EMDR Therapy for Grief and Bereavement: Finding Healing After Loss

Grief is a universal human experience, yet the journey through grief is deeply personal and unique for each individual. When loss occurs, whether sudden or anticipated, we find ourselves navigating a complex landscape of emotions and adjustments. For some, this journey becomes especially challenging, leading to what mental health professionals recognize as complicated grief or prolonged grief disorder.

In recent years, Eye Movement Desensitization and Reprocessing (EMDR) therapy has emerged as a powerful tool for addressing grief and bereavement issues. Let’s explore how EMDR Therapy can help those experiencing both normal grief reactions and more complicated grief responses, while also clarifying the clinical symptoms and presentations for grief-related conditions according to the DSM-5.

Understanding Grief Through the DSM-5 Lens

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provides important frameworks for understanding grief-related conditions. It's worth noting that grief itself is not classified as a mental disorder, as it's a normal human response to loss. However, the DSM-5 does recognize several grief-related conditions:

Adjustment Disorder Related to Bereavement

When grief symptoms cause significant distress or functional impairment beyond what would be considered proportionate to the loss, but don't meet the criteria for a major depressive episode, an adjustment disorder diagnosis may be appropriate.

This is coded as:

• Adjustment Disorder with Depressed Mood (F43.21): When the predominant manifestations are symptoms like depressed mood, tearfulness, and feelings of hopelessness

• Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23): When both anxiety and depression are prominent features of the response

Prolonged Grief Disorder (PGD) (F43.8)

In the DSM-5-TR (Text Revision released in 2022), Prolonged Grief Disorder was officially recognized as a diagnosable condition. It's characterized by:

• Intense yearning/longing for the deceased person or preoccupation with thoughts of the deceased

• At least 3 of the following symptoms experienced most days:

  • Identity disruption

  • Disbelief about the death

  • Avoidance of reminders of the loss

  • Intense emotional pain

  • Difficulty moving on with life

  • Emotional numbness

  • Feeling that life is meaningless

  • Intense loneliness

• Symptoms persisting beyond 12 months after the death (6 months in children)

• Significant impairment in social, occupational, or other important areas of functioning

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Other Specified Trauma- and Stressor-Related Disorder (F43.8)

This designation may be used for persistent grief reactions that cause clinically significant distress or impairment but don't meet the full criteria for other disorders.

How EMDR Therapy Works for Grief and Bereavement

EMDR Therapy was originally developed for trauma treatment by Francine Shapiro in the late 1980s. However, its applications have expanded significantly, with grief and bereavement processing being particularly promising areas.

The Grief-Trauma Connection

Grief and trauma often intersect in complex ways:

1. Traumatic Losses: Sudden, unexpected, or violent deaths can be inherently traumatic. These can be directly witnessed, or even a person hears about it later, hearing the news can cause trauma reactions

   
   

2. Traumatic Grief Responses: Even with anticipated losses, some individuals experience traumatic grief responses. For Example: Mental exhaustion or forg from long-term caregiving or emotional stress. Both relief + guilt, meaning that you feel peace that the person isn’t suffering, but guilt for feeling so relieved. You might start second-guessing yourself, wondering if there was more you could have done, especially during care decisions. It can be a big shift in your role identity to transition from caregiver to a different role.

   
   

3. Memory Networks: Grief-related memories can become "stuck" in ways similar to traumatic memories—like flashbacks to seeing some part of the losing of the loved one, or hearing something that triggers felt sense of losing that person all over again.

EMDR Therapy is especially effective because it addresses both the traumatic elements of grief and facilitates adaptive processing of the loss experience.

The 8-Phase EMDR Protocol Applied to Grief

EMDR therapy follows an 8-phase protocol that can be adapted specifically for grief work:

1. History Taking and Treatment Planning

For grief work, this involves:

• Mapping the loss history and prior losses—it’s never just about this loss, they are often connected to each other
  

  

• Identifying "stuck points" in grief processing. For example, “I didn’t get to say goodbye” or “If I stop grieving, I’m forgetting them” or “People expect me to be over it by now.”

• Assessing for complicated grief factors. For example, feeling strongly that “It was my fault” (when others have told you that it clearly was not your fault). “God (or the universe) is punishing me.” Another example: “I have to stay strong for everyone else.”

• Evaluating current coping strategies (see picture for both healthy & unhealthy ways to cope)

2. Preparation

• Establishing a therapeutic alliance sensitive to grief needs

• Building emotional regulation skills

• Creating "safe place" resources specific to grief needs

• Using Resource Development and Installation (RDI) to strengthen memories

  • of past times that person faced difficult moments

  • of other loved ones you still have around you now

  • to any symbols (see picture) that are meaningful to person coping with the grief  

• Explaining the dual attention mechanism of EMDR

3. Assessment

Identifying specific grief-related targets:

• Memories of receiving news of the death

• Difficult moments during funeral/memorial services

• Regrets or "unfinished business" with the deceased

• Intrusive images related to the loss

4-7. Desensitization, Installation, Body Scan, and Closure

These phases involve:

• Processing grief-related memories while engaging in bilateral stimulation (BLS)

• Strengthening positive beliefs about the relationship with the deceased, remembering happier times with the loved one

• Addressing physical sensations associated with grief

• Ensuring emotional stability between sessions

  
  
  
  

8. Reevaluation

• Monitoring grief progression and integration

• Assessing healthy continuing bonds with the deceased

• Evaluating meaningful engagement with life after loss

Benefits of EMDR for Different Types of Grief

For Normal Grief Reactions

• Accelerates (slightly) the natural grief process—but does not stop that process altogether

• Reduces intensity of painful emotions

• Facilitates healthy integration of the loss experience

• Helps establish meaningful continuing bonds both with the person who died, as well as the others in your life

For Prolonged Grief Disorder

• Addresses the "stuck" aspects of the grief experience

• Processes traumatic elements of the loss

• Helps resolve ambivalent feelings toward the deceased

• Facilitates adaptation to a changed world—create new traditions

For Grief Complicated by Trauma

• Processes traumatic memories related to the death

• Reduces intrusive images, nightmares, and flashbacks

• Addresses survivor guilt and meaning-making challenges

• Integrates fragmented aspects of the loss experience

Case Example: EMDR for Recent Loss

Note: This is a composite case with details changed to protect confidentiality

Maria sought therapy three months after the unexpected death of her husband from a heart attack. Although her friends suggested she just needed more time, Maria felt increasingly disconnected from her life and trapped in the moment of finding her husband unresponsive.

During EMDR therapy, Maria processed several targets:

1. The memory of finding her husband and attempting CPR

2. The moment in the hospital when the doctor pronounced him dead

3. The first night alone in their home

After EMDR processing, Maria reported:

• The memories remained sad but no longer felt overwhelming

• Physical panic symptoms when thinking about the loss had significantly diminished

• She could access positive memories of her husband without immediately returning to the traumatic images

• She felt more connected to her support system and daily activities

Considerations for EMDR with Recent Grief

When working with new grief through EMDR, several factors deserve special attention:

1. Timing: While there's no mandatory waiting period before starting EMDR Therapy for grief, ensuring basic stabilization and support systems are in place is essential.

2. Therapeutic Goals: The goal isn't to eliminate grief but to process its traumatic elements and facilitate natural grief progression.

3. Continuing Bonds: EMDR Therapy can help establish healthy continuing bonds with the deceased rather than breaking attachments.

4. Cultural Considerations: Grief expressions and expectations vary widely across cultures. EMDR Therapy protocols should be culturally responsive.

5. Pacing: Grief work often requires a gentler pace with more emphasis on resourcing than trauma-focused EMDR Therapy.

Finding an EMDR Therapist Specialized in Grief

If you're considering EMDR Therapy for grief support, look for a therapist who has:

• Completed EMDR Therapy basic training and certification

• Additional training in grief-specific EMDR protocols

• Experience working with bereavement

• Knowledge of grief theory and grief counseling fundamentals

Most EMDR Therapy practitioners will offer a consultation to discuss whether their approach matches your needs and to answer questions about how EMDR might help your specific grief situation.

Conclusion

Grief is both a universal human experience and a deeply individual journey. While most people navigate grief without requiring specialized interventions, those experiencing complicated grief responses or grief with traumatic elements may benefit significantly from EMDR therapy.

Whether your loss is recent or longstanding, whether it fits within normal grief parameters or meets criteria for Prolonged Grief Disorder, EMDR Therapy offers a neurobiologically-based approach that can help process difficult memories, establish meaningful continuing bonds with those we've lost, and gradually re-engage with life after loss.

Remember that seeking help for grief is not a sign of weakness but rather an act of self-compassion. The pain of loss may never completely disappear—nor should it, as it reflects the depth of our attachments—but EMDR can help ensure that grief becomes an integrated part of your life story rather than an ongoing, overwhelming present reality.

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