Relationship Dialogue for Grief Management

Neha Pandya*, Riri G Trivedi, Hemalatha Ramani, Gunjan Y Trivedi

Affiliation: Wellness Space

*Corresponding author: [email protected]

Abstract: Relationships are fundamental to human well-being, and their loss can cause profound psychological pain. While regression-based therapeutic methods show promise in processing grief, this study specifically evaluated the effectiveness of Relationship Dialogue, an evidence-based psychotherapy approach designed to address unresolved grief through regression to loss-related memories and structured dialogue.

Background:

Relationships are vital for human well-being. Losing someone significant leads to significant psychological pain. Recent developmental and therapy models have shown the promise of regression-based methods (which help in processing emotions related to the event in present life) in dealing with unresolved grief.

Objective: 

This study evaluated the effectiveness of Relationship Dialogue, an evidence-based psychotherapy approach that uses regression to grief-related memories and structured dialogue to process unresolved emotions, in reducing emotional distress associated with grief.

Methods: 

A total of 54 grief-focused sessions were conducted by at least three trained therapists at Wellness Space, India, using both online and in-person formats. The intervention included regression to recent loss events followed by the Relationship Dialogue process, which combines somatic release (“release from the body”) and cognitive reframing (“reframe in the mind”). Emotional distress was measured using the Subjective Units of Distress Scale (SUDS) weeks later. Data were analysed using the Wilcoxon signed-rank test due to non-normal distribution. The study focused exclusively on current-life loss experiences, excluding past-life regression.

Results:  Findings showed a statistically significant reduction in SUDS scores immediately after the sessions and at 4–6 weeks follow-up, indicating sustained reductions in grief-related emotional distress.

Conclusion: 

These results suggest that Relationship Dialogue may be an effective evidence-based psychotherapy approach for managing grief. It offers valuable insights, especially in culturally sensitive contexts, by helping individuals process loss, express emotions, and build emotional resilience.

Keywords: 

Relationship Dialogue, Release-Reframe Toolkit, grief, relationship loss, regression therapy, somatic release, cognitive reframing, evidence-based psychotherapy.

Introduction

Human beings innately are motivated to form meaningful relationships. These relationships impact their psychological well-being and also give a sense of purpose to the individual (Baumeister & Leary, 2017). Loss of these relationships, through death, separation or estrangement, often leads to psychological distress and impacts physiological functioning (Szuhany et al., 2021).

Grief, an emotional response to loss encompasses yearning, identity disturbance, loss of meaning and purpose, and other cognitive, physical, and behavioural reactions (Szuhany et al., 2021). Grief is an emotion universally experienced but how it is expressed differs as per cultural, interpersonal, and intrapsychic factors (Rosenblatt, 2008).  Acute grief is the initial response to the loss, which is often intrusive and disruptive (Shear et al., 2011). This phase usually wanes in the first few months following the loss, and most individuals successfully adjust, regaining their interest and motivation in their ongoing life (Bonanno & Kaltman, 1999; Shear et al., 2011). However, in some cases, the grief becomes prolonged and complex, and it starts interfering with the daily functioning of the individual. Prolonged Grief Disorder (PGD) is a newly recognized mental health disorder included in the World Health Organization’s (WHO) disorder classification manual, the International Classification of Diseases (ICD-11). PGD is characterized by core symptoms such as longing for and preoccupation with the diseased, along with emotional distress and significant functional impairment that persists beyond half a year after the loss (Eisma, 2023; Killikelly & Maercker, 2017; Szuhany et al., 2021). It is also newly included in the DSM 5 TR or Text Revision, though there are some variations between ICD-11 and DSM-5-TR (Prigerson et al., 2021).

Unresolved grief is linked with anxiety, substance abuse, social withdrawal and even increased mortality (Crunk et al., 2017). With respect to physiology, grief activates the stress response of the body which impacts the immune system and the nervous regulation (O’Connor et al., 2009).

Cultural factors also impact the grieving process. Cultural rituals, practices, and societal norms might have a significant impact on the way people grieve, mourn, and adjust to a loss. In western cultures, emotional expression and personal catharsis are more socially encouraged during bereavement (Casarett et al., 2001; Rosenblatt, 2008). However, in collective cultures in India, family harmony often precedes over individual emotional expression. Emotional suppression during grief is common in the Indian context (Sarkar et al., 2023). Thus, the person may carry the emotion for years. Clients who lose loved ones to accidental deaths or suicide, or even pets, often report intense, unresolved emotional pain, which may resurface when exposed to reminders such as photographs or anniversaries (Field et al., 2003).

Theoretical Foundation:

In 1969 Kubler Ross proposed one of the most recognized models for grief, which is the five-stage model. This approach helps to understand grief in a more structured way. For example, people that are grieving usually go through five stages: denial, anger, bargaining, depression, and acceptance (Kübler-Ross & Kessler, 2014). Although Kübler-Ross’s five stages model led to a paradigm shift in the understanding of grief, more recent studies seem to question its applicability for everyone. There are critics that highlight the failure of the model due to separating grief into phases and suggesting there is a set order in which one progresses through the stages (Stroebe et al., 2017).

This model is countered by The Dual Model of coping with grief (DPM) proposed by Stroebe and Schut. It argues that normal grief entails switching between two focuses which oscillates in alternating back and forth movements:

• Loss Orientation: The intrusion of loss triggers pain and yearning, active confrontation with memories of the deceased, imagination, and engagement with emotions related to the loss.
• Restoration Orientation: To compartmentalize grief to function on a day-to-day basis and adapt to changes, new roles and responsibilities created by the loss are attended to.

This model describes grief as a cyclical process in which individuals shift back and forth between these two ways of thinking. This illustrates the complex, nonlinear path involved in the process of grieving (Schut, 1999).

The meaning reconstruction approach to grief, championed by (Neimeyer et al., 2010), offers a powerful alternative lens. It posits that grief disrupts our self-narrative – the intricate web of life events that shapes how we interpret the past, navigate the present and envision the future.

Intriguingly, recent research paints a compelling picture. Individuals who embark on a painful search for meaning in the immediate aftermath of loss tend to experience more intense grief months and years later (Neimeyer, 2020; Neimeyer et al., 2010). Conversely, those who find significance in the loss exhibit greater long-term well-being.

This search for meaning holds even greater weight when considering “risk factors” for prolonged and intense grief, such as losing a spouse, lacking social support, experiencing insecure attachment, or facing violent death. Studies show that struggling to find meaning amplifies grief intensity, especially when rumination runs high (Milman et al., 2019). Similarly, research with bereaved parents reveals that grappling with the loss’s meaning contributes far more to their grief intensity than objective factors like time, cause of death, or even their gender.

These findings illuminate a crucial truth: grief is not merely a passive reaction to loss. It’s an active process of reconstructing our understanding of the world and our place within it. By embracing meaning-making, we can move beyond enduring grief and find peace and acceptance, even amidst immense loss.

Our experience in working with clients is consistent with above review of existing literature. Individuals remain stuck with grief for years, especially in cases when they have lost near and dear ones to accidental deaths or suicide, etc. This is also seen about pet parents who are unable to overcome the loss of a pet who is like a child to them. Sometimes, these clients continue to get triggered by the thought, mention or even photographs of the departed person/pet even after many years and find themselves breaking down or crying. Many times, unresolved grief also ends up as fear of dying or fear of losing loved ones.  In such cases, it becomes important to help the clients get closure and overcome certain emotions associated with the death of a near dear one – like regret, guilt, anger and sadness. In such cases, regressing into the memories with that person, allowing the body and mind to process and release what was not processed and released in the past and helping them reframe the experiences to the new present reality helps them to move on.

While there is acknowledgement of PGD in terms of diagnosis, there is gap in existing literature on how to address the long-term impact of negative emotions persisting from grief.  This research aims to explore a simple method to address the prolonged negative emotions from negative events pertaining to grief. The objective is to explore the effectiveness of simple method (Relationship Dialogue) in addressing the grief.

Relationship Dialogue is an evidence-based psychotherapy approach that guides clients into a safe, focused state to express unspoken emotions toward a lost or departed person. It helps them process unresolved anger, grief, and unfulfilled wishes to achieve emotional closure. The method replaces negative emotions with positive anchors and encourages healthier future responses. The technique (described later) is a unique approach to resolving unresolved emotions and have some conceptual similarities with drama therapy, psychodrama, and gestalt (Berghs et al., 2022; Maddox et al., 2019).

Aim and Hypotheses:

The study aims to evaluate the effectiveness of the Relationship Dialogue intervention, an evidence-based psychotherapy approach that involves regressing to current-life events of loss and using release from the body, reframe in the mind methodology to achieve cognitive reframing.  The outcome expected is reduced grief-related distress among individuals who have lost a significant person or relationship.

Hypothesis 1: There is a significant reduction in emotional distress as measured by SUDS before and after the session, for participants undergoing the intervention of relationship dialogue for grief management.

Hypothesis 2: This reduction in emotional distress was sustained at a follow-up assessment conducted 4 to 6 weeks after the intervention.

Methodology:

 

Study design and participants:

Participants were recruited through social media and word-of-mouth, and paid for initial consultation followed by therapy sessions. The consultation served as the foundation for establishing selection criteria. Every participant signed an informed consent, and the data collection procedures were consistent with the process outlined in the Institutional Ethics Committee (Ref No JMSHF IEC – BHR/O/18/2022, Aug 24, 2022) approval. The participants included individuals above 18 who experienced loss of a loved one or significant loss of relationship and reported distress due to the same.

54 sessions including relationship dialogue intervention for grief management were conducted which included 50 unique participants.

Subjective Units of Distress (SUDS):

Subjective Units of Distress (SUDS) was used as a self-reported scale to measure the degree of distress due to grief before the intervention, after the intervention and after one month of the intervention. The SUDS scale ranges from 0 (no distress) to 10 (maximum imaginable distress), and is widely used in clinical and experimental settings to track subjective emotional intensity (Van den Hout et al., 2011; Wolpe, 1990).

Participants who had acknowledged experience of loss, and who had minimum SUDS of 6 on 10 in the pre intervention scores were included. Individuals with chronic disease complications (recent myocardial infarction or hospitalization within the past one month) were excluded from the study. The sessions were conducted both online and offline. To minimize the impact of the therapist, at least three different therapists worked on the 54 sessions for grief work.

Relationship Dialogue Intervention

The process involves taking the client into a light state of trance and then asking the client to visualise or feel the other person’s presence in a safe space. Then, the client is encouraged to verbalise and express all the unexpressed emotions and feelings to the other person (this will require “inner child regression” to earlier actual situations). The client is encouraged to regress into the memories with the departed person or loss of relationship and process the emotions that were not processed back then. The regression might also include regressing into past painful events or unresolved experiences with the departed person that the client is encouraged to resolve and process without any self-judgement or filters. This allows the body to get closure in some past painful experiences with the departed person.

Usually in the Indian culture, we are not allowed to express anger or other negative emotions to the person who is no longer alive – so many times. Unresolved events remain as suppressed emotions for life – surfacing occasionally when triggered long after the person is no more. Therefore, encouraging the client to also accept, process and release all the negative emotions like anger, betrayal, rage etc for the departed person that were not allowed to be expressed.

In some situations, the client or departed soul may have had some unfulfilled wishes or desires that were not met due to sudden death (e.g. wanted to go on a certain trip, give something to someone, or get to see child marriage or see grandkid etc) – we encourage the client to regress and allow himself/herself to experience all those unfulfilled desires with the departed soul (or the lost relationship) to get a feeling of completion. Suppose there is any blockage due to fear or judgment, we allow the client to work through that first and then encourage the client to enable the body and mind to process and release all the unprocessed and unexpressed emotions to the other person. Once that is done, we anchor with a positive replacing emotion and behaviour. The client is then encouraged to face this person with the newly replaced emotion and behaviour and experience how that feels. Before ending the session, we do future pacing with the new behaviour and response and put a post-hypnotic suggestion about the changed behaviour and feeling regarding that person.

Therapist also encourages the client to visualise himself/herself moving on in life with the positively anchored emotion and behavioural response and moving on in life with the acceptance of death.

Therapist checks with the client after the session and after one week and one month if there are any changes that the client experiences in that relationship. Key points and measurement steps are outlined below.

• The beauty of this process lies in its versatility and simplicity.
• Relationship Dialogue isn’t a magic wand but a powerful tool. It offers clients the chance to bridge the gap, to release the past, and to rewrite their narratives, both with others and with themselves.
• Insights from small pilot indicate the following:
  • Regression into actual past events with the departed soul is necessary.
  • Outcomes are effective (N=10, Average SUDS reduces from >9 to <2) and sustained after 30 days

Intervention procedure:

Each session for grief work using relationship dialogue included the following structured format:

1. Identifying the relationship and emotion associated with the grief.
2. Taking the SUDS for the emotional disturbance (if there are multiple emotions, pick the emotion with highest SUDS)
3. Using the grief script for the client (Grief script)
4. Checking for SUDS post the session, and one month after the session

 

Analysis:

Quantitative data from the SUDS was analysed to understand the impact of relationship dialogue for grief intervention. Since the data is not normally distributed, the Wilcoxon signed-rank test was used to assess whether changes in distress levels were statistically significant. Two tests were conducted, one compared the SUDS pre session with post session. Another compared post session scores and follow up (after four to six weeks) scores. The analysis was conducted using Jamovi Version 2.3.28.0.

Results:

The demographics of the participants (the details by generation, age group, marital status and gender) are captured in Table 1.

A total of 54 grief-focused sessions were conducted by 10 different therapists at Wellness Space. Out of 10, 6 therapists conducted more than 5 sessions highlighting that diverse group of therapists have worked to generate the results.

Table 1: Demographics

Age >35	Counts	% of Total
No	23	46.0%
Yes	27	54.0%
Marital Status	Counts	% of Total
Married	43	86%
Others (separated, widowed, not married)	7	14.0%
Gender	Counts	% of Total
Female	47	94.0%
Male	3	6.0%

 

 

Table 2: Changes in SUDS

Measure	Scores Pre session N=54	Scores Post session N=54	Scores After 1 month N=39
Grief in Subjective Units of Distress Scale (SUDS)	9.0 ± 1.06	1.7*±1.69	0.9*±1.40

* Statistically significant reduction, Wilcoxon signed-rank test, p < .05

 

Additional perspective by demographics is highlighted in Table 3 below.

 

 

Table 3: Changes in SUDS as per age group

Age Group	N (sample size)	Avg SUDS before	Avg SUDS after
≤35	23	9.11± 1.14	1.88± 1.73
>35	27	8.98 ±1.02	1.39± 1.65

 

The time since the loss is highlighted in Table 4 below to provide perspective on the distribution of the “duration” since the loss occurred.

 

 

 

Table 4: Time Since Loss

Time since Loss (in years)	N (Frequency)	Percentage
0-1	11	20.37%
2-5	18	33.33%
6-10	6	11.11%
11 and above	19	35.19%
Total	54	100.00%

The outcomes of the intervention are shown in table 2. It indicates the average scores of SUDS before the session, after the session and after 1 month.

The findings highlight a statistically significant improvement (i.e. reduction) in subjective distress levels (SUDS) following the intervention. (a) post each session (b) post 1 month. The SUDS scores average decreased from 9.0 to 1.7 post each session and the reduction was significant as per Wilcoxon signed rank test (p<0.5).

Additionally, a month later, the follow-up revealed further progress. The gains made during the session were maintained over time, as evidenced by the SUDS scores further declining from 1.7 to 0.9 and reaching statistical significance (W = 168, p =.011).

In conclusion, the efficacy and durability of the intervention are supported by statistically significant improvements (p <.05) in distress levels observed in both immediate and follow-up comparisons.

Discussion:

The study identified individuals who carried grief and needed help in dealing with the emotional pain of the loss.  The result confirms that 54 grief experiences were addressed through relationship dialogue for grief management. The number of unique participants was 50 indicating that some individuals sought Relationship Dialogue intervention for more than one significant relationship loss supporting the need to work on event specific loss. This highlights that individuals may carry grief of multiple losses simultaneously, each requiring individual intervention. Participants demonstrated a significant decrease in emotional distress, including a reduction in SUDS from 9.0 immediately after the session to 1.7 and on the SUDS scale to 0.9 a month later. In this case, the results were quantitatively significant, and the scores displayed effectiveness and a durable change.

The distribution of time elapsed since the loss provides additional insight into the intervention’s relevance. Specifically, over one-third (35.19%) of losses were more than 11 years old, indicating that participants carried unresolved grief for over a decade before seeking therapeutic intervention. About 11.11% individuals had the events between 6–10 years ago, and hence together, nearly half of the participants (46.3%) benefited from the Relationship Dialogue process for losses that occurred more than six years ago. This strongly suggests that the passage of time alone does not resolve grief and, in many cases, may deepen emotional entrenchment if the grief remains unprocessed. The findings are consistent with some of the assessment criteria of PGD identified recently (Eisma, 2023; Killikelly & Maercker, 2017; Prigerson et al., 2021).

Along with how long the loss occurred, the nature of the lost relationship also contributed to the emotional response by participants. Most of the grief sessions (57.41%) involved the loss of a parent, which is to be expected since they tend to be our closest ones. However, around 20% of the losses dealt with ones which are not often called out specifically, such as pets, unborn fetes (due to miscarriages or abortions), or in-laws. This suggests that grief and loss can result from any kind of relationship and highlights the importance of accepting and assisting with all forms of loss, especially in a culture like India where some of these are taboo.

The results point to the relationship dialogue intervention supporting emotional closure, long-term integrating processes and reinterpretation of grief related experiences; this may be even more useful in cultural contexts like in India, where emotional expression is often discouraged, and grief can be carried in silence for many years.  Several qualitative insights (not part of the current scope) were also identified during the process which can help in training the therapists.  Additional unique insight was the need to approach the methodology with trauma-informed-care methodology (Bath, 2008; Huang et al., 2014).

To summarize, the findings support the effectiveness of Relationship Dialogue intervention in managing grief.  The successful outcome despite the prolonged nature of impact and simplicity of intervention support the need to include such intervention in any evidence-based psychotherapy program.

Limitations:

Despite encouraging outcomes, several limitations must be acknowledged:

1. Absence of a comparison or control group: Although the pre-post design yields encouraging results, conclusions regarding the intervention’s distinct efficacy in comparison to other approaches are limited by the lack of a randomized control or alternative treatment group. Future work should explore studies involving control group to validate the efficacy of the intervention.
2. Lack of a standardized Prolonged Grief Disorder (PGD) diagnostic tool: The study uses SUDS scores to measure the disturbance caused due to the loss. SUDS helps measure distress but doesn’t effectively diagnose prolonged grief. The findings cannot be applied to clinically diagnosed populations of prolonged grief. More work is needed to incorporate PGD assessment to expand the idea further through future studies.
3. Current study participants were mostly women (94%), and hence the findings should be interpreted for similar group only. Future work should expand the study to broader population.

Conclusion:

The findings indicate that Relationship Dialogue, an evidence-based psychotherapy intervention integrating somatic release and cognitive reframing (release from the body, reframe in the mind), may be a powerful tool for grief resolution, especially in culturally embedded contexts where emotional expression is often constrained. The intervention was shown to be effective across different time ranges, including more than 10 years post the loss.

The significant reduction in SUDS post the intervention are quite encouraging, for future research, validated tools to assess prolonged grief should be used. Future research should also include controlled groups for better analysis.

Despite the limitations, the current study provides empirical evidence that supports the use of relationship dialogue for grief management. The intervention helps individuals dealing with grief or bereavement to acknowledge, accept and deal with the loss.

Acknowledgements:

We sincerely appreciate the contributions of Meenakshi Nair, Anagha Nagpal, Ruhi Pabari, Kokilashree Vickneswaran, Renee Nair, Dr. Yibali Shetty, and Parishi Thakore for their dedication in conducting the grief work sessions.

We would also like to thank Krish Mehta for his valuable assistance with data analysis.

 

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Author profiles

Neha Pandya ([email protected]) is based in Ahmedabad, Neha is a dedicated psychologist and therapist with extensive experience in supporting individuals through their mental health journeys. She holds a bachelor’s degree in psychology from St. Xavier’s College and a Master’s in Clinical Psychology from Gujarat University.

Neha is a certified Inner Child Healer and Hypnotherapist, having conducted over 500 therapy sessions. Her background includes working as a counselor for a mental health counseling and suicide prevention helpline, where she honed her skills in crisis intervention, grounding techniques.

Since joining Wellness Space in 2022, Neha has focused on helping clients understand how present challenges often stem from unresolved past traumas. She uses her expertise to guide individuals toward healing, transformation, and achieving holistic wellness.

 

Riri G Trivedi ([email protected])

Riri G. Trivedi is a co-founder of Wellness Space and the Society for Energy and Emotions (SEE). She specializes in Evidence Based Psychotherapy and Life Coaching, focusing on Adverse Childhood Experiences (ACE), Inner Child Integration Techniques and Hypnotherapy.

Her extensive credentials include certifications as a Trauma Sensitive HeartMath© Practitioner and an Inner Child Integration Therapist. She is also an Integrated Clinical Hypnotherapist and holds a Diploma in Past Life Regression Therapy from the Past Life Regression Academy (UK), certifications in yoga therapy and teaching (S-Vyasa Singapore) and advanced credentials in family yoga, Yin Yoga, and Gestalt practices.

She is the author of “This Book Won’t Teach You Parenting”, published by Penguin Random House India. She has also co-authored a book on Breast Cancer: Medical Treatment, Side Effects, and Complementary Therapies’, both available online.

She has published several papers on Childhood trauma and mental health in leading journals as a part of her PHD on ACE, anxiety, depression, and subjective well-being among adults in India. As a social media influencer with over 1.4 million followers across Meta and YouTube, she uses her platform to raise awareness about mental health.

She integrates her corporate experience with P&G Japan, academic qualifications (BCom/LLB/MBA), and therapeutic expertise to connect meaningfully with diverse audiences.

She is the mother of two kids and resides in Ahmedabad with her husband Gunjan Y Trivedi

 

Dr Hemalatha Ramani ([email protected])

Hemalatha Ramani holds a PhD degree in Economics from the Institute of Social and Economic Change (ISEC), Bangalore, India. She has taught at the National University of Singapore, Singapore; BK School of Management, Ahmedabad University, Ahmedabad International School (Economics for the Cambridge, IB curriculums); and Prakash Higher Secondary School (Economics for the CBSE Classes XI, XII).

She has served the Samaritans of Singapore, The Women’s World Banking (Ahmedabad), The Indian Institute of Management, Ahmedabad, and the Behavioral Science Centre (St Xavier’s College, Ahmedabad). She is a co-author of books on Breast Cancer (“Breast Cancer: Medical Treatment, Side Effects, and Complementary Therapies”) and Lifestyle diseases (“Preventing Insidious Lifestyle Diseases”). She is engaged in research on childhood trauma, suicidal behavior, and related subjects and mentors the Wellness Space team.

 

Dr Gunjan Y Trivedi ([email protected])

Dr Gunjan Y. Trivedi is a co-founder of Wellness Space, Ahmedabad, India with a passion for wellness spanning over a decade. He combines this with a successful corporate career at Procter & Gamble, where he worked across the U.S., Japan, Singapore, China, and India.

Gunjan holds a master’s in marketing (MBA) and Computer Engineering (MS) from Michigan State University and a PhD for pioneering research on the Bhramari protocol to enhance heart rate variability.  At present, he teaches “Evidence-based psychotherapy” and provides therapeutic intervention and coaching with specific focus on adverse childhood experiences (ACEs), depression, PTSD (Post Traumatic Stress Disorder) and Complex PTSD.

Gunjan collaborates with institutions to publish scientific articles related to childhood trauma, mind-body connection and trauma (PTSD: Post Traumatic Stress Disorder), Complex CPTSD). He has co-authored a book on lifestyle diseases.

A former cricketer and classical music enthusiast, Dr. Trivedi continues to blend science, wellness, and tradition in his work.