Prolonged Grief Disorder Treatment (PGDT/CGT) vs SFBT

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

SFBT

Tradition

Postmodern

Founder

de Shazer / Insoo Kim Berg (1985)

Review status

2 source checks available

Official sources

Guidelines and official sources (2)

1 clinical guideline check · 1 professional reference check

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

• TIP 39: Substance Use Disorder Treatment and Family Therapy, Chapter 3

  SAMHSA · 2020 update · Professional reference · Chapter 3: Solution-Focused Brief Therapy

  Discussed in the source

  SAMHSA TIP 39 discusses solution-focused brief therapy and supporting research. This is a treatment-improvement reference rather than an unspecified registry endorsement.

  Scope: Families affected by substance-use problems.

  Source checked 2026-09-06

• Clinical Practice Guideline for Management of Stroke Rehabilitation

  VA/DoD · May 2024; version 5.0 · Clinical guideline · Recommendation 38 discussion; pp.90–91

  Discussed in the source

  The guideline discusses SFBT among pooled psychological interventions and makes a neutral recommendation for the broader prevention category. It does not separately grade SFBT as a treatment for established depression.

  Scope: SFBT included in the review of interventions to prevent depression following stroke.

  Source checked 2026-09-06

Focus

Strengths-based

Format

Indiv + Family + Group

Duration

Very short (1-8)

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

SFBT

Core mechanism: Identifying exceptions, preferred futures, and existing strengths amplifies what already works; solution-building vs. problem-solving

Ontology: Problems are not continuous; exceptions exist. Focusing on problems maintains problems; focusing on solutions builds solutions

Linked only in the Prolonged Grief Disorder Treatment (PGDT/CGT) entry

Linked only in the SFBT entry

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.

SFBT

Philosophical roots: Wittgenstein (language games: meaning is use); de Shazer and Insoo Kim Berg (solution-focused, developed jointly at the Milwaukee Brief Family Therapy Center); social constructionism (Gergen); pragmatism (what works matters more than why)

Blind spots: May minimize genuine suffering by focusing prematurely on solutions; limited depth for complex trauma or personality work

Therapeutic voice: Tell me about a recent time when the problem wasn't happening. What was different?