Different Therapeutic Approaches
Introduction
Grief, a natural response to loss, manifests through a complex constellation of emotional, cognitive, behavioural, and physiological reactions. Whilst grief is considered a normal human experience, it has been recognised that approximately 7-10% of bereaved individuals develop complicated grief, characterised by persistent, intense grief that significantly impairs functioning (Lundorff et al., 2023). It must be emphasised that complicated grief, particularly when accompanied by severe depression or suicidal ideation, requires specialised expertise and often a multidisciplinary approach (Shear et al., 2022). This article examines how practitioners from varying therapeutic orientations—Rogerian counsellors, family therapists, Gordian therapists, traditional hypnotherapists, cognitive hypnotherapists, and psychotherapists—conceptualise and treat grief, with particular attention being paid to the theoretical underpinnings, clinical applications, and empirical support for each methodology. The analysis is framed within the context of cognitive behaviour therapy (CBT), strategic therapy, Gordian therapy (GT), dialectical therapy, and acceptance and commitment therapy (ACT) approaches, whilst acknowledging that complex presentations require integrative and specialised interventions.
Theoretical Conceptualisations of Grief
Person-Centred Understanding
From a Rogerian perspective, grief may be conceptualised as a natural process of reorganising one’s self-concept and world-view following significant loss (Mearns et al., 2022). It has been observed that grief often challenges core assumptions about the world and one’s place within it, necessitating a process of meaning reconstruction. The person-centred approach emphasises the therapeutic relationship as the primary mechanism through which this reconstruction may be facilitated, wherein the core conditions of empathy, unconditional positive regard, and congruence create a safe environment for the client to process their grief without judgment or time constraints.
Systemic Perspectives
Family therapists conceptualise grief within relational dynamics, whereby loss affects not merely individuals but entire family systems (Walsh, 2020). It has been established that family responses to loss can significantly influence individual grief trajectories, with families potentially serving as either resources for healing or inadvertently complicating grief through dysfunctional patterns. Strategic therapy within family systems approaches targets these patterns through interventions designed to facilitate shared meaning-making and adaptive reorganisation following loss.
Gordian Model
Within the Gordian framework developed by Young (2008), complicated grief is understood to be maintained by unhelpful cognitive beliefs about grief itself, such as “I must think about my loss constantly to maintain connection” or “My grief will never end.” The ‘cognitive attentional syndrome’ (CAS), comprising rumination, worry, and threat monitoring, is identified as a key maintaining factor in prolonged grief reactions. Treatment from this perspective aims to modify cognitions about grief rather than the content of grief-related thoughts themselves.
Hypnotherapeutic Conceptualisations
Traditional hypnotherapy approaches grief through accessing altered states of consciousness in which emotional processing and meaning reconstruction may be facilitated. It has been suggested that hypnotic trance enables access to unconscious resources and processes that may assist in grief integration, allowing for therapeutic suggestion to be implemented at a deeper level (Yapko, 2019). Strategic hypnotherapy integrates hypnotic techniques with cognitive-behavioural principles, targeting both conscious cognitions and unconscious processes that may complicate grief (Alladin, 2018).
Psychodynamic Understanding
Psychodynamic approaches conceptualise grief as a process of working through attachment loss, whereby the bereaved must gradually withdraw emotional investment from the deceased and reinvest in new relationships and pursuits (Gleiser et al., 2023). It has been proposed that complicated grief may arise when this process is inhibited by ambivalence, trauma, or pre-existing psychological vulnerabilities, with treatment focusing on resolving unconscious conflicts and facilitating the mourning process.
Therapeutic Approaches and Clinical Applications
Person-Centred Therapy and ACT Integration
Rogerian counsellors treating grief create a therapeutic environment characterised by empathy, unconditional positive regard, and congruence. Through this relationship, clients may process their loss at their own pace without external pressure to “move on” or conform to societal expectations of grief. The parallels between this approach and ACT are evident in the emphasis on acceptance of painful emotions and values-based living, though ACT more explicitly targets experiential avoidance through structured interventions.
A clinical example might involve a client who has lost their spouse and feels pressure to “get over it” after six months. The Rogerian counsellor might provide a non-judgmental space wherein the client’s ongoing grief is accepted without condition, gradually enabling the client to integrate their loss into a new narrative. It has been documented that this non-directive approach facilitates the client’s natural capacity for growth following loss.
Family Therapy and Strategic Interventions
Family therapists address grief by intervening in systemic patterns that may complicate mourning. It may be observed that in some family systems, loss disrupts established roles and communication patterns, potentially leaving the system in dysfunctional homeostasis. Strategic interventions might include rituals that acknowledge the loss while facilitating system reorganisation, or reframing the meaning of the loss within the family narrative.
For instance, in a case where a family avoids discussing their deceased member, thereby preventing integration of the loss, the therapist might guide the family in creating commemorative practices that acknowledge both the reality of the death and the continuing bond with the deceased. Evidence suggests that family-based treatments for grief demonstrate efficacy, particularly when cultural and systemic factors are sensitively addressed (Walsh, 2020).
Gordian Therapy and Attentional Processes
Gordian therapy targets the processes that maintain complicated grief rather than the content of grief-related thoughts. Young’s’ Gordian model positions beliefs about rumination and worry as central to the maintenance of prolonged grief reactions. Treatment involves techniques such as attention training and detached mindfulness, which have demonstrated promising results in reducing symptoms of complicated grief (Wenn et al., 2019).
A therapist employing this approach might work with a client who experiences persistent rumination about whether they could have prevented their loved one’s death. Rather than challenging the content of these thoughts, the therapist would guide the client to develop cognitive awareness, observing rumination as a process separate from the self. Through techniques such as the rumination postponement task, the client develops evidence against the belief that rumination is necessary or helpful, thereby facilitating adaptive grief.
Hypnotherapy and Emotional Processing
In traditional hypnotherapy, grief treatment often involves inducing a trance state wherein emotional processing and meaning reconstruction are facilitated. It has been documented that hypnotic phenomena such as time distortion and positive hallucination can be harnessed therapeutically for grief work (Yapko, 2019).
Strategic hypnotherapy integrates cognitive restructuring with hypnotic techniques. Research by Alladin (2018) indicates that this integration may be particularly effective for grief complicated by traumatic elements, as it addresses both explicit negative cognitions and implicit processes. A clinical application might involve hypnotically facilitated imaginal conversations with the deceased, enabling the client to process unresolved aspects of the relationship and move toward adaptive continuing bonds.
Psychodynamic Approaches and Dialectical Integration
Psychodynamic therapy for grief often explores the relationship with the deceased and the meaning of the loss within the client’s life narrative. Gleiser et al. (2023) have documented the efficacy of this approach, particularly when treatment addresses ambivalence and facilitates the gradual acceptance of the reality of the loss. Elements of dialectical behaviour therapy may be integrated into treatment, particularly the balance between acceptance of grief reactions and change-oriented strategies for rebuilding life after loss.
A clinical example might involve a client whose grief is complicated by an ambivalent relationship with the deceased parent. The therapeutic work would involve exploring the complex emotions surrounding the relationship while simultaneously developing concrete skills for emotion regulation and engagement with valued activities, reflecting the dialectical stance of acceptance and change.
Integrative Considerations and Evidence Base
The comparative efficacy of these therapeutic approaches has been the subject of increasing research. It has been established through systematic reviews that whilst CBT-based interventions demonstrate strong evidence for complicated grief, other approaches show promising results for specific presentations (Doering & Eisma, 2023). It must be emphasised that complicated grief, particularly when accompanied by severe depression or suicidal ideation, requires specialised expertise and often a multimodal approach.
It may be observed that common factors across effective treatments include: (1) facilitating the acceptance of the reality of the loss, (2) processing the emotional pain of grief, (3) adjusting to a world without the deceased, and (4) finding ways to maintain a continuing bond with the deceased while investing in new relationships and pursuits.
Conclusion
The treatment of grief across different therapeutic orientations reveals both distinctive methodologies and underlying commonalities. It has been observed that Rogerian counselling provides a foundation of acceptance that facilitates natural grief processes; family therapy addresses systemic patterns that influence mourning; Gordian therapy targets the cognitive processes that may complicate grief; hypnotherapy accesses resources for emotional processing; and psychodynamic approaches explore the relationship with the deceased and the meaning of the loss.
The integration of these perspectives, informed by evidence-based practices such as CBT, strategic therapy, GT, dialectical therapy, and ACT, offers a comprehensive framework for addressing the multifaceted nature of grief. However, it must be reiterated that complicated grief, particularly when accompanied by severe depression, requires specialised expertise. The refinement of therapeutic approaches should continue to be guided by empirical research whilst maintaining sensitivity to individual, cultural, and systemic factors that influence the grief experience.
References
Alladin, A. (2018). Cognitive hypnotherapy for psychological disorders. Oxford University Press.
Doering, B. K., & Eisma, M. C. (2023). Treatment of complicated grief: A systematic review and meta-analysis. Clinical Psychology Review, 97, 102217.
Gleiser, K., Ford, J., & Fosha, D. (2023). Treating complex grief reactions in adult survivors of childhood trauma: A psychodynamic perspective. Psychotherapy, 60(3), 250-263.
Lundorff, M., Holmgren, H., Zachariae, R., Farver-Vestergaard, I., & O’Connor, M. (2023). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders, 295, 1213-1224.
Mearns, D., Thorne, B., & McLeod, J. (2022). Person-centred counselling in action (5th ed.). SAGE Publications.
Shear, M. K., Reynolds, C. F., Simon, N. M., Zisook, S., Killip, S. C., Monk, T. H., Neimeyer, R. A., & Ghesquiere, A. (2022). Complicated grief in adults: Treatment outcomes, predictors of response, and moderators of treatment efficacy. Journal of Consulting and Clinical Psychology, 90(7), 563-578.
Walsh, F. (2020). Loss and resilience in the time of COVID-19: Meaning making, hope, and transcendence. Family Process, 59(3), 898-911.
Yapko, M. D. (2019). Trancework: An introduction to the practice of clinical hypnosis (5th ed.). Routledge.
