When One Loss Leads to Another: Grieving a Miscarriage and the Loss of Fertility That Follows

She had grieved the miscarriage as best she knew how. She was still in the middle of that when her doctor told her she needed a hysterectomy. There would be no next pregnancy to hope for. Not this year, not ever. The first loss had barely finished announcing itself before the second one arrived and changed what the first loss even meant.

This is a pattern I see clinically that often gets little attention: a pregnancy loss followed, sometimes months later, sometimes years later, by a second and different loss of fertility itself. A hysterectomy. A diagnosis. A closing door where there used to be a possibility. These are not two separate griefs that happen to occur in the same life. They compound each other and the second loss often changes the meaning of the first one in ways that catch people off guard.

Why This Isn't Just "More Grief"

It would be reasonable to assume that grieving a second reproductive loss works the same way as the first, just with more practice. That is not what tends to happen.

A miscarriage, even a devastating one, usually still holds the possibility of trying again. That possibility, even when it is not consciously named, often functions as a kind of scaffolding. Some part of the mind is holding onto a future that could still include a pregnancy. When a hysterectomy or another loss of fertility follows, that scaffolding is removed. The grief is not simply added to. It is retroactively changed. The miscarriage stops being "a loss on the way to a family" and becomes, in a much more final way, the loss of a particular child who will never have existed, full stop.

This retroactive shift is part of why the second loss can feel disproportionately heavy, heavier sometimes than people expect or than they feel permitted to express.

The Hysterectomy Is Its Own Grief, Not Just a Medical Event

This is worth saying directly because it is often missed: the loss of fertility through hysterectomy can be a significant grief event on its own, separate from anything that came before it.

Research following over 1,100 women scheduled for hysterectomy found that the roughly one in ten who would have wanted a child, or another child, showed significantly higher depression, anxiety, and anger than the rest of the group, an elevation still present two years later.

What this tells us clinically is that grief following a hysterectomy is not automatically resolved by the fact that it was medically necessary or that it addressed a genuine health problem. A surgery can be the right medical decision and a real loss at the same time. Those two things are not in conflict and a person does not need to choose between understanding the medical necessity and grieving what it closed off.

When the Losses Layer, the Grief Is Not Simply Additive

I want to be honest about something here. I am unaware of research that specifically studies a miscarriage followed later by a hysterectomy or similar loss of fertility as its own combined phenomenon. That specific research gap is real and I would rather say so plainly than imply a study exists that ties the two together directly.

One analysis of self-reported miscarriage narratives found grief symptoms often persist well past the first year, with worse outcomes the longer the gap before they're addressed and standard screening tools used in reproductive healthcare are known to miss this kind of prolonged, complicated grief.

Put together, this points toward a reasonable clinical picture, even without a study on the exact sequence: grief that is already delayed or unprocessed from a first reproductive loss does not simply pause while a second loss is absorbed. It tends to resurface, reshaped by what has happened since, at the same time a new grief is beginning. The two do not take turns. They occupy the same space.

What This Can Look Like

A few patterns show up often in this kind of layered loss worth naming so they don't feel as disorienting when they appear.

Grief for the first loss can intensify after the second. It is common to think you had "finished" grieving a miscarriage, only to find it returning with new force once a hysterectomy or fertility diagnosis makes clear that this child, this specific loss, will never be followed by another pregnancy the way you once assumed it might be.

The second loss can feel harder to name as grief. A hysterectomy, especially one framed by medical providers primarily around symptom relief or cancer risk, does not always come with permission to grieve it. You are allowed to be relieved about your health and grieving the fertility you lost in the same breath.

Identity questions tend to surface hard here. Who you are after a loss that closes a door permanently, rather than one that theoretically could have gone differently, often asks harder questions of a person's sense of self and future than a single loss does on its own.

Support tends to thin out precisely when it's needed most. People around you may have shown up for the miscarriage and assume, understandably but incorrectly, that a later medical procedure does not carry the same emotional weight. It often carries more.

What Tends to Help

Naming both losses as real, distinct griefs, rather than folding the second into the first or dismissing it as "just medical," is usually where things start to loosen. They are related. They are not the same loss wearing two different coats.

It also helps to expect, rather than be alarmed by, the resurfacing of the earlier grief. If the miscarriage feels suddenly sharper again after a hysterectomy or a fertility diagnosis, that is not a sign you failed to grieve it the first time. It is a sign the ground underneath that grief has shifted, and grief naturally responds to that.

And it is worth finding support that understands reproductive loss specifically, whether that is a therapist, a support group, or both. General grief support is a good starting point, but the layered, compounding nature of this kind of loss often benefits from someone who has sat with this particular pattern before.

A Final Word

If you are carrying a miscarriage and a later loss of fertility together, you are not required to rank them, or to have finished grieving one before the other arrived. Both are real. Both deserve room. And the fact that the second loss might look, from the outside, like a resolved medical matter does not make what it took from you any less significant.

You do not have to carry this alone. I offer a free 15-minute consultation at shareyourgrief.org. No pressure, no commitment, just a conversation.

Managing the Anxious Perfectionist on Your Team

She's the first one to volunteer for the extra project. Her work is clean, thorough, and always in on time, sometimes early. On paper, she's your best performer. What you don't see is the three drafts before the one you got, the Sunday night spent rewriting a paragraph nobody asked her to touch, or the quiet dread that shows up every time you leave a comment on her work, even a positive one.

Managers are often the last to notice when a high performer is struggling, because the struggle looks like excellence from the outside. This post is about what's actually happening underneath that pattern, and what genuinely helps.

Why This Doesn't Look Like a Performance Problem

Most performance issues show up as visible gaps: missed deadlines, sloppy work, disengagement. Anxious perfectionism shows up as the opposite. The employee is producing, often at a high level, which is exactly what makes it easy to miss.

Research on perfectionism in the workplace helps explain why. A large-scale review of the research found that while perfectionism is often assumed to boost performance, its actual relationship with job performance is unclear at best, and its relationship with an employee's mental well-being is consistently negative. In other words, the intensity that looks like a strength on a performance review often carries a real cost that never shows up on that same review.

Part of what drives this is a kind of internal accounting that never balances. Completing a task doesn't register as done, it registers as the new baseline to be measured against next time. The finish line moves the moment it's reached. From the outside, this can look like ambition. From the inside, it rarely feels like anything is ever actually finished.

Anxiety often travels alongside this pattern and about a third of adults in the U.S. will experience an anxiety disorder in their lifetime, so if you manage people, you have very likely managed someone experiencing this, whether they told you or not. Anxiety and perfectionism aren't the same thing but they frequently reinforce each other: a mind already primed to catastrophize doesn't need much encouragement to seize on the fear that this project, this email, this presentation, is the one that reveals inadequacy.

A Note on What the Research Doesn't Yet Tell Us

I want to be direct about a limitation here. There is a real, substantial body of research on how anxiety functions at work and how managers can support employees with a diagnosed anxiety disorder. There is far less direct research specifically on how a manager should support an employee whose primary struggle is perfectionism rather than anxiety. Much of what follows for the perfectionism side of this is drawn from what we know about the underlying mechanisms, what triggers the pattern, what tends to reinforce it, rather than a body of intervention studies telling us exactly what managers should do. I'd rather say that plainly than imply more certainty than the research actually offers.

What Doesn't Help

Reassurance is the instinct most managers reach for first, and it's usually the least effective tool available. Telling someone "you're doing great" doesn't address the actual mechanism at play, because the problem was never a lack of praise. It's a relationship to completion that treats every finished task as provisional. Praise can even backfire slightly, reinforcing the idea that worth is tied to performance rather than interrupting that idea.

Raising the bar further, even with good intentions, tends to make things worse. One study looking at day-to-day fluctuations in perfectionism found that time pressure and criticism at work were specific triggers that intensified perfectionistic behavior in the moment. That's worth sitting with: the two levers a stressed manager reaches for most often, more urgency, more pointed feedback, are the same two things shown to make this pattern more acute, not less.

What Actually Helps

Define "done" before the work starts, not after. Much of the anxiety in this pattern comes from an undefined finish line. Naming specific, concrete completion criteria up front, this draft needs three things, this deck needs to cover these two points, gives someone a real stopping point instead of an open-ended standard they're left to guess at and then second-guess.

Make room for mistakes to be low-stakes. Psychological safety research consistently finds that teams where people feel safe admitting an error, without fear of embarrassment or punishment, perform and learn better than teams where mistakes carry a hidden cost. For an anxious perfectionist, this isn't abstract. If every small error feels like a potential verdict on their competence, they will keep over-preparing to avoid ever being caught in one.

Be specific rather than general. "Great job" gives an anxious or perfectionist mind almost nothing to hold onto, and it can even prompt a search for the catch. "The client specifically mentioned how clear your summary was" is concrete enough to actually land.

Model imperfection yourself. If a manager never visibly makes a mistake, sends a typo in an email and moves on, admits a decision didn't pan out, the unspoken standard in the room stays impossibly high. Small, low-stakes modeling does more than any verbal reassurance.

Watch for the line between drive and something clinical. Some intensity is simply someone's working style. It's worth paying attention when the pattern includes visible distress over minor feedback, an inability to acknowledge a task is complete even when it clearly is, or hours that are consistently, quietly unsustainable. That's a different conversation than a performance check-in.

When to Say Something Directly

Managers who feel confident having this conversation are significantly more likely to actually have it, according to a large survey of managers on supporting employees with anxiety and depression, rather than avoiding the topic out of uncertainty about what to say. Confidence here doesn't require clinical training. It requires a plan.

A few ways to open the door, without diagnosing anything:

"I've noticed you put in a lot of hours on this, more than I'd expect it to need. How are you doing with the workload?"

"You don't need to have this fully polished for our check-in. I'd rather see where it's at."

"If something feels stuck, come to me before you spend a weekend on it. I'd rather help you triage than have you carry it alone."

None of these require you to have answers. They open space for the employee to say more, or not, without putting them on the spot.

If an employee discloses a diagnosed anxiety condition, reasonable workplace accommodations, things like flexible scheduling, remote work options, or more frequent breaks, are worth discussing directly with HR, since specific obligations and options vary by organization and situation.

A Final Word

Your most anxious, most perfectionistic employee is very likely also one of your most conscientious. That's not a coincidence and it's not something to discourage. The goal isn't to lower the bar or dampen someone's drive. It's to separate genuine excellence from the exhausting, self-punishing version of it that eventually burns a good employee out entirely.

Grieving at Work: What to Do When the Bereavement Leave Runs Out

You went back on a Monday. Someone left a card on your desk. Two people said they were sorry. By ten in the morning you were in a meeting about Q3 targets nodding along and you realized you had not heard a single word anyone said.

This is the part of grief nobody we’re often unprepared for. Not the funeral. Not the first night alone in the house. The Tuesday a week after your loved one died when you are expected to be a functioning professional and you cannot remember your own password.

The Math Does Not Work

Bereavement leave, which on average is between three and five days, was never designed around what loss does to a person. It was designed around a funeral, a logistical event with a start time and an end time that has very little to do with the years of adjustment following it.

One thing worth knowing before you go back: bereavement leave is often not the only time available to you. Many employers permit accrued sick time or personal days to be used for grief, for memorial services, or for the legal and financial work that follows a death. Most people never ask because they assume the three days were the whole allotment. It is worth a direct question to HR before you burn through vacation you may want later, particularly for the first anniversary.

‍Why Work Is Uniquely Hard

‍There is a specific reason grief and employment collide so badly and it has nothing to do with how much you like your job.

Grief consumes an enormous amount of cognitive resource. Your brain is running a continuous background process reconciling the deep-seated knowledge that this person belongs here with the new information that they are gone. I have written elsewhere about why grief is so physically exhausting and the short version is that the fatigue is real and physiological.

What that looks like at a desk is specific and worth naming, because most people assume they are failing rather than functioning normally under load.

Tasks that used to take twenty minutes take an hour. Names, dates, and details of meetings you attended last week are simply gone. Small decisions carry the weight of large ones and choosing what to eat for lunch can feel genuinely difficult in a way that is embarrassing to admit. And the waves arrive without scheduling around your calendar. You can be entirely fine at nine and undone by two.

This is not a rare experience. In a survey of nearly 1,500 bereaved Americans conducted by the bereavement benefits company Empathy, 76 percent said their performance or standing at work had been harmed and 43 percent of full-time employees reported regular trouble concentrating.

Work asks for precisely the capacities grief takes first. It asks grieves to work for eight hours, on a schedule, in front of people.

And it asks for something else that grief makes almost impossible: consistency. Work has no category for someone who is competent in the morning and hollowed out by mid-afternoon. So most grieving people do the only available thing, which is to perform a stability they do not have.

The research bears this out. In a 2025 study of bereaved employees, nearly half reported feeling they needed to appear composed and professional, about a third felt they had to actively conceal expressions of grief, and about a third felt pressure to return to normal. That performance is exhausting on top of an exhaustion that was already total. That instinct to conceal isn't unique to bereavement leave. Plenty of grief goes unacknowledged even when no one has taken a single day off, including the grief carried by the people standing just outside the loss itself.

That instinct to conceal isn't unique to bereavement leave. Plenty of grief goes unacknowledged even when no one has taken a single day off, including the grief carried by the people standing just outside the loss itself.

The Card, and Then Nothing

‍Here is the pattern I hear most often and the research describes it with some precision.

The acknowledgment usually happens. In that same 2025 study, the large majority of bereaved employees reported that coworkers and direct supervisors recognized their loss. Someone signs a card. Someone says they are sorry. That part, most workplaces manage.

What almost never happens is anything after that. In the same study, only about a third of employees reported any check-in from their organization after they returned. Fewer than one in five were given a lighter workload. Fewer than one in ten received help with actual tasks. Recognition from HR or executive leadership was rare.

So the experience is not exactly that nobody says anything. It is that everyone says something once, in week one, and then the subject closes permanently while you are still four months from the worst of it. The card is on your desk. The casseroles have stopped. Nobody asks again.

And people do go quiet in the ordinary social sense too. The colleague who was warm at the funeral is awkward at the coffee machine two weeks later. Conversations reroute when you approach. What is worth understanding is that this is usually not indifference. Researchers looking at why colleagues withdraw find it is more often not knowing how to show care, feeling awkward, assuming the support would be unwanted, or simple discomfort with the emotion in the room.

Workplaces amplify all of this beyond ordinary social avoidance. There is already a professional norm against emotional display, and your grief hands people a socially sanctioned excuse to avoid something they were inclined to avoid anyway. I have written about why grief makes people disappear more generally, and everything in that post applies here with professional cover layered on top.

Understanding the mechanism does not undo the loneliness. You are still the person eating lunch alone while everyone talks around the thing that has reorganized your entire life. But it may spare you the additional work of searching your own behavior for what drove them off. Nothing did.

Work has a way of treating any loss it cannot see, a marriage ending, a job disappearing, a friendship fading, as less real than a death. That's part of a pattern worth naming.

What to Say, and Who to Say It To

‍You do not owe your workplace the full story and you do not owe everyone the same version. What helps is deciding in advance, because the moment of being asked is not a moment when you will be able to compose an answer.

This is the tiered response applied to a professional setting. Your close colleague may get the truth. The client on the Thursday call gets something brief and closed. Having the sentence ready matters more than which sentence you choose.

A few that my clients have found useful:

"I’m glad to be back, but I’m still navigating a difficult time. If I seem quiet or need to step away, please don’t take it personally."

"I’m struggling with focus right now. Could you send that request in an email so I can keep track of it?"

• Find one safe person. This does not appear in the research literature, but it is among the most useful things I recommend in practice. Pick one colleague or manager you trust and tell them plainly: if I am having a hard day, I may need ten minutes in a private room. That one conversation, held once, removes the need to explain yourself every subsequent time. It also means someone in the building knows what is going on with you which matters more on the bad days than you would expect.

• Tell people what you want from them because they will not guess. Given that most workplace silence comes from not knowing what to do rather than not caring, you have more influence here than it feels like you do. Something as plain as "you can say his name, it helps" or "I would rather you email me than come to my desk" gives a colleague a script they did not have. This is unfair. You are the one with the least energy and you are doing the work of teaching everyone else how to behave. It is still, in practice, the thing that most often breaks the silence.

• Ask for specific accommodations rather than general understanding. "I’m having a hard time" invites sympathy and produces nothing. "I need to move my recurring Monday morning meeting to Wednesday for the next two months" produces a changed calendar. Researchers who interviewed bereaved people about returning to work identified accommodation as one of four core elements of adequate support, alongside two-way communication, recognition of the loss, and emotional support. Accommodation is also the element that goes missing most often. Specific requests are easier to grant and far more likely to reduce the actual load.

Getting Through the Day

‍ Understanding why concentration has collapsed does not restore it. These are the practical measures that tend to help while your capacity is reduced.

• Work in twenty-minute blocks. Set a timer, work for twenty minutes, then take five minutes away from the screen. Sustained focus is not currently available to you and pretending otherwise mostly produces an hour of staring at the same paragraph. Short bursts with real breaks get more done than a long stretch of trying.

• Do not trust your memory. Write everything down. Checklists, calendar reminders, notes to yourself, whatever system you will actually use. The goal is to move as much as possible out of your head, because your head is occupied. This is not a failure of discipline. It is the appropriate response to a temporary and genuine reduction in working memory.

• Aim for B-grade work. For a few weeks, consistency matters more than excellence. Showing up and producing something adequate every day is a better outcome than three days of trying to hit your old standard and one day of collapse. If you are a perfectionist, this will be the hardest sentence in this post to accept, and it is the one I would most want you to take seriously.

• Know where the exits are. A car, a stairwell, a bathroom on a floor where nobody knows you. Somewhere you can go for five minutes without explaining. This sounds small and it is not. Knowing you have somewhere to go often prevents the need to go there.

• Consider whether work is a refuge and be honest about the answer. For some people work is the one place still running on the old rules, where competence is possible and nothing has changed. That can be genuinely restorative. It is a version of what I have described as dosing, stepping away from the grief on purpose and returning to it later. The distinction that matters is whether you are stepping away or running. If you are staying late every night because going home means facing an empty house, work has stopped being a break and become a place to hide.

If You Manage Someone Who Is Grieving

Your response matters more than you think. Research on workplace bereavement consistently finds that how an employer responds is associated with whether the employee stays, how engaged they are afterward, and how supported they felt through it. You have real influence here and most managers underestimate it.

• Acknowledge the loss. Do not step around it. "I’m sorry for your loss, and I’m glad you’re back" is sufficient. There is no eloquent version of this and reaching for one is how people end up saying nothing at all.‍

• Give flexibility where you can. Remote days, adjusted hours, a lighter load for the first few weeks. The evidence points toward a graduated return rather than a switch that flips back to full expectations on day one.

• Narrow their focus. This is the single most useful thing on this list and it costs nothing. Tell the person exactly which three tasks matter this week. A grieving employee looking at a full task list is not seeing a list, they are seeing evidence of how far behind they are. Deciding priorities for them, temporarily, removes a decision they currently cannot make well.

• Keep going after week six. The part that gets missed is not the initial acknowledgment. It is week twelve, and the anniversary, and the ordinary Tuesday four months out when everyone else has moved on. What bereaved employees consistently report needing is not eloquence but continuation. Someone who asks again after everyone else has stopped asking, who says the person’s name without flinching, and who lets the griever set the terms rather than deciding for them how much they want to talk about it.

‍There is nothing wise to say. There was never going to be. You are being asked to keep showing up, which is both simpler and harder than finding the right words.

‍When to Take It Seriously

Some difficulty at work is expected and will ease. What warrants closer attention is a pattern that is not improving after several months: making errors that are not like you, receiving feedback that surprises you, missing things you would never have missed, or dreading the workday in a way that has become its own weight. Grief and depression overlap significantly here and the workplace is often where the difference first becomes visible, because it is the place with objective measures.

If your work has changed in ways you can point to and it has not started to recover, that is worth talking to someone about. Not because you are failing at grief. Because the load you are carrying may be larger than what you can carry alone right now and there is real help for that.

A Final Word

You are not bad at your job. You are a person doing a demanding cognitive task while your brain runs the largest reorganization it will ever undertake. The gap between those two things is not a character problem. It is arithmetic.

Your worth is not measured by your output, and it never was. You are moving slower because something enormous has happened, and moving slower is the correct response to it.

Be as generous with yourself as you would be with a colleague in your position. And if you can, ask for what you actually need in words specific enough that someone could say yes to them.

If you are trying to work through a loss and finding the ordinary supports are not enough, I would be glad to talk. I offer a free 15-minute consultation at shareyourgrief.org. No pressure and no commitment, just a conversation.

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Why Grief Makes People Disappear

There is a particular kind of loneliness that shows up not in the funeral home but months later when the calls stop coming and the friend who promised to always be there has quietly gone quiet. Most people who experience this assume something is wrong with how they’re grieving. Often the truth is stranger and less personal than that.

In 1973, the cultural anthropologist Ernest Becker published The Denial of Death, arguing that much of human behavior is organized around managing one fact most of us spend our lives trying not to look at directly: we are going to die and we know it. In the mid-1980s, the social psychologists Sheldon Solomon, Jeff Greenberg, and Tom Pyszczynski built Becker's idea into something researchers could actually test. They called it Terror Management Theory and it may be one of the most useful frameworks I know for understanding why grieving people so often find themselves left by the very people who claimed they would always be there.

What the Research Shows

Studies in this area consistently find something unsettling: when people are made aware of their own mortality, even briefly and outside conscious awareness, their behavior shifts in predictable ways. They cling harder to familiar beliefs. They favor people who resemble them and quietly distance themselves from people who don't. None of this is a conscious decision. It happens beneath the level most of us would ever notice in ourselves.

Researchers call the triggering moment mortality salience and one of the most consistent findings is that almost anything can produce it. Completing a will. Walking past a funeral home. And, reliably, encountering someone who is visibly bereaved.

A grieving person is not simply someone in pain. To the nervous system of everyone standing near them, a grieving person is evidence of mortality: living proof that the worst thing can happen to ordinary people, in ordinary ways, on an ordinary Tuesday. That evidence is hard to sit with for very long so people often don't. They look away. They find a reason to be elsewhere. The relationship goes quiet, not out of malice, but because staying close to that evidence is uncomfortable in a way most people don't have language for.

Why This Isn't a Justification

I want to be clear that none of this excuse the harm caused by disappearing on someone in grief. Understanding a behavior is not the same as forgiving its impact. If you have been the person left standing alone while your community found reasons to be elsewhere, the explanation for why it happened doesn't undo the loneliness it created. You are allowed to need people who then failed to show up.

What understanding the mechanism does offer is something different. It can take the sting out of a question so many grieving people quietly carry, some version of what is wrong with me or my grief? In most cases, the honest answer is nothing. Your grief simply asked something of the people around you that their own nervous systems weren't equipped to give without a fight.

Why Some Losses Trigger It Harder

This effect isn't uniform. Losses that feel structurally close to a person's own life tend to trigger more avoidance than losses that feel distant. A peer's spouse dying suddenly is harder for others to sit with than a stranger's death on the news because the similarity, same age, same kind of marriage, same kind of ordinary day, makes the reminder of one's own mortality much harder to file away as something that happens to other kinds of people.

What This Means for You

If you're the one grieving, this isn't a reason to excuse anyone's absence, but it may be a reason to stop searching your own behavior for the imagined flaw that drove people away. And if you're the one standing at the edge of someone else's loss, feeling the pull to busy yourself elsewhere, it may be worth naming that pull for what it is: not a judgment about the person grieving, but a reflex in you. This pattern shows up with particular force in professional settings, where grief carries its own set of unwritten workplace rules. Naming it is often enough to override it. Sometimes the most important thing you can offer a grieving person is simply staying even when every instinct is telling you to look away.

If what you've read here resonates, you don't have to keep navigating this alone. I offer a free 15-minute consultation so we can talk about what you're carrying and whether grief therapy might help. There's no pressure and no commitment, just a conversation. Schedule here.

Who Are You Now? What Loss Does to Identity

There is a question that surfaces for many grieving people, one that can feel strange or even embarrassing to say out loud: who am I now?

It shows up in small, disorienting moments. Not knowing what to make for dinner because you have not had to choose alone in years. Struggling to picture your own future because it was built around a life that included someone who is no longer in it. Feeling unmoored in a way that has nothing to do with sadness and everything to do with not quite recognizing yourself.

If this is familiar, you are not being fragile. You are encountering one of the most predictable and least talked about features of significant loss.

The Self We Build in Relationship

We build our identities with other people, not in isolation. This is not a poetic observation; it is developmental fact. From childhood onward, our sense of who we are is shaped by the people closest to us, by how they see us, by what we become in their presence. By the time a relationship has years or decades behind it, the line between "who I am" and "who I am with this person" can be genuinely hard to locate.

So when someone central to that self dies, the disruption is not a side effect of grief. It is grief, expressed at the level of the self. None of this means something is wrong with you. It means your identity is doing exactly what identity does when a foundation it was built on disappears.

The Beliefs You Did Not Know You Had

Part of what makes this so disorienting is that most of us do not know these assumptions are there until loss breaks them open. Psychologist Ronnie Janoff-Bulman's research on what she calls the assumptive world identifies a few beliefs that quietly undergird most people's sense of security: that the world generally makes sense, that it is not senselessly cruel, that we are safe.

We rarely notice these beliefs consciously. We simply live as though they are true until something happens that makes them impossible to hold onto. Major loss, especially sudden loss, can shatter them at the root. That shattering is part of why grief can feel disorienting well beyond sadness. It is not only your heart that is hurting. It is your whole framework for how the world works.

The Questions That Surface

Some of the identity questions grief raises are immediate and practical. Am I still a wife if my husband has died? A father if my child is gone? These titles carry so much of who we understand ourselves to be and after a loss they can feel like they belong to a life that no longer exists even while the relationship itself still feels present in other ways.

Other questions arrive more slowly. What do I do with the years I assumed I had? Who am I outside the role that organized so much of my time and attention? What do I actually want now that the future I was building has to be reimagined from a different foundation?

There is no need to answer these quickly and trying to usually backfires. This is not something you decide. It is something you discover gradually by living a life that has no precedent for you yet.

What This Growth Actually Looks Like

Carrying a lost identity forward rarely happens as one clear moment of clarity. It tends to show up in a few different ways.

Some of it happens through carrying the person forward. Taking on values, habits, or ways of being that belonged to someone you lost is not just a way of remembering them. It is a way of living alongside a self that includes them.

Some of it happens through discovering capacities you did not know you had. Loss can push people into skills and roles they never needed before: managing finances for the first time, taking on new tasks or chores, traveling alone. These are not just coping mechanisms. They are new parts of who you are.

Some of it happens through renegotiating relationships. Friendships sometimes fade after a death, not from unkindness but because they were built around a context that no longer exists. New connections often form in their place, sometimes with people who understand this particular kind of loss.

And some of it, the hardest part to describe, happens simply through the accumulation of days in which you were still here, still making small decisions, still choosing what comes next.

A Note on "Finding Meaning"

You may have heard that loss can lead to what researchers call post-traumatic growth: more appreciation for life, deeper relationships, a clearer sense of purpose. This does happen for some people and it is real when it does.

But it is not a requirement and it cannot be forced. If your loss has not produced a lesson you can name or a purpose you can point to, you are not doing grief wrong. You are simply living with a loss which is its own form of work.

Questions Worth Sitting With

You do not need to answer these. They are meant to be companions, not assignments.

• What did I understand about myself only in relation to this person and how do I relate to that part of myself now?

• Is there a value or way of being of theirs that I notice showing up in me?

• What is one small capacity I have discovered in myself since this loss?

• Where do I feel most like myself these days, even briefly?

A Final Word

You are not the same person you were before this loss. You are also not only the person the loss made you. You are in the process of growing around both, carrying what remains while living alongside what has changed. That process is slow by nature and that is not a failure to move forward. It is what integrating a loss actually looks like.

If this resonates and you would like support working through it, I offer a free 15-minute consultation. No pressure, no commitment. Just a conversation.

What Happens to the Soul? Embedded Theology and the Fear We Can't Quite Shake

What Happens to the Soul? Embedded Theology and the Fear We Can't Quite Shake

There is a particular kind of fear that may surface after certain losses, one that rarely gets spoken aloud even in a therapist's office. It can arrive in the hour before sleep or in the quiet after a hard conversation. It sounds something like: where are they now?

This fear can surface after almost any loss, but it tends to arrive hardest after a death that carries its own history of judgment, a loss that a person's childhood faith would have had something specific and often severe to say about. People find themselves gripped by fear for someone's fate even though they no longer consider themselves religious, and even though they would tell you they do not believe in hell, or in a god who judges people this way, or in an afterlife of any kind.

The fear tends to arrive anyway and it can arrive with real physical weight: a tightness in the chest, a jolt of dread that lands before conscious thought has time to catch up. For many people this is disorienting on its own terms. How can a belief you have consciously rejected still have this much power over you?

If this describes something you have felt, you are not being irrational and you have not secretly stayed religious without noticing. What you are experiencing has a name and understanding it can loosen its grip.

Two kinds of belief

Theologians Howard Stone and James Duke describe two different types of belief a person carries. “Embedded theology” is what we absorb before we are old enough to evaluate it: the ideas soaked up through sermons, religious education, prayers, and the general emotional atmosphere of a religious upbringing. “Deliberative theology” is what we arrive at later through conscious thought and choice.

When someone leaves a faith community, their deliberative theology tends to change quickly. They can tell you what they no longer believe. Embedded theology moves at a different pace. It was not installed through argument so it does not respond to argument alone. It was installed through repetition, emotional intensity, and the authority of the adults who taught it, which is exactly why it can persist underneath a belief system a person has otherwise rejected for years.

Why this shows up hardest after certain losses

Many religious traditions have, at different points in their history, treated suicide as a defining moral failure rather than what clinicians now understand it to be: an outcome of unbearable pain. Someone who grew up hearing that framing, even indirectly, may carry a specific, vivid verdict rather than a vague unease, one that resurfaces in force after this particular kind of loss.

A related pattern can show up after the death of a loved one whose sexual orientation or gender identity was treated as a source of shame or condemnation by the faith community they, or their family, belonged to. Here too, the fear is rarely a general spiritual unease. It is often a specific claim a person heard stated outright as a child, about a specific kind of person now attached to someone they loved.

What makes this fear so hard to shake, in either case, is the specificity. Not a vague sense that religion disapproves of something, but a fully formed verdict, complete with language, that the grieving mind can retrieve intact decades later.

This sits alongside, but is distinct from, the social stigma that can surround these losses. What we are talking about here is quieter and more private: a fear about the deceased's fate that a person may never say aloud to anyone, sometimes because they feel foolish for having a fear rooted in a belief they no longer hold.

Why grief pulls it back to the surface

Grief is exhausting in a way that overwhelms our capacity for reflective thought. Under that kind of depletion, the mind tends to default to whichever framework was installed first, not whichever one it currently endorses. This lines up with a body of research on what psychologists call religious residue. A 2021 study followed people who no longer identify as religious, sometimes called religious dones in this research, and found their endorsement of core moral intuitions consistently falls between that of currently religious people and people who were never religious, rather than matching either group cleanly. The same body of research found this residue can fade somewhat with time, but for many people it persists well into adulthood. That fits what shows up clinically: a belief a person consciously set aside years ago can still be the one their mind reaches for at 2 a.m.

This isn't a referendum on faith

None of this is an argument for or against any particular tradition. Some people find real comfort in returning to an old prayer or ritual during grief and that can be a genuine way of staying connected to the person they lost, not something that needs correcting. The goal here is not to talk anyone out of a belief. It is to help you recognize where a reaction is coming from, so you can meet it with more clarity and less shame.

Noticing the old voice

You likely cannot argue the fear away in the moment it arrives and trying to usually backfires. What tends to help more is naming it for what it is. Instead of "they are being judged," try "I am having the thought that they are being judged." That small shift creates distance between you and the belief, enough distance to remember that you get to decide what to do with it.

Questioning this is not a betrayal of the person you lost and it is not a betrayal of the family or community that raised you. It is part of the same work grief always asks of us: understanding what we are carrying, so we can choose, with open eyes, what to keep and what to finally set down.

If this resonates and you would like support working through it, I offer a free 15-minute consultation. There is no pressure, just a conversation. Schedule here.

Why Grief Wrecks Your Sleep (And What Actually Helps)

You expected the sadness. You may have expected the waves of it arriving without warning at the grocery store or on an ordinary Tuesday afternoon. What many grieving people do not expect is what happens at night.

The insomnia that follows loss is one of the most disruptive and least talked-about features of grief. You are exhausted during the day, then wide awake at 2 a.m. You fall asleep easily enough, then jolt awake at 4 and cannot return. Or sleep comes but it offers no rest and you wake feeling as though you have been somewhere difficult all night. Sometimes you have been.

Understanding why grief does this to sleep can make the experience feel less frightening, and less like a sign that something is permanently broken.

What Grief Does to the Body at Night

During the day, the demands of ordinary life give the grieving mind something to work with. There are tasks, people, small decisions that require attention. At night, that scaffolding disappears and the mind turns toward what it has been circling all day: the loss, the absence, the unanswerable questions.

There is also something physiological happening. Grief activates the body's stress response, flooding the system with cortisol and adrenaline in a way that is well-suited to acute danger and poorly suited to restful sleep. The nervous system, already running on high alert, does not simply switch off when you lie down. It continues its work. It is exacerbated for those who were caregivers prior to a loved one’s death because that hypervigilance you experienced when your loved one was alive doesn’t dissipate the moment they died.

For people who shared a bed with the person who died, there is an additional layer. Close relationships involve a kind of biological co-regulation: partners unconsciously synchronize breathing, heart rate, and sleep rhythms over time. When that person is gone, the body loses its anchor. What felt like falling asleep beside someone was also, physiologically, a shared event. Sleeping alone now is not just emotionally difficult. It is a form of solo-regulation the nervous system has to relearn.

Dreams and the Grieving Brain

Many bereaved people are visited by the person who died in their dreams, sometimes in vivid, emotionally charged encounters that feel less like dreams and more like something else entirely. Others grieve the absence of these dreams feeling the separation even in sleep.

Both experiences are normal and both can complicate rest. Some find these dreams comforting; others find them destabilizing. Grief researchers have noted that these nighttime encounters are often a continuation of the mind's processing work, the brain doing in sleep what it cannot always do in waking hours.

When Sleep Disruption Becomes Concerning

Some degree of disrupted sleep is expected in bereavement, particularly in the early months. It tends to ease gradually as the acute phase of grief softens though it may return around anniversaries or significant dates.

What warrants closer attention is sleep disruption that persists for many months without improvement or that is accompanied by significant functional impairment during the day. Prolonged sleep disruption is both a feature and a driver of complicated grief and depression; poor sleep makes it harder to regulate emotion, harder to tolerate distress, and harder to engage with the grief work that supports integration. If sleep has been significantly disrupted for several months and shows no signs of improving, that is worth bringing to a clinician.

What Actually Helps

Standard sleep hygiene advice, while not wrong, may be insufficient alone to improve the sleep of grieving people because sleep hygiene addresses the mechanics of sleep without touching the grief itself. A consistent bedtime routine is useful. Avoiding caffeine and screen time is still important as is a quiet, dark, cool bedroom. However, all of these practices may be insufficient if the body is flooded with cortisol and the mind is running a loop of what-ifs.

A few things that tend to help more directly:

Acknowledge what nighttime actually is for you right now. For many grieving people, going to bed means going somewhere the absence is impossible to ignore. Naming that, rather than trying to simply optimize sleep conditions, can reduce some of the dread that builds around bedtime.

Give the mind something to do with the grief before sleep. Brief journaling, a few minutes of intentional remembering, or a simple ritual that acknowledges the loss can serve as a kind of container, giving the mind a designated time to engage rather than waiting until the lights are out.

Consider the body's stress response. Slow, deliberate breathing activates the parasympathetic nervous system and begins to lower cortisol. Even a few minutes of this before bed shifts the physiological conditions in a meaningful way. This is not a cure, but it is not nothing either.

Be honest with your prescribing clinician if you are using sleep medication. Short-term support can be appropriate during acute grief, but sedating the system indefinitely can interfere with the very processing that grief requires.

A Note on the Middle-of-the-Night Hours

Many grieving people dread waking at 3 or 4 a.m. with no ability to return to sleep. If this happens regularly, fighting it tends to make it worse. Getting up, doing something quiet, and returning to bed when sleep feels possible is often more effective than lying awake berating yourself for being awake. It is important to avoid watching the clock because this tends in increase anxiety. Similarly, stay away from screens because they disrupt our circadian rhythm. Consider reading in a dark room or engage in a “boring” activity such as folding laundry.

Some people find that the middle of the night, as uncomfortable as it is, becomes an unexpected time for genuine grief work. The house is quiet. There is nothing to perform for anyone. What surfaces in those hours is often real, and sometimes worth attending to.

Grief does not pause for sleep. But sleep, in time, does return. Being patient with your body while it finds its way back is not weakness. It is part of the work.

If you are struggling to sleep and the grief underneath it feels like too much to carry alone, I offer a free 15-minute consultation at shareyourgrief.org. No commitment, no pressure. Just a conversation.

When Thoughts Feel Like Monsters: A Different Way to Relate to the Mind

There is a particular kind of suffering that happens when we go to war with our own thoughts.

You know the loop. The thought arrives, sharp and uninvited, and then comes the attempt to argue it away, suppress it, distract from it, or convince yourself it is not true. And for a moment, maybe it works. But the thought comes back, often louder, and now you are exhausted from the fight as well as the original fear.

Grief and anxiety are full of these thoughts. I will never feel okay again. Something bad is about to happen. I am not enough, and eventually everyone will see it. They arrive without warning and carry a weight that can feel unbearable.

What if the problem is not the thoughts themselves, but the way we relate to them?

The Mind as a Storyteller

One of the central ideas in Acceptance and Commitment Therapy, or ACT, is that the human mind is an extraordinarily prolific storyteller. It produces thoughts, images, predictions, and judgments at a remarkable rate. Many of them are useful. Many of them are not. And quite a few of them are simply not true.

The trouble is that when we are inside our thoughts, they feel like reality. A thought like I cannot handle this does not arrive as a story the mind is telling. It arrives as a fact. And when we treat it as a fact, we respond accordingly: we avoid, we retreat, we quietly shrink the boundaries of our lives to keep ourselves safe from the thing we fear.

ACT calls this process fusion: the experience of becoming so merged with our thoughts that we cannot see any distance between us and them. The thought and the thinker become the same thing. The reverse, defusion, is the practice of stepping back and seeing thoughts as thoughts rather than facts. Not arguing with them. Not trying to eliminate them. Just recognizing them for what they are: mental events, passing through.

The Boat and the Monsters

Here is an image I find useful.

Imagine you are on a boat, adrift at sea. Below deck, there are monsters. They are the accumulated fears, doubts, and dark thoughts that come with anxiety, grief, and the ordinary weight of being human: You are not capable of this. Something will go wrong. You do not deserve what you are reaching for. As long as the boat remains adrift, the monsters stay below. It is not peaceful exactly, but it is tolerable. You have found a way to coexist.

Then, in the distance, you see a shore. It is sunny and inviting. There are people on the beach, living their lives, connected to one another. It represents the things that matter most to you: the relationships you want to be present for, the work that feels meaningful, the life you have been putting off until the fear gets smaller.

When you turn the boat toward shore, the monsters come up from below deck. They are loud. They shout, they cajole, they belittle. Who do you think you are? Turn back. Stay where it is safe. You are not ready for that.

And here is the thing that ACT asks us to notice: the monsters cannot actually harm you. They can make noise. They cannot touch the wheel. They have no power over the boat except the power you hand them when you decide their voices must be silenced before you can move.

The question they are really posing is this: will you stay adrift to keep them quiet, or will you sail toward the shore anyway?

What This Looks Like in Practice

Cognitive defusion is not positive thinking, and it is not a way of minimizing what you are going through. It does not ask you to pretend your fears are unfounded. It asks something simpler and, in some ways, harder: to hold your thoughts a little more lightly.

In practice, this often begins with naming. When a thought arrives with the force of fact, try silently labeling it: I notice I am having the thought that I cannot handle this. That small shift, from I cannot handle this to I am having the thought that I cannot handle this, creates a real if subtle distance between the thinker and the thought. You are not the monster. You are the one who can hear it and keep sailing anyway.

Some people find it helpful to imagine difficult thoughts as weather: conditions that move through, storms you can observe without becoming. The sun does not disappear when it rains. It simply cannot be seen for a while.

What all of these approaches share is an orientation of curiosity rather than combat. You are not trying to defeat the thought or wait until it falls quiet. You are learning to see it clearly, feel the discomfort it brings, and choose your direction anyway. In ACT, that direction is always guided by the same question: what matters to you, and are you moving toward it?

The Shore Is Still There

Anxiety and grief share something important: they both whisper that the shore is not for you, that you are not ready, that it would be safer to wait just a little longer. And the longer we wait, the more persuasive that whisper becomes.

The monsters will come up from below deck when you turn toward the life you want. That is simply what they do. The goal is not to silence them first. The goal is to recognize that their noise is not the same as danger, that they are not steering the boat, and that the shore is still there, whether the monsters are quiet or not.

You do not have to feel ready to sail. You just have to keep your hands on the wheel.

If the thoughts and fears are making it hard to move, hard to function, or hard to imagine what forward could look like, you do not have to find your way through alone. I offer a free 15-minute consultation at shareyourgrief.org. No commitment, no pressure. Just a conversation.

Anger in Grief

When someone you love dies, the world expects you to be sad. Sadness makes sense to people. It is visible, it is legible, and it fits the cultural script. What the world is far less prepared for is the anger.

And yet anger is one of the most common emotions in grief. Many of my clients are surprised by it, even frightened by it. They feel furious at the person who died for leaving them. They feel rage at the doctors, the universe, the friends who said the wrong thing. Sometimes the anger has no clear target at all, just a heat that rises without explanation and burns without a source. And underneath the anger, almost always, is the fear that feeling it makes them a bad person.

It does not.

Why Anger Makes Perfect Sense

Grief researchers have long recognized anger as a central, not peripheral, feature of mourning. Dr. J. William Worden, whose four tasks of mourning remain one of the most clinically grounded frameworks for understanding loss, identifies anger as a normal and expected response to bereavement. It is not a sign that something has gone wrong in your grieving. It is often a sign that it is going right.

To understand why, it helps to think about what loss actually does to us. When someone we love dies, we lose not just a person but a future, a sense of safety, a set of assumptions about how the world is supposed to work. That disruption is not just sad. It is threatening. And when we feel threatened, we get angry.

From a neurological perspective, anger is often a secondary emotion, one that arises in response to something more vulnerable beneath it. Fear. Helplessness. The raw exposure of loving someone and losing them anyway. Anger is, in many ways, the nervous system's preferred alternative to powerlessness. It is energy where grief is collapse. It is movement where loss is stillness. And for many people, it arrives before they have the language for what else they are feeling.

The Targets Are Many, and Often Surprising

One of the things that makes grief anger so disorienting is how many directions it can point at once.

Some people feel anger at the person who died. This is particularly common after a death that felt preventable, a suicide, an overdose, an accident, or a person who refused to see a doctor until it was too late. The anger makes sense: they left. They made choices that took them away. Even when those choices were driven by illness or by forces beyond their control, the loss can feel like abandonment. Feeling furious at a person you loved deeply is not a betrayal of that love. It is evidence of it.

Others feel anger at the people around them. At the friend who disappeared. At the relative who said the wrong thing. At the colleague who seemed to move on immediately. Grief is relational, and the ways others fail us in our loss are real and often worth acknowledging. The sting of those failures can linger long after the initial weeks of mourning.

Some feel anger at God, or at a universe that allowed this to happen. Some feel anger at themselves, looping through the "if onlys" in search of the place where they could have changed the outcome. Some feel anger and cannot name its source at all. Just a background heat that rises at unexpected moments and leaves them feeling ashamed.

All of these are normal. None of them make you a bad person.

Where the Shame Comes From

Grief anger is one of the most poorly supported emotions in our culture. We are comfortable with tears. We are less comfortable with rage, particularly when it is directed at someone who has died or at the people trying to help.

This discomfort has consequences. Many grievers learn quickly to hide their anger, or to express it in indirect and often self-destructive ways. They snap at people they love. They withdraw. They work too much or drink too much or spend too much, anything to channel the energy somewhere it will not make others uncomfortable.

What gets lost in this suppression is the information the anger was carrying. Anger in grief almost always has something to say. It may be pointing toward a genuine loss of trust, a relationship wound that deserves attention, or a place where the mourner needs to set a limit or ask for something they are not getting. Suppressing it does not resolve any of those things. It just drives them underground.

Working With the Anger, Not Against It

The goal is not to eliminate grief anger. The goal is to understand it well enough to work with it.

The first step is simply allowing it to exist. This sounds obvious and is harder than it sounds. Many grievers have spent months or years telling themselves they should not feel this way, that it is wrong or selfish or ungrateful. Getting curious about the anger, rather than immediately judging it, is often the beginning of something useful.

The second step is to look beneath it. When you notice the anger rising, it can help to ask: what else is here? Underneath the fury at your brother for not being there when your mother died, there may be grief about the relationship itself, or fear about who carries the family now. Underneath the rage at a doctor's missed diagnosis, there may be a devastating sense that the world is not as safe as you believed. The anger is real. But it is often pointing toward something that also deserves attention.

The third step is to find expression that is neither suppression nor explosion. Physical movement can help: anger is energy, and the body often needs somewhere to put it. Writing, particularly unsent letters to the person who died or to the people who failed you, can create a container for things that need to be said without requiring you to actually say them. In therapy, anger is something we can sit with carefully and follow to its source.

A Note on Anger and Guilt

Anger and guilt are close companions in grief, and they frequently travel together. The person who feels furious at a loved one who died by suicide may also feel crushing guilt for having felt that anger at all. The person who is angry at the doctors may also feel guilty for not having pushed harder or asked the right questions.

If that combination is familiar to you, please know this: feeling angry does not mean you did not love the person. It does not mean you are glad they are gone. It does not mean anything, except that you are a human being responding to an unbearable loss in one of the most human ways possible. The anger and the love can coexist. They almost always do.

Getting Support

Grief anger can be one of the loneliest parts of loss, precisely because it is the part people feel least able to share. If you are carrying anger alongside your grief and not sure what to do with it, therapy can be a place to bring it without having to manage how it lands on someone else.

You do not have to figure this out alone. If you would like to talk, I offer a free 15-minute consultation at shareyourgrief.org. No pressure, no commitment. Just a conversation.

What If Your Depression Is Trying to Tell You Something?

There is a story most of us have been told about depression. It goes something like this: depression is a brain disease. Something in your chemistry is off. You were born with a vulnerability, or you inherited it, and now it is expressing itself. The solution is to correct the imbalance, usually with medication, and get back to functioning.

It is a tidy story. It is also, increasingly, one that the research does not support.

This post is not an argument against medication, and it is not a dismissal of biology. It is an invitation to consider a different framework, one that many of my clients find more honest, more hopeful, and more useful: the idea that depression is not a malfunction. It is a signal.

The Collapse of the "Chemical Imbalance" Story

For decades, the dominant explanation for depression was straightforward: low serotonin causes depression, and antidepressants work by raising it. This idea was so widely repeated, in pharmaceutical ads, in doctors' offices, in popular books, that most people simply accepted it as established science.

It wasn't. In 2022, a comprehensive review published in the journal Molecular Psychiatry, led by researchers at University College London, examined decades of studies on serotonin and depression and found no consistent evidence that low serotonin levels cause depression. The researchers were not fringe critics. They were not arguing that antidepressants are useless. They were documenting what many researchers had privately understood for years: the chemical imbalance story was a significant oversimplification, one that had been marketed aggressively but never actually proven.

What this means, practically, is that if you have ever felt vaguely defective, as though your brain were simply broken in some fundamental way, that story may have done you a disservice. Depression is real. The suffering is real. But "your serotonin is low" is not a satisfying or accurate explanation for why you feel the way you do.

So if it is not a chemical imbalance, what is it?

Depression as a Signal

In 2023, researchers at the University of Michigan published a randomized controlled trial testing what happens when people are given a different framework for understanding their depression. Instead of describing depression as a disease or disorder, the "signal" framing presented it as something that serves a function, a meaningful response to something in a person's life or history that needs attention. People who received the signal framing reported less self-stigma and more hope for recovery than those given the standard disease explanation. The framing mattered. How we understand our depression shapes how we relate to it, and how much agency we feel in addressing it.

This idea, that depression functions as a signal rather than a malfunction, is not new in clinical circles. It draws on evolutionary psychiatry, which asks: why would a response this powerful and this universal exist if it served no purpose? The honest answer is that depression, in many of its forms, appears to be the mind and body's way of saying: something here needs to change. Something here has been injured. Something here is asking for your attention.

The question worth sitting with is not "what is wrong with my brain?" It is "what is my depression trying to tell me?"

Two of the Most Common Things It Points To

In my practice, depression rarely arrives out of nowhere. When I sit with clients and we slow down enough to look beneath the symptoms, two things come up again and again.

The first is trauma, particularly experiences from early in life that shaped how a person learned to see themselves and the world. The research here is striking. Studies consistently show that adverse childhood experiences, including abuse, neglect, and household instability, significantly increase a person's lifelong vulnerability to depression. The connection is not merely statistical. Early experiences of being unsafe, unseen, or unloved leave traces in the nervous system and in the stories we carry about our own worth. Depression, in many of these cases, is not a brain disease. It is the body's long memory of something painful that was never fully addressed.

The second is the inner critic: that relentless internal voice that tells you that you are not enough, that you have failed, that other people are managing life better than you are. Research published in 2024 found that working directly with self-criticism in depressed patients produced significant improvements in depressive symptoms, self-compassion, and self-esteem. This tracks with what I see clinically. For many of my clients, depression is not a mood that descended from nowhere. It is the cumulative weight of years of harsh self-judgment, the exhaustion of living under a verdict that is never quite "good enough."

Paul Gilbert, the psychologist who developed Compassion Focused Therapy, has spent decades studying the relationship between self-criticism and depression. His central insight is that the inner critic was not born cruel. It developed, usually in childhood, as a way to stay safe, to meet high expectations, to avoid punishment or rejection. It was adaptive once. Over time, it becomes the thing that is making you sick.

What It Means If Depression Is a Signal

If depression is a signal, then the job is not simply to silence it. The job is to get curious about what it is pointing toward.

This does not mean refusing medication if medication would help. Signals can be so loud they make it impossible to function, and sometimes we need support to turn the volume down enough to do the deeper work. But medication that quiets the signal without ever asking what it was signaling is, at best, a partial answer.

It also means something important about how you relate to yourself while you are in it. Depression is not evidence that you are broken. It is not proof that your brain is defective or that you are constitutionally ill-suited for the life you are trying to live. It may be evidence that something happened to you that left a mark, or that you have been living under a weight of self-judgment that no person was designed to carry indefinitely.

That is a very different story. And in my experience, it is a more useful one, because it opens a door that the disease model tends to close. If depression is a signal, there is something to listen to. There is something to address. There is a path forward that is not just management, but genuine change.

A Note on Getting Help

Getting curious about what your depression is pointing toward is not something you have to do alone. In fact, it is often easier with a guide, someone who can help you slow down, look beneath the surface, and begin to understand what your inner world has been trying to say.

If you have been carrying depression and wondering whether there might be more to it than a chemical imbalance, I would be glad to talk. You can schedule a free 15-minute consultation at shareyourgrief.org. No pressure, no commitment. Just a conversation.

The Grief Nobody Talks About: Surviving the Loss of Someone to Suicide

There is a particular kind of grief that arrives wrapped in silence.

When someone you love dies of cancer, people bring food. They call. They sit with you. The loss is visible, the mourning is communal, and the world, imperfectly but genuinely, shows up.

When someone you love dies by suicide, something different often happens. People don’t know what to say, so they say very little. Friends pull back. Conversations stop mid-sentence. And you are left to carry not only the devastating weight of your loss, but a second, quieter burden: the sense that your grief is somehow too complicated, too uncomfortable, too charged with questions that nobody wants to ask out loud.

This is the grief that nobody talks about. And that silence, more than almost anything else, is what makes it so hard.

You Are a Survivor of Suicide Loss

If you have lost someone to suicide, a parent, a child, a partner, a friend, a sibling, you are what the grief community calls a “suicide loss survivor.” The term matters, because naming what you are going through is the first step toward not being alone in it.

Suicide loss survivors are not a small group. Research published in Suicide and Life-Threatening Behavior found that as many as 135 people are significantly affected by each suicide death. These are not strangers. They are people who loved the person who died, who are now navigating a form of grief that is, in important ways, unlike any other.

Understanding what makes this grief distinct is not about ranking losses or suggesting that suicide loss is worse than other bereavements. It is about being honest that it is different, and that those differences matter for how you grieve, what you need, and why the ordinary supports so often fall short.

Why This Grief Is Different

The Stigma Is Real, and It Has Consequences

Suicide carries a stigma that has deep historical and cultural roots. For centuries, suicide was treated as a moral failing, a sin, even a crime. Those frameworks have largely been discredited, but their residue remains, in the awkward silences, in the phrases people reach for, in the questions that hang unspoken in the air.

When that stigma surrounds a death, it surrounds the grief as well. Survivors often report feeling as though they must protect the circumstances of the death, telling some people the truth, giving others a vague explanation, managing a kind of double life in which the full story is never fully told. This concealment, however understandable, comes at a significant cost. Grief that cannot be spoken openly is grief that cannot be fully processed.

Dr. Jack Jordan, one of the leading researchers in suicide bereavement, has described this as a kind of “disenfranchised grief,” grief for a loss that society does not fully sanction or support. When your grief is disenfranchised, you don’t just lose the person. You lose access to the ordinary rituals and community support that help people move forward.

The Questions That Don’t Have Answers

Grief after most deaths involves questions. Grief after suicide involves a particular kind of question that can become consuming: Why?

Why did this happen? Was there a sign I missed? Could I have said something, done something, changed something? Did they know how much I loved them? Did I fail them?

These questions are not signs of weakness or irrationality. They are the mind’s attempt to make sense of something that often resists sense-making. But they carry a unique feature that distinguishes them from other grief questions: they are unanswerable. And living with an unanswerable question, with what researchers call “ambiguity” at the heart of your loss, is one of the most psychologically demanding aspects of suicide bereavement.

The search for a reason is understandable. But it is worth knowing that the absence of an answer is not the same as the absence of meaning, and that the questions themselves, over time, can shift from instruments of self-punishment into something quieter and more bearable.

The Guilt Is a Special Kind of Painful

Guilt is common in grief. After a suicide loss, it can be overwhelming.

Survivors frequently carry the weight of things said and unsaid, decisions made and unmade, moments they wish had gone differently. The “if only” loop, if only I had called that day, if only I had taken it more seriously, if only I had said the right thing, can run almost continuously in the early months of loss.

It is important to say this clearly: suicide is the result of a complex convergence of biological, psychological, and circumstantial factors. It is not caused by the failure of the people who loved the person who died. The responsibility does not belong to you. And yet grief rarely responds to logical argument, and knowing this intellectually is very different from feeling it.

Part of what grief therapy can offer is a space to sit with the guilt, not to dismiss it, but to examine it honestly, to distinguish between genuine regret and the distorted self-blame that loss so often generates, and to begin, slowly, to put it down.

The Trauma Layer

For many suicide loss survivors, especially those who discovered the body or were among the first to know, the loss carries a traumatic dimension that adds another layer of complexity to the grief. Intrusive images, hypervigilance, difficulty sleeping, a heightened startle response: these are not unusual, and they are not signs that something is permanently wrong with you. They are signs that your nervous system has been through something profound.

When trauma and grief are intertwined, they tend to complicate each other. Trauma responses can make it difficult to engage with the grief work that supports integration, and unprocessed grief can intensify trauma symptoms. Recognizing this interplay, and finding support that addresses both, is an important part of the path forward.

What Integrating This Grief Can Look Like

None of this is meant to suggest that integrating a suicide loss is impossible. It is not. Survivors of suicide loss can and do find their way to lives that are meaningful, even joyful, lives in which the person they lost remains present in memory and love, without the grief being a constant emergency.

But grief integration after this kind of loss tends to require a few things that are worth naming.

Permission to grieve fully. You do not need to protect others from the circumstances of your loss, or from the intensity of your grief. You are allowed to mourn completely and openly, even when the world around you seems uncertain how to hold that.

Connection with others who understand. There is something that happens in a room full of people who have experienced the same kind of loss, a recognition, a relief, a sense that you are not alone in the specific texture of what you are carrying. Survivor of suicide loss support groups exist for exactly this reason, and the research consistently shows they help.

A space to sit with the unanswerable. A good therapist will not try to give you answers you cannot have. They will help you develop a different relationship with the questions, one that allows you to carry them without being crushed by them.

Time, and patience with the non-linearity of it. Suicide bereavement research suggests that the mourning process after this kind of loss often takes longer than after other deaths, and that the path is rarely straight. The second year is often harder than the first. Grief that seemed to be softening can resurface sharply around anniversaries, holidays, and milestones. None of this means you are stuck. It means you are grieving something real.

A Final Word

If you are reading this because you have lost someone to suicide, I want to say something directly: your grief is real, it is valid, and it deserves to be seen.

The silence around this kind of loss is not a reflection of its significance. It is a reflection of a cultural discomfort with suicide that has nothing to do with the depth of your love or the enormity of your loss. You are allowed to grieve loudly, or quietly, or in whatever way is true to you. And you deserve support that meets you where you actually are.

You do not have to carry this alone.

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I am a Licensed Clinical Social Worker and Certified Grief Counselor specializing in grief therapy in Boulder, Colorado. I also have the privilege of facilitating a survivor of suicide loss support group in the Boulder community. If you are a suicide loss survivor and wondering whether individual therapy, a support group, or both might help, I would welcome a conversation. You can schedule a free 15-minute consultation at shareyourgrief.org, no pressure, no commitment, just a chance to talk.

What Is Grief Integration? A Plain-Language Guide to the Term Therapists Use Instead of "Moving On"

If you have spent any time in grief therapy, or read anything about loss in the past decade, you have probably encountered the phrase grief integration. It shows up in books, in clinical handouts, in the language therapists use. But what does it actually mean? And why do grief counselors keep using it instead of the more familiar language of "healing" or "moving on"?

This post is an attempt to answer those questions plainly, because the concept matters. Understanding it can genuinely change how you relate to your own grief.

Why "Moving On" Falls Short

The cultural script for grief is familiar: you feel the loss, you work through it, and eventually you move on. The grief recedes. Life returns to something like normal.

The problem is that this script doesn't match what most people actually experience. For the vast majority of bereaved people, the loss doesn't recede. The person who died doesn't become less important. The relationship doesn't fade into the background. And for many grievers, the expectation that it should (that this is what "healthy" grief looks like) becomes its own source of shame and confusion.

Am I stuck? Is something wrong with me? Why haven't I moved on yet?

The concept of grief integration offers a different and, I would argue, more honest framework.

What Integration Actually Means

Grief integration is not the disappearance of grief. It is the reshaping of it.

Dr. M. Katherine Shear of the Columbia Center for Complicated Grief, one of the leading researchers in this field, describes it this way: grief begins as an acute experience, intense, disruptive, and all-consuming. Over time, through a natural mourning process, that acute grief is gradually reshaped into something quieter. It doesn't vanish, but it becomes woven into the fabric of a person's daily life rather than dominating it.

Integrated grief, in Shear's framework, is grief that allows you to remember and honor the person you lost without that grief continually derailing your ability to function and find meaning. The loss remains real and present. The love remains real and present. But the pain no longer occupies every room.

Think of it this way: in the early days of loss, grief is the whole house. Integration is the process by which your life (your capacity for joy, connection, and purpose) slowly grows larger around it, until grief becomes one room among many rather than the only room you can inhabit.

What the Mourning Process Involves

Integration doesn't happen passively, and it doesn't happen on a schedule. But research suggests that certain things tend to support it.

One is “dosing”: the natural rhythm of moving toward grief and then away from it. Bereaved people instinctively learn to spend time with their pain, and then let their minds turn toward something else, and then return. This isn't avoidance. It's regulation. It's the mind's way of managing what would otherwise be an unbearable continuous exposure to loss.

Another is “continuing bonds”: the gradual discovery that a relationship with someone who has died doesn't have to end; it simply changes form. Memories, values, rituals, and a felt sense of connection can all become ways of maintaining a relationship with someone who is gone. This is not denial. It is one of the most natural and healthy aspects of mourning.

Integration also involves adjusting to the practical and identity-level changes that loss creates, many of which are losses in their own right. Who are you now? What does your daily life look like without this person in it? These questions don't have fast answers, but sitting with them, and slowly finding new answers, is part of how integration happens.

Integration Is Not the Same as "Getting Over It"

This distinction matters enormously, and it is worth saying plainly: integrated grief is not resolved grief. You do not stop loving the person. You do not stop missing them. Grief integrated into your life is still grief.

What changes is the relationship between your grief and your life. Early in loss, grief tends to crowd everything else out. Over time, for most people, life gradually reclaims space alongside the grief. The two coexist. You can hold both the weight of the loss and moments of genuine happiness, connection, and even joy. Not because the loss has become less real, but because you have grown larger around it.

When Integration Doesn't Happen

For some people, the natural mourning process stalls. Grief researchers sometimes call this “complicated grief” or, in clinical language, Prolonged Grief Disorder: a state in which acute grief persists long past the point where integration would typically have begun. If you feel genuinely stuck, if the pain remains as raw and disorienting as it was in the earliest days of your loss, that is worth paying attention to. It is not a character flaw, and it is not permanent. It may be a signal that some additional support could help.

A Final Thought

You will never "get over" the death of someone you loved. You aren’t supposed to. Integration is not about leaving them behind. It is about learning to carry them with you, in memory, in love, in the values and habits and ways of being they shaped in you, while also stepping back into your own life.

That is not moving on. That is moving forward. And there is a profound difference.

If you are struggling with grief and wondering whether what you are experiencing is typical or something more, I am happy to talk. You can schedule a free consultation here.

Why Being in Nature Is Not Just a Nice Idea

There is a particular kind of relief that happens when you step outside, especially when the air is cool and the light is soft and the noise of the day falls away for a moment. Most of us have felt it. We tend to chalk it up to a break from routine, or simply the pleasure of fresh air. But what is actually happening when we spend time in nature goes considerably deeper than that.

Time outdoors does something real to the mind and body. Clinicians and researchers are increasingly treating time in nature not as a pleasant suggestion but as a legitimate intervention, one that produces measurable improvements in psychological well-being and measurable reductions in burnout and stress. Nature, it turns out, is doing something we have only recently begun to understand.

What Nature Actually Does

When we step into a natural setting, something in the nervous system shifts. The relentless mental noise of daily life, the to-do lists, the replaying of conversations, the anticipatory dread, begins to quiet. There is something about the sensory richness of the natural world, the texture of bark, the sound of water, the movement of light through leaves, that draws the mind out of its interior loops and anchors it, briefly, in the present.

This is not a soft or sentimental claim. Clinicians working in structured nature-based therapy settings have documented improvements in psychological well-being that persist long after the formal treatment ends. The benefits are not a temporary lift. They tend to hold.

What also emerges from this work is something less expected: a renewed sense of purpose and autonomy. People who spend time tending growing things, even something as simple as a seedling or a small garden plot, report feeling like active agents in the world rather than passive sufferers within it. Caring for something alive, something that needs you, has a way of quietly recalibrating how we see ourselves.

Nature and the Grief

Grief tends to narrow the world. The couch, the bedroom, the kitchen. The same rooms, the same thoughts, the same loop of memory and longing. Getting outside does not solve any of that. It does not fill the absence or move the timeline forward. But what nature offers is something grief often lacks: spaciousness.

There is something about the scale of the natural world that gently reorganizes our sense of proportion, not by diminishing the loss, but by placing it inside something larger. The grief is still there. But it is held differently when you are standing under a wide sky or listening to water move over rock. The world goes on, not in a way that dismisses your pain, but in a way that makes a little more room for it.

Nature also offers something important for those carrying anxiety alongside grief: a place with nothing to perform. No one to update, no progress to demonstrate, no correct way to be. The trees do not care how well you are grieving. That absence of evaluation, even a brief one, can feel like the first full breath in a long time.

The Body Remembers What the Mind Forgets

One of the quieter benefits of time in nature is what it does for informal mindfulness. Not the structured, sit-down-and-breathe kind, but the more ordinary variety that happens when you are simply moving through the world and paying some gentle attention to it.

A walk in a forest, a slow wander through a garden, a few minutes sitting outside without a phone in hand: these create a kind of low-demand awareness that our indoor, screen-filled lives rarely allow. And in that awareness, something useful tends to happen. Negative thought patterns become more visible, not because we are working hard to identify them, but because the natural world gives the mind just enough to attend to that the loops lose their grip.

This is why so many people report that they think more clearly outside. It is not just the movement or the air. It is that the body is doing something and the surroundings are offering something and the relentless interior monologue, just for a moment, steps aside.

Where to Begin

None of this requires a formal program, a trail map, or an ambitious plan. It requires very little, actually.

A walk in a neighborhood park counts. Sitting near water counts. Tending a few plants on a porch or a windowsill counts. The key is to slow down enough to arrive where you actually are, to let the senses lead rather than the task list. The point is not to exercise or accomplish something. It is to give yourself a few minutes in a place that does not require anything of you, where something living is simply going about its work, and you are welcome to watch.

If you are grieving, I would not tell you that going outside will fix anything. What I would say is this: your nervous system is not indifferent to the natural world. The relief you feel when the air is cool and the light is soft is not a coincidence. It is, in some sense, what you were built for. And on the hard days, that is worth remembering.

Grief is not something you have to figure out on your own. If you're in the thick of it right now — exhausted, overwhelmed, or just unsure what you're even feeling — I'd be honored to sit with you in it. Reach out for a free 15-minute consultation. Let's talk.

The Exhausting Math of Perfectionism: Why You're Always Behind Even When You're Ahead

There is a particular kind of exhaustion that has nothing to do with how much you've accomplished. You finish the project. You get the good review. You cross the last item off the list. And then, almost immediately, your mind pivots — not to satisfaction, but to the audit. What could have been sharper? What did I miss? What would it have looked like if I'd started earlier, tried harder, cared more?

This is the exhausting math of perfectionism: no matter what you produce, the numbers never quite add up.

The Moving Goalpost

Psychologists have a name for what happens in the moment after a perfectionist finishes something: contingent self-worth. The idea is that for people who struggle with perfectionism, their sense of value isn't stable — it's perpetually tied to the next performance. Complete one task, and rather than registering a moment of genuine satisfaction, the goalpost simply moves.

This isn't stubbornness or ingratitude. It is, in many ways, how perfectionism was designed to work. Researcher Dr. Gordon Flett has described perfectionism as a system built on the premise that you are only as good as your last output — which means that any completed output immediately becomes last, and therefore no longer enough.

The result is a psychological loop that is nearly impossible to win. The finish line exists only long enough to become the new starting line.

Why the Brain Can't Settle

Drawing from a neuroscience perspective, this experience has a name: the reward prediction error. When we complete something meaningful, the brain's dopamine system is supposed to provide a brief signal of satisfaction.  In the perfectionist's brain, the anticipated reward — the "good enough" standard — is set so high that the completion rarely triggers it. The brain registers not a reward, but a shortfall, and immediately redirects attention toward the gap.

What this means, practically, is that perfectionists are often working harder than anyone around them and feeling worse for it. The effort is real. The achievement is real. But the internal experience is one of chronic deficiency.

This is not a character flaw. It is a pattern — and patterns can be changed.

The "Should Have" Spiral

One of the clearest signs of this loop is the post-completion debrief that perfectionists conduct almost automatically. You finish a presentation and walk out of the room already cataloguing the slide you wish you'd revised. You send an email and immediately notice the sentence that could have been cleaner. You have a difficult conversation and spend the rest of the day reconstructing it, line by line, for a better outcome you can no longer reach.

Cognitive behavioral therapists refer to this as post-event processing — a tendency to mentally review completed events through a critical lens, emphasizing what went wrong and minimizing what went right. Research consistently shows that this kind of rumination doesn't improve future performance; it primarily increases anxiety and deepens self-doubt.

In other words, the debrief feels productive. It almost never is.

The Cost of Always Being "Almost There"

When the goalpost is always moving, you never actually arrive anywhere. And the cost of that relentless forward-leaning is significant.

Relationships suffer when the people around you sense that their effort — and yours — is never quite enough. Creative work suffers when the fear of the post-completion debrief makes starting feel dangerous. And perhaps most quietly devastating, your sense of identity suffers: if your worth is always contingent on the next thing, there is no stable ground beneath you.

Dr. Kristin Neff's research on self-compassion speaks directly to this. She has found that people who treat themselves with warmth and kindness after a setback or an imperfect performance are more resilient, not less — more likely to try again, not less motivated. The inner critic, for all its noise about raising standards, is in fact raising anxiety and lowering the capacity for genuine growth.

Toward a Different Kind of Accounting

If the perfectionist's math is always yielding a deficit, the work is not to lower your standards — it is to change the equation.

Notice the pivot. When you finish something and feel the pull toward the debrief, pause and name it: "I am doing the thing where I immediately look for what's wrong." That moment of naming — what therapists call defusion in Acceptance and Commitment Therapy — creates just enough distance to choose a different response.

Acknowledge completion as its own category. Not "it's good enough, I suppose," but a genuine recognition that you finished something, and finishing is a real accomplishment with real value. For many perfectionists, this feels almost embarrassingly simple. That discomfort is worth sitting with.

Set the terms of "done" in advance. Before you begin a project, decide what "complete" means. Write it down if it helps. When you reach that standard, completion is the verdict — not a provisional state pending further review.

Distinguish between reflection and rumination. Healthy reflection asks: What would I carry forward? Rumination asks: What does this say about whether I am enough? One is useful. The other is the loop.

A Note on Perfectionism and Grief

For those navigating grief alongside perfectionism — and there are many — this loop can take on an especially painful dimension. Perfectionists often apply the same relentless audit to their mourning: wondering if they are grieving correctly, enough, or in the right way. They may replay conversations with the person who died, cataloguing words they wish they had said and things they wish they had done differently. This shows up especially sharply at work, where grief and performance pressure collide directly.

If this resonates, please know that grief is not a performance to be evaluated. There is no standard you are failing to meet. And the love underneath all of that self-scrutiny — the love that made you want to do things right — is not something that needed to be earned in the first place.

The goal isn't perfection. It never was. The goal is a life you can actually inhabit while you're living it.

The Unseen Griever

There is a kind of loss that nobody sends flowers for. No one shows up at your door with a casserole when your marriage ends. There is no bereavement leave when your friendship quietly dissolves. The world doesn't pause when you lose a job that gave your days meaning, or when a parent you always hoped would finally see you makes clear that they never will.

And yet we can grieve these losses deeply. And, sadly, often grieve alone.

We have a narrow cultural script for grief. It involves death, a funeral, a period of mourning that is socially sanctioned and, above all, time-limited. But grief doesn't follow that script. And many people who are quietly devastated by losses that go unseen, often leaving the person with the belief they don't even have permission to grieve (we sometimes refer to such grief as “disenfranchised grief”.

The losses we forget to name

Therapists use the term "ambiguous loss" to describe losses that lack the clarity of death: the parent lost to dementia who is still physically present, the estranged sibling who is alive but gone, the version of your life you had to abandon when illness or circumstance intervened. Pauline Boss, who coined the term, observed these losses are often the hardest to heal precisely because they are unacknowledged. There is no ritual. No community. No shared language for what you are going through.

A divorce is one of the most disorienting experiences a person can go through. You are not just losing a partner. You are losing a future you believed in, a family structure, a home, a daily rhythm, sometimes an entire social world. And yet grief after divorce is frequently minimized, even by the people experiencing it. "At least you didn't lose a child." The comparison closes the door before you've even had a chance to open it.

Job loss carries a grief that often goes unnamed too. For many people, work is not simply income. It is identity, structure, community, and purpose. When it disappears, something foundational can collapse in ways that feel frightening and embarrassing in equal measure. Grief and employment collide in other ways too, including what happens once bereavement leave runs out.

And then there is the grief that comes from people who are still alive: the estrangement from a parent or sibling, the slow unraveling of a friendship that once felt permanent. This kind of grief can be the loneliest of all, because the person is still there. You can't mourn them the way you mourn the dead. But you are mourning something just as real.

Why it matters to call it what it is

Naming grief as grief is not self-pity. It is accuracy.

When we don't name what we're carrying, we often don't give ourselves the care we need. We push through. We tell ourselves to be grateful. We wonder why we feel so heavy and hollow, and we conclude that something must be wrong with us rather than recognizing that something happened to us.

Grief is the natural response to losing something that mattered. It doesn't require a death certificate or anyone else's validation to be real.

What this might mean for you

If you are reading this and feeling something loosen in your chest, it might be because you have been carrying a loss without permission to grieve it.

Whatever you have lost, whether it is a person, a relationship, a version of your life, a dream, a role, a future you had counted on, you are allowed to grieve it. You are allowed to take it seriously. You are allowed to be changed by it.

And if you have been wondering why you can't simply get over it, it might be because no one ever told you that what you went through was a loss worth grieving in the first place.

It was. It is.

The Weight You Were Never Meant to Carry Alone: Using Self-Compassion to Heal Shame and Guilt

There is a particular kind of suffering that is different from ordinary sadness or anxiety. It lives deeper, quieter, and often goes unspoken. It whispers that you are not just someone who has done something wrong, but that you are fundamentally wrong — defective, unlovable, beyond repair. That is shame.

And for those who are grieving, shame is a frequent and unwelcome companion.

Shame and Guilt: An Important Distinction

Before we explore how compassion heals shame, it helps to understand what shame actually is and how it differs from guilt.

Guilt says, I did something bad. Shame says, I am bad. This distinction matters enormously. Guilt, while painful, is actually connected to compassion. When we feel genuine guilt, we recognize that our actions affected someone else and we feel a desire to repair that harm. Guilt is oriented outward towards the relationship, towards making things right.

Shame, by contrast, turns inward and becomes an attack on the self. Rather than motivating repair, it tends to trigger what researchers call the threat response: fight, flight, freeze, or appease. We hide. We isolate. We drink, overwork, or lash out. And in doing so, we inadvertently fan the very flames we are trying to extinguish.

As psychologist Dr. Paul Gilbert, founder of Compassion Focused Therapy, explains, the goal in therapy is often to help clients move from shame toward guilt, because guilt at least opens the door to repair and reconnection.

The Three Faces of Shame

Shame takes different forms and it helps to recognize them.

External shame is about how we believe others see us. Often we fear that if people really knew us, they would find us wanting. Internal shame is what we privately believe about ourselves regardless of what others think. We see this as the relentless inner conviction of not being good enough. And then there is the inner critic who is that familiar internal voice pouring fuel on every fire, ensuring that a single mistake becomes a verdict on our entire worth.

What all three have in common is that they thrive in silence and isolation. As Dr. Christopher Germer notes, shame feels blameworthy, isolating, and all-encompassing. However, shame is actually an innocent emotion, a universal one, and a temporary one. The problem is that when we are inside it, it feels like the whole truth about who we are.

Why Logic Alone Doesn't Work

Many of us have tried to think our way out of shame. We remind ourselves that we are being too hard on ourselves, that others have done worse, that we are not defined by our mistakes. And yet nothing shifts. This is what researchers call the "heart-head lag." We can understand something intellectually while our emotional experience remains completely unchanged.

This is precisely why self-compassion is so powerful. It works not by changing our thoughts, but by changing the emotional tone we bring to our experience. Research by Dr. Kristin Neff consistently demonstrates that self-compassion, which is the practice of treating ourselves with the same kindness we would offer a struggling friend, directly reduces shame. It interrupts the threat response and activates what Gilbert calls the "soothing system," creating the safety our nervous system needs to begin healing.

Compassion as the Antidote

So what does self-compassion actually look like when shame is present?

It begins with labeling, i.e., naming what we are feeling. Research shows that the act of labeling an emotion can deactivate the amygdala, the brain's alarm system, reducing its intensity. "This is shame" is not a surrender to it. It is the beginning of perspective.

It continues with common humanity: the recognition that shame, guilt, and the fear of not being enough are not signs of personal failure. They are part of the human experience. Every person who has ever loved deeply has also known the terror of falling short.

And it deepens with tone: the quality of voice we bring to our own inner experience. Gilbert found that clients could reframe their thoughts completely and still feel no relief, because the emotional tone of their inner voice remained harsh and hostile. Learning to speak to ourselves with warmth — the way we would speak to someone we love — is not a soft or sentimental exercise. It is neurologically transformative.

A Note for Those Who Are Grieving

Grief and shame are deeply intertwined. Grieving people often carry shame about how they are mourning — feeling they are too much or not enough, too sad for too long, or somehow failing at the very human act of loss. Some carry shame about the circumstances of a death, particularly in cases of suicide loss or estranged relationships.

If this resonates with you, please know this: grief is not a performance. There is no correct way to mourn. And the shame you carry about your grief is not a reflection of your failure but rather a reflection of how deeply you loved, and how profoundly you have been changed by loss.

Compassion is not about letting yourself off the hook. It is about recognizing that you are a human being doing the impossibly hard work of carrying what you have been given and that you deserve kindness in the carrying of it.

If the voice in your head is harder on you than you'd ever be on anyone else, therapy can help you understand where that comes from — and quietly loosen its grip. I offer a free 15-minute consultation, no commitment required. Schedule a conversation here.

Perfectly Anxious: Understanding the Link Between Perfectionism and Anxiety

There is a particular kind of exhaustion that comes not from doing too much, but from never feeling like what you do is quite enough. If you have ever finished a project, received praise, and immediately shifted your focus to what you could have done better, you may be familiar with the quiet tyranny of perfectionism.

Perfectionism and anxiety are close companions — and understanding why can be the first step toward loosening their grip.

The Perfectionism-Anxiety Connection

Perfectionism is not simply having high standards. Researchers distinguish between adaptive perfectionism — a healthy pursuit of excellence — and maladaptive perfectionism, characterized by a fear of failure, harsh self-criticism, and an all-or-nothing thinking style. It is this latter form that fuels anxiety.

The mechanism is straightforward: perfectionists set standards that are, by definition, nearly impossible to meet. When those standards are not met — and they rarely are — the perfectionist interprets the shortfall not as a normal part of being human, but as evidence of personal inadequacy. This creates a chronic state of threat that the brain interprets as danger, activating the same anxiety response as a physical threat. The result is a relentless cycle of striving, falling short, and self-criticism that keeps the nervous system in a near-constant state of alert.

Where Does Perfectionism Come From?

Perfectionism rarely develops in a vacuum. Research consistently points to several contributing factors:

Early experiences of conditional approval — growing up in an environment where love or praise felt contingent on achievement can teach a child that their worth is earned, not inherent.

A response to uncertainty or chaos — for some, perfectionism develops as a coping mechanism. If I can just control my performance, I can control outcomes. It is an understandable strategy that ultimately creates more anxiety than it resolves.

Cultural and social messaging — we live in a culture that celebrates productivity and achievement while stigmatizing failure. Social media, with its curated highlight reels, amplifies the illusion that everyone else is performing life flawlessly.

Temperament — some people are simply wired with a stronger sensitivity to mistakes and a heightened need for order and predictability.

Tools for Loosening Perfectionism's Grip

The goal in managing perfectionism is not to abandon your standards — it is to build a healthier relationship with imperfection.

Practice self-compassion over self-criticism. Research by Dr. Kristin Neff demonstrates that self-compassion — treating yourself with the same kindness you would offer a struggling friend — is more effective at motivating change than self-criticism, which tends to increase shame and avoidance.

Challenge all-or-nothing thinking. Perfectionism thrives on binary thinking: success or failure, good enough or worthless. When you notice this pattern, try asking yourself, "Is there a middle ground here?" A project that is 80% of what you envisioned is not a failure — it is a completed project.

Set process goals rather than outcome goals. Instead of "I need to do this perfectly," try "I will give this my genuine effort for the time I have." Shifting focus from outcome to process reduces the anxiety that comes from fixating on results you cannot fully control.

Embrace "good enough." Psychologist Barry Schwartz's research on decision-making introduced the concept of "satisficing" — choosing an option that is good enough rather than optimal. Perfectionists are maximizers who exhaust themselves searching for the best possible outcome. Learning to satisfice in lower-stakes situations is a skill that can be practiced and gradually expanded.

A Note on Perfectionism and Grief

For those who are grieving, perfectionism can add an invisible layer of suffering. Perfectionists often feel they should be grieving "correctly": their emotions are too much or not enough, that they should be further along by now, or that they are somehow failing at the very human act of mourning. Work adds its own version of this pressure, a place where grieving 'correctly' can start to look like staying composed enough to get through the day. If this resonates with you, please know that there is no right way to grieve. Grief, like life, is beautifully and necessarily imperfect.

Reaching out for help is often the hardest step — especially when part of you worries that your struggles aren't "bad enough" to warrant it. They are. I offer a free 15-minute consultation where we can simply talk about what you're experiencing. You can schedule that here.‍ ‍

The Digital Afterlife: Grieving in the Age of AI and Social Media

In the past, the "stuff" of grief was tangible: a handwritten letter, a worn-out sweater, a photo album. Today, most of what we leave behind is a "digital shadow”: years of texts, voice notes, and social media footprints. This shift has changed the architecture of mourning, creating a world where the dead can remain surprisingly vocal.

As we navigate this landscape, we should ask: Does this digital continuity help us integrate our grief, or does it keep us tethered to a ghost?

The Rise of the "Griefbot"

The most provocative development in the AI space is the "griefbot"—AI trained on a deceased person’s digital footprint (texts, social media posts, recorded conversations, etc.) to simulate a conversation with the deceased. For some, it feels like a lifeline; a way to ask one last question or hear a familiar cadence.

However, from a clinical perspective, these "digital resurrections" carry significant risks. Grief is the process of coming to terms with the finality of loss. Interacting with a simulacrum can sometimes blur the boundaries of reality, potentially leading to emotional dependency or becoming “stuck” and unable to integrate our grief into a meaningful life. Stated another way, a griefbot has the potential to become a pernicious form of denial that ultimately inhibits healthy grieving.

This is not to say imagined conversations with a deceased love one are per se unhealthy. To the contrary, such conversations are often a form of healthy continuing bonds with their loved one. It is also important to note there are evidence-based therapies, such as Imaginal Conversations used in Prolonged Grief Disorder Therapy, where a grieving person engages in a conversation with their deceased loved one within a safe, therapeutic environment.

The "Algorithm of Loss"

Even if we stay away from AI, social media itself acts as a persistent reminder. A "On This Day" notification can feel like a gift or a gut-punch, depending on the morning.

• The Public Nature of Grief: Mourning has moved from the private living room to the public feed. This can create a sense of community, but it also leads to "grief policing," where people feel judged for how or how much they post about their loss.

• The Digital Haunting: Seeing a "Suggested Friend" who has died is a uniquely modern phenomenon. It’s a reminder that while the person is gone, their digital data is still moving through the world.

Practical Steps for Your Digital Legacy

Because our digital lives are so intertwined with our emotional ones, "digital estate planning" is now a vital part of end-of-life care. Taking control now can save your loved ones from a "second loss"—the pain of being locked out of memories or seeing an account handled in a way you wouldn't have wanted.

• Assign a Legacy Contact: Platforms like Facebook and Google allow you to name someone who can manage your account or download your data after you die.

• The "Social Media Will": Document your wishes. Do you want your profiles memorialized (frozen in time for friends to visit) or deleted entirely?

• Data Sovereignty: Consider who owns your "voice" and your "likeness" after you’re gone. Discuss with your family your feelings on AI recreations.

Finding a Digital Middle Ground

Technology should serve your grief, not the other way around. If a "memory" notification feels like a beautiful visit, cherish it. If it feels like an intrusion that resets your grief journey, give yourself permission to "Press Pause" or deactivate the accounts.

The goal is not to erase the digital footprints of those we love, but to ensure they don't become a barrier that keeps us from living in the present.

If what you've read here resonates, you don't have to keep navigating this alone. I offer a free 15-minute consultation so we can talk about what you're carrying and whether grief therapy might help. There's no pressure and no commitment — just a conversation. Schedule here.‍ ‍

Am I Stuck? When Grief Becomes a Cage

Grief is not a disease, and that truth does not change simply because you continue to carry it beyond an artificial timeframe. Whether it has been one year or ten, the presence of grief is not a symptom to be cured, but a reflection of a bond that continues to exist. We must be careful not to mistake the enduring nature of grief for a psychological failure.

At the same time, it is possible for the grieving process to lose its fluidity. There is a point where grief stops being a heavy, somber companion on your journey and starts becoming a cage: a place where the walls feel fixed and the exit feels barred. In the clinical world, we have defined this specific experience of "cage-like" or “stuck” grief: Prolonged Grief Disorder (PGD).

When Grief Becomes "Prolonged"

The inclusion of PGD in the DSM-5-TR was controversial, and for good reason. Grief is the natural reaction to loss. As such, pathologizing grief can be injurious and another way our society stigmatizes grief and grievers. There are times, however, where the PGD diagnosis allows us to identify when grief has derailed and our grief reactions are entrenched to the point that we cannot pursue a meaningful life.

For adults, we cannot diagnose someone with PGD within the first 12 months of the loss (for children this time period is 6 months). PGD is characterized by a persistent longing for the deceased or a preoccupation with thoughts and memories of the person who died. Beyond that, we look for "traffic jams" or “derailers” that occur nearly every day, such as:

• Identity Disruption: Feeling as though a part of oneself has died.

• Avoidance: Intense efforts to avoid reminders that the person is gone.

• Emotional Numbness: An inability to experience positive emotions.

• Life Interruption: Significant difficulty engaging with friends, interests, or planning for the future.

The Distinction: Stuckness vs. Integration

The difference between PGD and "regular" (though painful) grief is often one of stagnation versus movement. PGD feels like being caught in a circular storm where our acute grief persists long after the loss occurred.

Integration, by contrast, feels like a slow, erratic tide. If you feel like your grief hasn’t shrunk, you’re right; it hasn’t. But you aren’t "stuck" just because the pain remains the same size. Think of your grief like a stone in a jar. In the beginning, that stone fills the entire jar. As time passes, the stone doesn't get smaller, but the jar—your life, your hopes for the future, your capacity for joy—starts to grow larger around it.

Questions for Reflection: Identifying Your Growth

When that "stuck" feeling becomes overwhelming, take a moment to look at the landscape of your life. These questions can help you notice the subtle shifts of integration:

• The "And" Factor: Can I hold two seemingly opposite things at once? Am I able to feel a moment of beauty and the weight of my loss in the same afternoon?

• The Shape of the Day: Is my grief an all-consuming fog, or is it a heavy backpack that I am learning to wear as I go about my day?

• The Narrative Shift: When I think of them, am I beginning to have "visits" from happier memories rather than just the trauma of the end?

• The Quiet Growth: In what ways has my perspective on compassion or "what matters" expanded because of this loss?

A Final Thought

You aren't a project to be finished or a problem to be solved. You are a person who has been changed by a profound loss. Integration isn't the absence of pain; it’s the presence of the loss within a functioning, meaningful life. If you still feel the weight, it doesn't mean you’re standing still: it means you’re carrying something significant as you move forward. 

Grief is not something you have to figure out on your own. If you're in the thick of it right now — exhausted, overwhelmed, or just unsure what you're even feeling — I'd be honored to sit with you in it. Reach out for a free 15-minute consultation. Let's talk.

The Myth of Closure: Why Integrating Grief Doesn’t Mean Saying Goodbye

We are often told that the goal of grieving is "closure." The word itself suggests a neat and tidy conclusion—a door that swings shut, a book that is finished, a chapter that is permanently left behind. Friends and family might use this word with the best of intentions, hoping for the day you can finally "move on" and return to the person you were before.

But for those who have lived through deep loss, the word closure often feels like an insult. It implies that if we just work hard enough, we can somehow sever the bond with the person we lost.

Why Closure is a Cultural Fiction

The reality is that human beings are not designed for closure. Our brains are hardwired for attachment. When we love someone, they become part of our internal map—their voice, their values, and their presence are woven into our own identity. Death ends a life, but as pioneer Pauline Boss famously argued, it does not end a relationship.

Seeking closure is often an exercise in frustration because it sets up a false finish line. When you inevitably feel a wave of grief years later—triggered by a song, a scent, or a milestone—you may feel like you’ve "failed" at healing. In truth, that wave isn't a sign of failure; it’s a sign of the enduring nature of love.

Moving Forward, Not Moving On

If the goal isn’t closure, what is it? In grief therapy, our goal is integration: learning to live with our loss and pursue a life that is meaningful to us.

Instead of trying to close a door on the past, we learn to carry the absence with us. We move forward with our grief, not away from it. This is often called "Continuing Bonds." It means finding a new way to relate to the person who died—perhaps through rituals, through living out the values they taught us, or simply by acknowledging that they are still a part of our "inner committee."

Letting Go of the Pressure

If you are waiting for a day when the loss no longer matters, you are waiting for a day that will never come—and that is actually okay. You don't need to "resolve" your grief to live a beautiful, meaningful, and even joyful life.

Integrated grief is not about the disappearance of the pain; it is about the expansion of your world around that pain. You are allowed to be a person who carries this absence forever. You are allowed to keep the door open.

Grief is not something you have to figure out on your own. If you're in the thick of it right now — exhausted, overwhelmed, or just unsure what you're even feeling — I'd be honored to sit with you in it. Reach out for a free 15-minute consultation. Let's talk.