Psychiatric Annals

The articles prior to January 2012 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here

CME Article 

Complicated Grief

M. Katherine Shear, MD; Elizabeth Mulhare, MSW

Abstract

M. Katherine Shear, MD; and Elizabeth Mulhare, MSW

The death of a loved one can be one of the most painful experiences of a lifetime. The grief response that follows such a loss is often intense and debilitating. Nevertheless, studies document that, difficult though it may be, most people come to terms with the death of a loved one and regain their interest and engagement in ongoing life. Adjustment occurs during a period of acute grief, during which confrontation with the painful reality oscillates with defensive exclusion, in the form of numbing, focus on positive memories, imagined reunion, and other forms of respite in which attention is directed toward neutral or positive thoughts. Although there is a general progression from numbing and disbelief to painful acknowledgment and ultimate integration of loss and grief, discrete stages cannot be discerned. Clinicians should be cautious about suggesting that a bereaved person can expect to follow a predictable pathway. In the words of C.S. Lewis:

ABOUT THE AUTHORS

M. Katherine Shear, MD, is with the Columbia University School of Social Work, and Columbia University College of Physicians and Surgeons, New York, NY. Elizabeth Mulhare, MSW, is with the Department of Psychiatry, Weill Cornell Medical College, New York, NY.

Address correspondence to: M. Katherine Shear, MD, 1255 Amsterdam Ave., New York, NY 10027; or e-mail ks2394@columbia.edu.

Dr. Shear and Ms. Mulhare have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Describe an attachment-based model of acute, integrated, and complicated grief (CG).
  2. Describe the clinical syndrome of CG and its differential diagnosis.
  3. Explain the goals, strategies, and techniques used in psychotherapy for CG.

Abstract

M. Katherine Shear, MD; and Elizabeth Mulhare, MSW

The death of a loved one can be one of the most painful experiences of a lifetime. The grief response that follows such a loss is often intense and debilitating. Nevertheless, studies document that, difficult though it may be, most people come to terms with the death of a loved one and regain their interest and engagement in ongoing life. Adjustment occurs during a period of acute grief, during which confrontation with the painful reality oscillates with defensive exclusion, in the form of numbing, focus on positive memories, imagined reunion, and other forms of respite in which attention is directed toward neutral or positive thoughts. Although there is a general progression from numbing and disbelief to painful acknowledgment and ultimate integration of loss and grief, discrete stages cannot be discerned. Clinicians should be cautious about suggesting that a bereaved person can expect to follow a predictable pathway. In the words of C.S. Lewis:

ABOUT THE AUTHORS

M. Katherine Shear, MD, is with the Columbia University School of Social Work, and Columbia University College of Physicians and Surgeons, New York, NY. Elizabeth Mulhare, MSW, is with the Department of Psychiatry, Weill Cornell Medical College, New York, NY.

Address correspondence to: M. Katherine Shear, MD, 1255 Amsterdam Ave., New York, NY 10027; or e-mail ks2394@columbia.edu.

Dr. Shear and Ms. Mulhare have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Describe an attachment-based model of acute, integrated, and complicated grief (CG).
  2. Describe the clinical syndrome of CG and its differential diagnosis.
  3. Explain the goals, strategies, and techniques used in psychotherapy for CG.

M. Katherine Shear, MD; and Elizabeth Mulhare, MSW

The death of a loved one can be one of the most painful experiences of a lifetime. The grief response that follows such a loss is often intense and debilitating. Nevertheless, studies document that, difficult though it may be, most people come to terms with the death of a loved one and regain their interest and engagement in ongoing life. Adjustment occurs during a period of acute grief, during which confrontation with the painful reality oscillates with defensive exclusion, in the form of numbing, focus on positive memories, imagined reunion, and other forms of respite in which attention is directed toward neutral or positive thoughts. Although there is a general progression from numbing and disbelief to painful acknowledgment and ultimate integration of loss and grief, discrete stages cannot be discerned. Clinicians should be cautious about suggesting that a bereaved person can expect to follow a predictable pathway. In the words of C.S. Lewis:

ABOUT THE AUTHORS

M. Katherine Shear, MD, is with the Columbia University School of Social Work, and Columbia University College of Physicians and Surgeons, New York, NY. Elizabeth Mulhare, MSW, is with the Department of Psychiatry, Weill Cornell Medical College, New York, NY.

Address correspondence to: M. Katherine Shear, MD, 1255 Amsterdam Ave., New York, NY 10027; or e-mail ks2394@columbia.edu.

Dr. Shear and Ms. Mulhare have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Describe an attachment-based model of acute, integrated, and complicated grief (CG).
  2. Describe the clinical syndrome of CG and its differential diagnosis.
  3. Explain the goals, strategies, and techniques used in psychotherapy for CG.

10.3928/00485713-20081001-10

Sign up to receive

Journal E-contents