The cakes and casseroles, the kind words, the hugs from friends and family — sometimes these warm gestures, comforting as they may be, aren't enough to get someone through a period of grief. Even the passing of time may not bring healing as soon as we expect.

That's where grief support comes in. A number of organizations in the Twin Cities offer programs for those who need extra help coping with the loss of a loved one.

"A common theme is, there's a lot of support right away after we lose somebody — giving meals, checking in with people — but over time, life just naturally keeps going," said Jennifer Baker-Jones, clinical supervisor and therapist at the Center for Grief, Loss and Transition in St. Paul. "There aren't always spaces for people to continue talking about their loved one if they need to, even if it's the same story over and over again."

The center (www.griefloss.org, 651-641-0177) provides such a space in the welcoming environment of a Grand Avenue house. It serves about 500 clients a year, providing individual or group therapy for adults, children or teens who are dealing with death (the center also serves clients who've experienced other life losses). Therapy may be tailored to particular kinds of grief, such as the death of a child or a suicide.

Grief can bring sadness, depression or anxiety — possibly enough to interfere with day-to-day functioning, Baker-Jones said. At its most severe, it can trigger extreme withdrawal, thoughts of suicide, flashbacks.

Our culture tends to talk about grief as step-by-step progress to acceptance, but often it feels more like waves, Baker-Jones said, in which the emotions get "intense, then better, then worse." The center's therapists may encourage clients to talk about those feelings, to use social support and self-care. They help find ways to honor the deceased through rituals or objects.

"People find very creative ways to honor people," Baker-Jones said.

The Downtown Coalition for Grief Support (www.mplsgriefsupport.com), sponsored by downtown Minneapolis churches, holds free weekly meetings every Saturday morning at rotating locations. Participants hear a guest speaker, then divide into discussion groups led by trained facilitators.

"Often somebody goes for a while after a death and they're doing fine … then all of a sudden they're not doing fine," said Tom Anderson of Edina, a longtime volunteer who started with the group 14 years ago when his 12-year-old son died. "Time doesn't just kind of magically heal it."

Relief can come from talking to others who understand why a three-day funeral leave is not nearly enough time to process a significant loss, he said.

"It's good to hear, 'I'm not going crazy. The fact that I put my keys in the refrigerator — other people have done the same thing,'" Anderson said. "Everybody comes from a different place. In every case they have to come to sort of a new normal, a new equilibrium in their life."

Many churches, hospitals, hospices and funeral homes offer grief support or therapy, or can suggest programs elsewhere. Organizations offering grief support in the Twin Cities include Mount Olivet church in Minneapolis (612-927-7335), Bradshaw Funeral Home (612-724-3621 or www.bradshawfuneral.com), Health Partners (call Kay Johnson at 952-883-6839 or e-mail kay.l.johnson@healthpartners.com) the South Minneapolis Coalition of Churches (call Norine Larson at 952-925-2437) and the Compassionate Friends (for parents, grandparents and siblings who have experienced the death of a child www.compassionatefriends.org).

Katy Read • 612-673-4583