grief practice does not conceptualise bereavement as a linear stage process. Instead, it emphasises oscillation, adaptation, and meaning reconstruction. Stage models may be used descriptively, but are not typically used as treatment targets or indicators of progress.
Complicated or prolonged grief presentations may be considered when symptoms remain persistent and functionally impairing over time. Where trauma is present, clinicians may also observe intrusion, avoidance, or dysregulation. These presentations require careful assessment, pacing, and often a stabilisation-first approach.
Yes. Third-wave and cognitive-behavioural approaches are commonly integrated within grief therapy. CBT may support cognitive and behavioural formulation, ACT can facilitate acceptance and values-based adaptation, and CFT is often useful in addressing shame, self-criticism, and affect regulation within bereavement work.