Narrative Therapy vs Prolonged Grief Disorder Treatment (PGDT/CGT)
A side-by-side comparison of recorded mechanisms, evidence review status, related condition topics, and philosophical roots.
The previous comparative summary is being checked against its sources. Scoped guideline findings are available below.
At a glance
Source checks, condition-specific assessments and expert review are separate steps. Each assessment applies only to its stated population and use. Topic links do not establish comparative effectiveness.
Narrative Therapy
- Tradition
- Postmodern
- Founder
- Michael White / David Epston (1990)
- Review status
- Assessment not yet completed
- Focus
- Narrative + Relational
- Format
- Indiv + Family + Community
- Duration
- Short-medium
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
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.
- Prolonged Grief Disorder: patient and family information
- 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
How they work
Narrative Therapy
Core mechanism: Externalizing problems + re-authoring preferred identity narratives through unique outcomes
Ontology: Dominant cultural narratives constrain identity; problems are social/linguistic constructions, not internal pathology
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
Related condition topics
These editorial cross-references organize reading. A shared link does not mean both approaches are effective, recommended, or interchangeable for that condition.
0 shared · 5 Narrative Therapy-only · 1 Prolonged Grief Disorder Treatment (PGDT/CGT)-only
Linked only in the Narrative Therapy entry
Linked only in the Prolonged Grief Disorder Treatment (PGDT/CGT) entry
What each assumes — and misses
Narrative Therapy
Philosophical roots: Foucault (power/knowledge, subjugated knowledges); Myerhoff (definitional ceremony, re-membering, which is where the outsider-witness practice comes from); Bruner (narrative as mode of knowing); Bateson (ecology of mind; the difference that makes a difference); Vygotsky (scaffolding, in White's later work); Ricoeur (narrative identity); Derrida (deconstruction); social constructionism
Blind spots: Can feel intellectually abstract; political framing may not resonate with all clients; limited controlled research
Therapeutic voice: So depression has been telling you that you're worthless. When has there been a time when you didn't believe depression's story?
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.
Choosing between them
Narrative Therapy (Postmodern) and Prolonged Grief Disorder Treatment (PGDT/CGT) (Integrative) come from different traditions, which means they assume different things about what a person is, what causes suffering, and what the therapeutic relationship is for. The choice between them is often less about "which works better" and more about which set of assumptions fits the client and the therapist.
For deeper coverage: see the full Narrative Therapy and Prolonged Grief Disorder Treatment (PGDT/CGT) pages, or use the interactive comparison tool to add more modalities to this comparison.