Working with Grief
Guidance for counsellors, therapists and mental health professionals
Many clinicians feel confident working with anxiety, depression or trauma, but feel less certain when working with grief.
Unlike other areas of clinical practice, grief does not always present with a clear symptom to reduce, a problem to solve, or a straightforward pathway through therapy.
Instead, clinicians are often asked to sit alongside profound loss while helping someone adapt to a world that has fundamentally changed.
Working therapeutically with grief requires a different kind of understanding. It means recognising the complex ways loss can affect a person’s identity, relationships, sense of meaning and emotional wellbeing, while supporting them to find ways of living with their loss.
This guide brings together evidence-based psychological models and therapeutic approaches to help clinicians navigate the complexities of grief and feel more confident in their clinical practice.
A Guide to Working Therapeutically with Grief, written 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.
Understanding grief in clinical practice
Grief doesn’t follow a predictable clinical pathway
Grief does not always follow a predictable therapeutic pathway. There may be no symptom to eliminate, clear endpoint or linear progression.
Clients may move between periods of relative stability and intense grief, experiencing connection or hope alongside sadness, guilt or longing. These shifts do not necessarily indicate deterioration.
Contemporary grief theory understands adaptation as dynamic: grief can remain present while gradually becoming integrated into ongoing life.
For therapists, the question is often not “Has this person moved on?” but “How are they adapting to their loss, and what is helping or getting in the way?”
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).
CLINICAL TAKEAWAY
For therapists, this means resisting the urge to interpret fluctuating emotions as regression. Instead, help clients make sense of these shifts as part of adapting to loss, while remaining attentive to their individual needs and how they are functioning over time.
This flowchart illustrates how we conceptualise the distinction between integrated grief responses and more complex or complicated grief presentations. This framework helps clinicians focus on adaptation, risk, and how grief becomes integrated into a person’s life, rather than labelling it “normal” or “abnormal.”
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, identified five stages – denial, anger, bargaining, depression and acceptance. Originally developed through Kübler-Ross’s work with people facing their own mortality, the model was later applied more widely to bereavement. Although it remains influential and can help people recognise common emotional responses, it was not intended as a rigid sequence. We now understand that grief is rarely linear. People do not move neatly from one stage to another, and may revisit emotions or experience several at once.
CLINICAL TAKEAWAY
In practice, therapists should avoid using stage-based models as a checklist for progress or expecting clients to experience grief in a particular order. Instead, explore how each client understands their experience and use this to guide therapeutic conversations.
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.
CLINICAL TAKEAWAY
For therapists, this means recognising that adapting to loss does not necessarily involve letting go of the person who has died. Exploring memories, rituals and continuing connections can help clients make sense of the relationship and find ways to carry it forward that feel meaningful to them.
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)
- Previous experiences of loss and how these have shaped the person’s understanding of grief.
CLINICAL TAKEAWAY
These factors can help therapists develop an individualised understanding of a client’s grief. Rather than applying a single model to every person, consider their relationship with the person who died, previous experiences of loss, cultural context, available support and the circumstances of the death. Therapeutic approaches should be guided by the individual’s needs, rather than expectations about how grief should unfold.
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 make space for painful grief emotions, while reconnecting with personal values and engaging in meaningful activities. | Acceptance, mindfulness, cognitive defusion, values work, committed action |
| Cognitive Behavioural Therapy (CBT) | Understanding the relationship between thoughts, feelings, and behaviours | Helps clients explore unhelpful grief-related thoughts, avoidance and coping behaviours that may be contributing to ongoing distress. | Cognitive restructuring, behavioural strategies, coping skills, thought monitoring |
CLINICAL TAKEAWAY
In clinical practice, the choice of approach should be guided by the client’s needs rather than a one-size-fits-all model. CFT may be helpful where grief is accompanied by shame or self-criticism, ACT where clients are struggling to make space for painful emotions, and CBT where patterns of thinking or avoidance are contributing to distress. These approaches can also be integrated as the therapeutic work develops.
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 – whether related to the circumstances of the death, witnessing a loved one’s deterioration, or other distressing experiences surrounding the loss – 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 TAKEAWAY
For therapists, this means paying attention to how clients respond when the loss is discussed. If a client becomes overwhelmed, grounding, emotional regulation and a sense of safety may need to take priority before more detailed exploration. The aim is not to avoid grief, but to help clients engage with it at a manageable pace.
Clinical comparison of adaptive/integrated 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 support. 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.
| Common patterns in adapting to grief | Patterns suggesting additional difficulties | |
| Emotional experience | Emotions fluctuate and gradually become more manageable | Emotions remain persistently intense or difficult to regulate, with little movement over time |
| Trauma features | Trauma responses may be present but do not necessarily prevent adaptation to the loss | 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 | Persistent difficulty integrating the reality of the death or making sense of the loss |
| 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 | Assessing individual needs, supporting regulation and stability where needed, and considering targeted grief or trauma-focused interventions |
| Therapeutic stance | Curious, exploratory and meaning-oriented | Containment, safety-first, regulation, gradual processing |
Clinical note: These presentations are not mutually exclusive, and grief does not follow a fixed trajectory. Intense emotions, trauma responses and periods of reduced functioning can all occur within natural grief. The persistence, impact and context of these experiences are important when considering whether additional therapeutic support may be helpful.
What you might notice in grief and trauma presentations
The following table outlines what therapists may notice in the room, what these observations might suggest, and how they can inform therapeutic support.
| What you might notice | What this may suggest | Therapeutic Response |
| Intense intrusive images or memories associated with 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 | 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 |
A final thought
Ultimately, working well with grief is less about knowing the ‘right’ model and more about developing the confidence to stay alongside uncertainty, formulate thoughtfully and tailor therapy to the person in front of you.
Models and therapeutic approaches can guide the work, but they are tools rather than prescriptions. Good grief therapy remains curious, flexible and grounded in the individual experience of loss.
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.
-
Product on sale
The Compassion Fatigue WorkbookOriginal price was: $21.00.$14.00Current price is: $14.00. -
Letters to Your Loved One$3.00 -
Tonkin’s Model of Grief$3.00 -
Dual Process Model of Grief$3.00 -
Product on sale
Guided Grief MeditationOriginal price was: $21.00.$14.00Current price is: $14.00. -
Product on sale
Grief Processing Worksheet BundleOriginal price was: $14.00.$11.00Current price is: $11.00. -
Product on sale
Sleep Better Worksheet BundleOriginal price was: $14.00.$11.00Current price is: $11.00. -
Product on sale
Anxiety Worksheet BundleOriginal price was: $14.00.$11.00Current price is: $11.00.
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.
Prolonged grief may be considered when grief-related distress remains persistent, pervasive and significantly interferes with daily functioning over time, taking account of cultural and individual circumstances. Trauma-related responses may include intrusive memories, avoidance or heightened arousal, sometimes linked to distressing experiences surrounding the illness or death. Careful assessment can help therapists distinguish these experiences and identify appropriate support.
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.