Kim Davis
About 10 to 15 percent of bereaved people will develop what clinicians call complicated grief, and most of them won’t get the right treatment for it, not because it doesn’t exist, but because neither they nor their doctors know to look for it.
That number comes from a 2021 meta-analysis published in World Psychiatry, and when I first encountered it while working alongside a palliative care team years ago, it stopped me cold. We were seeing people who had lost someone six, eight, fourteen months earlier and were still completely unable to function. They’d tried standard depression treatment. Some had tried general talk therapy. A few had been told, gently but wrongly, that they just needed more time. What they actually needed was a specific, evidence-based approach called Complicated Grief Treatment, or CGT, and in most communities it remains genuinely hard to find.
If you’re here because you’re worried about yourself, or someone you love, I want you to know: what you’re experiencing has a name, it has structure, and there are trained people who can help.
- Complicated grief affects roughly 10-15% of bereaved people and won't resolve on its own without targeted treatment.
- Complicated Grief Treatment (CGT), developed at Columbia University, shows ~70% response rates in clinical trials.
- Standard depression therapy (like general CBT) is significantly less effective for complicated grief than CGT specifically.
- Treatment typically runs 16 weekly sessions; most people notice meaningful shifts by week 8.
- SAMHSA's treatment locator and the 988 Lifeline are real starting points if you need help today.
What “complicated grief” actually means
Grief is supposed to hurt. A lot. That part is normal. What distinguishes complicated grief, sometimes called prolonged grief disorder (PGD) in current diagnostic language, is that the acute pain doesn’t gradually soften over time. Instead, it stays sharp, or even intensifies, past the point where most bereaved people are beginning, slowly, to re-engage with life.
The DSM-5-TR, updated in 2022, finally gave prolonged grief disorder its own diagnostic code (F43.8), which matters more than it sounds. Before that codification, clinicians often treated it as depression and got poor results. The key symptoms are distinct: intense longing for the deceased that doesn’t ease, difficulty accepting the loss as permanent, bitterness or anger about the death, feeling that life is meaningless without that person, and an inability to trust others since the loss. You might be wondering whether you’re just “grieving hard” versus something that warrants clinical attention. Here’s what I tell people: if it’s been more than twelve months and the pain hasn’t softened at all, and your ability to work, connect with others, or care for yourself is significantly impaired, that’s worth a professional assessment. Not because something is wrong with you. Because something specific is happening that has a specific treatment.
The therapy that actually works
Helpful resource: First, We Make the Beast Beautiful by Sarah Wilson is a top-rated option for this. (As an Amazon Associate this site earns from qualifying purchases.)
I want to be blunt here, because I’ve watched people waste years in the wrong treatment: standard cognitive behavioral therapy (CBT) for depression is not the same as Complicated Grief Treatment. A 2016 randomized controlled trial published in JAMA Psychiatry, led by Dr. M. Katherine Shear at Columbia University, compared CGT directly against interpersonal therapy (IPT) and found that CGT produced response rates of approximately 70% versus 32% for IPT. That’s not a small difference. It’s the difference between getting better and staying stuck.
CGT is a 16-session, manualized protocol. It borrows from exposure therapy, motivational interviewing, and positive psychology, but the structure is specific. Sessions alternate between what Shear’s team calls the “loss-focused” strand and the “restoration-focused” strand. The loss-focused work includes revisiting the story of the death, processing the specific moment of loss, and working through complicated emotions like guilt or anger. The restoration strand looks at what kind of life the grieving person wants to build, reconnecting with things that gave meaning before the loss and finding ways to honor the relationship with the deceased in an ongoing way. One detail most people don’t know until they’re in it: the revisiting exercises feel counterintuitive at first. You’ll be asked to tell the story of the loss out loud, sometimes recorded, and then listen back. It sounds brutal. In my experience sitting with clients going through this process, that piece consistently produces the most significant shifts, usually around sessions six through nine.
A related approach worth knowing: Prolonged Grief Disorder therapy (PGD-therapy), developed by Paul Boelen in the Netherlands, has strong evidence across European samples. CGT and PGD-therapy overlap substantially but aren’t identical.
Who delivers it, and what to expect
This is where things get harder. CGT is a specialized protocol, and not every therapist offers it. As of August 2026, Columbia University’s Center for Complicated Grief maintains a training program and a partial directory of trained clinicians. The International Association for Grief Therapists also maintains referral resources. For finding providers more broadly, SAMHSA’s treatment locator at findtreatment.gov allows searches by specialty and is updated regularly.
When I help people find a CGT provider, I always tell them to ask one specific question in the first call: “Have you completed formal training in Complicated Grief Treatment or a manualized prolonged grief protocol?” If the answer is “I’ve worked with a lot of grief clients,” that’s not the same thing and they should keep looking.
Here’s what the experience actually looks like, in practical terms:
| Factor | Typical Range |
|---|---|
| Session count | 16 sessions (standard protocol) |
| Session frequency | Weekly |
| Session length | 50-60 minutes |
| Time to noticeable improvement | Weeks 6-10 for most clients |
| Cost per session (private pay, US) | $120-$250 depending on location |
| Insurance coverage | Varies; billed under F43.8 or F43.21 |
| Telehealth availability | Common; research supports remote delivery |
| Provider training source | Columbia CGT certification (primary) |
Telehealth delivery deserves a specific mention: a 2020 study in Depression and Anxiety found that CGT delivered via videoconference showed comparable outcomes to in-person delivery. This matters because it opens access to people in rural areas or places where no local CGT-trained clinicians exist.
Three examples from the work I’ve observed:
A woman in her late 50s lost her husband of 32 years and entered CGT fourteen months after the death, after standard antidepressants and six months of general grief counseling produced almost no improvement. By session 10 of CGT, she’d returned to her book club and was sleeping through the night for the first time since his death. She described session 7, the loss narrative revisiting exercise, as “the worst and most important hour I’ve spent in therapy.”
A man in his early 40s who lost his adult son to overdose came into treatment with significant guilt and anger layered on the grief. In CGT, the loss-focused strand addressed the guilt directly through imaginal conversation techniques. At 16-session completion, he reported a clinician-rated improvement on the Inventory of Complicated Grief (ICG) scale from a score of 42 (severe) to 19 (below clinical threshold).
A college student who lost her mother during finals week, then pushed through and “didn’t let herself grieve,” presented two years later with what looked like treatment-resistant depression. The missed piece was complicated grief, identified when a clinician asked specifically about loss history. Eight sessions into CGT, her PHQ-9 score dropped from 18 to 9, even though three prior antidepressant trials had barely moved the needle.
What you can do right now
If you’re not in treatment yet, or not sure whether you need to be, a few practical things are worth knowing.
First, if you’re in crisis, the 988 Suicide and Crisis Lifeline is available 24 hours a day by call or text. Complicated grief carries elevated suicide risk, and that’s not something to minimize or manage alone.
Second, self-help resources can genuinely complement therapy (though not replace it for complicated grief). Dr. Shear’s book “Grief is the Price of Love” is accessible and research-grounded. For people doing supplementary work between sessions, structured grief journals, like the Good Grief Journal by Marisa Renee Lee, provide useful scaffolding. (Disclosure: links to resources like these on Amazon may earn this site a small commission.) A mindfulness-based option that pairs reasonably well with CGT’s restoration strand is Jon Kabat-Zinn’s Full Catastrophe Living, particularly the chapters on chronic pain and loss, which share conceptual overlap with grief work.
Third, don’t assume your primary care doctor will recognize this. Honestly, in my experience, most won’t. If you’re going to bring this up at a doctor’s appointment, name the specific condition. Say “I’ve been reading about prolonged grief disorder and I think I might meet criteria.” Ask for a referral to someone who specializes in trauma or grief specifically.
Sources
- Shear MK et al. (2016): “Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial.” JAMA Psychiatry. Primary efficacy data for CGT versus IPT.
- Eisma MC & Boelen PA (2021): Meta-analysis on prevalence of prolonged grief disorder. World Psychiatry.
- Simon NM (2020): “Treating Complicated Grief.” CGT telehealth delivery study, Depression and Anxiety.
- DSM-5-TR (2022): Prolonged Grief Disorder (F43.8) diagnostic criteria, American Psychiatric Association.
- Columbia University Center for Complicated Grief: Training programs and clinician registry, active as of August 2026.
Photo: Vitaly Gariev via Pexels
This article is for general informational purposes only and does not constitute mental health, medical, or clinical advice. If you are in crisis or experiencing a mental health emergency, please contact the 988 Suicide and Crisis Lifeline (call or text 988) or go to your nearest emergency room. Always consult a licensed mental health professional for care specific to your needs.
Recommended Resources
Disclosure: As an Amazon Associate, we earn a small commission from qualifying purchases at no extra cost to you. We only recommend products that genuinely support the topics covered in this article.
- Feeling Good: The New Mood Therapy (~$14), The most clinically studied self-help book for depression, recommended by therapists worldwide as CBT-based self-treatment.
- Depression & Anxiety Therapy Journal (~$10), 8-week guided journal with trigger tracking and mood diary, mirrors the homework your therapist would assign between sessions.
