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How to write a treatment plan for grief

Grief and mourning are highly personal processes that can look different depending on the individual.

The death of a loved one is among the hardest things a person can go through. A major loss often provokes a range of intense and difficult emotions, which can sometimes persist for a long time. Often, people turn to therapy to cope.

Of course, everyone grieves differently. And because grief is so personal, treatment of it must be personalized, too. Among other assessments you must make as a therapist, it’s important to determine whether your client is experiencing standard grief or prolonged grief disorder (PGD), a new diagnosis recently added to the DSM-5. Learning about the differences between standard grief and PGD, as well as how their symptoms can be successfully addressed, will help you create a grief treatment plan for your client.

Symptoms of grief and loss

Grief is a normal human response to loss. Some people in mourning turn to therapy for help, while others require no professional support.

People can experience a wide range of physical and emotional issues related to loss, but common symptoms of acute grief include:

  • Sadness
  • Tearfulness
  • Shock, disbelief, or confusion
  • Numbness
  • Insomnia
  • Difficulty concentrating
  • Yearning for the deceased
  • Anger
  • Guilt
  • Denial
  • Helplessness
  • Loss of interest in daily activities
  • Irritability
  • Aggressiveness
  • Physical sensations including tightness in the chest or throat, nausea or gastrointestinal distress, dizziness, headaches, and fatigue

DSM-5-TR diagnostic criteria for prolonged grief disorder

It can be hard to tell PGD apart from non-clinical grief or other mental-health issues, such as major depressive disorder (MDD). To make that assessment, you’ll need to determine the length, severity, and persistence of the symptoms your client is experiencing.

To be diagnosed with PGD, someone must display disruptive and clinically significant symptoms above and beyond what is considered “normal” after a loss in their culture and context. Crucially, to be considered PGD, the grief response must last at least a year in adults, and at least six months in children and adolescents.

By contrast to MDD—which typically involves a persistently low mood that isn’t necessarily tied to a specific issue, such as loss—people who are grieving may fluctuate between high and low moods, and may have moments of positive remembrance along with mourning.

Below are the diagnostic criteria for PGD as defined by the DSM-5-TR.

A. The death, at least 12 months ago, of a person who was close to the bereaved individual (for children and adolescents, at least 6 months ago).

B. Since the death, the development of a persistent grief response characterized by one or both of the following symptoms, which have been present most days to a clinically significant degree. In addition, the symptom(s) has occurred nearly every day for at least the last month:

1. Intense yearning/longing for the deceased person.

2. Preoccupation with thoughts or memories of the deceased person (in children and adolescents, preoccupation may focus on the circumstances of the death).

C. Since the death, at least three of the following symptoms have been present most days to a clinically significant degree. In addition, the symptoms have occurred nearly every day for at least the last month:

1. Identity disruption (e.g., feeling as though part of oneself has died) since the death.

2. Marked sense of disbelief about the death.

3. Avoidance of reminders that the person is dead (in children and adolescents, may be characterized by efforts to avoid reminders).

4. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.

5. Difficulty reintegrating into one’s relationships and activities after the death (e.g., problems engaging with friends, pursuing interests, or planning for the future).

6. Emotional numbness (absence or marked reduction of emotional experience) as a result of the death.

7. Feeling that life is meaningless as a result of the death.

8. Intense loneliness as a result of the death.

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The duration and severity of the bereavement reaction clearly exceed expected social, cultural, or religious norms for the individual’s culture and context.

F. The symptoms are not better explained by another mental disorder, such as major depressive disorder or post-traumatic stress disorder, and are not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.


American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing

What to include in a treatment plan for grief and loss

Grief and mourning are highly personal processes that can look very different depending on the individual and the circumstances of their loss. Treatment plans for grief and loss must be similarly nuanced.

When crafting treatment plan goals for grief, you must take into account the specific symptoms and emotions your client is experiencing; the severity and duration of those symptoms; and whether other mental-health concerns are present. Below are some common elements of a grief treatment plan that can help shape your therapeutic goals, objectives, and interventions.

Process grief

One of your treatment plan’s primary goals will likely involve helping your client process their grief by identifying and expressing emotions triggered by their loss. Journaling and narrative therapy may be helpful interventions.

Reduce distress

Someone who is grieving often experiences distress in places or situations that remind them of their loss; negative emotions may also be amplified by guilt, self-blame, and other negative thought patterns. Using approaches such as exposure therapy and cognitive behavioral therapy may help bring relief.

Restore daily functioning

Grief can have a profound impact on an individual’s daily life, sometimes causing them to withdraw socially or neglect their work, personal life, and well-being. Creating plans for improving wellness, self-care, and social engagement — and reinforcing them with behavioral activation techniques — may be an important facet of treatment.

Foster new meaning in life

People with PGD, especially, may struggle to move forward after a significant loss. They may feel that their life has lost meaning, or resist thinking about a future without the deceased. One of the most important goals of grief therapy, then, will likely hinge on helping your client find new purpose as they move forward.

Grief treatment plan example

There is no such thing as a one-size-fits-all treatment plan, and that’s especially true for an experience as complex and varied as grief. With that said, there are some techniques that are broadly applicable when working with bereaved clients. Below, find a sample treatment plan for grief and loss.

Case example

Skylar, a 45-year-old woman, lost her wife to a sudden accident 18 months ago. While her initial grief was intense, she continues to feel overwhelming sadness, emptiness, and longing every day. She avoids their favorite places, reports feeling like she lost her sense of identity, and has difficulty reintegrating into daily life. Skylar has been socially isolated from friends and struggles to return to hobbies. She believes life has no purpose without her and has lost motivation to care for herself.

Goal 1: Facilitate grief processing.

  • Objective 1.1: Client will identify and express emotions related to her loss in therapy.
  • Intervention 1.1: Use narrative therapy and journaling exercise to help client tell their grief story.
  • Objective 1.2: Client will reduce avoidance of loss reminders by engaging in meaningful activities.
  • Intervention 1.2: Engage in gradual exposure therapy to places and memories related to the loss over next 3 months.


Goal 2: Improve daily functioning and social engagement.

  • Objective 2.1: Client will engage in at least two social or recreational activities per week.
  • Intervention 2.1: Utilize behavioral activation techniques to reintroduce pleasurable activities.
  • Objective 2.2: Client will establish a structured daily routine, incorporating self-care, to improve mood stability.
  • Intervention 2.2: Create a daily self-care and meal plan.


Goal 3: Reduce maladaptive guilt, self-blame, and catastrophic thought patterns related to loss.

  • Objective 3.1: Client will challenge and reframe guilt and self-blame thoughts related to loss.
  • Intervention 3.1: Use cognitive restructuring techniques from CBT to challenge and reframe unhelpful thoughts and beliefs.
  • Intervention 3.2: Utilize thought log 1x/week to track and reframe negative cognitions.

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