Grief and loss counselling, online across New Zealand

What is prolonged grief?

Grief is the natural response to loss, and there is no correct timetable for it. Prolonged grief disorder is diagnosed when intense yearning for, or preoccupation with, the person who died lasts well beyond what is expected (at least 12 months after the death under DSM-5-TR, and at least six months under ICD-11) and stops daily life from restarting. It is recognised in ICD-11 and DSM-5-TR and responds to targeted therapy.

Normal grief: messier and longer than people expect

Grief does not move through tidy stages. It comes in waves, often without warning: you are fine in the hardware store and undone by a brand of biscuits in aisle six. It can be sadness, but also anger, guilt, relief, numbness, fear, or a yearning so physical it feels like hunger. It affects sleep, appetite and concentration. It can make you forget where you parked.

Healthify He Puna Waiora, New Zealand's health information website, puts it plainly: "There is no correct way to grieve or time it should take; your grief is unique to you." Most people, given time, people who will listen, and permission to grieve in their own way, gradually find that the waves space out and that they can carry the loss while living again. That is not the same as getting over it. The relationship continues in a different form.

Culture shapes grief too. Tangihanga and unveilings give grief a communal shape and a timetable; other traditions are quieter and more private. People from every background can find that their grief doesn't match what their family or workplace expects. None of that is a problem to fix.

When grief becomes prolonged grief

For some people, grief does not ease. Both the World Health Organization's ICD-11 and the American Psychiatric Association's DSM-5-TR now describe prolonged grief disorder. In DSM-5-TR, it is considered when, at least twelve months after the death of someone close, there is still intense yearning or preoccupation with them most days, together with symptoms such as:

• feeling that part of you died with them, or that your identity is lost
• disbelief that they are really gone
• avoiding reminders that the person has died
• intense emotional pain, anger or bitterness about the death
• emotional numbness, or feeling that life is meaningless without them
• difficulty re-entering your own life: friendships, interests, plans
• intense loneliness

The American Psychiatric Association estimates that between 4 and 15 percent of bereaved adults experience prolonged grief. The risk is higher after sudden, violent or unexpected deaths, when the person who died was a child or partner, when support is thin, and where there is a history of depression.

Timeframes are a guide, not a rule. A psychologist won't tell you that you should be "better" by now. The question is whether grief has become a place you cannot move within, rather than a weather you are living through.

What actually helps when you're grieving

Most of what helps is not therapy.

It helps to have people who will say the person's name and let you tell the story of the death and the life more than once. It helps to keep some structure: getting up, eating something, going outside, even when nothing feels worth doing. It helps to let the waves come instead of bracing against them, and to notice that they pass. It helps to keep rituals, your own or your culture's, and to find ways to stay connected to the person: a photo, a walk they loved, cooking their recipe at Christmas.

It helps to be kind to yourself about the strange things grief does: snapping at people, forgetting things, laughing at the funeral, feeling relief if the death ended suffering. It helps to protect your sleep where you can, and to be careful with alcohol, which tends to deepen low mood and disturb sleep further.

And it helps to know that grief has no deadline. Anniversaries, birthdays, the first Christmas, the day their phone contract finally lapses: each can bring a wave, years later, and that is normal.

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When therapy is useful, and what it involves

Therapy is worth considering when grief is not shifting after many months, when it is tangled with trauma, guilt or unresolved conflict, when you have no one you can talk to, when you are using alcohol or work to avoid it, or when it has tipped into depression or thoughts of not wanting to be here.

The evidence is reassuring. A 2019 meta-analysis of 31 randomised trials found psychological intervention effective for grief symptoms in bereaved adults, with larger effects for people who were six months or more past the loss, who had elevated grief at the outset, and who received individual rather than group treatment. In other words, therapy is most useful for exactly the people who most need it, and is not necessary for everyone who grieves.

Treatment for prolonged grief has two strands. One is accepting the reality of the loss: telling the story of the death in a safe, structured way, approaching the memories and places you have been avoiding, and working through guilt, anger or "if only" thinking. The other is restoring your own life: rebuilding routines, relationships and purpose, and finding a way to stay connected to the person that lets you also move forward. In a landmark 2016 trial, around 83 percent of people who received this targeted grief therapy were rated as improved, compared with around 55 percent of those on placebo, and that adding an antidepressant did not improve grief outcomes, though it helped co-occurring depression.

Your psychologist may use these components within CBT, or draw on acceptance and commitment therapy and, where the death was traumatic, EMDR or other trauma-focused work.

Grief after suicide or sudden death

When someone dies by suicide, in an accident, through violence, or suddenly with no warning, grief often carries extra weight. There may be images or facts about how they died that you cannot stop replaying, or that you were not allowed to know. There may be a police process, a coroner, media. There is often guilt that feels unanswerable: that you should have seen it, said something, been there. And there can be a sense that others don't know what to say, so they say nothing.

The American Psychiatric Association notes that prolonged grief is more likely when a death is sudden or occurs in unnatural circumstances, and trauma symptoms and grief frequently overlap. Therapy can work with both: processing the traumatic parts of what happened so they stop intruding, and making room for the grief underneath.

In New Zealand, Aoake te Rā provides free therapeutic support to anyone bereaved by suicide, whenever the loss occurred, with providers nationwide and online options. You can refer yourself at aoaketera.org.nz or by calling 0800 000 053. We would encourage anyone bereaved by suicide to know that service exists, whether or not they also choose to see us.

If you are having thoughts of ending your own life, Mindwell is not a crisis service: call 111 if you are in immediate danger, or call or text 1737 any time.

Loss that isn't a death

Grief does not require a funeral. People grieve miscarriages and stillbirths, often with little acknowledgement from those around them. They grieve the end of a relationship, a parent who is alive but no longer knows them, a body or a career that illness has taken, a redundancy, a move away from the land or the town they grew up in, or the future they had assumed. Pet loss can be as sharp as any other.

These losses can be harder to grieve precisely because they are not recognised. There is no leave, no card, no gathering. If a loss like this is sitting heavily on you, it is a legitimate reason to seek support, and your psychologist will treat it as real.

Grief counselling online

Grieving people are often depleted, and the effort of getting to an appointment can be the thing that stops them going. Video sessions remove that. You can see a psychologist from the house you shared, surrounded by the photos, with tissues you own, and close the laptop afterwards without facing a car park. If you need to cry, pause or sit in silence, that works just as well on a call.

The evidence supports it. A 2020 systematic review of internet-delivered bereavement interventions found moderate to large effects on grief and post-traumatic symptoms, with gains maintained at follow-up, and a 2021 meta-analysis of video-delivered psychotherapy more broadly found it no less effective than in-person treatment.

Online also means access. If you are in a small town where everyone knew the person who died, or where the only counsellor is a family friend, seeing a psychologist in another part of the country can be a relief.

Free and low-cost grief support in New Zealand

• Skylight (0800 299 100, skylight.org.nz) is a national charity offering counselling and free resources on grief, loss and trauma.
• Aoake te Rā (0800 000 053) offers free support to anyone bereaved by suicide.
• Hospices: if the person died in hospice care, ask the hospice team about bereavement support for whānau.
• 1737, free call or text, any time, to talk to a trained counsellor.
• Your GP can check in on sleep, mood and physical health, and refer you to local services.

Private psychology makes sense when you want to start soon, when grief is complicated by trauma or depression, or when you would like to choose who you talk to. Many health insurers contribute to psychologist fees; we provide receipts.

What to expect at Mindwell

Inge Prince's focus includes grief and loss, mood and emotional regulation. Katherine Lee's focus includes grief alongside fertility, perinatal and relationship concerns. Candice van der Merwe's focus includes grief, trauma and depression. You can choose one of them when you book or be matched with the first available.

Sessions are 50 minutes by video, $199 + GST ($228.85 incl. GST), paid at booking, with first sessions typically available within 7 days and no referral needed. Your first session is simply a conversation about who you lost, what has happened since, and what you are hoping for. There is no pressure to perform grief in any particular way. What you tell your psychologist is confidential under the Health Information Privacy Code 2020, within the usual limits of confidentiality.

Related support: Depression counselling · Trauma therapy · Postnatal depression and anxiety · Relationships and attachment