How grief is showing up for you

Most grief moves through the months in a recognisable arc. By around six months out, the acute waves have softened and the client has reorganised some part of their life around the loss. When grief doesn’t move that way, when six months becomes twelve and the client is still functioning at the floor, the question is whether what’s happening is ordinary grief that’s just slow or prolonged grief disorder, which has a different treatment trajectory.

This checklist is the screening tool for that question, and a clinical conversation-opener for clients who haven’t yet been able to name what they’re feeling. The items cover the cluster that defines prolonged grief: persistent intense longing, identity disruption since the loss, marked sense of disbelief, intense emotional pain, difficulty reintegrating into life, emotional numbness, sense that life has become meaningless, intense loneliness. Clients filling it in often realise for the first time that what they’ve been carrying privately has clinical names.

Use it with bereaved clients past the six-month mark whose grief feels stuck, with anyone questioning whether what they feel is normal grief or something else, and with clients who have been describing only one or two symptoms verbally and may be carrying more.

The clinical pattern to watch for. Clients who tick most of the items and report that the loss happened many years ago are often presenting with chronic prolonged grief that’s never been treated. The trajectory there is treatable but takes longer than acute-onset prolonged grief.

A specific clinical note: the items about life not being worth living and wishing the client had died alongside the deceased. Both are common in early acute grief. They become clinical concerns when they persist past the first year, when they escalate, or when they’re paired with active planning. Always follow up directly on suicidality in session, separately from this worksheet, regardless of how the items are answered. The worksheet is a screening tool, not a risk assessment.

The other thing to follow up on is the identity-disruption items. Clients reporting “I don’t know who I am anymore” months after the loss are giving you the clinical material that grief-focused work directly addresses, and the conversation in session can start there.

In my-cbt, the worksheet is one of the bundled system templates. Assign it after the second or third session with a bereaved client, with a personal message that frames the form as a way to put names to what they’ve been carrying. The submission saves in the case file and you read it together in the next session.