What is Complicated Grief?

5min
Complicated grief can happen to anyone who has lost someone they love and it can stop them from re-engaging with life.
What is Complicated Grief Unit Guide

Grief is a normal process of life. When someone we love dies, we experience a sense of loss. Grief becomes complicated grief when the feelings you had when your loved one first died do not subside. Complicated grief affects your ability to function. People in complicated grief can experience intense longing and unwanted thoughts about their loved one or the way they died. There are ways to treat complicated grief to help you come to terms with your loss.

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

The Facts

Complicated Grief Can Happen to Anyone

While grief does not become complicated for everyone, it is estimated that 7 – 10 percent of people will experience it. Even though it may seem that your grief experiences are not shared by others who have had a loss, you are not alone.

We Need Grief

Grief is a signal we have lost someone important. If we don’t experience grief when we have a loss, losses can accumulate unresolved and make grieving more difficult later. So, although it is painful and our life can be disrupted, we need grief in our lives.

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

Understanding Complicated Grief

When Grief Becomes A Problem

While almost everyone experiences grief after the death of a loved one, some people seem to get stuck in their grief. They start to avoid situations, places and people, and cannot see a future without the person who died. If the intensity of your grief does not change for six months to a year after your loss, you may be experiencing complicated grief.

Attachment is a concept that explains the connection to another person which is deep and lasting. This connection can provide a sense of safety and meaning. When a person who is important to us dies, our attachment bond gets disturbed or unsettled. So, it makes sense that it can suddenly feel like our whole world is upside-down.

Some deaths tend to affect us more, such as the death of our child, death by suicide or other unexpected tragedy. For most people, these deaths likely take longer to process and to resolve.

Symptoms of Complicated Grief

There are many symptoms of complicated grief including thoughts, emotions, and behaviors. Here are a list of symptoms you may have experienced.

Thoughts

You may have unwanted, intruding thoughts about your loved one who died or the way that they died. You may not be able to accept the reality of your loss. You may not be able to imagine a life worth living without them. Finally, you may develop a negative view of yourself and of the world.

0:41
Andrea Sierralta, MA, RCC
Emotions

In complicated grief, it is common to have an intense longing or yearning for the loved one who died. Feeling overwhelmed, numb, and having intense emotional reactions to reminders of your loved one, that they died, or how they died. These emotions are all familiar to people in complicated grief.

0:42
Dr. Margaret Drewlo
Behaviors

Difficulty adapting to your new life is a significant challenge in complicated grief. Other central behaviors are avoiding situations, places or people who remind you of your loved one or the way they died. Withdrawing from people and activities is also common. You might feel loss about who you are, what to do with your life, or how to survive without your loved one.

0:34
Andrea Sierralta, MA, RCC

Treatments

Even though complicated grief can be very difficult after you suffer a loss in your life, it can be treated successfully.

Psychotherapy

There are many types of psychotherapy for complicated grief. Kelty's Key is based on cognitive behavioral therapy. This approach teaches you how to deal with the most challenging aspects of complicated grief. As you build your skills, your symptoms of complicated grief can be reduced.

1:33
Jerry Stochansky, RCAT
Medications

Grief in itself is not an illness requiring medication. Still, research shows medication may help you to engage in and complete treatment more easily.

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

Getting Started

20min
Learn how to begin your treatment for complicated grief. The first steps will get you started in treatment.
Getting Started Unit Guide

By the time you began this course, complicated grief may have taken over your life. Knowing how to get started addressing your process of grief can be confusing. There are tools to help you get going.

There are four basic areas that we will address in this unit. All are central to helping your grief get back on track so that it proceeds in a more natural way. These are key areas for the effective treatment of complicated grief.

  • Supports
  • Grief Self-Monitoring
  • Triggers
  • Re-Telling the Story
Dr. Francois Botha
Dr. Francois Botha describes how social support may change after a significant bereavement.
1:22

Your Supports

Supports change over time and with different life experiences. It is common that a person’s circle of support changes in bereavement. Well-meaning friends might distance themselves from you because they don't know how to talk to you about your loss. You might be the one to distance if it is hard for you to interact with your family and old friends and acquaintances now that your life has changed so much.

Were you shocked when the people you thought you could depend on disappeared from your life? Did people you had not expected step-up to offer their support? Both of these changes in support systems are common to people who experience grief. Complicated grief is an extra challenge to support systems. Sometimes there is even blame or conflict that surfaces after a death.

An essential part of the learning in this unit is to be able to identify your current circle of supportive friends, family, and community.

Why have support? Support is vital in all aspects of life but especially in the process of grieving. Going through grief alone adds to the feeling of separateness that already accompanies losing someone you love. Going through this particular process of psychotherapy with support makes the treatment more comfortable for you. Adequate support may mean it will be more likely you complete treatment and benefit from what you are learning.

What individuals or groups are your current supports? Try to name three:

Next

Edit
Dr. Francois Botha
Dr. Francois Botha explains why social support is important in recovery from complicated grief.
1:09

Getting and Receiving Support

Reaching out might be as simple as letting those friends and family with whom you have an uncomplicated relationship know you would like more contact with them. Reaching out takes some effort when you are in grief. Give yourself credit when you are able to reach out.

Getting support might also be a matter of being open to help when it's offered. Accepting help can be a challenge if you have been independent and self-reliant. Grief support groups can be a new source of support. Many grief support groups can be found online, at hospices, or at mosques, synagogues, or churches.

Below are the three sources of support you listed on the last page. What action can you take to access the support?

Next

Edit
Dr. Margaret Drewlo
Dr. Margaret Drewlo explains why monitoring the intensity of grief throughout the day is important in treatment.
1:00

Grief Self-Monitoring

The symptoms of complicated grief can be so powerful that is seems like you are grieving every minute of every day. It can make you feel demoralized and wonder if you will ever live without intense pain or live without feeling disconnected from the people and activities you used to love.

Does it seem that you don’t have any relief from the emotional pain of your loss? Do you sometimes wonder if life will ever get any better for you? Are you resigned to just getting through each day because of constant grief?

Those are thoughts expressed by many people who experience complicated grief. Thoughts like these can lead to feelings of hopelessness and loneliness. Self-monitoring will help you learn that your grief changes in intensity throughout the day, throughout the week, and that there are factors that either increase or decrease your felt sense of distress.

Grief Monitoring Record Example

The grief monitoring record is used to help differentiate emotions in grief. You will have times of intense emotional pain and times of emotionally under-responding to what is going on around you. You will also have times you might feel emotionally neutral or even feel some comfort or enjoyment.

You can use the record at any time. It takes about three minutes per entry. The information you include on the record will be most helpful to you if you use the record several times a day for about a month so you can see that there are variations in the intensity of your grief.

The worksheet at the end of this unit includes a grief monitoring record for your use.

The grief monitoring scale helps you to pinpoint your level of distress in the situation you are writing about. 0 is no distress and 10 is maximum or as much distress as you could imagine. High distress might occur in the form of overwhelm, panic, or rage or might occur in the form of being checked out, flat or on extreme auto pilot.

This example shows a record filled out by a parent whose son has died.

Grief Monitoring Record

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.
Dr. Margaret Drewlo
Dr. Margaret Drewlo discusses how therapists help clients work with triggers.
1:13

Triggers

As you practice with grief self-monitoring you may notice that some circumstances or events increase your distress more than others. These are called triggers. Triggers are connected to sensory or feeling memories. In other forms of trauma, triggers come from events that are unusual in a person’s life. Triggers might occur in complicated grief when the death is traumatic, but triggers can also be from daily routines and activities we strongly connect to our loved one.

We know something triggers us because we have an extreme reaction to it. The reaction could be deep sorrow, anger, nausea, shock, panic, a sense of doom or any other emotional, physical, or cognitive response. Triggers feel terrible and can be physically exhausting when they happen often enough.

Before we are aware of our triggers they can disrupt our life unexpectedly and can be difficult to handle. Our triggers signal us about our areas of particular sensitivity and inform us about experiences that we may tend to avoid.

Please note that the physical symptoms of grief can also happen for other reasons. It's important to make sure your symptoms are from grief and not something else. After a major loss it is a good idea to see your family doctor or healthcare provider for a check up.

What triggers are you currently aware of? Try to name three:

Got It

Edit

My Triggers Sample Worksheet

Here is a trigger worksheet filled out by a mother whose son died

Trigger My Response
Pancake smell. Tearful.
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.
The anniversary of my son’s death. Shortness of breath all day. Non-stop sobbing. I thought I was going crazy.
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 the responses you experience when you are triggered?

Next

Edit
Dr. Francois Botha
Dr. Francois Botha describes his experience with clients as they retell the story of their loved one’s death.
1:02

Re-Telling the Story

The next key tool you will learn in this unit is the re-telling of the story of the day or the night that you learned your loved one died. Research shows us that this is one of the central and most difficult memories for people with complicated grief to contend with. This memory is a traumatic memory for most people who have complicated grief.

The purpose for this exercise in which you tell the story of the death is to help your difficult emotions around the story of the death to subside and for you to be more comfortable with talking about and thinking about that time in your life. Re-telling the story is a gentle way of coming to terms with the reality that your loved one has died.

Re-telling the story of the death is done in a structured way and takes between 5 and 10 minutes each time. Each time you re-tell the story, record it on your computer or other device. Consider not using your cell phone for this exercise if you have it on your person at all times, since part of the effectiveness of the exercise is to be able to imagine that you are putting the device away in a safe place. This would be difficult if you have your phone in your pocket or in your hand most of the time.

The exercise is practiced repeatedly over several weeks. It is important to reward yourself after each time you re-tell the story. Balancing the difficult work you are doing in psychotherapy with activities or experiences that are positive or comforting helps grief to progress.

The reward should be something that you value and that you find uplifting or comforting. Try to make a list of 5 – 10 different rewards you would appreciate. You could also put ideas for rewards on small pieces of paper and keep them in a jar you keep somewhere you can see it.

Steps in Telling the Story

Here are the steps in Telling the Story. You can also listen to an instructional audio recording of the steps.

  1. Set your device to record.
  2. Record your current level of distress (on a scale of 0-10) and then answer the question, “What is the story of the moment you found out that died?” Where were you? Who was around you? What time of the day or night was it? Close your eyes as you tell the story. Closing your eyes allows your mind to create a more vivid image. The re-telling should last about 5 to 10 minutes. Set a timer and stop when the timer goes off.
  3. After you have opened your eyes, make a note of how distressed (on a scale of 0-10) you felt with the re-telling. With your eyes closed again imagine that you are rewinding the story on your device. In your mind’s eye see yourself clicking on the rewind function and see the sound- recording get rewound all the way back to beginning. Again, in your mind’s eye store the device somewhere safe. If the recording is on your recording program on your computer, imagine that you are putting it into a secure directory. Rewinding and putting away the story gives your mind a break from the intense feelings that can come up when you first start to complete this practice.
  4. Pick a reward from your list and give yourself the reward. Try to open yourself to feelings of enjoyment.
  5. Listen to the story you recorded each day for the next week. Record your level of distress before and after each time you listen to the story. Remember to reward yourself each time you listen.
  6. After one week repeat the procedure of telling the story anew and recording it, imagining afterward that you are re-winding the recording and putting the recording device away in a safe place.
  7. Know that you have been doing some of the most challenging and painful work you will ever do in your life. Acknowledge your courage in taking on this work.

William's Story

William's son David died while competing in a sporting activity nine months ago. It seems to William that he is consumed by grief every day, all day. He took some time off work just after David died. Now William is back at his job full-time. He is keeping up with work tasks but has the sense that his pain is all consuming and never ending. He is not sure how much more of this he can take.

William was introduced to the idea of doing a grief record throughout the day to track his level of distress. William wondered if it was a waste of time since he was pretty sure he knew how he was feeling and why. As a last resort and a favor to his wife who was worried about his obvious suffering, William decided to give the grief record a try.

William recorded many situations throughout the day. He recorded the level of distress he was feeling, and what made the distress increase or decrease. William had been reluctant to try the record because he thought it would take too much time. He discovered it only took him about three minutes per entry.

After the first few days William saw that his grief actually varied. At times it was very intense and seemed to last for a long time. At other times it was less intense and lasted for ten or fifteen minutes. William was surprised that they were even a few minutes every day he felt neutral and sometimes he had brief moments of happiness. He noticed that there were thoughts or contact with particular members of his social circle that intensified or reduced his experience of grief.

William kept up with his grief record for four weeks. William saw that his grief came and went. Sometimes intense and sometimes not. Sometimes lasting hours and sometimes last minutes. Keeping a record helped William to be less afraid and more accepting of his grief.

Good Job! You have learned how to get started on the work of healing complicated grief.

Download Your Worksheet

You have learned why you need support in doing grief work, how to determine your current sources of support, and how you may connect with these sources. You have learned how to use a grief monitoring record to gain mastery of your level of grief. You now know some of your triggers. You have learned how to re-tell the story of the moment you found out about the death so that you can become more comfortable thinking about and talking about it. You have worked hard. Remember to reward yourself.

Download Your Worksheet

Congratulations! You've learned how to use a grief monitoring record to gain mastery of your level of grief.

Continue making records to gain mastery of your level of grief and recognize new triggers. If you need more guidance, your psychotherapist can help.

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
Dr. Francois Botha
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.

Dr. Margaret Drewlo
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.

Dr. Margaret Drewlo
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 and minimize overwhelm. 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

Done

Edit

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?

Done

Edit

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

Edit
Dr. Francois Botha
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

Done

Edit

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. If 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 Your Worksheet

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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Dr. Francois Botha
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.

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

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Dr. Margaret Drewlo
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? Makes 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.

Download Your Worksheet

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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