Complicated grief: when your grief does not get easier

What is complicated grief?

Complicated grief is grief that has not softened and still has a grip on how you live. You go to work, you answer the phone, you keep the diary, and underneath nothing has moved.

What you feel is less like sadness than like a door that will not close. The longing comes first, then a disbelief that still arrives fresh on some mornings, then stretches of numbness that frighten people more than the crying did. The body carries its share: the tightness across the chest, food that holds no interest, the hour before dawn when you are awake with it again. What you make of all that comes last and is usually the harshest part. Other people have got through this, so something must be wrong with me.

There is a formal clinical description of this, and what it centres on is grief that stays intense and persistent and disables ordinary functioning in a way that grieving otherwise does not¹. Behind that description sit a symptom list and a minimum length of time, and I have left both out of this article on purpose. Counting yourself against a list tells you very little about your own loss, and it sends most people away more frightened than they arrived. Nothing on this page is a test or an assessment of you. What I take from that description clinically is narrower: whether your sense of who you are has survived the loss, and whether your life has been able to close over the gap at all. Read more about an identity crisis.

How is complicated grief different from ordinary grief?

The difference is the shape of it rather than the size.

• Ordinary grief. Savage at the start, and then it arrives in waves that gradually move further apart, until there are hours and then whole days when you are simply living.
• Grief that has stopped. The intensity holds its level, and your life stays arranged around the absence: the chair nobody sits in, the subject nobody raises, the plans you have quietly stopped making.
• Why I bother with the distinction. Long grief is not the difficulty and love carries no expiry date. What needs attention is grief with nowhere left to go.

Who is most likely to get stuck in grief?

Nobody is a type for this, and what signals it most clearly is what was already happening before the death.

When the factors that travel with grief of this kind are gathered up, the 2 that stand out are heavy grief already present before the loss and depression already present before it². Further down the same list sit an unexpected death, a violent death, low income, an anxious attachment style, and the loss of a child or a partner. Most of that evidence is self-reported and taken at a single point in time, so it maps what travels together across groups and predicts nothing about one person.

• What such a list is for. It tells me where to look first with a new client. It is not a score, and recognising yourself in several lines is not a result.
• What it leaves out. What the relationship was actually like, what was left unfinished in it, and whether there was anybody to grieve alongside. Those weigh more heavily in my consulting room than anything on the list.

Read more about anxious attachment and what your attachment style is.

What happens when the death is in another country?

The loss is the same, and everything that would ordinarily carry it is somewhere else.

The funeral happened while you were on a plane, or it happened without you. Everybody who knew the person is in another time zone, and nobody you see in an ordinary week has met them, so any mention of them would need a paragraph of explanation first. Most days you do not start. What that leaves is a particular loneliness: wanting the person spoken about more than you want almost anything, and then changing the subject when a colleague asks why you were away.

The news itself lands differently at this distance. It comes in one phone call, with none of the slow week of sitting beside it that the family had. So the work I do with clients here starts by building the place where the grief gets spoken, since the people who would have shared it are not in this country. Read more about reverse culture shock and about anticipatory grief.

Does grief therapy work?

It does most for grief that has stopped moving, and least for grieving that is painful and still under way.

Across randomised trials, psychological work on grief has a modest average effect, and the trials that took people in because their grief was intense and persistent produced larger effects than those recruiting bereaved people in general³. Study quality varies enough that the average is a reason to come rather than a promise about your own outcome.

That fits what I see. Somebody 3 months after a death needs people around them more than they need a therapist. Somebody 4 years on, whose life has narrowed to getting through the week, is in quite different territory, and that is where this work does the most.

How do you get complicated grief moving again?

You get it moving by taking the deadline away, finding out whether the day has any give in it, and saying the loss out loud to somebody who stays in the room while you do.

• Drop the calendar. Stop measuring yourself against the first year or against stages. Grief keeps no schedule, and the deadline for being over it almost never came from you.
• Do one ordinary thing. Pick something you have stopped doing since the death, a coffee, a walk, a phone call, and do it once this week.
• Expect it to feel wrong. What you are finding out is not whether it feels good, but whether the day has any give left in it.
• Say it out loud. Grief has to be spoken somewhere. When everybody who shares it lives in another country, that somewhere has to be built here on purpose.
• Look for the frozen moment. What has frozen is one moment rather than the whole loss: a phone call, a room, a sentence said or not said. Finding it opens more than talking about the person in general.
• Allow the early months. Being in pieces is not the same as being stuck, and early on there is no line to cross. That is a judgement from my practice, not a measured threshold.

Those steps assume there is still some give in the day. They do not reach you if the years have gone by, the ordinary thing stays undone and nothing loosens, and they do not reach a grief that has narrowed your life to getting through it. Where that is where you are, reading will not shift it and individual work with a therapist is the next step. Nothing on this page is a test or a measure of you, and no list decides whether your grief deserves attention. I work with clients in Copenhagen in English, and you are welcome to begin with a session or with the free 30-minute call.

Questions people ask

Is it worth starting therapy if the death was years ago?

Yes, and a long gap is one of the commoner reasons clients finally come. Grief that has stayed in one place does not expire, and it is workable whenever you bring it.

What does therapy for stuck grief actually involve?

I look for the one moment that has frozen rather than going over the whole loss again. Alongside that, I work on what your life has organised around the absence and what it would take to loosen it.

Will I have to talk about the death in detail before I am ready?

No, the pace is yours and nothing in the early sessions requires you to relive anything. Clients often find the detail arrives on its own once the room feels safe enough to hold it.

Everybody who shared this loss lives in another country. Does therapy here still reach it?

Yes, and that is often exactly why therapy here matters. When the people who knew the person are elsewhere, the place where the grief gets spoken has to be built where you live.

How do I know whether I need therapy or just more time?

Bring it if it has stopped moving and your life has narrowed around it, and nothing on this page settles that for you. A free 30-minute call is enough for me to say honestly whether I think the work would help.

When grief stays raw for far longer than you expected, complicated grief therapy is where I help it begin to move.

Sources

1. American Psychiatric Association, Prolonged grief disorder, DSM-5-TR
2. Buur, C. et al., Risk factors for prolonged grief symptoms: a systematic review and meta-analysis, Clinical Psychology Review, 2024
3. Johannsen, M. et al., Psychological interventions for grief in adults: a systematic review and meta-analysis of randomized controlled trials, Journal of Affective Disorders, 2019

How this article was written: I choose the subject and the angle. An AI assistant researches and drafts. I read the draft, correct and improve it and stand behind every clinical statement. The professional and clinical judgement is mine.