8 Psychotherapy8.7 Psychotherapeutic psychiatry
8.7.4 Loss, adaptation and psychological symptoms
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
What loss involves
A person may lose someone close, their health, a role, a home, their status or the future they expected. The effect depends on what the loss means to them and how much support they have.
Mourning is the process of adjusting to a loss. It can bring longing, anger, guilt and relief. It can also change a person's sense of who they are and how they manage day to day.
Grief does not have to follow a set sequence of stages. Periods of distress often alternate with periods of getting on with everyday life.
Continuing bonds with someone who has died can sit alongside healthy adjustment. On their own, they are not a sign of illness.
What keeps people stuck
Process | Possible effect |
|---|---|
Avoidance | Stops contact with reminders or with new roles |
Rumination | Goes over unanswerable questions and self-blame again and again |
Social withdrawal | Cuts down support and rewarding activity |
Threat appraisal | Keeps the person on watch for another catastrophe |
Restricted expression | Makes distress hard to share or for others to understand |
When to think of a disorder
Sadness after a loss is not a diagnosis in itself. A diagnosis rests on the pattern of symptoms, how long they persist, how much they impair the person and the cultural context.
Depression and post-traumatic stress disorder can both follow bereavement. Assess for them separately from grief.
Adaptation and resilience
Adaptation means adjusting to changed circumstances while keeping up, or rebuilding, relationships, meaning and daily activity.
Resilience depends on a person's resources and circumstances as well as their own coping. Ongoing difficulty does not show weakness or failure.
Helping
Supportive care offers recognition, practical help and connection. It does not expect the person to show any particular emotional response.
Psychological treatment follows the formulation. It targets whatever is keeping the impairment going, such as avoidance, self-blame or a disrupted role.
Safety assessment is needed when distress is severe. Ask about hopelessness, suicidal thinking and substance use, and check whether the person can meet their daily needs.