How to work through grief

SAMHSA’s National Helpline | SAMHSA

Your browser is not supported

Switch to Chrome, Edge, Firefox or Safari

Main page content

  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

    What Is Substance Abuse Treatment? A Booklet for Families
    Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.

    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

SAMHSA Behavioral Health Treatment Services Locator


Welcome to the Behavioral Health Treatment Services Locator, a confidential and anonymous source of information for persons seeking treatment facilities in the United States or U.S. Territories for substance use/addiction and/or mental health problems.

PLEASE NOTE: Your personal information and the search criteria you enter into the Locator is secure and anonymous. SAMHSA does not collect or maintain any information you provide.

Please enter a valid location.

please type your address

  • FindTreatment.


    Millions of Americans have a substance use disorder. Find a treatment facility near you.

  • 988 Suicide & Crisis Lifeline

    Call or text 988

    Free and confidential support for people in distress, 24/7.

  • National Helpline

    1-800-662-HELP (4357)

    Treatment referral and information, 24/7.

  • Disaster Distress Helpline


    Immediate crisis counseling related to disasters, 24/7.

  • Overview
  • Locator OverviewLocator Overview
  • Locator OverviewLocator Overview
  • Finding Treatment
  • Find Facilities for VeteransFind Facilities for Veterans
  • Find Facilities for VeteransFind Facilities for Veterans
  • Facility Directors
  • Register a New FacilityRegister a New Facility
  • Register a New FacilityRegister a New Facility
  • Other Locator Functionalities
  • Download Search ResultsDownload Search Results
  • Use Google MapsUse Google Maps
  • Print Search ResultsPrint Search Results
  • Use Google MapsUse Google Maps
  • Icon from Find practitioners and treatment programs providing buprenorphine for opioid addiction (heroin or pain relievers). Find practitioners and treatment programs providing buprenorphine for opioid addiction (heroin or pain relievers).
  • Icon from Find practitioners and treatment programs providing buprenorphine for opioid addiction (heroin or pain relievers). Find programs providing methadone for the treatment of opioid addiction (heroin or pain relievers).

The Locator is authorized by the 21st Century Cures Act (Public Law 114-255, Section 9006; 42 U.S.C. 290bb-36d). SAMHSA endeavors to keep the Locator current. All information in the Locator is updated annually from facility responses to SAMHSA’s National Substance Use and Mental Health Services Survey (N-SUMHSS). New facilities that have completed an abbreviated survey and met all the qualifications are added monthly. Updates to facility names, addresses, telephone numbers, and services are made weekly for facilities informing SAMHSA of changes. Facilities may request additions or changes to their information by sending an e-mail to [email protected], by calling the BHSIS Project Office at 1-833-888-1553 (Mon-Fri 8-6 ET), or by electronic form submission using the Locator online application form (intended for additions of new facilities).

how to deal with grief in the office

The topic of mourning is taboo: we do not know how to live with grief, especially if we have to work at the same time. Coach Sabina Nawaz, who advises Fortune 500 executives, wrote a handout for the Harvard Business Review on how to help yourself get over the loss while staying productive. T&P translated the main one.

In today's everyday culture, there is no place for intense, prolonged grief. Leave due to the death of a close relative under the Labor Code of the Russian Federation can be up to 5 working days, and it does not imply the preservation of wages. In addition to understandable grief after death, intense feelings also arise in a situation before an impending loss - for example, if a loved one is terminally ill (such a feeling is called anticipatory grief). It can also come before a non-death loss, such as the expectation of a divorce, war, layoffs, or even elective surgery. This situation can last unpredictably for a long time, and during this time you need to continue going to work. Here's how to help yourself - and how to interact with colleagues. As an example, Sabina talks about how she tried to hold on while waiting for the departure of her seriously ill mother.

Tell colleagues what you expect from them

Talk to one of your colleagues and say directly how you would like others to behave with you: many may simply be at a loss. Ask them to relay what you have said to your mutual colleagues.

Sabina needed to do a three-day intensive, and it was easier for her because the participants did not mention the topic of loss during classes and did not treat it differently than usual. Sabina writes that their sympathy in that situation would not have helped her, but only made her cry, although in another situation such a conversation with a sympathetic colleague can help her feel better.

Ask someone to insure you

In case you need to be at home urgently. It can be one trusted person, your boss, or you can distribute your responsibilities among several colleagues.

During the seminar, Sabina's plan was as follows: if she needed to leave urgently, the participants would lead a discussion, and a colleague whom Sabina had warned would act as a moderator.

Ask someone to be your second eye

And double-check especially important parts of the work. In crisis situations, there are a lot of thoughts in the head, as if fog covers the eyes, it can be difficult to maintain focus at the usual high level. This can prevent a costly mistake, and your teammates will be happy to support you in this way.

Sabina's colleague checked her documents and found an error there that would have cost her $2,000.

Ask friends and family for support

Ask them for help so you can focus on your work.

Sabina's friends visited her mother, held her hand and read to her. Sabina focused completely on work, completed tasks faster, freed herself earlier and ran to her mother.

Follow us on Facebook, VK, Twitter, Instagram, Telegram (@tandp_ru) and Yandex.Zen.

Theories and practices


#old age


#psychological trauma

#office psychology

#team work





  • 3 935


Psychologist Larisa Pyzhyanova herself experienced the loss of loved ones and, working in the Ministry of Emergencies, helped people, hundreds of times helped people, people, hundreds of times, hundreds of times, hundreds of times, hundreds of times, hundreds, whose relatives died tragically and suddenly. We publish an excerpt from her book “Sharing the pain. The experience of a psychologist from the Ministry of Emergency Situations, which is useful to everyone, ”which tells about what the work of grief is, what processes and why a person experiences after the death of a loved one, how long it can last, what is considered the norm, and what should alert.

The book can be bought on the site of the publishing house "Nikeya".

Crisis of grief

It is impossible to draw a clear framework and determine exactly whether the experience of loss is complicated or not complicated in a person. But still, it is possible to indicate when the process of natural grief goes through certain stages, each of which is characterized by its own set of physical and psychological symptoms.

The symptoms of "normal" grief in the middle of the last century were identified by the German-American psychiatrist, a specialist in social psychiatry, Erich Lindemann. The mourning process is divided into two main stages: the grief crisis and the work of grief.

A crisis of grief begins with the death of a loved one or the discovery of an imminent loss, for example, when a loved one is diagnosed with a fatal disease and his days are numbered. Human consciousness rejects the fact of loss, rushes between denial, splitting, persuasion, anxiety and guilt.

According to Lindemann, the first hours after a loss are usually characterized by the presence of periodic bouts of physical suffering, spasms in the throat, fits of suffocation with rapid breathing, a constant need to breathe - this breathing disorder is especially noticeable when a person talks about his grief. At the spiritual level, grief manifests itself as tension or acute suffering. Usually the grieving person feels the unreality of what is happening, deafness, the feeling that everything is happening as if not with him. He has the so-called "tunnel vision", a veil is growing before his eyes. Time speeds up or, conversely, stops. The perception of the surrounding reality is dulled, sometimes in the future there will be gaps in the memories of this period.

Lindemann noted that with a deep emotional experience, changes and disorders of consciousness can be observed. He describes a typical case in which it seemed to the patient that he saw his dead daughter, who was calling him from a telephone booth. He was so captured by this scene that he stopped noticing his surroundings.

It happens that a grieving person has no manifestations of strong feelings at all. Despite the deceptive external well-being, in reality the person is in a serious condition, and one of the dangers is that at any moment this imaginary calmness can be replaced by an acute reactive state.

It is possible to single out the mechanisms that are necessary for living through a crisis of grief: denial, splitting, persuasion, anxiety and guilt. When the first shock passes and the person begins to realize the reality of what is happening, the physical reactions weaken, and often there is an acute desire to return everything as it was before the loss. At this time, it seems to people that this is just a bad dream, you just need to wake up, and the nightmare will pass.

The well-known Russian psychotherapist, doctor of psychological sciences, professor Fedor Efimovich Vasilyuk, in his work “Surviving Grief” says that denial at this stage of mourning is not a denial of the fact that the deceased is no more, but a denial of the fact that I, “grieving”, here. But loss denial allows a person to maintain the illusion that the world remains unchanged. This softens the shock and helps to gradually accept reality, which is facilitated by the rituals of farewell to the deceased adopted in different religions. Such important actions as a funeral service in the church, a memorial meal, help to accept the death of a loved one as a fait accompli.

Farewell to the deceased Farewell in the morgue, funeral service, funeral service - what you need to know about them

Without such contact with reality, a person can get stuck in denial of the loss.

This is well illustrated by cases of missing people. Their death is very difficult to accept for loved ones. Splitting allows one part of the mind to know about the loss when the other denies it - this is when a person understands with the mind that a loved one has died, but feels his invisible presence. This is such a common phenomenon that many experts perceive it as part of the normal process of grief - people find comfort in this, the last chance to say goodbye to a loved one.

Vasilyuk writes: “There is… ‘a kind of double being’ (“I live as if on two planes,” says the mourner), where behind the fabric of reality one constantly senses another existence implicitly going through, breaking through islands of ‘meetings’ with the dead. Hope, which constantly gives rise to faith in a miracle, coexists in a strange way with a realistic attitude that guides all the external behavior of the mourner.

Persuasion manifests itself in the resistance of consciousness to what happened in such a way that, trying to deceive fate, as it were, a person concludes an internal deal, again and again remembering the last days, hours before parting, as if wishing to change the course of events: "Oh, if only . .. I would give everything so that ... "Grieving people constantly scroll through the events associated with the loss in their heads: they remember what they did not have time to do for the departed; they regret that they paid little attention to him, did not fulfill some requests, were not affectionate enough, did not have time to say “I love”, unfairly offended and did not have time to ask for forgiveness.

When people experience the reality of loss, they experience anxiety and helplessness. For a person who feels very insecure without his loved one, life is full of fears. Sometimes it is, for example, the fear of sleeping in the same bed or room, living in the same house.

The heaviest feeling when experiencing grief is guilt. Sometimes it can be real, more often far-fetched, but it must always be taken with great seriousness. Death exacerbates the problems that have ever taken place in a relationship, and the “stumbling blocks” that were hardly noticeable before turn into an insurmountable obstacle after the death of a loved one. Lindemann describes it this way: “A person who has suffered a loss tries to find in the events that preceded death evidence that he did not do what he could for the deceased. He accuses himself of inattention and exaggerates the significance of his slightest missteps. The person repeats the word "should" like a spell: "I should have done this" or "I should not have done this." There are many heavy thoughts, a feeling of emptiness and meaninglessness. Over time, a rational explanation of what happened will soften the feeling of guilt, but usually it returns until there is full acceptance of the loss.

Feelings of guilt before a deceased loved one: how to deal with it? When a loved one dies, a feeling of guilt often arises: you didn’t give enough, you didn’t say it, you didn’t do it, and now you can’t fix anything. Is this guilt always just, or is there something else behind it?

Israeli director Shmuel Maoz told an episode from his life. It was about his teenage daughter, who constantly woke up late, missed her school bus, and had to call her a taxi, which cost the family dearly. Once he told his daughter to take the bus, like all children, and if she oversleeps and is late, let this be a lesson for her. The next morning, the girl got up on time, left the house, and half an hour later, her father heard a message that there had been an explosion in this bus - a terrorist attack, dozens of people had died. He rushed to call his daughter, but could not get through. In the next hour, he experienced more than he had experienced in his entire life. And then the daughter returned home alive and unharmed - she still missed that bus. Shmuel Maoz said that later he tormented himself for a long time with the thought that he seemed to have done the right thing, logically, but how would he live if his daughter died?

Probably, this “but” always arises in front of a person when trouble happens to his loved ones. It seems that he did everything, but . .. But he could have done more, better, could have foreseen everything, warned, averted trouble.

The stages of living through grief come in waves, one wave of denial, splitting, persuasion, anxiety, guilt is rarely enough to accept the loss.

Over time, they change qualitatively and the impulse "I need to call my mother" is gradually replaced by a more urgent need - "I need to be able to call my mother." The weight of the loss begins to be felt. During a crisis of grief, many processes occur at the level of the unconscious; dreams indicate that serious internal work is underway to overcome the feeling of loss. They solve the main task of the crisis of grief - the recognition of the need to accept the death of a loved one.

Work of grief

The process of mourning is called the work of grief. This is a huge mental work to process tragic events, the main task of which is not to forget, to preserve the memory of a dear person, while building new relationships with a world in which this person no longer exists.

The work of grief begins when a person accepts the fact of death. Then complex processes of overcoming take place, as a result of which the lost relationships gradually become memories, which, ideally, do not completely absorb a person, but transfer grief into a state of light sadness.

It should be noted that with all the variety of Western studies, the experience of grief and loss comes down to one scheme of Sigmund Freud, given by him in Sorrow and Melancholy: "Out of sight, out of mind." “Freud's theory explains how people forget the departed, but it does not even raise the question of how they remember them. We can say that this is the theory of oblivion,” writes psychotherapist Fyodor Vasilyuk.

In the book of Metropolitan Anthony of Surozh “Life and eternity. 15 Conversations on Death and Suffering” is an important evidence of the attitude towards death of the British: “Here, in England, the attitude towards death is very surprising for a Russian person like me. It has improved somewhat, I dare say, not much, but it has become, let's say, less terrible. And when I first met him, I was amazed. I was under the impression that it was something completely obscene for a good Briton to die, that people should not do this to their friends and relatives, and if they fell so low as to leave this world, they would be hidden in their room until the funeral home will not take them to their place of rest and will not release the family from their presence, because in relation to their relatives a person should not do such an obscene thing as dying.

“Grief is not just one of the feelings, it is a constitutive anthropological phenomenon: not a single most intelligent animal buries its fellows. To bury is to be human. But to bury is not to discard, but to hide and preserve. And on the psychological level, the main acts of the mystery of grief are not the separation of energy from the lost object, but the arrangement of the image of this object for storage in memory. Human grief is not destructive (to forget, tear off, separate), but constructive, it is designed not to scatter, but to collect, not to destroy, but to create - to create memory, ”says Vasilyuk’s work“ Survive Grief.

There are two main components of successful grief work: to re-examine the relationship with the deceased in order to appreciate what they mean to us, and then "translate" them into the category of "memories without a future."

Surviving means realizing what happened, accepting changes in life, adapting to the changed situation and gradually replacing the feeling of suffering and pain with a calm memory.

Freud, in his work "Sadness and Melancholy", stressed that we never voluntarily give up our emotional attachments, and that we have been abandoned, rejected or left does not mean that we end relationships with those who did this . After the death of a loved one, we, one way or another, continue to respond to his emotional presence, while realizing that the person is not with us. In order to understand what we lost with the departed and what these relationships were for us, we return to them, look through them over and over again and play them again in memory, dreams, daydreams. Warm memories cause feelings of happiness, unfinished disputes and conflicts make us experience disappointment, anger, sadness again and again. The task of the work of grief is to bring us back again and again to these situations and states until we calmly look at them and accept them as they were.

One of the biggest obstacles to adjusting to a new life, according to Lindemann, is that many people try to avoid the intense suffering associated with grief and avoid expressing the emotions necessary for this experience.

That is why painful manifestations are observed in the form of a delay in the reaction or in its various distortions. The ability to perform the work of grief depends on many things, including age, the degree of personal maturity. In the absence of healthy breakups in the past, the work of grief is much slower. Before coming to terms with a new loss, a person is forced to experience the previous unfinished losses.

The work of grief is exhausting. Unconsciously, a person again and again returns to the past and is under its weight. He is constantly faced with loneliness and acute longing. It takes a lot of strength. Time passes, and little by little the demands of the present begin to assert themselves. The person begins to feel the desire to move on. However, a part of him is still gripped by grief. The desire to end the mourning and only from time to time remember the deceased can be unconsciously perceived as a betrayal, cause a feeling of guilt and slow down the processes of grief.

When does grief end?

When it seems that grief is over and everything is over, it can sometimes return in the form of acute experiences. In memorable places or on memorable dates. And that's okay.

Let me give you an example from my own life. Two and a half years have passed since my mother's death, and I finally decided to come to her empty apartment to sort things out and prepare the apartment for sale. It seemed to me that I had already experienced everything and accepted everything. My son and I sorted things out, sometimes hovering over something for a long time, sometimes very quickly deciding who to give what to, where to give what. Behind every item were many of my memories. I talked about something, we laughed, joked, sometimes sad, but in general I had the feeling that everything was going well and I was so afraid in vain. And I also thought: “It’s good that my son went with me.” And on the third day, I suddenly had a very familiar and very severe headache, and I said: “How strange, such a state, as if I have been working for an emergency for the third day.” My son answered me: “And you work for emergency situations.”

Loss Oncopsychologist - about personal experience of loss, feelings of guilt and warm memories that illuminate the darkness

Loss can always "come to life" and cause acute pain again, it can return on anniversaries or at moments of important life milestones. But gradually more and more memories appear, freed from pain, guilt, resentment. A person gets the opportunity to escape from the past and turns to the future - he begins to plan his life without the deceased. At this stage, life enters its own track, sleep, appetite, daily activities are restored, the deceased ceases to occupy all thoughts.

The meaning and task of the work of grief is to make a person forgive himself, let go of resentment, and take responsibility for his life. The image of the deceased must take its permanent worthy place in his life, then the person himself will return.

Remembering the deceased, he will no longer experience grief, but sadness - a completely different feeling. And this sadness will forever remain in the heart. If there are tears, they must be wept. But then there comes a time when you can say to yourself: if right now you can restrain yourself and not cry, don’t cry. We must get off the path of tears. If you continue to walk along it, the path can turn into a groove, and then into a trench so deep that it will be impossible to get out of it unless a hand is extended from above. And if you don’t want to reach out in response, then after a while not a single hand will simply be able to reach you - you will be so deep.

Heavy mourning is not synonymous with love, and to stop mourning does not mean to betray the departed. Because it will not go anywhere from the heart, because Love does not go anywhere.

Stages of grief

  • Shock and numbness (from a few seconds to several days). May result in an acute reactive state.
  • Suffering and disorganization - acute grief (6-7 weeks). Grief work becomes the leading activity.
  • Stage of residual shocks and reorganization (up to a year). Loss gradually enters into life.
  • Completion (1-1.5 years after loss). Grief is replaced by sadness.

The stage of acute grief may include: