Types of Grief Therapy and What the Research Says

Therapists describe their work with grief in many ways, and it is hard to tell from a website what the differences amount to. This article sets out what randomized trials have found for each main approach. A randomized trial assigns people to treatments by chance, which makes it the fairest test of whether one works better than another.

Two cautions first. Almost all of this research is about prolonged grief disorder, a diagnosis for grief that stays intense and disabling long after a death. Older studies call it complicated grief. Most bereaved people do not have it and do not need treatment at all, as do I need grief therapy? explains. And a response rate in a trial describes that group of participants. It does not predict what will happen for you.

What is prolonged grief disorder therapy?

It is a structured treatment designed specifically for prolonged grief, formerly called complicated grief treatment. A 2024 research review describes it as a form of cognitive behavioral therapy (CBT) that contains elements of CBT for post-traumatic stress disorder and of interpersonal therapy for depression. In the trials it was delivered in 16 sessions. Three randomized trials led by the same research group tested it.

• 2005. 95 adults with complicated grief received either the grief treatment or interpersonal psychotherapy. Both groups improved. The response rate was 51% for the grief treatment and 28% for interpersonal psychotherapy.
• 2014. 151 adults aged 50 or older. Again both groups improved, with a response rate of 70.5% for the grief treatment and 32.0% for interpersonal psychotherapy.
• 2016. 395 adults at four academic centers, in four groups: the antidepressant citalopram, a placebo pill, the grief treatment with citalopram, and the grief treatment with placebo. The response rate was 82.5% for the grief treatment with placebo and 54.8% for placebo alone.

That last comparison deserves a second look. More than half of the placebo group, who also received supportive clinical management, were rated as responders. Many people improved without the grief treatment, and the grief treatment added to that.

What about other forms of CBT?

CBT is a family of therapies that work on patterns of thinking and behavior. Versions adapted for grief often include exposure, which here means deliberately revisiting memories of the death and the things a person has been avoiding, with a therapist's support.

In a 2007 study, 54 people with complicated grief received one of two sequences of CBT or 12 sessions of supportive counseling. Both CBT sequences produced more improvement than supportive counseling, and exposure was more effective than the thinking-focused component alone. In a 2014 randomized trial of 80 patients in Sydney, everyone received group CBT, plus individual sessions of either exposure therapy or supportive counseling. Six months later, among those who completed treatment, 14.8% of the exposure group still met criteria for prolonged grief disorder, compared with 37.9% of the other group.

The 2024 review sums up the field this way: grief-focused CBT-based therapies currently have the strongest evidence for prolonged grief disorder, although there is significant variation and bias among the existing studies. It adds that web-based therapies do not appear to be less effective than in-person ones. The American Psychiatric Association likewise says treatments using elements of CBT have been found effective in reducing symptoms.

How did interpersonal therapy do?

Interpersonal psychotherapy is an established treatment for depression. In both head-to-head trials above, people who received it improved, but fewer responded than with the grief-targeted treatment: 28% against 51% in 2005, and 32.0% against 70.5% in 2014. The 2024 review concludes that treatments tailored to grief are superior to classical depression treatments such as interpersonal therapy for prolonged grief.

What is known about psychodynamic therapy?

Psychodynamic therapy is a talking therapy that looks at what a loss means to a person and how it connects to their history and relationships. For prolonged grief disorder specifically, there is little randomized-trial evidence about it. The one randomized trial in the National Cancer Institute's evidence table, published in 2007 with 135 participants, compared short-term interpretive group therapy with supportive group therapy. Both groups improved, and the interpretive approach was not shown to be superior. The 2024 review does not list psychodynamic therapy among the evidence-supported treatments for prolonged grief disorder.

That is an absence of strong evidence. It is not evidence that the approach does not help. It has simply not been tested in the way grief-focused CBT has, so no one can honestly claim trial support for it in prolonged grief disorder.

Does mindfulness-based therapy help?

One trial compares it directly. In 2024, researchers randomly assigned 100 adults with prolonged grief disorder to eleven weekly individual sessions of either grief-focused CBT or mindfulness-based cognitive therapy. At 6 months, the grief-focused CBT group showed a greater reduction in prolonged grief scores. The authors concluded that both treatments may be considered, but that grief-focused CBT might be the more effective choice. No adverse events were reported.

A 2025 systematic review of 13 studies, with only one randomized trial among the intervention studies, found that mindfulness-based approaches generally helped with related mental health outcomes, with mixed findings for prolonged grief symptoms. Its authors called for more research.

Is there medication for grief?

The American Psychiatric Association says there are currently no medications to treat specific symptoms of grief, though research is underway. In the 2016 trial, citalopram alone was not significantly better than placebo for grief (69.3% against 54.8%), and adding it to the grief treatment did not improve grief outcomes (83.7% against 82.5%). It did reduce depressive symptoms when added to the grief treatment.

The National Cancer Institute draws the same line: antidepressants alone have a limited impact on grief intensity but are critical for reducing depressive symptoms. Decisions about medication belong with a prescriber. How depression and grief differ is covered in grief vs. depression.

What does Dr. Rabin offer, and what should you ask?

Dr. Rabin's grief and loss therapy is contemporary psychodynamic, attachment-based, trauma-informed and mindfulness-based. She does not use a scripted set of techniques. The work centers on what a particular loss means to you and how it connects to your history, and it includes losses other than a death. She also offers CBT.

As this article has shown, that main approach is not the one with the strongest trial evidence for prolonged grief disorder. Many people seeking grief therapy do not have that disorder and are looking for something the trials did not measure: a place to understand a loss and its meaning. If you think you may have prolonged grief disorder, ask any therapist you are considering, including Dr. Rabin on her free consultation call of about 15 minutes, how they would approach it and whether a structured, grief-focused treatment would suit you better. How to choose a grief therapist has more questions to bring.

Keep reading

• How to Choose a Grief Therapist
• What to Expect in Grief Therapy
• What Grief Therapy Costs in Massachusetts
• All grief and loss guides

Sources

• LaPlante, Hardt, Maciejewski and Prigerson, State of the Science: Psychotherapeutic Interventions for Prolonged Grief Disorder, Behavior Therapy (2024)
• Shear, Frank, Houck and Reynolds, Treatment of complicated grief: a randomized controlled trial, JAMA (2005)
• Shear et al., Treatment of complicated grief in elderly persons: a randomized clinical trial, JAMA Psychiatry (2014)
• Shear et al., Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial, JAMA Psychiatry (2016)
• Bryant et al., Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder: A Randomized Clinical Trial, JAMA Psychiatry (2024)
• American Psychiatric Association, Prolonged Grief Disorder (2025)
• National Cancer Institute, Grief, Bereavement, and Coping With Loss (PDQ), Health Professional Version (2024)
• Boelen, de Keijser, van den Hout and van den Bout, Treatment of complicated grief: a comparison between cognitive-behavioral therapy and supportive counseling, Journal of Consulting and Clinical Psychology (2007)
• Bryant et al., Treating prolonged grief disorder: a randomized clinical trial, JAMA Psychiatry (2014)

Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis, call or text 988, or call 911 in an emergency.