The visit followed the same shape it had for months: a knock, a pause too long before an answer, and then a version of a parent recognizable mostly in outline. The photographs in the hallway were still of the right people. A particular way of asking about the drive up, a habit of finishing sentences a beat early — the specific things that had made this house feel like itself — had been gone longer than anyone in the family had said out loud. There was no funeral scheduled. By any clinical or legal measure, there was nothing yet to mourn.
And yet something had clearly ended — not a life, but a particular way of being reached by one. The drive home each week brought, with some regularity, a wave of sadness that made no obvious sense against the facts: the parent was alive, stable, cared for. The mismatch between the fact and the feeling became one more thing to carry, quietly, without a name for it.
Therese Rando, a psychologist best known for her work on anticipatory grief in the context of terminal and chronic illness, pushed back on the assumption that grief before a death is only about the death still to come. Working with families through long illnesses, she traced this early grief to losses already underway, not ones still to come: a parent's changing memory, a personality perceptibly reorganizing itself, a relationship that used to run one way now running another. Rando argued for the term anticipatory mourning over anticipatory grief, precisely because so much of what gets mourned has already happened by the time anyone names it as grief.
This kind of mourning carries an unusual burden. It has no single day that explains it, and it runs alongside a relationship that still has to be shown up for — the visits keep happening, the logistics keep being managed, the parent is still, undeniably, present. Grieving someone who is still in the room, recognizable in some moments and not in others, doesn't follow the shape grief is supposed to have. There is no service, no customary period after which people expect it to have lifted, because as far as most people watching from outside can tell, nothing has happened yet.
The people I work with in Massachusetts — around Boston, in Arlington and Watertown, and out toward towns in the Berkshires — often come in describing something closer to confusion than grief: sadness with no clear trigger, guilt about feeling it while the person is still alive, an exhaustion caregiving alone doesn't fully explain. What tends to be missing isn't clarity about what's happening medically — it's permission to treat the changes already visible as real losses, even while the relationship they're part of keeps going.
Anticipatory mourning doesn't resolve when the person eventually dies. In some ways that turns out to be the smaller ending — most of the grieving has already been happening, unnamed, for a long time before it.
I work with adults across Massachusetts — including Boston, Arlington, Watertown, and communities in the Berkshires — via telehealth. Prospective clients are welcome to reach out at verdantcounseling@hushmail.com or to request a complimentary 15-minute consultation through this site.
Frequently Asked Questions about Grief and Loss Therapy
What is grief and loss therapy?
Grief and loss therapy supports people processing the emotional impact of a loss, whether or not that loss involved a death. It treats grief as a natural response to any significant ending, including ones a person's social circle may not immediately recognize as one.
What does grief and loss therapy help with?
It is well-suited for bereavement, disenfranchised losses such as job loss or estrangement, ambiguous loss, and the sense that a grief response is out of proportion to what actually happened.
How is grief and loss therapy different from general talk therapy?
General talk therapy can address a wide range of concerns. Grief and loss therapy focuses specifically on mourning as its own process, with particular attention to the ways a loss can go unacknowledged, complicated, or delayed.
Who is a good fit for grief and loss therapy?
It tends to work well for people carrying a loss that others have minimized or moved past too quickly, and who want a space where the loss doesn't need to be justified before it can be discussed.
Jonathan Walsh, LMHC, LCMHC, LPC is a licensed therapist offering grief and loss therapy via telehealth in Massachusetts and several other states. He is a member of the New England Center for Existential Therapy and has completed core training at the Institute for Existential-Psychoanalytic Therapy. Learn more about Jonathan.