Complicated Grief

Losing a loved one is always hard. Feelings like sadness, numbness, or anger are a crucial part of the healing process. But when these emotions don’t resolve on their own, they can prevent you from leading a full life. Fortunately, there are ways to break through your grief. Remember to download your work and share it with your therapist or healthcare provider.
 

Please note that it is not recommended to use this course without a therapist who has training and experience in the treatment of complicated grief.

Kelty’s Key recognizes the work of the Center for Complicated Grief, Columbia University, New York, NY which was a resource for this course.

What is Complicated Grief?

5min
When grief does not pass naturally over time, it can stop you from enjoying life.
What is Complicated Grief Unit Guide

When someone we love dies, we experience a sense of loss. This grieving period is a normal process of life. But sometimes, grief does not resolve on its own over time. Complicated grief can affect your ability to function. Intense longings and unwanted thoughts can stop you from living fully. But there are ways to move forward. You can learn new skills that can help you resolve your grief.

  • The Facts
  • Understanding Complicated Grief
  • The Symptoms
  • Recovery
Audio Tip
Sandy Patola-Moosmann, MA, RCC, explains why grief is a necessary process.
1:22

The Facts

It is natural to feel pain after a significant loss. Grief is a sign that we have lost someone important. Without it, a person can’t come to terms with the massive change that death brings to their life. These feelings can bubble to the surface later on, or come out in other ways. If you lose more than one person in your life, unresolved grief can accumulate. You can end up grieving multiple deaths at once. In this situation, processing loss is even more difficult. Although grief is painful and disruptive, we need it. It is healthy and a natural process.

For some people, grief does not resolve on its own. Instead, you might find that you get stuck in feelings of yearning and hopelessness. If these emotions continue for more than 6 months, you may have complicated grief. About 7-10 percent of people will experience complicated grief. While you may feel isolated, you are not alone.

Audio Tip
Hilda Fernandez, MA, RCC, describes the difference between grief and complicated grief.
2:12

Understanding Complicated Grief

You may wonder why complicated grief has affected you and not someone else. Most likely, you were very attached to the person who died. Your connection was probably deep and long-lasting. They may have given you a sense of safety and meaning. When a bond like this gets shaken by death, it can feel like your world has been turned upside-down. You might think that your life has no purpose without the person who died. If your sense of self-worth is attached to your loved one, you may be unable to accept the death and let go.

While complicated grief can happen anytime, some deaths are more likely to bring it about. These include unexpected tragedies, suicides, or the death of a child. Untimely deaths often take longer to process and resolve. For this reason, complicated grief becomes more likely in these cases.

Symptoms of Complicated Grief

Complicated grief can affect you in many ways. It can change how you think, what you feel, and what you do.

Thoughts

It might feel like you can't stop thinking about your loved one or how they died. Life might not seem worth living without them. You may not be able to accept the reality of your loss. Thoughts about yourself and the world might become more and more negative over time. You might question who you are or how you'll survive without your loved one.

0:41
Andrea Sierralta, MA, RCC
Emotional

It is common to feel an intense longing or yearning for the person that passed. You might feel overwhelmed, shocked, or numb. Reminders of your loved one, in life or death, can cause powerful emotional reactions.

0:42
Dr. Margaret Drewlo
Behavioral

Difficulty adapting to your new life is a significant challenge in complicated grief. You may start avoiding things that remind you of your loved one. You might write off certain situations, places, or even people. Withdrawing yourself from activities and choosing to be alone is also common. Some people find it hard to get out of bed, take care of themselves, or get things done at work or school.

0:34
Andrea Sierralta, MA, RCC
Physical

Complicated grief does not have any specific physical symptoms associated with it. But many people do find they suffer from an ache in the area of their heart. When you are at your limit emotionally, you may feel nauseous or exhausted.

Note that physical changes to your body may not be from grief itself. After losing a loved one, we recommend seeing your family doctor for a checkup. It's important to make sure your symptoms are from grieving and not something else.

0:31
Dr. Francois Botha

Recovering From Grief

While you may feel eternally stuck in grief, all is not lost. There are ways to help you manage complicated grief and move past it.

Psychotherapy

There are many types of therapy to help you through complicated grief. Kelty's Key uses cognitive behavioral therapy. This approach teaches you how to face your grief and work towards resolving it. You'll learn skills to help you move forward and re-engage with life.

1:33
Jerry Stochansky, RCAT
Medications

You can't cure grief with medicine. Still, medication can help you get past some of the depressive symptoms that may get in the way. They may be the stepping stone you need to better engage in and complete therapy.

1:05
Sandy Patola-Moosmann, MA, RCC
Finish

Understanding Your Grief

20min
Believing that you are always in pain can keep you stuck in grief.
Understanding Your Grief Unit Guide

Complicated grief can take over your life. It might seem like there is nothing but darkness and terrible imagery. To resolve your grief, you need to believe that you can get through this. Understanding your day-to-day lows and noticing your highs is a great first step.

  • Supports
  • Grief Records
  • Triggers
  • Responses
Audio Tip
Dr. Francois Botha explains why social support is important in recovery from complicated grief.
1:09

Don’t Go It Alone

Moving through complicated grief is hard work. It can be emotionally and physically exhausting. With so many challenges ahead, it is essential to have people around you for support.

Who we turn to for help changes throughout our lives. After a loss, you may be surprised by sudden shifts. Were you shocked when the people you thought you could depend on disappeared from your life? Perhaps they didn't understand what's taking you "so long" to "get over it." Maybe they didn't know what to say or do. Sometimes conflict or blame can surface after a death.

Did people you had not expected step-up to offer their support? Have you found any groups or meet-ups helpful? Finding people who can be there for you, without being critical, is crucial at this time. You shouldn't have to go it alone. Supportive people will help you benefit from what you are learning and make it through.

Who can you currently reach out to for support? Try to name 3 people or groups:

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Audio Tip
Dr. Francois Botha describes how social support may change after a significant bereavement.
1:22

Reach Out

You may have experienced friends or family pulling away from you after your loss. They might not know what to say or misunderstand your actions. However, it is also possible that you are distancing yourself. You might find it hard to interact with your loved ones now that your life has changed so much.

It's important to recognize this behavior and try to reverse it. Isolating yourself will only make you feel more alone than you already do.

Reaching out might be as simple as letting certain people know that you need them. Of course, just because it's simple doesn't mean it's easy. Reaching out takes a lot of effort when you are in grief. When you manage to ask for help, give yourself credit. It's an accomplishment.

Accepting help can also be hard. It can be particularly challenging if you have been independent and self-reliant. Try to be open. It's ok to need support at this time.

Here are your 3 supports. How can you reach out to them this week?

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Audio Tip
Dr. Margaret Drewlo explains why monitoring the intensity of grief throughout the day is important.
1:00

Always Hurting

Grief is overwhelming. You probably feel like you are in anguish every minute of every day. Does it feel like you’ll never be happy? As though your body and mind are no longer able to be at peace? Many people start to believe that life will never get better. If you think this way, you’ll feel hopeless. It will be hard to stay motivated and work through your grief.

The power of grief is intense, but it’s not at full blast all the time. It ebbs and flows throughout the day. Moments of distress probably jump out at you. But times of neutrality or happiness might pass unnoticed. To believe that you can make it out of grief, you must pay attention to the fluctuations in your emotions. When you notice that you can feel neutral, or even half-decent, you’ll become more confident. You’ll feel more assured that you can move forward and embrace life again.

Grief Records

An excellent tool to track changes in your emotions is a grief record. Take a few minutes several times a day to write down what was happening and how distressed you felt. Rate the distress from 0 (none) to 10 (high). Different people experience the pain of grief in different ways. A 10 on your scale might be overwhelming panic or rage. On the other hand, it might be a feeling of numbness like you’re on autopilot.

It’s also helpful to track what made your pain change. Did an image come to you that made your panic even worse? Maybe a thought gave you some comfort and helped calm you.

A grief record is most beneficial when you use it several times a day for about a month. It will help you see a fuller picture of your grief and its intensity. You’ll start to collect evidence that you can feel emotions other than pain. What makes your grief more or less intense will also become apparent.

Take a minute and plan how you’ll use a grief record. Do you have a small notebook? Some people use their phone as it’s always on hand. Below is an example of what your grief record might look like:

Date / Time Situation Level of Distress What changed distress? Increased or decreased distress?
March 26
10:30 PM
Trying to fall asleep and the thought of my son in the ground came into my mind. 8 The more I thought about him being cold the worse it got. Could not sleep for another six hours.
March 26
11:00 PM
Trying to fall asleep and the thought of my son in the ground came into my mind. 7 Thought of him being with my Dad and my sister and they were comforting him. Distress went down a little.
March 27th
8:00 AM
Saw TV news item with happy child my son’s age. 6 Sharp emotional pain at first which subsided a bit when I called my friend Jill and talked to her for 15 minutes.
March 27th
5:30 PM
My neighbor came by to introduce me to her new puppy. 0 I noticed after my neighbor left I started to feel some distress again but felt none while I was holding the puppy. I wasn’t aware I had breaks in my emotional pain.
March 28th
9:30 AM
I saw a parent with her son and I got very angry. It is unfair! 7 I remembered that I had my son for longer than some parents get and I felt a small amount better. Later I started to think that it is unfair again and I got angrier and angrier.
Audio Tip
Dr. Margaret Drewlo discusses how therapists help clients work with triggers.
1:13

Triggers

As you use your grief record, you might notice some patterns. There may be places, situations, or even people that open the floodgates to your grief. These are called triggers. A trigger might be something closely tied to your loved one, like a birthday, or something more abstract, like a smell. Either way, triggers are linked to memories and feelings about the person who has died. They can interrupt your day and send you into a tailspin of pain.

You'll know something is a trigger because you'll have a strong reaction to it. For example, you might feel deep sorrow, anger, or nausea. Triggers make you feel terrible. Worrying about whether you'll come across a trigger can be draining. Naturally, many people deal with triggers by trying to avoid them.

But it's useful to take note of your triggers. They can help you pinpoint sensitive issues or emotions that are keeping you stuck in grief. Recognizing these problematic areas is the first step to moving past them. You can find ways to cope.

Take a minute to think of 3 triggers. As you continue working on your grief record, you may notice more.

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Responses to Triggers

It can also be helpful to write down how you react to different triggers. A trigger might cause you to experience intense emotions. Other times you might feel a physical reaction in your body.

Here are some examples:

Trigger My Response
The anniversary of my son’s death. Shortness of breath all day. Non-stop sobbing. I thought I was going crazy.
Seeing a group of school children. My stomach grabbed and I got a pain in my chest.
Mother’s Day talked about in a group of my friends. I felt like I was in a pit. Like a sense of doom. So alone. I wanted to run out of there.
Pancake smell. Tearful.
Walking into the hospital to visit my Mom. I smelled blood. I lost my way even though I knew the building layout. I got dizzy and had to sit down.
Emergency vehicle siren. The first time I heard a siren I vomited. Now I freeze.

What are some responses you have experienced when triggered?

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William's Story

William's son David died while competing in a sporting activity 9 months ago. Since then, William has felt like he is consumed by grief every day, all day. The pain seems like it is never-ending. He feels it at work, at home, in the morning, and at night. William is not sure how much more of this he can take. He's starting to question whether he'll ever feel anything but pain ever again.

William's therapist suggested he try keeping track of his daily emotions in a grief record. William thought this sounded like a waste of time. He already knew how he was feeling and why. As a favor to his wife, he decided to give it a go. The record doesn't take much time, so why not?

After a few days of tracking his grief, William noticed that his level of distress actually varied in the day. At times the pain was intense and long-lasting. Other times it felt duller and was short-lived. Surprisingly, there were also moments when he felt neutral or even a little happy. He felt best during several evenings he spent with his brother. On the other hand, William noticed that watching sports on TV always made him really upset.

William kept up his grief record for 4 weeks. He saw that his grief came and went. Sometimes it was very intense, and sometimes not. William felt a bit of relief, knowing that his body was still able to feel something aside from pain. He felt less afraid of his grief and a little more confident that he could work through it.

Good Job! You’re Ready to Start a Grief Record

Download Your Worksheet

Continue working on your grief record over the next week. It should only take a few minutes a day. Track your emotions and keep your eyes open for new triggers. As you gain evidence that your pain is not always at full blast, you'll become more assured that you can work through this.

Download

Congratulations! You're Tracking Your Grief

Keep working on your grief record and exploring the ups and downs of your grief. Remember to reach out for support, even if it’s hard.

Next Steps

If you are a Kelty's Key patient, your therapist will check in with you to see how your week is going and give you instructions for your next unit. If you are using this program on your own, share your progress with a healthcare provider and continue with the other units at your own pace.

Finish

Getting Unstuck

20min
Understandable tendencies to avoid pain can keep us stuck in a cycle of grief.
Getting Unstuck Unit Guide

Avoidance is an understandable reaction to the pain of grief. When it comes to grief, the pain we experience can be both emotional and physical. Sometimes people describe the pain from grief as a mental distress, suffering, or agony; as much as a human being could possibly hurt. You might expect emotional pain but be unpleasantly surprised at the pain you also feel in your body like aches, a heaviness in the trunk or limbs, or a sharp pain in the abdomen described like being “punched in the gut”. It is no wonder that grieving people would want to avoid these difficult feelings.

An important part of the treatment for complicated grief is to gently and gradually move towards experiences that have been distressing or painful. In this unit, you’ll learn tools that will help you master these challenges.

  • Understanding Avoidance
  • Challenging Situations
  • A Series of Goals
  • Keep Practicing
Audio Tip
Dr. Francois Botha discusses which situations people with complicated grief tend to avoid and why.
1:04

Avoidance

In complicated grief people might avoid anything that reminds them of their loved one, experiences they had with them, places they have been with them, or activities they used to do together. We can call these difficult reminders “triggers”.

We know that people who experience complicated grief avoid situations, people and places for good reason. Reminders of happier times or of great losses can be very painful and it is human to want to avoid pain. Avoidance usually works well in the short-term (they feel better in the moment) or people would not avoid. Simple. The problem with avoidance is that it is not a useful long term strategy. You can become increasingly sensitive to any reminders of your loss until avoidance means that you can go few places, meet up with few people or have few experiences without coming in contact with your painful thoughts and feelings. Instead of moving away from people, places and experiences, healing from complicated grief means gradually moving towards these things.

Audio Tip
Dr. Margaret Drewlo explains the role of avoidance in keeping people stuck in complicated grief.
1:06

Challenging Situations

Now you have come into treatment for a grief that does not seem to be progressing. You may have noticed that there are more and more situations, places and people that you have come to avoid. This pattern of restriction can happen without us even noticing. Sometimes all we know is we feel uncomfortable a lot. Our world becomes smaller and smaller. We end up spending most of our time alone, physically and emotionally – or both.

There were experiences with your loved one you used to enjoy, even if they seemed commonplace at the time. Now with them gone, those experiences may seem impossible to continue. You will be faced with the reality that in those experiences, your loved one is no longer enjoying them with you. There may also be many places that you used to go that involved your loved one and now those places seem too painful to visit.

Audio Tip
Dr. Margaret Drewlo describes the consequences of avoiding situations for people with complicated grief.
0:39

Why Change?

You might wonder why you would want to do anything uncomfortable or painful when you have already been through so much. You might even wonder why anyone would suggest you do that!

Doesn’t it make sense to avoid what is painful so that you can protect yourself from more pain? The suggestion that you expose yourself to uncomfortable or emotional pain might be confusing. In the early days after a loss the best thing to do is to focus on care for yourself. You may have even received this advice from healthcare providers or counsellors.

In the first days and weeks after loss it is recommended that you do not attempt to expose yourself to too many overwhelming experiences. The first period after a loss is for receiving support from others. It is also for basics of functioning such as healthful food, getting restful sleep, bathing, showering and getting dressed on some or most days. With uncomplicated grief this time will naturally flow into a gradually increasing ability to sleep well, function, receive and give care, and re-enter social life and volunteer or work activities.

In complicated grief, the natural progression of grief has become interrupted. The self-protection and avoidance that worked well in the first days and weeks after a loss persists. It becomes a barrier to healing rather than helping. What once helped does not help you to you feel better anymore. Still, you might think that if you stop avoiding or isolating, you will not be able to manage the feelings that come with triggering situations, places and people.

This unit will give you tools to help you to more easily tolerate coming into contact with situations, places and people. With time and practice it will get easier. With time and practice you may even begin to experience some enjoyment from re-engaging with the world.

Name a situation or place you’d like to stop avoiding:

Feeling Stuck?
Situations:PartiesGoing to the doctorBeing with other parents
Places:RestaurantsBedroom of the DeceasedGraveyard

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How to Take on the Challenge

It is important for you to have successes when you are attempting to do something that is difficult such as taking on contact with experiences you have been avoiding. With success you will be more encouraged to keep on trying.

Although there is no guarantee that you’ll complete a task each time you take on what you have been avoiding, starting small will make it more likely that you will be able to tolerate it and continue to take other healthy risks. Like steps on a ladder.

A way to start challenging yourself is to create a set of steps for a challenge you have decided will provide you with more satisfaction or enjoyment in your life. At this point you may think important goals are out of reach. For instance you may have a goal to attend your child’s graduation from school next year but you have been avoiding the building because you had another child who died who went to the same school. To start off you might look at a photo of the school or if that is too distressing, looking at a photo of a school.

Your goal might be to attend a holiday party that you and your loved one used to attend and enjoy together, but which you have not attended for some time. You may start off small by looking at the date on the calendar at which time the party would be usually taking place. You could drive past the building where the party takes place, or you could make a list of the people who usually attend the party. Or, some other small step.

You might have the goal of finding new purpose for the clothes and toys of your child who died. For most people the final step of leaving the items at a donation site would be too difficult a step to start with. Again the idea is to start small, such as just opening the box where the clothes and toys are stored. Just open the box. Nothing else. That is a big first step.

The main point of this exercise is to establish a goal and then make small manageable steps towards that goal. If you think your ultimate goal is very hard, then your first step should be at a 1 or 2 level of difficulty. Some challenges may require more than five steps. You can ask a person in your support system to help you in any of the steps to make it more likely you’ll be able to take the step. Using self care before and after you take a step can increase the likelihood you will take a step. This exercise will not be easy but the effort can be worth it to have an expanded and more enjoyable life. You have survived your loss. Life can be enjoyable again.

See an example of how to create a ladder of goals on the next page. Remember that everyone is different and will have different activities that will be more or less challenging. Start where you are and work from there.

Creating a Ladder of Goals

This Ladder of Goals was created by someone whose partner had died.

Worksheet: Sample Ladder of Goals 1 – Attend A Family Wedding

Level of Challenge Steps towards My Goal
Hardest Attend the family wedding
Harder Attend the wedding of my co-worker or neighbor
Middle Watch a movie that includes a wedding scene
Easier Reply to the invitation, saying I will attend
Easiest Open the invitation to the wedding and read it

Unique to You

You can see that the ladder starts with a step that the person thinks they can carry out with some effort. Each step should not be so hard that it is overpowering. Again, create steps that apply to your unique situation. Create steps that will be helpful for you as you move toward a goal you value.

My Ultimate Goal:

Write out a few different ways that you can expose yourself to your situation or place. Start with your easiest challenge and gradually work up to the hardest.

How can you build yourself up to your ultimate goal?

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Your First Challenge

Good job. You're ready to start planning your first challenge:

How much grief do you feel when thinking about trying this exercise?

5

When will you do your exercise?

How long will you do your exercise?

Done

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Audio Tip
Dr. Francois Botha explains why rewards are important for people engaged in treatment for complicated grief.
1:40

Reward Yourself

With each step and with all the exercises you do as part of your complicated grief therapy, reward yourself. It is important to reward yourself because you are doing hard work in your psychotherapy. Rewards are also important because many people who have been bereaved stop engaging in pleasurable activities. Sometimes people do not think they deserve anything good. The practice of small rewards is important to you being able to continue doing the needed work in psychotherapy and gradually moving towards more meaning or enjoyment in your life.

A reward should be something that is significant as a reward to you, not something someone else considers a reward. You will find the reward that fits best for you.

How will you reward yourself for completing the challenge?

Feeling Stuck?
Doing craftsWatch sportsWear favorite clothes
Listen to new musicBuy new cosmeticsAn hour of me-time
Go to the beachBuy a small gadgetApply cream to hands

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You Can Do It

You might make your list of challenges, try a few then find yourself with a cold or something else that gets in the way of continuing for a while. You may experience a wave of grief or deep sadness that makes you take a pause. You may feel discouraged and want to give up. That is to be expected. Remember, grief comes in waves and life in general never proceeds on a straight course. Be easy on yourself when things come up that interfere with your goals.

Try again. And reward yourself.

Daisy's Story

Daisy’s partner Blair died tragically last year. Since then Daisy has not been able to work, has gradually stopped seeing friends altogether, and avoids anything that reminds her of her partner or their former life together. She spends most of her time alone at home. Daisy wonders if she will ever "get better". Sometimes she wonders if there is something seriously wrong with her since her friends and family think that she should be “over it” by now. Daisy seriously wonders if her life will always be so painful.

Daisy decided she was going to try to deal with her grief even if feeling better did not seem
possible. One exercise that was recommended to her was an exposure exercise; looking at Blair's picture or holding one of Blair’s favorite belongings. She did not think she could do it. She thought that the pain would be too overwhelming. But the next day Daisy found the box of pictures she had stored away.

Later that night Daisy took the lid off the box. The next morning she put her hand in the box and took out a picture of Blair from before they met. She held the picture in her hand. It did hurt but it did not overwhelm her. Then Daisy held a picture from a time when they were working on their garden together. Finally Daisy found a picture from their last holiday, held it, and showed it to a good friend when the friend came over for coffee. None of this was easy, but it was not as painful as Daisy had thought it would be. It felt good to share her love for her partner.

It took looking at and holding pictures and her partner’s treasured objects about 50 times before it got easier for Daisy. She was able to honor her love for Blair by putting her favorite photo in a new frame she bought for this purpose and putting it in her living room. It warmed her heart to see the face she loved as she moved through her home.

That Took Courage. You've Started Working on Avoidance.

Download Your Worksheet

That took courage. You’ve learned about avoidance in grief and how to work with it so that your life can become freer. You avoided difficult situations and memories in the past for a good reason, to avoid pain. By the time you started this course you may have been avoiding situations and memories for a long time. It will take time and practice to make change. Keep working on approaching rather than avoiding experiences. Some experiences will be more challenging than others. Make a record of the result of each challenge you try. Not everyone will turn out the way you hoped, but many will. Your record can be helpful as a reminder of all the hard work you have done.

Download

Congratulations! You Are Doing the Work.

Continue to work on your list of challenges and reward yourself for your work. If you’re feeling stuck, you can review this unit or talk to your therapist or healthcare provider.

Next Steps

If you are a Kelty's Key patient, your therapist will check in with you to see how your week is going and give you instructions for your next unit. If you are using this program on your own, share your progress with a healthcare provider and continue with the other units at your own pace.

Finish

Resolving and Reinvesting

15min
When intense grief lingers, resolution and finding a way to reinvest in your life might seem impossible
Resolving and Reinvesting Unit Guide

It is possible to integrate your losses into your life and to find ways to reinvest or new ways to invest in your life. Several things can help. First of all, identifying your values as they are now will help you to reimagine and reinvest in the life that lays ahead. Second, when you know what your values are, you can develop new goals. Third, coming to a point of resolution involves accepting that your loved one had both positive and negative qualities to them. Finally, having an imaginary conversation can help you to resolve the loss.

An important part of the treatment for complicated grief is to gently and gradually move towards experiences that have been distressing or painful. In this unit, you’ll learn tools that will help you master these challenges.

  • Identify Your Values
  • New Goals
  • Both Sides
  • Having a Conversation

Life Can Be Worthwhile Again

When someone important to you dies, you think that life will never be the same. This is real. Life cannot go back to the way it was before your loved one died. But you might also think that life can never be good again. That is where treatment comes in to help you recognize that your loved one is gone, to help you remove the blocks in your natural grieving process and then to come to a resolution about your loss. In this treatment for complicated grief another goal is to have your remembrances of your loved one become “bittersweet”. You may never feel happy that they have died. But you can come to a state of being able to hold pain and regret for your loss and also positive emotions about your relationship with them.

How you get there from where you are now is let go of the relationship that was, creatively resolve remaining issues in the relationship if you can, and orient yourself to your new future with new goals.

Identifying your Values

Finding meaning in life is best found in our values. Our values give us a direction to how we want to spend our time and energy. Death teaches us that our life is finite. Experiencing a big loss can motivate you to decide how you want to spend your time and resources. Determining the values that are most important to you can help you gain clarity about your goals.

Identify the five values that are most important to you.

Feeling Stuck?
BeautyCommitmentContributionCompassionForgivenessFun
GenerosityHopeInner PeaceKnowledgeOpennessSafety
Self KnowledgePassionPleasurePurposeSuccessSpirituality

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Audio Tip
Dr. Francois Botha discusses how establishing longer term goals and clarifying values help clients with complicated grief.
1:21

Discover New Goals

If a miracle happened right now and you were at peace with the death, what goals would you have for your life? It is understandable that in grief you may have given up your goals and dreams. This exercise helps you discover what your goals are now that your life is very different. It might take a while for you to come up with new goals. There are no wrong answers.

Write down any ideas you have, even if you don’t think they are possible or practical. The purpose of the exercise is to get you to start thinking of a meaningful future.

Next

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Audio Tip
Dr. Margaret Drewlo explains why developing a balanced view of the person who died is part of treatment for complicated grief.
0:59

Both Sides

We can forget that the person who died was a whole person like we all are. We can forget that our loved one had positive qualities and qualities that were not positive. Sometimes we only remember the good times we spent with them or only remember the hard times. An important part of the work you are doing is to be able to see your loved one in all their humanness. Have a balanced view.

You can use a picture and or a treasured object to help tell the balanced story of the person who died. It can help to have these items in front of you as you complete the following exercise.


What are some of the positive qualities of the person who died?

What are some qualities of the person who died which are not positive?

What are some of the pleasant memories you have of times you spent together?

What are some of the unpleasant memories of times you spent together?

What are your reflections about the Both Sides exercise you just completed?

If you are using this course for self-help you can connect with your supportive friends or family for encouragement.

Done

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Audio Tip
Dr. Margaret Drewlo describes how imaginal conversations with the person who died help people with complicated grief.
0:54

Having a Conversation

If you had a positive relationship with the person who died there is research suggesting it can be beneficial to have a conversation with them about the events surrounding their death and your relationship. If you did not have a positive relationship you may decide not to do this exercise now. You might want to do it in the future when your relationship with the person who died is more resolved. This practice is a two-sided imaginal conversation. You will do the talking for both of you.

You may have already been talking to your loved one but did not realize that it could be helping you to feel at peace with their death. You may have been telling them about your day or asking them why they had to die when they did. You might wonder what they really thought of you or another question you never got to ask. Being curious about them and their death is entirely to be expected. If you did not know before now, it is worth repeating. Entirely to be expected.

Here is an example of how a conversation might go.

You: Why did you die? Why couldn’t I have more time with you?

Them: I wanted to stay with you, but I was too sick.
I wanted to have more time with you too. That was my biggest wish.
I am so sorry to leave you. If I could change it, I would.

You: I REALLY miss you.

Them: I knew you would, and I am sorry you are hurting. You are going to be okay. I think you are a strong woman.

Your Conversation

The typical way this conversation starts is for you to imagine that death has just occurred but your loved one can still hear you and talk to you. You will know what kind of language is authentic to them and what they would likely say to you if you asked them a question.

Take five minutes to have a conversation with your loved one now.

What was that like? Make some notes and share your reflections with your Kelty’s Key psychotherapist or a friend or family member who is supporting you. You could also show your friend or family this section of the website so that they understand the exercise.

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Martina's Story

After her sister died, Martina gave up her plans for her future. The goals she had for her life did not seem important anymore and she resigned herself to trying to make it through each day. She no longer expected that she’d have a bright future or that there was anything for her to look forward to.

In her psychotherapy, Martina was asked to think about what she would want for her future if she had been able to come to peace about her sister’s death. Martina had not thought about that for so long that she could not come up with anything. Between sessions, Martina considered this question.

Martina struggled to know what was important to her anymore. She was not sure of if she knew what was meaningful to her. She was not confident she knew her central values.

Martina did a values identification exercise and was able to come up with several core values. After becoming reacquainted with her values she was able to find a few causes that gave her meaning. Martina finally settled on volunteering for a cause her sister would have supported. Martina felt more connected to her home community and more connected to a positive memory of her sister.

Good Job! You have learned new strategies

Download Your Worksheet

Good Job! You have learned strategies to create new goals for your future and to resolve your relationship with your loved one who has died. You have done a lot of hard work to get to this point.

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Congratulations! You’ve learned new strategies to create new goals for your future

Your goals may change as you continue in your grieving process. That is as expected. If you have decided to have imaginal conversations with your loved one the conversations will also likely change over time.

Next Steps

If you are a Kelty's Key patient, your therapist will check in with you to see how your week is going and give you instructions for your next unit. If you are using this program on your own, share your progress with a healthcare provider and continue with the other units at your own pace.

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