How to Write a Grief Treatment Plan (With examples)

When we talk about grief in therapy, it's important to remember that we're not attempting to "fix" something that is wrong; grief is a natural, healthy response to loss. Consider Maria, a client who recently lost her partner of ten years to a sudden heart attack. She comes to therapy not because she is mourning "wrong," but because she is trapped in her fury - anger at the doctors who she says ignored warning signs, anger at her spouse for not taking better care of himself, and even anger at herself for not pressing him to see a doctor sooner.

5 Steps for Developing Grief Treatment Plan

1. Intake Session

• Conduct in-depth intake session about the loss, how much ever the client is comfortable in sharing. Try to understand client's unique grief experience
• Try to understand current social and psychological functioning
• Identify specific grief symptoms present in the client, for example - crying during working hours, not entering the deceased’s room
• Assess impact of the grief on the client’s daily life, work and relationships

2. Get an understanding of the client’s cultural background

• Recognise cultural nuances in grief expression
• Determine mourning practices that are typical of the client’s culture
• Distinguish between cultural norms and prospective clinical indicators
• Be mindful of the timeline of mourning in the client’s specific culture

3. Using the dual process model as a therapeutic framework

• Identify current loss-oriented activities and making the client aware of the same
• Setting up more restoration-oriented activity goals with the client
• Acknowledging that grieving is very normal while also promoting daily life functionality

4. Goal Setting in the Sessions

• It is important to set short term and long term goals and monitoring it regularly is important as well
• Choose appropriate therapeutic techniques, make use of somatic based, movement based and/or arts based techniques if need be
• Define measurable progress indicators and monitor progress after specific time intervals

5. Keep the Therapy Plan Flexible

• The therapy plan must be kept flexible so that it can be adapted to the client’s needs
• Provide holistic support by addressing psychological, social and physiological dimensions

Individual Experiences of Grief

Grief work is difficult since each person is different. Consider Tom, who lost his 15-year-old son to suicide. His treatment approach differs significantly from Maria's because, while she is processing anger, he is caught up in the "what ifs" - a type of bargaining that keeps him awake at night. His goals could include learning to deal with unanswered issues, as well as gradually minimising his time spent pondering over it. The idea of having closure and what it might looks like in this case is something that the therapist can focus on.

Then there's Sarah, who was recently diagnosed with cancer and the way she reacted to this is completely different from Tom’s. Sarah is coping by shifting between organising her memorial ceremony and discussing future holidays as if her diagnosis does not exist. Her intervention plan must consider both her need to prepare for death and her need to sustain optimism and normalcy.

What differentiates grief therapy plans is that they contradict typical therapeutic timelines. In grief therapy, we do not pathologize David for coming to therapy six months after his wife died, still wearing his wedding ring and leaving her side of the closet intact. Instead, we might consider what significance these rituals have for him and how they fit into his contemporary life. His therapy strategy could centre on finding methods to honour his connection to his wife while progressively making room for new experiences and relationships.

The Dual Process Model

The dual process model of grieving provides us with a useful foundation for designing interventions that acknowledge both loss-oriented activities (such as visiting the cemetery or looking at old photos) and restoration-oriented activities (such as taking a cooking class or reconnecting with old acquaintances).

For example, consider this client called Susan. Susan recently had a breakup with her partner. She keeps checking her ex-partner's social media multiple times every day. Here the therapist may design the intervention plan such that it may focus on gradually reducing her loss-oriented behaviour while enhancing restoration-oriented activities such as acquiring a new hobby. The idea is not to move on from the breakup immediately but rather to strike a sustainable balance between accepting the loss and creating a meaningful life around it.

Perhaps most importantly, grief treatment plans need to be fluid and adaptable. When Maya comes to therapy grieving her mother's death, we might start with a focus on processing traumatic memories of the hospital stay, but find ourselves shifting to address the unexpected grief triggers she encounters during her daughter's wedding planning. The plan evolves as her needs evolve, always maintaining space for the grief to be present while working toward greater functionality and meaning-making.

In a nutshell a grief treatment plan functions more like a compass than a blueprint, guiding us while allowing for the natural ebb and flow of the grief process. The objectives may include minimising specific symptoms (such as insomnia or anxiety), creating coping mechanisms for grief triggers, or establishing a support network, but they are always adaptable enough to suit the unpredictable nature of grief. Remember, we are not attempting to help our clients "get over" their loss; rather, we are assisting them in learning to carry it differently, weaving it into the fabric of their life in a way that allows for both sadness and joy, recollection and growth, ends and new beginnings.

Understanding Prolonged Grief

Let's explore the thin line between what is considered to be “normal” grief and when it becomes something that needs clinical attention. There is Resham, who lost her mother three years ago and still can't enter her mom's house or touch any of her belongings. The pain is so fresh, it's as if the loss happened yesterday. DSM-5-TR refers to this as Prolonged Grief Disorder. It's when that acute grief extends beyond a year or six months in children, and the person experiences intense emotional pain, identity crisis, and a feeling that life is meaningless without the person they have lost. They may have difficulty coming to terms with the death, experience numbing, or they might just feel that a part of themselves died along with their loved one. The therapist must be aware of the DSM guidelines for grief and grief related disorders.

The main goal would be to help the client adjust to life without their loved one while also respecting the client’s need to continue having a link with the person they have lost. The therapist can think of specific goals such as lowering preoccupation with the loss (measured by hours spent ruminating), increasing engagement in meaningful activities, and processing traumatic aspects of the death, if any. Interventions may include specialised grieving therapy approaches such as empty chair work, creating memory albums, or gradually confronting previously avoided places or activities linked with the departed.

I would urge therapists to note that, even when grief grows complex enough to earn a diagnosis, we never want to pathologize the fundamental emotion of missing and longing for the deceased person. The idea is not to cure the grief here, but rather to assist people move forward in life while preserving a healthy connection with their loved one. Treatment plans should reflect this balance so that we as therapists can be mindful about the clients’ feelings.

As therapists we must be mindful and sensitive towards the cultural considerations and how they might influence a client’s way of coping with their loss. What might look like "prolonged" grief in one culture could be completely normal in a different culture. Let us consider traditional Chinese mourning practices that last much longer than typical Western expectations of what a normal grieving period is. What makes it clinical is not the duration of his grief but how it has impacted the client’s  ability to function in ways that even his cultural context wouldn't expect.

The bottom line is that when grief turns into a clinical concern, it's usually not about the presence of grief itself but about how it's interfering with life functioning, how long it's been going on, and what other symptoms might be present. Our treatment plans need to honour the grief while addressing the clinical symptoms that are making it hard for our clients to move forward in their lives.

Case Studies

Case Study 1 - Aditya

Age: 28

Presenting Problem: End of 6-year relationship due to partner's infidelity and sudden abandonment (8 months ago); relationship ended one month before planned wedding

Current Symptoms

• Intrusive thoughts about ex-partner's betrayal
• Compulsive checking of ex-partner's social media (15-20 times daily)
• Sleep disruption ( insomnia)
• Loss of self-esteem and trust issues
• Physical symptoms (appetite changes, fatigue)
• Career impact (decreased performance at work)
• Avoiding mutual friends and social gatherings

Intervention Plan

Stage of Grief (Kübler-Ross Model)

Primary Stage: Anger

• Intense anger about betrayal and lost future plans
• Self-blame and depression about "not being enough"
• Difficulty accepting the relationship is over
• Periodic bargaining (attempts to identify what he could have done differently)

Dual Process Model Analysis

Loss-Oriented Activities (Current)

• Excessive social media monitoring of ex-partner
• Repeatedly reviewing old messages and photos
• Driving by ex-partner's workplace/home
• Maintaining wedding planning materials
• Ruminating about shared memories
• Avoiding places they frequented together
• Keeping ex-partner's belongings

Restoration-Oriented Activities (To Develop)

• Rebuilding individual identity
• Creating new daily routines
• Developing new hobbies and interests
• Establishing boundaries with mutual friends
• Career development focus
• Building new social connections
• Creating new living space aesthetics

Goals

Short-term Goals (about 3 months)

Reduce social media monitoring

• App blocking during work hours
• Mindfulness techniques when urges arise

Stabilise daily functioning

• Sleep hygiene protocol
• Meal planning and tracking
• Daily routine establishment
• Exercise routine implementation

Long-term Goals (about 6 months)

Process relationship trauma

• Addressing trust issues
• Processing betrayal
• Developing healthy relationship narratives
• Building self-worth

Develop new life vision

• Career planning
• Personal goal setting
• Building new social network development
• Identity exploration

Cultural Considerations

• Client from Indian family with traditional views on marriage
• Impact on extended family relationships

Case Study 2: Rekha

Age: 42

Presenting Problem: Loss of spouse (6 months ago) due to COVID-19 complications

Current Symptoms

• Insomnia (sleeping 3-4 hours/night)
• Loss of appetite, weight loss (15kg in 6 months)
• Social isolation
• Difficulty caring for teenage children
• Panic attacks when visiting hospitals
• Intense guilt about not being allowed in hospital during spouse's final moments

Intervention Plan

Stage of Grief

Stage: Depression with signs of Anger

• Shows deep sadness and withdrawal characteristic of depression
• Expresses anger toward health care system
• Has moved past denial but not reached acceptance

Dual Process Model Analysis

Loss-Oriented Activities (Current)

• Time spent looking at old photographs
• Keeping spouse's side of closet untouched
• Crying episodes when alone
• Avoiding family gatherings where spouse's absence is prominent

Restoration-Oriented Activities (To Develop)

• Resuming work in whatever capacity possible
• Having play time with children
• Joining a covid widows support group
• Learning about financial management
• Reconnecting with old friends

Goals

Short-term Goals (about 3 months)

Improve sleep hygiene

• Progressive muscle relaxation or meditation before bed
• Establishing bedtime routine

Address panic symptoms

• Teaching grounding techniques (example 5-4-3-2-1 technique)
• Breathing exercises

Long-term Goals (about 6 months)

Process trauma of COVID loss

• EMDR therapy for hospital-related trauma
• Create meaning from loss
• Processing guilt through cognitive restructuring

Increase restoration-oriented activities

• Weekly behavioural activation assignments
• Gradual return to work schedule
• Structured time with children

While these treatment programs give formal frameworks for tackling grief therapy, it is important to note that grief is rarely predictable. Grief's very nature defies formal organisation; it ebbs and flows like waves, sometimes manageable, other times overwhelming and chaotic. These treatment plans should be viewed as malleable recommendations rather than rigid guidelines, allowing for the natural oscillation between intense pain and periods of calm.

As a result, while these treatment plans provide significant structure and direction, they should be treated lightly, constantly available to be updated, delayed, or redesigned based on the client's progress. The true art of grieving therapy is not to follow a predetermined path, but to create a safe, flexible place in which all manifestations of grief are acknowledged, healing can occur at its own pace, and the profound individuality of each person's grief journey is fully accepted and encouraged.