Most of us have heard that “time heals all wounds.” But for some, time doesn’t heal; it seems to freeze. The world keeps spinning, seasons change, and friends move on, but you remain locked in the precise moment of loss, unable to breathe, unable to focus, and unable to imagine a future without your loved one.
If this resonates with you, you may not be experiencing typical grief. You might be experiencing Prolonged Grief Disorder (PGD), a distinct condition that affects approximately 10% of bereaved individuals. The good news is that there is a highly effective, evidence-based treatment designed specifically for this experience: Prolonged Grief Therapy (PGT).
Often referred to as the gold standard for grief counseling, PGT is not just another talk therapy. It is a targeted, short-term intervention that has helped thousands of people get “unstuck” and reclaim their lives. In this comprehensive guide, we will explore exactly what PGT is, why it works, and how it can help you or someone you love find a way forward.
What Is Prolonged Grief Therapy?
Prolonged Grief Therapy is a specific type of psychotherapy developed to treat Prolonged Grief Disorder. Unlike general supportive counseling, which provides a space to vent and process feelings generally, PGT is structured and goal-oriented. It was developed by Dr. Katherine Shear and her colleagues, drawing on attachment theory and cognitive behavioral principles to address the specific symptoms that keep people trapped in acute grief.
The Difference Between “Normal” Grief and Prolonged Grief
To understand the treatment, we must first understand the condition. Typical grief is a natural, albeit painful, response to loss. It comes in waves. Over time, the intensity of the pain usually subsides, and the bereaved person begins to integrate the loss into their life. They don’t forget their loved one, but the loss no longer dominates every waking moment.
In contrast, prolonged grief is like a wound that won’t clot. The natural healing process is derailed. Six months, a year, or even decades after the loss, the person feels as if the death happened yesterday.
Signs that PGT treatment might be necessary include:
- Intense longing or yearning for the deceased that doesn’t fade.
- Preoccupation with thoughts or memories of the loved one.
- Difficulty accepting the death.
- Feeling that life is meaningless without the person.
- An inability to trust others or re-engage with social activities.
- Bitterness or anger related to the loss.
If these symptoms persist for at least 12 months after the death (or 6 months for children and adolescents), a diagnosis of Prolonged Grief Disorder may be appropriate. You can read more about the nuances of grief on our Grief Therapy specialty page.
Why Is PGT the Gold Standard for Grief Counseling?
In the world of mental health, the term “gold standard” isn’t thrown around lightly. It means that a treatment has been rigorously tested in randomized clinical trials and has consistently outperformed other treatments.
PGT has been the subject of multiple National Institute of Mental Health (NIMH)-funded studies. The results are compelling: PGT has been shown to be significantly more effective than standard interpersonal therapy or tricyclic antidepressants in reducing symptoms of prolonged grief.
Key Reasons PGT Stands Out:
- It is Targeted: It doesn’t just treat “sadness.” It targets the specific cognitive and behavioral roadblocks that prevent adaptation to loss.
- It is Time-Limited: PGT is typically delivered over 16 sessions. This structured timeframe provides a sense of momentum and purpose.
- It is Dual-Focused: It addresses both the pain of the loss (loss-oriented) and the need to rebuild a life (restoration-oriented).
For individuals who have tried general talk therapy without success, Prolonged Grief Therapy often provides the breakthrough they have been waiting for.
The Core Components of PGT Treatment
How does PGT actually work? The therapy rests on the idea that grief is a natural healing process that has been obstructed. The therapist’s job is to identify and remove the “impediments” (roadblocks) so that natural healing can resume.
The treatment is generally divided into two main areas of focus:
- Processing the Loss: Helping the client accept the reality of the death and process the pain.
- Restoring Life: Helping the client envision a future where they can find joy and purpose again.
1. Psychoeducation about Grief
Understanding what is happening in your brain and body is the first step. Many people with prolonged grief feel like they are “going crazy” or are broken. PGT validates their experience by explaining the difference between acute and integrated grief.
Therapists explain that acute grief is the initial, intense reaction. Integrated grief is the permanent background state where the loss is accepted, and life continues. PGT is the bridge between the two.
2. Monitoring Grief
Just as you might track your blood pressure or blood sugar, PGT treatment involves tracking grief levels. Clients often rate their grief daily. This helps to identify triggers (specific times of day, locations, or thoughts) and demonstrates that grief is not a static block of pain—it fluctuates. Seeing these fluctuations can be empowering, showing that the intensity does vary and is therefore manageable.
3. Strengthening Relationships
Grief can be incredibly isolating. People with prolonged grief often withdraw from friends and family because they feel misunderstood or because socializing feels like a betrayal of the deceased. PGT actively works on reconnecting the client with their support system.
If the client is struggling with social anxiety or complex trauma alongside their grief, our clinicians might incorporate elements of Dialectical Behavior Therapy (DBT) to help manage interpersonal effectiveness and distress tolerance.
The “Big Two” Interventions in PGT
While PGT uses many techniques, two specific interventions are central to its success: Imaginal Revisiting and Situational Revisiting. These are designed to tackle the avoidance that fuels prolonged grief.
Imaginal Revisiting: Processing the Story
One of the hallmarks of prolonged grief is that the person either obsessively thinks about the death or tries desperately to block it out. Often, they are stuck on the most traumatic moments of the loss.
In Imaginal Revisiting, the client tells the story of the death to the therapist. They visualize the event and narrate it in the present tense. This is then recorded (usually audio). The client listens to this recording between sessions.
Why this works:
- Habituation: By listening repeatedly, the “shock” value of the memory decreases. The story moves from being a traumatic flashback to becoming a memory that can be stored away like other memories.
- Cognitive Restructuring: It allows the therapist to catch “stuck points” or irrational guilt, such as “If only I had called the doctor five minutes earlier.” Once identified, these thoughts can be challenged.
This process is handled with immense care. Our therapists, such as Mandy Rice, LMSW, are trained in trauma-informed care to ensure that revisiting the trauma is safe and contained.
Situational Revisiting: Reclaiming the World
Avoidance extends to the physical world, too. People avoid restaurants they used to visit with their loved one, hide photos, or refuse to listen to certain music. This avoidance shrinks their world.
Situational Revisiting involves creating a hierarchy of avoided places or activities and gradually re-engaging with them.
Why this works:
- Proof of Resilience: Clients learn that they can visit these places and survive the emotions that arise.
- New Associations: Visiting a favorite park might be sad, but it might also bring back happy memories, effectively “overwriting” the avoidance with a more nuanced experience.
Addressing the “Stuck Points”
In Prolonged Grief Therapy, we look for specific impediments that halt the healing process. These are the mental and emotional anchors keeping the ship from sailing.
Guilt and Self-Blame
“I should have done more.” “I was a bad spouse.” Guilt is perhaps the most common stuck point. PGT uses cognitive techniques to examine these beliefs. We look at the evidence. We ask, “Would you judge a friend as harshly as you are judging yourself?”
Sometimes, this guilt is rooted in deep-seated depression. In cases where depression is severe, combining PGT with medication management can be beneficial. Our Psychiatry team works closely with therapists to support clients who need pharmacological assistance to engage fully in therapy.
Counterfactual Thinking
“If only…” thinking is a trap. “If only I hadn’t let him drive that night.” “If only we had caught the cancer sooner.” PGT helps clients recognize that these thoughts are a wish for a different outcome, not a reflection of reality. We validate the wish (“I wish he were here, too”) while gently letting go of the illusion that we could have controlled the uncontrollable.
Anger and Bitterness
Anger at the medical system, at God, or even at the deceased is common. If left unaddressed, it calcifies into bitterness. PGT provides a safe space to express this anger without judgment, helping to release the physical tension it creates. For somatic release of this anger, some clients benefit from complementary therapies like Yoga and Reiki.
Rebuilding: The Future Focus
The second half of the “dual process model” of grief is restoration. Prolonged Grief Therapy is not just about looking back; it is about looking forward. This can be the hardest part for many clients who feel that enjoying life is a betrayal of the dead.
Defining Personal Goals
What did you want to do before the loss? What might you want to do now? PGT encourages clients to set small, achievable goals unrelated to their grief. This could be taking a class, gardening, or traveling.
Finding Meaning
Meaning doesn’t mean “everything happens for a reason.” It means finding a way to make the life you have now matter. This aligns closely with Meaning-Centered Grief Therapy principles. It might involve volunteering, creative expression, or simply committing to being present for living family members.
The Concept of Continued Bonds
Recovery doesn’t mean letting go of the person; it means changing your relationship with them. In PGT treatment, we encourage “continued bonds.” This means carrying the person with you as an internalized figure. You can still love them, talk to them in your head, and honor them, but they are no longer the only thing in your life.
Is PGT Right for You?
If you are reading this and wondering if Prolonged Grief Therapy is the answer, consider the timeline and intensity of your grief.
- Timeline: Has it been at least a year since your loss (or 6 months for a child/adolescent)?
- Functioning: Is your grief preventing you from working, parenting, or socializing?
- Stuckness: Do you feel exactly the same as you did the week after the funeral?
If you answered yes, PGT could be transformative.
However, PGT is not always the first line of defense for everyone.
- For recent loss: If the loss is fresh (less than 6 months), supportive counseling or Cognitive Behavioral Therapy (CBT) to prevent the development of prolonged grief might be more appropriate.
- For trauma: If the death was violent or sudden, trauma-focused therapies like EMDR might be needed before or alongside PGT.
- For children: Children process grief differently. Our Child Psychiatry and Therapy specialists can determine if a modified version of PGT or play therapy is best.
The Role of Medication and Holistic Support
While Prolonged Grief Therapy is a psychotherapeutic intervention, it doesn’t exist in a vacuum. The stress of prolonged grief wreaks havoc on the body. Insomnia, changes in appetite, and fatigue are common.
At Mind Body Seven, we take an integrative approach.
- Medication: Antidepressants generally do not cure grief, but they can treat the co-occurring depression or anxiety that makes engaging in therapy impossible. Our nurse practitioners, like Kathleen Fentress Tripp, can evaluate if medication is a helpful adjunct.
- Nutrition: Grief depletes the body. Our Nutrition & Supplements services can help restore physical resilience.
- Ketamine Therapy: For treatment-resistant depression associated with grief, Ketamine-Assisted Psychotherapy (KAP) is an emerging option that can help reset neural pathways.
Success Rates and Hope
The success rates for Prolonged Grief Therapy are incredibly encouraging. Studies show response rates of over 70%, with participants maintaining their gains long after therapy ends.
Clients often report:
- Being able to think of their loved one with “sweet sorrow” rather than searing pain.
- Sleeping better and having more energy.
- Reconnecting with friends and hobbies.
- Feeling like they have “permission” to live again.
One of the most profound realizations in PGT is that your joy does not diminish your love for the deceased. In fact, living a full life can be a way of honoring their memory.
Taking the Next Step
Admitting you need help with grief is not a sign of weakness. It is an acknowledgment that the love you felt was deep, and the loss is significant. If you are stuck in the loop of prolonged grief, you do not have to stay there.
The gold standard for grief counseling is available, and it is effective. At Mind Body Seven, our team of compassionate clinicians is trained to guide you through the PGT process, helping you navigate the darkness and find the light again.
We offer comprehensive assessments to determine if PGT is right for you. Whether you need the structure of PGT, the support of medication management, or the holistic care of functional medicine, we are here to help you heal.
Don’t let grief define the rest of your life.
Schedule a Consultation today to speak with our intake coordinators. We offer both in-person sessions in Brooklyn, NY, and virtual appointments to fit your needs. You can also learn more about our diverse team of providers on our About Us page.
