Anticipatory Grief Therapy: Support While They're Still Here
You are grieving someone who hasn't died. A parent whose dementia is taking them one memory at a time. A partner with a terminal diagnosis. A person you're caring for who is slowly becoming someone else. Anticipatory grief therapy gives that grief a place to go - so it doesn't have to sit in your chest while you hold everything together for everyone else.
What Is Anticipatory Grief Therapy?
Anticipatory grief is the mourning that begins before a loss - grieving the person someone used to be, the future you expected to share, and the version of your life that caregiving is reshaping. It is real grief, and it responds to real support.
Anticipatory grief therapy is one-on-one work with a licensed therapist who understands this in-between place. Unlike grief therapy after a loss, it holds two things at once: preparing for what's coming, and staying present for what's still here. Sessions are weekly, virtual, and shaped around what you're carrying - there is no protocol you have to keep up with.
Anticipatory grief work at Shifting Tides is provided by Ava Iannitti, LCSW and Madeline Pucheril, LMSW, who are welcoming new clients now. Deanna DiCostanzo, LCSW returns to new clients in January - if you would like to work with her specifically, join the waitlist.
What We Work On in Anticipatory Grief Counseling
Every situation is different, but these are the threads that come up most:
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The guilt of grieving someone who is still alive - and the relief you're not supposed to admit
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Caregiver exhaustion, resentment, and the love that sits right next to both
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Making medical and end-of-life decisions without drowning in them
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Grieving the relationship as it changes - especially when the roles have flipped
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Staying connected to the person in front of you instead of only the person you're losing
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Preparing for the loss without feeling like you're giving up on them
Therapy or Support Group - Which Is Right for You?
Both, honestly, for many people. Our anticipatory grief support group, led by Ava Iannitti, LCSW, offers eight weeks of community with others walking the same road - the relief of not having to explain. Individual therapy goes where a group can't: your specific family, your specific guilt, your history with the person you're losing, at your own pace and depth.
A good rule of thumb: if what you need most is to feel less alone, start with the group. If what you're carrying feels too tangled or too private to share in a circle, start with therapy. Many people do the group first and step into individual work when the loss gets closer.
How Our Therapists Approach Anticipatory Grief
This isn't advice-giving or five-stages worksheets. Depending on what you need, your therapist may draw on EMDR therapy to work with the traumatic edges of watching someone decline, or Internal Family Systems to make room for the parts of you that are angry, numb, or already mourning. Mostly, it's a steady hour that belongs only to you - possibly the only hour in your week that does.
Who Anticipatory Grief Therapy Is For
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Adult children watching a parent decline through dementia, Parkinson's, cancer, or age
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Spouses and partners holding a terminal or progressive diagnosis at home
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Primary caregivers - family or chosen - running on too little sleep and too much love
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Anyone with a loved one in hospice or palliative care, bracing and present at once
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People navigating the long goodbye of estrangement, addiction, or mental illness, where the person is alive but the relationship is already a loss
Online Anticipatory Grief Therapy in New York, Connecticut & Florida
All sessions are virtual, so support fits around caregiving - no commute, no coverage to arrange, no explaining a waiting room absence. You can meet with your therapist from the hospital cafeteria if that's what the week requires. Licensed in NY, CT, and FL.
Frequently Asked Questions About Anticipatory Grief Therapy
How long does anticipatory grief last?
Is anticipatory grief real grief?
As long as the decline does, and often into bereavement afterward. That's exactly why support matters now rather than "when it happens" - anticipatory grief left alone tends to harden into exhaustion, guilt, or a delayed grief that arrives months later with interest.
Yes. Research treats it as a genuine grief process, and clinically it behaves like one - waves, ambushes, numbness, bargaining. The difference is that you're grieving without permission, because the loss hasn't "counted" yet. Therapy gives it permission.
Can therapy really help before the loss happens?
What's the difference between anticipatory grief therapy and the support group?
It's arguably the best time. Working through the grief, guilt, and unsaid things while your person is still here often changes both the remaining time and the bereavement that follows. People who get support during the decline consistently describe the after differently.
The group is shared experience - eight weeks, a small circle, the comfort of people who get it. Therapy is private, unlimited in depth, and tailored to your specific situation. They combine well, and there's no wrong door to start with.