Complicated or prolonged grief treatment

Domain II · Behavioural & cognitive · M. Katherine Shear · 1998

What it is

PGDT is a time-limited, structured individual psychotherapy for people who meet criteria for prolonged grief disorder (DSM-5-TR: death at least 12 months ago; ICD-11: at least 6 months). Its view of change is this. Grief is natural and permanent, "the form love takes when someone we love dies" (Day…

Format

• Format. Individual, 16 weekly sessions over about 4–5 months. One session (session 3) includes a visitor the client chooses. Between sessions the client keeps a daily grief monitoring diary, listens to the recorded revisiting, does situational revisiting and fills in interval plans. Session length…
• Strengthen relationships → session with a visitor, ongoing attention to contact and support.

Who practises it, and how they are trained or regulated

• Version followed: M. Katherine Shear's 16-session Prolonged Grief Disorder Therapy (PGDT; earlier called Complicated Grief Treatment, CGT; some current Columbia materials say PGT), as taught in the Columbia Center for Prolonged Grief Practice-Focused Training slides (Day 2 deck dated 2022, Day 1 deck dated March 2023), with phase and session names from the 2015 CGT instruction manual (only its preview is drawn on).…
• PGDT is a time-limited, structured individual psychotherapy for people who meet criteria for prolonged grief disorder (DSM-5-TR: death at least 12 months ago; ICD-11: at least 6 months). Its view of change is this. Grief is natural and permanent, "the form love takes when someone we love dies" (Day 2 slides). Adapting to a loss has two tasks: accepting that the death is real and final, and regaining the capacity to…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• sessions that slide into unstructured support ("listening alone is not enough"). Plans should be specific and agreed, not imposed.
• plans that consist only of avoidance. It is working when the client meets the date with a plan and reports it was hard but manageable.
• skipped listening (avoidance, or feeling overwhelmed), and listening at night followed by rumination. It is working when ratings fall within and across listenings.
• little change in scores or in avoidance. Use this to adjust (more situational revisiting, a session on a specific derailer) rather than repeating more of the same.
• the client dismissing self-kindness as making excuses. Frame it as accurate, not lenient. It is working when self-blame statements soften in reflection and diary notes.

Problems the guide addresses

• Reluctance to do the activating procedures
• Diary non-adherence
• "I have no one to invite" (the slides' "don't want to burden them" vignette)
• A family member thinks the treatment is cruel (the slides' "this will make her feel worse" vignette)
• Distress stays high, or the client stops listening to the recording
• All-or-nothing situational revisiting (the slides' "Margie" vignette)
• "Everything is 100" (the slides' "Ben" vignette: ashes and belongings all rated above 100)
• Cannot imagine any goal, or responds with irritation
• Overwhelm or dissociation during revisiting
• Suicidal ideation

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.