MACP, CCC · Published
Anticipatory grief is grief that begins before a death or expected loss, often while someone you love has a terminal or progressive illness. It can bring sadness, dread, guilt, irritability, exhaustion and moments of relief. It is not a sign you are giving up, and it does not use up the grief that comes later.
You might be sitting by a hospital bed, sorting pills at the kitchen table, or visiting a parent who no longer knows your name, and feel that you are already losing them. That is a real loss even though nobody has died. If you would rather talk it through than read about it, TEO offers grief counselling online in six provinces, before a death as well as after one.
The psychiatrist Erich Lindemann named it in a 1944 paper on acute grief in the American Journal of Psychiatry. He noticed that some relatives of men away at war went through grief while the soldier was still alive, as if bracing for news of a death.
A 2017 review by Coelho and Barbosa in the American Journal of Hospice and Palliative Medicine brought together 29 articles, most with caregivers of people with terminal cancer. It identified ten themes, among them anticipating the death, emotional distress, hope, ambivalence, losses in the relationship and in your own life, and things people want to say or finish before the end. The authors describe a stressful, ambivalent experience: the person is still there and needs care, so families often hold their own grief back to keep functioning.
When the person who is ill is the one grieving, for their body, their plans and the people they will leave, clinicians often call it preparatory grief.
It rarely feels like one thing. Many people describe a mix that shifts from day to day:
None of these is a diagnosis or a sign that something is wrong with you.
Anyone close to a loss they can see coming, most often:
People in the same family often feel it at different times and in different ways, and there is no right pace.
The family therapist Pauline Boss named a related experience in her book Ambiguous Loss (Harvard University Press, 1999): a loss with no clear ending and no official recognition. In one form, a person is physically present but psychologically absent, as with dementia, a brain injury or an addiction that has taken over. In the other, a person is physically absent but psychologically present, as with estrangement or a missing person.
Ambiguous grief is the grief that comes with this kind of loss. It can go on for years with no death at all, and there is no ritual for it. Dementia is where this overlaps most with grief before a death: anticipatory grief in dementia means grieving each lost piece of the person while they are still in the room, then grieving again when they die. Boss's point is that the confusion comes from the situation, not from a weakness in the people living through it. Our grief counselling page has a section on the losses nobody holds a funeral for.
There is no timetable. It often lasts as long as the illness or decline, which can be weeks or many years, and it tends to come in waves. A new diagnosis, a fall, a move to long-term care or a conversation about stopping treatment can each bring a fresh wave. Calm stretches are common too, and they do not mean you have stopped caring.
Grief also changes shape after the death. Some people feel the loss more sharply than they expected; others feel relief alongside the sadness, then guilt about the relief. Relief after a long illness does not cancel love, and the section of our grief counselling page called Relief, anger and guilt do not disqualify it explains why.
It is often assumed that grieving in advance means less grief later. The research does not back that up. A 2016 systematic review by Nielsen and colleagues in Clinical Psychology Review looked at studies from 1990 to 2015 on adult caregivers of terminally ill adults. High levels of grief during caregiving, and feeling unprepared for the death, were associated with harder bereavement afterwards, such as complicated grief. The idea that grieving before the loss would ease bereavement was not confirmed.
Two things follow. If you are grieving heavily now, that is a reason for more support, not a sign you are getting it over with. And feeling prepared seems to matter: in the same review, higher preparedness for the death was associated with better outcomes for caregivers. Preparedness can be practical, such as knowing what the last weeks may look like and who to call when the death happens, as well as emotional. These are patterns across groups; they cannot predict your own grief.
Not in a fixed order. Elisabeth Kübler-Ross's five stages, denial, anger, bargaining, depression and acceptance, came out of her conversations with seriously ill patients in the late 1960s, so they are often applied to grief before a death. They were not meant as a checklist, and research has not confirmed them as a sequence people move through. Our article on the six stages explains why grief does not follow neat stages.
If the person can still talk, some families find it helps to say thank you, say sorry, share a memory, or simply say that you love them. Not every relationship allows that, and some things can stay unsaid. A letter you may never send is another way to say it.
Doing everything alone wears people down. List concrete jobs, such as meals, drives, a night shift or paperwork, and let people pick one. If you are reaching the end of what you can give, read about caregiver burnout; running out is a sign of load, not a flaw in you.
Eat something regularly, sleep when you can, and use respite: a few hours or days when someone else covers the care. Ask the care team, the local hospice or your province's home and community care program what respite is available.
Employment Insurance has caregiving benefits for people who take time off work to care for someone. According to the Government of Canada (checked 5 October 2026):
Check canada.ca for current eligibility rules and payment amounts.
The same kind of grief can come before losses that are not deaths:
Other people often do not recognise these losses, which can make them lonelier. They are still losses.
Many people get through grief before a death with family, friends, a faith community and hospice support. It may be time to talk to someone if:
Counselling before a death is a place to say what you cannot say at the bedside, and to work out what you want to say to the person and how to share the care. TEO does not diagnose or prescribe; that conversation belongs with a family doctor or nurse practitioner. If grief stays heavy long after a death, our grief counselling page has an FAQ on prolonged grief disorder and when to get help.
TEO grief work is led by Rola Shbib, BSW (Hons), RSW (Ontario), who holds an honours degree in thanatology and sees clients in all six provinces. She works online with individuals, in English. Mohamad Shabib, MACP, CCC, works online with clients in all six provinces, in English or Arabic. Alison Shaji, RCC, sees clients in British Columbia only.
Sessions are $150 per 60 minutes, online only, with no office to visit and no referral needed. TEO's sessions run between noon and 9 pm Pacific (3 pm to midnight Eastern), seven days a week. The first step is a free 15-minute consultation on a video call or a scheduled phone call, which is where timing and the choice of clinician are sorted out. If you live in Ontario, there is more on grief counselling in Ontario, including where OHIP stands.
Insurance depends on whether your extended health plan covers the clinician's designation: RSW for Rola, CCC for Mohamad, or, for clients in British Columbia only, RCC for Alison. Rola is not on the direct-bill line, so sessions with her are paid at the time, with a receipt to submit yourself. The fees page has the detail.
You can ask to start with Rola when you book or text. The text line is not a crisis service.
This article is general information about grief before a loss. It is not a diagnosis or a crisis service. In a crisis, call or text 9-8-8; in immediate danger, call 911.
Yes. Grieving while someone is still alive is a common response to a loss you can see coming, and it has been described since the 1940s. Sadness, dread, numbness or moments of relief during a long illness do not mean you love the person less. It is worth getting support if it starts to take over your sleep, work or days.
Yes. When an animal is old or seriously ill, many people grieve before the death, especially while deciding when to say goodbye. That grief is real, and at TEO it is treated as grief, before or after the death, the same as any other loss.
No. After a long illness, relief often arrives alongside sadness: relief that their suffering has ended, and that the strain of caregiving is over. Guilt about the relief is common too. Relief sits next to love and does not cancel it, and you can say it openly in grief counselling.
Yes. You do not have to wait for a death to get support. Counselling before a loss can help with the dread, guilt and exhaustion of caregiving, and with what you want to say to the person. At TEO, sessions are online and $150 for 60 minutes, and the first step is a free 15-minute consultation on a video call or a scheduled phone call.
Grief before a death is a common response, not a diagnosis. Prolonged grief disorder is a diagnosis that applies only after a death. DSM-5-TR requires the death to have been at least 12 months ago for adults (6 months for children and adolescents), and ICD-11 requires grief that has lasted more than 6 months at a minimum. Both also look for intense longing for, or preoccupation with, the person who died, and for grief that significantly disrupts daily life. TEO clinicians do not diagnose; a family doctor, nurse practitioner or psychologist can assess it.
Book a free, no-pressure consultation. We'll talk about what you're going through and figure out together if we're the right fit.
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