Grief counselling and therapy for grief: what is normal and when to get help

If the loss has left you thinking about ending your life, please use the urgent help numbers above now. The NHS lists suicidal thoughts among the symptoms of prolonged grief disorder^[1], and MedlinePlus advises contacting a doctor if you have suicidal thoughts after a loss; in the US you can call or text 988^[5].

What can grief feel like?

More than one feeling. The Royal College of Psychiatrists describes grief as “not just one feeling, but a whole succession of feelings”, which each person lives through at their own pace^[2]. The NHS lists signs that include^[1]:

• shock and numbness, often the first reaction, described as “being in a daze”
• overwhelming sadness, with lots of crying
• tiredness or exhaustion
• anger, towards the person you have lost or the reason for the loss
• guilt, for example about something you said or did not say, or about not being able to stop your loved one dying

Grief can also be physical. MedlinePlus, from the US National Library of Medicine, mentions sleeping problems and changes in appetite^[6]. The Royal College describes yearning for the person, finding it hard to relax or concentrate, upsetting dreams, and feeling that you “see” them in the street or around the house^[2]. Relief can be part of it too: if someone died after a painful illness, the College says feeling relieved is “natural, understandable and very common”, even though it can bring guilt^[2].

Is there a right way to grieve, or a normal timeline?

No. Bereavement affects people in different ways, and the NHS is clear: “There’s no right or wrong way to feel.” People often talk about stages of grief, but you may not go through all of them, or in any particular order^[1]. Feelings can come back when you thought they had passed, and some people do not have some of them at all^[2].

Time varies too. MedlinePlus says the acute phase of grief may last up to 2 months, and that milder symptoms may last for a year or longer^[5]. The Royal College of Psychiatrists says most people recover from a major bereavement within one or two years, but that “the sense of having lost a part of yourself never goes away entirely”^[2]. Culture shapes it as well: in some cultures the period of mourning is fixed and in others it is not, and the College notes that bereaved people may feel similar things while expressing them very differently^[2].

What is prolonged grief disorder?

It is grief that stays intense for much longer than usual and gets in the way of life. Prolonged grief disorder, sometimes called complicated grief^[1], is now in both of the main diagnostic manuals, and they set different time limits:

• WHO, ICD-11: after the death of someone close, a persistent and pervasive grief marked by longing for or preoccupation with the person, with intense emotional pain. It has lasted “more than 6 months at a minimum”, clearly exceeds the person’s social, cultural or religious norms, and causes significant problems in daily life^[3].
• American Psychiatric Association, DSM-5-TR: the death happened at least a year ago for adults (6 months for children and adolescents), and the person has had at least 3 of 8 symptoms nearly every day for at least the last month^[4].

The eight DSM-5-TR symptoms are feeling as though part of yourself has died, a marked sense of disbelief about the death, avoiding reminders that the person is dead, intense emotional pain such as anger, bitterness or sorrow, difficulty getting back into friendships, interests or plans, emotional numbness, feeling that life is meaningless without them, and intense loneliness^[4]. The American Psychiatric Association estimates that 4% to 15% of bereaved adults experience these persistent symptoms, and says the risk is greater when a death is very sudden or happens in unnatural circumstances^[4]. The NHS also says you are more likely to have it if the death was traumatic or sudden and unexpected^[1]; if what happened was traumatic, our trauma page may help too.

Only a qualified clinician can diagnose prolonged grief disorder. ICD-11 is clear that grief lasting a long time but within what is normal for the person’s culture and religion is a normal bereavement response, not a diagnosis^[3].

When should I get help for grief?

Most grief does not need treatment. The Royal College of Psychiatrists says bereavement “usually does not require medical attention”, but that if grief “just does not lift after a few months”, a GP can help^[2]. According to the NHS, it is worth seeing a GP when ^[1]:

• you are struggling to cope with stress, anxiety or a low mood
• you have had a low mood for more than 2 weeks
• nothing you are trying on your own is helping
• you have symptoms of prolonged grief disorder

MedlinePlus adds using a lot of alcohol or drugs, becoming very depressed, and depression that interferes with daily life^[5]. Grief and depression can overlap; our page on depression explains the signs.

What happens in grief counselling or bereavement therapy?

In counselling, the NHS says, you talk to a therapist about your thoughts, feelings and life experiences, and they listen and help you find your own solutions to problems^[7]. For bereavement, the Royal College of Psychiatrists says some people need a bereavement counsellor or psychotherapist “either in a special group or on their own for a while”, while for others it is enough to talk with people who have been through the same thing^[2]. Outside therapy too, the College says, going over the good times and the bad times again and again is “a quiet but essential part of coming to terms with a death”^[2].

For prolonged grief disorder, the American Psychiatric Association says treatments using elements of cognitive behavioural therapy (CBT) have been found to reduce symptoms^[4]. It describes Prolonged Grief Therapy, which focuses on accepting the reality of the loss and on working towards goals and satisfaction in a world without the person, and says CBT can also help with problems that come with it, such as poor sleep^[4].

We found no guideline that sets a number of sessions for grief counselling, so agree with your therapist early on how the work will run and when you will look back at progress.

Grief after a miscarriage, stillbirth or the death of a baby

The Royal College of Psychiatrists says people who have had stillbirths or miscarriages, or who have lost very young babies, grieve in the same way as after any death, and “need the same sort of care and consideration”^[2]. It also warns that a loss is sometimes not seen as a “proper” bereavement, which happens often, though by no means always, after a miscarriage or stillbirth, and that frequent periods of depression may follow^[2]. In the UK, the charity Sands runs a free, confidential helpline for anyone affected by pregnancy or baby loss, on 0808 164 3332^[10].

What if someone died in another country and I could not be there?

Our guidance: many people who live abroad know this. A parent or friend dies at home, and travel, visas, work or money mean you miss the last days or the funeral. That distance can leave grief with nowhere to go. The people around you may not have known the person, and the rituals of your family or faith may be happening without you. The Royal College of Psychiatrists notes that mourning rituals differ a great deal between cultures, from very public to private and quiet^[2], and both the WHO and the American Psychiatric Association judge grief against the norms of the person’s own culture and religion^[3][4].

Our guidance: it can help to mark the loss where you are, to join a service online if your family can share one, and to talk to someone who understands the customs you grew up with, in the language you grieve in. That is part of why Bliss Therapy may suit you: its psychologists who work with loss speak 16 languages between them, and you meet them by video from wherever you are. For the wider strain of life in a new country, see our page on living abroad.

How can I cope with grief day to day?

Keep people close. The Royal College of Psychiatrists says that keeping away from others can store up trouble, and that it is usually best to start returning to normal life, as far as possible, after a couple of weeks or so^[2]. The NHS suggests talking about your feelings to a friend, family member, healthcare professional or counsellor, considering peer support, setting yourself small, achievable targets, and not turning to alcohol, cigarettes, gambling or drugs to relieve grief^[1].

Expect hard days. The College says anniversaries of the death, birthdays and weddings, and festive occasions are particularly painful^[2]. Our guidance: plan those days in advance, and let someone know they are coming. If the loss was a relationship rather than a death, our page on relationships and breakups is a better fit.

Are there medicines for grief?

Not for grief itself. The American Psychiatric Association says there are currently no medications to treat specific symptoms of grief^[4]. If grief turns into depression, MedlinePlus says some people benefit from an antidepressant^[5]. Whether to take one is for you and a doctor to decide, since Bliss Therapy psychologists cannot prescribe. If an antidepressant is already part of your care, the NHS advises against coming off it abruptly or before you have spoken with your doctor^[8].

Can grief counselling be done online?

Yes, it is offered online. The NHS provides talking therapies in person, by video or phone, or as an online course^[7], and the American Psychiatric Association mentions online interventions, in which people write virtual notes to the person who died, among the approaches found to reduce prolonged grief symptoms^[4]. That describes a writing exercise, not live video sessions. Neither the WHO, the NHS nor the American Psychiatric Association, in the pages we read, tests grief counselling over video against seeing someone in person, so we do not claim the two are equivalent. Bliss Therapy offers grief counselling only as live 50-minute video sessions, with 32 psychologists listing loss or death, from €30 (about £25).

How do I find grief support or a grief therapist where I live?

Wherever you live, a family doctor is usually a good first step: they can check how you are doing and tell you what support is available nearby and whether it is covered. You can also go straight to a private grief therapist, in person or online. Bliss Therapy is one of the online options, with grief sessions from €30 (about £25).

In the UK. If you are 18 or over (16 or over in some areas), you can refer yourself to an NHS talking therapies service without seeing a GP^[1]. Cruse Bereavement Support has a helpline on 0808 808 1677, free from UK landlines and mobiles, where trained volunteers offer emotional support^[9]. If the person died of a terminal illness, the Royal College of Psychiatrists says many hospices offer a free bereavement service^[2]. For every route, see how to find a therapist in the UK.

In the US. The National Institute of Mental Health suggests starting with a primary care provider, who can refer you to a mental health professional; your insurer can list the providers your plan covers^[11]. HealthCare.gov says Marketplace plans must cover psychotherapy and counselling, though benefits vary by state and plan^[14]. You can search for care on FindTreatment.gov^[12], or call SAMHSA’s free, confidential National Helpline on 1-800-662-4357 for referrals at any hour^[13]. MedlinePlus lists clergy, social workers and support groups alongside mental health specialists as sources of help^[5]. In a crisis, call or text 988^[15].

How do I choose a grief therapist or bereavement counsellor?

Check registration first. Before choosing a private therapist, the NHS advises making sure they are registered with a professional organisation accredited by the Professional Standards Authority^[7]. Our guidance: then ask how much of their work is with bereavement, whether they have worked with the kind of loss you have had, such as a sudden death, a suicide or the loss of a baby, and how they would know if your grief needs a doctor’s assessment too. On Bliss Therapy, a profile tells you whether a psychologist lists loss or death, and 14 of those who do offer a free first session, so you can ask all of this before paying. If you are unsure what the job titles mean, see psychologist, psychiatrist or counsellor, and for typical prices see how much online therapy costs.

Online grief counselling on Bliss Therapy

32 English-speaking psychologists on Bliss Therapy say they help with loss or death. Their 50-minute video sessions start from €30 (about £25), the middle price is €50 (about £42), and 14 offer a free first session. 26 of them list CBT, 15 list psychodynamic therapy and 12 list person-centred therapy.

• You choose your therapist yourself: each profile shows their methods, languages and price.
• 14 offer a free first session, so you can find out whether you can talk to them about your loss before you pay.
• You pay per session, with no subscription, and book online.
• Between them they speak 16 languages, so if you are grieving far from home you may be able to talk about the person you lost in your own language.

Sessions are one-to-one; we do not run bereavement groups or family sessions. Bliss Therapy psychologists do not diagnose prolonged grief disorder or prescribe, and Bliss Therapy is not a crisis service: if you are thinking of ending your life, turn to the crisis contacts near the start of the page.

Our therapists are based outside the UK and the US, so they are unlikely to be on UK registers, and their sessions are unlikely to be covered by US health insurance. Ask any therapist about their training in bereavement work and their registration in the country where they practise.