Types of Grief Counseling: Which Kind Fits Your Loss?

Grief counseling is talk-based support for people coping with a death. The main types are one-on-one counseling, support groups, family or child counseling, and grief-focused therapy such as cognitive behavioral therapy (CBT) for people whose grief stays intense and disrupts daily life. Most grieving people do not need treatment, but the right type of help can make a hard stretch easier.

What are the main types of grief counseling?

The labels overlap, and many counselors mix approaches. This table shows the common formats and who they tend to suit.

If you are not sure whether you need counseling or therapy, our guide to grief counseling vs therapy explains how the two differ.

Which grief therapies have research behind them?

Cognitive behavioral therapy (CBT) helps you notice painful thought patterns, question them and change unhelpful behavior, according to the National Institute of Mental Health. In grief, that might mean working on guilt such as "I should have done more." The National Cancer Institute notes that CBT can help people with complicated grief.

Complicated grief therapy (also called prolonged grief disorder therapy) is a structured treatment built for grief that does not ease. In a 2016 randomized trial in JAMA Psychiatry, 395 adults with complicated grief received 16 weekly therapy sessions, with results measured at 20 weeks. Among those given the therapy plus placebo, 82.5% responded, compared with 54.8% of those given placebo alone. Adding the antidepressant citalopram did not improve grief outcomes, though it did reduce depressive symptoms more.

EMDR (eye movement desensitization and reprocessing) has its strongest backing for post-traumatic stress disorder (PTSD). The VA describes it as a therapy in which you hold a traumatic memory in mind while following back-and-forth movements or sounds. Some therapists use it after sudden or violent deaths when a person has flashbacks. Ask whether the therapist is trained in it, and note that the VA evidence is for PTSD rather than grief itself.

Acceptance and commitment therapy (ACT) and narrative therapy are also used by some grief counselors. ACT focuses on making room for painful feelings while acting on your values, and narrative therapy focuses on the story you tell about the loss and the person. If a counselor offers one of these, ask how they adapt it to grief.

Across approaches, a 2019 review of 31 randomized trials found that psychological interventions helped bereaved adults, with larger gains for people who had high grief symptoms at the start and for those at least six months past the loss. Individually delivered formats did better than group formats on average. The review does not say groups are unhelpful, only that they suit different needs.

What models do grief counselors use?

Counselors often describe grief with a model so the process makes sense. You may hear these.

• Dual process model. Developed by Margaret Stroebe and Henk Schut (1999), it says healthy coping means moving back and forth between "loss-oriented" tasks, such as feeling the pain and remembering, and "restoration-oriented" tasks, such as handling money, learning new roles and taking breaks from grief.
• Continuing bonds. This view holds that you don't have to "let go." Many people keep an ongoing sense of connection through rituals, memories or legacy projects, and counselors often support that.
• The five stages. Denial, anger, bargaining, depression and acceptance are widely known, but they are not a track everyone follows. In a 2007 JAMA study of 233 bereaved people followed for up to 24 months, disbelief was not the first or strongest reaction, and yearning was the most common negative feeling.

The word "closure" shows up a lot in popular writing. Many counselors avoid promising it, since the aim is usually to find a way to live with the loss, not to finish with it.

Specialized types of grief support

Some losses have their own kind of help.

• Anticipatory grief happens before a death, for the person who is dying or their family. The National Cancer Institute reports that about one in four patients with incurable cancer feels it. Our guide to anticipatory grief covers it in more detail.
• Disenfranchised grief describes losses that others may not acknowledge, such as an ex-partner, a miscarriage or a colleague. See disenfranchised grief.
• Complicated or prolonged grief is covered in our complicated grief guide.
• Traumatic loss, including death by suicide, accident or violence. A therapist trained in trauma can help, and suicide-loss survivor groups exist in many areas. See our suicide death funeral guide for practical support.
• Pregnancy, infant and pet loss often have dedicated counselors and groups, since these losses are sometimes dismissed by others.

When should you seek professional help?

Grief has no deadline, and strong feelings in the first months are normal. The National Cancer Institute says most people see their symptoms ease between six months and two years, and that the pace differs for everyone.

Prolonged grief disorder is diagnosed when the loss was at least 12 months ago in adults (6 months in children and adolescents) and at least three of these symptoms have happened nearly every day for the past month, per the American Psychiatric Association. The symptoms are identity disruption, marked disbelief about the death, avoiding reminders, intense emotional pain, difficulty reintegrating into life, emotional numbness, feeling life is meaningless, and intense loneliness. The APA estimates 4% to 15% of bereaved adults are affected, and a 2017 meta-analysis of studies of non-violent bereavement pooled the figure at 9.8%.

You don't need to wait for a diagnosis or a date. Reach out sooner if grief is stopping you from working, eating, sleeping or caring for others.

How to find and pay for grief counseling

Start with the lowest-barrier options, then add professional help if you need it.

• The hospice that cared for your loved one. Under federal rules, Medicare-certified hospices must make bereavement counseling available to the family and others in the bereavement plan of care for up to one year after the death. Ask the hospice social worker.
• Support groups. Hospices, hospitals, community centers and faith groups often run them. Our guide to online grief support groups compares virtual options, and grief support apps covers app-based tools.
• Your doctor. A primary care provider can check for depression or sleep problems and refer you to a therapist.
• Your employer. Some employers provide short-term counseling through an employee assistance program. Ask HR, and see bereavement leave if you need time off.
• Health insurance. Coverage differs by plan, so ask your insurer whether therapy sessions are covered, whether you need a referral and which providers are in network.

When you talk to a counselor, it helps to ask:

1. Are you licensed, and what training do you have in grief work?
2. Which approach do you use, and why would it suit me?
3. How many sessions do you expect, and how will we know it is working?
4. What do you charge, and do you offer a sliding scale?

It is fine to try a counselor for a session or two and switch if it doesn't feel right. Fit matters.

Medication is not a treatment for grief itself. The APA notes there are no medications for specific symptoms of grief, though a doctor may treat a related condition such as depression.

What to do next

1. Decide what kind of support feels manageable now, such as a group, a counselor or a call to the hospice.
2. Make one contact this week, even a short call to ask about options.
3. If symptoms are heavy a year or more after the loss, book an appointment with a licensed therapist and mention prolonged grief.
4. Keep 988 handy if thoughts of suicide ever come up.