About 48 hours after my son Brady died, my mother and sister led me to the car and drove me to a psychotherapist’s office. I wound up having a couple of dozen grief counseling sessions with him over the next few months.

The therapy sessions were difficult for me. At times they were downright excruciating. Often I found them strange or even bizarre.

psychologist-1015488_1920Therapy was also expensive. Grief counseling cost well over $3,000. My health insurance deductible is much higher, so insurance covered none of it. My older sister generously paid half, for which I was grateful since I was unable to work at all for a few weeks.

But therapy helped, much more than I expected. In fact, it was remarkable.

Sometimes in the middle of a session I could feel the pressure of the heart-melting, skull-crushing, soul-shredding horror, panic and black, hopeless despair leaking away, to be replaced by comparative calm and acceptance. This is not to say that the terrible feelings never returned. But the intensity was much lower. It was manageable.

Grief counseling wasn’t easy, fun or cheap. It didn’t make life wonderful again after Brady’s death. But it made living a lot more possible, and that’s not nothing.

Before therapy any time a thought or image of my son’s death passed through my head it was as if I had grabbed a 345,000-volt electrical transmission line. After therapy, grieving episodes are like brushing the back of my hand against a wire carrying 110-volt household current. It hurts, and no mistake. But it’s not like my entire body instantly explodes into flame.

Therapy wasn’t easy, fun or cheap. It didn’t make life wonderful again after Brady’s death. But it made living a lot more possible, and that’s not nothing.

I am not the only grieving person who has had a similar experience with therapy. A 2010 study, for instance, found that 91 percent of bereaved people who sought treatment thought it was beneficial. That was a small study, however, and some bigger studies have reached different conclusions. I’ll talk more about limitations of therapy later on.

Meanwhile, if you’re suffering greatly from loss of a loved one like I was, people may be leading you to a therapist or you may be considering grief therapy on your own. In this post I’ll briefly discuss some of the kinds of grief therapy. I’ll focus on one type of therapy that evidence suggests will work best for the people who are hurting the worst. I won’t get into medication. That seems like a good topic for a later discussion.

Kinds of Grief Counseling and Therapy

The popular image of psychotherapy is of somebody lying on a couch and talking about feelings while a bearded dude with a German accent takes notes, smokes cigars and maybe catches a nap. And some grief therapy does look like that. But there many different kinds, some of which involve little or no couch time. A partial list of grief therapies:

  1. Art Therapy

  2. Behavioral Activation Therapy

  3. Brief Dynamic Therapy

  4. Client-Centered Therapy

  5. Cognitive Behavioral Therapy

  6. Complicated Grief Therapy

  7. Emotional Transformation Therapy

  8. Equine Therapy

  9. Exposure Therapy

  10. Hypnosis

  11. Internet-Administered Therapy

  12. Interpersonal Therapy

  13. Logotherapy

  14. Meaning-Oriented Therapy

  15. Metacognitive Therapy

  16. Music Therapy

  17. Pastoral Counseling

  18. Play Therapy

  19. Supportive Therapy

  20. Virtual Reality

  21. Writing Therapy

There are many more, far too many to discuss even a sizable fraction of them here, even if I had the know-how to do it. So I’ll focus on the kind I did as well as the one that evidence suggests is most likely to help the people who are suffering the most.

Emotional Transformation Therapy

Many these schools of therapy have few practitioners, while others are offered by many thousands of trained therapists in practically every city and sizable town. I did one of the less well-known types. It is called emotional transformation therapy or ETT.

ETT was invented by the therapist I saw, Dr. Stephen Vazquez. It has some woo-woo elements, including looking into a hooded box at colored lights and moving your eyes in various directions while wearing special goggles. Here is a link to a page with a video that describes it.

ETT has some research evidence supporting its basic premise, which is that colored light and eye movement can strongly affect the way we handle emotions. And, as I said, it helped me considerably.

No therapy is guaranteed to work well or at all with everybody or anybody. Therapy may help you a lot or a little or none. That’s what the evidence says.

But ETT is not the kind of thing I would have selected on my own. The idea that looking at colored lights would somehow improve my mood would have seemed far-fetched.

However, my younger sister knew about Dr. Vazquez and thought it might help me. He had an office here and was available. I was so stunned by Brady’s death I was willing to try anything that might ease the pain. My family members took me there and I went.

Fortunately, it worked. I am grateful for my younger sister’s referral, my other sister’s financial support and my mother’s devotion in driving me to and from sessions when I didn’t feel capable of getting behind the wheel. And I’m grateful to Dr. Vazquez, who is an exceptionally intelligent, knowledgeable, empathetic, caring, curious and accomplished person.

Thank you, thank you, thank you, thank you.

Like ETT, nearly all these therapies have some evidence supporting their effectiveness. None is guaranteed to work perfectly or at all with everybody or anybody. Therapy may help you a lot or a little or none. That’s what the evidence says.

Complicated Grief Therapy

The type of grief therapy with the most evidence-based support seems to be complicated grief therapy or CGT for short. A 2016 randomized, placebo-controlled study of nearly 400 people suffering from complicated grief compared CGT with other therapies. It concluded by labeling CGT as “the treatment of choice” for complicated grief.

CGT is a talk therapy. As described in a 2012 article in Dialogues in Clinical Neuroscience, CGT includes elements from interpersonal therapy, cognitive behavioral therapy and exposure therapy.

Exposure is a key part of CGT. Exposure therapy involves confronting and re-experiencing painful aspects of the loss. For example, patients might be instructed to repeatedly tell the story of the death.

My own therapy also included exposure therapy. In several sessions I re-enacted in slow motion over and over different portions of the night my son died and my attempts to revive him. Believe me when I say these sessions were extremely painful. I dreaded them.

Exposure therapy involves confronting and re-experiencing painful aspects of the loss. For example, patients might be instructed to repeatedly tell the story of the death.

However, the first re-enactment each time was the worst. And the more I did them, the easier they got. By the third run-through I could feel the terror, horror, panic and other overwhelming emotions leaking away.

The best thing was that these feelings have not returned, at least not at the dialed-up-to-11 force they had before. Exposure worked for me.

Exposure therapy is often used for treating post traumatic stress disorder or PTSD. People who have survived extraordinarily challenging situations such as the one I had the night my son died sometimes experience PTSD and may be particularly suited for this therapy.

Another widely used PTSD treatment is called eye movement desensitization reprocessing. EMDR, as it’s abbreviated, shares some similarities with the ETT therapy I did. One significant difference is that there are many EMDR therapists and few ETT therapists. If you think you might have PTSD, you can learn more about EMDR here.

Cognitive Behavioral Therapy

Complicated grief therapy also draws from cognitive behavioral therapy or CBT. Cognitive behavioral therapy is also often used by itself to help bereaved people, without including exposure therapy or other parts of complicated grief therapy.

CBT was developed about 50 years ago and is often described as the form of psychotherapy with the most evidence-based support. Again, that doesn’t mean it’s guaranteed to work for you. But many studies show it is often effective for grief.

For instance, a 2010 review of prior research found CBT helped bereaved people feel better immediately after treatment. It’s worth noting that, over the long term, according to this meta-analysis of 11 other studies, the beneficial effects of CBT generally faded away.

CBT involves changing the way you think about a situation. Basically, you identify troublesome thoughts, challenge them and replace them with other thoughts that seem more helpful and realistic.

A troublesome grief-related thought might be, “I’m never going to feel happy again since my loved one died.” This thought promotes despair, hopelessness and depression.

CBT involves changing the way you think about a situation. Basically, you identify troublesome thoughts, challenge them and replace them with other thoughts that seem more helpful and realistic.

Challenging it might consist of pointing out to yourself that 1) you can’t read the future, 2) you have had other feelings you thought would never change, such as that you’d love your first girlfriend or boyfriend forever, but they faded with time and 3) if you talk to people who’ve lost loved ones a long time ago, many will tell you that they are, indeed, happy again.

Once you’ve undermined this problem-causing thought, CBT will help you replace it with something that better fits the facts and isn’t as upsetting. Instead of “I’m never going to feel happy again,” you might try to tell yourself, “I may be sad for a while, but odds are good that someday I’ll be about as happy as I was before.”

Evidence suggests CBT works pretty well for grief. For instance, a 2015 research article titled, “Efficacy of an integrative CBT for prolonged grief disorder: A long-term follow-up,” found a large positive impact of CBT that was maintained over about a year and a half after treatment.

Complicated grief therapy usually involves 15 or 20 sessions of an hour or so each. There is also often some homework consisting of doing written exercises that challenge thoughts.

The Limitations of Therapy

The general consensus among experts and research studies is that a sizable majority of bereaved people don’t need therapy and won’t benefit from it. Most people recover from bereavement on their own without any interventions at all.

For instance, in 2008, researcher Robert Neimeyer and others combined results from 61 controlled studies of different interventions. This large meta-analysis found that, overall, therapeutic interventions helped a little at first but the effects faded after a while.

The bottom line seems to be that most bereaved people don’t need therapy and won’t benefit from it. But it is likely to help those who are really suffering.

However, the same study also found that, when you looked only at people who were the most distressed by grief, therapy worked pretty well. The bottom line seems to be that most bereaved people don’t need therapy and won’t benefit from it. But it is likely to help those who are really suffering.

How effective is therapy when it does work? At best, it seems to be only modestly effective. In the 2012 study referred to earlier, a little more than half of patients who got complicated grief therapy responded positively. That is, they felt better. This is better than other grief therapies, but it’s obviously not fantastically effective.

So, are you one of the people likely to benefit from therapy?

One way to get an answer to that question is to take one or more of the grief assessments described in this earlier post, Yes, You Can Measure Grief And Here’s How. If you score above the cutoff on one or more of these assessments, therapy might be worth looking into.

Time is also a factor. If it’s been less than six months since your loss, the general consensus seems to be that it is too early to tell whether you are suffering from grief that would benefit from therapy. The grief assessments aren’t even supposed to be used, for the most part, until six months after loss. Even if your score is high, therapy may still not be indicated.

Of course, I started therapy 48 hours after Brady died. This obviously goes against the prevailing wisdom as I’ve discovered since.

Patience is one of the most powerful tools bereaved people have at their disposal. Waiting is generally effective therapy, even if it is no fun.

However, I think it was a good move for me. I was really suffering, possibly from PTSD as much as from grief, and I think it helped me. But your mileage may vary and, according to most of the experts and research findings, it might be a good idea to wait for a while to see if your symptoms clear up without therapy.

Patience is one of the most powerful tools bereaved people have at their disposal. Waiting is generally effective therapy, even if it is no fun.

Another limitation of therapy is that it doesn’t seem likely to work unless you want it to work. That doesn’t mean you have to believe in it. It does mean that most of these kinds of therapy require you to want to change, to get better, and to be willing to actively work at it if they are going to be effective.

I was more than willing to work and do uncomfortable things if it meant I’d stop wishing I could lie down and die.

I didn’t necessarily believe in the effectiveness of ETT when I started. If I’d known more about it at the time, I would likely have been skeptical. But I very much did want to get better. I was more than willing to work and do uncomfortable things if it meant I’d stop wishing I could lie down and die.

At bottom, therapy is simply a percentage bet that may or may not pay off. Odds of it working go up if you’re suffering badly and have been for more than six months and are willing to put in some effort and risk discomfort. If it’s sooner than that, or you don’t want to feel better, or don’t think you deserve to, or you don’t want to work at it, therapy is more likely be a waste of time, energy and money.

Where You Can Find Help

Like me, many people choose a therapist based on a personal referral from a friend or family member. If you don’t have a referral and want to look into grief therapy, here are some places to look:

Psychology Today Find a Therapist. This online directory lets you search by city or postal code to find therapists who treat people struggling with grief as well as dozens of other conditions. There’s no charge to you to use the site, but therapists pay to be listed.

GoodTherapy.org lets you filter search results by location and search for therapists who practice certain kinds of therapy, such as cognitive behavioral. CGT is not one of the listed specialties, however. This site also charges therapists be listed.

The Center for Complicated Grief at Columbia University has an online tool for finding therapists who have some familiarity with CGT. Unfortunately, there don’t seem to be many therapists trained in CGT. They are concentrated in and around New York City. And the location search tool didn’t work when I tried it. You might be able to find a local CGT therapist if you manually scan the whole list.

Wrapping Up Grief Therapy

My goal with this piece is to tell about my experience with therapy, give you an idea what kinds of therapy are available, which kind seems to work best, whether you’re likely to benefit and where you can find a suitable therapist. Even though this is longer than the typical Grief Science post, I only skimmed the surface. These topics could easily be discussed at book length. Feel free to ask questions. I’ll try to give you a good answer.

Thanks for visiting, reading, liking, commenting, sharing and subscribing. I am sorry for the losses that brought each of us here and hope we can all get at least a moment of peace today.