Grief and Loss
When the Mirror Lies and You Cannot Stop Looking
Natalie Noel, LMHC | Anxiety & OCD Treatment Specialists | Tampa, FL
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Grief is not something you fix. It is something you carry and over time, if you are given the right support, it becomes something you learn to carry differently.
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Losing someone or something you love changes you. It is supposed to. The question is not whether grief will affect your life. It is whether you have to face it completely alone.
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At Anxiety & OCD Treatment Specialists, we provide grief counseling for teens and adults in Tampa, Florida, and virtually across Florida and New York. We understand grief not just as an emotion, but as a process one that sometimes gets stuck and needs support to move forward.
If You Are in Crisis Right Now
If you are having thoughts of harming yourself or others, please reach out for help immediately.
- Call or text 988 — Suicide and Crisis Lifeline (available 24/7)
- Text HOME to 741741 — Crisis Text Line
- Call 911 or go to your nearest emergency room
You do not have to be alone in this moment. Help is available right now.
Quick Answer: What Is Grief?
Grief is the natural emotional response to loss. It most often refers to the death of someone we love but grief can also follow the loss of a relationship, a way of life, a role, a future you expected, or anything deeply meaningful. Grief is not a disorder. It is a natural human process. However, for some people grief becomes complicated persisting in a way that significantly impairs daily life and requires professional support.
What Is Grief?
Grief is love with nowhere to go. When someone or something central to your life is gone, the love you had for them does not disappear it has no destination anymore. That is the ache at the core of grief.
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Grief is not a weakness. It is not something to push through as quickly as possible. It is not something you should be over by now. Grief is a natural response to a real loss and it takes as long as it takes.
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At the same time, grief is not a passive experience. How you move through it whether you have support, whether you allow yourself to feel it, whether you stay connected to others shapes the path significantly.
Grief is not the same for everyone. There is no right way to grieve, no correct timeline, and no required set of emotions. What matters is that you have support, that you are not isolating, and that the grief is not causing harm to your relationships, your health, or your sense of a future.
What Can Cause Grief?
Most people think of grief in the context of death. But grief is the response to any significant loss and losses come in many forms:
Death of a Loved One
The death of a parent, spouse, child, sibling, or close friend is among the most profound losses a person can experience. Each relationship carries its own unique grief — and the circumstances of the death (sudden, anticipated, traumatic, by suicide) shape the grief in important ways.
Suicide Loss
Losing someone to suicide is a distinct and particularly painful form of grief. It often comes with layers of guilt, confusion, anger, and questions that can never be fully answered. Suicide loss survivors are at higher risk for complicated grief, depression, and PTSD. This form of grief benefits strongly from support from a therapist who understands its specific features. See our PTSD page for more on trauma after sudden or violent loss.
Death of a Child or Pregnancy Loss
The loss of a child at any age and pregnancy loss (miscarriage, stillbirth, or termination for medical reasons) are among the most isolating forms of grief. They are often minimized by others or surrounded by silence, which deepens the suffering. These losses deserve the same often more care and attention as any other grief.
Loss of a Relationship
Divorce, separation, the end of a long-term relationship, or estrangement from a family member can produce genuine grief even when the relationship ended by choice or for the right reasons. The loss of a shared future, a daily companion, and an identity built around that person is real and deserves to be taken seriously.
Loss of Identity, Role, or Way of Life
Retirement, job loss, a serious medical diagnosis, major disability, or a significant life transition can trigger grief for the life and self you expected. This type of grief is frequently overlooked because there is no funeral, no obvious moment of loss, no formal acknowledgment. But the suffering is real.
Anticipatory Grief
Anticipatory grief is grief that begins before a death occurs when a loved one is seriously ill, when dementia is progressing, or when a loss feels inevitable. It is exhausting and often invisible to others. People experiencing anticipatory grief frequently feel guilty for grieving someone who is still alive.
What Grief Actually Feels Like
Grief does not follow a script. While models like the five stages of grief (denial, anger, bargaining, depression, acceptance) have given many people a useful framework, grief in real life is far less orderly. It circles back. It surprises you. It shows up at unexpected moments a song on the radio, a smell, an ordinary Tuesday.
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Grief can feel like:
| Emotional Experiences | Physical and Behavioral Experiences |
|---|---|
| Deep sadness, crying, or inability to cry at all | Exhaustion that sleep does not fix |
| Anger at the person who died, at yourself, at others | Difficulty concentrating or making decisions |
| Guilt real or irrational about what you did or did not do | Loss of appetite or eating too much |
| Relief especially after a long illness followed by guilt about the relief | Disrupted sleep insomnia or sleeping constantly |
| Shock and disbelief, even when the death was expected | Physical aches, tightness in the chest, or feeling hollow |
| Longing an almost physical ache for the person's presence | Withdrawing from people and activities |
| Anxiety about the future, your own mortality, or others dying | Searching behaviors looking for the person, forgetting they are gone |
All of these experiences are normal expressions of grief. There is no emotion in grief that is wrong or inappropriate. The problem is not in what you feel it is only when grief becomes stuck, unrelenting, or begins to significantly harm your functioning and your future.
The Stages of Grief and Why They Are Not Really Stages
Elisabeth Kubler-Ross introduced the five stages of grief in 1969: denial, anger, bargaining, depression, and acceptance. These stages have been enormously influential and also widely misunderstood.
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The stages were never meant to be a rigid sequence that everyone follows in order. They were meant to describe common experiences of grief which most people do encounter in some form, but not on a schedule and not in any particular order.
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Most people move through grief in a non-linear way. You may feel acceptance for a period, then find yourself back in denial. You may never feel anger at all. You may skip bargaining entirely. You may visit acceptance briefly and then return to deep sadness.
What the Stages of Grief Do NOT Mean
- The stages of grief are not a timeline or a checklist.
- You are not 'behind' if you are still sad after a year.
- You are not 'doing it wrong' if you do not experience all five stages.
- You are not 'finished' grieving just because you have moments of acceptance.
Grief does not have a finish line. It has a transformation point a place where you are no longer consumed by the loss, but where the love for the person you lost becomes integrated into who you are going forward.
The Dual Process Model of Grief
A more current and helpful model of grief is the Dual Process Model developed by researchers Stroebe and Schut. It describes grief as an ongoing oscillation between two states:
- Loss-oriented processing: Actively experiencing the grief crying, remembering, feeling the pain of the loss.
- Restoration-oriented processing: Attending to life after the loss rebuilding identity, taking on new roles, finding a way to go forward.
Healthy grieving involves moving back and forth between both. Staying exclusively in loss-oriented processing can lead to complicated grief. Staying exclusively in restoration-oriented processing can lead to suppressed grief that surfaces later.
When Grief Becomes Complicated Prolonged Grief Disorder
For most people, the intensity of grief gradually decreases over time. Life rebuilds. The loss is still present, but it is no longer all-consuming. For others, grief does not follow this trajectory. It remains intense, disabling, and unrelenting lasting well beyond what is expected given the circumstances.
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In 2022, the DSM-5 formally recognized Prolonged Grief Disorder (PGD) sometimes still called complicated grief. PGD is diagnosed when:
- The bereaved person has experienced the death of someone close to them
- Intense grief symptoms have persisted for at least 12 months after the death (6 months in children)
- The grief is causing significant impairment in daily life work, relationships, functioning
When Grief Becomes Complicated Prolonged Grief Disorder
- Intense, persistent yearning or longing for the person who died
- Inability to accept the reality of the death, even after significant time has passed
- Bitterness or anger about the loss that has not faded
- Feeling that life is meaningless without the person
- Difficulty engaging with friends, family, or activities
- Emotional numbness or feeling detached from life
- A belief that part of yourself died with the person
- Avoiding reminders of the loss or being consumed by them
Prolonged Grief Disorder is not a failure to love correctly or a sign of excessive attachment. It is a recognized clinical condition that responds to specific, evidence-based treatment. You are not weak for needing help with grief that has become complicated.
Risk Factors for Complicated Grief
Certain circumstances increase the likelihood that grief will become complicated:
- Sudden, unexpected, or violent death including accidents, suicide, homicide
- Loss of a child at any age, including pregnancy loss
- Loss of a primary attachment figure a spouse, parent, or caregiver
- A history of depression, anxiety, or prior losses
- A relationship with the deceased that was conflicted, dependent, or ambivalent
- Lack of social support after the loss
- Being a caregiver before the death caregiver grief is often underrecognized
Grief in Children and Teenagers
Children grieve. Often people around them do not realize how deeply. Children’s grief does not look like adult grief it tends to be expressed in shorter but more intense bursts, and it is often communicated through behavior rather than words.
How Children Grieve
- Play may involve themes of death or loss this is normal and healthy
- They may seem fine one moment and devastated the next this is not denial, it is how children process
- Physical symptoms stomachaches, headaches are common expressions of grief
- Behavioral changes regression, aggression, school problems, clinginess
- Questions about death that may seem blunt or surprising "Did it hurt?" "Where did they go?"
- Concern for surviving caregivers children often hide their grief to protect the adults around them
Teenagers and Grief
Teens often grieve differently from younger children and adults. They may seem to be handling it well continuing school, spending time with friends while suffering deeply underneath. Teens are also at higher risk for depression, substance use, and risky behavior following significant loss. Peer relationships become the primary support system for many grieving teens, which can be both protective and limiting.
Early support for grieving children produces significantly better long-term outcomes. We provide therapy for teens and adults.
Grief and Mental Health When They Overlap
Grief and Depression
Grief and depression share many features sadness, low energy, withdrawal, difficulty concentrating. In the early weeks and months after a loss, a depressive episode is not only possible but common. The key distinction is duration and the presence of hope.
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In grief, even intense sadness is usually punctuated by moments of connection, memory, and meaning. In major depression, the darkness is more pervasive and persistent. Many people experience a genuine major depressive episode following a significant loss and this requires treatment, not just time.
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If you are several months past a significant loss and the darkness has not lifted, or if you are experiencing hopelessness, inability to function, or thoughts of self-harm, please reach out. This is depression and grief both of which we treat.
Grief and Anxiety
The death of someone we love can shatter the sense of safety we take for granted. In its wake, anxiety about mortality your own and others' is extremely common. Health anxiety, separation anxiety (particularly in children), and panic disorder can all emerge in the aftermath of loss. We treat grief-related anxiety alongside the grief itself.
Grief and PTSD
When the death was sudden, violent, or traumatic an accident, a suicide, a homicide, or a devastating medical emergency grief and PTSD can occur simultaneously. The trauma of witnessing or learning of a violent death needs to be addressed alongside the grief. These two processes require somewhat different treatment approaches, and we are trained in both. See our PTSD page for more information.
How Grief Counseling Works
Grief counseling is not about convincing you to feel better faster or teaching you to let go. It is about creating a supported space to fully experience and process loss and to find your way to a life that still has meaning and connection in it.
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We use several evidence-based approaches for grief, depending on what is needed:
Grief-Focused Therapy
For most people experiencing grief including complicated grief therapy focuses on creating space for the full experience of loss, processing the relationship with the person who died (including any unresolved feelings), and gradually re-engaging with life without the person. The goal is not to forget or move on it is to integrate the loss into who you are going forward.
Cognitive Behavioral Therapy (CBT)
CBT is particularly helpful for grief that has become complicated by problematic thinking patterns like survivor's guilt, excessive self-blame, or beliefs that life cannot continue without the person. CBT helps challenge these patterns and rebuild a more balanced relationship with the loss.
Prolonged Grief Disorder Treatment
For Prolonged Grief Disorder specifically, a structured treatment called Complicated Grief Treatment (CGT) has strong research support. It combines grief processing with behavioral interventions gradual reconnection with people and activities, working on the narrative of the loss, and addressing avoidance of grief reminders. We are trained in evidence-based approaches for complicated grief.
Trauma-Informed Care
When grief follows traumatic loss suicide, sudden death, violence, or a traumatic medical event trauma processing work is integrated into grief therapy. We do not address the trauma and the grief as separate problems; we work with them together, in a sequence that is safe and paced appropriately.
What to Expect When You Work With Us
- Free 10-minute phone consultation. A gentle, low-pressure call to hear what you are going through.
- Full assessment. We take time to understand your loss, the nature of your grief, and whether complicated grief, depression, anxiety, or trauma is also present.
- A personalized approach. Not all grief looks the same, and not all grief needs the same thing. Your treatment is built around your specific loss, your history, and your goals.
- Your pace. Grief therapy is not rushed. We go at the speed you can handle, with your therapist beside you throughout.
- Children and families. We work with grieving teens and adults. Family sessions are available when the loss has affected the whole family unit.
In-Person and Virtual CBT-I
In-person
730 S Sterling Ave, Suite 306, Tampa, FL 33609
Virtual:
Available throughout Florida and New York
Virtual grief counseling is effective and deeply meaningful. Many clients find that grieving from the comfort and safety of their own home surrounded by photos, meaningful objects, and familiar space actually enhances the work. Research supports the effectiveness of grief therapy delivered via telehealth.
Frequently Asked Questions
How long does grief last?
There is no universal answer, and anyone who gives you a specific timeline is not being honest about how grief works. For most people, the sharpest acute grief begins to soften within the first year but grief does not end. It transforms. Milestones, anniversaries, and life changes can bring grief back in waves for years. This is normal. What matters is whether grief is still significantly impairing your daily functioning. If it is at any point after the loss that is worth addressing with a therapist.
Is it normal to feel relieved after someone dies?
Yes. Relief is one of the most common and most guilt-inducing grief experiences. It is especially common when a loved one suffered a long illness, when the relationship was difficult or abusive, or when caregiving had been exhausting. Relief is not a sign that you did not love the person. It is a human response to the end of a hard situation and it can coexist with deep love and profound grief at the same time.
What is the difference between grief and depression?
Grief is a normal response to loss that, while painful, typically includes some variation in mood, moments of positive memory, and a connection to the person lost. Depression is a clinical condition characterized by persistent hopelessness, worthlessness, and inability to feel anything positive often without clear variation. The two can co-occur after a significant loss. If you are several months past a loss and still experiencing profound hopelessness, inability to function, or thoughts of self-harm, depression is likely present alongside the grief and both deserve treatment.
Should I be seeing a grief counselor if I feel like I am handling it okay?
Grief counseling is not only for people who are falling apart. Many people choose grief therapy not because they are in crisis, but because they want support navigating one of the hardest experiences of their life. Therapy provides a dedicated space to process loss that everyday life rarely allows free from having to manage others’ discomfort with your grief. Many people find that therapy helps them grieve more fully and more healthily, even when they seem to be coping on the surface.
Is grief after a pet the same as grief after losing a person?
Yes — and it is often dismissed in ways that make it harder. The loss of a beloved animal is a genuine grief, involving the same neurological and emotional processes as human loss. People who grieve pets deeply sometimes experience shame about the intensity of their reaction which adds suffering on top of suffering. Grief for a pet is real, valid, and sometimes benefits from the same therapeutic support as grief for a person.
Grief Is Not Something to Get Over. It Is Something to Move Through With Support.
You do not have to grieve alone. Whether your loss is recent or years old, simple or complicated, expected or sudden you deserve support. Our team at Anxiety & OCD Treatment Specialists is trained in grief counseling and in the conditions that so often accompany significant loss depression, anxiety, and trauma. We are here to walk through this with you.