Grief: Have We Moved Beyond the Five Stages?

Therapist

At first thought, you may associate grief with death and losing someone close to you. Grief over the loss of a loved one is specifically referred to as bereavement. However, if you’ve experienced any kind of significant loss, such as the loss of a relationship, career, health status, or any other loss that triggered strong emotional distress, then you are no stranger to grief. In this post I am going to explore a popular model for processing grief, and why that may no longer be the best way to approach the experience of loss.

Work through your loss with me through online counseling.

I have experience working with individuals dealing with different sources of grief. I’ve spent time as a hospice social worker helping patients and their loved ones process the emotional and practical aspects of death, as well as years in long term care helping people adjust to changes in lifestyle and health status. In my counseling practice, grief shows up in many ways, whether it’s the result of death, divorce, change in health status, career loss, and so on.

In helping you to process your loss, I partner with you to explore and make sense of your unique emotional reactions. Together, we navigate your grief and find ways to process, heal, and move forward in light of the changes that have been created by your loss.

The truth about the five stages

You may have heard of the 5 stages of grief as identified by Elizabeth Kübler-Ross, which are denial, anger, bargaining, depression, and acceptance. However, these stages were actually intended to apply to the emotional process that a patient experiences as they adjust to being diagnosed with a terminal illness.1 The grieving processes appeared to be similar for those experiencing the loss of their loved one, and so Kübler-Ross also applied them to the bereaved as well.

The 5 stages model continues to be widely popular despite major concerns about the theory. An article in OMEGA-Journal of Death and Dying from 2017 by Margaret Stroebe, Henk Schut, and Kathrin Boerner2 identifies issues with the way the stages model represents grief. Here are some of the concerns they identify:

1. Oversimplification – reactions to grief are as diverse and varied as each person who experiences loss. The 5 stages model does not account for this variability.

2. The stages model is passive, meaning that although it describes what a bereaved person experiences, it doesn’t address the struggle of coming to terms with the loss.

3. Stages include concepts that incorporate imprecise and broad terms. Some stages are identified by emotions, while others are cognitive processes.

4. It implies that stages have a smooth progression. This does not accurately represent that we actually know about the experience of grief, like someone may experience only some stages, the stages may be experienced out of order, stages can be re-experienced, and people may have experiences not included in the stage model.

5. Stages are presented in a prescriptive way. For instance, anger is identified as a necessary stage, and although it’s a common symptom, it’s not experienced by everyone.

6. It doesn’t take into account secondary stressors, such as the necessary adaptations that occur following a loss like changes in identity, roles, life changes, etc.

These are some of the concerns noted by Margaret Stroebe, Henk Schut, and Kathrin Boerner2 who feel that the stage theory should be abandoned and that the use of stage theory could potentially be harmful. Here are some examples of how the stage model could be detrimental to a grieving individual:

• If an individual is not experiencing grief in the stages indicated by Kübler-Ross, it could result in someone feeling that they are grieving incorrectly, potentially creating even more emotional distress for an individual.

• Since the stages could be interpreted as prescriptive, someone could end up relying more on the stages than on their own emotional experiences. This could create tension between the way grief is actually presenting vs. the stage of grief someone believes they should be experiencing.

• Mental health practitioners who adhere to the 5 stage model could inadvertently complicate someone’s grieving process by reinforcing the idea that grief must be experienced in these separate stages.

References:

1. https://www.psychologytoday.com/us/blog/supersurvivors/201707/why-the-five-stages-grief-are-wrong

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5375020/pdf/10.1177_0030222817691870.pdf

3. Photo by Danielle MacInnes on Unsplash