1.1. Bereavement Outcomes
1.2. Risk Factors for Complicated Grief
1.3. Spiritual Coping
1.4. Spiritual Struggle
1.5. Spiritual Crisis Following Loss
2. Complicated Spiritual Grief—A Program of Research
2.1. Complicated Spiritual Grief and Complicated Grief Following Homicide Loss 
2.2. Complicated Spiritual Grief, PTSD, and Depression 
2.3. Complicated Spiritual Grief and Meaning Making in a Diverse Sample 
2.4. Complicated Spiritual Grief and Complicated Grief: Comparing Violent vs. Non-Violent Death Loss 
2.5. Complicated Spiritual Grief: A Deductive Inquiry Following the Loss of a Loved One 
- What feelings or thoughts about God or your relationship with Him did you have following the loss of your loved one?
- Please discuss the ways in which the loss strengthened or challenged your relationship with God.
- What feelings or thoughts about your faith community or your relationship with it did you have following the loss of your loved one?
- Please discuss the ways in which the loss strengthened or challenged your relationship with your faith community
- Questioning God’s Character. A weakened faith in God following loss can cause one to question God’s character—his goodness, caring, intentions, and reasoning.
- Negative Feelings toward God. Negative perceptions and feelings in relation to God often emerge in the form of anger and confusion, leaving the griever devastated and shocked.
- Lack of Spiritual Sense Making. Some bereaved individuals struggle to make spiritual sense of their loss, often because their constructs or assumptions about God or life have been shattered as a result.
- Misunderstood by Spiritual Community. Well-intentioned yet fallible support can cause grievers to feel misunderstood by their spiritual community, especially when would-be supporters respond to their grief with invalidating clichés or questions.
- Negative Feelings about Spiritual Community. Spiritually inclined grievers can have negative perceptions and feelings in relation to the spiritual community, specifically when they feel judged or condemned for being angry at or questioning God following their loss.
- Selective about Sharing Feelings. Overall, mourners expressed a sense of frustration with the support received from their fellow church members, leaving them reluctant to show their true feelings because they feared receiving still greater hurt as a result.
- Spiritual Crisis Coupled with Strong Faith. A weakened faith in God that eventuates in a spiritual crisis also can be coupled with a strong faith that is not always realized or appreciated by one’s spiritual community.
- Betrayed and Robbed. Betrayal, and a sense of feeling robbed following loss are sometimes related to grievers feeling that their spiritual community lied to them about God’s character.
- Questioning What They Did to Cause Death. For some bereaved individuals, spiritual crisis is tied to a questioning of what they or their deceased loved one did to cause or deserve death.
- Desire to Hurt God in Return. Feelings of intense anger and cursing at God are sometimes exhibited by the griever as an attempt to hurt God in return for the pain he or she attributes to Him.
- Abandoned by Spiritual Community. Distrust in the form of questioning their spiritual community’s beliefs and intentions, and feelings of emotional or physical abandonment or neglect by the spiritual community caused some individuals to go to a new church where they could be anonymous.
- Silent Silencers. Bereaved individuals criticized their spiritual supporters who they felt remained silent about the death (as if had not happened), placed unrealistic expectations on them, would not let the griever express how he/she felt, tried to convince the griever to think differently, viewed the griever as a victim only, or appeared more concerned about their own comfort than the griever’s pain.
- Avoided Spiritual Community. Some grievers avoided their spiritual community in part because they questioned their community’s ability to handle their grief or because they feared that their own painful feelings would not be well received.
- Understanding Not Pity. Spiritually inclined grievers expressly stated that they do not want pity from their spiritual community, but do need them to try to understand how they feel.
- Faith-Related Changes. Changes in the griever’s faith-related behaviors, activities, and attitudes were expressed in terms of lower levels of church volunteerism, allowing his or her mood to govern levels of participation, or choosing to no longer worship God or fellowship with others at all, choosing not to celebrate religious holidays, and an overall sense of being less faithful.
- Afterlife Concerns. Concerns related to the afterlife were reflective of spiritual crisis. Specifically, grievers wondered about their loved one’s destiny or if they would see him/her again, and questioned the existence of heaven and hell.
- Lapse of Faith. Spiritual crisis that culminates in the bereaved individual walking away from God may represent a temporary or permanent loss of faith—a composite of both overt struggle (e.g., that the person is weak, lacks faith, has a poor knowledge of God or his Word) and hidden strength (e.g., the spiritual crisis might fluctuate, or might not last forever).
2.6. The Inventory of Complicated Spiritual Grief (ICSG) 
3. Future Directions
3.1. Spiritual Meaning Making in Family Members of Terminally Ill Veterans 
3.2. Spiritual Adaptation to Loss: A Pilot Intervention for Spiritually Inclined Grievers 
prolonged grief disorder
major depressive disorderx
posttraumatic stress disorder
positive religious coping
negative religious coping
complicated spiritual grief
Victims to Victory
time since loss
Inventory of Complicated Spiritual Grief (ICSG)
|Items||Not at all true||A little true||Somewhat true||Mostly True||Very definitely true|
|(1) I don’t understand why God has made it so hard for me.||0||1||2||3||4|
|(2) I have withdrawn from my fellowship with other believers.||0||1||2||3||4|
|(3) I go out of my way to avoid spiritual/religious activities (e.g., prayer, worship, Bible reading).||0||1||2||3||4|
|(4) I no longer feel safe and protected by God.||0||1||2||3||4|
|(5) I find that spiritual/religious activities are not very fulfilling (e.g., prayer, worship, Bible reading)||0||1||2||3||4|
|(6) I find it impossible to pray.||0||1||2||3||4|
|(7) I struggle with accepting how a good God allows bad things to happen.||0||1||2||3||4|
|(8) I find it difficult to surrender my life to God.||0||1||2||3||4|
|(9) I don’t feel as comforted by church fellowship as I used to.||0||1||2||3||4|
|(10) I can’t help feeling angry with God.||0||1||2||3||4|
|(11) I don’t feel very much like joining in fellowship to praise God or to glorify Him.||0||1||2||3||4|
|(12) The strong guiding light of my faith has grown dim and I feel lost.||0||1||2||3||4|
|(13) I’m confused as to why God would let this happen.||0||1||2||3||4|
|(14) I have lost my desire to worship.||0||1||2||3||4|
|(15) I find it impossible to worship.||0||1||2||3||4|
|(16) I feel my loss is unfair.||0||1||2||3||4|
|(17) I sense the absence of God more than I do the presence of God.||0||1||2||3||4|
|(18) I am a faithful believer, so I don’t understand why God did not protect me.||0||1||2||3||4|
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