complicated grief therapist Archives

Throughout Western societies, we buy into the prevalent sociocultural belief of the stage theory of grief. As if to bring comfort and understanding of our loss, we are told we should progress through a series of five stages: denial, anger, bargaining, depression, and acceptance.

Even while I was in graduate school for social work, I can vividly recall some professors ascribing to this model, never once questioning if their claims were accurate since it seems to be a universal statement as true as 2+2=4.

In short, this belief pushes the idea that bereaved individuals must undergo a specific sequence of reactions over time as the result of the death of someone who was significant to them. Not only is this inaccurate since individuals may not experience all the stages in their set order, but it also is stigmatizing to those who never experience the stages at all as they may think there is something “wrong” with them. Thus, I argue that the stage theory should be abandoned, for there are newer, different models that are more accurate for illustrating the grief journey.

On the History of the Five Stages of Grief

In 1969, psychiatrist Elisabeth Kübler-Ross introduced the model in her groundbreaking book On Death and Dying. At the time, there was a severe deficit in medical schools on the topics of death and dying, which motivated Elisabeth Kübler-Ross to do the research herself by observing the reactions of her patients with terminal diseases. She was also influenced by some researchers with stage models from decades earlier.

Quickly, the Kübler-Ross Five Stages of Grief model was branded as universal knowledge among the medical community, scholars, and the public at large.

Later, Kübler-Ross clarified she never intended for the stages to be viewed as a linear progression, and that she wrote them in a way that was misunderstood. She added she meant for the stages to reveal how people with terminal illness cope with learning they are close to death, not as a reflection of how people grieve once that person has died.

In a later book Kübler-Ross coauthored, she lengthened her model to consist of all forms of loss, such as bereavement (the specific term designated for the death of someone who was significant), the end of a relationship, unemployment or loss of income, substance abuse, incarceration, infertility, and the diagnosis of disease. Thus, at best, the model is helpful for understanding grief across multiple contexts.

Major Problems with the Model

Unfortunately, there are significant problems with the Kübler-Ross model. They include the following:

Oversimplicity. The model does not consider the variance in grief reactions between individuals, families, and cultures across time.
Passive model. It describes what an individual will experience, but there is an absence of the active force to come to accept the grief.
No sociocultural lens of grieving. The model assumes all people will grieve in the same way, regardless of relevant factors such as religion, culture, family traditions, socioeconomic classes, or historical elements.
Absence of secondary stressors. There is no mention of the stressors that can arise because of the grief, such as new roles.
Prescriptive statements. For instance, the model implores that someone must feel angry to pass onto the bargaining stage. While this is a common emotion to experience, it does not happen for everyone.
Assumption of a smooth, simple progression. The model portrays an easy, observable, predictable progression from one stage to the next. This does not account for the emotions and beliefs that can seesaw or be otherwise conflicted during grief.
Variances in how to cope with loss. The model assumes all people will cope the same way, ignoring the important fact that some people will reject the reality of death in a means to cope.
Vague terminology. The model uses vague wording to describe the complex thoughts and emotions that can accompany the grief. For instance, the word “depression” can range from sadness to major depressive disorder.

Please note: For a detailed report on the problems resulting from the Kübler-Ross model from an academic perspective, please visit the citations at the bottom.

On Grief Recognition and Resolution: The TEAR Model

In an effort to replace the Kübler-Ross model with a more practical, forgiving model to help people navigate through their bereavement, therapists and other professionals have adopted the TEAR model. This is also known as the Four Tasks of Mourning and is explored in-depth by researcher J. William Worden.

T: To accept the reality of the loss.
E: To experience the pain of the loss.
A: To adjust to the new environment without the lost object.
R: To reinvest in the new reality.

Notice the paramount difference between the two models. In the 5 Stages of Grief, acceptance is at the end of the sequence which assumes the work has been completed. Conversely, in the TEAR model, acceptance is at the start of the journey. In other words, grief work can only begin once the mourning period has ended. It must come after the sympathy cards, texts and phone calls have stopped. It approaches when the bereaved individual is expected back at work or school, operating as if things are “normal” like nothing happened.

This comes after the mourning period, after when the sympathy cards, texts and phone calls stop coming. This is when the bereaved individual is expected back at work, operating as “normal” like nothing happened.

It is time we discard the widespread belief that grief is a set of prescriptive stages. We should embrace grief as an ongoing set of work, ready to be approached only once the public mourning has ceased. Acceptance is the prerequisite to face true, raw grief, and from it come recognition and resolution.

About the Author, Valerie Smith, LMSW:
Valerie Smith, LMSW, CFTG, is a therapist, social worker, and certified forest therapy guide at Long Island EMDR under the supervision of our clinical director, Jamie Vollmoeller, LCSW. Valerie possesses a bachelor and master's degree in social work from Adelphi University and Fordham University, both from which she graduated summa cum laude. Valerie is also a certified forest therapy guide through the Association of Nature and Forest Therapy (ANFT), where she trained in the Rocky Mountains to master sensory-based, mindful activities through a biophilic perspective. Valerie is passionate about the health benefits of a plant-based diet as well as holistic wellness. Valerie is trained in EMDR and TF-CBT, with experience in DBT-informed skills. She focuses her treatment on adolescent girls and young women with C-PTSD and PTSD. Additionally, she helps people with life-threatening disease and their caregivers. Finally, she works alongside those experiencing grief and bereavement, especially young adults who lost one or both of their parents/guardians.

Grief is a normal response to mourning the loss of a significant attachment figure. However, some people experience complicated grief characterized by an intense, prolonged mourning period focused on unhelpful, painful thoughts, dysfunctional behaviors and difficulty regulating emotions. When someone struggles with complicated grief, unique therapeutic interventions are required to address it. Complicated Grief Therapy involves seven core themes, including understanding grief, managing painful emotions, thinking about the future, strengthening relationships, telling the story of the death, learning to live with reminders and remembering the person who died. Many people with complicated grief believe that they cannot be connected to their lost loved one without constant emotional pain. Overtime this can strain relationships, prevent an individual from honoring the memory of the deceased and prohibit the person from truly being connected to their loved one. It is possible to achieve meaningful relationships while still remaining connected to the deceased with the assistance of a Complicated Grief Therapist. Psychologist, J. William Worden named the four tasks of mourning which allow us to see how integrating loss into our lives does not erase their memories, but rather preserves our connections to them.

1. Accepting the Loss

Sometimes grief can become complicated by unhelpful, often catastrophizing thoughts that cause some people to feel they are not grieving “the right way” if they come to terms with their loss. These thoughts cause people to have dysfunctional behaviors, such as avoiding places that remind them of their loved one or constantly day dreaming about their loved one. When we distract ourselves from painful emotions with avoidant behaviors, we inadvertently keep ourselves stuck in a place that prevents us from experiencing pleasant moments of connection to our lost loved one. A main concern for people with Complicated Grief is that they might forget or dishonor their relationship with the deceased if they accept the loss. However when we spend our time refusing to accept the loss, we actually reframe our relationship with the lost loved one around their death rather than the joy and connection shared with them when they were alive.

2. Process the Pain and Grief of the Loss

Grief is a natural, emotional process that involves a balance between times of pain and sadness and times of respite where we are able set aside out grief for a time. Those with complicated grief have difficulty stepping out of their grief and inadvertently redefine who the deceased was as a perfect being. This means that we wind up moving away from the true identity of the deceased and our actual relationship with them. In an attempt to stay connected to this idealized person we hyper focus on reminders of them to feel close to them. Despite focusing on things that exacerbate their feelings of loss, we are unable to process our pain because we stay in a place where we are so overwhelmed by our grief that we are unable to cope or connect with our loved one. Allowing ourselves time and space to heal does not mean we have forgotten our loved one. In actuality permitting ourselves to process our pain will enhance our connection to the deceased by granting ourselves the ability to truly remember who they were and to cherish our memories of the true lost loved one.

3. Adjust to the World Without the Lost Loved One

Important people in our lives often take on specific roles. This adds another lay of adjustment and grief after someone close to us has died. We may have to take on more house chores and errands which can serve as additional reminders of the loss or we may have to go to events that we would have gone to with the deceased alone. All of these tasks call on us to adjust to the world without the deceased, not to forget them. When we are unable to make these changes we diminish our capacity to function in the world.

4. Integrate the Loss into A Meaningful Life

The purpose of Complicated Grief counseling is to integrate the loss into the survivor’s life in a way that allows the surviving person to feel connected to the deceased while still being able to function and feel joy in their lives. The purpose of integration is to create a healing process that celebrates the bond between the survivor and the deceased and highlights the joy experienced with the deceased rather than defining the relationship by the pain experienced as a result of the deceased’s death.

Grief is not a voyage from which we eventually return unchanged. We hold people who we have formed close connections with in our hearts, even after they have passed away. If you feel you have been in a prolonged, intense state of grief that has prevented you from living a meaningful life while maintaining a connection to your lost loved one, please call our office so we can work on adjusting to the present and redefining the future.

Be Well,

Marissa Ahern, LMSW