Psychotherapy of pathologic grief. Revisions and limitations

A significant minority (14 per cent) of a nonpatient bereaved population may be presumed to develop intense and enduring pathologic grief responses. The promise of recovery with short-term, focused intervention appears to be misleading, as a sizable proportion of patients with pathologic grief will be unresponsive to treatment. Prospective studies have demonstrated a positive correlation of dependent attachment, conflicted attachment, and unexpected loss with specific pathologic grief syndromes; preliminary reports suggest that these specific grief syndromes require specific interventions. The presentation of a nonresponsive case illustrates the clinical application and limitation of a revised strategy of treatment. The development and maintenance of formative imagery and symbols is of crucial support to the patient and therapist.