March 2026: Complexities of Bereavement: Support in loss

William G. Hoy

To be certain, there is lack of complete consensus about how we can best understand and help bereaved people. Is there really a phenomenon like prolonged grief disorder or is that a pharmaceutical-industry-driven overdiagnosis of normal grief? Can trauma and grief be addressed simultaneously or must we separate the two related but distinct experiences? Should bereaved children be routinely shuttled into therapy in the face of parental loss or do many—if not most—adapt well without therapeutic support? What is the place and role of medication in bereavement and should we embrace it, oppose it, or ignore it?

These and a hundred other questions swirl around the concepts of how best to support individuals who are grieving a significant loss. In the last two issues of GriefPerspectives , we have addressed how the situation of the loss and the selfhood of the person affect bereavement outcomes. This month we come to the third constellation of complexities , and I call this one the support one gets in bereavement. Good bereavement support comes with many different faces and caregiving professionals and volunteers can do much to supplement support when it is lacking in the natural family or community system (Hoy, 2016, 2025).

At its most basic level, social support in grief is made up of the natural resources available to an individual so that he or she does not feel alone in navigating the loss. Different people need different levels of support; for some, a simple hug is adequate and for others, a more robust response is needed from friends, family, and professional community so that they do not feel alone in the loss. Assessing what the support system is and the extent it is perceived by the bereaved individual as helpful or lacking is the key issue in determining next steps.

As a matter of course, I use assessment questions such as the following, both in my initial assessment and in our regular conversations (ongoing assessment). Remember, perceptions of support can and often do change over the course of the grief process. A person might sense little need early on but have an increased desire for social contact later in the process; what was once seen as supportive may later be viewed as annoying or even intrusive. In my history-taking, I ask questions such as these:

• What have been the hardest parts of this experience for you so far?

• What did you used to believe that you are finding hard to hold on to now?

• Who are the people who have most “shown up” for you in this loss? Who has surprised you by either their presence or their absence?

• Who are the folks you sense you could call at any hour of the night if you were having a hard time? In other words, who are the people in “your camp?”

• Who were the people who came to the memorial service or funeral? What happened for you during that gathering and how did you find it helpful or not?

• What resources outside of yourself, such as beliefs, religious ceremonies, or personal wellness routines—help you feel better? How do they seem to work in your life? 

These questions imply the issues I consider most critical in assessing and addressing support in the bereaved individual’s life and experience. Of first importance is what I refer to as the intrinsic belief system. Everyone has a set of organizational beliefs about how the world works. These might have to do with who dies (parents don’t bury children, for example) or how one copes (God won’t give me more than I can bear). Some of these beliefs grow out of one’s religious heritage, even if one is not currently active in a faith community. That is the reason I like to ask the question above, “What did you used to believe…? 

Especially religious professionals such as chaplains and congregational leaders might want to investigate further, even among members of their “faithful” with a question such as, “Where does God seem for you now: close at hand, far off, or somewhere in between.” When asked with a tone of genuine curiosity and without judgement, even devout individuals will sometimes share their misgivings and questions, providing an opportunity to offer meaningful spiritual support. Interestingly, patients, families, and bereaved individuals might be even more open to sharing honest feedback to this question when asked by a non-religious professional or volunteer such as a nurse, social worker, or physical therapist. 

Family structure and functionality is another key area of focus for assessment and possible intervention. Understanding how this individual’s family is working together—or not—can provide important clues to how well an individual will perceive support from that family. Sometimes, multiple adult siblings have deep mistrust of one another in how a recently deceased parent was cared for during the final illness and former spouses sometimes continue their marital fracture into parental bereavement. When asking questions about who the people were who are “showing up” or “in the camp” of the bereaved, listen for names and relationships of key family members. Know they can be on either list: the supportive or the non-supportive. 

My colleague and friend, Ken Doka (2002) first coined the term, disenfranchised grief to describe the phenomenon of losses that are socially “unacceptable.” Depending on the culture and background of the bereaved, these might include potentially embarrassing causes and manners of death (drug poisonings or suicide) as well as relationships that are unacknowledged. Sometimes, individuals do not grieve in expected ways by expressing more or less emotion than friends or family members deem “appropriate” (Doka & Martin, 2024). If bereaved individuals sense shame or lack of understanding, their experience of loss can become disenfranchised and this, in turn, makes that loss potentially much more difficult to integrate.

Participation in personally meaningful ceremonies is also related to how supported a bereaved person feels. While a growing number of bereaved families delay or completely dispense with funerals and memorial services, this strategy is not advisable. A personally-meaningful memorial gathering allows the immediate bereaved to derive support and share the grief experience with a wider community of friends and family members. My most recent book overviews some of the diverse ways such ceremonies are conducted as well as an overview of research about the value of such rituals. The COVID-19 pandemic laid bare the need for such memorial gatherings and the ongoing complexity of bereavement experiences for individuals and families who were forbidden to participate in them (Hoy, 2025).

What most matters in bereavement adjustment is not the level of social support a caregiver assesses as present, but rather, the level of support perceived by the bereaved individual. Some individuals report being well supported even though they catalog only one or two good friends or family members who are checking in on them. Even when there are many people seemingly concerned about the bereaved individual, some sense they are not recipients of good support. Curiously inquiring about who has shown up or is showing up in the loss is an important assessment of support perception.

In one small but important study, ten Black mothers were interviewed about their experience of social support following the death of a child to gun violence. While social support is known to be protective against poor adjustment in bereavement, these mothers often expressed disenfranchisement of the loss as if the death of their child was somehow their own fault. Others confessed friends avoided them or expected them to “recover” quickly (Hannays-King, et.al., 2015).

When bereaved people report good initial support, dig deeper to learn more about what feels supportive. Be alert to the changing dynamics of support since often support that is in plentiful supply in the first weeks of loss disappears within a few months. Even friends and family members who were initially supportive may quickly tire of the experience and unkindly ask a few months down the road, “Aren’t you over this yet?” Be sensitive both to changing support levels and bereaved individual’s ability to receive support.

One of the fallacies incumbent in many hospice bereavement programs is that an initial assessment is made during the patient’s admission or soon after the death. Besides the fact my interviews with families indicate these assessments are rarely thorough, bereavement needs can change mightily throughout the early months of grief. Available social support levels often change dramatically over time, implying the need for ongoing assessment throughout the year that hospices are required by Medicare to provide bereavement follow-up. In my experience, I find few hospice organizations who utilize a trained bereavement professional to routinely make this ongoing assessment unless the family members were seen as “high risk” at the initial assessment.

When bereaved people feel alone, support groups can be very beneficial in helping navigate the loss. These groups are especially useful when led by a competent individual—whether professional or volunteer—and when the losses are similar between members of the group. For example, bereaved parents seem to be generally better supported in a group of other bereaved parents while individuals whose loved one died from suicide seem to sense a greater level of support among groups specific to their loss. When an appropriate group is not available and a bereaved person reports a lack of support, a therapeutic relationship with a clinical professional can help bridge the gap.

What is absolutely true is that grief is hard to manage when we try to “go it alone.” Bereavement is best experienced when it is mutually shared with caring others who understand, who provide a healthy measure of caring curiosity about the relationship that was lost, and who offer a perspective on walking through grief.