Objectives: Engaging people with profound intellectual and multiple disabilities (PIMD) in relation to issues of bereavement and loss is often seen as a complex therapeutic challenge. The author examines the barriers preventing them from engaging with the grieving process in supported ways. Methods: Through the lens of Worden's Tasks of Grief model, the author provides an assessment of the social, emotional, and physical constraints that impact on the person's experience of bereavement. Results: Although there are some similarities between people with PIMD and their more able peers, there are some additional factors which may place people with PIMD at greater risk of complicated grieving. In addition, this paper identifies the socio-contextual factors that can mediate experiences of and reactions to loss in this group. Within this framework, the limitations of a purely cognitivist approach to this area are demonstrated. Conclusion: This conceptual paper encourages therapeutic practice with people with PIMD, which partly focuses on enabling the grieving process. Suggestions and approaches for support, including multi-sensory methods, are offered.