Grief is one of the most universal human experiences, yet it is also one of the most misunderstood. The stages of grief framework, originally developed by psychiatrist Elisabeth Kubler-Ross, has shaped how people think about loss for decades. While grief does not follow a tidy linear sequence, understanding these emotional phases can help people recognize what they are experiencing and know when their grief may benefit from professional support through grief therapy.
Table of Contents
What Is Grief?
Grief is the natural response to loss. While it is most commonly associated with the death of a loved one, grief can be triggered by many types of loss, including the end of a significant relationship, a major health diagnosis, job loss, infertility, the loss of a sense of safety after trauma, or any other experience where something meaningful is taken away.
Grief is not a pathology. It is a normal, healthy part of being human. However, it can become complicated or prolonged in ways that significantly interfere with a person’s functioning and quality of life, and those situations often call for professional support.
The Five Stages of Grief
The five stages model was first introduced by Kubler-Ross in her 1969 book On Death and Dying. It is important to note that these stages were originally developed based on research with terminally ill patients, not those who had experienced bereavement. Over time, the model was extended to describe the grief of those who have lost loved ones. The stages are:
Stage 1: Denial
Denial is often the first response to a significant loss. It serves as an emotional buffer, a way the mind protects itself from the full weight of a devastating reality. Denial does not necessarily mean a person literally refuses to believe what happened. It more often manifests as a sense of unreality, going through the motions of life while not yet fully absorbing the impact of the loss.
Denial is a temporary and protective response. As it fades, the emotions that were held at bay begin to surface.
Stage 2: Anger
As the reality of the loss sets in, anger often emerges. This anger may be directed at others, at circumstances, at a higher power, at the person who died, or at oneself. The intensity and target of grief-related anger can feel irrational or frightening, but it is a normal expression of the pain underneath.
Suppressing grief-related anger does not make it go away. It often finds expression in other ways, including irritability, physical tension, or relationships conflict. Allowing the anger to be acknowledged and worked through is part of the healing process.
Stage 3: Bargaining
Bargaining involves the mind searching for ways the loss could have been prevented or reversed. Common bargaining thoughts include replaying past events and asking what could have been done differently, making promises or deals in hope of undoing what has happened, or becoming preoccupied with “what if” and “if only” thinking.
This stage reflects a human tendency to seek control in situations where none exists. Working through bargaining involves moving toward an acceptance that some things cannot be undone or changed.
Stage 4: Depression
Depression in the context of grief refers to a deep sadness, emptiness, and heaviness that sets in as the full weight of the loss becomes real. This is often when the most profound grieving occurs. During this stage, a person may withdraw, have difficulty finding motivation, experience changes in sleep and appetite, and feel a profound sense of loneliness.
It is important to distinguish grief-related depression from clinical major depressive disorder, though the two can overlap. If depressive symptoms are severe, long-lasting, or accompanied by thoughts of suicide or self-harm, professional evaluation and support are warranted.
Stage 5: Acceptance
Acceptance does not mean being okay with the loss or moving on as though it did not happen. Rather, it means coming to terms with the reality of the loss and beginning to find a way to carry it while moving forward with life. Acceptance is often marked by a gradual return of energy, renewed engagement with relationships and activities, and the ability to hold memories of the loss with something other than raw pain.
Acceptance is rarely final or complete. Many people cycle back through earlier stages, particularly around significant dates or milestones.
What the Stages Get Right and Where They Fall Short
The five stages model has been valuable for normalizing the grief experience and giving people language for what they are going through. However, it has also been widely misunderstood and misapplied. Grief research over the past several decades has clarified some important limitations of the model:
- Grief is not linear. People do not move through the stages in order, and many experience multiple stages simultaneously or cycle back repeatedly.
- Not everyone experiences all five stages. Some people experience only a few of them, or experience grief in ways that do not map neatly onto this framework.
- There is no correct timeline. Grief cannot be rushed, and there is no prescribed duration for any stage or for the overall grieving process.
- Individual and cultural variation is enormous. How people grieve is shaped by their personality, their relationship with what was lost, their cultural and religious background, and the circumstances of the loss.
More recent models of grief, such as the Dual Process Model developed by Stroebe and Schut, recognize that grieving people oscillate between confronting their loss and taking breaks from it through engagement with daily life and new activities.
Complicated Grief: When Grieving Becomes Prolonged Grief Disorder
For most people, the acute intensity of grief diminishes gradually over time, even as the loss continues to be felt. For some, grief becomes stuck. Prolonged Grief Disorder (PGD), recognized in the DSM-5-TR, is characterized by a persistent and pervasive grief response that does not diminish and significantly impairs daily functioning.
Signs that grief may have become prolonged or complicated include:
- Intense grief and longing that remain as acute as the early days of loss, months or years later
- Difficulty accepting the reality of the loss
- Bitterness, anger, or guilt that does not diminish
- Inability to re-engage with relationships, work, or activities that were meaningful before the loss
- Feeling that life is meaningless or that a part of oneself died with the person lost
- Avoidance of all reminders of the loss, or conversely, an inability to stop engaging with reminders
Prolonged grief disorder is distinct from both typical bereavement and major depressive disorder, and it responds to specific therapeutic interventions, particularly a form of therapy called Complicated Grief Treatment (CGT), which has a strong evidence base.
When to Seek Grief Therapy
Grief does not require professional intervention to heal in most cases. Support from family, friends, faith communities, and informal peer support is often sufficient for many people to move through grief and find their footing again. However, professional grief therapy is appropriate when:
- Grief is significantly impairing daily functioning for an extended period
- Symptoms of prolonged grief disorder, depression, or anxiety are present
- The loss was traumatic, sudden, or involved violent or ambiguous circumstances
- The person is isolated and lacks adequate social support
- Thoughts of suicide or self-harm are present
- Substance use has increased significantly as a way of coping
Seeking therapy for grief is not a sign that you are grieving wrong. It is a sign that you recognize when extra support would help and that you are willing to reach out for it.
What Grief Therapy Involves
Grief therapy is tailored to the individual’s specific loss, relationship history, and therapeutic needs. It may involve exploring and processing emotions that have been suppressed, creating meaning from the loss, rebuilding a sense of identity and purpose, and integrating the loss into the ongoing story of a person’s life rather than treating it as something to get over.
Evidence-based approaches used in grief therapy include Complicated Grief Treatment, Cognitive Behavioral Therapy adapted for grief, narrative therapy, and for trauma-related losses, EMDR and other trauma-focused therapies.
Frequently Asked Questions
Is it normal to still be grieving years after a loss?
Yes. While the acute intensity of grief typically diminishes over time, grief does not have an expiration date. Many people continue to feel the presence of a loss for years or decades, particularly around meaningful dates or life transitions. The question is whether grief is allowing for functioning and growth, or preventing it.
What is the difference between grief and depression?
Grief and depression share some symptoms, including sadness, sleep changes, and difficulty with daily activities. However, grief typically involves a continued connection to the person or thing lost, fluctuates in intensity, and does not usually involve the pervasive sense of worthlessness seen in clinical depression. When depression develops during or after bereavement, it often warrants treatment in its own right.
Can children benefit from grief therapy?
Yes. Children grieve differently than adults, and their grief may manifest as behavioral changes, regression, physical complaints, or changes in school performance. Therapists who specialize in childhood grief use age-appropriate approaches to help children process loss in healthy ways.
How long does grief therapy last?
The duration of grief therapy varies based on the individual and the complexity of their grief. Some people benefit from a few months of therapy, while others with prolonged grief or complicated circumstances may work with a therapist over a longer period. Your therapist will discuss expectations and progress with you throughout the process.
What types of loss can grief therapy address?
Grief therapy is not limited to the loss of a loved one. It can address grief related to divorce, the end of significant relationships, diagnosis of a chronic or terminal illness, pregnancy loss, job loss, the loss of a sense of safety after trauma, and many other significant losses.