Complicated Grief: How to Cope with Loss in Complex Situations

“How lucky I am to have something that makes saying goodbye so hard.” — A. A. Milne, author of the “Winnie-the-Pooh” children’s books

For better or worse, loss is an unavoidable part of life. Loss can come in many forms, such as the death of a loved one, a life-altering injury or medical diagnosis, the breaking-up of a family, the termination of a friendship or romantic relationship, or even the untimely end of a job or career. A loss can be large, small or somewhere in between, and it can affect us in a wide variety of ways.

Grief is one common and very normal reaction to loss. In its simplest sense, grief is deep sorrow or distress that we feel because of a loss. Grief is our natural response to the loss of something that was familiar or comforting to us, and grieving is our way of coming to terms with that loss. The grieving process could take days, weeks, months or even longer, but it usually ends with acceptance and a return to relative peace.

However, grief can sometimes be so intense that it does not go away on its own. Rather than diminishing over time, feelings of grief may sometimes remain unchanged or even get worse as the loss fades into the past. This type of persistent, unresolved grief is known as “complicated grief,” and it can severely impact a person’s mental health and their ability to live a normal life after experiencing loss.

In order to heal from complicated grief if and when it occurs, it’s important that we understand what it is and how it affects us. In this blog post, Cummins school-based therapist April Allgood explains how complicated grief differs from regular grief, what types of loss may cause a person to experience complicated grief, and how someone who is suffering from complicated grief can begin to heal from their loss.

Layers of Loss, Layers of Grief

April Allgood, MSW, LSW, School-based Therapist at Cummins Behavioral Health
"Especially over the past few years, I've really had to become comfortable with grief, because about two-thirds of my caseload deals with complicated grief," says April Allgood, MSW, LSW, a school-based therapist at our Boone County office. April works with school-aged youth and their family members in her day-to-day work.

As mentioned above, the first major difference between regular grief and complicated grief is that regular grief goes away while complicated grief does not. “Typically, individuals are able to adapt to a new normal and learn how to move on,” April explains, “but with complicated grief, symptoms are persistent. They don’t go away, and they impair the person from moving on to what life was like before the loss.”

Just as everyone experiences grief in their own way, complicated grief doesn’t present itself the same way from person to person. In general, though, it is typically characterized by extreme, seemingly unbearable feelings of sadness, guilt or hopelessness. A person is also more likely to experience complicated grief if they’ve suffered multiple losses at the same time or if their grief has multiple layers.

April offers a few examples:

“Especially with COVID-19, there are individuals who are not able to be at their loved one’s bedside to have that final goodbye, or maybe they can’t have the typical funeral or celebration of life. That puts those individuals at a higher risk for complicated grief, because they’re not able to mourn the loss of their loved one in the way they normally would. Another example is when a child is removed from their home. For parents, having their child removed is very tragic and very hard, but sometimes they also have to come to the realization that their choices resulted in their child’s removal. Or maybe one parent is struggling with the loss of their child, so they may potentially resort to substance use, and then maybe they are incarcerated. For the remaining parent, not only was their child removed, but their spouse was then incarcerated for substance use, so they might experience complicated grief because they lost two big entities of their life and their support system.”

Another common difficulty of complicated grief is that each layer of grief can distract from the others, effectively prolonging the overall process of grieving and healing from loss. “Say it’s that parent—when they’re managing the emotion connected to their spouse going to jail, it takes their focus off of grieving their child’s removal from the home,” April says. “It creates a deeper layer because there’s two different things they have to grieve.”

Strategies for Coping with Complicated Grief

Although complicated grief can be an extremely difficult experience, there are many ways a person can cope with their feelings and begin to work toward some sense of resolution. First and foremost, it is always important to reach out to people who can provide emotional support. This support can be found through professional behavioral health services as well as among friends, family members, teachers, coaches, and other individuals who care about our personal well being.

When it comes to professional services, therapists and counselors can help a person make sense of the emotions they are experiencing and understand that their feelings are normal and valid. “It’s my job to help them understand what they’re going through and how it impacts their body, their emotions and their thoughts,” April says. “But I also try to help them comprehend the loss and address the grief. In my office, I try to create a safe, non-judgmental space where that individual can share what’s on their mind and understand that it’s OK to have the emotions they have.”

In addition to seeking support, April stresses the importance of increasing self-care and maintaining regular wellness behaviors like getting plenty of sleep, exercising regularly and eating a healthy diet. Another coping strategy that people sometimes overlook is emotionally preparing for upcoming holidays or anniversaries of their loss. “I help a lot of people of all ages prepare for those moments, because they can be a big shock for families and individuals to go through, especially if they’ve not had to process or deal with that before,” April says.

Professional therapy or counseling can also help the entire family deal with the ramifications of complicated grief, as it frequently affects others who are close to the grieving person. April explains,

“As professionals, we are trained to help not only children, teens and adults navigate this new way of life, but the family as a whole. Grief can be an uncomfortable topic to discuss, but we’re well trained in that area, and it’s not an uncommon topic for us to deal with. Therapists can help caregivers and guardians understand how to talk to their loved one about the loss, and we can also help them come alongside the grieving person to help them develop healthy coping skills and a new way of surviving life without that person who’s potentially gone forever or just gone temporarily.”

Ultimately, the goal for someone who is experiencing complicated grief is not only to move past their loss, but to emerge on the other side stronger than they were before. “I really try to help them understand their resiliency,” April says, “because anyone dealing with a loss is also creating very strong character traits. I try to help them understand that they’re sometimes stronger than they think they are.”

For more resources to help someone build resilience after a loss, we recommend reading our blog posts on gratitude and learned optimism below!

The Power of Being Thankful: Jessica Hynson, Jeremy Haire & Mindy Frazee Explain the Benefits of Gratitude
Training Ourselves to be Optimists: Positive Psychology

Wraparound Services: 360-Degree Support for Youth with Greater Behavioral Health Needs

Although childhood is typically perceived as a time of carefree happiness, children and adolescents can also face many challenges to their mental health.

For starters, many youth contend with difficult home issues like poverty, lack of food, poor family harmony, and even domestic violence. On top of these difficulties, about one in six children in the U.S. must also cope with a developmental disability such as ADHD, autism spectrum disorder, cerebral palsy, or other intellectual and learning disabilities. Finally, about half of all mental disorders start before or during the teenage years, further complicating life for youth who have them.

When a youth’s behavioral health needs are relatively mild or moderate, interventions such as individual therapy or counseling, family therapy, or skills training can be sufficient to help them address whatever challenges they may face. However, sometimes a child or teen needs a greater level of support to account for severe or very complicated behavioral health difficulties. In these cases, “wraparound” services may be the best option.

To learn more about wraparound services and how they fit into a behavioral health continuum of care, we spoke with Lakisha Wren, Wraparound Team Lead for our Hendricks County office. In this blog post, Lakisha explains what wraparound services entail, who might be a good fit to receive them, and how they can help create stability and healing for youth with greater behavioral health needs.

Comprehensive Support for Complex Challenges

Lakisha Wren, Wraparound Team Lead at Cummins Behavioral Health
"We've had a good success rate with our wraparound services here in Hendricks County. We've had a lot of people graduate the program, and we even have some families where the youths have gone on to college," says Lakisha Wren, a Wraparound Team Lead at Cummins Behavioral Health.

Wraparound services (also referred to as “wrap services” or “the wraparound process”) are intensive care programs specialized for the specific needs of each consumer. They comprise the highest level of care provided by community mental health agencies, and they are the last option before a youth is removed from their home for treatment purposes. “We work with youth who are at risk of being placed into residential facilities or acute hospitalization,” Lakisha explains.

In Indiana, wraparound services are funded by the Department of Child Services (DCS) and the FSSA’s Division of Mental Health and Addiction (DMHA), and children between the ages of 6 and 18 are eligible. Because the entire family tends to be involved in situations of this kind, wraparound services may be extended to everyone in the household. “We wrap services around everyone, not just the focus child. The mom, the dad, siblings—everyone can get services under the grant,” Lakisha says.

As the access site for wraparound services in Hendricks County, Lakisha is the first person a family will speak to if they are referred for wrap services. Lakisha’s job is to assess their eligibility and connect them with the appropriate care providers. “I’ll assign a therapist and a life skills specialist, and if they need more intensive services, that’s when I would assign a wrap facilitator,” Lakisha explains. “Then they might also receive habilitation services, respite services, and family support training as well.”

Regardless of the exact services provided, the wraparound process is always guided by four key principles of care:

  • Grounded in an inner strengths perspective: service providers assume that every individual possesses valuable inner strengths that can help them thrive in life if they are developed and applied
  • Family voice and choice: all family members have a say in their care and can choose how they would like services to proceed
  • Strengths-based: service providers aspire to identify each individual’s constructive life skills and nurture their development—not fixate on personal shortcomings
  • Outcomes-based: all services are designed to work toward a positive end result as defined by family members and care providers

How Wraparound Services Create Outcomes for Youth and Families

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The overall goal of wraparound services is to address whatever challenges a youth is facing without removing them from their normal home environment. With this in mind, efforts are also made to make services as unobtrusive as possible to a child or teen’s daily life. “A lot of our youth do not work well just with traditional services,” Lakisha explains. “They don’t do well just sitting, discussing their feelings and trying to stay focused for a 45-minute session. So, we try to be very creative and think outside the box with our plan of care.”

This is precisely where non-clinical service providers and interventions shine. “If skills training isn’t working, we might try some fun habitation services,” Lakisha says. “For example, a mentor could meet with the youth out in the community and try to do skills training at a basketball court, or just while walking around the community. I think that’s why a lot of our families benefit from wrap services—we try to be creative and make it fun for them.”

According to Lakisha, the highly individualized nature of wraparound services are another important key to their effectiveness for youth and families:

You may have Johnny who does not do well in a school setting, but we can have a support person at school who can sit next to him, help knock down some of those barriers and underlying needs, and pull the teacher aside and say, ‘Have you tried to do this with him, have you tried to do that?’ We can have a habitation provider help that teacher work with Johnny—explain Johnny’s needs, his care plan, and how the teacher can be creative with Johnny. Or we could have another individual who is struggling with just getting up, going to school and being motivated each day, or has suicidal ideation. We can give that person a mentor who’s there on the weekend to pick them up and take them to peer mentoring groups out in the community, or just sit down with the parents and talk about why it’s important to have crisis plans, help them understand suicidal ideation, and things like that. It’s just about having an individualized plan of care for every youth and family.”

By surrounding a youth with various types and levels of support, wraparound services can effectively treat complex behavioral health issues during childhood and adolescence. Most importantly, their focus on helping the whole family lowers the chances that problems will resurface in the future—and keeps youth in the home and community environments where they are loved and feel most comfortable.

Looking for more information about the types of services provided at Cummins Behavioral Health? You might enjoy our blog posts on employment services and substance use disorder services below!

Employment Services: Helping People with Mental Disabilities Find Rewarding Work
Managing Dual Diagnosis: Cummins’ Tracy Waible on How to Identify and Treat Substance Use with Co-Occurring Disorders