A loved one leaves on a military assignment, divorce papers are signed, a parent or a favorite pet passes away...

"Any loss -- and even an impending loss -- can bring on feelings of grief," according to Karl Goodkin, M.D., Ph.D., professor of psychiatry and behavioral sciences and professor of neurology at the University of Miami School of Medicine in Miami, Fla., and professor of psychology at the University of Miami Graduate School.

The grief process often brings with it shock or emotional numbness, followed by feelings of depression, anger, guilt, or helplessness. Grieving always hurts, but it's not a bad thing, Dr. Goodkin says. It's a very normal and necessary process for adjusting to difficult life changes.

Healthy grieving

“Major changes, such as new management, downsizing, or a company buyout, can result in a feeling of panic,” says Susan Starr, a human resource consultant and owner of H20 Marks, a Dallas-based marketing company.

"Most people seem to be able to process loss on their own, not just within their own thinking and coping, but also by getting support from their family, friends, and personal social networks," says Dr. Goodkin. "Tapping into social support at this time is perhaps the best predictor for adjusting to loss in a healthy way."

Grief usually moves through five stages:

• Denial or disbelief
• Anger or guilt
• Bargaining
• Depression or sadness
• Acceptance

Some of these stages can occur at the same time. Not all people who grieve experience all of these stages.

Other symptoms of grief include sleep problems, appetite changes, and difficulty getting back to work.

• With healthful grieving, one can:
• Resolve loss-related stress.
• Give meaning to the loss and to the place the relationship held for oneself.
• Begin looking toward the future.
• Start looking for others who might replace some of the lost aspects of the relationship.

Getting help

Some people do get stuck in the process, Dr. Goodkin says, and that's why grief-specific treatment can help.

According to Dr. Goodkin, people with the following symptoms of "complicated grief" may benefit from treatment:

• Persistent guilt feelings regarding actions taken or not taken at the time of death.
• A morbid preoccupation with self-worthlessness.
• A severe slowing down of one's thoughts and overall activity.
• Hallucinations, other than thinking one might be in connection with the deceased, or briefly hearing the voice of the deceased.

Grief can lead to depression or abuse of alcohol or drugs. Grief that lasts for more than two months and makes it difficult to deal with daily life may indicate a more serious problem.

Treatment options for unresolved grief include:

• Group psychotherapy sessions are designed specifically for bereavement. Guided by a leader with grief expertise, these groups provide a non-threatening structure for talking about one's loss, expressing one's feelings, benefiting from the social support offered by the group, and learning to move on in healthful ways. "Many general mental health counselors will say they're capable of addressing death and dying issues," Dr. Goodkin says. "That can be true, but working with someone who has grief expertise can make a big difference in a person's long-term recovery."
• Individual psychotherapy. Private counseling can be helpful for people who are dealing with deeper emotional issues not related solely to the recently experienced loss. It is also recommended when privacy issues related to the circumstances of the loss would prevent the person from speaking up within a group.
• Antidepressant or anti-anxiety medications. Drugs can often help when combined with psychotherapy. By improving mental health symptoms, medications can aid the person in moving through the grieving process more quickly.