Anticipatory grief worksheet

We tend to think of grief as something that follows the loss of a loved one. Anticipatory grief, however, is much less talked about, and clients may even feel confused or ashamed about their grief when their loved one is still alive.

Therapists, like palliative care nurses, are well placed to support and validate individuals processing anticipatory grief.

This article provides an overview of anticipatory grief and offers various anticipatory grief resources to recommend to clients. We’ve included a free downloadable anticipatory grief worksheet that you can save to your electronic health record (EHR) and provide to clients.

What is anticipatory grief?

Anticipatory grief refers to the grief and sadness experienced before a loss occurs. It was first observed in the relatives of soldiers in World War II, and has since been understood in various other relational contexts, such as a relative’s terminal diagnosis.

Anticipatory grief may include physical, emotional, cognitive, and spiritual symptoms, including:

• Depressed mood

• Anxiety

• Anger

• Emotional dysregulation

• Pain

• Separation anxiety

• Guilt

• Resentment

• Exhaustion

• Sadness

• Disappointment

• Denial

Some researchers report more intense emotions, such as anger and loss of emotional control, in anticipatory grief than in grief experienced after a loss.

While anticipatory grief includes painful experiences of mourning the future, shared identities, and loss of life, it can also strengthen coping strategies to deal with inevitable changes, help prepare for loss, and deepen clients’ bond with their loved one.

What are some anticipatory grief examples?

Examples of anticipatory grief include:

• Medical and end-of-life situations: A parent may grieve while caring for a child with a terminal cancer diagnosis, or an adult child may grieve while anticipating the loss of elderly parents who enter a hospice or nursing home.

• Chronic or progressive illness situations: A client may watch a partner slowly decline from Alzheimer’s disease, or watch a loved one lose the ability to participate in joint activities as their Parkinson’s disease progresses.

• Non-death losses: Clients may grieve personality changes caused by degenerative conditions like dementia, or parents may grieve the future they imagined for a child with a life-threatening, progressive, or life-limiting condition like cystic fibrosis, cancer, or muscular dystrophy.

• Pet and relationship losses: A pet owner may grieve before a sick pet’s euthanasia, or a client may grieve the future they imagined with a partner during a divorce.

Anticipatory grief can also be personal, such as when a client receives a terminal diagnosis. Clients may grieve their loss of function and identity and struggle to connect emotionally with others.

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Where can clients find anticipatory grief resources?

• The Dougy Center’s resource page to help families coping with advanced serious illness, which includes videos, parenting tips, groups, and school resources

• Booklet: Anticipatory Grief: A Guide to Impending Loss from What’s Your Grief

• Stanford Parkinson’s Community Outreach Emotions of Caregiving page, which includes articles, webinars, and blog posts on anticipatory grief

• Podcasts: In Sickness, Everything Happens, and Grief Out Loud

How can you use anticipatory grief worksheets?

You can download the anticipatory grief PDF and use the worksheet in several ways:

• Use the worksheet to provide psychoeducation about anticipatory grief.

• Complete the worksheet collaboratively in session and give the client a copy to take home.

• Send clients the anticipatory grief resources listed above.

• Ask the client to reflect on the worksheet, complete the reflection questions between sessions, and share their responses at their next appointment.

• Use the prompt questions in group therapy sessions to encourage clients to share more about their experiences of grief with other participants.

• Combine this worksheet with other grief-related worksheets and articles, including our grief fact sheet, tasks of mourning worksheet, stages of grief worksheet, grief sentence completion worksheet, and grief therapy worksheets.

• Share anticipatory grief worksheets with coworkers or leave copies in your office.

• Use anticipatory grief worksheets to provide training to interns or supervisees about grief.

Sources

• Bilić, J., Skokandić, L., & Puljak, L. (2022). Anticipatory grief and experience of providing at-home palliative care among informal caregivers of spouses in Croatia: A qualitative study. BMC Palliative Care.

• Najafi, K., Shirinabadi Farahani, A., Rassouli, M., Alavi Majd, H., & Karami, M. (2022). Emotional upheaval, the essence of anticipatory grief in mothers of children with life-threatening illnesses: A qualitative study. BMC Psychology.

• Shore, J. C., Gelber, M. W., Koch, L. M., & Sower, E. (2016). Anticipatory grief: An evidence-based approach. Journal of Hospice & Palliative Nursing.

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