Core Concepts for Grief-Sensitive Care
The Emotional Experience of Grief
Grief is Not a Single Emotion
Grief is often confused with depression or sadness, but it is more complex. It can involve a wide range of emotional responses, including sadness, relief, numbness, gratitude, guilt, anger, fear, or moments of joy, sometimes experienced at the same time.
Emotions that seem to contradict one another are common.
In this video Dr. Thejal Srikumar reflects on how grief often involves multiple emotions at the same time, extending beyond sadness alone.
While grief can involve the full range of human emotion, certain emotional responses emerge more frequently.
Anger
Anger is sort of the hidden emotion in grief. A lot of grieving people are incredibly angry for a lot of different reasons.
Anger
The Cambridge English Dictionary, defines anger as “a strong feeling that arises in response to something perceived as unfair or unkind.” When loss disrupts a sense of fairness, safety, or control, anger may surface alongside other grief responses.
Anger can even be surprising for the person who is grieving.
In this clip from Speaking Grief, griever Zee Wolters reflects on her experience with anger following her mother’s death.
In healthcare settings, recognizing that anger is a common and often misunderstood expression of grief can improve communication and reduce harm.
Recognizing Expressions of Anger
Grief-related anger can surface in different ways, depending on the person and the context.
It may be direct and intense, such as yelling, cursing, or visible agitation. In other cases, it may be more subtle, showing up as impatience, brief or curt communication, sarcasm, or withdrawal.
Anger can show up in different ways. Some expressions are more visible and intense, while others are quieter and less direct. Both can reflect underlying distress and unmet needs.
- Hot expressions of anger involve overt, intense reactions, such as shouting, slamming doors, or physical agitation.
- Cold expressions of anger tend to be more restrained and indirect, and may include sarcasm, withdrawal, silence, or passive resistance.
Both more visible and less direct expressions can reflect underlying distress or unmet needs.
Navigating Grief-Related Anger in Healthcare
When anger surfaces in clinical interactions, responding in a way that remains compassionate, steady, and constructive can feel challenging.
In this video, Dr. Thejal Srikumar reflects on the challenges healthcare professionals can experience when patients or supporters express grief through anger.
Feeling the impact of anger in clinical interactions can be uncomfortable. A reflective stance can help healthcare professionals pause, consider what may be driving the response, and respond with communication that balances validation with clear boundaries.
Anger
Approach with Curiosity
When anger feels disproportionate, it can help to pause and consider whether grief may be influencing the response. A more curious, engaged approach can help guide responses to strong emotions and reduce the likelihood of escalation.
Curiosity supports grief-sensitive care by promoting openness and a not-knowing stance and is central to mentalization, the capacity to reflect on one’s own thoughts and feelings as well as those of others, creating space for more flexible, compassionate responses during moments of uncertainty or strong emotion.
Grief-Sensitive Boundaries
Grief does not justify harmful or abusive behavior, and maintaining clear boundaries is essential for safety and care:
“I can see this is incredibly hard. I want to support you, and we need to keep this a respectful space.”
Acknowledging the emotion behind an interaction can be an important part of de-escalation.
In this video, shared with permission from New York Life as part of its Grief-Supportive Workplace initiative, Doneila McIntosh, PhD, a couple and family therapist and researcher, Rachelle Bensoussan, a thanatologist and grief educator, and Leslie Barber, a workplace grief and leadership specialist, reflect on how anger can show up in grief, particularly in workplace settings, and how colleagues and leaders can respond with compassion and curiosity.
Responding with calm validation, clear communication, and appropriate boundaries can help de-escalate tension, acknowledge underlying distress, and support respectful, ongoing engagement in care.
Scenario: A parent raises their voice during a care conference.
- Response: “I can hear how overwhelming and frustrating this feels. This is a very difficult situation, and we want to support you. Let’s pause for a moment and talk about what feels most urgent right now.”
Scenario: A team member becomes distant following a disagreement about care.
- Response: “I’ve noticed that we aren't communicating as usual, and I wanted to check in. If something I said or did added stress, that wasn’t my intention. Some cases are really complex. I’m open to talking when you feel ready.”
Scenario: Ongoing hostility or pointed remarks from a grieving colleague or patient.
- Response: “I recognize how hard this is, and I want to be supportive. At the same time, some recent interactions have felt tense. Can we talk about how I can support you and what you’re carrying and also address how we can work together.”
Fear
Fear is common in grief: fear of life without the person, fear of forgetting, or fear of what lies ahead. For many people, grief can unsettle what once felt predictable or secure, making uncertainty more present in everyday life.
“No one ever told me that grief felt so much like fear.”
Fear in Patients and Their Supporters
Healthcare settings can involve power dynamics that increase vulnerability for patients and their supporters. Medical language, institutional processes, waiting for results, and navigating insurance or financial systems can leave people feeling dependent on decisions and systems outside their control, which can intensify fear.
The root of grief-related fear is often uncertainty, especially in healthcare settings. This may include uncertainty about prognosis, treatment outcomes, or what life may look like after the death of a significant person.
In this clip from The Apologies Podcast, pediatric ICU nurse Hui-wen Sato shares how her breast cancer diagnosis gave her a deeper understanding of how overwhelming uncertainty can feel from the patient’s side.
Clear communication, patience, and transparency can help reduce distress and support a sense of safety when fear is present.
Fear in Healthcare Professionals
Just as patients and care partners may experience fear related to uncertainty and loss of control, healthcare professionals may also experience uncertainty when navigating emotionally charged or complex interactions or unclear outcomes.
Healthcare professionals may respond to the emotional demands of this work by distancing, compartmentalizing, or limiting emotional engagement. Cultivating emotional awareness can be an important skill for supporting reflective practice, communication, and connection in healthcare settings.
In this video, Elizabeth Peacock-Chambers, MD, Associate Professor at UMass Chan Medical School–Baystate, reflects on how engaging with emotions like fear can support growth, connection, and compassionate care.
Reflecting on these fears can help healthcare professionals build greater emotional awareness, steadiness, and presence when supporting grieving patients and supporters.
Fear of Failure
For many healthcare professionals, fear can be closely tied to another unspoken concern: failure. Even when outcomes are medically inevitable, the death of a patient can feel personal.
“Every time a patient dies, a part of me feels like I failed.”
In this video, Anne Chiang, MD, PhD, a thoracic medical oncologist, reflects on how a focus on fixing problems can shape experiences of grief, fear, and perceived failure, and highlights the value of presence and support when outcomes cannot be changed.
Healthcare professionals may feel constrained by expectations around emotional expression and professionalism, particularly early-career professionals who are navigating how their behavior and responses are perceived.
When fear of failure or judgment goes unacknowledged, it can make grief harder to recognize and respond to in oneself and others. Reframing outcomes and normalizing the challenges of high-stakes work can help mitigate this pressure.
Healthcare professionals may also experience moral distress when they feel unable to provide the care or support they believe is needed.
Collaborating with colleagues and connecting patients with supports such as palliative care, chaplaincy, social work, or psychology can help share this responsibility.
Joy
Grief is often associated with emotions such as sadness, anger, or despair, but the emotional experience is more complex and varied.
People may also experience moments of levity, laughter, gratitude, or joy alongside grief, and some may use humor as a way of coping.
These moments do not necessarily indicate that grief has ended or been resolved. Instead, they can reflect how individuals adapt to loss while continuing to experience a range of emotions.
People only think ‘sad,’ like, ‘you’re sad.’ But I feel like feeling happiness of memories is part of it, too.
Be Mindful of Assumptions
A person may appear “fine” or as though they have moved on while continuing to experience grief. Many people anticipate that others may not be able to respond to their grief, which can lead them to mask or limit expression of their experience in social contexts.
In the following videos, courtesy of WPSU, Jack StockLynn and Zee Wolters share their experiences after the deaths of their mothers. They describe how moments of humor or enjoyment were sometimes misunderstood and how these assumptions shaped their grief experiences.
Jack StockLynn is a bereaved son who was interviewed for Speaking Grief. Courtesy of WPSU.
Zee Wolters is a bereaved daughter who was interviewed for Speaking Grief. Courtesy of WPSU.
The Dual Process Model of coping with bereavement can help explain the back-and-forth between engaging with the pain of grief and attending to daily life. Recognizing this pattern can support a more flexible response to grief.
Hope
Hope can be an important way of coping with uncertainty and grief. Patients and their supporters may continue to hope for recovery, more time, or even a miracle while also recognizing the seriousness of the situation.
Hope in turn can sustain coping, as when the individual moves forward to deal with the demands of his or her new reality.
Healthcare professionals may worry that hope reflects a lack of understanding about prognosis. However, hope and awareness can coexist. Recognizing hope as part of the grief experience can support more attuned communication, particularly when hope is understood as meaningful to the person and shaped through their relationships.
Sadness
Sadness is commonly associated with grief, though it does not always appear in expected ways. Some people cry easily, while others may feel detached, restless, or weighed down without tears. In healthcare settings, sadness may show up quietly through a clenched jaw, a heavy sigh, or fatigue after an encounter or shift.
However it is expressed, sadness is a natural response to loss.
Allowing space for sadness, without rushing to fix or avoid it, can support compassionate care.
Grief and depression can share overlapping features, such as sadness, changes in sleep, or loss of interest, but they are distinct experiences.
Grief often includes a sense of longing or yearning for the person who died as a common feature of bereavement. Emotional pain may be most intense when thinking about or missing the person. The ability to experience moments of connection or positive emotion is often maintained, even alongside grief. In contrast, depression is more likely to involve a persistent low mood, reduced capacity to experience pleasure, and feelings that are less tied to a specific loss.
If a grieving individual shows signs of sustained despair, thoughts of self-harm, or significant disengagement from daily life, a mental health assessment is recommended.
Numbness
Numbness can be a common and often overlooked emotional response within the grief experience.
Numbness can be a common emotional response within the grief experience.
Feeling emotionally neutral, distant, or less reactive does not mean the loss has not mattered or that something is wrong.
At times, it may reflect a response to feeling overwhelmed by the demands of grief, including the need to regulate or step back from aspects of the loss.
In healthcare settings, this may be common, as the demands of the work can require setting aside emotions to continue caring for others. Repeated exposure to stress and limited opportunity to process these experiences can contribute to distress or burnout.
There is No One Way to Feel
Grief is a multidimensional experience that can include a range of emotional responses, some of which may feel conflicting.
The thing to remember is that anything a person feels inside their own, personal grief journey is correct.
There is no single path through grief, and recognizing this range can help normalize experiences and support more compassionate responses to ourselves and others.