At some time in our lives, we all suffer loss – but we don’t all experience or process grief in the same way. While some of us are able to heal and recreate a meaningful life with joy and purpose, others may get stuck somewhere along the way. When grief gets stuck, our lives can feel hopeless and unbearable. This form of prolonged grief is called complicated grief (CG), and while it is freshly in the news—as reported by Jane E. Brody in the New York Times in February—complicated grief has always been with us.
Hospice Bereavement Program Coordinator Marney Thompson, who recently became the only Canadian clinician trained in Complicated Grief Therapy (CGT), realized this years ago. "I had been facilitating a bereavement support group in Westshore," Thompson says, "and by chance the majority of the group members were bereaved parents—mothers who’d lost children. As I met with the group week after week I noticed that the mothers seemed to be having more difficulty than others in the group—their grief seemed to remain the same; intensely painful and highly disruptive over many months and even years. They felt disconnected from the people they were closest to and all were at times ambivalent about being alive. And this kind of prolonged, intense struggle was also reflected in some of the bereaved people I was seeing in individual counselling sessions. In spite of the mothers saying the group was their only lifeline, I felt that the work we were doing together wasn’t actually helping them adjust to their drastically changed lives. I felt professionally obligated and ethically challenged to learn more about this kind of grief."
Thompson describes complicated grief as "a kind of persistent, pervasive, paralyzing grief, impacting every single part of the person’s life, to the point where they aren’t really participating in life anymore. There isn’t that ability to generate enthusiasm or interest to do much beyond the basics. There may also be mental and physical illness, poor sleep habits, increased isolation, greater inclination toward substance use and suicidal thoughts. "
Until that experience, Thompson shared a resistance to the categorization of complicated grief as a mental disorder. In the early days of research and discourse about Complicated Grief, Thompson and many grief counsellors struggled against what felt like an attempt to pathologise or medicalize the grief process, which is felt to be as natural and normal as labour and birth. "My question was, what significant loss or grief isn’t complicated?" Thompson explains.
"Nevertheless, out of concern for my clients and a need to advance my skills in this area I began to look with more openness and curiosity into what people were saying about complicated grief," Thompson says. "I went back to the literature and rediscovered and reviewed the literature on CG completed by Holly Prigerson and Katherine Shear, among many others." In 2005, Dr. Holly G. Prigerson and Dr. Paul K. Maciejski of Weill Cornell Medical College in New York created a Grief Intensity Scale (GIS) to help screen those suffering from complicated grief from those whose healing from grief was following a more normal trajectory. Seven to 10% of some 30,000 survivors who tested with the GIS came up positive for complicated grief.
Dr. Katherine Shear of the Columbia University School of Social Work and College of Physicians and Surgeons is the foremost researcher, educator and trainer in Complicated Grief Treatment (CGT). "Complicated grief," said Dr. Shear in Jane E. Brody’s New York Times article, "is like a wound that doesn’t heal"—one of Dr. Shear’s findings that resonated deeply for Thompson. "Katherine Shear says that similarly to how our bodies naturally know how to cope with most physical injury or illness, within each one of us is the capacity for healing after loss," Thompson says. "Most of us come equipped with or learn responses that can potentially help us cope with loss. What’s different for people with complicated grief is that this natural healing process is disrupted by what Shear terms problem or complicating factors."
In early 2012, Thompson contacted Dr. Shear directly to enquire about opportunities for the Victoria Hospice team to learn more about her CG work. Fortunately, it turned out Dr. Shear was then assembling a group of professionals from around the world to participate in a pilot project called Train the Trainers (TTT). The idea was that these TTT professionals would receive education, training and supervision in CGT from Dr. Shear and her colleagues so that they would be competent to diagnose and treat people with CG and also train other professionals in their respective countries to use CGT. Thompson was invited to join the TTT project in 2012 began 2 years of training and supervision which was completed in 2014. Thompson is now the only grief counsellor in Canada trained in CGT, which sets another important benchmark for Victoria Hospice.
"I am now much more prepared and skilled to treat people with complicated grief," says Thompson. "This treatment helps people to diminish the intensity of their grief to a level that they are comfortable with, to increase their capacity to think and feel about the person who died without being paralyzed by overwhelming thoughts and feelings and to reconsider their life goals and aspirations. It isn’t about ‘getting over’ grief (no one wants to forget someone they’ve cared deeply for) but rather learning to live life fully even without that person alive."
Thompson notes that most people with complicated grief know that something isn’t working, that their grief process is different. "We have clients who come to us and say, ‘I feel stuck.’ They have noticed how other bereaved people seem to be adapting while they have somehow remained in one place, their grief is not settling and negatively impacting all aspects of daily life," she says. "A huge piece of our work is helping people with complicated grief learn new ways to think and feel about the death and their relationship with the person who died. When this learning occurs, they are more likely to experience the comfort of a deep and continuing bond (with the person who died) that survives even death and grief."