Dual Process Model of Grief vs Prolonged Grief Disorder Treatment (PGDT/CGT)

Dual Process Model of Grief

Tradition

Integrative

Founder

Margaret Stroebe & Henk Schut (1999)

Review status

Framework — unranked

Focus

Grief + Adaptive

Format

Individual, group

Duration

Variable

Prolonged Grief Disorder Treatment (PGDT/CGT)

Tradition

Integrative

Founder

M. Katherine Shear (2005)

Review status

1 condition assessment available

Official sources

Guidelines and official sources (1)

1 professional reference check

Read the recommendation and its scope. A source may discuss an approach without recommending it.

• Prolonged Grief Disorder: patient and family information

  American Psychiatric Association · Current information checked September 2026 · Professional reference · Treatment; Prolonged Grief Disorder in the DSM

  Discussed in the source

  The association discusses prolonged-grief therapy in patient information. This is distinct from a clinical practice guideline, and DSM recognition of the diagnosis is not treatment endorsement.

  Scope: Information about prolonged grief disorder and treatment approaches.

  Source checked 2026-09-06

Focus

Processing + Restoration

Format

Individual

Duration

16 sessions

Condition-specific assessments

Each conclusion applies to the population and use described. These source-based assessments do not certify the full entry or replace expert clinical review.

Grief & Loss

Population and scope: Bereaved adults aged 18–95 with clinically primary complicated grief in the 2016 trial; 16-session CGT added to placebo plus structured clinical management.

Randomized studies

Shear et al. (2016) randomized 395 adults to citalopram or placebo, with or without CGT. At 20 weeks, CGT plus placebo improved grief-response rates compared with placebo plus clinical management. Adding citalopram did not significantly improve the grief-response outcome, although depressive symptoms improved. This was not an IPT comparison. Missing assessments remained a limitation despite statistical adjustment; the sample was predominantly White, female and well educated. The historical complicated-grief criteria are not identical to current PGD criteria. Findings do not grade routine early bereavement, every grief therapy or suicide prevention.

Source assessment dated 2026-09-06

• Shear et al. 2016, original CGT trial: methods, outcomes and limitations

Dual Process Model of Grief

Core mechanism: Healthy adaptation requires dynamic oscillation between loss-oriented coping (processing grief) and restoration-oriented coping (rebuilding life); rigid fixation in either mode produces complications

Ontology: Grief is not a state to move through but a dynamic oscillation between confronting loss and rebuilding life; pathology emerges from rigidity, not from the pain itself

Prolonged Grief Disorder Treatment (PGDT/CGT)

Core mechanism: Revisiting the death narrative integrates the reality of loss + imaginal conversations transform the continuing bond + restoration goals rebuild engagement with life

Ontology: Prolonged grief as a failure of natural adaptation: the attachment system cannot update to accommodate the permanence of loss, leaving the bereaved stuck between wanting the person back and knowing they are gone

Dual Process Model of Grief

Philosophical roots: Lazarus & Folkman (coping as process); Bowlby (attachment and loss); Worden (task model as precursor); regulatory flexibility research (Bonanno); gender role socialization and grief

Blind spots: Descriptive rather than prescriptive: tells clinicians what healthy grief looks like but less guidance on what to do when someone is stuck; cultural assumptions about individual coping may not map to collective grief practices; as with Worden, pushing a client to oscillate on cue is a misapplication rather than a contraindication, since the model describes movement, it does not prescribe it

Therapeutic voice: Some days you need to sit with the grief. Other days you need to do your taxes and clean the kitchen. Both are grief work. The back and forth isn't a sign you're doing it wrong: it's exactly how this works.

Prolonged Grief Disorder Treatment (PGDT/CGT)

Philosophical roots: Bowlby (attachment); Shear (complicated grief as attachment disorder); Foa (emotional processing applied to grief); Klass & Silverman (continuing bonds); Stroebe & Schut (dual process model, source of the loss-oriented and restoration-oriented halves of the protocol); Worden (task model of mourning); DSM-5-TR nosology

Blind spots: Revisiting exercises may feel coercive for clients whose culture doesn't value explicit grief narration; the highly structured protocol may not suit every grieving style; much less evidence for non-death losses than for bereavement; 16-session format may be insufficient for losses compounded by other traumas; PGD diagnosis itself is debated as potentially pathologizing normal grief

Therapeutic voice: I'd like you to close your eyes and tell me the story of the day he died. Start a little before you knew, and tell it as though it's happening now, in the present tense. We'll go about ten minutes. I'm recording it so you can listen at home, and I'm right here the whole time.