Grief & Bereavement Counseling in FL & SC

The short answer

Stedfast Psychiatry offers grief and bereavement counseling for people whose grief has become stuck, overwhelming or complicated, including prolonged grief disorder, a diagnosis added to the DSM-5-TR in 2022. Therapy is time-limited and specific to grief; psychiatric care is available when grief triggers depression, anxiety or insomnia. In person at 13 offices or by video in Florida and South Carolina.

Stedfast Psychiatry provides grief counseling and psychiatric care for bereavement across Florida and South Carolina. Our therapists work with acute grief, complicated and prolonged grief, grief after suicide or sudden death, anticipatory grief during a long illness, and losses that are not deaths: a divorce, a diagnosis, a miscarriage, a career. Our prescribers treat the depression, anxiety and insomnia that grief can trigger.

Who it is for

Anyone whose grief is interfering with life in a way that time is not fixing. That includes people a few weeks out from a death who are not sleeping, not eating or not safe; people months out who cannot return to work or care for their children; and people a year or more out whose longing and preoccupation with the person they lost have not eased at all. It includes people grieving a loss that others do not recognize: a pregnancy, an ex-spouse, a pet, an estranged parent, a patient.

It also includes the specific situations that make grief harder. Death by suicide, overdose, homicide or accident. The death of a child. A death you witnessed or feel responsible for. A loss during a period when you could not grieve because you had to hold everything together. Caregivers who spent years in anticipatory grief and feel nothing, or relief, when the death finally comes. Older adults who have lost a spouse of fifty years. We see adults and adolescents, and we see families together when that helps.

How it works

The first session is an assessment of the loss and of you. Your therapist asks about the person who died and how, about your relationship, about what the days are like now, and about sleep, appetite, substance use, safety and whether the grief is changing with time. We distinguish three things that look alike and are treated differently: normal acute grief, which needs support and time; major depression triggered by the loss, which needs treatment in its own right; and prolonged grief disorder, which needs a specific therapy.

Prolonged grief disorder was added to the DSM-5-TR in 2022. It is diagnosed when, at least 12 months after a death (6 months for children), a person has intense yearning or preoccupation with the deceased nearly every day, plus symptoms such as identity disruption, disbelief, avoidance of reminders, intense emotional pain, numbness, a sense that life is meaningless, or loneliness, to a degree that impairs functioning and exceeds cultural norms. It affects roughly one in ten bereaved people and is more common after sudden or violent deaths. We screen for it with the Prolonged Grief Disorder scale.

Treatment for prolonged grief uses a structured approach developed and tested in randomized trials, drawing on CBT and on exposure: telling the story of the death in detail until it loses its rawness, re-engaging with reminders and places that have been avoided, rebuilding a relationship with the person's memory, and restoring goals and connections in a life that must now go on without them. It typically runs 16 sessions. For acute grief that is not prolonged, supportive counseling is shorter and less structured. Where depression is present, our prescribers treat it with medication alongside therapy; antidepressants do not treat grief itself but they do treat the depression it can set off.

Prolonged grief disorder was added to the DSM-5-TR in March 2022 and is estimated to affect about 7 to 10 percent of bereaved adults.

Source: American Psychiatric Association, DSM-5-TR; Lundorff et al., Journal of Affective Disorders, 2017

In a randomized trial, a targeted treatment for complicated grief produced response in 71 percent of patients compared with 32 percent for standard interpersonal therapy.

Source: Shear et al., Journal of the American Medical Association, 2005

Rates of prolonged grief are substantially higher after sudden, violent or unexpected deaths, including suicide, overdose and accidents.

Source: Kristensen, Weisaeth and Heir, Psychiatry, 2012

Bereaved spouses have an increased risk of death in the months following a partner's death, a pattern sometimes called the widowhood effect.

Source: Shah et al., JAMA Internal Medicine, 2013

What to expect

Sessions are 45 to 55 minutes, weekly, in person or by video for patients in Florida and South Carolina. Many people find video easier in the early weeks when leaving the house is hard. The first few sessions are mostly listening and assessment. If prolonged grief treatment is appropriate, your therapist explains the structure and you decide together when to start the harder parts; nothing is forced.

You can expect to cry, and you can expect sessions where you do not. You can expect to be asked to do things between sessions: visit a place you have avoided, look at photographs, write to the person, re-enter a routine. Progress in grief is not a straight line, and anniversaries, birthdays and holidays will set you back temporarily. Most courses of grief counseling end within a few months, with the option to return around difficult dates.

Benefits

Therapists experienced in bereavement, including sudden and traumatic loss
Clear distinction between normal grief, depression and prolonged grief disorder
Evidence-based, time-limited treatment for prolonged grief
Psychiatric care for depression, anxiety and insomnia triggered by loss
Support for losses others may not recognize
Family sessions when a household is grieving together
In person at 13 offices or by video in Florida and South Carolina

Risks and side effects

Grief counseling is safe, and the main discomfort is the one you would expect: the work involves approaching the loss rather than avoiding it, and sessions can be painful. Exposure-based elements of prolonged grief treatment deliberately revisit the death and are paced with you. Some people feel worse for a few sessions before they feel better.

The risk on the other side is medicalizing normal grief. Not everyone who is bereaved needs therapy, and not everyone who is sad needs an antidepressant. We are careful about that line. Sleep medications and benzodiazepines are sometimes requested in the first weeks after a death; we use them sparingly and briefly, because they can blunt the grieving process and carry their own risks. If grief includes thoughts of joining the person who died, that is a safety concern that we address directly, and we ask about it.

Cost and insurance

Grief counseling is billed as outpatient psychotherapy, which most commercial insurance plans and Medicare cover under behavioral health benefits at your copay or coinsurance. A diagnosis is required for insurance billing; this is usually an adjustment disorder, prolonged grief disorder or depression, and your therapist will explain what is being recorded. Some employer plans include bereavement sessions through an employee assistance program, and we can coordinate with that.

Psychiatric evaluation and medication management for grief-related depression or insomnia are billed as standard psychiatric visits. The self-pay rate for a new-patient evaluation is $185, with lower rates for therapy sessions and follow-ups. We do not charge for brief portal messages between sessions.

Normal grief, depression and prolonged grief

These three overlap and are often confused, including by clinicians. In normal grief, sadness is tied to the loss, comes in waves, coexists with positive memories and moments of relief, and self-esteem is intact. In major depression, mood is low and flat regardless of what you are thinking about, pleasure is gone from everything, guilt and worthlessness are pervasive, and the person may not be able to identify what they are grieving. In prolonged grief disorder, the problem is the grief itself: intense longing and preoccupation that do not diminish, avoidance of anything that reminds you of the death, and an inability to imagine a future. Depression responds to antidepressants and CBT; prolonged grief responds to grief-specific therapy and generally not to antidepressants alone. Getting the distinction right determines the treatment.

What prolonged grief treatment involves

The approach developed by Katherine Shear and colleagues, and tested in several randomized trials, has two threads. The loss thread involves telling the story of the death repeatedly in session, in detail, until it can be held without being overwhelming; revisiting places and objects that have been avoided; and having imagined conversations with the person who died. The restoration thread involves setting goals, rebuilding daily routine, reconnecting with people, and finding ways to carry the relationship forward in memory rather than closing it. Sessions are structured and include between-session tasks. Roughly seven in ten patients respond, more than double the rate for general supportive therapy.

Sudden, violent and stigmatized deaths

Suicide, overdose, homicide, accidents and deaths in infancy or childhood produce grief complicated by trauma, guilt, anger, legal processes and social awkwardness. Survivors of suicide loss often replay the final days looking for what they missed, and they frequently meet silence from people who do not know what to say. Overdose deaths carry similar guilt and stigma. These losses have higher rates of prolonged grief, PTSD and depression, and they benefit from therapists who know the terrain and from connection with others who have survived the same kind of loss.

Anticipatory grief and caregiver loss

Caring for a spouse or parent through a long illness means grieving in advance, sometimes for years. When the death comes, caregivers often feel relief, then guilt about the relief, then an emptiness where the caregiving used to be. This is normal and it is also a vulnerable period; depression is common in the year after a caregiving role ends. We see many caregivers through our geriatric and facility work, and we are glad to see them as patients in their own right.

Grief in older adults

Losing a spouse after decades together is among the most severe stressors in life, and older widows and widowers face it alongside their own health problems, shrinking social circles and sometimes cognitive change. Depression after spousal loss in older adults is common and frequently missed. Our geriatric clinicians evaluate for it specifically, and grief counseling by video reaches older adults who cannot easily travel.

Losses that are not deaths

A divorce, a miscarriage or stillbirth, a child's diagnosis, a career that ended, a home lost to a hurricane, a body that no longer does what it did: these are losses, and the grief is real even when there is no funeral. The same framework applies. If the loss is dominating your life and time is not helping, counseling helps.

Frequently asked questions

How do I know if my grief is normal or something more?

Normal grief is intense, comes in waves, and gradually changes over months so that you can function and feel moments of ordinary life between the waves. Grief that is not changing, that still dominates every day after a year, or that has turned into persistent depression, heavy drinking or thoughts of not wanting to live is something more. If you are unsure, one assessment session answers the question.

What is prolonged grief disorder?

A diagnosis added to the DSM-5-TR in 2022 for grief that remains intense and impairing at least 12 months after a death (6 months for children). Its core is persistent yearning or preoccupation with the person, with symptoms such as identity disruption, disbelief, avoidance, emotional pain, numbness and a sense that life is meaningless. It affects roughly one in ten bereaved people and responds to a specific structured therapy.

Do I need medication for grief?

Usually not. Grief itself does not respond to antidepressants. But grief can trigger major depression, anxiety or severe insomnia, and those do respond to treatment. If your sleep has collapsed, you cannot eat, you have no energy for weeks, or you have thoughts of death beyond missing the person, a psychiatric evaluation is worthwhile. We use sleep medications and sedatives sparingly and briefly after a loss.

How long does grief counseling take?

Supportive counseling after a loss often runs 6 to 12 sessions. Structured treatment for prolonged grief disorder typically runs about 16 sessions. Many people return for a session or two around anniversaries or holidays. Grief itself does not end on a schedule, and counseling aims to get it moving again, not to finish it.

Is it too soon, or too late, to come?

Neither. In the first weeks, counseling is mostly support and safety, and some people need that. Months or years later, grief that has stalled is still treatable, and prolonged grief treatment works even long after the loss. The right time is when grief is interfering with your life and you want help with it.

What about grief after suicide or overdose?

These losses carry extra weight: guilt, anger, stigma, unanswered questions, and sometimes the trauma of discovery. Rates of prolonged grief and depression are higher. Our therapists work with these situations specifically, and we can connect you with survivor support groups in Florida and South Carolina. You did not cause this and you could not have controlled it; that is true even when it does not feel true.

Can my family come together?

Yes. A household grieving the same person often grieves differently, and that difference causes conflict. We offer family sessions alongside individual counseling, and we see adolescents and, with some therapists, children who have lost a parent or sibling. Each family member can also have their own therapist within the practice.

Is grief counseling covered by insurance?

Yes, as outpatient psychotherapy under most commercial plans and Medicare, at your behavioral health copay. Insurance requires a diagnosis, usually adjustment disorder, prolonged grief disorder or depression, and your therapist will explain what is recorded. Employer bereavement benefits can be coordinated. Self-pay rates are available for therapy and $185 for a psychiatric evaluation.

Where this treatment is offered

Conditions this treats

Grief, Loss and Complicated Grief Major Depressive Disorder Adjustment Disorder and Life Stress Insomnia Generalized Anxiety Disorder Post-Traumatic Stress Disorder Depression in Older Adults Substance Use and Addiction Psychiatry

If you are in crisis, call or text 988 or go to the nearest emergency room. Educational content; individual results vary. Reviewed by Dr. David Husted, board-certified psychiatrist.

Grief and Bereavement Counseling