Grief and loss

Grief is a natural and healthy human response to loss. It is not pathological, it is not a problem to be fixed. It is an essential aspect of our humanity, and is deeply embedded in our history as a species. It is a response to loss that encompasses a range of emotions, thoughts, and behaviors. Whether mourning the death of a loved one, the end of a relationship, a significant life change, or the loss of species on our planet, individuals can grapple with the profound impact of the void left behind. Psychotherapy serves as a valuable tool in providing a supportive and therapeutic space for individuals to explore, express, and process their grief.

Grief and loss are universal experiences that profoundly impact individuals emotionally, mentally, and spiritually. Psychotherapy relationships can be an important part of the support system for those in the process of grieving and mourning. Grief can be private and it can also be shared. Because of the interconnected nature of our existence, story telling or sharing emotions related to loss with an attuned other can be an important part of finding a way to go on being.

At Self and Other, we turn to the influential ‘stages of grief’ model to support individuals in understanding, expressing, and ultimately integrating their grief. This model was inspired by the work of psychiatrist Kubler- Ross. In her acclaimed book ‘On Death and Dying,’ she based her model on observations from working with terminally ill patients. She then adapted these observations into a model that we use in the field today to understand people’s experience of coping with grief. While grieving is a subjective and unique experience, Kubler-Ross suggests that there are universal elements that include denial, anger, bargaining, depression, and acceptance. She later expanded these initial five stages to seven. This allowed her work to better reflect some of the complexities of the process and the non linear way that some people experience grief.

Incorporating Stages into Psychotherapy

Although difficult and painful to move through, each stage of grief represents an important aspect of healing.

In the early stages it is common to express denial, which can look like disbelief, numbness, finding it “hard to believe” the reality of the loss, or feeling that the loss is “unreal.” Supportive relationships can help validate these feelings. It is important to hold space for individuals to get in touch with hard to reach feelings. While denial can help protect us from emotional pain and manage the intensity of grief, we cannot rely on this defense to protect us forever.

As the denial defense starts to loosen and reality starts to intrude into consciousness, anger may emerge as a powerful emotion. Anger is often considered a secondary emotion in grief. Because it feels powerful and energizing, it masks more vulnerable feelings like sadness and helplessness. Therapists assist in exploring the sources of anger, helping clients express and process these intense feelings in a way that they can become understandable and integrated.

Like anger, bargaining can also be a way for us to manage the more vulnerable feelings of helplessness and sadness. Clients might express a desire to reverse or alter the circumstances of the loss, or make “deals'' with a higher power to undo the loss that is too overwhelming to accept. Our therapists may help to identify these tendencies, acknowledging the need for individuals to make sense of their loss through negotiation, and helping to see where it may be blocking access to other powerful emotional processes.

Depression is considered the “quiet” stage of grief, as compared to the other, more activating feelings and defenses. Depression can have a somatic quality like weight or heaviness, it can also contribute to brain fog or difficulty focusing and functioning in daily life. Other symptoms we notice in this stage include lack or increase in appetite, changes to sleep and anhedonia (difficulty taking pleasure or interest in our usual activities). While we may wish to be more alone in this period, isolation can make it harder to cope with this stage. Therapy relationships can provide a space for individuals to delve into feelings of sadness, despair, and emotional pain in a caring environment.

Acceptance was long believed to be the “final” stage of grief. However, after publishing her work on grief stages, Kubler-Ross shared that she never intended this process to be linear, or have a distinct end point. Nevertheless, reaching “acceptance” indicates that we have integrated the reality of the loss into our lives and can experience a range of emotions. In this stage we tend to see more meaning-making, an adjustment to the changes that the loss has brought, and maybe even a practice of rituals to honor the memory of what or who was lost.

Psychotherapy for grief and loss is a relational and dynamic process that acknowledges the unique nature of each individual's experience of grief and relational needs. The Kubler-Ross stages of grief provide a valuable framework for understanding the emotional landscape of grief, offering therapists insights into the client's journey and guiding the therapeutic process. Our therapists use their skills and sensitivity to meet the therapeutic moment and needs of each patient.