In this article, complicated mourning is operationalized in relation to the six “R” processes of mourning and its seven high-risk factors are identified. The main thesis is that the prevalence of complicated mourning is increasing today due to a number of contemporary sociocultural and technological trends which have influenced 1) today's types of death; 2) the characteristics of personal relationships severed by today's deaths; and 3) the personality and resources of today's mourner. Additionally, specific problems in both the mental health profession and the field of thanatology further escalate complicated mourning by preventing or interfering with requisite treatment. Thus, complicated mourning is on the rise at the precise time when caregivers are unprepared and limited in their abilities to respond. New treatment policies and models are mandated as a consequence.

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Little has been written on the topic of parental reactions to the loss of a child, despite the fact that there are unique psychological and sociological factors that make parental bereavement difficult to resolve. This article discusses factors involved in parental bereavement, including the unnaturalness of the child predeceasing the parents, social reactions to the death of a child, the loss of the spouse as a primary support during the grieving process, and grief-related problems with surviving children. Treatment recommendations are also presented.

The article argues for the creation and utilization of rituals in the psychotherapy of the bereaved to assist in the resolution of grief. Several sociological and anthropological writings discussing the importance of collective ceremony and ritual are briefly reviewed to determine therapeutic aspects that can be applied to individual ritual behavior. Nine specifically therapeutic properties of rituals employed in the psychotherapy of the bereaved are discussed. The criteria for appropriately designing therapeutic rituals are delineated. Case HistoryBarbara is accompanied by her therapist as she visits the grave of her daughter who died nineteen years ago. She lays a bouquet of flowers on the grave, speaks of what she has lost in the intervening years, and talks of when she will be reunited with her child. She then divides the bouquet in half taking one half home with her and leaving the remaining flowers on the grave. She has told herself symbolically that while she has lost the physical presence of her daughter forever, her relationship continues based on loving memory. She had been fearful that if she acknowledged the death and grieved her loss she would lose her daughter permanently. However, the ritual enabled her to acknowledge the death, grieve her loss, and still keep her daughter's memory.Denise, a seventeen-year-old girl, was killed in an auto accident. Her family has been told that they need to commemorate her at Christmas, the day they are dreading. They decide to bum a candle throughout the holiday to symbolize that she is still an important part of their lives, albeit in a radically different fashion. At dinner her empty chair will be occupied by a senior citizen who would normally not partake of a holiday feast.Violet, during her psychotherapy session, is given a rose Requests for reprints should be sent to

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