The loss of a friend, family member or loved one can be overwhelming for anyone, but by being part of a strong support system you can play an important role in his or her healing process. Being a great listener is a given, but by recognizing and understanding the typical stages of healing and how they have developed, you will be in a much better position to help your partner through his or her grief.
The 5 Stages of Grief: Are They Appropriate? Many doctors, clinicians, and caregivers still use the following stages as milestones for the bereaved. Yet for those struggling with the loss of a loved one, the idea that grief recovery follows a standard timeline of set stages can seem ridiculous, if not infuriating. Certainly those who have had to heal from a painful loss are well aware that the process doesn’t fit in to neat little boxes. These five stages were originally outlined by Elisabeth Kubler-Ross in her 1969 book On Death and Dying, and referred to the steps that a terminally ill patient may go through upon learning of the finality of their situation.
These five stages synthesized what caregivers had witnessed in dying patients from studying their coping mechanisms. The stages at that point were not yet known as the 5 Stages of Grief, but rather "The 5 Stages of Receiving Catastrophic News." Since then, these stages have morphed into what is commonly known as
The 5 Stages of Grief:
D enial—This isn’t happening; this isn’t real.
A nger—Why has this befallen me? What have I done to deserve this suffering?
B argaining—If I can get out of this, I promise will be a better person.
D epression—I don’t know what I’m going to do. I don’t care anymore what happens to me.
A cceptance—Okay. This is real, and I’m ready for whatever I have to go through.
How long is too long to be grieving? On the surface, these 5 Stages of Grief seem sensible. And when the world is spiraling seemingly out of control due to grief, these stages may provide a certain comfort in their structure. But the idea that everyone could go through the same stages at the same time—and in the same order—led to the early notion that those not following the standard progress of grief may have a pathological form of grief that needed professional help (in other words, psychological counseling). Worse still, if the bereaved weren’t completely through the stages by a certain time, some might be treated as if their grief was out of sorts or inappropriate to their situation. More recent efforts have been underway by bereavement researchers to look at how people grieve over time. Synthesizing several grief theories, Jacobs (1993) presented a hypothesized set of responses to grief that expanded the stages:
Recent studies (Bonanno, Wortman, et al 2002; 2004) have also highlighted several distinct recovery paths, and found that normal grief reactions persisted even eighteen months after the loss occurred.
Testing the theory that grief occurred in stages, a 2007 study (Maciejewski, Zhan, Block, Prigerson) found that participants whose partners died due to natural causes simultaneously felt all of the stages of grief to various degrees at each time point measured, with the feelings of acceptance being greatest even at the beginning when a person was closest to the loss, and this acceptance increased over time. And while many might feel that depression/sadness would be next on the list, yearning was the next most frequent response reported throughout the study.
It’s important to note that this study raised controversy when it was first published because all of the grief indicators were in decline by six months after the loss, and the authors implied that further evaluation and potential referral for treatment may be necessary after that time. But the time frame for the course of normal grief and adjustment could last much longer, with survivors incorporating positive memories into their lives years after their loss. Carnelley, Wortman, Bolger and Burke (2006) found that widowed respondents continued to experience memories and even participate in conversations about their deceased loved one beyond the first four years after the loss.
Contrary to popular belief, this was a normal response to the loss of a loved one, not inappropriate attachment or dependence. This was also a sign of good adjustment when participants were able to focus on the positive aspects of memories of their loved one. They also found that "anniversary reactions" (i.e., painful reminders of the loss during a specified time/reminder) were sometimes experienced for decades, with the intensity of these reactions dropping quickly in the first few years.
While these might be considered a setback in recovery, it’s important to emphasize the commonality of such reactions (infrequently as they may be) as a normal response in the grief process, not a pathological one. In fact, respondents of a study by Harvey and Hansen (2000) reported that they frequently engaged in "account making and confiding:" talking about their previous relationships with their new partners and /or close others as a way of coping with the loss (although this was used more by women than with men). Many emphasized the positive impact this had on their well being. So if your partner continues to discuss memories and tell stories of the deceased well after the loss, do not despair—it can be a normal part of the healing process.
How to Help Those Who are Grieving The grief work premise is that those grieving must confront and express their emotions in order to fully heal from their loss. Most who are familiar with grief work would say that people should reflect, process, and express all that is coming forth regarding the loss of their loved one. But researchers have found that disclosing grief isn’t always beneficial. Stroebe and colleagues (1996; 1997, from Pennebaker 2001) found those that were asked to disclose their grief through writing didn’t differ in the physical or mental health after a one year follow-up. In another study, family members were rated by those grieving as less helpful than friends (Marwit and Carusa 1998).
Obviously this is an intense time, and many factors need to be considered when helping those affected by grief and loss. Being sensitive to the type of loss, overall impact, and, if you are involved, your own feelings of grief, may improve your support to those that are grieving. For instance, death due to an unexpected event versus a long-term, painful illness might elicit different reactions from survivors. In the case of a partner passing after a long struggle with a terminal illness, the survivor may have already worked though their grieving during the time of their partner’s illness. But when a partner has died suddenly and unexpectedly, talking about the loss and processing the feelings can be beneficial in coming to terms with the event.
When an intimate partner dies, it’s quite possible to set off a crisis of the entire support system, and friends and family may have difficulty providing support to a partner because they are grieving themselves. Other researchers found that outsiders may be unaware of the full magnitude of the loss, with changes in financial security, emotional support, practical help, and so forth for the survivor. Death can elicit powerful feelings that might overwhelm the surrounding survivors with tumultuous and vulnerable feelings, and often not knowing what to do, those genuinely trying to help might create more harm than good. Wortman, Wolff and Bonanno (2004) provide culled evidence of three behavior types that can be detrimental to the bereaved:
- Discouraging open expression or discussion of feelings about the loss
- Encouraging recovery
- Falling back on cliched or scripted support attempts that trivialize the bereaved issues
What is beneficial is allowing survivors the opportunity to talk about their feelings on their own terms. Expressing concern without pushing advice, as well as reaffirming the presence of support (without necessarily forcing it) is also helpful. If you’re unsure how to approach the situation, it might be best to take a cue from your partner in how open and willing they are to talk about the loss. Finally, talking with others in a similar situation (e.g., a grief support group) is also thought to be beneficial.
Grief Work: Moving Beyond the 5 Stages The Counseling for Loss and Life Changes group (TLC) suggests that grief work actually begins where the last "stage" of acceptance leaves off. A common definition they use is summarized by the acronym TEAR:
T= To accept the reality of the loss
E= Experience the pain of the loss
A= Adjust to the new environment without the loss
R= Reinvest in the new reality If you know someone who is grieving right now, make sure they understand they can come to you on their terms. If you are struggling with how best to support them, sometimes asking then "What can I do that would be helpful to you?" or "What do you need from me?" may get a beneficial discussion started. If you are grieving and would like to seek professional help yourself, pick a counselor who is trained specifically in grief intervention work, and if something isn’t working for you, be sure to let them know. Complicated grief does exist, and if you feel you are experiencing thoughts and emotions beyond what is considered "normal" consider reaching out to a trusted doctor, clinician, or caregiver for more information and support. While interventions and therapy can be appropriate for some individuals, it isn’t necessary for everyone. Sometimes the best way to heal is just by accepting that adjustment and recovery go beyond five easy stages. Those closest to you can be a great source of support.
References and Further Reading: Counseling For Loss & Life Changes (1997). Article 8- Beware the 5 Stages of "Grief." Retrieved June 7, 2007 from http://www.counselingforloss.com/article8.htm Carnelley, K.B., Wortman, C.B., Bolger, N., &Burke, C.T. (2006). The time course of grief reactions to spousal loss: Evidence from a national probability sample. Journal of Personality and Social Psychology, 91, 476-492. Harvey, J.H., &Hansen, A.M (2000). Loss and bereavement in close romantic relationships. In C. Hendrick & S.S. Hendrick (Eds.), Close relationships: A Sourcebook (pp. 359-370). Thousand Oaks, CA: Sage Publications, Inc. Jacobs, S. (1993). Pathological grief: Maladaptation to loss. Washington, D.C.: American Psychiatric Press. Maciejewski, P.K., Zhang, B., Block, S.D., Prigerson, H.G., (2007). An empirical examination of the stage theory of grief. Journal of American Medical Association, 297, 716-724. Marwit, S.J., &Carusa, S.S. (1998). Communicated support following loss: Examining the experiences of parental death and parental divorce in adolescence. Death Studies, 22, 237-255. Pennebaker, J.W., Zech, E., and Rime, B (2001). Disclosing and Sharing Emotion: Psychological, Social and Health Consequences. In M.S. Stroebe, W. Stroebe, R.O. Hansson, & H. Schut (Eds.) Handbook of bereavement research: Consequences, coping, and care (pp. 517-539). Washington DC: American Psychological Association. Wortman, C.B., Wolff, K., Bonanno, G.A. (2004). Loss of an intimate partner through death. In D.J. Mashek, D.J., & A. Aron (Eds.), Handbook of Closeness and Intimacy (pp.305-320). Mahweh, NJ: Lawrence Erlbaum Associates.