How to tell the difference between resilient grief and complex grief response?

Find out about different types of professional help for grief.  

You might have heard this common saying: ‘There is no right or wrong way to grieve your loss.’ For the most part, it is true and often refers to the array of emotional reactions we tend to experience during grief. It highlights an issue with the discomfort many of us experience around feelings we do not approve of, such as anger with the person who died or the relief they are gone, for example in the context of a prolonged illness.

While grief is a natural response, losing a life partner prematurely is one of the most challenging forms of loss a person can face. It often takes place in unexpected circumstances, such as a sudden accident, a terminal illness or a suicide. When something out of the ordinary occurs, our capacity to cope gets overwhelmed by the intensity of sudden changes. The consequences of the unexpected loss often lead to profound secondary losses, such as financial problems, housing issues, responsibilities of solo parenting, social isolation, and a loss of a sense of self. The harder the shock and more profound the consequences to our lives the more likely it is that the loss is going to affect our mental health and lead to more significant complications. I often think of these kinds of losses as traumatic.

These traumatic experiences can also trigger memories of previous losses and consequently make our grieving process much more complicated. Every new loss confronts us with prior losses, leading to an accumulative effect of grief. This can prolong the time it takes to adapt to the new reality and live life alongside grief.

Understanding Complex Grief Response

As a clinical psychologist, I am not in favour of giving people labels of grief disorders; instead, I tend to think of them as different types of grief responses. We all respond to life events differently, shaped by our personality, the support system around us and the extent of the loss we face. Some people are more resilient and have adequate support systems in place to bounce back from adverse life events.  Others have reached the point that makes it hard to regain a sense of normal functioning.

The differences initially might be hard to spot because most people struggle with grief. It is normal to struggle, to be completely overwhelmed by the intensity of your emotional reactions or bodily sensations. However, with a more resilient response to grief we see that over time, there are some changes in our mood and the intensity of our emotions. You might have better days and worse days, moments of joy mixed up with hours of despair. Your feelings are likely to change suddenly. It is all to be expected. As time goes by you are likely to notice that you let yourself forget about your grief, for an hour or two, and then for a whole day. It doesn’t mean your grief is gone, but you are simply able to put it away at the back of your mind for a while and grow your life around it.

On the other hand, the complex grief response is when our grieving process still feels very stuck after a significant amount of time has passed (many months or years rather than weeks). It is not so much about how much time has passed, but how debilitating your symptoms might be and how they are impacting your life. You might feel that not much has changed in the way you think and feel about your loss and your grief is significantly impacting your daily functioning such as your ability to work, socialise, and engage in activities you used to enjoy. This is usually accompanied by strong and persistent emotions and intrusive thoughts.

Take a look at the table below to compare the differences between resilient and complex grief responses. We all begin in a state of shock. All of those reactions are healthy and to be expected but as time goes by you can see the differences in the way people respond to loss. Please not that this is not an exclusive list and the purpose of this exercise is not to diagnose anyone with a grief disorder.

Take part in The Grief MOT to find out your grief response and learn new skills to boost your resilience.

Professional Support Options

Before deciding what kind of support is best for you it is important to know the differences between various professional groups to help you decide which one is more likely to help you. Let's explore their roles, qualifications, and the types of therapies they provide.

It might be unclear at the beginning which type of mental health professional you should see and the truth is that there are no clear boundaries that distinguish various professional groups in terms of the type of talking therapies they provide. However,  there are clear differences between the professions regarding their training and how their membership is regulated.

One important thing to remember is that various professional groups have different regulating bodies and have to meet different standards to complete their training requirements. 

1. Clinical and Counselling Psychologists

This group of mental health professionals is trained to assess, identify, and treat a wide range of mental health conditions, including complex grief. They use evidence-based therapies and can tailor treatment plans to individual needs. They are thoroughly regulated by the government and have to meet rigorous criteria to achieve their qualifications. An average clinical psychologist spends about 8-10 years of training including undergrad, master’s and doctoral training. Many clinical psychologists also completed further psychotherapy training and worked actively on developing their therapeutic skills.

Clinical/Counselling Psychologists

• The highest level of training (doctorate level)
• Regulated by the Health and Care Professions Council (HCPC) and traditionally mainly  worked for the Nationa Health Service
• Experienced in various therapeutic approaches and can blend different models of therapy to fit your needs.
• Best suited for complex grief and traumatic grief as trained to work with more complex presentations.

To verify a clinical psychologist's registration, visit the HCPC website.

     2. Psychotherapists

Psychotherapists focus on helping clients understand their thoughts, feelings, and behaviours. They often use long-term, insight-oriented approaches to facilitate healing and personal growth. They tend to apply only one therapy model and specialise in this area. If you are interested in a particular model therapy, they might be well suited to help you. They are usually cheaper than clinical psychologists, but some tend to see clients 2-5 times a week while others only offer once-weekly therapy.

Psychotherapists:

•  Receive training in one particular therapeutic model (usually master’s and postgraduate diploma)
• May be registered with the UK Council for Psychotherapy (UKCP) or the British Psychoanalytic Council (BPC)
• Suitable for ongoing, in-depth therapy
• Less expensive than clinical psychologists

Check your psychotherapist registrations:

UKCP

BPC

BACP

3. Counsellors

Counsellors provide a supportive, non-judgmental space for clients to explore their feelings and develop coping strategies. They often focus on short to medium-term support. This is a less challenging form of psychological support which is suitable for non-complicated forms of grief. The grief counselling will facilitate your grieving process and make you more aware of your thoughts and feelings.

Counsellors:

• Have varied levels of training (diploma to master's level) but some might have minimal training.
• Should be registered with the British Association for Counselling and Psychotherapy (BACP)
• Suitable for less complex grief and emotional support

Verify counsellor registration with BACP.

4. Grief coaches

Typically offer support based on their personal experiences with loss. While they can provide practical advice and motivation, they are not equipped to handle complex psychological issues. It is not advised to seek coaching if you suspect you might be experiencing more complex difficulties with grief but they might be useful to help you sort out some practical issues in your life around loss. It's important to note that grief coaches are not regulated by any official body in the UK. While some may belong to coaching organisations, there are no standardised qualifications or ethical frameworks specifically for grief coaching. Please always ask the person who is running the coaching programme if they have any clinical experience how much training and supervision they receive and who is overseeing their work.

Grief Coaches:

•   Least regulated profession
•   Often guided by personal experiences of loss which prompted them to build their practice around it.
•   Limited clinical training
•   Better suited for practical support and goal-setting rather than ongoing therapeutic work
• Just because someone has a social media presence does not make them qualified to help vulnerable people, which is a common problem in the grief community.

Remember, a good coach should:

•  have received extensive training of at least several years (a one-week course is insufficient to run coaching programmes safely).
•  be regulated by a governing body
•  have additional training as a counsellor, psychotherapist or clinical psychologist
•  receive regular clinical supervision from a more experienced coach regularly.
•  be transparent about the work they can do with you and things they cannot support you with.

Forms of Therapy

There are various forms of therapy available for widows experiencing complex grief:

1. Trauma-Focused Therapy (e.g., EMDR)

Eye Movement Desensitisation and Reprocessing (EMDR) is a specialised therapy for trauma and PTSD. It involves bilateral stimulation (usually eye movements) while processing traumatic memories. EMDR can help reduce the emotional intensity of grief-related trauma. It is available from psychologists and psychotherapists but I would not recommend seeing a counsellor for EMDR therapy as they might not have adequate training in trauma therapy. Book a free 15-minute consultation with me to discuss whether you might need to be referred for trauma-focused therapy.

2. Acceptance and Commitment Therapy (ACT) is a compassionate approach to grief therapy that can help people cope with loss and find meaning in their lives. The focus of therapy is to help you live with the difficult thoughts and feelings associated with grieving and to enable them to gradually identify, reconnect with, and act in line with their values after loss. This form of therapy is generally accessible via clinical psychologists.

3. Psychodynamic Therapy explores unconscious thoughts and feelings that may be affecting the grieving process. It can help uncover and resolve underlying issues that complicate grief. You should see a psychodynamic psychotherapist or a clinical psychologist with further training in psychodynamic psychotherapy for this form of work. You might be required to attend more than once a week. Book a free 15-minute consultation with me to discuss whether you might need to be referred for psychodynamic therapy. 

4. Cognitive-Behavioural Therapy (CBT)

CBT focuses on identifying and changing unhelpful thought patterns and behaviours. For grief, it can help manage overwhelming emotions and develop coping strategies. This form of therapy is goal-oriented and can be accessed through clinical psychologists or CBT therapists.

5. Grief Counseling

This approach focuses specifically on the grief process, helping clients navigate the stages of grief, process emotions, and find ways to honour their loved one's memory while moving forward. Counsellors are best suited for this form of support and it is likely to be cheaper than seeing a therapist or a clinical psychologist.

6. Group Therapy

•    Structured Grief Support Groups led by professionals. These groups offer a safe space to share experiences and learn coping skills with others who have experienced similar losses.
•    Grief Group Therapy: These more intensive groups, led by mental health professionals, focus on interpersonal dynamics and deeper emotional processing of your loss. These groups are usually run over a longer period and are meant to help you with processing your grief when it feels stuck.

These are best run by group therapists or clinical psychologists.

Find out more about the grief group therapy for young widows I run in London and online. 

Mechanisms of Action

Each therapy works through different mechanisms:

• EMDR helps reprocess traumatic memories, reducing their emotional impact.
• Grief counselling provides a structured approach to understanding and navigating the grief process.
• Psychodynamic therapy uncovers unconscious patterns that may be complicating grief.
• CBT helps restructure thought patterns and behaviours that maintain distress.
• Group therapy offers peer support, normalises your experiences, and offers shared learning.

Fee Structures (approximate ranges):

London:

• Clinical Psychologists: £110-£200+ per session
• Psychotherapists: £60-£150 per session
• Counsellors: £40-£80 per session
• Coaches: £50-£300+ per session

Outside of London :

• Clinical Psychologists: £80-£150+ per session
• Psychotherapists: £40-£100 per session
• Counsellors: £30-£60 per session
• Coaches: £30-£300+ per session

Important Considerations before choosing the right mental health professional:

1. For complex grief, trauma, or severe symptoms, it's advisable to seek help from clinical psychologists or experienced psychotherapists.

2. Always verify the credentials and registrations of any professional you consider working with.

3. Many therapists offer sliding scale fees or reduced rates for those facing financial hardship.

4. Some services may be available through the NHS, though waiting times can be long. You should be entitled to at least 6 sessions of grief counselling from your local GP practice.

5. Your local hospice or grief charity can offer free or charge of low fee therapy for grief.

Taking the Next Steps:

If you're experiencing symptoms of complex grief, remember that seeking help is a sign of strength, not weakness.

1. Consider taking The Grief MOT assessment to gain insights into your grief journey and receive personalised recommendations for support.

2. Book your free 15-minute consultation with me once you receive The Grief MOT results. During our call, you can ask me any questions about grief therapy. I offer EMDR and psychodynamic therapy for grief, and I run therapy groups for widows.

3. Listen to an episode of my podcast that explains:

• the difference between resilient grief responses and more complex forms of grief response.
• Helping you identify signs that your grief might be complicated or stuck
• Talk you through the options for grief support and therapy.
• Help you decide when to seek professional help 

 4. Embark on Grief therapy. Whether individual or group-based, therapy can provide a safe space to process your loss, develop coping strategies, and work towards healing. By understanding the different types of support available, you can make an informed decision about the best path forward in your grief journey.