Complicated grief: implications for the treatment of post-traumatic stress disorder in couples

Abstract

Complicated grief has many interfaces with post-traumatic stress disorder (PTSD) including avoidance, flashbacks and shattered assumptions. Increasing use of cognitive behavioural therapy (CBT) models in grief work are drawing on lessons learned in PTSD treatment. However, models used in grief work, such as attachment, the Dual Process Model (Stroebe & Schut, 1999) and Psychosocial Transition Theory (Parkes, 1993), are less commonly applied to understanding and treating PTSD. This paper gives an overview of how these theories explain complicated grief and PTSD and considers implications they have on treatment of couples, based on literature review and clinical experience. Treatment implications include treating PTSD before traumatic grief, working with intra-couple coping style differences, promoting acceptance and forgiveness and taking a full attachment history.

Keywords:

• complicated grief
• post-traumatic stress disorder
• attachment
• couple relationships

Acknowledgements

Much of the inspiration for this paper was derived from a conference in July 2006, funded by the London Development Centre and addressed by Dr Colin Murray Parkes, on the interface between traumatic grief and PTSD and this paper develops some of the themes he discussed. We are grateful for this and his further feedback. We would also like to thank Dr Patricia D'Ardenne and Prof Stefan Priebe at the Institute of Psychotrauma for their helpful comments in drafting this paper.