Grief Counselling: When Grief Needs More Than Time

Grief counselling is professional support that helps you carry a loss you were never meant to carry alone. Most people who lose someone or something they love find that, with time and the support of people around them, the sharpest edge of the pain slowly softens. But grief does not follow a schedule, and for some people it does not simply fade with the calendar. It settles in, stays intense, and starts to interfere with everyday life. This article explains what grief actually is, how to tell the difference between grief that is healing and grief that has become stuck, the many forms that grief and loss can take, and how grief counselling and grief therapy can help.

What Grief Actually Is (and Why It Does Not Follow Neat Stages)

Grief is the natural response to losing something or someone who matters to you. It is not a single feeling but a whole process that can touch your emotions, your thoughts, your body, and your behaviour. As the Centre for Addiction and Mental Health notes, grief reactions can range from shock, disbelief, and anger to trouble concentrating, changes in sleep and appetite, and physical sensations such as headaches or an upset stomach (CAMH, Loss, grief and healing). Grieving is a normal and healthy response to loss, even when it is deeply painful, and there is no single correct way to do it.

Grief Versus Mourning

It helps to separate two words that often get used interchangeably. Grief is what you feel on the inside. Mourning is how you express that grief on the outside, through crying, talking, ritual, faith, art, or simply the quiet work of getting through the day. Both matter, and both look different from one person, one family, and one culture to the next.

The Problem With The “Stages Of Grief”

Many people expect grief to move through five tidy stages: denial, anger, bargaining, depression, and acceptance. That model came from Elisabeth Kubler-Ross’s work with people facing their own dying, not with the bereaved, and she never intended it as a checklist that everyone climbs in order. In reality, grief tends to come in waves. You can feel steady one hour and undone the next, circle back to feelings you thought had passed, and still be healing. Researchers often describe grief as a back and forth movement between facing the loss and stepping back into ordinary life, and that oscillation is a sign of coping, not a sign of failure.

How Long Does Grief Last?

There is no fixed answer to how long grief lasts, and anyone who offers you a firm deadline is guessing. For most people, the intensity of early, or acute, grief gradually eases over the months that follow a loss, even though reminders, anniversaries, and quiet moments can still bring it flooding back years later. What matters most is the direction of travel. Grief that is slowly loosening its grip, even unevenly, is usually doing what grief is meant to do. Grief that stays at full intensity and keeps you from living your life may be a sign that you need more than time.

When Grief Needs More Than Time: Complicated and Prolonged Grief

For most people, grief softens on its own. For a smaller group it does not, and the loss stays raw and disabling long after others expect life to have resumed. Clinicians call this complicated grief or, in its formally diagnosed form, prolonged grief disorder. A systematic review and meta-analysis estimated that prolonged grief affects roughly one in ten bereaved adults (Lundorff et al., 2017, Journal of Affective Disorders). Rates appear higher after sudden, violent, or unexpected deaths. This is not weakness or a failure to “move on.” It is a recognized condition that responds to the right support.

What Is Prolonged Grief Disorder?

Prolonged grief disorder is persistent, intense grief that continues well beyond what is expected for a person’s culture and situation and that gets in the way of daily functioning. The American Psychiatric Association added it to the DSM-5-TR in 2022 (American Psychiatric Association), and the World Health Organization also recognizes prolonged grief disorder in its ICD-11 classification. Under the DSM-5-TR, the diagnosis applies when at least twelve months have passed since the death for adults (at least six months for children and adolescents) and the person still experiences intense yearning for, or preoccupation with, the person who died, along with symptoms such as a sense of disbelief, intense emotional pain, feeling that part of oneself has died, emotional numbness, difficulty re-engaging with life, or a sense that life is now meaningless. The twelve-month threshold exists on purpose, so that normal grieving is not labelled a disorder too soon.

Signs Your Grief May Be Stuck

Grief counselling can help at any point, but certain signs suggest it is time to reach out. The Canadian Mental Health Association points to grief that does not ease after several months, an ongoing inability to carry out daily activities, loss of interest in the people and activities you used to care about, and leaning on alcohol or other substances to cope (CMHA, Understanding and Coping with Loss and Grief). Other signs include feeling frozen at the moment of the loss, avoiding every reminder of the person, and losing your sense of who you are without them. If you are having thoughts of not wanting to be here, that is a reason to reach out now rather than later. Anywhere in Canada you can call or text the 9-8-8 Suicide Crisis Helpline, free and around the clock (9-8-8: Suicide Crisis Helpline).

Who Is More At Risk

Anyone can develop prolonged grief, but some circumstances raise the risk. These include losing someone suddenly or through violence, suicide, or an accident, losing a child, having an especially close or dependent relationship with the person who died, grieving in isolation without support, and living with existing mental health challenges such as depression or anxiety. Recognizing that you are at higher risk is not a prediction. It is a good reason to accept support earlier rather than waiting it out.

The Many Faces of Grief: Types of Grief and Loss

Grief is not only about death, and understanding the different types of grief and loss can make the experience feel less bewildering. Any meaningful loss can set off grief, including the death of a pet, the end of a relationship, a separation or divorce, the loss of your health, a job, or a home, or a move away from the life you knew (CMHA, Understanding and Coping with Loss and Grief). A few forms of grief are worth naming, because people often go through them without realizing they have a name at all.

Anticipatory grief is the grief that begins before a loss has happened, for example while caring for someone living with a terminal illness or dementia. You may find yourself mourning and hoping at the same time. Disenfranchised grief, a term introduced by grief researcher Kenneth Doka, is grief that others do not recognize or validate, such as grief over a miscarriage, the death of a pet, an estranged family member, or a relationship few people knew about. Ambiguous loss, described by researcher Pauline Boss, is grief without closure, when someone is physically present but psychologically absent, as in dementia, or physically gone with no certainty, as with a missing person.

Naming your particular loss, whether it is the death of a parent, a pregnancy or infant loss, the death of a beloved pet, or the quieter grief of a life that did not turn out the way you expected, is often the first step toward being able to work with it.

How Grief Counselling Helps

People often ask what type of counselling is best for grief. The honest answer is that the best approach depends on you and on whether your grief is following its natural course or has become stuck. At its heart, grief counselling gives you a private, supportive space to tell the story of your loss, make sense of the feelings that come with it, and slowly find a way to carry the relationship forward while re-engaging with your own life. This is part of the grief and loss support offered through individual therapy at our clinic. For many people, supportive and meaning-centred counselling is enough to feel less alone and more able to cope.

When grief is complicated or prolonged, more structured, evidence-based approaches can help. Prolonged grief disorder therapy, also known as complicated grief treatment and developed at Columbia University, is a structured, time-limited therapy designed specifically for stuck grief. In randomized clinical trials led by Dr. M. Katherine Shear, most people who received it improved substantially, and its developers report that it is about twice as effective as the standard treatment for depression (Shear et al., 2016, JAMA Psychiatry; Columbia Center for Prolonged Grief). Cognitive behavioural therapy can help when grief is tangled up with guilt, avoidance, or persistent low mood, and approaches such as emotion-focused therapy can help you process painful emotions safely. Grief counselling will not make the loss disappear, and it should never promise to “cure” your love for the person who is gone. What it can do is ease the intensity of the suffering, reduce the symptoms that keep you stuck, and help you build a life that has room for both your loss and your future.

When to Reach Out for Grief Counselling

You do not need to be in crisis to benefit from grief counselling, and you do not need to wait until grief has become complicated. Some things genuinely help while you grieve: keeping a little gentle structure in your days, letting yourself feel what you feel without judging it, leaning on people you trust, and expressing your grief in whatever form fits you, whether that is talking, writing, movement, or ritual (CMHA, Understanding and Coping with Loss and Grief). It is worth knowing what tends not to help, too. Numbing grief with alcohol or drugs, cutting yourself off from other people completely, or forcing yourself toward a tidy sense of “closure” usually delays healing rather than speeding it up.

It makes sense to reach out for professional support when grief is interfering with your work, your sleep, or your relationships, when it is not easing over time, or simply when you feel you should not have to carry it on your own. It also helps to understand the difference between grief and depression, which can overlap but are not the same. Grief tends to come in waves that are tied to reminders of the loss, and moments of connection, and even warmth, usually remain possible. Depression is more constant and pervasive, often bringing a flat, heavy hopelessness and harsh self-criticism that colours nearly everything. If low mood is steady and lasting, or if it comes with thoughts of not wanting to be here, that is a clear signal to speak with a professional.

Grief Counselling in Ontario: Access, Cost and OHIP

If you are looking for grief counselling in Ontario, it helps to understand who provides it and how it is paid for. Grief counselling here is usually delivered by a Registered Psychotherapist (RP) or a Registered Social Worker (RSW), and sometimes by a psychologist. The title worth looking for is one regulated by a college such as the College of Registered Psychotherapists of Ontario, which sets the standards for training and ethics.

A common question is whether grief counselling is covered by OHIP. In most cases it is not. Psychotherapy provided privately by a Registered Psychotherapist is generally not covered by OHIP, although many extended health insurance plans reimburse some or all of the cost, and your clinic can provide receipts to submit to your insurer (see how this works for individual therapy). There are also free and lower-cost options in the province. The Ontario Structured Psychotherapy program offers free, publicly funded, cognitive behavioural therapy for depression and anxiety, which often accompany grief, with self-referral available (Ontario Structured Psychotherapy, via CAMH). Hospices and community agencies also offer grief and bereavement support, and the Bereavement Authority of Ontario points to free resources such as Bereaved Families of Ontario (Bereavement Authority of Ontario).

At 101 Psychotherapy, grief and loss are supported through individual therapy, in person at our Vaughan clinic serving Woodbridge, Maple, Thornhill, and the wider GTA, or online across Ontario, with sessions starting at $100 and a free initial consultation.

You Do Not Have to Grieve Alone

Grief is, in many ways, the price of having loved, and it is not something you have to work through by yourself. If your loss still feels as raw as the day it happened, if it is getting in the way of the life you want to live, or if you are simply tired of carrying it alone, grief counselling can help you find your footing again. You are welcome to book a free consultation with a Registered Psychotherapist at 101 Psychotherapy, in person in Vaughan or virtually anywhere in Ontario, whenever you feel ready.

References

1. Centre for Addiction and Mental Health (CAMH). Loss, grief and healing. https://www.camh.ca/en/health-info/mental-health-and-covid-19/loss-grief-and-healing
2. Canadian Mental Health Association, Ontario. Understanding and Coping with Loss and Grief. https://ontario.cmha.ca/documents/understanding-and-coping-with-loss-and-grief/
3. American Psychiatric Association. APA Offers Tips for Understanding Prolonged Grief Disorder (DSM-5-TR). https://www.psychiatry.org/news-room/news-releases/apa-offers-tips-for-understanding-prolonged-grief
4. Lundorff M, Holmgren H, Zachariae R, Farver-Vestergaard I, O’Connor M. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders, 212, 138-149. https://www.sciencedirect.com/science/article/abs/pii/S0165032716318651
5. Shear MK, Reynolds CF, Simon NM, et al. (2016). Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial. JAMA Psychiatry, 73(7), 685-694. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2526240
6. Columbia University, Center for Prolonged Grief. https://prolongedgrief.columbia.edu/
7. Centre for Addiction and Mental Health (CAMH). Ontario Structured Psychotherapy (OSP) Program. https://www.camh.ca/en/patients-and-families/programs-and-services/ontario-structured-psychotherapy-osp-program
8. Bereavement Authority of Ontario. Grief support information. https://thebao.ca/griefinformation/
9. 9-8-8: Suicide Crisis Helpline (Canada). https://988.ca/

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Written by

Alex Kazmin

Registered Psychotherapist (RP)

Alex Kazmin is a Registered Psychotherapist (RP) at 101 Psychotherapy in Vaughan, Ontario. He holds an International Medical Degree (IMG) and has more than twenty years of medical, clinical, and research experience, including twelve years as a registered psychotherapist.